Clinical medicine (London, England)
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Chronic diarrhoea is common, occurring as the first presentation of several diagnoses, or as a prolonged disorder where stool frequency, urgency and incontinence have major impacts on quality of life. Good history taking is necessary, with different causes to be considered: onset and duration of symptoms, previous treatments, co-existing conditions, travel and drug use may all be relevant. Tests include blood and faecal screening. ⋯ Functional bowel disorders with diarrhoea are prevalent, overlapping with other more treatable conditions. Dietetic assessment and advice are helpful. Awareness of high FODMAP foods, with identification of individual sensitivities, is often beneficial.
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21% of NHS staff are from Black, Asian and minority ethnic (BAME) backgrounds yet account for a disproportionately high number of medical-staff deaths from COVID-19. Using data from the published OpenSAFELY Collaborative, we analysed consultant physicians to determine those at increased risk of COVID-19 related death. ⋯ A third of consultant physicians have an increased risk of a COVID-19-related death, and one in five have a higher relative risk (HR >2). The risk is mainly driven by age, gender, and ethnicity, the risk is highest in male consultant physicians over 60, especially from BAME backgrounds.
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Perioperative optimisation can improve outcomes for older people having surgery. Integration with primary care could improve quality and reduce variability in access to preoperative optimisation. ⋯ This survey illustrates the importance of interprofessional education, cross-sector training opportunities and collaboration to deliver integrated preoperative optimisation for older people undergoing surgery.
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There have been significant advances in the diagnosis and management of non-ST-segment elevation myocardial infarction over recent years, which has been reflected in an international decline in mortality rates. This article provides an overview of the 2020 European Society of Cardiology Clinical Practice Guidelines for the topic, concentrating on areas relevant to the general or emergency physician. The recommendations and underlying evidence basis are analysed in three key areas: diagnosis (the recommendation to use high sensitivity troponin and how to apply it), pathways (the recommendation to facilitate early invasive coronary angiography to improve outcomes and shorten hospital stays) and treatment (a paradigm shift in the use of early intensive platelet inhibition). Gaps in the evidence base are highlighted, including the optimal management strategy for older people and the antiplatelet regime to consider when angiography may be delayed.