Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2010
ReviewThe four hour target to reduce Emergency Department 'waiting time': a systematic review of clinical outcomes.
Governments in Australasia are introducing emergency department length of stay (EDLOS) time targets similar to the UK 'four hour rule'. There is debate about whether this rule had beneficial effects on health-care outcomes. We sought to determine what effects the four hour time target for EDLOS had on clinically relevant outcomes in the UK by conducting a systematic search for evidence. ⋯ One hospital demonstrated a small reduction in return rate. The impact of the introduction of an ED time target and the associated massive financial investment has not resulted in a consistent improvement in care with markedly varying effects being reported between hospitals. Countries seeking to emulate the UK experience should proceed with caution.
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Emerg Med Australas · Oct 2010
ReviewA primer for clinical researchers in the emergency department: Part II: research science and conduct.
Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. ⋯ Part I addressed ethical and regulatory aspects. In Part II, we describe important elements of research science, and practical elements of research conduct and administration, which form the basis for high-quality research.
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Emerg Med Australas · Oct 2010
Clinical TrialStress testing before discharge is not required for patients with low and intermediate risk of acute coronary syndrome after emergency department short stay assessment.
To investigate the usefulness of stress testing before discharge in patients assessed low to intermediate risk of acute coronary syndrome (ACS). ⋯ The present study showed that an ED short stay unit can effectively evaluate and manage patients with low and intermediate risk of ACS. The study suggests that patients with low and intermediate risk for ACS might safely be discharged after normal serial ECG and cardiac biomarkers, with a view to early outpatient stress testing. With strict adherence to admission criteria, there does not appear to be any benefit of stress testing before discharge.
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Emerg Med Australas · Oct 2010
A primer for clinical researchers in the emergency department: part I: ethical and regulatory background.
Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. ⋯ The ethics of research in children as a particularly vulnerable group will also be addressed. Part II will address important elements of research science and conduct.
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In 2009 emergency medicine had not been officially established as a specialty in Vietnam. As a result of a non-government organization identifying the need to improve the delivery of emergency care, the Vietnam2010 Symposium in Emergency Medicine was held in Hue in March 2010. This involved 1 week of activity including: an Emergency Medicine Conference, providing lectures and practical workshops in topics of emergency medicine; a Deans' Conference, dedicated to the development of emergency medicine as a specialty; a Disaster and EMS Conference; and an Emergency Nursing Conference. ⋯ A consensus document committing to the development of emergency medicine as a specialty in Vietnam was signed by multiple national and international governmental, university and emergency medicine representatives. Challenges included a tendency for international flagbearers from mature systems to promote the specialty according to local expectations, with a consequent emphasis on vertical specialty topics and on technology, and the running of medical and nursing conferences separately. Vietnam now needs a medium-term plan to develop the specialty to ensure these initial steps are translated into a sustainable capacity to provide emergency care nationally.