The Novichok class of nerve agents are noxious chemical-weaponized organophosphates. Though its use is prohibited under the 1997 Chemical Weapons Convention, the attempted murder of an ex-Russian spy and his daughter has turned a spotlight on one of the world's deadliest poisons. Summary Novichok was developed by the Soviet Union in the 1970s and is reportedly ten times more lethal than VX, the nerve agent used to assassinate the half-brother of North Korean leader Kim Jongun. Novichok produces its toxic effect by irreversibly inhibiting acetylcholinesterase. Unlike other nerve agents, it is thought to target both the central and peripheral nervous systems. Exposure to Novichok invariably leads to death. Take Home Messages With an increase in worldwide chemical weapons usage, including recent use in the United Kingdom, clinicians should know how to rapidly recognize symptoms of nerve agent poisoning, lend their expertise in the education and treatment of such attacks and administer life-saving antidotes.
Almost half of NHS doctors are junior doctors, while high proportions are women and/or Black, Asian, and Minority Ethnic (BAME) individuals. Discrimination against this population is associated with poorer career-related outcomes and unequal representation. We aimed to qualitatively explore junior doctors’ experience of workplace racial and gender-based discrimination, and its impact on their psychological distress (PD). In this study, we carried out a secondary analysis of data from a UK-based parent study about junior doctors’ working cultures and conditions. Interview data was examined using thematic analysis. Transcripts (n = 14) documenting experiences of race and/or gender-based discrimination were sampled and analysed from 21 in-depth interviews conducted with UK junior doctors. Four themes were generated about the experiences and perpetrators of discrimination, the psychological impact of discrimination, and organisational interventions that tackle discrimination. Discrimination in various forms was reported, from racially charged threats to subtle microaggressions. Participants experienced profoundly elevated levels of PD, feeling fearful, undermined, and under-confident. Discrimination is associated with elevated levels of PD, whilst negatively impacting workforce sustainability and retention. This reduces the opportunity for more diversity in NHS medical leadership. We encourage NHS hospitals to review their policies about discrimination and develop in-person workshops that focus on recognising, challenging, and reporting workplace discrimination.
Scabies is a well-known, yet a poorly understood neglected tropical disease (NTD). Although less common in the UK, scabies epidemics regularly occur abroad, in tropical, less developed communities (LDCs). Cases are prevalent in communities which tend to live with overcrowding, poor sanitation and limited access to healthcare facilities and medication. This environment provides the perfect breeding ground for the growth and the transmission of scabies. The body has a delayed response to infestation -this is due to the scabies mites' ability to disrupt the complement cascade and delay the onset of the adaptive arm of the immune response.
RelevanceContrary to popular belief, anyone can become infested with scabies. Although not usually life-threatening, scabies can cause unpleasant symptoms as well as worsen existing skin conditions, which can reduce a person's quality of life. Prompt diagnosis is challenging in LDCs. Undiagnosed scabies may lead to serious complications such as secondary skin sepsis as well as allowing further transmission. Scabies is highly contagious; clinicians should be aware how to spot and treat scabies early on, and additionally know to o er treatment to other individuals that the patient has been in close contact with.
Take Home MessagesManagement for scabies is relatively simple and involves the application of topical medication, such as Permethrin. Despite this, there are still many barriers to treating epidemics in LDCs, such as a lack of access to treatment and healthcare professionals, a lack of awareness from clinicians about the condition's clinical manifestations, as well as lack of infrastructure to de nitively diagnose the condition. Despite progress in management of the condition, the pathophysiology and transmission of the condition are only partly understood, and the rise of resistance to current scabicides is indicative of the need for newer treatments, especially within resource-poor communities.
To increase the number of organ donors in England, the government will implement Max and Keira's Law: all adults over the age of 18 living in the United Kingdom become potential organ donors a er their death, unless they choose to opt out. The law will be employed by spring 2020. Despite there being presumed consent for the retrieval of organs, families of the deceased will still be contacted to recheck consent, and ensure that family wishes are upheld.
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