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Kennedy M, Rico JS, Liu SW, Engel KG, Ritchie CS. Emergency Palliative Care: Early Assessment of an Older Adult With a Fall and Hip Fracture. J Palliat Med 2024; 27:430-433. [PMID: 37862570 DOI: 10.1089/jpm.2023.0258] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
In this segment of the emergency department (ED) palliative care case series, we present a patient who arrives to the ED after a fall resulting in a hip fracture. He is also found to have hypernatremia and an acute kidney injury and develops delirium while in the ED awaiting an inpatient bed. The ED-based integrated geriatric palliative care program is consulted and performs a multidimensional assessment. The geriatric palliative care clinician facilitates discussion with his daughter about surgical intervention based on the patient's goals and values, diagnoses delirium, and worsening depression, creates a plan for delirium and pain management, and accelerates postdischarge planning.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet S Rico
- Division Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsten G Engel
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christine S Ritchie
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Wolf LA, Lo AX, Serina P, Chary A, Sri‐On J, Shankar K, Sano E, Liu SW. Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review. J Am Coll Emerg Physicians Open 2024; 5:e13084. [PMID: 38162531 PMCID: PMC10755799 DOI: 10.1002/emp2.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Given the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years. Methods A search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer-reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting. Results A total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full-text review. Twenty-eight were excluded for not meeting inclusion criteria, leaving 39 full-text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision-making phases of the ED care trajectory, with varying reports of usefulness for clinical decision-making. Conclusion The literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front-line medical professionals on patient-oriented outcomes, and to ensure these initiatives are acceptable for patients.
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Affiliation(s)
- Lisa A. Wolf
- Emergency Nurses AssociationSchaumburgIllinoisUSA
| | - Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Peter Serina
- Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Anita Chary
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Jiraporn Sri‐On
- Department of Emergency MedicineVajira HospitalBangkokThailand
| | - Kalpana Shankar
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Ellen Sano
- Department of Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Ouchi K, Prachanukool T, Aaronson EL, Lakin JR, Higuchi M, Liu SW, Kennedy M, Revette AC, Chary AN, Kaithamattam J, Lee B, Neville TH, Hasdianda MA, Sudore R, Schonberg MA, Tulsky JA, Block SD. The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: A mixed-method study. Acad Emerg Med 2024; 31:18-27. [PMID: 37814372 PMCID: PMC10794002 DOI: 10.1111/acem.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/20/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different. METHODS We conducted a sequential-explanatory, mixed-method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow-up interviews. We collected clinicians' self-reported approaches in code status conversations and their rationales. A survey with a 5-point Likert scale ("very unlikely" to "very likely") was used to assess the likelihood of asking about medical procedures (procedure based) and patients' values (value based) during code status conversations, followed by semistructured interviews. RESULTS Among 272 clinicians approached, 206 completed the survey (a 76% response rate). The reported approaches differed greatly (e.g., 91% of palliative care clinicians reported asking about a patient's acceptable quality of life compared to 59% of emergency medicine clinicians). Of the 206 respondents, 118 (57%) agreed to subsequent interviews; our final number of semistructured interviews included seven emergency medicine clinicians and nine palliative care clinicians. The palliative care clinicians stated that the value-based questions offer insight into patients' goals, which is necessary for formulating a recommendation. In contrast, emergency medicine clinicians stated that while value-based questions are useful, they are vague and necessitate extended discussions, which are inappropriate during emergencies. CONCLUSIONS Emergency medicine and palliative care clinicians reported conducting code status conversations differently. The rationales may be shaped by their clinical practices and experiences.
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Affiliation(s)
- Kei Ouchi
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thidathit Prachanukool
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Emily L. Aaronson
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua R. Lakin
- Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Masaya Higuchi
- Division of Palliative Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shan W. Liu
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna C. Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anita N. Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jenson Kaithamattam
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brandon Lee
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Thanh H. Neville
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Mohammad A. Hasdianda
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA
| | - Mara A. Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Susan D. Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Hayden EM, Borczuk P, Dutta S, Liu SW, White BA, Lavin-Parsons K, Zheng H, Filbin MR, Zachrison KS. Can video-based telehealth examinations of the abdomen safely determine the need for imaging? J Telemed Telecare 2023; 29:761-774. [PMID: 34142893 DOI: 10.1177/1357633x211023346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is little evidence on the reliability of the video-based telehealth physical examinations. Our objective was to evaluate the feasibility of a physician-directed abdominal examination using telehealth. This was a prospective, blinded observational study of patients >19 years of age presenting with abdominal pain to a large, academic emergency department. In addition to their usual care, patients had a video-based telehealth examination by an emergency physician early in the visit. We compared the in-person and telehealth providers' decisions on imaging. Thirty patients were enrolled and providers' recommendations for imaging were YES (telehealth: 18 (60%); in-person: 22 (73%)), UNSURE (telehealth: 9 (30%); in-person: 2 (7%)) and NO (telehealth: 6 (20%); in-person: 3 (10%)). There were 20 patients for whom both telehealth and in-person providers were not unsure; of these, 16 (80%, 95% confidence interval 56.3-94.3%) patients had a provider agreement on the need for imaging. While the use of video-based telehealth may be feasible for patients seeking emergency department care for abdominal pain, further study is needed to determine how it may be safely deployed. Currently, caution should be exercised when evaluating the need for abdominal imaging remotely.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - Pierre Borczuk
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | | | - Hui Zheng
- Department of Biostatistics, Massachusetts General Hospital, USA
| | - Michael R Filbin
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, USA
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Kennedy M, Liu SW. Geriatric Emergency Medicine: The Need Has Never Been Greater. Clin Geriatr Med 2023; 39:xv-xvii. [PMID: 37798074 DOI: 10.1016/j.cger.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Ma WL, Ma Y, Wang WH, Ding XC, Jiao Y, Liu SW, Hai L. [Analysis of the prognosis and survival of patients with acute-on-chronic liver failure]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:1051-1055. [PMID: 38016769 DOI: 10.3760/cma.j.cn501113-20230604-00243] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Objective: To explore the influencing factors and the impact of artificial liver treatment on the prognosis and survival of patients with acute-on-chronic liver failure (ACLF). Methods: Clinical data from 201 cases with ACLF from January 2016 to December 2019 was retrospectively analyzed. The survival rate was calculated by the Kaplan-Meier method, the log-rank test of univariate analysis, and the multivariate analysis of the stepwise Cox regression forward method. Results: The median survival time of patients was 6 months, and the survival rates at 6, 9, and 12 months were 51.2%, 38.3%, and 29.9%, respectively. In univariate analysis, age, presence or absence of hypertension and upper gastrointestinal bleeding, treatment method, model for end-stage liver disease (MELD) score, and cholinesterase were associated with prognosis (P < 0.05). Multivariate regression analysis results showed that MELD score was the main factor affecting the 1-year prognosis of ACLF patients (P = 0.002). Artificial liver treatment was beneficial for the 1-year prognosis of ACLF patients aged < 50 years or with a MELD score of ≥20 (P < 0.05 ). The relative risk ratio (RR) of mortality was 2.55 times higher in patients with advanced age (≥50 years old) than that of younger patients (P < 0.001). Regression analysis was performed using age as a stratification factor, and upper gastrointestinal bleeding was related to the prognosis of younger patients, while choline esterase was related to the prognosis of advanced age. Regression analysis after stratified MELD score showed that age and hypertension were related to the prognosis of patients with MELD score < 20, and treatment method and age were related to the prognosis of patients with MELD score≥20. Conclusion: Artificial liver treatment is beneficial for the 1-year prognosis of ACLF patients. Age, MELD score, hypertension, and upper gastrointestinal bleeding are independent risk factors affecting the prognosis of ACLF patients.
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Affiliation(s)
- W L Ma
- Department of Infectious Diseases, Ningxia Medical University General Hospital, Yinchuan 750004, China
| | - Y Ma
- Department of Infectious Diseases, Ningxia Medical University General Hospital, Yinchuan 750004, China
| | - W H Wang
- Department of Nutrition, Ningxia Medical University General Hospital, Yinchuan 750004, China
| | - X C Ding
- Department of Infectious Diseases, Ningxia Medical University General Hospital, Yinchuan 750004, China
| | - Y Jiao
- Department of Infectious Diseases, Ningxia Medical University General Hospital, Yinchuan 750004, China
| | - S W Liu
- Department of Infectious Diseases, Ningxia Medical University General Hospital, Yinchuan 750004, China
| | - L Hai
- Department of Infectious Diseases, Ningxia Medical University General Hospital, Yinchuan 750004, China
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Liu SW, Zhao YH, Ma J, Shen Z, Hu BH, Peng RM, Hong J. [Efficacy evaluation of 0.05% cyclosporine A and 0.1% tacrolimus eye drops in the treatment of severe dry eye associated with chronic graft-versus-host disease]. Zhonghua Yan Ke Za Zhi 2023; 59:805-813. [PMID: 37805414 DOI: 10.3760/cma.j.cn112142-20221112-00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To evaluate the effectiveness and safety of 0.05% cyclosporine A and 0.1% tacrolimus eye drops in treating severe dry eye associated with chronic graft-versus-host disease (cGVHD). Methods: This non-randomized concurrent control trial enrolled 83 eyes from 83 patients with cGVHD-associated severe dry eye. The treatment had two phases. During the initial shock treatment period (0-3 months), 44 patients received 0.05% cyclosporine A eye drops (4 times/day; group A) and 39 patients received 0.1% tacrolimus eye drops (twice/day; group B) alongside basic treatment. In the maintenance treatment period (3-6 months), both groups used 0.05% cyclosporine A eye drops (twice/day) and sodium hyaluronate. Examinations were conducted at 1, 3, and 6 months after treatment initiation, assessing the Ocular Surface Disease Index (OSDI), corneal fluorescein staining (CFS) score, and fluorescein tear break-up time (BUT) for efficacy. visual acuity and intraocular pressure (IOP) were evaluated for safety, and patients' post-medication irritation symptoms were recorded. Results: The study included 52 males and 31 females, aged (28.57±15.67) years. After 1 month of treatment, the CFS score in group A significantly decreased from 10.0 (6.0, 14.0) to 5.0 (3.0, 8.5) (P<0.001). in group B, the CFS score also significantly decreased from 10.0 (6.0, 15.0) to 6.0 (2.0, 10.0), and the BUT increased from 2.0 (1.0, 2.0) s to 2.0 (1.8, 3.3) s (P<0.001). No significant OSDI decrease was observed in either group. No significant differences were found in OSDI, CFS score, and BUT between the two groups. After 3 months, group A showed significant improvement in OSDI, CFS score, and BUT (P<0.05), while group B only demonstrated significant CFS score decrease (P<0.05). OSDI was significantly lower in group A than group B (P<0.05). No significant differences were noted in CFS score and BUT between groups. After 6 months, OSDI, CFS score, and BUT were 18.9 (9.3, 34.2), 7.0 (3.0, 8.5), and 2.0 (1.0, 3.0) s in group A, and 10.9 (3.6, 35.4), 5.5 (2.8, 10.0), and 2.0 (1.0, 10.0) s in group B. In both groups, CFS scores significantly decreased and BUT increased (P<0.05). Visual acuity improved significantly in group A at 1, 3, and 6 months (P<0.05), while no significant changes were seen in group B. Irritation symptoms were transient and self-resolving in both groups. Conclusions: Both 0.05% cyclosporine A and 0.1% tacrolimus eye drops, when combined with local glucocorticoids, exhibited significant anti-inflammatory effects, effectively and safely treating severe dry eye in cGVHD patients. Although the onset of 0.05% cyclosporine A was slower than 0.1% tacrolimus, it offered more stable long-term effects and better symptom improvement.
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Affiliation(s)
- S W Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - Y H Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - J Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - Z Shen
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - B H Hu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - R M Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - J Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
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8
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Liu WZ, Liu SW. [Review on the progress of tobacco epidemic monitoring methods]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:1661-1666. [PMID: 37875457 DOI: 10.3760/cma.j.cn112338-20230224-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Tobacco use is a major preventable contributor to premature death and disease globally. Tobacco epidemic monitoring plays a vital role in tobacco control, considered an essential component of tobacco control in the WHO Framework Convention on Tobacco Control and MPOWER package of tobacco control. In this paper, we reviewed the methods of tobacco monitoring worldwide, mainly including face-to-face surveys, telephone interviews, online questionnaire surveys, data sharing, model estimation, smoking cessation support, and the combination of multiple methods. Meanwhile, we analyzed the strengths and weaknesses of those monitoring methods. Tobacco monitoring methods vary in countries and regions. The review might provide a reference for tobacco epidemic monitoring in China.
