Machine learning (ML), a form of artificial intelligence using computer algorithms, is often applied in ways we take for granted: Spotify to predict music that people may enjoy, Facebook to suggest friends to tag in photos, and Amazon to identify products to buy. Aside from these quotidian tasks, ML holds the promise of enhancing the deliveryofqualityhealthcare. 1 Recently,MLhasbeenused to create programs capable of distinguishing between images of benign and malignant moles with accuracy similar to that of board-certified dermatologists. 2 This technology could greatly assist dermatologists in diagnosing and treating skin diseases, thereby improving patient care. However, if not developed with inclusivity in mind, ML could exacerbate health care disparities in dermatology.

Objective To audit the provision of urodynamic services on a part-time basis. Urodynamics are carried out by a variety of healthcare professionals but most are in the UK, with particular emphasis on the personnel involved and the training they received.performed by doctors and nurses. Half the respondents considered the training to be inadequate. Methods A questionnaire was sent to 163 centres carrying out urodynamics in the UK asking for information Conclusion Consideration should be given to requiring a minimum standard of training for personnel carrying on the department providing the service, the frequency of use, the number of patients investigated, proout urodynamics in the UK to ensure that a quality service is provided. fessional training of the personnel and whether the personnel thought that the training was adequate.

It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions.

By reading this article you should be able to: Describe the anatomical and physiological features of the pericardium in relation to common causes of pericardial disease. Explain the heartelung interactions that underpin the haemodynamic manifestations of pericardial effusion and tamponade. Discuss both the clinical and echocardiographic features of pericardial tamponade. Define the aims of anaesthetic management in patients with pericardial effusion and tamponade. Pericardial disease can present clinicians with unique challenges. An understanding of the relevant pathophysiology is essential for optimal management of patients with pericardial disease. This review discusses the pathophysiology and perioperative management of patients with pericardial effusions and cardiac tamponade.

Hemoglobin SE disease was first described during the 1950s as a relatively benign microcytosis, but increasing prevalence has revealed a predisposition towards vasoocclusive sickling. Recognition of SE hemoglobinopathies' potential complications is crucial so medical measures can be utilized to avoid multiorgan injury. M icrocytosis is a common fi nding on a peripheral blood smear that can refl ect a variety of hematologic issues. We demonstrate the signifi cance of identifying the etiology of a microcytosis by describing a patient whose underlying blood disorder resulted in multiorgan failure and death. CASE PRESENTATIONA 52-year-old black woman with known chronic obstructive pulmonary disease, hepatitis C, and recurrent pulmonary embolism presented with a 3-day history of abdominal pain, chest discomfort, nonproductive cough, and dyspnea. Home medications included inhaled bronchodilators and rivaroxaban. Her blood pressure was 143/64 mm Hg; heart rate, 126 beats/ minute; and respirations, 20 breaths/minute. Oxygen saturation was 91% on 5L nasal cannula. Her lungs were clear, and the physical exam was normal except for tenderness over the rectus abdominis. Laboratory results revealed normal electrolytes and liver enzymes but an elevated creatinine of 1.9 mg/dL and lactic acid of 3.2 mmol/L. Leukocytosis was present at 21 K/uL, with a platelet count of 122 K/uL. A microcytosis (68 fL) was noted with a hemoglobin of 13 g/dL. Chest radiograph and abdominal ultrasound disclosed cholelithiasis and a chronic right-sided pulmonary embolism. Broad-spectrum antibiotics, intravenous fl uids, bronchodilators, and intravenous steroids were initiated.Twelve hours later, the patient developed respiratory distress with coarse breath sounds. Blood gas after intubation revealed a pH of 7.43 and a partial pressure of oxygen of 58 (50% fraction of inspired oxygen). A repeat computed tomography scan did not show any new pulmonary emboli or infi ltrates. Shortly afterwards, the patient entered pulseless electrical activity but recovered after cardiopulmonary resuscitation. Her hemoglobin rapidly decreased to 6 g/dL, requiring packed red blood cell support without any gross evidence of bleeding. Th e prothrombin and partial prothrombin time were normal with a fi brinogen level of 281 mg/dL. Th e patient required multiple vasopressors and continuous renal replacement therapy for worsening hyperkalemia. All cultures remained negative, and the patient went into asystole 26 hours after admission. Laboratory values revealed a hemoglobin of 11.8 g/dL and 1+ schistocytes but no sickled erythrocytes. Iron studies disclosed a serum iron level of 50 μg/dL, total iron binding capacity of 294 μg/dL, and ferritin level of 50 ng/mL.At autopsy, the pulmonary hilar and peripheral arteries were free of grossly apparent thromboemboli. On microscopic examination, the alveolar septal capillaries were congested, with small and larger vessels packed with sickled erythrocytes ( Figure 1 ). In addition, sickled erythrocyte congestion was seen in the pituit...

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Introduction The Wirral Teletriage Service provides non-urgent clinical support to Wirral Care Homes in order to help avoid unnecessary hospital admissions for their residents. It also aims to provide quicker access to clinical assessment than via NHS 111 and to provide this care in the patient’s residence wherever possible. Methods Care homes call the Teletriage service when they have concerns about the health of one of their residents. The Teletriage nurse undertakes a clinical assessment of the resident remotely via Skype. Care Homes have been provided with a secure NHS email address to facilitate secure sharing of data. They have also been provided with iPads and training for their staff. After being assessed by Teletriage, residents are signposted to the most appropriate care pathway for their needs. Results 76 Care Homes have signed up to the service. On average, the Teletriage Service receives 300-400 calls a month. In an 18 month period, the number of calls to NHS 111 have reduced by 76%. Out of all the calls to Teletriage, 22% of patients were managed by the Teletriage team with no onward referral, 57% were managed via community services e.g GPs, Community Geriatricians, and 10% were referred to the ambulance service. Emergency Health Care Plans (EHCPs), Preferred Priorities of Care and EOL (End of Life) wishes are taken into account. Conclusions The Teletriage project has reduced the number of phone calls to NHS 111 and the ambulance service, and subsequently has reduced the number of patients conveyed to hospital by 12%. The Teletriage nurses work very closely with various community services as well as GPs, NWAS and Community Geriatricians. The ongoing training and education provided to the Care Home Staff means that overall there has been good engagement with the project from the majority of the Wirral Care Homes.

Introduction With advances in technology, virtual clinics are becoming increasingly attractive as a tool for outpatient follow up care. During the COVID-19 pandemic, the implementation of virtual outpatient clinics was crucial, for continued service provision despite social distancing guidelines. We aimed to ascertain patient satisfaction with virtual clinics in cardiothoracic surgery. Method Forty patients who attended virtual clinics, post cardiothoracic surgery, were invited to provide feedback by means of a questionnaire. Feedback was gathered by junior doctors. Results Thirty-four patients (20 had never had a telephone clinic appointment) agreed to provide feedback. Fifty percent of patients had not been seen since their operation. 91.2% (n = 31) of patients felt that the telephone consultation met their expectations/needs. Patient reported advantages of telephone consultations included: less concern regarding exposure to infection, no concern regarding parking, no travel time and less time off work. 79.4% (n = 27) would have preferred a face-to-face appointment. Patient reported disadvantages of telephone consultations were poor reception, felt they weren’t listened to and would have preferred to have been physically examined. Conclusions Patients were satisfied with telephone clinics for routine follow up post cardiothoracic surgery. However, the majority would have preferred face to face appointments.