Clinical medicine (London, England)
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In this article, I detail my rapport-building trial and error exercise and outline why addressing a patient's occupation at the beginning of a consultation worked during my history taking. Context permitting, addressing occupation can be useful when setting the tone and rhythm of a conversation, helping to focus explanations on the back of a patient's everyday experiences, and allowing a history-taker to address a patient's ideas, concerns and expectations more comfortably. Broaching occupation can also be a useful way to extrapolate information about disease risk factors and baseline understanding from the start. Whatever the rapport-building technique used, self-awareness seems to be a critical skill in this exercise, and an approach used with one patient may not necessarily be useful with another.
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Randomized Controlled Trial
The unspoken benefit of participation in a clinical trial.
Publicly funded trials do not usually offer financial incentives to volunteers. An intensive level of medical care could act as an additional motivator for participation. Our aim was to establish whether patients may draw any clinical benefit from volunteering in a clinical trial. ⋯ Compared with routine care, patients screened for a clinical trial may come under an increased level of scrutiny that may affect their clinical management. This may act as additional motivator to attract patients to future studies.
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Case Reports
Not always as simple as a UTI: An atypical case of Lemierre's syndrome, the forgotten disease.
A 65-year-old man, who was previously fit and well with no known medical comorbidities, was admitted with symptoms of dysuria, urinary frequency, pyrexia, chills and lethargy. His vitals showed that he was hypotensive, tachycardic and pyrexial. Urine dip was heavily positive for leukocytes and nitrites and had markedly elevated inflammatory markers and mild acute kidney injury. ⋯ The patient was continued on intravenous piperacillin/tazobactam and metronidazole as per sensitivities and later switched to oral metronidazole. He was initiated on warfarin anticoagulation. He made a remarkable recovery and was discharged with outpatient ear, nose and throat and haematology follow-up.
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The Royal College of Physicians' COVID-19 study was conducted in 2020 as a collaboration of 19 English NHS trusts, the Association of Professional Healthcare Analysts and a data team in the Institute of Global Health Innovation at Imperial College London. The participating trusts had a combined catchment population of 10.46 million and looked after over 26,000 patients with SARS-CoV-2. The study involved 510 patient cases the majority of which were mortality reviews. ⋯ Poor care was uncommon. Qualitative data generated 24 common themes that were articulated by the creation of nine vignettes (four explored here). Six recommendations were created, and further analysis of specific recommendations is advised.