Clin Med
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The objective of this study was to offer HIV testing to all patients attending the acute medical admissions unit (AMU) in Newcastle upon Tyne to assess feasibility, acceptability and point prevalence in accordance with the 2008 UK National HIV testing guidelines. A prospective audit was performed offering HIV testing to all patients with the capacity to give verbal consent who attended the AMU. In total, 3,753 eligible patients were admitted during the audit period and 586 (15.6%) were considered for testing. ⋯ Offering HIV testing in an AMU setting is feasible and acceptable to patients. The high uptake rate but low proportion of admissions tested suggests a lack of confidence of medical staff in offering a test. Misconceptions regarding HIV testing remain and greater education is required for healthcare workers.
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Weekend handover is vital for patient safety--poor handover is a cause of avoidable adverse events. This study evaluated whether the quality of information handed over for patients requiring weekend review was adequate. Two external doctors imagined themselves as the doctor on-call and judged whether the handed-over information was adequate for each case. ⋯ Similarly 70.6% and 75.8% of handovers of action plans were of adequate quality. Use of computerised proforma and discussion at a handover meeting gave the highest percentage of handovers of adequate quality, however, there was room for improvement. Training in handover may improve communication.
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The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards.
Excess average length of stay (ALoS) not only results in an increased cost to hospitals but also increases the risk of hospital-acquired infection and thromboembolism. Various factors suggested to affect ALoS have yet to demonstrate a significant impact in clinical practice. Increased consultant input has been identified as an important factor influencing ALoS. ⋯ The number of discharges (NoDs) significantly increased (p < 0.01), ALoS reduced (p < 0.01), whereas, readmission rate and mortality remained unchanged (p = NS) over 12 months following twice-daily WRs compared to two other wards with twice-weekly WRs. This innovative model resulted in almost doubling the NoDs and halving the ALoS. This study suggests that ALoS can be reduced and sustained with a cultural and behavioural shift in consultant working patterns, without affecting readmission rate or inpatient mortality.
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Case Reports
Lesson of the month (1). Homonymous left hemianopia secondary to traumatic extracranial vertebral artery dissection.
This lesson reports the case of a 32-year-old female presenting with left-sided homonymous hemianopia after a road traffic accident. A diagnosis of vertebral artery dissection (VAD) was missed at presentation after an initial computed tomography head scan was normal. Later, VAD was confirmed on neck magnetic resonance imaging. VAD is an uncommon cause of stroke in the young and, to date, there are no current emergency guidelines available for the management of patients with the condition.