bluuebunny/crossref_metadata_2025 huggingface dataset:
JAG accreditation of endoscopy services: What do units need to do?
Authors: Johnston Debbie
Published: May 2014

By choosing to participate in the accreditation process of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG), an endoscopy service in the UK asks to be measured against national standards for endoscopy services. These standards reflect what health professionals agree is most conducive to providing quality patient-centred care in organized endoscopy settings. Debbie Johnston outlines the JAG process, describing what endoscopy units need to do to prepare for and achieve accreditation.
Keeping pace with updates
Authors: Elliott Dawn
Published: May 2014

As demands on healthcare increase and patient expectations rise, any new development or change to treatment, diagnostics and patient management is often viewed with a mixture of scepticism, relief and the odd groan as the implications of understanding and financing these new developments is revealed.
Investigating pancreaticobiliary disorders through the use of endoscopic ultrasound
Authors: Leeds John S , Joy Diamond , Nayar Manu K
Published: May 2014

Pancreaticobiliary disorders are common in clinical practice and often require complex investigations before a final diagnosis and management plan is formulated. Many patients will undergo an endoscopic investigation or therapy, both of which can be challenging. Endoscopic ultrasound is increasingly used as one of the modalities for investigating and treating such patients and the indications for interventional endoscopic ultrasound appear to be increasing. In this review article, the role of endoscopic ultrasound in the investigation pathway of patients with benign and malignant pancreaticobiliary diseases will be considered. The limitations of endoscopic ultrasound and some areas of future expansion will also be discussed.
What next for advanced practitioners?
Authors: Harrison Penny
Published: May 2014

The potential changes to roles for support staff in the field of gastrointestinal (GI) nursing were considered in last month's column, which leads on to consideration of the roles of highly experienced and expert nurses within the many mixed environments of GI nursing—gastroenterology, GI surgery, endoscopy and related specialist practice.
Being ready for changes
Authors: Williams Julia
Published: May 2014

’Are U Ready?’ is the title of this year′s World Council of Enterostomal Therapists (WCET) UK conference to be held in Bournemouth, so bucket and spades at the ready as we prepare for much debate and discussion of current issues in the field of stoma care nursing. One such issue is the enforcement of appliance use reviews (AURs). AURs are one of the outcomes following the publication and implementation of the Department of Health′s (DH) (2009) consultation on Part IX of the Drug Tariff for the provision of stoma and urology appliances and related services. With changes being operational since April, they will require full implementation by the end of 2010. So are you ready?
Reassuring ostomates about travelling
Authors: Wood Jane
Published: May 2014

People with a colostomy often have many questions relating to managing their colostomy when out at work, shopping or away on holiday as they try to move forward and return to living their normal lives. While travelling in particular may be a daunting prospect, with encouragement, reassurance and pre-planning, these fears can be overcome. Even those who are expert at living with a colostomy may require travel advice from their stoma care nurse specialists or from patient associations.
Nutrition and diet in the aetiology and management of pancreatic cancer
Authors: Banim PJ , Hart AR
Published: May 2014

Pancreatic cancer is the sixth most common cause of cancer death is the UK with an average survival time of 6 months. Current evidence suggests diet is involved in the aetiology of pancreatic cancer, with obesity, high sugar intake and cooked red meats increasing risk, although fruit and vegetables and alcohol do not alter the risk of developing disease. Weight maintenance improves survival duration and the quality of life with the early use of pancreatic enzyme therapy and oral nutritional supplements helping to achieve this goal.
Assessing the prevalence of coeliac disease in patients with intellectual disabilities
Authors: Khoshbaten Manouchehr , Rostami Nejad Mohammad , Sharifi Nasrin , Torabi Majid , Al Dulaimi David , Rostami Kamran , J Mulder Chris
Published: May 2014

Previous studies have suggested a high prevalence of coeliac disease in patients with intellectual disabilities (Nisihara et al, 2005; Shamaly et al, 2007). To further explore any possible relationship, 196 patients with intellectual disabilities were identified in rehabilitation centres in the province of East Azerbaijan in Iran. They were matched with 196 healthy controls and screened for coeliac disease. Anti-tissue transglutaminase IgA antibodies (tTGA) and total serum IgA levels were measured, and the Marsh-Rostami criteria used to evaluate histological findings. Two patients (1%) were positive for tTG and duodenal biopsies showed Marsh I in one patient and Marsh 0 in the other. IgA deficiency was detected in three patients in the study group and tTGA was positive in one individual. Biopsies from this patient showed Marsh IIIc. From the control group only one individual had positive tTGA and five cases were IgA deficient. Two of these patients had positive tTG but both had normal histology. Coeliac disease was not found to be more prevalent in patients with intellectual disorders which suggests that screening for coeliac disease in these patients would not be cost effective.
Encouraging support and dialogue
Authors: Wood Jane
Published: May 2014

The Colostomy Association recently held an Open Day to promote the positive aspects of living with a colostomy. Jane Wood, editor of Tidings, reports.
Detecting inflammatory bowel disease through an electronic nose
Authors: Arasaradnam Ramesh P , Covington James A , Bardhan Karna D
Published: May 2014

