Jenna Karagianis | Northwestern University (original) (raw)

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Papers by Jenna Karagianis

Research paper thumbnail of A protocol to evaluate a clinical decision support tool using natural language processing to screen hospitalized adults for unhealthy substance use in a quasi-experimental design (Preprint)

BACKGROUND Automated and data-driven methods for screening using natural language processing (NLP... more BACKGROUND Automated and data-driven methods for screening using natural language processing (NLP) and machine learning may replace resource-intensive manual approaches in usual care of patients hospitalized with conditions related to unhealthy substance use. Rigorous evaluation of tools that use artificial intelligence (AI) is necessary to demonstrate effectiveness before system-wide implementation. OBJECTIVE To provide a study protocol to evaluate health outcomes and cost-benefit of an AI-driven automated screener compared to manual human screening for unhealthy substance use. METHODS A pre-post design to evaluate 12 months of manual screening followed by 12 months of automated screening across surgical and medical wards in a single medical center. Effectiveness in terms of patient outcomes will be determined by non-inferior rates of interventions (brief intervention/motivational interviewing, medication assisted treatment, naloxone dispensing, referral to outpatient care) in the ...

Research paper thumbnail of Opioid Misuse in Older Women

Journal of the American Geriatrics Society, 2019

To the Editor: Older women are uniquely affected by the opioid epidemic due to biological, medica... more To the Editor: Older women are uniquely affected by the opioid epidemic due to biological, medical, and societal factors related to their age and sex. Not only are women prescribed more than 65% of all opioids, 1 but opioid use disorder (OUD) progresses more rapidly in women. 2 Women entering treatment report shorter periods of substance use than men, and fewer treatment programs for women exist. 3 Finally, the number of deaths due to prescription opioid overdoses increased in women at twice the rate than it did for men between 1999 and 2015. 1 According to the US Food and Drug Administration Adverse Events Reporting System, nearly 10.4% of opioid adverse drug events occurred in women who were aged 65 years or older. 4 Older women have an increased prevalence of long-term opioid use due to an increased incidence of chronic pain compared to other age groups. 5 In fact, the prevalence of long-term opioid use increased from 61% to 135% in 2005, and older women comprised about 9% of this group. 5 Psychiatric conditions, such as depression and anxiety, are experienced by more women than men. 6 According to the National Institute of Mental Health, approximately 6.7% of Americans had at least one depressive episode, and of those, the prevalence was higher in adult females (8.5%) vs males (4.8%). 7 Approximately 30% of opioid-related deaths involve the concomitant use of a benzodiazepine, and coprescribing is associated with increased emergency department and inpatient visits. 8 Older women may be at a greater risk for opioid misuse because of the loss of a loved one, less financial stability, or poor mental health. 9 Older women are also more likely to use opioids privately because they attach more stigma to substance use than older men. 10 Older women with OUD may present with nonspecific symptoms, such as repeated falls, memory lapses, and urinary incontinence. Patients or their families may report changes in behavior/mood, car accidents, or neglect of personal and social responsibilities, such as bills, groceries, and family commitments. Women are more likely than men to have prescriptions from multiple providers, which can be detected through state drug monitoring programs. 11 Knowledge of sex disparities can inform pharmacists as members of a multidisciplinary team, allowing them to better advise multimodal analgesia plans, dose titrations, and dangerous drug interactions in this population. The 2016 Centers for Disease Control and Prevention guidelines on chronic pain recommend prescribing of naloxone with risk factors for opioid overdose, and in many states, this can be done at the pharmacy counter without an individual prescription through a statewide standing order. 12 Meanwhile, clinicians should advocate for more women-centered OUD treatment programs. 3 With an overwhelming epidemic that has permeated every population, improving clinician awareness of the risk and presenting symptoms of OUD in older women have the potential to improve care for this population.

Research paper thumbnail of Obesity and seatbelt use: a fatal relationship

The American Journal of Emergency Medicine, 2014

Research paper thumbnail of Naloxone access among an urban population of opioid users

The American Journal of Emergency Medicine, 2018

Background: Take-home naloxone is one method of curbing the mortality associated with the opioid ... more Background: Take-home naloxone is one method of curbing the mortality associated with the opioid epidemic. It is unclear if some opioid users have more access to naloxone than others. Research Question: What is the access to naloxone in an urban emergency department (ED) and does naloxone awareness and access differ between people who abuse different types of opioids?

