Patient flow within UK emergency departments: a systematic review of the use of computer simulation modelling methods

PubMed Central

Mohiuddin, Syed; Busby, John; Savović, Jelena; Richards, Alison; Northstone, Kate; Hollingworth, William; Donovan, Jenny L; Vasilakis, Christos

2017-01-01

Objectives Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK. Methods We searched eight bibliographic databases (MEDLINE, EMBASE, COCHRANE, WEB OF SCIENCE, CINAHL, INSPEC, MATHSCINET and ACM DIGITAL LIBRARY) from date of inception until 31 March 2016. Studies were included if they used a computer simulation method to capture patient progression within the ED of an established UK National Health Service hospital. Studies were summarised in terms of simulation method, key assumptions, input and output data, conclusions drawn and implementation of results. Results Twenty-one studies met the inclusion criteria. Of these, 19 used discrete event simulation and 2 used system dynamics models. The purpose of many of these studies (n=16; 76%) centred on service redesign. Seven studies (33%) provided no details about the ED being investigated. Most studies (n=18; 86%) used specific hospital models of ED patient flow. Overall, the reporting of underlying modelling assumptions was poor. Nineteen studies (90%) considered patient waiting or throughput times as the key outcome measure. Twelve studies (57%) reported some involvement of stakeholders in the simulation study. However, only three studies (14%) reported on the implementation of changes supported by the simulation. Conclusions We found that computer simulation can provide a means to pretest changes to ED care delivery before implementation in a safe and efficient manner. However, the evidence base is small and poorly developed. There are some methodological, data, stakeholder, implementation and reporting issues, which must be addressed by future studies. PMID:28487459

Use of a forensic technique to identify blood contamination of emergency department and ambulance trauma equipment.

PubMed

Lee, J B; Levy, M; Walker, A

2006-01-01

Using a Kastle-Meyer (KM) technique, the following equipment from the emergency departments of six UK hospitals (four trusts) and three regional ambulance services was tested for blood contamination: extrication ("spinal") boards, cervical collars, straps, box splints, head blocks, and headboards. Only equipment ready for patient use was tested. Over half of trauma equipment (57%) tested positive for blood, including 15% of equipment that was visibly stained with blood. There have been no recorded cases of infection from contaminated trauma equipment but our study has identified the potential risk. Disposable covers for boards, disposable straps, and disposable radiolucent head blocks which are currently available provide a solution but have resource implications.

1 Patient acceptability and feasibility of HIV testing in emergency departments in the UK - a systematic review and meta-analysis.

PubMed

Lungu, Nicola

2017-12-01

NICE 2016 HIV testing guidelines now include the recommendation to offer HIV testing in Emergency Departments, in areas of high prevalence, 1 to everyone who is undergoing blood tests. 23% of England's local authorities are areas of high HIV prevalence (>2/1000) and are therefore eligible. 2 So far very few Emergency Departments have implemented routine HIV testing. This systematic review assesses evidence for two implementation considerations: patient acceptability (how likely a patient will accept an HIV test when offered in an Emergency Department), and feasibility, which incorporates staff training and willingness, and department capacity, (how likely Emergency Department staff will offer an HIV test to an eligible patient), both measured by surrogate quantitative markers. Three medical databases were systematically searched for reports of non-targeted HIV testing in UK Emergency Departments. A total of 1584 unique papers were found, 9 full text articles were critically appraised, and 7 studies included in meta-analysis. There is a combined patient sample of 1 01 975. The primary outcome, patient acceptability of HIV testing in Emergency Departments (number of patients accepting an HIV test, as a proportion of those offered) is 54.1% (CI 40.1, 68.2). Feasibility (number of tests offered, as a proportion of eligible patients) is 36.2% (CI 9.8, 62.4). For an Emergency Department considering introducing routine HIV testing, this review suggests an opt-out publicity-lead strategy. Utilising oral fluid and blood tests would lead to the greatest proportion of eligible patients accepting an HIV test. For individual staff who are consenting patients for HIV testing, it may be encouraging to know that there is >50% chance the patient will accept an offer of testing.emermed;34/12/A860-a/T1F1T1Table 1Summary table of data extracted from final 7 studies, with calculated acceptability and feasibility if appropriate, and GRADE score. Studies listed in chronological order of data collection. GRADE working group evidence grades: 4= high quality, 3= moderate quality, 2= low quality, 1 or below = very low quality. (*study conclusion reports this figure is inaccurate)emermed;34/12/A860-a/F1F2F1Figure 1Patients accepting HIV tests, and being offered HIV tests, as a proportion of the eligible sample REFERENCES: National Institute for Health and Care Excellence, Public Health England. HIV testing: Increasing uptake among people who may have undiagnosed HIV . 2016 1 December 2016.Public Health England. HIV prevalence by Local Authority of residence to end December 2015 . Table No.1: 2016. Public Health Engand; 2016. © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ear, nose and throat problems in Accident and Emergency.

PubMed

Reynolds, Tanya

Nurses working in A&E departments throughout the UK frequently encounter patients with ear, nose and throat conditions. While the majority of these are straightforward, a small number are serious and even life-threatening. Tanya Reynolds discusses the nursing management of this group of patients and stresses the importance of appropriate assessment, pain management and referral.

Good intentions, increased inequities: developing social care services in Emergency Departments in the UK.

PubMed

Bywaters, Paul; McLeod, Eileen; Fisher, Joanne; Cooke, Matthew; Swann, Garry

2011-09-01

Addressing the quality of services provided in Emergency Departments (EDs) has been a central area of development for UK government policy since 1997. Amongst other aspects of this concern has been the recognition that EDs constitute a critical boundary between the community and the hospital and a key point for the identification of social care needs. Consequently, EDs have become the focus for a variety of service developments which combine the provision of acute medical and nursing assessment and care with a range of activities in which social care is a prominent feature. One approach to this has been the establishment of multidisciplinary teams aiming to prevent re-attendance or admission, re-direct patients to other services, or speed patients through EDs with the aim of providing improved quality of care. This study, carried out between September 2007 and April 2008, was the first UK national survey of social care initiatives based in EDs and aimed to determine the objectives, organisation, extent, functions, funding and evidence on outcomes of such interventions. Eighty-three per cent of UK Type I and II EDs responded to the survey. Approximately, one-third of EDs had embedded social care teams, with two-thirds relying on referrals to external social care services. These teams varied in their focus, size and composition, leadership, availability, funding and permanence. As a result, the unintended effect has been to increase inequities in access to social care services through EDs. Three further conclusions are drawn about policy led, locally-based service development. This survey adds to international evidence pointing to the potential benefits of a variety of social care interventions being based in EDs and justifies the establishment of a research programme which can provide answers to key outstanding questions. © 2011 Blackwell Publishing Ltd.

The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.

PubMed

Wilson, Edward C F; Stanley, George; Mirza, Zulfiquar

2016-04-01

Wernicke's encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum 5-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded. To estimate the cost impact on the UK public sector (NHS and social services) of a 5-day course of IV thiamine, vs a 2- and 10-day course, in harmful or dependent drinkers presenting to EDs. A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5 %. Increasing treatment from 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) over 35 years. Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realise both the health benefits to patients and savings to the public purse.

Making see and treat work for patients and staff.

PubMed

Parker, Louise

2004-02-01

Every department is at a different stage in the development of see and treat. Teams have been established in various ways and are experiencing different dilemmas in making see and treat work best. It is not enough to pick up an established see and treat model, place it in an emergency department and sit back and watch the results. There is no 'magic wand'; no single determining factor to make see and treat work well. Influencing factors need to be understood, applied locally and reviewed regularly to assess success. The NHS Modernisation Agency publishes its survey report, See and Treat: Making it work for patients and staff, on February 4. For Further details, access www.modern.nhs.uk/emergency

Use of a forensic technique to identify blood contamination of emergency department and ambulance trauma equipment

PubMed Central

Lee, J B; Levy, M; Walker, A

2006-01-01

Using a Kastle‐Meyer (KM) technique, the following equipment from the emergency departments of six UK hospitals (four trusts) and three regional ambulance services was tested for blood contamination: extrication (“spinal”) boards, cervical collars, straps, box splints, head blocks, and headboards. Only equipment ready for patient use was tested. Over half of trauma equipment (57%) tested positive for blood, including 15% of equipment that was visibly stained with blood. There have been no recorded cases of infection from contaminated trauma equipment but our study has identified the potential risk. Disposable covers for boards, disposable straps, and disposable radiolucent head blocks which are currently available provide a solution but have resource implications PMID:16373813

A Global Education Challenge: Harnessing Corporate Philanthropy to Educate the World's Poor. Center for Universal Education Working Paper 4

ERIC Educational Resources Information Center

van Fleet, Justin W.

2011-01-01

Major actors in the global education community are emerging with new education strategies, including the World Bank, U.S. Agency for International Development and U.K. Department for International Development. These strategies attempt to identify game-changing policies to make strides in global education in anticipation of the Millennium…

Seeking Researcher Identity through the Co-Construction and Representation of Young People's Narratives of Identity

ERIC Educational Resources Information Center

Kearns, Sarah

2012-01-01

This paper tells the story of how a model of action research was used to examine my own development and emerging identity as a researcher through the Master of Research programme at my employing university in Scotland. It is located within a context of increasing expectations on academics within vocational training departments of UK universities…

Characteristics of patients with ankle sprain presenting to an emergency department in the south of England (UK): A seven-month review.

PubMed

Al Bimani, Saed A; Gates, Lucy S; Warner, Martin; Ewings, Sean; Crouch, Robert; Bowen, Catherine

2018-06-06

There is lack of evidence about ankle sprain patients presenting to emergency department (ED) in the UK. The study aim was to determine prevalence, demographic and clinical characteristics of patients attending to one ED. Knowing those characteristics may help setting prevention strategies and inform effective clinical practice. A retrospective review of records from patients' database system was conducted between May and November 2015 (inclusive). 909 new patients with ankle sprain were recorded during the study period. Patients had a median age of 27 years (IQR 20). Men aged between 14 and 37 years had higher percentage of injuries compared to women of a similar age. Overall prevalence of injury was equally distributed between men and women. Most patients were sent to radiography department for ankle/foot X-ray (89%). Over half of patients (58%) were sent home with no follow-up treatment. A subsample (n = 106) from the original sample (n = 909) showed a variety of causes of injury such as tripping (29%), non-specific injury (26.4%), sports (26%), walking (12.2%) and other accidental causes (6%). Football was the most prevalent sport (13%). Prevention strategies, appropriate assessment tools and tailored rehabilitation programs are warranted to reduce number of patients and potential chronic symptoms. Copyright © 2018. Published by Elsevier Ltd.

TOXBASE: Poisons information on the internet

PubMed Central

Bateman, D; Good, A; Laing, W; Kelly, C

2002-01-01

Objectives: To assess the uptake, usage and acceptability of TOXBASE, the National Poisons Information Service internet toxicology information service. Methods: An observational study of database usage, and a questionnaire of users were undertaken involving users of TOXBASE within the UK between August 1999, when the internet site was launched, and May 2000. The main outcome measures were numbers of registered users, usage patterns on the database, responses to user satisfaction questionnaire. Results: The number of registered users increased from 567 to 1500. There was a 68% increase in accident and emergency departments registered, a 159% increase in general practitioners, but a 324% increase in other hospital departments. Between January 2000 and the end of May there had been 60 281 accesses to the product database, the most frequent to the paracetamol entry (7291 accesses). Ecstasy was the seventh most frequent entry accessed. Altogether 165 of 330 questionnaires were returned. The majority came from accident and emergency departments, the major users of the system. Users were generally well (>95%) satisfied with ease and speed of access. A number of suggestions for improvements were put forward. Conclusions: TOXBASE has been extensively accessed since being placed on the internet (http://www.spib.axl.co.uk). The pattern of enquiries mirrors clinical presentation with poisoning. The system seems to be easily used. It is a model for future delivery of treatment guidelines at the point of patient care. PMID:11777868

An initiative to provide emergency healthcare for older people in the community: the impact on carers.

PubMed

Knowles, E; Mason, S; Colwell, B

2011-04-01

The increase in the size and age of the UK older population has had a major effect on emergency services. Many older people will visit the emergency department but not necessarily require significant clinical intervention. The Paramedic Practitioner in Older People's Support (PPOPS) scheme was set up to provide community-based clinical assessment of older patients contacting the emergency services with minor acute conditions as an alternative approach to emergency department transfer. Patient carers were followed-up to evaluate the impact of this scheme when compared with standard transfer to the emergency department. Postal questionnaires, including items on the level of care provided, satisfaction with care received and carer impact, were administered to 561 carers. The overall response rate was 71.5% (401/561). The carers were predominantly female, approximately 60 years of age and family members, with more than three-quarters providing some form of physical care before the patient episode. Overall, carers did report an increase in the level of care provided before episode, significantly more so in the emergency department group (p=0.003). These increases related to more input needed in supporting physical activities. The carers in the PPOPS group were more likely to report greater satisfaction with their impression of care and staff attitude and would prefer treatment at home for the patient than those in the emergency department group (p<0.001). A minor health event does impact on the life of a carer. However, community-based schemes, such as PPOPS, do not increase the burden on carers and have high levels of satisfaction among this important group of the community.

Operation GRITROCK: the Defence Medical Services' story and emerging lessons from supporting the UK response to the Ebola crisis.

PubMed

Bricknell, Martin; Hodgetts, T; Beaton, K; McCourt, A

2016-06-01

This paper is a record of the UK Defence Medical Services (DMS) contribution to the UK response to the Ebola crisis in West Africa from the start of planning in July 2014 to the closure of the Ministry of Defence Ebola Virus Disease Treatment Unit at the end of June 2015. The context and wider UK government decisions are summarised. This paper describes the decisions and processes that resulted in the deployment of a DMS delivered Ebola Treatment Unit in conjunction with the Department for International Development and Save the Children. It covers arrangements for medical care for disease and non-battle injury, the Air Transportable Isolator and Force Health Protection policy, and finally, considers the medical lessons from this deployment. The core message is that the UK DMS are the only part of the UK health sector that is trained, equipped, manned and available to rapidly deploy and operate a complete medical unit as part of an international response to a health crisis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Why is it so difficult to recruit patients to research in emergency care? Lessons from the AHEAD study.

PubMed

Johnson, Rowena; Kuczawski, Maxine; Mason, Suzanne

2016-01-01

In February 2014, all 23 National Institute for Health Research medical research specialities were failing to meet recruitment targets, with 'Injuries and Emergencies' research performing particularly poorly. In this paper, the multicentre AHEAD study was used to explore issues surrounding recruitment in UK emergency departments. The AHEAD study investigated management and outcomes in over 3000 anticoagulated patients who suffered a head injury. Data from the study were used to compare patient recruitment at 33 Type-1 emergency departments. A questionnaire was sent to a research nurse at each of these sites and 30 replied (91% response rate). The survey investigated the difficulties encountered during patient recruitment and whether these were related to recruitment methods. More detailed interviews were conducted with three research nurses, to gain further insight into the barriers and facilitators involved. Overall recruitment varied widely between sites with an eightfold variation in recruitment rates. Population demographics and other uncontrollable factors will partly contribute to this variation. However, research nurses reported many problems, including site resources, lack of staff engagement and flaws in recruitment strategies, which could be improved. Many of the barriers to recruiting patients for research studies encountered by research nurses have previously been reported in the literature, but there remain consistent problems. Until solutions are found, researchers will continue to miss recruitment targets and this will have implications for the efficiency and quality of emergency medicine research in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective.

PubMed

Marsden, Max; Carden, Rich; Navaratne, Lalin; Smith, Iain M; Penn-Barwell, Jowan G; Kraven, Luke M; Brohi, Karim; Tai, Nigel R M; Bowley, Douglas M

2018-05-25

The management of trauma patients has changed radically in the last decade and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts. We undertook a review of two prospectively maintained trauma databases; the UK Joint Theatre Trauma Registry (JTTR) for the military cohort (4th February 2003 to 21st September 2014), and the trauma registry of the Royal London Hospital MTC (1st January 2012 to 1st January 2017) for civilian patients. Adults undergoing trauma laparotomy within 90 minutes of arrival at the Emergency Department (ED) were included. Hypotension was present on arrival at the ED in 155/761 (20.4%) military patients. Mortality was higher in hypotensive casualties 25.8% vs 9.7% normotensive casualties (p<0.001). Hypotension was present on arrival at the ED in 63/176 (35.7%) civilian patients. Mortality was higher in hypotensive patients 47.6% vs 12.4% normotensive patients (p<0.001). In both cohorts of hypotensive patients neither the average injury severity, the prehospital time, the ED arrival SBP, nor mortality rate changed significantly during the study period. Despite improvements in survival after trauma for patients overall, the mortality for patients undergoing laparotomy who arrive at the Emergency Department with hypotension has not changed and appears stubbornly resistant to all efforts. Specific enquiry and research should continue to be directed at this high-risk group of patients. IV; Observational Cohort Study.

Emergency department attendance by patients with cancer in the last month of life: a systematic review and meta-analysis.

PubMed

Henson, Lesley; Gao, Wei; Higginson, Irene; Smith, Melinda; Davies, Joanna; Ellis-Smith, Clare; Daveson, Barbara

2015-02-26

Emergency department visits towards the end of life by people with cancer are increasing over time. This increase has occurred despite evidence of an association with poor patient outcomes, the majority of patients preferring home-based care, and significant overcrowding and capacity concerns for many emergency departments. We aimed to explore factors associated with emergency department attendance by cancer patients in the last month of life. We searched Medline, Embase, CINAHL, PsychINFO, and the Cochrane Library from inception to February, 2014, for studies investigating emergency department attendances by adult cancer patients (≥18 years) towards the end of life. No time or language limitations were applied. We performed meta-analysis of factors using a random-effects model, with results expressed as odds ratios (OR) for emergency department attendance. Sensitivity analysis explored heterogeneity. 30 studies were identified, reporting three demographic, five clinical, and 13 environmental factors; they included data from five countries and 1 181 842 patients. An increased likelihood of emergency department attendance was found for men versus women (OR 1·24, 95% CI 1·19-1·29), black versus white race (1·45, 1·40-1·50), patients with lung cancer versus other cancers (1·17, 1·10-1·23), and those of lowest versus highest socioeconomic status (1·15, 1·10-1·19). Patients receiving palliative care were less likely than those not receiving palliative care to attend the emergency department in the last month of life (OR 0·43, 95% CI 0·36-0·51). We have identified demographic (men, black race), clinical (lung cancer), and environmental (low socioeconomic status, no palliative care) factors associated with an increased risk of emergency department attendance. These findings could be used to develop screening interventions and assist policy makers in directing limited resources. Future studies should also investigate previously neglected areas of research, including psychosocial factors, and the emergency care preferences of patients and caregivers. LH is a PhD clinical training fellow and funded through project BuildCARE which is supported by Cicely Saunders International and The Atlantic Philanthropies, and led by King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, UK. Copyright © 2015 Elsevier Ltd. All rights reserved.

Care for emergency department patients who have experienced domestic violence: a review of the evidence base.

PubMed

Olive, Philippa

2007-09-01

A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence. The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence. Systematic review. At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under-detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information. Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented. The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self-efficacy.

Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

PubMed

Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

2016-05-01

Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of the introduction of emergency ultrasound to one large UK emergency department: the REBUS study.

PubMed

Kwok, T'ng Choong; Johnson, Sue; Reed, Matthew James

2013-02-01

Firstly, to detail the experiences of one UK training region in establishing an emergency ultrasound (EU) training programme and secondly, to report the initial 30 months of EU scanning experience. Prospective study of all documented emergency department (ED) ultrasound scans. Results were extracted from written paper reports and/or electronically saved images. Details of scan date, time, type of scan, grade of operator, supervision status (whether supervised by a level 1 competent scanner) and whether the scan was clinical (performed or supervised by a level 1 operator) or training, were recorded. EU scans were reviewed for quality (internal quality assurance) and for diagnostic accuracy (external quality assurance). Between 14 January 2009 and 4 July 2011, 626 scans were performed by 41 operators. 263 (42%) scans were completed outside of normal working hours (09:00 to 17:00). There were 251 abdominal aorta and inferior vena cava scans (40% of all scans) and 198 focused assessment with sonography in trauma scans (32%). The number of scans performed by each operator varied widely. 87 scans (14%) were supervised but the majority (459; 73%) were not. 484 (77%) scans were for training purposes, 124 (20%) were clinical scans and the majority (401; 63%) were performed by either speciality registrars (ST4-6) or specialist registrars (SpR). When the three commonest types of scans performed were analysed, eight false positives and 11 false negatives were identified. Only seven of these were deemed of poor quality and none led to poor patient outcome. Since the acquisition of our ED ultrasound machine and the development of a quality assured training programme, on average 20 scans per month have been performed in the ED, with no known adverse patient outcomes.

A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’

PubMed Central

Conroy, Simon Paul; Ansari, Kharwar; Williams, Mark; Laithwaite, Emily; Teasdale, Ben; Dawson, Jeremey; Mason, Suzanne; Banerjee, Jay

2014-01-01

Background: the ageing demographic means that increasing numbers of older people will be attending emergency departments (EDs). Little previous research has focused on the needs of older people in ED and there have been no evaluations of comprehensive geriatric assessment (CGA) embedded within the ED setting. Methods: a pre-post cohort study of the impact of embedding CGA within a large ED in the East Midlands, UK. The primary outcome was admission avoidance from the ED, with readmissions, length of stay and bed-day use as secondary outcomes. Results: attendances to ED increased in older people over the study period, whereas the ED conversion rate fell from 69.6 to 61.2% in people aged 85+, and readmission rates in this group fell from 26.0% at 90 days to 19.9%. In-patient bed-day use increased slightly, as did the mean length of stay. Discussion: it is possible to embed CGA within EDs, which is associated with improvements in operational outcomes. PMID:23880143

Differences in the sodium content of bread products in the USA and UK: implications for policy.

PubMed

Coyne, Kasey J; Baldridge, Abigail S; Huffman, Mark D; Jenner, Katharine; Xavier, Dagan; Dunford, Elizabeth K

2018-02-01

Americans consume Na in excess of daily recommendations. Most dietary Na comes from packaged foods, and bread is a major contributor. In the UK, national Na reduction strategies contributed to lower Na levels in packaged foods and lower population Na intake. Similar initiatives are emerging in the USA and require surveillance to assess effectiveness. We aimed to examine Na levels in bread products in the USA and compare levels with similar UK products. Na data for bread products were obtained from the US Label Insight Open Data Initiative (n 4466) and the FoodSwitch UK database (n 1651). Mean, median and range of Na content, and proportion of products meeting Na targets established by the National Salt Reduction Initiative (NSRI) and the UK Department of Health (DH) were calculated overall, by bread type and by country. Mean (sd) Na content in bread was 455 (170) mg/100 g in the USA and 406 (179) mg/100 g in the UK. In both countries, savoury bread had the highest mean Na (USA=584 mg/100 g, UK=543 mg/100 g) and fruit bread the lowest mean Na (USA=345 mg/100 g, UK=277 mg/100 g). Na content of US bread products was 12 % higher than in the UK, with 21 % of US bread products and 31 % of UK bread products meeting the NSRI and DH targets, respectively. US bread products have, on average, 12 % more Na than similar products in the UK. Variation in Na content within product categories, and between countries, suggests the feasibility of manufacturing products with lower Na to lower dietary Na intake.

An integrated process and management tools for ranking multiple emerging threats to animal health.

PubMed

Del Rio Vilas, Victor J; Voller, Fay; Montibeller, Gilberto; Franco, L Alberto; Sribhashyam, Sumitra; Watson, Eamon; Hartley, Matt; Gibbens, Jane C

2013-02-01

The UK's Department for Environment, Food and Rural Affairs supports the use of systematic tools for the prioritisation of known and well defined animal diseases to facilitate long and medium term planning of surveillance and disease control activities. The recognition that emerging events were not covered by the existing disease-specific approaches led to the establishment of the Veterinary Risk Group (VRG), constituted of government officials, and supporting structures such as the Risk Management Cycle and the Emerging Threat Highlight Report (ETHiR), to facilitate the identification, reporting and assessment of emerging threats to UK's animal health. Since its inception in November 2009 to the end of February 2011, the VRG reviewed 111 threats and vulnerabilities (T&V) reported through ETHiR. In July 2010 a decision support system (DSS) based on multi-criteria-decision-analysis (MCDA) improved ETHiR to allow the systematic prioritisation of emerging T&V. The DSS allows the regular ranking of emerging T&V by calculating a set of measurement indices related to the actual impact, possible impact on public perception and level of available capabilities associated with every T&V. The systematic characterisation of the processes leading to the assessment of T&V by the VRG has led to a consistent, auditable and transparent approach to the identification and assessment of emerging risks. The regular use of MCDA to manage a portfolio of emerging risks represents a different and novel application of MCDA in a health related context. Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.

A stratified response system for the emergency management of the severely injured.

PubMed

Lloyd, D A; Patterson, M; Robson, J; Phillips, B

2001-01-01

A decade ago, there were justifiable criticisms of the delivery of emergency care for injured patients in accident and emergency departments in the UK. To address this, a trauma management system was developed in 1991 at Alder Hey Hospital, Liverpool. This includes a trauma team, communication system, management guidelines and quality assurance. On admission to the accident and emergency department, injured patients are triaged to one of three levels of injury severity, and a multidisciplinary team lead by a paediatric surgeon or senior accident and emergency department physician is activated. The level of injury severity determines the composition of the trauma team. A care pathway based on ATLS/APLS principles has been developed. The response process as well patient management are documented and reviewed at a monthly audit meeting. Currently, more than 80% of eligible patients are managed using the trauma system, with an over-triage rate of about 25%. Regular modifications to the trauma system since its inception in 1991 have resulted in an efficient and effective management structure. Stratification of the trauma response has minimised unnecessary use of the multidisciplinary trauma team and ensures that mobilisation and use of hospital staff and resources are tailored to the needs of the injured patient. Although developed in a specialist children's hospital, the system could be adapted for any acute hospital.

X-ray requesting patterns before and after introduction of the Ottawa Knee Rules in a UK emergency department.

PubMed

Atkinson, Paul; Boyle, Adrian; Chisholm, Edward

2004-08-01

To compare knee radiology requesting rates among junior doctors before and after the formal introduction of the Ottawa Knee Rules (OKR) in a UK emergency department (ED), and to test the validity of the OKR for decisions on the use of radiography for acute, isolated knee injuries. All junior doctors in a district general hospital ED seeing adult patients with isolated knee injuries completed a questionnaire before and after the introduction of the OKR. All patients were followed up to obtain a final diagnosis. The outcome measures were: adherence to the OKR, the presence of a fracture and whether a radiograph had been requested. The results were analysed to determine the sensitivity, specificity, positive and negative predictive values of the OKR. Comparisons between the request rate for knee radiography before and after the introduction of the OKR were made. A total of 130 patients were enrolled and followed up over a 3-month period; 58 before and 72 after OKR introduction. The OKR had a sensitivity of 100% (71.8-100%), a specificity of 55.1% (46.1-64.1%), a positive predictive value of 18.5% (9.03-27.9%) and a negative predictive value of 100% (87.8-100%) for the detection of bony injury. The introduction of the OKR did not result in a significant reduction in the number of radiographs performed (58.6-55.6%; P= 0.726). This study shows the OKR to be a highly sensitive clinical guide with a high negative predictive value in the setting of a UK ED. It suggests that the reduction in radiograph requests seen elsewhere may not be as apparent in this setting.

Strengths and weaknesses in team communication processes in a UK emergency department setting: findings using the Communication Assessment Tool-Team.

PubMed

Graham, Blair; Smith, Jason E; Enki, Doyo

2017-12-01

Identifying weaknesses in emergency department (ED) communication may highlight areas where quality improvement may be beneficial. This study explores whether the Communication Assessment Tool-Team (CAT-T) survey can identify communication strengths and weaknesses in a UK setting. This study aimed to determine the frequency of patient responses for each item on the CAT-T survey and to compare the proportion of responses according to patient and operational characteristics. Adults presenting to the minors area of a semi-urban ED between April and May 2015 were included. Those lacking capacity or in custody were excluded. Multivariate analysis identified associations between responses and demographic/operational characteristics. A total of 407/526 eligible patients responded (77.3%). Respondents were mostly White British (93.9%), with a median age of 45 years. Most responses were obtained during daytime hours (84.2% between 08 : 00 and 18 : 00). The median reported times to triage, assessment and disposition were 15, 35 and 90 min, respectively. Items most frequently rated as 'very good'/'excellent' (strengths) were 'ambulance staff treated me with respect' (86.7%), ED staff 'let me talk without interruptions' (85%) and 'paid attention to me' (83.7%). Items most frequently rated as 'poor'/'fair' (weaknesses) were 'encouraged me to ask questions', 'reception treated me with respect' (10.4%) and 'staff showed an interest in my health' (6.8%). Arrival time, analgesia at triage and time to assessment were associated with significantly increased odds of positive perception of team communication for a range of items. The CAT-T survey may be used within a UK setting to identify discrete strengths and weaknesses in ED team communication.

Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK.

PubMed

Tian, M; Gong, X; Rath, S; Wei, J; Yan, L L; Lamb, S E; Lindley, R I; Sherrington, C; Willett, K; Norton, R

2016-02-01

Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.

Analytical confirmation of synthetic cannabinoids in a cohort of 179 presentations with acute recreational drug toxicity to an Emergency Department in London, UK in the first half of 2015.

PubMed

Abouchedid, Rachelle; Hudson, Simon; Thurtle, Natalie; Yamamoto, Takahiro; Ho, James H; Bailey, George; Wood, Michelle; Sadones, Nele; Stove, Christophe P; Dines, Alison; Archer, John R H; Wood, David M; Dargan, Paul I

2017-06-01

Synthetic cannabinoid receptor agonists are the largest group of new psychoactive substances reported in the last decade; in this study we investigated how commonly these drugs are found in patients presenting to the Emergency Department with acute recreational drug toxicity. We conducted an observational cohort study enrolling consecutive adult patients presenting to an Emergency Department (ED) in London (UK) January-July 2015 (6 months) with acute recreational drug toxicity. Residual serum obtained from a serum sample taken as part of routine clinical care was analyzed using high-resolution accurate mass-spectrometry with liquid-chromatography (HRAM-LCMSMS). Minimum clinical data were obtained from ED medical records. 18 (10%) of the 179 patient samples were positive for synthetic cannabinoid receptor agonists. The most common was 5F AKB-48 (13 samples, concentration 50-7600 pg/ml), followed by 5F PB-22 (7, 30-400 pg/mL), MDMB-CHMICA (7, 80-8000 pg/mL), AB-CHMINACA (3, 50-1800 pg/mL), Cumyl 5F-PINACA (1, 800 pg/mL) and BB-22 (1, 60 pg/mL). Only 9/18 (50%) in whom synthetic cannabinoid receptor agonists were detected self-reported synthetic cannabinoid receptor agonist use. The most common clinical features were seizures and agitation, both recorded in four (22%) individuals. Fourteen patients (78%) were discharged from the ED, one of the four admitted to hospital was admitted to critical care. Synthetic cannabinoid receptor agonists were found in 10% of this cohort with acute recreational drug toxicity but self-reported in only half of these. This suggests that presentations to the ED with acute synthetic cannabinoid receptor agonist toxicity may be more common than reported.

Off-site Emergency Planning at UK Nuclear Licensed Sites.

PubMed

Leonard, Paul; Thomas, Gareth

2017-04-01

Nuclear emergency planning arrangements in the UK are continually kept under review. This work proposes to outline how experience from nuclear exercises and undertaking emergency response duties can be based on radiological knowledge of specific sites and utilised in the future. In 2014, the UK regulator, the Office for Nuclear Regulation (ONR) revised their principles for the determination of off-site emergency planning areas around nuclear sites where predetermined countermeasures and other protection measures are applied to protect those people who may be affected by a radiation emergency. The revised principles also enhanced communication from the nuclear site operators and local authorities to the public. This updated ONR's application of the UK Radiation (Emergency Preparedness and Public Information) Regulations 2001 (REPPIR) http://www.hse.gov.uk/radiation/ionising/reppir.htm, which includes details of minimising potential doses to the public, as well as assessment and reassurance, linked to other concurrent risks such as flooding. ONR undertakes site-specific assessments of each operators' hazard identification and risk evaluation, which include consideration of whether the public might receive a significant radiation dose in the year following the emergency (excluding countermeasures in the first 24 hours). In defining the areas for off-site emergency planning, practical and strategic factors are then considered, which include other local non-nuclear emergency planning arrangements and experience, and whether local geographic and demographic aspects could aid public credibility and confidence. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Burns teaching in UK medical schools: Is it enough?

PubMed

Zinchenko, Ruslan; Perry, Fiona M; Dheansa, Baljit S

2016-02-01

Burns are frequently seen and managed in non-specialist settings. The crowding of the UK medical undergraduate curriculum may have resulted in the reduction of teaching on burns. To determine the burns education experience and the level of competence among UK final year medical students in assessing and acutely managing patients with burns. An online questionnaire was circulated among UK final year medical students. There was a total of 348 respondents. The majority of the respondents (70%) have not received any specific teaching on how to manage patients with burns. Nearly two-thirds of the students (66%) have never seen a patient being managed for burns throughout their training. Over 90% of respondents stated that they would not feel confident in initially managing a burn in the emergency department. The majority of the respondents (57%) have not heard of the criteria for referring a burns patient for further specialist management. There was almost universal agreement about the importance of knowing how to manage a burn initially. There seems to be a lack of consistent undergraduate training in burns management and final year students lack the experience and knowledge to initially manage burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Complications of bariatric surgery--What the general surgeon needs to know.

PubMed

Healy, Paul; Clarke, Christopher; Reynolds, Ian; Arumugasamy, Mayilone; McNamara, Deborah

2016-04-01

Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the U.K. the Department of Health report that 61.3% of people in the U.K. are either overweight or obese. Surgery for obesity (bariatric surgery) is being performed with increasing frequency in specialist centres both in the U.K. and Ireland and abroad due to the phenomenon of health tourism. Its role and success in treating medical conditions such as diabetes mellitus and hypertension in obese patients will likely lead to an even greater number of bariatric surgery procedures being performed. Patients with early postoperative complications may be managed in specialist centres but patients with later complications, occurring months or years after surgery, may present to local surgical units for assessment and management. This review will highlight the late complications of the 3 most commonly performed bariatric surgery procedures that the emergency general surgeon may encounter. It will also highlight the complications that require urgent intervention by the emergency general surgeon and those that can be safely referred to a bariatric surgeon for further management after initial assessment and investigations. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Developing A&E nursing responses to people who deliberately self-harm: the provision and evaluation of a series of reflective workshops.

PubMed

Holdsworth, N; Belshaw, D; Murray, S

2001-10-01

Accident & Emergency (A&E) departments and Medical Admission Units (MAUs) are an essential part of emergency mental health care in the UK. Deliberate self-harm and attempted suicide are particular challenges to nursing staff in such departments. Two registered mental nurses with experience of education facilitated a series of workshops with nurses from four A&E departments, two Minor Injuries Units and two MAUs. These were focused upon the assessment and management of deliberate self-harm and attempted suicide. During the workshops, participants provided systematic information on presentations of deliberate self-harm and attempted suicide, and on their professional responses to such presentations. These accounts provided invaluable information on deliberate self-harm and attempted suicide as seen by nursing staff in A&E and MAUs. Critical reflection upon nursing responses to these presentations revealed particular concerns nurses had relating to their experience with this client group which might inform future practice. Evaluation of the workshops indicated a subsequent decrease in work-related stress, which was probably a consequence of improved professional coping responses by the nurses concerned.

Application of the Canadian CT head rules in managing minor head injuries in a UK emergency department: implications for the implementation of the NICE guidelines

PubMed Central

Sultan, H; Boyle, A; Pereira, M; Antoun, N; Maimaris, C

2004-01-01

Objective: : In 2002 a new protocol was introduced based on the Canadian CT rules. Before this the Royal College of Surgeons "Galasko" report guidelines had been followed. This study evaluates the effects of the protocol and discusses the impact of the implementation of the NICE head injury guidelines—also based on the Canadian CT rules. Methods: A "before and after" study was undertaken, using data from accident and emergency cards and hospital notes of adult patients with head injuries presenting to the emergency department over seven months in 2001 and nine months in 2002. The two groups were compared to see how rates of computed tomography (CT), admission for observation, discharge, and skull radiography had changed after introduction of the protocol. Results: : Head CT rates in patients with minor head injuries (MHI) increased significantly from 47 of 330 (14%) to 58 of 267 (20%) (p<0.05). There were also significantly increased rates of admission for observation, from 111 (34%) to 119 (45%). Skull radiography rates fell considerably from 33% of all patients with head injuries in 2001 to 1.6% in 2002, without any adverse effect. Conclusions: This study shows that it is possible to replace the current practice in the UK of risk stratification of adult MHI based on skull radiography, with slightly modified versions of the Canadian CT rule/NICE guidelines. This will result in a large reduction in skull radiography and will be associated with modest increases in CT and admissions rates. If introduction of the NICE guideline is to be realistic, the study suggests that it will not be cost neutral. PMID:15208222

The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study.

PubMed

Kutz, A; Struja, T; Hausfater, P; Amin, D; Amin, A; Haubitz, S; Bernard, M; Huber, A; Mueller, B; Schuetz, P

2017-07-01

The clinical relevance of hyperglycaemia in an emergency department population remains incompletely understood. We investigated the association between admission blood glucose levels and adverse clinical outcomes in a large emergency department cohort. We prospectively enrolled 7132 adult medical patients seeking emergency department care in three tertiary care hospitals in Switzerland, France and the USA. We used adjusted multivariable logistic regression models to examine the association between admission blood glucose levels and 30-day mortality, as well as adverse clinical course stratified by pre-existing diabetes and principal medical diagnoses. In 6044 people without diabetes (84.7%), severe hyperglycaemia, defined as a glucose level of > 11.1 mmol/l (200 mg/dl), was associated with a doubling in the risk of 30-day mortality [adjusted odds ratio (OR) 1.9; 95% confidence interval (95% CI), 1.1 to 3.3; P = 0.018] and a three-fold increase in the risk of intensive care unit admission (adjusted OR 3.0; 95% CI, 1.9 to 4.9; P < 0.001). These associations were similar among different diagnoses. In the population with diabetes (n = 1088), no association with 30-day mortality was found (adjusted OR 1.0; 95% CI, 0.6 to 1.8; P for interaction = 0.001), whereas the association with intensive care unit admission was weaker (adjusted OR 2.4; 95% CI, 1.5 to 4.1; P for interaction = 0.011). Overall 30-day mortality was higher in those with diabetes than in those without (6.1 vs. 4.4%, P = 0.015). In this large medical emergency department patient cohort, admission hyperglycaemia was strongly associated with adverse clinical course in people without diabetes. (Clinical Trial Registry No: NCT01768494). © 2017 Diabetes UK.

Five years of poisons information on the internet: the UK experience of TOXBASE

PubMed Central

Bateman, D N; Good, A M

2006-01-01

Introduction In 1999, the UK adopted a policy of using TOXBASE, an internet service available free to registered National Health Service (NHS) departments and professionals, as the first point of information on poisoning. This was the first use worldwide of the internet for provision of clinical advice at a national level. We report the impact on database usage and NPIS telephone call loads. Methods Trends in the pattern of TOXBASE usage from 2000–2004 are reported by user category. Information on the monographs accessed most frequently was also extracted from the webserver and sorted by user category. The numbers of telephone calls to the National Poisons Information Service (NPIS) were extracted from NPIS annual reports. Results Numbers of database logons increased 3.5 fold from 102 352 in 2000 to 368 079 in 2004, with a total of 789 295 accesses to product monographs in 2004. Registered users increased almost tenfold, with approximately half accessing the database at least once a year. Telephone calls to the NPIS dropped by over half. Total contacts with NPIS (web and telephone) increased 50%. Major users in 2004 were hospital emergency departments (60.5% of logons) and NHS public access helplines (NHS Direct and NHS24) (29.4%). Different user groups access different parts of the database. Emergency departments access printable fact sheets for about 10% of monographs they access. Conclusion Provision of poisons information by the internet has been successful in reducing NPIS call loads. Provision of basic poisons information by this method appears to be acceptable to different professional groups, and to be effective in reducing telephone call loads and increasing service cost effectiveness. PMID:16858093

Five years of poisons information on the internet: the UK experience of TOXBASE.

PubMed

Bateman, D N; Good, A M

2006-08-01

In 1999, the UK adopted a policy of using TOXBASE, an internet service available free to registered National Health Service (NHS) departments and professionals, as the first point of information on poisoning. This was the first use worldwide of the internet for provision of clinical advice at a national level. We report the impact on database usage and NPIS telephone call loads. Trends in the pattern of TOXBASE usage from 2000-2004 are reported by user category. Information on the monographs accessed most frequently was also extracted from the webserver and sorted by user category. The numbers of telephone calls to the National Poisons Information Service (NPIS) were extracted from NPIS annual reports. Numbers of database logons increased 3.5 fold from 102,352 in 2000 to 368,079 in 2004, with a total of 789,295 accesses to product monographs in 2004. Registered users increased almost tenfold, with approximately half accessing the database at least once a year. Telephone calls to the NPIS dropped by over half. Total contacts with NPIS (web and telephone) increased 50%. Major users in 2004 were hospital emergency departments (60.5% of logons) and NHS public access helplines (NHS Direct and NHS24) (29.4%). Different user groups access different parts of the database. Emergency departments access printable fact sheets for about 10% of monographs they access. Provision of poisons information by the internet has been successful in reducing NPIS call loads. Provision of basic poisons information by this method appears to be acceptable to different professional groups, and to be effective in reducing telephone call loads and increasing service cost effectiveness.

DRI Technical Program: Emerging Dynamics of the Marginal Ice Zone Ice, Ocean and Atmosphere Interactions in the Arctic Marginal Ice Zone. Year 3 Annual Report

DTIC Science & Technology

2014-09-30

Institution The Scottish Association for Marine Science tmaksym@whoi.edu Phil.Hwang@sams.ac.uk LONG-TERM GOALS This DRI TECHNICAL PROGRAM (Emerging...jpw28@bas.ac.uk tmaksym@whoi.edu Co-PRINCIPAL INVESTIGATOR: Byongjun (Phil) Hwang The Scottish Association for Marine Science Phil.Hwang@sams.ac.uk 2

Communicating with a deafblind person in an emergency.

PubMed

Scott, J

1998-07-01

Deafblind UK is the association of deafblind and dual sensory impaired people in the UK. This paper presents advice on the best way to communicate with people who are disabled in this way, particularly in an emergency.

Use of, and outputs from, an assault patient questionnaire within accident and emergency departments on Merseyside

PubMed Central

Young, C; Douglass, J

2003-01-01

Objectives: To describe the implementation, use of, and outputs from an assault patient questionnaire (APQ) introduced in accident and emergency (A&E) departments to determine Crime & Disorder and Community Safety priorities on Merseyside, a metropolitan county in north west England, UK. Methods: Why and how the APQ was implemented, data collected, and information obtained. The subsequent incorporation of the APQ into the Torex Patient Administration System (PAS) at the Royal Liverpool University Hospital A&E department and its routine completion by trained reception staff. Results: Analysis is based upon anonymised data—for example, patient ID and date of birth information is suppressed. A summary of "baseline" information obtained from the data collected is provided. Conclusions: It is possible for the APQ to be implemented at no extra cost in a large A&E department in an acute general teaching hospital. Valuable intelligence can be obtained for Crime & Disorder Act and Community Safety processes. The APQ forms part of a medium to long term strategy to prevent and reduce violent assaults in the community that subsequently require treatment in an A&E department. Such incidents include assaults both inside and outside licensed premises, attacks by strangers on the street, and domestic violence. Emphasis is also placed upon the feedback of results to staff in A&E departments. PMID:12748137

Letters to the Editor

NASA Astrophysics Data System (ADS)

1993-01-01

Elementary particles and philosophy of scienceEric ScerriDepartment of History and Philosophy of Science, King's College, London, UK Muscle forces and Newton's third lawA H BachmanPhysics Department, City College of New York, NY 10031, USA Science for the year 2000Martin Brown122 Bryansburn Road, Bangor, County Down BT20 3RG, UK More examples of the harmonic meanA TanDepartment of Physics, Alabama A & M University, Normal, AL 35762, USA Science SATsD L Richards16 Purcell Crescent, London SW6 7PB, UK

Travelling abroad for aesthetic surgery: Informing healthcare practitioners and providers while improving patient safety.

PubMed

Jeevan, R; Birch, J; Armstrong, A P

2011-02-01

Travelling abroad for surgery is a phenomenon reported internationally. It is particularly likely for aesthetic procedures not undertaken routinely by national health services. We assessed the impact of these patients presenting to the UK National Health Service (NHS) with concerns or complications on their return. All 326 UK consultant members of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) were asked to complete a short questionnaire about patients that had presented to the NHS with complications or concerns following surgery abroad. The results were subsequently presented to the Department of Health (DH). 203 (62%) UK consultant plastic surgeons responded. 76 (37%) of the 203 respondents had seen such patients in their NHS practice, most commonly following breast or abdominal procedures. A quarter underwent emergency surgery, a third out-patient treatment and a third elective surgical revision. In response to these findings, the DH clarified that NHS teams should provide emergency care to such patients but should not undertake any elective revision procedures. Travelling abroad for aesthetic surgery may reduce its cost. However, aesthetic procedures have high minor complication rates, and peri-operative travel is associated with increased risks. Fully informed consent is unlikely when patients do not meet their surgeon prior to paying and travelling for surgery, and national health services are used to provide a free safety net on their return. To help minimise the potential risks, BAPRAS has clarified the responsibilities of the NHS and is acting to better inform UK patients considering travelling abroad. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The attitudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies.

PubMed

Trivedy, Chetan; Kodate, Naonori; Ross, Alastair; Al-Rawi, Harrith; Jaiganesh, Thiagarajan; Harris, Tim; Anderson, Janet E

2012-04-01

Dentofacial emergencies are a common presentation to the emergency department (ED) but there is little recent data on physicians' knowledge, confidence and attitudes in handling these cases. A questionnaire was administered to 103 ED physicians. The sample was primarily drawn from London hospitals as well a smaller contribution from around the UK and included physicians with a range of experience and at different grades. The majority of the 102 participants (76.5%) did not receive any formal training in managing dentofacial emergencies. The percentage of participants who were happy to manage common dentofacial emergencies is as follows: dental trauma (20.4%); major facial trauma (39.8%); interpreting facial X-rays (68.0%); and facial suturing (85.4%). When questioned 12.1% of the participants felt that ED physicians should be responsible for managing dental emergencies compared to 22.4% who felt that ED physicians should manage maxillofacial emergencies. Only 3.9% of the participants would opt to be treated by an ED doctor in the event of them presenting to the ED with a dental injury. The remaining 72.5% would prefer to be seen by a maxillofacial surgeon, 23.5% by a dentist and none of the participants opted to be seen by the emergency nurse practitioner. ED physicians do not feel confident in managing some dentofacial emergencies. This may be attributed to a lack of training in this area as well as exposure to these types of emergencies. There is a need for greater awareness, validated guidelines and training resources for ED physicians to treat dentofacial emergencies as well more research in this field of emergency medicine. © 2011 John Wiley & Sons A/S.

Facilities for chemical decontamination in accident and emergency departments in the United Kingdom

PubMed Central

George, G; Ramsay, K; Rochester, M; Seah, R; Spencer, H; Vijayasankar, D; Vasicuro, L

2002-01-01

Objective: To audit the facilities for chemical decontamination, with special reference to cyanide poisoning, in all major accident and emergency departments in the UK. Method: A simple postal questionnaire was used to audit planning, premises, equipment, protection for staff, and stocks of specific antidotes to cyanide poisoning. Results: 227 questionnaires from 261 departments (87%) were returned and used in the survey. Of the 227 departments who responded, 151 (66%) had a written plan; 168 (74%) departments had premises for decontamination; 55 (24%) were judged to have satisfactory premises; 146 (64%) departments had a shower or hose for decontamination; 60 (26%) departments had a decontamination trolley suitable for "stretcher" patients; 203 (89%) had some protective equipment for staff but only 77 (34%) had complete protection—that is, goggles, chemical resistant clothing, and breathing apparatus. In the authors' opinion only seven (3%) departments had satisfactory premises and equipment to treat "stretcher" patients and full protection for staff. A further 11 (5%) departments were equipped to manage ambulant patients at a similar level. Some 205 (90%) departments stocked one or more antidotes to cyanide and 77 (34%) stocked all four antidotes. Thirty four (15%) departments held all four antidotes to cyanide and had full protection for staff. Only five (2%) departments had satisfactory premises and equipment to treat "stretcher" patients, full protection for staff, and at least three of four antidotes. Conclusions: Most departments had some equipment for chemical decontamination. However, there were major inconsistencies in the range of equipment held and these limited its usefulness. Only a small minority of departments was satisfactorily equipped to deal with a serious chemical incident. PMID:12205006

Managing competing organizational priorities in clinical handover across organizational boundaries.

PubMed

Sujan, Mark A; Chessum, Peter; Rudd, Michelle; Fitton, Laurence; Inada-Kim, Matthew; Cooke, Matthew W; Spurgeon, Peter

2015-01-01

Handover across care boundaries poses additional challenges due to the different professional, organizational and cultural backgrounds of the participants involved. This paper provides a qualitative account of how practitioners in emergency care attempt to align their different individual and organizational priorities and backgrounds when handing over patients across care boundaries (ambulance service to emergency department (ED), and ED to acute medicine). A total of 270 clinical handovers were observed in three emergency care pathways involving five participating NHS organizations (two ambulance services and three hospitals). Half-day process mapping sessions were conducted for each pathway. Semi-structured interviews were carried out with 39 participants and analysed thematically. The management of patient flow and the fulfilment of time-related performance targets can create conflicting priorities for practitioners during handover. Practitioners involved in handover manage such competing organizational priorities through additional coordination effort and dynamic trade-offs. Practitioners perceive greater collaboration across departments and organizations, and mutual awareness of each other's goals and constraints as possible ways towards more sustainable improvement. Sustainable improvement in handover across boundaries in emergency care might require commitment by leaders from all parts of the local health economy to work as partners to establish a culture of integrated, patient-centred care. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Abstract‐to‐publication ratio for papers presented at scientific meetings: a quality marker for UK emergency medicine research

PubMed Central

Macmillan, Craig D; Moore, Anthony K; Cook, Ronald J; Pedley, David K

2007-01-01

Objectives To determine the publication rate of abstracts presented by UK emergency physicians at major emergency medicine meetings, and to identify the site of publication of papers. Method All abstracts presented to the annual scientific meetings of both the British Association of Emergency Medicine and the Faculty of Accident and Emergency Medicine between 2001 and 2002 were identified retrospectively from conference programmes. To identify whether the work relating to the abstract had been published in a peer‐reviewed journal, the Medline database (Ovid interface) was searched using the first and last authors as well as key words from the abstract. Results Of the 404 abstracts identified, 124 (30%) had been published as full articles. For abstracts presented in the oral sessions, 83 (57%) resulted in publication. A range of journals accepted papers for publication. Conclusion The abstract‐to‐publication ratio for UK emergency medicine is lower than for other specialties, but broadly similar to emergency medicine in the US and Australia. PMID:17513542

Analysis of illicit ecstasy tablets: implications for clinical management in the accident and emergency department.

