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Fishe JN, Crisp AM, Riney L, Bertrand A, Burcham S, Hendry P, Semenova O, Blake KV, Salloum RG. Evaluation of the implementation of evidence-based pediatric asthma exacerbation treatments in a regional consortium of emergency medical Services Agencies. J Asthma 2024; 61:405-416. [PMID: 37930329 PMCID: PMC11035098 DOI: 10.1080/02770903.2023.2280917] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Asthma exacerbations are a frequent reason for pediatric emergency medical services (EMS) encounters. The objective of this study was to examine the implementation of evidence-based treatments for pediatric asthma in a regional consortium of EMS agencies. METHODS This retrospective study applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework to data from an EMS agency consortium in the Cincinnati, Ohio region. The study analyzed one year before an oral systemic corticosteroid (OCS) option was added to the agencies' protocol, and five years after the protocol change. We constructed logistic regression models for the primary outcome of Reach, defined as the proportion of pediatric asthma patients who received a systemic corticosteroid. We modeled Maintenance (Reach measured monthly over time) using time series models. RESULTS A total of 713 patients were included, 133 pre- and 580 post-protocol change. In terms of Reach, 3% (n = 4) of eligible patients received a systemic corticosteroid pre-OCS versus 20% (n = 116) post-OCS. Multivariable modeling of Reach revealed the study period, EMS transport time, months since implementation of OCS, and number of bronchodilators administered by EMS as significant covariates for the administration of a systemic corticosteroid. For Maintenance, it took approximately two years to reach maximal administration of systemic corticosteroids. CONCLUSIONS Indicators of asthma severity and time since the protocol change were significantly associated with EMS administration of systemic corticosteroids to pediatric asthma patients. The two-year time for maximal Reach suggests further work is required to understand how to best implement evidence-based pediatric asthma treatments in EMS.
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Affiliation(s)
- Jennifer N Fishe
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Amy M Crisp
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Lauren Riney
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Bertrand
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Shannon Burcham
- Department of Pediatrics, University of Florida College of Medicine, Cincinnati, OH, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Olga Semenova
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn V Blake
- Nemours Center for Pharmacogenomics and Translational Research, Nemours Children's Clinic, Pensacola, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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Sendi M, Fu Z, Harnett N, van Rooij S, Vergara V, Pizzagalli D, Daskalakis N, House S, Beaudoin F, An X, Neylan T, Clifford G, Jovanovic T, Linnstaedt S, Germine L, Bollen K, Rauch S, Haran J, Storrow A, Lewandowski C, Musey P, Hendry P, Sheikh S, Jones C, Punches B, Swor R, Gentile N, Murty V, Hudak L, Pascual J, Seamon M, Harris E, Chang A, Pearson C, Peak D, Merchant R, Domeier R, Rathlev N, O'Neil B, Sergot P, Sanchez L, Bruce S, Sheridan J, Harte S, Kessler R, Koenen K, McLean S, Stevens J, Calhoun V, Ressler K. Brain dynamics reflecting an intra-network brain state is associated with increased posttraumatic stress symptoms in the early aftermath of trauma. Res Sq 2024:rs.3.rs-4004473. [PMID: 38496567 PMCID: PMC10942549 DOI: 10.21203/rs.3.rs-4004473/v1] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This study examines the association between brain dynamic functional network connectivity (dFNC) and current/future posttraumatic stress (PTS) symptom severity, and the impact of sex on this relationship. By analyzing 275 participants' dFNC data obtained ~2 weeks after trauma exposure, we noted that brain dynamics of an inter-network brain state link negatively with current (r=-0.179, pcorrected= 0.021) and future (r=-0.166, pcorrected= 0.029) PTS symptom severity. Also, dynamics of an intra-network brain state correlated with future symptom intensity (r = 0.192, pcorrected = 0.021). We additionally observed that the association between the network dynamics of the inter-network brain state with symptom severity is more pronounced in females (r=-0.244, pcorrected = 0.014). Our findings highlight a potential link between brain network dynamics in the aftermath of trauma with current and future PTSD outcomes, with a stronger protective effect of inter-network brain states against symptom severity in females, underscoring the importance of sex differences.
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Affiliation(s)
| | - Zening Fu
- d Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University
| | | | | | | | | | | | | | - Francesca Beaudoin
- The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital
| | - Xinming An
- University of North Carolina at Chapel Hill
| | - Thomas Neylan
- San Francisco VA Healthcare System; University of California San Francisco
| | - Gari Clifford
- Emory University School of Medicine; Georgia Institute of Technology
| | | | | | | | | | | | - John Haran
- University of Massachusetts Medical School
| | | | | | | | | | | | | | - Brittany Punches
- University of Cincinnati College of Medicine & University of Cincinnati College of Nursing
| | | | | | | | | | - Jose Pascual
- Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | | | | | | | | | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth
| | | | | | | | | | | | | | | | | | - Vince Calhoun
- Georgia Institute of Technology, Emory University and Georgia State University
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Fishe JN, Garvan G, Bertrand A, Burcham S, Hendry P, Shah M, Kothari K, Ashby DW, Ostermeyer D, Riney L, Semenova O, Abo B, Abes B, Shimko N, Myers E, Frank M, Turner T, Kemp M, Landry K, Roland G, Blake KV. Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI-AS-ODT). Acad Emerg Med 2024; 31:49-60. [PMID: 37786991 PMCID: PMC10842452 DOI: 10.1111/acem.14813] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND In the emergency department (ED), prompt administration of systemic corticosteroids for pediatric asthma exacerbations decreases hospital admission rates. However, there is sparse evidence for whether earlier administration of systemic corticosteroids by emergency medical services (EMS) clinicians, prior to ED arrival, further improves pediatric asthma outcomes. METHODS Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial is a multicenter, observational, nonrandomized stepped-wedge design study with seven participating EMS agencies who adopted an oral systemic corticosteroid (OCS) into their protocols for pediatric asthma treatment. Using univariate analyses and multivariable mixed-effects models, we compared hospital admission rates for pediatric asthma patients ages 2-18 years before and after the introduction of a prehospital OCS and for those who did and did not receive a systemic corticosteroid from EMS. RESULTS A total of 834 patients were included, 21% of whom received a systemic corticosteroid from EMS. EMS administration of systemic corticosteroids increased after the introduction of an OCS from 14.7% to 28.1% (p < 0.001). However, there was no significant difference between hospital admission rates and ED length of stay before and after the introduction of OCS or between patients who did and did not receive a systemic corticosteroid from EMS. Mixed-effects models revealed that age 14-18 years (coefficient -0.83, p = 0.002), EMS administration of magnesium (coefficient 1.22, p = 0.04), and initial EMS respiratory severity score (coefficient 0.40, p < 0.001) were significantly associated with hospital admission. CONCLUSIONS In this multicenter study, the addition of an OCS into EMS agency protocols for pediatric asthma exacerbations significantly increased systemic corticosteroid administration but did not significantly decrease hospital admission rates. As overall EMS systemic corticosteroid administration rates were low, further work is required to understand optimal implementation of EMS protocol changes to better assess potential benefits to patients.
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Affiliation(s)
- Jennifer N Fishe
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
- Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gerard Garvan
- Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Andrew Bertrand
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Shannon Burcham
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Manish Shah
- Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Daniel Ostermeyer
- McGovern Medical School, University of Texas Health, Houston, Texas, USA
| | - Lauren Riney
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Olga Semenova
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Abo
- Lee County Emergency Medical Services, Fort Myers, Florida, USA
- Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Benjamin Abes
- Lee County Emergency Medical Services, Fort Myers, Florida, USA
| | - Nichole Shimko
- Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida, USA
| | - Emily Myers
- Sarasota County Fire Department, Sarasota, Florida, USA
| | - Marshall Frank
- Florida State University College of Medicine, Tallahassee, Florida, USA
- Sarasota County Fire Department, Sarasota, Florida, USA
| | - Tim Turner
- Walton County Fire Rescue, Defuniak Springs, Florida, USA
| | - Mac Kemp
- Leon County EMS, Tallahassee, Florida, USA
| | - Kim Landry
- Leon County EMS, Tallahassee, Florida, USA
| | - Greg Roland
- Nassau County Fire Rescue Department, Yulee, Florida, USA
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Sheikh S, Fernandez R, Smotherman C, Brailsford J, Langaee T, Velasquez E, Henson M, Munson T, Bertrand A, Hendry P, Anton S, Fillingim RB, Cavallari LH. A pilot study to identify pharmacogenomic and clinical risk factors associated with opioid related falls and adverse effects in older adults. Clin Transl Sci 2023; 16:2331-2344. [PMID: 37705211 PMCID: PMC10651658 DOI: 10.1111/cts.13634] [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: 04/24/2023] [Revised: 07/01/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Given the high prevalence of pain in older adults and current trends in opioid prescribing, inclusion of genetic information in risk prediction tools may improve opioid risk assessment. Our objectives were to (1) determine the feasibility of recruiting socioeconomically disadvantaged and racially diverse middle aged and older adult populations for a study seeking to identify risk factors for opioid-related falls and other serious adverse effects and (2) explore potential associations between the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) risk class and other patient factors with falls and serious opioid adverse effects. This was an observational study of 44 participants discharged home from the emergency department with an opioid prescription for acute pain and followed for 30 days. We found pain interference may predict opioid-related falls or serious adverse effects within older, opioid-treated patients. If validated, pain interference may prove to be a beneficial marker for risk stratification of older adults initiated on opioids for acute pain.
