Brit J Hosp Med
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Recent years have seen major advances in our understanding of primary biliary cholangitis, with the condition now renamed to reflect the majority of patients who do not have cirrhosis. Data from large multicentre studies have greatly increased our knowledge of the natural history of primary biliary cholangitis, making the identification of higher risk patients clearer and facilitating the development of new medications. Recent guidelines have emphasised the importance of risk stratification, targeted treatment of symptoms and early prioritisation for second line therapies. The review summarises recent major developments in our understanding of primary biliary cholangitis and its management.
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An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
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Rhinitis and rhinosinusitis are common conditions which have a significant burden on healthcare services and can lead to reduced productivity in patients across the entire age spectrum. Three disease-specific quality of life tools were analysed in hospital and community settings to explore prevalence, disease characteristics and financial costs to sufferers, and to compare these aspects between cohorts (young children, young adult and adults). ⋯ One of the top three symptoms in children aged 5-10 years was cough, which is a much less common symptom in adults. These validated, disease-specific, quality of life questionnaires provide a fuller illustration of the patient experience, allowing comprehensive comparative analysis across the ages.
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NHS England is planning to abolish the long-standing 4-hour target for waits in emergency departments. The target has been criticised as an arbitrary management target that is unrelated to clinical outcomes, but waits much longer than 4 hours in the emergency department cause a notable increase in mortality for admitted patients, suggesting that the 4-hour target is clinically important and should not be abolished.