Annals of emergency medicine
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To determine the effectiveness of life support courses for health care providers on the basis of one of three outcomes: (1) patient mortality and morbidity, (2) retention of knowledge or skills, and (3) change in practice behavior. ⋯ Among providers, retention of knowledge and skills acquired by participation in support courses is poor. However, refresher activities increase knowledge retention. Modular courses are as good as lectures for learning course material. There is evidence that use of the Advanced Trauma Life Support course has decreased mortality and morbidity. Further studies of patient outcome and provider behaviors are warranted.
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To determine whether race/ethnicity is an important determinant of emergency department use. ⋯ Race/ethnicity was not an important determinant of ED use after adjustment for age, health insurance coverage, regular source of care, and barriers to health care. Population-based studies of ED use should be conducted to further evaluate whether racial/ethnic differences in ED use exist that are not explained by differences in demographics, health, socioeconomic status, access to care, or other determinants of ED use.
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Two widely used formulas for calculating the number of practicing emergency physicians (EPs) are based on the total number of US emergency departments and patient visits. In this study we hypothesized that the number of physicians now working in EDs is significantly greater than the estimates yielded by these formulas. Therefore we attempted to determine the accuracy of these methods for predicting the true number of practicing EPs. We also examined the training, board certification, and distribution of EPs. ⋯ Current staffing estimates regarding EPs working in Missouri greatly underestimate actual staffing needs. Board-certified EPs are in severe shortage and are unequally distributed in Missouri. Extrapolated nationally, these estimates may negatively affect funding and available residency positions for emergency medicine.
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Patient involvement in medical decisionmaking is accepted as an ethical and a legal imperative. Medical decisions are based in part on individuals' knowledge and acceptance of risk of adverse consequences. It is unclear whether actions taken to protect against low risk of poor outcome reflect patient or physician preferences. We sought to test the hypothesis that emergency department chest pain patients presented with a hypothetical situation involving a low risk of myocardial infarction are more willing than ED physicians to accept the risk associated with discharge from the hospital. ⋯ ED patients with chest pain appear to be more likely than physicians to accept a small risk of poor outcome in a hypothetical circumstance. Many patients cannot identify the risks associated with their decision.