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Englander H, Thakrar AP, Bagley SM, Rolley T, Dong K, Hyshka E. Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl: A Review. JAMA Intern Med 2024:2818022. [PMID: 38683591 DOI: 10.1001/jamainternmed.2023.7282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Importance The rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions. Observations Clinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl's high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl's unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians' understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing. Conclusions and Relevance The findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in General Internal Medicine and the Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland
| | - Ashish P Thakrar
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sarah M Bagley
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Xing J, Dong K, Liu X, Ma J, Yuan E, Zhang L, Fang Y. Enhancing gestational diabetes mellitus risk assessment and treatment through GDMPredictor: a machine learning approach. J Endocrinol Invest 2024:10.1007/s40618-024-02328-z. [PMID: 38460091 DOI: 10.1007/s40618-024-02328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a serious health concern that affects pregnant women worldwide and can lead to adverse pregnancy outcomes. Early detection of high-risk individuals and the implementation of appropriate treatment can enhance these outcomes. METHODS We conducted a study on a cohort of 3467 pregnant women during their pregnancy, with a total of 5649 clinical and biochemical records collected. We utilized this dataset as our training dataset to develop a web server called GDMPredictor. The GDMPredictor utilizes advanced machine learning techniques to predict the risk of GDM in pregnant women. We also personalize treatment recommendations based on essential biochemical indicators, such as A1MG, BMG, CysC, CO2, TBA, FPG, and CREA. Our assessment of GDMPredictor's effectiveness involved training it on the dataset of 3467 pregnant women and measuring its ability to predict GDM risk using an AUC and auPRC. RESULTS GDMPredictor demonstrated an impressive level of precision by achieving an AUC score of 0.967. To tailor our treatment recommendations, we use the GDM risk level to identify higher risk candidates who require more intensive care. The GDMPredictor can accept biochemical indicators for predicting the risk of GDM at any period from 1 to 24 weeks, providing healthcare professionals with an intuitive interface to identify high-risk patients and give optimal treatment recommendations. CONCLUSIONS The GDMPredictor presents a valuable asset for clinical practice, with the potential to change the management of GDM in pregnant women. Its high accuracy and efficiency make it a reliable tool for doctors to improve patient outcomes. Early identification of high-risk individuals and tailored treatment can improve maternal and fetal health outcomes http://www.bioinfogenetics.info/GDM/ .
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Affiliation(s)
- J Xing
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China
| | - K Dong
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China
| | - X Liu
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China
| | - J Ma
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China
| | - E Yuan
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China.
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China.
| | - L Zhang
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China.
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China.
| | - Y Fang
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Qian Street, Zhengzhou, 450052, Henan, People's Republic of China.
- Zhengzhou Key Laboratory for In Vitro Diagnosis of Hypertensive Disorders of Pregnancy, Zhengzhou, 450052, People's Republic of China.
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Lakkadghatwala R, Lane D, Scheuermeyer F, Hilburt J, Buxton J, Johnson C, Nolan S, Sutherland C, Moe J, Daoust R, Dong K, Christenson J, Miles I, Orkin A, Whyte M, Kestler A. An emergency-department-initiated outreach program for patients with opioid use disorder is associated with an increase in agonist therapy and engagement in addictions care: a one-year cohort study. Subst Abuse Treat Prev Policy 2024; 19:14. [PMID: 38383467 PMCID: PMC10880351 DOI: 10.1186/s13011-023-00578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/31/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND People with opioid use disorder (OUD) are high-risk for short-term mortality and morbidity. Emergency department (ED) interventions can reduce those risks, but benefits wane without ongoing community follow-up. OBJECTIVE To evaluate an ED-based intensive community outreach program. METHODS At two urban EDs between October 2019 and March 2020, we enrolled patients with OUD not currently on opioid agonist therapy (OAT) in a prospective cohort study evaluating a one-year intensive community outreach program, which provided ongoing addictions care, housing resources, and community support. We surveyed patients at intake and at scheduled outreach encounters at one, two, six, and twelve months. Follow-up surveys assessed OAT uptake, addictions care engagement, housing status, quality of life scores, illicit opioid use, and outreach helpfulness. We used descriptive statistics for each period and conducted sensitivity and subgroup analyses to account for missing data. RESULTS Of 84 baseline participants, 29% were female and 32% were housed, with a median age of 33. Sixty participants (71%) completed at least one follow-up survey. Survey completion rates were 37%, 38%, 39%, and 40% respectively at one, two, six, and twelve months. Participants had a median of three outreach encounters. Among respondents, OAT was 0% at enrolment and ranged from 38% to 56% at follow-up; addictions care engagement was 22% at enrolment and ranged from 65% to 81% during follow-up; and housing was 40% at enrolment and ranged from 48% to 59% during follow-up. Improvements from baseline to follow-up occurred for all time periods. OAT and engagement in care benefits were maintained in sensitivity and subgroup analyses. Respondents rated the outreach program as helpful at all time periods, CONCLUSION: An ED-initiated intensive outreach program for patients with OUD not yet on OAT was associated with a persistent increase in OAT use and engagement in care, as well as housing.
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Affiliation(s)
- Rukaiyah Lakkadghatwala
- Department of Emergency Medicine, Surrey Memorial Hospital & Richmond Hospital, University of British Columbia, Vancouver, Canada.
| | - Daniel Lane
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine & St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jesse Hilburt
- Vancouver Coastal Health Overdose Outreach Team & St. Paul's Hospital, Vancouver, Canada
| | - Jane Buxton
- School of Population and Public Health & BC Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | - Cheyenne Johnson
- BC Centre on Substance Use & University of British Columbia School of Nursing, Vancouver, Canada
| | - Seonaid Nolan
- Department of Medicine & BC Centre on Substance Use, University of British Columbia, Vancouver, Canada
| | - Christy Sutherland
- Department of Family Practice, PHS Community Services Society & BC Centre on Substance Use, University of British Columbia, Vancouver, Canada
| | - Jessica Moe
- Department of Emergency Medicine, BC Centre for Disease Control & Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Raoul Daoust
- Département Médecine de Famille Et Médecine d'Urgence, Université de Montréal, Hôpital Sacré-Coeur de Montréal & CIUSSS Nord-de-L'ile, Montreal, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - Jim Christenson
- Department of Emergency Medicine & St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Isabelle Miles
- Department of Emergency Medicine & St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Aaron Orkin
- Department of Family & Community Medicine, Inner City Health Associates Toronto & St. Joseph's Health Centre, University of Toronto, Toronto, Canada
| | | | - Andrew Kestler
- Department of Emergency Medicine, Vancouver Coastal Health, BC Centre on Substance Use & St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Brooks HL, Speed KA, Dong K, Salvalaggio G, Pauly B(B, Taylor M, Hyshka E. Perspectives of patients who inject drugs on a needle and syringe program at a large acute care hospital. PLoS One 2024; 19:e0297584. [PMID: 38359010 PMCID: PMC10868849 DOI: 10.1371/journal.pone.0297584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND People who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services. METHODS We utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program. RESULTS Participants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients' fears. CONCLUSIONS Acute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.
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Affiliation(s)
- Hannah L. Brooks
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey A. Speed
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ginetta Salvalaggio
- Department of Family Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bernadette (Bernie) Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Marliss Taylor
- Streetworks, Boyle Street Community Services, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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MacKinnon N, Lane D, Scheuermeyer F, Kaczorowski J, Dong K, Orkin AM, Daoust R, Moe J, Andolfatto G, Klaiman M, Yan J, Koh JJ, Crowder K, Atkinson P, Savage D, Stempien J, Besserer F, Wale J, Kestler A. Factors associated with frequent buprenorphine / naloxone initiation in a national survey of Canadian emergency physicians. PLoS One 2024; 19:e0297084. [PMID: 38315732 PMCID: PMC10843078 DOI: 10.1371/journal.pone.0297084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs. METHODS We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence. RESULTS We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup. CONCLUSIONS Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.
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Affiliation(s)
- Nathalie MacKinnon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Daniel Lane
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | | | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aaron M. Orkin
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raoul Daoust
- Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche de l’Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gary Andolfatto
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Klaiman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Yan
- Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Justin J. Koh
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathryn Crowder
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, St. John, New Brunswick, Canada
| | - David Savage
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Floyd Besserer
- Department of Emergency Medicine, University of British Columbia, Prince George, British Columbia, Canada
| | - Jason Wale
- Department of Emergency Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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Duncan K, Scheuermeyer F, Lane D, Ahamad K, Moe J, Dong K, Nolan S, Buxton J, Miles I, Johnson C, Christenson J, Whyte M, Daoust R, Garrod E, Badke K, Kestler A. Patient opinion and acceptance of emergency department buprenorphine/naloxone to-go home initiation packs. CAN J EMERG MED 2023; 25:802-807. [PMID: 37606738 DOI: 10.1007/s43678-023-00568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Many emergency department (ED) patients with opioid use disorder are candidates for home buprenorphine/naloxone initiation with to-go packs. We studied patient opinions and acceptance of buprenorphine/naloxone to-go packs, and factors associated with their acceptance. METHODS We identified patients at two urban EDs in British Columbia who met opioid use disorder criteria, were not presently on opioid agonist therapy and not in active withdrawal. We offered patients buprenorphine/naloxone to-go as standard of care and then administered a survey to record buprenorphine/naloxone to-go acceptance, the primary outcome. Survey domains included current substance use, prior experience with opioid agonist therapy, and buprenorphine/naloxone related opinions. Patient factors were examined for association with buprenorphine/naloxone to-go acceptance. RESULTS Of the 89 patients enrolled, median age was 33 years, 27% were female, 67.4% had previously taken buprenorphine/naloxone, and 19.1% had never taken opioid agonist therapy. Overall, 78.7% believed that EDs should dispense buprenorphine/naloxone to-go packs. Thirty-eight (42.7%) patients accepted buprenorphine/naloxone to-go. Buprenorphine/naloxone to-go acceptance was associated with lack of prior opioid agonist therapy, less than 10 years of opioid use and no injection drug use. Reasons to accept included initiating treatment while in withdrawal; reasons to reject included prior unsatisfactory buprenorphine/naloxone experience and interest in other treatments. CONCLUSION Although less than half of our study population accepted buprenorphine/naloxone to-go when offered, most thought this intervention was beneficial. In isolation, ED buprenorphine/naloxone to-go will not meet the needs of all patients with opioid use disorder. Clinicians and policy makers should consider buprenorphine/naloxone to-go as a low-barrier option for opioid use disorder treatment from the ED when integrated with robust addiction care services.
