Annals of emergency medicine
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We examine access to care for acute depression by insurance status compared to access for acute medical conditions in 9 metropolitan areas in the United States. ⋯ Our findings indicate that the process for obtaining urgent follow-up appointments is systematically different for patients seeking behavioral health care than for those with physical complaints. The use of voicemail, in lieu of having a person answer the telephone, is much more prevalent in behavioral than physical health settings. More work is needed to determine the effect of this practice on depressed individuals and vulnerable populations.
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Multicenter Study Comparative Study
Validation of 3 termination of resuscitation criteria for good neurologic survival after out-of-hospital cardiac arrest.
Several termination of resuscitation criteria have been proposed to identify patients who will not survive to hospital discharge after out-of-hospital cardiac arrest. However, only 1 set has been derived to specifically predict survival to hospital discharge with good neurologic function. The objectives of this study were to externally validate the basic life support (BLS) termination of resuscitation, advanced life support (ALS) termination of resuscitation, and neurologic termination of resuscitation criteria and compare their abilities to predict survival to hospital discharge with good neurologic function after out-of-hospital cardiac arrest. ⋯ All 3 termination of resuscitation criteria had equally high abilities to identify patients requiring continued resuscitation. The BLS termination of resuscitation criteria, however, had the best combined ability to predict good neurologic survival and poor neurologic survival or death. These findings and the relative simplicity of the BLS termination of resuscitation criteria support their use.
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Randomized Controlled Trial
Do minority or white patients respond to brief alcohol intervention in trauma centers? A randomized trial.
The current study evaluates whether the effectiveness of brief alcohol intervention in reducing 6- and 12-month risk of injuries in a large Level I urban trauma center varies according to trauma patients' ethnicity. ⋯ Our study, congruent with some recent publications, implies that there are some patient- and provider-related impediments that could restrict the effectiveness of brief intervention programs in trauma centers, regardless of patient ethnicity. Unless those impediments are identified and eliminated, assuming that brief intervention will be an effective strategy for controlling future alcohol-related injuries among trauma patients and should be provided under any circumstances might not be reasonable.
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To identify any association between out-of-hospital transport interval and survival to hospital discharge in victims of out-of-hospital cardiac arrest. ⋯ In a large out-of-hospital cardiac arrest study from demographically diverse EMS systems, longer transport interval was not associated with decreased survival. Given the growing evidence showing major influence from specialized postarrest care, these findings support conducting clinical trials that assess the effectiveness and safety of bypassing local hospitals to take patients to regional cardiac arrest centers.
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Pediatric emergency patients have unique needs, requiring specialized personnel, training, equipment, supplies, and medications. Deficiencies in these areas have resulted in historically poorer outcomes for pediatric patients versus adults. ⋯ This includes implementation of a standardized system recognizing hospitals that are able to stabilize or manage pediatric medical emergencies and trauma cases. We describe the steps involved in implementing Illinois' 3-level facility recognition process to illustrate a model that other states might use to provide appropriate pediatric care and comply with new Health Resources and Services Administration performance measures.