bluuebunny/crossref_metadata_2025 huggingface dataset:
Living with a parastomal hernia
Authors: Cowin Caroline , Redmond Caroline
Published: May 2014

There are approximately 102 000 people in the UK living with a stoma ( Herlufsen et al, 2006 ) and the incidence of parastomal hernias in stoma patients is estimated to be as high as 50% ( Raymond and Abulafi, 2002 ; Williams, 2003 ). Therefore, a clearer understanding of the problems faced by stoma patients during diagnosis and treatment could enable health professionals to anticipate their patients’ needs and customize their care and management more effectively. In this article, Caroline Cowin and Caroline Redmond present a research study among UK patients in which Salts Healthcare sought to improve understanding of the experiences of patients living with a parastomal hernia. The type and severity of problems reported from initial diagnosis, through to treatment and subsequent management is described and quantified.
The value of, and feedback from, an open information event for those affected by inflammatory bowel disease
Authors: Middleton Hannah , O’Connor Marian , Tyrrell Tracey
Published: May 2014

Patient engagement is a key focus of the current NHS ( NHS Institute for Innovation and Improvement, 2006 ). In this article, Hannah Middleton, Marian O’Connor and Tracey Tyrrell describe an inflammatory bowel disease (IBD) open information event that took place at St Mark’s Hospital, organised by the IBD patient panel and the IBD team. The agenda was agreed at patient panel meetings and with the help of pharmaceutical sponsorship, it was well-publicised and attended by 160 people. At the event, delegates were given general information on IBD, current medical and surgical treatment options and specific IBD services at St Mark’s. They also had an opportunity to meet staff, the patient panel and representatives of patient groups, including Crohn’s and Colitis UK and the Crohn’s in Childhood Research Association (CICRA). The event was extremely well-received, with 100% of attendees reporting it to have been beneficial. This highlights the influence that patients and members of the public can have on service improvement.
Food fight: dietary choices made by people after stoma formation
Authors: Richbourg Leanne
Published: May 2014

People with colostomies, ileostomies, and urostomies have many similar and some different experiences as they resume eating. In this article, Leanne Richbourg discusses dietary choices following stoma formation. This study employed a cross-sectional, exploratory design with both quantitative and qualitative measures to answer the question, ‘Does having an ostomy affect what is eaten?’ Surveys were received from 301 ostomates, 86 with colostomies, 174 with ileostomies, and 41 with urostomies. The majority of survey respondents (78.7%) did not report that ostomy surgery had a negative effect on their enjoyment of food and drink. However, nearly two thirds (58.1%) of colostomates said that their stoma had an effect on heir food choices and just over two thirds (67.2%) of ileostomates reported that their ileostomy affected their dietary choices. The vast majority (94.6%) of urostomates experienced no significant changes in their relationship with food and fluids.
Living with a colostomy: a pilot study
Authors: Notter Joy , Chalmers Frances
Published: May 2014

In the UK there are approximately 100 000 people with a permanent stoma and around 21 000 new stomas are formed each year. In this article, Joy Notter and Frances Chalmers describe the results of a postal survey, designed as a pilot for a bigger national study. This survey explored issues impacting on quality of life for those living lifelong with a colostomy. Over 97% of respondents were over 50 years of age, and almost 30% reported complications necessitating further admissions and/or more surgery. Restrictions on activities of daily living (including social activities with family and friends) were present for 40% of the sample; 50% reported leakage and 33% found disposal problematic. Overall, the survey yielded a wealth of information and identifed areas where specialist help and advice are important.
Follow-up care of stoma patients: a systematic literature review
Authors: Johnson Toni
Published: May 2014

Each year approximately 21 000 people undergo stoma formation surgery in the UK ( High Impact Action Steering Group, 2010 ). Stoma care nurses are involved throughout the care pathway and the role of the stoma care nurse is fundamental in helping these patients adapt to living with a stoma, so they can resume a ‘normal’ life. There is much literature relating to adaption to living with a stoma and complications, but what evidence is available to support the provision of follow-up care for stoma patients? In this article, Toni Johnson describes a systematic review of the literature.
Inflammatory bowel disease in older people
Authors: Smith Graeme D
Published: May 2014

The physiological process of ageing can lead to a number of health challenges, including a deterioration of gastrointestinal functions and increase in digestive disorders. Therefore, although the occurrence of inflammatory bowel disease (IBD) is quite high in younger people, some individuals can develop this inflammatory disorder at an older age. As the global population ages, there is an increasing number of older people presenting with IBD, both early and late onset, in the gastroenterology setting. In this review paper, Graeme D Smith gives an overview of IBD in older people and examines the impact of ageing on the gastrointestinal tract.
Cost-efficiency in prescription reviews: pilot study of stoma patients in one health board in Wales
Authors: Williams Iris
Published: May 2014

