Clin Med
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This concise guideline summarises the key recommendations from the recent National Institute for Health and Care Excellence (NICE) clinical guideline on the assessment and management of psoriasis (CG153) that are relevant to the non-dermatologist. The aim is to highlight important considerations for assessment and referral of people with psoriasis, including identification of relevant comorbid conditions. Psoriasis is a common inflammatory skin condition and, especially when severe, can be associated with increased risk of cardiovascular disease, diabetes and depression. ⋯ Importantly, highly effective treatments are available. Appropriate assessment and referral of people with psoriasis therefore has the potential to improve outcomes by correctly identifying the appropriate treatment pathway. Assessment should involve not only disease severity but also the impact on patient well-being and whether the patient has any comorbid conditions, such as psoriatic arthritis, which requires rapid referral to a rheumatologist.
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The Department of Health Stroke Strategy (2007) recommends that post stroke patients are reviewed within 6 weeks of discharge. Historically, a 6-week outpatient appointment was offered. This was primarily a medical review and not a full assessment of health, social care status and secondary prevention needs. ⋯ This form of integrated partnership working seems to promote seamless life after-stroke care, while enhancing patients' understanding. It includes the provision of secondary prevention and self-management strategies. This 'one-stop shop' approach would warrant formal evaluation.
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Research is central to the National Health Service. Clinical trial recruitment has been aided by the National Institute for Health Research's Comprehensive Research Network but these networks do not support development of research. ⋯ The network is now a major contributor to UK trials, has published over 20 papers (>60 abstracts) and holds grants totalling more than £1.5 million. The NREG provides an exemplar model of how collaborative working can contribute significantly to biomedical research.
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A survey of 586 trainee doctors in Yorkshire was undertaken to ascertain current junior doctors' knowledge and understanding of alcohol units. Approximately 18% of trainees had no knowledge of alcohol units despite the fact that 82% believed they had a good knowledge. ⋯ Little progress seems to have been made on this important subject since our previous survey 7 years ago. Further steps must be taken to ensure that junior doctors are taught about alcohol units during the course of their training so that they are able to counsel patients appropriately.
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The UK's population is ageing and an adequately staffed geriatric medicine workforce is essential for high quality care. We evaluated the current and future geriatric medicine workforce, drawing on data relating to the UK population, current geriatric medicine consultants and trainees, recruitment into the specialty and trainee career progression. ⋯ The number of applicants to geriatric medicine training is increasing, yet increasing numbers of posts remain unfilled (4.7% in November 2010 and 14.1% in May 2013). The majority of geriatric medicine trainees secure a substantive consultant post within 6 months of obtaining their certificate of completion of training This work highlights challenges for the future: potential barriers to trainee recruitment, unfilled training posts and an ageing population and workforce.