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Introduction: An earlier study of physicians' perceptions of interactive online learning showed that these were shaped both by program design and quality and the quality and quantity of interpersonal interaction. We explore instructor roles in enhancing online learning through interpersonal interaction and the learning theories that inform these. Methods: This was a qualitative study using focus groups and interviews. Using purposive sampling, 50 physicians were recruited based on their experience with interactive online CME and face-to-face CME. Qualitative thematic and interpretive analysis was used. Results: Two facilitation roles appeared key: creating a comfortable learning environment and enhancing the educational value of electronic discussions. Comfort developed gradually, and specific interventions like facilitating introductions and sharing experiences in a friendly, informative manner were helpful. As in facilitating effective small-group learning, instructors' thoughtful use of techniques that facilitated constructive interaction based on learner's needs and practice demands contributed to the educational value of interpersonal interactions. Discussion: Facilitators require enhanced skills to engage learners in meaningful interaction and to overcome the transactional distance of online learning. The use of learning theories, including behavioral, cognitive, social, humanistic, and constructivist, can strengthen the educational design and facilitation of online programs. Preparation for online facilitation should include instruction in the roles and techniques required and the theories that inform them.

Purpose: Over 95% of patients who screen positive on the Patient Health Questionnaire-9 (PHQ-9) suicide risk item do not attempt or die by suicide, which could lead to unnecessary treatment and/or misallocation of limited resources. The present study seeks to determine if suicide risk screening can be meaningfully improved to identify the highest-risk patients.Methods: Patients eligible to receive medical treatment from the US Department of Defense medical system were recruited from 6 military primary care clinics located at 5 military installations around the United States. Patients completed self-report measures including the PHQ-9 and 16 items from the Suicide Cognitions Scale (SCS) during routine primary care clinic visits. Postbaseline suicidal behaviors (suicide attempts, interrupted attempts, and aborted attempts) were assessed by evaluators who were blind to screening results using the Self-Injurious Thoughts and Behaviors Interview.Results: Among 2,744 patients, 13 (0.5%) engaged in suicidal behavior in the 30 days after screening and 28 (1.0%) displayed suicidal behavior in the 90 days after screening. Multiple SCS items differentiated patients with suicidal behavior less than 30 days after screening positive for suicide risk. Augmenting the PHQ-9 suicide risk item with SCS items improved the identification of patients who were most likely to have suicidal behavior within a month of screening positive without sacrificing sensitivity.Conclusion: Among primary care patients who screen positive for suicide risk on the PHQ-9, SCS items improved screening efficiency by identifying those patients who are most likely to engage in suicidal behavior within the next 30 days. [ABSTRACT FROM AUTHOR]

Background: Bacteraemia data are often used as a general measure of resistance prevalence but may poorly represent other infection types. We compared resistance prevalence between bloodstream infection (BSI) and lower respiratory tract infection (LRTI) isolates collected by the BSAC Resistance Surveillance Programme.Methods: BSI isolates (n = 8912) were collected during 2014-18 inclusive and LRTI isolates (n = 6280) between October 2013 to September 2018 from participating laboratories in the UK and Ireland, to a fixed annual quota per species group. LRTI isolates, but not BSI, were selected by onset: community for Streptococcus pneumoniae; hospital for Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacterales. MICs were determined centrally by agar dilution; statistical modelling adjusted for ICU location and possible clustering by collection centre.Results: Resistance was more prevalent among the LRTI isolates, even after adjusting for a larger proportion of ICU patients. LRTI P. aeruginosa and S. pneumoniae were more often resistant than BSI isolates for most antibiotics, and the proportion of MRSA was higher in LRTI. For S. pneumoniae, the observation reflected different serotype distributions in LRTI and BSI. Relationships between LRTI and resistance were less marked for Enterobacterales, but LRTI E. coli were more often resistant to β-lactams, particularly penicillin/β-lactamase inhibitor combinations, and LRTI K. pneumoniae to piperacillin/tazobactam. For E. cloacae there was a weak association between LRTI, production of AmpC enzymes and cephalosporin resistance.Conclusions: Estimates of resistance prevalence based upon bloodstream isolates underestimate the extent of the problem in respiratory isolates, particularly for P. aeruginosa, S. pneumoniae, S. aureus and, less so, for Enterobacterales. [ABSTRACT FROM AUTHOR]

