Recent Submissions

  • Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019.

    Atkin, Catherine; Prinja, Paarul; Banerjee, Anita; Holland, Mark; Lasserson, Dan; Lasserson, Dan; Sandwell and West Birmingham NHS Trust; Medical and Dental; Sandwell and West Birmingham NHS Trust; University of Birmingham; Royal Wolverhampton NHS Trust (SAGE Publications, 2020-06-23)
    Background: Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods: Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results: One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion: Current provision of services within acute medicine for pregnant women does not meet national recommendations.
  • Sleep is the best medicine: How rest facilities and EnergyPods can improve staff wellbeing.

    Dore, Eoin; Guerero, Daniel; Wallbridge, Thomas; Holden, Angela; Anwar, Mehreen; Eastaugh, Alison; Desai, David; Clare, Sarbjit; Dore, Eoin; Guerero, Daniel; et al. (Elsevier, 2021-11-08)
    Introduction: Healthcare workers' wellbeing is critical to the NHS. Night shifts have a big impact on their physical and mental health. Recently there has been national funding for rest facilities. Methods: An EnergyPod was installed in the acute medical unit. The study comprised two surveys: one quantitative survey performed prior to the pod introduction and repeated 3 months after; and one qualitative survey performed immediately after pod use. Results: We observed more staff taking breaks of 30 minutes after the pod introduction (37% before vs 69% after). Of users, 81% felt more alert and 83% were more energised. Half of the respondents felt more able to drive after use.The feedback showed three themes: appreciation of designated space away from clinical areas, relaxation and improved interdisciplinary cohesion. Conclusion: We have shown consistent data that rest is important for wellbeing. We recommend the use of EnergyPods in high acuity areas.
  • Surgical management of a giant abdominal wall desmoid tumour.

    Patel, Nandesh; Slivkova, Ralitsa; James, Sunil; Almond, Max; Patel, Nandesh; Ralitsa, Slivkova; James, Sunil; Sandwell and West Birmingham NHS Trust; Medical and Dental; Sandwell and West Birmingham NHS Trust; University Hospitals Birmingham NHS Foundation Trust (BMJ Publishing Group, 2021-09-03)
    Desmoid tumours are clonal fibroblastic proliferations in soft tissues, characterised by infiltrative growth and local recurrence, but not metastasis. Various treatment strategies for desmoid tumours exist, varying from observation, medical and systemic therapy to radiotherapy and surgery. A 25-year-old woman with a background of familial adenomatous polyposis was referred with an enlarging abdominal desmoid tumour measuring 40×40×40 cm despite repeated radiofrequency ablation, surgical debulking and hormone therapy. The patient had a two-stage operation. The first stage involved excision of the desmoid tumour with full-thickness abdominal wall. The abdominal wall was not closed, and a topical negative pressure seal was applied. After 2 days, she underwent the second stage: reconstruction of the abdominal wall defect with a large porcine mesh which was covered with anterolateral thigh flaps. Postoperative complications included ileus and a fall which required further surgery. The patient was discharged 1 month after the first operation. Abdominal MRI scans were performed at 3 and 7 months postdischarge and showed no recurrence of diseaseBackground.
  • The provision of hospital at home care: Results of a national survey of UK hospitals

