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Coll-Vinent B, Sugranyes G. Sex and gender need to be integrated into emergency medicine. Recommendations for research and clinical practice. Eur J Emerg Med 2024:00063110-990000000-00140. [PMID: 39037732 DOI: 10.1097/mej.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- Blanca Coll-Vinent
- Comissió Clínica de Sexe i Gènere en Salut, Hospital Clínic
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Emergency Department, Hospital Clínic
| | - Gisela Sugranyes
- Comissió Clínica de Sexe i Gènere en Salut, Hospital Clínic
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Department of Child and Adolescent Psychiatry and Psychology Institute of Neuroscience, Hospital Clínic, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G04, Madrid, Spain
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2
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McGregor AJ, Greenberg MR, Donnelly EA. Invited editorial: A guide to caring for patients who identify as transgender and gender diverse in the emergency department: The evolution of evidence-based medicine. J Am Coll Emerg Physicians Open 2024; 5:e13218. [PMID: 38903765 PMCID: PMC11187803 DOI: 10.1002/emp2.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Alyson J. McGregor
- Department of Emergency MedicineUniversity of South Carolina School of MedicineGreenvilleSouth CarolinaUSA
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/USF Morsani College of Medicine, Lehigh CampusAllentownPennsylvaniaUSA
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Drogell K, Kincade B, Melaku M, Mangira C, Burns A, Krizo J. Race and Sex Are Associated With Variations in Pain Management in Patients Presenting to the Emergency Department With Undifferentiated Abdominal Pain. J Emerg Med 2022; 63:629-635. [PMID: 36347727 DOI: 10.1016/j.jemermed.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/08/2022] [Accepted: 09/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pain management is critical to the management of patients in the emergency department (ED). The clinical decision-making process for prescribing medications is complicated by its subjective nature. Historically, racial and ethnic minority groups and women have not had their pain managed as aggressively as White and male patients. OBJECTIVE The objective of this study was to determine whether race and biological sex affect the pain management process by means of evaluating data from a large hospital system with diverse patient demographic characteristics. METHODS This was a retrospective study of adult patients who presented an ED within the hospital system and were discharged from the ED with a diagnosis of undifferentiated abdominal pain during a single year. Patient pain was classified as mild, moderate, or severe, and patients were further stratified by race, ethnicity, sex, and insurance status. Pain management was assessed by narcotic vs non-narcotic administration. RESULTS A total of 32,676 patients were included in the study. Narcotic administration was more likely in White patients with undifferentiated abdominal pain (22%) compared with Black patients (12%; adjusted odds ratio 0.50; 95% CI 0.46-0.54). This persists across patient-reported pain scores. In addition, women (16.99%) were prescribed narcotics less often than men (19.41%; p < 0.0001). CONCLUSIONS Although differences in pain management practices have been explored previously, this study provided a large, updated, multifacility assessment that confirmed that race- and sex-based differences in pain management persist, specifically in the decision to treat with narcotics. Further investigation is warranted to determine the root causes of these differences.
