Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data

2019 ◽  
Vol 58 (7) ◽  
pp. 725-731 ◽  
Author(s):  
Joseph M. Friedrich ◽  
Christie Sun ◽  
Xue Geng ◽  
Diane P. Calello ◽  
Michael Gillam ◽  
...  
Keyword(s):  
United States ◽  
Child And Adolescent ◽  
The United States ◽  
Poison Center

scholarly journals BITES study: A qualitative analysis among emergency medicine physicians on snake envenomation management practices

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262215
Author(s):  
Anna Tupetz ◽  
Loren K. Barcenas ◽  
Ashley J. Phillips ◽  
Joao Ricardo Nickenig Vissoci ◽  
Charles J. Gerardo
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Financial Burden ◽  
The United States ◽  
Poison Center ◽  
Functional Impairments ◽  
Major Barrier ◽  
Snake Envenomation ◽  
Depth Interviews

Introduction Antivenom is currently considered standard treatment across the full spectrum of severity for snake envenomation in the United States. Although safe and effective antivenoms exist, their use in clinical practice is not universal. Objective This study explored physicians’ perceptions of antivenom use and experience with snake envenomation treatment in order to identify factors that influence treatment decisions and willingness to administer. Methods We conducted a qualitative study including in-depth interviews via online video conferencing with physicians practicing in emergency departments across the United States. Participants were selected based on purposive sampling methods. Data analysis followed inductive strategies, conducted by two researchers. The codebook and findings were discussed within the research team. Findings Sixteen in-depth interviews with physicians from nine states across the US were conducted. The participants’ specialties include emergency medicine (EM), pediatric EM, and toxicology. The experience of treating snakebites ranged from only didactic education to having treated over 100 cases. Emergent themes for this manuscript from the interview data included perceptions of antivenom, willingness to administer antivenom and influencing factors to antivenom usage. Overall, cost-related concerns were a major barrier to antivenom administration, especially in cases where the indications and effectiveness did not clearly outweigh the potential financial burden on the patient in non-life- or limb-threatening cases. The potential to decrease recovery time and long-term functional impairments was not commonly reported by participants as an indication for antivenom. In addition, level of exposure and perceived competence, based on prior education and clinical experience, further impacted the decision to treat. Resources such as Poison Center Call lines were well received and commonly used to guide the treatment plan. The need for better clinical guidelines and updated treatment algorithms with clinical and measurable indicators was stated to help the decision-making process, especially among those with low exposure to snake envenomation patients. Conclusions A major barrier to physician use of antivenom is a concern about cost, cost transparency and cost–benefit for the patients. Those concerns, in addition to the varying degrees of awareness of potential long-term benefits, further influence inconsistent clinical treatment practices.

The Risks Associated With Stimulant Medication Use in Child and Adolescent Populations Diagnosed With Attention-Deficit/Hyperactivity Disorder

2012 ◽  
Vol 14 (1) ◽  
pp. 5-14
Author(s):  
Jeanne M. Stolzer
Keyword(s):  
United States ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Developmental Stages ◽  
Stimulant Medication ◽  
Medical Model ◽  
Child And Adolescent ◽  
The United States ◽  
Hyperactivity Disorder ◽  
Chemical Imbalance

Throughout human history, psychiatric dysfunction in child and adolescent populations has been rare. However, over the last 2 decades, psychiatric diagnoses have reached epidemic proportions—particularly in the United States. Currently, attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric illness in child and adolescent populations with an estimated 10–12 million children diagnosed in the United States. Over the last 2 decades, behavior patterns that were once perceived as typical, normative developmental stages have been systematically redefined by those promoting the mass labeling and drugging of children as a “chemical imbalance of the brain.” Grounded in bioevolutionary theory, this article will challenge the existing medical model and will explore in-depth the risks associated with the ADHD label and the use of stimulant medication in pediatric populations. In addition, this article will examine the cultural, physical, neurological, psychological, and social correlates as they relate to the diagnosis of ADHD in America.

