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    491 results match your criteria Acute medicine[Journal]

    1 OF 10

    Oxford specialist handbooks in neurology: Stroke Medicine.
    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

    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

    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
    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

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