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Ramdin C, Tu J, Nelson L. The impact of COVID-19 on analgesic prescribing in an urban emergency department. J Addict Dis 2024; 42:83-90. [PMID: 36374305 DOI: 10.1080/10550887.2022.2141046] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Providers across the country have significantly decreased opioid prescribing over the past decade to prevent opioid misuse. The COVID-19 pandemic led to a disruption of the healthcare system and changes in the relationships between patients and providers. Consequently, we sought to investigate whether the pandemic had any impact on analgesic prescribing in an urban emergency department. METHODS This was a retrospective, single center study analyzing pharmacy records of patients that were treated with analgesics between January 2019 and May 2021. The most common analgesics utilized were tallied by month. Utilization of specific analgesics were compared between T1-pre-COVID-19 (1/2019-1/2020) and T2-post-COVID 19 (5/2020-5/2021). Analgesics were also categorized into broader categories (such as IV, oral, opioid, and non-opioid) and compared. Comparisons were analyzed using the t-test, Mann-Whitney u test, or chi-squared difference of proportions tests, as applicable. RESULTS There were significant decreases in the amount of IV (7.2% vs. 6.5; p = 0.039) and oral opioid (2.6% vs. 2.1%; p = 0.001) administered during COVID-19. There were also decreases in the percent of patients given opioids (T1: 6.7 vs. T2: 4.6, p < 0.001). During COVID, there was an increase in the amount of non-opioid analgesics given per patient (p = 0.013). Particularly, there was an increase in the amount of oral non-opioid administrations per patient (p = 0.005). There was a decrease in utilization of ibuprofen between the two time periods (p < 0.001). CONCLUSIONS Despite the pandemic, providers continued to decrease opioid prescribing and increase non-opioid prescribing.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jessica Tu
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Hawk KF, Weiner SG, Rothenberg C, Bernstein E, D'Onofrio G, Herring A, Hoppe J, Ketcham E, LaPietra A, Nelson L, Perrone J, Ranney M, Samuels EA, Strayer R, Sharma D, Goyal P, Schuur J, Venkatesh AK. Leveraging a Learning Collaborative Model to Develop and Pilot Quality Measures to Improve Opioid Prescribing in the Emergency Department. Ann Emerg Med 2024; 83:225-234. [PMID: 37831040 DOI: 10.1016/j.annemergmed.2023.08.490] [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] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023]
Abstract
The American College of Emergency Physicians (ACEP) Emergency Medicine Quality Network (E-QUAL) Opioid Initiative was launched in 2018 to advance the dissemination of evidence-based resources to promote the care of emergency department (ED) patients with opioid use disorder. This virtual platform-based national learning collaborative includes a low-burden, structured quality improvement project, data benchmarking, tailored educational content, and resources designed to support a nationwide network of EDs with limited administrative and research infrastructure. As a part of this collaboration, we convened a group of experts to identify and design a set of measures to improve opioid prescribing practices to provide safe analgesia while reducing opioid-related harms. We present those measures here, alongside initial performance data on those measures from a sample of 370 nationwide community EDs participating in the 2019 E-QUAL collaborative. Measures include proportion of opioid administration in the ED, proportion of alternatives to opioids as first-line treatment, proportion of opioid prescription, opioid pill count per prescription, and patient medication safety education among ED visits for atraumatic back pain, dental pain, or headache. The proportion of benzodiazepine and opioid coprescribing for ED visits for atraumatic back pain was also evaluated. This project developed and effectively implemented a collection of 6 potential measures to evaluate opioid analgesic prescribing across a national sample of community EDs, representing the first feasibility assessment of opioid prescribing-related measures from rural and community EDs.
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Affiliation(s)
- Kathryn F Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | | | - Craig Rothenberg
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Edward Bernstein
- Boston Medical Center Department of Emergency Medicine, Boston, MA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Andrew Herring
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, University of California, San Francisco
| | - Jason Hoppe
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver
| | - Eric Ketcham
- Presbyterian Healthcare, Espanola & Santa Fe, NM
| | - Alexis LaPietra
- Division of Emergency Medicine, RWJBarnabus Health, West Orange, NJ
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Megan Ranney
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | | | - Reuben Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Dhruv Sharma
- American College of Emergency Physicians, Dallas, TX
| | - Pawan Goyal
- American College of Emergency Physicians, Dallas, TX
| | - Jeremiah Schuur
- Department of Emergency Medicine, Brown School of Medicine, Providence, RI
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Evans R, Nelson L, Temple T. Operational data for the risk management of victim operated explosive devices in humanitarian mine action: A Practitioner's perspective. Heliyon 2024; 10:e25311. [PMID: 38327446 PMCID: PMC10847920 DOI: 10.1016/j.heliyon.2024.e25311] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Since Mine Action's inception at the end of the 1980s, operators have collected limited data on the Victim Operated Explosive Devices (VOEDs) they clear. This includes not only data on the explosive ordnance itself but data on how they were found, where they were found and how they were processed and ultimately destroyed. In a context where detection of mines, boobytraps and certain Victim Operated Improvised Explosive Devices (VOIEDs) is an ongoing humanitarian and military challenge, significantly expanded operational data collection provides an achievable way to facilitate enhanced operational risk management. Risk decisions inherent in the clearance of VOEDs are better if made on the basis of extensive operational data. In the absence of a technological solution to detect and positively discriminate VOEDs from false positive indications, the collection of operational data offers the best prospect for "managing" if not "solving" the problem.
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Affiliation(s)
- R. Evans
- Cranfield University, Centre for Defence Chemistry, Defence Academy of the United Kingdom, Shrivenham, SN6 7LA, UK
| | - L. Nelson
- Cranfield University, Centre for Defence Chemistry, Defence Academy of the United Kingdom, Shrivenham, SN6 7LA, UK
| | - T. Temple
- Cranfield University, Centre for Defence Chemistry, Defence Academy of the United Kingdom, Shrivenham, SN6 7LA, UK
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Makutonin M, Ramdin C, Meltzer A, Mazer-Amirshahi M, Nelson L. Concurrent Alcohol and Opioid Intoxication in Emergency Department Patients Leads to Greater Resource Utilization. Subst Use Misuse 2024; 59:616-621. [PMID: 38192231 DOI: 10.1080/10826084.2023.2294963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background: Concurrent alcohol intoxication can complicate emergency department (ED) presentations for opioid-related adverse events. We sought to determine if there was a difference in resource utilization among patients who presented to the ED with concurrent opioid and alcohol intoxication compared to opioid intoxication alone. Methods: Using linked state-wide databases from the Maryland Healthcare Cost and Utilization Project (HCUP), we identified patients with a diagnosis of opioid intoxication treated in the ED from 2016 to 2018. We measured healthcare utilization for each patient in the ED settings for one year after the initial ED visit and estimated direct costs. We performed logistic regression comparing patients presented with co-intoxication to those without. Results: Of 12,295 patients who presented to the ED for opioid intoxication during the study period, 703 (5.7%) had concurrent alcohol intoxication. Patients with co-intoxication had more recurrent ED visits (340 vs 247.4 per 1000 patients, p < 0.05), higher index ED visit admission rates (26.9% vs 19.4%, p < 0.001), but similar overall costs ($3736 vs $2861, p < 0.05) at one year. Co-intoxication was associated with suicidal ideation (OR = 1.58, 95% CI 1.51-1.65), high zip code income (OR = 1.16, 95% CI 1.12-1.21), and higher rates of intoxication with all classes of drugs analyzed (p < 0.001). Conclusion: Our study demonstrated that mental health disorders, socioeconomic status, and increased ED utilization are associated with co-intoxication of opioids and alcohol presenting to the ED. Further research is needed to elucidate factors responsible for the increased resource use in this population.
