The air of spring this year is been pushed back and back, with storms, rain and snow predicted for April/May. This seems to be the mirror image of the Brexit process, pushed back and delayed and delayed. At the time of writing the plan was to exit 20th June, although the EU may well offer a 12 month extension as most EU Heads of State are getting mighty peeved off, understandably so, of having to reconvene in Brussels every week or two to consider yet another extension/proposal from the UK.

In amongst all this you may well have missed the decision by our government that EU professionals e.g. doctors and nurses, will continue to have their qualifications recognised in the UK and that they can continue to work here too, without going through the planned registration process. This is another U turn as the realities of Brexit are brought into sharp relief of reality.

It was with astonishment that I learnt that Mr Peter Oborne, hardline Brexiteer and political commentator and journalist of Daily Mail fame, has had the epiphany and more so the bravery, to admit that Brexit has been found to be a calamity which he is no longer able to support. Hopefully, our political classes will also bite their lips and admit as such, although party politics and self aggrandisement may prevent such an occurrence. My bets are on a second referendum and revoking Article 50! It is likely that by the time this issue hits your doormat we may have no May, be involved in MEP elections and enjoying sunshine with a 12 months extension on Brexit, to come up with a credible and acceptable strategy. In statistics, time provides a regression to the mean, and I suspect the polarized right and left will end up at the mean i.e. no Brexit.

This issue has an excellent array of reviews. Lipids are the rage with their intimate relationship to cardiac and diabetic disorders. Jack and Keely (p.142) have provided a succinct and easy overview of importance of identifying and managing dyslipidaemias. We are what we eat. Our TV screens and newspapers and other media is constantly bombarding the public with nutritional advice, a lot of it contradictory. Munaf (p.152) has distilled the evidence and provides the information that you can use in your personal life and also pass onto patients.

Old diseases never really die! Measles is returning and Tuberculosis has never really been conquered, just contained. The barriers to containment are constantly under threat and primary care is a key element in that resistance. Manalan and Kon (p.159) have provided a useful update, highlighting some of the more current issues in tackling this scourge. Kaski (p.175) has given us a nice overview of tremor and the key physical examination to try and come to a diagnosis.

Morris, Poole and Fraser (p.167) have highlighted the issue of burden of treatment on the NHS and GPs in particular. They provide some insights on the approach to minimize duplication and reformat the delivery of healthcare to reduce such burden. All doctors should be interested in health economics and this article provides understanding on what issues need addressing.

Finally, the early recognition of sepsis has very much been of paramount importance as early diagnosis and management can avoid the terrible morbidity and potential mortality associated with any delay. This is a key problem in adults but even more so in children, who many times are not able to provide a history. Baily and Chodari (p. 182) have produced an elegant paper, which should enable the clinician to more readily pick up
sepsis in an under 5 year old.

Please participate in the CPD elements and use it as part of your appraisal and re-accreditation. I am very happy to receive correspondence and ideas to make this journal address the needs of its readership.


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