Emergency medicine journal : EMJ
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To evaluate the effectiveness of interventions aiming to reduce time from onset of signs and symptoms of an acute myocardial infarction (AMI) to seeking medical help/arrival at hospital. ⋯ There was little evidence that media/public education interventions reduced delay. There is some evidence that they may result in an increase in emergency switchboard calls and emergency department visits. Despite substantial expenditure of time and effort, methodological deficiencies of the studies mean that it is not possible to make definitive recommendations.
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A short cut review was carried out to establish whether antibiotic prophylaxis is indicated after trephining of a subungual haematoma. Two papers were found using the reported search, of which neither presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.
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This review examines the derivation of the NICE guidelines and discusses some of the problems of putting research into practice.
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A short cut review was carried out to establish whether parenteral thiamine was more effective than an oral preparation at replacing thiamine in alcoholics without encephalopathy. Twenty five papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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Problem based learning (PBL) has been the subject of considerable interest and debate in medical undergraduate and, increasingly, postgraduate education in recent years. Its supporters maintain that PBL enhances learning by providing a highly motivational environment for acquisition of knowledge, which is well received by those who take part in it. Critics argue that PBL is a time consuming exercise, often undertaken by people with a limited appreciation of its complexities, and the lack of evidence that PBL translates into better clinical competence brings into question the relevance of such intensive learning methods in everyday practice. This article outlines the background to PBL, explains its mechanics in action, and considers the potential disadvantages of its use as a clinical learning tool in the emergency department.