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3
100

Can a computer diagnose, treat cancer?

Hoping to build the ultimate cancer resource, doctors turn to supercomputer "Watson." CNN's Deborah Feyerick reports.  
YouTube
over 7 years ago
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3
44

Confidentiality Guidelines : Caldicott Report: key principles

Every proposed use or transfer of patient identifiable information within or from an organisation should be clearly defined and scrutinised. With continuing uses regularly reviewed, by an appropriate guardian.  
confidential.oxfordradcliffe.net
about 7 years ago
Foo20151013 2023 1i9rgu8?1444773940
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226

The elephant in the room: Is everything you see on an x-ray relevant?

Recent 'tongue in cheek' research which has been reported in a Washington Post blog recently has caused a lot of questions to be raised concerning inattention blindness, which could cause concern unless you understand the underlying psychology. Here's a CT scan: During psychology lectures at Med School, you may have encountered the basketball bouncing students in front of a bank of elevators where you were asked to count the number of passes the basketball made from the player wearing the white T shirt, while a gorilla ran between the students. (Even if you did watch it before, you can re-watch the video on the Washington Post blog). The recent study asked radiologists to identify and count how many nodules are present in the lungs on a regular CT thorax. If you look at the image you may see a gorilla waving his arms about. As a radiologist, I see the anatomy in the background, the chambers of the heart and mediastinum, but nothing there out of the ordinary. As radiologists, we are looking for pathology, but also report pathological findings that are unexpected. The clinical history of a patient is very important for us in interpretation of imaging examinations, as we need to answer the question you are asking, but have to be careful we do not miss anything else of serious import. As we do not see any other pathology, we would not expect to find a gorilla in the chest, so our brains can pass over distracting findings. The other psychological issue is the satisfaction of search, where we can see the expected pathology, but may miss the other cancer if we do not carefully and systematically look through the images. So the main thing to learn from this is that your training should always keep you alert, not just to expected happening, but to not discount the unexpected, then many lives will be saved as a result of your attention to detail.  
Chris Flowers
almost 9 years ago
Foo20151013 2023 fkplre?1444774007
3
1554

Pathological Priorities

Previously I blogged about the 'stigma' and discrimination often faced by those confronting mental illness - even by colleagues. It was incredibly apt, therefore, that just a week later, the Royal College of Psychiatrists (RCPsych) published their "Parity" report. The report entitled Whole Person Care: from rhetoric to reality calls for an equality in physical vs mental health. As with many of my colleagues, I saw the word "Whole Person Care" and was instantly guilty of a pre-formed stereotype. I don't like the term whole person care nor holistic medicine. I hear these terms and my thoughts instantly switch to bright colours, 60s attire and I start humming "this is the dawning of the age of Aquarius". More so, this topic becomes riddled with questionable pseuodoscience and tentative nods to evidence-less forms of complimentary medicine. I think such terms are perhaps self destructive and instantly mark out mental health as odd. Ambiguous terms such as this make the whole topic even more off putting. Holistic rants aside, this report is an exceptionally important read (or at least glance) for all future doctors. There is an unquestionable inequality in mental and physical health in this country. It seems that if we can't 'see' something, it's not quantifiable and therefore loses a position of importance. It leads us to have 'pathological priorities', putting the physical before the mental. Despite this, both influence one another and deserve equal importance. Some of the key points of the report are: A call for equal funding of Mental and Physical Health Services A call to reduce discrimination and stigmas associated with Mental Health A call for equal care and treatment of Mental health/Physical Health A call for management and leaders (such as commissioning boards)to acknowledge the equality of mental/physical health Perhaps the most important for myself as I read through this was a call for equal access to Mental Health treatments under NICE clinical guidelines. Currently, patients have the right to receive only mental health treatments which have undergone NICE technology appraisals - not those offered by clinical guidelines. For example, NICE Clinical Guidelines state talk therapies are more effective than instant antidepressants for treatment of mild depression. The report is a huge step toward equality in mental and physical health. Perhaps we should all just take a moment to address the importance of both. You can read the full report and a summary on the RCPsych website here: http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/op/op88.aspx  
Lucas Brammar
over 8 years ago
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3
63

