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1.
J Crit Care ; 82: 154760, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38492522

RESUMO

PURPOSE: Chest radiographs in critically ill patients can be difficult to interpret due to technical and clinical factors. We sought to determine the agreement of chest radiographs and CT scans, and the inter-observer variation of chest radiograph interpretation, in intensive care units (ICUs). METHODS: Chest radiographs and corresponding thoracic computerised tomography (CT) scans (as reference standard) were collected from 45 ICU patients. All radiographs were analysed by 20 doctors (radiology consultants, radiology trainees, ICU consultants, ICU trainees) from 4 different centres, blinded to CT results. Specificity/sensitivity were determined for pleural effusion, lobar collapse and consolidation/atelectasis. Separately, Fleiss' kappa for multiple raters was used to determine inter-observer variation for chest radiographs. RESULTS: The median sensitivity and specificity of chest radiographs for detecting abnormalities seen on CTs scans were 43.2% and 85.9% respectively. Diagnostic sensitivity for pleural effusion was significantly higher among radiology consultants but no specialty/experience distinctions were observed for specificity. Median inter-observer kappa coefficient among assessors was 0.295 ("fair"). CONCLUSIONS: Chest radiographs commonly miss important radiological features in critically ill patients. Inter-observer agreement in chest radiograph interpretation is only "fair". Consultant radiologists are least likely to miss thoracic radiological abnormalities. The consequences of misdiagnosis by chest radiographs remain to be determined.


Assuntos
Unidades de Terapia Intensiva , Variações Dependentes do Observador , Radiografia Torácica , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Humanos , Radiografia Torácica/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Feminino , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Pessoa de Meia-Idade , Estado Terminal , Idoso
2.
Clin Med (Lond) ; 12(2): 119-23, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22586784

RESUMO

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.


Assuntos
Serviço Hospitalar de Admissão de Pacientes , Hipersensibilidade a Drogas/diagnóstico , Erros de Medicação , Serviço de Farmácia Hospitalar , Padrões de Prática Médica , Serviço Hospitalar de Admissão de Pacientes/normas , Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Adulto , Idoso , Austrália , Auditoria Clínica/métodos , Documentação/normas , Documentação/estatística & dados numéricos , Serviços de Informação sobre Medicamentos/normas , Serviços de Informação sobre Medicamentos/estatística & dados numéricos , Feminino , Clínicos Gerais/normas , Humanos , Masculino , Registros Médicos Orientados a Problemas/normas , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Nova Zelândia , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Prevalência , Melhoria de Qualidade
3.
Med J Aust ; 194(11): 596-8, 2011 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-21644875

RESUMO

Medical Assessment Units (MAUs) provide an opportunity for multidisciplinary staff to manage recently admitted acutely unwell patients with complex medical illnesses. We propose concerted development of robust mechanisms for identifying and managing patients whose condition is unstable as they move through hospital departments. Track, trigger and response (TTR) systems (eg, medical emergency team calls and early warning scores) have been introduced to hospital practice, but evidence for their effectiveness is, so far, incomplete. The current variation in TTR systems within and between hospitals impairs intersite comparisons. A range of outcome measures, including risk of physiological deterioration, mortality and projected hospital length of stay, could be usefully investigated by future intersite collaborative research. More deliberate, systematic, evidence-based design of "response" in TTR systems may help in identifying patients who need early attention from skilled medical staff. We need more uniform TTR systems, more research on TTR systems and more multisite research; MAUs are ideally situated to address this important area.


Assuntos
Cuidados Críticos/organização & administração , Estado Terminal/terapia , Unidades Hospitalares/organização & administração , Unidades Hospitalares/estatística & dados numéricos , Triagem/organização & administração , Austrália , Humanos , Modelos Organizacionais , Gestão de Riscos/organização & administração , Triagem/estatística & dados numéricos
4.
Med J Aust ; 193(4): 227-8, 2010 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-20712544

RESUMO

Increasing numbers of patients are presenting for unscheduled medical admission to hospitals worldwide, prompting clinical redesign of "front-door" emergency medical services. In the United Kingdom, there has been considerable investment in the establishment of acute medical units (AMUs) and the training of acute medicine physicians. Some centres in Australia have established similar medical assessment units. While these initiatives have undoubtedly met with some success, the evidence base for their overall benefit remains elusive. We describe key aspects of the recent establishment of acute medical services in Britain and discuss the relevance of these experiences to Australia. Successful models of care in acute medicine have often been shared with other centres. The adaptation of existing models of care to meet local demands is superior to simply adopting an existing model. Once the desired clinical functionality of a service is determined, informed decisions can be made on staffing requirements, skill mix, and the structure of any new clinical unit. The functionality of the acute medical service, rather than simply the physicality of an AMU, should drive service design.


Assuntos
Cuidados Críticos/organização & administração , Serviços Médicos de Emergência/organização & administração , Política de Saúde , Medicina Estatal/organização & administração , Austrália , Humanos , Reino Unido
5.
Acute Med ; 5(1): 21-3, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-21655503

RESUMO

We present the case of a patient who presented with evidence of pneumonia, sepsis and anaemia but no significant abdominal signs. A routine abdominal ultrasound scan revealed evidence of spontaneous splenic rupture. He underwent splenectomy but passed away subsequently from respiratory complications. The many associations of spontaneous splenic rupture are discussed. The diagnosis should be considered in any patient presenting with shock and non-specific abdominal signs and in those with pre-existing conditions known to cause splenomegaly.

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