Brit J Hosp Med
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Management of cutaneous T-cell lymphoma should provide a holistic approach to a patient's wellbeing. Treatments depend on the stage of lymphoma. Patients with the early stages tend to have a near-normal life expectancy. ⋯ Three drugs received European Medicines Agency approval in 2017 and 2018 (chlormethine gel, brentuximab and mogamulizumab) but there still remains an unmet need for more improved treatments or combinations. Most treatments only result in a partial response and there is no cure for early-stage disease; as such, patients live for a long time with their disease. In the advanced stages if a good response is achieved eligible patients will be considered for an allogeneic haematopoietic stem cell transplant.
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Major abdominal surgery is associated with significant morbidity, not least the development of acute kidney injury. As a common perioperative complication, acute kidney injury is associated with increased length of stay, increased risk of perioperative infection and the potential development of chronic kidney disease. Moreover, the development of acute kidney injury is independently associated with an increased risk of death. ⋯ Currently, acute kidney injury is defined by changes in serum creatinine level and urine output criteria, which although robust in heterogenous populations, may not perform as accurately in the perioperative period. This article discusses these issues including the potential role of novel biomarkers for early detection of perioperative acute kidney injury, as well as the use of predictive modelling. Treatment is mainly supportive but evidence suggests that more targeted therapy may lead to improved outcomes.
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Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or 'being a doctor'. ⋯ Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.
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Antibiotics are one of the most widely used classes of drugs within hospitals in the UK. They have a wide range of uses within all surgical specialties, both as preoperative prophylaxis and for treatment of acute surgical conditions. ⋯ With the COVID-19 pandemic increasing concerns about antimicrobial resistance, there is an ever-increasing need for action. This article examines the particular challenges of antibiotic stewardship in surgical departments within the UK, and outlines possible solutions for improving adherence and reducing the risk of antimicrobial resistance in the future.