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The 'Unwell' clinical presentation- an opportunity for admission avoidance? “不适”的临床表现-逃避入院的机会?
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0887
R. Conway, D. Byrne, D. O'Riordan, B. Silke
{"title":"The 'Unwell' clinical presentation- an opportunity for admission avoidance?","authors":"R. Conway, D. Byrne, D. O'Riordan, B. Silke","doi":"10.52964/AMJA.0887","DOIUrl":"https://doi.org/10.52964/AMJA.0887","url":null,"abstract":"BACKGROUND\u0000An 'unwell' patient is a common presentation.\u0000\u0000\u0000METHODS\u0000We studied all ED 'unwell' admissions over 6 years, assessing factors influencing mortality with logistic regression.\u0000\u0000\u0000RESULTS\u0000From 49,965 admissions, the ED diagnosis was 'unwell' in 3650 (7.3%). 'Unwell' presentations were older and had longer length of stay. Mortality was not different 4.2% vs 4.6 % (p=0.28). Respiratory patients and those >=70 years had increased mortality, 8.3% (95%CI: 5.9%, 10.6%) and 7.1% (5.7%, 8.4%) respectively. Being unwell predicted a better outcome - univariate OR 0.35 (95%CI: 0.24, 0.52), multivariable OR 0.68 (95%CI: 0.44, 1.03).\u0000\u0000\u0000CONCLUSION\u0000A diagnosis of 'unwell' applied to a heterogenous group; clinical trajectories and outcomes were sufficiently different to preclude targeted admission avoidance as a strategy.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"12-18"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49199336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Can we improve patients' physical activity levels after discharge by interventions on the Acute Medical Unit? The 'teachable moment'. 急症病房的干预措施能否提高病人出院后的身体活动水平?“受教时刻”。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0924
Jnf Murphy, I Le Jeune
{"title":"Can we improve patients' physical activity levels after discharge by interventions on the Acute Medical Unit? The 'teachable moment'.","authors":"Jnf Murphy,&nbsp;I Le Jeune","doi":"10.52964/AMJA.0924","DOIUrl":"https://doi.org/10.52964/AMJA.0924","url":null,"abstract":"<p><strong>Introduction: </strong>>30% of the population does less physical activity (PA) than recommended and few patients receive PA advice during a hospital admission (2,5). This study aimed to assess the feasibility of recruiting acute medical unit (AMU) in-patients and to examine the effect of delivering PA interventions to them.</p><p><strong>Methods: </strong>In-patients who were inactive (<150mins/wk) were randomised to either a motivational interview (Long Interview, LI) or brief advice (Short Interview, SI). Participants' physical activity levels were assessed at baseline and at two follow-up consultations.</p><p><strong>Results: </strong>77 participants were recruited. At 12 weeks 22/39(56.4%) participants were physically active following the LI and 15/38(39.5%) following the SI.</p><p><strong>Discussion: </strong>Recruitment and retention of patients on the AMU was straightforward. PA advice helped a high proportion of participants become physically active.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 4","pages":"196-202"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10760853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mind the bubbles - A patient presents with seizure after haemodialysis. 注意气泡——一个病人在血液透析后出现癫痫发作。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0916
Sdpm Yu, Jsk Lau
{"title":"Mind the bubbles - A patient presents with seizure after haemodialysis.","authors":"Sdpm Yu,&nbsp;Jsk Lau","doi":"10.52964/AMJA.0916","DOIUrl":"https://doi.org/10.52964/AMJA.0916","url":null,"abstract":"<p><p>A patient with patent ductus arteriosus presents with seizure after haemodialysis. Although conscious on arrival to the emergency department with spontaneous limb movement, he develops recurrent convulsion and left hemiparesis after admission. The approach to the haemodialysis patient presenting with seizure is discussed and the role of early hyperbaric oxygen therapy for an uncommon but important diagnosis is highlighted.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 3","pages":"150-152"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation. 肺部超声对疑似新冠肺炎的诊断准确性和预后价值的回顾性服务评估。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0895
F. Lesser, M. Dachsel, N. Smallwood
{"title":"The Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation.","authors":"F. Lesser, M. Dachsel, N. Smallwood","doi":"10.52964/AMJA.0895","DOIUrl":"https://doi.org/10.52964/AMJA.0895","url":null,"abstract":"We read with interest the paper from Knight et al in Acute Medicine1 in particular the use of a lung ultrasound (LUS) score to predict outcome in patients with suspected COVID-19. LUS has been shown to be useful in the diagnosis and prognosis for COVID-19 by other authors. We have carried out a service evaluation project on our data from East Surrey Hospital looking into prognostic and diagnostic performance of LUS in suspected COVID-19. In contrast to the data used by Knight et al we had discharge diagnosis data available which allowed us to split the cohort into patients with COVID-19 and patients with other diagnoses and compare the LUS score between the two groups.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"56-58"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45107042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Weak legs. 疲软的双腿。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0917
P Timmons, A Williamson, V Gibbs, A Torgersen
{"title":"Weak legs.","authors":"P Timmons,&nbsp;A Williamson,&nbsp;V Gibbs,&nbsp;A Torgersen","doi":"10.52964/AMJA.0917","DOIUrl":"https://doi.org/10.52964/AMJA.0917","url":null,"abstract":"<p><p>A 48 year old lady presented with a 7-week history of progressive generalised myalgia and muscle weakness resulting in recurrent falls. Her past medical history included bipolar affective disorder and a previous stroke. Her medications included clopidogrel 75mg, atorvastatin 80mg, and quetiapine 400mg twice daily.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 3","pages":"153-156"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
