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Acute Medicine

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https://www.readbyqxmd.com/read/27759753/improving-acute-care-for-adolescents-and-young-adults-on-medical-admission-units-the-interventions-that-matter
#1
C A Whicher, R Shah, H Gleeson, L Vaughan, L Albon
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. We all knew I'd be back again within a month or two.
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759752/pneumomediastinum-as-a-complication-of-mdma-3-4-methylenedioxymetamfetamine-ecstasy-ingestion
#2
Suleiman Ezoubi, Hassan Kahal, William Stephen Waring
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. We recommend enquiring about illicit drug use in any patient presenting with spontaneous pneumomediastinum.
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759751/fever-delirium-and-incontinence-not-always-a-uti
#3
Emily McNicholas, Ahmed H Abdelhafiz
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. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759750/pheochromocytoma-presenting-as-a-mimic-of-acute-coronary-syndrome
#4
Yasmin Hakim, Anna Forbes, Momina Khan, Benjamin C Whitelaw
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. He was subsequently investigated for fever and found to have a 3cm right sided adrenal mass consistent with a pheochromocytoma. After confirmation and appropriate blockade laparoscopic adrenalectomy was performed...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759749/acute-generalised-exanthematous-pustulosis-agep-a-potential-pitfall-for-the-acute-physician
#5
T A Cranga, M A Simpson, P Featherstone
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. A patient with AGEP, who presented with generalized pustulosis lesions after the use of Flucloxacillin for cellulitis is described, along with the management and differential diagnosis of this condition...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759748/frailsafe-from-conception-to-national-breakthrough-collaborative
#6
Natalie Offord, Zoe Wyrko, Tom Downes, Adrian Hopper, Paul Harriman, Adam L Gordon
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...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759747/the-diagnostic-yield-of-ctpa-pulmonary-embolism-alternative-diagnoses-and-incidental-findings
#7
Shoaib Faruqi, Nalla Kishore, Richard Bodington, Salim Meghjee, Muthu Thirumaran
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. RESULTS: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759746/the-relationship-between-social-deprivation-and-a-weekend-emergency-medical-admission
#8
Richard Conway, Sean Cournane, Declan Byrne, Deirdre O'Riordan, Seamus Coveney, Bernard Silke
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. RESULTS: There were 30,794 weekend admissions in 16,665 patients...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759745/can-we-predict-acute-medical-readmissions-using-the-boost-tool-a-retrospective-case-note-review
#9
Geraldine A Lee, Daniel Freedman, Penelope Beddoes, Emily Lyness, Imogen Nixon, Vivek Srivastava
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. BOOST assessment was applied with 1 point for each risk factor. RESULTS: 324 patients were readmitted (mean age 77 years) with a median of 7 days between discharge and readmission...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759744/variation-in-acute-medicine-units-measuring-it-understanding-it-and-reducing-it
#10
Daniel J Beckett, Elaine Thomson, Lindsay Em Reid, Robert C Lloyd
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. This demonstrated that improving consultant continuity of care was associated with a reduction in AMULOS and reduced variation in AMULOS...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441313/providing-a-navigable-route-for-acute-medicine-nurses-to-advance-their-practice-a-framework-of-ascending-levels-of-practice
#11
Liz Lees-Deutsch, Jan Christian, Ian Setchfield
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. The current context of NHS efficiencies and recruitment issues emphasize the value of retaining tacit knowledge...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441312/acute-internal-medicine-trainee-survey-2016
#12
N Smallwood, S Krishnamoorthy
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. A total of 108 trainees responded. RESULTS: There were respondents from across the United Kingdom...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441311/an-unusual-pathogen-in-ambulatory-care-two-cases-of-scedosporium-soft-tissue-infections-presenting-as-unresponsive-cellulitis
#13
Gary Peter Misselbrook, Patrick Lillie, Claire P Thomas
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. We present two cases of Scedosporium presenting to the AMU as cellulitis not responding to initial antibiotic therapy and outline the assessment and management of this important condition...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441310/hiv-lessons-from-a-late-diagnosis
#14
Xin Hui S Chan, Barbara L Onen, Mansoor M Raza, Dushyant Mital, R William Smith
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...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441309/neurocysticercosis-presenting-as-a-stroke-mimic
#15
Reza Ghasemi, Aimee Rowe, Rajiv Shah, Pradhib Venkatesan, Timothy J England
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. The patient made almost a complete recovery after treatment with albendazole, praziquantel and steroids. Neurocysticercosis should be considered in the diffierential diagnosis when patients originating from endemic areas present with focal neurological deficit...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441308/unscheduled-care-admissions-at-end-of-life-what-are-the-patient-characteristics
#16
Emma Mason, Debbie Jenkins, Meg Williams, James Davies
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. The aim of our study was to explore the characteristics amongst patients who die shortly after unscheduled hospital admission...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441307/repeat-duplex-ultrasound-scanning-in-suspected-deep-vein-thrombosis-dvt-putting-the-onus-back-on-the-referring-clinician
#17
Bryan Renton, S Thiru, C P Griffin
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. Introduction of an electronic message to the report, placing the onus back on the referring clinician to arrange repeat scan if deemed appropriate resulted in a fall in the number of scans being undertaken without impacting on patient outcome...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441306/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital
#18
Elizabeth Janette Hamilton, Alistair Quentin Green, Jennifer Ann Cook, Henry Nash
This was a retrospective review of five years' data relating to patients referred to the Acute Medical Unit (AMU) of a large teaching hospital with suspected Pulmonary Embolism (PE) during pregnancy or 6 weeks postpartum. During this period, 210 patients in this group underwent half-dose perfusion scanning as investigation for possible PE and were managed via our ambulatory pathway. Pulmonary embolism was diagnosed in 5.2% of patients compared to 18% of non-pregnant patients identified in a previous audit. Half-dose Q scanning enabled exclusion of PE in almost 90% of patients without the need for further imaging...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27441305/tracking-the-take-using-patient-flow-data-to-improve-amu-performance-and-safety
#19
L Powter, T Brougham, C Gillett
AIMS: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimise working patterns to improve waiting times. METHOD: An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27116586/when-is-a-stroke-not-a-stroke-an-unusual-mimic-presenting-to-amu
#20
Shyamal Patel, Nicholas Smallwood, Hyacinth-John Abu, Youssif Abousleiman
INTRODUCTION: Creutzfeldt-Jakob disease (CJD) is a rare prion disease classically manifesting with rapidly progressive dementia, abnormal movements and typical electroencephalographic (EEG) changes. CASE REPORT: A 74 year-old Caucasian man was recently discharged from another centre diagnosed with a stroke. He re-presented to our acute medical unit with worsening symptoms, and stroke remained the working diagnosis. Collateral history revealed a progressive cognitive decline and unilateral myoclonus...
2016: Acute Medicine
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