    Knight, Thomas; Harris, Ciara; Mas, Miquel À.; Shental, Omri; Ellis, Graham; Lasserson, Daniel; Harris, Ciara; Knight, Thomas; Sandwell and West Birmingham NHS Trust; Medical and Dental; et al. (Hindawi LimitedWiley, 2021-10-11)
    Background: Hospital at home (HaH) replicates elements of hospital-based care in the community, to facilitate the safe management of a broad spectrum of acute illness in the patient's usual environment. The extent to which this model of care has been adopted in the United Kingdom is unknown. Methods: The Society for Acute Medicine Benchmarking Audit is a day of care survey undertaken annually within the United Kingdom. Participation is open to all hospital in the United Kingdom receiving acutely unwell medical patients. A questionnaire is used to collect hospital-level data on the structure and organisation of acute care delivery. The survey included questions designed to quantify the number of hospitals that offered HaH. When present, further questions were asked to clarify the characteristics of the HaH service in terms of workforce, range of diagnostic test and interventions. This information was used to build a picture of HaH service provision on a national scale. Results: A total of 130 hospitals contributed organisational data to SAMBA19. The capability to refer to a hospital at home service was recognised by 46.9% (n = 61) of units. The majority of these services, 83.3% (n = 50) were nurse-led. The capability to provide a physician review at home was reported in 23.3% (n = 14). The majority of services could provide intravenous antibiotics at home, but access to other simple interventions, such as intravenous diuretics or acute supplemental oxygen, is limited. Conclusion: At present, few acute hospitals for consitency in the United Kingdom have access to a hospital at home service capable of replicating essential elements of inpatient care. Our study suggests organisational change in acute care delivery and significant investment would be required to establish equal access to hospital-at-home care within the United Kingdom.
  • Fatal case of delayed-onset haemolytic anaemia after oral artemether-lumefantrine.

    Gustafsson, Lotta; James, Sunil; Zhang, Yimeng; Thozhuthumparambil, Karunakaran Pradeep; Gustafsson, Lotta; James, Sunil; Zhang, Yimeng; Thozhuthumparambil, Karunakaran Pradeep.; Acute Medicine; Medical and Dental; et al. (BMJ Publishing Group, 2021-11-19)
    Artemisinin derivatives are used globally in the management of falciparum malaria. Postartemisinin delayed haemolysis (PADH) is a recognised adverse event contributing to severe anaemia. To the best of our knowledge, we report the first recorded fatal case of PADH. A 60-year-old woman presented with two episodes of collapse at home and feeling generally unwell. She had recently been treated for uncomplicated falciparum malaria 1 month prior with artemether 80 mg/lumefantrine 480 mg in Congo. Her results on admission revealed an anaemia (haemoglobin 43 g/L), raised lactate dehydrogenase and positive direct antiglobulin test that suggested an intravascular haemolytic process. She made a capacitous decision to refuse blood products in line with her personal beliefs. Despite best supportive treatment, she did not survive. This case highlights the importance of postartemisinin follow-up and should encourage discussion and careful consideration of its use in the context of lack of access to/patient refusal of blood products.
  • Poly (ADP-ribose) polymerase inhibitor therapy and mechanisms of resistance in epithelial ovarian cancer

    Kulkarni, Sanat; Gajjar, Ketankumar; Madhusudan, Srinivasan; Kulkarni, Sanat; Acute Medicine; Medical and Dental; Sandwell and West Birmingham NHS Trust; University of Birmingham; Nottingham University Hospitals; University of Nottingham (Frontiers Media, 2024-07-29)
    Advanced epithelial ovarian cancer is the commonest cause of gynaecological cancer deaths. First-line treatment for advanced disease includes a combination of platinum-taxane chemotherapy (post-operatively or peri-operatively) and maximal debulking surgery whenever feasible. Initial response rate to chemotherapy is high (up to 80%) but most patients will develop recurrence (approximately 70-90%) and succumb to the disease. Recently, poly-ADP-ribose polymerase (PARP) inhibition (by drugs such as Olaparib, Niraparib or Rucaparib) directed synthetic lethality approach in BRCA germline mutant or platinum sensitive disease has generated real hope for patients. PARP inhibitor (PARPi) maintenance therapy can prolong survival but therapeutic response is not sustained due to intrinsic or acquired secondary resistance to PARPi therapy. Reversion of BRCA1/2 mutation can lead to clinical PARPi resistance in BRCA-germline mutated ovarian cancer. However, in the more common platinum sensitive sporadic HGSOC, the clinical mechanisms of development of PARPi resistance remains to be defined. Here we provide a comprehensive review of the current status of PARPi and the mechanisms of resistance to therapy.
  • Thyrotoxic periodic paralysis : a case report with patient perspective

