Clinical medicine (London, England)
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The COVID-19 pandemic has strained healthcare systems and how best to address post-COVID health needs is uncertain. Here we describe the post-COVID symptoms of 675 patients followed up using a virtual review pathway, stratified by severity of acute COVID infection. ⋯ Many patients continue to have a significant burden of post-COVID symptoms irrespective of severity of initial pneumonia. How best to assess and manage long COVID will be of major importance over the next few years.
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A 54-year-old woman presented to the emergency department with fluctuating consciousness without localising signs and non-specific neurology. Urgent computed tomography (CT) was unremarkable and differentials of opioid overdose or post-ictal state were considered. Magnetic resonance imaging of the brain demonstrated an artery of Percheron (AOP) infarct; resulting from occlusion of an uncommon anatomical variant in the thalamic and midbrain circulation. This should be considered in patients presenting with fluctuating consciousness and normal CT.
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Increasing numbers of doctors in training are taking career breaks, with burnout cited as a potential cause. This study analysed General Medical Council (GMC) national training survey data (renal medicine) to understand the impacts of changing workforce demographics on trainee outcomes and wellbeing. Increasing proportions of female, Black, Asian and minority ethnic (BAME), and international medical graduates are entering the workforce. ⋯ Self-reported burnout rates for renal trainees were higher than other medical specialties and highest for male BAME trainees. Burnout was only partially mitigated by less-than-full-time working, but had no impact on progression, sick-leave or time out of training. It is important to recognise changes to the workforce and proactively plan to effectively support a more diverse group of trainees, to enable them to succeed and reduce differential attainment.
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Insulin is required for all people living with type 1 diabetes, and may be required in nearly half of those with type 2 diabetes. It is a complex drug, manufactured in several forms and utilised in various regimens and devices. There is evidence that non-specialist professionals lack confidence in insulin therapy and, in addition, insulin-related prescribing errors are common in hospital care. In this article, I summarise commonly used insulin regimens, along with indications and safety considerations when prescribing insulin therapy.