Isolated distal rectus femoris rupture.
PMID: 31589492 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Matar HE, Sanger R Tags: Br J Hosp Med (Lond) Source Type: research

Epididymo-orchitis masquerading as an irreducible inguinal hernia.
PMID: 31589493 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Shaikh SR, Shaikh H, Kam J, Winter M Tags: Br J Hosp Med (Lond) Source Type: research

Localized synovial chondromatosis of the knee: assessment and management.
PMID: 31589495 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Matar HE, Sanger R Tags: Br J Hosp Med (Lond) Source Type: research

Colorectal cancer and an air pistol pellet.
PMID: 31589496 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Singh HK, Cribb E, Bains A, Pawa N Tags: Br J Hosp Med (Lond) Source Type: research

Disorders of gut-brain interaction and the long-term risks of opioids.
Abstract Prescription opioid abuse has become a public health crisis. It is often challenging to manage affected patients as their symptoms are often viewed through a prism of complex psychosocial issues. Clinicians are often unaware of the lack of evidence regarding opioid prescribing for non-cancer pain, and these trends in prescribing have been significantly escalated by pharmaceutical companies and prescribing culture in recent years. Opioid prescribing in the context of disorders of gut-brain interaction (formerly known as functional gastrointestinal disorders) can worsen conditions such as centrally-mediated...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Sahota S, Fortun P Tags: Br J Hosp Med (Lond) Source Type: research

Highs and lows: perioperative management of surgical patients with diabetes mellitus.
PMID: 31589498 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Butt A, Srivastava V, Sinclair M, Shotton H Tags: Br J Hosp Med (Lond) Source Type: research

Working together for a just culture.
PMID: 31589499 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Singh I, Goorah N, Singh S, Hughes B Tags: Br J Hosp Med (Lond) Source Type: research

Femoroacetabular impingement in young adults: assessment and management.
Abstract Femoroacetabular impingement is a cause of hip pain in young adults as a result of premature dynamic contact between the femur and acetabulum that occurs within the physiological range of hip motion. Diagnosis is made by patient history, clinical examination and radiographic findings. Cross-sectional imaging with computed tomography and magnetic resonance arthrography may be necessary in selected patients. Femoroacetabular impingement can be treated non-operatively with physiotherapist-led conservative care including analgesia and intra-articular steroid injections. Arthroscopic hip surgery aiming to rest...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Matar HE, Rajpura A, Board TN Tags: Br J Hosp Med (Lond) Source Type: research

The fight against cancer: is harnessing the immune system the ultimate strategy?
Abstract Malignancy is a micro-evolutionary phenomenon shaped by selection pressures. Chief among these is the adaptive immune system, which recognizes malignant cells as a threat and attempts to eradicate them. The task is not easily achieved - if it were, cancer would not be a part of our human experience. The field of immunotherapy has rapidly expanded over the last two decades. It has produced some of the most exciting results of 21st century medicine, and has deepened clinicians' understanding of the relationship between malignancy and the immune response. This review discusses this relationship and analyses ...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Watson E, Danby R Tags: Br J Hosp Med (Lond) Source Type: research

Clinical News.
Authors: PMID: 31589505 [PubMed] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Tags: Br J Hosp Med (Lond) Source Type: research

Supplementation with selenium and coenzyme Q10 in critically ill patients.
This article reviews the link between selenium and coenzyme Q10, and the potential role of their co-supplementation in critical illness. PMID: 31589506 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Hargreaves IP, Mantle D Tags: Br J Hosp Med (Lond) Source Type: research

Mapping transactional analysis to clinical leadership models.
This article considers how transactional analysis can be incorporated into professional development to help doctors develop insight into and optimize the use of different communication styles. The authors propose that a working knowledge of the transactional analysis ego state model can enhance effective communication, leadership and followership within and across health-care teams, with a view to optimizing patient outcomes and workforce interactions. PMID: 31589507 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Thiagarajan P, McKimm J Tags: Br J Hosp Med (Lond) Source Type: research

Should paralysis take place before or after checking facemask ventilation?
PMID: 31589508 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Sokhi J, John R Tags: Br J Hosp Med (Lond) Source Type: research

Enhanced recovery after obstetric surgery.
PMID: 31589509 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Ciechanowicz S, Patel N Tags: Br J Hosp Med (Lond) Source Type: research

