bluuebunny/crossref_metadata_2025 huggingface dataset:
Editorial Volume 17 Issue 2
Authors:   Manchester University Foundation Trust and The Christie, Manchester, UK, Cooksley Tim , Lovell Ben ,   University College London Hospitals, London
Published: June 2021

As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries. The global growth and interest in Acute Medicine is reflected in this issue of the journal, in which we are delighted to have a truly international cohort of authors. The papers in this issue add to the understanding of some of the fundamental tenets of the specialty key to delivering high quality acute medical care, including international adaptation of the AMU model of care, the Acute Medicine/Primary Care interface, the referral of older patients to Critical Care, readmissions and a reminder of the opportunities an acute medical admission presents to perform important health screening interventions. Rombach et al. describe the impact of implementing an AMU model of care in Amsterdam. The results of the first four years of the model mirror those seen following their introduction in the UK with improved patient flow and reduced length of stay with no effect on readmission rates. The crucial topic of trying to ensure and describe optimal transfer of clinical information between the Acute Medicine and Primary Care interface is addressed through a quality improvement project by Lockman et al. with an accompanying editorial by Professor Dan Lasserson. Their success highlights the opportunities to drive quality through multi-specialty working and innovative thinking. Nannan-Panday et al. examine the vital sign changes in readmitted patients. They describe that deterioration in key physiological signs is common in patients with unplanned readmissions and suggest early intervention through wearable technologies may be a strategy for reducing this adverse event. Bosch et al. retrospectively analyse the outcomes of elderly patients admitted to Intensive Care directly from the Emergency Department compared to those admitted from general wards finding the former group have better outcomes. This reinforces the importance of early decision making, particularly in elderly patients, so fundamental to the practice of Acute Medicine. Rice et al. report the results of a quality improvement project focusing on HIV testing in their Emergency Department at the world’s largest cancer hospital. They reflect that acute care specialties are uniquely positioned to influence clinical practice because of the large cross section of patients for whom it supports. As we as Acute Medicine practitioners reflect on what we are achieving and what there is to accomplish, we need to remind ourselves that the global footstep of our specialty is increasing and we have the opportunity to imprint its principles further in the acute care of medical patients.
HIV testing in Acute Care
Authors:   Manchester University Foundation Trust Cobbett House, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK, Newton Pippa J
Published: June 2021

Readers may be aware of the need to improve uptake of HIV testing in health care-settings to reduce the number of individuals with undiagnosed infection who later present with advanced disease. Late presentation of HIV infection is associated with a poorer immune response to antiretroviral therapy, an increased morbidity and mortality with a resultant higher cost burden to health-care services. Individuals with undiagnosed HIV infection who inadvertently transmit their infection to others are thought to be responsible for more than half of new HIV infections in the USA.
Effective acute care handover to GP: optimising the structure to improve discharge documentation
Authors:   Acute Medical Unit, Royal Infirmary of Edinburgh, Lockman K A , Lee W H ,   Acute Medical Unit, Royal Infirmary of Edinburgh, Sinha R ,   Liver Unit, Royal Infirmary of Edinburgh, Teoh WL ,   Acute Medical Unit, Royal Infirmary of Edinburgh, Bickler C ,   Edinburgh Community Health Partnership, Astley Ainsley Hospital, Dummer S ,   Acute Medical Unit, Royal Infirmary of Edinburgh, VeiraiahVeiraiah A ,   Acute Medical Unit, Royal Infirmary of Edinburgh
Published: June 2021

Time and resource constraints have often led to the use of assessment records as discharge communications from acute and emergency departments. However, whether this addresses the primary care needs has not been demonstrated. This study examined the optimal structure that can impart key discharge information effectively using feedback from general practitioners (GP). We implemented an electronic assessment template that focused on the most relevant headings. Prespecified process measures were examined and qualitative thematic analysis of free-text comments from GP surveys were conducted to optimise the document. Our findings suggest that the structure of a discharge summary can influence the quality of information, users’ compliance and readers’ perceptions of the length of the letter.
Abnormal cardiac conduction in a septic patient: incidental finding or cause for concern?
Authors:   The James Cook University Hospital, Middlesbrough, United Kingdom, TS4 3BW, Jackson M , Balasubramaniam K ,   The James Cook University Hospital, Middlesbrough, United Kingdom, TS4 3BW
Published: June 2021

A 64-year-old male presents to the emergency department in acute respiratory distress. He gives a limited history of progressive shortness of breath of one week’s duration and several episodes of sudden unexplained syncope. There was no history of chest pain, palpitations or localising symptoms of infection. He takes no regular medications.
Screening instruments for identification of vulnerable older adults at the emergency department: a critical appraisal
Authors:   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, van Dam Carmen S , Moss Nadia ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, A Schaper Sophie ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, C Trappenburg Marijke ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, ter Wee Marieke M ,   Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands, Scheerman Kira ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, Muller Majon ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, WB Nanayakkara Prabath ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands, JL Peters Mike ,   Department of Internal Medicine and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
Published: June 2021

