193 results on '"Boudreaux ED"'
Search Results
2. Medical Disorders Among Emergency Psychiatric Patients in a Municipal Emergency Department
- Author
-
Boudreaux, ED, Mandry, C, Francis, J, and Friess, K
- Subjects
Emergency medicine -- Research ,Health - Published
- 2001
3. Race-Ethnicity and Asthma-Chronic Obstructive Pulmonary Disease Exacerbations Among Adults Presenting to the Emergency Department
- Author
-
Boudreaux, ED, Cydulka, RK, and Camargo, CA
- Subjects
Emergency medicine -- Research ,Health - Published
- 2001
4. Patient Satisfaction in the Emergency Department: 1,001 Ways to Analyze Your Data
- Author
-
Boudreaux, ED, d'Autremont, S, Fleming, L, Ary, RD, and Jones, GN
- Subjects
Hospitals -- Emergency service ,Patient satisfaction -- Measurement ,Health - Published
- 2000
5. Knowledge and Perceived Impact of Prudent Layperson Legislation One Year After Ratification
- Author
-
Mandry, CV, Jordan, E, and Boudreaux, ED
- Subjects
Medical care, Cost of -- Health aspects ,Medical emergencies -- Economic aspects ,Health insurance -- Contracts ,Health - Published
- 2000
6. Initial development of the mental health assessment and dynamic referral for oncology (mhadro)
- Author
-
Boudreaux ED, O'Hea EL, Grissom G, Lord S, Houseman J, and Grana G
- Abstract
The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a program that conducts a computerized assessment of physical, psychological, and social functioning related to oncology treatment, prints personalized summary reports for both the patient and the provider, and for those who provide consent, faxes a referral and assessment summary report to a matched mental health treatment provider (i.e., dynamic referral). The functionality, feasibility, and end user satisfaction of the MHADRO were tested in a comprehensive care center. Of the 101 participants enrolled, 61 (60%) exhibited elevated distress on at least one of the mental health indices, and, of these, 12 (20%) chose a dynamic referral for mental health services. Patients and health care providers exhibited high levels of satisfaction with the program. The MHADRO has potential for assisting in meeting the psychosocial needs faced by individuals with cancer and should be tested further for its facilitation of mental health treatment initiation. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
7. Characteristics and referral of emergency department patients with elevated blood pressure.
- Author
-
Baumann BM, Abate NL, Cowan RM, Chansky ME, Rosa K, and Boudreaux ED
- Published
- 2007
8. Community-acquired pneumonia in North American emergency departments: drug resistance and treatment success with clarithromycin.
- Author
-
Rowe BH, Campbell SG, Boudreaux ED, Colman I, Abu-Laban RB, Sivilotti MLA, Clark S, and Camargo CA Jr.
- Published
- 2007
9. Pain assessments and the provision of analgesia: the effects of a templated chart.
- Author
-
Baumann BM, Holmes JH, Chansky ME, Levey H, Kulkarni M, and Boudreaux ED
- Published
- 2007
10. The use of performance improvement methods to enhance emergency department patient satisfaction in the United States: a critical review of the literature and suggestions for future research.
- Author
-
Boudreaux ED, Cruz BL, and Baumann BM
- Published
- 2006
11. Predicting smoking stage of change among emergency department patients and visitors.
- Author
-
Boudreaux ED, Hunter GC, Bos K, Clark S, and Camargo CA Jr.
- Published
- 2006
12. Smoking stage of change and interest in an emergency department-based intervention.
- Author
-
Boudreaux ED, Baumann BM, Friedman K, and Ziedonis DM
- Published
- 2005
13. A multicenter study of depression among emergency department patients.
- Author
-
Kumar A, Clark S, Boudreaux ED, and Camargo CA Jr.
- Published
- 2004
14. Emergency department patient satisfaction: examining the role of acuity.
- Author
-
Boudreaux ED, Friedman J, Chansky ME, and Baumann BM
- Published
- 2004
15. Predictors of emergency department patient satisfaction: stability over 17 months.
- Author
-
Boudreaux ED, d'Autremont S, Wood K, and Jones GN
- Published
- 2004
16. Acute asthma among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status.
- Author
-
Boudreaux ED, Emond SD, Clark S, Camargo CA Jr., Boudreaux, Edwin D, Emond, Stephen D, Clark, Sunday, and Camargo, Carlos A Jr
- Abstract
Objectives: To investigate racial/ethnic differences in acute asthma among adults presenting to the emergency department (ED), and to determine whether observed differences are attributable to socioeconomic status (SES).Design: Prospective cohort studies performed during 1996 to 1998 by the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers provided 24-h coverage for a median duration of 2 weeks per year. Adults with acute asthma were interviewed in the ED and by telephone 2 weeks after hospital discharge.Participants: Sixty-four North American EDs.Results: A total of 1,847 patients were enrolled into the study. Black and Hispanic asthma patients had a history of more hospitalizations than did whites (ever-hospitalized patients: black, 66%; Hispanic, 63%; white, 54%; p < 0.001; patients hospitalized in the past year: black, 31%; Hispanic, 33%; white, 25%; p < 0.05) and more frequent ED use (median use in past year: black, three visits; Hispanic, three visits; white, one visit; p < 0.001). The mean initial peak expiratory flow rate (PEFR) was lower in blacks and Hispanics (black, 47%; Hispanic, 47%; white, 52%; p < 0.001). For most factors, ED management did not differ based on race/ethnicity. After accounting for several confounding variables, blacks and Hispanics were twice as likely to be admitted to the hospital. Blacks and Hispanics also were more likely to report continued severe symptoms 2 weeks after hospital discharge (blacks, 24%; Hispanic, 31%; white, 19%; p < 0.01). After adjusting for sociodemographic factors, the race/ethnicity differences in initial PEFR and posthospital discharge symptoms were markedly reduced.Conclusion: Despite significant racial/ethnic differences in chronic asthma severity, initial PEFR at ED presentation, and posthospital discharge outcome, ED management during the index visit was fairly similar for all racial groups. SES appears to account for most of the observed acute asthma differences, although hospital admission rates were higher among black and Hispanic patients after adjustment for confounding factors. Despite asthma treatment advances, race/ethnicity-based deficiencies persist. Health-care providers and policymakers might specifically target the ED as a place to initiate interventions designed to reduce race-based disparities in health. [ABSTRACT FROM AUTHOR]- Published
- 2003
- Full Text
- View/download PDF
17. Congruence of readiness to change, self-efficacy, and decisional balance for physical activity and dietary fat reduction.
