Clin Med
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The drive to address social determinants of health is gaining momentum. Appreciating that health outcomes are only partly affected by healthcare, clinicians and clinical communities can play a significant role in this crusade by action at local, regional, national and global levels. A concerted and systematic focus on integrating and industrialising upstream interventions at every healthcare encounter is essential to prevent future illness, thus enabling a paradigm shift in the healthcare service from being one of illness management to health preservation. ⋯ Today, with a global economic crisis and challenged public sector funding, the need to address prevention has never been more pressing. Clinical engagement at all levels, from the front line to the boardroom is vital. Clinicians must address access, communication, strategy and commissioning to fulfil a professional responsibility to become and remain the corporate memory of a health service focused on preventing illness while simultaneously delivering cost-effective healthcare.
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Hypertrophic cardiomyopalthy can occur at any age, not just in younger patients. An electrocardiogram showing voltage criteria for left ventricular hypertrophy with prominent ST changes and deep T wave inversion should alert the clinician to this possibility Echocardiograpghy will make the diagnosis in the majority of patients.
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Patients who are face, arm, speech test (FAST) positive may have a stroke mimic diagnosis. Careful attention to the speed of onset of symptoms is paramount. Magnetic resonance imaging is helpful in supplementing the clinical assessment.
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Randomised controlled trials are the gold standard for testing the efficacy and safety of health interventions, especially medications, and researchers in the U. K. are required to gain approval from ethics committees, the regulatory body (Medicines and Healthcare products Regulatory Agency) and local NHS research governance departments for such trials. ⋯ K. and to the NHS's ability to deliver high-quality evidence on which doctors can base clinical decisions and improve the delivery of care. This article discusses recent experience of running large-scale clinical trials and suggests measures that could improve the current situation.