Bibliografias temáticas / Acute medical admissions

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Literatura científica selecionada sobre o tema "Acute medical admissions"

Autor: Grafiati

Publicado: 4 de junho de 2021

Última modificação: 14 de fevereiro de 2022

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Artigos de revistas sobre o assunto "Acute medical admissions"

Perkins, C., F. Ray Brown, K. Pohl, O. McLaren, J. Powles e R. Thorley. "Implementing a guideline for acute tonsillitis using an ambulatory medical unit". Journal of Laryngology & Otology 133, n.º 05 (10 de abril de 2019): 386–89. http://dx.doi.org/10.1017/s0022215119000380.

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AbstractObjectiveAcute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.MethodsA retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.ResultsThe rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.ConclusionThe tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.

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Forbes, Raeburn, John Craig, Michael Callender e Victor Patterson. "Liaison neurology for acute medical admissions". Clinical Medicine 4, n.º 3 (1 de maio de 2004): 290. http://dx.doi.org/10.7861/clinmedicine.4-3-290.

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Hider, P., J. O'Hagan, S. Bidwell e R. Kirk. "The rise in acute medical admissions". Australian and New Zealand Journal of Medicine 30, n.º 2 (abril de 2000): 252–60. http://dx.doi.org/10.1111/j.1445-5994.2000.tb00816.x.

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Spencer, B., L. Fook, P. Mcdonald e C. J. Turnbull. "Acute Medical Admissions from Nursing Homes". Age and Ageing 27, suppl 1 (1 de janeiro de 1998): P46. http://dx.doi.org/10.1093/ageing/27.suppl_1.p46-c.

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Shah, S., S. Coppack e J. Emmanuel. "Identifying obesity in acute medical admissions". Appetite 91 (agosto de 2015): 436. http://dx.doi.org/10.1016/j.appet.2015.04.030.

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Westall, Christopher, Robert Spackman, Channa Vasanth Nadarajah e Nicola Trepte. "Are hospital admissions reduced by Acute Medicine consultant telephone triage of medical referrals?" Acute Medicine Journal 14, n.º 1 (1 de janeiro de 2015): 10–13. http://dx.doi.org/10.52964/amja.0405.

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The NHS in England is facing well-documented pressures related to increasing acute hospital admissions at a time when the acute medical bed-base is shrinking, doctors working patterns are increasingly fragmented and many acute hospital trusts are operating a financial deficit. Novel strategies are required to reduce pressure on the acute medical take. We conducted a prospective cohort study to assess the impact of acute medicine consultant triage of referrals to the acute medical take on the number of acute hospital admissions as compared to a historical control cohort. The introduction of an acute medicine consultant telephone triage service was associated with a 21% reduction in acute medical admissions during whole the study period. True admission avoidance was achieved for 28.5% of referrals triaged by an acute medicine consultant. The greatest benefit was seen for consultant-triage of GP referrals; 43% of all GP referrals resulted in a decision not to admit and in 25% the referral was avoided by giving advice alone. Consultant telephone triage of referrals to the acute medical take substantially reduces the number of acute medical admissions as compared to triage by a trained band 6 or higher nurse coordinator. Our service is cost effective and can be job-planned using 6 full-time equivalent acute medicine consultants. The telephone triage service also provides additional benefits to admission numbers beyond its hours of operation and the general management of the acute medical take.

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Thompson, A., M. Stevens, I. Collin e N. Wennike. "Evolving sepsis definitions and their impact on Acute Medical Units". Acute Medicine Journal 16, n.º 1 (1 de janeiro de 2017): 25–29. http://dx.doi.org/10.52964/amja.0648.

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Background: There are currently several different definitions for sepsis. This study looked at what proportion of acute medical admissions were identified by the different definitions, what correlation they have, and how many patients would require a review with results in 1 hour. Methods: Data on 212 admissions was collected, on time of admission and review, and number of patients with sepsis by each diagnostic criteria calculated. Results: The NICE criteria identified 69% of admissions as requiring review within one hour, compared to 6% with qSOFA and 18% with previous sepsis definitions. The mean time to review was 1hr 18min, and only 50% of patients meeting the NICE criteria were reviewed within one hour. Conclusions: The proposed NICE guidance will be challenging to implement with current resources.

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Summers, Shaun A., e Paul A. Glynne. "Acute poisoning on the medical admissions unit". Clinical Medicine 7, n.º 3 (1 de junho de 2007): 277–79. http://dx.doi.org/10.7861/clinmedicine.7-3-277.

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O’Driscoll, Ronan, Nawar D. Bakerly, Peter Murphy e Peter Turkington. "Re: SpO2 values in acute medical admissions". Resuscitation 84, n.º 3 (março de 2013): e49. http://dx.doi.org/10.1016/j.resuscitation.2012.10.027.

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Jones, M., M. Kellett e C. Murphy. "029 Neurology input for acute medical admissions". Journal of Neurology, Neurosurgery & Psychiatry 83, n.º 3 (9 de fevereiro de 2012): e1.193-e1. http://dx.doi.org/10.1136/jnnp-2011-301993.71.

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Teses / dissertações sobre o assunto "Acute medical admissions"

Falk-Whynes, Jane. "Avoidable acute medical admissions : an evaluation of two interventions". Thesis, Nottingham Trent University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364414.