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Affiliation(s)
- Michael Makutonin
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Andrew Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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5
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Lucena MI, Villanueva-Paz M, Alvarez-Alvarez I, Aithal GP, Björnsson ES, Cakan-Akdogan G, Cubero FJ, Esteves F, Falcon-Perez JM, Fromenty B, Garcia-Ruiz C, Grove JI, Konu O, Kranendonk M, Kullak-Ublick GA, Miranda JP, Remesal-Doblado A, Sancho-Bru P, Nelson L, Andrade RJ, Daly AK, Fernandez-Checa JC. Roadmap to DILI research in Europe. A proposal from COST action ProEuroDILINet. Pharmacol Res 2024; 200:107046. [PMID: 38159783 DOI: 10.1016/j.phrs.2023.107046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
In the current article the aims for a constructive way forward in Drug-Induced Liver Injury (DILI) are to highlight the most important priorities in research and clinical science, therefore supporting a more informed, focused, and better funded future for European DILI research. This Roadmap aims to identify key challenges, define a shared vision across all stakeholders for the opportunities to overcome these challenges and propose a high-quality research program to achieve progress on the prediction, prevention, diagnosis and management of this condition and impact on healthcare practice in the field of DILI. This will involve 1. Creation of a database encompassing optimised case report form for prospectively identified DILI cases with well-characterised controls with competing diagnoses, biological samples, and imaging data; 2. Establishing of preclinical models to improve the assessment and prediction of hepatotoxicity in humans to guide future drug safety testing; 3. Emphasis on implementation science and 4. Enhanced collaboration between drug-developers, clinicians and regulatory scientists. This proposed operational framework will advance DILI research and may bring together basic, applied, translational and clinical research in DILI.
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Affiliation(s)
- M I Lucena
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Plataforma de Investigación Clínica y Ensayos Clínicos UICEC-IBIMA, Plataforma ISCIII de Investigación Clínica, Madrid, Spain.
| | - M Villanueva-Paz
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - I Alvarez-Alvarez
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - G P Aithal
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - E S Björnsson
- Faculty of Medicine, University of Iceland, Department of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland
| | - G Cakan-Akdogan
- Izmir Biomedicine and Genome Center, Izmir, Turkey. Department of Medical Biology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - F J Cubero
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Department of Immunology, Ophthalmology and ORL, Complutense University School of Medicine, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - F Esteves
- Center for Toxicogenomics and Human Health (ToxOmics), NMS | FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J M Falcon-Perez
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Exosomes Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, 48160, Spain. IKERBASQUE, Basque Foundation for Science, Bilbao, Bizkaia 48009, Spain
| | - B Fromenty
- INSERM, Univ Rennes, INRAE, Institut NUMECAN (Nutrition Metabolisms and Cancer) UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - C Garcia-Ruiz
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. University of Barcelona, Barcelona, Spain; Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB), CSIC, Barcelona, Spain
| | - J I Grove
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - O Konu
- Department of Molecular Biology and Genetics, Faculty of Science, Bilkent University, Ankara, Turkey; Interdisciplinary Neuroscience Program, Bilkent University, Ankara, Turkey; UNAM-Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, Turkey
| | - M Kranendonk
- Center for Toxicogenomics and Human Health (ToxOmics), NMS | FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - G A Kullak-Ublick
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; CMO & Patient Safety, Global Drug Development, Novartis Pharma, Basel, Switzerland
| | - J P Miranda
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - A Remesal-Doblado
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
| | - P Sancho-Bru
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. University of Barcelona, Barcelona, Spain
| | - L Nelson
- Institute for Bioengineering, School of Engineering, Faraday Building, The University of Edinburgh, Scotland, UK
| | - R J Andrade
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - A K Daly
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - J C Fernandez-Checa
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. University of Barcelona, Barcelona, Spain; Department of Cell Death and Proliferation, Institute of Biomedical Research of Barcelona (IIBB), CSIC, Barcelona, Spain; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Abstract
Xylazine is an animal sedative, approved by the U.S. Food and Drug Administration, that is commonly used in veterinary medicine and is not approved for human use. Since 2016, xylazine has consistently appeared in the illicitly manufactured fentanyl supply and has significantly increased in prevalence, likely due to its low cost, easy availability, and presumed synergistic psychoactive effect. Clinical experience along with the available pertinent research were used to review xylazine adulteration of the drug supply and provide guidance on the care of patients exposed to xylazine. This review discusses xylazine pharmacology, animal and human clinical effects, and what is known to date about care of patients experiencing acute overdose, xylazine-fentanyl withdrawal, and xylazine-associated wounds.
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Affiliation(s)
- Joseph D'Orazio
- Cooper University Healthcare, Camden, New Jersey (J.D., R.H.)
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Newark, New Jersey (L.N.)
| | | | - Rachel Wightman
- Alpert Medical School of Brown University, Providence, Rhode Island (R.W.)
| | - Rachel Haroz
- Cooper University Healthcare, Camden, New Jersey (J.D., R.H.)
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Ramdin C, Azer A, Ghafoor N, Attaalla K, Ghbrial M, Nelson L. Prevalence and services for the treatment of chronic pain at residential substance treatment centers. J Addict Dis 2023:1-6. [PMID: 37665562 DOI: 10.1080/10550887.2023.2251856] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction: Studies suggest that a large proportion of patients with substance use disorders (SUDs) also have underlying chronic pain. There is limited data on prevalence of chronic pain treatment as a component of residential substance use treatment. This initiative sought to investigate the prevalence and type of chronic pain services offered at these residential programs.Methods: This study was a retrospective review of information obtained from residential substance use treatment facility websites contained in SAMHSA's treatment navigator. Nine hundred-fifty out of 2952 websites were randomly selected for analysis. The primary outcome was prevalence of facilities that had chronic pain programs. Services offered were specified as available. Descriptive statistics were used to summarize data.Results: Nine-hundred nine websites (95.7%, [94,97]) were accessible. Twenty-six facilities (2.9%,[1.9,4.2]) had a chronic pain program and of these 22 (84.6%, [64.3,95.0]) specified services offered. Common services included physical therapy (6, 27.3%), massage (12, 54.6%), and acupuncture (10, 45.5%). Of the remaining sites, 630 (69.3%, [66.2,72.3]) specified services offered, including yoga (122, 19.4%) and exercise (199, 31.6%).Conclusion: Our study demonstrated that despite most facilities offering adjunctive services, few had chronic pain programs. This suggests that there is a possible need for better updating of facility websites or possibly an area for improvement in residential substance use treatment settings.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amanda Azer
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Naila Ghafoor
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kyrillos Attaalla
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mina Ghbrial
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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8
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Ramdin C, Bikkina R, Nelson L, Mazer-Amirshahi M. Trends in amphetamine prescriptions given at discharge in emergency departments: A national analysis (2012-2019). Am J Emerg Med 2023; 66:91-97. [PMID: 36738570 DOI: 10.1016/j.ajem.2023.01.042] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/09/2023] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES In parallel with the opioid epidemic, there has been a resurgence in abuse, medical complications, and deaths related to amphetamines. The opioid epidemic began with increasing rates of prescription products that evolved overtime to include heroin and more recently, fentanyl analogues. Current trends in amphetamine prescriptions are less well described. We sought to determine if there has been a change in amphetamine prescriptions given at discharge in U.S. emergency departments (EDs) in recent years. METHODS We conducted a retrospective review of data provided by the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 to 2019. We computed total number of visits that were given amphetamine prescriptions (amphetamine salts, methylphenidate derivatives, and dexmethylphenidate) at discharge for each year. We computed the total number and rate of visits (of all ED visits) that had both amphetamines and opioids prescribed at discharge over the years. We computed data normality using Shapiro Wilke's test and used descriptive statistics such as mean to describe the data distribution as applicable. We used spearman's rho (SR) or pearson's correlation (PC) as applicable to describe trends in data. All p-values were one-tailed and were reported at a 0.05 significance level. All analyses were conducted in IBM SPSS version 28. RESULTS/FINDINGS From 2012 to 2019, there were an estimated 817,895 ED visits where an amphetamine prescription was given at discharge, with an overall strong increase in rate over time (SR = 0.71, p = 0.02). At the beginning of the study period (2012) there were 83,503 (0.06%) visits and in 2019 there were 186,539 (0.12%) visits (123% absolute increase). On average, there were 102,237 (SD: 52,725) visits with discharge amphetamine prescriptions per year. There was a strong, linear increase in number of visits that involved a discharge amphetamine salt prescription (PC = 0.92, p = 0.001). In 2012, there were a total of 23,676 visits and in 2019, a total of 124,773 visits (427% increase). There was no trend in visits where both an amphetamine and opioid were prescribed (PC: 0.61, p = 0.06). CONCLUSION There have been increases in discharge prescriptions for amphetamines in the ED over time. This was largely driven by prescriptions for amphetamine salts. Future research initiatives should continue to monitor this trend and in prescriptions and associated abuse in the setting of rising amphetamine abuse.