Management of rib fractures.
This article discusses the management of simple rib fractures and provides practical guidance for junior doctors involved in the care of these patients. Careful assessment to identify patients at high risk of complications is essential and calculation of a rib fracture score can aid management decisions. Pain from rib fractures can be severe and requires multimodal analgesia started promptly and proactively on hospital admission. This may include the use of regional anaesthetic techniques such as thoracic epidurals and erector spinae blocks for patients with significant chest trauma or those at high risk of pulmonary compl...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Jeffery Z, Everson M, Carty S Tags: Br J Hosp Med (Lond) Source Type: research

William Dameshek: haematologist whose research initiated organ transplantation.
PMID: 31589511 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Ellis H Tags: Br J Hosp Med (Lond) Source Type: research

Is surgery more about doing than thinking?
This article discusses the technical skills of operating as a reflection of the 'tip of the iceberg' of a surgeon's cognition, the increasingly multidisciplinary strategic approach of surgeons today, the importance of surgical decision making, the influence of robotics, the role of non-medically trained staff, surgeons' role in postoperative care, adaptive expertise and the formation of professional identity. In so doing, a much wider view of a surgeon than simply 'doing' or 'thinking' is presented with implications for surgical training. PMID: 31589512 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Mukherjee S, Meacock J, Chumas P Tags: Br J Hosp Med (Lond) Source Type: research

Identifying emergency pathology on abdominopelvic CT for non-radiologists.
This article provides non-radiologists with a systematic approach to identifying emergency pathology on abdominal and pelvic CT scans. It reviews the relevant cross-sectional anatomy and discusses the CT appearances of bowel perforation, bowel obstruction, bowel ischaemia (gangrene), bleeding, appendicitis and hydronephrosis using illustrative examples from the authors' clinical practice. Underlying causes for these conditions and the importance of interpreting the radiological appearances in conjunction with the patient's clinical condition and history are discussed. The authors hope that by using the POGBAH acronym and a...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Evans O, Rea B, Shareef T Tags: Br J Hosp Med (Lond) Source Type: research

Challenges in the use of corticosteroids in the management of autoimmune hepatitis.
Abstract Autoimmune hepatitis is widely assumed by health-care professionals to be a disease that is easily controlled through the use of corticosteroids and immunosuppressants but recent studies in the UK indicate highly variable treatment regimens and often unsatisfactory treatment outcomes, such as dependence on long-term high-dose steroids and ongoing need for liver transplantation in some cases. The therapeutic use of the systemically acting corticosteroid prednisolone results in unacceptable side effects in many patients. Recent evidence suggests that it is not always necessary to use high-dose steroids (>...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Chapman RW, Aspinall RJ, Trivedi P, Wright G, Heneghan M Tags: Br J Hosp Med (Lond) Source Type: research

An introduction to proton beam therapy.
Abstract Radiotherapy is a highly effective anti-cancer treatment commonly used alongside systemic therapies and surgery to achieve long-term cancer-free survival. Conventional radiotherapy uses photon beams to deliver a high dose of radiation to the tumour volume to eradicate cancer cells. This has to be offset against the irradiation of surrounding normal tissues, as increasing this dose causes more treatment-related toxicity. In August 2018, the NHS's first high energy proton beam therapy centre opened at The Christie NHS Foundation Trust in Manchester. A second NHS centre is scheduled to open in 2020 at the Un...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Barker C, Lowe M, Radhakrishna G Tags: Br J Hosp Med (Lond) Source Type: research

Haemostatic radiotherapy for bleeding cancers of the upper gastrointestinal tract.
Abstract Bleeding can cause significant morbidity in patients with upper gastrointestinal malignancies. Palliative radiotherapy can palliate bleeding effectively across numerous cancer sites such as the lung and rectum. The data available regarding the role in bleeding from upper gastrointestinal cancers are limited to a single meta-analysis, a phase 2 trial, eleven retrospective cohorts and two case reports, with the majority focusing on gastric cancer. From the data available radiotherapy appears to be a well-tolerated, effective haemostatic agent that should be considered in all patients with bleeding from an u...
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Hughes C, Radhakrishna G Tags: Br J Hosp Med (Lond) Source Type: research

