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Objective: To compare commercial insurance payments for outpatient total knee and hip replacement surgeries performed in hospital outpatient departments (HOPDs) and in ambulatory surgery centers (ASCs). Data Sources: A large national claims database that contains information on actual prices paid to providers over the period 2014-2017. Data Collection: We identified all patients receiving total knee replacement surgery and total hip replacement surgery in HOPDs and in ASCs for each of the 4 years. Study Design: For each year, we conducted descriptive and statistical patient-level analyses of the facility component of payments to HOPDs and to ASCs. Principal Findings: For each procedure and for each year, ASC payments exceeded HOPD payments by a wide margin; however, the gap across settings declined over time. In 2014, knee replacement payments to HOPDs (n = 67) were $6016 compared to $23 244 in ASCs (n = 68). By 2017, payments to HOPDs (n = 223) had grown to $10 060 compared to $18 234 in ASCs (n = 602). Similarly, for hip replacements, HOPD payments (n = 43) rose from $6980 in 2014 to $11139 in 2017 (n = 206) and in ASCs fell from $28 485 in 2014 (n = 82) to $18 595 in 2017 (n = 465). Conclusions: Results suggest that for total joint replacement, common perceptions of cost savings from transition of services from hospitals to ASCs may be misguided. KEYWORDS ambulatory surgery centers, hospitals, joint replacement, outpatient, payments, 1 | INTRODUCTION Reorganization of health care delivery is a key factor in recent efforts to constrain the growing cost of health care in the United States. Surgery, a costly [...]

Objective: One potential benefit of greater electronic health information exchange is a reduction in the effort required for patients to switch between providers. We therefore assessed whether hospital participation in health information organizations (HIOs) led to increased patient sharing. Data Sources: Secondary data from 2010 to 2016. Study Design: Using hospital-pair and year fixed effects regression models, we assessed change in patient sharing volume following HIO participation by hospitals and compared the effect by the level of market competition and by hospital size. Data Extraction Methods: We used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016. Principal Findings: The volume of patients shared between hospitals increased by 2.6 percent when both hospitals participated in a health information organization (P = .008, 95% CI: 0.7%-4.5%). This increase was greater in competitive markets (3.1 percent increase, P = .03 95% CI: 0.3%-5.9%) and between large hospitals (4.3 percent increase, P = .007 95% CI: 1.2%-7.3%). Participation by only one hospital in a pair had no effect on patient sharing. Conclusions: Our results suggest that an important policy goal motivating the investment in health information exchange has been at least partially achieved. However, our results also support hospital concerns about the competitive implications of engaging in health information exchange. HIO participation appears to facilitate patient movement between hospitals, likely by lowering switching costs and resulting in greater competition. KEYWORDS competition, health information exchange, health information technology, hospitals, interoperability, 1 | INTRODUCTION Over the past decade, a wide array of public and private sector efforts have sought to increase the level of electronic health information exchange (HIE) between health [...]

2020 MAY 23 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Heart Disorders and Diseases - Heart Attack is [...]

2019 MAY 2 (NewsRx) -- By a News Reporter-Staff News Editor at Women's Health Weekly -- Investigators discuss new findings in Oncology - Breast Cancer. According to news reporting from [...]