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Affiliation(s)
- W Z Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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9
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Marill KA, Lopez S, Hark D, Spahr J, Kapadia N, Liu SW. Increased ventricular ectopy precedes Torsades de Pointes in patients with prolonged QT. J Electrocardiol 2023; 80:17-23. [PMID: 37105125 DOI: 10.1016/j.jelectrocard.2023.04.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Torsades de Pointes (TdP) is a potentially lethal ventricular tachydysrhythmia. Prolonged heartrate corrected QT interval (QTc) predicts TdP; however, with poor specificity. We performed this study to identify other predictors of TdP among patients with prolonged QTc. METHODS We performed a retrospective case control study with 2:1 matching at an urban academic hospital. We searched our hospital electrocardiogram (ECG) database for tracings with heartrate ≤ 60, QTc ≥ 500, and QRS < 120, followed by a natural language search for electronic records with "Torsades," "polymorphic VT," or similar to identify TdP cases from 2005 to 19. We identified controls from a similar ECG database search matching for QTc, heartrate, age, and sex. We compared cardiologic and historical factors, medications, laboratory values, and ECG measurements including ectopy using univariate statistics. For those cases with saved telemetry strips that included preceding beats or TdP onset, we compared ectopy and TdP onset characteristics between the ECG and telemetry strips using mixed linear modeling. RESULTS Seventy-five cases including 50 with telemetry strips and 150 controls were included. Historical, pharmacologic, laboratory, and cardiologic testing results were similar between cases and controls. The proportion of telemetry tracings with premature ventricular contractions (PVC's) preceding TdP was 0.78 compared to 0.16 for case ECG's (difference 0.62(95%CI 0.44-0.75)) and 0.10 for control ECGs (difference 0.68(95%CI 0.56-0.80)). Average telemetry heartrate was 72 and QTc 549 immediately preceding TdP, similar to the ECG values. CONCLUSIONS Clinical factors don't differentiate patients with long QTc who develop TdP, however, an increase in PVC's in patients with prolonged QTc may usefully predict imminent TdP.
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Affiliation(s)
- Keith A Marill
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Samantha Lopez
- University of Texas at Southwestern Medical Center, United States of America
| | - David Hark
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | | | - Nehal Kapadia
- Department of Biomedical Engineering, Massachusetts General Hospital, Boston, MA, United States of America
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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10
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Wu L, Chen X, Khalemsky A, Li D, Zoubeidi T, Lauque D, Alsabri M, Boudi Z, Kumar VA, Paxton J, Tsilimingras D, Kurland L, Schwartz D, Hachimi-Idrissi S, Camargo CA, Liu SW, Savioli G, Intas G, Soni KD, Junhasavasdikul D, Cabello JJT, Rathlev NK, Tazarourte K, Slagman A, Christ M, Singer AJ, Lang E, Ricevuti G, Li X, Liang H, Grossman SA, Bellou A. The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study. J Clin Med 2023; 12:4750. [PMID: 37510865 PMCID: PMC10381297 DOI: 10.3390/jcm12144750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60-74 (early elderly), 75-89 (late elderly), and ≥90 years (longevous elderly). We applied multiple machine learning approaches to identify the risk correlation trends between EDLOS and IHM, as well as boarding time (BT) and IHM. The incidence of IHM increased with age: 60-74 (2.7%), 75-89 (4.5%), and ≥90 years (6.3%). The best area under the receiver operating characteristic curve was obtained by Light Gradient Boosting Machine model for age groups 60-74, 75-89, and ≥90 years, which were 0.892 (95% CI, 0.870-0.916), 0.886 (95% CI, 0.861-0.911), and 0.838 (95% CI, 0.782-0.887), respectively. Our study showed that EDLOS and BT were statistically correlated with IHM (p < 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS ≤1 h (9.96%) vs. higher EDLOS 7 h <t≤ 8 h (1.84%). Special attention should be given to patients admitted after a short stay in the ED and a long BT, and new concepts of ED care processes including specific areas and teams dedicated to older patients care could be proposed to policymakers.
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Affiliation(s)
- Lijuan Wu
- Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Medical Research Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xuanhui Chen
- Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Anna Khalemsky
- Management Department, Hadassah Academic College, Jerusalem 91010, Israel
| | - Deyang Li
- Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Taoufik Zoubeidi
- Department of Statistics, College of Business and Economics, UAE University, Al Ain 1555, United Arab Emirates
| | - Dominique Lauque
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
- Department of Emergency Medicine, Purpan Hospital and Toulouse III University, 31300 Toulouse, France
| | - Mohammed Alsabri
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
- Department of Pediatrics, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212, USA
| | - Zoubir Boudi
- Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates
- Global Network on Emergency Medicine, Brookline, MA 02446, USA
| | - Vijaya Arun Kumar
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - James Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Dionyssios Tsilimingras
- Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Lisa Kurland
- Department of Medical Sciences, Örebro University, 70182 Örebro, Sweden
| | - David Schwartz
- Information Systems Department, Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan 529002, Israel
| | - Said Hachimi-Idrissi
- Global Network on Emergency Medicine, Brookline, MA 02446, USA
- Department of Emergency Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Geroge Intas
- Department of Critical Care, General Hospital of Nikaia Agios Panteleimon, 18454 Athens, Greece
| | - Kapil Dev Soni
- Jai Prakash Narayan Apex Trauma Center, Ring Road, New Delhi 110029, India
| | - Detajin Junhasavasdikul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | | | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School, Baystate, Springfield, MA 01199, USA
| | - Karim Tazarourte
- Department of Health Quality, University Hospital, Hospices Civils, 69002 Lyon, France
- Department of Emergency Medicine, University Hospital, Hospices Civils, 69002 Lyon, France
| | - Anna Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Michael Christ
- Department of Emergency Medicine, 6000 Lucerne, Switzerland
| | - Adam J Singer
- Department of Emergency Medicine, Renaissance Scholl of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Eddy Lang
- Department of Emergency Medicine, Emergency Medicine Cumming School of Medicine, University of Calgary, Alberta Health Services, Calgary, AB T2N 1N4, Canada
| | - Giovanni Ricevuti
- Emergency Medicine, School of Pharmacy, University of Pavia, 27100 Pavia, Italy
| | - Xin Li
- Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Huiying Liang
- Medical Big Data Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Shamai A Grossman
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
| | - Abdelouahab Bellou
- Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA
- Global Network on Emergency Medicine, Brookline, MA 02446, USA
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
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Lee S, Cavalier FR, Hayes JM, Doering M, Lo AX, Khoujah D, Howard MA, de Wit K, Liu SW. Delirium, confusion, or altered mental status as a risk for abnormal head computed tomogram findings in older adults in the emergency department: A Geriatric Emergency Department Guidelines 2.0 systematic review and meta-analysis. Am J Emerg Med 2023; 71:190-194. [PMID: 37423026 DOI: 10.1016/j.ajem.2023.06.034] [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] [Received: 02/16/2023] [Accepted: 06/17/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Altered mental status (including delirium) is a common presentations among older adults to the emergency department (ED). We aimed to report the association between altered mental status in older ED patients and acute abnormal findings on head computed tomogram (CT). METHODS A systematic review was conducted using Ovid Medline, Embase, Clinicaltrials.gov, Web of Science, and Cochrane Central from conception to April 8th, 2021. We included citations if they described patients aged 65 years or older who received head imaging at the time of ED assessment, and reported whether patients had delirium, confusion, or altered mental status. Screening, data extraction, and bias assessment were performed in duplicate. We estimated the odds ratios (OR) for abnormal neuroimaging in patients with altered mental status. RESULTS The search strategy identified 3031 unique citations, of which two studies reporting on 909 patients with delirium, confusion or altered mental status were included. No identified study formally assessed for delirium. The OR for abnormal head CT findings in patients with delirium, confusion or altered mental status was 0.35 (95% CI 0.031 to 3.97) compared to patients without delirium, confusion or altered mental status. CONCLUSION We did not find a statistically significant association between delirium, confusion or altered mental status and abnormal head CT findings in older ED patients.
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Affiliation(s)
- Sangil Lee
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, United States of America.
| | - Faithe R Cavalier
- College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, United States of America
| | - Jane M Hayes
- Harvard Affiliated Emergency Medicine Residency, Mass General Brigham, Boston, MA, United States of America
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO, United States of America
| | - Alexander X Lo
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Danya Khoujah
- Department of Emergency Medicine, Tampa AdventHealth, FL, United States of America; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Kerstin de Wit
- Department of Emergency Medicine, Queens University, Kingston, Ontario, Canada; Division of Emergency Medicine, Department of Medicine,McMaster University, Hamilton, Ontario, Canada
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
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Hayden EM, Borczuk P, Dutta S, Filbin MR, Liu SW, White BA, Kugener E, Parry BA, Horick N, Zachrison KS. Can tablet video-based telehealth assessment of the abdomen safely determine the need for abdominal imaging? A pilot study. J Am Coll Emerg Physicians Open 2023; 4:e12963. [PMID: 37193059 PMCID: PMC10182362 DOI: 10.1002/emp2.12963] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 05/18/2023] Open
Abstract
Objective There is limited evidence on the reliability of video-based physical examinations. We aimed to evaluate the safety of a remote physician-directed abdominal examination using tablet-based video. Methods This was a prospective observational pilot study of patients >19 years old presenting with abdominal pain to an academic emergency department July 9, 2021-December 21, 2021. In addition to usual care, patients had a tablet video-based telehealth history and examination by an emergency physician who was otherwise not involved in the visit. Both telehealth and in-person clinicians were asked about the patient's need for abdominal imaging (yes/no). Thirty-day chart review searched for subsequent ED visits, hospitalizations, and procedures. Our primary outcome was agreement between telehealth and in-person clinicians on imaging need. Our secondary outcome was potentially missed imaging by the telehealth physicians leading to morbidity or mortality. We used descriptive and bivariate analyses to examine characteristics associated with disagreement on imaging needs. Results Fifty-six patients were enrolled; the median age was 43 years (interquartile range: 27-59), 31 (55%) were female. The telehealth and in-person clinicians agreed on the need for imaging in 42 (75%) of the patients (95% confidence interval [CI]: 62%-86%), with moderate agreement with Cohen's kappa ((k = 0.41, 95% CI: 0.15-0.67). For study patients who had a procedure within 24 hours of ED arrival (n = 3, 5.4%, 95% CI: 1.1%-14.9%) or within 30 days (n = 7, 12.5%, 95% CI: 5.2%-24.1%), neither telehealth physicians nor in-person clinicians missed timely imaging. Conclusion In this pilot study, telehealth physicians and in-person clinicians agreed on the need for imaging for the majority of patients with abdominal pain. Importantly, telehealth physicians did not miss the identification of imaging needs for patients requiring urgent or emergent surgery.
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Affiliation(s)
- Emily M. Hayden
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Pierre Borczuk
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Sayon Dutta
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Michael R. Filbin
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Benjamin A. White
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Eleonore Kugener
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Blair A. Parry
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Nora Horick
- Biostatistics CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Kori S. Zachrison
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
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13
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Li SX, Ji W, Wei XY, Cui J, Ying YY, Chen JP, Li H, Liu SW. [Effect of health management service for hypertension patients under framework of Basic Public Health Service Project: a regression discontinuity design]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:772-777. [PMID: 37221066 DOI: 10.3760/cma.j.cn112338-20220721-00649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Objective: To evaluate the effect of health management service on hypertension patients (HMSFHP) under the framework of the Basic Public Health Service Project by using regression discontinuity design. Methods: The participants were enrolled from an observational cohort survey in 2015 and followed up was conducted in 2019. The participants with SBP 130-150 mmHg and/or DBP 80-100 mmHg in the baseline survey of the cohort in 2015 were included in the present study. Additionally, we obtained the dates of participants receiving HMSFHP and their blood pressure data from follow-up records, physical examination records and telephone interview. The participants were divided into intervention group and control group based on the cutoff points, i.e. SBP ≥140 mmHg and/or DBP ≥90 mmHg. The local linear regression model were used to estimate the effect of HMSFHP on reducing blood pressure of the participants. Results: After adjusting for age, sex and time length of receiving HMSFHP, the results of the model including participants with 80-100 mmHg for DBP in 2015 indicated that, for the participants who received HMSFHP, the DBP decreased by 6.66 mmHg from 2015 to 2019. For the participants with SBP 130-150 mmHg in 2015, the reduction estimate of the model was -6.17 mmHg, the difference was not significant (P=0.178), suggesting that receiving HMSFHP did not cause change in SBP for the participants who received HMSFHP. Conclusion: Receiving HMSFHP had effect to reduce DBP, and HMSFHP had a positive effect on the control of blood pressure in patients with hypertension.
