Brit J Hosp Med
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Anaemia is common before major surgery and increases complications. A new guideline aims to help with early diagnosis of the type and cause of anaemia and initiate effective treatment. The guideline includes clear education for all staff and patients about the biology of iron homeostasis and patient blood management.
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Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these should be documented as appropriate. ⋯ The goal of treatment is to reduce the risk of soft tissue and neurovascular compromise and achieve a supple, painless foot. This article highlights the importance of early identification of this injury and institution of appropriate management according to the latest evidence, to reduce the risk of complications and lead to the best outcomes.
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An increasing body of evidence suggests that fatigue among healthcare staff is widespread, owing to a combination of high work intensity, long daytime hours and night-shift working. This has been linked to poorer outcomes for patients and longer inpatient stays, and to increased risks of work-related accidents, errors and injuries for practitioners. ⋯ This review explains the basic physiology behind fatigue and outlines its impacts on healthcare practitioners' clinical practice and wellbeing. It proposes methods to minimise these effects for individuals, organisations and the wider UK health service.
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A case concerning the management of a child with meningitis in a hospital paediatrics department provided a judgement that has significant potential implications for medical practice. The case establishes that the examination findings of a previous clinician must be taken into account when investigating and treating patients. This case is of medicolegal relevance to clinicians practising in tertiary centres and who receive patients from other hospitals. This article highlights the medicolegal implications of this case, using an example of cauda equina syndrome for neurosurgeons, a condition that can have fluctuating symptomatology and that already has a high burden of litigation.