Search This Blog

Sunday, 19 October 2014

New words: 'Mewsing' on medical risk

'She's mewsing 6, doctor'.

New medical shorthand for an urgent message for the duty doctor, part of an 'escalation protocol'. The word 'mewsing' derives from Modified Early Warning Score (MEWS), a red flag system for identifying patients at risk of a rapid deterioration in their medical condition, either as assessed in the community by emergency medical services or by health professionals in hospital.

A recent systematic review of the value of early warning scores (EWS) concluded that "scores perform well for predicting cardiac arrest and death within 48 hours although the impact on (other) health outcomes and resource utilization remains uncertain ...".

Current forms of  Early Warning Scores (EWS) have their origins in the 1990s, arising from efforts aimed at development of a simple scoring system suitable for bedside application for identifying patients at increased risk of rapid deterioration in their medical condition, irrespective of the illness involved.

The EWS protocol describes a clinical pathway which starts with health workers making standard physiological measurements - systolic blood pressure, heart rate, respiratory rate, body temperature and level of consciousness.  If these recordings are outside the expected rates, the early warning score increases. The higher the score the greater the risk of worsening in the medical condition due e.g. to progression in infection, development of acute cardiac complication and other serious medical problems.

In response to a high EWS score practitioners are called to respond urgently to reassess the at risk patient and institute with appropriate escalation  in clinical treatment.

Modified Early Warning Score (MEWS) were later devised to improve identification of surgical and medical patients "at risk of catastrophic deterioration". Modified scores may for example include weighting for the level of saturation of oxygen in the blood, urine output and pain.

Tuesday, 7 October 2014

Is cannabis dangerous? A review of research over the last 20 years ...

From commentary in The Independent

"A newly published paper reminds health professionals, policy makers, and the public, of the potential acute and long-term risks of cannabis use

In his report, Professor Wayne Hall at The University of Queensland Centre for Youth Substance Abuse Research, considers how the evidence has evolved over the past 20 years. He points out potential risks, both in the short term, and higher risks for three settings: long-term heavy use, use in adolescence, and during pregnancy."

With acute use, risks of cannabis include psychological effects – some people have an unpleasant dysphoric rather than euphoric response – and impaired concentration and coordination, with risk of road and other accidents, enhanced in the presence of alcohol or other drugs. Risks from exposure during pregnancy include reduced birth weight and impaired post-natal educational development, at least until adolescence. Risks of sustained use from adolescence also include impaired intellectual development. Other reported adverse effects of long-term use of cannabis include dependence, the risk higher in those who start in adolescence, and an increased risk of psychotic symptoms, especially in those with a family history of psychotic disorders or those who start young.  Regular use in older adults increases the risk of heart attack and chronic bronchitis. Cardiovascular and respiratory risks of cannabis are increased by concomitant tobacco use.

 See more from the commentary ...