المؤلفون: Erani, Fareshte, Zolotova, Nadezhda, Vanderschelden, Benjamin, Khoshab, Nima, Sarian, Hagop, Nazarzai, Laila, Wu, Jennifer, Chakravarthy, Bharath, Hoonpongsimanont, Wirachin, Yu, Wengui, Shahbaba, Babak, Srinivasan, Ramesh, Cramer, Steven C

المصدر: Stroke. 51(11)

مصطلحات موضوعية: Humans, Ischemic Attack, Transient, Electroencephalography, Logistic Models, Sensitivity and Specificity, Aged, Aged, 80 and over, Middle Aged, Female, Male, Stroke, Deep Learning, Neural Networks, Computer, Hemorrhagic Stroke, Ischemic Stroke, brain, deep learning, early diagnosis, electroencephalography, transient ischemic attack, Brain Disorders, Neurosciences, Emergency Care, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery

الوصف: Background and purposeClinical methods have incomplete diagnostic value for early diagnosis of acute stroke and large vessel occlusion (LVO). Electroencephalography is rapidly sensitive to brain ischemia. This study examined the diagnostic utility of electroencephalography for acute stroke/transient ischemic attack (TIA) and for LVO.MethodsPatients (n=100) with suspected acute stroke in an emergency department underwent clinical exam then electroencephalography using a dry-electrode system. Four models classified patients, first as acute stroke/TIA or not, then as acute stroke with LVO or not: (1) clinical data, (2) electroencephalography data, (3) clinical+electroencephalography data using logistic regression, and (4) clinical+electroencephalography data using a deep learning neural network. Each model used a training set of 60 randomly selected patients, then was validated in an independent cohort of 40 new patients.ResultsOf 100 patients, 63 had a stroke (43 ischemic/7 hemorrhagic) or TIA (13). For classifying patients as stroke/TIA or not, the clinical data model had area under the curve=62.3, whereas clinical+electroencephalography using deep learning neural network model had area under the curve=87.8. Results were comparable for classifying patients as stroke with LVO or not.ConclusionsAdding electroencephalography data to clinical measures improves diagnosis of acute stroke/TIA and of acute stroke with LVO. Rapid acquisition of dry-lead electroencephalography is feasible in the emergency department and merits prehospital evaluation.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5w55j8d4Test

المؤلفون: Bruckner, Tim A, Singh, Parvati, Yoon, Jangho, Chakravarthy, Bharath, Snowden, Lonnie R

المصدر: Health Services Research. 55(1)

مصطلحات موضوعية: Health Services and Systems, Public Health, Health Sciences, Behavioral and Social Science, Mental Health, Clinical Research, Brain Disorders, Health Services, Mental health, Good Health and Well Being, Adolescent, Adult, Black or African American, Child, Child, Preschool, Emergency Medical Services, Emergency Service, Hospital, Female, Health Services Accessibility, Healthcare Disparities, Humans, Male, Mental Disorders, United States, White People, Young Adult, children, adolescents, youths, emergency department, Federally Qualified Health Centers, psychiatry, racial, ethnic disparities, children/adolescents/youths, racial/ethnic disparities, Public Health and Health Services, Policy and Administration, Health Policy & Services, Health services and systems, Policy and administration

الوصف: ObjectiveTo test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits.Data sourcesSecondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011. We used the HCUP SEDD and SID. We obtained FQHC service data from the Uniform Data System.Study designThe psychiatric ED visit is the dependent variable. Logistic regression methods control for individual risk factors for ED use, as well as county-level health system factors and county and year fixed effects. Key independent variables include indicators of mental health service capacity in FQHCs in a county-year.Data extraction methodsWe extracted ED psychiatric visits for 3.3 million African American and white youth in nine states, 2006-2011, from the HCUP SEDD and SID, and FQHC data from the Uniform Data System.Principal findingsOverall mental health visits at FQHCs correlate positively with psychiatric ED visits among African American youth. However, increases in the number of mental health visits per FQHC patient corresponds with fewer outpatient psychiatric ED visits among African American youth, relative to white youth (odds ratio = 0.96; 95% CI = 0.94, 0.98).ConclusionsIncreases in the intensity of services offered per mental health patient at FQHCs-rather than increases in overall capacity-may reduce African American youth's overreliance on the ED for psychiatric care.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0zw2571sTest

