Acute Medical Unit

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https://westmid.openrepository.com/handle/20.500.14200/29

The Primary role of the Acute Medical Unit is to provide rapid definitive assessment, investigation and treatment for patients admitted urgently or as an emergency from the Emergency Department, and/or referred by their GP. The AMU operates in close association with the Emergency Department.

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Cerebellar cavernoma
(Elsevier, 2019-07-25) Bukhari, Shanzay; Naeem, Asma; Upreti, Rajeev; George Eliot Hospital NHS Trust, Nuneaton; Acute Medicine; Medical and Dental; Bukhari, Shanzay; Naeem, Asma; Upreti, Rajeev
Introduction A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They're sometimes known as cavernous angiomas, cavernous haemangiomas or cerebral cavernous malformation. A case report of a young male with cavernomas is reported. Methods A 37-year-old man was referred to the ambulatory care unit from the accident and emergency department with a 2-day history of visual disturbance and dizziness. Clinical examinations of all systems were normal including neurologic examination which did not reveal any focal neurological signs. Routine haematology and biochemistry blood tests were all normal. Initially, a computed tomography of the brain was requested which showed no definite acute abnormality, but a small focus of high attenuation present within the left middle cerebellar peduncle may represent a small cavernoma. Further assessment with magnetic resonance imaging was suggested. The patient was then admitted to the acute medical unit for further investigations and workup. Results and discussion An MRI of the brain was performed and revealed multifocal cerebral microhaemorrhages of variable sizes spread randomly throughout the supra- and infra-tentorial compartments of the brain with no predilection for the deep structures (basal ganglia/thalami) to suggest chronic hypertensive encephalopathy. Cavernoma are less common in males at this age, which makes our case more unique. Conclusion A detailed history (personal and family) are key to detect such malformations in young patients, which also helps physicians be aware of its related complexities and further management.
Knowledge and practice regarding cancer screening in Nepal : a systematic review and meta-analysis
(Wolters Kluwer, 2023-11-23) Adhikari, Ayush; Kashyap, Basant; Acharya, Subi; Sharma, Supriya; Gurung, Shekhar; Yadav, Rupesh Kumar; Budhathoki, Pravash; Tribhuvan University Teaching Hospital, Kathmandu, Nepal; George Eliot Hospital NHS Trust, Nuneaton; Patan Academy of Health Sciences, Lalitpur, Nepal; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal; Bharatpur District Hospital, Nepal; BronxCare Hospital, New York, USA; General Medicine; Medical and Dental; Kashyap, Basant
Background: Cancer screening utilization can aid in the early diagnosis and treatment of cancer. However, the current scenario of the knowledge and practice regarding cancer screening remains unclear as the authors do not have sufficient studies. Hence, the authors conducted this systematic review and meta-analysis to assess the situation of cancer screening utilization and knowledge. Methods: A systematic literature review was conducted to identify all studies on knowledge and practice regarding cancer screening in the Nepalese population. Data extraction and analysis were done with SPSS and CMA-3. Results: The authors identified a total of 5238 studies after database searching, and 19 studies were included in a narrative synthesis. Lack of awareness and knowledge was the major barrier in cervical, breast, and testicular cancer screening. In cervical cancer screening, the most common reason for screening was the advice of health personnel in 85% of respondents, and the barrier was lack of awareness in 49.33% of participants. Conclusion: The knowledge and practice of cancer screening is lacking in Nepal, as shown by our review. More educational and awareness programs, easy access to screening services, and elimination of sociocultural barriers are necessary to increase the utilization of screening services. Keywords: cancer; cervical; knowledge; practice; screening.
