Brit J Hosp Med
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Proximal humeral fractures are common with a bimodal distribution and sex discrepancy, affecting younger men and older women. The presentation of a proximal humeral fracture can vary greatly because of this bimodal distribution and the associated differences in mechanism of injury. Initial management should involve assessment of life- and limb-threatening injuries as outlined by the British Orthopaedic Association Standards for Trauma, with particular attention paid to axillary nerve function and vascular status. ⋯ Head replacement techniques (hemiarthroplasty and reverse shoulder arthroplasty) are indicated when the risk of avascular necrosis is too high or in older patients with osteoporotic bone. In these patients, reverse shoulder arthroplasty is preferred as it achieves better functional results than hemiarthroplasty. Complication rates vary depending on the fracture configuration and the course of management undertaken.
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The recent judgement and suspension of Dr Manjula Arora has caused huge apprehension within the medical community and raised debate about whether the fitness to practise process is fit for purpose. This editorial focuses on the need for 21st century regulation to be proportionate, fair, supportive and compassionate.
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The results of the National Diabetes Inpatient Audit in 2013 showed that the Royal London Hospital had performed worse than the national average in several domains. The aim of this study was to improve inpatient diabetes care at the Royal London Hospital. ⋯ A multi-faceted approach led to significant improvements in patient outcomes and experience, resulting in Royal London Hospital performing well above the national average in the National Diabetes Inpatient Audit in 2016 and 2019. This simple consultant-led multidisciplinary approach could be replicated in other hospitals in UK facing similar challenges.
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One in two people that smoke tobacco will die prematurely and for every person that dies, thirty more will suffer from the serious diseases it causes. Treating this deadly disease lies on the shoulders of every healthcare professional, all of whom have a responsibility to provide highly effective and evidence-based interventions. Failure to treat tobacco dependency falls far below the required standard of care and could be considered negligent.