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Bad NEWS: standing still is risky for patients admitted to hospital (even with normal vital signs) 坏消息:对于入院的病人来说，站着不动是有风险的(即使生命体征正常)。
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0944
Christian P Subbe
{"title":"Bad NEWS: standing still is risky for patients admitted to hospital (even with normal vital signs)","authors":"Christian P Subbe","doi":"10.52964/amja.0944","DOIUrl":"https://doi.org/10.52964/amja.0944","url":null,"abstract":"Acute Physicians care for acutely unwell patients. Recognising and prioritising those at greatest risk of death is therefore at the heart of our specialty. The risk of catastrophic deterioration in the Acute Medical Unit is usually quantified through the measurement of vital signs. These are being summarised into the National Early Warning Score or similar instruments. Those with higher Early Warning Scores are usually prioritised by clinicians in and out of hospital and being seen before those with lower grades of abnormalities and preferably assessed by a more senior clinician.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807300","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
Acute Medicine: How will we grow? - An analysis of organisational capabilities for quality improvement, research & education from SAMBA 2021 急症医学:我们将如何成长?-质量改进、研究和amp的组织能力分析;SAMBA 2021的教育
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0947
Georgia Kate Galloway, Christian Peter Subbe, Mark Holland, Catherine Atkin
{"title":"Acute Medicine: How will we grow? - An analysis of organisational capabilities for quality improvement, research & education from SAMBA 2021","authors":"Georgia Kate Galloway, Christian Peter Subbe, Mark Holland, Catherine Atkin","doi":"10.52964/amja.0947","DOIUrl":"https://doi.org/10.52964/amja.0947","url":null,"abstract":"Background: Education, research, and Quality Improvement (QI) are key enablers for high quality care. We aimed to map the capability of Acute Medical Units (AMUs) to facilitate excellence in these areas. Methods: AMUs were surveyed in an organisational questionnaire within the Society for Acute Medicine Benchmarking Audit 2021. Results: 143 units participated. 80 units had a QI lead, 24 had a research lead and 99 had a medical education lead. 15 units had all three leadership roles. Most QI work considered service structure rather than changes in processes or care outcomes. Conclusion: The organisational capability of AMUs in the strategic areas considered is variable. Improving leadership and disseminating learning could help build a strategic foundation for acute medicine to grow.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807306","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
Nitrogen-Phosphorus-Potassium containing liquid fertilizer intoxication presenting with extreme hyperkalemia, metabolic acidosis and ECG changes 含氮磷钾液体肥料中毒，表现为极度高钾血症、代谢性酸中毒和心电图改变
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0952
Harm Rendering, Jan Westerink, Douwe Dekker, Dylan W De Lange, Karin AH Kaasjager
{"title":"Nitrogen-Phosphorus-Potassium containing liquid fertilizer intoxication presenting with extreme hyperkalemia, metabolic acidosis and ECG changes","authors":"Harm Rendering, Jan Westerink, Douwe Dekker, Dylan W De Lange, Karin AH Kaasjager","doi":"10.52964/amja.0952","DOIUrl":"https://doi.org/10.52964/amja.0952","url":null,"abstract":"Liquid fertilizers are widely used for fertilizing in- and outdoor vegetation. Despite the easy accessibility and widespread use, serious intoxications are rare. This case report describes a 61-year-old woman who was treated for life-threatening hyperkalemia, metabolic acidosis and ECG changes after intentional ingestion of liquid fertilizer. Our case shows that intake of liquid fertilizer, though infrequent, can cause serious, life threatening complications.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807298","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 admissions’ diagnoses and risk of in-hospital death according to the primary ICD-10 chapter assigned at discharge and the National Early Warning Score on admission 根据出院时指定的ICD-10初级章节和入院时的国家早期预警评分，急诊入院的诊断和院内死亡风险
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0945
Mark Holland, Alexander Dannatt, John Kellett, Darren Green
