Clin Med
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Engaging in end-of-life discussions is a major source of anxiety for doctors in training. The authors propose the use of a decision-making model to assist trainees and their clinical supervisors in such situations. Divided into' 'patient-centred' and 'physician-centred' components, the model ensures that the following aspects are analysed: patient and family safety, patient and family choice, physician competence and physician comfort. A real but historical end-of-life scenario is presented to a foundation year 1 doctor, and the particular risks of engaging in a discussion are subsequently clarified with reference to each of the model's components.
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Lyme disease is rare in the U. K. but there is evidence of an increase in both prevalence of, and patient concern about, the infection. There are no published data characterising Lyme disease as it is seen in the U. ⋯ Screening enzyme immunoassay tests were negative in 39% and reference laboratory immunoblots were negative in 31% of patients, principally those with early infection. The majority of patients were cured with one course of antibiotic treatment, three patients had evidence of persistent infection after treatment and two required intravenous therapy. No cases of chronic Lyme disease were seen.