Sarah K Rivelli

Duke University, Durham, North Carolina, United States

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Publications (22)

  • Article · Apr 2016
  • Source
    Timothy E. Yen · John C. Allen · Sarah K. Rivelli · [...] · Madan M. Kwatra
    [Show abstract] [Hide abstract] ABSTRACT: Evidence is mixed for an association between serum insulin-like growth factor-I (IGF-I) levels and postoperative delirium (POD). The current study assessed preoperative serum IGF-I levels as a predictor of incident delirium in non-demented elderly elective knee arthroplasty patients. Preoperative serum levels of total IGF-I were measured using a commercially available Human IGF-I ELISA kit. POD incidence and severity were determined using DSM-IV criteria and the Delirium Rating Scale-Revised-98 (DRS-R98), respectively. Median IGF-I levels in delirious (62.6 ng/ml) and non-delirious groups (65.9 ng/ml) were not significantly different (p = 0.141). The ratio (95% CI) of geometric means, D/ND, was 0.86 (0.70, 1.06). The Hodges-Lehmann median difference estimate was 7.23 ng/mL with 95% confidence interval (−2.32, 19.9). In multivariate logistic regression analysis IGF-I level was not a significant predictor of incident POD after correcting for medical comorbidities. IGF-I levels did not correlate with DRS-R98 scores for delirium severity. In conclusion, we report no evidence of association between serum IGF-I levels and incidence of POD, although the sample size was inadequate for a conclusive study. Further efforts to investigate IGF-I as a delirium risk factor in elderly should address comorbidities and confounders that influence IGF-I levels.
    Full-text Article · Feb 2016 · Scientific Reports
  • [Show abstract] [Hide abstract] ABSTRACT: Rationale: Delirium is common following lung transplantation and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined. Objectives: To examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients. Methods: Intraoperative hemodynamic function during lung transplantation was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute on all patients. Following transplantation, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge. Measurements and main results: Sixty-three patients were transplanted of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure (CPP) was associated with increased risk of delirium (OR = 2.08 [1.02, 4.24] per 10 mm Hg decrease, P = .043), longer durations of delirium (1.7 [1.1, 2.7] days longer per 10 mm Hg decrease, P = .022), and greater delirium severity (b = -0.81 [-1.47, -0.15], P = .017). Conclusions: Poorer cerebral perfusion pressure during lung transplantation is associated with greater risk for delirium following transplantation, as well as greater duration and severity of delirium, independent of demographic and medical predictors.
    Article · Jan 2016
  • Article · May 2015 · Academic Psychiatry
  • P J Smith · S K Rivelli · A M Waters · [...] · J.A. Blumenthal
    [Show abstract] [Hide abstract] ABSTRACT: Background: Delirium is relatively common after lung transplantation, although its prevalence and prognostic significance have not been systematically studied. The purpose of the present study was to examine pretransplant predictors of delirium and the short-term impact of delirium on clinical outcomes among lung transplant recipients. Methods: Participants underwent pretransplant cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test. After transplant, delirium was assessed using the Confusion Assessment Method until discharge. Results: Sixty-three patients were transplanted between March and November 2013, of which 23 (37%) developed delirium. Among transplanted patients, 48 patients completed pretransplant cognitive testing. Better pretransplant cognitive function was associated with lower risk of delirium (odds ratio, 0.69 [95% confidence interval 0.48, 0.99], P = .043); and demographic and clinical features including native disease (P = .236), the Charlson comorbidity index (P = .581), and the lung allocation score (P = .871) were unrelated to risk of delirium, although there was a trend for women to experience delirium less frequently (P = .071). The presence (P = .006) and duration (P = .027) of delirium were both associated with longer hospital stays. Conclusion: Delirium occurs in more than one-third of patients after lung transplantation. Delirium was associated with poorer pretransplant cognitive functioning and longer hospital stays, after accounting for other medical and demographic factors.
    Article · Sep 2014 · Journal of Critical Care
  • Sarah K. Rivelli · Kristen G. Shirey
    [Show abstract] [Hide abstract] ABSTRACT: Mental health and substance use disorders, or behavioral health (BH) disorders, are common and associated with significant morbidity, disability, and health-care costs. However, BH services are not adequate to meet this need. BH care in the general medical sector has increased substantially in the last decade. However, such care tends to lack adequate evidence-based mental health treatment despite a growing evidence base. Moreover, behavioral and medical conditions tend to co-occur, and thus, patients with combined needs are often seen in medical settings. BH and medical conditions are risk factors for one another, and each complicates the course and treatment of the other. Based on these observations, it is essential that we integrate mental health and medical care delivery to improve access, care, and reduce cost. © 2014 Springer Science+Business Media New York. All rights are reserved.
