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Jonassaint CR, Parchuri E, O'Brien JA, Lalama CM, Lin J, Badawy SM, Hamm ME, Stinson J, Lalloo C, Carroll CP, Saraf SL, Gordeuk VR, Cronin R, Shah N, Lanzkron SM, Liles D, Trimnell C, Bailey L, Lawrence RH, Abebe KZ. Mental health, pain and likelihood of opioid misuse among adults with sickle cell disease. Br J Haematol 2024; 204:1029-1038. [PMID: 38171495 PMCID: PMC10939903 DOI: 10.1111/bjh.19243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Depressive symptoms are prevalent in individuals living with sickle cell disease (SCD) and may exacerbate pain. This study examines whether higher depressive symptoms are associated with pain outcomes, pain catastrophizing, interference and potential opioid misuse in a large cohort of adults with SCD. The study utilized baseline data from the 'CaRISMA' trial, which involved 357 SCD adults with chronic pain. Baseline assessments included pain intensity, daily mood, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorders scale, PROMIS Pain Interference, Pain Catastrophizing Scale, the Adult Sickle Cell Quality of Life Measurement Information System and the Current Opioid Misuse Measure. Participants were categorized into 'high' or 'low' depression groups based on PHQ scores. Higher depressive symptoms were significantly associated with increased daily pain intensity, negative daily mood, higher pain interference and catastrophizing, poorer quality of life and a higher likelihood of opioid misuse (all p < 0.01). SCD patients with more severe depressive symptoms experienced poorer pain outcomes, lower quality of life and increased risk of opioid misuse. Longitudinal data from this trial will determine whether addressing depressive symptoms may potentially reduce pain frequency and severity in SCD.
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Affiliation(s)
| | - Ektha Parchuri
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia A O'Brien
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christina M Lalama
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan Lin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Hamm
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Stinson
- Child Health Evaluative Sciences in Research Institute, Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Chitra Lalloo
- Child Health Evaluation Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Santosh L Saraf
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Cronin
- Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Nirmish Shah
- Division of Hematology, Division of Pediatric Hematology/Oncology, Sickle Cell Transition Program, Duke University, Durham, North Carolina, USA
| | - Sophie M Lanzkron
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darla Liles
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Lakiea Bailey
- Sickle Cell Community Consortium, Atlanta, Georgia, USA
| | - Raymona H Lawrence
- The Jiann-Ping Hsu College of Public Health, Georgia Southern University in Statesboro, Statesboro, Georgia, USA
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Onyebuchi CO, Chumpitazi CE, Placencia JL, Jackson AN, Jones JL, Torres L, Tubman VN. Ketamine for Pain in Sickle Cell Disease Reduces Opioid Usage. J Pain Symptom Manage 2024; 67:e169-e175. [PMID: 38000561 PMCID: PMC11061893 DOI: 10.1016/j.jpainsymman.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
CONTEXT Pain attributable to sickle cell disease (SCD) is often unpredictable, recurrent, and requires complex treatments. Subanesthetic ketamine infusion has been studied in other diseases and disorders, but there is still limited data on its efficacy in pain management for SCD. OBJECTIVES The primary objective is to determine if subanesthetic ketamine infusion reduces pain scores and opioid requirements in hospitalized pediatric patients with SCD. RESULTS Forty-six admissions among 22 patients between February 2018 and December 2019 were analyzed. We observed decrease in pain scores within 24 hours of ketamine initiation in 34 of 46 admissions (mean pain score per patient before ketamine initiation: 2.2-9.7, mean pain score per patient after ketamine initiation: 0-9.7; P < .05). We observed a decrease in pain scores in the remaining 12 admissions after greater than 24 hours of ketamine initiation. Opioid usage declined after ketamine infusion, with a difference of means in oral morphine equivalents before and after ketamine of 122.8 mg/day. The side effects observed with ketamine infusion included hallucinations in 11 (23.9%) admissions. Only four (8.7%) admissions required cessation of the infusion due to side effects. The readmission rate at two weeks and four weeks after first ketamine infusion was the same (12.5%) at both time points. For all patients in the cohort, the introduction of ketamine into pain regimens did not reduce the number of admissions in the year following ketamine initiation relative to the year prior. CONCLUSION In pediatric patients with SCD, subanesthetic ketamine was safe as a continuous infusion and effectively reduced both pain scores and opioid requirements.
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Affiliation(s)
| | - Corrie E Chumpitazi
- Department of Pediatrics, Division of Emergency Medicine (C.C., J.L.), Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital (C.C., J.P., A.J.), Houston, Texas, USA
| | | | - Andrea N Jackson
- Texas Children's Hospital (C.C., J.P., A.J.), Houston, Texas, USA
| | - Jennifer L Jones
- Department of Pediatrics, Division of Emergency Medicine (C.C., J.L.), Baylor College of Medicine, Houston, Texas, USA
| | - Laura Torres
- Deparment of Anesthesiology (L.T.), Baylor College of Medicine, Houston, Texas, USA
| | - Venée N Tubman
- Department of Pediatrics (V.T.), Baylor College of Medicine, Houston, Texas, USA; Texas Children's Cancer and Hematology Centers (V.T.), Houston, Texas, USA.
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Prince E, Loeser P, Early M, Carroll CP, Lanzkron S, Pecker LH. "Buprenorphine, It Works so Differently": Adults with Sickle Cell Disease Describe Transitioning to Buprenorphine for Treatment of Chronic Pain. THE JOURNAL OF PAIN 2024; 25:632-641. [PMID: 37742907 PMCID: PMC11002816 DOI: 10.1016/j.jpain.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
A growing body of literature describes the use of buprenorphine for the treatment of chronic pain in people with sickle cell disease. The experiences of people with sickle cell disease who have tried buprenorphine have not yet reported. This qualitative descriptive study was conducted to explore perspectives on buprenorphine for chronic pain in sickle cell disease. We interviewed 13 participants with sickle cell disease who had been prescribed buprenorphine and had a clinic visit between December 1, 2020, and April 2022 in our Sickle Cell Center for Adults. Interviews were recorded, transcribed, and analyzed using thematic analysis. Eleven out of 13 participants were taking buprenorphine at the time of the interview, with a mean treatment duration of 33 months (SD 18, range 7-78 months). Five major themes were identified: 1) dissatisfaction with full agonist opioids; 2) navigating uncertainty with autonomy in deciding to try buprenorphine; 3) functional and relational changes after starting buprenorphine, 4) enduring systemic barriers to pain treatment, and 5) trusting treatment relationships are necessary when approaching patients about buprenorphine. The experience of adulthood living with sickle cell disease before and after starting buprenorphine is qualitatively different with significant improvements in social functioning. PERSPECTIVE: This study examined the experience of adults with sickle cell disease and chronic pain transitioning from full agonist opioids to buprenorphine. It is the first qualitative study of buprenorphine in people with sickle cell disease, contributing to a small but growing literature about buprenorphine and sickle cell disease.
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Affiliation(s)
- Elizabeth Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | | | - Macy Early
- Johns Hopkins University School of Medicine, Baltimore MD
| | - C. Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore MD
| | - Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore MD
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore MD
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Rees M, Spraker‐Perlman H, Moore R, Lavoie P, Schiff L, Allen JM, Rai P, Anghelescu DL. Patient and clinician beliefs about potential barriers to treatment of neuropathic pain for adolescents with sickle cell disease. EJHAEM 2024; 5:11-20. [PMID: 38406507 PMCID: PMC10887355 DOI: 10.1002/jha2.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 02/27/2024]
Abstract
Pain is the hallmark symptom causing morbidity for people with sickle cell disease (SCD) and may present as nociceptive, neuropathic, or mixed type pain. Neuropathic pain (NP) is underrecognized and undertreated in patients with SCD and is associated with decreased patient-reported quality of life. Surveys were completed by clinicians caring for adolescents with SCD in the outpatient setting. SCD patients ages 1418 at increased risk of NP completed a patient-facing survey at a scheduled clinic visit. Ninety-four percent of responding clinicians agreed that NP significantly contributes to reported pain in SCD. Clinicians believed that NP medications are effective for reducing chronic pain (62%) and decreasing opioid utilization (44%). Clinician-identified barriers to prescribing NP medications included concerns about medication adherence (82%), lack of pediatric guidelines for NP medications (70%), and perceived patient concern about side effects (65%). More than 1/3 (35%) of clinicians reported that they were not comfortable managing NP medications. Clinician-identified barriers to referral to a pain management specialist included scheduling concerns (88%) and perceived patient/family lack of interest (77%). Most patients expressed willingness to take a medication for NP (78%), see a pain management specialist (84%), or learn more about nonpharmacologic interventions (72%), although most (51%) also reported some concerns about taking a medication for NP, citing insufficient knowledge (34%), and potential for side effects (32%). A minority of respondents (15%) worried about referral to a pain management specialist. Clinician and patient perspectives provide insights that may guide education efforts or other interventions to improve treatment of SCD-related NP.
