bluuebunny/crossref_metadata_2025 huggingface dataset:
John Caius: early English physician, anatomist and epidemiologist
Authors: Ellis Harold
Published: May 2014

This year marks the birth, 500 years ago, of John Caius, a remarkable polymath. As a Greek scholar, physician, epidemiologist, anatomist, medical and academic administrator and generous benefactor, he was an interesting man! Caius was born in Lincoln in 1510. The family name was Keys, which he Latinised into a number of spellings, of which ‘Caius’ is the one in common use.
Recruitment and retention in obstetrics and gynaecology in the UK
Authors: Ogbonmwan SEO , Ogbonmwan DE
Published: May 2014

The problem of recruitment and retention into obstetrics and gynaecology could translate into serious manpower problems if not addressed now by making the experience of trainees and medical students rotating through the speciality memorable and improving trainees' work–life balance.
Perinatal and neonatal mortality in the advent of the neonatal network
Authors: Storey Imogen , Russell Alison Bedford
Published: May 2014

Infant mortality is highest during the neonatal period. The provision of medical care for low birth weight and premature babies is challenging. Neonatal networks aim to improve outcome, optimize efficiency and increase the quality of care for these infants.
Robert Koch: pioneer of bacteriology and Nobel prize winner
Authors: Ellis Harold
Published: May 2014

As a schoolboy I avidly read Paul de Kruif's (1926) Microbe Hunters. Robert Koch became my hero and I determined to become a doctor and to train as a bacteriologist. (Incidentally, my great disappointment was to find how boring the subject was, as taught at Oxford in those days. I rapidly changed my mind and decided to become a surgeon!) My school-boy role model died 100 years ago, in 1910.
Trans-Atlantic cryptogenic stroke
Authors: Pareek Nilesh , Lee Lorraine , James Rachael
Published: May 2014

A 27-year-old airline steward presented with a sudden onset of left-sided hemiparesis, which completely resolved in 48 hours. He had just completed a long-haul flight from the USA to England. He was previously fit and well, took no medications and was an occasional smoker and binge drinker. Physical examination on admission confirmed a left-sided hemiparesis and a left-sided upper motor neurone facial palsy. Cardiovascular and respiratory examinations were normal.

His admission bloods, chest radiograph and computed tomography scan of the brain were all normal. Magnetic resonance imaging of his brain (Figure 1) showed a small right-sided cerebral infarct in the internal capsule. Magnetic resonance angiography of his neck did not demonstrate carotid artery dissection. Venous Dopplers of the lower limbs were normal.

Standard transthoracic echocardiography was normal. A bubble contrast echocardiogram demonstrated a small right to left shunt at rest (Figure 2a). With release of the Valsalva manoeuvre, there was complete opacification of the left heart (Figure 2b) consistent with a large patent foramen ovale. The patient has now been enrolled into the Patent Foramen Ovale and Cryptogenic Embolism trial.
Tight glycaemic control in the critically ill: losing its grip?
Authors: Cain David
Published: May 2014

Tight glycaemic control in the critically ill is achieved by administering insulin to target a blood sugar concentration of 4.4–6.1 mmol/litre. This is a valid but controversial target: the Surviving Sepsis campaign currently supports a target of <8.3 mmol/litre. Proof of concept was originally demonstrated by Van den Berghe et al (2001) who recruited 1548 ventilated patients, two thirds post-cardiothoracic surgery, and found tight control reduced mortality from 8.0% to 4.6% (P<0.04), compared to conventional control (<11.9 mmol/litre). There was a 5% incidence of hypoglycaemia (blood glucose <2.2 mmol/litre) in the treatment group. However, subsequent studies, including a second by the same group in medical intensive care patients (Van den Berghe et al, 2006), have failed to replicate these impressive results. Some were terminated early owing to increased mortality and hypoglycaemic episodes (Brunkhorst et al, 2008; Wiener et al, 2008). A meta-analysis by Wiener et al (2008) failed to demonstrate any benefit. NICE-SUGAR, the largest single study performed to date, concluded that tight glucose control may increase mortality (Finfer et al, 2009).
Dr Jack Tinker: 1936-2010
Authors: Linssen Rebecca
Published: May 2014

It is with great sadness that we announce to our readers that the Editor-in-Chief of the British Journal of Hospital Medicine, Dr Jack Tinker, died in April 2010.
Thomas Addison: physician and clinical observer
Authors: Ellis Harold
Published: May 2014

This year marks the 150th anniversary of the death of Thomas Addison, a brilliant clinician after whom two diseases are named – Addison's (or pernicious) anaemia and Addison's disease. Keen young would-be medical researchers of today might be forgiven if they believe that their labours require expensive equipment in a sophisticated laboratory. It is salutary for them to be reminded that close clinical study may lead to remarkable advances – think of Richard Doll's work on the association of smoking and lung cancer and of Dennis Burkitt's research on a peculiar tumour in children in tropical Africa.
The campaign for common sense in medicine
Authors: Warriner David , Shippam Will , Turner Richard
Published: May 2014