    Chapter · May 2014
  • [Show abstract] [Hide abstract] ABSTRACT: With the implementation of the Affordable Care Act (ACA), there will be a growing demand for mental health care in this country (Patient Protection and Affordable Care Act. U. S. Public Law 111-148-March 23, 2010). It is likely much of this care will continue to be delivered in the primary care setting and not in traditional outpatient psychiatric clinic sites. Primary care providers (PCPs) will be in the position to further expand their existing role as primary behavioral health providers. What does this mean for the future of psychiatry and how psychiatrists are trained? This chapter addresses the current state of psychiatric education and suggests practical ways in which this training can adapt to fast moving organizational changes, while staying true to the essential components of psychiatric practice (e.g., biopsychosocial formulation, inclusion of psychotherapy, focus on the therapeutic alliance between provider and patient, and maintaining an expertise in psychopharmacology). We will discuss the importance of teaching psychiatry residents how to effectively interface with PCPs and other physicians, including as much-needed educational and clinical consultants. An overview on how best to train residents in the area of preventive medicine will also be provided.
    Chapter · May 2014
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    [Show abstract] [Hide abstract] ABSTRACT: Baclofen, an agonist at the B subunit of gaba-aminobutyric acid receptor, possesses pharmacologic properties that may confer utility for the treatment of alcohol dependence. Research suggests that not only can it be useful in promoting maintenance of alcohol abstinence but also it may play a key role in decreasing alcohol cravings and anxiety often associated with alcohol dependence. To assess the benefit of baclofen for alcohol dependence, a review of the literature was conducted to identify published data investigating this off-label treatment. Four randomized controlled trials to date have been published and were included in this review. Although primary outcomes differ between studies, patients randomized to baclofen experience higher rates of abstinence from alcohol than those taking placebo in two of the trials. Secondary analyses indicate that baclofen is safe in patients with alcohol dependence, including those with moderate to severe liver cirrhosis, and may provide beneficial anxiolytic effects. Despite some positive data, the largest available randomized controlled trial failed to find any differences between baclofen and placebo. In all studies, individuals with severe medical comorbidities, seizure disorders, and psychiatric disorders were excluded from trials, which may limit external validity. In summary, there may be beneficial effects from using baclofen for the treatment of alcohol dependence; however, limited conclusions can be drawn from the small number of studies currently available for review. Larger well-designed trials are needed to further define baclofen's role for the treatment of alcohol dependence.
    Full-text Article · Jul 2013 · Clinical Pharmacology: Advances and Applications
  • Emily S Prohaska · Andrew J Muzyk · Sarah K Rivelli
    Article · Dec 2012 · The Journal of Neuropsychiatry and Clinical Neurosciences
  • Article: In reply.
    Madan M Kwatra · Richard E Moon · William D White · [...] · Sarah K Rivelli
    Article · Dec 2012 · Anesthesiology
  • Dr Andrew J. Muzyk PharmD · Sarah K. Rivelli · Wei Jiang · [...] · Jane P. Gagliardi
    [Show abstract] [Hide abstract] ABSTRACT: Background: Intravenous haloperidol can increase the risk for corrected QT (QTc) interval prolongation, torsades de pointes (TdP) and sudden death. Objective: The purpose of this study was to examine the effects of implementation of a computerized physician order entry (CPOE) set on adherence to monitoring parameters, maximum and cumulative doses, and identification or mitigation of risk factors for QTc prolongation in patients prescribed intravenous haloperidol. Methods: A retrospective cohort study of medically ill hospitalized inpatients prescribed intravenous haloperidol was conducted. Data were collected for two distinct 1-year time periods: the pre-CPOE set period (30 June 2007 through 30 June 2008) and the post-CPOE set period (1 January 2009 through 1 January 2010). The CPOE set was implemented on 1 October 2008. Results: A total of 151 subjects were included; 84 subjects were in the pre-CPOE set group and 67 subjects were in the post-CPOE set group. Following CPOE set implementation, subjects in the post-CPOE group, compared with the pre-CPOE group, were more likely to receive a 24-hour cumulative dose of intravenous haloperidol <2mg (Fisher’s exact test; p< 0.048), have a baseline ECG (Fisher’s exact test; p = 0.045), have a follow-up ECG within 24 hours of intravenous haloperidol administration (Fisher’s exact test; p = 0.009) and have a magnesium value assessed at the time of intravenous haloperidol administration (Fisher’s exact test; p = 0.004). Conclusion: This study reports on the successful implementation of a CPOE set designed to improve the safety of intravenous haloperidol administration in medically ill patients.
