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Emergency Medicine Australasia
(February 2005)
17
293ndash294
Blackwell Science LtdOxford UKEMMEmergency Medicine Australasia1035-68512005 Blackwell Publishing Asia Pty LtdFebruary 2005173293294Miscellaneous
Peer ReviewPeer Review
P
EER
R
EVIEW
Peer Review June 2005
Taylor D McD
Bennett DM
Cameron PA
A para-digm shift in the nature of care provision in emergencydepartments
Emerg Med J
2004
21
681ndash4This cross-sectional survey of ED directors and nurse
unit managers in Melbourne aimed to determine theextent of changes in care provision of EDs as a conse-quence of access block and government initiatives Themajor new services have been care coordination teamsshort-stay units and psychiatry services though thestructure and function of these services vary consider-ably Other initiatives such as nurse-initiated manage-ment and fast-tracking have also been increasinglyemployed The authors conclude that there has been aparadigm shift in the care provided by EDs with greateremphasis on outpatient management which has neces-sitated a restructuring of how EDs operate
Brooks S Cicuttini FM Lim S
Taylor D
StuckeySL Wluka AE Cost effectiveness of adding magneticresonance imaging to the usual management of sus-pected scaphoid fractures
Br J Sports Med
2005
39
75ndash9
This study looks at the cost-effectiveness of an MRIscan within 5 days of suspected scaphoid fracture com-pared with usual therapy The MRI group had fracturediagnosed significantly earlier and significantly lesstime in plaster if no fracture was present There was nodifference between the two groups in terms of days offwork or disruption of daily activities There was a non-significant increase in cost for the MRI group Thestudy only enrolled 28 patients and one of these waslost to follow-up This paper raises one other interestingquestion It is taught that lsquothe fate of the scaphoid issealed at the time of the fracturersquo and yet we worryabout avascular necrosis of occult injuries My searchof the Cochrane database can find only one trial on themanagement of clinically suspected scaphoid fractures
1
In a prospective trial of 108 patients with clinicallysuspected scaphoid fracture and normal radiographspatients were randomized to either plaster cast or crepebandage Seven fractures (noncomplete) were later con-firmed The authors assert that these fractures nearlyalways heal and in this study the crepe bandage grouphad 10 less days of sick leave Is anyone brave enoughto do a bigger trial
Mackay MJ
A time to die
Med J Aust
2004
181
667ndash8
This is a personal reflection on societal and medicalattitudes to cardio-pulmonary resuscitation (CPR) Thearticle also highlights the danger of media storms andhow sound bites or headlines can gloss over the fullstory The author particularly discusses the role of CPRin sick elderly inpatients and the (often) lack of discus-sion about the subject between the medical team andthe patient Topical given the recent NSW Healthguidelines on end of life decisions httpwwwhealthnswgovaupubs2005endlifecarehtml
Taylor D McD
Bennett D Carter M Garewal D FinchCF Acute injury and chronic disability resulting fromsurfboard riding
J Sci Med Sport
2004
7
429ndash37This study sought to determine the incidence nature
and outcomes of acute surfing injuries and also theincidence of chronic health problems related to surfingInformation was gathered by interviewer-administeredquestionnaires at eight Victorian beaches The acuteinjury rate was 026 injuries per surfer per year mostlyfrom striking things (other boards other surfers and thesea-bed) or from lsquowiping outrsquo Lacerations sprains frac-tures and dislocations accounted for most injuriesChronic problems mainly related to ear problems andmusculoskeletal pain
Taylor D McD OrsquoBrien D Ritchie P Pasco J
Cameron PA
Propofol versus Midazolamfentanyl forreduction of anterior shoulder dislocation
Acad EmergMed
2005
12
13ndash19This prospective randomized trial found that propo-
fol was at least as effective as midazolamfentanyl inproviding sedation for reduction of anterior shoulderdislocations The propofol group had a shorter meantime to wakening full consciousness had easier shoul-der reduction and needed fewer reduction attempts buthad more respiratory depression Our departmentrsquosexperience with propofol over a number of years is thatit is far better than midazolam and fentanyl in thissetting but one must take the approach that it is ageneral anaesthetic albeit a short one and should betreated as such