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Affiliation(s)
- Kristin Drogell
- Department of Emergency Medicine, Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Brianna Kincade
- Department of Emergency Medicine, Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Mikhail Melaku
- Department of Emergency Medicine, Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Caroline Mangira
- Department of Research, Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Andrew Burns
- Department of Research, Cleveland Clinic Akron General Medical Center, Akron, Ohio
| | - Jessica Krizo
- Department of Research, Cleveland Clinic Akron General Medical Center, Akron, Ohio
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Siegelman JN, Zeidan AJ. Letter to the Editor, re: GRACE-2: Low-risk, recurrent abdominal pain in the emergency department. Acad Emerg Med 2022; 29:1146-1147. [PMID: 35849064 DOI: 10.1111/acem.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jeffrey N Siegelman
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy J Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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5
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Brinkley TE, Stites SD, Hunsberger HC, Karvonen-Gutierrez CA, Li M, Shaaban CE, Thorpe RJ, Kritchevsky SB. Research Centers Collaborative Network Workshop on Sex and Gender Differences in Aging. Innov Aging 2022; 6:igac055. [PMID: 36267320 PMCID: PMC9579719 DOI: 10.1093/geroni/igac055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 02/03/2023] Open
Abstract
Aging affects men and women differently; however, the impact of sex and gender on the aging process is not well understood. Moreover, these 2 concepts are often conflated, which further contributes to a lack of clarity on this important issue. In an effort to better understand the relevance of sex and gender in aging research, the Research Centers Collaborative Network sponsored a 1.5-day conference on sex and gender differences in aging that brought together key thought leaders from the 6 National Institute on Aging center programs. The meeting included sessions on comparing males and females, pathophysiological differences, sex/gender in clinical care, and gender and health in the social context. Presenters from a wide array of disciplines identified opportunities for multidisciplinary research to address current gaps in the field and highlighted the need for a more systematic approach to understanding the how and why of sex/gender differences, as well as the health implications of these differences and the sex/gender biases that affect clinical treatment and outcomes. This article summarizes the proceedings of the workshop and provides several recommendations to move the field forward, such as better data collection tools to assess the intersection of sex and gender in epidemiological research; a life course perspective with attention to fetal/developmental origins and key life stages; innovative animal models to distinguish contributions from sex hormones versus sex chromosomes; and integration of sex/gender into teaching and clinical practice. Ultimately, successful implementation of these recommendations will require thoughtful investigations across the translational spectrum and increased collaborations among those with expertise in sex and gender differences.
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Affiliation(s)
- Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shana D Stites
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly C Hunsberger
- Department of Foundational Science and Humanities, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Mengting Li
- School of Nursing, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Candel BG, Dap S, Raven W, Lameijer H, Gaakeer MI, de Jonge E, de Groot B. Sex differences in clinical presentation and risk stratification in the Emergency Department: An observational multicenter cohort study. Eur J Intern Med 2022; 95:74-79. [PMID: 34521584 DOI: 10.1016/j.ejim.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether sex differences exist in disease presentations, disease severity and (case-mix adjusted) outcomes in the Emergency Department (ED). METHODS Observational multicenter cohort study using the Netherlands Emergency Department Evaluation Database (NEED), including patients ≥ 18 years of three Dutch EDs. Multivariable logistic regression was used to study the associations between sex and outcome measures in-hospital mortality and Intensive Care Unit/Medium Care Unit (ICU/MCU) admission in ED patients and in subgroups triage categories and presenting complaints. RESULTS Of 148,825 patients, 72,554 (48.8%) were females. Patient characteristics at ED presentation and diagnoses (such as pneumonia, cerebral infarction, and fractures) were comparable between sexes at ED presentation. In-hospital mortality was 2.2% in males and 1.7% in females. ICU/MCU admission was 4.7% in males and 3.1% in females. Males had higher unadjusted (OR 1.34(1.25-1.45)) and adjusted (AOR 1.34(1.24-1.46)) risks for mortality, and unadjusted (OR 1.54(1.46-1.63)) and adjusted (AOR 1.46(1.37-1.56)) risks for ICU/MCU admission. Males had higher adjusted mortality and ICU/MCU admission for all triage categories, and with almost all presenting complaints except for headache. CONCLUSIONS Although patient characteristics at ED presentation for both sexes are comparable, males are at higher unadjusted and adjusted risk for adverse outcomes. Males have higher risks in all triage categories and with almost all presenting complaints. Future studies should investigate reasons for higher risk in male ED patients.
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Affiliation(s)
- Bart Gj Candel
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, the Netherlands; Department of Emergency Medicine, Máxima Medical Center, De Run 4600, Veldhoven, DB 5504, the Netherlands.
