Clin Med
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Autoimmune limbic encephalitis is an increasingly recognised cause of cognitive decline and confusion. The typical presentation is with subacute cognitive decline, behavioural disturbance and seizures. ⋯ It is a highly treatable condition, often responding well to intravenous immunoglobulin or steroids. Recognition of autoimmune limbic encephalitis is sometimes delayed--usually because the diagnosis has not been considered--which can result in long-term neurological consequences.
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In chronic obstructive pulmonary disease (COPD) a pathophysiological cycle occurs such that locomotor muscle weakness and fatiguabilty exist, which in turn limit exercise performance both because of leg discomfort and also because anaerobic metabolism leads to lactic acid production. Since the lactic acid is buffered by bicarbonate there is consequent carbon dioxide (CO2) production. Patients with advanced COPD are flow limited and cannot excrete the CO2 by raising ventilation and thus these patients experience breathlessness which discourages exercise and, in turn, prompts further deconditioning. Structured exercise, termed pulmonary rehabilitation is at the core of reversing the cycle but novel strategies should be employed for patients with advanced disease and alternative therapeutic opportunities may soon be available to improve pulmonary mechanics.
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All physicians who are training young doctors of the future recognise the current challenge of doing this in the NHS. The recently published Temple Report documents the challenge and some of the solutions. ⋯ This paper sets out the history, structure and purpose of LFGs, describes what happens during a LFG meeting in both open and closed sessions and presents feedback of learning from two years in action across 11 acute trusts in the South East Coast (SEC) strategic health authority area. The experience of trainers in SEC is that the local faculty group structure and associated processes is one strand in the more effective delivery of education in the current NHS environment.