NIMH » Gene May Bias Amygdala Response to Frightful Faces

The amygdala, the brain structure known as the hub of fear, responds differently to pictures of scary faces, depending on which version of a gene one has inherited, report National Institute of Mental Health (NIMH) scientists.  
nimh.nih.gov
almost 6 years ago
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2
41

The horrific toll of America's heroin 'epidemic' - BBC News

Heroin abuse in the US has spread beyond inner cities, resulting in a sharp rise in deadly addiction. The BBC's Ian Pannell reports from Chicago, a hub for cheap, pure and plentiful heroin.  
BBC News
over 7 years ago
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2
43

NHS fraud ‘equal to its entire budget for cancer treatment’

The true cost of fraud inside the NHS could be more than £5bn a year, more than 20 times the official government figure, a new report has warned.  
The Independent
over 7 years ago
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49

Asthma deaths report warns complacency is costing lives - BBC News

People with asthma are dying unnecessarily because of complacency among both medical staff and patients, a national study claims.  
BBC News
over 7 years ago
Foo20151013 2023 aoqg73?1444773932
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89

A Humble NHS?

A Recap Last week in my personal blog I reflected on humility as defined by James Ryle: God given self-assurance that eliminates the need to prove to others the worth of who you are and the rightness of what you do. Ryle suggests, from 1 Peter 5:5-7, that central to humbling ourselves is throwing our cares on to God. Every concern, care and fear being hurled on to God who is faithful and powerful enough to handle them. When we know that we are loved by Him no matter what and that He is in control no matter what, then we remove the need to prove ourselves or protect ourselves. We become humble – secure enough to allow God to be in control and to serve others. Once our eyes are lifted from ourselves we are able to see others to love and serve them. Stafford Hospital Just before writing the last post I was reading an article about the report by Robert Francis QC on the appalling treatment of patients at Stafford Hospital. One of the recurring comments made by many different people is that the pressure of targets and incentives increasingly displaces focus on compassion and patient care. When doctors, nurses and managers alike are bombarded with ever increasing and regularly changes hoops to jump through and targets to meet, no wonder their attention and efforts are dragged from patient care. I’ve seen something of the effects of this in a family member who for many years worked as a Health Visitor. In their decades of service they saw an ever increasing and ever changing string of targets and goals alongside cost cutting moves that stripped resources and personnel. Their desire to be compassionate and offer the best care possible became more and more stressful until it finally proved too much. She recently changed jobs. Now I’m not trying to attack the NHS and I am well aware that so many people receive great care. But this is not a new concern that is being bandied around with fresh vigour in the light of Stafford Hospital. What struck me is that it demonstrates on an institutional level what also seems true at a personal level. Namely, that when we are forced to operate from a place of insecurity we begin to miss the most important things. NHS services have to meet targets to receive funding to simply keep operating – there will be no patient care if there is no hospital. Oftentimes, especially as a leader, we can live with a sense that, unless we meet expectations or make people like us or recognise our worth, then we’ll have no influence to do any of the things we know we are called to do. The secret of personal humility is to recognise that we are already loved by our Father before we even move our finger; to recognise that He is control and we can throw every care on Him. A person who can live from that place of security finds, free from the need to prove themselves or their actions, can begin to simply do what they are made and called to do. They are no longer pulled in different directions by a multiplicity of cares. What about an institution? It strikes me that a similar solution is needed for the NHS. Is there a way to give security for doctors, nurses and caring professionals so that they are able to do what they are called to do without constantly watching their back? Obviously there is a need for accountability for the safety of patients and to ensure a good standard of care, but the constant need to prove worth and achievement cannot be helpful for those who are called to compassionate care. I’m not a healthcare professional. I don’t know exactly what this would look like. But I recognise in the diagnosis of struggles in the NHS, God’s diagnosis of struggles in many people’s lives. The way He designed us to live with Him is often a good basis to begin to imagine a new way for every level of society to function. So, my question is this: what would a humble NHS look like? To whom could a National Health Service throw it’s concerns and cares?  
Rev Samuel Pollard
almost 9 years ago
Foo20151013 2023 1f9109k?1444774063
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2679

Criticizing the NHS - Can students do this productively?

