This new book by Dr O’Kane is a very useful and interesting book directed towards Medical registrars but also with many positive features for anyone from Medical Student to Consultants.
Book Review: Acute Medicine by Declan O’Kane Read More
Hypercalcaemia is a common problem which may present to the Acute Medical Unit. Primary hyperparathyroidism (PHPT) and malignancy are the commonest causes of hypercalcaemia, accounting for over 90% of cases. Assessment of parathyroid hormone (PTH) levels is key to determining whether hypercalcaemia is parathyroid-mediated. Initial systematic assessment and adequate rehydration are important to help make the underlying diagnosis and determine longer-term management. The medical management of primary hyperparathyroidism not requiring surgery, with Cinacalcet is highlighted.
Problem based review: The patient with hypercalcaemia Read More
Acute Internal Medicine (AIM) may be the ‘new kid on the block’ as a medical specialty but it lies at the heart of our health service. Recognition of the importance of early senior review in managing medical patients admitted to hospital in an emergency has led to a dramatic expansion in the number of consultant posts being created in acute medical units across the UK. This has been matched by a similar rise in the number of higher speciality training positions, with over 100 posts being advertised every year. Although the majority of these posts have been filled, this expansion, combined with a relative lack of awareness of the speciality, has meant that vacancies remain in many Deaneries. This needs to be addressed in order for the speciality to continue to expand, and deliver high quality, consultant-led acute medical care in every hospital in the UK.
‘Take AIM’ – Raising awareness of Acute Internal Medicine Read More
The time has come to say goodbye and an incredibly big thankyou to Nerys who leaves her post as trainee rep after two years. Nerys’ enthusiasm and energy will be missed and we wish her well for her impending Consultant role (wherever that may be…). Her replacement has been confirmed as Sanjay Krishnamoorthy who many of you will hopefully have met at SAM Manachester, so congratulations Sanjay and welcome to the role.
Trainee update Autumn 2015 Read More
Abstract
The Acute GP Service has operated in Plymouth for the last 7 years. We have a mandate to improve patient care through supporting community GPs and their patients at the point of need for urgent medical assessment. I outline our service design and delivery and make the argument for the use of primary care physicians to help manage the interface between primary and secondary care.
Acute General Practice – the 7 year itch Read More
Abstract
Ambulatory Emergency Care is a key component of the service for many Acute Medical units across the United Kingdom. A well-functioning ambulatory care unit facilitiates early senior review by a consultant and may reduce the need for hospital admission by managing patients along alternative safe clinical pathways. In this article, we present 12 months of data (January 2014-January 2015) from our Ambulatory Unit at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL NHSFT), which demonstrates how many different conditions can be safely managed along ambulatory care pathways and how this can significantly contribute to postive patient satisfaction survey results and meeting the A&E 4 hour target for a medium-sized Acute Trust such as WWL NHSFT. We also emphasise that the key factors of co-location of ambulatory care with the Emergency Department along with dedicated medical and nursing staff are essential to the success of this model of care.
Can Ambulatory Emergency Care have a positive impact on acute services? Read More
Abstract
Acquired Haemophilia (AH) is an autoimmune bleeding disorder, which despite being rare, can be fatal. It occurs in patients with previously normal haemostasis who spontaneously develop IgG autoantibodies against factor VIII. Unlike congenital haemophilia, it manifests as spontaneous bleeding into skin and soft tissues. The presentation can be masked in patients who are receiving warfarin where the bleeding is often attributed to warfarin therapy, as in the case described in this report. Consideration of AH is important in patients taking anticoagulants, when coagulopathy and bleeding fails to correct with usual measures.
Acquired haemophilia: an easy diagnosis to miss in a patient taking warfarin Read More
Abstract
Headache with neurological deficit and cerebrospinal fluid (CSF) lymphocytosis (HaNDL) syndrome is an important diagnosis to consider in patients presenting with the relevant features to acute medicine. Investigations should aim to exclude more serious differential diagnoses such as infectious, inflammatory and neoplastic causes prior to making a formal diagnosis of HaNDL. Increased awareness and early consideration of HaNDL would help to avoid unnecessary prolonged courses of antimicrobial therapy and invasive investigations such as cerebral angiography.
Each year the best abstracts submitted for consideration at the Society for Acute Medicine meetings are selected for oral presentation. This autumn’s meeting in Manchester featured two oral presentation sessions; the abstracts from these are published here.
Abstracts from the Oral Presentations at SAM Manchester Read More
Abstract
Introduction: Poor drug history documentation on admission may lead to medication errors; a leading cause of avoidable harm.
Aims: To assess the quality of drug histories in the notes of patients admitted to an emergency assessment unit and impact of interventions to improve documentation.
Methods: Data were collected on the accuracy of documentation in 281 drug histories including errors of omission, frequency and dose.
Results: The mean error rate was high at more than five per drug history. Omitted drugs included warfarin and long-term steroids, the consequences of which were potentially serious. Clerking prompts and education alone did not improve errors significantly.
Conclusion: The error rate in drug histories is unacceptably high. More research is needed to explore factors involved in such documentation errors.