Brit J Hosp Med
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Open fractures are complex injuries strongly associated with high-energy trauma. Assessment should include the mechanism and place of injury, timing, associated injuries and comorbidities. The initial management of these fractures, whether in the prehospital setting or emergency department, must include the following in a prompt manner: administration of antibiotics and tetanus prophylaxis, photography, reduction or re-alignment, wound coverage and splintage. ⋯ Operative management can be a one- or two-stage procedure, because definitive internal skeletal fixation should only be attempted if soft tissue coverage can occur during the same operation. Ideally, all open fractures should be closed within 72 hours. This article explores the evidence for current best practice.
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Imaging technology has revolutionised modern medicine. It is difficult to imagine a time when we practiced without it, but have we become too reliant, and should we be aiming for more judicious use of imaging services?
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Most doctors in training will have completed the annual General Medical Council training survey, but what happens to the results and how do they lead to improvement in the quality of training? This article discusses the General Medical Council survey and potential ways in which the assessment of quality in postgraduate medical training could be improved.
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This study aims to identify and analyse the factors that influence or discourage junior doctors in the UK and across the world from wanting to pursue a career in orthopaedics. ⋯ Reducing the cost and length of training, diversification of role models, removal of bias and increasing positive early experiences may help to encourage people of all backgrounds to pursue a career in orthopaedic surgery.
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Gallstone disease is becoming increasingly common in the UK, with one in six people developing gallstones and over 100 000 cholecystectomies being performed annually. The gallbladder stores bile produced by the liver and, in the presence of fat in the stomach, releases bile into the duodenum to promote the emulsification and absorption of fats and fat-soluble vitamins from the small bowel. ⋯ Cholecystectomy provides definitive treatment of symptomatic disease and is usually offered as a laparoscopic, day-case procedure. This article explores the pathogenesis and management of gallstone disease.