Importance: Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped.Objective: To determine whether an ED-initiated intervention reduces subsequent suicidal behavior.Design, Setting, and Participants: This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013.Interventions: Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk.Main Outcomes and Measures: The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed.Results: A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts than participants in the TAU phase (incidence rate ratio, 0.72; 95% CI, 0.52-1.00; P = .05) but no differences between the TAU and screening phases (incidence rate ratio, 1.00; 95% CI, 0.71-1.41; P = .99).Conclusions and Relevance: Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior. [ABSTRACT FROM AUTHOR]

This study evaluated the concurrent validity of a brief suicide risk screener for adults in the emergency department (ED). Two versions of the verbally administered Patient Safety Screener (2-item, 3-item) were compared to a reference standard, the Beck Scale for Suicide Ideation (BSSI). Analyses included measures of agreement (Kappa). Agreement between the Patient Safety Screener-2 and -3 and the BSSI (n = 951) was almost perfect for overall positive screening (K = 0.94–0.95) and past suicide attempts (K = 0.97–0.98). Agreement on ideation ranged from fair (K = 0.34) for the 2 item version to good (K = 0.61) for the 3 item version. The Patient Safety Screener's concurrent validity with the BSSI ranged from fair to almost perfect and warrants additional study. [ABSTRACT FROM PUBLISHER]

Introduction: Understanding of statistical terms used to measure treatment effect is important for evidence-informed medical teaching and practice. We explored knowledge of these terms among clinical faculty who instruct and mentor a continuum of medical learners to inform medical faculty learning needs. Methods: This was a mixed methods study that used a questionnaire to measure a health professional's understanding of measures of treatment effect and a focus group to explore perspectives on learning, applying, and teaching these terms. We analyzed questionnaire data using descriptive statistics and focus group data using thematic analysis. Results: We analyzed responses from clinical faculty who were physicians and completed all sections of the questionnaire (n = 137). Overall, approximately 55% were highly confident in their understanding of statistical terms; self-reported understanding was highest for number needed to treat (77%). Only 26% of respondents correctly responded to all comprehension questions; however, 80% correctly responded to at least one of these questions. There was a significant association among self-reported understanding and ability to correctly calculate terms. A focus group with clinical/medical faculty (n = 4) revealed themes of mentorship, support and resources, and beliefs about the value of statistical literacy. Discussion: We found that half of clinical faculty members are highly confident in their understanding of relative and absolute terms. Despite the limitations of self-assessment data, our study provides some evidence that self-assessment can be reliable. Recognizing that faculty development is not mandatory for clinical faculty in many centers, and the notion that faculty may benefit from mentorship in critical appraisal topics, it may be appropriate to first engage and support influential clinical faculty rather than using a broad strategy to achieve universal statistical literacy. Second, senior leadership in medical education should support continuous learning by providing paid, protected time for faculty to incorporate evidence in their teaching. [ABSTRACT FROM AUTHOR]