    Baranskaya, Aliaksandra; Zhang, Yimeng; Lee, Brian; Baranskaya, Aliaksandra; Zhang, Yimeng; Lee, Brian; Acute Medical Unit; Medical and Dental; Sandwell and West Birmingham NHS Trust (Rila, 2024)
    We present a case report on a spot diagnosis of Thyrotoxic Periodic Paralysis (TPP) with a unique first-person account of events from the patient. It illustrates the importance of pattern recognition and exemplifies how timely treatment enables quick resolution of a life-threatening medical emergency. Patient X's account affirms the condition's insidious onset and rapid deterioration. This case highlights the need for raising awareness of diseases that are more prevalent in specific ethnic groups and is particularly crucial for work in culturally diverse environments. We hope by sharing our experience, readers will be prompted to consider TPP as a differential diagnosis for acute limb weakness in an acute setting; with prompt testing of thyroid function and initiation of the appropriate treatments.
  • Cat scratch disease sepsis in an immunocompromised patient.

    James, Sunil; Thozhuthumparambil, Karunakaran Pradeep; James, Sunil; Thozhuthumparambil, Karunakaran Pradeep.; Acute Medicine; Medical and Dental; Sandwell and West Birmingham NHS Trust (BMJ Publishing Group, 2021-07-13)
    As a greater number of households have pets, the likelihood of zoonotic infections can rise too. Although in most healthy individuals these infections are self-limiting, they are more serious and can lead to adverse outcomes in the immunocompromised. There is minimal information available for the immunocompromised patient who are pet owners or on pet handling. We report a case of cat scratch disease-related sepsis in an immunocompromised patient. This case illustrates the need for a detailed history, including a pet history, in immunocompromised patients presenting with fever of unknown origin and the need for UK-based information for the immunocompromised on pet care and risks associated with having a pet.
  • 'From highs to lows : a cautionary tale of nitrous oxide recreational use leading to sub-acute combined degeneration of the cord'

    Osman, Ayman; Yousif, Dalia; Hickman, Simon; Branagh, William; Yousif, Dalia; Acute Medicine; Medical and Dental; Bolton NHS Foundation Trust; Sandwell and West Birmingham NHS Trust (Oxford University Press, 2024-07-13)
    Background: Several causes lead to subacute combined degeneration (SACD) of the spinal cord, with nitrous oxide (N2O) inhalation rapidly emerging as the leading cause of functional Vitamin B12 deficiency [1]. Case presentation: A 28-year-old man presented with numbness in the extremities and an unstable gait despite having a normal serum Vitamin B12 level. He also disclosed the recreational abuse of N2O. Magnetic Resonance Imaging (MRI) of the cervical spine revealed abnormal signals consistent with SACD. The patient's condition gradually improved after treatment with high dose Vitamin B12. Given the increasing number of N2O-induced SACD cases, the potential for drug abuse requires vigilance from clinicians. Conclusion: Healthcare providers are urged to inquire about a patient's history of N2O inhalation to prevent the missed diagnosis of SACD.
  • Brainstem stroke presenting as isolated bilateral ptosis.

    James, Sunil; Thozhuthumparambil, Karunakaran Pradeep; James, Sunil; Thozhuthumparambil, Karunakaran Pradeep.; Acute Medicine; Medical and Dental; Sandwell and West Birmingham NHS Trust (BMJ Publishing Group, 2021-07-12)
    Pure midbrain infarctions not involving surrounding structures are an uncommon clinical phenomenon. A midbrain infarction that results in isolated bilateral ptosis as the only neurological deficit is much rarer and an easy diagnosis to miss; therefore, potentially leading to further downstream complications. We describe the case of an elderly patient who presented with isolated bilateral ptosis, initially thought to be consequent to myasthenia gravis but subsequently identified to have a perforator infarct in the midbrain, resulting in his symptoms.
  • Bilateral optic disc swelling resulting from lymphocytic meningitis and posterior uveitis secondary to syphilis.

