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Romero-Sánchez JM, Sánchez-Almagro CP, White-Ríos M, Paloma-Castro O. Prevalence and clustering of NANDA-I nursing diagnoses in the pre-hospital emergency care setting: A retrospective records review study. J Clin Nurs 2024; 33:3128-3144. [PMID: 38235516 DOI: 10.1111/jocn.16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
AIM To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams. DESIGN Retrospective descriptive study of electronic record review. METHODS Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. RESULTS Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). CONCLUSION Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting. IMPACT What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care. REPORTING METHOD STROBE checklist has been used as a reporting method. NO PATIENT OR PUBLIC CONTRIBUTION Only patients' records were reviewed without further involvement.
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Affiliation(s)
- José Manuel Romero-Sánchez
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, Universidad de Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
| | - César Pedro Sánchez-Almagro
- Medical Emergency Center 061 (CES 061), Andalusian Health Service, Provincial Service 061 in Cádiz, Regional Government of Andalusia, Cádiz, Spain
| | - Melanie White-Ríos
- Hospital Punta de Europa, Andalusian Health Service, Algeciras, Cádiz, Spain
| | - Olga Paloma-Castro
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, Universidad de Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
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Li Y, Cen J, Wu J, Tang M, Guo J, Hang J, Zhao Q, Zhao G, Huang X, Han B. The Degree of Anxiety and Depression in Patients With Cardiovascular Diseases as Assessed Using a Mobile App: Cross-Sectional Study. J Med Internet Res 2023; 25:e48750. [PMID: 37792455 PMCID: PMC10585437 DOI: 10.2196/48750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/12/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Depression and anxiety are common comorbidities in cardiovascular clinic outpatients. Timely identification and intervention of these mental and psychological disorders can contribute to correct diagnosis, better prognosis, less medical expenses, and improved quality of life. The convenience of online doctor-patient communication platforms has increasingly attracted patients to online consultations. However, online health care and offline health care are very different. Research on how to identify psychological disorders in patients who engage in an online cardiology consultation is lacking. OBJECTIVE This study aimed to explore the feasibility of using a self-rating scale to assess mental illness among patients who consult with a cardiologist online and to compare the differences in anxiety and depression between online and offline patients. METHODS From June 2022 to July 2022, we conducted follow-up visits with 10,173 patients on the Haodf platform. We conducted detailed consultations with 286 patients who visited the same cardiologist in the outpatient department. We used the self-rated Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales to assess anxiety and depression, respectively. We analyzed the influencing factors related to the degree of coordination of online patients. We also compared the prevalence of anxiety or depression between online and offline patients and analyzed the factors related to anxiety or depression. RESULTS Of the 10,173 online consultation patients, only 186 (1.8%) responded effectively. The response rate of the offline consultation patients was 96.5% (276/286). Frequent online communication and watching live video broadcasts were significantly related to effective responses from online patients (P<.001). The prevalence of anxiety (70/160, 43.7% vs 69/266, 25.8%; P<.001) or depression (78/160, 48.7% vs 74/266, 27.7%; P<.001) in online consultation patients was significantly higher than that in offline patients. In bivariate analyses, the factors related to anxiety included female sex, unemployment, no confirmed cardiovascular disease, and the online consultation mode, while smokers and those who underwent COVID-19 quarantine were less likely to present with anxiety. The factors related to depression included female sex, divorced or separated individuals, and the online consultation mode. COVID-19 quarantine was related with a lower likelihood of depression. BMI was negatively correlated with depression. In multiple ordered logistic regression analysis, women were more likely than men to present with anxiety (odds ratio [OR] 2.181, 95% CI 1.365-3.486; P=.001). Women (OR 1.664, 95% CI 1.082-2.559; P=.02) and online patients (OR 2.631, 95% CI 1.305-5.304; P=.007) were more likely to have depression. CONCLUSIONS Online patients had more anxiety or depression than offline patients. Anxiety was more prevalent in women, the unemployed, and those without confirmed cardiovascular disease. Women and divorced or separated individuals were more prone to depression. Increasing the frequency of doctor-patient communication and participating in video interactions can help improve patient cooperation.
