Background: Increases in emergency medical admissions are placing a strain upon hospitals throughout the world. The aim of the study was to evaluate the effect of a new post, the ''A&E physician'', upon emergency medical admissions to a hospital. Methods: For six months the A&E physician workload was audited and a randomised controlled comparison undertaken. Days were randomised to ''A&E physician present'' or ''A&E physician absent''. The A&E physician recorded details of all patients referred for medical admission, any intervention made, and their disposal from A&E. Routine hospital data compared the mean daily number of medical admissions, non-medical admissions, and referrals to other hospitals. Results: 124 days were randomised: 59 to A&E physician present, 65 to A&E physician absent. The A&E physician received 581 referrals and intervened in the management of 142 (24%). Of these, 80 were discharged home, apparently saving 1.4 admissions per day. However, randomised comparison showed that presence of the A&E physician was associated with a reduction of only 0.7 medical admissions per day (95% CI -1.7 to 3.2, p = 0.561), and an increase of 1.1 non-medical admissions (95% CI -0.2 to 2.3, p = 0.09) and 0.3 transfers to other hospitals per day (95% CI zero to 0.6, p = 0.09). Overall, hospital admissions were increased by 0.9 per day when the A&E physician was present (95% CI -1.8 to 3.6, p = 0.5). Conclusion: Despite receiving many referrals and discharging a substantial proportion of these patients home, the A&E physician did not significantly change emergency medical admissions and may have increased admissions to other specialties.

be not only the cause, but also the effect of the latest epileptic seizure, although in this particular case, the potential confounds of hypoxia and metabolic disturbances in contributing to the seizure and the elevation in CSF-tau cannot be excluded.There is clinical evidence of secondary damage caused by seizures from several studies. A longitudinal MRI study examined 24 patients with mild temporal lobe epilepsy and demonstrated that hippocampal volume loss of 9% on average was seen during the 3.5-year follow-up and that the volume loss was correlated with the number of generalized seizures. 2 Another study found that the duration of poorly controlled epilepsy was associated with ongoing cognitive deterioration. 8 These findings also strongly support that extra attention should be paid to patients with repeated seizures that may result in irreversible sequelae. By contrast, it was previously demonstrated that CSF-tau levels from six patients with chronic epilepsy were all within the normal range, 5 suggesting that well-controlled epilepsy has a favorable long-term outcome, although it is not clear to what extent intense epileptic seizure could raise CSF-tau levels. Therefore, CSF-tau may be a potential marker for patients with repeated seizures, helping to decide about choice of early and radical intervention to sustain cognitive function, although a large number of patients with different types of epilepsy will need to be studied to draw firm conclusions.

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