eLetters

862 e-Letters

  • What is "relative analgesia"? Reply
    Gary J Browne

    Dear Editor

    Howes [1] concern about the term !%relative analgesia!& pertaining to our recent description of nitrous oxide analgesia in children is noted.[2] This is actually a term that has been used to describe nitrous oxide analgesia for many years. It first appeared in the dental literature and was used originally to describe situations where continuous flow / variable concentration nitrous oxide was administ...

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  • Chest pain obervation unit (CPOU) - A road to a cost effective management of Acute Coronary Syndrome
    Ranjit Sinharay

    Dear Editor

    I read with interest the paper by Goodacre and Calvert.[1] I agree with the authors that as most patients of undifferentiated chest pain have a benign disorder, admission represents a considerable waste of resources. Nevertheless, it is worrying to note that in UK 6% of patients discharged from emergency departments after attendance with acute chest pain were found to have prognostically significant myo...

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  • Nurse initiated thrombolysis in the emergency department
    Rob G Taylor

    Dear Editor

    We read with interest the artlcle by Heath et al. in the Emergency Medicine Journal, looking at nurse initiated thrombolysis in the accident and emergency department.[1]

    Speed of thrombolysis (and hence the "door to needle" time) is well recognised as being important in reducing myocardial damage and decreasing mortality in acute myocardial infarction. In fact, "pain to needle" time is ev...

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  • Pethidine for renal colic
    Roderick Mackenzie

    Dear Editor

    Kastner and Tagg have produced a useful guideline for the emergency management of renal colic.[1] I would disagree however with their recommendation that Pethidine 50 to 100mg should be administered if pain is not relieved by combinations of NSAID and co-codamol or Tramadol. There is no evidence that Pethidine has any specific advantages over other opioids and the belief that it provides better analgesi...

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  • Primum non nocere
    Zane Sherif

    Dear Editor

    Air Bags-Primum non nocere

    Since airbags were installed initially as a safety feature in automobiles in the early 1970s there has been a significant drop in severity of injuries arising out of motor vehicle collisions. Injuries to the eye in particular have reduced since the introduction of laminated glass. Modern airbags however have significant potential to cause serious permanent damage...

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  • Re: Vasopressin or adrenaline in cardiac resuscitation
    Andrew P Webster

    Dear Editor

    I agree with Dr Lockers concerns regarding the publication of BETS in a peer reviewed journal. BETS are useful for introducing people to the theory of literature searching, and appraisal of published evidence, ideal skills for SPR's working towards their clinical topic review. However this does not necessarily warrant their publication in a peer reviewed journal. They occupy valuable space within a journal...

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  • Vasopressin - the continuing evidence.
    Kerstin E Hogg

    Dear Editor

    On the 8th of this month, the large mutlicentre European Resuscitation Council study comparing the effects of adrenaline and vasopressin in out-of-hospital cardiac arrest was published. This was a mutlicentre study conducted between 1999 and 2002 in Austria, Germany and Switzerland. Patients with an out-of-hospital cardiac arrest requiring cardiopulmonary resuscitation and intravenous vasopressor the...

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  • Author's response
    Christof Kastner

    Dear Editor

    We fully agree with the remarks made as to the use of morphine rather than pethidine in patients with renal colic. During our investigations primary pethidine was used in our institution and excursions about the use of morphine were limited by the format of our publication. Therefore this eletter is an extremely welcome contribution.

    Thank you very much.

  • This article incorrectly defines "power" and should not have been published.

    The following quote from the article is incorrect and misses the basic definition of power: "Strictly speaking 'power' refers to the number of patients required to avoid a type II error in a comparative study. Sample size estimation is a more encompassing term that looks at more than just the type II error and is applicable to all types of studies. In common parlance the terms are used interchangeably."

    "Power" is the probability that the test correctly rejects the null hypothesis H0 when a specific alternative hypothesis H1 is true. It's equal to 1 - type II error probability. "Power" and "sample size" are not the same thing and they are not used interchangeably. It's possible to derive power given sample size, or calculate sample size based on desired power.

    Please correct the article as it'll be highly misleading to beginners.

  • The need for explicit documentation of degree of skin pigmentation

    In an observational study where 200 participants were black, 269 asian, and 4330 white, the authors demonstrated an inverse association between blood pressure and pulse oximetry accuracy that was not influenced by ethnicity[1]. In that study no specific mention was made of the degree of pigmentation in individual members of the ethnic subgroups, presumable because self-reported ethnicity was accepted as a surrogate for skin colour. This acceptance is in sharp contrast with the methodology in the study where subjects of African-American descent were further characterised by a description of their degree of pigmentation, using terminology such as "very darkly pigmented".. This was one of the earliest prospective studies conclusively to show that some oximeters overestimate arterial oxygen saturation in hypoxic subjects who are "darkly pigmented" [2].
    In retrospective studies such as the ones subsequently undertaken to explore the theme of racial bias in oximetry it was easy to fall into the trap of using ethnicity as a surrogate for skin colour[3],[4], largely because skin colour is not consistently recorded as part of the medical record[3]. Explicit description of skin colour also gets omitted when race and ethnicity are defined using self-reported demographic data[4].
    Future studies, however, might seek to ascertain whether or not skin pigmentation compounds the overestimation of oxygen saturation attributable to hypotension....

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