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Affiliation(s)
- Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, United States of America.
| | - Rama Bikkina
- Georgetown University, School of Medicine, United States of America
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Department of Emergency Medicine, United States of America
| | - Maryann Mazer-Amirshahi
- Georgetown University, School of Medicine, United States of America; Department of Emergency Medicine, MedStar Washington Hospital Center, United States of America
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9
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Laverty C, Agar G, Sinclair-Burton L, Oliver C, Moss J, Nelson L, Richards C. The 10-year trajectory of aggressive behaviours in autistic individuals. J Intellect Disabil Res 2023; 67:295-309. [PMID: 36654499 DOI: 10.1111/jir.13004] [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] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Aggressive behaviours are common in people with neurodevelopmental conditions, contributing to poorer quality of life and placement breakdown. However, there is limited empirical research documenting the prevalence and persistence of aggressive behaviours in autism. In this longitudinal study, aggressive behaviours were investigated in a sample of autistic individuals over 10 years. METHODS Caregivers of autistic individuals, both with and without intellectual disability, completed questionnaires relating to the presence of aggressive behaviours at T1 [N = 229, mean age in years 11.8, standard deviation (SD) 5.9], T2 (T1 + 3 years, N = 81, mean age in years 15.1, SD 5.9) and T3 (T1 + 10 years, N = 54, mean age in years 24.5, SD 8.1). Analyses examined the presence and persistence of aggressive behaviours and the predictive value of established correlates of aggression. RESULTS Aggressive behaviours were common at baseline (61.6%) but only persistent in 30% of the sample over 10 years. Higher composite scores of overactivity and impulsivity at T1 were significantly associated with the persistence of aggressive behaviours at T2 (P = 0.027) and T3 (P = 0.012) with medium effect size. CONCLUSIONS Aggressive behaviours are common in autism, but reduce with age. Behavioural correlates of attention deficit hyperactivity disorder (ADHD) predict the presence and persistence of aggressive behaviour and as such may be useful clinical indicators to direct proactive intervention resources to ameliorate aggressive behaviours.
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Affiliation(s)
- C Laverty
- School of Psychology, University of Birmingham, Birmingham, UK
| | - G Agar
- School of Psychology, University of Birmingham, Birmingham, UK
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - C Oliver
- School of Psychology, University of Birmingham, Birmingham, UK
| | - J Moss
- School of Psychology, University of Surrey, Guildford, UK
| | - L Nelson
- School of Psychology, University of Birmingham, Birmingham, UK
| | - C Richards
- School of Psychology, University of Birmingham, Birmingham, UK
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10
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Santos C, Ramdin C, Becceril J, Al Kik B, Jefri M, Nelson L. The impact of an emergency department peer navigator (EDPN) program in improving clinical outcomes and healthcare utilization in an urban setting. Am J Emerg Med 2023; 68:10-16. [PMID: 36905880 DOI: 10.1016/j.ajem.2023.02.031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Emergency Department Peer Navigator Programs (EDPN) have been shown to increase the prescribing of medications for opioid use disorder (MOUD) and improve linkage to addiction care. However, what is not known is whether it can improve overall clinical outcomes and healthcare utilization in patients with OUD. METHODS This is a single-center, IRB approved, retrospective cohort study using patients with OUD enrolled in our peer navigator program from 11/7/19 to 2/16/21. On an annual basis, we determined MOUD clinic follow-up rates and clinical outcomes in those patients who utilized our EDPN program. Finally, we also looked at the social determinants of health factors (e.g., race, status of medical insurance, lack of housing, access to phone and/or internet, employment, etc.) that impact our patients clinical outcomes. ED and inpatient provider notes were reviewed to determine causes of ED visits and hospitalizations one year before and after enrollment into the program. The clinical outcomes of interest were number of ED visits from all-causes, number of ED visits from opioid-related causes, number of hospitalizations from all-causes, and number of hospitalizations from opioid-related causes one year after enrollment into our EDPN program, subsequent urine drug screens, and mortality. Demographic and socioeconomic factors (age, gender, race, employment, housing, insurance status, access to phone) were also analyzed to determine if any were independently associated with clinical outcomes. Death and cardiac arrests were noted. Clinical outcomes data were described using descriptive statistics and compared using t-tests. RESULTS 149 patients with OUD were included in our study. 39.6% had an opioid-related chief complaint at their index ED visit; 51.0% had any recorded history of MOUD and 46.3% had history of buprenorphine use. 31.5% had buprenorphine given in the ED with individual doses ranging from 2 to 16 mg and 46.3% were provided with a buprenorphine prescription. The average number of ED visits 1-year pre vs post enrollment, respectively, for all-causes was 3.09 vs 2.20 (p < 0.01); for opioid related complications 1.80 vs 0.72 (p < 0. 01). The average number of hospitalizations 1-year pre and post enrollment, respectively, for all-causes was 0.83 vs 0.60 (p = 0.05); for opioid related complications 0.39 vs 0.09 (p < 0.01). ED visits from all-causes decreased in 90 (60.40%) patients, had no change in 28 (18.79%) patients, and increased in 31 (20.81%) patients (p < 0.01). ED visits from opioid-related complications decreased in 92 (61.74%) patients, had no change in 40 (26.85%) patients, and increased in 17 (11.41%) (p < 0.01). Hospitalizations from all causes decreased in 45 (30.20%) patients, had no change in 75 patients (50.34%), and increased in 29 (19.46%) patients (p < 0.01). Lastly, hospitalizations from opioid-related complications decreased in 31 (20.81%) patients, had no change in 113 (75.84%) patients, and increased in 5 (3.36%) patients (p < 0.01). There were no socioeconomic factors that had a statistically significant association with clinical outcomes. Two patients (1.2%) died within 1 year after study enrollment. CONCLUSIONS Our study found that there was an association between implementation of an EDPN program and decreases in ED visits and hospitalizations from both all-causes as well as from opioid-related complications for patients with opioid use disorder.
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Affiliation(s)
- Cynthia Santos
- Rutgers New Jersey Medical School, Newark, NJ, United States of America; New Jersey Poison Information and Education system, Newark, NJ, United States of America.
| | - Christine Ramdin
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - John Becceril
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Bethany Al Kik
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Mohammed Jefri
- Rutgers New Jersey Medical School, Newark, NJ, United States of America; New Jersey Poison Information and Education system, Newark, NJ, United States of America
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Newark, NJ, United States of America; New Jersey Poison Information and Education system, Newark, NJ, United States of America
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Ramdin C, Chandran K, Nelson L, Mazer-Amirshahi M. Trends in naloxone prescribed at emergency department discharge: A national analysis (2012-2019). Am J Emerg Med 2023; 65:162-167. [PMID: 36638613 DOI: 10.1016/j.ajem.2023.01.006] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND While having access to naloxone is recommended for patients at risk for opioid overdose, little is known about trends in national naloxone prescribing rates in emergency departments (EDs) both for co-prescription with opioids and for patients who presented with opioid abuse or overdose. This study aims to evaluate the change in naloxone prescribing and opioid/naloxone co-prescribing at discharge using national data. METHODS We conducted an IRB exempt retrospective review of data collected by the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. The primary outcome was trend in rate of naloxone prescribing at discharge from ED visits. We also computed the proportion of visits where naloxone was both administered in the ED and prescribed at discharge, where naloxone and opioids were co-prescribed at discharge, and where an opioid was administered during the ED visit and naloxone was prescribed at discharge. All data were summarized using descriptive statistics and Spearman's Rho (SR) or Pearson's correlation (PR) were used to describe trends. RESULTS There was an estimated total of 250,365 patient visits where naloxone was prescribed at discharge with an increasing rate over time (0% of all ED visits in 2012 to 0.075% in 2019, p = 0.002). There were also increases in naloxone being both administered in the ED and prescribed at discharge (PC: 0.8, p = 0.02) as well as in naloxone and opioid co-prescribing (SR: 0.76, P = 0.03). There was an increase in utilization of opioids during the ED visit and naloxone prescribing at discharge for the same visit (SR: 0.80, p = 0.02). CONCLUSION There are increases in naloxone prescribing at discharge, naloxone and opioid co-prescribing, and opioid utilization during the same visit where naloxone is prescribed at discharge. Future studies should be done to confirm such trends, and targeted interventions should be put into place to increase access to this life-saving antidote.
