Clin Med
-
Modernising Medical Careers (MMC) asks trainees to commit to their specialty sooner than ever before. There has been a great deal of good-quality research on the career intentions of doctors in training. It is time to review this data with MMC's changes in mind and reflect on how earlier enforced choice may affect trainees. ⋯ Those in this group who fail to be selected will need focused career support. Doctors who commit late are more likely to be affected by quality of life and flexibility. The present 'one size fits all' system does not reflect the natural history of present career selection and commitment to specialty.
-
Prolonged diagnostic dilemma and poor clinical outcome in the absence of early HIV testing.
-
This case represents latent autoimmune diabetes in the young (LADY), and demonstrates that autoimmune diabetes can be slowly progressive even in younger patients with insulin independency period lasting for more than two years.
-
Polymyalgia rheumatica (PMR) was defined in 1957 and is linked with giant cell arteritis (GCA) in approximately 25% of cases. The peak incidence is between 60 and 75 years old and is increasing with the ageing population. Polymyalgia rheumatica is a clinical diagnosis without a 'gold standard' serological or histological test and there are other conditions that may mimic PMR. ⋯ The rate of reduction should be adjusted depending on the individual's response. Where temporal arteritis is suspected, this manifestation of GCA is a treatable medical emergency to prevent possible blindness, and steroids should be commenced immediately. There remain many unknowns in the cause, diagnosis and treatment of PMR and its overlap with GCA, and it is an ongoing challenge requiring further research.