Central DuPage Hospital in suburban Chicago recruited Barbara Buttin, M.D., a gynecologic oncologist, earlier this year. What made her a catch worth having is her robotic surgery skills. CDH plans [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.03.043 Byline: Frank Xavier Scheuermeyer (a), Jim Christenson (a), Grant Innes (b), Barb Boychuk (a), Eugenia Yu (a), Eric Grafstein (a) Abstract: Emergency department (ED) crowding has been associated with a variety of adverse outcomes. Current guidelines suggest that patients with potentially ischemic chest pain should undergo rapid assessment and treatment in a monitored setting to optimize the diagnosis of acute coronary syndrome. These patients may be at high risk of incorrect diagnosis and adverse events when their evaluation is delayed because of crowding. To mitigate crowding-related delays, we developed processes that enabled emergency physicians to evaluate potentially sick patients in the waiting room when all nurse-staffed stretchers are occupied. The objective of this study was to investigate the safety of waiting room chest pain evaluation. Author Affiliation: (a) Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada (b) Division of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, Alberta, Canada Article History: Received 26 November 2009; Revised 6 March 2010; Accepted 30 March 2010 Article Note: (footnote) Supervising editor: David L. Schriger, MD, MPH, Author contributions: FXS and JC conceived the study and designed the trial. JC, GI, BB, and EG supervised the conduct of the trial and data collection. BB and EY managed the database. FXS provided statistical analysis and drafted the article. All authors contributed substantially to its revision. FXS takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement., Publication date: Available online May 23, 2010., Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com., See page 456 for the Editor's Capsule Summary of this article., Provide feedback on this article at the journal's Web site, www.annemergmed.com.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.03.043 Byline: Frank Xavier Scheuermeyer (a), Jim Christenson (a), Grant Innes (b), Barb Boychuk (a), Eugenia Yu (a), Eric Grafstein (a) Abstract: Emergency department (ED) crowding has been associated with a variety of adverse outcomes. Current guidelines suggest that patients with potentially ischemic chest pain should undergo rapid assessment and treatment in a monitored setting to optimize the diagnosis of acute coronary syndrome. These patients may be at high risk of incorrect diagnosis and adverse events when their evaluation is delayed because of crowding. To mitigate crowding-related delays, we developed processes that enabled emergency physicians to evaluate potentially sick patients in the waiting room when all nurse-staffed stretchers are occupied. The objective of this study was to investigate the safety of waiting room chest pain evaluation. Author Affiliation: (a) Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada (b) Division of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, Alberta, Canada Article History: Received 26 November 2009; Revised 6 March 2010; Accepted 30 March 2010 Article Note: (footnote) Supervising editor: David L. Schriger, MD, MPH, Author contributions: FXS and JC conceived the study and designed the trial. JC, GI, BB, and EG supervised the conduct of the trial and data collection. BB and EY managed the database. FXS provided statistical analysis and drafted the article. All authors contributed substantially to its revision. FXS takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement., Publication date: Available online May 23, 2010., Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com., See page 456 for the Editor's Capsule Summary of this article., Provide feedback on this article at the journal's Web site, www.annemergmed.com.

Cardiac catheterization labs are typically stressful places to work. Days can be hectic and unpredictable, staff must constantly juggle schedules in order to slot emergent and urgent cases between scheduled [...]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.02103.x Keywords: hospital at home; hospital care; functional status; activities of daily living; instrumental activities of daily living Abstract: OBJECTIVES: To compare differences in the functional outcomes experienced by patients cared for in Hospital at Home (HaH) and traditional acute hospital care. DESIGN: Survey questionnaire of participants in a prospective nonrandomized clinical trial. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbations of chronic heart failure or chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in HaH and 130 in an acute care hospital. INTERVENTION: Treatment in a HaH care model that substitutes for care provided in the traditional acute care hospital. MEASUREMENTS: Change in activity of daily living (ADL) and instrumental activity of daily living (IADL) scores from 1 month before admission to 2 weeks post admission to HaH or acute hospital and the proportion of groups that experienced improvement, no change, or decline in ADL and IADL scores. RESULTS: Patients treated in HaH experienced modest improvements in performance scores, whereas those treated in the acute care hospital declined (ADL, 0.39 vs -0.60, P=.10, range -12.0 to 7.0; IADL 0.74 vs -0.70, P=.007, range -5.0 to 10.0); a greater proportion of HaH patients improved in function and smaller proportions declined or had no change in ADLs (44% vs 25%, P=.10) or IADLs (46% vs 17%, P=.04). CONCLUSION: HaH care is associated with modestly better improvements in IADL status and trends toward more improvement in ADL status than traditional acute hospital care. Author Affiliation: (*)Division of Geriatric Medicine, School of Medicine and ([dagger])Department of Health Policy and Management, School of Public Health, The Johns Hopkins University, Baltimore, Maryland ([double dagger])Portland Veterans Administration Medical Center, Portland, Oregon (s.)Division of General Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon ([parallel])Division of Geriatrics, Department of Medicine, State University of New York, Buffalo, New York (#)Independent Health, Buffalo, New York (**)Univera Health, Buffalo, New York; and ([dagger][dagger])Division of Geriatrics, Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts. Article note: Address correspondence to Bruce Leff, Johns Hopkins University School of Medicine, Johns Hopkins Care Center, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: bleff@jhmi.edu

