bluuebunny/crossref_metadata_2025 huggingface dataset:
An evaluation of the use of the mini-CEX in the foundation programme
Authors: Jackson Dawn , Wall David
Published: May 2014

The mini-clinical evaluation exercise (mini-CEX) is used as an assessment in the foundation programme. This article reports a study of its reliability, validity and feasibility when used by foundation trainees, and also evaluates their satisfaction with and the educational impact of the tool.
Professional development of medical educators
Authors: Swanwick Tim , McKimm Judy
Published: May 2014

Clinicians are increasingly involved in teaching, learning, assessment and supervisory activities with medical students, trainees and other health professionals. Participation in professional development pathways and activities in medical education enables clinical teachers to provide high quality education and training.
Lymphoma in the immunocompromised
Authors: Sita-Lumsden Ailsa , Harris Philippa , Bower Mark
Published: May 2014

Lymphomas occur with a greatly increased frequency among immunocompromised individuals regardless of whether the immunodeficiency is congenital, acquired as a result of HIV infection or iatrogenic as a result of anti-rejection therapy in allograft recipients. This article focuses on the differences in clinical management of these lymphomas.
Acute kidney injury in patients with decompensated heart failure
Authors: Borman Natalie L , Kalra Philip A , Kalra Paul R
Published: May 2014

Decompensated heart failure is one of the leading causes of acute hospital admission in the UK. Worsening renal function, essentially reflecting acute kidney injury, is frequently encountered in such patients and is associated with significantly worse outcome. Recognition and appropriate management of such patients is vital.
Management of delirium in the intensive care unit
Authors: Page Valerie , Gough Katie
Published: May 2014

Intensive care psychosis, intensive care unit syndrome, acute confusional state and acute brain dysfunction are all delirium, a manifestation of acute brain failure associated with serious adverse outcomes. Most intensive care delirium is hypoactive and undetected. Screening for and managing delirium could significantly improve outcomes.
Approaches to medical education research
Authors: Morris Clare , McKimm Judy
Published: May 2014

Clinical teachers need to be able to make informed judgements about the quality of published educational research before drawing upon it to enhance their teaching and learning. Those wishing to conduct educational research may have to re-think the nature of ‘evidence’ to develop and use appropriate research approaches.
Bearing couples in total hip arthroplasty
Authors: Tailor Hiteshkumar , Patel Shelain , Patel Rahul V , Haddad Fares S
Published: May 2014

Total hip arthroplasty is a well-established treatment for arthritis of the hip. The choice of bearing couple used for articulation should be tailored to the patient. This article reviews the history of different bearing surfaces, and outlines the advantages and disadvantages that may influence their use.
Cranial computed tomography 2: use in clinical practice
Authors: Thomas Robert H , Burke Christopher J , Howlett David
Published: May 2014

The importance of cranial computed tomography in the diagnosis and follow up of intracranial pathology cannot be underestimated. Clinicians at every level should have a basic understanding of this technique. This second part discusses the practical use of computed tomography in the clinical setting.
Epidurals and their care on a surgical ward
Authors: Whiteman Abigail , Stephens Robert CM
Published: May 2014

An epidural is a small catheter that is placed blindly into the epidural space. Local anaesthetics and other analgesics injected through the catheter act locally on the nerve roots and also directly on the spinal cord. In acute hospitals, epidurals are often the domain of the anaesthetist but it is important that all specialties know how to appropriately advise patients and recognize complications. This article gives a general overview of epidurals and their care on a surgical ward for the non-anaesthetist.
Wernicke’s encephalopathy: a preventable cause of maternal death
Authors: Wedisinghe Lilantha , Jayakody Kaushadh , Arambage Kirana
Published: May 2014

Wernicke’s encephalopathy is a rare cause of maternal death. It is a difficult diagnosis to make but prevention and treatment is straightforward. Severe thiamine deficiency causes Wernicke—Korsakoff syndrome. Correct diagnosis and treatment with thiamine will decrease the case fatality rate.
How will health-care organizations meet venous thromboembolism targets?
Authors: Brigic Adela , Bloor Jonathan , Clark Amanda , Thomas Michael
Published: May 2014

Health-care organizations need to develop a strategy to ensure that all hospitalized patients receive appropriate thromboprophylaxis. This review describes an evidence-based model which could improve service delivery, meet national targets, save money and reduce the incidence of hospital-acquired venous thromboembolism.
Carotid body tumours
Authors: Naughton Jamie , Morley Eoghan , Chan David , Fong Yiewfah , Bosanquet Dave , Lewis Mike
Published: May 2014

Carotid body tumours are a rare class of paraganglionoma arising from the upper neck, but should be considered in the differential diagnosis of neck lumps. A wrong diagnosis of cervical lymphadenopathy followed by excision biopsy may have serious consequences. The only way to minimize such risk is to be aware of their existence.
Opportunities for learning in the surgical workplace and how they can be exploited: a practical guide
Authors: Papettas Trifonas , Saedon Habiba , Saedon Mahmud
Published: May 2014

