Brit J Hosp Med
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The demand for total shoulder arthroplasty has grown over the years and is set to continue in a similar trend because of the ageing population. Following a global reduction in elective orthopaedic treatment and an exponential rise in surgical waiting times, innovative strategies are desperately needed to mitigate against the harmful effects of delaying vital operations on both patients and the wider society. ⋯ Rigorous patient selection and a multidisciplinary team approach are paramount when adopting a day case service to deliver joint replacement surgery. This review outlines the principles of day case total shoulder arthroplasty and highlights key considerations when transitioning to this approach.
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Intraoperative bleeding can be difficult to manage and is associated with worse patient outcomes. Good intraoperative haemostasis by the surgeon is a key factor in ensuring a bloodless field and reducing intraoperative blood loss. ⋯ The decision of which to use will depend on patient and procedural factors as well as the surgeon's preference. This article reviews techniques commonly used in surgical practice to maintain intraoperative haemostasis.
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Failure to recognise the deteriorating patient can cause severe harm and is related to preventable death. Human factors are often identified as contributing factors. Simulation-based education is used to develop clinicians' human factors skills. ⋯ The evidence demonstrating the impact of simulation-based education on patient outcomes was equivocal. The quality of the evidence was low grade regarding the efficacy of simulation-based education on human factors. Further research is required to confirm the efficacy of simulation-based education for human factors and patient outcomes.
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A radical overhaul of the regulatory regime for health professionals is both necessary and long overdue, so it is important to seize this chance to get it right and get it done.