On entering medical school we were taught that the most fundamental skill for a medical student to learn was how to elicit an accurate history from a patient, requiring communication skills, an inquisitive mind and, above all, patience. Once the scene was set by the history, the examination would proceed to add depth, colour and clarity to the patient's story-board narrative. History taking should generate a hypothesis, which is either confirmed or refuted by the examination. This generates a working diagnosis, which leads to a minimum of appropriate tests to refine. After all, we can only run after we have learnt to walk.
‘This medical student just gets sicker’
Authors: Bhalla Rekha , Das Satya S , Chin Aleong Joanne , Philpott Douglas , Fry Alastair , Simcock David E
Published: May 2014

A 26-year old female medical student presented to hospital with a 2-week history of abdominal pain, fevers and vomiting. There was no history of smoking, alcohol, foreign travel or animal contact. Examination revealed hepatomegaly and temperature of 38°C. Initial blood results were haemoglobin 9.1 g/dl, white cell count 2.7×109/litre, platelets 130×109/litre, alanine aminotransferase 199 IU/litre, aspartate aminotransferase 62 IU/litre, alkaline phosphatase 247 IU/ litre, international normalized ratio 1.4, sodium 133 mmol/litre. Admission chest radiograph was normal (Figure 1a). Hepatitis screen showed prior infection with hepatitis A and cytomegalovirus. Human immunodeficiency virus and autoimmune profile serology were negative. On day 4 the patient developed a dry cough and hypoxia. Chest radiograph revealed basal pulmonary infiltrates (Figure 1b). The patient was treated for ‘atypical’ pneumonia with co-amoxiclav, clarithromycin and continuous positive airway pressure on the intensive care unit. Over the next 48 hours she deteriorated, requiring intubation and ventilation; teicoplanin was added. Computed tomography scanning showed patchy pulmonary air space shadowing, pleural effusions, ascites and normal pelvic images. Pleural fluid aspiration and drainage revealed transudate effusions and a bronchoscopy and bronchoalveolar lavage was performed. Exhaustive microbiology investigations of blood (including multiple serological studies for bacteria and viruses), CSF (<1 white blood cell, glucose 3.8 mmol/litre, protein 460 mg/litre), urine, stool, sputum, nasopharyngeal aspirate, pleural and bronchoalveolar lavage fluid failed to identify an infectious cause for the patient's illness. She was extubated after 36 hours with complete resolution of chest radiological infiltrates. Lack of clinical improvement, persisting pyrexia, deteriorating pancytopenia and liver function tests prompted further investigation with liver and bone marrow biopsies.

Ziehl–Neelsen staining of a liver biopsy (Figure 2) and bone marrow demonstrated the presence of granulomatous inflammation and acid-fast bacilli. Acid-fast bacilli were abundantly seen in under 5 minutes of starting histological inspection of tissue sections. Mycobacterium tuberculosis was confirmed by tissue culture, and found to be sensitive to rifampicin by the reference laboratory using rapid reverse hybridization. A good clinical response was seen with non-hepatotoxic anti-tuberculous therapy, including amikacin, ofloxacin and ethambutol, since standard therapy resulted in marked hepatitis. First-line antituberculous drugs were then gradually introduced. The patient made a full recovery with resolution of liver function tests and blood counts.
Peter Lowe: a father figure of the Royal College of Physicians and Surgeons of Glasgow
Authors: Ellis Harold
Published: May 2014

This year marks the 400th anniversary of the death of Peter Lowe, one of the most colourful figures of early Scottish surgery and one of the founders of what was eventually to become the Royal College of Physicians and Surgeons of Glasgow.
Dramatic parasomnias: recognition and treatment
Authors: Stores Gregory
Published: May 2014

As each of the many parasomnias requires its own specific treatment, confusion between them can have serious consequences. By recognizing their distinctive features, misdiagnosis can be avoided and the appropriate management decided.
Crohn's disease and enterovesical fistulae: common things are common
Authors: Randall David , Tittle Victoria , Wright Gavin , Blanshard Christine
Published: May 2014

A 39-year-old Caucasian male presented with a 5-day history of acute severe left iliac fossa pain (radiating to the umbilicus), vomiting and episodic pneumaturia associated with brown urinary sediment. There had been no reported alteration in bowel habit, anorexia or weight loss. On examination he was apyrexial and haemodynamically stable with only mild tenderness limited to the area of the left lower rectus sheath, inferior to the umbilicus. Four years earlier he had been diagnosed with Crohn's disease at a nearby hospital, following a similar episode of left iliac fossa pain; the diagnosis of Crohn's disease was based on computed tomography findings of a thickened ascending colon despite normal histology at colonoscopy. Since the diagnosis of Crohn's disease he had remained on regular mesalazine, with five episodes of similar pain (and occasional pneumaturia) treated with intravenous steroids for presumed exacerbations of Crohn's disease.

Given the history of pneumaturia he was pending an outpatient magnetic resonance imaging scan to establish the presence of an enterovesical fistula. At admission, initial investigations revealed a negative urine dipstick for leucocytes and nitrites and only mildly raised inflammatory markers. A computed tomography scan demonstrated an abnormal sigmoid colon adherent to the bladder and anterior abdominal wall (Figure 1). There was also evidence of fluid within the left rectus abdominal sheath and of a fistulous tract between the bladder and sigmoid colon (Figure 2). Flexible sigmoidoscopy revealed an area of narrowing with tight angulation in the sigmoid colon and an abnormal red spot of uncertain aetiology, but there was no evidence of Crohn's disease macroscopically or histologically. Flexible cystoscopy showed thickening of the anterior dome of the bladder with a likely fistula opening superiorly, with non-specific cystitis on histology. Multidisciplinary team discussions concluded that the findings were more suggestive of a localized perforation of a sigmoid diverticulum 4 years earlier leading to secondary inflammatory erosion with the creation of a persistent enterovesical fistula. He therefore underwent a sigmoid colectomy and bladder wall repair.

