Clin Med
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A 65-year-old Caucasian woman presented to the emergency department with rapidly worsening shortness of breath. On presentation she was tachycardic and tachypnoeic with reduced (85%) oxygen saturation. Cardiovascular examination revealed elevated jugular venous pressure with positive Kussmaul's sign, pulsus paradoxus and muffled heart sounds. ⋯ She subsequently underwent aortic root and aortic valve replacement surgery. Histology of the resected specimen showed inflammatory infiltrate with giant cell formation indicative of giant cell arteritis (GCA). This case highlights the need to consider GCA in the differential diagnosis of patients presenting with aortic aneurysm and pericardial effusion.
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It is becoming increasingly clear that genomics is beginning to have a major impact in guiding diagnoses and treatment of many disorders. As the cost of DNA sequencing continues to drop and more patient genomes are sequenced, the challenge is to deliver this knowledge to the clinic, particularly in cancer. ⋯ Genetic approaches, thought to be pipedreams five years ago for diseases such as Duchenne muscular dystrophy, are now showing promise in clinical trials and many of these methodologies are being applied more widely for other diseases. The era of genomic medicine has arrived.
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The decision to admit a frail older patient is rarely made by a geriatrician and often falls to staff in the emergency department (ED), who may not have the training to balance the risks, benefits and alternatives. We based a consultant geriatrician in the ED with the primary aim of facilitating admission prevention for older patients and this was achieved for 64% (543/848) of patients. ⋯ The overall 7-day ED re-attendance rate was 10.1%, but only 3.4% of patients were admitted with the same problem, indicating true admission prevention rather than admission delay. In conclusion, the placement of a consultant geriatrician in the ED is effective in facilitating admission prevention for older patients.
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Comparative Study
The quality of patient experience of short-stay acute medical admissions: findings of the Adult Inpatient Survey in England.
Introduction of the specialty of acute medicine and of acute medical units (AMUs) in the UK have been associated with improvements in mortality, length of stay and flow, but there is no literature on the patient experience during the early phase of acute medical admissions. We analysed the Adult Inpatient Survey (AIPS) findings for short-stay unscheduled medical admissions who did not move from their first admission ward (n=3325) and therefore are likely to have been managed entirely in the AMU. ⋯ Scores for unscheduled admissions were worse in medical patients compared with other specialties for pain control, privacy, involvement, information, and for a number of questions relating to information on discharge. The specialty of acute medicine should work to improve future patient experience.
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Models suggested for managing acute, non-elective, medical admissions include expanding geriatric services, extending the role of the acute physician and rejuvenating the role of the general physician. We investigated improving inpatient care by changing consultants' work patterns and placing a higher priority on the ward rounds. A focus group and a questionnaire were used to study the impact on several ward round parameters. ⋯ Length of stay reduced to 4 days from 5.3 days without an increase in readmission. The main themes showed improved quality of care, better assured patients and relatives, and better consultant job satisfaction, but also showed reduced junior doctors' independent decision-making and a slight reduction in specialty-related activity. The study concluded that placing a higher priority on ward rounds by altering consultants' work patterns has a positive impact on inpatient care.