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Affiliation(s)
- Sophia Sheikh
- Department of Emergency MedicineUniversity of Florida College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Rosemarie Fernandez
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Carmen Smotherman
- Center for Data SolutionsUniversity of Florida, College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Jennifer Brailsford
- Center for Data SolutionsUniversity of Florida, College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Taimour Langaee
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision MedicineUniversity of Florida College of PharmacyGainesvilleFloridaUSA
| | - Esteban Velasquez
- Department of Emergency MedicineUniversity of Florida College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Morgan Henson
- Department of Emergency MedicineUniversity of Florida College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Taylor Munson
- Department of Emergency MedicineUniversity of Florida College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Andrew Bertrand
- Department of Emergency MedicineUniversity of Florida College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Phyllis Hendry
- Department of Emergency MedicineUniversity of Florida College of Medicine‐JacksonvilleJacksonvilleFloridaUSA
| | - Stephen Anton
- Department of Physiology and AgingUniversity of FloridaGainesvilleFloridaUSA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral ScienceUniversity of Florida College of DentistryGainesvilleFloridaUSA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision MedicineUniversity of Florida College of PharmacyGainesvilleFloridaUSA
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Riney L, Palmer S, Finlay E, Bertrand A, Burcham S, Hendry P, Shah M, Kothari K, Ashby DW, Ostermayer D, Semenova O, Abo BN, Abes B, Shimko N, Myers E, Frank M, Turner T, Kemp M, Landry K, Roland G, Fishe JN. Examination of disparities in prehospital encounters for pediatric asthma exacerbations. J Am Coll Emerg Physicians Open 2023; 4:e13042. [PMID: 37811360 PMCID: PMC10560007 DOI: 10.1002/emp2.13042] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma. Methods This is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2-18 years. We examined rates of EMS administration of systemic corticosteroids and inhaled bronchodilators by patient race. We geocoded EMS scene addresses, characterized the locations' neighborhood-based conditions and resources relevant to children using the Child Opportunity Index (COI) 2.0, and analyzed associations between EMS scene address COI with medications administered by EMS. Results A total of 765 patients had available racial data and 825 had scene addresses that were geocoded to a COI. EMS administered at least 1 bronchodilator to 84.7% (n = 492) of non-White patients and 83.2% of White patients (n = 153), P = 0.6. EMS administered a systemic corticosteroid to 19.4% (n = 113) of non-White patients and 20.1% (n = 37) of White patients, P = 0.8. There was a significant difference in bronchodilator administration between COI categories of low/very low versus moderate/high/very high (85.0%, n = 485 vs. 75.9%, n = 192, respectively, P = 0.003). Conclusions There were no racial differences in EMS administration of medications to pediatric asthma patients. However, there were significantly higher rates of EMS bronchodilator administration for encounters in low/very low COIs. That latter finding may reflect inequities in asthma exacerbation severity for patients living in disadvantaged areas.
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Affiliation(s)
- Lauren Riney
- Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Sam Palmer
- College of Design, Construction, and PlanningUniversity of Florida GeoPlan CenterGainesvilleFloridaUSA
| | - Erik Finlay
- College of Design, Construction, and PlanningUniversity of Florida GeoPlan CenterGainesvilleFloridaUSA
| | - Andrew Bertrand
- Department of Emergency MedicineUniversity of Florida College of MedicineJacksonvilleFloridaUSA
| | - Shannon Burcham
- Department of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Phyllis Hendry
- Department of Emergency MedicineUniversity of Florida College of MedicineJacksonvilleFloridaUSA
| | - Manish Shah
- Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Kathryn Kothari
- Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - David W. Ashby
- Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | | | - Olga Semenova
- Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Benjamin N. Abo
- Lee County Emergency Medical ServicesFort MyersFloridaUSA
- Department of Emergency MedicineFlorida State University College of MedicineTallahasseeFloridaUSA
- Sarasota County Fire DepartmentSarasotaFloridaUSA
| | - Benjamin Abes
- Lee County Emergency Medical ServicesFort MyersFloridaUSA
| | - Nichole Shimko
- Golisano Children's Hospital of Southwest FloridaFort MyersFloridaUSA
| | - Emily Myers
- Sarasota County Fire DepartmentSarasotaFloridaUSA
| | - Marshall Frank
- Department of Emergency MedicineFlorida State University College of MedicineTallahasseeFloridaUSA
- Sarasota County Fire DepartmentSarasotaFloridaUSA
| | - Tim Turner
- Walton County Fire Rescue DepartmentDefuniak SpringsFloridaUSA
| | - Mac Kemp
- Leon County EMSTallahasseeFloridaUSA
| | | | - Greg Roland
- Nassau County Fire DepartmentYuleeFloridaUSA
| | - Jennifer N. Fishe
- Department of Emergency MedicineUniversity of Florida College of MedicineJacksonvilleFloridaUSA
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Riney L, Palmer S, Finlay E, Bertrand A, Burcham S, Hendry P, Shah M, Kothari K, Ashby D, Ostermayer D, Semenova O, Abo BN, Abes B, Shimko N, Myers E, Frank M, Turner T, Kemp M, Landry K, Roland G, Fishe J. EMS Administration of Systemic Corticosteroids to Pediatric Asthma Patients: An Analysis by Severity and Transport Interval. PREHOSP EMERG CARE 2023; 27:900-907. [PMID: 37428954 PMCID: PMC10592383 DOI: 10.1080/10903127.2023.2234996] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Pediatric asthma exacerbations are a common cause of emergency medical services (EMS) encounters. Bronchodilators and systemic corticosteroids are mainstays of asthma exacerbation therapy, yet data on the efficacy of EMS administration of systemic corticosteroids are mixed. This study's objective was to assess the association between EMS administration of systemic corticosteroids to pediatric asthma patients on hospital admission rates based on asthma exacerbation severity and EMS transport intervals. METHODS This is a sub-analysis of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial (EASI AS ODT). EASI AS ODT is a non-randomized, stepped wedge, observational study examining outcomes one year before and one year after seven EMS agencies incorporated an oral systemic corticosteroid option into their protocols for the treatment of pediatric asthma exacerbations. We included EMS encounters for patients ages 2-18 years confirmed by manual chart review to have asthma exacerbations. We compared hospital admission rates across asthma exacerbation severities and EMS transport intervals using univariate analyses. We geocoded patients and created maps to visualize the general trends of patient characteristics. RESULTS A total of 841 pediatric asthma patients met inclusion criteria. While most patients were administered inhaled bronchodilators by EMS (82.3%), only 21% received systemic corticosteroids, and only 19% received both inhaled bronchodilators and systemic corticosteroids. Overall, there was no significant difference in hospitalization rates between patients who did and did not receive systemic corticosteroids from EMS (33% vs. 32%, p = 0.78). However, although not statistically significant, for patients who received systemic corticosteroids from EMS, there was an 11% decrease in hospitalizations for mild exacerbation patients and a 16% decrease in hospitalizations for patients with EMS transport intervals greater than 40 min. CONCLUSION In this study, systemic corticosteroids were not associated with a decrease in hospitalizations of pediatric patients with asthma overall. However, while limited by small sample size and lack of statistical significance, our results suggest there may be a benefit in certain subgroups, particularly patients with mild exacerbations and those with transport intervals longer than 40 min. Given the heterogeneity of EMS agencies, EMS agencies should consider local operational and pediatric patient characteristics when developing standard operating protocols for pediatric asthma.
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Affiliation(s)
- Lauren Riney
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
| | | | | | | | | | - Phyllis Hendry
- University of Florida College of Medicine – Jacksonville
| | - Manish Shah
- Baylor College of Medicine, Texas Children’s Hospital
| | | | - David Ashby
- Baylor College of Medicine, Texas Children’s Hospital
| | | | - Olga Semenova
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
| | - Benjamin N. Abo
- Lee County Emergency Medical Services, Florida
- Florida State University College of Medicine
- Sarasota County Fire Department, Florida
| | | | | | | | - Marshall Frank
- Florida State University College of Medicine
- Sarasota County Fire Department, Florida
| | | | | | | | - Greg Roland
- Nassau County Fire Rescue Department, Florida
| | - Jennifer Fishe
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
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LeLaurin JH, Montague M, Salloum RG, Shiekh SS, Hendry P. Implementation of a novel emergency department pain coach educator program: First year experience and evaluation. Res Sq 2023:rs.3.rs-2488709. [PMID: 36747798 PMCID: PMC9901022 DOI: 10.21203/rs.3.rs-2488709/v1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The ongoing opioid epidemic and rising number of patients with chronic pain have highlighted the need for alternative and integrative pain management approaches. A number of evidence-based nonpharmacologic pain management strategies are available; however, these approaches remain underutilized due to barriers such as time limitations, cost, and lack of clinician training. The aim of this work was to implement a nonpharmacologic pain coach educator program that addresses these barriers. We report an evaluation of the first year of program implementation in the emergency department of a large safety-net hospital. Methods We implemented a multimodal pain coach educator program that included education on pain neuroscience and over-the-counter analgesic options, demonstration of integrative techniques, and nonpharmacologic toolkits for home use. Implementation strategies included electronic health record tools, training and promotion, clinical champions, and clinician recognition. We used the RE-AIM framework to guide evaluation of the first year of program implementation using data from the electronic health record, quantitative and qualitative program records, and patient-reported outcomes. Results In the first year of program implementation 550 pain coach educator sessions were conducted. Upon immediate session completion, 61% of patients felt the program was helpful, 39% were unsure at the time, and none reported session was not helpful. Clinician feedback was overwhelmingly positive. Program cost per patient was $344.35. Adaptations to first year intervention and implementation strategies included modifications of session delivery timing for accommodation of clinical workflows, additions to program content to align with patient characteristics, and changes to patient identification strategies in response to the coronavirus 19 pandemic. Conclusions The PAMI pain coach educator program provides a model for nonpharmacologic pain management programs which can be scaled up and adapted for other settings. This work demonstrates the importance of intervention and implementation strategy adaptations to enhance program reach and effectiveness.
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Brailsford J, Sheikh S, Beneciuk J, Patel M, Johnson B, Li RM, Hendry P, Spindle N. RE-AIM EVALUATION OF A VIRTUAL “AGING WITH PAIN” INTEGRATIVE HEALTH EDUCATION PROGRAM DURING THE COVID-19 PANDEMIC. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.3072] [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: 12/24/2022] Open
Abstract
Abstract
Literature suggests integrative pain management strategies reduce chronic pain and opioid use. However, many older adults are unaware of these options. The Aging and Integrative Pain Assessment and Management Initiative (AI-PAMI) launched in 2020, providing webinars and recorded presentations on integrative pain management for adults > age 50, caregivers and healthcare providers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate AI-PAMI via the following measures: participant demographics, survey results, program elements and qualitative findings. Reach: There have been > 20,000 views of recorded content and 48% (885/1,859) of registrants attended a live webinar. Effectiveness: Survey results demonstrate 75% of providers and 73% of older adults/caregivers reported new knowledge gain; and 80% of providers and 60% of older adults/caregivers reported changing their pain management practice/routine. Adoption: Presentations were delivered by 33 multidisciplinary experts from 12 different institutions. Six regional stakeholders promoted AI-PAMI using their dissemination networks. Implementation: The COVID-19 pandemic changed program delivery from an in-person model to virtual. To date, AI-PAMI has delivered 17 live webinars and 25 recorded presentations. Live webinars are delivered with a didactic, Q&A discussion and follow-up email. To refine AI-PAMI, 11 healthcare providers and 16 older adults participated in focus groups or in-depth interviews. Maintenance: AI-PAMI is in its third year and will be maintained under a long-standing institution-wide program. Website content will be sustained and remain free access. AI-PAMI is a valuable educational resource for older adults, caregivers, and healthcare providers. Virtual delivery is accommodating for a post-COVID environment.
