107 e-Letters

published between 2013 and 2016

  • Sepsis Six: Are we doing the right thing?

    Dear Editor,

    The "Sepsis Six" resuscitation bundle is now common in UK hospitals, and endorsed by the College of Emergency Medicine, SIGN guidelines, and the Royal College of Physicians.1-3 However, the evidence behind it remains limited and must be re-evaluated as new data emerges - especially since the results of the PRoCESS and ARiSE trials on Early Goal Directed Therapy (EGDT) were published this year.4,5...

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  • Different populations, overall cost increase
    Timothy RJ Parke

    Sir I find the methodology for this paper to contain a significant flaw in that the triage criteria used to determine suitability for the GP unit contain a requirement that the patient will need minimal additional resources for them to be processed. It is hardly surprising therefore that the post intervention analysis sees fewer additional resources subsequently spent on this group with the associated savings.


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  • Towards a valid proxy measure for sepsis associated mortality
    Meghan L Bateson

    Wright and colleagues1 discuss some interesting issues around blood cultures and sepsis outcome measurement. We agree that evaluating and tracking sepsis associated mortality over time is important. It would facilitate assessment of the impact of changes in practice, both intended effects of sepsis improvement interventions and unintended consequences of other initiatives, e.g. restrictive antibiotic policies, as well a...

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  • Utility of a single early warning score in patients with sepsis in the emergency department
    Santiago Romero Brufau

    Santiago Romero-Brufau, MD1; Jeanne M. Huddleston, MD1,2

    1Healthcare Systems Engineering Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA 2Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Correspondence to: Santiago Romero-Brufau, MD, Mayo Clinic Robert D. and Patricia E. Kern C...

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  • Re:Prehospital care is not for amateurs
    John H G Antrum

    The authors thank Dr Clayton for her comments.

    However, they point out that her critique of their paper is largely inconsistent with what was actually written and can only assume a misunderstanding of the article.

    The article does not state, nor even imply, that the GMC require students to provide expert or definitive care as she asserted in her response. Indeed the article talks about basic skills an...

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  • High level disinfection reduces HPV contamination of transvaginal sonography probes in the emergency department
    Shuk Ting Christine Ma

    Our previous study reported in your journal in 2012 found that 7.5% of the transvaginal sonography (TVS) probe samples were human papillomavirus (HPV) DNA positive in our Emergency Department, when a barrier was applied along with low level disinfection using a quaternary ammonia based agent. (1)

    M'Zali et al also demonstrated that TVS probes remained substantially contaminated by HPV, C. trachomatis, mycoplasma...

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  • Oxygen Alert Cards: Are they working? Our Local Experience at Yeovil District Hospital
    Adam Hughes

    In Yeovil District Hospital (YDH), o2 alert cards are currently issued by the respiratory nurse specialist. Patients are usually referred by a doctor or the ward nurses for a respiratory nurse review to optimise management of a respiratory disorder and arrange appropriate follow up in the community. If a patient has a documented episode of type II respiratory failure the respiratory nurse will issue an o2 alert card as...

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  • Prehospital care is not for amateurs
    Kate Clayton

    The very fact that the author has written this article at all demonstrates to me a profound lack of understanding on his part of the complexities of prehospital care.

    Firstly, the obligation mentioned by the GMC to help victims of accidents is not a requirement to provide expert or definitive care - it is simply a moral duty to provide what help one can given ones own skill set and available resources. As the...

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  • Emergency medicine: the job we're all waiting for?
    Emma D Butterfield

    Much has been written about the current difficulties of recruiting and retaining doctors in key specialities: most recently psychiatry (1) and emergency medicine (2).

    Concurrently there has been a year-on-year decline in the number of doctors choosing to enter speciality training immediately upon finishing their FY2 year: in 2013 only 64% of FY2's chose to enter speciality training (3). Instead, many FY2's opt...

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  • Clinical Examination in place of end-tidal CO2
    Jecko Thachil

    Hunter and colleagues gives a good method to distinguish COPD and heart failure in a dyspnoeic patient. May i politely suggest an easier, clinical marker which can help in this distinction?

    This is based on the observation that patient who has prominent, bulging veins has COPD as the predominant cause for the breathlessness compared to the patient with heart failure who has collapsed, thready veins. The therapy...

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