The educational value of using cumulative sum charts.

Various workplace-based assessment tools are available, but none have been shown to improve performance in procedural skills. This study aimed to assess the impact of using one such tool, cumulative sum charts, on procedural skill ability. A single-blind randomised controlled trial was conducted on 82 final year medical students. Control group students received the usual teaching; in addition to this, intervention group students were provided with cumulative sum charts to log their cannulation attempts over a 7-month period. At the end of the year, students from both groups undertook a validated test of automaticity of cannulation skill. Students in the intervention group obtained median (IQR [range]) scores of 68.2 (60.5-74.3 [42.7-81.1]) vs 62.2 (52.2-68.8 [40.7-80.5]) for the control group (p = 0.013). The effect size was moderate (Cohen's d = 0.608). This study therefore provides support for the hypothesis that use of cumulative sum charts improves performance when learning procedural skills.

Outcome from a rapid-assessment chest pain clinic.

Chest pain accounts for much of the rising numbers of emergency admissions, but in-patient assessment is not necessarily the best way of dealing with these patients. We ran a 'rapid-assessment chest pain clinic' to provide an alternative route of assessment, and audited its outcome. General practitioners referred patients with recent-onset chest pain, increasing chest pain, chest pain at rest, or other chest pain of concern, on the understanding that they would be seen within 24 h. During 8 1/2 months, 334 patients were referred and 317 patients were seen, most of whom had exercise electrocardiography. A median of 6 months later, 278 patients were personally contacted to determine outcome. Of these, 18% had been admitted immediately with acute coronary syndromes, and 49% had been diagnosed as non-coronary chest pain (none of whom subsequently infarcted or died). Continuing symptoms were infrequent, and satisfaction was high, although 13% of patients had been revascularized. A significant number of patients required immediate admission and/or ultimate revascularization, but many more did not. The majority of these patients had non-coronary chest pain, and this diagnosis was substantiated by their excellent outcome and (in some cases) by further investigation.

The use of Scopoderm in palliative care.

The drug hyoscine has several indications for symptom control for patients with end-stage disease. The transdermal preparation, Scopoderm, is most widely used to control excess salivary secretions but it can also have a role in the management of terminal secretions and in the control of nausea.

Cancer of prostate metastatic to the skin diagnosed by immunoperoxidase staining.

The authors present a case in which the diagnosis of prostate cancer metastatic to the skin was made by skin biopsy with immunoperoxidase stains for prostatic specific antigen and prostatic acid phosphatase. These are tests that should be performed when the location of the primary malignancy is not otherwise evident.

[Mobile and digital documentation of inpatient treatments : use of personal digital assistants in addition with the ClinicCoach(c) software]. / Mobile und digitale Behandlungsdokumentation im Krankenhaus : Einsatz von "personal digital assistants" in Verbindung mit der ClinicCoach(c)-Software.

BACKGROUND: Documentation of the individual treatment course is essential from medical as well as economic and forensic aspects. With increasing hospital computerization the conventional hardcopy form of record keeping is seen to be associated with high outlays and restrictiveness. METHODS: Clinicians engaged consistently in the development of a personal digital assistant (PDA)-based electronic record system (Clinic Coach(c)), which maps the entire course of inpatient treatments. The system's effectiveness was reviewed by means of a standardized questionnaire and analysis of 8,595 data sets relating to PPR and wound findings. RESULTS: In patients undergoing surgery wound findings and PPR were documented in 83.6% and in 94.3% respectively. The ClinicCoach(c) System was rated more effective than paper-based documentation by 78.4% of the testing healthcare workers. CONCLUSION: The combination of PDAs and ClinicCoach(c) is a reliable and to clinical routine well adapted system that allows digital documentation at the bedside.

Domiciliary care: a comparison of the views of terminally ill patients and their family caregivers.

This study compares terminally ill patients and their family caregivers in terms of the physical and emotional status of the patients, the adequacy of the support provided for the patients and where the patients would be most appropriately placed during the last stage of their lives. Patients and caregivers shared similar views about the latter, but there was a lack of concordance between them regarding the patients' physical and emotional state. Patients generally reported a much more favourable view of their outlook and emotional state than did their caregivers. Caregivers may need help to review their assumptions about the patients' emotional welfare, and caution should be used in accepting caregivers' views about how patients are coping emotionally.

Endotracheal tube occlusion following blind oral intubation with the Endotrol (trigger) endotracheal tube: a case report.

Some cases of difficult airway intubation can be managed by using the Endotrol (trigger) endotracheal tube. This report describes such a case, in which the management of a difficult airway was facilitated initially by using the Endotrol tube; however, significant occlusion occurred approximately 16 hours later when the tube "kinked," leading to its partial collapse. The Endotrol tube has been used to maintain airways in critical and difficult situations, but its use for longer periods of intubation may need to be further studied.

Double-blind, randomized study of nalmefene and naloxone in emergency department patients with suspected narcotic overdose.

STUDY OBJECTIVES: To compare the efficacy, safety, and withdrawal symptoms in emergency department patients with suspected narcotic overdose treated with nalmefene, an opioid antagonist with a 4- to 10-hour duration of action, with those treated with naloxone. METHODS: Adults in 9 centers who would otherwise receive naloxone for altered consciousness levels were randomly assigned to receive intravenous study drug (1 mg nalmefene, or 2 mg nalmefene or 2 mg naloxone, double-blinded) every 5 minutes as needed for up to 4 doses in a 4-hour study. Outcomes were 20-minute and 4-hour posttreatment changes in respiratory rates, Neurobehavioral Assessment Scale scores, Opioid Withdrawal Scale scores, and incidences of adverse events. RESULTS: Opioid positivity was recorded for 30 of 63 (1-mg nalmefene), 23 of 55 (2-mg nalmefene), and 24 of 58 (naloxone) cases, 75% of whom also had nonopioid central nervous system depressants. Most patients received only 1 dose of study drug. Similar, clinically meaningful improvements in respiratory rates and Neurobehavioral Assessment Scale scores were seen with all treatments. No statistical differences in efficacy or withdrawal outcomes were seen between treatment groups, and no significant overall time-treatment interactions occurred, in either the entire patient group or among opioid-positive cases (P >.21, all comparisons). Adverse events occurred in 30.9% (2 mg nalmefene), 15.9% (1 mg nalmefene), and 15.5% (naloxone) of patients (P >.08); none were associated with morbidity. CONCLUSION: In this study of patients with varied potential causes of altered consciousness, nalmefene (1 mg and 2 mg) and naloxone (2 mg) appeared to be efficacious, safe, and to yield similar clinical outcomes.