602 results match your criteria Acute medicine[Journal]


Response to Letter to the editor: Acute Medicine Journal.

Acute Med 2020 ;19(1):57

Trainee representative to AIM Specialty Advisory Committee.

Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care. Read More

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January 2020

Letter to the editor: Acute Medicine Journal.

Authors:
Adam Williamson

Acute Med 2020 ;19(1):56

Specialist Registrar in Acute and General Medicine West of Scotland Deanery.

Editor- I note with interest that the Joint Royal College of Physicians Training Board curriculum for Acute Internal Medicine (AIM) has been reviewed and circulated for comment and consideration of implementation in August 2022. The proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It aims to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with comorbidities and recognise when specialty input is require in a variety of settings, including ambulatory and critical care. Read More

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January 2020

An unusual suspect for heart failure.

Acute Med 2020 ;19(1):52-55

Department of Cardiology, The Alfred Hospital, Australia.

Constrictive pericarditis though an uncommon diagnosis is a potentially reversible form of heart failure (with surgical pericardiectomy) and hence is imperative to diagnose. Diagnosis is dependent on a high index of clinical suspicion and further testing with appropriate cardiac investigations including cardiac imaging with invasive cardiac catheterisation as the gold standard. Read More

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January 2020

Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain.

Acute Med 2020 ;19(1):49-51

MD, MEd Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain. Read More

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January 2020

Ambulatory drainage and management of a pleural empyema.

Acute Med 2020 ;19(1):43-48

MBBS, Acute Medicine Staff Grade, Northumbria HealthCare NHS, Foundation Trust, Northumbria Specialist Emergency Care Hospital, Northumbria Way, Northumberland, Cramlington.

A 61 year old male presented to chest clinic with a lung abscess. This ruptured and resulted in an empyema that required a small bore chest drain. Pus started bypassing the drain, spilling out subcutaneously. Read More

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January 2020

An unusual suspect for heart failure.

Acute Med 2020 ;19(1):42

Department of Cardiology, The Alfred Hospital, Australia.

A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. Read More

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January 2020

Overview of acute renal manifestations in cancer patients.

Acute Med 2020 ;19(1):34-41

PhD, FRCP, Department of Renal Medicine, Norfolk and Norwich University Hospital, Norwich, UK.

Acute kidney injury is frequently encountered in patients with malignancy and is associated with prolonged hospitalization, significant morbidity, and increased mortality. Thorough evaluation is required to identify possible contributing factors, which may range from relatively easily reversible pre-renal causes to complex cancer-specific aetiologies. This review will serve as a practical guide for acute care physicians on the acute medical unit to the assessment and initial management of cancer patients presenting with acute kidney injury. Read More

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January 2020

Patient and Caregiver Experience of Hospital Discharge from an Acute Medicine Unit via the Discharge Lounge: A Qualitative Case Study.

Acute Med 2020 ;19(1):26-33

Professor of Nursing Room RG 24 Ramsden Building, School of Human and Health Sciences, The University of Huddersfield, Queensgate, Huddersfield, HD1 3DH.

Discharge lounges enable the swift movement of patients imminently awaiting hospital discharge, to free beds without delay. This Qualitative Yin-Style Case Study describes the patient and caregivers experience of transition from an Acute Medicine Unit (AMU) to a discharge lounge and staff perspectives, as organisers of this process. Audiorecorded, interviews and focus groups were undertaken. Read More

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January 2020

Can the examination time in CT and conventional x-ray be reduced in an emergency department with integrated radiology unit? A retrospective study.

Acute Med 2020 ;19(1):21-25

Research and Innovation Unit of Radiology, University of Southern Denmark Faculty of Health Sciences, Oslo Metropolitan University, Norway.

Quick radiological diagnosis is often needed in order to allow the clinicians to make a diagnosis. The purpose of this study was to measure examination time for radiology procedures before and after physical integration of a radiology unit in the ED. We retrospectively acquired data from the radiology information system and compared time from referral to end of radiological examination before and after physical integration of the radiology unit in the ED for 19,897 X-ray and 6,940 CT examinations. Read More

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January 2020

Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission.

Acute Med 2020 ;19(1):15-20

Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting.

Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared.

