diagnosis

Clinical decision making in acute medicine

Original Articles, Volume 21, Issue 4, Pages 165-208 (2022)

Clinical decision-making is a core skill for the practice of medicine and yet during training there is often little formal analysis of the process of clinical reasoning or instruction about how to do it better. This paper reviews the process of clinical decision-making with a particular focus on diagnostic reasoning. Aspects of psychology and philosophy are applied to the process along with consideration of potential sources of error and the steps that can be taken to minimize this.

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

Clinical decision making in acute medicine Read More

Communicating diagnostic uncertainty in the acute and emergency medical setting: A systematic review and ethical analysis of the empirical literature.

Clinical Reviews, Volume 20, Issue 3, Pages 157-248 (2021)

Background: diagnostic uncertainty is ubiquitous. Its communication to patients requires further investigation.
Aims: To determine: 1) What is known about how and why diagnostic uncertainty is communicated in acute care; 2) evidence of the effects of (not) communicating diagnostic uncertainty in the acute setting; 3) associated ethical issues.
Methods: systematic review of Medline, Web of Science and SCOPUS for (acute or emergency care) AND (diagnostic uncertainty) AND (ethics OR behaviours). Critical interpretive synthesis and ethical analysis were conducted.
Results and conclusion: Nine studies (primarily surveys and interviews) were identified. Doctors are not trained in communicating diagnostic uncertainty and perceive it to have negative effects on patients; however not communicating diagnostic uncertainty can disempower patients, resulting in delayed/missed diagnoses or inappropriate use of resource.

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

Communicating diagnostic uncertainty in the acute and emergency medical setting: A systematic review and ethical analysis of the empirical literature. Read More

Diagnoses and mortality in a population without acute myocardial infarction, but with elevated highsensitive troponin I – a retrospective register-based single center study

Original Articles, Volume 20, Issue 1, Pages 1-88 (2021)

Aim: To explore, which differential diagnoses to consider in individuals with elevated troponins without acute myocardial infarction (AMI), and the mortality for those individuals.

Methods: Retrospective, register-based study on a representative sample of the Danish population with the following inclusion criteria: High-sensitive troponin I (hs-TnI) ≥25 ng/L, age ≥18 years, and exclusion of AMI.

Results: 3067 individuals without AMI but increased hs-TnI were included. Most frequent discharge diagnoses: Pneumonia (12.8%), Aortic valve disorder (11.3%), Medical observation (10.9%) and Heart failure (8.9%). The 30-days and one-year mortality was 15.8% and 32.0%, respectively.

Conclusions: A selected number of alternative diagnoses must be considered in individuals with increased hs-TnI. Due to high mortality it is crucial to carefully evaluate these individuals despite the absence of AMI.

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

Diagnoses and mortality in a population without acute myocardial infarction, but with elevated highsensitive troponin I – a retrospective register-based single center study Read More

Diagnosis and Management of Deep Vein Thrombosis

Clinical Reviews, Volume 8, Issue 2, Pages 51 - 94 (2009)

Abstract

Awareness of deep venous thrombosis has increased considerably in the last decade including recognition of the importance of thromboprophylaxis for acutely ill hospital inpatients as preventative therapy. Combinations of a pre-test probability score plus a D-Dimer analysis can identify those patients where the chances of DVT are very low and radiological investigation can be obviated. The gold standard for diagnosis is still either ascending venography or venous Doppler ultrasound. Low molecular weight heparin has taken over from unfractionated calcium heparin as the initial treatment of choice. There are many challenges in management, especially deciding the optimum duration of anticoagulant treatment in order to balance the risks of drug induced bleeding against recurrent venous thromboembolic events.

