BMJ (Clinical research ed.)最新文献_第5页

An atypical, non-healing perioral lesion. 一种非典型的、不愈合的口周病变。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-28 DOI: 10.1136/bmj.j3823

Vinay Naresh Mistry, Mohamed Imran Suida, Deborah Kirkham, Michael Wing Sung Ho

{"title":"An atypical, non-healing perioral lesion.","authors":"Vinay Naresh Mistry, Mohamed Imran Suida, Deborah Kirkham, Michael Wing Sung Ho","doi":"10.1136/bmj.j3823","DOIUrl":"https://doi.org/10.1136/bmj.j3823","url":null,"abstract":"A 57 year old man was referred urgently to the oral and maxillofacial surgery clinic. He described a three month history of fatigue, recurrent sore throats, and a persistent “cold sore.” An irregular and indurated ulcer was present on the right oral commissure (fig 1⇓), and an ipsilateral swelling was palpable in the submandibular triangle (fig 2⇓). He had no relevant medical history. He drank little alcohol and was a non-smoker.\u0000\u0000\u0000\u0000Fig 1 Irregular and indurated ulcer present on the right oral commissure\u0000\u0000\u0000\u0000\u0000\u0000Fig 2 Ipsilateral swelling palpable in the submandibular triangle\u0000\u0000\u0000\u0000\u0000\u0000### 1. What are the most important differential diagnoses to consider?\u0000\u0000#### Short answer\u0000\u0000The most important differential diagnoses to consider include herpes labialis, primary syphilis, and squamous cell carcinoma.\u0000\u0000#### Discussion\u0000\u0000Primary syphilis should be considered alongside herpes simplex labialis if the symptoms do not resolve in 10-14 days.1 Association with other red flags such as induration, bleeding, and concurrent cervical lymphadenopathy should prompt fast track referral to the local head and neck oncology clinic. Malaise is a common feature of syphilis that would not normally be seen at an early stage of squamous cell carcinoma.\u0000\u0000Cases of syphilis have risen dramatically in recent years. In the UK, USA, and other Western countries, this rise has been most marked in men who have sex with men, so taking a targeted sexual history is essential.2 Syphilis is classified …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j3823"},"PeriodicalIF":105.7,"publicationDate":"2017-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j3823","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35456473","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}

引用次数: 3

Diagnosis and management of postpartum haemorrhage. 产后出血的诊断与处理。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j3875

Edwin Chandraharan, Archana Krishna

{"title":"Diagnosis and management of postpartum haemorrhage.","authors":"Edwin Chandraharan, Archana Krishna","doi":"10.1136/bmj.j3875","DOIUrl":"https://doi.org/10.1136/bmj.j3875","url":null,"abstract":"#### What you need to know\u0000\u0000Postpartum haemorrhage is a major cause of death during pregnancy and early motherhood, accounting for 25% of maternal deaths worldwide,1 and is the second leading direct cause of maternal deaths in the UK.2 It is defined as blood loss of more than 500 mL from the female genital tract after delivery of the fetus (or >1000 mL after a caesarean section). Primary postpartum haemorrhage occurs within the first 24 hours of delivery, whereas secondary postpartum haemorrhage occurs between 24 hours and 12 weeks after delivery and is less common.1 For every maternal death due to postpartum haemorrhage, there are at least 10 “near-misses.” Serious maternal morbidities include multiorgan failure, multiple blood transfusion, and peripartum hysterectomy.1 There have been recent advances in the management of postpartum haemorrhage secondary to coagulopathy and abnormal invasion of the placenta.3\u0000\u0000This review highlights the causes, diagnosis, and management of postpartum haemorrhage and is aimed at those involved in obstetric and postnatal care.\u0000\u0000#### Sources and selection criteria\u0000\u0000We searched PubMed using the key words “postpartum haemorrhage,” “balloon tamponade,” “uterine compression suture,” “embolization,” and “obstetric haemorrhage” from 1981 to 2016. We also considered review articles from 2001 to 2016 …","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j3875"},"PeriodicalIF":105.7,"publicationDate":"2017-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmj.j3875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35452797","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}

引用次数: 48

Multiple choice questions: general surgery. 选择题:普外科。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/sbmj.j3072

引用次数: 0

Telephone first consultations in primary care. 初级保健第一次电话咨询。

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4345

Brian McKinstry, John Campbell, Chris Salisbury

引用次数: 0

Five minutes with . . . Tom Treasure. 五分钟……汤姆的宝藏。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4472

Anne Gulland

引用次数: 1

Should we welcome plans to sell off NHS land? 我们应该欢迎出售NHS土地的计划吗?

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4290

Robert Naylor, Kailash Chand

引用次数: 3

When the only reasonable response is to be unreasonable. 唯一合理的回应就是不讲理。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4206

Michael O'Donnell

引用次数: 0

Whistleblowing: a word of warning from an unreasonable man. 告密:一个不讲理的人发出的警告。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4205

Hendrik J Beerstecher

引用次数: 0

Evaluation of telephone first approach to demand management in English general practice: observational study. 电话第一方法在英语全科医疗需求管理中的评价：观察研究。

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4197

Jennifer Newbould, Gary Abel, Sarah Ball, Jennie Corbett, Marc Elliott, Josephine Exley, Adam Martin, Catherine Saunders, Edward Wilson, Eleanor Winpenny, Miaoqing Yang, Martin Roland

{"title":"Evaluation of telephone first approach to demand management in English general practice: observational study.","authors":"Jennifer Newbould, Gary Abel, Sarah Ball, Jennie Corbett, Marc Elliott, Josephine Exley, Adam Martin, Catherine Saunders, Edward Wilson, Eleanor Winpenny, Miaoqing Yang, Martin Roland","doi":"10.1136/bmj.j4197","DOIUrl":"10.1136/bmj.j4197","url":null,"abstract":"Objective To evaluate a \"telephone first\" approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation.Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data.Participants 147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England.Intervention Management support for workload planning and introduction of the telephone first approach provided by two commercial companies.Main outcome measures Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies' protocols.Results After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices -38%, 95% confidence interval -45% to -29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval -1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs.Conclusions The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care.","PeriodicalId":93911,"journal":{"name":"BMJ (Clinical research ed.)","volume":"358 ","pages":"j4197"},"PeriodicalIF":0.0,"publicationDate":"2017-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35551521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Victims of blood contamination win right to sue government. 血液污染受害者赢得起诉政府的权利。

IF 105.7

BMJ (Clinical research ed.) Pub Date : 2017-09-27 DOI: 10.1136/bmj.j4504

Clare Dyer

引用次数: 0