Annals of emergency medicine
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The Centers for Disease Control and Prevention (CDC) recently released revised recommendations for HIV testing in health care settings, calling for the performance of nontargeted opt-out HIV screening, the integration of informed consent for HIV testing into the general consent for medical care, and the uncoupling of prevention counseling and testing. It is unclear, however, whether patients will understand opt-out screening or be satisfied with integration of the consent for HIV testing into the general medical consent or the uncoupling of counseling from testing. The objective of this study is to evaluate patients' acceptance of the CDC's revised recommendations in an urban emergency department (ED). ⋯ A large proportion of ED patients appear willing to be screened for HIV infection in accordance with the CDC's revised recommendations for HIV testing in health care settings. Similar proportions were willing to be tested when opt-out or opt-in screening strategies were used; however, a significantly greater proportion required explanation of opt-out screening.
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WHAT IS ALREADY KNOWN ON THIS TOPIC: The Centers for Disease Control and Prevention recommends that HIV screening be incorporated into routine care unless patients opt out, but most emergency departments (EDs) have not adopted routine screening. WHAT QUESTION THIS STUDY ADDRESSED: Will patients accept routine HIV testing in the ED without separate written consent or traditional pre- and posttest counseling? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: In this survey, 81% were willing to receive free HIV testing in the ED, but many required explanation of opt-out testing. ⋯ Nevertheless, screening is unlikely to be adopted in busy EDs unless payment and workload issues can be resolved. The yield of routine ED screening may be low in most settings.
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It is now clear that transient ischemic attacks and strokes are different manifestations of the same disease and transient ischemic attacks are often warning signs of an impending stroke. Unfortunately, it is unclear when the next event will occur in an individual patient. It is critical for emergency physicians to know what the true risk of stroke is for patients who present to the emergency department (ED) with a transient ischemic attack and a normal neurologic examination result. We perform an evidence-based emergency medicine shortcut review of the short-term outcome of stroke among patients diagnosed in the ED with a transient ischemic attack. ⋯ According to studies assessing the short-term prognosis of patients diagnosed with transient ischemic attack in the ED, approximately 1 in 20 patients will have a stroke during the following 48 hours.
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Routine ECG testing is recommended in the evaluation of syncope, although the value of such testing in young patients is unclear. For ECG testing, we assess the diagnostic yield (frequency that ECG identified the reason for syncope) and predictive accuracy for 14-day cardiac events after an episode of syncope as a function of age. ⋯ ECG testing in patients younger than 40 years did not reveal a cardiac cause of syncope and was associated with a significant frequency of abnormal ECG findings unrelated to syncope. Although our findings should be verified in larger studies, it may be reasonable to defer ECG testing in younger patients who have a presentation consistent with a benign cause of syncope.
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There is increasing concern that decreasing reimbursements to emergency departments (EDs) will negatively affect their functioning, but little evidence has been published identifying trends in reimbursement rates. We seek to examine and document the trends in reimbursement for outpatient ED visits throughout the past decade. ⋯ The proportion of charges paid for outpatient ED visits from Medicaid, Medicare, and privately insured and uninsured patients persistently decreased from 1996 to 2004. These concerning decreases may threaten the survival of EDs and their ability to continue to provide care as safety nets in the US health care system.