838 e-Letters

  • I applaud clear, respectful and understandable discussions with patients and their families
    Nancy Lutwak

    I applaud "It's good to talk--but the talk must be good" by Geoffrey Hughes I have been an emergency physician for over twenty years and have the pleasure of working at the VA Healthcare Center in Manhattan. The patients that come to our Emergency Department are brave men and women who served in the military with much sacrifice. There is no doubt they truly appreciate quality healthcare. I feel, however, they are even more...

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  • Possible bias in findings
    Ambuj Kumar

    We read with interest the systematic review by Stippler et al. which assesses efficacy of routine follow-up computed tomography (CT) for the management of mild traumatic brain injury (mTBI). The authors should be commended for undertaking this exhaustive review; however, the findings are limited due to failure to adhere to the contemporary systematic review methodology (Higgins 2011). Specifically, the findings of the...

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  • The pain passport: emphasis on the child's coping strategy.
    Johanna H.A.M. Megens

    We congratulate Dr Newstead and co-workers with the results they achieved introducing the pain passport in the emergency department. After introduction of the pain passport 69% of the children in pain in the emergency department received analgesia within 20 minutes and in 96% of children a pain score was recorded.

    However, the original concept of the pain passport was perhaps misunderstood. The pain passport i...

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  • Over dependence on Early Warning Scores in the Emergency Department
    James K Moore

    Dear Sir

    I read with interest the recent articles discussing the use of early warning scores (EWS) in the Emergency Department (ED).[1, 2] Whilst I agree with the observation that their current use in the ED is flawed, I would suggest there is perhaps a dangerous overdesire to seek out a 'system to recognise the sick patient'. Arguably this 'system' should be already in place - that is the nursing and medical t...

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  • Isolated analysis of one time measure - only seeing part of the picture
    Matthew W Cooke

    Woodcock et al highlight that changing the four hour standard from 98% to 95% resulted in processes adjusting accordingly. But they fail to address the key issue of whether it benefits patients. Their conclusion that this shows that more patients are waiting for care is imprecise and possibly wrong. The four hour standard relates to the total time spent in the emergency department until discharge or admission to a ward....

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  • Too Many Chiefs and Nowhere Near Enough Indians!
    Sandip Patel

    Dear Editor,

    I was absolutely transfixed by this paper and felt my jaw gently descending in a southerly direction as I read ever onward. So, in conclusion, EM Consultants are better than junior doctors at making decisions in a timely manner and admitting patients unnecessarily. That conclusion is hardly earth shattering.

    I note that at the time of the study, SHO's were working the weekends without sen...

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  • Utilizing a Team Approach in the Emergency Department to Improve Patient Safety
    Nancy Lutwak

    The recently published manuscript, Suicide attempts and completions in the emergency department in Veterans Affairs Hospitals, makes several recommendations to improve quality of care concerning emergency department patients with suicidal ideation. These recommendations are excellent and certainly will guard against untoward outcomes among VA patients who might attempt suicide while in the emergency department.


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  • How can one claim 'superiority' in a pilot study
    Tom Quinn

    I enjoyed reading the paper by Markus S?ren Roessler and colleagues, but wondered how a claim for superiority could be made on the basis of a pilot study?

    Conflict of Interest:

    None declared

  • Mental Health Care neglected in the Emergency Department
    Heather M Sowden

    I enjoyed reading the paper by Da Cruz et al. On starting my ED job I asked our consultants what our role is in terms of a good outcome for patients presenting in Mental Health Crisis. The overwhelming response was 'make sure they're medically fit' and let the psychiatric worker look after that side. These patients are a group with unmet needs in most ED's when the NICE guidelines are reviewed, a group who leave without be...

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  • Value of a rigid collar in- need to more research and better devices
    Matthew W Cooke
    The use of cervical collar, head blocks and tape on a stable surface (such as a long spine board or hospital trolley) has long been accepted as the standard of care for patients with potentially unstable spinal injury. holla raises important isues[1]. There is however scant evidence that supports their use and there are significant potential risks associated with their use, including aspiration of vomit, difficult airway access,...
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