Clin Med
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Adrenal incidentalomas (AIs) are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in several investigations that are usually conducted in the endocrinology clinic. In 2011, we audited the prevalence and management of AIs identified on computed tomography (CT) imaging of abdomen over 1 calendar month. ⋯ Of those, 1.01% in 2011 and 0.95% in 2012 had newly identified AIs. Only a few patients had been tested to exclude a functional lesion and there was inconsistent terminology in reporting adrenal lesions. Therefore, we support comprehensive reporting of AIs and a selective testing strategy.
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The need to ensure patient safety in the National Health Service (NHS) is a national priority. However, it has long been recognised that a culture of blame impedes learning from previous adverse incidents. ⋯ A forum for learning from mistakes could also provide an opportunity to review past incidents in an open and supportive environment. This could, in turn, start to change the current culture of blame in the NHS and contribute to higher standards of patient safety in the future.
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Biography Historical Article
Ethereal and material gain: unanticipated opportunity with illness or disability.
When caregivers address the positive aspects of illness or disability, there is a risk of patronising the sufferer. It is equally problematic when secondary gain is judged in a negative light and impedes an effective doctor-patient relationship. Changing attitudes, and particularly the negative perception of a patient's gain from illness, are reflected in biographies of artists, philosophers and other creative individuals. ⋯ The experience of continual sufferers may be more instructive. We examine contemporary examples of unanticipated advantage or gain arising from ongoing disability or illness. The contribution of disability/illness to remarkable achievement promotes enhanced self-appreciation for patients and may foster in others a better understanding of what it means to suffer and live with disability.