Background: Early detection of vulnerable older adults at the emergency department (ED) and implementation of targeted interventions to prevent functional decline may lead to better patient outcomes. Objective: To assess the level of agreement between four frequently used screening instruments: ISAR-HP, VMS, InterRAI ED Screener and APOP. Methods: Observational prospective cohort study in patients ≥ 70 years attending Dutch ED. Results: The prevalence of vulnerability ranged from 19% (APOP) to 45% (ISAR-HP). Overall there was a moderate agreement between the screening instruments (Fleiss Kappa of 0.42 (p<0.001)). Conclusion: Depending on the screening instrument used, either only a small percentage or almost as many as half of the presenting patients will be eligible for targeted interventions, leading to large dissimilarities in working processes, resources and costs.
Chronic deep vein thrombosis
Authors:   Department of Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Denny Nicholas , Musale Shreshta ,   Department of Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Edlin Helena ,   Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Serracino-Inglott Ferdinando ,   Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Thachil Jecko ,   Department of Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust
Published: June 2021

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Although acute DVT is often well managed, there is uncertainty in the management of chronic DVT which is increasingly being noted among patients presenting with similar symptoms to their initial DVT. The presence of a residual venous clot can be a problem for both physicians and patients fearing the risk of emboli to the same extent as the acute DVT. There are also issues in the accurate diagnosis and appropriate management of chronic DVT, which is the focus of the second part of this review.
What is the evidence base for ambulatory care for acute medical illness?
Authors:   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Lasserson Daniel , Harris C ,   Institute of Applied Health Research, University of Birmingham, Birmingham, UK, Elias TNE ,   Oxford University Hospitals NHS Foundation Trust, Oxford, UK, Bowen JST ,   Institute of Applied Health Research, University of Birmingham, Birmingham, UK, Clare Sarbjit ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
Published: June 2021

Acute ambulatory care is a critical component of the emergency care pathway with national policy support and a dedicated NHS Improvement network. The evidence base for treating acute medical illness outside hospital is a diverse mix of randomised and observational studies with varying inclusion criteria, prognostic stratification, interventions and healthcare setting which limits synthesis of all available evidence and translation to the UK context. There is little consensus on the level of risk for home-based treatment for acute medical illness. Selection tools for referral to acute ambulatory care have been developed but there is limited evidence for their use. There are still research questions concerning optimal staffing, referral mechanisms, point of care diagnostic portfolio and tools for shared decision making.
Exploring the value of routinely measured hematology parameters for identification of elderly patients at high risk of death at the Emergency Department
Authors:   Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands, Bindraban Renuka S , ten Berg Maarten J ,   University Medical Center Utrecht, Utrecht, The Netherlands, Haitjema Saskia ,   Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands, Hoefer Imo E ,   Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands, de Regt Marieke ,   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands, Kramer Mark H H ,   VU University Medical Center, Amsterdam, The Netherlands, van Solinge Wouter W ,   University Medical Center Utrecht, Utrecht, The Netherlands, Nanayakkara Prabath WB ,   Amsterdam University Medical Centre, VU University, The Netherlands, Naaktgeboren Christiana A ,   University Medical Center Utrecht, Utrecht, The Netherlands
Published: June 2021

Of the warning scores in use for recognition of high-risk patients at the Emergency Department (ED), few incorporate laboratory results. Although hematological characteristics have shown prognostic value in small studies, large studies in elderly ED populations are lacking. We studied the association between blood cell and platelet counts and characteristics as well as C-reactive protein (CRP) at ED presentation with mortality in non-multitrauma patients ≥ 65 years. Comparison between survivors and non-survivors showed small, significant differences with AUROCs ranging between 56.6% and 65.2% for 30-day mortality. Combining parameters yielded an evident improvement (AUROC of 70.4%). Efforts should be pursued to study the added value of hematological parameters on top of clinical data when assessing patient risk.
Pneumothorax management: are the guidelines all-encompassing for the purpose of Acute Medicine?
Authors:   Royal Free London NHS Foundation Trust, Cama Rigers , Murray James ,   Respiratory Medicine/ Clinical Teaching Fellow Royal Free London NHS Foundation Trust Royal Free Hospital, Murch Nicholas ,   Royal Free Hospital, Pond Street, London, NW3 2QG
Published: June 2021

