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Emergency Medicine Treatment and Labor Act

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1261. News Full Text available with Trip Pro

Emergency Medical Treatment and Active Labor Act 1986 Fairfax Hospital (Falls Church, VA) In re Baby K Legal Approach Sarasota General Hospital (FL) KIE BoB Subject Heading: allowing to die/infants KIE BoB Subject Heading: allowing to die/legal aspects News 1994 3 5 0 0 2001 11 2 10 1 1994 3 5 0 0 ppublish 11644525 PMC2539700 (...) News 11644525 1994 08 08 2009 12 29 0959-8138 308 6929 1994 Mar 05 BMJ (Clinical research ed.) BMJ Two American hospitals in dilemma over brain death. 618 Charatan Fred B FB eng News England BMJ 8900488 0959-8138 E Adolescent Anencephaly Brain Death Decision Making Economics Euthanasia, Passive Hospitals Humans Infant Jurisprudence Life Support Care Mothers Parents Persistent Vegetative State Physicians United States Ventilators, Mechanical Withholding Treatment 43766 Death and Euthanasia

1994 BMJ : British Medical Journal

1262. Screening and treatment of gestational diabetes melliitus in pregnant women

the National Horizon Scanning Unit, Adelaide Health Technology Assessment, Department of Public Health, Mail Drop 511, University of Adelaide, South Australia, 5005.PRIORITISING SUMMARY REGISTER ID: 000177 NAME OF TECHNOLOGY: SCREENING AND TREATMENT GESTATIONAL DIABETES PURPOSE AND TARGET GROUP: DETECTION AND TREATMENT OF GESTATIONAL DIABETES MELLITUS IN PREGNANT WOMEN STAGE OF DEVELOPMENT (IN AUSTRALIA): Yet to emerge ? Established Experimental Established but changed indication or modification (...) diagnosed with GDM are often intensively managed with increased obstetric monitoring, dietary regulation, and in some cases insulin therapy despite a lack of conclusive evidence for closer monitoring and treatment (Tuffnell et al 2003). Until recently there was inconclusive evidence that it results in any significant improvement in perinatal outcomes and some studies (level II intervention evidence) have demonstrated no evidence for improved perinatal outcomes (Tuffnell et al 2003, Rumbold and Crowther

2005 Australia and New Zealand Horizon Scanning Network

1263. Treatment and recommendations for homeless people with asthma

that homeless patients' complex health and social conditions complicate history taking, diagnosis, and treatment. • ER/ acute care visits – Ask how and when patient uses emergency rooms, outreach sites, and other health care facilities to assess symptom control, treatment adequacy, and potential for primary care. Physical examination • Nasal exam – Assess for nasal inflammation or signs of chronic sinusitis secondary to drug inhalation, which may complicate asthma control. • Mental health status – Assess (...) corticosteroids – Discuss importance of controller medications at each visit, but realize homeless clients may value quick relief over prevention and may not use ICS. • Short-acting beta agonists – Recognize potential for misuse and monitor number of inhalers used. Recognize that patients may be obtaining additional inhalers at emergency rooms, outreach sites, or other facilities. • Long-acting beta agonists – Assess patient's ability to use these correctly; prescribe cautiously or not at all if they may

2008 National Health Care for the Homeless Council

1264. Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

are currently the preferred therapy in acute headache management. Some agents, such as the triptans, are speci?c agonists at the 5-HT1 receptor, whereas other medications, such as dihydroergotamine, prochlorperazine, and metoclopramide, act at a variety of 5-HT and other aminergic receptors. 5,9 There are no prospective randomized controlled trials, evidence from meta-analysis from randomized controlled trials, or well-designed cohort studies to support or refute the practice of using response to therapy (...) status, a normal funduscopic examination, and no meningeal signs are theoretically the best candidates for the “lumbar puncture without CT” strategy. To characterize patients who could safely undergo a lumbar puncture without prior neuroimaging, researchers at Duke University Medical Center, in a Class II study, asked internal medicine residents supervised by ED attendings to complete standard forms before CT scan of all patients who presented to the ED and needed an emergent lumbar puncture. 80

