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Kajuluri LP, Lyu QR, Doja J, Kumar A, Wilson MP, Sgrizzi SR, Rezaeimanesh E, Miano JM, Morgan KG. Calponin 1 inhibits agonist-induced ERK activation and decreases calcium sensitization in vascular smooth muscle. J Cell Mol Med 2024; 28:e18025. [PMID: 38147352 PMCID: PMC10805486 DOI: 10.1111/jcmm.18025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/07/2023] [Indexed: 12/27/2023] Open
Abstract
Smooth muscle cell (SMC) contraction and vascular tone are modulated by phosphorylation and multiple modifications of the thick filament, and thin filament regulation of SMC contraction has been reported to involve extracellular regulated kinase (ERK). Previous studies in ferrets suggest that the actin-binding protein, calponin 1 (CNN1), acts as a scaffold linking protein kinase C (PKC), Raf, MEK and ERK, promoting PKC-dependent ERK activation. To gain further insight into this function of CNN1 in ERK activation and the regulation of SMC contractility in mice, we generated a novel Calponin 1 knockout mouse (Cnn1 KO) by a single base substitution in an intronic CArG box that preferentially abolishes expression of CNN1 in vascular SMCs. Using this new Cnn1 KO mouse, we show that ablation of CNN1 has two effects, depending on the cytosolic free calcium level: (1) in the presence of elevated intracellular calcium caused by agonist stimulation, Cnn1 KO mice display a reduced amplitude of stress and stiffness but an increase in agonist-induced ERK activation; and (2) during intracellular calcium depletion, in the presence of an agonist, Cnn1 KO mice exhibit increased duration of SM tone maintenance. Together, these results suggest that CNN1 plays an important and complex modulatory role in SMC contractile tone amplitude and maintenance.
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Affiliation(s)
- Lova Prasadareddy Kajuluri
- Vascular Biology Laboratory, Department of Health SciencesBoston UniversityBostonMassachusettsUSA
- Present address:
Cardiovascular Research CenterMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Qing Rex Lyu
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGeorgiaUSA
- Medical Research CenterChongqing General HospitalChongqingChina
| | - Jaser Doja
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGeorgiaUSA
| | - Ajay Kumar
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGeorgiaUSA
| | | | - Samantha R. Sgrizzi
- Vascular Biology Laboratory, Department of Health SciencesBoston UniversityBostonMassachusettsUSA
| | - Elika Rezaeimanesh
- Vascular Biology Laboratory, Department of Health SciencesBoston UniversityBostonMassachusettsUSA
| | - Joseph M. Miano
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGeorgiaUSA
| | - Kathleen G. Morgan
- Vascular Biology Laboratory, Department of Health SciencesBoston UniversityBostonMassachusettsUSA
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Thompson RG, Mullinax S, De Monte R, McBain S, Porter A, Eastin C, Landes SJ, Wilson MP. Effectiveness of a Self-Administered Computerized Mental Health Screening Tool in the Emergency Department. Psychiatr Serv 2023; 74:1180-1184. [PMID: 37161345 DOI: 10.1176/appi.ps.20220523] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The authors sought to determine the effectiveness of a self-administered computerized mental health screening tool in a general acute care emergency department (ED). METHODS Changes in patient care (diagnosis of a past-year psychiatric disorder, request for psychiatric consultation, psychiatric referral at discharge, or transfer to psychiatric facility) and patient ED return visits (3 months after discharge vs. 3 months before) were assessed among ED physicians (N=451) who received patients' computerized screening reports (N=207) and those who did not (N=244). All patients received copies of screening results. RESULTS The computerized mental health screening tool identified previously undiagnosed psychiatric problems. However, no statistically significant differences were found in physician care or patient ED return visits. CONCLUSIONS Computerized mental health screening did not result in further psychiatric diagnoses or treatment; it also did not significantly reduce patient ED return visits. Collaboration among EDs and mental health treatment agencies, organizations, and researchers is needed to facilitate appropriate treatment referrals and linkage.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Samuel Mullinax
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Robert De Monte
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Sacha McBain
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Austin Porter
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Carly Eastin
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Sara J Landes
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Michael P Wilson
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
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Makhanova A, Lambert WA, Blanchard R, Alcock J, Shattuck EC, Wilson MP. Pathogen disgust is associated with interpersonal bias among healthcare professionals. Evol Med Public Health 2023; 11:438-447. [PMID: 38022797 PMCID: PMC10667654 DOI: 10.1093/emph/eoad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives Pathogen avoidance is a fundamental motive that shapes many aspects of human behavior including bias against groups stereotypically linked to disease (e.g. immigrants, outgroup members). This link has only been examined in convenience samples and it is unknown how pathogen avoidance processes operate in populations experiencing prolonged and heightened pathogen threat such as healthcare professionals. We examined whether healthcare professionals demonstrate the same link between pathogen disgust and intergroup bias as has been documented among the general population. Methodology Participants (N = 317; 210 healthcare professionals) were recruited using snowball sampling to take an online survey. Participants completed the Three Domain Disgust Scale to assess pathogen, sexual and moral disgust. Participants then rated their perceptions of a fictitious immigrant group ('Krasneeans') and the degree to which they endorsed group-binding moral values. Results Compared to control participants, healthcare professionals reported lower levels of pathogen disgust, but not sexual or moral disgust. However, regardless of profession, higher pathogen disgust was associated with viewing Krasneeans as less likeable and more unclean. Additionally, regardless of profession, higher pathogen disgust was associated with greater endorsement of group-binding moral values, although healthcare professionals reported greater overall endorsement of group-binding moral values than did control participants. Conclusions and implications Although healthcare professionals demonstrated lower levels of pathogen disgust, they nevertheless exhibited largely the same relationship between pathogen disgust and interpersonal biases as did control participants. One practical implication of this association is that pathogen avoidance motives may contribute to inequitable patient treatment in healthcare settings.
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Affiliation(s)
- Anastasia Makhanova
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - W Allen Lambert
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - Ryan Blanchard
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - Joe Alcock
- Department of Emergency Medicine, University of New Mexico, Albuquerque NM 87131, USA
| | - Eric C Shattuck
- Department of Anthropology, Florida State University, 60 N Woodward Ave, Tallahassee FL 32304, USA
- Institute for Health Disparities Research, College for Health, Community, and Policy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Michael P Wilson
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA
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Okhawere KE, Pandav K, Grauer R, Wilson MP, Saini I, Korn TG, Meilika KN, Badani KK. Trends in the surgical management of kidney cancer by tumor stage, treatment modality, facility type, and location. J Robot Surg 2023; 17:2451-2460. [PMID: 37470910 DOI: 10.1007/s11701-023-01664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Partial nephrectomy (PN) is an alternative to radical nephrectomy (RN) in the appropriate localized renal tumor. The scope of PN has expanded over time and, since the advent and proliferation of minimally invasive surgery, more surgeons have access to and have been trained in laparoscopic and robotic technology. Amid the changing surgical landscape, we sought to characterize the trends in management by cancer stage, institution type, and geographic location using the National Cancer Database (NCDB). We queried the NCDB for patients with kidney cancer from 2004 to 2019. Overall, 241,311 patients who underwent PN or RN were included in the study. The nephrectomy approach was categorized as robotic partial (RPN), robotic radical (RRN), laparoscopic partial (LPN), laparoscopic radical (LRN), open or unspecified partial (OPN), and open or unspecified radical (ORN). The categorical variables were presented as frequency and percentages. Overall, there was an increase in the utilization of robotic approaches from 2010 to 2019. For cT1 tumors, the use of RPN and RRN increased from 14.27 to 33.06% and 5.24% to 19.63%, respectively. The use of ORN for cT2 and cT3 tumors declined, with rates dropping from 54.71 to 10.76% and 64.71 to 46.64%, respectively. Conversely, the utilization of RRN rose during this period. However, ORN remained the most common approach for cT3 tumors. The use of RPN increased across different facility types, with the highest utilization observed in academic/research programs. The use of ORN for cT2 and cT3 tumors declined across facility types, although it remained most prevalent in community cancer programs. The use of robot-assisted surgery to treat localized renal cancer increased in the US between 2010 and 2019 across all stages of disease. RPN became the most used approach for cT1 disease, while LRN was preferred for cT2 disease. ORN remained the approach of choice for cT3 disease throughout the study period. Trends in facility type and geographic location largely mirrored the overall trends.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA.
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Waliski A, Matthieu MM, Allison MK, Wilson MP, Skaggs EM, Adkins DA, Owen RR. Emergency Departments Treating Veterans for Suicide: Ensuring Quality Care for Veterans Outside of Department of Veterans Affairs Health Care Facilities. J Emerg Nurs 2023; 49:255-265. [PMID: 36653229 DOI: 10.1016/j.jen.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Veterans die by suicide at higher rates than nonveterans. Given that the emergency department is often the first point of entry to healthcare following a suicide attempt, it would be beneficial for community providers to have knowledge of the characteristics, medical issues, and effective treatments most often associated with those having served in the military to ensure guideline concordant and quality suicide care. This study aimed to identify assessment and referral practices of emergency departments at rural community hospitals related to care for suicidal veterans and explore the feasibility and acceptability of identifying veterans in need of postdischarge aftercare. METHODS This qualitative exploratory study involved content analysis of semistructured interviews. Ten emergency clinicians from 5 rural Arkansas counties with high suicide rates were interviewed about their experiences working with suicidal patients within the emergency department and perceptions of assessment, management, and referral practices. RESULTS Although most of the emergency departments had a process for assessing for suicide risk, emergency clinicians did not always feel confident in their knowledge of assessing and caring for suicidal patients. Military history was not included in assessment, treatment, or aftercare planning, nor were brief interventions such as safety planning or lethal means safety education provided. DISCUSSION Best practices for suicide assessment and management of veterans exist; however, challenges specific to the emergency department regarding staff training and engaging the community to effectively link at-risk veterans to needed care hinder implementation. Veteran-inclusive assessment and intervention practices could enhance the quality of care provided in community emergency departments.
