Browsing by Author "Holmes, Emily"

Now showing 1 - 5 of 5
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    Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial
    (Elsevier, 2023-01) Connors, Jill Nault; Kroenke, Kurt; Monahan, Patrick; Chernyak, Yelena; Pettit, Kate; Hayden, Julie; Montgomery, Chet; Brenner, George; Millard, Michael; Holmes, Emily; Musey, Paul; Psychiatry, School of Medicine
    Background Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. Objectives The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. Methods The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. Discussion PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
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    Discharges against medical advice: time to take another look. A retrospective review of discharges against medical advice focused on prevention
    (Taylor & Francis, 2023) Jaydev, Fnu; Gavin, Warren; Russ, Jason; Holmes, Emily; Kumar, Vinod; Sadowski, Joshua; Kara, Areeba; Medicine, School of Medicine
    Background Discharges against medical advice (DAMA) increase the risk of death. Methods We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021. Results DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed. Conclusions Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.
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    Navigating Minority and Gender Discrimination, Substance Use Disorder, Financial Distress, and Workplace Politics: Lessons for Work-Life Wellness in Academic Medicine: Part 2 of 3
    (University of Kansas Libraries, 2023-06-20) Ahmed, Rami; Hartwell, Jennifer L.; Farley, Heather; MacRae, Julia; Rogers, David A.; Lawrence, Elizabeth C.; Brazeau, Chantal Mlr; Park, Eliza M.; Cassidy, Anna; Hartsock, Jane; Holmes, Emily; Schroeder, Kristen; Barach, Paul; Emergency Medicine, School of Medicine
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    Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3
    (University of Kansas Libraries, 2023-06-20) Barach, Paul; Ahmed, Rami; Agarwal, Gaurava; Olson, Kristine; Welch, Julie; Chernoby, Kimberly; Hein, Christine L.; Anand, Tanya; Joseph, Bellal; Rosenstein, Donald L.; Sotto-Santiago, Sylk; Hartsock, Jane; Holmes, Emily; Schroeder, Kristen; Hartwell, Jennifer L.; Medicine, School of Medicine
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    Navigating Work-Life Integration, Legal Issues, Patient Safety: Lessons for Work-Life Wellness in Academic Medicine: Part 1 of 3
    (University of Kansas Libraries, 2023-06-20) Hartwell, Jennifer L.; Barach, Paul; Gunter, Tracy D.; Reed, Kyra; Kelker, Heather; Welch, Julie; Olson, Kristine; Harry, Elizabeth; Meltzer-Brody, Samantha; Quinn, Mariah; Ferrand, Jennifer; Kiely, Sharon C.; Hartsock, Jane; Holmes, Emily; Schroeder, Kristin; Ahmed, Rami; Psychiatry, School of Medicine