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Affiliation(s)
- S X Li
- Department of Chronic and Non-communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - W Ji
- Department of Big Data, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - X Y Wei
- Harris School of Public Policy, The University of Chicago, Chicago, Illinois 60637, USA
| | - J Cui
- Department of Chronic and Non-communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Y Y Ying
- Department of Chronic and Non-communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - J P Chen
- Department of Chronic and Non-communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - H Li
- Department of Health Promotion, Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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14
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Chary A, Brickhouse E, Torres B, Santangelo I, Carpenter CR, Liu SW, Godwin KM, Naik AD, Singh H, Kennedy M. Using the Electronic Health Record to Support Implementation of Emergency Department Delirium Screening: A Qualitative Study. Appl Clin Inform 2023. [PMID: 37054983 DOI: 10.1055/a-2073-3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Objective To understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening. Materials and Methods We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig socio-technical model, which addresses use of HIT in complex adaptive healthcare systems. Subsequently, we analyzed data for common themes across dimensions of the socio-technical model. Results Three themes emerged about how the EHR could be used to address challenges in implementation of delirium screening: (1) staff adherence to screening, (2) communication among ED team members about a positive screen, and (3) linking positive screening to delirium management. Participants described several HIT-based strategies including visual nudges, icons, hard stop alerts, order sets, and automated communications that facilitated implementation of delirium screening. An additional theme emerged about challenges related to the availability of HIT resources. Discussion Building delirium screening tools and reminders to perform screening into the EHR may prompt adherence to screening. Automating related workflows, team communication, and management of patients who screen positive for delirium may help save staff members' time. Staff education, engagement, and access to HIT resources may support successful screening implementation. Conclusion Our findings provide practical HIT-based strategies for healthcare institutions planning to adopt geriatric screenings.
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Affiliation(s)
- Anita Chary
- Emergency Medicine, Baylor College of Medicine, Houston, United States
- Baylor College of Medicine Department of Medicine, Houston, United States
- Michael E. DeBakey VA Medical Center, Center for Innovations in Quality Effectiveness and Safety, Houston, United States
| | - Elise Brickhouse
- School of Medicine, Baylor College of Medicine, Houston, United States
| | - Beatrice Torres
- UT Health Science Center, University of Texas School of Public Health, Houston, United States
| | | | - Christopher R Carpenter
- Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, United States
| | - Shan W Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, United States
- Harvard Medical School, Boston, United States
| | - Kyler M Godwin
- Baylor College of Medicine Department of Medicine, Houston, United States
- Center for Innovations in Quality Effectiveness and Safety, Houston, United States
| | - Aanand D Naik
- Center for Innovations in Quality Effectiveness and Safety, Houston, United States
- UT Health Science Center, University of Texas School of Public Health, Houston, United States
- Consortium on Aging, The University of Texas Health Science Center at Houston, Houston, United States
| | - Hardeep Singh
- Medicine, Baylor College of Medicine, Houston, United States
- Center for Innovations in Quality Effectiveness and Safety, Houston, United States
| | - Maura Kennedy
- Emergency Medicine, Massachusetts General Hospital, Boston, United States
- Harvard Medical School, Boston, United States
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15
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Xu QQ, Yan YF, Dong WL, Liu SW. [Potential short-term effects of tobacco control scheme under various application scenarios of tobacco control measures across the globe: a Meta-analysis]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:650-656. [PMID: 37147840 DOI: 10.3760/cma.j.cn112338-20220715-00630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Objective: based on summarizing the simulation and prediction of tobacco control measures across the globe and sorting out the various scenarios of tobacco control measures, the potential short-term effects of seven tobacco control measures in different scenarios were systematically analyzed. Methods: Until April 2022, PubMed, Embase, EconLit, PsychINFO, and CINAHL databases were used to retrieve literature about tobacco control measures simulation and prediction models across the globe. Inclusion and exclusion criteria were strictly followed. Meta-analysis for the potential short-term effects of seven tobacco control measures in different scenarios was performed using the R software. Results: A total of 22 papers covering 16 countries were selected. Five studies were conducted in the United States, three in Mexico, and two in Italy. There were all papers with the measures to tax increases, smoke-free air laws, and mass media campaigns, 21 papers with youth access restrictions, 20 with marketing restrictions, and 19 with cessation treatment programs and health warnings. The tax increases had diverse influences on the price elasticity of different age groups. The price elasticity in the age group 15-17 years was the highest, which was 0.044 (95%CI: 0.038-0.051). The potential short-term effects of smoke-free air laws in workplaces were higher than in restaurants and other indoor public places. The effects of youth access restrictions were greater in the age group <16 years than in the age group 16-17. The stronger the implementation of other measures, the greater the potential short-term effects. A comparison of seven tobacco control measures showed that the cessation treatment programs increase in cessation rate was the highest, 0.404 (95%CI: 0.357-0.456). The reduction in smoking rate and reduction in initiation rate of youth access restrictions strongly enforced and publicized was the highest in the age group <16 years, 0.292 (95%CI: 0.269-0.315), and 0.292 (95%CI: 0.270-0.316). Conclusions: The potential short-term effects of seven tobacco control measures in different scenarios were evaluated more accurately and objectively through Meta-analysis. In the short term, cessation treatment programs will substantially increase smoking cessation rates, and strong youth access enforcement will sharply reduce smoking and initiation rates among adolescents under 16. These results also offer strong data-related support for the simulation and prediction of tobacco control measures in China and other countries.
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Affiliation(s)
- Q Q Xu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Y F Yan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - W L Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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16
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Chary AN, Torres B, Brickhouse E, Santangelo I, Godwin KM, Naik AD, Carpenter CR, Liu SW, Kennedy M. Language discordance in emergency department delirium screening: Results from a qualitative interview-based study. J Am Geriatr Soc 2023; 71:1328-1331. [PMID: 36451059 PMCID: PMC10089935 DOI: 10.1111/jgs.18147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/12/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Anita N. Chary
- Department of Emergency Medicine, Baylor College of Medicine
- Department of Medicine, Baylor College of Medicine
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Beatrice Torres
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas
| | | | | | - Kyler M. Godwin
- Department of Medicine, Baylor College of Medicine
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas
- University of Texas Health Consortium on Aging, Houston, Texas
| | - Christopher R. Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, Washington University School of Medicine, Emergency Care Research Core
| | - Shan W. Liu
- Department of Emergency Medicine, Massachusetts General Hospital
- Harvard Medical School
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital
- Harvard Medical School
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17
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Liu SW, Carpenter CR. In adults aged ≥65 y with head injuries, use of warfarin, but not DOACs, was associated with delayed ICH. Ann Intern Med 2023; 176:JC23. [PMID: 36745892 DOI: 10.7326/j22-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Liu S, McLeod SL, Atzema CL, et al. Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department. CJEM. 2022;24:853-61. 36242733.
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Affiliation(s)
- Shan W Liu
- Massachusetts General Hospital, Boston, Massachusetts, USA (S.W.L.)
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18
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Marill KA, Lopez S, Hark D, Spahr J, Shesh-Muthal K, Xue J, Rowlandson GI, Liu SW. Electrocardiographic measures of repolarization heterogeneity are not predictive for Torsades de Pointes among undifferentiated patients with prolonged QTc: A case control study. J Cardiovasc Electrophysiol 2023; 34:166-176. [PMID: 36335640 DOI: 10.1111/jce.15735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Torsades de Pointes (TdP) is a potentially lethal polymorphic ventricular tachydysrhythmia associated with and caused by prolonged myocardial repolarization. However, prediction of TdP is challenging. We sought to determine if electrocardiographic myocardial repolarization heterogeneity is necessary and predictive of TdP. METHODS We performed a case control study of TdP at a large urban hospital. We identified cases based on a hospital center electrocardiogram (ECG) database search for tracings from 1/2005 to 6/2019 with heart rate corrected QT (QTc) > 500, QRS < 120, and heart rate (HR) < 60, and a subsequent natural language search of electronic health records for the terms: TdP, polymorphic ventricular tachycardia, sudden cardiac death, and relevant variants. Controls were drawn in a 2:1 ratio to cases from a similar pool of ECGs, and matching for QTc, heart rate, sex, and age. We abstracted historical, laboratory, and ECG data using detailed written instructions and an electronic database. We included a second blinded data abstractor to test data abstraction and manual ECG measurement reliability. We used General Electric (GE) QT Guard software for automated repolarization measurements. We compared groups using unpaired statistics. RESULTS We included 75 cases and 150 controls. The number of current QTc prolonging medications and serum electrolytes were substantially the same between the two groups. We found no significant difference in measures of QT or T wave repolarization heterogeneity. CONCLUSION Electrocardiographic repolarization heterogeneity is not greater in otherwise unselected patients with QTc prolongation who suffer TdP and does not appear predictive of TdP. However, previous observations suggest specific repolarization characteristics may be useful for defined patient subgroups at risk for TdP.
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Affiliation(s)
- Keith A Marill
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha Lopez
- University of Texas at Southwestern Medical Center, Dallas, Texas, USA
| | - David Hark
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ketaki Shesh-Muthal
- Department of Biomedical Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joel Xue
- General Electric Healthcare, Milwaukee, Wisconsin, USA
| | | | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Prachanukool T, Aaronson EL, Lakin JR, Higuchi M, Lee RS, Santangelo I, Hasdianda MA, Wang W, George N, Liu SW, Kennedy M, Schonberg MA, Block SD, Tulsky JA, Ouchi K. Communication Training and Code Status Conversation Patterns Reported by Emergency Clinicians. J Pain Symptom Manage 2023; 65:58-65. [PMID: 36265695 PMCID: PMC9790029 DOI: 10.1016/j.jpainsymman.2022.10.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT During acute health decompensations for seriously ill patients, emergency clinicians often determine the intensity end-of-life care. Little is known about how emergency clinicians conduct these conversations, especially among those who have received serious illness communication training. OBJECTIVES To determine the self-reported practice patterns of code status conversations by emergency clinicians with and without serious illness communication training. METHODS A cross-sectional survey was conducted among emergency clinicians with and without a recent evidence-based, serious illness communication training tailored for emergency clinicians. Emergency clinicians were included from two academic medical centers. A five-point Likert scale ("very unlikely" to "very likely" to ask) was used to assess the self-reported likelihood of asking about patients' preferences for medical procedures and patients' values and goals. RESULTS Among 161 respondents (71% response rate), 77 (48%) received the training. A total of 70% of emergency clinicians reported asking about procedure-based questions, and only 38% reported asking about patient's values regarding end-of-life care. For value-based questions, statistically significant differences were observed between emergency clinicians who underwent the training and those who did not in four of the seven questions asked (e.g., the higher odds of exploring the patient's life priorities [adjusted OR = 4.34, 95% CI = 1.95-9.65, P-value < 0.001]). No difference was observed in the self-reported rates of all procedure-based questions between the two groups. CONCLUSION Most emergency clinicians reported asking about procedure-based questions, and some asked about patient's value-based questions. Clinicians with recent serious illness communication training may ask more about some values and priorities.