| | - Saimi Dap
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, the Netherlands
| | - Wouter Raven
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, the Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden, AD 8934, the Netherlands
| | - Menno I Gaakeer
- Department of Emergency Medicine, Adrz Hospital, 's-Gravenpolderseweg 114, Goes, RA 4462, the Netherlands
| | - Evert de Jonge
- Department of Intensive Care Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, the Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, RC 2300, the Netherlands
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Mayfield J, Gill M, Zhang HJ, Ganti L. Sex-Based Differences in the Presentation of Myocardial Infarction. Cureus 2021; 13:e16906. [PMID: 34513479 PMCID: PMC8418226 DOI: 10.7759/cureus.16906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
The authors report a case of a middle-aged female presenting with a chief complaint of shoulder pain. Workup revealed a non-ST-segment elevation myocardial infarction. The typical symptoms of myocardial infarction and the evaluation of a non-ST-segment elevation myocardial infarction are discussed. The authors highlight the sex-based differences in the presentation of myocardial infarction and remind us to keep a broad differential and consider atypical presentations.
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Affiliation(s)
- Jeremy Mayfield
- Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Muneet Gill
- Emergency Medicine, Brown University, Providence, USA
| | - Helen J Zhang
- Emergency Medicine, Brown University, Providence, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Plantation, USA.,Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
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Preciado SM, Sharp AL, Sun BC, Baecker A, Wu YL, Lee MS, Shen E, Ferencik M, Natsui S, Kawatkar AA, Park SJ, Redberg RF. Evaluating Sex Disparities in the Emergency Department Management of Patients With Suspected Acute Coronary Syndrome. Ann Emerg Med 2021; 77:416-424. [PMID: 33358395 PMCID: PMC8005458 DOI: 10.1016/j.annemergmed.2020.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/02/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE We compare clinical management and outcomes of emergency department (ED) encounters by sex after implementation of a clinical care pathway in 15 community EDs that standardized recommendations based on patient risk, using the History, ECG, Age, Risk Factors, and Troponin (HEART) score. METHODS This was a retrospective analysis of adult ED encounters evaluated for suspected acute coronary syndrome with a documented HEART score from May 20, 2016, to December 1, 2017. The primary outcomes were hospitalization or 30-day stress testing. Secondary outcomes included 30-day acute myocardial infarction or all-cause death (major adverse cardiac event). A generalized estimating equation regression model was used to compare the odds of hospitalization or stress testing by sex; we report HEART scores (0 to 10) stratified by sex and describing major adverse cardiac events. RESULTS A total of 34,715 adult ED encounters met the inclusion criteria (56.0% women). A higher proportion of women were classified as low risk (60.5% versus 52.4%; odds ratio [OR] 1.39; 95% confidence interval [CI] 1.33 to 1.45). Women were hospitalized or received stress testing less frequently than men for low HEART scores (18.8% versus 22.8%; OR 0.79; 95% CI 0.73 to 0.84) and intermediate ones (46.7% versus 49.7%; OR 0.88; 95% CI 0.83 to 0.95), but similarly for high-risk ones (74.1% versus 74.4%; OR 0.99; 95% CI 0.77 to 1.28). Women had 18% lower odds of hospitalization or noninvasive cardiac testing (OR 0.82; 95% CI 0.78 to 0.86), even after adjusting for HEART score and comorbidities. Men had higher risks of major adverse cardiac events than women for all HEART score categories but the risk for men was significantly higher among low-risk HEART scores (0.4% versus 0.1%). CONCLUSION Women with low-risk HEART scores are hospitalized or stress tested less than men, which is likely appropriate, and women have better outcomes than men. Use of the HEART score has the potential to reduce sex disparities in acute coronary syndrome care.
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Affiliation(s)
- Salena M Preciado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Adam L Sharp
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Benjamin C Sun
- Department of Emergency Medicine, University of Pennsylvania, Leonard Davis Institute, Philadelphia, PA
| | - Aileen Baecker
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Yi-Lin Wu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ming-Sum Lee
- Division of Cardiology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Shaw Natsui
- New York City Health + Hospitals, New York, NY
| | - Aniket A Kawatkar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Stacy J Park
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Rita F Redberg
- Division of Cardiology, University of California-San Francisco, San Francisco, CA.
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Machluf Y, Chaiter Y, Tal O. Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy. World J Clin Cases 2020; 8:3645-3668. [PMID: 32953842 PMCID: PMC7479575 DOI: 10.12998/wjcc.v8.i17.3645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.