    James, Sunil; Thozhuthumparambil, Karunakaran Pradeep; James, Sunil; Thozhuthumparambil, Karunakaran Pradeep.; Acute Medicine; Medical and Dental; Sandwell and West Birmingham NHS Trust (BMJ Publishing Group, 2021-05-19)
    Idiopathic intracranial hypertension (IIH) is being diagnosed more often in the UK due to the rise in obesity. In fact, patients who present with bilateral optic disc swelling are habitually put on the papilloedema pathway, often without consideration of other diagnoses. We report the case of a middle-aged woman diagnosed with papilloedema and managed as IIH, until, cerebrospinal fluid (CSF) analysis revealed evidence of lymphocytic meningitis secondary to syphilis. The patient was treated successfully with intravenous antibiotics. Syphilis is the great masquerader and should be a diagnosis to consider in patients who have CSF findings incongruent with their clinical presentation.
  • Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial.

    Hinks, Timothy S C; Cureton, Lucy; Knight, Ruth; Wang, Ariel; Cane, Jennifer L; Barber, Vicki S; Black, Joanna; Dutton, Susan J; Melhorn, James; Jabeen, Maisha; et al. (Elsevier, 2021-07-09)
    Background: The antibacterial, anti-inflammatory, and antiviral properties of azithromycin suggest therapeutic potential against COVID-19. Randomised data in mild-to-moderate disease are not available. We assessed whether azithromycin is effective in reducing hospital admission in patients with mild-to-moderate COVID-19. Methods: This prospective, open-label, randomised superiority trial was done at 19 hospitals in the UK. We enrolled adults aged at least 18 years presenting to hospitals with clinically diagnosed, highly probable or confirmed COVID-19 infection, with fewer than 14 days of symptoms, who were considered suitable for initial ambulatory management. Patients were randomly assigned (1:1) to azithromycin (500 mg once daily orally for 14 days) plus standard care or to standard care alone. The primary outcome was death or hospital admission from any cause over the 28 days from randomisation. The primary and safety outcomes were assessed according to the intention-to-treat principle. This trial is registered at ClinicalTrials.gov (NCT04381962) and recruitment is closed. Findings: 298 participants were enrolled from June 3, 2020, to Jan 29, 2021. Three participants withdrew consent and requested removal of all data, and three further participants withdrew consent after randomisation, thus, the primary outcome was assessed in 292 participants (145 in the azithromycin group and 147 in the standard care group). The mean age of the participants was 45·9 years (SD 14·9). 15 (10%) participants in the azithromycin group and 17 (12%) in the standard care group were admitted to hospital or died during the study (adjusted OR 0·91 [95% CI 0·43-1·92], p=0·80). No serious adverse events were reported. Interpretation: In patients with mild-to-moderate COVID-19 managed without hospital admission, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death. Our findings do not support the use of azithromycin in patients with mild-to-moderate COVID-19.
  • Banter within the NHS : a tool for boosting morale or a front for workplace bullying?

    Dicks-Ilori, Lucy; Morgan, Marianne; Yuan, Mengshi; Clare, Sarbjit; Dicks-Ilori, Lucy; Morgan, Marianne; Yuan, Mengshi; Clare, Sarbjit; Acute Medicine; Medical and Dental; et al. (Elsevier, 2024-06)
    Workplace humour, such as banter between colleagues, is a widespread means of developing relationships and relieving daily work stresses. Despite this, banter in the workplace is a prevalent theme of harassment and bullying claims. With staff morale at an all-time low among NHS employees, efforts must be made to identify and rectify issues which work to damage staff experiences within the organisation. We aimed to explore both the positive and negative impacts of banter on NHS staff well-being. We discuss the role of staff training on the appropriate use of workplace humour, with reference to a workshop delivered to NHS employees, educating them on the appropriate use of banter.
  • NEWS2 to assess suspected COVID-19 in the community: a service evaluation of a primary care assessment centre.

