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Ruth H Green, Val Evans, Sheona MacLeod, Jonathan Barratt
Objective: Major changes in the design and delivery of clinical academic training in the United Kingdom have occurred yet there has been little exploration of the perceptions of integrated clinic academic trainees or educators. We obtained the views of a range of key stakeholders involved in clinical academic training in the East Midlands. Design: A qualitative study with inductive iterative thematic content analysis of findings from trainee surveys and facilitated focus groups...
February 2018: JRSM Open
Aimee Marie Charnell, Emma Ferriman, Rozalia Dimitriou, Michalis Panteli, Peter V Giannoudis
In this case, we opted for dual surgery combining caesarean section and internal fixation of acetabular fracture in late pregnancy, which allowed safe foetal delivery, fracture repair and early ambulation of the mother. In similar cases, this method could be potentially considered in the armamentarium of treatment options, aiming to facilitating prompt motherhood input and early hospital discharge, as well as minimising the risk of post-traumatic arthritis of the hip.
February 2018: JRSM Open
Carnjini Yogeswaran, Vaikuntam Srinivasan, Kingsley C Ekwueme
Template-guided transperineal aspiration is a minimally invasive treatment option for patients with Mullerian duct cysts. The precise targeting provided by the brachytherapy template grid enables specific targeting, quick recovery and resolution of symptoms without complications.
February 2018: JRSM Open
Queenie Luu, Gabor Major
Immune checkpoint inhibitors can lead to the development of organ and non-organ specific immune related adverse events.
January 2018: JRSM Open
Junaid Rafi, Haroona Khalil
Retroperitoneal haematomas in obstetrics are uncommon. The causes and pathogenesis of retroperitoneal haematomas lack clarity and the aim of this review is to recognise retroperitoneal haematomas as a separate entity from commonly seen vaginal and pelvic haematomas. It is time to raise awareness among obstetricians to recognise retroperitoneal haematomas as an important cause of maternal morbidity and mortality which requires high clinical suspicion and multidisciplinary input. As retroperitoneal haematomas are rare but can cause serious threat to maternal wellbeing, resources should be directed towards their management...
January 2018: JRSM Open
Ansu Basu, Nithya Sukumar, Robert Ej Ryder
Objective: To understand the ethnic differences in coronary heart disease risk among inpatients with diabetes following acute coronary syndrome. Design: Single-centre retrospective cohort-analysis of patients with type II diabetes over a six-year period receiving standard care. Setting: Birmingham, UK. Participants: One thousand and one hundred and five patients with type II diabetes from a multi-ethnic background. Main outcome measures: Odds ratios of coronary heart disease events among three ethnic groups...
January 2018: JRSM Open
Rasjid Skinner, Paul M Kaplick
Objectives: Post-traumatic stress disorder is an established diagnostic category. In particular, over the past 20 years, there has been an interest in culture as a fundamental factor in post-traumatic stress disorder symptom manifestation. However, only a very limited portion of this literature studies the historical variability of post-traumatic stress within a particular culture. Design: Therefore, this study examines whether stress responses to violence associated with armed conflicts have been a culturally stable reaction in Western troops...
December 2017: JRSM Open
Trevor W Lambert, Fay Smith, Michael J Goldacre
Objective: To report the changes to UK medicine which doctors who have emigrated tell us would increase their likelihood of returning to a career in UK medicine. Design: Questionnaire survey. Setting: UK-trained medical graduates. Participants: Questionnaires were sent 11 years after graduation to 7158 doctors who qualified in 1993 and 1996 in the UK: 4763 questionnaires were returned. Questionnaires were sent 17 and 19 years after graduation to the same cohorts: 4554 questionnaires were returned...
December 2017: JRSM Open
Saad Rehman, Hamish Sinclair, Alex Rodway, Alex Kovalic, Katharine Webb-Peploe, Syed Waquar Yusuf
In case of high output cardiac failure, an arteriovenous fistula should be considered.
