Emergency medicine journal : EMJ
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Clinical decision rules (CDRs) for paediatric head injury (HI) exist to identify children at risk of traumatic brain injury. Those of the highest quality are the Canadian assessment of tomography for childhood head injury (CATCH), Children's head injury algorithm for the prediction of important clinical events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs. They target different cohorts of children with HI and have not been compared in the same setting. We set out to quantify the proportion of children with HI to which each CDR was applicable. ⋯ Each CDR is applicable to a different proportion of children with HI. This makes a direct comparison of the CDRs difficult. Prior to selection of any for implementation they should undergo validation outside the derivation setting coupled with an analysis of their performance accuracy, usability and cost effectiveness.
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Street Doctors is an initiative set up by Liverpool medical students in 2008. The organisation aims to reduce the morbidity and mortality associated with violent crime by equipping 'at risk' young people with basic life support and first aid skills. The high prevalence of violent crime is indicated by NHS data from 2011/12, showing that 4,490 people were admitted to hospitals across England due to assault with a sharp object. With over 120 student volunteers, Street Doctors is now established in 6 cities where knife crime is becoming a persistent and worrying concern. ⋯ These results show the positive impact that street doctors are making. The vast majority of attendees leave feeling more confident in their ability to deal with a knife or gunshot wound in the critical moments before an ambulance arrives. As an ever expanding organisation, Street Doctors has an increasing potential to pass on the valuable skills that may one day be used to save a person's life.
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Paracetamol poisoning is common worldwide. Standard intravenous N-acetylcysteine (NAC) therapy is complex, and commonly associated with concentration-related adverse effects and the potential for administration errors. We aimed to determine whether adverse effect incidence could be reduced by antiemetic pre-treatment and/or a simpler and shorter intravenous N-acetylcysteine regimen. ⋯ In patients with paracetamol poisoning requiring acetylcysteine, adverse effects were substantially reduced by ondansetron pre-treatment and by using a modified, shorter treatment regimen. Ondansetron, but not the modified regimen, increased the frequency of liver function abnormalities. If large effectiveness studies confirm the modified regimen is non-inferior to conventional then shorter and safer treatment would be possible for this common poisoning.
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To describe the relationship between waiting time and patient satisfaction, and to determine predictors of overall care rating in an emergency department (ED) fast-track setting. ⋯ Waiting time was found to be highly predictive of patient satisfaction in an emergency fast-track unit with English language and NPs also associated with improved overall care rating. Future measures to improve patient satisfaction in fast-track units should focus on these factors.
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Handover in emergency care is an important patient safety issue and has particular problems due to different environmental, professional, organisational and cultural backgrounds. Previous work as focussed on the standardisation of handover content (including use of checklists), relatively little is known about the verbal behaviours that shape handover conversations. This study looks at both the content of the handover and the verbal behaviours during different types of handovers around the emergency department. ⋯ Handover may entail both descriptive (aimed at information transfer) and collaborative (aimed at joint decision-making) elements. Standardisation of handover needs to accommodate collaborative aspects with their greater variability according to the individual situation, and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.