Research Objective. To compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs). Data Sources. Patient-level ambulatory surgery (1997-2004), hospital discharge (1997-2004), and vital statistics data (1997-2004) for the state of Florida were assembled and analyzed. Study Design. We used a pooled, cross-sectional design. Logistic regressions with time fixed effects were estimated separately for the 12 most common ambulatory surgical procedures. Our quality outcomes were risk-adjusted 7-day and 30-day mortality and 7-day and 30-day unexpected hospitalizations. Risk adjustment for patient demographic characteristics and severity of illness were calculated using the DCG/HCC methodology adjusting for primary diagnosis only and separately for all available diagnoses. Principal Findings. Although neither ASCs nor HOPDs performed better overall, we found some difference by procedure that varied based on the risk-adjustment approach used. Conclusions. There appear to be important variations in quality outcomes for certain procedures, which may be related to differences in organizational structure, processes, and strategies between ASCs and HOPDs. The study also confirms the importance of risk-adjustment for comorbidities when using administrative data, particularly for procedures that are sensitive to differences in severity. Key Words. Quality, mortality, hospitalization, outpatient surgery, risk adjustment, Over the past few decades, several factors including improvements in medical technology, anesthesia, and pain management have facilitated the push of surgical services to outpatient facilities (Medicare Payment Advisory Commission [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2006.10.008 Byline: Manesh R. Patel (a), Anita Y. Chen (a), Matthew T. Roe (a), E. Magnus Ohman (a), L. Kristin Newby (a), Robert A. Harrington (a), Sydney C. Smith (b), W. Brian Gibler (c), James E. Calvin (d), Eric D. Peterson (a) Keywords: Acute coronary syndromes; Patient care; Quality improvement Abstract: Although adherence to guidelines recommendations is assumed to be more difficult for nonacademic community hospitals, patterns of adherence have not been evaluated by hospital type. We sought to identify hospital characteristics associated with high levels of adherence in order to gain insight into successful processes of care. Author Affiliation: (a) Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (b) University of North Carolina at Chapel Hill, Chapel Hill (c) University of Cincinnati School of Medicine, Cincinnati, Ohio (d) Rush University Medical Center, Chicago, Ill. Article Note: (footnote) CRUSADE is a National Quality Improvement Initiative of the Duke Clinical Research Institute. CRUSADE is funded by the Schering-Plough Corporation. The Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides additional funding support. Millennium Pharmaceuticals, Inc. also funded this research.

Web sites sponsored by states are enabling people to compare hospital and physician costs and performances. The issue of whether such state efforts to create Web sites that offer quality and cost comparison shopping are worth the political hassle it takes to get them up and running is discussed.

Study objective: COPD and cardiovascular disease (CVD) share common risk factors. We undertook to estimate rates of hospitalization and death from CVD in COPD patients relative to the general population. [...]

EXECUTIVE SUMMARY In many developed countries, including the United States and the United Kingdom, the relationships between doctors and hospital managers are strained. The purposes of this article are to [...]

Objective. To understand differences in length of stay for asthma patients between New York State and Pennsylvania across children's and general hospitals in order to better guide policy. Data Sources/Study Setting. All pediatric admissions for asthma in the states of Pennsylvania and New York using claims data obtained from each state for the years 1996-1998, n = 38,310. Study Design. A retrospective cohort design to model length of stay (LOS), the probability of prolonged stay, conditional length of stay (CLOS or the LOS after stay is prolonged), and the probability of readmission, controlling for patient factors, state, location and hospital type. Analytic Methods. Logit models were used to estimate the probability of prolonged stay and readmission. The LOS and the CLOS were estimated with Cox regression. Model variables included comorbidities, income, race, distance from hospital, and insurance type. Prolonged stay was based on a Hollander-Proschan "New-Worse-Than-Used" test, corresponding to a three-day stay. Principal Findings. The LOS was longer in New York than Pennsylvania, and the probabilities of prolonged stay and readmission were much higher in New York than Pennsylvania. However, once an admission was prolonged, there were no differences in CLOS between states (when readmissions were not added to the LOS calculation). In both states, children's hospitals and general hospitals had similar adjusted LOS. Conclusions. Management of asthma appears more efficient in Pennsylvania than New York: Less severe patients are discharged faster in Pennsylvania than New York; once discharged, patients are less likely to be readmitted in Pennsylvania than New York. However, once a stay is prolonged, there is little difference between New York and Pennsylvania, suggesting medical care for severely ill patients is similar across states. Differences between children's and general hospitals were small as compared to differences between states. We conclude that policy initiatives in New York, and other states, should focus their efforts on improving the care provided to less severe patients in order to help reduce overall length of stay. Key Words. Length of stay, conditional length of stay, prolonged stay, asthma, pediatrics, outcomes research, Asthma is the most common serious chronic disease of the pediatric population (Newacheck and Taylor 1992; Goodman, Stukel, and Chang 1998; Mannino et al. 1998). Annually, there are approximately 200,000 [...]

