Acute Medicine最新文献

{"title":"Enhanced Care Units: Guidance on development and implementation within Acute Medicine.","authors":"Nicholas Smallwood,&nbsp;Sanjay Krishnamoorthy,&nbsp;Kathleen Bonnici,&nbsp;Tim Wenham,&nbsp;Paul Dean,&nbsp;Sarah Dyson,&nbsp;Hattie Jones,&nbsp;Andrew Walden,&nbsp;Jennie Stephens,&nbsp;Jan Basey,&nbsp;Tash Kelly,&nbsp;Kirsten Evans","doi":"10.52964/AMJA.0929","DOIUrl":"https://doi.org/10.52964/AMJA.0929","url":null,"abstract":"<p><p>The Society for Acute Medicine (SAM) and Intensive Care Society (ICS) have produced joint guidance on the standards of care and infrastructure required to deliver enhanced care within Acute Medicine. The cohort of patients this relates to are in the most part already being looked after on the AMU, but co-location and providing enhanced monitoring and nursing input will ensure safe, high-quality care can be delivered to them. We strongly support the development of enhanced care units, whilst clearly acknowledging that they are not a replacement for critical care where that is indicated. Enhanced care and critical care complement each other and will help foster the close working between the two specialties that modern acute care requires. This guidance draws on expertise and existing relevant guidance from the two societies, alongside that from the Faculty of Intensive Care Medicine (FICM), British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and NHS England / Improvement (NHSE/I). We recognise this is an area with limited evidence and so will aim to review it regularly as the knowledge and experience in this area increases.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 1","pages":"12-23"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9788944","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}

{"title":"Listeria Meningitis, one of your five a day? A case report of Listeria Monocytogenes Meningitis in a fit and well 62-year-old woman.","authors":"L Harrington,&nbsp;G Fisk,&nbsp;M Elanchenny,&nbsp;S Shaikh,&nbsp;U Shah","doi":"10.52964/AMJA.0942","DOIUrl":"https://doi.org/10.52964/AMJA.0942","url":null,"abstract":"<p><p>Listeria Monocytogenes is transmitted via ingestion of contaminated food products and can cause invasive disease in susceptible hosts. Risk factors include immunocompromise; pregnancy; being elderly; and new-born. Listeriosis is uncommon but can occur in immunocompetent individuals and has a high mortality rate. We report a case of a 62-year-old female with no obvious risk factors who presented with atypical meningism. The patient was subsequently diagnosed with listeria meningitis and made a good recovery. The patient was a gardener regularly handling soil and ingested vegetables from her allotment patch; this case is reported to highlight less common risk factors and atypical ways in which listeria may present to the acute medical take.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 2","pages":"101-105"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624693","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}

{"title":"Artificial Intelligence: its Future and Impact on Acute Medicine.","authors":"M Schinkel,&nbsp;K Paranjape,&nbsp;S C Bhagirath,&nbsp;Pwb Nanayakkara","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"150-153"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153365","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}

{"title":"Both acuity and long term prognosis are important Emergency Department metrics: comparison of mobility assessment with the Emergency Severity Index.","authors":"I Arnold,&nbsp;T Kuster,&nbsp;J M Busch,&nbsp;J G Kellett,&nbsp;M Brabrand,&nbsp;R Bingisser,&nbsp;C H Nickel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"22 3","pages":"120-129"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172299","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}

{"title":"Antimicrobial neurotoxicity: an under-recognised cause of delirium.","authors":"D. Moynan, E. Maqbool, E. de Barra","doi":"10.52964/AMJA.0908","DOIUrl":"https://doi.org/10.52964/AMJA.0908","url":null,"abstract":"Antimicrobial associated encephalopathy (AAE) is a well-documented, though under recognised, adverse event associated with antimicrobial use. Clinical manifestations of AAE are varied, ranging from myoclonus and seizure to an encephalopathy with cerebellar signs. The phenotypic presentation of the encephalopathy syndrome is, in general, governed by the antimicrobial in question. Given its apparent rarity in everyday clinical practice, awareness of AAE is crucial for physicians. We describe a reversible encephalopathy characterised by confusion, myoclonus and stupor in a 76 year old gentleman on antimicrobial therapy for a peri-rectal abscess.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"115-116"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45319291","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}

{"title":"Developing priorities for quality improvement in acute medicine using a modified Delphi method A consensus process hosted by the Society for Acute Medicine Quality Improvement Committee (SAM-QI).","authors":"A. Kennedy, M. Holland, P. Sullivan, A. Gebril, N. Arora, V. Vijayakumar, A. Hoole, C. Nickel, C. Hodcroft, L. Harrington, M. Wheble, J. Soong, N. Scriven, J. Kellett, K. Slinger, V. Price, J. Alsma, S. Astbury, R. Varia, A. Rigby, C. Subbe","doi":"10.52964/AMJA.0901","DOIUrl":"https://doi.org/10.52964/AMJA.0901","url":null,"abstract":"INTRODUCTION\u0000The SAM Quality Improvement Committee (SAM-QI), set up in 2016, has worked over the last year to determine the priority Acute Medicine QI topics. They have also discussed and put forward proposals to improve QI training for Acute Medicine professionals.\u0000\u0000\u0000METHODS\u0000A modified Delphi process was completed over four rounds to determine priority QI topics. Online meetings were also used to develop proposals for QI training.\u0000\u0000\u0000RESULTS\u0000Same Day Emergency Care (SDEC) was chosen as the priority topic for QI work within Acute Medicine.\u0000\u0000\u0000CONCLUSION\u0000The SAM-QI group settled on SDEC being the priority topic for Acute Medicine QI development. Throughout the Delphi process SAM-QI has also developed proposals for QI training that will help Acute Medicine professionals deliver coordinated meaningful improvements in care.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"74-79"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49529351","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}

