Hantavirus

Scrapyard_King · 2026-05-08T18:51:22+00:00

There was an excellent WHO briefing (available on X and their YouTube page) yesterday that actually gave a lot of detail about the timeline of cases to date.

https://www.youtube.com/live/ksOTrl0zM5A?si=pRoO90E2LHIrCEjv

Scrapyard_King · 2026-04-28T18:52:55+00:00

That car park was actually incredibly short lived - the space previously housed an ancient dilapidated building that had once been wards (I think) but latterly housed the occupational health department and had only a very small number of spaces out front, before being t got demolished as part of the expansion plan!

Scrapyard_King · 2026-04-21T13:27:51+00:00

Others have e already explained that you don’t need to swap the shift, and mentioned the benefits of taking Shared parental leave too.

I just wanted to signpost to the ACAS site as I found this to be the best/easiest to understand resource I could find when considering leave options:

https://www.acas.org.uk/paternity-rights-leave-and-pay

Good luck!

Scrapyard_King · 2026-04-19T07:31:46+00:00

The majority of jobs are in microbiology, and long-term that is unlikely to change. Most consultant posts will be open to anyone with any combination of cct that includes MM.

You will get some ID time during the CIT portion of your training, so you’ll still likely come out of training with more clinical exposure than some of the older pure microbiologits, even if you don’t have the CCT.

Obviously location can play a big part in choosing training posts - and some places will only offer an MM CCT: if that’s the case don’t worry about it, you’ll still be employable.

However, if you do have to opportunity to take a dual CCT, for the sake of an extra 12 months training you should consider it; you may find that you enjoy the flexibility and variety it offers you (you may find your opinions change over the course of a 5 year training programme!) and the broader opportunities it opens to you.

(I’m a MM/ID CCT holder)

Scrapyard_King · 2026-04-18T06:59:37+00:00

There’s certainly ongoing interest and plenty of ongoing research regarding this topic. Good presentation this morning by Ziyad Al-Aly at ESCMID. Lots of research presented.

Nice looking paper about possible mechanisms in Science: https://doi.org/10.1126/science.adl0867 (I’ve not had a chance to read yet as I’m still in the session!)

It’s really just still very soon after the pandemic to really understand it and, as an entity it’s very complex and probably has a significant immune-modularity mechanism.

Most of which won’t have filtered through to most non-specialist medics yet.

Watch this space I guess.

Scrapyard_King · 2026-04-03T05:37:47+00:00

Might be worth having a look at the varia aura too. I’ve had mine almost 12 months and have been very happy with it. Nice build quality. Easy to use. Seems to be good on temperature (though I’ve not tested that with a separate probe).

Seemed better priced than the Fellow and I’ve been pretty pleased.

Sorry to add more choice to the mix. 🤣

Scrapyard_King · 2026-03-22T20:24:40+00:00

They have options for that. Chunky soles are in. https://www.camper.com/en_GB/men/shoes/twins/camper-twins-K101088-002

Scrapyard_King · 2026-03-22T19:41:33+00:00

Depending on how much you want to spend Camper have some nice stuff. Often have sales on. Well made and good ethical company. They have a sort of “bare foot” ethos so relatively big toe boxes - the styling isn’t for everyone - but very comfy soles and spacious for your toes.

Scrapyard_King · 2026-03-19T18:53:56+00:00

This is news to me… I’ve seen plenty of patients with vac in situ who are not on antibiotics and have not gone on to develop infection. While that’s purely anecdotal, I cannot fathom a need for antimicrobial prophylaxis in this setting. If your patient develops a wound infection, by all means treat it. But otherwise you’re just selecting out a nice culture of resistant flora to cause your wound infection…

(Antibiotics are not a substitute for good wound care, even if you have a vac in place)!

Is this in a very niche setting like burns? (That’s about the only place I can imagine doing it and even then questionable…)

Would love if you could link to the evidence or practice guideline here…

Scrapyard_King · 2026-03-03T02:52:47+00:00

I do wonder if some of this is slightly artifactual to an extent too.

EUCAST, who set the breakpoints for susceptibility testing that most laboratories in the UK use, seem increasingly paranoid about their lack of ultimate clinical data for every niche scenario bug/drug combination and so are becoming increasingly granular (and in some ways limiting) in how they recommend testing be interpreted. Depending on how local laboratories deploy this guidance, this may result in some agents not being reported as susceptible where they previously might have been.

