Clin Med
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The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. ⋯ A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy.
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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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Both the MRCP(UK) written examinations and the specialty certificate examinations (SCEs) use single-best-answer questions to assess the knowledge and problem-solving skills of physicians in training. Since 1999, specialists and senior trainees have created large banks of questions for these examinations that cover the relevant curricula. ⋯ Each question drafted is subjected to face-to-face peer review and subsequent stages of academic scrutiny before reaching the question bank, and later during the exacting processes of question selection and standard setting. Feedback to question writers at every level of scrutiny helps to support the development of question-writing competence, and the analysis of individual question performance provides some insight into optimal question design.