All Journals from Nicholas Murch
The transition from registrar to consultant in medicine is one that trainees feel ill prepared for and can be extremely stressful. We devised the concept of an Acute Medicine “Finishing School” for senior trainees in London training programmes and ran sessions on CV writing, a simulated consultant interview, consultant job planning, responding to complaints and an out of hospital emergency scenario. Our feedback survey indicated that our delegates’ confidence levels in all of the above aspects increased following the sessions. Both formal and informal feedback highlighted the need and appetite for such a course. By ensuring trainees are trained and supported through this transition process, we can ensure the process is a less stressful one.
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Accidental and intentional poisoning from prescribed, illicit and organic substances remains a major cause of morbidity and mortality worldwide and accounts for just under 1% of the total number of NHS hospital admissions, or around 170,000, a year in the UK. A knowledge of the constellation of signs and symptoms that constitute specific poisonings (referred to as toxidromes) may enable early empirical decontamination, antidote administration, enhanced elimination and supportive care, and may also help to predict the clinical course. This paper presents a series of clinical vignettes to demonstrate emerging presentations in toxicology to help inform the practice of Acute Physicians, who alongside colleagues in Emergency Medicine and Critical Care, are at the front line of diagnosing and treating poisoned patients.
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Pneumothorax is defined as the presence of air in the pleural space, between the lung and the chest wall. It is a significant global health problem, with considerable morbidity and healthcare costs. Best management strategy remains controversial, with significant variation in practise, both nationally and internationally. The lack of consensus is driven by the paucity of the evidence base. Current research trials, particularly those looking at ambulatory management, are making progress and may help streamline future guidelines. This review presents five case reports of patients treated with methods which are not entirely synchronous with the current British Thoracic Society (BTS) guidelines; providing guidance for acute medical physicians who are routinely presented with such cases and exploring future developments in pneumothorax management.
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Abstract Alcohol-use disorders including acute intoxication and withdrawal are common in the acute medical setting. Acute physicians should be aware of the indications for inpatient detoxification, and be able to liase with specialist alcohol services in the hospital and in the community to determine those patients for whom community-based detoxification may be beneficial. Additionally, it is important to recognise the benefit of Brief Interventions for higher-risk drinkers who are not yet dependent. For patients with confusion and a possible history of high alcohol intake and malnutrition, acute physicians should maintain a high index of suspicion for Wernicke’s Encephalopathy and treat appropriately with parenteral thiamine. References NHS Information Centre. Statistics on Alcohol: England. 2011. [Document online] available at URL: http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/Alcohol_2011/NHSIC_Statistics_on_Alcohol_England_2011.pdf. Hall W, Zador D. The alcohol withdrawal syndrome. The Lancet 1997; 349: 1897-1900. Scottish Intercollegiate Guidelines Network. The management of harmful drinking and alcohol dependence in primary care (Guideline No 74). 2004. [Document online] available at URL: http://www.sign.ac.uk/guidelines/fulltext/74/index.html. Department of Health (UK). Alcohol Misuse Interventions: Guidance on Developing a Local Programme of Improvement. [Document online] available at URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4123297. National Health Service (UK). Your drinking and you. 2010. [Document online] available at URL: http://www.gravesham.gov.uk/media/pdf/c/b/your-drinking-and-you.pdf. The National Clinical Guideline Centre for acute and chronic conditions. Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications (clinical guideline 100), 2010. [Document online] available at URL: http://www.nice.org.uk/nicemedia/live/12995/48989/48989.pdf. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA, for the Ambulatory Care Quality Improvement Project. The AUDIT Alcohol Consumption Questions (AUDIT-C): An Effective Brief Screening Test for Problem Drinking. Arch Intern Med. 1998; 158: 1789-1795. Ewing JA. Detecting Alcoholism. JAMA 1984; 252: 1905-1907. Smith SG, Touquet R, Wright S, Das Gupta N. Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT). Accid Emerg Med 1996; 13: 308-312. Hodgson R, Alwyn T, John B, Thom B, Smith A. The Fast Alcohol Screening Test. Alcohol and Alcoholism 2002; 37: 61-66. Grant BF, Stinson,F.S., Harford,T.C. Age of onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12 year follow-up. Journal of Substance Abuse 2001;13:493-504. Sørensen HJ, Manzardo AM, Knop J, et al. The Contribution of Parental Alcohol Use Disorders and Other Psychiatric Illness to the Risk of Alcohol Use Disorders in the Offspring. Alcoholism: Clinical and Experimental Research; 35: 1315-1320. Mayfield RD, Harris RA, Schuckit MA. Genetic factors influencing alcohol dependence. British Journal of Pharmacology 2008; 154: 275-287. Boschloo L, Vogelzangs N, Smit JH, et al. Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: Findings from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders; 131: 233-242. Amato L, Minozzi S, Davoli M. Efficacy and safety of pharmacological interventions for the treatment of the Alcohol Withdrawal Syndrome. Cochrane Database of Systematic Reviews 2011; (6): CD008537. Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of Alcohol Withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). British Journal of Addiction 1989; 84:1353-1357. Muzyk AJ, Fowler JA, Norwood DK, et al. Role of alpha-2 Agonists in the Treatment of Acute Alcohol Withdrawal. Ann Pharmacother 2011; 45: 649-657. Moos RH, Moos BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction 2006; 101: 212-222. House of Commons (UK). Supplementary memorandum by the Department of Health (AL 01B) 2010. [Document online] available at URL: http://www.parliament.the-stationery-office.co.uk/pa/cm200910/cmselect/cmhealth/151/151we03.htm. Heather N. FJ. Brief interventions for alcohol problems in hospital settings. Nursing Times 2005; 101: 38-41. Moyer A, Finney JW, Swearingen CE, et al. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002; 97: 279-292. Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s Enchephalopathy and Korsakoff’s Psychosis, 2006; 151-158. Hardern R, Protheroe D. Use of section 5(2) of the Mental Health Act on a medical admissions unit. J R Soc Med 2003; 96: 474 Full Text File size: 147 KB Downloads: 1276
Purple urine bag syndrome is a potentially alarming phenomenon caused by bacterial metabolism of urinary tryptophan into indigo (blue) and indirubin (red) pigments. We report the case of a 46-year-old female with an ileal conduit who presented with a 2 week history of abdominal pain and purple discolouration of her urine. In addition, we review the literature on purple urine bag syndrome, and identify potential new risk factors and management considerations.
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