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Affiliation(s)
- Matthew Rees
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Raechyl Moore
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Paul Lavoie
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Linda Schiff
- Department of Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jennifer M. Allen
- Department of PsychologySt. Louis Children's HospitalSt LouisMissouriUSA
| | - Parul Rai
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Doralina L. Anghelescu
- Department of Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
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5
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Azar SS, Simeone FJ, Jarolimova J, Nussbaum EZ. Case 37-2023: A 29-Year-Old Man with Sickle Cell Disease and Right Hip Pain. N Engl J Med 2023; 389:2088-2096. [PMID: 38048191 DOI: 10.1056/nejmcpc2309497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Sharl S Azar
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
| | - F Joseph Simeone
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
| | - Jana Jarolimova
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
| | - E Zachary Nussbaum
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
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Anderson D, Lien K, Agwu C, Ang PS, Abou Baker N. The Bias of Medicine in Sickle Cell Disease. J Gen Intern Med 2023; 38:3247-3251. [PMID: 37698721 PMCID: PMC10651605 DOI: 10.1007/s11606-023-08392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
Sickle cell disease (SCD) is the most common monogenetic condition in the United States (US) and one that has been subjected to a history of negative bias. Since SCD was first described approximately 120 years ago, the medical establishment has, directly and indirectly, harmed patients by reinforcing biases and assumptions about the disease. Furthermore, negative biases and stigmas have been levied upon patients with SCD by healthcare providers and society, researchers, and legislators. This article will explore the historical context of SCD in the US; discuss specific issues in care that lead to biases, social and self-stigma, inequities in access to care, and research funding; and highlight interventions over recent years that address racial biases and stigma.
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Affiliation(s)
- Daniela Anderson
- Tapestry 360 Health Center, Chicago, IL, USA
- Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Katie Lien
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Chibueze Agwu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Phillip S Ang
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Nabil Abou Baker
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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Long KA, Blakey AO, Amaro CM, Eilenberg JS, Brochier A, Garg A, Drainoni ML, Pashankar F, Esrick EB, Kavanagh PL. Bidirectional processes linking social determinants of health and pediatric sickle cell anemia management: A qualitative study. Pediatr Blood Cancer 2023; 70:e30539. [PMID: 37470711 PMCID: PMC10619973 DOI: 10.1002/pbc.30539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Children with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management. METHODS Parents/primary caregivers (N = 27) of children with SCA (≤12 years old) participated in semi-structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively. RESULTS Three qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed ≥1 basic need, including food insecurity (42%), housing instability (62%), and/or energy insecurity 19% (vs. 20%). CONCLUSION Despite documented associations, there remains a poor understanding of the processes linking SDoH and health. Findings underscore how day-to-day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family-centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.
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Affiliation(s)
- Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Ariel O Blakey
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Christina M Amaro
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Jenna S Eilenberg
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Memorial Children's Medical Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Farzana Pashankar
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Erica B Esrick
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia L Kavanagh
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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8
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Chronic Pain. Hematol Oncol Clin North Am 2022; 36:1151-1165. [DOI: 10.1016/j.hoc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Smith WR, Valrie C, Sisler I. Structural Racism and Impact on Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1063-1076. [DOI: 10.1016/j.hoc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Smith WR, McClish DK, Bovbjerg VE, Singh HK. Development and validation of the sickle cell stress scale-adult. Eur J Haematol Suppl 2022; 109:215-225. [PMID: 35585659 PMCID: PMC9531901 DOI: 10.1111/ejh.13789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Disease‐specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD‐specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3‐item Likert‐scale adapted from a previous disease stress measure and a 10‐item Likert‐scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health‐related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self‐defined vaso‐occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three‐item and 10‐item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6‐month stress for the 10‐item scale. Cronbach's alpha was high for both the 3‐item (0.73) and 10‐item (0.83) SCD stress scales, test–retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary‐measured healthcare utilization over 6 months. The correlations with the 3‐item scale were stronger, but only statistically significant for depression‐anxiety. The correlation between the two stress scales was 0.59. Both the 3‐item and the 10‐item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test–retest reliability. Further scale validation should determine population norms and response to interventions.
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Affiliation(s)
- Wally R Smith
- Section of Research, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Viktor E Bovbjerg
- College of Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Harjot K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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11
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Leuche VT, Cutler GJ, Nelson SC, Jin J, Bergmann KR. Emergency Department Health Care Utilization and Opioid Administration Among Pediatric Patients With Sickle Cell Vasoocclusive Pain Crisis and Coexisting Mental Health Illness. Pediatr Emerg Care 2022; 38:e664-e669. [PMID: 33969978 DOI: 10.1097/pec.0000000000002322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether patients with sickle cell disease (SCD) who present to the emergency department (ED) with vasoocclusive pain crises (VOC), and have coexisting mental health (MH) diagnoses, are more likely to have increased health care utilization and more frequent opioid administration compared with those without coexisting MH conditions. METHODS This is a retrospective study of patients aged 5 to 18 years with SCD who presented to a tertiary care ED with a primary complaint of VOC between January 1, 2013, and December 31, 2017. We excluded patients with sickle cell trait and without a pain management plan in the electronic medical record. Outcomes included ED length of stay (LOS), admission rate, and opioid administration in the ED. Morphine equivalents were used to standardize opioid dosing. Mann-Whitney U and χ2 tests were used for univariate analysis. Multivariable logistic was performed for categorical and continuous outcomes, respectively, after adjusting for confounding factors. RESULTS We identified 978 encounters. We excluded 196 without a pain management plan and one with inaccurate ED LOS, resulting in 781 encounters (148 patients) for analysis. Coexisting MH diagnoses were present in 75.0% of encounters, with anxiety (83.0%) and depressive disorders (55.9%) being most common. Compared with SCD patients without coexisting MH diagnoses, those with coexisting MH diagnoses had significantly longer ED LOS (252 ± 139 minutes vs 232 ± 145 minutes, P = 0.03), longer median hospital LOS (1.4 ± 3.2 days vs 0.3 ± 2.4 days, P < 0.001) in univariate analyses, but these differences were no longer significant in adjusted regression models. Patients with coexisting MH diagnoses had higher frequency of opioid administration in the ED (85.6% vs 71.4%, P < 0.0001) and higher odds of receiving opioids (adjusted odds ratio, 2.07; 95% confidence interval, 1.28-3.33). CONCLUSIONS Patients with SCD and coexisting MH diagnoses presenting with VOC have greater odds of receiving opioids compared with patients with SCD without coexisting MH diagnoses. Our results indicate a need for more MH resources in this vulnerable population and may help guide future management strategies.
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Affiliation(s)
| | | | - Stephen C Nelson
- Department of Hematology and Oncology, Children's Minnesota, Minneapolis, MN
| | - Jing Jin
- Children's Minnesota Research Institute
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12
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Collins PJ, Renedo A, Marston CA. Communicating and understanding pain: Limitations of pain scales for patients with sickle cell disorder and other painful conditions. J Health Psychol 2022; 27:103-118. [PMID: 32744117 PMCID: PMC8739581 DOI: 10.1177/1359105320944987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Pain communication in healthcare is challenging. We examine use of pain scales to communicate pain severity via a case study of people with sickle cell disorder (SCD). We show how pain communication involves complex social interactions between patients, healthcare professionals and significant others - none of which are included in pain ratings. Failure to account for relational aspects of pain may cause problems for any patient. For SCD, mutual distrust shapes pain communication, further complicating clinical assessments. Moreover, SCD pain is particularly severe, making ratings hard to interpret compared with ratings from non-SCD patients, potentially exacerbating problems in managing pain relief.
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Affiliation(s)
- Peter J Collins
- University of Greenwich, UK
- Munich Center for Mathematical Philosophy, Ludwig-Maximilian-University, Munich, Germany
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13
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The Practices of Anaesthesiologists in the Management of Patients with Sickle Cell Disease: Empirical Evidence from Cameroon. Healthcare (Basel) 2021; 9:healthcare9121617. [PMID: 34946343 PMCID: PMC8700951 DOI: 10.3390/healthcare9121617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published.
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Sagi V, Mittal A, Tran H, Gupta K. Pain in sickle cell disease: current and potential translational therapies. Transl Res 2021; 234:141-158. [PMID: 33711512 PMCID: PMC8217144 DOI: 10.1016/j.trsl.2021.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/26/2022]
Abstract
Pain is a major comorbidity of sickle cell disease (SCD). Patients with SCD may suffer from both acute and chronic pain. Acute pain is caused by recurrent and unpredictable episodes of vaso-occlusive crises (VOC), whereas the exact etiology of chronic pain is still unknown. Opioids are the mainstay for pain treatment, but the opioid epidemic has significantly altered access to prescription opioids and has brought concerns over their long-term use into the forefront, which have negatively impacted the treatment of sickle pain. Opioids remain potent analgesics but growing opioid-phobia has led to the realization of an unmet need to develop nonopioid therapies that can provide relief for severe sickle pain. This realization has contributed to the approval of 3 different drugs by the Food and Drug Administration (FDA) for the treatment of SCD, particularly to reduce VOC and/or have an impact on the pathobiology of SCD. In this review, we outline the challenges and need for validation of side-effects of opioids and provide an update on the development of mechanism-based translational therapies, specifically targeting pain in SCD.
