Clinical medicine (London, England)
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Medical emergencies causing unplanned hospital admission place considerable demands on acute healthcare services. Some patients can be assessed and treated through ambulatory pathways without inpatient admission, via same day emergency care (SDEC), potentially benefiting patients and reducing demands on inpatient services. There is currently considerable variation within acute medicine in aspects of SDEC delivery ranging from overall service design to patient selection methods. ⋯ Specific scoring systems exist for some common medical problems, including cardiac chest pain and pulmonary embolism, but further research is needed to demonstrate how these are most effectively incorporated into SDEC services. This review defines SDEC and describes the variation in services nationally. It reviews the evidence for their clinical impact, tools to screen patients for SDEC and current gaps in our knowledge regarding service deployment.
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Case Reports
A case of unilateral pulmonary oedema associated with severe acute mitral regurgitation.
A 44-year-old woman presented to the emergency department with sudden chest tightness and breathlessness, and a chest X-ray revealed unilateral pulmonary oedema (UPO). Colour Doppler echocardiography showed that the leaflet prolapsed with severe regurgitation, and the regurgitant jet tended to blow rightward within the left atrium. ⋯ UPO is easily misdiagnosed, which leads to delays in treatment. Therefore, accurate diagnosis and immediate treatment are crucial.
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Observational Study
Reduction of physical activity during the COVID-19 pandemic is related to increased neuropsychiatric symptoms in memory clinic patients.
The COVID-19 pandemic led to unprecedented restrictions on social contacts and mobility. Memory clinic patients were disproportionately affected when care was disrupted and routines were abruptly changed. This trial was designed as a pragmatic, prospective, observational study to evaluate the effects of lockdown on memory clinic patients. ⋯ Fears regarding the pandemic were common and mostly related to the patients' health. Lockdown restrictions reduced physical activity in memory clinic patients which was associated with increased neuropsychiatric symptoms. Future restrictions should aim to mitigate the impacts on this vulnerable population.