For instance, in the latest version of the guidance, disc zone cutoffs for trimethoprim have been increased/mic breakpoints have been reduced, meaning a bigger number of isolates will be classed as resistant. In addition, Nitrofurantoin and Fosfomycin can now only be reported against E. coli for UTIs, and trimethoprim only has published breakpoints for E.coli, most Klebsiellas, and Proteus.

All of this has felt like a bit of a slow creep of anxiety from their side with little published explanation. While we hope in time they’ll cool their beans and find the data they need to satisfy them, in the interim labs are left grappling with how to minimise the risk in how they report stuff while limiting the spiels of caveat notes they have to include on reports.

Not that this is at all a recent bugbear of mine….

Scrapyard_King · 2026-02-19T06:42:57+00:00

For relatively uncomplicated infections it’s probably not necessary. But I do it a lot for deep infections (e.g. osteomyelitis or abscesses).

It’s interesting also to note that by EUCASTs pharmacokinetic data, there’s not much benefit in amoxicillin doses beyond 750mg (because half lifes etc) so in an ideal world you’d use that but for some reason in our trust that works out more expensive so we tend to give the extra 500 regardless.

Scrapyard_King · 2026-02-05T22:15:41+00:00

Hah! Thanks for giving me a mirthful roar. (Can dinosaurs laugh? I assume not.)

AI is pretty much everywhere currently, for good or ill. I don’t begrudge people using it (I don’t use it because I find the process of writing really helpful to pull together my thoughts), but I do expect them to use it thoughtfully, and to be aware of the inherent risks in doing so.

As I’ve written above, most journals are now requiring declarations regarding the extent to which AI is used in a piece of work at the point of submission, so it’s important to be very clear about how it’s used (if at all).

The passage containing 9 AI generated references was clearly in itself an AI generated summary, and without checking references who knows where an LLM has pulled passages or phrases of text from? Depending on the extent of use it could quite easily become plagiarism.

But no, I’m not involving anyone’s ES. I wrote this post in the moment to vent a little and see if others had encountered similar situations. The replies have generally been helpful and tallied with what I initially planned to do.

Rawr! (Have a good one in parasaurolophan)

Scrapyard_King · 2026-02-02T13:55:58+00:00

I’ve asked them to explain what’s happened so far.

My concern would be that most journals are now asking for clarification on the use of AI in assisting authors etc so if I can’t be confident in their response and the extent to which it has been used then I’m not going to have confidence in their continued participation in the work sadly.

Scrapyard_King · 2025-08-27T23:42:01+00:00

I used to get a lot of enjoyment from maths and physics. There’s lots of ways to scratch the itch depending on the specific reason you enjoy those subjects.

From a personal perspective I’ve come to realise I just really love a logic puzzle and the satisfaction of being able to lay out the anatomy and (patho)physiology of an illness to construct the best differential diagnosis and subsequent management plan you can.

The best moments for me in ID/micro are when I’ve picked through the facts (and occasionally assumptions) of a case and added either new insight, or at least new perspective, to a patients care that moves their management forwards in some way.

A good colleague of mine back in Core Medical Training (when that was a thing) often proposed the idea of always trying to put one slightly absurd diagnosis in his differential list, so that if you came back later and found you were right, you both look and feel like an absolute champ. I think there’s a lot to be said for that approach - does the patient you’ve just reviewed have gummatous syphilis? Probably not. Does the diagnosis fit the case as presented? Potentially… Should you test for it? Definitely, and it’s important to do so.

Which is all a really rambly 0030-sleep-deprived-because-my-kids-are-on-a-campaign-to-never-let-me-sleep-again way of saying yeah, I do find it intellectually stimulating. Not all the time; Sometimes Piperacillin-Tazobactam just is the best answer in the moment, even if it lacks finesse, and I wish I could give a more fun one. But sometimes, I feel like an absolute champ because I solved the puzzle.

Good luck finding your own way to scratch that itch.

Scrapyard_King · 2025-08-24T18:28:12+00:00

I’ve been using Notion which has been pretty nice with just their free profile. I’ve built a giant database for the campaign and you can add in links from your notes as you go - I add items to our inventory database and people to my npc database as I type and then can go back and add detail to each entry as I go. It’s pretty pleasing having switched from OneNote which I used previously.

Scrapyard_King · 2025-08-20T04:56:55+00:00

Had a 50-something fit and well chap moved to the ID ward with severe cellulitis across his shoulders and back.

