I am a practicing emergency physician and an Associate Professor of Emergency Medicine. I have specific training (K23 AA023284: 2014 to 2020) and expertise (R01 AA023650 co-PI: 2016-2020) in designing and testing digital behavioral interventions, collecting and interpreting in situ digital sensor data (CTSI T1/T2: PI: 2019-2020; R21 AA030153 co-I: 2022-2023); and identifying unique mechanisms of behavior change. My current programmatic research foci include: (1) advancing the effectiveness and reach of brief alcohol interventions with a focus on using phone sensors to infer drinking events and conversational agents to improve alcohol counseling; and (2) improving identification of older adults at risk for poor outcomes after ED discharge using sensor technology to detect unique risk phenotypes and using digital technology and conversational agents to improve outcomes.

Clinical Focus

  • Emergency Medicine

Academic Appointments

Professional Education

  • Residency: University of Pittsburgh Emergency Medicine Residency (2006) PA
  • Medical Education: Loyola University Stritch School of Medicine (2003) IL

Current Research and Scholarly Interests

Active Projects

1. GaitMate Study: The aims of this study are to test the feasibility of collecting remote gait and balance data from community-dwelling older adults over 12 weeks using an iPhone app and determining if within-person changes in gait predict falls at 3-months.

2. RAMP-ED Study:The aim of this study is to build a robust fall prediction model in community-dwelling older adults incorporating functional data collected in the Emergency Department using wearable sensors and computer vision.

3. SAFE-STEPS Study: The aims of this study are to test the feasibility and acceptability of a digital behavioral intervention aimed at supporting safe physical activity during rehabilitation from acute illness and injury at home. for older adults discharged from the Emergency Department.

All Publications

  • A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults. Addictive behaviors Suffoletto, B., Lee, C. M., Mason, M. 2024; 154: 108020


    Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals.Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks.We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups.Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

    View details for DOI 10.1016/j.addbeh.2024.108020

    View details for PubMedID 38552400

  • Associations between acute pain after vaginal delivery and postpartum opioid prescription fills: a retrospective case-controlled study. British journal of anaesthesia Lim, G., Xue, L., Donohue, J. M., Junker, S., Wilson, J. D., Suffoletto, B., Lynch, M. J., Pacella-LaBarbara, M. L., Chang, C. H., Krans, E., Jarlenski, M. 2024

    View details for DOI 10.1016/j.bja.2024.01.038

    View details for PubMedID 38423825

  • Development of the geriatric risk assessment in the ED (GRAED) tool to predict decline after emergency department (ED) visit. Journal of the American Geriatrics Society Cinkowski, C., Yefimova, M., Suffoletto, B. 2024

    View details for DOI 10.1111/jgs.18745

    View details for PubMedID 38241203

  • Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions. Substance use & addiction journal Chung, T., Suffoletto, B., Feldstein Ewing, S. W., Bhurosy, T., Jiang, Y., Valera, P. 2024; 45 (1): 144-149


    BACKGROUND: An alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention.METHODS: This secondary analysis examined data from 916 young adults who reported HED (68.5% female, mean age=22.1, SD=2.1), were enrolled in an alcohol text message randomized clinical trial and who completed baseline assessment and the three month follow-up. A PRE with ten fold cross-validation, which included 21 baseline variables representing sociodemographic characteristics (e.g., sex, age, race, ethnicity, college enrollment), alcohol consumption (frequency of alcohol consumption, quantity consumed on a typical drinking day, frequency of HED), impulsivity subscales (i.e., negative urgency, positive urgency, lack of premeditation, lack of perseverance, sensation seeking), readiness to change, perceived peer drinking and HED-related consequences, and intervention status were used to predict HED at the three month follow-up.RESULTS: The PRE identified 12 rules that predicted HED at three months (R2 = 0.23) using 7 baseline features. Only two cases (0.2%) were not classified by the 12 rules. The most important features for predicting three month HED included baseline alcohol consumption, negative urgency score, and perceived peer drinking.CONCLUSIONS: The rules provide interpretable decision-making tools that predict who has higher alcohol consumption following exposure to alcohol text message interventions using baseline participant characteristics (prior to intervention), which highlight the importance of interventions related to negative urgency and peer alcohol use.

    View details for DOI 10.1177/29767342231206653

    View details for PubMedID 38258850

  • Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews. JMIR cardio Einhorn, J., Murphy, A. R., Rogal, S. S., Suffoletto, B., Irizarry, T., Rollman, B. L., Forman, D. E., Muldoon, M. F. 2023; 7: e51316


    Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support.We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices.Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs.Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member.In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider NCT03650166;

    View details for DOI 10.2196/51316

    View details for PubMedID 38048147

  • Automated, tailored adaptive mobile messaging to reduce alcohol consumption in help-seeking adults: A randomized controlled trial. Addiction (Abingdon, England) Muench, F., Madden, S. P., Oommen, S., Forthal, S., Srinagesh, A., Stadler, G., Kuerbis, A., Leeman, R. F., Suffoletto, B., Baumel, A., Haslip, C., Vadhan, N. P., Morgenstern, J. 2023


    To test differential outcomes between three 6-month text-messaging interventions to reduce at-risk drinking in help-seeking adults.A three-arm single-blind randomized controlled trial with 1-, 3-, 6- and 12-month follow-ups.United States. A fully remote trial without human contact, with participants recruited primarily via social media outlets.Seven hundred and twenty-three adults (mean = 39.9 years, standard deviation = 10.0; 62.5% female) seeking to reduce their drinking were allocated to 6 months of baseline 'tailored statically' messaging (TS; n = 240), 'tailored adaptive' messaging (TA; n = 239) or 'drink tracking' messaging (DT; n = 244).TS consisted of daily text messages to reduce harmful drinking that were tailored to demographics and alcohol use. TA consisted of daily, tailored text messages that were also adapted based on goal achievement and proactive prompts. DT consisted of a weekly assessment for self-reported drinking over the past 7 days.The primary outcome measure was weekly sum of standard drinks (SSD) at 6-month follow-up. Secondary outcome measures included drinks per drinking day (DDD), number of drinking days (NDD) per week and heavy drinking days (HDD) at 1-, 3-, 6- and 12-month follow-ups.At 6 months, compared with DT, TA resulted in significant SSD reductions of 16.2 (from 28.7 to 12.5) drinks [adjusted risk ratio (aRR) = 0.80, 95% confidence interval (CI) = 0.71, 0.91] using intent-to-treat analysis. TA also resulted in significant improvements in DDD (aRR = 0.84; 95% CI = 0.77-0.92) and drinking days per week (b = -0.39; 95% CI = -0.67, -0.10), but not HDD compared with DT at 6 months. TA was not significantly different from TS at any time-point, except DDD at 6 months. All groups made improvements in SSD at 12-month follow-up compared with baseline with an average reduction of 12.9 drinks per week across groups.Automated tailored mobile messaging interventions are scalable solutions that can reduce weekly alcohol consumption in remote help-seeking drinkers over time.

    View details for DOI 10.1111/add.16391

    View details for PubMedID 38009576

  • Feasibility of a pragmatic randomized adaptive clinical trial to evaluate a brief negotiational interview for harmful and hazardous alcohol use in Moshi, Tanzania. PloS one Staton, C. A., Friedman, K., Phillips, A. J., Minnig, M. C., Sakita, F. M., Ngowi, K. M., Suffoletto, B., Hirshon, J. M., Swahn, M., Mmbaga, B. T., Vissoci, J. R. 2023; 18 (8): e0288458


    Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the "Punguza Pombe Kwa Afya Yako (PPKAY)" ("Reduce Alcohol For Your Health") in Tanzania. This study aimed to evaluate the feasibility of a pragmatic randomized adaptive controlled trial of the PPKAY intervention.This feasibility trial piloted a single-blind, parallel, adaptive, and multi-stage, block-randomized controlled trial, which will subsequently be used to determine the most effective intervention, with or without text message booster, to reduce alcohol use among injury patients. We reported our feasibility pilot study using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with recruitment and retention rates being our primary and secondary outcomes. We enrolled adult patients seeking care for an acute injury at the Kilimanjaro Christian Medical Center in Tanzania if they (1) exhibited an Alcohol Use Disorder Identification Test (AUDIT) ≥8, (2) disclosed alcohol use prior to injury, or (3) had a breathalyzer ≥0.0 on arrival. Intervention arms were usual care (UC), PPKAY, PPKAY with standard text booster, or a PPKAY with a personalized text booster.Overall, 181 patients were screened and 75 enrolled with 80% 6-week, 82.7% 3-month and 84% 6-month follow-up rates showing appropriate Reach and retention. Adoption measures showed an overwhelmingly positive patient acceptance with 100% of patients perceiving a positive impact on their behavior. The Implementation and trial processes were performed with high rates of PPKAY fidelity (76%) and SMS delivery (74%). Intervention nurses believed Maintenance and sustainability of this 30-minute, low-cost intervention and adaptive clinical trial were feasible.Our intervention and trial design are feasible and acceptable, have evidence of good fidelity, and did not show problematic deviations in protocol. Results suggest support for undertaking a full trial to evaluate the effectiveness of the PPKAY, a nurse-driven BNI in a low-income country.Trial registration number NCT02828267.

    View details for DOI 10.1371/journal.pone.0288458

    View details for PubMedID 37535693

    View details for PubMedCentralID PMC10399826

  • Detection of alcohol intoxication using voice features: a controlled laboratory study. Journal of studies on alcohol and drugs Suffoletto, B., Anwar, A., Glaister, S., Sejdic, E. 2023


    Devices such as mobile phones and smart speakers could be useful to remotely identify voice alterations associated with alcohol intoxication, which could be used to deliver just-in-time interventions, but data to support such approaches for the English language are lacking. In this controlled lab study, we compare how well English spectrographic voice features identify alcohol intoxication.18 participants (72% male, aged 21-62 y) read a different randomly-assigned tongue twister prior to drinking and each hour for up to 7 hours after drinking a weight-based dose of alcohol. Vocal segments were cleaned and split into 1 second windows. We built support vector machine models for detecting alcohol intoxication, defined as breath alcohol concentration [BrAC] >0.08%, comparing the baseline voice spectrographic signature to each subsequent timepoint and present ensemble examine accuracy with 95% confidence intervals (CIs).Alcohol intoxication was predicted with an accuracy of 98% (95% CI 97.1 to 98.6); mean sensitivity = .98; specificity = .97; positive predictive value = .97; and negative predictive value = .98.In this small controlled lab study, voice spectrographic signatures collected from brief recorded English segments were useful in identifying alcohol intoxication. Larger studies using varied voice samples are needed to validate and expand models.

    View details for DOI 10.15288/jsad.22-00375

    View details for PubMedID 37306378

  • Trajectory classes of engagement with an alcohol text message intervention and predictors of intervention engagement. Addictive behaviors Chung, T., Ahn, C., Suffoletto, B. P. 2023; 144: 107729


    Digital interventions have increased our capacity to reach young adults who have hazardous alcohol use. Alcohol text message interventions have shown small effects in reducing hazardous drinking, leaving room for improvement. An important challenge to address in improving digital interventions is maintaining engagement, which reflects the "dose" of intervention received. This study aimed to identify trajectory classes of engagement with an alcohol text message intervention, and baseline predictors of the trajectory classes to determine "for whom" the digital intervention was more versus less engaging, to guide further intervention tailoring. This secondary analysis examined data from a study that compared five 12-week alcohol text message interventions designed to reduce hazardous drinking in young adults (aged 18-25; N = 1,131, 68% female) recruited from Emergency Departments in Western Pennsylvania. Engagement with the intervention was based on response (present/absent) to text message queries delivered twice per week during 2-week run-in and 12-week intervention. Repeated measures latent profile analysis identified five latent trajectory classes as having the best fit to the data: "High engagement" (55.1%), "Slow decrease, moderate engagement" (23.2%); "Mid-way decrease in engagement" (8.9%), "Steadily decreasing engagement" (8.1%); and "Fluctuating, moderate engagement" (4.6%). Females and individuals enrolled in college were overrepresented in the high engagement trajectory class, whereas individuals higher in impulsivity were more likely to be in decreasing (versus high) engagement trajectory classes. Methods to boost engagement using, for example, motivational enhancement for young adults with higher levels of impulsivity, at specific time points, such as the mid-point of the intervention, warrant consideration.

    View details for DOI 10.1016/j.addbeh.2023.107729

    View details for PubMedID 37094456

  • Goal commitment and goal confidence mediate the path between desire to get drunk and binge drinking among young adults receiving text message goal-related feedback. Alcoholism, clinical and experimental research Suffoletto, B., Chung, T. 2023


    This study sought to determine whether drinking limit goal commitment and goal confidence mediate the association between desire to get drunk and binge drinking (4+ drinks for a woman and 5+ drinks for a man on a given occasion) among young adults exposed to text message goal-related feedback.Participants were 297 young adults with hazardous drinking randomized to one of two text-message interventions incorporating drinking limit goal-related assessments and feedback who also completed at least two days of assessments over 12 weeks of intervention exposure. On the two days per week they typically drank alcohol, participants were asked to report plans to drink (yes/no). If a drinking plan was endorsed, participants reported desire to get drunk (0 [not at all] to 8 [completely]), willingness to commit to a drinking limit goal (yes/no), and (contingent on goal commitment) goal confidence (0 [not at all] to 8 [completely]). The next day, participants reported drinking quantity, coded as a binge drinking day (yes/no). Mediation was tested using path models of simultaneous between- and within-person effects using Maximum Likelihood.At both within- and between-person levels, we found significant indirect path effects of goal commitment and goal confidence between desire to get drunk and binge drinking. Greater than usual desire to get drunk was associated with lower drinking limit goal commitment and confidence, whereas greater than usual goal commitment and confidence were associated with lower likelihood of same day binge drinking.Findings support a mechanistic model where contextual variations in same day drinking limit goal commitment and confidence mitigate the path between desire to get drunk and binge drinking among young adults. Employing just-in-time strategies to reinforce drinking limit goal commitment and goal confidence could reduce hazardous drinking and related harms.

    View details for DOI 10.1111/acer.15065

    View details for PubMedID 36974483

  • Desire to get drunk partially mediates effects of a combined text message-based alcohol intervention for young adults. Drug and alcohol dependence Suffoletto, B., Chung, T. 2023; 246: 109848


    This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk.Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation.At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention.Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption.

    View details for DOI 10.1016/j.drugalcdep.2023.109848

    View details for PubMedID 36989707

  • Leveraging Mobile Phone Sensors, Machine Learning and Explainable Artificial Intelligence to Predict Imminent Same-Day Binge Drinking Events to Support Just-In-Time Adaptive Interventions: A Feasibility Study. JMIR formative research Bae, S. W., Suffoletto, B., Zhang, T., Chung, T., Ozolcer, M., Islam, M. R., Dey, A. 2023


    BACKGROUND: Digital Just-In-Time Adaptive Interventions (JITAIs) can reduce binge drinking events (BDEs: consuming 4+/5+ drinks per occasion for women/men) in young adults, but need to be optimized for timing and content. Delivering just-in-time support messages in the hours prior to BDEs could improve intervention impact.OBJECTIVE: We determined the feasibility of developing a machine learning model to accurately predict future, that is, same-day, 1 to 6-hours prior BDEs using smartphone sensor data. We aimed to identify the most informative phone sensor features associated with BDEs on weekend and weekdays, respectively, to determine the key features that explain prediction model performance.METHODS: We collected phone sensor data from 75 young adults (ages 21-25; mean =22.4, SD=1.9) with risky drinking behavior who reported drinking behavior over 14 weeks. Participants in this secondary analysis were enrolled in a clinical trial. We developed machine learning models testing different algorithms (e.g., XGBoost, decision tree) to predict same-day BDEs (versus low-risk drinking events and non-drinking periods) using smartphone sensor data (e.g., accelerometer, GPS). We tested various "prediction distance" time windows (more proximal: 1-hour; to distant: 6-hour) from drinking onset. We also tested various analysis time windows (i.e., amount of data to be analyzed), ranging from 1 to 12 hours prior to drinking onset, because this determines the amount of data that needs to be stored on the phone to compute the model. Explainable AI (XAI) was used to explore interactions between the most informative phone sensor features contributing to BDEs.RESULTS: The XGBoost model performed best in predicting imminent same-day BDE, with 95.0% accuracy on weekends and 94.3% accuracy on weekdays (F1 score = 0.95 and 0.94, respectively). This XGBoost model needed 12- and 9-hours of phone sensor data at 3- and 6- hours prediction distance from the onset of drinking, on weekends and weekdays, respectively, prior to predicting same-day BDEs. The most informative phone sensor features for BDE prediction were time (e.g., time of day) and GPS-derived, such as radius of gyration (an indicator of travel). Interactions among key features (e.g., time of day, GPS-derived features) contributed to prediction of same-day BDE.CONCLUSIONS: We demonstrated the feasibility and potential use of smartphone sensor data and machine learning to accurately predict imminent (same-day) BDEs in young adults. The prediction model provides "windows of opportunity" and with the adoption of XAI, we identified "key contributing features" to trigger JITAI prior to the onset of BDEs, with the potential to reduce the likelihood of BDEs in young adults.CLINICALTRIAL:

    View details for DOI 10.2196/39862

    View details for PubMedID 36809294

  • A Longitudinal Assessment of Posttraumatic Stress Symptoms and Pain Catastrophizing After Injury REHABILITATION PSYCHOLOGY Pacella-LaBarbara, M. L., Plaitano, E. G., Suffoletto, B. P., Kuhn, E., Germain, A., Jaramillo, S., Repine, M., Callaway, C. W. 2023; 68 (1): 32-42


    Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC).This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses.Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants.These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

    View details for DOI 10.1037/rep0000481

    View details for Web of Science ID 000937044900004

    View details for PubMedID 36821344

  • Impact of adherence to procalcitonin antibiotic prescribing guideline recommendations for low procalcitonin levels on antibiotic use. BMC infectious diseases Malley, B. E., Yabes, J. G., Gimbel, E., Chang, C. H., Yealy, D. M., Fine, M. J., Angus, D. C., Huang, D. T., ProACT Investigators, Doi, Y., Eaton, T. L., Fine, M. J., Gimbel, E. A., Peck Palmer, O. M., Pike, F., Ryman, A. M., Weissfeld, L. A., Wofford, K. A., Xu, T., Yabes, J. G., Donnino, M. W., Aisiku, I. P., Hou, P. C., Seethala, R. R., Sherwin, R. L., Holst, J. M., Fischer, M. A., Rafferty, C. M., Dachman, W. D., LoVecchio, F., Filbin, M. R., Mansour, M. K., Fine, J. M., Hammel, J. M., Exline, M. J., Southerland, L. T., Terndrup, T. E., Kurz, M. C., McCullum, D. L., Wang, H. E., Amin, A. N., Lotfipour, S., Khan, F. H., Gentry Wilkerson, R., Prunty, H. A., Suffoletto, B., Brown, A. M., Jovin, F. F. 2023; 23 (1): 30


    BACKGROUND: The Procalcitonin Antibiotic Consensus Trial (ProACT) found provision of a procalcitonin antibiotic prescribing guideline to hospital-based clinicians did not reduce antibiotic use. Possible reasons include clinician reluctance to follow the guideline, with an observed 64.8% adherence rate. In this study we sought to determine the threshold adherence rate for reduction in antibiotic use, and to explore opportunities to increase adherence.METHODS: This study is a retrospective analysis of ProACT data. ProACT randomized 1656 patients presenting to 14 U.S. hospitals with suspected lower respiratory tract infection to usual care or provision of procalcitonin assay results and an antibiotic prescribing guideline to the treating clinicians. We simulated varying adherence to guideline recommendations for low procalcitonin levels and determined which threshold adherence rate could have resulted in rejection of the null hypothesis of no difference between groups at alpha=0.05. We also performed sensitivity analyses within specific clinical settings and grouped patients initially prescribed antibiotics despite low procalcitonin into low, medium, and high risk of illness severity or bacterial infection.RESULTS: Our primary outcome was number of antibiotic-days by day 30 using an intention-to-treat approach and a null hypothesis of no difference in antibiotic use. We determined that an 84% adherence rate in the hospital setting (emergency department and inpatient) for low procalcitonin could have allowed rejection of the null hypothesis (3.7 vs 4.3 antibiotic-days, p=0.048). The threshold adherence rate was 76% for continued guideline adherence after discharge. Even 100% adherence in the emergency department alone failed to reduce antibiotic-days. Of the 218 patients prescribed antibiotics in the emergency department despite low procalcitonin, 153 (70.2%) were categorized as low or medium risk.CONCLUSIONS: High adherence in the hospital setting to a procalcitonin antibiotic prescribing guideline is necessary to reduce antibiotic use in suspected lower respiratory tract infection. Continued guideline adherence after discharge and withholding of antibiotics in low and medium risk patients with low procalcitonin may offer impactful potential opportunities for antibiotic reduction. Trial registration Procalcitonin Antibiotic Consensus Trial (ProACT), Identifier: NCT02130986. First posted May 6, 2014.

    View details for DOI 10.1186/s12879-022-07923-0

    View details for PubMedID 36658543

  • Examining the prevalence and health impairment associated with subthreshold PTSD symptoms (PTSS) among frontline healthcare workers during the COVID-19 pandemic. Journal of psychiatric research Hruska, B., Patterson, P. D., Doshi, A. A., Guyette, M. K., Wong, A. H., Chang, B. P., Suffoletto, B. P., Pacella-LaBarbara, M. L. 2022; 158: 202-208


    The COVID-19 pandemic has increased healthcare workers' (HCWs) risk for posttraumatic stress disorder (PTSD). Although subthreshold PTSD symptoms (PTSS) are common and increase vulnerability for health impairments, they have received little attention. We examined the prevalence of subthreshold PTSS and their relationship to physical health symptoms and sleep problems among HCWs during the pandemic's second wave (01/21-02/21). Participants (N=852; 63.1% male; Mage=38.34) completed the Short-Form PTSD Checklist (SF-PCL), the Cohen-Hoberman Inventory of Physical Symptoms, and the PROMIS Sleep-Related Impairment-Short-Form 4a. We created three groups with the SF-PCL: scores ≥11=probable PTSD (5.5%); scores between 1 and 10=subthreshold PTSS (55.3%); scores of 0=no PTSS (39.2%). After controlling for demographics, occupational characteristics, and COVID-19 status, HCWs with subthreshold PTSS experienced greater physical health symptoms and sleep problems than HCWs with no PTSS. While HCWs with PTSD reported the greatest health impairment, HCWs with subthreshold PTSS reported 88% more physical health symptoms and 36% more sleep problems than HCWs with no PTSS. Subthreshold PTSS are common and increase risk for health impairment. Interventions addressing HCWs' mental health in response to the COVID-19 pandemic must include subthreshold PTSS to ensure their effectiveness.

    View details for DOI 10.1016/j.jpsychires.2022.12.045

    View details for PubMedID 36592534

  • Feasibility of SMS booster for alcohol reduction in injury patients in Tanzania. PLOS global public health Staton, C. A., Minnig, M. C., Phillips, A. J., Kozhumam, A. S., Pesambili, M., Suffoletto, B., Mmbaga, B. T., Ngowi, K., Vissoci, J. R. 2022; 2 (11): e0000410


    Alcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is associated with a high burden of disease in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief negotiational intervention (BNI) in this low resourced setting. We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. A total of 41 study participants were assigned to each receive 12 SMS over a three-month period; 38 received messages correctly, 3 did not receive intended messages, and 1 received a message who was not intended to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants traveling out of cellular service range or turning off their phones. Participants interviewed in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n = 11) of participants interviewed believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact. This study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD.

