European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Clinical impression for identification of vulnerable older patients in the emergency department.
To investigate whether the clinical impression of vulnerability and the Dutch Safety Management Program (VMS), a screening instrument on four geriatric domains (activities in daily living, falls, malnutrition, delirium) are useful predictors of 1-year mortality in older patients in the emergency department. ⋯ The clinical impression of vulnerability is a simple dichotomous question which can be used as a first step in the identification of vulnerable older emergency department patients, whereas the more time-consuming VMS-screening is more specific for detection of vulnerability. The clinical impression of vulnerability is therefore useful in a busy emergency department environment where time and resources are limited.
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In the UK, the National Early Warning Score (NEWS) is recommended as part of screening for suspicion of sepsis. Is a change in NEWS a better predictor of mortality than an isolated score when screening for suspicion of sepsis?. ⋯ Persistently elevated NEWS, from prehospital through the ED to the time of ward admission, combined with an elevated ED lactate identifies patients with suspicion of sepsis at highest risk of in-hospital mortality.
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Medically unexplained symptoms, defined as physical symptoms for which no organic pathology can be found, represent 4% of all emergency department attendances annually. The standard management of these patients involves extensive investigation to rule out organic pathology, followed by simple reassurance. We conducted a literature review to determine if there was any intervention that could improve these patient's symptoms and reduce emergency department attendances. ⋯ Three studies tested cognitive behavioural therapy, with two finding a reduction in emergency department attendance. Overall, evidence regarding interventions for patients with medically unexplained symptoms in the emergency department is limited and of a variable quality, despite comprising 4% of emergency department attendances. Further research is required to determine the best intervention for this challenging patient group.
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Adequacy of bystander actions in unconscious patients: an audit study in the Ghent region (Belgium).
Early recognition and appropriate bystander response has proven effect on the outcome of many critically ill patients, including those in cardiac arrest. We wanted to audit prehospital bystander response in our region and identify areas for improvement. ⋯ We audited bystander response for unconscious patients in our region and found a high degree of suboptimal actions. These results should inform policy makers and healthcare professionals and force them to urgently reflect on how to improve the first parts of the chain of survival.