844 e-Letters

  • The value of taking a history in patients with chest pain
    Allan D Cameron

    In introducing Goodacre et al's paper on low risk chest pain patients, the Primary Survey of the December 2009 issue prompts emergency physicians to reflect on "why [they] take histories at all in this patient group".(1,2) This is, in our opinion, an inappropriate reaction to the results of the study. The patients under investigation were those with a potential diagnosis of a cardiac cause of chest pain, and according t...

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  • Simple buckle fracture? Are you sure of the diagnosis before discharge with no follow up?
    Elizabeth C Jones

    I read with interest the Best Evidence Topic report by May G, Grayson A regarding the follow up of buckle fractures.[1] I agree that buckle fractures should not require routine follow up, however systems need to be robust to ensure that the correct diagnosis has been made. Diagnosis may not be as simple as often believed; several studies researching this topic have inadvertently included fractures other than buckle fracture...

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  • On the philosophy of diagnosis: Authors' response
    Richard Body
    Dear Editor,

    We welcome the thoughtful responses of Dr. Challen and Dr. Cattermole to our paper entitled: On the philosophy of diagnosis: is doing more good than harm better than primum non nocere? Dr. Challen makes two principle criticisms of our review to which we would like to respond.

    1. The existence of reality

    Dr. Challen correctly states that outside the medico-scientific realm, th...
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  • When the Good of the One outweighs the Good of the Many
    Jean Marc Benoit

    I would like to thank Body and Foex for their thought-provoking article, and also Cattermole and Challen for their replies. Too often in the culture of emergency medicine, the philosophical underpinnings of thought and action are neglected. When is there time to reflect?

    One highlight of their discussion of utilitarianism is the inclusion of emotional factors into the weighing of what actions can be counted as...

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  • Don't we have a service concept?
    suzanne mason

    The article by Higginson made me think about our specialty and whether we have got a missing link. However, it reminded me to look at the Way Ahead document produce by the UK College of Emergency Medicine in 2008. Surely this provides an excellent service concept for our specialty? The document provides clear guidance as to what our core and extended services should be and how we should consider delivering them. I wonder...

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  • Sensitivity or specificity?
    Shenaida R. Oemar

    With great interest we read the recent article by Bevan and colleagues reporting how predictive ALT is for liver injury in children with blunt abdominal trauma. In the result section the authors describe the following: "The presence or absence of liver injury can be predicted with a sensitivity of 96% and a specificity of 80%". In their conclusion they reported: "a threshold of >104 IU/L gave a 96% specificity for t...

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  • Assessment and risk stratification of patients with acute chest pain
    Katherine McGinn

    We read with interest Manini et al’s 1 recent paper suggesting ischaemia-modified albumin assays could assist in decreasing the rate of inappropriate discharges from the ED, and that further studies into diagnostic tools for use in chest pain are warranted.

    We conducted an audit at Ealing Hospital that also supports the need for developing new diagnostic algorithms for chest pain. Medical histories of 14...

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  • Pellegrini-Stieda
    Andrew Plumb

    This case appears to be describing the Pellegrini-Stieda syndrome/lesion. This is, in fact, a well-known and fairly common finding, generally felt to reflect a post-traumatic ectopic ossification, either acute or chronic. MR is a useful test, as the signal void from the calcification can be seen in relation to the MCL. It may also uncover bone bruising from an associated avulsion fracture (the so-called Stieda fracture)....

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  • Importance of log roll and careful spine evaluation
    Tanvir ABBASS

    Dear Editor, I understand that it is very important to log roll and carefully evaluate the whole spine of the patient. By reading this article, I understand the importance of complete spinal evaluation but there are situations in which spinal injuries are missed as a result of incomplete evaluation or not adhering to systematic approach. I want to share one of the clinical cases in the management of which I was involved. A pa...

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  • Primum, non nocere.
    Giles N Cattermole

    Dear Editor,

    I was disturbed to read the article by Body and Foex [1] advocating the embrace of Utilitarian values in medicine. I hope it was merely a misuse of words. All penguins are birds, but not all birds are penguins. Utilitarianism is a form of consequentialism, but not all ethical thinking that considers the consequences of one’s actions is Utilitarian. The authors of the article correctly make a clear c...

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