Brit J Hosp Med
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Transient ischaemic attacks carry an increased risk of large ischaemic stroke in the 90 days after an event. Patients need to be seen within 24 hours in a dedicated clinic to start secondary prevention. This editorial reviews evidence for consideration of early dual antiplatelet therapy after a transient ischaemic attack.
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The National Institute for Health and Care Excellence guidelines advise stopping immunosuppressive drugs for confirmed or suspected COVID-19 patients with autoimmune and inflammatory disorders. This may not be in the patient's best interest, given the potential long-term consequences of not managing chronic conditions, and immunosuppression may even be protective in those affected with COVID-19.
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Rheumatology patients who are taking immunosuppressants are considered to be at 'high risk' from COVID-19, hence have been self-isolating or shielding. However, they may be protected from the features of hyperinflammation driven by a 'cytokine storm', so may have better clinical outcomes if infected. This editorial discusses whether it may not be necessary to advise these patients to shield.
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Amid the global COVID-19 pandemic, adaptation of healthcare systems, with strong medical leadership, has been integral to coping with the ever-changing situation. This article is based on the personal experiences of doctors in the NHS and insights into the frontline response to this situation. It reflects on leadership dilemmas and strategies implemented to overcome them, with a focus on systems thinking and adaptive leadership.