Editorial

2010 ◽  
Vol 9 (1) ◽  
pp. 2-2
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Correct Diagnosis ◽  
Favourable Outcome ◽  
Original Research ◽  
Free Text ◽  
High Stakes ◽  
Acute Medicine ◽  
Acute Medical Unit ◽  
Area Of Interest

The nature of Acute Medicine requires physicians to make ‘high stakes’ decisions on a regular basis. The constant pressure to create space within a busy Acute Medical Unit needs to be weighed up against the dangers of missing serious pathology due to a premature discharge. A visit to the Coroner’s court or the fear of litigation may make us more cautious, but even the most cautious physician will ‘get it wrong’ on occasions. Case reports submitted to this journal frequently highlight these dangers; rare or serious pathology masquerading as a common or benign illness, followed by an unexpected deterioration, is a regular theme. Early Warning Scores have helped to improve safety for those patients who remain in hospital – Katherine Rowe’s article on p8 discusses the value of Critical Care Outreach in supporting this process. However neither of these innovations is of use for those patients discharged home. The ability to provide early AMU-based follow-up clinics is an important element in reducing risk for this group. The case report on p24 from the team at Hutt Valley Hospital in New Zealand illustrates the value of early reassessment following discharge. In this case the diagnosis of lead poisoning was not considered as a cause for the patient’s myalgia at the time of admission – an understandable ‘miss’, given the apparent chest x-ray abnormality. However, early outpatient CT with follow-up enabled revisitation of the history and the correct diagnosis was made – with a favourable outcome. As finances become stretched over the coming months there will be pressure to reduce hospital follow-up visits. However any drive from Primary Care Trusts to reduce AMU follow-up clinics as a cost-saving measure needs to be resisted if we are to optimise the safety and efficiency of our service. On a different note, I am grateful to those of you who completed the on-line journal survey which was circulated to Society for Acute Medicine members earlier this year. I will aim to include a summary of the results in the next edition. The free-text sections have generated a number of interesting ideas, which we will try to incorporate into future editions on the journal. Many respondents indicated that they would like to see inclusion of more original research; however we remain dependent on submissions we receive, which explains the predominance of case reports in this, and previous, editions. The content of the journal can only be as good as the material we receive, so please keep the submissions coming, particularly AMU-based research projects and completed audits. I am also keen to expand the pool of expert referees for future articles. If any readers would like to contribute to this process, I would be grateful if you could contact me directly at the email address shown on this page, indicating your particular area of interest or expertise.

Editorial

2002 ◽  
Vol 1 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Gastrointestinal Haemorrhage ◽  
Medical Emergency ◽  
Editorial Team ◽  
Original Research ◽  
Acute Medicine ◽  
Previous Edition ◽  
Interesting Paper ◽  
Medical Emergencies ◽  
A Minor

So the brief ‘respite’ of summer is over, and we find ourselves plunging, once more towards the abyss of winter bed pressures. Hopefully those of you working at the coalface will find time to browse through the following pages. The production of a third issue in this ‘shortened’ year, following the launch of the Journal in July, is a credit to the hard work of the editorial and publishing teams. I am, as ever, grateful for their support. Next year will see a return to the planned 4-monthly cycle, with issues anticipated in March, July and November. One casualty of the tight schedule has been a minor adjustment to the cycle of reviews – COPD will now appear next Spring. In its place we have included an interesting paper reviewing the management of Neuroleptic Malignant Syndrome and Serotonin Syndrome, submitted by Consultant Psychiatrist David McNamara. Gastrointestinal haemorrhage and atrial fibrillation will be more familiar to readers, while Dr Joanna Girling’s review of the management of medical emergencies in pregnancy is essential reading for any physician working close to a maternity unit. Myasthenia gravis may not be the commonest medical emergency; nonetheless it is important that physicians are able to suspect, diagnose and initiate treatment for this condition. As I mentioned in my last editorial, I am keen to encourage submissions of case reports, audits, and pieces of original research provided they would appeal to a general medical readership. Cases need not be rare conditions, but must contain a clear teaching message for the reader. In future editions case reports will be categorised as ‘Tales of the Unexpected’, and ‘A Case to Remember’ (a memorable case or one with a message that readers should remember in future). The report on page 106 is an example of the latter – an important reminder that a radiological diagnosis of ‘pneumonia’ does not always imply an infective cause. Finally, I would like to thank those of you who have written with feedback following the previous edition of CPD Acute Medicine. We are clearly attempting to appeal to physicians from a broad range of backgrounds, and I hope that all readers find something which appeals to them in the pages which follow. Please feel free to write with your comments on any issue which you would like to share with the editorial team – depending on the response we may consider including a correspondence section in future editions of the journal.