2008 Congress of Neurological Surgeons

1265. Pain Management Options During Labour

opioid is ultra-short acting due to its rapid metabolism by nonspecific esterases in the blood and other tissues. It is occasionally used for labor analgesia as its short half life (3 minutes) has advantages for the mother and fetus. Remifentanil has a rapid onset (peak effect 60-90 seconds) and rapidly crosses the placenta to the fetus where it is rapidly Pain Management Options during Labour October 2007 Page 17 of 29 metabolized and redistributed. Because of its rapid metabolism and individual (...) epidural – medication is adjusted to allow for ambulation. Use a low-dose technique so there is no motor block or risk of postural hypotension. The woman should meet the criteria for walking epidurals (see section 7.6, page 25). H. Local Anesthetic Agents The drug concentration and volume of local anesthetics, opioids, and epinephrine used to initiate epidural analgesia will depend on the stage of labour and the woman's preference/need for analgesia. For example, in early labour 12 - 14 ml of 0.1

2007 British Columbia Perinatal Health Program

1266. On-call specialists and higher level of care transfers in California emergency departments. (Abstract)

On-call specialists and higher level of care transfers in California emergency departments. To survey California emergency department (ED) medical directors' impressions of on-call specialist availability and higher level of care (HLOC) transfer needs and difficulties and changes since the passage of the Emergency Medicine Treatment and Active Labor Act (EMTALA) final rule in 2003.The authors conducted a survey of all California ED medical directors from February to June 2006 with regard (...) to the composition of the ED on-call panel and need for HLOC transfer. ED demographic data were obtained from the California Office of Statewide Health Planning and Development.Overall response rate was 243 of 347 (70%). More than 80% of respondent EDs reported having internal medicine, obstetrics/gynecology (OB/GYN), and pediatrics on call. However, fewer than 60% of EDs reported cardiac surgery, otolaryngology, neurosurgery, plastic surgery, or vascular surgery on call. Specialists were less likely

2008 Academic Emergency Medicine

1267. Legal issues in the practice of critical care medicine: a practical approach. (Abstract)

of medical malpractice, informed consent, the law relating to research in critical care, Emergency Medical Treatment and Active Labor Act, the False Claims Act, peer review, state board disciplinary issues, and the Health Insurance Portability and Accountability Act; in addition, relevant procedural considerations will be briefly summarized. (...) Legal issues in the practice of critical care medicine: a practical approach. The intensive care unit is characterized by severely ill patients who frequently succumb to their disease, despite complex modern therapies and the best efforts of dedicated care teams. Although critical care is not historically characterized as a high-risk medical specialty with respect to litigation, the urgency, complexity, and invasive nature of intensive care unit care clearly increases legal risk exposure

2007 Critical Care Medicine

1268. Comparison of Long- and Short-Acting Diuretics in Congestive Heart Failure

of Health, Labour and Welfare, Japan Information provided by (Responsible Party): Tohru Masuyama, Hyogo College of Medicine Study Details Study Description Go to Brief Summary: The purpose of this study is to compare therapeutic effects of furosemide, a short-acting loop diuretic, and azosemide, a long-acting one, in patients with heart failure, and to test our hypothesis that long-acting diuretics are superior to short-acting types in heart failure. Condition or disease Intervention/treatment Phase (...) Congestive Heart Failure Drug: furosemide Drug: azosemide Phase 4 Detailed Description: The mortality and morbidity of heart failure are still high despite emerging evidences that have shown beneficial effects of ACE inhibitor, beta-blocker, ARB, and aldosterone receptor antagonist. Diuretics are the most prescribed in heart failure patients in attenuating symptoms due to fluid retention, and diuretics are recommended as essential medicines in patients with heart failure symptoms and/or fluid retention

2006 Clinical Trials

1269. Baby doe redux? The Department of Health and Human Services and the Born-Alive Infants Protection Act of 2002: a cautionary note on normative neonatal practice. Full Text available with Trip Pro

. In April 2005, the US Department of Health and Human Services (DHHS) brought life to the BAIPA, announcing: "As a matter of law and policy, [DHHS] will investigate all circumstances where individuals and entities are reported to be withholding medical care from an infant born alive in potential violation of federal statutes." The agency issued instructions to state officials on how the definitional provision within the BAIPA interacts with the Emergency Medical Treatment and Labor Act (EMTALA (...) that "at the time of delivery... the medical condition and prognosis of the newly born infant should be assessed. At that point decisions about withholding or discontinuing medical treatment that is considered futile may be considered by... providers in conjunction with the parents acting in the best interest of their child." However, most pediatricians skilled in screening and resuscitation are not currently called on to perform this function when the gestational age of a nonviable fetus is reasonably certain

