Wayne Satz - Academia.edu (original) (raw)

Papers by Wayne Satz

The Journal of emergency medicine, Jan 14, 2015

The Journal of Emergency Medicine, 2015

Death from opioid abuse is a major public health issue. The death rate associated with opioid ove... more Death from opioid abuse is a major public health issue. The death rate associated with opioid overdose nearly quadrupled from 1999 to 2008. Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain. Our aim was to determine whether a voluntary opioid prescribing guideline reduces the proportion of patients prescribed opioids for minor and chronic conditions. A retrospective chart review was performed on records of adult emergency department visits from January 2012 to July 2014 for dental, neck, back, or unspecified chronic pain, and the proportion of patients receiving opioid prescriptions at discharge was compared before and after the guideline. Attending emergency physicians were surveyed on their perceptions regarding the impact of the guideline on prescribing patterns, patient satisfaction, and physician-patient interactions. In our sample of 13,187 patient visits, there was a significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and sustained decrease in rates of opioid prescriptions for dental, neck, back, or unspecified chronic pain. The rate of opioid prescribing decreased from 52.7% before the guideline to 29.8% immediately after its introduction, and to 33.8% at an interval of 12 to 18 months later. The decrease in opioid prescriptions was observed in all of these diagnosis groups and in all age groups. All 31 eligible prescribing physicians completed a survey. The opioid prescribing guideline was supported by 100% of survey respondents. An opioid prescribing guideline significantly decreased the rates at which opioids were prescribed for minor and chronic complaints in an acute care setting.

Postgraduate Medicine, 2009

The purpose of this study was to assess the effects of a commercially available weight loss progr... more The purpose of this study was to assess the effects of a commercially available weight loss program on weight and glycemic control among obese patients with type 2 diabetes. Participants included 69 patients (49 females, 20 males) with type 2 diabetes who had a mean +/- SD age of 52.2 +/- 9.5 years, a body mass index of 39.0 +/- 6.2 kg/m(2), and hemoglobin A1c (HbA1c) of 7.5 +/- 1.6%. Over half (52.2%) of the participants were African American. Participants were randomly assigned to: 1) a portion-controlled diet (NutriSystem D) (PCD) or 2) a diabetes support and education (DSE) program. After the initial 3 months, the PCD group continued on the PCD for the remaining 3 months, and the DSE group crossed over to PCD for the remaining 3 months. The primary comparison for this study was at 3 months. At 3 months, the PCD group lost significantly more weight (7.1 +/- 4%) than the DSE group (0.4 +/- 2.3%) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). From 3 to 6 months the change in weight for both groups was statistically significant. After 3 months, the PCD group had greater reductions in HbA1c than the DSE group (-0.88 +/- 1.1 vs 0.03 +/- 1.09; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). From 3 to 6 months the PCD group had no further change in HbA1c, while the DSE group showed a significant reduction. These data suggest that obese patients with type 2 diabetes will experience significant improvements in weight, glycemic control, and cardiovascular disease risk factors after the use of a commercially available weight management program.

Annals of Emergency Medicine, 2004

The Journal of Emergency Medicine, 2006

A 54-year-old man with a recent history of blunt abdominal trauma presented to the Emergency Depa... more A 54-year-old man with a recent history of blunt abdominal trauma presented to the Emergency Department with severe pain in the chest and abdomen. He was tachycardic, tacypneic, and hypoxic. An electrocardiogram (EKG) at that time showed ST elevation and PR depression consistent with acute pericarditis, and a computed tomography (CT) scan subsequently showed herniation of abdominal contents into the pericardium and left hemithorax. After surgical repair of the diaphragmatic defect and intrapericardial hernia, the EKG findings resolved. He recovered over the course of several weeks and was subsequently discharged home.