At operation a mass was found in the left iliac fossa adherent to the bladder and abdominal wall and 5 ml of pus drained from an abscess in the anterior abdominal wall. Histology showed an inflamed and ulcerated diverticulum in the sigmoid and an acute and chronic inflammation with foreign body type multinucleated giant cell reaction in the bladder. The patient made a good recovery postoperatively with an early discharge and his longstanding medication for Crohn's disease was stopped.
Organizational culture: a guide for the foundation year doctor
Authors: Hooke Rachel
Published: May 2014

On your travels as a foundation doctor, you will experience different organizations and the way they work. You will notice certain features – for instance, one place may have a particularly congenial atmosphere – but some of these traits are almost imperceptible. You will learn what is and is not the ‘done thing’, which may be the opposite of what you have encountered elsewhere.
So you want to be … a breast surgeon
Authors: Dixon J Michael
Published: May 2014

One in four women attends a breast clinic at some time in their life. Breast cancer is increasing in frequency and the incidence has increased approximately 25% over the last decade. This is in part a result of breast screening which is available to all women between the ages of 50 and 70 years in the UK. The lifetime risk of breast cancer in the UK is now approaching one in eight. Although there have been significant advances in the systemic therapy of breast cancer, surgery remains the mainstay of treatment.
Radiology of acute knee injuries
Authors: Taylor V , Khan SHM
Published: May 2014

The knee has a variety of functional demands placed upon it and thus is one of the most vulnerable joints of the body. In acute knee injury clinical examination can be limited and therefore radiographs play an important role in the assessment.
The clinical anatomy of lumbar puncture
Authors: Ellis Harold
Published: May 2014

Lumbar puncture is a commonly performed clinical procedure. It may be used for diagnosis (meningitis, encephalitis, subarachnoid haemorrhage) and/or for therapeutics (introduction of antibiotics, spinal anaesthesia).
The eye in rheumatology
Authors: Morarji Jiten , Lightman Sue , Taylor Simon RJ
Published: May 2014

Rheumatic conditions affect a wide variety of tissues, including the eye, and can cause significant visual loss. Early diagnosis coupled with appropriate management, using immunosuppression where necessary, can significantly improve the outcome. This article reviews the most common manifestations seen in clinical practice.
Diagnosis and management of HIV infection
Authors: Palfreeman Adrian , Fisher Martin
Published: May 2014

Infection with human immunodeficiency virus (HIV) is now increasingly common in the UK, but the diagnosis is often missed or overlooked. This article summarizes who to test and how best to offer testing to patients in whom HIV testing is clinically indicated.
Enhanced recovery programme in colorectal surgery: a challenging approach
Authors: Marzook HH , Anwar S
Published: May 2014

The enhanced recovery programme in colorectal surgery is an exciting and innovative new approach for preand postoperative management of surgical patients. It challenges some of the non-evidence-based practices and myths which have been entrenched in the minds of clinicians for decades.
What is a quality improvement project?
Authors: Gill Deborah , Mountford James
Published: May 2014

This article outlines the why, what and how of quality improvement with the aim of encouraging readers to move ‘beyond audit’ to undertake high calibre quality improvement projects within their daily work. It also provides a framework for presenting, publishing and disseminating quality improvement findings.
Peripartum management of the pre-eclamptic patient
Authors: Jones Rhidian , Jones Sadie , Stacey Mark
Published: May 2014

Pre-eclampsia is a common problem in pregnancy which can present at any time to any delivery suite. This article summarizes current best practice to enable the multidisciplinary team to deliver appropriate timely management to achieve best outcomes for both mother and baby.
Cutaneous drug reactions in intensive care
Authors: Bigham Colin , Elsey Alison
Published: May 2014

Rashes are common on the wards and in intensive care, and can be the cause of the admission, an extension of an underlying pathology or a side effect of a drug. This review discusses the frequency and causes of these drug rashes, whether they are benign or life threatening, and looks at how to identify and manage them.
Sleep-induced hypoxaemia in patients with chronic obstructive pulmonary disease
Authors: Zhang Jing , Wang Yan , Feng Jing , Sun Xin
Published: May 2014

Patients with moderate or severe chronic obstructive pulmonary disease run a high risk of developing sleep-induced hypoxaemia, because of alveolar hypoventilation and ventilation-perfusion mismatch. This article looks at the prevalence, significance and treatment of sleep-induced hypoxaemia in chronic obstructive pulmonary disease.
Extending prescribing: nurse prescribing and the Crown Review
Authors: Gooch Sally , Bennett Gerald
Published: May 2014

This article discusses the implications of the Crown Review of the Prescribing, Supply and Administration of Medicines on the medical profession and its relationship with other health-care professions. To appreciate the far-reaching implications of the review, it is necessary to reflect on its origins. This article will summarize the history of nurse prescribing, and the current context in which health care is delivered.
Cardiology: new challenges for the millennium
Authors: Swanton Howard
Published: May 2014

