Bio

Bio


Dr. Suffoletto is an Associate Professor of Emergency Medicine at Stanford University who has been designing and testing digital behavioral interventions for the past 10 years. After clinical training in Emergency Medicine at the University of Pittsburgh, he completed a Master's of Science with a focus on Clinical Research. His main focus of programatic research is designing digital interventions to prevent hazardous alcohol consumption in young adults. In 2014, he was awarded an NIAAA Career Development Award (K23) to develop skills and knowledge on addiction treatment and behavioral interventions. He is currently the co-PI of an NIAAA R01 award to test mechanisms of change for an effective text-message intervention to reduce alcohol consumption in young adults and was the PI on a CTSI T1/T2 Pilot Grant to explore the use of smartphone sensor data to detect drinking events. Dr. Suffoletto has published 99 peer-review scientific papers, including 19 first-or senior authored papers in the past 2 years. Current work includes using smartphone sensors and machine and deep learning methods to detect and predict behaviors.

Clinical Focus


  • Emergency Medicine

Academic Appointments


Professional Education


  • Residency: University of Pittsburgh Emergency Medicine Residency (2006) PA
  • Medical Education: Loyola University Stritch School of Medicine (2003) IL

Research & Scholarship

Current Research and Scholarly Interests


Recent projects include:
-remotely detecting drinking events using smartphone sensors
-testing conversational agent strategies to prevent binge drinking in young adults
-identifying and responding to mental health crises among college students
-supporting longitudinal home blood pressure monitoring and self-care in older adults with hypertension
-identifying fall risk among older emergency department patients.

Publications

All Publications


  • In-Person Contacts and Their Relationship With Alcohol Consumption Among Young Adults With Hazardous Drinking During a Pandemic. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Suffoletto, B., Ram, N., Chung, T. 2020

    Abstract

    PURPOSE: Social distancing strategies such as "stay-at-home" (SAH) orders can slow the transmission of contagious viruses like the SARS-CoV-2 virus, but require population adherence to be effective. This study explored adherence to SAH orders by young adults with hazardous drinking, and the role of alcohol consumption with in-person contacts on adherence.METHODS: Analyses included young adults with hazardous drinking (i.e., AUDIT-C score ?3/4 for women/men; n= 50; ages 18-25) participating in a randomized trial in Pittsburgh, PA. Participants provided experience sampling reports on drinking twice per week from the week before SAH orders started on April 1, 2020 through 6weeks during the SAH period. We examined how in-person contact with non-household friends changed over time and event-level relationships between alcohol consumption and in-person contacts.RESULTS: The percentage of participants with any in-person contact in the week before SAH was 44% (95% confidence interval [CI] 30%-59%), which decreased to 29% (95% CI 15%-43%) in the first SAH week and increased to 65% (95% CI 46%-85%) by SAH week 6. Controlling for average levels of alcohol consumption, on days when young adults drank, participants reported more in-person contacts compared to nondrinking days.CONCLUSIONS: Preliminary data indicate that, among young adults with hazardous drinking, adherence to public policies like SAH orders is suboptimal, declines over time, and is associated with drinking events. Interventions aimed at enhancing young adults' adherence to social distancing policies are urgently needed.

    View details for DOI 10.1016/j.jadohealth.2020.08.007

    View details for PubMedID 32943290

  • ADOPTION AND EFFECTIVENESS OF AN EHEALTH INTERVENTION FOR HYPERTENSION IN OLDER ADULTS: A PILOT CLINICAL TRIAL Muldoon, M. F., Einhorn, J., Burton, D., Irizarry, T., Forman, D. E., Rollman, B., Kamarck, T., Yabes, J., Burke, L., Suffoletto, B. LIPPINCOTT WILLIAMS & WILKINS. 2020: A185
  • A Preliminary Study Using Smartphone Accelerometers to Sense Gait Impairments Due to Alcohol Intoxication. Journal of studies on alcohol and drugs Suffoletto, B., Dasgupta, P., Uymatiao, R., Huber, J., Flickinger, K., Sejdic, E. 2020; 81 (4): 505?10

    Abstract

    OBJECTIVE: Sensing the effects of alcohol consumption in real time could offer numerous opportunities to reduce related harms. This study sought to explore accuracy of gait-related features measured by smartphone accelerometer sensors on detecting alcohol intoxication (breath alcohol concentration [BrAC] > .08%).METHOD: In a controlled laboratory study, participants (N = 17; 12 male) were asked to walk 10 steps in a straight line, turn, and walk 10 steps back before drinking and each hour, for up to 7 hours after drinking a weight-based dose of alcohol to reach a BrAC of .20%. Smartphones were placed on the lumbar region and 3-axis accelerometer data was recorded at a rate of 100 Hz. Accelerometer data were segmented into task segments (i.e., walk forward, walk backward). Features were generated for each overlapping 1-second windows, and the data set was split into training and testing data sets. Logistic regression models were used to estimate accuracy for classifying BrAC ? .08% from BrAC > .08% for each subject.RESULTS: Across participants, BrAC > .08% was predicted with a mean accuracy of 92.5% using logistic regression, an improvement from a naive model accuracy of 88.2% (mean sensitivity = .89; specificity = .92; positive predictive value = .77; and negative predictive value = .97). The two most informative accelerometer features were mean signal amplitude and variance of the signal in the x-axis (i.e., gait sway).CONCLUSIONS: We found preliminary evidence supporting use of gait-related features measured by smartphone accelerometer sensors to detect alcohol intoxication. Future research should determine whether these findings replicate in situ.

    View details for PubMedID 32800088

  • A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury ACADEMIC EMERGENCY MEDICINE Pacella-LaBarbara, M. L., Suffoletto, B. P., Kuhn, E., Germain, A., Jaramillo, S., Repine, M., Callaway, C. W. 2020

    Abstract

    Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients.From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment.Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months.We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.

    View details for DOI 10.1111/acem.14000

    View details for Web of Science ID 000533683900001

    View details for PubMedID 32339359

  • The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial JMIR MHEALTH AND UHEALTH Demirci, J. R., Suffoletto, B., Doman, J., Glasser, M., Chang, J. C., Sereika, S. M., Bogen, D. L. 2020; 8 (4): e17328

    Abstract

    Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined.This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)-the single, leading modifiable cause of unintended breastfeeding reduction and cessation.We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message-based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging-based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum.Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants' pre-existing breastfeeding knowledge and unique breastfeeding trajectory.Prenatal and postpartum evidence-based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered.ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969.

    View details for DOI 10.2196/17328

    View details for Web of Science ID 000529333700001

    View details for PubMedID 32347815

    View details for PubMedCentralID PMC7221632

  • Risk and protective factors for repeated overdose after opioid overdose survival DRUG AND ALCOHOL DEPENDENCE Suffoletto, B., Zeigler, A. 2020; 209: 107890

    Abstract

    Nonfatal opioid overdose (OD) is an opportunity to identify patients who may benefit from interventions to reduce repeated overdose (rOD). In this study, we sought to determine risk and protective factors associated with rOD.In this retrospective cohort study of 4,155 patients aged 18-64 who presented to one of 16 emergency departments in a single Western Pennsylvania health system between July 2015 and January 2018 for index opioid overdose (iOD) and survived to discharge, we identified demographic and clinical factors association with rOD within one-year. Relative risk of repeated opioid overdose was estimated using adjusted Cox proportional hazard ratios (aHRs).14.9 % of patients (95 % CI 13.9-16.1) had a rOD, with 29 % occurring within 30 days from iOD. The adjusted hazard of opioid overdose was increased for male patients (aHR = 1.19; 95 % CI 1.01, 1.41), those with pre-iOD diagnoses of anxiety (aHR = 1.41; 95 % CI1.13, 1.77), depression (aHR = 1.44; 95 % CI 1.17, 1.78), substance use disorders (aHR = 1.30; 95 % CI 1.09, 1.55), and alcohol use disorder (aHR = 1.52; 95 % CI 1.02, 2.25). The hazard was lower for individuals prescribed an opioid in the 90 days prior to iOD (aHR = 0.59; 95 % CI 0.37, 0.97) and those admitted to the hospital for iOD (aHR = 0.56; 95 % CI 0.37, 0.86).We found that, among ED patients who survive an initial OD, mental health and substance use diagnoses are associated with a higher hazard of repeated overdoses whereas opioids prescriptions and admission are associated with lower hazards.

    View details for DOI 10.1016/j.drugalcdep.2020.107890

    View details for Web of Science ID 000527917700011

    View details for PubMedID 32058246

    View details for PubMedCentralID PMC7127977

  • Mobile Assessment of Acute Effects of Marijuana on Cognitive Functioning in Young Adults: Observational Study JMIR MHEALTH AND UHEALTH Chung, T., Bae, S., Mun, E., Suffoletto, B., Nishiyama, Y., Jang, S., Dey, A. K. 2020; 8 (3): e16240

    Abstract

    Mobile assessment of the effects of acute marijuana on cognitive functioning in the natural environment would provide an ecologically valid measure of the impacts of marijuana use on daily functioning.This study aimed to examine the association of reported acute subjective marijuana high (rated 0-10) with performance on 3 mobile cognitive tasks measuring visuospatial working memory (Flowers task), attentional bias to marijuana-related cues (marijuana Stroop), and information processing and psychomotor speed (digit symbol substitution task [DSST]). The effect of distraction as a moderator of the association between the rating of subjective marijuana high and task performance (ie, reaction time and number of correct responses) was explored.Young adults (aged 18-25 years; 37/60, 62% female) who reported marijuana use at least twice per week were recruited through advertisements and a participant registry in Pittsburgh, Pennsylvania. Phone surveys and mobile cognitive tasks were delivered 3 times per day and were self-initiated when starting marijuana use. Completion of phone surveys triggered the delivery of cognitive tasks. Participants completed up to 30 days of daily data collection. Multilevel models examined associations between ratings of subjective marijuana high (rated 0-10) and performance on each cognitive task (reaction time and number of correct responses) and tested the number of distractions (rated 0-4) during the mobile task session as a moderator of the association between ratings of subjective marijuana high and task performance.Participants provided 2703 data points, representing 451 reports (451/2703, 16.7%) of marijuana use. Consistent with slight impairing effects of acute marijuana use, an increase in the average rating of subjective marijuana high was associated with slower average reaction time on all 3 tasks-Flowers (B=2.29; SE 0.86; P=.008), marijuana Stroop (B=2.74; SE 1.09; P=.01), and DSST (B=3.08; SE 1.41; P=.03)-and with fewer correct responses for Flowers (B=-0.03; SE 0.01; P=.01) and DSST (B=-0.18; SE 0.07; P=.01), but not marijuana Stroop (P=.45). Results for distraction as a moderator were statistically significant only for certain cognitive tasks and outcomes. Specifically, as hypothesized, a person's average number of reported distractions moderated the association of the average rating of subjective marijuana high (over and above a session's rating) with the reaction time for marijuana Stroop (B=-52.93; SE 19.38; P=.006) and DSST (B=-109.72; SE 42.50; P=.01) and the number of correct responses for marijuana Stroop (B=-0.22; SE 0.10; P=.02) and DSST (B=4.62; SE 1.81; P=.01).Young adults' performance on mobile cognitive tasks in the natural environment was associated with ratings of acute subjective marijuana high, consistent with slight decreases in cognitive functioning. Monitoring cognitive functioning in real time in the natural environment holds promise for providing immediate feedback to guide personal decision making.

    View details for DOI 10.2196/16240

    View details for Web of Science ID 000518839800001

    View details for PubMedID 32154789

    View details for PubMedCentralID PMC7093776

  • The Effect of SMS Behavior Change Techniques on Event-Level Desire to Get Drunk in Young Adults PSYCHOLOGY OF ADDICTIVE BEHAVIORS Suffoletto, B., Huber, J., Kirisci, L., Clark, D., Chung, T. 2020; 34 (2): 320?26

    Abstract

    Text messaging (SMS) interventions incorporating a combination of behavior change techniques can assist reductions in alcohol consumption among young adult hazardous drinkers, but mechanisms of action remain unknown. In this secondary analysis, we test the hypothesis that desire to get drunk (DD) recorded prior to drinking episodes would mediate SMS intervention effects on the likelihood of event-level heavy drinking (4 +/5 + drinks for women/men). We recruited young adult hazardous drinkers to a trial where they were randomized to 1 of 5 SMS interventions: TRACK (self-monitoring of alcohol use), PLAN (feedback on drinking plans and DD), USE (postdrinking feedback on alcohol consumed), GOAL (goal prompts/support), and COMBO (i.e., 4 interventions combined). Up to 3 days per week for 14 weeks, when participants reported a plan to drink, they were asked to report DD on a scale from 0 (none) to 8 (completely) and next day asked to recall drink quantity. Multilevel structural equation models showed that DD mediated the treatment effect of GOAL on heavy drinking. This work illustrates the importance of goal support features in digital alcohol interventions and the utility of measuring desire to get drunk as a key mediator in alcohol studies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

    View details for DOI 10.1037/adb0000534

    View details for Web of Science ID 000525395200008

    View details for PubMedID 31750698

    View details for PubMedCentralID PMC7064373

  • SMS-facilitated home blood pressure monitoring: A qualitative analysis of resultant health behavior change Allen, M. E., Irizarry, T., Einhorn, J., Kamarck, T. W., Suffoletto, B. P., Burke, L. E., Rollman, B. L., Muldoon, M. F. ELSEVIER IRELAND LTD. 2019: 2246?53

    Abstract

    Hypertension is largely asymptomatic and, as a result, patients often fail to sufficiently engage in medication adherence and other health behaviors to control their blood pressure (BP). This study explores the mechanisms by which MyBP, an automated SMS-facilitated home blood pressure monitoring (HBPM) program, helps facilitate healthy behavior changes.A thematic analysis of transcribed audio-recordings from semi-structured post-intervention interviews (n?=?40) was conducted.Three primary themes were identified as contributing most to patients' decision to initiate a behavior change: 1) increased hypertension literacy attributed to educational videos presented at enrollment, 2) increased day-to-day salience of blood pressure levels as a result of consistent HBPM, and 3) use of BP readings as feedback, with high readings triggering motivations to make behavior changes. These themes and most accompanying sub-themes correspond to constructs in the Health Belief Model and Social Cognitive Theory.Patient-centered HBPM interventions such asMyBP appear to promote improvements in hypertension self-management via several mechanisms consistent with recognized models of behavior change.SMS-supported HBPM, paired with video-based education, may provide a simple and scalable way of encouraging health behavior adherence in hypertensive patients.

    View details for DOI 10.1016/j.pec.2019.06.015

    View details for Web of Science ID 000496130200014

    View details for PubMedID 31262674

    View details for PubMedCentralID PMC6851464

  • Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients ACADEMIC EMERGENCY MEDICINE Chernick, L. S., Chun, T. H., Richards, R., Bromberg, J. R., Ahmad, F. A., McAninch, B., Mull, C., Shenoi, R., Suffoletto, B., Casper, C., Linakis, J., Spirito, A., PECARN 2020; 27 (4): 283?90

    Abstract

    In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives.Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females.In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females.Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.

    View details for DOI 10.1111/acem.13867

    View details for Web of Science ID 000497961100001

    View details for PubMedID 31596987

    View details for PubMedCentralID PMC7141959

  • Positive urgency worsens the impact of normative feedback on 21st birthday drinking DRUG AND ALCOHOL DEPENDENCE Whitt, Z. T., Bernstein, M., Spillane, N., Stein, L. R., Suffoletto, B., Neighbors, C., Schick, M. R., Cyders, M. A. 2019; 204: 107559

    Abstract

    The 21st birthday is associated with more alcohol consumption and negative consequences than any other occasion. The current study investigated how positive urgency, the tendency to act rashly in response to positive emotions, influences 21st birthday drinking and the effectiveness of a single event text message intervention designed to reduce 21st birthday drinking and related negative consequences.Participants were 183 undergraduate students (69% female, 86% white) about to turn 21. Participants were randomly assigned to either a text message intervention or control condition. Those in the intervention condition received one text message the day before their 21st birthday that provided personalized normative feedback and one text message on the day of their 21st birthday. Participants reported actual alcohol consumption the day after their 21st birthday celebration.Hierarchical linear regression found that, after controlling for sex, intervention condition, and planned drinking, positive urgency was associated with greater number of drinks (??=?.15, p?=?.031) and drinking problems (??=?.25, p?=?.001). A moderated-mediation model was significant (B?=?0.42, CI95 [.10, .76]): At high levels of positive urgency, the intervention condition was associated with drinking more than planned, which significantly mediated the relationship between intervention and alcohol-related consequences; the mediation was not significant at mean or low levels of positive urgency.These findings are the first to link positive urgency with 21st birthday drinking and to empirically demonstrate that positive urgency negatively impacts the effectiveness of an intervention aimed at reducing alcohol consumption.

    View details for DOI 10.1016/j.drugalcdep.2019.107559

    View details for Web of Science ID 000501392200059

    View details for PubMedID 31563804

    View details for PubMedCentralID PMC6878139

  • Methodology and Demographics of a Brief Adolescent Alcohol Screen Validation Study PEDIATRIC EMERGENCY CARE Bromberg, J. R., Spirito, A., Chun, T., Mello, M. J., Casper, T., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M., Mull, C. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Shenoi, R. P., Suffoletto, B., Vance, C., Linakis, J. G., Pediat Emergency Care Appl Res Net 2019; 35 (11): 737?44

    Abstract

    The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample characteristics, and baseline outcomes of the NIAAA 2-question screen.Participants included 12- to 17-year-olds treated in one of the participating pediatric emergency departments across the United States. After enrollment, a criterion assessment battery including the NIAAA 2-question screen and other measures of alcohol, drug use, and risk behavior was self-administered by participants on a tablet computer. Two subsamples were derived from the sample. The first subsample was readministered the NIAAA 2-question screen 1 week after their initial visit to assess test-retest reliability. The second subsample is being reassessed at 12 and 24 months to examine predictive validity of the NIAAA 2-question screen.There were 4834 participants enrolled into the study who completed baseline assessments. Participants were equally distributed across sex and age. Forty-six percent of the participants identified as white, and 26% identified as black. Approximately one quarter identified as Hispanic. Using the NIAAA 2-question screen algorithm, approximately 8% were classified as low risk, 12% were classified as moderate risk, and 4% were classified as highest risk. Alcohol use was less likely to be reported by black participants, non-Hispanic participants, and those younger than 16 years.This study successfully recruited a large, demographically diverse sample to establish rates of the NIAAA screen risk categories across age, sex, ethnicity, and race within pediatric emergency departments.

    View details for DOI 10.1097/PEC.0000000000001221

    View details for Web of Science ID 000497516400009

    View details for PubMedID 29112110

    View details for PubMedCentralID PMC5752626

  • Do electronic health record prompts increase take-home naloxone administration for emergency department patients after an opioid overdose? ADDICTION Marino, R., Landau, A., Lynch, M., Callaway, C., Suffoletto, B. 2019; 114 (9): 1575?81

    Abstract

    Distribution of take-home naloxone (THN) to emergency department (ED) patients who have survived an opioid overdose (OD) could reduce future opioid mortality, but is not commonly performed. We examined whether electronic health record (EHR) prompts provided to ED physicians when discharging a patient after an OD could improve THN distribution.Interrupted time-series analysis to compare the percentage of OD patients who received THN during the 11 months before and after implementation of an EHR prompt on 18 June 2017.A total of 3492 adult patients with diagnoses of OD discharged from nine EDs in a single health system in Western Pennsylvania from July 2016 to April 2018.The EHR prompt was triggered by the presence of specific terms in the nurse's initial assessment note. The EHR displayed a pop-up window during the ED physician discharge process asking the physician to consider prescribing or providing naloxone to the patient. The comparator was 'no EHR prompt'.Measurements were based on standard criteria from ICD diagnostic codes and chief complaint keywords.In July 2016, 16.3% [95% confidence interval (CI) = 14.0, 18.5] of OD patients received THN, which decreased every month through June 2017 by 1.2% (P < 0.0001, 95% CI = 0.8,1.7). For each month post-EHR prompt there was an increase of 2.8% of OD patients receiving THN (P < 0.001, 95% CI = 2.0, 3.5). No increases occurred in the ED with the highest pre-EHR prompt THN distribution. Rates of THN distribution varied by patient age and race prior to, but not after, implementation of EHR prompts.Electronic health record prompts are associated with increased take-home naloxone distribution for emergency department patients discharged after opioid overdoses.