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

Diagnosis and Management of Deep Vein Thrombosis Read More

Acute abdominal pain: An unusual medical cause

Clinical Reviews, Volume 8, Issue 1, Pages 1 - 52 (2009)

Abstract

Lyme disease is an infectious illness that arises from the spirochete, Borrelia burgdorferi transmitted via a bite by Ixodid ticks. There were 768 cases in the United Kingdom (incidence 1.46/100,000) identified by the Health Protection Agency in 2006. Clinical manifestations of Lyme disease can be multi-systemic. It is important for the acute physician to be aware of this condition. Its relative infrequency and unusual presentation can result in delayed diagnosis with potential for suboptimal outcome. Here, we present a case of Lyme disease presenting with abdominal pain and intestinal dysmotility.

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

Acute abdominal pain: An unusual medical cause Read More

Managing Pleural Disease in Acute Medicine (II): Spontaneous Pneumothorax

Clinical Reviews, Volume 7, Issue 2, Pages 61 - 104 (2008)

Spontaneous pneumothoraces occur in individuals who have not experienced antecedent thoracic trauma. Primary spontaneous pneumothorax occurs in otherwise healthy individuals with no clinically apparent lung disease, whereas secondary pneumothorax is a consequence of an underlying lung disease. This review focuses on their management in the acute medical setting. The specific issues of simple aspiration versus intercostal tube drainage, who can be discharged home safely, and when to refer to a respiratory physician are addressed. In addition, recent developments in the management of pneumothorax are presented.

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

Managing Pleural Disease in Acute Medicine (II): Spontaneous Pneumothorax Read More

Managing Pleural Disease in Acute Medicine (I): Pleural Effusion

Original Articles, Volume 6, Issue 3, Pages 93 - 136 (2007)

Abstract

A pleural effusion is the accumulation of fluid in the pleural space. It is a relatively common finding in clinical practice. The diagnostic approach to the patient presenting with a pleural effusion is aimed at defining the effusion as a transudate or an exudate. This review summarises the initial assessment and investigation of pleural effusions diagnosed during the acute medical take, and who should be referred for specialist advice. In addition, recent developments, including the measurement of NT-proBNP levels and diagnostic markers for mesothelioma, are presented.

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

Managing Pleural Disease in Acute Medicine (I): Pleural Effusion Read More

Cerebrospinal Fluid analysis in Suspected Subarachnoid Haemorrhage

Clinical Reviews, Volume 5, Issue 1, Pages 1 - 40 (2006)

Abstract

Aneurysmal subarachnoid haemorrhage (SAH) is an acute life-threatening neurological disorder. A delay in diagnosis can lead to substantial and avoidable morbidity and mortality. It is important to identify patients with SAH promptly, to enable specialist referral to neurosurgical centres. This review aims to provide an up-to-date practical guide concerning the interpretation of spinal fluid results in patients with suspected SAH.

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

Cerebrospinal Fluid analysis in Suspected Subarachnoid Haemorrhage Read More

Psoas Abscess: Diagnosis and Treatment

Clinical Reviews, Volume 5, Issue 1, Pages 1 - 40 (2006)

Abstract

Psoas abscess is an uncommon presentation on the acute medical take. However recognition and appropriate treatment is essential. This review is designed to highlight the clinical features, microbiology, diagnostic tests and treatment for this condition. In order to illustrate some of the pitfalls and complexities in the management of psoas abscess we have included a case history of a patient who was recently treated in our department.

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

Psoas Abscess: Diagnosis and Treatment Read More

Pyrexia of unknown origin

Clinical Reviews, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Classical pyrexia of unknown origin (PUO), defined as fever of >38 oC on several occasions for greater than three weeks despite investigation in hospital (>3 days) or out of hospital (>2 visits), is an uncommon but challenging problem. The incidence and aetiology vary according to the geographic region, the age structure of the population, and the immune status of the patient; alternative definitions of PUO exist for immune compromised individuals. Preliminary investigations should be determined by detailed history and repeated examination. Biopsy of abnormal tissues should be performed early. If uncertainty persists, abdominal computerised tomography (CT), radiolabeled white cell scans, and the Duke endocarditis criteria carry the highest diagnostic yield. Blind bone marrow biopsy is probably only useful in immunocompromised patients.

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

Pyrexia of unknown origin Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search