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    482 results match your criteria Acute medicine[Journal]

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    Being SAM President - A Long Journey in a Short Time.
    Acute Med 2017 ;16(2):95-96
    President, Society for Acute Medicine.
    My first piece of advice for all aspiring medical leaders would be this, 'don't bother' with a leadership course, as nothing can fully prepare you for the role. That said, please continue reading as I will try and provide an honest review of my time as President to the Society for Acute Medicine (SAM). Read More

    An unusual case of sepsis: liver abscess masquerading as pneumonia.
    Acute Med 2017 ;16(2):92-94
    Department of Acute Medicine, Queens Hospital Burton, Burton on Trent, The Burton Hospitals NHS foundation Trust,UK.
    A 63-year-old woman presented with fever, tachycardia and tachypnoea, with right sided chest and hypochondrial pain. Chest radiograph showed right basal consolidation and she was treated for community acquired pneumonia with intravenous antibiotics. Subsequent clinical deterioration in presence of a previous history of complicated diverticulitis, persistent right hypochondrial pain and deranged liver function tests prompted further investigations that confirmed presence of a large pyogenic liver abscess. Read More

    The patient with Acute Thrombocytopenia.
    Acute Med 2017 ;16(2):84-91
    Senior Consultant Physician and Director of Acute Medicine. Department of Medicine, Ng Teng Fong General Hospital, Singapore.
    A wide variety of conditions can present with acute thrombocytopenia, ranging from those that are relatively benign and self-limiting to those that require urgent therapeutic intervention. Initial decision-making relies on a good history and the results of some simple investigations. Although a precise diagnosis of the underlying cause might often not be possible in the acute setting, supportive treatments should be provided to all patients. Read More

    Medical High Dependency Series 2: Haemodynamics and Shock: Assessment, Interventions and Support.
    Acute Med 2017 ;16(2):75-83
    Consultant Physicians in Critical Care, Queen Elizabeth University Hospital, Glasgow.
    Shock is a life-threatening state commonly encountered by the acute physician. As such those practicing and training in the specialty should strive to become true experts in this field by going beyond even the learning provided by generic life support courses when involved with identifying and managing the shocked state. This article explores the current evidence, where it exists and provides a framework for approaching such patients along with common pitfalls. Read More

    The Experience of a District General Hospital with a Large Outdoor Music Festival in England.
    Acute Med 2017 ;16(2):65-68
    Emergency Medicine, North Manchester General Hospital.
    Objectives: To assess the impact of the Parklife annual music festival on the local hospital, North Manchester General.

    Methods: Data was obtained retrospectively by analysis of emergency department records during the weekend of Parklife 2015.

    Results: 32 patients were identified, 56% reported taking drugs. Read More

    Predicting length of stay for acute medical admissions using the ALICE score: a simple bedside tool.
    Acute Med 2017 ;16(2):60-64
    Plymouth Hospitals NHS Trust Derriford Hospital, Derriford Road, Plymouth. UK.
    Background: Early identification of patients likely to have a short admission permits best use of limited resources to facilitate rapid discharge where possible. The ALICE score is a simple bedside tool developed in one hospital as a decision aid. This study sought to confirm its widespread applicability. Read More

    The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism.
    Acute Med 2017 ;16(2):52-59
    Director of pulmonary department; Pulmonary Department, Evangelismos General Hospital of Athens, Ypsilanti 45-47, 10676, Athens, Greece.
    Our aim was to prospectively assess the prognostic value of beta2-microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. Read More

    Cruising through the journey without getting drowned: The saga of a PhD student in the Netherlands.
    Acute Med 2017 ;16(1):43-45
    Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands.
    Young medical trainees all over the world are encouraged to investigate unknown areas of medicine that need clarification. This often leads them to undertake a PhD (Doctor of Philosophy). Being curious, critical, and creative are necessary competences which enable us to engender scientific research within acute (internal) medicine. Read More

    Acute Medicine Finishing School: Preparing for the next step.
    Acute Med 2017 ;16(1):37-42
    Acute Internal Medicine Consultant and Training Programme Director, North East & Central London. Royal Free Hospital, London.
    The transition from registrar to consultant in medicine is one that trainees feel ill prepared for and can be extremely stressful. We devised the concept of an Acute Medicine "Finishing School" for senior trainees in London training programmes and ran sessions on CV writing, a simulated consultant interview, consultant job planning, responding to complaints and an out of hospital emergency scenario. Our feedback survey indicated that our delegates' confidence levels in all of the above aspects increased following the sessions. Read More

