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Emergency Department Education Group Evidence Update
6th February 2017
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Journal Clubs
Do journal clubs improve patient care and decision making?
Do they help put evidence into practice?
If you attend a journal club, please fill in our 12 question survey at http://bit.ly/2j7VfHh.
The survey may not display properly on UHL computers using older versions of Internet Explorer, please use https://www.google.com/chrome/
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New and Updated Cochrane Systematic Reviews
Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma
Authors' conclusions: Overall, combination inhaled therapy with SAAC and SABA reduced hospitalisation and improved pulmonary function in adults presenting to the ED with acute asthma. In particular, combination inhaled therapy was more effective in preventing hospitalisation in adults with severe asthma exacerbations who are at increased risk of hospitalisation, compared to those with mild-moderate exacerbations, who were at a lower risk to be hospitalised. A single dose of combination therapy and multiple doses both showed reductions in the risk of hospitalisation among adults with acute asthma. However, adults receiving combination therapy were more likely to experience adverse events, such as tremor, agitation, and palpitations, compared to patients receiving SABA alone.
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To access full text, log in to your NHS Athens account (click here to register).
If full text is not available, please email us.
***Links will not work from UHL computers using older versions of Internet Explorer, please use https://www.google.com/chrome/ or an alternative browser. ***
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New England Journal of Medicine - Journal Watch
Surviving Sepsis Campaign Updates Guidelines for Management of Sepsis and Septic Shock. Daniel M. Lindberg, MD Reviewing Rhodes A et al.,
Intensive Care Med 2017 Jan 18
This revision of the 2012 guidelines focuses on early management in adults.
Emergency Department Treatment of Atrial Fibrillation in Canada, Where Cardioversion Is Common. Daniel J. Pallin, MD, MPH reviewing Stiell IG et al. Ann Emerg Med 2017 Jan 19.
In this prospective Canadian study, rhythm control seemed safe, with no related deaths and one stroke within 30 days.
Cardiac Monitoring Is Unnecessary for Most Patients with Chest Pain in the Emergency Department. Daniel M. Lindberg, MD reviewing Syed S et al. CMAJ 2017 Jan 30.
Arrhythmias were rare, especially in patients with normal or non-specific electrocardiogram results.
Can Patients with Febrile Neutropenia Be Sent Home from the ED? Daniel J. Pallin, MD, MPH reviewing Coyne CJ et al. Ann Emerg Med 2016 Dec 29.
The Clinical Index of Stable Febrile Neutropenia score had 98% specificity and 98% positive predictive value in identifying low-risk emergency department patients.
Perioperative Respiratory Adverse Events in Infants: LMA vs. Endotracheal Intubation. Katherine Bakes, MD reviewing Drake-Brockman TF et al. Lancet 2017 Jan 17.
Infants who underwent endotracheal intubation had three times greater risk for perioperative respiratory adverse events than those with a laryngeal mask airway.
Ocular Burns from Laundry Detergent Pods on the Rise in Preschoolers. Katherine Bakes, MD reviewing Haring RS et al. JAMA Ophthalmol 2017 Feb 2.
The incidence of ocular burns from laundry detergent pods in preschool-aged children increased 32-fold from 2012 to 2015.
Readmissions After Sepsis Outnumber Those for Other Tracked Diagnoses. Patricia Kritek, MD reviewing Mayr FB et al. JAMA 2017 Jan 22.
Patients rehospitalized after sepsis account for 12% of readmissions within 30 days of discharge.
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UHL Writing Club - "Informal Peer Review"
23rd February 2017 1-2pm, Stanley Tipton Room, Clinical Education Centre, Jarvis Building, LRI
Please bring examples of your own writing for an informal session on peer reviewing—have your work reviewed, and review others’ work
Email us to book your free place
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UpToDate - What's new in Emergency Medicine
This topic last updated: Feb 02, 2017, including:
- Determining the futility of resuscitation following cardiac arrest (December 2016)
- Iloprost therapy for severe frostbite (December 2016)
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DynaMed Plus
Topic: Assessment of intimate partner violence (IPV) in the emergency care setting
- Review of domestic violence and abuse screening in the emergency department can be found in J Clin Nurs 2016 Dec 28 early online (J Clin Nurs 2016 Dec 28 early online)
- Old fractures, new-plus-old fractures, facial bone fractures, and soft tissue thickening detected on imaging each appear to have high specificity for intimate partner violence in women presenting to the emergency department (Violence Vict 2016)
Topic: Overanticoagulation management
Prothrombin complex concentrate may be more effective than fresh frozen plasma for reducing 30-day all-cause mortality and INR in patients with major bleeding or requiring surgical or invasive procedures (Thromb Haemost 2016 Oct 28)
Topic: Acute respiratory distress syndrome (ARDS)
Review of acute respiratory syndrome (Lancet 2016 Nov 12)
Topic: Acute pancreatitis
Review of acute pancreatitis (N Engl J Med 2016 Nov 17)
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Other reports, statistics and guidance
Transforming urgent and emergency services
NHS Improvement has published Transforming urgent and emergency care services in England: safer, faster, better: good practice in delivering urgent and emergency care. This guide for local health and social care communities details how to redesign models of care through a fundamental shift in the way urgent and emergency care services are provided. It sets out design principles drawn from good practice, which have been tried, tested and delivered successfully by the NHS in local areas across England.
NHS ambulance services
The National Audit Office (NAO) has published NHS ambulance services. This report provides an update to the NAO 2011 report and examines: the challenges facing the ambulance service in England; the performance of the service; and the extent to which the service is maximising its impact and supporting the challenges facing the wider health system. It highlights that NHS ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services.
Confidentiality in patient information
The General Medical Council has updated Confidentiality: good practice in handling patient information. This guidance clarifies the public protection responsibilities of doctors; the importance of sharing information for direct care; the circumstances in which doctors can rely on implied consent to share patient information for direct care; and the role that those close to a patient can play in providing support and care.
Statistics
Provisional Accident and Emergency Quality Indicators for England - October 2016, by provider
Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatient and Accident and Emergency data - April 2016 - November 2016
Information sourced with thanks to HEES Daily Health Bulletin
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