Colorectal clinical nurse specialists (CNSs) often have to justify their roles and services and demonstrate quality service alongside cost-effective measures. Reducing posts to save costs is a false economy because there is evidence to show that specialist nurses can improve the lives of their patients and deliver value for money ( Royal College of Nursing, 2013 ). This body of evidence is growing as nursing stakeholders and frontline nurses continue to make the economic case for specialist nurses in both the community and hospital setting. A range of products and accessories are available for stoma patients, and it is important that patients receive the best care and appropriate choice of products and accessories. In this paper, the author describes an audit of stoma-prescribing practices in Wales and the effect of individualised patient reviews on both patients and the health economy.
Cognitive apprenticeship: a key component of contemporary endoscopy education
Authors: Gardiner Angela , Anderson John
Published: May 2014

Gastrointestinal endoscopy education and training in the UK has changed dramatically in recent years. The impetus for change was driven by the National Endoscopy Training Programme and a national training centre network. Endoscopy practice requires diverse skills and qualities, traversing the traditional cognitive, psychomotor and affective domains. This article explores the concept of cognitive apprenticeship and aligns it with typical endoscopy training. The application of supporting structures offers effective means of assisting learners through their training pathway from novice to expert. Cognitive apprenticeship is a model that can be effectively applied to endoscopy training. Through careful alignment of theoretical and practical activities with context rich, authentic situations, learners are afforded a safe, robust environment to develop and extend their skills.
Clinical guidelines for the management of childhood stroke
Authors: Ganesan Vijeya
Published: May 2014

Clinical guidelines have recently been published by the Royal College of Physicians (RCP) relating to the diagnosis, management and rehabilitation of stroke in children (Royal College of Physicians, 2004). Stroke affects several hundred children in the UK each year and is in the top ten causes of childhood death (Fullerton et al, 2002). One in ten children with sickle cell disease will have a stroke before their 20th birthday and a quarter will have evidence of brain injury as a result of overt or clinically silent stoke.
Neuroendocrine tumour management: a team approach
Authors: Banfield A , Green S , Ramage JK
Published: May 2014

This article gives an overview of neuroendocrine tumours of the gut, liver and pancreas and will make the case for a multidisciplinary approach to management.
Day case surgery: a modern view
Authors: Horton Bill , Doyle Brigid
Published: May 2014

For several decades day surgery clinicians have championed the invaluable contribution that can be made to the provision of elective surgical care. It is now acknowledged as high impact change number one: treat day surgery rather than inpatient surgery as the norm for elective surgery. However, the potential is much greater and ambulatory practice will be the vanguard for modernizing the delivery of all surgical services of the future. It has been described as crucial to the future of health care.
Diabetic eye disease
Authors: Clare Gerry , Cook Helen , Hykin Phillip
Published: May 2014

Diabetes mellitus affects at least 2% of the UK population and complications include blindness. Control of risk factors and laser treatment prevent visual loss. A National Screening Programme will identify at-risk patients. Treatments currently in clinical trial include antipermeability agents.
Visual loss as a result of age-related cataract
Authors: Sagoo Mandeep S , Tuft Stephen J
Published: May 2014

Cataract is a common cause of impaired quality of life in the elderly. Cataract extraction with implantation of an artificial lens within the eye is a safe and effective treatment. Initiatives are required to deliver surgery to the increasing numbers of patients who would benefit.
Coexistent gout and rheumatoid arthritis: a case report
Authors: Modesto dos Santos Vitorino , Cézar Breno F , Barbosa Elber R , Gomes Filomena R , de Oliveira Carvalho Fereira
Published: May 2014

A 56-year-old Brazilian man, non-alcoholic, with no family history of arthritis, complained of weight loss and fever during haemodialysis. Over the previous 3 years he had asymmetric podagra responsive to colchicine and allopurinol, and developed subcutaneous nodules in fingers and forearms, where tophi of monosodium urate crystals were found on needle aspiration. He also had recurrent symmetric polyarthritis in wrists and hands without morning stiffness. On admission his temperature was 36.5°C. The heart was rhythmic at 99 beats per minute and blood pressure 190/110 mmHg. The lungs were clear and respiratory rate 20 incursions per minute. The liver was normal and the spleen was enlarged. Symmetric nodules were found in the third proximal interphalangeal hand joints (Figure 1) and near the elbows (Figure 2) without rheumatoid deformities.

The results of blood tests were as follows: erythrocytes 2.77×106/mm3, haemoglobin 8.1g/dl, haematocrit 25.9%, leukocytes 13 100/mm3 (neutrophils 72%, lymphocytes 20%), platelets 280 000/mm3, erythrocyte sedimentation rate 89 mm/hr, albumin 3.6 g/dl, globulins 4.8 g/dl, Bence-Jones proteinuria negative, uric acid 11.3 mg/dl, iron 57 μg/dl, glucose 84 mg/dl, urea 93 mg/dl, creatinine 8.4 mg/dl, sodium 135 mEq/litre, potassium 4.8 mEq/litre, calcium 1.44 mmol/litre, phosphorus 5.3mg/dl, aspartate transaminase 20U/litre, alanine transaminase 33U/litre, gamma-glutamyl transpeptidase 170 UI/litre, triglycerides 101 mg/dl, cholesterol 117 mg/dl. C-reactive protein 4.8 mg/dl, acid alpha1-glycoprotein 235 mg/dl, rheumatoid factor 82.3 UI/dl, antinuclear, anti-DNA, and anti-microsomal antibodies negative. Complement levels were C3 116 mg/dl and C4 55 mg/dl. Tests for hepatitis C and toxoplasmosis immunoglobulin G were positive; and hepatitis B, brucellosis, mononucleosis, syphilis and human immunodeficiency virus were negative.

