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This book is a fictional account of the life of German film and theatre actor Werner Krauss, eponymous star of the classic silent film The Cabinet of Doctor Caligari. Upon gaining worldwide recognition in this film, Krauss was co-opted into the Nazi hate campaign of the 1930s and 1940s. He featured in the vicious propaganda film Jud Suss, and he was complicit in giving anti-Semitic performances onstage, most notably as Shylock in Shakespeare's The Merchant of Venice. The book focuses on three distinct eras in Krauss' life: the struggling, exuberant actor of the 1920s; the philandering pragmatist of the 1930s; and the elderly, neurotic outcast of the 1940s. Despite his honourable intentions, Krauss was all-too-often undermined by his inability to say no to women, alcohol and the egregious Joseph Goebbels. In this fictional re-imagining of his life, Krauss' motives and decisions are explored in an attempt to discover why he collaborated with the Nazis in the way that he did, as well as demonstrating the personal and political consequences of his actions. As someone who was influenced by the Nazi regime, and, in turn, influential in perpetuating their message, Krauss' story tells the wider story of the role of the arts and media in Nazi Germany. Extensively researched, including contemporary news stories, archived film material, critical essays on Krauss and translated passages from his autobiography, Das Schauspiel Meines Lebens, this fictional reconstruction of Krauss' life and career is preceded by a substantive Introduction by the author, setting the novel in the context of the genre of Holocaust fiction, emulating and reminiscent of Christopher Isherwood's Goodbye to Berlin and Thomas Keneally's Schindler's Ark.

IntroductionBreathlessness remains a highly prevalent and distressing symptom for many patients with progressive life-limiting illnesses. Evidence-based interventions for chronic breathlessness are limited, and there is an ongoing need for high-quality research into developing management strategies for optimal palliation of this complex symptom. Previous studies have suggested that selective serotonin reuptake inhibitors such as sertraline may have a role in reducing breathlessness. This paper presents the protocol for a large, adequately powered randomised study evaluating the use of sertraline for chronic breathlessness in people with progressive life-limiting illnesses.Methods and analysisA total of 240 participants with modified Medical Research Council Dyspnoea Scale breathlessness of level 2 or higher will be randomised to receive either sertraline or placebo for 28 days in this multisite, double-blind study. The dose will be titrated up every 3 days to a maximum of 100 mg daily. The primary outcome will be to compare the efficacy of sertraline with placebo in relieving the intensity of worst breathlessness as assessed by a 0–100 mm Visual Analogue Scale. A number of other outcome measures and descriptors of breathlessness as well as caregiver assessments will also be recorded to ensure adequate analysis of participant breathlessness and to allow an economic analysis to be performed. Participants will also be given the option of continuing blinded treatment until either study data collection is complete or net benefit ceases. Appropriate statistical analysis of primary and secondary outcomes will be used to describe the wealth of data obtained.Ethics and disseminationEthics approval was obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences.Trial registration numberACTRN12610000464066.

Gastric volvulus is a condition that is not frequently seen in clinical practice and can present with a myriad of symptoms, meaning it can be challenging to diagnose. We present an 82-year-old female attending the emergency department with epigastric pain and coffee ground vomiting on a background of rectosigmoid cancer and a large, complex hiatus hernia. On investigation there was no drop in haemoglobin. However, the chest X-ray showed air-fluid levels and raised the suspicion of gastric volvulus, particularly given her past medical history. The timely organisation of a computed tomogram (CT) scan allowed for prompt decision-making with involvement of surgical colleagues. The patient proceeded to successful conservative management with upper gastroduodenal endoscopy and a de-rotation technique. This case highlights the importance of considering gastric volvulus as a differential diagnosis in those presenting with epigastric pain and vomiting particularly in patients over 50 with a history of large hiatus hernia. This allows for prompt diagnosis and management and avoidance of major complications like gastric mucosal ischaemia.

IntroductionChronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD.Methods and analysisThe primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0–10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used.Ethics and disseminationEthics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness.Trial registration numberNCT02720822; Pre-results.

AimsThe project was conducted across all medical inpatient specialties within a UK teaching acute trust comprising a large hospital with secondary/tertiary services and a district general hospital (DGH). The trust faces the these challenges:General medical council (GMC) trainees’ survey highlighted red flags in training: workload, access to teaching and senior supervision.Discrepancy in ability to work within contracted hours between inpatient teams.Low morale amongst junior doctor (JD) workforce.Deanery training posts allocations not keeping pace with the change in medical inpatient demographics.This project aimed to:Benchmark workforce and workload against standards from the Royal College of Physicians (RCP).Identify root causes for variation.Suggest actions to future proof the medical workforce.MethodsTwo–week audit of activity of 20 medical teams across the trust applying the RCP tool to estimate workload against recommended workforce.Total JD ward work–hours per week within each tier of seniority calculated.Variation of workload to workforce ratio determined.Questionnaires sent to all JDs regarding their perceptions of challenges.ResultsWide variation of workload to workforce ratio.Tier 1 staffing is above minimum RCP recommendations in all teams.Tier 2 presence on medical wards is on average ¼ RCP recommendation.The reasons for non–compliance with contracted hours and dissatisfaction with training cannot be explained by shortage of tier 1 doctors. ConclusionsThe finding of adequate overall levels of staffing and outdated allocation is important. Addressing historical workload imbalances will impact significantly upon safety, quality of care, training and morale. JD staffing is often cited as inadequate. While this may be true, it is also likely that JD workload is similarly inefficient across the country. We hope this work will encourage others to identify and improve inefficiencies in JD workload.

The uses of social media have become ubiquitous in contemporary society at an astonishingly fast-paced rate. The internet and in particular platforms such as Facebook, Twitter and YouTube are now part of most people's vocabulary and are starting to replace many face-to-face interactions. The online world, in particular, is alive with discussions, comments and anecdotes about the topics of illness, disease, hospitals, death and dying. The topic of death and dying had in the not too distant past been seen as taboo, but willingness and need to talk openly about it appears to be on the increase. In parallel to this, many public awareness campaigns are highlighting society's need to be more prepared for dying and death. This will have a significant impact on the way terminally ill patients and their families approach the last years, months and weeks of their lives and how they might expect palliative health and social care professionals working with them through these difficult periods to interact with them. We pay particular attention to the areas of digital posterity creation and memorialisation within the wider holistic context of end-of-life care.