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Affiliation(s)
- Thidathit Prachanukool
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Emily L Aaronson
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua R Lakin
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Serious Illness Care Program (J.R.L., K.O.), Ariadne Labs, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Masaya Higuchi
- Palliative Care and Geriatric Medicine (M.H.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel S Lee
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ilianna Santangelo
- Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohammad A Hasdianda
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA
| | - Wei Wang
- Department of Medicine and Neurology, Brigham and Women's Hospital (W.W.), Boston, Massachusetts, USA
| | - Naomi George
- Department of Emergency Medicine `(N.G.), Division of Critical Care, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shan W Liu
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maura Kennedy
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mara A Schonberg
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Medicine (M.A.S.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Susan D Block
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Departments of Medicine (S.D.B., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James A Tulsky
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Departments of Medicine (S.D.B., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Serious Illness Care Program (J.R.L., K.O.), Ariadne Labs, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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20
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Liu SW, Lee S, Hayes JM, Khoujah D, Lo AX, Doering M, de Wit K, Nickels CH, Kennedy M, Eagles D, Carpenter C, Arendts G, Ragsdale L. Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med 2022. [DOI: 10.1111/acem.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Shan W. Liu
- Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School Boston MA USA
| | - Sangil Lee
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City IA USA
| | - Jane M. Hayes
- Washington University School of Medicine St Louis MO USA
| | - Danya Khoujah
- Department of Emergency Medicine University of Maryland School of Medicine Baltimore MD USA
| | - Alexander X. Lo
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | | | - Kerstin de Wit
- Department of Emergency Medicine, Queen's University Kingston ON Canada
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21
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Liu SW, Li M, Zhu JT, Zhang YC, Wu YH, Liu CF, Hu H. [Correlation of muscle strength with cognitive function and medial temporal lobe atrophy in patients with mild to moderate Alzheimer's disease]. Zhonghua Yi Xue Za Zhi 2022; 102:2786-2792. [PMID: 36124351 DOI: 10.3760/cma.j.cn112137-20220406-00715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: To analyze the correlation of muscle strength with cognitive function and medial temporal lobe atrophy (MTA) in patients with mild to moderate Alzheimer's disease (AD). Methods: General information, sarcopenia-related indicators, neuropsychological tests and MTA score were collected in 80 confirmed AD patients (41 mild and 39 moderate patients) and 43 normal controls (NC) from the Memory Disorders Clinic of Department Of Neurology in the Second Affiliated Hospital of Soochow University between January and December 2021. Appendicular skeletal muscle mass index (ASMI), grip strength and 5-times sit-to-stand time and 6-m gait speed were used for assessing muscle mass, muscle strength and physical function, respectively. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment scale (MoCA), Memory and Executive Screening Scale (MES), Digit Symbol Substitution Test (DSST), Digital Span Test (DST) and Verbal Fluency Task (VFT), respectively. DST included Forward Digit Span Test (FDST) and Backward Digit Span Test (BDST). All the subjects underwent 3.0T coronal three-dimensional gradient echo sequence MRI. MTA scale was performed to evaluate the degree of medial temporal lobe atrophy. The differences in the sarcopenia-related indicators, cognitive score and MTA score were analyzed among the three groups, and the partial correlation analysis was performed between the inter-groups. Results: Eighty AD patients (24 males and 56 females) were included, aged (72±7) years old, with 41 mild and 39 moderate patients. Meanwhile, 43 NC included 19 males and 24 females, with a mean age of (70±6) years old. The disease duration in moderate AD patients was longer than that of mild AD patients [34.0 (25.0, 43.5) months vs 24.0 (11.0, 34.0) months, P<0.001]. The differences of sarcopenia-related indicators and MTA score among the three groups were statistically significant (all P<0.001), including 5-times sit-to-stand time [(13.6±1.8) s vs (11.5±1.7) s vs (10.3±1.9) s, P<0.001] and MTA score [2.0 (2.0, 3.0) vs 1.0 (1.0, 2.0) vs 0 (0, 0), P<0.001]. In neuropsychological tests, compared to the NC group, MMSE, MoCA, MES and VFT scores in mild and moderate AD groups were lower (all P<0.001); meanwhile, compared to the mild AD group, the moderate group had lower MMSE, MoCA, MES, DSST and VFT scores (all P<0.001). In sarcopenia-related indicators, muscle strength in particular was correlated with widespread cognitive functioning domains and MTA score in AD patients. Grip strength was positively correlated with MMSE, MoCA , MES, FDST (r=0.387, 0.418, 0.522 and 0.484, respectively, all P<0.001), DSST (r=0.327, P=0.006) and VFT score (r=0.354, P=0.003), and negatively correlated with MTA score (r=-0.631, P<0.001). 5-times sit-to-stand time was negatively correlated with MMSE, MoCA, MES, DSST, FDST, VFT score (r=-0.583, -0.587, -0.814, -0.591, -0.552 and -0.485, respectively, all P<0.001), and BDST (r=-0.355, P=0.003) strongly positively correlated with MTA score (r=0.836, P<0.001). ASMI was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.257, 0.238, 0.428, 0.282 and 0.364, respectively, all P<0.05), and negatively correlated with MTA score (r=-0.377, P=0.001). 6-m gait speed was positively correlated with MMSE, MoCA, MES, DSST, FDST score (r=0.419, 0.486, 0.699, 0.559 and 0.500, respectively, all P<0.001), BDST and VFT score (r=0.384、0.377, respectively, both P=0.001), and strongly negatively correlated with MTA score (r=-0.803, P<0.001). Conclusions: Patients with mild to moderate AD have widespread cognitive impairment. Muscle mass, muscle strength and physical function are all significantly impaired. Compared to muscle mass and physical function, decreased muscle strength is significantly associated with widespread cognitive decline and increased degree of medial temporal lobe atrophy.
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Affiliation(s)
- S W Liu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - M Li
- Department of Imaging, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - J T Zhu
- Department of Imaging, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Y C Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Y H Wu
- Department of Geriatrics, Suzhou Municipal Hospital affiliated to Nanjing Medical University, Suzhou 215002, China
| | - C F Liu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - H Hu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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22
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Di XB, Liu SW, Xie HY, Zeng XY, Meng ZD, Xiao L. [Smoking relapse rate and influencing factors in smokers aged 15 years and above in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1388-1393. [PMID: 36117344 DOI: 10.3760/cma.j.cn112338-20211130-00929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To describe the relapse status of smokers aged ≥15 years in China, and investigate the main factors influencing their relapse behavior. Methods: The data of this study cames from the 2018 China Adult Tobacco Survey, covering 400 committees or villages in 200 districts or counties in 31 provinces (autonomous regions and municipalities) of China. The relevant data of smoking and relapsing in residents aged ≥15 years were collected by face-to-face interview. Software SAS 9.4 was used to clean and analyze the data, and logistic regression model was used to analyze the influencing factors for relapse rate. Results: A total of 19 376 questionnaires were completed, with a response rate of 91.50%. In 2018, 66.05% of smokers aged ≥15 years in China had smoking relapse, in whom 66.59% were males and 55.79% were females. In all age groups, the age group 15-24 years had the highest smoking relapse rate (82.63%). Multivariate analysis showed that the younger age 15-24 years (OR=4.618,95%CI:1.981-10.763), e-cigarette use (OR=9.782,95%CI:3.139-30.490), and tobacco advertising, promotion and sponsorship in the past 30 days (OR=1.710,95%CI:1.291-2.265) were associated with higher smoking relapse rate. Compared with people who were allowed smoking at home or those without smoking limit, the smoking relapse rate in people who were not allowed to smoke at home (OR=0.562, 95%CI: 0.439-0.719) or those with smoking limit (OR=0.487, 95%CI: 0.366-0.647) was lower. Conclusion: The smoking relapse rate in Chinese smokers is high, especially in young people. It is suggested to conduct targeted intervention based on the results of this study to reduce the smoking relapse rate and help achieve the smoking control goal in Healthy China 2030.
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Affiliation(s)
- X B Di
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China Tobacco Control Office,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - H Y Xie
- Tobacco Control Office,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - X Y Zeng
- Tobacco Control Office,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z D Meng
- Tobacco Control Office,Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L Xiao
- Tobacco Control Office,Chinese Center for Disease Control and Prevention, Beijing 100050, China
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23
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Chary A, Liu SW, Southerland L, Cameron-Comasco L, Ouchi K, Carpenter CR, Boyer EW, Naik AD, Kennedy M. Emergency Department Policies to Improve Care Experiences for Older Adults During the COVID-19 Pandemic. J Geriatr Emerg Med 2022; 3:10.17294/2694-4715.1031. [PMID: 36111131 PMCID: PMC9473422 DOI: 10.17294/2694-4715.1031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Anita Chary
- Section of Health Services Research, Dept. of Medicine; Dept. of Emergency Medicine; Center for Innovations in Quality, Effectiveness and Safety; Baylor College of Medicine
| | - Shan W Liu
- Dept. of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
| | | | - Lauren Cameron-Comasco
- Dept. of Emergency Medicine, Beaumont Hospital-Royal Oak, Oakland University William Beaumont School of Medicine
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Dana Farber Cancer Institute
| | - Christopher R Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, Washington University School of Medicine
| | - Edward W Boyer
- Department of Emergency Medicine, Ohio State University, Harvard Medical School
| | - Aanand D Naik
- Department of Management, Policy, and Community Health, UT School of Public Health and UT Health Consortium on Aging
| | - Maura Kennedy
- Dept. of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
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24
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Ren TZ, Deng LN, Li SL, Sun JC, Liu SW, Zhou JL. [Spectral CT multi-parameter imaging in preoperatively evaluation the status of lymphovascular and perineural invasion of gastric cancer]. Zhonghua Yi Xue Za Zhi 2022; 102:1741-1746. [PMID: 35705477 DOI: 10.3760/cma.j.cn112137-20211201-02682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the application value of spectral CT multi-parameter imaging in preoperative assessment the status of lymphovascular invasion (LVI) and perineural invasion (PNI) in patients with gastric cancer. Methods: A total of 62 patients who underwent energy spectral CT and with pathology confirmed gastric cancer in Lanzhou Uiversity Second Hospital from September 2020 to September 2021 were retrospectively collected, which including 46 males and 16 females, aged from 36 to 71 (57.5±9.1) years. According to the presence or absence of LVI/PNI in postoperative pathological results, they were divided into the positive group (42 cases) and the negative group (20 cases). The CT values of 40 keV and 70 keV (CT40 keV, CT70 keV), iodine concentration (IC), normalized iodine concentration (NIC) were measured in the arterial phase, the venous phase, and the delay phase, and the spectral curve slope of 40 keV to 70 keV (K(40-70)) and the combined parameters (the arterial phase: AP~all, the venous phase: VP~all, the delay phase: DP~all) were calculated. Spectral parameters between the positive and negative groups were compared, and the receiver operating characteristic curve (ROC) with the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated for evaluating the diagnostic performance of each parameter. Results: The CT40 keV, CT70 keV, K(40-70), IC, and NIC in the arterial phase and the venous phase and the CT70 keV and NIC in the delay phase of the LVI/PNI-positive group were all higher than those of the negative group [the representative parameters: the arterial phase NIC 0.14±0.04 vs 0.12±0.04, the venous phase NIC 0.5(0.5, 0.6) vs 0.4(0.4, 0.5), the delay phase NIC 0.6±0.1 vs 0.5±0.1, all P<0.05]. ROC curve analysis showed that the diagnostic efficacy of the parameters of the venous phase is better than that of the arterial phase and the delay phase, and the diagnostic efficiency of the combined parameters is better than that of the individual parameters. The AUC value, sensitivity, and specificity of the most optimal parameter VP~all of the venous phase were 0.931(95%CI:0.872-0.990), 80.95%, and 95.00%, respectively. Conclusions: In the preoperative evaluation the status of the LVI and PNI in gastric cancer, the diagnostic efficacy in the venous phase parameters is better than that in the arterial phase and delay phase, and the diagnostic efficacy of combined parameters is better than that of individual parameters.
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Affiliation(s)
- T Z Ren
- Department of Radiology of Lanzhou University Second Hospital, Second Clinical School of Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - L N Deng
- Department of Radiology of Lanzhou University Second Hospital, Second Clinical School of Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - S L Li
- Department of Radiology of Lanzhou University Second Hospital, Second Clinical School of Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - J C Sun
- Department of Radiology of Lanzhou University Second Hospital, Second Clinical School of Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - S W Liu
- Department of Radiology of Lanzhou University Second Hospital, Second Clinical School of Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - J L Zhou
- Department of Radiology of Lanzhou University Second Hospital, Second Clinical School of Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
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25
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Nan Y, Di XB, Zeng XY, Xie HY, Meng ZD, Liu SW, Xiao L. [Quit intention and smoking cessation behavior of current smokers aged 15 years and above in China, 2018]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:818-823. [PMID: 35725335 DOI: 10.3760/cma.j.cn112338-20211130-00932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To describe the current situation on quit intention and quit attempts among current smokers aged 15 years and above in China and explore the main factors affecting their smoking cessation behaviors. Methods: The subjects were people aged 15 years and above in China. A stratified multi-phased randomized cluster sampling method was used. The survey covered 200 districts/counties in 31 provinces (autonomous regions and municipalities directly under the central government), including 19 376 people under investigation. The data were weighted with SAS 9.4 for complex sampling analysis, and the frequency and weighted component ratio were used for description. The influencing factors were studied using the Rao Scott χ2 test and unconditional multivariate logistic regression. Results: Among current smokers, 6.63% reported that they planned to quit smoking in the next month, 5.44% for men and 8.49% for women. 17.96% of the current smokers made quit attempts in the past 12 months, with 17.80% men and 22.15% women. People who smoke occasionally (OR=3.42, 95%CI: 2.09-5.59) made quit attempts in the past (OR=4.91, 95%CI: 0.33-0.52) and knew that smoking would lead to three diseases (OR=2.24, 95%CI: 1.48-3.40) had higher quit intention. People who occasionally smoke (OR=1.68, 95%CI: 1.20-2.34) received smoking cessation suggestions from medical staff (OR=1.96, 95%CI: 1.62-2.37), were a ware of that smoking causes three diseases (OR=1.63, 95%CI: 1.32-2.02) and had smoking prohibition regulations in indoor areas of their homes, had a higher rate of quit attempts. Conclusion: Providing effective smoking cessation intervention services and creating a supportive tobacco control environment are significant in promoting smoking cessation behavior.
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Affiliation(s)
- Y Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - X B Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - X Y Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - H Y Xie
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z D Meng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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26
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Liu SW, Xiao L. [Development and challenges of tobacco epidemic surveillance in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:804-810. [PMID: 35725333 DOI: 10.3760/cma.j.cn112338-20211130-00931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tobacco use is the leading preventable risk factor causing the global burden of disease and one of China's most significant public health issues. Continuous and dynamic tobacco monitoring can provide critical index data for developing tobacco control strategies and measures and evaluating the impact of tobacco control. The WHO has incorporated monitoring programs into the crucial content of tobacco control and put forward relevant compliance requirements in the Framework Convention on Tobacco Control (FCTC). The Chinese government has actively promoted tobacco control significantly since the entry into force of the FCTC in China and continuously strengthened tobacco monitoring. In 2021, China's tobacco monitoring was honored to have reached the highest level required by the WHO. This study introduces the sampling design of tobacco surveys, monitoring content, the definition of key indicators and data weighting based on a complex sampling design, analyzing the challenges facing in the current setting, and provides a reference for the understanding and utilization of the data, the comparison of the results, and the future development of tobacco monitoring. The surveys involved in this study will focus on the specialized epidemiological surveys of tobacco for adults and adolescents carried out nationwide.
