Acute Medicine最新文献_第3页

Embedding penicillin de-labelling in the AMU: a feasibility and safety pilot study with exploratory economic and environmental analysis. 在普通药品箱中嵌入青霉素去标签：一项具有探索性经济和环境分析的可行性和安全性试点研究。

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1017

Bernice Ng, Jonathan McGuigan, Kathryn Allen, Tara Brennan-Finucane, Oisín Toner, Aaron Brady, Philip Toner

{"title":"Embedding penicillin de-labelling in the AMU: a feasibility and safety pilot study with exploratory economic and environmental analysis.","authors":"Bernice Ng, Jonathan McGuigan, Kathryn Allen, Tara Brennan-Finucane, Oisín Toner, Aaron Brady, Philip Toner","doi":"10.52964/AMJA.1017","DOIUrl":"10.52964/AMJA.1017","url":null,"abstract":"Background: Penicillin allergy labels affect 6-10% of the UK population, yet over 95% are inaccurate. These labels drive unnecessary broad-spectrum antibiotic use, antimicrobial resistance, healthcare costs, adverse patient outcomes and carbon emissions.Methods: This pilot study embedded a penicillin allergy de-labelling (PADL) clinic within an Acute Medical Unit, using a direct oral amoxicillin challenge for patients identified as low-risk for a true allergy to penicillin according to BSACI guidelines and PEN-FAST scoring. Primary outcomes were feasibility and safety. Secondary outcome was subsequent antibiotic prescribing patterns. Exploratory outcomes included retrospective economic, antimicrobial resistance and environmental impact modelling.Results: Sixty patients (mean age 56 years) were included in the study, of whom 59 (98%) were successfully de-labelled with one delayed type IV reaction but no anaphylaxis. Following de-labelling, 35% received subsequent antibiotic therapy and all were prescribed penicillin-based therapy. Retrospective analysis revealed antibiotic costs were approximately tenfold higher (£19,364 versus £2,092) due to allergy labels. Multidrug-resistant organisms were present in 47% of patients and 37% received unnecessary intravenous antibiotics.Conclusion: This pilot suggests that AMUembedded penicillin delabelling is safe and feasible, and may be associated with important clinical, economic, antimicrobial stewardship and environmental benefits that warrant confirmation in larger studies.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"24 3","pages":"125-131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934112","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

Variability in Anticoagulation Duration and Follow-up for Deep Vein Thrombosis in Ambulatory Care. 在门诊治疗中，深静脉血栓的抗凝时间和随访的变异性。

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1023

Adam Darnley, Thomas Knight, Jecko Thachil

{"title":"Variability in Anticoagulation Duration and Follow-up for Deep Vein Thrombosis in Ambulatory Care.","authors":"Adam Darnley, Thomas Knight, Jecko Thachil","doi":"10.52964/AMJA.1023","DOIUrl":"10.52964/AMJA.1023","url":null,"abstract":"Background: Deep vein thrombosis (DVT) is commonly managed in ambulatory care. Guidelines recommend reassessment at three months to review anticoagulation duration, but no structured follow-up pathway exists within our Trust.Aim: To evaluate anticoagulation duration, follow-up practices, and outcomes in patients with DVT diagnosed in ambulatory care.Methods: Retrospective, observational service evaluation across two ambulatory care units in Manchester, UK. Patients with confirmed lower limb DVT were identified between January 2023 and June 2023. Data were collected from electronic patient records including complication rates over a 2-year period.Results: Of 307 patients assessed for suspected DVT, 90 had confirmed DVT. Most cases were unprovoked (77.8%). At discharge, 39% were prescribed 3 months' anticoagulation, 31% 6 months, 11% lifelong, 6% received a duration range of 3-6 months, and 13% had no specified duration. Discrepancies between recommendation at discharge and primary care prescribing were seen in 53%, with nearly half receiving longer treatment. 20% had secondary care follow-up. Recurrent DVT occurred in nine patients, none of whom had received follow-up; no recurrences were seen in the followed-up group, although this difference was not statistically significant (Fisher's exact test, p = 0.195). Bleeding events were seen in 4.4% of cases and were minor.Conclusions: There is substantial variability in anticoagulation management following DVT in ambulatory care. Although recurrence was not observed in the followed-up group, the study was not powered to detect differences, and this finding should be interpreted cautiously. Further work is needed to establish if a follow-up DVT clinic will improve patient outcomes.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"24 4","pages":"164-167"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473252","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

