Postgraduate medical journal
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Endoscopic ultrasound (EUS) has become important in a variety of clinical settings. Echoendoscopes may be categorised into radial and linear configurations. Radial devices are used for diagnostic imaging, whereas linear echoendoscopes also facilitate image guided tissue sampling and intervention. ⋯ In patients with contraindications to magnetic resonance imaging, EUS is an alternative for the staging of rectal carcinoma. It is used in the staging of lung cancer, often in combination with endobronchial ultrasound. Finally, EUS is used therapeutically in image guided drainage (such as gastrocystostomy in pancreatic pseudocyst) and coeliac plexus neurolysis in patients with abdominal pain caused by pancreatic cancer or pancreatitis.
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Focused assessment with sonography in trauma (FAST) is a limited ultrasound scan performed in the emergency department to assess patients admitted with blunt abdominal trauma (BAT). It is normally undertaken by emergency physicians in order to identify the presence of free fluid, which may represent haemoperitoneum. This potentially allows prompt referral to further imaging, such as a computed tomography (CT) scan, and/or surgery. ⋯ Since the introduction of FAST, trauma patients are increasingly managed by non-surgical means if haemodynamically stable, and the presence of intraperitoneal fluid does not necessarily influence this decision. Recent developments in multi-detector CT, and in the use of contrast enhanced ultrasound, have broadened the management options for trauma patients, and can support a faster diagnostic pathway than was previously possible. FAST is a limited triage tool, whose actual value in the diagnostic and treatment pathway of patients with BAT remains questionable, and more data are needed to justify its use in the light of these recent developments.
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It has been well established that burnout, defined as emotional exhaustion (EE), de-personalisation (DP), and a 'decreased sense of personal accomplishment (PA) due to work related stress', is prevalent to a great extent among medical residents. This has been implicated in the delivery of suboptimal patient care. Residents in developing countries work under difficult working and social conditions and therefore examining burnout is important when addressing quality of care and working conditions. ⋯ The high burnout level calls for action. This could be addressed by re-examining workload and other working conditions of residents as well as attending to their psychological wellbeing. The limitations of the study are also discussed.
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Despite concern that many nursing home residents who become acutely unwell are admitted to hospital for often futile and distressing treatment, no previous studies analysing survival and readmission rates of this cohort were found in the literature. ⋯ Survival rates in nursing home residents admitted to an acute medical unit are low, and measures are suggested to reduce inappropriate admissions and facilitate improved end of life care.