Training times and the working week have been shortened but the amount needed to be learned remains the same. This article demonstrates how trainees in surgery can incorporate learning opportunities into their normal working day.
Drug fever and DRESS syndrome
Authors: Milliken Don , Roosinovich Elena , Wilton Hannah , Lipworth Adam D , Moore David , Morris-Jones Stephen , Marks Daniel JB
Published: May 2014

Febrile drug reactions are under-recognized and challenging to diagnose with possible major implications for treatment and, in the case of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, significant mortality. This review presents an illustrative case and describes the pathophysiology, diagnosis and management.
Renal failure in chronic liver disease and the hepatorenal syndrome
Authors: Srivastava Brijesh , Alexander Graeme JM
Published: May 2014

Hepatorenal syndrome is a distinctive complication of cirrhosis. Advances in understanding its pathogenesis have lead to new treatments with improved outcomes. This article focuses on evidence-based management of renal failure in cirrhosis including hepatorenal syndrome, in the context of pathophysiological changes that occur.
Clinical leadership: the challenge for senior leaders
Authors: McKimm Judy , Spurgeon Peter , Needham Gillian , O'Sullivan Helen
Published: May 2014

Doctors in senior positions in health care and health-care education organizations are increasingly required to take wider management and leadership responsibilities. A range of development programmes are available to support these leaders at local, regional, national and UK levels.
Management of surgical conditions of the wrist
Authors: Ali Erden , Horwitz Maxim , Sorene Elliot
Published: May 2014

The wrist is a joint with multiple ranges of motion, which permit a wide range of functional applications. This article reviews the surgical conditions that adversely affect wrist function and the management of these conditions.
Carpal tunnel syndrome
Authors: McCartan Bevin , Ashby Elizabeth , Taylor Emma J , Haddad Fares S
Published: May 2014

Carpal tunnel syndrome is an entrapment median neuropathy affecting up to 1 in 20 individuals. Owing to recent NHS cuts, it has now been classified as a low priority procedure. This article discusses the diagnosis and management of this common clinical condition.
Who should set the standards for surgical assessments?
Authors: Sadideen H , Kneebone R
Published: May 2014

In light of national policy and educational theory, this article addresses the question of who should set the standards for surgical assessments, highlighting the multidisciplinary nature of those currently (and potentially) involved.
Managing pancreatoduodenal trauma
Authors: Williamson JML , Williamson RCN
Published: May 2014

Pancreatoduodenal injuries are an uncommon but important source of morbidity and mortality in the trauma patient. They require a multidisciplinary approach, with a pancreatic surgeon involved at the earliest opportunity. The investigation and management of these injuries are discussed along with the role of operative intervention.
Paraoesophageal hernia: an overview
Authors: Hennessey D , Convie L , Barry M , Aremu M
Published: May 2014

Paraoesophageal hernias are a rare but clinically important type of hiatus hernia. Gastric volvulus and perforation may ensue. Investigation and management is determined by patient presentation.

This review summarizes current research regarding paraoesophageal hernias.
First seizure in the adult: management in the emergency department
Authors: Sarkar Pamela , Ibitoye Richard T , Sturman Steve , Sarkar Prabodh K
Published: May 2014

This article provides an up-to-date evidence-based framework for the management of first presentation of an adult seizure in the emergency department. It reviews current guidelines and outlines a patient pathway from decisions to admit to discharge in the emergency department.
Surgical management of chronic thromboembolic pulmonary hypertension
Authors: Ng Choo , Jenkins David P
Published: May 2014

Chronic thromboembolic pulmonary hypertension results from occlusion of the pulmonary vascular bed by non-resolving thromboembolism. This article reviews the pathogenesis, diagnosis and surgical management of chronic thromboembolic pulmonary hypertension with a focus on current literature and surgical management.
Coronary chronic total occlusions and percutaneous coronary intervention
Authors: Magri Caroline J , Carlino Mauro , Xuereb Robert G
Published: May 2014

Coronary chronic total occlusions occur in a third of patients with coronary artery disease but percutaneous coronary intervention is attempted in a minority. The benefits and limitations of percutaneous coronary intervention for chronic total occlusion are discussed together with suggested management and future directions.
Glucagon-like peptide-1 agonists in the treatment of type 2 diabetes
Authors: Edwards CMB
Published: May 2014

This review discusses the rationale behind escalation of treatment for type 2 diabetes, and argues that after failure of oral medication the next logical treatment is a glucagon-like peptide-1 agonist.
New therapies in the management of type 2 diabetes mellitus
Authors: Hardman TC , Dubrey SW
Published: May 2014

New therapies for type 2 diabetes are many and varied in their approach, with several recent advances now questioned because of an adverse longer-term side-effect profile. This review describes some of the major recent and prospective developments.
The future of surgical training
Authors: MacFie John
Published: May 2014

With the prospect of a 30-year medical career, surgical training today needs to meet the demands of society and the surgical landscape of the future. Surgery provides a stimulating, satisfying and rewarding career. This can only be maintained if we recognize and confront the challenges of modern surgical training.
Who should be treating rectal cancer in 2013?
Authors: Thompson Chris , Williams J Graham
Published: May 2014

