Clin Med
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Progress in complex disorders requires clear thinking facilitated by clear language. Clinicians and scientists occasionally become captive to inaccurate language or meaningless terminology and this generates lazy thinking and impedes progress. ⋯ Among other FGIDs, the situation is more serious; imprecision and lack of consistency in terminology continue to mar progress. This article reviews the chequered history of terminology in this area and concludes that removing the obfuscation generated by poor usage of language should be the first step towards understanding the pathogenesis and improving the management of these, and similar, disorders.
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Studies have shown that end-of-life care within the UK hospital setting is variable, and care pathways are now being advocated in the UK. This report presents results from an audit revealing that it is possible to anticipate a large proportion of deaths within an acute setting, but this is generally achieved very close to the end of life. ⋯ It discusses the challenges around making the 'diagnosis of dying' and highlights that if clinicians do not feel confident in performing such a diagnosis, then patients cannot benefit from end-of-life care pathways. Instead of asking healthcare professionals to make accurate prognoses or diagnose dying, an environment needs to be created where teams feel comfortable in actively managing patients (appropriately) alongside considering their symptom control and planning for possible end-of-life care.
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The 25th anniversary of the first reports of a catastrophic illness later classified as AIDS and the 10th anniversary of highly active antiretroviral therapy (HAART) both occurred in 2006. Where available, HAART has revolutionised the treatment of HIV. ⋯ These anniversaries allow us to appreciate the milestones achieved thus far and those yet to be achieved. Only a collaborative global effort will stop the epidemic from overwhelming efforts to contain it.
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Two weeks after starting the oral contraceptive pill, a 16-year-old girl developed increasingly violent chorea and an evolving psychosis with prominent hallucinations, ideas of reference, and paranoia. An erythematous skin rash subsequently developed and Sydenham's chorea (SC) was diagnosed. ⋯ This case illustrates that severe psychotic features can occur in SC. It is recommended that antistreptolysin O titres and antibasal ganglia antibodies are checked early in patients with evolving movement disorders and prominent neuropsychiatric features, as the window for modifying the course of this immune-mediated disorder may be narrow.
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The potential for the holder of a senior academic post to influence the medical world is usually enshrined in their job description. Even though Oxford University failed to provide one, this account of 25 years of undirected activity suggests that such posts can influence events, albeit to a limited extent and not always in the expected direction.