Brit J Hosp Med
-
Type 1 diabetes in pregnancy is associated with an increased risk of complications for both mother and fetus. However, managing glycaemia during pregnancy to reduce these risks is challenging, owing to changes in insulin resistance with advancing gestation, as well as increased daily variation in insulin pharmacokinetics. ⋯ While these can be empowering for people with type 1 diabetes, careful consideration is required in relation to how and when these can be continued safely in the inpatient setting (including acute antenatal admissions, labour and delivery) and when extra support is required from adequately trained healthcare professionals. This article describes current forms of diabetes technologies used and the latest national guidance relating to the care of type 1 diabetes in pregnancy.
-
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.
-
The number of cardiac devices implanted increases year on year, as does the complexity of the patients being managed. A large proportion of this patient group have an indication for anticoagulation, and this raises challenges around the perioperative management of these agents. ⋯ The implemented changes have shown an overall improvement in junior doctor feedback and also clinical documentation in the electronic patient records.
-
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.