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Affiliation(s)
- Varun Sagi
- School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Aditya Mittal
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Huy Tran
- School of Medicine, Kansas City University, Joplin, Missouri
| | - Kalpna Gupta
- Hematology/Oncology, Department of Medicine, University of California, Irvine and Southern California Institute for Research and Education, VA Medical Center, Long Beach, California.
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15
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Miller MM, Rumble DD, Hirsh AT, Vervoort T, Crosby LE, Madan-Swain A, Lebensburger J, Hood AM, Trost Z. Pain-Related Injustice Appraisals in Youth with Sickle Cell Disease: A Preliminary Investigation. PAIN MEDICINE 2021; 22:2207-2217. [PMID: 33723587 DOI: 10.1093/pm/pnab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Sickle cell disease (SCD) is a genetic disorder that affects approximately 100,000 Americans, the majority of whom are African American. SCD-related pain often has deleterious effects on functioning and quality of life. The inherited nature of SCD, SCD-related stigma, and serious physical and functional impact of SCD-related pain create a situation ripe for individuals to appraise their SCD-related pain as unfair or unjust. The aim of this preliminary investigation is to explore the extent to which pediatric patients with SCD appraise their pain as unjust and how these appraisals relate to functioning. METHODS Participants were youth with SCD (N = 30, mean age = 11.3, 57% boys) who attended a hematology clinic visit. Patients were invited to complete paper-based questionnaires assessing pain-related injustice appraisals, pain catastrophizing, pain and hurt, functional disability, depression, anxiety, and peer relationships. RESULTS Results of hierarchical regressions indicate that pain-related injustice significantly predicted functional disability, depression, and anxiety after controlling for patient pain and catastrophizing. CONCLUSIONS These findings suggest that pain-related injustice appraisals are an important contributor to the pain experience of youth with SCD. Early identification and remediation of pain-related injustice appraisals could have long-term functional benefits for youth with SCD.
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Affiliation(s)
- Megan M Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis,Indiana, USA
| | - Deanna D Rumble
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis,Indiana, USA
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Lori E Crosby
- Division of Behavioral Medicine & Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Avi Madan-Swain
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey Lebensburger
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Opioids and Sickle Cell Disease: From Opium to the Opioid Epidemic. J Clin Med 2021; 10:jcm10030438. [PMID: 33498726 PMCID: PMC7865837 DOI: 10.3390/jcm10030438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure. The clinical effects of the sickle gene are pleiotropic in nature causing multiple phenotypic expressions associated with the various complications of the disease. The hallmark of the disease is pain that could be acute, chronic, nociceptive, or neuropathic that could occur singly or in various combinations. The acute vaso-occlusive painful crisis (VOC) is the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing preventive and curative therapies, effective pain management continues to lag behind and depend mostly on the use of opioids. This review describes the history of opioids from the ancient times of opium to the current use of the many controversial opioids. In addition, the major cause of death of patients with SCD is the complications of the disease itself and not the use of opioids. The use of opioids by patients with SCD has been stable over the years. Judicious use of opioids to treat sickle cell pain according to available guidelines could minimize the unnecessary suffering experienced by patients with SCD.
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Albayati A, Douedi S, Alshami A, Hossain MA, Sen S, Buccellato V, Cutroneo A, Beelitz J, Asif A. Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions. Healthcare (Basel) 2021; 9:healthcare9020111. [PMID: 33494294 PMCID: PMC7909809 DOI: 10.3390/healthcare9020111] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.
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18
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Bray MA, Sartain SE, Gollamudi J, Rumbaut RE. Microvascular thrombosis: experimental and clinical implications. Transl Res 2020; 225:105-130. [PMID: 32454092 PMCID: PMC7245314 DOI: 10.1016/j.trsl.2020.05.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 02/07/2023]
Abstract
A significant amount of clinical and research interest in thrombosis is focused on large vessels (eg, stroke, myocardial infarction, deep venous thrombosis, etc.); however, thrombosis is often present in the microcirculation in a variety of significant human diseases, such as disseminated intravascular coagulation, thrombotic microangiopathy, sickle cell disease, and others. Further, microvascular thrombosis has recently been demonstrated in patients with COVID-19, and has been proposed to mediate the pathogenesis of organ injury in this disease. In many of these conditions, microvascular thrombosis is accompanied by inflammation, an association referred to as thromboinflammation. In this review, we discuss endogenous regulatory mechanisms that prevent thrombosis in the microcirculation, experimental approaches to induce microvascular thrombi, and clinical conditions associated with microvascular thrombosis. A greater understanding of the links between inflammation and thrombosis in the microcirculation is anticipated to provide optimal therapeutic targets for patients with diseases accompanied by microvascular thrombosis.
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Key Words
- adamts13, a disintegrin-like and metalloproteinase with thrombospondin type 1 motif 13
- ap, alternate pathway
- apc, activated protein c
- aps, antiphospholipid syndrome
- caps, catastrophic aps
- asfa, american society for apheresis
- atp, adenosine triphosphate
- cfh, complement factor h
- con a, concavalin a
- cox, cyclooxygenase
- damp, damage-associated molecular pattern
- dic, disseminated intravascular coagulation
- gbm, glomerular basement membrane
- hellp, hemolysis, elevated liver enzymes, low platelets
- hitt, heparin-induced thrombocytopenia and thrombosis
- hlh, hemophagocytic lymphohistiocytosis
- hus, hemolytic-uremic syndrome
- isth, international society for thrombosis and haemostasis
- ivig, intravenous immunoglobulin
- ldh, lactate nos, nitric oxide synthase
- net, neutrophil extracellular trap
- pai-1, plasminogen activator inhibitor 1
- pf4, platelet factor 4
- prr, pattern recognition receptor
- rbc, red blood cell
- scd, sickle cell disease
- sle, systemic lupus erythematosus
- tlr, toll-like receptor
- tf, tissue factor
- tfpi, tissue factor pathway inhibitor
- tma, thrombotic microangiopathy
- tnf-α, tumor necrosis factor-α
- tpe, therapeutic plasma exchange
- ulc, ultra large heparin-pf4 complexes
- ulvwf, ultra-large von willebrand factor
- vwf, von willebrand factor
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Affiliation(s)
- Monica A Bray
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Sarah E Sartain
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Jahnavi Gollamudi
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Rolando E Rumbaut
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas.
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Wilson JD, Lanzkron S, Pecker LH, Bediako SM, Han D, Beach MC. Psychosocial and Clinical Risk Factors Associated with Substance Use in Observational Cohort of Patients with Sickle Cell Disease. Subst Use Misuse 2020; 55:2205-2212. [PMID: 32762425 PMCID: PMC8208322 DOI: 10.1080/10826084.2020.1797807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) experience high rates of chronic pain, and have a high burden of mental health comorbidities shown to negatively influence health. There is limited research on substance use among individuals with SCD. Objective: The aim of this study is to measure the prevalence of substance use in patients with SCD and determine whether psychosocial or clinical risk factors are associated with substance use. Methods: This study was conducted as part of an observational study of patients with SCD at two academic medical centers. We asked participants (ages 15 and older) about the lifetime use of heroin, cocaine, amphetamines, and marijuana/cannabis. We measured stigma, depression, urban life stress, pain catastrophizing, and asked about a brief pain inventory. Results: Of 258 participants, 24.9% (n = 71) reported substance use. Marijuana was the most common substance used (22.5%; n = 65). The mean depressive score met criteria for positive screen amongst individuals who reported a history of substance use (mean 10.7(5.76)). Adjusting for age, sex, yearly family income, and education level, odds of substance use increased with higher levels of internalized stigma (aOR: 1.38; 95% CI: 1.07, 1.77; p = 0.012); higher urban life stress scores (aOR 1.06; 95% CI: 1.01, 1.12; p = 0.017) and higher pain catastrophizing scores (aOR: 1.03; 95% CI: 1.01, 1.06; p = 0.008). Conclusions: Among individuals with SCD who endorse substance use, there was markedly more stress and distress with higher rates of depression and poorer quality of life. Interventions focusing on improving distress tolerance and coping to not only pain, but also social stressors, might reduce substance use.
