Brit J Hosp Med
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Breast cancer is the most common global malignancy and the leading cause of cancer deaths. Despite this, undergraduate and postgraduate exposure to breast cancer is limited, impacting on the ability of clinicians to accurately recognise, assess and refer appropriate patients. This article provides a comprehensive review of the pathology, epidemiology, clinical presentation, referral pathways and management of breast cancer in the UK. It also describes how to conduct a thorough clinical breast examination.
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Rotator cuff repair is increasingly being performed, and this is likely to continue to given the ageing population. An improvement in functional outcome can be achieved, with the best results noted in those tendons that go on to heal. ⋯ Several operative strategies have been described, but careful evaluation is required to determine the most suitable option. This review describes the decision-making strategies and treatment options available during management of a failed rotator cuff repair.
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Olecranon fractures are common injuries, making up 10% of all fractures of the upper limb. They usually result from a fall from standing height in older people, or from a direct blow in young people. The olecranon's superficial location, with poor soft tissue and muscle protection, make it liable to fracture following direct impact. ⋯ Surgical techniques include tension band wiring, open reduction internal fixation with a pre-contoured locking plate and tension band suture fixation. Undisplaced fractures or displaced fractures in older patients can be managed conservatively with an above elbow cast for 4 weeks. This article covers applied anatomy, initial presentation, clinical assessment and evidence-based management.
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The specialised foundation programme, previously known as the academic foundation programme, is an alternate foundation training pathway for doctors that are interested in research, medical education and leadership. The programme is highly competitive, with competition ratios rising to 1:5 in some units of application. A series of courses is held each year out of goodwill to assist students with the application process, but little has been published with respect to evidence-based approaches to both the application process and interviews. This article provides a series of frameworks to simplify the challenges posed by the application process and the academic, personal and clinical interviews.
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The National Confidential Enquiry into Patient Outcome and Death reviewed the organisation of services and the quality of clinical care provided to patients who were admitted to hospital following an out-of-hospital cardiac arrest. The report looked at all four links in the 'chain of survival', covering the last link, in-hospital advanced life support and post-resuscitation care, in most detail.