- Author
-
Boudreaux ED, Wood KB, Mehan D, Scarinci I, Taylor CLC, Brantley PJ, Boudreaux, Edwin D, Wood, Karen B, Mehan, Dan, Scarinci, Isabel, Taylor, Cindy L Carmack, and Brantley, Phillip J
- Abstract
Purpose: The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise.Design: A cross-sectional design was used.Setting: The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with teaching hospitals and located in urban and rural areas.Subjects: Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%).Measures: Standard questionnaires were given to asses stage of change, decisional balance, and self-efficacy for exercise and dietary fat reduction.Results: Although the chi 2 analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson chi 2 (df = 16) = 74.30, p < .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precontemplators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however, the effect sizes were markedly attenuated.Conclusions: These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one. [ABSTRACT FROM AUTHOR]- Published
- 2003
- Full Text
- View/download PDF
18. Applying exercise stage of change to a low-income underserved population.
- Author
-
Taylor CLC, Boudreaux ED, Jeffries SK, Scarinci IC, and Brantley PJ
- Abstract
OBJECTIVES: To validate the transtheoretical model for exercise behavior and the constructs of decisional balance and self-efficacy for exercise in a low-income, poorly educated primary care sample. METHODS: Patients attending public primary-care clinics from 4 separate sites in Louisiana were interviewed regarding their health behaviors. RESULTS: The data provide equivocal support for applying the transtheoretical model for exercise and integrating it with other models of behavior change within this population. CONCLUSIONS: Further studies modifying the decisional balance measures are necessary before definitive statements regarding the applicability of these models to exercise within this specialized population can be made. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
- View/download PDF
19. Patient satisfaction data as a quality indicator: a tale of two emergency departments.
- Author
-
Boudreaux ED, Mandry CV, and Wood K
- Published
- 2003
20. Emergency department staff estimates of patient satisfaction: The squeaky wheel gets the grease
- Author
-
Boudreaux, ED, Ary, R, and Mandry, C
- Published
- 1999
- Full Text
- View/download PDF
21. Stressors experienced by emergency medicine residents
- Author
-
Boudreaux, ED and Ary, R
- Published
- 1999
- Full Text
- View/download PDF
22. The relation between stressors, strain, and coping among emergency medicine residents
- Author
-
Boudreaux, ED and Ary, R
- Published
- 1999
- Full Text
- View/download PDF
23. Race/ethnicity and asthma among children presenting to the emergency department: differences in disease severity and management.
- Author
-
Boudreaux ED, Emond SD, Clark S, Camargo CA Jr., and Multicenter Airway Research Collaboration Investigators
- Abstract
OBJECTIVE: To investigate racial/ethnic differences in acute asthma among children who present to the emergency department (ED). METHOD: We analyzed data from 2 prospective cohort studies performed during 1997-1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers at 40 EDs in 18 US states provided 24-hour-per-day coverage for a median of 2 weeks per year. Children with acute asthma were interviewed in the ED and by telephone 2 weeks after discharge. RESULTS: Among 1095 patients, 679 (62%) were black, 256 (23%) were Hispanic, and 160 (15%) were white. Black and Hispanic children had greater histories of lifetime (63%, 64%, 46%) and past-year (34%, 31%, 14%) hospitalization and more ED visits in the past year (medians: 2, 3, 1). Asthma severity at ED presentation, ED management and course, hospitalization during the index visit, discharge prescriptions, and postdischarge outcomes were equivalent among all race/ethnic groups. CONCLUSION: Despite pronounced race/ethnicity-based differences in chronic asthma, all racial/ethnic groups exhibited similar acute asthma severity, ED management, and course. However, given that black and Hispanic children exhibited much higher admission histories and past ED use, the equivalence in inhaled corticosteroid prescriptions on discharge is a disconcerting pattern that mirrors previous literature on outpatient prescription practices. In addition to barriers attributable to socioeconomic factors, health care providers and policy makers should target equalizing deficiencies in preventive medication prescription practices. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
- View/download PDF
24. Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.
- Author
-
Benz MB, Rafferty NS, Arias SA, Rabasco A, Miller I, Weinstock LM, Boudreaux ED, Camargo CA Jr, and Gaudiano BA
- Abstract
Objective: Availability and accessibility of a wide range of medications may be a contributing factor to rising medication-related overdose (OD) rates. Treatment for both suicide attempts (SAs) and ODs often occurs in the emergency department (ED), highlighting its potential as a screening and intervention point. The current study aimed to identify sociodemographic and clinical characteristics of individuals who reported SA via medication OD compared to other methods and to examine how these patients' suicide severity and behaviors differed over 12-month post-ED follow-up., Methods: Data were analyzed from Phases 1 and 2 of the Emergency Department Safety Assessment and Follow-up Evaluation multicenter study (N = 1376). Participants with a history of SA (n = 987) were categorized based on whether they indicated a past medication-related SA via OD., Results: Of participants with history of SA, 62.7% (n = 619) reported medication OD for either their most serious or their most recent SA. Multivariate analyses indicated female birth sex, diagnosis of bipolar disorder, and having some college education were significantly associated with membership in the medication OD attempt group (p <0.05). Of those who attempted suicide over the 12-month follow-up, nearly 60% of participants in the medication OD attempt group reported a subsequent SA via OD over follow-up. However, nearly half (46.5%) of participants with no medication OD at baseline also reported medication OD at follow-up., Conclusions: Among patients presenting to the ED, females, individuals with bipolar disorder, and patients with a college education, respectively, may be at highest risk for SAs via medication OD. Prospectively, medication OD appears to be a frequent method, even among individuals with no prior attempt via OD, as demonstrated by the high percentage of patients who did not have a medication OD at baseline, but reported a medication OD during follow-up., (© 2024 Society for Academic Emergency Medicine.)