Objective. To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades. Data Sources/Study Setting. Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n = 504). Study Design. Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression. Data Collection/Extraction Methods. Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts. Principal Findings. The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p Conclusions. (1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care. Key Words. Primary care, health system assessment, health reform, The World Health Organization (WHO) has recently proposed new methods for assessing the performance of national health systems (World Health Organization 2000). In spite of criticism of the methodologies employed [...]

Byline: Adam J Singer (*), Peter B Richman (a ), Agnes Kowalska (*), Henry C Thode (*) Abstract: Study objective: To compare patient and practitioner assessments of pain associated with commonly performed emergency department procedures and use of anesthetics before these procedures. Methods: This was a prospective, observational, cross-sectional study conducted at a university-based ED with a convenience sample of ED patients. Research assistants recorded the procedure performed and historical and demographic information on standardized data collection instruments. After each procedure, both the patient and practitioner independently recorded assessments of patient pain on a 100-mm visual analog scale (VAS). Use of preprocedure anesthetics and patient preferences regarding their use were also identified. Categorical variables were analyzed by I[degrees].sup.2 tests. Patient and practitioner VAS scores were compared using a paired t test; [alpha] was preset at .05. Correlation coefficients were calculated to assess correlation between patient and practitioner pain scores. Results: A total of 1, 171 procedures were evaluated for the 15 most common procedures performed. The mean patient age was 42.8[+ or -]18.7 years and 46.1% were male. Overall, the mean patient VAS was 20.8 mm[+ or -]25.1 mm; the mean practitioner VAS was 23.5 mm[+ or -]20.3 mm. The mean difference between groups was 3.0 mm (95% confidence interval [Cl], 1.3 to 4.1). Correlation between patient and practitioner pain scores for individual procedures was poor to fair (r=26 to .68). The most painful procedures according to patients in descending order were nasogastric intubation, abscess drainage, fracture reduction, and urethral catheterization. Local anesthetics were administered in 12.8% of procedures yet would be requested before similar future procedures by 17.1% of patients. Patients who would choose local anesthetics in the future gave higher pain scores than those who would not (43.3 mm versus 16.3 mm; mean difference=27.0 mm, 95% Cl, 22.2 to 31.8 mm). Conclusion: The most painful procedures for ED patients were nasogastric intubation, incision and drainage of abscesses, fracture reduction, and urethral catheterization. Although practitioners also identified these procedures as most painful, the correlation between patient and practitioner pain assessments in individual patients was highly variable. Overall use of anesthetics before these procedures was low. Practitioners should be attentive to their patients' individual anesthetic needs before performing painful procedures. Author Affiliation: (*) Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook, Stony Brook, NY, USA (a ) Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ. USA Article History: Received 28 September 1998; Revised 28 December 1998; Accepted 18 February 1999 Article Note: (footnote) * Presented in part at the annual meeting for the Society of Academic Emergency Medicine, Washington DC, May 1997.