Results: The bias of 15 seconds of observations was 1. Read More

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January 2020

Clinical Reliability of point-of-care tests to support community based acute ambulatory care.

Acute Med 2020 ;19(1):4-14

MA MBBS (Hons) MD FRCP Edin MRCGP, Nuffield Department of Medicine, Oxford University, Oxford, UK.

Objective: To ensure clinicians can rely on point-of-care testing results, we assessed agreement between point-of-care tests for creatinine, urea, sodium, potassium, calcium, Hb, INR, CRP and subsequent corresponding laboratory tests.

Participants: Community-dwelling adults referred to a community-based acute ambulatory care unit.

Interventions: The Abbott i-STATTM (Hb, clinical chemistry, INR) and the AfinionTM Analyser (CRP) and corresponding laboratory analyses. Read More

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January 2020

Editorial - "Eternal Winter": Acute Medicine the key to providing longer periods of summer.

Authors:
Tim Cooksley

Acute Med 2020 ;19(1):2-3

Editor-in-Chief, Consultant in Acute Medicine, Manchester University Foundation Trust and The Christie.

As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the "front door" safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders. Read More

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January 2020

Non-Cardiac Chest Pain.

Acute Med 2019 ;18(4):260

FRCP, Consultant acute physicians, Northwick Park Hospital.

We read with interest "Non-Cardiac Chest Pain: Management in the Ambulatory Clinic setting" (Acute Med 2019;18(3)165-70). It is useful to know about the various musculoskeletal causes of chest pain, especially where specific treatment may be available. Read More

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February 2020

MR-Brain Causing Confusion.

Acute Med 2019 ;18(4):259

Department of Acute Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, UK.

This is a T2 weighted image (T2WI). In T2WI compartments filled with fluid appear brighter (as is the case of the CSF in the lateral ventricles). On the contrary, tissues with a high fat content appear as dark. Read More

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February 2020

Non traumatic spinal epidural haematoma.

Authors:
N A Khalid N Shah

Acute Med 2019 ;18(4):255-258

MBBS, MD, MRCP, FRCP, Consultant Physician and Geriatrician University hospitals of Leicester NHS trust, Leicester Royal Infirmary.

Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Read More

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February 2020

Purple Urine Bag Syndrome in a Patient with an Ileal Conduit and Clostridium Difficile Infection.

Acute Med 2019 ;18(4):251-254

FRCP, Consultant in Acute Internal Medicine & Clinical Lead, Acute Medicine Unit, Royal Free Hospital, Pond Street, London, NW3 2QG.

Purple urine bag syndrome is a potentially alarming phenomenon caused by bacterial metabolism of urinary tryptophan into indigo (blue) and indirubin (red) pigments. We report the case of a 46-year-old female with an ileal conduit who presented with a 2 week history of abdominal pain and purple discolouration of her urine. In addition, we review the literature on purple urine bag syndrome, and identify potential new risk factors and management considerations. Read More

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February 2020

Spontaneous Thyroid Haemorrhage: A Cause of Upper Airway Obstruction.

Acute Med 2019 ;18(4):248-250

(MB, BCH, BAO, MRCS (Edinburgh), Master in Otorhinolaryngology, Head and Neck Surgery), Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Background: Spontaneous thyroid haemorrhage is a very rare condition that is potentially life-threatening. We report an unusual case of spontaneous thyroid haemorrhage leading to airway compromise requiring urgent intervention. We highlight key clinical findings and management steps with comparison to similar cases in the literature. Read More

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February 2020

MR-Brain Causing Confusion.

Acute Med 2019 ;18(4):247

Department of Acute Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, UK.

An 82-year-old lady was found on the floor of her home, confused and surrounded by vomitus. She had a past medical history of type II diabetes, hypothyroidism, previous left total hip replacement, and previous hip fracture treated with right dynamic screw fixation. Prior to the current presentation she had been living alone, mobilizing independently with a walking stick and self-caring for her activities of daily living. Read More

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February 2020

The Use of Lung Ultrasound in Acute Medicine.

Acute Med 2019 ;18(4):239-246

MBBS MSc(Medical Ultrasound) FRCS(Ed) FRCEM(UK) FRCP(Ed) CFEU, Consultant in Emergency Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK Visiting Professor and MSc Point-of-Care Ultrasound Lead, University of Teesside, Middlesbrough, UK.

