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Acute physician support in Acute Assessment unit or internal medicine setting

Kuven K Moodley, Valerie Jones, Mahinda Yogarajah, Bhavini Patel, Umesh Vivekananda, Pablo Garcia-Reitboeck, Kiran Samra, Gillian Cluckie, Oliver Foster, Anthony C Pereira, Niranjanan Nirmalananthan
St George's Hospital hyperacute neurology service (HANS) is a comprehensive, consultant-delivered service set in a teaching hospital regional neuroscience centre. The service addresses deficiencies in acute neurological care previously highlighted by the Royal College of Physicians and the Association of British Neurologists. HANS adopts a disease-agnostic approach to acute neurology, prioritising the emergency department (ED) management of both stroke and stroke mimics alike alongside proactive daily support to the acute medical unit and acute medical take...
March 2019: Clinical Medicine: Journal of the Royal College of Physicians of London
Jonathan S Jahr, Sergio D Bergese, Ketan R Sheth, Nicholas M Bernthal, Hung S Ho, Nicoleta Stoicea, Christian C Apfel
Objective: Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. Methods: The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk...
August 16, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
K S Blondon, F Maître, V Muller-Juge, N Bochatay, S Cullati, P Hudelson, N V Vu, G L Savoldelli, M R Nendaz
Clinical reasoning has been studied in residents or nurses, using interviews or patient-provider encounters. Despite a growing interest in interprofessional collaboration, the notion of collaborative reasoning has not been well studied in clinical settings. Our study aims at exploring resident-nurse collaborative reasoning in a simulation setting. We enrolled 14 resident-nurse teams from a general internal medicine division in a mixed methods study. Teams each managed one of four acute case scenarios, followed by a stimulated-recall session...
April 2017: Medical Teacher
Rose Mary Daniele, Ann Marie Bova, Michelle LeGar, Pauline J Smith, Lillie M Shortridge-Baggett
BACKGROUND: Utilisation of a rapid response team (RRT) in a hospital setting has been documented in the literature. RRTs were formed to intervene quickly when the hospitalised patient first shows signs of deterioration. The purpose was to prevent failure to rescue, leading to intensive care unit transfers, cardiac arrest and mortality. To date, however, there is a lack of evidence to support the effectiveness of this intervention. The focused question, subsequent systematic review and data analysis are presented...
2011: JBI Library of Systematic Reviews
Patrick Tighe, Chester C Buckenmaier, Andre P Boezaart, Daniel B Carr, Laura L Clark, Andrew A Herring, Michael Kent, Sean Mackey, Edward R Mariano, Rosemary C Polomano, Gary M Reisfield
BACKGROUND: Consensus indicates that a comprehensive,multimodal, holistic approach is foundational to the practice of acute pain medicine (APM),but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service,which is often unavailable or inconsistently applied...
September 2015: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Kristy Barnes Le, J Aaron Johnson, J Paul Seale, Hunter Woodall, Denice C Clark, David C Parish, David P Miller
BACKGROUND: Approximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention. OBJECTIVE: We aimed to determine primary care residents' current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI). DESIGN: This was a multi-site, cross-sectional survey conducted from March 2010 through December 2012...
June 2015: Journal of General Internal Medicine
Sion Kim Harris, Jennifer Louis-Jacques, John R Knight
Substance use is the most common health risk behavior among adolescents and is one of the greatest threats to their current and future health. Universal screening of adolescents in general medical settings can be instrumental in identifying substance use early, before further problems develop and when BIs are more likely to be effective. Screening in and of itself may have some therapeutic effect. Brief screening tools feasible for use by busy medical offices to quickly and reliably assess adolescent risk for a substance use disorder now are available...
April 2014: Adolescent Medicine: State of the Art Reviews
Francesco Dentali, Fulvio Pomero, Micaela La Regina, Francesco Orlandini, Sara Turato, Antonino Mazzone, Carlo Nozzoli, Andrea Fontanella, Walter Ageno, Giancarlo Agnelli, Mauro Campanini
AIMS: acutely ill medical patients are at increased risk of venous thromboembolism (VTE) and often require thromboprophylaxis, but patient selection and adequate therapeutic decisions may be difficult due to the heterogeneity and the complexity of this population. We conducted a survey among a large cohort of Italian physicians to assess their approach to some important "grey" areas of VTE prevention in this setting. METHODS: a questionnaire was distributed during the meeting of a national society of Internal Medicine (FADOI), held in May 2013...
September 2014: Thrombosis Research
Daniel Miller, Cameron Crandall, Charles Washington, Steven McLaughlin
OBJECTIVES: Teamwork and communication often play a role in adverse clinical events. Due to the multidisciplinary and time-sensitive nature of trauma care, the effects of teamwork and communication can be especially pronounced in the treatment of the acutely injured patient. Our hypothesis was that an in situ trauma simulation (ISTS) program (simulating traumas in the trauma bay with all members of the trauma team) could be implemented in an emergency department (ED) and that this would improve teamwork and communication measured in the clinical setting...
May 2012: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ruth M Kleinpell, E Wesley Ely, Robert Grabenkort
BACKGROUND: Advanced practitioners including nurse practitioners and physician assistants are contributing to care for critically ill patients in the intensive care unit through their participation on the multidisciplinary team and in collaborative physician practice roles. However, the impact of nurse practitioners and physician assistants in the intensive care unit setting is not well known. OBJECTIVES: To identify published literature on the role of nurse practitioners and physician assistants in acute and critical care settings; to review the literature using nonquantitative methods and provide a summary of the results to date incorporating studies assessing the impact and outcomes of nurse practitioner and physician assistant providers in the intensive care unit; and to identify implications for critical care practice...