    Use of a flumazenil infusion to treat chlordiazepoxide toxicity.
    Acute Med 2017 ;16(1):30-34
    Acute Medicine Unit, Ward 7B and 7C, Royal Victoria Hospital, Belfast, UK.
    "Alcohol detox" is a common presentation to acute medical services and is usually managed via standardised guidelines and protocols. We present a case of chlordiazepoxide toxicity, requiring repeated bolus doses and subsequently 24 hours of an intravenous infusion of flumazenil in response to guideline directed management of an alcohol withdrawal state. The use of prolonged flumazenil infusions to treat benzodiazepine toxicity is infrequently described. Read More

    Evolving sepsis definitions and their impact on Acute Medical Units.
    Acute Med 2017 ;16(1):25-29
    Musgrove Park Hospital, Taunton.
    Background: There are currently several different definitions for sepsis. This study looked at what proportion of acute medical admissions were identified by the different definitions, what correlation they have, and how many patients would require a review with results in 1 hour.

    Methods: Data on 212 admissions was collected, on time of admission and review, and number of patients with sepsis by each diagnostic criteria calculated. Read More

    Problem-based review: Immune-mediated complications of 'Checkpoint Inhibitors' for the Acute Physician.
    Acute Med 2017 ;16(1):21-24
    Immunotherapy with 'checkpoint-inhibitors' has significantly improved outcomes for patients with a range of malignancies. However, significant immune-mediated toxicities of these therapies are well-described. These immune-mediated toxicities can affect virtually all organ systems and are potentially fatal. Read More

    Progressing care in the Medical High Dependency Unit: unit configurations, staffing, standards, and daily routine.
    Acute Med 2017 ;16(1):16-20
    There are currently various models of care for provision of high dependency care for acutely ill medical patients across the UK. Acute Physicians are integral to the development and progression of this both challenging and rewarding area of medicine. This article outlines current standards, best evidence, and our own experience of both setting up and developing a medical high dependency unit (MHDU). Read More

    Role of Psychological Resilience on Health-Outcomes in Hospitalized Patients with Acute Illness: A Scoping Review.
    Acute Med 2017 ;16(1):10-15
    DM, MRCP, Consultant Acute, Respiratory & Critical Care Medicine, Ysbtyty Gwynedd, Penrhosgarnedd, Bangor and Senior Clinical Lecturer, School of Medical Sciences, Bangor University.
    Recovery from Acute Illness is dependent on severity of illness. We aimed to investigate whether resilience as the 'ability to bounce back' might also affect recovery. We conducted a scoping review to identify gaps in the existing literature. Read More

    Hospital Readmissions - Independent Predictors of 30-day Readmissions derived from a 10 year Database.
    Acute Med 2017 ;16(1):4-9
    Thunder Bay Regional Health Sciences Center, Thunder Bay, Ontario, Canada.
    Unplanned medical 30 day readmissions place a burden on the provision of acute hospital services and are increasingly used as quality indicators to assess quality of care in hospitals. Multivariable logistic regression of a 10 year database showed that four factors were most strongly associated with early readmission: Charlson comorbidity index >=1, respiratory disease as a principal diagnosis, liver disease and alcohol-related illness as an additional diagnosis, and the number of previous readmissions. Disease and patient-related factors beyond control of the hospital are the factors most strongly associated with 30 day readmission to hospital, suggesting that this may not be an appropriate quality indicator. Read More

    A Fellowship Further Afield.
    Acute Med 2016 ;15(4):217
    Darzi Fellow (Quality Improvement) Medical Directorate Barking, Havering and Redbridge University Hospitals NHS Trust.
    In the current climate of uncertainty over trainee working conditions and uneasy medical politics, more and more trainees are choosing to take planned time out of training. This is no longer considered an activity that unnecessarily prolongs one's training, and is generally welcomed by trainees and training programme directors alike. Read More

    National Training Numbers in AIM in the UK.
    Acute Med 2016 ;15(4):216
    Chair, Acute Internal Medicine Specialist Advisory Committee.
    It has recently become apparent that a few trainees in Acute Internal Medicine (IM) have not been made aware of what the final outcome of their training might be. There is a need, therefore, to ensure that there are no surprises for individuals as they approach the end of training. Read More

