Brit J Hosp Med
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Maternal collapse is a rare life-threatening event that can occur at any stage of pregnancy or up to 6 weeks postpartum. Prompt identification and timely intervention by a multidisciplinary team that includes an obstetrician, midwifery staff and an obstetric anaesthetist are essential to improve maternal and fetal outcomes. ⋯ During cardiac arrest, the emphasis is on advanced airway management, manual uterine displacement to relieve aortocaval compression and performing a resuscitative hysterotomy (peri-mortem caesarean delivery) swiftly in patients who are more than 20 weeks gestation to improve maternal survival. Annual multidisciplinary simulation training is recommended for all professionals involved in maternity care; this can improve teamwork, communication and emergency preparedness during maternal collapse.
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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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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.
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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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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.