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Drop Protesting And Start Your Very Own Resiquimod Promotion As A Substitute .

Of the 58 EDs, 28 (48%) were recruited from the EMNet. The median number of charts abstracted per ED was 70 (IQR?=?67�C70). Table?2 shows the ED and patient characteristics. Participating EDs had high annual visit volumes (median?=?59,108) and cared for high numbers of AMI patients (median?=?281) annually. Seventy-eight percent were affiliated with an EM residency program. Participating EDs were all urban but located in different geographic regions of the country. Ninety-one percent of the hospitals involved had cardiac catheterization laboratories. The median age of the patients was 65?years (IQR?=?54�C76?years); 62% were men, and LEE011 60% were white. Cardiac risk factors and comorbidities were common. About two-thirds of the patients presented to the ED Resiquimod within 12?hours of the onset of symptoms. Nearly half of the patients presented during daytime?hours (8:00 a.m. to 3:59 p.m.). On presentation to the ED, chest pain was the most common symptom. About one-third of the patients had ST-segment elevation on their initial ED ECGs. On lung examination, most patients did not have signs of pulmonary edema. Most patients (70%) were admitted to an inpatient unit (including coronary care unit), 27% were sent directly to the cardiac catheterization laboratory, and 2% were transferred out. Table?3 shows the item-by-item guideline-recommended care, as well as the composite guideline concordance scores. Except for aspirin use in the ED (mean concordance score?=?82), ED concordance scores of other quality measures were low: beta-blocker use, 56; timely ECG, 41; timely fibrinolytic therapy, 26; and timely ED disposition for STEMI patients, 43. Figure?2 shows the distribution of the ED composite concordance scores. The mean?��?SD score was 61?��?8, with a broad range of values (42 to 84). At the patient level, the overall concordance with guideline recommendations was also low to moderate, with a median score of 50 (IQR?=?50�C100). The median times for three timeliness measures all exceeded the benchmark target times: median for door-to-ECG time was 13?minutes (IQR?=?5�C27?minutes), door-to-needle time 45?minutes (IQR?=?28�C79?minutes), and door-to-disposition time 65?minutes (IQR?=?42�C107?minutes). Further subgroup analyses of the door-to-disposition times revealed that delays were more pronounced in patients who were transferred from selleckchem non�Cpercutaneous coronary intervention (PCI)-capable to PCI-capable facilities, compared with those who were sent directly to the on-site catheterization laboratory: median (IQR), 104 (75�C172)?minutes versus 61 (40�C103)?minutes (p?<?0.001). The ED and patient characteristics associated with guideline concordance are shown in Table?4. In the ED-level analysis (Model?1), after adjusting for several ED characteristics and aggregate patient mix, southern EDs were independently associated with lower ED composite concordance scores (beta-coefficient?=??10.3; 95% CI?=??19.4 to ?1.</div>
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