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Affiliation(s)
- S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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27
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Xi Z, Di XB, Nan Y, Zeng XY, Xie HY, Meng ZD, Liu SW, Xiao L. [Analysis of exposure to tobacco advertisement and promotion among Chinese adults aged 15 years and above, 2010 and 2018]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:830-834. [PMID: 35725337 DOI: 10.3760/cma.j.cn112338-20211130-00933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the exposure to tobacco advertisements and promotions among Chinese adults aged 15 and above, identify the publicity channels and forms of tobacco advertising and promotion in 2010 and 2018, and implicate further tobacco control measures in China. Methods: A multistage, stratified, randomized cluster sampling design was used in 2010 and 2018 China Adult Tobacco Survey, with national representativeness. 13 354 and 19 376 permanent residents were selected in the 2010 and 2018 surveys. SAS 9.4 software was applied for data analysis, and all the data were weighted based on a complex sampling design. Rao Scott χ2 test was used for group comparison of a single factor. Results: In 2010 and 2018, 19.61% and 18.14% of the survey respondents did see tobacco advertising and promotion. From 2010 to 2018, there was no significant change in the situation of tobacco advertisements and promotions. Among those who had gone to a cigarette shop, the proportion of seeing tobacco advertisements increased from 29.28% in 2010 to 43.28% in 2018. Among those who had seen tobacco advertisements on TV, the rate fell from 50.93% in 2010 to 28.58% in 2018. Among those who had gone to movie theaters, the proportion of seeing tobacco advertisements increased from 2.17% in 2010 to 9.89% in 2018. Among those who had used the Internet, the proportion of seeing tobacco advertisements online rose from 19.20% in 2010 to 42.30% in 2018. In terms of tobacco promotion, the percentages of people who had seen tobacco promotions, cigarette price discounts, cigarette discount coupons, gifts, and other preferential activities in various places in the past 30 days were 4.99% vs. 9.30%, 0.78% vs. 4.09%, 0.04% vs. 0.33% and 0.98% vs. 3.33% in 2010 and 2018, respectively (P<0.001). Conclusions: Tobacco advertising and promotion are still prevalent in China, with no significant change in 2010 and 2018. Tobacco advertising and promotion have been with the constant changes and development of media platforms. It is necessary to improve the implementation of relevant policies, comprehensively ban tobacco advertisements and promotions, and strengthen the supervision of ads and promotions.
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Affiliation(s)
- Z Xi
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - X B Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Y Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - X Y Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - H Y Xie
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z D Meng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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28
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Huang YY, Di XB, Nan Y, Zeng XY, Xie HY, Meng ZD, Xiao L, Liu SW. [Secondhand smoke exposure and its influencing factors among Chinese people aged 15 years and above in 2010 and 2018]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:824-829. [PMID: 35725336 DOI: 10.3760/cma.j.cn112338-20211130-00930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate secondhand smoke (SHS) exposure among non-current smokers aged 15 and over and its influencing factors in China in 2010 and 2018. Methods: The 2010 and 2018 China Adult Tobacco Surveys used multistage stratified cluster random sampling methods to obtain national representative samples across 31 provinces (autonomous regions and municipalities) in China. This study selected non-current smokers aged 15 and over as the research subjects to describe the general demographic characteristics, perceptions of SHS hazards, attitudes towards smoking bans in indoor areas in public places, and SHS exposure and the smoking restriction regulations in different places. The Rao-Scott χ2 test was used to compare the rates, and the unconditional logistic regression was used to analyze the influencing factors of SHS exposure. All the subjects in the analysis were weighted based on a complex sampling design. Results: Among non-current smokers aged 15 and over, from 2010 to 2018, the percentage of indoor smokers had decreased from 84.7% to 71.9%. The rates of people who saw smoking in various places declined with a statistically significant difference (P<0.001). The exposure to SHS for females, people aged 45-64, teachers, medical staff, workers in enterprises, businesses, waiters, and people who live in rural and central areas declined. The differences were statistically significant (P<0.05). In 2018, the percentage of SHS exposure for those who reported a comprehensive smoking ban in households or allowed smoking in certain areas was lower than for those who reported allowed or without a smoking ban. Among those aged 25-44, SHS exposure for those who reported complete smoking prohibition in workplaces was lower than those who reported allowed or without smoking prohibition (OR=0.65, 95%CI: 0.49-0.87). The proportion of SHS exposure for those who believe that smoking should not be allowed in indoor areas of 0-5 public places is higher than that smoking should not be allowed in the indoor spaces of 8 public places (OR=2.13, 95%CI: 1.35-3.36). Among people aged 45-64, the proportions of SHS exposure for teachers (OR=0.37, 95%CI: 0.17-0.78) and medical staff (OR=0.35, 95%CI: 0.16-0.76) and staff working in agriculture, forestry, animal husbandry, fishery, and water conservancy were lower than governmental staff (OR=0.49, 95%CI: 0.29-0.84). Conclusions: Data from the decreased exposure of Chinese non-current smokers aged 15 and over to SHS suggests the initial achievement through constructing a smoke-free environment, but continued efforts are needed. It is necessary to actively advocate for smoke-free families, strengthen publicity and education on the hazards of tobacco and SHS, and improve the skills of non-smokers in rejecting SHS exposure.
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Affiliation(s)
- Y Y Huang
- Health Promotion Office/Tobacco Control Office, Beijing Center for Disease Prevention and Control, Beijing 100013, China School of Public Health/Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - X B Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Y Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - X Y Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - H Y Xie
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z D Meng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Sri-on J, Wongthanasit P, Paksopis T, Liu SW, Rojtangkom K, Ruangsiri R. Perception of Older Thai Adults in a Do-Not-Attempt Resuscitation Order during the COVID-19 Era If Infected with COVID-19. Palliat Med Rep 2022; 3:107-115. [PMID: 35919382 PMCID: PMC9279120 DOI: 10.1089/pmr.2021.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jiraporn Sri-on
- Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Pannawat Wongthanasit
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Thitiwan Paksopis
- Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Shan W. Liu
- The Department of Emergency Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Khemika Rojtangkom
- The Clinical Research Center, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Rasida Ruangsiri
- Thai Health Promotion Organization (ThaiHealth), Bangkok, Thailand
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Liu SW, Xie WY, Zhang YC, Zhu JT, Liu CF, Hu H. [Third ventricle width measured by transcranial ultrasound and its diagnostic value in patients with Alzheimer's disease]. Zhonghua Yi Xue Za Zhi 2022; 102:948-953. [PMID: 35385967 DOI: 10.3760/cma.j.cn112137-20210901-01994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: To explore the diagnostic value of third ventricle width (TVW) measured by transcranial ultrasound (TCS) in the clinical diagnosis of Alzheimer's disease (AD) by analyzing and comparing the image characteristics of TVW in AD patients and healthy controls, and its correlation with cranial magnetic resonance medial temporal lobe atrophy (MTA) visual score and neuropsychological characteristics. Methods: TCS examination, MTA score and neuropsychological tests were performed in 39 confirmed AD and 41 normal controls from the Second Affiliated Hospital of Soochow University between January and July 2021. The correlation of TVW with MTA score and neuropsychological characteristics was analyzed and compared between the two groups. Results: A total of thirty-nine AD patients were enrolled, with 28 males and 11 females, aged (73±9) years, including 18 mild, 20 moderate, and 1 severe AD patient. Meanwhile, 41 healthy controls were also included, with 24 males and 17 females, aged (69±6) years old. TVW in AD patients was significantly wider than that in normal controls [0.76(0.66, 0.87) cm vs 0.50(0.44, 0.56) cm, P<0.001]. In neuropsychological tests, compared with normal controls, AD patients showed impaired performances in several cognitive functions, and there were statistically significant differences in delayed memory [0(0, 0) vs 4.0(4.0, 5.0), P<0.001], naming [2.0(1.0, 3.0) vs 3.0(2.0, 3.0), P<0.001], executive function [2.0(2.0, 3.0) vs 3.0(2.5, 3.0), P<0.001], language [0.0(0.0, 2.0) vs 3.0(2.0, 3.0), P<0.001] and other aspects between AD patients and normal controls (all P<0.05). TVW was negatively correlated with immediate memory (r=-0.339, P=0.035), delayed recall (r=-0.523, P<0.001), attention and computing power (r=-0.409, P=0.045), visual space and executive function (r=-0.333, P=0.039), but positively correlated with the atrophy of the medial temporal lobe (r= 0.552, P<0.001). Conclusions: TCS can be used to measure TVW in AD patients. When combined with MTA score and neuropsychological tests, it can provide a reliable objective basis for the clinical diagnosis of AD.
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Affiliation(s)
- S W Liu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - W Y Xie
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Y C Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - J T Zhu
- Department of Medical Imaging, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - C F Liu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - H Hu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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Kennedy M, Lesser A, Israni J, Liu SW, Santangelo I, Tidwell N, Southerland LT, Carpenter CR, Biese K, Ahmad S, Hwang U. Reach and Adoption of a Geriatric Emergency Department Accreditation Program in the United States. Ann Emerg Med 2022; 79:367-373. [PMID: 34389196 PMCID: PMC10015385 DOI: 10.1016/j.annemergmed.2021.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE The objectives of this study were to describe the reach and adoption of Geriatric Emergency Department Accreditation (GEDA) program and care processes instituted at accredited geriatric emergency departments (EDs). METHODS We analyzed a cross-section of a cohort of US EDs that received GEDA from May 2018 to March 2021. We obtained data from the American College of Emergency Physicians and publicly available sources. Data included GEDA level, geographic location, urban/rural designation, and care processes instituted. Frequencies and proportions and median and interquartile ranges were used to summarize categorical and continuous data, respectively. RESULTS Over the study period, 225 US geriatric ED accreditations were issued and included in our analysis-14 Level 1, 21 Level 2, and 190 Level 3 geriatric EDs; 5 geriatric EDs reapplied and received higher-level accreditation after initial accreditation at a lower level. Only 9 geriatric EDs were in rural regions. There was significant heterogeneity in protocols enacted at geriatric EDs; minimizing urinary catheter use and fall prevention were the most common. CONCLUSION There has been rapid growth in geriatric EDs, driven by Level 3 accreditation. Most geriatric EDs are in urban areas, indicating the potential need for expansion beyond these areas. Future research evaluating the impact of GEDA on health care utilization and patient-oriented outcomes is needed.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA.
| | | | | | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | | | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Kevin Biese
- West Health Institute, La Jolla, CA; Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Surriya Ahmad
- Department of Emergency Medicine, SUNY Downstate, Kings County Hospital Center, Brooklyn, NY
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Geriatrics Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
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Lo AX, Wedel LK, Liu SW, Wongtangman T, Thatphet P, Santangelo I, Chary AN, Biddinger PD, Grudzen CR, Kennedy M. COVID-19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end-of-life care. J Am Coll Emerg Physicians Open 2022; 3:e12622. [PMID: 35079730 PMCID: PMC8776041 DOI: 10.1002/emp2.12622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To characterize the national distribution of COVID-19 hospital and emergency department visitor restriction policies across the United States, focusing on patients with cognitive or physical impairment or receiving end-of-life care. METHODS Cross-sectional study of visitor policies and exceptions, using a nationally representative random sample of EDs and hospitals during the first wave of the COVID-19 pandemic, by trained study investigators using standardized instrument. RESULTS Of the 352 hospitals studied, 326 (93%) had a COVID-19 hospital-wide visitor restriction policy and 164 (47%) also had an ED-specific policy. Hospital-wide policies were more prevalent at academic than non-academic (96% vs 90%; P < 0.05) and at urban than rural sites (95% vs 84%; P < 0.001); however, the prevalence of ED-specific policies did not significantly differ across these site characteristics. Geographic region was not associated with the prevalence of any visitor policies. Among all study sites, only 58% of hospitals reported exceptions for patients receiving end-of-life care, 39% for persons with cognitive impairment, and 33% for persons with physical impairment, and only 12% provided policies in non-English languages. Sites with ED-specific policies reported even fewer exceptions for patients with cognitive impairment (29%), with physical impairments (24%), or receiving end-of-life care (26%). CONCLUSION Although the benefits of visitor policies towards curbing COVID-19 transmission had not been firmly established, such policies were widespread among US hospitals. Exceptions that permitted family or other caregivers for patients with cognitive or physical impairments or receiving end-of-life care were predominantly lacking, as were policies in non-English languages.
