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Controversy in thyroid disease. 甲状腺疾病的争议。
Journal of the Royal College of Physicians of London Pub Date : 2000-07-01
A P Weetman
{"title":"Controversy in thyroid disease.","authors":"A P Weetman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Effective management for hypothyroidism has been available for a century, thanks to the pioneering efforts of George Murray, who first tested injection of thyroid gland extracts in Newcastle. Radioiodine for the diagnosis and then treatment of Graves' hyperthyroidism was introduced by Hertz and Roberts in Boston, and by Leblond in Paris, in 1943, the same year that Astwood in the USA began to use the predecessors of modern antithyroid drugs. Despite this lengthy history, debate continues as to the most effective management of these common disorders. More use of radioiodine, including its use in euthyroid goitre, is being advocated as its safety is now well established. Recent developments in optimising these treatments will be considered in this brief review.</p>","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 4","pages":"374-80"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/c6/jrcollphyslond146953-0054.PMC9665486.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The National Clinical Guidelines for Stroke. 国家中风临床指南。
Journal of the Royal College of Physicians of London Pub Date : 2000-07-01
C Weinstein
{"title":"The National Clinical Guidelines for Stroke.","authors":"C Weinstein","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 4","pages":"402"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/4f/jrcollphyslond146953-0082b.PMC9665482.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health care cost in Africa. 非洲的医疗保健费用。
Journal of the Royal College of Physicians of London Pub Date : 2000-07-01
A R Walker, A A Wadee
{"title":"Health care cost in Africa.","authors":"A R Walker,&nbsp;A A Wadee","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 4","pages":"403-4"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/e2/jrcollphyslond146953-0083b.PMC9665484.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diabetes in African Caribbean, and Indo-Asian ethnic minority people. 非洲、加勒比和印亚少数民族的糖尿病。
Journal of the Royal College of Physicians of London Pub Date : 2000-07-01
M L Burden, O Woghiren, A C Burden
{"title":"Diabetes in African Caribbean, and Indo-Asian ethnic minority people.","authors":"M L Burden,&nbsp;O Woghiren,&nbsp;A C Burden","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 4","pages":"343-6"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/4d/jrcollphyslond146953-0023.PMC9665468.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The potential role of IT in supporting the work of junior doctors. 资讯科技在支援初级医生工作方面的潜在作用。
Journal of the Royal College of Physicians of London Pub Date : 2000-07-01
R J Young, S D Horsley, M McKenna
{"title":"The potential role of IT in supporting the work of junior doctors.","authors":"R J Young,&nbsp;S D Horsley,&nbsp;M McKenna","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To develop an information system using hand-held personal computers to support the work of junior doctors.</p><p><strong>Design: </strong>A user-driven design process was used. Functionality reflected the core work of house officers (HOs) and senior house officers (SHOs); i.e. ward round lists, immediate discharge summaries, patient handover, laboratory and guidelines reference information and a personal record of clinical experience.</p><p><strong>Setting: </strong>Salford Royal Hospital NHS Trust is a university hospital with a large acute medical case load.</p><p><strong>Subjects: </strong>Several 'generations' of HOs and SHOs working in two of the four medical firms. Predominantly acute medical case load.</p><p><strong>Main outcome measures: </strong>Robustness, acceptability and benefits, assessed by observations and questionnaires.</p><p><strong>Results: </strong>The system has proved robust. It is time neutral for the juniors and minimal time is needed for training/adaptation. Most felt the system to have either made their lives easier or to have had no detrimental impact. Ward round lists and printed immediate discharge summaries have been particularly successful.</p><p><strong>Conclusions: </strong>A hand-held IT system designed for house doctors can provide immediate, low-cost support for their activities.</p>","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 4","pages":"366-70"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/2f/jrcollphyslond146953-0046.PMC9665483.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Coping with pressures in acute medicine--the second RCP consultant questionnaire survey. 应对急症医学压力——第二次RCP咨询师问卷调查。
Journal of the Royal College of Physicians of London Pub Date : 2000-07-01
H M Mather, H Connor