Editorial Volume 1 Issue 1

2002 ◽  
Vol 1 (1) ◽  
Author(s):  
Paul F Jenkins ◽  
Keyword(s):  
Case Reports ◽  
General Medicine ◽  
Work Load ◽  
Original Research ◽  
Acute Medicine ◽  
The Past ◽  
Review Articles ◽  
Medical Emergencies

As you can see, the title of the Journal has changed and this is intended to emphasize its educational direction. It will continue to commission articles covering general medical topics with a particular emphasis on the management of acute medical emergencies, aiming to reflect the challenges that face those physicians responsible for supporting the acute medical intake. The CME component will continue,so helping to facilitate the accumulation of CPD points in General Medicine. As always we welcome submissions for publication and these can take the form of original research in areas of relevance to Acute Medicine or case-reports. We will continue to commission review articles as otherwise it proves impossible to maintain the cycle and the combination of articles we have planned. I am particularly enthused by the combination of topics covered in this Edition and I do hope that you enjoy reading them as much as I have enjoyed my editing duties. Profound thanks as always to those who have so kindly contributed;we do appreciate the extra commitment, especially in these days of inexorably heavier work-load for clinicians. This is my last Journal as Editor and I must extend my gratitude to those who have written articles over the past four years, to the member of the Editorial Board and of course to the Staff at RILA who have self lessly supported the Editor’s task. Unfailingly efficient they have been a complete pleasure to work with and very under tanding of the occasional memory lapse of this particular Editor! Chris Roseveare, Consultant in Acute Medicine in Southampton, takes over and the new editorial board will be announced in the next issue. Chris has some brilliant ideas and will lead this Journal to renewed success I am sure. I wish him the best of luck.

Editorial

2004 ◽  
Vol 3 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Favourable Outcome ◽  
Thyroid Storm ◽  
Acute Medicine ◽  
General Internal ◽  
The Face ◽  
Similar Theme

While the profile of the subspecialty of Acute Medicine continues to rise, so does the burden of work under which we are continually placed. Changes in General Practice out-of-hours cover, reduced junior doctor hours, continued pressure to achieve four hour A&E wait targets along with the arrival of yet another winter will be familiar themes for many readers. There are times when it may seem difficult to stay positive in the face of such adversity. In these moments of despair, I have recently taken to reading our ward admissions list in search of light relief. This list, compiled by non-clinical staff, describes the problems which doctors referring patients to the AMU ascribe to their patients. ‘COPD Exasperation’ appears to be a common problem (not least amongst the junior medical staff), while I hope that the patient admitted with ‘aspirations of pneumonia’ wasn’t too disappointed by his final diagnosis. A patient with Wegener’s granulomatosis was admitted several times with ‘acute f lare-up of vagueness’, an aff liction with which many of us will be familiar. My favourite, however, remains the unfortunate patient described as ‘Bilateral amputee – off legs’; things clearly could not get much worse for this man! If your own search for light relief leads you to browse through the following pages you will find more useful reviews, case reports and the second in our ‘Controversies in acute medicine’ series. This time Guha and Sheron tackle the issue of f luid resuscitation in chronic liver disease, an area which is frequently a source of considerable confusion. I have only ever treated one patient with thyroid storm, sadly without a favourable outcome; Ben Turner’s overview of the management of this rare condition will hopefully equip readers to deal with the consequences, should you ever be faced with such a problem. At the other end of the pulse-rate spectrum, bradyarrhythmias are a more familiar on-take emergency. In part one of a series of reviews on arrhythmias to be published over the next few editions, this subject is tackled in some detail. Diarrhoea and Cardiac Arrest have both been areas traditionally avoided by consultant physicians. In these days of the ‘hands-on’ consultant (preferably gloved!), I would urge colleagues to be prepared for such eventualities by taking note of our final two reviews. I am pleased to report that my continued pleas for submissions has resulted in more than a trickle of case reports, which has enabled us to publish two ‘Cases to remember’ in this edition. More on a similar theme would be most welcome. Mike Jones, originally brought into the editorial board for his renal expertise, wears his hat as Secretary of the SAC in General Internal Medicine to give an insight into Training developments in Acute Medicine in Viewpoint. Submissions for this section would again be welcomed. I hope you enjoy this edition, and that you continue to find the journal helpful in your everyday practice and personal CPD into the New Year.

