Clin Med
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Currently, there are no formal screening programmes for coronary artery disease (CAD). Computed tomographic coronary angiography (CTCA) has been suggested as a non-invasive and reliable method of atherosclerotic plaque assessment, with the potential for use in screening programmes. ⋯ Current evolving and future insights are also considered. Overall, in our view, there is currently insufficient evidence to support the formal use of CTCA in a screening programme for CAD, although this viewpoint will undoubtedly evolve.
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Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. ⋯ Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD.
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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.
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This study assesses NHS doctors' experiences of paternity leave and evaluates whether practices have changed since the introduction of additional paternity leave (APL) in April 2011. An anonymised online survey designed to discover experiences and uptake of APL and ordinary paternity leave (OPL) was distributed to all members of the London Deanery Synapse® network. In total, 364 fathers responded. ⋯ Since the introduction of APL, 3% of respondents took additional leave. Reasons for the low uptake of APL included the impracticalities of the law, poor awareness and perceived attitudes and implications for training. Problems with OPL included the inadequate provision of cover and difficulties in timing the leave appropriately.