المؤلفون: Bruckner, Tim A, Singh, Parvati, Chakravarthy, Bharath, Snowden, Lonnie, Yoon, Jangho

المصدر: Psychiatric Services. 70(10)

مصطلحات موضوعية: Behavioral and Social Science, Brain Disorders, Clinical Research, Health Services, Clinical Trials and Supportive Activities, Mental Health, Mental health, Good Health and Well Being, Adolescent, Adult, California, Child, Community Health Centers, Databases, Factual, Emergency Service, Hospital, Female, Health Services Accessibility, Humans, Male, Medically Uninsured, Poverty, Primary Health Care, Regression Analysis, Community mental health services, Emergency psychiatry, Public Health and Health Services, Psychiatry

الوصف: ObjectiveRegional primary health care system capacity may affect the demand for psychiatric visits to the emergency department (ED). In the United States, community health centers (CHCs), which serve low-income regions regardless of individuals' ability to pay, expanded primary care services by over 70% in the past decade. No research, however, evaluates whether this expansion affects overall psychiatric ED visits. This hypothesis is tested in 143 U.S. counties that expanded CHC services.MethodsFor the years 2006 through 2011, 18.84 million psychiatric outpatient ED visits were aggregated by county-year for the 143 U.S. counties with a participating CHC. The rate of psychiatric ED cases in a county-year is the dependent variable. Two independent variables were examined: total patients seen at CHCs and total patients receiving mental health services at CHCs. Fixed-effects regression methods controlled for county effects, year effects, and other health care and sociodemographic factors.ResultsPsychiatric ED visits fell below expected levels in county-years where the volume of overall CHC patients rose (coefficient=-0.059; standard error=0.027, p=0.03). Findings indicate no relation between the volume of mental health patients seen at CHCs and psychiatric ED visits.ConclusionsAn increase in general primary health care to an underserved population, in the form of CHCs, corresponds with a decline in psychiatric ED visits. This result coheres with a recent Medicaid expansion experiment in which increased access to general primary care reduced the prevalence of undiagnosed and untreated depression. Findings, if replicated, may hold policy implications for regional health systems.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2x1774ktTest

المؤلفون: Shreve, Lauren, Kaur, Arshdeep, Vo, Christopher, Wu, Jennifer, Cassidy, Jessica M, Nguyen, Andrew, Zhou, Robert J, Tran, Thuong B, Yang, Derek Z, Medizade, Ariana I, Chakravarthy, Bharath, Hoonpongsimanont, Wirachin, Barton, Erik, Yu, Wengui, Srinivasan, Ramesh, Cramer, Steven C

المصدر: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 28(8)

مصطلحات موضوعية: Brain, Humans, Brain Ischemia, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Electroencephalography, Early Diagnosis, Prognosis, Case-Control Studies, Feasibility Studies, Pilot Projects, Reproducibility of Results, Predictive Value of Tests, Time Factors, Aged, Aged, 80 and over, Middle Aged, Emergency Service, Hospital, Female, Male, Stroke, Brain Waves, Acute stroke, diagnosis, electroencephalography, emergency medicine, Neurosciences, Brain Disorders, Emergency Care, Clinical Research, Clinical Sciences, Neurology & Neurosurgery