Pneumothorax is defined as the presence of air in the pleural space, between the lung and the chest wall. It is a significant global health problem, with considerable morbidity and healthcare costs. Best management strategy remains controversial, with significant variation in practise, both nationally and internationally. The lack of consensus is driven by the paucity of the evidence base. Current research trials, particularly those looking at ambulatory management, are making progress and may help streamline future guidelines. This review presents five case reports of patients treated with methods which are not entirely synchronous with the current British Thoracic Society (BTS) guidelines; providing guidance for acute medical physicians who are routinely presented with such cases and exploring future developments in pneumothorax management.
Predicting value of prehospital body temperature for ICU admission of septic shock patients
Authors:   Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France., Jouffroy Romain , Saade Anastasia ,   Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France., Durand Stephane ,   Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France., Philippe Pascal ,   Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France., Carli Pierre ,   Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France., Vivien Benoît ,   Hôpital Necker - Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France.
Published: June 2021

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.
SAMBA18 Report – A National Audit of Acute Medical Care in the UK
Authors:   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Lasserson Daniel , Subbe Christian ,   Acute, Respiratory & Critical Care Medicine, Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales, Cooksley Timothy ,   Department of Acute Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, Holland Mark ,   Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, United Kingdom
Published: June 2021

SAMBA18 took place on Thursday 28th June 2018 with follow up data at 7 days. Acute medical teams from 127 Acute Medical Units (AMUs) across the UK collected data relating to operational performance, clinical quality indicators and standards from NHS Improvement. Data was collected from 6114 patients.
A Chest X-Ray causing confusion
Authors:   Acute Medicine, Great Western Hospital, Swindon, Novak Timea , Strait Catherine ,   Acute Medicine, Great Western Hospital, Swindon, Severn Deanery
Published: June 2021

The Chest X-Ray (Figure 1) shows right unilateral pulmonary oedema with small bilateral pleural effusions. Unilateral pulmonary oedema can easily be mistaken for other pathologies such as pneumonia or pulmonary haemorrhage or even malignancy.
The appropriateness of current UK training in acute internal medicine
Authors:   University College London, Rowland Hill Street, Hampstead, London NW3 2PF, De Silva Ravindu , Negus Rupert ,   The Royal Free London NHS Foundation Trust, Pond Street Hampstead, London NW3 2QG, Morgan Marsha Y ,   University College London, Rowland Hill Street, Hampstead, London NW3 2PF
Published: June 2021

Doctors training in Acute Internal Medicine (AIM) need to provide evidence that they can effectively manage 20 ‘top’ and 40 ‘other important’ acute medical presentations. However, the presentations considered important in the AIM curriculum do not have an empirical evidence base. This study compared real-life presentations against those in the AIM curriculum. Data on all presentations to the acute medical service at The Royal Free Hospital, London, were collected retrospectively for five non-consecutive weeks and prospectively for one week. Five frequently encountered presentations viz: cough, nausea and vomiting, dizziness, hyperglycaemia and lethargy were not amongst those listed as ‘top’ or ‘other important’ in the AIM curriculum. Hence, demonstration of competency in these presentations is currently not an explicit requirement.
Non-Cardiac Chest Pain: management in the Ambulatory Clinic setting
Authors:   Lifelong Health and Ageing at UCL, London, United Kingdom, Lanham David A , Lanham John G ,   London Lupus and Rheumatology Centre, London, United Kingdom
Published: June 2021

Non-cardiac chest pain (NCCP) is a common presenting complaint which can be better managed. This requires the recognition of clinical sub-groups with investigation and treatment tailored accordingly. The aim of this paper is to encourage more accurate diagnoses and the better recognition of the source of chest pain. We discuss the appropriate investigations and management of each clinical sub-group.
Pardon My French
Authors:   Elizabeth Blackwell Institute for Health Research, University of Bristol, Kimpton George
Published: June 2021

Cama et al’s review of pneumothorax management was excellent, especially their elegant depiction of chest tube diameter in comparison to the intercostal space, as measured in French gauge. The use of gauge is medicine is confusing due to differing systems and seemingly random increments. This diagram neatly shows that French gauge (Fr) is directly proportional to diameter, as the external diameter of the tube in millimetres is the gauge multiplied by three. For example, a 15 Fr chest tube has an external diameter of 5mm.
Described Practices for Assessing Fluid Resuscitation in Acute Hospital Care: A Qualitative Study
Authors:   Warwick Medical School, University of Warwick, Warwick, UK, Lloyd Edward , Ignatowicz Agnieszka ,   Institute of Applied Health Research, University of Birmingham, Birmingham, UK., Sapey Elizabeth ,   Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, Lasserson Daniel ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Seccombe Adam ,   Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Published: June 2021