    Zaman, Imran; Beevers, Zachary C R; Ahmed, Ridwan; Lasserson, Daniel; Knight, Thomas; Lasserson D, Knight T; Sandwell and West Birmingham NHS Trust; Medical and Dental; Aston Medical School; School of Medicine University of Leeds; University of Warwick; Sandwell and West Birmingham NHS Trust (Oxford University Press, 2021-08)
    Background: Primary care has played a central role in the community response to the coronavirus disease-19 (COVID-19) pandemic. The use of the National Early Warning Score 2 (NEWS2) has been advocated as a tool to guide escalation decisions in the community. The performance of this tool applied in this context is unclear. Aim: To evaluate the process of escalation of care to the hospital within a primary care assessment centre (PCAC) designed to assess patients with suspected COVID-19 in the community. Design and setting: A retrospective service evaluation of all adult patients assessed between 30 March and 22 April 2020 within a COVID-19 primary care assessment centre within Sandwell West Birmingham CCG. Method: A database of patient demographics, healthcare interactions and physiological observations was constructed. NEWS2 and CRB65 scores were calculated retrospectively. The proportion of patients escalated was within risk groups defined by NHSE guidelines in place during the evaluation period was determined. Results: A total of 150 patients were identified. Following assessment 13.3% (n = 20) patients were deemed to require escalation. The proportion of patients escalated with a NEWS2 greater than or equal to 3 was 46.9% (95% CI 30.8-63.6%). The proportion of patients escalated to secondary care using NHSE defined risk thresholds was 0% in the green group, 22% (n = 4) in the amber group, and 81.3% (n = 13) in the red group. Conclusion: Clinical decisions to escalate care to the hospital did not follow initial guidance written for the COVID-19 outbreak but were demonstrated to be safe.
  • AMU patient list generation : from junior scribe to junior doctor

    Ravat, Zahra; Sinha, Amil; Jellinek, Alistair; Page, Nigel; Ravat, Zahra; Sinha, Amil; Jellinek, Alistair; Page, Nigel; Acute Medical Unit; Medical and Dental; et al. (BMJ Publishing Group, 2024-03-01)
    This quality improvement project (QIP) aimed to assess the impact of automating patient list generation on the acute medical unit (AMU) at Sandwell and West Birmingham Hospitals NHS Trust. The AMU patient list categorises patients requiring 'clerking', 'post-take' (PTWR) and 'post-post-take' (PPTWR) for the morning ward round. During weekdays, this list need only include the patients in AMU. For weekends, this list must include 'outliers', that is, patients transferred to different wards (which may lack resident medical teams over the weekends) but still requiring PTWR/PPTWR. The list is created by the junior doctor on their night shift, a daily necessity due to the high AMU patient turnover.A pilot study, followed by three complete 'plan-do-study-act' (PDSA) cycles, was conducted over 2021/2022. Cycle 1 (pre-intervention) and cycle 2 (post-intervention) assessed the impact of the generator on weekdays. This was adapted for the weekend over cycles 2 and 3. The process measure assessed was the time taken for list generation. The outcome measure was the total number of patients clerked per night. The balancing measure was doctors' attitudes.The intervention reduced the time taken for list generation by an average of 44.3 min (66.3%) during weekdays and 37.8 min (42%) during weekends. Run charts demonstrated significance for the reduction in weekday list generation time. Both weekdays (63.5% decrease, p<0.00001) and weekends (50.5% decrease, p=0.0007) had significant reductions in total negative attitudes. Both weekdays and weekends had 'time-consuming' as the most frequently selected attitude pre-intervention, whereas 'easy to make' was most frequently selected post-intervention. Some junior doctors reported the generator enabled clerking of extra patients, supported by non-significant increases in the averages for this outcome.This QIP demonstrates how the automation of labour-intensive administrative tasks results in notable time-saving outcomes. Thereby improving doctor attitudes and well-being, and facilitating the delivery of quality patient care.
  • Bisphosphonate therapy in the management of diffuse sclerosing osteomyelitis of the mandible : a systematic review and narrative synthesis

