Clinical medicine (London, England)
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Employment, along with education, is central to the promotion of social mobility and the reduction of health inequalities. For the most part, however, physicians have limited exposure to occupational medicine during their training and rarely receive much in the way of formal training about occupational issues except those that fall commonly within their area of specialisation. Here, we illustrate why work and good employment can be so important for health and, therefore, why it should matter to all physicians. ⋯ There is an important relationship between unemployment and poor health which will be discussed, illustrating the importance of being able to support people with long-term conditions and disabilities to remain in work for as long as they wish to do so. Patients expect to be able to seek advice from their physician about taking time off work because of ill health, planning a return to work after sickness absence and whether or not they need to change their work status because of their health condition. Therefore, we describe the fitnote: what it is for, how to complete one well and what core principles are needed in order to give patients good advice about working.
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Working on a COVID-19 ward presents a number of challenges to staff, with communication between families, patients and staff being highlighted as a key challenge. Novel methods are needed to overcome the barriers presented by COVID-19, with many turning to technology to offer solutions. Recognising these challenges as an area for improvement on our own ward, we sought to introduce new methods of communication to improve patient, relative and staff understanding and wellbeing. Through our own experiences and a discussion of the literature on this topic, we have identified some key themes which we believe can assist in the development of communication strategies in the developing pandemic.
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Fluid-repellent surgical masks (FRSMs) are recommended by the UK government for healthcare workers as personal protective equipment (PPE) against SARS-COV-2. UK Infection Prevention and Control (IPC) national guidelines states that 'masks must be well-fitting and fit for purpose, fully covering the mouth and nose'. ⋯ The current supply of FRSMs are poorly fitting for many users and do not meet the UK IPC guideline standard. These issues were not evident when worn with a plastic strap or with FFP3 masks.
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Review Case Reports
Recurrent infection-induced autoimmune haemolytic anaemia complicated by pulmonary embolism: a case report and literature review.
A 73-year-old woman presented with progressive dyspnoea up to type 1 respiratory failure. Laboratory values showed leucocytosis, reduced haemoglobin to 71 g/L, elevated indirect serum bilirubin and lactic dehydrogenase. Computed tomography pulmonary angiography (CTPA) revealed peripheral pulmonary embolism (PE). ⋯ The patient was diagnosed with autoimmune haemolytic anaemia (AIHA), which was induced by recurrent infections without standard treatment in the past year. AIHA is the cause of PE due to the absence of common predisposing factors and other thrombophilia. The patient became better after administration of glucocorticoids, intravenous immunoglobulin and rivaroxaban.