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Bilateral distal femoral endoprosthesis for trauma. 双侧股骨远端假体治疗创伤。
Pub Date : 2020-12-24 eCollection Date: 2020-11-01 DOI: 10.1177/2054270420970725
Jarrad M Stevens, Nick D Clement, Tom Beckingsale, James T Patton

In this paper, we describe the outcome of bilateral distal femoral endoprosthesis for the management of acute severe trauma. We also review the literature to ascertain the published functional results of distal femoral endoprosthesis for acute trauma of native knees. In severely comminuted intra-articular fractures, such as those our patient sustained, reconstruction is not always possible, and predictable outcomes can rarely be assured with conviction. Endoprosthesis is an established treatment modality for replacement after resection in limb salvage surgery. In this regard, there is a limited but vital role that endoprosthesis can play in acute complex trauma. We demonstrate a good short-term outcome when bilateral endoprostheses are utilised for complex distal femur trauma.

在这篇文章中,我们描述了双侧股骨远端人工植入术治疗急性严重创伤的结果。我们也回顾文献,以确定已发表的远端股骨内假体治疗急性膝关节创伤的功能结果。在严重粉碎性关节内骨折中,如本例患者,重建并不总是可能的,而且预测的结果也很难确定。植入术是残肢手术切除后的一种成熟的治疗方式。在这方面,在急性复杂创伤中,内假体可以发挥有限但至关重要的作用。我们证明了当双侧内假体用于复杂的股骨远端创伤时,短期效果良好。
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引用次数: 0
Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study. 经验丰富的美国医师助理/助理在英国急性医院护理中对效率和安全性的感知影响:来自多地点病例组织研究的结果。
Pub Date : 2020-11-27 eCollection Date: 2020-10-01 DOI: 10.1177/2054270420969572
Vari M Drennan, Melania Calestani, Francesca Taylor, Mary Halter, Ros Levenson

Objectives: To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors.

Design: Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis.

Setting: Eight acute hospitals, England.

Participants: 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents.

Results: Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates.

Conclusions: The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

目的:调查英国急症医院医疗/外科团队人员配置中经验丰富的医师助理的贡献、效率和安全性,包括促进和阻碍因素。设计:采用混合方法,对27名美国医师助理进行为期两年的纵向多地点评估:访谈和文献分析。背景:英格兰八家急症医院。参与者:36名医务主任、顾问、初级医生、护士和管理人员,198份文件。结果:随着时间的推移,经验丰富的医师助理被视为医疗和外科团队的积极资产,即使在最初表达高度怀疑的服务中也是如此。他们的积极贡献被描述为使医疗/外科小组保持连续性,从而使病人、咨询医生、在职医生、护士和服务的整体效率受益。这是第一份关于包括医疗/外科小组助理医师在内的人员对培训医生实现安全工作时间产生积极影响的报告。许多人报告说,医生协会缺乏相应的法律授权来开处方和订购电离辐射,这阻碍了他们的部署和就业。然而,到方案结束时,已有七家医院公布了增加聘用医师助理人数和为实习医师助理提供临床实习的计划。结论:该计划展示了经验丰富的医师助理对患者经验、初级医生经验和医疗劳动力短缺的急性护理服务的贡献类型。总医务委员会将来将对这个行业进行管理。现在需要强有力的定量研究。
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引用次数: 2
Impact of diet on health and longevity in London 1850-1880. 1850-1880年伦敦饮食对健康和寿命的影响。
Pub Date : 2020-11-27 eCollection Date: 2020-09-01 DOI: 10.1177/2054270420969533
Peter Greaves

This study examines the impact of diet on health in different districts of mid-19th century London. Surveys of London diets and living condition were compared with mortality data between 1851 and 1880. Despite an abundance of fresh foods reaching London, the very poor labouring population living in the inner boroughs between 1850 and 1861 had great difficulty obtaining sufficient nourishment because of its cost. This population showed high death rates from infectious diseases, notably pulmonary tuberculosis, which was endemic and is typically associated with poor nutrition. This high death rate was exacerbated by more deaths from gastrointestinal infections associated with a polluted water supply from the river Thames. By contrast, the poor in the outer suburbs enjoyed both more nutritious diets and cleaner water which was associated with lower death rates comparable to those in rural Britain. Outer suburbs retained a relatively rural life-style associated with cleaner water and an abundance of locally grown food. In the following two decades, there was a significant reduction in the death rates from gastrointestinal infections in the inner boroughs which correlated with the major improvements in London's water supply. The decline in death rates from tuberculosis and other infectious disease was inconsistent and increased in some boroughs, suggesting patchy economic improvement and a persisting limited ability of many of London's poor to afford a nutritious diet.