In this month’s SBMJ (May 2013) a GP called Dr Michael Ingram has written a very good article highlighting some of the problems with the modern NHS’s administrative systems, especially relating to the huge amount of GP time wasted on following up after administrative errors and failings. I personally think that it is important for people working within the NHS to write articles like this because without them then many of us would be unaware of these problems or would feel less confident in voicing our own similar thoughts. The NHS is a fantastic idea and does provide an excellent service compared to many other health care systems around the world, but there is always room for improvement – especially on the administrative side! The issues raised by Dr Ingram were: Histology specimens being analysed but reports not being sent to the GP on time or with the correct information. Histology reports not being discussed with patient’s directly when they try and contact the hospital to find out the results and instead being referred to their GP, who experiences the problem stated above. GP’s are being left to deal with patient’s problems that have nothing to do with the GP and their job and have everything to do with an inefficient NHS bureaucracy. These problems and complaints often taking up to a third of a GP’s working day and thereby reducing the time they can spend actually treating patients. Having to arrange new outpatient appointments for patients when their appointment letters went missing or when appointments were never made etc. Even getting outpatient appointments in the first place and how these are often delayed well after the recommended 6 week wait. Patients who attend outpatient appointments often have to consult their GP to get a prescription that the hospital consultant has recommended, so that the GP bares the cost and not the hospital. My only issue with this article is that Dr Ingram highlights a number of problems with the NHS systems but then does not offer a single solution/idea on how these systems could be improved. When medical students are taught to write articles for publication it is drummed into us that we should always finish the discussion section with a conclusion and recommendations for further work/ implications for practice. I was just thinking that if doctors, medical students, nurses and NHS staff want to complain about the NHS’s failings then at least suggest some ways of improving these problems at the same time. This then turns what is essentially a complaint/rant into helpful, potentially productive criticism. If you (the staff) have noticed that these problems exist then you have also probably given some thought to why the problem exists, so why not just say/write how you think the issue could be resolved? If your grievances and solutions are documented and available then someone in the NHS administration might take your idea up and actually put it into practice, potentially reducing the problem (a disgustingly idealist thought I know). A number of times I have been told during medical school lectures and at key note speeches at conferences that medical students are a valuable resource to the NHS administration because we visit different hospitals, we wander around the whole hospital, we get exposed to the good and bad practice and we do not have any particular loyalty to any one department and can therefore objective observations. So, I was thinking it might be interesting to ask as many medical students as possible for their thoughts on how to improve the systems within the NHS. So I implore any of you reading this blog: write your own blog about short comings that you have noticed, make a recommendation for how to improve it and then maybe leave a link in the comments below this blog. If we start taking more of an interest in the NHS around us and start documenting where improvements could be made then maybe we could together work to create a more efficient and effective NHS. So I briefly just sat down and had a think earlier today about a few potential solutions for the problems highlighted in Dr Ingram’s article. A community pathology team that handles all of the GP’s pathology specimens and referrals. A “patient pathway co-ordinator” could be employed as additional administrative staff by GP surgeries to chase up all of the appointments and missing information that is currently using up a lot of the GP’s time and thereby freeing them to see more patients. I am sure this role is already carried out by admin staff in GP practices but perhaps in an ad hoc way, rather than that being their entire job. Do the majority of GP practices get access to the hospitals computer systems? Surely, if GPs had access to the hospital systems this would mean a greater efficiency for booking outpatient appointments and for allowing GPs to follow up test results etc. In the few outpatient departments I have come across outpatient appointments are often made by the administration team and then sent by letter to the patients, with the patient not being given a choice of when is good for them. Would it not be more efficient for the administrative staff to send the patients a number of appointment options for the patient to select one appropriate for them? Eliyahu M. Goldratt was a business consultant who revolutionized manufacturing efficiency a few years ago. He wrote a number of books on his theories that are very interesting and easy to read because he tries to explain most of his points using a narrative – “The Goal” and “Critical Chain” being just tow. His business theories focussed on finding the bottle neck in an industrial process, because if that is the rate limiting step in the manufacturing process then it is the most essential part for improving efficiency of the whole process. Currently, most GPs refer patients to outpatient appointments at hospitals and this can often take weeks or months. The outpatient appointments are a bottle neck in the process of getting patients the care they require. Therefore, focussing attention on how outpatient appointments are co-ordinated and run would improve the efficiency in the “patient pathway” as a whole. a. Run more outpatient clinics. b. Pay consultants overtime to do more clinics, potentially in the evenings or at weekends. While a lot may not want to do this, a few may volunteer and help to reduce the back log on the waiting lists. c. Have more patients seen by nurse specialists so that more time is freed up for the consultants to see the more urgent or serious patients. d. An obvious, yet expensive solution, hire more consultants to help with the ever increasing workload. e. Change the outpatient system so that it becomes more of an assembly line system with one doctor and a team of nurses handling the “new patient” appointments and another team handling the “old patient” follow up appointments rather than having them all mixed together at the same time. I am sure that there are many criticisms of the points I have written above and I would be interested to hear them. I would also love to hear any other solutions for the problems mentioned above. Final thought for today … Why shouldn’t medical students make criticisms of inefficiencies and point them out to the relevant administrator? If anyone else is interested in how the NHS as a whole is run then there is a new organisation called the Faculty of Medical Leadership and Management that is keen to recruit interested student members (www.fmlm.ac.uk).  
jacob matthews
over 8 years ago
Foo20151013 2023 1juzlhe?1444774136
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330

