Acute Medicine最新文献

This is a case report of a patient who presented with neck pain and intermittent pyrexia as a manifestation of pseudogout of the neck.

The training of Acute Physicians is crucial for future delivery of high-quality urgent care. The 2024 Acute Medicine Trainee Survey gathered 124 responses, assessing training satisfaction, challenges, and progress since the 2022 curriculum update. Most trainees (66.2%) reported satisfaction, with access to training in Point-of-Care Ultrasound (POCUS) improving (74.7% vs. 63% in 2023). Disparities in training provision and burnout remain significant concerns, with 29.1% experiencing burnout and 40% feeling at risk of this. Key challenges included patient flow issues, rota gaps, and limited respect from colleagues. Despite this, trainee satisfaction is rising, with the majority (88.7%) recommending a career in Acute Medicine. Continued efforts are essential to ensure equitable access to training opportunities and supporting well-being in this demanding specialty.

Background: the optimal period over which respiratory rate should be measured is uncertain.

Setting: medical ward of low resource Ugandan hospital, Methods: comparison of the first respiratory rates measured on admission over seconds using a smartphone application with measurements over 15 minutes using a piezoelectric device.

Results: There was a poor correlation between respiratory rates measured by the piezoelectric device and rates measured by a smartphone application. Although the discrimination for mortality of piezoelectric respiratory rates were slightly higher than those derived from the application, there were not statistically significant differences.

Conclusion: this study could not demonstrate potential clinical benefits that justify measuring the first respiratory rate after admission over 15 minutes by a device.

Introduction: Cardiovascular diseases are a substantial burden on healthcare systems, contributing significantly to avoidable hospital admissions. We propose a Cardiology Ambulatory Care Pathway.

Methods: Conducted a 1 month study redirecting admission streams from primary and emergency care, into a Cardiology Ambulatory Care Hub providing triage in Hot Clinic, and access to a Multi-Modal Testing Platform.

Results: 98 patients were referred to the Ambulatory Care Hub, 91 of which avoided admission. 52 patients received care in the cardiology hub, 38 of which required further testing.

Conclusion: We successfully streamlined various service streams, reducing admissions, and improving patient outcomes. Outpatient CTCA, ambulatory ECG, and echocardiography proved instrumental. We project a cost saving of £53,379 per month in bed days (£640,556 annual saving).

This article presents the case of a 25-year-old Moroccan male who contracted Orf disease (Ecthyma contagiosum), a common zoonotic viral infection in sheep and goats. The disease, caused by a parapoxvirus, can be transmitted to humans through contact with infected animals. The patient developed painful lesions on his fingers after interacting with a sheep during the Feast of Sacrifice. Diagnosis was clinically established considering exposure history and lesion characteristics. Treatment involved local antiseptics and 2% fusidic acid cream. The lesions resolved spontaneously over a few weeks without functional impairment.

The advent of the SARS-CoV-2 pandemic brought unprecedented challenges to healthcare systems worldwide. As the virus spread across continents, hospitals faced a surge in patient admissions, particularly to intensive care units (ICUs). Understanding the impact of the pandemic on the sickest patients admitted to hospital is crucial for enhancing preparedness for future outbreaks. In this edition of the journal, authors from Denmark report on a register-based national observational study that sheds light on the changes in ICU admission rates and demographic profiles of patients during the initial phase of the pandemic.

Research has shown an association between body temperature, heart rate and respiratory rate. We speculated that antipyretics could influence this. We performed this study with the aim of clarifying the association. We included 1,612 acutely admitted medically ill patients and registered their use of antipyretics. We performed crude and adjusted linear regression analyses. In adjusted analysis, we found that heart rate increased with 7.3 (95% CI: 4.5, 10.1) beats/min/°C in patients who were not on antipyretics and 10.0 (95% CI: 6.2, 13.9) beats/min/°C in patients who were. Respiratory rate increased 0.4 (95% CI: -0.2, 0.9) and 1.5 (95% CI: 0.6, 2.3), respectively. Our data shows that use of antipyretics affect the association between temperature, heart rate and respiratory rate positively.

Recently I had to have a few minutes in my office to regroup after I'd seen a patient. I didn't quite know how to process my feelings. I was feeling ashamed and upset. My patient had been in our waiting room for over 18 hours. He was a bilateral amputee and a wheelchair user. His medical problem was not life threatening and easy to treat but was affecting his arm and so affected his ability to care for himself, hence the need for admission. He was usually normally independent, worked full time, headed up a local charity but now suddenly found himself incredibly vulnerable.

Point of care ultrasound (POCUS) is increasing in use and popularity as the technology advances and understanding deepens. For many specialities such as Acute Internal Medicine and Emergency Medicine, POCUS is now mandated in the curriculum. The benefits of POCUS have been identified in multiple settings however currently there is little literature focusing on POCUS in the acute community setting as seen in Hospital at Home (HaH) and there is no formal framework for POCUS in HaH. As a result, the development and safety of this modality is at potential risk. Through adaptation of established protocols and accreditation pathways this could easily be addressed benefiting the patients care foremost, the clinician and the National Health Service as a whole.