Postgraduate medical journal
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Lung cancer is the most common cancer worldwide and causes more deaths per year than any other cancer. It has a very poor 5-year survival rate of 8-16%, partly because of comorbidity preventing curative treatments but mainly because of the disease presenting with symptoms only when it is at an advanced and incurable stage. When lung cancer is detected earlier and is amenable to radical treatments such as potentially curative surgery and radical radiotherapy, 5-year survival rates are much higher (up to 67%). ⋯ The lack of impact achieved by early studies using sputum cytology (in conjunction with chest radiographs) is described, and then newer technology used to measure other biomarkers in sputum, serum, exhaled breath and bronchial mucosa to diagnose (early) lung cancer is detailed. Many techniques show promise, but debate continues about which population to screen and what is the most (cost) effective modality to use. Moreover, no single biomarker or combination of biomarkers in screening has yet been shown to reduce lung cancer mortality in large prospective randomised studies.
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As a relative shortage of organs limits transplantation rates in many countries, the number of patients on dialysis is increasing. Nephrologists in specialist centres supervise their dialysis, but increasingly in the context of acute medical emergencies, such patients present to district general hospitals. Experience in managing patients on dialysis varies among institutions. This review aims to provide a practical guide to aid general physicians involved in the delivery of hospital care, by outlining the principles of dialysis (haemodialysis and peritoneal dialysis) and examining relevant medical issues specific to dialysis patients.
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Chest x rays (CXRs) are among the most difficult radiographs to interpret accurately. The aim of this study was to assess the ability of different grades and specialities of clinicians to evaluate a series of CXRs correctly. ⋯ To improve patient care, we suggest that all chest x rays should be reviewed at an early stage during a patient's hospital admission by a senior clinician and reported by a radiologist at the earliest opportunity. We also suggest that structured teaching on CXR interpretation should be made available for newly qualified doctors, especially with the introduction of shortened training.