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Affiliation(s)
- Kevin Duncan
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Daniel Lane
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Keith Ahamad
- St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
- Provincial Health Services Authority, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
- Division of Addiction Medicine, St Paul's Hospital, Vancouver, BC, Canada
| | - Cheyenne Johnson
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Providence Health Care Research Institute, Vancouver, BC, Canada
| | | | - Raoul Daoust
- Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
- Département Médecine de Famille et Médecine d'Urgence, Université de Montréal, Montreal, QC, Canada
| | - Emma Garrod
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Andrew Kestler
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
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Stone KD, Scott K, Holroyd BR, Lang E, Yee K, Taghizadeh N, Deol J, Dong K, Fanaeian J, Ghosh M, Low K, Ross M, Tanguay R, Faris P, Day N, McLane P. Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments. CAN J EMERG MED 2023; 25:598-607. [PMID: 37245202 PMCID: PMC10225037 DOI: 10.1007/s43678-023-00520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/30/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initiate buprenorphine/naloxone for eligible patients who live with opioid use disorder, and to provide unscheduled, next-day follow-up referrals to an opioid use disorder treatment clinic (in person or virtual) for continuing patient care throughout Alberta. METHODS In this quality improvement initiative, we supported local ED teams to offer buprenorphine/naloxone to eligible patients presenting to the ED with suspected opioid use disorder and refer these patients for follow-up care. Process, outcome, and balancing measures were evaluated over the first 2 years of the initiative (May 15, 2018-May 15, 2020). RESULTS The program was implemented at 107 sites across Alberta during our evaluation period. Buprenorphine/naloxone initiations in the ED increased post-intervention at most sites with baseline data available (11 of 13), and most patients (67%) continued to fill an opioid agonist prescription at 180 days post-ED visit. Of the 572 referrals recorded at clinics, 271 (47%) attended their first follow-up visit. Safety events were reported in ten initiations and were all categorized as no harm to minimal harm. CONCLUSIONS A standardized provincial approach to initiating buprenorphine/naloxone in the ED for patients living with opioid use disorder was spread to 107 sites with dedicated program support staff and adjustment to local contexts. Similar quality improvement approaches may benefit other jurisdictions.
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Affiliation(s)
- Kayla D Stone
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Ken Scott
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
| | - Brian R Holroyd
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eddy Lang
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Yee
- Data and Analytics (DIMR), Alberta Health Services, Edmonton, AB, Canada
| | - Niloofar Taghizadeh
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Janjeevan Deol
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Josh Fanaeian
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Monty Ghosh
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Keysha Low
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
| | - Marshall Ross
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert Tanguay
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Peter Faris
- Data and Analytics (DIMR), Alberta Health Services, Edmonton, AB, Canada
| | - Nathaniel Day
- Virtual Opioid Dependency Program, Alberta Health Services, Edmonton, AB, Canada
| | - Patrick McLane
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada.
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
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Galarneau LR, Scheuermeyer FX, Hilburt J, O'Neill ZR, Barbic S, Moe J, Buxton JA, Orkin AM, Kaczorowski J, Dong K, Tobin D, Miles I, Bath M, Grier S, Garrod E, Kestler A. Qualitative Exploration of Emergency Department Care Experiences Among People With Opioid Use Disorder. Ann Emerg Med 2023; 82:1-10. [PMID: 36967276 DOI: 10.1016/j.annemergmed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/28/2023]
Abstract
STUDY OBJECTIVE We described the experiences and preferences of people with opioid use disorder who access emergency department (ED) services regarding ED care and ED-based interventions. METHODS Between June and September 2020, we conducted phone or in-person semistructured qualitative interviews with patients recently discharged from 2 urban EDs in Vancouver, BC, Canada, to explore experiences and preferences of ED care and ED-based opioid use disorder interventions. We recruited participants from a cohort of adults with opioid use disorder who were participating in an ED-initiated outreach program. We transcribed audio recordings verbatim. We iteratively developed a thematic coding structure, with interim analyses to assess for thematic saturation. Two team members with lived experience of opioid use provided feedback on content, wording, and analysis throughout the study. RESULTS We interviewed 19 participants. Participants felt discriminated against for their drug use, which led to poorer perceived health care and downstream ED avoidance. Participants desired to be treated like ED patients who do not use drugs and to be more involved in their ED care. Participants nevertheless felt comfortable discussing their substance use with ED staff and valued continuous ED operating hours. Regarding opioid use disorder treatment, participants supported ED-based buprenorphine/naloxone programs but also suggested additional options (eg, different initiation regimens and settings and other opioid agonist therapies) to facilitate further treatment uptake. CONCLUSION Based on participant experiences, we recommend addressing potentially stigmatizing practices, increasing patient involvement in their care during ED visits, and increasing access to various opioid use disorder-related treatments and community support.
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Affiliation(s)
- Lexis R Galarneau
- George Spady Society, Edmonton, Alberta; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia
| | - Jesse Hilburt
- Vancouver Coastal Health, Vancouver, British Columbia
| | - Zoe R O'Neill
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia; Providence Health Research, Vancouver, British Columbia
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, and Vancouver General Hospital and British Columbia Children's Hospital, Vancouver, British Columbia; British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia; British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, and Inner City Health Associates, Toronto, Ontario
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, and Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta
| | - Dianne Tobin
- Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia
| | - Misty Bath
- Vancouver Coastal Health, Vancouver, British Columbia
| | - Sherry Grier
- Portland Hotel Society Community Services Society, Vancouver, British Columbia, Canada
| | - Emma Garrod
- Providence Health Care, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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Wu X, Yang M, Guo W, Hu J, Dong K, Gao Z. [CD5L is elevated in the serum of patients with candidemia and promotes disease progression in mouse models]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:368-374. [PMID: 37087580 PMCID: PMC10122748 DOI: 10.12122/j.issn.1673-4254.2023.03.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To investigate the changes of CD5L levels in patients with candidemia and explore the role of CD5L in progression of candidemia. METHODS Twenty healthy control individuals, 27 patients with bacteremia and 35 patients with candidemia were examined for serum CD5L levels using ELISA, and the correlations of CD5L level with other serological indicators were analyzed. A C57BL/6 mouse model of candidemia induced by intravenous injection of Candida albicans were treated with intraperitoneal injection of recombinant CD5L protein, and renal histopathological and serological changes were analyzed to assess renal injures. The effects of CD5L treatment on general condition, fungal burden, of survival of the mice were observed, and the changes in serum IL-6 and IL-8 levels of the mice were detected using ELISA. RESULTS CD5L levels were significantly elevated in patients with candidemia and positively correlated with WBC, BDG, Scr and PCT levels. The mouse model of candidemia also showed significantly increased serum and renal CD5L levels, and CD5L treatment significantly increased fungal burden in the renal tissue, elevated IL-6 and IL-8 levels in the serum and kidney, aggravated renal tissue damage, and reduced survival rate of candidemia mice. CONCLUSION Serum CD5L levels are increased in patients with candidemia, and treatment with CD5L aggravates candidemia in mouse models.