Fluid resuscitation is a widely-used treatment in acute and emergency medicine, however, the process used to perform a fluid assessment has never been studied. This qualitative study explored how acute physicians describe their approach to assessing for fluid resuscitation. 18 clinicians of varying grades consented to a semi-structured interview. Transcripts were coded and analysed using thematic analysis. Participants described three subtypes of assessment; screening assessment, emergency assessment and formal assessment. Whether a patient was ‘sick’ was key to determining which assessment they would receive. Marked heterogeneity was noted in the assessment processes, particularly regarding the use of history-taking. Further research is required to determine how the information gathered in these assessments is used to decide when fluid resuscitation is indicated.
The Use of Lung Ultrasound in Acute Medicine
Authors:   William Harvey Hospital (East Kent Hospitals University NHS Foundation Trust). Honorary Senior Lecturer, Queen Mary’s University of London., Parulekar Prashant , Harris Tim ,   Queen Mary University London The Blizzard Institute Whitechapel, London Deputy Chair Dept Emergency Medicine & Senior Consultant Emergency Medicine Hamad Medical Centre Doha, Qatar, Jarman Robert ,   Royal Victoria Infirmary, Newcastle upon Tyne, UK
Published: June 2021

POCUS (Point of Care Ultrasound) refers to ultrasound performed by clinicians as part of their initial patient evaluation, often with the aim of answering a specific question as opposed to being a comprehensive assessment. Such ultrasound is noninvasive, involves no radiation and can be rapidly performed at the bedside. It is also widely practiced in emergency and intensive care medicine leading to earlier and more accurate diagnoses for a wide range of presentations such as shock, renal failure and dyspnoea. POCUS has evolved from cardiological or radiological studies, reduced in complexity and scoped for clinician use. Lung ultrasound (LUS) has been largely developed by acute care clinicians and is a more recent addition to POCUS. Procedural LUS is widely recommended to improve the safety profile of pleural catheter placement (referring to BTS guidelines) but in the UK diagnostic LUS is not widely practiced despite good evidence and guideline support for its use. In this article we briefly review and describe the role of diagnostic LUS as applied to acute medicine. Potential advantages of LUS include a decreased time to diagnosis, improved diagnostic accuracy, a reduction in radiation exposure and unnecessary expensive tests. Studies have shown that at least one diagnosis was missed in around a fifth of patients with acute respiratory symptoms, resulting in increased length of stay and mortality in a third of patients.
Fentanyl patches: Use and Misuse
Authors:   City Hospital, Birmingham B18 7QH, Langford Nigel J
Published: June 2021

Transdermal fentanyl is a well-used and highly effective form of opioid analgesia for patients suffering with severe chronic pain. It is also an opioid that is widely abused. Acute clinicians need to be aware of the methods by which fentanyl patches may be used both therapeutically and illicitly as well as the impact this can have in managing a patient’s period of intoxication
https://staging.acutemedjournal.co.uk/ferric-carboxymaltose-ferinject-associated-hypophosphataemia-case-report-illustrating-the-need-for-increased-awareness-to-minimise-incidence-and-risk/
Authors:   Great Western Hospitals NHS Foundation Trust, Evans Jack , Ullah Sharif ,   Great Western Hospitals NHS Foundation Trust
Published: June 2021

Syncope is a common clinical presentation and accounts for 1-3% of Emergency Department (ED) visits. Cough syncope is a rare type of situational syncope, often caused by respiratory conditions like bronchial asthma and chronic obstructive pulmonary disease. Cough syncope due to pericardial effusion is a rare but treatable condition. Delay in diagnosis can lead to fatal complications due to cardiac tamponade. We present a case of recurrent cough syncope caused by large pericardial effusion.
Recovery after acute illness after hospital discharge – a prospective cohort study
Authors:   Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark, Ahmed Nadia , Emilia Grangård Olesen Karen ,   Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark, Musaeus Poulsen Lone ,   Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark, Gøgenur Ismail ,   Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark, Mathiesen Ole ,   Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark, Estrup Stine ,   Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
Published: June 2021

Background: Long-term outcomes after acute medical and surgical illness are largely unknown. Aim: To describe cognitive and physical function, health-related quality of life and risk of anxiety and depression after acute illness. Design: Prospective cohort study. Methods: Home visit at three and twelve months measuring: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Chelsea Critical Care Physical Assessment tool, Short Form Health Survey, Hospital Anxiety and Depression Scale and Trail Making Test. Results: Of 101 included patients, 60 were visited at three and 36 at twelve months. The RBANS value was 84 (69-96) at three months and 88 (69-101) at twelve months. Conclusions: We found a moderately reduced cognitive function three and twelve months after acute illness.
Acute care service performance during winter: report from the winter SAMBA 2020 national audit of acute care
Authors:   Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom, Atkin Cat , Knight Thomas ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Subbe Christian ,   Bangor University & Ysbyty Gwynedd Hospital Bangor, Wales, Holland Mark ,   Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, United Kingdom, Cooksley Timothy ,   Manchester Royal Infirmary, Oxford Road, Manchester, Lasserson Daniel ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
Published: June 2021

