Volume 20, Issue 4, Pages 249 – 308 (2021)

A Qualitative Evaluation of a Simulation Training Initiative for Registrars Working in Acute Medicine

Original Articles, Volume 20, Issue 4, Pages 249 – 308 (2021)

Introduction: We evaluated a simulation-based training day for medical registrars to define the hidden curriculum of the training.

Methods: We interviewed participants to explore their reflections about the day, what they had learned and how it had influenced their practice. Interviews were conducted iteratively and analysed in accordance with content thematic analysis.

Results: We established four themes: sharing (collaborative learning), sensing (comparing one’s practice against peers’), transforming (development or change in practice based on learning from the day), and endorsing (appreciating authenticity in the simulation and psychological safety in debriefing).

Conclusion: This evaluation furthered our understanding of the self-reported learning outcomes of our participants. We encourage other institutions to perform similar evaluations to build a collaborative understanding of simulationbased education for medical registrars.

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

A Qualitative Evaluation of a Simulation Training Initiative for Registrars Working in Acute Medicine Read More

Editorial – Virtual wards: A key concept that require careful evaluation to ensure successful in real world

Editorials, Volume 20, Issue 4, Pages 249 – 308 (2021)

Urgent and emergency care services remain under huge pressures with concerns regarding overcrowding, delays in patient care and exhausted staff with increasing unsustainable workforce pressures. Short term mitigation measures are needed alongside the imperative need to ensure long-term innovative and sustainable measures to ensure that the NHS can deliver high quality acute and emergency care.

Editorial – Virtual wards: A key concept that require careful evaluation to ensure successful in real world Read More

Seven Day Safety Net Service

Original Articles, Volume 20, Issue 4, Pages 249 – 308 (2021)

A seven day safety net telephone service was developed in an acute medical unit at a university hospital in London. The service attempts to provide all patients discharged from acute medicine with patient activated access to a member of the acute medical team. This allows patients to flag deterioration triggering further review in the ambulatory clinic or to ask for advice on symptoms or medication. Here we evaluate the first sixteen months of the service and report on its benefits and limitations.

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

Seven Day Safety Net Service Read More

Applying a COVID Virtual Ward model, assessing patient outcomes and staff workload

Original Articles, Volume 20, Issue 4, Pages 249 – 308 (2021)

A COVID virtual ward (CVW) is recommended by NHS England, but ‘usual care’ outcomes have not been reported.
A retrospective study of all adults with COVID-19 attending Queen Elizabeth Hospital Birmingham between 01/06/2020-31/01/2021, assessed against CVW criteria and followed for 28 days.
Of 2301 COVID-19 patients, 571(25%) would have met CVW criteria. Of these, 325(57%) were discharged after review and 246(43%) admitted. Of admitted patients who met CVW criteria, 81% required hospital-supported therapies; 11% died. Of the 325 discharged, 13% re-presented, 9% with COVID-related symptoms, 2% required intensive care admission, and one died (0.3%).
In this comparison, discharging patients without a CVW did not lead to more re-presentations, re-admissions, ITU escalations or deaths compared to published outcomes for hospitals with a CVW.

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

Applying a COVID Virtual Ward model, assessing patient outcomes and staff workload Read More

Point of care ultrasound 3-point compression vs departmental scanning for lower limb DVT in ambulatory and internal medicine patients

Research Audit and Clinical Practice, Volume 20, Issue 4, Pages 249 – 308 (2021)

Point of care ultrasound scanning (POCUS) is safe and effective in positively identifying lower limb DVT in emergency departments globally. In the UK, the requisite knowledge and skills are integrated into the FAMUS and FUSIC curricula.
Five FAMUS practitioners of varying experience performed 3-point compression POCUS on medical ambulatory and inpatients. Accuracy and timing of POCUS was compared between practitioners and with subsequent departmental scans.
89% sensitivity and 97% specificity were observed, with little difference between supervisors and candidates. Additionally, a significantly higher proportion of POCUS vs departmental scans (69% vs 7%, p = 0.0001) occurred within 24 hours of request.
Minimal experience was required to produce accurate results within ambulatory and internal medicine settings, and significant time savings can be made.

