RSS 1.0General Medicine
Recent Submissions
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Intravenous therapyA CPD article boosted Abby Morrow-Barnes’s knowledge of the insertion and use of cannulae in older patients.
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Management of patients with low-risk febrile neutropeniaThe National Institute for Health and Care Excellence in the UK advocates that patients with neutropenia who are at low risk of developing septic complications should be considered for management in the community rather than in hospital. The Multinational Association of Supportive Care in Cancer (MASCC) risk index is widely used to identify patients who are deemed to be at low risk of developing septic complications as a result of febrile neutropenia (FN), but it has limitations. A newer tool, the Clinical Index of Stable Febrile Neutropenia (CISNE), further stratifies patients who may be suitable for management in the community. This article uses a case study to explore the management of a patient who presented with suspected FN. It examines the use of the MASCC risk index and the CISNE to make recommendations for the future management of patients with low-risk FN in the community. Keywords : Chemotherapy - low-risk febrile neutropenia - management - risk - treatment complications
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Longstanding insulin dependent diabetics may not require insulin after the introduction of GLP-1 analoguesGlucagon like peptide (GLP-1) analogues are a relatively novel medication developed primarily for the treatment of type 2 diabetes since 2005. Although GLP-1 analogues have been shown to be more effective in the first few years of diagnosis in type 2 diabetes, we report a case of a patient with longstanding insulin-dependent diabetes started on a GLP-1 analogue, liraglutide, who now has controlled blood sugars without the need of insulin. Keywords: GLP-1; GLP-1 analogues; Obesity; insulin-dependent diabetes; type 2 diabetes.
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Pulmonary oedemaA CPD article refreshed Abby Morrow-Barnes’s knowledge of acute pulmonary oedema and prompted her to reflect on her practice.
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ADVICE for a healthier life : Adult Vaccination Campaign in EuropeImmunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe. Keywords: Adult immunization; European Federation of Internal Medicine; Guideline; Primary prevention; Vaccines.
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Are we up to date with the NEWS?No abstract available.
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Managing encephalitisA CPD article improved Abby Morrow-Barnes’s knowledge of the nursing care and treatment of patients with encephalitis.
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Daily aspirin 300mg : how much do patients take? Drug accountability for the first 5 years of the AspECT studyConference abstract PWE-124 of the British Society of Gastroenterology Annual Meeting, 19 Jun - 22 Jun 2017, Manchester, UK.
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Using simulation to prepare for clinical practiceBackground: A significant proportion of medical students feel underprepared for clinical practice, especially in skills such as decision making, prioritisation and prescribing. Changes to medical curricula, including assistantships and shadowing, provide supervised practise, but students remain unable to fully take responsibility for patient care. Simulation may assist in addressing this deficit. A simulation course entitled 'Simulated ward round and professional skills' (SWAPS) was developed to improve student preparation for clinical practice. Methods: Preliminary work surveyed 22 foundation doctors to identify perceived areas of weakness and to guide the learning outcomes of the course. Following the design and development of the course, 133 final-year medical students were observed completing a 60-minute simulation scenario aimed at providing experiential learning in a ward environment, reflecting professional practice. Students received structured feedback and completed pre- and post-course questionnaires to evaluate changes in confidence over the learning domains. Qualitative feedback was also collected. A significant proportion of medical students feel underprepared for clinical practice RESULTS: The p values were significant in all assessed domains, indicating a perceived improvement in confidence following the SWAPS course. Qualitative feedback highlighted the perceived utility of the course in exposing students to clinical ward-based scenarios infrequently encountered in their medical curriculum. Students praised the personal feedback received and realism of the simulation. Discussion: This paper contributes to the growing body of literature supporting the use of simulation to replicate a ward round and the daily roles of a junior doctor. The SWAPS course seems to empower students to take responsibility for clinical decision making and experience some of the realities of foundation training in a simulated setting.
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The outcome of dapagliflozin use in a real-life clinical setting in multi-district general hospitalsPoster abstract P470 in the section 'Clinical care and other categories posters' of the Diabetes UK Professional Conference 2015, ExCeL London, 11–13 March 2015.
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Filling the Gap - Improving Awareness and Practice in Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in the Older Patient: A European Consensus ViewIntroduction: Causes of hyponatraemia in older patients are multivariate and in the case of SIADH may often be drug induced. Diagnostic and treatment algorithms are unclear for this important age group. Methods: The author group identified 6 broad themes for consensus and formulated 42 separate consensus statements within these 6 themes. Statements were then circulated to geriatricians, general practitioners and other doctors to test agreement at the European level. Results: 64 responses were evaluated from around Europe. Agreement was achieved in 86% of the statements following amendment and redistribution of 6 of the statements. The survey and its feedback prompted the development of 13 recommendations related to the diagnosis and treatment of hyponatraemia including SIADH. Conclusion: The series of 13 recommendations developed here is intended to increase clarity for clinicians managing older patients with hyponatraemia and SIADH. Surprisingly, despite the lack of clear guidelines or recommendations for this age group consensus levels for the author-based statements were high among the respondents.
