The Foundation Years最新文献

A large proportion of the NHS workload involves dealing with children. An understanding of the special needs of this diverse group is necessary in order to manage successfully patients and their carers. This article gives a brief overview of some communication skills for use with children. It also gives a breakdown of the legal issues surrounding consent and parental responsibility and wider issues relating to the United Nations Convention on the Rights of the Child. Some paediatric ethical dilemmas are also explored. This article is relevant to both prospective paediatricians and those aspiring to any speciality involving work with children.

This article covers four major topics in paediatrics. Knowledge of their management is important for any Foundation Doctor working within the paediatric department. The febrile child is a common referral to any paediatric unit. Most febrile children are suffering from simple viral illnesses, but occasionally a fever is a sign of a life-threatening illness, such as meningitis. If meningitis is suspected, it is vital to carry out appropriate investigations before treatment is started. There are multiple causes of meningitis, so accurate interpretation of investigations is important in order to manage children appropriately.

Diabetes is a complex multi-systemic condition, which has an increasing incidence. There are many pitfalls in its management, both on first presentation and in long-term care. Diabetic ketoacidosis (DKA) continues to have a significant mortality if not recognised early and treated appropriately.

Neonatology is a vast subject that can only be touched upon in this article. Junior doctors working within paediatrics are often the first port of call for problems on postnatal wards, and therefore need to have a basic understanding of common neonatal problems to initiate management.

This article reviews the clinical assessment and management of depressive disorders. Depression is a common mental illness and presents in primary and secondary care settings. Depression often arises from an interaction between genetic, psychological, biological and social factors. One in eight patients with recurrent depressive disorder commits suicide. A process for clinical and risk assessment is presented. The identification of physical illnesses which can mimic or co-exist with depression is essential. A stepped care management approach, as recommended by NICE, is also discussed.

This article sets out the main provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003 of relevance to doctors in the first few years after qualification. It sets out the criteria for compulsory intervention, the main compulsory orders, requirements regarding compulsory treatment and the key safeguards, and gives some practical advice on using the Act.

The Mental Health Act 1983 provides a legal framework for the assessment and treatment of mental disorder in the absence of consent. The use of the Mental Health Act in the general hospital is considered from both a legal and practical perspective. Whilst the Foundation doctor is unable to fulfil any statutory functions under the Act an awareness of the aspects of the law relevant to problems that may arise in the general hospital and practical issues about organising specialist assessment are highlighted as being essential to good patient care.

Cognitive behavioural therapy (CBT) is a psychological treatment of choice for anxiety disorders. It works by understanding connections between thoughts, behaviours, emotions and physical feelings. It also uses the principle that anxiety is the result of overestimating threat or the individual underestimating their own capacity to deal with that threat. Exposure is a group of techniques used in anxiety disorders and involves exposing the individual to the object or set of circumstances that causes them to be afraid. Exposure aims to cause habituation and is used in different guises in all anxiety disorders. In obsessive-compulsive disorder (OCD), it is exposure to the anxiety caused by not carrying out the compulsive ritual that is used (this is known as ERP or exposure and response prevention). Although there is evidence supporting the use of CBT in all anxiety disorders, it is likely that some respond better than others. For example, simple phobias and panic generally respond more reliably than generalized anxiety disorder (GAD).

This article looks at the clinical assessment and management of individuals suffering from schizophrenia. It covers the aetiology, risk factors and clinical features of psychosis, in this case schizophrenia. Different tools and scales used to make a diagnosis of schizophrenia are also covered. Newly qualified doctors working in most specialties, but especially in a psychiatric setting, are likely to be faced with individuals experiencing symptoms of this illness. Suicide is a major risk associated with patients diagnosed with schizophrenia and there are identifiable factors which may increase or decrease this risk. These require good interview skills, clarification of current and past problems and symptoms, co-morbidity, family history and dynamics and premorbid functioning. Management includes a biopsychosocial approach and is tailored to the patient’s needs. An acute illness requires prompt action to reduce the risk that may be posed to the patient or others, as well as introduction of an early management plan to reduce long-term disability and improve prognosis, as suggested by various studies. It has been suggested that up to a quarter of first episode patients might make a complete recovery, while 50% recover after several relapses and 25% go on to develop the chronic form of the illness. The chronic illness requires regular follow-up, such as the care programme approach, which is the involvement of a multidisciplinary team in the care of the individual, with an allocated key worker.