Emergency medicine journal : EMJ
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Review Comparative Study
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Capillary blood gases as an alternative to arterial puncture in diabetic ketoacidosis.
A short cut review was carried out to establish whether capillary blood rather than arterial blood can be used to assess acid base status in patients with diabetic ketoacidosis. A total of 25 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are presented in table 1. It is concluded that while the correlations in the small study found were good, there is insufficient evidence to recommend adoption of this practice in the emergency setting.
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A short cut review was carried out to establish whether tamsulosin enhances the chances of spontaneous stone expulsion in renal colic. Thirty-five papers were found using the reported searches, of which two (a meta-analysis and one further randomised controlled trial) presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are presented in table 3. It is concluded tamsulosin may be useful during periods of watchful waiting to enhance ureteric stone expulsion.
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Despite the potential impact that emergency pharmacist (EPh) programmes could have on medication safety and quality of care in the emergency department (ED), very few programmes exist. This descriptive survey study aimed to assess staff perceptions of an EPh programme. ⋯ This study reinforced the value of many specific duties of the EPh programme and found that doctors and nurses overwhelmingly favour the presence of an EPh in the ED, frequently seek their advice, and feel they improve quality of care. Staff acceptance is clearly not a barrier to implementation of this programme.
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Comparative Study
A comparison between clinicians' assessment and the Manchester Self-Harm Rule: a cohort study.
As identifying patients at risk of subsequent suicidal behaviour is a key goal of assessment, a cohort study of presentations to five emergency departments following episodes of self-harm was carried out. We compared the accuracy of the prediction of subsequent self-harm within 6 months between global clinical assessments and the Manchester Self-harm Rule. ⋯ Global clinical assessments and the rule had a sensitivity of 85% (CI 83 to 87) versus 94% (CI 92% to 95%), specificity of 38% (CI 37% to 39%) versus 26% (CI 24% to 27%), a positive predictive value of 22% (CI 21% to 23%) versus 21% (CI 19% to 21%) and a negative predictive value of 92% (CI 91% to 93%) versus 96% (CI 94% to 96%). The accuracy of predicting short-term repetition of self-harm by clinicians could be improved by incorporating this simple rule into their assessment.
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Payment by results is a new funding mechanism being introduced into the National Health Service. It is a key part of current health reforms and will impact significantly on the way emergency departments are financed and run. This paper aims to describe the basics of payment by results, examines how it relates to and impacts upon emergency medicine, and considers how emergency physicians can set about integrating this new system into current practice and thinking.