الوصف: BackgroundEarly diagnosis of stroke optimizes reperfusion therapies, but behavioral measures have incomplete accuracy. Electroencephalogram (EEG) has high sensitivity for immediately detecting brain ischemia. This pilot study aimed to evaluate feasibility and utility of EEG for identifying patients with a large acute ischemic stroke during Emergency Department (ED) evaluation, as these data might be useful in the prehospital setting.MethodsA 3-minute resting EEG was recorded using a dense-array (256-lead) system in patients with suspected acute stroke arriving at the ED of a US Comprehensive Stroke Center.ResultsAn EEG was recorded in 24 subjects, 14 with acute cerebral ischemia (including 5 with large acute ischemic stroke) and 10 without acute cerebral ischemia. Median time from stroke onset to EEG was 6.6 hours; and from ED arrival to EEG, 1.9 hours. Delta band power (P = .004) and the alpha/delta frequency band ratio (P = .0006) each significantly distinguished patients with large acute ischemic stroke (n = 5) from all other patients with suspected stroke (n = 19), with the best diagnostic utility coming from contralesional hemisphere signals. Larger infarct volume correlated with higher EEG power in the alpha/delta frequency band ratio within both the ipsilesional (r = -0.64, P = .013) and the contralesional (r = -0.78, P = .001) hemispheres.ConclusionsWithin hours of stroke onset, EEG measures (1) identify patients with large acute ischemic stroke and (2) correlate with infarct volume. These results suggest that EEG measures of brain function may be useful to improve diagnosis of large acute ischemic stroke in the ED, findings that might be useful to pre-hospital applications.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4b31g5n8Test

المؤلفون: Chakravarthy, Bharath, Yang, Allen, Ogbu, Uzor, Kim, Carole, Iqbal, Anum, Haight, Joanna, Anderson, Craig, DiMassa, Giancarlo, Bruckner, Tim, Bhargava, Rishi, Schreiber, Merrit, Lotfipour, Shahram

المصدر: Pediatric emergency care. 33(9)

مصطلحات موضوعية: Humans, Hospitalization, Length of Stay, Retrospective Studies, Mental Health, Mental Disorders, Psychiatry, Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Hospitals, Urban, Quality of Health Care, California, Female, Male, Emergency Care, Health Services, Patient Safety, Clinical Research, Pediatric, Brain Disorders, Health and social care services research, 8.1 Organisation and delivery of services, Mental health, Good Health and Well Being, Paediatrics and Reproductive Medicine, Emergency & Critical Care Medicine

الوصف: ObjectivesPediatric mental illness poses a significant burden with an overall prevalence of approximately 10%. Increasingly, children with mental disorders seek care in the emergency department (ED). However, the ED is not an ideal setting. Pediatric mental health patients receive limited treatment and experience significantly longer length of stay (LOS) than other patients seen in the ED. This study examines patient and hospital factors associated with LOS and prolonged LOS (PLOS).MethodsThis is a retrospective chart review of patients between the ages of 3 and 17 presenting at 2 participating urban EDs with a psychiatric diagnosis from May 2010 to May 2012.ResultsThis study includes 939 patients with an average age of 14.1 years and a median LOS of 295 minutes. The diagnosis was the strongest predictor of LOS and PLOS. Patients with a psychotic disorder or suicide attempt or ideation experienced a longer LOS, 35% and 55% increases, respectively, and an increased odds of PLOS (odds ratio, 3.07 and 8.36, respectively). Patient sex, previous history of self-harm, and the daily census were associated with both a longer LOS and PLOS. Ethnicity, site of admission, and year of admission were only associated with LOS.ConclusionsDiagnosis-specific management factors are the primary determinant of LOS. However, some patient characteristics and hospital operational factors are also associated with LOS. Organizational reforms and an evaluation of the required human and material resources are necessary to improve access to and availability of pediatric mental health care.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/19q8c601Test

المؤلفون: Yanuck, Justin, Hicks, Bryson, Anderson, Craig, Billimek, John, Lotfipour, Shahram, Chakravarthy, Bharath

المصدر: World Journal of Emergency Medicine. 8(3)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Health Services, Mental Health, Emergency Care, Behavioral and Social Science, Brain Disorders, Mental health, Good Health and Well Being, Affordable Care Act, Disparities, Health Policy, Clinical sciences

الوصف: BackgroundThere is little consensus as to the effects of insurance expansion on emergency department (ED) utilization for mental health purposes. We aimed to study the race specific association between the dependent coverage provision of the Affordable Care Act (ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.MethodsWe utilized a Quasi-Experimental analysis of ED use in California from 2009-2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-in-differences approach comparing those targeted by the ACA dependent provision (19-25 years) and those who were not (27 to 31 years), evaluating changes in ED visit rates per 1 000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender.ResultsThe ACA dependent provision was associated with 0.05 per 1 000 people fewer psychiatric ED visits among the treatment group (19-25 years) compared to the control group (27-31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance.ConclusionThe ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacific Islander racial groups.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2rr6t0s4Test

