856 e-Letters

  • An interesting study of the wrong cohort
    Jamie P Fryer

    I thank the authors for highlighting an ongoing concern I have with NICE head injury guidance - namely that the guidance is based on studies of acute head injuries presenting soon after injury and doesn't take delayed presentations into account. However my concern would be the reverse of their own as I feel if we adhered to NICE guidance in patients presenting after 24 hours we would be performing large numbers of unnece...

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  • Measuring outcomes of first aid education
    Emily Oliver

    Pocock et al present fascinating insight to the challenges of the pre -hospital environment for undertaking clinical trials (Human factors in pre hospital research: lessons from the PARAMEDIC trial Pocock H, et al, Emerg Med J 2016; 33: 562-568) which explain the lack of clear strategies of the implementation of research protocol on this issue. The need for strong relationships between teams brings into focus the potenti...

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  • The effectiveness of primary care services located within EDs - optimising streaming
    Martin M McGrath

    The comprehensive review by Ramlakhan et al of the effectiveness of primary care services located within EDs draws mixed conclusions. Whilst initial efficiency savings were identified (both in terms of GP resource utilisation and overall cost) and subsequent hospital admission and referrals appeared reduced, other outcomes proved disappointing or at best equivocal including length of stay, waiting time and patient satisfa...

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  • 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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