A pilot trial of topical capsaicin cream for treatment of cannabinoid hyperemesis

Background: Patients with cannabinoid hyperemesis syndrome (CHS) frequently present to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. Research Question: This exploratory study examines the safety and potential efficacy of topical capsaicin in patients with vomiting due to a suspected CHS exacerbation. Methods: This is a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment. We excluded pregnant females and those with resolution of nausea. Following randomization, topical 0.1% capsaicin or placebo cream was applied to the anterior abdomen in a uniform manner. Primary outcome was the severity of nausea on a visual analog scale (VAS) of 0-10 assessed at 30 minutes. Secondary outcomes were occurrence of post-treatment vomiting, nausea by VAS at 60minutes, and hospital admission. Results: This pilot trial enrolled 30 patients: 17 in the capsaicin arm and 13 in the placebo arm. One patient in the capsaicin arm did not tolerate treatment due to skin irritation. Nausea severity at 30 minutes was 4.1 (95%CI 2.8-5.4) in the capsaicin arm and 6.1 (95% CI 4.1-8.1) in the placebo arm. At 60 minutes, nausea severity was 3.2 (95%CI 1.6-4.8) vs. 6.4 (4.7-8.1). The percent reduction in nausea at 60 minutes from baseline was 46.0% (95% CI 25.5-66.5%) in the capsaicin arm and 24.9% (95% CI 7.8-41.9%) in the placebo arm. Hospital admission was necessary for four patients in the capsaicin arm (23.5%) vs. five (38.5%) in the placebo arm (RR 0.61, 95% CI 0.20-1.84). Conclusion: In this pilot trial of topical capsaicin for CHS, capsaicin was well-tolerated and demonstrated signs of efficacy. Further trials are warranted

Potential for Mobile Health Technology to Reduce Health Disparities in Underserved Communities

Background: Mobile health (mHealth) technology has potential to change how patients make healthcare decisions. However, in underserved communities, the readiness to use mHealth technology is unclear. We sought to determine the readiness for these patients to use mHealth technology to guide their medical decision making. Methods: This is a prospective, observational study of patients presenting to the urgent care section of an urban emergency department with a large, underserved population. Patients over the age of 2 that presented with low acuity complaints were included. We excluded patients with any suspicion for acute illness that would require admission. A structured interview was conducted with each patient or parent (for minors) about willingness to use mHealth tools for guidance. Analysis included descriptive statistics and univariate analysis based on age and gender. Results: 560 patients were included with 80% adults, 64% female, and 90% Black. The mean age was 28 ± 9 years for adults and 9 ± 5 years for children. One-third of patients reported no primary care physician while 55% were without phone access to any nurse or clinician for medical advice. Adults were less likely to have access to phone consultation than parents of children (42% vs. 59%, p\u3c0.001), as were males compared to females (35% vs. 51%, p\u3c0.001). Most patients (96%) reported cellular access for mobile apps, and 76% of patients reported that they frequently using mobile apps. While 67% of patients described seeking medical advice from friends or relatives, an equal number also reported using online references. The most commonly used online references were Google (66%) and WebMD (14%). When asked how they would behave if an mHealth tool advised them that their current health problem is low risk, 69% of patients responded that they would seek care in an outpatient clinic (30%), stay home and not seek urgent medical care (28%), or utilize telehealth (11%). Conclusion: In an urban community of young adults and parents, there is a high degree of capacity and willingness to implement mHealth technology to guide medical decision making. While traditional models of care may be strained, these results highlight the potential for mHealth to reduce disparities in healthcare in these communities

Unique Risk Factors for Thiamine Deficiency in ED Patients without Alcohol Dependence