New breathlessness in a young patient with rheumatoid arthritis.
PMID: 31589517 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Morgan H, Zaidi A, Anderson R, Goodfellow R, Ellis G Tags: Br J Hosp Med (Lond) Source Type: research

A flitting pneumonia in a patient with advanced melanoma.
PMID: 31589518 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Beatty FE, Bingham LK, Gonzalez MA Tags: Br J Hosp Med (Lond) Source Type: research

Catheter-directed therapy in deep vein thrombosis: May-Thurner syndrome.
PMID: 31589519 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - October 2, 2019 Category: Internal Medicine Authors: Howley F, Motyer R, Torreggiani W, Govendar P Tags: Br J Hosp Med (Lond) Source Type: research

Management of nocturia: overcoming the challenges of nocturnal polyuria.
This article outlines the findings of a roundtable discussion into the optimal management of patients with nocturnal polyuria. PMID: 31498658 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Suman S, Robinson D, Bhal N, Fraser S, MacCormick A, Williams A, Tadtayev S Tags: Br J Hosp Med (Lond) Source Type: research

Trust compliance with best practice tariff criteria for total hip and knee replacement.
CONCLUSIONS: The authors would urge others to review their compliance with these four best practice tariff criteria to ensure that they too are not missing out on this significant reimbursement sum. PMID: 31498659 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Vanhegan I, Sankey A, Radford W, Ball S, Gibbons C Tags: Br J Hosp Med (Lond) Source Type: research

Minimally invasive surgery: early concepts to gold standards.
PMID: 31498660 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Ng A, Wang N, Tran M Tags: Br J Hosp Med (Lond) Source Type: research

Paediatric pigmented villonodular synovitis of the knee.
PMID: 31498661 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Matar HE, Acharya A Tags: Br J Hosp Med (Lond) Source Type: research

Why the General Medical Council's national training survey is so important.
PMID: 31498662 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Manton RN Tags: Br J Hosp Med (Lond) Source Type: research

Is rapid sequence spinal anaesthesia a valid alternative for an emergency caesarean?
PMID: 31498663 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Young F Tags: Br J Hosp Med (Lond) Source Type: research

Clinical News.
Authors: PMID: 31498664 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Tags: Br J Hosp Med (Lond) Source Type: research

Systemic sclerosis.
Abstract Systemic sclerosis is a complex autoimmune connective tissue disease which carries a significant burden of disease-related morbidity including potentially life-threatening complications. Systemic sclerosis can affect all the major organs and therefore, although the disease is uncommon, many hospital-based specialists are involved in patient care. Vascular disease (e.g. Raynaud's phenomenon) is an almost universal symptom in patients with systemic sclerosis and is often the earliest manifestation of the disease. Systemic sclerosis not uncommonly can overlap with other rheumatological conditions (e.g. rheum...
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Hughes M, Herrick AL Tags: Br J Hosp Med (Lond) Source Type: research

An education on servant leadership: a medical student perspective.
PMID: 31498666 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Raheem A, Yunus A, Khan-Ruf S, McKimm J, Cottey L Tags: Br J Hosp Med (Lond) Source Type: research

Capacity issues at the front door.
Abstract Decision-making capacity is often overestimated by clinicians. An average of one third of patients lack capacity to make complex decisions and clinicians should be alert to such a possibility. Cognitive impairment, acute infection, intoxication and other common medical and psychiatric problems can impair patients' capacity. The Mental Capacity Act 2005 has to be applied when treating patients who lack capacity. The main decision maker for a proposed treatment or investigation is responsible for assessing capacity. However, all clinicians have to consider and assess capacity, and act in a patient's best in...
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Lepping P Tags: Br J Hosp Med (Lond) Source Type: research

Acute thrombocytopenia: picking a way through a paucity of platelets.
This article guides the general hospital physician through the narrow but potentially confusing differential diagnoses related to thrombocytopenia, with particular focus on immune thrombocytopenia, disseminated intravascular coagulation and thrombotic thrombocytopenic purpura. Thrombocytopenia in pregnancy deserves special consideration and will not be discussed in this article. PMID: 31498668 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Musson EN, Lomas O, Murphy MF Tags: Br J Hosp Med (Lond) Source Type: research