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Griffiths, Pauline. "Nursing patients in transition : an ethnography of the role of the nurse on an Acute Medical Admissions Unit". Thesis, Swansea University, 2007. https://cronfa.swan.ac.uk/Record/cronfa42820.

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This thesis explores the role of the nurse on an Acute Medical Admissions Unit (AMAU). AMAUs provide a dedicated area for the assessment, treatment, and subsequent transfer or discharge of patients who are medical emergencies. Despite increasing numbers of AMAUs across the UK they are an under researched area and, in particular, there is limited research that has explored the role of the nurse in the AMAU setting. Data were generated through the use of ethnography that entailed participant observation over an eighteen-month period, semi-structured interviews with a purposive sample of doctors, nurses, paramedics, and patients (n= 19), and examination of documentary evidence. Drawing on the concept of communities of practice (Wenger 1998) and the demand-control-social support model of occupational stress (Baker et al., 1996) the key themes of the study were identified as: The AMAU nurse's role in co-ordinating patients ' transition; Professional skills and attributes o f the AMAU nurse; 7 love the buzz': the AMAU nurses' work place stresses and balances; and Organisational constraints and practice boundaries for AMA U nursing The findings from the study indicate that a key aspect of the AMAU nurse's role was the facilitation of rapid patient transition. In addition the study has identified the distinctive and locally negotiated working practices developed by the nurses to coordinate this transition. Another important claim arising from this study was the identification of this nursing role as an evolved construction within a community of practice. This study makes a significant contribution to the limited body of knowledge regarding AMAU nursing practice by aiding understanding of the complexity of this nursing role. Additionally, the application of the concept of community of practice provides a unique perspective and insight into this under explored role. Recommendations are offered for practice, education, management and future research.

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Hopes, Scott L. "Healthcare IT in Skilled Nursing and Post-Acute Care Facilities: Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations". Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.

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Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013). Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).

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Hoare, Sarah. "Understanding end-of-life admissions : an interview study of patients admitted to a large English hospital shortly before death". Thesis, University of Cambridge, 2017. https://www.repository.cam.ac.uk/handle/1810/275055.

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Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.

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Gazzana, Marcelo Basso. "Mortalidade intra-hospitalar no tromboembolismo pulmonar agudo : comparação entre pacientes com diagnóstico objetivo e com suspeita não confirmada". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2006. http://hdl.handle.net/10183/119419.

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Fundamentação: O tromboembolismo pulmonar (TEP) é uma doença freqüente no ambiente hospitalar e com significativa mortalidade. A investigação diagnóstica envolve uma série de etapas e o desfecho dos pacientes investigados para TEP, mas cuja investigação não confirmou nem excluiu TEP, não está bem documentado. Objetivo: Comparar a mortalidade intra-hospitalar nos casos com suspeita de TEP agudo entre aqueles com diagnóstico confirmado, diagnóstico excluído e investigação inconclusiva. Métodos: Estudo observacional, comparado, retrospectivo (coorte histórica), de pacientes adultos ( 18 anos) com suspeita de TEP internados no HCPA de 1996 a 2000 que realizaram testes diagnósticos para TEP (cintilografia pulmonar perfusional, angio-TC ou arteriografia pulmonar convencional) ou com CID-9 413/CID10 I26 (embolia pulmonar) na ficha de admissão ou na nota de alta/óbito. Resultados: Dos 741 pacientes selecionados, 687 constituíram a amostra final (54 excluídos). A média de idade foi 61,53 ± 16,75 anos, sendo 292 homens (42,5%). Ocorreu início dos sintomas de TEP no domicílio em 330 casos (48%) e no hospital em 357 (52%). Em 120 pacientes (17,5%) TEP foi objetivamente confirmado, em 193 (28,1%) foi objetivamente excluído e em 374 (54,4%) a investigação foi não conclusiva. A mortalidade intra-hospitalar da amostra foi de 19,1% (n=134). Na análise univariada, sexo masculino, hipotensão, TEP nosocomial, neoplasia maligna, investigação não conclusiva, ausência de tratamento para TEP, investigação em 1996-1997 foram associados à maior mortalidade. Na análise multivariada, hipotensão (beta 2,49, IC95% 1,35-4,63), TEP objetivamente confirmado (beta 2,199, IC95% 1,15-4,21), investigação não conclusiva (beta 1,70, IC95% 1,00 – 2,87), neoplasia maligna (beta 2,868, IC95% 1,80-4,45), TEP nosocomial (beta 1,57, IC95% 1,02-2,41), ano de inclusão 1996- 1997 (beta 1,71, IC95% 1,15-2,67) e infecção torácica ou abdominal (beta 1,71, IC95% 1,08-2,71) foram independentemente associados à maior mortalidade intrahospitalar (p<0,05). Conclusões: Pacientes com TEP agudo objetivamente confirmado tiveram mortalidade intra-hospitalar significativa-mente maior que pacientes nos quais TEP foi excluído. A investigação não conclusiva para TEP foi um fator independente para mortalidade intra-hospitalar em pacientes com suspeita desta doença.
Background: Pulmonary thromboembolism (PE) is frequent in hospital setting and has significant mortality. Diagnostic approach of PE has many steps and follow-up of patients with non-confirmed PE is unknown. Purpose: To compare the inhospital mortality in cases with suspected acute PE among those with confirmed diagnosis, excluding diagnosis and inconclusive diagnostic workup. Methods: Historical cohort including adult patients ( 18 years) with clinically suspected PE that performed perfusion lung scan, CT-angiography, pulmonary arteriography or had PE ICD-9 413/ICD-10 I26 at admission or in discharge charts, from 1996 to 2000. We excluded patients with incomplete or lost medical records. Medical records were reviewed using a standardized form. Statistical analysis was done by chi-square-test, Student’s t test and logistic regression, with statistical significance of 5% (bilateral). Results: Of 741 patients, 687 were included (54 were excluded). Mean age was 61.53 ± 16.75 years, 292 patients were men (42.5%). Primary PE was identified in 330 cases (48%) and secondary PE in 357 (52%). In 120 patients (17.5%), PE was objectively confirmed, in 193 (28.1%) was objectively excluded, and in 374 cases (54.4%) the diagnostic approach was non-conclusive. In-hospital mortality was 19.1% (n=134). In univariate analysis, male gender, hypotension, secondary PE, cancer, non-conclusive approach, untreated PE, inclusion in 1996- 1997 were associated to the highest mortality. In multivariate analysis, hypotension (beta 2.49, 95% confidence interval [CI] 1.35-4.63), PE objectively confirmed (beta 2.199, 95%CI 1.15-4.21), non-conclusive approach (beta 1.70, 95%CI 1.00-2.87), cancer (beta 2.87, 95%CI 1.80-4.45), secondary PE (beta 1.57, 95%CI 1.02-2.41), inclusion in 1996-1997 (beta 1.71, 95%CI 1.15-2.67) and thoracic or abdominal infection (beta 1.71, 95%CI 1.08-2.71) were associated with the highest in-hospital mortality (p<0.05). Conclusions: Patients with acute PE objectively confirmed had significantly higher in-hospital mortality than patients in whom PE was excluded. Non-conclusive approach of PE was an independent factor for in-hospital mortality in patients with suspected disease.

