Background: Questionnaires are commonly sent to accident and emergency (A&E) departments to determine common practice and are often extrapolated to best practice.
Aims: To determine if questionnaire based studies have a defined population of A&E departments and whether studies are reproducible.
Methods: All questionnaires in the Journal of Accident and Emergency Medicine were reviewed and assessed for inclusion criteria, departments studied and study design.
Results: 30 questionnaires were detected, 22 were postal, six telephone and two did not state method of contact. Sample sizes ranged from 15 to 740 and inclusion of A&E departments was highly variable according to geographical area, size of department or consultant status. Seventeen (54.8%) did not state the source of A&E department listings. Response rates ranged from 55-100%. Only three studies undertook subset analysis according to either size or locality.
Conclusions: Questionnaire of studies A&E departments have poor methodology descriptions, which means that many are not reproducible. Inclusion criteria are highly variable and failure to analyse important subsets may mean that individual departments cannot apply recommendations. Questionnaire studies relating to A&E do not use a consistent well defined population of A&E departments. Information in the studies is usually inadequate to allow them to be repeated.
{"title":"Questionnaires of accident and emergency departments: are they reproducible?","authors":"M W Cooke, S Wilson, P Bridge","doi":"10.1136/emj.17.5.355","DOIUrl":"https://doi.org/10.1136/emj.17.5.355","url":null,"abstract":"<p><strong>Background: </strong>Questionnaires are commonly sent to accident and emergency (A&E) departments to determine common practice and are often extrapolated to best practice.</p><p><strong>Aims: </strong>To determine if questionnaire based studies have a defined population of A&E departments and whether studies are reproducible.</p><p><strong>Methods: </strong>All questionnaires in the Journal of Accident and Emergency Medicine were reviewed and assessed for inclusion criteria, departments studied and study design.</p><p><strong>Results: </strong>30 questionnaires were detected, 22 were postal, six telephone and two did not state method of contact. Sample sizes ranged from 15 to 740 and inclusion of A&E departments was highly variable according to geographical area, size of department or consultant status. Seventeen (54.8%) did not state the source of A&E department listings. Response rates ranged from 55-100%. Only three studies undertook subset analysis according to either size or locality.</p><p><strong>Conclusions: </strong>Questionnaire of studies A&E departments have poor methodology descriptions, which means that many are not reproducible. Inclusion criteria are highly variable and failure to analyse important subsets may mean that individual departments cannot apply recommendations. Questionnaire studies relating to A&E do not use a consistent well defined population of A&E departments. Information in the studies is usually inadequate to allow them to be repeated.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"355-6"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Report by Rob Williams, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical …
{"title":"Towards evidence based emergency medicine:Best BETs from the Manchester Royal Infirmary. White cell count and diagnosing appendicitis in pregnancy.","authors":"R Williams, K Mackway-Jones","doi":"10.1136/emj.17.5.365","DOIUrl":"https://doi.org/10.1136/emj.17.5.365","url":null,"abstract":"Report by Rob Williams, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant \u0000\u0000A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"365"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A case of bilateral Lisfranc fracture--dislocations in a patient following polytrauma.","authors":"M D Carter, M J Wilby","doi":"10.1136/emj.17.5.387","DOIUrl":"https://doi.org/10.1136/emj.17.5.387","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"387"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Statistics inference is used to make comments about a population based upon data from a sample. In a similar manner it can be applied to a population to make an estimate about a sample. It is commonly seen in medical publications when the null hypothesis is being tested. This calculates the probability (p value) of a type I error--that is, that a particular finding is attributable to chance. It is also important to be aware of the chances of a type II error--that is, accepting the null hypothesis when it does not apply. Sample size, point estimate and variability are common factors that will affect the chances of making these two types of errors. Interpreting results therefore needs to take these factors into account as well as the clinical relevance of the findings. Statistical significance does not necessarily mean clinical significance.
