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Early senior decision-making in acute medicine: a critical review of health policy and implications for practice. 急性医学的早期高级决策:对卫生政策和实践影响的重要审查。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0911
N Irvine, R Van Der Meer, I Megiddo
{"title":"Early senior decision-making in acute medicine: a critical review of health policy and implications for practice.","authors":"N Irvine,&nbsp;R Van Der Meer,&nbsp;I Megiddo","doi":"10.52964/AMJA.0911","DOIUrl":"https://doi.org/10.52964/AMJA.0911","url":null,"abstract":"<p><p>UK urgent care health policies advocate senior clinical decision-making at the point of referral into the system. The costs of employing senior clinicians in this role are substantial with little evidence of the value they bring over other strategies, particularly for patient outcomes. We sought to explore current remote and ambulatory emergency care decision-making in acute medical care in a large central healthcare system - NHS Scotland. We found that many sites use remote decision-making for some allocation decisions. However, involvement of clinical expertise varies, and available decision-aids are few. There is also variation in access to resources that facilitate non-admission. Research into the value that senior clinicians bring to this task over other strategies is required.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40705945","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
Improving and Sustaining the Quality of Discharge Summaries. 改善和维持出院总结的质量。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0913
J Strange, Z Ali, M Holland, O Gaillemin
{"title":"Improving and Sustaining the Quality of Discharge Summaries.","authors":"J Strange,&nbsp;Z Ali,&nbsp;M Holland,&nbsp;O Gaillemin","doi":"10.52964/AMJA.0913","DOIUrl":"https://doi.org/10.52964/AMJA.0913","url":null,"abstract":"<p><p>High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40705947","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 man who became breathless after tiling a bathroom. 一个给浴室铺完瓷砖后上气不接下气的男人。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0915
H Andrews, M M Khattak, A Beale, T Novak
{"title":"A man who became breathless after tiling a bathroom.","authors":"H Andrews,&nbsp;M M Khattak,&nbsp;A Beale,&nbsp;T Novak","doi":"10.52964/AMJA.0915","DOIUrl":"https://doi.org/10.52964/AMJA.0915","url":null,"abstract":"<p><p>Inhalational lung injury should be considered in patients presenting with acute respiratory symptoms and a history of occupational or recreational exposure to toxic substances. We present the case of a 29-year-old patient who developed pneumonitis following usage of waterproofing sealant spray in an enclosed space, despite the use of a dust mask. The patient was managed with oxygen therapy, corticosteroids and bronchodilators. He made a complete clinical recovery with resolution of almost all changes seen on computerised tomography (CT) imaging within 7 days.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40705949","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 'Unwell' clinical presentation- an opportunity for admission avoidance? “不适”的临床表现-逃避入院的机会?
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0887
R. Conway, D. Byrne, D. O'Riordan, B. Silke
{"title":"The 'Unwell' clinical presentation- an opportunity for admission avoidance?","authors":"R. Conway, D. Byrne, D. O'Riordan, B. Silke","doi":"10.52964/AMJA.0887","DOIUrl":"https://doi.org/10.52964/AMJA.0887","url":null,"abstract":"BACKGROUND\u0000An 'unwell' patient is a common presentation.\u0000\u0000\u0000METHODS\u0000We studied all ED 'unwell' admissions over 6 years, assessing factors influencing mortality with logistic regression.\u0000\u0000\u0000RESULTS\u0000From 49,965 admissions, the ED diagnosis was 'unwell' in 3650 (7.3%). 'Unwell' presentations were older and had longer length of stay. Mortality was not different 4.2% vs 4.6 % (p=0.28). Respiratory patients and those >=70 years had increased mortality, 8.3% (95%CI: 5.9%, 10.6%) and 7.1% (5.7%, 8.4%) respectively. Being unwell predicted a better outcome - univariate OR 0.35 (95%CI: 0.24, 0.52), multivariable OR 0.68 (95%CI: 0.44, 1.03).\u0000\u0000\u0000CONCLUSION\u0000A diagnosis of 'unwell' applied to a heterogenous group; clinical trajectories and outcomes were sufficiently different to preclude targeted admission avoidance as a strategy.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49199336","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
Can we improve patients' physical activity levels after discharge by interventions on the Acute Medical Unit? The 'teachable moment'. 急症病房的干预措施能否提高病人出院后的身体活动水平?“受教时刻”。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0924
Jnf Murphy, I Le Jeune
{"title":"Can we improve patients' physical activity levels after discharge by interventions on the Acute Medical Unit? The 'teachable moment'.","authors":"Jnf Murphy,&nbsp;I Le Jeune","doi":"10.52964/AMJA.0924","DOIUrl":"https://doi.org/10.52964/AMJA.0924","url":null,"abstract":"<p><strong>Introduction: </strong>>30% of the population does less physical activity (PA) than recommended and few patients receive PA advice during a hospital admission (2,5). This study aimed to assess the feasibility of recruiting acute medical unit (AMU) in-patients and to examine the effect of delivering PA interventions to them.</p><p><strong>Methods: </strong>In-patients who were inactive (<150mins/wk) were randomised to either a motivational interview (Long Interview, LI) or brief advice (Short Interview, SI). Participants' physical activity levels were assessed at baseline and at two follow-up consultations.</p><p><strong>Results: </strong>77 participants were recruited. At 12 weeks 22/39(56.4%) participants were physically active following the LI and 15/38(39.5%) following the SI.</p><p><strong>Discussion: </strong>Recruitment and retention of patients on the AMU was straightforward. PA advice helped a high proportion of participants become physically active.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10760853","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
Mind the bubbles - A patient presents with seizure after haemodialysis. 注意气泡——一个病人在血液透析后出现癫痫发作。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0916
Sdpm Yu, Jsk Lau
{"title":"Mind the bubbles - A patient presents with seizure after haemodialysis.","authors":"Sdpm Yu,&nbsp;Jsk Lau","doi":"10.52964/AMJA.0916","DOIUrl":"https://doi.org/10.52964/AMJA.0916","url":null,"abstract":"<p><p>A patient with patent ductus arteriosus presents with seizure after haemodialysis. Although conscious on arrival to the emergency department with spontaneous limb movement, he develops recurrent convulsion and left hemiparesis after admission. The approach to the haemodialysis patient presenting with seizure is discussed and the role of early hyperbaric oxygen therapy for an uncommon but important diagnosis is highlighted.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707386","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
Editorial - The NHS urgent and emergency care crisis: how much worse could it get? 社论- NHS紧急和紧急护理危机:还能糟到什么程度?
