2024
Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol
Wong A, Nath B, Shah D, Kumar A, Brinker M, Faustino I, Boyce M, Dziura J, Heckmann R, Yonkers K, Bernstein S, Adapa K, Taylor R, Ovchinnikova P, McCall T, Melnick E. Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol. BMJ Open 2024, 14: e082834. PMID: 38373857, PMCID: PMC10882402, DOI: 10.1136/bmjopen-2023-082834.Peer-Reviewed Original ResearchConceptsComputerised clinical decision supportED treatRestraint useExperiences of restraint useMental health-related visitsEmergency departmentPrevent agitationSystems-related factorsImprove patient experienceClinical decision support systemsRegional health systemClinical decision supportDe-escalation techniquesRandomised controlled trialsFormative evaluationPeer-reviewed journalsBest-practice guidanceAt-risk populationsCDS toolsThematic saturationED cliniciansPatient experienceED sitesHealth systemED physicians
2022
User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial
Melnick ER, Nath B, Dziura JD, Casey MF, Jeffery MM, Paek H, Soares WE, Hoppe JA, Rajeevan H, Li F, Skains RM, Walter LA, Patel MD, Chari SV, Platts-Mills TF, Hess EP, D'Onofrio G. User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. The BMJ 2022, 377: e069271. PMID: 35760423, PMCID: PMC9231533, DOI: 10.1136/bmj-2021-069271.Peer-Reviewed Original ResearchConceptsOpioid use disorderUsual care armEmergency departmentUse disordersCare armPragmatic clusterClinical decision supportIntervention armRoutine emergency careSecondary implementation outcomesSeverity of withdrawalTertiary care centerClinical decision support toolInitiation of buprenorphineElectronic health record tasksElectronic health record workflowsRE-AIM frameworkElectronic health record platformsHealth record platformsClinical decision support systemElectronic health recordsVisit documentationTreatment of addictionUsual careAdult patientsImproving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol
Evans LV, Ray JM, Bonz JW, Joseph M, Gerwin JN, Dziura JD, Venkatesh AK, Wong AH. Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol. BMJ Open 2022, 12: e058980. PMID: 35589358, PMCID: PMC9121107, DOI: 10.1136/bmjopen-2021-058980.Peer-Reviewed Original ResearchConceptsRandomised controlled trialsEmergency departmentPhysician stressEmergency physiciansClinician safetySemi-structured qualitative interviewsReturn to the emergency departmentControlled trialsNon-COVID-19-related illnessesState-Trait Anxiety InventoryPersonal safety concernsIncreased work burdenCOVID-19 preparednessUp-to-date careThreat to patientsVirtual telesimulationClinician stressPreparedness interventionsPhysician preparednessHospital administratorsLonger-term outcomesHuman Investigation CommitteeSimulation interventionSimulation educationDissemination efforts
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 patientsHigh-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder
Herring AA, Vosooghi AA, Luftig J, Anderson ES, Zhao X, Dziura J, Hawk KF, McCormack RP, Saxon A, D’Onofrio G. High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder. JAMA Network Open 2021, 4: e2117128. PMID: 34264326, PMCID: PMC8283555, DOI: 10.1001/jamanetworkopen.2021.17128.Peer-Reviewed Original ResearchConceptsOpioid use disorderEmergency departmentBuprenorphine inductionRespiratory depressionAdverse eventsUse disordersUntreated opioid use disorderSerious adverse eventsFurther prospective investigationLength of stayUrban emergency departmentSafety-net hospitalAdvanced practice practitionersElectronic health recordsUnique cliniciansSublingual buprenorphineBuprenorphine doseED visitsED encountersCase seriesED patientsED physiciansSupplemental oxygenMedian lengthUnique patientsA Brief Negotiation Interview Adherence Scale for Smoking Cessation: A psychometric evaluation