    View details for DOI 10.1371/journal.pgph.0000410

    View details for PubMedID 36962731

    View details for PubMedCentralID PMC10022354

  • Effects of text message interventions with different behavior change techniques on alcohol consumption among young adults: A 5-arm randomized controlled trial. Addiction (Abingdon, England) Suffoletto, B., Pacella, M., Huber, J., Chung, T. 2022


    AIMS: To test the effectiveness of five interventions each utilizing a unique set of behavior change techniques on reducing alcohol consumption at 3- and 6-months among young adults with hazardous drinking.DESIGN: A 5-arm parallel randomized controlled multicentre trial with 3- and 6-month follow-ups.SETTING: Recruitment at four emergency departments in Pittsburgh, PA, USA.PARTICIPANTS: Non-treatment seeking young adults (mean age 22.1; 68.5% female; 37.1% Black) who reported hazardous drinking.INTERVENTIONS: Participants were randomized to one of five automated text message interventions for 12 weeks that interacted with participants on the 2 days per week they typically drank: assisted self-monitoring (TRACK: control condition; n=245); pre-drinking cognition feedback (PLAN; n=226); alcohol consumption feedback (USE; n=235); adaptive goal support (GOAL; n=214); and a combination of interventions (COMBO; n=221).MEASUREMENTS: Primary outcome was number of past month binge drinking days at 3-months post-randomization calculated from a 30-day Timeline Followback. Primary intention-to-treat analysis compared PLAN, USE, GOAL, and COMBO against TRACK (control condition). The four active conditions were not compared against each other. A secondary outcome, durability of effects, was measured at 6-months.FINDINGS: From baseline to 3-month follow-up (retention=81.1%), compared with TRACK, in which past month mean binge drinking days increased from 2.7 to 3.4, mean binge drinking days decreased in COMBO from 3.0 to 2.3 (adjusted beta= -.52; 95% CI -.77, -.26), GOAL from 3.0 to 2.6 (adjusted beta=-.34; 95% CI -.59, -0.10) and USE from 3.3 to 2.9 (adjusted beta= -.38; 95% CI -.62, -.14). At 6-months (retention=73.8%), COMBO, GOAL, USE, and PLAN had significantly lower mean binge drinking days compared with TRACK.CONCLUSION: Text message interventions incorporating feedback on either drinking plans and/or alcohol consumption and/or drinking limit goal support produced small yet durable reductions in binge drinking days in non-treatment seeking young adults with hazardous drinking.

    View details for DOI 10.1111/add.16074

    View details for PubMedID 36305694

  • Effectiveness of a Text Message Intervention Promoting Seat Belt Use Among Young Adults: A Randomized Clinical Trial. JAMA network open Suffoletto, B., Pacella-LaBarbara, M. L., Huber, J., Delgado, M. K., McDonald, C. 2022; 5 (9): e2231616


    Importance: Approximately 1 in 10 adults do not always wear a seat belt, with the lowest use rates reported among young adults.Objective: To determine the efficacy of a 6-week automated behavioral text message program promoting seat belt use compared with an attention control.Design, Setting, and Participants: This parallel, 2-group, single-blind, individually randomized clinical trial included a convenience sample of patients recruited from 4 emergency departments in 2 cities in Pennsylvania from December 2019 to September 2021, with follow-ups at 6 and 12 weeks after randomization. Patients in stable condition aged 18 to 25 years who, in standardized screening, reported driving or being a passenger in a car without always using a seat belt in the past 2 weeks were eligible for recruitment. Participants who completed a 2-week trial run-in phase were randomly assigned 1:1 to the intervention or the assessment control. Data were analyzed from October 2019 to January 2020.Interventions: The intervention group received Safe Vehicle Engagement (SAVE), a 6-week automated interactive text message program, including weekly seat belt use queries with feedback and goal support to promote consistent use of a seat belt. The control group received identical weekly seat belt use queries but no additional feedback.Main Outcomes and Measures: The primary outcome was the proportion of young adults reporting always wearing a seat belt over the past 2 weeks, collected at 6 weeks (after a 2-week run-in) via web-based self-assessments and analyzed under intent-to-treat models using multiple imputation procedures. Sensitivity analyses included complete-case analyses of ordered categorical outcomes by vehicle seat position. Secondary outcomes included seatbelt use at 12 weeks and select cognitive constructs related to seat belt use.Results: A total of 218 participants (mean [SD] age, 21.5 [2.1] years; 139 [63.8%] women) were randomized, with 110 randomized to SAVE and 108 randomized to the control group. A total of 158 individuals (72.4%) were included in the 6-week follow-up. The rate of always using a seat belt over the past 2 weeks at the 6-week follow-up was 41.3% (95% CI, 30.6%-52.0%) among SAVE participants and 20.0% (95% CI, 10.6%-29.3%) among control participants (odds ratio [OR], 2.8; 95% CI, 1.4-5.8; P=.005). A total of 140 individuals (64.2%) participated in the 12-week follow-up. At 12 weeks, the rate of always using a seat belt over the past 2-weeks was 42.8% (95% CI, 31.2%-54.2%) among SAVE participants and 30.7% (95% CI, 19.6%-41.6%) among control participants (OR, 1.7; 95% CI, 0.9-3.4; P=.13). When examining ordered categories of seat belt use by seat position, there were significantly greater odds of wearing a seat belt at 6 and 12 weeks among SAVE participants vs control participants (eg, 6 weeks for driver: OR, 5.2; 95% CI, 2.6-10.5; 6 weeks for front passenger: OR, 4.3; 95% CI, 2.2-8.2; 6 weeks for back passenger: OR, 4.3; 95% CI, 2.2-8.2).Conclusions and Relevance: In this randomized clinical trial, an interactive text message intervention was more effective at promoting seat belt use among targeted young adults than an attention control at 6 weeks. There was no significant difference between groups in always wearing a seat belt at 12 weeks. These findings, if replicated in a larger sample, suggest a scalable approach to improve seat belt use.Trial Registration: Identifier: NCT03833713.

    View details for DOI 10.1001/jamanetworkopen.2022.31616

    View details for PubMedID 36129713

  • Effectiveness of a Text Message Intervention to Reduce Texting While Driving Among Targeted Young Adults: A Randomized Controlled Trial. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Suffoletto, B., Pacella-LaBarbara, M. L., Huber, J., Delgado, M. K., McDonald, C. 2022


    PURPOSE: This randomized clinical trial tested the efficacy of a 6-week text message program to reduce texting while driving (TWD) for young adults.METHODS: Eligible individuals recruited from four emergency departments from December 2019 to June 2021 were aged 18-25years who reported TWD in the past 2 weeks. Participants were randomly assigned 1:1 to intervention:assessment control. The intervention arm (n= 57) received an automated interactive text message program, including weekly queries about TWD for 6 weeks with feedback and goal support to promote cessation of TWD. The assessment control arm (n= 55) received identical weekly TWD queries but no additional feedback. Outcomes were collected via web-based self-assessments at 6- and 12 weeks and analyzed under intent-to-treat models, presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: The mean (SD) age was 21.7 (2.1) years, 73 (65%) were female, and 40 (36%) were White. The 6-week follow-up rate was 77.7% (n= 87) and 12-week follow-up rate was 64.3% (n= 72). At 6 weeks, 52.6% (95% CI, 39.0%-66.0%) of intervention participants reported TWD versus 63.6% (95% CI, 49.6%-76.2%) of control participants (adjusted OR, 0.71; 95% CI, 0.32-1.59). At 12weeks, 38.2% (95% CI, 22.8%-53.5%) of intervention participants reported TWD versus 69.3% (95% CI, 53.8%-84.7%) of control participants (adjusted OR, 0.29; 95% CI, 0.11-0.80).DISCUSSION: An interactive text message intervention was more effective at reducing self-reported TWD among young adults than assessment control at 12 weeks.

    View details for DOI 10.1016/j.jadohealth.2022.05.016

    View details for PubMedID 35725538

  • The Role of Posttraumatic Stress Symptoms on Pain Catastrophizing among Acutely Injured Patients Pacella-LaBarbara, M. L., Plaitano, E., Suffoletto, B., Kuhn, E., Jaramillo, S., Repine, M., Germain, A., Callaway, C. CHURCHILL LIVINGSTONE. 2022: 52-53
  • Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet (London, England) Humphreys, K., Shover, C. L., Andrews, C. M., Bohnert, A. S., Brandeau, M. L., Caulkins, J. P., Chen, J. H., Cuellar, M., Hurd, Y. L., Juurlink, D. N., Koh, H. K., Krebs, E. E., Lembke, A., Mackey, S. C., Larrimore Ouellette, L., Suffoletto, B., Timko, C. 2022; 399 (10324): 555-604

    View details for DOI 10.1016/S0140-6736(21)02252-2

    View details for PubMedID 35122753

  • A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial. JMIR formative research Suffoletto, B., Goldstein, T., Brent, D. 2021; 5 (11): e30580


    BACKGROUND: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care.OBJECTIVE: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers.METHODS: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks.RESULTS: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care.CONCLUSIONS: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation.

    View details for DOI 10.2196/30580

    View details for PubMedID 34751665

  • The Role of Specific Sources of Social Support on Postinjury Psychological Symptoms REHABILITATION PSYCHOLOGY Brienza, A., Suffoletto, B. P., Kuhn, E., Germain, A., Jaramillo, S., Repine, M., Callaway, C. W., Pacella-LaBarbara, M. L. 2021; 66 (4): 600-610


    The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury.Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family.MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

    View details for DOI 10.1037/rep0000388

    View details for Web of Science ID 000725826700032

    View details for PubMedID 34398631

    View details for PubMedCentralID PMC8648976

  • Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial. JMIR formative research Suffoletto, B., Goldstein, T., Gotkiewicz, D., Gotkiewicz, E., George, B., Brent, D. 2021; 5 (10): e32271


    BACKGROUND: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation.OBJECTIVE: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college.METHODS: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months.RESULTS: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed.CONCLUSIONS: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed.TRIAL REGISTRATION: NCT04560075;

    View details for DOI 10.2196/32271

    View details for PubMedID 34647893

  • Mobile phone sensor-based detection of subjective cannabis intoxication in young adults: A feasibility study in real-world settings. Drug and alcohol dependence Bae, S. W., Chung, T., Islam, R., Suffoletto, B., Du, J., Jang, S., Nishiyama, Y., Mulukutla, R., Dey, A. 2021; 228: 108972


    BACKGROUND: Given possible impairment in psychomotor functioning related to acute cannabis intoxication, we explored whether smartphone-based sensors (e.g., accelerometer) can detect self-reported episodes of acute cannabis intoxication (subjective "high" state) in the natural environment.METHODS: Young adults (ages 18-25) in Pittsburgh, PA, who reported cannabis use at least twice per week, completed up to 30 days of daily data collection: phone surveys (3 times/day), self-initiated reports of cannabis use (start/stop time, subjective cannabis intoxication rating: 0-10, 10=very high), and continuous phone sensor data. We tested multiple models with Light Gradient Boosting Machine (LGBM) in distinguishing "not intoxicated" (rating=0) vs subjective cannabis "low-intoxication" (rating=1-3) vs "moderate-intensive intoxication" (rating=4-10). We tested the importance of time features (i.e., day of the week, time of day) relative to smartphone sensor data only on model performance, since time features alone might predict "routines" in cannabis intoxication.RESULTS: Young adults (N=57; 58 % female) reported 451 cannabis use episodes, mean subjective intoxication rating=3.77 (SD=2.64). LGBM, the best performing classifier, had 60 % accuracy using time features to detect subjective "high" (Area Under the Curve [AUC]=0.82). Combining smartphone sensor data with time features improved model performance: 90 % accuracy (AUC=0.98). Important smartphone features to detect subjective cannabis intoxication included travel (GPS) and movement (accelerometer).CONCLUSIONS: This proof-of-concept study indicates the feasibility of using phone sensors to detect subjective cannabis intoxication in the natural environment, with potential implications for triggering just-in-time interventions.

    View details for DOI 10.1016/j.drugalcdep.2021.108972

    View details for PubMedID 34530315

  • Automated Messaging Program To Facilitate Systematic Home Blood Pressure Monitoring: A Qualitative Analysis Of Provider Interviews Murphy, A. R., Einhorn, J., Rogal, S., Burton, D., Suffoletto, B. P., Rollman, B. L., Forman, D. E., Irizarry, T., Muldoon, M. F. LIPPINCOTT WILLIAMS & WILKINS. 2021
  • Randomized feasibility trial of a digital intervention for hypertension self-management. Journal of human hypertension Muldoon, M. F., Einhorn, J., Yabes, J. G., Burton, D., Irizarry, T., Basse, J., Forman, D. E., Rollman, B. L., Burke, L. E., Kamarck, T. W., Suffoletto, B. P. 2021


    Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial, we sought to generate preliminary evidence of feasibility and efficacy in community-dwelling adults ≥55y/o with hypertension recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Preliminary measures of efficacy included BP readings from phone-supervised home measurements and a self-efficacy questionnaire. Sixty-two participants (40 women, 33 Blacks, mean age 66, mean office BP 164/91) were randomized to MyBP (n=41) or a control group (n=21). Median follow-up was 22.9 (SD=6.7) weeks. In the MyBP group, median engagement with HBPM was 82.7% (Q1=52.5, Q3=89.6) and sustained over time. The decline in systolic [12mm Hg (SD=17)] and diastolic BP [5mm Hg (SD=7)] did not differ between the two treatment groups. However, participants with higher baseline systolic BP assigned to MyBP had a greater decline compared to controls [interaction effect estimate -0.56 (-0.96, -0.17)]. Overall hypertension self-efficacy improved in the MyBP group. In conclusion, trial results show that older hypertensive adults with substantial minority representation had sustained engagement with this digital self-monitoring program and may benefit clinically.

    View details for DOI 10.1038/s41371-021-00574-9

    View details for PubMedID 34239050

  • Adolescent alcohol use predicts cannabis use over a three year follow-up period. Substance abuse Linakis, J. G., Thomas, S. A., Bromberg, J. R., Casper, T. C., Chun, T. H., Mello, M. J., Richards, R., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Dean, J. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Mull, C. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Shenoi, R. P., Suffoletto, B., Vance, C., Spirito, A., Pediatric Emergency Care Applied Research Network.,, 2021: 1-6


    BACKGROUND: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12-17years old (n=1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94-2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00-1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39-4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use.

    View details for DOI 10.1080/08897077.2021.1949665

    View details for PubMedID 34236277

  • COVID-19 Vaccine Uptake and Intent Among Emergency Healthcare Workers: A Cross-Sectional Survey. Journal of occupational and environmental medicine Pacella-LaBarbara, M. L., Park, Y., Patterson, D., Doshi, A., Guyette, M., Wong, A. H., Chang, B. P., Suffoletto, B. P. 2021


    OBJECTIVE: Vaccine hesitancy limits population protection from SARS-CoV (coronavirus disease [COVID-19]). Vaccine hesitancy among healthcare workers (HCW) could put patients and coworkers at risk.METHODS: We surveyed 475 emergency department and emergency medical service workers from January to February 2021 to determine vaccine intent/uptake, perceived COVID-19 vulnerability, and factors associated with vaccine intent/uptake.RESULTS: Although 79% of HCWs received or had plans to receive the COVID-19 vaccine, 21% had no intent/were unvaccinated; intent/uptake was lower among females (odds ratio [OR] = 0.34) and those with a history of COVID-19 infection (OR = 0.55), and higher among those with advanced degrees (OR = 3.53) and high perceived COVID-19 vulnerability (OR = 1.99).CONCLUSIONS: This study provides a timely assessment of vaccination status among frontline HCWs and highlights subgroups who may be at high risk of exposure and transmission.

    View details for DOI 10.1097/JOM.0000000000002298

    View details for PubMedID 34138823

  • Brief Alcohol Screening and Intervention for Community College Students (BASICCS): Feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors Lee, C. M., Cadigan, J. M., Kilmer, J. R., Cronce, J. M., Suffoletto, B., Walter, T., Fleming, C. B., Lewis, M. A. 2021


    Objective: The Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff et al., 1999) is an evidence-based approach to reduce high-risk drinking and associated harms; however, implementation may present challenges for community colleges (CCs) that have limited budgets and mostly non-residential students. We examined feasibility, acceptability, and efficacy of BASICS for CC students (BASICCS) delivered remotely via web-conferencing with supporting automated text messages. Method: Participants included 142 CC students who reported exceeding National Institute on Alcohol Abuse and Alcoholism (NIAAA's) weekly low-risk drinking recommendations and/or heavy episodic drinking (HED). Participants were randomized to BASICCS or assessment-only control (AOC) and completed 1- and 3-month follow-up assessments. Results: Most students liked the personalized information in the program and found the web-conferencing platform useful, however intervention completion rate was 56%. Significant differences were found between BASICCS and AOC. At 1-month, individuals in BASICCS had 33% fewer alcohol consequences than those in AOC. At 3-month follow-up, individuals in BASICCS had lower estimated peak blood alcohol concentration, 29% fewer drinks per week, 62% fewer episodes of HED, and 24% fewer consequences than those in AOC. Conclusions: BASICCS showed evidence of being acceptable and the technology proved feasible, although the intervention completion rate in the non-treatment-seeking volunteer sample was modest. Preliminary evidence does suggest BASICCS shows promise in reducing alcohol use and consequences. Technology-based platforms could be a viable prevention solution for CC students. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

    View details for DOI 10.1037/adb0000745

    View details for PubMedID 34110840

  • Comparison of musculoskeletal pain severity and pain interference using ecological momentary assessment: a longitudinal analysis Mikati, N., Suffoletto, B., Pacella-LaBarbara, M., Callaway, C. CHURCHILL LIVINGSTONE. 2021: 594
  • Distress Tolerance Among Emergency Department Patients in Acute Pain: Associations with Substance Use Treatment. Stress and health : journal of the International Society for the Investigation of Stress Pacella-LaBarbara, M. L., Maltese, C., McConaghy, M., Porter, J., Young, M. L., Suffoletto, B. 2020


    Managing acute pain in individuals with a history of substance use disorders (SUD) is complex. Distress tolerance (DT) (e.g., the ability to handle uncomfortable sensations) may serve as an ideal non-pharmacological intervention target in this population. Among 293 emergency department (ED) patients seeking treatment for pain (Mage = 41; 42% Female; 43% Black), we examined rates of SUD treatment and DT, whether an objective DT task is feasible to conduct in the ED, and relationships between DT and SUD. Patients completed a self-report DT survey, an objective DT task, and brief surveys of pain, drug use, current or past SUD treatment, and depression/anxiety. Average DT was 18.50 (SD = 9.4) out of 50; patients with past or current SUD treatment (n = 43; 14.7%) reported lower DT than patients with no SUD treatment history (n = 250; 85.3%). Controlling for demographics, depression/anxiety, and pain severity, lower subjective DT (adjusted odds ratio [aOR] = 1.05) and objective DT (aOR = 1.02) was associated a current or past history or SUD treatment. Assessing subjective and objective DT in ED patients with acute pain is feasible; interventions aimed at boosting DT may improve outcomes among patients with acute pain and SUD. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/smi.3020

    View details for PubMedID 33369098

  • Implementation of a Web-Based Tool With Text Message Prompts to Improve End-of-Shift Assessments for Emergency Medicine Residents. Journal of graduate medical education Tobias, A., Sobehart, R., Doshi, A. A., Suffoletto, B. 2020; 12 (6): 753–58


    Background: End-of-shift assessments (ESA) can provide representative data on medical trainee performance but do not occur routinely and are not documented systematically.Objective: To evaluate the implementation of a web-based tool with text message prompts to assist mobile ESA (mESA) in an emergency medicine (EM) residency program.Methods: mESA used timed text messages to prompt faculty/trainees to expect in-person qualitative ESA in a milestone content area and for the faculty to record descriptive performance data through a web-based platform. We assessed implementation between January 2018 and November 2019 using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance).Results: Reach: 96 faculty and 79 trainees participated in the mESA program. Effectiveness: From surveys, approximately 72% of faculty and 58% of trainees reported increases in providing and receiving ESA feedback after program implementation. From ESA submissions, trainees reported receiving in-person feedback on 90% of shifts. Residency leadership confirmed perceived utility of the mESA program. Adoption: mESA prompts were sent on 7792 unique shifts across 4 EDs, all days of week, and different times of day. Faculty electronically submitted ESA feedback on 45% of shifts. Implementation quality: No technological errors occurred. Maintenance: Completion of in-person ESA feedback and electronic submission of feedback by faculty was stable over time.Conclusions: We found mixed evidence in support of using a web-based tool with text message prompts for mESA for EM trainees.

    View details for DOI 10.4300/JGME-D-20-00204.1

    View details for PubMedID 33391600

  • In-Person Contacts and Their Relationship With Alcohol Consumption Among Young Adults With Hazardous Drinking During a Pandemic. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Suffoletto, B., Ram, N., Chung, T. 2020


    PURPOSE: Social distancing strategies such as "stay-at-home" (SAH) orders can slow the transmission of contagious viruses like the SARS-CoV-2 virus, but require population adherence to be effective. This study explored adherence to SAH orders by young adults with hazardous drinking, and the role of alcohol consumption with in-person contacts on adherence.METHODS: Analyses included young adults with hazardous drinking (i.e., AUDIT-C score ≥3/4 for women/men; n= 50; ages 18-25) participating in a randomized trial in Pittsburgh, PA. Participants provided experience sampling reports on drinking twice per week from the week before SAH orders started on April 1, 2020 through 6weeks during the SAH period. We examined how in-person contact with non-household friends changed over time and event-level relationships between alcohol consumption and in-person contacts.RESULTS: The percentage of participants with any in-person contact in the week before SAH was 44% (95% confidence interval [CI] 30%-59%), which decreased to 29% (95% CI 15%-43%) in the first SAH week and increased to 65% (95% CI 46%-85%) by SAH week 6. Controlling for average levels of alcohol consumption, on days when young adults drank, participants reported more in-person contacts compared to nondrinking days.CONCLUSIONS: Preliminary data indicate that, among young adults with hazardous drinking, adherence to public policies like SAH orders is suboptimal, declines over time, and is associated with drinking events. Interventions aimed at enhancing young adults' adherence to social distancing policies are urgently needed.

    View details for DOI 10.1016/j.jadohealth.2020.08.007

    View details for PubMedID 32943290

  • A Preliminary Study Using Smartphone Accelerometers to Sense Gait Impairments Due to Alcohol Intoxication JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Suffoletto, B., Dasgupta, P., Uymatiao, R., Huber, J., Flickinger, K., Sejdic, E. 2020; 81 (4): 505–10
  • A Preliminary Study Using Smartphone Accelerometers to Sense Gait Impairments Due to Alcohol Intoxication. Journal of studies on alcohol and drugs Suffoletto, B., Dasgupta, P., Uymatiao, R., Huber, J., Flickinger, K., Sejdic, E. 2020; 81 (4): 505–10


    OBJECTIVE: Sensing the effects of alcohol consumption in real time could offer numerous opportunities to reduce related harms. This study sought to explore accuracy of gait-related features measured by smartphone accelerometer sensors on detecting alcohol intoxication (breath alcohol concentration [BrAC] > .08%).METHOD: In a controlled laboratory study, participants (N = 17; 12 male) were asked to walk 10 steps in a straight line, turn, and walk 10 steps back before drinking and each hour, for up to 7 hours after drinking a weight-based dose of alcohol to reach a BrAC of .20%. Smartphones were placed on the lumbar region and 3-axis accelerometer data was recorded at a rate of 100 Hz. Accelerometer data were segmented into task segments (i.e., walk forward, walk backward). Features were generated for each overlapping 1-second windows, and the data set was split into training and testing data sets. Logistic regression models were used to estimate accuracy for classifying BrAC ≤ .08% from BrAC > .08% for each subject.RESULTS: Across participants, BrAC > .08% was predicted with a mean accuracy of 92.5% using logistic regression, an improvement from a naive model accuracy of 88.2% (mean sensitivity = .89; specificity = .92; positive predictive value = .77; and negative predictive value = .97). The two most informative accelerometer features were mean signal amplitude and variance of the signal in the x-axis (i.e., gait sway).CONCLUSIONS: We found preliminary evidence supporting use of gait-related features measured by smartphone accelerometer sensors to detect alcohol intoxication. Future research should determine whether these findings replicate in situ.

    View details for PubMedID 32800088

  • ADOPTION AND EFFECTIVENESS OF AN EHEALTH INTERVENTION FOR HYPERTENSION IN OLDER ADULTS: A PILOT CLINICAL TRIAL Muldoon, M. F., Einhorn, J., Burton, D., Irizarry, T., Forman, D. E., Rollman, B., Kamarck, T., Yabes, J., Burke, L., Suffoletto, B. LIPPINCOTT WILLIAMS & WILKINS. 2020: A185
  • A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury ACADEMIC EMERGENCY MEDICINE Pacella-LaBarbara, M. L., Suffoletto, B. P., Kuhn, E., Germain, A., Jaramillo, S., Repine, M., Callaway, C. W. 2020


    Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients.From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment.Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months.We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.

