Brit J Hosp Med
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The prevalence of paediatric knee injuries is increasing due to higher participation in competitive sports, larger build and more use of imaging in diagnosis. A thorough history of injury (including mechanism and symptoms of pain and instability), together with a comprehensive examination (presence of an effusion, tender areas, range of movement and joint laxity) will dictate the need for radiological investigations. ⋯ Correct identification and management of injuries will help reduce long-term morbidity. The aim of this review is to provide the reader with an understanding of the management of paediatric knee injuries at primary presentation in the community setting or emergency department.
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Postgraduate leadership fellowships are becoming more popular among doctors-in-training. The author completed a one-year leadership fellowship with the Health Education England (HEE), East Midlands. A personal reflective approach was used to present the experiences of the author following the completion of the fellowship programme. ⋯ Personal benefits for the author were seen in the areas of improved leadership skills; completion of a postgraduate academic qualification; improvement of teaching skills; and honing of major trauma clinical skills. Furthermore, the literature review showed that there was high grade evidence from two randomised controlled trials, for the impact of such programmes in obstetrics/gynaecology simulation, and on team leadership for major trauma resuscitation. In addition, three systematic reviews reported positive impacts of such programmes at an individual level for participants' attitudes, knowledge and skills, with minimal evidence for the overall impacts on healthcare institutions.
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We outline the indications and contraindications of carotid endarterectomy (CEA) and appraise four key areas still debated to this day; shunting versus non-shunting, patch angioplasty (PA) versus primary closure (PC) and local anaesthesia (LA) versus general anaesthesia (GA). Importantly, we compare CEA with Best Medical Therapy (BMT), which is an area that is still largely debated, principally because many of the studies conducted to date do not reflect the era of modern BMT practices, and these outcomes are eagerly awaited. Literature searches were conducted using Pubmed with the keywords 'carotid', and 'endarterectomy', which provided a wide variety of journals and articles. ⋯ In carotid stenosis >50% BMT offers limited benefits without accompanying surgical intervention and BMT alone tends to be advantageous primarily for patients with <50% carotid stenosis. Where CEA is appraised in terms of superiority of the procedural components; the literature does not support wildly contrasting outcomes to change majority practice. However, the area of considerable interest is superiority of BMT to surgical intervention in terms of both carotid artery stenting (CAS) and CEA and more studies need to be conducted in this area.
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Palliative care, an integral component of supportive oncology, enhances the quality of life for patients living with cancer. Whilst palliative care has historically been synonymous with the provision of care at the end of life, it is increasingly playing a role earlier in a patient's cancer journey; frequently in conjunction with administration of anticancer treatment. ⋯ This review presents the role of early palliative care within the realm of supportive oncology with respect to the evidence of benefit and ethical, clinical and practical considerations. Relevant papers have been chosen for inclusion on the basis of clinical relevance, timeliness and relevance to cancer patients and clinical teams involved in their care.
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Meta Analysis
The Effect of Probiotics on Obesity with Comorbid Depression: A Systematic Review and Meta-Analysis.
Aims/Background Obesity and depression frequently co-occur, and the relationship between them is bidirectional. Being obese or overweight increases the risk of depression, and conversely, depression increases the risk of obesity or overweight. Emerging clinical research has shown that probiotics may be effective in treating obesity and associated depression. ⋯ Conclusion Overall, probiotics did not improve depressive symptoms in obesity. However, beneficial effects were observed with the Edinburgh Postnatal Depression Scale and short-term use of probiotic. Additional rigorous randomized controlled trials are warranted to elucidate the therapeutic potential of probiotics for obesity-related depression.