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1.  Impact of the new UK licensing law on emergency hospital attendances: a cohort study 
Emergency Medicine Journal : EMJ  2007;24(8):532-534.
To assess the effect of the new UK alcohol licensing law on overnight attendances to the emergency department.
A retrospective cohort study at the emergency department of St Thomas' Hospital, London over 2 months, one before and one after the introduction of the new legislation. All people over the age of 16 years who attended the emergency department between 21:00 and 09:00 during the two study periods (March 2005 and March 2006) were included. An alcohol‐related attendance was defined as having occurred if there was documentation of alcohol consumption before attendance, or of alcohol intoxication in relation to the patient's physical examination or final diagnosis. The primary outcome measure was change in the number and percentage of alcohol related attendances to the emergency department between the two study periods. Secondary outcome measures, compared between the two study periods, were number and percentage of alcohol‐related attendances as a consequence of assault, and of injury; and number and percentage of alcohol‐related attendances resulting in admission to hospital.
In March 2005 there were 2736 overnight attendances to the ED, of which 79 (2.9%) were classified as alcohol related. In comparison, in March 2006 there were a total of 3135 overnight attendances, of which 250 (8%) were alcohol related, representing a significant increase (p<0.001). There were also significant increases in percentage of alcohol related attendances as a consequence of injury (p<0.001) and assault (p = 0.002); and in admission rates for alcohol related attendances (p<0.001) between the two study periods.
Overnight alcohol related emergency attendances to St Thomas' hospital increased after the introduction of new alcohol licensing legislation. If reproduced over longer time periods and across the UK as a whole, the additional burden on emergency care could be substantial.
PMCID: PMC2660070  PMID: 17652670
2.  Propofol for procedural sedation in the emergency department 
Emergency Medicine Journal : EMJ  2007;24(7):459-461.
To observe procedural sedation practice within a district general hospital emergency department (ED) that uses propofol for procedural sedation.
Prospective observation of procedural sedation over an 11 month period. Patients over 16 years of age requiring procedural sedation and able to give informed consent were recruited. The choice of sedation agent was at the discretion of the physician. The following details were recorded on a standard proforma for each patient: indication for procedural sedation; agent used; depth and duration of sedation; ease of reduction; use of a reversal agent; complications and reasons for delayed discharge from the ED.
48 patients were recruited; propofol was used in 32 cases and midazolam in 16 cases. The median period of sedation was considerably shorter in the propofol group (3 vs 45 min) but this did not confer a shorter median time in the ED (200 vs 175 min). There were no documented cases of over‐sedation in the propofol group; however, four patients in the midazolam group were over‐sedated, three requiring reversal with flumazenil. There were no other significant complications in either group. There was no difference in the median depth of sedation achieved or ease of reduction between the two groups.
Propofol is effective and safe for procedural sedation in the ED. Propofol has a considerably shorter duration of action than midazolam, thereby shortening the period of sedation.
PMCID: PMC2658387  PMID: 17582032

Results 1-2 (2)