المؤلفون: Yanuck, Justin, Lee, Jonathan B, Saadat, Soheil, Rouhi, Jila, Ghanem, Ghadi, Chakravarthy, Bharath, Shah, Shalini

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Emergency Care, Prescription Drug Abuse, Health Services, Clinical Research, Substance Misuse, Pain Research, Chronic Pain, Good Health and Well Being, Analgesics, Opioid, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Patient Discharge, Practice Patterns, Physicians', Retrospective Studies, Anesthesiology, Clinical sciences, Dentistry, Neurosciences

الوصف: ObjectivesIt is important to analyze the types of etiologies and provider demographics that drive opioid prescription in our emergency departments. Our study aimed to determine which patients in the ED are receiving opioid prescriptions, as well as their strength and quantity. Secondary outcomes included identifying difference in prescribing between provider classes.MethodsWe conducted a retrospective study at a tertiary care university-based, level-one trauma ED from November 2017 to October 2018. We identified and analyzed data from 2,259 patients who were sent home with an opioid prescription. We retrieved patient and provider demographics, diagnosis, etiologies, and prescription information.ResultsThe mean age of a patient receiving an opioid prescription was 45, and 72.7% of patients were white. The most common diagnosis groups associated with an opioid prescription were abdominal pain (18.5%), nonfracture extremity pain (18.4%), and back/neck pain (12.5%). Hydrocodone-acetaminophen 5-325 mg was the most commonly prescribed (67.4%). The median total prescribed milligram morphine equivalent (MME) was highest for extremity fracture (75.0; IQR 54.0-100.0). The median total prescribed amount of pills was highest for patients with extremity fractures (15.0; IQR 12.0-20.0).ConclusionsOur study elucidates the prescribing patterns of an academic level 1 trauma center and should pave the way for future studies looking to maximize effectiveness at ways to curb ED opioid prescription.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2k19x13sTest

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: Imani, Ghasem, Barrios, Cristobal, Anderson, Craig L, Hosseini Farahabadi, Maryam, Banimahd, Faried, Chakravarthy, Bharath, Hoonpongsimanont, Wirachin, McCoy, Christopher E, Mercado, Georginne, Farivar, Babak, Pham, Jacqueline K, Lotfipour, Shahram

المصدر: BMC public health. 17(1)

مصطلحات موضوعية: Humans, Alcoholism, Diagnosis, Computer-Assisted, Risk Assessment, Retrospective Studies, Adolescent, Adult, Aged, Middle Aged, Trauma Centers, Referral and Consultation, Female, Male, Young Adult, At-risk drinking, Computerized alcohol screening, Level 1 trauma center, Level 2 trauma center, Diagnosis, Computer-Assisted, Substance Abuse, Alcohol Use and Health, Prevention, Clinical Research, Injury (total) Accidents/Adverse Effects, Screening And Brief Intervention For Substance Abuse, Public Health, Public Health and Health Services

الوصف: BackgroundAlcohol abuse is recognized as a significant contributor to injury. It is therefore essential that trauma centers implement screening and brief intervention (SBI) to identify patients who are problem drinkers. Although, the utility of SBI in identifying at-risk drinkers have been widely studied in level 1 trauma centers, few studies have been done in level 2 centers. This study evaluates the usefulness of SBI in identifying at-risk drinkers and to investigate the pattern of alcohol drinking among level 2 trauma patients.MethodsThis is a retrospective study of a convenience sample of trauma patients participating in computerized alcohol screening, brief intervention, and referral to treatment (CASI) in an academic level 1 trauma center and a nearby suburban community hospital level 2 trauma center. CASI utilized Alcohol Use Disorders Identification Test (AUDIT) to screen patients. We compared the pattern of alcohol drinking, demographic factors, and readiness-to-change scores between those screened in a level 2 and 1 trauma center.ResultsA total of 3,850 and 1,933 admitted trauma patients were screened in level 1 and 2 trauma centers respectively. There was no difference in mean age, gender, and language between the two centers. Of those screened, 10.2% of the level 1 and 14.4% of the level 2 trauma patients scored at-risk (AUDIT 8-19) (p  =20) (p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6tb2w5qfTest