这项研究考察了19世纪中期伦敦不同地区的饮食对健康的影响。对伦敦饮食和生活条件的调查与1851年至1880年间的死亡率数据进行了比较。尽管丰富的新鲜食品运抵伦敦,1850年至1861年间,居住在伦敦内城区的贫困劳动人口却很难获得足够的营养,因为成本高昂。这些人口的传染病死亡率很高,特别是肺结核,这是一种地方性疾病,通常与营养不良有关。由于泰晤士河的供水受到污染,更多的人死于胃肠道感染,这加剧了这一高死亡率。相比之下,远郊的穷人享有更有营养的饮食和更清洁的水,与英国农村相比,他们的死亡率更低。远郊保留了相对农村的生活方式,有更清洁的水和丰富的当地种植的食物。在接下来的二十年里,由于伦敦供水的重大改善,内城区因胃肠道感染导致的死亡率显著下降。结核病和其他传染病死亡率的下降是不稳定的,在一些行政区还在上升,这表明伦敦经济的改善并不全面,而且伦敦许多穷人负担得起营养饮食的能力仍然有限。
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引用次数: 0
Early career choices for emergency medicine and later career destinations: national surveys of UK medical graduates. 急诊医学的早期职业选择和后来的职业目的地:英国医学毕业生的全国调查。
Pub Date : 2020-10-23 eCollection Date: 2020-08-01 DOI: 10.1177/2054270420961595
Trevor W Lambert, Fay Smith, Michael J Goldacre

Objective: To report doctors' early career preferences for emergency medicine, their eventual career destinations and factors influencing their career pathways.

Design: Self-administered questionnaire surveys.

Setting: United Kingdom.

Participants: All graduates from all UK medical schools in selected graduation years between 1993 and 2015.

Main outcome measures: Choices for preferred eventual specialty; eventual career destinations; certainty about choice of specialty; correspondence between early specialty choice for emergency medicine and eventually working in emergency medicine.

Results: Emergency medicine was chosen by 5.6% of graduates of 2015 when surveyed in 2016, and 7.1% of graduates of 2012 surveyed in 2015. These figures represent a modest increase compared with other recent cohorts, but there is no evidence of a sustained long-term trend of an increase. More men than women specified emergency medicine - in 2016 6.6% vs. 5.0%, and in 2015 7.9% vs. 6.5%. Doctors choosing emergency medicine were less certain about their choice than doctors choosing other specialties. Of graduates of 2005 who chose emergency medicine in year 1, only 18% were working in emergency medicine in year 10. Looking backwards, from destinations to early choices, 46% of 2005 graduates working in emergency medicine in 2015 had specified emergency medicine as their choice of eventual specialty in year 1.

Conclusions: There was no substantial increase across the cohorts in choices for emergency medicine. Policy should address how to encourage more doctors to choose the specialty, and to create a future UK health service environment in which those who choose emergency medicine early on do not later change their minds in large numbers.

目的:了解急诊医师早期职业偏好、最终职业归宿及影响其职业路径的因素。设计:自我管理问卷调查。背景:英国。参与者:1993年至2015年选定毕业年份的所有英国医学院毕业生。主要结果衡量指标:最终首选专业的选择;最终的职业目标;专业选择的确定性;早期急诊医学专业选择与最终从事急诊医学工作的对应关系。结果:2015届毕业生在2016年接受调查时选择急诊医学的比例为5.6%,2012届毕业生在2015年接受调查时选择急诊医学的比例为7.1%。这些数字与最近的其他队列相比略有增加,但没有证据表明有持续的长期增长趋势。选择急诊医学的男性多于女性——2016年为6.6%对5.0%,2015年为7.9%对6.5%。选择急诊医学的医生比选择其他专业的医生更不确定他们的选择。2005年的毕业生在一年级选择急诊医学,只有18%的人在十年级从事急诊医学工作。回顾过去,从目的地到早期选择,2015年从事急诊医学工作的2005年毕业生中有46%在第一年将急诊医学作为最终选择的专业。结论:在所有队列中,选择急诊药物的人数没有显著增加。政策应该解决如何鼓励更多的医生选择这个专业,并创造一个未来的英国卫生服务环境,在这个环境中,那些早期选择急诊医学的人以后不会大量改变主意。
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引用次数: 1
Royal Society of Medicine Surgical Innovation Day Adrian Tanner Prize Winner 2019: Multidisciplinary care and surgical innovation for the benefit of the patient with head and neck cancer of unknown primary. 英国皇家医学会 2019 年 "阿德里安-坦纳奖"(Adrian Tanner Prize)外科创新日:多学科护理和外科创新,造福原发性不明的头颈部癌症患者。
Pub Date : 2020-07-08 eCollection Date: 2020-07-01 DOI: 10.1177/2054270420921066
Rakesh Mistry, Abigail Walker, Nathan Walker, Enyinnaya Ofo

