Postgraduate medical journal
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Type 2 diabetes is a major public health problem, accounting for significant premature mortality and morbidity. The growth in prevalence of the condition appears to be closely linked with obesity. ⋯ Vitamin D has important effects on insulin action, and may impact on a number of pathways which may be of importance in the development of type 2 diabetes. This article reviews the evidence linking Vitamin D deficiency in the pathogenesis of type 2 diabetes, and suggests areas for urgent further research to determine whether Vitamin D replacement has a role in the prevention of type 2 diabetes.
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To investigate the role of a nurse-led clinic in the assessment of patients with palpitations. ⋯ For low-risk patients, a nurse-led palpitations clinic may provide a viable alternative to the traditional cardiology outpatient service. Despite attempts to exclude them, some high-risk patients were seen. This was unforeseen and led to a clinically important delay in their appropriate assessment. Hence, before adopting a nurse-led palpitations service, a rigorous pathway for the early assessment of high-risk patients needs to be agreed.
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To determine the effects of a multifaceted paediatric rapid response system on the duration of predefined clinical instability and the subsequent rate of cardiac arrests. ⋯ The implementation of a paediatric rapid response system is associated with a significant reduction in the rate of cardiac arrests and duration of clinical instability before evaluation by critical care personnel. This study provides evidence that implementation of a rapid response system brings emergency personnel to deteriorating patients earlier, thus preventing cardiac arrests.
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Impulse control disorders (ICDs) are a heterogeneous group of conditions involving repetitive, excessive and compulsive activities that interfere with life functioning. Examples are pathological gambling, compulsive shopping and hypersexuality. Over the last decade, ICDs have become increasingly recognised as being associated with Parkinson disease (PD), with the literature highlighting a link between dopamine replacement therapy and the development of ICDs. ⋯ Currently, there is no clear evidence of an optimal treatment. Management is based on a careful balance of dopaminergic drugs with control of the aberrant behaviour, supported by psychological interventions. This review aims to summarise the current literature on ICDs, their phenomenology, epidemiology, clinical features, pathophysiology and management.
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Multicenter Study
How well prepared are medical students for their first year as doctors? The views of consultants and specialist registrars in two teaching hospitals.
To evaluate (1) the extent to which first year doctors (foundation year 1 doctors, F1s) in two teaching hospitals in the Trent Deanery were rated by specialist registrars (SpRs) and consultants as being well prepared for practice; (2) the importance ascribed by SpRs and consultants to the various items of core knowledge, skills and attitudes outlined in the publication of the General Medical Council, Tomorrow's Doctors. ⋯ Overall, F1s in the study were not well prepared either to perform the tasks that await them or in terms of most of the specific background knowledge and skills necessary for the successful execution of those tasks. The level of preparedness raises important issues about medical training and transition from medical graduate to first year doctor. Further research is needed to determine whether this situation exists in other regions of the UK.