POCUS (Point of Care Ultrasound) refers to ultrasound performed by clinicians as part of their initial patient evaluation, often with the aim of answering a specific question as opposed to being a comprehensive assessment. Such ultrasound is noninvasive, involves no radiation and can be rapidly performed at the bedside. It is also widely practiced in emergency and intensive care medicine leading to earlier and more accurate diagnoses for a wide range of presentations such as shock, renal failure and dyspnoea. Read More

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February 2020

Higher In-Hospital Mortality in Patients with Nonspecific Complaints Presenting to the Emergency Department.

Acute Med 2019 ;18(4):232-238

Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven, the Netherlands.

Background: Nonspecific complaints (NSC) at the Emergency Department (ED) are not well researched yet.

Objective: To investigate the number of patients who could be classified as having NSC early after arrival in the ED using an algorithm.

Method: Retrospective cohort study was conducted among all hemodynamically stable non-trauma adult patients with MTS category orange/yellow visiting the ED. Read More

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February 2020

Described Practices for Assessing Fluid Resuscitation in Acute Hospital Care: A Qualitative Study.

Acute Med 2019 ;18(4):223-231

MBChB, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.

Fluid resuscitation is a widely-used treatment in acute and emergency medicine, however, the process used to perform a fluid assessment has never been studied. This qualitative study explored how acute physicians describe their approach to assessing for fluid resuscitation. 18 clinicians of varying grades consented to a semi-structured interview. Read More

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February 2020

Using trends in electronic recordings of vital signs to identify patients stable for transfer from acute hospitals.

Acute Med 2019 ;18(4):216-222

Clinical Studies & Research Consultant Perpet Production, Kolumbusstr. 29, 70439 Stuttgart, Germany.

Patients who are stable might not be required to remain in hospital. We aimed to create objective criteria to indicate stability based on vital signs. An index based on NEWS (NBI) was compared to a Patient Stability Index (PSI) algorithm created by random forest analysis. Read More

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February 2020

Identifying avoidable switchboard delays in England's NHS hospitals: phase one of the national SWITCH project.

Acute Med 2019 ;18(4):210-215

The Royal London Hospital (Barts Health NHS trust), Whitechapel Rd, Whitechapel, London E1 1FR.

Background: Inter-hospital communication frequently requires mediation via a switchboard. Identifying and eliminating switchboard inefficiencies may improve patient care.

Methods: All 175 acute hospital switchboards in England were contacted six times. Read More

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February 2020

Which patients should be monitored, how should they be monitored, and why should they be monitored?

Authors:
J Kellett

Acute Med 2019 ;18(4):208-209

Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.

Intensively monitoring severely ill patients is like placing a smoke alarm in a burning building: it makes no sense. Smoke alarms only makes sense if they are placed in buildings before a fire starts, or after a fire has been extinguished in order to make sure it does not start again. Therefore, logic suggests that it is more important to monitor sick patients with normal vital signs in order to detect any deterioration as early as possible, or AFTER a severe illness in order to ensure they do not relapse, and it is safe for them to be discharged from hospital and return home. Read More

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February 2020

Editorial - Decision-making in acute medicine.

Authors:
Ben Lovell

Acute Med 2019 ;18(4):206-207

Associate Editor, Consultant in Acute Medicine, University College London Hospitals.

Acute physicians make patient-centred decisions at the start of the patient's hospital journey. Dozens more decisions are made by the individual members of the MDT (and, of course, by the patient) during the in-patient period. Decisions are made at every level of seniority and experience and range widely in scope and impact. Read More

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February 2020

Pardon My French.

Authors:
George Kimpton

Acute Med 2019 ;18(3):200

Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund.

Cama et al's review of pneumothorax management was excellent, especially their elegant depiction of chest tube diameter in comparison to the intercostal space, as measured in French gauge. The use of gauge is medicine is confusing due to differing systems and seemingly random increments. This diagram neatly shows that French gauge (Fr) is directly proportional to diameter, as the external diameter of the tube in millimetres is the gauge multiplied by three. Read More

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November 2019
1 Read

Life threatening pembrolizumabinduced myositis in a patient treated for advanced adenocarcinoma of the lung.