The Winter Society for Acute Medicine Benchmarking Audit (SAMBA) provides the first comparison of performance within acute medicine against clinical quality indicators during winter, a time of increased pressure and demand on acute services. 105 hospitals participated in Winter SAMBA, collecting data over 24-hours on 30th January 2020. 5626 patients were included. Participating units saw a median of 48 patients (range 13-131). Comparison between Winter SAMBA and SAMBA19 found less patients had an early warning score within 30 minutes during winter (74.3% vs 78.9%) and less were seen by a clinical decision maker within four hours (84.9% vs 87.9%). Unplanned admissions represented a higher proportion of workload (92.5% vs 90.1%). Patients were more likely to have a NEWS2 score of 3 or higher (30.1% vs 25.7%). Performance is poorer in winter, and patients are more unwell, needing prompt treatment. Services should ensure high quality care can be maintained through times of increased pressure, including winter.
Does thrombolysis for pulmonary embolism reduce the risk of chronic complications?
Authors:   Lewisham and Greenwich National Health Service Trust, London, Apsey Caroline , Jawad Muhammad ,   East Surrey Hospital, Surrey and Sussex Healthcare National Health Service Trust, Redhill, Daschel Martin ,   East Surrey Hospital, Surrey and Sussex Healthcare National Health Service Trust, Redhill, Woosey Daniel ,   East Surrey Hospital, Surrey and Sussex Healthcare National Health Service Trust, Redhill, Limb Chis ,   East Surrey Hospital, Surrey and Sussex Healthcare National Health Service Trust, Redhill, Wilde Mike ,   East Surrey Hospital, Surrey and Sussex Healthcare National Health Service Trust, Redhill
Published: June 2021

We assessed the efficacy of thrombolysis in avoiding long-term complications. Notes of patients thrombolysed for PE in the 2-year period were reviewed. The initial CTPA and echocardiogram results before thrombolysis were compared to the results of follow up imaging repeated after 6 months. Twenty-two patients were thrombolysed for PE. 14 patients had sub-massive PE and 8 patients had massive PE. The right ventricle (RV) was dilated on pre-thrombolysis echocardiogram in 16 patients. On follow up echocardiography all patients with massive PE (6 studies) had a normal RV size, with pulmonary artery pressures (PAP) of 29mmHg. Follow up echocardiography of patients with submassive PE (13 studies) showed 11 patients with a normal RV, with PAP of 28 mmHg.
Diagnoses and mortality in a population without acute myocardial infarction, but with elevated highsensitive troponin I – a retrospective register-based single center study
Authors:   Odense University Hospital, Denmark, Søgaard Hansen Rasmus , Revsholm Jesper ,   Odense University Hospital, Denmark, Pilsgaard Henriksen Daniel ,   Odense University Hospital, Denmark, Lund Lars Christian Lund ,   University of Southern, Denmark, Nybo Mads ,   Odense University Hospital, Denmark
Published: June 2021

Aim: To explore, which differential diagnoses to consider in individuals with elevated troponins without acute myocardial infarction (AMI), and the mortality for those individuals. Methods: Retrospective, register-based study on a representative sample of the Danish population with the following inclusion criteria: High-sensitive troponin I (hs-TnI) ≥25 ng/L, age ≥18 years, and exclusion of AMI. Results: 3067 individuals without AMI but increased hs-TnI were included. Most frequent discharge diagnoses: Pneumonia (12.8%), Aortic valve disorder (11.3%), Medical observation (10.9%) and Heart failure (8.9%). The 30-days and one-year mortality was 15.8% and 32.0%, respectively. Conclusions: A selected number of alternative diagnoses must be considered in individuals with increased hs-TnI. Due to high mortality it is crucial to carefully evaluate these individuals despite the absence of AMI.
Safer communication and clinical evaluation using mobile devices for COVID 19 patients could reduce post acute care stress and prevent burnout in patients and teams
Authors:   Federal Public Service Bosa, Brussels, Belgium, Reper A , Guinotte B ,   Université Catholique de Louvain, Brussels, Belgium, Reper P ,   Federal Public Service Health (Brussels), Belgium
Published: June 2021

Mobile App based ultrasound is very useful in the setting of the current coronavirus pandemic in all hospital wards. We have used this for videoconference (we called videovisit) between severely ill patients and family and for clinical ultrasound evaluation during the Covid 19 outbreak.
Keselamatan Diri dalam Qurban Idul Adha 1441 H sebagai Bentuk Pengabdian kepada Masyarakat Politeknik Penerbangan Palembang
Authors: Abdullah Anton , Nugraha Wildan , Masitoh Fitri , Sutiyo Sutiyo , Astutik Rinto
Published: May 2021