Research paper thumbnail of Managing Secondary Chylothorax: The Implications for Medical Nutrition Therapy

Journal of the American Dietetic Association, 2011

Research paper thumbnail of Obesity and seatbelt use: a fatal relationship

The American Journal of Emergency Medicine, 2014

Seatbelts significantly reduce the risk of death in motor vehicle accidents, but a certain number... more Seatbelts significantly reduce the risk of death in motor vehicle accidents, but a certain number of individuals from some subgroups tend not to wear their seatbelts. In this study, we hypothesized that obese drivers (in fatal crashes) were less likely to wear seatbelts than their normal-weight counterparts. A retrospective study was conducted on the drivers in motor vehicle crashes entered into the Fatality Analysis Reporting System database between 2003 and 2009. A number of precrash variables were found to be significantly associated with seatbelt use. These were entered into a multivariate logistic regression model using stepwise selection. Drivers were grouped into weight categories based on the World Health Organization definitions of obesity by body mass index. Seatbelt use was then examined by body mass index, adjusted for precrash variables that were significantly associated with seatbelt use. The odds of seatbelt use for normal-weight individuals were found to be 67% higher than the odds of seatbelt use in the morbidly obese. The relationship of seatbelt use between the different weight groups and the morbidly obese is as follows (odds ratios [ORs] for each comparison are listed with 95% confidence limits [CL]): underweight vs morbidly obese (OR, 1.62; CL, 1.47-1.79), normal weight vs morbidly obese (OR, 1.67; CL, 1.54-1.81), overweight vs morbidly obese (OR, 1.60; CL, 1.48-1.74), slightly obese vs morbidly obese (OR, 1.40; CL, 1.29-1.52), and moderately obese vs morbidly obese (OR, 1.24; CL, 1.13-1.36). Seatbelt use is significantly less likely in obese individuals compared with their normal-weight counterparts.

Research paper thumbnail of A protocol to evaluate a clinical decision support tool using natural language processing to screen hospitalized adults for unhealthy substance use in a quasi-experimental design (Preprint)

BACKGROUND Automated and data-driven methods for screening using natural language processing (NLP... more BACKGROUND Automated and data-driven methods for screening using natural language processing (NLP) and machine learning may replace resource-intensive manual approaches in usual care of patients hospitalized with conditions related to unhealthy substance use. Rigorous evaluation of tools that use artificial intelligence (AI) is necessary to demonstrate effectiveness before system-wide implementation. OBJECTIVE To provide a study protocol to evaluate health outcomes and cost-benefit of an AI-driven automated screener compared to manual human screening for unhealthy substance use. METHODS A pre-post design to evaluate 12 months of manual screening followed by 12 months of automated screening across surgical and medical wards in a single medical center. Effectiveness in terms of patient outcomes will be determined by non-inferior rates of interventions (brief intervention/motivational interviewing, medication assisted treatment, naloxone dispensing, referral to outpatient care) in the ...

