Brit J Hosp Med
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A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
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An 'experience day' is a novel concept in medical education, targeted at postgraduate doctors in training. In this article, the term postgraduate doctors in training includes all junior doctors, ranging from foundation year level to junior specialist doctors to higher specialist registrars. Experience days offer postgraduate doctors in training the opportunity to shadow other healthcare professionals in their working environment, to enhance their perspective of their role as a clinician and their understanding of the complex interplay of services. ⋯ Taster days are a well-established educational opportunity for junior doctors, supported by Health Education England. However, there is a paucity of literature concerning shadowing for doctors who have already qualified, or those who wish to shadow services that they work alongside. This article introduces the concept of experience days for postgraduate doctors in training.
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Stroke services must detect and manage psychological and neuropsychological problems that occur after stroke, such as cognitive and language impairments, post-stroke apathy, post-stroke emotionalism, depression, anxiety, post-traumatic stress disorder, personality changes and suicidality. Stroke neuropsychology plays a key role in the assessment, understanding and management of these consequences of stroke, as well as contributing to complex case management, staff supervision and training. ⋯ To manage the scale of psychological and neuropsychological needs post stroke, clinical guidance recommends the use of a matched care system, in which these needs are triaged and matched with corresponding levels of support. Recent workforce guidelines provide clear professional recommendations for psychological staffing skill mix and threshold requirements for clinical oversight and clinical governance assurances.
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In a climate where there is a fear of blame and litigation associated with medical practice, this editorial discusses the current guidance within the UK on the duty of candour, both professional and statutory, highlighting cases where action has been taken.