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Affiliation(s)
- X Wu
- Clinical Laboratory, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
| | - M Yang
- Clinical Laboratory, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
| | - W Guo
- Clinical Laboratory, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
| | - J Hu
- Clinical Laboratory, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
| | - K Dong
- Clinical Laboratory, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
| | - Z Gao
- Clinical Laboratory, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
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10
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Youssef M, Dong K, Lee SJ, Narula N. A167 HISTOLOGICAL REMISSION PLACEBO RATES IN ULCERATIVE COLITIS TRIALS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991206 DOI: 10.1093/jcag/gwac036.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background High histologic remission rates have been reported with placebos in randomized controlled trials (RCTs) evaluating ulcerative colitis (UC) therapies and have varied based on trial designs. We performed a systematic review and meta-analysis to quantify placebo histological remission rates and identify factors influencing those rates. Purpose This systematic review aims to improve future trials design and minimize placebo rates in UC trials. Method MEDLINE, EMBASE, and the Cochrane library were searched from inception of the databases until December 2021. We included placebo-controlled RCTs of adult patients with UC treated with aminosalicylates, corticosteroids, immunosuppressives, biologics, and small molecules. We pooled estimates using a random-effects model and performed subgroup analysis as well as meta-regression to evaluate the effect of different covariates on placebo rates. Result(s) Thirty-three studies (30 induction and 3 maintenance) were included. The overall placebo histological remission rate was 15.7% [95% CI 12.9-19%] across all 33 studies (Figure). High heterogeneity was observed among studies with I2 = 62.10%. In induction studies, the pooled estimate of histological remission was 15.8% [95% CI 12.7-19.5%], while in maintenance studies the pooled estimate was 14.5% [95% CI 8.4-24%]. Subgroup analysis revealed statistically significant differences in placebo rates when accounting for background medications, the intervention drug class, and disease severity [p= 0.041, 0.025, and 0.025, respectively]. There was no statistical difference between induction vs. maintenance studies or between different histological scales [p= 0.771, and 0.075, respectively]. Meta-regression showed similar results except that the therapy used was not statistically significant [p-value= 0.059]. Image ![]()
Conclusion(s) Placebo histological remission rates range from 13-19% in UC RCTs, but studies are highly heterogeneous. Factors found to influence placebo rates include presence of background medications, the drug used and the disease severity in UC patients. These observations have important implications in informing future trial designs to minimize placebo rates and reduce heterogeneity. Disclosure of Interest M. Youssef: None Declared, K. Dong: None Declared, S. J. Lee: None Declared, N. Narula Speakers bureau of: received honoraria from Janssen, Abbvie, Takeda, Pfizer, Merck, Sandoz, Novartis, and Ferring
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Affiliation(s)
- M Youssef
- Internal Medicine, University of Toronto, Toronto
| | | | - S J Lee
- Internal Medicine, University of Toronto, Toronto
| | - N Narula
- Gastroenterology, McMaster University, Hamilton, Canada
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11
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Singh AE, Ives N, Gratrix J, Vetland C, Ferron L, Crawford M, Hale-Balla L, Dong K, Meyer G, Smyczek P, Galli R, Rourke SB, Fonseca K. Sensitivity and Specificity of two Investigational Point of care Tests for Syphilis and HIV (PoSH Study) for the diagnosis and treatment of infectious syphilis in Canada: a cross sectional study. Clin Microbiol Infect 2023:S1198-743X(23)00085-X. [PMID: 36868357 DOI: 10.1016/j.cmi.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES Single visit testing and treatment for syphilis can reduce follow-up visits. The objectives of this study were to evaluate the performance and treatment outcomes of two dual syphilis/HIV point-of care tests (POCT). METHODS Participants aged 16 years and older were offered concurrent syphilis/HIV POCT from fingerstick blood using two extremely rapid (<5 minutes) devices [MedMira Multiplo Rapid TP/HIV Test and INSTI Multiplex HIV1/2 Syphilis Ab test]. Those with positive POCT results were offered same day syphilis treatment and linkage to HIV care. Nurses performed testing at two emergency departments, First Nations community, correctional facility and STI clinic. POCT results were compared to standard serological testing. Sensitivity and specificity were calculated. RESULTS Between August 2020 and February 2022, 1526 visits were completed. Both POCT accurately identified participants with HIV (sensitivity=100·0% [24/24], 95% CI=86·2-100·0%, specificity=99·6% [1319/1324], 95% CI=99·1-99·8%), linking 24 HIV cases to care. Both tests were most sensitive with an RPR > 8 dilutions (Multiplo: sensitivity=98·3% [231/235], 95% CI=95·7-99·3%, specificity=99·5% [871/875], 95% CI=98·8-99·8%, INSTI Multiplex: sensitivity=97·9% [230/235], 95% CI=95·1-99·1%, specificity=99·8% [873/875], 95% CI=99·2-99·9%) and least sensitive with non-reactive RPR (Multiplo: sensitivity=54·1% [59/109], 95% CI=44·8-63·2%, specificity=99·5% [871/875], 95% CI=98·8-99·8%, INSTI Multiplex: sensitivity=28·4% [31/109], 95% CI=20·8-37·5%, specificity=99·8% [873/875], 95% CI=99·2-99·9%). 87·0% with a positive POCT were treated the same day. CONCLUSIONS Two extremely rapid (<5 minutes) dual syphilis/HIV POCT showed excellent sensitivity and specificity for the diagnosis of active syphilis (RPR > 1:8 dilutions) and HIV and confirmed the ability to offer single visit testing and treatment for syphilis and linkage to HIV care in diverse clinical settings.
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Affiliation(s)
- Ameeta E Singh
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Edmonton STI Clinic, Edmonton, Alberta, Canada.
| | - Noel Ives
- Edmonton STI Clinic, Edmonton, Alberta, Canada
| | - Jennifer Gratrix
- Sexually Transmitted Infections Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Carla Vetland
- Health Systems Knowledge and Evaluation, Provincial Clinical Excellence, Calgary, Alberta, Canada
| | | | - Megan Crawford
- Northeast Community Health Centre, Edmonton, Alberta, Canada
| | | | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Petra Smyczek
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Edmonton STI Clinic, Edmonton, Alberta, Canada; Sexually Transmitted Infections Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Rick Galli
- MAP Centre for Urban Health Solutions, St. Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, St. Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada
| | - Kevin Fonseca
- Provincial Laboratory for Public Health, Alberta Precision Laboratories, Calgary, Alberta, Canada
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12
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Reddy K, Lee G, Reddy N, Chikowore T, Dong K, Walker B, Yu X, Lichterfeld M, Ndung'u T. PP 3.4 – 00079 HIV-1 clade C reservoir characteristics in early and chronic treated infection. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Du B, Ma X, Liu H, Dong K, Liu H, Zhang Y. Transcription factor MdLSD1 negatively regulates α-farnesene biosynthesis in apple-fruit skin tissue. Plant Biol (Stuttg) 2022; 24:1076-1083. [PMID: 35567570 DOI: 10.1111/plb.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
α-Farnesene is a sesquiterpene present in plants. It was first discovered in apples. It plays an important role in the plant defence response and is considered a key factor in the occurrence of superficial scald. The gene encoding α-farnesene synthase, which is the last key enzyme in the biosynthetic pathway of α-farnesene in apple fruit, has become the primary target enzyme for controlling the genetic manipulation of α-farnesene biosynthesis. In this study, the yeast one-hybrid assay and the dual luciferase assay were used to ascertain the relationship between MdLSD1 and MdAFS. Real-time PCR was used to analyse the molecular mechanism underlying the regulation of MdAFS by MdLSD1. Our results revealed that transcription factor MdLSD1, which is closely related to programmed cell death in apple fruit tissues, binds to MdAFS. Transient transformation of apple skin with vectors overexpressing MdLSD1 showed that the gene negatively regulates MdAFS. Overall, we suggest that MdLSD1 negatively regulates MdAFS. Our results are of great significance for future research on the transcriptional regulation of the α-farnesene synthase gene and provide a new direction for exploring the specific mechanism of programmed cell death involved in superficial-scald incidence.
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Affiliation(s)
- B Du
- State Key Laboratory of Crop Biology, College of Life Sciences, Shandong Agricultural University, Taian, Shandong, China
| | - X Ma
- College of Biological Sciences and Technology, Beijing Forestry University, Beijing, China
| | - H Liu
- State Key Laboratory of Crop Biology, College of Life Sciences, Shandong Agricultural University, Taian, Shandong, China
| | - K Dong
- State Key Laboratory of Crop Biology, College of Life Sciences, Shandong Agricultural University, Taian, Shandong, China
| | - H Liu
- State Key Laboratory of Crop Biology, College of Life Sciences, Shandong Agricultural University, Taian, Shandong, China
| | - Y Zhang
- State Key Laboratory of Crop Biology, College of Life Sciences, Shandong Agricultural University, Taian, Shandong, China
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14
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Dyson MP, Dong K, Sevcik W, Graham SZ, Saba S, Hartling L, Ali S. Quantifying unused opioids following emergency and ambulatory care: A systematic review and meta‐analysis. J Am Coll Emerg Physicians Open 2022; 3:e12822. [PMID: 36203538 PMCID: PMC9523453 DOI: 10.1002/emp2.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022] Open
Abstract
Objective To quantify unused opioids among adult and pediatric patients discharged from the emergency department (ED) or ambulatory care settings with a prescription for acute pain. Methods We searched MEDLINE, Embase, CINHAL, PsycINFO, the Cochrane Library, and the gray literature from inception to April 29, 2021. We included observational studies in which any patient with an acutely painful condition received a prescription for an opioid on discharge from an outpatient care setting, and unused opioids were quantified. Two reviewers screened records for eligibility, extracted data, and conducted the quality assessment. Where possible, we pooled data and otherwise described the results of studies narratively. Total unused prescriptions were synthesized using a weighted average. Random effects models were used, and heterogeneity was measured by the I2 statistic. Our primary outcome was the quantity of unused opioid medication available after receiving a prescription for acute pain. Secondary outcomes were the proportion of patients with unused opioids following a prescription, the proportion of patients using no opioids, morphine equivalents of unused opioids, and factors associated with leftover opioids. Results In this systematic review and meta‐analysis of 9 studies in emergency and ambulatory care settings, 59.6% of prescribed opioids remained unused; pediatric patients had 69.3% of their prescriptions remaining, compared to 54.6% among adult patients. The highest proportion of unused opioids was found following dental extractions (82.6%). Conclusions and Relevance More than 50% of opioids remain unused following prescriptions for acute pain. Responsible prescribing must be accompanied by education on safer use, storage, and disposal.
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Affiliation(s)
- Michele P. Dyson
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Kathryn Dong
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
- Inner City Health and Wellness Program Royal Alexandra Hospital Edmonton Alberta Canada
| | - William Sevcik
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Samir Z. Graham
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Sabrina Saba
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Lisa Hartling
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
| | - Samina Ali
- Department of Pediatrics University of Alberta Edmonton Alberta Canada
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
- Women and Children's Health Research Institute University of Alberta Edmonton Alberta Canada
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15
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Gehring ND, Speed KA, Dong K, Pauly B, Salvalaggio G, Hyshka E. Social service providers' perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study. BMC Health Serv Res 2022; 22:1138. [PMID: 36076267 PMCID: PMC9461250 DOI: 10.1186/s12913-022-08498-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers’ perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care. Methods We completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model. Results Tensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients’ ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs. Conclusions Broad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care’s ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08498-x.
