Guidance For Doctors Research Articles

One-stitch anastomosis through the skin with bicanalicular intubation: a modified approach for repair of bicanalicular laceration.

To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration. The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied. All the operations were performed under surgical microscope, 5-0 silk sutures were used and were with bicanalicular silicone tube (diameter was 8mm) intubation, for one lacerated canaliculi one-stitch anastomosis through the skin. The stents were left in place for 3 months postoperatively and then removed. The follow-up period was 3 - 36 months (average 14 months). In 15 patients, 13 patients were cured entirely, 1 patient was meliorated, 1 patient with no effects. All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus. Complication was seen in one case, for not followed the doctor's guidance to come back to hospital to had the suture removed on the 7(th) day after operation, when he came at the 15(th) day, the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound, and the inside silicone tube was exposed, a promptly repair with 10-0 nylon suture was done, the wound healed in a week. There were no early tube protrusions and punctal slits in the patients. One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye, the cut ends can be anastomosed directly, and with excellent cosmetic results, it is acceptable for the patients. For there is no suture remained in the wound permanently, so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi. It is simple, economical, effective and safe.

GMC publishes new version ofGood Medical Practice

The General Medical Council has published an updated version of its core guidance for doctors, Good Medical Practice , which emphasises doctors’ role in ensuring minimum standards of care and compassion. The new version of the guidance has been pared down from the 2006 original, with much of the explanatory detail moved into eight pieces of accompanying guidance. The regulator has also published explanatory guidance on social media for the first time. The guidance has been restructured so that it corresponds with the four domains in the Good Medical Practice Framework for Appraisal and Revalidation : knowledge, skills, and performance; safety and quality; communication, partnership, and team …

Commentary

Beginning in December 2012, all UK doctors will be required to complete a periodic revalidation process conducted by the General Medical Council (GMC) to retain their licence to practise medicine. Regular appraisals, based on the GMC's core guidance for doctors, will be used by responsible officers to evaluate a doctor's practice based on six types of supporting information. Feedback from patients and colleagues, referred to as multisource feedback (MSF), is one element of supporting information that doctors will present at appraisal to support their revalidation.This commentary by the Chair of the GMC expands on the research in this issue by Wright and colleagues to provide an overview of the history of revalidation in the United Kingdom, discuss the role of appraisal in revalidation, and examine the need for and value of MSF in this process. The author highlights the support that the GMC has received from UK patient organizations and ends by focusing on the benefits of revalidation and the expectations for its development in the future.

Toxical research of Kudiezi injection in safety re-evaluation

To explore the toxic effect on mouse administrated Kudiezi injection multy times a day, and on rats repeat administrated for many days. Mouse tail intravenous injection of Kudiezi, 0.04 mL x g(-1), 3 times a day, rats tail intravenous injection of Kudiezi, 20, 10, 4 mL x kg(-1), once a day, for 6 weeks. There is no abnormal to the mouses administrated many times a day. The rats administrated large doses of drug for many days have certain effects on hematology, blood biochemistry. Some animals appear liver, kidney lesions mild, injection local appear haemorrhage, edema and inflammatory reaction. The mouse which was intravenous injection in the dose of 180 times Kudiezi injection as much as people used, revealed no toxicity reaction. Repeated large-dose administration, rats caused by lesions of the main target organs may be for kidney, liver. But the recovery result on liver, kidney toxicity was reversible, no delayed toxicity. At the same time, large doses of long-term administration of local have a certain irritation. Tips the medication should be under the guidance of doctors, and pay attention to replace the injection site. This research will provide safety basis for the clinical use of Kudiezi injection.

Models of occupational medicine practice: an approach to understanding moral conflict in “dual obligation” doctors

In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor-patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor-patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with "dual obligations" in their various roles.

