Emergency medicine journal : EMJ
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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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Previous investigators have demonstrated increased mortality with longer distance from hospital in respiratory patients but it is unclear if these findings are applicable to all patients/conditions. However, it is widely assumed that patients may deteriorate during long journeys, which contributes to fear of service reconfiguration by public and professionals alike. We wished to ascertain whether clinical deterioration occurs during long ambulance journeys (up to 70 miles) to hospital from our rural catchment area. ⋯ Our findings suggest that adult patients living further from hospital are not more unwell on pick-up, they are not deteriorating en-route, and longer journeys to hospital do not necessarily lead to patients coming to harm.However, we did not explore any relationship to later mortality/morbidity.We appeal to colleagues in those areas of the UK with electronic ambulance records linked to hospital records to repeat this work with a much larger sample and wider range of end-points, in order to provide a definitive answer to this important question.