Acute Medicine最新文献

Background: Emergency departments (EDs) are increasingly managing elderly patients who present unique clinical challenges. This study explores the current management practices for patients aged 75 years and older in Belgian EDs.

Methods: An electronic survey was sent to 105 heads of Belgian EDs. The Collected data underwent descriptive analysis.

Results: Geriatric protocols, adapted equipment, availability of geriatricians, and paramedical staff improve the quality of care for older patients in the EDs. However, the limited use of geriatric scores, prolonged stays in the ED, and lack of hospital beds are frequent problems that negatively impact quality of care.

Conclusion: Given the variable level of care provided to the elderly in the EDs, care protocols should be standardized and improved at the national scale.

Subarachnoid haemorrhage (SAH) is a potentially life-threatening cause of acute severe headache. This service evaluation aimed to investigate the prevalence of SAH in patients referred to acute medicine with acute severe headache who underwent a lumbar puncture (LP) at a tertiary teaching hospital, over a four-year period. Of the 677 samples analysed for CSF bilirubin, 619 were negative (91.5%), 48 indeterminate (7%), and 10 classified as positive (1.5%). Only one patient (0.1%) was diagnosed with an aneurysmal SAH and underwent intervention. Therefore, the diagnostic yield of an LP to exclude SAH in this setting is extremely low. This service evaluation challenges the dogma that LP is necessary in all patients with acute severe headache.

Background: Efficient documentation is essential in Same Day Emergency Care (SDEC) settings to maintain smooth patient flow. Manual typing, although reliable, is time-consuming and can negatively impact clinical efficiency.

Objectives: This Service Improvement Pilot study evaluates the impact of Heidi Health's Ambient Voice Technology on documentation efficiency, clinician workload, and patient satisfaction during clinical consultations.

Methods: An observational analysis was conducted on 100 case notes in an SDEC setting. Documentation times using Heidi Health's Ambient Voice Technology were recorded, while manual documentation times were estimated based on word counts and typical typing speeds. Clinician feedback was gathered on usability and administrative burden, and patient feedback focused on the consultation experience.

Results: Ambient Voice Technology reduced documentation time by 85.8%, saving an average of 5.27 minutes (equivalent to 5 minutes 16 seconds) per case compared to manual typing (p < 0.001). Clinicians reported high usability scores (mean = 9.1/10), reduced administrative burden, and improved consultation flow. Additionally, 90% of patients reported an enhanced consultation experience.

Conclusions: Ambient Voice Technology significantly improves documentation efficiency, reduces clinician workload, and enhances patient satisfaction in SDEC settings. Future research should explore its application across a variety of clinical environments.

Introduction: Patients with respiratory infection-associated changes on chest X-ray often have follow-up chest X-rays (CXRs) to exclude malignancy. In the UK, same day emergency care (SDEC) units have been developed to manage patients needing urgent hospital care on an ambulatory basis. The yield of findings and benefit from follow-up CXRs in this population is unknown. We report the non-malignant and malignant findings from our cohort of SDEC patients.

Methods: We performed a retrospective service evaluation of CXRs for adult patients who attended our SDEC between 6/1/2020 and 25/9/2023, identifying CXRs arranged as follow-up for infection-related findings and assessing outcomes stratified by lung malignancy-associated risk factors.

Results: Of 27,336 CXR requests from our SDEC unit, we identified 419 follow-up CXRs. From these, 341 follow-up CXRs were done to assess resolution of infection-related changes; 304 (89%) showed resolution and 37 (11%) showed persistent changes. Further investigation of persistent changes identified two malignancies and several non-malignant conditions including 7 cases of interstitial lung disease, 2 requiring ongoing respiratory follow up. Both patients with cancer were over 50 with risk factors.

Conclusions: The small number of malignancies detected in follow-up CXRs in SDEC patients support risk factor-based targeting of CXRs although non-malignant findings may benefit some patients.