People with an acute sense of smell are often able to distinguish between certain diseases, for example, nurses in a gastrointestinal ward can detect—through smell—diarrhoea due to Clostridium difficile diarrhoea long before it is confirmed in the laboratory. Fermentation of undigested food in the colon by its resident bacteria can affect colonic health, but direct study is difficult due to lack of access. The anatomical structure of the colon is suited to act as a fermenting chamber with gaseous molecules emitted in faeces, absorbed in blood and excreted in urine. This complex system or ‘fermentome’ can be altered through dietary modification. A novel tool, the electronic nose, mimics the function of the human nose to detect certain colonic conditions and therefore has potential to help in early diagnosis.
Patients’ experiences of gallstone disease
Authors: Gustavsson Marie-Louise , Ung Kjell-Arne , Nilsson Åsa , Jakobsson Eva
Published: May 2014

In this article, Marie-Louise Gustavsson, Kjell-Arne Ung, Åsa Nilsson and Eva Jakobsson Ung examine patients’ experiences of developing, living with and being treated for gallstone disease. It also provides insight, establishing a basis for nursing practice in hospitals and community care. Twenty-seven patients who underwent a cholecystectomy were interviewed and the data were examined using qualitative content analysis. The time before diagnosis was characterized by protracted, diffuse and fluctuating symptoms, followed by dramatic pain attacks, resulting in considerable concern about the origin of the pain. While waiting for surgery, the patients experienced constant uncertainty and fear of gallstone attacks, resulting in avoidance of social and leisure-related activities as well as disruption at work. After the cholecystectomy, normalization of everyday life appeared to comprise freedom from pain and distress, a return to normal eating habits and fulfilling obligations. It is necessary to provide these patients with advice on pain management and nutrition, including support aimed at reducing fear associated with gallstone attacks while awaiting surgery.
A model for collaborative endoscopy research
Authors: Rees Colin , Davison Carolyn , Westwood Clare , Rutter Matt
Published: May 2014

The Northern Region Endoscopy Group (NREG) is a regionwide endoscopy research network, which aims to bring together local enthusiastic endoscopists as one research group and provide the opportunity to develop and participate in high quality, clinically meaningful research. In this article, Colin Rees, Carolyn Davison, Clare Westwood and Matt Rutter describe how the NREG works, its achievements and the contributions that endoscopy nurses and nurse endoscopists have had to the group.
Stoma care and enhanced recovery
Authors: Burch Jennie
Published: May 2014

Enhanced recovery programmes are now widely used to improve the experience of patients undergoing stoma-forming surgery. Such programmes utilise a number of evidence-based elements to improve patient outcomes, including a shorter preoperative starvation period, preoperative carbohydrate loading, early mobilisation, early resumption of oral intake, early removal of intravenous fluids and early urinary catheter removal. Enhanced recovery patients are less likely to have postoperative infections and are able to go home earlier—typically just four days after a colonic resection. While there are clear benefits to going home early, less time is available for stoma training. To ensure that patients are not compromised, adaptations of care need to be planned and undertaken. These may include preoperative training, daily or twice-daily teaching on stoma care, ward nurse training of patients and commencing training on the first postoperative day. Follow-up is also essential, to ensure that the patient is coping with their newly-formed stoma at home. This can be undertaken as a home visit, a telephone follow-up or in the clinic setting.
Hepatitis B virus part 1: risk factors, blood results and nursing care
Authors: Kate Jack , Joanne Cooper , Stephane Ryder
Published: May 2014

Chronic hepatitis B virus (HBV) is the most prevalent of the world's blood-borne viral infections. It may lead to liver cirrhosis, end-stage liver disease or hepatocellular carcinoma. HBV is spread via percutaneous and permucosal exposure to infected body fuids. The small numbers of people in the UK who contract acute HBV infection are usually infected in adulthood via unprotected sex or injected drug use using contaminated equipment. Kate Jack, Joanne Cooper and Stephen Ryder discuss HBV infection in terms of defnitions, risk factors, blood testing and immune system responses to infection and vaccination.
Anaesthesia for the super-morbidly obese: a role for specialist centres?
Authors: Craig James , Dering Andrew
Published: May 2014

Morbid obesity is growing in prevalence in the UK. In 1999, 0.8% of men and 1.8% of women, approximately 650000 people in total, were morbidly obese (body mass index (BMI) >40kg/m2). The associated increase in morbidity and mortality has led the UK government to sponsor several organizations to tackle obesity, including the National Audit Office (2001). In keeping with the Department of Health advocating specialist centres to manage morbidly obese patients, the authors believe these or similar centres should manage the even more challenging super-morbidly obese (SMO) patients (BMI >50kg/m2) during surgical episodes.
The molecular basis of prostate cancer
Authors: Olsson A Yvonne , Cooper Colin S
Published: May 2014

Cancer involves accumulation of genetic alterations. This review highlights the alterations in control pathways for cell division, development, DNA repair, angiogenesis and cell death that are believed to be key players in the development of prostate cancer.
Uncross-matched red blood cells save lives
Authors: Hess John R
Published: May 2014