    View details for DOI 10.1111/add.14635

    View details for Web of Science ID 000478744100007

    View details for PubMedID 31013394

  • Early Screening for Posttraumatic Stress Disorder and Depression Among Injured Emergency Department Patients: A Feasibility Study Jaramillo, S., Suffoletto, B., Callaway, C., Pacella-LaBarbara, M. WILEY. 2019: 1232?44

    Abstract

    Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury.In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL).Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL.These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.

    View details for DOI 10.1111/acem.13816

    View details for Web of Science ID 000476074000001

    View details for PubMedID 31179590

    View details for PubMedCentralID PMC7294865

  • Reliability and Validity of the Newton Screen for Alcohol and Cannabis Misuse in a Pediatric Emergency Department Sample JOURNAL OF PEDIATRICS Linakis, J. G., Bromberg, J. R., Casper, T., Chun, T. H., Mello, M. J., Ingebretsen, H., Spirito, A., Shenoi, R. P., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Dean, J., Fein, J., Grupp-Phelan, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Mull, C. C., Powell, E. C., Rogers, A., Suffoletto, B., Vance, C., Pediat Emergency Care Appl Res Net 2019; 210: 154-+

    Abstract

    To determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up.Adolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure.The sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis.The Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment.

    View details for DOI 10.1016/j.jpeds.2019.02.038

    View details for Web of Science ID 000472497600030

    View details for PubMedID 30967250

    View details for PubMedCentralID PMC6592736

  • Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use? SUBSTANCE USE & MISUSE Spirito, A., Bromberg, J. R., Casper, T., Chun, T., Mello, M. J., Mull, C. C., Shenoi, R. P., Vance, C., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Suffoletto, B., Linakis, J. G., PECARN 2019; 54 (6): 1007?16

    Abstract

    The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse.A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs.Participants included 12-17-year olds (n?=?4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer.A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.

    View details for DOI 10.1080/10826084.2018.1558251

    View details for Web of Science ID 000466910800015

    View details for PubMedID 30727811

    View details for PubMedCentralID PMC6476662

  • A NOVEL APPLICATION OF THE CENTRALITY OF EVENTS SCALE AFTER MINOR PHYSICAL INJURY: ASSOCIATIONS WITH POSTTRAUMATIC OUTCOMES AMONG INJURED EMERGENCY DEPARTMENT PATIENTS Pacella-LaBarbara, M. L., Suffoletto, B. P., Callaway, C. W. LIPPINCOTT WILLIAMS & WILKINS. 2019: A102?A103
  • THE UTILITY OF PTSD SYMPTOMS AND PAIN CATASTROPHIZING IN PREDICTING ACUTE PAIN AMONG EMERGENCY DEPARTMENT PATIENTS INJURED IN A MOTOR VEHICLE-RELATED ACCIDENT Pacella-LaBarbara, M. L., Germain, A., Suffoletto, B., Kuhn, E., Callaway, C. L. LIPPINCOTT WILLIAMS & WILKINS. 2019: A60
  • How Are Real-time Opioid Prescribing Cognitions by Emergency Providers Influenced by Reviewing the State Prescription Drug Monitoring Program? PAIN MEDICINE Landau, A., Lynch, M., Callaway, C., Suffoletto, B. 2019; 20 (5): 955?60

    Abstract

    To understand how real-time opioid prescribing cognitions by emergency medicine (EM) providers are influenced by review of the state prescription drug monitoring program (PDMP).We collected prospective data from a convenience sample of 103 patient encounters for pain from 23 unique EM providers. After seeing the patient, before and immediately after reviewing the PDMP, EM providers answered how much they thought "the patient need[ed] an opioid to help manage their pain?", how concerned they were "about drug abuse and/or diversion?", and whether they planned to prescribe an opioid (yes/no). If they changed their decision to prescribe after querying the PDMP, they were asked to provide comments. We categorized encounters by opioid prescribing plan before/after PDMP review (e.g., O+/O- means plan changed from "yes" to "no") and examined changes in cognitions across categories.Ninety-two of 103 (89.3%) encounters resulted in no change in opioid prescribing plan (61/92 [66.3%] O+/O+; 31/92 [33.7%] O-/O-). For the four O+/O- encounters, perceived patient opioid need decreased 75% of the time and concern for opioid abuse and/or diversion increased 75% of time. For the seven O-/O+?encounters, providers reported increased perceived patient opioid need 28.6% of the time and decreased concern for opioid abuse and/or diversion 14.3% of time.PDMP data rarely alter plans to prescribe an opioid among emergency providers. When changes in opioid prescribing plan were made, this was reflected by changes in cognitions. Findings support the need for a properly powered study to identify how specific PDMP findings alter prescribing cognitions.

    View details for DOI 10.1093/pm/pny083

    View details for Web of Science ID 000479175500011

    View details for PubMedID 29762757

    View details for PubMedCentralID PMC6497091

  • Which behavior change techniques help young adults reduce binge drinking? A pilot randomized clinical trial of 5 text message interventions ADDICTIVE BEHAVIORS Suffoletto, B., Kirisci, L., Clark, D. B., Chung, T. 2019; 92: 161?67

    Abstract

    Text message (SMS) interventions can reduce binge drinking in young adults, but optimal behavior change techniques (BCTs) remain unknown. The present study tests the acceptability and preliminary efficacy of different combinations of SMS-delivered BCTs. 149 young adults who screened positive for hazardous drinking completed a baseline survey in the Emergency Department. For the following 2-weeks, on days they typically drank (1 to 3?days per week), participants received ecological momentary assessments (EMA) of drinking plans and desire to get drunk; the next day they were prompted to report recall of number of drinks consumed the prior day. Participants who responded to at least 50% these EMA (N?=?127) were randomized to one of five 12-week interventions: Cued Self-Monitoring (TRACK); Drinking Intentions Feedback (PLAN); Drinking Performance Feedback (USE); Adaptive Goal Support (GOAL); and a combination of BCTs (COMBO). 79% of all EMA were completed over 12?weeks, which decreased from around 93% on week 1 to 65% by week 12. Using EMA data, relative to TRACK, only COMBO showed significant reductions in binge drinking and max drinks per drinking episode over time. Using TLFB data, there were no significant differences between groups from baseline to 14- and 28-weeks follow-up. Results lay the groundwork for a larger trial testing the effects of BCTs on binge drinking for young adults.

    View details for DOI 10.1016/j.addbeh.2019.01.006

    View details for Web of Science ID 000468708800027

    View details for PubMedID 30640148

  • Implementations of a text-message intervention to increase linkage from the emergency department to outpatient treatment for substance use disorders JOURNAL OF SUBSTANCE ABUSE TREATMENT Kmiec, J., Suffoletto, B. 2019; 100: 39?44

    Abstract

    To determine acceptability and explore potential usefulness of a text messaging (SMS) program aimed at increasing attendance at outpatient treatment for substance use disorders (SUD) after emergency department (ED) referral.A retrospective analysis of 377 adult patients from 2 urban EDs seeking treatment for SUD (opioids (n?=?168), alcohol (n?=?188), benzodiazepines (n?=?21)) referred to outpatient treatment and offered an SMS program which included daily (1) motivational messages focused on positive thinking, (2) ecological momentary assessments (EMA) related to craving with tailored behavioral strategy messages, (3) EMA of drug use with tailored feedback to reduce abstinence violation effects, and (4) reminders about treatment location and phone number. We assessed acceptability by examining opt-in rates, EMA completion rates over the first week and end-of-program qualitative feedback. We assessed how individuals who opt in differ in outcomes from those who opt out by examining rates of outpatient SUD treatment attendance recorded from the medical record.167 patients (44%) opted in to the SMS program. Over 7?days, around 33% of EMA were completed. Median helpfulness score was 8 (IQR 6 to 10) out of 10 and 84% would recommend the SMS program to someone else. Individuals who opted in to the SMS program had higher rates of SUD treatment initiation than individuals who did not opt-in (70.7% vs. 40.9%).We found evidence supporting acceptability and potential usefulness of an automated text message program to assist treatment attendance for some individuals with SUDs discharged from the ED. A controlled trial is needed to examine whether SMS program exposure is associated with improved treatment attendance compared to standard care.

    View details for DOI 10.1016/j.jsat.2019.02.005

    View details for Web of Science ID 000462951600005

    View details for PubMedID 30898326

    View details for PubMedCentralID PMC6432936

  • Predictive Validity of a 2-Question Alcohol Screen at 1-, 2-, and 3-Year Follow-up PEDIATRICS Linakis, J. G., Bromberg, J. R., Casper, T., Chun, T. H., Mello, M. J., Richards, R., Mull, C. C., Shenoi, R. P., Vance, C., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Suffoletto, B., Dean, J., Spirito, A., Pediat Emergency Care Applied 2019; 143 (3)

    Abstract

    The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question screen is a valid adolescent alcohol screening tool. No studies have examined if this tool predicts future alcohol problems. We conducted a study at 16 pediatric emergency departments to determine the tool's predictive validity for alcohol misuse and alcohol use disorders (AUDs).Participants (N = 4834) completed a baseline assessment battery. A subsample of participants completed the battery at 1, 2, and 3 years follow up.Of the 2209 participants assigned to follow-up, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. The differences in AUDs between baseline NIAAA screen nondrinkers and lower-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P <.0001), and 3 years (P = .0005), as were the differences between moderate- and highest-risk drinkers at 1 and 2 years (P < .0001 and P = .0088, respectively) but not at 3 years (P = .0758). The best combined score for sensitivity (86.2% at 1 year, 75.6% at 2 years, and 60.0% at 3 years) and specificity (78.1% at 1 year, 79.2% at 2 years, and 80.0% at 3 years) was achieved by using "lower risk" and higher as a cutoff for the prediction of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis.The NIAAA 2-question screen can accurately characterize adolescent risk for future AUDs. Future studies are needed to determine optimaluse of the screen.

    View details for DOI 10.1542/peds.2018-2001

    View details for Web of Science ID 000459796900009

    View details for PubMedID 30783022

    View details for PubMedCentralID PMC6398369

  • Attentional and approach biases to alcohol cues among young adult drinkers: An ecological momentary assessment study. Experimental and clinical psychopharmacology Suffoletto, B., Field, M., Chung, T. 2019

    Abstract

    Alcohol-specific attentional biases (AttB) and approach biases (AppB) are postulated to play a role in alcohol use disorders but their association with drinking in young adults remains unknown. A subsample of young adults with risky alcohol use (N = 296) enrolled in a randomized trial, testing different text message interventions completed weekly tasks via a mobile app for up to 14 weeks: Alcohol Stroop was used to measure AttB and Approach-Avoidance Task was used to measure AppB. Participants also provided reports of their alcohol consumption up to twice per week. We analyzed feasibility of measuring alcohol biases on mobile phones, whether repeated testing and conditions of testing affected mean reaction times (RTs), and whether mean AttB and AppB scores were associated with baseline alcohol use severity and same-day binge drinking (4+/5+ drinks per occasion for women/men). Task completion decreased from 93% on Week 1% to 39% by Week 14 with a mean of 8.2 weeks completed. Mean RTs for Alcohol Stroop decreased over weeks assessed. RTs to Stroop and Approach-Avoid tasks were longer when participants reported distractions or after alcohol and/or drug use. Mean AttB and AppB scores were not associated with baseline drinking, and within-day fluctuations of AttB and AppB scores did not predict same day binge drinking. Barriers to measuring alcohol biases in the natural environment include learning effects, contextual influences of distractions and prior alcohol/drug use, and absence of robust associations of RTs to alcohol cues with either baseline or same-day alcohol consumption. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/pha0000343

    View details for PubMedID 31886700

    View details for PubMedCentralID PMC7326641

  • Feasibility and acceptability of a motivational intervention combined with text messaging for alcohol and sex risk reduction with emergency department patients: a pilot trial ADDICTION RESEARCH & THEORY Mastroleo, N. R., Celio, M. A., Barnett, N. P., Colby, S. M., Kahler, C. W., Operario, D., Suffoletto, B. P., Monti, P. M. 2019; 27 (2): 85?94

    Abstract

    Interventions aimed at reducing co-occurring heavy drinking and risky sexual behavior among Emergency Department (ED) patients require feasibility and acceptability to optimally engage individuals.This pilot study explored the feasibility and acceptability of an interactive text-messaging (TM) supplement to a brief in-person intervention previously found successful in reducing alcohol use and condomless sex.Using a mixed-method design, ED patients with past hazardous alcohol use and condomless sex (N= 20) were randomly assigned to receive either a Motivational Intervention + TM or Brief Advice + TM. All participants completed exit interviews at four weeks follow-up, and transcripts were transcribed and coded to identify themes. We evaluated feasibility through quantitative assessment of TM response rates and latency to response, while acceptability was evaluated through thematic analysis of exit interviews.Findings provide support for the delivery of an integrated and personalized MI and TM. Participants engaged positively with the TM intervention and qualitative interviews offered strong support for the acceptability while offering information necessary to enhance the TM component.Integrating MI with TM is feasible and acceptable to at-risk ED patients and could facilitate behavior changes beyond MI alone.

    View details for DOI 10.1080/16066359.2018.1444159

    View details for Web of Science ID 000461676900004

    View details for PubMedID 31073283

    View details for PubMedCentralID PMC6502468

  • Nudging Emergency Care Providers to Reduce Opioid Prescribing Using Peer Norm Comparison Feedback: A Pilot Randomized Trial. Pain medicine (Malden, Mass.) Suffoletto, B., Landau, A. 2019

    Abstract

    To determine the feasibility, acceptability, and potential impact of using audit and feedback (A&F) with or without peer norm comparison on opioid prescribing by emergency medicine providers.A convenience sample of 37 emergency medicine providers were recruited from 16 emergency departments in Western Pennsylvania for a pilot randomized controlled trial. Participants completed a baseline survey, were randomly allocated to A&F (N?=?17) or A&F with peer norm comparison (N?=?20), and were asked to complete a postintervention survey. We matched each participant 1:1 to a control who was not exposed to either intervention.At baseline, 57% of participants perceived that they prescribed opioids at the same frequency as their peers, whereas 32% perceived prescribing less than and 11% perceived prescribing more than their peers. Most participants rated the interventions as helpful, with no differences between conditions. For the A&F with peer norm comparison condition, from pre- to postintervention, there was a relative increase of 20% in the percentage of participants who perceived that they prescribed more opioids than their peers but no change in the A&F condition (P?=?0.02). 56.8% of controls, 52.9% of A&F participants, and 75.5% of A&F with peer norm comparison participants reduced their opioid prescribing (P?=?0.33). The mean reduction in opioid prescriptions (SD) was 3.3. (9.6) for controls, 3.9 (10.5) for A&F, and 7.3 (7.8) for A&F with peer norm comparison (P?=?0.31).Audit and feedback interventions with peer norm comparisons are helpful to providers, can alter perceptions about prescribing norms, and are a potentially effective way to alter ED providers' opioid prescribing behavior.

    View details for DOI 10.1093/pm/pnz314

    View details for PubMedID 31846029

  • Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials PLOS MEDICINE Riper, H., Hoogendoorn, A., Cuijpers, P., Karyotaki, E., Boumparis, N., Mira, A., Andersson, G., Berman, A. H., Bertholet, N., Bischof, G., Blankers, M., Boon, B., Boss, L., Brendryen, H., Cunningham, J., Ebert, D., Hansen, A., Hester, R., Khadjesari, Z., Kramer, J., Murray, E., Postel, M., Schulz, D., Sinadinovic, K., Suffoletto, B., Sundstrom, C., de Vries, H., Wallace, P., Wiers, R. W., Smit, J. H. 2018; 15 (12): e1002714

    Abstract

    Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs).Systematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data. The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention, and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis. We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants. Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI -7.57 to -2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63-2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06-6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21-2.27, p = 0.002). Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: -6.78 SUs, 95% CI -12.11 to -1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22-4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29-0.93, p = 0.029). The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: -9.27 SUs, 95% CI -13.97 to -4.57, p < 0.001; TR: OR = 3.74, 95% CI 2.13-6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses.To our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.

    View details for DOI 10.1371/journal.pmed.1002714

    View details for Web of Science ID 000454833300006

    View details for PubMedID 30562347

    View details for PubMedCentralID PMC6298657

  • Text-Facilitated Home Blood Pressure Monitoring: A Qualitative Analysis of Health Behavior Change Allen, M., Irizarry, T., Einhorn, J., Suffoletto, B., Kamarck, T., Burke, L., Rollman, B., Muldoon, M. F. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Development and Preliminary Feasibility of an Automated Hypertension Self-Management System AMERICAN JOURNAL OF MEDICINE Irizarry, T., Allen, M., Suffoletto, B. P., Einhorn, J., Burke, L. E., Kamarck, T. W., Rollman, B. L., Muldoon, M. F. 2018; 131 (9)
  • The Association Between Daily Posttraumatic Stress Symptoms and Pain Over the First 14 Days After Injury: An Experience Sampling Study ACADEMIC EMERGENCY MEDICINE Pacella, M. L., Girard, J. M., Wright, A. C., Suffoletto, B., Callaway, C. W. 2018; 25 (8): 844?55

    View details for DOI 10.1111/acem.13406

    View details for Web of Science ID 000441740500001

  • Mobile phone sensors and supervised machine learning to identify alcohol use events in young adults: Implications for just-in-time adaptive interventions ADDICTIVE BEHAVIORS Bae, S., Chung, T., Ferreira, D., Dey, A. K., Suffoletto, B. 2018; 83: 42?47

    Abstract

    Real-time detection of drinking could improve timely delivery of interventions aimed at reducing alcohol consumption and alcohol-related injury, but existing detection methods are burdensome or impractical.To evaluate whether phone sensor data and machine learning models are useful to detect alcohol use events, and to discuss implications of these results for just-in-time mobile interventions.38 non-treatment seeking young adult heavy drinkers downloaded AWARE app (which continuously collected mobile phone sensor data), and reported alcohol consumption (number of drinks, start/end time of prior day's drinking) for 28days. We tested various machine learning models using the 20 most informative sensor features to classify time periods as non-drinking, low-risk (1 to 3/4 drinks per occasion for women/men), and high-risk drinking (>4/5 drinks per occasion for women/men).Among 30 participants in the analyses, 207 non-drinking, 41 low-risk, and 45 high-risk drinking episodes were reported. A Random Forest model using 30-min windows with 1day of historical data performed best for detecting high-risk drinking, correctly classifying high-risk drinking windows 90.9% of the time. The most informative sensor features were related to time (i.e., day of week, time of day), movement (e.g., change in activities), device usage (e.g., screen duration), and communication (e.g., call duration, typing speed).Preliminary evidence suggests that sensor data captured from mobile phones of young adults is useful in building accurate models to detect periods of high-risk drinking. Interventions using mobile phone sensor features could trigger delivery of a range of interventions to potentially improve effectiveness.