{"title":"Isolated paracetamol-induced acute kidney injury: a systematic review.","authors":"M. Williams, J. Coulson","doi":"10.52964/AMJA.0904","DOIUrl":"https://doi.org/10.52964/AMJA.0904","url":null,"abstract":"AIM\u0000We sought to characterise the syndrome of isolated paracetamol-induced acute kidney injury (AKI), whose incidence and mechanisms are poorly understood.\u0000\u0000\u0000METHODS\u0000Using systematic review methodology, fifty-six papers relating to paracetamol-induced AKI were identified.\u0000\u0000\u0000RESULTS\u000024 cases of isolated paracetamol-induced AKI were identified and compared to 87 identified cases of concurrent renal and hepatic injury. Paracetamol-induced AKI became detectable 3-4 days after exposure; liver injury, where it occurred, preceded AKI detection by 1 day. Risk factors affecting hepatotoxicity risk do not appear to influence isolated AKI, with no clear associated factors except younger age (mean 18.8 versus 33.1 years).\u0000\u0000\u0000CONCLUSIONS\u0000Isolated paracetamol-induced AKI appears commoner in younger patients. Paracetamol-induced AKI occurs late and may go undetected by current treatment guidelines.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"96-103"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41666689","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}

{"title":"The prediction of early mortality by the ROX index of oxygenation and respiratory rate in diverse Canadian and Ugandan cohorts of unselected patient: a post-hoc retrospective analysis of 80,558 patient observations.","authors":"J. Kellett, F. Sikakulya, C. Nickel","doi":"10.52964/AMJA.0900","DOIUrl":"https://doi.org/10.52964/AMJA.0900","url":null,"abstract":"AIM\u0000To investigate the association between in-hospital mortality and the ROX index of respiratory rate and oxygenation in diverse cohorts of unselected patient at different prediction windows.\u0000\u0000\u0000METHODS\u0000A retrospective post-hoc analysis of data from a major regional referral Canadian hospital and a low-resource hospital in sub-Saharan Africa.\u0000\u0000\u0000RESULTS\u0000Four patient cohorts were examined: Canadian medical, surgical and intensive care unit (ICU) patients, and all patients admitted to an African hospital. In all patients in-hospital mortality rose as ROX declined. Apart from ICU patients, ROX had a high discrimination for death within 72 hours. For non-ICU patients the negative predictive value of death within 72 hours for a ROX value <22 ranged from 0.994 to 1.000 Conclusion: In diverse cohorts of unselected patients, the ROX index has a high discrimination for death within 72 hours. However, the index has little or no prognostic value for patient admitted to ICU.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48794428","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}

{"title":"Shock first, ask questions later….","authors":"B. Brown, M. Jackson","doi":"10.52964/AMJA.0905","DOIUrl":"https://doi.org/10.52964/AMJA.0905","url":null,"abstract":"A 39-year-old man presented to the Emergency Department following a sudden onset of palpitations an hour earlier. He was clammy and felt generally unwell. He was normally fit and active with no history of cardiac symptoms including palpitations - he mentioned as a teenager he was told that he had an 'extra bit of wiring in his heart' but nothing further was done. His only regular medication was Sertraline. He drank alcohol to excess. On examination, he was hypotensive but pain free. Bloods including potassium and magnesium were within normal limits - venous lactate was mildly elevated at 2.8.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"104-106"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45613971","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}

{"title":"Improving care for patients in the outlying wards: Lessons from patients' care experience.","authors":"V. Sobolewska, H. Duff, F. Craighead, I. Macpherson, A. Veiraiah, S. Dummer, K. Lockman","doi":"10.52964/AMJA.0902","DOIUrl":"https://doi.org/10.52964/AMJA.0902","url":null,"abstract":"IMPORTANCE\u0000Overcrowding in hospitals and lack of capacity in general medical wards can result in a medical patient being transferred to other specialty wards often referred as 'outlying' or 'boarding' wards.\u0000\u0000\u0000OBJECTIVES\u0000We explored the experiences of our outlying patients to identify local factors that affect their care experience and inform interventions that could improve their care deliveries and outcomes.\u0000\u0000\u0000DESIGN, SETTING, AND PARTICIPANTS\u0000Qualitative interviews using semi-structured questions were conducted in 21 medical patients from a mixture of specialty wards in a large tertiary NHS hospital.\u0000\u0000\u0000MAIN OUTCOMES AND MEASURES\u0000Perceptions of the factors contributing to the experience of being a patient on a boarding ward, and potential solutions.\u0000\u0000\u0000RESULTS\u0000Almost all participants reported experiences of good care in an outlying ward. Positive comments highlighted good nursing care, restful environment and a strong focus on patient-centred care. However, none of the participants could identify the team or consultant responsible for their care and this was linked to multiple doctors being involved in the patient's care. Participants also perceived that the frequency of review was reduced and occurred much later in the day than that experienced in the medical ward. Most felt indifferent about the care ownership, timing and frequency of review but in some cases, this led to confusion and the perception of poor progress. Further, participants felt that they had to actively seek information relating to clinical progress. Negative experience of discharge planning was also reported. The associated themes included conflicting information and delays in social care provision. This led to anxiety, frustration and the perception of being a barrier to patient flow.\u0000\u0000\u0000CONCLUSIONS AND RELEVANCE\u0000Patient experience of the outlying ward is positive, and this can provide a foundation for improvement. Our findings suggest that better care processes and improved communication are needed to promote equity and quality of care. However, this should be complemented with efforts to overcome wider challenges that affect the entire continuum of flow within the healthcare system.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"80-85"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45614346","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}