Emergency medicine journal : EMJ
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Multicenter Study
Application of variable life adjusted display (VLAD) in early detection of deficiency in trauma care.
Early detection of deficient care is an increasingly important element of trauma audit. We aimed to assess the feasibility and demonstrate the use of a variable life adjusted display (VLAD) in trauma audit. Data from the Trauma Audit and Research Network database of Sheffield Teaching Hospitals NHS Trust were used to create a VLAD. ⋯ The first 2 months of this period were characterised by a downward trend in the line, which may indicate suboptimum performance and provides an example of a trend that would prompt detailed review. The VLAD chart is a potentially useful "early warning" system for poor performance in trauma care. Further work should to be carried out to evaluate VLAD prospectively as an audit tool, perhaps involving comparison of VLAD charts from different institutions.
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To evaluate the safety and efficacy of using intravenous cephazolin as a first line antibiotic for the treatment of cellulitis in a supervised outpatient programme. ⋯ Low re-admission rates verify the efficacy of cephazolin 2 g twice daily in treating cellulitis in the home environment. Benefits are multiple and include economic savings and reduced risk of nosocomial infection.
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To establish the discrepancy rate between the predicted cause of death and the actual cause of death as determined by postmortem examination result, for all deaths in the emergency department reported to the Scottish Procurator Fiscal and subsequently undergoing postmortem examination. ⋯ This study highlights the difficulties in accurately identifying cause of death for patients who die suddenly. This could have implications for the accuracy of health service statistics.
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Review Case Reports
Does noninvasive ventilation work in ARDS? A case report and review of the current literature.
The role of noninvasive positive pressure ventilation (NIPPV) in adult respiratory distress syndrome (ARDS) is controversial, in contrast to its well established benefits in other types of respiratory failure, especially acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary oedema. We report a case of ARDS caused by Mycoplasma pneumoniae in a 70 year old man, treated with NIPPV in addition to standard medical therapy and analyse current evidence regarding the role of NIPPV in patients with ARDS.
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A shortcut review was carried out to establish whether steroids are of benefit in sudden onset sensorineural deafness. Altogether 175 papers were found using the reported search, of which five 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 (table 4). It is concluded that there is insufficient good evidence to recommend early steroid treatment in this condition.