Dr Mark Newbold “Why Should Doctors Get Involved in Management – Understanding the Problems” - Birmingham Medical Leadership Society Lecture 3

The Birmingham Student’s Medical Leadership Society (MLS) held it’s third and final lecture of 2013 on Thursday December 5th. The final lecture was given by Dr Mark Newbold CEO of the Heart of England NHS Foundation Trust and was a particularly enlightening end to our autumn lecture series on why healthcare professionals should become involved in management and leadership. In contrast to the previous talk by Mr Tim Smart this lecture did not focus on why doctors would be suitable for management roles but rather on why clinical leadership is absolutely necessary to tackle the fundamental problems in our hospitals today. Once again, the Birmingham MLS heartily thanks Dr Newbold for giving up his valuable time to speak to us and we must also thank Michelle and Angie for video recording this event as well. Fingers crossed, the recordings of both of our last events should be available fairly shortly. The lecture began with a brief career history of why and how Dr Newbold became involved in hospital management, from front line doctor, to department lead and on to chief exec of a major NHS foundation trust. The second part of the lecture was a brief history of the recent NHS beginning with the Labour years. Between 1997 and 2010 NHS funding increased enormously, which was a good thing. Targets increased proportionally with the funding, not necessarily a good thing. Expectations to meet the targets at all costs and punishments for failure also increased, not a good thing. Focus became diverted from providing the best possible care to ensuring that the hospital didn’t go bankrupt from failing to hit it’s targets. The “budget culture” was an unintended consequence of overzealous central target setting. This system did have some major successes, such as overall reduced waiting times and new specialist urgent cancer referral pathways. However, these successes did not necessarily transform into better patient care or higher patient satisfaction. This came to ahead as well all know with the Mid-Staffs Enquiry, the Francis report and the Keogh review. The recent NHS reforms have tried to change the NHS management culture away from target driven accounting and more towards affordable, yet excellent patient care – a “quality culture”. The NHS structural reforms have been well meaning but messy and complicated. The NHS culture change has begun, but trying to change something as huge as the NHS is like trying to steer an oil tanker, it takes time for the tiniest change in direction to be noticed. Add to this list of changes, an ever ageing population, an ever growing population, an increasingly chronically ill, co-morbid population and a relative freeze in budget and you can start to see why NHS managers are having such a tough time at the moment. How can NHS managers adopt this culture? Put their priorities in order. Quality care + Patient satisfaction > Waiting lists > Budgets Engage with the public in a more meaningful way. Have a social media presence so that you, your hospital and its staff are more than just a faceless organisation. Have a twitter account and write blogs about your challenges and successes. This will increase patient satisfaction with your hospital. Ask for and listen to patient reviews regularly. Make sure these reviews are public and this will help ensure that any changes made are recognised. Better articulate why you are changing a service, e.g. you are not shutting a local A/E to save money but to save lives! Specialist centres have been shown to have better patient outcomes than smaller, less specialised centres. The London stroke service reforms are an excellent example of this principle. Realise that a budget is a constraint, not an aim! Create a dialogue with doctors about which targets are important and why they are important. If doctors don’t agree with the targets then they will not try to improve the measures. For example, the A/E 4 hour waiting time target annoys a lot of healthcare professionals, who see it as a criticism of their work. However, this target is in fact not a measure of A/E efficiency but actually a measure of FLOW through the entire hospital. If the 4h target is missed then there is a problem within the hospital system as a whole and the doctors needed to be aware that their service is reaching capacity and that this may affect their practice. They should also consider why the 4h target was missed and what can they do to increase the patient flow through the hospital – are they needed in an understaffed department? The essence of this part of the lecture can be summarised by saying that “poor hospital performance has consequences for that hospital and its staff, these consequences affect clinical care and therefore, healthcare professionals need to care about the bigger picture otherwise it will affect frontline care”. The next part of the talk went on to outline some of the recent problems that Dr Newbold has been made aware of and how this affects his hospitals performance. 