Implementing a Digital Deteriorating Patient Pathway to improve the safety and effectiveness of care of the adult deteriorating patient.

Identification, escalation and clinical review of the deteriorating patient is essential for a safe and effective hospital. We present a deteriorating patient pathway developed within our electronic patient record, including implementation of a digital escalation and senior review process, triggered from a logic algorithm and vital signs. The pathway is activated by an average 43 patients per day with median mortality of 13.

Major lower limb amputation audit - introduction and implementation of a multimodal perioperative pain management guideline.

Lower limb amputation is a frequent surgical intervention. It is well known to be associated with postoperative pain. Optimisation of perioperative pain has been shown to reduce the risk of chronic pain.

Outcome after Turndown for Elective Abdominal Aortic Aneurysm Surgery.

Objectives: The aim was to assess the survival of patients who had been turned down for repair of an abdominal aortic aneurysm (AAA) and to examine the factors influencing this.

Methods: This was a retrospective observational study of a prospectively maintained database of all patients turned down for AAA intervention by the Black Country Vascular Network multidisciplinary team (MDT) from January 2013 to December 2015. Data on AAA size, cardiopulmonary exercise testing (CPET) and cause of death were recorded.

The bronze kidney: membranous glomerulonephritis associated with iron overload.

A 55-year-old man with a history of diabetes mellitus, hypertension and hypercholesterolaemia developed increasing peripheral oedema over the course of several months. He was found to have nephrotic range proteinuria (15.7 g/24 h).

Tuberulous Meningitis masked by Temazepam Overdose.

A 47 year old Chinese businessman was found unconscious at home following an overdose of 280 mg temazepam. He was found by his sister who had visited because he had not returned her telephone calls for several weeks. He had been resident in England for 8 years but returned to Hong Kong frequently.

Effects of orthoptic treatment on the CA/C and AC/A ratios in convergence insufficiency.

Purpose: To evaluate the effect of orthoptic treatment on the AC/A (A, accommodation; C, convergence) and CA/C ratios in subjects with convergence insufficiency (CI).

Methods: The change in AC/A and CA/C ratios after a 12-week period of home-based orthoptic treatment was examined in 10 subjects (mean age, 25.4+/-4.

Measurements of objective and subjective fixation disparity with and without a central fusion stimulus.

Background: Fixation disparity is the condition in which the images of a binocularly fixated object are not imaged on exactly corresponding retinal points, but are still within Panum's fusional areas. Measurements of objective and subjective fixation disparity have indicated that subjective fixation disparity does not indicate the true eye position. However, the effect of the foveal fusional lock (FFL) on the relationship between objective and subjective fixation disparity is still not clear.