Management of rectal cancer has advanced significantly over the last 30 years. As the complexity of treatment increases the question of superspecialization has arisen as a means of concentrating expertise and improving outcome. This article argues that this may have merit, but only for very early and very advanced tumours.
A Papillon patient's journey
Authors: Davies Mark
Published: May 2014

The default setting in the treatment of lower rectal cancer is radical surgery. This is the story of a patient who said no to surgery and was more concerned about his quality of life post-treatment than the fear of his death.
Management of liver trauma
Authors: Williamson JML , Rees JRE , Streets CG , Strickland AD , Finch-Jones MD
Published: May 2014

The increasing incidence of hepatic trauma has been mirrored by a rise in the expectant management of these injuries. Liver injuries should be managed in a multimodal manner, with discussion with regional specialist units.
Using audit to improve provision of analgesia for insertion of permanent pacemakers in children
Authors: Boynton Claire , Jaggar Sian I
Published: May 2014

Pain has an adverse effect on the patient experience in hospital. The authors' institution used audit to improve the use of analgesia in the paediatric population.

The audit cycle was repeated five times. Using education and training the institution was able to improve analgesia provision. A significant reduction in the number of children receiving no analgesia was demonstrated. In addition no further adverse event forms were submitted. Using audit can be an effective way to improve delivery of quality care.
Gastrointestinal manifestations of HIV infection
Authors: Blanshard Christine
Published: May 2014

As patients with human immunodeficiency virus (HIV) infection become more immunocompromised, gastrointestinal symptoms become more common. Most symptoms result from opportunistic infections and can be diagnosed and treated by gastroenterologists, although medical microbiology and histopathology input is essential.
The experience of Spanish trainees in the UK (1986-1996): a tragedy in four acts
Authors: Santana Sergio
Published: May 2014

In 1986 Spain became a member of the European Economic Community. Since then an increasing number of Spanish doctors have come to the UK seeking specialist training. This article gives a brief account of their experience.
Early prevention of fracture in osteoporosis: new developments
Authors: Wilkin TJ
Published: May 2014

Fractures in postmenopausal women are an important health issue in industrialized countries. Their cost to the NHS is believed to exceed £1 000 million per year. Postmenopausal osteoporosis is characterized by high bone resorption consequent upon oestrogen deficiency.
External cephalic version
Authors: Green Pauline M , Alfirevic Zarko
Published: May 2014

The management of breech presentation at term is variable. This article presents the options, and reviews the current evidence for, and success rate of, external cephalic version. The work of the breech clinic at the Liverpool Women's Hospital is also discussed.
Diabetes and the heart
Authors: Hyde Tom , Timmis Adam D
Published: May 2014

Diabetes mellitus adversely affects the pathology, presentation and outcome of patients with coronary artery disease. Knowledge of the risks and benefits of medical and mechanical therapies particular to diabetic patients is useful in the optimal management of diabetic heart disease.
Nurse mentors for preregistration house officers
Authors: Pearce Heather , Blainey David
Published: May 2014

Newly qualified junior doctors experience ‘reality shock’ when they start work on the wards. This article describes the development of a nurse mentorship scheme which uses the skills and expertise of senior ward nurses to help them through this transition. It has proved to be both popular and successful.
Sildenafil: desired and undesired effects
Authors: Vallance Patrick
Published: May 2014

About 50% of men aged between 40–70 years have some degree of erectile dysfunction, and 30% report moderate to severe impotence (Goldstein and Beavo, 1998). Vascular disease, diabetes, prostate surgery, psychiatric disorders and concomitant drug therapy may predispose to impotence, and psychological factors exacerbate the problem. Sildenafil (Viagra, Pfizer) is the first orally active treatment for impotence, and has attracted much attention in the lay and professional press. This article describes some of its wanted and unwanted effects.
Surgical training for the next millennium
Authors: Varghese D , Patel H , Varghese A
Published: May 2014

The Calman reforms in training have meant that surgical training now consists of a 2-year basic training period followed by a 6-year period of higher surgical training. This article addresses the problems faced by the new Calman surgical trainees and proposes some new measures which could be introduced for surgical training in the next millennium.
Osteoporosis in anorexia nervosa
Authors: Treasure Janet , Serpell Lucy
Published: May 2014

Anorexia nervosa is a disorder characterized by low body weight and amenorrhoea (in females). These features lead to a risk of osteoporosis, a condition in which bone loss leads to weakening of bone structure and increased fracture risk.
Levomepromazine for nausea and vomiting in advanced cancer
Authors: Skinner Jenny , Skinner Andrew
Published: May 2014

Levomepromazine (previously known as methotrimeprazine), despite virtually no high quality scientific data to support its use, has become a very popular antiemetic for use in patients with advanced cancer. This article considers the reasons for this.
Stenting in the oesophagus
Authors: Cowling MG
Published: May 2014