- Published
- 2024
- Full Text
- View/download PDF
25. Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training.
- Author
-
Darnell D, Pierson A, Tanana MJ, Dorsey S, Boudreaux ED, Areán PA, and Comtois KA
- Subjects
- Humans, Female, Adult, Male, Pilot Projects, Middle Aged, Nursing Staff, Hospital education, Clinical Competence, Suicide Prevention, Education, Nursing, Continuing methods
- Abstract
Background: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance., Objective: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively., Methods: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses' performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor., Results: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94%) and White (n=13, 72%). Of the 17 nurses who started the training, 82% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (≥14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7)., Conclusions: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills., International Registered Report Identifier (irrid): RR2-10.2196/33695., (©Doyanne Darnell, Andria Pierson, Michael J Tanana, Shannon Dorsey, Edwin D Boudreaux, Patricia A Areán, Katherine Anne Comtois. Originally published in JMIR Formative Research (https://formative.jmir.org), 06.09.2024.)
- Published
- 2024
- Full Text
- View/download PDF
26. Adapting the Zero Suicide framework to the adult emergency department setting: Strategies for nurse leaders.
- Author
-
Roth B, Chen JI, Nagarkatti-Gude DR, Pfeiffer PN, Newgard CD, Hynes DM, and Boudreaux ED
- Subjects
- Humans, Adult, Nurse Administrators psychology, Psychiatric Nursing, Nurse's Role, Suicide Prevention, Emergency Service, Hospital, Leadership
- Abstract
The ED has been increasingly recognized as a key setting for suicide prevention. Zero Suicide (ZS) is an aspirational goal to eliminate suicide for all patients within a health care system through utilization of best practices. However, there has been limited exploration of ZS implementation within the ED. As ED nurses play an important role in suicide prevention through their close contact with patients at risk for suicide, ZS implementation would benefit from tailored strategies for ED nurse leadership. We describe the ZS framework and provides strategies for nurse leaders to adapt each ZS component in the adult ED., Competing Interests: Declaration of competing interest The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Institutes of Health, or the United States Government. The funding sources were not involved in the development, writing, or submission of this manuscript. The authors have no conflicts of interest to declare., (Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
27. Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge.
- Author
-
Chitavi SO, Patrianakos J, Williams SC, Schmaltz SP, Ahmedani BK, Roaten K, Boudreaux ED, and Brown GK
- Subjects
- Humans, Cross-Sectional Studies, United States, Joint Commission on Accreditation of Healthcare Organizations, Patient Safety standards, Safety Management organization & administration, Safety Management standards, Guideline Adherence statistics & numerical data, Patient Discharge standards, Suicide Prevention
- Abstract
Background: The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown., Methods: This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission-accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention., Results: Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge., Conclusion: The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
28. Clinician Attitudes Toward Suicide Prevention Practices and Their Implementation: Findings From the System of Safety Study.
- Author
-
Larkin C, Kiefe CI, Morena AL, Rahmoun MB, Lazar P, Sefair AV, and Boudreaux ED
- Subjects
- Humans, Male, Female, Adult, Middle Aged, Quality Improvement, Surveys and Questionnaires, Leadership, Suicide Prevention, Attitude of Health Personnel
- Abstract
Objective: The authors aimed to assess clinicians' attitudes toward suicide-related practices and their implementation, across roles and settings, before implementation of the Zero Suicide model in a health care system., Methods: Clinicians (N=5,559) were invited to complete a survey assessing demographic characteristics; confidence and self-reported suicide-related practice; leadership buy-in; and attitudes toward suicide prevention, safety planning, and continuous quality improvement (CQI)., Results: Of 1,224 respondents, most felt confident conducting suicide screening but less confident performing other suicide-related care. Provider role and care setting were significantly associated with confidence (p<0.001, Kruskal-Wallis H test) and practice (p<0.001, Kruskal-Wallis H test) of providing suicide prevention care, with behavioral health providers and providers in the emergency department (ED) reporting the highest confidence. Attitudes toward safety planning were more positive among women (p<0.001, t test) and behavioral health providers (p<0.001, F test) than among their counterparts or peers. Positive attitudes toward CQI were significantly associated with male sex (p=0.01), non-White race (p=0.03), younger age (p=0.02), fewer years working in health care (p<0.001), administrative role (p<0.001), working in the ED (p<0.001), outpatient settings (p<0.02), and medical provider role (p<0.001)., Conclusions: Behavioral health providers and those in the ED reported feeling prepared to deliver suicide-related care, with nurses feeling less confident and less supported. Initiatives to improve suicide-related care should account for clinical role and care setting during planning. CQI could help engage a broader range of clinicians in suicide-related care improvements., Competing Interests: The authors report no financial relationships with commercial interests.
- Published
- 2024
- Full Text
- View/download PDF
29. Longitudinal risk of suicide outcomes in people with severe mental illness following an emergency department visit and the effects of suicide prevention treatment.