Acute Med 2019 ;18(3):197-199

Department of Oncology, North Middlesex University Hospital, London.

The advent of immunotherapy in oncology has led to the emergence of a new spectrum of adverse effects. A number of these have the potential to contribute to life-threatening outcomes; and therefore require prompt identification and aggressive treatment to optimise management. In this report, we describe a case of pembrolizumab-induced CTCAE (common toxicity criteria for adverse events) grade 4 myositis in a non-small cell lung cancer patient. Read More

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November 2019
4 Reads

Delayed onset of liver injury after intentional chloroform overdose: a case report and literature review.

Acute Med 2019 ;18(3):192-196

Acute Medical Unit, York Teaching Hospitals NHS Foundation Trust.

Chloroform is a recognised cause of acute liver injury, although now rarely encountered in clinical practice. We present a case of inhalational chloroform self-poisoning in a 47-year-old man that presented to hospital initially with reduced conscious level and later developed acute liver injury that was treated with intravenous acetylcysteine. This paper reviews the existing literature and presents a summary of the mechanisms of chloroform hepatotoxicity. Read More

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November 2019
5 Reads

Diabetic ketoacidosis, a common disease with life-threatening pitfalls.

Acute Med 2019 ;18(3):189-191

Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 15 rue de l'école de Méédecine, 75006 Paris,France.

Diabetic ketoacidosis (DKA) is a common cause for admission in Emergency Department. Its treatment is well defined. Nevertheless, in some cases, type I diabetes combines with auto-immune polyendocrine syndrome, which can carry life-threatening consequences. Read More

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November 2019
1 Read

An acute presentation of haemophagocytic lymphohistiocytosis due to visceral leishmaniasis in a British adult returning traveller.

Acute Med 2019 ;18(3):184-188

BSc MBBS Portsmouth Hospitals NHS Trust.

A 62-year old British Caucasian woman normally resident in Spain presented with fever and pancytopaenia after returning to the UK. Her symptoms persisted despite broad-spectrum antibiotics, and she gradually became confused, hypotensive and progressively more pancytopaenic. Imaging demonstrated hepatosplenomegaly, and a bone marrow aspirate confirmed a diagnosis of haemophagocytic lymphohistiocytosis (HLH). Read More

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November 2019
3 Reads

Prediction models for mortality in adult patients visiting the Emergency Department: a systematic review.

Acute Med 2019 ;18(3):171-183

Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.

We provide a systematic overview of literature on prediction models for mortality in the Emergency Department (ED). We searched various databases for observational studies in the ED or similar setting describing prediction models for short-term mortality (up to 30 days or in-hospital mortality) in a non-trauma population. We used the CHARMS-checklist for quality assessment. Read More

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November 2019
1 Read

Non-Cardiac Chest Pain: management in the Ambulatory Clinic setting.

Acute Med 2019 ;18(3):165-170

London Lupus and Rheumatology Centre, London, United Kingdom.

Non-cardiac chest pain (NCCP) is a common presenting complaint which can be better managed. This requires the recognition of clinical sub-groups with investigation and treatment tailored accordingly. The aim of this paper is to encourage more accurate diagnoses and the better recognition of the source of chest pain. Read More

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November 2019

Reduced kidney function at presentation in unselected acute emergency medical admissions: incidence, outcome and associated factors.

Acute Med 2019 ;18(3):158-164

Nuffield Department of Clinical Medicine, University of Oxford, Henry Wellcome Building, Roosevelt Drive, Oxford, OX3 7BN, UK.

We sought to assess the impact of renal impairment on acute medical admissions and to identify potential contributory factors to admissions involving renal impairment at presentation. In a prospective cohort study, 29.5% of all acute medical emergency admissions had an eGFR <60ml/min/1. Read More

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November 2019
1 Read

The appropriateness of current UK training in acute internal medicine.

Acute Med 2019 ;18(3):148-157

UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, Hampstead, London NW3 2PF.