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Henriksson, Catrin. "Coronary Heart Disease and Early Decision Making, from Symptoms to Seeking Care : Studies with Focus on Pre-hospital Delay in Acute Myocardial Infarction Patients". Doctoral thesis, Uppsala universitet, Institutionen för medicinska vetenskaper, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-156636.

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Despite several investigations and interventions aimed at decreasing the time from symptom onset to medical care seeking in acute myocardial infarction patients, the delay time is still too long for best treatment outcomes. In this thesis, investigations aimed at improving our understanding of the factors influencing delay time are evaluated, as well as attitudes to medical care seeking in patients, relatives and the general public. Additionally, an evaluation was performed to examine whether health-related quality of life had any influence on delay time and re-admissions. Participating patients, relatives and representatives of the general public were generally knowledgeable about acute myocardial infarction (AMI) and its symptomatology. The majority of participants knew about the importance of receiving fast treatment when an AMI occurs. Despite people’s knowledge, several patients and relatives felt uncertain of symptom origin and how to act at symptom onset. Patients commonly consulted an additional person when symptoms did not disappear. However, people appeared to act more appropriately if someone else had chest pain compared to self-experienced symptoms. In patients who had suffered from more than one AMI, poor total health status increased the risk of delaying for more than two hours, but no independent association was found between total health status and re-admissions within the first year post-AMI.

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Benipal, Jagpal Singh. "Analysis of trends and reasons for rising acute medical admissions in Auckland's public hospitals". 2008. http://hdl.handle.net/2292/2419.

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The main purpose of this study was to examine empirically the trends and reasons for rising acute adult medical admissions at two major public hospitals in Auckland from 1997 to 2004. According to recent national and international literature published on the topic, there has been unsustainable growth in the adult medical admissions both in NZ and most of the other developed countries. Overall, the causes of this increase have not been explored sufficiently in the literature reviewed. The NZ research has largely focused on the macro-analysis of hospital throughput data from health policy points of view. Methodology: A mixed methodology research design was applied to address the problem. Phase 1 quantitatively analysed adult medical hospital admission data (N = 277,416) obtained from the two hospitals (Middlemore and Auckland Public Hospitals), and phase 2 qualitatively explored the responses and views of the health professional expert panel (n = 16) in relation to the findings of phase 1 of the study. Findings: Overall, the crude number of admissions and age-standardised admission rates at both hospitals increased more rapidly than actual population increases. Approximately 1/3 of the patients accounted for 2/3 of the total admissions. Five major diagnostic categories accounted for 70%-80% of total acute admissions, with circulatory and respiratory system disorders being the leading causes of medical admissions. There was a strong relationship between age and increased admissions. MMH hospital overall, and its ethnic groups separately, had significantly higher admission rates than APH. Comparison of ethnic groups highlighted significant variations in the admission rates at the two hospitals despite adjusting for age, morbidity and deprivation. Conclusions: Overall the increase and variation in admission rates between the hospitals and ethnic groups was dependent on factors such as the characteristics of the population and patients, hospital admission and administration processes, availability of hospital beds, medical management at the hospital, and availability of primary and community care services. By making changes to those factors in the control of hospitals and District Health Boards, hospitals can potentially influence the trajectory of rising medical admissions. These factors include systems for managing patients with chronic illness, and pathways from community services to hospital. Finally, a number of future research areas, such as a large-scale study to explore the health service utilisation of the 55+ age groups, have been proposed.

