526 results match your criteria Acute medicine[Journal]
Acute Med 2018 ;17(2):113
BSc (Hons) MBBS MRCP (Acute Medicine), ST5 Acute Internal Medicine, London Deanery.
I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs( and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training. Read More
Acute Med 2018 ;17(2):112
MBChB FAcadMEd FRCPE FRACP, Consultant Physician & Hon Clinical Associate Professor Derby Teaching Hospitals NHS Foundation Trust.
I read the article, 'Is the AIM curriculum, for higher specialty training, fit for purpose' with interest. However, I disagree with the author on a number of points. First, a curriculum is 'everything that happens in relation to an educational programme', not a document setting out intentions and expectations. Read More
Acute Med 2018 ;17(2):104-109
Consultant in Emergency Medicine, Whipps Cross University Hospital, Whipps Cross Rd, Leytonstone, London E11 1NR.
Both hyper and hypovolaemia have been associated with poor outcomes. Assessment of fluid responsiveness is challenging in the acute medical patient, due to time constraints, limited evidence and quite often the lack of accurate assessment tools on the Acute Medicine Unit (AMU). This article explains how focused echo assessment is quick and easy to use for this purpose on the acute medical take and highlights key principles to bear in mind when assessing for hypovolaemia and whether to administer fluid therapy. Read More
Acute Med 2018 ;17(2):99-103
MD, MRCP, FRCPath, Consultant Haematologist, Department of Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust.
Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. Read More
Acute Med 2018 ;17(2):98
The James Cook University Hospital, Middlesbrough, United Kingdom, TS4 3BW.
A 64-year-old male presents to the emergency department in acute respiratory distress. He gives a limited history of progressive shortness of breath of one week's duration and several episodes of sudden unexplained syncope. There was no history of chest pain, palpitations or localising symptoms of infection. Read More
Acute Med 2018 ;17(2):96-97
Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
Olanzapine is an antipsychotic drug used in psychiatric diseases. At high doses it exhibits cardiovascular and neurological sideeffects in particular. Lipid emulsion therapy for the removal of medication from plasma in high-dose lipophilic drug use has recently become very widespread. Read More
Acute Med 2018 ;17(2):91-95
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Read More
Acute Med 2018 ;17(2):83-90
MD, PhD, internist, Department of Internal Medicine, division of General Medicine, section Acute Medicine, Maastricht University Medical Centre, Maastricht University, School of CAPHRI, Maastricht, the Netherlands.
The aims of this retrospective cohort study were to retrieve characteristics and outcomes of older (65+) medical patients who are directly admitted to ICU from the ED and to compare these with those admitted to ICU from a ward. Of 1396 patients, 21 (1.5%) were directly admitted to ICU and 54 (3. Read More
Acute Med 2018 ;17(2):77-82
Section Acute Medicine, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Readmissions are treated as adverse events in many healthcare systems. Causes can be physiological deterioration or breakdown of social support systems. We investigated data from a European multi-centre study of readmissions for changes in vital signs between index admission and readmission. Read More
Acute Med 2018 ;17(2):68-76
MBBS, MRCP, Consultant Physician, Acute Medical Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA.
Time and resource constraints have often led to the use of assessment records as discharge communications from acute and emergency departments. However, whether this addresses the primary care needs has not been demonstrated. This study examined the optimal structure that can impart key discharge information effectively using feedback from general practitioners (GP). Read More
Acute Med 2018 ;17(2):62-67
VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands.
Background: There is an increased influx of patients needing admission. Introducing an acute medical unit (AMU) may increase the admission capacity without increasing the total number of beds.
Methods: Data collected during the first four years after implementation of an AMU in an academic tertiary care center in Amsterdam were analyzed. Read More
Acute Med 2018 ;17(2):61
Consultant in Infectious Diseases and General Internal Medicine, Manchester University Foundation Trust, Cobbett House, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK.
Readers may be aware of the need to improve uptake of HIV testing in health care-settings to reduce the number of individuals with undiagnosed infection who later present with advanced disease. Late presentation of HIV infection is associated with a poorer immune response to antiretroviral therapy, an increased morbidity and mortality with a resultant higher cost burden to health-care services. Individuals with undiagnosed HIV infection who inadvertently transmit their infection to others are thought to be responsible for more than half of new HIV infections in the USA. Read More
Acute Med 2018 ;17(2):60
Professor of Ambulatory Care, University of Birmingham, Birmingham, B15 2TT, UK.