Assessing the quality of use of venous thromboembolism (VTE) prophylactic devices for stroke patients at Leeds General Infirmary : an audit and re-audit
(Springer, 2024-12-13) McWilliams, Daniel; Zamani, Rohid; Limaye, Sameer; Leeds Teaching Hospitals NHS Trust; George Eliot Hospital NHS Trust, Nuneaton; University Hospitals Coventry and Warwickshire NHS Trust; Trauma and Orthopaedics; Medical and Dental; Zamani, Rohid
Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients suffering from stroke. Intermittent pneumatic compression devices (IPCs) and geko™ devices are used to reduce the risk of VTE in patients who have suffered an acute stroke. Correct use of the devices is essential for achieving the reduced risk of VTE. Objectives: To assess the quality of use of VTE prophylactic devices by observing if they are both applied and working correctly. To identify and address factors that contribute to suboptimal use of VTE prophylactic devices. Methods: Patients in beds 1-20 in the Acute Stroke Unit at Leeds General Infirmary were assessed on three separate days in June 2024. Data collected included: 'VTE prophylaxis prescribed', 'VTE prophylaxis in place and working correctly?', 'If not, how so?', 'Notes'. Following an intervention, an identical audit was performed three months later. A total of 41 and 42 patients were included in the audit and re-audit, respectively. Results: The audit included 35 patients who were prescribed IPCs (Kendall SCD™ 700 Smart Compression System) and demonstrated a very poor quality of use, with only 22.9% (n=35) observed to be in place and working correctly. The audit included six patients who were prescribed geko™ devices (Firstkind Ltd.) and found that 50% (n=6) were observed to be in place and working correctly. After a presentation of the results at local clinical governance and implementation of interventions, the re-audit demonstrated a substantial increase in the quality of use of both devices. The re-audit included 36 patients who were prescribed IPCs and six who were prescribed geko™ devices. The percentage of IPC and geko™ devices in place and working correctly increased to 75.0% (n=36, p<0.01) and 88.3% (n=6, p>0.01), respectively. Conclusions: The intervention focused on increasing staff awareness of the importance of proper use of VTE prophylaxis and awareness of how to use the devices. It is reasonable to conclude that the improvement seen is a result of a change in these factors. To maintain and further improve quality, awareness of the importance of the devices and how to use them must also be maintained and improved. This should be done by additional systematic measures, such as regular training, and should be regularly reassessed. Keywords: deep vein thrombosis (dvt); devices; geko; intermittent pneumatic compression; prophylaxis; stroke; stroke complications; venous thromboembolism.
Effects of novel therapies on heart failure patients investigate the efficacy and safety of emerging treatments or therapies for heart failure management
(Codon Publications, 2024-04-16) Ali, Muhammad Younas; Ullah, Obaid; Sikandar, Irsa; Noor, Muhammad Amin; Ahmad, Faizan; Yousaf, Aima; Jan, Ayiz; Rukh, Mah; Khan, Adeel; Gajju Khan Medical College, Swabi, Pakistan; South Tyneside and Sunderland NHS Foundation Trust; Lady Reading Hospital, Peshawar, Pakistan; Naseer Teaching Hospital, Peshawar, Pakistan; George Eliot Hospital, Nuneaton; Khyber Teaching Hospital, Peshawar, Pakistan; General and Acute Medicine; Medical and Dental; Yousaf, Aima
Background: Heart failure (HF) is a serious worldwide health issue that is defined by the heart's incapacity to adequately pump blood to meet the body's needs Objective: The research main objective was to examine the safety and effectiveness of novel medications or treatments for the management of HF. Methodology: The purpose of this prospective cohort study was to assess the safety and effectiveness of new heart failure treatments at MTI Lady Reading Hospital Peshawar, Pakistan. A total of 320 adult patients with heart failure (HFpEF or HFrEF) were enrolled between 1st April 2020 and 26th March 2023. Comprehensive data was collected using structured data collecting forms, and treatment outcomes were assessed using follow-up examinations conducted at 3, 6, and 12 months. Subgroup studies based on HF subtype were planned, and descriptive and inferential statistical analyses were used to compare results between innovative and traditional therapy. Results: The groups' baseline characteristics were comparable. The mean ejection fraction increased by +8.4% (±3.6) in the Novel Therapy group (NTG) and +5.9% (±2.8) in the Standard Therapy group (STG) (p < 0.001). Furthermore, improvement in NYHA functional class was observed in a larger proportion of patients in the NTG (76.2% vs. 62.5%, p = 0.013). According to the Kansas City Cardiomyopathy Questionnaire, the group receiving novel therapy had a considerably higher quality of life (45.7 ± 6.3) than the group receiving standard therapy (39.5 ± 7.1) (p < 0.001). The group receiving Novel Therapy saw fewer hospitalizations (15.6%) for worsening heart failure than the group receiving Standard Therapy (23.8%) (p = 0.049). There was no discernible difference in mortality rates across the groups (6.3% vs. 9.4%, p = 0.214). Conclusion: Comparing novel therapy to established treatments, there were notable improvements in heart function, symptom management, and quality of life. These results highlight the necessity for ongoing research and individualized treatment plans, and they promote the inclusion of novel therapies in HF care protocols.
