An overview of lower limb cellulitis in an acute medical ward-a few lessons we can learn

Lower limb cellulitis is a common cause for hospital admissions. In this retrospective study, we assessed the characteristics and outcome of patients admitted in an acute medical unit. The mean duration of treatment was 10.48 days, with 95.5% receiving antibiotics for more than 5 days. Mean length of stay (LOS) was 5.19 days. 12-month readmission rate was higher in patients with diabetes, chronic kidney disease (CKD) and previous stroke. Diabetes, CKD, previous stroke, and elevated procalcitonin levels were independently associated with prolonged admission (>3 days).

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Rhythmicity of patient flow in an acute medical unit: relationship to hospital occupancy, seven-day working, and the effect of COVID-19

QJM ◽

10.1093/qjmed/hcaa334 ◽

2021 ◽

Author(s):

S J Dauncey ◽

P A Kelly ◽

D Baykov ◽

A C Skeldon ◽

M B Whyte

Keyword(s):

Hospital Admissions ◽

Fourier Transforms ◽

Patient Flow ◽

Cohort Analysis ◽

Information Management System ◽

Hospital Performance ◽

Bed Occupancy ◽

Urban Hospital ◽

Medical Unit ◽

Acute Medical Unit

Abstract Background The Acute Medical Unit (AMU) provides care for unscheduled hospital admissions. Seven-day Consultant presence and morning AMU discharges have been advocated to improve hospital bed management. Aims To determine whether a later time of daily peak AMU occupancy correlates with measures of hospital stress; whether seven-day Consultant presence, for COVID-19, abolished weekly periodicity of discharges. Design Retrospective cohort analysis Methods Anonymised AMU admission and discharge times were retrieved from the Profile Information Management System (PIMS), at a large, urban hospital from 14th April 2014—31st December 2018 and 20th March—2nd May 2020 (COVID-19 peak). Minute-by-minute admission and discharge times were combined to construct a running total of AMU bed occupancy. Fourier transforms were used to determine periodicity. We tested association between i) average AMU occupancy and ii) time of peak AMU occupancy, with measures of hospital stress (total medical bed occupancy and ‘medical outliers’ on non-medical wards). Results Daily, weekly and seasonal patterns of AMU bed occupancy were evident. Timing of AMU peak occupancy was unrelated to each measure of hospital stress: total medical inpatients (Spearman’s rho, rs=0.04, P = 0.24); number of medical outliers (rs=-0.06, P = 0.05). During COVID-19, daily bed occupancy was similar, with continuation of greater Friday and Monday discharges than the weekend. Conclusions Timing of peak AMU occupancy did not alter with hospital stress. Efforts to increase morning AMU discharges are likely to have little effect on hospital performance. Seven-day Consultant presence did not abolish weekly periodicity of discharges – other factors influence weekend discharges.

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Cardiac stress tests – which one should I choose?

Acute Medicine Journal ◽

10.52964/amja.0256 ◽

2010 ◽

Vol 9 (1) ◽

pp. 3-7

Author(s):

Dhrubo Rakhit ◽

◽

Catherine Blakemore ◽

Keyword(s):

Chest Pain ◽

Stress Tests ◽

Stress Imaging ◽

Common Cause ◽

Medical Unit ◽

Cardiac Stress ◽

Acute Medical Unit ◽

Basic Understanding

Chest pain is a common cause of presentation to the Acute Medical Unit and the use of cardiac stress imaging in these patients is becoming more widespread. This article aims to provide Acute Physicians with a basic understanding of the different modalities and how to select a particular test for a given patient.

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Infrared Thermography Follow-Up After Lower Limb Revascularization

Journal of Diabetes Science and Technology ◽

10.1177/1932296820912311 ◽

2020 ◽

pp. 193229682091231

Author(s):

Arjaleena Ilo ◽

Pekka Romsi ◽

Matti Pokela ◽

Jussi Mäkelä

Keyword(s):

Skin Temperature ◽

Infrared Thermography ◽

Lower Limb ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Clear Correlation ◽

Before And After ◽

Patients With Diabetes ◽

The Mean

Background: The purpose of this study was with a simple clinical setting to compare skin temperature changes in the feet before and after revascularization and to identify possible correlation between ankle brachial index (ABI) and toe pressure (TP) values and foot skin temperature patient with and without diabetes. Methods: Forty outpatient clinic patients were measured ABI, TP, and the skin temperature using infrared thermography (IRT) at the foot before and after revascularization. Patients in the revascularization group were divided into subgroups depending on whether they had diabetes or not and a wound or not. Results: There were clear correlation between increase of ABI and TP and increase of the mean skin temperature on the feet after revascularization. The temperature was higher and the temperature change was greater among patients with diabetes. Side-to-side temperature difference between the revascularized feet and contralateral feet decreased after treatment. The mean temperature was higher in the feet with wound whether patient had diabetes mellitus or not. Conclusion: The simple, prompt, and noninvasive IRT procedure showed its potential as a follow-up tool among patients with diabetes or peripheral arterial disease and previous lower limb revascularization.

