844 e-Letters

  • Reply to: Modelling the effects of the weather on admissions to UK trauma units: a cross-sectional study
    Wouter Stomp

    With great interest we read the report by Parsons et al. regarding the effects of the weather on trauma unit admissions.[1] We would like to bring to the authors attention our study, in which we studied the same effects in an area in the Netherlands geographically and metereologically similar to the United Kingdom over a total period of 36 years, including over 350,000 patients.[2] Although the authors of the present stu...

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  • Treating Hypoglycemia

    Acute Care issues:

    Treating hypoglycaemia in Acute care due to insulin and oral agents create very different challenges. Decrease in blood sugar due to oral agents may be due to skipped meals or exercise. However concurrent illness (dehydration etc), new onset renal dysfunction and drug interactions are major factors that cause oral agents induced hypoglycaemia; such events prolong the half life of sulfonylureas....

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  • Your question and bottom line are too vague
    Mary Hickson

    The question you ask is akin to asking whether drugs can cure a headache. You cannot lump all probiotics together. Probiotics are defined as "live microorganisms that when administered in adequate amounts confer a health benefit on the host"(WHO 2001). Not all micro-organisms will confer a health benefit and the actions of potential probiotics are strain specific. Therefore, your question should be 'Which, if any, probiot...

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  • Lack of evidence, not knowledge, contributes to variability in massive transfusion practice
    Biswadev Mitra

    Milligan, et al. (1) provides valuable insight into the varied management of massive haemorrhage post trauma. However, the conclusions that emergency physicians lacked core knowledge and were unaware of how to prevent and treat early coagulopathy appear unfounded. It would be more prudent to conclude that a paucity of high level of evidence guiding trauma resuscitation was responsible for this varied practice.

    The defin...

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  • Medicines Reconciliation in Acute Medicine
    Tom Jaconelli

    We read with interest the work by Mills and Crawford regarding timely medicines reconciliation. We have seen similar results in the acute medical department.

    The presence of pharmacists, pharmacy technicians and a formalised medicines reminder system for junior doctors in acute medicine also significantly improves the rate of medicines reconciliation in the first 24 hours of an in-patient stay.

    Dr Tom...

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  • The Rapid Emergency Medicine Score?
    James R Griffiths

    I read with interest the Commentary by Roland and Coats with regard to early warning scores(1). The evidence base for the use of track and trigger systems (TTS)in the Emergency Department is not particularly strong and I agree that using a system that is designed for hospital inpatients will not be appropriate for our specific patient group.

    The rapid emergency medicine score(REMS) is a physiological scoring sy...

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  • Letter to the editor
    Marion Zock


    We congratulate Mueller et al. investigating the usefulness of serum protein S-100B to save cranial CT resources in the management of patients with minor head injury [1]. Although we definitely support their conclusions about the usefulness of protein S- 100B, two major concerns regarding the methodology of their study ought to be considered: Firstly, despite the well-described diagnostic time frame of S-100B...

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  • Patients still not taking analgesia before attending accident and emergency department
    Arif Razak

    Dear sir

    I was working at a A&E department in North West few years ago and had similar questions as to why patients not taking any analgesia before attending the department. I did a survey on this matter and this is the result of the survey.


    To determine the percentage of patients attending the accident and emergency department with pain but without taking any analgesia prior t...

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  • Re:Effects of bed height on the performance of chest compressions- Clinical application of results
    Je Hyeok Oh

    We are incredibly glad to hear that Dr. Sherren has taken an interest in our research (1). I concur with his position on this matter. I believe that cardiopulmonary resuscitation (CPR) issues in in-hospital cardiac arrest patients will be solved through near future technologies such as extracorporeal membrane oxygenators. However, if we divide cardiac arrests broadly into in-hospital and out-of-hospital, or on-site arrests...

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  • Intravenous lipid emulsion for calcium channel blocker overdose: fattening up the treatment
    Theophilus L Samuels

    We read with interest the case report by Abeysinghe and colleagues reporting hyperinsulinaemic euglycaemic therapy (HIET) in the treatment of a patient presenting with persistent hypotension following an overdose of the lipophilic calcium channel blocker diltiazem.[1]

    Diltiazem is extremely lipophilic with a log P value of 4.53 (a measure of lipid solubility). Thus we consider that it would have been amenable t...

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