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Affiliation(s)
- Yongguang Li
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Hospital Operation Research, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jue Cen
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junxia Wu
- Department of Comprehensive Statistics, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Min Tang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyi Guo
- Department of Clinical Research Center, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyu Hang
- Department of Cardiology, Shanghai United Family Hospital, Shanghai, China
| | - Qing Zhao
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Zhao
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoli Huang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Han
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Tan WA, Hong R, Gao F, Chua SJT, Keng YJF, Koh CH. Outpatient Myocardial Perfusion Imaging Scan for a Low-Risk Chest Pain Cohort From the Emergency Department: A Retrospective Analysis. Curr Probl Cardiol 2023; 48:101517. [PMID: 36455794 DOI: 10.1016/j.cpcardiol.2022.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Chest pain accounts for a significant attendances at emergency departments (ED). We examined the utility of early stress myocardial perfusion imaging (SMPI) for stratification of low-risk patients post-ED discharge. A retrospective audit was conducted of patients with chest pain and normal troponin-T (<30Ng/L), who were discharged with outpatient SMPI (median = 3 days post-ED discharge) between January 2018 to January 2020. 880 patients were included and followed up for 12 months. Outcomes measured were: 1) Cardiac events (CE) within 1 year of visit or 2) Significant coronary artery disease (CAD) - coronary angiography demonstrating ≥70% stenosis of epicardial vessels or coronary revascularization procedures performed. In the SMPI negative group, 2 of 802 patients (0.25%) had significant CEs and 11 patients (1.37%) were diagnosed with significant CAD. Of the 78 SMPI positive patients, 1 (1.28%) had a significant CE, while 24 had significant CAD. SMPI had a sensitivity of 65.8%, specificity of 93.7%, positive predictive value of 32.1% and a negative predictive value of 98.4% for predicting adverse CE. Early SMPI post-ED discharge demonstrated high negative predictive value in predicting CEs or significant CAD diagnosis at up to 1 year, suggesting that low-risk patients discharge from ED with early outpatient SMPI is a safe management option.
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Affiliation(s)
- Weixian Alex Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore.
| | - Rilong Hong
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Fei Gao
- National Heart Research Institute, National Heart Centre Singapore, Singapore
| | | | | | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Connors JN, Kroenke K, Monahan P, Chernyak Y, Pettit K, Hayden J, Montgomery C, Brenner G, Millard M, Holmes E, Musey P. Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial. Contemp Clin Trials 2023; 124:107020. [PMID: 36423863 DOI: 10.1016/j.cct.2022.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. OBJECTIVES The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. METHODS The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. DISCUSSION PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
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Affiliation(s)
- Jill Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Patrick Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kate Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Hayden
- National Alliance on Mental Illness (NAMI) of Greater Indianapolis, Inc., Indianapolis, IN, United States
| | - Chet Montgomery
- Patient Advisory Committee, Community Member, Indianapolis, IN, United States
| | - George Brenner
- Continuing the Care, LLC, Indianapolis, IN, United States
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
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Attia M, Ibrahim FA, Elsady MAE, Khorkhash MK, Rizk MA, Shah J, Amer SA. Cognitive, emotional, physical, and behavioral stress-related symptoms and coping strategies among university students during the third wave of COVID-19 pandemic. Front Psychiatry 2022; 13:933981. [PMID: 36186888 PMCID: PMC9523087 DOI: 10.3389/fpsyt.2022.933981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stress is manifested by different physical, cognitive, emotional, and behavioral stress-related symptoms, and everyone experiences it uniquely. The COVID-19 Pandemic has tremendously affected university students' lives. So, we conducted this study to determine the stress frequency, causes, determinants, and related symptoms involving physical, cognitive, emotional, and behavioral traits and coping strategies among university students in Egypt during the third wave of the COVID-19 pandemic, 2021. Methods Cross-sectional study targeted 1,467 randomly selected undergraduate university students, representing all colleges from 30 universities in Egypt, through a validated self-administrated questionnaire. Results The total stress-related symptom score was statistically significant (p < 0.05), higher among females, married, living on campus, with a (B) GPA, and those who had both organic and psychological disorders. The top 10 prevalent physical symptoms were headaches, chronic fatigue, hair loss, low back pain, neck pain, shoulders and arm pain, ophthalmological symptoms, acne, shakiness of extremities, and palpitations, respectively. The most reported symptoms regarding the cognitive, emotional, and behavioral aspects were anxiety and racing thoughts, moodiness and irritability, and excessive sleeping, respectively. Nine hundred and thirty-seven (63.9%) reported that the COVID-19 pandemic badly affected their lives, either directly or indirectly. The study showed that the prevalence of stress among university students is more than 97%. One thousand and five (68.5%) preferred isolation as a relieving technique. Conclusion Stress and its related physical, cognitive, emotional, and behavioral symptoms are prevalent among university students. Most of the university students who were recruited reported that the COVID-19 pandemic badly affected their lives and used negative ways to deal with stress, like staying alone and sleeping too much. Positive ways to deal with stress, like seeing a therapist or meditating, were less common.
