Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Intracranial hemorrhage (ICH) after acute stroke thrombolysis is associated with poor outcomes. Previous investigations of the relationship between preexisting antiplatelet use and the safety of intravenous (IV) thrombolysis have been limited by low event rates. The objective of this study was to determine whether preexisting antiplatelet therapy increased the risk of ICH following acute stroke thrombolysis. The primary hypothesis was that antiplatelet use would not be associated with radiographic evidence of ICH after controlling for relevant confounders. ⋯ The authors did not find that preexisting antiplatelet use was associated with postthrombolysis ICH or sICH in this cohort of community treated patients. Preexisting tobacco use, younger age, and lower severity were associated with lower odds of sICH. The meta-analyses demonstrated small, but statistically significant increases in the absolute risk of radiographic ICH and sICH, along with increased odds of sICH in patients with preexisting antiplatelet use.
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Recent legislation mandating reporting of undocumented immigrants may instill fear of discovery when they access emergency department (ED) services. The objectives of this study were to: 1) characterize the knowledge and beliefs of undocumented Latino immigrants (UDLI) about health care workers' reporting (or nonreporting) of illegal immigrants in the ED, 2) determine whether UDLI fear discovery when presenting to the ED, and 3) determine the nature and sources of this fear. ⋯ One in eight of UDLI presenting to the ED express fear of discovery and consequent deportation. Belief that medical staff report UDLI and recent immigration are risk factors for this fear. Family, friends, and media are the primary sources of these concerns.
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Older adults dwelling in senior living communities (SLCs) often experience barriers to medical care when they experience acute illness. The potential of telemedicine as a substitute for standard routes of evaluating and caring for individuals with acute illness (e.g., in-person or telephone-based interactions with primary care providers and emergency department [ED] visits) was explored in this study. ⋯ Telemedicine has a potentially significant role in the provision of acute care for older adults residing in SLCs. Studies are needed to evaluate the feasibility, acceptability, effectiveness, and efficiency of acute care telemedicine for this population.
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Comparative Study
Emergency research: using exception from informed consent, evaluation of community consultations.
In 1996, the U.S. Food and Drug Administration approved regulations authorizing an exception from informed consent (EFIC) for research conducted in emergency settings when obtaining prospective informed consent is not possible due to the potential subject's critical illness or injury. The regulations require that investigators conduct community consultation (CC) efforts before initiating a study and require that institutional review boards review the results of CC prior to approving a study. However, little is known about how communities view EFIC research or the CC process. ⋯ Overall, members of these two communities expressed satisfaction with the CC session and had relatively high levels of support for the study and trust in physician-investigators.