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Khan, Uzma Nasir. "Pattern and outcomes of admissions to the Medical Acute Care Unit of a tertiary teaching hospital in South Africa". Thesis, 2018. https://hdl.handle.net/10539/25451.

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A research report submitted to the University of the Witwatersrand, in fulfilment for the requirements of the degree of Master of Medicine in the branch of Internal Medicine. Johannesburg 2018.
Background A Medical Acute Care Unit (MACU) was established at Chris Hani Baragwanath Academic Hospital (CHBAH) to provide comprehensive medical specialist care to the patients presenting with acute medical emergencies. Improved standards of health care delivery systems at the MACU may result in shorter hospital stay, better outcomes and less mortality. Objectives The objective of the study was to describe the demographics, diagnoses, pattern of diseases and the outcomes, including mortality of patients admitted to the MACU at the Chris Hani Baragwanath Academic Hospital (CHBAH). Methods A record review of 200 patients admitted to the MACU at CHBAH was performed from March 2015 to August 2015. The records were analysed for patient demographics, diagnosis at admission and duration of stay in MACU. The outcome was defined as transfer to the medical ward, Intensive Care Unit (ICU) or discharged home. The main causes of mortality were also recorded. Results Of the 200 patients, 59% were females. The mean age of the patients was 46 ± 17.2 years and the mean duration of stay at the MACU was 1.45 ± 1.25 days. Noncommunicable diseases accounted for 76% of admissions. The most frequently diagnosed conditions included: diabetic ketoacidosis acidosis (DKA) and hyperosmolar non-ketotic (HONK) (17.5%), non-accidental self-poisoning (16%), hypertensive emergencies (9.5%), decompensated cardiac failure (8%) and ischemic v heart disease (7%). Infectious diseases comprised 14% of the diagnoses of which pneumonias were the most common (5%). Most patients (77.5%) were transferred to medical wards, 12% to ICU, while 10% demised at the MACU. The main causes of death included sepsis (25%), DKA/HONK (20%), non-accidental self-poisoning (10%) and cardiac failure (10%). Conclusion Non-communicable diseases particularly diabetic emergencies were the main causes of admission to the MACU at CHBAH. During the study period, high rates of case improvement, patient discharge, shorter hospital stay, and less mortality were observed. The main cause of mortality was sepsis related.
LG2018

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Lima, Marta Joana Achada. "Hospital Emergency Admissions for Acute Cerebrovascular Disease During COVID-19 Pandemic: the impact on a central hospital". Dissertação, 2021. https://hdl.handle.net/10216/134647.

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Lima, Marta Joana Achada. "Hospital Emergency Admissions for Acute Cerebrovascular Disease During COVID-19 Pandemic: the impact on a central hospital". Master's thesis, 2021. https://hdl.handle.net/10216/134647.

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Livros sobre o assunto "Acute medical admissions"

Royal College of Physicians of London. Research Unit. Audit of acute medical admissions. London: RCP, 1997.

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Royal College of Physicians of London. Research Unit. Guidelines & audit measures for good practice in acute medical admissions. London: RCP, 1995.

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DeCoster, Carolyn. Alternatives to acute care. Winnipeg: Manitoba Centre for Health Policy and Evaluation, Dept. of Community Health Services, Faculty of Medicine, University of Manitoba, 1996.

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United States. Congress. House. A bill to amend title XVIII of the Social Security Act to prevent overpayment for hospital discharges to post-acute care services by eliminating the limitation on the number of diagnosis-related groups (DRGs) subject to the special transfer policy. Washington, D.C: United States Government Printing Office, 1999.

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R, Hobbs F. D., Birmingham (England) City Council e West Midlands Regional Health Authority., eds. General practitioner and patient influences on acute medical admissions: Birmingham acute admissions study. Birmingham: Department of General Practice, University of Birmingham, 1994.

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Waldmann, Carl, Neil Soni e Andrew Rhodes. Poisoning. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0025.

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Management of acute poisoning 440Acute poisoning remains one of the most common medical emergencies, 5–10% of hospital medical admissions. In the majority of cases, the drug ingestion is intentional, but the in-hospital mortality remains low (<0.5%). There are specific antidotes available for a small number of poisons and drugs; in most intoxications, basic supportive care is the main requirement and recovery follows. Internet-based information services such as Toxbase are useful: ...

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Leach, Dr Richard, Professor Derek Bell e Professor Kevin Moore. Introduction to acute medicine. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199565979.003.0001.

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Chapter 1 provides an introduction to acute medicine, and discusses aspects relevant to the initial, acute management phase, including recognizing and assessing the acutely unwell patient, organization of acute medical admission wards, admission and discharge guidelines, general supportive care, severity of illness scoring systems, the hypotensive patient and shock, the blue and breathless (cyanosed) patient, the oliguric patient, the confused/disorientated/‘obtunded’ patient, and the ongoing management of acutely ill patient.

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Farmakis, Dimitrios, John Parissis, George Papingiotis e Gerasimos Filippatos. Acute heart failure. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0051_update_001.

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Acute heart failure is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total health care expenditure for heart failure. It is characterized by an adverse prognosis, with an in-hospital mortality rate of 4–7%, a 2–3-month post-discharge mortality of 7–11%, and a 2–3-month readmission rate of 25–30%. The majority of patients have a previous history of heart failure and present with normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia.

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Mokin, Maxim, Edward C. Jauch, Italo Linfante, Adnan Siddiqui e Elad Levy, eds. Acute Stroke Management in the First 24 Hours. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190856519.001.0001.