    View details for DOI 10.1111/acem.14000

    View details for Web of Science ID 000533683900001

    View details for PubMedID 32339359

  • The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial JMIR MHEALTH AND UHEALTH Demirci, J. R., Suffoletto, B., Doman, J., Glasser, M., Chang, J. C., Sereika, S. M., Bogen, D. L. 2020; 8 (4): e17328


    Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined.This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)-the single, leading modifiable cause of unintended breastfeeding reduction and cessation.We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message-based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging-based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum.Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants' pre-existing breastfeeding knowledge and unique breastfeeding trajectory.Prenatal and postpartum evidence-based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be NCT02724969;

    View details for DOI 10.2196/17328

    View details for Web of Science ID 000529333700001

    View details for PubMedID 32347815

    View details for PubMedCentralID PMC7221632

  • Risk and protective factors for repeated overdose after opioid overdose survival DRUG AND ALCOHOL DEPENDENCE Suffoletto, B., Zeigler, A. 2020; 209: 107890


    Nonfatal opioid overdose (OD) is an opportunity to identify patients who may benefit from interventions to reduce repeated overdose (rOD). In this study, we sought to determine risk and protective factors associated with rOD.In this retrospective cohort study of 4,155 patients aged 18-64 who presented to one of 16 emergency departments in a single Western Pennsylvania health system between July 2015 and January 2018 for index opioid overdose (iOD) and survived to discharge, we identified demographic and clinical factors association with rOD within one-year. Relative risk of repeated opioid overdose was estimated using adjusted Cox proportional hazard ratios (aHRs).14.9 % of patients (95 % CI 13.9-16.1) had a rOD, with 29 % occurring within 30 days from iOD. The adjusted hazard of opioid overdose was increased for male patients (aHR = 1.19; 95 % CI 1.01, 1.41), those with pre-iOD diagnoses of anxiety (aHR = 1.41; 95 % CI1.13, 1.77), depression (aHR = 1.44; 95 % CI 1.17, 1.78), substance use disorders (aHR = 1.30; 95 % CI 1.09, 1.55), and alcohol use disorder (aHR = 1.52; 95 % CI 1.02, 2.25). The hazard was lower for individuals prescribed an opioid in the 90 days prior to iOD (aHR = 0.59; 95 % CI 0.37, 0.97) and those admitted to the hospital for iOD (aHR = 0.56; 95 % CI 0.37, 0.86).We found that, among ED patients who survive an initial OD, mental health and substance use diagnoses are associated with a higher hazard of repeated overdoses whereas opioids prescriptions and admission are associated with lower hazards.

    View details for DOI 10.1016/j.drugalcdep.2020.107890

    View details for Web of Science ID 000527917700011

    View details for PubMedID 32058246

    View details for PubMedCentralID PMC7127977

  • Mobile Assessment of Acute Effects of Marijuana on Cognitive Functioning in Young Adults: Observational Study JMIR MHEALTH AND UHEALTH Chung, T., Bae, S., Mun, E., Suffoletto, B., Nishiyama, Y., Jang, S., Dey, A. K. 2020; 8 (3): e16240


    Mobile assessment of the effects of acute marijuana on cognitive functioning in the natural environment would provide an ecologically valid measure of the impacts of marijuana use on daily functioning.This study aimed to examine the association of reported acute subjective marijuana high (rated 0-10) with performance on 3 mobile cognitive tasks measuring visuospatial working memory (Flowers task), attentional bias to marijuana-related cues (marijuana Stroop), and information processing and psychomotor speed (digit symbol substitution task [DSST]). The effect of distraction as a moderator of the association between the rating of subjective marijuana high and task performance (ie, reaction time and number of correct responses) was explored.Young adults (aged 18-25 years; 37/60, 62% female) who reported marijuana use at least twice per week were recruited through advertisements and a participant registry in Pittsburgh, Pennsylvania. Phone surveys and mobile cognitive tasks were delivered 3 times per day and were self-initiated when starting marijuana use. Completion of phone surveys triggered the delivery of cognitive tasks. Participants completed up to 30 days of daily data collection. Multilevel models examined associations between ratings of subjective marijuana high (rated 0-10) and performance on each cognitive task (reaction time and number of correct responses) and tested the number of distractions (rated 0-4) during the mobile task session as a moderator of the association between ratings of subjective marijuana high and task performance.Participants provided 2703 data points, representing 451 reports (451/2703, 16.7%) of marijuana use. Consistent with slight impairing effects of acute marijuana use, an increase in the average rating of subjective marijuana high was associated with slower average reaction time on all 3 tasks-Flowers (B=2.29; SE 0.86; P=.008), marijuana Stroop (B=2.74; SE 1.09; P=.01), and DSST (B=3.08; SE 1.41; P=.03)-and with fewer correct responses for Flowers (B=-0.03; SE 0.01; P=.01) and DSST (B=-0.18; SE 0.07; P=.01), but not marijuana Stroop (P=.45). Results for distraction as a moderator were statistically significant only for certain cognitive tasks and outcomes. Specifically, as hypothesized, a person's average number of reported distractions moderated the association of the average rating of subjective marijuana high (over and above a session's rating) with the reaction time for marijuana Stroop (B=-52.93; SE 19.38; P=.006) and DSST (B=-109.72; SE 42.50; P=.01) and the number of correct responses for marijuana Stroop (B=-0.22; SE 0.10; P=.02) and DSST (B=4.62; SE 1.81; P=.01).Young adults' performance on mobile cognitive tasks in the natural environment was associated with ratings of acute subjective marijuana high, consistent with slight decreases in cognitive functioning. Monitoring cognitive functioning in real time in the natural environment holds promise for providing immediate feedback to guide personal decision making.

    View details for DOI 10.2196/16240

    View details for Web of Science ID 000518839800001

    View details for PubMedID 32154789

    View details for PubMedCentralID PMC7093776

  • The Effect of SMS Behavior Change Techniques on Event-Level Desire to Get Drunk in Young Adults PSYCHOLOGY OF ADDICTIVE BEHAVIORS Suffoletto, B., Huber, J., Kirisci, L., Clark, D., Chung, T. 2020; 34 (2): 320–26


    Text messaging (SMS) interventions incorporating a combination of behavior change techniques can assist reductions in alcohol consumption among young adult hazardous drinkers, but mechanisms of action remain unknown. In this secondary analysis, we test the hypothesis that desire to get drunk (DD) recorded prior to drinking episodes would mediate SMS intervention effects on the likelihood of event-level heavy drinking (4 +/5 + drinks for women/men). We recruited young adult hazardous drinkers to a trial where they were randomized to 1 of 5 SMS interventions: TRACK (self-monitoring of alcohol use), PLAN (feedback on drinking plans and DD), USE (postdrinking feedback on alcohol consumed), GOAL (goal prompts/support), and COMBO (i.e., 4 interventions combined). Up to 3 days per week for 14 weeks, when participants reported a plan to drink, they were asked to report DD on a scale from 0 (none) to 8 (completely) and next day asked to recall drink quantity. Multilevel structural equation models showed that DD mediated the treatment effect of GOAL on heavy drinking. This work illustrates the importance of goal support features in digital alcohol interventions and the utility of measuring desire to get drunk as a key mediator in alcohol studies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

    View details for DOI 10.1037/adb0000534

    View details for Web of Science ID 000525395200008

    View details for PubMedID 31750698

    View details for PubMedCentralID PMC7064373

  • Matchmaking and the Future of Hypertension Management. Circulation. Cardiovascular quality and outcomes Murphy, A. R., Suffoletto, B. P., Muldoon, M. F. 2020: CIRCOUTCOMES120007062

    View details for DOI 10.1161/CIRCOUTCOMES.120.007062

    View details for PubMedID 33302716

  • SMS-facilitated home blood pressure monitoring: A qualitative analysis of resultant health behavior change Allen, M. E., Irizarry, T., Einhorn, J., Kamarck, T. W., Suffoletto, B. P., Burke, L. E., Rollman, B. L., Muldoon, M. F. ELSEVIER IRELAND LTD. 2019: 2246–53


    Hypertension is largely asymptomatic and, as a result, patients often fail to sufficiently engage in medication adherence and other health behaviors to control their blood pressure (BP). This study explores the mechanisms by which MyBP, an automated SMS-facilitated home blood pressure monitoring (HBPM) program, helps facilitate healthy behavior changes.A thematic analysis of transcribed audio-recordings from semi-structured post-intervention interviews (n = 40) was conducted.Three primary themes were identified as contributing most to patients' decision to initiate a behavior change: 1) increased hypertension literacy attributed to educational videos presented at enrollment, 2) increased day-to-day salience of blood pressure levels as a result of consistent HBPM, and 3) use of BP readings as feedback, with high readings triggering motivations to make behavior changes. These themes and most accompanying sub-themes correspond to constructs in the Health Belief Model and Social Cognitive Theory.Patient-centered HBPM interventions such asMyBP appear to promote improvements in hypertension self-management via several mechanisms consistent with recognized models of behavior change.SMS-supported HBPM, paired with video-based education, may provide a simple and scalable way of encouraging health behavior adherence in hypertensive patients.

    View details for DOI 10.1016/j.pec.2019.06.015

    View details for Web of Science ID 000496130200014

    View details for PubMedID 31262674

    View details for PubMedCentralID PMC6851464

  • Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients ACADEMIC EMERGENCY MEDICINE Chernick, L. S., Chun, T. H., Richards, R., Bromberg, J. R., Ahmad, F. A., McAninch, B., Mull, C., Shenoi, R., Suffoletto, B., Casper, C., Linakis, J., Spirito, A., PECARN 2020; 27 (4): 283–90


    In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives.Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females.In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females.Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.

    View details for DOI 10.1111/acem.13867

    View details for Web of Science ID 000497961100001

    View details for PubMedID 31596987

    View details for PubMedCentralID PMC7141959

  • Positive urgency worsens the impact of normative feedback on 21st birthday drinking DRUG AND ALCOHOL DEPENDENCE Whitt, Z. T., Bernstein, M., Spillane, N., Stein, L. R., Suffoletto, B., Neighbors, C., Schick, M. R., Cyders, M. A. 2019; 204: 107559


    The 21st birthday is associated with more alcohol consumption and negative consequences than any other occasion. The current study investigated how positive urgency, the tendency to act rashly in response to positive emotions, influences 21st birthday drinking and the effectiveness of a single event text message intervention designed to reduce 21st birthday drinking and related negative consequences.Participants were 183 undergraduate students (69% female, 86% white) about to turn 21. Participants were randomly assigned to either a text message intervention or control condition. Those in the intervention condition received one text message the day before their 21st birthday that provided personalized normative feedback and one text message on the day of their 21st birthday. Participants reported actual alcohol consumption the day after their 21st birthday celebration.Hierarchical linear regression found that, after controlling for sex, intervention condition, and planned drinking, positive urgency was associated with greater number of drinks (β = .15, p = .031) and drinking problems (β = .25, p = .001). A moderated-mediation model was significant (B = 0.42, CI95 [.10, .76]): At high levels of positive urgency, the intervention condition was associated with drinking more than planned, which significantly mediated the relationship between intervention and alcohol-related consequences; the mediation was not significant at mean or low levels of positive urgency.These findings are the first to link positive urgency with 21st birthday drinking and to empirically demonstrate that positive urgency negatively impacts the effectiveness of an intervention aimed at reducing alcohol consumption.

    View details for DOI 10.1016/j.drugalcdep.2019.107559

    View details for Web of Science ID 000501392200059

    View details for PubMedID 31563804

    View details for PubMedCentralID PMC6878139

  • Methodology and Demographics of a Brief Adolescent Alcohol Screen Validation Study PEDIATRIC EMERGENCY CARE Bromberg, J. R., Spirito, A., Chun, T., Mello, M. J., Casper, T., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M., Mull, C. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Shenoi, R. P., Suffoletto, B., Vance, C., Linakis, J. G., Pediat Emergency Care Appl Res Net 2019; 35 (11): 737–44


    The aim of this study was to determine the psychometric properties of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within 16 Pediatric Emergency Care Applied Research Network pediatric emergency departments. This article describes the study methodology, sample characteristics, and baseline outcomes of the NIAAA 2-question screen.Participants included 12- to 17-year-olds treated in one of the participating pediatric emergency departments across the United States. After enrollment, a criterion assessment battery including the NIAAA 2-question screen and other measures of alcohol, drug use, and risk behavior was self-administered by participants on a tablet computer. Two subsamples were derived from the sample. The first subsample was readministered the NIAAA 2-question screen 1 week after their initial visit to assess test-retest reliability. The second subsample is being reassessed at 12 and 24 months to examine predictive validity of the NIAAA 2-question screen.There were 4834 participants enrolled into the study who completed baseline assessments. Participants were equally distributed across sex and age. Forty-six percent of the participants identified as white, and 26% identified as black. Approximately one quarter identified as Hispanic. Using the NIAAA 2-question screen algorithm, approximately 8% were classified as low risk, 12% were classified as moderate risk, and 4% were classified as highest risk. Alcohol use was less likely to be reported by black participants, non-Hispanic participants, and those younger than 16 years.This study successfully recruited a large, demographically diverse sample to establish rates of the NIAAA screen risk categories across age, sex, ethnicity, and race within pediatric emergency departments.

    View details for DOI 10.1097/PEC.0000000000001221

    View details for Web of Science ID 000497516400009

    View details for PubMedID 29112110

    View details for PubMedCentralID PMC5752626

  • Do electronic health record prompts increase take-home naloxone administration for emergency department patients after an opioid overdose? ADDICTION Marino, R., Landau, A., Lynch, M., Callaway, C., Suffoletto, B. 2019; 114 (9): 1575–81


    Distribution of take-home naloxone (THN) to emergency department (ED) patients who have survived an opioid overdose (OD) could reduce future opioid mortality, but is not commonly performed. We examined whether electronic health record (EHR) prompts provided to ED physicians when discharging a patient after an OD could improve THN distribution.Interrupted time-series analysis to compare the percentage of OD patients who received THN during the 11 months before and after implementation of an EHR prompt on 18 June 2017.A total of 3492 adult patients with diagnoses of OD discharged from nine EDs in a single health system in Western Pennsylvania from July 2016 to April 2018.The EHR prompt was triggered by the presence of specific terms in the nurse's initial assessment note. The EHR displayed a pop-up window during the ED physician discharge process asking the physician to consider prescribing or providing naloxone to the patient. The comparator was 'no EHR prompt'.Measurements were based on standard criteria from ICD diagnostic codes and chief complaint keywords.In July 2016, 16.3% [95% confidence interval (CI) = 14.0, 18.5] of OD patients received THN, which decreased every month through June 2017 by 1.2% (P < 0.0001, 95% CI = 0.8,1.7). For each month post-EHR prompt there was an increase of 2.8% of OD patients receiving THN (P < 0.001, 95% CI = 2.0, 3.5). No increases occurred in the ED with the highest pre-EHR prompt THN distribution. Rates of THN distribution varied by patient age and race prior to, but not after, implementation of EHR prompts.Electronic health record prompts are associated with increased take-home naloxone distribution for emergency department patients discharged after opioid overdoses.

    View details for DOI 10.1111/add.14635

    View details for Web of Science ID 000478744100007

    View details for PubMedID 31013394

  • Early Screening for Posttraumatic Stress Disorder and Depression Among Injured Emergency Department Patients: A Feasibility Study Jaramillo, S., Suffoletto, B., Callaway, C., Pacella-LaBarbara, M. WILEY. 2019: 1232–44


    Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury.In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL).Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL.These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.

    View details for DOI 10.1111/acem.13816

    View details for Web of Science ID 000476074000001

    View details for PubMedID 31179590

    View details for PubMedCentralID PMC7294865

  • Reliability and Validity of the Newton Screen for Alcohol and Cannabis Misuse in a Pediatric Emergency Department Sample JOURNAL OF PEDIATRICS Linakis, J. G., Bromberg, J. R., Casper, T., Chun, T. H., Mello, M. J., Ingebretsen, H., Spirito, A., Shenoi, R. P., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Dean, J., Fein, J., Grupp-Phelan, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Mull, C. C., Powell, E. C., Rogers, A., Suffoletto, B., Vance, C., Pediat Emergency Care Appl Res Net 2019; 210: 154-+


    To determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up.Adolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure.The sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis.The Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment.

    View details for DOI 10.1016/j.jpeds.2019.02.038

    View details for Web of Science ID 000472497600030

    View details for PubMedID 30967250

    View details for PubMedCentralID PMC6592736

  • Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use? SUBSTANCE USE & MISUSE Spirito, A., Bromberg, J. R., Casper, T., Chun, T., Mello, M. J., Mull, C. C., Shenoi, R. P., Vance, C., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Suffoletto, B., Linakis, J. G., PECARN 2019; 54 (6): 1007–16


    The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse.A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs.Participants included 12-17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer.A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.

    View details for DOI 10.1080/10826084.2018.1558251

    View details for Web of Science ID 000466910800015

    View details for PubMedID 30727811

    View details for PubMedCentralID PMC6476662

  • How Are Real-time Opioid Prescribing Cognitions by Emergency Providers Influenced by Reviewing the State Prescription Drug Monitoring Program? PAIN MEDICINE Landau, A., Lynch, M., Callaway, C., Suffoletto, B. 2019; 20 (5): 955–60


    To understand how real-time opioid prescribing cognitions by emergency medicine (EM) providers are influenced by review of the state prescription drug monitoring program (PDMP).We collected prospective data from a convenience sample of 103 patient encounters for pain from 23 unique EM providers. After seeing the patient, before and immediately after reviewing the PDMP, EM providers answered how much they thought "the patient need[ed] an opioid to help manage their pain?", how concerned they were "about drug abuse and/or diversion?", and whether they planned to prescribe an opioid (yes/no). If they changed their decision to prescribe after querying the PDMP, they were asked to provide comments. We categorized encounters by opioid prescribing plan before/after PDMP review (e.g., O+/O- means plan changed from "yes" to "no") and examined changes in cognitions across categories.Ninety-two of 103 (89.3%) encounters resulted in no change in opioid prescribing plan (61/92 [66.3%] O+/O+; 31/92 [33.7%] O-/O-). For the four O+/O- encounters, perceived patient opioid need decreased 75% of the time and concern for opioid abuse and/or diversion increased 75% of time. For the seven O-/O+ encounters, providers reported increased perceived patient opioid need 28.6% of the time and decreased concern for opioid abuse and/or diversion 14.3% of time.PDMP data rarely alter plans to prescribe an opioid among emergency providers. When changes in opioid prescribing plan were made, this was reflected by changes in cognitions. Findings support the need for a properly powered study to identify how specific PDMP findings alter prescribing cognitions.

    View details for DOI 10.1093/pm/pny083

    View details for Web of Science ID 000479175500011

    View details for PubMedID 29762757

    View details for PubMedCentralID PMC6497091

  • Which behavior change techniques help young adults reduce binge drinking? A pilot randomized clinical trial of 5 text message interventions ADDICTIVE BEHAVIORS Suffoletto, B., Kirisci, L., Clark, D. B., Chung, T. 2019; 92: 161–67


    Text message (SMS) interventions can reduce binge drinking in young adults, but optimal behavior change techniques (BCTs) remain unknown. The present study tests the acceptability and preliminary efficacy of different combinations of SMS-delivered BCTs. 149 young adults who screened positive for hazardous drinking completed a baseline survey in the Emergency Department. For the following 2-weeks, on days they typically drank (1 to 3 days per week), participants received ecological momentary assessments (EMA) of drinking plans and desire to get drunk; the next day they were prompted to report recall of number of drinks consumed the prior day. Participants who responded to at least 50% these EMA (N = 127) were randomized to one of five 12-week interventions: Cued Self-Monitoring (TRACK); Drinking Intentions Feedback (PLAN); Drinking Performance Feedback (USE); Adaptive Goal Support (GOAL); and a combination of BCTs (COMBO). 79% of all EMA were completed over 12 weeks, which decreased from around 93% on week 1 to 65% by week 12. Using EMA data, relative to TRACK, only COMBO showed significant reductions in binge drinking and max drinks per drinking episode over time. Using TLFB data, there were no significant differences between groups from baseline to 14- and 28-weeks follow-up. Results lay the groundwork for a larger trial testing the effects of BCTs on binge drinking for young adults.

    View details for DOI 10.1016/j.addbeh.2019.01.006

    View details for Web of Science ID 000468708800027

    View details for PubMedID 30640148

  • Implementations of a text-message intervention to increase linkage from the emergency department to outpatient treatment for substance use disorders JOURNAL OF SUBSTANCE ABUSE TREATMENT Kmiec, J., Suffoletto, B. 2019; 100: 39–44


    To determine acceptability and explore potential usefulness of a text messaging (SMS) program aimed at increasing attendance at outpatient treatment for substance use disorders (SUD) after emergency department (ED) referral.A retrospective analysis of 377 adult patients from 2 urban EDs seeking treatment for SUD (opioids (n = 168), alcohol (n = 188), benzodiazepines (n = 21)) referred to outpatient treatment and offered an SMS program which included daily (1) motivational messages focused on positive thinking, (2) ecological momentary assessments (EMA) related to craving with tailored behavioral strategy messages, (3) EMA of drug use with tailored feedback to reduce abstinence violation effects, and (4) reminders about treatment location and phone number. We assessed acceptability by examining opt-in rates, EMA completion rates over the first week and end-of-program qualitative feedback. We assessed how individuals who opt in differ in outcomes from those who opt out by examining rates of outpatient SUD treatment attendance recorded from the medical record.167 patients (44%) opted in to the SMS program. Over 7 days, around 33% of EMA were completed. Median helpfulness score was 8 (IQR 6 to 10) out of 10 and 84% would recommend the SMS program to someone else. Individuals who opted in to the SMS program had higher rates of SUD treatment initiation than individuals who did not opt-in (70.7% vs. 40.9%).We found evidence supporting acceptability and potential usefulness of an automated text message program to assist treatment attendance for some individuals with SUDs discharged from the ED. A controlled trial is needed to examine whether SMS program exposure is associated with improved treatment attendance compared to standard care.

    View details for DOI 10.1016/j.jsat.2019.02.005

    View details for Web of Science ID 000462951600005

    View details for PubMedID 30898326

    View details for PubMedCentralID PMC6432936

  • Predictive Validity of a 2-Question Alcohol Screen at 1-, 2-, and 3-Year Follow-up PEDIATRICS Linakis, J. G., Bromberg, J. R., Casper, T., Chun, T. H., Mello, M. J., Richards, R., Mull, C. C., Shenoi, R. P., Vance, C., Ahmad, F., Bajaj, L., Brown, K. M., Chernick, L. S., Cohen, D. M., Fein, J., Horeczko, T., Levas, M. N., McAninch, B., Monuteaux, M. C., Grupp-Phelan, J., Powell, E. C., Rogers, A., Suffoletto, B., Dean, J., Spirito, A., Pediat Emergency Care Applied 2019; 143 (3)


    The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question screen is a valid adolescent alcohol screening tool. No studies have examined if this tool predicts future alcohol problems. We conducted a study at 16 pediatric emergency departments to determine the tool's predictive validity for alcohol misuse and alcohol use disorders (AUDs).Participants (N = 4834) completed a baseline assessment battery. A subsample of participants completed the battery at 1, 2, and 3 years follow up.Of the 2209 participants assigned to follow-up, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. The differences in AUDs between baseline NIAAA screen nondrinkers and lower-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P <.0001), and 3 years (P = .0005), as were the differences between moderate- and highest-risk drinkers at 1 and 2 years (P < .0001 and P = .0088, respectively) but not at 3 years (P = .0758). The best combined score for sensitivity (86.2% at 1 year, 75.6% at 2 years, and 60.0% at 3 years) and specificity (78.1% at 1 year, 79.2% at 2 years, and 80.0% at 3 years) was achieved by using "lower risk" and higher as a cutoff for the prediction of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis.The NIAAA 2-question screen can accurately characterize adolescent risk for future AUDs. Future studies are needed to determine optimaluse of the screen.

