Emergency Medicine Journal 

About: Emergency Medicine Journal is an academic journal published by BMJ. The journal publishes majorly in the area(s): Emergency department & Poison control. It has an ISSN identifier of 1472-0205. Over the lifetime, 8052 publications have been published receiving 130796 citations. The journal is also known as: EMJ.

Observational research methods. Research design II: cohort, cross sectional, and case-control studies

Abstract: Cohort, cross sectional, and case-control studies are collectively referred to as observational studies. Often these studies are the only practicable method of studying various problems, for example, studies of aetiology, instances where a randomised controlled trial might be unethical, or if the condition to be studied is rare. Cohort studies are used to study incidence, causes, and prognosis. Because they measure events in chronological order they can be used to distinguish between cause and effect. Cross sectional studies are used to determine prevalence. They are relatively quick and easy but do not permit distinction between cause and effect. Case controlled studies compare groups retrospectively. They seek to identify possible predictors of outcome and are useful for studying rare diseases or outcomes. They are often used to generate hypotheses that can then be studied via prospective cohort or other studies.

The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain

Abstract: Objective —To determine whether minimum clinically significant difference in visual analogue scale (VAS) pain score varies according to the severity of pain reported. Method —Prospective descriptive study of adult patients in an urban emergency department (ED). On presentation to the ED, patients marked the level of their pain on a 100 mm, non-hatched VAS scale. At 20 minute intervals thereafter they were asked to give a verbal categorical rating of their pain as “a lot better”, “a little better”, “much the same”, “a little worse” or “much worse” and to mark the level of pain on a VAS scale of the same type as used previously. It was pre-defined that patients with VAS pain scores of 30 mm or less would be categorised as having mild pain, those with scores of 70 mm or more were categorised as having severe pain and those from 31 mm to 69 mm, moderate pain. The minimal clinically significant difference (MCSD) in VAS pain score was defined as the mean difference between current and preceding scores when the subject reported “a little worse” or “a little better” pain. Results —156 patients were enrolled in the study, yielding 88 evaluable comparisons where pain was rated as “a little better” or “a little worse”. The MCSD in VAS score in the group overall was 12 mm (95%CI 9 mm to 15 mm). MCSD in VAS score for the “mild pain” group was 11 mm (95%CI 4 mm to 18 mm), for the “moderate pain” group 14 mm (95%CI 10 mm to 18 mm) and for the severe pain group, 10 mm (95%CI 6 mm to 14 mm). There is no statistical difference between the MCSD in VAS score between the severity groups. Conclusions —The MCSD in VAS pain score does not differ with the severity of pain being experienced.

Emergency department overcrowding in the United States: an emerging threat to patient safety and public health

Abstract: Numerous reports have questioned the ability of United States emergency departments to handle the increasing demand for emergency services. Emergency department (ED) overcrowding is widespread in US cities and has reportedly reached crisis proportions. The purpose of this review is to describe how ED overcrowding threatens patient safety and public health, and to explore the complex causes and potential solutions for the overcrowding crisis. A review of the literature from 1990 to 2002 identified by a search of the Medline database was performed. Additional sources were selected from the references of the articles identified. There were four key findings. (1) The ED is a vital component of America's health care "safety net". (2) Overcrowding in ED treatment areas threatens public health by compromising patient safety and jeopardising the reliability of the entire US emergency care system. (3) Although the causes of ED overcrowding are complex, the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. (4) Potential solutions for ED overcrowding will require multidisciplinary system-wide support.

In search of excellence

Abstract: In Search Of Excellence, by Tom Peters and Robert Waterman,1 published in 1982, remains one of the biggest selling and most widely read business books ever. It was then, and still is, touted as a seminal text for those trying to improve systems and deliver quality to the public, mainly in the context of business. I was advised to read it on a senior registrar management course I attended in 1989. It’s not a page-turning bodice-ripper. I didn’t finish it. I tried hard. I mention this because I came across it the other day while perusing the shelves of the hospital library. Later that day I discussed the book with a friend who runs a successful business. He agreed that it is still widely referenced in business and training seminars. He then asked me the killer question “what are you guys [emergency doctors] excellent at?” He followed this up by asking “don’t you refer everything on to specialists?”. I was well behaved and refrained from pouring a jug of water over him. So, what are we excellent at? By the nature of our work, we are generalists and are …

An introduction to power and sample size estimation

Abstract: Previous evidence suggests different cortical areas naturally oscillate at distinct frequencies, reflecting tuning properties of each region. The concurrent use of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) has been used to perturb cortical regions, resulting in an observed post-stimulation response that is maximal at the natural frequency of that region. However, little is known about the spatial extent of TMS-induced activation differences in cortical regions when comparing resting state (passive) versus active task performance. Here, we employed TMS-EEG to directly perturb three cortical areas in the right hemisphere while measuring the resultant changes in maximal evoked frequency in healthy human subjects during a resting state (N=12) and during an active sensorimotor task (N=12). Our results revealed that the brain engages a higher dominant frequency mode when actively engaged in a task, such that the frequency evoked during a task is consistently higher across cortical regions, regardless of the region stimulated. These findings suggest that a distinct characteristic of active performance versus resting state is a higher state of natural cortical frequencies.