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IntroductionDespite unprecedented pressures on urgent and emergency care services, there is no clear consensus on how to provide acute medical care delivery in the UK. These pressures can lead to significant delays in care for patients presenting with emergencies when admitted via traditional routes through the emergency department. Historically, a separate pathway has existed where patients are directly admitted to acute medicine services without attending the emergency department. It is suspected that there is a significant variation in how these patients are selected, triaged and managed in the UK. This systematic review will assess the methods and evidence base used for direct patient admissions to acute medicine services compared with traditional admission pathways through the emergency department.Methods and analysisA systematic review of the literature will be conducted and a total of six databases will be searched: MEDLINE (Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in process, Web of Science, CINAHL and Embase. This will include studies from the period 01 January 1975 to 24 January 2024. Covidence software will be the platform for the extraction of data and paper screening with the selection process reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Both title and abstract screening and full-text screening will be done by two reviewers independently. The risk of bias of included studies will be assessed using the methods introduced in the Cochrane Handbook for Systematic Reviews of Interventions and the tool used will be dependent on the type of study. Where possible, outcomes will be dealt with as continuous variables. Change percentage will be assessed between any pathway characteristic or outcome. The χ² test and I² test will be used to evaluate the heterogeneity of included studies. Where appropriate, relevant meta-analysis techniques will be used to compare studies and forest plot produced.Ethics and disseminationThis systematic review does not require ethical approval. Findings will be disseminated widely in peer-reviewed publication and media, including conferences.PROSPERO registration numberCRD42023495786.

The fluid volume status of a patient is difficult to assess clinically. The aim of this study was to compare the ultrasound estimation of the height of the right internal jugular vein (CVPIJV) with direct estimation of central venous pressure (CVP) (CVPCVC). A portable ultrasound machine defined the “top” of the right internal jugular vein in 44 patients from a single tertiary hospital. The vertical height from this point to the sternal angle was used to estimate CVPIJV. A central venous catheter was then inserted and direct measurement of CVP was made with a pressure transducer. A normal CVP was defined as 3 to 6 mm Hg. For overloaded patients, CVPIJV correlated well with CVPCVC, P = .004, sensitivity of 64.3%, specificity of 81.3%, and positive predictive value of 85.7%. The area under the curve for the receiver operating characteristic curve was 0.73 (95% confidence interval, 0.59-0.86). For undervolumed patients, the correlation remained statistically significant, P < .001, sensitivity of 88.9%, specificity of 77.1%, and negative predictive value of 96.4%. The area under the curve was 0.83 (95% confidence interval, 0.70-0.96). Ultrasound estimation of CVP using a portable ultrasound machine and the internal jugular vein is simple, noninvasive, and accurate.

The Fundamentalist-Modernist Controversy in the Presbyterian Church began with two dueling sermons in the summer of 1922. After liberal preacher Harry Emerson Fosdick delivered the sermon “Shall the Fundamentalists Win?” a fundamentalist preacher named Clarence Macartney responded with his own rebuttal in the form of a sermon entitled “Shall Unbelief Win?” Because of their theological antagonism, as represented in this episode, the similarities between these two preachers have been overshadowed in the prevailing historical narrative. Not only did both men agree on a whole host of social and moral questions, but even their famous disagreements provided an opportunity for innovations in an attempt to reach America’s middle class with their messages.

[...]the only time I can recall a comparable feeling of such extreme wellbeing was the day when, as a teenager with a broken arm, I sat on a trolley in an A&E department watching the world go by in a blissful haze of intravenous morphine. Instinct tells me that he is right, that there is synergy here - with the body's natural response to the stress of exercise and to cold water amplified, a more profound sense of euphoria is produced.

Before taking my first tentative steps into home butchery, I watched an eight-minute video of a Scottish gamekeeper gralloching - the process of removing the guts without contaminating the flesh - an adult stag through a 6in incision. In the weeks after Christmas, when the river was running high, they charted the decomposition of a drowned sheep that had been swept downstream and left dangling from the branches of a felled tree.

Surveys show that 90 per cent of people support organ donation, yet only 31 per cent of the population is on the donor register, despite a government initiative in 2006 to increase the number.

The civil war resulted in the loss of the public health infrastructure and the panicked withdrawal of missionaries, charities and NGOs. The civilian population also attempted to flee to the bush or neighbouring Guinea, but at the checkpoints on the urban boundaries they were given the choice of a 'long sleeve or short sleeve' amputation; a political slogan proclaimed: 'The future is in your hands' and so the opposition militias removed the arms of 130,000 people.

  The civil war resulted in the loss of the public health infrastructure and the panicked withdrawal of missionaries, charities and NGOs. The civilian population also attempted to flee to the bush or neighbouring Guinea, but at the checkpoints on the urban boundaries they were given the choice of a 'long sleeve or short sleeve' amputation; a political slogan proclaimed 'The future is in your hands' and so the opposition militias removed the arms of 130,000 people.

I feel really sad because someone took our Grinch out of our yard and broke it all.