2025
Peer support enhanced behavioural crisis response teams in the emergency department: protocol for a stepped-wedge cluster-randomised controlled trial
Nath B, Desai R, Cook J, Dziura J, Davis-Plourde K, Youins R, Guy K, Pavlo A, Smith E, Smith D, Kangas K, Heckmann R, Hart L, Powsner S, Sevilla M, Evans M, Kumar A, Faustino I, Hu Y, Bellamy C, Wong A. Peer support enhanced behavioural crisis response teams in the emergency department: protocol for a stepped-wedge cluster-randomised controlled trial. BMJ Open 2025, 15: e103775. PMID: 40484432, PMCID: PMC12161358, DOI: 10.1136/bmjopen-2025-103775.Peer-Reviewed Original ResearchConceptsCluster randomised controlled trialEmergency departmentPeer supportDelivery of trauma-informed careStepped-wedge cluster randomised controlled trialExperience of mental illnessPhysical restraintRate of physical restraintBehavioral crisesPeer support workersReduce restraint useSecondary outcomesFollow-up data collectionResponse teamPatient-centred approachPositive patient outcomesTrauma-informed carePeer-reviewed journalsCrisis response teamsUsual careStepped-wedgeIntervention readinessPeer deliveryRestraint useED settingDisparities in use of physical restraint and chemical sedation in the emergency department by patient housing status
Robinson L, Ryus C, Nath B, Kumar A, Desai R, Shah D, Faustino I, Wong A. Disparities in use of physical restraint and chemical sedation in the emergency department by patient housing status. PLOS ONE 2025, 20: e0319286. PMID: 40080507, PMCID: PMC11906057, DOI: 10.1371/journal.pone.0319286.Peer-Reviewed Original ResearchConceptsPatient's housing statusEmergency departmentHousing statusPhysical restraintSedative usePsychiatric emergency careAdverse health outcomesCross-sectional studyLogistic regression modelsRestraint ordersEmergency careHealth outcomesED visitsPatient raceYears of ageDescriptive statisticsHealthcare networkRegional healthcare networkChemical sedationHoused patientsDemographic factorsMarginalized populationsRegression modelsCareChief complaintAssociation between patient primary language, physical restraints, and intramuscular sedation in the emergency department
Kumar A, Ryus C, Tartak J, Nath B, Faustino I, Shah D, Robinson L, Desai R, Heckmann R, Taylor R, Wong A. Association between patient primary language, physical restraints, and intramuscular sedation in the emergency department. Academic Emergency Medicine 2025 PMID: 39948714, DOI: 10.1111/acem.70004.Peer-Reviewed Original ResearchPatient's primary languagePortuguese-speaking patientsPhysical restraintEmergency departmentPrimary languageED visitsQuality of clinical interactionsRegional health care networkHealth care networkVerbal de-escalationElectronic medical recordsLogistic regression modelsAdult patients ageLanguage speakersEnglish speakersCare networkSpanish speakersPortuguese speakersCultural interpretationRetrospective cohort analysisAgitation symptomsOdds ratioClinical interactionsEvaluate associationsPrimary outcome
2024
Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department
Jivalagian P, Gettel C, Smith C, Robinson L, Brinker M, Shah D, Kumar A, Faustino I, Nath B, Chang-Sing E, Taylor R, Kennedy M, Hwang U, Wong A. Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department. American Journal Of Geriatric Psychiatry 2024, 33: 1-14. PMID: 39054237, PMCID: PMC11625012, DOI: 10.1016/j.jagp.2024.07.004.Peer-Reviewed Original ResearchPhysical restraint useRestraint useOlder adultsED visitsPhysical restraintEmergency departmentElectronic health record dataHealth record dataBlack non-HispanicPatient-level characteristicsAge-related disparitiesAssociated with increased useRegional hospital networkCross-sectional studyLogistic regression modelsChemical sedationRetrospective cross-sectional studyNon-Hispanic groupNon-HispanicAgitation managementHospital sitesHospital networkRecord dataWhite non-Hispanic groupPrimary outcome
2022
Odor blocking of stress hormone responses
Lee E, Saraiva L, Hanchate N, Ye X, Asher G, Ho J, Buck L. Odor blocking of stress hormone responses. Scientific Reports 2022, 12: 8773. PMID: 35610316, PMCID: PMC9130126, DOI: 10.1038/s41598-022-12663-x.Peer-Reviewed Original ResearchConceptsCorticotropin-releasing hormone neuronsBed nucleus of the stria terminalisOdor blockingHypothalamic corticotropin-releasing hormone neuronsInhibitory neuronsInhibition of excitatory neuronsBlood stress hormonesStress-induced increaseActivity of inhibitory neuronsActivate inhibitory neuronsHypothalamic ventromedial nucleusStress hormone responsesBed nucleusStria terminalisTransmit stress signalsPredator odorSocial confrontationVentromedial nucleusStress hormonesHormone neuronsAllay stressPhysical restraintExcitatory neuronsOdorHormonal responsesQualitative study of patient experiences and care observations during agitation events in the emergency department: implications for systems-based practice
