Acute Medicine最新文献

{"title":"Acute abdominal pain: chameleon presentations of acute myelitis","authors":"Samuel W. Mackrill, Michael E. Reschen","doi":"10.52964/amja.0907","DOIUrl":"https://doi.org/10.52964/amja.0907","url":null,"abstract":"Patients with acute abdominal pain typically undergo urgent clinical assessment to exclude serious underlying surgical diagnoses. However, a diverse range of less common medical conditions may also present with abdominal pain and their severity can range from benign to life threatening. Here we present a case of myelitis (inflammation of the spinal cord) presenting with acute abdominal pain that was initially diagnosed clinically as biliary pathology. We review the canonical differential diagnosis for medical causes of acute abdominal pain and highlight the clinical features that raise the suspicion of spinal pathology. We argue that awareness of the basic clinical features of structural and inflammatory spinal lesions could improve early recognition of these potentially overlooked diseases.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"212 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71185303","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":"'Just another asthma attack?' - point of care ultrasound as a game changer in respiratory failure.","authors":"L. Boella, S. Norman, G. Rajasekar, N. Smallwood","doi":"10.52964/AMJA.0906","DOIUrl":"https://doi.org/10.52964/AMJA.0906","url":null,"abstract":"Wheeze and shortness of breath are a common reason for admission to hospital but the cause of which is not always immediately apparent. We present a case of a patient with respiratory distress, wheeze and chest tightness on a background of well controlled asthma and androgen deprivation therapy for prostate cancer. The patient was provisionally treated as an asthma exacerbation but point of care ultrasound (POCUS) performed soon after admission revealed severe LV impairment and 'wet lungs' in keeping with acute decompensated heart failure. The case highlights the importance of POCUS to differentiate between different causes of wheeze in the acute setting and we discuss the diagnostic approach to the patient with suspected heart failure.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 2 1","pages":"107-110"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46050444","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":"Point-of-care lung ultrasound in the assessment of COVID-19: results of a UK multicentre service evaluation.","authors":"T Knight,&nbsp;P Parulekar,&nbsp;G Rudge,&nbsp;F Lesser,&nbsp;M Dachsel,&nbsp;A Aujayeb,&nbsp;D Lasserson,&nbsp;N Smallwood","doi":"10.52964/AMJA.0912","DOIUrl":"https://doi.org/10.52964/AMJA.0912","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 has had a dramatic impact on the delivery of acute care globally. Accurate risk stratification is fundamental to the efficient organisation of care. Point-of-care lung ultrasound offers practical advantages over conventional imaging with potential to improve the operational performance of acute care pathways during periods of high demand. The Society for Acute Medicine and the Intensive Care Society undertook a collaborative evaluation of point-of-care imaging in the UK to describe the scope of current practice and explore performance during real-world application.</p><p><strong>Methods: </strong>A retrospective service evaluation was undertaken of the use of point-of-care lung ultrasound during the initial wave of coronavirus infection in the UK. We report an evaluation of all imaging studies performed outside the intensive care unit. An ordinal scale was used to measure the severity of loss of lung aeration. The relationship between lung ultrasound, polymerase chain reaction for SARS-CoV-2 and 30-day outcomes were described using logistic regression models.</p><p><strong>Results: </strong>Data were collected from 7 hospitals between February and September 2020. In total, 297 ultrasound examinations from 295 patients were recorded. Nasopharyngeal swab samples were positive in 145 patients (49.2% 95%CI 43.5-54.8). A multivariate model combining three ultrasound variables showed reasonable discrimination in relation to the polymerase chain reaction reference (AUC 0.77 95%CI 0.71-0.82). The composite outcome of death or intensive care admission at 30 days occurred in 83 (28.1%, 95%CI 23.3-33.5). Lung ultrasound was able to discriminate the composite outcome with a reasonable level of accuracy (AUC 0.76 95%CI 0.69-0.83) in univariate analysis. The relationship remained statistically significant in a multivariate model controlled for age, sex and the time interval from admission to scan Conclusion: Point-of-care lung ultrasound is able to discriminate patients at increased risk of deterioration allowing more informed clinical decision making.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 3","pages":"131-138"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40705946","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":"Clinical decision making in acute medicine.","authors":"M Trimble,&nbsp;K Hennessy","doi":"10.52964/AMJA.0923","DOIUrl":"https://doi.org/10.52964/AMJA.0923","url":null,"abstract":"<p><p>Clinical decision-making is a core skill for the practice of medicine and yet during training there is often little formal analysis of the process of clinical reasoning or instruction about how to do it better. This paper reviews the process of clinical decision-making with a particular focus on diagnostic reasoning. Aspects of psychology and philosophy are applied to the process along with consideration of potential sources of error and the steps that can be taken to minimize this.