Clinical medicine (London, England)
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In May 2020, the new 'opt-out' organ donation law was passed in England. This law is a crucial step to help battle the long waiting lists of patients awaiting a transplant. This article aims to explore some of the challenges that the transplant teams may face with the new law, as well as raising awareness among the junior doctors, especially with the new COVID-19 transplant guidelines. ⋯ Organ transplant surgery is a life-changing moment for a patient. Ultimately, commissioning groups, clinicians and managers need to work together, evaluate the changes required and enact thorough business plans to ensure the NHS is not overwhelmed. Together with increasing the awareness of organ donation within the public, the government needs to support the NHS to fund, train and manage transplant centres to welcome this much-awaited 'opt-out' organ donation law in England successfully.
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False negative results in COVID-19 testing are well recognised and frequently discussed. False positive results, while less common and less frequently discussed, still have several adverse implications, including potential exposure of a non-infected person to the virus in a cohorted area. ⋯ The consequences of these results are discussed and implications for these results in both high and low prevalence settings are considered. We also provide recommendations to minimise the risk and impact of false-positive results.
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Case Reports
Tuberculous arthritis of the ankle joint masquerading as rheumatoid arthritis in a patient with lupus nephritis.
Tuberculosis is an airborne multisystemic disease which primarily infects the lungs. Isolated tuberculous arthritis is rare. We present a case of a 41-year-old woman with a known case of lupus nephritis class IV who complained of pain and swelling over her left ankle joint for several months. ⋯ However, she did not improve with treatment and was later diagnosed with tuberculous arthritis based on a molecular study from joint aspiration. She was started on antituberculosis medication and showed improvement. We highlight the challenges in reaching the diagnosis and the importance of including tuberculous arthritis in differential diagnoses in cases with persistent ankle swelling.
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Persistent symptoms lasting longer than 3 weeks are thought to affect 10-20% of patients following SARS-CoV-2 infection. No formal guidelines exist in the UK for treating patients with long COVID and services are sporadic and variable, although additional funding is promised for their development. ⋯ These individuals see the healthcare system from both professional and patient perspectives, thus represent an important wealth of expertise to inform service design. We present a set of co-designed quality standards, highlighting equity and ease of access, minimal patient care burden, clinical responsibility, a multidisciplinary and evidence-based approach, and patient involvement; and we apply these to propose a potential care pathway model that could be adapted and translated to improve care of patients long COVID.