    View details for DOI 10.1542/peds.2018-2001

    View details for Web of Science ID 000459796900009

    View details for PubMedID 30783022

    View details for PubMedCentralID PMC6398369

  • Attentional and approach biases to alcohol cues among young adult drinkers: An ecological momentary assessment study. Experimental and clinical psychopharmacology Suffoletto, B. n., Field, M. n., Chung, T. n. 2019


    Alcohol-specific attentional biases (AttB) and approach biases (AppB) are postulated to play a role in alcohol use disorders but their association with drinking in young adults remains unknown. A subsample of young adults with risky alcohol use (N = 296) enrolled in a randomized trial, testing different text message interventions completed weekly tasks via a mobile app for up to 14 weeks: Alcohol Stroop was used to measure AttB and Approach-Avoidance Task was used to measure AppB. Participants also provided reports of their alcohol consumption up to twice per week. We analyzed feasibility of measuring alcohol biases on mobile phones, whether repeated testing and conditions of testing affected mean reaction times (RTs), and whether mean AttB and AppB scores were associated with baseline alcohol use severity and same-day binge drinking (4+/5+ drinks per occasion for women/men). Task completion decreased from 93% on Week 1% to 39% by Week 14 with a mean of 8.2 weeks completed. Mean RTs for Alcohol Stroop decreased over weeks assessed. RTs to Stroop and Approach-Avoid tasks were longer when participants reported distractions or after alcohol and/or drug use. Mean AttB and AppB scores were not associated with baseline drinking, and within-day fluctuations of AttB and AppB scores did not predict same day binge drinking. Barriers to measuring alcohol biases in the natural environment include learning effects, contextual influences of distractions and prior alcohol/drug use, and absence of robust associations of RTs to alcohol cues with either baseline or same-day alcohol consumption. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/pha0000343

    View details for PubMedID 31886700

    View details for PubMedCentralID PMC7326641

  • Feasibility and acceptability of a motivational intervention combined with text messaging for alcohol and sex risk reduction with emergency department patients: a pilot trial ADDICTION RESEARCH & THEORY Mastroleo, N. R., Celio, M. A., Barnett, N. P., Colby, S. M., Kahler, C. W., Operario, D., Suffoletto, B. P., Monti, P. M. 2019; 27 (2): 85–94


    Interventions aimed at reducing co-occurring heavy drinking and risky sexual behavior among Emergency Department (ED) patients require feasibility and acceptability to optimally engage individuals.This pilot study explored the feasibility and acceptability of an interactive text-messaging (TM) supplement to a brief in-person intervention previously found successful in reducing alcohol use and condomless sex.Using a mixed-method design, ED patients with past hazardous alcohol use and condomless sex (N= 20) were randomly assigned to receive either a Motivational Intervention + TM or Brief Advice + TM. All participants completed exit interviews at four weeks follow-up, and transcripts were transcribed and coded to identify themes. We evaluated feasibility through quantitative assessment of TM response rates and latency to response, while acceptability was evaluated through thematic analysis of exit interviews.Findings provide support for the delivery of an integrated and personalized MI and TM. Participants engaged positively with the TM intervention and qualitative interviews offered strong support for the acceptability while offering information necessary to enhance the TM component.Integrating MI with TM is feasible and acceptable to at-risk ED patients and could facilitate behavior changes beyond MI alone.

    View details for DOI 10.1080/16066359.2018.1444159

    View details for Web of Science ID 000461676900004

    View details for PubMedID 31073283

    View details for PubMedCentralID PMC6502468

  • Nudging Emergency Care Providers to Reduce Opioid Prescribing Using Peer Norm Comparison Feedback: A Pilot Randomized Trial. Pain medicine (Malden, Mass.) Suffoletto, B. n., Landau, A. n. 2019


    To determine the feasibility, acceptability, and potential impact of using audit and feedback (A&F) with or without peer norm comparison on opioid prescribing by emergency medicine providers.A convenience sample of 37 emergency medicine providers were recruited from 16 emergency departments in Western Pennsylvania for a pilot randomized controlled trial. Participants completed a baseline survey, were randomly allocated to A&F (N = 17) or A&F with peer norm comparison (N = 20), and were asked to complete a postintervention survey. We matched each participant 1:1 to a control who was not exposed to either intervention.At baseline, 57% of participants perceived that they prescribed opioids at the same frequency as their peers, whereas 32% perceived prescribing less than and 11% perceived prescribing more than their peers. Most participants rated the interventions as helpful, with no differences between conditions. For the A&F with peer norm comparison condition, from pre- to postintervention, there was a relative increase of 20% in the percentage of participants who perceived that they prescribed more opioids than their peers but no change in the A&F condition (P = 0.02). 56.8% of controls, 52.9% of A&F participants, and 75.5% of A&F with peer norm comparison participants reduced their opioid prescribing (P = 0.33). The mean reduction in opioid prescriptions (SD) was 3.3. (9.6) for controls, 3.9 (10.5) for A&F, and 7.3 (7.8) for A&F with peer norm comparison (P = 0.31).Audit and feedback interventions with peer norm comparisons are helpful to providers, can alter perceptions about prescribing norms, and are a potentially effective way to alter ED providers' opioid prescribing behavior.

    View details for DOI 10.1093/pm/pnz314

    View details for PubMedID 31846029

  • Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials PLOS MEDICINE Riper, H., Hoogendoorn, A., Cuijpers, P., Karyotaki, E., Boumparis, N., Mira, A., Andersson, G., Berman, A. H., Bertholet, N., Bischof, G., Blankers, M., Boon, B., Boss, L., Brendryen, H., Cunningham, J., Ebert, D., Hansen, A., Hester, R., Khadjesari, Z., Kramer, J., Murray, E., Postel, M., Schulz, D., Sinadinovic, K., Suffoletto, B., Sundstrom, C., de Vries, H., Wallace, P., Wiers, R. W., Smit, J. H. 2018; 15 (12): e1002714


    Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs).Systematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data. The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention, and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis. We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants. Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI -7.57 to -2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63-2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06-6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21-2.27, p = 0.002). Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: -6.78 SUs, 95% CI -12.11 to -1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22-4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29-0.93, p = 0.029). The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: -9.27 SUs, 95% CI -13.97 to -4.57, p < 0.001; TR: OR = 3.74, 95% CI 2.13-6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses.To our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.

    View details for DOI 10.1371/journal.pmed.1002714

    View details for Web of Science ID 000454833300006

    View details for PubMedID 30562347

    View details for PubMedCentralID PMC6298657

  • Text-Facilitated Home Blood Pressure Monitoring: A Qualitative Analysis of Health Behavior Change Allen, M., Irizarry, T., Einhorn, J., Suffoletto, B., Kamarck, T., Burke, L., Rollman, B., Muldoon, M. F. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Development and Preliminary Feasibility of an Automated Hypertension Self-Management System AMERICAN JOURNAL OF MEDICINE Irizarry, T., Allen, M., Suffoletto, B. P., Einhorn, J., Burke, L. E., Kamarck, T. W., Rollman, B. L., Muldoon, M. F. 2018; 131 (9)
  • The Association Between Daily Posttraumatic Stress Symptoms and Pain Over the First 14 Days After Injury: An Experience Sampling Study ACADEMIC EMERGENCY MEDICINE Pacella, M. L., Girard, J. M., Wright, A. C., Suffoletto, B., Callaway, C. W. 2018; 25 (8): 844–55

    View details for DOI 10.1111/acem.13406

    View details for Web of Science ID 000441740500001

  • Mobile phone sensors and supervised machine learning to identify alcohol use events in young adults: Implications for just-in-time adaptive interventions ADDICTIVE BEHAVIORS Bae, S., Chung, T., Ferreira, D., Dey, A. K., Suffoletto, B. 2018; 83: 42–47


    Real-time detection of drinking could improve timely delivery of interventions aimed at reducing alcohol consumption and alcohol-related injury, but existing detection methods are burdensome or impractical.To evaluate whether phone sensor data and machine learning models are useful to detect alcohol use events, and to discuss implications of these results for just-in-time mobile interventions.38 non-treatment seeking young adult heavy drinkers downloaded AWARE app (which continuously collected mobile phone sensor data), and reported alcohol consumption (number of drinks, start/end time of prior day's drinking) for 28days. We tested various machine learning models using the 20 most informative sensor features to classify time periods as non-drinking, low-risk (1 to 3/4 drinks per occasion for women/men), and high-risk drinking (>4/5 drinks per occasion for women/men).Among 30 participants in the analyses, 207 non-drinking, 41 low-risk, and 45 high-risk drinking episodes were reported. A Random Forest model using 30-min windows with 1day of historical data performed best for detecting high-risk drinking, correctly classifying high-risk drinking windows 90.9% of the time. The most informative sensor features were related to time (i.e., day of week, time of day), movement (e.g., change in activities), device usage (e.g., screen duration), and communication (e.g., call duration, typing speed).Preliminary evidence suggests that sensor data captured from mobile phones of young adults is useful in building accurate models to detect periods of high-risk drinking. Interventions using mobile phone sensor features could trigger delivery of a range of interventions to potentially improve effectiveness.

    View details for DOI 10.1016/j.addbeh.2017.11.039

    View details for Web of Science ID 000435063200006

    View details for PubMedID 29217132

    View details for PubMedCentralID PMC5963979

  • Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection NEW ENGLAND JOURNAL OF MEDICINE Huang, D. T., Yealy, D. M., Filbin, M. R., Brown, A. M., Chang, C. H., Doi, Y., Donnino, M. W., Fine, J., Fine, M. J., Fischer, M. A., Holst, J. M., Hou, P. C., Kellum, J. A., Khan, F., Kurz, M. C., Lotfipour, S., LoVecchio, F., Peck-Palmer, O., Pike, F., Prunty, H., Sherwin, R. L., Southerland, L., Terndrup, T., Weissfeld, L. A., Yabes, J., Angus, D. C., ProACT Investigators 2018; 379 (3): 236–49


    The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear.In 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group. We hypothesized that within 30 days after enrollment the total antibiotic-days would be lower - and the percentage of patients with adverse outcomes would not be more than 4.5 percentage points higher - in the procalcitonin group than in the usual-care group.A total of 1656 patients were included in the final analysis cohort (826 randomly assigned to the procalcitonin group and 830 to the usual-care group), of whom 782 (47.2%) were hospitalized and 984 (59.4%) received antibiotics within 30 days. The treating clinician received procalcitonin assay results for 792 of 826 patients (95.9%) in the procalcitonin group (median time from sample collection to assay result, 77 minutes) and for 18 of 830 patients (2.2%) in the usual-care group. In both groups, the procalcitonin-level tier was associated with the decision to prescribe antibiotics in the emergency department. There was no significant difference between the procalcitonin group and the usual-care group in antibiotic-days (mean, 4.2 and 4.3 days, respectively; difference, -0.05 day; 95% confidence interval [CI], -0.6 to 0.5; P=0.87) or the proportion of patients with adverse outcomes (11.7% [96 patients] and 13.1% [109 patients]; difference, -1.5 percentage points; 95% CI, -4.6 to 1.7; P<0.001 for noninferiority) within 30 days.The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection. (Funded by the National Institute of General Medical Sciences; ProACT number, NCT02130986 .).

    View details for DOI 10.1056/NEJMoa1802670

    View details for Web of Science ID 000439063900007

    View details for PubMedID 29781385

    View details for PubMedCentralID PMC6197800

  • Developing Text Messages to Reduce Community College Student Alcohol Use AMERICAN JOURNAL OF HEALTH BEHAVIOR Lewis, M. A., Cadigan, J. M., Cronce, J. M., Kilmer, J. R., Suffoletto, B., Walter, T., Lee, C. M. 2018; 42 (4): 70–79


    Objectives The aim of this study is to evaluate how community college students with hazardous drinking perceived the usefulness of alcohol protective behavioral strategy text messages (TM-PBS). Methods Community college students with past hazardous single occasion or weekly drinking (N = 48; 60% female) were randomized to receive 2 TM-PBS on 3 typical drinking days per week for 2 weeks selected by: (1) research investigators (ie, based on clinical and theoretical application); (2) participants (ie, messages highly rated at baseline by the participants); or (3) a random process. Prior to 2 typical drinking days per week, immediately after receiving TMs, we asked: "How useful do you think this strategy will be for you when you drink? Text a number from 1 (not useful) to 5 (very useful)." Results Response rates for the 12 messages ranged from 72.9% to 87.5%, with no differences in response rates across selection categories (ie, investigator, participant, random). Investigator-selected messages were rated as less useful than messages that were self-selected by participants or messages that were selected at random. Conclusions TM-PBS chosen a priori by students were perceived as more useful than TM-PBS chosen by investigators, supporting this form of tailoring in alcohol interventions to optimize usefulness.

    View details for DOI 10.5993/AJHB.42.4.7

    View details for Web of Science ID 000437980800007

    View details for PubMedID 29973312

    View details for PubMedCentralID PMC6237090

  • Using Digital Interventions to Support Individuals with Alcohol Use Disorder and Advanced Liver Disease: A Bridge Over Troubled Waters ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Suffoletto, B., Scaglione, S. 2018; 42 (7): 1160–65

    View details for DOI 10.1111/acer.13771

    View details for Web of Science ID 000436930700001

    View details for PubMedID 29750368

    View details for PubMedCentralID PMC6028285

  • Postconcussive Symptoms Over the First 14 Days After Mild Traumatic Brain Injury: An Experience Sampling Study JOURNAL OF HEAD TRAUMA REHABILITATION Pacella, M., Prabhu, A., Morley, J., Huang, S., Suffoletto, B. 2018; 33 (3): E31–E39


    This study examined changes in postconcussive symptoms (PCS) over the acute postinjury recovery period, focusing on how daily PCSs differ between mild traumatic brain injury (mTBI) and other injury types.An urban emergency department (ED) in Western Pennsylvania.A total of 108 adult patients with trauma being discharged from the ED were recruited and grouped by injury type: mild TBI (mTBI; n = 39), head injury without mTBI (HI: n = 16), and non-head-injured trauma controls (TCs: n = 53).Subjects completed a baseline assessment and an experience sampling method (ESM) protocol for 14 consecutive days postinjury: outcomes were daily reports of headaches, anxiety, and concentration difficulties.Controlling for confounders, multilevel modeling revealed greater odds of headache and concentration difficulties on day 1 postinjury among the HI and mTBI groups (vs TCs). These odds decreased over time, with greater reductions for the HI and mTBI groups compared with TCs. By day 14, there were no group differences in PCS. In addition, only the HI group reported higher initial levels of anxiety and a steeper slope relative to TCs.Patients with HI, regardless of whether they meet the American Congress of Rehabilitation Medicines definition of mTBI, have higher odds of typical PCS immediately postinjury, but faster rates of recovery than TCs. ESM can improve understanding the dynamic nature of postinjury PCS.

    View details for DOI 10.1097/HTR.0000000000000335

    View details for Web of Science ID 000435555500004

    View details for PubMedID 28926480

  • The utility of assessing for pain interference and psychological factors among emergency department patients who present with pain GENERAL HOSPITAL PSYCHIATRY Brienza, A., Gianforcaro, A., Suffoletto, B., Callaway, C. W., Pacella, M. L. 2018; 52: 21–26
  • Short-term feasibility and impact assessments of an automated messaging system for hypertension self-management Muldoon, M. F., Allen, M., Einhorn, J., Irizarry, T., Rollman, B., Lora, B., Suffoletto, B., Thomas, K. LIPPINCOTT WILLIAMS & WILKINS. 2018: A138–A139
  • The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System JOURNAL OF PAIN Suffoletto, B., Lynch, M., Pacella, C. B., Yealy, D. M., Callaway, C. W. 2018; 19 (4): 430–38


    Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis.This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death.

    View details for DOI 10.1016/j.jpain.2017.11.010

    View details for Web of Science ID 000429184500008

    View details for PubMedID 29241835

    View details for PubMedCentralID PMC5869080

  • The Association between Daily Posttraumatic Stress Symptoms and Pain over the First 14-days after Injury: An Experience Sampling Study. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Pacella, M. L., Girard, J. M., Wright, A. G., Suffoletto, B., Callaway, C. W. 2018


    Psychosocial factors and responses to injury modify the transition from acute to chronic pain. Specifically, posttraumatic stress disorder symptoms (PTSS; reexperiencing, avoidance, and hyperarousal symptoms) exacerbate and co-occur with chronic pain. Yet no study has prospectively considered the associations among these psychological processes and pain reports using experience sampling methods (ESM) during the acute aftermath of injury. This study applied ESM via daily text messaging to monitor and detect relationships among psychosocial factors and post-injury pain across the first 14-days after emergency department (ED) discharge.We recruited 75 adults (59% male; M age = 33) who experienced a potentially traumatic injury (i.e., involving life threat or serious injury) in the past 24-hours from the EDs of two Level 1 trauma centers. Participants received 5 questions per day via text messaging from Day-1 to Day-14 post-ED discharge; three questions measured PTSS, one question measured perceived social support, and one question measured physical pain.Sixty-seven participants provided sufficient data for inclusion in the final analyses, and the average response rate per subject was 86%. Pain severity score decreased from a mean of 7.2 to 4.4 over 14 days and 50% of the variance in daily pain scores was within-person. In multilevel structural equation models, pain scores decreased over time, and daily fluctuations of hyperarousal (b = 0.22, 95% CI [0.08, 0.36]) were uniquely associated with daily fluctuations in reported pain level within each person.Daily hyperarousal symptoms predict same-day pain severity over the acute post-injury recovery period. We also demonstrated feasibility to screen and identify patients at risk for pain chronicity in the acute aftermath of injury. Early interventions aimed at addressing hyperarousal (e.g. anxiolytics) could potentially aid in reducing experience of pain. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/acem.13406

    View details for PubMedID 29513381

  • A Text Message Intervention to Reduce 21st Birthday Alcohol Consumption: Evaluation of a Two-Group Randomized Controlled Trial PSYCHOLOGY OF ADDICTIVE BEHAVIORS Bernstein, M. H., Stein, L. R., Neighbors, C., Suffoletto, B., Carey, K. B., Ferszt, G., Caron, N., Wood, M. D. 2018; 32 (2): 149–61


    Twenty-first birthdays are associated with extreme levels of heavy drinking and alcohol-related harm. Effective preventive interventions that are acceptable to young adults are needed. The current study tested the efficacy of a brief text-message intervention for reducing 21st birthday alcohol involvement designed to correct perceived 21st birthday drinking norms and provide protective behavioral strategies (PBS). We also examined potential moderators and mediators. College students (n = 200) with an upcoming 21st birthday completed a baseline assessment and were randomized to a text-message intervention or an assessment-only control condition. For participants in the intervention group, Message 1 (sent one day before the birthday celebration) focused on personalized normative feedback, and Message 2 (sent day of the birthday celebration) discussed PBS to minimize risk. Primary outcomes were assessed using responses to a follow-up assessment the day after their birthday celebration (93% completion rate). Zero-inflated negative binomial regression analyses did not reveal an overall intervention effect for estimated Blood Alcohol Content (eBAC) or alcohol problems on the 21st birthday celebration. In partial support of our hypothesis, there was an indirect effect of perceived 21st birthday norms on 21st birthday eBAC. The intervention was associated with reduced perceived norms, which was, in turn, related to a lower eBAC. There was a 3-way interaction between drinks per week, anticipated eBAC, and intervention condition for the count portion of actual eBAC such that the intervention reduced eBAC among a high-risk subset of the sample. Future research may benefit from further refining the personalized normative feedback (PNF) component of 21st birthday interventions. (PsycINFO Database Record

    View details for DOI 10.1037/adb0000342

    View details for Web of Science ID 000427738700002

    View details for PubMedID 29369673

    View details for PubMedCentralID PMC5858983

  • A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment JMIR MHEALTH AND UHEALTH Suffoletto, B., Chung, T., Muench, F., Monti, P., Clark, D. B. 2018; 6 (2): e35


    Stand-alone text message-based interventions can reduce binge drinking episodes (≥4 drinks for women and ≥5 drinks for men) among nontreatment-seeking young adults, but may not be optimized. Adaptive text message support could enhance effectiveness by assisting context-specific goal setting and striving, but it remains unknown how to best integrate it into text message interventions.The objective of this study was to evaluate young adults' engagement with a text message intervention, Texting to Reduce Alcohol Consumption 2 (TRAC2), which focuses on reducing weekend alcohol consumption. TRAC2 incorporated preweekend drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intraweekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and maximum weekend alcohol consumption EMA with drinking limit goal feedback.We enrolled 38 nontreatment-seeking young adults (aged 18 to 25 years) who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, subjects were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-month follow-up.Among a diverse sample of young adults (56% [28/50] female, 54% [27/50] black, 32% [12/50] college enrolled), response rates to EMA queries were, on average, 82% for the first 4-week intervention block, 75% for the second 4-week block, and 73% for the third 4-week block. In the first 4 weeks of the intervention, drinking limit goal commitment was made 68/71 times it was prompted (96%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 52% (15/29) in week 1 and decreased to 0% (0/15) by week 4. Subjects met their goal 130/146 of the times a goal was committed to (89.0%). There were lower rates of goal success when subjects reported lower confidence (score <4) in meeting the goal (76% [32/42 weekends]) compared with that when subjects reported high confidence (98% [56/57 weekends]; P=.001). There were reductions in alcohol consumption from baseline to 3 months, but reductions were not different by length of intervention exposure.Preliminary evidence suggests that nontreatment-seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success.

    View details for DOI 10.2196/mhealth.8530

    View details for Web of Science ID 000426415800014

    View details for PubMedID 29453191

    View details for PubMedCentralID PMC5834751

  • Using phone sensors and an artificial neural network to detect gait changes during drinking episodes in the natural environment GAIT & POSTURE Suffoletto, B., Gharani, P., Chung, T., Karimi, H. 2018; 60: 116–21


    Phone sensors could be useful in assessing changes in gait that occur with alcohol consumption. This study determined (1) feasibility of collecting gait-related data during drinking occasions in the natural environment, and (2) how gait-related features measured by phone sensors relate to estimated blood alcohol concentration (eBAC).Ten young adult heavy drinkers were prompted to complete a 5-step gait task every hour from 8pm to 12am over four consecutive weekends. We collected 3-axis accelerometer, gyroscope, and magnetometer data from phone sensors, and computed 24 gait-related features using a sliding window technique. eBAC levels were calculated at each time point based on Ecological Momentary Assessment (EMA) of alcohol use. We used an artificial neural network model to analyze associations between sensor features and eBACs in training (70% of the data) and validation and test (30% of the data) datasets.We analyzed 128 data points where both eBAC and gait-related sensor data were captured, either when not drinking (n=60), while eBAC was ascending (n=55) or eBAC was descending (n=13). 21 data points were captured at times when the eBAC was greater than the legal limit (0.08mg/dl). Using a Bayesian regularized neural network, gait-related phone sensor features showed a high correlation with eBAC (Pearson's r>0.9), and >95% of estimated eBAC would fall between -0.012 and +0.012 of actual eBAC.It is feasible to collect gait-related data from smartphone sensors during drinking occasions in the natural environment. Sensor-based features can be used to infer gait changes associated with elevated blood alcohol content.

    View details for DOI 10.1016/j.gaitpost.2017.11.019

    View details for Web of Science ID 000425129400022

    View details for PubMedID 29179052

    View details for PubMedCentralID PMC5809199

  • Development and Preliminary Feasibility of an Automated Hypertension Self-Management System. The American journal of medicine Irizarry, T., Allen, M., Suffoletto, B. P., Einhorn, J., Burke, L. E., Kamarck, T. W., Rollman, B. L., Muldoon, M. F. 2018; 131 (9)


    BACKGROUND: Uncontrolled hypertension constitutes a significant challenge throughout the world. Blood pressure measurement by patients is informative for both patients and providers but is rarely performed systematically, thereby reducing its utility. Mobile phones can be used to efficiently prompt individuals to measure blood pressure and automate data management while avoiding technology barriers to widespread adoption. Presented is the design and pilot test results of MyBP, an automated texting intervention to support blood pressure self-monitoring and patient self-management.METHODS: Three sequential phases are described: (1) stakeholders' needs assessment, (2) preliminary design pilot (n = 10), and (3) a 6-week pilot of the redesigned comprehensive program with hypertensive patients (n = 43) recruited from 3 clinical sites (Emergency Department, Primary Care, Hypertension Center).Outcomes of interest included participant adherence, perceived importance of blood pressure monitoring, and healthy behavior change.RESULTS: Median adherence to MyBP prompts over 6 weeks was 79% (72% emergency department, 84% primary care, and 96% hypertension center, H[2] = 5.56, P = .06). Adherence did not vary by age, sex, education, or baseline use of texting but was lowest among patients recruited from the emergency department (chi[2]2 = 6.66, P = .04). In the exit survey, MyBP was associated with increased importance of blood pressure self-monitoring and particularly motivated primary care and emergency department groups to improve dietary habits, increase daily physical activity, and focus on stress reduction. The majority of participants (88%) indicated interest in using the program for 6 months.CONCLUSIONS: Automated mobile-phone-based blood pressure self-monitoring using MyBP is feasible, acceptable, and scalable, and may improve self-management and support clinical care.

