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 ResearchMeSH KeywordsAdultDecision Support Systems, ClinicalEmergency Service, HospitalHumansInformed ConsentRandomized Controlled Trials as TopicResearch DesignConceptsComputerised 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 ResearchMeSH KeywordsAdultBuprenorphineDecision Support Systems, ClinicalEmergency Service, HospitalHumansNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersConceptsOpioid 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 patients
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 ResearchMeSH KeywordsEmergency Service, HospitalHumansInterrupted Time Series AnalysisPsychomotor AgitationQuality ImprovementRestraint, PhysicalConceptsResponse 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 patientsThe design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation
D'Onofrio G, Hawk KF, Herring AA, Perrone J, Cowan E, McCormack RP, Dziura J, Taylor RA, Coupet E, Edelman EJ, Pantalon MV, Owens PH, Martel SH, O'Connor PG, Van Veldhuisen P, DeVogel N, Huntley K, Murphy SM, Lofwall MR, Walsh SL, Fiellin DA. The design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation. Contemporary Clinical Trials 2021, 104: 106359. PMID: 33737199, PMCID: PMC9153252, DOI: 10.1016/j.cct.2021.106359.Peer-Reviewed Original ResearchMeSH KeywordsBuprenorphineDelayed-Action PreparationsEmergency Service, HospitalHumansNarcotic AntagonistsOpioid-Related DisordersConceptsOpioid use disorderRandomized clinical trialsPrimary outcomeFormal addiction treatmentOpioid withdrawalClinical trialsAncillary studiesUse disordersSelf-reported opioid useAddiction treatmentEmergency department initiationIncremental cost-effectiveness ratioReceipt of medicationEmergency department studyHealth service utilizationCost-effectiveness ratioOpioid useSecondary outcomesService utilizationTreatment accessEligibility criteriaImplementation facilitationBuprenorphineOverdose eventsDepartment studyAssociation 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
Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients
Vaca FE, Dziura J, Abujarad F, Pantalon MV, Hsiao A, Field CA, D'Onofrio G. Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients. Contemporary Clinical Trials 2020, 96: 106104. PMID: 32777381, PMCID: PMC8252296, DOI: 10.1016/j.cct.2020.106104.Peer-Reviewed Original ResearchMeSH KeywordsAdultAlcohol DrinkingAlcoholismEmergency Service, HospitalHispanic or LatinoHumansMass ScreeningResearch DesignConceptsAlcohol use disorderBrief interventionSevere alcohol use disorderUse disordersBinge drinking daysSpecialized treatment servicesAlcohol-related health disparitiesAlcohol screeningBrief intervention toolTimeline followback methodHigh-risk drinkingNegative behaviorsTreatment engagementAUD severityImpaired driversStandard careDrinking daysMeaningful contactIntervention toolDigital health toolsUnhealthy drinkingPrimary outcomeLatino patientsHealth toolsWork/schoolStudy 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 ResearchMeSH KeywordsEmergency Service, HospitalEvaluation Studies as TopicFeasibility StudiesHealth Plan ImplementationHumansPatient Care TeamPilot ProjectsConceptsEmergency 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 designInterrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder
Holland WC, Nath B, Li F, Maciejewski K, Paek H, Dziura J, Rajeevan H, Lu CC, Katsovich L, D'Onofrio G, Melnick ER. Interrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder. Academic Emergency Medicine 2020, 27: 753-763. PMID: 32352206, PMCID: PMC7496559, DOI: 10.1111/acem.14002.Peer-Reviewed Original ResearchConceptsOpioid use disorderComputerized clinical decision support systemsRates of EDBUP initiationUse disordersClinical decision support implementationEmergency department initiationRoutine emergency careInterrupted time series studyAdult ED patientsInterrupted time seriesClinical decision support systemElectronic health recordsClinicians' unfamiliarityED initiationDecision support implementationED dischargeOpioid withdrawalSecondary outcomesOngoing trialsPrimary outcomeAcademic EDED patientsSingle EDUnique patients