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Sodium Glucose Cotransporter 2 Inhibitors Treatment in Acromegalic Patients with Diabetes - A Case Series and Literature Review

10.21203/rs.3.rs-156859/v1 ◽

2021 ◽

Author(s):

Adnan Zaina ◽

Yuval Grober ◽

Ali Abid ◽

Eldad Arad ◽

Elena Golden ◽

...

Keyword(s):

Diabetes Management ◽

Case Series ◽

Limited Data ◽

Duration Of Treatment ◽

Sodium Glucose Cotransporter ◽

Before And After ◽

Patients With Diabetes ◽

The Mean ◽

First Time ◽

Reporting Data

Abstract PurposeDiabetes mellitus (DM) represents one of the most frequent comorbidities in patients with acromegaly. Sodium glucose cotransporter 2 inhibitors (SGLT2i) represent an important class for diabetes management. However, limited data is reported regarding the use of this class in patients with acromegaly and diabetes.Methods Reporting data regarding patients with acromegaly and diabetes under treatment with SGLT2i.Results 34 acromegalic patients with diabetes were identified. Treatment with SGLT-2i was documented in nine patients, out of them 5 females and 4 males with a mean age (SD) of 61± 12 yr. The mean (SD) duration of treatment with SGLT2i was 27.5 ± 7.3 months. Mean HbA1c before and after SGLT-2i initiation was 8.1 ± 1.1% and 7.0 ± 0.9% respectively. Mean IGF-1 level (SD) before SGLT-2i initiation was 177 ± 68 ng/mL and the mean GH level (SD) was 0.7 ± 0.5 µg/L. All nine patients are still under treatment with SGLT2i and none of them had reported any adverse reaction related to SGLT2i.Conclusions The present article provides us for the first time with new data regarding the use of SGLT2i among acromegalic patients with diabetes.

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Seasonality in Mortality in a Cardiology Department: A Five-Year Analysis in 500 Patients

Cardiology ◽

10.1159/000497815 ◽

2019 ◽

Vol 142 (2) ◽

pp. 67-72

Author(s):

Lourdes Vicent ◽

Vanesa Bruña ◽

Carolina Devesa ◽

Iago Sousa-Casasnovas ◽

Miriam Juárez ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Cause Of Death ◽

Cardiovascular Mortality ◽

Hospital Admissions ◽

Seasonal Trend ◽

Common Cause ◽

Refractory Heart Failure ◽

Cardiology Department ◽

The Mean

Background: Previous studies have indicated that cardiovascular mortality follows a seasonal trend. The aim of this work was to determine the evolution of mortality throughout the year in a cardiology department. Methods: All admissions and deaths occurring in our Cardiology Department over a 5-year period (2013–2017) were recorded retrospectively. Results: From a total of 17,829 hospital admissions, 500 patients died (2.8%, 0.3 patients/day). The mean age of deceased patients was 74.2 ± 13.1 years, and 186 (37.2%) were women. Mortality ranged from 0.17 deaths/day in August to 0.40 deaths/day in February (p = 0.03), and from 0.20 deaths/day in summer to 0.36 deaths/day in winter (p = 0.001). There was also a trend towards a variation in hospitalizations, with a peak in January (10.5 admissions/day) and the lowest figure in August (7.0 admissions/day), p = 0.047. We found no significant seasonal trend regarding mortality rate with respect to the number of hospital admissions (p = 0.89). The most common cause of death was refractory heart failure (267 patients [65.8%]). A noncardiac cause of death was observed in 134 patients (26.8%). Conclusions: In a cardiology department, there are twice as many deaths in winter as in summer. Hospitalizations also tend to be more frequent in winter than in summer.

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Sudden loss of vision in an Acute Medical Unit

Acute Medicine Journal ◽

10.52964/amja.0335 ◽

2014 ◽

Vol 13 (1) ◽

pp. 26-28

Author(s):

Muhammad Arif ◽

◽

Johan Jordaan ◽

Veronica Garcia Arias ◽

◽

...

Keyword(s):

Visual Loss ◽

Early Investigation ◽

Medical Unit ◽

Sudden Loss ◽

Acute Medical Unit ◽

Acute Visual Loss ◽

Patients With Diabetes ◽

Disseminated Aspergillosis ◽

Nose And Throat

We present a case report of young man with Type 1 diabetes who developed acute visual loss after initially presenting with diabetic ketoacidosis. The diagnosis of invasive paranasal sinusoidal aspergillosis was made following CT and biopsy. Although uncommon, visual loss is a recognised complication of disseminated aspergillosis and is more likely in immunecompromised patients and those with diabetes. Early investigation with appropriate sinus imaging and involvement of the Ear Nose and Throat team in recommended when patients with diabetes develop acute visual loss in the context of a non-specific infective illness.

