Brit J Hosp Med
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Optimisation of oxygenation strategies in patients with hypoxaemic respiratory failure is a top priority for acute care physicians, as hypoxaemic respiratory failure is one of the leading causes of admission. Various oxygenation methods range from non-invasive face masks to high flow nasal cannulae, which have advantages and disadvantages for this heterogeneous patient group. ⋯ The oxygenation strategy should be determined on an individualised basis for patients, and with new evidence from the COVID-19 pandemic, providers may now consider placing further emphasis on non-invasive approaches. As non-invasive ventilation continues to be used in increasing frequency, new methods of monitoring patient response, including when to escalate ventilation strategy, will need to be validated.
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Achalasia, characterised by the absence of peristalsis and failure of relaxation of the lower oesophageal sphincter, is an uncommon degenerative condition that results in dysphagia. If left untreated it can lead to aspiration, oesophageal perforation, oesophagitis and malnutrition. ⋯ Although no treatment can reverse the degenerative process, therapeutic strategies including lifestyle modification, medication, endoscopic and operative intervention can help to reduce symptoms. This article reviews the latest methods used to investigate and manage achalasia.
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Since the COVID-19 pandemic began, training and education have been significantly disrupted, causing an incalculable effect on trainees. However, the consultant workforce is crucial to the success of training recovery. The motivation of the consultant workforce to assist in training recovery, in a context of significant workload and increasing pressures on resources, is currently unknown. ⋯ These findings demonstrate a worrying trend that is likely to be replicated nationwide, which highlights the need to support consultants to avoid further disruption to training recovery.
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Unintended pregnancies are linked to multiple poor maternal and child outcomes. In Britain one in six pregnancies is unplanned (Wellings et al, 2013). ⋯ This article outlines the three options for emergency contraception and discusses simple options for starting an ongoing, regular method of contraception in hospital. The authors recommend signposting patients to online information sources, sexual health centres or their GP for further management.