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Ruiz M, Wilson MP, Randhawa S, Low G. Incidental maternal findings on fetal MRI. Clin Radiol 2023; 78:356-361. [PMID: 36890014 DOI: 10.1016/j.crad.2023.02.003] [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: 11/07/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
AIM To evaluate the type and frequency of maternal findings incidentally identified during fetal magnetic resonance imaging (MRI). MATERIALS AND METHODS A retrospective single-centre study was undertaken which included all consecutive fetal MRI studies performed between July 2017 and May 2021 at a tertiary institution. Two fellowship-trained radiologists reviewed the studies independently to determine the type and frequency of incidental maternal findings of both no clinical significance (requiring no further follow-up) and of clinical significance (requiring further follow-up, work-up, and/or management). Differences in acquisition were resolved by two-reader consensus. Non-diagnostic MRI examinations or abdominal MRI examinations indicated for maternal complications were excluded from review. RESULTS A total of 455 consecutive fetal MRI examinations performed in 429 women were included. Mean age was 30 years (SD 5.5 years). At least one incidental maternal finding was identified in 58% (265/455) of studies. Umbilical hernias (35%), maternal hydronephrosis (19%), and maternal hydro-ureter (15%) were the most common. Only two studies (0.5%) showed clinically significant incidental maternal findings (pancreatic pseudocyst and ovarian cyst). CONCLUSIONS Incidental maternal findings are common on fetal MRI but rarely require further follow-up, work-up, and/or management.
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Affiliation(s)
- M Ruiz
- Department of Radiology and Diagnostic Imaging, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada.
| | - M P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - S Randhawa
- Department of Radiology and Diagnostic Imaging, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - G Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
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Wilson MP, Craig L, Peacock E, Williams L, Fields T, Roberts S, Sarpong D, Krousel-Wood M. Using diverse community feedback to inform inclusive community action: Insights from the Louisiana Community Engagement Alliance. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00551-7] [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: 01/28/2023]
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Wilson MP, Hamrick E, Stiebel V, Nordstrom K. Contemporary Practices for Medical Evaluation of the Psychiatric Patient in the Emergency Department. Focus (Am Psychiatr Publ) 2023; 21:28-34. [PMID: 37205042 PMCID: PMC10172537 DOI: 10.1176/appi.focus.20220063] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although emergency department (ED) visits for patients with mental illness are frequent, medical evaluation (i.e., "medical screening") of patients presenting with psychiatric complaints is inconsistent. This may largely be related to differing goals for medical screening, which often vary according to specialty. Although emergency physicians typically focus on stabilization of life-threatening diseases, psychiatrists tend to believe that care in the ED is more comprehensive, which often places the two fields at odds. The authors discuss the concept of medical screening, review the literature on this topic, and offer a clinically oriented update to the 2017 American Association for Emergency Psychiatry consensus guidelines on medical evaluation of the adult psychiatric patient in the ED.
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Affiliation(s)
- Michael P Wilson
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Edward Hamrick
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Victor Stiebel
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Kimberly Nordstrom
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
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Okhawere KE, Beksac AT, Wilson MP, Korn TG, Meilika KN, Harrison R, Morgantini L, Ahmed M, Mehrazin R, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Kaouk J, Crivellaro S, Badani KK. A Propensity-Matched Comparison of the Perioperative Outcomes Between Single-Port and Multi-Port Robotic Assisted Partial Nephrectomy: A Report from the Single Port Advanced Research Consortium (SPARC). J Endourol 2022; 36:1526-1531. [PMID: 36053713 DOI: 10.1089/end.2022.0115] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Single-port (SP) robotic surgery is a new technology and early in its adoption curve. The goal of this study is to compare the perioperative outcomes of SP to multi-port (MP) robotic technology for partial nephrectomy. Materials and Methods: This is a prospective cohort study of patients who have undergone robot-assisted partial nephrectomy using SP and MP technology. Baseline demographic, clinical, and tumor-specific characteristics and perioperative outcomes were compared using χ2, t-test, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. Results: After propensity matching, 146 SP patients were matched with 146 MP patients. SP and MP groups had similar mean age (58 ± 12 years vs 59 ± 12 years; p = 0.606) and proportion of men (54.11% vs 52.05%; p = 0.725). The SP had a longer mean ischemia (18.29 ± 10.49 minutes vs 13.79 ± 6.29 minutes; p < 0.001). Estimated blood loss (EBL) and length of hospital stay (LOS), operative time, positive margin rate, and any complication rate were similar between the two groups. Conclusions: SP partial nephrectomy had a longer ischemia time, and a comparable LOS, EBL, operative time, positive margin rates, and complication rates to MP. These early data are encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared with the standard MP technique.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Harrison
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Luca Morgantini
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, Pennsylvania, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami, Florida, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Im DD, Scott KW, Venkatesh AK, Lobon LF, Kroll DS, Samuels EA, Wilson MP, Zeller S, Zun LS, Clifford KC, Zachrison KS. A Quality Measurement Framework for Emergency Department Care of Psychiatric Emergencies. Ann Emerg Med 2022; 81:592-605. [PMID: 36402629 DOI: 10.1016/j.annemergmed.2022.09.007] [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] [Received: 07/02/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022]
Abstract
As a primary access point for crisis psychiatric care, the emergency department (ED) is uniquely positioned to improve the quality of care and outcomes for patients with psychiatric emergencies. Quality measurement is the first key step in understanding the gaps and variations in emergency psychiatric care to guide quality improvement initiatives. Our objective was to develop a quality measurement framework informed by a comprehensive review and gap analysis of quality measures for ED psychiatric care. We conducted a systematic literature review and convened an expert panel in emergency medicine, psychiatry, and quality improvement to consider if and how existing quality measures evaluate the delivery of emergency psychiatric care in the ED setting. The expert panel reviewed 48 measures, of which 5 were standardized, and 3 had active National Quality Forum endorsement. Drawing from the measure appraisal, we developed a quality measurement framework with specific structural, process, and outcome measures across the ED care continuum. This framework can help shape an emergency medicine roadmap for future clinical quality improvement initiatives, research, and advocacy work designed to improve outcomes for patients presenting with psychiatric emergencies.
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Abstract
OBJECTIVE The emergency department (ED) is an important site for suicide prevention efforts, and safety planning has been identified as a best practice for suicide prevention among ED patients at increased suicide risk. However, few ED clinicians are prepared to assess suicide risk or guide patients in the creation of safety plans. This study was a pilot randomized controlled trial of the feasibility, acceptability, and preliminary effects of safety planning by individuals with lived experience of suicide attempt or of severe suicidal ideation but without medical training (i.e., peers) in the ED. METHODS Patients at risk for suicide in a general ED were randomly assigned to receive peer-delivered or mental health provider–delivered safety planning. Intervention feasibility measures included ED length of stay, safety plan completeness, and safety plan quality. Acceptability measures included patient satisfaction. Preliminary effects were assessed as number of ED returns within the 3 months after the ED visit. RESULTS Data from 31 participants were available for analysis. Compared with participants with provider-delivered safety planning, participants with peer-delivered safety planning had similar ED lengths of stay, higher safety plan completeness, and higher safety plan quality. Acceptability of the safety planning process was similar for the two groups. Compared with participants receiving provider-delivered safety planning, participants receiving peer-delivered planning had significantly fewer ED visits during the subsequent 3 months than during the 3 months preceding the ED visit. CONCLUSIONS Peer-delivered safety planning is feasible and acceptable and may result in fewer return ED visits. These findings provide preliminary support for peer-delivered safety planning in the ED.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Angie Waliski
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Ronald G Thompson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
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12
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Stone NN, Wilson MP, Griffith SH, Immerzeel J, Debruyne F, Gorin MA, Brisbane W, Orio PF, Kim LS, Stone JJ. Remote surgical education using synthetic models combined with an augmented reality headset. Surg Open Sci 2022; 10:27-33. [PMID: 35866070 PMCID: PMC9294657 DOI: 10.1016/j.sopen.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The objective was to investigate the use of an augmented reality headset to remotely train clinicians on medical devices using anatomic models. Design Disease-specific phantoms were developed to train physicians in mpMRI-guided fusion prostate biopsy, brachytherapy, and rectal spacer insertion. Training was remotely demonstrated using 1-way virtual video conferencing format. Participants responded to an educational content survey. A heads-up display with software and augmented reality was used for remote 2-way training with the proctor and student using on their own phantoms. Setting The virtual video meeting took place during a prostate cancer conference in 2020, while the augmented reality training occurred in 2021. The proctor and student wore a heads-up display containing a projector and webcam where the ultrasound image was displayed onto a see-through optic along with the physician's hands. The heads-up display allowed the proctor to teach by line-of-sight while the student watched and repeated the steps. Participants Faculty with expertise with the medical devices used in these procedures provided training to urologists unfamiliar with these techniques. Results Participants responded that the 1-way training on the phantoms was realistic and mimicked human tissue. A total of 70.9% requested more training or training on the phantoms. The remote training platform was successfully beta tested at the 2 locations in transperineal prostate biopsy and rectal spacer insertion. Conclusion Remote training using augmented reality eliminates the need for travel. For training programs and workshops, this technology may mitigate the risk of infectious exposures, reduce training cost, and increase proctor availability, allowing training from their own institution or clinic. This investigation qualifies for the Accreditation Council for Graduate Medical Education competency in medical knowledge. Disease and medical device specific simulation phantoms improve surgeons' skills. Hands-on training using phantoms can be accomplished with both instructor and student at different locations. A dedicated headset containing display optics and a webcam allows “line-of sight” instruction. Broadcasting of proctor to student and student to proctor content is optimized with specialized telecasting software which organizes the video feeds vertically.
