Clin Med
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Carotid artery dissection is an important cause of stroke in young adults. When focal neurological deficit or classic traumatic history is absent, the diagnosis can be challenging. This lesson reports an interesting case of a patient in whom pupillary dysfunction was the presenting sign of acute dissection of carotid artery.
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An electronic survey was used to assess perceptions of the disruption caused by the August transition and explore support for possible solutions. In total, 763 responses from members and fellows of the Royal College of Physicians of Edinburgh and the Society of Acute Medicine were received. The majority perceived the August transition to have a negative impact on patient care (93.1%), patient safety (90.4%) and training (57.8%) for a period of up to one month. ⋯ Changes to consultant working practices were felt to be beneficial, especially the cancellation of outpatient clinics (75%) and the restriction of leave (69.9%). Further use of shadowing (74.1%) and online induction (37%) was supported. This paper concludes that there is a high degree of support for structured change to the current provisions for junior doctor changeover.