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 4","pages":"190-195"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10770058","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":"Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions - Example of Risk Stratification Based on Clinical Testing.","authors":"R Conway,&nbsp;D Byrne,&nbsp;D O'Riordan,&nbsp;B Silke","doi":"10.52964/AMJA.0921","DOIUrl":"https://doi.org/10.52964/AMJA.0921","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the clinical predictive value of troponin (hscTnT) and blood culture testing.</p><p><strong>Methods: </strong>We examined all medical admissions from 2011-2020. Prediction of 30-day in-hospital mortality, dependent on blood culture and hscTnT requests/results, was evaluated using multiple variable logistic regression. Length of stay was related to utilization of procedures/services with truncated Poisson regression.</p><p><strong>Results: </strong>There were 77,566 admissions in 42,325 patients. With both blood cultures and hscTnT requested, 30-day in-hospital mortality increased to 20.9% (95%CI: 19.7, 22.1) vs 8.9% (95%CI: 8.5, 9.4) for blood cultures alone and 2.3% (95%CI: 2.2, 2.4) with neither. Blood culture 3.93 (95%CI: 3.50, 4.42) or hsTnT requests 4.58 (95%CI: 4.10, 5.14) were prognostic.</p><p><strong>Conclusion: </strong>Blood culture and hscTnT requests and results predict worse outcomes.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 4","pages":"176-181"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10770059","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":"Co-design of interventions to improve acute care in hospital: A rapid review of the literature and application of the BASE methodology, a novel system for the design of patient centered service prototypes.","authors":"C P Subbe,&nbsp;A Goodman,&nbsp;P Barach","doi":"10.52964/AMJA.0922","DOIUrl":"https://doi.org/10.52964/AMJA.0922","url":null,"abstract":"<p><p>Co-design in acute care is challenged by the inability of unwell patients to participate in the process and the often transient nature of acute care. We undertook a rapid review of the literature on co-design, co-production and co-creation of solutions for acute care that were developed with patients. We found limited little evidence for co-design methods in acute care. We adapted a novel design driven method (BASE methodology) that creates stakeholder groups through epistemological criteria for the rapid development of interventions for acute care. We demonstrated feasibility of the methodology in two case studies: A mHealth application with checklists for patients undergoing treatment for cancer and a patient held record for self-clerking on admission to hospital.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 4","pages":"182-189"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10770062","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":"Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit.","authors":"C. Atkin, T. Knight, T. Cooksley, M. Holland, C. Subbe, A. Kennedy, R. Varia, D. Lasserson","doi":"10.52964/AMJA.0889","DOIUrl":"https://doi.org/10.52964/AMJA.0889","url":null,"abstract":"INTRODUCTION\u0000Medical admissions to hospital represent a diverse range of patients, from those managed on ambulatory pathways through Same Day Emergency Care (SDEC) services, to those requiring prolonged inpatient admission. An understanding of current patterns of admission through acute medicine services and patient factors associated with longer hospital admission is needed to guide service planning and improvement.\u0000\u0000\u0000METHODS\u0000Data from the Society for Acute Medicine Benchmarking Audit (SAMBA) 2021 were analysed. Patients admitted to acute medicine services during a 24-hour period on 17th June 2021 were included, with data recording patient demographics, frailty score, acuity and follow-up of outcomes after seven days.\u0000\u0000\u0000RESULTS\u00008101 unplanned medical admissions were included, from 156 hospitals. 31.6% were discharged without overnight admission; the median hospital performance was 30.1% (IQR 19.3-39.3%). 22.1% of patients remained in hospital for more than 7 days. Those remaining in hospital for more than 48 hours and for more than seven days were more likely to be aged over 70, to be frail, or to have a NEWS2 of 3 or more on arrival to hospital.\u0000\u0000\u0000CONCLUSION\u0000The proportion of acute medical attendances receiving overnight admission varies between hospitals. Length of stay is impacted by patient factors and illness acuity. Strategies to reduce inpatient service pressures must ensure effective care for older patients and those with frailty.","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"21 1 1","pages":"27-33"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42616430","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":"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":"21 3","pages":"126-130"},"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}

{"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":"21 3","pages":"139-145"},"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}

{"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":"21 3","pages":"147-149"},"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}