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Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Kathryn Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada. .,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
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16
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Raval M, Gratrix J, Plitt S, Niruban J, Smyczek P, Dong K, Singh AE. Retrospective Cohort Study Examining the Correlates of Reported Lifetime Stimulant Use in Persons Diagnosed With Infectious Syphilis in Alberta, Canada, 2018 to 2019. Sex Transm Dis 2022; 49:551-559. [PMID: 35551418 DOI: 10.1097/olq.0000000000001648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We sought to examine the correlates for stimulant use in persons diagnosed with infectious syphilis during an outbreak in Alberta to help guide public health interventions. METHODS Infectious syphilis data were extracted from the Communicable Disease and Outbreak Management database from January 1, 2018, to December 31, 2019. Behavioral, demographic, and lifetime reported stimulant use data were obtained. Descriptive analyses and logistic regression were performed for 3 subpopulations (gay, bisexual, and other men who have sex with men; men who have sex with women; and women). RESULTS Of 3627 individuals diagnosed with infectious syphilis, 23.9% (n = 867) cases were not interviewed for substance use and were removed from further analysis. Of the remaining 2759 people, 41.8% (n = 1153) self-reported lifetime stimulant use. Gay, bisexual, and other men who have sex with men reported stimulant use less often than women (24.6% vs. 44.1%; P < 0.0001) and men who have sex with women (24.6% vs. 46.2%; P < 0.0001). Multivariable analyses demonstrated that stimulant use was associated with persons who injected drugs, had correctional involvement, or reported multiple sex partners. Men who have sex with women were more likely to self-report First Nations ethnicity (adjusted odds ratio, 1.76 [95% confidence interval, 1.25-2.49]), and women were more likely to have a concurrent gonorrhea infection (adjusted odds ratio, 1.62 [95% confidence interval, 1.15-2.28]). CONCLUSIONS Nearly half of infectious syphilis cases in Alberta reported lifetime nonprescription stimulant use. Infectious syphilis cases with stimulant use were associated with injection drug use, multiple sex partners, and correctional involvement. Our observations highlight the need for integration of sexual health services into programs for people who use substances and those in corrections custody.
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Affiliation(s)
- Milan Raval
- From the Division of Infectious Diseases, University of Alberta
| | | | - Sabrina Plitt
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario
| | - John Niruban
- Public Health Surveillance and Infrastructure, Alberta Health Services
| | - Petra Smyczek
- STI Services, Alberta Health Services, Edmonton, Alberta
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ameeta E Singh
- From the Division of Infectious Diseases, University of Alberta
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17
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Moe J, Wang YE, Schull MJ, Dong K, McGregor MJ, Hohl CM, Holroyd BR, McGrail KM. Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada. BMC Emerg Med 2022; 22:127. [PMID: 35836121 PMCID: PMC9281237 DOI: 10.1186/s12873-022-00673-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015. Results In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37–43 years; 60.9–63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with “extreme” and “moderate” frequent visits (median 13–19 versus 4–6 visits/year). “Extreme” versus “moderate” subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups. Conclusions Subgroups of people with “extreme” (13–19 visits/year) and “moderate” (4–6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the “extreme” subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00673-x.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Yueqiao Elle Wang
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Michael J Schull
- Institute for Clinical Evaluative Sciences, G1 06, 075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Brian R Holroyd
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health and Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
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18
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Brooks HL, Salvalaggio G, Pauly B, Dong K, Bubela T, Taylor M, Hyshka E. "I have such a hard time hitting myself, I thought it'd be easier": perspectives of hospitalized patients on injecting drugs into vascular access devices. Harm Reduct J 2022; 19:54. [PMID: 35619121 PMCID: PMC9137200 DOI: 10.1186/s12954-022-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hospital patients who use drugs may require prolonged parenteral antimicrobial therapy administered through a vascular access device (VAD). Clinicians’ concerns that patients may inject drugs into these devices are well documented. However, the perspectives of patients on VAD injecting are not well described, hindering the development of informed clinical guidance. This study was conducted to elicit inpatient perspectives on the practice of injecting drugs into VADs and to propose strategies to reduce associated harms. Methods Researchers conducted a focused ethnography and completed semi-structured interviews with 25 inpatients at a large tertiary hospital in Western Canada that experiences a high rate of drug-related presentations annually. Results A few participants reported injecting into their VAD at least once, and nearly all had heard of the practice. The primary reason for injecting into a VAD was easier venous access since many participants had experienced significant vein damage from injection drug use. Several participants recognized the risks associated with injecting into VADs, and either refrained from the practice or took steps to maintain their devices while using them to inject drugs. Others were uncertain how the devices functioned and were unaware of potential harms. Conclusions VADs are important for facilitating completion of parenteral antimicrobial therapy and for other medically necessary care. Prematurely discharging patients who inject into their VAD from hospital, or discontinuing or modifying therapy, results in inequitable access to health care for a structurally vulnerable patient population. Our findings demonstrate a need for healthcare provider education and non-stigmatizing clinical interventions to reduce potential harms associated with VAD injecting. Those interventions could include providing access to specialized pain and withdrawal management, opioid agonist treatment, and harm reduction services, including safer drug use education to reduce or prevent complications from injecting drugs into VADs.
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Affiliation(s)
- Hannah L Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.,Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.,Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Kathryn Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.,Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Marliss Taylor
- Streetworks, Boyle Street Community Services, 10116 105 Ave NW, Edmonton, AB, T5H 0K2, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada. .,Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.
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19
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Xie EC, Chan K, Khangura JK, Koh JJK, Orkin AM, Sheikh H, Hayman K, Gupta S, Kumar T, Hulme J, Mrochuk M, Dong K. CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary. CAN J EMERG MED 2022; 24:369-375. [PMID: 35389188 PMCID: PMC8988109 DOI: 10.1007/s43678-022-00303-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Edward C Xie
- Department of Family & Community Medicine, Division of Emergency Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada. .,Emergency Department, RFE Building, Toronto General Hospital, Toronto, ON, Canada.
| | - Kathryn Chan
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Jaspreet K Khangura
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin Jek-Kahn Koh
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aaron M Orkin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Joseph's Health Centre, Unity Health Toronto, Inner City Health Associates, Toronto, ON, Canada
| | - Hasan Sheikh
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sahil Gupta
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Thara Kumar
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,Medical Officer of Health, Central Zone, Alberta, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Hulme
- Department of Family and Community Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada
| | - May Mrochuk
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,B804 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
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20
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Moe J, Wang EY, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Hohl CM, Grafstein E, O'Sullivan F, Trimble J, McGrail KM. Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study. CMAJ Open 2022; 10:E232-E246. [PMID: 35292481 PMCID: PMC8929427 DOI: 10.9778/cmajo.20210132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. METHODS This was a retrospective cohort study that captured patients in Ontario or Alberta from fiscal years 2011/12 to 2015/16 in the Dynamic Cohort from the Canadian Institute for Health Information, which defined people with frequent visits to the emergency department in the top 10% of annual visits and randomly selected controls from the bottom 90%. We included patients 18 years of age or older and linked to emergency department, hospitalization, continuing care, home care and mental health-related hospitalization data. We characterized people who made frequent visits to the emergency department over time, compared them with controls and identified subgroups using cluster analysis. We examined emergency department visit acuity using the Canadian Triage and Acuity Scale. RESULTS The number of patients who made frequent visits to the emergency department ranged from 435 334 to 477 647 each year in Ontario (≥ 4 visits per year), and from 98 840 to 105 047 in Alberta (≥ 5 visits per year). The acuity of these visits increased over time. Those who made frequent visits to the emergency department were older and used more health care services than controls. We identified 4 subgroups of those who made frequent visits: "short duration" (frequent, regularly spaced visits), "older patients" (median ages 69 and 64 years in Ontario and Alberta, respectively; more comorbidities; and more admissions), "young mental health" (median ages 45 and 40 years in Ontario and Alberta, respectively; and common mental health-related and alcohol-related visits) and "injury" (increased prevalence of injury-related visits). INTERPRETATION From 2011/12 to 2015/16, people who visited emergency departments frequently had increasing visit acuity, had higher health care use than controls, and comprised distinct subgroups. Emergency departments should codevelop interventions with the identified subgroups to address patient needs.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Elle Yuequiao Wang
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Margaret J McGregor
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Michael J Schull
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kathryn Dong
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Brian R Holroyd
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Corinne M Hohl
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Johanna Trimble
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kimberlyn M McGrail
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
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21
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Moe J, Wang EY, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Hohl CM, Grafstein E, O'Sullivan F, Trimble J, McGrail KM. People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study. CMAJ Open 2022; 10:E220-E231. [PMID: 35292480 PMCID: PMC8929439 DOI: 10.9778/cmajo.20210131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. METHODS This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health-related hospitalization data. RESULTS We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol- and substance use-related presentations, mental health hospitalizations and instances of leaving hospital against medical advice. INTERPRETATION Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Elle Yuequiao Wang
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Margaret J McGregor
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Michael J Schull
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kathryn Dong
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Brian R Holroyd
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Corinne M Hohl
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Johanna Trimble
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kimberlyn M McGrail
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
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22
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Ahrari M, Ali S, Hartling L, Dong K, Drendel AL, Klassen TP, Schreiner K, Dyson MP. Nonmedical Opioid Use After Short-term Therapeutic Exposure in Children: A Systematic Review. Pediatrics 2021; 148:183452. [PMID: 34816280 DOI: 10.1542/peds.2021-051927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear. OBJECTIVE To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors. DATA SOURCES We searched 11 electronic databases. STUDY SELECTION Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse. DATA EXTRACTION Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively. RESULTS We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear. LIMITATIONS Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve. CONCLUSIONS Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.