Hospital Medicine will be holding a major international cardiology conference from 6–9 December towelcome in the millennium and to explore the changing face of cardiology. In spite of enormous strides in the diagnosis and management of ischaemic heart disease, it still remains the single largest cause of death in the UK. As the population ages, and our management of angina and acute myocardial infarction improves, we will see an increase in the number of elderly patients with end-stage heart failure as a result of ischaemic heart disease. What advances have there been and what can we expect?
Coronary artery stenting
Authors: Ramsdale David R
Published: May 2014

Coronary artery stenting minimizes the occurrence of abrupt closure and late restenosis after angioplasty. The range of stents now available allows interventional cardiologists to perform more complex angioplasties at lower risk. In the near future, biologically inert, biodegradable stents coated with antiproliferative and antithrombotic agents may become available.
A new cardiothoracic centre: how to do it?
Authors: Lewis Terence , Allen Simon , Kuo James , Unsworth-White Jonathan
Published: May 2014

All cardiac surgical patients, emergency and routine, from the South West peninsula of England had to travel long distances until 19 months ago, a stressful if not dangerous situation. This paper describes the planning, commissioning and start-up of a brand new cardiac surgical facility. The lessons learnt may help similar projects as provision of specialist health care decentralizes.
From traditional herbalism to modern phytomedicine
Authors: Ernst E
Published: May 2014

Many of medicine's most potent drugs were originally isolated from plants. Aspirin was derived from the bark of the willowtree, digoxin from the leaf of the foxglove and Intal from the fruit of Ammi visnaga. Today pharmaceutical companies run large screening programmes to identify new active compounds from herbs. However, when it comes to acknowledging that phytotherapy, medicaltreatment with remedies derived from plants, can be a useful addition to our modern therapeutic repertoire, many of us remain unconvinced: British GPs, for instance, judge herbal remedies as the least effective of all major complementary therapies (White et al, 1997).
Gastric cancer in patients under the age of 30
Authors: Torkington J , Raju TR , Jenkinson LR
Published: May 2014

A26-year-old white male presented to surgical outpatients with an 18-month history of epigastric pain relieved by food and oral ranitidine. Gastroscopy showed a chronic gastric ulcer in the mid-body on the lesser curve. Biopsies were of an inflammatory cell infiltration with no evidence of malignancy. Helicobacter culture was negative and the patient was commenced on omeprazole 40 mg once daily. Repeat gastroscopy 6 weeks later showed a persistent non-healed gastric ulcer. Empirically the patient was given a course of quadruple Helicobacter eradication therapy. His symptoms, however, persisted. Two months later, a further endoscopy with biopsies confirmed the diagnosis of a poorly differentiated adenocarcinoma of the stomach. He subsequently underwent total gastrectomy with splenectomy and distal pancreatectomy. Histology showed a 1.5 cm intramucosal signet ring adenocarcinoma with all resected nodes negative. He remains well 5 years following surgery.
Albumin in meningococcal disease
Authors: Peters Mark
Published: May 2014

The management of acute meningococcal disease (MD) exemplifies what is best and worst about modern paediatric intensive care. The best because, in the face of well-staffed teams with centralized experience, survival has improved dramatically (clinical scoring systems such as the Glasgow Meningococcal Septicaemia Prognostic Score indicate that for the highest risk patients (score >12) the mortality has fallen from 100% (Thomson et al, 1991) to 37% (unpublished data, Peters et al, 2000)). The worst because there are no randomized trial data supporting many widely used interventions. This has caused problems in recent years as enthusiasts for novel therapies suggest that trials are now unethical because of improved outcome (Smith et al, 1997), while across the board outcomes are better than previously.
Antibiotic-resistant gonorrhoea
Authors: Bingham JS , Barlow David
Published: May 2014

The gonococcus has become either relatively or completely resistant to many antibiotics. However, knowledge of prevailing local resistance patterns and region in the world of acquisition of infection means that effective treatment is always possible.
Management
Authors: Ellis Michael , Richardson Malcolm
Published: May 2014

The management of invasive fungal infection utilizes a variable multidisciplinary approach involving antifungals, appropriate surgery and immuno-correction. Conventional amphotericin B has been the mainstay of treatment but newer pathogens and poor outcomes has led to new formulations of this drug as well as to new and novel antifungals.
Successes and shortcomings of fetal echocardiography
Authors: Gardiner Helena M
Published: May 2014

While it is possible to perform balloon valvuloplasty of a critically stenosed pulmonary valve in the fetus safely, the majority of serious heart conditions remain undiagnosed until after birth. This article addresses the successes and shortcomings of fetal cardiology.
National guideline on induced abortion
Authors: Penney Gillian C
Published: May 2014

Evidence-based clinical guidelines represent a fundamental component of the NHS clinical effectiveness (NHS Executive, 1996) and clinical governance (Donaldson and Muir Gray, 1998) initiatives. The clinical effectiveness initiative was built around three themes — inform, change and monitor — with clinical guidelines representing the principal means of informing health-care professionals about the available evidence base on discrete clinical topics. Education and training programmes were seen as the main means of changing practice, and clinical audit the main way of monitoring practice and confirming beneficial changes.
Advanced nurse practitioners and physician assistants: what is the difference? Comparing the USA and UK
Authors: Cox Carol L
Published: May 2014

