General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation.
Abstract
Higher specialist training in general internal medicine (GIM) and the medical specialties has been subject to many changes and increasing subspecialisation in recent years. The 'Shape of Training' review proposes 'broad-based specialty training', shortening of training by one year, and subspecialisation to be undertaken after the certificate of specialty training is obtained. All higher level gastroenterology trainees based in the UK were invited to complete an online survey between July and September 2012 to assess their experience of gastroenterology and GIM training. Overall, 72.7% of trainees ...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Neale JR, Basford PJ, British Society of Gastroenterology Trainees Section Tags: Clin Med Source Type: research
UK medical selection: lottery or meritocracy?
Abstract
From senior school through to consultancy, a plethora of assessments shape medical careers. Multiple methods of assessment are used to discriminate between applicants. Medical selection in the UK appears to be moving increasingly towards non-knowledge-based testing at all career stages. We review the evidence for non-knowledge-based tests and discuss their perceived benefits. We raise the question: is the current use of non-knowledge-based tests within the UK at risk of undermining more robust measures of medical school and postgraduate performance?
PMID: 25650197 [PubMed - in process] (S...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Harris BH, Walsh JL, Lammy S Tags: Clin Med Source Type: research
Drug therapies in older adults (part 1).
Abstract
Prescribing for older adults represents a significant challenge as the UK population ages. Physiological decline and the rising prevalence of frailty increase the likelihood of altered pharmacodynamics and pharmacokinetics, suboptimal prescribing and adverse effects among this growing cohort of the population. In the first of two articles, we begin by considering these issues and posit four key questions which should be considered when prescribing for older adults. Does this agent reflect the priorities of the patient? Are there alternatives - with greater efficacy, effectiveness or tolerability -...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Mukhtar O, Jackson SH Tags: Clin Med Source Type: research
Ebola virus disease epidemic in West Africa: lessons learned and issues arising from West African countries.
Abstract
The current Ebola virus disease (EVD) outbreak ravaging three nations in West Africa has affected more than 14,000 persons and killed over 5,000. It is the longest and most widely spread Ebola epidemic ever seen. At the time of this overview (written November 2014), having affected eight different nations, Nigeria and Senegal were able to control and eliminate the virus within a record time. Ghana has successfully, to date, kept the virus away from the country, despite economic and social relationships with affected nations. What lessons can we learn from Nigeria, Senegal and Ghana in the current ...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Oleribe OO, Salako BL, Ka MM, Akpalu A, McConnochie M, Foster M, Taylor-Robinson SD Tags: Clin Med Source Type: research
Fever, jaundice and acute renal failure.
Abstract
Leptospirosis is an uncommon infectious disease that has protean clinical manifestations ranging from an innocuous 'flu-like' illness to potentially life-threatening multi-organ failure. Here we describe a case of Weil's disease that presented on the acute medical take with fever, jaundice and acute renal failure. We highlight the importance of careful history taking at the time of admission and how understanding the epidemiology and pathophysiology of leptospirosis enables a definitive diagnosis to be reached.
PMID: 25650200 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: O'Toole SM, Pathak N, Toms GC, Gelding SV, Sivaprakasam V Tags: Clin Med Source Type: research
Viral haemorrhagic fever.
Abstract
Viral haemorrhagic fevers (VHF) are a range of viral infections with potential to cause life-threatening illness in humans. Apart from Crimean-Congo haemorrhagic fever (CCHF), they are largely confined to Africa, distribution being dependent on the ecology of reservoir hosts. At present, the largest ever epidemic of Ebola virus disease (EVD or Ebola) is occurring in West Africa, raising the possibility that cases could be imported into non-endemic countries. Diagnosis and management is challenging due to the non-specificity of early symptoms, limited laboratory facilities in endemic areas, severit...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Fhogartaigh CN, Aarons E Tags: Clin Med Source Type: research
Schistosomiasis in non-endemic countries.
This article summarises the aetiology, clinical presentation, diagnosis and management of schistosomiaisis for clinicians in non-endemic countries.
PMID: 25650202 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Coltart C, Whitty CJ Tags: Clin Med Source Type: research
Human African trypanosomiasis in non-endemic countries.
