Brit J Hosp Med
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Radiological investigations are a powerful tool in the assessment of patients with intracranial vascular anomalies. 'Visual' assessment of neurovascular lesions is central to their diagnosis, monitoring, prognostication and management. Computed tomography and magnetic resonance imaging are the two principal non-invasive imaging modalities used in clinical practice for the assessment of the cerebral vasculature, but these techniques continue to evolve, enabling clinicians to gain greater insights into neurovascular pathology and pathophysiology. This review outlines both established and novel imaging modalities used in modern neurovascular practice and their clinical applications.
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This article gives a general overview of pressure ulcers, with a focus on secondary care. Pressure ulcers are damage to the skin or underlying tissue as a result of pressure, friction or shearing forces. They place a significant physical, psychological and financial burden on patients and healthcare systems which will be explored. This review also covers risk assessment, classification and management of pressure ulcers in the inpatient setting.
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Asthma places a significant burden on acute and non-acute services and is frequently encountered in the emergency department and the medical take. The UK has one of the highest asthma mortality rates in Europe. The National Review of Asthma Deaths has identified multiple factors that have contributed to preventable asthma deaths and solutions to these factors, including a better understanding and implementation of asthma guidelines. ⋯ It highlights key areas of the initial assessment, establishing severity and initiating and escalating treatment. Furthermore, the discharge process from discharge criteria to promoting patient safety, education and ongoing self-management is discussed. This process, in particular education and personalised asthma action plans, can make a significant difference to the patient's outcomes and day-to-day burden of symptoms.
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The interface between the Mental Capacity Act 2005 and the Mental Health Act 1983 can be complex, particularly in patients with co-existing mental and physical illnesses. The management of these patients requires the involvement of patients, relatives and multidisciplinary teams. This article presents four illustrative patient cases, all of whom suffered from co-existing mental and physical illnesses. ⋯ Often, principles from both legal frameworks may be applied by the treatment team. These cases help to highlight the significant overlap between mental and physical health, which often cannot be managed independently. This may call for the need to better integrate the current legal frameworks, and the optimal involvement of specialists across both settings.
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The 1990s saw the implementation of three European directives that aimed to standardise medical device legislation. EU regulations replace and repeal these directives, to improve the safety, effectiveness and traceability of medical devices. This article discusses the implications of the Regulation (EU) 2017/745 (Medical Device Regulation) for hospital doctors who prescribe and manufacture custom-made medical devices.