In the acute care pathway, patients often need to move from home to hospital and for the majority, back again. This movement across care interfaces ensures that assessments and interventions are delivered to reduce risk of harm and enhance recovery. However, information needs to move across interfaces too, which enables the clinician taking over care to understand the problem, what has been done and what remains to be done. Read More
Acute Med 2018 ;17(2):59
Associate Editor, Consultant in Acute Medicine, University College London Hospitals.
As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries. Read More
Acute Med 2018 ;17(1):2-3
Associate Editor, Consultant in Acute Medicine, University College London Hospitals.
Acute Medicine remains a specialty in its infancy and, as such, faces many challenges associated with developing new ways of working. As the Society for Acute Medicine celebrates its 18th birthday the extraordinary role of Acute Medicine in both maintaining and indeed enhancing the care and welfare of patients is increasingly evident. However, scepticism still persists among some colleagues with regards to its effectiveness - a perception heightened by the difficult environment that currently pervades in acute and emergency care in the UK which mirrors the experience of many countries internationally. Read More
Acute Med 2018 ;17(1):50-52
Department of Renal Medicine, Norfolk and Norwich University Hospital, Norwich, UK.
Quinine has long been used for the treatment of conditions such as malaria and leg cramps, and is also present at low levels in some beverages; however, it can cause serious side effects. We describe a patient who developed severe haemolysis, thrombocytopaenia, and acute kidney injury following the ingestion of a single dose of quinine. This case demonstrates the importance of awareness of such potentially life-threatening consequences of exposure to this agent. Read More
Acute Med 2018 ;17(1):49
FRCR MRCS MBChB BSc, Consultant Radiologist, Forth Valley Royal Hospital, Larbert, Scotland.
A 34-year-old gentleman, with a background of osteoarthritis, presented to the Acute Medical Unit with a short history of breathlessness. He had returned from holiday to the United States five days previously. Since return, he had complained of myalgia, sore throat, a non-productive cough, mild anorexia and fevers at home. Read More
Acute Med 2018 ;17(1):44-48
MBBS MRCP (UK), Endocrine Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP UK.
Thyrotoxicosis is common and can present in numerous ways with patients exhibiting a myriad of symptoms and signs. It affects around 1 in 2000 people annually in Europe1. The thyroid gland produces two thyroid hormones - thyroxine (T4) and triiodothyronine (T3). Read More
Acute Med 2018 ;17(1):36-43
MD FRCP, Renal Unit, Royal London Hospital, Barts Health NHS Trust London, UK.
Nephrotic syndrome is an important presentation of glomerular disease characterised by heavy proteinuria, hypoalbuminaemia and oedema. The differential diagnosis of the underlying condition is wide including primary renal disorders and secondary diseases such as malignancy, infection, diabetes and amyloid. Presentations to acute medicine may be with hypervolaemia, complications of the nephrotic state (such as venous thromboembolism), or complications of therapy (such as infection). Read More
Acute Med 2018 ;17(1):31-35
Consultant in Critical Care & Nephrology Guy's & St Thomas' Hospital London.
Managing kidney transplant patients in an acute medical unit can be challenging, as patients have a single functioning kidney, underlying chronic kidney disease, and are immunosuppressed. Transplant patients develop AKI for all usual reasons but the differential diagnosis is wider and includes specific problems, such as obstruction of a single functioning kidney, vascular thrombosis, rejection, drug toxicity and drug-induced thrombotic microangiopathy. Septic AKI is common but again, the differential diagnosis of sepsis is wider. Read More
Acute Med 2018 ;17(1):26-30
Department of Emergency Medicine, Odense University Hospital, Søndre Boulevard 29, DK-5000 Odense, Denmark.
Objective: To clarify if leucocyte count progression can predict one-week mortality in unselected medical patients admitted to the emergency department. Additionally, we investigated the importance of leucocyte count progression for admission to the intensive care unit and length of stay.
Method: This retrospective cohort study uses data collected in two phases from patients admitted through the emergency department at Hospital of South West Jutland. Read More
Acute Med 2018 ;17(1):18-25
Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
Background: An Illness Severity and Co-morbidity composite score can predict 30-day mortality outcome.
