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Acute Medicine: How will we grow? - An analysis of organisational capabilities for quality improvement, research & education from SAMBA 2021. 急性医学：我们将如何成长SAMBA 2021对质量改进、研究和教育的组织能力的分析。
Acute Medicine Pub Date : 2023-01-01
G K Galloway, C P Subbe, M Holland, C Atkin
{"title":"Acute Medicine: How will we grow? - An analysis of organisational capabilities for quality improvement, research & education from SAMBA 2021.","authors":"G K Galloway,&nbsp;C P Subbe,&nbsp;M Holland,&nbsp;C Atkin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>AMUs were surveyed in an organisational questionnaire within the Society for Acute Medicine Benchmarking Audit 2021.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"130-136"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159822","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 retrospective observational study investigating safety netting documentation in the emergency department. 调查急诊科安全网文件的回顾性观察研究。
Acute Medicine Pub Date : 2023-01-01
C H Wood, R Whiticar
{"title":"A retrospective observational study investigating safety netting documentation in the emergency department.","authors":"C H Wood, R Whiticar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Safety netting is an important aspect of medical practice, especially for first contact clinicians. Adequate safety netting provision and documentation is vital for optimal patient care and medicolegal security. This is the first study to report safety netting documentation practices in the emergency department, a specialty with a variety of high-acuity presentations and which is particularly vulnerable to medicolegal issues.</p><p><strong>Methods: </strong>A retrospective observational study was conducted at University Hospital Wales (UHW) Emergency Department (ED) in the months January-February and August 2023. Randomized paper notes review was performed for adult patients who were discharged from the ED without admission to hospital. Patient characteristics, time of consultation, grade of emergency medicine practitioner (EMP) and presence/level of safety netting documentation was recorded. The statistical software STATA was used to identify any associations between these factors on safety netting practices.</p><p><strong>Results: </strong>A total of 500 notes were included. Safety netting advice was documented in 45% of consultations (n=224). This was 'basic' in 166 cases, 'general' in 32, 'specific' in 15 and both 'general and specific' in 11. Frequency of safety netting documentation was higher for ages < 65 years and consultations within working hours (09:00 - 17:00).</p><p><strong>Conclusion: </strong>This study shows that there is no 'universal' level of safety netting documentation amongst practicing EMPs. Although there is well-established guidance about when, what and how safety netting should be provided, there is little guidance in terms of documentation details. Further audit and quality improvement to embed safety netting documentation in ED clerking is required to further improve safety netting practices.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"195-200"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571598","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
Centralization of emergency hospital care is not associated with increased in-hospital mortality; a population-based cohort study. 医院紧急护理的集中化与院内死亡率的增加无关;一项基于人群的队列研究。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0928
Søren Bie Bogh, Jonathan Harbak, Marianne Fløjstrup, Lars Morsø, Mikkel Brabrand, Mickael Bech
{"title":"Centralization of emergency hospital care is not associated with increased in-hospital mortality; a population-based cohort study.","authors":"Søren Bie Bogh,&nbsp;Jonathan Harbak,&nbsp;Marianne Fløjstrup,&nbsp;Lars Morsø,&nbsp;Mikkel Brabrand,&nbsp;Mickael Bech","doi":"10.52964/AMJA.0928","DOIUrl":"https://doi.org/10.52964/AMJA.0928","url":null,"abstract":"<p><strong>Background: </strong>We describe changes in the distance travelled, the utilization of emergency services, and the inhospital mortality before and after the centralization of hospital emergency services in Denmark.</p><p><strong>Methods: </strong>All unplanned non-psychiatric hospital contacts from adults (aged ≥18 years) in 2008 and 2016 are included. Analyses are age-standardized and conducted at a municipality level. The municipalities are divided into groups according to the presence of emergency hospital services.</p><p><strong>Results: </strong>Municipalities where hospitals with emergency services have been closed differed by having the most significant increase in distance travelled from 2008 to 2016. All groups experienced a reduction in overall in-hospital mortality. The reduction in mortality was not present for acute myocardial infarct contacts from municipalities where hospitals with emergency services have been closed.</p><p><strong>Conclusion: </strong>Our data do not suggest that hospital closures, and thereby increased travel distance, have contributed significantly as a barrier to emergency-care access and changes to in-hospital mortality.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"4-11"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9289140","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 COVID-19 pandemic has not affected the mortality for patients admitted with pneumonia in Denmark. COVID-19大流行并未影响丹麦入院的肺炎患者的死亡率。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0934