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Affiliation(s)
- Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Center for Health Services & Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Logan K. Wedel
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Thiti Wongtangman
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineLerdsin General HospitalBangkokThailand
| | - Phraewa Thatphet
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineFaculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Ilianna Santangelo
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Anita N. Chary
- Departments of Medicine and Emergency MedicineBaylor College of Medicine
| | - Paul D. Biddinger
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Mass General BrighamBostonMassachusettsUSA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
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Alsabri M, Boudi Z, Lauque D, Dias RD, Whelan JS, Östlundh L, Alinier G, Onyeji C, Michel P, Liu SW, Jr Camargo CA, Lindner T, Slagman A, Bates DW, Tazarourte K, Singer SJ, Toussi A, Grossman S, Bellou A. Impact of Teamwork and Communication Training Interventions on Safety Culture and Patient Safety in Emergency Departments: A Systematic Review. J Patient Saf 2022; 18:e351-e361. [PMID: 33890752 DOI: 10.1097/pts.0000000000000782] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 11/26/2022]
Abstract
OBJECTIVES This study aimed to narratively summarize the literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings. METHODS We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, the Web of Science, and Educational Resources Information Centre for peer-reviewed journal articles published from January 1, 1988, to June 8, 2018, that assessed teamwork and communication interventions focusing on how they influence patient safety in the ED. One additional search update was performed in July 2019. RESULTS Sixteen studies were included from 8700 screened publications. The studies' design, interventions, and evaluation methods varied widely. The most impactful ED training interventions were End-of-Course Critique, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), and crisis resource management (CRM)-based training. Crisis resource management and TeamSTEPPS CRM-based training curriculum were used in most of the studies. Multiple tools, including the Kirkpatrick evaluation model, the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, the TeamSTEPPS Teamwork Attitudes Questionnaire, the Safety Attitudes Questionnaire, and the Communication and Teamwork Skills Assessment, were used to assess the impact of such interventions. Improvements in one of the domains of safety culture and related domains were found in all studies. Four empirical studies established improvements in patient health outcomes that occurred after simulation CRM training (Kirkpatrick 4), but there was no effect on mortality. CONCLUSIONS Overall, teamwork and communication training interventions improve the safety culture in ED settings and may positively affect patient outcome. The implementation of safety culture programs may be considered to reduce incidence of medical errors and adverse events.
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Affiliation(s)
- Mohamed Alsabri
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston, Massachusetts
| | - Zoubir Boudi
- Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai, United Arab Emirates
| | | | - Roger Daglius Dias
- STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School
| | - Julia S Whelan
- MS Knowledge Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Linda Östlundh
- The National Medical Library, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | | - Churchill Onyeji
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston, Massachusetts
| | | | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos A Jr Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tobias Lindner
- Division of Emergency and Acute Medicine (CVK, CCM), Charité University Medicine, Berlin, Germany
| | - Anna Slagman
- Division of Emergency and Acute Medicine (CVK, CCM), Charité University Medicine, Berlin, Germany
| | - David W Bates
- Department of Healthcare Quality, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Sara J Singer
- Department of Medicine, Division of Primary Care, Stanford University School of Medicine, Stanford, California
| | - Anita Toussi
- ∥Department of Emergency Medicine, Union Hospital Terre Haute and Clinton IN, Simulation Center for Health Care Education, Indiana State University, Terre Haute, Indiana
| | - Shamai Grossman
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Harvard Medical School, Boston, Massachusetts
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Chary A, Joshi C, Castilla-Ojo N, Santangelo I, Ouchi K, Naik AD, Carpenter CR, Liu SW, Kennedy M. Emergency Clinicians’ Perceptions of Communication Tools to Establish the Mental Baseline of Older Adults: A Qualitative Study. Cureus 2021; 13:e20616. [PMID: 35103191 PMCID: PMC8782497 DOI: 10.7759/cureus.20616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/05/2022] Open
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Chary AN, Castilla-Ojo N, Joshi C, Santangelo I, Carpenter CR, Ouchi K, Naik AD, Liu SW, Kennedy M. Evaluating older adults with cognitive dysfunction: A qualitative study with emergency clinicians. J Am Geriatr Soc 2021; 70:341-351. [PMID: 34796476 PMCID: PMC9200057 DOI: 10.1111/jgs.17581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evaluating older adults with cognitive dysfunction in emergency departments (EDs) requires obtaining collateral information from sources other than the patient. Understanding the challenges emergency clinicians face in obtaining collateral information can inform development of interventions to improve geriatric emergency care and, more specifically, detection of ED delirium. The objective was to understand emergency clinicians' experiences obtaining collateral information on older adults with cognitive dysfunction, both before and during the COVID-19 pandemic. METHODS From February to May 2021, we conducted semi-structured interviews with a purposive sample of 22 emergency physicians and advanced practice providers from two urban academic hospitals and one community hospital in the Northeast United States. Interviews lasted 10-20 min and were digitally recorded and transcribed. Interview transcripts were analyzed for dominant themes using a combined deductive-inductive approach. Responses regarding experiences before and during the pandemic were compared. RESULTS Five major challenges emerged regarding (1) availability of caregivers, (2) reliability of sources, (3) language barriers, (4) time constraints, and (5) incomplete transfer documentation. Participants perceived all challenges, but those relating to transfer documentation were amplified by the COVID-19 pandemic. CONCLUSION Emergency clinicians' perspectives can inform efforts to support caregiver presence at bedside and develop standardized communication tools to improve recognition of delirium and, more broadly, geriatric emergency care.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Christopher Joshi
- School of Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher R Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, Missouri, USA.,Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Aanand D Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,School of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,School of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Thatphet P, Rosen T, Kayarian F, Southerland L, McQuown CM, Dresden S, Liu SW. Impact of Geriatric Emergency Fellowship Training on the careers of Emergency Physicians. Cureus 2021; 13:e17903. [PMID: 34660099 PMCID: PMC8509112 DOI: 10.7759/cureus.17903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The geriatric population continues to increase and will impact the emergency department (ED). Older adult patients require different care from other groups of patients. Hence, it is essential to create a workforce that specializes in geriatric emergency medicine (GEM). Geriatric emergency medicine fellowships were developed to serve this need. However, despite 20 years since the creation of GEM fellowships, it is not known how GEM fellowships have impacted the career of graduates of GEM fellowships. The goal of this study is to examine the impact of these geriatric emergency fellowship training programs on the career of geriatric emergency fellows. Methods We surveyed the emergency physicians who had graduated from GEM fellowship programs in the US and Canada by using a 36-question, web-based questionnaire. The survey was pilot-tested on five GEM experts, fellowship graduates, and a GEM fellowship director. Result We had a 68% survey completion rate, two partially answered the study. All participants reported that they continue to have GEM as a part of his/her career. More than half either received grants, published papers, helped establish GEM divisions or caring in their hospital, and worked beyond clinical work in the ED, including academic and administrative fields. More than 80% reported that their fellowship helped obtain their current positions and was helpful in career progression. Approximately two-thirds were satisfied with their current work/life balance. Conclusion The GEM fellowship training has been impactful in the careers of former GEM fellows and has contributed to many becoming leaders in GEM clinical service, administration, education, and research. It can serve as a stepping stone to a leadership position in a GEM career. Furthermore, our study demonstrates that GEM graduates report high levels of career and clinical satisfaction.
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Affiliation(s)
- Phraewa Thatphet
- Emergency Medicine, Massachusetts General Hospital, Boston, USA.,Emergency Medicine, Khon Kaen University, Khon Kaen, THA
| | - Tony Rosen
- Emergency Medicine, Weill Cornell Medical College, New York, USA
| | - Fae Kayarian
- Emergency Medicine, Massachusetts General Hospital, Boston, USA
| | - Lauren Southerland
- Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Colleen M McQuown
- Department of Emergency Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, USA
| | - Scott Dresden
- Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shan W Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, USA
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Thatphet P, Kayarian FB, Ouchi K, Hogan T, Schumacher JG, Kennedy M, Liu SW. Lessons Learned From Emergency Department Fall Assessment and Prevention Programs. Cureus 2021; 13:e16526. [PMID: 34430136 PMCID: PMC8377387 DOI: 10.7759/cureus.16526] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives This research describes the experiences of emergency departments (EDs) with geriatric fall programs and qualitatively synthesizes lessons learned to inform other EDs planning new fall program implementation. Methods By using grounded theory, we conducted semi-structured, open-ended telephone/skype interviews of emergency physicians and geriatric providers recruited from a purposeful sampling technique. The interviews were transcribed and reviewed by two investigators. The codes were generated and listed, and common concepts emerged. Lastly, the final codes were organized into concepts and themes with the aim to create a strong coding structure. Result The main lessons learned are: (1) understand the hospital’s existing local environment and resources, (2) utilize champions and interdisciplinary teams, (3) acknowledge that specific fall assessment tools and interventions vary widely between institutions, (4) engage in routine plan-do-study-act (PDSA) cycles to improve the quality of fall initiatives, and (5) operate under the principle that falls are a syndrome, which must be incorporated within the multifactorial medical needs of geriatric fall patients. Conclusion Based on the lessons learned from our ED fall implementation pioneers, implementing an effective geriatric fall protocol in an ED setting is complicated. Understanding a hospital’s resources, assigning champions, working as an interdisciplinary team, choosing proper fall assessment tools/interventions, and completing regular PDSA cycles are important lessons for ED programs planning to implement their own ED fall programs.
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Affiliation(s)
- Phraewa Thatphet
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA.,Emergency Medicine, Khon Kaen University, Khon Kaen, THA
| | - Fae B Kayarian
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Massachusetts, USA
| | - Teresita Hogan
- Department of Emergency Medicine, University of Chicago Medicine, Illinois, USA
| | - John G Schumacher
- Epidemiology and Public Health, University of Maryland, Maryland, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
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Dong WL, Mao F, Jiang YY, Xia Z, Zhang WW, Dong JQ, Liu SW, Zhou MG, Wu J. [Evaluation on the quality of 236 National Demonstration Areas for comprehensive prevention and control of chronic diseases betweem 2017 and 2019]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1413-1419. [PMID: 34814562 DOI: 10.3760/cma.j.cn112338-20200729-00994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To evaluate the quality of the National Demonstration Area for Comprehensive Prevention and Control of NCDs (referred to as "the Demonstration Area"). Methods: Based on the evaluation scores of the Demonstration Area field survey from 2017 to 2019, we counted the scores of each indicator, comparing the scores among indicators and regions. x±s was used to describe the scores. The 95%CI of the score was used to test the statistical difference among regions. Each score was converted into a hundred-mark system to compare the scores among indicators. Results: Of 236 Demonstration Areas, the total score was 83.5. The scores of the first-level indicator listed from high to low appeared as Integrating System of NCD Prevention and Control (92.8), Policy Perfection (90.3), Building Supportive Environment for NCD Prevention and Control (88.4), Implementation of Health Education and Health Promotion (87.4), Whole-course Management of NCDs (78.1), Innovation and Guidance (76.5), Surveillance and Evaluation (75.1). Total scores were higher in the east (259.2±18.8) comparing to the middle (243.2±15.2) or the west (245.4±19.7) regions. Conclusions: Substantial variations on the quality in the Demonstration Area existed across different regions in China. These disparities are important to the government when developing health policies and allocating resources. Whole-course Management of NCDs, Surveillance and Evaluation, and Innovation and Guidance in the Demonstration Area also needs to be improved.
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Affiliation(s)
- W L Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - F Mao
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Y Y Jiang
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z Xia
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - W W Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - J Q Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - M G Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - J Wu
- National Center for Chronic and Non-communicable Disease Control and Prevention/Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Qi JY, Wang CR, Liu M, Liu SW, Wang ZW, Wang CP. [Analysis on disease burden of stroke in China and the regions with different sociodemographic index from 1990 to 2017]. Zhonghua Yu Fang Yi Xue Za Zhi 2021; 55:958-964. [PMID: 34445833 DOI: 10.3760/cma.j.cn112150-20201013-01274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To examine the trend of stroke disease burden and its main risk-attributable factors in China and regions with different Socio-Demographic Index (SDI) from 1990 to 2017. Methods: With 2017 Global Burden of Disease (GBD) data, years lived with disability (YLDs), years of life lost (YLLs) and disability-adjusted of life years (DALYs) were applied to describe the disease burden and major risk factors of stroke in China and different SDI regions from 1990 to 2017, and to analyze the changing trend of the disease burden and major risk factors of stroke. Results: From 1990 to 2017, the YLD crude rate, YLL crude rate and DALY crude rate for stroke in China showed an increasing trend and the rate of change was 126.5%, 14.6%, and 24.4%, respectively. In 2017, the YLD crude rate, YLL crude rate and DALY crude rate for stroke in China were 502.6 per 100 000, 2 633.1 per 100 000 and 3 135.7 per 100 000, respectively. Among them, the YLD crude rate, YLL crude rate, and DALY crude rate of stroke were the highest in the ≥70 age group, which were 2 617.2 per 100 000, 16 789.4 per 100 000 and 19 406.6 per 100 000, respectively. The YLD crude rate in male was 475.5 per 100 000, which was slightly lower than that of female (530.9 per 100 000), while the DALY crude rate and YLL crude rate for stroke were 3 657.1 per 100 000 and 3 181.7 per 100 000, respectively, which were significantly higher than that of female (2 591.8 per 100 000 and 2 060.9 per 100 000). Compared with regions with different SDI, the age standardized YLD rate, the age standardized YLL rate, the age standardized DALY rate in China were all at a high level. Among them, the age-standardized YLD rate increased from 286.2 per 100 000 to 374.5 per 100 000, with a rate of change of 30.9%; the age-standardized YLL rate decreased from 3 215.6 per 100 000 to 1 967.8 per 100 000, with a rate of change of -38.8%; the age-standardized DALY rate increased from 3 501.8 per 100 000 to 2 342.3 per 100 000, with a rate of change of -33.1%. The top five risk factors for stroke in China were hypertension, excessive sodium intake, insufficient fruit intake, insufficient cereal intake, and smoking in 1990 and 2017. High Body-Mass Index and Alcohol Use's rankings rose from the 9th and 10th in 1990 to the 6th and 7th in 2017, respectively. Conclusion: The burden of stroke disease in China is at a high level, and hypertension is the primary risk factor.
