Clinical medicine (London, England)
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The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Recent EU legislation on the recognition of professional qualifications (to take effect January 2016) updates the framework within which doctors and others can migrate freely between EU member states to practise their profession. ⋯ The revised law covers the rules to be applied by regulators on (for example) assuring language competence, warning 'blacklists' of practitioners subject to sanctions, 'fast track' registration based on mutual recognition of professional qualifications, agreed minimum education and training requirements for mutual recognition, and encouragement of continuing professional development. Drafting of detailed secondary legislation is ongoing and poses opportunities and challenges for patient safety, quality of care and transparency.
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We carried out a cross-sectional online survey of fellows and members of the Royal College of Physicians to establish physicians' experiences of adverse patient safety events and near misses, and the professional and personal impact of these. 1,755 physicians answered at least one question; 1,334 answered every relevant question. Of 1,463 doctors whose patients had an adverse event or near miss, 1,119 (76%) believed this had affected them personally or professionally. 1,077 (74%) reported stress, 995 (68%) anxiety, 840 (60%) sleep disturbance and 886 (63%) lower professional confidence. 1,192 (81%) became anxious about the potential for future errors. ⋯ Adverse safety events affect physicians, but few formal sources of support are available. Most doctors use incident-reporting systems, but many describe a lack of useful feedback, systems change or local improvement.
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Exercise has a beneficial effect on metabolic parameters affecting cardiovascular risk, such as lipids and blood glucose, and is a key component in both the prevention and the management of type 2 diabetes. Glycaemic control improves with both aerobic and resistance exercise in type 2 diabetes, but no glycaemic benefit is seen in type 1 diabetes. ⋯ Low and moderate intensity exercise are generally associated with a fall in blood glucose, and high intensity exercise can be associated with a rise in blood glucose. Trial evidence is suggestive of a reduction in cardiovascular risk with exercise, although evidence from prospective, randomised controlled trials is certainly not conclusive.
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Diabetes is an increasingly common health problem, and accounts for one-tenth of NHS spending, chiefly managing avoidable complications. Approximately one-third of people with diabetes have psychological and/or social problems which impede their ability to self-manage their diabetes. ⋯ Ensuring that any mental health problems are treated and social needs are met, will be valuable in improving the individuals health. Addressing the psychiatric and psychological barriers to good glucose control can help to reduce the burden of diabetes and its complications, on both the individual and the wider health service.
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Atypical haemolytic uraemic syndrome is a thrombotic microangiopathy with a predominant renal phenotype. Research developments in the last 15 years have led to the elucidation of the role of complement over activation in the pathogenesis of the disease. This was to lead to the successful introduction of targeted pharmacological therapy, in the form of the complement inhibitor, eculizumab.