Haemorrhage is the second leading cause of death among patients with severe traumatic injury (Sauaia et al, 1995). It is also their most preventable cause of death, since blood loss can frequently be stopped and lost blood replaced. However, timing is critical. Eleven per cent of the red blood cells (RBC) used in acute trauma care are used in the first hour before cross-matched blood is available (Como et al, 2004). Using group O RBC in the first hour is associated with the survival of more than half of the most severely injured patients who reach a trauma centre alive.
Implications of the new curriculum for medical trainers
Authors: Long Andrew
Published: May 2014

The increasing complexity of the role of trainer, highlighted in the expectations of the Modernising Medical Careers curriculum, currently out for consultation, exposes inadequacies in the current system. Changes in the supervisory structure are required and further training is essential if consultants are to fulfil this role adequately.
The management and treatment of cervical spine injuries
Authors: Al-Khateeb Hesham , Oussedik Sam
Published: May 2014

This is a burst fracture of the ring of C1 (Figure 10). This fracture is caused by a compressive downward force that is transmitted evenly through the occipital condyles to the superior articular surfaces of the lateral masses of C1. This process displaces the masses laterally and causes fractures of the anterior and posterior arches, along with possible disruption of the transverse ligament. Quadruple fracture of all four aspects of the C1 ring occurs.
Suprapubic catheters: indications and complications
Authors: Kumar Priyadarshi , Pati Jhumur
Published: May 2014

Although considered a simple and easy procedure suprapubic catheterization is not without complications and these are likely to be under-reported. This article reviews the various techniques, indications, contraindications, complications and offers guidelines for performing suprapubic cystostomy.
Applying for a job
Authors: Johnson Chris
Published: May 2014

Applying for medical jobs is stressful. Professional advancement and social happiness depend upon getting the job you want. This article describes the stages of the appointments process, the paperwork involved and suggests what you need to do to be successful.
Tracheostomy care
Authors: Homewood J , de Beer JMA
Published: May 2014

Significant numbers of patients with tracheostomies are now being looked after on general wards and doctors need to understand tracheostomy care, complications and the management of emergencies.
Clinical audit
Authors: Johnson Chris
Published: May 2014

Clinical audit is defined as: ‘the systematic and critical analysis of the quality of clinical care, including the procedures used for diagnosis, treatment, and care, the associated use of resources, and the resulting outcome and quality of life for the patient’ (NHS Training Directorate, 1994).
Chronic obstructive pulmonary disease: the evidence for use of tiotropium
Authors: Burns Graham , Bianchi Stephen
Published: May 2014

Tiotropium is the first long-acting anticholinergic bronchodilator for the treatment of chronic obstructive pulmonary disease. There is now evidence that it improves key clinical outcomes. Doctors need to decide how this evidence base should influence clinical practice.
The genetics of melanoma
Authors: Newton Bishop Julia , Harland Mark , Bishop D Tim
Published: May 2014

Melanoma is an increasingly common cancer and in order to direct preventative advice at those at risk, an understanding of susceptibility is crucial. This review summarizes what is known about common low-risk genes (such as those controlling red hair) and rare high-risk genes.
A new moral consensus is needed for medical decision making
Authors: Sooriakumaran Prasanna
Published: May 2014

Medical law in the UK has been influenced by ethical principles from various schools of thought. Society as a whole, and doctors in particular, need to make difficult choices regarding medical decisions, using their knowledge of law, medicine and ethics. This editorial is intended to equip the medical practitioner with this knowledge.
Cancer vaccines: a clinical perspective
Authors: Dangoor Adam , Thistlethwaite Fiona , Hawkins Robert
Published: May 2014

Using the immune system to treat cancer is an attractive proposition for patients and their doctors. It suggests low toxicity therapy, manipulating a natural process, to prevent or cure disease. Exciting advances in cancer vaccine development have recently been made.
Painful swollen legs in a diabetic patient
Authors: Neill Johanne
Published: May 2014

A 52-year-old man presented with a 6-week history of bilateral painful thighs and reduced mobility. Glycaemic control of his type 2 diabetes of 25 years' duration was poor and he had recently commenced on insulin. His disease was complicated by retinopathy, peripheral neuropathy and nephropathy. He denied trauma to the legs.

The thighs were swollen with pitting oedema extending from the ankles. There was no erythema or temperature disparity. The thighs were exquisitely tender on palpation of the anterior muscle compartment. Both calves were also tender to palpate. No mass was identified. The peripheral pulses were intact and the upper limbs were entirely normal.

Haematological investigations revealed erythrocyte sedimentation rate 136 mm/hr, C reactive protein 13 mg/dl, normal white cell indices and normal coagulation profile. On biochemical analysis urea and creatinine were elevated; creatine kinase was increased at 250 U/litre. Glycosylated haemoglobin was 14%. All immunological and vasculitic profiles were normal. Urinary protein excretion was 12 000 mg/24 hours.

This man was admitted for investigations, rest and rigorous control of his diabetes. He underwent ultrasound Doppler of his legs ruling out deep venous thrombosis or insufficiency of the large arteries. A computed tomography scan of the thighs revealed diffuse inflammation of the right thigh musculature. Nuclear bone scan confirmed increased uptake in the muscles but no bony abnormality. Magnetic resonance imaging was the definitive investigation showing diffuse enhancement on T2 weighted images of the anterior muscle compartment of the right thigh (vastus intermedius and vastus lateralis) with lesser changes noted in the left thigh and both calves (soleus) (Figure 1). A focal area of nonenhancement in the right rectus femoris following administration of gadolinium was consistent with an area of infarction (Figure 2).