- Author
-
Rabasco A, Arias S, Benz MB, Weinstock LM, Miller I, Boudreaux ED, Camargo CA Jr, Kunicki ZJ, and Gaudiano BA
- Subjects
- Adult, Humans, United States, Suicide Prevention, Emergency Room Visits, Prospective Studies, Mental Disorders therapy, Mental Disorders psychology, Schizophrenia therapy
- Abstract
Background: Individuals with severe mental illness (SMI), including bipolar disorder (BD) and schizophrenia-spectrum disorders (SSD), are at high risk for suicide. However, suicide research often excludes individuals with SMI. The current research examined differences in suicide outcomes (i.e., suicide attempt or death) for adults with and without BD and SSD diagnoses following an emergency department (ED) visit and investigated the efficacy of the Coping Long Term with Active Suicide Program (CLASP) intervention in reducing suicide outcomes among people with SMI., Methods: 1235 adults presenting with recent suicidality were recruited from 8 different EDs across the United States. Using a quasi-experimental, stepped wedge series design, participants were followed for 52-weeks with or without subsequent provision of CLASP., Results: Participants in the SSD group and the BD group had significantly shorter time to and higher rate of suicide outcomes than participants with other psychiatric diagnoses in all study phases and in non-CLASP phases, respectively. Participants with BD receiving the CLASP intervention had significantly longer time to suicide outcomes than those not receiving CLASP; these differences were not observed among those with SSD., Limitations: Study limitations include self-reported psychiatric diagnosis, exclusion of homeless participants, and small sample size of participants with SSD., Conclusions: Participants with SMI were at higher risk for suicide outcomes than participants with other psychiatric diagnoses. CLASP was efficacious among those participants with BD. Psychiatric diagnosis may be a key indicator of prospective suicide risk. More intensive and specialized follow-up mental health treatment may be necessary for those with SSD., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
30. Comparing the Acceptability and Quality of Intervention Modalities for Suicidality in the Emergency Department: Randomized Feasibility Trial.
- Author
-
Larkin C, Tulu B, Djamasbi S, Garner R, Varzgani F, Siddique M, Pietro J, and Boudreaux ED
- Abstract
Background: Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in the ED, as well as a comparison of these measures across 3 potential delivery modalities., Objective: Our aim was to test the feasibility of the ReachCare intervention in its entirety through conducting a pilot study with patients presenting with suicidality to the ED. We tested three different ways of receiving the ED-based components of ReachCare: (1) self-administered on the tablet app using a chatbot interface, (2) administered by an in-person clinician, or (3) administered by a telehealth clinician., Methods: In total, 47 ED patients who screened positive for suicide risk were randomly allocated to receive one of three delivery modalities of ReachCare in the ED: (1) self-administered on the patient-facing tablet app with a chatbot interface, (2) delivered by an in-person clinician, or (3) delivered by a telehealth clinician, with the latter two using a clinician-facing web app. We measured demographic and clinical characteristics, acceptability and appropriateness of the intervention, and quality and completeness of the resulting safety plans., Results: Patients assigned high ratings for the acceptability (median 4.00/5, IQR 4.00-4.50) and appropriateness (median 4.00/5, IQR 4.00-4.25) of ReachCare's ED components, and there were no substantial differences across the 3 delivery modalities [H(acceptability)=3.90, P=.14; H(appropriateness)=1.05, P=.59]. The self-administered modality took significantly less time than the 2 clinician modalities (H=27.91, P<.001), and the usability of the self-administered version was in the "very high" range (median 93.75/100, IQR 80.00-97.50). The safety plans created across all 3 modalities were high-quality (H=0.60, P=.74)., Conclusions: Patients rated ReachCare in the ED as highly acceptable and appropriate regardless of modality. Self-administration may be a feasible way to ensure patients with suicide risk receive an intervention in resource constrained EDs. Limitations include small sample size and demographic differences between those enrolled versus not enrolled. Further research will examine the clinical outcomes of patients receiving both the in-ED and post-ED components of ReachCare., Trial Registration: ClinicalTrials.gov NCT04720911; https://clinicaltrials.gov/ct2/show/NCT04720911., (©Celine Larkin, Bengisu Tulu, Soussan Djamasbi, Roscoe Garner, Fatima Varzgani, Mariam Siddique, John Pietro, Edwin D Boudreaux. Originally published in JMIR Mental Health (https://mental.jmir.org), 24.10.2023.)
- Published
- 2023
- Full Text
- View/download PDF
31. Preventing Suicide in Health Systems: How Can Implementation Science Help?
- Author
-
Larkin C, Arensman E, and Boudreaux ED
- Subjects
- Humans, Suicide Prevention, Suicidal Ideation, Implementation Science, Suicide
- Abstract
Suicide prevention is an emotive, complex goal for clinicians and health systems. Effective interventions for suicidality do exist; however, many patients do not receive them because implementation efforts tend to be time-limited and unsystematic. Implementation science is the study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice. This narrative review introduces implementation science to suicide researchers, with a special focus on healthcare settings. We outline prominent theories, methods, and measures, as well as examples of implementation research from suicidology. By embracing the principles of implementation science, suicidologists can help to close the gap between evidence-based practice and routine practice, thereby improving the delivery and uptake of suicide-related interventions and prevention programs.
- Published
- 2023
- Full Text
- View/download PDF
32. Acute and intensive care nurses' perspectives on suicide prevention with medically hospitalized patients: Exploring barriers, facilitators, interests, and training opportunities.
- Author
-
Darnell D, Pierson A, Whitney JD, Wolkow CA, Dorsey S, Boudreaux ED, Areán PA, and Comtois KA
- Subjects
- Humans, Suicide Prevention, Pandemics, Qualitative Research, Critical Care, COVID-19, Nurses
- Abstract
Aims: To explore opportunities for acute and intensive care nurses to engage in suicide prevention activities with patients hospitalized for medical, surgical or traumatic injury reasons., Design: A qualitative descriptive study., Methods: We conducted two studies consisting of 1-h focus groups with nurses. Study 1 occurred prior to the onset of the COVID-19 pandemic during January and February of 2020 and identified barriers and facilitators of engaging in an eLearning training in suicide safety planning and engaging patients on their units in suicide safety planning. Study 2 occurred in December of 2020 and explored nurses' perspectives on their role in suicide prevention with patients on their units and training needs related to this. The research took place at an urban level 1 trauma center and safety net hospital where nurses universally screen all admitted patients for suicide risk. We conducted a rapid analysis of the focus group transcripts using a top-down, framework-driven approach to identify barriers, facilitators, strategies around barriers, and training interests mentioned., Results: Twenty-seven registered nurses participated. Nurses indicated they serve a population in need of suicide prevention and that the nursing role is an important part of suicide care. A primary barrier was having adequate uninterrupted time for suicide prevention activities and training; however, nurses identified various strategies around barriers and offered suggestions to make training successful., Conclusion: Findings suggest training in suicide prevention is important for nurses in this context and there are opportunities for nurses to engage patients in interventions beyond initial screening; however, implementation will require tailoring interventions and training to accommodate nurses' workload in the hospital context., Impact: Acute and intensive care nurses play a key role in the public health approach to suicide prevention. Understanding perspectives of bedside nurses is critical for guiding development and deployment of effective brief interventions., No Public or Patient Involvement: This study is focused on eliciting and exploring perspectives of acute and intensive care nurses., (© 2023 John Wiley & Sons Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
33. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis.
