Clin Med
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Biography Historical Article
Ethereal and material gain: unanticipated opportunity with illness or disability.
When caregivers address the positive aspects of illness or disability, there is a risk of patronising the sufferer. It is equally problematic when secondary gain is judged in a negative light and impedes an effective doctor-patient relationship. Changing attitudes, and particularly the negative perception of a patient's gain from illness, are reflected in biographies of artists, philosophers and other creative individuals. ⋯ The experience of continual sufferers may be more instructive. We examine contemporary examples of unanticipated advantage or gain arising from ongoing disability or illness. The contribution of disability/illness to remarkable achievement promotes enhanced self-appreciation for patients and may foster in others a better understanding of what it means to suffer and live with disability.
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This article explores the current and emerging therapies for skin disease, with a particular focus on chronic plaque psoriasis and metastatic malignant melanoma. We discuss the current biological therapies used for psoriasis and those on the horizon, including small molecules and biosimilars. We also summarise the recent advances in the use of novel therapeutic agents in other dermatological diseases and outline the promise of translational research and stratified medicine approaches in dermatology. Better matching of patients with therapies is anticipated to have a major effect on both clinical practice and the development of new drugs and diagnostics.
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The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund or GFATM) is a private public partnership aimed at leveraging and providing funding for the three focal diseases outlined in its title. Set up in 2002, the fund was part of a new 'breed' of players in the field of global health, combining skills from bilateral and multilateral agencies with private sector and civil society. Highly innovative in its structure and funding model, the Global Fund's secretariat in Geneva provides grants directly to one or more organisations - not just governments - in recipient countries. ⋯ This includes discussion of its impact on health systems and allegations of financial irregularities among recipients in four countries. The organisation has now emerged with a new strategy, funding model and executive director. This paper charts its history, discusses some of the challenges faced, drawing on fieldwork conducted by the author in 2007-08, and reflects on recent changes and the road ahead.
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The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.
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Postgraduate medical education in the UK has gone through a maelstrom of change in the last 20 years; many components have disadvantaged clinical academic training in particular. In this article we summarise some of the changes and describe the advantages of the creation of a dedicated clinical academic graduate school as a response to these changes.