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Guest Editorial - Moral injury in acute medicine. 特邀社论--急症医学中的道德伤害。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0983
Vicky Price, Michael Trimble
{"title":"Guest Editorial - Moral injury in acute medicine.","authors":"Vicky Price, Michael Trimble","doi":"10.52964/AMJA.0983","DOIUrl":"10.52964/AMJA.0983","url":null,"abstract":"<p><p>Recently I had to have a few minutes in my office to regroup after I'd seen a patient. I didn't quite know how to process my feelings. I was feeling ashamed and upset. My patient had been in our waiting room for over 18 hours. He was a bilateral amputee and a wheelchair user. His medical problem was not life threatening and easy to treat but was affecting his arm and so affected his ability to care for himself, hence the need for admission. He was usually normally independent, worked full time, headed up a local charity but now suddenly found himself incredibly vulnerable.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 3","pages":"98-99"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606669","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
POCUS use in Acute Hospital at Home - working through clinical presentations and addressing management questions. POCUS在家庭急症医院的应用——通过临床表现和解决管理问题。
Acute Medicine Pub Date : 2024-01-01
A Broad, T Knight, S Kiani, N Rajaiah, S Clare, D Lasserson
{"title":"POCUS use in Acute Hospital at Home - working through clinical presentations and addressing management questions.","authors":"A Broad, T Knight, S Kiani, N Rajaiah, S Clare, D Lasserson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Point of care ultrasound (POCUS) is increasing in use and popularity as the technology advances and understanding deepens. For many specialities such as Acute Internal Medicine and Emergency Medicine, POCUS is now mandated in the curriculum. The benefits of POCUS have been identified in multiple settings however currently there is little literature focusing on POCUS in the acute community setting as seen in Hospital at Home (HaH) and there is no formal framework for POCUS in HaH. As a result, the development and safety of this modality is at potential risk. Through adaptation of established protocols and accreditation pathways this could easily be addressed benefiting the patients care foremost, the clinician and the National Health Service as a whole.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"195-199"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721821","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
Artificial Intelligence: its Future and Impact on Acute Medicine 人工智能:未来及其对急症医学的影响
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0950
Michiel Schinkel, Ketan Paranjape, Sheena Charente Bhagirath, Prabath WB Nanayakkara
{"title":"Artificial Intelligence: its Future and Impact on Acute Medicine","authors":"Michiel Schinkel, Ketan Paranjape, Sheena Charente Bhagirath, Prabath WB Nanayakkara","doi":"10.52964/amja.0950","DOIUrl":"https://doi.org/10.52964/amja.0950","url":null,"abstract":"This commentary explores the potential impact of artificial intelligence (AI) in acute medicine, considering its possibilities and challenges. With its ability to simulate human intelligence, AI holds the promise for supporting timely decision-making and interventions in acute care. While AI has significantly contributed to improvements in various sectors, its implementation in healthcare remains limited. The development of AI tools tailored to acute medicine can improve clinical decision-making, and AI’s role in streamlining administrative tasks, exemplified by ChatGPT, may offer immediate benefits. However, challenges include uniform data collection, privacy, bias, and preserving the doctor-patient relationship. Collaboration among AI researchers, healthcare professionals, and policymakers is crucial to harness the potential of AI in acute medicine and create a future where advanced technologies synergistically enhance human expertise.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"125 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":"135807301","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 1例糖尿病妇女手臂无法控制
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0953
Luís Marote Correia, Mariana Bilreiro
{"title":"A case of a diabetic woman with an uncontrollable arm","authors":"Luís Marote Correia, Mariana Bilreiro","doi":"10.52964/amja.0953","DOIUrl":"https://doi.org/10.52964/amja.0953","url":null,"abstract":"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.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"20 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":"135807302","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
Both acuity and long term prognosis are important Emergency Department metrics: comparison of mobility assessment with the Emergency Severity Index 视力和长期预后都是重要的急诊科指标:活动能力评估与紧急程度指数的比较
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0946
Arnold Isabelle, Kuster Tobias, Busch Jeannette-Marie, Kellett John Gale, Brabrand Mikkel, Bingisser Roland, Nickel Christian
{"title":"Both acuity and long term prognosis are important Emergency Department metrics: comparison of mobility assessment with the Emergency Severity Index","authors":"Arnold Isabelle, Kuster Tobias, Busch Jeannette-Marie, Kellett John Gale, Brabrand Mikkel, Bingisser Roland, Nickel Christian","doi":"10.52964/amja.0946","DOIUrl":"https://doi.org/10.52964/amja.0946","url":null,"abstract":"Objective: To compare the SUHB mobility scale (i.e., stable(S), unstable gait(U), needing help to walk(H), or bedridden(B)) and the Emergency Severity Index (ESI) associations with admission and mortality outcomes. Design: Post-hoc analysis of a prospective observational study including all consenting presenting to the ED over a period of 3 weeks. Odd ratios and AUCs were calculated to assess predictive performance of SUHB and compared with ESI. Results: Out of 2422 patients, 65% presented with a stable gait, 45% with an ESI level 3. With increasing mobility impairment on the SUHB scale, the probability for admission and mortality increased. SUHB had a higher AUC than ESI for 1-year mortality. Conclusion: SUHB was a better predictor than ESI of long-term mortality. The scale, which is rapid, requires little additional training, and no extra costs, could be used as a useful supplement to the triage process.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"28 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":"135807305","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
Renal replacement and extracorporeal therapies in critical care: current and future directions 重症监护中的肾脏替代和体外治疗:当前和未来的方向
Acute Medicine Pub Date : 2023-07-01 DOI: 10.52964/amja.0951
Sophie F Lane, Elizabeth Harvey-Jones, Olivia Ward, Roger Davies
{"title":"Renal replacement and extracorporeal therapies in critical care: current and future directions","authors":"Sophie F Lane, Elizabeth Harvey-Jones, Olivia Ward, Roger Davies","doi":"10.52964/amja.0951","DOIUrl":"https://doi.org/10.52964/amja.0951","url":null,"abstract":"There are a wide number of indications for extracorporeal therapies in the critical care environment. A common indication seen by the acute physician is continuous renal replacement therapy (CRRT) in a proportion of patients with acute kidney injury. It is therefore important that acute physicians have a sound understanding of the principles of CRRT in the acutely unwell patient. This review will outline the indications for its use, commonly used methods and anticoagulation considerations. It will discuss when to start and stop CRRT as well as describing potential treatment complications. This review will also discuss the role of therapeutic plasma exchange in critical care and novel extracorporeal therapies including blood purification in sepsis and carbon dioxide removal in acute respiratory distress syndrome and acute exacerbations of obstructive lung disease. Extracorporeal membrane oxygenation is outside of the scope of this article.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"48 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":"135807299","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
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 &amp; 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
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