Emergency medicine journal : EMJ
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The present study was designed to build and validate a composite score based on the Global Registry of Acute Coronary Events (GRACE) score and B-type natriuretic peptide (BNP) concentrations to predict outcome in patients with acute coronary syndromes (ACS). ⋯ Plasma BNP levels refine the accuracy of the GRACE score. A comprehensive risk score, which includes BNP concentration and the GRACE risk score, might improve ACS risk stratification in clinical practice.
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Over 40% of patients admitted to emergency departments (ED) with chest pain receive a non-cardiac diagnosis. Patients with non-cardiac chest pain (NCCP) have a good prognosis in terms of cardiac adverse events and mortality; however, they tend to have poor outcomes in terms of psychological morbidity, quality of life (QoL), further chest pain and the use of health services. In recent years there has been an increase in the use of ED-based 'rapid rule-out' protocols and the provision of dedicated chest pain units. ⋯ Factors associated with poorer psychological outcomes included gender, age, previous psychiatric history and certain symptoms such as fear of dying and light headedness. However, the studies were heterogeneous, with a variety of outcome measures, designs and settings. In summary, the review identifies poor psychological outcomes in NCCP patients accessing ED-based care; however, there is a need for longitudinal studies using reliable and valid measures to define further the predictors of these poor outcomes.
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Comparative Study
Quality and safety of care provided by emergency care practitioners.
The emergency care practitioner (ECP) role in the UK health service involves paramedic and nurse practitioners with advanced training to assess and treat minor illness and injury. Available evidence suggests that the introduction of this role has been advantageous in terms of managing an increased demand for emergency care, but there is little evidence regarding the quality and safety implications of ECP schemes. ⋯ As a minimum, care provided should meet the standards of existing service models and the findings from the study suggest that this is true of ECPs regardless of the service they are operational in.
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This trial investigated whether advanced paramedics from a UK regional ambulance service have the ability to acquire and interpret diagnostic quality ultrasound images following a 2-day programme of education and training covering the fundamental aspects of lung ultrasound. ⋯ This trial demonstrated that ultrasound-naive practitioners can achieve an acceptable standard of competency in a simulated environment in a relatively short period of time.
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To assess how child emergency department (ED) attendances are distributed between hospitals across England, Wales and Northern Ireland and how care is organised for children with a head injury. ⋯ Given the extent of variation between hospitals in the facilities available for head injured children, further comparative studies into the standards of care delivered and outcomes (including a confidential enquiry) are indicated.