Christopher Carpenter - Academia.edu (original) (raw)

Papers by Christopher Carpenter

Academic Emergency Medicine

Journal of the American Geriatrics Society

The scientific growth of geriatric emergency care is accelerating. While North American clinical ... more The scientific growth of geriatric emergency care is accelerating. While North American clinical leaders seeking American College of Emergency Physician’s Geriatric Emergency Department Accreditation adapt infrastructure, continuing medical education foci, and operational protocols to optimize the outcomes of care for aging populations, researchers seek markers of short-term postemergency department (ED) vulnerability for preventable undesirable outcomes. A clinically useful prognostic instrument to identify high-risk or low-risk populations would have a positive likelihood ratio of 10 or higher or a negative likelihood ratio of .1 or lower, respectively. Heeren et al add to our understanding of vulnerability accuracy by comparing the Identification of Seniors at Risk (ISAR), Flemish version of Triage Risk Screening Tool (fTRST), and the interRAI Emergency Department Screener. Their findings are consistent with decades of research quantifying the prognostic accuracy of numerous instruments (Table 1): ISAR, fTRST, and interRAI identify neither high risk nor low risk for vulnerability to prolonged ED length of stay, hospitalization, or unplanned readmissions. Despite these imperfections, geriatric ED vulnerability screeners are widely used because they promote the awareness of geriatric syndrome among patients and professionals and trigger safe interventions that demand low resources, such as delirium prevention. If after decades of research we cannot accurately predict outcomes associated with vulnerability in older ED patients, should we halt attempts to develop better screening instruments? Will it ever be possible to target those older patients effectively during an ED visit who are likely to benefit from intensive geriatric interventions and advanced care planning? Or is geriatric ED vulnerability research futile because aging in essence is chaotic and unpredictable? These questions address the core of geriatric emergency medicine. Figure 1 depicts two paths forward. Vulnerability screening instruments ideally would identify older ED patients most likely to benefit from additional evaluation with Comprehensive Geriatric Assessment, which is effective for a range of patient-centered outcomes but not feasible for all patients in most EDs. Pragmatically, we therefore envision a three-step ED approach. Step 1: Use an accurate vulnerability assessment instrument to identify patients who may benefit from more holistic geriatric care. Step 2: Target assessment of geriatric impairments and presentations (such as cognitive impairment and falls) on the most vulnerable subset identified before initiating preventive interventions in a manner that is feasible and adaptable for different EDs. Step 3: Ensure adequate follow-up for a more thorough assessment either in the inpatient or outpatient setting. Ideally, this approach is associated with both better patient outcomes and better ED flow, but this theoretical construct unfortunately awaits conclusive validation. Until then, the real-world tension constraining geriatric syndrome screening is that the contemporary ED confronts at-capacity hospital volumes every day. Lacking proof of benefit or cost effectiveness, comprehensive serial assessments in the ED are not palatable when waiting rooms are filled with anxiously waiting patients of all ages. Some healthcare systems are adapting to this tension by creating geriatric-focused observation or frailty units that provide time for specialists’ consultations, but many organizations lack this flexibility. Why has predicting geriatric vulnerability been such a challenge? Heeren et al offer several explanations intended to guide future researchers. First, identifying the complexities underlying aging-related vulnerabilities such as cognitive dysfunction, mobility issues, polypharmacy, frailty, and social isolation may be unrealistic without more objective geriatric assessments beyond self-reported checklists. Diagnostic and prognostic ED accuracy research is emerging and evolving for dementia, delirium, falls, frailty, and other geriatric syndromes. Incorporation of these more objective validated measures into future vulnerability studies might improve instrument accuracy. Alternatively, these objective assessments of dementia, delirium, falls, or frailty could be used as serial geriatric assessment measures for those identified by the rapid screener as “vulnerable.” Second, Heeren et al suggest that one screening tool to predict multiple outcomes may be unrealistic because the intrinsic and extrinsic precipitants and risk factors for ED returns, hospitalization, functional decline, or institutionalization probably differ between patients and healthcare systems. ED return visits are often unpredictable with information routinely available in the ED. Alternatively, predictors of DOI: 10.1111/jgs.16502