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Affiliation(s)
- Yossy Machluf
- Shamir Research Institute, University of Haifa, Kazerin 1290000, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
| | - Orna Tal
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
- Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 7030100, Israel
- Department of Management, Program of Public Health and Health System Administration, Bar Ilan University, Ramat Gan 5290002, Israel
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10
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McGregor AJ, Greenberg MR, Barron R, Walter LA, Wolfe J, Deutsch AL, Johnson SA, Robinett DA, Beauchamp GA. Incorporating Sex and Gender-based Medical Education Into Residency Curricula. AEM EDUCATION AND TRAINING 2020; 4:S82-S87. [PMID: 32072111 PMCID: PMC7011412 DOI: 10.1002/aet2.10390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Emergency medicine (EM) residents do not generally receive sex- and gender-specific education. There will be increasing attention to this gap as undergraduate medical education integrates it within their curriculum. METHODOLOGY Members of the Sex and Gender in Emergency Medicine (SGEM) Interest Group set out to develop a SGEM toolkit and pilot integrating developed components at multiple residency sites. The curriculum initiative involved a pre- and posttraining assessment that included basic demographics and queries regarding previous training in sex-/gender-based medicine (SGBM). It was administered to PGY-1 to -4 residents who participated in a 3-hour training session that included one small group case-based discussion, two oral board cases, and one simulation and group debriefing. ANALYSIS Components of the developed toolkit (https://www.sexandgenderhealth.org) were implemented at four unique SGEM Interest Group member residency programs. Residents (n = 82/174, 47%) participated; 64% (n = 49) were male and 36% (n = 28) were female. Twenty-six percent (n = 21) of the residents reported that they had less than 1 hour of training in this domain during residency; 59% (n = 48) reported they had 1 to 6 hours and 16% (n = 13) reported they had >6 hours. The average preassessment score was 61% and postassessment was 88%. After training, 74% (n = 60) felt that their current practice would have benefited from further training in sex-/gender-based topics in medicine during medical school and 83% (n = 67) felt their clinical practice would have benefited from further training in this domain during residency. IMPLICATIONS The majority of EM residents who participated in this training program reported that they had limited instruction in this domain in medical school or residency. This initiative demonstrated a method that can be emulated for the incorporation of SGBM educational components into an EM residency training educational day. After training, the majority of residents who participated felt that their current practice would have benefited from further training in sex- and gender-based topics in residency.
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Affiliation(s)
- Alyson J. McGregor
- Department of Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRI
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital MedicineLehigh Valley Health NetworkUSF Morsani College of MedicineAllentownPA
| | - Rebecca Barron
- Department of Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRI
| | - Lauren A. Walter
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAL
| | - Jeannette Wolfe
- Department of Emergency MedicineUniversity of Massachusetts Medical School–Baystate SpringfieldSpringfieldMA
| | - Ashley L. Deutsch
- Department of Emergency MedicineUniversity of Massachusetts Medical School–Baystate SpringfieldSpringfieldMA
| | - Steven A. Johnson
- Department of Emergency and Hospital MedicineLehigh Valley Health NetworkUSF Morsani College of MedicineAllentownPA
| | - Derek A. Robinett
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAL
| | - Gillian A. Beauchamp
- Department of Emergency and Hospital MedicineLehigh Valley Health NetworkUSF Morsani College of MedicineAllentownPA
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11
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Beauchamp GA, Amaducci A, Greenberg MR, Meyers M, Cook M, Cannon RD, Katz KD, Finkelstein Y. Adverse Drug Events and Reactions Managed by Medical Toxicologists: an Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010-2016. J Med Toxicol 2019; 15:262-270. [PMID: 31309522 PMCID: PMC6825075 DOI: 10.1007/s13181-019-00719-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Adverse drug events/reactions (ADE/ADRs) cost more than $30 billion annually and are among the leading causes of death in the USA. Little is known about patients treated at the bedside for ADE/ADR by medical toxicologists. METHODS We conducted a retrospective study of ADE/ADR cases reported to the Toxicology Investigators Consortium (ToxIC) registry between January 1, 2010, and December 31, 2016. Clinical and demographic data were collected including age, sex, circumstances surrounding exposure, suspected offending substance, clinical manifestations, treatment, disposition, and outcome. RESULTS Among 51,440 ToxIC cases during this time period, 673 ADE/ADR cases were reported (337 females). By age, ADE/ADRs were seen most commonly among adults age 19-65 years (442/673, 65.7% of ADE/ADR) and older adults age 65-89 years (134/673, 19.9% of ADE/ADR). 