The peer-assisted ultrasound course described here enabled the majority of students to feel confident gaining elementary ultrasound views, and performing abdominal aneurysm screening and trauma assessments: techniques that they could hopefully put to use during their placements. The peer-assisted model has an acceptable role in teaching emerging clinical skills to medical students.

The re-attendance of patients to emergency departments is becoming an increasingly common problem and yet there is not much research available on this subject. This report describes an audit carried out in the emergency department of this hospital, specifically looking at the issue of re-attendance and if there is anything that can be done to prevent it. Traditionally, emergency departments in the United Kingdom have been staffed at junior doctor level by senior house officers (SHO); however, with the advent of modernising medical careers in the United Kingdom, departments are being staffed at this level by foundation year 2 doctors (FY2). Whereas SHO range in experience from a year post-qualification to a possible 5-6 years post-qualification, all FY2 doctors have only one year post-qualification clinical experience. In this audit, FY2 doctors, despite seeing fewer patients per head than the middle-grade tier, had a higher level of re-attendance and it is hypothesised whether this is due to the impact of modernising medical careers on their training.

Background/Aims: Hypertension, chronic kidney disease (CKD) and cardiovascular disease (CVD) have reached epidemic proportions globally. Patients with CKD are at increased risk of CVD and yet conventional factors have yet to be linked with the risk associated with patients with CKD. The aim of this research was to establish whether there is a link between insulin resistance (IR) and estimated glomerular filtration rate (eGFR), and assess whether insulin-resistant subjects experience a more rapid deterioration in eGFR. Methods: IR was determined using HOMA-IR (homeostasis model assessment for IR) in normoglycaemic, male subjects with treated hypertension and correlated with clinical variables over a period of 5 years. Results: 106 subjects were assigned to three groups according to insulin sensitivity. Patients with IR had a higher body mass index, fasting glucose, triglyceride and lower HDL cholesterol. Half of the insulin-resistant patients developed an impaired fasting glucose by 1 year and 14% were being treated for type 2 diabetes mellitus by 5 years. Baseline and 5-year data revealed that there was no link between IR and eGFR, which deteriorated equally in all groups. Conclusion: We established that both CKD and IR are common and that the majority of subjects with IR developed impaired fasting glucose or type 2 diabetes mellitus in only 5 years. Although eGFR deteriorated in all groups, no link was found between eGFR and IR.

Heat stroke is a medical emergency that requires immediate attention to prevent multiorgan dysfunction. It is vital that, as emergency physicians, we aim for early diagnosis and aggressive treatment of this condition to prevent the high morbidity and mortality that is associated with it. The case history is presented of a 21-year-old man who presented with exertional heat stroke with a raised troponin I level 24 h after admission which subsequently normalised. To our knowledge, there are no case reports in the literature of a patient with a raised troponin level following exertional heat stroke.

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