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Affiliation(s)
- Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, United States.
| | - Kira Chandran
- Georgetown University, School of Medicine, United States
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Department of Emergency Medicine, United States
| | - Maryann Mazer-Amirshahi
- Georgetown University, School of Medicine, United States; Department of Emergency Medicine, MedStar Washington Hospital Center, United States
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Ramdin C, Santos C, Nelson L. Alcohol Use in Patients with Opioid Use Disorder Linked to and Undergoing Buprenorphine Treatment via a Peer-Navigator Program Based in an Urban Emergency Department. Alcohol Alcohol 2023; 58:113-114. [PMID: 36420974 DOI: 10.1093/alcalc/agac061] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Cynthia Santos
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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Betti S, Hosseini S, Ramdin C, Nelson L. 372 Perceptions, Use, and Behaviors Surrounding the Receipt of a Naloxone Kit for Patients with Opioid Use Disorder in an Urban Emergency Department. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.401] [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: 11/26/2022]
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14
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Finkel R, Farrar M, Vlodavets D, Zanoteli E, Al-Muhaizea M, Nelson L, Prufer A, Servais L, Wang Y, Fisher C, Gerber M, Gorni K, Kletzl H, Palfreeman L, Scalco R, Bertini E. FP.24 RAINBOWFISH: Preliminary efficacy and safety data in risdiplam-treated infants with presymptomatic spinal muscular atrophy (SMA). Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.183] [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: 11/07/2022]
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15
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Ramdin C, Makutonin M, Nelson L, Meltzer A, Amirshahi M. 259 Outcomes and Resource Utilization of Patients Presenting to the Emergency Department With Opioid and Benzodiazepine Poisoning. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.286] [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: 11/01/2022]
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16
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Tran T, Dym A, Rosania A, Nelson L, Ramdin C, Santos C. 91 The Promising Use of an Emergency Department Observation Unit to Manage Patients With Opioid Use Disorder. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.114] [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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17
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Paller A, Siegfried E, Marron S, Clark M, DiBenedetti D, Nelson L, Chao J, Bansal A, Sun Y, Chuang C, Wang Z. 147 Development and validation of a caregiver-reported numeric rating scale for measuring pruritus in children aged 6 months to <6 years with atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.154] [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: 10/17/2022]
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18
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Loughran D, Calello D, Nelson L. Treatment of acute aluminum toxicity due to alum bladder irrigation in a hemodialysis patient: a case report. Toxicology Communications 2022. [DOI: 10.1080/24734306.2022.2040148] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- David Loughran
- Rutgers New Jersey Medical School, Department of Medical Toxicology, Newark, NJ, USA
| | - Diane Calello
- Rutgers New Jersey Medical School, Department of Medical Toxicology, New Jersey Poison Information and Education System, Newark, NJ, USA
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Department of Medical Toxicology, Newark, NJ, USA
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19
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Loughran D, Jacob J, Calello D, Nelson L. Direct maternal injection of digoxin in error during a fetal pre-termination procedure. Clin Toxicol (Phila) 2022; 60:776-778. [PMID: 35107053 DOI: 10.1080/15563650.2022.2032129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David Loughran
- Department of Medical Toxicology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jeena Jacob
- Department of Medical Toxicology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Diane Calello
- Department of Medical Toxicology, New Jersey Poison Information and Education System, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Lewis Nelson
- Department of Medical Toxicology, Rutgers New Jersey Medical School, Newark, NJ, USA
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20
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Ramdin C, Guo M, Fabricant S, Santos C, Nelson L. The Impact of a Peer-Navigator Program on Naloxone Distribution and Buprenorphine Utilization in the Emergency Department. Subst Use Misuse 2022; 57:581-587. [PMID: 34970942 DOI: 10.1080/10826084.2021.2023187] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives: In recent years many emergency departments (EDs) have adopted interventions to help patients with opioid use disorder (OUD), particularly buprenorphine initiation and ED-based peer recovery support. There are limited data on the impact of peer navigators on provider naloxone kit distribution and buprenorphine utilization. We aimed to examine the impact of a peer recovery program on naloxone kit distribution and buprenorphine administration. Methods: This was a retrospective study analyzing the change in naloxone kits distributed as well as buprenorphine administrations. Data on naloxone kit and buprenorphine administrations was generated every month between November 2017 and February 2021. Time periods were as follows: implementation of guidelines for buprenorphine and naloxone kits, initiation of the navigator program, and first wave of COVID-19. Numbers of naloxone kits distributed and buprenorphine administrations per month were computed. Results: Between November 2017 and December 2020, there was a significant increase overtime among the 238 naloxone kits distributed (p < 0.0001). Between implementation of guidelines and introduction of peer navigators, there were 49 kits distributed, compared to an increase overtime among 235 kits when the navigator program began (p = 0.0001). There was also a significant increase overtime among 1797 administrations of buprenorphine (p < 0.0001). Administrations increased by 22.4% after implementation of the navigator program-a total of 787 compared to 643 post guideline (p = 0.007). Conclusion: Peer recovery support programs for patients with OUD can have an impact on administration of naloxone kits and buprenorphine. Future studies should determine whether these programs can cause a long-term culture change in the ED.
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Affiliation(s)
- Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marshall Guo
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Scott Fabricant
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Cynthia Santos
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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21
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Stolbach A, Connors N, Nelson L, Kulig K. ACMT Position Statement: Interpretation of Urine Opiate and Opioid Tests. J Med Toxicol 2021; 18:176-179. [PMID: 34780053 DOI: 10.1007/s13181-021-00864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Andrew Stolbach
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ken Kulig
- Toxicology Associates, Prof LLC, Littleton, CO, USA
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22
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Servais L, Al-Muhaizea M, Farrar M, Nelson L, Prufer A, Finkel R, Wang Y, Zanoteli E, El-Khairi M, Gerber M, Gorni K, Kletzl H, Palfreeman L, Scalco R, Bertini E. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.021] [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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23
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Shamsie I, Gomez B, Khalid S, Boni A, Ramdin C, Nelson L. 37 The Impact of the Coronavirus (COVID-19) Pandemic on Access to Care and Basic Necessities of Emergency Department Patients With Opioid Use Disorders Who Are Linked to Treatment. Ann Emerg Med 2021. [PMCID: PMC8536263 DOI: 10.1016/j.annemergmed.2021.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Chandran K, Mazer-Amirshahi M, Shankar N, Desale S, Nelson L, Mete M. Impact of COVID-19 pandemic on emergency department substance use screens and overdose presentations. Am J Emerg Med 2021; 50:472-476. [PMID: 34509745 PMCID: PMC8387574 DOI: 10.1016/j.ajem.2021.08.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/26/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic can exacerbate underlying substance use disorder and has impacted this vulnerable population in a variety of ways. There are limited data regarding how this pandemic has impacted emergency department (ED) patient presentations. Methods We extracted data on ED visits from the electronic health record (EHR) of a large healthcare system in the Washington, DC/Baltimore, MD metropolitan area. The dataset includes data from 7 hospitals on ED visits between 11/1/2019–6/30/2020. The health system utilizes a validated screening program for substance use, Screening, Brief Intervention, and Referral to Treatment (SBIRT), for ED patients who are clinically stable and willing to complete screening. We evaluated trends in patients with a positive SBIRT screen and those presenting with a clinical diagnosis of acute alcohol or substance intoxication/overdose before (11/1/19–2/29/2020-pre) and during the first wave of the COVID pandemic (3/1/2020–6/30/2020-post). Data were described using descriptive statistics. Bivariate analyses were conducted using chi-square test and two-sample t-tests. Interrupted time series analysis was used to evaluate the changes in the weekly trends with the start of the pandemic. Results There were 107,930 screens performed in the EDs during the study period (61,961 pre, 45,969 post). The population was primarily African American (64.7%) and female (57.1%). Positive SBIRT screens increased from 12.5% to 15.8% during COVID (p < 0.001). Alcohol intoxication presentations increased as a proportion of positive screens from 12.6% to 14.4% (p = 0.001). A higher percentage of screened patients reported problem drinking (AUDIT score ≥ 7) during the pandemic (2.4% pre vs 3.2% post, p < 0.001). Substance intoxication/overdoses among all screened increased from 2.1% to 3.1% (p < 0.001) and as a percentage of positive screens during the pandemic (16.8% to 20%, p < 0.001). The proportion of opioid vs. non-opioid overdoses remained unchanged before (67%) and during the pandemic (64%, p = 0.33). Discussion There was an increase in the proportion of positive SBIRT screens and visits for acute overdoses and intoxication during the first wave of the COVID-19 pandemic. Additional research should focus on mitigation strategies to address substance use during this vulnerable time.
