Clin Med
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Case Reports
Acute aortic dissection with a high D-dimer and pleuritic chest pain in an airline passenger.
D-dimer can be significantly elevated in acute aortic dissection and poses a diagnostic challenge in someone with pleuritic chest pain occurring after a flight. Electrocardiogram abnormalities in isolated acute aortic dissection may mimic other acute cardiovascular conditions.
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The NHS has long held a paradoxical position in the national psyche: a constant, reassuring presence that seems to be in a state of continual flux. This is partly because while the service is based in the public sector (with its reputation for risk aversion and change at a glacial pace), it is also exposed to the ever present currents of political pressure. ⋯ During this time the notion of organising healthcare has developed and formed the focus of much of the change in systems across the developed world. The narrative will highlight some of the major challenges that the NHS will face over the next few years, and introduce the series about the future of the NHS that will appear in this journal signposting some of the topics that will be followed up in these articles.