Abstract
Human African trypanosomiasis (HAT) or sleeping sickness is a parasitic disease, acquired by the bite of an infected tsetse fly. In non-endemic countries HAT is rare, and therefore the diagnosis may be delayed leading to potentially fatal consequences. In this article the clinical presentation, diagnosis and treatment of the two forms of HAT are outlined. Rhodesiense HAT is an acute illness that presents in tourists who have recently visited game parks in Eastern or Southern Africa, whereas Gambiense HAT has a more chronic clinical course, in individuals from West or Central Africa.
PMID:...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Sudarshi D, Brown M Tags: Clin Med Source Type: research
Diseases from North America: focus on tick-borne infections.
Abstract
Tick-borne infections are seen throughout the United States, with varying geographical locations. Many of these infections are also increasingly seen in Europe. Certain ticks (eg Ixodes) can transmit more than one infection. Diagnosis, particularly in early infection, can be challenging and therefore knowledge of the distinguishing clinical features and epidemiology of these diseases is important. Testing for Lyme disease often causes confusion for patients and medical providers, as serological tests may be negative in early infection and conversely may be positive for years after infection. Newer...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Nathavitharana RR, Mitty JA Tags: Clin Med Source Type: research
Rabies: the clinical features, management and prevention of the classic zoonosis.
Abstract
The diagnosis of rabies encephalitis relies on awareness of the varied clinical features and eliciting a history of unusual contact with a mammal throughout the endemic area. The diagnosis is easily missed. Laboratory tests are not routine and only confirm clinical suspicion. Rabies infection carries a case fatality exceeding 99.9%. Palliation is appropriate, except for previously-vaccinated patients or those infected by American bats, for whom intensive care is probably indicated. However, as rabies vaccines are outstandingly effective, no one should die of dog-transmitted infection. Vaccines and...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Warrell MJ, Warrell DA Tags: Clin Med Source Type: research
Dengue: an update for clinicians working in non-endemic areas.
Abstract
Dengue is one of the most rapidly emerging viral infections globally, with 2.5 billion people now thought to live in dengue-endemic areas. In addition, reports of travel-related and autochthonous infections are increasing in non-endemic areas. Most patients with dengue experience a self-limiting febrile illness, but a proportion develop potentially life threatening complications around the time of fever clearance, including plasma leakage occasionally leading to shock, bleeding, and organ impairment. As dengue can present with non-specific symptoms of fever, headache and myalgias, the potential fo...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Yacoub S, Wills B Tags: Clin Med Source Type: research
Viral encephalitis in travellers.
Abstract
Viral infections are the commonest cause of encephalitis, and the purpose of this article is to inform UK clinicians of the presentation, diagnosis and management of viral encephalitis in travellers returning to the UK. The classical presentation is as a triad of fever, headache and altered mental state. There may be other findings either on examination or on imaging which, together with a travel history, may give clues as to the aetiology. It is important to note that in high- and middle-income countries the commonest cause of viral encephalitis is herpes simplex. This, coupled with the fact that...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Aryee A, Thwaites G Tags: Clin Med Source Type: research
Brucella and Coxiella; if you don't look, you don't find.
Abstract
Brucella and Coxiella are similar; both are obligate intracellular, zoonotic pathogens with a broad geographic distribution. Infection in animals is usually asymptomatic, but causes fetal loss and therefore has significant economic impact. Human infection may be asymptomatic or give rise to either organ-specific or multi-system disease. Organism culture is challenging for Coxiella and can lack sensitivity for Brucella. Therefore, infection is most commonly diagnosed by serology, but this may be negative in early infection and serology results may be challenging to interpret. Both Brucella and Coxi...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Lambourne JR, Brooks T Tags: Clin Med Source Type: research
Gastrointestinal symptoms in travellers.
Abstract
Diarrhoea is probably the single most common medical complaint in returning travellers. The most common pathogens are entero-toxigenic Escherichia coli, Shigella, Salmonella and Campylobacter. Viruses, toxigenic Arcobacter and Bacteroides fragilis, as well as parasites such as Cryptosporidium sp, are increasingly recognised but are not tested for in most diagnostic laboratories. Blood in stools is a sign of invasive disease and should trigger exclusion of invasive amoebic disease. The use of empiric antibiotics may shorten illness but is complicated by the diversity of bacterial causes and emergi...
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: McGregor AC, Wright SG Tags: Clin Med Source Type: research
CME Tropical medicine SAQs (91578): Self-assessment questionnaire.
PMID: 25650210 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - February 1, 2015 Category: Journals (General) Authors: Coltart EB, Chowdhury T Tags: Clin Med Source Type: research
