Clinical medicine (London, England)
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In January 2019, a new nationally commissioned Genomic Medicine Service (GMS) has now commenced in the NHS. Capitalising on the infrastructure developed through the 100,000 Genomes Project, the GMS is underpinned by seven supra-regional Genomic Laboratory Hubs (GLHs) delivering the new inherited rare disease and cancer somatic tissue genetic test directory. This replaces the UKGTN test directory, with the aim of standardising criteria for whole genome sequencing or targeted panel tests where applicable. ⋯ The aim is to simplify patient pathways and reduce regional or social inequalities. We will discuss the implications of whole genome sequencing and the potential impact of the new nationally commissioned GMS for both patients, their relatives and clinicians. We will also discuss the imminent challenges in implementing genomic medicine into the NHS, and the future impact of novel technologies on service delivery as genomic medicine becomes increasingly integrated into routine healthcare.
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Significant uncertainty surrounds the sustainability of healthcare services in which junior doctors work. It is essential that student and foundation doctors (SFDs) are actively engaged if workforce morale is rebuilt. This narrative review explores the evidence driving the individual work-streams of the Royal College of Physicians' newly formed Student and Foundation Doctor Network. ⋯ Fewer foundation year-2 doctors are entering specialty training immediately after the foundation programme. Providing dedicated careers guidance and highlighting opportunities within traditional placements and other career paths can support doctors who undertake non-traditional career routes, including those who take time out of programme. Disseminating these resources through an effective peer-to-peer framework and a well-established mentoring scheme could be the most appropriate way to spread good practice.
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Acute presentations for dementia, particularly dementia with Lewy bodies (DLB), are rare and can pose diagnostic challenges. We present a case of a 75-year-old woman who was previously fit, well and independent in all activities of daily living. She had no history of psychiatric, cognitive or memory problems. ⋯ Further neurological examination demonstrated she had subtle Parkinsonian signs (cogwheel rigidity, bradykinesia) and was hypersensitive to small doses of antipsychotic (haloperidol and risperidone). A positive dopamine transporter scan was done confirming a diagnosis of an acute presentation of DLB. She has been commenced on a cholinesterase inhibitor (rivastigmine) and is presently settled in care.
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Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care, enhanced well-being for physicians as well as safer, more effective and less costly healthcare. To accomplish the mission/goal of meaningful physician engagement, we set about to establish a 'charter' for physician engagement. ⋯ There is a need for widespread physician engagement across the organisation. The objective is both an improvement in patient care and in physician well-being.