Self-expanding metallic stents have assumed increasing importance in the palliative treatment of malignant dysphagia in recent years. This is most commonly the result of inoperable oesophageal cancer, but may also be the result of extrinsic compression on the oesophagus by other malignant masses. Stents are also occasionally used as a last resort in benign disease.
Improving outcomes in rectal cancer
Authors: Myint Arthur Sun , Carter Paul , Hershman Michael J
Published: May 2014

Concerted efforts are being made to improve the poor surgical outcomes in rectal carcinomas and this includes the use of total mesorectal excision by specially trained colorectal surgeons, in addition to the use of pre- or postoperative radiotherapy and chemotherapy. The role of each modality should be carefully evaluated, and benefits weighed against toxicity and added costs.
Acute heart failure: a practical guide to management
Authors: Murdoch David R , McMurray John JV
Published: May 2014

Acute heart failure is a common cause of referral and admission to hospital. It requires prompt recognition and treatment. This article will address the practical issues regarding diagnosis, investigation, treatment and prevention of recurrence.
Sample size determination in clinical research: 2
Authors: Ogundipe Laofe
Published: May 2014

In the second of this two-part series, comparative study design is considered and, using examples, power calculation is explained. The information required for calculating sample size for comparative studies is highlighted.
Managing patients with meconium-stained amniotic fluid
Authors: Ash Alok K
Published: May 2014

Meconium-stained amniotic fluid might signify underlying acute or chronic fetal hypoxia with adverse perinatal outcome, especially if associated with cardiotocographic abnormality. Management requires awareness of this potential risk, appropriate intrapartum care and a combined obstetric-neonatal approach. Amnioinfusion can be an effective preventative measure.
The effect of 1-year rotations on stress in preregistration house officers
Authors: Firth-Cozens Jenny , Rayner Catherine , Moss Fiona , Paice Elisabeth
Published: May 2014

A comparison of stress levels in preregistration house officers demonstrated lower levels in those completing 1-year rotations compared with those completing 6-month posts in two different hospitals. One-year rotations provide a more stable environment, allow new doctors to become familiar with the workings of an organization from several viewpoints and permit a better sense of working within a multiprofessional team than the traditional arrangements.
Writing a case report: an editor's eye view
Authors: Fox Robin
Published: May 2014

‘That was a nice presentation. Why not write it up for a journal?’ With such words a thousand case reports are born. But they are like birds tossed over a stormy ocean: only a few gain a foothold in the rigging of passing ships — for the rest, oblivion. So, how do you persuade an editor to accept your wonderful case report? Here are some reflections from the editor's standpoint.
The value of ultrasound scanning in breast disease
Authors: Svensson WE
Published: May 2014

Ultrasound is the modality of choice for imaging breast masses. Most benign and malignant lesions can be accurately categorized as a result of improvements in grey scale imaging and the development of sensitive colour Doppler vascular mapping. Ultrasound contrast agents, harmonic imaging, elasticity imaging and other advances will further enhance the utility of breast ultrasound.
Transportation of the critically ill and injured patient
Authors: Shirley Peter J
Published: May 2014

Transferring the seriously ill and injured is becoming a more formalized procedure in the UK. Whether from an accident site to medical care or between hospitals, the public expects that organized services are in place for safe patient transfer. As this is a developing subspeciality it is necessary to review the developments that have occurred over the previous 5 years.
Modernizing the journal club
Authors: Dwarakanath Linga S , Khan Khalid S
Published: May 2014

Traditionally journal clubs provide a forum to learn presentation skills. We propose a new approach to teaching and learning in journal clubs, focusing on literature acquisition and critical appraisal skills. This approach will enable trainees to use journal clubs for personal professional development as well as for application of new knowledge in clinical medicine to improve patients' outcomes.
Recurrent alcoholic ketoacidosis with hyperglycaemia in a non-diabetic patient
Authors: Gill Geoffrey , Yong Alice
Published: May 2014

A39-year-old man was admitted urgently with abdominal pain and vomiting to a surgical ward. He had a history of excessive alcohol intake and previous attacks of acute alcoholrelated pancreatitis. Examination was unremarkable apart from a tachycardia of 120/minute in sinus rhythm and generalized abdominal tenderness. Investigations revealed normal haemoglobin, urea and electrolyte levels. White cell count (WCC) was 11.5/mm3 and plasma glucose 13.1 mmol/litre (there was no past or family history of diabetes). Urine was heavily positive for ketones. Serum amylase was normal. Arterial blood gases showed a metabolic acidosis (pH 7.18, pCO2 2.1 kPa, pO2 18.7 kPa, base deficit 19 mmol/litre and standard bicarbonates 10 mmol/litre). No definite diagnosis was made, but the patient was treated with intravenous 0.9% sodium chloride (NaCl) infusion, and his symptoms settled and the blood gases normalized spontaneously over the next 1–2 days. Apart from the initial raised plasma glucose, all subsequent levels were normal.

