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Shared decision making is a collaborative process between clinicians and patients, which aims to select the most suitable management option based on both best available evidence and patient preferences. This article looks at the role of shared decision making in perioperative medicine.Desflurane has a carbon equivalence 20 times greater than sevoflurane. This article discusses alternative anaesthetic techniques, including sevoflurane, xenon, total intravenous anaesthesia and regional techniques, and methods of reducing venting of gases, which might lower the environmental impact of anaesthesia.Metastatic spinal cord compression is compression of the spinal cord or cauda equina as a result of metastatic deposits in the spinal column. It affects approximately 4000 cases per year in England and Wales. Prompt identification and treatment of metastatic spinal cord compression is necessary to prevent irreversible neurological injury, treat pain and maintain patients' mobility, function and independence. Survival of patients with common malignancies has improved significantly with the ongoing development of radiotherapy and chemotherapy, as well as improved surgical treatment of resectable primary tumours. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.Radial head fractures are a common fracture involving the elbow joint. Guggulsterone E&Z concentration Patients typically present after a fall onto an outstretched hand with elbow pain and swelling. Without adequate treatment, this can lead to long-term complications, including loss of elbow motion and pain. Radial head fractures may also be associated with other injuries including elbow dislocation, neighbouring bony fractures and associated ligamentous rupture. It is therefore imperative that hospital clinicians understand the diagnosis and treatment of this condition. The plain radiograph is the optimum method to diagnose a radial head fracture. These fractures can be managed using a variety of techniques, from non-surgical conservative methods for the undisplaced fracture through to surgical fixation, radial head replacement and excision for the more complex, displaced fracture.Interventional radiology is a subspecialty of radiology that provides a range of minimally invasive diagnostic and therapeutic procedures. It continues to expand and evolve, and has had a marked impact on clinical care in many settings, in some cases averting the need for major surgery and hospital admission. While its role in the setting of trauma is relatively well established, with arterial embolisation a valuable option in the management of haemodynamically unstable patients, it is less prominent in the elective setting. This article provides an overview of emerging applications of interventional radiology in the elective treatment of orthopaedic conditions.This year is the 150th anniversary of James Young Simpson's death in 1870. As well as being responsible for the introduction of general anaesthesia into obstetric practice, he made other important contributions to obstetrics and also to surgery as well as in the control of hospital infection.Major trauma in the UK has changed and can now be thought of as two different diseases the traditional type of high energy transfer major trauma occurring in younger patients, and low energy transfer major trauma (usually an older person falling on one level). The current NHS trauma system is not well set up to treat low energy transfer major trauma - adapting to the changing disease is the next big challenge.While use of mechanical circulatory support is increasing, knowledge of its fundamental role and limitations remains poorly understood by many medical professionals. This article summarises the main types of mechanical circulatory support and how they work, particularly focusing on the key information medical professionals should know should they encounter them in hospital. Mechanical circulatory support can be an effective treatment modality in selected pathologies, including myocardial ischaemia, pulmonary congestion, massive pulmonary embolic disease, postcardiotomy cardiogenic shock with failure to wean off bypass, right ventricular failure, bridge to heart and lung transplant and, increasingly, extracorporeal cardiopulmonary resuscitation. Intra-aortic balloon pumps increase coronary perfusion and reduce myocardial oxygen demand in a variety of cardiac conditions. Extracorporeal membrane oxygenation can provide both respiratory and circulatory support to patients. Ventricular assist devices can provide support for not only patients with acute cardiogenic shock, but also for ambulant patients in the community setting.Systemic lupus erythematosus can affect any organ or tissue, but skin manifestations, joint pain and fatigue are the most common symptoms. Two case reports in this issue describe patients with systemic lupus erythematosus who suffered severe internal organ manifestations.Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness and in the most critically unwell patients, with muscle loss estimated to occur at 2-3% per day. This muscle loss is likely a result of a reduction in protein synthesis relative to muscle breakdown, resulting in altered protein homeostasis. The associated weakness is associated with in an increase in both short- and long-term mortality and morbidity, with these detrimental effects demonstrated up to 5 years post discharge. This article highlights the significant impact that muscle wasting has on critically ill patients' outcomes, how this can be reduced, and how this might change in the future.National guidance in the UK continues to recommend urgent referral of selected patients with non-visible haematuria for urological assessment. The positive predictive value of non-visible haematuria for urological cancer is low, so it is uncertain whether this is an effective and equitable use of healthcare resources. This article considers rationales for and against continuing this practice, and outlines alternative investigative strategies for patients presenting with non-visible haematuria based on current knowledge and modern technology.E-cigarette or vaping product use-associated lung injury is a recently recognised, acute pulmonary syndrome which has been reported (particularly from June to October 2019) throughout the USA, but not in Europe (although one probable case, in the UK, has been reported; Medicines and Healthcare products Regulatory Agency, 2020). It presents acutely, most often in young men, as severe pulmonary consolidation, usually with respiratory failure. The mortality is around 2%. The cause(s) are unknown, but it is associated with vaping, particularly using unlicensed cannabis-containing products with tetrahydrocannabinol. Vitamin E acetate, often present in tetrahydrocannabinol-containing vape products as a solvent, has been implicated, as it has been identified in the bronchoalveolar lavage fluid of patients with e-cigarette or vaping product use-associated lung injury. This article reviews the recent literature, including clinical features, presentation and investigations, and possible mechanisms, in the context of vaping practices in the USA and the UK.Background Historically, the content of psychotic experiences has tended to be of little importance to biological psychiatry, with hallucinations and delusions being seen as symptoms of mental illness rather than meaningful experiences or responses to life circumstances.Aims This study aims to explore the thematic content of psychotic phenomena in a sample of clients with a first episode of psychosis.Methods The electronic medical records of 160 services users of two Early Intervention for Psychosis Services were comprehensively reviewed. A thematic analysis was used to explore the thematic content of psychotic symptoms recorded by healthcare professionals.Results The results illustrate 30 themes and 85 sub-themes. This includes delusional beliefs (e.g. "being harmed, attacked or killed", "being monitored or followed by others", "special powers or abilities") and hallucinations (e.g. "commanding voice", "derogatory/critical voice", "commentary").Conclusions The results illustrate the extensive and varied experience of psychosis within this sample. Based on the findings of this study, it is hoped that future research studies and mental health services will attend to the meaning and content of psychotic experiences.The solubility profile of codeine phosphate in the carbitol and 2-propanol mixtures at 293.2 - 313.2 K are determined and correlated with some developed cosolvency models. Moreover, the density values of codeine phosphate saturated solutions are also determined and fitted with the Jouyban-Acree model. The model accuracy is investigated by calculating the mean relative deviations (MRD%). The thermodynamic parameters of codeine phosphate dissolution in the non-aqueous mixtures of carbitol and 2-propanol are also computed by using van't Hoff and Gibbs equations.Patients with oral cavity cancers often present late to seek medical care. Surgery is usually the preferred upfront treatment. However, surgical resection cannot be achieved in many cases with advanced disease without major impact on patient's quality of life. On the other hand, radiotherapy (RT) and chemotherapy (CT) have not been employed routinely to replace surgery as curative treatment or to facilitate surgery as neoadjuvant therapy. The optimal care of these patients is challenging when surgical treatment is not feasible. In this review, we aimed to summarize the best available evidence-based treatment approaches for patients with locally advanced oral cavity cancer. Surgery followed by RT with or without CT is the standard of care for locally advanced oral cavity squamous cell carcinoma. In the case of unresectable disease, induction CT prior to surgery or chemoradiotherapy (CRT) can be attempted with curative intent. For inoperable patients or when surgery is expected to result in poor functional outcome, patients may be candidates for possibly curative CRT or palliative RT with a focus on quality of life.OBJECTIVE This study aimed to examine the effect of active learning strategies using analogical models versus didactic lectures on student learning of spinal anatomy and biomechanics. METHODS Students enrolled into year 1 of a chiropractic program in 2014 and 2015 were eligible to participate. The 2014 cohort received didactic lectures. Active learning approaches using analogical models were incorporated into the 2015 cohort. Both groups received an identical written assessment at the end of the 3rd lecture. Between-group differences in age and written assessment percentages were analyzed using independent t tests. RESULTS Fifty-nine students from the 2014 cohort and 62 students from the 2015 cohort took part. There were no significant differences in age or gender between the cohorts. The differences in the mean of the written assessment percentages between the didactic group and the analogical models group were significant (p = .00), with a mean difference of 22.6% (95% CI, 17.4-27.9). The didactic group mean percentage was 37.