    Abukhder, Munir; Nasri Elmi, Salmane; Van Der Lith, Sarah; Hawesa, Nour; Abukhder, Daniah; Abid, Husnain; Liu, Linda; Abid, Husnain; General Medicine; Medical and Dental; et al. (Wolters Kluwer, 2023-12-13)
    Background: Diffuse sclerosing osteomyelitis (DSO) affecting the mandible is an uncommon condition characterised by recurrent pain and functional disturbances. Traditional treatments involving antibiotics, steroids, and analgesics have generally yielded unsatisfactory results. Numerous articles have proposed the utilisation of bisphosphonate therapy as an alternative approach to achieve sustained symptom relief. This study aims to consolidate the available evidence on the effectiveness of bisphosphonate therapy in managing DSO. Methods: A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies were devised, and studies were screened based on predefined inclusion and exclusion criteria. Results: Ten articles met the eligibility criteria, encompassing a total of 135 patients diagnosed with DSO who received bisphosphonate treatment. All included studies consistently reported a reduction in pain levels and swelling, along with a decrease in the cumulative use of analgesics. The majority of patients reported long-lasting symptom improvement with bisphosphonate therapy. Notably, four studies documented improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Furthermore, six studies observed improvements in panoramic radiographs and cone beam computed tomography scans, with one publication describing two patients exhibiting near-normal bone architecture. Importantly, all studies reported the absence of long-term complications. Conclusions: Bisphosphonate therapy emerges as a promising treatment modality for DSO, exhibiting efficacy in symptom alleviation and radiological enhancement while conferring lasting benefits. Nevertheless, further prospective studies are warranted to refine treatment protocols and substantiate these findings.
  • Care pathways in older patients seen in a multidisciplinary same day emergency care (SDEC) unit

    Elias, Tania C N; Jacklin, Chloe; Bowen, Jordan; Lasserson, Daniel; Pendlebury, Sarah T; Lasserson, Daniel; Acute Medicine; Medical and Dental; Great Western Hospital NHS Foundation Trust; North Middlesex University Hospital NHS Trust; Oxford University Hospitals NHS Foundation Trust; Sandwell and West Birmingham NHS Trust; et al. (Oxford University Press, 2024-01-02)
    Background: Same day emergency care (SDEC) services are being advocated in the UK for frail, older patients in whom hospitalisation may be associated with harm but there are few data on the 'ambulatory pathway'. We therefore determined the patient pathways pre- and post-first assessment in a SDEC unit focussed on older people. Methods: In consecutive patients, we prospectively recorded follow-up SDEC service reviews (face-to-face, telephone, Hospital-at-Home domiciliary visits), outpatient referrals (e.g. to specialist clinics, imaging, and community/voluntary/social services), and hospital admissions <30 days. In the first 67 patients, we also recorded healthcare interactions (except GP attendances) in the 180 days pre- and post-first assessment. Results: Among 533 patients (mean/SD age = 75.0/17.5 years, 246, 46% deemed frail) assessed in an SDEC unit, 210 were admitted within 30 days (152 immediately). In the 381(71%) remaining initially ambulatory, there were 587 SDEC follow-up reviews and 747 other outpatient referrals (mean = 3.5 per patient) with only 34 (9%) patients being discharged with no further follow-up. In the subset (n = 67), the number of 'healthcare days' was greater in the 180 days post- versus pre-SDEC assessment (mean/SD = 26/27 versus 13/22 days, P = 0.003) even after excluding hospital admission days, with greater healthcare days in frail versus non-frail patients. Discussion and conclusion: SDEC assessment in older, frail patients was associated with a 2-fold increase in frequency of healthcare interactions with complex care pathways involving multiple services. Our findings have implications for the development of admission-avoidance models including cost-effectiveness and optimal delivery of the multi-dimensional aspects of acute geriatric care in the ambulatory setting.
  • Antihypertensive treatment in people of very old age with frailty : time for a paradigm shift?