    View details for DOI 10.1016/j.addbeh.2017.11.039

    View details for Web of Science ID 000435063200006

    View details for PubMedID 29217132

    View details for PubMedCentralID PMC5963979

  • Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection NEW ENGLAND JOURNAL OF MEDICINE Huang, D. T., Yealy, D. M., Filbin, M. R., Brown, A. M., Chang, C. H., Doi, Y., Donnino, M. W., Fine, J., Fine, M. J., Fischer, M. A., Holst, J. M., Hou, P. C., Kellum, J. A., Khan, F., Kurz, M. C., Lotfipour, S., LoVecchio, F., Peck-Palmer, O., Pike, F., Prunty, H., Sherwin, R. L., Southerland, L., Terndrup, T., Weissfeld, L. A., Yabes, J., Angus, D. C., ProACT Investigators 2018; 379 (3): 236?49

    Abstract

    The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear.In 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group. We hypothesized that within 30 days after enrollment the total antibiotic-days would be lower - and the percentage of patients with adverse outcomes would not be more than 4.5 percentage points higher - in the procalcitonin group than in the usual-care group.A total of 1656 patients were included in the final analysis cohort (826 randomly assigned to the procalcitonin group and 830 to the usual-care group), of whom 782 (47.2%) were hospitalized and 984 (59.4%) received antibiotics within 30 days. The treating clinician received procalcitonin assay results for 792 of 826 patients (95.9%) in the procalcitonin group (median time from sample collection to assay result, 77 minutes) and for 18 of 830 patients (2.2%) in the usual-care group. In both groups, the procalcitonin-level tier was associated with the decision to prescribe antibiotics in the emergency department. There was no significant difference between the procalcitonin group and the usual-care group in antibiotic-days (mean, 4.2 and 4.3 days, respectively; difference, -0.05 day; 95% confidence interval [CI], -0.6 to 0.5; P=0.87) or the proportion of patients with adverse outcomes (11.7% [96 patients] and 13.1% [109 patients]; difference, -1.5 percentage points; 95% CI, -4.6 to 1.7; P<0.001 for noninferiority) within 30 days.The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection. (Funded by the National Institute of General Medical Sciences; ProACT ClinicalTrials.gov number, NCT02130986 .).

    View details for DOI 10.1056/NEJMoa1802670

    View details for Web of Science ID 000439063900007

    View details for PubMedID 29781385

    View details for PubMedCentralID PMC6197800

  • Developing Text Messages to Reduce Community College Student Alcohol Use AMERICAN JOURNAL OF HEALTH BEHAVIOR Lewis, M. A., Cadigan, J. M., Cronce, J. M., Kilmer, J. R., Suffoletto, B., Walter, T., Lee, C. M. 2018; 42 (4): 70?79

    Abstract

    Objectives The aim of this study is to evaluate how community college students with hazardous drinking perceived the usefulness of alcohol protective behavioral strategy text messages (TM-PBS). Methods Community college students with past hazardous single occasion or weekly drinking (N = 48; 60% female) were randomized to receive 2 TM-PBS on 3 typical drinking days per week for 2 weeks selected by: (1) research investigators (ie, based on clinical and theoretical application); (2) participants (ie, messages highly rated at baseline by the participants); or (3) a random process. Prior to 2 typical drinking days per week, immediately after receiving TMs, we asked: "How useful do you think this strategy will be for you when you drink? Text a number from 1 (not useful) to 5 (very useful)." Results Response rates for the 12 messages ranged from 72.9% to 87.5%, with no differences in response rates across selection categories (ie, investigator, participant, random). Investigator-selected messages were rated as less useful than messages that were self-selected by participants or messages that were selected at random. Conclusions TM-PBS chosen a priori by students were perceived as more useful than TM-PBS chosen by investigators, supporting this form of tailoring in alcohol interventions to optimize usefulness.

    View details for DOI 10.5993/AJHB.42.4.7

    View details for Web of Science ID 000437980800007

    View details for PubMedID 29973312

    View details for PubMedCentralID PMC6237090

  • Using Digital Interventions to Support Individuals with Alcohol Use Disorder and Advanced Liver Disease: A Bridge Over Troubled Waters ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Suffoletto, B., Scaglione, S. 2018; 42 (7): 1160?65

    View details for DOI 10.1111/acer.13771

    View details for Web of Science ID 000436930700001

    View details for PubMedID 29750368

    View details for PubMedCentralID PMC6028285

  • Postconcussive Symptoms Over the First 14 Days After Mild Traumatic Brain Injury: An Experience Sampling Study JOURNAL OF HEAD TRAUMA REHABILITATION Pacella, M., Prabhu, A., Morley, J., Huang, S., Suffoletto, B. 2018; 33 (3): E31?E39

    Abstract

    This study examined changes in postconcussive symptoms (PCS) over the acute postinjury recovery period, focusing on how daily PCSs differ between mild traumatic brain injury (mTBI) and other injury types.An urban emergency department (ED) in Western Pennsylvania.A total of 108 adult patients with trauma being discharged from the ED were recruited and grouped by injury type: mild TBI (mTBI; n = 39), head injury without mTBI (HI: n = 16), and non-head-injured trauma controls (TCs: n = 53).Subjects completed a baseline assessment and an experience sampling method (ESM) protocol for 14 consecutive days postinjury: outcomes were daily reports of headaches, anxiety, and concentration difficulties.Controlling for confounders, multilevel modeling revealed greater odds of headache and concentration difficulties on day 1 postinjury among the HI and mTBI groups (vs TCs). These odds decreased over time, with greater reductions for the HI and mTBI groups compared with TCs. By day 14, there were no group differences in PCS. In addition, only the HI group reported higher initial levels of anxiety and a steeper slope relative to TCs.Patients with HI, regardless of whether they meet the American Congress of Rehabilitation Medicines definition of mTBI, have higher odds of typical PCS immediately postinjury, but faster rates of recovery than TCs. ESM can improve understanding the dynamic nature of postinjury PCS.

    View details for DOI 10.1097/HTR.0000000000000335

    View details for Web of Science ID 000435555500004

    View details for PubMedID 28926480

  • The utility of assessing for pain interference and psychological factors among emergency department patients who present with pain GENERAL HOSPITAL PSYCHIATRY Brienza, A., Gianforcaro, A., Suffoletto, B., Callaway, C. W., Pacella, M. L. 2018; 52: 21?26
  • Short-term feasibility and impact assessments of an automated messaging system for hypertension self-management Muldoon, M. F., Allen, M., Einhorn, J., Irizarry, T., Rollman, B., Lora, B., Suffoletto, B., Thomas, K. LIPPINCOTT WILLIAMS & WILKINS. 2018: A138?A139
  • The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System JOURNAL OF PAIN Suffoletto, B., Lynch, M., Pacella, C. B., Yealy, D. M., Callaway, C. W. 2018; 19 (4): 430?38

    Abstract

    Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis.This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death.

    View details for DOI 10.1016/j.jpain.2017.11.010

    View details for Web of Science ID 000429184500008

    View details for PubMedID 29241835

    View details for PubMedCentralID PMC5869080

  • A Text Message Intervention to Reduce 21st Birthday Alcohol Consumption: Evaluation of a Two-Group Randomized Controlled Trial PSYCHOLOGY OF ADDICTIVE BEHAVIORS Bernstein, M. H., Stein, L. R., Neighbors, C., Suffoletto, B., Carey, K. B., Ferszt, G., Caron, N., Wood, M. D. 2018; 32 (2): 149?61

    Abstract

    Twenty-first birthdays are associated with extreme levels of heavy drinking and alcohol-related harm. Effective preventive interventions that are acceptable to young adults are needed. The current study tested the efficacy of a brief text-message intervention for reducing 21st birthday alcohol involvement designed to correct perceived 21st birthday drinking norms and provide protective behavioral strategies (PBS). We also examined potential moderators and mediators. College students (n = 200) with an upcoming 21st birthday completed a baseline assessment and were randomized to a text-message intervention or an assessment-only control condition. For participants in the intervention group, Message 1 (sent one day before the birthday celebration) focused on personalized normative feedback, and Message 2 (sent day of the birthday celebration) discussed PBS to minimize risk. Primary outcomes were assessed using responses to a follow-up assessment the day after their birthday celebration (93% completion rate). Zero-inflated negative binomial regression analyses did not reveal an overall intervention effect for estimated Blood Alcohol Content (eBAC) or alcohol problems on the 21st birthday celebration. In partial support of our hypothesis, there was an indirect effect of perceived 21st birthday norms on 21st birthday eBAC. The intervention was associated with reduced perceived norms, which was, in turn, related to a lower eBAC. There was a 3-way interaction between drinks per week, anticipated eBAC, and intervention condition for the count portion of actual eBAC such that the intervention reduced eBAC among a high-risk subset of the sample. Future research may benefit from further refining the personalized normative feedback (PNF) component of 21st birthday interventions. (PsycINFO Database Record

    View details for DOI 10.1037/adb0000342

    View details for Web of Science ID 000427738700002

    View details for PubMedID 29369673

    View details for PubMedCentralID PMC5858983

  • A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment JMIR MHEALTH AND UHEALTH Suffoletto, B., Chung, T., Muench, F., Monti, P., Clark, D. B. 2018; 6 (2): e35

    Abstract

    Stand-alone text message-based interventions can reduce binge drinking episodes (?4 drinks for women and ?5 drinks for men) among nontreatment-seeking young adults, but may not be optimized. Adaptive text message support could enhance effectiveness by assisting context-specific goal setting and striving, but it remains unknown how to best integrate it into text message interventions.The objective of this study was to evaluate young adults' engagement with a text message intervention, Texting to Reduce Alcohol Consumption 2 (TRAC2), which focuses on reducing weekend alcohol consumption. TRAC2 incorporated preweekend drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intraweekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and maximum weekend alcohol consumption EMA with drinking limit goal feedback.We enrolled 38 nontreatment-seeking young adults (aged 18 to 25 years) who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, subjects were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-month follow-up.Among a diverse sample of young adults (56% [28/50] female, 54% [27/50] black, 32% [12/50] college enrolled), response rates to EMA queries were, on average, 82% for the first 4-week intervention block, 75% for the second 4-week block, and 73% for the third 4-week block. In the first 4 weeks of the intervention, drinking limit goal commitment was made 68/71 times it was prompted (96%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 52% (15/29) in week 1 and decreased to 0% (0/15) by week 4. Subjects met their goal 130/146 of the times a goal was committed to (89.0%). There were lower rates of goal success when subjects reported lower confidence (score <4) in meeting the goal (76% [32/42 weekends]) compared with that when subjects reported high confidence (98% [56/57 weekends]; P=.001). There were reductions in alcohol consumption from baseline to 3 months, but reductions were not different by length of intervention exposure.Preliminary evidence suggests that nontreatment-seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success.

    View details for DOI 10.2196/mhealth.8530

    View details for Web of Science ID 000426415800014

    View details for PubMedID 29453191

    View details for PubMedCentralID PMC5834751

  • Using phone sensors and an artificial neural network to detect gait changes during drinking episodes in the natural environment GAIT & POSTURE Suffoletto, B., Gharani, P., Chung, T., Karimi, H. 2018; 60: 116?21

    Abstract

    Phone sensors could be useful in assessing changes in gait that occur with alcohol consumption. This study determined (1) feasibility of collecting gait-related data during drinking occasions in the natural environment, and (2) how gait-related features measured by phone sensors relate to estimated blood alcohol concentration (eBAC).Ten young adult heavy drinkers were prompted to complete a 5-step gait task every hour from 8pm to 12am over four consecutive weekends. We collected 3-axis accelerometer, gyroscope, and magnetometer data from phone sensors, and computed 24 gait-related features using a sliding window technique. eBAC levels were calculated at each time point based on Ecological Momentary Assessment (EMA) of alcohol use. We used an artificial neural network model to analyze associations between sensor features and eBACs in training (70% of the data) and validation and test (30% of the data) datasets.We analyzed 128 data points where both eBAC and gait-related sensor data were captured, either when not drinking (n=60), while eBAC was ascending (n=55) or eBAC was descending (n=13). 21 data points were captured at times when the eBAC was greater than the legal limit (0.08mg/dl). Using a Bayesian regularized neural network, gait-related phone sensor features showed a high correlation with eBAC (Pearson's r>0.9), and >95% of estimated eBAC would fall between -0.012 and +0.012 of actual eBAC.It is feasible to collect gait-related data from smartphone sensors during drinking occasions in the natural environment. Sensor-based features can be used to infer gait changes associated with elevated blood alcohol content.

    View details for DOI 10.1016/j.gaitpost.2017.11.019

    View details for Web of Science ID 000425129400022

    View details for PubMedID 29179052

    View details for PubMedCentralID PMC5809199

  • The Association between Daily Posttraumatic Stress Symptoms and Pain over the First 14-days after Injury: An Experience Sampling Study. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Pacella, M. L., Girard, J. M., Wright, A. G., Suffoletto, B., Callaway, C. W. 2018

    Abstract

    Psychosocial factors and responses to injury modify the transition from acute to chronic pain. Specifically, posttraumatic stress disorder symptoms (PTSS; reexperiencing, avoidance, and hyperarousal symptoms) exacerbate and co-occur with chronic pain. Yet no study has prospectively considered the associations among these psychological processes and pain reports using experience sampling methods (ESM) during the acute aftermath of injury. This study applied ESM via daily text messaging to monitor and detect relationships among psychosocial factors and post-injury pain across the first 14-days after emergency department (ED) discharge.We recruited 75 adults (59% male; M age = 33) who experienced a potentially traumatic injury (i.e., involving life threat or serious injury) in the past 24-hours from the EDs of two Level 1 trauma centers. Participants received 5 questions per day via text messaging from Day-1 to Day-14 post-ED discharge; three questions measured PTSS, one question measured perceived social support, and one question measured physical pain.Sixty-seven participants provided sufficient data for inclusion in the final analyses, and the average response rate per subject was 86%. Pain severity score decreased from a mean of 7.2 to 4.4 over 14 days and 50% of the variance in daily pain scores was within-person. In multilevel structural equation models, pain scores decreased over time, and daily fluctuations of hyperarousal (b = 0.22, 95% CI [0.08, 0.36]) were uniquely associated with daily fluctuations in reported pain level within each person.Daily hyperarousal symptoms predict same-day pain severity over the acute post-injury recovery period. We also demonstrated feasibility to screen and identify patients at risk for pain chronicity in the acute aftermath of injury. Early interventions aimed at addressing hyperarousal (e.g. anxiolytics) could potentially aid in reducing experience of pain. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/acem.13406

    View details for PubMedID 29513381

  • Development and Preliminary Feasibility of an Automated Hypertension Self-Management System. The American journal of medicine Irizarry, T., Allen, M., Suffoletto, B. P., Einhorn, J., Burke, L. E., Kamarck, T. W., Rollman, B. L., Muldoon, M. F. 2018; 131 (9)

    Abstract

    BACKGROUND: Uncontrolled hypertension constitutes a significant challenge throughout the world. Blood pressure measurement by patients is informative for both patients and providers but is rarely performed systematically, thereby reducing its utility. Mobile phones can be used to efficiently prompt individuals to measure blood pressure and automate data management while avoiding technology barriers to widespread adoption. Presented is the design and pilot test results of MyBP, an automated texting intervention to support blood pressure self-monitoring and patient self-management.METHODS: Three sequential phases are described: (1) stakeholders' needs assessment, (2) preliminary design pilot (n?=?10), and (3) a 6-week pilot of the redesigned comprehensive program with hypertensive patients (n?=?43) recruited from 3 clinical sites (Emergency Department, Primary Care, Hypertension Center).Outcomes of interest included participant adherence, perceived importance of blood pressure monitoring, and healthy behavior change.RESULTS: Median adherence to MyBP prompts over 6 weeks was 79% (72% emergency department, 84% primary care, and 96% hypertension center, H[2] = 5.56, P = .06). Adherence did not vary by age, sex, education, or baseline use of texting but was lowest among patients recruited from the emergency department (chi[2]2?=?6.66, P = .04). In the exit survey, MyBP was associated with increased importance of blood pressure self-monitoring and particularly motivated primary care and emergency department groups to improve dietary habits, increase daily physical activity, and focus on stress reduction. The majority of participants (88%) indicated interest in using the program for 6 months.CONCLUSIONS: Automated mobile-phone-based blood pressure self-monitoring using MyBP is feasible, acceptable, and scalable, and may improve self-management and support clinical care.

    View details for DOI 10.1016/j.amjmed.2018.04.038

    View details for PubMedID 29806998

  • An Artificial Neural Network for Movement Pattern Analysis to Estimate Blood Alcohol Content Level SENSORS Gharani, P., Suffoletto, B., Chung, T., Karimi, H. A. 2017; 17 (12)

    Abstract

    Impairments in gait occur after alcohol consumption, and, if detected in real-time, could guide the delivery of "just-in-time" injury prevention interventions. We aimed to identify the salient features of gait that could be used for estimating blood alcohol content (BAC) level in a typical drinking environment. We recruited 10 young adults with a history of heavy drinking to test our research app. During four consecutive Fridays and Saturdays, every hour from 8 p.m. to 12 a.m., they were prompted to use the app to report alcohol consumption and complete a 5-step straight-line walking task, during which 3-axis acceleration and angular velocity data was sampled at a frequency of 100 Hz. BAC for each subject was calculated. From sensor signals, 24 features were calculated using a sliding window technique, including energy, mean, and standard deviation. Using an artificial neural network (ANN), we performed regression analysis to define a model determining association between gait features and BACs. Part (70%) of the data was then used as a training dataset, and the results tested and validated using the rest of the samples. We evaluated different training algorithms for the neural network and the result showed that a Bayesian regularization neural network (BRNN) was the most efficient and accurate. Analyses support the use of the tandem gait task paired with our approach to reliably estimate BAC based on gait features. Results from this work could be useful in designing effective prevention interventions to reduce risky behaviors during periods of alcohol consumption.

    View details for DOI 10.3390/s17122897

    View details for Web of Science ID 000423285800197

    View details for PubMedID 29236078

    View details for PubMedCentralID PMC5751642

  • Not all texts are created equal: Design considerations for text message interventions to improve antihypertensive medication adherence JOURNAL OF CLINICAL HYPERTENSION Suffoletto, B., Muldoon, M. 2017; 19 (12): 1285?87

    View details for DOI 10.1111/jch.13093

    View details for Web of Science ID 000417627000011

    View details for PubMedID 28942613

  • Acceptability of an Opioid Relapse Prevention Text-message Intervention for Emergency Department Patients JOURNAL OF ADDICTION MEDICINE Suffoletto, B., Yanta, J., Kurtz, R., Cochran, G., Douaihy, A., Chung, T. 2017; 11 (6): 475?82

    Abstract

    To explore whether a text message-based relapse prevention intervention (Preventing and Interrupting Early Relapse [PIER]1) is acceptable to treatment-seeking adults with opioid use disorder (OUD) after Emergency Department (ED) discharge using mixed-methods design.Adults seeking care in an urban ED for OUD (n?=?20; mean age 22; 55% female; 75% white race) completed a baseline survey, and were invited to enroll in PIER1, which was delivered in 7-day blocks, with the option to re-enroll at the end of each block, up to 4 blocks. PIER1 included a morning "push" message focused on positive thinking, adaptive coping feedback tailored to twice-daily assessments of craving severity and contextual correlates of craving, and end-of-day feedback on daily opioid use and goal commitment. Participants were asked to complete a follow-up phone interview after the first 7 days of PIER1. Transcripts were thematically coded.Seventeen out of 20 participants enrolled in PIER1. In the first 7 days, response rates to text-message assessments averaged 30%. Ten out of 17 participants re-enrolled after 7 days. Main themes from follow-up interviews (n?=?9) included ease of use, social connection, and self-empowerment. Participants desired more personalized support and the ability to communicate through text messaging with another person about their struggles. Event-level data suggest that higher craving severity increased risk of opioid lapses.In this mixed-methods intervention development study, we found conflicting evidence supporting an automated text-message intervention providing relapse prevention support for treatment-seeking individuals with OUD discharged from the ED. Qualitative feedback suggests that PIER1 could be useful and acceptability enhanced through personalized human support.

