Clin Med
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Many people with dementia are admitted to general hospitals, yet doctors feel ill-prepared to manage them. Problems are often multiple and complex. In many cases, dementia is complicated by delirium. ⋯ Skilled communication is vital and family carers should be kept informed and involved. People with dementia are prone to side effects of prescribed drugs. Antipsychotic drugs are rarely the answer to difficult behaviours, but may be used in cases of psychosis or severe distress.
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More HIV-positive patients are living longer and presenting to non-infection specialties with non-HIV-related issues (eg diabetes, heart disease). National recommendations advise routinely offering HIV testing to all new registrants to primary care and all general medical admissions where community prevalence exceeds 2:1000. ⋯ This study aimed to establish regional medical registrars' opinions on teaching provision, and confidence in, HIV medicine. The results indicated a lack of confidence in HIV medicine and, in those without postgraduate rotations in HIV medicine or infectious diseases, a perception that HIV and infection-related teaching provision is inadequate.
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Warfarin-induced skin necrosis is a rare but serious complication of treatment with this commonly prescribed drug. This lesson presents the case of a patient with extensive skin necrosis after inappropriately prolonged warfarinisation and delayed recognition. The condition is briefly reviewed to highlight key features and risk factors.
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Doctors are required to issue Form Med 3 (the Statements of Fitness for Work, commonly known as the fit note) where appropriate to patients for whom they provide clinical care. Much sickness absence is attributed to mild or moderate mental ill health, musculoskeletal or cardiorespiratory conditions. The effects of these conditions and others can often be accommodated at work, with appropriate adjustments, adaptations or support if necessary. ⋯ Evidence shows that work can be therapeutic and help promote recovery and rehabilitation. Conversely, unemployment is generally harmful to health and can lead to increased morbidity and poorer physical and mental health, as well as poverty, health inequalities and social exclusion. This concise guideline has been developed to aid doctors in understanding when and how to issue a fit note to the greatest benefit for their patients.