{"title":"Perioperative management of anaemia","authors":"Richard Harris, Erin Prentice","doi":"10.1016/j.mpmed.2024.10.003","DOIUrl":"10.1016/j.mpmed.2024.10.003","url":null,"abstract":"<div><div>Anaemia continues to present a challenge in the perioperative period, particularly in older people, as its prevalence is higher than that in the general population. Most commonly, perioperative anaemia is secondary to iron deficiency, where timely identification and a clear treatment plan with oral or intravenous replacement before surgery is required. Additional strategies to prevent anaemia intraoperatively and postoperatively should also be implemented, including ways to minimize blood loss and established pathways for additional unplanned blood loss. Failure to prevent and treat such anaemia can not only lead to an increased length of stay and costs, but also increased morbidity and mortality. With this in mind, recent publications from the UK National Institute for Health and Care Excellence and Centre for Perioperative Care have set out standards and approaches to anaemia in perioperative settings.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 1","pages":"Pages 34-38"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143134712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perioperative management of diabetes mellitus and hyperglycaemia","authors":"Nicholas Levy, Gerry Rayman","doi":"10.1016/j.mpmed.2024.10.005","DOIUrl":"10.1016/j.mpmed.2024.10.005","url":null,"abstract":"<div><div>Diabetes mellitus is the most common endocrine disorder affecting surgical patients; although it occurs in 10% of the general population it is seen in up to 25% of the surgical population. Historically, patients with diabetes undergoing surgery were deemed to be very high risk and were often denied the benefits of day surgery. The application of the integrated care pathway coupled with perioperative manipulation of patients’ drugs has transformed surgical care for people with diabetes. Despite these advances, harm from dysglycaemia is not infrequent. The challenge facing clinicians and patients is to further mitigate the harm from hypo- and hyperglycaemia.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 1","pages":"Pages 29-33"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143134713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Frailty and multimorbidity in perioperative care","authors":"Mark Johnston, Claire Jane Swarbrick","doi":"10.1016/j.mpmed.2024.10.008","DOIUrl":"10.1016/j.mpmed.2024.10.008","url":null,"abstract":"<div><div>The UK's surgical population is ageing, resulting in increasing proportions of surgical patients living with frailty and multimorbidity. Frailty is a clinical syndrome where there is multidomain decline in physiological reserve and function resulting in an increased vulnerability to stressors. Multimorbidity is the coexistence of ≥2 long-term health conditions, including physical and mental health problems, learning disability, symptom complexes (e.g. frailty), sensory impairment and substance misuse. Surgery in high-risk older people can provide symptomatic relief or the resolution of underlying pathological problems. High-risk patients benefit from the standard surgical pathway being tailored to address their individual needs. Identifying high-risk patients via screening such as the Clinical Frailty Scale at an early stage in the surgical pathway allows this individualization of care. For older people, a surgical pathway should include the following: identification of the patient's priorities for treatment with a careful discussion of benefits, risks and alternative management options; optimization of medical co-morbidities including anaemia; management of polypharmacy; preoperative discharge planning; organization of staffing and timing of surgery to minimize risk; and postoperative destination planning. Who delivers this care varies by hospital; teams can include perioperative physicians from a variety of backgrounds, specialist nurses, allied health professionals and social workers.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 1","pages":"Pages 10-14"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143134708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postoperative cardiovascular and renal complications","authors":"John Holland, Matthew E Li Kam Wa, Kalpa De Silva","doi":"10.1016/j.mpmed.2024.10.006","DOIUrl":"10.1016/j.mpmed.2024.10.006","url":null,"abstract":"<div><div>Postoperative cardiovascular and renal complications represent common and challenging issues in clinical practice, manifesting as a worsening of chronic conditions or new acute processes related to the surgical intervention. These complications often overlap because of the intricate physiological relationship between the heart and kidneys. This chapter explores key postoperative complications: myocardial infarction, arrhythmia (particularly atrial fibrillation), heart failure and acute kidney injury. Myocardial infarction can be difficult to identify, and the definitive invasive investigation and treatment carries its own risks. Postoperative atrial fibrillation can be both a cause of clinical instability, as well as merely being triggered by physiological stressors, and anticoagulation should be considered based on individual risk assessments. Heart failure involves an optimization of cardiac function and fluid balance, where traditional bedside clinical examination is challenging. Acute kidney injury, a multifactorial condition, requires comprehensive diagnostic evaluation and targeted interventions to prevent progression to chronic kidney disease. We underscore the importance of recognizing, evaluating and managing these complications to improve postoperative outcomes for at-risk patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 1","pages":"Pages 23-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143134715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical considerations in trauma and major incidents","authors":"Mark Baxter","doi":"10.1016/j.mpmed.2024.10.010","DOIUrl":"10.1016/j.mpmed.2024.10.010","url":null,"abstract":"<div><div>Major trauma is defined as ‘an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability’. It accounts for around 22,000 admissions per year across the UK. Since 2012, the UK trauma system has been delivered using a hub and spoke ‘network’ of regional major trauma centres, with surrounding trauma units. This has enabled access to timely, coordinated and highly specialist trauma care, resulting in significantly reduced mortality rates. Trauma remains the leading cause of death in children and young adults in the UK; however, in recent years there has