BMC emergency medicine
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BMC emergency medicine · Jul 2019
Comparative StudyStrengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?
The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. ⋯ The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care.
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BMC emergency medicine · Jul 2019
Epidemiology of injuries presenting to the accident centre of Korle-Bu Teaching Hospital, Ghana.
Injuries directly lead to 5 million deaths every year, accounting for 9% of all deaths worldwide. While knowledge of the pattern of injuries is essential to plan health interventions to reduce the incidence of injuries, these are not thoroughly described in Ghana. The aim of this study was to describe the epidemiology of injuries seen at the Accident centre of the Korle-Bu Teaching Hospital, Ghana's main referral hospital. ⋯ Road Traffic accidents (RTA), especially motorcycle related, are a significant cause of injuries in Ghana. Future studies should focus on interventions that can reduce the incidence of RTA's to reduce the number of injuries that present to the Korle-Bu Teaching Hospital.
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BMC emergency medicine · Mar 2019
Multicenter Study Observational StudyCT imaging history for patients presenting to the ED with renal colic--evidence from a multi-hospital database.
Patients with renal colic have a 7% chance of annual recurrence. Previous studies evaluating cumulative Abbreviations: computed tomography (CT) exposure for renal colic patients were typically from single centers. ⋯ Within our EDCV cohort of renal colic patients, 55% had at least one prior CT. The mean number of prior CTs was lower for patients receiving CT on EDCV, and Ultrasound (US) alone was used more often in patients with prior stone history vs. those with no prior history.
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BMC emergency medicine · Feb 2019
Respiratory compromise in children presenting to an urban emergency department of a tertiary hospital in Tanzania: a descriptive cohort study.
Respiratory compromise is the leading cause of cardiac arrest and death among paediatric patients. Emergency medicine is a new field in low-income countries (LICs); the presentation, treatment and outcomes of paediatric patients with respiratory compromise is not well studied. We describe the clinical epidemiology, management and outcomes of paediatric patients with respiratory compromise presenting to the first full-capacity Emergency Department in Tanzania. ⋯ In this EMD of a LICs, respiratory compromise in children carries high mortality, with children of young age being the most vulnerable. Many children arrived in respiratory failure and few children received ICU care. Outcomes can be improved by earlier recognition to prevent cardiac arrest, and more intensive treatment, including ICU and assisted ventilation.
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BMC emergency medicine · Jan 2019
Randomized Controlled TrialCluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest: a feasibility study. PROXY: post ROSC OXYgenation study.
Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. ⋯ It may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research.