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Affiliation(s)
- J Y Qi
- School of Public Health, Weifang Medical University, Weifang 261053, China
| | - C R Wang
- Maternal and Child Health Center, Chinese Center for Disease Control and Prevention, Beijing 100081, China
| | - M Liu
- School of Public Health, Weifang Medical University, Weifang 261053, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z W Wang
- Department of Neurosurgery, Weifang People's Hospital, Weifang 261000, China
| | - C P Wang
- School of Public Health, Weifang Medical University, Weifang 261053, China
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Lou G, Li SX, Gong QH, Zhu YC, Ying YY, Wang Y, Liu Y, Dong WL, Liu SW, Li H. [Association between physical activity and risk of stroke among adults aged 40 years and above: a prospective cohort study]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1030-1036. [PMID: 34814502 DOI: 10.3760/cma.j.cn112338-20201010-01221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the effect of physical activity (PA) on the incident risk of stroke among adults aged 40 years and above. Methods: The baseline data including PA and demographic characteristics were obtained from the Adult Chronic Disease Surveillance with population representativeness in Ningbo in 2015. The follow-up data of interested health outcomes from 2015 to 2019 were retrieved from a population-based Integrated Noncommunicable Disease Collaborative Management System in Ningbo. The two databases were matched to form a queue. PA was divided into three levels of low-intensity, moderate-intensity, and vigorous-intensity according to the metabolic equivalents (METs) spent per week. Cox regression model was used to calculate the hazard ratio (HR) and 95% confidence interval. Results: A total of 3 353 subjects were included at baseline survey in 2015. Until Dec 31, 2019, there had been 31 stroke events had occurred since then, with accumulative incidence rate of 242/100 000, and an average follow-up time of (50.28±2.54) months. When adjusted for gender, age, education level, smoking status, alcohol consumption, BMI and hypertension, multivariate Cox regression analysis showed that greater PA was associated with a 37.9% reduction of incidence of stroke (HR=0.621,95%CI:0.393-0.983). Compared with those who had low-intensity PA, those who were with vigorous-intensity. PA appeared associated with a 63.1% decrease in the incidence of stroke (HR=0.369, 95%CI: 0.139-0.976). However, there was no statistical significance with moderate-intensity PA (HR=0.712,95%CI:0.323-1.569), noticed. Conclusions: Greater PA is likely to reduce the incidence of stroke. Our findings indicated that people should be encouraged to increase the PA level and developing a healthy supportive environment in the community.
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Affiliation(s)
- G Lou
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S X Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Q H Gong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Y C Zhu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Y Y Ying
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Y Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - Y Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - W L Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - H Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
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Zirulnik A, Chary A, Thatphet P, Wongtangman T, Gacioch B, Ouchi K, Kennedy M, Liu SW. The Interface of Emergency and Palliative Care. J Geriatr Emerg Med 2021; 2:4. [PMID: 34296215 PMCID: PMC8294785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Alexander Zirulnik
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anita Chary
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Phraewa Thatphet
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thiti Wongtangman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brian Gacioch
- Section of Hospice and Palliative Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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42
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Liu Y, Li H, Zeng XY, Dong WL, Liu SW. [Application of healthy big data in prevention and control of chronic diseases]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 41:2163-2168. [PMID: 33378833 DOI: 10.3760/cma.j.cn112338-20191119-00815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the continuous development of informatization, big data has been increasingly used in the prevention and control of chronic diseases, which has a significant and considerable influence on public health. This paper briefly introduces the definition, characteristics and classification of big data and healthy big data, focusing on the analysis methods and their applications in tertiary prevention, as well as the challenges in technology, data management, sharing and quality, ethics and privacy, with the aim of providing more research approaches for healthy big data application in chronic disease prevention and control.
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Affiliation(s)
- Y Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; Tobacco Control office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - H Li
- Ningbo Prefectural Center for Disease Control and Prevention, Ningbo 315010, China
| | - X Y Zeng
- Tobacco Control office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - W L Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - S W Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; Tobacco Control office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Shokoohi H, Loesche MA, Duggan NM, Liteplo AS, Huang C, Al Saud AA, McEvoy D, Liu SW, Dutta S. Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:1660-1668. [PMID: 33392574 PMCID: PMC7771794 DOI: 10.1002/emp2.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Difficult intravenous access (DIVA) is common in the emergency department (ED). We investigated the extent to which DIVA is associated with care delay outcomes including time to first laboratory draw, therapies, imaging, and ED disposition. METHODS An observational retrospective cohort analysis of patients with DIVA treated between 2018 and 2020 at 2 urban academic EDs was performed. DIVA was defined as patients requiring ultrasound-guided intravenous access placed by physicians or advanced practice providers (APPs) as opposed to landmark-based intravenous placement by nurses. ED throughput variables and disposition time were compared. We correlated DIVA with time to administration of intravenous pain medications, fluids, imaging contrast, laboratory results, and ED disposition. RESULTS A total of 108,256 subjects with 161,122 total encounters were included. DIVA occurred in 4961 (3.1%) of ED visits. Patients with DIVA were more likely to be female (3.5% vs 2.6% for males, odds ratio [OR] 1.34, 95% confidence interval [CI]: 1.27-1.42), self-identify as black (OR 1.78, 95% CI: 1.66-1.91), and have higher acuity of illness (P < 0.001). Among pediatric patients, DIVA occurred most often in the first year of life at a rate of 3.25%. In adults, DIVA occurred in 2 age peaks; at 35 years (4.02%), and at 63 years (3.44%). In all workflow metrics, the presence of DIVA was associated with significant delays in median time to completion: 50 minutes for pain medication administration, 36 minutes for intravenous fluid administration, 29 minutes for laboratory results, 57 minutes for intravenous contrast administration, and 87 minutes for discharge orders. CONCLUSION DIVA was associated with increased time to therapies, diagnostic studies, imaging completion, and ED disposition. A more expeditious approach to achieving intravenous access in patients with predicted DIVA could improve ED throughput and patient care overall.
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Affiliation(s)
- Hamid Shokoohi
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael A. Loesche
- Department of Emergency MedicineMassachusetts General HospitalHarvard Affiliated Emergency Medicine Residency ProgramBostonMassachusettsUSA
| | - Nicole M. Duggan
- Department of Emergency MedicineMassachusetts General HospitalHarvard Affiliated Emergency Medicine Residency ProgramBostonMassachusettsUSA
| | - Andrew S. Liteplo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Calvin Huang
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ahad A. Al Saud
- Division of Emergency UltrasoundDepartment of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Dustin McEvoy
- Clinical Data AnalystPartners HealthCareSomervilleMassachusettsUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Sayon Dutta
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Samson M, Davenport K, Rizzo C, Liu SW. Stand Up and Fight Falls: Can a Video Intervention Help Reduce Falls in the Geriatric Population? Cureus 2020; 12:e11508. [PMID: 33354452 PMCID: PMC7744203 DOI: 10.7759/cureus.11508] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Falls are a major source of morbidity and mortality in the geriatric population. However, efforts to reduce falls have had limited success. This study examines if a video intervention presented in the ED to patients who have fallen could improve fall education and reduce future falls. Methods: Patients 65 years and older who presented to a large academic ED for a fall between June and December 2017 were identified via triage note for an intercept study. Patients who did not speak English, who were cognitively impaired, or whose condition was too acute (determined by providing physician) were excluded. Sixty-two eligible and consenting patients were shown a six-minute video intervention with recommendations to prevent future falls. Primary objectives include (1) whether patients found the recommendations reasonable to implement and (2) rate of implementation. Secondary aims were (3) perceived health status between patients who followed the recommendations versus those who did not and (4) rates of recurrent falls and ED revisits between the two groups. Data were analyzed using the Newcombe-Wilson Score Method and Fisher's exact two-tailed t-tests. Results: Of 62 patients enrolled, 38 were retained at a six-month follow-up. Ninety-two percent of patients found the video intervention to be a reasonable education tool. At six months, 44.7% of patients implemented behavioral changes discussed in the video, and 21.1% had at least one new fall, with no significant difference between people who implemented video interventions and those who did not (23.5% and 19.0%, difference 0.045, 95% CI [-0.24 to 0.34], p=1.0). The rate of return to the ED at six months for all patients was 31.6%, with no significant difference between the two groups (23.5% versus 38.1%, difference 0.146, 95% CI [-0.18 to 0.43], p=0.49). Difference in the proportion of people feeling the same or better between the two groups was not significant at either the one-month (66.7% versus 75.0%, difference 0.083, 95% CI [-0.21 to 0.34], p=0.75) or six-month follow up (64.7% versus 47.6%, difference 0.171, 95% CI [-0.17 to 0.46], p=0.34). Conclusion: This study found that while most patients find behavioral interventions feasible and reasonable to implement, only half actually make changes to their lives to reduce the risk of falling. This suggests that identifying and limiting barriers to implementation should be a priority in future studies, along with exploring the relationship between interventions and health status, ED revisits, and recurrent falls.
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Affiliation(s)
- Margot Samson
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Kathleen Davenport
- Emergency Medicine, University of North Carolina Hospital, Chapel Hill, USA.,Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Caroline Rizzo
- Emergency Medicine, Massachussetts General Hospital, Boston, USA
| | - Shan W Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, USA.,Emergency Medicine, Harvard Medical School, Boston, USA
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Zhang YW, Li H, Duan DH, Han LY, Liu SW. [Current status and projection of non-communicable diseases in 126 countries participating in the Belt and Road initiative]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1487-1493. [PMID: 33076604 DOI: 10.3760/cma.j.cn112338-20191101-00774] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the indicators of non-communicable diseases (NCD) and predict the achieving time of United Nations (UN) Sustainable Development Goals (SDG) in 125 countries participating in the Belt and Road (B&R) initiative and China. Methods: Using the open access data of Global Burden of Disease study, we first got the premature mortality rates of four main chronic diseases (cardiovascular disease, cancer, diabetes and chronic respiratory diseases) and suicide mortality rate in the 126 countries from1990 to 2017. We transformed the value of each indicator into a scale of 0-100 in percentile for each country and applied geometric mean to calculate total NCD score for comparison among 126 countries. We then examined the association of NCD scores with socio-demographic index (SDI) values. Finally, we used annualized rates of change during 1990-2015 to predict achieving time of the UN goal by 2030 for each indicator of chronic diseases premature mortality rate and suicide mortality rates in each B&R country. Results: The integral median of total NCD score in the 126 countries in 2017 was 82.7. The score of China was 87.6, ranking 33(rd). The top three countries were Kuwait (98.1), Peru (97.5) and Italy (96.0). The last three countries were Papua New Guinea (28.9), Vanuatu (54.7) and Ukraine (58.0). The total NCD score showed positive correlation with SDI values (r=0.33) mainly due to chronic disease indicator (r=0.45). Fifteen countries will achieve the SDG goal of chronic disease premature mortality in or before 2030, but China will achieve it in 2038. Fifteen countries are expected to achieve the goal of suicide mortality, and China will acheive the goal ahead of schedule in 2024. Conclusions: The NCD rates varied widely among the countries along B&R. It is a challenge to achieve the SDG goal of chronic disease premature mortality rate by 2030 for China. In order to achieve the SDG goals by 2030, we should strengthen multilateral cooperation and complement each other's advantages, and reduce NCD mortality of people and improve people's health in countries along B&R.