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Affiliation(s)
| | - Sophia Sheikh
- University of Florida College of Medicine – Jacksonville , Jacksonville, Florida , United States
| | - Jason Beneciuk
- University of Florida , Gainesville, Florida , United States
| | - Monika Patel
- University of Florida College of Medicine – Jacksonville , Jacksonville, Florida , United States
| | | | - Robin Moorman Li
- University of Florida College of Pharmacy , Jacksonville, Florida , United States
| | - Phyllis Hendry
- University of Florida College of Medicine – Jacksonville , Jacksonville, Florida , United States
| | - Natalie Spindle
- University of Florida College of Medicine – Jacksonville , Jacksonville, Florida , United States
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Woodruff G, Palmer L, Fontane E, Kalynych C, Hendry P, Thomas A, Crandall M. Nine years of pediatric gunshot wounds: a descriptive analysis. Prev Med Rep 2022; 28:101890. [PMID: 35832637 PMCID: PMC9272024 DOI: 10.1016/j.pmedr.2022.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/26/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Firearm injury increases with age with previous studies examining ages 0–14 vs. 15–18. There is poor documentation in the literature of key demographic details surrounding the injury. There are important demographic differences that exist between older adolescent (13–14 years) and younger children (0–12 years). Adolescents aged 13 years and older have similar profile to older adolescents/teens and may benefit from interventions such as violence intervention programs.
Pediatric firearm violence carries significant morbidity and mortality. Studies targeting children ≤14 years are limited. Our goal was to study the distribution and determinants of GSWs in the pediatric population. We performed a retrospective review of children ≤14 years presenting with GSWs at this level 1 trauma center. This cohort was split into younger children, 0–12 years, and older children, 13–14 years. Summary and bivariate statistics were calculated using Stata v10. 142 patients (68.3% black, 76.7% male) were identified. Injuries more often occurred at home (39.6%) by family or friends (60.7%). Older children often suffered handgun injuries (85.5%) and more often were sent immediately to the OR on presentation (29.2%). Younger children more often suffered from air-gun (50%) and pistols (40%). Younger children more commonly had blood transfusions (9.4%) compared to exploratory laparotomy in older children (13.5%). The most common disposition from the ED was home (36.2%). Descriptive data entailing incident specifics such as time of injury and CPS involvement were frequently missing in the healthcare record. Older children were more likely to be injured by strangers, have longer lengths of stay especially associated with surgical operations, and have a disposition of immediate arrest compared to their younger cohort. Consequently, this group may benefit from interventions typically aimed at older patients such as violence intervention programs. When available, differences in demographics and outcomes were identified which could shape novel prevention strategies for firearm injury.
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Beaudoin F, Zhai W, Merchant R, Clark M, Kurz M, Hendry P, Swor R, Peak D, Pearson C, Domeier R, Ortiz C, McLean S. This Article Corrects: “Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study”. West J Emerg Med 2022; 23:289. [PMID: 35302467 PMCID: PMC8967453 DOI: 10.5811/westjem.2022.2.56585] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Francesca Beaudoin
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Wanting Zhai
- Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island
| | - Roland Merchant
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Melissa Clark
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island
| | - Michael Kurz
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Phyllis Hendry
- University of Florida College of Medicine – Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Robert Swor
- Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan
| | - David Peak
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Claire Pearson
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert Domeier
- St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan
| | - Christine Ortiz
- Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island
| | - Samuel McLean
- University of North Carolina – Chapel Hill, Department of Anesthesiology and Emergency Medicine, Chapel Hill, North Carolina
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Owusu‐Ansah S, Harris M, Fishe JN, Adelgais K, Panchal A, Lyng JW, McCans K, Alter R, Perry A, Cercone A, Hendry P, Cicero MX. State emergency medical services guidance and protocol changes in response to the COVID‐19 pandemic: A national investigation. J Am Coll Emerg Physicians Open 2022; 3:e12687. [PMID: 35252975 PMCID: PMC8886181 DOI: 10.1002/emp2.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Sylvia Owusu‐Ansah
- Department of Pediatrics Division of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Matthew Harris
- Department of Pediatrics Section of Emergency Medicine Zucker School of Medicine at Hofstra/Northwell Hempstead New York USA
| | - Jennifer N. Fishe
- Department of Emergency Medicine University of Florida College of Medicine – Jacksonville Jacksonville Florida USA
| | - Kathleen Adelgais
- Department of Pediatrics Section of Pediatric Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
| | - Ashish Panchal
- Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - John W. Lyng
- Department of Emergency Medicine University of Minnesota School of Medicine Minneapolis Minnesota USA
| | - Kerry McCans
- Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Rachel Alter
- National Association of State EMS Officials Falls Church Virginia USA
| | - Amanda Perry
- Louisiana Department of Health EMS for Children Baton Rouge Louisiana USA
| | - Angelica Cercone
- Department of Pediatrics Division of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Phyllis Hendry
- Department of Emergency Medicine University of Florida College of Medicine – Jacksonville Jacksonville Florida USA
| | - Mark X. Cicero
- Department of Pediatrics Section of Pediatric Emergency Medicine Yale University School of Medicine New Haven Connecticut USA
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Peacock WF, Soto‐Ruiz KM, House SL, Cannon CM, Headden G, Tiffany B, Motov S, Merchant‐Borna K, Chang AM, Pearson C, Patterson BW, Jones AE, Miller J, Varon J, Bastani A, Clark C, Rafique Z, Kea B, Eppensteiner J, Williams JM, Mahler SA, Driver BE, Hendry P, Quackenbush E, Robinson D, Schrock JW, D'Etienne JP, Hogan CJ, Osborne A, Riviello R, Young S. Utility of COVID-19 antigen testing in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12605. [PMID: 35072154 PMCID: PMC8760952 DOI: 10.1002/emp2.12605] [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: 08/23/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The BinaxNOW coronavirus disease 2019 (COVID-19) Ag Card test (Abbott Diagnostics Scarborough, Inc.) is a lateral flow immunochromatographic point-of-care test for the qualitative detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid protein antigen. It provides results from nasal swabs in 15 minutes. Our purpose was to determine its sensitivity and specificity for a COVID-19 diagnosis. METHODS Eligible patients had symptoms of COVID-19 or suspected exposure. After consent, 2 nasal swabs were collected; 1 was tested using the Abbott RealTime SARS-CoV-2 (ie, the gold standard polymerase chain reaction test) and the second run on the BinaxNOW point of care platform by emergency department staff. RESULTS From July 20 to October 28, 2020, 767 patients were enrolled, of which 735 had evaluable samples. Their mean (SD) age was 46.8 (16.6) years, and 422 (57.4%) were women. A total of 623 (84.8%) patients had COVID-19 symptoms, most commonly shortness of breath (n = 404; 55.0%), cough (n = 314; 42.7%), and fever (n = 253; 34.4%). Although 460 (62.6%) had symptoms ≤7 days, the mean (SD) time since symptom onset was 8.1 (14.0) days. Positive tests occurred in 173 (23.5%) and 141 (19.2%) with the gold standard versus BinaxNOW test, respectively. Those with symptoms >2 weeks had a positive test rate roughly half of those with earlier presentations. In patients with symptoms ≤7 days, the sensitivity, specificity, and negative and positive predictive values for the BinaxNOW test were 84.6%, 98.5%, 94.9%, and 95.2%, respectively. CONCLUSIONS The BinaxNOW point-of-care test has good sensitivity and excellent specificity for the detection of COVID-19. We recommend using the BinasNOW for patients with symptoms up to 2 weeks.
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Affiliation(s)
- W. Frank Peacock
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | | | - Stacey L. House
- Department of Emergency MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Chad M. Cannon
- Department of Emergency MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Gary Headden
- Department of Emergency MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Sergey Motov
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNew YorkUSA
| | - Kian Merchant‐Borna
- Department of Emergency MedicineUniversity of Rochester Medical CenterUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Anna Marie Chang
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State UniversityAscension St. JohnDetroitMichiganUSA
| | - Brian W. Patterson
- Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alan E. Jones
- Department of Emergency MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Joseph Miller
- Department of Emergency MedicineHenry Ford HospitalDetroitMichiganUSA
| | - Joseph Varon
- Department of Intensive Care MedicineUnited Memorial Medical CenterThe University of Houston School of MedicineHoustonTexasUSA
| | - Aveh Bastani
- Department of Emergency MedicineWilliam Beaumont Health SystemTroyMichiganUSA
| | - Carol Clark
- Department of Emergency MedicineWilliam Beaumont Health SystemRoyal OakMichiganUSA
| | - Zubaid Rafique
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Bory Kea
- Department of Emergency MedicineOregon Health & Sciences UniversityPortlandOregonUSA
| | - John Eppensteiner
- Department of Emergency MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - James M. Williams
- Department of Emergency MedicineSchool of MedicineMeritus Medical Center, Texas Tech University Health Science CenterLubbockTexasUSA
| | - Simon A. Mahler
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Brian E. Driver
- Department of Emergency MedicineHennepin County Medical CenterMinneapolisMinnesotaUSA
| | - Phyllis Hendry
- Department of Emergency MedicineUniversity of Florida College of MedicineJacksonvilleFloridaUSA
| | - Eugenia Quackenbush
- Department of Emergency MedicineUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - David Robinson
- Department of Emergency Medicine at McGovern Medical SchoolThe University of TexasHoustonTexasUSA
| | - Jon W. Schrock
- Department of Emergency MedicineMetroHealth Medical CenterCase Western Reserve University School of MedicineClevelandOhioUSA
| | - James P. D'Etienne
- John Peter Smith Health Network/Integrative Emergency ServicesFort WorthTexasUSA
| | - Christopher J. Hogan
- Virginia Commonwealth University Medical CenterDepartments of Emergency Medicine and SurgeryRichmondVirginiaUSA
| | - Anwar Osborne
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgia
| | - Ralph Riviello
- Department of Emergency MedicineUniversity of Texas Health San AntonioSan AntonioTexasUSA
| | - Stephen Young
- TriCore Reference LaboratoriesAlbuquerqueNew MexicoUSA
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Sheikh S, Brailsford J, Beneciuk J, Patel M, Johnson B, Li RM, Hendry P, Mitchell N. Exploring the Patient-Provider Relationship in Older Adult Pain Management. Innov Aging 2021. [PMCID: PMC8682646 DOI: 10.1093/geroni/igab046.3391] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Successful health outcomes in older patients are linked to the quality of the patient-provider relationship. Our study objective was to further understand the role of this relationship specific to pain management through perspectives from older adults and healthcare providers. Semi-structured interviews and focus groups were conducted with 9 older adults and 11 multidisciplinary healthcare providers. Transcripts were analyzed using a thematic analysis. Three main concepts emerged: (1) defining pain management goals — differences in providers and patients’ goals for pain and function, with sub-themes of realistic goal setting and a shift in pain treatment to minimize opioids as a first-line medication; (2) communication — perceived gap in providers communicating and coordinating across disciplines and with patients, with sub-themes of improving positive communication and inconsistent messaging among providers; and (3) therapeutic alliance — all parties feel that developing a relationship is built on consistent trust and open dialogue. Although providers and older adults often expressed similar perspectives, there were several areas of misalignment identified within each concept, representing areas of disconnect within the patient-provider pain management relationship. Our findings indicate providers could benefit from education on improving communication around realistic goals and patient-centered outcomes and incorporation of more holistic pain management approaches when working with older adult patients. Further study should focus on developing educational interventions to address the identified shortcomings.
