ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Repetition of psychiatric emergency department use by a relatively small number of patients constitutes a major problem for clinicians and service providers. This study aimed at the identification of risk factors for repetition by addressing the time interval between the first and second visits to the emergency department. The purpose was to investigate what patient characteristics and referral circumstances determine this interval. Over a two year period, data on all psychiatric emergency referrals to the emergency department of four public hospitals were collected with a standardized form. Data collected during the index referral of all patients were used for estimating the risk for repetition using survival analysis techniques. A large proportion of repeaters revisits the emergency department within a short time interval. Younger, male patients who present themselves spontaneously are more likely to repeat than others. Previous inpatient service use and the presence of a diagnosis of substance abuse disorder or psychotic disorder at the first visit further increases the risk for repetition. Previous service use and, to a lesser degree, demographic and clinical characteristics of psychiatric patients are useful in the prediction of variations in time between first and second referrals to the emergency department

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The objective of this paper was to determine the views of accident and emergency consultants and trainees towards practice guidelines and their experiences using guidelines. A postal questionnaire survey of consultants, senior registrars and registrars in accident and emergency medicine was carried out in Yorkshire. The results of this survey show that the potential benefits of practice guidelines are appreciated, and that evidence-based and 'user-friendly' guidelines are wanted. It is concluded that unless rigorously developed and clear and easy to use, guidelines are unlikely to be implemented in accident and emergency departments in the UK

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The aim of this research was to describe men and women who were discharged from the emergency department after having an initial suspicion of acute myocardial infarction ruled out in terms of patient characteristics, symptom reevaluation, electrocardiogram and exercise stress test. Consecutive patients below the age of 65 years who came to the emergency department of Sahlgrenska Hospital with acute chest pain or other symptoms raising suspicion of acute myocardial infarction for whom the suspicion was ruled out either directly in the emergency department or less than 1 day after hospital admission were included in the study. Four hundred and eighty-four patients participated, of whom 295 (61 %) were men. Men had a higher prevalence of ischaemic heart disease. The cause of pain was judged similarly at reevaluation compared with in the emergency department in 53% of the cases. Only in 4.6% of the cases were the symptoms judged to be caused by myocardial ischaemia on both occasions. At the initial visit 36.0% of the patients were judged to have uncertain cause of the symptoms. This proportion was lowered to 26.4% at reevaluation. The exercise electrocardiogram at reevaluation revealed clinical and electrocardiographic signs indicating definite myocardial ischaemia in 2.6% of the cases. Early follow-up of patients discharged from the emergency department after acute myocardial infarction was ruled out revealed that a low proportion showed signs of myocardial ischaemia. In about half of the cases the judgement differed from that being made in the emergency department

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Portugal has many weak links in the so-called 'chain of survival' both in the pre-hospital and inhospital setting. Apart from evaluating the performance of a newly implemented in-hospital cardiac arrest system, we assessed the correlation between different clinical variables and outcome after cardiopulmonary resuscitation (CPR). All resuscitation attempts during 1995 were registered using the form recommended by the European Resuscitation Council. One hundred and twenty-five patients either collapsing out-of-hospital (42; 33.6%) or having in-hospital cardiac arrest (83; 66.4%) were included in the study. The number of patients who experienced recovery of spontaneous circulation was 10 (23.8%) in the out-of-hospital group and 35 (42.2%) in the in-hospital one. Of all out-of-hospital patients, 11.9% were discharged from hospital compared with 22.8% of the in-hospital group. Asystole was the initial rhythm in a significant number of arrests. The average call-response interval of the in-hospital cardiac arrest team was under 3 min. The results from this series concur with other reported series. Although good standards of care were achieved, we are aware that this was only an isolated step in the implementation of the 'chain of survival' in our country. The authors conclude that there is an urgent need for a nationwide programme that improves the standards of care for these patients