35% of patients who present to the A/E department have at least 1 chronic condition. 12% of patients are re-admitted within 30 days. Did they receive suboptimal care the first time? Patients who are re-admitted have a far higher mortality rate than other patients. Once, a patient has been in hospital for longer than 5 days their mortality rate begins to rise drastically. Being in a hospital is bad for your health and patients are often not discharged as soon as they should be. A hospital of 1500 people needs to discharge over 200 patients a day just to maintain its flow of patients. If this discharge rate decreases then the pressure on the system increases and beds are no longer available, which starts to decrease the services a hospital can provide, such as elective operations. Hospitals tend to be managed on 4 layers of alert. When the hospital is on top alert i.e. the most under pressure, mortality rates can be up to 8% higher than when the hospital is at its least pressured. By not discharging patients promptly, doctors are increasing the pressure on the system as a whole with awful unintended consequences for the patients. By admitting patients to the wards, who do not necessarily require in-patient care, doctors are also increasing the pressure on the system. Bed blocking has consequences for the patients, not just the budgets. The list above demonstrates how unintended consequences of frontline staff decisions affect patient outcomes. That is why it is critical that frontline staff are involved with helping to improve some of these problems. Does that patient really need to be admitted to an already full hospital? Does that patient really need to stay on the ward until Friday? Did that man with an exacerbation of asthma get the best acute treatment and has a plan been made for his long term management that will decrease the chance of him re-admitting? Healthcare staff can help by adjusting their practice to the situation and by helping to change the systems overall, so that the above consequences are less likely to occur. This part of the lecture was really quite sobering. It spelled out some hard facts about how such a complex system as a hospital operates. But more importantly it helped clarify just what needs to be done in the future to make hospital care the best it can be. Dr Newbold quoted the RCP report “Hospitals are not the problem, they have a problem” to highlight his believe that in the future the health service needs to change to be less focussed on acute crises and more focussed on exacerbation prevention. Hospitals should be a last resort, not a first choice. Hospitals themselves need to change how they deliver care. NHS staff need to explore ways of providing their services in an ambulatory fashion, so that patients don’t need to stay on the wards for any pre-longed period of time but come and go as quickly as possible. This will involve a major shake up in how hospital trusts fund care. They will need to increase their funding for the provision of more services at home. They need to get their employs out of the hospital and into the community. They need to work more closely with GP’s and with local social services. As the previous Chief Medical Officer said “Good Health is about team work”. Only when GP’s, community staff, hospital staff and social services work as a team will patient care really improve. At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite. Email us at med.leadership.soc.uob@gmail.com Follow us on Twitter @UoBMedLeaders Find us on Facebook @ https://www.facebook.com/groups/676838225676202/ Come along to our up coming events… Wednesday 22nd January 2014 LT3 Medical School, 6pm ‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’ By Prof Jon Glasby, Director of the Health Services Management Centre , UoB Thursday 20th February LT3 Medical School, 6pm ‘Reforming the West Midlands Major Trauma Care” By Sir Prof Keith Porter, Professor of Traumatology, UHB Saturday 8th March WF15 Medical School, 1pm “Applying the Theory of Constraints to Healthcare” By Mr A Dinham and J Nieboer ,QFI Consulting  
jacob matthews
almost 8 years ago
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2
121

