Introduction: >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.
Methods: 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.
Results: 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.
Discussion: Recruitment and retention of patients on the AMU was straightforward. PA advice helped a high proportion of participants become physically active.
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.
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.
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.
This article describes my personal journey through Acute Medicine from the late 1980's and incorporates the development of Acute Medical Units (AMU's), co-establishing the Society for Acute Medicine (SAM), as well as involvement in the development of training curricula, research and audit. I am deeply indebted to a great number of professional colleagues over the last three decades, who have been pivotal to the development of the Acute Medicine specialism, and many of whom in turn became presidents of SAM.
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