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Quantitative assessment of the relationship between body mass index and risk of pulmonary embolism: a retrospective case-control study. 体重指数与肺栓塞风险关系的定量评估:一项回顾性病例对照研究。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0937
I Le Jeune, R Hubbard
{"title":"Quantitative assessment of the relationship between body mass index and risk of pulmonary embolism: a retrospective case-control study.","authors":"I Le Jeune,&nbsp;R Hubbard","doi":"10.52964/AMJA.0937","DOIUrl":"https://doi.org/10.52964/AMJA.0937","url":null,"abstract":"<p><p>In the context of a significant increase in obesity rates, quantifying the relationship between body mass index (BMI) and risk of pulmonary embolism (PE) is an essential component of accurate clinical risk assessment. This observational study is the first to explore this association by clinician-defined cause of the PE. We demonstrate that the association between BMI and PE is driven by patients with otherwise 'unprovoked' PE where there is a strong positive correlation with odds ratios equivalent to well-recognised major risk factors such as cancer, pregnancy and surgery. We make a case for the inclusion of BMI in risk-prediction tools.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"67-71"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9621788","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. 根据出院时分配的ICD-10主要章节和入院时的国家预警评分，急诊入院的诊断和住院死亡风险。
Acute Medicine Pub Date : 2023-01-01
M Holland, A Dannatt, J Kellett, D 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":"M Holland,&nbsp;A Dannatt,&nbsp;J Kellett,&nbsp;D Green","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The relationship between diagnosis, illness severity, and mortality risk for unselected emergency admissions is poorly defined.</p><p><strong>Aim: </strong>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.</p><p><strong>Method: </strong>Retrospective, observational, cohort study of 122,259 unselected, adult emergency admissions to Salford Royal Hospital between 2014 and 2022.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"113-119"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132993","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. 成为医疗注册员：将职业转变作为一项变革性学习活动的定性研究。
Acute Medicine Pub Date : 2023-01-01
Z Ferguson, R Selman
{"title":"Becoming the medical registrar: a qualitative study of a professional transition as a transformative learning event.","authors":"Z Ferguson,&nbsp;R Selman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>Doctors working as medical registrars were invited to participate in semi-structured interviews. The qualitative data collected underwent thematic analysis.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Acute physicians involved in supervising new medical registrars must facilitate meaningful independent practice to encourage the next generation of medical generalists.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"144-149"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153366","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 case of a diabetic woman with an uncontrollable arm. 一例患有糖尿病的妇女手臂无法控制。
Acute Medicine Pub Date : 2023-01-01
L M Correia, M Bilreiro
{"title":"A case of a diabetic woman with an uncontrollable arm.","authors":"L M Correia,&nbsp;M Bilreiro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present the case of an 83-year-old female patient with left-side hemichorea and hemiballism associated with poorly controlled type 2 diabetes mellitus. Hyperintensity in the right basal ganglia was evident in T1-weighted brain magnetic resonance. Clinical and radiological findings were consistent with diabetic striatopathy.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"165-166"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158585","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 - Acute Medicine Curriculum: "Pulling everything together". 特约编辑 - 急症医学课程："汇聚一切"。
Acute Medicine Pub Date : 2023-01-01
N Murch
{"title":"Guest Editorial - Acute Medicine Curriculum: \"Pulling everything together\".","authors":"N Murch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite still being seen as a relatively 'new' specialty, Acute Internal Medicine (AIM) has reached full adulthood, with its 23rd birthday being celebrated in 2023, and as a new specialty it is somewhat apt that it's the same age as the new millennium. Arguably, the coming of age of the specialty has been its role in helping deal with the increased pressures on the urgent and emergency care system, not least with Covid pandemic. However, AIM still faces challenges in its implementation in certain areas. The specialty continues to innovate with regards to service development including Same Day Emergency Care (SDEC), a new Higher Specialty Training curriculum including innovations such as mandatory Point of Care Ultrasound (POCUS) as well as the guidance for Enhanced Care Units (ECUs) allowing centralised care for those patients needing closer monitoring and specialized care.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"170-171"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571607","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
Ethics in acute medicine. 急性医学伦理学。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0940
M Trimble
