Clin Med
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Purulent pericarditis is now rare due to the widespread use of antibiotics. However, it is associated with significant morbidity and mortality, and non-specific symptoms and signs can make diagnosis difficult. We report a patient who presented with left-sided chest pain, mild fever and ST segment elevation on electrocardiography, who required prolonged organ support in the intensive care unit. This lesson highlights the diagnostic difficulties and management challenges that this condition can present.
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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.
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This article explores the current and emerging therapies for skin disease, with a particular focus on chronic plaque psoriasis and metastatic malignant melanoma. We discuss the current biological therapies used for psoriasis and those on the horizon, including small molecules and biosimilars. We also summarise the recent advances in the use of novel therapeutic agents in other dermatological diseases and outline the promise of translational research and stratified medicine approaches in dermatology. Better matching of patients with therapies is anticipated to have a major effect on both clinical practice and the development of new drugs and diagnostics.
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Postgraduate medical education in the UK has gone through a maelstrom of change in the last 20 years; many components have disadvantaged clinical academic training in particular. In this article we summarise some of the changes and describe the advantages of the creation of a dedicated clinical academic graduate school as a response to these changes.