Brit J Hosp Med
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Paget's disease of the breast typically affects postmenopausal women and is associated with an underlying malignancy. Skin changes are a common presenting symptom, as well as a lump, nipple discharge, pain and changes to the nipple shape. Imaging options include ultrasound for women under the age of 35 years or mammogram and ultrasound for women over the age of 40 years. ⋯ Management options are typically surgical and include breast-conserving surgery or mastectomy in addition to oncoplastic techniques. Sentinel lymph node biopsy is performed in all patients undergoing surgery. Adjuvant chemotherapy, radiotherapy or endocrine therapy can be used to treat concomitant invasive disease or ductal carcinoma in situ.
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Since the COVID-19 pandemic began, training and education have been significantly disrupted, causing an incalculable effect on trainees. However, the consultant workforce is crucial to the success of training recovery. The motivation of the consultant workforce to assist in training recovery, in a context of significant workload and increasing pressures on resources, is currently unknown. ⋯ These findings demonstrate a worrying trend that is likely to be replicated nationwide, which highlights the need to support consultants to avoid further disruption to training recovery.
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Patients with low platelet counts are a concern to the obstetric anaesthetist as, although rare, there is a risk of a spinal epidural haematoma following central neuraxial blockade. Although conventional plasma-based tests are frequently used to guide central neuraxial blockade in patients with thrombocytopenia, interest in the use of viscoelastic haemostatic assays is increasing.
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Unintended pregnancies are linked to multiple poor maternal and child outcomes. In Britain one in six pregnancies is unplanned (Wellings et al, 2013). ⋯ This article outlines the three options for emergency contraception and discusses simple options for starting an ongoing, regular method of contraception in hospital. The authors recommend signposting patients to online information sources, sexual health centres or their GP for further management.