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Incidence, predictors and outcomes associated with acute pulmonary embolism in patients hospitalized with pneumonia: Insights from the National Inpatient Sample. 肺炎住院患者急性肺栓塞的发病率、预测因素和预后：来自全国住院患者样本的见解
Acute Medicine Pub Date : 2024-01-01
Chun Shing Kwok, Adnan I Qureshi, Yanshan Lin, Fanna Liu, Eric Holroyd, Gregory Y H Lip, Anteo Bradaric, Josip A Borovac
{"title":"Incidence, predictors and outcomes associated with acute pulmonary embolism in patients hospitalized with pneumonia: Insights from the National Inpatient Sample.","authors":"Chun Shing Kwok, Adnan I Qureshi, Yanshan Lin, Fanna Liu, Eric Holroyd, Gregory Y H Lip, Anteo Bradaric, Josip A Borovac","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of acute pulmonary embolism (PE) among patients hospitalized with pneumonia and its association with adverse outcomes remain uncertain.</p><p><strong>Methods: </strong>Data from the US National Inpatient Sample between 2016 to 2020 was used to determine the proportion of patients with chief diagnosis of pneumonia that had concomitant PE and to examine the relationship between PE and in-hospital outcomes such as mortality, mechanical ventilation, thrombolysis, length of stay (LoS), and inpatient costs.</p><p><strong>Results: </strong>A total of 13,956,485 patients with a diagnosis of pneumonia were included and 2.6% had a concomitant diagnosis of PE. The median LoS for patients with PE was 7 days, compared to 5 days for those without PE. The median hospitalization cost was higher for patients with a diagnosis of PE compared to those without PE ($16,917 vs. $10,656). The strongest factors associated with a diagnosis of PE were other venous thromboembolism (Odds Ratio (OR) 11.65, 95%CI 11.42-11.88, p<0.001), arterial thrombosis (OR 2.64, 95%CI 2.40-2.89, p<0.001), previous venous thromboembolism (OR 1.72, 95%CI 1.68-1.77, p<0.001), cardiac arrest (OR 1.69, 95%CI 1.62-1.77, p<0.001) and cancer (OR 1.45, 95%CI 1.42-1.48, p<0.001). Co-diagnosis of PE was associated with greater in-hospital mortality (OR 1.50, 95%CI 1.46-1.54), mechanical ventilation (OR 1.12, 95%CI 1.10-1.15), thrombolysis use (OR 6.69, 95%CI 6.31-7.09), and major bleeding (OR 1.48, 95%CI 1.39-1.57).</p><p><strong>Conclusions: </strong>A diagnosis of PE occurs in 2.6% of patients hospitalized with a principal diagnosis of pneumonia. Having concomitant PE was associated with greater risks of in-hospital mortality, increased use of mechanical ventilation and thrombolysis, extended hospital stay, and higher inpatient costs.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"181-190"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721816","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
Implementing a Digital Deteriorating Patient Pathway to improve the safety and effectiveness of care of the adult deteriorating patient. 实施 "数字化病情恶化患者路径"，提高对病情恶化的成年患者的护理安全性和有效性。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0968
Adrian Jennings, Philip Brammer, Sian Annakin, Helen Bromage, Tom Cook, Michele Hickey, Jagjit Dhami, Fhezan Ashraf, Ravi Sahota-Thandi, Stephen Borrington
{"title":"Implementing a Digital Deteriorating Patient Pathway to improve the safety and effectiveness of care of the adult deteriorating patient.","authors":"Adrian Jennings, Philip Brammer, Sian Annakin, Helen Bromage, Tom Cook, Michele Hickey, Jagjit Dhami, Fhezan Ashraf, Ravi Sahota-Thandi, Stephen Borrington","doi":"10.52964/AMJA.0968","DOIUrl":"https://doi.org/10.52964/AMJA.0968","url":null,"abstract":"<p><p>Identification, escalation and clinical review of the deteriorating patient is essential for a safe and effective hospital. We present a deteriorating patient pathway developed within our electronic patient record, including implementation of a digital escalation and senior review process, triggered from a logic algorithm and vital signs. The pathway is activated by an average 43 patients per day with median mortality of 13.3%. Our Trust has seen a significant improvement in escalation and senior review and increased use of treatment escalation plans. The pathway has facilitated a cultural shift in the Trust towards the deteriorating patient. The new pathway is transferrable to both other digital Trusts as well as maternity and paediatric practice.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 1","pages":"18-23"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869488","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
Evaluating dynamic patterns in mortality before and after reconfiguration of the Danish emergency healthcare system. 评估丹麦急诊医疗系统重组前后死亡率的动态模式。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0967
Marianne Fløjstrup, Anna Kollerup, Søren B Bogh, Mickael Bech, Daniel Henriksen, Søren P Johnsen, Mikkel Brabrand