An open biopsy specimen showed non-specific inflammation and regenerating muscle fibres. Occasional necrotic muscle fibres were remarked upon. No haemorrhage was noted and the intramuscular blood vessels were normal.

The diagnosis of diabetic muscle infarction was made. After 1 month of rest, analgesia and good glycaemic control the swelling and pain had completely resolved. A similar episode affecting the left thigh some months previously was reported. He is the only recorded patient to have had involvement of both thighs and calves bilaterally in the same episode.
Crystal ball gazing: planning the medical workforce
Authors: Curson Judy
Published: May 2014

Should we try to plan to produce a medical workforce that meets the future needs of patients? Or should we abandon the impossible task and let the market rip? While we can never predict the future precisely, we owe it to patients to do the best we can.
Review of new guidelines for prophylaxis and treatment of MRSA infections
Authors: French Gary
Published: May 2014

A joint working party has produced evidence-based guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. These guidelines will help clinicians choose appropriate therapy and point to areas where further research is needed. This review summarizes the main recommendations and discusses their implementation into clinical practice.
Intestinal obstruction
Authors: Chapple Keith S , Hartley John E
Published: May 2014

Adult intestinal obstruction is a common surgical emergency to confront the surgical trainee. Rapid diagnosis of the condition and institution of basic management skills are essential to reduce the considerable morbidity and mortality associated with the condition.
So you want to be … a specialist in HIV/AIDS medicine
Authors: Jones Rachael , Pozniak Anton
Published: May 2014

There is no single speciality called ‘HIV/AIDS’ (human immunodeficiency virus/acquired immune deficiency syndrome) so physicians with a major interest in this field have to progress via alternative routes in terms of training and accreditation.
Fracture of the proximal femur
Authors: Young Claire F , Haddad Fares
Published: May 2014

The proximal femur comprises the femoral head articulating with the acetabulum as the hip joint, the femoral neck, greater and lesser trochanters. It allows for the transmission of body weight from the upper body to the leg and moves the leg.
Interpretation of thoracolumbar spine radiographs
Authors: Allen Steven D , Harvey Chris J , O' Regan Declan
Published: May 2014

Thoracolumbar vertebral trauma is a major cause of spinal cord injury. Such severe disruption invariably results from significant force, although this is relatively uncommon. However, more minor injuries are frequently encountered yet still may cause uneasiness in their assessment.
Chronic fatigue syndrome in young people: the spectrum and the myths
Authors: Crawley Esther
Published: May 2014

Large telephone surveys in both the UK and USA suggest that chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) in children is both surprisingly common (0.19–2%), and indiscriminate in who it affects (Jordan et al, 2000; Chalder et al, 2003; Jones et al, 2004). There is no gender preference, no social class gradient, and all ethnic groups are affected. The CFS/ME described in studies where patients are recruited from specialist care is much rarer and predominantly affects white females of higher socioeconomic status (Patel et al, 2003).
High tibial osteotomy: back to the future
Authors: Punwar Shahid , Haddad Fares S
Published: May 2014

High tibial osteotomy was once a popular surgical treatment for isolated medial compartment osteoarthritis of the knee. Although largely superseded by prosthetic arthroplasty for this purpose, exciting new applications for the procedure have recently developed, which will be discussed below.
Massive inguinoscrotal hernia
Authors: Thomas Rhys , Ali Tahir
Published: May 2014

II 79-year-old man presented with an incarcerated right inguinoscrotal hernia of 5 years' duration. His history of weight loss and central abdominal pain suggested mesenteric ischaemia. There was no history suggesting previous small bowel obstruction. Examination agreed with radiographical findings of the entire small bowel viscera residing in the scrotal hernial sac without proximal small bowel dilatation (Figures 1 and 2). He underwent uneventful Lichenstein mesh repair with preservation of his testicle leading to symptom resolution. Inguinal hernias are common, accounting for about 7% of surgical outpatient appointments and a tenth of surgical operating time (Burkitt and Quick, 2002). Indirect hernias are prone to small bowel
Relief of symptoms in end-stage neurological conditions
Authors: Stevenson Valerie L
Published: May 2014

Effective multidisciplinary team working is essential to manage neurological symptoms as end of life approaches. Coordination of care ensures timely input of specialist therapies, pharmacological measures and occasionally invasive techniques including surgery. This can impact not only on function but also aid passive care and comfort.
What sources of careers information do medical students prefer to use?
Authors: Ahsan Safiyah , McConville Catherine , Hogg Rachel , Sivakumar Shivan , Roberts C Michael
Published: May 2014

A survey of 764 medical undergraduates explored their preferred careers information sources. Students wished to access careers information from a variety of sources but most valued face-to-face interviews with both trained careers counsellors and senior medical colleagues.
Managing epistaxis in hospital
Authors: Osman Eslam , Swift Andrew
Published: May 2014