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An Accident and Emergency Department's View of Self-poisoning: a Retrospective Study from the United Norwich Hospitals 1978-1982

Human Toxicology ◽

10.1177/096032718600500102 ◽

1986 ◽

Vol 5 (1) ◽

pp. 5-10 ◽

Cited By ~ 23

Author(s):

R.H.M. Adams

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Hospital Admissions ◽

Medical Unit ◽

Acute Medical Unit ◽

Accident And Emergency ◽

Accident And Emergency Department

This 5-year review of deliberate self-poisoning cases seen in an accident and emergency department revealed that about 700 patients were seen per year. Three-quarters of these needed admission (forming some 15% of all hospital admissions). Of these 65% were referred to the psychiatrist. The remaining quarter were dealt with in the accident and emergency department. Analysis of the data identifies problems where further research is needed. In particular the question is raised as to whether these patients would not be better dealt with in an acute medical unit now that accident departments are turning their attention increasingly to the management of trauma.

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Case based review: Toxicology on the Acute Medical Unit

Acute Medicine Journal ◽

10.52964/amja.0744 ◽

2019 ◽

Vol 18 (1) ◽

pp. 23-32

Author(s):

A Achilleos ◽

◽

Oliver Collas ◽

Nicholas Murch ◽

◽

...

Keyword(s):

Hospital Admissions ◽

Clinical Course ◽

Signs And Symptoms ◽

Organic Substances ◽

Front Line ◽

Medical Unit ◽

Acute Medical Unit ◽

Clinical Vignettes ◽

The Uk ◽

Case Based

Accidental and intentional poisoning from prescribed, illicit and organic substances remains a major cause of morbidity and mortality worldwide and accounts for just under 1% of the total number of NHS hospital admissions, or around 170,000, a year in the UK. A knowledge of the constellation of signs and symptoms that constitute specific poisonings (referred to as toxidromes) may enable early empirical decontamination, antidote administration, enhanced elimination and supportive care, and may also help to predict the clinical course. This paper presents a series of clinical vignettes to demonstrate emerging presentations in toxicology to help inform the practice of Acute Physicians, who alongside colleagues in Emergency Medicine and Critical Care, are at the front line of diagnosing and treating poisoned patients.

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Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

Journal of Neurosurgery ◽

10.3171/2019.5.jns19227 ◽

2020 ◽

Vol 133 (3) ◽

pp. 830-838 ◽

Cited By ~ 1

Author(s):

Andrea Franzini ◽

Giuseppe Messina ◽

Vincenzo Levi ◽

Antonio D’Ammando ◽

Roberto Cordella ◽

...

Keyword(s):

Neuropathic Pain ◽

Lower Limb ◽

Internal Capsule ◽

Posterior Limb ◽

Vas Score ◽

The Mean ◽

Deep Brain ◽

Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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Digital volumetric measurements based on 3D scans of the lower limb: A valid and reproducible method for evaluation in lymphedema therapy. (Preprint)

10.2196/preprints.16923 ◽

2019 ◽

Author(s):

Daniel Schiltz ◽

Natalie Kiermeier ◽

Dominik Eibl ◽

Christoph Koch ◽

Karolina Müller ◽

...

Keyword(s):

Lower Limb ◽

Lower Leg ◽

T Test ◽

Volume Changes ◽

Quick Method ◽

Reproducible Method ◽

The Mean ◽

3D Scans ◽

Paired T Test ◽

Volumetric Measurements

BACKGROUND Exact quantification of volumetric changes of the extremities is difficult. There are several direct and indirect methods to assess extremity volume. As water displacement volumetry is rarely viable in a clinical setting and circumference measurements are prone to errors due to poor reproducibility and high inter- and intra-observer variability, an objective and easily reproducible method is indispensable. OBJECTIVE The aim of this study was to establish a standardized method based on 3D scans with defined caudal and cranial landmarks of the lower leg which allows for measurements of exactly the same body area. Furthermore, this study tests the method in terms of reproducibility and evaluates volume changes after surgical therapy in patients suffering from lymphedema. METHODS 3D-scans of the lower limb were performed with a mobile 3D-scanner. Volumetric calculation was done digitally. “Repeatability“ and “Inter-observer reliability” of digital volumetry were tested. Furthermore, the method was applied on 31 patients suffering from chronic lymphedema. ANOVA (analyses of variance) was conducted to compare the digital volumetric measurements. To assess the sensitivity to changes in digital volumetry, the mean volume of 31 patients before and 3 months after therapy were compared by a paired t-Test. RESULTS Calculations of repeatability of the volume based on 20 3D-scans of the same lower leg showed a mean volume of 2,488 ± 0,011 liters (range: 2,470 – 2,510). The mean volume of the 7 measurements of the 3 examiners did not differ significantly (F(2,18) = 1,579, p = .233). The paired t-Test showed a significant mean volume decrease of 375ml (95% CI = 245/505ml) between pre and post treatment (t (30) =5,892, p < .001). CONCLUSIONS 3D-Volumetry is a noninvasive, easy and quick method to assess volume changes of the lower leg. Other than the costs, it is reproducible and precise and therefore ideal for evolution of therapy in lymphedema.

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