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Affiliation(s)
- Nelson N. Stone
- Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY
- Corresponding author at: 1355 1st Ave, 2FL, New York, NY 10021. Tel.: + 1 845 323 1727.
| | | | | | | | | | - Michael A. Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wayne Brisbane
- Department of Urology, University of Florida Health, Gainesville, FL
| | - Peter F. Orio
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA
| | | | - Jonathan J. Stone
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY
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13
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Gursahani K, Char D, Wilson MP, Poirier RF. Emergency Department Management of Suicidal Ideation: Challenges, Misperceptions, and Hope. Mo Med 2022; 119:437-443. [PMID: 36337996 PMCID: PMC9616452] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Behavioral crises continue to escalate across the United States. Our country has one of the highest suicide rates amongst developed nations. More than 45,000 U.S. citizens are dying annually now from suicide. Many with suicidal ideation seek care in Emergency Departments in hospital systems under resourced to handle this growing public health crisis. Evidenced-based screening, risk stratification, and treatment continues to evolve and is not standardized. Improved suicide education needs to be more broadly applied across healthcare and society. Missouri as a state is making concentrated efforts to improve resources and care for those with suicidal ideation. Many challenges need to be overcome and time will tell if new statewide initiatives will reduce Missouri's high rate of suicide.
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Affiliation(s)
- Kamal Gursahani
- Vice Chair for Education, and Associate Professor, Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas Char
- Associate Vice Chair for Faculty Development, and Professor, Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael P Wilson
- Assistant Professor, Department of Psychiatry, Department of Emergency Medicine, at the University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Robert F Poirier
- Chief of Clinical Operations and Associate Professor of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
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14
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Coralic Z, Rader ES, Vinson DR, Wilson MP. Haloperidol Versus Ziprasidone With Concomitant Medications and Other Predictors of Physical Restraint Duration in the Emergency Department. J Emerg Med 2022; 62:636-647. [PMID: 35361510 DOI: 10.1016/j.jemermed.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/09/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with severe agitation are frequently encountered in the emergency department (ED). At times, these patients are physically restrained and given calming medications; however, little is known about the effects of medications and other predictors on restraint duration. OBJECTIVE Our aim was to compare restraint duration when haloperidol or ziprasidone was used as the primary antipsychotic with or without concomitant medications, and to identify predictors of restraint duration. METHODS We performed a review of a retrospective cohort of physically restrained ED patients between January 1, 2013 and November 30, 2017. An unadjusted analysis and adjusted linear regression model were used to evaluate the effect of antipsychotic choice on restraint duration, controlling for sex, age, race, homelessness, arrival in restraints, re-restraint during visit, concomitant medications (i.e., benzodiazepines or anticholinergics), additional medications given during restraint, time of day, and patient disposition. RESULTS In 386 patients (319 haloperidol, 67 ziprasidone), the average restraint duration was 2.4 h (95% confidence interval [CI] 2.2 to 2.6 h). There were no differences in physical restraint times between ziprasidone and haloperidol groups in the unadjusted (mean difference 0.12 h; 95% CI -0.42 to 0.66 h) or adjusted analyses (-12.7%; 95% CI -33.9% to 8.6%). Haloperidol given with diphenhydramine alone was associated with decreased restraint duration (-30.8%; 95% CI -50.6% to -11.1%) The largest association with restraint duration was administration of additional sedating medications during restraint, prolonging restraint by 62% (95% CI 27.1% to 96.9%). In addition, compared with White patients, Black patients spent significantly more time restrained (mean difference 33.9%; 95% CI 9.0% to 58.9%). CONCLUSIONS Restraint duration of agitated ED patients was similar when haloperidol or ziprasidone was used as the primary antipsychotic. However, race and additional medications given during restraint were significantly associated with restraint duration.
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Affiliation(s)
- Zlatan Coralic
- Department of Pharmacy, University of California San Francisco, San Francisco, California; Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | | | - David R Vinson
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California; Division of Research, Kaiser Permanente, Oakland, California
| | - Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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15
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Abstract
Behavioral emergencies in the United States have been increasing, with some studies reporting a doubling in the number of people experiencing symptoms related to mental health conditions, although overall visits to US emergency departments (EDs) decreased during the coronavirus disease 2019 (COVID-19) pandemic. The uncertainty surrounding the COVID-19 pandemic caused many people to avoid health care facilities, including EDs, even if they may have otherwise sought emergency care, and was associated with increases in new behavioral health diagnoses. Measures to limit the spread of COVID-19 led to people limiting their in-person contact with others, likely exacerbating preexisting mental health issues.
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Affiliation(s)
- Manuel G Alvarez Romero
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #584, Little Rock, AR 72205, USA
| | - Chandra Penthala
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #584, Little Rock, AR 72205, USA
| | - Scott L Zeller
- Department of Psychiatry, University of California-Riverside, Riverside, CA, USA; Acute Psychiatry, Vituity, Emeryville, CA, USA.
| | - Michael P Wilson
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #584, Little Rock, AR 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #584, Little Rock, AR 72205, USA
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16
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Porter A, Brown CC, Tilford JM, Cima M, Zohoori N, McCormick D, Wilson MP, Amick BC, Romero JR. Association of the COVID-19 pandemic and dying at home due to ischemic heart disease. Prev Med 2021; 153:106818. [PMID: 34599924 PMCID: PMC8480010 DOI: 10.1016/j.ypmed.2021.106818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been associated with a declining volume of patients seen in the emergency department. Despite the need for seeking urgent care for conditions such as myocardial infarction, many people may not seek treatment. This study seeks to measure associations between the COVID-19 pandemic and location of death among individuals who died from ischemic heart disease (IHD). Data obtained from death certificates from the Arkansas Department of Health was used to conduct a difference-in-difference analysis to assess whether decedents of IHD were more likely to die at home during the pandemic (March 2020 through September 2020). The analysis compared location of death for decedents of IHD pre and during the pandemic to location of death for decedents from non-natural causes. Before the pandemic, 50.0% of decedents of IHD died at home compared to 57.9% dying at home during (through September 2020) the pandemic study period (p < .001). There was no difference in the proportion of decedents who died at home from non-natural causes before and during the pandemic study period (55.8% vs. 53.5%; p = .21). After controlling for confounders, there was a 48% increase in the odds of dying at home from IHD during the pandemic study period (p < .001) relative to the change in dying at home due to non-natural causes. During the study period, there was an increase in the proportion of decedents who died at home due to IHD. Despite the ongoing pandemic, practitioners should emphasize the need to seek urgent care during an emergency.
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Affiliation(s)
- Austin Porter
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Arkansas Department of Health, Little Rock, AR 72205, United States of America.
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Michael Cima
- Arkansas Department of Health, Little Rock, AR 72205, United States of America
| | - Namvar Zohoori
- Arkansas Department of Health, Little Rock, AR 72205, United States of America; Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Donald McCormick
- Arkansas Department of Health, Little Rock, AR 72205, United States of America
| | - Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Benjamin C Amick
- Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - José R Romero
- Arkansas Department of Health, Little Rock, AR 72205, United States of America; Pediatric Infectious Diseases Section, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72205, United States of America
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17
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Thompson RG, Oliveto A, Thostenson JD, Wilson MP, McGaugh J, Mancino MJ. Utility of a controlled amphetamine withdrawal paradigm among adults who use methamphetamine: A pilot clinical trial. J Psychopharmacol 2021; 35:1420-1430. [PMID: 34697965 PMCID: PMC10110391 DOI: 10.1177/02698811211050563] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The continued increase in prevalence of methamphetamine use in the United States has resulted in a significant increase in the number of patients entering treatment for methamphetamine use. However, no robustly efficacious pharmacologic treatment for methamphetamine use or withdrawal has been identified to date after stopping methamphetamine use. AIMS Given the association between methamphetamine withdrawal and relapse during early treatment, this study tested a controlled d-amphetamine withdrawal paradigm among methamphetamine-using individuals. METHODS Treatment-seeking adults who used methamphetamine (N = 34; 47% female; 100% white) were enrolled in a 4-week, randomized, double-blind, placebo-controlled trial in a residential setting, in which all participants were maintained on d-amphetamine (30 mg BID) during week 1, then half were switched to placebo during weeks 2-3. All participants received placebo during week 4. Outcomes included vital signs, withdrawal, cravings for methamphetamine, mood, and cognition. Bivariate analyses tested treatment group differences on baseline demographic and outcome variables. Repeated measures models examined main and interaction effects of treatment over time. RESULTS/OUTCOMES Participants were successfully randomized and safely stabilized on d-amphetamine. Craving for methamphetamine increased during weeks 2-3 in the placebo group relative to those on d-amphetamine. Interactions with age and heart rate were noted. CONCLUSIONS/INTERPRETATION To our knowledge, this is the first double-blind, placebo-controlled trial measuring pharmacologic effects of abruptly stopping controlled d-amphetamine administration in adults who use methamphetamine. Results support the potential of this withdrawal paradigm to further examine the efficacy of pharmacologic agents in ameliorating methamphetamine withdrawal symptoms.