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Affiliation(s)
- J. Deanna Wilson
- Division of General Internal Medicine, University of Pittsburgh, PA
| | - Sophie Lanzkron
- Department of Hematology, Johns Hopkins University School of Medicine
| | - Lydia H. Pecker
- Department of Pediatric Hematology, Johns Hopkins University School of Medicine
| | - Shawn M. Bediako
- Department of Psychology, University of Maryland, Baltimore County, MD
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
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20
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Abstract
OBJECTIVES In children with sickle cell disease treated for vasoocclusive episodes (VOEs), it is unknown if the temperature of infused fluids impacts clinical outcomes. We compared infusions of warmed and nonwarmed saline for treatment of VOE. We also assessed the tolerability and feasibility of infusing warmed saline in patients with VOEs. METHODS Patients aged 4 to 21 years with sickle cell disease presenting to the emergency department with VOE were randomized to infusions of warmed (37.5°C, experimental arm) versus nonwarmed (22°C-24°C, controls) saline. Intravenous opioids were administered according to previously established guidelines. We compared hospital admission rates, pain scores, disposition times, dosages of opioid, and comfort. RESULTS Eighty of 92 visits were eligible (40 per arm). The mean age of enrollees was 14 years, and 53% were female. Hospital admission rates were comparable (63% experimental arm and 55% control arm, P = 0.5). Pain score reduction (-2.9 and -2.6, P = 0.52), median morphine equivalents (0.23 mg/kg and 0.25 mg/kg, P = 0.58), and mean treatment-to-disposition times (158 minutes and 155 minutes, P = 0.85) were also similar. Global comfort was higher in children who received warmed saline (4 vs 3, P = 0.01). There were no adverse events reported in patients who received warmed saline. CONCLUSIONS It is feasible and tolerable to infuse warmed saline for the treatment of VOE, and it is well tolerated. Patient comfort was higher in those patients who received warmed saline, but there was no improvement in admission rates, disposition times, pain scores, and opioid dosages.
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21
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Kumar V, Chaudhary N, Achebe MM. Epidemiology and Predictors of all-cause 30-Day readmission in patients with sickle cell crisis. Sci Rep 2020; 10:2082. [PMID: 32034210 PMCID: PMC7005718 DOI: 10.1038/s41598-020-58934-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 11/26/2019] [Indexed: 01/22/2023] Open
Abstract
The 30-day readmission rate after hospitalization for a sickle cell crisis (SCC) is extremely high. Accurate information on readmission diagnoses, total readmission costs and factors associated with readmission is required to effectively plan resource allocation and to plan interventions to reduce readmission rates. The present study aimed to examine readmission diagnoses and factors associated with all-cause 30-day readmission after hospitalization for SCC. We analyzed 2016 nationwide readmission database (NRD) to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for SCC. We estimated the percentage and most common readmission diagnoses for 30-day and 7-day readmissions after discharge. We studied the relationship between risk factors and readmission and the impact of readmission on patient outcomes and resulting financial burden on health care in dollars. In 2016, of 67,887 discharges after index hospitalizations, 18099 (26.9%) were readmitted within 30-days. Of all readmissions, 5166 (7.6%) were readmitted within 7 days. The spectrum of readmission diagnoses was largely similar in both 30-day and 7-day readmission with more than 80% patients in both time periods readmitted with diagnoses related to SCC. The mean length of stay for readmitted patients was significantly longer than the index hospitalization (5.3 days (5.1–5.5) vs 4.9 days (CI 4.8–5.1, p < 0.01). Also, the mean cost of hospitalization in readmitted patients $8485 was significantly higher than the index hospitalization $8064 p < 0.01. In 2016, readmission among patients with SCC incurred an additional 95,445 hospitalization days resulting a total charge of $609 million and a total cost of $152 million in the US. On Multivariate analysis, age group 18–30 years, discharge against medical advice, higher Charlson comorbidity index, low socioeconomic status and admission at high volume centers were associated with a higher likelihood of 30-day readmission. Among patients hospitalized for SCC, 30-day readmissions were frequent throughout the month post hospitalization and resulted in an enormous financial burden on the United States healthcare system.
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Affiliation(s)
- Vivek Kumar
- Department of Internal Medicine and Medical Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, USA
| | - Neha Chaudhary
- Department of Pediatrics and Neonatology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Maureen M Achebe
- Division of Hematology, Brigham and Women's Hospital, and Dana Farber Cancer Institute, Boston, USA.
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22
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Lee L, Smith-Whitley K, Banks S, Puckrein G. Reducing Health Care Disparities in Sickle Cell Disease: A Review. Public Health Rep 2019; 134:599-607. [PMID: 31600481 DOI: 10.1177/0033354919881438] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder most common among African American and Hispanic American persons. The disease can cause substantial, long-term, and costly health problems, including infections, stroke, and kidney failure, many of which can reduce life expectancy. Disparities in receiving health care among African Americans and other racial/ethnic minority groups in the United States are well known and directly related to poor outcomes associated with SCD. As an orphan disease-one that affects <200 000 persons nationwide-SCD does not receive the research funding and pharmaceutical investment directed to other orphan diseases. For example, cystic fibrosis affects fewer than half the number of persons but receives 3.5 times the funding from the National Institutes of Health and 440 times the funding from national foundations. In this review, we discuss the health inequities affecting persons with SCD, describe programs intended to improve their care, and identify actions that could be taken to further reduce these inequities, improve care, control treatment costs, and ease the burden of disease.
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Affiliation(s)
- LaTasha Lee
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Kim Smith-Whitley
- Comprehensive Sickle Cell Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sonja Banks
- Sickle Cell Disease Association of America, Baltimore, MD, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
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23
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Sinha CB, Bakshi N, Ross D, Krishnamurti L. Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic: A Qualitative Study. JAMA Netw Open 2019; 2:e194410. [PMID: 31125105 PMCID: PMC6632133 DOI: 10.1001/jamanetworkopen.2019.4410] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 11/14/2022] Open
Abstract
Importance The hallmark of sickle cell disease (SCD) is vaso-occlusive pain that may be acute and episodic or may progress to chronic, persistent pain with unpredictable and disabling exacerbations. Patients with SCD rely on opioids almost exclusively for acute and chronic pain management. Objective To understand how the current opioid epidemic and subsequent guidelines from the Centers for Disease Control and Prevention are associated with the management of acute and chronic pain for patients with SCD. Design, Setting, and Participants Qualitative study using semistructured interview guides. Interviews 1 hour or longer were conducted over the telephone. Participants were adults (aged ≥18 years) diagnosed with SCD who experienced pain on 3 or more days per week recruited from national SCD conferences, symposiums, and 2 sickle cell clinics. Open coding analysis facilitated thematic analysis of interview transcripts. Data collection took place from May 2017 to June 2018. Main Outcomes and Measures Participant perspective of any changes to their pain management associated with the 2016 guidelines from the Centers for Disease Control and Prevention. Results The 15 adults interviewed had a median (range) age of 32 (21-52) years; 13 (87%) were female; and all were of African American race/ethnicity. Participants reported that recently their opioid prescriptions had become more restrictive, were more closely monitored, and were increasingly difficult to fill in pharmacies. Participants also described increased stigmatization about opioid use and that their medical care was being affected by the physician's exclusive focus on reducing pain medication use. There was an emerging interest among adult patients in the consideration of the use of alternative therapies, including marijuana, to manage pain. Conclusions and Relevance These findings suggest that from the perspective of adults living with SCD, the opioid epidemic may have negatively affected patients' care by increasing barriers to opioids. Patients reported decreased opioid dosing, increased stigmatization regarding opioid use, physician preoccupation with opioid dosage interfering with comprehensive care, and lack of access to alternative therapies.
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Affiliation(s)
- Cynthia B. Sinha
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
| | - Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Diana Ross
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Emory University, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Now with the Department of Pediatric Hematology/Oncology/BMT, Emory University, Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
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24
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Fearon A, Marsh A, Kim J, Treadwell M. Pediatric residents' perceived barriers to opioid use in sickle cell disease pain management. Pediatr Blood Cancer 2019; 66:e27535. [PMID: 30387290 PMCID: PMC6301127 DOI: 10.1002/pbc.27535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Current guidelines recommend high-priority treatment of severe sickle cell disease (SCD) pain with opioids; however, patients with SCD have historically been undertreated. We used mixed methods to assess pediatric residents' perceptions toward opioid use in SCD pain management. METHODS We distributed a survey to 88 residents at an urban pediatric medical center in a cross-sectional study. Participants responded to questions about perceived barriers to acute SCD pain management and attitudes toward patients with SCD. Responses were examined using bivariate analyses. Five pediatric residents were interviewed, to provide more in-depth understanding of barriers to SCD pain management. RESULTS Fifty-three residents (60%) completed the survey. Participants were divided into "more experienced" (had seen ≥ 21 patients with SCD; 45.3%) or "less experienced." Both groups reported potential for tolerance and dependence as major barriers to opioid use in SCD. Less experienced residents reported a greater need for additional training in SCD pain management (P < 0.05), more concern about addiction, and greater empathy for patients with SCD (P < 0.05). Both groups agreed that patients with SCD were "frustrating to care for." Thematic analysis revealed that increased patient and provider barriers led to distrust, ultimately leading to undertreatment of pain and inadequate care. CONCLUSION Although more experienced residents reported feeling more comfortable treating acute SCD pain and were less concerned with addiction compared with less experienced residents, certain negative views of patients with SCD were prevalent among all residents. Findings suggest that residency training must address provider attitudes as well as knowledge about SCD.
