ABSTRACT
Out-of-programme (OOP) activities enable postgraduate trainees to undertake an experience outside of their individual subspecialty training programmes. Activities vary but may include a period of research, additional clinical experiences or time for a planned career break. Determining whether to go OOP is a common dilemma faced by many trainees as they progress through postgraduate training. This review assesses the options trainees have with regards to going OOP, evaluates the potential advantages and disadvantages and also provides advice for those considering an OOP activity.
Subject(s)
Education, Medical, Graduate , Biomedical Research , Humans , Medicine , United KingdomABSTRACT
This review aims to change clinical practice and alert clinicians to consider that unrecognised coeliac disease may present acutely with abdominal pain. Targeting patients who have non-specific abdominal pain or coeliac-associated symptoms/diseases may improve diagnosis.
Subject(s)
Abdominal Pain/etiology , Celiac Disease/complications , Abdominal Pain/diagnosis , Abdominal Pain/therapy , HumansABSTRACT
BACKGROUND: Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease. AIMS: We aimed to assess the association of celiac disease with surgical abdominal pain. PATIENTS AND METHODS: A case-control study was undertaken involving 300 consecutive new unselected patients presenting with acute abdominal pain (in a university hospital) and healthy controls (age and sex matched) without abdominal pain (n = 300). Initial investigations for celiac disease were immunoglobulins, IgA/IgG anti-gliadin (AGA), and endomysial antibodies (EMA). Any patient with a positive IgA AGA, EMA, or only IgG AGA in the presence of IgA deficiency was offered a small bowel biopsy to confirm the diagnosis. RESULTS: : There were 33 patients with abdominal pain who had positive antibodies, of whom 9 had histologically confirmed celiac disease (6 EMA positive; 3 EMA negative). One antibody positive patient (EMA in isolation) declined duodenal biopsy and the remaining 23 had normal duodenal mucosa. Within the control group, there were 2 cases of celiac disease. Compared with matched controls the association of acute abdominal pain with celiac disease gave an odds ratio 4.6. (P = 0.068, 95% confidence interval, 1.11-19.05). When only considering NSAP the prevalence of celiac disease was highly significant at 10.5% (9 of 86, P = 0.006). Patients' symptoms improved on a gluten-free diet at 12- to 18-month follow-up. CONCLUSION: Celiac disease was diagnosed in 3% of patients who presented with unselected acute abdominal pain to secondary care. Targeting patients who have NSAP or celiac associated symptoms/diseases may improve the diagnostic yield.
Subject(s)
Abdomen, Acute/etiology , Celiac Disease/complications , Abdomen, Acute/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Celiac Disease/diagnosis , Celiac Disease/immunology , Celiac Disease/pathology , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
INTRODUCTION: Genetic polymorphisms in the promoter region of the tumour necrosis factor (TNF) gene can regulate gene expression and have been associated with inflammatory and malignant conditions. We have investigated two polymorphisms in the promoter of the TNF gene (-308 G>A and -238 G>A) for their role in breast cancer susceptibility and severity by means of an allelic association study. METHODS: Using a case-control study design, breast cancer patients (n = 709) and appropriate age-matched and sex-matched controls obtained from the Breast Screening Unit (n = 498) were genotyped for these TNF polymorphisms, using a high-throughput allelic discrimination method. RESULTS: Allele frequencies for both polymorphisms were similar in both breast cancer cases and controls. However, the -308 polymorphism was found to be associated with vascular invasion in breast tumours (P = 0.024). Comparison with other standard prognostic indices did not show any association for either genotype. CONCLUSIONS: We demonstrated no association between the -308G>A polymorphism and the -238G>A polymorphism in the promoter region of TNF and susceptibility to breast cancer, in a large North European population. However, the -308 G>A polymorphism was found to be associated with the presence of vascular invasion in breast tumours.
Subject(s)
Breast Neoplasms/genetics , Breast Neoplasms/pathology , Genetic Predisposition to Disease/genetics , Polymorphism, Genetic/physiology , Tumor Necrosis Factor-alpha/genetics , Adult , Aged , Aged, 80 and over , Case-Control Studies , Disease Susceptibility , Female , Gene Frequency/genetics , Genotype , Humans , Middle Aged , Polymorphism, Genetic/geneticsABSTRACT
Although not mandatory, a period of formalized research leading to a higher degree is still commonplace for doctors wishing to pursue a career in hospital medicine. This may be undertaken before or during specialist registrar training. This article provides practical information for those planning to undertake research. The potential pitfalls of research are discussed and strategies are suggested to ensure that this phase of medical training is both productive and fulfilling.