Radiograph of hands showed cortical erosions in the third proximal interphalangeal joints, with normal joint spaces, erosions and cysts in metacarpal epiphyses, with symmetrical periarticular osteoporosis and soft tissue swelling (Figure 3). Medial epicondyle erosion with overhanging edges and fluffy calcifications of chronic tophaceous gout (Monu and Pope, 2004) were seen in the left olecranon.

Biopsy of subcutaneous nodule disclosed granulomas with central zones of fibrinoid necrosis surrounded by palisades of mononuclear cells (Figures 4 and 5), and characterized rheumatoid arthritis coexistent with gout.
Oxygen: could there be too much of a good thing?
Authors: Rosenthal Robert E , Fiskum Gary
Published: May 2014

Supplemental oxygen is provided routinely to virtually all victims of serious injury or illness, often with little attention paid to the consequences of prolonged hyperoxia. Preclinical evidence, however, is mounting which suggests that the simple administration of oxygen can be damaging when given following selected incidences of ischaemia (low flow) and reperfusion.
Give oxygen, get a blood pressure… but don't overdo it
Authors: Singer Mervyn
Published: May 2014

Medical practice is based on a bedrock of conventional doctrine yet can be readily influenced by papers from high-impact factor journals and adroit marketing by opinion leaders and/or industry. These fads and fashions variably stand the test of time – some become ensconced as established dogma, some are jettisoned for ever, while others are discarded then belatedly rediscovered. Aspects of cardiorespiratory management of the trauma patient fall into all the above categories. Alas, the evidence base that makes these ‘facts’ incontrovertible is largely lacking. This article will attempt to steer a course through fact and supposition and will conclude with recommendations that, to the author at least, are founded in commonsense.
Damage control for torso trauma
Authors: Scalea Thomas M , X Kelly Francis
Published: May 2014

In the late 1980s, high-powered weaponry and multiple trajectories became common causes of injury in urban American trauma centres. Definitive injury repair often took many hours. Although surgery was technically successful, these patients often died of a lethal triad of hypothermia, acidosis and coagulopathy.
Uncross-matched blood is unnecessary
Authors: Thomas Michael JG
Published: May 2014

The proposition ‘uncross-matched RBCs save lives’ cannot be justified by just showing a few lives are saved in one of the world’s major trauma centres. It must be shown that, when used in an ordinary hospital setting, more lives are saved than lost. What are the risks and what are the benefits of using uncross-matched blood and, on balance, which is the greater? To answer this we need to ask three questions: Is uncross-matched blood necessary, safe and the best use of resources?
Renal medullary carcinoma: beware of diagnosing a urinary tract infection in a young sickle cell patient
Authors: Johal NS , Desai D , Cuckow PM
Published: May 2014

An 18-year-old Afro-Caribbean woman presented to her GP with a 2-week history of intermittent abdominal pain and was found to have microscopic haematuria. Her medical history was notable only for sickle cell trait. Examination was unremarkable and she was diagnosed as having a urinary tract infection. She re-presented with similar bouts of abdominal pain 2 months later and on clinical examination a large left supraclavicular lymph node was present. Excision biopsy of the lymph node raised the possibility of a metastatic renal tumour. Subsequent computed tomography imaging demonstrated a large 6 × 7 cm mass involving the upper part of the right kidney with extensive paracaval lymphadenopathy and encasement of the renal artery with metastasis to the liver, lung and ovaries (Figure 1). A laparotomy was carried out to make a definitive diagnosis before the start of chemotherapy. The tumour was found at multiple sites and was invading the inferior vena cava extending to the hepatic veins. Excision biopsy of the ovarian mass was performed and histology confirmed a metastatic renal medullary carcinoma. Following a trial of chemotherapy the patient died 4 weeks later.
Fatigue and doctors
Authors: Wilson Iain H
Published: May 2014

The Association of Anaesthetists of Great Britain and Ireland (2004) recently issued guidelines ‘Fatigue and Anaesthetists’. Although aimed primarily at anaesthetists, the document will prove helpful to all doctors and health-care staff. It provides a useful insight into the problem of fatigue, the implications for patients and staff, and looks at ways of reducing its impact in the workplace.
The Postgraduate Medical Education and Training Board
Authors: Thomas Anita J
Published: May 2014

The Postgraduate Medical Education and Training Board (PMETB) is an independent regulatory body which sets standards, approves, quality assures and evaluates postgraduate medical education and training. The PMETB is currently preparing to take over as the single competent authority for postgraduate medical education and training in September 2005.
Bladder extrophy
Authors: Sellaturay Senthy , Arya Mr Manit , Johal Nav , Cuckow Peter
Published: May 2014

