Articles: emergency-department.
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Review Case Reports
Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Immobilisation of stable ankle fractures: plaster cast or functional brace?
A short-cut review of the literature was carried out to establish whether a functional brace was as good as a traditional plaster of Paris to immobilise a stable ankle fracture in terms of functionality and recovery speed. A total of 260 papers was found using the below outlined search method, of which five were thought to represent the best evidence to answer the specific clinical question. ⋯ The clinical bottom line is that the limited evidence seems to suggest that a functional brace appears to give more favourable outcomes. Good quality studies involving large populations are, however, needed to delineate a clear answer to this specific question.
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We compared high-sensitivity cardiac troponin T (hs-cTnT) and standard cTnT for acute myocardial infarction (AMI) diagnosis in everyday clinical practice of an emergency department (ED). ⋯ In unselected ED patients the diagnostic performances of hs-cTnT and standard cTnT for AMI diagnosis did not differ significantly. hs-cTnT detected significantly more cardiac diseases. hs-cTnT and standard cTnT were not independent predictors of ED readmissions and mortality from all causes.
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BMJ quality & safety · Jun 2013
Comparative StudyContextual information influences diagnosis accuracy and decision making in simulated emergency medicine emergencies.
It is well documented that adaptations in cognitive processes with increasing skill levels support decision making in multiple domains. We examined skill-based differences in cognitive processes in emergency medicine physicians, and whether performance was significantly influenced by the removal of contextual information related to a patient's medical history. ⋯ Our findings have implications for scenario design and the manipulation of contextual information during simulation training.
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The patient visits to Norwegian emergency departments (EDs) have increased significantly over the last few years. A national evaluation revealed a lack of systematic activity control, resource management and quality improvement. This paper describes some variables in patient visits to an urban Norwegian university hospital. ⋯ The increase in ED visits to the St. Olav's Hospital in recent years follows the same trend as in other countries. The authors see a slightly higher percentage of high level acuity patients compared with international studies due the general practitioner's intended 'gatekeeper' function. The authors also found a high total admission rate and a low ICU admission rate compared with other countries. These differences cannot be explained solely by differences in the healthcare system in Norway. The cultural and traditional organisation of the Norwegian Health Care System needs to change and this creates an excellent opportunity to improve the competence by establishing emergency medicine as a specialty in Norway.
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Delayed access to specialist care for emergency patients is associated with increased risk of morbidity and mortality, and increased patient anxiety. ⋯ The interventions reduced the time for ED patients to access specialist outpatient and inpatient care. The systematic organisational change management approach resulted in sustained compliance.