Fatovich DMRogers IR Jelinek GA Jacobs I
Levi CR Tissue plasminogen activator (tPA) in acute
Peer Review
et al
294
ischaemic stroke time for collegiate communication andconsensus
Med J Aust
2005
182
44ndash5These letters in the
MJA
present some spirited debateon the use of thrombolytics in stroke and consider therisk versus harm benefits of this therapy The lettersalso highlight the need for collegiate collaboration ininitiatives that are cross-disciplinary
Kelly A-M
Kerr D Dietze P Patrick I Walker TKoutsogiannis Z Randomised trial of intranasal versusintramuscular naloxone in prehospital treatment ofsuspected opioid overdose
Med J Aust
2005
182
24ndash7
This prospective randomized unblended trial com-pared 2 mg of naloxone intramuscularly (im) versus2 mg intranasally (in) for respiratory depression in sus-pected opiate overdose in the prehospital setting Theadvantage of intranasal use is that no needles arerequired reducing the risk of needle-stick injury andthat it would be easier for lay people (eg family mem-bers) to administer The im group had a more rapidresponse The in route while not as effective was stillsufficient at reversing the respiratory depression of opi-ate toxicity in 74 of cases Given that 67 were inthe company of a friend or family member before para-medics arrived it does raise the possibility of widercommunity availability of naloxone
Holland J
Cooksley DG
Safety of helicopter aeromed-ical transport in Australia a retrospective study
MedJ Aust
2005
182
17ndash19This study sought to look at the risk of helicopter
emergency medical services (HEMS) over an 11-yearperiod There were only three accidents or one accidentevery 16 721 missions with one patient death (but fivetotal fatalities) ndash after the study period another threecrew members died in a separate accident The one riskthis paper doesnrsquot examine and one that I believe is agreater risk is inappropriate tasking of HEMS whichdelays definitive care This though would be a difficultsubject to study
Garner A
Keetelaar DM Konermann J Safety of emer-gency medical service helicopters
Med J Aust
2005
182
12ndash13This editorial accompanies the article by Holland and
Cooksley and discusses the complexities of aircraftsafety Unlike other countries Australian helicopteremergency medical services are usually multitaskedoperations undertaking search and rescue work as wellas retrieval and scene work It is argued that safety
margins are lower crew training and experience lessand funding insufficient
Ting JYS Humphrey KJ
After hours medical wardduties in a teaching hospital
Aust Health Rev
2005
29
37ndash42
This study looked at the reasons for 10 523 nurse-initiated requests for out-of-hours medical review ofinpatients over a 2-year period Of these calls 275 werefor cannula resites or venesection 245 were for med-icationfluid charts and 7 were for review of pathol-ogy In total two-thirds of the calls were consideredinappropriate or non-essential Increased training of non-medical staff in phlebotomy and cannulation and poli-cies to ensure day staff completed routine ward workwould greatly reduce unnecessary out-of-hours calls
Papadopulos-Eleopulos E
Turner VF
PapadimitriouJ
et al
A critique of the Montagnier evidence for theHIVAIDS hypothesis
Med hypotheses
2004
63
597ndash601
What diverse interests emergency physicians haveThis paper questions the widely held belief that a ret-rovirus HIV is the cause of AIDS The authors arguethat the HIV hypothesis does not explain the clinicalobservations that manifest as AIDS Furthermore theyargue that the HIV theory predicted heterosexual trans-mission vaccine development and the development ofan animal model none of which they argue hasoccurred They also question the three strands of evi-dence originally used to prove the existence of the newvirus known as HIV Despite at times getting a bitbaffling with the lsquolanguage of virologyrsquo the article ismostly quite readable and interesting
Reference
1 Sjolin SU Andersen JC Clinical fracture of the carpal scaphoidndash supportive bandage or plaster cast immobilization
J HandSurg [Br]
1988
1
75ndash6
Associate Professor Steven Doherty MB BS FACEM
Emmergency Physician
Tamworth Base Hospital
Associate Professor