{"title":"Coping with pressures in acute medicine--the second RCP consultant questionnaire survey.","authors":"H M Mather,&nbsp;H Connor","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The second questionnaire survey of consultant physicians involved in acute unselected takes in 1999 achieved a 76% response rate, and the results have been compared with those from the first survey of 1997. The proportion of consultants whose trainees worked partial shifts had increased from 42% to 61%, although these patterns of duty were adjudged to have detrimental effects on the quality and continuity of care, and on junior staff education and training. The benefits of ward-based systems were counterbalanced by their disadvantages, but introductions of admission wards and assessment units were considered a resounding success. The number of hospitals with 'physician of the week' schemes had increased from 12 to 23, but opinion of their value was sharply divided. The provision and competence of all grades of locums was identified as an increasing problem. Seventy per cent of respondents stated that they would never participate in 'hands-on' emergency care, although 86% thought that future consultants might have to do so. Seventy-nine per cent reported increases in the pressures of their posts and in their working hours, and the tensions between general and specialist duties were highlighted. Most consultants considered that the only long-term solution to the staffing crisis was a marked expansion in the numbers of all grades of medical staff.</p>","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 4","pages":"371-3"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/f5/jrcollphyslond146953-0051.PMC9665479.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alpha-1-antitrypsin deficiency, the serpinopathies and conformational disease. α -1-抗胰蛋白酶缺乏，丝状病变和构象疾病。
Journal of the Royal College of Physicians of London Pub Date : 2000-05-01
J S Parmar, D A Lomas
{"title":"Alpha-1-antitrypsin deficiency, the serpinopathies and conformational disease.","authors":"J S Parmar,&nbsp;D A Lomas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Alpha-1-antitrypsin deficiency results from point mutations that distort the structure of the protein to allow a unique protein-protein interaction that we have termed loopsheet polymerisation. Polymers of Z alpha 1-antitrypsin accumulate within hepatocytes to form inclusion bodies that are associated with juvenile cirrhosis and hepatocellular carcinoma. The lack of circulating protein predisposes the Z alpha 1-antitrypsin homozygote to emphysema. This process also occurs in other members of the serine proteinase inhibitor (serpin) superfamily, antithrombin, C1-inhibitor and alpha 1-antichymotrypsin, in association with thrombosis, angioedema and chronic obstructive pulmonary disease, respectively, and we have recently shown that it underlies a novel inclusion body dementia. The interaction provides a useful paradigm for other 'conformational diseases' such as Huntington's disease, Creutzfeldt-Jakob disease and the amyloidoses.</p>","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 3","pages":"295-300"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/d6/jrcollphyslond146952-0075.PMC9665556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21746693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Managed clinical networks: a new paradigm for clinical medicine. 管理临床网络:临床医学的新范式。
Journal of the Royal College of Physicians of London Pub Date : 2000-05-01
I H Kunkler
{"title":"Managed clinical networks: a new paradigm for clinical medicine.","authors":"I H Kunkler","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 3","pages":"230-3"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/93/jrcollphyslond146952-0010b.PMC9665542.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21745404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical research: is the filling missing from the medical research sandwich? 临床研究:医学研究三明治缺补了吗?
Journal of the Royal College of Physicians of London Pub Date : 2000-05-01
P Dieppe, M Bachmann
{"title":"Clinical research: is the filling missing from the medical research sandwich?","authors":"P Dieppe,&nbsp;M Bachmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Clinical research is essential for patients to benefit from the advances of medical science. Particularly needed are thorough and imaginative investigations into applied physiology, clinical observation, and patients' experience. This can help clinicians and their patients to distinguish between pathology and healthy variation, interpret diagnostic information, understand what patients want and gain from health care, and apply study results to individuals' problems. Clinical research has not grown as much as other forms of medical research, and is sometimes regarded as unscientific. Young academic clinicians are often persuaded that the only road to science leads through the laboratory. Clinical research, however, offers equal opportunities for original enquiry, rigour and excellence. The medical research sandwich will continue to provide an unbalanced diet unless research leaders and funders take the clinical setting more seriously.</p>","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 3","pages":"282-4"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/0b/jrcollphyslond146952-0062.PMC9665552.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21745412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Measuring the quality of care for older people: preparing for the National Service Framework. 衡量老年人护理质量:为《国家服务框架》做准备。
Journal of the Royal College of Physicians of London Pub Date : 2000-05-01
P H Millard
{"title":"Measuring the quality of care for older people: preparing for the National Service Framework.","authors":"P H Millard","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76057,"journal":{"name":"Journal of the Royal College of Physicians of London","volume":"34 3","pages":"306-7"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/c0/jrcollphyslond146952-0086.PMC9665537.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21746695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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