Recent Submissions

  • Exploring BAME student experiences in healthcare courses in the United Kingdom : a systematic review

    Singh Grewal, Callum; Bilal Khan, Mohammed; Kiran Kaur Panesar, Jasmin; Asher, Simal; Mehan, Navjyot; Asher, Simal; Accident and Emergency; Medical and Dental; Royal Wolverhampton NHS Trust; Cardiff University; Walsall Healthcare NHS Trust; University of Manchester (Shiraz University of Medical Sciences, 2024-01-01)
    Introduction: Black, Asian, and Minority Ethnic (BAME) students in healthcare-related courses are exposed to various challenging experiences compared to their White counterparts, not only in the UK (United Kingdom) but across the globe. Underachieving, stereotyping, racial bias, and cultural differences, among other experiences, hinder their medical education, practice, and attainment. This review aimed to explore and understand the experiences of BAME students enrolled in healthcare related courses in the United Kingdom. Methods: Computerised bibliographic search was carried out using MeSH and free text descriptors via PubMed, Cochrane, Google Scholar, and Science Direct for eligible English-published studies exploring BAME experiences in the UK from 2010-2023. Results: A cumulative total of 813 studies were obtained from the literature search, of which five met the inclusion criteria. Quality assessment for risk of bias was assessed using the Newcastle Ottawa scale, yielding one study of satisfactory quality, while four were deemed to be of good quality. Conclusion: BAME students pursuing health-related courses across the UK. face a range of experiences, including racial discrimination, unconscious bias, and a lack of representation and support. Additionally, BAME students are more likely to report incidents of racial harassment and withdraw from their respective courses as well as experiencing mental health issues due to their experiences.
  • A progressive and severe rash - answers

    McCormack, M; McDonagh, C; Ali, M; McCormack, M; McDonagh, C; Ali, M; Accident and Emergency; Medical and Dental; Walsall Healthcare NHS Trust (Karger Publishers, 2021-04)
    A 73-year-old female patient with epilepsy presented to hospital with a progressive, diffuse macular rash over the trunk and limbs with associated mucosal blistering and discharge. Ocular symptoms initially predominated and she was treated for presumed bacterial conjunctivitis by her General Practitioner the previous day. On the acute medical unit supportive management was initiated for suspected adverse drug reaction (ADR) to a recent lamotrigine dose increase. Skin biopsy confirmed a diagnosis of toxic epidermal necrolysis. We present this case to highlight the importance of medication history taking and raise awareness of indolent presentations of life-threatening ADRs. Caution should be applied following dose changes to anti-epileptics, even if previously stable.
  • A progressive and severe rash

    McCormack, M; McDonagh, C; Ali, M; McCormack, M; McDonagh, C; Ali, M; Accident and Emergency; Medical and Dental; Walsall Healthcare NHS Trust (Karger Publishers, 2021-04)
    A 73-year-old female attended the Emergency Department with a twenty four hour history of a progressive, diffuse macular rash, predominantly affecting limbs and trunk, with associated oral and ocular discharge.
  • Relationship between emergency department and inpatient occupancy and the likelihood of an emergency admission: a retrospective hospital database study

    Wyatt, Steven; Joshi, Ruchi; Mortimore, Janet M; Mohammed, Mohammed A; Joshi, Ruchi; Mortimore, Janet; Emergency Department; Admin and Clerical; Medical and Dental; NHS Midlands and Lancashire Commissioning Support Unit; Walsall Healthcare NHS Trust; University of Wolverhampton; University of Bradford (BMJ Publishing Group, 2021-08-04)
    Background: We investigate whether admission from a consultant-led ED is associated with ED occupancy or crowding and inpatient (bed) occupancy. Methods: We used general additive logistic regression to explore the relationship between the probability of an ED patient being admitted, ED crowding and inpatient occupancy levels. We adjust for patient, temporal and attendance characteristics using data from 13 English NHS Hospital Trusts in 2019. We define quintiles of occupancy in ED and for four types of inpatients: emergency, overnight elective, day case and maternity. Results: Compared with periods of average occupancy in ED, a patient attending during a period of very high (upper quintile) occupancy was 3.3% less likely (relative risk (RR) 0.967, 95% CI 0.958 to 0.977) to be admitted, whereas a patient arriving at a time of low ED occupancy was 3.9% more likely (RR 1.039 95% CI 1.028 to 1.050) to be admitted. When the number of overnight elective, day-case and maternity inpatients reaches the upper quintile then the probability of admission from ED rises by 1.1% (RR 1.011 95% CI 1.001 to 1.021), 3.8% (RR 1.038 95% CI 1.025 to 1.051) and 1.0% (RR 1.010 95% CI 1.001 to 1.020), respectively. Compared with periods of average emergency inpatient occupancy, a patient attending during a period of very high emergency inpatient occupancy was 1.0% less likely (RR 0.990 95% CI 0.980 to 0.999) to be admitted and a patient arriving at a time of very low emergency inpatient occupancy was 0.8% less likely (RR 0.992 95% CI 0.958 to 0.977) to be admitted. Conclusions: Admission thresholds are modestly associated with ED and inpatient occupancy when these reach extreme levels. Admission thresholds are higher when the number of emergency inpatients is particularly high. This may indicate that riskier discharge decisions are taken when beds are full. Admission thresholds are also high when pressures within the hospital are particularly low, suggesting the potential to safely reduce avoidable admissions.
  • COVID 19 and BAME health care staff : wrong place at the wrong time

