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Burk BG, Penherski P, Snider K, Lewellyn L, Mattox L, Polancich S, Fargason R, Waggoner B, Caine E, Hand W, Eagleson RM, Birur B. Use of a Novel Standardized Administration Protocol Reduces Agitation Pro Re Nata (PRN) Medication Requirements: The Birmingham Agitation Management (BAM) Initiative. Ann Pharmacother 2023; 57:397-407. [PMID: 35950625 DOI: 10.1177/10600280221117813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Agitation management is a principal challenge on inpatient psychiatric units. Overreliance on common prescribing strategies of pro re nata (PRN) medication administration is problematic, given the tendencies to have overlapping or unclear indications. OBJECTIVE Piloted project to determine whether a standardized protocol for agitation intervention may reduce PRN medication administration. METHODS The Birmingham Agitation Management (BAM) interdisciplinary team uniquely connected the Brøset Violence Checklist (BVC) for assessment of agitation severity to a standardized PRN medication order set. Nurses on the piloted unit were trained on how to score the BVC and administer medications. Patients were assessed by the BVC every 4 hours and, based on their score, would receive no medication, low-dose benzodiazepine, high-dose benzodiazepine, or high-dose benzodiazepine plus antipsychotic. The primary end point compared the number of PRNs administered after novel protocol implementation with a retrospective cohort. Secondary measures included analysis of medication-related effects, seclusion, and physical restraint rates. RESULTS 377 patients were included in the final analyses (184 pre-BAM, 193 BAM intervention group). No significant differences were seen in patient characteristics between groups. The total number of PRNs administered decreased by 42.5%, with both the mean and median number of administrations decreasing significantly (95% confidence interval [CI] = [1.68-5.75]; P < 0.001). A trend was noted between the number of PRNs administered and seclusion rates, but did not reach statistical significance (95% CI = [-7.28 to 60.31]; P = 0.124). CONCLUSIONS In seemingly the first initiative of its kind, we found that a standardized agitation management protocol can help decrease the total number of PRN administrations for agitation without worsening of restraint rates and may possibly reduce the risk of adverse effects. These results require validation in specific, larger populations.
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Affiliation(s)
- Bradley G Burk
- Department of Pharmacy, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Peter Penherski
- Department of Psychiatry, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Kendall Snider
- Department of Regulatory Services, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Lesli Lewellyn
- Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Lisa Mattox
- Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Shea Polancich
- Department of Regulatory Services, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.,Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.,School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Fargason
- Department of Psychiatry, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Barry Waggoner
- Department of Clinical Informatics, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Elizabeth Caine
- Department of Hospital Administration, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Wren Hand
- Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Reid M Eagleson
- Department of Nursing, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Badari Birur
- Department of Psychiatry, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Broughton D, Scheaffer S, Skaznik-Wikiel M, Halabi J, Govero J, Caine E, Diamond M, Moley K. ZIKA virus exhibits tropism to the ovary and increases follicular apoptosis in a mouse model. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Knowles R, Laxton V, Caine E, Verran A, Uddin A, Hartley R, Wade M, Galliver M, Rahman A. 7DELIRIUM: DIAGNOSIS, PREVENTION AND MANAGEMENT. A MULTIDISCIPLINARY PROBLEM WITH A MULTIDISCIPLINARY SOLUTION. Age Ageing 2016. [DOI: 10.1093/ageing/afw024.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case-controlled psychological autopsy approach. METHOD Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization. RESULTS Eighty-six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy-seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One-third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls. CONCLUSION Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late-life suicide in the Chinese population of Hong Kong, similar to findings in western studies.
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Affiliation(s)
- H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, and Tai Po Hospital, Tai Po, Hong Kong, P.R. China.
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Abstract
Magnetic analyses of hippocampal material from deceased normal and epileptic subjects, and from the surgically removed epileptogenic zone of a living patient have been carried out. All had magnetic characteristics similar to those reported for other parts of the brain [6]. These characteristics along with low temperature analysis indicate that the magnetic material is present in a wide range of grain sizes. The low temperature analysis also revealed the presence of magnetite through manifestation of its low temperature transition. The wide range of grain sizes is similar to magnetite produced extracellularly by the GS-15 strain of bacteria and unlike that found in magnetotactic bacteria MV-1, which has a restricted grain size range. Optical microscopy of slices revealed rare 5-10 micron clusters of finer opaque particles, which were demonstrated with Magnetic Force Microscopy to be magnetic. One of these was shown with EDAX to contain AI, Ca, Fe, and K, with approximate weight percentages of 55, 19, 19, and 5, respectively.