- Author
-
Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, and Byatt N
- Subjects
- Pregnancy, Female, Humans, Psychosocial Intervention, Anxiety psychology, Anxiety Disorders prevention & control, Depression diagnosis, Cognitive Behavioral Therapy, Mindfulness
- Abstract
Objective: Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis., Method: We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity)., Results: Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective., Conclusions: Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed., Competing Interests: Declaration of Competing Interest All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
34. Effect of an Emergency Department Process Improvement Package on Suicide Prevention: The ED-SAFE 2 Cluster Randomized Clinical Trial.
- Author
-
Boudreaux ED, Larkin C, Vallejo Sefair A, Ma Y, Li YF, Ibrahim AF, Zeger W, Brown GK, Pelletier L, and Miller I
- Subjects
- Humans, Male, Adult, Female, Suicidal Ideation, Suicide Prevention, Emergency Service, Hospital, Suicide
- Abstract
Importance: Suicide is a leading cause of deaths in the US. Although the emergency department (ED) is an opportune setting, ED-initiated interventions remain underdeveloped and understudied., Objective: To determine if an ED process improvement package, with a subfocus on improving the implementation of collaborative safety planning, reduces subsequent suicide-related behaviors., Design, Setting, and Participants: The Emergency Department Safety Assessment and Follow-up Evaluation 2 (ED-SAFE 2) trial, a stepped-wedge cluster randomized clinical trial conducted in 8 EDs across the US, used an interrupted time series design with three 12-month sequential phases: baseline, implementation, and maintenance. A random sample of 25 patients per month per site 18 years and older who screened positive on the Patient Safety Screener, a validated suicide risk screener, were included. The primary analyses focused on those who were discharged from the ED, while secondary analyses focused on all patients who screened positive, regardless of disposition. Data were collected on patients who presented for care from January 2014 to April 2018, and data were analyzed from April to December 2022., Interventions: Each site received lean training and built a continuous quality improvement (CQI) team to evaluate the current suicide-related workflow in the ED, identify areas of improvement, and implement efforts to improve. Each site was expected to increase their universal suicide risk screening and implement collaborative safety planning for patients at risk of suicide who were discharged home from the ED. Site teams were centrally coached by engineers experienced in lean CQI and suicide prevention specialists., Main Outcomes and Measures: The primary outcome was a composite comprising death by suicide or suicide-related acute health care visits, measured over a 6-month follow-up window., Results: Across 3 phases, 2761 patient encounters were included in the analyses. Of these, 1391 (50.4%) were male, and the mean (SD) age was 37.4 (14.5) years. A total of 546 patients (19.8%) exhibited the suicide composite during the 6-month follow-up (9 [0.3%] died by suicide and 538 [19.5%] of a suicide-related acute health care visit). A significant difference was observed for the suicide composite outcome between the 3 phases (baseline, 216 of 1030 [21%]; implementation, 213 of 967 [22%]; maintenance, 117 of 764 [15.3%]; P = .001). The adjusted odds ratios of risk of the suicide composite during the maintenance phase was 0.57 (95% CI, 0.43-0.74) compared with baseline and 0.61 (0.46-0.79) compared with the implementation phase, which reflect a 43% and 39% reduction, respectively., Conclusions and Relevance: In this multisite randomized clinical trial, using CQI methods to implement a department-wide change in suicide-related practices, including the implementation of a safety plan intervention, yielded a significant decrease in suicide behaviors in the maintenance period of the study., Trial Registration: ClinicalTrials.gov Identifier: NCT02453243.
- Published
- 2023
- Full Text
- View/download PDF
35. Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection.
- Author
-
Horowitz LM, Ryan PC, Wei AX, Boudreaux ED, Ackerman JP, and Bridge JA
- Abstract
Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings., Competing Interests: The authors report no financial relationships with commercial interests., (Copyright © 2023 by the American Psychiatric Association.)
- Published
- 2023
- Full Text
- View/download PDF
36. Systems Approach to Suicide Prevention: Strengthening Culture, Practice, and Education.
- Author
-
Pisani AR and Boudreaux ED
- Abstract
Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce., Competing Interests: Dr. Pisani owns equity in SafeSide Prevention, which receives fees for consultation and educational programs provided to health, military, and government organizations and pays royalties to the University of Rochester; he receives royalties from Cambridge University Press for a book cited in the references. Dr. Boudreaux reports receiving grants (small business innovation research and small business technology transfer) for intellectual property shared between the UMass Chan Medical Center and their small business partners., (Copyright © 2023 by the American Psychiatric Association.)
- Published
- 2023
- Full Text
- View/download PDF
37. ReachCare Mobile Apps for Patients Experiencing Suicidality in the Emergency Department: Development and Usability Testing Using Mixed Methods.
