Working Without a Net: Leukemia and Lymphoma Survivors’ Perspectives on Care Delivery at End-of-Treatment and Beyond

This study explored survivors’ perspectives on care delivery and supportive care needs during reentry. Fifty-one individual interviews were conducted with adult leukemia and lymphoma survivors, 3 to 48 months from treatment cessation. Survivors reported poor continuity of care across the patient–survivor transition, difficulty finding appropriate information/services, lack of preparation, lack of support for survivorship issues, and inadequate or poorly timed follow-up as factors contributing to adjustment difficulties at end of treatment and beyond. Improved care coordination is needed after active treatment, including use of an exit interview and delivery of services that are more congruent and better timed to meet ongoing and emergent survivorship needs.     

The management of hypotension in the neonatal intensive care unit

Hypotension in the first few days of a pre-term baby's life is not an uncommon event. This paper will define hypotension and give the reader a clear understanding of how blood pressure is maintained in the first few days of life. It will provide information on the physiology of cardiac output (CO), and blood pressure (BP) regulation in the newborn infant. An appreciation of this physiology is essential to effectively administer and manage the commonly used pharmacological agents ‘inotropes’ in the Neonatal Intensive Care Unit (NICU).     

Open sutureless lumbar hernia repair using a ‘memory ring’ patch

Various techniques have been used to repair lumbar hernias. We describe here a sutureless repair with a flat ‘memory ring’ patch performed as a day case.     

Could exercise improve mental health and cognitive skills for surgeons and other healthcare professionals?

Workplace-related illness is common in the UK, and in healthcare more than five million working days over 10 years have been lost as a result. Occupational stress is well known and can affect clinicians at any stage, yet many healthcare professionals continue to work with this or other psychological problems (including anxiety, chronic fatigue, and burnout) as they do not wish to let their colleagues down. Mental health issues might be dismissed, particularly in surgery, because there is a misconception that surgeons can cope better with stress than those working in other specialties, and are better protected from clinical burnout. The benefit of exercise on physical health is clear, but its role in the maintenance of good mental health and well-being should not be underestimated. As society adopts an increasingly sedentary lifestyle, exercise for many has a lower priority than other activities. In this article we give an overview of the mental health issues that might affect doctors and surgeons, and explore how exercise can benefit our well-being and clinical performance.     

The roles of toxin A and toxin B in Clostridium difficile infection

We recently published our findings indicating that anti-TcdB antibodies were effective as treatment for C. difficile infection, but that anti-TcdA actually worsened prognosis in the gnotobiotic piglet model. To further investigate the roles of the two toxins, we administered purified toxins separately or together, systemically, to piglets and found that both toxins, either alone or together, are able to elicit severe lesions systemically and are also able to cross into the gut lumen and cause large intestinal lesions typical of infection. We also found that anti-TcdA administered before systemic challenge with TcdA again did not protect from development of disease, but, in this case, did not appear to worsen prognosis. Further work is still needed, but these findings add to the growing knowledge regarding the roles of the C. difficile toxins.