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Affiliation(s)
- Ronald G Thompson
- Center for Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alison Oliveto
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeff D Thostenson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael P Wilson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Janette McGaugh
- Ouachita Behavioral Health and Wellness, Hot Springs, AR, USA
| | - Michael J Mancino
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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18
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Badani KK, Okhawere KE, Chen T, Korn TG, Razdan S, Meilika KN, Wilson MP, Tomy T, Ucpinar B, Kyprianou N, Dogra N. SARS-CoV-2 RNA Detected in Abdominal Insufflation Samples During Laparoscopic Surgery. Eur Urol 2021; 81:125-127. [PMID: 34794853 PMCID: PMC8552661 DOI: 10.1016/j.eururo.2021.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Cancer Institute at Mount Sinai, New York, NY, USA.
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tina Chen
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tara Tomy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Cancer Institute at Mount Sinai, New York, NY, USA; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Navneet Dogra
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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19
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Wilson MP, Kaur J, Blake L, Oliveto AH, Thompson RG, Pyne JM, Wolf L, Walker AP, Waliski AD, Nordstrom K. Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review. Am J Emerg Med 2021; 50:553-560. [PMID: 34547697 DOI: 10.1016/j.ajem.2021.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/05/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. METHODS This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. RESULTS Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. CONCLUSIONS Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Jaskiran Kaur
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lindsay Blake
- Academic Affairs, UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeffrey M Pyne
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, Illinois
| | - A Paige Walker
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Angela D Waliski
- Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare System, Little Rock, AR, United States of America
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
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20
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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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21
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Allison Schneider BS, Samuel Mullinax BA, Oliveto AH, Acheson A, Wilson MP. In reply: Bias risk in systematic reviews. Am J Emerg Med 2021; 45:600-601. [PMID: 33390297 DOI: 10.1016/j.ajem.2020.12.035] [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: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- B S Allison Schneider
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - B A Samuel Mullinax
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Center for Addiction Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ashley Acheson
- Center for Addiction Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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22
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Schneider A, Mullinax S, Hall N, Acheson A, Oliveto AH, Wilson MP. Intramuscular medication for treatment of agitation in the emergency department: A systematic review of controlled trials. Am J Emerg Med 2020; 46:193-199. [PMID: 33071100 DOI: 10.1016/j.ajem.2020.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Severely agitated patients in the emergency department (ED) are often sedated with intramuscularly-administered medications. The evidence base underlying particular medication choices is surprisingly sparse, as existing reviews either have methodological limitations or have included data collected outside of emergent settings. OBJECTIVES The objective of this review was to examine all controlled trials in emergent settings that have used standardized scales to measure the effectiveness of intramuscular medication for the treatment of acute agitation. METHODS This review was registered in Prospero as CRD42018105745. PubMed, International Pharmaceutical Abstracts, Web of Science, PsycINFO, and clinicaltrials.gov were searched for prospective controlled trials investigating intramuscular antipsychotics for agitation. Articles were assessed for bias across five domains using the revised Cochrane Risk of Bias Tool. RESULTS Eight studies were eligible for inclusion in the systematic review, none of which had a low risk of bias. Five studies had a moderate risk of bias with heterogenous designs, populations, and treatments. These studies seemed to suggest that second generation antipsychotics (SGAs) likely reduce agitation as effectively as first generation antipsychotics (FGAs) plus an adjunctive medication with similar or lower risk of side effects. CONCLUSIONS Existing trials on the use of intramuscular antipsychotics in the ED/psychiatric ED setting were small, heterogenous, and at a moderate or high risk of bias. Given the clinical importance of this topic, further prospective investigations are desperately needed but are currently unfeasible under Food and Drug Administration Exception From Informed Consent regulations.
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Affiliation(s)
- Allison Schneider
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Samuel Mullinax
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Nathanael Hall
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ashley Acheson
- Center for Addiction Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Center for Addiction Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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Roppolo LP, Morris DW, Khan F, Downs R, Metzger J, Carder T, Wong AH, Wilson MP. Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation). J Am Coll Emerg Physicians Open 2020; 1:898-907. [PMID: 33145538 PMCID: PMC7593430 DOI: 10.1002/emp2.12138] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022] Open
Abstract
Agitated patients presenting to the emergency department (ED) can escalate to aggressive and violent behaviors with the potential for injury to themselves, ED staff, and others. Agitation is a nonspecific symptom that may be caused by or result in a life-threatening condition. Project BETA (Best Practices in the Evaluation and Treatment of Agitation) is a compilation of the best evidence and consensus recommendations developed by emergency medicine and psychiatry experts in behavioral emergencies to improve our approach to the acutely agitated patient. These recommendations focus on verbal de-escalation as a first-line treatment for agitation; pharmacotherapy that treats the most likely etiology of the agitation; appropriate psychiatric evaluation and treatment of associated medical conditions; and minimization of physical restraint/seclusion. Implementation of Project BETA in the ED can improve our ability to manage a patient's agitation and reduce the number of physical assaults on ED staff. This article summarizes the BETA guidelines and recent supporting literature for managing the acutely agitated patient in the ED followed by a discussion of how a large county hospital integrated these recommendations into daily practice.
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Affiliation(s)
- Lynn P. Roppolo
- University of Texas Southwestern Medical CenterDepartment of Emergency MedicineDallasTexasUSA
| | - David W. Morris
- University of Texas Southwestern Medical CenterDepartment of PsychiatryDallasTexasUSA
| | - Fuad Khan
- University of Texas Southwestern Medical CenterDepartment of PsychiatryDallasTexasUSA
| | - Rohini Downs
- Parkland Memorial HospitalPharmacy ServicesDallasTexasUSA
| | - Jeffery Metzger
- University of Texas Southwestern Medical CenterDepartment of Emergency MedicineDallasTexasUSA
| | - Tiffany Carder
- Parkland Memorial HospitalEmergency Services DepartmentDallasTexasUSA
| | - Ambrose H. Wong
- Yale School of MedicineDepartment of Emergency MedicineNew HavenConnecticutUSA
| | - Michael P. Wilson
- University of Arkansas for Medical SciencesDepartment of Emergency MedicineLittle RockArkansasUSA
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Wilson MP, Katlariwala P, Low G. Potential implications of novel coronavirus disease (COVID-19) related gastrointestinal symptoms for abdominal imaging. Radiography (Lond) 2020; 26:274. [PMID: 32387085 PMCID: PMC7252126 DOI: 10.1016/j.radi.2020.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 12/21/2022]
Affiliation(s)
- M P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, Alberta, Canada.
| | - P Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, Alberta, Canada.
| | - G Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, Alberta, Canada.
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Wilson MP, Coulden RA, Low G. COVID-19-related cardiac involvement and potential implications for cardiothoracic imaging. Clin Radiol 2020; 75:476-477. [PMID: 32331780 PMCID: PMC7165293 DOI: 10.1016/j.crad.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022]
Affiliation(s)
- M P Wilson
- University of Alberta, Edmonton, Alberta, Canada.
| | - R A Coulden
- University of Alberta, Edmonton, Alberta, Canada
| | - G Low
- University of Alberta, Edmonton, Alberta, Canada
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Wong AH, Roppolo LP, Chang BP, Yonkers KA, Wilson MP, Powsner S, Rozel JS. Management of Agitation During the COVID-19 Pandemic. West J Emerg Med 2020; 21:795-800. [PMID: 32726244 PMCID: PMC7390577 DOI: 10.5811/westjem.2020.5.47789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the coronavirus SARS-CoV-2 has radically altered delivery of care in emergency settings. Unprecedented hardship due to ongoing fears of exposure and threats to personal safety, along with societal measures enacted to curb disease transmission, have had broad psychosocial impact on patients and healthcare workers alike. These changes can significantly affect diagnosing and managing behavioral emergencies such as agitation in the emergency department. On behalf of the American Association for Emergency Psychiatry, we highlight unique considerations for patients with severe behavioral symptoms and staff members managing symptoms of agitation during COVID-19. Early detection and treatment of agitation, precautions to minimize staff hazards, coordination with security personnel and psychiatric services, and avoidance of coercive strategies that cause respiratory depression will help mitigate heightened risks to safety caused by this outbreak.
