Clin Med
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Comparative Study
Comparative studies and healthcare policy: learning and mislearning across borders.
This article addresses the vocabulary of cross-national analysis and commentary about health care, health policy and health politics. We conclude there is a large gap between promise and performance in comparative policy commentary and point to major sources of confusion, such as the lack of generally agreed vocabulary, vague language and the use of faddish and misleading terms and aspirational labels (illustrated by a selection of widely used expressions in comparative reports). We next examine the basic purposes of international policy comparison, distinguish three useful and two misleading approaches and frame defensible ground rules for comparative work.
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Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare cause of secondary adrenal insufficiency and its presentation with adrenal crisis is rather rare. Acute adrenal insufficiency (adrenal crisis) can be an elusive diagnosis, particularly in previously undiagnosed patients. As in this patient, the presentation of adrenal crisis with acute abdominal pain was misdiagnosed as an acute surgical abdomen, leading to a delay in the diagnosis and in the initiation of life saving treatment.
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Stroke is a common and devastating disease and, until very recently, was largely unrecognised as a -preventable or treatable condition. Between 1998 and 2010, the National Sentinel Stroke Audit (NSSA) achieved 100% voluntary participation, collecting data on more than 60,000 patients from stroke services within England, Wales and Northern Ireland and becoming a benchmark for hospital stroke services. In this way it has informed stroke improvement at the local, regional and national levels and has overseen a radical change in stroke care within the NHS. This article describes the achievements of the NSSA and the -lessons learned.
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The landscape and opportunities for clinical research have changed significantly following the creation of the National Institute for Health Research (NIHR) in 2006. This article describes the scale and impact of the NIHR network infrastructure for clinical research and identifies areas for future development in partnership with the National Health Service (NHS), clinicians and research funders.
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Venous thromboembolism is an increasingly recognised complication in the community and in hospital in-patients. Nowadays, most physicians are familiar with the algorithmic approach to the management of suspected deep vein thrombosis. However, a lack of understanding remains with regard to certain aspects of the diagnostic and treatment pathways, which has resulted in the wrong information being imparted to patients. Some of these issues are discussed in this paper, with considerations for changes in management.