With the reduction in junior doctors' hours and fewer doctors being trained in the UK, there is a need for other types of health-care practitioners to fill the gap. This article describes some of the background to the present situation and delineates two types of roles, the advanced nurse practitioner and the physician assistant, for consideration as alternatives to address the present and growing shortage of doctors.
Toxic megacolon: remember cytomegalovirus
Authors: Sharma Ricky A , Steward Will P , West Kevin P , Hemingway David
Published: May 2014

A 63-year-old female retired clerical officer was admitted with a 1-week history of profuse diarrhoea. The patient had been diagnosed with non-Hodgkin's lymphoma 4 years previously, and a human immunodeficiency virus (HIV) test at that time was negative. She had received two regimens of chemotherapy, and had been in remission for 3 months with a normal leukocyte count. The diarrhoea was watery with no blood or mucus, and associated with mild nausea and diffuse left-sided abdominal pain relieved by defaecation. The patient had a mild pyrexia and scanty bowel sounds, but the abdomen was not distended. Full blood count and full biochemistry were normal apart from the white cell count (13.8x109/litre — predominantly neutrophils and monocytes). Initial blood cultures and routine viral serology were negative, but the latter was never repeated. Stool samples were negative for bacteria, parasites and toxins.
Defining myocardial infarction: not too late for common sense or consistency?
Authors: Birkhead JS
Published: May 2014

A recent consensus statement from a joint committee of the European Society of Cardiology and the American College of Cardiology (Joint European Society of Cardiology/American College of Cardiology Committee, 2000) has proposed a new biochemical definition for acute myocardial infarction. This definition is based on the measurement of cardiac troponins T and I rather than the widely used creatine kinase (CK) and the isoenzyme CK_MB. The implications of implementing this proposal require careful examination.
A patient with hypertrophic obstructive cardiomyopathy presenting for total knee replacement
Authors: Stone J , Ravalia A
Published: May 2014

A 72-year-old woman with a history of hypertrophic obstructive cardiomyopathy (HOCM) was listed for a left total knee replacement (TKR). She had had an uneventful general anaesthetic (GA) for a knee arthroscopy 4 years earlier but had been refused TKR because she was a high anaesthetic risk. She now presented with pain that was keeping her awake at night and was keen for surgery, being fully aware of the attendant risks. She had a strong family history of HOCM and had had one episode of self-terminating fast atrial fibrillation. Her current medication was aspirin 75 mg, amiodarone 100 mg twice daily and atenolol 25 mg once daily.
Reading and assessing qualitative research
Authors: Powell Alison E , Davies Huw TO
Published: May 2014

What makes doctors burn out? What is it like to have epilepsy? Why do smokers not give up? Qualitative research makes it possible to look behind the statistics and to study health and health care from the inside: to find out what it is really like for the health professionals who provide the care and for the patients on the receiving end.
Changing scene in hepatitis B serology interpretation
Authors: Chan Henry Lik-Yuen
Published: May 2014

Serological tests have been used in the diagnosis of hepatitis B virus (HBV) infection since the virus was first discovered. Advances in molecular biology and improvements in the understanding of HBV virology have changed the scene of hepatitis B serology interpretation.
Effects of the Omagh bombing on medical staff working in the local NHS trust: a longitudinal survey
Authors: Luce Anna , Firth-Cozens Jenny
Published: May 2014

This article investigates post-traumatic stress disorder (PTSD) symptoms reported by doctors working in the aftermath of the Omagh bombing. Doctors responding to surveys 4 and 17 months after the incident reported the lowest symptom levels compared with other health service staff, with only 12% (2) above PTSD threshold at 17 months. Junior doctors had higher mean PTSD scores than seniors, although numbers are too small to test significance. Possible explanations are discussed and recommendations made.
Obtaining consent in the elderly patient
Authors: Crowe Suzanne
Published: May 2014

Consent is a powerful concept. It is versatile, yet vulnerable to conflicting interpretations. Considerable confusion remains among anaesthetists regarding their responsibilities in obtaining consent for anaesthesia. As a result, practice varies enormously between departments, and between individuals within each department. This is particularly the case when ethical difficulties arise, or when emergency surgery is required. Consent also has implications for the enrolment of patients in clinical research. The Association of Anaesthetists of Great Britain and Ireland established a working party in 1999 to examine this thorny issue and to produce guidelines for clinicians.
Further reduction in mortality following myocardial infarction
Authors: Abhyankar Brihad
Published: May 2014

Omacor is a new omega-3 fatty acid product that is licensed for secondary prevention post-myocardial infarction. It confers an additional 20% reduction in all-cause mortality, based on the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico prevenzione (GISSI-P) study data. The GISSI-P results are compared with other trials of secondary prevention.
Anaesthesia for caesarean section complicated by placenta praevia
Authors: MacCallum NS , Cox M
Published: May 2014