Journal of the American Geriatrics Society

See related editorial by High et al. in this issue. Through the National Institute on Aging's (NI... more See related editorial by High et al. in this issue. Through the National Institute on Aging's (NIA's) "Grants for Early Medical/Surgical Specialists" Transition to Aging Research (GEMSSTAR) U13 grant, the NIA and the American Geriatrics Society (AGS) developed three transdisciplinary research conferences with a focus on mentoring and leadership skills development. The NIA's GEMSSTAR program evolved from two earlier programs, the AGS' Dennis W. Jahnigen and the Association of Specialty Professors' T. Franklin Williams Career Development Scholars Awards. It supports the continued cultivation of the next generation of medical and surgical specialty researchers with an interest in aging research. The award requires both geriatrics and specialty mentoring and currently provides up to $150,000 a year in direct support to scholars. Additionally, the award requires that scholars have a professional development plan that is complementary to the GEMSSTAR award. The U13 conferences, focused on frailty, models of aging, and cognition, brought together GEMSSTAR scholars, former scholars, innovators, mentors, and leaders in aging research, the specialties, and geriatric medicine. This article describes the themes of each of the GEMSSTAR U13 conferences and highlights the lessons learned on mentoring, team science, aging research networks, and work-life balance. We plan to use these lessons to guide the support we provide to the growing group of emerging leaders who are poised to lead the transdisciplinary research network of the future.

Emergency Medicine Australasia

Fall injuries and consequences Generally speaking, the falls in older people we see in the ED are... more Fall injuries and consequences Generally speaking, the falls in older people we see in the ED are the tip

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 17, 2018

Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain.... more Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain. Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low-dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED. This systematic review and meta-analysis sought to quantify whether LDK is an effective and safe opioid alternative for acute pain reduction in adults in the ED setting. (PROSPERO Registration Number CRD42017065303). This was a systematic review of randomized controlled trials comparing intravenous opioids to LDK for relief of acute pain in the ED. Studies where the control group initially received opioids prior to ketamine were excluded. A research librarian designed the electronic search strategy. Changes in visual analog scale or numeric rating scale pain scales were analyzed to determine the relative effects of LDK and opioids in the treatment of acute pain. Three studies met the criteria for inclusion in ...

BMJ open, Mar 16, 2018

Cognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency ... more Cognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency department (ED). Our primary objective was to determine the diagnostic accuracy of the Ottawa 3DY (O3DY) and Short Blessed Test (SBT) as screening tools for the detection of CD in the ED. Our secondary objective was to estimate the inter-rater reliability of these instruments. We conducted a prospective cross-sectional comparative study at an inner-city academic medical centre (annual ED visit census 86 000). Patients aged 75 years or greater were evaluated for inclusion, 163 were screened, 150 were deemed eligible and 117 were enrolled. The research team completed the O3DY, SBT and Mini-Mental State Exam (MMSE) for each participant. Descriptive statistics were calculated. Sensitivity and specificity of the O3DY and SBT were calculated in STATA V.11.2 using the MMSE as our criterion standard. We enrolled 117 patients from June to November 2016. The median ED length of stay at the time of...

Academic Emergency Medicine

Academic Emergency Medicine, 2016

Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicin... more Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Aug 16, 2016

The proportion of patients over age 65 who seek care in the Emergency Department (ED) has been in... more The proportion of patients over age 65 who seek care in the Emergency Department (ED) has been increasing for decades and many of these visits are related to musculoskeletal injury or pain. The elderly are less likely to have their pain appropriately assessed and managed in the ED in comparison to younger adults, although gender and ethnic disparities in oligoanalgesia occur across all age groups. Emergency medicine resident geriatric core competencies include the assessment and management of pain in accordance with the patient's goals of care. In spite of this, the Society for Academic Emergency Medicine Geriatric Task Force identified pain management in the elderly as one condition for which there is a significant quality gap. This article is protected by copyright. All rights reserved.