Treatment of Endodontic Perforations Using Guided Tissue Regeneration and Freeze-Dried Bone Allograft: Two Case Reports with 2-4 Year Post-Surgical Evaluations

2004 ◽  
Vol 5 (3) ◽  
pp. 131-141 ◽  
Author(s):  
Elton Golçalves Zenobio ◽  
Jamil Awad Shibli
Keyword(s):  
Tissue Regeneration ◽  
Case Reports ◽  
Correct Diagnosis ◽  
Combined Treatment ◽  
Bone Allograft ◽  
Guided Tissue Regeneration ◽  
Radiographic Evidence ◽  
Freeze Dried ◽  
Bone Gain

Abstract Clinicians often have difficulty with the diagnosis and treatment of root perforation. This paper reports two patients with root perforation treated with periodontal surgery associated with guided tissue regeneration (GTR) and demineralized freeze-dried bone allograft (DFDBA). This combined treatment resulted in minimal probing depths, minimal attachment loss, and radiographic evidence of bone gain after follow-up evaluations that ranged from 2 to 4 years. These case reports show a correct diagnosis and removal of etiologic factors can restore both periodontal and endodontic health. Citation Zenobio EG, Shibli JA. Treatment of Endodontic Perforations Using Guided Tissue Regeneration and Freeze-Dried Bone Allograft: Two Case Reports with 2-4 Year Post-Surgical Evaluations. J Contemp Dent Pract 2004 August;(5)3:131-141.

scholarly journals An artificial intelligence-based first-line defence against COVID-19: digitally screening citizens for risks via a chatbot

2020 ◽  
Author(s):  
Alistair Martin ◽  
Jama Nateqi ◽  
Stefanie Gruarin ◽  
Nicolas Munsch ◽  
Isselmou Abdarahmane ◽  
...  
Keyword(s):  
Case Reports ◽  
Digital Health ◽  
Free Text ◽  
First Line ◽  
Text Input ◽  
Health Authorities ◽  
Health Assistant ◽  
Disease Specific ◽  
Clinical Cases

ABSTRACTTo combat the pandemic of the coronavirus disease (COVID-19), numerous governments have established phone hotlines to prescreen potential cases. These hotlines have struggled with the volume of callers, leading to wait times of hours or, even, an inability to contact health authorities. Symptoma is a symptom-to-disease digital health assistant that can differentiate more than 20,000 diseases with an accuracy of more than 90%. We tested the accuracy of Symptoma to identify COVID-19 using a set of diverse clinical cases combined with case reports of COVID-19. We showed that Symptoma can accurately distinguish COVID-19 in 96.32% of clinical cases. When considering only COVID-19 symptoms and risk factors, Symptoma identified 100% of those infected when presented with only three signs. Lastly, we showed that Symptoma’s accuracy far exceeds that of simple “yes-no” questionnaires widely available online. In summary, Symptoma provides unparalleled accuracy in systematically identifying cases of COVID-19 while also considering over 20,000 other diseases. Furthermore, Symptoma allows free text input, furthered with disease-specific follow up questions, in 36 languages. Combined, these results and accessibility give Symptoma the potential to be a key tool in the global fight against COVID-19. The Symptoma predictor is freely available online at https://www.symptoma.com.

scholarly journals Transitions of Care Operations at a Family Medicine Clinic: Patient Follow Up and Financial Outcome Analysis

2016 ◽  
Vol 7 (1) ◽  
Author(s):  
Ashley Thomas ◽  
Jessica Skelley ◽  
Julie Wheeler ◽  
English Gonzalez
Keyword(s):  
Family Medicine ◽  
Transitions Of Care ◽  
Outcome Analysis ◽  
Original Research ◽  
Financial Outcomes ◽  
Medicine Clinic ◽  
Area Of Interest ◽  
Financial Consequences ◽  
Emergency Department Discharge