Wong AH, Ray JM, Eixenberger C, Crispino LJ, Parker JB, Rosenberg A, Robinson L, McVaney C, Iennaco JD, Bernstein SL, Yonkers KA, Pavlo AJ. Qualitative study of patient experiences and care observations during agitation events in the emergency department: implications for systems-based practice. BMJ Open 2022, 12: e059876. PMID: 35545394, PMCID: PMC9096567, DOI: 10.1136/bmjopen-2021-059876.Peer-Reviewed Original ResearchConceptsEmergency departmentAgitation eventsQualitative studyEmergency careQualitative studies of patients' experiencesPhysical restraintStudies of patients' experiencesAvoidance of physical restraintSystem of healthcare deliveryPhysical restraint useEmergency care networkCommunity-based teaching hospitalSystems-based practiceTertiary care academic centreInterviews of patientsVerbal de-escalationGrounded theory approachPatient-oriented strategiesExposure to psychological traumaExcessive psychomotor activityCare approachSocioeconomic inequalitiesPatient experienceRestraint useCare networkA qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department
Wong AH, Sabounchi NS, Roncallo HR, Ray JM, Heckmann R. A qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department. BMC Health Services Research 2022, 22: 75. PMID: 35033071, PMCID: PMC8760708, DOI: 10.1186/s12913-022-07472-x.Peer-Reviewed Original ResearchConceptsExperience of workplace violenceClinician burnoutWorkplace violenceIncreased perceptions of safetyPhysical restraintPerceptions of safetyClinician stressWorkplace assaultsAgitated patientsEmergency departmentEffects of workplace violenceUse of restraintsQualitative system dynamics methodsModel building sessionsSymptoms of burnoutIncreased perceptionInterprofessional panelClinician stakeholdersResultsThe final modelRisk of assaultImpact future decisionsPatient safetyEpisodes of agitationAgitation managementClinician experience
2021
Design and Implementation of an Agitation Code Response Team in the Emergency Department
Wong AH, Ray JM, Cramer LD, Brashear TK, Eixenberger C, McVaney C, Haggan J, Sevilla M, Costa DS, Parwani V, Ulrich A, Dziura JD, Bernstein SL, Venkatesh AK. Design and Implementation of an Agitation Code Response Team in the Emergency Department. Annals Of Emergency Medicine 2021, 79: 453-464. PMID: 34863528, PMCID: PMC9038629, DOI: 10.1016/j.annemergmed.2021.10.013.Peer-Reviewed Original ResearchConceptsResponse team interventionPhysical restraint useInterrupted time series analysisRestraint useEmergency departmentTeam interventionRates of physical restraint useTeam-based interventionAdministrative supportQuality improvement studyResponse teamBehavioral health systemManagement of agitated patientsInterprofessional collaborationRestraint ordersExcessive psychomotor activityRestraint ratesHealth systemED visitsImprovement studyPhysical restraintCompare trendsPrimary outcomeTime series analysisAgitated patientsRacial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department
Nash KA, Tolliver DG, Taylor RA, Calhoun AJ, Auerbach MA, Venkatesh AK, Wong AH. Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department. JAMA Pediatrics 2021, 175: 1283-1285. PMID: 34515764, PMCID: PMC8438617, DOI: 10.1001/jamapediatrics.2021.3348.Peer-Reviewed Original Research49156 Effects of Race and Demographics on Use of Physical Restraints in the Emergency Department
Wong A, Whitfill T, Ohuabunwa E, Ray J, Dziura J, Bernstein S, Taylor R. 49156 Effects of Race and Demographics on Use of Physical Restraints in the Emergency Department. Journal Of Clinical And Translational Science 2021, 5: 121-122. PMCID: PMC8827920, DOI: 10.1017/cts.2021.710.Peer-Reviewed Original ResearchEmergency departmentAlcohol useAfrican AmericansHealth systemED visitsEffects of raceIllicit drug useOdds ratioPhysical restraintSignificant oddsUse of physical restraintsPrivate insuranceLack of private insuranceRegional health systemAssociated with significant oddsNon-Hispanic ethnicityPrevent self-harmTotal ED visitsAssociated with oddsRetrospective cohort analysisAssociated with safety risksAfrican American raceStatistically significant oddsTertiary health systemSignificant demographic factorsAssociation of Race/Ethnicity and Other Demographic Characteristics With Use of Physical Restraints in the Emergency Department
Wong AH, Whitfill T, Ohuabunwa EC, Ray JM, Dziura JD, Bernstein SL, Taylor RA. Association of Race/Ethnicity and Other Demographic Characteristics With Use of Physical Restraints in the Emergency Department. JAMA Network Open 2021, 4: e2035241. PMID: 33492372, PMCID: PMC7835716, DOI: 10.1001/jamanetworkopen.2020.35241.Peer-Reviewed Original Research
2020