    The Challenges of Conducting Research on the Acute Medical Unit.
    Acute Med 2016 ;15(4):212-214
    Senior Clinical Research Fellow, Centre for Health Improvement Research, Chelsea and Westminster Hospital, London.
    Conducting research on the Acute Medical Unit (AMU) poses unique challenges; the environment is one that sees a diverse range of patient groups and pathologies and holds the potential for easy patient recruitment to research studies, however is geared towards a specific set of triage and discharge goals. We conducted a study into Stress Hyperglycaemia (SH) on a busy AMU, which involved profiling glycaemic changes using specialist equipment and interventions in patients with unscheduled medical admissions, and experienced a number of challenges. This article discusses these challenges and proposes potential solutions. Read More

    An Unusual Case of Acute Muscle Weakness.
    Acute Med 2016 ;15(4):209-211
    MRCP(Acute), Consultant Acute Physician, London Northwest Healthcare NHS Trust, Northwick Park Hospital, Watford Road, Harrow.
    A previously healthy 35-year old man presented to hospital with acute leg weakness following an alcohol binge. On assessment, tachycardia, urinary retention and bilateral upper and lower limb proximal weakness with preserved peripheral power were noted. Biochemistry revealed marked hypokalaemia, which responded to intravenous replacement, and biochemical thyrotoxicosis, leading to the diagnosis of Thyrotoxic Periodic Paralysis (TPP). Read More

    COKE LIVe: recurrent vasculitis secondary to cocaine contaminated with levamisole.
    Acute Med 2016 ;15(4):206-208
    MB BCh BAO LRCP&SI MRCPI.
    Levamisole-induced vasculitis (LIV) is becoming an increasingly common entity secondary to both rising cocaine use in the UK and high levels of adulteration of cocaine with various contaminants. We report the first documented case of LIV secondary to adulterated cocaine in Ireland, which presented as a 6-year history of recurrent vasculitis of unknown aetiology. Classically, LIV is diagnosed by a combination of positive ANCA serology and agranulocytosis however, given the frequency of cocaine use, we urge acute physicians to consider the diagnosis in cases of typical retiform (angulated) purpura in association with a history of cocaine use. Read More

    Focused Acute Medicine Ultrasound (FAMUS) - point of care ultrasound for the Acute Medical Unit.
    Acute Med 2016 ;15(4):193-196
    Society for Acute Medicine ultrasound working group.
    Point of care ultrasound (POCU) is becoming increasingly popular as an extension to clinical examination techniques. Specific POCU training pathways have been developed in specialties such as Emergency and Intensive Care Medicine (CORE Emergency Ultrasound and Core UltraSound Intensive Care, for example), but until this time there has not been a curriculum for the acutely unwell medical patient outside of Critical Care. We describe the development of Focused Acute Medicine Ultrasound (FAMUS), a curriculum designed specifically for the Acute Physician to learn ultrasound techniques to aid in the management of the unwell adult patient. Read More

    Improving acute care for older people at scale - the Acute Frailty Network.
    Acute Med 2016 ;15(4):185-192
    Professor of Medicine for Older People, University of Nottingham.
    Older people form a growing proportion and volume of those accessing urgent care. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. Comprehensive Geriatric Assessment offers an evidence based framework to assess and mange older people, especially those with frailty. Read More

    Study protocol for a Multi-centre, Investigator-initiated, Randomized Controlled Trial to Compare the Effects of Prehospital Antibiotic Treatment for Sepsis Patients with Usual Care after Training Emergency Medical Services (EMS) Personnel in Early Recognition (- The Prehospital ANTibiotics Against Sepsis (PHANTASi) trial.
    Acute Med 2016 ;15(4):176-184
    Section acute medicine, Department of Internal Medicine and Institute of Cardiovascular research, VU University Medical Centre, Amsterdam, The Netherlands.
    Introduction: Sepsis is one of the most frequent reasons for referral to emergency departments (EDs) worldwide. Sepsis becomes more serious when left untreated with a high mortality rate, exceeding even those of myocardial infarction and stroke. Therefore, much effort has been put in to start with appropriate therapy as early as possible. Read More

    Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study.
    Acute Med 2016 ;15(4):168-175
    Departments of Internal Medicine and Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
    Introduction: General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals. Read More

    Improving acute care for adolescents and young adults on medical admission units: The interventions that matter.
    Acute Med 2016 ;15(3):157-160
    Consultant Physician Queen Alexandra Hospital, Cosham, Portsmouth.
    It had become a familiar routine. My seventh admission with diabetic ketoacidosis (DKA) in a year. Each time I was admitted it was the same; a DKA protocol, a diabetes specialist nurse visit, and a few questions from the doctors checking if "everything is okay?" On each admission, I would be discharged home after a couple of days. Read More