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Affiliation(s)
- Merna Attia
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Jaffer Shah
- New York State Department of Health, New York, NY, United States
| | - Samar A. Amer
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Member at Royal Colleague of General Practitioners [INT], London, United Kingdom
- Department of Mental Health Primary Care, Nova University, Lisbon, Portugal
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6
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Shah MN, Jacobsohn GC, Jones CMC, Green RK, Caprio TV, Cochran AL, Cushman JT, Lohmeier M, Kind AJ. Care transitions intervention reduces ED revisits in cognitively impaired patients. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12261. [PMID: 35310533 PMCID: PMC8919246 DOI: 10.1002/trc2.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 01/25/2023]
Abstract
Introduction About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population. Methods We conducted a pre-planned subgroup analysis of community-dwelling, cognitively impaired older (age ≥60 years) participants from a randomized controlled trial testing the effectiveness of the CTI adapted for ED-to-home transitions. The parent study recruited ED patients from three university-affiliated hospitals from 2016 to 2019. Subjects eligible for this sub-analysis had to: (1) have a primary care provider within these health systems; (2) be discharged to a community residence; (3) not receive care management or hospice services; and (4) be cognitively impaired in the ED, as determined by a score >10 on the Blessed Orientation Memory Concentration Test. The primary outcome, ED revisits within 30 days of discharge, was abstracted from medical records and evaluated using logistic regression. Results Of our sub-sample (N = 81, 36 control, 45 treatment), 57% were female and the mean age was 78 years. Multivariate analysis, adjusted for the presence of moderate to severe depression and inadequate health literacy, found that the CTI significantly reduced the odds of a repeat ED visit within 30 days (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.07 to 0.90) but not 14 days (OR 1.01, 95% CI 0.26 to 3.93). Multivariate analysis of outpatient follow-up found no significant effects. Discussion Community-dwelling older adults with cognitive impairment receiving the CTI following ED discharge experienced fewer ED revisits within 30 days compared to usual care. Further studies must confirm and expand upon this finding, identifying features with greatest benefit to patients and caregivers.
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Affiliation(s)
- Manish N. Shah
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine (Geriatrics and Gerontology)University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Gwen C. Jacobsohn
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Courtney MC Jones
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA,Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Rebecca K. Green
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Thomas V. Caprio
- Department of Medicine, Division of GeriatricsUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Amy L. Cochran
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Department of MathematicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jeremy T. Cushman
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA,Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Amy J.H. Kind
- Department of Medicine (Geriatrics and Gerontology)University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA,William S. Middleton VA Geriatrics Research Education and Clinical Center (GRECC)MadisonWisconsinUSA
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Crump CA, Wernz C, Schlachta-Fairchild L, Steidle E, Duncan A, Cathers L. Closing the Digital Health Evidence Gap: Development of a Predictive Score to Maximize Patient Outcomes. Telemed J E Health 2021; 27:1029-1038. [DOI: 10.1089/tmj.2020.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Cindy A. Crump
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christian Wernz
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Statistical Sciences, Operations Research, and College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Loretta Schlachta-Fairchild
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ernest Steidle
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Angela Duncan
- Department of Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lauretta Cathers
- Doctoral Program in Health-Related Sciences, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
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Crijns TJ, Ring D, Koenig K, Fatehi A. Factors associated with return musculoskeletal specialty visits. J Orthop 2021; 27:23-27. [PMID: 34456527 DOI: 10.1016/j.jor.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Prior studies suggested that a greater number of return visits is associated with greater symptoms of depression and greater symptom intensity. Methods All new adult patients presenting for musculsoskeletal specialty care between October 2017 and October 2018 were included. Patients completed the PROMIS Global Health, the PHQ-2, and the GAD-7 as part of usual care. Results Accounting for confounders, having a return visit was associated with lower PROMIS Global Health, greater symptoms of depression, and greater symptoms of anxiety. Conclusions These findings provide support for the importance of 1) improved coordination with non-specialist referring clinicians, and 2) interdisciplinary care teams. Level of evidence Level II, Prognostic.