Liddle's syndrome variant: a diagnostic and therapeutic conundrum.
PMID: 31498669 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Mandal AK, Mouyis K, Walker IA, Missouris CG Tags: Br J Hosp Med (Lond) Source Type: research

Urinary catheterization 2: technique and managing failure.
This article discusses this in more detail to help guide clinicians involved in urethral catheterization. PMID: 31498670 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Tan E, Ahluwalia A, Kankam H, Menezes P Tags: Br J Hosp Med (Lond) Source Type: research

A surprising chest radiograph.
PMID: 31498671 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Mohamed R, Dattani R, Cayley C Tags: Br J Hosp Med (Lond) Source Type: research

Grisel's syndrome developed after adenotonsillectomy.
PMID: 31498672 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Park JA, Jun Yi H, Kang JW, Hong Kim J Tags: Br J Hosp Med (Lond) Source Type: research

Social media etiquette in medicine.
This article gives physicians and students a synthesis of current guidelines and pointers on online behaviour. PMID: 31498673 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Alleje ML, Austria BC, Shrestha PA Tags: Br J Hosp Med (Lond) Source Type: research

Urinary catheterization 1: indications.
This article discusses this in more detail to help guide clinicians involved in urethral catheterization. PMID: 31498674 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Tan E, Ahluwalia A, Kankam H, Menezes P Tags: Br J Hosp Med (Lond) Source Type: research

Chronic myelomonocytic leukaemia: leukaemia cutis predicts disease progression.
PMID: 31498675 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Qiao Y, Zhao L, Jian J, Guo Y, Liu B Tags: Br J Hosp Med (Lond) Source Type: research

Successful cardiac massage 100 years ago.
PMID: 31498676 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Ellis H Tags: Br J Hosp Med (Lond) Source Type: research

Managing repeated deliberate foreign body ingestion.
PMID: 31498677 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Ashman A, Bola S, Topiwala A Tags: Br J Hosp Med (Lond) Source Type: research

Granulomatosis with polyangiitis presents with sinus changes and brainstem lesions.
PMID: 31498678 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Izgi E, Gedikli Y, Ogul H Tags: Br J Hosp Med (Lond) Source Type: research

What is noise-induced hearing loss?
Abstract Noise-induced hearing loss is sensory deafness caused by long-term exposure of the auditory system to a noisy environment. Auditory fatigue is an early symptom of noise-induced hearing loss, and hearing can gradually recover after people leave a noisy environment. However, if people remain in a noisy environment for a prolonged period of time, their hearing will be permanently impaired. Societal changes mean that people are more likely to be exposed to noise. The hearing loss and tinnitus caused by noise seriously affect people's quality of life and lead to huge economic loss. The pathogenesis of noise-in...
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Ding T, Yan A, Liu K Tags: Br J Hosp Med (Lond) Source Type: research

A view from the acute hospital: managing patients with alcohol problems.
Abstract Regular heavy consumption of alcohol is associated with a wide range of physical, psychological and social problems. All health-care clinicians should be able to screen for and detect problematic levels of alcohol consumption in their patients, and deliver an effective brief intervention. When patients with alcohol dependence are admitted to hospital there must be an assessment of whether medication is required to prevent withdrawal symptoms and potential delirium tremens and withdrawal seizures. Medically assisted alcohol withdrawal using a long-acting benzodiazepine such as chlordiazepoxide should be ca...
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Pang D, Duffield P, Day E Tags: Br J Hosp Med (Lond) Source Type: research

A case of new onset ulcerative colitis following secukinumab treatment.
PMID: 31498681 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - September 2, 2019 Category: Internal Medicine Authors: Johnston DN, Veettil R Tags: Br J Hosp Med (Lond) Source Type: research

Good use of 'BAD' guidelines.
PMID: 31437032 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - August 2, 2019 Category: Internal Medicine Authors: Al Omran Y, Huq S Tags: Br J Hosp Med (Lond) Source Type: research

A patient-centred check sheet improves communication on the trauma ward round.
CONCLUSIONS: The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them. PMID: 31437033 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Source: British Journal of Hospital Medicine - August 2, 2019 Category: Internal Medicine Authors: Brown OS, Toi TH, Barbosa PR, Pookarnjanamorakot P, Trompeter A Tags: Br J Hosp Med (Lond) Source Type: research