Emergency department (ED or A&E)
Permanent URI for this collection
Research outputs from the Emergency Department at the RD&E.
Browse
Recent Submissions
Item Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial(BMJ, 2023-06-01) Appelboam, A.; Osborne, R.; Ukoumunne, O.; Black, S.; Boot, S.; Richards, N.; Scotney, N.; Rhodes, S.; Cranston, T.; Hawker, R.; Gillett, A.; Jones, B.; Hawton, A.; Dayer, M.; Creanor, S.INTRODUCTION: Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital. METHODS AND ANALYSIS: This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months. ETHICS AND DISSEMINATION: The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity. TRIAL REGISTRATION NUMBER: ISRCTN16145266.Item EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION(Thieme Gruppe, 2022-10-13) Jarman, R. D.; McDermott, C.; Colclough, A.; Bøtker, M.; Knudsen, L.; Harris, T.; Albaroudi, B.; Albaroudi, O.; Haddad, M.; Darke, R.; Berry, E.; Breslin, T.; Fitzpatrick, G.; Flanagan, L.; Olusanya, O.; Craver, D.; Omar, A.; Simpson, T.; Cherian, N.; Dore, M.; Prosen, G.; Kay, S.; Villén-Villegas, T.; Gargani, L.; Carley, S.; Woo, M.; Dupriez, F.; Hussain, A.; Via, G.; Connolly, J. A.; Peck, M.; Melniker, L.; Walden, A.; Attard Biancardi, M. A.; Żmijewska-Kaczor, O.; Lalande, E.; Geukens, P.; McLaughlin, R.; Olszynski, P.; Hoffmann, B.; Chin, E.; Muhr, C.; Kim, D. J.; Mercieca, A.; Shukla, D.; Hayward, S.; Smith, M.; Gaspari, R.; Smallwood, N.; Pes, P.; Tavazzi, G.; Corradi, F.; Lambert, M.; Morris, C.; Trauer, M.; Baker, K.; Bystrzycki, A.; Goudie, A.; Liu, R.; Rudd, L.; Dietrich, C. F.; Jenssen, C.; Sidhu, P. S.AIMS: To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). METHODS: We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of strongly agree" and "agree" on the Likert scale responses. FINDINGS AND RECOMMENDATIONS: One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). CONCLUSION: These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings."Item EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) SHORT VERSION(Thieme Gruppe, 2022-10-13) Jarman, R. D.; Colclough, A.; McDermott, C.; Bøtker, M.; Knudsen, L.; Harris, T.; Albaroudi, B.; Albaroudi, O.; Haddad, M.; Darke, R.; Berry, E.; Breslin, T.; Fitzpatrick, G.; Flanagan, L.; Olusanya, O.; Craver, D.; Omar, A.; Simpson, T.; Cherian, N.; Dore, M.; Prosen, G.; Kay, S.; Villén-Villegas, T.; Gargani, L.; Carley, S.; Woo, M.; Dupriez, F.; Hussain, A.; Via, G.; Connolly, J. A.; Peck, M.; Melniker, L.; Walden, A.; Attard Biancardi, M. A.; Żmijewska-Kaczor, O.; Lalande, E.; Geukens, P.; McLaughlin, R.; Olszynski, P.; Hoffmann, B.; Chin, E.; Muhr, C.; Kim, D. J.; Mercieca, A.; Shukla, D.; Hayward, S.; Smith, M.; Gaspari, R.; Smallwood, N.; Pes, P.; Tavazzi, G.; Corradi, F.; Lambert, M.; Morris, C.; Trauer, M.; Baker, K.; Bystrzycki, A.; Goudie, A.; Liu, R.; Rudd, L.; Dietrich, C. F.; Jenssen, C.; Sidhu, P. S.OBJECTIVE: To evaluate the evidence and produce a summary and recommendations for the most common heart and lung point-of-care ultrasound (PoCUS). METHODS: We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendations were produced, including assigning levels of evidence (LoE) and grading of recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement of the summary and recommendation for each question (using a 5-point Likert scale), which was approved in the case of a level of agreement of greater than 75 %. A level of agreement was defined as a summary of strongly agree" and "agree" on the Likert scale responses. FINDINGS AND RECOMMENDATIONS: One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1), the remaining 9 questions achieved broad agreement with an assigned LoE of 4 and a weak GRADE recommendation (question 2), three achieved an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8) and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). CONCLUSION: These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings."Item Is there a role for botulinum toxin A in the emergency setting for delayed abdominal wall closure in the management of the open abdomen? A systematic review(Royal College of Surgeons, 2022-02-17) Luton, O. W.; Mortimer, M.; Hopkins, L.; Robinson, D.; Egeler, C.; Smart, N. J.; Harries, R.INTRODUCTION: Emergency laparotomy for either trauma or non-trauma indications is common and management is varied. Use of the open abdomen technique allowing for planned re-look is an option; however, performing delayed definitive fascial closure (DFC) following this can be a challenge. The use of botulinum toxin-A (BTX) infiltration into the lateral abdominal wall has been well documented within the elective setting; its use within the emergency setting is undecided. This systematic review assesses the efficacy and safety of BTX injection into the lateral abdominal wall muscles in the emergency setting. The primary outcome is DFC rate. METHODS: Systematic review was performed according to the PROSPERO registered protocol (CRD42020205130). Papers were dual screened for eligibility, and included if they met pre-stated criteria where the primary outcome was DFC. Articles reporting fewer than five cases were excluded. Bias was assessed using the Cochrane Risk of Bias and Joanna Brigg's appraisal tools. FINDINGS: Fourteen studies were screened for eligibility, twelve full texts were reviewed and two studies were included. Both studies showed evidence of bias due to confounding factors and lack of reporting. Both studies suggested significantly higher rates of DFC than reported in the literature against standard technique (90.7% vs 66%); however, these data are difficult to interpret due to strict study inclusion criteria or lack of a control population. CONCLUSION: The use of BTX is deemed safe and its effects in the emergency situation may have great potential. Unfortunately, to date, there is insufficient evidence to facilitate opinion.Item Self-learning methodology in simulated environments (MAES©) utilized in hospital settings. Action-research in an Emergency Department in the United Kingdom(Elsevier, 2022-01-18) Fenzi, G.; Reuben, A. D.; Agea, J. L. D.; Ruipérez, T. H.; Costa, C. L.INTRODUCTION: This article describes the impact of a simulation-based learning method on emergency nurses at the Royal Devon Hospital (Exeter, United Kingdom). OBJECTIVES: To determine the training needs of nurses who were recently hired, as well as to evaluate the perception on the acquisition of emergency nurse competencies after the educational intervention. METHOD: The study was composed of 3 phases. FIRST PHASE: The training needs were analysed from the point of view of the participants (through a focus group), and the institution (by consulting experts through an online questionnaire). SECOND PHASE: Various simulations were implemented and designed by the participants themselves according to their needs, using the Self-Learning Methodology in Simulated Environments (MAES©). THIRD PHASE: The results of the education program were evaluated. RESULTS: Many categories were obtained that served to determine the training needs of the participants, and to design various self-directed simulation scenarios. Three simulation scenarios were performed and afterwards discussed. CONCLUSION: The experience was positively evaluated by the participants. The participants believed that the MAES© method was adequate, given that at all times, they were the protagonists of their own learning according to their training needs, and considering their previous knowledge.