    Pneumomediastinum as a complication of MDMA (3,4-methylenedioxymetamfetamine, Ecstasy) ingestion.
    Acute Med 2016 ;15(3):152-156
    Department of Acute Medicine. York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK.
    MDMA (3,4-methylenedioxymethamfetamine, Ecstasy) is a widely used recreational drug. We present a case of pneumomediastinum as a complication of MDMA use in a 21-year-old man with no previous history of lung or gastrointestinal pathology. We have performed a literature review, and summarised the symptoms, signs, and prognosis for this under-recognised complication of a commonly used recreational drug. Read More

    Fever, delirium and incontinence: not always a UTI.
    Acute Med 2016 ;15(3):149-151
    Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
    Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. Read More

    Pheochromocytoma presenting as a mimic of acute coronary syndrome.
    Acute Med 2016 ;15(3):145-148
    King's College Hospital, Denmark Hill, London.
    Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed near normal coronary arteries. Read More

    Acute generalised exanthematous pustulosis (AGEP)-a potential pitfall for the acute physician.
    Acute Med 2016 ;15(3):140-144
    Acute generalised exanthematous pustulosis is a rare drug-induced dermatosis with an incidence of 1-5 cases per million cases per year, characterised by the appearance of hundreds of sterile pustules over erythematous and oedematous skin. Fever and neutrophilia are usually present. It has a rapid course and usually resolves following discontinuation of the precipitating drug or as a result of topical corticosteroid treatment. Read More

    Frailsafe: from conception to national breakthrough collaborative.
    Acute Med 2016 ;15(3):134-139
    University of Nottingham Derby Teaching Hospitals NHS Foundation Trust.
    The number of people aged over 60 years worldwide is projected to rise from 605 million in 2000 to almost 2 billion by 2050, while those over 80 years will quadruple to 395 million. Two-thirds of UK acute hospital admissions are over 65, the highest consultation rate in general practice is in those aged 85-89 and the average age of elective surgical patients is increasing. Adjusting medical systems to meet the demographic imperative has been recognised by the World Health Organisation to be the next global healthcare priority and is a key feature of discussions on policy, health services structures, workforce reconfiguration and frontline care delivery. Read More

    The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings.
    Acute Med 2016 ;15(3):130-133
    Department of Respiratory Medicine, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefiled, WF1 4DG.
    Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses.

    Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed. Read More

    The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission.
    Acute Med 2016 ;15(3):124-129
    Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
    Background: Deprivation increases admission rates; the specific effect of deprivation with regard to weekend admissions is unknown.

    Methods: We calculated annual weekend admission rates for each small area population unit and related these to quintiles of Deprivation Index from 2002-2014. Univariate and multivariable risk estimates were calculated using truncated Poisson regression. Read More

    Can we predict Acute Medical readmissions using the BOOST tool? A retrospective case note review.
    Acute Med 2016 ;15(3):119-123
    Acute Medicine, King's College Hospital Department of Trauma, Emergency and Medicine 4th Floor, Hambleden Wing (North) King's College Hospital Denmark Hill, London, SE5 9RS.
    Background: Readmissions within 30-days of hospital discharge are a problem. The aim was to determine if the Better Outcomes for Older Adults through Safe Transitions (BOOST) risk assessment tool was applicable within the UK.

    Methods: Patients over 65 readmitted were identified retrospectively via a casenote review. Read More

    Variation in Acute Medicine Units: Measuring it, understanding it, and reducing it.
    Acute Med 2016 ;15(3):111-118
    Vice President, Institute for Healthcare Improvement, Boston, USA.
    Although there are national recommendations on the function of Acute Medicine Units (AMUs), there is no single agreed best model of care. Additionally, robust data is not always available to determine whether system changes have resulted in improvement. We designed an Excel file to interface with the hospital patient management system to provide real-time data on a number of metrics including AMU length of stay (AMULOS), mortality and readmissions. Read More

    Providing a navigable route for acute medicine nurses to advance their practice: a framework of ascending levels of practice.
    Acute Med 2016 ;15(2):98-103
    RGN, BSc, MSc, Acute Care Nurse Consultant.
    This article conveys concerns raised by delegates at the International SAM Conference (Manchester, 2015) regarding how to advance nursing practice in acute medicine. It endeavors to capture the essence of 'how to advance practice' and 'how to integrate advanced practice' within the workforce structures of an acute medicine unit (AMU). It addresses the production of tacit knowledge and the recognition and integration of this to developing the nursing workforce. Read More

    Acute Internal Medicine Trainee Survey 2016.
    Acute Med 2016 ;15(2):93-7
    Objectives: To ascertain the views of current Acute Internal Medicine (AIM) trainees on the strengths and weakness of the specialty, their training programmes, practical procedures and the provision of training days.