2005 Pediatrics

1270. The cost of an emergency department visit and its relationship to emergency department volume. (Abstract)

and somewhat dated and fails to differentiate between trauma and nontrauma hospitals. We believe a careful review of these questions is necessary because several changes (greater managed care penetration, increased price competition, cost of compliance with Emergency Medical Treatment and Active Labor Act regulations, and so on) may have significantly altered ED economics in recent years.We use a 2-pronged approach, 1 based on descriptive analyses of publicly available accounting data and 1 based (...) The cost of an emergency department visit and its relationship to emergency department volume. This article addresses 2 questions: (1) to what extent do emergency departments (EDs) exhibit economies of scale; and (2) to what extent do publicly available accounting data understate the marginal cost of an outpatient ED visit? Understanding the appropriate role for EDs in the overall health care system is crucially dependent on answers to these questions. The literature on these issues is sparse

2005 Annals of Emergency Medicine

1271. Are patients being transferred to level-I trauma centers for reasons other than medical necessity? Full Text available with Trip Pro

Are patients being transferred to level-I trauma centers for reasons other than medical necessity? In the United States, the Emergency Medical Treatment and Active Labor Act defines broad guidelines regarding interhospital transfer of patients who have sought care in the emergency department. However, patient transfers for nonmedical reasons are still considered a common practice. The purpose of this study was to evaluate the possible risk factors for hospital transfer in a population (...) of patients unlikely to require transfer to a level-I center for medical reasons.A retrospective case-control national database study was performed with use of data from the National Trauma Data Bank (version 4.3). The study group consisted of patients with low Injury Severity Scores (< or =9) who were transferred to a level-I trauma center from another hospital. The controls were patients with low Injury Severity Scores who were treated at any hospital that was lower than a level-I trauma center and were

2006 The Journal of Bone and Joint Surgery. American Volume

1272. Medical staff knowledge of EMTALA at a large, tertiary-care hospital. (Abstract)

Medical staff knowledge of EMTALA at a large, tertiary-care hospital. The study objective was to determine what percentage of a hospital's medical staff have heard of the Emergency Medical Treatment and Active Labor Act (EMTALA) statute, and of those who have heard of it, to determine the extent of their knowledge. A questionnaire was mailed to 600 members of the active medical staff of an urban, 900-bed, private, tertiary-care hospital asking if they had ever heard of the EMTALA statute (...) were skewed toward older ages. Approximately one-third (34.5%) took ED call at least monthly. Only 29.3% had ever heard of EMTALA. There was a significant linear correlation between on-call frequency and positive knowledge of the law, but of those who took call at least monthly, 50% had never heard of EMTALA. The average score on the 20-question quiz was 69%. Questions concerning definition of a transfer, definition of an emergency medical condition, investigations of EMTALA, on-call staff

2003 American Journal of Emergency Medicine

1273. Requests for 692 transfers to an academic level I trauma center: implications of the emergency medical treatment and active labor act. (Abstract)

Requests for 692 transfers to an academic level I trauma center: implications of the emergency medical treatment and active labor act. The Emergency Medical Treatment and Active Labor Act (EMTALA) effectively requires Level I trauma centers (TC) to accept all transfers for a higher level of care if capacity exists. We hypothesized that EMTALA would burden a Level I TC by a selective referral of a poor payer mix of primarily nonoperative patients.All transfer calls (December 2003 and September

2007 Journal of Trauma

1274. Emergency Medical Treatment and Active Labor Act and trauma triage. (Abstract)

Emergency Medical Treatment and Active Labor Act and trauma triage. The Emergency Medical Treatment and Active Labor Act (EMTALA) was conceived as a means to ensure that patients with emergent conditions would receive stabilizing care and to avert the potentially dangerous, economically driven, interhospital transfer of patients. This legislation and its subsequent application arrived near the time that regional and statewide trauma systems were established. Trauma systems were developed (...) cannot accomplish this task, secondary triage from a nondesignated or lower-level hospital to the higher-level trauma center is needed. EMTALA has served as a driver to change the priority for secondary triage from addressing the needs of the severely injured patient to filling community hospital surgical specialist emergency department on-call coverage gaps for less severely injured patients. Further, legal action associated with claims of EMTALA violations has needlessly extended medical

2006 Prehospital emergency care

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