The prevalence of Type 1 and Type 2 diabetes are increasing significantly worldwide. Whilst vascular complications of diabetes are well recognized, and account for principle mortality and morbidity from the condition, musculoskeletal manifestations of diabetes are common and whilst not life threatening, are an important cause of morbidity, pain and disability. Joints affected by diabetes include peripheral joints and the axial skeleton. Charcot neuroarthropathy is an important cause of deformity and amputation associated with peripheral neuropathy. A number of fibrosing conditions of the hands and shoulder are recognized, including carpal tunnel syndrome, adhesive capsulitis, tenosynovitis and limited joint mobility. People with diabetes are more prone to gout and osteoporosis. Management of these conditions requires early recognition and close liaison between diabetes and rheumatology specialists.
Our findings suggest that medical schools may be currently failing to ensure that medical students have a basic competence in musculoskeletal medicine. Further investigation is warranted to fully assess the current training provided by U.K. medical schools in musculoskeletal medicine, and appropriate steps must be taken to improve the quantity and quality of training in musculoskeletal medicine in the United Kingdom.
Significant levels of circulating immune complexes (ICs)
Attendance at surgical conferences designed for medical students can significantly increase the desire of high-school students and preclinical medical students to pursue a surgical career, but may not have the same effect for clinical medical students. Surgical conferences may act as an effective means of recruiting students towards choosing a surgical career for a certain subset of students.
Background Bechet's disease (BD), a chronic multiorgan involving disease, has a significant impact on quality of life in spite of effective treatment modalities. Disease manifestations such as arthritis, orogenital ulcerations, rashes, angiitis, and neurological involvement affect health‐related quality of life (HRQoL) through its impact on depression, anxiety, and fatigue. Objectives We aimed explore the psychological impact of BD, taking into consideration the effect on the HRQoL, as well as the association with depression, anxiety, wellbeing, and fatigue. Methods This is a narrative review of the literature that looks into the association of BD on the HRQoL including all studies that have assessed such as association. Results/Findings Depression and anxiety are prevalent among patients with BD, and contribute significantly to fatigue, a common symptom among BD patients. In addition, the psychological wellbeing is affected by the disease, however, more studies are needed to assess this relationship. Conclusion Depression and anxiety are strongly associated with BD, and contribute significantly to fatigue, a common symptom among BD patients. In addition, the psychological wellbeing is affected by the disease, however, more studies are needed to assess this relationship. Besides, the controlling factors of the psychological impact are still to be deciphered.
Introductionin-service training of healthcare workers is essential for improving healthcare services and outcome.MethodsThe Millennium Development Goal (MDG) 6 Partnership for African Clinical Training (M-PACT) program was an innovative in-service training approach designed and implemented by the Royal College of Physicians (RCP) and West African College of Physicians (WACP) with funding from Eco Bank Foundation. The goal was to develop sustainable capacity to tackle MDG 6 targets in West Africa through better postgraduate medical education. Five training centres were establised: Nigeria (Abuja, Ibadan), Ghana (Accra), Senegal (Dakar) and Sierra Leone (Freetown) for training 681 physicians from across West Africa. A curriculum jointly designed by the RCP-WACP team was used to deliver biannual 5-day training courses over a 3-year period.ResultsOf 602 trained in clinical medicine, 358 (59.5%) were males and 535 (88.9%) were from hosting countries. 472 (78.4%) of participants received travel bursaries to participate, while 318 (52.8%) were residents in Internal Medicine in the respective institutions. Accra had the highest number of participants (29.7%) followed by Ibadan, (28.7%), Dakar, (24.9%), Abuja, (11.0%) and Freetown, (5.6%). Pre-course clinical knowledge scores ranged from 35.1% in the Freetown Course to 63.8% in Accra Course 1; whereas post-course scores ranged from 50.5% in the Freetown course to 73.8% in Accra course 1.ConclusionM-PACT made a positive impact to quality and outcome of healthcare services in the region and is a model for continued improvement for healthcare outcomes, e.g malaria, HIV and TB incidence and mortality in West Africa.
Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 300 words and should be typed double spacedTeaching clinical skills to preregistration house of®cersWe agree with Goodfellow and Claydon (October 2001 JRSM 1 ) that the training of ®nal-year medical students and preregistration house of®cers (PRHOs) in clinical skills can be improved. Better use can be made of the induction programme for PRHOs to include training in clinical skills, particularly as there is a substantial gap between MB BS ®nal examinations and the start of the ®rst house job.This year, our induction programme at Barts and The London NHS Trust was extended to 2 days and the structure was changed. The purpose of this was threefoldÐ foremost, to enable the new PRHOs to spend more time on the wards with the outgoing house of®cers; secondly, the number of talks was reduced to those deemed essential, to prevent information overload, and a less formal approach of stands' for other information was adopted; ®nally, the increased length of the induction allowed us to include small-group`hands-on' training in cardiopulmonary resuscitation and also training in the patient database system. We would like to expand on clinical skills for the new PRHO induction in August 2002 to include urinary catheterization, venepuncture, intravenous cannulation, arterial blood sampling and electrocardiography interpretation, using the facilities of a clinical skills laboratory. Training in needle-stick injury should be included either in induction or early in the weekly teaching sessions for PRHOs.Post-induction, we have used our Simulation Centre to train PRHOs in management of acute emergencies in respiratory medicine and cardiology, and this year two more sessions have been added in head injury and diabetic emergencies.Extending induction to more than 2 days may pose logistical dif®cultiesÐe.g. payment for PRHOs, and accommodation. Since the starting day is always a Tuesday, greater than 2 days is not feasible. Oesophageal cancer surgery
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