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Suarez DF, Blustein EC, Bausano BJ, Lacy AJ. Obstructing Urolithiasis Leading to Renal Forniceal Rupture. J Emerg Med 2023; 65:e559-e560. [PMID: 37838491 DOI: 10.1016/j.jemermed.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Daniel F Suarez
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Erica C Blustein
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Brian J Bausano
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Aaron J Lacy
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
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d'Etienne JP, Zhou Y, Kan C, Shaikh S, Ho AF, Suley E, Blustein EC, Schrader CD, Zenarosa NR, Wang H. Two-step predictive model for early detection of emergency department patients with prolonged stay and its management implications. Am J Emerg Med 2020; 40:148-158. [PMID: 32063427 DOI: 10.1016/j.ajem.2020.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To develop a novel model for predicting Emergency Department (ED) prolonged length of stay (LOS) patients upon triage completion, and further investigate the benefit of a targeted intervention for patients with prolonged ED LOS. MATERIALS AND METHODS A two-step model to predict patients with prolonged ED LOS (>16 h) was constructed. This model was initially used to predict ED resource usage and was subsequently adapted to predict patient ED LOS based on the number of ED resources using binary logistic regressions and was validated internally with accuracy. Finally, a discrete event simulation was used to move patients with predicted prolonged ED LOS directly to a virtual Clinical Decision Unit (CDU). The changes of ED crowding status (Overcrowding, Crowding, and Not-Crowding) and savings of ED bed-hour equivalents were estimated as the measures of the efficacy of this intervention. RESULTS We screened a total of 123,975 patient visits with final enrollment of 110,471 patient visits. The overall accuracy of the final model predicting prolonged patient LOS was 67.8%. The C-index of this model ranges from 0.72 to 0.82. By implementing the proposed intervention, the simulation showed a 12% (1044/8760) reduction of ED overcrowded status - an equivalent savings of 129.3 ED bed-hours per day. CONCLUSIONS Early prediction of prolonged ED LOS patients and subsequent (simulated) early CDU transfer could lead to more efficiently utilization of ED resources and improved efficacy of ED operations. This study provides evidence to support the implementation of this novel intervention into real healthcare practice.
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Affiliation(s)
- James P d'Etienne
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX 760199, USA.
| | - Chen Kan
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX 760199, USA.
| | - Sajid Shaikh
- Department of Information Technology, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Amy F Ho
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Eniola Suley
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX 760199, USA.
| | - Erica C Blustein
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Chet D Schrader
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA; Integrative Emergency Services, 4835 LBJ Fwy Suite 900, Dallas, TX 75244, USA.
| | - Nestor R Zenarosa
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA; Integrative Emergency Services, 4835 LBJ Fwy Suite 900, Dallas, TX 75244, USA.
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA; Integrative Emergency Services, 4835 LBJ Fwy Suite 900, Dallas, TX 75244, USA.
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Hughes JW, Bao YK, Salam M, Joshi P, Kilpatrick CR, Juneja K, Nieves D, Bouhairie V, Jordan OJ, Blustein EC, Tobin GS, McGill JB. Late-Onset T1DM and Older Age Predict Risk of Additional Autoimmune Disease. Diabetes Care 2019; 42:32-38. [PMID: 30361208 PMCID: PMC6300704 DOI: 10.2337/dc18-1157] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/02/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes (T1DM) is associated with other autoimmune diseases (AIDs), which may have serious health consequences. The epidemiology of AIDs in T1DM is not well defined in adults with T1DM. In this cross-sectional cohort study, we sought to characterize the incident ages and prevalence of AIDs in adults with T1DM across a wide age spectrum. RESEARCH DESIGN AND METHODS A total of 1,212 adults seen at the Washington University Diabetes Center from 2011 to 2018 provided informed consent for the collection of their age, sex, race, and disease onset data. We performed paired association analyses based on age at onset of T1DM. Multivariate logistic regression was used to evaluate the independent effects of sex, race, T1DM age of onset, and T1DM duration on the prevalence of an additional AID. RESULTS Mean ± SD age of T1DM onset was 21.2 ± 14.4 years. AID incidence and prevalence increased with age. Female sex strongly predicted AID risk. The most prevalent T1DM-associated AIDs were thyroid disease, collagen vascular diseases, and pernicious anemia. T1DM age of onset and T1DM duration predicted AID risk. Patients with late-onset T1DM after 30 years of age had higher risks of developing additional AIDs compared with patients with younger T1DM onset. CONCLUSIONS The prevalence of AIDs in patients with T1DM increases with age and female sex. Later onset of T1DM is an independent and significant risk factor for developing additional AIDs. Individuals who are diagnosed with T1DM at older ages, particularly women, should be monitored for other autoimmune conditions.
