European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Poisoning is one of the most common reasons for acute medical admission to hospital in the UK. However, certain poisons are rarely implicated. Two unusual cases involving poisoning with atropine are presented. The clinical features were classical, but the way in which the patients became poisoned by drinking contaminated Indian tonic water was most unusual.
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The aim of the study was to evaluate the referral of outpatients with non-traumatic conditions for radiographic examinations and to assess the impact of the radiological report on the patient's management in an emergency department. In a prospectively designed study, 1223 X-ray examinations of 1116 non-trauma outpatients (640 males, 476 females; mean age: 44 +/- 18 years) requested over a 10-month period were evaluated. Patients were classified into four groups according to the presenting complaints (respiratory, abdominal, neurological or non specific symptoms). ⋯ The radiological result had an impact on the further management in 948 (85%) patients. As 45% of all radiographic examinations revealing a normal radiological result had a clinical impact, normal radiological reports are just as helpful as abnormal radiological findings in the management of non-trauma outpatients in an emergency department. Thus, we assume that the radiological result has a major impact on the management of non-trauma outpatients in the emergency department.
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Evidence-based medicine (EBM) is advocated by its protagonists as prototypical of, and therefore normative for, 'best professional practice', a position which has precipitated visceral anti-EBM sentiments within the international medical press. This article examines the nomenclature, claims, principles and practice of EBM, the matters of authority and competence in defining evidence for practice and how selective utilization of EBM findings will be employed by health service managers in an attempt to manage clinical decision making and ration the medical care of patients and populations.
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Editorial Comment
Randomized control trials and evidence-based medicine--what's in a name?