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0919
Tim Cooksley
{"title":"Editorial - The NHS urgent and emergency care crisis: how much worse could it get?","authors":"Tim Cooksley","doi":"10.52964/AMJA.0919","DOIUrl":"https://doi.org/10.52964/AMJA.0919","url":null,"abstract":"<p><p>NHS urgent and emergency care is under intolerable strain. This strain is increasingly causing harm to patients. Timely and high-quality patient care is often not being delivered due to overcrowding driven by workforce and capacity constraints. This drives low staff morale perpetuating burn out and high absence levels which currently dominate. Whilst COVID19 has accentuated and arguably expedited the crisis; the spiral of decline in urgent and emergency care has been decade long and unless urgent action is taken, we may not yet have reached its nadir.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10760856","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 Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation. 肺部超声对疑似新冠肺炎的诊断准确性和预后价值的回顾性服务评估。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0895
F. Lesser, M. Dachsel, N. Smallwood
{"title":"The Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation.","authors":"F. Lesser, M. Dachsel, N. Smallwood","doi":"10.52964/AMJA.0895","DOIUrl":"https://doi.org/10.52964/AMJA.0895","url":null,"abstract":"We read with interest the paper from Knight et al in Acute Medicine1 in particular the use of a lung ultrasound (LUS) score to predict outcome in patients with suspected COVID-19. LUS has been shown to be useful in the diagnosis and prognosis for COVID-19 by other authors. We have carried out a service evaluation project on our data from East Surrey Hospital looking into prognostic and diagnostic performance of LUS in suspected COVID-19. In contrast to the data used by Knight et al we had discharge diagnosis data available which allowed us to split the cohort into patients with COVID-19 and patients with other diagnoses and compare the LUS score between the two groups.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45107042","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
Weak legs. 疲软的双腿。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0917
P Timmons, A Williamson, V Gibbs, A Torgersen
{"title":"Weak legs.","authors":"P Timmons,&nbsp;A Williamson,&nbsp;V Gibbs,&nbsp;A Torgersen","doi":"10.52964/AMJA.0917","DOIUrl":"https://doi.org/10.52964/AMJA.0917","url":null,"abstract":"<p><p>A 48 year old lady presented with a 7-week history of progressive generalised myalgia and muscle weakness resulting in recurrent falls. Her past medical history included bipolar affective disorder and a previous stroke. Her medications included clopidogrel 75mg, atorvastatin 80mg, and quetiapine 400mg twice daily.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40707387","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
5-Oxoproline acidosis caused by acetaminophen and flucloxacillin treatment - a case report. 对乙酰氨基酚和氟氯西林治疗致5-氧脯氨酸酸中毒1例报告。
Acute Medicine Pub Date : 2022-01-01 DOI: 10.52964/AMJA.0892
P. van Montfort, F. Helmich, Gjm Mostard, D. van Twist
{"title":"5-Oxoproline acidosis caused by acetaminophen and flucloxacillin treatment - a case report.","authors":"P. van Montfort, F. Helmich, Gjm Mostard, D. van Twist","doi":"10.52964/AMJA.0892","DOIUrl":"https://doi.org/10.52964/AMJA.0892","url":null,"abstract":"High anion gap metabolic acidosis (HAGMA) is a common diagnosis in the emergency department, which requires a systematic work-up in order to identify and treat the underlying cause. We present an unusual case of HAGMA due to 5-oxoproline accumulation caused by prolonged treatment with both acetaminophen (paracetamol) and flucloxacillin. This paper describes the diagnostic work-up of HAGMA and emphasizes on the approach and initial treatment in case the underlying etiology is unclear.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49091044","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: 1
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