    View details for DOI 10.1016/j.amjmed.2018.04.038

    View details for PubMedID 29806998

  • An Artificial Neural Network for Movement Pattern Analysis to Estimate Blood Alcohol Content Level SENSORS Gharani, P., Suffoletto, B., Chung, T., Karimi, H. A. 2017; 17 (12)


    Impairments in gait occur after alcohol consumption, and, if detected in real-time, could guide the delivery of "just-in-time" injury prevention interventions. We aimed to identify the salient features of gait that could be used for estimating blood alcohol content (BAC) level in a typical drinking environment. We recruited 10 young adults with a history of heavy drinking to test our research app. During four consecutive Fridays and Saturdays, every hour from 8 p.m. to 12 a.m., they were prompted to use the app to report alcohol consumption and complete a 5-step straight-line walking task, during which 3-axis acceleration and angular velocity data was sampled at a frequency of 100 Hz. BAC for each subject was calculated. From sensor signals, 24 features were calculated using a sliding window technique, including energy, mean, and standard deviation. Using an artificial neural network (ANN), we performed regression analysis to define a model determining association between gait features and BACs. Part (70%) of the data was then used as a training dataset, and the results tested and validated using the rest of the samples. We evaluated different training algorithms for the neural network and the result showed that a Bayesian regularization neural network (BRNN) was the most efficient and accurate. Analyses support the use of the tandem gait task paired with our approach to reliably estimate BAC based on gait features. Results from this work could be useful in designing effective prevention interventions to reduce risky behaviors during periods of alcohol consumption.

    View details for DOI 10.3390/s17122897

    View details for Web of Science ID 000423285800197

    View details for PubMedID 29236078

    View details for PubMedCentralID PMC5751642

  • Not all texts are created equal: Design considerations for text message interventions to improve antihypertensive medication adherence JOURNAL OF CLINICAL HYPERTENSION Suffoletto, B., Muldoon, M. 2017; 19 (12): 1285–87

    View details for DOI 10.1111/jch.13093

    View details for Web of Science ID 000417627000011

    View details for PubMedID 28942613

  • Acceptability of an Opioid Relapse Prevention Text-message Intervention for Emergency Department Patients JOURNAL OF ADDICTION MEDICINE Suffoletto, B., Yanta, J., Kurtz, R., Cochran, G., Douaihy, A., Chung, T. 2017; 11 (6): 475–82


    To explore whether a text message-based relapse prevention intervention (Preventing and Interrupting Early Relapse [PIER]1) is acceptable to treatment-seeking adults with opioid use disorder (OUD) after Emergency Department (ED) discharge using mixed-methods design.Adults seeking care in an urban ED for OUD (n = 20; mean age 22; 55% female; 75% white race) completed a baseline survey, and were invited to enroll in PIER1, which was delivered in 7-day blocks, with the option to re-enroll at the end of each block, up to 4 blocks. PIER1 included a morning "push" message focused on positive thinking, adaptive coping feedback tailored to twice-daily assessments of craving severity and contextual correlates of craving, and end-of-day feedback on daily opioid use and goal commitment. Participants were asked to complete a follow-up phone interview after the first 7 days of PIER1. Transcripts were thematically coded.Seventeen out of 20 participants enrolled in PIER1. In the first 7 days, response rates to text-message assessments averaged 30%. Ten out of 17 participants re-enrolled after 7 days. Main themes from follow-up interviews (n = 9) included ease of use, social connection, and self-empowerment. Participants desired more personalized support and the ability to communicate through text messaging with another person about their struggles. Event-level data suggest that higher craving severity increased risk of opioid lapses.In this mixed-methods intervention development study, we found conflicting evidence supporting an automated text-message intervention providing relapse prevention support for treatment-seeking individuals with OUD discharged from the ED. Qualitative feedback suggests that PIER1 could be useful and acceptability enhanced through personalized human support.

    View details for DOI 10.1097/ADM.0000000000000351

    View details for Web of Science ID 000415102300012

    View details for PubMedID 28858888

    View details for PubMedCentralID PMC5659903

  • Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection BMC EMERGENCY MEDICINE Huang, D. T., Angus, D. C., Chang, C. H., Doi, Y., Fine, M. J., Kellum, J. A., Peck-Palmer, O. M., Pike, F., Weissfeld, L. A., Yabes, J., Yealy, D. M., ProACT Investigators 2017; 17: 25


    Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns.The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection.We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline NCT02130986 . Registered May 1, 2014.

    View details for DOI 10.1186/s12873-017-0138-1

    View details for Web of Science ID 000409211500001

    View details for PubMedID 28851296

    View details for PubMedCentralID PMC5576372

  • Detecting Drinking Episodes in Young Adults Using Smartphone-based Sensors. Proceedings of the ACM on interactive, mobile, wearable and ubiquitous technologies Bae, S., Ferreira, D., Suffoletto, B., Puyana, J. C., Kurtz, R., Chung, T., Dey, A. K. 2017; 1 (2)


    Alcohol use in young adults is common, with high rates of morbidity and mortality largely due to periodic, heavy drinking episodes (HDEs). Behavioral interventions delivered through electronic communication modalities (e.g., text messaging) can reduce the frequency of HDEs in young adults, but effects are small. One way to amplify these effects is to deliver support materials proximal to drinking occasions, but this requires knowledge of when they will occur. Mobile phones have built-in sensors that can potentially be useful in monitoring behavioral patterns associated with the initiation of drinking occasions. The objective of our work is to explore the detection of daily-life behavioral markers using mobile phone sensors and their utility in identifying drinking occasions. We utilized data from 30 young adults aged 21-28 with past hazardous drinking and collected mobile phone sensor data and daily Experience Sampling Method (ESM) of drinking for 28 consecutive days. We built a machine learning-based model that is 96.6% accurate at identifying non-drinking, drinking and heavy drinking episodes. We highlight the most important features for detecting drinking episodes and identify the amount of historical data needed for accurate detection. Our results suggest that mobile phone sensors can be used for automated, continuous monitoring of at-risk populations to detect drinking episodes and support the delivery of timely interventions.

    View details for DOI 10.1145/3090051

    View details for PubMedID 35146236

    View details for PubMedCentralID PMC8827207

  • Can an app help identify psychomotor function impairments during drinking occasions in the real world? A mixed-method pilot study SUBSTANCE ABUSE Suffoletto, B., Goyal, A., Puyana, J., Chung, T. 2017; 38 (4): 438–49


    Being able to measure the acute effects of alcohol consumption on psychomotor functions in natural settings could be useful in injury prevention interventions. This study examined the feasibility and acceptability of collecting app-based measures of information processing, working memory, and gait stability during times of typical alcohol consumption among young adults.Ten young adults (aged 21-26) with hazardous drinking completed a baseline assessment and ecological momentary assessments (EMA) on 4 consecutive Fridays and Saturdays, every hour from 8 pm to 12 am. EMA assessed alcohol consumption and perceived intoxication, followed by a digit symbol substitution task (DSST), a visuospatial working memory task (VSWMT), and a 5-step tandem gait task (TGT). Exit interviews probed user experiences. Multilevel models explored relationships between estimated blood alcohol concentration (eBAC; mg/dL) and DSST and VSWMT performance.Participants completed 32% of EMA. Higher rates of noninitiation occurred later in the evening and over time. In multilevel models, higher eBAC was associated with lower DSST scores. Eight out of 10 individuals had at least 1 drinking occasion when they did not perceive any intoxication. Lower DSST scores would identify impairment in 45% of these occasions. Exit interviews indicated that adding real-time feedback on task performance could increase awareness of alcohol effects.Collecting app-based psychomotor performance data from young adults during drinking occasions is feasible and acceptable, but strategies to reduce barriers to task initiation are needed. Mobile DSST is sensitive to eBAC levels and could identify occasions when an individual may not perceive impairments.

    View details for DOI 10.1080/08897077.2017.1356797

    View details for Web of Science ID 000415738200012

    View details for PubMedID 28723276

    View details for PubMedCentralID PMC6103191

  • Using video conferencing to deliver a brief motivational intervention for alcohol and sex risk to emergency department patients: a proof-of-concept pilot study ADDICTION RESEARCH & THEORY Celio, M. A., Mastroleo, N. R., DiGuiseppi, G., Barnett, N. P., Colby, S. M., Kahler, C. W., Operario, D., Suffoletto, B., Monti, P. M. 2017; 25 (4): 318–25


    Brief motivational intervention (MI) is an efficacious approach to reduce heavy drinking and associated sexual risk behavior among Emergency Department (ED) patients, but the intensity of demands placed on ED staff makes the implementation of in-person MIs logistically challenging. This proof-of-concept pilot study examined the acceptability and logistic feasibility of using video-conferencing technology to deliver an MI targeting heavy drinking and risky sexual behavior to patients in an ED setting. Rigorous screening procedures were employed to ensure that the pilot sample represents the target portion of ED patients who would benefit from this multi-target MI. Mixed qualitative and quantitative data from a sample of seven ED patients (57% Female; Mage = 35 years) who received MI by video conference consistently demonstrated high levels of satisfaction, engagement, and acceptability. The observed completion rate supports logistic feasibility, and patient feedback identified methods to improve the experience by using high-definition hardware, ensuring stronger network connectivity, and effectively communicating information regarding protection of privacy. Post-intervention patient ratings and independent ratings of the audio-recorded sessions (using the Motivational Interviewing Skills Coding system) were very high, suggesting that intervention fidelity and MI adherence was not compromised by delivery modality. Collectively, these data suggest video conferencing is a viable technology that can be employed to implement brief evidence-based MIs in ED settings.

    View details for DOI 10.1080/16066359.2016.1276902

    View details for Web of Science ID 000398242200007

    View details for PubMedID 28649188

    View details for PubMedCentralID PMC5478195

  • Quantitative sensory testing measures individual pain responses in emergency department patients JOURNAL OF PAIN RESEARCH Duffy, K. J., Flickinger, K. L., Kristan, J. T., Repine, M. J., Gianforcaro, A., Hasley, R. B., Feroz, S., Rupp, J. M., Al-Baghli, J., Pacella, M. L., Suffoletto, B. P., Callaway, C. W. 2017; 10: 1241–53


    Refining and individualizing treatment of acute pain in the emergency department (ED) is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients.In three studies, we 1) describe performance characteristics of brief quantitative sensory testing (QST) in 50 healthy volunteers, 2) test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3) measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT), pressure pain response (PPR), and cold pain tolerance (CPT) tests.First, all QST measures had high inter-rater reliability and test-retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16%) ED subjects relative to healthy volunteers. In 173 (88%) ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen's dz 0.10-0.19). Verbal pain scores (0-10) for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6) (Cohen's dz 0.97) but did not covary with the changes in PPT and PPR (r=0.05-0.13). Treatment effects were greatest in ED subjects with a history of treatment for anxiety or depression (Cohen's dz 0.26-0.43) or with baseline hyperalgesia (Cohen's dz 0.40-0.88).QST reveals individual differences in perception of fixed painful stimuli in ED patients, including hyperalgesia. Subgroups of ED patients with hyperalgesia and psychiatric history report larger treatment effects on ED pain and QST measures.

    View details for DOI 10.2147/JPR.S132485

    View details for Web of Science ID 000402119800001

    View details for PubMedID 28579822

    View details for PubMedCentralID PMC5449126

  • Patterns of Change in Weekend Drinking Cognitions Among Non-Treatment-Seeking Young Adults During Exposure to a 12-Week Text Message Intervention JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Suffoletto, B., Chung, T. 2016; 77 (6): 914–23


    We sought to identify patterns of response (latent classes) to a text-message (short message service) intervention based on weekend drinking cognitions (e.g., drinking plans, commitment to a low consumption goal), and to examine how the latent classes differed in baseline characteristics and alcohol consumption outcomes.We conducted a secondary analysis of 384 non-treatment seeking young adults with hazardous alcohol use randomly assigned to a 12-week short message service intervention. Responses to weekly short message service queries related to weekend drinking cognitions were categorized as (a) planned not to drink, (b) planned to drink but did not plan a heavy drinking episode (HDE), (c) planned to have an HDE but willing to limit alcohol consumption, (d) planned to have an HDE and not willing to limit alcohol consumption We used repeated-measures latent class analysis to identify distinct classes based on these categories and examined associations of the classes with baseline covariates and alcohol consumption outcomes through 6 months.We identified the following three latent classes: planned not to drink (62%), willing to limit drinks (27%), and not willing to limit drinks (12%). The "not willing to limit drinks" class exhibited the least reductions in alcohol consumption and was more likely to include White individuals and those with higher baseline drinking severity. The "planned not to drink" class had the greatest reductions in alcohol consumption.Young adults who exhibited low likelihood of committing to goals to limit weekend drinking were less responsive to short message service intervention, suggesting the need for alternative interventions.

    View details for DOI 10.15288/jsad.2016.77.914

    View details for Web of Science ID 000386986600009

    View details for PubMedID 27797693

    View details for PubMedCentralID PMC5088173

  • Expanding Adolescent Depression Prevention Through Simple Communication Technologies JOURNAL OF ADOLESCENT HEALTH Suffoletto, B., Aguilera, A. 2016; 59 (4): 373–74
  • CHARACTERISTICS AND OUTCOMES OF BLOOD PRODUCT TRANSFUSION DURING CRITICAL CARE TRANSPORT PREHOSPITAL EMERGENCY CARE Mena-Munoz, J., Srivastava, U., Martin-Gill, C., Suffoletto, B., Callaway, C. W., Guyette, F. X. 2016; 20 (5): 586–93


    Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport.We studied patients transported by a regional critical care air-medical service who received blood products during transport. This service carries two units of uncrossmatched packed Red Blood Cells (pRBCs) on every transport in addition to blood obtained from referring facilities. The pRBC are administered according to a protocol for the treatment of hemorrhagic shock or based on medical command physician order. Transfusion amount was categorized into three groups based on the volume transfused (<350 mL, 350-700 mL, >700 mL). The association between prehospital transfusion and in-hospital outcomes (mortality, subsequent blood transfusion and emergent surgery) was estimated using logistic regression models, controlling for age, first systolic blood pressure, first heart rate, Glasgow Coma Score, time of transfer, and length of hospital admission.Among the 1,440 critical care transports with transfusions examined, 81% were for medical patients, being gastrointestinal hemorrhage the most common indication (26%, CI 24-28%). pRBC transfusions were associated with emergent surgery (OR = 1.81, 95% CI = 1.31-2.52) and in-hospital transfusions (OR = 2.00, 95% CI = 1.46-2.76). Those with transfusions >700 mL were associated with emergent surgery (OR = 1.79, 95% CI = 1.10-2.92) and mortality (OR = 2.11; 95% CI = 1.21-3.69).In this sample, the majority of patients receiving blood products during air-medical transport were transfused for medic conditions; gastrointestinal hemorrhage was the most common chief complaint. The pRBC transfusions were associated with emergent surgery and in-hospital transfusion. Transfusions of >700 mL were associated with mortality.

    View details for DOI 10.3109/10903127.2016.1163447

    View details for Web of Science ID 000383915000006

    View details for PubMedID 27484298

  • Text message behavioral interventions: from here to where? CURRENT OPINION IN PSYCHOLOGY Suffoletto, B. 2016; 9: 16–21


    Text messaging is an efficient and personal electronic form of communication, making it an ideal modality for remote delivery of behavioral interventions. The ubiquity of cell phones and short message service (SMS) worldwide allow the possibility of SMS behavioral inteventions to impact global health. Studies to date suggest that SMS interventions can effectively support health behaviors and may offer advantages compared to other forms of computerized interventions. Program features optimizing user engagament and persuasiveness are suggested to mediate SMS intervention effect. Future research is tasked with identifying what SMS features are useful to which individuals at what times to best help them initiate and maintain health behaviors.

    View details for DOI 10.1016/j.copsyc.2015.09.012

    View details for Web of Science ID 000378212300005

    View details for PubMedID 26665157

    View details for PubMedCentralID PMC4671292

  • Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings JMIR MHEALTH AND UHEALTH Suffoletto, B., Kristan, J., Mecca, L., Chung, T., Clark, D. B. 2016; 4 (2): 420–29


    Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized.To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design.We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes.We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants' comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention.Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important.

    View details for DOI 10.2196/mhealth.5330

    View details for Web of Science ID 000381182400033

    View details for PubMedID 27335099

    View details for PubMedCentralID PMC4935795

  • A text message program as a booster to in-person brief interventions for mandated college students to prevent weekend binge drinking JOURNAL OF AMERICAN COLLEGE HEALTH Suffoletto, B., Merrill, J. E., Chung, T., Kristan, J., Vanek, M., Clark, D. B. 2016; 64 (6): 481–89


    To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students.Undergraduates (N = 224; 46% female) who violated an on-campus alcohol policy over a 2-semester period in 2014.The SMS program sent drinking-related queries each Thursday and Sunday and provided tailored feedback for 6 weeks. Response rates to SMS drinking-related queries and the associations between weekend drinking plans, drinking-limit goal commitment, and alcohol consumption were examined. Gender differences were explored.Ninety percent of SMS queries were completed. Weekend binge drinking decreased over 6 weeks, and drinking-limit goal commitment was associated with less alcohol consumption. Compared with women, men had greater reductions in alcohol consumption when they committed to a drinking-limit goal.Preliminary evidence suggests that an SMS program could be useful as a booster for helping mandated students reduce weekend binge drinking.

    View details for DOI 10.1080/07448481.2016.1185107

    View details for Web of Science ID 000381369900007

    View details for PubMedID 27149662

    View details for PubMedCentralID PMC4992551

  • Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors EMERGENCY MEDICINE JOURNAL Suffoletto, B., Miller, T., Shah, R., Callaway, C., Yealy, D. M. 2016; 33 (1): 4–9


    We sought to evaluate the ability of the Identification of Seniors At Risk (ISAR) tool to differentiate between older adult patients having a poor outcome within 30 days of emergency department (ED) care and those who do not. We compare prognostic accuracy of subjective versus objective risk factors.202 community-dwelling patients age 65 years and older presenting to two EDs were prospectively enrolled. Participants completed the six-question ISAR and objective testing (cognition, ambulation, vision). We reviewed electronic medical records for current medications, hospitalisations in the past six months, ED disposition, length of hospital stay, subsequent ED visits or inpatient admissions or death at 30 days. Participants were given a point for each risk factor present; subjective and objective risk factors were scored separately. We tested ability of individual risk factors and scores to predict a composite outcome of subsequent ED visit, postdischarge hospitalisation or death by day 30 after the index ED visit. We computed receiver operating curve area under the curves (AUC) to determine tool discrimination.23% of participants had a poor 30-day outcome. The optimum subjective ISAR cut-off score for screening was ≥2, which was present in 84% of participants, had a sensitivity of 91% and specificity of 19%. Using the subjective ISAR tool, the AUC was 0.66. The optimum objective ISAR-related risk cut-off score for screening was ≥3, which was present in 82% of participants, had a sensitivity of 87% and specificity of 40%. Using the objective ISAR-related tool, the AUC was 0.69.The self-reported ISAR tool did not discriminate well between older adults with or without 30-day hospital revisit or death. An optimum score of ≥2 would identify many older adults at no apparent increased risk of poor outcomes at 30 days. Using objective ISAR-related risk factors did not improve overall discrimination.

    View details for DOI 10.1136/emermed-2014-203936

    View details for Web of Science ID 000367462000002

    View details for PubMedID 25987595

  • An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes PLOS ONE Suffoletto, B., Kristan, J., Chung, T., Jeong, K., Fabio, A., Monti, P., Clark, D. B. 2015; 10 (11): e0142877


    Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults.Young adult participants (18-25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses.An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young NCT01688245.

    View details for DOI 10.1371/journal.pone.0142877

    View details for Web of Science ID 000365154600064

    View details for PubMedID 26580802

    View details for PubMedCentralID PMC4651466

  • Real-Time Fatigue Reduction in Emergency Care Clinicians: The SleepTrackTXT Randomized Trial AMERICAN JOURNAL OF INDUSTRIAL MEDICINE Patterson, P., Buysse, D. J., Weaver, M. D., Doman, J. M., Moore, C. G., Suffoletto, B. P., McManigle, K. L., Callaway, C. W., Yealy, D. M. 2015; 58 (10): 1098–1113


    We assessed performance characteristics and impact of a mobile phone text-message intervention for reducing intra-shift fatigue among emergency clinician shift workers.We used a randomized controlled trial of 100 participants. All participants received text-message assessments at the start, every 4 hr during, and at end of scheduled shifts over a 90-day period. Text-message queries measured self-rated sleepiness, fatigue, and difficulty with concentration. Additional text-messages were sent to intervention participants to promote alertness. A performance measure of interest was compliance with answering text-messages.Ninety-nine participants documented 2,621 shifts and responded to 36,073 of 40,947 text-messages (88% compliance rate). Intervention participants reported lower mean fatigue and sleepiness at 4 hr, 8 hr, and at the end of 12 hr shifts compared to controls (P < 0.05). Intervention participants reported better sleep quality at 90-days compared to baseline (P = 0.01).We showed feasibility and short-term efficacy of a text-message based assessment and intervention tool.

    View details for DOI 10.1002/ajim.22503

    View details for Web of Science ID 000362664000013

    View details for PubMedID 26305869

    View details for PubMedCentralID PMC4573891

  • Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention A Scientific Statement From the American Heart Association CIRCULATION Burke, L. E., Ma, J., Azar, K. J., Bennett, G. G., Peterson, E. D., Zheng, Y., Riley, W., Stephens, J., Shah, S. H., Suffoletto, B., Turan, T. N., Spring, B., Steinberger, J., Quinn, C. C. 2015; 132 (12): 1157–1213

    View details for DOI 10.1161/CIR.0000000000000232

    View details for Web of Science ID 000361485400011

    View details for PubMedID 26271892

    View details for PubMedCentralID PMC7313380

  • Using online crowdsourcing to understand young adult attitudes toward expert-authored messages aimed at reducing hazardous alcohol consumption and to collect peer-authored messages TRANSLATIONAL BEHAVIORAL MEDICINE Kristan, J., Suffoletto, B. 2015; 5 (1): 45–52


    Text message delivered prevention interventions have the potential to improve health behaviors on a large scale, including reducing hazardous alcohol consumption in young adults. Online crowdsourcing can be used to efficiently develop relevant messages, but remains largely understudied. This study aims to use online crowdsourcing to evaluate young adult attitudes toward expert-authored messages and to collect peer-authored messages. We designed an online survey with four drinking scenarios and a demographic questionnaire. We made it available to people who reported age 18-25 years, residence in the US, and any lifetime alcohol consumption via the Amazon Mechanical Turk crowdsourcing platform. Participants rated 71 sample text messages on instrumental (helpful) and affective (interesting) attitude scales and generated their own messages. All messages were coded as informational, motivational, or strategy facilitating. We examined differences in attitudes by message type and by drinking status and sex. We surveyed 272 participants in 48 h, and 222 were included in analysis for a total participant payment cost of $178. Sample mean age was 23 years old, with 50 % being female, 65 % being of white race, and 78 % scored as hazardous drinkers. Informational messages were rated the most helpful, whereas motivational messages were rated the most interesting. Hazardous drinkers rated informational messages less helpful than non-hazardous drinkers. Men reported messages less helpful and interesting than women for most categories. Young adults authored 161 messages, with the highest proportion being motivational. Young adults had variable instrumental and affective attitudes toward expert-authored messages. They generated a substantial number of peer-authored messages that could enhance relevance of future alcohol prevention interventions.

    View details for DOI 10.1007/s13142-014-0298-4

    View details for Web of Science ID 000356788400005

    View details for PubMedID 25729452

    View details for PubMedCentralID PMC4332899

  • Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta-analysis ACADEMIC EMERGENCY MEDICINE Carpenter, C. R., Shelton, E., Fowler, S., Suffoletto, B., Platts-Mills, T. F., Rothman, R. E., Hogan, T. M. 2015; 22 (1): 1–21


    A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical test-treatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR- = 0.27) and nursing home placement (LR- = 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR- range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the risk of 1-year mortality, no individual risk factor, frailty construct, or risk assessment instrument accurately predicts risk of adverse outcomes in older ED patients. Existing instruments designed to risk stratify older ED patients do not accurately distinguish high- or low-risk subsets. Clinicians, educators, and policy-makers should not use these instruments as valid predictors of post-ED adverse outcomes. Future research to derive and validate feasible ED instruments to distinguish vulnerable elders should employ published decision instrument methods and examine the contributions of alternative variables, such as health literacy and dementia, which often remain clinically occult.

