Could adjusting D-dimer thresholds to clinical probability reduce ultrasound use for suspected DVT? This 2022 appraisal of the Canadian 4D study examines diagnostic safety, excluded patient groups and the challenges of transferring its algorithm into UK pathways.
How should emergency care respond when demand exceeds available resources? Drawing on civilian and military experience, Simon Horne explores the tension between capacity and quality, arguing for honest priorities, less low-value activity and reliable delivery of the best care resources allow.
A fictional glimpse of chest pain assessment in 2050. Rick Body follows Fiona through a future of personalised risk prediction, implanted diagnostics and virtual consultation, using medical fiction to explore how technology might change both care and the experience of illness.
A 2020 appraisal of intravenous haloperidol for acute benign headache. The review considers pain relief, adverse effects and patient selection, asking whether a placebo-controlled trial can tell us enough when the useful clinical comparison would be with usual headache treatment.
Roberto Cosentini returns to reflect on staff wellbeing after the first COVID-19 surge in Bergamo. This July 2020 conversation explores routines, relationships, interests outside medicine and sharing experiences, drawing on his personal response to an exceptionally difficult period.
Dan Horner reviews the 2020 NICE guidance on diagnosing and managing venous thromboembolism. The article discusses PERC, age-adjusted D-dimer, outpatient pulmonary embolism care and anticoagulant choices, including cancer-associated VTE, with attention to patient selection, bleeding risk and questions outside the guideline's scope.
Practical perspectives on trauma care and team leadership.
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