A newborn male presented with bladder extrophy, a condition in which the abdominal wall and underlying structures, including the ventral wall of the bladder, fail to fuse in utero. As a result, the lower urinary tract is exposed, and the everted bladder appears through the abdominal opening (Figure 1).
Adult spontaneous hypoglycaemia
Authors: Griffiths MJ , Gama R
Published: May 2014

Spontaneous hypoglycaemia is not a diagnosis, but a manifestation of a disease process. It is important to recognize spontaneous hypoglycaemia, as treatment may be preventative or curative. It is equally important to avoid mislabelling healthy individuals as having hypoglycaemia as this may have a negative impact on the quality of life and use of scarce health-care resources.
Oesophago-bronchial fistula causing cough and recurrent lower respiratory tract infections in a patient with Crohn's disease
Authors: Brittenden J , Hosker HSR , Healey C , Porter G
Published: May 2014

A40-year-old non-smoking woman was referred to the outpatient clinic because of an increasing dry cough and recurrent lower respiratory tract infections over a 10-year period. The patient was diagnosed with Crohn's disease in 1979. The disease was initially confined to the large intestine but despite intensive medical treatment she required a total colectomy with ileostomy formation and, 2 years later, she was treated with a proctectomy.

In 1996 she developed a problematic nocturnal cough with associated early morning sputum expectoration and intermittent wheeze, which did not respond to a trial of inhaled bronchodilators. In 1998 she was admitted to hospital with a severe left lower lobe pneumonia, which responded well to oral ampicillin and erythromycin. She subsequently complained of coughing during meals but denied any indigestion or heartburn. There was no background of atopy, or history of asthma or rhinitis.

Systemic examination was unremarkable. Review of previous chest radiographs revealed recurrent changes of left lower lobe consolidation (Figure 1). Initial investigations including spirometry, biochemical screen, full blood count, immunoglobulin subclasses, aspergillus precipitins and sputum culture for bacteriology and tuberculosis were normal.

An initial diagnosis of minor localized bronchiectasis was made and the patient was referred to the physiotherapy department for postural drainage. Because of the persistent nocturnal cough, gastro-oesophageal reflux with aspiration was considered and a barium swallow arranged.

The barium swallow (Figure 2) demonstrated a fistula between the oesophagus and the left lower lobe bronchus arising approximately 10 cm from the gastro-oesophageal junction. Multiple ‘rose-thorn’ ulcers were also seen in the mid- and lower oesophagus. The barium, which passed into the left lower bronchial tree, did not demonstrate bronchiectatic changes (Figure 3). This was confirmed with high resolution computer tomography, which revealed some localized fibrosis in the left lower lobe, but did not show any evidence of bronchiectasis.

At endoscopy a 4 mm defect was seen at 32 cm, which was biopsied. The histology showed hyperplastic squamous epithelium with inflammatory changes but no features of malignancy.

The patient gained considerable relief of her symptoms from the use of antacid suspensions and propping the head of her bed at night. She discontinued the proton pump inhibitor owing to side effects, but has remained relatively symptom free during the last year. She has consistently refused enteral feeding and surgical intervention despite being aware of the potential risks of complications from the oesophago-bronchial fistula.
Prevention and management of ureteric injuries
Authors: Sorinola Olanrewaju , Begum Roksana
Published: May 2014

Ureteric injury is one of the most serious complications of gynaecological surgery with important medico-legal considerations. This review is aimed at understanding the anatomy of the ureter, sites of ureteric injuries, types and causes of injury, simple preventive measures and management.
Depression: diagnosis and management in terminal illness
Authors: Bache Xenia , Bolton Jim
Published: May 2014

Depressive illness is often not recognized in terminally ill patients, because it is seen as an ‘understandable’ reaction. However, treating depression in such patients can significantly improve the quality of their remaining life. The diagnosis and management of depression in terminally ill patients will be discussed in this article.
Career intentions of preregistration house officers and the influence of career advice
Authors: Stern Colin
Published: May 2014

Preregistration house officers were asked about their career intentions several times during their second 6-month posting. Most had decided already. Fewer planned to enter general practice at the end than at the start. Access to Web-based career advice and using Sci45, a computer-based career advice programme, were more valued than discussion with a career adviser or clinical tutor.
Metacarpal and phalangeal injuries
Authors: Wardle NS , Haddad FS
Published: May 2014

Injuries to the hand are common, phalangeal and metacarpal fractures account for 10% of all fractures. The resulting morbidity from delayed treatment to hand injuries is particularly high in the dominant hand. A brief overview of the salient conditions is presented here.
Improving outcome in Parkinson's disease
Authors: Nasar MA , Bankar RN
Published: May 2014

Parkinson's disease (PD), shaking palsy or paralysis agitans was described in 1817 by James Parkinson in his publication ‘An essay on the shaking palsy’ (Burch and Sheerin, 2005). PD is a syndrome characterized by bradykinesis, rigidity and tremor. In addition to reduced mobility, postural instability and falls, patients can experience difficulty in swallowing, malnutrition, depression and dementia.
Factitious disorder
Authors: Velazquez MD , Bolton J
Published: May 2014