{"title":"An introduction to statistical inference--3.","authors":"P Driscoll, F Lecky, M Crosby","doi":"10.1136/emj.17.5.357","DOIUrl":"https://doi.org/10.1136/emj.17.5.357","url":null,"abstract":"Statistics inference is used to make comments about a population based upon data from a sample. In a similar manner it can be applied to a population to make an estimate about a sample. It is commonly seen in medical publications when the null hypothesis is being tested. This calculates the probability (p value) of a type I error--that is, that a particular finding is attributable to chance. It is also important to be aware of the chances of a type II error--that is, accepting the null hypothesis when it does not apply. Sample size, point estimate and variability are common factors that will affect the chances of making these two types of errors. Interpreting results therefore needs to take these factors into account as well as the clinical relevance of the findings. Statistical significance does not necessarily mean clinical significance.","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"357-63"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospitals have always had to make arrangements for those who arrive at their doors seeking help. Over the years the numbers and complexity of problems presenting in this way have increased at an exponential rate. This increase in demand has been managed in different ways in different countries but in North America, Australia, some parts of Europe and the United Kingdom a new medical specialty has evolved, that of accident and emergency (A&E) medicine (UK) or emergency medicine. This article will examine the evolution of the specialty in the United Kingdom and also look at the possible future changes in the scope of the specialty. The A&E department is the “shop window” of acute hospitals. It is the part of the hospital most closely in contact with the public as it offers the most informal access.1 It plays the most important part in caring for the acutely ill and injured patients. Also it is surrounded by so much drama, tragedy, and media interest. The department and specialty are a rich subject for programmes, debates and criticism; if Shakespeare had been a doctor he would surely have worked in the A&E department.2 What are the origins of our specialty, what has made it successful and what lessons of the past should we not forget when planning our future? The original term (casualty) meant a seriously injured patient. It was predominantly a military word, a general term for the accidents of service: after a battle the dead, the wounded, and the sick lumped together as “casualties”. The term “casual” has its origin from the workhouse “casual” who was not one of the unemployable permanents, but the irregular and unexpected caller who needed temporary help.3 The casualty ward also occurred in Shakespeare, and Dickens writing in 1837 to describe the …
{"title":"Casualty, accident and emergency, or emergency medicine, the evolution.","authors":"M Sakr, J Wardrope","doi":"10.1136/emj.17.5.314","DOIUrl":"https://doi.org/10.1136/emj.17.5.314","url":null,"abstract":"Hospitals have always had to make arrangements for those who arrive at their doors seeking help. Over the years the numbers and complexity of problems presenting in this way have increased at an exponential rate. This increase in demand has been managed in different ways in different countries but in North America, Australia, some parts of Europe and the United Kingdom a new medical specialty has evolved, that of accident and emergency (A&E) medicine (UK) or emergency medicine. This article will examine the evolution of the specialty in the United Kingdom and also look at the possible future changes in the scope of the specialty.\u0000\u0000The A&E department is the “shop window” of acute hospitals. It is the part of the hospital most closely in contact with the public as it offers the most informal access.1\u0000\u0000It plays the most important part in caring for the acutely ill and injured patients. Also it is surrounded by so much drama, tragedy, and media interest.\u0000\u0000The department and specialty are a rich subject for programmes, debates and criticism; if Shakespeare had been a doctor he would surely have worked in the A&E department.2\u0000\u0000What are the origins of our specialty, what has made it successful and what lessons of the past should we not forget when planning our future?\u0000\u0000The original term (casualty) meant a seriously injured patient. It was predominantly a military word, a general term for the accidents of service: after a battle the dead, the wounded, and the sick lumped together as “casualties”. The term “casual” has its origin from the workhouse “casual” who was not one of the unemployable permanents, but the irregular and unexpected caller who needed temporary help.3\u0000\u0000The casualty ward also occurred in Shakespeare, and Dickens writing in 1837 to describe the …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"314-9"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been a long struggle to provide the world class journal for emergency medicine not based in North America. Pioneering work by Tony Redmond, Mark Prescott and others led to the production of Archives of Emergency Medicine and the beginnings of a true scientific publication. However, much work remained to be done. It was therefore fortunate that someone of the calibre of John Heyworth volunteered to become the editor in 1995. Major changes occurred, including the title and the publishers. As a result the JAEM is becoming increasingly successful. This success is a reflection of John's hard work and dedication. His contribution requires acknowledgement and thanks from the specialty. Thank you John! Nevertheless significant future uncertainties remain:
