Emergency medicine journal : EMJ
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Hyperbaric oxygen (HBO2) therapy has been proposed to treat hypoxaemia and reduce inflammation in COVID-19. Our objective was to analyse safety and efficacy of HBO2 in treatment of hypoxaemia in patients with COVID-19 and evaluate time to hypoxaemia correction. ⋯ Our findings support the safety and efficacy of HBO2 in the treatment of COVID-19 and severe hypoxaemia.
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To determine the agreement and predictive value of emergency department (ED) triage nurse scoring of frailty using the Rockwood Clinical Frailty Scale (CFS) when compared with inpatient medical assessment using the same scale. ⋯ Agreement between ED CFS and inpatient CFS was found to be weak. In addition the ability of ED CFS to predict clinically important outcomes was limited. NPV and PPV for ED CFS cut-off value of ≥5 were found to be low. Further work is required on the feasibility, clinical impact and appropriate tools for screening of frailty in EDs.
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The crisis of prescription opioid addiction in the USA is well-documented. Though opioid consumption per capita is lower in the UK, prescribing has increased dramatically in recent decades with an associated increase in deaths from prescription opioid overdose. At one Scottish Emergency Department high rates of prescribing of take-home co-codamol (30/500 mg) were observed, including for conditions where opioids are not recommended by national guidelines. An Implementation Science approach was adopted to investigate this. ⋯ The increasing incidence of prescription opioid addiction in the UK suggests the need for all clinicians who write opioid prescriptions to re-evaluate their practice. This study suggests that knowledge of addiction risk and prescribing guidelines is poor among Emergency Department prescribers. We show that a rapid and sustained reduction in prescribing of take-home opioids is feasible in a UK Emergency Department, and that this reduction was not associated with any increase in unplanned re-attendances or complaints related to analgesia.
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Review Meta Analysis
Improving outcomes for older people in the emergency department: a review of reviews.
There has been a recognised trend of increasing use of emergency and urgent care and emergency departments (EDs) by older people, which is marked by a substantial evidence base reporting interventions for this population and guidance from key organisations. Despite this, outcomes for this population remain suboptimal. A plethora of reviews in this area provides challenges for clinicians and commissioners in determining which interventions and models of care best meet people's needs. The aim of this review was to identify effective ED interventions which have been reported for older people, and to provide a clear summary of the myriad reviews and numerous intervention types in this area. ⋯ PROSPERO CRD42018111461.
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Government opioid policies-such as the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act-have aided in lowering the days' supply of opioid prescriptions. However, what effect do these laws have on codeine-containing antitussive syrup? We aimed to assess the effect of the North Carolina STOP Act on ED opioid prescriptions written for >5 days for acute pain/non-pain diagnoses and whether it had an effect on the prescribing of codeine-containing antitussive syrup. ⋯ The North Carolina STOP Act was associated with a reduction in the overall percentage of opioid prescriptions for >5 days for acute pain/non-pain diagnoses. However, there was no statistically significant effect on the prescribing of codeine-containing antitussive syrup.