Three months later the patient was again admitted urgently with abdominal pain and vomiting, this time to a medical ward. In the period since his last admission he had continued to drink excessive amounts of alcohol, and had had a particularly heavy ‘binge’ over the preceding 2–3 days. On examination he was moderately dehydrated and tachycardic, with hyperventilation and generalized abdominal tenderness. Serum amylase and electrolytes were normal, but urea and creatinine were slightly raised at 8.1 mmol/litre and 142 μmol/litre respectively. WCC was 22.1/mm3 and urine was heavily positive for ketones. Plasma glucose was 13.9 mmol/litre. Arterial blood gases again showed a metabolic acidosis (pH 7.22, pCO2 1.5 kPa, pO2 18.5 kPa, base deficit 20 mmol/litre and standard bicarbonate 8 mmol/litre). A serum lactate level was taken at the time and later returned at 3.9 mmol/litre. A diagnosis of either euglycaemic diabetic ketoacidosis or alcoholic ketoacidosis was made. He was treated with 0.9% NaCl intravenous rehydration, as well as a glucose–potassium–insulin infusion. He improved clinically and biochemically over the next 2 days, and again, apart from the initial raised plasma glucose level, all subsequent levels were normal.

Six weeks after the second admission an outpatient glucose tolerance test was performed, with the patient on a free diet and no medication. The fasting plasma glucose level was 7.3 mmol/litre, and the plasma glucose level 2 hours after a loading dose of 75 g of glucose was 6.4 mmol/litre. Over the subsequent 2 years the patient had 3 further hospitalizations (one with a haematemesis as a result of a Mallory–Weiss oesophageal tear, and two with non-specific abdominal pain). No further episodes of alcoholic ketoacidosis occurred, nor did the patient develop diabetes.
Clinical and laboratory diagnosis
Authors: Richardson Malcolm , Ellis Michael
Published: May 2014

Clinical diagnosis of invasive fungal infections demands a high clinical acumen, but both under- and over-diagnosis are common. Laboratory mycological tests have traditionally been limited by a range of complications. Development of methodologies to detect fungal-specific immunoglobulins, cell wall antigens and nucleic acid have improved dramatically in recent years.
Transanal endoscopic microsurgery
Authors: Seehra Harkiran , Carter Paul S , Hershman Michael J
Published: May 2014

The anatomy of the pelvis makes it difficult to perform local excisions in the rectum when a tumour is some distance from the anal verge. Transanal endoscopic microsurgery, a minimally invasive procedure, has been developed. It provides an alternative to the transsacral or transabdominal approach, with subsequent shorter hospital stay and fewer complications.
Why do we still use suxamethonium for caesarean section?
Authors: England AJ , Sodhi Vinnie
Published: May 2014

The argument for retaining suxamethonium for general anaesthesia revolves around its rapid onset and short duration. Suxamethonium has served anaesthesia well for over 40 years, but has many adverse effects. Most women experience myalgia and histamine release, others suffer life-threatening cardiac dysrhythmias, anaphylactoid reactions, electrolyte disturbances, and muscle abnormalities such as malignant hyperpyrexia, masseter spasm and myotonic crises. Rocuronium provides comparable conditions for tracheal intubation without these problems.
Marfan's syndrome: a review
Authors: Aburawi EH , O'Sullivan J , Hasan A
Published: May 2014

Marfan's syndrome is an inherited disorder of connective tissue, in which the most pronounced abnormalities occur in the musculoskeletal, cardiovascular and ocular systems. Aortic dilatation and dissection are the major causes of morbidity and mortality. Recent advances in surgical techniques and earlier intervention have reduced postoperative mortality and morbidity.
Thyrotoxicosis induced by alpha interferon therapy for hepatitis C
Authors: De P , Allison MC
Published: May 2014

Aman aged 41 years was referred in 1995 for investigation of longstanding gastrointestinal symptoms. He was found to have an alanine transferase activity of 244 iu/litre and to be hepatitis C positive, both by antibody testing and polymerase chain reaction. He was human immunodeficiency virus negative. He was later confirmed to have cirrhosis on liver biopsy and was started on interferon-alpha (IFN-a) 3 MU three times weekly. Past medical history included irritable bowel syndrome, appendicectomy and intussuception. His surgery may have been accompanied by blood transfusion. He drank moderately, occasionally smoked marijuana and had a past history of injection drug use. His wife was also known to be hepatitis C positive following multiple blood transfusions. He had a positive family history of thyroid disease. His thyroid function tests before starting IFN-a showed free thyroxine (T4) 15.6 pmol/litre (normal range 9.6—26.5 pmol/litre) and thyroid-stimulating hormone (TSH) 0.2 mu/litre (normal range 0.6—4.8 mU/litre). Thyroid antibodies were not measured.
Postictal electrocardiographic changes mimicking acute myocardial infarction
Authors: Hodson AC , Poullis A
Published: May 2014

A63-year-old male presented to the accident and emergency department having collapsed. On arrival in the department a generalized tonic—clonic fit was witnessed which lasted less than a minute and resolved spontaneously. The patient was asymptomatic following this episode.
Microangiopathic haemolytic anaemia in metastatic malignancy
Authors: Lockhart A Craig
Published: May 2014