Target dan luaran dari kegiatan ini adalah untuk melaksanakan Tridharma Perguruan Tinggi, pengabdian masyarakat bagi dosen di lingkungan Politeknik Penerbangan Palembang, Sumatera Selatan. Metode kegiatan yang digunakan adalah 1) ceramah agama, yaitu memberikan bimbingan rohani kepada keluarga besar Politeknik Penerbangan dan warga sekitar; 2) lecturing di mana narasumber menjelaskan kepada keluarga besar Politeknik Penerbangan dan warga sekitar tentang hikmah berkurban dan meneladani syari’at Nabi Ibrahim As., menumbuhkan kesadaran dan peran serta keluarga besar Politeknik Penerbangan dan warga sekitar dalam menumbuhkan kecintaan kepada sesama dalam perwujudan rasa sukur dan taqwa kepada Allah Swt.; dan 3) evidence-based learning, dimana para pengkurban dan tim pelaksana diajak untuk bersama-sama bagaimana cara pengumpulan, penyembelihan, dan pembagian hewan kurban. Hasil yang diperoleh dari kegiatan ini dapat membuat tim pelaksana, keluarga besar Politeknik Penerbangan dan warga sekitar yaitu: 1) meneladani syari’at Nabi Ibrahim AS; 2) menumbuhkan kesadaran dan peran serta umat Islam (dosen)  dalam menumbuhkan kecintaan kepada sesama dalam perwujudan taqwa kepada Allah Swt.; 3) mengabdi kepada masyarakat dalam memperkokoh tali silaturahmi untuk menjalin ukuwah Islamiyah di antara dengan warga sekitar.
Pelatihan Basic Human Factor untuk Peningkatan Self Awareness dan Safety Culture Petugas Operasi Bandar Udara Gusti Syamsir Alam
Authors: Amalia Direstu , Nugraha Wildan , Suryan Viktor , Septiani Virma , Napitulu Belen Sri H
Published: May 2021

Studi tentang human factor adalah tentang memahami perilaku (behaviour) dan kinerja (performance) manusia (human). Ketika diterapkan pada operasi penerbangan, human factor digunakan untuk mengoptimalkan hubungan antara manusia (human) dan sistem (system) tempat mereka bekerja (workplace) untuk meningkatkan keselamatan (safety) dan kinerja (performance). Gambaran tentang efek human factor  dalam penerbangan serta pentingnya self-awareness akan dijabarkan pada diklat ini. Hasil pelatihan yang memuaskan dicapai oleh 16 orang, 8 orang baik sekali, dan 2 orang berpredikat baik dengan range nilai tertinggi 94,70 dan nilai terendah 74,25.
DEPRESSÃO E BURNOUT EM PASTORES
Authors: Do Nascimento Sousa Fabiana Josefa , Falcão Sérgio Da Cunha , Delgado Ana Beatriz De Andrade Borba , Melo Victória Emmanuely de
Published: June 2021

A saúde mental de pastores é um tema pouco debatido embora seja uma evidência atual. Com efeito, estudos sobre a condição psíquica de pastores, hodiernamente, é de indubitável importância, uma vez que a depressão e burnout têm ultrapassado níveis aceitáveis de normalidade. Ainda são tímidas as publicações com este objeto de estudo. Este fato se justifica a importância de trazer à tona os fatores desencadeantes destes transtornos com efeitos alarmantes no cenário eclesiástico e na vida dos indivíduos pastores. Assim, o objetivo é provocar reflexão sobre depressão e burnout em pastores a partir de uma revisão de literatura. Na narrativa bíblica tem-se o registro do líder religioso Moisés que se apresentava com esgotamento físico e emocional, e seu sogro Jetro o orientou a delegar funções aos; no que diz respeito às depressões temos relatos de alterações patológicas do humor em Davi e Saul, por exemplo. Concepções equivocadas de que pastores são para “resolver as coisas de Deus” e o limite é a exaustão têm contribuído para constituição quadro alarmante de pessoas que cuidam dos outros, ao custo de tornarem-se sufocadas, angustiadas, em pânico e emocionalmente adoecidas. Algumas são levadas ao ponto da ideação ou cometimento de atos suicidas.
HEBREUS 11.1
Authors: Pereira Aislan Fernandes
Published: June 2021

Este trabalho apresenta uma interpretação de Hebreus 11.1, cuja reivindicação principal é de que o verso não trata de fé, mas antes de confiança resistente. Essa afirmação é baseada principalmente na elucidação do uso das palavras gregas “pistis” (πίστις), “hipostasis” (ὑπόστασις) e “elenchos” (ἔλεγχος) contidas no versículo. Assim, argumenta-se em favor, não da tradicional definição de fé cristã, porém a respeito do que a confiança genuinamente cristã é capaz de resistir, ou melhor, suportar.
A PEDAGOGIA DA EXCLUSÃO NAS POLÍTICAS PÚBLICAS INOVADAS E TECNOLÓGICAS NOS PAÍSES EM DESENVOLVIMENTO
Authors: Da Costa Rui Quintas
Published: May 2021

