Brit J Hosp Med
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For patients with a life-limiting diagnosis, guidance by the General Medical Council recommends exploring patients' beliefs and values about tissue donation with the patient and family towards the end of life. This article gives guidance to healthcare professionals on the process of giving patients the opportunity to donate their corneas, including eligibility, communication and practicalities.
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Breast cancer is the most commonly diagnosed female cancer in the UK, with one in eight women receiving a cancer diagnosis during their lifetime. Forty per cent of women diagnosed with breast cancer undergo mastectomy as their primary therapeutic procedure. ⋯ This review discusses the evolution of implant-based reconstruction, focusing on the recent trend towards prepectoral breast reconstruction. Key quality indicators in the current literature are considered, including oncological outcomes, aesthetics and patient-related outcome measures, as are the health-care economics of this emerging surgical technique.
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Navigating the rapidly evolving field of materials for soft tissue reinforcement is challenging given the volume of clinically available options. Additionally, the current generally accepted classifications of these mesh materials confound the understanding of their utility by grouping disparate materials that have attributes overlapping category boundaries and that do not fully consider their clinically functionality. This review article highlights, from a materials science perspective, the most important attributes of these materials to improve the clinical decision-making process in the selection of the most appropriate features and design for the patient, surgery and clinical need. These characteristics include the physical attributes that directly impact the surgical procedure and immediate postoperative mechanical requirements as well as the post-implantation properties such as an adequate reinforcement time, strength of the resulting tissue and infection risk profile.
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Peripheral artery disease of the lower limbs is a chronically progressive disorder characterised by the presence of occlusive lesions in the medium and large arteries that result in symptoms secondary to insufficient blood flow to the lower extremities. It is both a manifestation of systemic atherosclerosis and a marker of increased cardiovascular morbidity and mortality. Because of its highly heterogenous clinical picture, a detailed history and physical assessment, a high degree of suspicion for peripheral artery disease and the use of the ankle-brachial pressure index is essential to identify patients with peripheral artery disease. This will allow early administration of basic pharmacotherapy and lifestyle changes to reduce cardiovascular events, minimise claudication symptoms and enable optimal revascularisation to prevent loss of limb function.
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Attention deficit hyperactivity disorder is a persistent, pervasive neurodevelopmental disorder, characterised by the core features of hyperactivity, impulsivity and inattention. While previously thought to be a condition that only affects children, it is now well recognised that in a significant proportion of cases both symptoms and associated impairment will persist into adulthood. ⋯ However, once correctly diagnosed, attention deficit hyperactivity disorder responds well to treatment, particularly pharmacological intervention. This article gives an overview of attention deficit hyperactivity disorder with special emphasis on the diagnosis and pharmacological treatment of attention deficit hyperactivity disorder in adults.