    View details for DOI 10.1111/acem.12569

    View details for Web of Science ID 000347447900001

    View details for PubMedID 25565487

  • A Text Message Alcohol Intervention for Young Adult Emergency Department Patients: A Randomized Clinical Trial ANNALS OF EMERGENCY MEDICINE Suffoletto, B., Kristan, J., Callaway, C., Kim, K. H., Chung, T., Monti, P. M., Clark, D. B. 2014; 64 (6): 664–72


    Opportunistic brief in-person emergency department (ED) interventions can be effective at reducing hazardous alcohol use in young adult drinkers, but require resources frequently unavailable. Mobile telephone text messaging (short message service [SMS]) could sustainably deliver behavioral support to young adult patients, but efficacy remains unknown. We report 3-month outcome data of a randomized controlled trial testing a novel SMS-delivered intervention in hazardous-drinking young adults.We randomized 765 young adult ED patients who screened positive for past hazardous alcohol use to one of 3 groups: SMS assessments+feedback (SA+F) intervention who were asked to respond to drinking-related queries and received real-time feedback through SMS each Thursday and Sunday for 12 weeks (n=384), SMS assessments (SA) who were asked to respond to alcohol consumption queries each Sunday but did not receive any feedback (N=196), and a control group who did not participate in any SMS (n=185). Primary outcomes were self-reported number of binge drinking days and number of drinks per drinking day in the past 30 days, collected by Web-based timeline follow-back method and analyzed with regression models. Secondary outcomes were the proportion of participants with weekend binge episodes and most drinks consumed per drinking occasion during 12 weekends, collected by SMS.With Web-based data, there were decreases in the number of self-reported binge drinking days from baseline to 3 months in the SA+F group (-0.51 [95% confidence interval {CI} -0.10 to -0.95]), whereas there were increases in the SA group (0.90 [95% CI 0.23 to 1.6]) and the control group (0.41 [95% CI -0.20 to 1.0]). There were also decreases in the number of self-reported drinks per drinking day from baseline to 3 months in the SA+F group (-0.31 [95% CI -0.07 to -0.55]), whereas there were increases in the SA group (0.10 [95% CI -0.27 to 0.47]) and the control group (0.39 [95% CI 0.06 to 0.72]). With SMS data, there was a lower mean proportion of SA+F participants reporting a weekend binge during 12 weeks (30.5% [95% CI 25% to 36%) compared with the SA participants (47.7% [95% CI 40% to 56%]). There was also a lower mean drinks consumed per weekend during 12 weeks in the SA+F group (3.2 [95% CI 2.6 to 3.7]) compared to the SA group (4.8 [95% CI 4.0 to 5.6]).A text message intervention can produce small reductions in self-reported binge drinking and the number of drinks consumed per drinking day in hazardous-drinking young adults after ED discharge.

    View details for DOI 10.1016/j.annemergmed.2014.06.010

    View details for Web of Science ID 000346220200022

    View details for PubMedID 25017822

    View details for PubMedCentralID PMC4254153

  • Emergency healthcare worker sleep, fatigue, and alertness behavior survey (SFAB): Development and content validation of a survey tool ACCIDENT ANALYSIS AND PREVENTION Patterson, P., Buysse, D. J., Weaver, M. D., Suffoletto, B. P., McManigle, K. L., Callaway, C. W., Yealy, D. M. 2014; 73: 399–411


    Workplace safety is a recognized concern in emergency medical services (EMS). Ambulance crashes are common and injury rates exceed that of the general working public. Fatigue and sleepiness during shift work pose a safety risk for patients and EMS workers. Changing EMS worker behaviors and improving alertness during shift work is hampered by a lack of instruments that reliably and accurately measure multidimensional beliefs and habits that predict alertness behavior.We sought to test the reliability and validity of a survey tool (the sleep, fatigue, and alertness behavior survey [SFAB]) designed to identify the cognitions of EMS workers concerning sleep, fatigue, and alertness behaviors during shift work.We operationalized the integrative model of behavioral prediction (IMBP) and developed a pool of 97 candidate items and sub-items to measure eight domains of the IMBP. Five sleep scientists judged the content validity of each item and a convenience sample of EMS workers completed a paper-based version of the SFAB. We retained items judged content valid by five sleep scientists and performed exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and tests of reliability and internal consistency. We identified a simple factor structure for each scale and calculated means and standard deviations for each item and scale.We received 360 completed SFAB surveys from a convenience sample of 800 EMS workers attending two regional continuing education conferences (45% participation rate). Forty-seven candidate items and sub-items/options were removed following content validation, EFA, and CFA testing. Analyses revealed a simple factor structure for seven of eight domains and a final pool of 50 items and sub-items/options. Domains include: attitudes, normative beliefs, knowledge, salience, habits, environmental constraints, and intent. EFA tests of self-efficacy items failed to identify a simple factor structure. We retained two self-efficacy items based on Spearman-Brown correlation of 0.23 (p<0.0001).Measurement of sleep, fatigue, and alertness behavior among EMS workers is challenging. We describe the development and psychometric testing of a survey tool that may be useful in a variety of applications addressing sleep, fatigue, and alertness behavior among EMS workers.

    View details for DOI 10.1016/j.aap.2014.09.028

    View details for Web of Science ID 000346453600046

    View details for PubMedID 25449415

    View details for PubMedCentralID PMC4254576

  • Chest compressions do not disrupt the seal created by the laryngeal mask airway during positive pressure ventilation: a preliminary porcine study CANADIAN JOURNAL OF EMERGENCY MEDICINE Carlson, J. N., Suffoletto, B. P., Salcido, D. D., Logue, E. S., Menegazzi, J. J. 2014; 16 (5): 378–82


    Pulmonary aspiration of gastric contents occurs 20 to 30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Although the American Heart Association has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by emergency medical service personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the occurrence of aspiration after LMA placement, CPR, and PPV.We inserted a size 4 LMA, modified so that a vacuum catheter could be advanced past the LMA diaphragm, into the hypopharynx of 16 consecutive postexperimental mixed-breed domestic swine. Fifteen millilitres of heparinized blood was instilled into the oropharynx. Chest compressions were performed for 60 seconds with asynchronous ventilation via a mechanical ventilator. We then suctioned through the LMA for 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated, removed, and inspected for signs of blood.None of 16 animals (95% CI 0-17%) had a positive test for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm.In this swine model of regurgitation after LMA placement, there were no cases with evidence of blood beyond the seal created by the LMA cuff. Future studies are needed to determine the frequency of pulmonary aspiration after LMA placement during CPR and PPV in the clinical setting.

    View details for DOI 10.2310/8000.2014.141029

    View details for Web of Science ID 000349250500007

    View details for PubMedID 25227646

  • PRE-RESUSCITATION LACTATE AND HOSPITAL MORTALITY IN PREHOSPITAL PATIENTS PREHOSPITAL EMERGENCY CARE Tobias, A. Z., Guyette, F. X., Seymour, C. W., Suffoletto, B. P., Martin-Gill, C., Quintero, J., Kristan, J., Callaway, C. W., Yealy, D. M. 2014; 18 (3): 321–27


    Serum lactate elevations are associated with morbidity and mortality in trauma patients, but their value in prehospital medical patients prior to resuscitation is unknown. We sought to assess the distribution of blood lactate concentrations prior to intravenous (i.v.) resuscitation and examine the association of elevation on in-hospital death.A convenience sample of adult patients over 14 months who received an i.v. line by eight EMS agencies in Western Pennsylvania had lactate measurement prior to any i.v. treatment. We assessed the lactate values and any relationship between these and hospital mortality (our primary outcome) and admission to the intensive care unit (ICU). We also compared the ability of lactate to discriminate outcomes with a prehospital critical illness score using age, Glasgow Coma Score, and initial vital signs.We included 673 patients, among whom 71 (11%) were admitted to the ICU and 21 (3.1%) died in-hospital. Elevated lactate (≥2 mmol/L) occurred in 307 (46%) patients and was strongly associated with hospital death after adjustment for known covariates (odds ratio = 3.57, 95% confidence interval [CI]: 1.10, 11.6). Lactate ≥2 mmol/L had a modest sensitivity (76%) and specificity (55%), and discrimination for hospital death (area under the curve [AUC] = 0.66, 95%CI: 0.56, 0.75). Compared to the prehospital critical illness score alone (AUC = 0.69, 95% CI: 0.59, 0.80), adding lactate to the score offered modest improvement (net reclassification improvement = 0.63, 95%CI: 0.23, 1.01, p < 0.05).Initial lactate concentration in our prehospital medical patient population was associated with hospital mortality. However, it is a modest predictor of outcome, offering similar discrimination to a prehospital critical illness score.

    View details for DOI 10.3109/10903127.2013.869645

    View details for Web of Science ID 000337903300001

    View details for PubMedID 24548128

    View details for PubMedCentralID PMC4240252

  • Mobile phone text messaging intervention to improve alertness and reduce sleepiness and fatigue during shiftwork among emergency medicine clinicians: study protocol for the SleepTrackTXT pilot randomized controlled trial TRIALS Patterson, P., Moore, C. G., Weaver, M. D., Buysse, D. J., Suffoletto, B. P., Callaway, C. W., Yealy, D. M. 2014; 15: 244


    Mental and physical fatigue while at work is common among emergency medical services (EMS) shift workers. Extended shifts (for example 24 hours) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management. Text message-based interventions are a potentially high-impact, low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue.We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website. Participants will be allocated to one of two possible arms for a 90-day study period. The intervention arm will involve text message assessments of sleepiness, fatigue, and difficulty with concentration at the beginning, during, and end of scheduled shifts. Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork. Control subjects will receive assessment only text messages. We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention. We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers. Additional aims include testing whether a theory-based behavioral intervention, delivered by text message, changes 'alertness behaviors'.The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms: 1) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers; or 2) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management NCT02063737, Registered on 10 January 2014.

    View details for DOI 10.1186/1745-6215-15-244

    View details for Web of Science ID 000338462800005

    View details for PubMedID 24952387

    View details for PubMedCentralID PMC4080698

  • Extending Our Reach: Use of mHealth to Support Patients After Emergency Care ANNALS OF EMERGENCY MEDICINE Ranney, M. L., Suffoletto, B. 2014; 63 (6): 755–56
  • Factors Contributing to Emergency Department Care Within 30 Days of Hospital Discharge and Potential Ways to Prevent It: Differences in Perspectives of Patients, Caregivers, and Emergency Physicians JOURNAL OF HOSPITAL MEDICINE Suffoletto, B., Hu, J., Guyette, M., Callaway, C. 2014; 9 (5): 315–19


    Identifying needs in patients who utilize the emergency department (ED) soon after being discharged from inpatient care is essential for planning appropriate care-transition interventions.To examine differences in stakeholder perspectives on reasons for ED care soon after hospital discharge and interventions that could be useful to prevent these ED visits.A convenience sample of 135 patients who presented to an urban teaching hospital ED <30 days after last hospital discharge, their caregivers (when present), and emergency physicians were administered identical structured surveys. Concordance and agreement rates between patient-physician and patient-caregiver dyads were calculated.Concordances between stakeholders were poor, with weighted kappas ranging from 0.02 to 0.34 for patient-physician dyads and 0.03 to 0.68 for patient-caregiver dyads. Emergency physicians and caregivers identified factors between 1% and 42% of the time the patients did not. Less than half of any stakeholder could identify an intervention to potentially prevent the ED visit.Our findings suggest the difficulty in forming unified definitions for root cause of ED visits soon after hospital discharge and support the use of multiple stakeholders in identifying appropriate targets for care-transition interventions.

    View details for DOI 10.1002/jhm.2167

    View details for Web of Science ID 000335664200007

    View details for PubMedID 24497467



    To determine the prevalence and significance of ST-segment elevation resolution between prehospital and first hospital ECG.We examined consecutive prehospital ECGs transmitted to a single medical command center in southwestern Pennsylvania between January 1, 2009 and December 31, 2011. We included ECG cases with ST-segment elevation myocardial infarction (STEMI) and excluded cases with incomplete prehospital and/or hospital data. Our primary outcome was ST-segment resolution (STR), defined by cases no longer meeting STEMI criteria on the first in-hospital ECG. Primary variables of interest included prehospital vital signs and treatment, cardiac catheterization findings, and time intervals for diagnostics and treatment. Analysis included t-tests for continuous variables and chi-squared analysis for categorical variables.We reviewed 24,197 prehospital ECGs and identified 293 cases of prehospital STEMI. Complete hospital and prehospital records were available for 83 cases (28%). Analyzed cohort was an average 62 years old and the majority were male (67%), with a primary complaint of chest pain (93%). STR occurred in 18 cases (22%, CI 14-32%). There were no differences between STR and non-STR cases in prehospital vital signs or treatments. 95% of patients underwent cardiac catheterization with a mean door-to-needle time of 57 minutes (interquartile range 43-71). Comparing STR and non-STR cases, significant lesions (≥50%) were found in 94 and 97% of patients (p = 0.6), and subtotal or total lesions (≥95%) were found in 63 and 85% (p = 0.1), respectively.We found that ST-segment resolution occurred prior to catheterization in 1 of 5 patients with prehospital STEMI, emphasizing the necessity of prehospital ECG in risk stratification of patients with suspected coronary disease. Coronary lesions and intervention rates did not differ between STR and non-STR, suggesting that catheterization is warranted even when STEMI criteria are no longer met in-hospital.

    View details for DOI 10.3109/10903127.2013.851310

    View details for Web of Science ID 000333098000002

    View details for PubMedID 24400994

  • Characterization of Out of Hospital Resuscitation Utilizing Blood Transfusion Mena-Munoz, J., Srivastava, U., Martin-Gill, C., Suffoletto, B., Guyette, F. LIPPINCOTT WILLIAMS & WILKINS. 2013
  • Emergency physician recognition of delirium POSTGRADUATE MEDICAL JOURNAL Suffoletto, B., Miller, T., Frisch, A., Callaway, C. 2013; 89 (1057): 621–25


    To compare the recognition of delirium by emergency physicians based on observations made during routine clinical care with concurrent ratings made by a trained researcher after formal cognitive assessment and to examine each of the four individual features of delirium separately to determine the variation in identification across features.In a prospective study, a convenience sample of 259 patients, aged ≥65 years, who presented to two urban, teaching hospital emergency departments (EDs) in Western Pennsylvania between 21 June and 29 August 2011, underwent paired delirium ratings by an emergency physician and a trained researcher. Emergency physicians were asked to use their clinical judgment to decide whether the patient had any of the following delirium features: (1) acute change in mental status, (2) inattention, (3) disorganised thinking and (4) altered level of consciousness. Questions were prompted with examples of delirium features from the Confusion Assessment Method. Concurrently, a trained researcher interviewed surrogates to determine feature 1, conducted a cognitive test for delirium (Confusion Assessment Method for the intensive care unit) to determine delirium features 2 and 3 and used the Richmond Agitation and Sedation Scale to determine feature 4.In the 2-month study period, trained researchers identified delirium in 24/259 (9%; 95% CI 0.06 to 0.13) older patients admitted to the ED. However, attending emergency physicians recognised delirium in only 8 of the 24 and misidentified delirium in a further seven patients. Emergency physicians were particularly poor at recognising altered level of consciousness but were better at recognising acute change in mental status and inattention.When emergency physicians use routine clinical observations, they may miss diagnosing up to two-thirds of patients with delirium. Recognition of delirium can be enhanced with standardised cognitive testing.

    View details for DOI 10.1136/postgradmedj-2012-131608

    View details for Web of Science ID 000327926500003

    View details for PubMedID 23788663

  • A Sex Risk Reduction Text-Message Program for Young Adult Females Discharged From the Emergency Department JOURNAL OF ADOLESCENT HEALTH Suffoletto, B., Akers, A., McGinnis, K. A., Calabria, J., Wiesenfeld, H. C., Clark, D. B. 2013; 53 (3): 387–93


    To pilot test a text message (SMS) sex risk reduction program among at-risk young adult female patients discharged from an emergency department (ED).A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and randomized to the SMS program (n = 23) or a control group (n = 29). All participants completed a web-based questionnaire in the ED and at 3-month follow-up. For 12 weeks, SMS participants were asked to report whether they had a risky sexual encounter in the past week, received theory-based feedback, and were asked if they were willing set a goal to refrain from having another risky encounter.Thirty-nine percent of SMS participants completed all weeks of SMS reports, and noncompletion increasing from 12% on week 1 to a 33% by week 12. Three-month follow-up was completed in 56% of participants. In the intervention group, there was an increase in the proportion with condom use with last vaginal sex from 20% (95% CI 4%-48%) to 53% (95% CI 27%-79%) and an increase in always condom use over the past 28 days from 0% (95% CI 0%-22%) to 33% (95% CI 12%-62%). These changes were not statistically different from control participants.SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample.

    View details for DOI 10.1016/j.jadohealth.2013.04.006

    View details for Web of Science ID 000323602900014

    View details for PubMedID 23707402

  • The Trouble With Medication Adherence After Emergency Care ANNALS OF EMERGENCY MEDICINE Suffoletto, B., Yealy, D. M. 2013; 62 (3): 235–36
  • Mobile Phone Text Messaging to Assess Symptoms After Mild Traumatic Brain Injury and Provide Self-Care Support: A Pilot Study JOURNAL OF HEAD TRAUMA REHABILITATION Suffoletto, B., Wagner, A. K., Arenth, P. M., Calabria, J., Kingsley, E., Kristan, J., Callaway, C. W. 2013; 28 (4): 302–12


    To examine whether patients with mild traumatic brain injury (mTBI) receiving text messaging-based education and behavioral support had fewer and less severe postconcussive symptoms than those not receiving text-message support. Our secondary objective was to determine the feasibility of using text messaging to assess daily symptoms and provide support to patients with mTBI.Randomized controlled trial with 14-day follow-up.Convenience sample of 43 adult emergency department patients with mTBI.Fourteen days of timed SMS (short-message service) symptom assessments (9 AM: headaches; 1 PM: difficulty concentrating; 5 PM: irritability or anxiety) with self-care support messages.SMS symptom reports, Rivermead Postconcussion Symptoms Questionnaire.Compared with the control group, intervention participants trended to lower odds of reporting headaches (odds ratio [OR] = 0.38; 95% confidence interval [CI]: 0.07-1.99), concentration difficulty (OR = 0.32; 95% CI: 0.04-2.24), and irritability or anxiety (OR = 0.33; 95% CI: 0.05-2.35). There were also trends of lower mean scores for headaches (0.99 vs 1.19; P = .5), difficulty concentrating (0.88 vs 1.23; P = .2), and irritability/anxiety (1.00 vs 1.62; P = .06). There were high response rate to SMS symptom assessments and high satisfaction with the intervention.Those receiving the text messaging-based education and support had fewer and less severe postconcussive symptoms than the controls but none of the differences reached statistical significance. Further evaluation of more robust mobile interventions and larger sample of participants are still needed.

    View details for DOI 10.1097/HTR.0b013e3182847468

    View details for Web of Science ID 000330363900008

    View details for PubMedID 23474882

  • Diagnostic Accuracy of a Single Point-of-Care Prehospital Serum Lactate for Predicting Outcomes in Pediatric Trauma Patients PEDIATRIC EMERGENCY CARE Shah, A., Guyette, F., Suffoletto, B., Schultz, B., Quintero, J., Predis, E., King, C. 2013; 29 (6): 715–19


    Preliminary evidence suggests that a single prehospital lactate level (pLA) improves prediction of morbidity and mortality in adult trauma patients independent of vital signs. However, the value of pLA for pediatric trauma patients is unknown. Our objective was to determine whether pLA is associated with the need for critical care in pediatric trauma patients.We conducted a cohort study of 217 patients transported by helicopter to a level I pediatric trauma center over 24 months. The primary outcome was the need for predefined critical care measures. Covariates included vital signs and Glasgow Coma Scale (GCS) scores documented by prehospital providers.Forty-one subjects required critical care. Abnormal prehospital vital signs were not associated with need for critical care. Overall, median pLA level for patients who required critical care was 2.1 mmol/L (interquartile range [IQR], 1.6-2.7 mmol/L) versus 1.7 mmol/L (IQR, 1.2-2.2 mmol/L) for those who did not (P = 0.01). In addition, there were 85 subjects who had normal vital signs and a normal GCS during transport. Of these, 11 (13%) required critical care. In the subset of patients with normal prehospital vital signs and GCS, median pLA level for patients who required critical care was 2.6 mmol/L (IQR, 1.8-2.6 mmol/L) versus 1.7 mmol/L (IQR, 1-2.1 mmol/L) for those who did not (P = 0.01).Prehospital lactate level was higher in pediatric trauma patients who required critical care, including those who had normal prehospital vital signs and GCS. In this cohort, lactate was an early identifier of children with severe traumatic injuries.

    View details for DOI 10.1097/PEC.0b013e318294ddb1

    View details for Web of Science ID 000330469400006

    View details for PubMedID 23714761

  • Tissue oximetry by near-infrared spectroscopy in a porcine model of out-of-hospital cardiac arrest and resuscitation RESUSCITATION Reynolds, J. C., Salcido, D., Koller, A. C., Sundermann, M. L., Frisch, A., Suffoletto, B. P., Menegazzi, J. J. 2013; 84 (6): 843–47


    Monitoring during resuscitation remains relatively crude. Near-infrared spectroscopy (NIRS) measures aggregate oxygen saturation in a volume of tissue. We assessed the utility of continuous StO2 measurement in a porcine model of cardiac arrest, and explored the effects of differential vasoconstriction on StO2. We hypothesized that (1) StO2 trends correspond with the onset of loss of pulses, resuscitation, and return of spontaneous circulation (ROSC); (2) epinephrine has a dose-dependent effect on StO2.We anesthetized and instrumented 7 female swine, placing a NIRS probe on the left forelimb to recorded StO2. After 8 min of untreated VF and 2 min of CPR, we randomized animals to 0.015 mgkg(-1) (SDE) or 0.1mgkg(-1) (HDE) epinephrine. After 3 min of CPR, animals were defibrillated. Animals with ROSC were given SDE, then HDE for subsequent hemodynamic deteriorations. Data were analyzed with descriptive statistics and generalized linear model (alpha=0.05) to determine overall slope of pooled StO2 across animals for resuscitation segments.Four animals received HDE and three SDE. All achieved ROSC. Significant coefficients (ΔStO2 min(-1)) were noted for resuscitation segments. StO2 decreased after loss of pulses (-29.1; 95%CI -33.4, -24.7; p<0.01) but plateaued during CPR (-0.2; 95%CI -1.2, 0.8; p=0.71). There was a graded decline in StO2 between SDE (-1.3; 95%CI -1.5, -1.2; p<0.01) and HDE (-3.1; 95%CI -5.8, -0.4; p=0.03). The slowest change occurred with ROSC (0.4; 95%CI 0.3, 0.5; p<0.01).In a porcine model of OHCA, peripheral StO2 rapidly decreased after loss of pulses, but did not improve with CPR or epinephrine. It increased extremely slowly after ROSC.

    View details for DOI 10.1016/j.resuscitation.2012.11.031

    View details for Web of Science ID 000320996800037

    View details for PubMedID 23228556

  • Mobile phone text message intervention to reduce binge drinking among young adults: study protocol for a randomized controlled trial TRIALS Suffoletto, B., Callaway, C. W., Kristan, J., Monti, P., Clark, D. B. 2013; 14: 93


    Heavy episodic (binge) drinking is common among young adults and can lead to injury and illness. Young adults who seek care in the Emergency Department (ED) may be disproportionately affected with binge drinking behavior, therefore provide an opportunity to reduce future risk through screening, brief intervention and referral to treatment (SBIRT). Mobile phone text messaging (SMS) is a common form of communication among young adults and has been shown to be effective at providing behavioral support to young adult drinkers after ED discharge. Efficacy of SMS programs to reduce binge drinking remains unknown.We will conduct a three parallel arm, randomized trial. A convenience sample of adults aged 18 to 25 years attending three EDs in Pittsburgh, PA and willing to participate in the study will be screened for hazardous alcohol consumption. Participants identified as hazardous drinkers will then be allocated to either 12 weeks of weekly SMS drinking assessments with feedback (SA+F), SMS drinking assessments without feedback (SA), or a control group. Randomization will be via an independent and remote computerized randomization and will be stratified by study site. The SA+F group will be asked to provide pre-weekend drinking intention as well as post-weekend consumption via SMS and will receive feedback messages focused on health consequences of alcohol consumption, personalized normative feedback, protective drinking strategies and goal setting. Follow-up data on alcohol use and injury related to alcohol will be collected through a password-protected website three, six and nine months later. The primary outcome for the study is binge drinking days (≥4 drinks for women; ≥5 drinks for men) during the previous month, and the main secondary outcome is the proportion of participants who report any injury related to alcohol in the prior three months.This study will test the hypothesis that a mobile phone text-messaging program will result in immediate and durable reductions in binge drinking among at-risk young adults. By testing an intervention group to an assessment-only and control group, we will be able to separate the effect of assessment reactivity. By collecting pre-weekend drinking intentions and post-weekend consumption data in the SA+F group, we will be able to better understand mechanism of NCT01688245.

