Clin Med
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Case Reports
Addison's disease masked by long-term exogenous steroid treatment for presumed polymyalgia rheumatica.
Addison's disease can present insidiously. A 78-year-old woman presented with non-specific symptoms and hyponatremia, with a previous history of polymyalgia rheumatica treated with glucocorticoids. ⋯ Primary autoimmune Addison's disease can present with protean symptoms and diagnosis is often delayed. A high index of suspicion remains the cornerstone of diagnosis.
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The National Lung Cancer Audit was developed to improve the quality and outcomes of services for patients with lung cancer, knowing that outcomes vary widely across the UK and are poor compared to other western countries. After five years the audit is capturing approximately 100% of the expected number of incident cases across hospitals in England, Wales, Scotland, Northern Ireland and Jersey. ⋯ These national averages hide wide variations between hospitals providing lung cancer care which cannot be accounted for by differences in casemix. This paper describes the evolution of the audit, and describes the ways in which it may have improved clinical practice.
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Medical professionalism has been notoriously difficult to define and remains poorly understood. Because of this, graduates often have contrasting views on how it is best taught. ⋯ They were also asked to identify how they felt teaching about professionalism was best delivered from a selection of educational resources. The findings highlight major differences between how the material is taught and how students and graduates feel they learn best about professionalism and more research into this field is needed.
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The coalition government has set out its stall in a cluster of white paper consultation documents. One theme to emerge is a commitment to monitoring outcomes. ⋯ Clinicians have a duty to improve patient care and measurement and comparison is one of the tools at their disposal. Clinical involvement in the development of metrics and quality indicators is essential for meaningful results and it is vital that clinicians now take ownership of the quality of the clinical data captured on their patients.
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The medical registrar in the acute on-call and out-of-hours setting is usually considered to be one of the busiest and most challenging jobs in the entire hospital. This is perhaps a reflection of the changes in the structure and organisation of acute medicine precipitated by the European Working Time Directive and Modernising Medical Careers. ⋯ This article explores what the pragmatic role of the medical registrar broadly should be. The Medical Workforce Unit at the Royal College of Physicians is launching an initiative, part funded by the Department of Health, to answer this difficult question.