In May 1998, a middle-aged woman with a history of breast cancer, diagnosed and treated with a right-sided mastectomy 9 years previously, presented to the Duke University Medical Center with intermittent headaches, slurred speech, left arm numbness and a right facial droop.
Ascitic fluid analysis: the role of biochemistry and haematology
Authors: Jeffery Jinny , Murphy Michael J
Published: May 2014

In specific settings, biochemical and haematological analysis of ascitic fluid may provide answers to important clinical questions. This review seeks to outline the value and limitations of ascitic fluid analysis and the main clinical scenarios in which it may be useful.
A case of spontaneous cervical extradural haematoma
Authors: Ferry Peter , Reisner Colin , Ashpole Richard
Published: May 2014

This 75-year-old woman was woken by sudden-onset left-sided neck and shoulder pain. As she walked a few steps, her legs gave way and she collapsed. Her feet felt 'dead', with the right side feeling worse, and she felt pins and needles over both upper limbs. She had no headache, loss of consciousness, chest pain or palpitations. She had a past history of large joint osteoarthritis, cervical radiculopathy and essential hypertension. Two months previously, she had fallen to the ground while standing on a chair and had, in the process, hit the back of her head. She had suffered no immediate ill effects from this. She was on doxazosin, lisinopril and diclofenac. She lived alone and was normally fully mobile and independent.
Stress in hospital medicine: a problem for key hospital staff
Authors: Allen Isobel
Published: May 2014

Many factors which contribute to stress in the workplace apply to both consultants and ward sisters. Both groups find that their roles have become more complex while they have increasingly lost control of their own clinical and professional territory in a managerial culture. The erosion of the key relationship between consultants and ward sisters is of concern and the need for teamworking is insufficiently recognized.
Flexible training under threat
Authors: Houghton Anita , Eaton Jennifer
Published: May 2014

As the number of women in medicine and the general demand for a better work—life balance rises, flexible training is an increasingly important mechanism for maintaining the medical workforce. The new pay deal, together with entrenched cultural attitudes, are potential threats. Ways forward include more substantive part-time posts, more part-time opportunities at consultant level, and using positive experiences as a way of tackling attitudes in the less accepting specialties.
Treatment paradigms in heart failure
Authors: Money-Kyrle Andrew RW , Timmis Adam D
Published: May 2014

Heart failure patients suffer very severe morbidity, high mortality and are common in medical practice. Their need for effective treatments is only partially answered by current options. Effective treatments often address cellular and pathophysiological mechanisms which are involved in the progression of heart failure. This article reviews those mechanisms and treatments.
Lowering lipids after a stroke or transient ischaemic attack
Authors: McNaughton Harry
Published: May 2014

There is a lot of clinical uncertainty about how to aggressively pursue elevated cholesterol levels in patients following stroke or transient ischaemic attack. This article reviews the evidence linking cholesterol level with stroke and looks at whether treatment with lipid-lowering drugs can be justified.
Profound hypotension: ethical considerations
Authors: Jones Andrew G
Published: May 2014

The use of profound induced hypotension to provide better operating conditions for surgery is long established. However, it is a controversial technique and it may be argued that it is inappropriate in modern anaesthetic practice. A currently used technique is reviewed against the benchmark of a lawsuit concerning profound hypotension.
Glutamine-enhanced nutrition in the critically ill patient
Authors: Andrews Francis , Griffiths Richard
Published: May 2014

It is well established that critically ill patients have a deficiency of the amino acid glutamine. This article reviews the evidence for supplemental glutamine in the critically ill, focusing on the benefits in terms of reduced mortality and infectious morbidity.
The lesson from a yellow psychotic patient
Authors: Chari Suresh
Published: May 2014

The importance of a thorough physical examination in patients with psychiatric manifestations is highlighted in this interesting case. Although the presentation is by no means common, a missed diagnosis could potentially lead to a fatal outcome in what is otherwise an eminently treatable condition.
Testicular torsion unravelled
Authors: Shergill IS , Foley CL , Arya M , Bott SRJ , Mundy AR
Published: May 2014

Testicular torsion is a true vascular emergency - prompt diagnosis and surgical management is critical. If treatment is not instigated within 4-6hours of the onset of pain, irreversible testicular infarction may result, necessitating orchidectomy. This review presents the key features, management principles and medicolegal considerations of this serious condition.
Benign prostatic hyperplasia: solutions to an ageing problem
Authors: Foley Charlotte L , Bott Simon RJ , Arya Manit , Kirby Roger S
Published: May 2014

As the population ages, the demand for treatment of the symptoms of benign prostatic hyperplasia has never been higher. Equally the choice of treatments has never been greater. This review considers the medical and surgical options.
Activated protein C resistance and pregnancy loss
Authors: Dawood Feroza , Farquharson Roy , Quenby Siobhan
Published: May 2014