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Diagnosis and treatment of acute stroke has advanced considerably in the past 2 decades. Most notably, in cases of ischemic stroke, intravenous alteplase has become the standard of medical treatment despite its multiple contraindications and limited time window. More recently, trials have proven that endovascular thrombectomy is superior to medical therapy alone, advancing the standard of care for patients who present with acute ischemic stroke from a large vessel occlusion and salvageable brain tissue. The treatment of hemorrhagic stroke now involves the use of novel pharmacological agents and advanced minimally invasive technology. Important changes have also occurred at the levels of hospital organization and treatment decision-making. Such changes in organization and designation of hospitals with distinct levels of stroke care and the variety of stroke protocols now requires team work of emergency medical services (EMS), Emergency Department, stroke neurologists, neurosurgeons, and neurointerventionalists. This book provides an overview of the modern medical and surgical options for the treatment of patients with acute ischemic and hemorrhagic strokes. The pivotal role of EMS in prehospital evaluation and triage of a stroke patient and the levels of stroke systems of care are discussed. In addition, the current guidelines on the management of acute stroke, with the focus on early care of acute stroke patients at the Emergency Department and the first 24 hours of hospital admission, are reviewed. Each chapter contains a discussion of common clinical scenarios including initial management steps, practical points, and common pitfalls.

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Barrera, Alvaro, Caroline Attard e Rob Chaplin, eds. Oxford Textbook of Inpatient Psychiatry. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198794257.001.0001.

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Acute inpatient mental health care remains an irreplaceable part of some people’s mental health recovery pathway, either through the severity of their difficulties or the associated risks. It can often be a traumatic experience associated with distress and vulnerability both for patients and their relatives. Modern acute inpatient psychiatric care must undoubtedly be truly multidisciplinary and part of a wider community-based system. It must emphasize dignity, compassion, and well-being as well as addressing challenges such as involuntary admissions, cultural diversity, physical comorbidities, and the needs of relatives, just to name a few. The present textbook focuses on these and related issues in a way that is relevant to frontline clinicians dealing with them daily, with medical, nursing, and legal aspects going hand in hand with topics such as team leadership or multidisciplinary work. The textbook describes inpatient services as provided in England, so it describes work that takes place within a national health service free at the point of delivery, carried out by universal primary care as well as secondary mental health care services, both operating within clinical governance structures that seek quality improvement and accountability. Crucially, both the Mental Health Act and the Mental Capacity Act provide unique legal frameworks for the care of mental ill health. The editors hope that for readers in the UK and beyond, the textbook will provide a real-life system which can be questioned and problematized and, in that way, may help to orient clinical work.

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Capítulos de livros sobre o assunto "Acute medical admissions"

Marks, Daniel, e Marcus Harbord. "Drug-induced liver injury". In Emergencies in Gastroenterology and Hepatology, 291–307. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199231362.003.0018.

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Drug-induced liver injury Paracetamol Statins NSAIDs and aspirin Anticonvulsants Antidepressants Amiodarone Anti-tuberculosis drugs Co-amoxiclav Minocycline Oral contraceptive pill Khat Herbal remedies Drug-induced liver injury (DILI) accounts for ~1% of general medical admissions, 〈5% of all cases of jaundice, but up to 30% of acute liver failure. It is associated with 〉1,000 medications and herbal products. The following principles apply: ...

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Naidoo, Vishaya, e Yedishtra Naidoo. "Home Telecare, Medical Implant, and Mobile Technology". In E-Health and Telemedicine, 1658–73. IGI Global, 2016. http://dx.doi.org/10.4018/978-1-4666-8756-1.ch083.

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With a rapidly expanding global aging population, alternatives must be developed to minimize the inevitable increase in acute and long-term care admissions to the health care system. This chapter explores the use of home telecare as an alternative medical approach to managing this growing trend, while also providing superior care to geriatric patients. To address some of the emergent disadvantages of home telecare concerning usability, self-management, and confinement to the home, the use of a cardiac implant in conjunction with a mobile device—to assist in the management of chronic heart failure in seniors—is proposed as a promising technological solution to overcoming these limitations. Ultimately, it seems that the growth of home telecare, as well as the great potential to enhance its services with the use of mobile wireless technology, stands to drastically improve clinical decision-making and management of health services in the future.

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"Chronic obstructive pulmonary disease (COPD)". In Emergencies in Respiratory Medicine, editado por Robert Parker, Catherine Thomas e Lesley Bennett, 127–32. Oxford University Press, 2007. http://dx.doi.org/10.1093/med/9780199202447.003.0021.

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Diagnosis 128 Acute exacerbation of COPD 128 Chronic obstructive pulmonary disease (COPD) is increasing in frequency worldwide, particularly in developed countries, and has a major impact both in terms of mortality and morbidity. In 2004, respiratory disease accounted for 20% of all deaths in the UK, with COPD accounting for more than a fifth of these. Cases of COPD account for up to 12% of acute medical admissions and use more than 1 million bed days a year in the NHS in England. Approximately 95% of cases of COPD are smoking related, with the remainder being secondary to occupational and environmental exposure....

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Briscoe, Daren. "Respiratory assessment and care". In Care of the Acutely Ill Adult, 13–55. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198793458.003.0002.

