Clin Med
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Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare cause of secondary adrenal insufficiency and its presentation with adrenal crisis is rather rare. Acute adrenal insufficiency (adrenal crisis) can be an elusive diagnosis, particularly in previously undiagnosed patients. As in this patient, the presentation of adrenal crisis with acute abdominal pain was misdiagnosed as an acute surgical abdomen, leading to a delay in the diagnosis and in the initiation of life saving treatment.
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Stroke is a common and devastating disease and, until very recently, was largely unrecognised as a -preventable or treatable condition. Between 1998 and 2010, the National Sentinel Stroke Audit (NSSA) achieved 100% voluntary participation, collecting data on more than 60,000 patients from stroke services within England, Wales and Northern Ireland and becoming a benchmark for hospital stroke services. In this way it has informed stroke improvement at the local, regional and national levels and has overseen a radical change in stroke care within the NHS. This article describes the achievements of the NSSA and the -lessons learned.
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Asthma is a heterogeneous condition with multiple phenotypes that respond to treatments in different ways. Allergic asthma is an important phenotype and although currently available treatments are effective, about 5% of affected patients have severe, treatment-refractory disease. ⋯ Clinical trials are ongoing with novel biologic agents that demonstrate potential efficacy; determining the subsets of patients for which they are suitable will be crucial to ensure cost effectiveness. Personalised medicine and targeted therapies may hold the key to long-term control in this group of patients.
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There is a widespread perception that trainees in medicine in the UK are 'not as good as they used to be' and reduction in hours of training is often cited as one cause. However, there are no data on the current experience of medical trainees in general medicine. ⋯ There was a significant lack of experience in both the management of medical conditions and the use of common procedures. These results highlight the challenges in general medical training and show that there is substantial room for improvement.