Activated protein C resistance is a thrombophilia with an established role in producing thrombosis which more recently has been implicated in the pathogenesis of pregnancy loss. This review will analyse recent literature to evaluate this association and address the gestation and type of pregnancy loss.
Progressive supranuclear palsy
Authors: Amar Khaled
Published: May 2014

Progressive supranuclear palsy, also known as Steele–Richardson–Olszewski syndrome, is an uncommon neurodegenerative parkinsonian disorder that starts in middle and late life, and is frequently misdiagnosed as Parkinson's disease. This review will cover the epidemiology, clinical picture, differential diagnosis and management of patients with progressive supranuclear palsy.
Carotid sinus syndrome
Authors: Mallet Mark
Published: May 2014

This article reviews the recent literature about carotid sinus syndrome. It looks principally at the various ways in which it may present, the limited knowledge of its pathophysiology, and the role of carotid sinus massage in the investigation of carotid sinus syndrome.
Specialist registrar training: what still needs to be improved?
Authors: Paice Elisabeth , Ginsburg Robert
Published: May 2014

It is 6 years since specialist training in the UK was radically reformed. Is educational quality still improving or have early improvements slipped as the novelty has worn off? What further improvements are needed to ensure the production of specialists who are properly prepared to be the consultants of the future? The authors address these questions from the perspective of one postgraduate deanery.
Bone transplantation
Authors: Rees DC , Haddad FS
Published: May 2014

Bony deficiency, particularly loss of bone stock associated with failed joint replacements or tumours, is a challenging problem in orthopaedic surgery. Bone transplantation techniques provide solutions that can be tailored to the clinical problem. However, the risks of bone transplantation are well documented and the biology of allograft incorporation remains unpredictable and poorly understood.
Tuberculous meningitis with tuberculomata presenting as postpartum pyrexia of unknown origin
Authors: Chan KH , Fong GCY , Tsang KL , Cheung RTF , Ho SL , Cheng PW , Ho PL
Published: May 2014

A35-year-old Chinese woman had primary infertility as a result of bilateral fallopian tube blockage. She had had uterine fibroids resected 3 years previously. Her precious pregnancy via in-vitro fertilization was complicated by premature rupture of amniotic membrane at 18 weeks' gestation. Two doses of betamethasone 12 mg were given at 29 weeks' gestation, and fetal bradycardia was noted on the next day. A baby girl was delivered by emergency caesarean section. The patient had a high swinging fever following the delivery. Extensive investigations for postpartum pyrexia were normal or negative. She was given courses of broad-spectrum antibiotics for 4 weeks before she developed mental dullness and right partial ptosis. On the next day, she became disorientated with left hemiplegia. Examination also revealed left-sided neglect, dysphasia, conjugate gaze deviation to the right, and left homonymous hemianopia. Computed tomography (CT) of the brain revealed a left temporal hypodense area (Figure 1a). Lumbar puncture revealed the following CSF findings: opening pressure of 34 cmH2O, protein level of 3.8 g/litre, glucose level of 2.1 mM (serum 6.4 mM), cell count of 30 × 106/litre (56% lymphocytes, 40% neutrophils, 4% monocytes), and red cell count of 11 × 106/litre. Other CSF tests were negative.
The role of the nurse endoscopist
Authors: McCallum Jane
Published: May 2014

Colorectal nurse specialist roles have developed since the publication of the Calman-Hine report, with most of the post-holders dealing specifically with patients with a diagnosis of colorectal cancer. While posts vary, many of these nurses also perform endoscopy as part of their role.
HIV/AIDS and the eye
Authors: Kramer Michal , Lynn William , Lightman Susan
Published: May 2014

The type of ocular involvement in the patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) depends on the level of immune function and systemic diseases present. Although the prognosis for patients with HIV/AIDS has changed dramatically with the introduction of antiretroviral therapy, infections involving the retina, such as toxoplasmosis, herpes simplex and herpes zoster (HZV), still occur although opportunistic infections such as cytomegalovirus (CMV) retinitis are much less common except in patients who present late in the course of the disease (Jabs and Bartlett, 1997; Jabs et al, 2002).
Non-traumatic coma
Authors: Tasker Robert C
Published: May 2014

Coma or encephalopathy implies a disorder of consciousness (Plum and Posner, 1983). In the UK, in children under 16 years of age, the incidence is around 30 per 100 000 children per year (Wong et al, 2001). There are a range of non-traumatic conditions capable of inducing coma (Seshia et al, 1977). Acute hospital management now follows standardized procedures and protocols that will be familiar to those who have completed either the Advanced Paediatric Life Support or Pediatric Advanced Life Support courses; a requirement for most paediatric senior house officers. This approach is summarized in Table 1
Radiotherapy for prostate cancer and sexual functioning
Authors: Incrocci Luca
Published: May 2014

The incidence of erectile dysfunction after radiotherapy for prostate cancer is high. A multifactorial aetiology has to be considered, taking into account pretreatment erectile function. Patients need to be informed about effective treatments such as sildenafil and intracavernosal injections.
Orthopaedic manifestations of tuberculosis
Authors: Wardle N , Ashwood N , Pearse M
Published: May 2014