Objective: The Clinical Global Impression for Schizoaffective Disorder scale is a new rating scale adapted from the Clinical Global Impression scale for use in patients with schizoaffective disorder. The psychometric characteristics of the Clinical Global Impression for Schizoaffective Disorder are described. Design: Content validity was assessed using an investigator questionnaire. Inter-rater reliability was determined with 12 sets of videotaped interviews rated independently by two trained individuals. Test-retest reliability was assessed using 30 randomly selected raters from clinical trials who evaluated the same videos on separate occasions two weeks apart. Convergent and divergent validity and effect size were evaluated by comparing scores between the Clinical Global Impression for Schizoaffective Disorder and the Positive and Negative Syndrome Scale, 21-item Hamilton Rating Scale for Depression, and Young Mania Rating Scale scales using pooled patient data from two clinical trials. Clinical Global Impression for Schizoaffective Disorder scores were then linked to corresponding Positive and Negative Syndrome Scale scores. Results: Content validity was strong. Inter-rater agreement was good to excellent for most scales and subscales (intra-class correlation coefficient ≥0.50). Test-retest showed good reproducibility, with intraclass correlation coefficients ranging from 0.444 to 0.898. Spearman correlations between Clinical Global Impression for Schizoaffective Disorder domains and corresponding symptom scales were 0.60 or greater, and effect sizes for Clinical Global Impression for Schizoaffective Disorder overall and domain scores were similar to Positive and Negative Syndrome Scale, Young Mania Rating Scale, and 21-item Hamilton Rating Scale for Depression scores. Raters anticipated that the scale might be less effective in distinguishing negative from depressive symptoms, and, in fact, the results here may reflect that clinical reality. Conclusion: Multiple lines of evidence support the reliability and validity of the Clinical Global Impression for Schizoaffective Disorder for studies in schizoaffective disorder. [ABSTRACT FROM AUTHOR]

Introduction: Clinical trial data can be presented in ways that exaggerate treatment effectiveness. Physicians consider therapy more effective, and may be more likely to make inappropriate practice changes, when data are presented in relative terms such as relative risk reduction rather than in absolute terms such as absolute risk reduction and number needed to treat. Our purpose was to determine (1) how frequently continuing medical education (CME) speakers present research data in relative terms compared to absolute terms; (2) how knowledgeable CME speakers and learners are about these terms; and (3) how CME learners want these terms presented. Methods: Analysis of videotapes and PowerPoint slides of 26 CME presentations, questionnaire survey of CME speakers and learners, and focus groups with learners. Results: Speakers presented data more frequently in relative than absolute terms, but most frequently in general terms such as frequencies, percentages, graphs, and P-values with no data. Of 1367 PowerPoint slides, 269 presented research data, and of these, 225 (84%) presented data in general terms, 50 (19%) in relative terms and 19 (7%) in absolute terms. CME speakers understood relative and absolute terms better than learners. Approximately 25–35% of speakers and 45–65% of learners could not correctly calculate relative risk reduction, absolute risk reduction, and number needed to treat. Learners wished to have these terms presented in CME programs in a consistent and easily understood format and requested a brief review of them at the beginning of CME programs. Discussion: Presentation of research data in most CME programs is inadequate to allow learners to make fully informed therapeutic decisions. Speakers and learners need professional development to improve their presentation and understanding of research data. [ABSTRACT FROM AUTHOR]

Infusion data from ruminants has shown that propionate stimulates satiety and decreases meal size, possibly because of increased propionate oxidation in the liver. In this experiment, phlorizin was used to increase glucose demand, which was expected to decrease propionate oxidation and attenuate the decrease in dry matter intake (DM1) caused by propionate infusion. Twelve multiparous, ruminally-cannulated Holstein cows (49 ± 33 d in milk, 40 ± 7 kg/d milk; mean ± SD) were randomly assigned to square and treatment sequence in a replicated 4 × 4 Latin square experiment with a 2 )< 2 factorial arrangement of treatments. Treatments were subcutaneous injection of phlorizin or propylene glycol in combination with intraruminal infusion of either Na acetate or Na propionate. Following a 7-d adaptation period, phlorizin (4 g/d) and control injections were administered every 6 h for] d. During the final 2 d of inlections, Na acetate or Na propionate solutions (1 mol/L, pH 6.0) were infused continuously at the rate of 0.80 LIh. Feeding behavior data were collected during the final 2 d of treatment. Phlorizin caused urinary excretion of 400 ± 40 g glucose/d across infusion treatments. Phiorizin tended to increase plasma free fatty acid and !-hydroxybutyrate concentrations to a greater extent with Na acetate compared to Na propionate infusion (both interactions P < 0.15). Phlorizin decreased and Na propionate increased plasma insulin and glucose concentrations. Infusion of Na propionate decreased DM1 (18.4 vs. 21.1 ± 1.4 kg/d, P < 0.001) through an increase in intermea) interval (89.2vs. 77.3 ± 6.6 mi P= 0.03), resulting in fewer meals per day (11.6 vs. 13.7 ± 0.7, P < 0.001). Phlorizin did ndt alterDMI (P = 0.39) or measures of feeding behavior, nor were there interactions with infusion type. Increasing glucose demand does not limit the extent to which propionate decreases DM1 in lactating dairy cows. J. Nutr. 13]: 326-330, 2007. [ABSTRACT FROM AUTHOR]