    View details for DOI 10.1097/ADM.0000000000000351

    View details for Web of Science ID 000415102300012

    View details for PubMedID 28858888

    View details for PubMedCentralID PMC5659903

  • Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection BMC EMERGENCY MEDICINE Huang, D. T., Angus, D. C., Chang, C. H., Doi, Y., Fine, M. J., Kellum, J. A., Peck-Palmer, O. M., Pike, F., Weissfeld, L. A., Yabes, J., Yealy, D. M., ProACT Investigators 2017; 17: 25

    Abstract

    Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns.The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection.We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline implementation.ClinicalTrials.gov NCT02130986 . Registered May 1, 2014.

    View details for DOI 10.1186/s12873-017-0138-1

    View details for Web of Science ID 000409211500001

    View details for PubMedID 28851296

    View details for PubMedCentralID PMC5576372

  • SELF-MANAGEMENT SUPPORT FOR PATIENTS WITH HYPERTENSION USING ONLINE VIDEOS AND AUTOMATED, BIDIRECTIONAL TEXT-MESSAGING Allen, M. E., Einhorn, J., Suffoletto, B. P., Burke, L., Kamarck, T., Rollman, B. L., Muldoon, M. F. LIPPINCOTT WILLIAMS & WILKINS. 2017: A85?A86
  • Can an app help identify psychomotor function impairments during drinking occasions in the real world? A mixed-method pilot study SUBSTANCE ABUSE Suffoletto, B., Goyal, A., Puyana, J., Chung, T. 2017; 38 (4): 438?49

    Abstract

    Being able to measure the acute effects of alcohol consumption on psychomotor functions in natural settings could be useful in injury prevention interventions. This study examined the feasibility and acceptability of collecting app-based measures of information processing, working memory, and gait stability during times of typical alcohol consumption among young adults.Ten young adults (aged 21-26) with hazardous drinking completed a baseline assessment and ecological momentary assessments (EMA) on 4 consecutive Fridays and Saturdays, every hour from 8 pm to 12 am. EMA assessed alcohol consumption and perceived intoxication, followed by a digit symbol substitution task (DSST), a visuospatial working memory task (VSWMT), and a 5-step tandem gait task (TGT). Exit interviews probed user experiences. Multilevel models explored relationships between estimated blood alcohol concentration (eBAC; mg/dL) and DSST and VSWMT performance.Participants completed 32% of EMA. Higher rates of noninitiation occurred later in the evening and over time. In multilevel models, higher eBAC was associated with lower DSST scores. Eight out of 10 individuals had at least 1 drinking occasion when they did not perceive any intoxication. Lower DSST scores would identify impairment in 45% of these occasions. Exit interviews indicated that adding real-time feedback on task performance could increase awareness of alcohol effects.Collecting app-based psychomotor performance data from young adults during drinking occasions is feasible and acceptable, but strategies to reduce barriers to task initiation are needed. Mobile DSST is sensitive to eBAC levels and could identify occasions when an individual may not perceive impairments.

    View details for DOI 10.1080/08897077.2017.1356797

    View details for Web of Science ID 000415738200012

    View details for PubMedID 28723276

    View details for PubMedCentralID PMC6103191

  • Quantitative sensory testing measures individual pain responses in emergency department patients JOURNAL OF PAIN RESEARCH Duffy, K. J., Flickinger, K. L., Kristan, J. T., Repine, M. J., Gianforcaro, A., Hasley, R. B., Feroz, S., Rupp, J. M., Al-Baghli, J., Pacella, M. L., Suffoletto, B. P., Callaway, C. W. 2017; 10: 1241?53

    Abstract

    Refining and individualizing treatment of acute pain in the emergency department (ED) is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients.In three studies, we 1) describe performance characteristics of brief quantitative sensory testing (QST) in 50 healthy volunteers, 2) test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3) measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT), pressure pain response (PPR), and cold pain tolerance (CPT) tests.First, all QST measures had high inter-rater reliability and test-retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16%) ED subjects relative to healthy volunteers. In 173 (88%) ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen's dz 0.10-0.19). Verbal pain scores (0-10) for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6) (Cohen's dz 0.97) but did not covary with the changes in PPT and PPR (r=0.05-0.13). Treatment effects were greatest in ED subjects with a history of treatment for anxiety or depression (Cohen's dz 0.26-0.43) or with baseline hyperalgesia (Cohen's dz 0.40-0.88).QST reveals individual differences in perception of fixed painful stimuli in ED patients, including hyperalgesia. Subgroups of ED patients with hyperalgesia and psychiatric history report larger treatment effects on ED pain and QST measures.

    View details for DOI 10.2147/JPR.S132485

    View details for Web of Science ID 000402119800001

    View details for PubMedID 28579822

    View details for PubMedCentralID PMC5449126

  • Using video conferencing to deliver a brief motivational intervention for alcohol and sex risk to emergency department patients: a proof-of-concept pilot study ADDICTION RESEARCH & THEORY Celio, M. A., Mastroleo, N. R., DiGuiseppi, G., Barnett, N. P., Colby, S. M., Kahler, C. W., Operario, D., Suffoletto, B., Monti, P. M. 2017; 25 (4): 318?25

    Abstract

    Brief motivational intervention (MI) is an efficacious approach to reduce heavy drinking and associated sexual risk behavior among Emergency Department (ED) patients, but the intensity of demands placed on ED staff makes the implementation of in-person MIs logistically challenging. This proof-of-concept pilot study examined the acceptability and logistic feasibility of using video-conferencing technology to deliver an MI targeting heavy drinking and risky sexual behavior to patients in an ED setting. Rigorous screening procedures were employed to ensure that the pilot sample represents the target portion of ED patients who would benefit from this multi-target MI. Mixed qualitative and quantitative data from a sample of seven ED patients (57% Female; Mage = 35 years) who received MI by video conference consistently demonstrated high levels of satisfaction, engagement, and acceptability. The observed completion rate supports logistic feasibility, and patient feedback identified methods to improve the experience by using high-definition hardware, ensuring stronger network connectivity, and effectively communicating information regarding protection of privacy. Post-intervention patient ratings and independent ratings of the audio-recorded sessions (using the Motivational Interviewing Skills Coding system) were very high, suggesting that intervention fidelity and MI adherence was not compromised by delivery modality. Collectively, these data suggest video conferencing is a viable technology that can be employed to implement brief evidence-based MIs in ED settings.

    View details for DOI 10.1080/16066359.2016.1276902

    View details for Web of Science ID 000398242200007

    View details for PubMedID 28649188

    View details for PubMedCentralID PMC5478195

  • Patterns of Change in Weekend Drinking Cognitions Among Non-Treatment-Seeking Young Adults During Exposure to a 12-Week Text Message Intervention JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Suffoletto, B., Chung, T. 2016; 77 (6): 914?23

    Abstract

    We sought to identify patterns of response (latent classes) to a text-message (short message service) intervention based on weekend drinking cognitions (e.g., drinking plans, commitment to a low consumption goal), and to examine how the latent classes differed in baseline characteristics and alcohol consumption outcomes.We conducted a secondary analysis of 384 non-treatment seeking young adults with hazardous alcohol use randomly assigned to a 12-week short message service intervention. Responses to weekly short message service queries related to weekend drinking cognitions were categorized as (a) planned not to drink, (b) planned to drink but did not plan a heavy drinking episode (HDE), (c) planned to have an HDE but willing to limit alcohol consumption, (d) planned to have an HDE and not willing to limit alcohol consumption We used repeated-measures latent class analysis to identify distinct classes based on these categories and examined associations of the classes with baseline covariates and alcohol consumption outcomes through 6 months.We identified the following three latent classes: planned not to drink (62%), willing to limit drinks (27%), and not willing to limit drinks (12%). The "not willing to limit drinks" class exhibited the least reductions in alcohol consumption and was more likely to include White individuals and those with higher baseline drinking severity. The "planned not to drink" class had the greatest reductions in alcohol consumption.Young adults who exhibited low likelihood of committing to goals to limit weekend drinking were less responsive to short message service intervention, suggesting the need for alternative interventions.

    View details for DOI 10.15288/jsad.2016.77.914

    View details for Web of Science ID 000386986600009

    View details for PubMedID 27797693

    View details for PubMedCentralID PMC5088173

  • Expanding Adolescent Depression Prevention Through Simple Communication Technologies JOURNAL OF ADOLESCENT HEALTH Suffoletto, B., Aguilera, A. 2016; 59 (4): 373?74
  • CHARACTERISTICS AND OUTCOMES OF BLOOD PRODUCT TRANSFUSION DURING CRITICAL CARE TRANSPORT PREHOSPITAL EMERGENCY CARE Mena-Munoz, J., Srivastava, U., Martin-Gill, C., Suffoletto, B., Callaway, C. W., Guyette, F. X. 2016; 20 (5): 586?93

    Abstract

    Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport.We studied patients transported by a regional critical care air-medical service who received blood products during transport. This service carries two units of uncrossmatched packed Red Blood Cells (pRBCs) on every transport in addition to blood obtained from referring facilities. The pRBC are administered according to a protocol for the treatment of hemorrhagic shock or based on medical command physician order. Transfusion amount was categorized into three groups based on the volume transfused (<350 mL, 350-700 mL, >700 mL). The association between prehospital transfusion and in-hospital outcomes (mortality, subsequent blood transfusion and emergent surgery) was estimated using logistic regression models, controlling for age, first systolic blood pressure, first heart rate, Glasgow Coma Score, time of transfer, and length of hospital admission.Among the 1,440 critical care transports with transfusions examined, 81% were for medical patients, being gastrointestinal hemorrhage the most common indication (26%, CI 24-28%). pRBC transfusions were associated with emergent surgery (OR = 1.81, 95% CI = 1.31-2.52) and in-hospital transfusions (OR = 2.00, 95% CI = 1.46-2.76). Those with transfusions >700 mL were associated with emergent surgery (OR = 1.79, 95% CI = 1.10-2.92) and mortality (OR = 2.11; 95% CI = 1.21-3.69).In this sample, the majority of patients receiving blood products during air-medical transport were transfused for medic conditions; gastrointestinal hemorrhage was the most common chief complaint. The pRBC transfusions were associated with emergent surgery and in-hospital transfusion. Transfusions of >700 mL were associated with mortality.

    View details for DOI 10.3109/10903127.2016.1163447

    View details for Web of Science ID 000383915000006

    View details for PubMedID 27484298

  • Text message behavioral interventions: from here to where? CURRENT OPINION IN PSYCHOLOGY Suffoletto, B. 2016; 9: 16?21

    Abstract

    Text messaging is an efficient and personal electronic form of communication, making it an ideal modality for remote delivery of behavioral interventions. The ubiquity of cell phones and short message service (SMS) worldwide allow the possibility of SMS behavioral inteventions to impact global health. Studies to date suggest that SMS interventions can effectively support health behaviors and may offer advantages compared to other forms of computerized interventions. Program features optimizing user engagament and persuasiveness are suggested to mediate SMS intervention effect. Future research is tasked with identifying what SMS features are useful to which individuals at what times to best help them initiate and maintain health behaviors.

    View details for DOI 10.1016/j.copsyc.2015.09.012

    View details for Web of Science ID 000378212300005

    View details for PubMedID 26665157

    View details for PubMedCentralID PMC4671292

  • UNDERSTANDING THE TRAJECTORY OF POST-TRAUMATIC HEADACHES OVER THE FIRST 14 DAYS AFTER INJURY USING DAILY ASSESSMENTS AND MULTLEVEL MODELS Pacella, M., Suffoletto, B. L., Prabhu, A. LIPPINCOTT WILLIAMS & WILKINS. 2016: A140
  • Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings JMIR MHEALTH AND UHEALTH Suffoletto, B., Kristan, J., Mecca, L., Chung, T., Clark, D. B. 2016; 4 (2): 420?29

    Abstract

    Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized.To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design.We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes.We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants' comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention.Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important.

    View details for DOI 10.2196/mhealth.5330

    View details for Web of Science ID 000381182400033

    View details for PubMedID 27335099

    View details for PubMedCentralID PMC4935795

  • A text message program as a booster to in-person brief interventions for mandated college students to prevent weekend binge drinking JOURNAL OF AMERICAN COLLEGE HEALTH Suffoletto, B., Merrill, J. E., Chung, T., Kristan, J., Vanek, M., Clark, D. B. 2016; 64 (6): 481?89

    Abstract

    To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students.Undergraduates (N = 224; 46% female) who violated an on-campus alcohol policy over a 2-semester period in 2014.The SMS program sent drinking-related queries each Thursday and Sunday and provided tailored feedback for 6 weeks. Response rates to SMS drinking-related queries and the associations between weekend drinking plans, drinking-limit goal commitment, and alcohol consumption were examined. Gender differences were explored.Ninety percent of SMS queries were completed. Weekend binge drinking decreased over 6 weeks, and drinking-limit goal commitment was associated with less alcohol consumption. Compared with women, men had greater reductions in alcohol consumption when they committed to a drinking-limit goal.Preliminary evidence suggests that an SMS program could be useful as a booster for helping mandated students reduce weekend binge drinking.

    View details for DOI 10.1080/07448481.2016.1185107

    View details for Web of Science ID 000381369900007

    View details for PubMedID 27149662

    View details for PubMedCentralID PMC4992551

  • Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors EMERGENCY MEDICINE JOURNAL Suffoletto, B., Miller, T., Shah, R., Callaway, C., Yealy, D. M. 2016; 33 (1): 4?9

    Abstract

    We sought to evaluate the ability of the Identification of Seniors At Risk (ISAR) tool to differentiate between older adult patients having a poor outcome within 30?days of emergency department (ED) care and those who do not. We compare prognostic accuracy of subjective versus objective risk factors.202 community-dwelling patients age 65?years and older presenting to two EDs were prospectively enrolled. Participants completed the six-question ISAR and objective testing (cognition, ambulation, vision). We reviewed electronic medical records for current medications, hospitalisations in the past six?months, ED disposition, length of hospital stay, subsequent ED visits or inpatient admissions or death at 30?days. Participants were given a point for each risk factor present; subjective and objective risk factors were scored separately. We tested ability of individual risk factors and scores to predict a composite outcome of subsequent ED visit, postdischarge hospitalisation or death by day 30 after the index ED visit. We computed receiver operating curve area under the curves (AUC) to determine tool discrimination.23% of participants had a poor 30-day outcome. The optimum subjective ISAR cut-off score for screening was ?2, which was present in 84% of participants, had a sensitivity of 91% and specificity of 19%. Using the subjective ISAR tool, the AUC was 0.66. The optimum objective ISAR-related risk cut-off score for screening was ?3, which was present in 82% of participants, had a sensitivity of 87% and specificity of 40%. Using the objective ISAR-related tool, the AUC was 0.69.The self-reported ISAR tool did not discriminate well between older adults with or without 30-day hospital revisit or death. An optimum score of ?2 would identify many older adults at no apparent increased risk of poor outcomes at 30?days. Using objective ISAR-related risk factors did not improve overall discrimination.

    View details for DOI 10.1136/emermed-2014-203936

    View details for Web of Science ID 000367462000002

    View details for PubMedID 25987595

  • An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes PLOS ONE Suffoletto, B., Kristan, J., Chung, T., Jeong, K., Fabio, A., Monti, P., Clark, D. B. 2015; 10 (11): e0142877

    Abstract

    Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults.Young adult participants (18-25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses.An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults.ClinicalTrials.gov NCT01688245.

    View details for DOI 10.1371/journal.pone.0142877

    View details for Web of Science ID 000365154600064

    View details for PubMedID 26580802

    View details for PubMedCentralID PMC4651466

  • Real-Time Fatigue Reduction in Emergency Care Clinicians: The SleepTrackTXT Randomized Trial AMERICAN JOURNAL OF INDUSTRIAL MEDICINE Patterson, P., Buysse, D. J., Weaver, M. D., Doman, J. M., Moore, C. G., Suffoletto, B. P., McManigle, K. L., Callaway, C. W., Yealy, D. M. 2015; 58 (10): 1098?1113

    Abstract

    We assessed performance characteristics and impact of a mobile phone text-message intervention for reducing intra-shift fatigue among emergency clinician shift workers.We used a randomized controlled trial of 100 participants. All participants received text-message assessments at the start, every 4?hr during, and at end of scheduled shifts over a 90-day period. Text-message queries measured self-rated sleepiness, fatigue, and difficulty with concentration. Additional text-messages were sent to intervention participants to promote alertness. A performance measure of interest was compliance with answering text-messages.Ninety-nine participants documented 2,621 shifts and responded to 36,073 of 40,947 text-messages (88% compliance rate). Intervention participants reported lower mean fatigue and sleepiness at 4?hr, 8?hr, and at the end of 12?hr shifts compared to controls (P?

    View details for DOI 10.1002/ajim.22503

    View details for Web of Science ID 000362664000013

    View details for PubMedID 26305869

    View details for PubMedCentralID PMC4573891

  • Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention A Scientific Statement From the American Heart Association CIRCULATION Burke, L. E., Ma, J., Azar, K. J., Bennett, G. G., Peterson, E. D., Zheng, Y., Riley, W., Stephens, J., Shah, S. H., Suffoletto, B., Turan, T. N., Spring, B., Steinberger, J., Quinn, C. C. 2015; 132 (12): 1157?1213

    View details for DOI 10.1161/CIR.0000000000000232

    View details for Web of Science ID 000361485400011

    View details for PubMedID 26271892

    View details for PubMedCentralID PMC7313380

  • Using online crowdsourcing to understand young adult attitudes toward expert-authored messages aimed at reducing hazardous alcohol consumption and to collect peer-authored messages TRANSLATIONAL BEHAVIORAL MEDICINE Kristan, J., Suffoletto, B. 2015; 5 (1): 45?52

    Abstract

    Text message delivered prevention interventions have the potential to improve health behaviors on a large scale, including reducing hazardous alcohol consumption in young adults. Online crowdsourcing can be used to efficiently develop relevant messages, but remains largely understudied. This study aims to use online crowdsourcing to evaluate young adult attitudes toward expert-authored messages and to collect peer-authored messages. We designed an online survey with four drinking scenarios and a demographic questionnaire. We made it available to people who reported age 18-25 years, residence in the US, and any lifetime alcohol consumption via the Amazon Mechanical Turk crowdsourcing platform. Participants rated 71 sample text messages on instrumental (helpful) and affective (interesting) attitude scales and generated their own messages. All messages were coded as informational, motivational, or strategy facilitating. We examined differences in attitudes by message type and by drinking status and sex. We surveyed 272 participants in 48 h, and 222 were included in analysis for a total participant payment cost of $178. Sample mean age was 23 years old, with 50 % being female, 65 % being of white race, and 78 % scored as hazardous drinkers. Informational messages were rated the most helpful, whereas motivational messages were rated the most interesting. Hazardous drinkers rated informational messages less helpful than non-hazardous drinkers. Men reported messages less helpful and interesting than women for most categories. Young adults authored 161 messages, with the highest proportion being motivational. Young adults had variable instrumental and affective attitudes toward expert-authored messages. They generated a substantial number of peer-authored messages that could enhance relevance of future alcohol prevention interventions.

