An algorithm for the emergency treatment of anaphylaxis is presented. The need for early hands-on involvement of senior personnel is stressed. Continuous assessment, monitoring of response to treatment, and a low threshold for hospital admission for observation and further treatment if necessary are required. (7 Accid Emerg Med 1998;15:96-98)
Existing methods of risk adjustment in surgical audit are complex and costly. The present study aimed to develop a simple risk stratification score for mortality and a robust audit tool using the existing resources of the hospital Patient Administration System (PAS) database. This was an observational study for all patients undergoing surgical procedures over a two-year period, at a London university hospital. Logistic regression analysis was used to determine predictive factors of in-hospital mortality, the study outcome. Odds ratios were used as weights in the derivation of a simple risk-stratification model-the Surgical Mortality Score (SMS). Observed-to-expected mortality risk ratios were calculated for application of the SMS model in surgical audit. There were 11,089 eligible cases, under five surgical specialties (maxillofacial, orthopedic, renal transplant/dialysis, general, and neurosurgery). Incomplete data were 3.7% of the total, with no evidence of systematic underreporting. The SMS model was well calibrated [Hosmer-Lemeshow C-statistic: development set (3.432, p = 0.33), validation set (6.359, p = 0.10) with a high discriminant ability (ROC areas: development set [0.837, S.E.=0.013] validation set [0.816, S.E. = 0.016]). Subgroup analyses confirmed that the model can be used by the individual specialties for both elective and emergency cases. The SMS is an accurate risk- stratification model derived from existing database resources. It is simple to apply as a risk-management, screening tool to detect aberrations from expected surgical outcomes and to assist in surgical audit.
Palmar fracture-dislocations of the proximal interphalangeal (PIP) joint are uncommon injuries, which can be associated with long-term complications if sub-optimally treated. We report two cases of palmar fracture-dislocations of the PIP joint treated by open reduction and internal fixation using a single mini-fragment screw. The long term results of hand and finger function were excellent.
We have demonstrated deficiencies in chaperone use and have identified specific factors that render A&E departments particularly vulnerable to allegations of inappropriate practice. We believe that policies should be designed and implemented focusing on the specific needs of A&E departments to counteract the rising numbers of medico-legal cases, thus safeguarding patient care and protecting the health providers.
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