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    Ophthalmoscopy in the Emergency Department

    As Petrushkin and colleagues point out ophthalmoscopy is a difficult but essential skill in the Emergency Department environment, particularly with regard to recognition of optic disc pathologies. In their short report they compare the sensitivity and specificity of the panOptic ophthalmoscope to that of traditional direct ophthalmoscopy in conditions comparable to those found in most EDs. While the newer instrument performs better than the traditional technique (and was preferred by the users) the actual clinical utility of doctors using both is worryingly poor. You probably have a view as to why this might be—to inform your thoughts turn to (see page 1007) to see the performance of trainee emergency physicians for yourselves.

    Perfect World or Dark World

    Emergency Department crowding is a problem just about everywhere and it is good to see that disciplines other than medicine are taking an interest. In a fascinating paper Baboolal and Operational Research collaborators use discrete event simulation to create models of the Emergency Unit (the Emergency Department itself as well as medical and surgical receiving wards) in Cardiff, Wales. Within their model …

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