    View details for DOI 10.1007/s13142-014-0298-4

    View details for Web of Science ID 000356788400005

    View details for PubMedID 25729452

    View details for PubMedCentralID PMC4332899

  • Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta-analysis ACADEMIC EMERGENCY MEDICINE Carpenter, C. R., Shelton, E., Fowler, S., Suffoletto, B., Platts-Mills, T. F., Rothman, R. E., Hogan, T. M. 2015; 22 (1): 1?21

    Abstract

    A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical test-treatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR- = 0.27) and nursing home placement (LR- = 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR- range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the risk of 1-year mortality, no individual risk factor, frailty construct, or risk assessment instrument accurately predicts risk of adverse outcomes in older ED patients. Existing instruments designed to risk stratify older ED patients do not accurately distinguish high- or low-risk subsets. Clinicians, educators, and policy-makers should not use these instruments as valid predictors of post-ED adverse outcomes. Future research to derive and validate feasible ED instruments to distinguish vulnerable elders should employ published decision instrument methods and examine the contributions of alternative variables, such as health literacy and dementia, which often remain clinically occult.

    View details for DOI 10.1111/acem.12569

    View details for Web of Science ID 000347447900001

    View details for PubMedID 25565487

  • A Text Message Alcohol Intervention for Young Adult Emergency Department Patients: A Randomized Clinical Trial ANNALS OF EMERGENCY MEDICINE Suffoletto, B., Kristan, J., Callaway, C., Kim, K. H., Chung, T., Monti, P. M., Clark, D. B. 2014; 64 (6): 664?72

    Abstract

    Opportunistic brief in-person emergency department (ED) interventions can be effective at reducing hazardous alcohol use in young adult drinkers, but require resources frequently unavailable. Mobile telephone text messaging (short message service [SMS]) could sustainably deliver behavioral support to young adult patients, but efficacy remains unknown. We report 3-month outcome data of a randomized controlled trial testing a novel SMS-delivered intervention in hazardous-drinking young adults.We randomized 765 young adult ED patients who screened positive for past hazardous alcohol use to one of 3 groups: SMS assessments+feedback (SA+F) intervention who were asked to respond to drinking-related queries and received real-time feedback through SMS each Thursday and Sunday for 12 weeks (n=384), SMS assessments (SA) who were asked to respond to alcohol consumption queries each Sunday but did not receive any feedback (N=196), and a control group who did not participate in any SMS (n=185). Primary outcomes were self-reported number of binge drinking days and number of drinks per drinking day in the past 30 days, collected by Web-based timeline follow-back method and analyzed with regression models. Secondary outcomes were the proportion of participants with weekend binge episodes and most drinks consumed per drinking occasion during 12 weekends, collected by SMS.With Web-based data, there were decreases in the number of self-reported binge drinking days from baseline to 3 months in the SA+F group (-0.51 [95% confidence interval {CI} -0.10 to -0.95]), whereas there were increases in the SA group (0.90 [95% CI 0.23 to 1.6]) and the control group (0.41 [95% CI -0.20 to 1.0]). There were also decreases in the number of self-reported drinks per drinking day from baseline to 3 months in the SA+F group (-0.31 [95% CI -0.07 to -0.55]), whereas there were increases in the SA group (0.10 [95% CI -0.27 to 0.47]) and the control group (0.39 [95% CI 0.06 to 0.72]). With SMS data, there was a lower mean proportion of SA+F participants reporting a weekend binge during 12 weeks (30.5% [95% CI 25% to 36%) compared with the SA participants (47.7% [95% CI 40% to 56%]). There was also a lower mean drinks consumed per weekend during 12 weeks in the SA+F group (3.2 [95% CI 2.6 to 3.7]) compared to the SA group (4.8 [95% CI 4.0 to 5.6]).A text message intervention can produce small reductions in self-reported binge drinking and the number of drinks consumed per drinking day in hazardous-drinking young adults after ED discharge.

    View details for DOI 10.1016/j.annemergmed.2014.06.010

    View details for Web of Science ID 000346220200022

    View details for PubMedID 25017822

    View details for PubMedCentralID PMC4254153

  • Emergency healthcare worker sleep, fatigue, and alertness behavior survey (SFAB): Development and content validation of a survey tool ACCIDENT ANALYSIS AND PREVENTION Patterson, P., Buysse, D. J., Weaver, M. D., Suffoletto, B. P., McManigle, K. L., Callaway, C. W., Yealy, D. M. 2014; 73: 399?411

    Abstract

    Workplace safety is a recognized concern in emergency medical services (EMS). Ambulance crashes are common and injury rates exceed that of the general working public. Fatigue and sleepiness during shift work pose a safety risk for patients and EMS workers. Changing EMS worker behaviors and improving alertness during shift work is hampered by a lack of instruments that reliably and accurately measure multidimensional beliefs and habits that predict alertness behavior.We sought to test the reliability and validity of a survey tool (the sleep, fatigue, and alertness behavior survey [SFAB]) designed to identify the cognitions of EMS workers concerning sleep, fatigue, and alertness behaviors during shift work.We operationalized the integrative model of behavioral prediction (IMBP) and developed a pool of 97 candidate items and sub-items to measure eight domains of the IMBP. Five sleep scientists judged the content validity of each item and a convenience sample of EMS workers completed a paper-based version of the SFAB. We retained items judged content valid by five sleep scientists and performed exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and tests of reliability and internal consistency. We identified a simple factor structure for each scale and calculated means and standard deviations for each item and scale.We received 360 completed SFAB surveys from a convenience sample of 800 EMS workers attending two regional continuing education conferences (45% participation rate). Forty-seven candidate items and sub-items/options were removed following content validation, EFA, and CFA testing. Analyses revealed a simple factor structure for seven of eight domains and a final pool of 50 items and sub-items/options. Domains include: attitudes, normative beliefs, knowledge, salience, habits, environmental constraints, and intent. EFA tests of self-efficacy items failed to identify a simple factor structure. We retained two self-efficacy items based on Spearman-Brown correlation of 0.23 (p<0.0001).Measurement of sleep, fatigue, and alertness behavior among EMS workers is challenging. We describe the development and psychometric testing of a survey tool that may be useful in a variety of applications addressing sleep, fatigue, and alertness behavior among EMS workers.

    View details for DOI 10.1016/j.aap.2014.09.028

    View details for Web of Science ID 000346453600046

    View details for PubMedID 25449415

    View details for PubMedCentralID PMC4254576

  • Chest compressions do not disrupt the seal created by the laryngeal mask airway during positive pressure ventilation: a preliminary porcine study CANADIAN JOURNAL OF EMERGENCY MEDICINE Carlson, J. N., Suffoletto, B. P., Salcido, D. D., Logue, E. S., Menegazzi, J. J. 2014; 16 (5): 378?82

    Abstract

    Pulmonary aspiration of gastric contents occurs 20 to 30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Although the American Heart Association has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by emergency medical service personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the occurrence of aspiration after LMA placement, CPR, and PPV.We inserted a size 4 LMA, modified so that a vacuum catheter could be advanced past the LMA diaphragm, into the hypopharynx of 16 consecutive postexperimental mixed-breed domestic swine. Fifteen millilitres of heparinized blood was instilled into the oropharynx. Chest compressions were performed for 60 seconds with asynchronous ventilation via a mechanical ventilator. We then suctioned through the LMA for 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated, removed, and inspected for signs of blood.None of 16 animals (95% CI 0-17%) had a positive test for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm.In this swine model of regurgitation after LMA placement, there were no cases with evidence of blood beyond the seal created by the LMA cuff. Future studies are needed to determine the frequency of pulmonary aspiration after LMA placement during CPR and PPV in the clinical setting.

    View details for DOI 10.2310/8000.2014.141029

    View details for Web of Science ID 000349250500007

    View details for PubMedID 25227646

  • PRE-RESUSCITATION LACTATE AND HOSPITAL MORTALITY IN PREHOSPITAL PATIENTS PREHOSPITAL EMERGENCY CARE Tobias, A. Z., Guyette, F. X., Seymour, C. W., Suffoletto, B. P., Martin-Gill, C., Quintero, J., Kristan, J., Callaway, C. W., Yealy, D. M. 2014; 18 (3): 321?27

    Abstract

    Serum lactate elevations are associated with morbidity and mortality in trauma patients, but their value in prehospital medical patients prior to resuscitation is unknown. We sought to assess the distribution of blood lactate concentrations prior to intravenous (i.v.) resuscitation and examine the association of elevation on in-hospital death.A convenience sample of adult patients over 14 months who received an i.v. line by eight EMS agencies in Western Pennsylvania had lactate measurement prior to any i.v. treatment. We assessed the lactate values and any relationship between these and hospital mortality (our primary outcome) and admission to the intensive care unit (ICU). We also compared the ability of lactate to discriminate outcomes with a prehospital critical illness score using age, Glasgow Coma Score, and initial vital signs.We included 673 patients, among whom 71 (11%) were admitted to the ICU and 21 (3.1%) died in-hospital. Elevated lactate (?2 mmol/L) occurred in 307 (46%) patients and was strongly associated with hospital death after adjustment for known covariates (odds ratio = 3.57, 95% confidence interval [CI]: 1.10, 11.6). Lactate ?2 mmol/L had a modest sensitivity (76%) and specificity (55%), and discrimination for hospital death (area under the curve [AUC] = 0.66, 95%CI: 0.56, 0.75). Compared to the prehospital critical illness score alone (AUC = 0.69, 95% CI: 0.59, 0.80), adding lactate to the score offered modest improvement (net reclassification improvement = 0.63, 95%CI: 0.23, 1.01, p < 0.05).Initial lactate concentration in our prehospital medical patient population was associated with hospital mortality. However, it is a modest predictor of outcome, offering similar discrimination to a prehospital critical illness score.

    View details for DOI 10.3109/10903127.2013.869645

    View details for Web of Science ID 000337903300001

    View details for PubMedID 24548128

    View details for PubMedCentralID PMC4240252

  • Mobile phone text messaging intervention to improve alertness and reduce sleepiness and fatigue during shiftwork among emergency medicine clinicians: study protocol for the SleepTrackTXT pilot randomized controlled trial TRIALS Patterson, P., Moore, C. G., Weaver, M. D., Buysse, D. J., Suffoletto, B. P., Callaway, C. W., Yealy, D. M. 2014; 15: 244

    Abstract

    Mental and physical fatigue while at work is common among emergency medical services (EMS) shift workers. Extended shifts (for example 24 hours) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management. Text message-based interventions are a potentially high-impact, low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue.We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website. Participants will be allocated to one of two possible arms for a 90-day study period. The intervention arm will involve text message assessments of sleepiness, fatigue, and difficulty with concentration at the beginning, during, and end of scheduled shifts. Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork. Control subjects will receive assessment only text messages. We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention. We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers. Additional aims include testing whether a theory-based behavioral intervention, delivered by text message, changes 'alertness behaviors'.The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms: 1) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers; or 2) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management services.Clinicaltrials.gov NCT02063737, Registered on 10 January 2014.

    View details for DOI 10.1186/1745-6215-15-244

    View details for Web of Science ID 000338462800005

    View details for PubMedID 24952387

    View details for PubMedCentralID PMC4080698

  • Extending Our Reach: Use of mHealth to Support Patients After Emergency Care ANNALS OF EMERGENCY MEDICINE Ranney, M. L., Suffoletto, B. 2014; 63 (6): 755?56
  • Factors Contributing to Emergency Department Care Within 30 Days of Hospital Discharge and Potential Ways to Prevent It: Differences in Perspectives of Patients, Caregivers, and Emergency Physicians JOURNAL OF HOSPITAL MEDICINE Suffoletto, B., Hu, J., Guyette, M., Callaway, C. 2014; 9 (5): 315?19

    Abstract

    Identifying needs in patients who utilize the emergency department (ED) soon after being discharged from inpatient care is essential for planning appropriate care-transition interventions.To examine differences in stakeholder perspectives on reasons for ED care soon after hospital discharge and interventions that could be useful to prevent these ED visits.A convenience sample of 135 patients who presented to an urban teaching hospital ED <30 days after last hospital discharge, their caregivers (when present), and emergency physicians were administered identical structured surveys. Concordance and agreement rates between patient-physician and patient-caregiver dyads were calculated.Concordances between stakeholders were poor, with weighted kappas ranging from 0.02 to 0.34 for patient-physician dyads and 0.03 to 0.68 for patient-caregiver dyads. Emergency physicians and caregivers identified factors between 1% and 42% of the time the patients did not. Less than half of any stakeholder could identify an intervention to potentially prevent the ED visit.Our findings suggest the difficulty in forming unified definitions for root cause of ED visits soon after hospital discharge and support the use of multiple stakeholders in identifying appropriate targets for care-transition interventions.

    View details for DOI 10.1002/jhm.2167

    View details for Web of Science ID 000335664200007

    View details for PubMedID 24497467

  • HOW DOES PRE-TRAUMA DEPRESSION, PTSD AND ALCOHOL USE INFLUENCE DAILY SOMATIC, COGNITIVE AND EMOTIONAL SYMPTOMS AFTER TRAUMA? Morley, J., Suffoletto, B., Kristan, J., Kingsley, E. SPRINGER. 2014: S112
  • PREVALENCE AND INTERVENTIONAL OUTCOMES OF PATIENTS WITH RESOLUTION OF ST-SEGMENT ELEVATION BETWEEN PREHOSPITAL AND IN-HOSPITAL ECG PREHOSPITAL EMERGENCY CARE Ownbey, M., Suffoletto, B., Frisch, A., Guyette, F. X., Martin-Gill, C. 2014; 18 (2): 174?79

    Abstract

    To determine the prevalence and significance of ST-segment elevation resolution between prehospital and first hospital ECG.We examined consecutive prehospital ECGs transmitted to a single medical command center in southwestern Pennsylvania between January 1, 2009 and December 31, 2011. We included ECG cases with ST-segment elevation myocardial infarction (STEMI) and excluded cases with incomplete prehospital and/or hospital data. Our primary outcome was ST-segment resolution (STR), defined by cases no longer meeting STEMI criteria on the first in-hospital ECG. Primary variables of interest included prehospital vital signs and treatment, cardiac catheterization findings, and time intervals for diagnostics and treatment. Analysis included t-tests for continuous variables and chi-squared analysis for categorical variables.We reviewed 24,197 prehospital ECGs and identified 293 cases of prehospital STEMI. Complete hospital and prehospital records were available for 83 cases (28%). Analyzed cohort was an average 62 years old and the majority were male (67%), with a primary complaint of chest pain (93%). STR occurred in 18 cases (22%, CI 14-32%). There were no differences between STR and non-STR cases in prehospital vital signs or treatments. 95% of patients underwent cardiac catheterization with a mean door-to-needle time of 57 minutes (interquartile range 43-71). Comparing STR and non-STR cases, significant lesions (?50%) were found in 94 and 97% of patients (p = 0.6), and subtotal or total lesions (?95%) were found in 63 and 85% (p = 0.1), respectively.We found that ST-segment resolution occurred prior to catheterization in 1 of 5 patients with prehospital STEMI, emphasizing the necessity of prehospital ECG in risk stratification of patients with suspected coronary disease. Coronary lesions and intervention rates did not differ between STR and non-STR, suggesting that catheterization is warranted even when STEMI criteria are no longer met in-hospital.

    View details for DOI 10.3109/10903127.2013.851310

    View details for Web of Science ID 000333098000002

    View details for PubMedID 24400994

  • Characterization of Out of Hospital Resuscitation Utilizing Blood Transfusion Mena-Munoz, J., Srivastava, U., Martin-Gill, C., Suffoletto, B., Guyette, F. LIPPINCOTT WILLIAMS & WILKINS. 2013
  • Emergency physician recognition of delirium POSTGRADUATE MEDICAL JOURNAL Suffoletto, B., Miller, T., Frisch, A., Callaway, C. 2013; 89 (1057): 621?25

    Abstract

    To compare the recognition of delirium by emergency physicians based on observations made during routine clinical care with concurrent ratings made by a trained researcher after formal cognitive assessment and to examine each of the four individual features of delirium separately to determine the variation in identification across features.In a prospective study, a convenience sample of 259 patients, aged ?65 years, who presented to two urban, teaching hospital emergency departments (EDs) in Western Pennsylvania between 21 June and 29 August 2011, underwent paired delirium ratings by an emergency physician and a trained researcher. Emergency physicians were asked to use their clinical judgment to decide whether the patient had any of the following delirium features: (1) acute change in mental status, (2) inattention, (3) disorganised thinking and (4) altered level of consciousness. Questions were prompted with examples of delirium features from the Confusion Assessment Method. Concurrently, a trained researcher interviewed surrogates to determine feature 1, conducted a cognitive test for delirium (Confusion Assessment Method for the intensive care unit) to determine delirium features 2 and 3 and used the Richmond Agitation and Sedation Scale to determine feature 4.In the 2-month study period, trained researchers identified delirium in 24/259 (9%; 95% CI 0.06 to 0.13) older patients admitted to the ED. However, attending emergency physicians recognised delirium in only 8 of the 24 and misidentified delirium in a further seven patients. Emergency physicians were particularly poor at recognising altered level of consciousness but were better at recognising acute change in mental status and inattention.When emergency physicians use routine clinical observations, they may miss diagnosing up to two-thirds of patients with delirium. Recognition of delirium can be enhanced with standardised cognitive testing.

    View details for DOI 10.1136/postgradmedj-2012-131608

    View details for Web of Science ID 000327926500003

    View details for PubMedID 23788663

  • A Sex Risk Reduction Text-Message Program for Young Adult Females Discharged From the Emergency Department JOURNAL OF ADOLESCENT HEALTH Suffoletto, B., Akers, A., McGinnis, K. A., Calabria, J., Wiesenfeld, H. C., Clark, D. B. 2013; 53 (3): 387?93

    Abstract

    To pilot test a text message (SMS) sex risk reduction program among at-risk young adult female patients discharged from an emergency department (ED).A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and randomized to the SMS program (n = 23) or a control group (n = 29). All participants completed a web-based questionnaire in the ED and at 3-month follow-up. For 12 weeks, SMS participants were asked to report whether they had a risky sexual encounter in the past week, received theory-based feedback, and were asked if they were willing set a goal to refrain from having another risky encounter.Thirty-nine percent of SMS participants completed all weeks of SMS reports, and noncompletion increasing from 12% on week 1 to a 33% by week 12. Three-month follow-up was completed in 56% of participants. In the intervention group, there was an increase in the proportion with condom use with last vaginal sex from 20% (95% CI 4%-48%) to 53% (95% CI 27%-79%) and an increase in always condom use over the past 28 days from 0% (95% CI 0%-22%) to 33% (95% CI 12%-62%). These changes were not statistically different from control participants.SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample.