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Affiliation(s)
- Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Powell AC, Long JW, Carneal G, Schormann KJ, Friedman DP. The association between a history of anxiety or depression and utilization of diagnostic imaging. PLoS One 2021; 16:e0254572. [PMID: 34252170 PMCID: PMC8274845 DOI: 10.1371/journal.pone.0254572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective While prior research shows that mental illness is associated with lower utilization of screening imaging, little is known about how mental illness impacts use of diagnostic imaging, other than for screening. This study explores the association between a history of anxiety or depression in the prior year and utilization of diagnostic imaging. Methods Commercial and Medicare Advantage health plan claims from 2017 and 2018 from patients with plans from one national organization were extracted. Exclusions were made for patients without continuous plan enrollment. History of anxiety or depression was determined using 2017 claims, and downstream diagnostic imaging was determined using 2018 claims. Univariate associations were assessed with Chi-square tests. A matched sample was created using Coarsened Exact Matching, with history of mental illness serving as the treatment variable. Logistic regressions were used to calculate adjusted odds ratios, before and after matching, controlling for age, sex, urbanicity, local income, comorbidities, claims history, region, and health plan characteristics. Associations between mental illness and chest imaging, neuroimaging, and emergency department imaging were also evaluated. Results The sample included 2,381,851 patients before matching. Imaging was significantly more likely for patients with a history of anxiety (71.1% vs. 55.7%, P < .001) and depression (73.2% vs. 55.3%, P < .001). The adjusted odds of any imaging were 1.24 (95% confidence interval [CI]: 1.22–1.26) for patients with a history of anxiety, and 1.43 (CI: 1.41–1.45) for patients with a history of depression before matching, and 1.18 (CI: 1.16–1.20) for a history of anxiety and 1.33 (CI: 1.32–1.35) for a history of depression after matching. Adjusted analyses found significant, positive associations between mental illness and chest imaging, neuroimaging, and emergency department imaging both before and after matching. Discussion In contrast to prior findings on screening, anxiety and depression were associated with greater likelihood of diagnostic imaging within the population studied.
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Affiliation(s)
- Adam C. Powell
- HealthHelp, Houston, TX, United States of America
- * E-mail:
| | - James W. Long
- Humana Inc., Louisville, KY, United States of America
| | - Garry Carneal
- The Kennedy Forum, Annapolis, MD, United States of America
| | | | - David P. Friedman
- Thomas Jefferson University, Philadelphia, PA, United States of America
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Musey PI, Bellolio F, Upadhye S, Chang AM, Diercks DB, Gottlieb M, Hess EP, Kontos MC, Mumma BE, Probst MA, Stahl JH, Stopyra JP, Kline JA, Carpenter CR. Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low-risk chest pain in the emergency department. Acad Emerg Med 2021; 28:718-744. [PMID: 34228849 DOI: 10.1111/acem.14296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low-risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low-risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high-sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non-obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (6) for those with a prior coronary computed tomographic angiography within the past 2 years with no coronary stenosis, we suggest no further diagnostic testing other than a single, normal high-sensitivity troponin below a validated threshold to exclude ACS within that 2 year time frame; (7) we suggest the use of depression and anxiety screening tools as these might have an effect on healthcare use and return emergency department (ED) visits; and (8) we suggest referral for anxiety or depression management, as this might have an impact on healthcare use and return ED visits.