Review on interferon beta: from cells to clinical usage
(Semnan University of Medical Sciences, 2022-01) Hajilou, Fatemeh; Youeseflee, Pouya; Pashaei, Mehrnoosh; Bagheri, Kimiya; Bagheri, Bahador; Islamic Azad University, Tehran, Iran; Semnan University of Medical Sciences, Iran; Tehran University of Medical Sciences, Iran; George Eliot Hospital NHS Trust, Nuneaton; University of Zurich, Schlieren, Switzerland; Medical and Dental; Bagheri, Kimiya
Introduction: Interferon (IFN) was first introduced by Isaacs and Linddeman in 1957. It referred to a factor that could cause inhibition in the growth of the live influenza virus. Interferons are intracellular proteins that are involved in many cellular processes such as growth, proliferation, differentiation, metabolism of the extracellular matrix, apoptosis, and regulating immune responses. There are different intereferones. Amog them, interferons-beta (IFN-β) is a natural cytokine produced by immune cells in response to biological and chemical stimuli. Signal transduction of IFN-β is initiated throughout a heterodimeric receptor complex that is composed of IFNAR1 and IFNAR2 which leads to expression of various proteins via the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway as well as other pathways. In addition to antiviral effects of IFN-β, it has been shown to have therapeutic effects in some autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and lupus. It has recently been shown that the use of IFN-β in combination with other antiviral compounds may be effective in treatment of Covid-19. In this review the various topics about IFN-β are investigated such as signalling pathways, biological functions, therapeutic effects, and side effects of IFN-β therapy.
Unexpected Diagnosis
(Cureus, 2019-09-26) Gill, Gauravpal S; Govindu, Rukma R; Fouda, Ragai; Ammar, Hussam M; Medstar Washington Hospital Center, Washington DC, USA; The University of Texas Health Science Center at Houston, Houston, USA; George Eliot Hospital NHS Trust, Nuneaton; Acute Medicine; Medical and Dental; Gill, Gauravpal S; Govindu, Rukma R; Fouda, Ragai; Ammar, Hussam M
A 74-year-old man presented to the ER with an eight-month history of shortness of breath, cough, anorexia, and weight loss. He had emigrated from sub-Saharan African to the USA, where he was diagnosed and treated for coronary artery disease, heart failure, and stroke; was hospitalized several times; and underwent hernia surgery. Despite the complex care that he received in the USA for many years, the diagnosis of AIDS was continually missed for years, and the patient was eventually diagnosed at the age of 74.
