Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether the odontoid peg view is useful to radiologically exclude cervical spine injury in children under 9 years of age. Altogether 156 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. ⋯ The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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A short cut review was carried out to establish whether antacids can be used as a diagnostic test in atypical chest pain. Altogether 374 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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Mainly in response to the policy drive to avoid unnecessary acute hospital admissions and delayed discharge on social grounds, there has been a gradual development of social work services attached to emergency departments (EDs) in the UK. In the absence of a clearly articulated evidence base or debate about the roles of ED attached social workers, a model of ED based social work practice and indicative supporting evidence is presented. ⋯ A number of obstacles remain to the implementation of this model of service, including the narrow focus of current social care practice, the hours that a social work service is normally provided, chronic under-funding, and continuing perverse incentives in the health and social care system. More systematic evidence in the UK context is needed to support the case for change.
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The Department of Health document Reforming emergency care stated that new initiatives need to be developed to improve the care and assessment of patients. The Audit Commission has suggested that ambulance services should be allowed to decide who should be sent to each type of emergency and treat some patients at home. ⋯ This scheme explores a new way of providing clinical assessment of older patients in their homes or in care homes within Sheffield. It sets out to provide a very patient centred model of care by providing community based clinical assessment for patients presenting to the emergency services with minor acute conditions. Scope, development, and structure of scheme: The scheme trains paramedic practitioners in the assessment and treatment of minor conditions to emergency nurse practitioner level. It consists of a three week full time theory based course and a 45 day period of supervised clinical practice based in the emergency department, minor injury unit, care of the elderly falls clinic, and with community services. Subsequently, the competence of the practitioners is assessed. Service delivery: The service will be activated by a 999 call between 0800 to 2000 each day. It is anticipated that between 25% to 50% of patients eligible to receive the service will be assessed and treated within the home. This approach to providing emergency care is untested and the frequency of use, patient acceptability, safety, and cost effectiveness are unknown, therefore rigorous assessment is essential through a randomised controlled trial.
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Existing rural prehospital models have been criticised for being isolated from the healthcare system, and for following inflexible clinical protocols. Greater reliance on clinical judgement and informed decision making in the prehospital setting offer the potential to improve patient care. ⋯ Implementing this new model would see the prehospital system using its available capacity more effectively to fulfill broader public health and primary care outreach roles than is currently the case. Patients would be referred or transported to the most appropriate and cost effective facility as part of a seamless system that provides patients with well organised and high quality care.