Clin Med
-
Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and heavy physical workload). The adverse outcomes considered are: miscarriage, preterm delivery, small for gestational age, low birth weight, pre-eclampsia and gestational hypertension. ⋯ In general, patients can be reassured that such work is associated with little, if any, adverse effect on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling.
-
First reported in 1898, post-dural puncture headache (PDPH) remains a significant clinical issue. Here, we present a brief case history and a summary of the current evidence for methods to reduce PDPH rates, along with the experience in our department of implementing these methods in clinical practice. The key points to note are that needle design, gauge and orientation, as well as stylet reinsertion, are factors known to affect the incidence of PDPH, and that there is no evidence to support the use of hydration and bed rest to reduce headache following dural puncture.
-
High performance sports medicine involves the medical care of athletes, who are extraordinary individuals and who are exposed to intensive physical and psychological stresses during training and competition. The physician has a broad remit and acts as a 'medical guardian' to optimise health while minimising risks. This review describes this interesting field of medicine, its unique challenges and priorities for the physician in delivering best healthcare.
-
Modern medicine is complex and delivered by interdependent teams. Conscious redesign of the way in which these teams interact can contribute to improving the quality of care by reducing practice variation. This requires techniques that are different to those used for individual patient care. ⋯ Reporting the collected indicator data in longitudinal run charts supports teams in monitoring the effect of their QI effort. After identifying the opportunities for improvement, the second section discusses how to reduce practice variation. This includes selecting the 'package' of clinical actions to implement, identifying subsidiary actions to achieve the improvement aim, designing the implementation strategy and ways to incentivise QI.
-
Comparative Study
Investigating the frail elderly patient with lower bowel symptoms: what do we do now and can we improve?
To assess the utility of flexible sigmoidoscopy (FS) and minimal preparation CT (MPCT) in investigating lower gastrointestinal (LGI) symptoms in elderly patients who are too frail to undergo colonoscopy or spiral CT. ⋯ LGI investigation in frail elderly patients can be rationalised according to indication. Performing FS and MPCT together is not always necessary.