Brit J Hosp Med
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The COVID-19 pandemic has necessitated unprecedented changes to the functioning of hospitals across the world. This article evaluates the acute impact of COVID-19 on the provision of symptomatic breast services in the UK and explores suggestions for more sustainable functioning of services in the post-COVID-19 era.
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Diabetes mellitus is a growing epidemic and places a great burden on healthcare services in the UK. Trauma and orthopaedic surgeons find themselves dealing with patients with diabetes on an increasingly regular basis. Any level of surgical trauma can lead to a physiological stress response involving the hypothalamic-pituitary-adrenal axis. ⋯ Non-union of fractures is more common in patients with diabetes, as are deep-seated postoperative infections. National guidelines from the Joint British Diabetes Societies for Inpatient Care advise how to manage patients with diabetes in the perioperative period. Trauma and orthopaedic surgeons must be aware of these increased risks of operating and ensure that patients are involved in surgical decision making.
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Urological trauma is frequently encountered in patients with high energy pelvic fractures and can have debilitating long-term sequelae for patients without appropriate multidisciplinary management. Anterior pelvic ring disruption causes a high incidence of bladder rupture and urethral injuries, and initial assessment requires urological tract imaging and emergent bladder drainage before subsequent surgical repair. ⋯ Optimisation of patient outcomes relies heavily on collaborative management between orthopaedic and urological specialists and requires an appreciation of the anatomical intricacies of the pelvis. This article provides an overview of the British Orthopaedic Association Standards for Trauma and Orthopaedics management of urological trauma in the context of pelvic fractures.
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Many doctors take time out of clinical practice, and then have decreased confidence and poor performance ratings on their return. Simulation training provides a safe and effective learning platform for healthcare professionals to become immersed in realistic scenarios that provide an opportunity to develop technical and non-technical skills. ⋯ Quantitative and qualitative analysis showed a significant pre/post-course increase in candidates' self-reported confidence in returning to practice along with learning in non-technical skills. The carefully designed standardised format may facilitate wider expansion of such training.
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Blood tests to assess the endocrine system are commonly performed in patients admitted to hospital. This may be because an endocrinopathy is thought to be aetiological in the presenting disease or suspected as an incidental occurrence by the clinician. Many patients, in addition to the pathology leading to admission, frequently have one or more comorbidities, a change in nutritional status and polypharmacy. ⋯ All of these are likely to impact on one or more endocrine axes, although often only transiently. Endocrine evaluation in the vast majority of cases can be safely deferred to the outpatient setting. This article considers the most common endocrine anomalies discovered in hospital, the confounders, and provides guidance on how to investigate these further.