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Affiliation(s)
- Ambrose H. Wong
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Lynn P. Roppolo
- University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas
| | - Bernard P. Chang
- Columbia University, Irving Medical Center, Department of Emergency Medicine, New York, New York
| | - Kimberly A. Yonkers
- Yale School of Medicine, Department of Psychiatry, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut
| | - Michael P. Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Department of Psychiatry, Little Rock, Arkansas
| | - Seth Powsner
- Yale School of Medicine, Department of Psychiatry, Department of Emergency Medicine New Haven, Connecticut
| | - John S. Rozel
- University of Pittsburgh School of Law and School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
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Tucci V, Calvo JA, Moukaddam N, Waheed A, Wilson MP. Psychiatric Emergencies for Clinicians: Emergency Department Management of Acute Drug-Induced Akathisia. J Emerg Med 2020; 58:922-926. [PMID: 32362371 DOI: 10.1016/j.jemermed.2020.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/19/2020] [Accepted: 03/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Veronica Tucci
- Emergency Medicine and Research, William Carey University College of Medicine, Hattiesburg, Mississippi
| | - Joseph A Calvo
- Emergency Medicine Residency, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, Illinois
| | - Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Abdul Waheed
- HCA West Florida GME Consortium, Oak Hill Hospital Emergency Medicine Residency, Brooksville, Florida
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Wilson MP, Worrall F, Davies RJ, Hart A. A dynamic baseline for dissolved methane in English groundwater. Sci Total Environ 2020; 711:134854. [PMID: 31818574 DOI: 10.1016/j.scitotenv.2019.134854] [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] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
Elevated dissolved methane (CH4) concentrations in groundwater are an environmental concern associated with hydraulic fracturing for shale gas. Therefore, determining dissolved CH4 baselines is important for detecting and understanding any potential environmental impacts. Such baselines should change in time and space to reflect ongoing environmental change and should be able to predict the probability that a change in dissolved CH4 concentration has occurred. We considered four dissolved CH4 concentration datasets of English groundwater using a Bayesian approach: two national datasets and two local datasets from shale gas exploration sites. The most sensitive national dataset (the previously published British Geological Survey CH4 baseline) was used as a strong prior for a larger (2153 measurements compared to 439) but less sensitive (detection limit 1000 times higher) Environment Agency dataset. The use of the strong prior over a weak prior improved the precision of the Environment Agency dataset by 75%. The expected mean dissolved CH4 concentration in English groundwater based on the Bayesian approach is 0.24 mg/l, with a 95% credible interval of 0.11 to 0.45 mg/l, and a Weibull distribution of W(0.35 ± 0.01, 0.34 ± 0.16). This result indicates the amount of CH4 degassing from English groundwater to the atmosphere equates to between 0.7 and 3.1 kt CH4/year, with an expected value of 1.65 kt CH4/year and a greenhouse gas warming potential of 40.3 kt CO2eq/year. The two local monitoring datasets from shale gas exploration sites, in combination with the national datasets, show that dissolved CH4 concentrations in English groundwater are generally low, but locations with concentrations greater than or equal to the widely used risk action level of 10.0 mg/l do exist. Statistical analyses of groundwater redox conditions at these locations suggest that it may be possible to identify other locations with dissolved CH4 concentrations ≥10.0 mg/l using redox parameters such as Fe concentration.
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Affiliation(s)
- M P Wilson
- Department of Earth Sciences, Durham University, Science Labs, Durham DH1 3LE, UK.
| | - F Worrall
- Department of Earth Sciences, Durham University, Science Labs, Durham DH1 3LE, UK
| | - R J Davies
- School of Natural and Environmental Sciences, Newcastle University, Newcastle NE1 7RU, UK
| | - A Hart
- Environment Agency, Research Assessment and Evaluation, Sapphire East, Streetsbrook Road, Solihull B91 1QT, UK
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Wilson MP, Moutier C, Wolf L, Nordstrom K, Schulz T, Betz ME. ED recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature. Am J Emerg Med 2020; 38:571-581. [DOI: 10.1016/j.ajem.2019.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/28/2023] Open
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Chalmers CE, Mullinax S, Brennan J, Vilke GM, Oliveto AH, Wilson MP. Corrigendum to “Screening Tools Validated in the Outpatient Pain Management Setting Poorly Predict Opioid Misuse in the Emergency Department: A Pilot Study” [J Emerg Med. 2019;56(6):601–10]. J Emerg Med 2020; 58:174. [PMID: 37046426 DOI: 10.1016/j.jemermed.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med 2019; 75:136-145. [PMID: 31563402 DOI: 10.1016/j.annemergmed.2019.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022]
Abstract
Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.
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Affiliation(s)
- Christina Shenvi
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
| | - Maura Kennedy
- Massachusetts General Hospital Department of Emergency Medicine and Harvard Medical School, Boston, MA
| | - Charles A Austin
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, AR
| | - Michael Gerardi
- Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ; Coalition on Psychiatric Emergencies
| | - Sandy Schneider
- American College of Emergency Physicians, Irving, TX; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX; Hofstra Northwell School of Medicine, Hempstead, NY
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Vilke GM, Mash DC, Pardo M, Bozeman W, Hall C, Sloane C, Wilson MP, Coyne CJ, Xie X, Castillo EM. EXCITATION study: Unexplained in-custody deaths: Evaluating biomarkers of stress and agitation. J Forensic Leg Med 2019; 66:100-106. [PMID: 31252195 DOI: 10.1016/j.jflm.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Law enforcement personnel often confront violent and dangerous individuals suffering from Excited Delirium Syndrome (ExDS) who need emergent medical evaluation and treatment to optimize the best outcomes for this potentially lethal medical emergency. These subjects typically require physical restraint and use of force measures to control them. We sought to determine if stress-related biomarkers can differentiate ExDS subjects when compared with agitation and stress under other circumstances, including agitation and extreme physical exhaustion and restraint coupled with emotional stressors. METHODS This was a prospective multi-center study enrolling a convenience sample of patients who presented with agitation or ExDS. Patients were enrolled from three academic emergency departments (ED), two in the United States and one in Canada. Three study groups (SG) included: SG1) patients brought to the ED with ExDS based on the use of standardized clinical criteria; SG2) ED patients with acute agitation who were not in a clinical state of ExDS but required sedation; SG3) a laboratory control group of subjects exercised to physical exhaustion, restrained, and psychologically stressed with threat of Conducted Energy Device (CED) activation. We examined a panel of stress-related biomarkers, including norepinephrine (NE), cortisol, copeptin, orexin A, and dynorphin (Dyn) from the blood of enrolled subjects. RESULTS A total of 82 subjects were enrolled: 31 in the agitation group, 21 in the ExDS group, and 30 in the laboratory control group. Data were analyzed, comparing the findings between ExDS and the two other groups to determine if specific stress-related biomarkers are associated with ExDS. Biomarker comparisons between subjects identified with ExDS, agitation, and control groups demonstrated that cortisol levels were more elevated in the ExDS group compared with the other groups. Orexin was only significant in ExDs (with Agitated tendency but lot of variability in the group). NE and Dyn increased as response to stress in Agitated and ExDS. CONCLUSIONS Cortisol levels were more elevated in subjects in the ExDS group compared with the other comparison groups and orexin was elevated in ExDS compared to controls, a trend that did not reach statistical significance in the agitated group. The clinical or diagnostic significance of these difference have yet to be defined and warrants further study.
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Affiliation(s)
- Gary M Vilke
- University of California, San Diego Medical Center, Department of Emergency Medicine, San Diego, CA, USA.
| | - Deborah C Mash
- University of Miami Miller School of Medicine, Department of Neurology and Molecular and Cellular Pharmacology, Miami, FL, USA
| | - Marta Pardo
- University of Miami Miller School of Medicine, Department of Neurology and Molecular and Cellular Pharmacology, Miami, FL, USA
| | - William Bozeman
- Wake Forest University School of Medicine, Department of Emergency Medicine, Winston Salem, NC, USA
| | - Christine Hall
- University of British Columbia, Department of Emergency Medicine, Island Health, Victoria, Canada
| | - Christian Sloane
- University of California, San Diego Medical Center, Department of Emergency Medicine, San Diego, CA, USA
| | | | - Christopher J Coyne
- University of California, San Diego Medical Center, Department of Emergency Medicine, San Diego, CA, USA
| | - Xiaobin Xie
- University of Miami Miller School of Medicine, Department of Neurology and Molecular and Cellular Pharmacology, Miami, FL, USA
| | - Edward M Castillo
- University of California, San Diego Medical Center, Department of Emergency Medicine, San Diego, CA, USA
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Wilson MP, Cucciare MA, Porter A, Chalmers CE, Mullinax S, Mancino M, Oliveto AH. The utility of a statewide prescription drug-monitoring database vs the Current Opioid Misuse Measure for identifying drug-aberrant behaviors in emergency department patients already on opioids. Am J Emerg Med 2019; 38:503-507. [PMID: 31221474 DOI: 10.1016/j.ajem.2019.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The most recent guidelines on prescribing opioids from the United States Centers for Disease Control recommend that clinicians not prescribe opioids as first-line therapy for chronic non-cancer pain. If an opioid prescription is considered for a patient already on opioids, prescribers are encouraged to check the statewide prescription drug monitoring database (PDMP). Some additional guidelines recommend screening tools such as the Current Opioid Misuse Measure (COMM) which may also help identify drug-aberrant behaviors. OBJECTIVE To compare the PDMP and the Current Opioid Misuse Measure (COMM), a commonly-recommended screening tool for patients on opioids, in detecting drug-aberrant behaviors in patients already taking opioids at the time of ED presentation. METHODS Patients on opioids were enrolled prospectively in a mixed urban-suburban ED seeing approximately 65,000 patients per year. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratios of the PDMP and COMM were compared against objective criteria of drug-aberrant behaviors as documented in the electronic medical record (EMR) and medical examiner databases. RESULTS Compared to the COMM, the PDMP had similar sensitivity (36% vs 45%) and similar specificity (79% vs 55%), but better positive predictive value, better negative predictive value, and better diagnostic odds ratio. The combination of the PDMP and the COMM did not improve the detection of drug-aberrant behaviors. CONCLUSIONS The PDMP alone is a more useful as a screening instrument than either the COMM or the combination of the PDMP plus COMM in patients already taking opioids at time of ED presentation. However, the PDMP misses a majority of patients with documented drug-aberrant behaviors in the EMR, and should not be used in isolation to justify whether a particular opioid prescription is appropriate.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205 USA
| | - Austin Porter
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Arkansas Department of Health, Little Rock, AR, United States of America
| | - Christen E Chalmers
- School of Medicine, University of California, Irvine, United States of America
| | - Samuel Mullinax
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Michael Mancino
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Santillanes G, Rowland K, Demarest M, Lam CN, Wilson MP, Claudius I, Menchine M. Discontinuing involuntary mental health holds for children: Does psychiatrist specialty matter? A pilot study. Am J Emerg Med 2019; 38:702-708. [PMID: 31204151 DOI: 10.1016/j.ajem.2019.06.002] [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: 04/16/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Involuntary mental health detainments should only be utilized when less restrictive alternatives are unavailable and should be discontinued as soon as safety can be ensured. The study objective was to determine if child and adolescent psychiatrists discontinue a greater proportion of involuntary holds than general psychiatrists for similar pediatric patients. METHODS Retrospective analysis of consecutive patients under 18 years placed on an involuntary hold in the prehospital setting presenting over a 1-year period to one high-volume emergency department (ED) where youth on involuntary holds are seen by child and adolescent psychiatrists when available and general psychiatrists otherwise. The primary outcome of interest was hold discontinuation after initial psychiatric consultation. The key predictor of interest was psychiatrist specialty (child and adolescent vs. general). We conducted multivariate logistic regression modeling adjusting for patient characteristics and time of arrival. RESULTS Child and adolescent psychiatrists discontinued 27.4% (51/186) of prehospital holds while general psychiatrists discontinued only 10.6% (22/207). After adjusting for observable confounders, holds were over 3 times as likely to be discontinued in patients evaluated by child and adolescent psychiatrists rather than general emergency psychiatrists (adjusted OR 3.2, 95% CI 1.7-5.9, p < 0.001). CONCLUSIONS Child and adolescent psychiatrists are much more likely to discontinue prehospital involuntary mental health holds compared with general emergency psychiatrists. While inappropriate hold discontinuation places patients at risk of harm, prolonged hold continuation limits patients' rights and potentially increases psychiatric boarding in EDs. Earlier access to child and adolescent psychiatry may facilitate early hold discontinuation and standardize patient care.