Mikkel Brabrand, Christian B Laursen, Marianne Fløjstrup, Søren Bie Bogh
{"title":"The COVID-19 pandemic has not affected the mortality for patients admitted with pneumonia in Denmark.","authors":"Mikkel Brabrand,&nbsp;Christian B Laursen,&nbsp;Marianne Fløjstrup,&nbsp;Søren Bie Bogh","doi":"10.52964/AMJA.0934","DOIUrl":"https://doi.org/10.52964/AMJA.0934","url":null,"abstract":"<p><p>During the COVID-19 pandemic, several hospital systems observed a reduction in patients with respiratory complaints. Using the Danish national registers, we conducted an observational study on disease severity and 30-day all-cause mortality for acutely admitted pneumonia patients before (3/19-3/20) and during (3/20-2/21) the pandemic. We calculated mortality rate ratios and Cox regression analyses. We identified 54,405 patients and during the pandemic, patients were older, more likely to be male, had more co-morbidity and a lower albumin on admission. Crude mortality was higher during the pandemic (8.4 vs. 6.9%). Adjusted hazard ratio for 30-day all-cause mortality was 1.07 (95%CI 1.01-1.14). We showed a small but significant, increase in mortality risk for patients admitted to hospital during the COVID-19 pandemic in Denmark.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"50-52"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9289141","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
Use of procedural ultrasound for the insertion of peripheral intravenous catheters: A nationwide survey in acute care departments in Belgium. 使用程序超声置入外周静脉导管:在比利时急症护理部门的一项全国性调查。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0931
Florence Dupriez, Cedric Smets, Hannelore Raemen, Marie Van Laer, Martin Hachez
{"title":"Use of procedural ultrasound for the insertion of peripheral intravenous catheters: A nationwide survey in acute care departments in Belgium.","authors":"Florence Dupriez,&nbsp;Cedric Smets,&nbsp;Hannelore Raemen,&nbsp;Marie Van Laer,&nbsp;Martin Hachez","doi":"10.52964/AMJA.0931","DOIUrl":"https://doi.org/10.52964/AMJA.0931","url":null,"abstract":"<p><strong>Purpose: </strong>Assessment of ultrasound use for peripheral intravenous cannulation among acute care nurses and physicians.</p><p><strong>Methods: </strong>Over a population of 17,437, the calculated sample size of respondents required was 376.</p><p><strong>Results: </strong>A total of 388 health professionals; 249 (64.2%) physicians and 139 (35.8%) nurses completed the entire questionnaire. 166 (45.2%) used ultrasound for intravenous cannulation. A statistically significant difference favored physicians' ultrasound use (p<0.001). Respondents with less than 10 years of clinical practice used ultrasound significantly more (p<0.001). The main reported obstacle among users was the lack of time.</p><p><strong>Conclusion: </strong>This survey revealed the gap between the current recommendations for ultrasound use for peripheral intravenous cannulation and the actual practices. Efforts should be made to develop specific training using ultrasound.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"33-38"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9284051","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
Point of care ultrasound: Current and future directions for Acute Medicine. 护理点超声:急性医学的当前和未来方向。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0939
S Biart, F Stanley, L Rahman, H Jones, N Smallwood
{"title":"Point of care ultrasound: Current and future directions for Acute Medicine.","authors":"S Biart,&nbsp;F Stanley,&nbsp;L Rahman,&nbsp;H Jones,&nbsp;N Smallwood","doi":"10.52964/AMJA.0939","DOIUrl":"https://doi.org/10.52964/AMJA.0939","url":null,"abstract":"<p><p>Point of care ultrasound (POCUS) represents an exciting tool for current and future acute care practitioners. POCUS has come a long way in a short space of time and its widespread implementation may well be one of the biggest changes seen in acute medicine across the next decade. This narrative review explores the increasing evidence base for the accuracy of POCUS use in various acute scenarios, whilst also addressing current gaps in the evidence and areas for potential future POCUS development.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"83-90"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624692","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