{"title":"Emergency admissions’ diagnoses and risk of in-hospital death according to the primary ICD-10 chapter assigned at discharge and the National Early Warning Score on admission","authors":"Mark Holland, Alexander Dannatt, John Kellett, Darren Green","doi":"10.52964/amja.0945","DOIUrl":"https://doi.org/10.52964/amja.0945","url":null,"abstract":"Background: The relationship between diagnosis, illness severity, and mortality risk for unselected emergency admissions is poorly defined. Aim: To define primary ICD-10 diagnostic chapters at discharge, admission illness severity by the National Early Warning Score, and in-hospital mortality for all unselected emergency admissions. Method: Retrospective, observational, cohort study of 122,259 unselected, adult emergency admissions to Salford Royal Hospital between 2014 and 2022. Results: In-hospital mortality was 4.3% but most patients had an ICD-10 chapter associated with a lower risk of death. 60% of in-hospital deaths were in four chapters, infections, circulatory and respiratory diseases, or neoplasms. An admission NEWS ≥3 was associated with earlier mortality and an eight-fold increased risk of in-hospital mortality. 45% of all in-hospital deaths occurred in patients with an admission NEWS <3. Conclusion: Mortality in emergency hospital admissions is associated with illness severity and four diagnostic chapters. NEWS should not be the only arbiter of hospital admission, as for certain diagnostic chapters the risk of death is high even if vital signs on presentation are normal.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807303","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
Becoming the medical registrar: a qualitative study of a professional transition as a transformative learning event 成为一名医疗注册员:一项定性研究，将专业过渡作为一种变革性的学习事件
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0949
Zachary Ferguson, Rebecca Selman
{"title":"Becoming the medical registrar: a qualitative study of a professional transition as a transformative learning event","authors":"Zachary Ferguson, Rebecca Selman","doi":"10.52964/amja.0949","DOIUrl":"https://doi.org/10.52964/amja.0949","url":null,"abstract":"Background: The medical registrar is a daunting role to take on for the first time. While studies have explored how preparedness can be improved through simulation, less has been written about how doctors learn to be registrars through clinical practice. Method: Doctors working as medical registrars were invited to participate in semi-structured interviews. The qualitative data collected underwent thematic analysis. Results: The clinical environment was considered fertile ground for transformative experiential learning, but opportunities for debriefing and guided reflection were rare. Participants felt they needed additional support from supervisors after difficult experiences and mistakes, but this support was not always forthcoming. Conclusion: Acute physicians involved in supervising new medical registrars must facilitate meaningful independent practice to encourage the next generation of medical generalists.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807307","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
Society for Acute Medicine’s Patients: Learning from Experience Report (SAM-PLER) A service evaluation of patient reported experience in Acute Medicine – establishing the feasibility of a quality improvement collaborative 急性医学患者学会:从经验报告中学习(SAM-PLER)对急性医学患者报告经验的服务评估-建立质量改进协作的可行性
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0948
Christian Peter Subbe, Catherine Atkin, Adnan Gebril, Latif Raiyan Rahman, Ragit Varia
{"title":"Society for Acute Medicine’s Patients: Learning from Experience Report (SAM-PLER) A service evaluation of patient reported experience in Acute Medicine – establishing the feasibility of a quality improvement collaborative","authors":"Christian Peter Subbe, Catherine Atkin, Adnan Gebril, Latif Raiyan Rahman, Ragit Varia","doi":"10.52964/amja.0948","DOIUrl":"https://doi.org/10.52964/amja.0948","url":null,"abstract":"Patient reported experience measures (PREMS) are a key part of measured quality. There is no tool currently used in the UK in Acute Medicine. On the 8th of September 2022 10 units based in England, Scotland and Wales collected data for the validated PREM, alongside the EQ-5D and variables from the Society for Acute Medicine’s Benchmarking Audit (SAMBA) dataset. 365 patients were screened, 200 were included (55%): 159 patients from AMUs and 41 from SDEC units. Overall experience of patients was rated 8.5/10, patients rated their experience of safety, trust and listening highly. Collection of PREMS was feasible. Further research is required to link experience to clinical outcome and explore tools that capture experience of patients with altered mental status.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807304","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
A whole healthcare system mortality review of the second wave COVID-19 pandemic response, were lessons learned? 对第二波COVID-19大流行应对的整个医疗系统死亡率进行审查，是否吸取了教训?