November 2017: JRSM Open
Sumedha Chhatre, Joseph J Gallo, Marsha Wittink, J Sanford Schwartz, Ravishankar Jayadevappa
Objective: To elicit patient stakeholders' experience and perspectives about patient-centred care. Design: Qualitative. Setting: A large urban healthcare system. Participants: Four patient stakeholders who are prostate cancer survivors. Main outcome measures: Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions. Results: Our patient stakeholders represented a diverse socio-demographic group...
November 2017: JRSM Open
Ahmed El-Medany, W Wallace, E Mcrorie, Sy Tan, K Lim
This report provides a rare histological example and the appropriate management of spontaneous aortic dissection secondary to giant cell arteritis.
October 2017: JRSM Open
Selena Gray, Judy Orme, Hannah Pitt, Matthew Jones
OBJECTIVES: To evaluate the impact and challenges of implementing a Food for Life approach within three pilot NHS sites in 2014/2015 in England. Food for Life is an initiative led by the Soil Association, a non-governmental organisation in the UK that aims to encourage a healthy, sustainable food culture across communities. DESIGN: A case-study approach was undertaken using semi-structured interviews with staff and key stakeholders together with analysis of relevant documents such as meeting minutes, strategic plans and reports...
October 2017: JRSM Open
Abhilash Koratala, Hussain Aboud, Robert Gibson, Karen K Hamilton
In end stage renal disease patients on dialysis, the use of catheter as a vascular access is associated with a significant risk of sepsis compared to an arterio-venous fistula. Our case emphasizes the importance of having high index of suspicion for unusual complications in patients presenting with possible catheter-related blood stream infection and early use of complementary tools such as trans-oesophageal echocardiography whenever applicable.
September 2017: JRSM Open
Daniela Noakes, Katherine Evans, Rohan Pathansali
This article highlights a rare complication of syphilis infection and the importance of including syphilis and antiphospholipid antibody testing in the acute stroke screen..
September 2017: JRSM Open
Charles Dr Thompson, Arun Mahay, David Stuckler, Sarah Steele
OBJECTIVE: We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. DESIGN: Freedom of Information requests were sent to the 105 England's NHS Trusts delivering acute care in England. SETTING: NHS Trusts providing secondary care in England. PARTICIPANTS: English NHS Trusts...
September 2017: JRSM Open
Andy Zamar, Gurvinder Warrya, Christos Kouimtsidis
In this article, we report two cases from our centre: case A has the longest recovery period and case B is one of the most complex from a diagnostic and management perspective, highlighting how treatment resistance can be overcome depending on patient response and needs.
September 2017: JRSM Open
W J Ribbans, J Chadwick, R Natarajan
The first case of bilateral distal tibiofibular joint fusions for osteochondromas is reported with excellent long-term outcomes.
August 2017: JRSM Open
Sara Imanpour, Obioma Nwaiwu, Darcy K McMaughan, Bethany DeSalvo, Adnan Bashir
OBJECTIVE: To test the potential association between time spent with a doctor and antibiotic overprescriptions in case of the common cold, runny nose, bronchitis, chest colds, flu, sore throats, and fluid in the middle ear. DESIGN: Cross-sectional study. SETTING: Office-based physicians in the US. PARTICIPANTS: A total of 261,623 patient visits recorded to office-based physicians in the US. MAIN OUTCOME MEASURES: The interest outcome was unnecessary antibiotic prescription...
August 2017: JRSM Open
Katerina Zakka, Mohamad Bitar, Bassel Lakkis, Sahar H Koubar
In patients with complex psychosocial history presenting with resistant hypertension, observed therapy should be implemented early on to avoid unnecessary investigations and delayed diagnosis.
August 2017: JRSM Open
Daniel G Cacione, Daniel H Moreno, Luis Cu Nakano, José Cc Baptista-Silva
Buerger's disease is characterized by recurring progressive inflammation and occlusions in small and medium arteries and veins of the limbs. Its cause is unknown, but it is most common in young men with a history of tobacco use. It is responsible for ischemic ulcers and extreme pain in the hands and feet. In many cases, notably in patients with the most severe presentations, there is no possibility of improving the condition with surgery (limb revascularisation), and therefore, alternative therapies (e.g. sympathectomy) is used...
August 2017: JRSM Open
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