Frontal lobe epilepsy is an episodic neurological disorder characterised by recurrent seizures arising from one or both frontal lobes. Seizures may appear atypical and are easily misdiagnosed in the emergency department as nonepileptic attacks (psychological episodes) or parasomnias (sleep disorders). Given the multiple connections and functions of the frontal lobes, Frontal lobe epilepsy presentations are highly variable, including motor, psychic, behavioral or cognitive changes, with a wide differential diagnosis. Prompt diagnosis in the busy emergency department may be difficult, because of complex, often multiple but brief episodes, and sometimes bizarre manifestations; frequent nocturnal presentation, and a wide range of aetiologies. This narrative review summarises clinical and investigation features that help clinicians to reach an accurate and prompt diagnosis.

Objective: This retrospective study analysed clinical characteristics, diagnosis, and management of infective meningitis in the UK, aiming to identify emerging trends and pitfalls in the patient pathway.

Methods: A ten-year review of meningitis patients at a UK tertiary centre was conducted. Inclusion criteria encompassed signs/symptoms of meningitis with CSF WCC ≥4 cells/mm3 or causative pathogen identification.

Results: The study included 298 cases (184 viral, 87 bacterial, 22 tuberculosis, 5 fungal). Key findings indicated underutilisation of culture-independent investigations, delayed administration of antibiotics, and lumbar puncture. Viral meningitis cases with a positively identified causative virus had shorter hospital stays.

Conclusion: Culture-independent investigations are under-utilised in meningitis diagnosis. Patients experience delays in essential interventions. Future advancements in rapid, point-of-care genomic sequencing could enhance diagnostic accuracy and speed.

Over the current and subsequent few financial years, a set of significant changes will be implemented affecting the research landscape in the United Kingdom. On the 22nd of September 2025 NHS England released the paper "Increasing research activity in the NHS". This paper highlights the clear ambitions of decreasing trial set up times, from the current 250 to under 150 days, while doubling commercial interventional trial participants by 2026 and again by 2029 in the UK. The paper also reveals the UK's aspiration to become a more attractive Country for international research and commercial investments from the biotechnology industry sector. The plan builds on the Government's "Life Science Sector Plan", published in July 2025, which followed "Fit for the Future: 10 Year Health Plan for England". The government has consistently highlighted a commitment for the NHS to support the life sciences industry in the UK. Importantly, research performance will be monitored at both aggregate and individual site level. Furthermore, each NHS organisation's research budget will be allocated based on historical performance, number of studies and recruitment activity (with weighting based on the type of study), and new performance, including study set up times, efficiency of delivery and commercial research activity expansion.

Transfusion of red blood cells is routine in acute care settings and adverse events are not uncommon. While bleeding protocols are familiar to acute physicians, guidance is less clear for non-bleeding patients. This review offers consolidated guidance on transfusion in the adult acute patient, including restrictive targets and the use of alternatives in anaemia, the role of group O emergency red blood cells (RBC) and important considerations in individuals with childbearing potential, immunosuppressed patients and transfusion-dependent patients.

Acute Medicine Journal is evolving, in a move to prioritize the publication of more randomized controlled trials (RCTs) and large prospective cohort studies, therefore accepting fewer case reports and retrospective studies. This trend reflects a fundamental shift towards stronger, more reliable and more generalisable scientific evidence in clinical research and practice.

Background: Specialist skills are central to the AIM curriculum, supporting both service delivery and portfolio careers.

Methods: We surveyed UK Acute Medicine consultants and registrars via the Society for Acute Medicine to assess specialist skills selected, perceived value in obtaining consultant roles, and job-planned time.

Results: 146 responses (64 registrars, 82 consultants) were received across all UK regions. Among registrars, Intensive Care Medicine (19%) and echocardiography (14%) were most common. Medical Education, while previously dominant among consultants, has declined. Skills such as Neurology and Infectious Diseases were less frequently chosen but associated with greater job-planned time and perceived value.

Conclusions: Specialist skill preferences are changing, influenced by training pathways and consultant job structure. With increasing rates of burnout and moral injury, as well as changes to the AIM curriculum, it is vital that we monitor trends in their selection going forward.