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Spiral computed tomography (CT) has proved to be a valuable tool by providing threedimensional (3D) images of the studied structures. We hypothesized that a more realistic depiction of lesions by 3D CT could be of interest for surgeons who are treating blunt abdominal traumas and lead to less inappropriate triage. A good working relationship between surgeons and radiologists allowed us to perform a 3D CT examination in six patients. In the first patient, the 3D CT accurately demonstrated spleen fragmentation without devascularized fragment. The second patient had complete devascularization of the spleen upper pole. Conservative treatment was pursued for both patients. For the third patient, 3D CT helped us to differentiate peritonealperisplenic fluid from subcapsular fluid. The fourth patient had minor spleen injury associated with severe lacerations of the left kidney. 3D CT showed a complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. The fifth patient presented a fragmented spleen and transient massive haematuria related to a well-contained laceration of the kidney upper pole that were amenable to nonoperative management. The sixth patient was emergency operated for active bleeding from a fragmented spleen. 3D CT performed 2 months after spleen repair allowed the assessment of the amount of devascularized tissue, as well as the status of the upper abdomen arteries. For haemodynamically stable patients, 3D CT could be a helpful addition to conventional axial CT for quantifying blunt abdominal traumas, for making the choice between nonoperative and operative treatment, but also between emergency and delayed surgical strategy

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The treatment of trauma patients in the admitting area is performed under stress and requires team work. The goals of this research were to develop and analyse the implementation process of videotaping trauma care. The Rambam Medical Center is a 900-bed referral teaching hospital. It serves a population of more than 1.5 million in northern Israel. The trauma unit has focused on various activities to increase the quality of trauma care over the past few years. We installed a video camera and taped the treatment as part of a programme for the quality improvement of trauma care. Reviewing the tapes was carried out by the trauma team under guidance in order to identify deviation from treatment protocols, errors in techniques, improper usage of time, equipment failure and problems in team work. After 3 years' experience, we found that videotaping is an accurate and inexpensive way of achieving quality control in the admitting area. It now serves as a regular method in Israeli trauma centres and we encourage others to try this method

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The aim of this study was to evaluate the day-to-day trauma care in a developing country highlighted by a major accident. In this accident, early management was not carried out according to triage principles. Scene mortality and in-hospital mortality were 72% (n = 55) and 14% (n = 3), respectively. Overall mortality rate was 76%. Five survivors were minor wounded. Three laparotomies, one thoracotomy and three tube thoracostomies were performed in the acute phase. Skeletal injuries, mainly rib fractures (43.3%) and haemothorax (10.8%), were the most frequent pathologies seen. One liver laceration, one splenic rupture, one intraabdominal bleeding due to rupture of mesenteric vessels, two major cranial traumas and an abruptio placenta were the other pathologies. The missed injury rate in this accident was 16% (n = 6). It is concluded that the missed injuries in this incident reflect the inadequacy of trauma care in the rural area of the developing country

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Acute confusion in the elderly as a presenting symptom in an accident and emergency department requires just the same energy devoted to diagnosis as does, say for example, acute coma, epilepsy or haematemesis. Doctors in accident and emergency departments are reminded not to succumb to the pitfalls of assuming that acute confusion is merely part of a progressive dementia in an elderly person and therefore incapable of treatment. In this paper a number of clinical examples are given where treatment of the cause of the acute confusion has led to restoration of the patient's independent existence. In passing, the abbreviated mental test score is commended to accident and emergency doctors as being just as useful in a different context as the worldwide acceptance has been of the Glasgow Coma Score. Currently the standard abbreviated mental test score seems confined to the United Kingdom as part of the generally accepted practice

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Epidemiologic research of disasters is hampered by a lack of uniformity and standardization in describing these events. By applying a classification and scoring system, which recently became available, an analysis could be performed of 416 disasters from the past 40 years. Only 79 references were useful in obtaining reliable figures for a scoring on the Disaster Severity Scale (DSS). The various disaster types show a relationship between the DSS-scoring on the one hand, and the severity factor (S) and the number of dead and wounded («) on the other. It is concluded that the classification and scoring system used could serve as a tool for evaluating the majority of disasters. A small improvement of this system is recommended

ISSN:0969-9546    

出版商:OVID    

年代:1997

数据来源: OVID