Results-There was a significant reduction in the time spent in A&E when no radiograph was requested (P << 0-001). The mean time saved in the "Doctor First" (DF) group was 51 min, and in the "Nurse First" (NF) group 36 min. For those who were sent for an x ray 14 min was saved by getting the patient to see the nurse first. However, because the overall referral rate for x rays was greater in the NF group, (78% ofpatients compared with 74% of the DF group, a significant 40/o increase (P=0.05) this potential benefit was largely lost. Overall the average waiting time in the DF group of 92*5 min (95% confidence interval: 89-2 to 96-1 min) was reduced to 88'5 min (95% CI: 85 2 to 91-8 min) in the NF group, a non-significant saving of 4 min. There was no overall difference between the proportion of relevant abnormalities reported by the radiologists for the DF or NF groups (G2 = 0-739, ldf, P = 0-30); however, there was a significant association between the number of relevant abnormalities reported by the radiologists and the different hospitals (G2 = 9'7626, 3df, P = 0-02).Hospital C had the highest abnormality rate reported by the radiologists in both the DF (450/o) and the NF (51%) groups.The most time saved in A&E was in the DF category when comparing those who did not have an x ray [58][59][60][61][62][63] (_Accid Emerg Med 1996;13:86-89)
Nine patients with anorexia nervosa are described, 7 of whom have abnormal electrocardiograms. These are contrasted with 2 patients with other psychiatric disorders who had also lost weight through failure to eat, and whose electrocardiograms were normal. The abnormalities occurred in the absence of cardiac disease and with normal serum electrolytes. It is postulated that the abnormalities are mediated through stimulation of sympathetic centres within the hypothalamus and release of catecholamines within the myocardium.
Objective-To obtain a representative national picture of the type of people with asthma attending accident and emergency (A&E) departments in the UK, the reasons why they attend, and to determine the proportion admitted to hospital. Design-A national census involving questionnaires. Setting-100 A&E departments throughout the UK. Subjects-All those with asthma attending because of asthma during a one week period in September 1994. Results-Details were obtained about 1292 attendances. About half of all attendances were by adults and half by children, and 87.8% were previously diagnosed asthmatics; 18.8% of adult attenders were unemployed. Perceived severity of asthma was the reason for attendance in 65.5%, but 11.5% reported non-availability, or perceived non-availability, of the general practitioner (GP) as the reason for attending. One fifth of adults had been kept awake by their asthma for over three nights before attendance. 425 of the 1292 attenders (32.9%) had been admitted to hospital in the previous 12 months and 316 (24.5%) had attended the A&E department in the previous three months. Only 24.6% of attenders had had contact with their general practitioner in the previous 24 h. 61.6% of under-5 attenders (n = 341) were admitted to hospital; the figures for those aged 5-15 and 15+ years and above were 265 (41.4%) and 665 (38.7%). Conclusions-Many people with asthma attend A&E departments without first having seen their GP. In many adult cases the asthma, while severe, is not acute, but a high proportion of both adults and children are admitted to hospital. Many of these attendances and admissions are repeat attendances. To enhance the quality of care provided to those with asthma may require easier access to primary care, enhanced patient education, or enhanced health professional education.Further study is needed of a variety of potential interventions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.