Postgraduate medical journal
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Most consultants are involved in the training and assessment of several grades of doctors in training especially senior house officers (SHOs) and specialist registrars. In the medical and other specialties there is an increasing trend towards assessing junior doctors' competency using the record of in-training assessment process for specialist registrars and using the Royal College of Physicians folder to record competences of medical SHOs. It is necessary to consider why there is a need to assess competency, how it may be done practically, and the advantages and disadvantages of this system of assessment. There are considerable hurdles to the implementation of this system in the medical specialties within today's NHS and the organisation may need to undergo fairly radical change to facilitate this system.
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Dyspnoea is defined as a sensation of difficult breathing. It is common in hospitalised patients and is often a harbinger of serious and potentially fatal pathology. The pathophysiology of dyspnoea involves complex interactions between peripheral and central receptors and cognition. ⋯ A good history and systemic examination are necessary as it is important to quickly identify the cause and treat it promptly. Investigations are numerous but chest radiography and electrocardiography are among the commonest and most useful. It is important to understand the mechanisms underlying dyspnoea to treat breathless patients successfully.
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Biography Historical Article
Dr William Coley and tumour regression: a place in history or in the future.
Spontaneous tumour regression has followed bacterial, fungal, viral, and protozoal infections. This phenomenon inspired the development of numerous rudimentary cancer immunotherapies, with a history spanning thousands of years. Coley took advantage of this natural phenomenon, developing a killed bacterial vaccine for cancer in the late 1800s. ⋯ Can it be a coincidence that this method of immunotherapy has been "rediscovered" repeatedly throughout the centuries? Clearly, Coley's approach to cancer treatment has a place in the past, present, and future. It offers a rare opportunity for the development of a broadly applicable, relatively inexpensive, yet effective treatment for cancer. Even in cases beyond the reach of conventional therapy, there is hope.