Annals of 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.
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To assess the incidence of cardiac arrest among patients who use self-transport to seek medical care for chest pain. ⋯ The incidence of cardiac arrest among patients who attempted to reach the hospital by private transportation was very low compared with the incidence among those who chose the EMS system for transport. This suggests that patient self-selection occurs, with the more seriously ill patients more commonly calling 911 for transport.
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In two separate cases, pediatric patients exposed to Armor-All Quicksilver Wheel Cleaner exhibited systemic toxicity including mental status changes, marked hypocalcemia, and ventricular fibrillation. One child also demonstrated profound hypomagnesemia. These are the first pediatric reports of near-fatal outcomes after ingestion or inhalation of a hydrofluoric acid-like product, namely, ammonium bifluoride.
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To determine the effects of actual waiting time, perception of waiting time, information delivery, and expressive quality on patient satisfaction. ⋯ Perceptions regarding waiting time, information delivery, and expressive quality predict overall patient satisfaction, but actual waiting times do not. Providing information, projecting expressive quality, and managing waiting time perceptions and expectations may be a more effective strategy to achieve improved patient satisfaction in the ED than decreasing actual waiting time.
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The traditional (and unvalidated) five-point Cerebral Performance Category (CPC) score at hospital discharge does not correlate with the results yielded by a validated functional status instrument and subjective quality-of-life assessment. ⋯ The CPC score, relied on as a measure of functional outcome in cardiac arrest, correlates poorly with subsequent subjective quality of life and with validated objective functional testing instruments, and conclusions based on it are suspect. Future researchers should employ standardized testing instruments.