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Affiliation(s)
- Y W Zhang
- Panjin Center for Disease Control and Prevention, Panjin 124010, China
| | - H Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - D H Duan
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - L Y Han
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315200, China; Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315200, China
| | - S W Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Yan F, Liu SW, Li XY, Li CC, Wu Y. Silencing LncRNA LINC01305 inhibits epithelial mesenchymal transition in lung cancer cells by regulating TNXB-mediated PI3K/Akt signaling pathway. J BIOL REG HOMEOS AG 2020; 34:499-508. [PMID: 32549529 DOI: 10.23812/20-73-a-33] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to investigate whether LINC01305 can regulate TNXB-mediated phosphatidilinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway and therefore affect epithelial mesenchymal transition in lung cancer cells. Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to detect LINC01305 level in 52 non-small cell lung cancer (NSCLC) tissues and paracancerous normal lung tissues, and the relationship between LINC01305 expression and clinical pathological parameters of these subjects was analyzed. After LINC01305 was knocked down in PC9 cell and overexpressed in A549 cells, qRT-PCR was used to verify the transfection efficiency, and nuclear fractionation technique, cell counting kit-8 (CCK-8), plate cloning assay and Transwell test were used to detect the effect of LINC01305 on cell viability. LINC01305 had an obviously higher expression in NSCLC tissues, and the expression in lung cancer patients with tumor size >3 cm was higher than those with tumor ≤3 cm. LINC01305 expression in tumor tissues in T3-T4 stage was obviously higher than those in T1-T2 stage, and the overall survival rate of lung cancer patients with high expression of LINC01305 was lower than those with low expression. Moreover, clinical analysis revealed that LINC01305 level was related to tumor size, TNM stage and lymph node metastasis of patients with lung cancer, but not related to age or gender. Silencing LINC01305 can inhibit the epithelial mesenchymal transition-induced transformation of lung cancer cells through regulating TNXB-mediated PI3K/Akt signaling pathway, which in turn affects the progression of lung cancer.
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Affiliation(s)
- F Yan
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - S W Liu
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - X Y Li
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - C C Li
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Y Wu
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
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Wang CR, Meng XF, Wang CP, Liu SW. [Trends of burden on ischemic heart disease and epidemiological transition of related risk factors in China, 1990-2017]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1703-1709. [PMID: 33297630 DOI: 10.3760/cma.j.cn112338-20191018-00743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the trend of burden on ischemic heart disease (IHD) and epidemiological transition on related risk factors among the Chinese population from 1990 to 2017. Methods: Based on open access data from the Global Burden of Disease (GBD) 2017 Study, we used years of life lost (YLD), years lived with disability (YLL), and disability-adjusted of life years (DALY) to describe the changes of IHD burden stratified by different sex and age groups from 1990 to 2017. We applied population-attributable faction (PAF) to analyze the burden attributable to risk factors and epidemiological transition. Results: In 2017, rates on YLD, YLL, and DALY for IHD were 74.2/100 000, 2 459.6/100 000, and 2 523.1/100 000, respectively. DALY rate and YLL rate for IHD in males were invariably higher than those in females except for YLD rate in females. 24 modifiable risk factors were causally associated with IHD. The top five risk factors that influencing DALYs, PAF, and DALY rate in 2017 appeared as: high blood pressure (16.429 million person years, 54.6%, 1 163.1/100 000), high LDL cholesterol (13 941 million person years, 46.3%, 987.0/100 000), diet high in sodium (10.900 million person years, 36.2%, 771.1/100 000), smoking (8.647 million person years, 28.7%, 612.2/100 000), and low-nut diet (7.452 million person years, 24.8%, 527.6/100 000). DALY rate for IHD showed an increase of 90.9%, from 1 116.4/100 000 in 1990 to 2 131.0/100 000 in 2017. Compared with 1990, the YLD rate experienced an evident increase in those aged 15-49 and over 70, in 2017. Annual average growth rate of YLD rate was higher in the ≥70 age group, between 2007 and 2017 (0.4%) than that between 1990 and 2007 (0.2%). The annual average increasing rates of both YLL and DALY were much lower from 2007 to 2017 (0.6%, 0.6%) than those from 1990 to 2007 (1.3%, 1.2%). From 1990 to 2017, DALYs attributed to meaty food (929.7%), beverages with high sugar content (822.7%), and high body-mass index (327.3%) experienced the highest increase. The largest increase in PAF occurred for beverages with high sugar content (400.0%). DALY rates increased for the 8 risk factors whereas decreased on the 7 risk factors, in consecutive rankings between 2007 and 2017. Conclusions: Despite the fact that burden on IHD-caused premature death had been reducing, related disabilities remain challenging with IHD the leading cause of burden, particularly in the ≥70 year-olds. Higher IHD burden from premature death was seen in males but disability appeared higher in females. It is significantly important to strengthen programs on prevention and control for hypertension including reducing modifiable risk factors such as smoking, unreasonable diet habits.
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Affiliation(s)
- C R Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100081, China
| | - X F Meng
- Weifang Municipal Center for Disease Control and Prevention, Weifang 261061, China
| | - C P Wang
- School of Public Health, Weifang Medical University, Social Health Risk Collaborative Innovation Center, "Healthy Shandong" Collaborative Innovation Center for Prediction and Governance of Major Social Risks, Weifang 261053, China
| | - S W Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Sun LJ, Du X, Liu SW, He R, Zeng H, Sun C, Li L, Zhang Y, Ma CS, Gao W. [Current status of the clinical practice and analysis on the ratioanl prescription of antiarrhythmic drugs in Chinese patients with atrial fibrillation: Results from the Chinese Atrial Fibrillation Registry (CAFR) trial]. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48:740-747. [PMID: 32957756 DOI: 10.3760/cma.j.cn112148-20200103-00004] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the practice patterns and the related factors of oral antiarrhythmic drug (AAD) treatment in Chinese patients with atrial fibrillation (AF), and to evaluate the compliance of AAD application to atrial fibrillation management guidelines. Methods: From August 2011 to August 2016, medical records from 18 014 patients with AF were analyzed based on data from the Chinese Atrial Fibrillation Registry trial. Patients were divided into AAD group (7 788 cases, 43.23%) and non-AAD group (10 226 cases, 56.77%) according to whether AAD was used at baseline or at the time of first use during follow-up. Amiodarone (4 129 cases, 53.02%) and propafenone (3 211 cases, 41.23%) were the mostly prescribed AAD and subgroup analysis was performed accordingly. Medical records were analyzed by random forest regression to evaluate the use of AAD and related factors in patients with AF, and the rationality of AAD was analyzed according to the guidelines for the management of atrial fibrillation. Result: A total of 18 014 patients were included in this study, of which 60.48% (10 895/18 014) were male patients, 22.65% (4 081/18 014) were elderly patients(≥75 years old), there were 7 788 patients (43.23%) in AAD group, and 10 226 patients(56.77%) in non-AAD group. Compared with the non-AAD group, the elderly patients (≥75 years old, 13.74%(1 070/7 788) vs. 29.44%(3 011/10 226)), persistent AF (28.95% (2 250/7 788) 45.80% (4 683/10 226)), heart failure(8.29% (646/7 788) vs. 21.95% (2 245/10 226)), stroke and (or) TIA(12.15% (946/7 788) vs. 19.95% (2 040/10 226)), renal dysfunction(16.36%(1 274/7 788) vs. 29.37% (3 003/10 226)), and high thromboembolism risk(60.17% (4 748/7 788) vs. 76.40% (7 813/10 226)) were less prevalent in the AAD subgroup (P<0.001). Multivariate analysis showed that patients in tertiary hospitals (OR=3.72, 95%CI 3.17-4.37) were more likely to use AAD, elderly patients (≥75 years old, OR=0.47, 95%CI 0.39-0.55), persistent atrial fibrillation (OR=0.66, 95%CI 0.60-0.72), and patients with heart failure (OR=0.54, 95%CI 0.47-0.63), stroke and (or) TIA (OR=0.77, 95%CI 0.68-0.87), renal dysfunction (OR=0.75, 95%CI 0.59-0.95) and high thromboembolism risk(OR=0.7, 95%CI 0.58-0.84) were more likely not to use AAD(P<0.05). In the AAD group, amiodarone and propafenone were the most commonly used AAD, accounting for 53.02% (4 129/7 788) and 41.23% (3 211/7 788), respectively. Multivariate analysis showed that patients with persistent atrial fibrillation (OR=4.57, 95%CI 3.94-5.29) and coronary heart disease (OR=4.14, 95%CI 3.03-5.64), heart failure (OR=2.07, 95%CI 1.48-2.89), non-ischemic cardiomyopathy (OR=4.84, 95%CI 2.41-9.73) were more likely to use amiodarone, and those with normal left ventricular ejection fraction (OR=0.31, 95%CI 0.15-0.65) and low thromboembolism risk (OR=0.78, 95%CI 0.63-0.97) were more likely to use propafenone (P<0.001). The overall incidence of AAD treatment, which was not indicated by the guidelines was 6.5% (480/7 340); 5.1% (212/4 129) in the amiodarone group and 8.3% (268/3 211) in the propafenone group, respectively. Compared with the rational AAD use group, the proportion of irrational drug use was higher in the elderly (≥75 years old) (20.4% (98/480) vs. 12.9% (887/6 860)), patients of high thromboembolism risk (77.1% (379/480) vs. 59.0% (4 047/6 860)), and in non-tertiary hospitals (7.1% (34/480) vs. 3.3% (299/6 860)), but lower in men(50.8% (244/480) vs. 64.5% (4 427/6 860)), P<0.001. Conclusions: The patients with paroxysmal atrial fibrillation, who were treated with AAD, were mostly patients with fewer complications, and the patients who were treated with amiodarone were mostly patients with persistent atrial fibrillation, patients were more likely to complicate with organic heart disease. The incidence of AAD that do not comply with the guidelines was low, and it was more common in non-tertiary hospitals and the elder patients with high thromboembolism risk.
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Affiliation(s)
- L J Sun
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - X Du
- Department of Cardiology, Beijing Anzhen Hospital of the Capital University of Medical Sciences, Beijing 100029, China
| | - S W Liu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - R He
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - H Zeng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - C Sun
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - L Li
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - Y Zhang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
| | - C S Ma
- Department of Cardiology, Beijing Anzhen Hospital of the Capital University of Medical Sciences, Beijing 100029, China
| | - W Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education. Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
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49
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Benton E, Liteplo AS, Shokoohi H, Loesche MA, Yacoub S, Thatphet P, Wongtangman T, Liu SW. A pilot study examining the use of ultrasound to measure sarcopenia, frailty and fall in older patients. Am J Emerg Med 2020; 46:310-316. [PMID: 33041131 DOI: 10.1016/j.ajem.2020.07.081] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The importance of this study is to devise an efficient tool for assessing frailty in the ED. The goals of this study are 1) to correlate ultrasonographic (US) measurements of muscle thickness in older ED patients with frailty and 2) to correlate US-measured sarcopenia with falls, subsequent hospitalizations and ED revisits. METHODS Participants were conveniently sampled from a single ED in this prospective cohort pilot study of patients aged 65 or older. Participants completed a Fatigue, Resistance, Ambulation, Illness and Loss of Weight (FRAIL) scale assessment and US measurements of their upper arm muscles, quadricep muscles, and abdominal wall muscles thickness. We conducted one-month follow-up phone calls to assess for falls, ED revisits, and subsequent hospital visits. RESULTS We enrolled 43 patients (mean age of 78.5). Ultrasound measurements of the three muscle groups were not significantly different between frail and non-frail groups. Frail participants had greater bicep asymmetry (a difference of 0.47 cm vs 0.24 cm, p < .01). A predictive logistic regression model using average quadriceps thickness and biceps asymmetry was found to identify frail patients (AUC of 0.816). Participants with subsequent falls had smaller quadriceps (1.18 cm smaller, p < .01). Subsequently hospitalized patients were found to have smaller quadriceps muscles (0.54 cm smaller, p = .03) and abdominal wall muscles (0.25 cm smaller, p = .01). CONCLUSION US measurements of sarcopenia in older patients had mild to moderate associations with frailty, falls and subsequent hospitalizations. Further investigation is needed to confirm these findings.
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Affiliation(s)
- Emily Benton
- NewYork-Presbyterian Hospital, Department of Emergency Medicine, 525 East 68th Street, New York, NY 10065, United States of America.
| | - Andrew S Liteplo
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Hamid Shokoohi
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Michael A Loesche
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Sarah Yacoub
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Phraewa Thatphet
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Thiti Wongtangman
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Shan W Liu
- Massachusetts General Hospital, Department of Emergency Medicine, 55 Fruit Street, Boston, MA 02114, United States of America
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50
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Rosen T, Ferrante LE, Liu SW, Benton EA, Mulcare MR, Stern ME, Biese K, Hwang U, Sanon M. Managing Older Adults with Presumed COVID-19 in the Emergency Department: A Rational Approach to Rationing. J Am Geriatr Soc 2020; 68:1631-1635. [PMID: 32574404 PMCID: PMC7361631 DOI: 10.1111/jgs.16651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily A Benton
- NewYork-Presbyterian Emergency Medicine Residency Program, New York, New York
| | - Mary R Mulcare
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York
| | - Kevin Biese
- Department of Emergency Medicine, Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ula Hwang
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Geriatrics Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York
| | - Martine Sanon
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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