Brit J Hosp Med
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Octreotide is the cornerstone of perioperative management of neuroendocrine tumours, but there is no universal agreement on the optimal regimen. This article discusses the evidence for its use during different parts of the perioperative pathway.
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Feedback from foundation trainees in Blackpool highlighted low levels of confidence with the prospect of surgical on-call shifts. Key areas of concern were assessing and managing the acute surgical patient, identifying which patients need an operation and having the technical skills to proficiently assist in theatre. This lack of confidence prevents trainees engaging in what should be an educational and rewarding rotation. ⋯ All trainees that attended the course displayed a marked improvement. This course is now being incorporated into foundation teaching programmes at a regional level and has scope to be expanded nationally.
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A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
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Stroke services must detect and manage psychological and neuropsychological problems that occur after stroke, such as cognitive and language impairments, post-stroke apathy, post-stroke emotionalism, depression, anxiety, post-traumatic stress disorder, personality changes and suicidality. Stroke neuropsychology plays a key role in the assessment, understanding and management of these consequences of stroke, as well as contributing to complex case management, staff supervision and training. ⋯ To manage the scale of psychological and neuropsychological needs post stroke, clinical guidance recommends the use of a matched care system, in which these needs are triaged and matched with corresponding levels of support. Recent workforce guidelines provide clear professional recommendations for psychological staffing skill mix and threshold requirements for clinical oversight and clinical governance assurances.