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Affiliation(s)
- Kira Chandran
- Georgetown University School of Medicine, Washington, DC, USA.
| | | | - Nikash Shankar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, USA
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25
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Ravi C, Gang M, Sugalski G, Kenyon V, Nelson L. Extubating trauma patients in the emergency department. Am J Emerg Med 2021; 50:289-293. [PMID: 34419710 DOI: 10.1016/j.ajem.2021.08.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Trauma patients often require endotracheal intubation for urgent or emergent airway protection or to allow expeditious imaging when they cannot cooperate with the needed evaluation. These patients may occasionally be extubated in the emergency department (ED) when the trauma workup is negative for consequential injuries and eventually discharged from the ED. The timing and safety of discharging these patients is unclear. OBJECTIVE The objective of this study was to identify the adverse outcomes and evaluate the safety of extubating trauma patients who are clinically well following evaluation in the ED. METHODS Records of trauma patients who were intubated and then extubated in the ED at a single level 1 trauma referral center during the 4-year study period (Jan 2014 - Dec 2017) were retrospectively abstracted. The primary outcome was the incidence of a post-extubation complication, including desaturation, emesis, aspiration, need for sedative administration, or unplanned reintubation. Additional outcome measures included final disposition, duration of observation following extubation, ED length of stay and return to the hospital within 72 h. RESULTS There were 59 eligible patients identified over the study period, of whom 95% presented following blunt trauma. One patient (1.7%; 95% confidence interval 0-9) required unplanned reintubation and developed aspiration pneumonia following re-extubation. Forty-two (71%) of the patients were discharged from the ED following extubation and a period of post-extubation observation with a mean of 5.8 h (0.6-16.7 h). None of the patients who were discharged returned to the ED within 72 h with complications related to extubation (0%; 95% confidence interval 0-6%). CONCLUSIONS Patients presenting to the ED with possible acute traumatic injuries who are intubated and then extubated after trauma evaluation and resolution of the indication for intubation appear to have a low incidence of complication or return visit when discharged from the ED after a brief period of observation. Specific extubation and discharge criteria should be developed to ensure the safety of this practice. Further validation is required in the form of larger and prospective studies.
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Affiliation(s)
- Chandni Ravi
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB E609, Newark, NJ 07103,.
| | - Maureen Gang
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB E609, Newark, NJ 07103
| | - Gregory Sugalski
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB E609, Newark, NJ 07103
| | - Van Kenyon
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB E609, Newark, NJ 07103
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB E609, Newark, NJ 07103,.
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26
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Hawk K, Hoppe J, Ketcham E, LaPietra A, Moulin A, Nelson L, Schwarz E, Shahid S, Stader D, Wilson MP, D'Onofrio G. Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department. Ann Emerg Med 2021; 78:434-442. [PMID: 34172303 DOI: 10.1016/j.annemergmed.2021.04.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 12/17/2022]
Abstract
The treatment of opioid use disorder with buprenorphine and methadone reduces morbidity and mortality in patients with opioid use disorder. The initiation of buprenorphine in the emergency department (ED) has been associated with increased rates of outpatient treatment linkage and decreased drug use when compared to patients randomized to receive standard ED referral. As such, the ED has been increasingly recognized as a venue for the identification and initiation of treatment for opioid use disorder, but no formal American College of Emergency Physicians (ACEP) recommendations on the topic have previously been published. The ACEP convened a group of emergency physicians with expertise in clinical research, addiction, toxicology, and administration to review literature and develop consensus recommendations on the treatment of opioid use disorder in the ED. Based on literature review, clinical experience, and expert consensus, the group recommends that emergency physicians offer to initiate opioid use disorder treatment with buprenorphine in appropriate patients and provide direct linkage to ongoing treatment for patients with untreated opioid use disorder. These consensus recommendations include strategies for opioid use disorder treatment initiation and ED program implementation. They were approved by the ACEP board of directors in January 2021.
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Affiliation(s)
- Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | - Jason Hoppe
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Eric Ketcham
- Department of Emergency Medicine, Santa Fe & Espanola, Presbyterian Healthcare System, NM
| | - Alexis LaPietra
- Department of Emergency Medicine, Santa Fe & Espanola, Presbyterian Healthcare System, NM
| | - Aimee Moulin
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Evan Schwarz
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Sam Shahid
- American College of Emergency Physicians, Dallas, TX
| | - Donald Stader
- Section of Emergency Medicine, Swedish Medical Center, Englewood, CO
| | - Michael P Wilson
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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27
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Ramdin C, Yu C, Colorado J, Nelson L. The impact of adherence to a guideline for minimizing opioid use for treatment of pain in an urban emergency department. Am J Emerg Med 2021; 49:104-109. [PMID: 34098328 DOI: 10.1016/j.ajem.2021.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/10/2020] [Revised: 03/25/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The opioid epidemic has significantly evolved over the last three decades. The initiation and continuation of prescription opioids for pain control were one of the primary contributors, across different medical settings. The emergency department (ED) is typically the first place patients go to for management of acute pain, and often where opioid naïve patients first become exposed to opioids. In 2018, the ED of University Hospital located in Newark, NJ implemented a pain guideline to ensure that patients are not unnecessarily exposed to opioids. The goal of our study was to determine whether provider adherence was successful in reducing opioid administration. METHODS We conducted a retrospective review of pharmacy records of patients treated for pain in the ED within the time frame January 1, 2017 and December 31, 2019. We analyzed the change in our practice by comparing the amount of opioid and non-opioid medications administered and the number of patients administered each type, as well as the change in our utilization of specific medications. The t-test or the χ2 test were used as applicable. RESULTS There were decreases in the mean number of opioid doses administered in 2017 (1273) compared to 2019 (498; p = 0.027). There was an increase in non-opioid analgesics administered, (mean 2017: 1817, mean 2019: 2432.5, p = 0.018). There was also an increase in the proportion of patients given non-opioid analgesics (mean 2017: 22%, mean 2019: 28%, p < 0.0001). There were increases in administrations of acetaminophen (40% to 52%) and ibuprofen (30% to 35.1%), and decreases in administrations of hydromorphone (2.5% to 0.03%), morphine (11.5% to 5.6%), oxycodone (10.6% to 5.3%), and tramadol (5.7% to 1.9%) (all p < 0.0001). DISCUSSION A guideline that emphasizes the use of non-opioid analgesics first line treatment for acute pain can be effective for reducing opioid administration in the ED. Through the use of our guideline, we reduced the number of patients who have received opioid analgesics and, at the same time, increased non-opioid analgesic administration. Future studies should explore readmission rates, duration of pain relief in patients managed with non-opioid versus opioid analgesics, and perception of relief through the use of satisfaction scores.
