Clin Med
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Cardiovascular disease is predicted to be a leading cause of death and disability worldwide for the foreseeable future. Observational studies link a variety of prevalent early life experiences (for example, smoking in pregnancy, child poverty) to increased risk of adult cardiovascular disease. Experimental animal studies suggest plausible causal relationships. ⋯ This has led to a general policy emphasis on prevention and early intervention. To date, there are few examples of the evidence base being useful in shaping specific policies, despite potential to do so, and some examples of policy misunderstanding of science. Minor changes to the perspectives of epidemiological research in this area might greatly increase the potential for evidence-based policy.
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Comparative Study
Competency mapping in quality management of foundation training.
Competency-based curricula focus on outcomes in terms of application of knowledge and acquisition of competencies. The aim of this exercise was to analyse posts and programmes for potential training outcomes. A mapping process against the UK foundation curriculum was designed. ⋯ Widespread difficulty in achieving these competencies raises the question of whether they should be included within the national curricula. Development of competency-based training is a complex, multistep process. However, it is possible to analyse it in a large programme of trainees in the setting of the modern, busy NHS.
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Patients admitted to UK hospitals with community-acquired pneumonia (CAP) require a chest radiograph for diagnostic purposes and to look for complications. This study investigated the association between a chest radiograph performed early in the process of care and clinical outcomes. ⋯ Antibiotics were administered after the radiograph in 89.8% of patients with a time to first radiograph < 4 hours compared with 40.7% of patients with time to first radiograph of > or = 4 hours (odds ratio 12.8, p < 0.001). A chest radiograph performed within four hours of hospital admission for CAP is significantly associated with a shorter hospital LOS and with antibiotic use after chest radiography.