Methods: We computed a summary risk score (RS) for emergency medical admissions and used cluster analysis to define four subsets Results: Four cluster groups were defined. Cluster 1 - RS 7 points (IQR 5, 8) Cluster 2 - 9 (IQR 8, 11), Cluster 3 - 12 (IQR 11, 13) and Cluster 4 - 14 (IQR 13, 15). Read More
Acute Med 2018 ;17(1):10-17
Honorary Assistant Professor, University of Nottingham, Nottingham, NG7 2RD.
Physical inactivity causes morbidity, mortality and healthcare expenditure. A minority of people undertake sufficient physical activity to meet the DoH recommendations. NICE has determined that brief advice in primary care is costeffective in increasing physical activity levels but there is no current recommendation for secondary care. Read More
Acute Med 2018 ;17(1):5-9
Clinical Studies and Research Consultant, Penpet Production, Stuttgart, Germany.
A high respiratory rate is a significant predictor of deterioration. The accuracy of measurements has been questioned. We performed a prospective observational study of automated electronic respiratory rate measurements and compared measurements with electronic counts obtained in the 10 minutes prior to the manual measurement. Read More
Acute Med 2017 ;16(4):206-210
Brighton and Sussex Medical School (BSMS) Teaching Fellow and ST6 Acute Internal Medicine Department of Medical Education, 344a Mayfield House, University of Brighton campus, Falmer, BN1 9PH.
This review will critically appraise the AIM curriculum from a trainee,s perspective. The author will focus on the curriculum,s aims and objectives, availability of learning opportunities, adopted assessment and evaluation strategies and finally make recommendations to aid curriculum development. Read More
Acute Med 2017 ;16(4):205
Trainee Representatives, Society for Acute Medicine.
The Specialist Advisory Committee (SAC) of June 2017 discussed the sign off of procedural competences relating to Sengstaken-Blakemore tube insertion and transvenous cardiac pacing and the application for chief registrar roles. Read More
Acute Med 2017 ;16(4):204
Chair, Acute Medicine Speciality Advisory Committee Consultant in Acute Medicine University Hospital Southampton Foundation Trust Tremona Road, Southampton SO16 6YD.
Acute medicine training has come a long way in a relatively short period of time. Acute Medicine was recognised as a speciality by the Royal College of Physicians in 2003, initially as a subspeciality of General Internal Medicine. Acute Medicine was formally recognised as a speciality in its own right in 2009. Read More
Acute Med 2017 ;16(4):200-203
Acute Medicine Consultant, Huddersfield Royal Infirmary, Acre St, Lindley, Huddersfield. HD3 3EA.
Chest pain is an extremely common presenting complaint on the acute medical unit. It is important to distinguish between patients who have serious pathology and those without. Often, the focus is on ruling out an acute coronary syndrome and inadequate consideration is given to other possible causes. Read More
Acute Med 2017 ;16(4):196-199
Consultant Physician (Diabetes and Endocrinology), Frimley Park Hospital, Frimley, GU16 7UJ UK.
Diabetic ketoacidosis (DKA) is a state of hyperglycaemia, ketosis and metabolic acidosis. This carries a significant morbidity and mortality particularly if left untreated or if the diagnosis is delayed. We present a case of euglycaemic DKA in a 48 year old female with non-insulin treated T2DM who had good glycaemic control. Read More
Acute Med 2017 ;16(4):192-195
FRCP, DTM&H, PhD.
A 25-year-old Caucasian flight attendant with an extensive travel history presented with night sweats, fevers, weight loss and axillary and supraclavicular lymphadenopathy. Apart from surgical breast augmentation, she had no past medical or surgical history. She was anaemic, leucopenic and lymphopenic, and a broad infection screen was negative. Read More
Acute Med 2017 ;16(4):185-191
Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF.
The number of patients with tracheostomies managed within high dependency units is increasing. National audits have suggested that the care of these patients could have been improved upon with a significant minority of cases resulting in death or serious adverse events. Because of this, it is crucial that staff working within medical high dependency units have a good understanding of the indications for and techniques of insertion of tracheostomies. Read More
Acute Med 2017 ;16(4):177-184
Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH.
A Delphi study approach was used to develop a national standard of competencies for Occupational Therapists and Physiotherapists working in acute medicine. Nineteen expert therapists participated in the Delphi study, which consisted of four rounds. A total of two hundred and seventy one competencies were developed and agreed for inclusion in a single document. Read More
Acute Med 2017 ;16(4):170-176
Department of Internal Medicine, Singapore General Hospital, Academia level 4, 20 College Road Singapore, 169856.