PubMed Central

Sherlock, K; Wolff, K; Hay, A W; Conner, M

1999-01-01

OBJECTIVE: To examine the composition of illicitly manufactured "ecstasy" tablets sold on the UK drugs market. METHODS: Analysis by gas chromatography of 25 illicit ecstasy tablets handed in under amnesty to Leeds Addiction Unit. RESULTS: Illicitly manufactured ecstasy tablets contain a range of ingredients, of widely differing concentrations, and even tablets with the same brand name have variable concentrations of active ingredients. Concentrations of 3,4-methylenedioxymethamphetamine (MDMA) more popularly known as ecstasy, varied 70-fold between tablets. Nine tablets contained neither MDMA nor related analogues. CONCLUSIONS: These results have implications for emergency workers attending to those who have become casualties of the drug ecstasy. Those claiming to have ingested ecstasy may actually have taken other agents that require different clinical management. PMID:10353046

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

PubMed Central

Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

2016-01-01

Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. PMID:27324707

A one-year review of maxillofacial sports injuries treated at an accident and emergency department.

PubMed

Hill, C M; Burford, K; Martin, A; Thomas, D W

1998-02-01

To assess the aetiology and demand for oral and maxillofacial surgery services associated with sports injuries, a prospective study was undertaken. Data were collected from consecutive patients (with maxillofacial injuries associated with sports) attending the accident and emergency department at the Cardiff Royal Infirmary in the UK during a 12-month period and analysed. Data relating to demography, aetiology, site and extent of injury, treatment and outcome were collected. There were 790 attendances (695M:85F) arising principally from injuries related to rugby (n = 206), cycling (n = 189) and football (n = 109) but few from recognized contact sports (n = 26). The principal causes of these injuries were direct bodily contact (n = 260) and falls (n = 219). The commonest injury was soft-tissue laceration (n = 604); 80 patients had dentoalveolar fractures and 64 patients had fractures of the facial skeleton. Injuries were located in the upper- (n = 257), middle- (n = 201) and lower third of the face (n = 124) with 188 lip/intraoral injuries. Repair of lacerations (n = 600) was the commonest treatment; only 46 fractures required interventive treatment. Follow-up was performed for most of these patients at the Department of Oral and Maxillofacial Surgery at the Dental Hospital (n = 404) and general medical/dental practitioners (n = 258). These data highlight the importance of oral and maxillofacial surgery staff in the management of sports injuries in accident and emergency departments. Moreover, they suggest the need for prioritization of rule and legislation changes and the continuing need to improve safety standards to prevent maxillofacial injuries.

Safety and feasibility of sublingual microcirculation assessment in the emergency department for civilian and military patients with traumatic haemorrhagic shock: a prospective cohort study

PubMed Central

Naumann, David N; Mellis, Clare; Smith, Iain M; Mamuza, Jasna; Skene, Imogen; Harris, Tim; Midwinter, Mark J; Hutchings, Sam D

2016-01-01

Objectives Sublingual microcirculatory monitoring for traumatic haemorrhagic shock (THS) may predict clinical outcomes better than traditional blood pressure and cardiac output, but is not usually performed until the patient reaches the intensive care unit (ICU), missing earlier data of potential importance. This pilot study assessed for the first time the feasibility and safety of sublingual video-microscopy for THS in the emergency department (ED), and whether it yields useable data for analysis. Setting A safety and feasibility assessment was undertaken as part of the prospective observational MICROSHOCK study; sublingual video-microscopy was performed at the UK-led Role 3 medical facility at Camp Bastion, Afghanistan, and in the ED in 3 UK Major Trauma Centres. Participants There were 15 casualties (2 military, 13 civilian) who presented with traumatic haemorrhagic shock with a median injury severity score of 26. The median age was 41; the majority (n=12) were male. The most common injury mechanism was road traffic accident. Primary and secondary outcome measures Safety and feasibility were the primary outcomes, as measured by lack of adverse events or clinical interruptions, and successful acquisition and storage of data. The secondary outcome was the quality of acquired video clips according to validated criteria, in order to determine whether useful data could be obtained in this emergency context. Results Video-microscopy was successfully performed and stored for analysis for all patients, yielding 161 video clips. There were no adverse events or episodes where clinical management was affected or interrupted. There were 104 (64.6%) video clips from 14 patients of sufficient quality for analysis. Conclusions Early sublingual microcirculatory monitoring in the ED for patients with THS is safe and feasible, even in a deployed military setting, and yields videos of satisfactory quality in a high proportion of cases. Further investigations of early microcirculatory behaviour in this context are warranted. Trial registration number NCT02111109. PMID:28003301

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

PubMed Central

Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

2016-01-01

Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. PMID:26306608

Ethical, legal and professional issues arising from social media coverage by UK Helicopter Emergency Medical Services.

PubMed

Steele, Sarah; Adcock, Christopher; Steel, Alistair

2016-01-01

Social media (SoMe) are gaining increasing acceptance among, and use by, healthcare service deliverers and workers. UK Helicopter Emergency Medical Services (HEMS) use SoMe to deliver service information and to fundraise, among other purposes. This article examines UK HEMS use of SoMe between January and February 2014 to determine the extent of adoption and to highlight trends in use. The database of the Association of Air Ambulances, crosschecked with UK Emergency Aviation, was used to identify flying, charitable UK HEMS. This search identified 28 UK HEMS, of which 24 services met the criteria for selection for review. Using information harvested from the public domain, we then systematically documented SoMe use by the services. SoMe use by UK HEMS is extensive but not uniform. All selected UK HEMS maintained websites with blogs, as well as Facebook, Twitter, Wikipedia and JustGiving profiles, with the majority of services using Ebay for Charity, LinkedIn and YouTube. Some HEMS also held a presence on Pinterest, Google+, Instagram and Flickr, with a minority of services maintaining their own Rich Site Summary (RSS) feed. The SoMe adopted, while varied, allowed for increased, and different forms of, information delivery by HEMS to the public, often in real time. Such use, though, risks breaching patient confidentiality and data protection requirements, especially when information is viewed cumulatively across platforms. There is an urgent need for the continued development of guidance in this unique setting to protect patients while UK HEMS promote and fundraise for their charitable activities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effect of a structured diabetes education programme in primary care on hospitalizations and emergency department visits among people with Type 2 diabetes mellitus: results from the Patient Empowerment Programme.

PubMed

Wong, C K H; Wong, W C W; Wan, Y F; Chan, A K C; Chan, F W K; Lam, C L K

2016-10-01

To assess whether a structured diabetes education programme, the Patient Empowerment Programme, was associated with a lower rate of all-cause hospitalization and emergency department visits in a population-based cohort of patients with Type 2 diabetes mellitus in primary care. A cohort of 24 250 patients was evaluated using a linked administrative database during 2009-2013. We selected 12 125 patients with Type 2 diabetes who had at least one Patient Empowerment Programme session attendance. Patients who did not participate in the Patient Empowerment Programme were matched one-to-one with patients who did, using the propensity score method. Hospitalization events and emergency department visits were the events of interest. Cox proportional hazard and negative binomial regressions were performed to estimate the hazard ratios for the initial event, and incidence rate ratios for the number of events. During a median 30.5 months of follow-up, participants in the Patient Empowerment Programme had a lower incidence of an initial hospitalization event (22.1 vs 25.2%; hazard ratio 0.879; P < 0.001) and emergency department visit (40.5 vs 44%; hazard ratio 0.901; P < 0.001) than those who did not participate in the Patient Empowerment Programme. Participation in the Patient Empowerment Programme was associated with a significantly lower number of emergency department visits (incidence rate ratio 0.903; P < 0.001): 40.4 visits per 100 patients annually in those who did not participate in the Patient Empowerment Programme vs. 36.2 per 100 patients annually in those who did. There were significantly fewer hospitalization episodes (incidence rate ratio 0.854; P < 0.001): 20.0 hospitalizations per 100 patients annually in those who did not participate in the Patient Empowerment Programme vs. 16.9 hospitalizations per 100 patients annually in those who did. Among patients with Type 2 diabetes, the Patient Empowerment Programme was shown to be effective in delaying the initial hospitalization event and in reducing their frequency. © 2015 Diabetes UK.

Developing a multidisciplinary approach within the ED towards domestic violence presentations.

PubMed

Basu, Subhashis; Ratcliffe, Giles

2014-03-01

To improve the detection and quality of care of patients who attend the emergency department (ED) with confirmed or suspected domestic abuse (DA). A quality improvement report on the design, implementation and evaluation of a specialised service and structured training programme to detect and manage DA presentations within an emergency medicine department. The study was set in the ED at the Northern General Hospital, Sheffield, UK. Key measures for improvement included introducing a service within the ED to help staff manage DA and coordinate responses; improve staff confidence in detecting DA; develop a structured and consistent process by which to manage DA presentations. An Independent Domestic Violence Advocate service was introduced into the department in July 2011 through a multiagency agreement. A structured training and education programme was delivered to ED staff. A 'communications form' was developed for DA risk assessment and case management. The process was reviewed quarterly. One hundred and seventy-two referrals were made to the service (121 distinct clients) over a 12-month period. Staff reported greater confidence in detecting DA, and community partners highlighted the role the service had in improving DA detection and care quality within the city. Strong leadership and prioritising the issue within the department has facilitated the development of the process and contributed substantially to its success. Support from community partners has been invaluable in tailoring the service and education programme to the needs of staff and patients within the department.

Ilya Neustadt, Norbert Elias, and the Leicester Department: personal correspondence and the history of sociology in Britain.

PubMed

Goodwin, John; Hughes, Jason

2011-12-01

The central aims of this paper are: (1) to explore the utility of using personal correspondence as a source of data for sociological investigations into the history of sociology in the UK; (2) in relation to this undertaking, to advance the beginnings of a figurational analysis of epistolary forms; and (3), to provide an empirically-grounded discussion of the historical significance of the Department of Sociology at the University of Leicester (a University largely ignored in 'standard histories' of the subject) at a formative phase in the development of the discipline within the UK. The correspondence drawn upon in the paper is between Norbert Elias and Ilya Neustadt between 1962 and 1964 when Elias was Professor of Sociology at the University of Ghana and Ilya Neustadt was Professor of Sociology and Head of the Sociology Department at the University of Leicester. From an analysis of this correspondence, we elucidate an emergent dynamic to the relationship between Neustadt and Elias, one which, we argue, undergirds the development of sociology at Leicester and the distinctive character of the intellectual climate that prevailed there during the 1960s. The paper concludes with a consideration of whether it was a collapse of this dynamic that led to a total breakdown in the relationship between Neustadt and Elias, and by extension, an important phase in the expansion of sociology at Leicester. © London School of Economics and Political Science 2011.

Observations on the Re-Emergence of a Binary System in UK Universities for Economics Degree Programmes

ERIC Educational Resources Information Center

Talbot, Steve; Reeves, Alan; Johnston, James

2014-01-01

An audit of economics provision shows that over the past decade economics has disappeared from large parts of the UK's higher education landscape, especially the post-1992 universities. In the north of Britain the binary system has effectively re-emerged leaving many potential students unable to study key subjects such as economics. Post-1992…

What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK Army personnel who have served in Iraq or Afghanistan

PubMed Central

2012-01-01

Background The negative impact of sustaining an injury on a military deployment on subsequent mental health is well-documented, however, the relationship between having an illness on a military operation and subsequent mental health is unknown. Methods Population based study, linking routinely collected data of attendances at emergency departments in military hospitals in Iraq and Afghanistan [Operational Emergency Department Attendance Register (OpEDAR)], with data on 3896 UK Army personnel who participated in a military health study between 2007 and 2009 and deployed to Iraq or Afghanistan between 2003 to 2009. Results In total, 13.8% (531/3896) of participants had an event recorded on OpEDAR during deployment; 2.3% (89/3884) were medically evacuated. As expected, those medically evacuated for an injury were at increased risk of post deployment probable PTSD (odds ratio 4.27, 95% confidence interval 1.80-10.12). Less expected was that being medically evacuated for an illness was also associated with a similarly increased risk of probable PTSD (4.39, 1.60-12.07) and common mental disorders (2.79, 1.41-5.51). There was no association between having an OpEDAR event and alcohol misuse. Having an injury caused by hostile action was associated with increased risk of probable PTSD compared to those with a non-hostile injury (3.88, 1.15 to 13.06). Conclusions Personnel sustaining illnesses on deployment are just as, if not more, at risk of having subsequent mental health problems as personnel who have sustained an injury. Monitoring of mental health problems should consider those with illnesses as well as physical injuries. PMID:23095133

Developing and assessing the acceptability of an epilepsy first aid training intervention for patients who visit UK emergency departments: A multi-method study of patients and professionals.

PubMed

Snape, Darlene A; Morgan, Myfanwy; Ridsdale, Leone; Goodacre, Steve; Marson, Anthony G; Noble, Adam J

2017-03-01

Epilepsy affects around 1% of the UK population; 40% of whom experience two or more seizures annually. However, most Emergency Department (ED) visits by people with epilepsy (PWE) are clinically unnecessary. Evidence highlights that with correct training, seizures can be safely managed by patients and their families within the community. Arguably therefore, PWE who frequently visit the ED might benefit from a self-management intervention that improves their own and their families' confidence and ability in managing seizures. Currently, no such intervention is available for PWE attending the ED. A collaborative approach (patients, carers, health professionals) was adopted to develop a patient-focused, self-management intervention. An existing group-based seizure management course, offered by the Epilepsy Society, was adapted. Collaborative feedback was sought via a base-line document review, one-to-one semi-structured interviews, and focus group discussions. The applied framework provided a systematic approach from development through to implementation. Participant feedback overall was extremely positive. People with epilepsy who visit the ED reported a positive view of epilepsy seizure first aid training and associated educational materials. Their feedback was then used to develop the optimized intervention presented here. Strengths and perceived barriers to successful implementation and participation, as well as the practical and psychosocial benefits, were identified. We describe the developed intervention together with the process followed. This description, while being project-specific, provides a useful template to assist in the development of interventions more generally. Ongoing evaluation will determine the effects of the training intervention on participants' behavior. Copyright © 2017 Elsevier Inc. All rights reserved.

Management of School Attendance in the UK: A Strategic Analysis

ERIC Educational Resources Information Center

Reid, Ken

2010-01-01

Prior to 1997, managing school attendance was the sole responsibility of the Department for Education and Skills (DfES). Since devolution, responsibility for school attendance has resided with each of the four UK-wide administrations. These are the Department for Children, Schools and Families (DCSF) in England; the Scottish Executive Education…

Employer Engagement Practices of UK Business Schools and Departments: An Empirical Investigation

ERIC Educational Resources Information Center

Bennett, Roger; Kane, Suzanne

2009-01-01

A survey of managers in charge of employer engagement activities in UK business schools and departments was completed to ascertain: (1) the employer engagement methods that were most commonly used by institutions; (2) business school managers' attitudes towards employers' involvement in course design; and (3) the respondents' perceptions of the…

Telephone-based low intensity therapy after crisis presentations to the emergency department is associated with improved outcomes.

PubMed

Bidargaddi, Niranjan; Bastiampillai, Tarun; Allison, Stephen; Jones, Gabrielle M; Furber, Gareth; Battersby, Malcolm; Richards, David

2015-10-01

In Australia there is an overwhelming need to provide effective treatment to patients presenting to the Emergency Department (ED) in mental health crisis. We adapted Improving Access to Psychological Therapies service model (IAPT) from the National Health Service (NHS) method for the large scale delivery of psychological therapies throughout the United Kingdom to an Australian ED setting. This telephone-based low intensity therapy was provided to people presenting in crisis to the EDs with combinations of anxiety, depression, substance use, and suicidal thinking. This uncontrolled study utilised session-by-session, before-and-after measures of anxiety and depression via Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7). Of 347 eligible post-crisis ED referred patients, 291 (83.9%) engaged with the IAPT team. Most patients (65%) had attended the ED previously on an average of 3.9 (SD = 6.0) occasions. Two hundred and forty one patients received an average of 4.1 (SD = 2.3) contacts of low-intensity psychological therapies including 1.2 (SD = 1.7) community outreach visits between 20th Oct 2011 and 31st Dec 2012. Treated patients reported clinically significant improvements in anxiety, depression and suicidal ideation. Uncontrolled effect sizes were moderate for anxiety (0.6) and depression (0.6). The Australian ED IAPT program demonstrated that the UK IAPT program could be adapted for emergency mental health patients and be associated with similar clinical benefits as the original program. The Flinders Medical Centre IAPT program received Emergency Department project funding from the Australian Commonwealth Government through the Council of Australian Governments (COAG) and the South Australian Government initiative, Every Patient Every Service (EPES). © The Author(s) 2015.

Lost in Transition: Languages Transition from Post-16 Schooling to Higher Education

ERIC Educational Resources Information Center

Harnisch, Henriette; Sargeant, Helen; Winter, Natasha

2011-01-01

Ever decreasing numbers of applicants arrive in language departments at UK universities. In the face of this decline, and against the backdrop of higher education languages departments being reduced across the UK, it is important to investigate the supply chain of languages undergraduates in the pre-entry sector. This article reports on a…

History of UK contribution to astronautics: Politics and government

NASA Astrophysics Data System (ADS)

Hicks CB, Colin

2009-12-01

In all developed countries, once it emerged from the amateur era, Space (and especially rocketry) moved on the public agenda because of its potential significance for both the civil and military policies of governments (coupled with its appetite for new money). In the UK the policy treatment of Space broadly paralleled that in other countries until the post-Empire trauma, the burn-out of the White-Hot Technological revolution of Harold Wilson, and the financial crises of the 1970s exhausted the public appetite for large scale publicly funded projects in high technology. The culmination for Space of these pressures came in 1986-1987 when the UK rejected the emerging international consensus and, almost alone, stayed outside the manned space commitments which developed into the International Space Station. In this paper, Colin Hicks will review the UK political developments which led up to the 1986-1987 decision and how the politics and organisation of UK space activity have developed since then to the point where in 2008 a major government review of the UK involvement in manned space was commissioned.

New glossary of terms used in regenerative medicine: standardization continues to emerge as regenerative medicine matures.

PubMed

Sheridan, Ben; Harris, Neil

2009-07-01

Regenerative medicine is an evolving, cross-disciplinary, international field that, as a result, uses terms that are either not widely understood, or may have a number of different meanings. Many stakeholders have identified this lack of clarity as a potential barrier to effective communication within the field. To address this, BSI British Standards, supported by the UK Department for Innovation, Universities and Skills (DIUS), was commissioned to develop guidance on the definitions of terms used within regenerative medicine. The resulting document aims to provide clear consensus terminology to improve communication and facilitate a common understanding for a broad range of potential users.

Evidence-based first aid advice for paediatric burns in the United Kingdom.

PubMed

Varley, Alice; Sarginson, Julia; Young, Amber

2016-05-01

Burn and scald injuries are common in children. First aid advice for paediatric burns is offered by a range of health organisations and charities in the UK. Despite this, children still present to emergency departments and burn services having received little or inadequate first aid. A survey was undertaken regarding the content and consistency of the advice given by a cross-section of UK health organisations involved in first aid prevention and education. The advice was subsequently examined to determine if it was evidence-based. Our study has demonstrated inconsistencies in the content of the first aid advice provided by the 21 organisations included in the study. Seventy-one percent of the information was only available online. The temperature, method and duration of cooling varied substantially, as did the advice recommended for the removal of clothing and jewellery and methods for covering the burn immediately after injury. Results from the literature review concluded the following based on available evidence; cool the burn with running tap water for 20min, remove clothing and jewellery and cover the burn with cling film or a clean non-adhesive dressing. This study highlights the lack of consistency between first aid guidance provided by health organisations and charities in the UK. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Facilities for investigating occupational asthma in UK non-specialist respiratory departments.

PubMed

Barber, Christopher M; Naylor, Steven; Bradshaw, Lisa; Francis, Mandy; Harris-Roberts, Joanne; Rawbone, Roger; Curran, Andrew; Fishwick, David

2008-01-01

The facilities which should be available to physicians offering specialist occupational asthma services have recently been agreed upon by a UK panel of experts. This study aimed to investigate whether these facilities are available in UK non-specialist secondary care respiratory departments and to document tertiary care referral patterns. A random sample of 100 UK respiratory units was selected, and the lead consultant invited to participate. Face-to-face interviews were conducted to document information on departmental facilities available for investigating cases of occupational asthma and utilization of tertiary referral centres. In total, 66% of consultants interviewed had seen a case of occupational asthma in the previous month, and 76% reported having ever referred a patient with suspected occupational asthma to a specialist centre for further investigation (referral distance range 1-111 miles). All the departments were able to perform the investigations previously deemed an absolute necessity in all patients. The availability of in-house facilities that were deemed as must be available varied between 3-100%. The results of this study demonstrate that while the majority of basic facilities are widely available, many respiratory departments do not have direct access to investigations routinely required to investigate occupational asthma. Access to specialist occupational respiratory centres varies within the UK, and in some parts of the country involves long travelling distances for patients.

Caring for the health of the public: cross sectional study of the activities of UK public health departments.

PubMed

Lawlor, D A; Morgan, K; Frankel, S

2002-03-01

The relative time spent in different areas of work in public health departments in the UK was assessed by means of a postal questionnaire. Departments spend one third of their time on population health work, this being similar to the amount of time spent on planning health services. Having a planning department in the health authority did not affect the amount of time spent in any area of work. Having a greater number of consultants in the department was associated with a tendency to spend more time on population health and being involved in training was associated with spending less time on planning. Public health departments in the UK are the only part of the health service with responsibility for the broader aspects of public health. Whilst the tensions between medical care and the wider influences upon population health may represent a false dichotomy, public health professionals must maintain a central focus of their work on the wider influences upon population health if balance is to be maintained within the National Health Service.

Potential impact of climate change on emerging vector-borne and other infections in the UK.

PubMed

Baylis, Matthew

2017-12-05

Climate is one of several causes of disease emergence. Although half or more of infectious diseases are affected by climate it appears to be a relatively infrequent cause of human disease emergence. Climate mostly affects diseases caused by pathogens that spend part of their lifecycle outside of the host, exposed to the environment. The most important routes of transmission of climate sensitive diseases are by arthropod (insect and tick) vectors, in water and in food. Given the sensitivity of many diseases to climate, it is very likely that at least some will respond to future climate change. In the case of vector-borne diseases this response will include spread to new areas. Several vector-borne diseases have emerged in Europe in recent years; these include vivax malaria, West Nile fever, dengue fever, Chikungunya fever, leishmaniasis, Lyme disease and tick-borne encephalitis. The vectors of these diseases are mosquitoes, sand flies and ticks. The UK has endemic mosquito species capable of transmitting malaria and probably other pathogens, and ticks that transmit Lyme disease. The UK is also threatened by invasive mosquito species known to be able to transmit West Nile, dengue, chikungunya and Zika, and sand flies that spread leishmaniasis. Warmer temperatures in the future will increase the suitability of the UK's climate for these invasive species, and increase the risk that they may spread disease. While much attention is on invasive species, it is important to recognize the threat presented by native species too. Proposed actions to reduce the future impact of emerging vector-borne diseases in the UK include insect control activity at points of entry of vehicles and certain goods, wider surveillance for mosquitoes and sand flies, research into the threat posed by native species, increased awareness of the medical profession of the threat posed by specific diseases, regular risk assessments, and increased preparedness for the occurrence of a disease emergency.

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.

PubMed

Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

2016-06-01

The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Comparison of perceived and modelled geographical access to accident and emergency departments: a cross-sectional analysis from the Caerphilly Health and Social Needs Study.

PubMed

Fone, David L; Christie, Stephen; Lester, Nathan

2006-04-13

Assessment of the spatial accessibility of hospital accident and emergency departments as perceived by local residents has not previously been investigated. Perceived accessibility may affect where, when, and whether potential patients attend for treatment. Using data on 11,853 respondents to a population survey in Caerphilly county borough, Wales, UK, we present an analysis comparing the accessibility of accident and emergency departments as reported by local residents and drive-time to the nearest accident and emergency department modelled using a geographical information system (GIS). Median drive-times were significantly shorter in the lowest perceived access category and longer in the best perceived access category (p < 0.001). The perceived access and GIS modelled drive-time variables were positively correlated (Spearman's rank correlation coefficient, r = 0.38, p < 0.01). The strongest correlation was found for respondents living in areas in which nearly all households had a car or van (r = 0.47, p < 0.01). Correlations were stronger among respondents reporting good access to public transport and among those reporting a recent accident and emergency attendance for injury treatment compared to other respondents. Correlation coefficients did not vary substantially by levels of household income. Drive-time, road distance and straight-line distance were highly inter-correlated and substituting road distance or straight-line distance as the GIS modelled spatial accessibility measure only marginally decreased the magnitude of the correlations between perceived and GIS modelled access. This study provides evidence that the accessibility of hospital-based health care services as perceived by local residents is related to measures of spatial accessibility modelled using GIS. For studies that aim to model geographical separation in a way that correlates well with the perception of local residents, there may be minimal advantage in using sophisticated measures. Straight-line distance, which can be calculated without GIS, may be as good as GIS-modelled drive-time or distance for this purpose. These findings will be of importance to health policy makers and local planners who seek to obtain local information on access to services through focussed assessments of residents' concerns over accessibility and GIS modelling.

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication.

PubMed

Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

2016-06-20

Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. ED of a UK tertiary referral hospital. All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with 'Severe' or 'Very Severe' acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Injury resulting from targeted violence: An emergency department perspective.

PubMed

Sivarajasingam, Vaseekaran; Read, Simon; Svobodova, Martina; Wight, Lucy; Shepherd, Jonathan

2018-06-01

Hate crimes - those perpetrated because of perceived difference, including disability, race, religion, sexual orientation or transgender status - have not been studied at the point of the victim's hospital emergency department (ED) use. To investigate the frequency, levels of physical harm and circumstances of targeted violence in those seeking treatment at EDs in three UK cities. In a multimethods study, face-to-face semi-structured interviews were conducted with 124 adult ED attenders with violent injuries. Victim and perpetrator socio-demographics were recorded. Patient narratives about perceived motives and circumstances were transcribed, uploaded onto NVivo for thematic analysis. Nearly a fifth (23, 18.5%) of the injured patients considered themselves to have been attacked by others motivated by hostility or prejudice to their 'difference' (targeted violence). Thematic analyses suggested these prejudices were to appearance (7 cases), racial tension (5 cases), territorial association (3 cases) and race, religious or sexual orientation (8 cases). According to victims, alcohol intoxication was particularly relevant in targeted violence (estimated reported frequency 90% and 56% for targeted and non-targeted violence, respectively). Our findings support a broader concept of hate victimisation and suggest that emergency room violence surveys could act as a community tension sensor and early warning system in this regard. Tackling alcohol misuse seems as important in this as in other forms of violence perpetration. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Enabling Healthcare IT Governance: Human Task Management Service for Administering Emergency Department's Resources for Efficient Patient Flow.

PubMed

Rodriguez, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

The use of Health Information Technology (HIT) to improve healthcare service delivery is constantly increasing due to research advances in medical science and information systems. Having a fully automated process solution for a Healthcare Organization (HCO) requires a combination of organizational strategies along with a selection of technologies that facilitate the goal of improving clinical outcomes. HCOs, requires dynamic management of care capability to realize the full potential of HIT. Business Process Management (BPM) is being increasingly adopted to streamline the healthcare service delivery and management processes. Emergency Departments (EDs) provide a case in point, which require multidisciplinary resources and services to deliver effective clinical outcomes. Managed care involves the coordination of a range of services in an ED. Although fully automated processes in emergency care provide a cutting edge example of service delivery, there are many situations that require human interactions with the computerized systems; e.g. Medication Approvals, care transfer, acute patient care. This requires a coordination mechanism for all the resources, computer and human, to work side by side to provide the best care. To ensure evidence-based medical practice in ED, we have designed a Human Task Management service to model the process of coordination of ED resources based on the UK's NICE Clinical guideline for managing the care of acutely ill patients. This functionality is implemented using Java Business process Management (jBPM).

Audit of radiology communication systems for critical, urgent, and unexpected significant findings.

PubMed

Duncan, K A; Drinkwater, K J; Dugar, N; Howlett, D C

2016-03-01

To determine the compliance of UK radiology departments and trusts/healthcare organisations with National Patient Safety Agency and Royal College of Radiologist's published guidance on the communication of critical, urgent, and unexpected significant radiological findings. A questionnaire was sent to all UK radiology department audit leads asking for details of their current departmental policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued. One hundred and fifty-four of 229 departments (67%) responded. Eighty-eight percent indicated that they had a policy in place for the communication of critical, urgent, and unexpected significant radiological findings. Only 34% had an automated electronic alert system in place and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 departments with an electronic acknowledgement system was someone regularly monitoring the read rate. There is wide variation in practice across the UK with regard to the communication and monitoring of reports with many departments/trusts not fully compliant with published UK guidance. Despite the widespread use of electronic systems, only a minority of departments/trusts have and use electronic tracking to ensure reports have been read and acted upon. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

PubMed

Gorman, Mark; Coelho, James; Gujral, Sameer; McKay, Alastair

2015-01-01

Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey

PubMed Central

Gorman, Mark; Coelho, James; Gujral, Sameer; McKay, Alastair

2015-01-01

Introduction. “See and treat” one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service. PMID:26236502

Measuring the Population Burden of Injuries—Implications for Global and National Estimates: A Multi-centre Prospective UK Longitudinal Study

PubMed Central

Lyons, Ronan A.; Kendrick, Denise; Towner, Elizabeth M.; Christie, Nicola; Macey, Steven; Coupland, Carol; Gabbe, Belinda J.

2011-01-01

Background Current methods of measuring the population burden of injuries rely on many assumptions and limited data available to the global burden of diseases (GBD) studies. The aim of this study was to compare the population burden of injuries using different approaches from the UK Burden of Injury (UKBOI) and GBD studies. Methods and Findings The UKBOI was a prospective cohort of 1,517 injured individuals that collected patient-reported outcomes. Extrapolated outcome data were combined with multiple sources of morbidity and mortality data to derive population metrics of the burden of injury in the UK. Participants were injured patients recruited from hospitals in four UK cities and towns: Swansea, Nottingham, Bristol, and Guildford, between September 2005 and April 2007. Patient-reported changes in quality of life using the EQ-5D at baseline, 1, 4, and 12 months after injury provided disability weights used to calculate the years lived with disability (YLDs) component of disability adjusted life years (DALYs). DALYs were calculated for the UK and extrapolated to global estimates using both UKBOI and GBD disability weights. Estimated numbers (and rates per 100,000) for UK population extrapolations were 750,999 (1,240) for hospital admissions, 7,982,947 (13,339) for emergency department (ED) attendances, and 22,185 (36.8) for injury-related deaths in 2005. Nonadmitted ED-treated injuries accounted for 67% of YLDs. Estimates for UK DALYs amounted to 1,771,486 (82% due to YLDs), compared with 669,822 (52% due to YLDs) using the GBD approach. Extrapolating patient-derived disability weights to GBD estimates would increase injury-related DALYs 2.6-fold. Conclusions The use of disability weights derived from patient experiences combined with additional morbidity data on ED-treated patients and inpatients suggests that the absolute burden of injury is higher than previously estimated. These findings have substantial implications for improving measurement of the national and global burden of injury. Please see later in the article for the Editors' Summary PMID:22162954

Sustaining Knowledge Exchange and Research Impact in the Social Sciences and Humanities: Investing in Knowledge Broker Roles in UK Universities

ERIC Educational Resources Information Center

Lightowler, Claire; Knight, Christine

2013-01-01

Over the last decade, higher education policy in the United Kingdom (UK) has increasingly focused on the impact of academic research. This has resulted in the emergence of specialist knowledge brokers within UK universities in the social sciences and humanities. Our empirical research identified a tension between the research impact agenda and the…

The Growth of Private and For-Profit Higher Education Providers in the UK. Research Report

ERIC Educational Resources Information Center

Fielden, John

2010-01-01

This report was commissioned by Universities UK's Longer Term Strategy Group to examine private and for-profit providers' role in the delivery of higher education in the UK, and to inform further discussions on this issue. The private higher education sector is emerging as a growing force in many parts of the world and presents a range of…

Retrospection and Reflection: The Emerging Influence of an Institutional Professional Recognition Scheme on Professional Development and Academic Practice in a UK University

ERIC Educational Resources Information Center

van der Sluis, Hendrik; Burden, Penny; Huet, Isabel

2017-01-01

Raising the quality and profile of teaching and student learning is something universities across the UK are aspiring to achieve in order to maintain reputations. Currently, the UK Professional Standards Framework (UKPSF) provides a standard by which academic staff can gain professional recognition for their academic practice and many UK…

Soil-related geohazard assessments for maintaining the UK's minor road network

NASA Astrophysics Data System (ADS)

Pritchard, Oliver; Hallett, Stephen; Farewell, Timothy

2015-04-01

The minor road network of the UK (United Kingdom) encompasses 98% of the overall road network. In recent years the UK's roads have been deteriorating, currently rated 26th in the world and considered at risk and declining by the Institution of Civil Engineers (ICE). Many factors contribute to the degradation and ultimately, to the failure of particular road sections. However, several UK local authorities have identified that during drought conditions, road sections founded upon clay soils which are susceptible to volumetric shrinkage and swelling undergo significant deterioration compared to those sections on non-susceptible soils. Droughts in East Anglia recently resulted in estimated damages of £26 million, leading several local authorities to apply to Central Government for emergency funding. The minor or evolved road network is most at risk due to them having often little, if any, structural foundations. This paper addresses the use of soil-related geohazard assessments and GIS (Geographical Information Systems) in helping to provide a soil-informed maintenance strategy for the asset management of the important (both socially and commercially) local road network of the UK. Furthermore, to establish future subsidence risk, UKCP09 climate projections have been used to model the likely potential soil moisture deficit (PSMD) for baseline (1961-1990), 2030 (2020-2049) and 2050 (2040-2069) scenarios. The incorporation of probabilistic PSMD data into clay-related subsidence models has allowed an assessment of potential subsidence risk, with a range of uncertainties, for these scenarios. Intersection of road networks with future projections of subsidence risk has enabled metrics of potential vulnerability to be established. This will aid prioritisation of areas which require further maintenance to make them more climate resilient, avoiding emergency funding situations. Subsequently, this approach can then be extrapolated to the entire UK minor road network, on a local authority level, to provide a series of regional risk assessments. Case studies are drawn from the UK administrative counties of Lincolnshire and Worcestershire. Data from observed road assessments, obtained from the respective local authorities have been analysed and intersected with clay-related subsidence risk. Lincolnshire County Council have already implemented this research to prioritise approximately £600,000 of road maintenance fund to their minor road network. Further appreciation of the spatial distribution and understanding of soil-related hazards has also led Lincolnshire County Council to trial new resurfacing strategies; these new techniques helping to reduce carbon outputs in the form of materials and transport. A reduction in the amount of potential hazardous (bituminous) waste to landfill is also being achieved through re-inclusion of waste material back into the road foundation where areas are particularly prone to soil shrinkage. Our research shows that soil-related geohazard assessments have a part to play in the asset management of the UK's local highways network. The study supports the ICE's recommendation for a regime which moves towards planned, preventative maintenance and achieving Defra's (Department for Environment, Food and Rural Affairs) aim of a climate resilient UK infrastructure. The methodology introduced here also has applicability to other countries, where appropriate soils and infrastructure data are available.

Emergency management in health: key issues and challenges in the UK.

PubMed

Lee, Andrew C K; Phillips, Wendy; Challen, Kirsty; Goodacre, Steve

2012-10-19

Emergency planning in the UK has grown considerably in recent years, galvanised by the threat of terrorism. However, deficiencies in NHS emergency planning were identified and the evidence-base that underpins it is questionable. Inconsistencies in terminologies and concepts also exist. Different models of emergency management exist internationally but the optimal system is unknown. This study examines the evidence-base and evidence requirements for emergency planning in the UK health context. The study involved semi-structured interviews with key stakeholders and opinion leaders. Purposive sampling was used to obtain a breadth of views from various agencies involved in emergency planning and response. Interviews were then analysed using a grounded approach using standard framework analysis techniques. We conducted 17 key informant interviews. Interviewees identified greater gaps in operational than technical aspects of emergency planning. Social and behavioural knowledge gaps were highlighted with regards to how individuals and organisations deal with risk and behave in emergencies. Evidence-based approaches to public engagement and for developing community resilience to disasters are lacking. Other gaps included how knowledge was developed and used. Conflicting views with regards to the optimal configuration and operation of the emergency management system were voiced. Four thematic categories for future research emerged:(i) Knowledge-base for emergency management: Further exploration is needed of how knowledge is acquired, valued, disseminated, adopted and retained.(ii) Social and behavioural issues: Greater understanding of how individuals approach risk and behave in emergencies is required.(iii) Organisational issues in emergencies: Several conflicting organisational issues were identified; value of planning versus plans, flexible versus standardized procedures, top-down versus bottom-up engagement, generic versus specific planning, and reactive versus proactive approaches to emergencies.(iv) Emergency management system: More study is required of system-wide issues relating to system configuration and operation, public engagement, and how emergency planning is assessed.

Disposable versus non-disposable tonometer prisms: a UK national survey

PubMed Central

Jasani, Kirti M; Putri, Christine; Pearl, Amy; Sattar, Nayeem; Mercieca, Karl; Spaeth, George; Bhan-Bhargava, Archana

2017-01-01

Purpose To determine the prevalence of disposable tonometer versus non-disposable tonometer use in the UK and to determine methods of decontamination and frequency of replacement of prisms. A total of 137 ophthalmology departments were interviewed by telephone using a structured questionnaire. The main outcome measured were:types of tonometer prisms used in clinic (disposable, non-disposable and/or other)average disposable prisms used per clinic sessionaverage lifespan of non-disposable prismsprism preference by glaucoma and other teams within department. A cost and benefit analysis was then performed on the data acquired. Results One hundred and fifty-five departments were identified for the survey. Of these, 137 (88.3%) responded. Eighty-one departments (59.1%) used Tonosafe prisms alone, whereas 22 departments (16.1%) used Goldmann non-disposable prisms exclusively. Thirty-five departments (64%) on average have a change rate of 26.5% per year (range: 0–100, median: 20) attributed to damage, loss or theft. Sixteen departments (29%) reported that prisms were used until damaged or lost. Four departments (7%) were uncertain of their prism usage and could not provide further information. Conclusions Majority of eye departments in the UK opt for disposable prisms. This survey shows the perceived cost-effectiveness of disposable prisms is overestimated when the true cost of disinfection and damage is taken into account. Significant cost savings coupled with the low risk of infectivity (if decontaminated properly) should prompt clinicians and ophthalmic departments worldwide to reconsider the use of non-disposable prisms. PMID:29354698

What is the relation between number of sessions worked and productivity of radiologists-a pilot study?

PubMed

Khan, Shah H M; Hedges, William P

2016-04-01

Increasing workloads and the current austerity measures are putting UK radiology departments under considerable stress. We need to look at the most efficient ways to manage radiology departments in order to cope with increasing demand. Consequently, a system is needed that can compare productivity between radiologists with different jobs. We measured workload in a UK radiology department and compared the productivities of consultants working different numbers of sessions, which are called programmed activities (PAs), to identify the optimal job plan structure for reporting productivity. Reporting data was gathered from electronic records for 14 consultants working different numbers of PA during the period April 2010-March 2011. These were converted into relative value unit (RVU) scores using a modified RCSI RVU system. Crude and net workloads were calculated for each consultant by dividing their total RVU score by the number of PAs they were contracted for and how many they spent reporting. The consultants reported 118,001 imaging studies. There was statistically significant variation in productivity between consultants working different numbers of PAs on χ (2) analysis (p < 0.05). Consultants working 12 PAs were more productive than consultants working 11 PAs, with net workloads of 7636 RVU/PA/year versus net 6146 RVU/PA/year, p < 0.05. Although UK consultants working 12 PAs per week are more productive than their colleagues, the reasons why are unclear. We have identified a method that can be developed further to identify efficient working practices in UK radiology departments. However, a UK-specific RVU system would make this productivity analysis more accurate.

THE POTENTIAL FOR PHARMACISTS TO MANAGE CHILDREN ATTENDING EMERGENCY DEPARTMENTS.

PubMed

Terry, David; Petridis, Konstantinos; Aiello, Matt; Sinclair, Anthony; Huynh, Chi; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Hughes, Elizabeth

2016-09-01

There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0-16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training. A prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases-age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP-cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training-cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only-cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group. 1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0-16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60. Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

77 FR 33405 - Small Diameter Graphite Electrodes From the People's Republic of China: Affirmative Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-06

...The Department of Commerce (``Department'') preliminarily determines that certain small diameter graphite electrodes (``SDGE'') are being exported from the United Kingdom (``U.K.'') to the United States by UK Carbon and Graphite Co., Ltd. (``UKCG'') in circumvention of the antidumping duty order on SDGE from the People's Republic of China (``PRC''),\\1\\ as provided in section 781(b) of the Tariff Act of 1930, as amended (``the Act''). ---------------------------------------------------------------------------

Learning Outcomes in Higher Education: Assumptions, Positions and the Views of Early-Career Staff in the UK System

ERIC Educational Resources Information Center

Hadjianastasis, Marios

2017-01-01

According to the UK Quality Assurance Agency, the adoption and use of learning outcomes has been complete across UK higher education since 2007, when it declared that "most departments and institutions have fully adopted the principles of learning outcomes". And yet, the evidence from the ground to support this statement is currently…

U.K. science budget. Gene jocks, data crunchers hit jackpot.

PubMed

Pickrell, J

2000-12-01

Unveiling its science spending plan for the next 3 years, the U.K. government last week announced major new investments in three key areas: tracking disease genes, leveraging the Internet for data analysis, and supporting emerging industries such as nanotechnology and bioengineering. Although these programs cut across a range of disciplines funded by the U.K.'s science councils, the government also bestowed a long-anticipated gift on astronomers: membership in the European Southern Observatory, which will give U.K. researchers access to the world's largest optical telescope.

Letters to the Editor

NASA Astrophysics Data System (ADS)

1991-12-01

Radon variations D J Noble Plockton High School, Ross shire IV52 8TU, UK Environmental physics A T Jackson Belfast Institute of Further and Higher Education On mnemonic schemes A T Bardócz Teacher Training College, Szombathely, Hungary Regarding mnemonic devices for Maxwell's relations A H Kalantar Department of Chemistry, University of Alberta, Edmonton, Canada TG6 2G2 On an analogy for Ohm's law H S Fricker Bradford Grammar School Further reflections D Hinson `Brenig', Town Hill, Llanrwst, Gwynedd LL26 0NF, UK Moving charges W Jarvis 6 Peggy''s Mill Road, Edinburgh EH4 6JY, UK More on the distance travelled A Tan Department of Physics, Alabama A&M University, USA

Meeting the needs of people in emergencies: a review of UK experiences and capability

PubMed Central

Eyre, A

2008-01-01

This article summarises the key findings of two research studies conducted for the UK Government in 2006–2007. The first was a literature review of evidence about provisions and interventions to meet the needs of people affected by ‘emergencies’ as defined within the Civil Contingencies Act (2004). Drawing on both historical and contemporary research and practice, the literature review presented an assessment of people's psychosocial needs after events such as natural disasters, terrorism, and other major incidents. Although some reference was made about the needs of and consequences on disaster workers responding to these events, the main emphasis was on those directly affected as bereaved people and/or injured survivors. The review offered best practice guidelines based on the most effective methods of humanitarian assistance in the immediate, short-term, and long-term aftermath of major emergencies. The second report was a follow-up study conducted in 2007. This was a piece of primary research focusing on the UK's current capability in humanitarian assistance in terms of the extent of planning, training, exercising, and experience relating to meeting people's needs in emergencies. A variety of methods were used to gather quantitative and qualitative evidence of the nature and status of such activity across the UK, including questionnaires, focus groups, and a review of literature and documentary evidence. The report included a number of good practice case studies and made recommendations for the development of best practice in humanitarian assistance within the UK. PMID:22460218

Keep calm and carry on: the 2009 NEHA sabbatical exchange ambassador report.

PubMed

Barnett, Marcy

2011-06-01

Sabbatical goal as an environmental health specialist working with the California Department of Public Health as an emergency planner, I was interested in the NEHA sabbatical exchange program for the opportunity it affords its awardees to see how Canada and the United Kingdom utilize their environmental health workforce. Specifically, I wanted to examine the role environmental health has in the preparations being made for the 2012 Olympic Games to be held in London. I had a special interest in the emergency preparedness efforts related to the games as my work involves promoting the integration of environmental health into the emergency response structure. In California, environmental health services are delivered by several state agencies as well as 62 local jurisdictions. This multifaceted system tends to diminish the important role environmental health plays in disaster response and recovery operations due to the lack of a central focus, and as a result, environmental health is often an overlooked resource. This situation is not unique to California, as the emergency management system in the U.S. has traditionally focused primarily on "blue light" first responders: police, fire, and emergency medical services. After an article caught my eye on involving environmental health in emergency planning, posted on the Chartered Institute of Environmental Health (CIEH) (NEHA's counterpart in the UK) Web site, I became intrigued and used it to form the basis of my sabbatical mission.

The National Stroke Strategy - is it achievable?

PubMed

Reid, T D; Finney, L J; Hedges, A R

2009-11-01

Timing of intervention in symptomatic carotid disease is critical. The UK Department of Health's National Stroke Strategy published in December 2007 recommends urgent carotid intervention within 48 h, in appropriate patients, who have suffered a transient ischaemic attack (TIA), amaurosis fugax or minor stroke. Despite the running of a rapid-access clinic for patients with symptoms of TIA, the time from symptom to surgery is rarely less than 2 weeks. To date, there has been little published research on the UK public response to the symptoms of TIA, and no study at all of the response of primary care to such patients. The aim of this study was to ascertain both these responses to see whether a 48-h target is achievable. A total of 402 men attending our aortic aneurysm screening sessions were asked to complete a questionnaire requesting their most likely response to an episode of amaurosis fugax or TIA. All 45 GP practices in the hospital catchment area were asked how they would respond to patients requesting to be seen with the symptoms used in the questionnaire. Nearly one in six patients would ignore the symptom unless it recurred, approximately half would request a GP appointment and a third would see an optician if they had amaurosis fugax. The mean waiting time to see a GP was 2 days for a routine appointment and within 24 h for an emergency appointment. It is clear that a significant number of people would ignore the first symptom of carotid ischaemia; for those with amaurosis fugax, nearly a third would initially seek help from their optician. Those given a routine GP appointment would have to wait a minimum of 2 days. If the Department of Health is serious about reducing the incidence of stroke and introducing a target of 48 h from symptom to treatment, then there needs to be a wide-spread public and healthcare education programme, in particular alerting opticians and GP receptionists that these symptoms constitute a medical emergency.

A foot in two camps: an exploratory study of nurse leaders in universities.

PubMed

Ross, Fiona; Marks-Maran, Di; Tye, Christopher

2013-11-01

Nursing education was fully absorbed into universities in the United Kingdom in the late 1990s and thus is a relatively young academic discipline. In contrast to a lively literature on clinical nursing leadership, little attention has been given to the leadership of academic nursing as these roles encompass contract management, research and teaching. The purpose of this study was to explore the scope and meaning of leadership from the experience of nurse leaders in universities in the United Kingdom (UK). The qualitative design used open ended telephone interviews. Interview transcripts were checked with participants. Framework analysis was used for capturing and identifying themes. A convenience sample of academic nurse leaders (responsible for a School, Department or a Faculty) was identified through the UK Council of Deans of Health. All ten respondents were managing health care portfolios and running departments of various sizes and often with a mix of nursing and other health care disciplines. There was regional and country representation (England, Scotland and Wales) and half the respondents were employed at pre 1992 and half at post 1992 universities (the latter institutions that were previously polytechnics and gained university status in 1992). Three core issues emerged from the data: the leadership context; ways in which the deans articulated their leadership skills and the issue of legitimacy of nursing in higher education. Two important issues emerged for nursing deans, firstly the university as a knowledge producer and secondly the need to create strong academic and professional identities. The findings highlight role complexity as academic nurse leaders navigate the dichotomy between the different worlds of the university and health care practice. The legitimacy of nursing as a practice discipline in the university continues to be contested territory. There is an opportunity for nurse leaders to do more to develop a collective narrative about the contribution that academic nursing can make to the quality of the workforce. Copyright © 2013 Elsevier Ltd. All rights reserved.

An increase in accident and emergency presentations for adverse events following immunisation after introduction of the group B meningococcal vaccine: an observational study.

PubMed

Nainani, Viveka; Galal, Ushma; Buttery, Jim; Snape, Matthew D

2017-08-09

To determine whether the introduction of the capsular group B meningococcal vaccine (4CMenB) in the UK has increased presentations of infants to emergency departments with adverse events following immunisation (AEFI). A retrospective review of hospital records of infants aged 1-6 months presenting to Oxford University Hospitals NHS Trust's emergency departments from September 2013 to August 2016 with discharge diagnoses of vaccine reactions or non-specific conditions. Immunisation history was checked by reference to centralised immunisation records. Presentation classifications were 'probable vaccine reaction' (ie, symptoms within 48 hours of immunisation; no alternative cause found), 'possible vaccine reaction' (symptoms within 48 hours of immunisation with a possible alternative cause) or 'not related' (clear alternative diagnosis or not immunised within previous 48 hours). Prior to 4CMenB introduction (2013-15), an annual average of 12 infants presented with probable or possible AEFIs, increasing to 38 infants in the year following 4CMenB introduction (2015/2016). Rates of AEFIs per 1000 immunisation episodes increased post-4CMenB introduction from 1.03 to 3.4 (p<0.001) at 2 months and from 0.14 to 1.13 (p=0.005) at 4 months. At 3 months, when 4CMenB is not given, no increase was seen (p=0.380). 4CMenB introduction was also associated with increased AEFI-related hospital admissions, invasive investigations and intravenous antibiotic use. The increase in emergency department attendances, investigations and antibiotic use for AEFIs following 4CMenB immunisation may influence the cost-effectiveness of the 4CMenB immunisation campaign. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Persistence of Phytophthora ramorum and Phytophthora kernoviae in U.K. natural areas and implications for North American forests

Treesearch

Elizabeth J. Fichtner; David M. Rizzo; Joan Kirk Webber; Alistair. Whybrow

2010-01-01

Phytophthora kernoviae (Pk) and Phytophthora ramorum (Pr) are recently introduced pathogens in United Kingdom (U.K.) woodlands. Pk is also an emerging threat to coastal heathland where it infects Vaccinium myrtillus. In infested woodlands,...

Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility?

PubMed

Philip, Joe; Selvan, David; Desmond, Anthony D

2006-01-01

To report clinical findings associated with an increased incidence of mumps orchitis in Liverpool, UK, as in the last 2 years there has been a four-fold increase in the number of notified viral mumps cases in the UK. In the 8 months before April 2005, patients presenting to the Accident and Emergency/Urology Departments of the Royal Liverpool University Hospital with a diagnosis of epididymo-orchitis were identified from the emergency urological admission database. Of 195 males presenting with an acute history of testicular pain and swelling, 25 gave a history of mumps parotitis 4-11 days earlier. Three had bilateral orchitis and two needed scrotal exploration to exclude torsion. Scrotal ultrasonography findings varied from increased vascularity to abnormal testicular echo texture. Treatment included analgesia, scrotal support, re-hydration and broad-spectrum antibiotics. Of the 10 patients followed-up to date, four had testicular abnormalities; one had persistent testicular pain, one a change in testicular consistency, one a noticeably reduced size of one testis, and one significant testicular atrophy. As postpubertal mumps in males is associated with a 40% incidence of orchitis, parents should be made aware that failing to immunize their children threatens the future fertility of their sons. Young men not immunized as children should be counselled and offered urgent vaccination. Clinicians should be aware that epididymo-orchitis may be secondary to mumps infection even with no history or clinical evidence of parotitis.

Emerging and legacy flame retardants in UK human milk and food suggest slow response to restrictions on use of PBDEs and HBCDD.

PubMed

Tao, Fang; Abou-Elwafa Abdallah, Mohamed; Ashworth, Danielle C; Douglas, Philippa; Toledano, Mireille B; Harrad, Stuart

2017-08-01

The legacy flame retardants (LFRs) polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCDD), together with six emerging flame retardants (EFRs) were measured in United Kingdom (UK) human milk collected in 2010 (n=25) and 2014-15 (n=10). These data are the first report of the presence of EFRs in UK human milk. The most abundant EFR was β-tetrabromoethylcyclohexane (DBE-DBCH) (average=2.5ng/g lw; geometric mean=1.5ng/g lw), which is comparable to the concentrations of the most abundant LFRs i.e. BDE 47 and α-HBCDD at 2.8 and 2.1ng/g lw, respectively (geometric mean=2.1 and 1.7). The estimated median dietary intake of ΣEFRs by UK nursing infants was 18ng/kg bw/day. EFRs were also measured in UK foodstuffs with β-DBE-DBCH again the predominant compound detected, accounting - on average - for 64.5±23.4% of ΣEFRs. Average estimated dietary intakes of ∑EFRs in the UK were 89 and 26ng/day (1.3 and 2.6ng/body weight/day) for adults and toddlers, respectively. Concentrations of Σtri-hexa BDEs in our UK food samples exceeded those reported in UK samples from the same food categories collected in 2003-04 and 2006. Despite this and our recent report elsewhere of significant temporal declines in concentrations of BDE 209 in UK indoor dust (p<0.05) and HBCDDs in UK indoor dust and air (p<0.001), no significant temporal differences (p>0.05) were observed between concentrations of Σtri-hexa BDEs, BDE 209 and HBCDDs in human milk sampled in 2010 and those obtained in 2014-15. UK adult body burdens for EFRs were predicted via inhalation, diet and dust ingestion using a simple pharmacokinetic model. The predicted EFR body burdens compared well with observed concentrations in human milk. Copyright © 2017 Elsevier Ltd. All rights reserved.

Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms--a qualitative study.

PubMed

Shefer, Guy; Henderson, Claire; Howard, Louise M; Murray, Joanna; Thornicroft, Graham

2014-01-01

We conducted a qualitative study in the Emergency Departments (EDs) of four hospitals in order to investigate the perceived scope and causes of 'diagnostic overshadowing'--the misattribution of physical symptoms to mental illness--and other challenges involved in the diagnostic process of people with mental illness who present in EDs with physical symptoms. Eighteen doctors and twenty-one nurses working in EDs and psychiatric liaisons teams in four general hospitals in the UK were interviewed. Interviewees were asked about cases in which mental illness interfered with diagnosis of physical problems and about other aspects of the diagnostic process. Interviews were transcribed and analysed thematically. Interviewees reported various scenarios in which mental illness or factors related to it led to misdiagnosis or delayed treatment with various degrees of seriousness. Direct factors which may lead to misattribution in this regard are complex presentations or aspects related to poor communication or challenging behaviour of the patient. Background factors are the crowded nature of the ED environment, time pressures and targets and stigmatising attitudes held by a minority of staff. The existence of psychiatric liaison team covering the ED twenty-four hours a day, seven days a week, can help reduce the risk of misdiagnosis of people with mental illness who present with physical symptoms. However, procedures used by emergency and psychiatric liaison staff require fuller operationalization to reduce disagreement over where responsibilities lie.

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

PubMed

Back, Jonathan; Ross, Alastair J; Duncan, Myanna D; Jaye, Peter; Henderson, Katherine; Anderson, Janet E

2017-11-01

Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined"). Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Methoxyflurane: A Review in Trauma Pain.

PubMed

Blair, Hannah A; Frampton, James E

2016-12-01

Methoxyflurane (Penthrox ® ) is a halogenated ether first used clinically as a volatile inhalational anaesthetic. It has been used as an analgesic in Australia and New Zealand for the past 30 years. In the UK and Europe, methoxyflurane has been approved for the emergency relief of moderate to severe trauma pain in conscious adult patients. Methoxyflurane is self-administered using a hand-held inhaler. This article reviews the pharmacological properties of methoxyflurane and its clinical efficacy and tolerability in these patients. In the phase III STOP! trial, methoxyflurane was effective and generally well tolerated for the management of acute pain due to minor trauma, with a rapid onset of analgesia. In a prospective study, methoxyflurane was more effective than intramuscular tramadol when administered for the treatment of acute musculoskeletal pain in the pre-hospital setting (i.e. by paramedics). Methoxyflurane had a more rapid onset of action than tramadol when administered for the treatment of pain related to ankle injuries in the emergency department. Although methoxyflurane is known to be potentially nephrotoxic at anaesthetic doses, the much lower doses used for pain relief were not associated with nephrotoxicity or an increased risk of renal disease. Inhaled methoxyflurane may offer advantages over other analgesics administered via the intravenous, intramuscular or intranasal routes in terms of its non-invasive self-administration, ease of use and/or rapid onset of action. As such, it is a useful additional treatment option for the management of trauma pain in the pre-hospital or emergency department setting.

Reconstructing the emergence of a lethal infectious disease of wildlife supports a key role for spread through translocations by humans

PubMed Central

Cunningham, Andrew A.; Langton, Tom E. S.

2016-01-01

There have been few reconstructions of wildlife disease emergences, despite their extensive impact on biodiversity and human health. This is in large part attributable to the lack of structured and robust spatio-temporal datasets. We overcame logistical problems of obtaining suitable information by using data from a citizen science project and formulating spatio-temporal models of the spread of a wildlife pathogen (genus Ranavirus, infecting amphibians). We evaluated three main hypotheses for the rapid increase in disease reports in the UK: that outbreaks were being reported more frequently, that climate change had altered the interaction between hosts and a previously widespread pathogen, and that disease was emerging due to spatial spread of a novel pathogen. Our analysis characterized localized spread from nearby ponds, consistent with amphibian dispersal, but also revealed a highly significant trend for elevated rates of additional outbreaks in localities with higher human population density—pointing to human activities in also spreading the virus. Phylogenetic analyses of pathogen genomes support the inference of at least two independent introductions into the UK. Together these results point strongly to humans repeatedly translocating ranaviruses into the UK from other countries and between UK ponds, and therefore suggest potential control measures. PMID:27683363

Safety of vaginal delivery among dichorionic diamniotic twins over 10 years in a UK teaching hospital.

PubMed

Rzyska, Ewelina; Ajay, Bini; Chandraharan, Edwin

2017-01-01

To determine whether vaginal delivery among dichorionic diamniotic twins remains a safe option following full implementation of the European Working Time Directive in the UK. A retrospective study was conducted using data for women with dichorionic diamniotic twin pregnancies who attended a teaching hospital in London, UK, for delivery between January 4, 2000, and December 23, 2010. Among 892 women, 474 (53.1%) attempted vaginal delivery, 220 (46.4%) of whom achieved spontaneous vaginal delivery of both twins. Instrumental vaginal delivery was performed among 89 women (18.8%), and 165 (34.8%) women underwent emergency cesarean delivery. Delivery of the second twin by emergency cesarean (n=31) was predominantly for fetal distress (13 [41.9%]) or abnormal lie (10 [32.3%]). A 5-minute Apgar score of 9 or 10 was recorded for 384 (83.7%) of 459 first twins and 369 (82.9%) of 445 second twins, irrespective of the mode of delivery. Vaginal delivery among dichorionic diamniotic twins had a good success rate and a low intrapartum emergency cesarean delivery rate. Training in cardiotocography and intrapartum procedures might further reduce the need for emergency cesarean delivery. © 2016 International Federation of Gynecology and Obstetrics.

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST).

PubMed

Babl, Franz E; Lyttle, Mark D; Bressan, Silvia; Borland, Meredith; Phillips, Natalie; Kochar, Amit; Dalziel, Stuart R; Dalton, Sarah; Cheek, John A; Furyk, Jeremy; Gilhotra, Yuri; Neutze, Jocelyn; Ward, Brenton; Donath, Susan; Jachno, Kim; Crowe, Louise; Williams, Amanda; Oakley, Ed

2014-06-13

Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria. This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting. The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014).

Communicating geohazard information for emergency responders, a case study from the UK.

NASA Astrophysics Data System (ADS)

Banks, Vanessa; Cooper, Anthony

2016-04-01

SSS11.4/ESSI4.6/HS11.39/NH9.13 Communication of uncertain information in earth sciences: data, models and visualization Communicating geohazard information for emergency responders, a case study from the UK. Cooper, A. H.1, Banks, V.J.1, Cowup, P.2, Curness, J.3, Davis, R.4, Dawson, L3. and Gazzard, L.4 1 British Geological Survey, Keyworth, NG12 5GG, UK 2 London Fire Brigade, 169 Union Street, London, SE1 0LL, UK 3.Coventry University, Priory Street, Coventry, CV1 5FB, UK 4.Avon Fire and Rescue, Temple Back, Bristol, BS1 6EU, UK. In February 2013 a sinkhole opened beneath a Florida Home resulting in the loss of a life and demolition of the affected home. The resulting void was in the order of 15 m deep. Neighbouring homes also had to be demolished. Television footage of this unfortunate incident resonated with an Assistant Commissioner of the London Fire Brigade who questioned whether or not such a feature would be recognised in the UK and if so, how the emergency response would be managed. Stemming from this, the British Geological Survey was invited to work with the Chief Fire Officers Association Urban Search and Rescue working group on geohazards. The aim of this group was to develop national tactical operational guidance on geohazards that would form the basis for regional guidance and training. The project was addressed collaboratively providing opportunities for two students from the Coventry University Disaster Management course, that were on placements with Avon Fire and Rescue, to work with the BGS to develop the guidance. Key to the success of the project was an iterative approach to knowledge exchange with respect to firstly, the characterization of the geohazards, and the processes and uncertainties associated with them and secondly, with respect to emergency responders' needs and priorities. Effective communication was achieved through challenging and rationalising the geoscience language for the end user and through a series of customised illustrations that portray the geohazard and associated zoning for response management. This paper shows the value of BGS data in developing resilience through preparedness, describes the approach to this project and the key outcomes in terms of geohazard communication, as well as considering how the project may develop in the future.

Digital pathology access and usage in the UK: results from a national survey on behalf of the National Cancer Research Institute's CM-Path initiative.

PubMed

Williams, Bethany Jill; Lee, Jessica; Oien, Karin A; Treanor, Darren

2018-05-01

To canvass the UK pathology community to ascertain current levels of digital pathology usage in clinical and academic histopathology departments, and prevalent attitudes to digital pathology. A 15-item survey was circulated to National Health Service and academic pathology departments across the UK using the SurveyMonkey online survey tool. Responses were sought at a departmental or institutional level. Where possible, departmental heads were approached and asked to complete the survey, or forward it to the most relevant individual in their department. Data were collected over a 6-month period from February to July 2017. 41 institutes from across the UK responded to the survey. 60% (23/39) of institutions had access to a digital pathology scanner, and 60% (24/40) had access to a digital pathology workstation. The most popular applications of digital pathology in current use were undergraduate and postgraduate teaching, research and quality assurance. Investigating the deployment of digital pathology in their department was identified as a high or highest priority by 58.5% of institutions, with improvements in efficiency, turnaround times, reporting times and collaboration in their institution anticipated by the respondents. Access to funding for initial hardware, software and staff outlay, pathologist training and guidance from the Royal College of Pathologists were identified as factors that could enable respondent institutions to increase their digital pathology usage. Interest in digital pathology adoption in the UK is high, with usage likely to increase in the coming years. In light of this, pathologists are seeking more guidance on safe usage. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Digital pathology access and usage in the UK: results from a national survey on behalf of the National Cancer Research Institute’s CM-Path initiative

PubMed Central

Williams, Bethany Jill; Lee, Jessica; Oien, Karin A; Treanor, Darren

2018-01-01

Aim To canvass the UK pathology community to ascertain current levels of digital pathology usage in clinical and academic histopathology departments, and prevalent attitudes to digital pathology. Methods A 15-item survey was circulated to National Health Service and academic pathology departments across the UK using the SurveyMonkey online survey tool. Responses were sought at a departmental or institutional level. Where possible, departmental heads were approached and asked to complete the survey, or forward it to the most relevant individual in their department. Data were collected over a 6-month period from February to July 2017. Results 41 institutes from across the UK responded to the survey. 60% (23/39) of institutions had access to a digital pathology scanner, and 60% (24/40) had access to a digital pathology workstation. The most popular applications of digital pathology in current use were undergraduate and postgraduate teaching, research and quality assurance. Investigating the deployment of digital pathology in their department was identified as a high or highest priority by 58.5% of institutions, with improvements in efficiency, turnaround times, reporting times and collaboration in their institution anticipated by the respondents. Access to funding for initial hardware, software and staff outlay, pathologist training and guidance from the Royal College of Pathologists were identified as factors that could enable respondent institutions to increase their digital pathology usage. Conclusion Interest in digital pathology adoption in the UK is high, with usage likely to increase in the coming years. In light of this, pathologists are seeking more guidance on safe usage. PMID:29317516

The state of UK anaesthesia: a survey of National Health Service activity in 2013.

PubMed

Sury, M R J; Palmer, J H M G; Cook, T M; Pandit, J J

2014-10-01

Details of current UK anaesthetic practice are unknown and were needed for interpretation of reports of accidental awareness during general anaesthesia (GA) within the 5th National Audit Project. We surveyed NHS anaesthetic activity to determine numbers of patients managed by anaesthetists and details of 'who, when, what, and where': activity included GA, local anaesthesia, sedation, or patients managed awake. Anaesthetists in NHS hospitals collected data on all patients for 2 days. Scaling enabled estimation of annual activity. Hospital response rate was 100% with 20,400 returns. The median return rate within departments was 98% (inter-quartile range 0.95-1). Annual numbers (% of total) of general anaesthetics, sedation, and awake cases were 2,766,600 (76.9%), 308,800 (8.6%), and 523,100 (14.5%), respectively. A consultant or career grade anaesthetist was present in more than 87% of cases. Emergency cases accounted for 23.1% of workload, 75% of which were undertaken out of hours. Specialties with the largest workload were orthopaedics/trauma (22.1%), general surgery (16.1%), and gynaecology (9.6%): 6.2% of cases were non-surgical. The survey data describe: who anaesthetized patients according to time of day, urgency, and ASA grade; when anaesthesia took place by day and by weekday; the distribution of patient types, techniques, and monitoring; where patients were anaesthetized. Nine patients out of 15 460 receiving GA died intraoperatively. Anaesthesia in the UK is currently predominantly a consultant-delivered service. The low mortality rate supports the safety of UK anaesthetic care. The survey data should be valuable for planning and monitoring anaesthesia services. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Underage drinking in the UK: changing trends, impact and interventions. A rapid evidence synthesis.

PubMed

Healey, Christine; Rahman, Atif; Faizal, Mohammad; Kinderman, Peter

2014-01-01

The UK is a high prevalence country for underage alcohol use. We conducted an evidence synthesis to examine (1) the changing trends in underage drinking in the UK compared to Europe and the USA, (2) the impact of underage drinking in terms of hospital admissions, (3) the association between underage drinking and violent youth offending, and (4) the evidence base for the effectiveness of alcohol harm reduction interventions aimed at children and adolescents under the age of 18 years. The following databases were searched from November 2002 until November 2012: Cochrane Database of Systematic Reviews, National Institute for Health and Clinical Excellence, The Evidence for Policy and Practice Information, DARE, Medline, The Campbell Collaboration, CINAHL, Criminal Justice Abstracts, Psych INFO and Social Care Online. Our findings revealed changes in the way children drink in the UK and how much they drink. Alcohol related harms are increasing in the UK despite overall population levels of consumption reducing in this age group. Girls aged 15-16 years report binge drinking and drunkenness more than boys. Girls are also more likely than boys to be admitted to hospital for alcohol related harm. The evidence suggests a strong association between heavy episodic binge drinking and violent youth offending. Only 7 out of 45 randomised controlled trials (RCTs) identified for this review included children and adolescents under the age of 18 years. Most were delivered in the emergency department (ED) and involved a brief intervention. All were characterised by a wide age range of participants, heterogeneous samples and high rates of refusal and attrition. The authors conclude that whilst the ED might be the best place to identify children and adolescents at risk of harm related to alcohol use it might not be the best place to deliver an intervention. Issues related to a lack of engagement with alcohol harm reduction interventions have been previously overlooked and warrant further investigation. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA.

PubMed

Suruki, Robert Y; Daugherty, Jonas B; Boudiaf, Nada; Albers, Frank C

2017-04-27

Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK. Patients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT (2010-2011; WEUSKOP7048) and the UK-based Clinical Practice Research Datalink (2009-2011; WEUSKOP7092) databases were categorized by disease severity (Global Initiative for Asthma [GINA]; Step and exacerbation history) during the 12 months pre-asthma medical code (index date). Outcomes included: frequency of exacerbations (asthma-related ED visit, hospitalization, or oral corticosteroid use with an asthma medical code recorded within ±2 weeks) 12 months post-index, asthma-related ED visits/hospitalization, and asthma-related costs 30 days post-index. Risk of a subsequent exacerbation was determined by proportional hazard model. Of the 222,817 and 211,807 patients with asthma included from the US and UK databases, respectively, 12.5 and 8.4% experienced ≥1 exacerbation during the follow-up period. Exacerbation frequency increased with disease severity. Among the 5,167 and 2,904 patients with an asthma-related ED visit/hospitalization in the US and UK databases, respectively, 9.2 and 4.7% had asthma-related re-admissions within 30 days. Asthma-related re-admission rates and costs increased with disease severity, approximately doubling between GINA Step 1 and 5 and in patients with ≥2 versus <2 exacerbations in the previous year. Risk of a subsequent exacerbation increased 32-35% for an exacerbation requiring ED visit/hospitalization versus oral corticosteroids. Increased disease severity was associated with higher exacerbation frequency, ED/hospitalization re-admission, costs and risk of subsequent exacerbation, indicating that these patients require high-intensity post-exacerbation management.

Safe and sustainable increases in day case emergency surgery.

PubMed

Hotchen, Andrew J; Coleman, Grant; O'Callaghan, John M; McWhinnie, Doug

2016-03-01

Selected patients referred to emergency general surgery departments are suitable for day case emergency surgery with no overnight hospital stay. There are no well-described sustainable pathways for these expedited operations and in many hospitals patients undergo unnecessary admissions and experience long waiting times. The authors proposed a new, sustainable, day case emergency surgery pathway which was implemented to streamline the assessment, treatment and discharge of acute surgical referrals. It requires rapid assessment of the patient by a senior clinician, and ready availability of diagnostic services and operating facilities. To assess this pathway, the authors conducted a prospective audit of general surgical referrals to a district general hospital in the UK. During the inclusion period 746 emergency referrals were assessed, 281 (37%) of these underwent an operation. Over a 5-month investigation period, the audit found that approximately 27% of all emergency general surgery patients requiring an operation could be managed with day case emergency surgery. This figure was maintained throughout the duration of the study. Operations included incision and drainage of abscesses, incarcerated hernia repairs and appendicectomies. The average length of stay of all surgical admissions decreased from 5 days to less than 3 days and the median time to senior review was 30 minutes. The authors have developed a pathway involving permanent members of the surgical assessment team that is sustainable over a 5-month period. The pathway has allowed rapid assessment of patients and reduced unnecessary inpatient stay in a sustainable and reproducible manner.

UK nuclear medicine survey, 1992-93.

PubMed

Elliott, A T; Elliott, F M; Shields, R A

1996-01-01

A postal survey of UK nuclear medicine departments was undertaken to collate information on equipment, numbers of procedures and staffing levels for the years 1992 and 1993. It was estimated that there are 235 sites undertaking nuclear medicine, the total number of procedures performed being some 490,000 in 1993 compared with 430,000 in 1989. Informal investigation suggests that the increase is due to greater usage of myocardial perfusion and lung ventilation/perfusion studies. Wide variations were noted in staffing levels, with only 22% of departments having medical cover of half-time equivalent or better: over 30% of departments have less than one consultant session per week. Approximately 20% of departments claimed to have no physics input, with a further 20% having less than one session per week.

An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study.

PubMed

McDevitt, Joe; Melby, Vidar

2015-02-01

To evaluate the quality of the emergency nurse practitioner service provided to people presenting to a rural urgent care centre with minor injuries. The three objectives that were focused were an evaluation of the safety and effectiveness of the emergency nurse practitioner service, an assessment of patients' satisfaction with the emergency nurse practitioner service and a determination of factors that may enhance the quality of the emergency nurse practitioner service. Urgent care centres have become increasingly prevalent across the UK. Emergency nurse practitioner services at these rural urgent care centres remain largely unevaluated. This study attempts to redress this deficit by evaluating the quality of an emergency nurse practitioner service in relation to the care of patients presenting with minor injuries to a rural urgent care centre. This descriptive study used a case-note review and a survey design with one open-ended exploratory question. Patient views were collected using a self-completed questionnaire and a data extraction tool to survey patients' case notes retrospectively. Despite comparatively low total length-of-stay times, most patients felt they had enough time to discuss things fully with the emergency nurse practitioner. Although emergency nurse practitioners routinely impart injury advice, feedback from some patients suggests a need for the provision of more in-depth information regarding their injury. The vast majority (97·3%) of patients felt that the quality of the emergency nurse practitioner service was of a high standard. Contrary to some other studies, the findings in this study indicate that patient satisfaction is not influenced by waiting times. Emergency nurse practitioners in rural urgent care centres have the potential to deliver a safe and effective quality service that is reflected in high levels of patient satisfaction. This study provides some evidence to support the continued expansion of the emergency nurse practitioner service in rural settings in the UK. © 2014 John Wiley & Sons Ltd.

Letters to the Editor

NASA Astrophysics Data System (ADS)

1995-05-01

Stirling 1994Lis Unsworth and Alexander BellSCOTVEC External Verifiers in Physical Sciences, Edinburgh, UK An elephant in the back seatJ M HathawayRetired Head of Physics, King Edward VI College, Nuneaton, UK Graphical construction of the tangent law of refractionA TanDepartment of Physics, Alabama A & M University, Normal, AL 35762, USA Measuring up to rainJim FawcettKing's School, Worcester, UK No flies on trainsCyril IsenbergUniversity of Kent at Canterbury, UK More on flies and trainsAlvin H BachmanThe City College/CUNY, NEW York, USA

Universities give record level of support to the UK economy

NASA Astrophysics Data System (ADS)

Banks, Michael

2009-08-01

Universities in the UK are providing record levels of services to businesses, according to a recent survey by the Department for Business, Innovation and Skills (BIS) and the Higher Education Funding Council for England. The survey concludes that the income earned by universities and higher-education colleges in the UK is now worth a total of £2.812bn - an increase of 6.5% from the previous year.

Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network.

PubMed

Saunders, D I; Murray, D; Pichel, A C; Varley, S; Peden, C J

2012-09-01

Emergency laparotomy is a common intra-abdominal procedure. Outcomes are generally recognized to be poor, but there is a paucity of hard UK data, and reports have mainly been confined to single-centre studies. Clinicians were invited to join an 'Emergency Laparotomy Network' and to collect prospective non-risk-adjusted outcome data from a large number of NHS Trusts providing emergency surgical care. Data concerning what were considered to be key aspects of perioperative care, including thirty-day mortality, were collected over a 3 month period. Data from 1853 patients were collected from 35 NHS hospitals. The unadjusted 30 day mortality was 14.9% for all patients and 24.4% in patients aged 80 or over. There was a wide variation between units in terms of the proportion of cases subject to key interventions that may affect outcomes. The presence of a consultant surgeon in theatre varied between 40.6% and 100% of cases, while a consultant anaesthetist was present in theatre for 25-100% of cases. Goal-directed fluid management was used in 0-63% of cases. Between 0% and 68.9% of the patients returned to the ward (level one) after surgery, and between 9.7% and 87.5% were admitted to intensive care (level three). Mortality rates varied from 3.6% to 41.7%. This study confirms that emergency laparotomy in the UK carries a high mortality. The variation in clinical management and outcomes indicates the need for a national quality improvement programme.

Current UK practice in emergency laparotomy

PubMed Central

Barrow, E; Varley, S; Pichel, AC; Peden, CJ; Saunders, DI; Murray, D

2013-01-01

Introduction Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Methods Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Results Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. ‘True’ emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. Conclusions This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study. PMID:24165345

Current UK practice in emergency laparotomy.

PubMed

Barrow, E; Anderson, I D; Varley, S; Pichel, A C; Peden, C J; Saunders, D I; Murray, D

2013-11-01

Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

Piloting a real-time surface water flood nowcasting system for enhancing operational resilience of emergency responders

NASA Astrophysics Data System (ADS)

Yu, Dapeng; Guan, Mingfu; Wilby, Robert; Bruce, Wright; Szegner, Mark

2017-04-01

Emergency services (such as Fire & Rescue, and Ambulance) can face the challenging tasks of having to respond to or operate under extreme and fast changing weather conditions, including surface water flooding. UK-wide, return period based surface water flood risk mapping undertaken by the Environment Agency provides useful information about areas at risks. Although these maps are useful for planning purposes for emergency responders, their utility to operational response during flood emergencies can be limited. A street-level, high resolution, real-time, surface water flood nowcasting system, has been piloted in the City of Leicester, UK to assess emergency response resilience to surface water flooding. Precipitation nowcasting over 7- and 48-hour horizons are obtained from the UK Met Office and used as inputs to the system. A hydro-inundation model is used to simulate urban surface water flood depths/areas at both the city and basin scale, with a 20 m and 3 m spatial resolution respectively, and a 15-minute temporal resolution, 7-hour and 48-hour in advance. Based on this, we evaluate both the direct and indirect impacts of potential surface water flood events on emergency responses, including: (i) identifying vulnerable populations (e.g. care homes and schools) at risk; and (ii) generating novel metrics of accessibility (e.g. travel time from service stations to vulnerable sites; spatial coverage with certain legislative timeframes) in real-time. In doing so, real-time information on potential risks and impacts of emerging flood incidents arising from intense rainfall can be communicated via a dedicated web-based platform to emergency responders thereby improving response times and operational resilience.

A retrospective analysis of 34 potentially missed cases of female genital mutilation in the emergency department.

PubMed

Fawcett, Richard John; Kernohan, George

2017-09-12

To discover if healthcare professionals working within an ED are able to make a diagnosis of female genital mutilation (FGM) in those patients who have previously undergone the procedure and report it as per UK law. A retrospective analysis of patients' notes who were assigned an FGM code during the period of May 2015 to August 2016. Single-centre, large UK major trauma centre offering a tertiary FGM clinic. Any woman coded during the study period as having undergone FGM. Number of FGM cases identified by the ED. Mean age, presenting complaint, discharge diagnosis, genitourinary exam and defibulation status. 34 patients were identified as having undergone FGM, 19 had previously attended ED and none had their FGM identified during their ED attendance. The age range of those identified was 23 to 40 years. None had undergone defibulation. This study demonstrates that the identification of FGM victims by an ED is very poor, and more work needs to be done to increase awareness of the subject by front-line staff. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

'1966 and all that': Trends and developments in UK ergonomics during the 1960s.

PubMed

Waterson, Patrick; Eason, Ken

2009-11-01

The 1960s represents a key decade in the expansion of ergonomics within the UK. This paper reviews trends and developments that emerged out of the 1960s and compares these with ergonomics research and practice today. The focus in particular is on the expansion of ergonomics as a discipline within industry, as well as more specific topics, such as the emergence of areas of interest, for example, computers and technology, automation and systems ergonomics and consumer ergonomics. The account is illustrated with a detailed timeline of developments, a set of industrial case studies and the contents of important publications during the decade. A key aim of the paper is to provide the opportunity to reflect on the past and the implications this may have for future directions for ergonomics within the UK. The paper provides practitioners with an insight into the development of ergonomics in the UK during one of the most important decades of its history. This is especially relevant given the fact that in 2009 the Ergonomics Society celebrates its 60th anniversary.

The Emergence and Development of Bioethics in the Uk

PubMed Central

Chadwick, Ruth; Wilson, Duncan

2018-01-01

ABSTRACT Bioethics emerged in a specific social and historical context. Its relationship to older traditions in medical ethics and to environmental ethics is an ongoing matter of debate. This article analyses the social, institutional, and economic factors that led to the development of bioethics in the UK in the 1980s, and the course it has taken since. We show how phenomena such as globalisation, the focus on ‘ethical legal and social issues’ and the empirical turn have affected the methods employed, and argue that ongoing controversies about the nature and possibility of ethical expertise will affect its future. PMID:29635295

The Emergence and Development of Bioethics in the Uk.

PubMed

Chadwick, Ruth; Wilson, Duncan

2018-05-01

Bioethics emerged in a specific social and historical context. Its relationship to older traditions in medical ethics and to environmental ethics is an ongoing matter of debate. This article analyses the social, institutional, and economic factors that led to the development of bioethics in the UK in the 1980s, and the course it has taken since. We show how phenomena such as globalisation, the focus on 'ethical legal and social issues' and the empirical turn have affected the methods employed, and argue that ongoing controversies about the nature and possibility of ethical expertise will affect its future.

Potential Threats Posed by New or Emerging Marine Biotoxins in UK Waters and Examination of Detection Methodology Used in Their Control: Brevetoxins

PubMed Central

Turner, Andrew D.; Higgins, Cowan; Davidson, Keith; Veszelovszki, Andrea; Payne, Daniel; Hungerford, James; Higman, Wendy

2015-01-01

Regular occurrence of brevetoxin-producing toxic phytoplankton in commercial shellfishery areas poses a significant risk to shellfish consumer health. Brevetoxins and their causative toxic phytoplankton are more limited in their global distribution than most marine toxins impacting commercial shellfisheries. On the other hand, trends in climate change could conceivably lead to increased risk posed by these toxins in UK waters. A request was made by UK food safety authorities to examine these toxins more closely to aid possible management strategies, should they pose a threat in the future. At the time of writing, brevetoxins have been detected in the Gulf of Mexico, the Southeast US coast and in New Zealand waters, where regulatory levels for brevetoxins in shellfish have existed for some time. This paper reviews evidence concerning the prevalence of brevetoxins and brevetoxin-producing phytoplankton in the UK, together with testing methodologies. Chemical, biological and biomolecular methods are reviewed, including recommendations for further work to enable effective testing. Although the focus here is on the UK, from a strategic standpoint many of the topics discussed will also be of interest in other parts of the world since new and emerging marine biotoxins are of global concern. PMID:25775421

Health is global: proposals for a UK Government-wide strategy.

PubMed

Donaldson, Liam; Banatvala, Nicholas

2007-03-10

Global health enables the harmonisation of international and domestic-health concerns-its outlook is much wider than a development or foreign-assistance perspective alone. Engaging globally in health requires the creation of relevant and effective partnerships to implement solutions for shared or common problems. To build on the UK's achievements and leadership in global health, the central government Department of Health is now leading the development of a UK Government-wide global strategy. This paper describes the rationale and process for developing the new UK Government-wide strategy for global health and highlights some of the issues that must be discussed.

Control chart applications in healthcare: a literature review

NASA Astrophysics Data System (ADS)

Suman, Gaurav; Prajapati, DeoRaj

2018-05-01

The concept of Statistical process control (SPC) was given by the physicist Walter Shewhart in order to improve the industrial manufacturing. The SPC was firstly applied in laboratory and after then shifted to patient level in hospitals. As there is more involvement of human in healthcare, the chances of errors are also more. SPC i.e., control chart can help in determining the source of errors by identifying the special and common causes of variations. This paper presents the review of literature on the application of SPC and control chart in healthcare sector. Forty articles are selected out of 142 potentially relevant searched studies. Selected studies are categorised into eight departments. Literature survey shows that most of work on control chart applications in healthcare is carried out in Surgery, Emergency and Epidemiology departments. US, UK and Australia are the main customers where maximum amount of work was done. The US is the country where control chart in healthcare sector have been used at regular interval. This shows the gap of deploying control chart in different departments and different countries as well. The CUSUM and EWMA chart came into picture in healthcare sector after 2008 and are used at regular interval.

Availability and use of capnography for in-hospital cardiac arrests in the United Kingdom.

PubMed

Turle, Sarah; Sherren, Peter B; Nicholson, Stuart; Callaghan, Thomas; Shepherd, Stephen J

2015-09-01

Airway complications occur more frequently outside the operating theatre and in emergency situations. Capnography remains the gold standard for confirming correct endotracheal tube placement, retaining high sensitivity and specificity in cardiac arrest. The 2010 European Resuscitation Council guidelines for adult advanced life support recommended waveform capnography in this setting. We investigated current UK practice relating to the availability and use of this technology during cardiac arrest. Between June and November 2014, a study was conducted of all UK acute hospitals with both a level three adult intensive care unit (ICU) and an emergency department (ED). A telephone questionnaire was administered examining intubation practice and utilisation of capnography within the ED, ICU and general wards. Two hundred and eleven hospitals met the inclusion criteria. The response rate was 100%. Arrests were mainly attended by anaesthesia (48%) and ICU physicians (38%) of registrar grade (56%). The ability to measure end tidal carbon dioxide (ETCO2) was available in all but 4 EDs; most used in waveform devices. Most ICUs were similar. However, in 67% of hospitals surveyed, it was not possible to measure ETCO2 in general wards. Where available, 87% used capnography to confirm ETT placement with less than 50% using ETCO2 to determine CPR effectiveness and 8% to prognosticate. We believe this is the first study of its kind to fully investigate the availability and use of capnography during cardiac arrest throughout the hospital. Whilst equipment provision appears adequate in critical care areas, it is insufficient in general wards. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

RESEARCH ON ENDOCRINE DISRUPTERS IN THE AQUATIC ENVIRONMENT BY THE UNITED STATES ENVIRONMENTAL PROTECTION AGENCY

EPA Science Inventory

Research on Endocrine Disrupters in the Aquatic Environment by the United States Environmental Protection Agency (Abstract). Presented at the Endocrine Disrupters Workshop sponsored by the UK Department of Environment, Food and Rural Affairs, 8-9 September 2001, Weymouth, UK. 1 p...

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol

PubMed Central

Sayers, Adele E; Drake, Thomas M; Hollyman, Marianne; Bradburn, Mike; Hind, Daniel; Wilson, Timothy R; Fearnhead, Nicola S; Abercrombie, John

2017-01-01

Introduction Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. Methods and analysis UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. Ethics and dissemination This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives. PMID:28982819

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol.

PubMed

Lee, Matthew J; Sayers, Adele E; Drake, Thomas M; Hollyman, Marianne; Bradburn, Mike; Hind, Daniel; Wilson, Timothy R; Fearnhead, Nicola S

2017-10-05

Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Management of acute paracetamol (acetaminophen) toxicity: a standardised proforma improves risk assessment and overall risk stratification by emergency medicine doctors.

PubMed

McQuade, David J; Aknuri, Srikanth; Dargan, Paul I; Wood, David M

2012-12-01

Paracetamol (acetaminophen) poisoning is the most common toxicological presentation in the UK. Doctors managing patients with paracetamol poisoning need to assess the risk of their patient developing hepatotoxicity before determining appropriate treatment. Patients deemed to be at 'high risk' of hepatotoxicity have lower treatment thresholds than those deemed to be at 'normal risk'. Errors in this process can lead to harmful or potentially fatal under or over treatment. To determine how well treating doctors assess risk factor status and whether a standardised proforma is useful in the risk stratification process. Retrospective 12-month case note review of all patients presenting with paracetamol poisoning to our large inner-city emergency department. Data were collected on the documentation of risk factors, the presence of a local hospital proforma and treatment outcomes. 249 presentations were analysed and only 59 (23.7%) had full documentation of all the risk factors required to make a complete risk assessment. 56 of the 59 (94.9%) had the local hospital proforma included in the notes; the remaining 3 (5.1%) had full documentation of risk factors despite the absence of a proforma. A local hospital proforma was more likely to be included in the emergency department notes in those with 'adequate documentation' (78 out of 120 (65%)) than for those with 'inadequate documentation' (16 out of 129 (12.4%)); X(2), p<0.001. Despite a low overall uptake of the proforma, use of a standardised proforma significantly increased the likelihood of documentation of the risk factors which increase risk for hepatotoxicity following paracetamol poisoning.

UK Hazard Assessment for a Laki-type Volcanic Eruption

NASA Astrophysics Data System (ADS)

Witham, Claire; Felton, Chris; Daud, Sophie; Aspinall, Willy; Braban, Christine; Loughlin, Sue; Hort, Matthew; Schmidt, Anja; Vieno, Massimo

2014-05-01

Following the impacts of the Eyjafjallajokull eruption in 2010, two types of volcanic eruption have been added to the UK Government's National Risk Register for Civil Emergencies. One of these, a large gas-rich volcanic eruption, was identified as a high impact natural hazard, one of the three highest priority natural hazards faced by the UK. This eruption scenario is typified by the Laki eruption in Iceland in 1783-1784. The Civil Contingency Secretariat (CCS) of the UK's Cabinet Office, responsible for Civil Protection in the UK, has since been working on quantifying the risk and better understanding its potential impacts. This involves cross-cutting work across UK Government departments and the wider scientific community in order to identify the capabilities needed to respond to an effusive eruption, to exercise the response and develop increased resilience where possible. As part of its current work, CCS has been working closely with the UK Met Office and other UK agencies and academics (represented by the co-authors and others) to generate and assess the impacts of a 'reasonable worst case scenario', which can be used for decision making and preparation in advance of an eruption. Information from the literature and the findings of an expert elicitation have been synthesised to determine appropriate eruption source term parameters and associated uncertainties. This scenario is then being used to create a limited ensemble of model simulations of the dispersion and chemical conversion of the emissions of volcanic gases during such an eruption. The UK Met Office's NAME Lagrangian dispersion model and the Centre for Ecology and Hydrology's EMEP4UK Eulerian model are both being used. Modelling outputs will address the likelihood of near-surface concentrations of sulphur and halogen species being above specified health thresholds. Concentrations at aviation relevant altitudes will also be evaluated, as well as the effects of acid deposition of volcanic species on ecosystems. Modelling results from a preliminary study have suggested a risk to both human health and the environment in the UK and across other parts of Europe from harmful levels of sulphate aerosol (as previously recognised from modelling of a Laki-type eruption by Schmidt et al (2011), amongst others), but also sulphur dioxide, which has not received as much attention. The presentation will discuss the UK's national assessment of risk and how the Government works to prepare for newly identified high impact hazards. We will show how this is benefitting from innovative approaches being taken in the research community and more detailed modelling findings will be presented. We will demonstrate that this work is a good example of practical hazard assessment through collaboration of scientists with decision makers. This work also has wider reaching links back to Supersite and observations initiatives such as the FUTUREVOLC project, as improved monitoring of source characteristics will enable the UK to refine its models (both numerical and procedural) for better risk management. "This work is distributed under the Creative Commons Attribution 3.0 Unported License together with an author copyright. This license does not conflict with the regulations of the Crown Copyright."

Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK

PubMed Central

Kovats, R; Hajat, S; Wilkinson, P

2004-01-01

Background: Epidemiological research has shown that mortality increases during hot weather and heat waves, but little is known about the effect on non-fatal outcomes in the UK. Aims and Methods: The effects of hot weather and heat waves on emergency hospital admissions were investigated in Greater London, UK, for a range of causes and age groups. Time series analyses were conducted of daily emergency hospital admissions, 1 April 1994 to 31 March 2000, using autoregressive Poisson models with adjustment for long term trend, season, day of week, public holidays, the Christmas period, influenza, relative humidity, air pollution (ozone, PM10), and overdispersion. The effects of heat were modelled using the average of the daily mean temperature over the index and previous two days. Results: There was no clear evidence of a relation between total emergency hospital admissions and high ambient temperatures, although there was evidence for heat related increases in emergency admissions for respiratory and renal disease, in children under 5, and for respiratory disease in the 75+ age group. During the heat wave of 29 July to 3 August 1995, hospital admissions showed a small non-significant increase: 2.6% (95% CI –2.2 to 7.6), while daily mortality rose by 10.8% (95% CI 2.8 to 19.3) after adjusting for time varying confounders. Conclusions: The impact of hot weather on mortality is not paralleled by similar magnitude increases in hospital admissions in the UK, which supports the hypothesis that many heat related deaths occur in people before they come to medical attention. This has evident implications for public health, and merits further enquiry. PMID:15477282

UK Parents' Beliefs about Applied Behaviour Analysis as an Approach to Autism Education

ERIC Educational Resources Information Center

Denne, Louise D.; Hastings, Richard P.; Hughes, J. Carl

2017-01-01

Research into factors underlying the dissemination of evidence-based practice is limited within the field of Applied Behaviour Analysis (ABA). This is pertinent, particularly in the UK where national policies and guidelines do not reflect the emerging ABA evidence base, or policies and practices elsewhere. Theories of evidence-based practice in…

The New Decade: A Watershed in UK Higher Education?

ERIC Educational Resources Information Center

McNay, Ian

2012-01-01

This article first draws together a range of published statistics to analyse trends in participation in higher education in the UK over recent years. That provides evidence of the shifting profile in the student population and sets a context for examining emerging evidence of the impact of recent government policy decisions on control of student…

Re-Invigorating Openness at The Open University: The Role of Open Educational Resources

ERIC Educational Resources Information Center

Gourley, Brenda; Lane, Andy

2009-01-01

This paper describes the internal motivations and external drivers that led The Open University UK to enter the field of Open Educational Resources through its institution-wide OpenLearn initiative (www.open.ac.uk/openlearn). It also describes some of the emerging evidence of the impacts inside and outside the university. Through the rapid…

The Interpersonal World of Direct Marketing: Examining Conventions of Quality at UK Farmers' Markets

ERIC Educational Resources Information Center

Kirwan, James

2006-01-01

Inherent within emerging new food supply chains (FSCs) in the UK in recent years, and in particular those based upon direct marketing, is the (re)connection of production--consumption processes and concomitantly producers and consumers. New forms of connection are apparent, as food produce is differentiated on the basis of quality constructs which…

Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg?

PubMed

Parry, S; Bundle, N; Ullah, S; Foster, G R; Ahmad, K; Tong, C Y W; Balasegaram, S; Orkin, C

2018-06-01

UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The 'Going Viral' campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.

An emergency department registration kiosk can increase HIV screening in high risk patients.

PubMed

Hsieh, Yu-Hsiang; Gauvey-Kern, Megan; Peterson, Stephen; Woodfield, Alonzo; Deruggiero, Katherine; Gaydos, Charlotte A; Rothman, Richard E

2014-12-01

We evaluated the feasibility and the patient acceptability of integrating a kiosk into routine emergency department (ED) practice for offering HIV testing. The work was conducted in four phases: phase 1 was a baseline, in which external testing staff offered testing at the bedside; phase 2 was a pilot assessment of a prototype kiosk; phase 3 was a pilot implementation and phase 4 was the full implementation with automated login. Feasibility was assessed by the proportion of offering HIV tests, acceptance, completion and result reporting. During the study period, the number of ED patients and eligible patients for screening were similar in the three main phases. However, the number and proportion of patients offered testing of those eligible for screening increased significantly from phase 1 (32%) to phase 3 (37%) and phase 4 (40%). There were slightly higher prevalences of newly diagnosed HIV with kiosk versus bedside testing (phase 1, 0%; phase 3, 0.2%; phase 4, 0.5%). Compared to patients tested at the bedside, patients tested via the kiosk were significantly younger, more likely to be female, to be black, and to report high risk behaviours. ED-based HIV screening via a registration-based kiosk was feasible, yielded similar proportions of testing, and increased the proportion of engagement of higher-risk patients in testing. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Radiotherapy physics research in the UK: challenges and proposed solutions

PubMed Central

Mackay, R I; Burnet, N G; Green, S; Illidge, T M; Staffurth, J N

2012-01-01

In 2011, the Clinical and Translational Radiotherapy Research Working Group (CTRad) of the National Cancer Research Institute brought together UK radiotherapy physics leaders for a think tank meeting. Following a format that CTRad had previously and successfully used with clinical oncologists, 23 departments were asked to complete a pre-meeting evaluation of their radiotherapy physics research infrastructure and the strengths, weaknesses, opportunities and threats within their own centre. These departments were brought together with the CTRad Executive Group and research funders to discuss the current state of radiotherapy physics research, perceived barriers and possible solutions. In this Commentary, we summarise the submitted materials, presentations and discussions from the meeting and propose an action plan. It is clear that there are challenges in both funding and staffing of radiotherapy physics research. Programme and project funding streams sometimes struggle to cater for physics-led work, and increased representation on research funding bodies would be valuable. Career paths for academic radiotherapy physicists need to be examined and an academic training route identified within Modernising Scientific Careers; the introduction of formal job plans may allow greater protection of research time, and should be considered. Improved access to research facilities, including research linear accelerators, would enhance research activity and pass on developments to patients more quickly; research infrastructure could be benchmarked against centres in the UK and abroad. UK National Health Service departments wishing to undertake radiotherapy research, with its attendant added value for patients, need to develop a strategy with their partner higher education institution, and collaboration between departments may provide enhanced opportunities for funded research. PMID:22972972

Radiotherapy physics research in the UK: challenges and proposed solutions.

PubMed

Mackay, R I; Burnet, N G; Green, S; Illidge, T M; Staffurth, J N

2012-10-01

In 2011, the Clinical and Translational Radiotherapy Research Working Group (CTRad) of the National Cancer Research Institute brought together UK radiotherapy physics leaders for a think tank meeting. Following a format that CTRad had previously and successfully used with clinical oncologists, 23 departments were asked to complete a pre-meeting evaluation of their radiotherapy physics research infrastructure and the strengths, weaknesses, opportunities and threats within their own centre. These departments were brought together with the CTRad Executive Group and research funders to discuss the current state of radiotherapy physics research, perceived barriers and possible solutions. In this Commentary, we summarise the submitted materials, presentations and discussions from the meeting and propose an action plan. It is clear that there are challenges in both funding and staffing of radiotherapy physics research. Programme and project funding streams sometimes struggle to cater for physics-led work, and increased representation on research funding bodies would be valuable. Career paths for academic radiotherapy physicists need to be examined and an academic training route identified within Modernising Scientific Careers; the introduction of formal job plans may allow greater protection of research time, and should be considered. Improved access to research facilities, including research linear accelerators, would enhance research activity and pass on developments to patients more quickly; research infrastructure could be benchmarked against centres in the UK and abroad. UK National Health Service departments wishing to undertake radiotherapy research, with its attendant added value for patients, need to develop a strategy with their partner higher education institution, and collaboration between departments may provide enhanced opportunities for funded research.

The use of emergency contraception in Australasian emergency departments.

PubMed

Millar, J R; Leach, D S; Maclean, A V; Kovacs, G T

2001-09-01

To review the prescribing of emergency contraception by emergency departments in Australasia and compare it with other providers. A postal questionnaire was sent to the director of each of the 79 Australasian College for Emergency Medicine accredited emergency departments in Australasia inquiring about the availability and prescribing habits for emergency contraception within each department. Of the 79 emergency departments, 69 (87.3%) responded to the questionnaire and were aware of the 'emergency contraception regimen'. The majority of departments prescribed appropriately (56%) and only one department did not arrange adequate follow up. Anti-emetics are always used by 45 departments (78.9%). Discussion of future contraceptive needs at the time of presentation was only undertaken by 25 departments (43.9%). Written clinical guidelines for emergency contraception were present in 28 departments (40.6%). Emergency departments are accessed by patients requesting contraception following unprotected intercourse or contraceptive failure. The prescribing of emergency contraception in Australasian emergency departments is comparable with other providers but substantial improvements could be made. Suggestions to assist this improvement include written clinical guidelines and patient information and purpose-made medication packs.

Updated posters to help manage medical emergencies in the dental practice.

PubMed

Jevon, P

2015-09-11

Medical emergencies can occur in the dental practice. Medical Emergencies in the Dental Practice and Emergency Drugs in the Dental Practice posters have been designed to help dental practitioners to respond effectively and safely to a medical emergency. These posters, endorsed by the British Dental Association, are included with this issue of the British Dental Journal. Further copies can be downloaded from: https://www.walsallhealthcare.nhs.uk/medical-education.aspx.

75 FR 13556 - Biocompatibles UK Ltd.; Filing of Color Additive Petition

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-C-0077] Biocompatibles UK Ltd.; Filing of Color Additive Petition AGENCY: Food and Drug Administration, HHS. ACTION... filed a petition proposing that the color additive regulations be amended to provide for the safe use of...

Using Space to Inspire and Engage Children

ERIC Educational Resources Information Center

Clements, Allan

2015-01-01

The European Space Education Resources Office (ESERO-UK) is a project of the European Space Agency (ESA) and national partners including the Department for Education (DfE), The UK Space Agency (UKSA) and the Science and Technology Facilities Council (STFC). The key objective of the project is to promote space as an exciting inspirational context…

Diagnostic Testing at UK Universities: An E-Mail Survey

ERIC Educational Resources Information Center

Gillard, Jonathan; Levi, Margaret; Wilson, Robert

2010-01-01

In July 2009, an e-mail survey was sent to various UK universities to gain information regarding current practices concerning mathematics diagnostic testing, and to provide an update from the review "Diagnostic Testing for Mathematics" published by the LTSN MathsTEAM Project in 2003. A total of 38 university departments were contacted…

The discrepancy rate between preliminary and official reports of emergency radiology studies: a performance indicator and quality improvement method.