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Affiliation(s)
| | - Samina Ali
- Departments of Pediatrics.,Emergency Medicine.,Women and Children's Health Research Institute
| | | | | | - Amy L Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Terry P Klassen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kurt Schreiner
- Pediatric Parents' Advisory Group, University of Alberta, Edmonton, Alberta, Canada
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Dong K, Chen V, Shannon C, Tebbutt S, Ng R, Quon B. 533: Whole-blood transcriptome biomarkers of pulmonary exacerbations in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01957-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dong K, Huh S, Lam G, Jang J, Franciosi A, Wilcox P, Quon B. 154: Characterizing pulmonary exacerbation inflammatory phenotypes in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gill E, Dong K, Zuniga J, Quon B. 546: Correlation between systemic inflammatory biomarkers and the CFRSD-CRISS tool in people with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stafa K, Dong K, Layman D, Corallo K, Trivero J, Eagle W, Goyarts E, Pernodet N. LB721 miR-146a, circadian rhythm and impact on collagen. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Galarneau LR, Hilburt J, O’Neill ZR, Buxton JA, Scheuermeyer FX, Dong K, Kaczorowski J, Orkin AM, Barbic SP, Bath M, Moe J, Miles I, Tobin D, Grier S, Garrod E, Kestler A. Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0255396. [PMID: 34324589 PMCID: PMC8320992 DOI: 10.1371/journal.pone.0255396] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
AIM To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. DESIGN We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. SETTING We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. PARTICIPANTS Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. MEASUREMENTS We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants' knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. RESULTS One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. CONCLUSION COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.
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Affiliation(s)
- Lexis R. Galarneau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (LG); (AK)
| | - Jesse Hilburt
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Zoe R. O’Neill
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Jane A. Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, and Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Aaron M. Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Skye Pamela Barbic
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Misty Bath
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jessica Moe
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columba, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Tobin
- Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
| | - Sherry Grier
- Portland Hotel Society Community Services Society, Vancouver, British Columbia, Canada
| | - Emma Garrod
- Providence Health Care, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- * E-mail: (LG); (AK)
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Kestler A, Kaczorowski J, Dong K, Orkin AM, Daoust R, Moe J, Van Pelt K, Andolfatto G, Klaiman M, Yan J, Koh JJ, Crowder K, Webster D, Atkinson P, Savage D, Stempien J, Besserer F, Wale J, Lam A, Scheueremeyer F. A cross-sectional survey on buprenorphine-naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey. CMAJ Open 2021; 9:E864-E873. [PMID: 34548331 PMCID: PMC8476213 DOI: 10.9778/cmajo.20200190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Buprenorphine-naloxone (BUP) initiation in emergency departments improves follow-up and survival among patients with opioid use disorder. We aimed to assess self-reported BUP-related practices and attitudes among emergency physicians. METHODS We designed a cross-sectional physician survey by adapting a validated questionnaire on opioid harm reduction practices, attitudes and barriers. We recruited physician leads from 6 Canadian provinces to administer surveys to the staff physicians in their emergency department groups between December 2018 and November 2019. We included academic and community non-locum emergency department staff physicians. We excluded responses from emergency department groups with response rates less than 50% to minimize nonresponse bias. Primary (BUP prescribing practices) and secondary (willingness and attitudes) outcomes were analyzed using descriptive statistics. RESULTS After excluding 1 group for low response (9/26 physicians), 652 of 798 (81.7%) physicians responded from 22 groups serving 34 emergency departments. Among respondents, 64.1% (95% confidence interval [CI] 60.4%-67.8%, emergency department group range 7.1%-100.0%) had prescribed BUP at least once in their career, 38.4% had prescribed it for home initiation and 24.8% prescribed it at least once a month. Overall, 68.9% (95% CI 65.3%-72.4%, emergency department group range 24.1%-97.6%) were willing to administer BUP, 64.2% felt it was a major responsibility and 37.1% felt they understood people who use drugs. Respondents most frequently rated lack of adequate training (58.2%) and lack of time (55.2%) as very important barriers to BUP initiation. INTERPRETATION Two-thirds of the emergency physicians surveyed prescribed BUP, although only one-quarter did so regularly and one-third prescribed it for home initiation; wide variation between emergency department groups existed. Strategies to increase BUP initiation must address physicians' lack of time and training for BUP initiation and improve their understanding of people who use drugs.
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Affiliation(s)
- Andrew Kestler
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que.
| | - Janusz Kaczorowski
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kathryn Dong
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Aaron M Orkin
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Raoul Daoust
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Jessica Moe
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kelsey Van Pelt
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Gary Andolfatto
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Michelle Klaiman
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Justin Yan
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Justin J Koh
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kathryn Crowder
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Devon Webster
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Paul Atkinson
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - David Savage
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - James Stempien
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Floyd Besserer
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Jason Wale
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Alice Lam
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Frank Scheueremeyer
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
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Li L, Xu MZ, Wang L, Jiang J, Dong LH, Chen F, Dong K, Song HF. Conjugating MMAE to a novel anti-HER2 antibody for selective targeted delivery. Eur Rev Med Pharmacol Sci 2021; 24:12929-12937. [PMID: 33378043 DOI: 10.26355/eurrev_202012_24196] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the target delivery properties of RC48-ADC, a novel antibody drug conjugate (ADC) comprising cytotoxic monomethyl auristatin E (MMAE) and an anti-human epidermal growth factor receptor 2 (HER2) antibody tethered via valine-citrulline linker, in vitro and in vivo. MATERIALS AND METHODS Dissociation rate of MMAE from RC48-ADC was used as an estimate of its stability in serum. Cytotoxicity of the antibody and RC48-ADC towards multiple cell lines was measured. Subcellular distribution of the drug was determined by fluorescence imaging. The mechanism of lysosome targeting was verified. Endocytic pathways of RC48-ADC were assessed by the cellular fluorescence intensity of fluorescently-labelled drugs. Intracellular and extracellular distribution of MMAE was analysed after RC48-ADC or MMAE administration to characterize MMAE release. The serum and tumour concentration of MMAE was compared after tail-vein injection of RC48-ADC into tumour-bearing mice. RESULTS RC48-ADC was highly stable in human serum. HER2-overexpressed cell line SK-BR-3 proliferation was stronger when suppressed by RC48-ADC than by the naked antibody. Both RC48-ADC and naked antibody were internalized via caveolae-mediated and clathrin-mediated endocytosis and concentrated in lysosomes. Higher HER2 expression was associated with enhanced uptake and intracellular release of conjugated MMAE; free MMAE could kill tumour cells via the bystander effect. Although serum RC48-ADC concentration was higher than that in tumours, exposure of MMAE in tumours was ~200 times higher than in serum, which rationalized the reduced toxicity of RC48-ADC. CONCLUSIONS In vitro and in vivo experiments confirmed the targeted transport and release of RC48-ADC; it could selectively deliver MMAE to the targeted HER2-positive cell or tumour tissue, which could reduce off-target toxicity and enhance anti-tumour potency in humans.
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Affiliation(s)
- L Li
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China.
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Kosteniuk B, Salvalaggio G, McNeil R, Brooks HL, Dong K, Twan S, Brouwer J, Hyshka E. "You don't have to squirrel away in a staircase": Patient motivations for attending a novel supervised drug consumption service in acute care. Int J Drug Policy 2021; 96:103275. [PMID: 34020865 DOI: 10.1016/j.drugpo.2021.103275] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute care hospitals have been described as a high risk environment for people who use drugs (PWUD). Formal and informal bans on drug use can lead patients to conceal their use and consume under unsafe circumstances. Provision of hospital-based supervised consumption services (SCS) could help reduce drug-related harms and improve patient care. However, no peer-reviewed research documents patient experiences with attending SCS in this setting. To address this gap, the present study examines key factors that shape patients' decisions to attend or not attend a novel SCS embedded within a large, urban acute care hospital in Western Canada. METHODS We adopted a focused ethnographic design and conducted 28 semi-structured interviews with SCS-eligible patients. We examined participant accounts thematically, and Rhodes' "Risk Environment" framework helped guide our analysis. RESULTS Most participants perceived the SCS as a safer environment that made it possible to reduce drug-related risks and avoid using in unsafe areas of the hospital where they could be caught by staff, security, or police. However, some participants did not trust that the SCS would provide adequate protection from criminalization, which motivated them to avoid the site. Several participants also worried about the potential for unwanted changes to their patient care following SCS use. Physical site and policy limitations, such as eligibility requirements and a lack of infrastructure to support supervised inhalation, were additional reasons for not attending the SCS. CONCLUSION PWUD in this study attended the hospital-based SCS in an attempt to reduce risks associated with their hospital stay. However, we note a number of access barriers that should be addressed to ensure optimal uptake. Wider provision of SCS in acute care requires both changes to the hospital environment and broader drug policy reform.
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Affiliation(s)
- Brynn Kosteniuk
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AL, T6G 1C9, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada; Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112St. NW, Edmonton, AL, T6G 2R7, Canada
| | - Ryan McNeil
- School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Hannah L Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AL, T6G 1C9, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada
| | - Kathryn Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada; Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112St. NW, Edmonton, AL, T6G 2R7, Canada
| | - Shanell Twan
- Streetworks, 10116-105 Ave, Edmonton, AL, T5H 0K2, Canada
| | - Jennifer Brouwer
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AL, T6G 1C9, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada.