Byline: Mark A Brandenburg, Daniel J Dire Abstract: Study objective: To determine whether venous blood gas values can replace arterial gas values in the initial emergency department evaluation of patients with suspected diabetic ketoacidosis. Methods: This prospective comparison was performed in an adult university teaching hospital ED. Samples for arterial and venous blood gas analysis were obtained during initial ED evaluations. The venous gas samples were collected with samples for other blood tests at the time of intravenous line insertion. Both arterial and venous samples were obtained before the initiation of treatment. Result: Data from 44 episodes of diabetic ketoacidosis in 38 patients were analyzed. Laboratory findings of those patients with diabetic ketoacidosis were as follows (mean[+ or -]SD): arterial pH, 7.20[+ or -].14; venous pH, 7.17[+ or -].13; serum glucose, 33.8[+ or -]16 mmol/L (609[+ or -]288 mg/dL); arterial HCO.sub.3.sup.-, 11.0[+ or -]6.0 mmol; venous HCO.sub.3.sup.-, 12.8[+ or -]5.5 mmol/L; serum CO.sub.2, 11.8[+ or -]5.0 mmol/L; and anion gap, 26.7[+ or -]7.6 mmol/L. The mean difference between arterial and venous pH values was 0.03 (range 0.0 to 0.11). Arterial and venous pH results (r=.9689) and arterial and venous HCO.sub.3.sup.- results (r=.9543) were highly correlated and showed a high measure of agreement. Conclusion: Venous blood gas measurements accurately demonstrate the degree of acidosis of adult ED patients presenting with diabetic ketoacidosis. [Brandenburg MA, Dire DH: Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Ann Emerg Med April 1998; 31:459-465.] Article History: Received 26 September 1996; Revised 20 May 1997; Revised 22 October 1997; Accepted 29 October 1997 Article Note: (footnote) [star] From the Section of Emergency Medicine & Trauma, University of Oklahoma Health Sciences Center, Oklahoma City, OK., [star][star] Address for reprints: Daniel J Dire, MD, Section of Emergency Medicine & Trauma, PO Box 26307, Room EB319, Oklahoma City, OK 73126-0307, 405-271-5135, a 47/1/88630

Byline: Andrew B Cole, Francis L Counselman Abstract: Study objective: To compare transcribed and handwritten emergency department charts for completeness of documentation. Design: Convenience sample, retrospective chart review. Setting: Level I tertiary-care referral center and primary training site for a fully accredited postgraduate year 2 through postgraduate year 4 emergency medicine residency program. Participants: Two hundred two patients admitted to telemetry or CCU/ICU with a final diagnosis of myocardial infarction, unstable angina, rule out myocardial infarction, or evaluation of chest pain from July 15, 1990, through June 30, 1991. Interventions: Each chart, unknown to the faculty and residents, was reviewed for documentation of the presence or absence of 28 critical items. Equal weight was given to each item. Two-tailed testing for independent proportions was used to determine the presence of a statistically significant difference between the transcribed and handwritten charts. In addition, the mean and SD for the number of critical items documented were determined for both the transcribed and handwritten charts. A two-tailed Student t test was used to determine the presence of a statistically significant difference. Significance was set at a P value of less than .05. Results: Ninety-four transcribed and 108 handwritten charts were reviewed. Transcribed charts contained a greater proportion of the 28 critical items than did the handwritten charts (P Article History: Received 6 June 1994; Revised 10 August 1994; Accepted 6 September 1994 Article Note: (footnote) [star] From the Department of Emergency Medicine Eastern Virginia Medical Schol, and Emergency Physicians of Tidewater, Norfolk, Virginia., [star][star] No reprints available from the authors. , a Reprint no. 47/1/62559

CANCER TREATMENT CENTER This facility is a collaboration between dedicated radiation and medical oncologists and two small, rural hospitals. Its clock tower slab and lightning rod serve as community landmarks. [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2008.03.008 Byline: Tyler W. Barrett (a), David L. Schriger (b) Abstract: Nesiritide was widely advocated as a useful therapy for heart failure patients until safety concerns were raised. Author Affiliation: (a) Vanderbilt University Medical Center, Nashville, TN (b) University of California, Los Angeles, Los Angeles, CA Article Note: (footnote) SEE RELATED ARTICLE, P. 571. , Editor's Note: You are reading the third installment of Annals of Emergency Medicine Journal Club. This bimonthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers, be they clinicians, academics, residents, or medical students, to critically appraise the literature. Answers to this Journal Club will be published in the October issue. During a 2- to 3-year cycle, we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue, but they are articles that serve the mission of covering the clinical epidemiology curriculum. Journal Club entries will be published in 2 phases. In the first phase, a list of questions about the article will be published in the issue in which the article appears. Questions are rated 'novice,' (a*) 'intermediate,' (a*) and 'advanced' (a*) so that individuals planning a journal club can assign the right question to the right student. The 'novice' rating does not imply that a novice should be able to spontaneously answer the question. 'Novice' means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. The second phase of each journal club consists of the publication of suggested answers. This will be done 5 months after the publication of the questions. However, residency directors can have immediate access to the answers for the purpose of guiding the journal club. US residency directors can access the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. International residency directors can gain access to the answers by going to http://www.emergencymedicine.ucla.edu/annalsjc/ and following the directions. Thus, if an actual journal club is conducted within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by both residents and medical students and discourage regurgitation of the published answers. It is our hope that the Journal Club will broaden Annals of Emergency Medicine's appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments. This is the first journal club in our series that considers a randomized controlled trial (RCT). For that reason, we include some basic questions about this fundamental study design. We will cover other topics about RCTs in future installments. Those planning a journal club should note that although 1a is a novice question, it requires a substantial amount of work to answer. This task could be divided among several participants.