October 2008: Critical Care Medicine
C van Weel, E D Bateman, J Bousquet, J Reid, L Grouse, T Schermer, E Valovirta, N Zhong
Asthma is one of the most common chronic airways diseases worldwide, and its prevalence is increasing. Family doctors (sometimes called 'primary care physicians' or 'general practitioners') are frequently an asthma patient's first point of contact with healthcare systems. Disease management that follows evidence-based practice guidelines yields better patient results, but such guidelines are often complicated and may recommend the use of resources not available in the family practice setting. A joint expert panel of the World Organization of Family Doctors (Wonca), International Primary Care Airways Group (IPAG) and the International Primary Care Respiratory Group (IPCRG) offers support to family doctors worldwide by distilling the globally accepted, evidence-based recommendations from the Global Initiative for Asthma (GINA) into this brief reference guide...
August 2008: Allergy
J Kendall
INTRODUCTION: Acute ischaemic stroke (AIS) is a leading cause of death and disability within the United Kingdom. Despite evidence of the benefit of thrombolysis for appropriately selected patients with AIS, this intervention remains markedly underutilised in this country when compared with other developed countries. The delivery of thrombolysis for AIS has become a political, as well as a clinical, priority in the United Kingdom. DISCUSSION: Research has shown that, although thrombolysis for AIS is associated with increased short-term mortality, this is offset by a significant benefit in terms of reduced long-term death and disability...
August 2008: Emergency Medicine Journal: EMJ
M UdDin, S Ramakrishnan
Acute Medical assessment and admission units are a relatively new model in Irish healthcare system. AMAU supports the primary physician to improved practice and to take responsibility for their patients. The setting up of medical assessment units model is a suitable alternative for many hospitals at present, where staff, training and quality matters surround their present A&E Departments and are not well developed or staffed. Acute Medical assessment units have the potential to play a very useful role in Irish healthcare system...
September 2007: Irish Medical Journal
Karen E A Burns, Tasnim Sinuff, Neill K J Adhikari, Maureen O Meade, Diane Heels-Ansdell, Claudio M Martin, Deborah J Cook
OBJECTIVE: To determine physicians' stated practices regarding the use of bilevel noninvasive ventilation (NIV) for acute respiratory failure and the predictors of practice variation. DESIGN: Cross-sectional postal survey. SETTING: Province of Ontario, Canada. PARTICIPANTS: Attending physicians and residents in four specialties at 15 teaching hospitals. INTERVENTIONS: We used literature searches and focus groups to design questions related to NIV utilization with respect to frequency, location of and indications for use, awareness of supporting literature, and perceived efficacy...
July 2005: Critical Care Medicine
D J Godden, A Ludbrook, L McIntyre, J G Perez, R Harvey
INTRODUCTION: Providing local consultant-delivered hospital services in remote and island communities in the United Kingdom is increasingly problematic due to difficulties with recruitment and retention of staff, statutory restrictions to hours worked by health professionals and the expectation each clinician must manage an externally defined volume of cases to maintain clinical standards. This article describes a before-and-after evaluation of a novel method of providing consultant support for acute internal medicine to an island grouping off the Scottish coast...
April 2004: Rural and Remote Health
Neil R MacIntyre
Ventilator management of the patient recovering from acute respiratory failure must balance competing objectives. On the one hand, aggressive efforts to promptly discontinue support and remove the artificial airway reduce the risk of ventilator-induced lung injury, nosocomial pneumonia, airway trauma from the endotracheal tube, and unnecessary sedation. On the other hand, overly aggressive, premature discontinuation of ventilatory support or removal of the artificial airway can precipitate ventilatory muscle fatigue, gas-exchange failure, and loss of airway protection...
February 2005: Respiratory Care
Richard Hawkins, Margaret MacKrell Gaglione, Tony LaDuca, Cynthia Leung, Laurel Sample, Gayle Gliva-McConvey, William Liston, André De Champlain, Andrea Ciccone
CONTEXT: Standardised assessments of practising doctors are receiving growing support, but theoretical and logistical issues pose serious obstacles. OBJECTIVES: To obtain reference performance levels from experienced doctors on computer-based case simulation (CCS) and standardised patient-based (SP) methods, and to evaluate the utility of these methods in diagnostic assessment. SETTING AND PARTICIPANTS: The study was carried out at a military tertiary care facility and involved 54 residents and credentialed staff from the emergency medicine, general surgery and internal medicine departments...
September 2004: Medical Education
Wendy C Coates
There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage...
March 2004: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ana Azevedo, Joana Pimenta, Paula Dias, Paulo Bettencourt, António Ferreira, Mário Cerqueira-Gomes
Ambulatory care by physicians especially devoted to the management of heart failure (HF) has been reported to have beneficial effects. The aim of this work was to assess the effect of outpatient management at a HF clinic, as compared with care by the usual assistant physician, on prognosis of HF patients. In this non-randomised study, we prospectively followed 339 patients after a hospitalisation index for HF, in order to compare prognosis between two groups of HF patients according to the ambulatory assistance setting: either a specific outpatient clinic (n=157) or the usual assistant physician (n=182)...
June 2002: European Journal of Heart Failure
C V Pollack, W B Gibler
Of all the clinical syndromes with which emergency physicians must deal, chest pain of coronary cause has benefited from the most striking recent advances both in diagnostic approach (cognitive and technologic) and in therapeutic options. Chest pain evaluation and management have become important foci of research in emergency medicine, and entire units are dedicated to its clinical prosecution in emergency departments and elsewhere in the hospital. New diagnostic tools are proposed and studied on a regular basis...
September 2001: Annals of Emergency Medicine
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