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BAYESIAN DIAGNOSIS OF PULMONARY EMBOLISM
Bayes theorem provides a mathematical way of integrating new diagnostic information to allow us to appropriately alter our estimates of the probability of disease. It sounds complicated, but it’s what we all do when we examine and investigate patients to build up a diagnosis. However, whereas humans are prone to errors in this process, computers do it with remorseless logic. Luciani and colleagues used data from the PIAS-PED study to develop BayPED, an evidence-based expert system focussed upon diagnosis of pulmonary embolism, and have shown that it offers a flexible and accurate method of diagnosis.
See page 157
CLINICIANS DO WHAT THEY CAN
Ball and colleagues report their comparison of the management of injuries by doctors, emergency nurse practitioners and physiotherapy practitioners. Junior doctors were more likely to prescribe analgesia, nurses were more likely to apply bandages and physiotherapy practitioners were more likely to refer patients for physiotherapy. This sounds like practitioner-based practice, rather than evidence-based practice.
See page 185
UNNECESSARY BLOOD TESTS
Howie and colleagues report that out of 2213 blood culture samples, 132 were positive, 30 were "true" positive and only four results influenced subsequent management. How can we stop emergency department staff ordering unnecessary tests? Any ideas?
See page 213
HAS THE EMJ GONE TO THE DOGS?
The EMJ has not traditionally published many animal studies, but in this issue we publish a study of the effect of cyanide upon oxygen transport characteristics using a canine model. Do EMJ readers want to see more of these studies? Or is one too many?
See page 152
ANIMALS FIGHT BACK
The animal kingdom extracts its’ revenge in the case report from Kuo et al. A 19 year old female developed life-threatening atriventricular block after ingesting toad eggs. Fortunately, with good supportive care she made a full recovery.
See page 215
HYPOKALAEMIA AND SUDDEN CARDIAC DEATH
Implantable cardioverter defibrillators are usually used for patients with heart abnormalities that predispose them to life-threatening arrhythmias. Maeder et al report four cases of patients with implantable cardioverter defibrillators who presented with arrhythmia secondary to hypokalaemia. Would these patients have survived without rapid defibrillation? And if not, how could anyone have known that hypokalaemia might have contributed to their death?
See page 206
DIY WOUND CARE
Clinicians may be reassured by the case report from Cascarini and Kumar, showing that do-it-yourself enthusiasts should pause for thought before entering medical territory.
See page 228
TOUGH DECISIONS IN SOUTH KOREA
Would you force a patient to have a potentially dangerous procedure against their will, with no reliable evidence that it will be effective? The answer may seem obvious, but not to the Supreme Court in South Korea.
See page 233
Relevant Articles
Emerg. Med. J. 2007 24: 151.
Emerg. Med. J. 2007 24: 157-164.
Emerg. Med. J. 2007 24: 185-188.
Emerg. Med. J. 2007 24: 206-208.
Emerg. Med. J. 2007 24: 213-214.
Emerg. Med. J. 2007 24: 215-216.
Emerg. Med. J. 2007 24: 228-229.
Emerg. Med. J. 2007 24: 233.
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