Volume 21, Issue 1, Pages 1-64 (2022)

Guest Editorial – A personal journey in Acute Medicine

Guest Editorial, Volume 21, Issue 1, Pages 1-64 (2022)

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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Number, nature & impact of incoming telephone calls on residents and their work during evening shifts

Original Articles, Volume 21, Issue 1, Pages 1-64 (2022)

Background: Internal medicine residents are frequently interrupted by phone calls, which may compromise workflow, work quality and job satisfaction.
Aim: This study investigates the number, nature and impact of calls on residents and their work during evening shifts in the emergency department and ward.
Methods: This prospective observational study compares measurements from direct observations with subjective data from questionnaires.
Results: Residents received 26 resp. 30 (median) calls per shift in the emergency department and ward, with duration of 50 resp. 80 seconds. Residents perceived high burden and impact on quality of work and job satisfaction.

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The ‘Unwell’ clinical presentation– an opportunity for admission avoidance?

Original Articles, Volume 21, Issue 1, Pages 1-64 (2022)

Background: An ‘unwell’ patient is a common presentation.
Methods: We studied all ED ‘unwell’ admissions over 6 years, assessing factors influencing mortality with logistic regression.
Results: From 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).

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Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services

Research Audit and Clinical Practice, Volume 21, Issue 1, Pages 1-64 (2022)

The Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21) took place on 17th June 2021, providing the first assessment of performance against the Society for Acute Medicine’s Clinical Quality Indicators (CQIs) within acute medical units since the start of the COVID-19 pandemic.

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Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit

Research Audit and Clinical Practice, Volume 21, Issue 1, Pages 1-64 (2022)

Medical 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.

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Gastric bypass surgery contributing to hyperammonaemic encephalopathy: an under-reported cause of severe nutritional deficiency and significant patient mortality

Case Reports, Volume 21, Issue 1, Pages 1-64 (2022)

Gastric-bypass associated hyperammonaemia (GaBHA) is an under-recognised cause of non-hepatic encephalopathy that is associated with significant mortality and has limited reporting in published literature.
GaBHA has been reported predominately in middle-aged females with a past surgical history of Roux-En-Y surgical procedure. Individuals may present at any stage post-surgery and an important minority may have an undiagnosed inherited metabolic disorder.

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Gastric bypass surgery contributing to hyperammonaemic encephalopathy: an under-reported cause of severe nutritional deficiency and significant patient mortality Read More

Valproate-Associated Hyperammonaemic Encephalopathy

Case Reports, Volume 21, Issue 1, Pages 1-64 (2022)

We present the case of a 55 year old who presented multiple times with altered conscious levels. He was often treated as being post-ictal, when in fact, he had Sodium Valproate induced hyperammonaemic encephalopathy. Sodium Valproate can frequently increase ammonia levels, and in some patient lead to hyperammonaemic encephalopathy.

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5-Oxoproline acidosis caused by acetaminophen and flucloxacillin treatment – a case report

Case Reports, Volume 21, Issue 1, Pages 1-64 (2022)

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.

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Case Report: Congenital Methaemoglobinaemia Type 1: Benign Cyanosis?

Case Reports, Volume 21, Issue 1, Pages 1-64 (2022)

Type 1 congenital methaemoglobinaemia is a rare cause of cyanosis which may manifest in affected individuals during concomitant illness. Treatment indications and aims differ from that of acquired methaemoglobinaemia. Type 1 methaemoglobinaemia is a distinct condition from the type 2 form which has a high mortality rate in infancy. A 25 year old male with known type 1 congential methaemoglobinaemia presented with cyanosis in the context of Influenza A with raised methaemoglobin levels on arterial blood gas analysis.

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Case Report: Congenital Methaemoglobinaemia Type 1: Benign Cyanosis? Read More

Tocilizumab for treatment of SARS-CoV-2 infection at home: A case report

Case Reports, Volume 21, Issue 1, Pages 1-64 (2022)

SARS-CoV-2 virtual wards have successfully developed to monitor and escalate patients to hospital throughout the pandemic. Here we describe the case of an 84 year old man who received his complete care for severe SARS-CoV-2 pneumonitis at home, including the administration of oxygen, dexamethasone and tocilizumab.

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