Clinical medicine (London, England)
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A 12-month pilot was carried out on assessments for learning and assessments of learning as part of workplace-based assessments in postgraduate medical education. This was carried out in three regions and core medical trainees and higher specialty medical trainees participated. Focus groups and questionnaires were utilised to investigate the trainees' and trainers' experiences and perceptions of assessments for learning. ⋯ There was a lack of, or delayed or non-specific, feedback following SLEs, which would have impeded its educational value. Trainee and trainer disengagement was one of the contributing factors. These findings are valuable in informing and facilitating future successful implementation of assessments for learning.
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Diabetes comes in many shapes and forms. It is important for the general physician to recognise when clinical characteristics, response to treatment and associated features suggest an alternative variety of diabetes, over and above the traditional type 1 and type 2 forms which are far more common. Key to these suspicions are taking a clear history of the development of the diabetes and being aware of the family history.
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The purpose of modern radiotherapy is to deliver a precise high dose of radiation which will result in reproductive death of the cells. Radiation should transverse within the tumour volume whilst minimising damage to surrounding normal tissue. Overall 40% of cancers which are cured will have received radiotherapy. ⋯ Brachytherapy enables very high radiation doses to be delivered by the direct passage of a radiation source through or within the tumour volume and similar results can be achieved using rotational stereotactic X-ray beam techniques. Protons have the characteristics of particle beams which deposit their energy in a finite fixed peak at depth in tissue with no dose beyond this point - the Bragg peak. This has advantages in certain sites such as the spine adjacent to the spinal cord and particularly in children when the overall volume of tissue receiving radiation can be minimised.
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Insulin therapy is important in many patients with diabetes, but the UK National Diabetes Inpatient Audit (NaDIA) suggests that insulin therapy in hospital is poorly monitored and managed. Although most hospitals should have access to an inpatient diabetes specialist team, it is important for the non-specialist clinician to be aware of the indications for insulin therapy, types of insulin and insulin regimens, methods of adjusting insulin doses and the need for care with insulin prescribing. Here, we demystify issues around insulin therapy.