Placenta praevia is present when the placenta implants below the presenting part of the fetus. It is classified into grades I—IV depending on the relationship between the placenta and the cervical os. Placenta praevia complicates 1 in 200 deliveries and is associated with considerable maternal and fetal morbidity and mortality (Iyasu et al, 1993; Department of Health, 2001). Increased bleeding is seen from the placental bed, which is abnormally implanted into the less contractile, lower segment of the uterus. A morbidly adherent placenta (accreta) further increases these risks.
Somatoform disorder: how good are we at diagnosis?
Authors: Weinberg Laurence , Wyatt Jonathan , Sardesai Suhrud Hanmant
Published: May 2014

A 39-year-old man presented to his GP with symptoms of transient sharp anterior chest pain, shortness of breath, headaches and episodes of haemoptysis. Despite normal serial chest X-rays and routine blood tests, his symptoms persisted. Over the following year, referrals for further special investigations including lung function tests, bronchoscopy and lung perfusion scanning were arranged; no pathological cause for his symptoms could be ascertained. He then presented on five separate occasions to the emergency department with atypical chest pain. On each occasion examination was normal and serial cardiac enzymes and electrocardiographs excluded myocardial infarction/ischaemia. An exercise stress test was non-diagnostic for ischaemic heart disease.
The controversy over breast cancer screening
Authors: Duffy Stephen W
Published: May 2014

For the last 10 years or so, there has been general agreement, with few dissenters, that screening for breast cancer with mammography reduces mortality from breast cancer. This is based on the results of seven randomized trials worldwide, which found substantially fewer breast cancer deaths in those invited to screening, and on numerous uncontrolled studies. A recent quantitative overview of all the randomized controlled trials of screening showed a significant 24% reduction in breast cancer mortality in association with invitation to screening (Duffy et al, 2002). Evaluation of service screening programmes suggests that the mortality reduction is substantially greater in those who actually attend for screening (Tabar et al, 2001).
Ovarian cancer screening
Authors: Farhad Alexander-Sefre , Menon Usha , Jacobs Ian J
Published: May 2014

Ovarian cancer is the fourth commonest cause of cancer deaths in women. Multimodal screening with serum CA125 and transvaginal ultrasonography have been shown to improve survival. However, the results so far do not justify routine screening until the impact of screening on mortality has been assessed in larger randomized trials.
Biliary tract emergencies
Authors: Parks Rowan W
Published: May 2014

Gallstones are responsible for the majority of biliary tract emergencies and will be the main focus of this article. Gallstones present with features related to the site of the calculi and are therefore considered separately. Cholecystolithiasis refers to gallstones confined to the gallbladder, whereas choledocholithiasis refers to gallstones within the common bile duct.
Advances in the medical management of rheumatoid arthritis
Authors: Scott David L
Published: May 2014

New treatments, such as leflunomide and biologic therapy, are making an important impact on the management of rheumatoid arthritis. This article reviews the efficacy of these agents, the use of combination therapy, and the importance of early treatment with a disease-modifying antirheumatic drug.
Juvenile xanthogranuloma of the nose in an adult
Authors: Gedela VR , Roy D , Swift AC
Published: May 2014

Juvenile xanthogranuloma is a rare benign lesion occurring in infancy and childhood. Despite the term juvenile xanthogranuloma, onset during adulthood can occur with a peak incidence in the second and third decades of life (Tahan et al, 1989). It is characterized by single or multiple cutaneous nodules, which show spontaneous involution. It is commonly mistaken for a malignant lesion. The authors report a case of juvenile xanthogranuloma of the nose in an adult, which was excised for diagnostic and cosmetic reasons. This is the first reported case of juvenile xantho-granuloma in the nose in an adult.
Laying the foundations for good medical practice: a new educational resource
Authors: Mann Robin Y , Williams Professor John G , Wade Winnie
Published: May 2014

Balancing service commitments with educational development is never easy. The European Working Time Directive and the Chief Medical Officer's report on senior house officer training bring new challenges. The Royal College of Physicians has developed ‘Laying the Foundations for Good Medical Practice’, a resource that enables tutors to teach generic skills to small groups of trainees in a fun and interactive way.
Immunosuppression in renal transplantation: where are we now?
Authors: McDonald Kenneth , Jardine Alan G
Published: May 2014

The development of potent and well-tolerated immunosuppressive agents has established renal transplantation as the treatment of choice for patients with end-stage renal disease. This is the result of two therapeutic revolutions; the introduction of azathioprine in the 1960s that made renal transplantation possible, and the introduction of cyclosporin in the 1980s that enabled other solid organ transplants and radically improved the outcome of renal transplantation.
Management of stroke: acute, rehabilitation and long-term care
Authors: Smithard David G
Published: May 2014

Stroke is the major cause of disability in adults, resulting in much morbidity and mortality in the west. Each year 120 000 people will suffer their first stroke with a further 40 000 suffering a recurrent stroke and 40 000 a transient ischaemic attack. The prevalence rises from 2/1000 population to 2/100 in those over 85 years of age. Consequently stroke is seen as a problem of the elderly.
Biological therapy in Crohn's disease
Authors: Gordon JN , MacDonald TT
Published: May 2014

The discovery of the central role of tumour necrosis factor-α in Crohn's disease and the subsequent introduction of infliximab into routine clinical practice has transformed the treatment of refractory disease. Advances in understanding of the immunopathological basis of Crohn's disease are leading to the development of new biological therapies which are likely to play an increasing role in future.
Best practice of hypertensive patietns with kidney disease
Authors: de Zeeuw Dick
Published: May 2014

