The safe transport of critically ill patients is recognized internationally as a key competency for clinicians working in anaesthesia, critical care, and emergency medicine. This includes inter- and intra-hospital, land, and air transport. The centralization of specialist services and growing demand for critical care beds have increased pressure on hospitals to provide transfer support for critically ill patients. A variety of systems have emerged to facilitate the increasing need for both inter- and intra-hospital transfer of patients, ranging from a national coordinated retrieval service to the ad hoc utilization of on-call teams. The potential for complications during all types of transfer has been well documented. In order to improve safety, a number of national guidelines and courses have been developed to provide a standardized approach to transfer medicine. This chapter reviews the current literature on the subject and provides a summary of best practice for the transfer of the critically ill patient.
Background Skin disorders are common in HIV infection, even where the condition has not yet progressed to full-blown AIDS. The impact of Anti Retro Virals (ARV) on these manifestations is not clear although multiple anecdotal reports suggest a close relationship between CD4, ARV and the prevalence of skin disorders. Our main objectives were to estimate the prevalence of skin disorders in children with HIV, the relationship between immune status and skin disorders and whether HAART modifi ed the prevalence of skin disorders. Methods This was a retrospective study of case-notes where the unit of the study was the record of a single consultation. Data were collected from all HIV positive children currently in follow-up at the clinic. Case notes were used to determine the CD4 and treatment status, and diagnostic record of skin conditions. Skin conditions were assumed to continue until case notes indicated their resolution or change. Statistical analysis included the use of linear regression to determine independent effects of risk factors for the presence of skin disease. Results 75 children under follow-up in the HIV clinic were included in the study. The median age at the time of diagnosis of skin disease was 10.88 years; 32/34 (94%) were of African origin, one child was white British and another was of Southeast Asian origin. Overall 34/75, (45%, CI 34.06 -56.6%) children had a skin diagnosis recorded and among 118 consultations, 80 (67%) were accompanied by a record of skin
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