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Affiliation(s)
| | | | - Jason Beneciuk
- Brooks Rehabilitation and the College of Public Health & Health Professions at the University of Florida, Jacksonville, Florida, United States
| | - Monika Patel
- University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, United States
| | - Brittany Johnson
- University of Florida College of Pharmacy, Jacksonville, Florida, United States
| | - Robin Moorman Li
- University of Florida College of Pharmacy, Jacksonville, Florida, United States
| | - Phyllis Hendry
- UF College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Natalie Mitchell
- UF College of Medicine Jacksonville, Jacksonville, Florida, United States
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14
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Mandadi AR, Dully K, Brailsford J, Wylie T, Morrissey TK, Hendry P, Gautam S, Fishe JN. A national survey of pediatric emergency medicine physicians on improving education in child maltreatment recognition and reporting child abuse & neglect. Child Abuse Negl 2021; 122:105324. [PMID: 34547715 DOI: 10.1016/j.chiabu.2021.105324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Child maltreatment is an important public health problem with serious consequences. Even in the face of increased research and enhanced public awareness over the last decade, the rate of child fatalities due to reported child maltreatment has increased. OBJECTIVE This study describes pediatric emergency medicine (PEM) physicians' knowledge, training, confidence, and barriers in recognition and reporting suspected child maltreatment. PARTICIPANTS AND SETTING A nationally representative sample of PEM physician members of Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) participated. METHODS A cross-sectional 36-item survey study of PEM physicians with content domains including provider knowledge, preparedness, confidence, and barriers to identifying and reporting child maltreatment was conducted and distributed. RESULTS 113 of 486 members completed the survey. Confidence with recognizing and reporting child abuse (95%) was greater than in child neglect (88%). Knowledge in child maltreatment recognition and reporting was significantly correlated with confidence in reporting and recognition (p < 0.001). There was a significant relationship between knowledge and confidence for respondents from states with training in child maltreatment recognition and reporting requirement as a condition of licensure and re-licensure compared to states without the requirement (p < 0.01). Qualitative responses revealed insightful themes to improve child maltreatment training, recognition and reporting. CONCLUSION Our national survey study demonstrates that PEM-trained physicians have high confidence and knowledge with the management of child maltreatment, and that inclusion of mandated child maltreatment training in residency/fellowship and mandated training for medical licensure in all states could improve child maltreatment recognition and reporting.
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Affiliation(s)
- Akhila R Mandadi
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, United States of America.
| | - Kathleen Dully
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, United States of America
| | - Jennifer Brailsford
- Department of Research, University of Florida College of Medicine, Jacksonville, United States of America
| | - Todd Wylie
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, United States of America
| | - Thomas K Morrissey
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, United States of America
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, United States of America
| | - Shiva Gautam
- Department of Medicine, University of Florida College of Medicine, Jacksonville, United States of America
| | - Jennifer N Fishe
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, United States of America
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Fishe JN, Palmer E, Finlay E, Smotherman C, Gautam S, Hendry P, Hendeles L. A Statewide Study of the Epidemiology of Emergency Medical Services' Management of Pediatric Asthma. Pediatr Emerg Care 2021; 37:560-569. [PMID: 30829849 PMCID: PMC6693989 DOI: 10.1097/pec.0000000000001743] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Little is known about emergency medical services' (EMS') management of pediatric asthma. This study's objective was to describe the demographic, clinical, and geographic characteristics of current EMS' management of pediatric asthma in the state with the fourth-largest pediatric population. METHODS This was a retrospective observational study of EMS patients ages 2 to 18 years with an asthma exacerbation from 2011 to 2016. Patients from Florida's EMS Tracking and Reporting System were included if their EMS chief complaint indicated respiratory distress, if they received at least 1 albuterol treatment, and if they were transported to a hospital. RESULTS A total of 11,226 patients met the inclusion criteria. The median age was 9 years, and 49% were African-American. Geospatial analysis revealed 4 rural counties with disproportionate numbers of African-American patients. In addition to albuterol, 37% of patients received ipratropium bromide and 9% received systemic corticosteroids. Adjusted logistic regression revealed that the strongest predictors of receiving systemic corticosteroids from EMS were intravenous access (odds ratio, 33.4; 95% confidence interval, 24.4-45.6) and intravenous magnesium sulfate administration (odds ratio, 5.0; 95% confidence interval, 3.4-7.3), indicating a more severe presentation. CONCLUSIONS This statewide study demonstrated low rates of EMS administration of ipratropium bromide and systemic corticosteroids, both evidence-based treatments for asthma exacerbations. Targeted EMS education should attempt to increase utilization of both those medications. In addition, the feasibility and efficacy of EMS administration of oral systemic corticosteroids for children should be explored.
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Affiliation(s)
- Jennifer N. Fishe
- University of Florida – Jacksonville, Department of Emergency Medicine
| | - Eugene Palmer
- University of Florida, College of Design, Construction, and Planning
- GeoPlan Center, University of Florida
| | - Erik Finlay
- University of Florida, College of Design, Construction, and Planning
- GeoPlan Center, University of Florida
| | | | - Shiva Gautam
- University of Florida – Jacksonville, College of Medicine
| | - Phyllis Hendry
- University of Florida – Jacksonville, Department of Emergency Medicine
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Sheikh S, Fishe J, Norse A, Henson M, James D, Sher W, Lott M, Kalynych C, Hendry P. Comparing Pain Intensity Using the Numeric Rating Scale and Defense and Veterans Pain Rating Scale in Patients Revisiting the Emergency Department. Cureus 2021; 13:e17501. [PMID: 34603880 PMCID: PMC8476185 DOI: 10.7759/cureus.17501] [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] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the relationship between Numeric Rating Scale (NRS) and Defense and Veterans Pain Rating Scale (DVPRS) as pain intensity measures, we compared pain scores to sociodemographic and treatment data in patients revisiting the emergency department (ED). Methods After Institutional Review Board approval, 389 adults presenting within 30 days of an index visit were enrolled. Pain scores were classified as follows: 0-3 (mild), 4-7 (moderate), and 8-10 (high). Data were analyzed using descriptive analysis. Wilcoxon rank-sum test measured the association of pain score with gender. Pain scales were correlated using Spearman correlation coefficient. Pain scale association with opioid treatment was tested via ordinal logistic regression controlling for gender, home opioid use, and if ED revisit was for pain. Results Average patient age was 49. Most patients were African American (68.4%), male (51.2%), and returned for pain (67.0%). As continuous measures, both scales were positively correlated with each other (p<0.0001). Pain score severity categories were distributed differently between the two scales (p=0.0085), decreasing by 8% in patients reporting high pain severity when using DVPRS. For both scales, the proportion of patients (1) administered opioids (p=0.0009 and p≤0.0001, respectively) and (2) discharged with opioids (p=0.0103 and p=0.0417, respectively) increased with pain severity. Discharge NRS (p=0.0001) (OR=3.2, 1.780-5.988) and DVPRS pain score categories (p<0.0001) (OR=2.7, 95% CI=1.63-4.473) were associated with revisits for pain. Conclusions Our findings demonstrate a link between NRS and administration of opioid medications and suggest that DVPRS may better differentiate between moderate and high levels of pain in the ED setting.
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Affiliation(s)
- Sophia Sheikh
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Jennifer Fishe
- Pediatric Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Ashley Norse
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Morgan Henson
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Divya James
- Emergency Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Warren Sher
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Michelle Lott
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Colleen Kalynych
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Phyllis Hendry
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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The PAMI ED-ALT Group, Sheikh S, Schmitzberger M, Liao R, Brailsford J, Fishe J, Norse A, Webb K, Spindle N, Suffield D, Hendry P. 222 Preliminary Results of PAMI-ED ALT: An Emergency Department Opioid-Alternatives Program. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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AURORA Study Group, Beaudoin F, An X, Li Q, House S, Musey P, Hendry P, Jones C, Lewandowski C, Storrow A, McLean S. 207 Associations Between Alcohol Use and Adverse Posttraumatic Neuropsychiatric Sequelae in the Early Aftermath of Trauma. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pain Assessment and Management Initiative, Hendry P, Suffield D, Sheikh S, Spindle N, Schmitzberger M, Velasquez E, Lott M, Fishe J, Johnson B, Kendall Webb L, Norse A. 214 Preliminary Results From an Emergency Department Pain Coach Service and Discharge Toolkit Pilot Project During COVID-19. Ann Emerg Med 2021. [PMCID: PMC8536285 DOI: 10.1016/j.annemergmed.2021.09.226] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sheikh S, Booth-Norse A, Holden D, Henson M, Dodd C, Edgerton E, James D, Kalynych C, Smotherman C, Hendry P. Opioid Overdose Risk in Patients Returning to the Emergency Department for Pain. Pain Med 2021; 22:2100-2105. [PMID: 33560418 DOI: 10.1093/pm/pnab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Using the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) in patients returning to the emergency department (ED) for pain and discharged with an opioid prescription, we assessed overall opioid overdose risk and compared risk in opioid naive patients to those who are non-opioid naive. DESIGN This was a secondary analysis from a prospective observational study of patients ≥ 18 years old returning to the ED within 30 days. Data were collected from patient interviews and chart reviews. Patients were categorized as Group 1 (not using prescription opioids) or Group 2 (consuming prescription opioids). Statistical analyses were performed using Fisher's exact and Wilcoxon's rank sum tests. Risk class and probability of overdose was determined using Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD). RESULTS Of the 389 enrollees who returned to the ED due to pain within 30 days of an initial visit, 67 (17%) were prescribed opioids. The majority of these patients were in Group 1 (60%). Both Group 1 (n = 40) and Group 2 (n = 27) held an average CIP-RIOSORD risk class of 3. Race significantly differed between groups; the majority of Group 1 self-identified as African American (80%) (P = .0267). There were no differences in age, gender, or CIP-RIOSORD risk class between groups. However, Group 2 had nearly double the number of predictive factors (median = 1.93) as Group 1 (median = 1.18) (P = .0267). CONCLUSIONS A substantial proportion of patients (25%) were high risk for opioid overdose. CIP-RIOSORD may prove beneficial in risk stratification of patients discharged with prescription opioids from the ED.