222/673 (33%) of consults for ADE/ADR were seen in the emergency department (ED); 181/673 (26.9%) were seen in the hospital ward; and 160/673 (23.8%) were seen in the intensive care unit (ICU). The most commonly reported sign for ADE/ADR was tachycardia: 51/673 (7.6%), followed by bradycardia: 49/673 (7.3%). Most commonly reported agents associated with ADE/ADR were as follows: 97/673 (14.4%) due to cardiovascular medications; 76/673 (11.3%) due to antipsychotic medications; and 61/673 (9.1%) due to antidepressants. 429/673 (63.7%) of ADE/ADR were reported as due to a single agent, and 212/673 (31.5%) were reported as due to multiple agents. CONCLUSIONS 4.2% of cases managed at the bedside by a consulting toxicologist and reported to the ToxIC registry between 2010 and 2016 had ADE/ADR as the reason for consultation. Agents most commonly involved in ADE/ADRs included cardiovascular medications, antipsychotic medications, and antidepressants.
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Affiliation(s)
- Gillian A Beauchamp
- Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
- Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Alexandra Amaducci
- Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Matthew Meyers
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Matthew Cook
- Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
- Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Robert D Cannon
- Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
- Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kenneth D Katz
- Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
- Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Yaron Finkelstein
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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12
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Sex-Specific Considerations in Guidelines Generation and Application. Can J Cardiol 2018; 35:598-605. [PMID: 30910247 DOI: 10.1016/j.cjca.2018.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022] Open
Abstract
New knowledge about male-female differences in pathophysiology, diagnosis, and treatment is shifting the practice of medicine from a one-size-fits all approach to a more individualized process that considers sex-specific interventions at the point of care. In this article, we review how clinical practice guideline committees can incorporate a structured framework to determine whether sex-specific assessments of the quality of the evidence or the particular recommendations should be made. The process can be operationalized by societies who author clinical practice guidelines by developing formal policies to approach biological sex in a systematic way, and by ensuring that writing committees include an individual who will champion the formal appraisal of the literature for associations between sex and the outcomes of interest. Ongoing challenges are discussed, and solutions are provided for how to disaggregate the evidence, how to assess bias, how to improve search strategies, and what to do when the data are insufficient to make sex-specific recommendations. Application of sex-specific recommendations will involve routinely asking whether the presentation, diagnostic workup, or management might change for each patient if they were the opposite sex.
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13
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Tannenbaum C, van Hoof K. Effectiveness of online learning on health researcher capacity to appropriately integrate sex, gender, or both in grant proposals. Biol Sex Differ 2018; 9:39. [PMID: 30157942 PMCID: PMC6114804 DOI: 10.1186/s13293-018-0197-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/15/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To describe the effectiveness of online learning to augment academic capacity to consider sex and gender in the conduct of basic science, clinical research, and population health studies. METHOD The analysis compares pre- and post-test scores from 1441 individuals who completed the Canadian Institutes of Health Research Institute of Gender and Health's interactive e-learning modules between February 2016 and May 2017. The tests measured knowledge, self-efficacy, and self-reported intent to change behavior for three competencies: (1) the ability to appropriately define and distinguish between sex-related versus gender-related variables, (2) the application of methods for integrating sex and gender, and (3) the critical appraisal of sex and gender integration in the design, methods, and analysis plan of research proposals and publications. RESULTS Of the 543 individuals who completed the basic science module, 62% demonstrated improved knowledge, and 86% increased self-efficacy across all competencies. Gains in knowledge and self-efficacy also occurred among 84% and 77% of completers of the human data collection module (n = 463) and among 73% and 82% of those who completed the secondary data analysis module (n = 435). In aggregate, 95% of participants reported an intent to change their behavior with respect to sex and gender in health research. CONCLUSIONS Interactive online learning combined with feedback and self-assessment results in improved knowledge and self-efficacy for integrating sex and gender in health research.
