Emergency medicine journal : EMJ
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A shortcut review was carried out to establish whether ST elevation in aVR accurately identifies acute myocardial infarction caused by left main coronary artery stenosis. 141 unique papers were found in Medline, EMBASE, Cochrane Database of Systematic Reviews, ACP Journal Club and the Database of Abstracts of Reviews of Effects using the reported searches. Of these, 12 presented the best evidence to answer the clinical question. ⋯ It is concluded that ST elevation in aVR can identify high-risk patients for early intensive investigation, particularly when found alongside widespread ST depression. It has insufficient utility to identify patients who require immediate revascularisation.
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A shortcut review was carried out to establish whether silibinin is better than conservative management at reducing liver transplantation and death after poisoning with amatoxin-containing mushrooms. Thirty-eight papers were found in Medline and 86 in EMBASE using the reported searches. ⋯ The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that the evidence is limited, but given the lack of alternative treatments in patients with suspected amatoxin-containing mushroom poisoning and the relatively few adverse effects, silibinin should be considered in some patients.
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To synthesise the existing literature on the roles that emergency medical services (EMS) play in unplanned, urgent and emergency care for older people with dementia (OPWD), to define these roles, understand the strength of current research and to identify where the focus of future research should lie. ⋯ The use of EMS by OPWD is not well understood, although the literature reviewed demonstrated a concern for this group and awareness that services are not optimum. Research in dementia care should consider the role that EMS plays, particularly if considering crises, urgent care responses and transitions between care settings. EMS research into new ways of working, training or extended paramedical roles should consider specific needs and challenges of responding to people with dementia.