Brit J Hosp Med
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This article summarises the findings from a review of publications related to healthcare leadership that were published during the first wave of the COVID-19 crisis in 2020. The review discusses a range of strategies for leaders to adopt in challenging situations and identifies three aspects of leadership which are considered essential when leading teams during a crisis: 1) communication, 2) decision making and 3) mental health and wellbeing. This article identifies key principles for each of these three aspects and provides practical tips for how leaders can use the lessons learned from the pandemic in their own contexts.
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Hand fractures are the most common fractures of the upper extremity, with a reported incidence of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Understanding the diagnosis and management of these injuries is vital for any clinician working in the emergency department, plastic or orthopaedic surgery or providing community care. This review identifies the most common presentations and outlines how to assess and manage such fractures appropriately, with an emphasis on clinical and radiographic examination. The majority of hand fractures are managed conservatively and operative management should be carefully considered on a case-by-case basis with analysis of patient and fracture-related factors, in order to achieve optimal hand function following treatment.
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Lithium is a mood stabiliser widely used in the treatment and prophylaxis of mania, bipolar disorders and recurrent depression. Treatment with lithium can give rise to various endocrine and metabolic abnormalities, including thyroid dysfunction, nephrogenic diabetes insipidus and hypercalcaemia. Lithium may induce hypercalcaemia through both acute and chronic effects. ⋯ Lithium-associated hyperparathyroidism, especially in patients on chronic lithium therapy, is associated with increased morbidity. Hence, regular monitoring of calcium levels in patients on lithium therapy is of paramount importance as early recognition of lithium-associated hyperparathyroidism can improve outcomes. This review focuses on the definition, pathophysiology, presentation, investigations and management of lithium-associated hyperparathyroidism.
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Traumatic digit amputations account for 1% of all trauma admissions and are an important cause of morbidity in young, working people. It is essential that patients are worked up appropriately and referred promptly to a specialist unit for consideration of replantation. This review summarises the acute management of a patient presenting to the emergency department with an amputated digit. It discusses the assessment, initial management in the emergency department, how to make the decision to replant and operative steps.
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The number of people with kidney transplants has increased rapidly over the last 20 years. They are often medically complex and have a significant need for both routine and urgent care. ⋯ They are vulnerable to infections and acute kidney injury; disease presentation and course may be atypical and they are at risk of rapid deterioration. This review describes a systematic approach to their assessment and management and highlights specific considerations to be borne in mind.