4123 Characterization of Physical Restraint and Sedative Use for Treatment of Agitation in the Emergency Department
Wong A, Crispino L, Parker J, McVaney C, Rosenberg A, Ray J, Whitfill T, Iennaco J, Bernstein S. 4123 Characterization of Physical Restraint and Sedative Use for Treatment of Agitation in the Emergency Department. Journal Of Clinical And Translational Science 2020, 4: 125-125. PMCID: PMC8823616, DOI: 10.1017/cts.2020.374.Peer-Reviewed Original ResearchLogistic regression modelsRestraint useSedative useEmergency departmentOvert Aggression Scale scoresPhysical restraintOvert Aggression ScaleAggression scale scoresTreatment of agitationAgitated Behavior ScaleSeverity ScaleHigher oddsAgitation ScaleScale scoreLogistic regression models of factorsAssociated with significantly higher oddsTertiary care referral centerUrban tertiary care referral centerProspective cohort study of adult patientsFrequent chief complaintProspective cohort studySignificantly higher oddsAlcohol/drug useCohort study of adult patientsSeverity Scale scoreExperiences of Individuals Who Were Physically Restrained in the Emergency Department
Wong AH, Ray JM, Rosenberg A, Crispino L, Parker J, McVaney C, Iennaco JD, Bernstein SL, Pavlo AJ. Experiences of Individuals Who Were Physically Restrained in the Emergency Department. JAMA Network Open 2020, 3: e1919381. PMID: 31977058, PMCID: PMC6991263, DOI: 10.1001/jamanetworkopen.2019.19381.Peer-Reviewed Original ResearchConceptsEmergency departmentPhysical restraintED visitsExperiences of restraint useQualitative studyExperiences of physical restraintCombination of mental illnessPatient-centered approachMacArthur Perceived Coercion ScaleRestraint experienceParticipants' demographic informationAssociated with injuryExperiences of individualsData saturationEpisodes of physical restraintRestraint ordersCare provisionSelf-reported responsesRestraint useEpisodes of agitationMental illnessLast restraintMain OutcomesEligible visitsPrimary themes
2018
Physical Restraint Use in Adult Patients Presenting to a General Emergency Department
Wong AH, Taylor RA, Ray JM, Bernstein SL. Physical Restraint Use in Adult Patients Presenting to a General Emergency Department. Annals Of Emergency Medicine 2018, 73: 183-192. PMID: 30119940, DOI: 10.1016/j.annemergmed.2018.06.020.Peer-Reviewed Original ResearchConceptsPhysical restraint useEmergency departmentRestraint ordersRestraint usePhysical restraintDrug useRegional health systemManagement of behavioral disordersAdult emergency departmentPrevent self-harmCross-sectional studyPrevalence of agitationCross-sectional study of adult patientsAssociation of alcoholAdult patientsGeneral EDHealth systemED visitsManaging agitationMedical complaintsStudy of adult patientsVulnerable populationsSelf-harmUnique patientsTotal ED visits
2011
Physical Restraints in an Italian Psychiatric Ward: Clinical Reasons and Staff Organization Problems
Di Lorenzo R, Baraldi S, Ferrara M, Mimmi S, Rigatelli M. Physical Restraints in an Italian Psychiatric Ward: Clinical Reasons and Staff Organization Problems. Perspectives In Psychiatric Care 2011, 48: 95-107. PMID: 22458723, DOI: 10.1111/j.1744-6163.2011.00308.x.Peer-Reviewed Original ResearchMeSH KeywordsAdultAggressionAttitude of Health PersonnelCommitment of Persons with Psychiatric DisordersConsciousness DisordersFemaleHumansItalyMaleMiddle AgedPatient AdmissionPrecipitating FactorsPsychiatric Department, HospitalPsychotic DisordersRestraint, PhysicalRetrospective StudiesSchizophreniaConceptsPsychiatric wardsHr of hospitalizationItalian psychiatric wardPhysical restraint rateAcute psychiatric wardsPhysical restraint useNursing chartsClinical reasonsRestraint usePsychotic disordersRestraint ratesVoluntary admissionPhysical restraintMechanical restraintPatientsAggressive behaviorWardsHospitalizationAltered statesAdmissionSchizophrenia
2001
Environmental Risk Factors for Delirium in Hospitalized Older People
McCusker J, Cole M, Abrahamowicz M, Han L, Podoba J, Ramman‐Haddad L. Environmental Risk Factors for Delirium in Hospitalized Older People. Journal Of The American Geriatrics Society 2001, 49: 1327-1334. PMID: 11890491, DOI: 10.1046/j.1532-5415.2001.49260.x.Peer-Reviewed Original ResearchConceptsEnvironmental risk factorsRisk factorsPhysical restraintDelirium symptomsSeverity scoreHospital unitsObservational prospective clinical studyPrior cognitive impairmentSymptoms of deliriumConfusion Assessment MethodModifiable risk factorsGeneral community hospitalProspective clinical studyPatients age 65Potential environmental risk factorsSymptom severity scoresHospitalized older peopleDelirium severity scoresMedical wardsPatient characteristicsDelirium IndexIntensive careInitial severityCommunity hospitalClinical studies
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