Emergency medicine journal : EMJ
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Significant numbers of people attend ED either as a direct result of domestic violence and abuse (DVA) or related admissions, for example self-harm (Boyle et al, 2006, Boursnell and Prosser, 2010). However, effective management remains problematic and as Gibbons (2011) has highlighted DVA often goes unreported by ED staff. The recent National Institute of Health and Care Excellence (NICE) (2014) guidance Domestic violence and abuse […] has identified that front line health care professionals will have a pivotal role and responsibility in the management of DVA in the future. The aim of our research therefore was to gather evidence regarding current practice in the recognition and management of DVA within ED in order to develop recommendations for service development through the following questions:How are survivors of DVA currently identified and managed within the ED?What systems can be put into place to maximize recognition and effective support within this context? ⋯ A number of barriers exist including cultural and organizational structures which mediate against effective assessment and support. The recent NICE (2014) guidelines provide a potential platform to transform effective assessment and support for survivors by ED staff. Findings of the study and implications for service and practice development will form the basis of the presentation.
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Paediatric gynaecology can provide challenging and varied consultations in the emergency department setting. Although the first international journal and society were established in the late 1980's, no specific UK guidelines have been published for the care of children and teenagers in this specialty. Moreover, limited published data is available regarding the types of cases presenting at the "front door". This study aimed to investigate the scope of paediatric and adolescent gynaecological problems presenting to the emergency department of a UK children's hospital. ⋯ The study demonstrates the wide variety of paediatric gynaecology cases that present to the emergency department, nearly two thirds of which require ongoing care. This exhibits a need for both national guidance and appropriate training for front line medical staff covering the common gynaecological problems found in children.
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We aimed to determine the effectiveness of pre-hospital continuous positive airway pressure (CPAP) or bi-level inspiratory positive airway pressure (BiPAP) compared with usual care for adults presenting to the emergency services with acute respiratory failure. ⋯ Pre-hospital CPAP can reduce mortality and intubation rates compared to standard care, while the effectiveness of pre-hospital BiPAP is uncertain. emermed;31/9/778-a/EMERMED2014204221F5F1EMERMED2014204221F5Comparison of mortality for interventions versus standard care from the primary trials.
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To establish whether the need to pay for GP services including consultations, phlebotomy and referrals, affects how households utilise A&E in Jersey. To describe the reasons why households have previously utilised A&E instead of a GP. ⋯ This study confirms that in Jersey, GP user-fees create cost-related demand for the Emergency Department.Willingness to pay for primary care does not reflect ability to pay in Jersey, evidenced by both high and low income groups reporting use of A&E for non-urgent problems.Further research is indicated to examine whether A&E cost-related demand would arise if GP user-fees were introduced in the NHS.
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We aimed to determine the cost-effectiveness of pre-hospital CPAP compared with standard care for adults presenting to the emergency services with acute respiratory failure. ⋯ The cost-effectiveness of pre-hospital CPAP is uncertain and current evidence is insufficient to support widespread implementation. The immediate research priority is to estimate the incidence of patients eligible for pre-hospital CPAP. This appears to be the key determinant of the cost-effectiveness of a future trial and of pre-hospital CPAP itself. emermed;31/9/780-b/EMERMED2014204221F6F1EMERMED2014204221F6 Model structure.