    View details for DOI 10.1016/j.jadohealth.2013.04.006

    View details for Web of Science ID 000323602900014

    View details for PubMedID 23707402

  • The Trouble With Medication Adherence After Emergency Care ANNALS OF EMERGENCY MEDICINE Suffoletto, B., Yealy, D. M. 2013; 62 (3): 235?36
  • Mobile Phone Text Messaging to Assess Symptoms After Mild Traumatic Brain Injury and Provide Self-Care Support: A Pilot Study JOURNAL OF HEAD TRAUMA REHABILITATION Suffoletto, B., Wagner, A. K., Arenth, P. M., Calabria, J., Kingsley, E., Kristan, J., Callaway, C. W. 2013; 28 (4): 302?12

    Abstract

    To examine whether patients with mild traumatic brain injury (mTBI) receiving text messaging-based education and behavioral support had fewer and less severe postconcussive symptoms than those not receiving text-message support. Our secondary objective was to determine the feasibility of using text messaging to assess daily symptoms and provide support to patients with mTBI.Randomized controlled trial with 14-day follow-up.Convenience sample of 43 adult emergency department patients with mTBI.Fourteen days of timed SMS (short-message service) symptom assessments (9 AM: headaches; 1 PM: difficulty concentrating; 5 PM: irritability or anxiety) with self-care support messages.SMS symptom reports, Rivermead Postconcussion Symptoms Questionnaire.Compared with the control group, intervention participants trended to lower odds of reporting headaches (odds ratio [OR] = 0.38; 95% confidence interval [CI]: 0.07-1.99), concentration difficulty (OR = 0.32; 95% CI: 0.04-2.24), and irritability or anxiety (OR = 0.33; 95% CI: 0.05-2.35). There were also trends of lower mean scores for headaches (0.99 vs 1.19; P = .5), difficulty concentrating (0.88 vs 1.23; P = .2), and irritability/anxiety (1.00 vs 1.62; P = .06). There were high response rate to SMS symptom assessments and high satisfaction with the intervention.Those receiving the text messaging-based education and support had fewer and less severe postconcussive symptoms than the controls but none of the differences reached statistical significance. Further evaluation of more robust mobile interventions and larger sample of participants are still needed.

    View details for DOI 10.1097/HTR.0b013e3182847468

    View details for Web of Science ID 000330363900008

    View details for PubMedID 23474882

  • Diagnostic Accuracy of a Single Point-of-Care Prehospital Serum Lactate for Predicting Outcomes in Pediatric Trauma Patients PEDIATRIC EMERGENCY CARE Shah, A., Guyette, F., Suffoletto, B., Schultz, B., Quintero, J., Predis, E., King, C. 2013; 29 (6): 715?19

    Abstract

    Preliminary evidence suggests that a single prehospital lactate level (pLA) improves prediction of morbidity and mortality in adult trauma patients independent of vital signs. However, the value of pLA for pediatric trauma patients is unknown. Our objective was to determine whether pLA is associated with the need for critical care in pediatric trauma patients.We conducted a cohort study of 217 patients transported by helicopter to a level I pediatric trauma center over 24 months. The primary outcome was the need for predefined critical care measures. Covariates included vital signs and Glasgow Coma Scale (GCS) scores documented by prehospital providers.Forty-one subjects required critical care. Abnormal prehospital vital signs were not associated with need for critical care. Overall, median pLA level for patients who required critical care was 2.1 mmol/L (interquartile range [IQR], 1.6-2.7 mmol/L) versus 1.7 mmol/L (IQR, 1.2-2.2 mmol/L) for those who did not (P = 0.01). In addition, there were 85 subjects who had normal vital signs and a normal GCS during transport. Of these, 11 (13%) required critical care. In the subset of patients with normal prehospital vital signs and GCS, median pLA level for patients who required critical care was 2.6 mmol/L (IQR, 1.8-2.6 mmol/L) versus 1.7 mmol/L (IQR, 1-2.1 mmol/L) for those who did not (P = 0.01).Prehospital lactate level was higher in pediatric trauma patients who required critical care, including those who had normal prehospital vital signs and GCS. In this cohort, lactate was an early identifier of children with severe traumatic injuries.

    View details for DOI 10.1097/PEC.0b013e318294ddb1

    View details for Web of Science ID 000330469400006

    View details for PubMedID 23714761

  • Tissue oximetry by near-infrared spectroscopy in a porcine model of out-of-hospital cardiac arrest and resuscitation RESUSCITATION Reynolds, J. C., Salcido, D., Koller, A. C., Sundermann, M. L., Frisch, A., Suffoletto, B. P., Menegazzi, J. J. 2013; 84 (6): 843?47

    Abstract

    Monitoring during resuscitation remains relatively crude. Near-infrared spectroscopy (NIRS) measures aggregate oxygen saturation in a volume of tissue. We assessed the utility of continuous StO2 measurement in a porcine model of cardiac arrest, and explored the effects of differential vasoconstriction on StO2. We hypothesized that (1) StO2 trends correspond with the onset of loss of pulses, resuscitation, and return of spontaneous circulation (ROSC); (2) epinephrine has a dose-dependent effect on StO2.We anesthetized and instrumented 7 female swine, placing a NIRS probe on the left forelimb to recorded StO2. After 8 min of untreated VF and 2 min of CPR, we randomized animals to 0.015 mgkg(-1) (SDE) or 0.1mgkg(-1) (HDE) epinephrine. After 3 min of CPR, animals were defibrillated. Animals with ROSC were given SDE, then HDE for subsequent hemodynamic deteriorations. Data were analyzed with descriptive statistics and generalized linear model (alpha=0.05) to determine overall slope of pooled StO2 across animals for resuscitation segments.Four animals received HDE and three SDE. All achieved ROSC. Significant coefficients (?StO2 min(-1)) were noted for resuscitation segments. StO2 decreased after loss of pulses (-29.1; 95%CI -33.4, -24.7; p<0.01) but plateaued during CPR (-0.2; 95%CI -1.2, 0.8; p=0.71). There was a graded decline in StO2 between SDE (-1.3; 95%CI -1.5, -1.2; p<0.01) and HDE (-3.1; 95%CI -5.8, -0.4; p=0.03). The slowest change occurred with ROSC (0.4; 95%CI 0.3, 0.5; p<0.01).In a porcine model of OHCA, peripheral StO2 rapidly decreased after loss of pulses, but did not improve with CPR or epinephrine. It increased extremely slowly after ROSC.

    View details for DOI 10.1016/j.resuscitation.2012.11.031

    View details for Web of Science ID 000320996800037

    View details for PubMedID 23228556

  • Mobile phone text message intervention to reduce binge drinking among young adults: study protocol for a randomized controlled trial TRIALS Suffoletto, B., Callaway, C. W., Kristan, J., Monti, P., Clark, D. B. 2013; 14: 93

    Abstract

    Heavy episodic (binge) drinking is common among young adults and can lead to injury and illness. Young adults who seek care in the Emergency Department (ED) may be disproportionately affected with binge drinking behavior, therefore provide an opportunity to reduce future risk through screening, brief intervention and referral to treatment (SBIRT). Mobile phone text messaging (SMS) is a common form of communication among young adults and has been shown to be effective at providing behavioral support to young adult drinkers after ED discharge. Efficacy of SMS programs to reduce binge drinking remains unknown.We will conduct a three parallel arm, randomized trial. A convenience sample of adults aged 18 to 25 years attending three EDs in Pittsburgh, PA and willing to participate in the study will be screened for hazardous alcohol consumption. Participants identified as hazardous drinkers will then be allocated to either 12 weeks of weekly SMS drinking assessments with feedback (SA+F), SMS drinking assessments without feedback (SA), or a control group. Randomization will be via an independent and remote computerized randomization and will be stratified by study site. The SA+F group will be asked to provide pre-weekend drinking intention as well as post-weekend consumption via SMS and will receive feedback messages focused on health consequences of alcohol consumption, personalized normative feedback, protective drinking strategies and goal setting. Follow-up data on alcohol use and injury related to alcohol will be collected through a password-protected website three, six and nine months later. The primary outcome for the study is binge drinking days (?4 drinks for women; ?5 drinks for men) during the previous month, and the main secondary outcome is the proportion of participants who report any injury related to alcohol in the prior three months.This study will test the hypothesis that a mobile phone text-messaging program will result in immediate and durable reductions in binge drinking among at-risk young adults. By testing an intervention group to an assessment-only and control group, we will be able to separate the effect of assessment reactivity. By collecting pre-weekend drinking intentions and post-weekend consumption data in the SA+F group, we will be able to better understand mechanism of change.Clinicaltrials.gov NCT01688245.

    View details for DOI 10.1186/1745-6215-14-93

    View details for Web of Science ID 000318987400001

    View details for PubMedID 23552023

    View details for PubMedCentralID PMC3652768

  • DIAGNOSTIC ACCURACY OF A RAPID CHECKLIST TO IDENTIFY DELIRIUM IN OLDER PATIENTS TRANSPORTED BY EMS PREHOSPITAL EMERGENCY CARE Frisch, A., Miller, T., Haag, A., Martin-Gill, C., Guyette, F. X., Suffoletto, B. P. 2013; 17 (2): 230?34

    Abstract

    The presence of delirium in elderly patients is common and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. Early recognition of delirium in the prehospital setting has the potential to improve outcomes, but is not feasible without valid assessment tools.To determine whether use of a rapid delirium checklist by prehospital providers is a valid way to identify cases of delirium compared with a criterion standard and whether the checklist is better at identifying delirium than the Glasgow Coma Score (GCS).We conducted a prospective study at two academic, tertiary-care emergency departments (EDs) where a convenience sample of matched dyads of emergency medical services providers and elderly patients (age ?65 years) were enrolled. Prehospital providers reported limited demographics and work history about themselves. They also reported vital signs and GCS for each patient and completed the checklist asking about presence of the four features of delirium. The patient then underwent a cognitive assessment using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by a trained investigator, which was used as the criterion standard. Criterion validity and concurrent validity of the delirium checklist and abnormal GCS were evaluated using sensitivity and specificity.Two hundred fifty-nine matched dyads were studied. Delirium occurred in 24 (9%) of the elderly patients sampled. Prehospital providers' recognition of any delirium symptom resulted in a sensitivity of 0.63 (95% confidence interval [CI] 0.43-0.79) and a specificity of 0.74 (95% CI 0.73-0.84). Prehospital report of a GCS <15 has a sensitivity of 0.67 (95% CI 0.47-0.82) and a specificity of 0.85 (95% CI 0.80-0.89).A rapid delirium checklist can identify 63% of patients with delirium, but performed no better than the GCS. Future research should determine whether a rapid test of cognition improves early identification of elderly patients with delirium.

    View details for DOI 10.3109/10903127.2012.744785

    View details for Web of Science ID 000315634500014

    View details for PubMedID 23281619

  • POTENTIAL UTILITY OF NEAR-INFRARED SPECTROSCOPY IN OUT-OF-HOSPITAL CARDIAC ARREST: AN ILLUSTRATIVE CASE SERIES PREHOSPITAL EMERGENCY CARE Frisch, A., Suffoletto, B. P., Frank, R., Martin-Gill, C., Menegazzi, J. J. 2012; 16 (4): 564?70

    Abstract

    We evaluated the measurement of tissue oxygen content (StO(2)) by continuous near-infrared spectroscopy (NIRS) during and following cardiopulmonary resuscitation (CPR) and compared the changes in StO(2) and end-tidal carbon dioxide (ETCO(2)) as a measure of return of spontaneous circulation (ROSC) or rearrest.This was a case series of five patients who experienced out-of hospital cardiac arrest. Patients included those who had already experienced ROSC, who were being transported to the hospital, or who were likely to have a reasonable amount of time remaining in the resuscitation efforts. Patients were continuously monitored from the scene using continuous ETCO(2) monitoring and a NIRS StO(2) monitor until they reached the hospital. The ETCO(2) and StO(2) values were continuously recorded and analyzed for comparison of the time points when patients were clinically identified to have ROSC or rearrest.Four of five patients had StO(2) and EtCO(2) recorded during an episode of CPR and all were monitored during the postarrest period. Three patients experienced rearrest en route to the hospital. Downward trends were noted in StO(2) prior to each rearrest, and rapid increases were noted after ROSC. The StO(2) data showed less variance than the ETCO(2) data in the periarrest period.This preliminary study in humans demonstrates that StO(2) dynamically changes during periods of hemodynamic instability in postarrest patients. These data suggest that a decline in StO(2) level may correlate with rearrest and may be useful as a tool to predict rearrest in post-cardiac arrest patients. A rapid increase in StO(2) was also seen upon ROSC and may be a better method of identifying ROSC during CPR than pauses for pulse checks or ETCO(2) monitoring.

    View details for DOI 10.3109/10903127.2012.702191

    View details for Web of Science ID 000308214500019

    View details for PubMedID 22823984

    View details for PubMedCentralID PMC4263912

  • A Mobile Phone Text Message Program to Measure Oral Antibiotic Use and Provide Feedback on Adherence to Patients Discharged From the Emergency Department ACADEMIC EMERGENCY MEDICINE Suffoletto, B., Calabria, J., Ross, A., Callaway, C., Yealy, D. M. 2012; 19 (8): 949?58

    Abstract

    Nonadherence to prescribed medications impairs therapeutic benefits. The authors measured the ability of an automated text messaging (short message service [SMS]) system to improve adherence to postdischarge antibiotic prescriptions.This was a randomized controlled trial in an urban emergency department (ED) with an annual census of 65,000. A convenience sample of adult patients being discharged with a prescription for oral antibiotics was enrolled. Participants received either a daily SMS query about prescription pickup, and then dosage taken, with educational feedback based on their responses (intervention), or the usual printed discharge instructions (control). A standardized phone follow-up interview was used on the day after the intended completion date to determine antibiotic adherence: 1) the participant filled prescription within 24 hours of discharge and 2) no antibiotic pills were left on the day after intended completion of prescription.Of the 200 patients who agreed to participate, follow-up was completed in 144 (72%). From the 144, 26% (95% confidence interval [CI] = 19% to 34%) failed to fill their discharge prescriptions during the first 24 hours, and 37% (95% CI = 29% to 45%) had pills left over, resulting in 49% (95% CI = 40% to 57%) nonadherent patients. There were no differences in adherence between intervention participants and controls (57% vs. 45%; p = 0.1). African American race, greater than twice-daily dosing, and self-identifying as expecting to have difficulty filling or taking antibiotics at baseline were associated with nonadherence.Almost one-half (49%) of our patients do not adhere to antibiotic prescriptions after ED discharge. Future work should improve the design and deployment of SMS interventions to optimize their effect on improving adherence to medication after ED discharge.

    View details for DOI 10.1111/j.1553-2712.2012.01411.x

    View details for Web of Science ID 000307772300008

    View details for PubMedID 22849787

  • Near-infrared spectroscopy in post-cardiac arrest patients undergoing therapeutic hypothermia RESUSCITATION Suffoletto, B., Kristan, J., Rittenberger, J. C., Guyette, F., Hostler, D., Callaway, C. 2012; 83 (8): 986?90

    Abstract

    To investigate the relationship between tissue oxygen saturation during a vascular occlusion test with systemic hemodynamics, central and peripheral skin temperature in patients resuscitated from cardiac arrest.This prospective, observational study included a convenience sample of 30 patients hospitalized in a multidisciplinary intensive care unit in a university hospital and treated with therapeutic hypothermia. Near infrared spectroscopy (NIRS) was used to measure thenar tissue oxygen saturation, desaturation rate and saturation recovery rate after the vascular occlusion test, conducted within 24h of hospital admission and within 12h of initiating re-warming. Measurements included heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation, use of vasopressors and sedatives, core body (esophageal) and peripheral skin temperature and sequential organ failure assessment (SOFA) score.Peripheral skin temperature was found to have a significant effect on StO(2) deoxygenation and recovery slopes, resulting in lower rates at colder temperatures. This effect was independent of MAP, HR, and core temperature. NIRS-derived variables were not associated with SOFA score or use of vasopressors and did not predict mortality.Colder peripheral skin temperatures resulting in lower StO(2) desaturation rates may be explained by slower aerobic metabolism, thus lower extraction rate of oxygen, in the tissue beds. Lower recovery slopes at colder local temperatures may result from peripheral vasoconstriction during reactive hyperemia.We found that peripheral skin temperature in post-arrest critically ill patients undergoing TH strongly influences tissue oxygen desaturation and reoxygenation rates. In additional, changes in NIRS derived variables were independent of measures of shock, vasopressor use or illness severity.

    View details for DOI 10.1016/j.resuscitation.2012.03.021

    View details for Web of Science ID 000309048000024

    View details for PubMedID 22521725

  • Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients JOURNAL OF TRAUMA AND ACUTE CARE SURGERY Guyette, F. X., Gomez, H., Suffoletto, B., Quintero, J., Mesquida, J., Kim, H., Hostler, D., Puyana, J., Pinsky, M. R. 2012; 72 (4): 930?35

    Abstract

    Tissue oximetry (StO2) plus a vascular occlusion test is a noninvasive technology that targets indices of oxygen uptake and delivery. We hypothesize that prehospital tissue oximetric values and vascular occlusion test response can predict the need for in-hospital lifesaving interventions (LSI).We conducted a prospective, blinded observational study to evaluate StO2 slopes to predict the need for LSI. We calculated the DeO2 slope using Pearson's coefficients of regression (r2) for the first 25% of descent and the ReO2 slope using the entire recovery interval. The primary outcome was LSI defined as the need for emergent operation or transfusion in the first 24 hours of hospitalization. We created multivariable logistic regression models using covariates of age, sex, vital signs, lactate, and mental status.We assessed StO2 in a convenience sample of 150 trauma patients from April to November of 2009. In-hospital mortality was 3% (95% confidence interval [CI], 1.1-7.6); 31% (95% CI, 24-39) were admitted to the intensive care unit, 6% (95% CI, 2.8-11.1) had an emergent operation, and 10% (95% CI, 5.7-15.9) required transfusion. Decreasing DeO2 was associated with a higher proportion of patients requiring LSI. In the multivariate model, the association between the need for LSI and DeO2, Glasgow Coma Scale, and age persists.Prehospital DeO2 is associated with need for LSI in our trauma population. Further study of DeO2 is warranted to determine whether it can be used as an adjunct triage criterion or an endpoint for resuscitation.

    View details for DOI 10.1097/TA.0b013e31823d0677

    View details for Web of Science ID 000302784600030

    View details for PubMedID 22491607

    View details for PubMedCentralID PMC3770128

  • Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency Department ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Suffoletto, B., Callaway, C., Kristan, J., Kraemer, K., Clark, D. B. 2012; 36 (3): 552?60

    Abstract

    Brief interventions have the potential to reduce heavy drinking in young adults who present to the emergency department (ED), but require time and resources rarely available. Text-messaging (TM) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change. The feasibility of screening young adults in the ED, recruiting them for a TM-based interventional trial, collecting weekly drinking data through TM, and the variance in drinking outcomes remains unknown.Young adults in 3 urban EDs (n = 45; aged 18 to 24 years, 54% women) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were randomly assigned to weekly TM-based feedback with goal setting (Intervention), weekly TM-based drinking assessments without feedback (Assessment), or control. Participants in the Intervention group who reported ?5 (for men) and ?4 (for women) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week. We describe the interaction with TM and goal setting. We also describe the heavy drinking days (HDDs), drinks per drinking day (DPDD) using timeline follow-back procedure at baseline and 3 months.We screened 109 young adults over 157 hours across 24 unique days and 52 (48%; 95% CI 38 to 50) screened positive for hazardous drinking. Of these, 45 (87%; 95% CI 74 to 94) met inclusion criteria, were enrolled and randomized, and 6 (13%; 95% CI 5 to 27) did not complete 3-month web-based follow-up; 88% (95% CI 84 to 91) of weekly TM-based drinking assessments were answered, with 77% (95% CI 58 to 90) of participants responding to all 12 weeks. Agreeing to set a goal was associated with a repeat HDD 36% (95% CI 17 to 55) of the time compared with 63% (95% CI 44 to 81) when not willing to set a goal. At 3 months, participants that were exposed to the TM-based intervention had 3.4 (SD 5.4) fewer HDDs in the last month and 2.1 (SD 1.5) fewer DPDD when compared to baseline.TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy.

