Volume 17

Routine HIV Screening in Cancer Patients in the Emergency Department

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Routine HIV Screening in Cancer Patients in the Emergency Department Read More

Changes in vital signs post discharge as a potential target for intervention to avoid readmission

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

Readmissions are treated as adverse events in many healthcare systems. Causes can be physiological deterioration or breakdown of social support systems.

We investigated data from a European multi-centre study of readmissions for changes in vital signs between index admission and readmission. Data sets were graded according to the National Early Warning Score (NEWS).

Of 487 patients in whom NEWS could be calculated on discharge and again on re-admission, 39.6% had worse vital signs with a NEWS score difference ≥ 2 points while only 7.6% had improved by ≥ 2 points. Changes in individual vital signs of 20% or more were most common in respiratory rate and heart rate.

Monitoring of respiratory rate and pulse rate post-discharge might predict some deteriorations.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Changes in vital signs post discharge as a potential target for intervention to avoid readmission Read More

Direct and delayed admissions to ICU in older medical patients

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

The aims of this retrospective cohort study were to retrieve characteristics and outcomes of older (65+) medical patients who are directly admitted to ICU from the ED and to compare these with those admitted to ICU from a ward.

Of 1396 patients, 21 (1.5%) were directly admitted to ICU and 54 (3.9%) after a delay. Blood pressure was lower and respiratory rate higher in the direct than in the delayed group. The direct group had lower mortality (28-day: 19.0 vs.

38.9%, p=0.14; 1-year: 42.9 vs. 66.7%; p=0.06), shorter length-of-stay and returned more frequently to independent living than the delayed group.

Only a fraction of older patients are admitted to ICU; directly admitted patients tend to have better outcomes.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Direct and delayed admissions to ICU in older medical patients Read More

Effective acute care handover to GP: optimising the structure to improve discharge documentation

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

Time and resource constraints have often led to the use of assessment records as discharge communications from acute and emergency departments. However, whether this addresses the primary care needs has not been demonstrated. This study examined the optimal structure that can impart key discharge information effectively using feedback from general practitioners (GP). We implemented an electronic assessment template that focused on the most relevant headings. Prespecified process measures were examined and qualitative thematic analysis of free-text comments from GP surveys were conducted to optimise the document. Our findings suggest that the structure of a discharge summary can influence the quality of information, users’ compliance and readers’ perceptions of the length of the letter.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Effective acute care handover to GP: optimising the structure to improve discharge documentation Read More

Results on patient flow of implementing an Acute Medical Unit

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

Background: There is an increased influx of patients needing admission. Introducing an acute medical unit (AMU) may increase the admission capacity without increasing the total number of beds.

Methods: Data collected during the first four years after implementation of an AMU in an academic tertiary care center in Amsterdam were analyzed.

Results: A 24 bed unit was realized. The total number of admissions increased in the first year with 977 (16%), with an additional 4.1% increase after 2 years with stabilization thereafter. The length of stay decreased, the absolute number of refusals declined, the number of readmissions remained unchanged.

Conclusion: Introduction of AMUs in overcrowded services could be beneficial in improving the strain on the acute healthcare systems

Please subscribe to see more.
Subscribe
Already a member? Log in here

Results on patient flow of implementing an Acute Medical Unit Read More

HIV testing in Acute Care

Guest Editorial, Volume 17, Issue 2, Pages 57 – 116 (2018)

Readers may be aware of the need to improve uptake of HIV testing in health care-settings to reduce the number of individuals with undiagnosed infection who later present with advanced disease. Late presentation of HIV infection is associated with a poorer immune response to antiretroviral therapy, an increased morbidity and mortality with a resultant higher cost burden to health-care services. Individuals with undiagnosed HIV infection who inadvertently transmit their infection to others are thought to be responsible for more than half of new HIV infections in the USA.

HIV testing in Acute Care Read More

Getting information across the acute medicine and primary care interface – steps in the right direction

Guest Editorial, Volume 17, Issue 2, Pages 57 – 116 (2018)

In the acute care pathway, patients often need to move from home to hospital and for the majority, back again. This movement across care interfaces ensures that assessments and interventions are delivered to reduce risk of harm and enhance recovery. However, information needs to move across interfaces too, which enables the clinician taking over care to understand the problem, what has been done and what remains to be done. This is as important for the journey into hospital as it is for the journey home again and is highlighted in the forthcoming NICE guidance on Emergency and Acute Medical Care.

Getting information across the acute medicine and primary care interface – steps in the right direction Read More

Is the AIM curriculum, for higher specialty training, fit for purpose? – response

Correspondence, Volume 17, Issue 2, Pages 57 – 116 (2018)

I read the article, ‘Is the AIM curriculum, for higher specialty training, fit for purpose’ with interest.
However, I disagree with the author on a number of points. First, a curriculum is ‘everything that happens in relation to an educational programme’, not a document setting out intentions and expectations.

Is the AIM curriculum, for higher specialty training, fit for purpose? – response Read More

Shaping the future of Acute Medical training

Correspondence, Volume 17, Issue 2, Pages 57 – 116 (2018)

I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs) and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training. Indeed, the recent Joint Royal Colleges of Physicians Training Board (JRCPTB) statement regarding quality criteria for GIM/AIM Registrars appears to regard the role of the AIM registrar as that of the DMR rather than a specialist in their own field.

Shaping the future of Acute Medical training Read More

Editorial Volume 17 Issue 2

Editorials, Volume 17, Issue 2, Pages 57 – 116 (2018)

As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries.

Editorial Volume 17 Issue 2 Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search