Doctors training in Acute Internal Medicine (AIM) need to provide evidence that they can effectively manage 20 'top' and 40 'other important' acute medical presentations. However, the presentations considered important in the AIM curriculum do not have an empirical evidence base. This study compared real-life presentations against those in the AIM curriculum. Read More

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November 2019

How well are heart rates measured by pulse oximeters and electronic sphygmomanometers? Practice-based evidence from an observational study of acutely ill medical patients during hospital admission.

Acute Med 2019 ;18(3):144-147

Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.

Background: heart rates generated by pulse oximeters and electronic sphygmomanometers in acutely ill patients may not be the same as those recorded by ECG.

Methods: heart rates recorded by an oximeter and an electronic sphygmomanometer were compared with electrocardiogram (ECG) heart rates measured on acutely ill medical patients.

Results: 1010 ECGs were performed on 217 patients while they were in the hospital. Read More

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November 2019

Fever increases heart rate and respiratory rate; a prospective observational study of acutely admitted medical patients.

Acute Med 2019 ;18(3):141-143

Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark.

Background: The relationship between increase in body temperature, heart rate, and respiratory rate has only been studied in young, healthy subjects.

Aim: To show the changes in heart and respiratory rate associated with fever in acutely admitted medical patients.

Design: A prospective observational cohort study. Read More

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November 2019

Altered kidney function on the Acute Medical Unit.

Authors:
Darren Green

Acute Med 2019 ;18(3):138-140

Acute Medicine, Salford Royal NHS Foundation Trust, Division of Cardiovascular Sciences, University of Manchester.

Reduced kidney function, whether acute or chronic, is a highly significant biomarker of in most clinical settings. This is particularly true on the acute medical take where altered renal function is associated with a worse prognosis, and may also impact on immediate management strategies such as drug choice, dosing and suspension, and the use of contrast agents for imaging. In this edition of the Acute Medical Journal, Yang et al present the results of their study describing the renal function and associated characteristics in 2,070 consecutive patients presenting on the unselected medical take at their hospital over a 40 day period. Read More

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November 2019
1 Read

Shortness of breath: a common symptom with a rare cause.

Authors:
S Ghosh

Acute Med 2019 ;18(2):127-131

MBBS, Clinical Fellow, Medicine Tameside General Hospital.

A 51-year old Caucasian male was admitted to the hospital with a history of breathlessness of one month duration. Prior to this he had been well. He complained that the shortness of breath had worsened over the previous 10 days and was associated with fatigue and fever. Read More

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August 2019
8 Reads

Dealer's Dytonia (Croupier's Cramp) - An Unusual Hazard Of Gambling.

Acute Med 2019 ;18(2):124-126

University College London.

Dystonia takes many forms and often presents acutely to emergency care. The diagnosis is often delayed because it mimics other more common conditions. This report describes a patient with a rare occupational dystonia, the typical clinical features of dystonia in general, and differentials to consider. Read More

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August 2019
3 Reads

Malignant renal obstruction without dilatation.

Acute Med 2019 ;18(2):121-123

MRCP, Consultant Nephrologist, University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom.

A 61 year old male presented with a one-week history of abdominal pain and loose stools. He had recently received treatment for cellulitis with flucloxacillin. He was anuric on presentation requiring haemodialysis. Read More

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August 2019
4 Reads

A Chest X-Ray causing confusion.

Authors:
T Novak C Strait

Acute Med 2019 ;18(2):120

MRCP Consultant in Acute Medicine Great Western Hospital Swindon Severn Deanery.

A 91-year old female presented to Acute Medical Unit with a 2 week history of shortness of breath and haemoptysis. Her past medical history included osteoporosis, depression, irritable bowel syndrome, asthma, cataracts, and a colonic polypectomy. Her medications: Citalopram 10 mg, Co-codamol, Beclomethasone 200 mcg inhaler, Salbutamol MDI inhaler, Omeprazole 20 mg and Alendronic acid. Read More

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August 2019
2 Reads

Acute management of cellulitis: A review.

Acute Med 2019 ;18(2):112-119

Cellulitis is an acute localised skin infection, usually accompanied by symptoms such as fever and rigors, nausea, and vomiting. It most commonly affects the lower limbs, although it can involve any part of the skin. It presents as area of redness and inflammation of the skin, with associated pain and swelling. Read More

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August 2019
6 Reads

Struggling with the last breath: breathlessness at the end of life on the AMU.