    View details for DOI 10.1186/1745-6215-14-93

    View details for Web of Science ID 000318987400001

    View details for PubMedID 23552023

    View details for PubMedCentralID PMC3652768



    The presence of delirium in elderly patients is common and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. Early recognition of delirium in the prehospital setting has the potential to improve outcomes, but is not feasible without valid assessment tools.To determine whether use of a rapid delirium checklist by prehospital providers is a valid way to identify cases of delirium compared with a criterion standard and whether the checklist is better at identifying delirium than the Glasgow Coma Score (GCS).We conducted a prospective study at two academic, tertiary-care emergency departments (EDs) where a convenience sample of matched dyads of emergency medical services providers and elderly patients (age ≥65 years) were enrolled. Prehospital providers reported limited demographics and work history about themselves. They also reported vital signs and GCS for each patient and completed the checklist asking about presence of the four features of delirium. The patient then underwent a cognitive assessment using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by a trained investigator, which was used as the criterion standard. Criterion validity and concurrent validity of the delirium checklist and abnormal GCS were evaluated using sensitivity and specificity.Two hundred fifty-nine matched dyads were studied. Delirium occurred in 24 (9%) of the elderly patients sampled. Prehospital providers' recognition of any delirium symptom resulted in a sensitivity of 0.63 (95% confidence interval [CI] 0.43-0.79) and a specificity of 0.74 (95% CI 0.73-0.84). Prehospital report of a GCS <15 has a sensitivity of 0.67 (95% CI 0.47-0.82) and a specificity of 0.85 (95% CI 0.80-0.89).A rapid delirium checklist can identify 63% of patients with delirium, but performed no better than the GCS. Future research should determine whether a rapid test of cognition improves early identification of elderly patients with delirium.

    View details for DOI 10.3109/10903127.2012.744785

    View details for Web of Science ID 000315634500014

    View details for PubMedID 23281619



    We evaluated the measurement of tissue oxygen content (StO(2)) by continuous near-infrared spectroscopy (NIRS) during and following cardiopulmonary resuscitation (CPR) and compared the changes in StO(2) and end-tidal carbon dioxide (ETCO(2)) as a measure of return of spontaneous circulation (ROSC) or rearrest.This was a case series of five patients who experienced out-of hospital cardiac arrest. Patients included those who had already experienced ROSC, who were being transported to the hospital, or who were likely to have a reasonable amount of time remaining in the resuscitation efforts. Patients were continuously monitored from the scene using continuous ETCO(2) monitoring and a NIRS StO(2) monitor until they reached the hospital. The ETCO(2) and StO(2) values were continuously recorded and analyzed for comparison of the time points when patients were clinically identified to have ROSC or rearrest.Four of five patients had StO(2) and EtCO(2) recorded during an episode of CPR and all were monitored during the postarrest period. Three patients experienced rearrest en route to the hospital. Downward trends were noted in StO(2) prior to each rearrest, and rapid increases were noted after ROSC. The StO(2) data showed less variance than the ETCO(2) data in the periarrest period.This preliminary study in humans demonstrates that StO(2) dynamically changes during periods of hemodynamic instability in postarrest patients. These data suggest that a decline in StO(2) level may correlate with rearrest and may be useful as a tool to predict rearrest in post-cardiac arrest patients. A rapid increase in StO(2) was also seen upon ROSC and may be a better method of identifying ROSC during CPR than pauses for pulse checks or ETCO(2) monitoring.

    View details for DOI 10.3109/10903127.2012.702191

    View details for Web of Science ID 000308214500019

    View details for PubMedID 22823984

    View details for PubMedCentralID PMC4263912

  • A Mobile Phone Text Message Program to Measure Oral Antibiotic Use and Provide Feedback on Adherence to Patients Discharged From the Emergency Department ACADEMIC EMERGENCY MEDICINE Suffoletto, B., Calabria, J., Ross, A., Callaway, C., Yealy, D. M. 2012; 19 (8): 949–58


    Nonadherence to prescribed medications impairs therapeutic benefits. The authors measured the ability of an automated text messaging (short message service [SMS]) system to improve adherence to postdischarge antibiotic prescriptions.This was a randomized controlled trial in an urban emergency department (ED) with an annual census of 65,000. A convenience sample of adult patients being discharged with a prescription for oral antibiotics was enrolled. Participants received either a daily SMS query about prescription pickup, and then dosage taken, with educational feedback based on their responses (intervention), or the usual printed discharge instructions (control). A standardized phone follow-up interview was used on the day after the intended completion date to determine antibiotic adherence: 1) the participant filled prescription within 24 hours of discharge and 2) no antibiotic pills were left on the day after intended completion of prescription.Of the 200 patients who agreed to participate, follow-up was completed in 144 (72%). From the 144, 26% (95% confidence interval [CI] = 19% to 34%) failed to fill their discharge prescriptions during the first 24 hours, and 37% (95% CI = 29% to 45%) had pills left over, resulting in 49% (95% CI = 40% to 57%) nonadherent patients. There were no differences in adherence between intervention participants and controls (57% vs. 45%; p = 0.1). African American race, greater than twice-daily dosing, and self-identifying as expecting to have difficulty filling or taking antibiotics at baseline were associated with nonadherence.Almost one-half (49%) of our patients do not adhere to antibiotic prescriptions after ED discharge. Future work should improve the design and deployment of SMS interventions to optimize their effect on improving adherence to medication after ED discharge.

    View details for DOI 10.1111/j.1553-2712.2012.01411.x

    View details for Web of Science ID 000307772300008

    View details for PubMedID 22849787

  • Near-infrared spectroscopy in post-cardiac arrest patients undergoing therapeutic hypothermia RESUSCITATION Suffoletto, B., Kristan, J., Rittenberger, J. C., Guyette, F., Hostler, D., Callaway, C. 2012; 83 (8): 986–90


    To investigate the relationship between tissue oxygen saturation during a vascular occlusion test with systemic hemodynamics, central and peripheral skin temperature in patients resuscitated from cardiac arrest.This prospective, observational study included a convenience sample of 30 patients hospitalized in a multidisciplinary intensive care unit in a university hospital and treated with therapeutic hypothermia. Near infrared spectroscopy (NIRS) was used to measure thenar tissue oxygen saturation, desaturation rate and saturation recovery rate after the vascular occlusion test, conducted within 24h of hospital admission and within 12h of initiating re-warming. Measurements included heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation, use of vasopressors and sedatives, core body (esophageal) and peripheral skin temperature and sequential organ failure assessment (SOFA) score.Peripheral skin temperature was found to have a significant effect on StO(2) deoxygenation and recovery slopes, resulting in lower rates at colder temperatures. This effect was independent of MAP, HR, and core temperature. NIRS-derived variables were not associated with SOFA score or use of vasopressors and did not predict mortality.Colder peripheral skin temperatures resulting in lower StO(2) desaturation rates may be explained by slower aerobic metabolism, thus lower extraction rate of oxygen, in the tissue beds. Lower recovery slopes at colder local temperatures may result from peripheral vasoconstriction during reactive hyperemia.We found that peripheral skin temperature in post-arrest critically ill patients undergoing TH strongly influences tissue oxygen desaturation and reoxygenation rates. In additional, changes in NIRS derived variables were independent of measures of shock, vasopressor use or illness severity.

    View details for DOI 10.1016/j.resuscitation.2012.03.021

    View details for Web of Science ID 000309048000024

    View details for PubMedID 22521725

  • Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients JOURNAL OF TRAUMA AND ACUTE CARE SURGERY Guyette, F. X., Gomez, H., Suffoletto, B., Quintero, J., Mesquida, J., Kim, H., Hostler, D., Puyana, J., Pinsky, M. R. 2012; 72 (4): 930–35


    Tissue oximetry (StO2) plus a vascular occlusion test is a noninvasive technology that targets indices of oxygen uptake and delivery. We hypothesize that prehospital tissue oximetric values and vascular occlusion test response can predict the need for in-hospital lifesaving interventions (LSI).We conducted a prospective, blinded observational study to evaluate StO2 slopes to predict the need for LSI. We calculated the DeO2 slope using Pearson's coefficients of regression (r2) for the first 25% of descent and the ReO2 slope using the entire recovery interval. The primary outcome was LSI defined as the need for emergent operation or transfusion in the first 24 hours of hospitalization. We created multivariable logistic regression models using covariates of age, sex, vital signs, lactate, and mental status.We assessed StO2 in a convenience sample of 150 trauma patients from April to November of 2009. In-hospital mortality was 3% (95% confidence interval [CI], 1.1-7.6); 31% (95% CI, 24-39) were admitted to the intensive care unit, 6% (95% CI, 2.8-11.1) had an emergent operation, and 10% (95% CI, 5.7-15.9) required transfusion. Decreasing DeO2 was associated with a higher proportion of patients requiring LSI. In the multivariate model, the association between the need for LSI and DeO2, Glasgow Coma Scale, and age persists.Prehospital DeO2 is associated with need for LSI in our trauma population. Further study of DeO2 is warranted to determine whether it can be used as an adjunct triage criterion or an endpoint for resuscitation.

    View details for DOI 10.1097/TA.0b013e31823d0677

    View details for Web of Science ID 000302784600030

    View details for PubMedID 22491607

    View details for PubMedCentralID PMC3770128

  • Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency Department ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Suffoletto, B., Callaway, C., Kristan, J., Kraemer, K., Clark, D. B. 2012; 36 (3): 552–60


    Brief interventions have the potential to reduce heavy drinking in young adults who present to the emergency department (ED), but require time and resources rarely available. Text-messaging (TM) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change. The feasibility of screening young adults in the ED, recruiting them for a TM-based interventional trial, collecting weekly drinking data through TM, and the variance in drinking outcomes remains unknown.Young adults in 3 urban EDs (n = 45; aged 18 to 24 years, 54% women) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were randomly assigned to weekly TM-based feedback with goal setting (Intervention), weekly TM-based drinking assessments without feedback (Assessment), or control. Participants in the Intervention group who reported ≥5 (for men) and ≥4 (for women) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week. We describe the interaction with TM and goal setting. We also describe the heavy drinking days (HDDs), drinks per drinking day (DPDD) using timeline follow-back procedure at baseline and 3 months.We screened 109 young adults over 157 hours across 24 unique days and 52 (48%; 95% CI 38 to 50) screened positive for hazardous drinking. Of these, 45 (87%; 95% CI 74 to 94) met inclusion criteria, were enrolled and randomized, and 6 (13%; 95% CI 5 to 27) did not complete 3-month web-based follow-up; 88% (95% CI 84 to 91) of weekly TM-based drinking assessments were answered, with 77% (95% CI 58 to 90) of participants responding to all 12 weeks. Agreeing to set a goal was associated with a repeat HDD 36% (95% CI 17 to 55) of the time compared with 63% (95% CI 44 to 81) when not willing to set a goal. At 3 months, participants that were exposed to the TM-based intervention had 3.4 (SD 5.4) fewer HDDs in the last month and 2.1 (SD 1.5) fewer DPDD when compared to baseline.TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy.

    View details for DOI 10.1111/j.1530-0277.2011.01646.x

    View details for Web of Science ID 000300663900019

    View details for PubMedID 22168137

  • Prediction of Serious Infection During Prehospital Emergency Care PREHOSPITAL EMERGENCY CARE Suffoletto, B., Frisch, A., Prabhu, A., Kristan, J., Guyette, F. X., Callaway, C. W. 2011; 15 (3): 325–30


    Regionalization of emergency care for patients with serious infections has the potential to improve outcomes, but is not feasible without accurate identification of patients in the prehospital environment.To determine the incremental predictive value of provider judgment in addition to prehospital physiologic variables for identifying patients who have serious infections.We conducted a prospective study at a single teaching tertiary-care emergency department (ED) where a convenience sample of emergency medical services (EMS) providers and ED clinicians completed a questionnaire about the same patients. Prehospital providers provided limited demographics and work history about themselves. They also reported the presence of abnormal prehospital physiology for each patient (heart rate >90 beats/min, systolic blood pressure <100 mmHg, respiratory rate >20 breaths/min, pulse oximetry <95%, history of fever, altered mental status) and their judgment about whether the patient had an infection. At the end of formal evaluation in the ED, the physician was asked to complete a survey describing the same patient factors in addition to patient disposition. The primary outcome of serious infection was defined as the presence of both 1) ED report of acute infection and 2) patient admission. We included prehospital factors associated with serious infection in the prediction models. Operating characteristics for various cutoffs and the area under the curve (AUC) were calculated and reported with 95% confidence intervals (95% CIs).Serious infection occurred in 32 (16%) of 199 patients transported by EMS, 50% of whom were septic, and 16% of whom were admitted to the intensive care unit. Prehospital systolic blood pressure <100 mmHg, EMS-elicited history or suspicion of fever, and prehospital judgment of infection were associated with primary outcome. Presence of any one of these resulted in a sensitivity of 0.59 (95% CI 0.40-0.76) and a specificity of 0.81 (95% CI 0.74-0.86). The AUC for the model was 0.71.Including prehospital provider impression to objective physiologic factors identified three more patients with infection at the cost of overtriaging five. Future research should determine the effect of training or diagnostic aids for improving the sensitivity of prehospital identification of patients with serious infection.

    View details for DOI 10.3109/10903127.2011.561411

    View details for Web of Science ID 000290967800004

    View details for PubMedID 21524204

  • Less Encouraging Lessons From the Front Lines: Barriers to Implementation of an Emergency Department-Based HIV Screening Program ANNALS OF EMERGENCY MEDICINE Mumma, B. E., Suffoletto, B. P. 2011; 58 (1): S44–S48


    We describe barriers to, and discuss recommendations for, implementing a limited emergency department (ED)-based HIV screening program.A pilot program was designed to study the feasibility of integrating HIV screening into ED care among patients aged 18 to 64 years at an urban academic emergency department with an annual census of 50,000 patients.During the first 12 weeks of the pilot program, 395 patients were screened. Of those, 2 (0.5%; 95% confidence interval 0.06% to 1.8%) received a positive test result for HIV. Both were contacted by telephone, and one was seen for result notification, posttest counseling, and further care in the local health department. Of the patients who received a negative test result, 98% were contacted about their results. We encountered numerous barriers to implementation, which we categorized as departmental, public health, legal, institutional, test limitations, and infrastructure.Understanding potential barriers and making plans for dealing with them are critical to the successful implementation of an HIV screening program in the ED.

    View details for DOI 10.1016/j.annemergmed.2011.03.022

    View details for Web of Science ID 000292341200009

    View details for PubMedID 21684407

  • Prehospital Serum Lactate as a Predictor of Outcomes in Trauma Patients: A Retrospective Observational Study JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Guyette, F., Suffoletto, B., Castillo, J., Quintero, J., Callaway, C., Puyana, J. 2011; 70 (4): 782–86


    Lactate is associated with morbidity and mortality; however, the value of prehospital lactate (pLA) is unknown. Our objective was to determine whether pLA improves identification of mortality and morbidity independent of vital signs.We measured pLA in 1,168 patients transported by rotorcraft to a Level I trauma center over 18 months. The primary outcome was in-hospital mortality; secondary outcomes were emergent surgery and multiple organ dysfunction syndrome (MODS). Covariates include age, sex, prehospital vital signs, and mental status. We created multivariable logistic regression models and tested them for interaction terms and goodness of fit. Cutoff values were established for reporting operating characteristics using shock (defined as shock index >0.8, heart rate >110, and systolic blood pressure <100), tachypnea (RR ≥30), and altered sensorium (Glasgow Coma Scale score <15).In-hospital mortality was 5.6%, 7.4% required surgery and 5.7% developed MODS. Median lactate was 2.4 mmol/L. Lactate was associated with mortality (odds ratio [OR], 1.23; p < 0.0001), surgery (OR, 1.13; p < 0.001), and MODS (OR, 1.14; p < 0.0001). Inclusion of pLA into a logistic model significantly improved the area under the receiver operator curves from 0.85 to 0.89 for death (p < 0.001), 0.68 to 0.71 for surgery (p = 0.02), and 0.78 to 0.81 for MODS (p = 0.002). When a threshold lactate value of >2 mmol/L was added to a predictive model of shock, respiratory distress, or altered sensorium, it improved sensitivity from 88% to 97% for death, 64% to 86% for surgery, and 94% to 99% for MODS.The pLA measurements improve prediction of mortality, surgery, and MODS. Lactate may improve the identification of patients who require monitoring, resources, and resuscitation.

    View details for DOI 10.1097/TA.0b013e318210f5c9

    View details for Web of Science ID 000289558700009

    View details for PubMedID 21610386

  • Therapeutic Hypothermia Does Not Affect Tissue Oxygenation, Metabolism or Microvascular Reactivity in Peripheral Muscle Suffoletto, B., Kristan, J., Rittenberger, J., Guyette, F., Hostler, D., Callaway, C. LIPPINCOTT WILLIAMS & WILKINS. 2010
  • Knowledge translation in emergency medical services: A qualitative survey of barriers to guideline implementation RESUSCITATION Bigham, B. L., Aufderheide, T. P., Davis, D. P., Powell, J., Donn, S., Suffoletto, B., Nafziger, S., Stouffer, J., Morrison, L. J., ROC Investigators 2010; 81 (7): 836–40


    The American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest in 2005. We sought to identify what barriers delayed the implementation of these guidelines in EMS agencies.We surveyed 178 EMS agencies as part of a larger quantitative survey regarding guideline implementation and conducted a single-question semi-structured interview using the Grounded Theory method. We asked "What barriers if any, delayed implementation of the (2005 AHA) guidelines in your EMS agency?" Data were coded and member validation was employed to verify our findings.176/178 agencies completed the quantitative survey. Qualitative data collection ceased after reaching theoretical saturation with 34 interviews. Ten unique barriers were identified. We categorized these 10 barriers into three themes. The theme instruction delays (reported by 41% of respondents) included three barriers: booking/training instructors (9%), receiving training materials (15%), and scheduling staff for training (18%). The second theme, defibrillator delays (38%), included two barriers; reprogramming defibrillators (24%) and receiving new defibrillators to replace non-upgradeable units (15%). The third theme was decision-making (38%) and included five barriers; coordinating with allied agencies (9%), government regulators such as state and provincial health authorities (9%), medical direction and base hospitals (9%), ROC participation (9%), and internal crises (3%).Many barriers contributed to delays in the implementation of the 2005 AHA guidelines in EMS agencies. These identified barriers should be proactively addressed prior to the 2010 Guidelines to facilitate rapid translation of science into clinical practice.

    View details for DOI 10.1016/j.resuscitation.2010.03.012

    View details for Web of Science ID 000279758500014

    View details for PubMedID 20398994

    View details for PubMedCentralID PMC3209799

  • DELAYED PREHOSPITAL IMPLEMENTATION OF THE 2005 AMERICAN HEART ASSOCIATION GUIDELINES FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIAC CARE PREHOSPITAL EMERGENCY CARE Bigham, B. L., Koprowicz, K., Aufderheide, T. P., Davis, D. P., Donn, S., Powell, J., Suffoletto, B., Nafziger, S., Stouffer, J., Idris, A., Morrison, L. J., ROC Investigators 2010; 14 (3): 355–60


    In 2005, the American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest (OHCA).To determine if, and when, emergency medical services (EMS) agencies participating in the Resuscitation Outcomes Consortium (ROC) implemented these guidelines.We contacted 178 EMS agencies and completed structured telephone interviews with 176 agencies. The survey collected data on specific treatment protocols before and after implementation of the 2005 guidelines as well as the date of implementation crossover (the "crossover date"). The crossover date was then linked to a database describing the size, type, and structure of each agency. Descriptive statistics and regression were used to examine patterns in time to crossover.The 2005 guidelines were implemented by 174 agencies (99%). The number of days from guideline release to implementation was as follows: mean 416 (standard deviation 172), median 415 (range 49-750). There was no difference in time to implementation in fire-based agencies (mean 432), nonfire municipal agencies (mean 365), and private agencies (mean 389, p = 0.31). Agencies not providing transport took longer to implement than agencies that transported patients (463 vs. 384 days, p = 0.004). Agencies providing only basic life support (BLS) care took longer to implement than agencies who provided advanced life support (ALS) care (mean 462 vs. 397 days, p = 0.03). Larger agencies (>10 vehicles) were able to implement the guidelines more quickly than smaller agencies (mean 386 vs. 442 days, p = 0.03). On average, it took 8.9 fewer days to implement the guidelines for every 50% increase in EMS-treated runs/year to which an agency responded.ROC EMS agencies required an average of 416 days to implement the 2005 AHA guidelines for OHCA. Small EMS agencies, BLS-only agencies, and nontransport agencies took longer than large agencies, agencies providing ALS care, and transport agencies, respectively, to implement the guidelines. Causes of delays to guideline implementation and effective methods for rapid EMS knowledge translation deserve investigation.

    View details for DOI 10.3109/10903121003770639

    View details for Web of Science ID 000283118400012

    View details for PubMedID 20388032

    View details for PubMedCentralID PMC3209500

  • Sleep Quality and Fatigue Among Prehospital Providers PREHOSPITAL EMERGENCY CARE Patterson, P., Suffoletto, B. P., Kupas, D. F., Weaver, M. D., Hostler, D. 2010; 14 (2): 187–93


    Fatigue is common among medical professionals and has been linked to poor performance and medical error. Objective. To characterize sleep quality and its association with severe fatigue in emergency medical services (EMS) providers.We studied a convenience sample of EMS providers who completed three surveys: the Pittsburgh Sleep Quality Index (PSQI), the Chalder Fatigue Questionnaire (CFQ), and a demographic survey. We used established measures to examine survey psychometrics and performed t-tests, analysis of variance (ANOVA), and chi-square tests to identify differences in PSQI and CFQ scores.One hundred nineteen surveys were completed. The eight-hour shift was most commonly reported (35.4%). A majority of subjects were overweight (41.9%) or obese (42.7%), and 59.6% had been diagnosed with one or more health conditions (e.g., diabetes). Results from psychometric tests were positive. The mean (+/- standard deviation) PSQI score was 9.2 (+/- 3.7). A CFQ score > or =4, indicating severe mental and physical fatigue, was present in 44.5% of the subjects. The mean PSQI score was higher among those reporting severe fatigue (11.3 +/- 3.2) than among those not reporting fatigue (7.5 +/- 3.0, p < 0.0001).The results from this study suggest that the sleep quality and fatigue status of EMS workers are at unhealthy levels. The health and safety of the EMS worker and patient population should be considered in light of these results.

    View details for DOI 10.3109/10903120903524971

    View details for Web of Science ID 000275155100009

    View details for PubMedID 20199233

    View details for PubMedCentralID PMC2895322

  • Body temperature changes are associated with outcomes following in-hospital cardiac arrest and return of spontaneous circulation RESUSCITATION Suffoletto, B., Peberdy, M., van der Hoek, T., Callaway, C. 2009; 80 (12): 1365–70


    Spontaneous changes in body temperature after return of circulation (ROSC) from cardiac arrest are common, but the association of these changes with outcomes in hospitalized patients who survive to 24h post-ROSC is not known. We tested the hypothesis that adults who experience temperature lability in the first 24h have worse outcomes compared with those who maintain normothermia.A prospective observational study from a multicenter registry of cardiac arrests (National Registry of Cardiopulmonary Resuscitation) from 355 US and Canadian hospitals. 14,729 adults with return of circulation from a pulseless cardiac arrest. We excluded those who died or were discharged before 24h post-event, those made Do-Not-Resuscitate (DNR) within 24h of event, those that had a preceding trauma, and those with multiple cardiac arrests. Finally, we included only subjects that had both a lowest (T(min)) and highest (T(max)) body temperature value recorded during the first 24-h after ROSC, resulting in a study sample of 3426 patients.After adjustment for potential covariates, there was a lower odds of survival in those having an episode of hypothermia (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.80), those having an episode of hyperthermia (OR, 0.67; 95% CI, 0.48-0.80), and those having an episode of both (OR, 0.59; 95% CI, 0.39-0.91). Among those who survived to discharge, there was also a lower odds of favorable neurologic performance in those who had an episode of hyperthermia (OR, 0.71; 95% CI, 0.51-0.98).Episodes of temperature lability following in-hospital resuscitation from cardiac arrest are associated with lower odds of surviving to discharge. Hyperthermia is also associated with fewer patients leaving the hospital with favorable neurologic performance. Further studies should identify whether therapeutic control over changes in body temperature after in-hospital cardiac arrest improves outcomes.

