Postgraduate medical journal
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Barrett's oesophagus is a frequent complication of gastro-oesophageal reflux disease predicting oesophageal adenocarcinoma. The majority of Barrett's patients will not develop cancer, so that specific methods of identification of those at risk are required. ⋯ The ASPECT trial in the UK aims to establish whether chemoprevention with aspirin and a proton pump inhibitor will reduce adenocarcinoma development and mortality in patients with Barrett's oesophagus. It will also validate biomarkers for progression and clinical response and further study disease pathogenesis.
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Dual energy x ray absorptiometry (DXA) scans to measure bone mineral density (BMD) at the spine and hip have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.
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Bone hydatid disease lacks a typical clinical appearance and image characteristics on x ray or CT are similar to those of tuberculosis, metastases and giant cell tumour or bone cysts. However, MRI does show distinctive diagnostic features of bone hydatid disease, especially in the spine. ⋯ Effective chemotherapy using benzimidazoles, particularly mebendazole, albendazole and combination treatments, has now been achieved in experimental studies and clinical practice. However, most of these drugs are still in the experimental stage or are in the early stages of clinical use.
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The UK chief medical officer's recommendations for the re-licensing and performance management of doctors will mean a move from a formative towards a summative role for appraisal and its adjunct, the personal development plan. Where does this leave medical educators trying to promote reflective learning? It is taken for granted that self-directed learning is the sine qua non of all adult learning. But is it? This review re-evaluates self-directed learning and its corollary, the personal development plan, in the light of the chief medical officer's report, seeking the evidence behind today's accepted educational practice. It discovers a reality which challenges assumptions long enshrined in medical education.
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Appropriate assessment of community-acquired pneumonia (CAP) allows accurate severity scoring and hence optimal management, leading to reduced morbidity and mortality. British Thoracic Society (BTS) guidelines provide an appropriate score. Adherence to BTS guidelines was assessed in our medical assessment unit (MAU) in 2001/2 and again in 2005/6, 3 years after introducing an educational programme. ⋯ Coding remains poor. Adherence to CAP management guidelines was poor and has significantly worsened. Educational programmes, alone, do not improve adherence. Restriction of antibiotic prescribing should be considered.