    Article · Sep 2012 · Drug Safety
  • Andrew J Muzyk · Sarah K Rivelli · Wei Jiang · [...] · Jane P Gagliardi
    [Show abstract] [Hide abstract] ABSTRACT: Intravenous haloperidol can increase the risk for corrected QT (QTc) interval prolongation, torsades de pointes (TdP) and sudden death. The purpose of this study was to examine the effects of implementation of a computerized physician order entry (CPOE) set on adherence to monitoring parameters, maximum and cumulative doses, and identification or mitigation of risk factors for QTc prolongation in patients prescribed intravenous haloperidol. A retrospective cohort study of medically ill hospitalized inpatients prescribed intravenous haloperidol was conducted. Data were collected for two distinct 1-year time periods: the pre-CPOE set period (30 June 2007 through 30 June 2008) and the post-CPOE set period (1 January 2009 through 1 January 2010). The CPOE set was implemented on 1 October 2008. A total of 151 subjects were included; 84 subjects were in the pre-CPOE set group and 67 subjects were in the post-CPOE set group. Following CPOE set implementation, subjects in the post-CPOE group, compared with the pre-CPOE group, were more likely to receive a 24-hour cumulative dose of intravenous haloperidol <2 mg (Fisher's exact test; p < 0.048), have a baseline ECG (Fisher's exact test; p = 0.045), have a follow-up ECG within 24 hours of intravenous haloperidol administration (Fisher's exact test; p = 0.009) and have a magnesium value assessed at the time of intravenous haloperidol administration (Fisher's exact test; p = 0.004). This study reports on the successful implementation of a CPOE set designed to improve the safety of intravenous haloperidol administration in medically ill patients.
    Article · Sep 2012 · Drug Safety
  • Andrew J Muzyk · Ramonna G Cvelich · Sarah K Rivelli
    Article · Jun 2012 · The Journal of Neuropsychiatry and Clinical Neurosciences
  • Andrew J. Muzyk · Jane Y. Revollo · Sarah K. Rivelli
    Article · Jun 2012 · Journal of Neuropsychiatry
  • Andrew J Muzyk · Jane Y Revollo · Sarah K Rivelli
    Article · Jun 2012 · The Journal of Neuropsychiatry and Clinical Neurosciences
  • Source
    Benjamin J Flink · Sarah K Rivelli · Elizabeth A Cox · [...] · Madan M Kwatra
    [Show abstract] [Hide abstract] ABSTRACT: Postoperative delirium, a common complication in the elderly, can occur following any type of surgery and is associated with increased morbidity and mortality; it may also be associated with subsequent cognitive problems. Effective therapy for postoperative delirium remains elusive because the causative factors of delirium are likely multiple and varied. Patients 65 yr or older undergoing elective knee arthroplasty were prospectively evaluated for postoperative Diagnostic and Statistical Manual of Mental Disorders-IV delirium. Exclusion criteria included dementia, mini-mental state exam score less than 24, delirium, clinically significant central nervous system/neurologic disorder, current alcoholism, or any serious psychiatric disorder. Delirium was assessed on postoperative days 2 and 3 using standardized scales. Patients' preexisting medical conditions were obtained from medical charts. The occurrence of obstructive sleep apnea was confirmed by contacting patients to check their polysomnography records. Data were analyzed using Pearson chi-square or Wilcoxon rank sum tests and multiple logistic regressions adjusted for effects of covariates. Of 106 enrolled patients, 27 (25%) developed postoperative delirium. Of the 15 patients with obstructive sleep apnea, eight (53%) experienced postoperative delirium, compared with 19 (20%) of the patients without obstructive sleep apnea (P = 0.0123, odds ratio: 4.3). Obstructive sleep apnea was the only statistically significant predictor of postoperative delirium in multivariate analyses. This is the first prospective study employing validated measures of delirium to identify an association between preexisting obstructive sleep apnea and postoperative delirium.
    Full-text Article · Feb 2012 · Anesthesiology
  • Andrew J. Muzyk · Sarah K. Rivelli · Jane P. Gagliardi
    [Show abstract] [Hide abstract] ABSTRACT: The pharmacological properties of baclofen, a GABA(B) receptor agonist, have led to investigation of its use for the off-label treatment of alcohol dependence. Literature examining the role of baclofen in alcohol dependence suggests that it may be a useful medication in the treatment armamentarium with an additional benefit of promoting abstinence and reducing alcohol-associated cravings and anxiety. We conducted a systematic review of prospective, randomized controlled trials comparing baclofen with placebo for the treatment of alcohol dependence. Four randomized controlled trials were identified but only three met criteria for inclusion. The excluded trial was a post hoc analysis of data collected from an original trial whose primary outcome did not tit our inclusion criteria and was terminated prior to completion. Compared with placebo, subjects randomized to baclofen experienced higher rates of abstinence and lower anxiety scores; the effect of baclofen was statistically significant in two trials assessing patients with more severe alcohol dependence and non-significant in a trial of outpatients receiving concomitant manualized psychotherapy. Baclofen appeared to be safe, well tolerated and to have low addiction liability even in the setting of moderate-to-severe liver cirrhosis, a known complication of alcohol dependence. Though baclofen may hold promise, the different outcomes and sample populations of the three studies highlight the need for more research to better understand the appropriate target patient population to benefit from this medication. Questions still remain about optimal dosing and duration. There is not enough evidence to support the use of baclofen as a first-line treatment option, except for those alcohol-dependent patients with moderate-to-severe liver cirrhosis in whom other pharmacological treatments are not safe or practical.