O presente artigo tem como escopo uma análise relacionada a pedagogia da exclusão nas políticas públicas inovadas e tecnológicas nos países em desenvolvimento. O olhar recai sobre o período neoliberal, que reduziu a ideia da educação a uma simplificação do processo de ensino-aprendizagem, sustentado pelo capitalismo dos países mais ricos sobre a hegemonia das comunidades aliadas à pobreza. A exclusão da inovação e da tecnologia tornaram dependentes não apenas a produção e os bens de consumos, mas, sobretudo, o conhecimento. Que é o principal aliado para o desenvolvimento económico, político e social? A evidência é tão profunda que a humanidade passa despercebida às conjunturas ideológicas marcadas pela pedagogia da exclusão nas políticas públicas, voltadas para inovação e tecnologia nos Estados periféricos do capitalismo.
Integrating Mindfulness and Character Strengths for Improved Well-Being, Stress, and Relationships: A Mixed-Methods Analysis of Mindfulness-Based Strengths Practice
Authors: Whelan-Berry Karen , Niemiec Ryan
Published: June 2021

The integration of mindfulness and character strengths is an emerging area of research and practice. The evidence-based, 8-week program, Mindfulness-Based Strengths Practice (MBSP) represents a unique approach in that the starting point and focus is on what is best in human beings – their character strengths. These qualities are then leveraged to improve one’s meditation practice or area of mindful living (referred to as “strong mindfulness”) and in turn, mindfulness is used as a lens for deepening awareness and use of strengths (referred to as “mindful strengths use”). While early controlled studies find MBSP to elicit well-being and reduce stress, and find it to be superior to popular mindfulness programs for different outcomes, we are not aware of any published qualitative analyses examining the MBSP participant’s experience. This study offers insights from a large international sample and extends the empirical data on MBSP, including the novel finding of benefit for building positive relationships, as well as confirming other findings such as the most common obstacles people confront in mindfulness practices. Additional areas discussed using qualitative and quantitative findings include the most beneficial mindfulness/character strengths practices, the use of inward and outward-oriented practices, cognizance of the integration of mindfulness and character strengths, and self-reported positive outcomes, including substantial benefits to stress and problem management and boosts to meaning, purpose, engagement, accomplishment, and sense of self.
Research on the Drapery in Ancient Greek Sculptures
Authors: Chen Jing , Cao Yiqiang
Published: May 2021

Sculpture in the ancient Greek period has an extremely lofty position in the history of Western art, and the drapery is one of the most important modeling characteristics of ancient Greek sculpture. This article summarizes the style evolution of drapery in ancient Greek sculptures through the performance of ancient Greek costume characteristics and dressing methods in sculptures. And through the drapery produced by the different postures of the human body in the sculptures, it is explored how the ancient Greek artists used drapery to show the dialectical relationship between clothing, the human body and the posture, thereby shaping the beauty model of classical clothing.
Reviewer Acknowledgements for Asian Social Science, Vol. 17, No. 6
Authors: Zhang Jenny
Published: May 2021

Reviewer Acknowledgements for Asian Social Science, Vol. 17, No. 6 2021.
OSCILLATIONS IN CERTAIN DIFFERENCE EQUATIONS
Authors: SZAFRANSKI ZDZISLAW , SZMANDA BLAZEJ
Published: May 2021

We obtain sufficient conditions for the oscillation of all solutions of some linear difference equations with variable coefficients.
Additional Great cardiac vein
Authors: Gózd-Barszczewska Anna , Dworzański Wojciech , Szczasny Marcin , Leus Marcin , Chromiński Tomasz , Grzywna Ryszard
Published: May 2021

We report a case of a patient with an additional great cardiac vein, discovered during the implantation for car­diac resynchronization therapy (CRT). Anomalies of the coronary sinus and its tributaries may cause difficulties in appropriate implantation of the left ventricular lead but they can also be considered as alternatives for lead placement. Although unusual angiogram of the coronary venous system, a left ventricular pacing lead was successfully placed in the left marginal vein. To settle diagnostic doubts, multislice computed tomography was carried out.
New cryoballoon atrial fibrillation ablation, is it the time for changes?
Authors: Hordyński Grzegorz , Wojdyła-Hordyńska Agnieszka
Published: May 2021

Since the release of the second-generation cryoballoon (CB2; Arctic Front AdvanceTM, Medtronic Inc) and its modifications with improved cooling characteristics, the technique, dosing, and complication profile is significantly different from that of the first-generation cryoballoon. Several reports of CB2 procedural recommendations have been presented. Hereby, the literature summary was performed and the technical and procedural study based regimen delivered. The best practice overview presents large centers contemporary techniques for safer and more effective outcomes and perhaps new approved recommendations for atrial fibrillation treatment.
Direct Acting Oral Anticoagulants in electrotherapy
Authors: Mitkowski Przemysław , Ochotny Romuald
Published: May 2021