    View details for DOI 10.1111/j.1530-0277.2011.01646.x

    View details for Web of Science ID 000300663900019

    View details for PubMedID 22168137

  • Less Encouraging Lessons From the Front Lines: Barriers to Implementation of an Emergency Department-Based HIV Screening Program ANNALS OF EMERGENCY MEDICINE Mumma, B. E., Suffoletto, B. P. 2011; 58 (1): S44?S48

    Abstract

    We describe barriers to, and discuss recommendations for, implementing a limited emergency department (ED)-based HIV screening program.A pilot program was designed to study the feasibility of integrating HIV screening into ED care among patients aged 18 to 64 years at an urban academic emergency department with an annual census of 50,000 patients.During the first 12 weeks of the pilot program, 395 patients were screened. Of those, 2 (0.5%; 95% confidence interval 0.06% to 1.8%) received a positive test result for HIV. Both were contacted by telephone, and one was seen for result notification, posttest counseling, and further care in the local health department. Of the patients who received a negative test result, 98% were contacted about their results. We encountered numerous barriers to implementation, which we categorized as departmental, public health, legal, institutional, test limitations, and infrastructure.Understanding potential barriers and making plans for dealing with them are critical to the successful implementation of an HIV screening program in the ED.

    View details for DOI 10.1016/j.annemergmed.2011.03.022

    View details for Web of Science ID 000292341200009

    View details for PubMedID 21684407

  • Prediction of Serious Infection During Prehospital Emergency Care PREHOSPITAL EMERGENCY CARE Suffoletto, B., Frisch, A., Prabhu, A., Kristan, J., Guyette, F. X., Callaway, C. W. 2011; 15 (3): 325?30

    Abstract

    Regionalization of emergency care for patients with serious infections has the potential to improve outcomes, but is not feasible without accurate identification of patients in the prehospital environment.To determine the incremental predictive value of provider judgment in addition to prehospital physiologic variables for identifying patients who have serious infections.We conducted a prospective study at a single teaching tertiary-care emergency department (ED) where a convenience sample of emergency medical services (EMS) providers and ED clinicians completed a questionnaire about the same patients. Prehospital providers provided limited demographics and work history about themselves. They also reported the presence of abnormal prehospital physiology for each patient (heart rate >90 beats/min, systolic blood pressure <100 mmHg, respiratory rate >20 breaths/min, pulse oximetry <95%, history of fever, altered mental status) and their judgment about whether the patient had an infection. At the end of formal evaluation in the ED, the physician was asked to complete a survey describing the same patient factors in addition to patient disposition. The primary outcome of serious infection was defined as the presence of both 1) ED report of acute infection and 2) patient admission. We included prehospital factors associated with serious infection in the prediction models. Operating characteristics for various cutoffs and the area under the curve (AUC) were calculated and reported with 95% confidence intervals (95% CIs).Serious infection occurred in 32 (16%) of 199 patients transported by EMS, 50% of whom were septic, and 16% of whom were admitted to the intensive care unit. Prehospital systolic blood pressure <100 mmHg, EMS-elicited history or suspicion of fever, and prehospital judgment of infection were associated with primary outcome. Presence of any one of these resulted in a sensitivity of 0.59 (95% CI 0.40-0.76) and a specificity of 0.81 (95% CI 0.74-0.86). The AUC for the model was 0.71.Including prehospital provider impression to objective physiologic factors identified three more patients with infection at the cost of overtriaging five. Future research should determine the effect of training or diagnostic aids for improving the sensitivity of prehospital identification of patients with serious infection.

    View details for DOI 10.3109/10903127.2011.561411

    View details for Web of Science ID 000290967800004

    View details for PubMedID 21524204

  • Prehospital Serum Lactate as a Predictor of Outcomes in Trauma Patients: A Retrospective Observational Study JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Guyette, F., Suffoletto, B., Castillo, J., Quintero, J., Callaway, C., Puyana, J. 2011; 70 (4): 782?86

    Abstract

    Lactate is associated with morbidity and mortality; however, the value of prehospital lactate (pLA) is unknown. Our objective was to determine whether pLA improves identification of mortality and morbidity independent of vital signs.We measured pLA in 1,168 patients transported by rotorcraft to a Level I trauma center over 18 months. The primary outcome was in-hospital mortality; secondary outcomes were emergent surgery and multiple organ dysfunction syndrome (MODS). Covariates include age, sex, prehospital vital signs, and mental status. We created multivariable logistic regression models and tested them for interaction terms and goodness of fit. Cutoff values were established for reporting operating characteristics using shock (defined as shock index >0.8, heart rate >110, and systolic blood pressure <100), tachypnea (RR ?30), and altered sensorium (Glasgow Coma Scale score <15).In-hospital mortality was 5.6%, 7.4% required surgery and 5.7% developed MODS. Median lactate was 2.4 mmol/L. Lactate was associated with mortality (odds ratio [OR], 1.23; p < 0.0001), surgery (OR, 1.13; p < 0.001), and MODS (OR, 1.14; p < 0.0001). Inclusion of pLA into a logistic model significantly improved the area under the receiver operator curves from 0.85 to 0.89 for death (p < 0.001), 0.68 to 0.71 for surgery (p = 0.02), and 0.78 to 0.81 for MODS (p = 0.002). When a threshold lactate value of >2 mmol/L was added to a predictive model of shock, respiratory distress, or altered sensorium, it improved sensitivity from 88% to 97% for death, 64% to 86% for surgery, and 94% to 99% for MODS.The pLA measurements improve prediction of mortality, surgery, and MODS. Lactate may improve the identification of patients who require monitoring, resources, and resuscitation.

    View details for DOI 10.1097/TA.0b013e318210f5c9

    View details for Web of Science ID 000289558700009

    View details for PubMedID 21610386

  • Therapeutic Hypothermia Does Not Affect Tissue Oxygenation, Metabolism or Microvascular Reactivity in Peripheral Muscle Suffoletto, B., Kristan, J., Rittenberger, J., Guyette, F., Hostler, D., Callaway, C. LIPPINCOTT WILLIAMS & WILKINS. 2010
  • Knowledge translation in emergency medical services: A qualitative survey of barriers to guideline implementation RESUSCITATION Bigham, B. L., Aufderheide, T. P., Davis, D. P., Powell, J., Donn, S., Suffoletto, B., Nafziger, S., Stouffer, J., Morrison, L. J., ROC Investigators 2010; 81 (7): 836?40

    Abstract

    The American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest in 2005. We sought to identify what barriers delayed the implementation of these guidelines in EMS agencies.We surveyed 178 EMS agencies as part of a larger quantitative survey regarding guideline implementation and conducted a single-question semi-structured interview using the Grounded Theory method. We asked "What barriers if any, delayed implementation of the (2005 AHA) guidelines in your EMS agency?" Data were coded and member validation was employed to verify our findings.176/178 agencies completed the quantitative survey. Qualitative data collection ceased after reaching theoretical saturation with 34 interviews. Ten unique barriers were identified. We categorized these 10 barriers into three themes. The theme instruction delays (reported by 41% of respondents) included three barriers: booking/training instructors (9%), receiving training materials (15%), and scheduling staff for training (18%). The second theme, defibrillator delays (38%), included two barriers; reprogramming defibrillators (24%) and receiving new defibrillators to replace non-upgradeable units (15%). The third theme was decision-making (38%) and included five barriers; coordinating with allied agencies (9%), government regulators such as state and provincial health authorities (9%), medical direction and base hospitals (9%), ROC participation (9%), and internal crises (3%).Many barriers contributed to delays in the implementation of the 2005 AHA guidelines in EMS agencies. These identified barriers should be proactively addressed prior to the 2010 Guidelines to facilitate rapid translation of science into clinical practice.

    View details for DOI 10.1016/j.resuscitation.2010.03.012

    View details for Web of Science ID 000279758500014

    View details for PubMedID 20398994

    View details for PubMedCentralID PMC3209799

  • DELAYED PREHOSPITAL IMPLEMENTATION OF THE 2005 AMERICAN HEART ASSOCIATION GUIDELINES FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIAC CARE PREHOSPITAL EMERGENCY CARE Bigham, B. L., Koprowicz, K., Aufderheide, T. P., Davis, D. P., Donn, S., Powell, J., Suffoletto, B., Nafziger, S., Stouffer, J., Idris, A., Morrison, L. J., ROC Investigators 2010; 14 (3): 355?60

    Abstract

    In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA).To determine if, and when, emergency medical services (EMS) agencies participating in the Resuscitation Outcomes Consortium (ROC) implemented these guidelines.We contacted 178 EMS agencies and completed structured telephone interviews with 176 agencies. The survey collected data on specific treatment protocols before and after implementation of the 2005 guidelines as well as the date of implementation crossover (the "crossover date"). The crossover date was then linked to a database describing the size, type, and structure of each agency. Descriptive statistics and regression were used to examine patterns in time to crossover.The 2005 guidelines were implemented by 174 agencies (99%). The number of days from guideline release to implementation was as follows: mean 416 (standard deviation 172), median 415 (range 49-750). There was no difference in time to implementation in fire-based agencies (mean 432), nonfire municipal agencies (mean 365), and private agencies (mean 389, p = 0.31). Agencies not providing transport took longer to implement than agencies that transported patients (463 vs. 384 days, p = 0.004). Agencies providing only basic life support (BLS) care took longer to implement than agencies who provided advanced life support (ALS) care (mean 462 vs. 397 days, p = 0.03). Larger agencies (>10 vehicles) were able to implement the guidelines more quickly than smaller agencies (mean 386 vs. 442 days, p = 0.03). On average, it took 8.9 fewer days to implement the guidelines for every 50% increase in EMS-treated runs/year to which an agency responded.ROC EMS agencies required an average of 416 days to implement the 2005 AHA guidelines for OHCA. Small EMS agencies, BLS-only agencies, and nontransport agencies took longer than large agencies, agencies providing ALS care, and transport agencies, respectively, to implement the guidelines. Causes of delays to guideline implementation and effective methods for rapid EMS knowledge translation deserve investigation.

    View details for DOI 10.3109/10903121003770639

    View details for Web of Science ID 000283118400012

    View details for PubMedID 20388032

    View details for PubMedCentralID PMC3209500

  • Sleep Quality and Fatigue Among Prehospital Providers PREHOSPITAL EMERGENCY CARE Patterson, P., Suffoletto, B. P., Kupas, D. F., Weaver, M. D., Hostler, D. 2010; 14 (2): 187?93

    Abstract

    Fatigue is common among medical professionals and has been linked to poor performance and medical error. Objective. To characterize sleep quality and its association with severe fatigue in emergency medical services (EMS) providers.We studied a convenience sample of EMS providers who completed three surveys: the Pittsburgh Sleep Quality Index (PSQI), the Chalder Fatigue Questionnaire (CFQ), and a demographic survey. We used established measures to examine survey psychometrics and performed t-tests, analysis of variance (ANOVA), and chi-square tests to identify differences in PSQI and CFQ scores.One hundred nineteen surveys were completed. The eight-hour shift was most commonly reported (35.4%). A majority of subjects were overweight (41.9%) or obese (42.7%), and 59.6% had been diagnosed with one or more health conditions (e.g., diabetes). Results from psychometric tests were positive. The mean (+/- standard deviation) PSQI score was 9.2 (+/- 3.7). A CFQ score > or =4, indicating severe mental and physical fatigue, was present in 44.5% of the subjects. The mean PSQI score was higher among those reporting severe fatigue (11.3 +/- 3.2) than among those not reporting fatigue (7.5 +/- 3.0, p < 0.0001).The results from this study suggest that the sleep quality and fatigue status of EMS workers are at unhealthy levels. The health and safety of the EMS worker and patient population should be considered in light of these results.

    View details for DOI 10.3109/10903120903524971

    View details for Web of Science ID 000275155100009

    View details for PubMedID 20199233

    View details for PubMedCentralID PMC2895322

  • EFFECT OF PHARMACOLOGIC VASODILATION ON SKELETAL MUSCLE OXYGEN EXTRACTION Simon, P., Mesquida, J., Suffoletto, B., Gomez, H., Kellum, J., Pinsky, M. LIPPINCOTT WILLIAMS & WILKINS. 2009: A88
  • Body temperature changes are associated with outcomes following in-hospital cardiac arrest and return of spontaneous circulation RESUSCITATION Suffoletto, B., Peberdy, M., van der Hoek, T., Callaway, C. 2009; 80 (12): 1365?70

    Abstract

    Spontaneous changes in body temperature after return of circulation (ROSC) from cardiac arrest are common, but the association of these changes with outcomes in hospitalized patients who survive to 24h post-ROSC is not known. We tested the hypothesis that adults who experience temperature lability in the first 24h have worse outcomes compared with those who maintain normothermia.A prospective observational study from a multicenter registry of cardiac arrests (National Registry of Cardiopulmonary Resuscitation) from 355 US and Canadian hospitals. 14,729 adults with return of circulation from a pulseless cardiac arrest. We excluded those who died or were discharged before 24h post-event, those made Do-Not-Resuscitate (DNR) within 24h of event, those that had a preceding trauma, and those with multiple cardiac arrests. Finally, we included only subjects that had both a lowest (T(min)) and highest (T(max)) body temperature value recorded during the first 24-h after ROSC, resulting in a study sample of 3426 patients.After adjustment for potential covariates, there was a lower odds of survival in those having an episode of hypothermia (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.80), those having an episode of hyperthermia (OR, 0.67; 95% CI, 0.48-0.80), and those having an episode of both (OR, 0.59; 95% CI, 0.39-0.91). Among those who survived to discharge, there was also a lower odds of favorable neurologic performance in those who had an episode of hyperthermia (OR, 0.71; 95% CI, 0.51-0.98).Episodes of temperature lability following in-hospital resuscitation from cardiac arrest are associated with lower odds of surviving to discharge. Hyperthermia is also associated with fewer patients leaving the hospital with favorable neurologic performance. Further studies should identify whether therapeutic control over changes in body temperature after in-hospital cardiac arrest improves outcomes.

    View details for DOI 10.1016/j.resuscitation.2009.08.020

    View details for Web of Science ID 000273575400009

    View details for PubMedID 19804929

  • Ethyl pyruvate enhances intra-resuscitation hemodynamics in prolonged ventricular fibrillation arrest RESUSCITATION Suffoletto, B. P., Salcido, D. D., Logue, E. S., Caprio, T. W., Menegazzi, J. J. 2009; 80 (12): 1411?16

    Abstract

    As the duration of untreated cardiac arrest increases, the effectiveness of standard therapies declines, and may be more harmful than helpful. We investigated the hemodynamic, metabolic and anti-inflammatory effects of Ringer's ethyl pyruvate solution (REPS) versus Ringer's solution (RS) in the acute model of prolonged porcine arrest.Seventeen mixed-breed swine were induced into ventricular fibrillation (VF) and left untreated for 8min. CPR was begun using a mechanical chest compression device at a rate of 100 per minute. At the onset of CPR, animals were randomly assigned to treatment with either 25mL/kg of RS or 25mL/kg of REPS containing 40mg/kg of ethyl pyruvate, infused over 5min in blinded fashion. CPR continued with administration of a drug cocktail at 2min and the first rescue shock was delivered at minute 13 of VF. Animals having ROSC were supported with standardized care for 2h.Both groups had 100% ROSC and 100% 2-h survival. The REPS group exhibited higher median CPP (27.3mmHg) than the control group (16.5mmHg) by 3min of CPR, which continued throughout the duration of CPR (p=0.02). The median time to hypotension following ROSC was 9.64min in the REPS group and 7.25min in controls (p=0.04) and there was a non-significant trend of decreased use of vasopressors for the duration of resuscitation. There was no difference in systemic or cerebral metabolism between groups. There were non-significant trends of decreased IL-6, increased Il-10 and decreased mesenteric bacterial colony growth in those treated with REPS when compared to RS.The administration of REPS with CPR significantly improved intra- and post-resuscitation hemodynamics in this swine model of prolonged cardiac arrest, but did not definitely change the metabolic or inflammatory profile during the acute resuscitation period.

    View details for DOI 10.1016/j.resuscitation.2009.08.014

    View details for Web of Science ID 000273575400017

    View details for PubMedID 19818545

  • PREHOSPITAL DYNAMIC TISSUE O2 SATURATION RESPONSE PREDICTS IN-HOSPITAL MORTALITY IN TRAUMA PATIENTS Guyette, F., Gomez, H., Suffoletto, B., Quintero, J., Mesquida, J., Kim, H., Hostler, D., Puyana, J., Pinsky, M. LIPPINCOTT WILLIAMS & WILKINS. 2009: A28
  • Decreasing Cortisol Levels in the First Day Following Cardiac Arrest May Be Associated With the Development of Multi-System Organ Failure Rittenberger, J. C., Guyette, F. X., Suffoletto, B. P., Callaway, C. W. LIPPINCOTT WILLIAMS & WILKINS. 2009: S1450
  • Association of intramyocardial high energy phosphate concentrations with quantitative measures of the ventricular fibrillation electrocardiogram waveform RESUSCITATION Salcido, D. D., Menegazzi, J. J., Suffoletto, B. P., Logue, E. S., Sherman, L. D. 2009; 80 (8): 946?50

    Abstract

    Quantitative measures of the ventricular fibrillation (VF) electrocardiogram (ECG) have been correlated with the success of rescue shocks, making them ideal measures for guiding resuscitative interventions. Correlation of intramyocardial energy stores with the change in quantitative VF ECG measures would provide mechanistic insight into their utility. We sought to investigate the relationship between intramyocardial energy stores and four quantitative ECG measures.Eighteen mixed-breed, domestic swine were sedated, anaesthetized and paralyzed. Swine were block randomized into three groups receiving 5, 10, or 15 min of untreated VF. Thoracotomy was performed and the heart was delivered. VF was induced by a 100 mA transthoracic shock while ECG was recorded. Biopsies of myocardial tissue were taken from the left and right ventricles after the prescribed duration of VF. Adenosine triphosphate (ATP) and adenosine diphosphate (ADP) concentrations in the tissue samples were measured. ECG data immediately prior to each biopsy were analyzed by each of four quantitative ECG methods: Scaling Exponent (ScE), Median Slope (MS), Amplitude Spectrum Area (AMSA), and logarithm of the Absolute Correlation (LAC). ATP and ADP concentrations of VF duration groups were compared. ATP and ADP concentrations were regressed against each quantitative ECG measure.ATP concentrations differed between VF duration groups, but ADP concentrations differed only between 5 and 10 min groups. A significant association existed between ATP and three quantitative measures--ScE, MS, and AMSA--but no significant relationship was found for ADP.Intramyocardial ATP levels correlate with quantitative measures of the ECG during ventricular fibrillation.

    View details for DOI 10.1016/j.resuscitation.2009.05.002

    View details for Web of Science ID 000268862100021

    View details for PubMedID 19523740

  • Lipid Emulsion Combined with Epinephrine and Vasopressin Does Not Improve Survival in a Swine Model of Bupivacaine-induced Cardiac Arrest Hicks, S. D., Salcido, D. D., Logue, E. S., Suffoletto, B. P., Empey, P. E., Poloyac, S. M., Miller, D. R., Callaway, C. W., Menegazzi, J. J. LIPPINCOTT WILLIAMS & WILKINS. 2009: 138?46

    Abstract

    This study sought to evaluate the efficacy of lipid emulsion in reversing bupivacaine-induced cardiovascular collapse when added to a resuscitation protocol that included the use of epinephrine and vasopressin.After induction of general anesthesia and instrumentation, 19 mixed-breed domestic swine had cardiovascular collapse induced by an intravenous bolus of 10 mg/kg bupivacaine. After 5 min of resuscitation including chest compressions, epinephrine (100 microg/kg) and vasopressin (1.5 U/kg), animals were randomized to receive either a bolus of 20% lipid emulsion (4 ml/kg) followed by a continuous infusion (0.5 ml x kg(-1) x min(-1)) or an equal volume of saline. Investigators were blinded to the treatment assignment. The primary endpoint was return of spontaneous circulation (mean arterial pressure of at least 60 mmHg for at least 1 min).Treatment groups were similar with respect to baseline measurements of weight, sex, and hemodynamic and metabolic variables. The rates of return of spontaneous circulation were similar between groups: (3 of 10) in the lipid group and 4 of 9 in the saline group (P = 0.65). Total serum bupivacaine concentrations were higher in the lipid group at the 10-min timepoint (mean +/- SEM: 23.13 +/- 5.37 ng/ml vs. 15.33 +/- 4.04 ng/ml, P = 0.004). More norepinephrine was required in the lipid group compared to the saline group to maintain a mean arterial pressure above 60 mmHg during the 60-min survival period (mean +/- SEM: 738.6 +/- 94.4 vs.. 487.3 +/- 171.0 microg).In this swine model, lipid emulsion did not improve rates of return of spontaneous circulation after bupivacaine-induced cardiovascular collapse.

