Clin Med
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Acute kidney injury (AKI) is associated with increased patient morbidity and mortality, and represents a significant financial burden for the NHS. The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD)'s report, Adding insult to injury, demonstrated that only 50% of patients who died from AKI received good care and 30% of patients had predictable and avoidable AKI. ⋯ The tips emphasise the importance of good basic medical care and the need for engagement with patients, healthcare professionals and hospital processes. The implementation of these tips in hospitals across the UK could potentially improve patient outcomes and reduce associated costs.
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Renal specialty medical training in the UK was reformed in August 2007, with an emphasis placed on competency-based training and the publication of a new curriculum and assessment blueprint. This model of training places additional time demands on both trainees and trainers, with implications for job planning and service delivery. We evaluated the resource requirements and impact on service delivery of implementing a high-quality training programme in renal medicine. ⋯ The mean total consultant time involved in implementing the training programme was 0.7 programmed activities (PAs) per trainee per week in the first year, which decreased to 0.5 PAs per trainee per week in the second year. This pilot study indicates that it is possible to integrate successful and high-quality specialty training in a busy clinical environment. The model outlined could form a template for postgraduate specialist training delivery in a variety of medical specialties.
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Case Reports
Ulcerative colitis presenting as pyrexia of unknown origin (PUO) without bowel symptoms.
Ulcerative colitis (UC) can rarely present with fever but it is unusual for it to be devoid of gastrointestinal symptoms. We report a case of UC that presented without bowel symptoms; fever being the only clinical feature. This case highlights the importance of considering UC as a cause of pyrexia of unknown origin (PUO) even in the absence of the lower gastrointestinal features commonly associated with this pathology. It is important to recognise this association as the incidence of UC is increasing in the older population.
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Secondary hyperparathyroidism in patients with chronic kidney disease (CKD) is common and usually caused by associated metabolic abnormalities, in particular, hypocalcaemia and hyperphosphataemia. Nevertheless, other causes of hyperparathyroidism can exist concurrently with CKD, challenging diagnostic interpretation and therapeutic intervention. We present four cases of hyperparathyroidism in patients with CKD that highlight some of these dilemmas.
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Many medical (and other) trainees will have heard mention during their training years of the specialty training committee (STC) relevant to their chosen medical specialty and might even be aware of some of the trainer members who sit on this committee. However, there is a perception that, equally, many trainees have no clear understanding of the roles and functions of STCs in relation to their training and, furthermore, the relation of their STC to its local deanery. This might also extend to consultant educational trainers who are less involved in the broader provision of postgraduate medical training (although, ideally this should not be the case). Here, I provide a brief guide to the role of STCs in training and their relation to their local deanery.