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Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Kathleen Rowland
- Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Matthew Demarest
- Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research Lab and Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4395 Shuffield Dr., Little Rock, AR 72205, United States of America.
| | - Ilene Claudius
- Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA 90509, United States of America
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America; Leonard D. Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, 635 Downey Way Verna & Peter Dauterive Hall (VPD), Los Angeles, CA 90089, United States of America
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Chalmers CE, Mullinax S, Brennan J, Vilke GM, Oliveto AH, Wilson MP. Screening Tools Validated in the Outpatient Pain Management Setting Poorly Predict Opioid Misuse in the Emergency Department: A Pilot Study. J Emerg Med 2019; 56:601-610. [PMID: 31043338 DOI: 10.1016/j.jemermed.2019.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Currently, no universally accepted methods exist to assess drug-related aberrant behaviors in emergency department (ED) patients. There are several screening tools to identify opioid misuse in patients with chronic pain, however, the validity of these screening tools to assess for misuse within the ED remains unclear. OBJECTIVES This study investigated the effectiveness of three commonly used screening tools, previously validated in outpatient pain management settings, to assess risk of opioid misuse in ED patients. METHODS This was a prospective observational study of 154 participants (median age 50 years; 49.6% female) presenting to an academic ED for a chief complaint of pain ≥ 6 months or an opioid refill request. Participants completed the Opioid Risk Tool, the Screener and Opioid Assessment for Patients with Pain-Revised, and the Current Opioid Misuse Measure. Scores for each were compared with electronic medical record (EMR) data alone or a reference standard comprising EMR + statewide prescription drug monitoring program (PDMP) + medical examiner database. RESULTS Using the combined reference standard, 55.8% of participants displayed at least one aberrant behavior. Regardless of the reference standard, the test characteristics of these screening tools were modest at best, with likelihood ratios close to 1. CONCLUSION Three screening tools previously validated in outpatient pain management settings poorly categorized risk among ED patients with chronic noncancer pain or requests for opioid refills, and should not be used to assess drug-aberrant behaviors in the ED. Review of the EMR alone or together with the PDMP may be more useful methods to assess drug-aberrant behaviors in the ED setting.
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Wilson MP, Stone JJ, Stone NN. Development of a Novel Prostate Phantom for MRI-Fusion Imaging, Transrectal and Transperineal Biopsy, and Brachytherapy Training. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cole JB, Klein LR, Mullinax SZ, Nordstrom KD, Driver BE, Wilson MP. Study Enrollment When "Preconsent" Is Utilized for a Randomized Clinical Trial of Two Treatments for Acute Agitation in the Emergency Department. Acad Emerg Med 2019; 26:559-566. [PMID: 30548977 DOI: 10.1111/acem.13673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute agitation in the emergency department (ED) represents a danger to both patients and their caregivers. Medication is often needed, and few high-quality randomized trials have evaluated the optimal drugs for this vulnerable population. In the United States, as of 2017, randomized trials of drugs typically cannot be conducted under Waiver of Consent (46 CFR 45.116), and Exception From Informed Consent trials (21 CFR 50.24) are limited to life-threatening conditions, are onerous, and require filing an investigational new drug application with the FDA. We sought to conduct a randomized double-dummy trial of inhaled loxapine versus intramuscular haloperidol + lorazepam for acute agitation in the ED by obtaining consent in advance ("preconsent") in patients at risk of future agitation, allowing study drug administration up to 3 years later if the patient presented with acute agitation. OBJECTIVE We sought to report the successful enrollment rate of patients preconsented at an earlier ED visit for this trial. METHODS This was an analysis of patients age 18 to 64 with bipolar I disorder or schizophrenia preconsented for enrollment in the trial (clinicaltrials.gov, NCT02877108) conducted at a single urban academic center seeing approximately 60,000 patients per year. Eligible patients were assessed for capacity to consent by trained research associates, and informed consent was obtained at an ED visit for the possibility of administering drugs for agitation within the next 3 years. In the event the patient later presented to the ED and the attending physician deemed the patient required treatment for acute agitation, preconsent was confirmed and study drug would be administered. RESULTS Over 67 days, 1,461 patients were screened in the ED, 269 had bipolar I or schizophrenia, 194 of whom had a contraindication to inhaled loxapine leaving 75 eligible patients; preconsent was obtained in 43 patients. Four additional patients who had not preconsented were consented for the trial in real time (three by surrogate, one patient had capacity while agitated) resulting in a total of 47 consented patients. Of these 47, a total of 12 were later removed from the study: 10 patients had unrecognized exclusion criteria for inhaled loxapine, one preconsented patient contacted the investigators at a later date and asked to be removed, and one surrogate revoked consent immediately after providing it. Only two patients were successfully enrolled, neither by preconsent: one was enrolled via a surrogate the day of enrollment, and the other was mildly agitated and had capacity to consent. The remaining patient with a valid surrogate consent did not receive study medication. CONCLUSIONS Utilization of preconsent to enroll patients in a randomized trial of treatments for acute agitation in the ED requires substantial resources and may not be feasible.
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Affiliation(s)
- Jon B Cole
- Department of Emergency Medicine Hennepin Healthcare Minneapolis MN
| | - Lauren R. Klein
- Department of Emergency Medicine Hennepin Healthcare Minneapolis MN
| | - Samuel Z. Mullinax
- Department of Emergency Medicine University of Arkansas for Medical Sciences Little Rock AR
| | | | - Brian E. Driver
- Department of Emergency Medicine Hennepin Healthcare Minneapolis MN
| | - Michael P. Wilson
- Department of Emergency Medicine University of Arkansas for Medical Sciences Little Rock AR
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Seelig S, Ryus CR, Harrison RF, Wilson MP, Wong AH. Cryptococcal Meningoencephalitis Presenting as a Psychiatric Emergency. J Emerg Med 2019; 57:203-206. [PMID: 31014972 DOI: 10.1016/j.jemermed.2019.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/27/2017] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Organic conditions can often mimic neuropsychiatric disorders, leading to delays in diagnosis and treatment for the most vulnerable populations presenting to the emergency department (ED). CASE REPORT Here we discuss a case of cryptococcal meningoencephalitis seemingly consistent with psychosis on initial evaluation, and present strategies to recognize and treat this condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to the indolent time course of this disease, initial symptoms of altered mental status and personality changes may be attributed to drug use or psychiatric illness before more overt evidence for increased intracranial pressure and neurologic infection develops. It is important for emergency clinicians to maintain a high level of suspicion for this condition in at-risk patients and reassess them frequently during their ED visit.
