Clinical medicine (London, England)
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Hamman's syndrome is a spontaneous pneumomediastinum and is described as a rare complication of diabetic ketoacidosis (DKA). It typically follows a self-limiting course after successful treatment of the underlying DKA. We describe a case of a 28-year-old woman with type 1 diabetes presenting with facial pain, vomiting and abdominal pain. ⋯ Follow-up computed tomography showed near-complete resolution of pneumomediastinum with no intervention other than treatment of DKA. This therefore confirmed Hamman's syndrome. We propose that given the benign nature of the condition and the incidental finding in this report, as well as poor identification of mediastinal gas on chest X-ray, Hamman's syndrome is more common than reported.
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Raynaud's phenomenon (RP) is a common vasospastic condition which affects ~5% of the general population. The majority of individuals have primary RP; however, Raynaud's can also occur secondary to a broad range of underlying medical conditions and drug therapies. RP is a cardinal feature in patients with systemic sclerosis and is often the earliest symptom of the disease. ⋯ Non-pharmacological management is indicated in all patients. There are a wide range of available drug therapies to treat RP, including when complicated by digital ulceration, and surgical intervention is sometimes required. Future research is needed to understand the complex pathogenesis of RP and to measure the impact and severity of RP to develop optimised approaches to management.
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We describe a preceptorship model that was initiated in March 2018 for newly qualified physician associates (PAs) in primary care in Sheffield, UK. The scheme enabled part funding for four band 6 preceptorship posts initially, alongside fortnightly teaching and mentorship by the preceptorship lead and a senior PA external to the employer. ⋯ The advantages of an external senior GP PA mentoring the preceptorship PA is highlighted, and this scheme may be the first of its kind to initiate this level of mentorship. A 'preceptorship scale' is suggested, which may aid employers in thinking about in-house support for this new member of their team in their first year of practice.
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The COVID-19 pandemic has impacted the training of foundation doctors across the UK. A survey of foundation year 1 doctors across several district general hospitals in the East of England and East Midlands deaneries was carried out to investigate their perceptions of the impact on their training.