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Affiliation(s)
- Amber Fearon
- Rosalind Franklin Chicago Medical School, North Chicago, IL
| | - Anne Marsh
- Department of Hematology/Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA
| | - Jennifer Kim
- Department of Hematology/Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA
| | - Marsha Treadwell
- Department of Hematology/Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA
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Uche E, Akinbami A, Bola O, Badiru M, Olowoselu O, Suleiman A, Augustine B. Pentazocine addiction among sickle cell disease patients and perception of its use among health-care workers. JOURNAL OF APPLIED HEMATOLOGY 2019. [DOI: 10.4103/joah.joah_39_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Coping with Pain in the Face of Healthcare Injustice in Patients with Sickle Cell Disease. J Immigr Minor Health 2018; 19:1449-1456. [PMID: 27215766 DOI: 10.1007/s10903-016-0432-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To evaluate the pain coping strategies of patients with sickle cell disease (SCD) who experience healthcare injustice from either physicians or nurses during medical visits for pain management. It is unknown how patients' coping with pain relates to their experiences of healthcare injustice from physicians or nurses. This descriptive comparative study included adult outpatients with SCD who completed the PAINReportIt®, Healthcare Justice Questionnaire©, and Coping Strategies Questionnaire-SCD. Data were analyzed using independent t tests. Frequent coping strategies of patients who experienced healthcare justice from physicians were praying-hoping and from nurses were praying-hoping, calming self-statements, diverting attention, and increasing behavioral activity. In contrast, frequent coping strategies of patients who experienced healthcare injustice from physicians were catastrophizing and isolation and from nurses were isolation. Patients who experienced healthcare justice used different sets of pain coping strategies than those who experienced healthcare injustice during medical visits for pain management.
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27
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Ezenwa MO, Molokie RE, Wang ZJ, Yao Y, Suarez ML, Dyal B, Abudawood K, Wilkie DJ. Differences in Sensory Pain, Expectation, and Satisfaction Reported by Outpatients with Cancer or Sickle Cell Disease. Pain Manag Nurs 2018; 19:322-332. [PMID: 29501359 DOI: 10.1016/j.pmn.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) report pain scores that appear greater than those reported in a meta-analysis for patients with cancer, but statistical comparisons of the pain scores from both populations have not been published. AIMS The goal of the study described here was to compare pain outcomes reported by outpatients with cancer or SCD. DESIGN Descriptive comparative study. SETTING Outpatient oncology or sickle cell clinics. SUBJECTS The participants were outpatients (N = 415) from three studies: (1) 106 patients with SCD, 93% African-American (referent group); (2) 140 patients with cancer, 90% Caucasian (race discordant); (3) 169 patients with cancer, 20% Caucasian, 65% African-American (race concordant). METHODS Patients completed the PAINReportIt including pain location, quality, pattern, intensity, expectation, satisfaction, and demographic questions. Analyses included the χ2 test, analysis of variance, and regression. RESULTS Outpatients with SCD reported more pain location sites than the race-discordant (p < .001) and race-concordant (p < .001) cancer groups; higher pain quality than the race-discordant (p < .001) and race-concordant (p < .001) groups; and greater pain pattern scores than the race-discordant (p < .001) and race-concordant (p < .001) groups. The race-concordant group reported higher worst pain intensity than the SCD (p < .001) and race-discordant (p = .002) groups. The three groups did not differ significantly on pain expectation (p = .06). Regarding satisfaction with pain level, there was a significant difference between the race-concordant and SCD (p = .006) groups, but not between the race-discordant and SCD (p = .12) groups or between the race-discordant and race-concordant (p = .49) groups. CONCLUSIONS Outpatients with SCD reported three of four sensory pain parameters that were greater than those reported by outpatients with cancer. A better understanding of these differences is pertinent to improving pain outcomes.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Robert E Molokie
- College of Medicine, College of Pharmacy, and Comprehensive Sickle Cell Center, University of Illinois, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, Cancer Center and Comprehensive Sickle Cell Center, University of Illinois, Chicago, Illinois
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Marie L Suarez
- Department of Biobehavioral Health Science (MC 802), University of Illinois at Chicago, College of Nursing, Chicago, Illinois
| | - Brenda Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Khulud Abudawood
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida.
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Stehouwer N, Edge P, Katie Park B, Piccone C, Little J. Acute pain in adolescents and young adults with sickle cell disease: Delayed and increased opioid dosing following transition to adult care. Am J Hematol 2017; 92:E40-E42. [PMID: 28066934 DOI: 10.1002/ajh.24647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nathan Stehouwer
- Department of Internal Medicine and Pediatrics; University Hospitals Cleveland Medical Center/Rainbow Babies and Children's Hospital; Cleveland Ohio
- Case Western Reserve University; Cleveland Ohio
| | | | | | - Connie Piccone
- Case Western Reserve University; Cleveland Ohio
- Division of Hematology and Oncology; Rainbow Babies and Children's Hospital; Cleveland Ohio
| | - Jane Little
- Case Western Reserve University; Cleveland Ohio
- University Hospitals Seidman Cancer Center; Cleveland Ohio
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Evensen CT, Treadwell MJ, Keller S, Levine R, Hassell KL, Werner EM, Smith WR. Quality of care in sickle cell disease: Cross-sectional study and development of a measure for adults reporting on ambulatory and emergency department care. Medicine (Baltimore) 2016; 95:e4528. [PMID: 27583862 PMCID: PMC5008546 DOI: 10.1097/md.0000000000004528] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Documented deficiencies in adult sickle cell disease (SCD) care include poor access to knowledgeable providers and inadequate treatment in emergency departments (EDs).The aim of this study was to create patient-reported outcome measures of the quality of ambulatory and ED care for adults with SCD.We developed and pilot tested SCD quality of care questions consistent with Consumer Assessments of Healthcare Providers and Systems surveys. We applied psychometric methods to develop scores and evaluate reliability and validity.The participants of this study were adults with SCD (n = 556)-63% aged 18 to 34 years; 64% female; 64% SCD-SS-at 7 US sites.The measure used was Adult Sickle Cell Quality of Life Measurement information system Quality of Care survey.Most participants (90%) reported at least 1 severe pain episode (pain intensity 7.8 ± 2.3, 0-10 scale) in the past year. Most (81%) chose to manage pain at home rather than the ED, citing negative ED experiences (83%). Using factor analysis, we identified Access, Provider Interaction, and ED Care composites with reliable scores (Cronbach α 0.70-0.83) and construct validity (r = 0.32-0.83 correlations with global care ratings). Compared to general adult Consumer Assessments of Healthcare Providers and Systems scores, adults with SCD had worse care, adjusted for age, education, and general health.Results were consistent with other research reflecting deficiencies in ED care for adults with SCD. The Adult Sickle Cell Quality of Life Measurement Quality of Care measure is a useful self-report measure for documenting and tracking disparities in quality of SCD care.
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Affiliation(s)
| | - Marsha J. Treadwell
- Department of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA
- Correspondence: Marsha J. Treadwell, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 (e-mail: )
| | - San Keller
- American Institutes for Research, Chapel Hill, NC
| | | | | | - Ellen M. Werner
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Wally R. Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA
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Ezenwa MO, Patil C, Shi K, Molokie RE. Healthcare injustice in patients with sickle cell disease. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2016. [DOI: 10.1108/ijhrh-07-2014-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to detail experiences that sickle cell disease (SCD) patients associate with healthcare justice and injustice in pain control.
Design/methodology/approach
– A content analysis study of open-ended comments written by 31 participants who completed a 20-item healthcare injustice questionnaire-revised twice: once in reference to experiences with doctors and once in reference to experiences with nurses.
Findings
– Participants’ mean age was 33±10 years; most were African-Americans and women. Themes showed: the four domains of healthcare justice were represented in patients’ comments; examples of justice and injustice were provided; specific incidents and interactions with healthcare providers were memorable to patients; and setting was a factor important to healthcare experiences because expectations about services vary by setting.
Research limitations/implications
– Patients were self-selected. Future work will include qualitative interviews and focus groups to uncover more details about how patients experience healthcare injustice.
Practical implications
– Additional training is needed for SCD providers and about proper management of sickle cell pain; educational modules are also needed that address areas of healthcare injustice by patients.
Originality/value
– The authors are the first to report how patients define healthcare justice and injustice. Specific details about memorable SCD patient-provider interactions and pain control are described.