been recognition of an increasing incidence in major trauma in older people. The combination of severe, multisystem injury and a background of co-morbidity and frailty adds an extra dimension to the coordination and management of trauma care in this complex population. The changing demographics of major trauma have meant there is a growing recognition that physicians should be aware of trauma management as patients may end up under their care, and should also take an active role in the continuing care of major trauma patients from admission to definitive care through to rehabilitation and discharge. This has led to the development of physicians in trauma care, usually in the form of ‘major trauma geriatrics’ to help facilitate this and work alongside colleagues in surgery, anaesthetics and specialist rehabilitation to optimize the outcomes for these complex patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 1","pages":"Pages 39-43"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143134706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurological complications: prevention and management","authors":"Robert Grange, David JH Shipway","doi":"10.1016/j.mpmed.2024.10.004","DOIUrl":"10.1016/j.mpmed.2024.10.004","url":null,"abstract":"<div><div>Perioperative neurological complications are common and potentially devastating, resulting in life-changing and life-limiting sequelae. <em>Delirium</em> is the most commonly encountered complication; pre-emptive pharmacological intervention has not been shown to consistently prevent delirium, and research findings are mixed. <em>Postoperative cognitive dysfunction</em> is a controversial diagnosis of subtle cognitive decline with no agreed treatment. <em>Stroke</em> risk is generally low in most surgical settings but can rise 20-fold in patients with a previous stroke. Clinical dilemmas arise when balancing improving stroke-risk profile by delaying surgery against the risk of deleterious outcomes from such delays. <em>Parkinson disease's</em> treatment must continue throughout the perioperative period as abrupt cessation risks the development of the life-threating neuroleptic malignant-like syndrome. The enteral route for dopaminergic therapy is preferred where possible. <em>Myasthenia gravis</em> management should be optimized in partnership with a patient's neurologist before surgery. Neuromuscular blocking agents should be used with care. <em>Anti-seizure</em> medication should be continued perioperatively and be given parentally if required, particularly as surgery can lower the seizure threshold. <em>Perioperative peripheral nerve injuries</em> can result in significant morbidity and are a common source of litigation.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 1","pages":"Pages 19-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143134714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Systemic vasculitides: an overview","authors":"Jonathan A Briggs, Stephen P McAdoo","doi":"10.1016/j.mpmed.2024.09.002","DOIUrl":"10.1016/j.mpmed.2024.09.002","url":null,"abstract":"<div><div>The systemic vasculitides are a rare but serious group of multisystem autoimmune diseases characterized by inflammation of the blood vessels. Diagnosis requires careful clinical assessment in combination with immunological testing, imaging and often tissue biopsy. Prompt treatment is vital to prevent irreversible organ damage and decrease mortality and morbidity. Immunosuppressive drugs are the mainstay of treatment and have significantly improved outcomes in recent decades. However, relapses are common, and individuals with vasculitis have a higher risk of infections, cardiovascular diseases and cancer compared with the general population. The toxicity of treatments, especially glucocorticoids, contributes to these complications.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 12","pages":"Pages 746-753"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Behçet's syndrome","authors":"Edoardo Biancalana, Emanuele Chiara, Giacomo Bagni, Giacomo Emmi","doi":"10.1016/j.mpmed.2024.09.004","DOIUrl":"10.1016/j.mpmed.2024.09.004","url":null,"abstract":"<div><div>Behçet's syndrome (BS) is a rare systemic vasculitis that can involve the skin, mucosa, joints, vessels, eyes, nervous and gastrointestinal systems. These manifestations can present alone or coexist in the same patient in specific clusters that can require different treatment strategies. BS is a ubiquitous disease although it has a peculiar geographical distribution, being almost endemic in Eurasian countries. The aetiopathogenesis of BS is still unknown and probably depends on the interaction of different pathways, including genetic predisposition, immune dysregulation and infectious triggers. The therapeutic approach includes systemic corticosteroids, colchicine for mild forms of BS, and traditional or biological immunosuppressive agents for moderate to severe disease. Here we summarize the clinical and therapeutical aspect of BS according to the most recent scientific evidence.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 12","pages":"Pages 807-810"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2024.10.001","DOIUrl":"10.1016/j.mpmed.2024.10.001","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 12","pages":"Pages 816-820"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advances in systemic lupus erythematosus","authors":"Güllü Sandal Uzun, Rym Abida, David A Isenberg","doi":"10.1016/j.mpmed.2024.09.010","DOIUrl":"10.1016/j.mpmed.2024.09.010","url":null,"abstract":"<div><div>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a heterogeneous course and systemic involvement. It is the result of a complex pathogenic pathway that culminates in autoantibody formation. The interaction between environmental triggers and genetic susceptibility is key in this process. Genome-wide association studies have recognized >200 loci associated with SLE that lead to the formation of key proteins, each contributing a small increase to the risk. Advances in the management of the disease include new validated standardized tools to capture disease activity, damage and quality of life, for clinical and research purposes. The prognosis of SLE has greatly improved in the last 50 years because of better general management and specific treatment, including a better use of immunosuppressive agents. The development of biological therapies including chimeric antigen receptor T cell therapy offers the realistic prospect of further improvement.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"52 12","pages":"Pages 737-745"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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