A 38-year-old man presented with a 3-day history of abdominal pain and haematemesis, after swallowing several metal objects: razor blades, a magnet, a battery and keys. He requested surgery to have the objects removed. On physical examination he had generalized abdominal tenderness. The ingested objects were visible on an abdominal X-ray (Figure 1). Following admission the patient discharged himself before a psychiatric assessment could be made. Subsequently it was found that the patient had presented with the same problem to two local hospitals within the previous month.
Human rabies and its prevention
Authors: Durai Rajaraman , Venkatraman Ramya
Published: May 2014

Rabies is an important health problem worldwide and is invariably lethal. As there is no cure, prevention is very important. This review provides a comprehensive report on prevention of rabies for health professionals from both developed and developing countries.
Radiological signs of pneumoperitoneum: a pictorial review
Authors: Kasznia-Brown Joanna , Cook Chris
Published: May 2014

The erect chest X-ray is often the first investigation in the evaluation of free intra-peritoneal gas. This article reviews the appearances of free intra-peritoneal gas on both chest and abdominal radiographs.
Morton's neuroma
Authors: Briggs Peter J
Published: May 2014

Morton's neuroma is a common cause of metatarsalgia. This review highlights the importance of the history and examination in making the diagnosis and discusses the options for management.
Is central venous pressure monitoring appropriate for assessment of perioperative fluid balance?
Authors: Craig James , Mathieu Steve
Published: May 2014

Central venous pressure (CVP) has been the mainstay of perioperative fluid balance monitoring in the UK for many years. The relationship between CVP and right heart function is based on extrapolation of the Frank–Starling principle which assumes that CVP is proportional to right ventricular end diastolic volume and so contractility.
Hyper-elevated prostate-specific antigen levels are not always carcinoma
Authors: Lawrentschuk Nathan , Davidson Adee-Jonathan , Hurley Michael R , Crowley Peter F , Bolton Damien M
Published: May 2014

An 81-year-old man with a past history of diabetes, hypertension, ischaemic heart disease and cerebrovascular disease was admitted to hospital with hypotension and bradycardic collapse. Owing to persistent hypotension and a low urine output, an indwelling catheter (IDC) was inserted per urethra and a cardiac pacemaker was placed the following day. A serum prostate-specific antigen (PSA) level was back-ordered on initial bloods taken before IDC insertion, as passing the catheter was difficult and he was noted to have an enlarged prostate. A trial of void without catheter was successful 24 hours after initial insertion, leading to discharge that evening

He represented to the emergency department in acute urinary retention the day following discharge and gave no past history of significant lower urinary tract symptoms. An IDC was again inserted draining 700 ml and notes were obtained from his previous admission indicating that he had a PSA of 933 ng/ml (Immulite 2000, Diagnostic Products Corporation, Los Angeles, USA) on admission. The plan was for staging of prostate cancer and needle biopsy in the future to confirm the diagnosis. On examination, his prostate was enlarged and firm with no obvious nodular change.

A bone scan was negative for metastatic prostate cancer. Prostatic needle biopsies (18 gauge) were undertaken revealing benign glands and also the edge of coagulative necrosis (Figure 1). The necrosis involved both stroma and glands, and was surrounded by a zone of immature fibrous tissue containing nests of metaplastic squamous epithelium (Figure 2). Findings were consistent with prostatic infarction and there was no evidence of malignancy. A repeat serum PSA demonstrated a rapid descent to 9.3 ng/ml. The patient was discharged after a successful trial of void and is now catheter free.
Epidermolysis bullosa
Authors: McGrath John A , Mellerio Jemima E
Published: May 2014

Over the last decade, defining the molecular pathology of the inherited blistering condition, epidermolysis bullosa, has led to more accurate diagnoses, better genetic counselling, the feasibility of DNA-based prenatal diagnosis, and the possibility of newer forms of treatment, including somatic gene therapy.
Novel strategies in joint replacement
Authors: Jenabzadeh AR , Haddad FS
Published: May 2014

As the need for hip and knee replacement continues to increase, technical and material changes have allowed a dramatic evolution in the way that degenerative, inflammatory and traumatic arthritis are managed. Advances include new bearing surfaces which should have greater longevity, minimal incision joint replacement, computer guidance and partial joint resurfacing for younger patients. These advances and their implications are discussed.
Endocrine therapies for sarcopenia in older men
Authors: Solomon Andrew , Bouloux Pierre
Published: May 2014

This review looks at new therapeutic developments for the increasingly recognized problem of sarcopenia. Increased adiposity and reduced lean body mass characterize ageing men. The potential therapeutic role of the growth hormone/insulin-like growth factor axis, androgen modulators and myostatin inhibition are discussed.
Deliberate self harm and assessing suicidal risk
Authors: Ali Afia , Hassiotis Angela
Published: May 2014

Deliberate self harm (DSH) is one of the leading causes of acute medical admissions, with an estimated prevalence of 400 per 100 000 people (NHS Centre for Reviews and Dissemination, 1998). A large proportion of individuals who self harm do not present to accident and emergency and therefore the figure above is an underestimate of the true incidence. DSH has a strong association with completed suicide. The rate of suicide is highest in the year following an episode of DSH (Owens et al, 2002). Suicide accounts for 1% of all deaths every year, and the current rate is 10 per 100 000 people per year (Wright et al, 2003). Rates of suicide also increase following discharge from psychiatric hospital and release from prison. Patients who regularly present with DSH have a greater rate of eventual suicide.
So you want to be … a neurologist
Authors: Manji Hadi
Published: May 2014