المؤلفون: Lotfipour, Shahram, Cisneros, Victor, Ogbu, Uzor C, McCoy, Christopher Eric, Barrios, Cristobal, Anderson, Craig L, Hoonpongsimanont, Wirachin, Alix, Kristin, Chakravarthy, Bharath

المصدر: BMC emergency medicine. 15(1)

مصطلحات موضوعية: Humans, Multivariate Analysis, Logistic Models, Retrospective Studies, Cross-Sectional Studies, Alcohol Drinking, Age Factors, Sex Factors, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Emergency Service, Hospital, Trauma Centers, California, Female, Male, Health Status Disparities, Young Adult, Self Report, and over, Emergency Service, Hospital, Clinical Research, Health Services, Alcoholism, Alcohol Use and Health, Substance Abuse, Cancer, Oral and Gastrointestinal, Stroke, Cardiovascular, Emergency & Critical Care Medicine, Clinical Sciences

الوصف: BackgroundPrevious studies of alcohol use have recognized several trends in consumption patterns among gender and age yet few have examined ethnic differences. This study examines the intra- and inter-ethnic differences in alcohol consumption among a population of patients seen in the emergency department.MethodsThis is a cross-sectional study conducted in the emergency department in a large urban setting. Information on drinking behavior and ethnicity was collected using the Computerized Alcohol Screening and Brief Intervention (CASI) tool. We explored differences in drinking patterns using a multivariate multinomial logistic regression model.ResultsWe analyzed the drinking habits of 2,444 patients surveyed between November 2012 and May 2014. The results indicate that when compared to non-Hispanic whites, Asians have the lowest odds of drinking within normal limits or excessively, followed by other Latinos, and Mexicans. Age and gender consistently showed statistically significant associations with alcohol-use. The odds of drinking within normal limits or excessively are inversely associated with age and were lower among females. The predicted probabilities show a marked gender-specific difference in alcohol use both between and within ethnic/racial groups. They also highlight an age-related convergence in alcohol use between men and women within ethnic groups.DiscussionThe results of this study show intra-racial/ethnic variability associated with sex and education. The highlighted differences within and between ethnic groups reinforce the need to use refined categories when examining alcohol use among minorities.ConclusionThe results of this study confirm some alcohol consumption trends among ethnic minorities observed in literature. It provides empirical evidence of the marked gender differences and highlights an age-related convergence for gender-specific alcohol use. Health-care personnel should be aware of these differences when screening and counseling.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1n1009m9Test

المؤلفون: Anderson, Craig, Habicht, Michael, Bruckner, Tim, Chakravarthy, Bharath, Lotfipour, Shahram, Hoonpongsimanont, Wirachin

المصدر: Western Journal of Emergency Medicine. 15(2)

مصطلحات موضوعية: Adolescent, Adult, Age Factors, Aged, Child, Depression, Emergency Service, Hospital, Female, Humans, Logistic Models, Male, Middle Aged, Patient Discharge, Retrospective Studies, Suicidal Ideation, Suicide, Attempted, United States, Young Adult

الوصف: INTRODUCTION: The World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED. METHODS: We conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey from 2006 to 2008. We used logistic regression to identify factors associated with discharge, in SI, SA and depression patients. Independent variables included socio-demographic information, vital signs, mode of arrival, insurance status, place of residence and concomitant psychiatric diagnosis. RESULTS: Of the 93,030 subjects, 2,314 met the inclusion criteria (1,362 depression, 353 SI and 599 SA). Patients who arrived by ambulance were less likely to be discharged (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.92). Hispanic patients and patients age 15 to 29 were likely to be discharged (OR 1.61, 95% CI 1.16-2.24 and OR 1.55, 95% CI 1.15-2.10 respectively). Insurance status and housing status were not significantly associated patient was being discharge from EDs. CONCLUSION: The Hispanic population had higher discharge rates, but the reasons are yet to be explored. Patients with SA and SI are discharged less frequently than those with depression, regardless of insurance type or housing status.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8pm255ztTest
https://escholarship.org/content/qt8pm255zt/qt8pm255zt.pdfTest

المؤلفون: Pham, Danny, Lee, Stephen, Abrishami, Sadaf, Chakravarthy, Bharath, Saadat, Soheil

المصدر: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health; May2023, Vol. 24 Issue 3, p396-400, 5p

