Work Based Assessments (WBAs) amongst UK medical trainees during the COVID-19 pandemic: How have we adapted?
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Letter to the editor
“Inside the word emerging is emerge, from an emergency new things come forth. The old certainties are crumbling first, but danger and possibility are sisters.’’1
The population burden of SARS-CoV-2, in terms of number of new cases, has declined significantly since the peak of the outbreak. Concerns rightfully persist regarding a possible second wave of infection. We feel the impact upon acute medicine warrants further discussion.
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Is fake news contributing to increased Covid-19 BAME deaths?
We write this letter as doctors and proud members of the Black, Asian and Minority Ethnic (BAME) community from a South Asian background. Recent Office for National Statistics (ONS) data suggest that the BAME population is disproportionately affected by Covid-19.1 Observations and experiences from within our family and wider community led us to explore how cultural aspects may account for these figures. Both intrinsic and extrinsic factors are likely to contribute to this unfortunate statistic. Intrinsic factors such as pre-existing health conditions and comorbidities e.g. cardiovascular risk factors, diabetes2 and diet are likely to play a role. Extrinsic factors such as living in overcrowded conditions,3 multigenerational households and a large proportion of this population being key/essential workers,4 which are often less likely to be amenable to remote working. Faith also plays a part and the large congregational gatherings in places of worship may add to the risk in this community, as does the tactile nature of greeting in BAME communities.
Is fake news contributing to increased Covid-19 BAME deaths? Read More
Response to Letter to the editor: Acute Medicine Journal
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
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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Non-Cardiac Chest Pain
We read with interest “Non-Cardiac Chest Pain: Management in the Ambulatory Clinic setting” (Acute Med 2019;18(3)165-70). It is useful to know about the various musculoskeletal causes of chest pain, especially where specific treatment may be available.
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Pardon My French
Cama et al’s review of pneumothorax management was excellent, especially their elegant depiction of chest tube diameter in comparison to the intercostal space, as measured in French gauge. The use of gauge is medicine is confusing due to differing systems and seemingly random increments. This diagram neatly shows that French gauge (Fr) is directly proportional to diameter, as the external diameter of the tube in millimetres is the gauge multiplied by three. For example, a 15 Fr chest tube has an external diameter of 5mm.
Predicting value of prehospital body temperature for ICU admission of septic shock patients
To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.
Response to: Assessment of Fluid responsiveness in the Acute Medical Patient and the Role of Echocardiography
I read the article, ‘Assessment of Fluid responsiveness in the Acute Medical Patient and the Role of Echocardiography’ by Dr Parulekar and Dr Harris with interest. It rightly highlights the challenges posed when assessing for fluid resuscitation in a pressured setting with limited information. This scenario is a routine one for our speciality, which is why it is a concern that the evidence-base outside of intensive care remains limited. Of particular relevance to the Acute Medical specialist, the article acknowledges that performing a focussed-echocardiogram on all acutely-unwell patients is “impractical”. Developing a quick and straightforward approach to fluid resuscitation assessment should be a high research priority for Acute Medicine.
Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS)
Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.
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