Brit J Hosp Med
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Trauma to the face and neck is a frequent reason for emergency department attendance. Imaging is invaluable in the characterisation of such injuries, enabling delineation of fracture patterns as well as identification of vascular and other soft tissue injuries. It may also be used to prevent long-term mortality and morbidity and provide a roadmap for surgical intervention so that form and function may be restored. ⋯ It discusses appropriate imaging modalities for each trauma category, describes major patterns of craniofacial trauma on cross-sectional imaging and identifies clinically relevant imaging features that should trigger subspecialist review or be of relevance to pre-surgical planning. It starts with the upper third comprising frontal sinus fractures before describing the component fractures of the middle third (including nasal, zygomaticomaxillary and orbital fractures) and then focusing on the lower third (specifically mandibular and dentoalveolar fractures). The article concludes with a review of soft tissue injuries of the neck, particularly penetrating, blunt and laryngeal trauma.
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Reduced glomerular filtration rate and presence of albuminuria are both associated with increased risk of several poor outcomes. People with chronic kidney disease also commonly suffer from lower quality of life than their age-matched peers. The experiences reported by patients with chronic kidney disease include being shocked by the diagnosis, being uncertain about the cause and worrying about progression and future treatment. ⋯ Helping people to live well with a long-term condition like chronic kidney disease should include efforts to reduce the risk of adverse events occurring in the future, and consider what can be done to enhance quality of life now. Clinicians can help by being aware of the patient perspective, communicating clearly and recommending interventions that reduce future risk as well as recognising and treating symptoms. Assessing overall treatment burden is an important component of management and non-pharmacological interventions that may improve mobility, strength and pain should be considered.
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Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid with other physical and mental health problems, yet training on management of people with eating disorders and working knowledge of clinicians working with underweight adolescents is inconsistent. This review of anorexia nervosa in adolescents provides an overview of the presentation, aetiology and treatment of this disorder, with a particular focus on the assessment and management of physical health risks, including refeeding syndrome.
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Nausea and vomiting after surgery is common and can be both unpleasant and lead to an array of other adverse patient effects. Identification of high-risk patients and targeted prophylaxis can reduce its incidence and associated complications.