Bilateral orbital myositis in a patient with rheumatoid arthritis on treatment with tofacitinib: a report and review of literature. 一名接受托法替尼治疗的类风湿关节炎患者的双侧眼眶肌炎：一份报告和文献综述。
Acute Medicine Pub Date : 2023-01-01
G Brambilla, N Nair, Y Osman, S Akram
{"title":"Bilateral orbital myositis in a patient with rheumatoid arthritis on treatment with tofacitinib: a report and review of literature.","authors":"G Brambilla, N Nair, Y Osman, S Akram","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Orbital myositis is a rare inflammatory condition affecting the extraocular muscles of the eyes. It has also been linked to systemic autoimmune diseases. We present a case of orbital myositis in a 57-year-old male undergoing treatment for rheumatoid arthritis (RA) with tofacitinib, a Janus kinase inhibitor (JAK). Prompt administration of intravenous steroids led to rapid symptom improvement. To date, only six published cases have documented the association between RA and orbital myositis. This is the first description of orbital myositis occurring during treatment with the anti-inflammatory drug tofacitinib, an increasingly used disease-modifying anti-rheumatic drug (DMARD). We review the literature and emphasize the importance of ongoing vigilance regarding adverse events linked to tofacitinib.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"258-260"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571574","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
Correspondence - Further reflections of the role of artificial intelligence in acute medicine. 通信 - 进一步思考人工智能在急症医学中的作用。
Acute Medicine Pub Date : 2023-01-01
S Sreenivasan, M Monaghan
{"title":"Correspondence - Further reflections of the role of artificial intelligence in acute medicine.","authors":"S Sreenivasan, M Monaghan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We read with great interest the article \"Artificial Intelligence: its Future and Impact on Acute Medicine\". Regarding the historical perspective on artificial intelligence (AI) origins, we believe the role of John von Neumann (1903-1957) also deserves emphasis.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"264"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571575","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 coronary syndrome after initiation of amoxicillin/clavulanate. 阿莫西林/克拉维酸起始治疗后急性冠脉综合征。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0933
Jacopo Davide Giamello, Chiara Bertone, Gabriele Sobrero, Letizia Barutta, Giulia Paglietta, Luigi Losardo, Giuseppe Lauria
{"title":"Acute coronary syndrome after initiation of amoxicillin/clavulanate.","authors":"Jacopo Davide Giamello,&nbsp;Chiara Bertone,&nbsp;Gabriele Sobrero,&nbsp;Letizia Barutta,&nbsp;Giulia Paglietta,&nbsp;Luigi Losardo,&nbsp;Giuseppe Lauria","doi":"10.52964/AMJA.0933","DOIUrl":"https://doi.org/10.52964/AMJA.0933","url":null,"abstract":"<p><p>We report the case of a 54 year old man referred to the Emergency Department for rapid onset of an itchy rash and oppressive epigastric pain after assumption of amoxicillin/clavulanate. Electrocardiogram aand laboratory findings were consistent with acute coronaty syndrome. After coronary angiography, diagnosis of type II Kounis syndrome was made.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"47-49"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9284050","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 Case of a Primary Hyperparathyroidism Mimic. 一个罕见的原发性甲状旁腺功能亢进症模拟病例
Acute Medicine Pub Date : 2023-01-01
T Wynn, H Marath, A Brahma, V Rajagopal
{"title":"An Unusual Case of a Primary Hyperparathyroidism Mimic.","authors":"T Wynn, H Marath, A Brahma, V Rajagopal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 32-year-old lady with a history of bulimia nervosa was noted to have a raised adjusted calcium of 2.94mmol/L associated with high parathyroid hormone (PTH) 17.2pmol/L. On review, she had an apparent hypercalcaemia for at least three years, and also had a chronic, severe alkalosis with a bicarbonate up to 81.9mEQ/L. Ionised calcium during that time had actually been low, down to 1.03mmol/L. This case highlights the effects of alkalosis on calcium, as more albumin is available for binding to ionised calcium. This results in a low ionised calcium, which triggers PTH release and overall leads to raised adjusted calcium levels. Clinicians may misdiagnose a similar patient with primary hyperparathyroidism and treatment would cause worsening of true hypocalcaemia.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"261-263"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571567","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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