PubMed

Issa, Ghada; Taslakian, Bedros; Itani, Malak; Hitti, Eveline; Batley, Nicholas; Saliba, Miriam; El-Merhi, Fadi

2015-05-01

At teaching hospitals, radiology residents give preliminary reports for imaging studies requested from the Emergency Department (ED). Discrepancy rates between preliminary and final reports represent an important performance indicator. To present a system for feedback and follow-up of discrepancies, identify the variables associated with the rate and severity of such discrepancies, target the weaknesses, and suggest the need of a standard reference value for comparison among institutions. A monitoring and communication system between the Department of Diagnostic Radiology and Emergency Department was initiated to mark and follow all studies from the ED for which the official reading was different than the preliminary interpretation. Data analysis was performed on all studies from 1 June 2011 to 31 May 2012, based on the severity of the discrepancy, imaging modality, resident training level, and organ system. The distribution of the number of discrepancies among the different resident levels and imaging modalities was determined, as well as the distribution of three severity scores in correlation with other variables. The overall discrepancy rate was 1.62%. The discrepancy rate was higher for first and second year residents (1.62% and 1.96%) than for third and fourth year residents (1.35% and 1.24%). It was higher for computed tomography (2.13%) than for radiographs (1.29%) and ultrasound (0.8%) (P value < 0.01), and higher for musculoskeletal (1.61%) than non-musculoskeletal (0.99%) radiographs (P value = 0.0003). Discrepancies with severity score one constituted 35.5% of the total discrepancies, those with severity scores two and three constituted 22.9% and 41.6%, respectively. We have demonstrated a system for follow-up of discrepancy in interpreting emergency radiology studies, and recorded the discrepancy rate, with further analysis based on different variables. In terms of quality assurance, a periodical analysis might help to reduce the number of discrepant reports by targeted intervention. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Open Science Strategies in Research Policies: A Comparative Exploration of Canada, the US and the UK

ERIC Educational Resources Information Center

Lasthiotakis, Helen; Kretz, Andrew; Sá, Creso

2015-01-01

Several movements have emerged related to the general idea of promoting "openness" in science. Research councils are key institutions in bringing about changes proposed by these movements, as sponsors and facilitators of research. In this paper we identify the approaches used in Canada, the US and the UK to advance open science, as a…

Conference call.

PubMed

2002-03-01

The RCN A&E Nursing Association, Black Country A&E professional development group and University of Wolverhampton school of health are holding the Emergency Nursing Research 2002 conference on March 6 in Wolverhampton. For more information, contact Alastair Gray by phone on 01902 307999 ext 2055 or by email at a.d.gray@wlv.ac.uk. Details available at www.man.ac.uk/rcn/conference/enrc2002.doc.

When Rights Are Not Enough: What Is? Moving towards New Pedagogy for Inclusive Education within UK Universities

ERIC Educational Resources Information Center

Gibson, Suanne

2015-01-01

There is confusion surrounding "Inclusion". The aims and drivers of inclusive education (IE) as experienced in the 1990s to early 2000s, in the UK and globally, emerged from a "successful" disability rights movement with its depiction of the medical model as pejorative and promotion of the social model. In education, what we…

Favoured Free-Time: Comparing Children's Activity Preferences in the UK and the USA

ERIC Educational Resources Information Center

Griffiths, Merris

2011-01-01

This study presents a comparative study of the free-time activity preferences of 9- to 11-year-old children in the UK and USA, as drawn by them in art workshops. Six themes emerged relating to sport, outdoor play, family/peers, media, special occasions and other (indefinable) activities. The children's talk about their drawings revealed additional…

Revisions to Rationality: The Translation of "New Knowledges" into Policy under the Coalition Government

ERIC Educational Resources Information Center

McGimpsey, Ian; Bradbury, Alice; Santori, Diego

2017-01-01

This article gives an account of the use of knowledges from emerging scientific fields in education and youth policy making under the Coalition government (2010-15) in the UK. We identify a common process of "translation" and offer three illustrations of policy-making in the UK that utilise diverse knowledges produced in academic fields…

Continuous bioprocessing: the real thing this time? 10(th) Annual bioProcessUK Conference, December 3-4, 2013, London, UK.

PubMed

Farid, Suzanne S; Thompson, Bill; Davidson, Andrew

2014-01-01

The Annual bioProcessUK Conference has acted as the key networking event for bioprocess scientists and engineers in the UK for the past 10 years. The following article is a report from the sessions that focused on continuous bioprocessing during the 10(th) Annual bioProcessUK Conference (London, December 2013). These sessions were organized by the 'EPSRC Centre for Innovative Manufacturing in Emergent Macromolecular Therapies' hosted at University College London. A plenary lecture and workshop provided a forum for participants to debate topical issues in roundtable discussions with industry and academic experts from institutions such as Genzyme, Janssen, Novo Nordisk, Pfizer, Merck, GE Healthcare and University College London. The aim of these particular sessions was to understand better the challenges and opportunities for continuous bioprocessing in the bioprocessing sector.

Designing and implementing E-health Applications in the UK's National Health Service.

PubMed

Bower, D Jane; Barry, Nessa; Reid, Margaret; Norrie, John

2005-12-01

Telemedicine/e-health applications have the potential to play an important role in Britain's National Health Service (NHS), including the NHS in Scotland. The Scottish Telemedicine Action Forum (STAF) was established by the Scottish Executive Department of Health in 1999 to take a range of applications, targeted on national priorities, into routine service. In the process it has provided insights into how advanced information and communication technologies (ICTs) can be moved from the research stage into routine service. In this article four of the projects are described and analysed focusing on the key issues that have emerged as critical for carrying projects successfully through to implementation in service as follows: 1. A multisite videoconferencing network linking 15 minor injury units to the main accident and emergency (A&E) centre. 2. A single-site neonatal intensive care "cotside" laptop system to assist communication between parents and clinical staff. 3. A single-site outpatient chronic disease management system. 4. A multisite software audit tool to support the care of cleft lip and palate patients from birth onward.

Should nurses be trained to use ultrasound for intravenous access to patients with difficult veins?

PubMed

Smith, Claire

2018-06-14

Peripheral venous access is the most common invasive procedure performed on patients in the UK and is traditionally the responsibility of nursing staff. In an emergency, intravenous therapy can be lifesaving. Approximately 11% of adults have difficult venous access and are often subjected to repeated failed attempts, resulting in delayed diagnosis and treatment. Eventually, rescue methods are used by a doctor, but this increases demand on their time and the workflow of emergency departments. This article explores whether training nurses to obtain venous access using ultrasound would have a positive effect on doctors' workload and benefit adult patients with difficult veins. Research indicates that nurses can successfully use ultrasound to reduce the number of attempts, time to access and patient discomfort, and can prevent the insertion of unnecessary central lines. Ultrasound training programmes for nurses demonstrate benefits for patients and clinicians. © 2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Factors influencing the decision to use nurse practitioners in the emergency department.

PubMed

McGee, Laurie A; Kaplan, Louise

2007-10-01

Emergency department overcrowding is a serious problem nationwide. Of an estimated 14 million visits to hospital emergency departments, only 12.9% are considered emergent. Many emergency departments, however, employ only physicians despite the fact that nurse practitioners have a proven record of providing high quality, cost-effective care in the emergency department. The purpose of the study was to determine factors that influence the decision to use nurse practitioners in the emergency department. Interviews were conducted with ED managers in hospitals that both employ and do not employ nurse practitioners in the emergency department. In this study, the primary reason that nurse practitioners were not employed by emergency departments was that physician groups with whom the hospitals contract refuse to use nurse practitioners. Emergency department managers of facilities with nurse practitioners reported high levels of satisfaction with the nurse practitioners performance. The 2 ED managers without nurse practitioners in their facility were highly supportive of having nurse practitioners in the emergency department and have advocated for hiring nurse practitioners. Education needs to occur with emergency departments regarding the value of the nurse practitioner's role to the facility. Research is needed to investigate why emergency department physician groups resist hiring nurse practitioners. Increased staffing with nurse practitioners in the emergency department can serve to reduce overcrowding, reduce waiting times, and increase patient satisfaction.

The development of the specialism of emergency medicine: media and cultural influences.

PubMed

Timmons, Stephen; Nairn, Stuart

2015-01-01

In this article we analyse, via a critical review of the literature, the development of a relatively new medical specialism in the United Kingdom, that of emergency medicine. Despite the high media profile of emergency care, it is a low-status specialism within UK medicine. The creation of a specialist College in 2008 means that, symbolically, recognition as a full specialism has now been achieved. In this article, we will show, using a sociology of professions approach, how emergency medicine defined itself as a specialism, and sought to carve out a distinctive jurisdiction. While, in the context of the UK National Health Service, the state was clearly an important factor in the development of this profession, we wish to develop the analysis further than is usual in the sociology of professions. We will analyse the wider cultural context for the development of this specialism, which has benefited from its high profile in the media, through both fictional and documentary sources. © The Author(s) 2014.

Initial experience in setting up a medical student first responder scheme in South Central England.

PubMed

Seligman, William H; Ganatra, Sameer; England, David; Black, John J M

2016-02-01

Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention in many undergraduate medical curricula. However, there is growing interest in PHEM among medical students and junior doctors. Several programmes are in existence across the UK that serve to provide teaching and exposure of prehospital care to medical students and junior doctors. However, relatively few students are able to gain significant first-hand experience of treating patients in the prehospital phase. In this short report, we discuss our experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Medical students are trained by the regional ambulance service and respond to life-threatening medical emergencies in an ambulance response vehicle. The scheme is likely to benefit the ambulance service by providing a wider pool of trained volunteer first responders able to attend to emergency calls, to benefit patients by providing a quick response at their time of need, and to benefit medical students by providing first-hand experience of medical emergencies in the community. In its first 15 months of operation, SFRs were dispatched to 343 incidents. This scheme can serve as a training model for other ambulance services and medical schools across the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

HIV-1 drug resistance mutations emerging on darunavir therapy in PI-naive and -experienced patients in the UK.

PubMed

El Bouzidi, Kate; White, Ellen; Mbisa, Jean L; Sabin, Caroline A; Phillips, Andrew N; Mackie, Nicola; Pozniak, Anton L; Tostevin, Anna; Pillay, Deenan; Dunn, David T

2016-12-01

Darunavir is considered to have a high genetic barrier to resistance. Most darunavir-associated drug resistance mutations (DRMs) have been identified through correlation of baseline genotype with virological response in clinical trials. However, there is little information on DRMs that are directly selected by darunavir in clinical settings. We examined darunavir DRMs emerging in clinical practice in the UK. Baseline and post-exposure protease genotypes were compared for individuals in the UK Collaborative HIV Cohort Study who had received darunavir; analyses were stratified for PI history. A selection analysis was used to compare the evolution of subtype B proteases in darunavir recipients and matched PI-naive controls. Of 6918 people who had received darunavir, 386 had resistance tests pre- and post-exposure. Overall, 2.8% (11/386) of these participants developed emergent darunavir DRMs. The prevalence of baseline DRMs was 1.0% (2/198) among PI-naive participants and 13.8% (26/188) among PI-experienced participants. Emergent DRMs developed in 2.0% of the PI-naive group (4 mutations) and 3.7% of the PI-experienced group (12 mutations). Codon 77 was positively selected in the PI-naive darunavir cases, but not in the control group. Our findings suggest that although emergent darunavir resistance is rare, it may be more common among PI-experienced patients than those who are PI-naive. Further investigation is required to explore whether codon 77 is a novel site involved in darunavir susceptibility. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Influencing Health Policy in the Antenatal and Postnatal Periods: The UK Experience

ERIC Educational Resources Information Center

Hawthorne, Joanna

2015-01-01

Since 1997, the Brazelton Centre UK has offered courses to a wide range of professionals working with newborn infants and their families. In 2009, the Neonatal Behavioral Assessment Scale was recommended in the Healthy Child Programme by the Department of Health. Both the Neonatal Behavioral Assessment Scale and the Newborn Behavioral Observations…

Mediating Science and Society in the EU and UK: From Information-Transmission to Deliberative Democracy?

ERIC Educational Resources Information Center

Tlili, Anwar; Dawson, Emily

2010-01-01

In this paper we critically review recent developments in policies, practices and philosophies pertaining to the mediation between science and the public within the EU and the UK, focusing in particular on the current paradigm of Public Understanding of Science and Technology (PEST) which seeks to depart from the science information-transmission…

Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10-2012/2013: a longitudinal study.

PubMed

Tammes, Peter; Morris, Richard W; Brangan, Emer; Checkland, Kath; England, Helen; Huntley, Alyson; Lasserson, Daniel; MacKichan, Fiona; Salisbury, Chris; Wye, Lesley; Purdy, Sarah

2017-08-08

The UK National Health Service Emergency Departments (ED) have recently faced increasing attendance rates. This study investigated associations of general practice and practice population characteristics with emergency care service attendance rates. A longitudinal design with practice-level measures of access and continuity of care, patient population demographics and use of emergency care for the financial years 2009/10 to 2012/13. The main outcome measures were self-referred discharged ED attendance rate, and combined self-referred discharged ED, self-referred Walk-in Centre (WiC) and self-referred Minor Injuries Unit (MIU) attendance rate per 1000 patients. Multilevel models estimated adjusted regression coefficients for relationships between patients' emergency attendance rates and patients' reported satisfaction with opening hours and waiting time at the practice, proportion of patients having a preferred GP, and use of WiC and MIU, both between practices, and within practices over time. Practice characteristics associated with higher ED attendance rates included lower percentage of patients satisfied with waiting time (0.22 per 1% decrease, 95%CI 0.02 to 0.43) and lower percentage having a preferred GP (0.12 per 1% decrease, 95%CI 0.02 to 0.21). Population influences on higher attendance included more elderly, more female and more unemployed patients, and lower male life-expectancy and urban conurbation location. Net reductions in ED attendance were only seen for practices whose WiC or MIU attendance was high, above the 60th centile for MIU and above the 75th centile for WiC. Combined emergency care attendance fell over time if more patients within a practice were satisfied with opening hours (-0.26 per 1% increase, 95%CI -0.45 to -0.08). Practices with more patients satisfied with waiting time, having a preferred GP, and using MIU and WIC services, had lower ED attendance. Increases over time in attendance at MIUs, and patient satisfaction with opening hours was associated with reductions in service use.

Committee on air pollution effects research: 40 years of UK air pollution.

PubMed

Fowler, David; Dise, Nancy; Sheppard, Lucy

2016-01-01

The UK Committee on Air Pollution Effects Research (CAPER) was established 40 years ago. This special section was compiled to mark this anniversary. During this time there have been dramatic changes in the composition of the air over the UK. The four papers in this special section of Environmental Pollution represent the current air pollution effects research focus on ozone and nitrogen deposition, two related issues and are proving from a policy perspective to be quite intractable issues. The UK CAPER research community continues to advance the underpinning science and engages closely with the user community in government departments. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals.

PubMed

Raghavendran, S; Bagry, H S; Leith, S; Budd, J M

2006-09-01

Hospital staff are at risk from occupational exposure to blood-borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.

Issues in the Articulation of "Impact": The Responses of UK Academics to "Impact" as a New Measure of Research Assessment

ERIC Educational Resources Information Center

Watermeyer, Richard

2014-01-01

This paper reflects on the emergence of an impact agenda and its incorporation as a feature of the academic contract in UK universities. It focuses on the depositions of senior academic managers across a range of social science research centres, as they critically reflect upon their organizational strategy for capturing and communicating the…

Money, Finance and the Personalisation Agenda for People with Learning Disabilities in the UK: Some Emerging Issues

ERIC Educational Resources Information Center

Abbott, David; Marriott, Anna

2013-01-01

In the UK, policy on adult social care places an emphasis on maximising choice and control for service users, including people with learning disabilities. The shift from the provision of organised services for groups of people to offering individual and personal budgets and pots of money for people to buy their own services has major implications…

Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA).

PubMed

Dhatariya, Ketan K; Vellanki, Priyathama

2017-05-01

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries. Large-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK. The diagnosis of HHS in the USA is based on total rather than effective osmolality. Unlike the USA, the UK has separate guidelines for DKA and HHS. Treatment of DKA and HHS also differs with respect to timing of fluid and insulin initiation. There is considerable overlap but important differences between the UK and USA guidelines for the management of DKA and HHS. Further research needs to be done to delineate a unifying diagnostic and treatment protocol.

Identification, assessment and management of new and re-emerging animal-related risks: UK perspective.

PubMed

Kosmider, R; Gibbens, J; R, Avigad

2017-07-15

Veterinary surveillance programmes aim to reduce the burden to the public, livestock and wider society posed by animal-related ‘risks’ (referred to as ‘threats’ later in the paper in line with a definition used by the European Food Safety Authority) including the reemergence of diseases believed absent or eradicated. To achieve this, it is important to have a systematic approach to identifying and dealing with such threats rapidly and effectively. This paper describes the transparent, systematic and auditable process used for identifying, assessing, escalating and prioritising new and re-emerging animal-related threats in the UK. This has been achieved through the establishment of a Veterinary Risk Group in late 2009.

Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study

PubMed Central

Parkinson, Kathryn; Newbury-Birch, Dorothy; Phillipson, Angela; Hindmarch, Paul; Kaner, Eileen; Stamp, Elaine; Vale, Luke; Wright, John; Connolly, Jim

2016-01-01

Background Alcohol related hospital attendances are a potentially avoidable burden on emergency departments (EDs). Understanding the number and type of patients attending EDs with alcohol intoxication is important in estimating the workload and cost implications. We used best practice from previous studies to establish the prevalence of adult alcohol related ED attendances and estimate the costs of clinical management and subsequent health service use. Methods The setting was a large inner city ED in northeast England, UK. Data were collected via (i) retrospective review of hospital records for all ED attendances for four pre-specified weeks in 2010/2011 to identify alcohol related cases along with 12 months of follow-up of the care episode and (ii) prospective 24/7 assessment via breath alcohol concentration testing of patients presenting to the ED in the corresponding weeks in 2012/2013. Results The prevalence rates of alcohol related attendances were 12% and 15% for the retrospective and prospective cohorts, respectively. Prospectively, the rates ranged widely from 4% to 60% across week days, rising to over 70% at weekends. Younger males attending in the early morning hours at weekends made up the largest proportion of alcohol related attendances. The mean cost per attendance was £249 (SD £1064); the mean total cost for those admitted was £851 (SD £2549). The most common reasons for attending were trauma related injuries followed by psychiatric problems. Conclusions Alcohol related attendances are a major and avoidable burden on emergency care. However, targeted interventions at weekends and early morning hours could capture the majority of cases and help prevent future re-attendance. PMID:26698364

Beware the yellow slimming pill: fatal 2,4-dinitrophenol overdose.

PubMed

Holborow, Alexander; Purnell, Richard M; Wong, Jenny Frederina

2016-04-04

An industrial chemical, 2,4-dinitrophenol (DNP), has found use as a weight loss drug. It is extremely toxic in overdose and has a narrow therapeutic window with significant interindividual variability in metabolism. The rise in internet-based sales and distribution of this drug has seen an increased incidence of both accidental and intentional overdose presenting to emergency departments across the UK. No antidote currently exists and overdose is often fatal despite management based on current recommendations. We report a case of intentional overdose of DNP in a young man and discuss the current treatment guidelines. The case highlights the need for an increased awareness among frontline medical staff of the effects of DNP poisoning and questions the need for a more aggressive approach in the management of acute toxicity. 2016 BMJ Publishing Group Ltd.

The composition of precarity: 'emerging' composers' experiences of opportunity culture in contemporary classical music.

PubMed

Smith, Neil Thomas; Thwaites, Rachel

2018-02-28

This paper examines the precarious working lives of 'emerging' composers attempting to build a career in the world of new classical music in the UK. This topic is approached by considering the 'composition opportunity', success in which is seen as an important element in 'making it' in this sphere. We argue that such schemes in fact manifest a crucial tension in the nature of artistic labour, and are, at the very least, problematic in their function as conduits towards full professional identity. They may instead act to maintain the precarious working situation of composers in a neoliberal age. The working lives of artists are all too rarely illuminated, and new music composers are no exception; this survey of 47 emerging composers is the largest study of such individuals in the UK. © London School of Economics and Political Science 2018.

Food for thought: an ethnographic study of negotiating ill health and food insecurity in a UK foodbank.

PubMed

Garthwaite, K A; Collins, P J; Bambra, C

2015-05-01

Emergency foodbanks have become an increasingly prominent and controversial feature of austerity in Europe and the USA. In the UK, foodbanks have been called a 'public health emergency'. Despite this, there has been no UK research examining the health of foodbank users. Through an ethnographic study, this paper is the first to explore the health and health perceptions of foodbank users via a case study of Stockton-on-Tees in the North East of England, UK during a period of welfare reform and austerity. Participant observation, field notes and interviews with foodbank users and volunteers were conducted over a seventeen month period (November 2013 to March 2015) inside a Trussell Trust foodbank. Foodbank users were almost exclusively of working age, both men and women, with and without dependent children. All were on very low incomes - from welfare benefits or insecure, poorly paid employment. Many had pre-existing health problems which were exacerbated by their poverty and food insecurity. The latter meant although foodbank users were well aware of the importance and constitution of a healthy diet, they were usually unable to achieve this for financial reasons - constantly having to negotiate their food insecurity. More typically they had to access poor quality, readily available, filling, processed foods. Foodbank users are facing the everyday reality of health inequalities at a time of ongoing austerity in the UK. Copyright © 2015 Elsevier Ltd. All rights reserved.

Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

PubMed

Brandling, J; Kirby, K; Black, S; Voss, S; Benger, J

2017-07-25

There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA.

Exploring physiotherapists' experiences of implementing a cognitive behavioural approach for managing low back pain and identifying barriers to long-term implementation.

PubMed

Richmond, Helen; Hall, Amanda M; Hansen, Zara; Williamson, Esther; Davies, David; Lamb, Sarah E

2018-03-01

Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use. We conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire. Questions centred on (i) using iBeST to support implementation, (ii) what barriers they encountered to implementation and (iii) what of information or resources they required to support sustained implementation. Interviews were transcribed and thematically analysed using NVivo. Themes were categorised using the Theoretical Domains Framework (TDF). Evidence-based techniques were identified using the behaviour change technique taxonomy to target relevant TDF domains. Three themes emerged from interviews: anxieties about using a CBA, experiences of implementing a CBA, and sustainability for future implementation of a CBA. Themes crossed multiple TDF domains and indicated concerns with knowledge, beliefs about capabilities and consequences, social and professional roles, social influences, emotion, and environmental context and resources. We identified evidence-based strategies that may support sustainable implementation of a CBA for LBP in a physiotherapy setting. This study highlighted potential challenges for physiotherapists in the provision of evidence-based LBP care within the current UK NHS. Using the TDF provided the foundation to develop a tailored, evidence-based, implementation intervention to support long term use of a CBA by physiotherapists managing LBP within UK NHS outpatient departments. Copyright © 2017 Chartered Society of Physiotherapy. All rights reserved.

Enabling Process Improvement and Control in Higher Education Management

ERIC Educational Resources Information Center

Bell, Gary; Warwick, Jon; Kennedy, Mike

2009-01-01

The emergence of "managerialism" in the governance and direction of UK higher education (HE) institutions has been led by government demands for greater accountability in the quality and cost of universities. There is emerging anecdotal evidence indicating that the estimation performance of HE spreadsheets and regression models are poor.…

Teaching and Technology Transfer as Alternative Revenue Streams: A Primer on the Potential Legal Implications for UK Universities

ERIC Educational Resources Information Center

Van Hoorebeek, Mark; Marson, James

2005-01-01

Purpose: The purpose of this paper is to assess the financial and intellectual issues facing the university sector as many institutions in the UK pursue alternative revenue streams. As a consequence to the increasing financial pressures, university departments are increasingly exposed to new forms of potential litigation and also face the risk to…

Nurturing the H in HR: Using Action Learning to Build Organisation Development Capability in the UK Civil Service

ERIC Educational Resources Information Center

Hale, Richard; Saville, Martin

2014-01-01

In the UK, the Civil Service Reform Plan is being implemented with urgency. This requires Civil Service departments and agencies to reform their structures and ways of working in order to deliver effective services in a climate of economic austerity and rapid social and technological change. Historically, Human Resource (HR) professionals have…

Can an emergency department-based Clinical Decision Unit successfully utilize alternatives to emergency hospitalization?

PubMed

Roberts, Mark Vignesha; Baird, Wendy; Kerr, Paul; O'Reilly, Seamus

2010-04-01

To evaluate a Clinical Decision Unit (CDU) designed to utilize alternatives to emergency hospitalization. CDUs are one model of care designed to strengthen the gatekeeper role of Emergency Departments (EDs). This retrospective cohort study was carried out in a UK NHS acute hospital. All 854 patients in the CDU cohort were compared with three age-stratified, historical cohorts from the same clinical centre. The median age was 62 years (range 16-94).The main outcome measures were discharge to general practitioner, outpatient services or hospitalization, the 30-day unplanned reattendance rate for those not hospitalized, and monthly medical admission figures. Approximately 511 [59.8%, 95% confidence interval (CI): 56.5-63.1%] to 560 (65.6%, 95% CI: 62.3-68.7%) patients were admitted in the comparison cohorts, compared with only 186 (21.8%, 95% CI: 19.1-24.7%) in the CDU cohort (P≤0.05). Approximately 243 (28.5%, 95% CI: 25.5-31.6%) to 289 (33.8%, 95% CI: 30.7-37.1%) patients were discharged to general practitioner services in the comparison groups, compared with 562 (65.8%, 95% CI: 62.6-68.9%) in the CDU group (P≤0.05). Approximately eight (0.9, 95% CI: 0.5-1.8%) to 17 (2%, 95% CI: 1.2-3.2%) patients in the comparison groups were discharged to outpatient clinics, compared with 82 (9.6%, 95% CI: 7.8-11.8%) in the CDU group (P≤0.05). There was no consistent trend towards statistically significant rises in unplanned reattendance (P>0.05). Monthly medical admissions fell substantially during CDU operation. This CDU model was associated with statistically and clinically significant reductions in hospital admissions. The judicious application of this CDU model to other ED environments can be expected to yield similar benefits.

Nonemergent emergency department visits under the National Health Insurance in Taiwan.

PubMed

Tsai, Jeffrey Che-Hung; Chen, Wen-Yi; Liang, Yia-Wun

2011-05-01

To explore the magnitude of nonemergent emergency department visits under the Taiwan National Health Insurance program and to identify significant factors associated with these visits. A cross-sectional analysis of the 2002 Taiwan National Health Insurance Research Database was used to identify nonemergent emergency department conditions according to the New York University algorithm. The data contained 43,384 visits, of which 83.89% could be classified. Multivariate logistic regression identified individual and contextual factors associated with nonemergent emergency department visits. Nearly 15% of all emergency department visits were nonemergent; an additional 20% were emergent-preventable with primary care. Patients likely to make nonemergent emergency department visits were older, female, categorized as a Taiwan National Health Insurance Category IV beneficiary, and without major illness. Hospital accreditation level, teaching status, and location were associated with an increased likelihood of nonemergent emergency department visits. Understanding the factors leading to nonemergent emergency department visits can assist in evaluating the overall quality of a health care system and help reduce the use of the emergency department for nonemergent conditions. Policy makers desiring cost-effective care should assess emergency department visit rates in light of available resources for specific populations. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Initiating an online asthma management program in urban emergency departments: the recruitment experience.

PubMed

Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie; Johnson, Dayna A; Duffy, Elizabeth; Demers, Michele; Zhang, Talan; Ownby, Dennis R; Zoratti, Edward; Mahajan, Prashant

2016-01-01

The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Factors affecting blood sample haemolysis: a cross-sectional study.

PubMed

Barnard, Ed B G; Potter, David L; Ayling, Ruth M; Higginson, Ian; Bailey, Andrew G; Smith, Jason E

2016-04-01

To determine the effect of blood sampling through an intravenous catheter compared with a needle in Emergency Department blood sampling. We undertook a prospective, cross-sectional study in a UK university teaching hospital Emergency Department. A convenience sample of 985 patients who required blood sampling via venepuncture was collected. A total of 844 complete sets of data were analysed. The median age was 63 years, and 57% of patients were male. The primary outcome measure was the incidence of haemolysis in blood samples obtained via a needle compared with samples obtained via an intravenous catheter. Secondary outcome measures defined the effect on sample haemolysis of the side of the patient the sample was obtained from, the anatomical location of sampling, the perceived difficulty in obtaining the sample, the order of sample tubes collected, estimated tourniquet time and bench time. Data were analysed with logistic regression, and expressed as odds ratios (95% confidence intervals; P-values). Blood samples obtained through an intravenous catheter were more likely to be haemolysed than those obtained via a needle, odds ratio 5.63 (95% confidence interval 2.49-12.73; P<0.001). Blood sampling via an intravenous catheter was significantly associated with an increase in the likelihood of sample haemolysis compared with sampling with a needle. Wherever practicable, blood samples should be obtained via a needle in preference to an intravenous catheter. Future research should include both an economic evaluation, and staff and patient satisfaction of separating blood sampling and intravenous catheter placement.

Respiratory rate estimation during triage of children in hospitals.

PubMed

Shah, Syed Ahmar; Fleming, Susannah; Thompson, Matthew; Tarassenko, Lionel

2015-01-01

Accurate assessment of a child's health is critical for appropriate allocation of medical resources and timely delivery of healthcare in Emergency Departments. The accurate measurement of vital signs is a key step in the determination of the severity of illness and respiratory rate is currently the most difficult vital sign to measure accurately. Several previous studies have attempted to extract respiratory rate from photoplethysmogram (PPG) recordings. However, the majority have been conducted in controlled settings using PPG recordings from healthy subjects. In many studies, manual selection of clean sections of PPG recordings was undertaken before assessing the accuracy of the signal processing algorithms developed. Such selection procedures are not appropriate in clinical settings. A major limitation of AR modelling, previously applied to respiratory rate estimation, is an appropriate selection of model order. This study developed a novel algorithm that automatically estimates respiratory rate from a median spectrum constructed applying multiple AR models to processed PPG segments acquired with pulse oximetry using a finger probe. Good-quality sections were identified using a dynamic template-matching technique to assess PPG signal quality. The algorithm was validated on 205 children presenting to the Emergency Department at the John Radcliffe Hospital, Oxford, UK, with reference respiratory rates up to 50 breaths per minute estimated by paediatric nurses. At the time of writing, the authors are not aware of any other study that has validated respiratory rate estimation using data collected from over 200 children in hospitals during routine triage.

Red flag findings in children with headaches: Prevalence and association with emergency department neuroimaging.

PubMed

Tsze, Daniel S; Ochs, Julie B; Gonzalez, Ariana E; Dayan, Peter S

2018-01-01

Background Clinicians appear to obtain emergent neuroimaging for children with headaches based on the presence of red flag findings. However, little data exists regarding the prevalence of these findings in emergency department populations, and whether the identification of red flag findings is associated with potentially unnecessary emergency department neuroimaging. Objectives We aimed to determine the prevalence of red flag findings and their association with neuroimaging in otherwise healthy children presenting with headaches to the emergency department. Our secondary aim was to determine the prevalence of emergent intracranial abnormalities in this population. Methods A prospective cohort study of otherwise healthy children 2-17 years of age presenting to an urban pediatric emergency department with non-traumatic headaches was undertaken. Emergency department physicians completed a standardized form to document headache descriptors and characteristics, associated symptoms, and physical and neurological exam findings. Children who did not receive emergency department neuroimaging received 4-month telephone follow-up. Outcomes included emergency department neuroimaging and the presence of emergent intracranial abnormalities. Results We enrolled 224 patients; 197 (87.9%) had at least one red flag finding on history. Several red flag findings were reported by more than a third of children, including: Headache waking from sleep (34.8%); headache present with or soon after waking (39.7%); or headaches increasing in frequency, duration and severity (40%, 33.1%, and 46.3%). Thirty-three percent of children received emergency department neuroimaging. The prevalence of emergent intracranial abnormalities was 1% (95% CI 0.1, 3.6). Abnormal neurological exam, extreme pain intensity of presenting headache, vomiting, and positional symptoms were independently associated with emergency department neuroimaging. Conclusions Red flag findings are common in children presenting with headaches to the emergency department. The presence of red flag findings is associated with emergency department neuroimaging, although the risk of emergent intracranial abnormalities is low. Many children with headaches may be receiving unnecessary neuroimaging due to the high prevalence of non-specific red flag findings.

Portrait of rural emergency departments in Quebec and utilisation of the Quebec Emergency Department Management Guide: a study protocol

PubMed Central

Fleet, Richard; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Dupuis, Gilles; Haggerty, Jeannie; Poitras, Julien; Tanguay, Alain; Simard-Racine, Geneviève; Gauthier, Josée

2013-01-01

Introduction Emergency departments are important safety nets for people who live in rural areas. Moreover, a serious problem in access to healthcare services has emerged in these regions. The challenges of providing access to quality rural emergency care include recruitment and retention issues, lack of advanced imagery technology, lack of specialist support and the heavy reliance on ambulance transport over great distances. The Quebec Ministry of Health and Social Services published a new version of the Emergency Department Management Guide, a document designed to improve the emergency department management and to humanise emergency department care and services. In particular, the Guide recommends solutions to problems that plague rural emergency departments. Unfortunately, no studies have evaluated the implementation of the proposed recommendations. Methods and analysis To develop a comprehensive portrait of all rural emergency departments in Quebec, data will be gathered from databases at the Quebec Ministry of Health and Social Services, the Quebec Trauma Registry and from emergency departments and ambulance services managers. Statistics Canada data will be used to describe populations and rural regions. To evaluate the use of the 2006 Emergency Department Management Guide and the implementation of its various recommendations, an online survey and a phone interview will be administered to emergency department managers. Two online surveys will evaluate quality of work life among physicians and nurses working at rural emergency departments. Quality-of-care indicators will be collected from databases and patient medical files. Data will be analysed using statistical (descriptive and inferential) procedures. Ethics and dissemination This protocol has been approved by the CSSS Alphonse–Desjardins research ethics committee (Project MP-HDL-1213-011). The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences. PMID:23633423

Portrait of rural emergency departments in Quebec and utilisation of the Quebec Emergency Department Management Guide: a study protocol.

PubMed

Fleet, Richard; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Dupuis, Gilles; Haggerty, Jeannie; Poitras, Julien; Tanguay, Alain; Simard-Racine, Geneviève; Gauthier, Josée

2013-01-01

Emergency departments are important safety nets for people who live in rural areas. Moreover, a serious problem in access to healthcare services has emerged in these regions. The challenges of providing access to quality rural emergency care include recruitment and retention issues, lack of advanced imagery technology, lack of specialist support and the heavy reliance on ambulance transport over great distances. The Quebec Ministry of Health and Social Services published a new version of the Emergency Department Management Guide, a document designed to improve the emergency department management and to humanise emergency department care and services. In particular, the Guide recommends solutions to problems that plague rural emergency departments. Unfortunately, no studies have evaluated the implementation of the proposed recommendations. To develop a comprehensive portrait of all rural emergency departments in Quebec, data will be gathered from databases at the Quebec Ministry of Health and Social Services, the Quebec Trauma Registry and from emergency departments and ambulance services managers. Statistics Canada data will be used to describe populations and rural regions. To evaluate the use of the 2006 Emergency Department Management Guide and the implementation of its various recommendations, an online survey and a phone interview will be administered to emergency department managers. Two online surveys will evaluate quality of work life among physicians and nurses working at rural emergency departments. Quality-of-care indicators will be collected from databases and patient medical files. Data will be analysed using statistical (descriptive and inferential) procedures. This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-1213-011). The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.

Implementing UK Autism Policy & National Institute for Health and Care Excellence Guidance--Assessing the Impact of Autism Training for Frontline Staff in Community Learning Disabilities Teams

ERIC Educational Resources Information Center

Clark, Alex; Browne, Sarah; Boardman, Liz; Hewitt, Lealah; Light, Sophie

2016-01-01

UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty-six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire…

Can It Really Be as Good as It Seems? The Financial Health of the UK HE Sector

ERIC Educational Resources Information Center

Palfreyman, David

2013-01-01

The accountants Grant Thornton (GT) do a welcome and nice piece of pro bono work by analysing the annual accounts of the UK's 160 (sic) HEIs and compiling a report on "The Financial Health of the Higher Education Sector"--this year entitled "The calm before the storm"! GT duly note that, if the US Department of Education's…

77 FR 69627 - Findings of Research Misconduct

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-20

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Findings of Research Misconduct... Research Integrity (ORI) has taken final action in the following case: Eric J. Smart, Ph.D., University of... Professor of Pediatrics and Physiology, Department of Pediatrics and Physiology, UK, engaged in research...

Genome datasets for Calonectria henricotiae and C. pseudonaviculata causing boxwood blight disease and related species

USDA-ARS?s Scientific Manuscript database

Boxwood blight disease, caused by the fungi Calonectria henricotiae and C. pseudonaviculata, is an emergent threat to natural and managed landscapes worldwide. Boxwood blight emerged for the first time in the U.K. during the 1990s, then spread rapidly throughout Europe. By 2011, the fungus that cau...

Technologies, Learning and Culture: Some Emerging Themes

ERIC Educational Resources Information Center

Lally, Vic; Sclater, Madeleine; Brown, Ken

2018-01-01

This paper reflects on some of the themes emerging from a consideration of recent research at the nexus of technologies, learning and culture. The authors comment on the expansive nature of the concept of learning spaces in papers featuring an investigation of technology enhanced learning (TEL) and communication design studios in the UK and…

"We Don't Do Public Libraries Like We Used to": Attitudes to Public Library Buildings in the UK at the Start of the 21st Century

ERIC Educational Resources Information Center

Black, Alistair

2011-01-01

Although the quality, performance and future of public library services in the UK is a matter of debate, there is little doubt that in recent years, despite claims relating to the emergence of a cyber-society, interest in library buildings and the library as "place" has been intense, almost matching that seen during the Carnegie era of…

Human Computer Collaboration at the Edge: Enhancing Collective Situation Understanding with Controlled Natural Language

DTIC Science & Technology

2016-09-06

settled all but question 36 which was: ‘What sport does Capt Falcon play?’ and answers conflicted because some players used the name ‘soccer’ while others...email: PreeceAD@cardiff.ac.uk †Emerging Technology Services, IBM United Kingdom Ltd, Hursley Park, Winchester, UK ‡US Army Research Laboratory, Human... Research and Engineering Directorate, Aberdeen Proving Ground, USA Abstract—Effective coalition operations require support for dynamic information

Burden of disease, research funding and innovation in the UK: Do new health technologies reflect research inputs and need?

PubMed

Ward, Derek; Martino, Orsolina; Packer, Claire; Simpson, Sue; Stevens, Andrew

2013-04-01

New and emerging health technologies (innovation outputs) do not always reflect conditions representing the greatest disease burden. We examine the role of research and development (R&D) funding in this relationship, considering whether areas with fewer innovative outputs receive an appropriate share of funding relative to their disease burden. We report a retrospective observational study, comparing burden of disease with R&D funding and innovation output. UK disability-adjusted life years (DALYs) and deaths came from the World Health Organization (WHO) 2004 Global Burden of Disease estimates; funding estimates from the UK Clinical Research Collaboration's 2006 Health Research Analysis; and innovation output was estimated by the number of new and emerging technologies reported by the National Institute for Health Research (NIHR) Horizon Scanning Centre between 2000 and 2009. Disease areas representing the biggest burden were generally associated with the most funding and innovation output; cancer, neuropsychiatric conditions and cardiovascular disease together comprised approximately two-thirds of DALYs, funding and reported technologies. Compared with DALYs, funding and technologies were disproportionately high for cancer, and technologies alone were disproportionately high for musculoskeletal conditions and endocrine/metabolic diseases. Neuropsychiatric conditions had comparatively few technologies compared to both DALYs and funding. The relationship between DALYs and innovation output appeared to be mediated by R&D funding. The relationship between burden of disease and new and emerging health technologies for different disease areas is partly dependent on the associated level of R&D funding (input). Discrepancies among key groups may reflect differential focus of research funding across disease areas. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

An intensive assessment of alcohol use and emergency department utilization in homeless alcohol-dependent adults.

PubMed

Holtyn, August F; Jarvis, Brantley P; Subramaniam, Shrinidhi; Wong, Conrad J; Fingerhood, Michael; Bigelow, George E; Silverman, Kenneth

2017-09-01

Excessive alcohol use among the homeless may contribute to their high rates of emergency department use. Survey-based studies have provided some information on the relation between alcohol and emergency department use among the homeless. This study used an intensive schedule of random breath collections and self-report assessments to examine the relation between emergency department utilization and alcohol use in homeless alcohol-dependent adults. Data were from homeless alcohol-dependent adults (N=116) who were participating in a therapeutic workplace that provided job-skills training every weekday for 26 weeks. Breath-sample collections and assessments of self-reported alcohol use were scheduled each week, an average of twice per week per participant, at random times between 9:00 A.M. and 5:00 P.M. Participants received $35 for each breath sample collected. Self-reports of emergency department use were assessed throughout the study. Thirty-four percent of participants reported attending an emergency department and reported an average of 2.2 emergency department visits (range 1-10 visits). Alcohol intoxication was the most common reason for emergency department use. Participants who used the emergency department had significantly more alcohol-positive breath samples and more self-reported heavy alcohol use than participants who did not use the emergency department. This study provided a rare intensive assessment of alcohol and emergency department use in homeless alcohol-dependent adults over an extended period. Emergency department use was high and was significantly related to indices of alcohol use. Copyright © 2017 Elsevier B.V. All rights reserved.

Cohort study of oncologic emergencies in patients with head and neck cancer.

PubMed

Reyes-Gibby, Cielito C; Melkonian, Stephanie C; Hanna, Ehab Y; Yeung, Sai-Ching J; Lu, Charles; Chambers, Mark S; Banala, Srinivas R; Gunn, Gary B; Shete, Sanjay S

2017-06-01

Treatments for head and neck squamous cell carcinoma (HNSCC) are associated with toxicities that lead to emergency department presentation. We utilized data from an ongoing prospective cohort of newly diagnosed, previously untreated patients (N = 298) with HNSCC to evaluate the association between clinical and epidemiologic factors and risk for and frequency of emergency department presentation. Time to event was calculated from the date of treatment initiation to emergency department presentation, date of death, or current date. Frequency of emergency department presentation was the sum of emergency department visits during the follow-up time. History of hypertension, normal/underweight body mass index (BMI), and probable depression predicted increased risk for emergency department presentation. BMI and severe pain were associated with higher frequency of emergency department presentations. Clinical and epidemiologic factors can help predict patients with HNSCC who will present to the emergency department. Such knowledge may improve treatment-related patient outcomes and quality of life. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1195-1204, 2017. © 2017 Wiley Periodicals, Inc.

Avoiding emergency department visits for COPD, pneumonia, and heart failure: when should patients go to the emergency department?

PubMed

Fritz, Deborah; McKenzie, Patricia

2014-01-01

Patients with pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure make frequent visits to the emergency department. Heart failure alone is the reason for more than 1 million emergency department visits annually in the United States. This article describes strategies home care clinicians can use to prevent unnecessary emergency department visits for patients with pneumonia, COPD and heart failure.

Implementing a successful data-management framework: the UK10K managed access model

PubMed Central

2013-01-01

This paper outlines the history behind open access principles and describes the development of a managed access data-sharing process for the UK10K Project, currently Britain’s largest genomic sequencing consortium (2010 to 2013). Funded by the Wellcome Trust, the purpose of UK10K was two-fold: to investigate how low-frequency and rare genetic variants contribute to human disease, and to provide an enduring data resource for future research into human genetics. In this paper, we discuss the challenge of reconciling data-sharing principles with the practicalities of delivering a sequencing project of UK10K’s scope and magnitude. We describe the development of a sustainable, easy-to-use managed access system that allowed rapid access to UK10K data, while protecting the interests of participants and data generators alike. Specifically, we focus in depth on the three key issues that emerge in the data pipeline: study recruitment, data release and data access. PMID:24229443

Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

PubMed Central

Bevan, Gwyn; Hamblin, Richard

2009-01-01

Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of ‘star rating’, which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries. PMID:19381327

The entrepreneur: a new breed of health service leader?

PubMed

Exton, Rosemary

2008-01-01

This paper aims to critically examine the notion of entrepreneurship in the UK National Health Service (NHS), promoted by government ministers and senior civil servants as part of the rhetoric of the modernisation agenda. The paper explores literature on entrepreneurship in the private and public sector and qualitative case study evidence on the emergence (and non-emergence) of "entrepreneurs" who led the improving working lives (IWL) initiative in the UK National Health Service and discusses the issues involved. The rhetoric serves an essentially ideological function, obscuring the real difficulty of securing effective and sustainable change, in organisations with deeply engrained power structures and as complex and intransient as the NHS in particular and health services more generally. A "new breed of entrepreneurial leaders" may eventually appear but they face the challenge of surviving in the hierarchical NHS culture and in a climate of turbulent change created by the volatility of government policy. The paper shows that efforts to pursue entrepreneurship in the UK NHS have to overcome obstacles involving the interplay of power, gender and language.

Emergency Preparedness technology support to the Health and Safety Executive (HSE), Nuclear Installations Inspectorate (NII) of the United Kingdom. Appendix A

DOE Office of Scientific and Technical Information (OSTI.GOV)

O`Kula, K.R.

1994-03-01

The Nuclear Installations Inspectorate (NII) of the United Kingdom (UK) suggested the use of an accident progression logic model method developed by Westinghouse Savannah River Company (WSRC) and Science Applications International Corporation (SAIC) for K Reactor to predict the magnitude and timing of radioactivity releases (the source term) based on an advanced logic model methodology. Predicted releases are output from the personal computer-based model in a level-of-confidence format. Additional technical discussions eventually led to a request from the NII to develop a proposal for assembling a similar technology to predict source terms for the UK`s advanced gas-cooled reactor (AGR) type.more » To respond to this request, WSRC is submitting a proposal to provide contractual assistance as specified in the Scope of Work. The work will produce, document, and transfer technology associated with a Decision-Oriented Source Term Estimator for Emergency Preparedness (DOSE-EP) for the NII to apply to AGRs in the United Kingdom. This document, Appendix A is a part of this proposal.« less

Advanced training in emergency medicine: a pedagogical journey from didactic teachers to virtual problems

PubMed Central

Mackway‐Jones, Kevin; Carley, Simon; Kilroy, Darren

2007-01-01

Background As trainee numbers and the geographical spread of training departments have increased, the model of weekly face‐to‐face teaching has come under strain because of long travel times. This has been compounded by a reduction in the total number of hours worked by trainees. Furthermore the traditional teacher centred educational programme has been challenged as unfit for purpose on grounds of both content and style. Objective This article describes two shifts in the delivery of the programme. The first involved migration from a didactic delivery to a problem‐based model; the second a gradual shift to the internet culminating in implementation of a web based virtual learning environment. Conclusion The principles outlined in this paper are widely applicable and will be of interest to all clinical educators within the specialty, both within the UK and overseas. PMID:17901268

Comparison of traditional and interactive teaching methods in a UK emergency department.

PubMed

Armstrong, Peter; Elliott, Tim; Ronald, Julie; Paterson, Brodie

2009-12-01

Didactic teaching remains a core component of undergraduate education, but developing computer assisted learning (CAL) packages may provide useful alternatives. We compared the effectiveness of interactive multimedia-based tutorials with traditional, lecture-based models for teaching arterial blood gas interpretation to fourth year medical students. Participants were randomized to complete a tutorial in either lecture or multimedia format containing identical content. Upon completion, students answered five multiple choice questions assessing post-tutorial knowledge, and provided feedback on their allocated learning method. Marks revealed no significant difference between either group. All lecture candidates rated their teaching as good, compared with 89% of the CAL group. All CAL users found multiple choice questions assessment useful, compared with 83% of lecture participants. Both groups highlighted the importance of interaction. CAL complements other teaching methods, but should be seen as an adjunct to, rather than a replacement for, traditional methods, thus offering students a blended learning environment.

Implementing human factors in clinical practice

PubMed Central

Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

2015-01-01

Objectives To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Methods Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. Results The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. Conclusions In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. PMID:24631959

Treatment of a critically ill child with disseminated Candida glabrata with a recombinant human antibody specific for fungal heat shock protein 90 and liposomal amphotericin B, caspofungin, and voriconazole.

PubMed

Sutherland, Adam; Ellis, David

2008-07-01

To report a case of fungal sepsis treated prospectively with liposomal amphotericin, caspofungin, and a novel monoclonal antibody specific for candidal heat shock protein 90 (Mycograb, Neutec Pharma, Manchester, UK). Case report. Pediatric intensive care unit in a tertiary care children's hospital. A 7-yr-old male with a history of global developmental delay, epilepsy, and gastroesophageal reflux, who presented to the emergency department with a transdiaphragmatic herniation of bowel and subsequent Candida glabrata infection. Efungumab 1 mg/kg twice daily for 5 days. C-reactive protein fell from 225 mg/L to 99 mg/L, and physiological monitoring parameters improved when Mycograb was used in conjunction with high-dose antifungals. Mycograb therapy was well tolerated, but further experience with this therapy in children is needed.

Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations.

PubMed

Black, Joyce; Clark, Michael; Dealey, Carol; Brindle, Christopher T; Alves, Paulo; Santamaria, Nick; Call, Evan

2015-08-01

The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for pressure ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for pressure injury and shear injury were also provided. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Fatal gliding accidents in the United Kingdom: 1960-1980.

PubMed

Cooke, J N; Balfour, A J; Underwood Ground, K E

1983-11-01

For many years, the Department of Aviation and Forensic Pathology of the RAF Institute of Pathology and Tropical Medicine has assisted in the medical investigation of fatal military and civil aircraft accidents, both in the U.K. and overseas. These included 33 glider accidents involving 39 deaths over the period 1960-1980. They do not include all the fatal gliding accidents in the U.K. because there is no mandatory obligation to call in the department, but probably represent over 50%. The Department is primarily interested in the nature of fatal injuries, the performance of safety equipment and the presence or absence of pre-existing medical factors which might have affected or caused the accident. It also makes recommendations intended to improve flight safety, and is often involved in the discussions between the British Gliding Association, the Civil Aviation Authority, and the other organizations involved.

Turbulence Model Effects on Cold-Gas Lateral Jet Interaction in a Supersonic Crossflow

DTIC Science & Technology

2014-06-01

performance computing time from the U.S. Department of Defense (DOD) High Performance Computing Modernization program at the U.S. Army Research Laboratory... time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the...thanks Dr. Ross Chaplin , Defence Science Technology Laboratory, United Kingdom (UK), and Dr. David MacManus and Robert Christie, Cranfield University, UK

On the Impact of School Teacher Fellows in Chemistry Departments within UK Higher Education Institutes, from 2005-2013

ERIC Educational Resources Information Center

Shallcross, Dudley E.; Harrison, Timothy G.; Read, David; Barker, Nicholas

2014-01-01

Two UK programmes to place school teachers in a university setting are compared; the Excellence Fellowship Awards Pilot Scheme and the School Teacher Fellows Scheme. In this paper we compare the School Teacher Fellow Scheme supported by Bristol ChemLabS (Shallcross et al., 2013a, 2013b) and subsequently by the Royal Society of Chemistry with the…

Emergency department crowding in Singapore: Insights from a systems thinking approach.