Direct Acting Oral Anticoagulants (DOAC) since last 9 years catch on medical treatment and number of patients who receive them forced guidelines on its usage in high bleeding risk circumstances including ablation and cardiac implantable electronic devices (CIED) procedures. In current paper the available publications and guidelines in this field were discussed. In VENTURE-AF, RE-CIRCUIT and AXAFA-AFNET 5 trials safety of uninterrupted DOAC therapy during ablation procedure were confirmed. All patient during procedure received additional unfractionated heparine (UFH) to obtain value of ACT > 300 s. Bleeding event rate was comparable in patients treated with DOAC and those on vitamin K antagonists (VKA), and even lower when patients were on dabigatran. In BRUISE CONTROL 2 trial, in which patients undergoing CIED implantation were enrolled, no statistically significant differences in effectiveness and safety between uninterrupted and interrupted periprocedural DOAC treatment were noticed.
Prognosis after lead extraction because of infectious complications
Authors: Mitkowski Przemysław , Świerżyńska Ewa
Published: May 2021

In last years significantly higher rate of infectious complications than increase of procedure number has been observed. Despite treatment according to current recommendations in this group of patients long term outcome is still severe. Hospital mortality is around 5%, one year 7-37% and 3-year – even 53%. High risk of death belongs to patients with lead vegetations, lower to those with bacteriaemia and the lowest – when infection is localized to pocket. Risk of death beside type of infectious complication is increased by: dementia, heart failure, chronic kidney disease, anticoagulation treatment, bleeding which required blood transfusion and concomitant infection. Presence of tubular, free masses in echocardiography after extraction procedure also influence outcome. Patients with infectious complication require aggressive therapeutic options.
Cardiovascular complications in cancer patients recieving chemiotherapy or radiation
Authors: Dudek Magdalena , Lesiak Maciej , Straburzyński-Migaj Ewa , Mitkowski Przemysław
Published: May 2021

Cardiovascular diseases and cancer are among the main causes of death in developed countries. Early detection of malignant pathology, the continuous development of cancer therapy and improvement in the quality of patient care makes the survival of patients in this group constantly growing. It should be noted that people who have been cured of cancer are one of the largest, constantly growing subgroups that have access to health care. Cardiovascular diseases occurring in oncological patients are often a consequence of anti-cancer treatment, but they may also result from a malignant disease. The occurrence of cardiotoxicity in cancer patients, which is the result of applied oncological treatment, is an increasing challenge for both oncologists and cardiologists. The toxic effect of anticancer treatment on the cardiovascular system may manifest itself in a wide spectrum of changes such as electrophysiological abnormalities, vascular toxicity or heart failure. In this paper, we will discuss the latest views on the cardiotoxicity associated with various chemotherapeutic agents and radiation therapy used.
Cryoablation – how to avoid complications?
Authors: Farkowski Michał M.
Published: May 2021

Cryoballon ablation (CB) of atrial fibrillation represents similar risk but slightly different profile of complications to radiofrequency ablation. Phrenic nerve palsy is the typical complication of CB which can be avoided in most cases by a strict adherence to a couple of simple safety procedures. The article presents review of complications related to CB as well as practical suggestions how to avoid most of them.
Vasospastic angina and early repolarization induced polymorphic ventricular tachycardia – a chance For treatment success?
Authors: Wojdyła-Hordyńska Agnieszka , Hordyński Grzegorz , Pawlik Tomasz , Feusette Piotr , Gierlotka Marek , Kowalski Oskar
Published: May 2021

We describe a case of Vasospastic angina and early repolarisation syndrome, which induced polymorphic Ventricular tachycardia episodes. Surprisingly, the angina episodes dissapeared only after atrial arrhythmias treatment and percutaneous atrial fibrillation ablation.
PROCEDURE IN PATIENTS WITH HEART FAILURE (UPDATE 2019) – NON-PHARMACOLOGICAL THERAPY
Authors: Mitkowski Przemysław
Published: May 2021

Up-date of ESC Guidelines on management of patients with heart failure was published last year. Beside topics related to pharmacological treatment one can find also chapters dedicated to non-pharmacological management. In the field of ICD therapy Authors propose one may consider not to implant the device in patients over 70 years old, especially when they suffer from advanced heart failure and life-threatening comorbidities. It is in contra with meta-analysis presented after results of DANISH trial has been published, which underlined benefits of ICD treatment in such patients. Moreover in patients randomized to treatment without ICD almost 60% received CRTP. It is also important that 24 patients randomized to no-ICD group finally received ICD because of appearance of life-threatening ventricular arrhythmia. In such situation additional on-treatment analysis would be beneficial. One can get an impression that pulmonary vein ablation in patients with heart failure and atrial fibrillation achieve enough high level of recommendation despite favourable results of CASTLE-AF and on-treatment analysis of CABANA trials. Analysis of data according to received treatment seemed to be beneficial especially when the percentage of crossover is significant. Functional mitral regurgitation should be managed after meaningful analysis of each case and referral to MitraClip implantation should be based on the protocol of COAPT trial which proves benefits of a such device implantation.