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'I Only want to RUN': how fun athletes understand and handle injuries.
More-severe adverse reactions and longer durations of adverse reactions were related to higher SARS-CoV-2 antibody levels. The agreements and correlations among the assays applied were substantial (к, 0.73 to 0.95) and strong (ρ, 0.83 to 0.91). A single dose of the AZ vaccine led to high positivity rates based on the five assays. Days after vaccination and adverse reactions could help estimate serologic conversion rates. The results should be interpreted cautiously considering the assays and cutoffs applied. Our findings could inform decisions regarding vaccination and laboratory settings and could thus contribute to the control of the spread of SARS-CoV-2 infection.This year marks the 150th anniversary of the birth of Grafton Elliot Smith, the distinguished Australian-born anatomist and an early expert on the excavations of ancient Egypt.
Exception reporting is a function by which junior doctors report when their work has varied from expected. This study analysed the reporting at the authors' hospital.

The authors analysed 204 reports submitted across 12 months to investigate the nature and pattern of the exception reports.

The majority of reports (86%) were for 'hours and rest', 5% for education and 9% for both. On average doctors reported an additional 1.32 hours of work per report. The most common response was time off in lieu, but 13% of reports were never responded to. Qualitative analysis showed the most common reasons for reporting were 'work outside of rostered hours', 'workload' and 'staffing issues'. Over 10% of the reports discussed an educational issue.

The data were not specific and there was fewer than one report per junior doctor in the period analysed. AGI-6780 It is therefore unlikely that the reports submitted represent the additional work done by junior doctors at the hospital. Guardians should investigate local attitudes to exception reporting and educate both seniors and juniors on the importance of submitting accurate exception reports.
The data were not specific and there was fewer than one report per junior doctor in the period analysed. It is therefore unlikely that the reports submitted represent the additional work done by junior doctors at the hospital. Guardians should investigate local attitudes to exception reporting and educate both seniors and juniors on the importance of submitting accurate exception reports.Advances in pharmacokinetic understanding have popularised the safe and effective use of total intravenous anaesthesia delivered by continuous infusion. This article explores why the practical and outcome benefits have made total intravenous anaesthesia an increasingly accepted alternative to use of inhalational agents.The coagulopathy of chronic liver disease causes derangement of the results of traditional laboratory tests. As such, there is an expectation that when undergoing invasive procedures patients with cirrhosis are at increased risk of bleeding. Standard practice is to optimise laboratory values with prophylactic transfusions of platelets, plasma and fibrinogen to reduce perceived bleeding risk. There has been a shift in thinking regarding coagulation in patients with chronic liver disease, whereby a rebalancing of haemostasis occurs with reduction in both procoagulants and anticoagulants. Guidelines for the preprocedural management of patients with chronic liver disease are inconsistent and may not account for this new paradigm. The risk of prophylactic transfusion should be measured against the risk of bleeding while considering the rebalancing of haemostasis. link2 Future management may be guided by whole blood viscoelastic tests or use of thrombopoietin receptor agonists to optimise patients in these scenarios.Temporary epicardial pacing wires are used after cardiothoracic surgery to maintain a stable cardiac rhythm. They must be distinguished from the more commonly encountered transvenous temporary pacing wires, which are often used in coronary care units for the same purpose. Patients with temporary epicardial pacing wires may be transferred to hospital wards where these wires are not usually encountered, such as COVID wards, the general intensive care unit, the coronary care unit or general surgical wards if a laparotomy was required in the early period following cardiac surgery. Serious complications may arise in managing patients with temporary epicardial pacing wires, which are well known in the cardiothoracic unit but not so well known elsewhere in the hospital. This article discusses the dangers associated with the management of temporary epicardial pacing wires in adult patients, some of which are common to temporary transvenous pacing wires and others are unique to temporary epicardial pacing wires.Obesity is a worldwide epidemic and official figures demonstrate a rising prevalence, both in the UK and globally. Increasingly, there is a recognised place for surgical intervention in carefully selected patients, but there is limited understanding of the pathway and process among non-specialist clinicians. This article summarises the available guidelines and literature on the surgical management of obesity for hospital physicians, surgeons and GPs. The focus is on appropriate referral criteria, key bariatric procedures, postoperative management and, most importantly, the complications of surgery and how to recognise them.A well thought-out business case offers an opportunity for clinicians to bring about evidenced-based change in clinical practice. It is a powerful tool that can have a significant impact on healthcare services and patient outcomes, while also offering desirable solutions to the NHS, which is facing growing healthcare demands on increasingly limited resources. The role of a business case is to justify the need for change, argue its value, gain support from leadership and illustrate how it can be sustainably implemented. This article guides clinicians through the process of producing a successful business case using the five-case model, which can be applied to the majority of improvement projects or services in healthcare settings. Clinicians might use this guide to support the development of a case to make a change in their own workplace or to help them take a full part in wider system changes.Falls are a common presenting complaint, particularly in older patients, and are associated with significant morbidity. Inpatient falls also have financial implications for healthcare systems, including litigation costs. This article provides an approach to assessing a patient presenting with a fall, encompassing the cause and consequence of the event. It also highlights the need to consider both the acute and chronic factors that predispose a particular patient to fall. Chronic factors such as frailty, sarcopenia, cognitive impairment, and continence issues are often under-recognised and, as a result, not managed optimally. A comprehensive geriatric assessment is an ideal structure to identify modifiable risks. Practical interventions that can be of benefit to minimise a patient's risk of falling include a medication review, assessment of their mobility and their environment. In addition, continence review and visual assessment may be appropriate.Patient and public involvement involves ascertaining the opinions of and collaborating with patients and members of the public to holistically improve the quality of research. Patient and public involvement provides patients with a platform to use and share their lived experiences. This allows healthcare professionals to gain a deeper appreciation of the patient's perspective, which enables future research to be more patient centred and tailored to patients' requirements. Patient and public involvement aims to broadly encapsulate the opinions of the public, so ensuring diversity is recommended. This article provides a practical framework to increase diversity and engage hard-to-reach demographics in patient and public involvement. link3 It highlights some common barriers to participation and methods for overcoming this, describes sampling frameworks and provides examples of how these have been adopted in practice.
Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions.

The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019-20.

The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing.

The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.
The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.Complications following surgery are common, predictable and often preventable. New preoperative assessment and optimisation guidance recommends clear pathways with triggers for interventions, patient involvement, shared decision making and team education, to help both patients and service efficiency.The oesophageal Doppler monitor received early endorsement as an effective emerging medical technology, although numerous alternatives have since been widely adopted. This article examines the evidence supporting the continued use of the oesophageal Doppler.
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