Brit J Hosp Med
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In the field of breast reconstruction, products and techniques are continuing to evolve to ensure good clinical and quality outcomes. This article reviews the published literature regarding the use of fetal bovine-derived acellular dermal matrix (SurgiMend, SurgiMend PRS and SurgiMend PRS meshed), focusing on safety, clinical outcomes and surgical techniques.
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Clinical reasoning is an essential part of medical practice and therefore should be an important part of clinical teaching. However, it has been and is still a challenge for clinical teachers to support learners in the development of their clinical reasoning skills. As learners progress in clerkship, so do their learning needs. ⋯ The article focuses on three tools that were developed by faculty at the University of Sherbrooke Faculty of Medicine and Health Sciences: the iSNAPPS-OMP Technique, the Anticipatory Supervision Technique and the Clinical Sudoku or table of discriminating clues. This article uses the term 'tools' as a generic expression to signify 'items in a toolbox'. It includes all kinds of resources (techniques, strategies, models) that were gathered to help clinical teachers with the teaching of clinical reasoning.
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Multimodality perioperative interventions could accelerate patient recovery and improve cost-effectiveness. An evidence review found an association between enhanced recovery after surgery and decreased length of stay, while complications and recovery time were unchanged or reduced. More specialties should develop and implement enhanced recovery after surgery pathways.
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Diaphragm disease of the small bowel has been described in the literature over the last three decades. The pathognomonic characteristic of multiple circumferential stenosis is noted on gross examination of the bowel. It is a severe form of non-steroidal anti-inflammatory drug-induced enteropathy, often presenting as acute small bowel obstruction. A systematic review was performed to identify risk factors and patient outcomes in histologically-proven diaphragm disease of the small intestine in patients undergoing emergency operation for small bowel obstruction. ⋯ This is a rare disease, difficult to diagnose and often confirmed by the intra-operative macroscopic appearance of circumferential stenosis of the bowel. Risk factors for developing small bowel diaphragm disease include long-term use of non-steroidal anti-inflammatory drugs, and female gender. Patients with this disease are at increased risk of developing acute small bowel obstruction, so early identification is important.