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 […]
Category: Quality and Safety in Medicine
‘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
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
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 […]
‘Quality and Safety in Medicine’ Series: Subungual malignant melanoma – re-learning the lesson
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
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 […]
‘Quality and Safety in Medicine’ Series: Atypical mycobacteria in a superficial femoral artery occlusion
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 […]
‘Quality and Safety in Medicine’ Series: When a groin lump is more than a simple groin lump
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 […]
‘Quality and Safety in Medicine’ Series: Faulty fetal packing
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 […]
‘Quality and Safety in Medicine’ Series
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 […]