مصطلحات موضوعية: PATIENT aftercare, HOSPITAL emergency services, EVALUATION of human services programs, URINARY tract infections, RETROSPECTIVE studies, HUMAN services programs, PRE-tests & post-tests, COMPARATIVE studies, URINALYSIS, DISCHARGE planning

مستخلص: Introduction: Urinary tract infections (UTI) are a common reason for an emergency department (ED) visit. The majority of these patients are discharged directly home without a hospital admission. After discharge, emergency physicians have traditionally managed the care of the patient if a change is warranted (as a result of urine culture results). However, in recent years clinical pharmacists in the ED have largely incorporated this task into their standard practice. In our study, we aimed to 1) describe our unique process in having a pharmacist-led, urinary culture follow-up, and 2) compare it to our previous, more traditional process. Methods: In our retrospective study, we evaluated the impact of a pharmacist-led, urinary culture follow-up program after discharge from the ED. We included patients prior to and after the implementation of our new protocol to compare the differences. The primary outcome was time to intervention after urine culture result was released. Secondary outcomes included rate of documentation of intervention, appropriate interventions made, and repeat ED visits within 30 days. Results: We included a total of 265 unique urine cultures from 264 patients in the study: 129 cultures were from the period prior to implementation of the protocol, and 136 were from the post-implementation period. There were no significant differences between pre- and post-implementation groups for the primary outcome. Appropriate therapeutic intervention based on positive urine culture results was 16.3% in the preimplementation group vs 14.7% in the post-implementation group (P=0.72). Secondary outcomes of time to intervention, documentation rates, and readmissions were similar between both groups. Conclusion: Implementation of a pharmacist-led, urinary culture follow-up program after discharge from the ED led to similar outcomes as a physician-run program. An ED pharmacist can successfully run a urinary culture follow-up program in an ED without physician involvement. [ABSTRACT FROM AUTHOR]

: Copyright of Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health is the property of Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Lee, Jonathan B., Ghanem, Ghadi, Saadat, Soheil, Yanuck, Justin, Yeung, Brent, Chakravarthy, Bharath, Nelson, Ariana, Shah, Shalini

المصدر: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health; Sep2021, Vol. 22 Issue 5, p1067-1075, 9p

مصطلحات موضوعية: NARCOTICS, ANTIDEPRESSANTS, SUBSTANCE abuse, PSYCHIATRIC drugs, ACQUISITION of data methodology, ACADEMIC medical centers, HOSPITAL emergency services, GANGLIONIC stimulating agents, PHYSICIANS' attitudes, RETROSPECTIVE studies, TERTIARY care, JOINT dislocations, NALOXONE, MEDICAL protocols, DRUG prescribing, MEDICAL records, TOXICOLOGY, PHYSICIAN practice patterns, URINALYSIS, AMPUTATION, BONE fractures, DISCHARGE planning

مستخلص: Introduction: Given the general lack of literature on opioid and naloxone prescribing guidelines for patients with substance use disorder, we aimed to explore how a physician’s behavior and prescribing habits are altered by knowledge of the patient’s concomitant use of psychotropic compounds as evident on urine and serum toxicology screens. Methods: We conducted a retrospective chart review study at a tertiary, academic, Level I trauma center between November 2017–October 2018 that included 358 patients who were discharged from the emergency department (ED) with a diagnosis of fracture, dislocation, or amputation and received an opioid prescription upon discharge. We extracted urine and serum toxicology results, number and amount of prescription opioids upon discharge, and the presence of a naloxone script. Results: The study population was divided into five subgroups that included the following: negative urine and serum toxicology screen; depressants; stimulants; mixed; and no toxicology screens. When comparing the 103 patients in which toxicology screens were obtained to the 255 patients without toxicology screens, we found no statistically significant differences in the total prescribed morphine milligram equivalent (75.0 and 75.0, respectively) or in the number of pills prescribed (15.0 and 13.5, respectively). Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. Conclusion: Our study found no association between positive urine toxicology results for psychotropically active substances and the rates of opioid prescribing within a single-center, academic ED. Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. More research on the associations between illicit drug use, opioids, and naloxone prescriptions is necessary to help establish guidelines for high-risk patients. [ABSTRACT FROM AUTHOR]

: Copyright of Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health is the property of Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Hosseini Farahabadi, Maryam¹, Chakravarthy, Bharath¹, Hoonpongsimanont, Wirachin¹, Vaca, Federico E.², McCoy, Christopher E.¹, Anderson, Craig L.¹, Imani, Ghasem¹, Wong, Priscilla¹, Lotfipour, Shahram¹ shl@uci.edu

المصدر: Journal of Human Behavior in the Social Environment. Jul2018, Vol. 28 Issue 5, p623-631. 9p. 3 Charts.

