Emergency medicine journal : EMJ
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There is currently little evidence defining the clinical importance of detecting and treating isolated distal deep vein thrombosis (IDDVT). Contemporary international guidelines vary regarding diagnostic and therapeutic advice. The potential benefits of anticoagulation remain poorly defined. We sought to evaluate the feasibility of a randomised controlled trial within a modern emergency department cohort. ⋯ We have established feasibility for a definitive trial on the value of therapeutic anticoagulation for IDDVT. Our pilot study currently provides the largest prospective randomised clinical dataset on this topic and demonstrates a non-significant trend towards reduction in complications with anticoagulation.
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Formative assessments support learning. Ideally then, such trainee/ trainer interaction would occur throughout the training year and include cases that are stretching. In this way areas for trainee development could be identified and a training plan refined and executed. Such an approach would give time to revisit themes with further assessments towards the end of the year. ⋯ There is a high rate of excellence recorded is assessments, and around half of assessments are performed at the end of the academic year. There were more assessments performed in the month of ARCP (June) than in the first 5 months of the academic year. Future iterations of the assessment schedule will include means of ensuring trainee/trainer interaction is scheduled throughout the year and includes a case mix that stretches the trainee with trainer support.
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Emergency Department information sharing with Community Safety Partnerships and the Police is well established, Emergency Department Data about the location, time of assault and weapon type is shared with the police to support targetted policing and licensing decisions. It is not established whether ambulance data, which routinely collects automated location and time data, provides additional information to police and emergency department data. We aimed to find out what proportion of ambulance call outs to assault was not recorded by the police or the emergency department services. ⋯ The ambulance service is responding to many victims of community violence that are not recorded by the police and probably not recorded by the emergency department. Ambulance data has potential to inform licensing and targetted policing. It is not proven whether this will reduce community violence.
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Following a spate of high profile murders there is concern that injuries and deaths caused by knives is increasing in England and Wales, especially within the teenage population. Excluding police and Home Office statistics, there are few UK studies examining Emergency Department data. ⋯ Both from TARN and ONS data, the rate of death and serious injury from stab wounds rose in the middle of the last decade but since 2006 is falling. Stabbings account for a low proportion of overall injury deaths and hospitalised trauma patients. The vast majority are due to assault and affect young men in urban areas, particularly London, the North East and the North West. Accidental death from stabbing is rare although suicide using sharp implements, particularly amongst older men, is perhaps more common than previously thought.
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The Emergency Department (ED) is a fertile ground for medical error. In numerous other areas checklists (and the associated cultural changes) have been brought in to reduce error. Following the National Audit Project into airway complications in 2011, guidelines were produced recommending the use of a checklist prior to rapid sequence induction (RSI) along with capnography in the ED. Similarly, College of Emergency Medicine (CEM) guidelines recommended 'checks' prior to sedation and capnography use. The project objectives were firstly to review the national use of checklists (and capnography). Secondly, within one trust which has already implemented the checklists, to ascertain if they were used in reality. Finally, the study looked into attitudes and how barriers to implementation could be overcome. ⋯ The use of checklists within Emergency Medicine remains limited. Their uptake within a trust that has implemented them has been slow. Cultural resistance within the workplace remains a barrier that needs to be overcome.