Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Association of training level and short-term cosmetic appearance of repaired lacerations.
To determine the association between emergency practitioner level of training and cosmetic appearance of primarily closed wounds as evaluated at the time of suture removal. ⋯ Significant improvement in short-term cosmetic results following wound repair is associated with a training level beyond PGY1. These data reinforce the need for careful patient selection and close supervision of wound repair by trainees, especially of wound repair by medical students and interns.
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To determine trends in the numbers of drive-by shootings, individuals shot at, innocent bystanders shot at, and homicides by drive-by shootings in the city of Los Angeles from 1989 to 1993. ⋯ Drive-by shootings are a major public health problem in Los Angeles. While the rate of drive-by shootings decreased in 1992 and 1993, the proportion of fatal cases increased. To prevent drive-by shootings, the root causes of violent street gang formation must be addressed.
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Multicenter Study
Level I trauma certification and emergency medicine resident major trauma experience.
American College of Surgeons (ACS) and Residency Review Committee for Emergency Medicine (RRC-EM) guidelines conflict regarding the role of emergency physicians in directing major trauma resuscitations. This article describes the impact of ACS level I trauma certification on emergency medicine (EM) resident trauma experience. ⋯ EM residents direct a smaller percentage of major trauma resuscitations at ACS level I hospitals than they do at non-level I facilities. This finding is not offset by an increased trauma census at level I facilities and may be more pronounced in the Northeast and the Midwest.
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To determine the test performance of 24-lead variance cardiography (VC), an ECG technique that measures QRS morphologic variability, for ED evaluation of chest pain associated with coronary artery disease (CAD). ⋯ A CADI < 75, in addition to clinical impression and initial ECG, may identify chest pain patients who do not have significant CAD. Further prospective assessment of VC is warranted.
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To examine the effect on patient care of HMO-mandated calls for authorization prior to ED evaluation. The study examined this phenomenon prior to implementation of a California law that discourages such calls. ⋯ Calls for payment authorization prior to ED patient evaluation delay patient care and place some patients' health and safety in jeopardy.