GMC bans doctors from signing contracts containing “gagging” clauses

Doctors should boycott “gagging” clauses in agreements with employers or contracting bodies that try to stop them raising concerns about patients’ safety or quality of care, new guidance from the General Medical Council recommends. Mirror guidance for doctors in management roles will put them under a corresponding duty not to propose or condone contracts or agreements containing such clauses. Gagging clauses still appear, despite NHS guidance as far back as 1999 that all trusts should “prohibit confidentiality ‘gagging’ clauses in contracts of employment and compromise agreements which seek to prevent the disclosure of information in the public interest.” The House of Commons health select committee …

Short-term effect of rehabilitation training on children with neuropathic acontractile sphincter incontinence

Objective To evaluate the short-term effect of pelvic floor muscle rehabilitation training under the guidance of doctors on children with neuropathic acontractile sphincter incontinence ( NASI ).Methods Sixty eighty children[aged 4 - 12 ( mean, 7 ) years]with NASI were selected.All children were randomly divided into multiple guidance group and single guidance group.Pelvic floor muscle rrehabilitation training was successfully accomplished in all children.Three-day urinary diary, 7-day fecal diary, the ICI-Q-SF score and urodynamic evaluations were completed before and after the treatment.Three months later, follow-up was carried out.The results were compared between the groups.Results After treatment,TOV, LT, TFI and ICI-Q-SF of multiple guidance group were significantly lower than those of single guidance group[(29±8) vs (34±12), (19±10) vs (25 ±12), (1.9±1.1) vs (2.5 ±1.3), (9±5) vs ( 12 ± 6 ), P ＜ 0.05], however, PMUC of multiple guidance group was significantly higher than those of single guidance group[(5.6 ± 2.0 ) vs (4.7 ± 1.7 ), P ＜ 0.05].The effective rate of multiple guidance group after treatment and at follow-up were respectively 79.4% and 70.6% , significantly higher than those of single guidance group ( 64.7% and 50.0%, P ＜ 0.05 ).Conclusion Pelvic floor muscle rehabilitation training under the guidance of doctors has satisfactory therapeutic efficacy on the children with NASI. Key words: Child; Urinary incontinence; Rehabilitation outcome

Will the Defendant Please Rise! Documentation of Chaperone use in Breast Examinations

Introduction: The Ayling Report recommended organisations develop chaperone policies and make them available to patients. A Postgraduate Medical Journal publication (August 2010) revealed that 43.5% of 92 trusts surveyed had no chaperone policy in place and only half of these planned to implement one. The General Medical Council addresses the importance of offering an impartial chaperone for intimate examinations (Maintaining Boundaries- Guidance for Doctors 2006). The majority of doctors would offer a chaperone to patients undergoing breast examination. However recording of such chaperones may be less robust. If complaints are made against doctors it may be difficult to defend if there is no evidence of the presence of a chaperone.

Is more choice always better?

Greater choice is always better for patients, right? The regulatory body for doctors in the United Kingdom, the General Medical Council, certainly thinks so. At the heart of their guidance for doctors is the principle that patients have the right to self determination. The doctor’s role is to inform, counsel, and empower but not to choose on the patient’s behalf. UK policymakers also aspire to promote patient choice. Reforms of the National Health Service aim to transform it from state monopoly to a diverse healthcare marketplace, where patient-consumers can shop around for the doctors, hospitals, and treatments they want. The result is that, increasingly, doctors and healthcare systems are divesting themselves of responsibility for decision making. By …

The GMC and End-of-Life Care

This now has become the official guidance for doctors dealing with patients at the end of their lives, when death is expected within 12 months. It came into effect on the 1 July and intensivists must be aware of what the guidance contains and how it may affect practice. New guidance was needed partly in order to recognise changes in the law and partly to deal with challenges to the law dealing with end-of-life care since the publication of the 2002 document.

Latest guidance for doctors on end of life care will help to reduce discrimination

Latest guidance for doctors on end of life care will help to reduce discrimination

Identifying and managing clinical responsibility

Clinical responsibility is an area that requires extensive consideration and development to align with other changes in healthcare in the NHS. Increasing levels of litigation and investigation into the practice of medical practitioners have highlighted the need for clearer guidance for doctors. Using hypothetical case studies, this project explored the understandings and experiences of physicians and potential solutions in areas where there was ambiguity in clinical responsibility. In addition, existing policy and practice within trusts throughout the UK was analysed. The output from the focus group discussion and policy analysis led to the recommendations and guidance for doctors outlined in this paper, with the aim of illustrating the central themes that both doctors and trusts need to address in the future.

Educational resources on the internet for trainee doctors: a practical guide

The quantity of educational resources which are available on the internet is enormous and the quality of these is very variable. This two-article series will provide practical guidance for doctors on assessing quality and making effective use of these resources. The second article will discuss some good quality radiology and medical learning resources available on the internet.

