Brit J Hosp Med
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Epidural analgesia is a key component in the management of inpatient pain relief, particularly in surgical and trauma patients, and those with comorbidities. When used appropriately epidurals can decrease a patient's opiate consumption, as well as reducing the risk of adverse cardiorespiratory outcomes. ⋯ This article demystifies the epidural for hospital clinicians, looking at the anatomy and pharmacology, helping to identify patients who may benefit from epidural analgesia, highlighting some common pitfalls and questions posed by nursing staff, and providing a framework via which junior clinicians can detect, manage and appropriately escalate epidural-related problems and complications. Epidural analgesia is an invasive and high-risk intervention; as such it should always be managed by a multidisciplinary team, including anaesthesia and acute pain services.
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The impact of hospital-acquired pneumonia and the pressure to reduce unnecessary antibiotic prescribing has lead to the publication of prescribing guidelines from the National Institute for Health and Care Excellence. This editorial gives an overview of the guidelines and emphasises the need for more high-quality evidence to inform decision making in this group of patients.
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George Armstrong was probably the first physician to practice exclusively as a paediatrician in this country. He published the first account of the postmortem appearance of congenital pyloric stenosis. This year marks the 300th anniversary of his birth.
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The significance of early diagnosis for melanoma prognosis and survival cannot be understated. The public health benefits of melanoma prevention and detection have driven advances in diagnostics for skin cancer, particularly in the field of artificial intelligence. Evaluating the benefits and limitations of artificial intelligence in dermatology is paramount to its future development and clinical application.