Many patients with non-diabetic and diabetic renal disease undergo chronic renal function loss leading to dialysis or renal transplantation. The US National Kidney Foundation guidelines recommend that angiotensinconverting enzyme inhibitors and angiotensin type receptor antagonists are first choice therapy for these patients.
An initiative to reform senior house officer training in histopathology
Authors: Gallagher PJ , Dixon MF , Heard S , Moore JK , West KP
Published: May 2014

Senior house officer schools in histopathology have been established in Leeds, Leicester and Southampton, each training six new recruits each year. Nine hours of protected teaching time is provided each week giving a ratio of apprenticeship learning to formal teaching of 3:1. Evaluations have been very positive. Much of this success is attributed to careful planning and adequate funding. This may be a useful model for other specialties to follow.
Guidelines are not directives
Authors: McDonald Peter
Published: May 2014

Year by year politicians seem compelled to regulate the activity of their citizens more and more. Despite paying lip service to the democratic concepts of autonomy and local decision making they continue to strengthen their central authority with the result that individual freedom of action is diminished.
Managing vascular impairment following orthopaedic injury
Authors: Ashwood Neil , Challanor Eddie
Published: May 2014

Orthopaedic trauma is associated with vascular impairment in approximately 1% of cases, complicating management of the injury, particularly to the shoulder, elbow, pelvis and knee. Doctors treating trauma would be expected to detect and manage several such patients a year.
Imaging of testicular tumours
Authors: Owens EJ , Kabala J , Goddard P
Published: May 2014

This article reviews the diagnosis, pathology and imaging of testicular tumours, predominantly germ cell tumours. It will discuss the imaging techniques used in their diagnosis, staging and surveillance.
Preserving vision with verteporfin photodynamic therapy
Authors: Yang Yit Chiun
Published: May 2014

Wet age-related macular degeneration (AMD) is the leading cause of blindness in the elderly population. Verteporfin photodynamic therapy (PDT) is significantly effective in preventing visual loss in patients with subfoveal choroidal neovascularization caused by exudative AMD. This article reviews verteporfin PDT and discusses treatment and evolving appraisal guidance.
Radial artery as a conduit for coronary artery bypass graft
Authors: Jutley RS , Sarkar PK
Published: May 2014

Since its resurgence in the 1990s, some 30 years after its abandonment as an alternative conduit, the radial artery has rapidly gained popularity. This article describes the application of this conduit in coronary grafting and details the controversies surrounding its use. A historical account as well as technical aspects such as operative technique are also discussed.
Older drivers and motor vehicle crashes
Authors: Braver Elisa R
Published: May 2014

Older drivers are a source of great public concern, particularly after wellpublicized incidents in which an older driver has caused a grievous event. As their numbers grow, understanding the risks that older drivers pose to themselves and other road users is important for appropriate clinical and policy decisions.
The first successful renal graft in man
Authors: Ellis Harold
Published: May 2014

Today, organ transplantation – of kidney, liver, heart, lung or pancreas, alone or in combination – is accepted as a more or less routine operative procedure, yet the first successful organ graft in man took place a mere 50 years ago, on December 23 1954.
Have workforce development confederations succeeded?
Authors: Sargent John
Published: May 2014

Workforce development confederations (WDCs) were established in 2001. Three years on – are they making any difference to the quantity, quality or diversity of the workforce that the NHS needs? The evidence is now emerging.
Persistent pulmonary hypertension of the newborn
Authors: Pierce CM
Published: May 2014

Pulmonary hypertension refers to the elevation of the pulmonary artery pressure above normal. In utero a raised pulmonary arterial pressure in the baby is normal; at birth there is a marked decrease in pulmonary vascular resistance allowing the lung to establish gas exchange. Persistent pulmonary hypertension of the newborn (PPHN; Figure 1) occurs when this decrease fails to occur.
Treatment of intermittent claudication: cilostazol
Authors: Collins P , Brittenden J
Published: May 2014

Intermittent claudication is a potentially disabling disorder that impairs quality of life and is a marker of underlying cardiovascular disease. Treatment involves secondary prevention and measures to improve walking. Cilostazol significantly increases walking distance and quality of life in claudicants.
Postobstructive pulmonary oedema
Authors: Windsor J , Dewdney A , Crooks R , Grocott M
Published: May 2014

A muscular 30-year-old man was admitted for an elective bilateral subcutaneous mastectomy. He had mild asthma relieved with salbutamol but was otherwise in good health, and smoked five cigarettes a day. He had undergone wisdom tooth extraction under general anaesthetic without complications.
Training in obstetrics and gynaecology in the Netherlands
Authors: Hakvoort Robert A
Published: May 2014

This article gives global insights on past, present and future training in obstetrics and gynaecology in the Netherlands. Comparisons are made with the British system.
The right balance
Authors: O'Connell Suzanne
Published: May 2014

It used to be that the teaching assistant (TA) was a classroom helper. They put up displays and backed books, listened to readers and photocopied worksheets. Then came workforce reform and everything changed
Leadership in action
Authors: Mynard Steve
Published: May 2014

In the November 2009 issue of Headteacher Update we looked at the theory of leadership styles and how these influence the modern primary school. Here Steve Mynard talks to individual headteachers about what leadership means to them
Cultivating creativity
Authors: Cripps Denise
Published: May 2014