Epistaxis is defined as acute haemorrhage from the nostril, nasal cavity or nasopharynx. It is a frequent emergency in otolaryngology and this article will present an overview of the current concepts of the different levels of management of epistaxis.
Cardiac device therapy 2: indications, techniques and complications
Authors: Modi Simon , Rao Archana , Hughes Susan , Ramsdale David
Published: May 2014

With advancing technology and ever-expanding indications for implantable cardiac pacing and defibrillation devices, this article reviews modern day practice in this field. This article focuses on topics pertinent not only to cardiologists but also to general physicians, medical trainees and allied medical specialties.
Diagnosing multiple sclerosis: expect the unexpected
Authors: Ramtahal J , Larner AJ
Published: May 2014

A previously healthy 41-year-old Hong Kong Chinese man, who emigrated to the UK at the age of 20 years, presented with a complaint of visual blurring and of painless double vision but without directional selectivity. Ophthalmological assessment found normal visual acuity, colour vision, visual fields, and pupillary reactions; examining eye movements there was a left hypertropia, with weak left inferior rectus on Hess chart. A diagnosis of acute partial pupil-sparing left oculomotor (third) nerve palsy was made.

Symptoms resolved spontaneously within 2 weeks, but magnetic resonance brain imaging arranged at the initial consultation showed multiple high signal intensity lesions in the white matter of the cerebral hemispheres periventricularly and in the corpus callosum, suggestive of demyelination, although no brainstem lesions were noted. When subsequently seen in the neurology clinic, the patient was asymptomatic and there were no neurological or neuro-ophthalmological signs. Serum angiotensinconverting enzyme level and chest X-ray were both normal. Interval magnetic resonance brain imaging 7 months later showed no new changes, and since the patient was asymptomatic he declined further investigation or follow up.

Five years later, the patient presented again with a complaint of double vision without directional selectivity. Signs were now of a right abducens (sixth) nerve palsy, without any other neurological or neuro-ophthalmological signs. Symptoms resolved spontaneously after 4 months. Magnetic resonance brain imaging again showed multiple high signal lesions in the periventricular white matter and corpus callosum, but no brainstem or cerebellar lesions were seen. Pattern shift visual evoked potentials were within normal limits, providing no evidence for a demyelinating optic neuropathy. The patient agreed to lumbar puncture, and CSF analysis showed normal protein, glucose, cell count, angiotensin-converting enzyme level, and cytology, but oligoclonal bands were present in a type 2 pattern consistent with a diagnosis of multiple sclerosis.
Understanding clinical governance: a guide for the foundation year doctor
Authors: Trivedi Deepali , Kuo Kwilan , Hooke Rachel
Published: May 2014

Clinical governance is defined as ‘the framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish’ (Department of Health, 1998).
Ultrasound imaging of the scrotum
Authors: Hart Jonathan L , Lloyd Claire , Niewiarowski Sylwia , Harvey Chris J
Published: May 2014

Although there is a wide variety of scrotal pathology, the clinical features are not always particularly discriminatory. These may include pain, generalized swelling or a focal mass. Ultrasound examination of the testes with a high-frequency linear transducer is the primary (and usually the only) diagnostic modality required for evaluation of the testes. This article outlines the technique of scrotal ultrasound and illustrates some of the more common testicular and extratesticular pathologies encountered.
Preoperative diagnosis of choledocholithiasis: the role of MRCP
Authors: Samaraee Ahmad Al , Khan Usman , Almashta Zaid , Yiannakou Yan
Published: May 2014

Biliary imaging has changed as a result of technological advances, but the timing and modality of preoperative biliary tree imaging is controversial. An ideal imaging modality would be risk free and have a high sensitivity and specificity, a role fulfilled by magnetic resonance cholangiopancreatography (MRCP).
Management of venous thromboembolism in patients with cancer
Authors: Noble Simon , Jenkins Debbie A
Published: May 2014

The association between venous thromboembolism and cancer has been recognized for over 140 years. This article reviews current prevention, diagnosis and treatment of cancer-related venous thromboembolism, and highlights emerging anticoagulants and the possible anticancer effects of anticoagulants such as low molecular weight heparins.
Working as a newly appointed consultant: a study into the transition from specialist registrar
Authors: Brown JM , Ryland I , Shaw NJ , Graham DR
Published: May 2014

Practising for the first time as a consultant can be extremely challenging. This study explored the experiences of 45 physicians and surgeons who had made the transition from specialist registrar to hospital consultant.
Prevention of catheter-related urinary tract infections
Authors: Hameed Ammar , Chinegwundoh Frank , Thwaini Ali
Published: May 2014

Catheter-associated urinary tract infection is the most common nosocomial infection, with hospitalized patients having a risk of 5% per day an indwelling catheter is in place. Use of catheters coated with silver alloy-hydrogel significantly reduces the risk of catheter-associated urinary tract infection and the burden on the NHS.
Fatal avulsion of inferior vena cava following blunt abdominal trauma
Authors: Bourkiza R , Hegade V , Menon J
Published: May 2014

A 25-year-old woman was brought in by ambulance to the accident and emergency department following a road traffic accident where the car hit a tree at 70 miles/hour. At the scene, her Glasgow Coma Score was 9/15 and her blood pressure was 94/64 mmHg, for which she was fluid resuscitated. On arrival at accident and emergency, she was conscious and maintaining her airways. Although she was complaining of abdominal and back pain, there was no external haemorrhage. Secondary survey showed rigid abdomen with guarding. Trauma series showed stable cervical spine and pelvis, with no evidence of rib fractures or blunt trauma to the chest. Computed tomography of her chest and abdomen revealed pulmonary contusion with a small right pneumothorax. The right atrium, right ventricle and inferior vena cava appeared compressed and no obvious leakage could be seen in the pleural or pericardial space (Figures 1–3).