    View details for DOI 10.1016/j.resuscitation.2009.08.020

    View details for Web of Science ID 000273575400009

    View details for PubMedID 19804929

  • Ethyl pyruvate enhances intra-resuscitation hemodynamics in prolonged ventricular fibrillation arrest RESUSCITATION Suffoletto, B. P., Salcido, D. D., Logue, E. S., Caprio, T. W., Menegazzi, J. J. 2009; 80 (12): 1411–16


    As the duration of untreated cardiac arrest increases, the effectiveness of standard therapies declines, and may be more harmful than helpful. We investigated the hemodynamic, metabolic and anti-inflammatory effects of Ringer's ethyl pyruvate solution (REPS) versus Ringer's solution (RS) in the acute model of prolonged porcine arrest.Seventeen mixed-breed swine were induced into ventricular fibrillation (VF) and left untreated for 8min. CPR was begun using a mechanical chest compression device at a rate of 100 per minute. At the onset of CPR, animals were randomly assigned to treatment with either 25mL/kg of RS or 25mL/kg of REPS containing 40mg/kg of ethyl pyruvate, infused over 5min in blinded fashion. CPR continued with administration of a drug cocktail at 2min and the first rescue shock was delivered at minute 13 of VF. Animals having ROSC were supported with standardized care for 2h.Both groups had 100% ROSC and 100% 2-h survival. The REPS group exhibited higher median CPP (27.3mmHg) than the control group (16.5mmHg) by 3min of CPR, which continued throughout the duration of CPR (p=0.02). The median time to hypotension following ROSC was 9.64min in the REPS group and 7.25min in controls (p=0.04) and there was a non-significant trend of decreased use of vasopressors for the duration of resuscitation. There was no difference in systemic or cerebral metabolism between groups. There were non-significant trends of decreased IL-6, increased Il-10 and decreased mesenteric bacterial colony growth in those treated with REPS when compared to RS.The administration of REPS with CPR significantly improved intra- and post-resuscitation hemodynamics in this swine model of prolonged cardiac arrest, but did not definitely change the metabolic or inflammatory profile during the acute resuscitation period.

    View details for DOI 10.1016/j.resuscitation.2009.08.014

    View details for Web of Science ID 000273575400017

    View details for PubMedID 19818545

  • Decreasing Cortisol Levels in the First Day Following Cardiac Arrest May Be Associated With the Development of Multi-System Organ Failure Rittenberger, J. C., Guyette, F. X., Suffoletto, B. P., Callaway, C. W. LIPPINCOTT WILLIAMS & WILKINS. 2009: S1450
  • Association of intramyocardial high energy phosphate concentrations with quantitative measures of the ventricular fibrillation electrocardiogram waveform RESUSCITATION Salcido, D. D., Menegazzi, J. J., Suffoletto, B. P., Logue, E. S., Sherman, L. D. 2009; 80 (8): 946–50


    Quantitative measures of the ventricular fibrillation (VF) electrocardiogram (ECG) have been correlated with the success of rescue shocks, making them ideal measures for guiding resuscitative interventions. Correlation of intramyocardial energy stores with the change in quantitative VF ECG measures would provide mechanistic insight into their utility. We sought to investigate the relationship between intramyocardial energy stores and four quantitative ECG measures.Eighteen mixed-breed, domestic swine were sedated, anaesthetized and paralyzed. Swine were block randomized into three groups receiving 5, 10, or 15 min of untreated VF. Thoracotomy was performed and the heart was delivered. VF was induced by a 100 mA transthoracic shock while ECG was recorded. Biopsies of myocardial tissue were taken from the left and right ventricles after the prescribed duration of VF. Adenosine triphosphate (ATP) and adenosine diphosphate (ADP) concentrations in the tissue samples were measured. ECG data immediately prior to each biopsy were analyzed by each of four quantitative ECG methods: Scaling Exponent (ScE), Median Slope (MS), Amplitude Spectrum Area (AMSA), and logarithm of the Absolute Correlation (LAC). ATP and ADP concentrations of VF duration groups were compared. ATP and ADP concentrations were regressed against each quantitative ECG measure.ATP concentrations differed between VF duration groups, but ADP concentrations differed only between 5 and 10 min groups. A significant association existed between ATP and three quantitative measures--ScE, MS, and AMSA--but no significant relationship was found for ADP.Intramyocardial ATP levels correlate with quantitative measures of the ECG during ventricular fibrillation.

    View details for DOI 10.1016/j.resuscitation.2009.05.002

    View details for Web of Science ID 000268862100021

    View details for PubMedID 19523740

  • Lipid Emulsion Combined with Epinephrine and Vasopressin Does Not Improve Survival in a Swine Model of Bupivacaine-induced Cardiac Arrest Hicks, S. D., Salcido, D. D., Logue, E. S., Suffoletto, B. P., Empey, P. E., Poloyac, S. M., Miller, D. R., Callaway, C. W., Menegazzi, J. J. LIPPINCOTT WILLIAMS & WILKINS. 2009: 138–46


    This study sought to evaluate the efficacy of lipid emulsion in reversing bupivacaine-induced cardiovascular collapse when added to a resuscitation protocol that included the use of epinephrine and vasopressin.After induction of general anesthesia and instrumentation, 19 mixed-breed domestic swine had cardiovascular collapse induced by an intravenous bolus of 10 mg/kg bupivacaine. After 5 min of resuscitation including chest compressions, epinephrine (100 microg/kg) and vasopressin (1.5 U/kg), animals were randomized to receive either a bolus of 20% lipid emulsion (4 ml/kg) followed by a continuous infusion (0.5 ml x kg(-1) x min(-1)) or an equal volume of saline. Investigators were blinded to the treatment assignment. The primary endpoint was return of spontaneous circulation (mean arterial pressure of at least 60 mmHg for at least 1 min).Treatment groups were similar with respect to baseline measurements of weight, sex, and hemodynamic and metabolic variables. The rates of return of spontaneous circulation were similar between groups: (3 of 10) in the lipid group and 4 of 9 in the saline group (P = 0.65). Total serum bupivacaine concentrations were higher in the lipid group at the 10-min timepoint (mean +/- SEM: 23.13 +/- 5.37 ng/ml vs. 15.33 +/- 4.04 ng/ml, P = 0.004). More norepinephrine was required in the lipid group compared to the saline group to maintain a mean arterial pressure above 60 mmHg during the 60-min survival period (mean +/- SEM: 738.6 +/- 94.4 vs.. 487.3 +/- 171.0 microg).In this swine model, lipid emulsion did not improve rates of return of spontaneous circulation after bupivacaine-induced cardiovascular collapse.

    View details for DOI 10.1097/ALN.0b013e3181a4c6d7

    View details for Web of Science ID 000267346200023

    View details for PubMedID 19512878

    View details for PubMedCentralID PMC4174466

  • CORTICUS: the end of unconditional love for steroid use? Critical care (London, England) Mason, P. E., Al-Khafaji, A., Milbrandt, E. B., Suffoletto, B. P., Huang, D. T. 2009; 13 (4): 309

    View details for DOI 10.1186/cc7986

    View details for PubMedID 19691813

  • Effects of pre-arrest and intra-arrest hypothermia on ventricular fibrillation and resuscitation Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Salcido, D. D., Reynolds, J. C., Sherman, L. D. ELSEVIER IRELAND LTD. 2009: 126–32


    Hypothermia has been shown to improve survival and neurological outcomes for ventricular fibrillation (VF) cardiac arrest. The electrophysiological mechanisms of hypothermia are not well-understood, nor are the effects of beginning cooling during the resuscitation.We hypothesized that inducing hypothermia prior to the onset of VF would slow the deleterious changes seen in the ECG during VF and that inducing hypothermia at the start of resuscitation would increase the rates of ROSC and short-term survival in a porcine model of prolonged VF. We randomly assigned 42 domestic swine (27.2+/-2.3 kg) to either pretreatment with hypothermia before induction of VF (PRE), normothermic resuscitation (NORM) or intra-resuscitation hypothermia (IRH). During anesthesia, animals were instrumented via femoral cutdown. Lead II ECG was recorded continuously. PRE animals were cooled before the induction of VF, with a rapid infusion of 4 degrees normal saline (30mL/kg). VF was induced electrically, left untreated for 8min, then mechanical CPR began. During CPR the NORM animals got 30mL/kg body-temperature saline and the IRH animals got 30mL/kg 4 degrees saline. In all groups first rescue shocks were delivered after 13min of VF. We calculated the VF scaling exponent (ScE) for the entire 8min period (compared using GEE). ROSC and survival were compared with Fisher's exact test. Mean temperature in degrees C at the onset of VF was PRE=34.7 degrees (+/-0.8), NORM=37.8 (+/-0.9), and IRH=37.9 (+/-0.9). The ScE values over time were significantly lower after 8min in the PRE group (p=0.02). ROSC: PRE=10/14 (71%), NORM=6/14 (43%) and IRH=12/14 (86%); p for IRH vs. NORM=0.02. Survival: PRE=9/14 (64%), NORM=5/14 (36%), IRH 8/14 (57%).Hypothermia slowed the decay of the ECG waveform during prolonged VF. IRH improved ROSC but not short-term survival compared to NORM. It is possible to rapidly induce mild hypothermia during CPR using an IV infusion of ice-cold saline.

    View details for DOI 10.1016/j.resuscitation.2008.09.002

    View details for Web of Science ID 000262542800027

    View details for PubMedID 18952346

    View details for PubMedCentralID PMC2720166

  • Prevalence of Staphylococcus aureus Nasal Colonization in Emergency Department Personnel ANNALS OF EMERGENCY MEDICINE Suffoletto, B. P., Cannon, E. H., Ilkhanipour, K., Yealy, D. M. 2008; 52 (5): 529–33


    Nasal colonization with Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) can precede infection in patients and contacts. Although general population S aureus/MRSA rates are well described, the prevalence of S aureus and MRSA nasal colonization in emergency department health care workers is not defined. We seek to determine the prevalence of S aureus and MRSA nasal colonization among ED health care workers without evidence of an active site of staphylococcal infection and identify variables associated with colonization.We prospectively studied a convenience sample of ED health care workers from 5 urban teaching hospitals in Pittsburgh, PA. Each participant completed a questionnaire and nasal culturing. We tested susceptibility with the oxacillin disc diffusion method. We analyzed data with descriptive statistics and univariate regression, with alpha set at 0.05.Of 255 subjects, 23% were physicians; 62% were nurses, nursing assistants, or patient care technicians; and 15% were clerical staff or social service workers. Of 81 (31.8%) S aureus isolates, 11 (13.6%) were MRSA, an overall prevalence of 4.3%. All positive MRSA samples were from nurses, nursing assistants, or patient care technicians. No other covariate had an association with S aureus or MRSA colonization.In this urban ED health care worker population, the prevalence of S aureus is similar but MRSA nasal colonization is higher than previously reported estimates in the general population of the United States. Physicians and nonpatient contact ED health care workers did not have MRSA colonization.

    View details for DOI 10.1016/j.annemergmed.2008.03.020

    View details for Web of Science ID 000260904600013

    View details for PubMedID 18439722

  • Barriers to Guideline Implementation: A Qualitative Survey of Emergency Medical Services Bigham, B. L., Aufderheide, T. P., Donn, S., Stouffer, J. A., Powell, J., Suffoletto, B., Davis, D. P., Nafziger, S., Idris, A., Helbock, M., Morrison, L. J. LIPPINCOTT WILLIAMS & WILKINS. 2008: S822
  • The Effect of Type of Anesthesia and Technique of Cardiac Arrest Induction on Outcomes in Rats Logue, E. S., Suffoletto, B. P., Teng, X., Callaway, C. W. LIPPINCOTT WILLIAMS & WILKINS. 2008: S1468
  • EMS Agencies Implemented the 2005 AHA Guidelines for CPR and ECC an Average of 416 Days after Their Release Bigham, B. L., Koprowicz, K., Stouffer, J. A., Aufderheide, T. P., Donn, S., Powell, J., Davis, D. P., Nafziger, S., Suffoletto, B., Idris, A., Helbock, M., Morrison, L. J. LIPPINCOTT WILLIAMS & WILKINS. 2008: S822
  • Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation RESUSCITATION Rittenberger, J. C., Suffoletto, B., Salcido, D., Logue, E., Menegazzi, J. J. 2008; 79 (1): 155–60


    The optimum duration of cardiopulmonary resuscitation (CPR) prior to first rescue shock is unknown. Clinical trials have used 90 and 180 s. Neither of these durations may be optimal. We sought to determine the optimum duration of CPR prior to first defibrillation attempt and whether this varied depending on the duration of ventricular fibrillation (VF). In this porcine model of basic life support, our outcomes were rates of return of spontaneous circulation (ROSC), survival, and coronary perfusion pressure (CPP).We anesthetized and instrumented 45 swine and then induced VF. After 5 or 8 min of untreated VF, we randomized the swine to mechanical CPR for 90, 180, or 300 s. A single rescue shock (150 J biphasic) was then administered. If this shock failed, 2 min of mechanical CPR were completed prior to the next rescue shock. CPP was calculated for each 30s epoch. ROSC was defined as a blood pressure >80 mmHg sustained for 60s. Survival was defined as sustained ROSC for 20 min. Data were analyzed with descriptive statistics, Fisher's exact test, and ANOVA.In the 5 min VF cohort, the rate of ROSC did not differ between the three groups (90 s: 25%; 180 s: 38%; 300 s: 38%, p>.05). Survival rates did not differ (90 s: 25%; 180 s: 25%; 300 s: 25%, p>0.05). In the 8 min VF cohort, no animals experienced ROSC or survival. CPP were calculated by 30s epoch and did not differ between the three groups (p>0.05). CPPs decline after 180 s of CPR.ROSC and survival were equivalent regardless of VF duration and CPR duration. When CPR begins late, CPPs are low, stressing the importance of early CPR. We do not recommend 300 s of CPR unless a defibrillator is unavailable.

    View details for DOI 10.1016/j.resuscitation.2008.04.022

    View details for Web of Science ID 000260265600025

    View details for PubMedID 18620793

    View details for PubMedCentralID PMC2582345

  • Achalasia: a rare cause of stridor INTERNAL AND EMERGENCY MEDICINE Suffoletto, B., Katz, K., Tozzetti, C., Modesti, P. 2008; 3 (2): 127–29

    View details for DOI 10.1007/s11739-008-0158-7

    View details for Web of Science ID 000264318100008

    View details for PubMedID 18438628

  • The effect of adenosine A(1) receptor antagonism on return of spontaneous circulation and short-term survival in prolonged ventricular fibrillation Mader, T. J., Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. S., Callaway, C. W., Salcido, D. D., Logue, E. S., Sherman, L. D. TAYLOR & FRANCIS INC. 2008: 352–58


    Endogenous adenosine (ADO) is cardioprotective during ischemia and its myocardial concentration increases during untreated ventricular fibrillation (VF). We have previously shown that ADO A1 receptor (ADOA1R) antagonism hastens the time-dependent decay in VF waveform morphology during the circulatory phase of cardiac arrest.To determine the effect of ADOA1R antagonism on ROSC and short-term survival in prolonged VF.Thirty-six swine were assigned by block randomization to one of three groups: a group that received only vehicle (CONTROL), an ADOA1R antagonist pretreatment group (PRE), and a group that was given ADOA1R antagonist during resuscitation (DURING). The animals were instrumented under anesthesia, and ADOA1R antagonist or vehicle, per group assignment, was infused 5 minutes prior to VF induction. At minute 8 of untreated VF, chest compression with ventilation was initiated and a standard drug cocktail, with ADOA1R antagonist or vehicle, was given. The first rescue shock (150 J biphasic) was delivered after 11 minutes of VF. Proportions with 95% confidence intervals (CIs) were calculated for the two outcome measures.The baseline characteristics and chemistry values for the three groups were mathematically the same. The DURING group had a greater proportion of female animals (seven of 12) in comparison with the CONTROL group (two of 12) (p=0.03). ADOA1R antagonism hastened the decay of VF as previously demonstrated, but the rate of ROSC was the same for all groups: CONTROL=seven of 12, PRE=six of 12, and DURING=seven of 12. There were also no differences in short-term survival: CONTROL=four of 12, PRE=five of 12, and DURING=seven of 12.In this study, ADOA1R antagonism had no effect on outcome whether given before induction of VF or upon resuscitation after 8 minutes of untreated VF. The role of endogenous ADO in prolonged VF remains unclear.

    View details for DOI 10.1080/10903120802101223

    View details for Web of Science ID 000257147000014

    View details for PubMedID 18584504

  • Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: A survey of the national association of emergency medical services physicians PREHOSPITAL EMERGENCY CARE Suffoletto, B. P., Salcido, D. D., Menegazzi, J. J. 2008; 12 (1): 52–56


    Postresuscitation care of comatose survivors of cardiac arrest using induced hypothermia (IH) is recommended by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) to improve neurological outcomes but has been performed primarily later in the course of care. Recently, it was shown that prehospital cooling is feasible, safe, and effective in lowering patient temperature. We sought to determine the prevalence of EMS agencies that use prehospital IH. We also sought to determine what perceived barriers to initiating IH might exist and the understanding EMS physicians have of guidelines for IH.We collected a convenience sample of completed questionnaires from physician members of the National Association of EMS Physicians at the national conference on 3 days from January 11 to 13, 2007.One hundred forty-five (59%) physician members who had attended the conference completed the survey, representing 109 EMS Medical Directors and 36 non-Medical Director EMS Physicians from 92 regions of 34 U.S. states, three Canadian provinces, and one European country. A total of 9 of 145 (6.2%) of physicians stated that the EMS agency they are affiliated with uses a protocols for IH, 6 of whom were local EMS Medical Directors. The median (IQR) duration of having a protocol was 12 months (6-12), and all used either ice bags or cold IV fluid or a combination of the two. Among those who reported prehospital use of IH, only one of eight (12.5%) recall having cooled greater than 10% of eligible patients in the field. Common perceived barriers to IH include the following: overburden with other tasks (62.1%), short transport times (60.7%), lack of refrigeration equipment (60.0%), and receiving hospitals' failure to continue therapeutic hypothermia (56.6%). A small but significant percentage (22.1%) believed that the lack of guidelines specifically addressing prehospital cooling was a barrier to initiating a protocol, and only 62% correctly identified 32-34 degrees C as the recommended target temperature range.The practice of prehospital IH is rare. Infrequent use of prehospital cooling seen in our select population may be due to the perceived barriers that were identified and/or inadequate guidance from the scientific literature. Statements from the AHA and ILCOR first published in 2003 and reiterated in 2005 recommend the implementation but do not specify the most beneficial time to initiate postresuscitation cooling of comatose survivors of cardiac arrest. Further studies should examine the relative benefit of prehospital cooling.

    View details for DOI 10.1080/10903120701707880

    View details for Web of Science ID 000252347100009

    View details for PubMedID 18189178

  • Prehospital induced hypothermia after out-of-hospital cardiac arrest: Emergency medical services state of the practice in the US in 2007 Suffoletto, B., Menegazzi, J., Salcido, D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 936
  • The incidence of pulmonary aspiration with laryngeal mask airway use during cardiopulmonary resuscitation and positive pressure ventilation in swine Suffoletto, B., Menegazzi, J., Logue, E., Salcido, D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 935
  • Spontaneous body temperature is associated with survival following in-hospital cardiac arrest and return of spontaneous circulation: A report from the national registry of cardiopulmonary resuscitation Suffoletto, B., Callaway, C., Pelberdy, M., Hoek, T. LIPPINCOTT WILLIAMS & WILKINS. 2007: 935
  • Early post-resuscitation levels of cytochrome-c and interleukin-6 after prolonged porcine cardiac arrest Salcido, D. D., Logue, E. S., Suffoletto, B. P., Rittenberger, J. C., Menegazzi, J. J. LIPPINCOTT WILLIAMS & WILKINS. 2007: 931–32
  • Inducing hypothermia during resuscitation improves return of spontaneous circulation in prolonged porcine ventricular fibrillation Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Salcido, D. D., Sherman, L. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 923
  • Intramyocardial high-energy phosphate depletion during ventricular fibrillation correlates with electrocardiographic change Salcido, D. D., Menegazzi, J. J., Logue, E. S., Suffoletto, B. P., Sherman, L. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 582
  • Mild hypothermia slows the decay of quantitative ventricular fibrillation waveform morphology during prolonged cardiac arrest Menegazzi, J. J., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Salcido, D. D., Sherman, L. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 530
  • Increasing CPR duration prior to first defibrillation does not improve ROSC or survival in a swine model of prolonged ventricular fibrillation Rittenberger, J. C., Suffoletto, B., Salcido, D., Logue, E., Menegazzi, J. LIPPINCOTT WILLIAMS & WILKINS. 2007: 36
  • Effects of an impedance threshold device on hemodynamics and restoration of spontaneous circulation in prolonged porcine ventricular fibrillation PREHOSPITAL EMERGENCY CARE Menegazzi, J. J., Salcido, D. D., Menegazzi, M. T., Rittenberger, J. C., Suffoletto, B. P., Logue, E. S., Mader, T. J. 2007; 11 (2): 179–85


    An impedance threshold device (ITD) has been designed to enhance circulation during CPR by creating a negative intrathoracic pressure during the relaxation phase of chest compression.We sought to determine the effects of the ITD on coronary perfusion pressure (CPP), return of spontaneous circulation (ROSC), and short-term survival (20 minutes after ROSC). We hypothesized that the ITD would improve all 3 variables when compared to standard CPR.Using a case-control design nested within a randomized primary study, we compared CPR with the ITD (ITD-CPR) to standard CPR without the device (S-CPR). We systematically assigned 36 domestic swine, weighing 23-29 kg, (18 per group) to resuscitation with either ITD-CPR or S-CPR after 8 minutes of untreated ventricular fibrillation (VF). At minute 8, mechanical chest compression and ventilation began, and drugs (0.1 mg/kg epinephrine, 40U vasopressin, 1.0 mg propranolol, 1 mEq/kg sodium bicarbonate) were given. The first rescue shock (150J biphasic) was delivered at minute 11 of VF. We recorded CPP, ROSC (systolic pressure > 80 mmHg sustained for 60 s continuously), and survival. Data were analyzed with Fisher's exact test and generalized estimating equations (GEE), with alpha = 0.05.We analyzed 3,150 compressions. CPP for the ITD-CPR group (28.1 mmHg [95% CI 27-29.3 mmHg]), did not differ from the S-CPR group (32.3 mmHg [95% CI 31.2-33.4 mmHg]). ROSC occurred in 6/18 (33%) animals in the ITD-CPR, and 14/18 (78%) in the S-CPR group (p = 0.02). Survival occurred in 3/18 (17%) ITD-CPR and 13/18 (72%) S-CPR group (p = 0.003).ITD-CPR did not improve CPP compared to S-CPR. ROSC and survival were significantly lower with ITD-CPR.

    View details for DOI 10.1080/10903120701206073

    View details for Web of Science ID 000245626700005

    View details for PubMedID 17454804

  • Intra-resuscitation hypothermia improves short-term survival in prolonged porcine ventricular fibrillation Menegazzi, J., Logue, E., Rittenberger, J., Reynolds, J., Suffoletto, B., Callaway, C. LIPPINCOTT WILLIAMS & WILKINS. 2006: 354
  • Feasibility of basic emergency medical technicians to perform selected advanced life support interventions PREHOSPITAL EMERGENCY CARE Guyette, F. X., Rittenberger, J. C., Platt, T., Suffoletto, B., Hostler, D., Wang, H. E. 2006; 10 (4): 518–21


    Emergency medical technician-basic (EMT-B) providers often provide the initial care to victims of out-of-hospital cardiac arrest. While automated external defibrillators enable EMT-B providers to deliver rescue shocks, patients in cardiac arrest may require additional interventions that EMT-B providers may not presently deliver. We sought to evaluate the feasibility of training EMT-B providers to provide additional cardiac resuscitation procedures using the laryngeal mask airway (LMA) and intraosseous (IO) access.In this prospective observational study, we trained 18 EMT-B providers to use the LMA and IO drill (EZ-IO) in a three-hour educational session. Working in two-person teams, the rescuers performed a simulated ventricular fibrillation resuscitation. We evaluated placement success as well as elapsed time to placement of the LMA and EZ-IO.EMT-B providers successfully placed the LMA in 14 of 18 scenarios (78%; 95% confidence interval, 52% to 94%), with a mean of two attempts for placement. Subjects successfully placed the EZ-IO in 17 of 18 scenarios (94%; 95% confidence interval, 73% to 100%), all on the first attempt. The median time to LMA placement following the third shock was 109 seconds (interquartile range, 58-158) and the median time to EZ-IO placement was 72 seconds (interquartile range, 50-93) after LMA placement.EMT-B providers demonstrated moderate success in performing advanced-level cardiac resuscitation interventions. These observations suggest potential for expanding the role of basic-level rescuers in cardiopulmonary resuscitation.

    View details for DOI 10.1080/10903120600726015

    View details for Web of Science ID 000242396900018

    View details for PubMedID 16997785