PubMed

Schoenenberger, Lukas K; Bayer, Steffen; Ansah, John P; Matchar, David B; Mohanavalli, Rajagopal L; Lam, Sean Sw; Ong, Marcus Eh

2016-01-01

Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care. The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied. The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created. Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.

The hospital microbiome project: meeting report for the UK science and innovation network UK-USA workshop ‘beating the superbugs: hospital microbiome studies for tackling antimicrobial resistance’, October 14th 2013

PubMed Central

2014-01-01

The UK Science and Innovation Network UK-USA workshop ‘Beating the Superbugs: Hospital Microbiome Studies for tackling Antimicrobial Resistance’ was held on October 14th 2013 at the UK Department of Health, London. The workshop was designed to promote US-UK collaboration on hospital microbiome studies to add a new facet to our collective understanding of antimicrobial resistance. The assembled researchers debated the importance of the hospital microbial community in transmission of disease and as a reservoir for antimicrobial resistance genes, and discussed methodologies, hypotheses, and priorities. A number of complementary approaches were explored, although the importance of the built environment microbiome in disease transmission was not universally accepted. Current whole genome epidemiological methods are being pioneered in the UK and the benefits of moving to community analysis are not necessarily obvious to the pioneers; however, rapid progress in other areas of microbiology suggest to some researchers that hospital microbiome studies will be exceptionally fruitful even in the short term. Collaborative studies will recombine different strengths to tackle the international problems of antimicrobial resistance and hospital and healthcare associated infections.

Evaluating Quality Management in University Departments

ERIC Educational Resources Information Center

Becket, Nina; Brookes, Maureen

2006-01-01

Purpose: Despite the abundance of research on quality management there is no universal consensus on how best to measure quality in higher education. This paper undertakes a critical evaluation of the different methods used to assess the quality of provision in higher education departments in the UK. Design/methodology/approach: Drawing on relevant…

Embedding Sustainable Development at Cambridge University Engineering Department

ERIC Educational Resources Information Center

Fenner, Richard A.; Ainger, Charles M.; Cruickshank, Heather J.; Guthrie, Peter M.

2005-01-01

Purpose--The paper seeks to examine the latest stage in a process of change aimed at introducing concepts of sustainable development into the activities of the Department of Engineering at Cambridge University, UK. Design/methodology/approach--The rationale behind defining the skills which future engineers require is discussed and vehicles for…

Integrating horizon scanning and strategic risk prioritisation using a weight of evidence framework to inform policy decisions.

PubMed

Garnett, K; Lickorish, F A; Rocks, S A; Prpich, G; Rathe, A A; Pollard, S J T

2016-08-01

Poor connection between data on emerging issues and credible policy decisions continues to challenge governments, and is only likely to grow as demands on time and resources increase. Here we summarise recent efforts to integrate horizon scanning and risk prioritisation approaches to better connect emerging issues to the political discourse on environmental and food-related issues. Our categorisation of insights including potential future risks and opportunities to inform policy discussions has emerged from a structured three-year programme of horizon scanning for a UK pan-governmental futures partnership led by the Department for Environment, Food and Rural Affairs (Defra). Our efforts to integrate horizon scanning and risk prioritisation, utilising a qualitative weight of evidence framework, has created a systematic process for identifying all signals of potential future change with significant impact for the strategic mission and underlying values of policy actors. Our approach encourages an exploration of factors out of the control of organisations, recognising that resilience depends on the flexibility of management strategies and the preparedness to deal with a variety of unexpected outcomes. We discuss how this approach addresses key cultural and evaluative challenges that policy actors have had in embedding horizon scanning in evidence-based policy processes, and suggest further developments to build confidence in the use of horizon scanning for strategic planning. Copyright © 2016 Elsevier B.V. All rights reserved.

[Concept of an interdisciplinary emergency department at the Schwarzwald-Baar Hospital].

PubMed

Kumle, B; Merz, S; Geiger, M; Kugel, K; Fink, U

2014-10-01

Numerous hospitals were combined years ago into a new Central Hospital for cost reasons in the Schwarzwald-Baar region. This also suggested the idea of a large central emergency department. The concept of a central emergency department is an organizational challenge, since they are directly engaged in the organizational structure of all medical departments that are involved in emergency treatment. Such a concept can only be enforced if it is supported by hospital management and all parties are willing to accept interdisciplinary and interprofessional work. In this paper, the concept of a central emergency department in a tertiary care hospital which was rebuilt as an organizationally independent unit is described. Collaborations with various departments, emergency services, and local physicians are highlighted. The processes of a central emergency department with an integrated admission department and personnel structures are described. The analysis of the concept after almost a year has shown that the integration into the clinic has been successful, the central emergency department has proven itself as a central hub and has been accepted as a unit within the hospital.

Designing a data-driven decision support tool for nurse scheduling in the emergency department: a case study of a southern New Jersey emergency department.

PubMed

Otegbeye, Mojisola; Scriber, Roslyn; Ducoin, Donna; Glasofer, Amy

2015-01-01

A health system serving Burlington and Camden Counties, New Jersey, sought to improve labor productivity for its emergency departments, with emphasis on optimizing nursing staff schedules. Using historical emergency department visit data and operating constraints, a decision support tool was designed to recommend the number of emergency nurses needed in each hour for each day of the week. The pilot emergency department nurse managers used the decision support tool's recommendations to redeploy nurse hours from weekends into a float pool to support periods of demand spikes on weekdays. Productivity improved significantly, with no unfavorable impact on patient throughput, and patient and staff satisfaction. Today's emergency department manager can leverage the increasing ease of access to the emergency department information system's data repository to successfully design a simple but effective tool to support the alignment of its nursing schedule with demand patterns. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

[Online survey of the organizational structures of emergency neurology in Germany].

PubMed

Topka, H; Pfefferkorn, T; Andres, F; Kastrup, A; Klein, M; Niesen, W; Poppert, H

2017-06-01

In 2007, the first poll among neurologists provided some insight into the organizational structures of emergency neurology in Germany. Given that emergency neurology as well as emergency medicine in general have undergone substantial changes during the last decade, the subcommittee Neurological Emergency Medicine of the German Neurological Society conducted a follow-up study to explore current structures supporting neurological emergency medicine in German neurological hospitals. Between July and September 2016, an online questionnaire was e‑mailed to 675 neurologists in institutions participating in in-patient neurological care. Of these, some 32% (university hospitals 49%) answered. Neurological patients represent 12-16% and hence a significant proportion of emergency patients. The fraction of in-patients admitted to hospitals via emergency departments amounted to 78% (median) in general hospitals and 52% in university hospitals. Most emergency departments are organized as an interdisciplinary structure combining conservative with surgical disciplines frequently led by an independent department head. Neurology departments employ rather diverse strategies to organize neurological emergency care. Also, the way emergency patients are assigned to different disciplines varied largely. Currently, neurological patients represent a rather growing fraction of patients in emergency departments. An increasing proportion of neurology in-patients enter the hospital via emergency departments. Neurology departments in Germany face increasing challenges to cope with large numbers of neurological emergency patients. While most of the participating neurologists indicated suffering predominantly from scarce personal resources both in neurology and neuroradiology, an independent neurological emergency department was not considered an option.

78 FR 2682 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

... following a suicide attempt. The overarching purpose of the proposed Evaluation of Emergency Department... patients admitted to emergency departments following a suicide attempt on subsequent emergency department... patients seen in the emergency department following a suicide attempt. Patient data will be collected for...

78 FR 16518 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-15

... following a suicide attempt. The overarching purpose of the proposed Evaluation of Emergency Department... to emergency departments following a suicide attempt on subsequent emergency department readmissions... patients seen in the emergency department following a suicide attempt. Patient data will be collected for...

Expect the unexpected: a role for behavioral economics in understanding the impact of cost-sharing on emergency department utilization.

PubMed

Tzeel, Albert; Brown, Jack

2010-07-01

AS EMPLOYERS AND PAYERS ADDRESS INCREASING HEALTHCARE COSTS, THEY RESORT TO THE TENETS OF CLASSICAL ECONOMICS: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (-58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of "gains" or "losses" relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design.

Emergency department visits due to pesticide poisoning in South Korea, 2006-2009.

PubMed

Ko, Yousun; Kim, Hyun Joong; Cha, Eun Shil; Kim, Jaeyoung; Lee, Won Jin

2012-02-01

The objective of this study is to estimate the numbers and rate of emergency department visits in South Korea that are the result of pesticide poisoning and to describe their epidemiologic characteristics. Data collected from the National Emergency Department Information System were used to estimate the number of emergency department visits due to pesticide poisoning in South Korea for the period spanning 2006 through 2009. Emergency department visits for pesticide poisoning were defined by ICD-10 codes (T60.0-T60.9). National estimates and their 95% confidence intervals were calculated per 100 000 population. Among the 65 877 total poisoning-related emergency department visits in the data, 11 985 (18.2%) were emergency department visits resulting from pesticide poisoning. During the study period, the annual average rate of emergency department visits for pesticide poisoning was 26.8 per 100 000 population. Intentional pesticide poisoning (51.4%) was more frequent than unintentional. The fatality rate from intentional pesticide poisoning was also higher than that from unintentional or cases where the intention was unknown. In terms of age-specific rates of emergency department visits for pesticide poisoning, they increased with age, as did the gap between men and women. This study provide estimates for emergency department visits due to pesticide poisoning at the national level and suggests that pesticide poisonings, both intentional and unintentional, require significant public health interventions in South Korea.

The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings.

PubMed

Mackintosh, Nicola; Sandall, Jane

2016-02-01

The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio-political influences and the specifics of how staff manage trade-offs linked to the enactment of core values such as safety and equity in practice. © 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

Review of implementation strategies to change healthcare provider behaviour in the emergency department.

PubMed

de Wit, Kerstin; Curran, Janet; Thoma, Brent; Dowling, Shawn; Lang, Eddy; Kuljic, Nebojsa; Perry, Jeffrey J; Morrison, Laurie

2018-05-01

Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies. We produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research. We present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

Nonemergency Medicine-Trained Physician Coverage in Rural Emergency Departments

ERIC Educational Resources Information Center

Peterson, Lars E.; Dodoo, Martey; Bennett, Kevin J.; Bazemore, Andrew; Phillips, Robert L., Jr.

2008-01-01

Context: Rural areas have fewer physicians compared to urban areas, and rural emergency departments often rely on community or contracted providers for staffing. The emergency department workforce is composed of a variety of physician specialties and clinicians. Purpose: To determine the distribution of emergency department clinicians and the…

Antimicrobial resistance, infection control and planning for pandemics: the importance of knowledge transfer in healthcare resilience and emergency planning.

PubMed

Cole, Jennifer

Over the last 70 years, the efficacy, ready availability and relatively low cost of antimicrobial drugs - medicines that kill microorganisms such as bacteria and viruses or inhibit their multiplication, growth and pathogenic action - has led to their considerable overuse. It is estimated that nearly 50 per cent of all antimicrobial use in hospitals is unnecessary or inappropriate1 while in neonatal care, the figure is even higher, with infection confirmed in only five per cent of neonates treated with antibiotics.2 The more antimicrobials are used, the faster the microorganisms they target evolve into new, resistant strains, a natural process of evolution that threatens to undermine the tremendous life-saving potential of these drugs. Antimicrobial resistance (AMR) is a growing concern not only for the healthcare sector3 but also, increasingly, for security and resilience. Pandemic influenza, comparable only to 'Catastrophic terrorist attacks' at the top of the UK's National Risk Register4 may well result from the emergence of a strain that cannot be treated effectively with currently available drugs or from one that quickly develops resistance to the stockpiled countermeasures. Multidrug-resistant tuberculosis impacts on immigration policy, methicillin-resistant Staphylococcus aureus (MRSA), a major cause of hospital-acquired infections is an ongoing challenge for the health sector and the increase in drug-resistant strains of malaria is problematic both in its own right and as an additional consequence of climate change. AMR places a significant burden on international governments and tackling it requires changes to thinking across a number of government departments. In 2011, the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) published Recommendations for future collaboration between the US and EU1 and both the EU and the UK's Department of Health have recently developed new AMR strategies and Action Plans. This paper will explore the cross-disciplinary policy challenges that AMR presents and the difficulties that are likely to be faced in implementing the recommendations of the TATFAR report. It will compare and contrast the efficacy of some of the programmes already in place to help reduce or better target the use of antimicrobials and discuss potential areas for further research and development into tackling a growing international problem.

Overseas trained nurses' perception of UK nurses' caring attitudes: a qualitative study.

PubMed

Alexis, Obrey

2009-08-01

The aim of this study was to explore overseas nurses' perception of their nursing colleagues' caring attitudes in the National Health Service (NHS) in the UK. A qualitative phenomenological approach using semi-structured interviews was used to obtain data from 12 overseas nurses. The interview transcripts were transcribed verbatim and analysed using van Manen thematic approach. Although many themes emerged following thematic analysis, this study will report the findings of three themes such as empathy, understanding and caring perspectives, emotional impact and lack of teamwork. In conclusion, this study provides an insight and it increases our understanding of overseas nurses' perceptions of their nursing colleagues' caring attitudes in the NHS in the UK. This paper concludes by indicating that teamwork, being empathetic, understanding and reducing emotional labour for overseas nurses could lead to a more satisfied working environment for overseas nurses in the NHS in the UK.

Composition, concentration and deprivation: exploring their association with social cohesion among different ethnic groups in the UK.

PubMed

Bécares, Laia; Stafford, Mai; Laurence, James; Nazroo, James

2011-01-01

Although studies in the US have shown an association between the ethnic residential composition of an area and reports of decreased social cohesion among its residents, this association is not clear in the UK, and particularly for ethnic minority groups. The current study analyses a merged dataset from the 2005 and 2007 Citizenship Survey to assess the evidence for an association between social cohesion and ethnic residential concentration, composition and area deprivation across different ethnic groups in the UK. Results of the multilevel regression models show that, after adjusting for area deprivation, increased levels of social cohesion are found in areas of greater ethnic residential heterogeneity. Although different patterns emerge across ethnic groups and the measure of social cohesion used, findings consistently show that it is area deprivation, and not ethnic residential heterogeneity, which erodes social cohesion in the UK.

100 years of STIs in the UK: a review of national surveillance data.

PubMed

Mohammed, Hamish; Blomquist, Paula; Ogaz, Dana; Duffell, Stephen; Furegato, Martina; Checchi, Marta; Irvine, Neil; Wallace, Lesley A; Thomas, Daniel Rhys; Nardone, Anthony; Dunbar, J Kevin; Hughes, Gwenda

2018-04-13

The 1916 Royal Commission on Venereal Diseases was established in response to epidemics of syphilis and gonorrhoea in the UK. In the 100 years since the Venereal Diseases Act (1917), the UK has experienced substantial scientific, economic and demographic changes. We describe historical and recent trends in STIs in the UK. We analysed surveillance data derived from STI clinics' statistical returns from 1917 to 2016. Since 1918, gonorrhoea and syphilis diagnoses have fluctuated, reflecting social, economic and technological trends. Following spikes after World Wars I and II, rates declined before re-emerging during the 1960s. At that time, syphilis was more common in men, suggestive of transmission within the men who have sex with men (MSM) population. Behaviour change following the emergence of HIV/AIDS in the 1980s is thought to have facilitated a precipitous decline in diagnoses of both STIs in the mid-1980s. Since the early 2000s, gonorrhoea and syphilis have re-emerged as major public health concerns due to increased transmission among MSM and the spread of antimicrobial-resistant gonorrhoea. Chlamydia and genital warts are now the most commonly diagnosed STIs in the UK and have been the focus of public health interventions, including the national human papillomavirus vaccination programme, which has led to substantial declines in genital warts in young people, and the National Chlamydia Screening Programme in England. Since the 1980s, MSM, black ethnic minorities and young people have experienced the highest STI rates. Although diagnoses have fluctuated over the last century, STIs continue to be an important public health concern, often affecting more marginalised groups in society. Prevention must remain a public health priority and, as we enter a new era of sexual healthcare provision including online services, priority must be placed on maintaining prompt access for those at greatest risk of STIs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

PubMed

Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

2015-12-01

Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

The legal framework for end-of-life decisions in the UK.

PubMed

Rennie, Janet M; Leigh, Bertie

2008-10-01

We have reviewed the current UK guidance regarding withholding and withdrawing life-prolonging treatment in the infant and termination of pregnancy for fetal malformation. We provide summaries of the key cases. The framework provided by professional bodies and the law in this difficult area stresses the importance of good and frequent communication between different professional groups and parents with early recourse to second opinions if a difference of view emerges. Legal proceedings should be used only as a last resort.

Emergency Contraception in Emergency Departments in Oregon, 2003

PubMed Central

Rosenberg, Kenneth D.; DeMunter, Jodi K.; Liu, Jihong

2005-01-01

Objectives. We sought to learn about access to emergency contraception (EC) in Oregon emergency departments, both for women who are rape patients and for women who have had consensual unprotected sexual intercourse (“nonrape patients”). Methods. We interviewed emergency department staff in 54 of Oregon’s 57 licensed emergency departments in February–March 2003 (response rate = 94.7%). Results. Only 61.1% of Oregon emergency departments routinely offered EC to rape patients. Catholic hospitals were as likely as non-Catholic hospitals to routinely offer EC to rape patients. The hospitals most likely to routinely offer EC to rape patients had a written protocol for the care of rape patients that included offering EC (P = .02) and access to staff with specialized sexual assault training (P=.002). For nonrape patients, 46.3% of emergency departments discouraged the prescribing of EC. Catholic hospitals were significantly less likely than non-Catholic hospitals to provide access to EC for nonrape patients (P=.05). Conclusions. Oregon emergency departments do not routinely offer EC to women who have been raped or to women who have had consensual unprotected sexual intercourse. PMID:15985646

44 CFR 351.27 - The Department of Defense.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true The Department of Defense. 351.27 Section 351.27 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... Assignments § 351.27 The Department of Defense. (a) Determine appropriate planning bases for Department of...

Exploring the key predictors of retention in emergency nurses.

PubMed

Sawatzky, Jo-Ann V; Enns, Carol L

2012-07-01

To explore the factors that predict the retention of nurses working in emergency departments. The escalating shortage of nurses is one of the most critical issues facing specialty areas, such as the emergency department. Therefore, it is important to identify the key influencing and intermediary factors that affect emergency department nurses' intention to leave. As part of a larger study, a cross-sectional survey was completed by 261 registered nurses working in the 12 designated emergency departments within rural, urban community and tertiary hospitals in Manitoba, Canada. Twenty-six per cent of the respondents will probably/definitely leave their current emergency department jobs within the next year. Engagement was the key predictor of intention to leave (P < 0.001). Engagement was also associated with job satisfaction, compassion satisfaction, compassion fatigue, and burnout (P < 0.05). In an ordinal least-squares model (R(2) = 0.44), nursing management, professional practice, collaboration with physicians, staffing resources and shift work emerged as significant influencing factors for engagement. Engagement plays a central role in emergency department nurses intention to leave. Addressing the factors that influence engagement may reduce emergency department nurses' intention to leave. This study highlights the value of research-based evidence as the foundation for developing innovative strategies for the retention of emergency department nurses. © 2012 Blackwell Publishing Ltd.

Reductions in emergency department visits after primary healthcare use of the UK National Poisons Information Service.

PubMed

Elamin, Muhammad E M O; James, David A; Holmes, Peter; Jackson, Gillian; Thompson, John P; Sandilands, Euan A; Bradberry, Sally; Thomas, Simon H L

2018-05-01

Suspected poisoning is a common cause of hospital admission internationally. In the United Kingdom, the National Poisons Information Service (NPIS), a network of four poisons units, provides specialist advice to health professionals on the management of poisoning by telephone and via its online poisoning information and management database, TOXBASE ® . To demonstrate the impact of NPIS telephone advice and TOXBASE ® guidance on poisoning-related referrals to emergency departments (ED) from primary healthcare settings. A telephone survey of primary healthcare providers calling the NPIS and an online survey of TOXBASE ® primary care users were conducted to evaluate the effect of these services on poisoning-related ED referrals. Enquirers were asked to indicate whether referral was needed before and after using these information sources. The number of cases considered by enquirers appropriate for ED referral was reduced from 1178 (58.1%) before to 819 (40.4%) after the provision of telephone advice for 2028 cases (absolute reduction 17.7%, 95% CI 14.6, 20.7%) and from 410 (48.2%) before to 341 (40.1%) after consideration of TOXBASE ® guidance for 851 cases (absolute reduction 8.1%, 95% CI 3.3, 12.9%). By extrapolating these figures over a full year, it is estimated that these services prevent approximately 41,000 ED referrals annually. The use of NPIS services significantly reduced ED referrals from primary healthcare services with resulting avoided healthcare costs exceeding the current annual NPIS budget. Further studies are needed to evaluate other potential benefits of accessing NPIS services.

Defense.gov Special Report: Invictus Games 2014

Science.gov Websites

Department of Defense Submit Search DEPARTMENT OF DEFENSE: 2014 Invictus Games U.S. Service Members Compete in Invictus Games UK Flag London | Sept. 10-14, 2014 More than 400 competitors from 13 nations will participate in the inaugural Invictus Games in London, an international sporting event for wounded warriors to

U.S. Department of Energy-Funded Performance Validation of Fuel Cell Material Handling Equipment (Presentation)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurtz, J.; Sprik, S.; Ramsden, T.

2013-11-01

This webinar presentation to the UK Hydrogen and Fuel Cell Association summarizes how the U.S. Department of Energy is enabling early fuel cell markets; describes objectives of the National Fuel Cell Technology Evaluation Center; and presents performance status of fuel cell material handling equipment.

Expect the Unexpected: A Role for Behavioral Economics in Understanding the Impact of Cost-Sharing on Emergency Department Utilization

PubMed Central

Tzeel, Albert; Brown, Jack

2010-01-01

Background As employers and payers address increasing healthcare costs, they resort to the tenets of classical economics: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. Objective To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. Method In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Results Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (−58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. Conclusion When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of “gains” or “losses” relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design. PMID:25126317

The UK Out of Hospital Cardiac Arrest Outcome (OHCAO) project.

PubMed

Perkins, Gavin D; Brace-McDonnell, Samantha J

2015-10-01

Reducing premature death is a key priority for the UK National Health Service (NHS). NHS Ambulance services treat approximately 30 000 cases of suspected cardiac arrest each year but survival rates vary. The British Heart Foundation and Resuscitation Council (UK) have funded a structured research programme--the Out of Hospital Cardiac Arrest Outcomes (OHCAO) programme. The aim of the project is to establish the epidemiology and outcome of OHCA, explore sources of variation in outcome and establish the feasibility of setting up a national OHCA registry. This is a prospective observational study set in UK NHS Ambulance Services. The target population will be adults and children sustaining an OHCA who are attended by an NHS ambulance emergency response and where resuscitation is attempted. The data collected will be characterised broadly as system characteristics, emergency medical services (EMS) dispatch characteristics, patient characteristics and EMS process variables. The main outcome variables of interest will be return of spontaneous circulation and medium-long-term survival (30 days to 10-year survival). Ethics committee permissions were gained and the study also has received approval from the Confidentiality Advisory Group Ethics and Confidentiality committee which provides authorisation to lawfully hold identifiable data on patients without their consent. To identify the key characteristics contributing to better outcomes in some ambulance services, reliable and reproducible systems need to be established for collecting data on OHCA in the UK. Reports generated from the registry will focus on data completeness, timeliness and quality. Subsequent reports will summarise demographic, patient, process and outcome variables with aim of improving patient care through focus quality improvement initiatives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Restraint practices in Australasian emergency departments.

PubMed

Cannon, M E; Sprivulis, P; McCarthy, J

2001-08-01

The objective of this study was to estimate the use of restraint techniques and evaluate restraint policies and training in Australasian emergency departments A survey of 116 Australasian emergency departments was conducted to determine the type, indications/contraindications, training, policies, documentation and audit requirements for restraint. The overall estimated rate of patient restraint is 3.3 episodes per 1000 presentations. The commonest indications for restraint are violence or threatened violence (52%), psychosis (32%) and acute brain syndrome (10%). Major contraindications are medical instability, risk of harm to staff in applying restraint and the availability of alternatives to restraint. Chemical restraint is used in all emergency departments surveyed. The commonest agents used are haloperidol (93%), midazolam (82%) and diazepam (59%). At least one benzodiazepine and one major tranquilliser are used in 97% of emergency departments. Manual restraint (87%) is frequently used as a prelude to chemical or, less frequently, mechanical restraint (69%). Seclusion restraint is used in 23% of Australasian emergency departments. Formal training is most commonly undertaken for chemical restraint, being used in 33% of departments surveyed. Less than half of the departments have written policies guiding the use of restraint, and only 11% audit their use of restraint. A specific form for restraint documentation is used in only one emergency department. Patient restraint is a common procedure in Australasian emergency departments. There is little formal training in, or documentation or audit of, restraint practices in Australasian emergency departments, despite the important clinical, occupational health and medical legal issues associated with the use of restraint.

Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery.

PubMed

2017-01-01

Evidence-based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency. Patients aged 16 years or more presenting with emergency general surgery problems were identified over a 7-day period and then screened for sepsis compliance (using the Sepsis Six standards, devised for severe sepsis) and the timing of source control (whether radiological or surgical). Exploratory analyses examined associations between the mode (emergency department or general practitioner) and time of admission, adherence to the sepsis guidelines, and outcomes (complications or death within 30 days). Of a total of 5067 patients from 97 hospitals across the UK, 911 (18·0 per cent) fulfilled the criteria for sepsis, 165 (3·3 per cent) for severe sepsis and 24 (0·5 per cent) for septic shock. Timely delivery of all Sepsis Six guidelines for patients with severe sepsis was achieved in four patients. For patients with severe sepsis, 17·6-94·5 per cent of individual guidelines within the Sepsis Six were delivered. Oxygen was the criterion most likely to be missed, followed by blood cultures in all sepsis severity categories. Surgery for source control occurred a median of 19·8 (i.q.r. 10·0-35·4) h after diagnosis. Omission of Sepsis Six parameters did not appear to be associated with an increase in morbidity or mortality. Although sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Referral pathways of patients with gallstones: a potential source of financial waste in the U.K. National Health Service?

PubMed

Borowski, David; Knox, Margaret; Kanakala, Venkat; Richardson, Stuart; Seymour, Keith; Attwood, Stephen; Slater, Bary

2010-01-01

Gallstone-related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone-disease is by laparoscopic cholecystectomy, which can be safely and cost-effectively performed during a short hospital stay or as day-case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings. The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment. Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co-morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least pounds 16,194. A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

"The One That Got Away": How Angling as a Culture of Practice Manifests in the Teaching and Learning Relationship within Angling-Based Intervention Programmes

ERIC Educational Resources Information Center

Djohari, Natalie; Brown, Adam; Stolk, Paul

2016-01-01

In recent years a professional sector has emerged within the UK delivering angling-based intervention programmes targeted at young people "disengaged" with education. These coaches bring with them an angling cultural background, which influences their interactions with young people as "novices", emerging in "angler…

Lessons from the UK Know How Funds Initiative: Development of Peer Education for Business in Emergent Market Economies

ERIC Educational Resources Information Center

Morrison, A.

2003-01-01

The relationship that has existed historically between industry and higher education in Western economies is currently being mirrored in the transforming economies of the former Soviet Union. These emerging market economies have been encouraged by their association with a now obsolete British Council awards scheme to study historical and current…

Universities and nursing education.

PubMed

Hayward, J

1982-07-01

Trends reflected by Department of Health and Social Security statistics on the nursing workforce are examined and the ratios between grades discussed. Recruitment into nursing degree courses in the UK is considered in relation to overall recruitment into nursing. The somewhat ambiguous position of nursing degree courses in the UK leads into consideration of policy statements by the universities and the nursing profession. The importance of such policies is emphasized in the current financial climate, as are the potential contributions of university departments to professional debate, for example standards of care. Comparisons are drawn between the goals of courses involving full-time studentships as opposed to part-time apprenticeships and the present boundaries between these noted, especially in relation to the expanding roles of courses. On-going research into the preparation of nurse-tutors in the UK is mentioned, together with a preliminary analysis of the academic basis in the biological sciences possessed by learners and tutors. Out of this is derived a suggestion that the present-day shortage of nurse teachers could be helped by varying the existing patterns of recruitment, especially involving subject specialists in the biological, behavioural and social sciences.

Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: a mixed-methods study of UK NHS Consultants.

PubMed

Dasan, Sunil; Gohil, Poonam; Cornelius, Victoria; Taylor, Cath

2015-08-01

To estimate prevalence and explore potential causes and consequences of compassion satisfaction and compassion fatigue in UK emergency medicine consultants. A sequential mixed-methods design. Cross-sectional e-survey to all UK NHS emergency medicine consultants (n=1317) including Professional Quality of Life (ProQOL) (compassion satisfaction/fatigue), followed by interviews with consultants scoring above (n=6) and below (n=6) predefined ProQOL thresholds. 681 (52%) consultants responded. Most (98%) reported at least 'average' compassion satisfaction. Higher scores were associated with type of workplace (designated trauma centres faring better) and number of years worked as a consultant (gradually worsen over time, except 20 years onwards when it improves). Consultants with lower (worse) compassion satisfaction scores were more likely to report being irritable with patients or colleagues and reducing their standards of care (a third reported these behaviours at least monthly) and were more likely to intend to retire early (59% had such plans). Key features distinguishing 'satisfied' from 'fatigued' interviewed consultants included having strategies to deal with the high work intensities associated with their role and having positive views of the team within which they worked. The degree of variety in their roles and the ability to maintain empathy for their patients were also distinguishing features between these groups. Findings support an urgent review of workforce and resources in emergency medicine and suggest that a multifactorial approach to identification, prevention and treatment of occupational stress in the workforce is required that considers individual, job and organisational factors, particularly those that impact on perceived control and support at work. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Length of Stay of Pediatric Mental Health Emergency Department Visits in the United States

ERIC Educational Resources Information Center

Case, Sarah D.; Case, Brady G.; Olfson, Mark; Linakis, James G.; Laska, Eugene M.

2011-01-01

Objective: To compare pediatric mental health emergency department visits to other pediatric emergency department visits, focusing on length of stay. Method: We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of US emergency department visits from 2001 to 2008, for patients aged less than…

Accelerated technology transfer: the UK quantum initiative

NASA Astrophysics Data System (ADS)

Bennett, Simon D.

2016-10-01

A new generation of quantum technology based systems, exploiting effects such as superposition and entanglement, will enable widespread, highly disruptive applications which are expected to be of great economic significance. However, the technology is only just emerging from the physics laboratory and generally remains at low TRLs. The question is: where, and when, will this impact be first manifest? The UK, with substantial Government backing, has embarked on an ambitious national program to accelerate the process of technology transfer with the objective of seizing a significant and sustainable share of the future economic benefit for the UK. Many challenges and uncertainties remain but the combined and co-ordinated efforts of Government, Industry and Academia are making great progress. The level of collaboration is unusually high and the goal of embedding a "QT Ecosystem" in the UK looks to be attainable. This paper describes the UK national programme, its key players, and their respective roles. It will illustrate some of the likely first commercial applications and provide a status update. Some of the challenges that might prevent realisation of the goal will be highlighted.

Evaluation of Glyphosate, Flumioxazin and Imazamox against Japanese Knotweed s. l.

DTIC Science & Technology

2013-06-01

DEFRA). 2003. Review of non-native species policy. Department of Environment, Food and Rural Affairs, London, UK. http://jncc.defra.gov.uk/page-4010...Simmers and Lee 1997). The site consists of three distinct ecological zones (aquatic, wetland and upland) and is utilized by more than 200 species ...of resident and migratory birds (Andrle 1986, Simmers and Lee 1997). Approximately 46 acres of Times Beach has been designated as a state wetland by

Comparing emergency department presentations among children with cerebral palsy with general childhood presentations: a data linkage study.

PubMed

Meehan, Elaine; Williams, Katrina; Reid, Susan M; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Vidmar, Suzanna; Donath, Susan; Reddihough, Dinah S

2017-11-01

The aims of this study were to estimate the proportion of emergency department presentations attributable to children with cerebral palsy (CP), investigate the frequency of emergency department presentations in a CP cohort, and compare emergency department presentations among children with CP with those of other children. This was a retrospective cohort study. The Victorian Cerebral Palsy Register was linked to the Victorian Emergency Minimum Dataset. Data on emergency department presentations for the CP cohort occurring between 2007 and 2014 and population control data were obtained. The CP cohort (n=1748) had 7015 emergency department presentations during the 7-year period, accounting for 0.4% of the 1.69 million age-specific presentations during that time. The number of annual presentations per 1000 children rose with increasing CP severity. Compared with presentations among the general population, higher proportions of presentations among the CP cohort were preceded by ambulance arrivals (27% vs 8%), triaged as urgent (66% vs 32%), and required hospital admission (38% vs 12%). The marked differences in presentations between the CP cohort and the general population in the proportions that were urgent and required ambulance arrivals and hospital admissions was an important finding. Strategies to ensure appropriate use of services, including encouragement to seek earlier assistance from primary care providers, may prevent problems escalating to the need for urgent care. Children with cerebral palsy (CP) account for 0.4% of childhood emergency department presentations. More emergency department presentations among children with CP require ambulance arrival. More CP emergency department presentations are urgent and require hospital admission. Traditional emergency department triage scales seem less accurate for this group. © 2017 Mac Keith Press.

Mild soaps and radiotherapy: a survey of the UK public to identify brands of soap considered mild and analysis of these to ascertain suitability for recommendation in radiotherapy departments.

PubMed

Robertson, K; Brown, P

2011-05-01

Cancer agencies recommend that patients use mild soap when undergoing external beam radiotherapy to minimise skin reactions. They define 'mild soap' as non-alkaline, lanolin free, unperfumed soap with a neutral pH. This study aimed to identify which soaps the UK public perceive as mild and ascertain if these were clinically mild and could potentially be recommended within radiotherapy departments. A survey of 237 participants identified eight top brands of mild soap, which were then tested for pH and analysed for potential irritants. All soaps were lanolin free and non-alkaline, with Simple and Johnson's the closest to pH 5.5. All contained fragrances except Simple and E45. Dove, Pears and Imperial Leather contained the highest concentration of fragrances. All soaps except E45 contained potential irritants. Only Simple and E45 fit the cancer agencies' definition of mild soap and could therefore be recommended for radiotherapy patients. Future research should identify current practices and recommendations in the UK as anecdotal evidence suggests large variations in skin care advice. Further scientific analysis could potentially identify cheaper brands that fit the definition of 'mild'. UK recommendations should be standardised and consistent with best practice to reduce skin reaction severity in radiotherapy patients. © 2010 Blackwell Publishing Ltd.

Creating an integrated clinical enterprise at the University of Kentucky: the emergence of UK HealthCare.

PubMed

Karpf, Michael; Perman, Jay; Lofgren, Richard; Melgar, Sergio; Butler, Frank; Day, Zed; Clark, Murray; Claypool, Joseph O; Gilbert, Peter; Gombeski, William; Higdon, Courtney M

2007-12-01

If the medical system in the United States is to change, as has been recommended, academic medical centers must, in fact, lead this change process. To prepare for the future, the University of Kentucky decided to move aggressively toward developing an integrated clinical enterprise branded as UK HealthCare, where leadership of the various components of the academic medical center make strategic and financial decisions together to achieve common organizational goals. The authors discuss senior leadership's development of the vision for the enterprise and the governance structure that was established to engage board members and faculty of the institution. They examine the rigorous strategic, facilities, financial, and academic planning that ensued, and the early successes achieved. The authors introduce some of the lessons learned by the organization during the emergence of UK HealthCare and describe the corporate structure and senior management team that was established to support the quick and efficient implementation of the planning strategies. It was this corporate structure and senior management team which has proven to be an effective agent of change and a key to the successful development of a truly integrated clinical enterprise.

Emergent authority and expert knowledge: psychiatry and criminal responsibility in the UK.

PubMed

Loughnan, Arlie; Ward, Tony

2014-01-01

In the UK context, the rise of the discipline and practice of forensic psychiatry is intimately connected with the concurrent development of principles and practices relating to criminal responsibility. In this article, we seek to chart the relationship between psychiatry and the principles and practices of criminal responsibility in the UK over the early modern, modern and late modern periods. With a focus on claims about authority and expert knowledge around criminal responsibility, we suggest that these claims have been in a state of perpetual negotiation and that, as a result, claims to authority over and knowledge about criminal non-responsibility on the part of psychiatrists and psychiatry are most accurately understood as emergent and contingent. The apparent formalism of legal discourse has tended to conceal the extent to which legal policy has been preoccupied with maintaining the primacy of lay judgments in criminal processes of evaluation and adjudication. While this policy has been somewhat successful in the context of the trial - particularly the murder trial - it has been undermined by administrative procedures surrounding the trial, including those that substitute treatment for punishment without, or in spite of, a formal determination of criminal responsibility. © 2013.

Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

PubMed

Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

2016-05-01

Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Cost comparison and safety of emergency department conscious sedation for the removal of ear foreign bodies.

PubMed

Olson, Michael D; Saw, Jessica; Visscher, Sue L; Balakrishnan, Karthik

2018-07-01

The purpose of this study is to investigate the relative cost and safety of ear foreign body (FB) removal via conscious sedation in the emergency department. A retrospective review of patients presenting from 2000 to 2015 to the emergency department at Mayo Clinic, Rochester, Minnesota was performed. 63 patients requiring sedation for ear foreign body removal were identified. Descriptive data, safety data, and costs were obtained for the study. There were no appreciable differences in patient safety outcomes and otologic outcomes in patients who received sedation in the emergency department or anesthesia in the operating room for FB removal. Cost analysis demonstrated increased cost associated with operating room utilization verses conscious sedation in the emergency department, with the greatest cost increase being in patients evaluated first in the emergency department and then sent to the operating room. Ear foreign body removal in the emergency department is shows a similar safety profile to removal in the operating room, but at a markedly lower cost. Emergency department conscious sedation should be considered a viable option in appropriately selected patients with this common problem given these results. Copyright © 2018. Published by Elsevier B.V.

Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department.

PubMed

Ngo, Stephanie; Shahsahebi, Mohammad; Schreiber, Sean; Johnson, Fred; Silberberg, Mina

2017-11-09

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p < 0.001) and a decrease of 9.5 h in emergency department length of stay per average visit per patient (p<0.001). There was no significant effect on the number of hospitalizations or hospital length of stay. This intervention demonstrated a correlation with reducing emergency department use in patients with behavioral health issues, but no correlation with reducing hospital utilization. This under-researched approach of integrating medical records at point-of-care could serve as a model for better emergency department management of behavioral health patients.

Sustainable diet policy development: implications of multi-criteria and other approaches, 2008-2017.

PubMed

Lang, Tim; Mason, Pamela

2017-12-04

The objective of the present paper is to draw lessons from policy development on sustainable diets. It considers the emergence of sustainable diets as a policy issue and reviews the environmental challenge to nutrition science as to what a 'good' diet is for contemporary policy. It explores the variations in how sustainable diets have been approached by policy-makers. The paper considers how international United Nations and European Union (EU) policy engagement now centres on the 2015 Sustainable Development Goals and Paris Climate Change Accord, which require changes across food systems. The paper outlines national sustainable diet policy in various countries: Australia, Brazil, France, the Netherlands, Qatar, Sweden, UK and USA. While no overarching common framework for sustainable diets has appeared, a policy typology of lessons for sustainable diets is proposed, differentiating (a) orientation and focus, (b) engagement styles and (c) modes of leadership. The paper considers the particularly tortuous rise and fall of UK governmental interest in sustainable diet advice. Initial engagement in the 2000s turned to disengagement in the 2010s, yet some advice has emerged. The 2016 referendum to leave the EU has created a new period of policy uncertainty for the UK food system. This might marginalise attempts to generate sustainable diet advice, but could also be an opportunity for sustainable diets to be a goal for a sustainable UK food system. The role of nutritionists and other food science professions will be significant in this period of policy flux.

Security aspects of electronic data interchange between a state health department and a hospital emergency department.

PubMed

Magnuson, J A; Klockner, Rocke; Ladd-Wilson, Stephen; Zechnich, Andrew; Bangs, Christopher; Kohn, Melvin A

2004-01-01

Electronic emergency department reporting provides the potential for enhancing local and state surveillance capabilities for a wide variety of syndromes and reportable conditions. The task of protecting data confidentiality and integrity while developing electronic data interchange between a hospital emergency department and a state public health department proved more complex than expected. This case study reports on the significant challenges that had to be resolved to accomplish this goal; these included application restrictions and incompatibilities, technical malfunctions, changing standards, and insufficient dedicated resources. One of the key administrative challenges was that of coordinating project security with enterprise security. The original project has evolved into an ongoing pilot, with the health department currently receiving secure data from the emergency department at four-hour intervals. Currently, planning is underway to add more emergency departments to the project.

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Department and agency responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency...

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Department and agency responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency...

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Department and agency responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency...

44 CFR 352.21 - Participating Federal agencies.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Department of Defense; (3) Department of Energy; (4) Department of Health and Human Services; (5) Department... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Participating Federal agencies. 352.21 Section 352.21 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

44 CFR 352.21 - Participating Federal agencies.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Department of Defense; (3) Department of Energy; (4) Department of Health and Human Services; (5) Department... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Participating Federal agencies. 352.21 Section 352.21 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

Comparison of two European paediatric emergency departments: does primary care organisation influence emergency attendance?

PubMed

Poropat, F; Heinz, P; Barbi, E; Ventura, A

2017-03-08

To compare paediatric Emergency Department (ED) attendances and admission outcomes in two European hospitals with different paediatric primary care set-up. This is a retrospective prevalence study comparing all paediatric ED attendances during calendar years 2013 in two EDs with similar catchment area: one in Italy (Trieste) where paediatric primary care is provided by office paediatricians, the other, in the UK (Cambridge), where paediatric primary care is provided by general practitioners. Data on reason for presentation, discharge diagnosis and admission rate were collected and sub-group analysis for specific age groups (<1 year, 1-4 years, 5-15 years) was performed. Over 12 months, 20.331 children (0-15 years old) were seen in Cambridge and 18.646 in Trieste, with a very similar age distribution in both centres, except for the youngest age group: the percentage of infants seen in comparison with the total number of children attending ED was 1/3 higher in England than in Italy (15.4% vs 11.4%). The reasons for attendance were similar: under 1 year of age, the chief complaints were fever, breathing difficulties and gastrointestinal problems while in the older age groups trauma represented the commonest reason. Among discharge diagnoses, no differences were found between the two hospitals, except for faltering growth and "well child", more frequently diagnosed in English children under 5 years. The proportion of admissions was three times higher in Cambridge (14.1% vs 4.8%) with most children being admitted for infectious diseases. ED attendances in infants are more common in a primary care setting provided by general practicioner and, moreover, admission rates in all age groups are 1/3 reduced by primary care based paediatricians. Due to the methodological limits of this study, it isn't possible to evaluate whether these results depend only on paediatric primary care set-up or be determined by other confounding factors. New studies are needed to confirm this preliminary evidence.

Successful implementation of strategies to transform Emergency Department transfusion practice.

PubMed Central

Reed, Matthew J; Kelly, Sarah-Louise; Beckwith, Hannah; Innes, Catherine J; Manson, Lynn

2013-01-01

Blood component transfusion is an important and lifesaving Emergency Department (ED) procedure. It is not however risk-free and careful consideration of its clinical benefit for each individual patient is therefore essential. In 2008, we audited the patterns of blood component usage in 2007 within our ED. This work revealed that whilst 3209 units of blood component were ordered only 39.5% were transfused, and 9.5% were unaccounted for. This was the first and only published detailed look at ED blood transfusion practices. We had to address our poor traceability (i.e. unaccounted for units), our high blood usage, and our ordering of units which were then not transfused as this can lead to wastage. Firstly, better links between the ED and the Scottish National Blood Transfusion Service (SNBTS) were established. A set of improvement measures were then implemented including better ED medical and nursing staff education, monthly traceability reports sent to the ED clinical management teams, the introduction of an ED transfusion guideline, moving our blood fridge into the resuscitation room, having a named ED transfusion consultant and ED transfusion link nurse, ED consultant representation on the Hospital Transfusion Group and finally increasing awareness of ED emergency transfusion with a rotational thromboelastometry (ROTEM) research programme. In 2012, we re-audited our practice looking at our blood component usage in 2011. There was a 64% reduction in blood component ordering (3209 vs. 1034 units), a 39% reduction in blood component transfusion (1131 vs. 687 units), a 68% increase in the proportion of ordered units that were transfused and a 96% reduction in unaccounted units (289 vs. 9 units) between 2007 and 2011. In attempting to cost the savings resulting from our changes we showed that SNBTS spent £306,437 less in 2011 compared to 2007 on handling and issuing ED transfusion requests. Our improvements are immediately generalizable across the UK and the potential savings to the NHS are enormous. PMID:26734190

A Dialogue about MCQs, Reliability, and Item Response Modelling

ERIC Educational Resources Information Center

Wright, Daniel B.; Skagerberg, Elin M.

2006-01-01

Multiple choice questions (MCQs) are becoming more common in UK psychology departments and the need to assess their reliability is apparent. Having examined the reliability of MCQs in our department we faced many questions from colleagues about why we were examining reliability, what it was that we were doing, and what should be reported when…

Would You Credit It? Navigating the Transitions between Curricular and Extra-Curricular Learning in University Music Departments

ERIC Educational Resources Information Center

Pitts, Stephanie E

2013-01-01

Extra-curricular activities have for many years been a prominent and valuable feature of UK university music departments, but the current political and economic climate poses several significant threats to their survival, including uncertain funding, demands on students’ time (including the need to undertake paid employment), and, potentially, the…

Delivering quality care: what can emergency gynaecology learn from acute obstetrics?

PubMed

Bika, O H; Edozien, L C

2014-08-01

Emergency obstetric care in the UK has been systematically developed over the years to high quality standards. More recently, advances have been made in the organisation and delivery of care for women presenting with acute gynaecological problems, but a lot remains to be done, and emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. This paper highlights areas such as consultant presence, risk management, patient flow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities, where lessons from obstetrics are transferrable to emergency gynaecology.

The association between home care visits and same-day emergency department use: a case-crossover study.

PubMed

Jones, Aaron; Schumacher, Connie; Bronskill, Susan E; Campitelli, Michael A; Poss, Jeffrey W; Seow, Hsien; Costa, Andrew P

2018-04-30

The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. © 2018 Joule Inc. or its licensors.

The association between home care visits and same-day emergency department use: a case–crossover study

PubMed Central

Jones, Aaron; Schumacher, Connie; Bronskill, Susan E.; Campitelli, Michael A.; Poss, Jeffrey W.; Seow, Hsien

2018-01-01

BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. METHODS: We conducted a population-based case–crossover study among patients receiving publicly funded home care in the Hamilton–Niagara–Haldimand–Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs (“long stay”) or short-term home care needs (“short stay”). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. RESULTS: A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17–1.48) and short-stay patients (OR 1.22, 95% CI 1.07–1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. INTERPRETATION: Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. PMID:29712671

Rates and features of methamphetamine-related presentations to emergency departments: An integrative literature review.

PubMed

Jones, Rikki; Woods, Cindy; Usher, Kim

2018-07-01

To review the clinical impact methamphetamine has on emergency departments by assessing the available research on the rates and features of methamphetamine-related presentations. Globally, methamphetamine availability, distribution and use have rapidly increased. As a result, the number of methamphetamine-related presentations to emergency departments has also increased. In this context, it is timely to review the rate and features of methamphetamine-related presentations to understand the impact of methamphetamine on emergency departments and facilitate the allocation of services, staff and resources. An integrative literature review. This study presents an integrated literature review, following the systematic review process as outlined in the PRISMA flow chart. Several databases were searched using a combination of search terms. Articles were measured against inclusion and exclusion criteria, and the final ten articles were subjected to quality appraisal and outcomes reported. Methamphetamine accounted for 2.3% or less of all emergency departments presentations. The majority of methamphetamine users presenting to emergency departments were males, with a mean age 31-37. Methamphetamine-related presentations to emergency departments were more likely to present with trauma, psychosis, and be placed on 24-hr psychiatric hold. Methamphetamine-related presentations were more likely to present with agitation, aggression and homicidal behaviour and present to emergency departments out of hours and accompanied by police compared with other emergency departments substance-related presentations. Several important themes were highlighted in this review that has an impact on emergency departments services, resources and staff. Understanding the rate and patterns of methamphetamine-related presentations can help to provide evidence for policy development and staff education in emergency departments. Methamphetamine-related presenters are more aggressive and agitated and more likely to be brought in by police. There is a need for policy development and staff training around these issues and further research in this area using stronger study designs. © 2018 John Wiley & Sons Ltd.

Winter chilling speeds spring development of temperate butterflies.

PubMed

Stålhandske, Sandra; Gotthard, Karl; Leimar, Olof

2017-07-01

Understanding and predicting phenology has become more important with ongoing climate change and has brought about great research efforts in the recent decades. The majority of studies examining spring phenology of insects have focussed on the effects of spring temperatures alone. Here we use citizen-collected observation data to show that winter cold duration, in addition to spring temperature, can affect the spring emergence of butterflies. Using spatial mixed models, we disentangle the effects of climate variables and reveal impacts of both spring and winter conditions for five butterfly species that overwinter as pupae across the UK, with data from 1976 to 2013 and one butterfly species in Sweden, with data from 2001 to 2013. Warmer springs lead to earlier emergence in all species and milder winters lead to statistically significant delays in three of the five investigated species. We also find that the delaying effect of winter warmth has become more pronounced in the last decade, during which time winter durations have become shorter. For one of the studied species, Anthocharis cardamines (orange tip butterfly), we also make use of parameters determined from previous experiments on pupal development to model the spring phenology. Using daily temperatures in the UK and Sweden, we show that recent variation in spring temperature corresponds to 10-15 day changes in emergence time over UK and Sweden, whereas variation in winter duration corresponds to 20 days variation in the south of the UK versus only 3 days in the south of Sweden. In summary, we show that short winters delay phenology. The effect is most prominent in areas with particularly mild winters, emphasising the importance of winter for the response of ectothermic animals to climate change. With climate change, these effects may become even stronger and apply also at higher latitudes. © 2017 The Authors. Journal of Animal Ecology © 2017 British Ecological Society.

Meet EPA Scientist Michael Nye, Ph.D.

