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Acute Medicine

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https://www.readbyqxmd.com/read/28112293/a-fellowship-further-afield
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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