eLetters

838 e-Letters

  • 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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  • The benefit of intravenous magnesium sulphate is not proven in adults with acute severe asthma
    Steve Goodacre

    The correct answer to question 2a in the EMQs on magnesium is false, at least with regard to adults. For children it is probably true. The evidence cited to support the answer provided is ten years old [1]. Avid EMJ readers will know that a more recent meta-analysis [2] showed that in adults there was only weak evidence that intravenous magnesium sulphate had an effect upon respiratory function (standardised mean differe...

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  • Re:'Unstable' buckle fractures
    Thomas W Hamilton

    In reply to Dr Kennedy's comments Salter Harris IV and displaced Salter Harris II fractures are seen in this population, these may be initially interpreted as stable fractures but may require manipulation or observation to avoid long term disability. Misdiagnosis may also occur where a fracture is diagnosed in the absence of any bony injury.

    Conflict of Interest:

    None declared...

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  • Trauma care in England: Londons Trauma System goes live
    Anna Vondy

    We were encouraged by Hughes editorial on Trauma Care in England (1), which highlighted the key points from the National Audit Office publication Major Trauma Care in England (2).

    As an update, the London Trauma System was launched on 6th April 2010. The system is composed of four trauma networks, each with a major trauma centre providing care for the most seriously injured patients, linked in with a number of l...

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