New to Meducation?
Sign up
Already signed up? Log In
view moderators

ResearchReport

Category

Preview
1
6

Implementing the NHS five year forward view

Our report calls for fundamental changes to how health services are commissioned, paid for and regulated to deliver the vision of the NHS five year forward view. A new paper from The King’s Fund calls for fundamental changes to how health services are commissioned, paid for and regulated to deliver the vision of the NHS five year forward view.  
The King's Fund
about 7 years ago
Preview
1
17

The future is now

Featuring the voices of patients, volunteers, clinicians and managers, our new digital report explores future ways of changing health and health care for the better. Today’s debates over health service pressures must not prevent us from addressing tomorrow’s need for radical change in our care systems. In this new digital report, The King’s Fund embarks on a journey across England and overseas into future ways of changing health and health care for the better.  
The King's Fund
about 7 years ago
Preview
1
5

The NHS under the coalition government

Our new report assesses the coalition government's record on the NHS. It comes in two parts, with this first part focusing on the reforms set out in the Health and Social Care Act. The 2010–15 parliament has been a parliament of two halves for the NHS. The first half was dominated by debate on the Health and Social Care Bill (which was largely designed to devolve decision-making, put GPs in control of commissioning, and extend competition and choice). The second half was taken up with limiting the damage caused by the Bill, with less emphasis on competition and greater efforts to strengthen the regulation and quality of care and prioritise patient safety.  
The King's Fund
about 7 years ago
Preview
1
6

Risk or reward?

A report from the Nuffield Trust and The King’s Fund finds that CCGs risk becoming unsustainable without changes to the way they attract leaders and adequate funding to help them expand their remit. A report from the Nuffield Trust and The King’s Fund finds that clinical commissioning groups (CCGs) risk becoming unsustainable without changes to the way they attract leaders and adequate funding to help them expand their remit.  
The King's Fund
about 7 years ago
Preview
1
7

British Social Attitudes 2014

The King's Fund report on the British Social Attitudes 2014 survey of the public's satisfaction with the NHS and health care issues. By John Appleby and Ruth Robertson Since 1983, the National Centre for Social Research’s British Social Attitudes survey has asked the public – rather than simply patients – about their views on and feelings towards the NHS and health care issues generally.  
The King's Fund
about 7 years ago
Foo20151013 2023 1eqve0g?1444774030
1
99