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 boardBuprenorphineUse of Non–Face-to-Face Modalities for Emergency Department Screening, Brief Intervention, and Referral to Treatment (ED-SBIRT) for High-Risk Alcohol Use: A Scoping Review
Biroscak BJ, Pantalon MV, Dziura JD, Hersey DP, Vaca FE. Use of Non–Face-to-Face Modalities for Emergency Department Screening, Brief Intervention, and Referral to Treatment (ED-SBIRT) for High-Risk Alcohol Use: A Scoping Review. Substance Abuse 2019, 40: 20-32. PMID: 30829126, PMCID: PMC6579646, DOI: 10.1080/08897077.2018.1550465.Peer-Reviewed Original ResearchMeSH KeywordsAlcohol DrinkingCounselingEmergency Service, HospitalHumansMass ScreeningPrimary PreventionReferral and ConsultationTelemedicineConceptsHigh-risk alcohol useFull-text articlesBrief interventionStudy participantsAlcohol useEmergency Department ScreeningPublic health preventionAlcohol use patternsCenter studyDisorder researchersBaseline assessmentIntervention studiesHealth preventionIntervention effectsReview populationModalitiesScoping ReviewReferralInterventionTreatmentTotalUnique referencesScreeningParticipantsReview
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 outcomeAn Interventionist Adherence Scale for a Specialized Brief Negotiation Interview Focused on Treatment Engagement for Opioid use Disorders
Pantalon MV, Dziura J, Li FY, Owens PH, O'Connor PG, D'Onofrio G. An Interventionist Adherence Scale for a Specialized Brief Negotiation Interview Focused on Treatment Engagement for Opioid use Disorders. Substance Abuse 2017, 38: 191-199. PMID: 28398192, PMCID: PMC7222694, DOI: 10.1080/08897077.2017.1294548.Peer-Reviewed Original ResearchConceptsTreatment engagementPsychometric propertiesUse disordersPredictive validityBrief Negotiation InterviewGood internal consistencyEnhance motivationBrief interventionDiscriminant validityFair predictive validitySkill performanceValid measureInternal consistencyExcellent interrater reliabilityControl encountersBASFactor itemsMotivationEngagementDisordersCritical actionsOpioid use disorderValidityRatersItemsEvaluation 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
2014
Elevated CK-MB with a Normal Troponin Does Not Predict 30-Day Adverse Cardiac Events in Emergency Department Chest Pain Observation Unit Patients
Safdar B, Bezek SK, Sinusas AJ, Russell RR, Klein MR, Dziura JD, D’onofrio G. Elevated CK-MB with a Normal Troponin Does Not Predict 30-Day Adverse Cardiac Events in Emergency Department Chest Pain Observation Unit Patients. Critical Pathways In Cardiology A Journal Of Evidence-Based Medicine 2014, 13: 14-19. PMID: 24526146, DOI: 10.1097/hpc.0000000000000001.Peer-Reviewed Original ResearchConceptsAdverse cardiac eventsCPU patientsNormal troponinAdverse eventsCardiac eventsMultiple logistic regression modelComposite adverse eventsElevated creatinine kinaseObservation unit patientsSerial troponin testingStandardized chart reviewRetrospective cohort studyAcute coronary syndromeNational Death RegistryCoronary artery diseaseLogistic regression modelsPositive troponinPrior CADRenal insufficientCoronary syndromeHemodynamic instabilityChart reviewCohort studyDeath RegistryIschemic electrocardiogramMeta-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 ResearchMeSH KeywordsClinical ProtocolsEmergency Service, HospitalHemodynamicsHumansPatient Care PlanningSepsisShock, SepticTreatment Outcome
2013
New Media Use by Patients Who Are Homeless: The Potential of mHealth to Build Connectivity
Post LA, Vaca FE, Doran KM, Luco C, Naftilan M, Dziura J, Brandt C, Bernstein S, Jagminas L, D'Onofrio G. New Media Use by Patients Who Are Homeless: The Potential of mHealth to Build Connectivity. Journal Of Medical Internet Research 2013, 15: e195. PMID: 24001876, PMCID: PMC3786002, DOI: 10.2196/jmir.2724.Peer-Reviewed Original ResearchConceptsED patientsHomeless patientsUnmet health care needsCross-sectional observational studyAlcohol/substance abuseEmergency department visitsAdjusted odds ratioHealth care needsStable housingPotential of mHealthDepartment visitsSmoking cessationPrimary careOdds ratioObservational studyCare needsPatientsExperienced homelessnessSubstance abuseMental healthHealth carePoor accessHealth informationSignificant differencesDescriptive statistics