Clinical medicine (London, England)
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A recent survey of UK core medical training (CMT) training conducted jointly by the Royal College of Physicians (RCP) and Joint Royal College of Physicians Training Board (JRCPTB) identified that trainees perceived major problems with their training. Service work dominated and compromised training opportunities, and of great concern, almost half the respondents felt that they had not been adequately prepared to take on the role of medical registrar. ⋯ This article draws together some of these excellent ideas on how the quality of training and the experience of trainees could be improved. It presents a vision for how CMT trainees, consultant supervisors, training programme directors, clinical directors and managers can work together to implement relevant, feasible and affordable ways to improve training for doctors and deliver the best possible care for patients.
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Kidney transplants do not last for the natural lifespan of most recipients. Of the reasons why transplants fail, damage by the immune system is the commonest cause. Understanding how the immune system recognises transplanted organs has increased significantly in recent years, but there is little insight into how organs are damaged, and no still no way of suppressing immune-mediated damage without exposing patients to the detrimental effects of long-term immunosuppression. In this article, we review the role of antibodies and B cells in immune-mediated damage of kidney transplants, and discuss the potential for manipulation of B cells to improve clinical outcomes.
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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.