Brit J Hosp Med
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Upon discovery of a thyroid nodule (or nodules), a patient is usually referred for evaluation by ultrasound, which is typically performed by a trained radiologist or sonographer. More recently, this technology has been used intraoperatively by endocrine surgeons and also by endocrinologists, often in the context of 'one-stop shops' or point of care ultrasound in the outpatient setting. ⋯ This article provides an overview of ultrasound in assessing the thyroid nodule in the context of this classification. This can be used as a guide to interpretation of thyroid ultrasonography for non-radiologists.
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Proximal humeral fractures are common with a bimodal distribution and sex discrepancy, affecting younger men and older women. The presentation of a proximal humeral fracture can vary greatly because of this bimodal distribution and the associated differences in mechanism of injury. Initial management should involve assessment of life- and limb-threatening injuries as outlined by the British Orthopaedic Association Standards for Trauma, with particular attention paid to axillary nerve function and vascular status. ⋯ Head replacement techniques (hemiarthroplasty and reverse shoulder arthroplasty) are indicated when the risk of avascular necrosis is too high or in older patients with osteoporotic bone. In these patients, reverse shoulder arthroplasty is preferred as it achieves better functional results than hemiarthroplasty. Complication rates vary depending on the fracture configuration and the course of management undertaken.
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Ischaemic stroke and transient ischaemic attack are of particular interest to the vascular surgeon as over one-third of all strokes are caused by thromboembolism from a stenotic carotid artery, making carotid artery stenosis the leading cause of stroke. If detected early, stenosis can be managed medically, surgically or endovascularly. ⋯ This article discusses the evidence outlining the epidemiology, measurement and surgical management of carotid artery stenosis that inform national guidelines. Vascular and non-vascular trainees should understand these guidelines because of the potentially debilitating or fatal consequences of untreated carotid stenosis.
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The results of the National Diabetes Inpatient Audit in 2013 showed that the Royal London Hospital had performed worse than the national average in several domains. The aim of this study was to improve inpatient diabetes care at the Royal London Hospital. ⋯ A multi-faceted approach led to significant improvements in patient outcomes and experience, resulting in Royal London Hospital performing well above the national average in the National Diabetes Inpatient Audit in 2016 and 2019. This simple consultant-led multidisciplinary approach could be replicated in other hospitals in UK facing similar challenges.
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One in two people that smoke tobacco will die prematurely and for every person that dies, thirty more will suffer from the serious diseases it causes. Treating this deadly disease lies on the shoulders of every healthcare professional, all of whom have a responsibility to provide highly effective and evidence-based interventions. Failure to treat tobacco dependency falls far below the required standard of care and could be considered negligent.