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Acute Medicine

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https://www.readbyqxmd.com/read/28424805/cruising-through-the-journey-without-getting-drowned-the-saga-of-a-phd-student-in-the-netherlands
#1
Louise van Galen, Joyce Wachelder
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. Worldwide, huge numbers of professionals are pursuing a PhD, with the aim of receiving a 'Doctor'-title. These PhD trajectories vary distinctly between countries. Since the distances in the scientific world are getting smaller and it is becoming more easy to work with each other across borders, it might be interesting to know what it requires to become an academic 'doctor' overseas...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424804/acute-medicine-finishing-school-preparing-for-the-next-step
#2
Tehmeena Khan, Nicholas Murch
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...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424803/use-of-a-flumazenil-infusion-to-treat-chlordiazepoxide-toxicity
#3
I R Wallace, E C Campbell, M Trimble
"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. Chlordiazepoxide is metabolised in the hepatic microsomal pathway and hepatic impairment can lead to accumulation of toxic metabolites, which may have been the explanation for toxicity in this case...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424802/evolving-sepsis-definitions-and-their-impact-on-acute-medical-units
#4
A Thompson, M Stevens, I Collin, N Wennike
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. RESULTS: The NICE criteria identified 69% of admissions as requiring review within one hour, compared to 6% with qSOFA and 18% with previous sepsis definitions...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424801/problem-based-review-immune-mediated-complications-of-checkpoint-inhibitors-for-the-acute-physician
#5
Philip Webb, Terry W Rice, Tim Cooksley
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. The timing of onset of the adverse effects is dependent on the organ system affected and can occur after completion of the treatment. The increasing utilisation of 'checkpoint-inhibitors' means that Acute Physicians are likely to see a number of immune-mediated complications presenting to the AMU...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424800/progressing-care-in-the-medical-high-dependency-unit-unit-configurations-staffing-standards-and-daily-routine
#6
Christopher John Wright, Russell Allan
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).
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424799/role-of-psychological-resilience-on-health-outcomes-in-hospitalized-patients-with-acute-illness-a-scoping-review
#7
Elen Marged Bradley-Roberts, Christian P Subbe
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. We used emergency care, intensive care, critical care and trauma as surrogates for acute illness. We mapped synonyms for resilience and selected 'resilience' and 'robustness'. The search was limited to adult patients admitted to hospitals. We found strong evidence for psychological sequelae of acute illness but no research focusing specifically on the concepts of resilience or robustness and no interventional studies in the acute hospital setting...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28424798/hospital-readmissions-independent-predictors-of-30-day-readmissions-derived-from-a-10-year-database
#8
Rachel Kidney, Eithne Sexton, Louise Van Galen, Bernard Silke, Prabath Nanayakkara, John Kellett
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...
2017: Acute Medicine
https://www.readbyqxmd.com/read/28112293/a-fellowship-further-afield
#9
T Khan
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.
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112292/national-training-numbers-in-aim-in-the-uk
#10
M Jones
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.
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112291/the-challenges-of-conducting-research-on-the-acute-medical-unit
#11
Thomas O'Dell, Anjali Zalin, Louella Vaughan
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...
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112290/an-unusual-case-of-acute-muscle-weakness
#12
Suzanne R Harrogate, Edouard Mills, Asjid Qureshi, Jacob F de Wolff
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). Anti-thyroid therapy and beta-blockers were commenced and his neurological symptomatology resolved as he became progressively euthyroid...
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112289/coke-live-recurrent-vasculitis-secondary-to-cocaine-contaminated-with-levamisole
#13
Vicki Sandys, Shanti Mahabir, Declan Byrne, Bairbre Wynne
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...
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112288/focused-acute-medicine-ultrasound-famus-point-of-care-ultrasound-for-the-acute-medical-unit
#14
Nicholas Smallwood, Martin Dachsel, Ramprasad Matsa, Eugene Tabiowo, Andrew Walden
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...
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112287/improving-acute-care-for-older-people-at-scale-the-acute-frailty-network
#15
Simon Conroy, Deborah Thompson, Simon Griffiths, Matthew Tite, Jennifer Guest, Amanda Rumley-Buss, Lisa Smith, Paula Burge, Jack Hawkins, John Gladman
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. In this article we describe the CGA approach, underpinned by specific examples illustrating some of the key competencies required, and describe the role of the Acute Frailty Network (AFN)...
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112286/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
#16
Nadia Alam, Peter M van de Ven, Erick Oskam, Patricia Stassen, Mark Hh Kramer, Pieternel van Exter, Prabath Wb Nanayakkara
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. Emergency medical services (EMS) personnel have already made a significant difference in improving care for patients with acute coronary syndrome, multiple trauma and stroke. Patients with severe sepsis or septic shock could also benefit from timely prehospital care...
2016: Acute Medicine
https://www.readbyqxmd.com/read/28112285/epidemiology-recognition-and-documentation-of-sepsis-in-the-pre-hospital-setting-and-associated-clinical-outcomes-a-prospective-multicenter-study
#17
Nadia Alam, Kirtiedevi Bns Doerga, Tahira Hussain, Sadia Hussain, Frits Holleman, Mark Hh Kramer, Prabath Wb Nanayakkara
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...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27759753/improving-acute-care-for-adolescents-and-young-adults-on-medical-admission-units-the-interventions-that-matter
#18
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
#19
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
#20
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
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