Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Recent health policy changes have focused efforts on reducing emergency department (ED) visits as a way to reduce costs and improve quality of care. This was a systematic review of interventions based outside the ED aimed at reducing ED use. ⋯ Many studies have explored interventions based outside the ED to reduce ED use in various populations, with mixed evidence. Approximately two-thirds identified here showed reductions in ED use. The interventions with the greatest number of studies showing reductions in ED use include patient financial incentives and managed care, while the greatest magnitude of reductions were found in patient education. These findings have implications for insurers and policymakers seeking to reduce ED use.
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Recent health policy changes have focused efforts on reducing emergency department (ED) visits as a way to reduce costs and improve quality of care. This was a systematic review of interventions based outside the ED aimed at reducing ED use. ⋯ Many studies have explored interventions based outside the ED to reduce ED use in various populations, with mixed evidence. Approximately two-thirds identified here showed reductions in ED use. The interventions with the greatest number of studies showing reductions in ED use include patient financial incentives and managed care, while the greatest magnitude of reductions were found in patient education. These findings have implications for insurers and policymakers seeking to reduce ED use.
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Review Meta Analysis
Triple Rule-out Computed Tomographic Angiography for Chest Pain: A Diagnostic Systematic Review and Meta-Analysis.
The objective was to compare the image quality, diagnostic accuracy, radiation exposure, and contrast volume of "triple rule-out" (TRO) computed tomography (CT) to other diagnostic modalities commonly used to evaluate patients with nontraumatic chest pain (dedicated coronary, pulmonary embolism [PE], and aortic dissection CT; invasive coronary angiography; and nuclear stress testing). ⋯ Triple rule-out CT is highly accurate for detecting coronary artery disease. Given the low (<1%) prevalence of PE and aortic dissection in the included studies, and the increased radiation and contrast exposure, there are insufficient data to recommend use of TRO CT in the diagnosis of these conditions.
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In critical care and emergency medicine research, obtaining consent can be problematic when patients present with life-threatening conditions. This issue is further complicated in children, as even while coherent, they are often incapable of making decisions regarding their own care. To enable the ethical conduct of research in such situations, the Food and Drug Administration (FDA) of the United States has set recommendations for the conduct of research employing a waiver of consent. These regulations have been termed "exception from informed consent," or EFIC. As this is an evolving concept with limited pediatric experience, the authors conducted a review to examine the conduct of emergency research in the absence of prospectively obtained informed consent. Our review focused both on opinions and on the ability to conduct research without informed consent in life-threatening situations. ⋯ Limited data exist evaluating ethical issues in pediatric acute care resuscitation research. This review highlighted the fact that every proposal is unique and the method of obtaining consent (or waiver) requires careful consideration by local ethics committees. Particular attention must be paid to use of the population selected for community consultation. Several studies highlighted the need to consider the use of alternatives to prospective informed consent to enable the conduct of research in emergency departments (EDs) in life-threatening situations. Future research should evaluate children's opinions on this topic.
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In critical care and emergency medicine research, obtaining consent can be problematic when patients present with life-threatening conditions. This issue is further complicated in children, as even while coherent, they are often incapable of making decisions regarding their own care. To enable the ethical conduct of research in such situations, the Food and Drug Administration (FDA) of the United States has set recommendations for the conduct of research employing a waiver of consent. These regulations have been termed "exception from informed consent," or EFIC. As this is an evolving concept with limited pediatric experience, the authors conducted a review to examine the conduct of emergency research in the absence of prospectively obtained informed consent. Our review focused both on opinions and on the ability to conduct research without informed consent in life-threatening situations. ⋯ Limited data exist evaluating ethical issues in pediatric acute care resuscitation research. This review highlighted the fact that every proposal is unique and the method of obtaining consent (or waiver) requires careful consideration by local ethics committees. Particular attention must be paid to use of the population selected for community consultation. Several studies highlighted the need to consider the use of alternatives to prospective informed consent to enable the conduct of research in emergency departments (EDs) in life-threatening situations. Future research should evaluate children's opinions on this topic.