Highwatkins1846

The study group showed a predominance of polymorphonuclear neutrophils as opposed to the three control subgroups including uveitis (p<0.00001). The best sensitivity/specificity was obtained using a polymorphonuclear neutrophil threshold of 10 per field (sensitivity, 0.90; specificity, 0.75). The sensitivity of the bacterial culture was 32% in the AqH. JAK cancer High neutrophil count was associated with poorer initial BCVA (r

=0.62; p<0.00001) and higher risk of retinal detachment during (p=0.04) and after (p<0.001) hospitalisation.

Anterior chamber tap cytology is a quick and accessible tool complementary to culture and PCR for the management of acute postoperative endophthalmitis.

Anterior chamber tap cytology is a quick and accessible tool complementary to culture and PCR for the management of acute postoperative endophthalmitis.In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a 'portfolio' approach to safety improvement in four broad categories prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.

Traumatic pneumothoraces are present in one-fifth of multiple trauma victims. Traditional teaching mandates the insertion of a chest drain in the majority of cases. However, recent observational evidence suggests a trend towards conservative management. The aim of this survey was to understand current emergency medicine (EM) practice in placing chest drains for the management of moderate to severe traumatic pneumothoraces.

The survey was developed through expert consensus and sent electronically to senior EM doctors in 21 sites internationally. It described six clinical/imaging vignettes asking 'how likely are you to insert an intercostal chest drain to manage the pneumothorax in ED?'. A five-point response was available from

to

. All pneumothoraces were >1 cm on imaging, but mechanism, physiology and need for ventilation varied.

Of a potential 606 respondents, 222 responses were received (37% response rate). Respondents were from five different countries, with the majority qualified for more than 10 years (median; 18 years). Within each scenario, there was a large variation in responses with the exception of tension pneumothorax. For vignettes without tension pneumothorax, there was a range from 52% (non-compromised 1 cm pneumothorax in a ventilated patient) to 89% (open pneumothorax with minimal clinical compromise) in respondents reporting that they would be

or

to insert a chest drain.

There is considerable variation in clinical practice involving both conservative and invasive strategies in the treatment of moderate to severe traumatic pneumothoraces. This suggests clinical equipoise for interventional trials to determine the optimal management strategy for this patient group.

There is considerable variation in clinical practice involving both conservative and invasive strategies in the treatment of moderate to severe traumatic pneumothoraces. This suggests clinical equipoise for interventional trials to determine the optimal management strategy for this patient group.Emilia-Romagna was one of the most affected Italian regions during the COVID-19 outbreak in February 2020. We describe here the profound regional, provincial and municipal changes in response to the COVID-19 pandemic, to cope with the numbers of patients presenting with COVID-19 illness, as well as coping with the ongoing need to care for patients presenting with non-COVID-19 emergencies. We focus on the structural and functional changes in one particular hospital within the city of Bologna, the regional capital, which acted as the central emergency hub for time-sensitive pathologies for the province of Bologna. Finally, we present the admissions profile to our emergency department in relation to the massive increase of infected patients observed in our region as well as the organisational response to prepare for the second wave of the pandemic.

Acute or chronic stress can lead to physical and mental disorders. Measuring cortisol can objectify the degree of stress. Cortisol is traditionally measured in serum, but recently the relevant fraction of free cortisol can be reliably measured in saliva, using the very sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The use of saliva is non-invasive and allows easy serial testing around stressful events. The main objective of this study is to investigate whether serial saliva cortisol determinations using the LC-MS/MS method can be used to assess the stress response that first responders may experience during moments of acute professional deployment in their daily work.

Healthy first responders (police officers, firefighters, rapid response team, ambulance personnel, first aid and emergency medical personnel) were recruited to participate in a Euregional high-reliability simulation training ('Be Aware'-scenario training, 19 April 2018). At three time points, simultaneous venous blood samples and saliva samples were obtained.