Renal hypouricemia in school-aged children: screening of serum uric acid level before physical training

We present two cases of a 12-year-old Japanese boy and a 14-year-old Japanese girl who had exercise-induced acute renal failure (ARF). They experienced general fatigue, nausea/vomiting, and vague discomfort in the abdomen after physical exercise at school. In case of the boy, abdominal pain subsided, but renal dysfunction lasted 17 days, with peak levels of creatinine 9.4 mg/dl and uric acid 11.3 mg/dl. On the other hand, as the girl had suffered from hypouricemia before, she followed a doctor's guidance on prevention of ARF. Consequently, she was promptly diagnosed as having exercise-induced ARF associated with hypouricemia, and rapidly recovered from ARF within a week. The difference between their clinical courses suggested a possibility that previous laboratory evaluation of serum uric acid assisted in the management of exercise-induced ARF associated with hypouricemia. School-aged children, especially Japanese and Asian, may be advised to have their serum uric acid measured before starting physical training at school.

Supporting revalidation: methods and evidence

The aim of revalidation is to reassure the public that doctors are up to date and fit to practise. The Royal College of Physicians has developed various programmes of work, both ongoing and under development, in support of revalidation. The purpose of this work is to provide guidance for doctors about the standards of practice expected and the types of evidence required for revalidation. A range of methods and tools are outlined that could be used by doctors to demonstrate their commitment to evaluating and reflecting on the way they practise medicine. These methods include ways of assessing both professional standards and clinical competence. Although the conclusions of the Chief Medical Officer in terms of the absolute requirements for revalidation are still unknown, the College is committed to supporting its Members and Fellows to prepare for revalidation through setting educational, professional and clinical standards in medicine.

Book Review: Assessment of Mental Capacity Guidance for Doctors and Lawyers Second Edition

Book Review: Assessment of Mental Capacity Guidance for Doctors and Lawyers Second Edition

Mountain Biking Injuries

Mountain bicyclists are subject to various traumatic and overuse injuries. Traumatic injuries range from minor abrasions and contusions to wrist fractures, shoulder injuries, and concussions. Helmet use is important in preventing serious head trauma. Many overuse injuries stem from improper bike fit, anatomic malalignments, and training errors. Treatment includes adjustments to the bike and modification of training habits. Included are tables regarding a variety of malalignments, related overuse injuries, and suggested bicycle adjustments. A companion article (page 71) provides guidance for doctors and patients on proper bike fit.

Book Reviews

Book reviewed in this article:Day Services for People with Learning Disabilities Philip Seed (ed).Mental Illness in People with a Learning Disability Andrew Swift.Insights Into Inspection — The Regulation of Social Care Roger Clough (ed.).Brain Development and Epilepsy P.A. Schwartzkroin, S.L. Moshe, J.L. Noebels and J.W. Swann (eds).Behavioral Interventions with Brain‐Injured Children A. MacNeill Horton and William G. Miller.Assessment of Mental Capacity: Guidance for Doctors and Lawyers British Medical Association and The Law Society.Teachers with Special Needs: Training for Teachers of Adults with Learning Difficulties M. Boice.St Lawrence's. The Story of a Hospital, 1870–1994 Robert Malster.Mothers, Babies and Cocaine M. Lewis and M. Bendersky (eds).Opening New Doors. An Evaluation of Community Care for People Discharged from Psychiatric and Mental Handicap Hospitals Michael Donnelly, Sinead McGilloway, Nicholas Mays, Sarah Perry, Martin Knapp, Shane Kavanagh, Jennifer Beecham, Andrew Fenyo and Jack Austin.

Discussing cardiopulmonary resuscitation with patients and relatives.

This paper aims to give clear guidance for doctors working in the UK about their responsibilities when discussing cardiopulmonary resuscitation with patients and their relatives. The ethical and legal framework for making decisions is outlined and the commonly encountered dilemmas are discussed.

A hospital-based benzodiazepine policy

Over 500 000 patients in Britain take a prescribed benzodiazepine (BZ) long term, and many will suffer withdrawal effects if their drugs are stopped.1 Prescribing in hospitals contributes to the initiation of BZ use,2 and some prescriptions are clearly unnecessary.3 A BZ prescribing policy offering guidance for doctors, nurses, pharmacists and patients should help curb the inappropriate use and potential abuse of BZs.