{"title":"Evaluating dynamic patterns in mortality before and after reconfiguration of the Danish emergency healthcare system.","authors":"Marianne Fløjstrup, Anna Kollerup, Søren B Bogh, Mickael Bech, Daniel Henriksen, Søren P Johnsen, Mikkel Brabrand","doi":"10.52964/AMJA.0967","DOIUrl":"https://doi.org/10.52964/AMJA.0967","url":null,"abstract":"<p><strong>Background: </strong>This study explored changes in short-term mortality during a national reconfiguration of emergency care starting in 2007.</p><p><strong>Methods: </strong>Unplanned hospital contacts at emergency departments across Denmark from 2007 to 2016. The reconfiguration was a natural experiment, resulting in individual timelines for each hospital. The outcome was in-hospital and 30-day mortality.</p><p><strong>Results: </strong>Individual patient-level data included 9,745,603 unplanned hospital contacts from 2007 to 2016 at 20 hospitals with emergency departments. We observed a sharp downwards shift in in-hospital mortality and 30-day mortality in three hospitals in relation to the reconfiguration.</p><p><strong>Conclusion: </strong>This nationwide study identified three hospitals where the reconfiguration was closely associated with reduced in-hospital and 30-day mortality. In contrast, no major effects were identified for the remaining hospitals.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 1","pages":"11-17"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866783","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
Emergency physicians' experiences with defensive medicine and their motives for acting defensively - an interview study. 急诊医生的防御性医疗经验及其采取防御性行动的动机--访谈研究。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0988
Thorbjørn Hougaard Mikkelsen, Mikkel Brabrand, Anne Friesgaard Christensen, Merethe Kousgaard Andersen
{"title":"Emergency physicians' experiences with defensive medicine and their motives for acting defensively - an interview study.","authors":"Thorbjørn Hougaard Mikkelsen, Mikkel Brabrand, Anne Friesgaard Christensen, Merethe Kousgaard Andersen","doi":"10.52964/AMJA.0988","DOIUrl":"https://doi.org/10.52964/AMJA.0988","url":null,"abstract":"<p><strong>Background: </strong>Defensive medicine (DM) has been increasingly studied in recent years. This study aims to investigate the understanding of DM and the motives for practicing DM among emergency physicians.</p><p><strong>Methods: </strong>Focus group interviews.</p><p><strong>Results: </strong>Themes identified: The understanding of DM, DM is a matter of self-confidence, DM or tests to ensure diagnosis and patient flow, DM due to confounding by availability, DM due to guidelines, Patient-initiated DM, Fear of complaints, DM in an emergency department setting.</p><p><strong>Conclusion: </strong>This study shows that emergency physicians perform an abundance of diagnostic tests and investigations but only categorize few of them as DM. The many flow-mediating tests based on guidelines may, however, mask activities that individual physicians would possibly find defensive, if it was up to them to decide based on pure and simple anamnesis and clinical findings. It might be argued that flow optimization has overruled medical clinical reasoning in some ways, thereby introducing an inclination to conduct DM.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 3","pages":"132-139"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606660","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 - Ambulatory Care: Turning Urgent and Emergency Care inside out. 特邀社论--非住院医疗：将急诊和急救护理翻转过来。
Acute Medicine Pub Date : 2024-01-01
Rosalind Rowland, Daniel Lasserson
{"title":"Guest Editorial - Ambulatory Care: Turning Urgent and Emergency Care inside out.","authors":"Rosalind Rowland, Daniel Lasserson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Emergency departments are under year-round pressure, driven by high hospital bed occupancy and compounded by increasing attendances and admissions. In 2023, 1.5 million people waited 12 hours or more for a bed. Long waits are associated with increased mortality and there is a disproportionate impact on people living in more deprived areas. Addressing this problem begins with unity of purpose and vision, such that we all view emergency department performance as our responsibility, whatever our place in the healthcare system.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 2","pages":"54-55"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917698","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
Editorial - Acute Medical Care: "Exit block". 社论--急诊护理："退出障碍"。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0965
T Cooksley
{"title":"Editorial - Acute Medical Care: \"Exit block\".","authors":"T Cooksley","doi":"10.52964/AMJA.0965","DOIUrl":"10.52964/AMJA.0965","url":null,"abstract":"<p><p>NHS urgent and emergency care (UEC) remains under immense and unsustainable pressure. This is increasingly causing harm to patients and emotional trauma to the staff striving to deliver basic standards of care.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 1","pages":"2-3"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856181","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