5-Oxoproline acidosis caused by acetaminophen and flucloxacillin treatment - a case report. 对乙酰氨基酚和氟氯西林治疗致5-氧脯氨酸酸中毒1例报告。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0892
P. van Montfort, F. Helmich, Gjm Mostard, D. van Twist
{"title":"5-Oxoproline acidosis caused by acetaminophen and flucloxacillin treatment - a case report.","authors":"P. van Montfort, F. Helmich, Gjm Mostard, D. van Twist","doi":"10.52964/AMJA.0892","DOIUrl":"https://doi.org/10.52964/AMJA.0892","url":null,"abstract":"High anion gap metabolic acidosis (HAGMA) is a common diagnosis in the emergency department, which requires a systematic work-up in order to identify and treat the underlying cause. We present an unusual case of HAGMA due to 5-oxoproline accumulation caused by prolonged treatment with both acetaminophen (paracetamol) and flucloxacillin. This paper describes the diagnostic work-up of HAGMA and emphasizes on the approach and initial treatment in case the underlying etiology is unclear.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"47-49"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49091044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Number, nature & impact of incoming telephone calls on residents and their work during evening shifts. 夜班期间来电的数量、性质及对住院医师及其工作的影响。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0886
Mark WL van Geffen, Koen M van der Waaij, Patricia M Stassen
{"title":"Number, nature & impact of incoming telephone calls on residents and their work during evening shifts.","authors":"Mark WL van Geffen, Koen M van der Waaij, Patricia M Stassen","doi":"10.52964/AMJA.0886","DOIUrl":"https://doi.org/10.52964/AMJA.0886","url":null,"abstract":"BACKGROUND\u0000Internal medicine residents are frequently interrupted by phone calls, which may compromise workflow, work quality and job satisfaction.\u0000\u0000\u0000AIM\u0000This study investigates the number, nature and impact of calls on residents and their work during evening shifts in the emergency department and ward.\u0000\u0000\u0000METHODS\u0000This prospective observational study compares measurements from direct observations with subjective data from questionnaires.\u0000\u0000\u0000RESULTS\u0000Residents received 26 resp. 30 (median) calls per shift in the emergency department and ward, with duration of 50 resp. 80 seconds. Residents perceived high burden and impact on quality of work and job satisfaction.\u0000\u0000\u0000DISCUSSION & CONCLUSION\u0000Frequent interruptions by phone calls were observed, which resulted in high burden. Our study raises the urgency for finding solutions and provides insights necessary for possible interventions.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71185041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Editorial - The NHS urgent and emergency care crisis: how much worse could it get? 社论 - 国家医疗服务体系的紧急护理危机：还能恶化到什么程度？
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0919
Tim Cooksley
{"title":"Editorial - The NHS urgent and emergency care crisis: how much worse could it get?","authors":"Tim Cooksley","doi":"10.52964/AMJA.0919","DOIUrl":"10.52964/AMJA.0919","url":null,"abstract":"<p><p>NHS urgent and emergency care is under intolerable strain. This strain is increasingly causing harm to patients. Timely and high-quality patient care is often not being delivered due to overcrowding driven by workforce and capacity constraints. This drives low staff morale perpetuating burn out and high absence levels which currently dominate. Whilst COVID19 has accentuated and arguably expedited the crisis; the spiral of decline in urgent and emergency care has been decade long and unless urgent action is taken, we may not yet have reached its nadir.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 4","pages":"166-167"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10760856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Guest Editorial - A personal journey in Acute Medicine. 客座社论-急性医学的个人旅程。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0885
D Bell
{"title":"Guest Editorial - A personal journey in Acute Medicine.","authors":"D Bell","doi":"10.52964/AMJA.0885","DOIUrl":"10.52964/AMJA.0885","url":null,"abstract":"<p><p>This article describes my personal journey through Acute Medicine from the late 1980's and incorporates the development of Acute Medical Units (AMU's), co-establishing the Society for Acute Medicine (SAM), as well as involvement in the development of training curricula, research and audit. I am deeply indebted to a great number of professional colleagues over the last three decades, who have been pivotal to the development of the Acute Medicine specialism, and many of whom in turn became presidents of SAM.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"2-4"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44617464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Valproate-Associated Hyperammonaemic Encephalopathy. 丙戊酸盐相关性高氨血症脑病。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0891
P. Anthonipillai, G. Sharp, J. Kimber, V. Ziauddin
{"title":"Valproate-Associated Hyperammonaemic Encephalopathy.","authors":"P. Anthonipillai, G. Sharp, J. Kimber, V. Ziauddin","doi":"10.52964/AMJA.0891","DOIUrl":"https://doi.org/10.52964/AMJA.0891","url":null,"abstract":"We present the case of a 55 year old who presented multiple times with altered conscious levels. He was often treated as being post-ictal, when in fact, he had Sodium Valproate induced hyperammonaemic encephalopathy. Sodium Valproate can frequently increase ammonia levels, and in some patient lead to hyperammonaemic encephalopathy.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"43-46"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42917938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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