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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-z18hg30pp1.pdf

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

/pdf/2015-esc-guidelines-for-the-management-of-acute-coronary-6did6h5nxk.pdf

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

Introduction The UK ambulance service often attends to suspected seizures. Most persons attended to will not require the facilities of a hospital emergency department (ED) and so should be managed at scene or by using alternative care pathways. Most though are transported to ED. One factor that helps explain this is paramedics can have low confidence in managing seizures. Objectives With a view to ultimately developing additional seizure management training for practicing paramedics, we explored their learning needs, delivery preferences and potential drivers and barriers to uptake and effectiveness. Design and setting Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed. Participants A diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics. Results Participants said seizure management was neglected within basic and postregistration paramedic training. Most welcomed additional learning opportunities and identified gaps in knowledge. This included how to differentiate between seizure types and patients that do and do not need ED. Practical, interactive e-learning was deemed the most preferable delivery format. To allow paramedics to fully implement any increase in skill resulting from training, organisational and structural changes were said to be needed. This includes not penalising paramedics for likely spending longer on scene. Conclusions This study provides the first evidence on the learning needs and preferences of paramedics regarding seizures. It can be used to inform the development of a bespoke training programme for paramedics. Future research should develop and then assess the benefit such training has on paramedic confidence and on the quality of care they offer to seizure patients.

https://bmjopen.bmj.com/content/bmjopen/7/1/e014024.full.pdf

Paramedics' views on their seizure management learning needs: a qualitative study in England

Acute, undifferentiated chest pain (chest pain ?cause) presents a frequent and difficult challenge to clinicians working in the emergency setting. We aimed to survey current management of this problem in UK accident and emergency departments by sending a postal questionnaire to the lead clinician or first named consultant in every major A&E department in the UK. Responses were received from 177/238 departments (74%). Although 74 departments (42%) had formal guidelines, many referred only to diagnosed coronary syndromes. Guidelines for undifferentiated chest pain usually recommended observation for six to 12 hours followed by troponin testing. Short-stay facilities were available in 38 departments (21%) and were planned for 55 departments (31%). Provocative cardiac testing could be accessed by 38 departments (21%). Patients were admitted by general physicians in 152 hospitals (86%) and cardiologists in 18 (10%). The estimated proportion of patients admitted was extremely variable. Although 45 departments (25%) employed specialist nurses, only in 20 did they manage patients with undifferentiated chest pain. Reported management of acute, undifferentiated chest pain in the UK shows wide variation. Innovative technologies and diverse methods of service delivery are being adopted in a number of departments. These innovations require thorough evaluation.

National survey of emergency department management of patients with acute undifferentiated chest pain

OBJECTIVE: To determine whether the frequency and pattern of use of the accident and emergency (AE 121 visits were directly related to diabetes, including 52 for hypoglycaemia. The diabetic cohort also had more visits for medical illness unrelated to diabetes (357 v 231, P = 0.0001). The number of visits for injuries was similar (524 v 475, P = 0.3). Individuals with diabetes who attended A&E were not significantly more likely to be referred by a general practitioner (14% v 16%) or admitted (20% v 17%). CONCLUSIONS: Individuals with diabetes made more frequent visits than the general population to the A&E department. Since there was no excess of visits for injuries and the proportion requiring admission was similar, the hypothesis that they have a different threshold for attending is not supported.

https://emj.bmj.com/content/emermed/14/6/371.full.pdf

How do individuals with diabetes use the accident and emergency department

As the 2003 Licensing Act comes into effect, what will the impact of the extending drinking hours be on UK emergency departments?

The 2003 Licensing Act will be coming into effect shortly in England and Wales. This removes restrictions on the sale of alcohol from bars and pubs, extending drinking time beyond 11pm. The Government hopes that this will lead to the English taking a more relaxed approach to drinking, and reduce the incidence of drunkenness, assaults, and anti-social behaviour often seen after 11pm closing. Senior police officers and judges are sceptical and have warned of increasing alcohol-related crime and violence.

What are the implications for emergency departments? …

/pdf/the-2003-licensing-act-an-act-of-stupidity-3hm16i64dx.pdf

The 2003 Licensing Act: an act of stupidity?

Background Unspecified chest pain is an important and potentially avoidable cause of emergency hospital admission. We aimed to examine inter-hospital variation in admission rates with unspecified chest pain and identify population characteristics, services and technologies that might explain this variation. Methods We used Hospital Episodes Statistics data from 152 acute trusts in England to calculate a direct standardised annual admission rate per 100 000 population for each trust. Regression analysis was used to identify factors explaining variation, first, using routinely available data relating to the hospital catchment area and service and then using responses to a survey of emergency department (ED) management. Results The best predictors of admission rate using routine data were total beds per 1000 population (p=0.001), rapid access chest pain clinic (RACPC) attendances per year (p<0.001) and percentage of households in poverty (p=0.01). Including data from 105/142 (74%) survey responses, the best predictors of admission rate were total beds (p<0.001), RACPC attendances (p=0.001), mean ED waiting time (p=0.049) and percentage of households in poverty (p<0.001). All associations were positive (higher variable predicts higher rate) except ED waiting time. We found no significant associations between factors relating to acute chest pain management and admission rate. Conclusions Hospitals with higher admission rates for unspecified chest pain have greater bed provision, more RACPC attendances and serve populations with a higher percentage of households in poverty. These findings may be explained by services responding to demand in populations with greater need. We found no evidence that chest pain management influenced admission rates.

/pdf/factors-influencing-unspecified-chest-pain-admission-rates-1sx3rqqfv7.pdf

Steve Goodacre

Papers

Paramedics' views on their seizure management learning needs: a qualitative study in England

National survey of emergency department management of patients with acute undifferentiated chest pain

How do individuals with diabetes use the accident and emergency department

The 2003 Licensing Act: an act of stupidity?

Factors influencing unspecified chest pain admission rates in England