{"title":"From Archives to JAEM to the future","authors":"P. Driscoll, J. Wardrope","doi":"10.1136/EMJ.17.5.313","DOIUrl":"https://doi.org/10.1136/EMJ.17.5.313","url":null,"abstract":"There has been a long struggle to provide the world class journal for emergency medicine not based in North America. Pioneering work by Tony Redmond, Mark Prescott and others led to the production of Archives of Emergency Medicine and the beginnings of a true scientific publication. However, much work remained to be done. It was therefore fortunate that someone of the calibre of John Heyworth volunteered to become the editor in 1995. Major changes occurred, including the title and the publishers. As a result the JAEM is becoming increasingly successful. This success is a reflection of John's hard work and dedication. His contribution requires acknowledgement and thanks from the specialty.\u0000\u0000Thank you John!\u0000\u0000Nevertheless significant future uncertainties remain:","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 1","pages":"313 - 313"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/EMJ.17.5.313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64230343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reading radiographs is one of the many skills senior house officers (SHOs) learn in accident and emergency (A&E). One of the more difficult aspects of radiological interpretation is that of children's radiographs. As the authors state the young doctor in the A&E department has only a sketchy idea of how very different children's fractures are from adults. The growing skeleton and the different nature of the bones make the nature of the injuries different and their interpretation very difficult. This book goes a long way to solving this conundrum. The general idea …
{"title":"Children's Fractures.","authors":"Thomas F Beattie","doi":"10.1136/emj.17.5.389-a","DOIUrl":"https://doi.org/10.1136/emj.17.5.389-a","url":null,"abstract":"Reading radiographs is one of the many skills senior house officers (SHOs) learn in accident and emergency (A&E). One of the more difficult aspects of radiological interpretation is that of children's radiographs. As the authors state the young doctor in the A&E department has only a sketchy idea of how very different children's fractures are from adults. The growing skeleton and the different nature of the bones make the nature of the injuries different and their interpretation very difficult. This book goes a long way to solving this conundrum.\u0000\u0000The general idea …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 1","pages":"389 - 389"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.389-a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64230869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trauma induced testicular torsion is a well recognised entity, the incidence being 4-8% in most studies reporting on testicular torsion. The signs and symptoms of testicular torsion may easily be mistakenly attributed to preceding testicular trauma if there was such an event. A patient is described with trauma induced testicular torsion who presented on three occasions before a decision was made to perform scrotal exploration. Unfortunately, an orchidectomy was the outcome. The message that trauma can and not infrequently does precipitate torsion, needs to be reiterated. Awareness of the entity and constant vigilance is required of clinicians to avoid a delay in definitive treatment.
{"title":"Trauma induced testicular torsion: a reminder for the unwary.","authors":"Y J Seng, K Moissinac","doi":"10.1136/emj.17.5.381","DOIUrl":"https://doi.org/10.1136/emj.17.5.381","url":null,"abstract":"<p><p>Trauma induced testicular torsion is a well recognised entity, the incidence being 4-8% in most studies reporting on testicular torsion. The signs and symptoms of testicular torsion may easily be mistakenly attributed to preceding testicular trauma if there was such an event. A patient is described with trauma induced testicular torsion who presented on three occasions before a decision was made to perform scrotal exploration. Unfortunately, an orchidectomy was the outcome. The message that trauma can and not infrequently does precipitate torsion, needs to be reiterated. Awareness of the entity and constant vigilance is required of clinicians to avoid a delay in definitive treatment.</p>","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"381-2"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An unusual diagnosis for a swollen limb.","authors":"M S Lloyd","doi":"10.1136/emj.17.5.385","DOIUrl":"https://doi.org/10.1136/emj.17.5.385","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"385-6"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21837951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombolysis for acute ischaemic stroke Thrombolysis for acute ischaemic stroke remains a controversial area. The National Institute of Neurological Disorders and Stroke study (NINDS) trial reported improved long term neurological function when patients were treated with intravenous tissue type plasminogen activator (iv tPA) within three hours of symptom onset. This benefit was set against an increased risk of intracerebral haemorrhage (ICH). Further studies have produced similar results, although others have not shown any benefit. Doubts remain regarding the safety and eYcacy in routine clinical use outside specialist centres. The debate continues in this contentious area and two contrasting papers show diVerent positions and results. It would be a useful postgraduate educational exercise to compare and contrast these studies in detail and try to explain the very diVerent findings in these trials. What are the main conclusions that you draw from this issue? Prize for the best critique that is e-mailed to the Journal scan editor by 22 September 2000.
{"title":"Journal scan.","authors":"J Wardrope, R Russell","doi":"10.1136/emj.17.5.368","DOIUrl":"https://doi.org/10.1136/emj.17.5.368","url":null,"abstract":"Thrombolysis for acute ischaemic stroke Thrombolysis for acute ischaemic stroke remains a controversial area. The National Institute of Neurological Disorders and Stroke study (NINDS) trial reported improved long term neurological function when patients were treated with intravenous tissue type plasminogen activator (iv tPA) within three hours of symptom onset. This benefit was set against an increased risk of intracerebral haemorrhage (ICH). Further studies have produced similar results, although others have not shown any benefit. Doubts remain regarding the safety and eYcacy in routine clinical use outside specialist centres. The debate continues in this contentious area and two contrasting papers show diVerent positions and results. It would be a useful postgraduate educational exercise to compare and contrast these studies in detail and try to explain the very diVerent findings in these trials. What are the main conclusions that you draw from this issue? Prize for the best critique that is e-mailed to the Journal scan editor by 22 September 2000.","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 5","pages":"368-70"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.5.368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21838607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号