    Article · Jan 2012 · CNS Drugs
  • Andrew J Muzyk · Sarah K Rivelli · Jane P Gagliardi
    [Show abstract] [Hide abstract] ABSTRACT: The pharmacological properties of baclofen, a GABA(B) receptor agonist, have led to investigation of its use for the off-label treatment of alcohol dependence. Literature examining the role of baclofen in alcohol dependence suggests that it may be a useful medication in the treatment armamentarium with an additional benefit of promoting abstinence and reducing alcohol-associated cravings and anxiety. We conducted a systematic review of prospective, randomized controlled trials comparing baclofen with placebo for the treatment of alcohol dependence. Four randomized controlled trials were identified but only three met criteria for inclusion. The excluded trial was a post hoc analysis of data collected from an original trial whose primary outcome did not fit our inclusion criteria and was terminated prior to completion. Compared with placebo, subjects randomized to baclofen experienced higher rates of abstinence and lower anxiety scores; the effect of baclofen was statistically significant in two trials assessing patients with more severe alcohol dependence and non-significant in a trial of outpatients receiving concomitant manualized psychotherapy. Baclofen appeared to be safe, well tolerated and to have low addiction liability even in the setting of moderate-to-severe liver cirrhosis, a known complication of alcohol dependence. Though baclofen may hold promise, the different outcomes and sample populations of the three studies highlight the need for more research to better understand the appropriate target patient population to benefit from this medication. Questions still remain about optimal dosing and duration. There is not enough evidence to support the use of baclofen as a first-line treatment option, except for those alcohol-dependent patients with moderate-to-severe liver cirrhosis in whom other pharmacological treatments are not safe or practical.
    Article · Dec 2011 · CNS Drugs
  • Andrew J Muzyk · Sarah K Rivelli · Jane P Gagliardi · [...] · Wei Jiang
    Article · Aug 2011 · Journal of clinical psychopharmacology
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    [Show abstract] [Hide abstract] ABSTRACT: The objective was to test the hypothesis that heart failure (HF) patients treated with sertraline will have lower depression scores and fewer cardiovascular events compared with placebo. Depression is common among HF patients. It is associated with increased hospitalization and mortality. The SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial was a randomized, double-blind, placebo-controlled trial of sertraline 50 to 200 mg/day versus matching placebo for 12 weeks. All participants also received nurse-facilitated support. Eligible patients were age 45 years or older with HF (left ventricular ejection fraction < or =45%, New York Heart Association functional class II to IV) and clinical depression (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for current major depressive disorder). Those with significant cognitive impairment, psychosis, recent alcohol or drug dependence, bipolar or severe personality disorder, active suicidal ideation, and current antipsychotic or antidepressant medications were excluded. Primary end points were change in depression severity (Hamilton Depression Rating Scale total score) and composite cardiovascular status at 12 weeks. A total of 469 patients were randomized (n = 234 sertraline, n = 235 placebo). The mean +/- SE change from baseline to 12 weeks in the Hamilton Depression Rating Scale total score was -7.1 +/- 0.5 (sertraline) and -6.8 +/- 0.5 (placebo) (p < 0.001 from baseline, p = 0.89 between groups, mean change between groups -0.4; 95% confidence interval: -1.7 to 0.92). The proportions whose composite cardiovascular score worsened, improved, or was unchanged were 29.9%, 40.6%, and 29.5%, respectively, in the sertraline group and 31.1%, 43.8%, and 25.1%, respectively, in the placebo group (p = 0.78). Sertraline was safe in patients with significant HF. However, treatment with sertraline compared with placebo did not provide greater reduction in depression or improved cardiovascular status among patients with HF and depression. (Antidepressant Medication Treatment for Depression in Individuals With Chronic Heart Failure [SADHART-CHF]; NCT00078286).
    Full-text Article · Aug 2010 · Journal of the American College of Cardiology