Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2019
Message in a bottle: How evidence-based medicine and a programme change model improved asthma management in a low-income emergency department in Papua New Guinea.
To improve asthma care in a complex, low resource, developing country setting. This observational study was carried out in a challenging low-income real-life setting in the ED at Modilon Hospital, Papua New Guinea. The only government hospital in Madang Province, with 258 beds, it provides medical care to a population of nearly 700 000 people of whom 40% live on less than US$1.25/day. ⋯ This project highlights the difficulties experienced with change management, both in general and in a limited resource setting. Lack of data limits conclusions about asthma management improvement. However, positive trends were apparent and make this approach reasonable for those considering change management strategies in a similar setting.
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Emerg Med Australas · Feb 2019
ReviewReview article: The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia.
Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. ⋯ Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.
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Emerg Med Australas · Feb 2019
ReviewReview article: A scoping review of physiotherapists in the adult emergency department.
To provide an overview of the literature that considers physiotherapists working in the ED in relation to their roles, training levels, patient profile, safety, effectiveness, efficiency, cost-effectiveness and the provision of low-value care. We performed a scoping review of the literature. Four databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched from their inception to December 2016 and we updated searches on PubMed in September 2017. ⋯ However, none of the studies followed participants to measure adverse events that became apparent after the ED visit, nor did they consider unsafe discharge decisions or suboptimal follow-up care. The available evidence suggests that physiotherapists may be as effective as other health providers in managing low urgency musculoskeletal conditions in the ED. There is uncertainty about appropriate training and a lack of robust studies investigating the efficiency, safety and cost-effectiveness of this model of care.
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Emerg Med Australas · Feb 2019
Observational StudyInfluence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out-of-hospital cardiac arrest.
To describe the association between prehospital airway management and neurological outcomes in patients transferred by the ambulance service directly to a heart attack centre (HAC) post-return of spontaneous circulation (ROSC). ⋯ In this observational study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest and in the post-ROSC transfer phase. Further research is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest.
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Trauma and other disease registries have been used to improve patient care and outcomes at the system level. Paradoxically, registries have had little role in informing the care of any individual patient while that care is being determined and delivered. The lack of timeliness of useful data is a major barrier to the value of registries in improving individual patient care real-time. What do trauma and emergency care providers require from their trauma registries to inform real-time patient-tailored improvements in trauma care? Research is urgently needed to improve the usefulness of disease registries, and to develop innovative processes and applications using patient data to inform patient care real-time, thereby improving patient outcomes.