Articles: emergency-department.
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Delayed access to specialist care for emergency patients is associated with increased risk of morbidity and mortality, and increased patient anxiety. ⋯ The interventions reduced the time for ED patients to access specialist outpatient and inpatient care. The systematic organisational change management approach resulted in sustained compliance.
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Emergency Departments (ED) in the UK have seen increasing attendance rates in recent years. Departments are now seeking strategies to reduce their attendances. A review of all ambulance attendances to the ED at Ninewells Hospital was conducted to identify if patients presenting by ambulance could be seen and treated more appropriately in other parts of the health service. ⋯ The ambulance services present one-third of the patients to the ED at Ninewells Hospital. 30%-32% were found to be attending inappropriately and 74%-80% of these could have been managed in primary care. Reducing inappropriate ambulance attendances could reduce the departmental patient load by 11%.
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A case is presented in which topical tranexamic acid was used to stop local bleeding from a nipple following piercing in a young man with haemophilia. This case, with a review of the relevant literature, highlights the use of topical tranexamic acid as part of a methodical approach to stop localised, non-massive bleeding, particularly in patients with inherited or acquired coagulopathies.
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A short-cut review of the literature was carried out to establish whether biological markers (namely carbohydrate-deficient transferrin (CDT), gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV)) could reliably predict patients at risk of developing alcohol withdrawal syndrome. Using the below outlined search method and after exclusion of the non-relevant papers, five papers were found to be relevant to the specific question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 1. The clinical bottom line is that CDT/GGT/MCV are not reliable enough as stand-alone markers to predict alcohol withdrawal syndrome in chronic alcohol abusers.
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A short-cut review of the literature was carried out to establish whether the biological marker procalcitonin could safely rule out the diagnosis of meningococcal disease (MCD) in children. Using the below outlined search method and after the exclusion of the non-relevant papers, two were found to be relevant to the specific question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 3. The clinical bottom line is that the currently available evidence is not sufficient to support the sole use of procalcitonin to rule out the diagnosis of MCD.