bmj.com: Education

Breaking the mould in patient safety

Most current safety interventions are an ethical, emotional, and insurance driven response to specific incidents in hospitals. We need to move from this reactive approach to a more proactive and integrated approach. To achieve real improvements in patient safety we need to look at the whole of patients' care not just specific procedures, argue Laurent Degos and colleagues

Managing hepatitis C virus infection

Chronic infection with the RNA flavivirus hepatitis C is a major cause of liver disease. The Department of Health estimates that in the United Kingdom, chronic infection is present in 200 000 people - of whom 50% are unaware that they carry the virus - and the main mode of acquisition is recreational intravenous drug use. This clinical review highlights risk factors for acquisition, groups to screen, and specialist management of patients with chronic infection.

Chronic wound sepsis due to retained vacuum assisted closure foam

Vacuum assisted closure therapy is widely used in the management of complex wounds. Although the retention of surgical instruments and swabs inside body cavities after surgery is well recognised, the retention of foam dressings used in vacuum therapy has not been widely reported. Outside the ordered theatre environment, however, dressing counts may be overlooked, and with such foam this can have serious consequences because it is radiolucent.

A case of mistaken mesial temporal identity

The accurate diagnosis and treatment of paroxysmal events can be difficult. It requires a detailed eye witness account and a clear description of the circumstances of the event. Even with this information, a definitive diagnosis may not be attainable. In this lesson of the week, A Neligan and colleagues re-examine a diagnosis of epilepsy when control is worsening and investigations are normal.

The extremely premature neonate

Preterm deliveries are increasing, and although many extremely preterm infants now survive, neurodevelopmental and other morbidities are common. In this clinical review, Natalie K Yeaney and colleagues explain how to care for extremely premature babies.

Diagnosing and managing vaginismus

Vaginismus is a well recognised clinical condition associated with non-consummation and considerable distress in women. It is a clinical syndrome, not a definitive diagnosis, which consists of overlapping elements of hypertonic pelvic floor muscles, pain, anxiety, and difficulty in penetration. It has received little scientific attention, and further well designed studies are needed.