Gender Differences in Emergency Department (ED) Patient Mechanical Fall Risk and Openness to Communication with Providers

Gender Differences in Emergency Department (ED) Patient Mechanical Fall Risk and Openness to Communication with Providers Bryan G Kane, MD, Michael C Nguyen MD, Robert D Barraco, MD MPH, Brian Stello MD, Arnold Goldberg MD, Clare M Lenhart, PhD MPH, Bernadette G Porter BA ,Anita Kurt PhD, RN, Marna Rayl Greenberg DO, MPH Objectives: The CDC reports that among older adults (≥65), falls are the leading cause of injury-related death and rates of fall-related fractures among older women are more than twice those for men. We set out to determine ED patient perceptions (analyzed by gender) about their personal fall risk compared to their actual risk and their comfort level in discussing their fall history or a home safety plan with their healthcare provider. Methods: After IRB approval, a convenience sample of ED patients (50 years or older) was surveyed at a suburban Level 1 Trauma center with an annual ED census of approximately 75,000. The survey included demographics, the Falls Efficacy Scale (FES), and questions about fall risk. The FES is a validated survey measuring concern of falling. Analysis included descriptive statistics and assessment of fall risk and fear of falling by gender using chi-square and t-tests as indicated. Significance was set at 0.05. Results: Of the 150 surveys collected, 149 indicated gender and were included in this analysis. Fifty-five percent of the sample was female (n=82); 45% (n=67) were male. Most (98%) were Caucasian and 22% reported living alone. There was not a difference in the mean age of female participants 69.79 years (SD=12.08) vs. males 68.06 (SD=10.36; p=0.355). See Table 1 for distribution of reported fall risk factors between genders. Collectively, these variables resulted in a mean risk of falling score of 3.37(SD=1.62) out of 9. On average, female participants had a significantly higher objective risk of falling than did male participants (3.65 vs. 3.02 p=0.018). Similarly, females also reported greater fear of falling than did males (FES score 12.33 vs. 9.62; p=0.005). Significantly more females (41.5%) than males (23.9%, p=0.037) reported having fallen in the past year. Of the 50 participants reporting past-year falls, only 19 (12 female and 7 male, p=0.793) sought treatment. The correlation between actual fall risk and fear of falling were greater among females (p The majority of patients (76.4%) were willing to speak to a provider about their fall risk. No significant difference was noted in willingness to discuss this topic with a provider based on gender (p=0.619), objective fall risk (p=0.145) or FES score (p=0.986). Similarly, many respondents indicated a willing to discuss a home safety evaluation with a provider (58.1%) and responses did not vary significantly by gender (p=.140), objective fall risk (p=0.168) or FES score (p=.584). Conclusion: In this study, female ED patients reported a greater fear of falling, had a significantly higher objective risk of falling, and had a higher correlation between their perceived risk and actual risk of falling than did males. The majority of both genders were amenable to discussing their fall risk and a home safety evaluation with their provider

Modified CAGE as a Screening Tool for Mechanical Fall Risk Assessment: A Pilot Survey