Neurologists have, rightly or wrongly, had a reputation for being ‘brainy’ doctors. When I qualified in 1982, it was always the gold medallist who wanted to become a neurologist – a daunting prospect for mere mortals like myself. However, my decision to become a neurologist, after meandering through general practice and gastroenterology, pivoted on a chance remark by one of my mentors (who was considered one of the best clinical neurologists of his era) that ‘there is room for cloth cap neurologists like us.’
Taking blood for culture
Authors: Williams Emrys
Published: May 2014

Blood cultures are a common and useful investigation. Positive blood cultures can help in confirming a clinical diagnosis, localizing the site of infection and rationalizing antibiotic therapy. This review examines some of the issues regarding the optimal methods of blood culture collection. For the purposes of this review, a blood culture is defined as the blood taken at one venepuncture, irrespective of how many bottles are inoculated.
Interpretation of the shoulder radiograph
Authors: O'Regan Declan , Harvey Chris J , Allen Steve D
Published: May 2014

Shoulder injuries are a common presentation to emergency departments. The patient's history is important in determining the mechanism of injury and most fractures or dislocations will be apparent on clinical examination. Conventional (Xray) radiography provides the mainstay of traumatic shoulder imaging and it is important to request the appropriate views to avoid misinterpretation. Computed tomography (CT) may be used as a second-line investigation in complex fractures that require surgical intervention. It is important to remember that musculotendinous and cartilaginous injuries may not be apparent on plain radiographs and that ultrasound and magnetic resonance imaging (MRI) may be used to image these structures in selected cases.
Joint and soft tissue aspiration and injection
Authors: Patel Rahul , Haddad Fares
Published: May 2014

The indications for joint or soft tissue aspiration and injection are diagnostic or therapeutic. A common diagnostic indication is the aspiration of synovial fluid for evaluation. Synovial fluid evaluation can differentiate among various joint disease aetiologies including infection, inflammation and trauma. A second diagnostic indication involves injection of a local anaesthetic to confirm the presumptive diagnosis through symptom relief of the affected body part. Therapeutic indications for joint or soft tissue aspiration and injection include decreased mobility and pain, and injection of medication as an adjunct to other forms of treatment.
A sinus tachycardia and chest pain
Authors: Strike Philip C , Lambiase Pier D
Published: May 2014

This patient presented with severe central chest pain and the electrocardiogram (ECG) in Figure 1. What are the principal findings and which specific diagnoses should be promptly evaluated?
Femoral shaft fracture
Authors: Young Claire F , Haddad Fares
Published: May 2014

The femur is a long bone that extends from the hip to the knee. At its proximal end is the head, neck, greater and lesser trochanters, at the distal end a metaphyseal flare to the medial and lateral condyles. The femoral diaphysis (shaft) is bowed anteriorly. The femur is a tubular bone, which gives it strength to withstand axial loading; this enables it to perform its main function of allowing standing and walking.
Urethral catheters: a review of current practice
Authors: Kumar Priyadarshi , Pati Jhumur
Published: May 2014

The urethral catheter is one of the most recognizable and useful devices found on the wards. It is used in good measure by all medical and surgical specialities – both in hospital and the community. Its ubiquitousness has led to its acceptance as a benign tool. This does not, however, take into account the costs of morbidities that occur as a result of its use and the specialized care required to manage patients with long-term catheters. It is imperative therefore for medical practitioners of all specialities to understand the indications, techniques and complications that may occur.
Tibial and fibula fractures
Authors: Young Claire F , Haddad Fares
Published: May 2014

The tibia is the main bone of the lower leg. The diaphysis is triangular in cross section with an anteriorly directed apex. The medial border of the tibia lies subcutaneously. Proximally it articulates with the distal femur at the knee joint and distally with the talus at the ankle. It allows the limb to weight bear, acts as a lever arm for the calf muscles and helps transmit the neurovascular structures to the ankle and foot.
Telecare on tap, but at what price?
Authors: Claridge Sarah
Published: May 2014

A new UK telephone service recently launched by Talk to a Doctor claims to be the first in the world to give people the chance to connect directly with a doctor to discuss their concerns. Talk to a Doctor offers a private telephone and email service claiming to provide ‘access to immediate medical advice from home…giving people the chance to talk to a fully qualified doctor whenever they need to’.
Intestinal failure: the scale of the problem
Authors: Mathew Duncan , Carlson Gordon L
Published: May 2014

Intestinal failure is defined as a reduction in intestinal absorption, so that macronutrient and/or water and electrolyte supplements are needed to maintain health and/or growth. This review aims to clarify the nature and epidemiology of this condition.
Promoting intestinal adaptation
Authors: Wallis Katharina , Lloyd David AJ , Gabe Simon M
Published: May 2014

