Emergency medicine journal : EMJ
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Acute heart failure (AHF) symptoms are similar to some respiratory conditions making it challenging for paramedics to diagnose AHF accurately, especially as they infrequently encounter it. Little is known about the clinical reasoning strategies (CRS) used by student or qualified paramedics to diagnose and manage patients with AHF, inaccurate diagnosis associated with inappropriate diuretic management can cause patient complications. ⋯ Although a small study, consideration should be given to participants immature CRS; they may require post-registration support to develop consistently accurate and appropriate clinical decisions which avoid patient exposure to risk. Further research should identify whether other paramedic students, from the various registration routes, reflect these results.
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The SAFER 2 study, in three UK ambulance services, evaluated a complex intervention to support paramedics safely to leave older patients at home with referral to a falls service, following a call to 999 for a fall. The intervention comprised a training programme, referral pathway, clinical support, clinical decision flowchart and referral feedback. Normalisation Process Theory (NPT) examines the factors required for successful implementation of an intervention such as SAFER 2 into routine practice, through four components: coherence, cognitive participation, collective action and reflexive monitoring. We used NPT to frame an analysis of paramedics' views of implementation of SAFER 2. ⋯ Usage of NPT to support analysis of paramedic views on implementation of the SAFER 2 intervention highlighted issues with coherence and collective action that may have affected the trial. The novel intervention was seen as beneficial by paramedics during both pre- and post-trial interviews, although barriers to utilisation were identified.
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It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. ⋯ This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access.
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Comparative Study
Paediatric ED reattendance rates: comparing nurse practitioners and other clinicians.
The aim of this project is to establish the unplanned reattendance rate for paediatric emergency nurse practitioners (PENPs) working in a designated paediatric emergency department (PED) while identifying the case mix of patients seen by PENPs compared with their medical counterparts. ⋯ PENPs work autonomously when seeing children presenting with minor trauma and make a positive contribution in achieving the reattendance Clinical Quality Indicator.
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2,4-Dinitrophenol (DNP) increases energy consumption by uncoupling oxidative phosphorylation. Although not licensed as a medicine, it is sometimes used by 'body sculptors' and for weight loss as a 'fat burning' agent. This research was performed to characterise patterns of presentation, clinical features and outcomes of patients reported to the National Poisons Information Service (NPIS) in the UK after exposure to DNP. ⋯ The study indicates a substantial recent increase in clinical presentations with toxicity caused by exposure to DNP in the UK with an associated high mortality. Further steps are needed to warn potential users of the severe and sometimes fatal toxicity that may occur after exposure to this compound.