Modified CAGE as a Screening Tool for Mechanical Fall Risk Assessment: A Pilot Survey Marna Rayl Greenberg DO, MPH, Michael C Nguyen MD, Bernadette G Porter BA,Robert DBarraco, MD MPH, Brian Stello MD, Arnold Goldberg MD, Clare M Lenhart, PhD MPH,Anita Kurt PhD, RN, Bryan G Kane, MD Background: Falls in the elderly cause serious injury. The literature does not hold answers to patient perceptions about their personal fall risk, their comfort level in discussing their fall history, or a home safety plan with their healthcare provider. Existing risk-assessing tools may be prohibitive in the Emergency Department due to their length and complexity. Objective: We piloted a modified CAGE screen (Fig1) to identify adults at risk for falls. Methods: At a community health event, a convenience sample ofparticipants (50 years or older) was surveyed. The survey included demographics, the Falls Efficacy Scale (FES), the modified CAGEand questions about fall risk.The FES is a validated, but longer, survey metric for comparison. A modified CAGE score greater than or equal to 1 was considered positive. Analysis included descriptive statistics and modified CAGE groups were compared by gender, fall risk and history with chi-square. Results: One hundred sevensubjects (66.4%female, 32.7% male) with a mean age of 66 (SD7.9)participated; 98 (91.6%)were Caucasian. Twenty (18.7%) lived alone,43 (40.2%) had a cat or dog, and 91 (85%) had stairs at home. Six (5.6%) reported using assistive devices, 2 (1.9%) at-risk alcohol use; 9 (8.4%)taking blood thinners, 50 (46.7%) taking blood pressure medications, and 22 (20.6%) one or more medications that could make them drowsy. Thirty-threesubjects(30.8%) reported having fallen in the past year; only13 (39.4% of those fallen)sought treatment. Collectively, these variables resulted in a mean risk of falling score of 2.49 (SD=1.36) out of 9. Eleven (31.4%)femalesand27 (38.0%)malesrecorded ≥1 positive responses on the modified CAGE.A modified CAGE positive responsewas significantly greater among those with past-year falls (51.5%) than those without (29.7%), p=0.031.A positive modified CAGE screen was also associated with a higher mean FES score (10.82 v7.83, p More females than males reported past year falls (36.6% vs. 17.1%, p=0.04) yet no difference in fall risk was noted between genders (4.44 vs. 4.26, p=0.506). The proportion of modified CAGE positive participants did not vary between females and males (38% vs. 31%, p=0.505). Of those whoscreened positive on the modified CAGE, 36 (92.3%) reported comfort in speaking to their healthcare provider about their fall risk and 26 (66.7%) in having a home safety evaluation. Conclusions: In this pilot, a positive modified CAGE is associated with both higher FES scores and a willingness to discuss fall risk with a health care provider. The modifiedCAGE may be a usefulbrief screening tool to detect fall risk in adults. Further studies to determine the extent of its utility in an Emergency Department should be considered

Comparison of Airway Intubation Devices When Using a Biohazard Suit: A Feasibility Study

OBJECTIVES: We set out to compare emergency medicine residents\u27 intubating times and success rates for direct laryngoscopy (DL), GlideScope-assisted intubation (GS), and the Supraglottic Airway Laryngopharyngeal Tube (SALT) airway with and without biohazard gear. METHODS: Each resident passed through 2 sets of 3 testing stations (DL, GS, SALT) in succession, intubating Laerdal mannequin heads with the 3 modalities after randomization to start with or without biohazard gear. RESULTS: Thirty-seven residents participated, and 27 were male (73%); 14 (37.8%) had prior experience intubating in biohazard suits. There was a statistically significant difference in those who had prior intubation experience between DL (37, 100%), GS (32, 86.5%), and SALT (12, 32.4%) (P \u3c .001) and in median time to intubation (48 seconds, no suit; 57 seconds, with suits) (P = .03). There was no statistically significant difference between the overall times to intubate for the 3 devices. First-pass success was highest for DL (91.2%, no suit; 83.7%, suit) followed by GS (89%, no suit; 78.3%, suit) and SALT (51%, no suit; 67.6%, suit). CONCLUSION: A minority of participants had prior experience intubating in biohazard suits. Use of biohazard suits extends time to successful intubation. There was no difference in time to intubation for the 3 devices, but first-pass success was highest for DL (with or without biohazard gear)

A Predictive Model for Corticosteroid Response in Individual Patients with MS Relapses

<div><p>Objectives</p><p>To derive a simple predictive model to guide the use of corticosteroids in patients with relapsing remitting MS suffering an acute relapse.</p><p>Materials and Methods</p><p>We analysed individual patient randomised controlled trial data (n=98) using a binary logistic regression model based on age, gender, baseline disability scores [physician-observed: expanded disability status scale (EDSS) and patient reported: multiple sclerosis impact scale 29 (MSIS-29)], and the time intervals between symptom onset or referral and treatment.</p><p>Results</p><p>Based on two a priori selected cut-off points (improvement in EDSS ≥ 0.5 and ≥ 1.0), we found that variables which predicted better response to corticosteroids after 6 weeks were younger age and lower MSIS-29 physical score at the time of relapse (model fit 71.2% - 73.1%).</p><p>Conclusions</p><p>This pilot study suggests two clinical variables which may predict the majority of the response to corticosteroid treatment in patients undergoing an MS relapse. The study is limited in being able to clearly distinguish factors associated with treatment response or spontaneous recovery and needs to be replicated in a larger prospective study.</p></div

Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial

Background: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA. Methods/Design: This is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System. Discussion: This culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Funded by Patient-Centered Outcomes Research Institute (PCORI) Award (AD-1408-19519)