Aims/Objectives/Background One approach to addressing increasing demand in emergency departments (EDs) has been the co-location of general practitioners (GPs) in or alongside the emergency department (ED), known as GPED. This approach was both advocated by the National Health Service (NHS) and supported by capital funding in 2017. However, little is known about the models of GPED that have been implemented as a result. Methods/Design We collected data on the model of GPED in use (if any) at 163/177 (92%) of type one EDs in England at two time points: September 2017 and December 2019. Multiple data sources were used including: on-line surveys; interviews; case study data; publicly available information. Models were classified according to an iteratively developed taxonomy as Inside/integrated, Inside/parallel, Outside/onsite, Outside/offsite. Results/Conclusions The proportion of EDs using GPED increased from 81% to 95% over the study period. The most common model was ‘Inside/parallel’ to the ED: 30% (44/149) in 2017, rising to 49% (78/159) in 2019. The number of Inside/integrated models dropped from 26% (38/149) to 9% (15/159). 23 sites commenced and four sites ceased GPED provision. 87% (142/163) of the EDs sampled were awarded capital funding. We identified no association between the type of GPED model adopted and the observable characteristics of EDs such as annual attendance, rurality of location and deprivation within the population served. The majority of EDs in England have now adopted GPED. The increase in Inside/parallel models and the reduction in Inside/integrated models is likely to be related to the availability of capital funding to finance structural changes to EDs so that separate GP services could be provided. Further research is required to understand the relative effectiveness of the various models of GPED identified.
The accepted definition of postpartum haemorrhage is an estimated blood loss of at least 500 ml. after vaginal delivery. Estimation of blood loss is often unreliable, for few attendants have a clear appreciation of the appearance of 500 ml. of blood soaked into linen and the other accoutrements of delivery. Because of the failure to recognize the extent of haemorrhage, its true importance in maternal morbidity and mortality tends to be missed. Several methods have been used in attempts to measure blood loss accurately. Gatch and Little (1924) extracted haemoglobin and measured it as acid haematin by photometric comparison with a series of acid haematin solutions prepared by diluting the patient's venous blood. Pilcher and Sheard (1937) used the spectrophotometer to measure oxy haemoglobin concentrations. Coller et al. (1944) compared preand post-delivery haemoglobin and plasma protein con centrations. Gahres et al. (1962) used chromium-51-labelled red cells to compare the red cell mass before and after delivery, while Spoerel and Heagy (1962) used radioiodinated serum albumin to compare plasma volumes before and after delivery. Murdoch (1958) attempted complete collections in calibrated receptacles. The aim of the present investigation was to measure the amount of bleeding at vaginal delivery. In order to prevent confusion the estimate made by the attendant will be referred to as the recorded blood loss. The loss determined subse quently by calculation, using the washing-machine extraction method, is referred to as the measured loss.
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Journal Article Cancer of the Cervix: Diagnosis and Treatment Get access H. A. Brant H. A. Brant University College London, London WCIE 6HX Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, Volume 60, Issue 703, May 1984, Page 380, https://doi.org/10.1136/pgmj.60.703.380-a Published: 01 May 1984
This project leverages advances in machine learning based data analysis techniques and untargeted omic analytical methods to progress nuclear nonproliferation technologies beyond current capabilities. The developed approaches can be used to identify and detect complex chemical fingerprints of facilities of interest. These techniques have been developed for fields such as metabolomics and genomics but have not been applied to nuclear nonproliferation applications. Adaptation of these techniques for volatile organic compound analysis has far reaching application within the scientific community including environmental chemistry, atmospheric physics, and climate sciences.
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