Emergency medicine journal : EMJ
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In 1999, the UK adopted a policy of using TOXBASE, an internet service available free to registered National Health Service (NHS) departments and professionals, as the first point of information on poisoning. This was the first use worldwide of the internet for provision of clinical advice at a national level. We report the impact on database usage and NPIS telephone call loads. ⋯ Provision of poisons information by the internet has been successful in reducing NPIS call loads. Provision of basic poisons information by this method appears to be acceptable to different professional groups, and to be effective in reducing telephone call loads and increasing service cost effectiveness.
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Case Reports
Complete atrioventricular block and ventricular tachyarrhythmia associated with donepezil.
Donepezil is a reversible inhibitor of acetylcholinesterase. Its commonest adverse events are nausea, diarrhoea, malaise, dizziness, and insomnia. Symptomatic cardiac rhythm disturbances associated with the use of donepezil are extremely unusual. ⋯ Treatment of AD with cholinesterase inhibitors carries a risk of cardiac disturbances. In addition to sinusal bradycardia, it may lead to such major dysrhythmias as complete atrioventricular block and ventricular tachyarrhythmia, as in our case. In this report, we describe symptomatic complete atrioventricular block and ventricular tachyarrhythmia associated with the use of donepezil.
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Death rates are an outcome that can be used to describe a service. We measured three death rates that can be used to describe an emergency department (ED): death rates for those seen in the ED and discharged, those that die within the ED, and those that die after admission. We also wanted to establish how easy it was to obtain these rates and how frequently autopsy was performed. ⋯ These three death rates were easy to calculate and could be used to describe the outcome of an ED service. Further research to establish the range of rates for different departments is now required to determine their potential use.
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Modernising Medical Careers (MMC) is a project designed to reconfigure postgraduate medical education throughout the United Kingdom. It is proposed that all UK medical school graduates undertake a 2 year foundation programme to build basic professional skills to which specialist training can be added. ⋯ In the case of emergency medicine, a common stem of training in emergency and critical care is being proposed which would be suitable early training for potential specialists in emergency medicine, anaesthesia, intensive care, and acute medicine. In both foundation training and higher specialist training, the trainee should have the skills of a self directing, reflective learner and the trainer the skills required to produce a good learning environment with a supportive and open atmosphere and learning structured to maximise the opportunities for experiential learning in the workplace.