The patient deteriorated haemodynamically and was immediately taken to the operating theatre. On laparotomy more than 3 litres of blood was found, and as soon as the tamponade was released, the patient sustained cardiac arrest. With ongoing resuscitation, the laparotomy was extended as a left anterolateral thoracotomy, to cross clamp the descending aorta and to perform open cardiac massage after opening the pericardium. The abdomen was packed with four quadrant packs. Despite transfusion of 13 units of blood and ten cycles of cardiopulmonary resuscitation the patient died. On removing the abdominal packs, the retrohepatic inferior vena cava was found to be completely transected.
Online postings and medical professionalism
Authors: Esen Umo
Published: May 2014

The online age has brought a new challenge to medical professionalism. Medical students and trainee doctors who use social network sites may not be aware of the potential risks they could be exposing themselves as well as their professional careers to, as there is significant potential for the breach of medical professionalism from online postings. The bulk of medical teachers are older doctors who may use these sites less often and so lack the skills to teach the safe navigation of these sites.
Imaging of stroke and transient ischaemic attack
Authors: Thomas Robert H , Burke Christopher J , Howlett David
Published: May 2014

Non-fatal stroke has significant social and financial implications, and the use of appropriate imaging is essential for early diagnosis and treatment to prevent permanent disability. This article discusses the pivotal role radiological imaging plays in the management of stroke and transient ischaemic attack.
Approaches to improving antibiotic management
Authors: G Masterton Robert , Williams Craig
Published: May 2014

New information is available to improve antibiotic outcomes in severe sepsis where increasing resistance and reducing novel compound development make reaching the right decisions ever more difficult and important.
Diversity, equal opportunities and human rights
Authors: McKimm Judy , Webb Helen
Published: May 2014

Equality and diversity are central to education and health services, in terms of both employment and service delivery. Clinical teachers need to be able to support students and trainees around equality issues, have the confidence to challenge discriminatory practice and provide an inclusive and safe learning and teaching environment.
Radiology of acute hip and femoral injuries
Authors: Kiu AKC , Khan SHM
Published: May 2014

Hip injury involving the femoral neck is one of the more common fractures seen in casualty. It is predominantly seen in the geriatric population and the incidence is increasing as life expectancy increases. Femoral neck fracture most commonly occurs following a fall, and hip fractures are most commonly found in the osteoporotic elderly. Femoral shaft injuries are mostly the result of high energy trauma. Hip dislocation is usually caused by high energy blunt trauma, generally in a road traffic accident. Hip injuries are associated with significant morbidity and mortality.
Medicines management: a guide for the foundation year doctor
Authors: Hooke Rachel
Published: May 2014

As a foundation doctor, you will deal with patients' medicines. This includes taking the initial drug history, completing and updating the prescription chart and prescribing take-home medication.
So you want to be … a urologist
Authors: Osman NI , Moore KC , Mokete M
Published: May 2014

‘I will not cut for the stone… I will leave this operation to be performed by practitioners, specialists in this art’ said Hippocrates in his famous oath and thus urology came to be defined as the first of all the surgical specialties (Herr, 2008). Urologists deal with medical and surgical diseases involving the male and female urinary tracts and the male reproductive system. The wide spectrum of disease and operative techniques has long attracted some of the brightest and enthusiastic trainees.
A foundation doctor's guide to clerking the confused older patient
Authors: Winstanley Laura , Glew Simon , Harwood Rowan
Published: May 2014

Confusion is a common cause of acute admissions, encompassing dementia, delirium and depression (Bostwick, 2000). Because of this diagnostic challenge, acute confusion is often misdiagnosed and undertreated; one study found this to be the case in 94% of older people in hospitals (Ski and O'Connell, 2006). For a foundation doctor it can be difficult to know where to start with such a patient and yet this type of admission is extremely common. This article raises awareness of the appropriate management of a patient with confusion as part of good medical practice and thus improve the quality of care for patients with dementia and delirium in hospitals.
An ethical dilemma on call
Authors: Ahmad Z
Published: May 2014

Being a junior doctor, especially early on, can be very daunting. A new hospital, new colleagues and new authority along with the incumbent added responsibility. The amalgamation of these issues, in tandem with a difficult ethical dilemma let alone a medical dilemma, can pose problems for any doctor.
Otitis externa: a clinical review
Authors: Narayan Surya , Swift Andrew
Published: May 2014

This article provides a clinical overview of otitis externa, focusing on clinical aspects of the aetiology, diagnosis and management of this important and debilitating condition.
Use of coblation in otolaryngology, head and neck surgery
Authors: Joshi Himani , Carney A Simon
Published: May 2014