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Affiliation(s)
- Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA.
| | - Catherine Yu
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA
| | - Joshua Colorado
- Rutgers Robert Wood Johnson University Hospital, Department of Emergency Medicine, Pharmacy, New Brunswick, NJ, USA
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA
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Pearson E, Nielsen E, Kita S, Groves L, Nelson L, Moss J, Oliver C. Low speech rate but high gesture rate during conversational interaction in people with Cornelia de Lange syndrome. J Intellect Disabil Res 2021; 65:601-607. [PMID: 33694205 DOI: 10.1111/jir.12829] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cornelia de Lange syndrsome (CdLS) is a rare genetic syndrome with notable impaired expressive communication characterised by reduced spoken language. We examined gesture use to refine the description of expressive communication impairments in CdLS. METHODS During conversations, we compared gesture use in people with CdLS to peers with Down syndrome (DS) matched for receptive language and adaptive ability, and typically developing (TD) individuals of similar chronological age. RESULTS As anticipated the DS and CdLS groups used fewer words during conversation than TD peers (P < .001). However, the CdLS group used twice the number of gestures per 100 words compared with the DS and TD groups (P = .003). CONCLUSIONS Individuals with CdLS have a significantly higher gesture rate than expected given their level of intellectual disability and chronological age. This result indicates the cause of reduced use of spoken language does not extend to all forms of expressive communication.
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Affiliation(s)
- E Pearson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - E Nielsen
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - S Kita
- Department of Psychology, University of Warwick, Coventry, UK
| | - L Groves
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - L Nelson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
- Royal Derby Hospital, Derby, UK
| | - J Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
- School of Psychology, University of Surrey, Surrey, UK
| | - C Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
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Ramdin C, Muckey E, Rosania A, Nelson L. Trends in visits related to drug use adverse effects in an urban ED during COVID-19. Am J Emerg Med 2021; 53:264-265. [PMID: 33933308 PMCID: PMC8076727 DOI: 10.1016/j.ajem.2021.04.067] [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: 03/28/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Christine Ramdin
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA.
| | - Erin Muckey
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA
| | - Anthony Rosania
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA
| | - Lewis Nelson
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, NJ, USA
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Nelson L, Iannaccone S, Forrest D, Valle M, Klingman E, Castro D. SMA – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.271] [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: 11/17/2022]
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Mugahid DA, Sengul TG, You X, Wang Y, Steil L, Bergmann N, Radke MH, Ofenbauer A, Gesell-Salazar M, Balogh A, Kempa S, Tursun B, Robbins CT, Völker U, Chen W, Nelson L, Gotthardt M. Author Correction: Proteomic and Transcriptomic Changes in Hibernating Grizzly Bears Reveal Metabolic and Signaling Pathways that Protect against Muscle Atrophy. Sci Rep 2020; 10:4381. [PMID: 32127597 PMCID: PMC7054357 DOI: 10.1038/s41598-020-61340-4] [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] [Indexed: 11/16/2022] Open
Affiliation(s)
- D A Mugahid
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - T G Sengul
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - X You
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Y Wang
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - L Steil
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - N Bergmann
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - M H Radke
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - A Ofenbauer
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - M Gesell-Salazar
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - A Balogh
- Experimental and Clinical Research Center, Charité & Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - S Kempa
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - B Tursun
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - C T Robbins
- School of the Environment and School of Biological Sciences, Washington State University, Pullman, Washington, USA
| | - U Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - W Chen
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - L Nelson
- College of Veterinary Medicine and Department of Veterinary Clinical Science, Washington State University, Pullman, Washington, USA
| | - M Gotthardt
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany. .,Charité Universitätsmedizin Berlin, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Mugahid DA, Sengul TG, You X, Wang Y, Steil L, Bergmann N, Radke MH, Ofenbauer A, Gesell-Salazar M, Balogh A, Kempa S, Tursun B, Robbins CT, Völker U, Chen W, Nelson L, Gotthardt M. Proteomic and Transcriptomic Changes in Hibernating Grizzly Bears Reveal Metabolic and Signaling Pathways that Protect against Muscle Atrophy. Sci Rep 2019; 9:19976. [PMID: 31882638 PMCID: PMC6934745 DOI: 10.1038/s41598-019-56007-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
Muscle atrophy is a physiological response to disuse and malnutrition, but hibernating bears are largely resistant to this phenomenon. Unlike other mammals, they efficiently reabsorb amino acids from urine, periodically activate muscle contraction, and their adipocytes differentially responds to insulin. The contribution of myocytes to the reduced atrophy remains largely unknown. Here we show how metabolism and atrophy signaling are regulated in skeletal muscle of hibernating grizzly bear. Metabolic modeling of proteomic changes suggests an autonomous increase of non-essential amino acids (NEAA) in muscle and treatment of differentiated myoblasts with NEAA is sufficient to induce hypertrophy. Our comparison of gene expression in hibernation versus muscle atrophy identified several genes differentially regulated during hibernation, including Pdk4 and Serpinf1. Their trophic effects extend to myoblasts from non-hibernating species (including C. elegans), as documented by a knockdown approach. Together, these changes reflect evolutionary favored adaptations that, once translated to the clinics, could help improve atrophy treatment.
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Affiliation(s)
- D A Mugahid
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - T G Sengul
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - X You
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Y Wang
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - L Steil
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - N Bergmann
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - M H Radke
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - A Ofenbauer
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - M Gesell-Salazar
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - A Balogh
- Experimental and Clinical Research Center, Charité & Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - S Kempa
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - B Tursun
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - C T Robbins
- School of the Environment and School of Biological Sciences, Washington State University, Pullman, Washington, USA
| | - U Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - W Chen
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - L Nelson
- College of Veterinary Medicine and Department of Veterinary Clinical Science, Washington State University, Pullman, Washington, USA
| | - M Gotthardt
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany. .,Charité Universitätsmedizin Berlin, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Kole M, Nelson L, Has P, Werner E, Rouse D, Hardy E. Pregnancy latency associated with oral compared to intravenous antibiotics following preterm premature rupture of membranes. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.074] [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: 10/25/2022]
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Santos C, Adam A, Calello D, Nelson L. Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose. Ann Emerg Med 2019; 73:99-100. [PMID: 30577966 DOI: 10.1016/j.annemergmed.2018.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Cynthia Santos
- Rutgers New Jersey Medical School, New Jersey Poison Information and Education System, Newark, NJ
| | - Adeeb Adam
- Newark Beth Israel Medical Center, Newark, NJ
| | - Diane Calello
- Rutgers New Jersey Medical School, New Jersey Poison Information and Education System, Newark, NJ
| | - Lewis Nelson
- Rutgers New Jersey Medical School, New Jersey Poison Information and Education System, Newark, NJ
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Yosipovitch G, Reaney M, Mastey V, Eckert L, Abbé A, Nelson L, Clark M, Williams N, Chen Z, Ardeleanu M, Akinlade B, Graham N, Pirozzi G, Staudinger H, Plaum S, Radin A, Gadkari A. 峰值瘙痒数字评价量表的验证. Br J Dermatol 2019. [DOI: 10.1111/bjd.18401] [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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36
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Lowes L, Alfano L, Chen D, Nelson L, Miller N, Iammarino M, McColly M, Mendell J, Rust S. P.214Presymptomatic spinal muscular atrophy: reality or myth? Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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37
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Yosipovitch G, Reaney M, Mastey V, Eckert L, Abbé A, Nelson L, Clark M, Williams N, Chen Z, Ardeleanu M, Akinlade B, Graham N, Pirozzi G, Staudinger H, Plaum S, Radin A, Gadkari A. Validation of the Peak Pruritus Numerical Rating Scale. Br J Dermatol 2019. [DOI: 10.1111/bjd.18390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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38
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Randall CL, Hort K, Huebner CE, Mallott E, Mancl L, Milgrom P, Nelson L, Senturia K, Weiner BJ, Cunha-Cruz J. Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization. JDR Clin Trans Res 2019; 5:156-165. [PMID: 31499017 DOI: 10.1177/2380084419871904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure. OBJECTIVES The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness. METHODS A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics. RESULTS Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for. CONCLUSION Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.
