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1. Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients

Author

Timothy F. Platts-Mills, Allison G. Hollowell, Gary F. Burke, Sheryl Zimmerman, Joseph A. Dayaa, Benjamin R. Quigley, Montika Bush, Morris Weinberger, and Mark A. Weaver

Subjects
Musculoskeletal pain, Geriatrics, Emergency medicine, Pain, Medicine (General), R5-920
Abstract

Abstract Background Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain. Methods ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48–72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0–10 numerical rating scale. Results Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function. Conclusion Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes. Trials registration ClinicalTrials.gov, NCT02438384 . Registered on 5 May 2015.

Published
2018
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2. Focus Section on Health IT Usability: Perceived Burden of EHRs on Physicians at Different Stages of Their Career

Author

Heather Archambault, Gary F. Burke, James Larson, Todd A. Schwartz, Saif Khairat, and Raj M. Ratwani

Subjects
medicine.medical_specialty, 020205 medical informatics, business.industry, health care facilities, manpower, and services, MEDLINE, Health Informatics, Workload, Usability, 02 engineering and technology, Emergency department, Burnout, Computer Science Applications, 03 medical and health sciences, 0302 clinical medicine, Health Information Management, health services administration, Family medicine, 0202 electrical engineering, electronic engineering, information engineering, medicine, Research article, Job satisfaction, Observational study, 030212 general & internal medicine, business, health care economics and organizations
Abstract

Objective The purpose of this study was to further explore the effect of EHRs on emergency department (ED) attending and resident physicians' perceived workload, satisfaction, and productivity through the completion of six EHR patient scenarios combined with workload, productivity, and satisfaction surveys. Methods To examine EHR usability, we used a live observational design combined with post observation surveys conducted over 3 days, observing emergency physicians' interactions with the EHR during a 1-hour period. Physicians were asked to complete six patient scenarios in the EHR, and then participants filled two surveys to assess the perceived workload and satisfaction with the EHR interface. Results Fourteen physicians participated, equally distributed by gender (50% females) and experience (43% residents, 57% attendings). Frustration levels associated to the EHR were significantly higher for attending physicians compared with residents. Among the factors causing high EHR frustrations are: (1) remembering menu and button names and commands use; (2) performing tasks that are not straightforward; (3) system speed; and (4) system reliability. In comparisons between attending and resident physicians, time to complete half of the cases as well as the overall reaction to the EHR were statistically different. Conclusion ED physicians already have the highest levels of burnout and fourth lowest level of satisfaction among physicians and, hence, particular attention is needed to study the impact of EHR on ED physicians. This study investigated key EHR usability barriers in the ED particularly, the assess frustration levels among physicians based on experience, and identifying factors impacting those levels of frustrations. In our findings, we highlight the most favorable and most frustrating EHR functionalities between both groups of physicians.

Published
2018
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3. Pain and Interference of Pain with Function and Mood in Elderly Adults Involved in a Motor Vehicle Collision: A Pilot Study

Author

Young M. Lee, Timothy F. Platts-Mills, Samuel A. McLean, Robert A. Swor, Erin Z. Zaleski, Daniel J. Clauw, and Gary F. Burke

Subjects
Adult, Male, Aging, medicine.medical_specialty, Adolescent, Poison control, Context (language use), Pilot Projects, Motor Activity, Severity of Illness Index, Occupational safety and health, Article, Young Adult, Physical medicine and rehabilitation, Arts and Humanities (miscellaneous), Musculoskeletal Pain, Severity of illness, Injury prevention, Medicine, Humans, General Psychology, Aged, Aged, 80 and over, Neck pain, Neck Pain, business.industry, Incidence, Accidents, Traffic, Middle Aged, Affect, Mood, Physical therapy, Observational study, Female, Geriatrics and Gerontology, medicine.symptom, business, Emergency Service, Hospital
Abstract

BACKGROUND/STUDY CONTEXT: Musculoskeletal pain after motor vehicle collision is a substantial public health problem. The number of elderly individuals experiencing motor vehicle collision is increasing. The authors conducted analyses of data collected as part of a prospective observational study of outcomes after motor vehicle collision to estimates rates of persistent pain, pain interference, and change in physical function in patients 65 or older.Adults presenting to one of four emergency departments following motor vehicle collision without severe or life-threatening injury were recruited. Outcomes were assessed using 1-month follow-up surveys.The frequencies of persistent moderate or severe pain resulting from the motor vehicle collision were similar among elderly and nonelderly participants, both in the neck region (27% vs. 30%) and in any region (60% vs. 56%). For both elderly and nonelderly patients, persistent pain was associated with high levels of interference with physical activity and mood.Further studies of this vulnerable and rapidly increasing injury population are needed.

Published
2012

4. Assessment of the impact of chloride control measures in the Upper Wichita River system by a population genetics study of the plains killifish (Fundulus zebrinus)

Author

Department of Biology, Gary F. Burke, Department of Biology, and Gary F. Burke

Abstract

Populations of plains killifish (Fundulus zebrinus) were collected in the Upper Wichita River basin and examined for genetic variance in relation to implemented chloride control measures on the Wichita River. Microsatellite allele data were compiled. Observed genotypic frequencies within and between sampled sites were compared with expected genotypic frequencies on the assumption of Hardy-Weinberg equilibrium and evaluated using an X² analysis. This study did not detect any indication that the U.S. Army Corps of Engineers chloride control measures were negatively impacting populations of plains killifish. Detection of the heterozygous FhCA-22 microsatellite allele in plains killifish will be useful for future genetic studies.

Published
2007

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