Introduction: Coordinating smooth patient transitions remains a growing area of interest among healthcare professionals in light of the addition of the Readmission Reductions Program to the Affordable Care Act, which enables CMS to penalize hospitals for 30-day readmissions due to myocardial infarction, pneumonia, heart failure, and in due time, COPD. 2 Many facilities have tested varying TOC models previously piloted at other institutions, focusing on ensuring the proper measures are in place before patients depart. However, there is a significant lack in data quantifying the rate of timely patient follow up after discharge, despite the evidence supporting the value of this visit. The purpose of this study is to analyze TOC outcomes at a local family medicine clinic to assess potential lack of billing utilization and gaps of care related to patient follow up. Methods: The investigators were provided with emergency department discharge charts from the local hospital affiliated with the family medicine clinic; discharge dates ranged from April 2014 to August 2014. Discharge charts were analyzed to establish medical complexity. Investigators used electronic medical records to extract descriptive data to analyze patient and financial outcomes. A subgroup analysis was performed utilizing a subset of patients identified as “established” at the clinic. Results: A total of 317 unique discharge reports were evaluated, with 104 of those in the “established” patient subgroup. During the study period, 8.8% of the total group of patients demonstrated timely follow-up. Additionally, rate of incorrect billing techniques was 79%. A consequence of the low percentage of patient follow up and improper billing is missed revenue opportunity for the clinic; financial consequences range from $3,248.60-$67,150 over the 5 month period. Conclusion: A coordinated outpatient TOC procedure cannot be determined from this study. However, need for further analysis of outcomes at outpatient facilities has been identified.   Type: Original Research

Editorial

2006 ◽  
Vol 5 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Medical Training ◽  
Case Reports ◽  
Junior Doctors ◽  
Acute Medicine ◽  
The Past ◽  
Acute Medical Unit ◽  
Application Service ◽  
Public House ◽  
The Uk

They say time flies when you’re having fun – and the 5 years since Paul Jenkins convinced me to take over as editor of this journal have certainly flown by. This period has seen a dramatic expansion in the numbers of physicians specialising in Acute Medicine, the confirmation of subspeciality status and development of a training curriculum. Addressing over 300 delegates at the recent Society for Acute Medicine meeting at the Royal College of Physicians, President Mike Jones reminded us that only seven years earlier the Society’s entire membership had sat around a small table in a public house just a few hundred yards from that spot. At that time many were predicting that recruitment to the speciality would be a major challenge. ‘Why would anyone choose to specialise in acute medicine?’ was a question, sometimes whispered in the corridors of St Andrew’s Place. And yet many have made this choice, and many more continue to do so. The Society for Acute Medicine now has upwards of 400 members, a figure which has doubled in the past 12 months. Even more encouraging was the large number of trainees who visited the Acute Medicine stand at the recent BMJ careers fair. Many junior doctors clearly view Acute Medicine as a positive career choice, not the ‘last resort’ which some predicted it may become. However, challenges remain. By the time this edition hits the press the Medical Training Application Service (MTAS) will be swinging into action to produce the first applicants for ‘post MMC’ training positions across the UK. For those of us who are involved in the shortlisting and interview process, the enormity of the task is rapidly becoming apparent. In Wessex, the Deanery has suggested that Acute Medicine shortlisting may take as much as a week, with a further week set aside for interviews of the hopeful candidates. Then comes ‘round two’, later in the year, when potentially we do it all over again. Suddenly the prospect of annual leave in the months of March or April looks like a forlorn hope. But before I break this news to my wife and family, I should spare a thought for those readers who find themselves on the opposite side of the process. To be part of the first cohort of trainees to be involved in this must be a daunting prospect. Many of those enthusiastic potential recruits to the speciality are clearly struggling to know where to turn to for advice on the process, confused by often contradictory messages and unanswered questions. Hopefully all will become clearer as the deadlines approach. A smaller ‘Reviews’ section in this edition reflects a dramatic increase in the number of articles submitted for consideration of publication in this journal over the past 6 months. As a result we have accommodated more case reports than normal, along with two papers in our new section for research and audit. I would encourage similar submissions in the future; case reports need not be rare or esoteric, provided they contain a clear teaching message clinicians involved in the acute ‘take’. Completed audits will be considered if they demonstrate clear evidence of how to improve practice in an acute medical unit. Owing to some software problems, Rila has temporarily suspended their submissions website which, until recently, had been the mechanism for submission of articles to this journal. Until these problems are resolved, I would be grateful if any articles could be e-mailed directly to me at the address shown on this page, so that I can arrange for peer review. Finally, a reminder that this edition concludes the cycle of reviews which started in 2002 and has now covered the majority of conditions presenting as emergencies on the acute medical ‘take’. The new cycle, starting in 2007 with volume 6 issue 1 will follow a modified pattern, with different authors hopefully providing a fresh perspective in their updated reviews. My thanks go to all of the authors who have produced material over the past 5 years as well as to the editorial board for their ongoing hard work in commissioning articles for the past and future cycles.

