Emergency medicine journal : EMJ
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A short cut review was carried out to establish whether intranasal midazolam was effective for stopping fits. Altogether 36 papers were found using the reported search, of which four 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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Comparative Study
Comparison of clinical outcomes between anteroposterior and lateral penetrating craniocerebral gunshot wounds.
To investigate and compare, using a retrospective clinical study, the clinical outcomes of penetrating craniocerebral gunshot wounds (PCGW) with respect to the trajectory of penetration in the axial plane. ⋯ We found that lateral PCGW is the most devastating type of missile injury to the head.
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To describe the case mix, activity, and outcome for admissions to intensive care units (ICUs) from emergency departments (EDs). ⋯ A large proportion of admissions to ICU (26%) originate in EDs, and differ from those not originating in EDs in terms of both case mix and outcome. Additionally, those admitted directly to ICU from EDs differ from those admitted indirectly via a ward. The observed differences in outcome between different admission routes require further investigation and explanation.
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The ESCAPE trial showed that chest pain observation unit (CPOU) care appeared to be cost effective compared with routine care. This finding may not be generalizable to hospitals that currently admit fewer patients than the trial hospital or that require higher direct costs to provide CPOU care. This study aimed to explore these issues in sensitivity analyses and develop a nomogram to allow prediction of whether a CPOU will be cost effective in a specific hospital. ⋯ Findings of the ESCAPE trial are likely to be generalizable to most settings. The nomogram presented here can be used to predict cost effectiveness in a specific hospital.
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What are the beliefs and attitudes of paramedics to prehospital thrombolysis? A questionnaire study.
The Ambulance Services have a critical role in the management of acute myocardial infarction (AMI). Paramedic delivered prehospital thrombolysis (PHT) has been proposed. To the authors' knowledge there has been no research carried out to ascertain the views of paramedics. ⋯ The majority of paramedics in WYMAS responding to the questionnaire supported the principle of PHT. Concerns included the risks of thrombolytic treatment, training, and the medico-legal implications for them as individual paramedics. Models for paramedic thrombolysis for each ambulance service should include the views of paramedics.