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Respiratory conditions are a common complication for the acutely ill patient. Early recognition of the onset of a respiratory crisis is fundamental to prevent further deterioration of the acutely ill patient. This chapter provides a discussion of the respiratory system and the physiological mechanisms which control respiratory function with a useful overview of common respiratory symptoms. The principles of arterial blood gas analysis, respiratory support mechanisms, and tracheostomy care precedes a discussion of three commonly encountered respiratory disorders; asthma, COPD, and pneumonia, with focus upon nursing and medical support to support patients with these acute illnesses. A large proportion of emergency admissions to acute care wards are due to these diseases and thus a good understanding of the assessment and management of these conditions is essential.

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Nguyen, Linh My Thi. "Palliative Care in End-Stage Heart Failure". In Hospice and Palliative Medicine and Supportive Care Flashcards. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190633066.003.0032.

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Heart failure (HF) is the most common cause of death. The acute syndrome of HF, better known as congestive heart failure, accounts for at least 20% of medical admissions to all hospitals for patients older than age 65 years. HF tends to have a high symptom burden (dyspnea, fatigue, edema, pain, nausea, anxiety, and depression) and periods of decompensation often requiring hospitalization. There is a high level of prognostic uncertainty, leading to significant psychosocial distress for both patients and their caregivers. Advance care planning and complex shared decision-making become increasingly important as HF progresses, particularly when patients are faced with options such as transplant and mechanical circulatory support, which may not align well with their overall goals or preferences. This chapter discusses the key issues related to end-stage HF, including diagnosis, symptom management, and prognosis.

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Tomkins, Alannah. "Mad doctors: lunacy and the asylum". In Medical Misadventure in an Age of Professionalisation, 1780-1890. Manchester University Press, 2017. http://dx.doi.org/10.7228/manchester/9781526116079.003.0006.

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The stresses of professional life could become so severe as to prompt an admission to an asylum. This chapter considers the propensity of practitioners to undergo admission to either a pauper lunatic asylum or a private, licensed house, and unpacks the experiences of those men whose suffering was acute, or which exemplified the issues which arose when men were treated by their former and (for some) future colleagues. It locates causes of professional stress and fears of competitive practice.

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Pifko, Elysha. "Drowning". In Acute Care Casebook, editado por Jennifer Sanders, 263–66. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190865412.003.0053.

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This case illustrates how to approach a patient who presents after drowning in the setting of a new-onset seizure. Immediate attention should always be given to the airway, breathing, and circulation of any patient that presents after drowning. The majority of these patients recover without the need for further medical intervention. However, patients with significant rales, hypotension, or ventilatory failure will require admission to the intensive care unit. In patients that present with a first unprovoked seizure, laboratory tests and radiologic imaging should only be obtained in those with a concerning history. Antiepileptic drugs should also not be initiated in the majority of these patients. In general, management of seizures in the emergency department need to be catered toward each individual patient based on the circumstances of his or her presentation.

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"Critical care". In Oxford Handbook for Medical School, editado por Kapil Sugand, Miriam Berry, Imran Yusuf, Aisha Janjua, Chris Bird, David Metcalfe, Harveer Dev et al., 199–212. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780199681907.003.0009.

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Critical care medicine is the specialty providing organ support to acutely unwell patients, and overlaps with anaesthetics, acute medicine, surgery, and emergency medicine. Patients are usually managed on the intensive care unit (ICU) or high dependency unit and require organ support in the form of intubation/ventilation/sedation, circulatory support (inotropes/vasopressors), renal replacement therapy (usually continuous venovenous haemofiltration), and nutrition. Common reasons for ICU admission include sepsis, complex surgery, respiratory disease, metabolic disturbance (such as diabetic ketoacidosis), head injury or reduced conscious level, and following cardiac arrest. A standardized approach to the evaluation of critically ill patients is outlined, as well as management of sepsis, acute asthma, and head injury. Principles of sedation, intubation, and ventilation/respiratory support are covered, as well as renal replacement therapy. The role of indwelling devices such as arterial lines and central venous catheters is also summarized.

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Hoogmartens, Olivier, Michiel Stiers, Koen Bronselaer e Marc Sabbe. "The emergency medical system". In The ESC Textbook of Intensive and Acute Cardiovascular Care, editado por Marco Tubaro, Pascal Vranckx, Eric Bonnefoy-Cudraz, Susanna Price e Christiaan Vrints, 65–75. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198849346.003.0008.

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The mission of the emergency medical services is to promote and support a system that provides timely, professional and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time and any location. A medical emergency has five different phases, namely: population awareness and behaviour, occurrence of the problem and its detection, alarming of trained responders and help rendered by bystanders and trained pre-hospital providers, transport to the nearest or most appropriate hospital, and, if necessary, admission or transfer to a tertiary care centre which provides a high degree of subspecialty expertise. In order to meet these goals, emergency medical services must work aligned with local, state officials; with fire and rescue departments; with other ambulance providers, hospitals, and other agencies to foster a high performance network. The term emergency medical service evolved to reflect a change from a straightforward system of ambulances providing nothing but transportation, to a complex network in which high-quality medical care is given from the moment the call is received, on-scene with the patient and during transportation. Medical supervision and/or participation of emergency medicine physicians (EP) in the emergency medical service systems contributes to the quality of medical care. This emergency medical services network must be capable to respond instantly and to maintain efficacy around the clock, with well-trained, well-equipped personnel linked through a strong communication system. Research plays a pivotal role in defining necessary resources and in continuously improving the delivery of high-quality care. This chapter gives an overview of the different aspects of emergency medical services and calls for high quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

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Palmer, Keith T., e Paul Cullinan. "Respiratory disorders". In Fitness for Work, 372–97. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199643240.003.0018.

