Brit J Hosp Med
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A case concerning the management of a child with meningitis in a hospital paediatrics department provided a judgement that has significant potential implications for medical practice. The case establishes that the examination findings of a previous clinician must be taken into account when investigating and treating patients. This case is of medicolegal relevance to clinicians practising in tertiary centres and who receive patients from other hospitals. This article highlights the medicolegal implications of this case, using an example of cauda equina syndrome for neurosurgeons, a condition that can have fluctuating symptomatology and that already has a high burden of litigation.
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The National Confidential Enquiry into Patient Outcome and Death reviewed the quality of dysphagia care provided to patients with Parkinson's disease admitted to hospital when acutely unwell. It highlights both clinical and organisational changes that should be made to improve patient care and outcomes.
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For every medical trainee, the Membership of the Royal College of Physicians' Practical Assessment of Clinical Examination Skills (PACES) exam is one of the most difficult exams they must face in their career. It is designed to assess the clinical knowledge and skills of the trainee doctors who are entering higher specialist training. It sets rigorous standards to ensure the competence of the candidates across a range of skills. This article discusses a systematic approach to a patient with jaundice, which is a commonly encountered station in the exam, so that candidates will become more familiar with common causes and how to differentiate between these, as well as important bedside examination skills.
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Several psychological factors, including anxiety and depression, are associated with poor surgical outcomes, likely as a result of chronic dysfunction of the hypothalamic-pituitary-adrenal axis. However, despite some encouraging results, a lack of high-quality studies means that there is limited evidence to support the use of psychological interventions to improve surgical outcomes.