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Gamification of dermatology : Stud2yBuddy, a novel game to facilitate dermatology revision for final-year medical studentsThis abstract from the British Association of Dermatologists 99th Annual Meeting introduces a card-based board game to facilitate dermatology revision for final-year medical students.
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Gamification of dermatology: Stud2yBuddy, a novel game to facilitate dermatology revision for final-year medical studentsBrief report on a card-based board game used as a dermatology revision tool with the aim of increasing the confidence of final year medical students.
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Reflect and rehydrate: improving junior doctor wellbeing and promotion of coping skills through peer-led education and supportA brief report on a trial of formal reflection circles named ‘Reflect and rehydrate’ (R&R) sessions as a model for improving junior doctor wellbeing.
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Reducing readmission rates through a discharge follow-up serviceApproximately 15% of elderly patients are readmitted within 28 days of discharge. This costs the NHS and patients. Previous studies show telephone contact with patients -post-discharge can reduce readmission rates. This service -evaluation used a cohort design and compared 30-day emergency readmission rate in patients identified to receive a community nurse follow-up with patients where no attempt was made. 756 patients across seven hospital wards were -identified; 303 were identified for the intervention and 453 in a -comparison group. Hospital admission and readmission data was extracted over 6 months. Where an attempt to contact a patient was made post-discharge, the readmission rate was 9.24% compared to 15.67% where no attempt to -contact was made (p=0.011). After adjustment for -confounding using logistic regression, there was evidence of reduced readmissions in the 'attempt to contact' group odds ratio = 1.93 (95% c-onfidence interval = 1.06-3.52, p=0.033). Of the patients who community nurses attempted to contact, 288 were contacted, and 202 received a home visit with general practitioner -referral and medications advice being the most common -interventions initiated. This service evaluation shows that a simple intervention where community nurses attempt to contact and visit geriatric patients after discharge causes a significant reduction in 30-day hospital readmissions. Keywords: Discharge; geriatrics; readmission; telephone contract.
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Perceptions of foundation year doctors: barriers to delivering teaching and accessing teaching trainingA brief report on the results of a questionnaire examining potential barriers which exist for foundation year doctors in teaching or accessing teaching training.
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Interactive teaching workshop for foundation year doctors at a district general hospitalReport on an interactive teaching workshop for foundation year doctors at a district general hospital to assess whether teaching skills training for foundation-year doctors improves confidence in teaching.
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A survey of frailty services in acute NHS hospitals in the West MidlandsA short article reporting a survey of frailty services in acute NHS hospitals in the West Midlands.
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Superficial CD34+ fibroblastic tumour: clinicopathological, molecular and cytogenetic study of 4 casesAn abstract from the 31st European Congress of Pathology reporting on a clinicopathological, molecular and cytogenetic study of 4 cases of superficial CD34+ fibroblastic tumour.
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Comparative evaluation of quality of diabetes care within a population using discrete HbA1c thresholds versus longitudinal trends within a defined time periodBackground: HbA1c is a quality measurement for a population's diabetes care. Currently, discrete values are used to judge the care quality. However, an improved trend may have been achieved without reaching a discrete threshold. We aimed to compare the quality of glycaemic care using discrete thresholds versus longitudinal trends of a patient's HbA1c. Methods: We derived a study population of 4062 with two consecutive HbA1c's within 1-6 months. We used current discrete thresholds and then used these to define the longitudinal thresholds (the change in HbA1c between the first and second measurement). Results: We found that even with discrete thresholds, overall care was improving with 61% (Excellent care), 13% (Good care), 13% (Average care) and 13% (Poor care) turning into 68%, 12%, 11% and 9%, respectively (χ² 3335, p<0.0001). Using longitudinal trends shows a greater improvement of care with the original values achieving 74%, 7%, 9%, 7% and 4%, respectively (χ² 4111.3, p<0.0001). There was an additional 28% (Good care), 15% (Average care) and 12% (Poor and Very poor care) who with longitudinal trends improved to an excellent category without being identified as such. Conclusion: Our study highlights the need to consider longitudinal trends when measuring quality of diabetes care. Keywords: diabetes & endocrinology.