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Sandra Schneider, MD

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Updated: 4 days 10 min ago

Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool.

Fri, 10/04/2019 - 14:55
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Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool.

Ann Emerg Med. 2019 Sep 26;:

Authors: Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S

Abstract
Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.

PMID: 31563402 [PubMed - as supplied by publisher]

A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients.

Wed, 03/20/2019 - 20:55
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A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients.

West J Emerg Med. 2019 Mar;20(2):403-408

Authors: Peltzer-Jones J, Nordstrom K, Currier G, Berlin JS, Singh C, Schneider S

Abstract
Introduction: Emergency departments (ED) manage a wide variety of critical medical presentations. Traumatic, neurologic, and cardiac crises are among the most prevalent types of emergencies treated in an ED setting. The high volume of presentations has led to collaborative partnerships in research and process development between experts in emergency medicine (EM) and other disciplines. While psychosis is a medical emergency frequently treated in the ED, there remains a paucity of evidence-based literature highlighting best practices for management of psychotic presentations in the ED. In the absence of collaborative research, development of best practice guidelines cannot begin. A working group convened to develop a set of high-priority research questions to address the knowledge gaps in the care of psychotic patients in the ED. This article is the product of a subgroup considering "Special Populations: Psychotic Spectrum Disorders," from the 2016 Coalition on Psychiatric Emergencies first Research Consensus Conference on Acute Mental Illness.
Methods: Participants were identified with expertise in psychosis from EM, emergency psychiatry, emergency psychology, clinical research, governmental agencies, and patient advocacy groups. Background literature reviews were performed prior to the in-person meeting. A nominal group technique was employed to develop group consensus on the highest priority research gaps. Following the nominal group technique, input was solicited from all participants during the meeting, questions were iteratively focused and revised, voted on, and then ranked by importance.
Results: The group developed 28 separate questions. After clarification and voting, the group identified six high-priority research areas. These questions signify the perceived gaps in psychosis research in emergency settings. Questions were further grouped into two topic areas: screening and identification; and intervention and management strategies.
Conclusion: While psychosis has become a more common presentation in the ED, standardized screening, intervention, and outcome measurement for psychosis has not moved beyond attention to agitation management. As improved outpatient-intervention protocols are developed for treatment of psychosis, it is imperative that parallel protocols are developed for delivery in the ED setting.

PMID: 30881564 [PubMed - in process]

Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology.

Wed, 03/20/2019 - 20:55
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Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology.

West J Emerg Med. 2019 Mar;20(2):380-385

Authors: Wilson MP, Shenvi C, Rives L, Nordstrom K, Schneider S, Gerardi M

Abstract
Introduction: Despite the ever-increasing numbers of mental health patients presenting to United States emergency departments, there are large gaps in knowledge about acute care of the behavioral health patient. To address this important problem, the Coalition on Psychiatric Emergencies convened a research consensus conference in December 2016 consisting of clinical researchers, clinicians from emergency medicine, psychiatry and psychology, and representatives from governmental agencies and patient advocacy groups.
Methods: Participants used a standardized methodology to select and rank research questions in the order of importance to both researchers and patients.
Results: Three working groups (geriatrics, substance use disorders, and psychosis) reached consensus on 26 questions within their respective domains. These questions are summarized in this document.
Conclusion: The research consensus conference is the first of its kind to include non-clinicians in helping identify knowledge gaps in behavioral emergencies. It is hoped that these questions will prove useful to prioritize future research within the specialty.

PMID: 30881561 [PubMed - in process]

Financial planning and satisfaction across life domains among retired emergency physicians in the United States.

Wed, 01/30/2019 - 08:35
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Financial planning and satisfaction across life domains among retired emergency physicians in the United States.

Am J Emerg Med. 2018 Mar;36(3):508-510

Authors: Kuhn GJ, Marco CA, Mallory MNS, Blanda M, Kaplan JA, Schneider SM, Joldersma KB, Martin SI, Choo EK

PMID: 28784258 [PubMed - indexed for MEDLINE]