scholarly journals An artificial intelligence-based first-line defence against COVID-19: digitally screening citizens for risks via a chatbot

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Alistair Martin ◽  
Jama Nateqi ◽  
Stefanie Gruarin ◽  
Nicolas Munsch ◽  
Isselmou Abdarahmane ◽  
...  
Keyword(s):  
Case Reports ◽  
Digital Health ◽  
Free Text ◽  
First Line ◽  
Text Input ◽  
Health Authorities ◽  
Health Assistant ◽  
Disease Specific ◽  
Clinical Cases

Abstract To combat the pandemic of the coronavirus disease 2019 (COVID-19), numerous governments have established phone hotlines to prescreen potential cases. These hotlines have struggled with the volume of callers, leading to wait times of hours or, even, an inability to contact health authorities. Symptoma is a symptom-to-disease digital health assistant that can differentiate more than 20,000 diseases with an accuracy of more than 90%. We tested the accuracy of Symptoma to identify COVID-19 using a set of diverse clinical cases combined with case reports of COVID-19. We showed that Symptoma can accurately distinguish COVID-19 in 96.32% of clinical cases. When considering only COVID-19 symptoms and risk factors, Symptoma identified 100% of those infected when presented with only three signs. Lastly, we showed that Symptoma’s accuracy far exceeds that of simple “yes–no” questionnaires widely available online. In summary, Symptoma provides unparalleled accuracy in systematically identifying cases of COVID-19 while also considering over 20,000 other diseases. Furthermore, Symptoma allows free text input, furthered with disease-specific follow up questions, in 36 languages. Combined, these results and accessibility give Symptoma the potential to be a key tool in the global fight against COVID-19. The Symptoma predictor is freely available online at https://www.symptoma.com.

Editorial Volume 1 Issue 2

2002 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Case Reports ◽  
Editorial Team ◽  
Original Research ◽  
Self Assessment ◽  
Acute Medicine ◽  
Questions And Answers ◽  
Medical Emergencies ◽  
Near Future

When I was invited to take over as Editor of this journal, I had little idea of the amount of work which went into its production. I am indebted to Paul Jenkins for staying on in the role of sub-editor, and for helping me up a very steep learning curve over the past few months. I am certain that regular readers will wish to join me in thanking Paul and his editorial team for all their hard work during the last three years. The new editorial board has been expanded to include physicians with a broad range of specialty interests. We will be making use of their expertise and their contacts within their fields to commission reviews on a range of topics relevant to Physicians involved in the Acute Medical take. The intention is to cover all of the common (and some less common) conditions presenting as medical emergencies over a four yearly cycle. Ultimately this will mean that regular subscribers will have access to a comprehensive ‘textbook’ of acute medicine, with ongoing regular updates. The cycle schedule has already been determined, and a provisional plan is listed on page 71. The second section of the journal will include some new features. Some of these will be commissioned, but we would also like to encourage submissions from the readership. Case reports of a ‘General Medical’ nature, pieces of original research and audits relevant to Acute Medicine would be most welcome for this section. ‘Viewpoint’ is intended as a soapbox for anyone with a strong opinion which they would like to air in around 1000 words. This edition contains reviews of the management of suspected pulmonary embolism, diabetic ketoacidosis, anaphylaxis and cellulitis, all relatively common presentations on an Acute Medical take. In addition, we have a detailed review of the management of severe asthma, written from an intensivist’s perspective. This should provide an insight into the management of this complex group of patients, for those of you who are unfamiliar with what goes on beyond the ITU doors. Our ‘How to do it’ feature for this edition is an ophthalmologists’ view of fundoscopy, and some key abnormalities of the optic disc. Self assessment questions and answers are included at the back of this edition. Unfortunately, external CPD credits cannot currently be accrued by completion of these, although we hope to remedy this in the near future. I am sure this will not detract from the enjoyment of reading the journal, which I hope you find as educational an experience as I have had in editing it.

Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Head Injury ◽  
Brain Tumour ◽  
Severe Head Injury ◽  
Case Reports ◽  
Subsequent Development ◽  
Malignant Brain Tumour ◽  
Tumour Development ◽  
Short Period ◽  
The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

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