European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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To evaluate the rate of diagnostic errors leading to preventable deaths among patients admitted to our intensive care unit (ICU), we retrospectively reviewed the medical and autopsy records of all patients who died in the ICU between 1 January 1991 and 31 December 1993. Excluded were patients with traumatic injuries, cerebrovascular accidents and primary cardiac arrest. According to their length of stay (LOS) in the ICU, patients were subdivided into Group A (LOS 0-24 hours), Group B (LOS > 24 hours-14 days), and Group C (LOS > 14 days). ⋯ Type 2 errors were 18% in Group A, 34% in Group B, and 30% in Group C. Fully correct diagnoses or Type 3 errors were present in 77% of patients in Group A, 62% of patients in Group B, and 61% of patients in Group C. Clinical errors of any type were not related with the LOS in the ICU or in the hospital, age and the number of underlying chronic diseases.
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Randomized Controlled Trial Clinical Trial
Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy.
Management of severe acute asthma attacks in children sometimes bring difficulties to the physician. Some current treatment strategies have focused on intravenous magnesium sulphate administration in patients nonresponding to therapy with beta-2 agonists and corticosteroids. The use and efficacy of this drug has been discussed in this randomized, double-blind, placebo-controlled clinical trial consisting of 20 children with moderate to severe acute asthma exacerbation admitted to the emergency department in Dicle University Hospital, Turkey. ⋯ These significant changes persisted at 45, 60, 75 and 90 minutes. No significant side effects were observed. In conclusion, severe asthmatic cases may benefit from magnesium sulphate therapy when beta-2 agonists are inadequate in preventing deterioration.
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The aims of our study were to study the early impact of bereavement and to evaluate the effectiveness of the bereavement care given by our multidisciplinary team to close relatives of a sudden death, measured by the intensity of grief reaction (Texas Revised Inventory of Grief). The study sample consisted of close relatives of patients certified dead at the accident and emergency department (AED) between March 1996 and February 1997. The relatives received immediate care at the AED and were supported continually by the members of the bereavement care team. ⋯ The mean score of the intensity of grief reactions were 41.8 and 34.6 in the control (n = 11) and study (n = 18) groups respectively among high risk sample (p = 0.04). However, in the low risk sample, the mean scores were 35.3 and 30.2 in the control (n = 18) and study (n = 25) groups respectively (p = 0.11). Our study suggests that the bereavement care was especially effective in reducing the intensity of the grief at 6 months in the high risk group.
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When waiting times in accident and emergency (A&E) departments become too long, some patients leave the department before seeing a doctor. This study was designed to investigate the characteristics and outcome of this group of patients in one A&E department. We identified all patients who left the department without seeing a doctor on 12 randomly selected days in October and November 1997. ⋯ Of the patients reviewed, 45 (58%) sought medical attention afterwards and one required hospital admission. The majority of patients were satisfied by the explanation given for the delay in seeing a doctor. This limited study suggests that patients are able themselves to gauge the severity of their symptoms and safely defer medical consultation.
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In this study we attempted to assess the role of trauma in acute haematogenic osteomyelitis (AHO). Twenty-four 6-8 week-old white New Zealand rabbits were divided into three groups. ⋯ Scintigraphy was done by Gallium-67 citrate and, histopathologic examination was used for the diagnosis of osteomyelitis. In contrast to group I, AHO was seen in one case in group II and in all cases of group III.