Research and audit amongst undergraduate medical students

The student’s perception of their role in research and development Medical undergraduates are often too focused on their studies and disregard the importance of Medical Research and Audit both for their own personal development and also for the benefit of the general medical community. This is probably due to the lack of exposure and understanding of what being involved in such projects truly entails. Some view it as a waste of time, others see it as beyond their expertise while others don’t know where to start. This review on the topic is aimed at giving a general introduction to medical research, the pros and cons of getting involved and how any student should get started.peer-reviewe

GPs and end of life decisions : views and experiences

The views and experiences of GPs with respect to end of life (EoL) care are seldom addressed. The aim of this article is to better understand this aspect of care. A cross-sectional survey of all doctors in the country was designed and set up. The overall response was 396 (39.7%), 160 of which were GPs. 28.7% of GPs received no formal training in palliative medicine. 89.8% of respondents declared that their religion was important in EoL care. 45.3% agreed with the right of a patient to decide whether or not to hasten the EoL. 70.5% agreed that physicians should aim to preserve life. 15% of GPs withdrew or withheld treatment in the care of these patients. 41.1% had intensified analgesia at EoL. 7.5% had sedated patients at EoL. Lastly, 89.1% GPs would never consider euthanasia. Significant correlation (p< 0.05) was observed between considering euthanasia, using sedation, importance of religion and patients’ rights in EoL. A thematic analysis of comments highlighted the importance of the topic and feeling uncomfortable in EoL care. In conclusion there needs to be more training in palliative care. GPs believe in preserving life, would not consider euthanasia but do not shun intensification of analgesia at the end of life. There might be some misunderstanding with respect to the role of sedation at the EoL. GPs need legal and moral guidance in EoL care, in the absence of which, their religion is used as a guide.peer-reviewe

Emergency medicine and general practice

Emergency Medicine and Immediate Medical Care are relatively new specialties. In Malta, there is quite a considerable area of overlap between these specialties and general practice. Indeed, the family physician is confronted with some sort of medical emergency quite regularly. The brief of this article is to go through recent developments in Emergency Medicine as applied to General Practice. The areas considered are Basic Life Support, Head Injury, Asthma, Anaphylaxis, Community Acquired Pneumonia, Burns and Controlled Hypotensive Resuscitation. Whenever possible, distinct practical guidelines will be suggested as an aid in the clinical management of emergency situations which the family physician may encounter. This overview of new developments is by no means comprehensive but serves to highlight the increasing importance given to the role of the first-line medical practitioner in the emergency situation.peer-reviewe

A biomarker guided approach in heart failure

Heart failure is one of the commonest diagnoses presenting to physicians in the community or hospital care. Symptoms are often subjective, with clinicians having to rely on clinical assessment and radiological imaging to manage these patients. Treatment is often symptomatic with no clear therapeutic goals as yet identified. To date, there are no objective measures to diagnose, predict, prognosticate or guide therapy in compensated and decompensated heart failure, which is why a novel biomarker guided management approach is gaining so much momentum in the clinical community. This review encompasses recent data on this new approach and details on the potential clinical benefits of the most widely studied cardiac biomarkers currently available.peer-reviewe

Practical aspects of palliative care

Palliative Care is a relatively young medical specialty. In fact, it was only in 1987 that it was recognised as such in UK. The aim of this contribution is to highlight some important but practical points in the practice of palliative care, especially with respect to the ethical aspects of palliative care.peer-reviewe

A case of hypertension

You are consulted by MB, a 58 year old lady. She is single and works as a manager with a leading advertising agency, keeping up with a lot of deadlines. During the visit, which was mainly related to some minor elbow complaint, you discover a raised blood pressure of 170/95 mmHg. Subsequent visits confirm the raised blood pressure. She is known to suffer from dyslipidaemia, with a LDL-cholesterol of 4.5mmol/L and a total cholesterol of 6.3mmol/L. MB does not smoke. How would you manage this case?peer-reviewe

Some aspects of medical care in the USSR

As a participant in the World Health Organization Seminar on Medical Care, which was held earlier this year in the Soviet Union, I had the opportunity of observing certain characteristic features of the Soviet system of medical care which, in some respects, render it quite unique. It is the purpose of this article to describe some of these features. First priority was given to the provision of elementary forms of first aid in those areas where medical services were non-existent and, concomitantly, to instruct the people in the rudiments of hygiene and health care. The next step was the setting up of small cottage-type hospitals which were sited so as to be within reasonable distance from a number of first aid points. Major operations were carried out however in Rayon hospitals, which were purposely established to cater for a wide range of facilities. The urban woman also has a domiciliary medical care service, and facilities are also being provided for adolescents to see specialists at polyclinics with whom they can discuss their problems and who give them advice. The desire to provide a medical service by highly qualified workers has developed almost into an obsession for specialization. It is practically true to say that Soviet Medical Schools do not produce "doctors" but "specialists". Moreover, the term prevention is taken in the widest possible sense. It is not taken to signify simply the prevention of disease but also the prevention of the exacerbation of pathological conditions already existing. Although the medical service is not completely free, of significant importance is the extraordinary role of health volunteers.peer-reviewe

Advances in general surgical laparoscopy

Minimally invasive surgery has been with us for the past century. The lasl thirty years have seen an exponential growth in the development of laparoscopic techniques which allow major surgery to be performed through smaller incisions and less trauma leading to enhanced recovery and earlier discharge from hospitalpeer-reviewe

General practice

The remarkable rate of development of medical knowledge and pharmacology affects all medical specialties and in particular general practice, since the latter embraces various aspects of different medical fields. Certain areas of medical practice, such as Hormone Replacement Therapy (HRT), hypercholesterolaemia and drugs affecting the Renin Angiotensin System (RAS) feature in a vast amount of literature which is constantly being updated. The increasing awareness of the previously unknown effects of HRT on one side, and the widespread prevalence of cardiovascular disease in the case of hypercholesterolaemia and drugs affecting the RAS have contributed to this large amount of studies. On the other hand, certain areas of practice such as atopic eczema and anti-thrombotic therapy have been rather quiescent as far as developments are concerned, but revolutionary treatments have recently been introduced in both areas, namely the calcineurin antagonists and ximelagratan. The latter is a very promising drug which can replace warfarin, while the former are the first steroid-sparing medications which effectively control atopic eczema. Keeping abreast with recent developments is a further hurdle which the modern general practioner has to contend with in order to offer valid treatment options, and to be able to answer questions by increasingly well-informed patients.peer-reviewe

Adult learning theories and medical education : a review

Adult learning theories describe ways in which adults assimilate knowledge, skills and attitudes. One popular theory is andragogy. This is analysed in detail in this review. The importance of extrinsic motivation and reflective practice in adult learning is highlighted, particularly since andragogy fails to address adequately these issues. Transformative Learning is put forward as an alternative concept. Using the three recognised domains of knowledge, skills and attitudes, ways of applying these theoretical concepts in medical education are subsequently discussed.peer-reviewe