Brit J Hosp Med
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National guidance for cancer multidisciplinary teams recommends streamlining cases according to clinical complexity and guidelines. This article explores how the existing knowledge base and resources, accumulated since the introduction of multidisciplinary teams, can help to improve their effectiveness.
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Clinical reasoning is an essential part of medical practice and therefore should be an important part of clinical teaching. However, it has been and is still a challenge for clinical teachers to support learners in the development of their clinical reasoning skills. As learners progress in clerkship, so do their learning needs. ⋯ The article focuses on three tools that were developed by faculty at the University of Sherbrooke Faculty of Medicine and Health Sciences: the iSNAPPS-OMP Technique, the Anticipatory Supervision Technique and the Clinical Sudoku or table of discriminating clues. This article uses the term 'tools' as a generic expression to signify 'items in a toolbox'. It includes all kinds of resources (techniques, strategies, models) that were gathered to help clinical teachers with the teaching of clinical reasoning.
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Peripheral artery disease of the lower limbs is a chronically progressive disorder characterised by the presence of occlusive lesions in the medium and large arteries that result in symptoms secondary to insufficient blood flow to the lower extremities. It is both a manifestation of systemic atherosclerosis and a marker of increased cardiovascular morbidity and mortality. Because of its highly heterogenous clinical picture, a detailed history and physical assessment, a high degree of suspicion for peripheral artery disease and the use of the ankle-brachial pressure index is essential to identify patients with peripheral artery disease. This will allow early administration of basic pharmacotherapy and lifestyle changes to reduce cardiovascular events, minimise claudication symptoms and enable optimal revascularisation to prevent loss of limb function.
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Multimodality perioperative interventions could accelerate patient recovery and improve cost-effectiveness. An evidence review found an association between enhanced recovery after surgery and decreased length of stay, while complications and recovery time were unchanged or reduced. More specialties should develop and implement enhanced recovery after surgery pathways.
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Diaphragm disease of the small bowel has been described in the literature over the last three decades. The pathognomonic characteristic of multiple circumferential stenosis is noted on gross examination of the bowel. It is a severe form of non-steroidal anti-inflammatory drug-induced enteropathy, often presenting as acute small bowel obstruction. A systematic review was performed to identify risk factors and patient outcomes in histologically-proven diaphragm disease of the small intestine in patients undergoing emergency operation for small bowel obstruction. ⋯ This is a rare disease, difficult to diagnose and often confirmed by the intra-operative macroscopic appearance of circumferential stenosis of the bowel. Risk factors for developing small bowel diaphragm disease include long-term use of non-steroidal anti-inflammatory drugs, and female gender. Patients with this disease are at increased risk of developing acute small bowel obstruction, so early identification is important.