Academic Emergency Medicine, 2016

Academic Emergency Medicine, 2015

Injury Epidemiology, 2014

Background: Driving self-restriction is well-documented among older drivers but might also occur ... more Background: Driving self-restriction is well-documented among older drivers but might also occur among younger drivers. Little is known about the driving patterns of emergency department (ED) patients, who may be a high-risk population for motor vehicle crashes (MVCs). We sought to compare the driving patterns and MVCs of younger and older adult ED patients in order to inform development of injury prevention interventions in EDs. Methods: We surveyed English-speaking younger adult (age 25-64) and older adult (age ≥65) ED patients, excluding non-drivers and those who were cognitively-impaired or too sick to participate. We compared drivers by age group and used logistic regression with adjustment for driving frequency to examine factors associated with driving self-restriction. Results: Of those eligible, 82% (n = 178) of younger adult and 91% (n = 134) of older adult patients participated; approximately half were women. Similar proportions of younger and older adult patients reported driving everyday/almost everyday (80%) but also self-restricting driving in inclimate weather (48%), heavy traffic (27%), in unfamiliar places (21%), when travelling with passengers (1.6%) or when alone (1.3%). Fewer younger adult than older adult patients avoided driving at night (22% versus 49%) or on highways (6.7% versus 26%). In multivariable logistic regression, factors significantly associated self-imposed driving restriction in ≥1 driving situation were female gender (Odds Ratio [OR] 2.40; 95% CI 1.42-4.05) and ever feeling "confused, nervous or uncomfortable" while driving (OR 1.87; 95% CI 1.03-3.39). There was a non-significant trend for differences in proportions between younger adult (11%) and older adult (6.8%) drivers reporting ≥1 MVC as a driver in the past 12 months. Conclusions: Similar proportions of younger and older adult ED patients self-restrict driving, albeit in different situations, which has implications for behavioral interventions for injury prevention and for education of patients and medical providers.

Annals of Emergency Medicine, 2011

Study objective-We evaluate the diagnostic test characteristics of the Six-Item Screener and the ... more Study objective-We evaluate the diagnostic test characteristics of the Six-Item Screener and the AD8 to detect cognitive dysfunction in adults older than 65 years and using the emergency department (ED) for any reason. Methods-We conducted an observational cross-sectional cohort study at a single academic urban university-affiliated hospital. Subjects were consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED. We quantitatively assessed the diagnostic test characteristics of the Six-Item Screener and AD8 by using the Mini-Mental State Examination score less than 24 as the criterion standard for cognitive dysfunction. Results-The prevalence of cognitive dysfunction was 35%, but only 6% of charts noted a preexisting deficit. The Six-Item Screener was superior to either the caregiver-administered AD8 or the patient-administered AD8 for the detection of cognitive dysfunction. Conclusion-The Six-Item Screener was superior to the caregiver-or patient-administered AD8 to identify older adults at increased risk for occult cognitive dysfunction.

Annals of Emergency Medicine, 2004

Academic Emergency Medicine, 2007

This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge... more This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge Translation, at the 2007 Academic Emergency Medicine Consensus Conference on knowledge translation (KT) in emergency medicine (EM). The objective was to develop a research strategy that incorporates KT into EM graduate medical education (GME). To bridge the gap between the best evidence and optimal patient care, Pathman et al. suggested a multistage model for moving from evidence to action. Using this theoretical knowledge-to-action framework, the KT consensus conference group focused on four key components: acceptance, application, ability, and remembering to act on the existing evidence. The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT. Current residents are limited by faculty GME role models to demonstrate bedside KT principles. The rapid uptake of KT theory will depend on developing KT champions locally and internationally for resident physicians to emulate. The consensus participants combined published evidence with expert opinion to outline recommendations for identifying the barriers to KT by asking four specific questions: 1) What are the barriers that influence a resident's ability to act on valid health care evidence? 2) How do we break down these barriers? 3) How do we incorporate this into residency training? 4) How do we monitor the longevity of this intervention? Research in the fields of GME and KT is currently limited. GME educators assume that if we teach residents, they will learn and apply what they have been taught. This is a bold assumption with very little supporting evidence. This article is not an attempt to provide a complete overview of KT and GME, but, instead, aims to create a starting point for future work and discussions in the realm of KT and GM.

The SAGE Handbook of Persuasion: Developments in Theory and Practice, 2012

Journal of Policy Analysis and Management, 2004

This paper uses the widespread variation across states in the timing of adoption of tougher drunk... more This paper uses the widespread variation across states in the timing of adoption of tougher drunk driving laws that set very low legal blood alcohol limits for drivers under age 21-“zero tolerance” (ZT) laws-to provide new evidence on the causal effect of alcohol use on youth suicide. ZT laws reduced heavy episodic drinking by underage men, with no effect for

Page 498. 24 Persuading in the Small Group Context FRANKLIN J. BOSTER MICHAEL G. CRUZ From LeBon&... more Page 498. 24 Persuading in the Small Group Context FRANKLIN J. BOSTER MICHAEL G. CRUZ From LeBon's (1896) fascination with mobs and Tarde's (1903) interest in imitation to studies of social impact (Latane, 1996) and ...

