Brit J Hosp Med
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Editorial Review
Making the cut? Reviewing the quality of surgical care in adults with Crohn's disease.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reviewed the quality of care provided to adult patients undergoing surgery for Crohn's disease. The study reviewed elective, and emergency surgical pathways and the report highlighted clinical and organisational changes that should be made to improve patient care and outcomes.
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A 37-year-old woman presented with nausea, vomiting and headache. She was found to be profoundly hyponatraemic with a sodium of 121 mmol/L, which deteriorated following a fluid challenge. ⋯ After 3 days of fluid restriction and steroid replacement, her sodium returned to normal (139 mmol/L). This article reviews the possible harmful effects of over-the-counter herbal remedies and highlights the importance of considering a wide differential diagnosis in patients presenting with non-specific symptoms.
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Editorial Review
Learning from the multidisciplinary team: advancing patient care through collaboration.
Training for doctors, and other healthcare workers, has traditionally focussed on developing the knowledge and technical skills relevant to individual specialties. There has been an assumption that once trained in this way, we will be able to work easily and effectively in teams with other professionals. ⋯ Healthcare staff who are already qualified have not had the benefit of being taught the particular skills needed to work well as part of diverse teams, nor given the skills to identify and overcome barriers to effective teamwork. We all need to develop these skills to help our patients get the best care from the teams looking after them.
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There are many studies on central catheter related thrombosis (CCRT), however, there are significantly fewer studies focusing on the incidence and evolution of CCRT in the adult critical care population. This article reviews data collected from observational studies that have performed bedside duplex ultrasound for surveillance of CCRT and discuss if we should routinely screen for CCRT. ⋯ Nearly all CCRT are designated as asymptomatic (no associated pulmonary embolism (PE) or deep vein thrombosis (DVT)) and no significant changes in mortality rates amongst patients that develop CCRT were reported. Based on the evidence reviewed, we do not recommend screening routinely for CCRT in the adult critical care population.