The journal of the Royal College of Physicians of Edinburgh
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J R Coll Physicians Edinb · Jan 2014
Historical ArticleCost and value in medical education--what we can learn from the past.
What lessons can be learned from the history of cost and value in medical education? First, the issue of cost and value in medical education has been around for a long time. Rising costs and an economic recession have made us focus on the subject more, but the issue has been just below the surface for over 200 years. A problem like this will not go away by itself - we must tackle it now. ⋯ It probably always will. Looking at issues in medical education from the perspective of cost often makes them more stark and explicit - this in turn may help us to start to find solutions. In the future our solutions must be evidence based and must take account of cost.
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J R Coll Physicians Edinb · Jan 2014
Assisted death: a basic right or a threat to the principal purpose of medicine?
There is much debate in the UK and abroad around whether the law should be changed to license doctors to prescribe lethal drugs to assist terminally ill patients to commit suicide. Here, Sir Graeme Catto argues that terminally ill mentally competent adults should be able to choose the time and place of their death. Opposing him, Baroness Ilora Finlay argues that both the Assisted Suicide (Scotland) Bill and Lord Falconer's private member's bill in the House of Lords endanger patients' safety and require doctors to assess patients against criteria that cannot be verified.
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J R Coll Physicians Edinb · Jan 2014
Case ReportsA masquerading mass: an unusual presentation of IgG4-related systemic disease with tubulointerstitial nephritis.
IgG4 tubulointerstitial nephritis (IgG4-TIN) is the most common form of IgG4 renal disease. When IgG4-TIN is accompanied by other systemic manifestations the disease is known as IgG4-related systemic disease (IgG4-RSD). ⋯ This case highlights the importance of recognising IgG4-RSD as a non-malignant disease with presentations having commonly shared features including tumour-like swelling of involved organs and its ability to mimic many systemic diseases. In the majority of patients it can be treated successfully with corticosteroids.
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J R Coll Physicians Edinb · Jan 2014
Case ReportsPulmonary hypertension and hepatic encephalopathy: lethal complications of Rendu-Osler-Weber disease.
Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterised by epistaxis, mucocutaneous telangiectasia with systemic manifestations due to visceral telangiectasia and arterio-venous malformations (AVMs). We describe unusual complications of HHT in a 68-year-old male who developed high-output cardiac failure with pulmonary hypertension in combination with hepatic encephalopathy due to hepatic AVMs. This case shows the importance of a multi-system approach to HHT and considers the treatment of its hepatic complications.