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Affiliation(s)
- Sandra Seelig
- Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Caitlin R Ryus
- Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Raquel F Harrison
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael P Wilson
- Department of Emergency Medicine, Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Wilson MP, Shenvi C, Rives L, Nordstrom K, Schneider S, Gerardi M. Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology. West J Emerg Med 2019; 20:380-385. [PMID: 30881561 PMCID: PMC6404701 DOI: 10.5811/westjem.2019.1.39260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Despite the ever-increasing numbers of mental health patients presenting to United States emergency departments, there are large gaps in knowledge about acute care of the behavioral health patient. To address this important problem, the Coalition on Psychiatric Emergencies convened a research consensus conference in December 2016 consisting of clinical researchers, clinicians from emergency medicine, psychiatry and psychology, and representatives from governmental agencies and patient advocacy groups. Methods Participants used a standardized methodology to select and rank research questions in the order of importance to both researchers and patients. Results Three working groups (geriatrics, substance use disorders, and psychosis) reached consensus on 26 questions within their respective domains. These questions are summarized in this document. Conclusion The research consensus conference is the first of its kind to include non-clinicians in helping identify knowledge gaps in behavioral emergencies. It is hoped that these questions will prove useful to prioritize future research within the specialty.
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Affiliation(s)
- Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, Arkansas
| | - Christina Shenvi
- University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina
| | - Loren Rives
- American College of Emergency Physicians, Irving, Texas
| | - Kimberly Nordstrom
- University of Colorado School of Medicine, Department of Psychiatry, Denver, Colorado
| | - Sandra Schneider
- American College of Emergency Physicians, Irving, Texas.,John Peter Smith Hospital, Department of Emergency Medicine, Fort Worth, Texas.,Hofstra Northwell School of Medicine, Hempstead, New York
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Wilson MP, Worrall F, Davies RJ, Hart A. Identifying groundwater compartmentalisation for hydraulic fracturing risk assessments. Environ Sci Process Impacts 2019; 21:352-369. [PMID: 30394464 DOI: 10.1039/c8em00300a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An environmental concern with hydraulic fracturing (fracking) is that injected fluids or formation fluids could migrate upwards along high-permeability faults and contaminate shallow groundwater resources. However, numerical modelling has suggested that compartmentalisation by low-permeability faults may be a greater risk factor to shallow aquifers than high-permeability faults because lateral groundwater flow is reduced and upward flow through strata may be encouraged. Therefore, it is important that compartmentalisation can be adequately identified prior to fracking. As a case study we used historical groundwater quality data and two-dimensional seismic reflection data from the Bowland Basin, northwest England, to investigate if compartmentalisation could be adequately identified in a prospective shale basin. Five groundwater properties were spatially autocorrelated and interpolation suggests a regional trend from recent (<10 000 years old) meteoric groundwater in the upland Forest of Bowland to more brackish groundwater across the Fylde plain. Principal components analysis suggests two end-member brackish groundwater types. These end-members along with seismic interpretation suggest that a fault may structurally compartmentalise the northwest Bowland Basin. Furthermore, the Woodsfold fault structurally compartmentalises the southern Fylde and the Blackpool area provides evidence for stratigraphic compartmentalisation in the superficial deposits. However, large areas of the Bowland Basin are not sampled and the influence of known faults on groundwater is therefore difficult to assess. Consequently, the adequate identification of compartmentalisation in prospective basins may require supplementing historic data with dedicated basin-wide groundwater monitoring programmes and the acquisition of new seismic reflection data in areas of poor coverage or quality.
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Affiliation(s)
- M P Wilson
- Department of Earth Sciences, Durham University, Science Labs, Durham, DH1 3LE, UK.
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Hawk KF, Glick RL, Jey AR, Gaylor S, Doucet J, Wilson MP, Rozel JS. Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders. West J Emerg Med 2019; 20:386-392. [PMID: 30881562 PMCID: PMC6404722 DOI: 10.5811/westjem.2019.1.39261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain. Methods In December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups. Background literature review was conducted prior to the meeting, and questions were iteratively focused, revised, voted on and ranked by perceived importance using nominal group method. Results The main goal of the SUD workgroup was to identify research priorities and develop a research agenda to improve the early identification of and management of emergency department (ED) patients with SUDs with the goal of improving outcomes. This article is the product of a breakout session on “Special Populations: Substance Use Disorder.” The workgroup identified with high consensus six research priorities for their importance related to the care of ED patients with SUDs in these overall domains: screening; ED interventions; the role of peer navigators; initiation of SUD management in the ED; specific patient populations that may impact the effectiveness of interventions including sociogenerational and cultural factors; and the management of the acutely intoxicated patient. Conclusion Emergency providers are increasingly recognizing the important role of the ED in reducing adverse outcomes associated with untreated SUDs. Additional research is required to close identified knowledge gaps and improve care of ED patients with SUD.
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Affiliation(s)
- Kathryn F Hawk
- Yale University, Department of Emergency Medicine, New Haven, Connecticut
| | - Rachel L Glick
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Arthur R Jey
- Sutter Medical Center, Department of Emergency Medicine, Sacramento, California
| | - Sydney Gaylor
- University of California-San Diego, Department of Emergency Medicine, San Diego, California
| | | | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, Arkansas
| | - John S Rozel
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania
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Shenvi C, Wilson MP, Aldai A, Pepper D, Gerardi M. A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients. West J Emerg Med 2019; 20:393-402. [PMID: 30881563 PMCID: PMC6404700 DOI: 10.5811/westjem.2019.1.39262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Agitation, mental illness, and delirium are common reasons for older adults to seek care in the emergency department (ED). There are significant knowledge gaps in understanding how to best screen older adults for these conditions and how to manage them. In addition, in areas where research has been performed, implementation has been slow. A working group convened to develop a set of high-priority research questions that would advance the understanding of optimal management of older adults with acute behavioral changes in the ED. This manuscript is the product of a breakout session on "Special Populations: Agitation in the Elderly" from the 2016 Coalition on Psychiatric Emergencies' first Research Consensus Conference on Acute Mental Illness. Methods Participants were identified with expertise in emergency medicine (EM), geriatric EM, and psychiatry. Background literature reviews were performed prior to the in-person meeting in four key areas: delirium; dementia; substance abuse or withdrawal; and mental illness in older adults. Input was solicited from all participants during the meeting, and questions were iteratively focused and revised, voted on, and ranked by importance. Results Fourteen questions were identified by the group with high consensus for their importance related to the care of older adults with agitation in the ED. The questions were grouped into three topic areas: screening and identification; management strategies; and the approach to delirium. Conclusion It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes, have the tools to screen older adults for those causes, and employ methods to treat the underlying causes and ameliorate their symptoms. Answers to the identified research questions have great potential to improve the care of older adults presenting with behavioral changes.
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Affiliation(s)
- Christina Shenvi
- University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina
| | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, Arkansas
| | - Alessandra Aldai
- University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California
| | - David Pepper
- Hartford Hospital/Institute of Living, Department of Psychiatry, Hartford, Connecticut
| | - Michael Gerardi
- Morristown Medical Center, Department of Emergency Medicine, Morristown, New Jersey
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Alfaraj DN, Wilson MP, Akeely Y, Vilke GM, Nordstrom K. Psychiatric Emergencies for Clinicians: Emergency Department Management of Hypercalcemia. J Emerg Med 2018; 55:688-692. [PMID: 30336968 DOI: 10.1016/j.jemermed.2018.07.018] [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: 02/28/2018] [Revised: 06/13/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Dunya N Alfaraj
- Department of Emergency Medicine, UC San Diego Health System, San Diego, California
| | - Michael P Wilson
- Department of Emergency Medicine, UC San Diego Health System, San Diego, California
| | - Yahia Akeely
- Department of Emergency Medicine, UC San Diego Health System, San Diego, California
| | - Gary M Vilke
- Department of Emergency Medicine, UC San Diego Health System, San Diego, California
| | - Kimberly Nordstrom
- Department of Emergency Medicine, UC San Diego Health System, San Diego, California
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Shuen JA, Wilson MP, Kreshak A, Mullinax S, Brennan J, Castillo EM, Hinkle C, Vilke GM. Telephoned, Texted, or Typed Out: A Randomized Trial of Physician-Patient Communication After Emergency Department Discharge. J Emerg Med 2018; 55:573-581. [PMID: 30181075 DOI: 10.1016/j.jemermed.2018.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/06/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Novel means of emergency department (ED) post-discharge communication-telephone callbacks and text messages-are increasingly being utilized to facilitate patient-oriented outcomes, such as ED revisits, patient adherence, and satisfaction. OBJECTIVE The primary measure of interest is the rate of ED revisits in the week after discharge. The secondary measures of interests are rate of primary medical doctor (PMD) or specialist physician contact in the week after discharge and patient satisfaction. METHODS Pilot randomized controlled trial with three groups: usual discharge; usual care + phone call 48 h after discharge asking if patients wanted to speak with a physician; or usual care + text message 48 h after discharge asking if patients wanted to speak with a physician. All participants received a 1-week assessment of patient satisfaction. ED revisit and contact with PMD or specialist physician within 7 days of discharge were obtained from electronic medical record and analyzed using χ2 test. RESULTS Two hundred and fifty-one patients were enrolled and randomized (66 control, 103 phone, 82 text). Although the three groups did not show a statistically significant difference, the phone and text groups had similar and lower proportions of patients revisiting the ED (>50% reduction) and calling or visiting their PMD or specialist physician (approximately 30% reduction) than the control group (χ2 = 4.57, degrees of freedom [df] = 2, p = 0.10; χ2 = 1.36, df = 2, p = 0.51). There was no difference in patient satisfaction (χ2 = 2.88, df = 2, p = 0.24). CONCLUSIONS Patients who are contacted for ED follow-up by phone and text, though perhaps not more satisfied, may tend to revisit the ED and contact their PMD or specialty physician less often than patients receiving standard written discharge instructions. However, this pilot study is underpowered, so larger randomized studies are needed to confirm.
