Brit J Hosp Med
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Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers of the eye, leading to a sudden rise in intraocular pressure and secondary optic neuropathy if left untreated. The most common primary cause is a pupillary block in patients with pre-existing narrow angles, such as those who are long-sighted. However, awareness should be raised to identify secondary causes of angle closure, including the use of commonly prescribed medications. ⋯ Basic examination of the eye should include assessment of the anterior segment with a bright light, measurement of intraocular pressure and a full neurological exam. Immediate treatment must be initiated whenever there is high clinical suspicion of acute angle closure, with the administration of systemic ocular hypotensive therapy to prevent damage to the optic nerve and limit visual loss. An urgent referral to the ophthalmologist is mandatory to dictate definitive management.
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Palliative and end of life care forms an important part of the role of any doctor in training, and an awareness of a structured approach to managing common symptoms and end of life care is essential. Common symptoms include pain, nausea and vomiting, constipation, and breathlessness. ⋯ Prescribing or medication errors in relation to symptom control in palliative care can relate to individual errors, poor communication, poor care coordination, equipment and care planning. There are some important key points relating to prescribing to consider, for example, using recognized conversions when changing between opioids and from the oral to syringe drivers route; that diamorphine and morphine are not equipotent; prescribing liquid opioids in milligrams not millilitres where there are multiple concentrations available; making the indication for steroids clear when used, as they are multiple possible indications (and also their intended duration, to avoid unintended longer term sequelae of steroid use); and avoiding the use of oxygen for symptomatic relief of breathlessness in the absence of hypoxia.
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Burns are devastating injuries which represent a significant global health burden. In the UK alone, it is estimated that 175 000 people suffer from burns injuries requiring hospital attention every year. ⋯ Simulation has an increasingly important role in medical education, not only allowing practitioners to apply their knowledge in a controlled and safe environment, but also allowing them to gain technical and non-technical skills. This article explores the role of simulation as an important and effective tool for burns education worldwide.
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The General Medical Council was originally set up to 'protect, promote and maintain the health and safety of the public'. In 2012, the Privy Council instructed the General Medical Council to set up and run a licensing and revalidation system for all practicing doctors in the UK, to protect patients from actions of medical staff. Despite this mandate, the General Medical Council has been a bystander in a series of regulatory failures. ⋯ The other responsibility of the General Medical Council is to monitor teaching standards and curricula of medical schools in the UK, which it does by eliciting feedback from students and trainees. The General Medical Council has not responded to 'new ways of working' (especially in England) involving non-medical staff undertaking tasks previously carried out by doctors. Furthermore, the General Medical Council has not updated its description of the role of the future doctor in light of increasing use of technology, use or non-use of which could both be considered to be evidence of poor practice.