Two experiments were designed to assess the potential utility of the propionate challenge test (PCT) as an index of gluconeogenic capacity. In Expt. 1, the dose-response to jugular propionate infusion was assessed in a duplicated 4 × 4 Latin square experiment with 8 lactating dairy cows. Sodium propionate (4.5 mol/L, pH 7.4) was infused in an intrajugular bolus at 0 (saline), 0.52, 1.04, or 1.56 mmol/kg body weight (BW), and jugular blood was sampled over the following 2 h. Peak propionate concentration in plasma and area under the curve for plasma glucose both increased linearly with increasing propionate dose (P < 0.01). Plasma free fatty acid (FFA) concentration was elevated by all propionate treatments at 20 min postinfusion (P = 0.03), and plasma cortisol concentration tended to increase (P < 0.10) after propionate infusions. Experiment 2 was designed to study the effect of short-term differences in fed state on responses to propionate infusion. Lactating dairy cows (n = 8) were included in a duplicated 4 × 4 Latin square design with a 2 × 2 factorial arrangement of treatments. Sodium propionate (1.04 mmol/kg BW) or saline was infused either before feeding (0900) or 2 h after feeding (1300). Fed cows consumed 4.4 ± 1.4 kg dry matter before the PCT. Although fed cows had a significantly higher preinfusion plasma propionate concentration, fed state did not influence postinfusion changes in plasma propionate, glucose, insulin, glucagon, or FFA concentrations. Liver glycogen concentration decreased significantly after propionate, but not saline infusion (P < 0.05). Short-term differences in fed state do not affect the physiological responses to PCT. However, glucagon release after jugular administration of propionate is likely supraphysiologic, and postinfusion lipolysis and glycogenolysis suggest that stress responses may alter PCT measurements. Although the PCT may help to diagnose liver dysfunction, it is not a useful index with which to assess differences in gluconeogenic capacity. [ABSTRACT FROM AUTHOR]

Rates of fatty acid biohydrogenation and passage were determined for fat supplements varying in saturation using lactating dairy cows. First-order fractional passage rates were determined by dividing the duodenal flux of fatty acids by their respective ruminal pool sizes. The determination of rates of biohydrogenation required the development of a model to account for the transfer of fatty acids among pools. Ruminally and duodenally cannulated multiparous Holstein cows (n = 8) were used in a replicated 4 x 4 Latin square design with 21-d periods. Treatments were control and a linear substitution of 25 g/kg supplemented fatty acids varying in saturation as follows: saturated (prilled hydrogenated free fatty acids), intermediate mix of saturated and unsaturated (calcium soaps of long-chain fatty acids), and partially unsaturated fatty acids. Passage rates of 16:0, 18:0, and total 18-carbon fatty acids were linearly decreased with increasing unsaturated fatty acids and the trans-18:1 fractional passage rate was quadratically affected with a maximum for the intermediate treatment. Increasing unsaturated fatty acids increased the extent of 18:2 and 18:3 biohydrogenation and decreased the extent of 18:1 and trans-18:1 biohydrogenation. Calcium salts did not protect PUFA from ruminal biohydrogenation despite a mean ruminal pH of 6.0, and unsaturated fatty acids decreased ruminal biohydrogenation of trans-18:1, resulting in increased duodenal flow of these fatty acids. The model allows a mechanistic description of ruminal biohydrogenation and determination of the extent of 18:1 biohydrogenation. [ABSTRACT FROM AUTHOR]

