Clinical medicine (London, England)
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The COVID-19 pandemic will impact on how care for chronic conditions is delivered. We use epilepsy to exemplify how care for patients will be affected, and suggest ways in which healthcare systems can respond to deliver the most effective care. ⋯ At the same time, neurologists should support emergency departments and acute medical units, advising on appropriate management of seizures and other acute neurological presentations. Ultimately, the revolution in our clinical practice is unlikely to cease after this pandemic, with reconfiguration of services likely to bring improvements in efficiency and convenience, and a reduced environmental impact.
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Pneumothoraces (1%) and pleural effusions (5%) are two of the less common complications of infection with COVID-19. Following a referral for a pleural drain insertion for a pneumothorax in a patient with COVID-19, we reassessed the infection risks involved in this procedure and its aftercare. ⋯ Consequently, we chose to attach an antiviral filter to the venting port of an underwater seal drain bottle to mitigate this risk. A fluorescein dye experiment was used to demonstrate the reduction in aerosol emission output from the bottle with our described technique, allowing an antiviral filter to be attached to a pleural underwater seal drainage bottle for added protection of patients and staff in the local environment.
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A case is presented highlighting the emerging association of COVID-19 with pneumomediastinum, even in patients who have never received mechanical ventilation or positive airway pressure.
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In recent years, autoimmunity has been increasingly recognised as an important cause of encephalitis. Many different antibodies are now known to target antigens on the neuronal surface, and some of these are associated with characteristic clinical presentations, although seronegative cases are also recognised. Autoimmune encephalitis may mimic other conditions, including primary psychiatric disorders, particularly early in the disease. Because early immune treatment of autoimmune encephalitis improves patient outcomes, and indeed many make a good recovery, it is important to recognise these syndromes promptly.
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Evidence has suggested that when senior doctors are less approachable, junior staff are less likely to raise safety issues. There are limited existing data on whether the name by which junior doctors address their seniors reflects approachability and if this varies between grade and specialties. ⋯ Throughout all specialties, the majority of junior doctors consider the consultants that they address informally to be more approachable.