    Chaudhry, Faisal Bashir; Raza, Samavia; Raja, Khurram Zeeshan; Ahmad, Usman; Raja, Khurram Zeeshan; Acute Internal Medicine; Medical and Dental; University Hospital North Midlands NHS Trust; Walsall Healthcare NHS Trust; Hull Royal Infirmary (International Society of Global Health, 2020-12-01)
    No abstract available
  • Trends in rates of complications and adverse outcomes in diabetic ketoacidosis following changes to the Joint British Diabetes Societies' management guidelines

    Skaria, Maria; Ponniah, Gobeka; Birchenough, Amy; Owen, Megan; Pan, Carina; Soghal, Shamanth; Warmington, Emily; Sheikh, Haaziq; Karamat, Ali; Saraf, Sanjay; et al. (Royal College of Physicians, 2022-07)
    Serious complications of diabetes-related ketoacidosis (DKA) and its management with fixed rate intravenous insulin infusion (FRIII) include hypoglycaemia, hyperkalaemia and hypokalaemia. Revised Joint British Diabetes Societies for Inpatient Care (JBDS) guidelines in June 2021 recommend a reduced rate FRIII of 0.05 units/kg/hour from 0.1 units/kg/hour once blood glucose levels fall to ≤14.0 mmol/L to alleviate the risk of these complications.
  • Advanced clinical practitioners' inter-shift need for recovery : a cross-sectional survey in emergency medicine

    Fenwick, Rob; Price, Rebecca; Kershaw, Tanya; Boddy, Rachael; Chessum, Peter; Kershaw, Tanya; Boddy, Rachael; Chessum, Peter; Accident & Emergency; Medical and Dental; et al. (MA Healthcare, 2022-07-21)
    Background: Healthcare settings are high-risk environments for fatigue and staff burnout. The Need For Recovery (NFR) scale quantifies inter-shift recovery, which contributes to cumulative fatigue and may precede occupational burnout. Advanced clinical practitioners (ACPs) are an established feature of the emergency medicine workforce in the UK, however, little is known about factors affecting their inter-shift recovery, fatigue or how NFR correlates with formal burnout inventories. Methods: A prospective cross-sectional online survey of UK emergency medicine ACPs from 1 September to 30 September 2020. The primary aim was to determine the NFR of these ACPs. The secondary aims were to determine any statistical associations between NFR and selected variables, and whether NFR could reliably predict burnout using the Copenhagen Burnout Inventory (CBI) as a comparator. Results: There were 529 responses to the survey from 50 sites (response rate: 88%). The median NFR was 63.6 (95% CI 54.5-63.6). Lower NFR scores were found in ACPs who see both adults and children (54.5, 95% CI 45.4-63.6), work shifts of 7-10 hours (54.5, 95% CI 36.3-63.6) and who found it easy to park before work (54.5, 95% CI 45.5-54.5). Linear regression modelling indicated significant associations between shift length, ease of parking, ability to get breaks and feeling overwhelmed. Spearman's rho between NFR and CBI for personal and work-related burnout was 0.741 and 0.766 respectively. Correlation between NFR and patient-related burnout was less at 0.471. Conclusion: This study has shown the second highest NFR score reported in any occupational group. Several factors have been identified that may potentially reduce NFR and could be changed by organisations. NFR could also be used to identify those suffering with occupational burnout.
  • De novo pancytopaenia in an older adult with severe COVID-19 infection

    Lee, Helena; Thein, Onn Shaun; Muneer, Tazeen; Lee, Helena; Muneer, Tazeen; Thein, Onn Shaun; Acute Care; Respiratory Medicine; Medical and Dental; University of Birmingham; Walsall Healthcare NHS Trust; University Hospitals Birmingham NHS Foundation Trust; Sandwell and West Birmingham Hospitals NHS Trust;; et al. (BMJ Publishing Group, 2022-11)
    During the COVID-19 pandemic, it was recognised that SARS-CoV-2 can cause multisystem illness. Non-respiratory complications observed early in the pandemic were haematological in nature. A rare but serious haematological complication of COVID-19 infection is pancytopaenia. We describe a case of an older adult without pre-existing haematological disease or risk factors for cell dyscrasia with severe pancytopaenia induced by COVID-19, who developed critical illness requiring respiratory support in intensive care and died. Our case report highlights that de novo pancytopaenia may only present with mild dermatological manifestations and may indicate severe COVID-19 infection. Management is primarily supportive and early involvement of haematology should be sought.