Bibliometric analysis of poison center-related research published in peer-review journals

2015 ◽  
Vol 35 (7) ◽  
pp. 705-712 ◽  
Author(s):  
MB Forrester
Keyword(s):  
United States ◽  
Peer Review ◽  
Medical Toxicology ◽  
The United States ◽  
Poison Center ◽  
Related Research ◽  
Pubmed Database ◽  
Poison Centers ◽  
Number Of Publications ◽  
Advance Knowledge

Poison centers advance knowledge in the field of toxicology through publication in peer-review journals. This investigation describes the pattern of poison center-related publications. Cases were poison center-related research published in peer-review journals during 1995–2014. These were identified through searching the PubMed database, reviewing the tables of contents of selected toxicology journals, and reviewing abstracts of various national and international meetings. The following variables for each publication were identified: year of publication, journal, type of publication (meeting abstract vs. other, i.e. full article or letter to the editor), and the country(ies) of the poison center(s) included in the research. Of the 3147 total publications, 62.1% were meeting abstracts. There were 263 publications in 1995–1999, 536 in 2000–2004, 999 in 2005–2009, and 1349 in 2010–2014. The publications were in 234 different journals. The journals in which the highest number of research was published were Clinical Toxicology (69.7%), Journal of Medical Toxicology (2.2%), and Veterinary and Human Toxicology (2.1%). The research was reported from 62 different countries. The countries with the highest number of publications were the United States (67.9%), United Kingdom (6.5%), Germany (3.9%), France (2.5%), and Italy (2.4%). The number of publications increased greatly over the 20 years. Although the publications were in a large number of journals, a high proportion of the publications were in one journal. While the research came from a large number of countries, the preponderance came from the United States.

Translating research to support practitioners in addressing disparities in child and adolescent mental health and services in the United States.

2019 ◽  
Vol 25 (1) ◽  
pp. 126-135 ◽  
Author(s):  
Carmen R. Valdez ◽  
Caryn R. R. Rodgers ◽  
Omar G. Gudiño ◽  
Patricia Isaac ◽  
Natalie A. Cort ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
The United States

BITES study: A qualitative analysis among emergency medicine physicians on Snake Envenomation Management practices

2021 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Financial Burden ◽  
The United States ◽  
Poison Center ◽  
Functional Impairments ◽  
Major Barrier ◽  
Snake Envenomation ◽  
Depth Interviews

Introduction: Antivenom is currently considered standard treatment across the full spectrum of severity for snake envenomation in the United States. Although safe and effective antivenoms exist, their use in clinical practice is not universal.Objective: This study explored physicians’ perceptions of antivenom use and experience with snake envenomation treatment in order to identify factors that influence treatment decisions and willingness to administer.Methods: We conducted a qualitative study based on a grounded theory framework including in-depth interviews via online video conferencing with physicians practicing in emergency departments across the United States. Participants were selected based on purposive sampling methods. Data analysis followed a combination of inductive and deductive strategies, conducted by two researchers. The codebook and findings were discussed within the research team. Findings: Sixteen in-depth interviews with physicians from nine states across the US were conducted. The participants’ specialties include emergency medicine (EM), pediatric EM, and toxicology. The experience of treating snakebites ranged from only didactic education to having treated over 100 cases. Emergent themes for this manuscript from the interview data included perceptions of antivenom, willingness to administer antivenom and influencing factors to antivenom usage. Overall, cost-related concerns were a major barrier to antivenom administration, especially in cases where the indications and effectiveness did not clearly outweigh the potential financial burden on the patient in non-life- or limb-threatening cases. The potential to decrease recovery time and long-term functional impairments was not commonly reported by participants as an indication for antivenom. In addition, level of exposure and perceived competence, based on prior education and clinical experience, further impacted the decision to treat. Resources such as Poison Center Call lines were well received and commonly used to guide the treatment plan. The need for better clinical guidelines and updated treatment algorithms with clinical and measurable indicators was stated to help the decision-making process, especially among those with low exposure to snake envenomation patients.Conclusions: A major barrier to physician use of antivenom is a concern about cost, cost transparency and cost–benefit for the patients. Those concerns, in addition to the varying degrees of awareness of potential long-term benefits, further influence inconsistent clinical treatment practices.