Research paper thumbnail of Opioid Misuse in Older Women

Journal of the American Geriatrics Society, 2019

To the Editor: Older women are uniquely affected by the opioid epidemic due to biological, medica... more To the Editor: Older women are uniquely affected by the opioid epidemic due to biological, medical, and societal factors related to their age and sex. Not only are women prescribed more than 65% of all opioids, 1 but opioid use disorder (OUD) progresses more rapidly in women. 2 Women entering treatment report shorter periods of substance use than men, and fewer treatment programs for women exist. 3 Finally, the number of deaths due to prescription opioid overdoses increased in women at twice the rate than it did for men between 1999 and 2015. 1 According to the US Food and Drug Administration Adverse Events Reporting System, nearly 10.4% of opioid adverse drug events occurred in women who were aged 65 years or older. 4 Older women have an increased prevalence of long-term opioid use due to an increased incidence of chronic pain compared to other age groups. 5 In fact, the prevalence of long-term opioid use increased from 61% to 135% in 2005, and older women comprised about 9% of this group. 5 Psychiatric conditions, such as depression and anxiety, are experienced by more women than men. 6 According to the National Institute of Mental Health, approximately 6.7% of Americans had at least one depressive episode, and of those, the prevalence was higher in adult females (8.5%) vs males (4.8%). 7 Approximately 30% of opioid-related deaths involve the concomitant use of a benzodiazepine, and coprescribing is associated with increased emergency department and inpatient visits. 8 Older women may be at a greater risk for opioid misuse because of the loss of a loved one, less financial stability, or poor mental health. 9 Older women are also more likely to use opioids privately because they attach more stigma to substance use than older men. 10 Older women with OUD may present with nonspecific symptoms, such as repeated falls, memory lapses, and urinary incontinence. Patients or their families may report changes in behavior/mood, car accidents, or neglect of personal and social responsibilities, such as bills, groceries, and family commitments. Women are more likely than men to have prescriptions from multiple providers, which can be detected through state drug monitoring programs. 11 Knowledge of sex disparities can inform pharmacists as members of a multidisciplinary team, allowing them to better advise multimodal analgesia plans, dose titrations, and dangerous drug interactions in this population. The 2016 Centers for Disease Control and Prevention guidelines on chronic pain recommend prescribing of naloxone with risk factors for opioid overdose, and in many states, this can be done at the pharmacy counter without an individual prescription through a statewide standing order. 12 Meanwhile, clinicians should advocate for more women-centered OUD treatment programs. 3 With an overwhelming epidemic that has permeated every population, improving clinician awareness of the risk and presenting symptoms of OUD in older women have the potential to improve care for this population.

Research paper thumbnail of Obesity and seatbelt use: a fatal relationship

The American Journal of Emergency Medicine, 2014

Research paper thumbnail of Naloxone access among an urban population of opioid users

The American Journal of Emergency Medicine, 2018

Background: Take-home naloxone is one method of curbing the mortality associated with the opioid ... more Background: Take-home naloxone is one method of curbing the mortality associated with the opioid epidemic. It is unclear if some opioid users have more access to naloxone than others. Research Question: What is the access to naloxone in an urban emergency department (ED) and does naloxone awareness and access differ between people who abuse different types of opioids?

Research paper thumbnail of Managing Secondary Chylothorax: The Implications for Medical Nutrition Therapy

Journal of the American Dietetic Association, 2011

Research paper thumbnail of Obesity and seatbelt use: a fatal relationship

The American Journal of Emergency Medicine, 2014

Seatbelts significantly reduce the risk of death in motor vehicle accidents, but a certain number... more Seatbelts significantly reduce the risk of death in motor vehicle accidents, but a certain number of individuals from some subgroups tend not to wear their seatbelts. In this study, we hypothesized that obese drivers (in fatal crashes) were less likely to wear seatbelts than their normal-weight counterparts. A retrospective study was conducted on the drivers in motor vehicle crashes entered into the Fatality Analysis Reporting System database between 2003 and 2009. A number of precrash variables were found to be significantly associated with seatbelt use. These were entered into a multivariate logistic regression model using stepwise selection. Drivers were grouped into weight categories based on the World Health Organization definitions of obesity by body mass index. Seatbelt use was then examined by body mass index, adjusted for precrash variables that were significantly associated with seatbelt use. The odds of seatbelt use for normal-weight individuals were found to be 67% higher than the odds of seatbelt use in the morbidly obese. The relationship of seatbelt use between the different weight groups and the morbidly obese is as follows (odds ratios [ORs] for each comparison are listed with 95% confidence limits [CL]): underweight vs morbidly obese (OR, 1.62; CL, 1.47-1.79), normal weight vs morbidly obese (OR, 1.67; CL, 1.54-1.81), overweight vs morbidly obese (OR, 1.60; CL, 1.48-1.74), slightly obese vs morbidly obese (OR, 1.40; CL, 1.29-1.52), and moderately obese vs morbidly obese (OR, 1.24; CL, 1.13-1.36). Seatbelt use is significantly less likely in obese individuals compared with their normal-weight counterparts.