Head and neck carcinoma of unknown primary accounts for approximately 1-5% of all head and neck cancers and presents a genuine diagnostic and therapeutic dilemma. Despite advanced investigations, the primary tumour location remains unknown in up to 40% of these cases. Transoral robotic surgery presents a viable diagnostic and therapeutic option in these patients. This surgical innovation alongside advances in the understanding of head and neck cancer biology means that a multidisciplinary approach in the management of these complex patients is of utmost importance to ensure optimal therapeutic outcomes.

原发灶不明的头颈部癌症约占所有头颈部癌症的 1-5%,是一个真正的诊断和治疗难题。尽管进行了先进的检查,但仍有高达 40% 的病例原发肿瘤位置不明。经口机器人手术为这些患者提供了可行的诊断和治疗方案。这种手术创新以及对头颈部癌症生物学认识的进步意味着,采用多学科方法治疗这些复杂的患者对确保最佳治疗效果至关重要。
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引用次数: 0
Hyperglycaemia-related occipital lobe seizures. 高血糖相关的枕叶癫痫。
Pub Date : 2020-06-15 eCollection Date: 2020-06-01 DOI: 10.1177/2054270420920999
A Alakkas, P Chen, M Chen, K Longardner, D E Piccioni

Recognition of the role of hyperglycaemia in seizures is vital, because they tend to refractory to antiepileptic drugs and respond to insulin therapy and hydration.

认识到高血糖在癫痫发作中的作用是至关重要的,因为它们往往对抗癫痫药物无效,而对胰岛素治疗和水合作用有反应。
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引用次数: 3
Decades of cough: delayed recognition of atypical cystic fibrosis in an adult patient. 数十年的咳嗽:成人患者非典型囊性纤维化的延迟识别。
Pub Date : 2020-06-11 eCollection Date: 2020-06-01 DOI: 10.1177/2054270420921003
Abhimanyu Chandel, Kevin Pak, Sean Dooley, Krystle Salazar

We present a case of a 30-year-old male diagnosed with atypical cystic fibrosis. This report demonstrates the heterogeneity of the presentation of this common genetic disease.

我们提出一例30岁男性诊断为非典型囊性纤维化。本报告证明了这种常见遗传疾病表现的异质性。
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引用次数: 3
Ruptured ovarian dermoid cyst - an unusual cause for peritonitis in pregnancy: a case report. 卵巢皮样囊肿破裂——妊娠期腹膜炎的罕见病因:1例报告。
Pub Date : 2020-06-06 eCollection Date: 2020-06-01 DOI: 10.1177/2054270417744502
Thajammul Moin, Bruce Ramsay, Barbara Mckeown, Elizabeth Astall, Niteen Tapuria

Computed tomography scanning could be safely used in later pregnancy to aid diagnosis and target management of the acute abdomen.

计算机断层扫描可以安全地用于妊娠后期的急腹症的诊断和目标管理。
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引用次数: 1
Junior doctors' aspirations for careers in ophthalmology: 40 years of surveys of UK medical graduates. 初级医生对眼科职业的期望:对英国医学毕业生40年的调查
Pub Date : 2020-05-06 eCollection Date: 2020-05-01 DOI: 10.1177/2054270419892155
Trevor W Lambert, Atena Barat, Michael J Goldacre

Objective: Using data from 40 years of national surveys of UK medical graduates, we report on ophthalmology as a career choice.

Design setting and participants: Self-administered questionnaire surveys of all graduates from all UK medical schools in selected years of qualification between 1974 and 2015.