Coblation is a relatively new, low-temperature electrosurgery technique that has established its place in various surgical fields. This article summarizes the published work on the use of coblation in the field of otorhinolaryngology.
Management of transient ischaemic attack
Authors: Giles Matthew F
Published: May 2014

Transient ischaemic attack carries a high stroke risk. Accurate diagnosis requires careful clinical assessment and high-risk individuals can be identified by the ABCD2 score and the presence of large artery disease and brain infarction on imaging. Urgent secondary prevention improves early outcome.
Care of the dying patient in hospital
Authors: Rayment Clare , Ward Jason
Published: May 2014

Patients die in hospital every day, some receiving suboptimal care. This article focuses on the care of these patients in their last days specifically discussing medication review, symptom control, assisted nutrition and hydration, spiritual and religious needs, and documentation.
Vitamin D deficiency: a iagnosis often missed
Authors: Paterson Colin
Published: May 2014

Vitamin D deficiency causes rickets in children and osteomalacia in adults. These are common today but often not recognized. This article summarizes the clinical features, investigation and treatment of these disorders and examines the factors contributing to failures of diagnosis.
Management of branch retinal vein occlusion
Authors: Shirodkhar Amy-Lee , Lightman Sue , Taylor Simon RJ
Published: May 2014

This article addresses advances in the management of branch retinal vein occlusion – a common retinal vascular disorder in elderly patients which is a significant cause of ocular morbidity. New intravitreal therapies have improved the prognosis for patients, albeit with significant cost implications.
Imaging the pleura
Authors: Mortensen Chloe , Bhatnagar Rahul , Edey Anthony J
Published: May 2014

Pleural disease is now recognized as an important subspecialty of pulmonary medicine, with increasing provision being made for specialist services and procedures. In response, the field of pleural imaging has advanced in recent years, especially with regard to ultrasound. Salient multimodality imaging techniques are discussed.
Radiofrequency intravascular ultrasound and detection of the vulnerable plaque
Authors: Calvert Patrick A , Bennett Martin R
Published: May 2014

Radiofrequency intravascular ultrasound uses radiofrequency backscatter data to determine the sub-plaque anatomy and composition of coronary atherosclerosis and hence permits plaque classification. The thin-capped fibroatheroma is associated with future major adverse cardiovascular events, emphasizing its biological importance.
Quality improvement
Authors: Arasaratnam Reuben
Published: May 2014

Quality improvement in health care is a structured analysis of a health-care system with a view to improving its performance. This review describes the history of quality improvement and its growing application in health care. It gives further information for doctors wanting to participate.
System sclerosis
Authors: Hughes Michael , Herrick Ariane
Published: May 2014

This review updates the clinician on the pathogenesis, differential diagnosis and spectrum of disease in systemic sclerosis. The wide range of current therapeutic options and future targeted molecular therapies are also explored.
Idiopathic normal pressure hydrocephalus: an important differential diagnosis
Authors: Paranathala Menaka P , Sitsapesan Holly , Green Alexander L , Cadoux-Hudson Tom AD , Pereira Erlick AC
Published: May 2014

Idiopathic normal pressure hydrocephalus, an uncommon but important differential diagnosis for ataxia, cognitive impairment and urinary incontinence, is surgically treatable, unlike many of its differential diagnoses. This article discusses its assessment, investigation and therapeutic interventions.
Investigation and management of functional dyspepsia
Authors: Sood Ruchit , Mohammed Noor , Hegade Vinod S , Moreea Sulleman
Published: May 2014

Dyspepsia is a common presentation but only a small minority of patients have organic pathology. The majority have functional dyspepsia. All physicians should have a framework to manage dyspepsia to avoid over-investigation but to also recognize when it is appropriate to refer patients for further investigations.
The clinical and ecological impact of childhood pneumococcal vaccination
Authors: Gil Eliza , Noursadeghi Mahdad , Brown Jeremy S
Published: May 2014

Routine childhood vaccination against Streptococcus pneumoniae with PCV7 has reduced the incidence of pneumococcal disease as a result of the vaccine serotypes. However, it has also resulted in the emergence of serotypes not included in the vaccine, offsetting, but not yet overcoming, the benefits of vaccination.
Cardiac transplantation: who to refer and when
Authors: Dar Owais , Banner Nicholas R
Published: May 2014

For some patients with advanced heart failure, heart transplantation or mechanical circulatory support may be the only treatment left to improve quality life and survival. The timing of intervention is crucial, as patients should be referred before complications such as pulmonary hypertension, cardiorenal syndrome or liver failure develop.
Contact radiotherapy for elderly patients with early low rectal cancers
Authors: Myint A Sun
Published: May 2014

The National Bowel Cancer Screening Programme hopes to diagnose early bowel cancer. The dilemma is how best to treat it. The standard of care for rectal cancer is surgery, but not all patients are fit or keen to undergo extirpative surgery. A national guideline for the management of screen-detected malignant polyps is urgently needed.
Is liver transplant for alcohol-related end-stage liver disease appropriate?
Authors: Bailey Deborah , Pathak Samir , Ahmad Niaz
Published: May 2014