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Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN USA
| | | | - Suneel Upadhye
- Division of Emergency Medicine McMaster University Hamilton Canada
| | - Anna Marie Chang
- Department of Emergency Medicine Thomas Jefferson University Philadelphia PA USA
| | - Deborah B. Diercks
- Department of Emergency Medicine UT Southwestern Medical Center Dallas TX USA
| | - Michael Gottlieb
- Department of Emergency Medicine Rush Medical Center Chicago IL USA
| | - Erik P. Hess
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Michael C. Kontos
- Department of Internal Medicine Virginia Commonwealth University Richmond VA USA
| | - Bryn E. Mumma
- Department of Emergency Medicine UC Davis School of Medicine Sacramento CA USA
| | - Marc A. Probst
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Jason P. Stopyra
- Department of Emergency Medicine Wake Forest School of Medicine Winston‐SalemNC USA
| | - Jeffrey A. Kline
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN USA
| | - Christopher R. Carpenter
- Department of Emergency Medicine and Emergency Care Research Core Washington University School of Medicine St. Louis MO USA
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11
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Nault Connors JD, Prittie A, Musey PI. Why an Algorithmic "Rule-Out MI" Order Set Is Necessary But Not Sufficient Care for Chest Pain in the Emergency Department Setting. J Patient Exp 2020; 7:685-687. [PMID: 33294601 PMCID: PMC7705824 DOI: 10.1177/2374373519881279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jill D Nault Connors
- Department of Emergency Medicine, Indiana School of Medicine, Indianapolis, IN, USA
| | - Alex Prittie
- Pipeline-to-Proposal Award to the Trustees of Indiana University, Indianapolis, IN, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana School of Medicine, Indianapolis, IN, USA
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12
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Beasant L, Carlton E, Williams G, Benger J, Ingram J. Patients' and health professionals' perceptions of the LoDED (limit of detection and ECG discharge) strategy for low-risk chest pain management: a qualitative study. Emerg Med J 2020; 38:184-190. [PMID: 33298603 PMCID: PMC7907550 DOI: 10.1136/emermed-2020-209539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 12/02/2022]
Abstract
Background Rapid discharge strategies for patients with low-risk chest pain using high-sensitivity troponin assays have been extensively evaluated. The adherence to, and acceptability of such strategies, has largely been explored using quantitative data. The aims of this integrated qualitative study were to explore the acceptability of the limit of detection and ECG discharge strategy (LoDED) to patients and health professionals, and to refine a discharge information leaflet for patients with low-risk chest pain. Methods Patients with low-risk chest pain who consented to a semi-structured interview were purposively sampled for maximum variation from four of the participating National Health Service sites between October 2018 and May 2019. Two focus groups with ED health professionals at two of the participating sites were completed in April and June 2019. Results A discharge strategy based on a single undetectable hs-cTn test (LoDED) was acceptable to patients. They trusted the health professionals who were treating them and felt reassured by other tests, (ECG) alongside blood test(s), even when the clinical assessment did not provide a firm diagnosis. In contrast, health professionals had reservations about the LoDED strategy, including concern about identifying low-risk patients and a shortened patient observation period. Findings from 11 patient interviews and 2 staff focus groups (with 20 clinicians) centred around three overarching themes: acceptability of the LoDED strategy, perceptions of symptom severity and uncertainty, and patient discharge information. Conclusion Rapid discharge for low-risk chest pain is acceptable to patients, but clinicians reported some reticence in implementing the LoDED strategy. Further work is required to optimise discharge discussions and information provision for patients.
