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      Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome

      , , ,

      Clinical Medicine

      Royal College of Physicians

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          Most cited references 4

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          A risk score to predict need for treatment for upper-gastrointestinal haemorrhage.

          Current risk-stratification systems for patients with acute upper-gastrointestinal bleeding discriminate between patients at high or low risks of dying or rebleeding. We therefore developed and prospectively validated a risk score to identify a patient's need for treatment. Our first study used data from 1748 patients admitted for upper-gastrointestinal haemorrhage. By logistic regression, we derived a risk score that predicts patients' risks of needing blood transfusion or intervention to control bleeding, rebleeding, or dying. From this score, we developed a simplified fast-track screen for use at initial presentation. In a second study, we prospectively validated this score using receiver operating characteristic (ROC) curves--a measure of the validity of a scoring system--and chi2 goodness-of-fit testing with data from 197 patients. We also validated the quicker screening tool. We calculated risk scores from patients' admission haemoglobin, blood urea, pulse, and systolic blood pressure, as well as presentation with syncope or melaena, and evidence of hepatic disease or cardiac failure. The score discriminated well with a ROC curve area of 0.92 (95% CI 0.88-0.95). The score was well calibrated for patients needing treatment (p=0.84). Our score identified patients at low or high risk of needing treatment to manage their bleeding. This score should assist the clinical management of patients presenting with upper-gastrointestinal haemorrhage, but requires external validation.
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            Evaluation of a dedicated short-stay unit for acute medical admissions.

            The number of acute medical admissions to hospital continues to rise although not all need a prolonged stay. At the Queen Elizabeth Hospital, Gateshead, a short-stay unit (SSU) was developed specifically for such patients. Admissions to SSU over the first three weeks of 2006 were assessed. A total of 209 patients were admitted to SSU (10 patients a day). This accounted for 35% of all admissions through the medical assessment unit (MAU). Of these, 149 (71%) went home within 48 hours and a further 14 (7%) went home from SSU within 72 hours. The mean length of stay was 33 hours and the overall length of stay across the MAU (4.6 days) was significantly lower than the corresponding period a year earlier (5.5 days) (p = 0.02). The mean daily number of medical patients staying on non-medical wards was also lower during the study period than in 2005 (11 v 38; p = 0.015). Readmission rates and percentage bed occupancy did not change. This paper shows that the introduction of an SSU helps to identify and treat those patients with more minor illness who can often be discharged home at an earlier stage.
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              A national survey of the provision for patients with latex allergy

               G. Yuill,  D. Saroya,  S. Yuill (2003)
              The prevalence of latex allergy has increased since the 1980s. As latex is found throughout hospitals and operating theatres, careful planning is required for latex-allergic patients who present pre-operatively. We conducted a postal survey of 269 departments of anaesthesia in England and Wales; responses were received from 208 (77%). Of these, 198 (95%) had a latex allergy protocol and 181 (87%) had a store of latex-free equipment. Only 113 (54%) had a named nurse and 58 (28%) had a named consultant responsible for the update of latex allergy provisions. Access to allergy clinics and further investigations were available to 189 (91%). Many respondents called for national guidelines. We are reassured that the majority of trusts have an up-to-date latex allergy protocol and latex-free equipment store. However, relatively few have nominated members of staff responsible for these and peri-operative care of susceptible patients.
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                Author and article information

                Journal
                Clinical Medicine
                Clinical Medicine
                Royal College of Physicians
                1470-2118
                1473-4893
                February 01 2009
                February 01 2009
                : 9
                : 1
                : 30-33
                Article
                10.7861/clinmedicine.9-1-30
                © 2009

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