{"title":"Ethics in acute medicine.","authors":"M Trimble","doi":"10.52964/AMJA.0940","DOIUrl":"https://doi.org/10.52964/AMJA.0940","url":null,"abstract":"<p><p>Clinical ethics is a core part of the decision-making process. Whilst often reduced to the four principles approach, the situation is more complex. Teaching of ethics frequently focuses on quandary issues, such as assisted-suicide, but there is an ethical component to every clinical encounter. Where differences of opinion arise it is important to understand one's own perspective and that of others. Compassion is an important starting point.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"91-95"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624690","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 - Ultrasound for Lumbar Punctures - An Invaluable tool for the Acute Physician. 通信-超声腰椎穿刺-一个宝贵的工具，为急症医生。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0943
A Taylor, S Clare
{"title":"Correspondence - Ultrasound for Lumbar Punctures - An Invaluable tool for the Acute Physician.","authors":"A Taylor,&nbsp;S Clare","doi":"10.52964/AMJA.0943","DOIUrl":"https://doi.org/10.52964/AMJA.0943","url":null,"abstract":"<p><p>The traditional procedure of identifying anatomical landmarks when performing lumbar punctures can lead to a failure rate of 19%. The Society of Hospital Medicine have published a statement, recommending use of ultrasound (US) guidance for all adult lumbar punctures (LP). A recent meta-analysis found several advantages of point of care US guided LP: higher success rate and diminished pain. US assisted LP is easy to learn, integrating ultrasound guided LP into Acute Medicine curriculum, could lead to better patient outcome.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"106"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624691","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 undergraduate syllabus for Acute Internal Medicine. 急症医学学会急症内科本科教学大纲。
Acute Medicine Pub Date : 2023-01-01
M Trimble, N Murch, V Price, K Slinger
{"title":"Society for Acute Medicine undergraduate syllabus for Acute Internal Medicine.","authors":"M Trimble, N Murch, V Price, K Slinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This syllabus is intended to act as a guide for students and their instructors in medical schools. It describes the range of clinical presentations that they should be able to recognize and the underlying conditions that they should know how to treat. It also includes knowledge of the practice of Acute Internal Medicine and systems of care. The appropriate level of knowledge is that which would be expected of a non-specialist Foundation level doctor.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 4","pages":"204-208"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571621","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
Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample. 胸腔积液对肺栓塞患者临床结局的影响:来自全国住院患者样本的见解。
Acute Medicine Pub Date : 2023-01-01 DOI: 10.52964/AMJA.0930
Kirellos Said Abbas, Adnan Qureshi, Soban Ahmad, Gregory Y H Lip, Chun Shing Kwok
{"title":"Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample.","authors":"Kirellos Said Abbas,&nbsp;Adnan Qureshi,&nbsp;Soban Ahmad,&nbsp;Gregory Y H Lip,&nbsp;Chun Shing Kwok","doi":"10.52964/AMJA.0930","DOIUrl":"https://doi.org/10.52964/AMJA.0930","url":null,"abstract":"<p><strong>Background: </strong>The incidence of hospital admissions for pulmonary embolism (PE) and associated pleural effusion, and the impact of these effusions on outcomes on a national level is unknown.</p><p><strong>Methods: </strong>Data from the National Inpatient Sample between 2016 to 2019 was used to conduct a retrospective nationwide cohort study of hospital admissions for PE with and without pleural effusion. Multiple logistic regressions and linear regression analyses were used to determine the independent impact of effusions on in-hospital mortality, length of stay, and cost.</p><p><strong>Results: </strong>There were 937,744 hospital admissions with PE included in our analysis (median age 64 [interquartile range 50-76] years; 52.5% females). The in-hospital mortality rate overall was 3.7% which was 5.5% for patients with pleural effusion and 3.6% for patients without pleural effusion (p<0.001). The median length of stay was longer in the group with pleural effusion (6 [3-12] days vs 4 [2-6] days, p<0.001) and the median healthcare cost was higher among patients with pleural effusion (13,689 [7,279-30,915] vs 8,855 [5,472-16,531], p<0.001). The factors most associated with pleural effusion were atrial fibrillation (OR 1.89 95%CI 1.78-2.00, p<0.001) and arterial thrombosis (OR 1.48 95%CI 1.19-1.84, p<0.001). Pleural effusion was associated with increased odds of mortality in patients with PE (OR 1.30 95%CI 1.18-1.45, p<0.001). Pleural effusion was associated with increased length of stay (Coefficient 4.15 95%CI 3.99 to 4.32, p<0.001), and healthcare costs (Coefficient 12,164; 95%CI:11,639 to 12,688, p<0.001)).</p><p><strong>Conclusion: </strong>Concomitant pleural effusion is not uncommon among PE patients which is more common in patients with atrial fibrillation and previous arterial thrombosis. Pleural effusions in patients with PE are associated with higher in-hospital mortality, length of stay and cost.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"24-32"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9289138","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 - Bad NEWS: standing still is risky for patients admitted to hospital (even with normal vital signs). 客座编辑-坏消息：对于入院的患者来说，站着不动是有风险的（即使生命体征正常）。
Acute Medicine Pub Date : 2023-01-01
C P Subbe
{"title":"Guest Editorial - Bad NEWS: standing still is risky for patients admitted to hospital (even with normal vital signs).","authors":"C P Subbe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"110-112"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41112933","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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