Are weekend handovers of adequate quality for the on-call general medical team?
C…

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The impact of twice-daily consultant ward rounds on the length of stay in two general med…

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Wearing white coats and sitting on beds: why should it matter?
Clin Med. 2011 Dec…

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Including pharmacists on consultant-led ward rounds: a prospective non-randomised control…

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The inpatient neurology consultation service: value and cost.
Clin Med. 2011 Jun;…

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Quality and safety at the point of care: how long should a ward round take?
Clin Med. 2011 Feb;11(1):20-2
Authors: Herring R, Desai T, Caldwell G
In April 2009 a ‘considerative checklist’ was developed to ensure that a…

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The impact of an early chest radiograph on outcome in patients hospitalised with community-acquired pneumonia.
Clin Med. 2010 Dec;10(6):563-7
Authors: Bewick T, Greenwood S, Lim WS
Patients admitted to UK hospitals wit…

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A structured course teaching junior doctors invasive medical procedures results in sustained improvements in self-reported confidence.

Clin Med. 2010 Oct;10(5):464-7

Authors: Garrood T, Iyer A, Gray K, Prentice H, Bamford R, Jenkin R, Shah N, Gray R, Mearns B, Ratoff JC

Pressure on working hours has led to a decrease in opportunities for training in invasive medical procedures for junior doctors. The effect of a structured course on immediate and medium-term changes in self-reported confidence was investigated. A one-day model-based practical course was run on two separate occasions teaching central venous line placement, lumbar puncture, Seldinger-technique chest drain insertion and knee joint aspiration. Attendees were asked to indicate their confidence in each procedure on a 10-point Likert scale before, immediately after and three months after the course. Significant improvements in self-reported confidence were seen for all procedures which were sustained at three months. Feedback was universally positive. Practical preclinical training may be a useful adjunct to patient-based training in invasive procedures. The course was particularly popular with foundation year trainees: ideally this training should be available before trainees’ first exposure in the clinical setting.

PMID: 21117378 [PubMed - indexed for MEDLINE]

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Evidence-based algorithms and the management of falls and syncope presenting to acute medical services.

Clin Med. 2008 Apr;8(2):157-62

Authors: Parry SW, Frearson R, Steen N, Newton JL, Tryambake P, Kenny RA

Falls and syncope are symptoms that commonly present to medical services. Detailed international guidelines for their management are available but tend to be aimed at specialists rather than generalists. Novel, evidence-based algorithms for the management of these symptoms when they present to acute medical services were formulated and their impact on patient care audited. The percentage of people admitted with falls and syncope was unexpectedly high (10.6% at baseline); this had decreased to 8.2% at repeat audit. Readmission rates decreased from 12% at baseline audit to 0% in repeat audit, while length of inpatient stay was unchanged. Mortality was strikingly high (12%) in both audits. Although inappropriate use of investigations decreased, the use of appropriate management strategies increased. Easy-to-use algorithms can help reduce the number of patients admitted to acute medical services with falls and syncope while optimising the care of those managed as inpatients. The algorithms are provided for use by interested parties.

PMID: 18478859 [PubMed - indexed for MEDLINE]

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The Mental Capacity Act 2007 and capacity assessments: a guide for the non-psychiatrist.

Clin Med. 2008 Feb;8(1):65-9

Authors: Mukherjee E, Foster R

The Mental Capacity Act 2007 affects doctors in all areas of practice. The act recognises that capacity is a ‘balance of probability rather than certainty’, and based on this it attempts to ‘maximise capacity’ in an individual, so to facilitate a decision-making process. The act comprises five key principles as well as a test to determine lack of capacity. It also alludes to areas such as consent by proxy, restraint and capacity, and regulations regarding clinical research. This paper provides a brief background into the fundamental tenets of the act as well as a simple scheme for assessing capacity in hospital inpatients. It also looks at what physicians should be aware of and what will be required of them, particularly from a medico-legal perspective.

PMID: 18335673 [PubMed - indexed for MEDLINE]

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The contribution of a pharmacy admissions service to patient care.

Clin Med. 2008 Feb;8(1):53-7

Authors: Bracey G, Miller G, Franklin BD, Jacklin A, Gaskin G

The aim of this study was to determine the impact of two specialised admissions pharmacists on an acute medical admissions ward. For a one-week period, contributions made to the medical post-take ward round (PTWR), the number of drug histories taken and interventions made as a result, and the availability of medication needed on discharge were documented. An average of 1.1 contributions per patient were made on the PTWR; a large proportion of these concerned therapeutic choice. Pharmacists also intervened to stop medication due to adverse drug reactions in 12% (n=10) of contributions. Fifty-two drug histories were checked by a pharmacist, resulting in 61 interventions (1.1 interventions per patient). The majority of interventions resulted from the unintentional omission of a regular medication (65%, n=39). Only 24% (n=29) of items needed on discharge had to be dispensed in pharmacy and 33% (n=41) were available as patients’ own drugs.

PMID: 18335670 [PubMed - indexed for MEDLINE]

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