All Journals from Stuart Henderson
Abstract
This study assessed the quality of post-take ward round (PTWR) documentation, specifically looking at twelve criteria, in the medical assessment unit (MAU) prior to, 3- months and 2-years after introducing a PTWR proforma. 216 case records were analysed; 40 prior to, 40 three-months and 146 two-years after introducing the PTWR proforma. There was a significant improvement in eight criteria threemonths after introducing the PTWR proforma. These improvements were sustained two-years later and significant improvements made in a further 3 criteria (1 at p < 0.05 and 2 at p < 0.01).
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At last! A book that addresses the needs of every junior doctor faced with the management of acutely sick patients. Concise and readable, its format allows the reader to absorb the principles of human physiology, and to apply them to everyday situations involving critically ill patients. With each chapter being dedicated to a separate physiological ‘insult’, Cooper and Cramp open with a brief outline of what happens under ‘normal’conditions. This is followed by a summary of how physiology adapts under disease conditions. In this way the authors cover oxygen therapy, acid base disturbance,fluid balance, circulatory failure, sepsis, acute renal failure and coma. There are also chapters on identifying the patient at risk, and optimising physiology in the preoperative patient. With a distinct ‘anaesthetic slant’, the layout and emphasis are different to that with which most physicians will be familiar. This is however to its advantage, as it effectively bridges the traditional gap between medicine and critical care.
Unlike many texts, the authors have ignored the minutiae and have concentrated on the most relevant and applicable information. Well illustrated throughout, the reader is guided towards establishing a logical approach to the ill patient. With self-test questions relevant to each chapter, it becomes a valuable learning tool. ‘Mini- tutorials’ in each chapter highlight controversies, such as the relative merits of crystalloid versus colloid in f luid resuscitation, or the use of sodium bicarbonate in the treatment of metabolic acidosis.
The size of the book lends itself well to being carried in the white coat pocket. However the layout of the text makes it more suited to evening reading, rather than as a bedside reference. Some algorithms summarising the key points of each chapter might have added to the practical uses of the text.
Although this book will not help in passing the MRCP examination, it will hopefully make its readers into safer, better clinicians. If you ’ve ever been faced with a sick patient, a blank mind and a room full of expectant faces, then this is the book for you.
Dr Stuart Henderson Specialist Registrar in Medicine Southampton University Hospitals NHS Trust
Abstract
With increasing awareness, earlier diagnosis, and aggressive use of anti-retroviral therapy, more people with HIV are living longer so that the average survival time from diagnosis is now significantly better than what it was 10 years ago. As a consequence of this, more patients with HIV are now presenting to hospitals and emergency departments as acute medical emergencies either directly related to their HIV infection, or their treatment.1 An awareness of the potential problems with which these patients can present to hospital, plus guidance on their management is essential to all acute care physicians. In this article we outline the general management of patients with HIV presenting as emergencies to hospital, and then systematically focus on some of the more common clinical problems which may arise.
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