Clin Med
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Most patients with primary hyperparathyroidism (PHPT) are asymptomatic at presentation. This presents the dilemma whether to treat surgically or manage by conservative follow-up. ⋯ Others, such as effects on cardiovascular function or the risk of malignancy are more controversial. These factors are critical to decisions relating to surgical or conservative management of mild PHPT.
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In a paper in the last issue of Clinical Medicine, some of the background to attitudes to newly dead bodies, the current context of an urgent need for organs for transplant and the objections to calling a proposal to address this 'presumed consent' were outlined. Here further concerns are explored.
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Academic health centres (AHCs) bring significant economic and health benefits to a community. This study focuses on four integrated AHCs in the USA. They are described as the 'traditional great' or 'transformational great', where a number of common characteristics have been identified on how these organisations have demonstrated superior performance over time. The conceptual framework of 'good to great' provides a structure to explore key factors that support enhanced performance.
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Case Reports
Delayed pericardial effusions: life-threatening complication presenting up to 100 days after chest trauma.
Stab wounds are often managed conservatively with simple wound assessment and closure. However, even apparently minor thoracic wounds can cause delayed pericardial effusions presenting as life-threatening tamponade sometimes days, weeks or months later. Patients suffering stab wounds to the chest should receive echocardiographic follow-up to exclude delayed pericardial effusions.