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Affiliation(s)
- Lucy Beasant
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
| | | | - Jonathan Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jenny Ingram
- Bristol Medical School, University of Bristol, Bristol, UK
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13
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The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review. J Clin Med 2020; 9:jcm9082486. [PMID: 32756298 PMCID: PMC7464293 DOI: 10.3390/jcm9082486] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pain conditions are among the leading causes of global disability, impacting on global healthcare utilization (HCU). Health seeking behavior might be influenced by cognitive and emotional factors (CEF), which can be tackled by specific therapies. The purpose of this study was to systematically review the evidence concerning associations between CEF and HCU in people experiencing pain. Three databases were consulted: PubMed, Web of Science and EconLit. Risk of bias was assessed using the Downs and Black Checklist (modified). A total of 90 publications (total sample n = 59,719) was included after double-blind screening. In people experiencing pain, positive associations between general anxiety symptoms, depressive symptoms and catastrophizing and pain medication use were found. Additionally, there appears to be a relationship between general anxiety and depressive symptoms and opioid use. Symptom-related anxiety and psychological distress were found to be positively related with consulting behavior. Last, a positive association between use of complementary and alternative medicine and level of perceived symptom control was confirmed in people with pain. For other relationships no evidence or inconsistent findings were found, or they were insufficiently studied to draw firm conclusions, indicating that more research on this topic is needed.
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14
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Musey PI, Schultebraucks K, Chang BP. Stressing Out About the Heart: A Narrative Review of the Role of Psychological Stress in Acute Cardiovascular Events. Acad Emerg Med 2020; 27:71-79. [PMID: 31675448 DOI: 10.1111/acem.13882] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Survivors of acute cardiovascular disease (CVD) events, such as acute coronary syndrome (ACS) and stroke, may experience significant psychological distress during and following the acute event. Long-term adverse effects may follow, including the development of posttraumatic stress disorder (PTSD), increased overall all-cause mortality, and recurrent cardiac events. The goal of this concepts paper is to describe and summarize the rates of adverse psychological outcomes, such as PTSD, following cardiovascular emergencies, to review how these psychological factors are associated with increased risk of future events and long-term health and to provide a theoretical framework for future work. METHODS A panel of two board-certified emergency physicians, one with a doctorate in experimental psychology, along with one PhD clinical psychologist with expertise in psychoneuroendocrinology were co-authors involved in the paper. Each author used various search strategies (e.g., PubMed, Psycinfo, Cochrane, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors RESULTS: A meta-analysis of 24 studies (N > 2,300) found the prevalence of ACS-induced PTSD at nearly 12%, while a meta-analysis of nine studies (N = 1,138) found that 25% of survivors of transient ischemic attack and stroke report PTSD symptoms. The presence of PTSD doubles 3-year risk of CVD/mortality risk in ACS survivors. Cardiac patients treated during periods of ED overcrowding, hallway care, and perceived poor clinician-patient communication appear at greater risk for subsequent PTSD. CONCLUSIONS Psychological stress is often present in patients undergoing evaluation for acute CVD events. Understanding such associations provides a foundation to appreciate the potential contribution of psychological variables on acute and long-term cardiovascular recovery, while also stimulating future areas of research and discovery.
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Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN
| | | | - Bernard P. Chang
- Department of Emergency Medicine Columbia University Medical Center New York NY
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15
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Egeland GM, Akerkar R, Kvåle R, Sulo G, Tell GS, Bakken IJ, Ebbing M. Hospitalised patients with unexplained chest pain: incidence and prognosis. J Intern Med 2019; 286:562-572. [PMID: 31322304 DOI: 10.1111/joim.12948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prognosis of unexplained chest pain patients provides valuable information for evaluation of health services. OBJECTIVE To examine prognosis of unexplained chest pain. METHODS Using data from in- and outpatient hospital visits in Norway of patients discharged with a main diagnosis of unexplained chest pain (ICD-10: R072-R074) in 2010-2012, the 1-year incidence of coronary heart disease (CHD), any cardio-vascular disease (CVD) and mortality was evaluated. Cases with prior 2-year history of CVD or chest pain were excluded. Cox proportional hazards evaluated outcomes by patient characteristics and standardized mortality ratios evaluated observed versus expected mortality. RESULTS Of 59 569 patients identified (20-89 years of age), the majority (86%) were referred to hospital by out-of-hours emergency care centres. Subsequent CHD was noted for 12.5%, 19.5% and 25.0% of men and 7.2%, 11.0%, 14.0% of women aged 45-64, 65-74 and 75-89 years, respectively. The per cent of deaths attributed to CVD were greatest within the first 2 months of postdischarge. Total mortality rates (per 1000 person-years) were 6.6 in men and 4.7 in women aged 45-64 and 69.2 in men and 39.5 in women aged 75-89 years. Relative to the general population, mortality was 53% and 45% higher for men and women under 65 years of age, respectively, attributed primarily to non-CVD causes. CONCLUSION Patients in Norway discharged with unexplained chest pain are an at-risk group in terms of incident CHD, any CVD and mortality, including non-CVD mortality during the first-year postdischarge. The results suggest that unexplained chest pain patients may benefit from greater healthcare coordination between medical disciplines.
