Brit J Hosp Med
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The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernisation of consenting practice. Failure to demonstrate informed consent is a common source of litigation. This quality improvement project aimed to provide pragmatic guidance for surgeons on consent and to improve the patient experience during decision making. ⋯ Highlighting poor documentation habits and refining departmental education can lead to improvements in practice. The use of consenting clinics should be considered and clinicians should individually reflect on how to address their own shortcomings. Other units should strongly consider a similar audit. This article provides stepwise advice to improve consent and specifics from which to audit.
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In the absence of separate guidelines for critically unwell ventilated patients in the intensive care unit who are undergoing surgery, questions arise about whether patients in intensive care should be starved preoperatively, despite already having a protected airway.
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In view of the high morbidity and mortality associated with COVID-19, early and honest conversations with patients about goals of care are vital. Advance care planning in its traditional manner may be difficult to achieve given the unpredictability of the disease trajectory. Despite this, it is crucial that patients' care wishes are explored as this will help prevent inappropriate admissions to hospital and to critical care, improve symptom control and advocate for patient choice. ⋯ Using a framework such as the 'SPIKES' mnemonic can help to structure this conversation. Verbally conveying empathy will be key, particularly when wearing personal protective equipment or speaking to relatives over the phone. It is also important to make time to recognise your own emotions during and/or after these conversations.
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Predicting outcomes for surgical patients accurately can be challenging preoperatively. Fortunately, there is an array of evidence-based scoring systems which can guide perioperative decision making and discussions of risk with patients.
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Peripatetic teaching originated in the Aristotelian school of ancient Greece and refers to the action of walking, discussion and deep learning. A pilot study was carried out to evaluate the educational impact of peripatetic teaching in clinical medical education. There has been no previous evaluation of this form of teaching within medical education. ⋯ This article identifies educational and health benefits to peripatetic teaching. The authors present a simple framework to structure each teaching session using the mnemonic FIRM - Feedback, dIscussion, Reflection and Mentorship. From this pilot study, the authors conclude that there are perceived benefits for teacher and learner from this teaching method.