EPA Pesticide Factsheets

Michael Nye, Ph.D., is a social scientist who studies natural risk, socio-demographic change and sustainable behavior. Prior to joining EPA, he worked for the UK Environment Agency in flood risk management and emergency preparedness

Methodology for developing quality indicators for the care of older people in the Emergency Department

PubMed Central

2013-01-01

Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important groups of older people, such as patients with cognitive impairment, residents of long term care and patients with palliative care needs. This project will develop a suite of quality indicators focused on the care of older persons in the emergency department. Methods/design Following input from an expert panel, an initial set of structural, process, and outcome indicators will be developed based on thorough systematic search in the scientific literature. All initial indicators will be tested in eight emergency departments for their validity and feasibility. Results of the data from the field studies will be presented to the expert panel at a second meeting. A suite of Quality Indicators for the older emergency department population will be finalised following a formal voting process. Discussion The predicted burgeoning in the number of older persons presenting to emergency departments combined with the recognised quality deficiencies in emergency department care delivery to this population, highlight the need for a quality framework for the care of older persons in emergency departments. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients. The development of well-selected, validated and economical quality indicators will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. PMID:24314126

Emergency Department Use by Centenarians: The 2008 Nationwide Emergency Department Sample

PubMed Central

Howell, Embry M.; McHugh, Megan Colleen

2013-01-01

Introduction Older adults have higher rates of emergency department use than do younger adults, and the number of centenarians is expected to increase. The objective of this study was to examine centenarians’ use of the emergency department in the United States, including diagnoses, charges, and disposition. Methods The 2008 Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality provided encounter-level data on emergency department visits and weights for producing nationwide estimates. From this data set, we collected patient characteristics including age, sex, primary diagnosis, and disposition. We used χ2 tests and t tests to test for significant differences among people aged 80 to 89, 90 to 99, and 100 years or older. Results Centenarians had a lower rate of emergency department use than those aged 90 to 99 (736 per 1,000 vs 950 per 1,000; P < .05). We found no significant difference in use between centenarians and those aged 80 to 89. The most common diagnoses for centenarians were superficial injuries (5.8% of visits), pneumonia (5.1%), and urinary tract infections (5.1%). Centenarians were more likely to visit the emergency department for fall-related injuries (21.5%) than those aged 80 to 89 (14.1%; P < .05) and 90 to 99 (18.7%; P < .05). Centenarians were more likely to die in the emergency department (2.0%) than were those aged 80 to 89 (0.6%; P < .05) and 90 to 99 (0.7%; P < .05). Conclusion Centenarians in emergency departments in the United States have different diagnoses, conditions, and outcomes than other older Americans. PMID:24286272

Incident reporting in one UK accident and emergency department.

PubMed

Tighe, Catherine M; Woloshynowych, Maria; Brown, Ruth; Wears, Bob; Vincent, Charles

2006-01-01

Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. This tool must be responsive and flexible to the local circumstances and work for the department to support the clinical governance agenda. In this paper, we describe the local processes for reporting and reviewing clinical incidents in one A&E department in a London teaching hospital and report recent changes to the system within the department. We used the historical data recorded on the Trust incident database as a representation of the information that would be available to the department in order to identify the high risk areas. In this paper, we evaluate the internal processes, the information available on the database and make recommendations to assist the emergency department in their internal processes. These will strengthen the internal review and staff feedback system so that the department can learn from incidents in a consistent manner. The process was reviewed by detailed examination of the centrally held electronic record (Datix database) of all incidents reported in a one year period. The nature of the incident and the level and accuracy of information provided in the incident reports was evaluated. There were positive aspects to the established system including evidence of positive changes made as a result of the reporting process, new initiatives to feedback to staff, and evolution of the programme for reporting and discussing the incidents internally. There appeared to be a mismatch between the recorded events and the category allocated to the incident in the historical record. In addition the database did not contain complete information for every incident, contributory factors were rarely recorded and relatively large numbers of incidents were recorded as "other" in the type of incident. There was also observed difficulty in updating the system as there is at least a months time lag between reporting or an incident and discussion/resolution of issues at the local departmental clinical risk management committee meetings. We used Leape's model for assessing the reporting system as a whole and found the system in the department to be relatively safe, fairly easy to use and moderately effective. Recommendations as a result of this study include the introduction of an electronic reporting system, limiting the number of staff who categorise the incidents--using clear definitions for classifications including a structured framework for contributory factors, and a process that allows incidents to be updated on the database locally after the discussion. This research may have implications for the incident reporting process in other specialities as well as in other hospitals.

A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain.

PubMed

Foldes-Busque, Guillaume; Denis, Isabelle; Poitras, Julien; Fleet, Richard P; Archambault, Patrick; Dionne, Clermont E

2017-01-01

This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%-37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%-80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.

Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study

PubMed Central

Kushel, Margot B.; Perry, Sharon; Bangsberg, David; Clark, Richard; Moss, Andrew R

2002-01-01

Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons. Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models. Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% exhibited high rates of use (more than 3 visits) and accounted for 54.5% of all visits. Factors associated with high use rates included less stable housing, victimization, arrests, physical and mental illness, and substance abuse. Predisposing and need factors appeared to drive emergency department use. Conclusions. Efforts to reduce emergency department use among the homeless should be targeted toward addressing underlying risk factors among those exhibiting high rates of use. PMID:11988447

Perceptions of emergency department staff of the role of physiotherapists in the system: a qualitative investigation.

PubMed

Lefmann, S A; Sheppard, L A

2014-03-01

To investigate the perceptions of doctors, nurses and physiotherapists of emergency department physiotherapy for acute patients, and explore the scope of its contribution in an otherwise nontraditional allied health setting in Australia. Qualitative investigation using semi-structured interviews. A large, metropolitan tertiary hospital with a well-established emergency department physiotherapy/allied health network in place. Two emergency department doctors, two emergency department nurses and two senior physiotherapists working in an emergency department were recruited purposefully from the study hospital. Semi-structured interviews lasting from 20 minutes to 1 hour were conducted with each participant by the lead investigator. Data were analysed using NVivo software, coded manually and verified with member checking, facilitating constant case comparisons. Issues explored included defining the role of physiotherapists, uncovering organisational themes from the introduction of physiotherapy into the established emergency department setting, and conflicts around preserving and expanding an allied health identity in a highly-medicalised clinical environment. Participants described the benefits of having physiotherapists located in the emergency department, and the physiotherapists were eager to advance their roles and responsibilities, but were, at times, restricted by a complicated organisational landscape influencing professional autonomy and capacity for professional advocacy. Ongoing evidence supporting the breadth of physiotherapy practice in the emergency department is needed to further advocate the usefulness of the profession in this acute setting. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

A survey of the clinical use of SeHCAT in the UK.

PubMed

Smith, Michael J; Perkins, Alan C

2013-04-01

The radiopharmaceutical 23-(Se)selena-25-homotaurocholic acid (SeHCAT), introduced 30 years ago, serves as a convenient and reliable diagnostic test for bile acid malabsorption. Recent advances in understanding the pathophysiology of bile acid diarrhoea have led to increased use of SeHCAT; however, some questions on its applicability remain unanswered. To obtain a better understanding of the application of this diagnostic test, a national survey was carried out within the UK. A web-based semistructured questionnaire was used. Invitations to participate were sent to the lead contacts of the 227 Nuclear Medicine Departments in the UK known to the British Nuclear Medicine Society. Information was sought on workload, trends in referrals, acquisition protocols, patient preparation, results, normal ranges and interpretation. For those not using SeHCAT, questions on reasons for not using the test and intentions to commence its use in the future were asked. Responses from 129 UK centres were included in analysis. Seventy-three of these (57%) used SeHCAT in diagnosis, and most of them reported an increase in referrals over the last 3 years. Several departments have started using SeHCAT recently in response to demand from clinicians. There was considerable variability in the practical implementation of the technique and the 'normal' range used for reporting. The findings from the survey have provided a better understanding of how diagnosis using SeHCAT is carried out in the UK. An important finding was the wide variation in the normal reference values used for diagnostic reporting. Establishing greater consistency in the interpretation and reporting of the results of this test would be of considerable clinical value.

Physicians in Hospital Emergency Departments. [Proceedings, New Jersey Training Program].

ERIC Educational Resources Information Center

Health Services and Mental Health Administration (DHEW), Rockville, MD. Div. of Emergency Health Services.

This program was organized in response to the rapidly increasing demands placed upon the emergency departments of general hospitals, and in recognition of the fact that the crucial ingredient in emergency department services is physician capability. The training program was implemented for hospital department physicians and other interested…

A Scoping Review: Communication Between Emergency Physicians and Patients in the Emergency Department.

PubMed

Roh, HyeRin; Park, Kyung Hye

2016-05-01

Understanding the basic qualities of communication between emergency physicians and patients could improve communication in the emergency department. The objectives of this scoping review are to map the literature about the gaps in communication between emergency physicians and patients in the emergency department and make recommendations for further research. A scoping review of literature published since 1980 and written in English was undertaken using the following databases: Pubmed, Scopus, and SocINDEX. The articles were searched for using two-keyword combinations of the following keywords joined by "AND": "communication," "patient," "emergency physician," "emergency department/emergency room/accident," and "emergency room." Seventeen articles were included in the final review. Five research issues were covered by the 17 papers: patient-centered communication, information sharing, bad news delivery, shared decision making, and physicians' perspectives on communication. Emergency physicians have several communication characteristics: doctor-driven decision making, focusing on efficient information gathering, immature communication techniques, and obstacles to overcoming miscommunication. Patients also have several communication characteristics: active participation in medical encounters, expectation of physician as a reliable guide, understanding physicians' difficulties, and factors that contribute to understanding. Several conclusions about emergency department communication between patients and emergency physicians were drawn. Additional research is required to consider diverse patient needs in the emergency department. Furthermore, training programs for emergency physicians to improve the quality of communication should be developed and implemented in line with our research findings. Copyright © 2016 Elsevier Inc. All rights reserved.

Drug Prices and Emergency Department Mentions for Cocaine and Heroin

PubMed Central

Caulkins, Jonathan P.

2001-01-01

Objectives. In this report, the author illustrates the historic relation between retail drug prices and emergency department mentions for cocaine and heroin. Methods. Price series based on the Drug Enforcement Administration's System to Retrieve Information From Drug Evidence database were correlated with data on emergency department mentions from the Drug Abuse Warning Network for cocaine (1978–1996) and heroin (1981–1996). Results. A simple model in which emergency department mentions are driven by only prices explains more than 95% of the variation in emergency department mentions. Conclusions. Fluctuations in prices are an important determinant of adverse health outcomes associated with drugs. PMID:11527779

An audit of bronchoscopy practice in the United Kingdom: a survey of adherence to national guidelines

PubMed Central

Honeybourne, D.; Neumann, C. S.

1997-01-01

BACKGROUND: Both patient and staff safety are of major importance during the procedure of fibreoptic bronchoscopy. Patient safety depends partly on adequate disinfection of instruments and accessories used as well as careful monitoring during the procedure. Adequate facilities, manpower and training are also essential. Staff safety depends partly on adequate procedures to minimise any risks of sensitisation to agents such as glutaraldehyde. An audit was carried out of bronchoscopy procedures in hospitals in the UK and the findings were compared with published guidelines on good practice and clinical consensus. METHODS: A postal questionnaire was sent to 218 bronchoscopy units in the UK. Findings were then compared with published evidence of good practice in the areas of disinfection, including the use of glutaraldehyde, patient monitoring, manpower, facilities, and training. RESULTS: A 73% response rate was obtained. Recommended minimum disinfection times before and after routine bronchoscopies were not achieved by 35% of units. No disinfection was carried out in 34% of units before emergency bronchoscopies and in 19% of units after suspected cases of tuberculosis. Adequate rinsing of the bronchoscope with sterile or filtered water was not carried out by 43% of units. Contrary to recommendations, 31% of departments were still using glutaraldehyde in the patient examination room and inadequate room ventilation was common. Protective clothing was often not worn by staff during bronchoscopy. Inadequate intravenous access and use of supplementary oxygen were found in many units. Practice standards were higher in departments where dedicated bronchoscopy/endoscopy units of the hospital were used, and also where staff had been on external training courses. CONCLUSIONS: This audit has shown that many units do not adhere to guidelines on disinfection procedures and patient monitoring. Unnecessary potential risks due to staff exposure to glutaraldehyde were apparent. National guidelines on good practice are not being followed in areas which may potentially affect patient and staff safety. 


 PMID:9337830

Time series modelling and forecasting of emergency department overcrowding.

PubMed

Kadri, Farid; Harrou, Fouzi; Chaabane, Sondès; Tahon, Christian

2014-09-01

Efficient management of patient flow (demand) in emergency departments (EDs) has become an urgent issue for many hospital administrations. Today, more and more attention is being paid to hospital management systems to optimally manage patient flow and to improve management strategies, efficiency and safety in such establishments. To this end, EDs require significant human and material resources, but unfortunately these are limited. Within such a framework, the ability to accurately forecast demand in emergency departments has considerable implications for hospitals to improve resource allocation and strategic planning. The aim of this study was to develop models for forecasting daily attendances at the hospital emergency department in Lille, France. The study demonstrates how time-series analysis can be used to forecast, at least in the short term, demand for emergency services in a hospital emergency department. The forecasts were based on daily patient attendances at the paediatric emergency department in Lille regional hospital centre, France, from January 2012 to December 2012. An autoregressive integrated moving average (ARIMA) method was applied separately to each of the two GEMSA categories and total patient attendances. Time-series analysis was shown to provide a useful, readily available tool for forecasting emergency department demand.

A Review of Current and Emerging Approaches to Pain Management in the Emergency Department.

PubMed

Todd, Knox H

2017-12-01

Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches. For some of these therapies, sparse evidence exists to support their efficacy for emergency department use. The purpose of this paper is to review historical trends and emerging approaches to emergency department analgesia, with a particular focus on the USA and Canada. We conducted a qualitative review of past and current descriptive studies of emergency department pain practice, as well as clinical trials of emerging pain treatment modalities. The review considers the increasing use of non-opioid and multimodal analgesic therapies, including migraine therapies, regional anesthesia, subdissociative-dose ketamine, nitrous oxide, intravenous lidocaine and gabapentinoids, as well as broad programmatic initiatives promoting the use of non-opioid analgesics and nonpharmacologic interventions. While migraine therapies, regional anesthesia, nitrous oxide and subdissociative-dose ketamine are supported by a relatively robust evidence base, data supporting the emergency department use of intravenous lidocaine, gabapentinoids and various non-pharmacologic analgesic interventions remain sparse. Additional research on the relative safety and efficacy of non-opioid approaches to emergency department analgesia is needed. Despite a limited research base, it is likely that non-opioid analgesic modalities will be employed with increasing frequency. A new generation of emergency physicians is seeking additional training in pain medicine and increasing dialogue between emergency medicine and pain medicine researchers, educators and clinicians could contribute to better management of emergency department pain.

Emergency department triage: an ethical analysis

PubMed Central

2011-01-01

Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach. PMID:21982119

Genetics Home Reference: homocystinuria

MedlinePlus

... reductase deficiency Orphanet: Homocystinuria without methylmalonic aciduria Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (6 links) Children Living with Inherited Metabolic Diseases (CLIMB) (UK) CLIMB: ...

Supporting research in a recession

NASA Astrophysics Data System (ADS)

Allport, Phil

2009-08-01

I am writing in support of Philip Moriarty's article on "The economic-impact fallacy" (June pp16-17). While we all welcome the increases in UK research funding over the last decade, there needs be to a recognition that this was required to compensate for previous chronic underfunding and that, despite what Prime Minister Gordon Brown has called a "knowledge economy", our overall spending still lags significantly behind our competitors. Given the gulf between the rhetoric and the reality, articles by Moriarty and others reflect the sense of disbelief, which most of us feel, that the UK government now also seems to want to limit us all to the kind of shortterm, near-market research that can never hope to give the UK any sustainable lead with respect to (for example) the emerging economies in the Far East.

Continuous bioprocessing: The real thing this time?

PubMed Central

Farid, Suzanne S; Thompson, Bill; Davidson, Andrew

2014-01-01

The Annual bioProcessUK Conference has acted as the key networking event for bioprocess scientists and engineers in the UK for the past 10 years. The following article is a report from the sessions that focused on continuous bioprocessing during the 10th Annual bioProcessUK Conference (London, December 2013). These sessions were organized by the ‘EPSRC Centre for Innovative Manufacturing in Emergent Macromolecular Therapies’ hosted at University College London. A plenary lecture and workshop provided a forum for participants to debate topical issues in roundtable discussions with industry and academic experts from institutions such as Genzyme, Janssen, Novo Nordisk, Pfizer, Merck, GE Healthcare and University College London. The aim of these particular sessions was to understand better the challenges and opportunities for continuous bioprocessing in the bioprocessing sector. PMID:25484060

[Career guidance for registered nurse in the UK].

PubMed

Simón Melchor, Lucía; Simón Melchor, Alba

2014-04-01

Cuts in temporary contracts has had big consequences for newly qualified nurses with regards to finding employment. This cut in contracts has resulted in a doubling in the rate of unemployment in this profession. In the past nurses emigrated to other countries for purposes like knowledge of the language or to extend their training and experience, however today the emigration has become the only way out for many professional nurses. The reputation of nurses in Spain is recognised internationally, with the UK being one of the countries with the largest demand for Spanish nurses. Due to the great amount of job opportunities that are emerging in the UK, nurses need help and guidance in their careers, and also nurses need training in areas such as Professional Body, developing a curriculum, facing an interview etc...

Highlights from SelectBio 2015: Academic Drug Discovery Conference, Cambridge, UK, 19-20 May 2015.

PubMed

Spencer, John; Coaker, Hannah

2015-01-01

The SelectBio 2015: Academic Drug Discovery Conference was held in Cambridge, UK, on 19-20 May 2015. Building on the success of academic drug discovery events in the USA, this conference aimed to showcase the exciting new research emerging from academic drug discovery and to help bridge the gap between basic research and commercial application. At the event the authors heard from a number of speakers on a broad array of topics, from partnering models for academia and industry to novel drug discovery approaches across various therapeutic areas, with a few talks, such as those by Susanne Muller-Knapp (Structure Genomics Consortium, Oxford University, Oxford, UK) and Julian Blagg (Institute of Cancer Research, UK), covering both remits, by highlighting a number of such partnerships and then delving into some case studies. The conference concluded with a heated debate on whether phenotypic discovery should be favored over targeted discovery in academia and pharma, in a panel discussion chaired by Roland Wolkowicz (San Diego State University, USA).

Thyroid surgery as a 23-hour stay procedure

PubMed Central

Perera, AH; Patel, SD

2014-01-01

Introduction The main barriers to short stay thyroidectomy are haemorrhage, bilateral recurrent laryngeal nerve palsy causing respiratory compromise and hypocalcaemia. This study assessed the safety and effectiveness of thyroidectomy as a 23-hour stay procedure. Methods All patients undergoing total or completion thyroidectomy were prescribed calcium and vitamin D3 supplements following surgery. Retrospective analysis identified patients admitted for longer than 23 hours and any readmissions. Results A total of 164 patients were admitted for 23-hour stay thyroid surgery over a 25-month period between 2008 and 2010. Four patients (2%) required admission for longer than 23 hours. No patients required emergency intervention for postoperative haemorrhage or airway compromise. Biochemical hypocalcaemia (despite calcium supplements) was detected in one patient when measured at the outpatient clinic two weeks following surgery. Twelve patients (7.3%) attended the accident and emergency department following discharge; four required admission for intravenous antibiotics for wound infection and one for biochemical hypocalcaemia. Conclusions This single centre UK experience demonstrates that thyroidectomy can be carried out both safely and effectively as a 23-hour stay procedure. Prophylactic prescription of calcium and vitamin D3 reduces hypocalcaemia, and thereby also prolonged admission and readmission due to hypocalcaemia. Supplements are an acceptable, cost effective method of reducing hypocalcaemia and shortening postoperative length of stay. PMID:24780020

Convenience, quality and choice: Patient and service-provider perspectives for treating primary care complaints in urgent care settings.

PubMed

Sturgeon, David

2017-11-01

To investigate why patients chose to attend two, nurse-led, minor injury units (MIUs) to access primary healthcare services rather than attend their GP practice. Since the 1980's, healthcare organisations in the UK and elsewhere have implemented an increasingly consumer-orientated model of healthcare provision. As a result, patients with non-urgent presentations are attending Emergency Departments (EDs) and other urgent care facilities in growing numbers. A comparative case study approach was adopted and between October 2014 and May 2015 the researcher was embedded as a participant observer as part of the emergency nurse practitioner team at two, nurse-led, MIUs (site A and B). During this time, 40 patients, 17 service-providers and 1 senior manager were interviewed. Patients and service-providers at both sites identified convenience and quality of care as the principle reasons patients presented for primary healthcare services at MIUs rather than their GP practice. Service-providers were aware that by providing treatment, they established a precedent and a sense of expectation for future care. Patients are acting rationally and predictably in response to healthcare policy promises regarding choice, expectation created by service-providers, and local demographic factors. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Developing an analytical toxicology service: principles and guidance.

PubMed

Flanagan, Robert J

2004-01-01

Many acutely poisoned patients are treated with no laboratory help other than general clinical chemistry and haematology. Emergency toxicological analyses (24-hour availability) that could influence immediate patient management such as iron, lithium and paracetamol (acetaminophen), are relatively few in number and are remarkably similar worldwide. These assays should be provided at hospitals with large accident and emergency departments. More complex, less frequently needed clinical toxicological assays that can often be offered on a less urgent basis are usually provided from regional or national centres because of the need to make best use of resources. Recommendations as to the assays that should be provided locally and at regional centres are available for the UK and US, and are generally applicable. Regional centres normally diversify into specialised therapeutic drug monitoring, urine screening for drugs of abuse, metals analysis and sometimes forensic work in order to widen the repertoire of tests available and to increase funding. Whatever the type and quantity of work undertaken and the instrumentation used, guidelines are now available delineating staff training, method validation, assay operation, quality control/quality assurance, and indeed virtually all other aspects of laboratory operation. These considerations notwithstanding, clinical interpretation of analytical results remains a difficult area and is the responsibility of the reporting laboratory, at least in the first instance.

The Geriatric Emergency Department.

PubMed

Rosenberg, Mark; Rosenberg, Lynne

2016-08-01

This article presents an overview of the complex needs of older patients presenting to the emergency department for care. Discussion points for hospital communities considering emergency services to accommodate the aging population are highlighted. The essential components of a geriatric emergency department, including transition of care strategies, are reviewed. Copyright © 2016 Elsevier Inc. All rights reserved.

Documenting the doable and doing the documented: bridging strategies at the UK Stem Cell Bank.

PubMed

Stephens, Neil; Atkinson, Paul; Glasner, Peter

2011-12-01

We explore the local negotiation of regulatory practice at the UK Stem Cell Bank, the first Bank of its type in the world. Basing our empirical work on a detailed analysis of one aspect of the Bank's regulatory commitment--the completion of the Cell Line Information form--we make visible the necessary judgements and labour involved in interpreting and operationalizing externally imposed regulation. The discussion opens by detailing the problems encountered when the Bank completes the form: reconciling a bureaucratic system of accountability with craft-like laboratory skills involving multiple kinds of tacit knowledge. We follow this by explicating the emergent 'bridging strategies' pursued by the Bank to address these issues, highlighting their reliance upon the formation of trust and social networks. The closing discussion emphasizes the contingent assembly of regulatory practices that emerge in the local setting.

The impact of an emergency fee increase on the composition of patients visiting emergency departments.

PubMed

Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo

2014-11-01

This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

Physical activity among adolescents and barriers to delivering physical education in Cornwall and Lancashire, UK: a qualitative study of heads of PE and heads of schools.

PubMed

Boyle, Spencer Earl; Jones, Georgina L; Walters, Stephen J

2008-08-01

Recent initiatives have been introduced by the UK government into secondary schools to increase pupils' access to physical activity (PA). Despite this, not enough is known about pupils' levels of physical activity or whether the delivery of these initiatives in schools facilitates or creates a barrier for pupils' PA. The aim of this study was to gain an understanding of adolescents PA levels from the perspective of those responsible for delivering physical education (PE) in schools; heads of PE (HOPE) and heads of school (HS). Seventeen semi-structured qualitative interviews were carried out with a snowball sample of HOPE and HS in schools in the Northwest and Southwest of England. Thematic data analysis using NVIVO was used to identify emergent themes. 17 core themes were generated, 12 of which confirmed the findings from similar research. However, five themes relating to 'ethos of performance/elitism', 'lower fitness leads to lower ability', 'undervaluing activities within PE dept' or school as a whole', 'role of the school' and 'PE department doing all it can' offer valuable new insight into the factors which may encourage or prevent PA inside or outside the curriculum. Despite many positive perceptions of the delivery of PE in schools, it is evident that barriers still exist within that delivery which discourages physical activity. More research is needed to particularly address the complex issues of elitism and the ethos of PA in schools.

76 FR 23708 - Safety Zone; Pierce County Department of Emergency Management Regional Water Exercise, East...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

...-AA00 Safety Zone; Pierce County Department of Emergency Management Regional Water Exercise, East... the Regional Water Rescue Exercise. Basis and Purpose The Pierce County, Washington, Department of... to read as follows: Sec. 165.T13-0251 Safety Zone; Pierce County Department of Emergency Management...

Genetics Home Reference: citrullinemia

MedlinePlus

... Type II MalaCards: citrullinemia, classic Orphanet: Citrullinemia Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (5 links) Children Living with Inherited Metabolic Diseases (CLIMB) (UK) National ...

Suicide Assessment in Hospital Emergency Departments: Implications for Patient Satisfaction and Compliance

PubMed Central

Mitchell, Ann M.; Garand, Linda; Dean, Diane; Panzak, George; Taylor, Melissa

2010-01-01

Suicide is a complex, multidimensional event with a host of contributing factors. Suicidal emergencies are among other behavioral and psychiatric emergencies that provide the basis for emergency department visits. Therefore, emergency departments are ideal clinical environments for the assessment of suicidal patients. A case example from an emergency department visit is provided as a basis of discussion as we describe subpopulations at high risk for suicide and review critical assessment parameters for the recognition and treatment of suicidal patients. Lastly, factors associated with patient satisfaction and treatment compliance are addressed to promote positive health outcomes among suicidal patients. PMID:20448823

Emergency nurses' and department preparedness for an ebola outbreak: A (narrative) literature review.

PubMed

Pincha Baduge, Mihirika Sds; Morphet, Julia; Moss, Cheryle

2018-05-01

The 2014 Ebola Virus Disease outbreak in West Africa triggered a public health emergency of international concern. Emergency departments worldwide responded with Ebola containment and preparation measures. This paper reports a literature inquiry into how emergency departments and emergency nurses prepared to manage the Ebola risk. Narrative review was the method used. Guidelines (n = 5) for organisational and emergency department preparedness were retrieved from relevant websites. Searches for primary studies and case reports were undertaken in the MEDLINE and CINAHL databases. After screening and quality appraisal, 20 papers were included in the review. Research and case reports identified 17 different preparedness strategies, and practical interventions for containment undertaken in emergency departments. These included a requirement for surveillance and reporting, Ebola case management, inventory and logistic management, laboratory management, and communication and education. Emergency nurses' personal preparedness was influenced by the emotional readiness, their willingness to care for people at risk of Ebola, and the provision of psychological support. The preparation efforts reported internationally were generally consistent in strategy and intervention. The findings provide guidance for future preparedness strategies by emergency departments in response to threats like Ebola. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Military Families In Transition: Stress, Resilience, And Well-Being

DTIC Science & Technology

2014-01-01

Smith College of Engineering and Computer Science Professor, Department of Physics , College of Arts and Sciences Fellow: AIAA, ASME, APS, Institute...of Physics (UK) Syracuse University Richard E. Heyman, PhD Professor Family Translational Research Group Department of Cariology and Comprehensive...Pasquina, MD COL(R), USA Residency Director and Chair, Physical Medicine & Rehabilitation Uniformed Services University Walter Reed National

Rural Emergency Nurses' Suggestions for Improving End-of-Life Care.

PubMed

Beckstrand, Renea L; Smith, Kelly E; Luthy, Karlen E Beth; Macintosh, Janelle L B

2017-05-01

Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments. A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify the one aspect of EOL care they would change for dying patients in rural emergency departments. Each qualitative response was individually reviewed by a research team and then coded into a theme. Four major themes and three minor themes were identified. The major themes were providing greater privacy during EOL care for patients and family members, increasing availability of support services, additional staffing, and improved staff and community education. Providing adequate privacy for patients and family members was a major obstacle to providing EOL care in the emergency department, largely because of poor department design, especially in rural emergency departments where space is limited. Lack of support services and adequate staffing were also obstacles to providing quality EOL care in rural emergency departments. Consequently, rural nurses are commonly pulled away from EOL care to perform ancillary duties because additional support personnel are lacking. Providing EOL care in rural emergency departments is a challenging task given the limited staffing and resources, and thus it is imperative that nurses' suggestions for improvement of EOL care be acknowledged. Because of the current lack of research in rural EOL care, additional research is needed. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

In the face of increasing subspecialisation, how does the specialty ensure that the management of ENT emergencies is timely, appropriate and safe?

PubMed

Rouhani, M J

2016-06-01

The field of ENT surgery is one of the most varied specialties, with numerous subspecialties and continuing divergence. With this evolution there comes, however, a risk that specialists become de-skilled in certain areas. In the case of ENT emergencies, this can be particularly dangerous. Current guidance from relevant UK professional membership bodies regarding emergency surgery provision was inspected and a literature search was performed to identify studies relating to management of ENT emergencies in the context of increasing subspecialisation. The specialty currently has provisions in place to ensure timely, appropriate and safe management of emergencies, in the form of guidelines and emergency clinics; however, there is scope for improvement of the system.

Development and evaluation of educational materials for pre-hospital and emergency department personnel on the care of patients with autism spectrum disorder.

PubMed

McGonigle, John J; Migyanka, Joann M; Glor-Scheib, Susan J; Cramer, Ryan; Fratangeli, Jeffrey J; Hegde, Gajanan G; Shang, Jennifer; Venkat, Arvind

2014-05-01

With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there is little education provided to front-line emergency medical technicians, paramedics and emergency nurses on the characteristics of ASD and how these characteristics can create challenges for individuals with ASD and their health care providers in the pre-hospital and emergency department settings. This paper describes the development of educational materials on ASD and the results of training of emergency medical services and emergency department personnel.

Top 10 Tips for Taking an Elderly Parent to the Emergency Department

MedlinePlus

... Department Top 10 Tips for Taking an Elderly Parent to the Emergency Department With America's rapidly growing ... to seek emergency care. Caring for an elderly parent is one of the most important things an ...

Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients.

PubMed

Mathews, Kusum S; Durst, Matthew S; Vargas-Torres, Carmen; Olson, Ashley D; Mazumdar, Madhu; Richardson, Lynne D

2018-05-01

ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. A retrospective cohort study. Single academic tertiary care hospital. Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period. None. Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase). ICU admission decisions for critically ill emergency department patients are affected by medical ICU bed availability, though higher emergency department volume and other ICU occupancy did not play a role. Prolonged emergency department boarding times were associated with worse patient outcomes, suggesting a need for improved throughput and targeted care for patients awaiting ICU admission.

Latest trends in the assessment and management of paediatric snoring and sleep apnoea.

PubMed

Sharma, S D; Kanona, H; Kumar, G; Kotecha, B

2016-05-01

To investigate the assessment and management of paediatric snoring and obstructive sleep apnoea in UK otolaryngology departments. A telephone questionnaire survey of UK otolaryngology departments was conducted over a 16-week period. The response rate was 61 per cent (85 out of 139 trusts). Use of pre-operative pulse oximetry was reported by 84 per cent of respondents, mainly to diagnose obstructive sleep apnoea (73 per cent) or stratify post-operative risk (46 per cent). Thirty-one per cent of respondents reported using post-operative pulse oximetry. Twenty-five per cent of respondents have a dedicated management protocol for paediatric obstructive sleep apnoea and snoring. Thirty-four per cent require prior clinical commissioning group approval before performing surgery. Fifty-eight per cent of respondents reported following up their obstructive sleep apnoea patients after surgery. The mean follow-up period (±standard deviation) was 6.8 ± 1.2 weeks. There is variation in the assessment and management of paediatric snoring and obstructive sleep apnoea across the UK, particularly in the use of pre- and post-operative pulse oximetry monitoring, and further guidelines regarding this are necessary.

Genetics Home Reference: isovaleric acidemia

MedlinePlus

... Consortium of Metabolic Programs Orphanet: Isovaleric acidemia Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (4 links) CLIMB (Children Living With Inherited Metabolic Diseases) (UK) National Organization ...

Genetics Home Reference: propionic acidemia

MedlinePlus

... Consortium of Metabolic Programs Orphanet: Propionic acidemia Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (6 links) CLIMB (Children Living With Inherited Metabolic Diseases) (UK) National Organization ...

Sharing the British National Health Service around the world: a self-interested perspective

PubMed Central

2013-01-01

As the UK reiterates its commitment to protecting and growing its development aid budget amidst an adverse economic environment for the UK and Europe, we discuss the potential to use the country’s National Health Service (NHS) model as a vehicle for promoting the country’s economic as well as global health diplomacy and development priorities, through a coordinated cross-government plan of action. With the country’s Prime Minister serving as a co-chair of the UN post-2015 development agenda panel,a this is a unique opportunity for the UK to put forward its health system architecture as a highly applicable and well-tested model for providing access to efficient and cost-effective care, with minimal financial hardship. Arguably, such a model tailored to the needs of specific countries could consequently lead to commercial opportunities for UK plc. in areas such as consulting, training, education and healthcare products. Finally, this approach would be consistent with the current thinking on the evolving role of UK aid, especially in the case of emerging powers such as India, where the focus has shifted from aid to investment in technical assistance and cooperation as a means of boosting bilateral business and trade. PMID:24160168

Sharing the British National Health Service around the world: a self-interested perspective.

PubMed

Chalkidou, Kalipso; Vega, Jeanette

2013-10-25

As the UK reiterates its commitment to protecting and growing its development aid budget amidst an adverse economic environment for the UK and Europe, we discuss the potential to use the country's National Health Service (NHS) model as a vehicle for promoting the country's economic as well as global health diplomacy and development priorities, through a coordinated cross-government plan of action. With the country's Prime Minister serving as a co-chair of the UN post-2015 development agenda panel,a this is a unique opportunity for the UK to put forward its health system architecture as a highly applicable and well-tested model for providing access to efficient and cost-effective care, with minimal financial hardship. Arguably, such a model tailored to the needs of specific countries could consequently lead to commercial opportunities for UK plc. in areas such as consulting, training, education and healthcare products. Finally, this approach would be consistent with the current thinking on the evolving role of UK aid, especially in the case of emerging powers such as India, where the focus has shifted from aid to investment in technical assistance and cooperation as a means of boosting bilateral business and trade.

Effect of climate change on vector-borne disease risk in the UK.

PubMed

Medlock, Jolyon M; Leach, Steve A

2015-06-01

During the early part of the 21st century, an unprecedented change in the status of vector-borne disease in Europe has occurred. Invasive mosquitoes have become widely established across Europe, with subsequent transmission and outbreaks of dengue and chikungunya virus. Malaria has re-emerged in Greece, and West Nile virus has emerged throughout parts of eastern Europe. Tick-borne diseases, such as Lyme disease, continue to increase, or, in the case of tick-borne encephalitis and Crimean-Congo haemorrhagic fever viruses, have changed their geographical distribution. From a veterinary perspective, the emergence of Bluetongue and Schmallenberg viruses show that northern Europe is equally susceptible to transmission of vector-borne disease. These changes are in part due to increased globalisation, with intercontinental air travel and global shipping transport creating new opportunities for invasive vectors and pathogens. However, changes in vector distributions are being driven by climatic changes and changes in land use, infrastructure, and the environment. In this Review, we summarise the risks posed by vector-borne diseases in the present and the future from a UK perspective, and assess the likely effects of climate change and, where appropriate, climate-change adaptation strategies on vector-borne disease risk in the UK. Lessons from the outbreaks of West Nile virus in North America and chikungunya in the Caribbean emphasise the need to assess future vector-borne disease risks and prepare contingencies for future outbreaks. Ensuring that adaptation strategies for climate change do not inadvertently exacerbate risks should be a primary focus for decision makers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Temporal and spatial organization of doctors' computer usage in a UK hospital department.

PubMed

Martins, H M G; Nightingale, P; Jones, M R

2005-06-01

This paper describes the use of an application accessible via distributed desktop computing and wireless mobile devices in a specialist department of a UK acute hospital. Data (application logs, in-depth interviews, and ethnographic observation) were simultaneously collected to study doctors' work via this application, when and where they accessed different areas of it, and from what computing devices. These show that the application is widely used, but in significantly different ways over time and space. For example, physicians and surgeons differ in how they use the application and in their choice of mobile or desktop computing. Consultants and junior doctors in the same teams also seem to access different sources of patient information, at different times, and from different locations. Mobile technology was used almost exclusively during the morning by groups of clinicians, predominantly for ward rounds.

Brief Report: Emergency Department Utilization by Individuals with Autism

ERIC Educational Resources Information Center

Iannuzzi, Dorothea A.; Cheng, Erika R.; Broder-Fingert, Sarabeth; Bauman, Margaret L.

2015-01-01

To identify medical problems most commonly presenting to emergency departments among individuals with autism as compared to non-autistic persons across age groups. Data was obtained from the 2010 National Emergency Department database and was analyzed by age categories: 3-5, 6-11, 12-15, 16-18 and 19 years and older. Epilepsy emerged as the…

Building national public health capacity for managing chemical events: A case study of the development of health protection services in the United Kingdom

PubMed Central

Palmer, Stephen; Coleman, Gary

2013-01-01

The revised International Health Regulations (2005) require that countries develop plans for chemical threats. In 2012, the World Health Assembly reported that most countries had not yet achieved ‘adequate capacity'. We review the evolution of chemical hazards services in the United Kingdom, the result of 15 years of grass-roots pressure and an accumulating weight of chemical incidents that eventually convinced the UK Department of Health of the need for a new national public health function, culminating, in 2003, in the creation of the Chemical Hazards Division of the new Health Protection Agency. Ten years later, public health services are again being radically reorganized with the creation of Public Health England, potentially destabilizing health protection arrangements and creating confusion among roles in managing chemical emergencies. Incorporating health protection into a broader public health organization, however, offers a new opportunity to broaden the scope of health protection services to embrace prevention of non-infectious environmental diseases. PMID:23447032

Building national public health capacity for managing chemical events: a case study of the development of health protection services in the United Kingdom.

PubMed

Palmer, Stephen; Coleman, Gary

2013-05-01

The revised International Health Regulations (2005) require that countries develop plans for chemical threats. In 2012, the World Health Assembly reported that most countries had not yet achieved 'adequate capacity'. We review the evolution of chemical hazards services in the United Kingdom, the result of 15 years of grass-roots pressure and an accumulating weight of chemical incidents that eventually convinced the UK Department of Health of the need for a new national public health function, culminating, in 2003, in the creation of the Chemical Hazards Division of the new Health Protection Agency. Ten years later, public health services are again being radically reorganized with the creation of Public Health England, potentially destabilizing health protection arrangements and creating confusion among roles in managing chemical emergencies. Incorporating health protection into a broader public health organization, however, offers a new opportunity to broaden the scope of health protection services to embrace prevention of non-infectious environmental diseases.

The Boundary Integral Equation Method for Porous Media Flow

NASA Astrophysics Data System (ADS)

Anderson, Mary P.

Just as groundwater hydrologists are breathing sighs of relief after the exertions of learning the finite element method, a new technique has reared its nodes—the boundary integral equation method (BIEM) or the boundary equation method (BEM), as it is sometimes called. As Liggett and Liu put it in the preface to The Boundary Integral Equation Method for Porous Media Flow, “Lately, the Boundary Integral Equation Method (BIEM) has emerged as a contender in the computation Derby.” In fact, in July 1984, the 6th International Conference on Boundary Element Methods in Engineering will be held aboard the Queen Elizabeth II, en route from Southampton to New York. These conferences are sponsored by the Department of Civil Engineering at Southampton College (UK), whose members are proponents of BIEM. The conferences have featured papers on applications of BIEM to all aspects of engineering, including flow through porous media. Published proceedings are available, as are textbooks on application of BIEM to engineering problems. There is even a 10-minute film on the subject.

Implementing human factors in clinical practice.

PubMed

Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

2015-05-01

To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Qualitative risk analysis of introducing Batrachochytrium dendrobatidis to the UK through the importation of live amphibians.

PubMed

Peel, Alison J; Hartley, Matt; Cunningham, Andrew A

2012-03-20

The international amphibian trade is implicated in the emergence and spread of the amphibian fungal disease chytridiomycosis, which has resulted in amphibian declines and extinctions globally. The establishment of the causal pathogen, Batrachochytrium dendrobatidis (Bd), in the UK could negatively affect the survival of native amphibian populations. In recognition of the ongoing threat that it poses to amphibians, Bd was recently included in the World Organisation for Animal Health Aquatic Animal Health Code, and therefore is in the list of international notifiable diseases. Using standardised risk analysis guidelines, we investigated the likelihood that Bd would be introduced to and become established in wild amphibians in the UK through the importation of live amphibians. We obtained data on the volume and origin of the amphibian trade entering the UK and detected Bd infection in amphibians being imported for the pet and private collection trade and also in amphibians already held in captive pet, laboratory and zoological collections. We found that current systems for recording amphibian trade into the UK underestimate the volume of non-European Union trade by almost 10-fold. We identified high likelihoods of entry, establishment and spread of Bd in the UK and the resulting major overall impact. Despite uncertainties, we determined that the overall risk estimation for the introduction of Bd to the UK through the importation of live amphibians is high and that risk management measures are required, whilst ensuring that negative effects on legal trade are minimised.

A study of deliberate self-harm and its repetition among patients presenting to an emergency department.

PubMed

Yip, Paul S F; Hawton, Keith; Liu, Kayuet; Liu, Kwong-Sun; Ng, Pauline W L; Kam, Pui-Man; Law, Yik-Wa; Wong, Tai-Wai

2011-01-01

Marked differences have been found in the characteristics of people dying by suicide in Western and Asian countries. However, there is less information available on possible differences for deliberate self-harm (DSH). To compare the characteristics of people presenting to hospital in Hong Kong and Oxford (UK) with DSH, and to assess the outcome of those persons in Hong Kong. A sample of DSH patients admitted to the accident and emergency (A&E) department of a regional hospital in Hong Kong was assessed and followed up 6 months later to assess the risk of repetition of DSH, and was then compared with such patients in Oxford. The majority of patients in Hong Kong were female (male:female ratio of 1:2.4), young (59% were under 35), and had used self-poisoning (78%). Over one-third were single (37%) and one-fourth unemployed (26%). About half (49%) scored in the high or very high categories of the Beck's Suicide Intent Scale, considerably more so than in Oxford; 44.6% of patients defaulted psychiatric outpatient service during the 6-month follow-up period. The repetition rate within the following 6 months was 16.7%. The number of self-reported adverse life problems, history of childhood sexual and physical abuse, and repetitive self-mutilation were shown to be the factors most strongly correlated with the risk of re-attempt. Alcohol problems were much lower than in Oxford. The findings show that DSH patients in Hong Kong show some marked differences compared to those in Oxford. Implications for the prevention of repeated DSH in Hong Kong are discussed.

Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.

PubMed

Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

2013-08-09

Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and standardised assessment across EDs.

How much do parents know about first aid for burns?

PubMed

Davies, M; Maguire, S; Okolie, C; Watkins, W; Kemp, A M

2013-09-01

Prompt first aid reduces burn morbidity. With an estimated 19,000 children attending emergency departments (ED) with a burn or scald every year in the UK, a parent's knowledge of first aid is particularly important. This study evaluates the extent and source of this knowledge. Parents attending the emergency and antenatal departments of a University Hospital answered a structured questionnaire detailing demographics, knowledge of burns first aid and its source. Knowledge was stratified into 4 categories: contraindicated, poor, inadequate and adequate. Individual chi-squared tests and ordered logistic regressions were performed to relate knowledge to demographic features. The 106 respondents (44% men) reflected a wide range of socio-economic (SE) grouping and educational level. Overall 32% had an adequate knowledge of burns first aid while 43% had poor or no knowledge. There was no significant correlation between gender, educational status or age and knowledge; however those from higher SE groups (p<0.05) and those who had undergone first aid training (p<0.01) had greater knowledge. Among 40% of parents who had undergone first aid training, 74% had adequate knowledge. The logistic regression accounting for all significant variables showed that previous first aid training was the most influential factor in knowledge of first aid (p<0.001). Interestingly, although 2/3 of parents wanted further training, 75% of those who did not had poor or no first-aid knowledge. Overall, the knowledge of burns first aid among parents is inadequate and correlates with lower SE groups. There was a significant association between knowledge and previous first aid training. Results suggest that targeting burns first aid training to all new parents, particularly those in low income households, would be of value. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

44 CFR 321.7 - [Reserved

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false [Reserved] 321.7 Section 321.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS MAINTENANCE OF THE MOBILIZATION BASE (DEPARTMENT OF DEFENSE, DEPARTMENT OF ENERGY...

44 CFR 321.7 - [Reserved

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true [Reserved] 321.7 Section 321.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS MAINTENANCE OF THE MOBILIZATION BASE (DEPARTMENT OF DEFENSE, DEPARTMENT OF ENERGY, MARITIME...

44 CFR 321.7 - [Reserved

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false [Reserved] 321.7 Section 321.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS MAINTENANCE OF THE MOBILIZATION BASE (DEPARTMENT OF DEFENSE, DEPARTMENT OF ENERGY...

44 CFR 321.7 - [Reserved

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false [Reserved] 321.7 Section 321.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS MAINTENANCE OF THE MOBILIZATION BASE (DEPARTMENT OF DEFENSE, DEPARTMENT OF ENERGY...

44 CFR 321.1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false General. 321.1 Section 321.1 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS MAINTENANCE OF THE MOBILIZATION BASE (DEPARTMENT OF DEFENSE, DEPARTMENT OF ENERGY, MARITIME...

44 CFR 321.7 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false [Reserved] 321.7 Section 321.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS MAINTENANCE OF THE MOBILIZATION BASE (DEPARTMENT OF DEFENSE, DEPARTMENT OF ENERGY...

Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand.

PubMed

Yuwanich, Nuttapol; Sandmark, Hélène; Akhavan, Sharareh

2015-10-30

Occupational stress has been a health-related issue among nurses for many decades. Emergency department nurses are frequently confronted with occupational stress in their workplace; in particular, they encounter stressful situations and unpredictable events. These encounters could make them feel more stressed than nurses in other departments. Research considering occupational stress from the perspective of Thai emergency department nurses is limited. This study aimed to explore nurses' perceptions of occupational stress in an emergency department. A qualitative approach was used to gain an understanding of nurses' experiences and perceptions regarding stress in their workplace. Semi-structured interviews were used for data collection. Twenty-one emergency department nurses working in a public hospital in Thailand were interviewed, and the data were analyzed using content analysis. The findings comprised three themes: (1) perceived stress, (2) consequences of stress, and (3) stress management. The results of this study can be used by hospital management to help them adopt effective strategies, such as support programs involving co-workers/supervisors, to decrease occupational stress among emergency department nurses. Future research that explores each of the themes found in this study could offer a more comprehensive understanding of nurses' occupational stress in the emergency department.

The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock.

PubMed

Henning, Daniel J; Carey, Jeremy R; Oedorf, Kimie; Day, Danielle E; Redfield, Colby S; Huguenel, Colin J; Roberts, Jonathan C; Sanchez, Leon D; Wolfe, Richard E; Shapiro, Nathan I

2017-06-01

This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality. This was a secondary analysis of a prospective, observational study of patients with shock. The study was conducted in an urban, academic emergency department. The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both. Among 378 patients with septic shock, 207 of 378 (55%; 50-60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2-8.2; area under the curve = 0.83). In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.

The public health dashboard: a surveillance model for bioterrorism preparedness.

PubMed

Foldy, Seth L; Biedrzycki, Paul A; Baker, Bevan K; Swain, Geoffrey R; Howe, Donna S; Gieryn, Douglas; Barthell, Edward N; Pemble, Kim R

2004-01-01

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology. Emergency Departments at 8 area hospitals reported a total of 314 cases meeting syndromic criteria from 26,888 patient encounters. Participants were satisfied with data entry and communications. All participating Emergency Departments received e-mail and text pager alerts sent by the Milwaukee Health Department. No unexplained findings or suggestions of an early outbreak were reported through syndrome surveillance for the 4-week duration of the project. Similar surveillance and communications systems could provide multiple benefits to Emergency Department workflow and management, as well as to public health and emergency response.

The impact of thunderstorm asthma on emergency department attendances across London during July 2013.

PubMed

Elliot, A J; Hughes, H E; Hughes, T C; Locker, T E; Brown, R; Sarran, C; Clewlow, Y; Murray, V; Bone, A; Catchpole, M; McCloskey, B; Smith, G E

2014-08-01

This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

European Society of Cardiology - Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department.

PubMed

Miró, Òscar; Peacock, Frank W; McMurray, John J; Bueno, Héctor; Christ, Michael; Maisel, Alan S; Cullen, Louise; Cowie, Martin R; Di Somma, Salvatore; Martín Sánchez, Francisco J; Platz, Elke; Masip, Josep; Zeymer, Uwe; Vrints, Christiaan; Price, Susanna; Mebazaa, Alexander; Mueller, Christian

2017-06-01

Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.

Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms.

PubMed

Exadaktylos, Aristomenis K; Evangelopoulos, Dimitrios S; Wullschleger, Marcel; Bürki, Leo; Zimmermann, Heinz

2008-11-17

Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor.This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

PubMed

Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

2011-08-19

Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.

An agent based simulation tool for scheduling emergency department physicians.

PubMed

Jones, Spencer S; Evans, R Scott

2008-11-06

Emergency department overcrowding is a problem that threatens the public health of communities and compromises the quality of care given to individual patients. The Institute of Medicine recommends that hospitals employ information technology and operations research methods to reduce overcrowding. This paper describes the development of an agent based simulation tool that has been designed to evaluate the impact of various physician staffing configurations on patient waiting times in the emergency department. We evaluate the feasibility of this tool at a single hospital emergency department.

The business case for payer support of a community-based health information exchange: a humana pilot evaluating its effectiveness in cost control for plan members seeking emergency department care.

PubMed

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R

2011-07-01

As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.

Health effects of the September 2009 dust storm in Sydney, Australia: did emergency department visits and hospital admissions increase?

PubMed

Merrifield, Alistair; Schindeler, Suzanne; Jalaludin, Bin; Smith, Wayne

2013-04-16

During September 2009, a large dust storm was experienced in Sydney, New South Wales, Australia. Extremely high levels of particulate matter were recorded, with daily average levels of coarse matter (<10 μm) peaking over 11,000 μg/m3 and fine (<2.5 μm) over 1,600 μg/m3. We conducted an analysis to determine whether the dust storm was associated with increases in all-cause, cardiovascular, respiratory and asthma-related emergency department presentations and hospital admissions. We used distributed-lag Poisson generalized models to analyse the emergency department presentations and hospital admissions adjusted for pollutants, humidity, temperature and day of week and seasonal effects to obtain estimates of relative risks associated with the dust storm. The dust storm period was associated with large increases in asthma emergency department visits (relative risk 1.23, 95% confidence interval 1.10-1.38, p < 0.01), and to a lesser extent, all emergency department visits (relative risk 1.04, 95% confidence interval 1.03-1.06, p < 0.01) and respiratory emergency department visits (relative risk 1.20, 95% confidence interval 1.15-1.26, p < 0.01). There was no significant increase in cardiovascular emergency department visits (p = 0.09) or hospital admissions for any reason. Age-specific analyses showed the dust storm was associated with increases in all-cause and respiratory emergency department visits in the ≥65 year age group; the ≤5 year group had higher risks of all-cause, respiratory and asthma-related emergency department presentations. We recommend public health measures, especially targeting asthmatics, should be implemented during future dust storm events.

