Brit J Hosp Med
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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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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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Several psychological factors, including anxiety and depression, are associated with poor surgical outcomes, likely as a result of chronic dysfunction of the hypothalamic-pituitary-adrenal axis. However, despite some encouraging results, a lack of high-quality studies means that there is limited evidence to support the use of psychological interventions to improve surgical outcomes.
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For every medical trainee, the Membership of the Royal College of Physicians' Practical Assessment of Clinical Examination Skills (PACES) exam is one of the most difficult exams they must face in their career. It is designed to assess the clinical knowledge and skills of the trainee doctors who are entering higher specialist training. It sets rigorous standards to ensure the competence of the candidates across a range of skills. This article discusses a systematic approach to a patient with jaundice, which is a commonly encountered station in the exam, so that candidates will become more familiar with common causes and how to differentiate between these, as well as important bedside examination skills.
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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.