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Affiliation(s)
- C L Randall
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - K Hort
- Southeast Alaska Regional Health Consortium, Juneau, AK, USA
| | - C E Huebner
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - E Mallott
- Southeast Alaska Regional Health Consortium, Juneau, AK, USA
| | - L Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - P Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - L Nelson
- School of Nursing, Washington State University, Spokane, WA, USA
| | - K Senturia
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - B J Weiner
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - J Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Zamora-Kapoor A, Sinclair K, Nelson L, Lee H, Buchwald D. Obesity risk factors in American Indians and Alaska Natives: a systematic review. Public Health 2019; 174:85-96. [PMID: 31326761 DOI: 10.1016/j.puhe.2019.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/26/2018] [Revised: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We systematically reviewed the literature on risk factors for obesity in American Indians (AIs) and Alaska Natives (ANs) of all ages. STUDY DESIGN We searched titles and abstracts in PubMed with combinations of the following terms: obesity, body mass index (BMI), American Indian, Alaska Native, and Native American. METHODS We limited our review to articles that provided an empirically testable claim about a variable associated with obesity, measured obesity as a dependent variable, and provided data specific to AI/ANs. RESULTS Our final sample included 31 articles; 20 examined AI/AN youth (<18 years), and 11 examined AI/AN adults (≥18 years). Risk factors for obesity varied by age. In infants, low birth weight, early termination of breastfeeding, and high maternal BMI, and maternal diabetes increased the risk of childhood obesity. In children and adolescents, parental obesity, sedentary behaviors, and limited access to fruits and vegetables were associated with obesity. In adulthood, sedentary behaviors, diets high in fats and carbohydrates, stress, verbal abuse in childhood, and the belief that health cannot be controlled were associated with obesity. CONCLUSIONS Extant studies have three limitations: they do not apply a life course perspective, they lack nationally representative data and have limited knowledge of the resilience, resistance and resourcefulness of AI/ANs. Future studies that avoid these shortcomings are needed to inform interventions to reduce the prevalence of obesity in AI/ANs across the life course.
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Affiliation(s)
- A Zamora-Kapoor
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
| | - K Sinclair
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - L Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - H Lee
- Department of Sociology, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - D Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Medicine, Washington State University, Spokane, WA 99202, USA
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Wilmoth K, Mau K, Guzowski N, Brett B, McCrea M, Nelson L. Direct Comparison of Multidimensional Clinical Assessment Tools: Sensitivity to Concussion in Student Athletes. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Consensus guidelines recommend multidimensional assessment for concussion diagnosis and management. Among cognitive, oculomotor, and postural stability, it remains unclear which modalities perform best in the acute/subacute periods. We conducted a direct comparison to identify those with the strongest sensitivity to sport-related concussion.
Methods
High school and collegiate football players (aged 14–24) completed preseason baseline assessments. Concussed (n=91) and matched non-concussed teammates (n=85) underwent repeat testing at 48 hours, 8 days, and 15 days post-injury. Postconcussive symptoms (SCAT-3 symptom severity), cognition (Standardized Assessment of Concussion, Immediate Post-Concussion and Cognitive Testing, Trail Making Test, Wechsler Adult Intelligence Scale-IV Processing Speed Index), oculomotor functioning (King-Devick Test), and postural stability (Balance Error Scoring System) were compared using Cohen’s d and Receiver Operating Characteristic analyses.
Results
Symptom severity had the greatest sensitivity at 48 hours and 8 days post-injury (Cohen’s d=1.43 and 0.53, AUC=.93 and .63, p<.01). Of the performance-based assessments, BESS was most sensitive to SRC at 48 hours post-injury (Cohen’s d=.74, AUC=.70, p<.01). Oculomotor and cognitive testing via ImPACT, WAIS-IV PSI, and TMT-A were sensitive to a lesser degree (Cohen’s d=.35–.58, p<.05). Verbal memory was the only significant performance-based assessment at days 8 and 15, with small-to-medium effect sizes (Cohen’s d=.37 and .44, p<.05). Other cognitive measures (SAC, TMT-B) were not sensitive to SRC across timepoints (p>.05).
Conclusion
We observed heterogeneity in clinical assessment performance such that the clinical domains strongest in the initial days post-injury (symptom severity, balance) were less sensitive at later follow-up, supporting the potential need for multidimensional assessment.
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Hassanian-Moghaddam H, Zamani N, Roberts DM, Brent J, McMartin K, Aaron C, Eddleston M, Dargan PI, Olson K, Nelson L, Bhalla A, Hantson P, Jacobsen D, Megarbane B, Balali-Mood M, Buckley NA, Zakharov S, Paasma R, Jarwani B, Mirafzal A, Salek T, Hovda KE. Consensus statements on the approach to patients in a methanol poisoning outbreak. Clin Toxicol (Phila) 2019; 57:1129-1136. [PMID: 31328583 DOI: 10.1080/15563650.2019.1636992] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Methanol poisoning is an important cause of mortality and morbidity worldwide. Although it often occurs as smaller sporadic events, epidemic outbreaks are not uncommon due to the illicit manufacture and sale of alcoholic beverages.Objective: We aimed to define methanol poisoning outbreak (MPO), outline an approach to triaging an MPO, and define criteria for prioritizing antidotes, extracorporeal elimination treatments (i.e., dialysis), and indications for transferring patients in the context of an MPO.Methods: We convened a group of experts from across the world to explore geographical, socio-cultural and clinical considerations in the management of an MPO. The experts answered specific open-ended questions based on themes aligned to the goals of this project. This project used a modified Delphi process. The discussion continued until there was condensation of themes.Results: We defined MPO as a sudden increase in the number of cases of methanol poisoning during a short period of time above what is normally expected in the population in that specific geographic area. Prompt initiation of an antidote is necessary in MPOs. Scarce hemodialysis resources require triage to identify patients most likely to benefit from this treatment. The sickest patients should not be transferred unless the time for transfer is very short. Transporting extracorporeal treatment equipment and antidotes may be more efficient.Conclusion: We have developed consensus statements on the response to a methanol poisoning outbreak. These can be used in any country and will be most effective when they are discussed by health authorities and clinicians prior to an outbreak.
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Affiliation(s)
- Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, and Department of Renal Medicine, St Vincent's Hospital, University of NSW, Sydney, NSW, Australia.,NSW Poisons Information Centre, Sydney Children's Hospital, Westmead, Sydney, NSW, Australia
| | - Jeffrey Brent
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Kenneth McMartin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA
| | - Cynthia Aaron
- Michigan Regional Poison Control Center at Children's Hospital of Michigan, Detroit, MI, USA.,Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael Eddleston
- Department of Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Paul I Dargan
- Department of Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kent Olson
- California Poison Control System, San Francisco Division, University of California, San Francisco, San Francisco, CA, USA
| | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Philippe Hantson
- Université catholique de Louvain, Cliniques universitaires Saint Luc, Bruxelles-Department of Intensive Care, Brussels, Belgium.,Université catholique de Louvain, Cliniques universitaires Saint Luc, Bruxelles-Louvain Centre for Toxicology and Applied Pharmacology, Brussels, Belgium
| | - Dag Jacobsen
- Department of Acute Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS 1144, Paris-Diderot University, Paris, France
| | - Mahdi Balali-Mood
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Sergey Zakharov
- Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Toxicological Information Centre, Prague 2, Czech Republic
| | - Raido Paasma
- Department of Anesthesiology and ICU, Pärnu County Hospital, Pärnu, Estonia
| | | | - Amirhossein Mirafzal
- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Tomas Salek
- Department of Clinical biochemistry and pharmacology, Tomas Bata Hospital, ZLÍN, Czech Republic
| | - Knut Erik Hovda
- The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Yosipovitch G, Reaney M, Mastey V, Eckert L, Abbé A, Nelson L, Clark M, Williams N, Chen Z, Ardeleanu M, Akinlade B, Graham NMH, Pirozzi G, Staudinger H, Plaum S, Radin A, Gadkari A. Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis. Br J Dermatol 2019; 181:761-769. [PMID: 30729499 PMCID: PMC6850643 DOI: 10.1111/bjd.17744] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Moderate-to-severe atopic dermatitis (AD) is a chronic disease characterized by intense, persistent and debilitating itch, resulting in sleep deprivation, signs of anxiety and depression, impaired quality of life and reduced productivity. The Peak Pruritus Numerical Rating Scale (NRS) was developed and validated as a single-item, patient-reported outcome (PRO) of itch severity. OBJECTIVES To describe the content validity and psychometric assessment (test-retest reliability, construct validity, known-groups validity, sensitivity to change) of the Peak Pruritus NRS, and to derive empirically a responder definition to identify adults with a meaningful change in itch. METHODS Content validity was assessed through in-depth patient interviews. Psychometric assessments used data from phase IIb and phase III dupilumab clinical trials and included test-retest reliability, construct validity, known-groups validity and sensitivity to change in patients with moderate-to-severe AD. RESULTS Interview participants indicated that the Peak Pruritus NRS was a relevant, clear and comprehensive assessment of itch severity. Peak Pruritus NRS scores showed large, positive correlations with existing PRO measures of itch, and weak or moderate correlations with clinician-reported measures assessing objective signs of AD. Peak Pruritus NRS score improvements were highly correlated with improvements in other itch PROs, and moderately correlated with improvements in clinician-reported measures assessing objective signs of AD. The most appropriate threshold for defining a clinically relevant, within-person response was ≥ 2-4-point change in the Peak Pruritus NRS. CONCLUSIONS The Peak Pruritus NRS is a well-defined, reliable, sensitive and valid scale for evaluating worst itch intensity in adults with moderate-to-severe AD.