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Respiratory illnesses commonly cause sickness absence, unemployment, medical attendance, illness, and handicap.¹ Collectively these disorders cause 19 million days/year of certified sickness absence in men and 9 million days/year in women (with substantial additional lost time from self-certified illness) and, among adults of working age, a general practitioner consultation rate of 48.5 per 100/year with more than 240 000 hospital admissions/year. Prescriptions for bronchodilator inhalers run at some 24 million/year, and mortality from respiratory disease causes an estimated loss of 164 000 working years by age 64 and an estimated annual production loss of £1.6 billion (at prices in 2000). Respiratory disease may be caused, and pre-existing disease may be exacerbated, by the occupational environment. More commonly, respiratory disease limits work capacity and the ability to undertake particular duties. Finally, individual respiratory fitness in ‘safety critical’ jobs can have implications for work colleagues and the public. Within this broad picture, different clinical illnesses pose different problems. For example, acute respiratory illness commonly causes short-term sickness absence, whereas chronic respiratory disease has a greater impact on long-term absence and work limitation; and the fitness implications of respiratory sensitization at work are very different from non-specific asthma aggravated by workplace irritants. Occupational causes of respiratory disease represent a small proportion of the burden, except in some specialized work settings where particular exposures give rise to particular disease excesses. The corollary is that the common fitness decisions on placement, return to work, and rehabilitation more often involve non-occupational illnesses than occupational ones. By contrast, statutory programmes of health surveillance focus on specific occupational risks (e.g. baking) and specific occupational health outcomes (e.g. occupational asthma). In assessing the individual it is important to remember that respiratory problems are often aggravated by other illnesses, particularly disorders of the cardiovascular and musculoskeletal systems.

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Trabalhos de conferências sobre o assunto "Acute medical admissions"

Barker, B., A. Atewah, K. Srinivasan e H. Moudgil. "Emergency Oxygen Prescription in Acute Medical Admissions." In American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California. American Thoracic Society, 2009. http://dx.doi.org/10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a5198.

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Kent, BD, SB Cooney, P. Nadarjan, I. Sulaiman, N. Akasheh, SJ Lane e ED Moloney. "Acute Medical Admissions Following Implementation of a Workplace Smoking Ban." In American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California. American Thoracic Society, 2009. http://dx.doi.org/10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a1640.

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Coughlan, JJ, G. Fitzgerald, M. Wafer, C. MacDonnell e R. Liston. "49 Prevalence and predictors of qtc prolongation in acute medical admissions". In Irish Cardiac Society Annual Scientific Meeting & AGM, Thursday October 5th – Saturday October 7th 2017, Millennium Forum, Derry∼Londonderry, Northern Ireland. BMJ Publishing Group Ltd and British Cardiovascular Society, 2017. http://dx.doi.org/10.1136/heartjnl-2017-ics17.49.

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Bart-Smith, Emily, e Fionnuala Crummy. "Identifying Patients Appropriate For Outpatient Management Of PE Within The Acute Medical Admissions Unit". In American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California. American Thoracic Society, 2012. http://dx.doi.org/10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a2377.

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Howorth, Kate, Emma Foggett, Jane Atkinson, Fraser Henderson, Eleanor Grogan e Katie Frew. "10 Developing guidelines for opioid prescribing and adjustment in renal impairment in an acute medical admissions unit". In The APM’s Annual Supportive and Palliative Care Conference, In association with the Palliative Care Congress, “Towards evidence based compassionate care”, Bournemouth International Centre, 15–16 March 2018. British Medical Journal Publishing Group, 2018. http://dx.doi.org/10.1136/bmjspcare-2018-aspabstracts.37.

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Chakrabarti, B., J. Curtis, A. Kwok e M. Gautam. "P44 The utility of bedside lung ultrasound in the assessment of emergency medical admissions presenting with acute dyspnoea: a prospective analysis". In British Thoracic Society Winter Meeting 2017, QEII Centre Broad Sanctuary Westminster London SW1P 3EE, 6 to 8 December 2017, Programme and Abstracts. BMJ Publishing Group Ltd and British Thoracic Society, 2017. http://dx.doi.org/10.1136/thoraxjnl-2017-210983.186.

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Barwisemunro, R., H. Morgan e S. Turner. "G79(P) Physician and parental decision-making prior to acute medical admission". In Royal College of Paediatrics and Child Health, Abstracts of the Annual Conference, 13–15 March 2018, SEC, Glasgow, Children First – Ethics, Morality and Advocacy in Childhood, The Journal of the Royal College of Paediatrics and Child Health. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2018. http://dx.doi.org/10.1136/archdischild-2018-rcpch.77.

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Mohan, A., G. Sindhu, J. Harikrishna, M. H. Rao e K. V. S. Sarma. "Acute Respiratory Failure Requiring Admission to Medical Intensive Care Unit: A Prospective Study". In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a1633.

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Bossaert, L., H. Demey, L. Colemont e H. HRM. "PREHOSPITAL THROMBOLYTIC TREATMENT: A FEASIBILITY STUDY". In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642982.

