eLetters

831 e-Letters

  • Is S100-B better then rolling a die?
    Steve W Goodacre

    Muller et al report that S-100B had a specificity of 12.2% and a sensitivity of 86.4% and conclude that use of serum S-100B as a biomarker for CCT triage may improve patient screening and decrease the number of CCT scans performed. However, if we were to roll a 6-sided die and call the number 6 negative and the numbers 1 to 5 positive we would expect to have a test with similar parameters: 83.3% sensitivity (i.e. positiv...

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  • Nail polish and pulse oximetry
    Wolfgang A. Wetsch

    To the Editor!

    We have read the original contribution by Sutcu Cicek et al. [1] with high interest regarding the effect of nail polish and henna on pulse oximetry readings. In their study, these authors report on the influence of both factors in 33 normoxic healthy females. Although the study is interesting, it has significant limitations, which must be addressed. To our surprise, the authors state, it is not pro...

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  • Response to: Survival after cardiac arrest and severe lactic acidosis (pH 6.61) due to haemorrhage.
    Harvey J Pynn

    Dear Sirs

    I read, with considerable interest, your case history of a 21 year old man who was stabbed in his buttock and went on to suffer a hypovolaemic cardiac arrest whilst on the emergency unit ward awaiting transfusion and exploration of the wound under general anaesthesia.

    A pH of 6.61 is undeniably low and had he presented at such extremes of physiology to your Emergency Department his outcome wo...

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  • The good and the harm.
    michel g soete

    The principle of 'primum non nocere' stems from the ancient world of Plato. In the 'real' world it is immpossible to act without doing harm. An examination or treatment takes always some time and money from the patient. Taking time and money is the minimum harm that is done. In many cases ther is additional harm.

    Therefore the principle 'doing more good than harm' seems at first sight a better and more realistic...

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  • What Price 90 Seconds; is "Call Connect" a disservice to 999 users?
    Jonathan Leach

    Woollard et al reiterate the view that many of us have for some time, there is no evidence that an 8 minute response target is worthwhile in itself, that it should be replaced with more clinically orientated priorities and that it has had unfortunate consequences. It is interesting to reflect that most other health organisations (whether primary or secondary care) have significantly increased both the breadth and depth of...

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  • GP Co-op and ED Dept Colocation
    Seamus Clarke

    I thank the authors for an interesting article. The article states that none of the other 13 GP co-ops are located on hospital grounds close to an ED. This is factually incorrect. The North East Doctor on call service has 2 co-located sites on hospital grounds, Cavan and Navan. In the case of the Cavan centre the GPs are located in the hospital building. In Navan, the site is on the hospital grounds. In both cases, unlik...

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  • Posterior reversible encephalopathy syndrome
    Hong-Liang Zhang

    Moratalla describes a case of posterior reversible encephalopathy syndrome (PRES) in a female patient after delivery.1 We feel concerned about the accuracy of his diagnosis. PRES (also termed reversible posterior leukoencephalopathy syndrome) represents a clinical and radiological disease entity characterized by reversible vasogenic oedema in the brain, which primarily results from autoregulation failure and endothelial...

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  • prevalence of sudden death in asthma
    Rex Harrison

    The case Dr. Alzetta describes is similar to the ones I described. Although these cases are rare in any one location and undocumented especially after death I believe that taken nationally they are of significant numbers. The evidence lies in a paper written to discover the cause of the dramatic increase in asthma deaths in the sixties by Speizer, Doll et al. They studied all the deaths in England and Wales for six cons...

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  • Over-bedding or de-bunking
    Nick Harrop

    The paper by Harris and Sharma [1] confirms what many emergency physicians think they know : no beds means no admissions. An automatic plea for more beds needs to be regarded sceptically.

    The authors rightly conclude that "the availability of fully staffed beds is a major determinant of ED overcrowding".

    It is crucial for clinicians as well as planners to realise that availability does not equate simpl...

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  • diagnosis of swine flu: wieghting between false positive and false negative
    professor viroj wiwanitkit

    Editor, I read the recent publication by Mann et al. with a great interest. Mann et al. concluded that " There is a significant risk of harm with false-positive diagnoses and potential delays in appropriate treatment [1]." I agree that there are several problem in diagnosis of swine flu. Several problems can lead to the failure of using any scoring system or algorithm for diagnosis [2-3]. On the other hands, although sev...

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