Brit J Hosp Med
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The PARTNER 3 and Evolut LRT trials have provided the evidence base for transcatheter aortic valve implantation in low-risk patients. However, there are still issues with durability, long-term follow up and complications before their widespread use can be considered appropriate in this group.
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Pregnancy is a hypercoaguable state. As part of the multidisciplinary team on labour ward, the anaesthetist plays a role particularly in advising the women and the obstetric team regarding the timing and even choice of regional analgesia given the potential risk of complications, as this may be affected by the anticoagulation treatment pregnant women may be on. ⋯ Although a rare presentation, management of women with mechanical prosthetic heart valves who are pregnant requires detailed and highly specialised care in tertiary care centres with a well-developed multidisciplinary team and pathway. Despite their rare presentation, it is important to understand the intricate and complex management that these women require as they have a high morbidity and mortality rate.
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The European Medicines Agency's Pharmacovigilance Risk Assessment Committee has issued statements regarding limiting the use of high-dose oestradiol creams by women experiencing the genitourinary syndrome of menopause, and such statements carry much medicolegal weight. Although a low dose is most often used, some clinicians opt to use higher dose creams with close monitoring of the patient. The committee should publish the evidence behind these statements or amend its official position.
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Globus is the sensation of a foreign body in the throat. Investigation and management of patients with globus is widely variable. ⋯ History taking is key and can help to identify possible causative pathology, directing further investigations and management if necessary. Treatment of globus mainly centres on patient reassurance and counselling, and may include reflux management, neuromodulation, or speech therapy in selected cases, and treatment of any identified cause.