Every year, more than 44,000 Americans take their own lives, and suicide is the second-leading cause of death in adolescents between the ages of 15 to 24.
These alarming numbers beg for better identification of patients at risk for suicide to ensure they get the care they need, when they need it. That’s why two UPMC doctors – Dr. David Brent and Dr. Neal Ryan – and one University of Pittsburgh professor, Dr. Fuchiang (Rich) Tsui, are leading a project to better track patients at risk for suicide through the electronic health record (EHR).
“In many cases, the last clinical contact a suicide victim sees is a primary care physician or someone in the emergency room, not a mental health professional,” Brent said. “This project is working to change that.”
Using Brent’s background in child psychology, epidemiology and suicide prevention, Ryan’s experience in child psychology, and Tsui’s expertise in data science, the group set out to develop EHR algorithms to track patient patterns and flag those at high risk of suicide.
The algorithms combine diagnostic, machine learning and natural language processing information to analyze all relevant information about a patient, automating the process of analyzing records and searching for signs of suicide that often go undetected by humans. Patients at risk for suicide and suicidal behavior will be identified and their chart flagged so psychiatric professionals can provide the help patient needs.
“Our initial efforts will look just within the electronic medical records of the clinical sites involved in the study at UPMC,” Ryan said. “Once the algorithm is solidified at UPMC, we are hoping to expand it to other health systems and adapt the algorithms to fit their electronic health records.”
To help develop and expand the system, the research team was awarded a Bench to Bedside grant from The Beckwith Institute in June 2017. The program supports research that translates directly to patient care.
“As a data scientist, I am excited by this project that has developed a predictive system that automatically identifies relevant risk factors from potentially tens of thousands of clinical findings and computes a patient’s suicide risk accordingly,” Tsui said.
As the project expands across different health systems, the algorithms will need to be able to read all the data languages the various hospitals employ. After the system is up and running, it will need training every few years to update the algorithms.
“This project is a low-cost, low-risk method to yield better patient care,” Brent said. “This is an extra resource to guide physician decision making and referrals, which ultimately uses this predictive data approach to save lives.”
When it comes to caring for stroke patients, every minute counts. But, for ischemic stroke patients who have their blood clots surgically removed, timing can be even more important.
After having their clot surgically removed, patients with symptoms of a severe ischemic stroke are often immediately transported to a tertiary care hospital. Ischemic stroke patients can lose millions of brain cells each minute they are being transported, which could be upwards of 30 minutes. The more brain cells a stroke patient loses, the longer it takes them to heal.
To combat this problem, a team of researchers in the Applied Physiology Laboratory at the University of Pittsburgh’s Department of Emergency Medicine have designed an innovative new process to slow down brain cell loss in stroke patients. The study, called Dex III, involves lowering a patient’s core temperature.
Much like therapeutic hypothermia used in cardiac arrest patients, the patient’s core body temperature is lowered down to 93 degrees Fahrenheit, which is almost 6 degrees Fahrenheit cooler than the normal 98.6 degrees Fahrenheit. This works because when the brain cells are cooled, their need for oxygen and sugar drops. This process is similar to what happens to a bear during hibernation.
However, while this concept may seem simple, the process becomes more complicated because humans do not naturally hibernate.
“When you cool a person, their natural response is to shiver, so you need to give medications that will stop the shivering,” said Dr. Jon Rittenberger, associate professor of emergency medicine, occupational therapy, and clinical and translational science, and emergency physician at UPMC Presbyterian. “Unfortunately, most of those drugs also sedate patients. This makes it hard for the neurologist to properly evaluate them and see if removing the clot has improved their symptoms.”
A novel drug called dexmedetomidine, a sedative typically used during surgery, is used to prevent shivering. It makes the patient drowsy, but easily awakened so they can respond to neurological evaluations. Moreover, dexmedetomidine is an excellent medication for suppressing shivering.
In their prior work, the group found combining both cooling and dexmedetomidine drops the patient’s heart rate. To make the protocol safer, the group is now using a second drug called glycopyrrolate to prevent a lowered heart rate.
Rittenberger and his team have been working on Dex III since May 2017 thanks to a $25,000 grant from the Clinical and Translational Science Institute at Pitt. They hope to finish it by the end of the calendar year.
“My hope would be that after this research, we have a safe method to cool these patients,” Rittenberger said. “Then, we can see if it improves their outcomes.”