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Adams-Graves P, Bronte-Jordan L. Recent treatment guidelines for managing adult patients with sickle cell disease: challenges in access to care, social issues, and adherence. Expert Rev Hematol 2016; 9:541-52. [DOI: 10.1080/17474086.2016.1180242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ruta NS, Ballas SK. The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association. PAIN MEDICINE 2016; 17:1793-1798. [DOI: 10.1093/pm/pnw074] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Development, Content Validity, and User Review of a Web-based Multidimensional Pain Diary for Adolescent and Young Adults With Sickle Cell Disease. Clin J Pain 2016; 31:580-90. [PMID: 25565585 DOI: 10.1097/ajp.0000000000000195] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaso-occlusive pain, the hallmark of sickle cell disease (SCD), is a major contributor to morbidity, poor health-related quality of life, and health care utilization associated with this disease. There is wide variation in the burden, frequency, and severity of pain experienced by patients with SCD. As compared with health care utilization for pain, a daily pain diary captures the breadth of the pain experience and is a superior measure of pain burden and its impact on patients. Electronic pain diaries based on real-time data capture methods overcome methodological barriers and limitations of paper pain diaries, but their psychometric properties have not been formally established in patients with SCD. OBJECTIVES To develop and establish the content validity of a web-based multidimensional pain diary for adolescents and young adults with SCD and conduct an end-user review to refine the prototype. MATERIALS AND METHODS Following identification of items, a conceptual model was developed. Interviews with adolescents and young adults with SCD were conducted. Subsequently, end-user review with use of the electronic pain diary prototype was conducted. RESULTS Two iterative cycles of in-depth cognitive interviews in adolescents and young adults with SCD informed the design and guided the addition, removal, and modification of items in the multidimensional pain diary. Potential end-users provided positive feedback on the design and prototype of the electronic diary. CONCLUSION A multidimensional web-based electronic pain diary for adolescents and young adults with SCD has been developed and content validity and initial end-user reviews have been completed.
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Haywood C, Lanzkron S, Hughes M, Brown R, Saha S, Beach MC. The Association of Clinician Characteristics with their Attitudes Toward Patients with Sickle Cell Disease: Secondary Analyses of a Randomized Controlled Trial. J Natl Med Assoc 2015; 107:89-96. [PMID: 27269495 DOI: 10.1016/s0027-9684(15)30029-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A high level of evidence exists to suggest that negative attitudes held by clinicians toward persons with sickle cell disease serve as important barriers to the delivery of high quality care to this patient population. Little is known, though, about the characteristics of clinicians that may be predictive of these negative attitudes. METHODS During spring and summer 2009, we conducted a randomized controlled trial to test an intervention to improve clinician attitudes toward persons with sickle cell disease. Participating clinicians completed questionnaires regarding their demographic characteristics and their attitudes toward sickle cell patients. Principal clinician characteristics of interest included their race, professional discipline (nurse/physician), and the amount of their recent exposure to sickle cell patients in pain. Secondary analyses from this trial are presented here. MAIN FINDINGS Asian clinicians reported more negative attitudes towards these patients than did Black or White clinicians, nurses reported more negative attitudes than physicians, and clinicians with the greatest levels of recent exposure to sickle cell patients in pain reported more negative attitudes than did clinicians with lower levels of recent exposure. CONCLUSIONS Our findings could facilitate the development of tailored educational resources needed to improve the quality of care delivered to persons with sickle cell disease, a national priority for sickle cell efforts.
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Affiliation(s)
- Carlton Haywood
- The Johns Hopkins School of Medicine, The Johns Hopkins Berman Institute of Bioethics.
| | | | - Mark Hughes
- The Johns Hopkins School of Medicine, The Johns Hopkins Berman Institute of Bioethics
| | | | - Somnath Saha
- Section of General Internal Medicine, Oregon Health and Science University, Division of General Internal Medicine & Geriatrics
| | - Mary Catherine Beach
- The Johns Hopkins School of Medicine, The Johns Hopkins Berman Institute of Bioethics
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Haywood C, Williams-Reade J, Rushton C, Beach MC, Geller G. Improving Clinician Attitudes of Respect and Trust for Persons With Sickle Cell Disease. Hosp Pediatr 2015; 5:377-84. [PMID: 26136312 DOI: 10.1542/hpeds.2014-0171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To test the effect of 1 high-intensity, and 1 reduced-intensity, educational intervention designed to improve health care provider attitudes toward youth with sickle cell disease (SCD). METHODS We exposed a regional sample of pediatric health care providers to a 2.5-day high-intensity educational and experiential intervention using videos about the SCD patient experience. Additionally, we traveled to a different set of regional health care institutions and offered pediatric providers a reduced-intensity intervention, consisting of a 90-minute lunchtime in-service centered on our same set of videos about the patient's experience. We assessed the impact of both interventions by taking pre/post measurements of the negative and positive attitudes expressed by participating providers toward patients with SCD. RESULTS Both interventions tested elicited improvements in the SCD attitudes expressed by the pediatric providers as suggested through a reduction in measured negative attitude scores (20.0 vs 12.1, P < .001), and an improvement in positive attitude scores (67.1 vs 72.2, P < .001). Further testing suggested that the high-intensity intervention elicited a stronger effect than the reduced-intensity intervention across multiple attitudinal domains. CONCLUSIONS Video-based interventions can be used to improve the attitudes of pediatric providers toward patients with SCD. The availability of interventions of varying intensities provides greater flexibility in designing efforts to advance the quality of SCD care through the improvement of provider attitudes.
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Affiliation(s)
- Carlton Haywood
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Cynda Rushton
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
| | - Mary Catherine Beach
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
| | - Gail Geller
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
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Ezenwa MO, Molokie RE, Wilkie DJ, Suarez ML, Yao Y. Perceived injustice predicts stress and pain in adults with sickle cell disease. Pain Manag Nurs 2014; 16:294-306. [PMID: 25439119 DOI: 10.1016/j.pmn.2014.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
Research evidence shows that perceived injustice is a context-based unfair treatment that has negative influence on health outcomes. We examined the contribution of patients' perceived injustice regarding interactions with health care providers to stress and pain in adults with sickle cell disease (SCD). This study was a cross-sectional correlational pilot study. Included in the study were adults with SCD who received their care from a university-affiliated comprehensive sickle cell clinic. Participants were 52 adults whose mean age was 34 ± 11 years (minimum [min] 20 years, maximum [max] 70 years). Most of the patients were African American (n = 48, 92%) and female (n = 41, 79%). Forty-eight patients (92%) reported having a high school diploma or higher. Participants completed the perceived injustice questionnaire, perceived stress questionnaire, and the PAINReportIt, which includes questions to measure pain and demographics. We analyzed the data using the linear regression analyses. Perceived injustice from doctors was a significant predictor of perceived stress (p < .001) and pain (p = .002). Perceived injustice from nurses also was a significant predictor of perceived stress (p < .001) and pain (p = .02). The procedural, distributive, and informational domains of perceived injustice attributed to both doctors and nurses consistently predicted patients' perceived stress, but only the procedural and distributive domains of perceived injustice consistently predicted patients' pain. Findings suggest that perceived injustice was negatively associated with stress and pain in adults with SCD and warrant further investigation in a larger sample.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois.
| | - Robert E Molokie
- University of Illinois at Chicago, College of Medicine Department of Medicine, Division of Hematology/Oncology College of Pharmacy Department of Biopharmaceutical Sciences, and Comprehensive Sickle Cell Center, Chicago, Illinois
| | - Diana J Wilkie
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing and Comprehensive Sickle Cell Center, Chicago, Illinois
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Azonobi IC, Anderson BL, Byams VR, Grant AM, Schulkin J. Obstetrician-gynecologists' knowledge of sickle cell disease screening and management. BMC Pregnancy Childbirth 2014; 14:356. [PMID: 25311876 PMCID: PMC4287569 DOI: 10.1186/1471-2393-14-356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/22/2014] [Indexed: 01/19/2023] Open
Abstract
Background Although obstetrician/gynecologists (OB/GYNs) play an important role in sickle cell disease (SCD) screening and patient care, there is little information on knowledge of SCD or sickle cell trait (SCT) or related practices in this provider group. Our objective was to assess SCD screening and prenatal management practices among OB/GYNs. Methods Twelve hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (the College)a were invited to complete a mailed survey, of which half (n = 600) belonged to the Collaborative Ambulatory Research Network.b Participants answered questions regarding appropriate target patient groups for prenatal SCD screening, folic acid requirements, practice behaviors and adequacy of their medical school and residency training. Results A total of 338 CARN members (56.3%) and 165 non-CARN members (27.5%) returned a survey. Of the 503 responders, 382 provided obstetric services and were included in the analyses. Forty percent of these respondents (n = 153) reported seeing at least 1 patient with SCD in the last year. Of these, 97.4% reported regularly screening people of African descent for SCD or SCT, whereas 52.9% reported regularly screening people of Mediterranean descent and 30.1% reported regularly screening people of Asian descent. Only 56.2% knew the correct recommended daily dose of folic acid for pregnant women with SCD. The proportion of respondents that rated training on SCD screening, assessment and treatment as barely adequate or inadequate ranged from 19.7% to 39.3%. Conclusions The practice of many OB/GYNs who care for patients with SCD are not consistent with the College Practice Guidelines on the screening of certain target groups and on folic acid supplementation. There may be an opportunity to improve this knowledge gap through enhanced medical education.
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Affiliation(s)
| | | | | | | | - Jay Schulkin
- The American College of Obstetricians and Gynecologists, Washington, DC, USA.