Intestinal adaptation is the process by which the intestine responds to loss of surface area in order to maximize functional capacity. Recent studies suggest that the process can be accelerated and augmented by a combination of nutritional and non-nutritional interventions.
Recruitment and retention into obstetrics and gynaecology: the influencing factors
Authors: Whitten SM , Higham J
Published: May 2014

The number of UK trained medical students entering obstetrics and gynaecology has fallen dramatically in recent years. Reasons for this are multifactorial, but consultation of the views of over 1500 undergraduates and postgraduates identified concerns over work–life balance, medical litigation and poor undergraduate experience. These negative perceptions need addressing to improve recruitment and to re-emphasize the key attractions of the specialty.
Managing the neuropsychiatric complications of hepatitis C treatment
Authors: Sockalingam Sanjeev , Shammi Chekkera , Stergiopoulos Vicky
Published: May 2014

Interferon-α is the mainstay of hepatitis C treatment and has been linked to several neuropsychiatric complications, including depression, anxiety, mania, psychosis and cognitive changes. This article reviews the management of neuropsychiatric adverse effects and the risks of interferon-α treatment to psychiatric patients.
Maternal request caesarean section: maternalvsmedical autonomy
Authors: Esen Umo I , Archibong Eric I
Published: May 2014

Maternal request caesarean section often pitches patient autonomy against medical autonomy. Where possible patient autonomy should form the cornerstone of treatment, without abdicating the physician's duty of care to the patient by agreeing to procedures which may cause more harm than good to the patient even if the patient so wishes.
Lung abscess rather than pneumatocele following kerosene ingestion
Authors: Aziz Azian Abd , Abdullah Ahmad Fadzil , Mahmud Azhar
Published: May 2014

A 5-year-old Malay boy was admitted to the authors' hospital for accidental kerosene oil ingestion with possible aspiration. He accidentally ingested kerosene oil which had been kept in a mineral water bottle but the amount ingested was not known. He then had several episodes of vomiting and subsequently became tachypnoeic. There was no history of seizures.

On physical examination, he was conscious but tachypnoeic with a respiratory rate of 50 per minute. There was a smell of kerosene from his mouth. He was afebrile and other vital signs were normal. His oxygen saturation ranged from 97% to 99%. Respiratory system examination did not show other abnormalities. Examination of other systems was unremarkable.

His chest radiograph on admission (Figure 1) showed no abnormal findings. He was observed in the ward and managed conservatively. He became more tachypnoeic and developed a high grade fever of about 39°C 12 hours after admission. His repeated chest radiograph (Figure 2) suggested pneumonitis of the left lung. Intravenous cefuroxime was instituted.

He showed clinical improvement and was asymptomatic 1 week later. However, a chest radiograph taken before discharge (Figure 3) showed a thick wall cavity approximately 3 × 2.5 cm in size with evidence of air–fluid level in the left lower lobe. Computed tomography of the thorax (Figure 4) showed that only one cavity was present. This was presumed to be a partially treated lung abscess and intravenous ceftriaxone was commenced. He completed 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral cefuroxime. He responded well to the antibiotics and a chest radiograph taken on follow up about 5 months later showed the cavity in the left lower lobe had completely resolved.
Choroidal melanoma
Authors: Sallam Ahmed , Hungerford John
Published: May 2014

This article reviews the current literature on choroidal melanoma and discusses its presentation, simulating lesions and current management. Choroidal melanoma is a major ocular problem that could threaten the patient's life and requires early diagnosis and treatment.
Mechanisms of symptoms of the common cold and influenza
Authors: Eccles Ron
Published: May 2014

The symptoms of colds and flu are well known by everyone, but the mechanisms causing the symptoms are poorly understood despite a great increase in our knowledge of the viruses involved.
Caecal diverticulitis: can it be differentiated from acute appendicitis?
Authors: Siriwardana HPP , Abeysekara AMS , Lauffer GL
Published: May 2014

Caecal diverticulitis is a rare cause of right iliac fossa pain in the Western world. It is often clinically indistinguishable from acute appendicitis. This article presents two cases of patients with caecal diverticulitis who were suspected to have acute appendicitis before operation.
Major elective gastrointestinal surgery: does fluid restriction improve outcome?
Authors: Gobindram A , Gowrie-Mohan S
Published: May 2014

Controversy regarding fluid therapy for major surgery dates back to the 1950s and is largely based on two differing concepts: the first, that the metabolic and stress response to surgery causes water and sodium retention, and the second, that there is redistribution of fluid into a hypothetical ‘third space’ leading to a fall in intravascular volume. Aggressive perioperative fluid resuscitation is the standard of care provided by many anaesthetists, however, evidence seems to suggest that this is flawed. Unfortunately, the answer is not as simple as following a restrictive fluid regimen.
Career choices: foundation year trainees' views on careers advice and information
Authors: Goodyear Helen , Kennedy Clare , Wall David
Published: May 2014

This article looks at careers information sources and advice for junior doctors in foundation training programmes and their specialty of choice. The need for targeted career planning is discussed.
Controlled non-heart-beating organ donation in intensive care
Authors: Murphy Paul G
Published: May 2014

