Clin Med
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Cardiac disease is the leading cause of maternal mortality in the UK. The major causes of cardiac deaths in pregnancy include cardiomyopathy, myocardial infarction, ischaemic heart disease and dissection of the thoracic aorta. With increasing numbers of migrant women in the UK, rheumatic heart disease in pregnancy has also re-emerged. ⋯ The care of pregnant women with heart disease thus requires a multidisciplinary approach, involving obstetricians, cardiologists and anaesthetists. This allows appropriate surveillance of maternal and fetal wellbeing, as well as planning and documentation of the management of elective and emergency delivery. This review discusses common cardiac conditions encountered in pregnancy and their antenatal and intrapartum management.
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The 'Learning To Make a Difference' (LTMD) initiative was a Royal College of Physicians/Joint Royal Colleges of Physicians Training Board collaboration supported by The Health Foundation. It aimed to support the learning and development of new and relevant skills in quality improvement (QI) methodology by trainees to enable them to deliver effective QI projects at the frontline. Core medical trainees in five deaneries were offered the opportunity to undertake a QI project in place of a mandatory clinical audit during 2010-2011. ⋯ Evaluation of the project outcomes demonstrated the acceptability, feasibility and strengths of trainee-led small-scale change and how this can deliver improvement in the quality of multidisciplinary working, clinical practice and patient care. The LTMD project supports the further development and spread of this approach, encouraging all physician trainees, and their supervisors, to understand, develop and embed appropriate skills in QI methodology as part of their professional role. In addition, the project has identified the necessary infrastructure to enable this to happen.
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We reviewed outcomes of the Cambridge Bachelor of Medicine (MB)/Doctor of Philosophy (PhD) programme for the period 1989-2010. Of the 90 alumni contacted, 80 (89%; 24 women) completed an anonymous questionnaire. Thirty were academic staff and 35 were in general professional (core) or higher medical training. ⋯ Twelve graduates had further substantive research support (six clinician scientist awards and three senior fellowships) and two were Wellcome Trust postdoctoral MB/PhD fellows. Alumni included two full university professors, one reader, six senior lecturers, two assistant professors and nine university clinical lecturers. MB/PhD programmes offer an alternative training pathway for clinician-scientists in UK medical schools: the Cambridge programme promotes scientific discovery and sustained academic development within the context of contemporary medicine and clinical practice.