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Affiliation(s)
- Sophia Sheikh
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Ashley Booth-Norse
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - David Holden
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Morgan Henson
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Caroline Dodd
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Eric Edgerton
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Divya James
- University of Florida College of Medicine, Gainesville, Florida
| | - Colleen Kalynych
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Phyllis Hendry
- University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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McLean SA, Ressler K, Koenen KC, Neylan T, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt S, Beaudoin F, House S, Bollen KA, Musey P, Hendry P, Jones CW, Lewandowski C, Swor R, Datner E, Mohiuddin K, Stevens JS, Storrow A, Kurz MC, McGrath ME, Fermann GJ, Hudak LA, Gentile N, Chang AM, Peak DA, Pascual JL, Seamon MJ, Sergot P, Peacock WF, Diercks D, Sanchez LD, Rathlev N, Domeier R, Haran JP, Pearson C, Murty VP, Insel TR, Dagum P, Onnela JP, Bruce SE, Gaynes BN, Joormann J, Miller MW, Pietrzak RH, Buysse DJ, Pizzagalli DA, Rauch SL, Harte SE, Young LJ, Barch DM, Lebois LAM, van Rooij SJH, Luna B, Smoller JW, Dougherty RF, Pace TWW, Binder E, Sheridan JF, Elliott JM, Basu A, Fromer M, Parlikar T, Zaslavsky AM, Kessler R. Correction: The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry 2021; 26:3658. [PMID: 32989243 PMCID: PMC10853881 DOI: 10.1038/s41380-020-00897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuel A McLean
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA.
| | - Kerry Ressler
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | | | - Thomas Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Laura Germine
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, UNC Gillings School of Public Health, Chapel Hill, NC, USA
| | - Xinming An
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sarah Linnstaedt
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth A Bollen
- Department of Statistics and Operational Research, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Elizabeth Datner
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Health Medical Center, Philadelphia, PA, USA
| | - Jennifer S Stevens
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Christopher Kurz
- Department of Emergency Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas, Houston, TX, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deborah Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niels Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Robert Domeier
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - John Patrick Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vishnu P Murty
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | | | - Paul Dagum
- Mindstrong Health, Mountain View, CA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Mark W Miller
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Larry J Young
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sanne J H van Rooij
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thaddeus W W Pace
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Elisabeth Binder
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sheridan
- College of Dentistry, Ohio State University School of Medicine, Columbus, OH, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Archana Basu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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22
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Schumacher JR, Lutz BJ, Hall AG, Harman JS, Turner K, Brumback BA, Hendry P, Carden DL. Impact of an Emergency Department-to-Home Transitional Care Intervention on Health Service Use in Medicare Beneficiaries: A Mixed Methods Study. Med Care 2021; 59:29-37. [PMID: 33298706 PMCID: PMC8689563 DOI: 10.1097/mlr.0000000000001452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital-based acute care [emergency department (ED) visits and hospitalizations] that is preventable with high-quality outpatient care contributes to health care system waste and patient harm. OBJECTIVE To test the hypothesis that an ED-to-home transitional care intervention reduces hospital-based acute care in chronically ill, older ED visitors. RESEARCH DESIGN Convergent, parallel, mixed-methods design including a randomized controlled trial. SETTING Two diverse Florida EDs. SUBJECTS Medicare fee-for-service beneficiaries with chronic illness presenting to the ED. INTERVENTION The Coleman Care Transition Intervention adapted for ED visitors. MEASURES The main outcome was hospital-based acute care within 60 days of index ED visit. We also assessed office-based outpatient visits during the same period. RESULTS The Intervention did not significantly reduce return ED visits or hospitalizations or increase outpatient visits. In those with return ED visits, the Intervention Group was less likely to be hospitalized than the Usual Care Group. Interview themes describe a cycle of hospital-based acute care largely outside patients' control that may be difficult to interrupt with a coaching intervention. CONCLUSIONS AND RELEVANCE Structural features of the health care system, including lack of access to timely outpatient care, funnel patients into the ED and hospital admission. Reducing hospital-based acute care requires increased focus on the health care system rather than patients' care-seeking decisions.
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Affiliation(s)
- Jessica R. Schumacher
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison WI
| | - Barbara J. Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina-Wilmington, Wilmington NC
| | - Allyson G. Hall
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey S. Harman
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee FL
| | | | - Babette A. Brumback
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida-Gainesville, Gainesville FL
| | - Phyllis Hendry
- Department of Emergency Medicine, College of Medicine, University of Florida-Jacksonville, Jacksonville FL
| | - Donna L. Carden
- Department of Emergency Medicine, College of Medicine, University of Florida-Gainesville, Gainesville FL
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23
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Beaudoin FL, Zhai W, Merchant RC, Clark MA, Kurz MC, Hendry P, Swor RA, Peak D, Pearson C, Domeier R, Ortiz C, McLean SA. Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study. West J Emerg Med 2020; 22:139-147. [PMID: 33856293 PMCID: PMC7972399 DOI: 10.5811/westjem.2020.8.47450] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/12/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care. METHODS This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at the ED visit via patient interview and self-report surveys at six weeks after the ED visit via internet-based, self-report survey, or telephone interview. We assessed MSAP pain at ED visit and persistence at six weeks. Multivariable models examined factors associated with MSAP persistence at six weeks post-MVC. RESULTS Among 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [CI], 77.1 - 82.2) reported MSAP and 28.3 (95% CI, 25.5 - 31.3) had widespread pain. At six weeks, 67% (95% CI, 64, 70%) had MSAP and 31% (95% CI, 28, 34%) had widespread pain. ED characteristics predicting MSAP at six weeks post-MVC (area under the curve = 0.74; 95% CI, 0.72, 0.74) were older age, peritraumatic dissociation, moderate to severe pain in the ED, feeling uncertain about recovery, and symptoms of depression. CONCLUSION These data indicate that Blacks presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.
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Affiliation(s)
- Francesca L Beaudoin
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Wanting Zhai
- Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Roland C Merchant
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Melissa A Clark
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Michael C Kurz
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Phyllis Hendry
- University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert A Swor
- Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - David Peak
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Claire Pearson
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert Domeier
- St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Christine Ortiz
- Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Samuel A McLean
- University of North Carolina - Chapel Hill, Department of Anesthesiology and Emergency Medicine, Chapel Hill, North Carolina.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
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24
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Sheikh S, Booth-Norse A, Smotherman C, Kalynych C, Lukens-Bull K, Guerrido E, Henson M, Gautam S, Hendry P. Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults. Pain Med 2020; 21:2748-2756. [PMID: 32875332 PMCID: PMC8557807 DOI: 10.1093/pm/pnaa213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients > 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. METHODS Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. RESULTS The majority of the 130 enrolled patients > 55 years of age returned for pain (57%), were African American (78%), were younger (55-64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8-0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3-7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0-1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. CONCLUSIONS The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.
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Affiliation(s)
- Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Ashley Booth-Norse
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, Florida
| | - Colleen Kalynych
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Katryne Lukens-Bull
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, Florida
| | - Erika Guerrido
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, Florida
| | - Morgan Henson
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Shiva Gautam
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
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25
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Sheikh S, Brailsford J, James D, Holden D, Anton S, Hendry P, Fillingim R, Fernandez R, Cavallari L. 156 Use of a Risk Index to Predict Falls and Opioid Adverse Events in Opioid Naive Older Adults. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Fishe JN, Hendry P, Brailsford J, Salloum RG, Vogel B, Finlay E, Palmer S, Datta S, Hendeles L, Blake K. Early administration of steroids in the ambulance setting: Protocol for a type I hybrid effectiveness-implementation trial with a stepped wedge design. Contemp Clin Trials 2020; 97:106141. [PMID: 32931918 DOI: 10.1016/j.cct.2020.106141] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric asthma exacerbations are a frequent reason for emergency care. Early administration of oral systemic corticosteroids (OCS) in the emergency department (ED) decreases hospitalization rates and ED length-of-stay (LOS). However, it is unknown whether even earlier OCS administration by emergency medical services (EMS) in the prehospital setting further improves outcomes. PURPOSE To describe the background and methods of a type 1 hybrid effectiveness-implementation trial of EMS-administered OCS for pediatric asthma patients incorporating a stepped wedge design and the RE-AIM framework. METHODS The study employs a non-randomized stepped wedge design where multiple EMS agencies adopt OCS as a treatment for pediatric asthma exacerbations at varying times. This design accommodates ethical considerations of studying pediatric subjects in the prehospital setting where informed consent is not feasible. We will compare hospitalization rates, ED LOS, and short-term healthcare costs between pediatric asthma patients who do and do not receive OCS from EMS. Using geographic information systems (GIS), we will measure how differences in outcomes scale with increasing EMS transport time. We will use the RE-AIM framework to guide a mixed methods analysis of barriers and enablers to EMS administration of OCS for pediatric asthma patients, including quantitative measures of adoption and uptake and qualitative EMS provider focus group data. CONCLUSION This trial will determine if earlier EMS administration of OCS to pediatric asthma patients decreases hospitalizations, ED LOS, and short-term healthcare costs, and if those outcomes scale with longer EMS transport times. We will identify barriers and enablers to implementing EMS-administered OCS for pediatric asthma patients.