Two experiments were conducted to evaluate how dose-response effects of intraruminal infusion of propionate on feeding behavior and plasma metabolites are altered by diets differing in fermentability. Twelve ruminally cannulated Holstein cows were used in each experiment. Cows were fed diets containing either steam flaked corn or dry cracked corn (30% of dietary dry matter) in expt. 1, and diets differing in forage-to-concentrate ratio (66:34 vs. 36:64) in expt. 2. For both experiments, the experimental design was a crossover for dietary treatment, and a 6 x 6 Latin square for infusion treatment within a diet for each period. Infusion treatments were mixtures of sodium propionate and sodium acetate, containing propionate at 0, 0.2, 0.4, 0.6, 0.8 and 1.0 as a fraction of total volatile fatty acids infused. Treatment solutions were infused into the rumen continuously for 18 h starting 6 h before feeding at a rate of 23.1 mmol/min. Although propionate production from ruminal fermentation was expected to be different, dietary treatments did not affect dry matter intake (DMI) responses to propionate infusion for either experiment. However, propionate infusion decreased DMI linearly in expt. 1, but did not decrease DMI at lower rates of propionate infusion, which were much more effective at increasing plasma glucose concentration in expt. 2. Propionate had a smaller hypophagic effect at low concentrations of plasma glucose and had a greater hypophagic effect at elevated concentrations of plasma glucose, which could be explained by changes in the metabolism of propionate in the liver. [ABSTRACT FROM AUTHOR]

The dose-response effects of intraruminal infusion of propionate on feeding behavior of lactating dairy cows were evaluated with eight ruminally cannulated Holstein cows past peak lactation. Treatments were mixtures of propionic acid and acetic acid containing propionic acid at eight different concentrations in Experiment 1, and mixtures of sodium propionate and sodium acetate containing sodium propionate at 4 different concentrations in Experiment 2. Experimental designs were an 8 x 8 and duplicated 4 x 4 Latin squares, respectively, for Experiments 1 and 2. Treatment solutions were infused into the rumen continuously for 14 h at a rate of 16.7 and 25 mmol/min, respectively, for Experiments 1 and 2. Infusion started 2 h before feeding and ended 12 h after feeding; feeding behavior was monitored for 12 h after feeding using a computerized data acquisition system. Total metabolizable energy (ME) intake was calculated by adding the energy of infusates to dietary energy intake. In both experiments, as the proportion of propionate of the infusates increased, total ME intake and dry matter intake decreased linearly. As infusion of propionate increased, meal size tended (P < 0.09) to decrease linearly and intermeal interval tended (P < 0.07) to increase linearly in Experiment 1; meal size decreased linearly and number of meal bouts tended (P < 0.08) to decrease linearly in Experiment 2. These observations indicate that the reduction in dietary energy intake from propionate infusion was greater than the energy supplied from infusates, and that propionate plays an important role in feed intake regulation by affecting both satiety and hunger. [ABSTRACT FROM AUTHOR]

The objective of this experiment was to determine interactions between hypophagic effects of propionate and ammonium in lactating dairy cows. Eight ruminally cannulated Holstein cows in mid-lactation were used in a duplicated 4 x 4 Latin square design experiment with a 2 x 2 factorial arrangement of treatments. Factors evaluated were type of volatile fatty acid (VFA; acetate vs. propionate) and type of salt (sodium vs. ammonium). Treatment solutions were infused continuously into the rumen at a rate of 16.7 mmol of VFA salts/min starting 2 h before feeding and ending 12 h after feeding. Hypophagic effects of ammonium were significantly greater for cows infused with propionate (4.3 vs. 12.1 kg/12 h; SEM = 1.3) compared with acetate (13.5 vs. 15.3 kg/12 h; SEM = 1.3; interaction P < 0.01). This interaction was attributed to a greater reduction in meal frequency for ammonium treatment compared with sodium treatment when infused with propionate (3.9 vs. 7.2/12 h; SEM = 0.8) compared with acetate (6.6 vs. 7.0/12 h; SEM = 0.8), indicating that infusion of ammonium propionate reduced hunger. Meal size was decreased by infusion of propionate compared with acetate, but was not affected by ammonium compared with sodium, indicating that ammonium did not affect satiety. Mechanisms to explain the interactions between ammonium and propionate on meal frequency and feed intake warrant further investigation. [ABSTRACT FROM AUTHOR]

