Clin Med
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Pulmonary embolism (PE) continues to be associated with significant mortality despite advances in the diagnostic techniques available for its detection. Anticoagulation remains standard treatment in PE although there is a consensus view that 'step-up' to thrombolytic therapy in addition to anticoagulation is indicated in those patients who are systemically shocked at presentation--a group defined as having suffered 'massive pulmonary embolism'. ⋯ In particular, the potential benefit of extending thrombolytic therapy to include those patients with sub-massive PE has been the subject of much enquiry and debate. This review examines the evidence for thrombolytic therapy and explores the potential for risk stratification in PE.
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Randomized Controlled Trial Multicenter Study
Presenting the results of clinical trials to participants.
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This study examined whether two machine-marked tests (MMTs; a clinical problem-solving test and situational judgement test), previously validated for selection into U. K. general practice (GP) training, could provide a valid methodology for shortlisting into core medical training (CMT). A longitudinal design was used to examine the MMTs' psychometric properties in CMT samples, and correlations between MMT scores and CMT interview outcomes. ⋯ Both MMTs showed good reliability in CMT samples, similar to GP samples. Both MMTs were good predictors of CMT interview performance (r = 0.56, p < 0.001 in 2008; r = 0.61, p < 0.001 in 2009) and offered incremental validity over the current shortlisting process. The GP MMTs offer an appropriate measurement methodology for selection into CMT, representing a significant innovation for selection methodology.
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Implementing national guidance such as that produced by the National Institute for Health and Clinical Excellence should be a priority for NHS trusts. The best way of managing successful implementation is through collaboration across the healthcare community. This helps to improve communication, ensures progress is being made and enables healthcare professionals to concentrate on the whole pathway of care, not just specific aspects of it. The Sheffield Parkinson's Stakeholder Group has successfully engaged all who are involved with providing the service across the city and has also received national recognition for its approach to implementation.
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Recent developments in the field of diabetes and endocrinology have led to greater understanding of the body's complex hormonal axes. This article reviews the latest significant treatments which have the potential to impact greatly on a wide variety of disease states in the not too distant future.