Academic Emergency Medicine

Journal of the American Geriatrics Society

The scientific growth of geriatric emergency care is accelerating. While North American clinical ... more The scientific growth of geriatric emergency care is accelerating. While North American clinical leaders seeking American College of Emergency Physician’s Geriatric Emergency Department Accreditation adapt infrastructure, continuing medical education foci, and operational protocols to optimize the outcomes of care for aging populations, researchers seek markers of short-term postemergency department (ED) vulnerability for preventable undesirable outcomes. A clinically useful prognostic instrument to identify high-risk or low-risk populations would have a positive likelihood ratio of 10 or higher or a negative likelihood ratio of .1 or lower, respectively. Heeren et al add to our understanding of vulnerability accuracy by comparing the Identification of Seniors at Risk (ISAR), Flemish version of Triage Risk Screening Tool (fTRST), and the interRAI Emergency Department Screener. Their findings are consistent with decades of research quantifying the prognostic accuracy of numerous instruments (Table 1): ISAR, fTRST, and interRAI identify neither high risk nor low risk for vulnerability to prolonged ED length of stay, hospitalization, or unplanned readmissions. Despite these imperfections, geriatric ED vulnerability screeners are widely used because they promote the awareness of geriatric syndrome among patients and professionals and trigger safe interventions that demand low resources, such as delirium prevention. If after decades of research we cannot accurately predict outcomes associated with vulnerability in older ED patients, should we halt attempts to develop better screening instruments? Will it ever be possible to target those older patients effectively during an ED visit who are likely to benefit from intensive geriatric interventions and advanced care planning? Or is geriatric ED vulnerability research futile because aging in essence is chaotic and unpredictable? These questions address the core of geriatric emergency medicine. Figure 1 depicts two paths forward. Vulnerability screening instruments ideally would identify older ED patients most likely to benefit from additional evaluation with Comprehensive Geriatric Assessment, which is effective for a range of patient-centered outcomes but not feasible for all patients in most EDs. Pragmatically, we therefore envision a three-step ED approach. Step 1: Use an accurate vulnerability assessment instrument to identify patients who may benefit from more holistic geriatric care. Step 2: Target assessment of geriatric impairments and presentations (such as cognitive impairment and falls) on the most vulnerable subset identified before initiating preventive interventions in a manner that is feasible and adaptable for different EDs. Step 3: Ensure adequate follow-up for a more thorough assessment either in the inpatient or outpatient setting. Ideally, this approach is associated with both better patient outcomes and better ED flow, but this theoretical construct unfortunately awaits conclusive validation. Until then, the real-world tension constraining geriatric syndrome screening is that the contemporary ED confronts at-capacity hospital volumes every day. Lacking proof of benefit or cost effectiveness, comprehensive serial assessments in the ED are not palatable when waiting rooms are filled with anxiously waiting patients of all ages. Some healthcare systems are adapting to this tension by creating geriatric-focused observation or frailty units that provide time for specialists’ consultations, but many organizations lack this flexibility. Why has predicting geriatric vulnerability been such a challenge? Heeren et al offer several explanations intended to guide future researchers. First, identifying the complexities underlying aging-related vulnerabilities such as cognitive dysfunction, mobility issues, polypharmacy, frailty, and social isolation may be unrealistic without more objective geriatric assessments beyond self-reported checklists. Diagnostic and prognostic ED accuracy research is emerging and evolving for dementia, delirium, falls, frailty, and other geriatric syndromes. Incorporation of these more objective validated measures into future vulnerability studies might improve instrument accuracy. Alternatively, these objective assessments of dementia, delirium, falls, or frailty could be used as serial geriatric assessment measures for those identified by the rapid screener as “vulnerable.” Second, Heeren et al suggest that one screening tool to predict multiple outcomes may be unrealistic because the intrinsic and extrinsic precipitants and risk factors for ED returns, hospitalization, functional decline, or institutionalization probably differ between patients and healthcare systems. ED return visits are often unpredictable with information routinely available in the ED. Alternatively, predictors of DOI: 10.1111/jgs.16502

