eLetters

193 e-Letters

published between 2001 and 2004

  • Appropriate analysis and reporting of cluster randomised trials
    Steve Goodacre

    Dear Editor

    Dyson et al [1] use a pragmatic design to address an interesting question, but I am concerned that the statistical analysis may be inappropriate and could have led to erroneous conclusions being drawn. The study is a cluster randomised controlled trial. Instead of randomising individual House Officers (HOs), the authors have randomised groups of HOs (those working at the same hospital). This is entirely...

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  • In need of a PEA?
    Andrew M. Mason

    Dear Editor

    For feeble-minded souls such as myself, the aide mémoire has played a key part in my professional life. Some 30 years ago whilst demonstrating anatomy at Cambridge, I devised numerous mnemonics to assist with teaching. To illustrate their power, whilst I have forgotten the names of virtually all my students and most of my fellow demonstrators, I can recall each and every segment of the right lung, all...

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  • Best Bets, how robust is the review process?
    Adrian A Boyle

    Dear Editor

    The correspondence between Professor Mackway Jones [1] and Dr Locker et al.[2] and Dr Webster [3] raises some interesting points about how Best Bets are developed.

    Best Bets represent an admirable attempt to improve the evidence on which our practice is based and no one should underestimate the hours of work that go into this. Of course, the biggest problem for Best Bets is that the answer...

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  • Topical Anaesthesia in Children – an alternative to cocaine
    Bimal M Mehta

    Dear Editor

    The Emergency Department (ED) at Alder Hey Children’s Hospital, Liverpool has several years experience using topical adrenaline and cocaine gel (topAC) as an anaesthetic for suturing lacerations of head and body in children. We, therefore, read the article by Kennedy et al. with interest.[1]

    An audit conducted within our department showed similar results to Kennedy’s with a high degr...

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  • Risks of Overzelous Adrenalin Administration
    Luigi Gori

    Dear Editor

    In the paper of SGA Brown [1] adrenaline was administered to 19 patients of 21, 3 of which in stage II and 5 in stage I of Muller's grading of systemic allergic reactions, we think that adrenaline administrationat at this stage is excessive and potentially hazardous in respect to signs and symptoms, although the patients were continuously monitored. We think adrenaline administration should be avoided o...

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  • A caution with semi-paramedics: the SAO Paulo case
    Celio Levyman MD, MSc

    Dear Editor

    This paper shows a good outcome of undiagnosed cervical spine trauma when the intubation was performed by a senior practioner, in an ED of a UK.

    In USA, for example, paramedics perform access to airway in the local of an accident, and they are members of the Fire Department of some city.

    In Sao Paulo, the largest city of Brazil, with 10 million habitants, this type of rescue is perfor...

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  • Ketamine sedation - safe and effective
    Ian Ayenga Sammy

    Dear Editor

    I read with great interest the article by MC Howes. It concerns me that much current practice in Emergency Medicine in the UK is still dictated by those outside the speciality, who have little or no idea of the needs of our patients, or the settings in which we work.

    I was not surprised to read that, while ketamine sedation has been accepted both in the US and Australia as a part of modern eme...

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  • Futility of Nalbuphine
    Aruni Sen

    Dear Editor

    Woollard and his colleagues' study on nalbuphine identifies the gap that can exist between research and clinical practice. I resent the claims in this paper that nalbuphine somehow is an effective analgesic.

    Since 1996, I have been receiving patients in my hospital who have been given nalbuphine pre hospital with very little benefit and lot of problem. These patients get grossly inadequate anal...

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  • Ketamine marches on regardless
    Philip Munro

    Dear Editor

    Neil Morton's points are concise and thought provoking as always.[1] The withdrawal and ongoing reevaluation of the SIGN guidelines on paediatric procedural sedation were rightly welcomed as a chance to address issues which many emergency physicians felt had been overlooked. Our colleagues from Australasia and the United States are somewhat puzzled by our hesitation in adopting what is viewed by them a...

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  • AMTS
    Richard D Hardern

    Dear Editor

    We do not want to detract from the overall value of the recent article by Wardrope and MacKenzie,[1] but we feel it important to point out our concerns over the proposed assessment of cognitive function.

    Cognitive impairment due to dementia and delirium is common in emergency situations but formal assessment of cognitive function is rare. This could explain why at least 67% of older people wi...

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