Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2006
ReviewRacial and ethnic disparities in the emergency department: a public health perspective.
This article discusses racial and ethnic disparities from a public health perspective, specifically why they threaten to impede the efforts to improve the nation's health. The authors (1) provide background information, including a review of the Institute of Medicine report on health care disparities; (2) describe the racial and ethnic compositions of the individuals in the emergency department setting from the perspective of both the patient and health care provider; (3) discuss the most prevalent disease presentations to the emergency department that are likely to have racial and ethnic disparities; and (4) give conclusions and general recommendations on how to address disparities in emergency health care.
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Emerg. Med. Clin. North Am. · Nov 2006
ReviewEmergency department crowding: old problem, new solutions.
Emergency department (ED) crowding is becoming an increasing problem in EDs throughout the United States for a multitude of reasons, including an increase in patient volume and a decrease in available EDs. Crowding has an adverse impact on the ability to deliver quality and timely care and may contribute to adverse patient outcomes. ⋯ A number of measures have been developed to better quantify crowding and its effects. More research needs to be done to better understand the factors that contribute to crowding, the impact of this problem on patients and ED throughput, and how to alleviate this nationwide crisis.
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Emerg. Med. Clin. North Am. · Nov 2006
ReviewCommunicable respiratory threats in the ED: tuberculosis, influenza, SARS, and other aerosolized infections.
Respiratory infections are the most common communicable infectious diseases. EDs are the front line for patients with respiratory infections because of their acute nature and because the ED is the principal site of health care for those at highest risk. ⋯ We discuss epidemiology, pathogenesis, diagnosis, and treatment of each agent. Emphasis is on the ED's role as a public health prevention arena, with attention to education and disease prevention, early identification of disease in patients at risk, and reduction of illnesses.
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Issues regarding patient care near the end of life can be challenging and rewarding for emergency physicians. Knowledge of the patient's wishes is essential, and may be accomplished by advance directives or communication with patients and surrogates. ⋯ The goals of medicine remain the following: providing optimal health care, provision of the best possible symptom control, communication, empathy, and caring. As death approaches, provision of the best possible medical care, in accordance with the patient's wishes, can be rewarding for patients, families, and health care providers.
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Emerg. Med. Clin. North Am. · Nov 2006
ReviewHealth promotion and disease prevention in the emergency department.
This article provides an overview of health promotion and disease and injury prevention concepts. It provides an emergency medicine perspective and reviews approaches that can be used in the emergency department. It discusses examples of innovative emergency medicine-based preventive activities including prevention in the prehospital setting. This article ends with a discussion of the importance of a system approach to prevention and suggests a role for a preventionist as a new member of the emergency medicine team.