Journal of the American Geriatrics Society

See related editorial by High et al. in this issue. Through the National Institute on Aging's (NI... more See related editorial by High et al. in this issue. Through the National Institute on Aging's (NIA's) "Grants for Early Medical/Surgical Specialists" Transition to Aging Research (GEMSSTAR) U13 grant, the NIA and the American Geriatrics Society (AGS) developed three transdisciplinary research conferences with a focus on mentoring and leadership skills development. The NIA's GEMSSTAR program evolved from two earlier programs, the AGS' Dennis W. Jahnigen and the Association of Specialty Professors' T. Franklin Williams Career Development Scholars Awards. It supports the continued cultivation of the next generation of medical and surgical specialty researchers with an interest in aging research. The award requires both geriatrics and specialty mentoring and currently provides up to $150,000 a year in direct support to scholars. Additionally, the award requires that scholars have a professional development plan that is complementary to the GEMSSTAR award. The U13 conferences, focused on frailty, models of aging, and cognition, brought together GEMSSTAR scholars, former scholars, innovators, mentors, and leaders in aging research, the specialties, and geriatric medicine. This article describes the themes of each of the GEMSSTAR U13 conferences and highlights the lessons learned on mentoring, team science, aging research networks, and work-life balance. We plan to use these lessons to guide the support we provide to the growing group of emerging leaders who are poised to lead the transdisciplinary research network of the future.

Emergency Medicine Australasia

Fall injuries and consequences Generally speaking, the falls in older people we see in the ED are... more Fall injuries and consequences Generally speaking, the falls in older people we see in the ED are the tip

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 17, 2018

Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain.... more Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain. Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low-dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED. This systematic review and meta-analysis sought to quantify whether LDK is an effective and safe opioid alternative for acute pain reduction in adults in the ED setting. (PROSPERO Registration Number CRD42017065303). This was a systematic review of randomized controlled trials comparing intravenous opioids to LDK for relief of acute pain in the ED. Studies where the control group initially received opioids prior to ketamine were excluded. A research librarian designed the electronic search strategy. Changes in visual analog scale or numeric rating scale pain scales were analyzed to determine the relative effects of LDK and opioids in the treatment of acute pain. Three studies met the criteria for inclusion in ...

BMJ open, Mar 16, 2018

Cognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency ... more Cognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency department (ED). Our primary objective was to determine the diagnostic accuracy of the Ottawa 3DY (O3DY) and Short Blessed Test (SBT) as screening tools for the detection of CD in the ED. Our secondary objective was to estimate the inter-rater reliability of these instruments. We conducted a prospective cross-sectional comparative study at an inner-city academic medical centre (annual ED visit census 86 000). Patients aged 75 years or greater were evaluated for inclusion, 163 were screened, 150 were deemed eligible and 117 were enrolled. The research team completed the O3DY, SBT and Mini-Mental State Exam (MMSE) for each participant. Descriptive statistics were calculated. Sensitivity and specificity of the O3DY and SBT were calculated in STATA V.11.2 using the MMSE as our criterion standard. We enrolled 117 patients from June to November 2016. The median ED length of stay at the time of...

Academic Emergency Medicine

Academic Emergency Medicine, 2016

Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicin... more Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Aug 16, 2016

The proportion of patients over age 65 who seek care in the Emergency Department (ED) has been in... more The proportion of patients over age 65 who seek care in the Emergency Department (ED) has been increasing for decades and many of these visits are related to musculoskeletal injury or pain. The elderly are less likely to have their pain appropriately assessed and managed in the ED in comparison to younger adults, although gender and ethnic disparities in oligoanalgesia occur across all age groups. Emergency medicine resident geriatric core competencies include the assessment and management of pain in accordance with the patient's goals of care. In spite of this, the Society for Academic Emergency Medicine Geriatric Task Force identified pain management in the elderly as one condition for which there is a significant quality gap. This article is protected by copyright. All rights reserved.