    Methods: Online electronic survey circulated to all Higher Specialty Trainees (HST) in AIM. Participation was voluntary and all answers confidential. Read More

    An unusual pathogen in ambulatory care: two cases of Scedosporium soft tissue infections presenting as "unresponsive cellulitis".
    Acute Med 2016 ;15(2):88-91
    MRCP, FRCPath, DPhil OXON, Consultant in Microbiology and Infectious Diseases, Hampshire Hospitals NHS Foundation Trust.
    Soft tissue infections with Scedosporium spp. are an uncommon but serious and emerging cause of infection in immunocompromised patients. Acute Medical Units (AMUs) in the UK are increasingly managing patients with cellulitis in an outpatient setting, therefore acute physicians should be aware of some of the more uncommon causes of soft tissue infection, particularly in patients not responding to initial antibiotic therapy. Read More

    HIV - lessons from a late diagnosis.
    Acute Med 2016 ;15(2):84-7
    FRCP, Milton Keynes Hospital, Standing Way, Eaglestone, Milton Keynes, MK6 5LD, UK.
    Late HIV diagnosis is the most important predictor of HIV-related morbidity and mortality in the UK and often results from missed testing opportunities during earlier contact with health services. The HPA now recommends routine HIV testing be commissioned as a priority for all general medical admissions in high prevalence areas, such as Milton Keynes. We present the case of a patient admitted to our Medical Admissions Unit (MAU) managed initially for presumed septic complications of metastatic disease who was later found to have terminal HIV disease. Read More

    Neurocysticercosis presenting as a 'Stroke Mimic'.
    Acute Med 2016 ;15(2):79-83
    MBChB MRCP PhD, Vascular Medicine, School of Medicine, Royal Derby Hospital Centre, University of Nottingham.
    A 62 year old Nepalese gentleman presented with left sided weakness and sensory loss. Initial brain CT scanning was suggestive of acute infarction but a subsequent MRI scan showed cysts with oedema. Cysticercosis serology was positive and a diagnosis of neurocysticercosis was made. Read More

    Unscheduled care admissions at end-of-life - what are the patient characteristics?
    Acute Med 2016 ;15(2):68-72
    ST3 in Palliative Medicine, Wales Deanery.
    Unscheduled acute hospital admissions and subsequent deaths in hospitals of patients considered palliative are increasing, despite many patients' preference to die at home. A large proportion of these patients are admitted via acute medical units or emergency departments. The integration of primary and secondary care within Wales should enhance the delivery of end-of-life care at home but unscheduled admission for patients with palliative care needs remains prevalent. Read More

    Repeat duplex ultrasound scanning in suspected Deep Vein Thrombosis (DVT): putting the onus back on the referring clinician.
    Acute Med 2016 ;15(2):63-7
    Consultant Physician in Acute Medicine, Royal Liverpool University Hospital, Acute Medical Unit, Prescot Street, Liverpool, L7 8XP.
    Duplex scanning is utilised by many departments in the investigation of suspected DVT. NICE Guideline CG144 recommended repeat scanning for patients in whom the initial Wells score was 'likely' in the presence of a raised D-Dimer, following a normal first scan. Following implementation of this recommendation in our department there was a dramatic rise in the number of repeat scans being undertaken, all of which were negative for DVT. Read More

    Investigating for pulmonary embolism in pregnancy: Five year retrospective review of referrals to the acute medical unit of a large teaching hospital.
    Acute Med 2016 ;15(2):58-62
    Anaesthetics SpR. MBBS, FRCA. West Suffolk NHS Foundation Trust.
    This was a retrospective review of five years' data relating to patients referred to the Acute Medical Unit (AMU) of a large teaching hospital with suspected Pulmonary Embolism (PE) during pregnancy or 6 weeks postpartum. During this period, 210 patients in this group underwent half-dose perfusion scanning as investigation for possible PE and were managed via our ambulatory pathway. Pulmonary embolism was diagnosed in 5. Read More

