Articles: ninos.
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I am increasingly bemused by the narrowing and blinkered view of training to becoming a GP. Rosenthal and Chana1 comment 'many trainees still spend part of this time in posts that offer traditional hospital-based experience that may not reflect the context of new community based service models'. Cautiously I would like to add the comment 'so what?' We do want 'well rounded' GPs, people open to new ideas, and who are open to 'lifelong learning.' Many who qualified at a similar time to me will have done hospital jobs as 'part of the team.' Six months at the end of which we were hopefully competent but also confident. ⋯ This also seems to becoming more difficult and not encouraged generally while trying to achieve CCT. That great idea of learner-led education, particularly for trainees, seems to have gone out of the window. I suppose I am saying, can we be a bit more generic in our training years, widen our horizons again, and use First5 to help settle doctors into the rewarding job we do?
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There are often many interpretations of patient-centred care. The plethora of information at a patients disposal coupled with current financial strictures, highlights the importance of the concept of patient-centred care and its place in providing evidence based medicine that is cost-effective. Many PCTs and hospitals have and continue to place increasing restrictions in various aspects of health care; screening tests, for example, cervical smear, pathological and radiological investigations, not to mention the proliferation of referral management schemes. ⋯ Now, one could argue that this is whatdoctors should always have been doing. One benefit of the current restrictions is to return doctors to their professional roots and to encourage evaluation of the scope of care with patients. In both these scenarios doctors would be required to address the perennial issue of needs versus wants and their own professionalism.
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The eye is an easily accessible, highly compartmentalised and immune-privileged organ that offers unique advantages as a gene therapy target. Significant advancements have been made in understanding the genetic pathogenesis of ocular diseases, and gene replacement and gene silencing have been implicated as potentially efficacious therapies. Recent improvements have been made in the safety and specificity of vector-based ocular gene transfer methods. ⋯ Gene therapy prospects have advanced for a variety of retinal disorders, including retinitis pigmentosa, retinoschisis, Stargardt disease and age-related macular degeneration. Advances have also been made using experimental models for non-retinal diseases, such as uveitis and glaucoma. These methodological advancements are critical for the implementation of additional gene-based therapies for human ocular diseases in the near future.
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A 69-year-old patient presented with episodic, acute hypoxia and an increasing oxygen requirement. His hemoglobin oxygenation reached its nadir in the 80% to 85% range as measured by pulse oximetry while he was sitting upright. ⋯ He was found to have a large secundum atrial septal defect with bidirectional intracardiac shunting, left hemidiaphragmatic dysfunction, a dilated ascending aorta and a prominent Eustachian valve. The patient was stabilized with oxygen therapy, and the cardiology service provided definitive treatment via percutaneous shunt closure with a septal occluder.