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Quality and Safety in Medicine

‘Quality and Safety in Medicine’ Series: Gastric ischaemia following a fall

3 Aug, 11 | by Emma

Having an open mind:
This case is of a gentleman with a series of unusual complications of a fall. The patient is managed by sequential teams of doctors of different specialisms and reflects, very much, the workings of the modern NHS. The presentation, alone, is unusual but the treatment at each stage and the response of the teams to each complication is of note. The final decision – urgent laparotomy -reveals all.

Seema Biswas
Editor-in-Chief

Gastric ischaemia following a fall

‘Quality and Safety in Medicine’ Series: Efficacy of administration of coagulation factor XIII with definitive surgery for multiple intractable enterocutaneous fistulae in a patient with decreased factor XIII activity

25 May, 11 | by Emma

Enterocutaneous fistula is amongst the most challenging of surgical complications to manage. Here a patient with multiple comorbidities treated successfully results in a favourable outcome.

Seema Biswas
Editor-in-Chief

Efficacy of administration of coagulation factor XIII with definitive surgery for multiple intractable enterocutaneous fistulae in a patient with decreased factor XIII activity

‘Quality and Safety in Medicine’ Series: Hypertensive emergency as a complication of brachial plexus block

19 May, 11 | by Emma

Complications recognised early and treated promptly can avert disaster. In this case regional anaesthetic blockade exacerbates hypertension in a patient prepared for emergency surgery. The patient is treated urgently and surgery is cancelled. The authors discuss possible mechanisms where nerve blockade of baroreceptors may result in life-threatening hypertension and myocardial damage.

Seema Biswas
Editor-in-Chief

Hypertensive emergency as a complication of brachial plexus block

‘Quality and Safety in Medicine’ Series: Subungual malignant melanoma – re-learning the lesson

11 May, 11 | by Emma

It is not unusual for patients to present with trauma only to be found to have a second, more sinister, diagnosis. Here, the authors present two cases of hand trauma where subungual melanoma is subsequently found.

Seema Biswas
Editor-in-Chief

Subungual malignant melanoma – re-learning the lesson

‘Quality and Safety in Medicine’ Series: The assessment and treatment of a complex geriatric patient by an interprofessional primary care team

4 May, 11 | by Emma

The multi-disciplinary team is perhaps one of the triumphs of modern medicine. The following account of the inter-professional management of an 89 year old lady who suffers recurrent falls is an example of how well the system can work.

Seema Biswas
Editor-in-Chief

The assessment and treatment of a complex geriatric patient by an interprofessional primary care team

‘Quality and Safety in Medicine’ Series: Atypical mycobacteria in a superficial femoral artery occlusion

20 Apr, 11 | by Emma

A rare cause of superficial femoral artery occlusion is discovered in a patient who undergoes surgery for worsening claudication. The patient is young and an occasional smoker. The authors go on to research the pathophysiology of the lesion and suggest how it might have been formed.

Seema Biswas
Editor-in-Chief

Atypical mycobacteria in a superficial femoral artery occlusion

‘Quality and Safety in Medicine’ Series: When a groin lump is more than a simple groin lump

13 Apr, 11 | by Emma

In this case of the series we highlight attention to detail.

The authors report a young footballer who presents acutely with an irreducible, painful groin lump. An incarcerated inguinal hernia is a reasonable diagnosis in spite of a combination of intriguing examination findings. The groin is explored and there is no hernia. Instead, a blood clot is found. The wound is not closed after evacuation of the clot; the authors continue to explore until the cause is revealed and treated effectively.

Seema Biswas
Editor-in-Chief

When a groin lump is more than a simple groin lump

‘Quality and Safety in Medicine’ Series: Faulty fetal packing

6 Apr, 11 | by Emma

Here the authors report the birth of a baby delivered by emergency caesarian section after preterm prolonged rupture of membranes. The situation must have been tense; and, there is considerable blood loss at surgery. The baby requires extensive resuscitation and transfusion. A depression is then noted in the baby’s skull. What now?

Seema Biswas
Editor-in-Chief

Faulty fetal packing

‘Quality and Safety in Medicine’ Series

30 Mar, 11 | by Emma

Markers to measure quality and safety in health care are much debated. A decline in adverse event reporting may represent a genuine decline in adverse events or merely a decline in their reporting; just as a rise in the reporting of poor outcomes may represent significant cultural changes in a healthcare system more vigilant or more responsible. While audits of quality control or patient satisfaction have their place, case reports are an opportunity to present well managed patients who have received good care; and, at the same time near misses promptly dealt with and complex cases well worked through.

Our aim is to become a repository of well managed cases. The cases need not be rare, indeed we learn much more from each other’s experience of pitfalls in common cases and rare presentations of common diseases. In the upcoming weeks we will present a series of cases that illustrate aspects of quality and safety in medicine and invite you to submit your experience of quality and safety in healthcare.

Seema Biswas
Editor-in-Chief

This is an example of a rare presentation of a common condition, recognised because of the vigilance of the medical team.

Optic nerve involvement as a first manifestation of acute lymphoblastic leukaemia after remission

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