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Affiliation(s)
- Jennifer N Fishe
- Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America; Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America.
| | - Phyllis Hendry
- Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America.
| | - Jennifer Brailsford
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America.
| | - Ramzi G Salloum
- Department of Health Outcomes and Bioinformatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Bruce Vogel
- Department of Health Outcomes and Bioinformatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Erik Finlay
- GeoPlan Center, University of Florida College of Design, Construction, and Planning. 1480 Inner Rd, Gainesivlle, FL 32601, United States of America.
| | - Sam Palmer
- GeoPlan Center, University of Florida College of Design, Construction, and Planning. 1480 Inner Rd, Gainesivlle, FL 32601, United States of America.
| | - Susmita Datta
- Department of Biostatistics, University of Florida. 2004 Mowry Road, 5(th) Floor CTRB, Gainesville, FL 32611, United States of America.
| | - Leslie Hendeles
- Department of Pediatrics, Pediatric Pulmonary Division, University of Florida College of Medicine, 1600 SW Archer Rd, Ste HD-506, Gainesville, FL 32610, United States of America
| | - Kathryn Blake
- Nemours Center for Pharmacogenomics and Translational Research, 807 Children's Way, Jacksonville, FL 32207, United States of America.
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27
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Zeretzke-Bien C, McCall J, Wylie T, Chowdhury M, Balakrishnan M, Hendry P, Kalynych C, Chung HT. Using an Online Vaccination Registry to Confirm Tetanus Status in Children with Tetanus-prone Wounds. West J Emerg Med 2020; 21:1140-1146. [PMID: 32970567 PMCID: PMC7514397 DOI: 10.5811/westjem.2020.6.46582] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS – State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED). Methods We conducted a retrospective review of all patients less than 18 years old who received ED tetanus prophylaxis at two separate sites between January 2011–May 2015. The Florida SHOTS database was accessed to determine vaccination status for each patient in the study group at the time of the encounter. We compared vaccination status for each patient, as documented in the electronic health record (EHR), with Florida SHOTS data to determine whether tetanus prophylaxis was indicated. The proportion of patients receiving tetanus prophylaxis in the ED, who were subsequently identified as up to date with tetanus vaccination per Florida SHOTS, was determined. Results We identified 743 patients who received ED tetanus prophylaxis. Forty-three (6%) were listed as “up to date” on the EHR and 656 (93%) were listed as “not up to date.” In comparison, 209 (30%) of the study group were identified as “up to date” via Florida SHOTS, and 477 (70%) were not. We accessed the Florida SHOTS record retrospectively to determine whether the vaccine was required. It was determined that 174 (25%) of the patients received tetanus prophylaxis unnecessarily as they were already up to date per Florida SHOTS documentation. Conclusion Twenty-five percent of patients vaccinated for tetanus in the ED could have been spared if Florida SHOTS data had been used by providers at the time of the encounter. Access to Florida SHOTS provides valuable information regarding vaccination status that impacts patient care and resource utilization in the ED.
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Affiliation(s)
- Cristina Zeretzke-Bien
- University of Florida in Gainesville, Department of Emergency Medicine, Gainesville, Florida
| | - Janelle McCall
- University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas
| | - Todd Wylie
- University of Florida in Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Muhammad Chowdhury
- University of Florida in Gainesville, Department of Emergency Medicine, Gainesville, Florida
| | - Meenakshi Balakrishnan
- University of Florida in Gainesville, Department of Emergency Medicine, Gainesville, Florida
| | - Phyllis Hendry
- University of Florida in Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Colleen Kalynych
- University of Florida in Jacksonville, Office of Educational Affairs, Jacksonville, Florida
| | - Hac-Tu Chung
- University of Florida in Gainesville, Department of Emergency Medicine, Gainesville, Florida
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Odia OA, Yorkgitis B, Gurien L, Hendry P, Crandall M, Skarupa D, Fishe JN. An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal trauma patients. Am J Surg 2020; 220:482-488. [DOI: 10.1016/j.amjsurg.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/25/2022]
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McLean SA, Ressler K, Koenen KC, Neylan T, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt S, Beaudoin F, House S, Bollen KA, Musey P, Hendry P, Jones CW, Lewandowski C, Swor R, Datner E, Mohiuddin K, Stevens JS, Storrow A, Kurz MC, McGrath ME, Fermann GJ, Hudak LA, Gentile N, Chang AM, Peak DA, Pascual JL, Seamon MJ, Sergot P, Peacock WF, Diercks D, Sanchez LD, Rathlev N, Domeier R, Haran JP, Pearson C, Murty VP, Insel TR, Dagum P, Onnela JP, Bruce SE, Gaynes BN, Joormann J, Miller MW, Pietrzak RH, Buysse DJ, Pizzagalli DA, Rauch SL, Harte SE, Young LJ, Barch DM, Lebois LAM, van Rooij SJH, Luna B, Smoller JW, Dougherty RF, Pace TWW, Binder E, Sheridan JF, Elliott JM, Basu A, Fromer M, Parlikar T, Zaslavsky AM, Kessler R. The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry 2020; 25:283-296. [PMID: 31745239 PMCID: PMC6981025 DOI: 10.1038/s41380-019-0581-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/26/2019] [Indexed: 11/08/2022]
Abstract
Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.
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Affiliation(s)
- Samuel A McLean
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA.
| | - Kerry Ressler
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | | | - Thomas Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Laura Germine
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, UNC Gillings School of Public Health, Chapel Hill, NC, USA
| | - Xinming An
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sarah Linnstaedt
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth A Bollen
- Department of Statistics and Operational Research, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Elizabeth Datner
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Health Medical Center, Philadelphia, PA, USA
| | - Jennifer S Stevens
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Christopher Kurz
- Department of Emergency Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas, Houston, TX, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deborah Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niels Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Robert Domeier
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - John Patrick Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vishnu P Murty
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | | | - Paul Dagum
- Mindstrong Health, Mountain View, CA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Mark W Miller
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Larry J Young
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sanne J H van Rooij
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thaddeus W W Pace
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Elisabeth Binder
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sheridan
- College of Dentistry, Ohio State University School of Medicine, Columbus, OH, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Archana Basu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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McManus K, Finlay E, Palmer S, Anders JF, Hendry P, Fishe JN. A Statewide Analysis of EMS' Pediatric Transport Destination Decisions. PREHOSP EMERG CARE 2019; 24:672-682. [PMID: 31815580 DOI: 10.1080/10903127.2019.1699211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Deciding where to transport a patient is a key decision made by emergency medical services (EMS), particularly for children because pediatric hospital resources are regionalized. Since evidence-based guidelines for pediatric transport destinations are being developed, the purpose of this study was to use a large statewide EMS database to describe current patterns of EMS providers' transport destination decisions for pediatric patients.Methods: This is a retrospective study of pediatric transports from 2011-2016 in EMS Tracking and Reporting System (EMSTARS), Florida's statewide EMS database. We included patients greater than 1 day and less than or equal to 18 years who were primary EMS scene transports. Our primary outcome variable was 'reason for choosing destination.' We performed descriptive and comparative analysis between closest facility and all other 'reason for choosing destination' choices. We used geospatial analysis to examine destination choice in urban and rural counties.Results: Our final study sample was 446,274, and 48.2% of patients had closest facility as their 'reason for choosing destination.' The next largest category was patient/family choice (154,035 patients, 35.7%). Closest facility patients were older (median age 12 versus 10 years, p < 0.0001) and had shorter median EMS transport times (11.3 versus 15 minutes, p < 0.0001) compared to all other destination decisions. Notably, 60% of respiratory distress patients' and 44% of seizure patients' reason for choosing destination was something other than closest facility. Geospatial analysis revealed that fewer rural patients were documented as closest facility compared to urban (43.9% versus 47%, p < 0.0001). Correspondingly, more rural patients' destination decision was patient/family choice than urban patients (36.3% versus 34.3%, p < 0.0001).Conclusions: This large, statewide study describes EMS' reason for choosing destination for pediatric patients. We found that just under half of patients were documented as closest facility, and over one-third as patient/family choice. Significant differences in destination reasons were noted for rural versus urban counties. This study can help those currently developing pediatric EMS destination guidelines by revealing a high proportion of patient/family choice and identifying conditions with high proportions of destination reasons other than closest facility.
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House S, Beaudoin F, An X, Musey P, Hendry P, Jones C, Lewandowski C, Storrow A, McLean S. 342 Smartphone and Wrist-Wearable-Based Biomarkers of Pain Severity After Emergency Department Discharge: Preliminary Results From the AURORA Study. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McLean S, An X, House S, Beaudoin F, Musey P, Hendry P, Jones C, Lewandowski C, Storrow A. 338 Improved Trauma Survivor Phenotypes Are Critical for Better Biomarkers, Prediction Tools, and Treatments: Initial Results From the AURORA study. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lynch S, Pines J, Mutter R, Teich JL, Hendry P. Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers. Soc Work Health Care 2019; 58:807-824. [PMID: 31422764 DOI: 10.1080/00981389.2019.1653418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
While the frequency of children's behavioral health (BH)-related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011-2012) for children age 0-18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.
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Affiliation(s)
- Sean Lynch
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Jesse Pines
- Department of Emergency Medicine, George Washington University , Washington , DC , USA
| | - Ryan Mutter
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Judith L Teich
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida-Jacksonville , Jacksonville , FL , USA
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Fishe JN, Gautam S, Hendry P, Blake KV, Hendeles L. Emergency Medical Services Administration of Systemic Corticosteroids for Pediatric Asthma: A Statewide Study of Emergency Department Outcomes. Acad Emerg Med 2019; 26:549-551. [PMID: 30414344 DOI: 10.1111/acem.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer N. Fishe
- Department of Emergency Medicine University of Florida College of Medicine–Jacksonville Jacksonville FL
| | - Shiva Gautam
- Department of Medicine University of Florida College of Medicine–Jacksonville Jacksonville FL
| | - Phyllis Hendry
- Department of Emergency Medicine University of Florida College of Medicine–Jacksonville Jacksonville FL
| | - Kathryn V. Blake
- College of Pharmacy University of Florida Gainesville FL
- Nemours Center for Pharmacogenomics and Translational Research Jacksonville FL
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Fishe J, Finlay E, Palmer S, Hendry P. A Geospatial Analysis of Distances to Hospitals that Admit Pediatric Asthma Patients. PREHOSP EMERG CARE 2019; 23:882-886. [PMID: 30874466 DOI: 10.1080/10903127.2019.1593565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Pediatric care is now concentrated in urban specialty centers ("regionalization"), even for common conditions such as asthma. At the same time, rural emergency medical services (EMS) faces challenges related to adequate workforce staffing and financing. This statewide study describes how regionalization of pediatric inpatient care for asthma exacerbations affects EMS operations, particularly for rural agencies. Methods: This is a statewide cross-sectional study of EMS encounters for pediatric asthma in patients aged 2-18 years from 2011 to 2016 using Florida's EMS Tracking and Reporting System (EMSTARS) database. EMSTARS encounters were deterministically linked to Florida's Agency for Healthcare Administration (AHCA) database. We categorized AHCA hospital facilities that received included patients by whether they did or did not admit pediatric asthma patients during the study period ("admitting facility"). We used geospatial analysis to map the EMS agency's home county and the admitting facilities addresses. For each county in Florida, we calculated the average estimated EMS travel distance to the nearest admitting facility using a dasymetric mapping approach. Results: The study included a total of 11,226 EMS pediatric asthma encounters, of which 11,153 (99%) matched to an EMS home county. AHCA data was available for 3,812 (34%) patients. Most counties with distances to admitting facilities less than or equal to 15 miles were urban (31 of 39). For distances of 31-45 miles to an admitting facility, 7 of 8 of counties were rural, and for distances greater than 46 miles, all 4 counties were rural. Conclusions: In this statewide study in Florida, we found long average estimated EMS travel distances to admitting facilities for Florida's pediatric population in rural counties for pediatric asthma exacerbations. Those long distances have great implications for rural EMS operations, including pediatric destination decisions, transport times, and availability for others who call 9-1-1. Further research on bypass and secondary transport rates, and outcomes for asthma and other pediatric conditions are required to further characterize pediatric regionalization's impact on rural EMS.