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Affiliation(s)
- Jing W Hughes
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Yicheng K Bao
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Maamoun Salam
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Prajesh Joshi
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,Mercy Hospital Northwest Arkansas and University of Arkansas for Medical Sciences Northwest Regional Campus, Fayetteville, AR
| | - C Rachel Kilpatrick
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,Washington Regional Medical Center, Fayetteville, AR
| | - Kavita Juneja
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,Gilead Sciences, Foster City, CA
| | - David Nieves
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,Northwell Health Lenox Hill Hospital, New York, NY
| | - Victoria Bouhairie
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,Novant Health, Charlotte, NC
| | - Olivia J Jordan
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Erica C Blustein
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO.,John Peter Smith Hospital, Fort Worth, TX
| | - Garry S Tobin
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO
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Affiliation(s)
- Michael D. Collins
- Department of Biology, Rhodes College, 2000 North Parkway, Memphis, TN 38112
| | - George E. Relyea
- School of Public Health, University of Memphis, Memphis, TN 38152
| | - Erica C. Blustein
- Department of Biology, Rhodes College, 2000 North Parkway, Memphis, TN 38112
| | - Steven M. Badami
- Department of Biology, Rhodes College, 2000 North Parkway, Memphis, TN 38112
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Blustein EC, Munn-Chernoff MA, Grant JD, Sartor CE, Waldron M, Bucholz KK, Madden PAF, Heath AC. The Association of Low Parental Monitoring With Early Substance Use in European American and African American Adolescent Girls. J Stud Alcohol Drugs 2016; 76:852-61. [PMID: 26562593 DOI: 10.15288/jsad.2015.76.852] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Research indicates that low parental monitoring increases the risk for early substance use. Because low parental monitoring tends to co-occur with other familial and neighborhood factors, the specificity of the association is challenging to establish. Using logistic regression and propensity score analyses, we examined associations between low parental monitoring and early substance use in European American (EA) and African American (AA) girls, controlling for risk factors associated with low parental monitoring. METHOD Participants were 3,133 EA and 523 AA girls from the Missouri Adolescent Female Twin Study with data on parental monitoring assessed via self-report questionnaire, and with ages at first use of alcohol, tobacco, and cannabis queried in at least one of three diagnostic interviews (median ages = 15, 22, and 24 years). RESULTS The rate of early alcohol use was greater in EA than AA girls, whereas the proportion of AA girls reporting low parental monitoring was higher than in EA girls. EA girls who experienced low parental monitoring were at elevated risk for early alcohol, tobacco, and cannabis use, findings supported in both logistic regression and propensity score analyses. Evidence regarding associations between low parental monitoring and risk for early substance use was less definitive for AA girls. CONCLUSIONS Findings highlight the role of parental monitoring in modifying risk for early substance use in EA girls. However, we know little regarding the unique effects, if any, of low parental monitoring on the timing of first substance use in AA girls.
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Affiliation(s)
- Erica C Blustein
- Department of Biology, Rhodes College, Memphis, Tennessee.,College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Melissa A Munn-Chernoff
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julia D Grant
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri
| | - Carolyn E Sartor
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Mary Waldron
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Department of Counseling and Educational Psychology, Indiana University School of Education, Bloomington, Indiana
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.,Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri
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