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Haywood C, Bediako S, Lanzkron S, Diener-West M, Strouse J, Haythornthwaite J, Onojobi G, Beach MC. An unequal burden: poor patient-provider communication and sickle cell disease. PATIENT EDUCATION AND COUNSELING 2014; 96:159-164. [PMID: 24935607 PMCID: PMC4115582 DOI: 10.1016/j.pec.2014.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess disparities in the quality of healthcare provider communication experienced by African-American adults with and without sickle cell disease (SCD) in the U.S. METHODS Poor provider communication was assessed by the Provider Communication subscale of the Consumer Assessment of Healthcare Plans and Systems survey. The SCD sample was obtained from participants in a multicenter observational study of healthcare experiences. The national African-American sample data was obtained from published national estimates. RESULTS The SCD sample was more likely than the national sample to report poor communication in 3 out of 4 communication domains: listening (22.3% vs. 11.5%, p<0.0001); showing respect (26.1% vs. 9.5%, p<0.0001); and spending enough time (38.3% vs. 16.2%, p<0.0001). Differences were consistent in young, but not old, patients and showed some variation by self-reported health status and education. CONCLUSIONS The communication difficulties experienced by persons with SCD do not appear reducible to their predominantly African-American race, but may result from more disease-specific factors. PRACTICE IMPLICATIONS Healthcare providers should take particular care in recognizing and demonstrating recommended communication skills with SCD patients as these patients may be particularly vulnerable to, and cognizant of, poor quality interactions.
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Affiliation(s)
- Carlton Haywood
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, USA.
| | - Shawn Bediako
- Department of Psychology, The University of Maryland, Baltimore County, Baltimore, MD 21205, USA
| | - Sophie Lanzkron
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Marie Diener-West
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - John Strouse
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Jennifer Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, USA
| | - Gladys Onojobi
- Department of Medicine, The Howard University Hospital, Washington, USA
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Porter J, Feinglass J, Artz N, Hafner J, Tanabe P. Sickle cell disease patients' perceptions of emergency department pain management. J Natl Med Assoc 2013; 104:449-54. [PMID: 23342819 DOI: 10.1016/s0027-9684(15)30199-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with sickle cell disease (SCD) experience painful crises that often require admission to the emergency department (ED) for pain management. Factors such as ED overcrowding and negative perception and stigmatization of SCD may impact patients' perceptions of the quality of pain management in the ED. Data from a multisite prospective cohort study was assessed to determine whether demographic (age and sex), clinical (time to administration of initial analgesia, number of analgesic doses, discharge disposition, and clinical site), or interpersonal factors (separately measured perceptions of being treated with trust and respect by ED triage nurses, nurses, and physicians) were associated with patient ratings of their pain management in the ED. Patients were adults with SCD seen at 3 EDs (2 urban and 1 rural). Demographic and clinical information was derived from medical record review; interpersonal and ED pain management ratings were derived from interviews conducted 1 week post ED visit. A total of 209 interviews by 98 patients were analyzed. Results indicated significant differences among the ED sites on the demographic, clinical, and interpersonal factors. Overall, patients reported being treated with trust and respect by ED clinicians. Adjusted logistic regression analyses indicated that ED clinical site 1 (odds ratio [OR], 10.42; 95% confidence interval [Cl], 1.44-7.36) and being treated with trust and respect by the ED physician (OR, 25.53; 95% CI, 2.07-314.96) predicted good ED pain management ratings. Interpersonal health care experiences may be an important indicator of patient satisfaction and quality of care received by patients with SCD in the ED.
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Affiliation(s)
- Jerlym Porter
- St. Jude Children's Research Hospital, Department of Psychology, Memphis, TN 38105, USA
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Abstract
OBJECTIVES The objectives of the study were to test the impact of emergency department (ED) crowding and to identify factors associated with delay in analgesic administration in pediatric sickle cell pain crises. METHODS This was a cross-sectional study at a children's hospital ED. Data included demographics, clinical features, triage acuity, 10-level triage pain score, and arrival-to-analgesic-administration time. Emergency department census was the crowding measure assigned to each patient at arrival. Severe pain was a triage pain score of more than 7. Delays of more than 60 minutes from arrival to analgesic administration represented poor care. Logistic regression tested the effect of ED census on time to analgesic administration after adjusting for patient demographic and clinical characteristics. RESULTS From 243 encounters (161 patients), we excluded 11 visits (missing charts [n = 7], no pain at triage [n = 3], analgesic refusal [n = 1]). Final analysis involved 232 encounters (150 patients). Most were black with hemoglobin SS. Median age was 12 years. Mean ED census was 57. Median time from arrival to analgesic administration was 90 minutes. Analgesics were administered in less than 60 minutes in 70 encounters (30%). Most delays occurred after triage. Univariate analysis revealed that analgesic administration within 60 minutes of arrival was associated with severe pain at triage. After controlling for other factors, analgesic administration was significantly delayed during higher ED census and significantly earlier for young children and those with severe pain at triage. The time to analgesic administration from arrival significantly increased per increasing quartile of ED census (P = 0.0009). CONCLUSION Emergency department crowding is associated with delay in analgesic administration in pediatric patients with sickle cell pain crisis.
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Shanley LA, Ebeling M, Titus MO. Changes in platelet count as a predictive tool in sickle cell acute vaso-occlusive crises: a pediatric study. Clin Pediatr (Phila) 2011; 50:657-61. [PMID: 21382920 DOI: 10.1177/0009922811399347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Studies have shown that platelets play an important role in the pathophysiology of vaso-occlusive crises (VOC) in sickle cell disease. This study investigates whether changes in platelet indices from baseline can be predictive of complications during acute pain crisis. METHODS Data were obtained from pediatric sickle cell patients in the well-clinic setting and compared with data gathered during VOC (n = 67). Primary outcome was complicated (admission, acute chest syndrome, transfusion, etc) versus uncomplicated (discharge from emergency department without subsequent return) course. RESULTS Patients with uncomplicated courses had larger platelet declines (53.7) than those with complicated courses (14.8, P = .005). CONCLUSIONS The study suggests that patients with uncomplicated VOC are more likely to experience a larger decline in platelets. The predictive value is limited by the need to have preexisting steady-state data and relatively small decline. Ongoing studies are needed to identify useful laboratory data to help predict severity of VOC.
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A video-intervention to improve clinician attitudes toward patients with sickle cell disease: the results of a randomized experiment. J Gen Intern Med 2011; 26:518-23. [PMID: 21181560 PMCID: PMC3077483 DOI: 10.1007/s11606-010-1605-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/11/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clinician attitudes toward patients are associated with variability in the quality of health care. Attitudes are typically considered difficult to change, and few interventions have attempted to do so. Negative attitudes toward adults with sickle cell disease have been identified as an important barrier to the receipt of appropriate pain management for this patient population. OBJECTIVE To test the effect of a video-intervention designed to improve clinician attitudes toward adults with sickle cell disease. INTERVENTIONS An 8-minute video depicting a clinician expert and patients discussing challenges in seeking treatment for sickle cell pain. DESIGN AND PARTICIPANTS A randomized post-test only control group design was used to assess the impact of the intervention on the attitudes of 276 nurses and housestaff working at a large, urban, academic medical center. MAIN MEASURES Attitudes toward adult sickle cell patients assessed using 5- and 6-point Likert-scale items. Exploratory factor analysis was used to identify underlying attitudinal domains and develop scales. Examples of the negative and positive attitudes assessed include clinician estimates of the percentage of SCD patients that exaggerate pain (negative) or make clinicians glad they went into medicine (positive). KEY RESULTS Compared to the control group, the intervention group exhibited decreased negative attitudes (Difference in means = -8.9, 95%CI [-14.2, -3.6]; Cohen's d = 0.41), decreased endorsement of certain patient behaviors as "concern-raising" (Difference in means = -7.8, 95%CI [-13.1, -2.5]; Cohen's d = 0.36), and increased positive attitudes toward sickle cell patients (Difference in means = 6.6, 95% CI [0.6, 12.6]; Cohen's d = 0.27). CONCLUSIONS Our results suggest that the attitudes of clinicians toward sickle cell patients may be improved through a short and relatively easy to implement intervention. Whether the attitudinal differences associated with our intervention are sustainable or are linked to clinical outcomes remains to be seen.
