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    Is the Acute Internal Medicine (AIM) curriculum, for higher specialty training (HST), fit for purpose?
    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

    The current state of Acute Medicine training.
    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

    Dissecting the Diagnosis - An Unusual Case of Pericarditis.
    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

    Euglycaemic DKA secondary to Canaglifozin, an easily missed diagnosis.
    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

    Painful lymphadenopathy due to silicone breast implant rupture following extensive global air travel.
    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

    Medical High Dependency Unit series, Article 4: Tracheostomy management.
    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

    Using a Delphi study approach to develop competencies for Allied Health Professionals working in Acute Medicine.
    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 Medical Ward for better care coordination of patients admitted with infection - evidence from a tertiary hospital in Singapore.
    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

    Long-term health related quality of life in patients with sepsis after intensive care stay: A systematic review.
    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

    Characteristics and outcome of acute medical admissions with hyponatremia: even mild hyponatremia is associated with higher mortality.
    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

    Not just a simple sore throat.
    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

    Third cranial nerve palsy: an unusual manifestation of Mycoplasma pneumoniae.
    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

    Disseminated intravascular coagulation in an under-recognised zoonotic infection.
    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

    Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU.
    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

    Research Protocol: Intravenous Access during Resuscitation: the IVAR trial.
    Acute Med 2017 ;16(3):111-114
    MD, PhD.
    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

    Electronic Prompts Can Reduce The Number Of Unnecessary Clotting Screens Ordered For Patients.
    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

    Measuring impact of telephone triage in Acute Medicine.
    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

    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

    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
    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

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