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0932
Jeremy W Tankel, David Ratcliffe, Martin Smith, Clare Hindley, Andrew Mullarkey, Dee Waterhouse, Andrea Riley, Darren Green
{"title":"A whole healthcare system mortality review of the second wave COVID-19 pandemic response, were lessons learned?","authors":"Jeremy W Tankel,&nbsp;David Ratcliffe,&nbsp;Martin Smith,&nbsp;Clare Hindley,&nbsp;Andrew Mullarkey,&nbsp;Dee Waterhouse,&nbsp;Andrea Riley,&nbsp;Darren Green","doi":"10.52964/AMJA.0932","DOIUrl":"https://doi.org/10.52964/AMJA.0932","url":null,"abstract":"<p><p>We previously reported a study of features of emergency healthcare response to COVID-19 that could be modified to mitigate against future excess deaths. Here we determined what themes persisted in later waves. This was an expert panel review of all components of care delivered to COVID-19 patients who died (primary and secondary care, community services, NHS 111 and 999, COVID oximetry at home, virtual wards). 174 deaths were included. 5% were deemed >50% avoidable, 75% included avoidability themes. Contact with primary care remains mostly via telephone, creating diagnostic risk. Patient decision to avoid healthcare contact was common. Recommendations include: better utilisation of home monitoring in future pandemics; improved avoidance of nosocomial spread; patients be encouraged to seek medical advice earlier.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9289134","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
Quantitative assessment of the relative effects of patient and pulmonary embolism-related factors on longer-term mortality after pulmonary embolism. 定量评估患者和肺栓塞相关因素对肺栓塞后长期死亡率的相对影响。
Acute Medicine Pub Date : 2023-01-01
I Le Jeune, R Hubbard
{"title":"Quantitative assessment of the relative effects of patient and pulmonary embolism-related factors on longer-term mortality after pulmonary embolism.","authors":"I Le Jeune, R Hubbard","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This observational study used a large audit dataset to examine the relative effects of patient-related factors and those related to the pulmonary embolism (PE) on longer-term mortality after PE. We identified that longer-term mortality is higher in provoked compared to unprovoked PE and that, in this group, obesity is relatively protective. Simplified PE severity index (sPESI), known to link to short term mortality, remains predictive in the longer-term and there is no relationship of mortality to right heart strain or extent of clot. Interestingly mortality is higher in those with negative CTPA scans than those with PE. These clinically important results should encourage careful, holistic clinical assessment of patients in these groups prior to discharge to look for treatable comorbidities.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"188-194"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571618","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
Wilson's disease - a tricky diagnosis on the acute take. 威尔逊氏病——急性发作时的疑难诊断。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0941
J Baker, S Chakraborty, R Buccoliero, S Thakur
{"title":"Wilson's disease - a tricky diagnosis on the acute take.","authors":"J Baker,&nbsp;S Chakraborty,&nbsp;R Buccoliero,&nbsp;S Thakur","doi":"10.52964/AMJA.0941","DOIUrl":"https://doi.org/10.52964/AMJA.0941","url":null,"abstract":"<p><p>Wilson's disease is a rare genetic disorder that affects copper metabolism in the body, leading to excess copper accumulation in various organs, including the liver and brain. It often presents to both primary and secondary care, with a combination of liver disease and neurological or psychiatric symptoms, but the presentation can be highly variable. Early recognition and treatment of Wilson's disease is important to prevent critical hepatic and neurological complications. In this case report, we describe the presentation of an 18-year-old male university student with a combination of dysphagia, tremors, and slurred speech, which progressed over several months. Through a series of investigations, the patient was diagnosed with Wilson's disease and received appropriate treatment. This report highlights the importance of considering Wilson's disease in patients with a wide range of symptoms and the need for a pragmatic approach to diagnosis, including routine and additional testing as necessary.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"96-100"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9621789","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
Real-world characteristics and outcomes of patients with intermediate high risk acute pulmonary embolism. 中高危急性肺栓塞患者的真实世界特征和预后。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0936
Ajc Overgaauw, L J Meijboom, J van Es, E J Lust, E H Serne, Pwb Nanayakkara, Y M Smulders, A J Kooter, R W Sprengers, H J de Grooth, R J Lely, A Thijs, A Vonk Noordegraaf, Lma Heunks, Pwg Elbers, H J Bogaard, P R Tuinman, E J Nossent
{"title":"Real-world characteristics and outcomes of patients with intermediate high risk acute pulmonary embolism.","authors":"Ajc Overgaauw,&nbsp;L J Meijboom,&nbsp;J van Es,&nbsp;E J Lust,&nbsp;E H Serne,&nbsp;Pwb Nanayakkara,&nbsp;Y M Smulders,&nbsp;A J Kooter,&nbsp;R W Sprengers,&nbsp;H J de Grooth,&nbsp;R J Lely,&nbsp;A Thijs,&nbsp;A Vonk Noordegraaf,&nbsp;Lma Heunks,&nbsp;Pwg Elbers,&nbsp;H J Bogaard,&nbsp;P R Tuinman,&nbsp;E J Nossent","doi":"10.52964/AMJA.0936","DOIUrl":"https://doi.org/10.52964/AMJA.0936","url":null,"abstract":"<p><strong>Background: </strong>Exact benefits of currently recommended close monitoring in intermediate high risk acute pulmonary embolism (PE) patients are unknown.</p><p><strong>Methods: </strong>This prospective observational cohort study determined clinical characteristics, and disease course of intermediate high risk acute PE patients in an academic hospital setting . Frequency of hemodynamic deterioration, use of rescue reperfusion therapy and PE related mortality, were outcomes of interest.</p><p><strong>Results: </strong>Of 98 intermediate high risk PE patients included for analysis, 81 patients (83%) were closely monitored. Two deteriorated hemodynamically and were treated with rescue reperfusion therapy. One patient survived after this.</p><p><strong>Conclusions: </strong>In these 98 intermediate high risk PE patients, hemodynamic deterioration occurred in three patients and rescue reperfusion therapy of two closely monitored patients led to survival of one. Underlining the need for better recognition of patients benefitting from and research in the optimal way of close monitoring.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"61-66"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9621787","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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