- Author
-
Larkin C, Djamasbi S, Boudreaux ED, Varzgani F, Garner R, Siddique M, Pietro J, and Tulu B
- Abstract
Background: Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk (Emergency Department Safety Assessment and Follow-up Evaluation [ED-SAFE]) has been found to be effective but faces trenchant barriers for widespread adoption., Objective: On the basis of the ED-SAFE intervention, we aimed to develop 2 apps for patients with suicide risk: a web app guiding patients through safety planning in the ED (ED app) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (patient app). We then tested the usability of these apps with patients presenting to the ED with suicide risk., Methods: Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of patients who are at risk for suicide using inputs from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in 2 iterative cycles to assess their usability and engagement using a mixed methods approach. We also rated the quality and fidelity of the safety plans created., Results: We developed 2 interoperable and complementary apps. The first is a web app designed for use on a tablet device during ED admission that guides the patient by creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. The initial prototype usability testing (n=9) demonstrated satisfactory scores (ED app System Usability Scale [SUS], mean 78.6/100, SD 24.1; User Engagement Scale, mean 3.74/5, SD 0.72; patient app SUS, mean 81.7/100, SD 20.1). After refining the apps based on participant feedback, the second cycle testing (n=5) showed improvement (ED app SUS, mean 90.5/100, SD 9.9; User Engagement Scale, mean 4.07/5, SD 0.36; patient app SUS, mean 97.0/100, SD 1.9). The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief, mean 27.4, SD 3.4)., Conclusions: By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk and obtain satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help overcome trenchant implementation barriers in challenging health care settings., (©Celine Larkin, Soussan Djamasbi, Edwin D Boudreaux, Fatima Varzgani, Roscoe Garner, Mariam Siddique, John Pietro, Bengisu Tulu. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.01.2023.)
- Published
- 2023
- Full Text
- View/download PDF
38. Universal Suicide Screening Is Feasible and Necessary to Reduce Suicide.
- Author
-
Goldstein Grumet J and Boudreaux ED
- Subjects
- Humans, Suicide Prevention, Emergency Service, Hospital, Mass Screening, Suicidal Ideation, Suicide
- Published
- 2023
- Full Text
- View/download PDF
39. Studying the implementation of Zero Suicide in a large health system: Challenges, adaptations, and lessons learned.
- Author
-
Boudreaux ED, Larkin C, Sefair AV, Mick E, Clements K, Pelletier L, Yang C, and Kiefe C
- Abstract
Background: Suicide remains the 10th leading cause of death in the United States. Many patients presenting to healthcare settings with suicide risk are not identified and their risk mitigated during routine care. Our aim is to describe the planned methodology for studying the implementation of the Zero Suicide framework, a systems-based model designed to improve suicide risk detection and treatment, within a large healthcare system., Methods: We planned to use a stepped wedge design to roll-out the Zero Suicide framework over 4 years with a total of 39 clinical units, spanning emergency department, inpatient, and outpatient settings, involving ∼310,000 patients. We used Lean, a widely adopted a continuous quality improvement (CQI) model, to implement improvements using a centralize "hub" working with smaller "spoke" teams comprising CQI personnel, unit managers, and frontline staff., Results: Over the course of the study, five major disruptions impacted our research methods, including a change in The Joint Commission's safety standards for suicide risk mitigation yielding massive system-wide changes and the COVID-19 pandemic. What had been an ambitious program at onset became increasingly challenging because of the disruptions, requiring significant adaptations to our implementation approach and our study methods., Conclusions: Real-life obstacles interfered markedly with our plans. While we were ultimately successful in implementing Zero Suicide, these obstacles led to adaptations to our approach and timeline and required substantial changes in our study methodology. Future studies of quality improvement efforts that cut across multiple units and settings within a given health system should avoid using a stepped-wedge design with randomization at the unit level if there is the potential for sentinel, system-wide events., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier Inc.)
- Published
- 2022
- Full Text
- View/download PDF
40. Suicide Screening Tools for Pediatric Emergency Department Patients: A Systematic Review.
- Author
-
Scudder A, Rosin R, Baltich Nelson B, Boudreaux ED, and Larkin C
- Abstract
Background: According to the Centers for Disease Control and Prevention, suicidality and suicidal behavior among youth continues to increase significantly each year. Many of those who die by suicide interact with health services in the year before death. This systematic review sought to identify and describe empirically tested screening tools for suicidality in youth presenting to Emergency Departments (ED)., Objective: (1) To identify and compare existing tools used to screen for suicidality in children and adolescents who present to the ED and (2) to ascertain the prevalence of suicidality in pediatric populations found with these tools., Methods: We searched Ovid Medline, CINAHL, Scopus, and Cochrane databases for primary research studies that identified and evaluated screening tools for suicide risk in pediatric ED patients. A total of 7,597 publications published before August 25, 2021 met search criteria and were screened by two independent reviewers based on our inclusion and exclusion criteria, with any conflicts resolved via consensus meetings or an independent reviewer. A total of 110 papers were selected for full text review, of which 67 were excluded upon further inspection. Covidence was used to extract and synthesize results., Results: 43 articles were eligible for inclusion. Most studies ( n = 33) took place in general pediatric EDs; the quality was generally high. Patients ranged from 4-24 years old, with most screening tested in patients 12 years and older. The most researched tools were the Ask-Suicide Screening Questions (ASQ) ( n = 15), Columbia-Suicide Severity Rating Scale (C-SSRS) ( n = 12), Suicidal Ideation Questionnaire (SIQ) ( n = 11), and the Risk of Suicide Questionnaire (RSQ) ( n = 7). Where screening was applied to all patients, about one-fifth of pediatric ED patients screened positive; where suicide screening was applied to psychiatric patients only, over half screened positive. Positive screens were more likely to be female and older than negative screens and they were more likely to be assessed and admitted., Conclusion: Several validated screening tools exist for the purpose of screening pediatric populations in EDs for suicidality. Such tools may help to support early detection and appropriate intervention for youth at risk of suicide., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276328, identifier: 276328., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Scudder, Rosin, Baltich Nelson, Boudreaux and Larkin.)
