eLetters

833 e-Letters

  • The diagnostic difficulties of lunate and perilunate dislocations.
    Anne-marie Kennedy

    I read with interest your recent case report of a perilunate dislocation. This case highlights the importance of careful assessment of often complex wrist X-rays. As a small point, I would however disagree that the 'spilled teacup sign' is a sign of a perilunate dislocation. This sign is a radiological sign of a lunate rather than perilunate dislocation. The key to distinguishing between between both is to first determine...

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  • POLST CAn Help Paramedics with End-of-Life Dilemmas
    Arthur R. Derse

    Murphy-Jones and Timmons described paramedics' experiences of end-of- life decision making with regard to nursing home residents, including the challenges faced by paramedics when patients lacked decision making capacity and the resultant stress from uncertainty about appropriate treatments. [1] Among the solutions suggested, an essential, straightforward and well-tested tool for the perplexed paramedic was not available...

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  • Designing urgent primary care centres located at hospital sites: the devil is in the details
    Koen Van den Heede

    We have read with great interest the review of Ramlakhan et al. (2016)1 on the effectiveness of co-locating emergency departments (ED) and primary care centres and the findings of the authors that the evidence is inconclusive. Yet, we are confident that there are more hints and clues in the available evidence for policy guidance than was done in the paper by Ramlakhan et al. (2016). We will illustrate this with a recent po...

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  • Primary care services located with EDs: Effectiveness depends on matching patients to the right clinician
    Tim Daniel

    We read with interest the paper by Ramlakhan et al (10.1136/emermed- 2015-204900) on the effectiveness of primary care services located in EDs. We have just completed a test cycle week of a GP led model for managing lower acuity patients who present to the Clinical Decisions Unit (CDU) at the Glenfield Hospital, Leicester; however, we reached different conclusions. The CDU is a cardiorespiratory unit that receives mixed...

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  • Bland-Altman comparison of haemodynamic monitoring methods; not simply a matter of black and white.
    Robert A. Phillips

    This comparison of non-invasive haemodynamic devices, although valuable, demonstrates some methodological aspects of the Bland-Altman method that should be considered to ensure the accuracy of any proposed conclusions.

    The statistical minimum for comparison of two medical device measurement methods includes reporting mean ?SD values for both methods, correlation, and Bland-Altman bias and precision, mean % diff...

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  • Paediatric Early Warning Scores: Acute Paediatrics' Cinderella's Slipper
    Julian M Sandell

    Paediatric Early Warning Scores: Acute Paediatrics' Cinderella's Slipper

    Lillitos et al are to be congratulated on a most helpful paper clarifying whether disease severity and the need for hospital admission can be predicted using two similar PEWS systems (Brighton PEWS and COAST - the Children's Observation And Severity Tool).

    There has been a proliferation in the uptake and usage of Paediatric Earl...

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  • Air ambulance tasking: mechanism of injury, telephone interrogation or ambulance crew assessment?
    James M Vassallo

    We wish to thank Wilmer et al for their recent article "Air ambulance tasking: mechanism of injury, telephone interrogation or ambulance crew assessment", which we read with interest. As researchers in the field of triage we feel it raises a number of interesting questions. We believe that there are considerable similarities between triaging for enhanced trauma team despatch (eg LAA) and effective triage for direct trans...

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  • Preparing medical students for the front line: experiences from a curricular innovation in Ireland
    Gerard T. Flaherty

    Dear Editor,

    We read with interest the article by Seligman and colleagues (1) which evaluated a novel first responder scheme for medical students as a collaborative venture between a medical school and the local ambulance service. Previous authors have advocated the early introduction of Emergency Medical Technician teaching in an undergraduate medical curriculum in the United States.(2) We would like to report...

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  • Encouraging task-orientated coping mechanisms
    Lucy E Joslin

    Dear Editor,

    This article by Howlett et al. makes for interesting reading as a junior doctor at the start of Emergency Medicine training.

    This study suggests that in order for trainees (and Consultants) to maintain successful, long, enjoyable and fruitful careers, and avoid 'burnout', we should develop 'task-orientated coping' mechanisms. Currently one may argue that this is encouraged via personal ref...

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  • RE: Bowness J, Kilgour PM, Whiten S, et al. Emerg Med J 2015;32: 620-625.
    Timothy C Hardcastle

    We read this article with interest, given the high prevalence of penetrating chest trauma in South Africa and the fact that we and others (1,2) have published on the challenges faced in high-volume systems with errant tube placement. While we also advocate the "safe-triangle" approach, we aim to place the tube rather in the 4th ICS to avoid the risk of trans-diaphragmatic injury. We are also adamant that the "finger-sweep...

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