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Li Miao, Qian S, Qi S, Jiang W, Dong K. Culture Medium Optimization and Active Compounds Investigation of an Anti-Quorum Sensing Marine Actinobacterium Nocardiopsis dassonvillei JS106. Microbiology (Reading) 2021. [DOI: 10.1134/s0026261721010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Gupta S, Xie E, Dong K. Treating homelessness as an emergency: learning from the COVID-19 response. CAN J EMERG MED 2021; 23:8-9. [PMID: 33683622 PMCID: PMC7829655 DOI: 10.1007/s43678-020-00051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sahil Gupta
- Department of Emergency Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.
| | - Edward Xie
- Division of Emergency Medicine, University Health Network, Toronto, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
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Yarema MC, Johnson DW, Sivilotti MLA, Nettel-Aguirre A, DeWitt C, Gosselin S, Murphy N, Victorino C, Bailey B, Dong K, Haney E, Purssell R, Thompson M, Lord JA, Spyker DA, Rumack BH. Predicting mortality from acetaminophen poisoning shortly after hospital presentation. Br J Clin Pharmacol 2021; 87:3332-3343. [PMID: 33507553 DOI: 10.1111/bcp.14755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
AIMS Early identification of patients likely to die after acetaminophen (APAP) poisoning remains challenging. We sought to compare the sensitivity and time to fulfilment (latency) of established prognostic criteria. METHODS Three physician toxicologists independently classified every in-hospital death associated with APAP overdose from eight large Canadian cities over three decades using the Relative Contribution to Fatality scale from the American Association of Poison Control Centres. The sensitivity and latency were calculated for each of the following criteria: King's College Hospital (KCH), Model for End Stage Liver Disease (MELD) ≥33, lactate ≥3.5 mmol/L, phosphate ≥1.2 mmol/L 48+ hours post-ingestion, as well as combinations thereof. RESULTS A total of 162 in-hospital deaths were classified with respect to APAP as follows: 26 Undoubtedly, 40 Probably, 27 Contributory, 14 Probably not, 25 Clearly not, and 30 Unknown. Cases from the first three classes (combined into n = 93 "APAP deaths") typically presented with supratherapeutic APAP concentrations, hepatotoxicity, acidaemia, coagulopathy and/or encephalopathy, and began antidotal treatment a median of 12 hours (IQR 3.4-30 h) from the end of ingestion. Among all patients deemed "APAP deaths", meeting either KCH or lactate criteria demonstrated the highest sensitivity (94%; 95% CI 86-98%), and the shortest latency from hospital arrival to criterion fulfilment (median 4.2 h; IQR 1.0-16 h). In comparison, the MELD criterion demonstrated a substantially lower sensitivity (55%; 43-66%) and longer latency (52 h; 4.4-∞ h, where "∞" denotes death prior to criterion becoming positive). CONCLUSIONS Meeting either KCH or serum lactate criteria identifies most patients who die from acetaminophen poisoning at or shortly after hospital presentation.
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Affiliation(s)
- Mark C Yarema
- Poison and Drug Information Service, Alberta Health Services, Calgary, Alberta.,Section of Clinical Pharmacology and Toxicology, Alberta Health Services, Calgary, Alberta.,Department of Emergency Medicine, University of Calgary, Calgary, Alberta.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta.,Department of Critical Care Medicine, University of Calgary, Calgary, Alberta
| | - David W Johnson
- Poison and Drug Information Service, Alberta Health Services, Calgary, Alberta.,Section of Clinical Pharmacology and Toxicology, Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, University of Calgary, Calgary, Alberta.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta
| | - Marco L A Sivilotti
- Departments of Emergency Medicine, and of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario.,Ontario Poison Centre, Toronto, Ontario
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, University of Calgary, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute for Child & Maternal Health, Calgary, Alberta
| | - Chris DeWitt
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia.,British Columbia Drug and Poison Information Centre, Vancouver, British Columbia
| | - Sophie Gosselin
- Department of Emergency Medicine, Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park, Québec.,Departments of Medicine and Emergency Medicine, McGill University Health Centre, Montréal, Quebec.,Centre Antipoison du Québec, Québec City, Québec
| | - Nancy Murphy
- Centre Antipoison du Québec, Québec City, Québec.,IWK Poison Centre and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia
| | | | - Benoit Bailey
- Department of Pediatric Emergency Medicine, CHU Sainte Justine, Montréal, Quebec
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta
| | - Elizabeth Haney
- Division of Emergency Medicine, Western University, London, Ontario
| | - Roy Purssell
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia.,British Columbia Drug and Poison Information Centre, Vancouver, British Columbia
| | - Margaret Thompson
- Ontario Poison Centre, Toronto, Ontario.,Division of Emergency Medicine and Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Jason A Lord
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta
| | - Daniel A Spyker
- Department of Emergency Medicine, Oregon Health Sciences University, Portland, Oregon
| | - Barry H Rumack
- Departments of Emergency Medicine and Pediatrics, University of Colorado School of Medicine, Denver, Colorado
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Wan PQ, Zhang JH, Du Q, Dong K, Luo J, Heres C, Geller DA. Analysis of the relationship between microRNA-31 and interferon regulatory factor-1 in hepatocellular carcinoma cells. Eur Rev Med Pharmacol Sci 2021; 24:647-654. [PMID: 32016965 DOI: 10.26355/eurrev_202001_20041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE MicroRNAs (miRNAs) play a role in the pathogenesis of hepatocellular carcinoma (HCC). This study was designed to elucidate the role of microRNA-31 (miR-31) in HCC. MATERIALS AND METHODS HuH7 cell lines were transfected with miR-31 mimic or miR-31 inhibitor to investigate the role of miR-31 in regulating interferon regulatory factor-1 (IRF-1). The mRNA and protein expression levels of IRF-1 were quantitatively detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot, respectively. Subsequently, Dual-Luciferase reporter assay was also performed. RESULTS The expression level of miR-31 was significantly up-regulated in HuH7 cells when compared with that in primary human hepatocytes (hHC). Dual-Luciferase reporter assay indicated that IRF-1 was the direct target of miR-31. The expression levels of IRF-1 were decreased in HuH7 and HepG2 cell lines. IRF-1 was negatively correlated with miR-31 in HCC tissues and paired adjacent tissues. The expression level of miR-31 was inversely correlated with IRF-1. MiR-31 inhibitor up-regulated the expression levels of IRF-1 in HuH7 cells, whereas miR-31 mimic down-regulated the expression levels of IRF-1. Furthermore, the miR-31 mimic repressed IRF-1-3'UTR reporter activity, whereas the miR-31 inhibitor enhanced IRF-1-3'UTR reporter activity depending on the concentration of miR-31 mimic and miR-31 inhibitor. CONCLUSIONS These results indicated that miR-31 can regulate the expression level of IRF-1 in HCC, which probably provided novel theoretical evidence for the application of target miR-31 treatment of HCC.
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Affiliation(s)
- P-Q Wan
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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Moe J, O'Sullivan F, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Grafstein E, Hohl CM, Trimble J, McGrail KM. Identifying subgroups and risk among frequent emergency department users in British Columbia. J Am Coll Emerg Physicians Open 2021; 2:e12346. [PMID: 33532752 PMCID: PMC7823092 DOI: 10.1002/emp2.12346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/01/2020] [Accepted: 12/11/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were the top 10% of patients by ED visits. We employed cluster analysis to identify frequent user subgroups. We assessed 365-day mortality using Kaplan-Meier curves and conducted Cox regressions to assess mortality risk factors within subgroups. Results: We identified 4 subgroups. Subgroup 1 ("Elderly") had median age 77 years (interquartile range [IQR]: 66-85), 5 visits/year (IQR: 4-6), median 8 prescription medications (IQR: 5-11), and 24.7% mortality. Subgroup 2 ("Mental Health and Alcohol Use") had median age 48 years (IQR: 34-61), 13 visits/year (IQR: 10-16), and 12.3% mortality. They made a median 31 general practitioner visits (IQR: 19-51); however, only 23.7% received a majority of services from 1 primary care physician. Subgroup 3 ("Young Mental Health") had median age 39 years (IQR: 28-51), 5 visits/year (IQR: 4-6), and 2.2% mortality. Subgroup 4 ("Short-term") had median age 50 years (IQR: 34-65), 4 visits/year (IQR: 4-5) regularly spaced over a short term, and 1.4% mortality. Male sex (all subgroups), long-term care ("Mental Health and Alcohol Use;" "Young Mental Health"), and rural residence ("Elderly" in long-term care; "Young Mental Health") were associated with increased mortality. Conclusions: Our results identify frequent user subgroups with varying mortality. Future research should explore subgroups' unmet needs and tailor interventions toward them.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British ColumbiaDepartment of Emergency Medicine, Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Fiona O'Sullivan
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Margaret J. McGregor
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michael J. Schull
- Institute for Clinical Evaluative SciencesDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Kathryn Dong
- Department of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Brian R. Holroyd
- Department of Emergency MedicineEmergency Strategic Clinical Networ, Alberta Health ServicesUniversity of AlbertaEdmontonAlbertaCanada
| | - Eric Grafstein
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Corinne M. Hohl
- Department of Emergency Medicine, University of British ColumbiaDepartment of Emergency Medicine, Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Johanna Trimble
- Patients for Patient Safety CanadaRoberts CreekVancouverBritish ColumbiaCanada
| | - Kimberlyn M. McGrail
- Population Data BCSchool of Population and Public Health, University of British ColumbiaVancouverBritish ColumbiaCanada
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Deschamps J, Gilbertson J, Straube S, Dong K, MacMaster FP, Korownyk C, Montgomery L, Mahaffey R, Downar J, Clarke H, Muscedere J, Rittenbach K, Featherstone R, Sebastianski M, Vandermeer B, Lynam D, Magnussen R, Bagshaw SM, Rewa OG. Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis. BMC Emerg Med 2021; 21:17. [PMID: 33514325 PMCID: PMC7845034 DOI: 10.1186/s12873-020-00398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact. METHODS We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy. RESULTS A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the "supports for patients in pain" supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I2 = 78%). CONCLUSION For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is "supports for patients in pain".