* University of Wisconsin Hospital and Clinics in Madison, Wisc., has focused on developing some key service lines, notably transplantation, cancer, pediatric, neuroscience, and orthopedic services to differentiate its capabilities [...]

The healthcare facilities under the Indian systems of medicines registered lower growth during 1980-2012. As per the data of the Department of Ayush, Government of India the average annual growth [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.04.019 Byline: Elke Platz (a)(b), Katja Goldflam (a), Maria Mennicke (a), Emilio Parisini (b), Michael Christ (c), Christian Hohenstein (d) Abstract: Training physicians in new skills through classroom-based teaching has inherent cost and time constraints. We seek to evaluate whether Web-based didactics result in similar knowledge improvement and retention of basic ultrasonographic principles and the Extended Focused Assessment with Sonography for Trauma (EFAST) compared with the traditional method. Author Affiliation: (a) Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA (b) Harvard School of Public Health, Boston, MA (c) Department of Emergency Medicine, Klinikum Nurnberg, Nurnberg, Germany (d) Department of Anesthesiology, Klinikum Kempten Oberallgau, Kempten, Germany Article History: Received 27 September 2009; Revised 4 January 2010; Revised 13 March 2010; Revised 10 April 2010; Accepted 22 April 2010 Article Note: (footnote) Provide feedback on this article at the journal's Web site, www.annemergmed.com., Supervising editor: Peter C. Wyer, MD, Author contributions: E. Platz and KG conceived the study, designed the trial, and supervised the conduct of the trial and data collection. E. Platz obtained research funding. MC and CH undertook recruitment of participating centers and subjects. MM managed the data, including quality control. E. Parisini provided statistical advice on study design and analyzed the data. E. Platz drafted the article, and all authors contributed substantially to its revision. E. Platz takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the Esther B. Kahn Fund from the Department of Emergency Medicine, Brigham and Women's Hospital, Boston., Publication dates: Available online June 11, 2010., Please see page 661 for the Editor's Capsule Summary of this article., Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.04.019 Byline: Elke Platz (a)(b), Katja Goldflam (a), Maria Mennicke (a), Emilio Parisini (b), Michael Christ (c), Christian Hohenstein (d) Abstract: Training physicians in new skills through classroom-based teaching has inherent cost and time constraints. We seek to evaluate whether Web-based didactics result in similar knowledge improvement and retention of basic ultrasonographic principles and the Extended Focused Assessment with Sonography for Trauma (EFAST) compared with the traditional method. Author Affiliation: (a) Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA (b) Harvard School of Public Health, Boston, MA (c) Department of Emergency Medicine, Klinikum Nurnberg, Nurnberg, Germany (d) Department of Anesthesiology, Klinikum Kempten Oberallgau, Kempten, Germany Article History: Received 27 September 2009; Revised 4 January 2010; Revised 13 March 2010; Revised 10 April 2010; Accepted 22 April 2010 Article Note: (footnote) Provide feedback on this article at the journal's Web site, www.annemergmed.com., Supervising editor: Peter C. Wyer, MD, Author contributions: E. Platz and KG conceived the study, designed the trial, and supervised the conduct of the trial and data collection. E. Platz obtained research funding. MC and CH undertook recruitment of participating centers and subjects. MM managed the data, including quality control. E. Parisini provided statistical advice on study design and analyzed the data. E. Platz drafted the article, and all authors contributed substantially to its revision. E. Platz takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the Esther B. Kahn Fund from the Department of Emergency Medicine, Brigham and Women's Hospital, Boston., Publication dates: Available online June 11, 2010., Please see page 661 for the Editor's Capsule Summary of this article., Reprints not available from the authors.