Prescribing - a worldwide survey on governance.

PURPOSE OF THE STUDY: To explore the governance regarding prescribing across the world. STUDY DESIGN: We used a web-based questionnaire to ask the doctors about their prescribing practices and perception of governance in relation to prescribing. We sent the questionnaire to all doctors working in our hospital and primarily targeted doctors who had acquired their medical qualifications outside the UK to get a global view. RESULTS: We received 139 responses describing prescribing practices from 40 countries. More than 50% of doctors said there is no restriction in prescribing for themselves and their relatives. A third of them said that they could even prescribe controlled drugs without any restriction. 56% said that one doesn't need a prescription to get antibiotics. When analysed by countries, 80% said that they could self-prescribe and in 50% of the countries, one could get antibiotics without a prescription. CONCLUSIONS: In many countries there is poor governance with regards to prescribing. This is due to a lack of restrictions on prescribing (both self-prescribing and for friends/family) and the public's ability to obtain antibiotics and controlled drugs.

Is it appropriate to link 'old age' to certain causes of death on the medical certificate of cause of death?

In the current list of acceptable causes of death in the medical certificate of cause of death, some causes are either linked to old age or could be used for all people over the age of 80 years. Notable ones include 'frailty of old age', 'debility of old age' and 'senility'. It is best to avoid these terms as they provide an erroneous impression that these conditions occurred because a person was old; we recommend that the list of acceptable causes of death is revised by engaging all stakeholders.

Improving the quality of electronic discharge summaries from medical wards: A quality improvement project.

INTRODUCTION: The electronic discharge (e-discharge) summary forms an essential component of communication between secondary and primary care. However, its content and quality can often be substandard due to inadequate or inaccurate information. METHOD: Two retrospective audits were completed with intervening e-discharge workshops. Local general practitioners were involved in identifying areas for improvement and assisted with the workshops. Crib sheets were emailed to all junior staff and posted on all medical wards. RESULTS: There was an improvement in the quality of e-discharges with particular improvements on the documentation of test results and patient progress and outcome. Those who attended the workshops produced better quality e-discharges and none recommended unnecessary actions for general practitioners. CONCLUSIONS: E-discharge workshops are effective in improving the overall quality of discharge summaries from medical wards. Introduction of mandatory e-discharge training sessions during hospital induction and junior doctor rotations would be beneficial to teach this important yet challenging skill.

The contributions of NHS healthcare workers who are shielding or working from home during COVID-19.

During the COVID-19 pandemic, many healthcare staff and others who work for the NHS have been working from home (WFH) or shielding due to various health conditions, including pregnancy. While emphasis has been given to the support and wellbeing of those working at the frontline, little is known about the contribution of those who are working remotely. This online survey attempts to throw some light on how these healthcare workers have been contributing to the NHS while WFH, the resources they may or may not have to undertake their remote duties, their perception of whether their contribution is valued at the workplace, and their views on whether the new ways of working would influence the manner in which they would work in the future.

Survey on the attitudes of hospital doctors towards the terms 'acopia' and 'social admission' in clinical practice.

Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.

Predictors of mortality in leptospirosis: an observational study from two hospitals in Kolkata, eastern India.

BACKGROUND: Leptospirosis has a mortality rate of 5-20%. Poor prognostic factors are older age; oliguria; elevated potassium, creatinine and/or bilirubin levels; and altered mental status. We conducted this retrospective study to analyse the predictors of mortality among Indian patients with leptospirosis. METHODS: Clinical, biochemical, demographic and treatment related data (time between onset of symptoms and commencement of leptospira specific antibiotics) of 101 leptospirosis patients were reviewed. Predictors identified by univariate analysis were analysed by multivariable Cox regression for survival analysis. RESULTS: Prominent clinical features were: fever (101/101, 100%), jaundice (62, 62.4%), vomiting (42, 41.6%), oliguria (35, 34.7%), cough (18, 17.8%) and dyspnoea (10, 10.0%). Common complications were acute kidney injury (22, 21.8%), cardiovascular collapse (13, 12.9%), haemorrhages (10, 10.0%), meningitis (7, 6.9%), acute respiratory distress syndrome and pancreatitis (5, 5.0% each). Seventeen patients died (16.8%). Univariate predictors of mortality were older age, delayed antibiotic therapy, higher bilirubin, aspartate aminotransferase, alkaline phosphatase, leucocyte count and aspartate/alanine aminotransferase ratio (AAR). Only AAR (HR 1.208, 95% CI 1.051-1.388) and number of days the patient was symptomatic before access to specific antibiotic therapy (HR 1.304, 95% CI 1.081-1.574) remained significant predictors after Cox regression. CONCLUSIONS: Multivariate analysis showed high AAR and delayed antibiotic therapy might be associated with fatality.