Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2015
ReviewReview article: Emergency department models of care in the context of care quality and cost: A systematic review.
To identify current ED models of care and their impact on care quality, care effectiveness, and cost. A systematic search of key health databases (Medline, CINAHL, Cochrane, EMbase) was conducted to identify literature on ED models of care. Additionally, a focused review of the contents of 11 international and national emergency medicine, nursing and health economic journals (published between 2010 and 2013) was undertaken with snowball identification of references of the most recent and relevant papers. ⋯ Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost-effectiveness analysis of service models. Although various models of delivering emergency healthcare exist, further research is required in order to make accurate and reliable assessments of their safety, clinical effectiveness and cost-effectiveness.
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Emerg Med Australas · Apr 2015
Comparative Study Observational StudyComparison of the C-MAC video laryngoscope with direct Macintosh laryngoscopy in the emergency department.
To investigate the first pass success rate, airway grade and complications in two tertiary EDs with the C-MAC video laryngoscope (VL), when compared with standard direct laryngoscopy (DL). ⋯ This is the first observational study of airway management comparing the C-MAC VL with DL blades in an Australian ED population. Our findings revealed that although the C-MAC VL overall did not provide an enhanced view of the larynx over the Macintosh DL, it was superior to DL when the grade was at least grade III. Currently we are unable to reliably predict the grade by any algorithm prior to intubation. Findings from this study suggest that the C-MAC VL should be considered as the first line laryngoscope in all ED intubations not just the ones predicted to be difficult.
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Emerg Med Australas · Apr 2015
Should external short courses be a compulsory part of ACEM specialty training? No.
I am proud to be a product of an excellent training system that builds trainees and fellows with an ongoing desire to learn. Dogmatic incorporation of external courses into training would be incongruent with medical education best practice principles upon which the new curriculum is founded. I am confident that our junior colleagues can – as we were – be trusted for generations to come to fashion their own learning paths, identifying and addressing their own knowledge gaps, using whatever media engages them best.