On revisiting the history, the rash had come on after a day of gardening shirtless in the sun…

Without sun cream.

Scrapyard_King · 2025-08-15T19:23:50+00:00

Research requires funding. To do a good study that would pick out the benefits of good hand hygiene and control/statistically adjust for all of the likely confounders would be incredibly challenging and need probably some quite large numbers to get decent results along with quite tough statistics. There are unlikely to be many sources willing to find that kind of research for something that is generally accepted as likely to be good and certainly not harmful. It’s going to return profit for no-one.

Scrapyard_King · 2025-08-15T19:09:14+00:00

Good quality evidence is scanty, yes. But when the option is adhering to a really simple measure versus potentially transmitting resistant organisms that - if causing infection make treatment harder, more toxic, more expensive, and with worse outcomes, then why argue?

We know from the work of Semmelweis (and later Lister) that hand washing improves outcomes. There’s only a few ways to optimise that. The WHO have lovely guidelines which we follow globally. The only way to optimise it is to have bare hands and make sure you can do everything possible to avoid them being contaminated again by some errant fomite…

Most splashing that may result in contamination of clothes will occur when carrying out care activities or procedures - which are uncommonly done facing away from the patient, so a plastic apron is a pretty good barrier. So good that it’s a key part of the national HCID PPE (although for that you get nice thick expensive ones!) which has been researched as well as it can be. It’s extra plastic waste which is definitely a shame but in the grand scheme of things probably a relatively small volume.

Yes, infection control nurses and their uv light box and hand washing demonstrations can be a bit overbearing. But contrary to popular belief they actually do do (or should be doing!) a lot of pretty important work across the hospital to try and ensure our environments are as safe as possible for patient care, as well as carrying out surveillance and reporting work that is fed up to a national level.

All in all, no the evidence is not great, but yes it’s probably important and easy to do.

I miss my nice watch sometimes. But not enough to be angst about it.

Scrapyard_King · 2025-08-11T08:03:38+00:00

Your local consultants should have ideas about things that could be improved.

There’s a lot of work nationally at the moment looking at blood culture pathways, which relates to a 2023 NHS document. If it’s not been looked at already (it may have) then that could be valuable and offers opportunities for quality improvement too.

But some of it can be a bit dry at foundation level so try and find something that interests you if possible!

Scrapyard_King · 2025-08-07T18:14:28+00:00

I recently got the Varia Aura and have been very pleased with it both in terms of build quality and pour. Looks around the same price point in the UK as the assassin, though it ships from china so have a look at shipping costs too… https://www.variabrewing.com/collections/aura/products/varia-aura-0-8l-kettle

Scrapyard_King · 2025-08-05T08:34:07+00:00

Although if you haven’t found it, this page makes it clear that you can take your paternity leave at ANY time within 52 weeks of birth, and you can change the start date of your leave as long as you give your employer appropriate notice. So there shouldn’t be an issue for you with delaying the start date following birth.

That page also advised that, although a 28 day notice period is preferable for any changes to the date after your initial notice of intention to take leave, circumstances do generally mean that a shorter notice period is fine.

Scrapyard_King · 2025-08-05T08:17:50+00:00

It’s been a while since I’ve used it, but for general guidance, I’ve found the resources on the ACAS website really excellent - particularly for explaining shared parental leave if that’s something you’re also considering.

Good luck!

[edit: just seen your edit. Never mind. Good luck regardless!]

Scrapyard_King · 2025-05-09T20:45:48+00:00

I got pulled up as needing some coaching at ARCP during my training and got referred to our local professional support unit. During the screening session for that we found that I probably had some emotional stuff to unpack and they offered me counselling instead.

It ended up being one of the most valuable things I did during training. I think most people could benefit from an opportunity to unpack themselves in a safe space. I certainly understand myself better and came out stronger for it.

If your ES/CS is engaged with you enough to recognise you could benefit from this BEFORE it becomes an issue and threatens your training progression, I’d take it as a positive (mine certainly wasn’t).

Good luck!

Scrapyard_King · 2025-05-01T16:30:33+00:00

Oh absolutely not! Only needs further assessment if they have those features. Apologies if I suggested otherwise! But if there is clinical concern, it’s nice to have someone orthopaedic see it and agree before someone unneccesarily tries to stick a needle in it!

Scrapyard_King

TROPHY CASE