Brit J Hosp Med
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Knowledge of the aetiologies of large bowel perforation are fundamental to its management. Stercoral perforation is a rare cause associated with high mortality. Owing to the paucity of coverage of this condition in the literature, this review raises awareness of stercoral perforation among clinicians. ⋯ The median age of patients with stercoral perforation has decreased from that found in previous studies and the mortality rate has improved. Chronic opioid users have also emerged as an important cohort. Early recognition, diligent decision making and focused perioperative care form the backbone of the definitive management of stercoral perforation.
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Incontinence is a problem that can affect individuals of all ages. However, it is more frequently seen in older adults. It is a common geriatric syndrome, and its investigation should form part of a comprehensive geriatric assessment. ⋯ The treatment for incontinence can be split into non-surgical and surgical management. Simple conservative measures, such as education around fluid intake, weight loss, managing constipation and pelvic floor exercises, can make a huge and positive impact on managing incontinence. If these are not effective, pharmaceutical therapies and surgical management can be considered, but there needs to be a careful consideration of the risk vs benefit in frail older adults.
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Spinal cord stimulation is the main neuromodulation therapy for certain chronic neuropathic pain conditions. This article describes neuromodulation and the process of spinal cord stimulation therapy. It also clarifies the suitability of a patient for referral and consideration for spinal cord stimulation.
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This article discusses the joint guidance from the Faculty of Intensive Care Medicine and Centre for Perioperative Care, which provides recommendations for establishing and delivering enhanced perioperative care services.