Cerebellar cavernoma
(Elsevier, 2019-06) Bukhari, Shanzay; Naeem, Asma; Upreti, Rajeev; George Eliot Hospital, Nuneaton; Acute Medicine; Medical and Dental; Bukhari, Shanzay; Naeem, Asma; Upreti, Rajeev
Introduction A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They're sometimes known as cavernous angiomas, cavernous haemangiomas or cerebral cavernous malformation. A case report of a young male with cavernomas is reported. Methods A 37-year-old man was referred to the ambulatory care unit from the accident and emergency department with a 2-day history of visual disturbance and dizziness. Clinical examinations of all systems were normal including neurologic examination which did not reveal any focal neurological signs. Routine haematology and biochemistry blood tests were all normal. Initially, a computed tomography of the brain was requested which showed no definite acute abnormality, but a small focus of high attenuation present within the left middle cerebellar peduncle may represent a small cavernoma. Further assessment with magnetic resonance imaging was suggested. The patient was then admitted to the acute medical unit for further investigations and workup. Results and discussion An MRI of the brain was performed and revealed multifocal cerebral microhaemorrhages of variable sizes spread randomly throughout the supra- and infra-tentorial compartments of the brain with no predilection for the deep structures (basal ganglia/thalami) to suggest chronic hypertensive encephalopathy. Cavernoma are less common in males at this age, which makes our case more unique. Conclusion A detailed history (personal and family) are key to detect such malformations in young patients, which also helps physicians be aware of its related complexities and further management. Conflict of interest statement None declared.
Utility of severity assessment tools in COVID-19 pneumonia: a multicentre observational study.
(Elsevier, 2022-01) Ahmed, Asim; Alderazi, Sayed A; Aslam, Rumaisa; Barkat, Barooq; Barker, Bethan L; Bhat, Rahul; Cassidy, Samuel; Crowley, Louise E; Dosanjh, Davinder Ps; Ebrahim, Hussain; Elndari, Najla; Gardiner, Claudia; Gogokhia, Atena; Grudzinska, Frances S; Gurung, Megha T; Hughes, Terry; Ismail, Iyad; Iredale, Natasha; Irshad, Sannaan; Johnson, Sarah; Kavanagh, Diana; Knight, Thomas; Livesey, Alana; Lugg, Sebastian T; Marathe, Manoj; McDougall, Andrew; Nawaz, Wasim; Nettleton, Kimberly; O'Flynn, Lauren; Okoth, Kelvin; Parekh, Dhruv; Perry, Rita; Pudney, Elizabeth J; Sadiq, Ambreen; Soge, Olutobi; Soloman, Rhania; Soltan, Marina; Strecker, Martin; Thein, Onn S; Thickett, David; Thomas, Ajit; Thornton, Riah; Royal Stoke University Hospital; George Eliot Hospital; Good Hope Hospital; Russells Hall Hospital; Worcestershire Acute Hospitals NHS Trust; Queen Elizabeth Hospital Birmingham; Sandwell and West Birmingham NHS Trust; Sandwell and West Birmingham NHS Trust; Respiratory; Acute Medical Unit; Critical Care; Medical and Dental; Kavanagh, Diana; Gogokhia, Atena; Ismail, Iyad; Nawaz, Wasim; Crowley, Louise E; Lugg, Sebastian T; Parekh, Dhruv; Soltan, Marina; Thein, Onn S; Thickett, David
Background: Severity scores in pneumonia and sepsis are being applied to SARS-CoV-2 infection. We aimed to assess whether these severity scores are accurate predictors of early adverse outcomes in COVID-19. Methods: We conducted a multicentre observational study of hospitalised SARS-CoV-2 infection. We assessed risk scores (CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2) in relation to admission to intensive care or death within 7 days of admission, defined as early severe adverse events (ESAE). The 4C Mortality Score was also assessed in a sub-cohort of patients. Findings: In 2,387 participants, the overall mortality was 18%. In all scores examined, increasing score was associated with increased risk of ESAE. Area under the curve (AUC) to predict ESAE for CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2 were 0.61, 0.62, 0.59, 0.59 and 0.68, respectively. AUC to predict ESAE was 0.60 with ISARIC 4C Mortality Score. Conclusion: None of the scores examined accurately predicted ESAE in SARS-CoV-2 infection. Non-validated scores should not be used to inform clinical decision making in COVID-19. Keywords: COVID-19; collaborative; pneumonia; severity score.

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