Clinical medicine (London, England)
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During the COVID-19 pandemic, many final-year medical students were qualified early with the voluntary option to join the workforce as foundation interim year 1 (FiY1) doctors. In this column, a foundation year 1 (FY1) doctor reflects on their FiY1 experience of starting work as a practising doctor in the height of a pandemic. The process of the induction, the structure of the job, and the overall experience of an FiY1 doctor is reviewed and reflected on against previous years. The author aims to shed light on the FiY1 role for students who may find themselves in similar positions in the future.
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This article aims to provide a comprehensive overview of key advances on various aspects of hyper-acute management of acute ischaemic stroke. These include neuroimaging, acute stroke unit care, management of blood pressure, reperfusion therapy including intravenous thrombolysis, mechanical thrombectomy and decompressive hemicraniectomy for malignant stroke syndrome. The challenge ahead is to ensure these evidence-based treatments are now being delivered and implemented to maximise the benefits across the population.
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Psoriasis is a clinically heterogeneous lifelong skin disease that presents in multiple forms such as plaque, flexural, guttate, pustular or erythrodermic. An estimated 60 million people have psoriasis worldwide, with 1.52% of the general population affected in the UK. ⋯ Psoriasis treatments include topical agents (vitamin D analogues and corticosteroids), phototherapy (narrowband ultraviolet B radiation (NB-UVB) and psoralen and ultraviolet A radiation (PUVA)), standard systemic (methotrexate, ciclosporin and acitretin), biologic (tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors) or small molecule inhibitor (dimethyl fumarate and apremilast) therapies. Advances in the understanding of its pathophysiology have led to development of highly effective and targeted treatments.
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Acute pancreatitis (AP) is a medical emergency associated with significant morbidity and mortality. Hypertriglyceridaemia is a well-established but often neglected cause of AP, associated with delayed diagnosis and worse outcome than other more common causes of AP. ⋯ We describe the features underlying the management of AP caused by hypertriglyceridaemia and review the link between oral oestrogen, hypertriglyceridaemia and AP. Given the growth in transgender medicine leading to increasing use of therapeutic high-dose oestrogens in biological males for gender reassignment, it is important that clinicians are alert to the phenomenon of oestrogen-induced-hypertriglyceridaemia and its associated risk of AP.
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Since 2018, there has been no requirement to bring decisions about the withdrawal of clinically-assisted nutrition and hydration (CANH) in patients with persistent disorders of consciousness before the courts, providing that the requirements of the Mental Capacity Act 2005 (MCA) are fulfilled. Subsequent British Medical Association and Royal College of Physicians guidance on CANH withdrawal recommended standards of record keeping and internal and external audit to ensure local decision making was compliant with the MCA to safeguard patients. The scope of the guidance also included patients with stroke and neurodegenerative disorders. ⋯ Neither is the Care Quality Commission reviewing these decisions, as there is 'no statutory requirement' to do so. It appears there is a lack of organised scrutiny of these highly complex life-ending treatment decisions. This omission must surely be a cause for concern.