Development and Validation of a Comorbidity Index to Predict In-hospital Mortality Risk for Stevens-Johnson Syndrome. 预测Stevens-Johnson综合征住院死亡风险的合并症指数的发展和验证

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1011

Renxi Li

引用次数: 0

Lumbar puncture in patients with acute severe headache - Response to letter. 急性严重头痛患者腰椎穿刺-对字母的反应。

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1026

Sophie Voase, Jonathan Underwood, Elin Foden, Mae Upcott, Robert Stroud, Sian Thomas, Danja Schulenburg-Brand

引用次数: 0

Adjunctive Atorvastatin for Sepsis in the Acute Medical Unit: A Randomized Controlled Trial. 急性内科辅助阿托伐他汀治疗败血症：一项随机对照试验

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1004

Ch Adrees Rashid, Mohan Kumar H, Mandip Singh Bhatia, Atul Saroch, Navneet Sharma, Saurabh Chandrabhan Sharda

{"title":"Adjunctive Atorvastatin for Sepsis in the Acute Medical Unit: A Randomized Controlled Trial.","authors":"Ch Adrees Rashid, Mohan Kumar H, Mandip Singh Bhatia, Atul Saroch, Navneet Sharma, Saurabh Chandrabhan Sharda","doi":"10.52964/AMJA.1004","DOIUrl":"10.52964/AMJA.1004","url":null,"abstract":"Background: Sepsis, a devastating syndrome of organ dysfunction triggered by a dysregulated host response to infection, remains a leading cause of global mortality. Statins, renowned for lipid-lowering, also exhibit potent anti-inflammatory and endothelial-stabilizing properties, offering a theoretical advantage in the septic milieu. This study investigated whether adjunctive atorvastatin could improve survival and modulate key sepsis-related outcomes.Methods: In this open-label, randomized controlled trial conducted in the acute medical unit of a tertiary academic center, adult patients with sepsis (defined as suspected infection plus a SOFA score increment of ≥2) were allocated to receive either standard sepsis management plus daily oral atorvastatin 20mg or standard management alone for up to 28 days. The primary endpoint was 28-day all-cause mortality. Secondary endpoints included requirements for organ support, duration of hospitalization, and kinetic changes in C-reactive protein(CRP), procalcitonin(PCT), and lactate. Analysis adhered to intention-to-treat principles.Results: Sixty-eight patients were randomized(36 atorvastatin, 32 control). While 28-day mortality trended lower in the atorvastatin arm(36% vs. 56% in controls; Risk Difference -20%, 95% CI -45% to 5%), this difference did not achieve statistical significance(p=0.10). Similarly, no significant benefits were observed in organ support needs or hospital stay. Critically, atorvastatin administration led to a significant and more pronounced reduction in both procalcitonin (median change -8 vs 0 ng/ml, p=0.005) and lactate levels(median change -0.95 vs -0.62 mmol/l, p=0.048) by day 7.Conclusion: While adjunctive atorvastatin did not demonstrably reduce 28-day mortality in this sepsis cohort, its significant impact on attenuating procalcitonin and lactate levels suggests a beneficial modulation of underlying inflammatory and metabolic derangements.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"24 1","pages":"27-34"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309602","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

Improving Communication and Coordination in Medical Ward Rounds: A Quality Improvement Initiative in an Acute Teaching Hospital. 加强病房查房的沟通和协调：急症教学医院的质量改进举措。

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1005

Marie E Ward, Barry Kennedy, Sharon O'Hara, Susie O'Callaghan, Una Geary, Fiona Keogan, Declan Byrne, Bláthnaid Mealy, Ricardo Paco, Joe Deegan, Shadan Kahatab, Jennifer Sheerin, John Drought, Conor MacDonnchadha, Cormac Kennedy

