Brit J Hosp Med
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Review
Life-threatening and terminal illness: considerations for hospitalised Orthodox Jewish patients.
For Orthodox Jewish patients, palliative care in general and withholding and withdrawing treatment in particular pose potential conflicts with some aspects of current religious practice. This article gives an introduction to the relevant cultural context and summarises the relevant principles of Jewish law to help clinicians provide appropriate care for their Jewish patients.
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Human factors and ergonomics in healthcare is an important discipline that considers both the physical and mental characteristics of healthcare workers, as well as the complex interactions within which organisations exist.
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This article is based on the Association for the Study of Medical Education Gold Medal Plenary for 2022, given by the first author. It outlines different ways in which medical training can be approached, based on his career and his work with colleagues. Among the attributes that it would be desirable to promote in future doctors are conscientiousness, competence and care for patients as individuals. ⋯ A 'conscientiousness index' calculated on this basis is a statistically significant predictor of later events such as performance in exams, the prescribing safety assessment, and the UK situational judgement test in subsequent years, and also in postgraduate assessments such as Royal college exams and the annual reviews of competence progression. The second proposes that competence in tasks undertaken by junior doctors is better achieved by teaching on medical imaging, clinical skills and living anatomy than by cadaveric dissection. The final section argues that the incorporation of arts and humanities teaching into medical education is likely to lead to better understanding of the patient perspective in later practice.
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Musculoskeletal infection in children is challenging to treat, and includes septic arthritis, deep tissue infection, osteomyelitis, discitis and pyomyositis. Delays to diagnosis and management, and under-treatment can be life-threatening and result in chronic disability. ⋯ Orthopaedic and paediatric services are likely to encounter cases of acute musculoskeletal infection in children and thus an awareness and thorough understanding of the British Orthopaedic Association Standards for Trauma guidelines is essential. This article reviews these guidelines and associated published evidence for the management of children with acute musculoskeletal infection.
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Key factors for successful total knee arthroplasty include accurate implant positioning with precise tibial and femoral resection, combined with appropriate soft tissue balancing to achieve the desired alignment. Robotic-assisted total knee arthroplasty allows surgeons to execute pre-planned strategies with precision, with growing evidence suggesting that robotic-assisted-total knee arthroplasty reduces radiological outliers. ⋯ While fully autonomous systems showed initial promise, semi-autonomous systems are gaining popularity with encouraging early outcomes suggesting improved radiological and clinical outcomes, although concerns remain regarding a significant learning curve, installation costs, radiation exposure and cost associated with preoperative imaging. The future of total knee arthroplasty seems certain to involve robotic technology, although to what degree and in what capacity will depend on further high-quality studies assessing long-term outcomes, complications, survivorship and cost-benefit analyses.