Pantalon MV, Dziura J, Li FY, D'Onofrio G, Weiss J, Bernstein SL. A Brief Negotiation Interview Adherence Scale for Smoking Cessation: A psychometric evaluation. Journal Of Substance Use And Addiction Treatment 2021, 126: 108398. PMID: 34116807, DOI: 10.1016/j.jsat.2021.108398.Peer-Reviewed Original ResearchConceptsBrief Negotiation InterviewNicotine replacement therapySmoking cessationAdherence ScaleQuitline referralHigh-risk alcohol consumptionOpioid use disorderPsychometric propertiesReplacement therapyEmergency departmentExcellent internal consistencyTobacco abstinenceClinical trialsInter-rater reliabilityUse disordersAlcohol consumptionPsychometric evaluationCessationFactor 1Behavioral contractingDiscriminant validityFactor 2Independent ratersPredictive validityInternal consistencyAssociation 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
Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department
Wong AH, Ray JM, Auerbach MA, Venkatesh AK, McVaney C, Burness D, Chmura C, Saxa T, Sevilla M, Flood CT, Patel A, Whitfill T, Dziura JD, Yonkers KA, Ulrich A, Bernstein SL. Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department. BMJ Open 2020, 10: e036982. PMID: 32606062, PMCID: PMC7328814, DOI: 10.1136/bmjopen-2020-036982.Peer-Reviewed Original ResearchConceptsEmergency departmentRestraint useCode teamControlled interrupted time series designResponse interventionsRate of restraint useInterrupted time series designAcute care settingDe-escalation techniquesTime series designPeer-reviewed publicationsED staffIdentified teamworkPilot interventionCare settingsHealth systemPatient encountersAgitation managementHuman Investigation CommitteeWorkplace violenceEthical approvalStaff safetyPatient agitationReduce harmSeries designProgress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder †
Melnick ER, Nath B, Ahmed OM, Brandt C, Chartash D, Dziura JD, Hess EP, Holland WC, Hoppe JA, Jeffery MM, Katsovich L, Li F, Lu CC, Maciejewski K, Maleska M, Mao JA, Martel S, Michael S, Paek H, Patel MD, Platts-Mills TF, Rajeevan H, Ray JM, Skains RM, Soares WE, Deutsch A, Solad Y, D’Onofrio G. Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder †. Journal Of Psychiatry And Brain Science 2020, 2: e200003. PMID: 32309637, PMCID: PMC7164817, DOI: 10.20900/jpbs.20200003.Peer-Reviewed Original ResearchBuprenorphine/naloxoneOpioid use disorderClinical decision supportPragmatic trialElectronic health recordsUse disordersEmergency Department-Initiated BuprenorphineMulti-centre pragmatic trialRoutine emergency careHealthcare systemRates of EDNaloxone prescribingPilot testingSingle EDEmergency departmentPhysicians' perceptionsEmergency careMortality rateEarly identificationComputable phenotypeUnique physiciansInformed consentCare paradigmHealth recordsIntervention effectiveness
2019
User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial
Melnick ER, Jeffery MM, Dziura JD, Mao JA, Hess EP, Platts-Mills TF, Solad Y, Paek H, Martel S, Patel MD, Bankowski L, Lu C, Brandt C, D’Onofrio G. User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial. BMJ Open 2019, 9: e028488. PMID: 31152039, PMCID: PMC6550013, DOI: 10.1136/bmjopen-2018-028488.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineCluster AnalysisDecision Support Systems, ClinicalEmergency Service, HospitalFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicUnited StatesYoung AdultConceptsOpioid use disorderEmergency departmentSecondary outcomesUse disordersEmergency department-initiated buprenorphineWestern Institutional Review BoardData Safety Monitoring BoardIndependent study monitorsRates of cliniciansRoutine emergency careSafety monitoring boardInstitutional review boardClinical decision support systemClinician prescribingPragmatic clusterPatient characteristicsPeer-reviewed journalsClinical decision supportPrimary outcomeED cliniciansWithdrawal symptomsOngoing treatmentPatients' willingnessMonitoring boardBuprenorphineElevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia
Safdar B, Guo X, Johnson C, D'Onofrio G, Dziura J, Sinusas AJ, Testani J, Rao V, Desir G. Elevated renalase levels in patients with acute coronary microvascular dysfunction – A possible biomarker for ischemia. International Journal Of Cardiology 2019, 279: 155-161. PMID: 30630613, PMCID: PMC6482834, DOI: 10.1016/j.ijcard.2018.12.061.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionFramingham risk scorePET/CTChest painInflammatory markersMicrovascular dysfunctionEmergency departmentRisk scoreRb-82 PET/CTElevated renalase levelsAcute chest painCoronary artery diseaseC-reactive proteinVascular endothelial growth factorAnti-inflammatory proteinTumor necrosis factorEndothelial growth factorAngina historyCMD diagnosisRenalase levelsHypertensive crisisED presentationsHemodynamic instabilityArtery diseaseHeart failure