An estimated 1 million people will be infected with tuberculosis worldwide in the first 20 years of the 21st century. If the disease is not recognized and treated early the morbidity and mortality of this condition will rise. This article highlights the varying manifestations of tuberculosis from an orthopaedic perspective.
Population screening for lung cancer
Authors: Armstrong Peter , Husband Janet E , Holemans John A
Published: May 2014

The feasibility of diagnosing small stage I lung cancers using low-dose chest computed tomography in asymptomatic at-risk individuals has been demonstrated in multiple studies. However, it has yet to be proved that the introduction of a chest computed tomography screening programme would do more good than harm at an acceptable cost.
Acute medicine: making it work for patients
Authors: Black Carol
Published: May 2014

The report of a working party of the Royal College of Physicians, Acute Medicine: making it work for patients, seeks to improve hospital care of patients who are acutely ill and highlights the developing role of consultant physicians in acute medicine.
Improving infrastructure
Authors: Claxton Peter
Published: May 2014

The Primary Capital Programme (PCP) is well underway and local authorities across England are considering how best to invest the extra funding. Peter Claxton looks at how schools can ensure the PCP supports an improvement in their teaching and learning
Autism training
Authors: Huggett Steve
Published: May 2014

The first national autism training programme for schools is offering free CPD for a range of education professionals. Steve Huggett explains
Measuring the intraocular pressure
Authors: Smith Chris
Published: May 2014

Measuring the intraocular pressure using Goldmann applanation tonometry is becoming an essential skill for ophthalmic nurses and technicians. Learning to competently perform this procedure will enhance your professional practice and the patient experience.
Interprofessional working: factors that contribute in practice
Authors: Tapper Gissel
Published: May 2014

Aim:

This paper comments on the processes involved in promoting interprofessional working in practice and elements that detract from the process. Analysis of empirical research data was carried out to answer the question: ‘How is interprofessional working promoted in practice?’

Background:

The common concern between all the authors of the studies selected was to identify contributing and detracting factors to effective interprofessional working.

Results:

The main findings were derived from views expressed by professionals interviewed regarding their experiences of interprofessional working. One most common theme that emerged was that trust developed over time and was vital for the process. Other features included professional's confidence, knowledge and skill in their own practice. Difficulties that arose were mostly attributable to the blurring of boundaries, lack of respect and understanding towards each others’ professional duties and responsibilities.

Conclusions:

The valuable knowledge gained can be used as the foundation for future studies in health and social care. As a result of the complexity of relationships in interprofessional working further exploration is needed to identify potential issues of professional differences. This study has identified a gap regarding the impact of interprofessional working in an ophthalmology setting. Further research could be conducted to identify how patients and various professionals could benefit from active interprofessional working in the area of ophthalmic practice.
Advanced level nursing: leadership and collaboration on practice
Authors: Cox Carol L
Published: May 2014

In 2010 the Department of Health for England published its position statement on advanced level nursing practice. It indicated that the position statement is intended to be used as a benchmark to enhance parient safety and the delivery of high quality care. Rationale for publishing the statement relates to confusion regarding the scope and competence required at an advanced level of practice. There has been a need for a set of nationally agreed standards for advanced level practice to support employers and commissioners in order to delineate good governance arrangements. In addition to defining the nature of advanced level nursing and what it encompasses the position statement serves as a guide that will help practitioners, commissioners, educators, service and workforce planners achieve their aim of building services focused on improving outcomes and experiences for patients. It has been indicated that as responsible automonous practitioners, advanced practice level nurses working in the field of ophthalmology must advocate for and on behalf of the community of patients and their interests.
Retinopathy of prematurity from a neonatal nursing perspective
Authors: Smith Liz
Published: May 2014

Retinopathy of prematurity is a potentially treatable disease of the preterm infant that is likely to continue being a complication in the neonatal intensive care. Today it is, at least to some extent, possible to predict those infants most likely to develop significant disease. Screening is still an essential and sometimes painful element for the baby. Treatment, where necessary, needs to be provided promptly and parents require effective support and information. Joint working between neonatal staff, ophthalmologists and allied personnel is vital to provide quality care.
The MOEWAT as a proposed method of evaluating orbital exenteration wounds
Authors: Cooper J , Waterman H
Published: May 2014

Orbital exenteration is a disfiguring and life-changing surgical procedure that involves the removal of the socket contents, including the eye, surrounding adnexa and, in some cases, the eyelids, orbital bone and sinuses. Wound healing of exenterated sockets can be complex and may take several months to completely heal. In an attempt to provide a framework for continuity of care for patients who undergo orbital exenteration surgery, we propose a socket wound assessment tool, which will allow professionals to track changes in orbital exenteration wounds. The Manchester orbital exenteration wound assessment tool (MOEWAT) has been developed to facilitate assessment and evaluation of post-operative exenterated sockets at any given time. Consequently, as the _first assessment instrument specifically developed for use in orbital exenterated patients, the MOEWAT could provide a basis for wound care decision making in relation to clinical findings.