Emergency medicine journal : EMJ
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To explore the increasing numbers of Emergency Medicine registrars that obtained their primary medical degree from United Kingdom (UK) or Irish universities, who work in Emergency Departments (ED) throughout Australia and New Zealand. emermed;31/9/777-a/SA4EMERMED2014204221TB1T1sa4-EMERMED2014204221TB1 Table 1 Trends in Australasian Emergency Medicine registrar numbers 2008-2013 (courtesy of ACEM Policy & Research Department) Year Total registrars Total IMGs UK/Ire IMGs % UK/Ire of total IMGs % UK/Ire of total registrars 2008 1420 787 285 36.2 20.1 2009 1654 958 329 34.3 19.9 2010 1952 1137 413 36.3 21.2 2011 1973 1144 437 38.2 22.1 2012 2078 1185 481 40.6 23.1 2013 2258 1252 566 45.2 25.1 METHODS: The VERS-2013 (Victoria Emergency Registrar Study) was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013.(1) As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working in Australasian EDs. ⋯ Many IMGs (in particular from UK and Ireland) leave their country of origin to work overseas in Australia and New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to the UK to work at consultant level. However, evidence from ACEM (table 1) and the VERS-20131 study show clearly that these doctors are now migrating to Australia for the long-term, leaving EDs the length and breath of the British Isles bereft of talented senior EM decision-making personnel. Meanwhile in Australia, continued IMG influx is at odds with a stated Health Workforce Australia taskforce aim to achieve self-sufficiency by 2025.2 The challenge is set for the College of Emergency Medicine, in conjunction with the UK and Irish governments, to enhance the attractiveness of Emergency Medicine as a credible and sustainable career option. emermed;31/9/777-a/EMERMED2014204221F4F1EMERMED2014204221F4.
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Existing practice in emergency departments (ED) in the UK for managing anticoagulated patients after blunt head trauma is variable and based on limited evidence. We aimed to determine the head injury complication rate within this group of patients and identify risk factors associated with a poor outcome. ⋯ This is the largest cohort of anticoagulated head injury patients ever reported. The head injury complication rate was 6.1% which correlates well with previous findings. INR was not found to be associated with a poor outcome however GCS <13, vomiting and loss of consciousness were identified as significant risk factors for an adverse outcome in anticoagulated patients with a head injury.
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The continuing shortfall of organs for transplantation has led to interest in Maastricht Category II (uncontrolled) Donation after Circulatory Death (DCD) organ donation. As preparation for a proposed pilot, this study aimed to explore the potential of uncontrolled DCD organ donation from patients presenting in cardiac arrest to the emergency department (ED) who are unsuccessfully resuscitated. ⋯ Identifying potential organ donors in the ED who are unsuccessfully resuscitated from cardiac arrest may contribute to reducing the shortfall of organs for transplantation, although numbers are likely to be small. If such a programme was to be introduced during weekday working hours, there may be around four donors a year. However, even one additional donor per year from hospitals across the UK with an ED and a transplantation service would add considerably to the overall organ donation rate.
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Circulating leucine-rich α-2-glycoprotein-1 (LRG1) protein has been found in the plasma and urine of patients with acute appendicitis (AA) and may be useful for diagnosis. The present study aimed to investigate whether circulating LRGI mRNA levels also improve the early diagnosis of AA. ⋯ This research study was supported by a Direct Grant for Research from the Chinese University of Hong Kong (reference no.: 2041642) (HK$18000).
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In the past nine years, the number of patients attending the A&E department of the Royal Victoria Hospital Belfast, with neurological complaints has more than doubled.The number of A&E attendees with neurological complaints is similar to cardiology and higher than gastroenterological complaints. Approximately half of attendees were referred for further investigations or specialist opinion via their primary care physician. Of all attendees only a small number (29%) were referred to or discussed with the neurology department.More than half of A&E attendees presenting with neurological complaints are admitted, mostly under medical team (95%). The number of patients admitted with neurological complaints is higher than for gastroenterology or cardiology. ⋯ The results of the pilot study suggest that provision of a RANC can reduce unnecessary hospital admissions for patients with neurological complaints. The pilot study received very positive feedback from A&E colleagues and patients. Regular provision of the service may lead to considerable cost savings.emermed;31/9/779-b/SA32EMERMED2014204221TB1T1sa32-EMERMED2014204221TB1Compare time period with and without RANC01/08/13-31/08/13RANC not in place25/09/13-23/10/13RANC in placeA+E attendees71496849Neurology patients479436Admitted269211% admitted56.2%48.4%Referred to RANC048Admission avoided028If no RANC availableAdmission rate56.2%54.8%emermed;31/9/779-b/SA32EMERMED2014204221TB2T2sa32-EMERMED2014204221TB2A and E attendances in last 9 years in RVH by medical specialityYearCardGastroNeuroResp200527211747237124652006235917692292248020072831182225202908200825982247254031502009295920102836328820103103220930503362201133142629363635842012488234014419550420134966383950635714emermed;31/9/779-b/EMERMED2014204221F15F1EMERMED2014204221F15RVH A&E attendances by speciality since 2005emermed;31/9/779-b/EMERMED2014204221F16F2EMERMED2014204221F16Neurological symptoms seen in the RANC.