The Journal of Emergency Medicine, 2010

e Abstract-Background: Traditionally, Emergency Physicians (EPs) have used the external jugular (... more e Abstract-Background: Traditionally, Emergency Physicians (EPs) have used the external jugular (EJ) vein to gain vascular access in patients who have failed nursing attempts at peripheral access. Recently, some EPs have used ultrasound (USIV) to gain peripheral access. Study Objective: This study seeks to determine which initial approach by EPs would lead to greater success. Methods: This was a prospective, randomized study of all adult patients who presented to the Emergency Department (ED) between June and December 2007. Inclusion criteria were failed nursing attempts at peripheral access (at least three). EPs were 2 nd -or 3 rd -year residents who had previously performed more than five each of EJs and USIVs. Patients were randomized into either an initial EJ or USIV approach. Results: Sixty patients were enrolled, 32 in the ultrasound group, 28 in the EJ group. Fifteen different EPs performed access. Initial Success: USIV 84% (95% confidence interval [CI] 68 -93%) vs. EJ 50% (95% CI 33-67%), p ‫؍‬ 0.006. Success if EJ visible: USIV 84% vs. EJ 66% (p ‫؍‬ 0.18). Overall success, including data from the crossover pathway: a total of 41 lines were successfully placed by ultrasound out of 46 attempts (89%) vs. 18 out of 33 for EJ (55%), p ‫؍‬ 0.001. In total, 59/60 patients (98%) had a peripheral i.v. successfully placed. The percentage of functioning lines when the patient left the ED was: USIV 89% (95% CI 72-96%) vs. EJ 93% (95% CI 68 -98%), p ‫؍‬ 0.88. Conclusion: As an initial approach to all patients with difficult venous access, ultrasound-guided peripheral lines are superior to the EJ approach. However if the EJ was visible, there was no difference in success among the initial approaches. Both techniques, when used together, could achieve peripheral vascular access in 98% of difficult access patients.

The Journal of Emergency Medicine, 2010

e Abstract-Background: Ultrasound is a useful adjunct to many Emergency Department (ED) procedure... more e Abstract-Background: Ultrasound is a useful adjunct to many Emergency Department (ED) procedures. Arthrocentesis is typically performed using a landmark technique but ultrasound may provide an opportunity to improve arthrocentesis performance. Objective: To assess the success of emergency physicians performing landmark (LM) vs. ultrasound (US)-guided knee arthrocentesis techniques. Methods: This was a prospective, randomized, controlled study of patients requiring knee arthrocentesis who presented to one urban university ED and two community EDs between June 2005 and February 2007. Results: There were 66 patients enrolled (39 US-guided, 27 LM). Among all users, there was no difference in arthrocentesis success (US 37/39 vs. LM 25/27); p ‫؍‬ 1.0. Secondary Endpoints: 1) Patients reported less pain with ultrasound; US-guided 3.71 (95% confidence interval [CI] 2.61-4.80) cm vs. LM 5.19 (95% CI 3.94 -6.45) cm; p ‫؍‬ 0.02. 2) Providers felt the US-guided technique was easier to perform than LM; 1.67 units on 5-point scale (95% CI 1.37-1.97) vs. 2.11 (95% CI 1.79 -2.42) units; p ‫؍‬ 0.02. 3) The total procedure time was shorter with the US-guided technique; 10.58 (95% CI 7.36 -13.80) min vs. LM 13.37 (95% CI 9.83-16.92) min; p ‫؍‬ 0.05. 4) There was no difference in the amount of fluid obtained between techniques; US-guided 45.33 (95% CI 35.45-55.21) mL vs. LM 34.7 (95% CI 26.09 -43.32) mL; p ‫؍‬ 0.17. Conclusion: US-guided knee arthrocentesis technique does not improve overall success of obtaining joint fluid aspirate vs. the standard LM and palpation technique. An USguided approach does not result in more pain for the patient, takes no additional time to perform and, at least for novice physicians, leads to more fluid aspiration and greater novice provider confidence with the procedure.

Annals of Emergency Medicine, 2010

Study Objectives: A common assumption is that a lack of health insurance is a primary reason for ... more Study Objectives: A common assumption is that a lack of health insurance is a primary reason for frequent use of emergency department (ED) services. In light of the recent federal health care reform to broaden the insured population, we sought to compare the impact of adequate health insurance with other social factors on frequent users to the ED.

Annals of Emergency Medicine, 2010

HMGB1 levels were determined using purified recombinant HMGB1 at various dilutions (5, 10, 25 ng)... more HMGB1 levels were determined using purified recombinant HMGB1 at various dilutions (5, 10, 25 ng) by Western blot analysis with a standard reference curve. UN-SCAN-IT Gel 6.1 software was used to digitize Western blots for quantitative analysis. Levels of 42 other cytokines were determined in a subset of septic shock patients by the Ray Bio® Human Cytokine Antibody Array 3. Nonparametric tests were used for statistical analysis. The difference in HMGB1 levels in healthy controls and sepsis patients at baseline was analyzed using the Mann-Whitney test. The difference in HMGB1 levels among the Sepsis status groups (SIRS/sepsis and severe sepsis/septic shock) was analyzed using the Wilcoxen Two-Sample Test.

Annals of Emergency Medicine, 2004

Annals of Emergency Medicine, 1998

To correlate changes in core body temperature with changes in mean arterial pressure (MAP) and ca... more To correlate changes in core body temperature with changes in mean arterial pressure (MAP) and cardiac output (CO) and with the administration of room-temperature intravenous fluids in a clinically relevant large-animal model of uncontrolled hemorrhage.