    Tracking the take - Using patient flow data to improve AMU performance and safety.
    Acute Med 2016 ;15(2):51-7
    Department of Acute Medicine, Southmead Hospital, Southmead Way, Bristol, Avon, BS16 1LE.
    Aims: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimise working patterns to improve waiting times. Read More

    When is a stroke not a stroke? An unusual mimic presenting to AMU.
    Acute Med 2016 ;15(5):33-6
    Consultant Stroke Physician, East Surrey Hospital, Redhill, Surrey, UK.
    Introduction: Creutzfeldt-Jakob disease (CJD) is a rare prion disease classically manifesting with rapidly progressive dementia, abnormal movements and typical electroencephalographic (EEG) changes.

    Case Report: A 74 year-old Caucasian man was recently discharged from another centre diagnosed with a stroke. He re-presented to our acute medical unit with worsening symptoms, and stroke remained the working diagnosis. Read More

    Acute Mitral Regurgitation: an important cause of respiratory distress.
    Acute Med 2016 ;15(5):30-2
    Consultant Cardiologist Portsmouth Hospitals NHS Trust.
    Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Read More

    Implementation of NICE recommendations on abdomino-pelvic CT, following unprovoked venous thromboembolism, in a UK teaching hospital: no additional detection of occult malignancy and high numbers of incidental findings.
    Acute Med 2016 ;15(5):25-9
    Consultant Radiologist, Royal Liverpool University Hospital, UK.
    Introduction: NICE Clinical Guideline 144 recommends that patients with an unprovoked VTE, who do not have signs or symptoms of cancer on initial investigation, be considered for further investigation with an abdomino-pelvic CT to exclude occult malignancy. This study aimed to evaluate numbers of scans performed in a UK teaching hospital and outcomes, following this recommendation.

    Methods: Retrospective review of CT scans performed before and after publication of the NICE guidance in 2012. Read More

    A simple intervention to improve patient safety, save time and improve staff experience in the AMU procedure room.
    Acute Med 2016 ;15(1):20-4
    Core Medical Trainee Year 2, University Hospitals Southampton NHS Foundation Trust.
    Over the last decade, operating theatres and Intensive Care Units (ICUs) have established systematic methods for performing procedures on patients that have been shown to reduce complications and improve patient safety. Whilst the use of procedure rooms on Acute Medicine Units (AMUs) is highly recommended by patient safety groups and Royal College publications, they are not universally available or appropriately utilised. In this article we discuss a quality improvement project that was undertaken on an AMU at a large university teaching hospital in the United Kingdom, highlighting its successes and challenges. Read More

    Measurement of generic patient reported outcome measures (PROMs) in an acute admission unit: A feasibility study.
    Acute Med 2016 ;15(1):13-9
    VU University Medical Center, Section acute medicine, Department of Internal Medicine, Amsterdam, The Netherlands.
    Objective: Measuring patient-reported outcome measures (PROMs) is a challenge in Acute Admission Units (AAUs), where patients present with a variety of pathologies. Generic PROMs may be used to measure the quality of care in this population. The main objective of this study was to assess the feasibility of measuring generic PROMs in a Dutch AAU. Read More

    The Relationship between Resource Utilization, Clinical Risk and Hospital Costs for Emergency Medical Admissions.
    Acute Med 2016 ;15(1):7-12
    Division of Internal Medicine, St. James's Hospital, Dublin 8, Ireland.
    There has been little study of the relationship between resource utilisation, clinical risks and hospital costs in acute medicine with the question remaining as to whether current funding models reflect patient acuity. We examined the relationship between resource use for investigations/allied professional and patient episode costs in all emergency medical admissions admitted to our institution during 2008-2013. Univariate estimates were compared with a multivariate model adjusted for major cost predictors. Read More

    A simple intervention to improve antibiotic treatment times for neutropenic sepsis.
    Acute Med 2016 ;15(1):3-6
    Musgrove Park Hospital, Parkfield Drive, Taunton, Somerset, TA1 5AD.
    Objectives: Patients with suspected Neutropenic sepsis require rapid antibiotic administration, but despite extensive education, only 67% of patients received antibiotics within 60 minutes .

    Methods: A Neutropenic Sepsis Alert Card was created, as a Patient Specific Directive - this allows nurses to administer antibiotics to specific patients without prior medical review.

    Results: Since the intervention, 301 patients presented with suspected neutropenic sepsis. Read More

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