    Shantsila, Eduard; Lip, Gregory Y H; Shantsila, Alena; Kurpas, Donata; Beevers, Gareth; Gill, Paramjit S; Williams, Nefyn H; Beevers, Gareth; Medicine; University of Liverpool; Aalborg University; Wrocław Medical University; Sandwell and West Birmingham NHS Trust; et al. (Lippincott, Williams & Wilkins, 2023-07-05)
    The optimal management of hypertension in individuals aged 80 years or older with frailty remains uncertain due to multiple gaps in evidence. Complex health issues, polypharmacy, and limited physiological reserve make responding to antihypertensive treatments unpredictable. Patients in this age group may have limited life expectancy, so their quality of life should be prioritized when making treatment decisions. Further research is needed to identify which patients would benefit from more relaxed blood pressure targets and which antihypertensive medications are preferable or should be avoided. A paradigm shift is required in attitudes towards treatment, placing equal emphasis on deprescribing and prescribing when optimizing care. This review discusses the current evidence on managing hypertension in individuals aged 80 years or older with frailty, but further research is essential to address the gaps in knowledge and improve the care of this population.
  • Correspondence - Ultrasound for lumbar punctures : an Invaluable tool for the acute physician

    Taylor, A; Clare, S; Taylor, Andreea; Clare, Sarbjit; Acute Internal Medicine; Medical and Dental; Sandwell and West Birmingham NHS Trust (Rila, 2023)
    The traditional procedure of identifying anatomical landmarks when performing lumbar punctures can lead to a failure rate of 19%. The Society of Hospital Medicine have published a statement, recommending use of ultrasound (US) guidance for all adult lumbar punctures (LP). A recent meta-analysis found several advantages of point of care US guided LP: higher success rate and diminished pain. US assisted LP is easy to learn, integrating ultrasound guided LP into Acute Medicine curriculum, could lead to better patient outcome.
  • COVID-19 seroprevalence after the first UK wave of the pandemic and its association with the physical and mental wellbeing of secondary care healthcare workers.

    Sethi, Sonika; Manuelpillai, Natasha; Mandal, Anandadeep; Simpson, Olivia; Morrissey, Hana; Ball, Patrick; Sharrod-Cole, Hayley; Ford, Clare; Whittaker, Anna C; Drayson, Mark; et al. (Elsevier, 2022-08-06)
    Objectives: To determine the seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibody status amongst healthcare workers (HCWs) working through the first wave of the Coronavirus (COVID-19) pandemic in 2020. To examine the association of seroprevalence and self-reported COVID-19 symptoms with occupation, sex, and ethnicity; and how these factors were associated with physical and mental wellbeing. Design: Single-centre cohort study. Setting: Large public hospital in the United Kingdom. Intervention: All HCWs who had been tested for anti-SARS-CoV-2 immunoglobulin (Ig) G nucleocapsid antibody in summer 2020 were asked to complete an electronic survey focusing on their physical and mental health in Winter 2020-21. This survey was comprised of the Short Form 12v2, Physical Component Summary (PCS), Mental Component Summary (MCS), and Generalised Anxiety Disorder 7-item (GAD-7) questionnaires. Results: 7604/9781 (77.7%) HCWs were antibody tested, of which 1082 completed the full survey. Antibody testing was conducted between 17/06/20-30/07/20, during which time our seroprevalence rate was 28% (299/1082). Of those self-reporting COVID-19 symptoms, 51% (201/395) were antibody positive. Antibody-positive participants had lower PCS scores (p = 0.016), indicating poorer physical health. Lower PCS scores were also found in those deemed high risk for COVID-19 by their GP (p = 0.001), and those aged >44 years (p = 0.009). Antibody-negative participants had lower MCS scores (p = 0.044), indicating poorer mental health. Those who self-reported COVID-19 symptoms had lower PCS scores (p=<0.001) than those with no symptoms. Lower MCS scores were found in women (p = 0.001), Caucasians (p = 0.018), non-clinicians (p = 0.001), and those aged <44 years (p = 0.009). Significantly higher GAD-7 anxiety scores were evident in staff aged <44 years (p = 0.023), and those with self-reported COVID symptoms (p = 0.031). Doctors had lower GAD-7 anxiety scores (p = 0.009). Conclusion: Self-reported symptoms did not correlate with seroprevalence; data surrounding this can be useful for future workforce planning. Interventions are needed to reduce the mental and physical burden of the pandemic on HCWs. Further work is needed to identify which particular HCWs may require further support, to ensure well-being and effective patient care.

View more