Volume 19, Issue 1, Pages 1 – 60 (2020)

Response to Letter to the editor: Acute Medicine Journal

Correspondence, Volume 19, Issue 1, Pages 1 - 60 (2020)

Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care.

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Letter to the editor: Acute Medicine Journal

Correspondence, Volume 19, Issue 1, Pages 1 - 60 (2020)

Editor- I note with interest that the Joint Royal College of Physicians Training Board curriculum for Acute Internal Medicine (AIM) has been reviewed and circulated for comment and consideration of implementation in August 2022. The proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It aims to produce a workforce that reflects the current trends of increasing patient attendances to bothprimary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with comorbidities and recognise when specialty input is require in a variety of settings, including ambulatory and critical care.

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An unusual suspect for heart failure

Picture Quiz - Answers, Volume 19, Issue 1, Pages 1 - 60 (2020)

Constrictive pericarditis though an uncommon diagnosis is a potentially reversible form of heart failure (with surgical pericardiectomy) and hence is imperative to diagnose. Diagnosis is dependent on a high index of clinical suspicion and further testing with appropriate cardiac investigations including cardiac imaging with invasive cardiac catheterisation as the gold standard.

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Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain

Case Reports, Volume 19, Issue 1, Pages 1 - 60 (2020)

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain.

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Ambulatory drainage and management of a pleural empyema

Case Reports, Volume 19, Issue 1, Pages 1 - 60 (2020)

A 61 year old male presented to chest clinic with a lung abscess. This ruptured and resulted in an empyema that required a small bore chest drain. Pus started bypassing the drain, spilling out subcutaneously. This was probably due to the impending formation of an empyema necessitans. To stem the flow, a large bore drain was inserted. An ambulatory bag was connected to the end of that drain which enabled outpatient management through the ambulatory care unit over a ten week period. The chest drain stayed in for nine weeks. Risk stratification using the RAPID score was applied. This is a routine medical presentation with well-known and accepted investigations with routine organisms (mixed aerobic and anaerobic microbiota) and treatment with classical broad spectrum antibiotics. The striking feature of the case is that with strict supervision, patient education and motivation, ambulatory management is perfectly feasible and safe.

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An unusual suspect for heart failure

Picture Quiz, Volume 19, Issue 1, Pages 1 - 60 (2020)

A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. On chest auscultation there were bilateral crepitations at his lung bases.

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Overview of acute renal manifestations in cancer patients

Clinical Reviews, Volume 19, Issue 1, Pages 1 - 60 (2020)

Acute kidney injury is frequently encountered in patients with malignancy and is associated with prolonged hospitalization, significant morbidity, and increased mortality. Thorough evaluation is required to identify possible contributing factors, which may range from relatively easily reversible pre-renal causes to complex cancer-specific aetiologies. This review will serve as a practical guide for acute care physicians on the acute medical unit to the assessment and initial management of cancer patients presenting with acute kidney injury.

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Patient and Caregiver Experience of Hospital Discharge from an Acute Medicine Unit via the Discharge Lounge: A Qualitative Case Study

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Discharge lounges enable the swift movement of patients imminently awaiting hospital discharge, to free beds without delay. This Qualitative Yin-Style Case Study describes the patient and caregivers experience of transition from an Acute Medicine Unit (AMU) to a discharge lounge and staff perspectives, as organisers of this process. Audiorecorded, interviews and focus groups were undertaken. Data were analysed using Framework Analysis. Lack of patientcenteredness in moving patients to the discharge lounge emerged with three themes: ‘moving the problem’; ‘being moved’ and ‘feeling removed’. Patients were transferred at accelerated speed. Communications between staff, patients and carers were abruptly curtailed. Patient transfer from AMU to a discharge lounge is a transitional stage in the acute discharge process and must be adequately communicated.

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Can the examination time in CT and conventional x-ray be reduced in an emergency department with integrated radiology unit? A retrospective study

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Quick radiological diagnosis is often needed in order to allow the clinicians to make a diagnosis. The purpose of this study was to measure examination time for radiology procedures before and after physical integration of a radiology unit in the ED. We retrospectively acquired data from the radiology information system and compared time from referral to end of radiological examination before and after physical integration of the radiology unit in the ED for 19,897 X-ray and 6,940 CT examinations. After integration examination time for X-ray examinations was reduced by 5 to 14 minutes (p<0.001). For CT head and chest examination time was reduced by 7 to 15 minutes (p<0.003) while examination time for CT abdomen was prolonged by 4 minutes (p=0.78).

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Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting.

Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared.

Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation.

Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.

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Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission Read More

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