Background: Thiamine (vitamin B1) is a crucial component in multiple essential biochemical pathways, andB1deficiency is increasingly recognized as a treatment target in sepsis and other critical illnesses. Our objective was to determine risk factors for B1 deficiency in severely ill ED patients without a history of alcohol dependence. Methods: This was a multi-pronged, prospective observational study that assessed B1 levels in ED patients with diabetic ketoacidosis, severe sepsis, and oncological emergencies. We excluded patients that had known alcohol dependence or for whom the ED clinicians planned B1 treatment. Investigators collected whole blood levels on all patients in ED, which measure thiamine-diphosphate,the active form of B1. We collected demographic and clinical characteristics that could contribute to nutritional deficiencies. We collected data specific to metformin use as pre-clinical data suggests that metformin may interfere with intestinal B1 transporters. Analysis consisted of univariate comparisons and multivariable logistic regression to assess significant risk factors for the primary outcome of B1 deficiency, defined as a whole blood level below the normal reference range. Results: The study enrolled 342 patients, of whom the average age was 57 (SD 17) years, 47% were female, and 80% African American. In univariate analysis, patients with B1 deficiency had greater mean age (62 vs. 56 years, p = 0.007), lower mean albumin (2.9 vs. 3.5 g/dL, p \u3c 0.001), and similar body mass index (28 vs. 28, p = 0.81). Patients with B1 deficiency were more often female (24% vs. 14%, p = 0.023). Thiamine deficiency occurred most frequently in patients with severe sepsis (27%) and oncological emergencies (28%) compared to all other diagnoses (10%, p=0.002). Diabetics on metformin had significantly higher rates of B1 deficiency compared to those not on metformin (22% vs. 10%, p = 0.03). In multivariate analysis, the following clinical characteristics (OR, 95% CI) were associated with B1 deficiency: female gender 2.0 (1.1 - 3.7), history of cancer 2.2 (1.2 - 4.0), metformin use 2.6 (1.0 - 6.5), and low albumin 2.6 (1.2 - 5.3). Conclusions: In this study,independent risk factors for B1 deficiency were female gender, cancer, and low albumin. Furthermore, this is the first clinical data to indicate a significant association between metformin use and B1 deficiency.https://scholarlycommons.henryford.com/merf2019clinres/1016/thumbnail.jp

Potential of Mobile Health Technology to Reduce Health Disparities in Underserved Communities.

INTRODUCTION: Mobile health (mHealth) has the potential to change how patients make healthcare decisions. We sought to determine the readiness to use mHealth technology in underserved communities. METHODS: We conducted a cross-sectional survey of patients presenting with low-acuity complaints to an urban emergency department (ED) with an underserved population. Patients over the age of two who presented with low-acuity complaints were included. We conducted structured interview with each patient or parent (for minors) about willingness to use mHealth tools for guidance. Analysis included descriptive statistics and univariate analysis based on age and gender. RESULTS: Of 560 patients included in the survey, 80% were adults, 64% female, and 90% Black. The mean age was 28 ± 9 years for adults and 9 ± 5 years for children. One-third of patients reported no primary care physician, and 55% reported no access to a nurse or clinician for medical advice. Adults were less likely to have access to phone consultation than parents of children (odds ratio [OR] 0.49, 95% confidence interval [CI], 0.32 - 0.74), as were males compared to females (OR 0.52, 95% CI, 0.37-0.74). Most patients (96%) reported cellular internet access. Two-thirds of patients reported using online references. When asked how they would behave if an mHealth tool advised them that their current health problem was low risk, 69% of patients responded that they would seek care in an outpatient clinic instead of the ED (30%), stay home and not seek urgent medical care (28%), or use telehealth (11%). CONCLUSION: In this urban community we found a large capacity and willingness to use mHealth technology in medical triage

Unique risk factors for thiamine deficiency in patients without alcohol dependence

Background: Thiamine (vitamin B1) is a crucial component in multiple essential biochemical pathways, and B1 deficiency is increasingly recognized as a treatment target in sepsis and other critical illnesses. Our objective was to determine risk factors for B1 deficiency in severely ill ED patients without a history of alcohol dependence. Methods: This was a multi-pronged, prospective observational study that assessed B1 levels in ED patients with diabetic ketoacidosis, severe sepsis, and oncological emergencies. We excluded patients that had known alcohol dependence or for whom the ED clinicians planned B1 treatment. Investigators collected whole blood levels on all patients in ED, which measure thiamine-diphosphate, the active form of B1. We collected demographic and clinical characteristics that could contribute to nutritional deficiencies. We collected data specific to metformin use as pre-clinical data suggests that metformin may interfere with intestinal B1 transporters. Analysis consisted of univariate comparisons and multivariable logistic regression to assess significant risk factors for the primary outcome of B1 deficiency, defined as a whole blood level below the normal reference range. Results: The study enrolled 342 patients, of whom the average age was 57 (SD 17) years, 47% were female, and 80% African American. In univariate analysis, patients with B1 deficiency had greater mean age (62 vs. 56 years, p = 0.007), lower mean albumin (2.9 vs. 3.5 g/dL, p \u3c 0.001), and similar body mass index (28 vs. 28, p = 0.81). Patients with B1 deficiency were more often female (24% vs. 14%, p = 0.023). Thiamine deficiency occurred most frequently in patients with severe sepsis (27%) and oncological emergencies (28%) compared to all other diagnoses (10%, p=0.002). Diabetics on metformin had significantly higher rates of B1 deficiency compared to those not on metformin (22% vs. 10%, p = 0.03). In multivariate analysis, the following clinical characteristics (OR, 95% CI) were associated with B1 deficiency: female gender 2.0 (1.1-3.7), history of cancer 2.2 (1.2-4.0), metformin use 2.6 (1.0-6.5), and low albumin 2.6 (1.2-5.3). Conclusion: In this study, independent risk factors for B1 deficiency were female gender, cancer, and low albumin. Furthermore, this is the first clinical data to indicate a significant association between metformin use and B1 deficiency