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Blount J, Pan Y, Mauck M, Datner E, Kurz M, Hendry P, Lewandowski C, Pearson C, McLean S, Linnstaedt S. (208) 17b-Estradiol as a Predictor and Potential Mediator of Chronic Musculoskeletal Pain Development in Women following Trauma Exposure. The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Patients frequently come to the emergency department for pain. For decades, ketamine has been used in the emergency department for procedural sedation but is now receiving attention as a potential alternative to opioids because of its unique analgesic effects. Additionally, ketamine's dissociative properties have made it a popular choice for sedating profoundly agitated patients. In this narrative review, these new roles for ketamine in the emergency department are discussed.
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Affiliation(s)
- Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA
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Madsen TE, McLean S, Zhai W, Linnstaedt S, Kurz MC, Swor R, Hendry P, Peak D, Lewandowski C, Pearson C, O'Neil B, Datner E, Lee D, Beaudoin F. Gender Differences in Pain Experience and Treatment after Motor Vehicle Collisions: A Secondary Analysis of the CRASH Injury Study. Clin Ther 2018; 40:204-213.e2. [PMID: 29371004 DOI: 10.1016/j.clinthera.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/17/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Little is known about gender differences in the treatment of pain after motor vehicle collisions (MVCs) in an emergency department (ED). We aimed to describe gender differences in pain experiences and treatment, specifically the use of opioids and benzodiazepines after ED discharge, for MVC-related pain. METHODS This was a secondary analysis of previously collected data from the CRASH Injury studies. We included patients who were seen and discharged from an ED after an MVC and who were enrolled in 1 of 2 multicenter longitudinal prospective cohort studies (1 black/non-Hispanic and 1 white/non-Hispanic). First, we compared the experience of pain as defined by self-reported moderate-to-severe axial pain, widespread pain, number of somatic symptoms, pain catastrophizing, and peritraumatic distress between women and men using bivariate analyses. We then determined whether there were gender differences in the receipt of prescription medications for post-MVC pain symptoms (opioids and benzodiazepines) using multivariate logistic regression adjusting for demographic characteristics, pain, and collision characteristics. FINDINGS In total, 1878 patients were included: 61.4% were women. More women reported severe symptoms on the pain catastrophizing scale (36.8% vs 31.0%; P = 0.032) and peritraumatic distress following the MVC (59.7% vs 42.5%; P < 0.001), and women reported more somatic symptoms than men (median, 3.9; interquartile range, 3.7-4.0 vs median, 3.3; interquartile range, 3.1-3.5; P < 0.001). Unadjusted, similar proportions of women and men were given opioids (29.2% vs 29.7%; P = 0.84). After adjusting for covariates, women and men remained equally likely to receive a prescription for opioids (relative risk = 0.83; 95% confidence interval, 0.58-1.19). Women were less likely than men to receive a benzodiazepine at discharge from an ED (relative risk = 0.53; 95% confidence interval, 0.32-0.88). IMPLICATIONS In a large, multicenter study of ED patients treated for MVC, there were gender differences in the acute psychological response to MVC with women reporting more psychological and somatic symptoms. Women and men were equally likely to receive opioid prescriptions at discharge. Future research should investigate potential gender-specific interventions to reduce both posttraumatic distress and the risk of developing negative long-term outcomes like chronic pain.
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Affiliation(s)
- Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Samuel McLean
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Wanting Zhai
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Sarah Linnstaedt
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - David Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Brian O'Neil
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Elizabeth Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - David Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
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Hall AG, Schumacher JR, Brumback B, Harman JS, Lutz BJ, Hendry P, Carden D. Health-related quality of life among older patients following an emergency department visit and emergency department-to-home coaching intervention: A randomized controlled trial. International Journal of Care Coordination 2017. [DOI: 10.1177/2053434517733263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Many older patients experience repeated emergency department visits and hospitalizations and inadequate links to primary care. This fragmented care can result in anxiety, uncertainty, and poor health outcomes. This study compares the impact of an emergency department-to-home coaching intervention to usual, post-emergency department care on patient-reported health-related quality of life measures: information support, anxiety, and physical function. Methods This was a randomized controlled trial. Seven hundred and forty-nine chronically ill older adults presenting to emergency departments were randomized into Intervention (emergency department-to-home coaching) or Usual Care groups. Participants completed baseline, in-person and follow-up, telephone surveys. Within- and between-group differences in health-related quality of life were assessed using unweighted linear regression and propensity-weighted difference-in-difference analyses. Three Patient Reported Outcomes Measurement System measures were assessed: social health (informational support), mental health (anxiety/emotional distress), and physical health (physical functioning). Results Usual Care participants experienced statistically significant declines in informational support in unweighted (−3.13) and weighted (−2.84) analyses not observed in the Intervention group (−0.91 and −1.45, respectively). Self-reported anxiety was lowest and physical function highest at the time of emergency department visit. Patient-reported anxiety increased and physical function declined statistically significantly in Intervention participants. Conclusion Among older emergency department patients, health-related quality of life was highest at the emergency department visit and declined following the encounter. The emergency department visit per se appears to provide needed information, and in the short term, reassurance about patients’ medical conditions. The coaching intervention blunts the fall in informational support observed after usual, post-emergency department care but may heighten patients’ anxiety and awareness of chronic health conditions.
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Lutz B, Jones A, Carden D, Hall A, Schmucher J, Harman J, Hendry P. REASONS FOR CARE SEEKING IN THE EMERGENCY DEPARTMENT BY OLDER ADULTS WITH CHRONIC ILLNESS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1188] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- B. Lutz
- University of North Carolina-Wilmington, Wilmington, North Carolina,
| | - A. Jones
- University of North Carolina-Wilmington, Wilmington, North Carolina,
| | - D. Carden
- University of Florida, Gainesville/Jacksonville, Florida,
| | - A. Hall
- University of Alabama at Birmingham, Birmingham, Alabama,
| | - J. Schmucher
- University of Wisconsin-Madison, Madison, Wisconsin,
| | - J.S. Harman
- Florida State University, Tallahassee, Florida
| | - P. Hendry
- University of Florida, Gainesville/Jacksonville, Florida,
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Schumacher JR, Lutz BJ, Hall AG, Pines JM, Jones AL, Hendry P, Kalynych C, Carden DL. Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation. West J Emerg Med 2017; 18:743-751. [PMID: 28611897 PMCID: PMC5468082 DOI: 10.5811/westjem.2017.2.32570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients’ care-seeking decisions. Methods We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients’ reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. Results PAM scores fell in both groups after the ED visit but fell significantly more in “usual care” (average decline −4.64) than “intervention” participants (average decline −2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. Conclusion The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare.
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Affiliation(s)
| | - Barbara J Lutz
- University of North Carolina-Wilmington, College of Health and Human Services, School of Nursing, Wilmington, North Carolina
| | - Allyson G Hall
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, Alabama
| | - Jesse M Pines
- The George Washington University School of Medicine, Department of Emergency Medicine and Health Policy & Management, Washington, DC
| | - Andrea L Jones
- University of North Carolina-Wilmington, College of Health and Human Services, School of Social Work, Wilmington, North Carolina
| | - Phyllis Hendry
- University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Colleen Kalynych
- University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Donna L Carden
- University of Florida, Department of Emergency Medicine, Gainesville, Florida
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Huckins DS, Copeland K, Self W, Vance C, Hendry P, Borg K, Gogain J. Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain. Am J Emerg Med 2016; 35:418-424. [PMID: 27876541 DOI: 10.1016/j.ajem.2016.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/19/2016] [Revised: 10/14/2016] [Accepted: 11/10/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis. METHODS This study prospectively enrolled subjects >18years of age presenting to seven U.S. emergency departments with <72hours of abdominal pain suggesting possible acute appendicitis. The APPY1 panel was performed on blood samples drawn from each patient at the time of initial evaluation and results were correlated with the final diagnosis either positive or negative for acute appendicitis. RESULTS 431 patients were enrolled with 422 completing all aspects of the study. The APPY1 biomarker panel exhibited a sensitivity of 97.5% (95% CI, 91.3-99.3%), a negative predictive value of 98.4% (95% CI, 94.4-99.6%), a negative likelihood ratio of 0.07 (95% CI, 0.02-0.27), with a specificity of 36.5% (95% CI, 31.6-41.8%) for acute appendicitis. The panel correctly identified 125 of 342 (36.6%) patients who did not have appendicitis with 2 (2.5%) false negatives. The CT utilization rate in this population was 72.7% (307/422). Of 307 CT scans, 232 were done for patients who did not have appendicitis and 79 (34%) of these patients were correctly identified as negative with "low risk" biomarker panel results, representing 26% (79/307) of all CT scans performed. CONCLUSION This biomarker panel exhibited high sensitivity and negative predictive value for acute appendicitis in this prospective adult cohort, thereby potentially reducing the dependence on CT for the evaluation of possible acute appendicitis.