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Affiliation(s)
- Cara Tannenbaum
- Institute of Gender and Health, Canadian Institutes of Health Research, 4545 Queen Mary Road, Montreal, Quebec, H3W 1W5, Canada.
- Faculties of Medicine and Pharmacy, Université de Montréal, Montreal, Canada.
| | - Krystle van Hoof
- Institute of Gender and Health, Canadian Institutes of Health Research, 4545 Queen Mary Road, Montreal, Quebec, H3W 1W5, Canada
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Beauchamp GA, Carey JL, Adams T, Wier A, Colón MF, Cook M, Cannon R, Katz KD, Greenberg MR. Sex Differences in Poisonings Among Older Adults: An Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010 to 2016. Clin Ther 2018; 40:1366-1374.e8. [PMID: 30072041 DOI: 10.1016/j.clinthera.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Adults aged >65 years are susceptible to intentional and unintentional poisoning, with contributing factors that include polypharmacy, comorbidity, susceptibility to medication error, and gaps in research. Although toxicologists are often tasked with managing and preventing poisoning among older adults, little is known about sex differences in these poisonings. The aim of this study was to review sex differences in poisonings among older adults managed at the bedside by medical toxicologists. METHODS All case subjects aged >65 years in the Toxicology Investigators Consortium (ToxIC) registry between January 2010 and December 2016 were reviewed. Data included reasons for exposure and consultation, exposure agents and routes, presenting clinical findings, and treatment provided. Cases missing age, sex, or primary reason for toxicology consultation data were excluded. We used χ2 tests to assess differences in distribution of study variables according to participant sex. FINDINGS Among 51,441 total registry cases, 542 (1.05%) were excluded because of missing data. Among the remaining 50,899 cases, 2930 (5.8%) were included for age >65 years; 52.3% of older adults were female. Race was missing or unknown for 49.2% of cases. Adverse drug reactions were more commonly encountered in female subjects than in their male counterparts (9.6% vs 6.4%; P = 0.001). No statistically significant sex differences were observed for total numbers of intentional, unintentional pharmaceutical, and nonpharmaceutical exposures. The most common medications involved were cardiovascular (16.8%) and analgesics/opioids (14.8%). Female subjects were more likely than male subjects to be evaluated by a toxicologist for cardiovascular medications (18.7% vs 14.7%; P = 0.004) and analgesics/opioids (17.6% vs 11.8%; P < 0.001). Male subjects were more likely than female subjects to be evaluated for ethanol toxicity (7.4% vs 1%; P < 0.001) and for envenomations (4.2% vs 1.8%; P < 0.001). The most common route of exposure was oral ingestion (81.3%). Signs/symptoms were noted in 54.8% of cases, with the most common abnormal vital sign being bradycardia (17.2%). Pharmacologic support was the most common intervention and was more common in male subjects than in female subjects (17.7% vs 12.3%; P < 0.001). Deaths were reported in 38 female subjects (2.45%) and 46 male subjects (3.34%); there was no statistically significant difference in death rate according to sex (P = 0.148). IMPLICATIONS Older female adults were more commonly evaluated by a medical toxicologist for an adverse drug reaction than older male adults. Female patients were more likely than male patients to be evaluated for poisoning related to analgesic/opioids and cardiovascular medications, and older male patients more frequently received pharmacologic support than older female patients. No significant sex differences were observed in numbers of toxicology consultations for intentional, unintentional pharmaceutical, and nonpharmaceutical exposures.
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Affiliation(s)
- Gillian A Beauchamp
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania.
| | - Jennifer L Carey
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, Massachusetts
| | - Tyler Adams
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Amy Wier
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Manuel F Colón
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Matthew Cook
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania
| | - Robert Cannon
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania
| | - Kenneth D Katz
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
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