Clinical medicine (London, England)
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The call for community and patient involvement in the COVID-19 response is yet to be heard and answered. There are practical and ethical reasons for researchers not to neglect patient and public involvement (PPI), which has become an important cornerstone of UK-based clinical research. There has been a commendable effort towards driving evidence-based research, particularly through clinical trials in the UK. This article presents a brief background to PPI and points for consideration for clinical researchers currently active in or planning COVID-19 research.
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Adrenal insufficiency (AI) is an often-unrecognised endocrine disorder, which can lead to adrenal crisis and death if not identified and treated. Omission of steroids in patients with AI, particularly during physiological stress such as an intercurrent illness or surgery, can also lead to an adrenal crisis. ⋯ A new NHS Steroid Emergency Card has been developed to be carried by patients at risk of adrenal crisis. We hope the new emergency card and this guidance will increase awareness of the need to start steroids promptly in patients at risk of an adrenal crisis, particularly those presenting in the emergency department or to acute medicine teams and those undergoing surgery or invasive procedures.
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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.
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Case Reports
Images of the month: Demonstrative oral mucosal sarcoidosis in a patient with pulmonary disease.
Sarcoidosis is a multisystem granulomatous disease that preferentially affects the lungs and intrathoracic lymph nodes. Oral involvement is quite rare and usually appears in patients with known systemic sarcoidosis but it may also be the initial finding of a systemic disease. ⋯ Recognising oral sarcoidosis may be difficult but it is important not to miss an asymptomatic pulmonary sarcoidosis. Patients with oral lesions of sarcoidosis should be screened for systemic disease.