Creativity is a concept that can be applied across the curriculum. Denise Cripps discusses what it means and how teachers can bring it out in their pupils
The power of song
Authors: Chapman Baz
Published: May 2014

Baz Chapman is programme director at Sing Up, the national singing programme. He explores how singing can act as a leveller for primary school children with special educational needs and those outside mainstream education
Why assess wellbeing in schools?
Authors: Ivens John
Published: May 2014

Dr John Ivens, executive headteacher at the Bethlem and Maudsley Hospital School, discusses his work on children's wellbeing and looks at how schools can help create conditions in which pupils and staff can thrive
Adding adventure to the curriculum
Authors: Mynard Steve
Published: May 2014

In these more cautious times, children have less and less opportunity to get out and discover the world around them. Steve Mynard looks at the importance of adventurous activities and shares some ideas on how to develop them around the current curriculum
Which way now for primary languages?
Authors: Tinsley Teresa
Published: May 2014

Primary schools have made substantial progress with languages in recent years but secondary schools still seem reluctant to take into account prior learning. Tessa Tinsley from CILT, the National Centre for Languages, discusses what can be done
The future of regulation
Authors: Mortimer Gail
Published: May 2014

Since the announcement last year that the General Teaching Council for England (GTCE) is to be abolished there has been much speculation about future regulation of the profession. Gail Mortimer, chair of the GTCE, discusses the new arrangements
The future for SEN
Authors: Petersen Lorraine
Published: May 2014

Provisions for young people with special educational needs (SEN) are under continued focus as the education community awaits the publication of the SEN Green Paper. Lorraine Petersen looks at the crucial areas that the paper must address
Anti-Bullying Week 2012
Authors: Seager-Smith Lauren
Published: May 2014

Anti-bullying Week 2012 takes place from November 19 to 23. As primary schools prepare to mark the event, the Anti-Bullying Alliance's Lauren Seager-Smith offers some food for thought
Tackling homophobic bullying
Authors: Dellenty Shaun
Published: May 2014

In 2009, 75 per cent of pupils at Alfred Salter Primary School were hearing homophobic language on a daily basis. Now, the school is to become the only primary in the country offering training days to support school staff in tackling homophobic bullying.
Developing a culture to drive standards
Authors: Bigland Brenda
Published: May 2014

How can a headteacher create a school culture and ethos that drives standards? Brenda Bigland offers her advice
Careers education for primary pupils
Authors: O'Connell Suzanne
Published: May 2014

It is becoming more common for primary schools to focus on pupils' career aspirations and to begin preparing them for the world of work. Suzanne O'Connell reports
BESD: What's in a name?
Authors: O'Connell Suzanne
Published: May 2014

How do we define our pupils with emotional, behavioural and social needs? Suzanne O'Connell looks at how useful the BESD category is and whether abandoning it might improve children's life chances
Curriculum innovation
Authors: Bannister Nick
Published: May 2014

Getting creative with your school's curriculum need not be a risky enterprise. Nick Bannister speaks to headteachers and experts about how to develop an innovative curriculum that focuses on both knowledge and skills
Handling requests for flexible working
Authors: Latham Vanessa
Published: May 2014

What are the legal and practical considerations for primary school headteachers when considering requests for flexible working? Employment law expert Vanessa Latham explains
The grammar test
Authors: O'Connell Suzanne
Published: May 2014

Suzanne O'Connell takes a look at the new grammar, punctuation and spelling test and some of the criticism it has received
Language barriers
Authors: Tinley Teresa
Published: May 2014

A new study focusing on global language learning finds that English-speaking education often provides less resource and encouragement for languages. Teresa Tinley and Therese Comfort consider the challenges common to successful primary language teaching
Embedding effective ICT
Authors: Bigland Brenda
Published: May 2014

Earlier this year, Michael Gove said that ICT in schools was a mess. Brenda Bigland discusses how her school embedded ICT across its classrooms and curriculum and offers an insight into developing an effective ICT strategy
Working together
Authors: Bennett Paul
Published: May 2014

The government's stated aim is to give schools more autonomy. Paul Bennett from the National College discusses how focused and sustainable collaborative working could be the key to making the most of increased freedoms
Scratching the itch
Authors: Brown Christine
Published: May 2014

Head lice are a source of frustration for many parents but, given the right information, they are more than capable of eliminating the problem themselves. Christine Brown explains
Looking for the Olympic legacy
Authors: Bannister Nick
Published: May 2014

London 2012 has captured the imaginations of primary schools across the country, but what of the prospects for a legacy that will last well beyond the closing ceremony? Nick Bannister reports
An engaging science experience
Authors: McClelland Roy
Published: May 2014

Headteacher Roy McClelland discusses his school's involvement with the Rolls-Royce Science Prize and how he has used it to teach his pupils key technology and problem-solving skills
Partnerships: Crossing the road
Authors: David Anthony
Published: May 2014

Anthony David, headteacher of a small one-form entry school, explains how he has forged a strong and fruitful partnership with a neighbouring private school
Research-engaged schools
Authors: Wilkins Raphael
Published: May 2014

Dr Raphael Wilkins reflects on the benefits for schools of being ‘research-engaged’ and argues that headteachers must embrace research and collaboration as part of school and staff development