Medical leadership - in the scrum or shouting from the sidelines?

As has often been the case in its nearly 70-year history, the NHS finds itself in difficult times with very real clinical and financial sustainability challenges and a need to transform itself. The vision has been laid out in the , but if there was a 'how-to' manual for delivery it could be argued that it isn't always completely clear and some chapters are incomplete. In the context of change in the modern NHS, medical leadership is often spoken about as being key and yet what this means varies between different people and at different times and on a whole spectrum of scale, from small projects to whole health-economy redesign.

Cardiac toxicity screening by echocardiography in healthy volunteers: a study of the effects of diurnal variation and use of a core laboratory on the reproducibility of left ventricular function measurement.

Background: In investigational medicinal products testing centers (IMP), reliable methods for monitoring early signs of cardiotoxicity of a potential new drug in healthy volunteers are essential. This study examines what levels of left ventricular ejection fraction (LVEF) variance can be achieved with two-dimensional echocardiography (2DE) in a core laboratory versus a site laboratory. Diurnal variability of LVEF and diastolic parameters were also reviewed.

Pharmacogenetics in clinical practice: considerations for testing.

Pharmacogenetics is a rapidly evolving field that will undoubtedly lead to the development of pharmacogenetic tests. Such tests will need to be assimilated into healthcare systems, but represent a further call on scarce healthcare resources. Therefore, in order for a pharmacogenetic test to fulfill its potential beyond the laboratory and into the clinical environment, it must prove itself on a wide range of multifaceted criteria.

The quality of information on monitoring for haematological adverse drug reactions.

Aims: To examine the adequacy of instructions to monitor for haematological adverse drug reactions in the Summary of Product Characteristics.

Methods: We searched the United Kingdom eMedicines Compendium to identify instructions to monitor for haematological adverse drug reactions, and selected 84 Summaries of Product Characteristics for nonhaematological drugs, which were then scored independently by five clinicians, using a scale we devised, the Systematic Instructions for Monitoring (SIM) score. A subset of comparable summaries from Australian and United States summaries was also examined.

Drugs and the retina.

The retina is relatively protected from systemic drug administration because of the blood-retinal barrier, a highly selective mechanism adapted to providing a regulated homeostatic environment for this highly specialised tissue. However, a number of drugs have been associated with retinal toxicity. Vigabatrin, as an adjunctive therapy for the management of partial epilepsy, is associated with visual field defects in approximately 40% of patients.