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Aim of the study: Thrombolysis is the treatment of choice in acute myocardial infarction (AMI). The delay between onset of symptoms and administration of thrombolytic drugs is critical for successful reperfusion and myocardial salvage. We studied the feasibility and safety of early prehospital thrombolytic treatment of AMI “at home”Methods: Eminase(R)(APSAC;BRL 26921 ) was used as thrombolytic agent: its long half-life allows administration as a single IV bolus. The study was performed in collaboration with a well organised group of GP's, extensively retrained in ECG and CPR for the purpose of this study. Whenever a GP made the tentative diagnosis of AMI of less than 2 hours, inclusion and exclusion criteria were reviewed using a check-list, and the mobile intervention team of the hospital (MITUZA), consisting of CCU physicians and emergency nurses, was activated. After rechecking all criteria, including a 12 lead ECG, brief medical history and physical examination, a single IV bolus of 30 U Eminase(R) was given, followed by transferral to the CCU. Follow-up included estimation of infarct-size and LV function using biochemical, ECG, radionuclide and angiographic methods.Results: Up till now, 15 male patients (age=57±9) have been treated using this protocol. Initial prehospital treatment consisted of Eminase(R) IV in 10 (reperfusion 9/10). Subsequent in-hospital treatment was streptokinase in 3 (reperfusion 2/3). In the 11 reperfused patients, PTCA was performed in 7 and CABG in 4. After onset of symptoms, the GP arrived after 55±24 min (15-90 min), Eminase(R) was administered after 95±28 min (75-130 min). The total calculated time gain (interval between treatment at home and admission in the CCU) was 42±15 min (20-75 min). There were no adverse events.Conclusion: This pilot study indicates that prehospital thrombolytic treatment of AMI is feasible and safe, resulting in a considerable time gain. Early reperfusion was obtained in 90%. Collaboration with a well organised and trained group of GP's, clearly defined inclusion and exclusion criteria and administration of the thrombolytic drug exclusively by experienced critical care physicians are mandatory.

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Thie, A., T. h. Henze, D. Deggar, M. Obering, R. Clemers, H. J. Kleinz e G. F. Lombard. "FACTOR XIII CONCENTRATE FOR PROPHYLAXIS OF REBLEEDING IN SUBARACHNOID HEMORRHAGE (SAH) - RESULTS OF A PROSPER TIVE MULTICENTER PILOT STUDY". In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643312.

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Rebleeding occurs in subarachnoid hemorrhage (SAH) in 20 - 25 % of patients, with a mortality rate being above 50 %. The cause of rebleeding is considered to be premature fibrinolysis of the fibrin clot surrounding the site of rupture. Since the stability of the fibrin clot is influenced by the activity of coagulation factor XIII, and moreover, a factor XIII deficiency has been reported in SAH patients, the question arises as to whether the incidence of rebleeding can be influenced by the administration of F XIII concentrate.During a period of 6 months, 69 patients with acute SAH were enlisted in an open, prospective, multicenter study. On admission, 5 patients were classified as stage I (7.2%) according to the Hunt and Hess scale, 22 as stage III (31.9%), 11 as stage IV (16%) and 9 as stage V (13%). Aneurysm was confirmed by angiography in 52 patients (75%). All the patients received 10 x 1250 U F XIII concentrate during the first 15 days after the initial hemorrhage. Surgery on the aneurysm was performed between day 3 and 32 (median: day 13) in 35 patients.A total of 7 rebleedings occurred in 6 patients (8.7%), of whom 2 were stage I - II and 4 were stage III - V cases. Cerebral infarction was observed in 10 patients (14.5%), and hydrocephalus requiring shunting occurred in 1 patient. There were no cases of peripheral thromboses or embolisms. After 4 weeks, the overall mortality rate was 26%. (stage I - II: 11.1%, stage III - V: 37.5%).The conventional approach in the prophylaxis of rebleeding in SAH is an early operation or intravenous administration of antifibrinolytics. However, as none of these measures significantly reduce overall mortality, the present pilot study investigated a new, therapeutic approach in which F XIII concentrates were administered in order to stabilize the fibrin clots and prevent premature fibrinolysis. The data so far show that Fibrogammin P is an effective and well tolerated agent for the prophylaxis of post-SAH rebleeding. In order to statistically confirm the results of the pilot study, we have, in the meantime, started a prospective, randomized, placebo-controlled, multicenter double-blind study, which will involve 750 patients over a period of 2 years.

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Relatórios de organizações sobre o assunto "Acute medical admissions"

Altantuya, Jigjidsuren,, Oyun Bayar e Habib Najibullah. Rationalizing Mongolia’s Hospital Services: Experiences, Lessons Learned, and Future Directions. Asian Development Bank, agosto de 2021. http://dx.doi.org/10.22617/wps210305-2.

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Before the 1990s, Mongolia had a health care system that largely depended on hospital-based services. The country’s hospital sector was characterized by the extensive use of an excessive number of acute beds, a large number of medically unjustified admissions, and lengthy hospital stays. In the early 1990s, the Government of Mongolia started socioeconomic reforms as part of the transition to a market economy. It requested the Asian Development Bank (ADB) to support health sector reforms in the country. This paper describes the hospital sector in Mongolia along with the reforms and results achieved, challenges that remain, and ongoing and future directions for ADB support to better respond to the needs of the people.

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