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

Point of care ultrasound 3-point compression vs departmental scanning for lower limb DVT in ambulatory and internal medicine patients Read More

Eosinophilic fasciitis: experience with a patient and review of the potential mimics

Case Reports, Volume 20, Issue 4, Pages 249 – 308 (2021)

Bilateral lower limb swelling is a common clinical scenario with a wide differential diagnosis. We present a young man with gradually worsening bilateral leg swelling, who was diagnosed with eosinophilic fasciitis.
A 20 year old Hispanic male presented with a six week history of bilateral lower limb pain and swelling, later involving the upper limbs, but sparing the hands, feet and face. He had initial pitting, followed by non-pitting oedema and had a positive ‘groove sign’. With peripheral eosinophilia, a clinical diagnosis of eosinophilic fasciitis was suspected and was later confirmed on histology. He improved with prednisolone initially and is currently maintained on tapering prednisolone alongside methotrexate.

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

Eosinophilic fasciitis: experience with a patient and review of the potential mimics Read More

Fatal pulmonary toxicity following Carfilzomib administration

Case Reports, Volume 20, Issue 4, Pages 249 – 308 (2021)

Carfilzomib has shown excellent outcomes for relapsed Multiple Myeloma. There have been increasing reports on cardiovascular adverse events. However, reports on severe pulmonary adverse events are rare. Our patient was a 79-year-old female, undergoing fourth-line therapy with Carfilzomib. At 24h after first administration, the patient was admitted to the emergency room complaining of dyspnoea. After a full recovery, the patient was re-evaluated. Since echocardiography showed normal cardiac function, Carfilzomib was re-initiated. At 24h after administration, the patient was re-admitted to the emergency room with severe dyspnoea, meeting criteria for ARDS. Despite mechanical ventilation, the patient developed cardiac arrest. Resuscitation was unsuccessful. Although patients might fully recover from a first episode of Carfilzomib-induced pulmonary toxicity, re-initiation of Carfilzomib is not recommended.

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

Fatal pulmonary toxicity following Carfilzomib administration Read More

Ischaemic stroke caused by Group B Streptococcus associated meningoencephalitis in young, immunocompetent adults – a case series and systematic review of literature

Case Reports, Volume 20, Issue 4, Pages 249 – 308 (2021)

A 51-year-old man presented with mild headache followed by sudden onset of right sided weakness and ysarthria on the background of one week history of right sided sciatica and malaise. He was apparently immunocompetent with only past medical history being hypertension. There was no consumption of tobacco or excess alcohol and he previously had normal liver and renal function.

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

Ischaemic stroke caused by Group B Streptococcus associated meningoencephalitis in young, immunocompetent adults – a case series and systematic review of literature Read More

Ventricular tachycardia and raised troponin: “What if it’s a pheochromocytoma”? Some lessons from a crisis

Case Reports, Volume 20, Issue 4, Pages 249 – 308 (2021)

A 63-year-old female with cardiovascular risk factors presented with tremor, sweating, lower back discomfort, nausea and dyspnoea. Electrocardiogram showed sinus tachycardia with lateral ST-depression. High-sensitivity troponin-T was dynamically elevated (72ng/L to 112ng/L on one-hour repeat). Overnight, there was an episode of ventricular tachycardia with further troponin rise to 364ng/L. Coronary angiogram demonstrated non-obstructive coronary artery disease. Post-procedure, the patient developed a hypertensive crisis with pulmonary oedema (invasive blood pressure 350/140mmHg). This was managed with intravenous phentolamine. Ondansetron and metoclopramide were given for intractable vomiting. A pheochromocytoma was subsequently confirmed and surgically excised. Our experience in this case generated several important learning points that we hope may be of benefit to others who encounter suspected pheochromocytomas on the acute medical take.

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

Ventricular tachycardia and raised troponin: “What if it’s a pheochromocytoma”? Some lessons from a crisis Read More

A progressive and severe rash

Picture Quiz - Answers, Volume 20, Issue 4, Pages 249 – 308 (2021)

A 73-year-old female patient with epilepsy presented to hospital with a progressive, diffuse macular rash over the trunk and limbs with associated mucosal blistering and discharge. Ocular symptoms initially predominated and she was treated for presumed bacterial conjunctivitis by her General Practitioner the previous day. On the acute medical unit supportive management was initiated for suspected adverse drug reaction (ADR) to a recent lamotrigine dose increase. Skin biopsy confirmed a diagnosis of toxic epidermal necrolysis. We present this case to highlight the importance of medication history taking and raise awareness of indolent presentations of life-threatening ADRs. Caution should be applied following dose changes to anti-epileptics, even if previously stable.

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

A progressive and severe rash Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search