Annals of emergency medicine
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Acute HIV infection is a clinical diagnosis aided by technology. Detecting the highly infectious acute stage of HIV infection is critical to reducing transmission and improving long-term outcomes. The Maricopa Integrated Health System implemented nontargeted, opt-out HIV screening with a fourth-generation antigen/antibody combination HIV assay test in our adult emergency department (ED) at Maricopa Medical Center to assess the prevalence of both acute and chronic unrecognized HIV. ⋯ HIV testing with a fourth-generation antigen/antibody laboratory test producing rapid results is feasible in an ED. Unexpectedly, nearly one fourth of patients with undiagnosed HIV had acute infections, which would have been more difficult to detect with previous testing technology.
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Although numerous studies have demonstrated a relationship between higher volume and improved outcomes in the delivery of health services, it has not been extensively explored in the emergency department (ED) setting. Therefore, we seek to examine the association between ED hospitalization volume and mortality for common high-risk conditions. ⋯ Patients have a lower likelihood of inhospital death if admitted through high-volume EDs.
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Randomized Controlled Trial Multicenter Study Comparative Study
Antiemetic Use for Nausea and Vomiting in Adult Emergency Department Patients: Randomized Controlled Trial Comparing Ondansetron, Metoclopramide, and Placebo.
We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department (ED) nausea and vomiting. ⋯ Reductions in nausea severity for this adult ED nausea and vomiting population were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo. There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups, but differences from the placebo group did not reach significance. The majority of patients in all groups were satisfied with treatment.