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Carroll CP, Haywood C, Lanzkron S. Prediction of onset and course of high hospital utilization in sickle cell disease. J Hosp Med 2011; 6:248-55. [PMID: 21661098 DOI: 10.1002/jhm.850] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although sickle cell disease (SCD) patients typically manage their pain at home, a small subgroup is frequently hospitalized and accounts for the majority of costs. OBJECTIVES 1) To identify prospective diagnostic and demographic markers of new periods of high utilization; 2) To identify demographic and diagnostic markers of a persistent rather than moderating course of high utilization; 3) To replicate the finding that high utilization tends to moderate. DESIGN The State Inpatient Databases for California, 2004-2007, were used. Patients with new onset periods of high utilization were compared with non-high utilizers, and new high utilizers who moderated were compared with those who had a persistent course. SETTING All hospitals in the state of California. PATIENTS Patients age 13 years or older in 2004 with a recorded diagnosis of sickle cell disease and at least one hospitalization for crisis during the study period. METHODS Groups from hospitals throughout California were compared on demographics and discharge diagnoses of SCD complications and comorbidities. Patients age 13 years or older in 2004 with a recorded diagnosis of sickle cell disease and at least 1 hospitalization for crisis during the study period were included. RESULTS New periods of high utilization were associated with more prior hospitalizations and previous diagnoses of aseptic necrosis and renal disease. High utilization typically moderated. A persistent course was associated with slightly more hospitalizations during the initial year of high utilization, and, subsequently, by more mentions of septicemia and mood disorders. CONCLUSIONS Overall, high utilization was difficult to predict, as was its course. The diagnoses most associated with high utilization indicated more severe sickle cell disease. Septicemia deserves further investigation as a preventable cause for high utilization, as do mood disorders.
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Affiliation(s)
- C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Abstract
OBJECTIVES We sought to evaluate the relationship between pain scores and time to analgesic administration in 2 patient groups: those with sickle cell disease (SCD) and those with long-bone fractures (LBFs). METHODS Patients between the ages of 3 and 21 years who presented to a pediatric emergency department (ED) with a vaso-occlusive episode secondary to SCD or an isolated LBF during 2005 were included. A retrospective chart review was conducted for each visit. Data collected included demographics, visual analog scale (VAS) pain scores, and time analgesic intervention. In 2005, all patients with SCD received analgesic management according to protocol. RESULTS Seventy-seven patients with SCD had 152 visits to the ED for pain, whereas 219 patients had 221 visits for isolated LBF. In the long-bone-fracture group, for every 1-point increase in the VAS score, time to analgesic administration decreased by 5.6 minutes (P = 0.003), whereas in the SCD group, there was no relationship between VAS score and time to analgesic administration (P = 0.69). CONCLUSIONS Our data suggest that pain scores are not used in the initial decision-making process in those patients with SCD presenting to the ED; however, they are utilized for patients presenting with another painful condition.
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Evaluation and Treatment of Sickle Cell Pain in the Emergency Department: Paths to a Better Future. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2010; 11:265-273. [PMID: 21499553 DOI: 10.1016/j.cpem.2010.09.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pain is the hallmark of sickle cell disease in children and adolescents. Many children seek relief from their pain in the emergency department. These visits have historically been characterized by undertreatment, bias and distrust. Through compassionate care, aggressive pain management, and the development of clinical pathways or care guidelines, better analgesia and a better experience can be assured for the child with sickle cell disease in need of emergency care.
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Reddin CDRC, Cerrentano E, Tanabe P. Sickle cell disease management in the emergency department: what every emergency nurse should know. J Emerg Nurs 2010; 37:341-5; quiz 426. [PMID: 21741568 DOI: 10.1016/j.jen.2010.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 04/01/2010] [Accepted: 04/19/2010] [Indexed: 11/25/2022]
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Fournier-Charrière E, Tourniaire B. [Patient controlled analgesia in children]. Arch Pediatr 2010; 17:566-77. [PMID: 20347578 DOI: 10.1016/j.arcped.2010.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 02/02/2010] [Accepted: 02/16/2010] [Indexed: 11/25/2022]
Abstract
Patient Controlled Analgesia is a useful technic to deliver morphine analgesia via a programmable pump: the patient himself choose to self-administer a bolus dose (usually morphine); the dosage is calculated and prescribed according to the level of pain, limits of dose and period of interdiction are planned. After initial bolus to decrease severe pain (titration), the patient from the age of 6 years can manage his analgesia. This method of administration of the analgesic allows to adapting at best the posology of morphine to the level of pain and has a high safety level. A continuous flow can be prescribed if the pain is severe, but requires a greater level of surveillance of the essential parameters: breath and sedation, in order to avoid any overdose. As for any morphine analgesia, the unwanted effects must be prevented or treated. If the child cannot handle the pump (young age, handicap, tiredness) the nurse or sometimes the relative can activate the delivery of bolus after a specific training. The education of the relatives (parents) and the child is essential. This simple and efficacious method of analgesia requires an adequate training of the nursing staff.
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Affiliation(s)
- E Fournier-Charrière
- Unité douleur et soins palliatifs de l'adulte et de l'enfant, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Haywood C, Beach MC, Lanzkron S, Strouse JJ, Wilson R, Park H, Witkop C, Bass EB, Segal JB. A Systematic Review of Barriers and Interventions to Improve Appropriate Use of Therapies for Sickle Cell Disease. J Natl Med Assoc 2009; 101:1022-33. [DOI: 10.1016/s0027-9684(15)31069-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zempsky WT, Loiselle KA, McKay K, Lee BH, Hagstrom JN, Schechter NL. Do children with sickle cell disease receive disparate care for pain in the emergency department? J Emerg Med 2009; 39:691-5. [PMID: 19703740 DOI: 10.1016/j.jemermed.2009.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 06/01/2009] [Accepted: 06/13/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND There may be disparities in pain management practice in the emergency department (ED) for sickle cell disease patients (SCD) with vaso-occlusive episodes (VOE). OBJECTIVES To compare pain management practice for children who presented to the ED with VOE to those with isolated long bone fractures (LBF). METHODS Children who presented with a VOE or a LBF to a children's hospital ED during 2005 were included. A retrospective medical chart review was conducted for each patient visit. Data collected included demographics, pain scores, time from triage to analgesia, and analgesic intervention. RESULTS Seventy-seven patients with SCD had 152 visits to the ED for pain, and 219 patients had 221 visits for LBF. Fifty-five patients (108 visits) with SCD and 123 patients (124 visits) with LBF received opiates. Subsequent analysis was done on these groups. Patients with SCD were older, less likely to be male and more likely to be African-American than the LBF group. Patients with SCD had higher triage pain scores (7.7 ± 2.5 vs. 6.7 ± 3.0, p = 0.005) and spent less time in the waiting room (7.4 ± 9.0 vs. 12.1 ± 26.8 min, p = 0.10), were given higher initial opiate doses (0.09 ± 0.03 vs. 0.07 ± 0.03 mg/kg morphine, p < 0.001); however, time from triage to analgesic intervention did not differ (69.0 ± 42.6 vs. 70.4 ± 57.1 min, p = 0.92). CONCLUSIONS No disparities in care for children with sickle cell pain were identified. More timely administration of opiates needs to be encouraged, assuming other factors such as time of day, ED census, and acuity permit.
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Affiliation(s)
- William T Zempsky
- Pain Relief Program, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA
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Ratanawongsa N, Haywood C, Bediako SM, Lattimer L, Lanzkron S, Hill PM, Powe NR, Beach MC. Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: development of a scale. PATIENT EDUCATION AND COUNSELING 2009; 76:272-8. [PMID: 19233587 PMCID: PMC3119258 DOI: 10.1016/j.pec.2009.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Revised: 12/15/2008] [Accepted: 01/06/2009] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Patients with sickle cell disease (SCD) often perceive negative provider attitudes, which may affect the quality of patient-provider communication and care during vaso-occlusive crises (VOCs). This study investigated the validity and reliability of a scale to measure provider attitudes toward patients with acute VOC. METHODS Using a cohort of adults with VOC (September 2006 to June 2007), we administered a 10-item provider questionnaire within 72 h of patient encounters. After factor analysis, we created a 7-item Positive Provider Attitudes toward Sickle Cell Patients Scale (PASS); higher scores indicate more positive attitudes. We assessed internal consistency and evidence of construct validity, exploring bivariate relationships between provider or patient characteristics and the PASS score using multilevel modeling. RESULTS We collected 121 surveys from 84 health care providers for 47 patients. Patients averaged 30.3 years in age, and 60% were women. Among providers, 79% were nurses, and 70% worked in inpatient settings. PASS scores averaged 24.1 (S.D. 6.7), ranged 7-35, and had high internal consistency (Cronbach's alpha=0.91). As hypothesized, inpatient vs. emergency department providers (Delta=4.65, p<0.001) and nurses vs. other providers (Delta=0.95, p<0.001) had higher PASS scores. Higher patient educational attainment (Delta per year=2.74, p<0.001) and employment (Delta=5.62, p=0.001) were associated with higher PASS scores. More frequent hospitalizations (Delta per episode=-0.52, p<0.001) and prior disputes with staff (Delta=-7.53, p=0.002) were associated with lower PASS scores. CONCLUSION Our findings provide preliminary evidence for the reliability and construct validity of the PASS score in measuring provider attitudes toward patients with VOC. PRACTICE IMPLICATIONS Future studies should examine the validity of PASS in other cohorts of patients with SCD and their providers. With further evidence, PASS may prove useful for investigating the impact of provider attitudes on the quality of communication and care provided to these patients.
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Affiliation(s)
- Neda Ratanawongsa
- General Internal Medicine, Center for Vulnerable Populations, University of California, San Francisco, CA 94110, USA.
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