Clinical medicine (London, England)
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Medically unexplained symptoms (MUS) are those with no identified organic aetiology. Our emergency department (ED) perceived an increase in MUS frequency during COVID-19. The primary aim was to compare MUS incidence in frequent attenders (FAs) during COVID-19 and a control period. ⋯ During COVID-19, ED attendances reduced by 32.7%, with a significant increase in the incidence of FA-MUS and FA-MUS ED visits compared to control; RR 1.5 (95%CI 1.1-1.8) p=0.0006, and RR 1.8 (95%CI 1.6-2.0), p<0.0001, respectively. Despite reduced ED attendances during COVID-19, there was a significant increase in the incidence of FA-MUS patients and corresponding ED visits by this cohort. This presents a challenge to ED clinicians who may feel underprepared to manage these patients effectively.
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Inpatient hyperglycaemia is associated with poor patient outcomes. The majority of inpatients with diabetes are admitted with non-diabetes-related conditions and are primarily cared for by a clinician who does not specialise in diabetes. We describe common inpatient hyperglycaemia scenarios and outline strategic management approaches for the general physician, enabling better frontline care for people with diabetes.
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No published protocol to guide the withdrawal of continuous positive airway pressure (CPAP) for patients with COVID-19 exists. ⋯ The use of the protocol ensures a comfortable and dignified death and supports the delivery of individualised care at the end of life. Future research on this topic should focus on qualitative outcomes and consider the applicability of this protocol in other patient groups.
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To review advance care planning (ACP) practice during the COVID-19 pandemic, evaluating the number of plans created, patient participation, cardiopulmonary resuscitation recommendations and variation between different population groups. ⋯ Increased ACP during a crisis can be achieved alongside increased patient participation in decision making. A tool such as ReSPECT that supports recommendations for, as well as limitations on, treatment may have enabled the expansion of ACP observed.