Journal of accident & emergency medicine
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Review Comparative Study
A transatlantic comparison of training in emergency medicine.
The system of training in accident and emergency (A&E) medicine in the United Kingdom is at a critical and much earlier stage of development than in the United States. Transatlantic comparison offers the opportunity to explore possible ways of improving training in the United Kingdom. Comparison revealed deficiencies in the UK training system in the following: prehospital care training, formal theoretical teaching, close supervision in a clinical setting, and in-service training examinations. Implementation of measures designed to address these deficiencies would enhance UK training in A&E medicine.
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Comparative Study
Analgesia in the accident and emergency department: do SHOs have the knowledge to provide optimal analgesia?
To assess senior house officers' knowledge in prescribing emergency analgesia for acute presentations in the accident and emergency (A&E) department. ⋯ A&E SHOs lack knowledge and confidence when asked to prescribe emergency analgesia for acute conditions. Responses to certain scenarios were extremely varied, indicating a need for national analgesia guidelines and protocols. Recognised training in pain management should be more readily available.
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The organisation of the American emergency health care system has changed rapidly during recent years, but it remains very different to the system in the United Kingdom. American emergency departments are organised around an attending physician based service, rather than a consultant led service. ⋯ The problems associated with working in an attending physician based service include antisocial hours of work, sleep deprivation, decreased job satisfaction, and "burn out," all in the context of a relatively hostile medicolegal climate. Although there appear to be no easy answers to some of these problems, the A&E specialist should be aware of the potential future difficulties for A&E medicine as it develops within the United Kingdom.
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Comparative Study Clinical Trial
Do supine oblique views provide better imaging of the cervicothoracic junction than swimmer's views?
To determine whether a swimmer's view or supine (trauma) oblique views are more likely to visualise the lower cervical spine when a lateral view fails to show the cervicothoracic junction. ⋯ In injured patients for whom the standard three view series fails to demonstrate the cervicothoracic junction, swimmer's views and supine oblique views show the alignment of the vertebral bodies with equal frequency. However, supine oblique films are safer, expose patients to less radiation, and are more often successful in demonstrating the posterior elements.
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Clinical Trial
Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department.
To assess the value of ultrasound in an emergency department in the diagnosis of early pregnancy complications, the efficacy of a study protocol in identifying ectopic pregnancies, and the agreement on ultrasound findings among emergency department staff and gynaecologists. ⋯ Transabdominal ultrasound performed in the emergency department is useful in screening for early pregnancy complications. Ectopic pregnancy should be suspected when no IUP is found on preliminary scanning.