2018
Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department
Safdar B, D’Onofrio G, Dziura J, Russell RR, Johnson C, Sinusas AJ. Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department. European Heart Journal Acute Cardiovascular Care 2018, 9: 5-13. PMID: 29543037, DOI: 10.1177/2048872618764418.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary artery diseaseCardiac positron emission tomography/Positron emission tomography/Chest pain patientsArtery diseaseAcute myocardial infarctionEmission tomography/Chest painMyocardial infarctionMicrovascular dysfunctionPain patientsEmergency departmentTomography/General emergency department populationLower coronary flow reserveNon-obstructive coronary arteriesPrior emergency department visitsTraditional cardiac risk factorsCardiac risk factorsModerate-risk patientsEmergency department visitsEmergency department patientsCoronary flow reserveEmergency department population
2017
Tobacco dependence treatment in the emergency department: A randomized trial using the Multiphase Optimization Strategy
Bernstein SL, Dziura J, Weiss J, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Tobacco dependence treatment in the emergency department: A randomized trial using the Multiphase Optimization Strategy. Contemporary Clinical Trials 2017, 66: 1-8. PMID: 29287665, PMCID: PMC5851600, DOI: 10.1016/j.cct.2017.12.016.Peer-Reviewed Original ResearchMeSH KeywordsAdultCost-Benefit AnalysisEmergency Service, HospitalFemaleHotlinesHumansMaleMiddle AgedMotivational InterviewingNicotine Chewing GumQualitative ResearchQuality-Adjusted Life YearsReferral and ConsultationSmoking CessationSmoking Cessation AgentsText MessagingTobacco Use Cessation DevicesTobacco Use DisorderTransdermal PatchTreatment OutcomeUnited StatesConceptsExhaled carbon monoxideHospital emergency departmentEmergency departmentMultiphase optimization strategyTobacco dependenceSubsequent confirmatory trialTobacco dependence interventionsNicotine replacement therapyTobacco dependence treatmentRecent clinical trialsLower socioeconomic groupsCost-effectiveness analysisPrimary endpointED patientsInitial treatmentStudy enrollmentTelephone quitlinesClinical efficacyPreventable causeReplacement therapyFuture trialsDependence treatmentTobacco abstinenceClinical trialsMulticomponent interventionDepression is associated with recurrent chest pain with or without coronary artery disease: A prospective cohort study in the emergency department
Kim Y, Soffler M, Paradise S, Jelani QU, Dziura J, Sinha R, Safdar B. Depression is associated with recurrent chest pain with or without coronary artery disease: A prospective cohort study in the emergency department. American Heart Journal 2017, 191: 47-54. PMID: 28888269, DOI: 10.1016/j.ahj.2017.06.003.Peer-Reviewed Original ResearchConceptsRecurrent chest painCoronary artery diseaseAcute chest painChest painProspective cohort studyChest pain centerClinical Anxiety ScaleEmergency departmentPerceived Stress ScalePain centerCohort studyArtery diseaseNonobstructive coronary artery diseaseObstructive coronary artery diseaseChest pain recurrenceED chest painCardiac risk factorsCardiac stress testingPatient Health QuestionnaireSignificant independent predictorsStress testingMultivariable regression modelsPain recurrenceIndependent predictorsPrimary outcomeEvaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department
Swenson KE, Dziura JD, Aydin A, Reynolds J, Wira CR. Evaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department. Internal And Emergency Medicine 2017, 13: 257-268. PMID: 28132131, DOI: 10.1007/s11739-017-1607-y.Peer-Reviewed Original ResearchConceptsInitial serum lactate levelSerum lactate levelsEmergency departmentLactate elevationVasoplegic shockLactate levelsCryptic shockVasopressor useInfected patientsShock mortalityHigh-risk ED patientsGroup mortality rateInitial serum lactateVasopressor-dependent patientsIdentifiable risk factorsSepsis-3 definitionRisk-stratify patientsHigh-risk subgroupsInitial lactate levelProximal phaseVasopressor dependenceVasopressor requirementHospital outcomesED patientsSerum lactateRanolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial
Safdar B, D’Onofrio G, Dziura J, Russell RR, Johnson C, Sinusas AJ. Ranolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial. Clinical Therapeutics 2017, 39: 55-63. PMID: 28081848, PMCID: PMC10345862, DOI: 10.1016/j.clinthera.2016.12.002.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary flow reserveCoronary artery diseaseChest painSymptomatic patientsArtery diseasePrimary outcomeEmergency departmentNonobstructive coronary artery diseaseRb-82 positron emission tomographyEffect of ranolazineRate-pressure productEmergency department patientsQTc-prolonging drugsRobust clinical trialsPositron emission tomographyHypertensive urgencyMicrovascular anginaMicrovascular dysfunctionUnderdiagnosed causeControlled TrialsDepartment patientsHeart failureAcute symptomsPressure product
2015
Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans
Safdar B, Dziura J, Bathulapalli H, Leslie DL, Skanderson M, Brandt C, Haskell SG. Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans. BMC Primary Care 2015, 16: 88. PMID: 26202799, PMCID: PMC4511555, DOI: 10.1186/s12875-015-0287-9.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseUnexplained chest painChest painUCP patientsCAD patientsArtery diseaseRisk factorsReturn visitsSpecific ICD-9 codesVeterans AffairsChest pain syndromeRecurrent chest painReference groupRetrospective cohort studyEvidence-based guidelinesICD-9 codesUnited States veteransDirect total costCAD cohortCause deathCardiac painPain syndromeCohort studyCox regressionEmergency department
2014
Meta-analysis of Protocolized Goal-Directed Hemodynamic Optimization for the Management of Severe Sepsis and Septic Shock in the Emergency Department
Wira CR, Dodge K, Sather J, Dziura J. Meta-analysis of Protocolized Goal-Directed Hemodynamic Optimization for the Management of Severe Sepsis and Septic Shock in the Emergency Department. Western Journal Of Emergency Medicine 2014, 15: 51-59. PMID: 24696750, PMCID: PMC3952890, DOI: 10.5811/westjem.2013.7.6828.Peer-Reviewed Original Research
2013
Point-of-Care Focused Cardiac Ultrasound for Prediction of Pulmonary Embolism Adverse Outcomes
Taylor RA, Davis J, Liu R, Gupta V, Dziura J, Moore CL. Point-of-Care Focused Cardiac Ultrasound for Prediction of Pulmonary Embolism Adverse Outcomes. Journal Of Emergency Medicine 2013, 45: 392-399. PMID: 23827166, DOI: 10.1016/j.jemermed.2013.04.014.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overEchocardiographyEmergency Service, HospitalFemaleHemorrhageHospital MortalityHumansMaleMiddle AgedPoint-of-Care SystemsPredictive Value of TestsPrognosisPulmonary EmbolismRecurrenceRespiratory InsufficiencyRetrospective StudiesRisk FactorsShockVenous ThromboembolismVentricular Dysfunction, RightConceptsRight ventricular strainHospital adverse outcomesRetrospective chart reviewPulmonary embolismAdverse outcomesEmergency departmentChart reviewCardiac ultrasoundHighest positive likelihood ratioRecurrent venous thromboembolismLow negative likelihood ratioSignificant predictorsEmergency care practitionersFocused cardiac ultrasoundFOCUS examinationPositive likelihood ratioNegative likelihood ratioMajor bleedingLikelihood ratioRespiratory failureVenous thromboembolismTransthoracic echocardiographyHospital admissionIndependent predictorsVentricular strain
2012
CT Overuse for Mild Traumatic Brain Injury
Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT Overuse for Mild Traumatic Brain Injury. The Joint Commission Journal On Quality And Patient Safety 2012, 38: 483-489. PMID: 23173394, DOI: 10.1016/s1553-7250(12)38064-1.Peer-Reviewed Original ResearchConceptsMild traumatic brain injuryCanadian CT Head RuleNew Orleans CriteriaTraumatic brain injuryProportion of casesComputed tomographyEmergency departmentBrain injuryCT useEmergency Physicians Clinical PolicyLevel I emergency departmentImportant brain injuryClinical Excellence (NICE) guidelinesMinor head injuryProspective observational studyCurrent guideline recommendationsHead CT findingsEvidence-based guidelinesHealth care costsRadiation-induced cancerCT overuseAdult patientsExcellence guidelinesCT findingsGuideline recommendations