    View details for DOI 10.1097/ALN.0b013e3181a4c6d7

    View details for Web of Science ID 000267346200023

    View details for PubMedID 19512878

    View details for PubMedCentralID PMC4174466

  • CORTICUS: the end of unconditional love for steroid use? Critical care (London, England) Mason, P. E., Al-Khafaji, A., Milbrandt, E. B., Suffoletto, B. P., Huang, D. T. 2009; 13 (4): 309

    View details for DOI 10.1186/cc7986

    View details for PubMedID 19691813

  • Effects of pre-arrest and intra-arrest hypothermia on ventricular fibrillation and resuscitation Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Salcido, D. D., Reynolds, J. C., Sherman, L. D. ELSEVIER IRELAND LTD. 2009: 126?32

    Abstract

    Hypothermia has been shown to improve survival and neurological outcomes for ventricular fibrillation (VF) cardiac arrest. The electrophysiological mechanisms of hypothermia are not well-understood, nor are the effects of beginning cooling during the resuscitation.We hypothesized that inducing hypothermia prior to the onset of VF would slow the deleterious changes seen in the ECG during VF and that inducing hypothermia at the start of resuscitation would increase the rates of ROSC and short-term survival in a porcine model of prolonged VF. We randomly assigned 42 domestic swine (27.2+/-2.3 kg) to either pretreatment with hypothermia before induction of VF (PRE), normothermic resuscitation (NORM) or intra-resuscitation hypothermia (IRH). During anesthesia, animals were instrumented via femoral cutdown. Lead II ECG was recorded continuously. PRE animals were cooled before the induction of VF, with a rapid infusion of 4 degrees normal saline (30mL/kg). VF was induced electrically, left untreated for 8min, then mechanical CPR began. During CPR the NORM animals got 30mL/kg body-temperature saline and the IRH animals got 30mL/kg 4 degrees saline. In all groups first rescue shocks were delivered after 13min of VF. We calculated the VF scaling exponent (ScE) for the entire 8min period (compared using GEE). ROSC and survival were compared with Fisher's exact test. Mean temperature in degrees C at the onset of VF was PRE=34.7 degrees (+/-0.8), NORM=37.8 (+/-0.9), and IRH=37.9 (+/-0.9). The ScE values over time were significantly lower after 8min in the PRE group (p=0.02). ROSC: PRE=10/14 (71%), NORM=6/14 (43%) and IRH=12/14 (86%); p for IRH vs. NORM=0.02. Survival: PRE=9/14 (64%), NORM=5/14 (36%), IRH 8/14 (57%).Hypothermia slowed the decay of the ECG waveform during prolonged VF. IRH improved ROSC but not short-term survival compared to NORM. It is possible to rapidly induce mild hypothermia during CPR using an IV infusion of ice-cold saline.

    View details for DOI 10.1016/j.resuscitation.2008.09.002

    View details for Web of Science ID 000262542800027

    View details for PubMedID 18952346

    View details for PubMedCentralID PMC2720166

  • Prevalence of Staphylococcus aureus Nasal Colonization in Emergency Department Personnel ANNALS OF EMERGENCY MEDICINE Suffoletto, B. P., Cannon, E. H., Ilkhanipour, K., Yealy, D. M. 2008; 52 (5): 529?33

    Abstract

    Nasal colonization with Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) can precede infection in patients and contacts. Although general population S aureus/MRSA rates are well described, the prevalence of S aureus and MRSA nasal colonization in emergency department health care workers is not defined. We seek to determine the prevalence of S aureus and MRSA nasal colonization among ED health care workers without evidence of an active site of staphylococcal infection and identify variables associated with colonization.We prospectively studied a convenience sample of ED health care workers from 5 urban teaching hospitals in Pittsburgh, PA. Each participant completed a questionnaire and nasal culturing. We tested susceptibility with the oxacillin disc diffusion method. We analyzed data with descriptive statistics and univariate regression, with alpha set at 0.05.Of 255 subjects, 23% were physicians; 62% were nurses, nursing assistants, or patient care technicians; and 15% were clerical staff or social service workers. Of 81 (31.8%) S aureus isolates, 11 (13.6%) were MRSA, an overall prevalence of 4.3%. All positive MRSA samples were from nurses, nursing assistants, or patient care technicians. No other covariate had an association with S aureus or MRSA colonization.In this urban ED health care worker population, the prevalence of S aureus is similar but MRSA nasal colonization is higher than previously reported estimates in the general population of the United States. Physicians and nonpatient contact ED health care workers did not have MRSA colonization.

    View details for DOI 10.1016/j.annemergmed.2008.03.020

    View details for Web of Science ID 000260904600013

    View details for PubMedID 18439722

  • Barriers to Guideline Implementation: A Qualitative Survey of Emergency Medical Services Bigham, B. L., Aufderheide, T. P., Donn, S., Stouffer, J. A., Powell, J., Suffoletto, B., Davis, D. P., Nafziger, S., Idris, A., Helbock, M., Morrison, L. J. LIPPINCOTT WILLIAMS & WILKINS. 2008: S822
  • The Effect of Type of Anesthesia and Technique of Cardiac Arrest Induction on Outcomes in Rats Logue, E. S., Suffoletto, B. P., Teng, X., Callaway, C. W. LIPPINCOTT WILLIAMS & WILKINS. 2008: S1468
  • EMS Agencies Implemented the 2005 AHA Guidelines for CPR and ECC an Average of 416 Days after Their Release Bigham, B. L., Koprowicz, K., Stouffer, J. A., Aufderheide, T. P., Donn, S., Powell, J., Davis, D. P., Nafziger, S., Suffoletto, B., Idris, A., Helbock, M., Morrison, L. J. LIPPINCOTT WILLIAMS & WILKINS. 2008: S822
  • Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation RESUSCITATION Rittenberger, J. C., Suffoletto, B., Salcido, D., Logue, E., Menegazzi, J. J. 2008; 79 (1): 155?60

    Abstract

    The optimum duration of cardiopulmonary resuscitation (CPR) prior to first rescue shock is unknown. Clinical trials have used 90 and 180 s. Neither of these durations may be optimal. We sought to determine the optimum duration of CPR prior to first defibrillation attempt and whether this varied depending on the duration of ventricular fibrillation (VF). In this porcine model of basic life support, our outcomes were rates of return of spontaneous circulation (ROSC), survival, and coronary perfusion pressure (CPP).We anesthetized and instrumented 45 swine and then induced VF. After 5 or 8 min of untreated VF, we randomized the swine to mechanical CPR for 90, 180, or 300 s. A single rescue shock (150 J biphasic) was then administered. If this shock failed, 2 min of mechanical CPR were completed prior to the next rescue shock. CPP was calculated for each 30s epoch. ROSC was defined as a blood pressure >80 mmHg sustained for 60s. Survival was defined as sustained ROSC for 20 min. Data were analyzed with descriptive statistics, Fisher's exact test, and ANOVA.In the 5 min VF cohort, the rate of ROSC did not differ between the three groups (90 s: 25%; 180 s: 38%; 300 s: 38%, p>.05). Survival rates did not differ (90 s: 25%; 180 s: 25%; 300 s: 25%, p>0.05). In the 8 min VF cohort, no animals experienced ROSC or survival. CPP were calculated by 30s epoch and did not differ between the three groups (p>0.05). CPPs decline after 180 s of CPR.ROSC and survival were equivalent regardless of VF duration and CPR duration. When CPR begins late, CPPs are low, stressing the importance of early CPR. We do not recommend 300 s of CPR unless a defibrillator is unavailable.

    View details for DOI 10.1016/j.resuscitation.2008.04.022

    View details for Web of Science ID 000260265600025

    View details for PubMedID 18620793

    View details for PubMedCentralID PMC2582345

  • Achalasia: a rare cause of stridor INTERNAL AND EMERGENCY MEDICINE Suffoletto, B., Katz, K., Tozzetti, C., Modesti, P. 2008; 3 (2): 127?29

    View details for DOI 10.1007/s11739-008-0158-7

    View details for Web of Science ID 000264318100008

    View details for PubMedID 18438628

  • The effect of adenosine A(1) receptor antagonism on return of spontaneous circulation and short-term survival in prolonged ventricular fibrillation Mader, T. J., Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. S., Callaway, C. W., Salcido, D. D., Logue, E. S., Sherman, L. D. TAYLOR & FRANCIS INC. 2008: 352?58

    Abstract

    Endogenous adenosine (ADO) is cardioprotective during ischemia and its myocardial concentration increases during untreated ventricular fibrillation (VF). We have previously shown that ADO A1 receptor (ADOA1R) antagonism hastens the time-dependent decay in VF waveform morphology during the circulatory phase of cardiac arrest.To determine the effect of ADOA1R antagonism on ROSC and short-term survival in prolonged VF.Thirty-six swine were assigned by block randomization to one of three groups: a group that received only vehicle (CONTROL), an ADOA1R antagonist pretreatment group (PRE), and a group that was given ADOA1R antagonist during resuscitation (DURING). The animals were instrumented under anesthesia, and ADOA1R antagonist or vehicle, per group assignment, was infused 5 minutes prior to VF induction. At minute 8 of untreated VF, chest compression with ventilation was initiated and a standard drug cocktail, with ADOA1R antagonist or vehicle, was given. The first rescue shock (150 J biphasic) was delivered after 11 minutes of VF. Proportions with 95% confidence intervals (CIs) were calculated for the two outcome measures.The baseline characteristics and chemistry values for the three groups were mathematically the same. The DURING group had a greater proportion of female animals (seven of 12) in comparison with the CONTROL group (two of 12) (p=0.03). ADOA1R antagonism hastened the decay of VF as previously demonstrated, but the rate of ROSC was the same for all groups: CONTROL=seven of 12, PRE=six of 12, and DURING=seven of 12. There were also no differences in short-term survival: CONTROL=four of 12, PRE=five of 12, and DURING=seven of 12.In this study, ADOA1R antagonism had no effect on outcome whether given before induction of VF or upon resuscitation after 8 minutes of untreated VF. The role of endogenous ADO in prolonged VF remains unclear.

    View details for DOI 10.1080/10903120802101223

    View details for Web of Science ID 000257147000014

    View details for PubMedID 18584504

  • Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: A survey of the national association of emergency medical services physicians PREHOSPITAL EMERGENCY CARE Suffoletto, B. P., Salcido, D. D., Menegazzi, J. J. 2008; 12 (1): 52?56

    Abstract

    Postresuscitation care of comatose survivors of cardiac arrest using induced hypothermia (IH) is recommended by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) to improve neurological outcomes but has been performed primarily later in the course of care. Recently, it was shown that prehospital cooling is feasible, safe, and effective in lowering patient temperature. We sought to determine the prevalence of EMS agencies that use prehospital IH. We also sought to determine what perceived barriers to initiating IH might exist and the understanding EMS physicians have of guidelines for IH.We collected a convenience sample of completed questionnaires from physician members of the National Association of EMS Physicians at the national conference on 3 days from January 11 to 13, 2007.One hundred forty-five (59%) physician members who had attended the conference completed the survey, representing 109 EMS Medical Directors and 36 non-Medical Director EMS Physicians from 92 regions of 34 U.S. states, three Canadian provinces, and one European country. A total of 9 of 145 (6.2%) of physicians stated that the EMS agency they are affiliated with uses a protocols for IH, 6 of whom were local EMS Medical Directors. The median (IQR) duration of having a protocol was 12 months (6-12), and all used either ice bags or cold IV fluid or a combination of the two. Among those who reported prehospital use of IH, only one of eight (12.5%) recall having cooled greater than 10% of eligible patients in the field. Common perceived barriers to IH include the following: overburden with other tasks (62.1%), short transport times (60.7%), lack of refrigeration equipment (60.0%), and receiving hospitals' failure to continue therapeutic hypothermia (56.6%). A small but significant percentage (22.1%) believed that the lack of guidelines specifically addressing prehospital cooling was a barrier to initiating a protocol, and only 62% correctly identified 32-34 degrees C as the recommended target temperature range.The practice of prehospital IH is rare. Infrequent use of prehospital cooling seen in our select population may be due to the perceived barriers that were identified and/or inadequate guidance from the scientific literature. Statements from the AHA and ILCOR first published in 2003 and reiterated in 2005 recommend the implementation but do not specify the most beneficial time to initiate postresuscitation cooling of comatose survivors of cardiac arrest. Further studies should examine the relative benefit of prehospital cooling.

    View details for DOI 10.1080/10903120701707880

    View details for Web of Science ID 000252347100009

    View details for PubMedID 18189178

  • Prehospital induced hypothermia after out-of-hospital cardiac arrest: Emergency medical services state of the practice in the US in 2007 Suffoletto, B., Menegazzi, J., Salcido, D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 936
  • Spontaneous body temperature is associated with survival following in-hospital cardiac arrest and return of spontaneous circulation: A report from the national registry of cardiopulmonary resuscitation Suffoletto, B., Callaway, C., Pelberdy, M., Hoek, T. LIPPINCOTT WILLIAMS & WILKINS. 2007: 935
  • The incidence of pulmonary aspiration with laryngeal mask airway use during cardiopulmonary resuscitation and positive pressure ventilation in swine Suffoletto, B., Menegazzi, J., Logue, E., Salcido, D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 935
  • Early post-resuscitation levels of cytochrome-c and interleukin-6 after prolonged porcine cardiac arrest Salcido, D. D., Logue, E. S., Suffoletto, B. P., Rittenberger, J. C., Menegazzi, J. J. LIPPINCOTT WILLIAMS & WILKINS. 2007: 931?32
  • Inducing hypothermia during resuscitation improves return of spontaneous circulation in prolonged porcine ventricular fibrillation Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Salcido, D. D., Sherman, L. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 923
  • Intramyocardial high-energy phosphate depletion during ventricular fibrillation correlates with electrocardiographic change Salcido, D. D., Menegazzi, J. J., Logue, E. S., Suffoletto, B. P., Sherman, L. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 582
  • Mild hypothermia slows the decay of quantitative ventricular fibrillation waveform morphology during prolonged cardiac arrest Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Salcido, D. D., Sherman, L. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 530
  • Increasing CPR duration prior to first defibrillation does not improve ROSC or survival in a swine model of prolonged ventricular fibrillation Rittenberger, J. C., Suffoletto, B., Salcido, D., Logue, E., Menegazzi, J. LIPPINCOTT WILLIAMS & WILKINS. 2007: 36
  • Effects of an impedance threshold device on hemodynamics and restoration of spontaneous circulation in prolonged porcine ventricular fibrillation PREHOSPITAL EMERGENCY CARE Menegazzi, J. J., Salcido, D. D., Menegazzi, M. T., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Mader, T. J. 2007; 11 (2): 179?85

    Abstract

    An impedance threshold device (ITD) has been designed to enhance circulation during CPR by creating a negative intrathoracic pressure during the relaxation phase of chest compression.We sought to determine the effects of the ITD on coronary perfusion pressure (CPP), return of spontaneous circulation (ROSC), and short-term survival (20 minutes after ROSC). We hypothesized that the ITD would improve all 3 variables when compared to standard CPR.Using a case-control design nested within a randomized primary study, we compared CPR with the ITD (ITD-CPR) to standard CPR without the device (S-CPR). We systematically assigned 36 domestic swine, weighing 23-29 kg, (18 per group) to resuscitation with either ITD-CPR or S-CPR after 8 minutes of untreated ventricular fibrillation (VF). At minute 8, mechanical chest compression and ventilation began, and drugs (0.1 mg/kg epinephrine, 40U vasopressin, 1.0 mg propranolol, 1 mEq/kg sodium bicarbonate) were given. The first rescue shock (150J biphasic) was delivered at minute 11 of VF. We recorded CPP, ROSC (systolic pressure > 80 mmHg sustained for 60 s continuously), and survival. Data were analyzed with Fisher's exact test and generalized estimating equations (GEE), with alpha = 0.05.We analyzed 3,150 compressions. CPP for the ITD-CPR group (28.1 mmHg [95% CI 27-29.3 mmHg]), did not differ from the S-CPR group (32.3 mmHg [95% CI 31.2-33.4 mmHg]). ROSC occurred in 6/18 (33%) animals in the ITD-CPR, and 14/18 (78%) in the S-CPR group (p = 0.02). Survival occurred in 3/18 (17%) ITD-CPR and 13/18 (72%) S-CPR group (p = 0.003).ITD-CPR did not improve CPP compared to S-CPR. ROSC and survival were significantly lower with ITD-CPR.

    View details for DOI 10.1080/10903120701206073

    View details for Web of Science ID 000245626700005

    View details for PubMedID 17454804

  • Intra-resuscitation hypothermia improves short-term survival in prolonged porcine ventricular fibrillation Menegazzi, J., Logue, E., Rittenberger, J., Reynolds, J., Suffoletto, B., Callaway, C. LIPPINCOTT WILLIAMS & WILKINS. 2006: 354
  • Feasibility of basic emergency medical technicians to perform selected advanced life support interventions PREHOSPITAL EMERGENCY CARE Guyette, F. X., Rittenberger, J. C., Platt, T., Suffoletto, B., Hostler, D., Wang, H. E. 2006; 10 (4): 518?21

    Abstract

    Emergency medical technician-basic (EMT-B) providers often provide the initial care to victims of out-of-hospital cardiac arrest. While automated external defibrillators enable EMT-B providers to deliver rescue shocks, patients in cardiac arrest may require additional interventions that EMT-B providers may not presently deliver. We sought to evaluate the feasibility of training EMT-B providers to provide additional cardiac resuscitation procedures using the laryngeal mask airway (LMA) and intraosseous (IO) access.In this prospective observational study, we trained 18 EMT-B providers to use the LMA and IO drill (EZ-IO) in a three-hour educational session. Working in two-person teams, the rescuers performed a simulated ventricular fibrillation resuscitation. We evaluated placement success as well as elapsed time to placement of the LMA and EZ-IO.EMT-B providers successfully placed the LMA in 14 of 18 scenarios (78%; 95% confidence interval, 52% to 94%), with a mean of two attempts for placement. Subjects successfully placed the EZ-IO in 17 of 18 scenarios (94%; 95% confidence interval, 73% to 100%), all on the first attempt. The median time to LMA placement following the third shock was 109 seconds (interquartile range, 58-158) and the median time to EZ-IO placement was 72 seconds (interquartile range, 50-93) after LMA placement.EMT-B providers demonstrated moderate success in performing advanced-level cardiac resuscitation interventions. These observations suggest potential for expanding the role of basic-level rescuers in cardiopulmonary resuscitation.

    View details for DOI 10.1080/10903120600726015

    View details for Web of Science ID 000242396900018

    View details for PubMedID 16997785

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