A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome.

PubMed

Fuller, Brian M; Ferguson, Ian T; Mohr, Nicholas M; Drewry, Anne M; Palmer, Christopher; Wessman, Brian T; Ablordeppey, Enyo; Keeperman, Jacob; Stephens, Robert J; Briscoe, Cristopher C; Kolomiets, Angelina A; Hotchkiss, Richard S; Kollef, Marin H

2017-04-01

To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. Quasi-experimental, before-after trial. Emergency department and ICUs of an academic center. Mechanically ventilated emergency department patients experiencing acute respiratory distress syndrome while in the emergency department or after admission to the ICU. An emergency department ventilator protocol which targeted variables in need of quality improvement, as identified by prior work: 1) lung-protective tidal volume, 2) appropriate setting of positive end-expiratory pressure, 3) oxygen weaning, and 4) head-of-bed elevation. A total of 229 patients (186 preintervention group, 43 intervention group) were studied. In the emergency department, the intervention was associated with significant changes (p < 0.01 for all) in tidal volume, positive end-expiratory pressure, respiratory rate, oxygen administration, and head-of-bed elevation. There was a reduction in emergency department tidal volume from 8.1 mL/kg predicted body weight (7.0-9.1) to 6.4 mL/kg predicted body weight (6.1-6.7) and an increase in lung-protective ventilation from 11.1% to 61.5%, p value of less than 0.01. The intervention was associated with a reduction in mortality from 54.8% to 39.5% (odds ratio, 0.38; 95% CI, 0.17-0.83; p = 0.02) and a 3.9 day increase in ventilator-free days, p value equals to 0.01. This before-after study of mechanically ventilated patients with acute respiratory distress syndrome demonstrates that implementing a mechanical ventilator protocol in the emergency department is feasible and associated with improved clinical outcomes.

Health effects of the September 2009 dust storm in Sydney, Australia: did emergency department visits and hospital admissions increase?

PubMed Central

2013-01-01

Background During September 2009, a large dust storm was experienced in Sydney, New South Wales, Australia. Extremely high levels of particulate matter were recorded, with daily average levels of coarse matter (<10 μm) peaking over 11,000 μg/m3 and fine (<2.5 μm) over 1,600 μg/m3. We conducted an analysis to determine whether the dust storm was associated with increases in all-cause, cardiovascular, respiratory and asthma-related emergency department presentations and hospital admissions. Methods We used distributed-lag Poisson generalized models to analyse the emergency department presentations and hospital admissions adjusted for pollutants, humidity, temperature and day of week and seasonal effects to obtain estimates of relative risks associated with the dust storm. Results The dust storm period was associated with large increases in asthma emergency department visits (relative risk 1.23, 95% confidence interval 1.10-1.38, p < 0.01), and to a lesser extent, all emergency department visits (relative risk 1.04, 95% confidence interval 1.03-1.06, p < 0.01) and respiratory emergency department visits (relative risk 1.20, 95% confidence interval 1.15-1.26, p < 0.01). There was no significant increase in cardiovascular emergency department visits (p = 0.09) or hospital admissions for any reason. Age-specific analyses showed the dust storm was associated with increases in all-cause and respiratory emergency department visits in the ≥65 year age group; the ≤5 year group had higher risks of all-cause, respiratory and asthma-related emergency department presentations. Conclusions We recommend public health measures, especially targeting asthmatics, should be implemented during future dust storm events. PMID:23587335

After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department

MedlinePlus

... the person’s physical and mental health. Emergency department staff should look for underlying physical problems that may ... that can cause emotional distress. While emergency department staff prefer to assess people who are sober, they ...

Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center - an Indian perspective.

PubMed

Samudrala, Suvarna; Dandakeri, Sukumar; Bhat, Ramesh M

2018-05-01

Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5-8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit. A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed. A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%). This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India. © 2018 The International Society of Dermatology.

[Competence of triage nurses in hospital emergency departments].

PubMed

Martínez-Segura, Estrella; Lleixà-Fortuño, Mar; Salvadó-Usach, Teresa; Solà-Miravete, Elena; Adell-Lleixà, Mireia; Chanovas-Borrás, Manel R; March-Pallarés, Gemma; Mora-López, Gerard

2017-06-01

To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

The Development of Children's Understanding of Distant Places and Environmental Issues: Report of a UK Longitudinal Study of the Development of Ideas between the Ages of 4 and 10 Years

ERIC Educational Resources Information Center

Palmer, Joy A.; Suggate, Jennifer

2004-01-01

The research reported here forms part of a major international study entitled "Emergent Environmentalism". The overall purpose of the Emergent Environmentalism research is to investigate the acquisition and development of environmental knowledge, awareness and concern in both adults and young children. This report is of the results of one aspect…

Secondary Chemistry School Teachers Working in Tertiary Education Chemistry Departments; Critical Reflections on the Positives and Negatives

ERIC Educational Resources Information Center

Glover, S. R.; Harrison, T. G.; Shallcross, D. E.

2016-01-01

Several UK University Chemistry Departments have former secondary school chemistry teachers employed as School Teacher Fellows (STF) who are heavily involved in outreach work and a range of teaching responsibilities. This study looks at the outreach role from the point of view of several of the STFs; the benefits, and the barriers and how this…

Implementation of the Western Australian Osteoporosis Model of Care: a fracture liaison service utilising emergency department information systems to identify patients with fragility fracture to improve current practice and reduce re-fracture rates: a 12-month analysis.

PubMed

Inderjeeth, C A; Raymond, W D; Briggs, A M; Geelhoed, E; Oldham, D; Mountain, D

2018-04-27

Fracture liaison service linked to an emergency department database effectively identifies patients with OP, improves best practice care, reduces recurrent fractures, and improves quality of life (QoL). The next step is to establish cost-effectiveness. This should be seen as the standard model of care. The Western Australian Osteoporosis Model of Care recommends implementation of a fracture liaison service (FLS) to manage patients with minimal trauma fractures (MTFs). This study evaluates the efficacy of a FLS linked to a tertiary hospital emergency department information system (EDIS) in reducing recurrent fractures. Patients aged ≥ 50 years with MTF identified from EDIS were invited to the FLS. Patient outcomes were compared to routine care (retrospective group-same hospital, and prospective group-other hospital) at 3- and 12-month follow-up. Two hundred forty-one of 376 (64.1%) eligible patients participated in the FLS with 12 months of follow-up. Absolute risk of recurrent MTF at 12 months was reduced by 9.2 and 10.2% compared with the prospective and retrospective controls, respectively. After age/sex adjustment, FLS participants had less MTF at 12 months vs. the retrospective controls, OR 0.38 (95%CI 0.18-0.79), but not the prospective controls, OR 0.40 (95%CI 0.16-1.01). FLS patients were more likely to receive the 'best practice' care, i.e. awareness of osteoporosis, investigations, and treatment (all p < 0.05). 'Fallers' (OR 0.48 (95%CI 0.24, 0.96)) and fall rates were lower in the FLS (p = 0.001) compared to the prospective control. FLS experienced the largest improvement in QoL from 3 to 12 months as measured by the EuroQoL 5-domain (EQ-5D) UK weighted score (+ 15 vs. - 11 vs. - 16%, p < 0.001) and EQ-5D Health State visual analogue scale (+ 29 vs. - 2 vs. + 1%, p < 0.001). Patients managed in a linked EDIS-FLS were more likely to receive the 'best practice' care and had lower recurrent MTF and improved QoL.

Are Londoners Prepared for an Emergency? A Longitudinal Study Following the London Bombings

PubMed Central

Rubin, James; Amlôt, Richard; Simpson, John; Wessely, Simon

2008-01-01

The UK government sees increasing individual preparedness as a priority, but the level of preparedness of people in the UK for a large-scale emergency is not known. The London bombings of July 7, 2005, affected many Londoners and may have altered their sense of vulnerability to a future terrorist attack. We used a longitudinal study design to assess individual preparedness within the same sample of Londoners at 2 points in time: immediately after the bombings (T1) and 7 to 8 months later (T2). A demographically representative sample of 1,010 Londoners participated in a phone interview at T1. Subsequently, at T2, 574 of the same people participated in a follow-up phone interview. At T1 51% of Londoners had made 4 or more relevant emergency plans; 48% had gathered 4 or more relevant supplies in case of emergency. There was evidence of increased preparedness at T2, by which time 90% had made 4 or more emergency plans. Ethnicity, low social status, and having felt a sense of threat during the bombings predicted increased preparedness between T1 and T2. Women in general, and women of low social status in particular, perceived themselves to be unprepared in the event of a future terrorist attack. In summary, Londoners show moderate levels of emergency preparedness, which increased following the London bombings. Although we cannot know whether this association is causal, the prospective nature of the study increases the likelihood that it is. However, preparedness is still patchy, and there are important demographic associations with levels of preparedness and perception of vulnerability. These findings have implications for future development of individual and community emergency preparedness policy. PMID:19117430

Neurosurgical Care in the Elderly: Increasing Demands Necessitate Future Healthcare Planning.

PubMed

Whitehouse, Kathrin Joanna; Jeyaretna, Deva Sanjeeva; Wright, Alan; Whitfield, Peter C

2016-03-01

The worldwide elderly population is steadily increasing. It has been recommended that age-appropriate information should be available for older patients, but little exists in neurosurgery. We aim to better understand the clinical characteristics, bed occupancy and outcomes of elderly patients admitted to a UK neurosurgical unit. Retrospective review of medical records of all patients aged 75 years and older admitted for at least 1 night to the Southwest Neurosurgery Centre from 2007 to 2010. Mortality data up to 31 December 2012 were obtained from a national registry. Eight hundred and eighty-six elderly patients were admitted, for whom 877 records were available. Three hundred and eighty-nine patients were admitted electively; 488 were emergency or urgent; 48.8% had cranial pathology and 50.7% had spinal disease. Emergency cases were significantly older and more likely to be male than elective patients. The median length of stay for emergency patients was significantly longer than that of elective patients (P < 0.0001, 3 vs. 8 days). One elective patient died as an inpatient, compared with 46 emergency patients. Of emergency and elective patients, 25.6% and 3.6%, respectively, had died by 6 months after discharge. Age and length of stay were not associated with early death. The demographics and outcomes of the elderly admitted to a UK neurosurgical center are discussed. Differences between elective and emergency groups are attributable to both the pathologic processes and case selection. Neurosurgical treatment should not be denied based on age, however the high risks of emergency surgery in this age group should be acknowledged. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Approaches to Post-Conflict Peacebuilding: The UK Post-Conflict Reconstruction Unit (PCRU) and US Office for the Coordinator of Reconstruction and Stabilization (S/CRS)

DTIC Science & Technology

2006-09-01

POST-CONFLICT PEACEBUILDING: THE UK POST-CONFLICT RECONSTRUCTION UNIT (PCRU) AND US OFFICE FOR THE COORDINATOR OF RECONSTRUCTION AND STABILIZATION ( S ...CRS) 6. AUTHOR( S ) 2D LT KRIEGER MIRIAM A 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION KINGS COLLEGE REPORT NUMBER CI04...1874 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSORING/MONITORING THE DEPARTMENT OF THE AIR FORCE AGENCY REPORT NUMBER AFIT/CIA

Current trends, examples of regulations and practical approaches to occupational health services in the United Kingdom.

PubMed

Aw, T C

2001-01-01

Occupational health services in the United Kingdom are evolving from the traditional approach using doctor and nurses to provide clinical care at the worksite for any medical ailment, to multidisciplinary occupational health practitioners focussing on the prevention of ill-health from workplace factors. Nevertheless, there continues to be an artificial divide between safety departments and occupational health departments within the same organisation. Many occupational health services focus on the need to comply with the requirements of health and safety legislation. In the UK, these include the Health and Safety at Work, etc. Act of 1974, the Control of Substances Hazardous to Health, the 1994 regulations, and a newer legislation based on the European Union Directives. A practical approach to providing occupational health cover has been the development of occupational health departments within the public healthcare sector, private occupational health service providers, and independent consultants. These are some similarities between the UK situation and other countries in the models used for providing occupational health care. The appropriate model for any country would depend on their perceived needs, resources, industries and hazards.

Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injuries units and EDs in England 2012/2013: a cross-sectional study.

PubMed

Tammes, Peter; Morris, Richard W; Brangan, Emer; Checkland, Kath; England, Helen; Huntley, Alyson; Lasserson, Daniel; MacKichan, Fiona; Salisbury, Chris; Wye, Lesley; Purdy, Sarah

2016-10-01

For several years, EDs in the UK NHS have faced considerable increases in attendance rates. Walk-in centres (WiCs) and minor injuries units (MIUs) have been suggested as solutions. We aimed to investigate the associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and the associations between WiC/MIU and ED attendance. We used general practice-level data including 7462 English practices in 2012/2013 and present adjusted regression coefficients from linear multivariable analysis for relationships between patients' emergency attendance rates and practice characteristics. Every percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95% CI 0.06 to 0.66) per 1000 population. Percentage-point increases in patients unable to speak to a general practitioner (GP)/nurse within two workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1000 population by 0.23 (95% CI 0.05 to 0.42) and 0.10 (95% CI 0.00 to 0.19), respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK whites and lower male life expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates. Improving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

REAL-TIME high-resolution urban surface water flood mapping to support flood emergency management

NASA Astrophysics Data System (ADS)

Guan, M.; Yu, D.; Wilby, R.

2016-12-01

Strong evidence has shown that urban flood risks will substantially increase because of urbanisation, economic growth, and more frequent weather extremes. To effectively manage these risks require not only traditional grey engineering solutions, but also a green management solution. Surface water flood risk maps based on return period are useful for planning purposes, but are limited for application in flood emergencies, because of the spatiotemporal heterogeneity of rainfall and complex urban topography. Therefore, a REAL-TIME urban surface water mapping system is highly beneficial to increasing urban resilience to surface water flooding. This study integrated numerical weather forecast and high-resolution urban surface water modelling into a real-time multi-level surface water mapping system for Leicester City in the UK. For rainfall forecast, the 1km composite rain radar from the Met Office was used, and we used the advanced rainfall-runoff model - FloodMap to predict urban surface water at both city-level (10m-20m) and street-level (2m-5m). The system is capable of projecting 3-hour urban surface water flood, driven by rainfall derived from UK Met Office radar. Moreover, this system includes real-time accessibility mapping to assist the decision-making of emergency responders. This will allow accessibility (e.g. time to travel) from individual emergency service stations (e.g. Fire & Rescue; Ambulance) to vulnerable places to be evaluated. The mapping results will support contingency planning by emergency responders ahead of potential flood events.

44 CFR 351.28 - The Department of Commerce.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true The Department of Commerce. 351.28 Section 351.28 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Assignments § 351.28 The Department of Commerce. (a) Assist State and local governments in determining their...

44 CFR 351.28 - The Department of Commerce.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false The Department of Commerce. 351.28 Section 351.28 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Assignments § 351.28 The Department of Commerce. (a) Assist State and local governments in determining their...

44 CFR 351.28 - The Department of Commerce.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false The Department of Commerce. 351.28 Section 351.28 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Assignments § 351.28 The Department of Commerce. (a) Assist State and local governments in determining their...

44 CFR 334.2 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY... government to meet essential defense and civilian needs during any national security emergency. Accordingly, each Federal department and agency shall prepare its national security emergency preparedness plans and...

Understanding the Experience of Miscarriage in the Emergency Department.

PubMed

MacWilliams, Kate; Hughes, Jean; Aston, Megan; Field, Simon; Moffatt, Faith Wight

2016-11-01

Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women. Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis. Five themes emerged: "Pregnant/Life: Miscarriage/Death"; "Deciding to go to the emergency department: Something's wrong"; "Not an illness: A different kind of trauma"; "Need for acknowledgement"; and "Leaving the emergency department: What now?". Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization. This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Rebuilding Emergency Care After Hurricane Sandy.

PubMed

Lee, David C; Smith, Silas W; McStay, Christopher M; Portelli, Ian; Goldfrank, Lewis R; Husk, Gregg; Shah, Nirav R

2014-04-09

A freestanding, 911-receiving emergency department was implemented at Bellevue Hospital Center during the recovery efforts after Hurricane Sandy to compensate for the increased volume experienced at nearby hospitals. Because inpatient services at several hospitals remained closed for months, emergency volume increased significantly. Thus, in collaboration with the New York State Department of Health and other partners, the Health and Hospitals Corporation and Bellevue Hospital Center opened a freestanding emergency department without on-site inpatient care. The successful operation of this facility hinged on key partnerships with emergency medical services and nearby hospitals. Also essential was the establishment of an emergency critical care ward and a system to monitor emergency department utilization at affected hospitals. The results of this experience, we believe, can provide a model for future efforts to rebuild emergency care capacity after a natural disaster such as Hurricane Sandy. (Disaster Med Public Health Preparedness. 2014;0:1-4).

Designing a Clinical Dashboard to Fill Information Gaps in the Emergency Department

PubMed Central

Swartz, Jordan L.; Cimino, James J.; Fred, Matthew R.; Green, Robert A.; Vawdrey, David K.

2014-01-01

Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties. PMID:25954420

Designing a clinical dashboard to fill information gaps in the emergency department.

PubMed

Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K

2014-01-01

Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.

Thoracotomy in the emergency department for resuscitation of the mortally injured.

PubMed

DiGiacomo, J Christopher; Angus, L D George

2017-06-01

Emergency department resuscitative thoracotomy is an intervention of last resort for the acutely dying victim of trauma. In light of improvements in pre-hospital emergency systems, improved operative strategies for survival such as damage control and improvements in critical care medicine, the most extreme of resuscitation efforts should be re-evaluated for the potential survivor, with success properly defined as the return of vital signs which allow transport of the patient to the operating room. A retrospective review of all patients at a suburban level I trauma center who underwent emergency department resuscitative thoracotomy as an adjunct to the resuscitation efforts normally delivered in the trauma receiving area over a 22 year period was performed. Survival of emergency department resuscitative thoracotomy was defined as restoration of vital signs and transport out of the trauma resuscitation area to the operating room. Sixty-eight patients were identified, of whom 27 survived the emergency department resuscitative thoracotomy and were transported to the operating room. Review of pre-hospital and initial hospital data between these potential long term survivors and those who died in the emergency department failed to demonstrate trends which were predictive of survival of emergency department resuscitative thoracotomy. The only subgroup which failed to respond to emergency department resuscitative thoracotomy was patients without signs of life at the scene who arrived to the treatment facility without signs of life. The patient population of the "potential survivor" has been expanded due to advances in critical care practices, technology, and surgical technique and every opportunity for survival should be provided at the outset. Emergency department resuscitative thoracotomy is warranted for any patient with thoracic or subdiaphragmatic trauma who presents in extremis with a history of signs of life at the scene or organized cardiac activity upon arrival. Patients who have no evidence of signs of life at the scene and have no organized cardiac activity upon arrival should be pronounced. Production and hosting by Elsevier B.V.

A comparative analysis of drug safety withdrawals in the UK and the US (1971-1992): implications for current regulatory thinking and policy.

PubMed

Abraham, John; Davis, Courtney

2005-09-01

By going beyond individual case studies and solely quantitative surveys, this paper systematically examines why there were over twice as many new prescription drugs withdrawn from the market on grounds of safety in the UK as there were in the US between 1971 and 1992. Drawing on interviews with regulators, industry scientists and others involved, and on regulatory data never before accessed outside governments and companies, five key hypotheses which might explain this difference in drug safety withdrawals are analysed. These are: (1) simply because the UK approved more new drugs than the US; (2) because of an industrial corporate strategy to seek approval of 'less safe' drugs in the UK earlier; (3) because British regulators were more vigilant at spotting post-marketing safety problems than their US counterparts; (4) because the slowness of the US in approving new drugs enabled regulators there to learn from, and avoid, safety problems that had already emerged in the UK or European market; and (5) because more stringent regulation in the US meant that they approved fewer unsafe drugs on to the market in the first place. It is concluded that the main explanation for fewer drug safety withdrawals in the US is that the regulatory agency there applied more stringent pre-market review and/or standards, which took longer than UK regulatory checks, but prevented unsafe drugs marketed in the UK from entering the US market. Contrary to the claims frequently made by the pharmaceutical industry and regulatory agencies on both sides of the Atlantic, these results imply that it is likely that acceleration of regulatory review times in the US and the UK since the early 1990s is compromising drug safety.

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

PubMed

Layani, Géraldine; Fleet, Richard; Dallaire, Renée; Tounkara, Fatoumata K; Poitras, Julien; Archambault, Patrick; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2016-01-01

Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.

44 CFR 351.27 - The Department of Defense.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false The Department of Defense..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS RADIOLOGICAL EMERGENCY PLANNING AND PREPAREDNESS Interagency Assignments § 351.27 The Department of Defense. (a) Determine appropriate planning bases for Department of...

44 CFR 351.27 - The Department of Defense.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false The Department of Defense..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS RADIOLOGICAL EMERGENCY PLANNING AND PREPAREDNESS Interagency Assignments § 351.27 The Department of Defense. (a) Determine appropriate planning bases for Department of...

44 CFR 351.27 - The Department of Defense.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false The Department of Defense..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS RADIOLOGICAL EMERGENCY PLANNING AND PREPAREDNESS Interagency Assignments § 351.27 The Department of Defense. (a) Determine appropriate planning bases for Department of...

44 CFR 351.27 - The Department of Defense.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false The Department of Defense..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS RADIOLOGICAL EMERGENCY PLANNING AND PREPAREDNESS Interagency Assignments § 351.27 The Department of Defense. (a) Determine appropriate planning bases for Department of...

New UK graduates' knowledge of training and service provision within restorative dentistry - a survey.

PubMed

Kalsi, A S; Kochhar, S; Lewis, N J; Hemmings, K W

2017-06-09

Objective To assess new UK graduates' knowledge of training and service provision within restorative dentistry.Design A national descriptive cross-sectional survey.Subjects and methods An online survey assessing clinicians' knowledge of restorative dentistry, who had graduated within the last four years in the UK, was distributed across the UK via postgraduate dental deaneries. One-hundred responses were accepted as a sample of a potential population of 4,000.Main outcome measure How well respondents understood the service provision and training aspects of the specialty of restorative dentistry.Results The responses were received from graduates from a variety of dental schools across the UK. Of those respondents, 41 reported receiving career guidance within restorative dentistry. 45 new graduates were confident in their understanding of the specialty, while 53 were confident in the differences between restorative dentistry and monospecialty training. The respondents appeared unaware regarding treatment priorities within restorative dentistry departments. Most respondents felt that receiving teaching on restorative dentistry as a specialty and career pathway would be beneficial.Conclusion The results suggest that new graduates may benefit from clarification regarding the specialty of restorative dentistry, however, caution must be taken due to the limitations of the study.

Synergy between medicinal chemistry and biological research.

PubMed

Moncada, Salvador; Coaker, Hannah

2014-09-01

Salvador Moncada studied medicine at the University of El Salvador (El Salvador) before coming to the UK in 1971 to work on a PhD with Professor John Vane at the Institute of Basic Medical Sciences, Royal College of Surgeons (UK). After a short period of research at the University of Honduras (Honduras), he joined the Wellcome Research Laboratories (UK) where he became Head of the Department of Prostaglandin Research and later, Director of Research. He returned to academic life in 1996 as founder and director of the Wolfson Institute for Biomedical Research at University College London (UK). Moncada played a role in the discovery of the mechanism of action of aspirin-like drugs and later led the teams which discover prostacyclin and identified nitric oxide as a biological mediator. In his role as a Director of Research of the Wellcome Laboratories, he oversaw the discovery and development of medicines for epilepsy, migraine, malaria and cancer. Currently, he is working on the regulation of cell proliferation as Director of the Institute of Cancer Sciences at the University of Manchester (UK). Moncada has won numerous awards from the international scientific community and in 2010, he received a knighthood from Her Majesty Queen Elizabeth II for his services to science.

44 CFR 351.26 - The United States Department of Agriculture.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false The United States Department of Agriculture. 351.26 Section 351.26 Emergency Management and Assistance FEDERAL EMERGENCY... PREPAREDNESS Interagency Assignments § 351.26 The United States Department of Agriculture. (a) Assist FEMA in...

44 CFR 351.26 - The United States Department of Agriculture.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false The United States Department of Agriculture. 351.26 Section 351.26 Emergency Management and Assistance FEDERAL EMERGENCY... PREPAREDNESS Interagency Assignments § 351.26 The United States Department of Agriculture. (a) Assist FEMA in...

44 CFR 351.26 - The United States Department of Agriculture.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true The United States Department of Agriculture. 351.26 Section 351.26 Emergency Management and Assistance FEDERAL EMERGENCY... PREPAREDNESS Interagency Assignments § 351.26 The United States Department of Agriculture. (a) Assist FEMA in...

44 CFR 351.26 - The United States Department of Agriculture.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false The United States Department of Agriculture. 351.26 Section 351.26 Emergency Management and Assistance FEDERAL EMERGENCY... PREPAREDNESS Interagency Assignments § 351.26 The United States Department of Agriculture. (a) Assist FEMA in...

44 CFR 351.26 - The United States Department of Agriculture.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false The United States Department of Agriculture. 351.26 Section 351.26 Emergency Management and Assistance FEDERAL EMERGENCY... PREPAREDNESS Interagency Assignments § 351.26 The United States Department of Agriculture. (a) Assist FEMA in...

44 CFR 350.6 - Assistance in development of State and local plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Assistance in development of State and local plans. 350.6 Section 350.6 Emergency Management and Assistance FEDERAL EMERGENCY... Nuclear Regulatory Commission, Department of Health and Human Services, Department of Energy, Department...

44 CFR 350.6 - Assistance in development of State and local plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Assistance in development of State and local plans. 350.6 Section 350.6 Emergency Management and Assistance FEDERAL EMERGENCY... Nuclear Regulatory Commission, Department of Health and Human Services, Department of Energy, Department...

An increase in sexually transmitted infections seen in US emergency departments.

PubMed

Pearson, William S; Peterman, Thomas A; Gift, Thomas L

2017-07-01

Surveillance data show that there is an increase in the incidence of sexually transmitted infections (STI) and we believe that because of this increased incidence, coupled with a deteriorating public health infrastructure, these STIs are being seen more often in emergency departments. Therefore, we used six years of the most recently available nationally-representative emergency department data to show an increase in the number of emergency department visits where a sexually transmitted infection was treated. We further described the population for these visits. Published by Elsevier Inc.

The legal and ethical implications of social media in the emergency department.

PubMed

Lyons, Rachel; Reinisch, Courtney

2013-01-01

Social media is a growing and popular means of communication. It is understandable that health care providers may not share identifying information on patients through these sources. Challenges arise when patients and family members wish to record the care provided in the emergency department. The health care provider may be faced with an ethical and possibly legal dilemma when social media is present in the emergency department. This article seeks to discuss the legal and ethical principles surrounding social media in the emergency department.

The proportion of work-related emergency department visits not expected to be paid by workers' compensation: implications for occupational health surveillance, research, policy, and health equity.

PubMed

Groenewold, Matthew R; Baron, Sherry L

2013-12-01

To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits. A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys. Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression. A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation. Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications. © Health Research and Educational Trust.

Drug-related visits to the emergency department: how big is the problem?

PubMed

Patel, Payal; Zed, Peter J

2002-07-01

To review the literature concerning drug-related problems that result in emergency department visits, estimate the frequency of these problems and the rates of hospital admissions, and identify patient risk factors and drugs that are associated with the greatest risk. A systematic search of MEDLINE (January 1966-December 2001), EMBASE (January 1980-December 2001), and PubMed (January 1966-December 2001) databases for full reports published in English was performed. The Ottawa Valley Regional Drug Information Service database of nonindexed pharmacy journals also was searched. Data from eight retrospective and four prospective trials retrieved indicated that as many as 28% of all emergency department visits were drug related. Of these, 70% were preventable, and as many as 24% resulted in hospital admission. Drug classes often implicated in drug-related visits to an emergency department were nonsteroidal antiinflammatory drugs, anticonvulsants, antidiabetic drugs, antibiotics, respiratory drugs, hormones, central nervous system drugs, and cardiovascular drugs. Common drug-related problems resulting in emergency department visits were adverse drug reactions, noncompliance, and inappropriate prescribing. Drug-related problems are a significant cause of emergency department visits and subsequent resource use. Primary caregivers, such as family physicians and pharmacists, should collaborate more closely to provide and reinforce care plans and monitor patients to prevent drug-related visits to the emergency department and subsequent morbidity and mortality.

Genetics Home Reference: 3-methylcrotonyl-CoA carboxylase deficiency

MedlinePlus

... Targets Orphanet: 3-methylcrotonyl-CoA carboxylase deficiency Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (3 links) Children Living with Inherited Metabolic Diseases (CLIMB) (UK) Organic ...

Genetics Home Reference: 3-hydroxy-3-methylglutaryl-CoA lyase deficiency

MedlinePlus

... Targets Orphanet: 3-hydroxy-3-methylglutaric aciduria Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (3 links) Children Living with Inherited Metabolic Diseases (CLIMB) (UK) FOD ( ...

Collaboration with the United Kingdom on Air Quality Research

EPA Pesticide Factsheets

To initiate research collaboration among the United States Environmental Protection Agency (EPA), the Unitd Kingdom's (UK) Department for Environment, Food and Rural Affairs (Defra), and the Environment Agency for England and Wales (EA) on exposure science

Emergency Victim Care. A Textbook for Emergency Medical Personnel.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

This textbook for emergency medical personnel should be useful to fire departments, private ambulance companies, industrial emergency and rescue units, police departments, and nurses. The 30 illustrated chapters cover topics such as: (1) Emergency Medical Service Vehicles, (2) Safe Driving Practices, (3) Anatomy and Physiology, (4) Closed Chest…

Delayed emergency department presentation in critically ill patients.

PubMed

Rodriguez, R M; Passanante, M; Phelps, M A; Dresden, G; Kriza, K; Carrasco, M; Franklin, J

2001-12-01

To determine the frequency and causes of delayed emergency department presentation in critically ill patients who did not have acute myocardial infarction and to evaluate whether factors such as age, gender, prior medical advice, lack of insurance, or low educational level are associated with delayed presentation. Prospective, descriptive analysis. Emergency department and medical intensive care unit of an urban county hospital. All adult patients admitted from the emergency department to the medical intensive care unit for reasons other than unstable angina, acute myocardial infarction, or stroke over two 9-wk blocks. Within 72 hrs of intensive care unit admission, patients or their families were interviewed to determine time elapsed between the onset of symptoms and patient emergency department presentation and to elicit reasons for delays in seeking medical treatment. We interviewed 155 of 173 (90%) of eligible patients and found that 58% waited >24 hrs before presenting to the emergency department. The most commonly cited primary reason for delays were beliefs that symptoms were not serious enough for emergency care (31%) and that symptoms would resolve spontaneously (29%). Most (55%) sought medical treatment only at the urging of family members or other advocates. Although variables such as lack of insurance and low educational level were not associated with delayed presentation, male gender and having sought medical advice before presenting to the emergency department were significantly associated with delay (p =.036 for each). Because of poor understanding of the gravity and natural progression of their symptoms, most critically ill patients waited >24 hrs to present to our emergency department. Education on warning symptom recognition for serious illnesses may be warranted not only for patients themselves but also for family members and caregivers.

Experiences of counselling in the emergency department during the waiting period: importance of family participation.

PubMed

Paavilainen, Eija; Salminen-Tuomaala, Mari; Kurikka, Sirpa; Paussu, Paula

2009-08-01

To describe patients' experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling. Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient's life situation. Descriptive quantitative study. Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis. Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care. It is to encourage patients' family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared. Patients' family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.

Emergency Department Care in the Postpartum Period: California Births, 2009-2011.

PubMed

Batra, Priya; Fridman, Moshe; Leng, Mei; Gregory, Kimberly D

2017-11-01

To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.

Recording of community violence by medical and police services

PubMed Central

Sutherland, I; Sivarajasingam, V; Shepherd, J

2002-01-01

Objectives: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police. Methods: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located. Results: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0). Conclusions: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0–10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection. PMID:12226126

Idaho National Laboratory Emergency Readiness Assurance Plan - Fiscal Year 2015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Farmer, Carl J.

Department of Energy Order 151.1C, Comprehensive Emergency Management System requires that each Department of Energy field element documents readiness assurance activities, addressing emergency response planning and preparedness. Battelle Energy Alliance, LLC, as prime contractor at the Idaho National Laboratory (INL), has compiled this Emergency Readiness Assurance Plan to provide this assurance to the Department of Energy Idaho Operations Office. Stated emergency capabilities at the INL are sufficient to implement emergency plans. Summary tables augment descriptive paragraphs to provide easy access to data. Additionally, the plan furnishes budgeting, personnel, and planning forecasts for the next 5 years.

The 'unnecessary' use of emergency departments by older people: findings from hospital data, hospital staff and older people.

PubMed

Faulkner, Debbie; Law, Julia

2015-11-01

Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations'. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.

Protocolized Treatment Is Associated With Decreased Organ Dysfunction in Pediatric Severe Sepsis.

PubMed

Balamuth, Fran; Weiss, Scott L; Fitzgerald, Julie C; Hayes, Katie; Centkowski, Sierra; Chilutti, Marianne; Grundmeier, Robert W; Lavelle, Jane; Alpern, Elizabeth R

2016-09-01

To determine whether treatment with a protocolized sepsis guideline in the emergency department was associated with a lower burden of organ dysfunction by hospital day 2 compared to nonprotocolized usual care in pediatric patients with severe sepsis. Retrospective cohort study. Tertiary care children's hospital from January 1, 2012, to March 31, 2014. Patients older than 56 days old and younger than 18 years old with international consensus defined severe sepsis and who required PICU admission within 24 hours of emergency department arrival were included. The exposure was the use of a protocolized emergency department sepsis guideline. The primary outcome was complete resolution of organ dysfunction by hospital day 2. One hundred eighty nine subjects were identified during the study period. Of these, 121 (64%) were treated with the protocolized emergency department guideline and 68 were not. There were no significant differences between the groups in age, sex, race, number of comorbid conditions, emergency department triage level, or organ dysfunction on arrival to the emergency department. Patients treated with protocolized emergency department care were more likely to be free of organ dysfunction on hospital day 2 after controlling for sex, comorbid condition, indwelling central venous catheter, Pediatric Index of Mortality-2 score, and timing of antibiotics and IV fluids (adjusted odds ratio, 4.2; 95% CI, 1.7-10.4). Use of a protocolized emergency department sepsis guideline was independently associated with resolution of organ dysfunction by hospital day 2 compared to nonprotocolized usual care. These data indicate that morbidity outcomes in children can be improved with the use of protocolized care.

Children's views on research without prior consent in emergency situations: a UK qualitative study.

PubMed

Roper, Louise; Sherratt, Frances C; Young, Bridget; McNamara, Paul; Dawson, Angus; Appleton, Richard; Crawley, Esther; Frith, Lucy; Gamble, Carrol; Woolfall, Kerry

2018-06-09

We explored children's views on research without prior consent (RWPC) and sought to identify ways of involving children in research discussions. Qualitative interview study. Participants were recruited through a UK children's hospital and online advertising. 16 children aged 7-15 years with a diagnosis of asthma (n=14) or anaphylaxis (n=2) with recent (<12 months) experience of emergency care. Children were keen to be included in medical research and viewed RWPC as acceptable in emergency situations if trial interventions were judged safe. Children trusted that doctors would know about their trial participation and act in their best interests. All felt that children should be informed about the research following their recovery and involved in discussions with a clinician or their parent(s) about the use of data already collected as well as continued participation in the trial (if applicable). Participants suggested methods to inform children about their trial participation including an animation. Children supported, and were keen to be involved in, clinical trials in emergency situations. We present guidance and an animation that practitioners and parents might use to involve children in trial discussions following their recovery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mechanisms of Coagulation Abnormalities and Trauma

DTIC Science & Technology

2011-07-01

Medicine & Dentistry , Queen Mary University of London, London, UK 3 and Department of Anesthesia , University of Alabama at Birmingham, Birmingham, AL 4... local hypoperfusion and fibrin clot formation. Other groups have confirmed these findings in the gut, liver, and lung. Furthermore, skin biopsies from...Brohi,‡ Daniel Frith,‡ Jean-François Pittet,*† and Mitchell J. Cohen* The Departments of *Surgery and † Anesthesia , University of California, San

Community first responders and responder schemes in the United Kingdom: systematic scoping review.

PubMed

Phung, Viet-Hai; Trueman, Ian; Togher, Fiona; Orner, Roderick; Siriwardena, A Niroshan

2017-06-19

Community First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK. There has been no previous review of UK literature on these schemes. This is the first systematic scoping review of UK literature on CFR schemes, which identifies the reasons for becoming a CFR, requirements for training and feedback and confusion between the CFR role and that of ambulance service staff. This study also reveals gaps in the evidence base for CFR schemes. We conducted a systematic scoping review of the published literature, in the English language from 2000 onwards using specific search terms in six databases. Narrative synthesis was used to analyse article content. Nine articles remained from the initial search of 15,969 articles after removing duplicates, title and abstract and then full text review. People were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. There were concerns about the possible emotional impact on CFRs responding to incidents. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low, patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles. There was support for local autonomy of CFR schemes but with greater sharing of best practice. Most studies dated from 2005 and were descriptive rather than analytical. In the UK and Australia CFRs are usually lay volunteers equipped with basic skills for responding to medical emergencies, whereas in the US they include other emergency staff as well as lay people. Opportunities for future research include exploring experiences and perceptions of patients who have been treated by CFRs and other stakeholders, while also evaluating the effectiveness and costs of CFR schemes.

Nursing management of aggression in a Singapore emergency department: A qualitative study.

PubMed

Tan, Mei Fen; Lopez, Violeta; Cleary, Michelle

2015-09-01

In Singapore, anecdotal evidence suggests that nurses are concerned about managing aggressive incidents in the emergency department. In this study, registered nurses' perceptions of managing aggressive patients in an emergency department were explored. Ten registered nurses from the emergency department of an acute public hospital in Singapore were interviewed. Four overarching themes emerged from the thematic analysis: (i) impact of aggressive patients on nurses; (ii) nursing assessment of aggressive behaviors; (iii) nursing management of aggressive behaviors; and (iv) organizational support and responsiveness. Further research is required to better support nurses to deliver optimal care for aggressive patients and achieve positive and effective outcomes. © 2015 Wiley Publishing Asia Pty Ltd.

Ethical issues in the response to Ebola virus disease in US emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine.

PubMed

Venkat, Arvind; Wolf, Lisa; Geiderman, Joel M; Asher, Shellie L; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C

2015-03-01

The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Recent Suicidal Ideation among Patients in an Inner City Emergency Department

ERIC Educational Resources Information Center

Ilgen, Mark A.; Walton, Maureen A.; Cunningham, Rebecca M.; Barry, Kristen L.; Chermack, Steve T.; De Chavez, Peter; Blow, Frederic C.

2009-01-01

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner-city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in…

Using Simulation to Examine the Effect of Physician Heterogeneity on the Operational Efficiency of an Overcrowded Hospital Emergency Department

NASA Astrophysics Data System (ADS)

Kuo, Y.-H.; Leung, J. M. Y.; Graham, C. A.

2015-05-01

In this paper, we present a case study of modelling and analyzing the patient flow of a hospital emergency department in Hong Kong. The emergency department is facing the challenge of overcrowding and the patients there usually experience a long waiting time. Our project team was requested by a senior consultant of the emergency department to analyze the patient flow and provide a decision support tool to help improve their operations. We adopt a simulation approach to mimic their daily operations. With the simulation model, we conduct a computational study to examine the effect of physician heterogeneity on the emergency department performance. We found that physician heterogeneity has a great impact on the operational efficiency and thus should be considered when developing simulation models. Our computational results show that, with the same average of service rates among the physicians, variation in the rates can improve overcrowding situation. This suggests that emergency departments may consider having some efficient physicians to speed up the overall service rate in return for more time for patients who need extra medical care.

A critical discussion of the concept of recovery for mental health consumers in the Emergency Department.

PubMed

Marynowski-Traczyk, Donna; Moxham, Lorna; Broadbent, Marc

2013-08-01

The Emergency Department has increasingly become the initial point of contact for mental health crisis assessment and intervention, and is the interface between community and inpatient care. Questions regarding the appropriateness of the Emergency Department in providing a suitable environment for people who have a mental health issue abound with commentary regarding the confidence and competence of general Registered Nurses to provide mental health care. Emergency Departments are busy noisy places where rapid assessments and response is the norm and is counterintuitive to contemporary mental health care. The model of care currently considered best practice in mental health is the Recovery-oriented model; a long term individualised approach to collaborative care. The notion of Recovery as understood and practised in contemporary mental health care is almost polarised to that which is embedded in generalist Emergency Registered Nurses' practice. As Emergency Departments play an integral role in the assessment of people experiencing mental illness, close collaboration and support is required between emergency and mental health specialities to achieve optimal client outcomes in an environment that is nested within the medical model. Furthermore, Emergency Department staff must be supported in acquiring the knowledge and skills required to care for and manage people with a mental health issue. This includes cognisance and understanding of the Recovery-oriented model of care which is the model of care considered best practice for this client group. This paper offers a critical discussion of the concept of recovery for mental health consumers in the Emergency Department. Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

PubMed

Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

2018-06-01

Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

Erythropoiesis-stimulating agent dosing, haemoglobin and ferritin levels in UK haemodialysis patients 2005-13.

PubMed

Birnie, Kate; Caskey, Fergus; Ben-Shlomo, Yoav; Sterne, Jonathan A C; Gilg, Julie; Nitsch, Dorothea; Tomson, Charles

2017-04-01

Erythropoiesis-stimulating agents (ESAs) with intravenous iron supplementation are the main treatment for anaemia in patients with chronic kidney disease. Although observational studies suggest better outcomes for patients who achieve higher haemoglobin (Hb) levels, randomized controlled trials comparing higher and lower Hb targets have led to safety concerns over higher targets and to changes in treatment guidelines. Quarterly data from 2005 to 2013 were obtained on 28 936 haemodialysis patients from the UK Renal Registry. We examined trends in ESA use and average dose, Hb and ferritin values over time and Hb according to the UK Renal Association guideline range. The average ESA dose declined over time, with sharper decreases of epoetin seen towards the end of 2006 and from 2009. Average Hb for patients on ESAs was 114.1 g/L [95% confidence interval (CI) 113.7, 114.6] in the first quarter of 2005, which decreased to 109.6 g/L (95% CI 109.3, 109.9) by the end of 2013. Average serum ferritin was 353 µg/L (95% CI 345, 360) at the start of 2005, increasing to 386 µg/L (95% CI 380, 392) in the final quarter of 2013. The percentage of patients with Hb in the range of 100-120 g/L increased from 46.1 at the start of 2005 to 57.6 at the end of 2013. Anaemia management patterns for haemodialysis patients changed in the UK between 2005 and 2013. These patterns most likely reflect clinician response to emerging trial evidence and practice guidelines. Registries play an important role in continued observation of anaemia management and will monitor further changes as new evidence on optimal care emerges. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA.

Erythropoiesis-stimulating agent dosing, haemoglobin and ferritin levels in UK haemodialysis patients 2005–13

PubMed Central

Caskey, Fergus; Ben-Shlomo, Yoav; Sterne, Jonathan A.C.; Gilg, Julie; Nitsch, Dorothea; Tomson, Charles

2017-01-01

ABSTRACT Background: Erythropoiesis-stimulating agents (ESAs) with intravenous iron supplementation are the main treatment for anaemia in patients with chronic kidney disease. Although observational studies suggest better outcomes for patients who achieve higher haemoglobin (Hb) levels, randomized controlled trials comparing higher and lower Hb targets have led to safety concerns over higher targets and to changes in treatment guidelines. Methods: Quarterly data from 2005 to 2013 were obtained on 28 936 haemodialysis patients from the UK Renal Registry. We examined trends in ESA use and average dose, Hb and ferritin values over time and Hb according to the UK Renal Association guideline range. Results: The average ESA dose declined over time, with sharper decreases of epoetin seen towards the end of 2006 and from 2009. Average Hb for patients on ESAs was 114.1 g/L [95% confidence interval (CI) 113.7, 114.6] in the first quarter of 2005, which decreased to 109.6 g/L (95% CI 109.3, 109.9) by the end of 2013. Average serum ferritin was 353 µg/L (95% CI 345, 360) at the start of 2005, increasing to 386 µg/L (95% CI 380, 392) in the final quarter of 2013. The percentage of patients with Hb in the range of 100–120 g/L increased from 46.1 at the start of 2005 to 57.6 at the end of 2013. Conclusions: Anaemia management patterns for haemodialysis patients changed in the UK between 2005 and 2013. These patterns most likely reflect clinician response to emerging trial evidence and practice guidelines. Registries play an important role in continued observation of anaemia management and will monitor further changes as new evidence on optimal care emerges. PMID:27190350

Impact of environmental discourses on public health policy arrangements: a comparative study in the UK and Flanders, (Belgium).

PubMed

Stassen, K R; Gislason, M; Leroy, P

2010-10-01

Theoretically inspired by discursive institutionalism and multi-level governance, this paper assesses the extent to which 'environmental health' has emerged as a new discourse at European level, the effects it has had on national public health governance in two European countries, and what mechanisms have triggered or hindered these effects. Comparison of the dynamics in public health policy arrangements in Flanders (Belgium) and the UK, nations influenced by both international and European environmental health discourses. The Policy Arrangement Approach was the analytical framework used to structure the results of this textual analysis. Despite their shared focus on environmental health, Belgium and the UK display quite different approaches to environmental health governance. While Belgium works on environmental health in a predominantly top-down approach, the UK has developed a more inward-facing approach to environmental health policies. The cases of the UK and Belgium show that, although these countries respond similarly to internationally agreed charters and both are members of the European Union, national differences in environmental health policies persist, mainly due to pre-existing national policy arrangements and the activities of national institutions. This leads to a divergent interplay between national and international institutions. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

UK Policy on Doctor Remediation: Trajectories and Challenges.

PubMed

Price, Tristan; Archer, Julian

2017-01-01

Around the world, policy-makers, academics, and health service professionals have become increasingly aware of the importance of remediation, the process by which poor performance is "remedied," as part of the changing landscape of medical regulation. It is, therefore, an opportune time to critique the UK experience with remediation policy. This article frames, for the first time, the UK remediation policy as developing from a central policy aim that was articulated in the 1990s: to accelerate the identification of underperformance and, subsequently, remedy any problems identified as soon as possible. In pursuit of this aim, three policy trajectories have emerged: professionalizing and standardizing remediation provision; linking remediation with other forms of regulation, namely relicensure (known in the UK as medical revalidation); and fostering obligations for doctors to report themselves and others for remediation needs. The operationalization of policy along these trajectories, and the challenges that have arisen, has relevance for anyone seeking to understand or indeed improve remediation practices within any health care system. It is argued here that the UK serves as an example of the more general challenges posed by seeking to integrate remediation policy within broader frameworks of medical governance, in particular systems of relicensure, and the need to develop a solid evidence base for remediation practices.

Soil geohazard mapping for improved asset management of UK local roads

NASA Astrophysics Data System (ADS)

Pritchard, O. G.; Hallett, S. H.; Farewell, T. S.

2015-09-01

Unclassified roads comprise 60 % of the road network in the United Kingdom (UK). The resilience of this locally important network is declining. It is considered by the Institution of Civil Engineers to be "at risk" and is ranked 26th in the world. Many factors contribute to the degradation and ultimate failure of particular road sections. However, several UK local authorities have identified that in drought conditions, road sections founded upon shrink-swell susceptible clay soils undergo significant deterioration compared with sections on non-susceptible soils. This arises from the local road network having little, if any, structural foundations. Consequently, droughts in East Anglia have resulted in millions of pounds of damage, leading authorities to seek emergency governmental funding. This paper assesses the use of soil-related geohazard assessments in providing soil-informed maintenance strategies for the asset management of the locally important road network of the UK. A case study draws upon the UK administrative county of Lincolnshire, where road assessment data have been analysed against mapped clay-subsidence risk. This reveals a statistically significant relationship between road condition and susceptible clay soils. Furthermore, incorporation of UKCP09 future climate projections within the geohazard models has highlighted roads likely to be at future risk of clay-related subsidence.

Soil geohazard mapping for improved asset management of UK local roads

NASA Astrophysics Data System (ADS)

Pritchard, O. G.; Hallett, S. H.; Farewell, T. S.

2015-05-01

Unclassified roads comprise 60% of the road network in the United Kingdom (UK). The resilience of this locally important network is declining. It is considered by the Institution of Civil Engineers to be "at risk" and is ranked 26th in the world. Many factors contribute to the degradation and ultimate failure of particular road sections. However, several UK local authorities have identified that in drought conditions, road sections founded upon shrink/swell susceptible clay soils undergo significant deterioration compared with sections on non-susceptible soils. This arises from the local road network having little, if any structural foundations. Consequently, droughts in East Anglia have resulted in millions of pounds of damage, leading authorities to seek emergency governmental funding. This paper assesses the use of soil-related geohazard assessments in providing soil-informed maintenance strategies for the asset management of the locally important road network of the UK. A case study draws upon the UK administrative county of Lincolnshire, where road assessment data have been analysed against mapped clay-subsidence risk. This reveals a statistically significant relationship between road condition and susceptible clay soils. Furthermore, incorporation of UKCP09 future climate projections within the geohazard models has highlighted roads likely to be at future risk of clay-related subsidence.

Worker, workplace, and community/environmental risk factors for workplace violence in emergency departments.

PubMed

Gillespie, Gordon Lee; Pekar, Bunnany; Byczkowski, Terri L; Fisher, Bonnie S

2017-03-04

Workplace violence committed by patients and visitors has high propensity to occur against emergency department employees. This article reports the association of worker, workplace, and community/environmental factors with violence risks. A cross-sectional research design was used with 280 employees from six emergency departments in the Midwest United States. Respondents completed the Survey of Violence Experienced by Staff and a 10-item demographic questionnaire. Data were analyzed using frequencies, percentages, Chi-square tests, and adjusted relative risks with 95% confidence intervals. Over 80% of respondents experienced at least one type of workplace violence with their current employer and approximately 40% experienced all three types. Risks for workplace violence were significantly higher for registered nurses and hospital-based emergency departments. Workplace violence can impact all employees in the emergency department regardless of worker, workplace, and community/environmental factors.

