The journal of the Royal College of Physicians of Edinburgh
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J R Coll Physicians Edinb · Jan 2014
Case ReportsPulmonary hypertension and hepatic encephalopathy: lethal complications of Rendu-Osler-Weber disease.
Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterised by epistaxis, mucocutaneous telangiectasia with systemic manifestations due to visceral telangiectasia and arterio-venous malformations (AVMs). We describe unusual complications of HHT in a 68-year-old male who developed high-output cardiac failure with pulmonary hypertension in combination with hepatic encephalopathy due to hepatic AVMs. This case shows the importance of a multi-system approach to HHT and considers the treatment of its hepatic complications.
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The haemostatic system comprises four compartments: the vasculature, platelets, coagulation factors, and the fibrinolytic system. There is presently no laboratory or near-patient test capable of reproducing the complex regulated interaction between these four compartments. ⋯ This article will give a general overview of the limitations of PT and APTT and discuss specific issues that need to be considered when the tests are requested, in the context of anticoagulant monitoring, bleeding symptoms, and routine preoperative screening. Of these indications, routine preoperative screening is the most controversial and is generally not warranted in the absence of an abnormal bleeding history.
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James Reason's classic Swiss cheese model is a vivid and memorable way to visualise how patient harm happens only when all system defences fail. Although Reason's model has been criticised for its simplicity and static portrait of complex systems, its use has been growing, largely because of the direct clarity of its simple and memorable metaphor. ⋯ We present the hot cheese model, which is more realistic, particularly in portraying defence layers as dynamic and active - more defences may cause more hazards. The hot cheese model, being more flexible, encourages deeper discussion of incidents than the simpler Swiss cheese model permits.
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J R Coll Physicians Edinb · Jan 2014
Biography Historical ArticleMurder, mortsafes and Moir: a medical student looks at anatomy teaching in Aberdeen.
During the eighteenth and early nineteenth centuries anatomy theatres in Scotland suffered from a shortage of cadaveric material. Medical students and their teachers were eager to improve their medical education and began to look for ways to further their anatomy knowledge and so turned to bodysnatching. Bodysnatching failed to meet the demand so some resorted to murder to acquire cadavers, sometimes in exchange for money. Bodysnatching became common throughout the British Isles and prompted the 1832 Anatomy Act, which allowed unclaimed bodies to be used for dissection.
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J R Coll Physicians Edinb · Jan 2014
Historical ArticleCost and value in medical education--what we can learn from the past.
What lessons can be learned from the history of cost and value in medical education? First, the issue of cost and value in medical education has been around for a long time. Rising costs and an economic recession have made us focus on the subject more, but the issue has been just below the surface for over 200 years. A problem like this will not go away by itself - we must tackle it now. ⋯ It probably always will. Looking at issues in medical education from the perspective of cost often makes them more stark and explicit - this in turn may help us to start to find solutions. In the future our solutions must be evidence based and must take account of cost.