Main outcome measures: Career specialty preferences of doctors one, three, and five years after graduation; career specialty destinations 10 years after graduation.

Results: One year after graduation, ophthalmology was the first career preference of 1.6% of the qualifiers of 1974-83, 2.2% of 1993-2002, and 1.8% of 2005-15. The corresponding percentages three years after graduation were 1.5, 1.8, and 1.2%. Men were more likely than women to choose ophthalmology: among graduates of 2005-15, 2.4% of men and 1.4% of women did so at one year, as did 1.7% of men and 0.7% of women at five years. Seventy per cent of doctors practising as ophthalmologists 10 years after qualification had told us in their first post-qualification year that ophthalmology was their first choice of career.

Conclusions: There has been no systematic change in recent years in the proportion of recent medical graduates intending to have a career in ophthalmology when surveyed one year after graduation. However, the proportion at three and five years after graduation was lower than that at year 1. Suggestions for maintaining interest in the specialty include improved career advice, greater early clinical exposure to ophthalmology, and improved access to flexible training. Most practising ophthalmologists had made early decisions that this was their intended career.

目的:利用英国医学毕业生40年的全国调查数据,我们报告了眼科作为职业选择的情况。设计环境和参与者:对1974年至2015年间选定资格年份的所有英国医学院毕业生进行自我管理的问卷调查。主要结局指标:医生毕业后1、3、5年的职业专业偏好;毕业后10年的职业专业目标。结果:1974-83年度、1993-2002年度和2005-15年度毕业生中,有1.6%、2.2%和1.8%的毕业生在毕业1年后选择眼科为第一职业。毕业3年后相应比例分别为1.5%、1.8%和1.2%。男性比女性更有可能选择眼科:在2005-15届毕业生中,2.4%的男性和1.4%的女性在一年内选择了眼科,而在五年内选择眼科的男性和女性比例分别为1.7%和0.7%。在获得资格10年后从事眼科工作的医生中,有70%的人在获得资格后的第一年告诉我们,眼科是他们的第一职业选择。结论:近年来,在毕业一年后的调查中,近期医学毕业生打算从事眼科职业的比例没有系统的变化。然而,毕业后3年和5年的比例低于第一年。建议保持对专业的兴趣包括改善职业建议,更多的早期临床接触眼科,以及改善灵活培训的机会。大多数执业眼科医生很早就决定这是他们想要的职业。
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引用次数: 2
Barista's fracture: a new occupational hazard. 咖啡师骨折:一种新的职业危害。
Pub Date : 2020-05-06 eCollection Date: 2020-05-01 DOI: 10.1177/2054270420918493
Baasil Syed Yusuf, Neil Segaren, Nicholas Segaren, Livio Di Mascio

Stress fracture of the clavicle is a rare injury usually occurring in high-level athletes. It is typically a result of repetitive sporting activity or unusual strain. We present the first case of an occupational clavicle stress fracture in a young female barista. The patient initially presented with insidious onset clavicular pain. There was no history of trauma, and an undisplaced fracture was present on the plain radiograph but overlooked by the emergency physicians. Two weeks later, the patient presented again with worsening symptoms, and a displaced fracture of the clavicle was diagnosed on plain radiograph. A thorough occupational history revealed the cause of her pain, which was the mechanical activity of coffee tamping and the fracture went on to unite with no further complications. No other cause was found on investigations including magnetic resonance imaging. The fracture healed with cessation of coffee tamping. This case highlights a previously unrecognised occupational hazard of coffee tamping as a potential cause of stress fracture of clavicle.

锁骨应力性骨折是一种罕见的损伤,通常发生在高水平运动员中。它通常是重复性运动或异常劳损的结果。我们提出的第一例职业锁骨应力性骨折在一个年轻的女咖啡师。患者最初表现为隐匿性锁骨疼痛。患者无外伤史,平片显示未移位骨折,但急诊医师忽略了。两周后,患者再次出现症状恶化,x平片诊断为锁骨移位性骨折。彻底的职业病史揭示了她疼痛的原因,这是咖啡夯实的机械活动,骨折继续愈合,没有进一步的并发症。在包括核磁共振成像在内的调查中没有发现其他原因。骨折在停止咖啡夯实后愈合。这个病例强调了以前未被认识到的咖啡夯实的职业危害是锁骨应力性骨折的潜在原因。
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引用次数: 1
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