Clin Med
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Acute neurovisceral attacks of porphyria can be life threatening. They are rare and notoriously difficult to diagnose clinically, but should be considered, particularly in female patients with unexplained abdominal pain, and associated neurological or psychiatric features or hyponatraemia. ⋯ Severe attacks require treatment with intravenous haem arginate and supportive management with safe drugs, including adequate analgesia. Intravenous glucose in water solutions are contraindicated as they aggravate hyponatraemia, which can prove fatal.
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Medical training is a complex endeavour and analysing its quality is not a simple task. The accuracy of information, particularly of data gathered from trainees, will depend greatly on its source, on perceptions relating to confidentiality and on the uses to which the data are put. These factors should guide our choice of feedback instrument. ⋯ Administrative support is needed but the workload should not be onerous, especially if an on-line process can be developed. Strong evidence to support the validity of this instrument has been collected. The next step is the development and evaluation of the approach as an online process.
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Enhanced education has been recommended to improve non-specialist management of acute kidney injury (AKI). However, the extent of any gaps in knowledge has yet to be defined fully. The aim of this study was to assess understanding of trainee doctors in the prevention, diagnosis and initial management of AKI. ⋯ Fifty percent of trainees could not define AKI, 30% could not name more than two risk factors for AKI and 37% could not name even one indication for renal referral. These serious gaps in knowledge highlight the need for enhanced education aimed at all training grades. Organisational changes may also be required to optimise patient safety.