Extolling the benefits of learning plans

“You’re a boring whore! Fix it.” The barked criticism came like a slap in the face. The director of Les Miserables was right, though. I was a boring whore. Actors need to immerse themselves in their roles, shed inhibitions and squelch embarrassment. I was not managing to do this while rehearsing the Lovely Ladies prostitute scene. My performance was overly self-conscious and restrained. Three days later I found myself at a medical education conference, attending a session discussing learning plans. A popular tool in adult education generally, and a training requirement for all GP registrars, learning plans are actively disliked by many. Done purposely and thoughtfully, they can be of great benefit; completed hastily or reluctantly because they are compulsory, they are next to useless. I have to confess that, as a registrar, my own learning plans were dashed off with little thought, submitted and then promptly forgotten. I’d never thought this technique would work for me. At the conference, the attending educators were instructed to each write a learning plan that addressed an aspect of their non-medical lives. We were asked to choose something that we genuinely wanted to improve. I instantly knew what I’d write about, and completed the task with seriousness and sincerity. The facilitator randomly picked a few participants to read out their learning plans. The topics were predictable: “I want to exercise each morning”, “I want to get at least seven hours of sleep a night” and the like. Yes, you can see where this is leading ... I should have anticipated being called upon, but when the “We have time for one more, how about you?” came, along with direct eye contact and a kindly smile, I momentarily panicked. Surveying the room of mostly middle-aged, male faces, many of whom I didn’t know, I considered making something up on the spot. Instead, I stood up, took a deep breath and read out: “I want to be a more exciting whore.” I then outlined my proposed methods for achieving this objective and how I intended to measure my progress. Without explanation, I then sat down. Silence. Not a sound. Most eyes were glued to me, the others looking anywhere but. The atmosphere was thick with shock, amusement, confusion, suspense and fascination. I didn’t leave them hanging for too long. After my disclosure as to why I chose the topic and the context in which I was “whoring”, there were audible sighs of relief and a sprinkling of laughter throughout the room. It was memorable for those present. Four years later, I still get the occasional question about my “whoring” when I run into certain educators at conferences. I am pleased to report that my learning plan well and truly achieved its aim. I enacted my plan exactly as written and practised diligently. I knew I had been successful when the director instructed me to “Tone it down a bit. This is a family show, you know!” I now feel a lot more comfortable extolling the benefits of learning plans to unconvinced registrars. I tell them: “I used to think that I wasn’t a learning plan-type person either but I’ve discovered that if you choose a relevant and important objective and spend time and effort working out how to achieve it, the technique can really work.” I tend to leave out: “It didn’t do much for my medicine, but it turned me into a fabulous whore.” This blog post has been adapted from a column first published in Australian Doctor. Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/  
Dr Genevieve Yates
over 7 years ago
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2
26

Significant Number Of Wrong-patient Errors In Radiology Reports | 2 Minute Medicine

1. In a retrospective review of over 1.7 million imaging examinations and interpretations, the estimated incidence of near miss imaging and interpretation  
2minutemedicine.com
over 6 years ago
4
1
44

The 'Wisdom' Behind Wisdom Teeth Extractions

Wisdom teeth, whether impacted or not, are frequent causes of patholog and recommendations for early removal has been well documented in th literature and again most recently by a special task force from AAOMS What is most alarming is that problems occur even in patients with n symptoms or with non-impacted wisdom teeth. This podcast reviews th report by AAOMS task force and other key information to help patient and dentists make better decisions.  
H. Ryan Kazemi, Dmd
about 11 years ago
6
1
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Radiation Injury / Nuclear MCI

The US government last week released a report that the threat of a nuclear device used in an act of terrorism is high in the next couple of years. In this episode we discuss the some concepts of the medical care required to those exposed to radiation as well as blast injuries. I hope this is information that none of you will ever need.  
Jeffrey S. Guy, MD, FACS
about 11 years ago
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51

A Case Report: X-linked Dominant Protoporphyria

This narrated case report illustrates this newly discovered porphyria and also provides some background medical education to the porphyrias as a whole.  
Matthew Seager
over 9 years ago