Every year patients die from end-stage liver disease while they are on the waiting list to receive a liver transplant because of the shortage of available organs. Should patients with alcohol-related end-stage liver disease compete equally for access to this scarce resource?
Haemochromatosis: a time for guidelines?
Authors: Hall CJ , Critchley AT , Norfolk DR
Published: May 2014

Hereditary haemochromatosis is an autosomal recessive metabolic abnormality which causes excessive absorption of dietary iron. Iron accumulation leads to potentially fatal damage to organs such as the heart, liver and pancreas. Normal life expectancy can be restored simply by therapeutic venesection. Discovery of the gene, HFE, has rekindled interest in pathogenesis, management and screening strategies.
Cardiac rehabilitation: are the potential benefits being realized?
Authors: Wright DJ
Published: May 2014

Cardiac rehabilitation or exercise training programmes are provided by many hospitals. This article discusses the evidence supporting the implementation of such facilities and reviews the reality of services in the UK.
Menire's disease
Authors: Hollis Lance , Bottrill Ian
Published: May 2014

Menière's disease is an idiopathic condition classically described as a triad of vertigo, deafness and tinnitus. A wide differential diagnosis exists, but acoustic neuroma must be actively excluded. Various medical and surgical treatment options are available, although two-thirds of patients spontaneously resolve with time.
Bias in treatment trials
Authors: Davies Huw TO
Published: May 2014

Rigorous treatment trials exhibit a number of key features to guard against bias. Randomization, blinding (of patients, care staff and assessors), full follow-up on all patients, and ‘intention-to-treat’ analyses all contribute to removing bias so that any true treatment effect can be revealed. This article outlines the rationale behind these features and advises how bias in treatment trials can be assessed.
Melanoma
Authors: Bishop Julia A Newton
Published: May 2014

Cutaneous melanoma is becoming more common. Although still rarer than some cancers it is important, particularly as it afflicts young adults relatively frequently. Furthermore early detection with resultant better prognosis should be achievable if the public was to become more aware, and if health-care professionals were more familiar with melanoma and the behaviour of normal moles.
Burns resuscitation: what place albumin?
Authors: Judkins Keith
Published: May 2014

The Cochrane analysis of the use of albumin in critical illness has highlighted the need for more well-conducted studies on colloid use in burns. The lack of objectivity in the press regarding this material has compromised our ability to deliver those studies. The analysis provides no evidence that albumin is unsafe for the initial resuscitation of uncomplicated burns, and the fall in its use is more likely to be cost-related.
Job sharing in medical training: an evaluation of a 3-year project
Authors: Goldberg Ilfra , Paice Elisabeth
Published: May 2014

Job sharing has been introduced on a major scale in one deanery to help accommodate increasing demand for flexible (part-time) training. We arranged 37 job shares for 74 trainees between 1996 and 1999. Job shares lasted from 6 months to 2 years. Trainees in job shares were as satisfied with their training as those in supernumerary posts or in full-time training.
Tuberculosis and travel
Authors: Ormerod Peter
Published: May 2014

Tuberculosis is increasing worldwide with most countries having a high prevalence. Protection against tuberculosis, the risks of acquiring tuberculosis during air travel, and the evidence for clinical tuberculosis acquired on extended visits to such countries are all reviewed in this article.
Human oocyte cryopreservation
Authors: Salha Osama , Picton Helen , Balen Adam , Rutherford Anthony
Published: May 2014

Despite early success with sperm and embryo cryopreservation, human oocyte cryopreservation has met with limited success both in terms of survival and subsequent fertilization. However, compared with embryo cryopreservation, oocyte freezing has great potential for eliminating the ethical and legal problems of embryo storage.
Pharmacological treatment of depression: the role of paroxetine
Authors: Deahl M
Published: May 2014

Depression is reaching epidemic proportions in the western world. With each successive generation more people are becoming more severely depressed at a younger age.
The success of paediatric oncological research
Authors: Makin Guy , Eden Tim
Published: May 2014

The current health service climate has focussed attention on the lack of a solid evidence base for much accepted practice in medicine. Paediatric oncology is more fortunate than most specialties in being able to draw on an evidence base for much of its practice. The speciality has benefitted from a history of robust randomized trials, which also serve as the basis for future improvements.
A new collaboration between Hospital Medicine and Doctors.net.uk
Authors: Tucker Danny
Published: May 2014

As the leading source of clinical review articles for hospital doctors, as well as an invaluable source of information about education and training, Hospital Medicine is delighted to announce details of our collaboration with Doctors.net.uk, the UK's leading ebsite for doctors.
Use of electronic devices in pain management
Authors: Royle John
Published: May 2014

Far from being a recent phenomenon, electroanalgesia has been a feature of medicine for thousands of years. Perhaps it is now time that we let history teach us a lesson and look again at how the use of electronic devices in pain management may benefit our cash-strapped NHS.
A new approach to improving facilities for resident hospital doctors
Authors: Whitehouse Andrew , Wall David , Davies Anne
Published: May 2014

The British Medical Association and the Department of Health recently agreed tougher systems to force NHS trusts to improve living conditions for resident doctors. Central to the proposals is the system of monitoring pioneered in the West Midlands, described below, which has resulted in significant improvements in the facilities provided by the region's trusts in the last 3 years.