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Duckitt R.,Acute Medicine Unit | Palsson R.,University of Iceland | Bosanska L.,Charite - Medical University of Berlin | Dagna L.,San Raffaele Scientific Institute | And 2 more authors.
European Journal of Internal Medicine | Year: 2010

Objective: Information on the medical problems and diseases encountered by practicing Internists in the hospital environment is lacking. The aim of this study is to assess the prevalence of various diagnostic categories that present to internists in the hospital setting in Europe. Design: A pan-European study used the Young Internists Research Network of the European Federation of Internal Medicine. Results: Data on 1501 patients from 31 physicians in 18 European countries were included in the study. The patients carried an average of 2.75 (± 2.22) chronic medical diagnoses, ranging from 0 to 18. The most common presenting complaint was shortness of breath, followed by chest pain and abdominal pain. A cardiac condition was most common, followed by infectious disease. The complexity of patients averaged 2.5 (± 1.14). Conclusions: The results of this study will be useful for the development of a modern internal medicine curriculum, both at the graduate and postgraduate level, which reflects the competencies required for the delivery of comprehensive patient care in internal medicine wards. © 2010 European Federation of Internal Medicine. Source


Vardi M.,Carmel Medical Center | Vardi M.,Technion - Israel Institute of Technology | Dagna L.,San Raffaele Scientific Institute | Haran M.,Haematology and Coagulation Unit | Duckit R.,Acute Medicine Unit
Thrombosis Research | Year: 2012

Introduction: Hospitalised patients in Internal Medicine departments are at risk of venous thromboembolism (VTE). Adherence to risk stratification methods is poor. We conducted a survey among Internists from member countries of the European Federation of Internal Medicine (EFIM) to assess current knowledge and attitude towards VTE prevention. Methods: A multinational survey of Internists affiliated to EFIM. Results: 226 physicians from 30 countries were included. Seventy nine percent of the physicians were aware of clinical guidelines to prevent VTE. Most considered their knowledge of the guidelines to be moderate. Many had not updated their knowledge recently. The magnitude of the clinical problem was over- and underestimated by many (12.2% and 40.1%, respectively). Only 46.7% thought their patients were mostly receiving proper prophylaxis. Sixty four percent worked in departments without a formal VTE prophylaxis program. Risk of bleeding, lack of awareness and lack of decision support systems were the three most common reasons for deferring treatment (88.6%, 32.3% and 27.9%, respectively). Most of the participants stated that they strongly believe in VTE prophylaxis as an intervention that prevents morbidity and mortality. Conclusions: Despite general awareness of clinical guidelines, many medical wards do not have formal risk assessment methodologies incorporated into their operative workflow. This gap, as well as fear of complications, may be one of the reasons for the low rates of adherence reported by physicians. We speculate that perhaps current guidelines have not been accepted by Internists due to paucity of well defined and validated risk assessment tools. © 2012 Elsevier Ltd. All rights reserved. Source


Ahmed S.V.,Acute Medicine Unit
BMJ case reports | Year: 2012

A 32-year-old married Asian woman, previously fit and well, presented with a 3-day history of interscapular back pain followed by a 1-day history of frontal headache and a few episodes of vomiting. She did not have photophobia or neck stiffness. On examination, there was evidence of herpes zoster infection involving the right T3 dermatome. There were no signs of meningeal irritation, cognitive impairment or any neurological deficit. As it is uncommon to have reactivation of herpes zoster infection at a young age, HIV serology was requested to exclude immunodeficiency state. While awaiting serology, a lumbar puncture was performed to exclude opportunistic infections of the central nervous system as she had transient headache and vomiting at the onset. The cerebrospinal fluid showed an elevated level of protein, an increase in lymphocytes and a strongly positive PCR for varicella zoster. The HIV test was negative. Oral acyclovir was changed to intravenous therapy and, a week later, she was discharged with uneventful recovery. Source


Marwick C.,Medical Research Institute | Rae N.,Rotation Medical | Irvine N.,Acute Medicine Unit | Davey P.,Medical Research Institute
Journal of Antimicrobial Chemotherapy | Year: 2012

Background: Several severity scoring systems have been proposed for skin and soft tissue infections (SSTIs), but none has been tested prospectively. Methods: We prospectively enrolled adult, acute medical admissions with SSTI between April 2009 and June 2010. Severity was assessed using two proposed SSTI scoring systems, one based on a generic sepsis definition. Antimicrobial prescribing was compared with guideline recommendations. Results: We enrolled 79 patients. One of the scoring systems classified 47% into class I (no sepsis or comorbidity), 5% into class II (no sepsis, but comorbidity), 34% into class III [sepsis, but standardized early warning system (SEWS) <4], and 14% into class IV (sepsis with SEWS ≥4). The other system classified 39% as mild and 61% as moderate/severe. There were significant discrepancies between the two scoring systems. Using the worst clinical observations in the first 24 h, 19% of patients had more severe disease than was apparent on admission. Under-treatment of patients with sepsis occurred in 13% of patients according to admission observations, increasing to 22% according to the worst observations. Seventy-nine percent of patients with sepsis received antibiotics within 4 h of admission. This was associated with fewer adverse outcomes (P = 0.05). Conclusions: There is significant room for improvement in the management of SSTIs presenting to acute medical units. The added value of specific SSTI severity scores over generic sepsis assessment requires validation in a larger prospective study. We have changed our antibiotics policy for SSTI to use generic sepsis scores, and we emphasize the need to reassess patients on the day of admission. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source


Anwuzia-Iwegbu C.,Acute Medicine Unit | Fikree A.,Acute Medicine Unit | Tufton N.,Acute Medicine Unit
BMJ Case Reports | Year: 2013

A 41-year-old Bangladeshi man presented with a 2-month history of bilateral feet/hand swelling which intermittently resolved without medication. All blood tests performed by the general practitioner (GP) were unremarkable. Following admission to the accident and emergency department, a chest X-ray revealed a 'vail-like' opacification in the right side. High-resolution CT confirmed dilation of oesophagus with food debris and circumferential thickening of the lower oesophageal sphincter. Copyright 2013 BMJ Publishing Group. All rights reserved. Source

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