An Unusual Cause of Acute Hyponatraemia. 急性低钠血症的一个不寻常原因。
Acute Medicine Pub Date : 2024-01-01
C Gyan, O Cox, C Roseveare
{"title":"An Unusual Cause of Acute Hyponatraemia.","authors":"C Gyan, O Cox, C Roseveare","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present the case of an 81 year old man, admitted with ataxia and hyponatraemia. Biochemical analysis was suggestive of Syndrome of Inappropriate ADH (SiADH) which was initially attributed to a recent respiratory infection or treatment with omeprazole. Neurological symptoms worsened despite normalisation of sodium levels and further examination revealed generalised areflexia; subsequent investigation by the Regional Neurology team led to a diagnosis of Guillan Barre syndrome, and symptoms improved following treatment with Intravenous Immunoglobulin and prolonged in-patient rehabilitation. Guillan Barre syndrome is a recognised cause of SiADH and this case highlights the importance of considering this diagnosis along with full neurological examination when patients with hyponatraemia present with neurological symptoms.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"200-202"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721803","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
Patients cared for in the Corridor of a large hospital in the United Kingdom: Sick, elderly, and sad. 在英国一家大医院的走廊里照顾的病人：病人、老人和悲伤的人。
Acute Medicine Pub Date : 2024-01-01
E Barnes, N Ndlovu, L Knowles, V Price, C Subbe
{"title":"Patients cared for in the Corridor of a large hospital in the United Kingdom: Sick, elderly, and sad.","authors":"E Barnes, N Ndlovu, L Knowles, V Price, C Subbe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Care of patients in corridors of emergency departments is being normalised in many hospitals across the United Kingdom. Clinicians within Emergency Medicine and Acute Medicine have been discussing the impact of this care on patients, as well as the 'morale injury' on the staff looking after them. Whilst the authors of this paper have seen evidence of harm caused by delays of care to patients facing long waits in the emergency department, we believe that this is the first analysis that describes the case mix in a large UK hospital. Care in corridors affected patients with a broad range of conditions; 16% had a NEWS of 5 or more, 67% were elderly patients with markers of frailty, and 42% had a history of mental health problems or substance abuse.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"172-175"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721819","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
Taking medicines as prescribed (Picture Quiz). 遵医嘱服药（图片测验）。
Acute Medicine Pub Date : 2024-01-01
Abdulrahman Al-Mohammad, Dafydd Davies, Sally Hamour
{"title":"Taking medicines as prescribed (Picture Quiz).","authors":"Abdulrahman Al-Mohammad, Dafydd Davies, Sally Hamour","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A man in his 50s with a history of end-stage kidney disease on haemodialysis and chronic mental health issues underwent thoracoabdominal CT to characterise a prolonged lower respiratory tract infection. A single metallic density foreign object was noted within the lower oesophagus. (Figure 1).</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"206"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721828","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
Thyrotoxic Periodic Paralysis: A Case Report with Patient Perspective. 甲亢性周期性麻痹：带患者视角的病例报告
Acute Medicine Pub Date : 2024-01-01
Aliaksandra Baranskaya, Yimeng Zhang, Brian Lee
{"title":"Thyrotoxic Periodic Paralysis: A Case Report with Patient Perspective.","authors":"Aliaksandra Baranskaya, Yimeng Zhang, Brian Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present a case report on a spot diagnosis of Thyrotoxic Periodic Paralysis (TPP) with a unique first-person account of events from the patient. It illustrates the importance of pattern recognition and exemplifies how timely treatment enables quick resolution of a life-threatening medical emergency. Patient X's account affirms the condition's insidious onset and rapid deterioration. This case highlights the need for raising awareness of diseases that are more prevalent in specific ethnic groups and is particularly crucial for work in culturally diverse environments. We hope by sharing our experience, readers will be prompted to consider TPP as a differential diagnosis for acute limb weakness in an acute setting; with prompt testing of thyroid function and initiation of the appropriate treatments.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 2","pages":"91-94"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917614","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
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