Brit J Hosp Med
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Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. ⋯ Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
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Recent years have seen major advances in our understanding of primary biliary cholangitis, with the condition now renamed to reflect the majority of patients who do not have cirrhosis. Data from large multicentre studies have greatly increased our knowledge of the natural history of primary biliary cholangitis, making the identification of higher risk patients clearer and facilitating the development of new medications. Recent guidelines have emphasised the importance of risk stratification, targeted treatment of symptoms and early prioritisation for second line therapies. The review summarises recent major developments in our understanding of primary biliary cholangitis and its management.
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An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
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Rhinitis and rhinosinusitis are common conditions which have a significant burden on healthcare services and can lead to reduced productivity in patients across the entire age spectrum. Three disease-specific quality of life tools were analysed in hospital and community settings to explore prevalence, disease characteristics and financial costs to sufferers, and to compare these aspects between cohorts (young children, young adult and adults). ⋯ One of the top three symptoms in children aged 5-10 years was cough, which is a much less common symptom in adults. These validated, disease-specific, quality of life questionnaires provide a fuller illustration of the patient experience, allowing comprehensive comparative analysis across the ages.
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There is a paucity of literature analysing the importance of leadership within trauma and orthopaedics. However, such skills are essential to make an orthopaedic surgeon proficient in their various roles. This literature review on leadership within orthopaedics enables an understanding of current issues. ⋯ Through reviewing the themes in this article, a framework was developed to identify the current issues and potential avenues of advancing orthopaedic leadership. This narrative literature review has demonstrated a paucity of research in orthopaedic leadership. Further work would create a robust evidence base, outline ideal orthopaedic leadership and standardise training to create better orthopaedic leaders.