مصطلحات موضوعية: *DIAGNOSIS of alcoholism, *CHI-squared test, *COMPARATIVE studies, *CONFIDENCE intervals, *PATIENT aftercare, *HOSPITAL emergency services, *MEDICAL screening, *PROBABILITY theory, *QUESTIONNAIRES, *T-test (Statistics), *LOGISTIC regression analysis, *RETROSPECTIVE studies, *DATA analysis software, *DESCRIPTIVE statistics, *ODDS ratio

مستخلص: Many studies have evaluated the effectiveness of alcohol screening and brief intervention (SBI) but most of them have reported substantial loss to follow-up without investigating the characteristics of those lost to follow-up. We examined the association between Alcohol Use Disorders Identification Test (AUDIT) scores, readiness-to-change scores and the demographic factors with lost to follow-up. This retrospective study compared demographic characteristics, AUDIT and readiness-to-change scores for 190 lost to follow-up patients to 221 completed follow-up patients who participated in SBI in the Emergency Department between June 2006 and May 2007. Comparing the association between baseline characteristics and completed follow-up rate, those 30-39, 40-49 and 50 years and older had 0.46 (95% CI 0.32-0.91), 0.49 (95% CI 0.29-0.90) and 0.58 (95%CI 0.22-0.79) lower odds of completing follow-up, respectively, in comparison to those 18-29 years of age. The loss to follow-up group reported more negative consequences of alcohol and binge drinking than the completed follow-up group (p = 0.04). Using logistic regression, patients who experienced more negative effects of alcohol had 0.87 lower odds of completing follow-up (95% CI 0.79-0.96). The patients lost to follow-up in this study were significantly different in age and alcohol drinking habits compared to those completed follow-ups. It is important to consider differential loss to follow-up in assessing the validity and generalizability of intervention studies. This could help in tailoring methods of approaching patients based on target population characteristics. [ABSTRACT FROM AUTHOR]

المؤلفون: Marshall, John R., Katzer, Robert, Lotfipour, Shahram, Chakravarthy, Bharath, Shastry, Siri, Andrusaitis, Jessica, Anderson, Craig L., Barton, Erik D.

المصدر: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health; 2017, Vol. 18 Issue 2, p181-188, 8p

مصطلحات موضوعية: ABDOMINAL pain, EMERGENCY physicians, LENGTH of stay in hospitals, HOSPITAL emergency services, LONGITUDINAL method, MEDICAL triage, DECISION making in clinical medicine, RETROSPECTIVE studies

مستخلص: Introduction: Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission). Methods: This was a retrospective cohort study of patients admitted to a protocol-driven EDOU with a diagnosis of abdominal pain in a single university hospital center ED. We obtained compiled data for all patients admitted to the EDOU with a diagnosis of abdominal pain that met EDOU protocol admission criteria. We divided data for each cohort into age, gender, payer status, and LOS. The data were then analyzed to assess any significant differences between the cohorts. Results: A total of 327 patients were eligible for this study (85 triage group, 242 main ED group). The total success rate was 90.8% (n=297) and failure rate was 9.2% (n=30). We observed no significant differences in success rates between those dispositioned to the EDOU by triage physicians (90.6%) and those via the traditional route (90.5 % p) = 0.98. However, we found a significant difference between the two groups regarding total LOS with significantly shorter main ED times and EDOU times among patients sent to the EDOU by the physician-in-triage group (p< .001). Conclusion: There were no significant differences in EDOU disposition outcomes in patients admitted to an EDOU by a physician-in-triage or via the traditional route. However, there were statistically significant shorter LOSs in patients admitted to the EDOU by triage physicians. The data from this study support the implementation of a physician-in-triage model in combination with the EDOU in improving efficiency in the treatment of abdominal pain. This knowledge may spur action to cut healthcare costs and improve patient flow and timely decision-making in hospitals with EDOUs. [ABSTRACT FROM AUTHOR]

: Copyright of Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health is the property of Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)