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Affiliation(s)
- Jean Deschamps
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada.
| | - James Gilbertson
- School of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 - 112 St NW, Edmonton, Alberta, T6G 2T4, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Strategic Clinical Network for Addictions and Mental Health 2888 Shaganappi Trail NW Calgary, Calgary, Alberta, T3B 6A8, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 112 St NW, Edmonton, Alberta, T6G 2C8, Canada
| | - Lori Montgomery
- Department of Family Medicine, Calgary Chronic Pain Center 1820 Richmond Road SW Calgary, Calgary, Alberta, T2T 5C7, Canada
| | - Ryan Mahaffey
- Department of Anesthesia, University of Ottawa, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada
- Transitional Pain Program, Toronto General Hospital, University Health Network, Ottawa, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Katherine Rittenbach
- Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Meghan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, 362-B Heritage Medical Research Centre (HMRC), Edmonton, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Alberta SPOR SUPPORT Unit KT Platform, 4-486D Edmonton Clinical Health Academy, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Deborah Lynam
- Primary Health Care Information Network, Edmonton, Alberta, Canada
| | - Ryan Magnussen
- Critical Care Strategic Clinical Network, Foothills Medical Centre, ICU Administration - Ground Floor, McCaig Tower, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta, T6G 2B7, Canada
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Moe J, O'Sullivan F, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Grafstein E, Hohl CM, Trimble J, McGrail KM. Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis. CMAJ Open 2021; 9:E134-E141. [PMID: 33653768 PMCID: PMC8034376 DOI: 10.9778/cmajo.20200168] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada. METHODS We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergency department visit from 2012/13 to 2015/16, linked to hospital, physician billing, prescription and mortality data. We used annual emergency department visits made by the top 10% of patients to define frequent users (≥ 3 visits/year). RESULTS Over the study period, 13.8%-15.3% of patients seen in emergency departments were frequent users. We identified 205 136 frequent users among 1 196 353 emergency department visitors. Frequent users made 40.3% of total visits in 2015/16. From 2012/13 to 2015/16, their visit rates per 100 000 BC population showed a relative increase of 21.8%, versus 13.1% among all emergency department patients. Only 1.8% were frequent users in all study years. Mental illness accounted for 8.2% of visits among those less than 60 years of age, and circulatory or respiratory diagnoses for 13.3% of visits among those aged 60 or more. In 2015/16, frequent users were older and had lower household incomes than nonfrequent users; the sex distribution was similar. Frequent users had more prescriptions (median 9, interquartile range [IQR] 5-14 v. 1, IQR 1-3), primary care visits (median 15, IQR 9-27 v. 7, IQR 4-12) and hospital admissions (median 2, IQR 1-3 v. 1, IQR 1-1), and higher 1-year mortality (10.2% v. 3.5%) than nonfrequent users. INTERPRETATION Emergency department use by frequent users increased in BC between 2012/13 and 2015/16; these patients were heterogenous, had high mortality and rarely remained frequent users over multiple years. Our results suggest that interventions must account for heterogeneity and address triggers of frequent use episodes.
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Affiliation(s)
- Jessica Moe
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Fiona O'Sullivan
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Margaret J McGregor
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Michael J Schull
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Kathryn Dong
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Brian R Holroyd
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Eric Grafstein
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Corinne M Hohl
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Johanna Trimble
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
| | - Kimberlyn M McGrail
- Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
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Guo Y, Lv J, Zhao Q, Dong Y, Dong K. Cinnamic Acid Increased the Incidence of Fusarium Wilt by Increasing the Pathogenicity of Fusarium oxysporum and Reducing the Physiological and Biochemical Resistance of Faba Bean, Which Was Alleviated by Intercropping With Wheat. Front Plant Sci 2020; 11:608389. [PMID: 33381139 PMCID: PMC7767866 DOI: 10.3389/fpls.2020.608389] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/12/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Continuous cropping has resulted in the accumulation of self-toxic substances in faba beans which has restricted their global production. Intercropping is widely used to alleviate these problems. AIMS To explore the role of cinnamic acid stress in faba bean physiology and disease resistance, and the potential mitigating effects of intercropping the faba bean with wheat. METHODS Faba bean seedlings were grown with or without wheat in both field and hydroponic conditions in the presence of different cinnamic acid concentrations and Fusarium oxysporum (FOF), the occurrence of. Fusarium-mediated wilt and oxidative stress, as well as plant growth indices and the anti-pathogen defense system were analyzed. RESULTS Cinnamic acid significantly increased Fusarium pathogenicity, inhibited the activity of defense enzymes and reduced the ability of plants to resist pathogens, indicating the importance of cinnamic acid in the promotion of Fusarium wilt resulting in reduced seedling growth. Intercropping with wheat improved plant resistance by alleviating cinnamic acid-induced stress, which promoted crop growth and decreased the incidence and disease index of Fusarium wilt. CONCLUSION Cinnamic acid promotes Fusarium wilt by stimulating pathogen enzyme production and destroying the defense capability of faba bean roots. Intercropping reduces Fusarium wilt by alleviating the damage caused by cinnamic acid to the defense system of the faba bean root system.
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Affiliation(s)
- Yuting Guo
- College of Resources and Environment, Yunnan Agricultural University, Kunming, China
| | - J. Lv
- College of Resources and Environment, Yunnan Agricultural University, Kunming, China
| | - Q. Zhao
- College of Resources and Environment, Yunnan Agricultural University, Kunming, China
| | - Yan Dong
- College of Resources and Environment, Yunnan Agricultural University, Kunming, China
| | - K. Dong
- College of Animal Science and Technology, Yunnan Agricultural University, Kunming, China
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Kaczorowski J, Bilodeau J, Orkin A, Dong K, Daoust R, Kestler A. Emergency Department-initiated Interventions for Patients With Opioid Use Disorder: A Systematic Review. Acad Emerg Med 2020; 27:1173-1182. [PMID: 32557932 DOI: 10.1111/acem.14054] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The opioid crisis has risen dramatically in North America in the new millennium, due to both illegal and prescription opioid use. While emergency departments (EDs) represent a potentially strategic setting for interventions to reduce harm from opioid use disorder (OUD), the absence of a recent synthesis of literature limits implementation and scalability. To fill this gap, we conducted a systematic review of the literature on interventions targeting OUDs initiated in EDs. METHODS Using an explicit search strategy (PROSPERO), the MEDLINE, CINAHL Complete, EMBASE, and EBM reviews databases were searched from 1980 to October 4, 2019. The gray literature was explored using Google Scholar. Study characteristics were abstracted independently. The methodologic quality and risk of bias were assessed. RESULTS Twelve of 2,270 studies met the inclusion criteria (two of high quality). In addition to the heterogeneity of the outcome measures used (retention in treatment, opioid consumption, and overdose), brief intervention and buprenorphine initiation (six of 12 studies) were the most documented with mixed effects for the former and positive short-term and confined to single ED sites effects for the latter. CONCLUSION Emergency departments can be an appropriate setting for initiating opioid agonist treatment, but to be sustained, it likely needs to be coupled with community-based follow-up and support to ensure longer-term retention. The scarcity of high-quality evidence on OUD interventions initiated in emergency settings highlights the need for future research.
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Affiliation(s)
- Janusz Kaczorowski
- From the Département de Médecine de Famille et Médecine d'Urgence Université de Montréal Montréal Québec Canada
- the Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM) Université de Montréal Montréal Québec Canada
| | - Jaunathan Bilodeau
- the Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM) Université de Montréal Montréal Québec Canada
| | - Aaron Orkin
- the Department of Family & Community Medicine University of Toronto Toronto Ontario Canada
| | - Kathryn Dong
- the Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Raoul Daoust
- From the Département de Médecine de Famille et Médecine d'Urgence Université de Montréal Montréal Québec Canada
- the Centre de recherche de l’Hôpital Sacré‐Coeur de Montréal Montréal Québec Canada
| | - Andrew Kestler
- and the Department of Emergency Medicine University of British Columbia Vancouver British Columbia Canada
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Dong K, Xu G, Lei M, Zhao S, Yao M. 995P CTNNB1 mutations in Chinese HCC patients and immune microenvironment related analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dong K, Layman D, Pernodet N. 682 A systems biology approach for skin brightening, including autophagy as a critical mechanism to control pigmentation. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Trivero J, Dong K, Goyarts E, Pelle E, Collins D, Corallo K, Pernodet N. 235 The importance of sirtuins in skin and new findings about sirt2 and its link to mechanobiology. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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43
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Pernodet N, Stafa K, Dong K, Layman D, Corallo K, Trivero J, Eagle W, Goyarts E. 178 miR-146a and its importance in skin cell aging. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dong K, Goyarts EC, Pelle E, Trivero J, Pernodet N. Blue light disrupts the circadian rhythm and create damage in skin cells. Int J Cosmet Sci 2020; 41:558-562. [PMID: 31418890 DOI: 10.1111/ics.12572] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/12/2019] [Indexed: 12/22/2022]
Abstract
On a daily basis, the skin is exposed to many environmental stressors and insults. Over a 24-h natural cycle, during the day, the skin is focused on protection; while at night, the skin is focused on repairing damage that occurred during daytime and getting ready for the next morning. Circadian rhythm provides the precise timing mechanism for engaging those different pathways necessary to keep a healthy skin through clock genes that are present in all skin cells. The strongest clue for determining cellular functions timing is through sensing light or absence of light (darkness). Here, we asked the question if blue light could be a direct entrainment signal to skin cells and also disrupt their circadian rhythm at night. Through a reporter assay for per1 transcription, we demonstrate that blue light at 410 nm decreases per1 transcription in keratinocytes, showing that epidermal skin cells can sense light directly and control their own clock gene expression. This triggers cells to "think" it is daytime even at nighttime. Elsewhere, we measured different skin cell damage because of blue light exposure (at different doses and times of exposure) vs. cells that were kept in full darkness. We show an increase in ROS production, DNA damage and inflammatory mediators. These deleterious effects can potentially increase overall skin damage over time and ultimately accelerates ageing.
