Clinical medicine (London, England)
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The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Recent EU legislation on the recognition of professional qualifications (to take effect January 2016) updates the framework within which doctors and others can migrate freely between EU member states to practise their profession. ⋯ The revised law covers the rules to be applied by regulators on (for example) assuring language competence, warning 'blacklists' of practitioners subject to sanctions, 'fast track' registration based on mutual recognition of professional qualifications, agreed minimum education and training requirements for mutual recognition, and encouragement of continuing professional development. Drafting of detailed secondary legislation is ongoing and poses opportunities and challenges for patient safety, quality of care and transparency.
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The last 20 years have seen a transformation in the landscape of rheumatoid arthritis, which has changed from being a life limiting condition to a chronic but often remitting illness. The importance of early disease control, the better use of existing therapies, and the development of new therapies have all been key to this success. The future of therapy now lies in the identification of stratifying biomarkers, to allow more rational delivery of treatment. The ultimate goal remains the reintroduction of immune tolerance to potentially achieve a 'cure.'
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It is a common perception that young people do not become ill and do not pose a challenge in the unscheduled healthcare setting. The research, however, increasingly suggests that young adults and adolescents (YAAs) are a highly vulnerable group, with poorer outcomes than either older adults or children, and distinct healthcare needs. ⋯ This requires cooperation and linkage with local paediatric and emergency services, as well as the input of other relevant stakeholder groups. Staff on AMUs also need to develop the knowledge, skills and attitudes to communicate effectively and address the developmental and health needs of YAAs and their parents/carers at times of high risk and stress.
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An increasing number of women who are pregnant have diabetes, whether gestational or pre-existing. Diabetes in pregnancy is associated with a number of adverse outcomes including birth trauma, neonatal hypoglycaemia, macrosomia and pre-eclampsia. Those with pre-existing diabetes have the additional risks which include congenital defects and increased perinatal mortality. This paper summarises the complications of diabetes in pregnancy and highlights some of the recent controversy surrounding the diagnosis of gestational diabetes.
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Although surgery is the definitive treatment for almost all hip fractures, there is evidence that outcomes such as morbidity and mortality are not determined by the type of surgery but by comorbidities and postoperative complications. A team approach, especially the involvement of an orthogeriatrician in managing medical issues, has been shown to improve surgical outcomes and should be encouraged in hospitals worldwide. ⋯ An orthogeriatrician-led unit can deal with the preoperative and complex postoperative medical, social, ethical, physical, and mental health issues that are associated with 'hip fracture syndrome', providing structured standardised evidence-based care by trained staff. This could be the model of care for the future.