Potential of Mobile Health Technology to Reduce Health Disparities in Underserved Communities

INTRODUCTION: Mobile health (mHealth) has the potential to change how patients make healthcare decisions. We sought to determine the readiness to use mHealth technology in underserved communities. METHODS: We conducted a cross-sectional survey of patients presenting with low-acuity complaints to an urban emergency department (ED) with an underserved population. Patients over the age of two who presented with low-acuity complaints were included. We conducted structured interview with each patient or parent (for minors) about willingness to use mHealth tools for guidance. Analysis included descriptive statistics and univariate analysis based on age and gender. RESULTS: Of 560 patients included in the survey, 80% were adults, 64% female, and 90% Black. The mean age was 28 ± 9 years for adults and 9 ± 5 years for children. One-third of patients reported no primary care physician, and 55% reported no access to a nurse or clinician for medical advice. Adults were less likely to have access to phone consultation than parents of children (odds ratio [OR] 0.49, 95% confidence interval [CI], 0.32 - 0.74), as were males compared to females (OR 0.52, 95% CI, 0.37-0.74). Most patients (96%) reported cellular internet access. Two-thirds of patients reported using online references. When asked how they would behave if an mHealth tool advised them that their current health problem was low risk, 69% of patients responded that they would seek care in an outpatient clinic instead of the ED (30%), stay home and not seek urgent medical care (28%), or use telehealth (11%). CONCLUSION: In this urban community we found a large capacity and willingness to use mHealth technology in medical triage

A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome.

BACKGROUND: Patients with cannabinoid hyperemesis syndrome (CHS) present frequently to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. This exploratory study examined the potential effectiveness of topical capsaicin in patients with nausea and vomiting due to a suspected CHS exacerbation. METHODS: This was a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment. We excluded pregnant women and those with resolution of symptoms. Following randomization, topical 0.1% capsaicin or placebo cream was applied to the anterior abdomen in a uniform manner. The primary outcome was the severity of nausea on a visual analog scale (VAS) of 0-10 cm assessed at 30 minutes. Secondary outcomes were adverse events, occurrence of post-treatment vomiting, nausea by VAS at 60 minutes, and hospital admission. RESULTS: This pilot trial enrolled 30 patients; 17 in the capsaicin arm and 13 in the placebo arm. One patient in the capsaicin arm did not tolerate treatment due to skin irritation. Mean nausea severity at 30 minutes was 4.1 ±2.3 cm in the capsaicin arm and 6.1 ±3.3 cm in the placebo arm (difference -2.0 cm, 95% CI, 0.2 to -4.2 cm). At 60 minutes, mean nausea severity was 3.2 ±3.2 cm versus 6.4 ±2.8 cm (difference -3.2 cm, 95% CI, -0.9 to -5.4 cm). The percent reduction in nausea at 60 minutes from baseline was 46.0% in the capsaicin arm and 24.9% in the placebo arm (difference 21.1%, 95% CI, -5.6% to 47.9%). A higher proportion of capsaicin group patients (29.4% vs. 0%) had complete resolution of nausea (RR 3.4, 95% CI, 1.6 to 7.1). CONCLUSION: In this pilot trial, the application of topical capsaicin cream was associated with a significant reduction in nausea at 60 minutes but not at 30 minutes and provided more complete relief of nausea