Fundoscopy is an under-performed examination in the acute medical assessment. There is a need to develop different methods of learning to help trainees maintain basic clinical skills, with potential lying in the development and institution of model eyeballs into clinical skills labs. Doctors may also benefit from teaching with a real patient within a clinical environment. Therefore, we recommend hospitals focus on incorporating bedside teaching into postgraduate training.

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In this prospective, single-centre, slightly underpowered, double-blind randomised controlled trial (RCT) with intention-to-treat analysis, use of moderate-dose hydrocortisone in etomidate-related adrenal insufficiency was not shown to reduce the proportion of patients with a cardiovascular Sequential Organ Failure Assessment (SOFA) score of 3 or 4. Level of evidence: 2B (CEBM, low quality RCT)

Sickle cell disease is a multisystem disease characterised by chronic haemolytic anaemia, painful vasoocclusive crises and acute and chronic end-organ damage. It is one of the most common serious inherited single gene conditions worldwide and has a major impact on the health of affected individuals. Peri-operative complications are higher in patients with sickle cell disease compared with the general population and may be sickle or non-sickle-related. Complications may be reduced by meticulous peri-operative care and transfusion, but unnecessary transfusion should be avoided, particularly to reduce the risk of alloimmunisation. Planned surgery and anaesthesia for patients with sickle cell disease should ideally be undertaken in centres with experience in caring for these patients. In an emergency, advice should be sought from specialists with experience in sickle cell disease through the haemoglobinopathy network arrangements. Emerging data suggest that patients with sickle cell disease are at increased risk of COVID-19 infection but may have a relatively mild clinical course. Outcomes are determined by pre-existing comorbidities, as for the general population.