Annals of Emergency Medicine, 2008

Background: The use of US during central venous catheterization (CVC) seems infrequent despite th... more Background: The use of US during central venous catheterization (CVC) seems infrequent despite the demonstrated benefits of this technology. The knowledge and barriers to the use of US by emergency medicine residents during CVC have never been investigated before.

Academic Emergency Medicine, 1996

To compare hemodynamics, mortality rates, and bleeding rates at 3 severities of hemorrhage in a n... more To compare hemodynamics, mortality rates, and bleeding rates at 3 severities of hemorrhage in a new model of uncontrolled intra-abdominal bleeding that uses an injury of varying severity and geometry unfavorable to thrombosis. Ten swine were bled through a flow-monitored shunt placed between the femoral artery and the peritoneal cavity. The shunt was connected to catheters of varying diameters placed in the femoral artery to create 3 rates of hemorrhage. Blood flow through the shunt was measured with an in-line Doppler probe. Arterial pressures, cardiac output (CO), and ECGs were monitored. Survival and blood loss were calculated. The model successfully produced 3 hemorrhage severities. At all 3 rates of bleeding, blood flow was linearly related to mean arterial pressure, with R2 > 0.72. Bleeding was continuous in all groups. The mean numbers of minutes until death were 53, 45, and 25, respectively, at the increasing shock severities. Blood pressure (BP) and CO decreased continuously in all groups, but did so more rapidly with increasing severity of hemorrhage. In this model of uncontrolled hemorrhage, bleeding was continuous and linearly related to BP. The hemodynamic response to uncontrolled bleeding in this model differs markedly from those in previous wire aortotomy models where wound geometry is favorable to thrombosis. Hence, when injury geometry is favorable to thrombosis (as in aortotomy), thrombosis formation affects hemorrhage rates and hemodynamic responses.

Academic Emergency Medicine, 2012

Traditionally, emergency physicians (EPs) have used anatomic landmark-based needle aspiration to ... more Traditionally, emergency physicians (EPs) have used anatomic landmark-based needle aspiration to drain peritonsillar abscesses (PTAs). If this failed, an imaging study and/or consultation with another service to perform the drainage is obtained. Recently, some EPs have used ultrasound (US) to guide PTA drainage. This study seeks to determine which initial approach leads to greater successful drainage. The primary objective of this study was to compare the diagnostic accuracy of EPs for detecting PTA or peritonsillar cellulitis (PTC) using either intraoral US or initial needle aspiration after visual inspection (the landmark technique [LM]). Secondary objectives included the successful aspiration of purulent material in those patients with a PTA in each arm, the use of computed tomography (CT) scanning in each arm, and the otolaryngology (ENT) consultation rate in each arm. This was a prospective, randomized, controlled clinical trial of a convenience sample of adult patients who presented to a single, large, urban university hospital. Patients were enrolled if they presented with a constellation of signs and symptoms that were judged to be a PTA. These patients were randomized to receive intraoral US or to undergo LM drainage. The US was performed using an 8-5 MHz intracavitary transducer immediately prior to the procedure. The probe was then withdrawn and the provider who did the US also performed the needle aspiration. The LM was performed using visual landmarks in a superior to inferior approach until pus was obtained or at least two sticks were performed. Anesthesia was standardized. Patients returned for follow-up in 2 days where a final diagnosis was rendered. There were 28 patients enrolled, with 14 in each arm. US established the correct diagnosis more often than LM [(100%, 95% confidence interval [CI] = 75% to 100% vs. 64%, 95% CI = 39% to 84%; p = 0.04)]. US also led to more successful aspiration of purulent material by the EP than LM in patients with PTA [(100%, 95% CI =63% to 100% vs. 50%, 95% CI = 24% to 76%; p = 0.04)]. The ENT consult rate was 7% (95% CI = 0% to 34%) for US versus 50% (95% CI = 27% to 73%) for LM (p = 0.03). The CT usage rate was 0% for US versus 35% for LM (p = 0.04). An initial intraoral US performed by EPs can reliably diagnose PTC and PTA. Additionally, using intraoral US to assist in the drainage of PTAs with needle aspiration leads to greater success compared to the traditional method of LM relying on physical exam alone.