{"title":"Improving Communication and Coordination in Medical Ward Rounds: A Quality Improvement Initiative in an Acute Teaching Hospital.","authors":"Marie E Ward, Barry Kennedy, Sharon O'Hara, Susie O'Callaghan, Una Geary, Fiona Keogan, Declan Byrne, Bláthnaid Mealy, Ricardo Paco, Joe Deegan, Shadan Kahatab, Jennifer Sheerin, John Drought, Conor MacDonnchadha, Cormac Kennedy","doi":"10.52964/AMJA.1005","DOIUrl":"https://doi.org/10.52964/AMJA.1005","url":null,"abstract":"Background: Medical ward rounds are essential to support care delivery, however a lack of multi-disciplinary team rounding may have a knock-on effect on care coordination and may lead to delayed discharges and increased length of stays.Methods: The aim of this study was to improve patient outcomes by improving communication and coordination surrounding medical ward rounds through bringing disciplines together during medical ward rounds or at post-round operational huddles. The primary outcome measure was to improve the number of patients discharged by noon.Results: At the end of the study there was no impact on our primary outcome measure. Efforts for improvement were redirected from the micro- to the meso- and macrosystem of the organisation.Conclusion: While developing this complex project, we found reforms at a macrosystem of how care is provided are needed including ward-based care. Reforms must balance system resilience and efficiency while ensuring 'slack' in the system to support communication, relationship building and coordination of care.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"24 1","pages":"35-48"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309548","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

Lumbar puncture in patients with acute severe headache. 急性剧烈头痛患者的腰椎穿刺。

Acute Medicine Pub Date : 2025-01-01 DOI: 10.52964/AMJA.1025

Chris Gyan, Monica Monaghan, Shiva Sreenivasan

引用次数: 0

Improving emergency department flow by introducing a simple time out moment (The TRAFFIC LIGHT study). 通过引入一个简单的暂停时刻来改善急诊科的流程（TRAFFIC LIGHT 研究）。

Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0966

Audrey Jc Overgaauw, Marijn Ligthart, Kaoutar Azilji, Tanca C Minderhoud, Jonne J Sikkens, Tessa H Biesheuvel, Prabath Wb Nanayakkara

{"title":"Improving emergency department flow by introducing a simple time out moment (The TRAFFIC LIGHT study).","authors":"Audrey Jc Overgaauw, Marijn Ligthart, Kaoutar Azilji, Tanca C Minderhoud, Jonne J Sikkens, Tessa H Biesheuvel, Prabath Wb Nanayakkara","doi":"10.52964/AMJA.0966","DOIUrl":"https://doi.org/10.52964/AMJA.0966","url":null,"abstract":"Background and importance: Long waiting times in the emergency department (ED) is an increasing problem in the recent years and is expected to become an even bigger problem in the future Objective: We aimed to test the hypothesis whether increasing awareness of the time lapse with the treating physician, 2 hours after patient arrival, can reduce long patient turnaround time (TAT).Method: In this prospective single-center cohort study we compared and analyzed patient TAT in the ED before and after implementation of a so called 'traffic light' moment 2 hours after patient arrival. At this 'traffic light' moment a team member contacted the treating physician to increased awareness over the time lapse. Difference in percentage of patients who stayed more than 4 hours in the ED before and after intervention was the primary outcome Results: Between October 2nd 2021 and January 2nd,2022 1494 patients were included for primary outcome analysis. A total of 419 patients (n=740, 56.6%) had a TAT of less than 4 hour in the ED before intervention, compared to 497 (n=754, 65.9%) after intervention (p <0.001). Median time spent in de ED before intervention was 3:40 (IQR 2:24 - 5:04) compared to 3:15 (IQR 2:03 - 4:38) after intervention (p<0.001).Conclusion: This simple and low-cost intervention reduces the ED length of stay significantly. Although multiple interventions will be required to ensure less patients spending more than 4-hours in the ED, a 'traffic light' moment can be a simple and an effective tool.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 1","pages":"4-10"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866825","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

Balancing acute medical management of acute kidney injury and hyperkalaemia versus medicines optimisation for long-term Cardio-Renal-Metabolic (CaReMe) diseases: a narrative review. 平衡急性肾损伤和高钾血症的急性药物治疗与长期心肾代谢疾病（CaReMe）的药物优化：叙述性综述。

Acute Medicine Pub Date : 2024-01-01

Benjamin David James, Mark Holland, Darren Green

引用次数: 0

Point of Care Ultrasound Bladder Volume Calculation on the Acute Medical Unit. 急诊科护理点超声膀胱容量计算。

Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0970

Joseph Nunan, Tom Lister, Harriet Howgill, Mia Marie Merced Parreno, Guy Brown, Andrew Walden

引用次数: 0