Brit J Hosp Med
-
Microbiologists are frequently consulted for guidance on the investigation and management of infection, including antimicrobial prescribing in hospital settings. There is a rising demand for timely microbiology advice in the context of increasing global travel and antibiotic resistance, which give rise to complex cases. However, junior doctors are seldom trained in making effective referrals. ⋯ This benefits patients who are more likely to receive appropriate treatment. This article presents guidance, developed in consultation with specialists, to improve the quality of referrals to microbiologists. This includes the information required for a high-quality referral, and signposts referring clinicians to existing resources which are suitable for simpler cases not requiring specialist input.
-
This article considers the strong public health response to the COVID-19 pandemic, while recognising that the system must be strengthened moving forwards. It provides an overview of the challenges facing public health today including widening social inequalities, increasingly squeezed health and social care budgets, changes to the public health landscape, and recovery from COVID-19.
-
Review
Ethical considerations during a pioneering surgical procedure: porcine cardiac xenotransplantation.
Preclinical advances in life-sustaining porcine cardiac xenotransplantation from donor pigs to baboons have paved the way for the performance of porcine cardiac xenotransplantation in a human. This procedure was performed with emergency use authorisation granted by the United States Food and Drug Administration under the umbrella of investigational new drug use on compassionate grounds. The patient was denied candidacy for durable mechanical circulatory support and heart transplantation as a result of non-adherence to medical advice. ⋯ This article focuses on some of the ethical conflicts encountered in relation to the use of mechanical circulatory support, pretransplant evaluation, shared decision making during informed consent, infectious disease risk, preclinical and clinical testing, and the role of regulatory bodies during performance of the first human porcine cardiac xenotransplantation. An increase in human trials of xenotransplantation procedures is imminent. Potential ethical conflicts associated with xenotransplantation should be addressed appropriately.
-
Documentation is key for communicating between members of the multidisciplinary team, allowing for better care, but documentation for spinal patients in the authors' centre was poor. ⋯ The authors believe that this improvement may avoid adverse effects on patient care, streamline doctors' time and reduce medicolegal consequences.