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Affiliation(s)
- K Dong
- Estee Lauder Research Laboratories, 125 Pinelawn Road, Melville, NY, 11747, USA
| | - E C Goyarts
- Estee Lauder Research Laboratories, 125 Pinelawn Road, Melville, NY, 11747, USA
| | - E Pelle
- Estee Lauder Research Laboratories, 125 Pinelawn Road, Melville, NY, 11747, USA.,Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York,, NY, 10010, USA
| | - J Trivero
- Estee Lauder Research Laboratories, 125 Pinelawn Road, Melville, NY, 11747, USA
| | - N Pernodet
- Estee Lauder Research Laboratories, 125 Pinelawn Road, Melville, NY, 11747, USA.,Materials Science & Engineering, Stony Brook University, 100 Nicolls Road, Stony Brook,, NY, 11794, USA
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Fowler M, Ali S, Gouin S, Drendel AL, Poonai N, Yaskina M, Sivakumar M, Jun E, Dong K. Knowledge, attitudes and practices of Canadian pediatric emergency physicians regarding short-term opioid use: a descriptive, cross-sectional survey. CMAJ Open 2020; 8:E148-E155. [PMID: 32184278 PMCID: PMC7082107 DOI: 10.9778/cmajo.20190101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the midst of the current opioid crisis, physicians are caught between balancing children's optimal pain management and the risks of opioid therapy. This study describes pediatric emergency physicians' practice patterns for prescribing, knowledge and attitudes regarding, and perceived barriers to and facilitators of short-term use of opioids. METHODS We created a survey tool using published methodology guidelines and distributed it from October to December 2017 to all physicians in the Pediatric Emergency Research Canada database using Dillman's tailored design method for mixed-mode surveys. We performed bivariable binomial logistic regressions to ascertain the effects of clinically significant variables (e.g., training, age, sex, degree of worry regarding severe adverse events) on use of opioids as a first-line treatment for moderate pain in the emergency department, and prescription of opioids for moderate or severe pain for at-home use in children. RESULTS Of the 224 physicians in the database, 136 (60.7%) completed the survey (60/111 [54.1%] women; median age 44 yr). Of the 136, 74 (54.4%) had subspecialty training. Intranasally administered fentanyl was the most commonly selected opioid for first-line treatment of moderate (47 respondents [34.6%]) and severe (82 [60.3%]) pain due to musculoskeletal injury. On a scale of 0 (not worried) to 100 (extremely worried), physicians' median score for worry regarding physical dependence was 6.0 (25th percentile 0.0, 75th percentile 16.0), for worry regarding addiction 10.0 (25th percentile 2.0, 75th percentile 20.0) and for worry regarding diversion of opioids 24.5 (25th percentile 14.0, 75th percentile 52.0). On a scale of 0 (not at all) to 100 (extremely), the median score for influence of the opioid crisis on willingness to prescribe opioids was 22.0 (25th percentile 8.0, 75th percentile 49.0). The top 3 reported barriers to prescribing opioids were parental reluctance (57 [41.9%]), lack of clear guidelines for pediatric opioid use (35 [25.7%]) and concern about adverse effects (33 [24.3%]). Binomial logistic regression did not identify any statistically significant variables affecting use of opioids in the emergency department or prescribed for use at home. INTERPRETATION Emergency department physicians appeared minimally concerned about physical dependence, addiction risk and the current opioid crisis when prescribing opioids to children. Evidence-based development of guidelines and protocols for use of opioids in children may improve physicians' ability to manage pain in children responsibly and adequately.
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Affiliation(s)
- Megan Fowler
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Samina Ali
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.
| | - Serge Gouin
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Amy L Drendel
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Naveen Poonai
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Maryna Yaskina
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Mithra Sivakumar
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Esther Jun
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
| | - Kathryn Dong
- Department of Pediatrics (Fowler, Ali, Sivakumar, Jun) and Women and Children's Health Research Institute (Ali, Yaskina), University of Alberta, Edmonton, Alta.; Department of Pediatric Emergency Medicine (Gouin), Centre hospitalier universitaire Sainte-Justine, Montréal, Que.; Section of Emergency Medicine (Drendel), Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisc.; Division of Emergency Medicine (Poonai), London Health Sciences Centre, Western University, London, Ont.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta
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Jun E, Ali S, Yaskina M, Dong K, Rajagopal M, Drendel AL, Fowler M, Poonai N. A two-centre survey of caregiver perspectives on opioid use for children's acute pain management. Paediatr Child Health 2019; 26:19-26. [PMID: 33542771 DOI: 10.1093/pch/pxz162] [Citation(s) in RCA: 4] [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: 04/10/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.
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Affiliation(s)
- Esther Jun
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Kathryn Dong
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta
| | - Manasi Rajagopal
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Amy L Drendel
- Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Megan Fowler
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Naveen Poonai
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario
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Hyshka E, Morris H, Anderson-Baron J, Nixon L, Dong K, Salvalaggio G. Patient perspectives on a harm reduction-oriented addiction medicine consultation team implemented in a large acute care hospital. Drug Alcohol Depend 2019; 204:107523. [PMID: 31541875 DOI: 10.1016/j.drugalcdep.2019.06.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Addiction medicine consultation teams [AMCTs] are a promising strategy for improving hospital care for patients with substance use disorders. Yet very little research has examined AMCT implementation in acute care settings. To address this gap, we conducted a process evaluation of a novel harm reduction-oriented AMCT. Our specific aims included examining patients' perspectives on factors that facilitated or hindered AMCT delivery, and its impact on their hospital care and outcomes. METHODS The AMCT provided integrated addiction medicine, harm reduction services, and wraparound health and social supports for patients of a large, urban acute care hospital in Western Canada. We adopted a focused ethnographic design and recruited 21 patients into semi-structured interviews eliciting their views on the care they received from the team. RESULTS Participants highlighted the AMCT's harm reduction approach; reputation amongst peers; and specialized training as especially important intervention facilitators. Key barriers that constrained the impact of the team included unmet expectations; difficulty accessing follow-up care; and residual conflicts between the AMCT's harm reduction approach and the abstinence-only orientation of some hospital staff. For a few participants these conflicts led to negative experiences. Despite this, participants reported that the AMCT had positive impacts overall, including declines in substance use, enhanced mental and emotional wellbeing, and improved socio-economic circumstances. CONCLUSIONS A novel harm reduction-oriented AMCT led to better hospital experiences and perceived outcomes for patients. However, further efforts are needed to ensure adequate post-discharge follow-up, and a consistent approach to substance use disorder care amongst all hospital staff.
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Affiliation(s)
- Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6C 1C9, Canada.
| | - Heather Morris
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6C 1C9, Canada
| | - Jalene Anderson-Baron
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6C 1C9, Canada
| | - Lara Nixon
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Kathryn Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B804 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, Alberta T5H 3V9, Canada
| | - Ginetta Salvalaggio
- Department of Family Medicine, University of Alberta, 610 University Terrace, University of Alberta, Edmonton, Alberta T6G 2T4, Canada
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O'Brien DC, Dabbs D, Dong K, Veugelers PJ, Hyshka E. Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review. BMC Health Serv Res 2019; 19:632. [PMID: 31488142 PMCID: PMC6727417 DOI: 10.1186/s12913-019-4469-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overdose deaths can be prevented by distributing take home naloxone (THN) kits. The emergency department (ED) is an opportune setting for overdose prevention, as people who use opioids frequently present for emergency care, and those who have overdosed are at high risk for future overdose death. We evaluated the implementation of an ED-based THN program by measuring the extent to which THN was offered to patients presenting with opioid overdose. We analyzed whether some patients were less likely to be offered THN than others, to identify areas for program improvement. METHODS We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN. RESULTS Among the 342 ED visits for opioid overdose, THN was offered in 49% (n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97). CONCLUSIONS In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.
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Affiliation(s)
- Daniel C O'Brien
- University of Alberta, School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Daniel Dabbs
- University of Alberta, Faculty of Medicine and Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Kathryn Dong
- University of Alberta, Faculty of Medicine and Dentistry, 790 University Terrace Building, 8303 112 St. NW, Edmonton, Alberta, T6G 2T4, Canada
| | - Paul J Veugelers
- University of Alberta, School of Public Health, 33-50 University Terrace, 8303 - 112 Ave, Edmonton, Alberta, T6G 2T4, Canada
| | - Elaine Hyshka
- University of Alberta, School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
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Adedokun S, Dong K, Harmon D. Evaluating the effects of adaptation length, dietary electrolyte balance, and energy source on ileal endogenous amino acid losses in pigs fed nitrogen-free diets. Can J Anim Sci 2019. [DOI: 10.1139/cjas-2018-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S.A. Adedokun
- Department of Animal and Food Sciences, University of Kentucky, Lexington, KY 40546, USA
- Department of Animal and Food Sciences, University of Kentucky, Lexington, KY 40546, USA
| | - K. Dong
- Department of Animal and Food Sciences, University of Kentucky, Lexington, KY 40546, USA
- Department of Animal and Food Sciences, University of Kentucky, Lexington, KY 40546, USA
| | - D.L. Harmon
- Department of Animal and Food Sciences, University of Kentucky, Lexington, KY 40546, USA
- Department of Animal and Food Sciences, University of Kentucky, Lexington, KY 40546, USA
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Baiyegunhi O, Mann J, Nkosi T, Pansegrou J, Dong K, Ndungu T, Walker B, Ndhlovu Z. High HIV viral burden persists in CXCR3+TFH despite very early cART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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