Hematologic Abnormalities Following Crotaline Snakebites In South Carolina

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4753-4753
Author(s):  
Zaina Qureshi ◽  
Jill Michels ◽  
Zach Kiker ◽  
Charles Bennett ◽  
William Richardson
Keyword(s):  
United States ◽  
South Carolina ◽  
The United States ◽  
Upper Extremities ◽  
Hematologic Toxicity ◽  
Poison Center ◽  
Local Effects ◽  
Delayed Onset ◽  
Primary Indication ◽  
Hematological Abnormalities

Abstract Abstract 4753 Background: Pit viper envenomation causes local tissue edema, pain, and ecchymosis. In certain geographical areas of the United States thrombocytopenia, hypofibrinogenemia and coagulopathy are common hematological abnormalities, and ones that dictate both a reason for treatment with antivenom as well as an important monitor of therapeutic efficacy. Data on the frequency and severity of hematological abnormalities following envenomation by crotaline species in South Carolina has not been reported. We evaluated clinical and hematologic laboratory findings and treatment course following copperhead and rattlesnake bites in South Carolina. Method: We conducted a retrospective evaluation of all copperhead and rattlesnake bites reported to the Palmetto Poison Center from April 2005 through June 2010. Severity of the snakebite and development of hematologic toxicity associated with envenomation cases were documented before and after crotaline Fab antivenom (CroFab®) administration. Adverse events associated with antivenom therapy, recurrence phenomena, delayed onset of symptoms, and performance of fasciotomy were also recorded. Results: Overall, 194 crotaline snakebites were identified- 156 copperhead bites and 38 rattlesnake bites. Males accounted for 75% of copperhead bite patients (median age, 36 years; 51% with bites on upper extremities) and 82% of rattlesnake bite patients (median age, 42.5 years; 76% on upper extremities). All patients except one were treated at a healthcare facility with > 80% arriving within 6 hours following the bite. Over 60% of patients received crotaline Fab antivenom; no patients received the older Antivenin Crotalidae Polyvalent. Severity of the envenomation for copperheads and rattlesnakes was classified as dry (7.74%, 13.16%), mild (68.39%, 73.68%), moderate (22.58%, 10.53%), and severe (1.39%, 2.63%), respectively. Seventeen of 156 patients (10.89%) developed abnormal hematologic laboratory results following copperhead bites and two of 38 (5.26%) patients developed abnormal hematologic laboratory parameters with rattlesnake bites. Of these, the most common abnormality was coagulopathy (16/17 = 94.11%; 2/2 = 100%), followed by hypofibrinogenemia (5/17 = 29.41%; 0/0 = 0.00%) and thrombocytopenia (2/17 = 11.76%; 0/0 = 0.00%) for copperheads and rattlesnakes respectively. Recurrence phenomena was observed in 4 patients with copperhead bites and 2 patients with rattlesnake bites, while delayed onset of symptoms were seen in 12 patients and 5 patients, respectively. Among those experiencing recurrence, 75% of patients bitten by copperheads experienced local effects including pain and swelling and 25% experienced coagulopathy, while a 100% of the patients bitten by rattlesnakes experienced recurrent local effects. Among those experiencing a delayed onset of symptoms, 90% of the patients with copperhead bites experienced coagulopathy while 10% had local effects and 100% of the patients bitten by rattlesnakes experienced coagulopathy. Reaction to the antivenom developed in three patients. Three patients underwent a fasciotomy. Conclusions: Antivenom therapy is typically administered to halt the progression of local envenomation effects and improve abnormal hematologic parameters towards normal. In South Carolina, the primary indication for antivenom treatment is most commonly to treat local clinical findings. Our poison center experience suggests coagulopathy is the most common hematologic laboratory abnormality following crotaline envenomation in addition to a low rate of thrombocytopenia in our geographic location. Other geographic areas of the United States are recognized to have more frequent and severe hematologic complications following crotaline bites. Disclosures: Bennett: Pfizer: Consultancy.

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