Emergency medicine journal : EMJ
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Clinical trials are required to strengthen the evidence base for prehospital care. This questionnaire study aimed to explore paramedics' perceptions of prehospital research and barriers to conducting prehospital clinical trials. ⋯ Paramedics reported interest and understanding of research, but a number of practical and ethical barriers were recognised that need to be addressed if prehospital clinical trials are to increase.
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A shortcut review was carried out to establish whether steroids prevent biphasic anaphylactic reactions in children. Seven papers were directly relevant to the question. ⋯ The clinical bottom line is that there are no trials to show that steroids prevent biphasic reactions. However, there are other grounds for using them in anaphylactic reactions and they are still recommended in guidelines.
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Cranial CT is the gold standard for the investigation of intracranial emergencies. The aim of this pilot study was to audit whether senior emergency physicians were able to report CT head scans accurately and reliably having attended structured teaching. ⋯ In conclusion, we feel that this model can be employed as a safe and long-term alternative provided that the radiology department are committed to providing ongoing teaching and that a database is maintained to highlight problem areas. Emergency physicians need to remember that the clinical status of the patient must never be ignored, irrespective of their CT head findings.
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Telephone calls for emergency ambulances are rising annually, increasing the pressure on ambulance resources for clinical problems that could often be appropriately managed in primary care. ⋯ Many calls are based on fundamental misconceptions about the types of treatment other urgent-care avenues can provide, which may be amenable to educational intervention. This is particularly relevant for patients with chronic conditions with frequent exacerbations. Callers who have care responsibilities often default to the most immediate response available, with decision making driven by a lower tolerance of perceived risk. There may be a greater role for more detailed triage in these cases, and closer working between ambulance responses and urgent primary care, as a perceived or actual distance between these two service sectors may be influencing patient decision making on urgent care.