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Affiliation(s)
- G Yosipovitch
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, U.S.A
| | | | - V Mastey
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | | | - A Abbé
- Sanofi, Chilly-Mazarin, France
| | - L Nelson
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - M Clark
- RTI Health Solutions, Ann Arbor, MI, U.S.A
| | - N Williams
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - Z Chen
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | - B Akinlade
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | | | | | | | - S Plaum
- Sanofi, Bridgewater, NJ, U.S.A
| | - A Radin
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
| | - A Gadkari
- Regeneron Pharmaceuticals, Tarrytown, NY, U.S.A
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Bethsabee B, Laurent Q, Pierre C, Valerie H, Sophie G, Thomas A, Nelson L, Jean-Marc G, Hennequin C. EP-1407 Sarcopenia is a weak prognostic factor before chemoradiotherapy of esophageal carcinomas. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31827-4] [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: 11/15/2022]
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44
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Royston R, Oliver C, Moss J, Adams D, Berg K, Burbidge C, Howlin P, Nelson L, Stinton C, Waite J. Brief Report: Repetitive Behaviour Profiles in Williams syndrome: Cross Syndrome Comparisons with Prader-Willi and Down syndromes. J Autism Dev Disord 2019; 48:326-331. [PMID: 28980100 DOI: 10.1007/s10803-017-3319-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes the profile of repetitive behaviour in individuals with Williams syndrome, utilising cross-syndrome comparisons with people with Prader-Willi and Down syndromes. The Repetitive Behaviour Questionnaire was administered to caregivers of adults with Williams (n = 96), Prader-Willi (n = 103) and Down (n = 78) syndromes. There were few group differences, although participants with Williams syndrome were more likely to show body stereotypies. Individuals with Williams syndrome also showed more hoarding and less tidying behaviours than those with Down syndrome. IQ and adaptive ability were negatively associated with repetitive questioning in people with Williams syndrome. The profile of repetitive behaviour amongst individuals with Williams syndrome was similar to the comparison syndromes. The cognitive mechanisms underlying these behaviours in genetic syndromes warrant further investigation.
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Affiliation(s)
- R Royston
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - C Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - J Moss
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - D Adams
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Griffith University, PO Box 3370, South Brisbane Qld 4101, Sidon Street, South Bank, QLD, Australia
| | - K Berg
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,School of Psychology, University of East London, AE 1.10, Stratford Campus, London, E15 4LZ, UK
| | - C Burbidge
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Coventry and Warwickshire Partnership NHS Trust, Wayside House, Wilsons Lane, Coventry, CV6 6NY, UK
| | - P Howlin
- Department of Psychology, King's College London, Strand, London, WC2R 2L, UK.,University of Sydney, Sydney, Australia
| | - L Nelson
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - C Stinton
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,University of Warwick, Coventry, CV4 7AL, UK
| | - J Waite
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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45
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Nelson L, Valle M, Forrest D, Klingman E, Ramm T, Farrow-Gillespie A, Spain T, Castro D, Iannaccone S. SMA THERAPIES I. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.201] [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: 10/28/2022]
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46
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O'Brien ER, Read E, Deyholos M, Nelson L. Effects of Nitric oxide Producing Bacteria Azospirillum brasilense on Microbial Composition and Secondary Metabolite Profile of Cannabis. Am J Transl Res 2018. [DOI: 10.1055/s-0038-1644915] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- ER O'Brien
- Valens Agritech, Kelowna, British Columbia, Canada
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - E Read
- Thompson Rivers University, Kamloops, British Columbia
| | - M Deyholos
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - L Nelson
- The University of British Columbia, Kelowna, British Columbia, Canada
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Stolbach A, Bebarta V, Beuhler M, Carstairs S, Nelson L, Wahl M, Wax PM, McKay C. ACMT Position Statement: Alternative or Contingency Countermeasures for Acetylcholinesterase Inhibiting Agents. J Med Toxicol 2018; 14:261-263. [PMID: 29667118 DOI: 10.1007/s13181-018-0658-4] [Citation(s) in RCA: 5] [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: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 11/25/2022] Open
Abstract
First responders and health care providers must prepare to provide care for patients poisoned by acetylcholinesterase (AchE) inhibitor chemical warfare agents or pesticides. However, pre-deployed medical countermeasures (MCMs) may not be sufficient due to production and delivery interruption, rapid depletion of contents during a response, expiration of MCM components, or lack of local availability of approved MCMs. To augment supplies of community-based and forward-deployed nerve agent countermeasures, the American College of Medical Toxicology (ACMT) supports several strategies: (1) The use of expired atropine, diazepam, and pralidoxime auto-injectors and vials if non-expired drugs are unavailable; and (2) Investigation, development, and identification of alternative countermeasures-commonly stocked drugs that are not approved for nerve agent poisoning but are in the same therapeutic class as approved drugs.
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Affiliation(s)
| | | | | | | | - Lewis Nelson
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Paul M Wax
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Charles McKay
- University of Connecticut School of Medicine, Farmington, CT, USA
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48
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Farmer BM, Hayes BD, Rao R, Farrell N, Nelson L. The Role of Clinical Pharmacists in the Emergency Department. J Med Toxicol 2018; 14:114-116. [PMID: 29075954 PMCID: PMC6013729 DOI: 10.1007/s13181-017-0634-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Brenna M Farmer
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Rama Rao
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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49
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Gonzales KL, Garcia GE, Jacob MM, Muller C, Nelson L, Manson SM. Patient-provider relationship and perceived provider weight bias among American Indians and Alaska Natives. Obes Sci Pract 2018; 4:76-84. [PMID: 29479467 PMCID: PMC5818742 DOI: 10.1002/osp4.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The objective of this study was to examine patient-provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health. Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations. Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation. Conclusion These findings point to the importance of a positive patient-provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.
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Affiliation(s)
- K. L. Gonzales
- Oregon Health Sciences University‐Portland State University School of Public HealthPortland State UniversityPortlandORUSA
| | - G. E. Garcia
- Department of SociologyPortland State UniversityPortlandORUSA
| | - M. M. Jacob
- Department of Education Studies, College of EducationUniversity of OregonEugeneORUSA
| | - C. Muller
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - L. Nelson
- Initiative for Research and Education to Advance Community HealthWashington State UniversitySeattleWAUSA
| | - S. M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado DenverAuroraCOUSA
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50
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Nelson L, Pollard H, Ames R, Jarosz B, Garbutt P, Da Costa C. A descriptive study of sports chiropractors. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.237] [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: 10/18/2022]
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