المؤلفون: Bruckner, Tim A, Kim, Yonsu, Lubens, Pauline, Singh, Amrita, Snowden, Lonnie, Chakravarthy, Bharath

المصدر: Administration and Policy in Mental Health and Mental Health Services Research. 43(1)

مصطلحات موضوعية: Behavioral and Social Science, Brain Disorders, Clinical Research, Health Services, Pediatric, Mental Health, Emergency Care, Health and social care services research, 8.1 Organisation and delivery of services, Mental health, Good Health and Well Being, Adolescent, Black or African American, Asian, California, Child, Child, Preschool, Emergency Services, Psychiatric, Ethnicity, Female, Healthcare Disparities, Hispanic or Latino, Humans, Interrupted Time Series Analysis, Male, Medicaid, Mental Disorders, Mental Health Services, September 11 Terrorist Attacks, United States, White People, Young Adult, Emergency, Children, 9/11, Racial disparities, Clinical Sciences, Public Health and Health Services, Psychology, Psychiatry

الوصف: Much literature documents elevated psychiatric symptoms among adults after the terrorist attacks of September 11, 2001 (9/11). We, however, know of no research in children that examines emergency mental health services following 9/11. We test whether children's emergency services for crisis mental health care rose above expected values in September 2001. We applied time-series methods to California Medicaid claims (1999-2003; N = 127,200 visits). Findings in California indicate an 8.7% increase of children's emergency mental health visits statistically attributable to 9/11. Non-Hispanic white more than African American children account for this acute rise in emergency services.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/90x9b2c2Test

المؤلفون: Chakravarthy, Bharath, Frumin, Erica, Lotfipour, Shahram

المصدر: Western Journal of Emergency Medicine. 15(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Health Services and Systems, Public Health, Clinical Sciences, Health Sciences, Clinical Research, Prevention, Behavioral and Social Science, Aging, Brain Disorders, Suicide, Mental Health, Suicide Prevention, Mental health, Good Health and Well Being, Adolescent, Adult, Age Factors, Aged, Child, Female, Humans, Male, Mental Disorders, Middle Aged, United States, Young Adult

الوصف: The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to suicide rates in the United States (U.S.). Suicide is the 10th leading cause of death in U.S. adults, and rates are increasing across all geographic regions. There is a significant increase in the suicide rate among adults in the 35-64 age range. We present findings from the CDC's Morbidity and Mortality Weekly Report (MMWR) with commentary on current resources and barriers to psychiatric care.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0tn6v2cmTest

المؤلفون: Chakravarthy, Bharath, Toohey, Shannon, Rezaimehr, Yalda, Anderson, Craig L, Hoonpongsimanont, Wirachin, Menchine, Michael, Lotfipour, Shahram

المصدر: The American journal of emergency medicine, vol 32, iss 5

مصطلحات موضوعية: Humans, Ambulatory Care, Health Care Surveys, Incidence, Depression, Suicide, Attempted, Adolescent, Adult, Middle Aged, Emergency Service, Hospital, United States, Female, Male, Suicidal Ideation, Emergency Care, Mental Health, Behavioral and Social Science, Suicide Prevention, Prevention, Health Services, Serious Mental Illness, Clinical Research, Brain Disorders, Clinical Sciences, Emergency & Critical Care Medicine

جغرافية الموضوع: 443 - 447

الوصف: BackgroundMany suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high.Study objectiveThe primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients.MethodsThe National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution.ResultsEmergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year.ConclusionFrom 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics.

وصف الملف: application/pdf

العلاقة: qt9rm0f11n; https://escholarship.org/uc/item/9rm0f11nTest; https://escholarship.org/content/qt9rm0f11n/qt9rm0f11n.pdfTest

الإتاحة: https://doi.org/10.1016/j.ajem.2013.12.044Test
https://escholarship.org/uc/item/9rm0f11nTest
https://escholarship.org/content/qt9rm0f11n/qt9rm0f11n.pdfTest