Academic Emergency Medicine, 2003

Objectives: To compare emergency medicine resident performance on an ultrasound-oriented, America... more Objectives: To compare emergency medicine resident performance on an ultrasound-oriented, American Board of Emergency Medicine-styled written examination with the following variables in resident education: number of ultrasound scans performed, presence of a formal, structured ultrasound rotation, presence of a mandatory ultrasound rotation, number of hours of didactic ultrasound education, and percentage of ultrasound education taught by emergency physicians. Methods: This was a prospective cohort study involving 14 residency programs. A 60question multiple-choice test was completed by individual residents and returned for scoring. Results: 262 residents completed the study. Average score was 39.1/60 6 6.5 (65%). Scores improved as residency year increased (year 1: 36.6, year 2: 39.3, year 3: 42.6) (p , 0.005). Scores improved as number of scans performed increased from 34.3 (57%) for those residents who had performed 0-10 scans to 45.4 (76%) for those with .150 scans (p , 0.005). The presence of an

Academic Emergency Medicine, 1996

To determine the effects of aggressive fluid administration vs permissive hypotension on survival... more To determine the effects of aggressive fluid administration vs permissive hypotension on survival, blood loss, and hemodynamics in a model of uncontrolled hemorrhage in which bleeding has been shown to be continuous. Methods: In this porcine model, 10 animals were bled through a flow-monitored shunt placed between the femoral artery and the peritoneal cavity. The animals received either no fluid (n = 5 ) or 80 m u g lactated Ringer's solution (n = 5 ) during a resuscitation phase between 10 and 20 minutes postinjury, followed by a 40-minute evaluation phase. Arterial pressures, cardiac output (CO), and hemorrhage rate were measured, Survival and blood loss were calculated outcome measures. Results: The difference in survival between the animals left hypotensive (40%) and those receiving normotensive resuscitation (20%) was not significant (p = 0.49). In the animals receiving fluid resuscitation, mean arterial pressure (MAP) and CO increased during the resuscitative phase, but all the animals suffered the same pattern of hemodynamic deterioration in the evaluation phase. Rate of hemorrhage during the resuscitative phase was 20 t 5 mumin in the animals not receiving fluid and 56 ? 9 mWmin in the animals receiving fluids. Total blood loss was subsequently 20 mL/kg greater in the animals receiving fluids than in the animals without fluid resuscitation. Conclusions: In this model of continuous uncontrolled hemorrhage, the difference in survival between the animals left hypotensive and the animals receiving fluid resuscitation was not statistically significant. Increases in MAP and CO with fluid resuscitation were transient and were offset by larger volumes of blood loss. In contrast to the aortotomy model (where thrombosis is likely and hypotensive resuscitation has proven beneficial), this model suggests that in continuous bleeding, avoiding fluid resuscitation has a much smaller effect on outcome. Much of the benefit from hypotensive resuscitation may depend on having an injury that can stop bleeding.

Academic Emergency Medicine, 2000

Objectives: To determine the prevalence of thiamine deficiency in a high-risk group of elder emer... more Objectives: To determine the prevalence of thiamine deficiency in a high-risk group of elder emergency department (ED) patients who reside in nursing homes and need admission to the hospital, and to determine the effect of patients' diets on this prevalence. Methods: This was an observational pilot study of 75 consecutive ED patients aged 65 years or older who lived in a nursing home and were admitted to the hospital. Plasma thiamine levels were measured by high-pressure liquid chromatography on serum samples collected within 24 hours of hospital admission. Nursing home records were reviewed to determine whether patients received nutritional supplementation or enteral tube feedings. Results: Seventy patients participated and had a mean plasma thiamine level of 27.3 /dL (95% CI = 20.2 to 34.4). Fourteen percent (n = 10, 95% CI = 8% to 24%) were thiamine-deficient (<10 g/dL). Patients not receiving dietary supplements or tube feedings (n = 26) had lower mean thiamine levels (20.3 g/dL, 95% CI = 12.7 to 27.9) and were thiamine-deficient more often (27%) than patients receiving dietary support (n = 44, 31.5 g/dL, 95% CI = 24.7 to 38.3, 7% thiamine-deficient). Conclusions: Elder nursing home patients seen in the ED and admitted to the hospital are frequently thiamine-deficient. Empiric thiamine supplementation is often used in the ED for other high-risk patients, such as alcoholic individuals, and may be appropriate for high-risk elder patients. Further research is needed to determine whether thiamine supplementation in these patients can improve their clinical outcomes.

The Journal of emergency medicine, Jan 14, 2015

The Journal of Emergency Medicine, 2015

Postgraduate Medicine, 2009

Annals of Emergency Medicine, 2004

The Journal of Emergency Medicine, 2006

The Journal of Emergency Medicine, 2010

Annals of Emergency Medicine, 2010

Annals of Emergency Medicine, 2004

Annals of Emergency Medicine, 1998

Annals of Emergency Medicine, 2008

Academic Emergency Medicine, 1996

Academic Emergency Medicine, 2012

Academic Emergency Medicine, 2003

Academic Emergency Medicine, 1996

Academic Emergency Medicine, 2000