Clinical medicine (London, England)
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Over the last year, hundreds of thousands of refugees fleeing war and persecution have travelled from the Middle East to Europe. Arduous journeys and poor living conditions are causing myriad health problems and access to basic healthcare is extremely limited for those on the move. ⋯ Pregnant women are frequently unable to access antenatal care in Europe and the vaccination rate for refugee children is worrying low. Those who have suffered traumatic experiences in their home country are highly susceptible to developing psychological problems; an issue compounded by poverty, their displacement and being victims of violence.
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Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. ⋯ Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects.
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Haemophagocytic lymphohistiocytosis is a rare inflammatory condition. It can present in adult general medical patients and is a challenging diagnostic conundrum. This article provides an overview of the pathophysiology and clinical presentation of the syndrome for the general physician who will be rarely confronted with this problem but will have to act promptly when the situation arises. Treatment is also briefly discussed, although this usually occurs in a specialist setting after the diagnosis has been established.
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Optimal management of diabetes involves a multidisciplinary approach. Prioritisation of lifestyle change, blood pressure and lipid control, and regular screening for complications are advocated in most international guidelines. ⋯ In recent years, a number of newer therapies for hyperglycaemia have become available. This review aims to discuss currently available options for patients with type 2 diabetes, and also discusses potential new therapies that may be on the horizon in the future.
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Adverse drug reactions (ADRs) remain a challenge in modern healthcare, particularly given the increasing complexity of therapeutics, an ageing population and rising multimorbidity. This article summarises some of the key facts about ADRs and explores aspects relating to their prevention, diagnosis, reporting and management in current clinical practice.