Authors:
M Lander J Martin

Acute Med 2019 ;18(2):105-111

MRCGP FRCP FHEA Consultant in Palliative Medicine Central and North West London NHS Foundation Trust National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust.

Breathlessness is one of the most common symptoms experienced at the end of life, affecting all areas of a patient's life. It is frightening and leads to high rates of emergency hospital attendances. Often, there is no easily reversible cause and patients are admitted to the acute medical unit (AMU) in order to manage their symptoms with little overall benefit - frustrating patients and clinicians alike. Read More

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August 2019
18 Reads

Management of Acute Admissions of Heart Failure Patients with Kidney Disease.

Acute Med 2019 ;18(2):96-104

Renal and Transplantation Unit, St Georges University Hospital NHS Foundation Trust.

Acute heart failure (HF) admissions are common. They are often associated with prolonged hospitalisations and poor outcomes. One-third of chronic HF patients also suffer from chronic kidney disease (CKD). Read More

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August 2019
22 Reads

Are vital sign abnormalities associated with poor outcomes after emergency department discharge?

Acute Med 2019 ;18(2):88-95

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

To examine association between vital sign abnormalities in the emergency department (ED) and early death after ED discharge, we performed a matched case-control study. Conditional logistic regression showed that presence of any vital sign abnormality at ED discharge was significantly associated with over three-fold increase in likelihood of death within 15 days of ED discharge (OR: 3.06, 95%CI: 2. Read More

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August 2019
4 Reads

SAMBA18 Report - A National Audit of Acute Medical Care in the UK.

Acute Med 2019 ;18(2):76-87

Consultant in Acute Medicine, Salford Royal Hospital, UK.

SAMBA18 took place on Thursday 28th June 2018 with follow up data at 7 days. Acute medical teams from 127 Acute Medical Units (AMUs) across the UK collected data relating to operational performance, clinical quality indicators and standards from NHS Improvement. Data was collected from 6114 patients. Read More

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August 2019
2 Reads

Feasibility of measuring psychological resilience in hospitalized patients with acute illness: The Resilience After the Trauma of Acute Illness (RAFT) study.

Acute Med 2019 ;18(2):71-75

DM, MRCP, Consultant Acute, Respiratory & Critical Care Medicine, Ysbtyty Gwynedd, Penrhosgarnedd, Bangor and Senior Clinical Lecturer, School of Medical Sciences, Bangor University.

Resilience is the 'ability to bounce back'. We want to investigate whether measurement of resilience during an acute hospital admission is feasible. We conducted a feasibility study. Read More

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August 2019
7 Reads

Socio-Economic Status and MultiOriginal morbidity - Fact or Fiction?

Acute Med 2019 ;18(2):64-70

Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.

Background: Areas of low socio-economic status (SES) have a disproportionate number of emergency medical admissions; we quantitate the profile of multi-morbidity related to SES.

Methods: We developed a logistic multiple variable regression model, based on over 15 years of hospital data, to examine the effect of socio-demography on hospital outcomes.

Results: Admissions from low SES cohort were a decade younger, and had a shorter hospital stay, and lower 30-day episode mortality outcome. Read More

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August 2019
3 Reads

Death after Discharge - Every heart beat counts (probably)!

Authors:
C P Subbe

Acute Med 2019 ;18(2):62-63

The assumption would be that patients who are discharged from an emergency or acute medicine department have been thoroughly assessed and are good to return to the safety of their own home. An unplanned death after discharge from hospital is the worst-case scenario for patients, families and indeed clinicians. In order to prevent adverse events after patients leave hospital most units have a multi-layered system to capture risk that includes triage, recording of vital signs, basic blood tests, understanding of existing past medical history and assessment by a senior clinician to add experience and intuition. Read More

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August 2019
3 Reads

Medicine vs Motherhood.

Authors:
Caroline Lebus

Acute Med 2018;17(3):169

Acute medicine consultant, Addenbrooke's Hospital Hills Road, Cambridge, CB2 0QQ.

I'm sitting at my desk, trying to concentrate. On anything. It's impossible. Read More

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December 2018
9 Reads