Emergency medicine journal : EMJ
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The authors reconfigured the emergency care system of Addenbrookes Hospital, Cambridge. The medical admissions unit and the emergency department (ED) have been combined into one emergency assessment unit. This paper aims to determine if reconfiguration has reduced non-elective hospital admissions and reduced mortality for non-elective admissions. ⋯ Integrating emergency care within a hospital reduces hospital admissions, is associated with reduced inhospital mortality and a better quality of care.
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To determine the accuracy of using nitroglycerine as a 'test of treatment' in the diagnosis of cardiac chest pain we undertook a systematic review of studies of diagnostic accuracy. Databases searched included PubMed, Cochrane Database, Google Scholar, Science Citation Index, EMBASE and manual searching of bibliographies of known primary and review articles. Studies were included if sublingual nitroglycerine was the index test, its effect on the patient's pain score was recorded and the reference test was performed on at least 80% of patients. ⋯ The diagnostic OR from the combined studies was 1.2 (95% CI 0.97 to 1.5), which is not significantly different from 1. In the acute setting, nitroglycerine is not a reliable test of treatment for use in the diagnosis of coronary artery disease. However, further studies are needed to determine the diagnostic accuracy of nitroglycerine for recurrent exertional chest pain.
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Randomized Controlled Trial Multicenter Study
Interhospital variation in the RATPAC trial (Randomised Assessment of Treatment using Panel Assay of Cardiac markers).
The RATPAC trial showed that using a point-of-care panel of CK-MB(mass), myoglobin and troponin at baseline and 90 min increased the proportion of patients successfully discharged home, leading to reduced median length of initial hospital stay. However, it did not change mean hospital stay and may have increased mean costs per patient. The aim of this study was to explore variation in outcome and costs between participating hospitals. ⋯ The effect of point-of-care panel assessment on successful discharge and costs per patient varied markedly between hospitals and may depend on local protocols, staff practices and available facilities.
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Randomized Controlled Trial
Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial.
Strategies to restore sinus rhythm in patients with atrial fibrillation (AF) lasting less than 48 h with haemodynamic stability remain controversial. The aim of this study was to test the hypothesis that electrical cardioversion (EC) would be more effective and safer in converting acute AF to sinus rhythm, compared with intravenous propafenone treatment. ⋯ EC was more effective in patients with acute AF and resulted in a shorter length of stay in the ED than PC. Adverse events were small in number and transient in both groups of patients. Clinical trials registration number NCT00933634.
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Mental and physical symptoms are common in paramedics, which may relate to high work stress, including critical incidents. As previous trauma is a risk factor for psychological symptoms after exposure to critical incidents, the prevalence of childhood experiences with abuse and neglect and paramedics' adaptation to critical incidents may be important. ⋯ Childhood abuse may be more common in paramedics than in other healthcare workers, at least in women. Childhood abuse and neglect is associated with acute stress responses to critical incidents and to current physical and mental symptoms. These results are based on a low response rate and may not be generalisable.