Coordination and consolidation of care provided in acute care hospitals need reconfiguration and reorganization to meet the demand of large number of acute admissions. We report on the effectiveness of an Acute Medical Ward AMW (AMW) receiving cases that were suspected to have infection related diagnosis on admission by Emergency Department (ED), addressing this in a large tertiary hospital in South East Asia. Mean Length of Stay (LOS) was compared using Gamma Generalized Linear Models with Log-link while odds of readmissions and mortality were compared using logistic regression models. Read More
Acute Med 2017 ;16(4):164-169
VU University Medical Centre, Amsterdam, The Netherlands, Section Acute Internal Medicine.
Sepsis is a major health care issue and sepsis survivors are often confronted with long-term complications after admission to the intensive care unit (ICU) which may negatively influence their health related quality of life (HRQOL). This study aimed to systematically evaluate the outcome in terms of HRQOL in patients with sepsis after ICU discharge. A literature search was conducted in the bibliographic databases PubMed, EMBASE, and CINAHL, including reference lists of published guidelines, reviews and associated articles. Read More
Acute Med 2017 ;16(4):156-163
Department of Internal Medicine, Division of General Medicine, Section Acute Medicine & CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Hyponatremia is a common finding in hospitalized patients. In this retrospective cohort study we assessed the characteristics and outcome of acute medical admissions with hyponatremia. Compared to the normal sodium group, those with hyponatremia were significantly older and the Charlson Comorbidity Index (CCI) was higher. Read More
Acute Med 2017 ;16(3):150
Specialty Doctor in Stroke Medicine and Elderly Care.
This is a pocket sized book (if your pockets are 20×18×2 cm big, that is) and it weighs less than two decent stethoscopes. Its small physical size belies the comprehensive coverage given to the subject. It is a really a compact textbook covering all aspects of stroke care. Read More
Acute Med 2017 ;16(3):149
Tehmeena Khan has replaced Sanjay Krishnamoorthy as a Trainee Representative for SAM. We would like to thank Sanjay for all his hard work and contribution during his tenure as Rep. Tehmeena is a final year trainee from North East & Central London. Read More
Acute Med 2017 ;16(3):145-148
Consultant in acute medicine, Kingston Hospital, Galsworthy Road, Kingston upon Thames, KT2 7QB.
The presentation of a 'sore throat' is common and often requires only symptomatic treatment. This is the case of a 20-year-old female who presented with persistent symptoms of a sore throat. On admission she had raised inflammatory markers and a subsequent blood culture demonstrated a fusobacterium necrophorum and arcanobacterium haemolyticum bacteraemia. Read More
Acute Med 2017 ;16(3):142-144
MB ChB, MRCP (UK), PGCert, Barnet Hospital, Royal Free London NHS Trust.
Mycoplasma Pneumoniae (M.pneumoniae) is a well-known cause of atypical pneumonia, however it is also associated with many extra pulmonary manifestations. This report highlights a patient with gastroenterological, haematological and neurological complications, including a third cranial nerve palsy which developed after her initial treatment and discharge from hospital. Read More
Acute Med 2017 ;16(3):138-141
MB BChir MRCP, ST5 in Acute Medicine and Intensive Care Medicine, Central Manchester Foundation Trust.
A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. Read More
Acute Med 2017 ;16(3):115-122
Consultants in Critical Care, Queen Elizabeth University Hospital, Glasgow.
Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls. Read More
Acute Med 2017 ;16(3):111-114
Objective: To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR.
Study Design: Randomized clinical trial.
Study Population: Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring CPR. Read More
Acute Med 2017 ;16(3):107-110
Consultant in Acute Medicine, Royal Liverpool University Hospital.
In an attempt to reduce the number of inappropriate clotting screens being performed in our Trust, an electronic prompt was introduced to our haematology requesting system. Over the six month period after introduction of this prompt the number of clotting screen requests reduced by 7001, representing a 21% reduction when compared to the same 6 month period one year earlier. This represented a cost saving of over £98,000 without any increase in adverse incidents being reported related to bleeding complications. Read More
Acute Med 2017 ;16(3):104-106
DM, MRCP. Senior Clinical Lecturer, Bangor University, School of Medical Sciences, Bangor, UK.
The Society for Acute Medicine's Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Read More
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
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
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
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
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
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