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Affiliation(s)
- David S Huckins
- Division of Emergency Medicine, Newton-Wellesley Hospital, Newton, MA, United States.
| | | | - Wesley Self
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Cheryl Vance
- University of California Davis, Sacramento, CA, United States
| | - Phyllis Hendry
- University of Florida College of Medicine, Jacksonville, FL, United States
| | - Keith Borg
- Medical University of South Carolina, Charleston, SC, United States
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Jones L, Borstov A, Fillingim R, Peak D, Kurz M, Hendry P, Rathlev N, Swor R, Domeier R, Damiron K, Pearson C, Kaushik S, Feldman J, McLean S. (100) African Americans experience a greater burden of acute pain after motor vehicle collision than European Americans. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sheikh S, Hendry P, Kalynych C, Owensby B, Johnson J, Kraemer DF, Carden D. Assessing patient activation and health literacy in the ED. Am J Emerg Med 2016; 34:93-6. [DOI: 10.1016/j.ajem.2015.09.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022] Open
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Lynch S, Bautista M, Freer C, Kalynych C, Cuffe S, Hendry P. Toward Effective Utilization of the Pediatric Emergency Department: The Case of ADHD. Soc Work Public Health 2015; 31:9-18. [PMID: 26667350 DOI: 10.1080/19371918.2015.1087909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This project's purpose was to characterize attention-deficit/hyperactivity disorder (ADHD)-related emergency department (ED) visits compared with other psychiatric visits made by children with Medicaid and to determine whether any visits were avoidable. Medicaid claims of children who visited the ED for mental health services were analyzed. Logistic regression was used to examine whether demographic, ED-, and system-level variables increased the odds of an ED visit for children with Medicaid, comparing those with ADHD to other psychiatric diagnoses. Children who were African American, arrived during the daytime, and lived in counties with mental health professional shortages had greater odds of an ED visit for ADHD compared to other psychiatric visits. Approximately 24% of all ED visits were for ADHD and about 30% of these visits may have been avoidable. ADHD-related ED visits comprise a sizeable proportion of all ED visits. Some visits appeared to be emergent but possibly treatable in primary care.
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Affiliation(s)
- Sean Lynch
- a Department of Psychiatry , University of Florida-Jacksonville , Jacksonville , Florida , USA
- b Center for Health Equity & Quality Research, University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Maria Bautista
- b Center for Health Equity & Quality Research, University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Cecilia Freer
- b Center for Health Equity & Quality Research, University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Colleen Kalynych
- c Department of Emergency Medicine , University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Steven Cuffe
- a Department of Psychiatry , University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Phyllis Hendry
- c Department of Emergency Medicine , University of Florida-Jacksonville , Jacksonville , Florida , USA
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Sheikh S, Hendry P, Lynch S, Kalynych CJ, Aldridge P, Kraemer D. Poisonings with Suicidal Intent Aged 0-21 Years Reported to Poison Centers 2003-12. West J Emerg Med 2015; 16:497-502. [PMID: 26265960 PMCID: PMC4530906 DOI: 10.5811/westjem.2015.5.25459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/27/2015] [Accepted: 05/19/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Few studies explore the clinical features of youth suicide by poisoning. The use of both social and clinical features of self-poisoning with suicidal intent could be helpful in enhancing existing and creating new prevention strategies. We sought to characterize self-poisonings with suicide intent in ages 0 to 21 years reported to three regional poison control centers from 2003–2012. Methods This study was a blinded retrospective review of intentional self-poisonings by those age 21 or younger captured by the Poison Information Control Network. Age, sex, substance(s) used, medical outcome, management site, clinical effects, and therapies were described using counts and percentages and analyzed using chi-square tests. We analyzed the medical outcome ranging from no effect to death using the Wilcoxon rank-sum test. Serious medical outcome was defined as death or major outcome. Results We analyzed a total of 29,737 cases. The majority were females (20,945;70.5%), of whom 274 (1.3%) were pregnant. Most cases were 15–18 year olds (15,520;52.2%). Many experienced no effects (9,068;30.5%) or minor medical outcomes (8,612;29%). Males had more serious medical outcomes (p<0.0001), but females were more likely to be admitted to a critical care unit (p<0.0001). There were 17 deaths (0.06%), most in males (10;p=0.008). Of the 52 substances reported in the death cases, 12 (23.1%) were analgesics. In eight (47.1%) of the deaths, over two substances were used. Overall, drowsiness/lethargy (7,097;19.3%) and single-dose charcoal (8,815;16.3%) were frequently reported. Nearly 20% were admitted to critical care units (5,727;19.3%) and 28.7% went to psychiatric facilities (8,523). Of those admitted to hospitals (8,203), nearly 70% (5,727) required critical care units. Almost half <10 years old were evaluated and released (43;47.2%). Of the 114 reported substances for this population, 22.8% involved psychotropic medications, 15.8% analgesics, and 14% Attention Deficit-Hyperactive Disorder (ADHD) medications. Analgesics (13,539;33.6%) were the most common medication category used by all age groups. Typically only one substance (20,549;69.1%) was used. Conclusion Undiagnosed ADHD may be a potential underlying cause for self-harming behaviors in the very young. Gender-specific suicide prevention strategies may be more effective at identifying those at risk than traditional measures alone. Further study into admitting practices by emergency physicians is needed to understand the difference in critical care admission rates based on gender. Once identified to be at-risk for suicidal behavior, access to analgesics and psychotropics should be monitored by care-givers especially in those between the ages of 15–18.
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Affiliation(s)
- Sophia Sheikh
- University of Florida College of Medicine-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Phyllis Hendry
- University of Florida College of Medicine-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Sean Lynch
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Center, Rockville, Maryland
| | - Colleen J Kalynych
- University of Florida College of Medicine-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Petra Aldridge
- University of Florida College of Medicine-Jacksonville, Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Dale Kraemer
- University of Florida College of Medicine-Jacksonville, Department of Neurology, Jacksonville, Florida
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Affiliation(s)
- W J Keon
- University of Ottawa Heart Institute, Ont., Canada
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Linnstaedt SD, Hu J, Bortsov AV, Soward AC, Swor R, Jones J, Lee D, Peak D, Domeier R, Rathlev N, Hendry P, McLean SA. μ-Opioid Receptor Gene A118 G Variants and Persistent Pain Symptoms Among Men and Women Experiencing Motor Vehicle Collision. J Pain 2015; 16:637-44. [PMID: 25842347 DOI: 10.1016/j.jpain.2015.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 01/09/2023]
Abstract
UNLABELLED The μ-opioid receptor 1 (OPRM1) binds endogenous opioids. Increasing evidence suggests that endogenous OPRM1 agonists released at the time of trauma may contribute to the development of posttraumatic musculoskeletal pain (MSP). In this prospective observational study, we evaluated the hypothesis that individuals with an AG or GG genotype at the OPRM1 A118 G allele, which results in a reduced response to opioids, would have less severe MSP 6 weeks after motor vehicle collision (MVC). Based on previous evidence, we hypothesized that this effect would be sex-dependent and most pronounced among women with substantial peritraumatic distress. European American men and women ≥ 18 years of age presenting to the emergency department after MVC and discharged to home after evaluation (N = 948) were enrolled. Assessments included genotyping and 6-week evaluation of overall MSP severity (0-10 numeric rating scale). In linear regression modeling, a significant A118 G Allele × Sex interaction was observed: an AG/GG genotype predicted reduced MSP severity among women with substantial peritraumatic distress (β = -.925, P = .014) but not among all women. In contrast, men with an AG/GG genotype experienced increased MSP severity at 6 weeks (β = .827, P = .019). Further studies are needed to understand the biologic mechanisms mediating observed sex differences in A118 G effects. PERSPECTIVE These results suggest a sex-dependent mechanism by which an emotional response to trauma (distress) contributes to a biologic mechanism (endogenous opioid release) that increases MSP in the weeks after stress exposure. These results also support the hypothesis that endogenous opioids influence pain outcomes differently in men and women.
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Affiliation(s)
- Sarah D Linnstaedt
- TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - JunMei Hu
- TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Andrey V Bortsov
- TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - April C Soward
- TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, Michigan
| | - David Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - David Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Domeier
- Department of Emergency Medicine, St Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Niels Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine/Jacksonville, Jacksonville, Florida
| | - Samuel A McLean
- TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, North Carolina; Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
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Sim YT, Litherland J, Lindsay E, Hendry P, Brauer K, Dobson H, Cordiner C, Gagliardi T, Smart L. Upgrade of ductal carcinoma in situ on core biopsies to invasive disease at final surgery: a retrospective review across the Scottish Breast Screening Programme. Clin Radiol 2015; 70:502-6. [PMID: 25649441 DOI: 10.1016/j.crad.2014.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/19/2014] [Accepted: 12/29/2014] [Indexed: 11/27/2022]
Abstract
AIM To identify factors affecting upgrade rates from B5a (non-invasive) preoperative core biopsies to invasive disease at surgery and ways to improve screening performance. MATERIAL AND METHODS This was a retrospective analysis of 1252 cases of B5a biopsies across all six Scottish Breast Screening Programmes (BSPs), ranging between 2004 and 2012. Final surgical histopathology was correlated with radiological and biopsy factors. Data were analysed using basic Microsoft Excel and standard Chi-squared test used for evaluating statistical significance. RESULTS B5a upgrade rates for the units ranged from 19.2% to 29.2%, with an average of 23.6%. Mean sizes of invasive tumours were small (3-11 mm). The upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion, or asymmetry, compared with micro-calcification alone (33.2% versus 21.7%, p = 0.0004). The upgrade rate was significantly lower with the use of large-volume vacuum-assisted biopsy (VAB) devices than 14 G core needles (19.9% versus 26%, p = 0.013); in stereotactic than ultrasound-guided biopsies (21.2% versus 36.1%, p < 0.001). Heterogeneity of data from different centres limited evaluation of other potential factors. CONCLUSION Upgrade rates are lower for cases with micro-calcification as the sole mammographic feature with the use of VAB devices. Nevertheless, there is variation in practice across Scottish BSPs, including first-line biopsy technique and/or device; and it is of interest that a few centres maintain low upgrade rates despite not using VAB routinely for biopsy of micro-calcification.
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Affiliation(s)
- Y T Sim
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - J Litherland
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK.
| | - E Lindsay
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - P Hendry
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - K Brauer
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - H Dobson
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - C Cordiner
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - T Gagliardi
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
| | - L Smart
- Scottish Breast Screening Programme, West Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow G2 1QT, UK
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