Videoconferencing has been used to provide distance education for medical students, physicians and other health-care professionals, such as nurses, physiotherapists and pharmacists. The Dalhousie University Office of Continuing Medical Education (CME) has used videoconferencing for CME since a pilot project with four sites in 1995-6. Since that pilot project, videoconferencing activity has steadily increased; in the year 1999-2000, a total of 64 videoconferences were provided for 1059 learners in 37 sites. Videoconferencing has been well accepted by faculty staff and by learners, as it enables them to provide and receive CME without travelling long distances. The key components of the development of the videoconferencing programme include planning, scheduling, faculty support, technical support and evaluation. Evaluation enables the effect of videoconferencing on other CME activities, and costs, to be measured. [ABSTRACT FROM AUTHOR]

Introduction: Suicide rates are extremely high among emergency department patients seen for deliberate self-harm. Inpatient hospitalization is often recommended for these patients, but evidence on the suicide prevention impacts of hospitalization is scarce. Confounding by indication and challenges to implementing randomized designs are barriers to advances in this field.Methods: Investigators used 2009-2012 statewide data on 57,312 self-harm emergency department patients from California, linked to mortality records. Naive 12-month and 30-day suicide risks were estimated among patients who were hospitalized versus those who were discharged. Then, generalized random forest methods were applied to estimate the average treatment impacts of hospitalization on suicide, conditioning on observable covariates. Associations were calculated separately for sex- and age-specific subgroups. Analyses were conducted in February 2019-August 2021.Results: In naive analyses, suicide risk was significantly higher in hospitalized than in discharged patients in each subgroup. In 12-month models accounting for the observed covariates through generalized random forest methods, hospitalized male patients had 5.4 more suicides per 1,000 patients (95% CI=3.0, 7.8), hospitalized patients aged 10-29 years had 2.4 more suicides per 1,000 (95% CI=1.1, 3.6), and those aged ≥50 years had 5.8 more suicides per 1,000 (95% CI=0.5, 11.2) than corresponding discharged patients. Hospitalization was not significantly associated with suicide among female patients or patients aged 30-49 years in generalized random forest analyses. Patterns were similar in 30-day generalized random forest models.Conclusions: Emergency department personnel intend to hospitalize self-harm patients with high suicide risk; this study suggests that this goal is largely realized. Analyses that control for confounding by observable covariates did not find clear evidence that hospitalization reduces suicide risk and could not rule out the possibility of iatrogenic effects. [ABSTRACT FROM AUTHOR]

Many patients treated in the emergency department (ED) for non-psychiatric complaints have elevated suicide risk. Universal screening can detect occult suicide risk, but gold standard risk measurement tools, such as the Beck Scale for Suicidal Ideation (BSS), are too long and cumbersome for ED use. To test the performance of seven novel 0- to 10-point suicide risk "rulers" against the BSS. 399 patients from three EDs completed seven novel risk rulers, traditional binary screening items, and the BSS. Using BSS criterion references, we tested the diagnostic performance of each risk ruler and examined correlations between the rulers and BSS scores. By varying thresholds on the risk rulers, high levels of sensitivity and specificity were obtained. A threshold of 3 on the "sadness" ruler gave 89% sensitivity for the BSS criterion reference, and a threshold of 1 on the "wish to be dead" ruler provided 94–97% specificity. Our novel risk rulers may be an efficient way to detect risk and triage potentially suicidal patients, showing good concurrent validity with the BSS. Clinicians can obtain high sensitivity and high specificity using just two rulers. Further research should examine the rulers' ability to predict independent clinician risk ratings and prospective suicidal behavior. [ABSTRACT FROM AUTHOR]

Introduction: The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED).Methods: A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014.Results: Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ(2) [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ(2) [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview.Conclusions: Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.Trial Registration: Emergency Department Safety Assessmentand Follow-up Evaluation (ED-SAFE) ClinicalTrials.gov: (NCT01150994). https://clinicaltrials.gov/ct2/show/NCT01150994?term=ED-SAFE&rank=1. [ABSTRACT FROM AUTHOR]