- Published
- 2022
- Full Text
- View/download PDF
41. Corrigendum to "Learning from gain and loss: Links to suicide risk" [J. Psychiatr. Res. 147 (2022) 126-134].
- Author
-
Dixon-Gordon KL, Waite EE, Ammerman BA, Haliczer LA, Boudreaux ED, Rathlev N, and Cohen AL
- Published
- 2022
- Full Text
- View/download PDF
42. Benchmarking expectations for interventions to reduce emergency department use among today's high users.
- Author
-
Davis-Martin RE, Boudreaux ED, Flahive J, Bergman AL, and Ash AS
- Subjects
- Emergency Service, Hospital, Humans, Benchmarking, Motivation
- Published
- 2022
- Full Text
- View/download PDF
43. Harmonization of Four Delirium Instruments: Creating Crosswalks and the Delirium Item-Bank (DEL-IB).
- Author
-
Helfand BKI, Detroyer E, Milisen K, Adamis D, Metzger ED, Boudreaux ED, Inouye SK, and Jones RN
- Subjects
- Aged, Belgium, Humans, Mass Screening, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results, Delirium diagnosis
- Abstract
Objectives: Over 30 instruments are in current, active use for delirium identification. In a recent systematic review, we recommended 4 commonly used and well-validated instruments for clinical and research use. The goal of this study is to harmonize the four instruments on the same metric using modern methods in psychometrics., Design: Secondary data analysis from 3 studies, and a simulation study based on the observed data., Setting: Hospitalized (non-ICU) adults over 65 years old in the United States, Ireland, and Belgium., Participants: The total sample comprised 600 participants, contributing 1,623 assessments., Measurements: Confusion Assessment Method (long-form and short-form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (DRS-R-98) (total and severity scores), and Memorial Delirium Assessment Scale., Results: Using item response theory, we linked scores across instruments, placing all four instruments and their separate scorings on the same metric (the propensity to delirium). Kappa statistics comparing agreement in delirium identification among the instruments ranged from 0.37 to 0.75, with the highest agreement between the DRS-R-98 total score and MDAS. After linking scores, we created a harmonized item bank, called the Delirium Item Bank (DEL-IB), consisting of 50 items. The DEL-IB allowed us to create six crosswalks, to allow scores to be translated across instruments., Conclusions: With our results, individual instrument scores can be directly compared to aid in clinical decision-making, and quantitatively combined in meta-analyses., (Copyright © 2021 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
44. Learning from gain and loss: Links to suicide risk.
- Author
-
Dixon-Gordon KL, Waite EE, Ammerman BA, Haliczer LA, Boudreaux ED, Rathlev N, and Cohen AL
- Subjects
- Emotions, Humans, Reinforcement, Psychology, Suicidal Ideation, Borderline Personality Disorder psychology, Suicide, Attempted psychology
- Abstract
Despite preliminary evidence that people with suicide attempt histories demonstrate deficits in processing feedback, no studies have examined the interrelations of learning from feedback and emotional state on suicide risk. This study examined the influence of suicide risk and negative emotions on learning accuracy and rates among individuals with a range of borderline personality features (N = 145). Participants completed a reinforcement learning task after neutral and negative emotion inductions. Results revealed interactions between suicide risk and emotion condition, with elevated risk linked to greater increases in loss learning rate (training phase models) and gain learning rate (test phase models) post-negative emotion induction. Emotion-dependent fluctuations in learning performance may be markers of decision-making that are associated with greater suicide risk. This line of work has the potential to identify the contexts that confer greater risk for suicidal behaviors., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
45. Modeling Health Event Impact on Smoking Cessation.
- Author
-
Boudreaux ED, O'Hea E, Wang B, Quinn E, Bergman AL, Bock BC, and Becker BM
- Abstract
Background: This study examined how cognitive and affective constructs related to an acute health event predict smoking relapse following an acute cardiac health event., Methods: Participants were recruited from emergency departments and completed cognitive and emotional measures at enrollment and ecological momentary assessments (EMA) for 84 days postvisit., Results: Of 394 participants, only 35 (8.9%) remained abstinent 84 days postvisit. Time to relapse was positively associated with age, actual illness severity, self-efficacy, and quit intentions., Conclusions: Older, seriously ill patients with strong confidence and intentions to quit smoking remain abstinent longer after discharge, but most still relapse within three months., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2022 Edwin D. Boudreaux et al.)
- Published
- 2022
- Full Text
- View/download PDF
46. Survivorship care planning, quality of life, and confidence to transition to survivorship: A randomized controlled trial with women ending treatment for breast cancer.
- Author
-
O'Hea EL, Creamer S, Flahive JM, Keating BA, Crocker CR, Williamson SR, Edmiston KL, Harralson T, and Boudreaux ED
- Subjects
- Female, Humans, Survivorship, Breast Neoplasms psychology, Breast Neoplasms therapy, Quality of Life
- Abstract
Purpose: The Polaris Oncology Survivorship Transition (POST) system is a computer-based program that integrates information from the electronic health record, oncology team, and the patient to produce a personalized Survivorship Care Plan. The purpose of this study was to compare the POST to treatment as usual on confidence, quality of life, and interest in mental health referrals in women ending treatment for breast cancer., Sample: Two hundred women (100 POST, 100 treatment as usual) ending treatment for breast cancer were enrolled in a randomized controlled trial., Design: Women randomized to the POST condition received a personalized care plan during a baseline/intervention appointment. At enrollment and baseline/intervention, a number of outcomes were examined in this study, including confidence to enter survivorship measured by the Confidence in Survivorship Index (CSI) and Quality of Life (QOL). One, three, and six month follow up assessments were also conducted., Findings: Treatment groups did not differ in terms of QOL scores at any time points. Mean CSI scores were statistically different between POST and treatment as usual at baseline for the total CSI score and both subscales, but only for confidence in knowledge about prevention and treatment at the 1-month follow-up. All significant differences were in favor of the POST intervention as mean CSI scores were higher for participants who received the POST intervention as opposed to treatment as usual. These findings disappeared at the 3 and 6 month follow up assessments. Finally, patients who received the POST intervention were twice as likely to request mental health/social services referrals compared to women who received treatment as usual., Implications: Oncologists may use the POST to build personalized care plans for women ending treatment for cancer, which may enhance patients' confidence in the short term as well as encourage use of mental health resources.