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Affiliation(s)
- Jessica A Shuen
- Emergency Trauma Department, Hackensack University Medical Center, Hackensack, New Jersey
| | - Michael P Wilson
- Division of Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Allyson Kreshak
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Samuel Mullinax
- Division of Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jesse Brennan
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Edward M Castillo
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Corinne Hinkle
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
| | - Gary M Vilke
- Department of Emergency Medicine, UC San Diego Health System, University of California at San Diego, San Diego, California
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Pepa PA, Lee KC, Huynh HE, Wilson MP. Safety of Risperidone for Acute Agitation and Alcohol Intoxication in Emergency Department Patients. J Emerg Med 2018; 53:530-535. [PMID: 29079068 DOI: 10.1016/j.jemermed.2017.05.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/14/2017] [Accepted: 05/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute agitation in the setting of alcohol intoxication is commonly encountered in the Emergency Department (ED). In this setting, expert consensus guidelines recommend haloperidol over second-generation antipsychotics due to their limited safety data in alcohol intoxication. OBJECTIVE The primary objective was to compare vital sign changes prior to and after risperidone administration between ED patients presenting with alcohol intoxication [ETOH (+)] and without alcohol intoxication [ETOH (-)]. The secondary objective was to assess the effect of benzodiazepine co-administration with risperidone on vital signs. METHODS This was a retrospective chart review of patients who received oral risperidone for acute agitation at two university EDs between January 1, 2012 and December 31, 2015. Vital signs (oxygen saturation, systolic and diastolic blood pressure, heart rate, and respiratory rate) were compared in patients who had ingested alcohol with those who had not. RESULTS There were 785 patients without evidence of alcohol intoxication who received risperidone in the ED, and 52 patients with alcohol intoxication who received risperidone. Overall, risperidone with and without alcohol intoxication and benzodiazepine administration had no statistically significant effect on vital signs (p = ns for all comparisons). CONCLUSION This study suggests that oral risperidone may be a safe option for acute agitation in patients presenting to the ED with alcohol intoxication.
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Affiliation(s)
- Patricia A Pepa
- Department of Pharmacy, UC San Diego Health, San Diego, California
| | - Kelly C Lee
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California
| | - Hien E Huynh
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California
| | - Michael P Wilson
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Emergency Medicine, Behavioral Emergencies Research Laboratory, Little Rock, Arkansas
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Wilson MP, Seupaul RA. Are There Tools to Screen Children and Adolescents in the Emergency Department With Mental Health and Substance Abuse Issues? Ann Emerg Med 2018; 71:233-235. [DOI: 10.1016/j.annemergmed.2017.07.486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 10/18/2022]
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Mullinax S, Chalmers CE, Brennan J, Vilke GM, Nordstrom K, Wilson MP. Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department. Am J Emerg Med 2018. [PMID: 29530359 DOI: 10.1016/j.ajem.2018.01.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Suicide screening scales have been advocated for use in the ED setting. However, it is currently unknown whether patients classified as low-risk on these scales can be safely discharged from the emergency department. This study evaluated the utility of three commonly-used suicide screening tools in the emergency department to predict ED disposition, with special interest in discharge among low-risk patients. METHODS This prospective observational study enrolled a convenience sample of patients who answered "yes" to a triage suicidal ideation question in an urban academic emergency department. Patients were administered the weighted modified SADPERSONS Scale, Suicide Assessment Five-step Evaluation and Triage, and Columbia-Suicide Severity Rating Scale. Patients who subsequently received a psychiatric evaluation were included, and the utility of these screening tools to predict disposition was evaluated. RESULTS 276 subjects completed all three suicide screening tools and were included in data analyses. Eighty-two patients (30%) were admitted or transferred. Three patients (1%) died by suicide within one year of enrollment; one was hospitalized at the end of his or her enrollment visit, dying by suicide seven months later and the other two were discharged, dying by suicide nine and ten months later, respectively. The screening tools exhibited modest negative predictive values (range: 0.66-0.73). CONCLUSION Three suicide screening tools displayed modest ability to predict the disposition of patients who presented to an emergency department with suicidal ideation. This study supports the current ACEP clinical policy on psychiatric patients which states that screening tools should not be used in isolation to guide disposition decisions of suicidal patients from the ED.
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Affiliation(s)
- Samuel Mullinax
- Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States.
| | - Christen E Chalmers
- Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States
| | - Jesse Brennan
- Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Department of Emergency Medicine, UC San Diego Health System, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103, United States
| | - Gary M Vilke
- Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Department of Emergency Medicine, UC San Diego Health System, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103, United States
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Office of Behavioral Health, State of Colorado, 3824 W Princeton Cir, Denver, CO 80236, United States; Department of Psychiatry, University of Colorado at Denver, 1201 Larimer St, Denver, CO 80204, United States
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 West Markham St, #584, Little Rock, AR 72205, United States
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Leung A, Zun L, Nordstrom K, Wilson MP. Psychiatric Emergencies for Physicians: Clinical Management and Approach to Distinguishing Pheochromocytoma From Psychiatric and Thyrotoxic Diseases in the Emergency Department. J Emerg Med 2017; 53:712-716. [DOI: 10.1016/j.jemermed.2017.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/02/2017] [Accepted: 05/30/2017] [Indexed: 11/29/2022]
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Stuck AR, Wilson MP, Chalmers CE, Lucas J, Sarkin A, Choi K, Center K. Health Care Usage and Suicide Risk Screening within 1 Year of Suicide Death. J Emerg Med 2017; 53:871-879. [PMID: 28988740 DOI: 10.1016/j.jemermed.2017.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/01/2017] [Accepted: 06/28/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Research indicates patients often seek medical care within 1 year of suicide. Health care encounters are a crucial opportunity for health professionals to identify patients at highest risk and provide preventative services. OBJECTIVE Study aims were to determine the characteristics of persons seeking health care within 12 months of suicide death and evaluate suicide risk screening (SRS) frequency in the emergency department (ED) vs. clinic settings. METHODS Medical examiner and hospital data of patients who died by suicide from 2007 to 2013 were evaluated. Descriptive analyses included demographics and frequency of ED vs. clinic visits. We also compared SRS before and after implementation of The Joint Commission's recommendation to assess suicide risk. RESULTS The 224 deceased patients were primarily single white males (mean age 67 years). Mental health issues, substance abuse, and prior suicide attempts were present alone or in combination in 74%. Visits were primarily behavioral health or substance abuse problems in the ED, and medical issues in the clinic. After implementation of universal SRS in the ED, screening increased from 39% to 92%. Among patients screened in the ED, 73% (37 of 51) screened negative for suicide risk. CONCLUSIONS Universal SRS increased the number of people screened in the ED. However, negative SRS may not equate to reduced risk for future suicide within 1 year. Future studies might investigate targeted screening of individuals with known suicide risk factors, as well as alternatives to patient self-report of intent to self-harm for patients with mental health or substance abuse problems.
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Affiliation(s)
- Amy R Stuck
- Department of Emergency Medicine, UC San Diego Health System, San Diego, California
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Christen E Chalmers
- Department of Emergency Medicine Behavioral Emergencies Research, UC San Diego Health System, San Diego, California
| | - Jonathan Lucas
- Medical Examiner Office, County of San Diego, San Diego, California
| | - Andrew Sarkin
- Health Services Research Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Kyle Choi
- Health Services Research Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Kimberly Center
- Health Services Research Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
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Wilson MP, Nordstrom K, Hopper A, Porter A, Castillo EM, Vilke GM. Risperidone in the Emergency Setting is Associated with More Hypotension in Elderly Patients. J Emerg Med 2017; 53:735-739. [PMID: 28987309 DOI: 10.1016/j.jemermed.2017.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/03/2016] [Revised: 03/17/2017] [Accepted: 06/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Expert consensus panels have recommended risperidone as first-line treatment for agitation of psychiatric origin. However, there are few if any studies on this medication in the emergency setting. OBJECTIVES To assess the hemodynamic effects of risperidone in an emergency department (ED) setting, stratified by age. METHODS This is a structured chart review of all patients who received oral risperidone over a 6-year period in an ED setting, excluding patients who received this medication as a prescription refill. Vital signs were analyzed for this subset prior to and after medication administration, and changes in vital signs were stratified by age. RESULTS The median dose of risperidone was less in patients aged > 65 years. However, the median drop in systolic blood pressure was larger in this age group compared with younger patients. CONCLUSIONS Clinicians tend to be more cautious with dosing of risperidone to geriatric patients in the ED. Despite this, decreases in systolic blood pressure are larger and more frequent in this age group. When possible, clinicians should consider or attempt nonpharmacologic methods of agitation treatment prior to administering medications such as risperidone to elderly patients.
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Affiliation(s)
- Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Psychiatric Emergency Services, Denver Health Medical Center; University of Colorado at Denver, Denver, Colorado
| | - Austin Hopper
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Austin Porter
- Arkansas Department of Health, Little Rock, Arkansas; Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Edward M Castillo
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Emergency Medicine, UC San Diego Health System, University of California San Diego, San Diego, California
| | - Gary M Vilke
- Department of Emergency Medicine Behavioral Emergencies Research (DEMBER), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Emergency Medicine, UC San Diego Health System, University of California San Diego, San Diego, California
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