Controlled non-heart-beating organ donation offers the option of donation following anticipated cardiac death on an intensive care unit. Although a number of units in the UK have successful non-heart-beating organ donation programmes, many clinicians still have significant ethicolegal uncertainties about the process.
Ten years on: has competence and training in temporary transvenous cardiac pacing improved?
Authors: Sankaranarayanan Rajiv , Msairi Adel , Davis Gershan
Published: May 2014

Ten years ago in the pre-Calman era, Davis and Roberts (1996) examined the practice of temporary cardiac pacing in north-west England. Now, in the post-Calman and Modernising Medical Careers era, a new survey has found no improvement in this important practice.
Urogynaecology: an ambulatory approach
Authors: Patwardhan S , Arunkalaivanan AS
Published: May 2014

An ambulatory approach in urogynaecology offers advantages to both patients and providers, offering significant savings on service delivery. This review provides an analysis of and information on procedures available for the ambulatory setup.
Haematuria 2: imaging investigations, management and follow up
Authors: Ghani Khurshid R , Keeler Barrie , Nargund Vinod
Published: May 2014

Haematuria is a common complaint presenting to doctors in both primary and secondary care. It can be a sign of underlying urinary tract malignancy. Appropriate investigation and management should follow evidence-based practice and recognized guidelines, and subsequently lead to a rapid diagnosis.
Principles of plaster application
Authors: F Young Claire , Haddad Fares
Published: May 2014

The principle of management of any fracture is to reduce the fracture, immobilize until bony union is achieved and then rehabilitate the patient. There are various methods of fracture immobilization varying from simple custom-made splints or plaster application for non-operative methods to various different operative techniques.
Oesophageal rupture
Authors: Shenfine Jon , Griffin S Michael
Published: May 2014

Oesophageal perforation is a rare but catastrophic event which can occur through a variety of insults. The risks of external trauma are low because of the mediastinal position of the oesophagus but the escalating availability of upper gastrointestinal endoscopy and associated instrumentation has resulted in an increase in iatrogenic damage which now accounts for the majority of injuries. Oesophageal perforation carries a high morbidity and mortality because of the difficulty of access to the oesophagus, the unusual blood supply, the lack of a strong serosal layer and the proximity of vital structures. Added to this, clinicians gain limited exposure to these cases because of their rarity.
Rib fractures, pneumothorax, haemothorax and chest drain insertion
Authors: Kang Sertaz-Niel
Published: May 2014

Thoracic trauma poses a significant threat to life and contributes significantly to deaths that occur within the so-called ‘golden hour’. Therefore, it is important to recognize patients with significant chest trauma and to treat them immediately without the need for a definitive diagnosis. This article deals with the presentation and management of the most common chest injuries.
The contribution of physiotherapy to the management of osteoarthritis
Authors: Hurley Michael V
Published: May 2014

People with osteoarthritis are frequently referred for physiotherapy to improve pain and function. All health-care interventions must be safe, effective, acceptable, deliverable and affordable. This article summarizes some of the evidence evaluating whether physiotherapy achieves these aims.
The UK Renal Registry: an overview
Authors: Tomson Charles , Ford Daniel , Ansell David
Published: May 2014

The UK Renal Registry ( www.renalreg.org ) performs national audits of the care of patients with established renal failure in the UK. Data from all patients receiving renal replacement therapy in each renal centre in England, Wales and Northern Ireland are analysed in the UK Renal Registry, and data on Scottish patients are sent by the Scottish Renal Registry, which is run independently.
Congenital malformations of the brain
Authors: Ganeshan Dhakshina , Das Kumar
Published: May 2014

This article describes some of the commonly encountered malformations of the brain. It is important to be aware of the characteristic clinical and radiological features of these conditions to enable correct diagnosis and proper management.
The changing face of coeliac disease
Authors: Mehta Gautam , Taslaq Samer , Littleford Sarah , Bansi Devinder Singh , Thillainayagam Andrew
Published: May 2014

Coeliac disease was considered to be a rare childhood affliction causing malabsorption and weight loss. It is now recognized to occur at any age with a range of non-specific manifestations including anaemia, recurrent miscarriages, neuropsychiatric disorders and osteopenia. This article summarizes advances in diagnosis and innovations in therapy.
Medical conditions in works of art
Authors: Salter Victoria , Ramachandran Manoj
Published: May 2014

With their stark contrast and blurred boundaries, the relationship between science, medicine and art has long been a fascinating area of exploration. The depiction of medical conditions in art has enhanced our understanding of the evolution of disease and its treatment, but exact diagnosis of the underlying medical conditions can be difficult. This article reviews some paintings suggesting underlying medical diagnoses under specialty-based headings.
Surgical management of morbid obesity
Authors: Aggarwal Rajesh , Hodgson Luke , Rao Christopher , Ashrafian Hutan , Chow Andre , Zacharakis Emmanouil , Athanasiou Thanos , Darzi Ara , Johnston Desmond
Published: May 2014

Obesity affects 1.7 million people worldwide, and is a leading cause of morbidity and mortality. Outcomes of conservative management are generally poor. Surgery for morbid obesity has reported excellent results, leading to an exponential increase in numbers of procedures performed.