LWW: Case Of The Month - May 2013

This month’s case is by Barbara J. Mroz, M.D. and Robin R. Preston, Ph.D., author of Lippincott’s Illustrated Reviews: .Physiology (ISBN: 9781451175677). For more information, or to purchase your copy, visit: http://tiny.cc/PrestonLIR, with 15% off using the discount code: MEDUCATION. The case below is followed by a choice of diagnostic tests. Select the one lettered selection that would be most helpful in diagnosing the patient’s condition. The Case A 54-year-old male 2 pack-per-day smoker presents to your office complaining of cough and shortness of breath (SOB). He reports chronic mild dyspnea on exertion with a daily cough productive of clear mucus. During the past week, his cough has increased in frequency and is now productive of frothy pink-tinged sputum; his dyspnea is worse and he is now short of breath sometimes even at rest. He has had difficulty breathing when lying flat in bed and has spent the past two nights sleeping upright in a recliner. On physical examination, he is a moderately obese male with a blood pressure of 180/80 mm Hg, pulse of 98, and respiratory rate of 22. His temperature is 98.6°F. He becomes winded from climbing onto the exam table. Auscultation of the lungs reveals bilateral wheezing and crackles in the lower posterior lung fields. There is pitting edema in the lower extremities extending up to the knees.  Question Which if the following tests would be most helpful in confirming the correct diagnosis? A. Spirometry B. Arterial blood gas C. Complete blood count D. B-type natriuretic peptide blood test E. Electrocardiogram Answer? The correct answer is B-type natriuretic peptide blood test. Uncomfortable breathing, or feeling short of breath, is a common medical complaint with multiple causes. When approaching a patient with dyspnea, it is helpful to remember that normal breathing requires both a respiratory system that facilitates gas exchange between blood and the atmosphere, and a cardiovascular system that transports O2 and CO¬2 between the lungs and tissues. Dysfunction in either system may cause dyspnea, and wheezing (or bronchospasm) may be present in both cardiac and pulmonary disease. In this patient, the presence of lower extremity edema and orthopnea (discomfort when lying flat) are both suggestive of congestive heart failure (CHF). Elevated blood pressure (systolic of 180) and a cough productive of frothy pink sputum may also be associated symptoms. While wheezing could also be caused by COPD (chronic obstructive pulmonary disease) in the setting of chronic tobacco use, the additional exam findings of lung crackles and edema plus systolic hypertension are all more consistent with CHF. What does the B-type natriuretic peptide blood test tell us? When the left ventricle (LV) fails to maintain cardiac output (CO) at levels required for adequate tissue perfusion, pathways are activated to increase renal fluid retention. A rising plasma volume increases LV preload and sustains CO via the Frank-Starling mechanism. Volume loading also stimulates cardiomyocytes to release atrial- (ANP) and B-type (BNP) natriuretic peptides. BNP has a longer half-life than ANP and provides a convenient marker for volume loading. Plasma BNP levels are measured using immunoassay; levels >100 pg/mL are suggestive of overload resulting in heart failure. How does heart failure cause dyspnea? Increasing venous pressure increases mean capillary hydrostatic pressure and promotes fluid filtration from the vasculature. Excess filtration from pulmonary capillaries causes fluid accumulation within the alveoli (pulmonary edema) and interferes with normal gas exchange, resulting in SOB. Physical signs and symptoms caused by high volume loading include: (1) Lung crackles, caused by fluid within alveoli (2) Orthopnea. Reclining increases pulmonary capillary hydrostatic pressure through gravitational effects, worsening dyspnea when lying flat. (3) Pitting dependent edema caused by filtration from systemic capillaries, an effect also influenced by position (causing edema in the lower legs as in our ambulatory patient or in dependent areas like the sacrum in a bedridden patient). What would an electrocardiogram show? Heart failure can result in LV hypertrophy and manifest as a left axis deviation on an electrocardiogram (ECG), but some patients in failure show a normal ECG. An ECG is not a useful diagnostic tool for dyspnea or CHF per se. Wouldn’t spirometry be more suitable for diagnosing the cause of dyspnea in a smoker? Simple spirometry will readily identify the presence of airflow limitation (obstruction) as a cause of dyspnea. It's a valuable test to perform in any smoker and can establish a diagnosis of chronic obstructive pulmonary disease (COPD) if abnormal. While this wheezing patient is an active smoker who could have airflow obstruction, the additional exam findings above point more to a diagnosis of CHF. What would an arterial blood gas show? An arterial blood gas measures arterial pH, PaCO¬2, and PaO2. While both CHF and COPD could cause derangements in the values measured, these abnormalities would not necessarily be diagnostic (e.g., a low PaO2 could be seen in both conditions, as could an elevated PaCO¬2). Would a complete blood count provide useful information? A complete blood count could prove useful if anemia is a suspected cause of dyspnea. Test result BNP was elevated (842 pg/mL), consistent with CHF. Diuretic treatment was initiated to help reduce volume overload and an afterload reducing agent was started to lower blood pressure and improve systolic function.  
Lippincott Williams & Wilkins
about 9 years ago
Preview
1
52

Next government should take 'immediate action' to boost nurse numbers - BBC News

Immediate action must be taken by the next government to increase the number of NHS nurses, a report warns.  
bbc.co.uk
about 7 years ago
Preview
1
9

Physician Salaries, Job Satisfaction Detailed in New Survey

Compensation is still a sore issue for many physicians, according to Medscape's 2015 Physician Compensation Report.  
medscape.com
about 7 years ago
Preview
1
14

Frostbite: How to Classify and Treat It - Emergency Physicians Monthly

You find yourself working the overnight shift on sub-zero night in February. You stop outside of a room to listen to the ambulance report about a homeless patient who has been brought in for foot pain. He is intoxicated and was found asleep in a snow bank.  
epmonthly.com
about 7 years ago
Preview
1
5

Aarkstore — Stem Cell Research in Cardiology

Aarkstore.com announces, The Latest market research report is available in its vast collection “Stem Cell Research in Ca…  
medium.com
about 7 years ago
Preview
1
6

Viral hepatitis surveillance and outbreak report is published in India

Some 291 outbreaks and 804 782 cases of hepatitis infections occurred in India from 2011 to 2013, a national surveillance and outbreak data report on viral hepatitis has shown.1 In over 90% of cases, however, the causative agent was not identified.  
feeds.bmj.com
almost 7 years ago