Postmortem procedures in the emergency department: using the recently dead to practise and teach.

PubMed Central

Iserson, K V

1993-01-01

In generations past, it was common practice for doctors to learn lifesaving technical skills on patients who had recently died. But this practice has lately been criticised on religious, legal, and ethical grounds, and has fallen into disuse in many hospitals and emergency departments. This paper uses four questions to resolve whether doctors in emergency departments should practise and teach non-invasive and minimally invasive procedures on the newly dead: Is it ethically and legally permissible to practise and teach non-invasive and minimally invasive procedures on the newly dead emergency-department patient? What are the alternatives or possible consequences of not practising non-invasive and minimally invasive procedures on newly dead patients? Is consent from relatives required? Should doctors in emergency departments allow or even encourage this use of newly dead patients? PMID:8331644

Clinician awareness of tetanus-diphtheria vaccination in trauma patients: a questionnaire study

PubMed Central

2012-01-01

Background Most trauma patients visit the hospital via the emergency department. They are at high risk for tetanus infection because many trauma patients are wounded. Tetanus immunity in the Korean population has been revealed to be decreased in age groups over 20 years old. It is important for emergency physicians to vaccinate patients with the tetanus booster in wound management. Methods Questionnaires were sent to the directors of the emergency departments of resident training hospitals certified by the Korean Society of Emergency Medicine. Results Two thirds of the emergency department directors surveyed reported applying tetanus prophylaxis guidelines to more than 80% of wounded patients. However, about 45% of clinicians in the emergency departments considered giving less than half of the wounded patient tetanus booster vaccinations, and there were no distinct differences in tetanus booster vaccination rates among different age groups. Most emergency physicians are familiar with tetanus prophylaxis guidelines for wound management. However, more than half of the emergency department directors reported that the major reason for not considering tetanus-diphtheria vaccination was due to assumptions that patients already had tetanus immunity. Conclusion Attitude changes should be encouraged among emergency physicians regarding tetanus prophylaxis. As emergency physicians are frequently confronted with patients that are at a high risk for tetanus infection in emergency situations, they need to be more informed regarding tetanus immunity epidemiology and encouraged to administer tetanus booster vaccines. PMID:22587533

Genetics Home Reference: very long-chain acyl-CoA dehydrogenase deficiency

MedlinePlus

... Very long chain acyl-CoA dehydrogenase deficiency Screening, Technology, and Research in Genetics Virginia Department of Health (PDF) Patient Support and Advocacy Resources (4 links) Children's Mitochondrial Disease Network (UK) FOD (Fatty Oxidation Disorders) ...

Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.

PubMed

Behr, Joshua G; Diaz, Rafael

2016-01-01

First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department. Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.

The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care

PubMed Central

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R.

2011-01-01

Background As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. Objective To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel Methods The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Results Post–propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. Conclusions When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care. PMID:25126351

Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National Emergency Department Overcrowding Score (NEDOCS) to measure emergency department crowding: pilot study.

PubMed

Boyle, Adrian; Abel, Gary; Raut, Pramin; Austin, Richard; Dhakshinamoorthy, Vijayasankar; Ayyamuthu, Ravi; Murdoch, Iona; Burton, Joel

2016-05-01

There is uncertainty about the best way to measure emergency department crowding. We have previously developed a consensus-based measure of crowding, the International Crowding Measure in Emergency Departments (ICMED). We aimed to obtain pilot data to evaluate the ability of a shortened form of the ICMED, the sICMED, to predict senior emergency department clinicians' concerns about crowding and danger compared with a very well-studied measure of emergency department crowding, the National Emergency Department Overcrowding Score (NEDOCS). We collected real-time observations of the sICMED and NEDOCS and compared these with clinicians' perceptions of crowding and danger on a visual analogue scale. Data were collected in four emergency departments in the East of England. Associations were explored using simple regression, random intercept models and models accounting for correlation between adjacent time points. We conducted 82 h of observation in 10 observation sets. Naive modelling suggested strong associations between sICMED and NEDOCS and clinician perceptions of crowding and danger. Further modelling showed that, due to clustering, the association between sICMED and danger persisted, but the association between these two measures and perception of crowding was no longer statistically significant. Both sICMED and NEDOCS can be collected easily in a variety of English hospitals. Further studies are required but initial results suggest both scores may have potential use for assessing crowding variation at long timescales, but are less sensitive to hour-by-hour variation. Correlation in time is an important methodological consideration which, if ignored, may lead to erroneous conclusions. Future studies should account for such correlation in both design and analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain

PubMed Central

Buron, Andrea; Cots, Francesc; Garcia, Oscar; Vall, Oriol; Castells, Xavier

2008-01-01

Background The recent increase in the number of immigrants of Barcelona represents a challenge for the public healthcare system, the emergency department being the most used healthcare service by this group. However, utilisation rates in our environment have not yet been studied. We aimed to compare emergency department utilisation rates between Spanish-born and foreign-born residents in a public hospital of Barcelona. Methods The study population included all adults residing in the area of study and visiting the emergency department of Hospital del Mar in 2004. The emergency care episodes were selected from the Emergency Department register, and the population figures from the Statistics Department of Barcelona. Emergency care episodes were classified into five large clinical categories. Adjusted rate ratios (RR) of utilisation among foreign-born vs. Spanish-born residents were assessed through negative binomial regression. Results The overall utilisation rate was 382 emergency contacts per 1,000 persons-years. The RR for foreign-born versus Spanish-born residents was 0.62 (95% CI: 0.52; 0.74%). The RR was also significantly below one in surgery (0.51, 95% CI: 0.42; 0.63), traumatology (0.47, 95% CI: 0.38; 0.59), medicine (0.48, 95% CI: 0.38; 0.59) and psychiatry (0.42, 95% CI: 0.18; 0.97). No differences were found in utilisation of gynaecology and minor emergency services. Conclusion The overall lower utilisation rates obtained for foreign-born residents is consistent with previous studies and is probably due to the "healthy immigrant effect". Thus, the population increase due to immigration does not translate directly into a corresponding increase in the number of emergency contacts. The lack of differences in minor and gynaecological emergency care supports the hypothesis that immigrants overcome certain barriers by using the emergency department to access to health services. The issue of healthcare barriers should therefore be addressed, especially among immigrants. PMID:18315871

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data.

PubMed

Cowling, Thomas E; Majeed, Azeem; Harris, Matthew J

2018-01-22

The UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England. The study included 8124 general practices between 2011-2012 and 2013-2014. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours and overall experience (on 0-100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification. Mean practice-level rates of A&E visits and emergency admissions increased from 2011-2012 to 2013-2014 (310.3-324.4 and 98.8-102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011-2012 and 76.6 in 2013-2014. In the adjusted regression analysis, an SD increase in experience of making appointments (equal to 9 points) predicted decreases of 1.8% (95% CI -2.4% to -1.2%) in A&E visit rates and 1.4% (95% CI -1.9% to -0.9%) in admission rates. This equalled 301 174 fewer A&E visits and 74 610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses. Associations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

History of Inclusive Design in the UK.

PubMed

John Clarkson, P; Coleman, Roger

2015-01-01

The UK Design Council describes Inclusive Design as neither a new genre of design, nor a separate specialism, but as a general approach to designing in which designers ensure that their products and services address the needs of the widest possible audience, irrespective of age or ability. Inclusive Design (also known [in Europe] as Design for All and as Universal Design in the USA) is in essence the inverse of earlier approaches to designing for disabled and elderly people as a sub-set of the population, and an integral part of a more recent international trend towards the integration of older and disabled people in the mainstream of society. This paper describes the development of Inclusive Design in the UK, from its early beginnings, through its subsequent adoption as a topic of academic research, leading to its recent emergence embodied as a framework and toolkit for design. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

The moral economy of austerity: analysing UK welfare reform.

PubMed

Morris, Lydia

2016-03-01

This paper notes the contemporary emergence of 'morality' in both sociological argument and political rhetoric, and analyses its significance in relation to ongoing UK welfare reforms. It revisits the idea of 'moral economy' and identifies two strands in its contemporary application; that all economies depend on an internal moral schema, and that some external moral evaluation is desirable. UK welfare reform is analysed as an example of the former, with reference to three distinct orientations advanced in the work of Freeden (1996), Laclau (2014), and Lockwood (1996). In this light, the paper then considers challenges to the reform agenda, drawn from third sector and other public sources. It outlines the forms of argument present in these challenges, based respectively on rationality, legality, and morality, which together provide a basis for evaluation of the welfare reforms and for an alternative 'moral economy'. © London School of Economics and Political Science 2016.

[Care organization at French pediatric emergency department].

PubMed

Gras-Le Guen, Christèle; Vrignaud, Bénédicte; Levieux, Karine

2015-05-01

The number of children admitted to paediatric emergencies is increasing steadily, and is responsible for an altered quality in the patients' reception and some major perturbations in the care organization. In this context, the primary care physicians play a major role in explaining their patients "how to use" the paediatric emergency department (priority in case of vital emergency, periods with lot of admissions and increased waiting time ...). Everything must be done to find an altemative to the pediatric emergency department passage by facilitating communication between caregivers and for example by offering semi urgent consultations possibility.

Digital Library Collaboration: A Service-Oriented Perspective

ERIC Educational Resources Information Center

Buchanan, Steven; Gibb, Forbes; Simmons, Susan; McMenemy, David

2012-01-01

Collaboration in the digital domain offers an opportunity to provide enhanced digital services and extended reach to the community. This article adopts a service-oriented perspective through which it considers environmental drivers for digital library collaboration; discusses emergent collaborative partnerships across UK educational institutions,…

China forges ahead in global research race

NASA Astrophysics Data System (ADS)

Chen, Binglin

2016-12-01

China is performing “outstanding” research in a number of emerging topics, putting the country's output on a par with the UK but still behind the US, according to a new study by the Chinese Academy of Sciences (CAS) and the scientific data company Clarivate Analytics.

Changing Schools of Thought: Back to the Future

ERIC Educational Resources Information Center

Davies, Tom

2004-01-01

The UK Education Act 2002 furthers a sense of institutional fragmentation and scope for local enterprise. An emerging "decentralised" agenda enables schools that demonstrably meet accountability criteria to opt out of National Curriculum requirements in order to pursue individual interests, supportive technologies and new partnership…

Spatio-temporal Assessment Of The Land Use Implications Of Solar PV And Bioenergy Deployment In The UK TM Energy Model

NASA Astrophysics Data System (ADS)

Sobral Mourao, Z.; Konadu, D. D.; Skelton, S.; Lupton, R.

2015-12-01

The UK TIMES model (UKTM) succeeds the UK MARKAL as the underlying model of the UK Department of Energy and Climate Change (DECC) for long term energy system planning and policy development. It generates energy system pathways which achieve the 80% greenhouse gas (GHG) emissions reduction target by 2050, stipulated in the UK Climate Change Act (2008), at the least possible cost. Some of these pathways prescribe large-scale deployment of solar PV and indigenously sourced bioenergy, which are land intensive and could result in significant land use transitions; but would this create competition and stress for UK land use? To answer the above question, this study uses an integrated spatio-temporal modelling approach, ForeseerTM, which characterises the interdependencies between the energy and land systems by evaluating the land required under each pathways for solar PV and bioenergy, based on scenarios of a range of PV conversion efficiencies, and energy crop yield projections. The outcome is compared with availability of suitable locations for solar PV and sustainable limits of agricultural land appropriation for bioenergy production to assess potential stresses and competition with other land use services. Preliminary results show UKTM pathways could pose significant impact on the UK land use system. Bioenergy deployment could potentially compete with other land services by taking up a significant part of the available UK agricultural land thus competing directly with food production, most notably livestock production. For pathways with significant solar PV deployment, direct competition would not be focussed on the high quality land used for food crop production but rather for land used for livestock production and other ecosystem services.

Workplace violence against nurses in Indonesian emergency departments.

PubMed

Noorana Zahra, Anggri; Feng, Jui-Ying

2018-02-01

The objective of this study was to examine the experiences of violent incidents by nurses in Indonesian emergency departments. The World Health Organization's structured questionnaire on workplace violence in the health sector was modified and translated into Bahasa. The study participants were 169 nurses working in emergency departments in six hospitals in Jakarta and Bekasi, Indonesia. The gathered data were analyzed using descriptive and multivariate logistic regression. Ten percent of emergency nurses reported experiencing physical violence, perpetrated mostly by patients, whereas more than half of emergency nurses (54.6%) reported experiencing non-physical violence, with patients' relative as the main perpetrators. A majority of nurses (55.6%) did not have encouragement to report workplace violence, and very few nurses (10.1%) had received any information or training about workplace violence. The findings of this study highlighted the seriousness of violence in Indonesian emergency departments. Support from management, encouragement to report violence, and access to workplace violence training were expected to mitigate and manage violence against nurses in emergency departments. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Primary care in the UK: understanding the dynamics of devolution.

PubMed

Exworthy, M

2001-09-01

The United Kingdom is ostensibly one country and yet public policy often varies between its constituent territories - England, Scotland, Wales and Northern Ireland. Health policy illustrates the dilemmas inherent in an apparently unitary system that permits scope for territorial variation. Administrative devolution has now been accompanied by political devolution but their interaction has yet to produce policy outcomes. This paper describes recent health policy reform with regard to primary care in terms of the tension inherent in current policy between notions of a 'one nation NHS' and the territorial diversity wrought by devolution. The paper provides a framework for understanding the emergent outcomes by exploring various concepts. In particular, the existing character of territorial policy networks, the properties of policies in devolved territories and intergovernmental relations are considered from various disciplines to examine whether greater diversity or uniformity will result from the dual reform process. Whilst this evaluation can, at this stage, only be preliminary, the paper provides a framework to appraise the emerging impact of devolution upon primary care in the UK.

44 CFR 334.6 - Department and agency responsibilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... responsibilities. 334.6 Section 334.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS GRADUATED MOBILIZATION RESPONSE § 334.6 Department and agency responsibilities. (a) During Stage 3, each Federal department and agency with mobilization responsibilities will...

Managing aggression in the emergency department: promoting an interdisciplinary approach.

PubMed

Rintoul, Yvonne; Wynaden, Dianne; McGowan, Sunita

2009-04-01

Incidents of aggression are frequent occurrences in hospitals, particularly the emergency department. Aggression creates instability in the environment, impacts on patient care outcomes and leads to increased levels of stress in staff. Regular exposure to aggression in the workplace can have detrimental effects on health professionals' ongoing quality of life. The emergency department is a gateway to care and is heavily populated 24h a day. Therefore, it is essential that all health professionals are confident and well prepared to manage aggression. Based upon a review of the literature this paper outlines the causes of aggression and provides an interdisciplinary action plan for intervening with aggressive patients in the emergency department. The importance of interdisciplinary ownership and the well planned management of aggression are outlined. When well managed, the impact of aggression can be limited. Stability in the emergency department ensures that health professionals can be responsive to the community's needs for emergency care. This leads to the provision of effective and timely care and a stable work environment for all health professionals.

Physical activity among adolescents and barriers to delivering physical education in Cornwall and Lancashire, UK: A qualitative study of heads of PE and heads of schools

PubMed Central

Boyle, Spencer Earl; Jones, Georgina L; Walters, Stephen J

2008-01-01

Background Recent initiatives have been introduced by the UK government into secondary schools to increase pupils' access to physical activity (PA). Despite this, not enough is known about pupils' levels of physical activity or whether the delivery of these initiatives in schools facilitates or creates a barrier for pupils' PA. The aim of this study was to gain an understanding of adolescents PA levels from the perspective of those responsible for delivering physical education (PE) in schools; heads of PE (HOPE) and heads of school (HS). Methods Seventeen semi-structured qualitative interviews were carried out with a snowball sample of HOPE and HS in schools in the Northwest and Southwest of England. Thematic data analysis using NVIVO was used to identify emergent themes. Results 17 core themes were generated, 12 of which confirmed the findings from similar research. However, five themes relating to 'ethos of performance/elitism', 'lower fitness leads to lower ability', 'undervaluing activities within PE dept' or school as a whole', 'role of the school' and 'PE department doing all it can' offer valuable new insight into the factors which may encourage or prevent PA inside or outside the curriculum. Conclusion Despite many positive perceptions of the delivery of PE in schools, it is evident that barriers still exist within that delivery which discourages physical activity. More research is needed to particularly address the complex issues of elitism and the ethos of PA in schools. PMID:18673562

Estimating the burden of heat illness in England during the 2013 summer heatwave using syndromic surveillance

PubMed Central

Smith, Sue; Elliot, Alex J; Hajat, Shakoor; Bone, Angie; Smith, Gillian E; Kovats, Sari

2016-01-01

Background The burden of heat illness on health systems is not well described in the UK. Although the UK generally experiences mild summers, the frequency and intensity of hot weather is likely to increase due to climate change, particularly in Southern England. We investigated the impact of the moderate heatwave in 2013 on primary care and emergency department (ED) visits using syndromic surveillance data in England. Methods General practitioner in hours (GPIH), GP out of hours (GPOOH) and ED syndromic surveillance systems were used to monitor the health impact of heat/sun stroke symptoms (heat illness). Data were stratified by age group and compared between heatwave and non-heatwave years. Incidence rate ratios were calculated for GPIH heat illness consultations. Results GP consultations and ED attendances for heat illness increased during the heatwave period; GPIH consultations increased across all age groups, but the highest rates were in school children and those aged ≥75 years, with the latter persisting beyond the end of the heatwave. Extrapolating to the English population, we estimated that the number of GPIH consultations for heat illness during the whole summer (May to September) 2013 was 1166 (95% CI 1064 to 1268). This was double the rate observed during non-heatwave years. Conclusions These findings support the monitoring of heat illness (symptoms of heat/sun stroke) as part of the Heatwave Plan for England, but also suggest that specifically monitoring heat illness in children, especially those of school age, would provide additional early warning of, and situation awareness during heatwaves. PMID:26873949

Emergency nurses perceptions of the role of family/carers in caring for cognitively impaired older persons in pain: a descriptive qualitative study.

PubMed

Fry, Margaret; Chenoweth, Lynn; MacGregor, Casimir; Arendts, Glenn

2015-08-01

On arrival to the emergency department many older persons are accompanied by family/carers. Yet the role of family/carers in the emergency department is unclear. We know very little about how emergency department nurses balance care practices to accommodate family/carers while specifically meeting the needs of cognitively impaired older persons experiencing pain. The aim of this paper was to understand emergency nurses' perceptions of the role of family/carers in caring for the older cognitively impaired person experiencing pain. Emergency nurses were invited to participate in focus group interviews. A semi-structured interview tool was developed from the literature and comprised open-ended questions and three Likert scale items which assisted to focus nurses' thoughts on their perceived role of family/carers in the emergency department. The study was undertaken across four emergency departments in Sydney, Australia and included two district hospitals and two tertiary referral hospitals. Emergency nurses were invited to participate in one face to face, focus group interview. Purposive sampling was used and inclusion criteria included at least one year emergency department experience. Interview data were analysed and organised thematically. Two expert qualitative researchers independently reviewed transcripts and emerging coding and interpretation. Eighty nurses participated in 16 focus group interviews across four hospitals. Participating nurses included 67 (84%) females and 13 (16%) males with 8.6 years (mean; SD ±8.64) experience in the emergency department. Three key themes relating to family/carers emerged from the analysis. The themes included (i) the role of families and carers in building a clinical picture; (ii) family and carers as a hidden workforce; and (iii) family and carer roles in pain management decision making. The study has provided insight into the role of family/carers as perceived by emergency nurses. There were many benefits in partnering with family/carers when information gathering on the older cognitively impaired person in pain. Family/carers are sensitive to health behaviour changes of older cognitively impaired people, which can assist nurses to optimise pain management. Copyright © 2015 Elsevier Ltd. All rights reserved.

U.S. Emergency Department Admissions for Nontraumatic Dental Conditions for Individuals with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Chi, Donald L.; Masterson, Erin E.; Wong, Jacqueline J.

2014-01-01

The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and…

Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology.

PubMed

Sutton, A J; Vohra, R S; Hollyman, M; Marriott, P J; Buja, A; Alderson, D; Pasquali, S; Griffiths, E A

2017-01-01

The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a 'delayed' operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost-utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0-120 000). Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Family needs of critically ill patients in the emergency department.

PubMed

Hsiao, Ping-Ru; Redley, Bernice; Hsiao, Ya-Chu; Lin, Chun-Chih; Han, Chin-Yen; Lin, Hung-Ru

2017-01-01

Family members' experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses. A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory. Family members ranked needs related to 'communication with family members,' as most important, followed by 'family member participation in emergency department care', 'family member support' and 'organizational comfort'; rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to 'communication with family members' and 'family members' participation in emergency department care'. Family members place greater importance than emergency nurses on the need for effective communication. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

PubMed

Carpenter, Christopher R; Platts-Mills, Timothy F

2013-02-01

Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care. Copyright © 2013 Elsevier Inc. All rights reserved.

Communication between nurses and physicians: strategies to surviving in the emergency department trenches.

PubMed

Abourbih, Daniel; Armstrong, Sherry; Nixon, Kirsty; Ackery, Alun D

2015-02-01

The emergency department (ED) is a challenging and stressful work environment where communication lapses can lead to negative health outcomes. This article offers strategies to Emergency Medicine residents, nurses and staff physicians on how to improve communication to optimize patient care. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Challenges to accessing pediatric health care in the Mississippi delta: a survey of emergency department patients seeking nonemergency care.

PubMed

Grant, Roy; Ramgoolam, Andres; Betz, Ryan; Ruttner, Laura; Green, John J

2010-10-01

Increases in hospital emergency department use have been driven by insured patients with problems accessing primary care services. Access problems are especially pronounced in rural communities with health professional shortages. This qualitative study explored reasons for nonurgent pediatric emergency department use in the Mississippi Delta. Using a community-based participatory research framework, a semistructured survey was administered face-to-face in a hospital emergency department waiting room with parents/caregivers who brought their children. Interviews were done over 144 hours in 2-hour blocks covering regular "business hours" and "after hours" (evenings/weekends). Open-ended items allowed qualitative data to be gathered describing reasons for emergency department use and perceptions of urgency of the visit in the parents'/caregivers' own words. There were 112 children, with a response rate of 87%. The mean child age was 5.7 years; 52% were male; 95% were African American and 5% white; 80.6% had Medicaid/SCHIP, 7.8% commercial, and 3.9% other insurance; 7.8% were uninsured. Most (88%) had a usual source of pediatric care. Only 24.3% tried to obtain care before emergency department visit; 23.2% said their children required "urgent" care. Mean distance from home to usual source of care was 10 miles. Ten percent cited transportation as a barrier to keeping health care appointments; 5.5% cited insurance or cost. Families who used the emergency department during evening/weekends were significantly more likely to have cited clinic hours of operation as a reason care was not sought previously than were "business hours" users, who emphasized convenience. Nonurgent pediatric emergency department use could be reduced by extending clinic hours, adding a walk-in service, and making transportation more available.

Forecasting Hospitalization and Emergency Department Visit Rates for Chronic Obstructive Pulmonary Disease. A Time-Series Analysis.

PubMed

Gershon, Andrea; Thiruchelvam, Deva; Moineddin, Rahim; Zhao, Xiu Yan; Hwee, Jeremiah; To, Teresa

2017-06-01

Knowing trends in and forecasting hospitalization and emergency department visit rates for chronic obstructive pulmonary disease (COPD) can enable health care providers, hospitals, and health care decision makers to plan for the future. We conducted a time-series analysis using health care administrative data from the Province of Ontario, Canada, to determine previous trends in acute care hospitalization and emergency department visit rates for COPD and then to forecast future rates. Individuals aged 35 years and older with physician-diagnosed COPD were identified using four universal government health administrative databases and a validated case definition. Monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were determined from 2003 to 2014 and then forecasted to 2024 using autoregressive integrated moving average models. Between 2003 and 2014, COPD prevalence increased from 8.9 to 11.1%. During that time, there were 274,951 hospitalizations and 290,482 emergency department visits for COPD. After accounting for seasonality, we found that monthly COPD hospitalization and emergency department visit rates per 1,000 individuals with COPD remained stable. COPD prevalence was forecasted to increase to 12.7% (95% confidence interval [CI], 11.4-14.1) by 2024, whereas monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were forecasted to remain stable at 2.7 (95% CI, 1.6-4.4) and 3.7 (95% CI, 2.3-5.6), respectively. Forecasted age- and sex-stratified rates were also stable. COPD hospital and emergency department visit rates per 1,000 people with COPD have been stable for more than a decade and are projected to remain stable in the near future. Given increasing COPD prevalence, this means notably more COPD health service use in the future.

2015 UK national guideline for the management of infection with Chlamydia trachomatis.

PubMed

Nwokolo, Nneka C; Dragovic, Bojana; Patel, Sheel; Tong, C Y William; Barker, Gary; Radcliffe, Keith

2016-03-01

This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of Chlamydia trachomatis genital infection. It covers the management of the initial presentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged 16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexually transmitted infections management within the UK. However, the principles of the recommendations should be adopted across all levels, using local care pathways where appropriate. © The Author(s) 2016.

Assessment of disaster preparedness among emergency departments in Italian hospitals: a cautious warning for disaster risk reduction and management capacity.

PubMed

Paganini, Matteo; Borrelli, Francesco; Cattani, Jonathan; Ragazzoni, Luca; Djalali, Ahmadreza; Carenzo, Luca; Della Corte, Francesco; Burkle, Frederick M Jr; Ingrassia, Pier Luigi

2016-08-15

Since the 1990s, Italian hospitals are required to comply with emergency disaster plans known as Emergency Plan for Massive Influx of Casualties. While various studies reveal that hospitals overall suffer from an insufficient preparedness level, the aim of this study was to better determine the preparedness level of Emergency Departments of Italian hospitals by assessing the knowledge-base of emergency physicians regarding basic disaster planning and procedures. A prospective observational study utilized a convenience sample of Italian Emergency Departments identified from the Italian Ministry of Health website. Anonymous telephone interviews were conducted of medical consultants in charge at the time in the respective Emergency Departments, and were structured in 3 parts: (1) general data and demographics, (2) the current disaster plan and (3) protocols and actions of the disaster plan. Eighty-five Emergency Departments met inclusion criteria, and 69 (81 %) agreed to undergo the interview. Only 45 % of participants declared to know what an Emergency Plan for Massive Influx of Casualties is, 41 % believed to know who has the authority to activate the plan, 38 % knew who is in charge of intra-hospital operations. In Part 3 physicians revealed a worrisome inconsistency in critical content knowledge of their answers. Results demonstrate a poor knowledge-base of basic hospital disaster planning concepts by Italian Emergency Department physicians-on-duty. These findings should alert authorities to enhance staff disaster preparedness education, training and follow-up to ensure that these plans are known to all who have responsibility for disaster risk reduction and management capacity.

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study

PubMed Central

Layani, Géraldine; Fleet, Richard; Dallaire, Renée; Tounkara, Fatoumata K.; Poitras, Julien; Archambault, Patrick; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2016-01-01

Background: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. Methods: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Results: Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Interpretation: Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments. PMID:27730103

75 FR 24705 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... health departments to monitor syndrome-based (e.g., case information collected in emergency departments... monitor syndromic data from emergency departments, 911 calls, physician office data, school and business...

The history of the early years of metamaterials in USA and UK defense agencies

NASA Astrophysics Data System (ADS)

Derov, John S.; Hammond, Richard; Youngs, Ian J.

2017-08-01

This article discusses the historical events that occurred in the early years of metamaterials leading to the current development of metamaterials in the Defense Advanced Research Projects Agency, Department of Defense, and Ministry of Defence.

Undergraduate teaching in UK general practice: a geographical snapshot.

PubMed

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-06-01

Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. National survey of all medical schools in the UK. All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK's health departments. All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum-maximum) of 142 (17-385) practices per school. The median (minimum-maximum) distance between a school and a teaching practice was 28 km (0-1421 km), 41 (0:00-23:26) minutes' travel by car and 1 hour 12 (0:00-17:29) minutes' travel by public transport. All teaching practices were accessible by public transport in one school and 90-99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. © British Journal of General Practice 2014.

Are UK undergraduate Forensic Science degrees fit for purpose?

PubMed

Welsh, Charles; Hannis, Marc

2011-09-01

In October 2009 Skills for Justice published the social research paper 'Fit for purpose?: Research into the provision of Forensic Science degree programmes in UK Higher Education Institutions.' The research engaged employers representing 95% of UK Forensic Science providers and 79% of UK universities offering Forensic Science or Crime Scene degree programmes. In addition to this, the research collected the views of 430 students studying these degrees. In 2008 there were approximately 9000 people working in the Forensic Science sector in the UK. The research found that the numbers of students studying Forensic Science or Crime Scene degrees in the UK have more than doubled since 2002-03, from 2191 in to 5664 in 2007-08. Over the same period there were twice as many females as males studying for these degrees. The research concluded that Forensic Science degree programmes offered by UK universities were of a good quality and they provided the student with a positive learning experience but the content was not relevant for Forensic Science employers. This echoed similar research by the former Government Department for Innovation, Universities and Skills on graduates from wider science, technology, engineering and mathematics degree programmes. The research also found that 75% of students studying Forensic Science or Crime Scene degrees expected to have a career in the Forensic Science sector, meaning that ensuring these courses are relevant for employers is a key challenge for universities. This paper reflects on the original research and discusses the implications in light of recent government policy. Copyright © 2011 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

Lesbian workers: personal strategies amid changing organisational responses to 'sexual minorities' in UK workplaces.

PubMed

Colgan, Fiona; Creegan, Chris; McKearney, Aidan; Wright, Tessa

2008-01-01

This article reports emerging findings from a qualitative research study about lesbian, gay and bisexual (LGB) people at work in the UK. The research focuses on the personal experiences and strategies of LGB people amidst changing organisational responses to sexuality within a new legal and political landscape following the introduction of the Employment Equality (Sexual Orientation) Regulations 2003. The article draws specifically on the perceptions of lesbian respondents about a range of issues concerning social inclusion and exclusion in the workplace including coming out at work, treatment by managers and colleagues, workplace and organisational culture and participation in LGBT groups and networks.

ConKit: a python interface to contact predictions.

PubMed

Simkovic, Felix; Thomas, Jens M H; Rigden, Daniel J

2017-07-15

Recent advances in protein residue contact prediction algorithms have led to the emergence of many new methods and a variety of file formats. We present ConKit , an open source, modular and extensible Python interface which allows facile conversion between formats and provides an interface to analyses of sequence alignments and sets of contact predictions. ConKit is available via the Python Package Index. The documentation can be found at http://www.conkit.org . ConKit is licensed under the BSD 3-Clause. hlfsimko@liverpool.ac.uk or drigden@liverpool.ac.uk. Supplementary data are available at Bioinformatics online. © The Author(s) 2017. Published by Oxford University Press.

Contracts and supply assurance in the UK health care market.

PubMed

Fenn, P; Rickman, N; McGuire, A

1994-07-01

We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of hospital care. The comparative static analysis implies that the transaction cost of using non-local hospitals, the expected patient demand, the extent of excess capacity in local hospitals, and the proportion of that excess capacity expected to be lost to competitive purchasers, are all important determinants of the choice of contract.

Mediating the World: Development, Education and Global Citizenship

ERIC Educational Resources Information Center

Smith, Matt

2004-01-01

Academic debate around transnational concepts such as globalization and development has not been matched by interrogation of their public roles in the "North". Despite this, a range of governmental policies are emerging in the UK focused on engendering global citizenship and educating about "global" and "development"…

Developing Movement as Inclusive Pedagogy

ERIC Educational Resources Information Center

Peter, Melanie; Walter, Ofra

2010-01-01

This article details the emergence of a training framework to support professional development in inclusive Movement teaching. This arose from a collaborative research project in spring 2008 (supported by the Training and Development Agency, UK), between two universities in England and Israel. Movement education is surprisingly underused globally,…

Aquatic Sentinels Forecasting Human Exposure To Emerging Contaminants

EPA Science Inventory

Most of us have heard the axiom, “canary in the coal mine”. These melodious exposure indicators - a necessity in U.K. mines well into the 20th century - were especially sensitive to methane and carbon monoxide gases, and would cease singing (and oftentimes die) at le...

Learning Global Citizenship?: Exploring Connections between the Local and the Global

ERIC Educational Resources Information Center

Mayo, Marjorie; Gaventa, John; Rooke, Alison

2009-01-01

This article identifies historical connections between adult learning, popular education and the emergence of the public sphere in Europe, exploring potential implications for adult learning and community development, drawing upon research evaluating programmes to promote community-based learning "for" active citizenship in UK. The…

Emerging Communities at BBC Learning English

ERIC Educational Resources Information Center

Chapman, Catherine; Scott, Paul

2008-01-01

This paper traces the development of the BBC Learning English [http://www.bbc.co.uk/worldservice/learningenglish/] online community, focusing on tools such as e-mail discussion lists, message boards, comments boards, student/teacher blogs, competitions, and voting. It describes how relationships between the intermediate level users of all…

78 FR 69861 - Privacy Act of 1974; Department of Homeland Security, Federal Emergency Management Agency...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-21

... DEPARTMENT OF HOMELAND SECURITY Office of the Secretary [DHS-2013-0073] Privacy Act of 1974; Department of Homeland Security, Federal Emergency Management Agency, Federal Government--001 National Defense Executive Reserve System of Records AGENCY: Department of Homeland Security, Privacy Office...

38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health...

38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health...

38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health...

38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health...

38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Department of Defense, Public Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health...

38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency services may be made only if all of the following conditions are met: (a) The emergency services were provided in a hospital emergency department or...

Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study

PubMed Central

2016-01-01

Objectives First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. Data Source Primary data collection over an eight week period within a level-1 trauma urban hospital’s emergency department. Study Design Representative randomized sample of 1,443 adult patients triaged ESI levels 4–5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. Principal Findings 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. Conclusions Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization. PMID:26784515

The Experiences of Registered Nurses Who are Injured by Interpersonal Violence While on Duty in an Emergency Department.

PubMed

Wright-Brown, Salena; Sekula, Kathleen; Gillespie, Gordon; Zoucha, Rick

A successful career as an emergency department registered nurse (RN) requires the ability to respond quickly to a wide variety of potentially life-threatening illnesses and injuries. The unpredictable nature of this work can evoke emotional and physical stress on the RN beyond that which might be experienced by nurses who work in more stable, controlled, and predictable environments. Emergency healthcare is predicated on unexpected illness or injury leading to unscheduled episodic work. Additional stress is placed on the RN by the potential for violence that occurs in emergency departments. This mixed method pilot study describes the experiences of RNs who have been injured by violence while working in an emergency department. The study included an assessment of the job satisfaction of RNs in the emergency department based on Porter's Need Satisfaction Scale. This scale addresses need fulfillment in five categories: security, social, esteem, autonomy, and self-actualization. The self-actualization subscale measures satisfaction with personal growth, worthwhile accomplishments, and self-fulfillment. During the second strand of the study, phenomenological informed interviews were held with RNs who had been injured while on duty in an emergency department. The findings indicate that the largest reported gaps between the current state and the desired state were found in the area of security and self-actualization. RNs in the emergency department who answered the survey indicated that they desired a safe, secure worksite where they could achieve personal growth, worthwhile accomplishments, and self-fulfillment; but they were not satisfied with their current status in these areas.

Visual function and fitness to drive.

PubMed

Kotecha, Aachal; Spratt, Alexander; Viswanathan, Ananth

2008-01-01

Driving is recognized to be a visually intensive task and accordingly there is a legal minimum standard of vision required for all motorists. The purpose of this paper is to review the current United Kingdom (UK) visual requirements for driving and discuss the evidence base behind these legal rules. The role of newer, alternative tests of visual function that may be better indicators of driving safety will also be considered. Finally, the implications of ageing on driving ability are discussed. A search of Medline and PubMed databases was performed using the following keywords: driving, vision, visual function, fitness to drive and ageing. In addition, papers from the Department of Transport website and UK Royal College of Ophthalmologists guidelines were studied. Current UK visual standards for driving are based upon historical concepts, but recent advances in technology have brought about more sophisticated methods for assessing the status of the binocular visual field and examining visual attention. These tests appear to be better predictors of driving performance. Further work is required to establish whether these newer tests should be incorporated in the current UK visual standards when examining an individual's fitness to drive.

Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis.

PubMed

Jelinek, George; Mackinlay, Claire; Weiland, Tracey; Hill, Nicole; Gerdtz, Marie

2011-06-01

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.

A major sporting event does not necessarily mean an increased workload for accident and emergency departments. Euro96 Group of Accident and Emergency Departments

PubMed Central

Cooke, M. W.; Allan, T. F.; Wilson, S.

1999-01-01

AIM: To determine whether there were any changes in attendance at accident and emergency departments that could be related to international football matches (Euro96 tournament). METHOD: Fourteen accident and emergency departments (seven adjacent to and seven distant from a Euro96 venue) provided their daily attendance figures for a nine week period: three weeks before, during, and after the tournament. The relation between daily attendance rates and Euro96 football matches was assessed using a generalised linear model and analysis of variance. The model took into account underlying trends in attendance rates including day of the week. RESULTS: The 14 hospitals contributed 172 366 attendances (mean number of daily attendances 195). No association was shown between the number of attendances at accident and emergency departments and the day of the football match, whether the departments were near to or distant from stadia or the occurrence of a home nation match. The only observed independent predictors of variation were day of the week and week of the year. Attendance rates were significantly higher on Sunday and/or Monday; Monday was about 9% busier than the daily average. Increasing attendance was observed over time for 86% of the hospitals. CONCLUSION: Large sports tournaments do not increase the number of patients attending accident and emergency departments. Special measures are not required for major sporting events over and above the capacity of an accident and emergency department to increase its throughput on other days. 


 PMID:10522636

A Prospective, Randomized Trial of Intravenous Prochlorperazine Versus Subcutaneous Sumatriptan in Acute Migraine Therapy in the Emergency Department(Preprint)

DTIC Science & Technology

2009-01-01

Acute Migraine Therapy in the Emergency Department Mark A. Kostic, MD Francisco J. Gutierrez, MD Thomas S. Rieg, PhD Tammy S. Moore, MD Richard T...1995;25:154-155. 17. Goldstein J, Camargo CA Jr, Pelletier J, et al. Headache in United States emergency departments: demography, work up and

[Ultrasound in the emergency department as an extension of the practitioner's clinical examination].

PubMed

Schmit, Aline; Pécoul, David; Lebret, Yannick; Dussoix, Philippe

2018-01-31

Ultrasound in the emergency department and general practice can be used as an extension of the physical examination, answering simple questions. It requires a short basic training that is easily accessible. This article illustrates with a few examples (kidney, lung and fractures) the interest of this formidable tool becoming unavoidable in the emergency department and general practice.

A Rural-Urban Comparison in Emergency Department Visits for U.S. Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Zhang, Wanqing; Mason, Ashley E.; Boyd, Brian; Sikich, Linmarie; Baranek, Grace

2017-01-01

We examined rural-urban differences in emergency department visits, and child and clinical characteristics associated with visits for U.S. children aged 3-17 years with autism spectrum disorder (ASD). Rural children with ASD were twice more likely to have emergency department visits in urban hospitals than rural children without ASD. The children…

Brief Report: Factors Associated with Emergency Department Visits for Epilepsy among Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Zhang, Wanqing; Baranek, Grace; Boyd, Brian

2018-01-01

We examined how demographic and clinical characteristics differ between emergency department (ED) visits for epilepsy (EP cohort) and ED visits for other reasons (non-EP cohort) in children with ASD. The data were drawn from the 2009 and 2010 Nationwide Emergency Department Sample. We performed both univariate and multivariate analyses to compare…

Evidence-based management of neonatal vomiting in the emergency department.

PubMed

Ratnayake, Kristin; Kim, Tommy Y

2014-11-01

Vomiting accounts for up to 36% of neonatal visits to the emergency department. The causes of vomiting can range from benign to life-threatening. Evidence to guide the diagnosis and management of neonatal vomiting in the emergency department is limited. History and physical examination are extremely important in these cases, especially in identifying red flags such as bilious or projectile emesis. A thorough review is presented, discussing various imaging modalities, including plain abdominal radiography, upper gastrointestinal studies, ultrasonography, and contrast enema. A systematic approach in the emergency department, as outlined in this review, is required to identify the serious causes of vomiting in the neonate.

Survey of illegal immigrants seen in an emergency department.

PubMed Central

Chan, T C; Krishel, S J; Bramwell, K J; Clark, R F

1996-01-01

There is growing controversy regarding illegal immigrants and their use of social services, including health care, in this country. We surveyed undocumented persons presenting at our emergency department to investigate the reasons why they sought care in the United States. Overall, 227 visits (8.6%) were made in the emergency department by illegal immigrants, mostly Hispanics. Of 104 patients surveyed, all sought care in this country because they were here at the time, and 86 (83%) intended to remain permanently. Of the 104 persons, 83 (80%) cited lack of funding as a reason for seeking emergency department care. Undocumented Hispanics had a higher uninsured rate (64%) than both Hispanics (32%) and non-Hispanics (30%). Of the 104 patients, 38 (36%) had difficulty obtaining care elsewhere because of their status, 53 (51%) knew of no other sources of care, and 46 (44%) said that even if available, only the emergency department was acceptable. Many undocumented persons seek care in the United States because they reside here permanently, often using this emergency department as their source of care. These findings may be important in light of recent efforts to restrict services for this group. PMID:8775931

Forensic patients in the emergency department: Who are they and how should we care for them?

PubMed

Filmalter, Celia J; Heyns, T; Ferreira, R

2017-10-16

Patients who suffer violent, crime related injuries are likely to seek medical assistance in emergency departments. Forensic patients may not disclose the cause of their injuries leading to the impairment of evidence. We explored healthcare providers' perceptions of forensic patients and how they should be cared for. The perceptions of physicians and nurses regarding the profiles and care of forensic patients were explored in three urban emergency departments. The data were collected through a talking wall and analysed collaboratively, with the participants, using content analysis. Healthcare providers in emergency departments differentiated between living and deceased forensic patients. Healthcare providers identified living forensic patients as victims of sexual assault, assault, gunshots and stab wounds, and abused children. Deceased patients included patients that were dead on arrival or died in the emergency departments. Healthcare providers acknowledged that evidence should be collected, preserved and documented. Every trauma patient in the emergency department should be treated asa forensic patient until otherwise proven. If healthcare providers are unable to identify forensic patients and collect the evidence present, the patients' human right to justice will be violated. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prevention for College Students Who Suffer Alcohol-Induced Blackouts Could Deter High-Cost Emergency Department Visits

PubMed Central

Mundt, Marlon P.; Zakletskaia, Larissa I.

2012-01-01

Fifty percent of college students who drink report alcohol-induced blackouts, and alcohol abusers in general put a heavy burden on the medical care system. Using data drawn from a randomized, controlled alcohol intervention trial at five university sites, our study quantified the costs of visits to emergency departments by college students who experienced blackouts from drinking alcohol. Of 954 students in the study, 52 percent of males and 50 percent of females at the outset of the study had experienced an alcohol-induced blackout in the past year. Of 404 emergency department visits among the study participants over a two-year observation period, about one in eight were associated with blackout drinking. Injuries ranged from broken bones to head and brain injuries requiring computed tomography. We calculate that on a large university campus having more than 40,000 students, blackout-associated emergency department visit costs would range from $469,000 to $546,000 per year. We conclude that blackouts are a strong predictor of emergency department visits for college drinkers and that prevention efforts aimed at students with a history of blackouts might reduce injuries and emergency department costs. PMID:22422503

Confined space emergency response: assessing employer and fire department practices.

PubMed

Wilson, Michael P; Madison, Heather N; Healy, Stephen B

2012-01-01

An emergency response plan for industrial permit-required confined space entry is essential for employee safety and is legally required. Maintaining a trained confined space rescue team, however, is costly and technically challenging. Some employers turn to public fire departments to meet their emergency response requirements. The confined space emergency response practices of employers and fire departments have not been previously assessed. We present (1) federal data on the U.S. occurrence between 1992 and 2005 of confined space fatal incidents involving toxic and/or oxygen-deficient atmospheres; (2) survey data from 21 large companies on permit-required confined space emergency response practices; (3) data on fire department arrival times; and (4) estimates by 10 senior fire officers of fire department rescue times for confined space incidents. Between 1992 and 2005, 431 confined space incidents that met the case definition claimed 530 lives, or about 0.63% of the 84,446 all-cause U.S. occupational fatal injuries that occurred during this period. Eighty-seven (20%) incidents resulted in multiple fatalities. Twelve (57%) of 21 surveyed companies reported that they relied on the fire department for permit-required confined space emergency response. Median fire department arrival times were about 5 min for engines and 7 min for technical rescue units. Fire department confined space rescue time estimates ranged from 48 to 123 min and increased to 70 and 173 min when hazardous materials were present. The study illustrates that (1) confined space incidents represent a small but continuing source of fatal occupational injuries in the United States; (2) a sizeable portion of employers may be relying on public fire departments for permit-required confined space emergency response; and (3) in the event of a life-threatening emergency, fire departments usually are not able to effect a confined space rescue in a timely manner. We propose that the appropriate role for the fire department is to support a properly trained and equipped on-site rescue team and to provide advanced life support intervention following extrication and during ambulance transportation.

Sick notes, general practitioners, emergency departments and fracture clinics

PubMed Central

Walker, C A; Gregori, A; O'Connor, P; Jaques, K; Joseph, R

2007-01-01

Background General practitioner waiting times are increasing. The two national surveys regarding general practice showed that the number of patients waiting for ⩾2 days for an appointment rose from 63% to 72% between 1998 and 2002, with 25% waiting for ⩾4 days. The Department of Health recognised that many patients discharged from hospitals and outpatient clinics required to visit their general practitioner for the sole purpose of obtaining a sick note. The report entitled Making a difference: reducing general practitioner paperwork estimated that 518 000 appointments (and 42 000 GP h) could be saved by ensuring that these patients were issued with a sick note directly from hospital rather than being referred to their general practitioner. This practice was to be adopted from July 2001 and included patients discharged from wards as well as those seen in outpatient departments. Method 50 emergency departments and fracture clinics in Scotland and England were contacted to assess whether these guidelines had been adopted. Only hospitals with both accident and emergency and fracture clinics were included; nurse‐led and paediatric departments were excluded. Results Of the 25 Scottish emergency hospitals contacted, 4 (16%) accident and emergency departments and 8 (32%) fracture clinics issued sick notes. This was compared with 5 of 25 (20%) accident and emergency departments and 12 of 25 (48%) fracture clinics in England. Four Scottish and five English accident and emergency departments stated that it was policy to give sick notes, three Scottish and four English departments said that it was policy not to give them and the rest (72% in Scotland and 64% in England) stated that they had no clear policy but “just don't give them”. Conclusion The 2001 guidance from the joint Cabinet Office/Department of Health has not been fully incorporated into standard practice in Scotland and England. If all emergency departments and fracture clinics were to issue sick notes to patients requiring >7 days absence from work, this could reduce general practitioner consultations and improve waiting times. PMID:17183039

Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

PubMed

Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

2015-04-01

To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing patient survey data would be timely, and could improve rigour and comparability across the NHS. Performance comparisons need to be perceived as fair and scientifically robust to maintain confidence in publicly reported data, and to support their use by both the public and the NHS. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Interview with Professor Mark Wilcox.

PubMed

Wilcox, Mark

2016-08-01

Mark Wilcox speaks to Georgia Patey, Commissioning Editor: Professor Mark Wilcox is a Consultant Microbiologist and Head of Microbiology at the Leeds Teaching Hospitals (Leeds, UK), the Professor of Medical Microbiology at the University of Leeds (Leeds, UK), and is the Lead on Clostridium difficile and the Head of the UK C. difficile Reference Laboratory for Public Health England (PHE). He was the Director of Infection Prevention (4 years), Infection Control Doctor (8 years) and Clinical Director of Pathology (6 years) at the Leeds Teaching Hospitals. He is Chair of PHE's Rapid Review Panel (reviews utility of infection prevention and control products for National Health Service), Deputy Chair of the UK Department of Health's Antimicrobial Resistance and Healthcare Associated Infection Committee and a member of PHE's HCAI/AR Programme Board. He is a member of UK/European/US working groups on C. difficile infection. He has provided clinical advice as part of the FDA/EMA submissions for the approval of multiple novel antimicrobial agents. He heads a healthcare-associated infection research team at University of Leeds, comprising approximately 30 doctors, scientists and nurses; projects include multiple aspects of C. difficile infection, diagnostics, antimicrobial resistance and the clinical development of new antimicrobial agents. He has authored more than 400 publications, and is the coeditor of Antimicrobial Chemotherapy (5th/6th/7th Editions, 15 December 2007).

By land, sea and air (and space): Verifying UK methane emissions at a range of scales by integrating multiple measurement platforms

NASA Astrophysics Data System (ADS)

Rigby, M. L.; Lunt, M. F.; Ganesan, A.

2015-12-01

The Greenhouse gAs Uk and Global Emissions (GAUGE) programme and Department of Energy and Climate Change (DECC) network aim to quantify the magnitude and uncertainty of UK greenhouse gas (GHG) emissions at a resolution and accuracy higher than has previously been possible. The on going DECC tall tower network consists of three sites, and an eastern background site in Ireland. The GAUGE project includes instruments at two additional tall tower sites, a high-density measurement network over agricultural land in eastern England, a ferry that performs near-daily transects along the east coast of the UK, and a research aircraft that has been deployed on a campaign basis. Together with data collected by the GOSAT satellite, these data represent the GAUGE/DECC GHG measurement network that is being used to quantify UK GHG fluxes. As part of the wider GAUGE modelling efforts, we have derived methane flux estimates for the UK and northwest Europe using the UK Met Office NAME atmospheric transport model and a novel hierarchical Bayesian "trans-dimensional" inversion framework. We will show that our estimated fluxes for the UK as a whole are largely consistent between individual measurement platforms, albeit with very different uncertainties. Our novel inversion approach uses the data to objectively determine the extent to which we can further refine our national estimates to the level of large urban areas, major hotspots or larger sub-national regions. In this talk, we will outline some initial findings of the GAUGE project, tackling questions such as: At what spatial scale can we effectively derive greenhouse gas fluxes with a dense, multi-platform national network? Can we resolve individual metropolitan areas or major hotspots? What is relative impact of individual stations, platforms and network configurations on flux estimates for a country of the size of the UK? How can we effectively use multi-platform observations to cross-validate flux estimates and determine likely errors in model transport?

Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

PubMed

Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

2017-04-28

Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health agencies and emergency department clinicians at the local level. Our framework which is grounded in qualitative evidence focuses on strategies to promote effective communication in the emerging public health incident setting and may be useful in informing practice.

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...

44 CFR 206.34 - Request for utilization of Department of Defense (DOD) resources.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Department of Defense (DOD) resources. 206.34 Section 206.34 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE The Declaration Process § 206.34 Request for utilization of Department of Defense (DOD) resources. (a...