University Department of Rural Health
Tamworth
Research Fellow
National Institute of Clinical Studies
Tamworth New South Wales Australia
Peer Review
et al
294
ischaemic stroke time for collegiate communication andconsensus
Med J Aust
2005
182
44ndash5These letters in the
MJA
present some spirited debateon the use of thrombolytics in stroke and consider therisk versus harm benefits of this therapy The lettersalso highlight the need for collegiate collaboration ininitiatives that are cross-disciplinary
Kelly A-M
Kerr D Dietze P Patrick I Walker TKoutsogiannis Z Randomised trial of intranasal versusintramuscular naloxone in prehospital treatment ofsuspected opioid overdose
Med J Aust
2005
182
24ndash7
This prospective randomized unblended trial com-pared 2 mg of naloxone intramuscularly (im) versus2 mg intranasally (in) for respiratory depression in sus-pected opiate overdose in the prehospital setting Theadvantage of intranasal use is that no needles arerequired reducing the risk of needle-stick injury andthat it would be easier for lay people (eg family mem-bers) to administer The im group had a more rapidresponse The in route while not as effective was stillsufficient at reversing the respiratory depression of opi-ate toxicity in 74 of cases Given that 67 were inthe company of a friend or family member before para-medics arrived it does raise the possibility of widercommunity availability of naloxone
Holland J
Cooksley DG
Safety of helicopter aeromed-ical transport in Australia a retrospective study
MedJ Aust
2005
182
17ndash19This study sought to look at the risk of helicopter
emergency medical services (HEMS) over an 11-yearperiod There were only three accidents or one accidentevery 16 721 missions with one patient death (but fivetotal fatalities) ndash after the study period another threecrew members died in a separate accident The one riskthis paper doesnrsquot examine and one that I believe is agreater risk is inappropriate tasking of HEMS whichdelays definitive care This though would be a difficultsubject to study
Garner A
Keetelaar DM Konermann J Safety of emer-gency medical service helicopters
Med J Aust
2005
182
12ndash13This editorial accompanies the article by Holland and
Cooksley and discusses the complexities of aircraftsafety Unlike other countries Australian helicopteremergency medical services are usually multitaskedoperations undertaking search and rescue work as wellas retrieval and scene work It is argued that safety
margins are lower crew training and experience lessand funding insufficient
Ting JYS Humphrey KJ
After hours medical wardduties in a teaching hospital
Aust Health Rev
2005
29
37ndash42
This study looked at the reasons for 10 523 nurse-initiated requests for out-of-hours medical review ofinpatients over a 2-year period Of these calls 275 werefor cannula resites or venesection 245 were for med-icationfluid charts and 7 were for review of pathol-ogy In total two-thirds of the calls were consideredinappropriate or non-essential Increased training of non-medical staff in phlebotomy and cannulation and poli-cies to ensure day staff completed routine ward workwould greatly reduce unnecessary out-of-hours calls
Papadopulos-Eleopulos E
Turner VF
PapadimitriouJ
et al
A critique of the Montagnier evidence for theHIVAIDS hypothesis
Med hypotheses
2004
63
597ndash601
What diverse interests emergency physicians haveThis paper questions the widely held belief that a ret-rovirus HIV is the cause of AIDS The authors arguethat the HIV hypothesis does not explain the clinicalobservations that manifest as AIDS Furthermore theyargue that the HIV theory predicted heterosexual trans-mission vaccine development and the development ofan animal model none of which they argue hasoccurred They also question the three strands of evi-dence originally used to prove the existence of the newvirus known as HIV Despite at times getting a bitbaffling with the lsquolanguage of virologyrsquo the article ismostly quite readable and interesting
Reference
1 Sjolin SU Andersen JC Clinical fracture of the carpal scaphoidndash supportive bandage or plaster cast immobilization
J HandSurg [Br]
1988
1
75ndash6
Associate Professor Steven Doherty MB BS FACEM
Emmergency Physician
Tamworth Base Hospital
Associate Professor
University Department of Rural Health
Tamworth
Research Fellow
National Institute of Clinical Studies
Tamworth New South Wales Australia