- Published
- 2022
- Full Text
- View/download PDF
47. Delirium Item Bank: Utilization to Evaluate and Create Delirium Instruments.
- Author
-
Helfand BKI, Tommet D, Detroyer E, Milisen K, Adamis D, Metzger ED, Marcantonio ER, Boudreaux ED, Inouye SK, and Jones RN
- Subjects
- Aged, Diagnostic and Statistical Manual of Mental Disorders, Humans, Psychometrics, Reproducibility of Results, Sensitivity and Specificity, Delirium diagnosis, Delirium etiology
- Abstract
Introduction: The large number of heterogeneous instruments in active use for identification of delirium prevents direct comparison of studies and the ability to combine results. In a recent systematic review we performed, we recommended four commonly used and well-validated instruments and subsequently harmonized them using advanced psychometric methods to develop an item bank, the Delirium Item Bank (DEL-IB). The goal of the present study was to find optimal cut-points on four existing instruments and to demonstrate use of the DEL-IB to create new instruments., Methods: We used a secondary analysis and simulation study based on data from three previous studies of hospitalized older adults (age 65+ years) in the USA, Ireland, and Belgium. The combined dataset included 600 participants, contributing 1,623 delirium assessments, and an overall incidence of delirium of about 22%. The measurements included the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for delirium, Confusion Assessment Method (long form and short form), Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98 (total and severity scores), and Memorial Delirium Assessment Scale (MDAS)., Results: We identified different cut-points for each existing instrument to optimize sensitivity or specificity, and compared instrument performance at each cut-point to the author-defined cut-point. For instance, the cut-point on the MDAS that maximizes both sensitivity and specificity was at a sum score of 6 yielding 89% sensitivity and 79% specificity. We then created four new example instruments (two short forms and two long forms) and evaluated their performance characteristics. In the first example short form instrument, the cut-point that maximizes sensitivity and specificity was at a sum score of 3 yielding 90% sensitivity, 81% specificity, 30% positive predictive value, and 99% negative predictive value., Discussion/conclusion: We used the DEL-IB to better understand the psychometric performance of widely used delirium identification instruments and scorings, and also demonstrated its use to create new instruments. Ultimately, we hope that the DEL-IB might be used to create optimized delirium identification instruments and to spur the development of a unified approach to identify delirium., (© 2022 S. Karger AG, Basel.)
- Published
- 2022
- Full Text
- View/download PDF
48. Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research.
- Author
-
Darnell D, Areán PA, Dorsey S, Atkins DC, Tanana MJ, Hirsch T, Mooney SD, Boudreaux ED, and Comtois KA
- Abstract
Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers., Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence-based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide., Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center., Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board., Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies., International Registered Report Identifier (irrid): DERR1-10.2196/33695., (©Doyanne Darnell, Patricia A Areán, Shannon Dorsey, David C Atkins, Michael J Tanana, Tad Hirsch, Sean D Mooney, Edwin D Boudreaux, Katherine Anne Comtois. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.12.2021.)
- Published
- 2021
- Full Text
- View/download PDF
49. Applying Machine Learning Approaches to Suicide Prediction Using Healthcare Data: Overview and Future Directions.
- Author
-
Boudreaux ED, Rundensteiner E, Liu F, Wang B, Larkin C, Agu E, Ghosh S, Semeter J, Simon G, and Davis-Martin RE
- Abstract
Objective: Early identification of individuals who are at risk for suicide is crucial in supporting suicide prevention. Machine learning is emerging as a promising approach to support this objective. Machine learning is broadly defined as a set of mathematical models and computational algorithms designed to automatically learn complex patterns between predictors and outcomes from example data, without being explicitly programmed to do so. The model's performance continuously improves over time by learning from newly available data. Method: This concept paper explores how machine learning approaches applied to healthcare data obtained from electronic health records, including billing and claims data, can advance our ability to accurately predict future suicidal behavior. Results: We provide a general overview of machine learning concepts, summarize exemplar studies, describe continued challenges, and propose innovative research directions. Conclusion: Machine learning has potential for improving estimation of suicide risk, yet important challenges and opportunities remain. Further research can focus on incorporating evolving methods for addressing data imbalances, understanding factors that affect generalizability across samples and healthcare systems, expanding the richness of the data, leveraging newer machine learning approaches, and developing automatic learning systems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Boudreaux, Rundensteiner, Liu, Wang, Larkin, Agu, Ghosh, Semeter, Simon and Davis-Martin.)
- Published
- 2021
- Full Text
- View/download PDF
50. Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients.
- Author
-
Mournet AM, Smith JT, Bridge JA, Boudreaux ED, Snyder DJ, Claassen CA, Jobes DA, Pao M, and Horowitz LM
- Subjects
- Adult, Aged, Depression diagnosis, Female, Humans, Male, Mass Screening, Middle Aged, Surveys and Questionnaires, Inpatients, Suicide Prevention
- Abstract
Background: Medically ill hospitalized patients are at elevated risk for suicide. Hospitals that already screen for depression often use depression screening as a proxy for suicide risk screening. Extant research has indicated that screening for depression may not be sufficient to identify all patients at risk for suicide., Objective: The present study aims to determine the effectiveness of a depression screening tool, the Patient Health Questionnaire-9, in detecting suicide risk among adult medical inpatients., Methods: Participants were recruited from inpatient medical/surgical units in 4 hospitals as part of a larger validation study. Participants completed the Patient Health Questionnaire-9 and 2 suicide risk measures: the Ask Suicide-Screening Questions and the Adult Suicidal Ideation Questionnaire., Results: The sample consisted of 727 adult medical inpatients (53.4% men; 61.8% white; mean age 50.1 ± 16.3 years). A total of 116 participants (116 of 727 [16.0%]) screened positive for suicide risk and 175 (175 of 727 [24.1%]) screened positive for depression. Of the 116 patients who screened positive for suicide risk, 36 (31.0%) screened negative for depression on the Patient Health Questionnaire-9. Of 116, 73 (62.9%) individuals who were at risk for suicide did not endorse item 9 (thoughts of harming oneself or of being better off dead) on the Patient Health Questionnaire-9., Conclusion: Using depression screening tools as a proxy for suicide risk may be insufficient to detect adult medical inpatients at risk for suicide. Asking directly about suicide risk and using validated tools is necessary to effectively and efficiently screen for suicide risk in this population., (Published by Elsevier Inc.)
- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.