Clin Med
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Case Reports
Severe orthostatic hypotension in a diabetic patient may not be due to diabetic autonomic neuropathy.
This lesson describes an unusual case of a man who was recently diagnosed with type 1 diabetes and who presented with severe orthostatic hypotension. As his diabetes was recent in onset, well controlled, and he had no other signs of microvascular disease, other causes of orthostatic hypotension were sought. His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported.
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Multicenter Study Comparative Study
British HIV Association national audit on the management of patients co-infected with tuberculosis and HIV.
This audit aims to compare UK management of tuberculosis (TB)/HIV co-infection with recommended practice and to describe local care arrangements. Services providing HIV care were invited to complete a survey of care arrangements and to review case notes of HIV positive patients aged over 16 who started therapy for active TB between October 2007 and April 2008. Corresponding TB services, if separate, were invited to complete a similar survey. ⋯ Culture confirmation of pulmonary TB met the CMO's 65% target. A high number of patients were diagnosed with HIV during investigation of TB. Contrary to current guidelines, many services do not routinely test TB patients for HIV.
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Following successful pilots in 2006, knowledge-based assessments for those engaged in specialty training have been developed and implemented in 11 medical specialties, by the Federation of Royal Colleges of Physicians in partnership with the specialist societies. Over 400 physicians have been involved in a project that has required recruitment and training of up to 25 question writers in each discipline, and the constitution of examining boards and standard setting advisory groups in each specialty. ⋯ A total of 786 candidates sat the examination in the UK, 162 in overseas centres. Pass rates among UK trainees have generally exceeded 80%, with reliability coefficients well in excess of 0.8.
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Biography Historical Article
Isolation in time: a cause of suffering in the elderly. Lessons from Krapp's last tape.
This column explores the links and synergies between medicine and literature. What roles can literature play in reflecting and influencing good practice, and what sorts of images of doctoring are to be found in drama, poetry, fiction, biography, electronic fora and film? The editors would be pleased to receive short papers, ranging from 500–1,000 words, on relevant topics. Those interested in contributing should email brian.hurwitz@kcl.ac.uk or neil.vickers@kcl.ac.uk