Annals of emergency medicine
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Case Reports
Non-Contrast-Enhancing Glioma Mimicking Acute Ischemic Stroke Within Three Hours of Onset.
Intravenous thrombolytic therapy is recommended within 3 hours of onset of acute ischemic stroke. However, stroke mimics create challenges because of time pressures. We describe a case of an undiagnosed glioma, a rarely reported condition, that was nearly treated with thrombolytic therapy. ⋯ Cerebral neoplasms are an absolute contraindication for thrombolysis therapy. Several brain tumors are rarely seen on a brain CT scan. The mismatch between neurologic examination and brain perfusion imaging may suggest a stroke mimic in some cases.
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Multicenter Study Observational Study
Disparities in Accessing and Reading Open Notes in the Emergency Department Upon Implementation of the 21st Century CURES Act.
There is a continued movement toward health data transparency, accelerated by the 21st Century CURES Act, which mandated the automatic and immediate release of clinical notes, often termed "open notes." Differences in utilization among different patient demographics and disproportionately affected populations within the emergency department (ED) are not yet known. ⋯ We identified substantial differences in digital access to clinical notes as well as patient utilization of open notes in a large, diverse sample. Health transparency initiatives must address not only technology adoption broadly but also the unique barriers faced by populations experiencing disadvantage to facilitate equitable access to and awareness about digital health tools without the unintended consequence of expanding disparities.
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We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. ⋯ Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.