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Affiliation(s)
- J R Dunn
- Department of Geological Sciences, University of California at Santa Barbara 93106
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Sinclair D, Ballantyne F, Shanley S, Caine E, O'Reilly D, Shenkin A. Estimation of paraproteins by immunoturbidimetry and electrophoresis followed by scanning densitometry. Ann Clin Biochem 1990; 27 ( Pt 4):335-7. [PMID: 2119564 DOI: 10.1177/000456329002700409] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A comparison of paraprotein estimation by immunoturbidimetry (IT) and electrophoresis followed by scanning densitometry (EFD) showed significant differences in concentration for IgG, IgA, and IgM paraproteins. Overestimation of IgM paraproteins by IT was particularly marked. Our data suggest that both techniques should be used for IgG and IgA paraproteins but for IgM paraproteins IT was found to be unsuitable and EFD is the method of choice.
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Affiliation(s)
- D Sinclair
- Institute of Biochemistry, Royal Infirmary, Glasgow, UK
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Shoulson I, Odoroff C, Oakes D, Behr J, Goldblatt D, Caine E, Kennedy J, Miller C, Bamford K, Rubin A. A controlled clinical trial of baclofen as protective therapy in early Huntington's disease. Ann Neurol 1989; 25:252-9. [PMID: 2524992 DOI: 10.1002/ana.410250308] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We carried out a controlled clinical trial to examine the potential of baclofen to slow the functional decline of patients with early Huntington's disease (HD). The basis of the trial was: (1) the hypothesis that excitatory amino acid neurotransmission mediates the neuronal degeneration of HD, (2) preclinical evidence that baclofen retards corticostriatal release of glutamate and aspartate, and (3) reports that baclofen produces short-term clinical benefits in some HD patients. Sixty patients with early HD were randomized to chronic baclofen, 60 mg/day, or placebo treatments and followed systematically for up to 42 months. Total functional capacity was not favorably influenced by baclofen treatment. Factors that contributed, although nonsignificantly, to a more rapid rate of total functional capacity decline included younger age (less than 35 years), earlier stage (stage I) of illness, paternal inheritance of the HD gene, and baclofen treatment. Our patients declined at a pace slower than that observed in other prospective studies, a finding likely due to selection criteria, avoidance of neuroleptic therapy, and strong psychosocial support.
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Affiliation(s)
- I Shoulson
- Department of Neurology, University of Rochester Medical Center, NY 14642
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Kurlan R, Caine E, Rubin A, Nemeroff CB, Bissette G, Zaczek R, Coyle J, Spielman FJ, Irvine C, Shoulson I. Cerebrospinal fluid correlates of depression in Huntington's disease. Arch Neurol 1988; 45:881-3. [PMID: 2456053 DOI: 10.1001/archneur.1988.00520320071018] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patients with Huntington's disease (HD) commonly have concomitant depressive disorders. Prompted by reports of elevated corticotropin releasing factor (CRF) and reduced 5-hydroxyindoleacetic acid (5-HIAA) concentrations in lumbar cerebrospinal fluid (CSF) of patients with major depression, these CSF constituents were examined in 56 nonmedicated patients who were in the early stages of HD. Elevated CRF concentrations were found in patients with HD in comparison with a control group of 21 subjects without neurologic illness. The CSF 5-HIAA concentrations in patients with HD did not differ from that in four normal volunteers. Patients with HD who had depressive disorders (major depression or dysthymia) did not differ from those without depression with respect to CSF 5-HIAA or CRF concentration. However, a positive correlation was observed between severity of major depression and CRF concentration. These findings suggest that the depression associated with HD may differ neurochemically from that seen in other major depressive disorders, and support the notion that clinically significant depressive symptoms reflect heterogeneous pathophysiologic conditions with different neurochemical correlates.
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Affiliation(s)
- R Kurlan
- Department of Neurology, University of Rochester, School of Medicine, NY 14642
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