Academic Emergency Medicine, 2016

Academic Emergency Medicine, 2015

Injury Epidemiology, 2014

Background: Driving self-restriction is well-documented among older drivers but might also occur ... more Background: Driving self-restriction is well-documented among older drivers but might also occur among younger drivers. Little is known about the driving patterns of emergency department (ED) patients, who may be a high-risk population for motor vehicle crashes (MVCs). We sought to compare the driving patterns and MVCs of younger and older adult ED patients in order to inform development of injury prevention interventions in EDs. Methods: We surveyed English-speaking younger adult (age 25-64) and older adult (age ≥65) ED patients, excluding non-drivers and those who were cognitively-impaired or too sick to participate. We compared drivers by age group and used logistic regression with adjustment for driving frequency to examine factors associated with driving self-restriction. Results: Of those eligible, 82% (n = 178) of younger adult and 91% (n = 134) of older adult patients participated; approximately half were women. Similar proportions of younger and older adult patients reported driving everyday/almost everyday (80%) but also self-restricting driving in inclimate weather (48%), heavy traffic (27%), in unfamiliar places (21%), when travelling with passengers (1.6%) or when alone (1.3%). Fewer younger adult than older adult patients avoided driving at night (22% versus 49%) or on highways (6.7% versus 26%). In multivariable logistic regression, factors significantly associated self-imposed driving restriction in ≥1 driving situation were female gender (Odds Ratio [OR] 2.40; 95% CI 1.42-4.05) and ever feeling "confused, nervous or uncomfortable" while driving (OR 1.87; 95% CI 1.03-3.39). There was a non-significant trend for differences in proportions between younger adult (11%) and older adult (6.8%) drivers reporting ≥1 MVC as a driver in the past 12 months. Conclusions: Similar proportions of younger and older adult ED patients self-restrict driving, albeit in different situations, which has implications for behavioral interventions for injury prevention and for education of patients and medical providers.

Annals of Emergency Medicine, 2011

Study objective-We evaluate the diagnostic test characteristics of the Six-Item Screener and the ... more Study objective-We evaluate the diagnostic test characteristics of the Six-Item Screener and the AD8 to detect cognitive dysfunction in adults older than 65 years and using the emergency department (ED) for any reason. Methods-We conducted an observational cross-sectional cohort study at a single academic urban university-affiliated hospital. Subjects were consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED. We quantitatively assessed the diagnostic test characteristics of the Six-Item Screener and AD8 by using the Mini-Mental State Examination score less than 24 as the criterion standard for cognitive dysfunction. Results-The prevalence of cognitive dysfunction was 35%, but only 6% of charts noted a preexisting deficit. The Six-Item Screener was superior to either the caregiver-administered AD8 or the patient-administered AD8 for the detection of cognitive dysfunction. Conclusion-The Six-Item Screener was superior to the caregiver-or patient-administered AD8 to identify older adults at increased risk for occult cognitive dysfunction.

Annals of Emergency Medicine, 2004

Academic Emergency Medicine, 2007

This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge... more This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge Translation, at the 2007 Academic Emergency Medicine Consensus Conference on knowledge translation (KT) in emergency medicine (EM). The objective was to develop a research strategy that incorporates KT into EM graduate medical education (GME). To bridge the gap between the best evidence and optimal patient care, Pathman et al. suggested a multistage model for moving from evidence to action. Using this theoretical knowledge-to-action framework, the KT consensus conference group focused on four key components: acceptance, application, ability, and remembering to act on the existing evidence. The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT. Current residents are limited by faculty GME role models to demonstrate bedside KT principles. The rapid uptake of KT theory will depend on developing KT champions locally and internationally for resident physicians to emulate. The consensus participants combined published evidence with expert opinion to outline recommendations for identifying the barriers to KT by asking four specific questions: 1) What are the barriers that influence a resident's ability to act on valid health care evidence? 2) How do we break down these barriers? 3) How do we incorporate this into residency training? 4) How do we monitor the longevity of this intervention? Research in the fields of GME and KT is currently limited. GME educators assume that if we teach residents, they will learn and apply what they have been taught. This is a bold assumption with very little supporting evidence. This article is not an attempt to provide a complete overview of KT and GME, but, instead, aims to create a starting point for future work and discussions in the realm of KT and GM.

The SAGE Handbook of Persuasion: Developments in Theory and Practice, 2012

Journal of Policy Analysis and Management, 2004

This paper uses the widespread variation across states in the timing of adoption of tougher drunk... more This paper uses the widespread variation across states in the timing of adoption of tougher drunk driving laws that set very low legal blood alcohol limits for drivers under age 21-“zero tolerance” (ZT) laws-to provide new evidence on the causal effect of alcohol use on youth suicide. ZT laws reduced heavy episodic drinking by underage men, with no effect for

Page 498. 24 Persuading in the Small Group Context FRANKLIN J. BOSTER MICHAEL G. CRUZ From LeBon&... more Page 498. 24 Persuading in the Small Group Context FRANKLIN J. BOSTER MICHAEL G. CRUZ From LeBon's (1896) fascination with mobs and Tarde's (1903) interest in imitation to studies of social impact (Latane, 1996) and ...