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Affiliation(s)
- G M Egeland
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Akerkar
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - R Kvåle
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - G Sulo
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - G S Tell
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - I J Bakken
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - M Ebbing
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway
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16
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Chang BP. Can hospitalization be hazardous to your health? A nosocomial based stress model for hospitalization. Gen Hosp Psychiatry 2019; 60:83-89. [PMID: 31376645 PMCID: PMC6791742 DOI: 10.1016/j.genhosppsych.2019.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Hospitalization places patients at elevated risk for the development of "nosocomial" or hospital acquired complications, ranging from multidrug resistant infections to delirium and physical deconditioning. Adverse nosocomial psychological effects of hospitalization may also exist. This paper introduces a nosocomial based stress model, conceptualizing hospitalization as a unique period of biopsychosocial vulnerability, due to physiologic effects of acute illness and psychosocial variables of the hospital experience. METHOD A research synthesis and narrative review was performed to evaluate evidence supporting this model, integrating existing knowledge of the psychological and physiological effects of acute life threatening events, with known sequelae associated with hospitalization. RESULT Psychosocial factors during hospitalization may act as independent predictors of recovery following hospitalization, moderating variables impacting ongoing physiologic changes due to acute illness, and/or dynamic bidirectional elements, influencing medical and psychological outcomes in the near and long-term setting. CONCLUSION The Nosocomial Stress model provides a novel framework to understanding the biopsychosocial interactions between the psychological and physiologic processes associated with illness and hospitalization. Based on this model, a research agenda is proposed to assess the contributions of acute illness, the hospital experience, and their interactions on the recovery of patients following hospitalization.
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Affiliation(s)
- Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY, United States of America.
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17
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Kline JA, Fisher MA, Pettit KL, Linville CT, Beck AM. Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department. PLoS One 2019; 14:e0209232. [PMID: 30625184 PMCID: PMC6326463 DOI: 10.1371/journal.pone.0209232] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Test if therapy dogs reduce anxiety in emergency department (ED) patients. Methods In this controlled clinical trial (NCT03471429), medically stable, adult patients were approached if the physician believed that the patient had “moderate or greater anxiety.” Patients were allocated on a 1:1 ratio to either 15 min exposure to a certified therapy dog and handler (dog), or usual care (control). Patient reported anxiety, pain and depression were assessed using a 0–10 scale (10 = worst). Primary outcome was change in anxiety from baseline (T0) to 30 min and 90 min after exposure to dog or control (T1 and T2 respectively); secondary outcomes were pain, depression and frequency of pain medication. Results Among 93 patients willing to participate in research, 7 had aversions to dogs, leaving 86 (92%) were willing to see a dog six others met exclusion criteria, leaving 40 patients allocated to each group (dog or control). Median and mean baseline anxiety, pain and depression scores were similar between groups. With dog exposure, median anxiety decreased significantly from T0 to T1: 6 (IQR 4–9.75) to T1: 2 (0–6) compared with 6 (4–8) to 6 (2.5–8) in controls (P<0.001, for T1, Mann-Whitney U and unpaired t-test). Dog exposure was associated with significantly lower anxiety at T2 and a significant overall treatment effect on two-way repeated measures ANOVA for anxiety, pain and depression. After exposure, 1/40 in the dog group needed pain medication, versus 7/40 in controls (P = 0.056, Fisher’s exact test). Conclusions Exposure to therapy dogs plus handlers significantly reduced anxiety in ED patients.
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Affiliation(s)
- Jeffrey A. Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States of America
- * E-mail:
| | | | - Katherine L. Pettit
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States of America
| | - Courtney T. Linville
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States of America
| | - Alan M. Beck
- Purdue University, Department of Comparative Pathobiology, Lafayette, IN, United States of America
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