M. Alexander Otto

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

PORTLAND, ORE. – In a randomized trial, attachment-based family therapy helped depressed, suicidal adolescents more than other approaches even if they had been sexually abused, a factor associated with worse outcomes with other therapies.

The goal of attachment-based family therapy (ABFT) is to strengthen family cohesion as a buffer against adolescent suicidal thinking, depression, and risk behaviors. Parents and teenagers work individually with therapists on communication, trust, self-esteem, and other issues, and then work on them together in family sessions.

The process "puts the burden of change on all the family members," not just the adolescent, said Matthew B. Wintersteen, director of research in the division of child and adolescent psychiatry at Thomas Jefferson University, Philadelphia.

In the trial, 35 adolescents aged 12-17 were randomized to 12 weeks of ABFT; 31 others were referred to 12 weeks of family or individual therapy from community providers and stayed in weekly phone contact with the researchers.

All of the adolescents were depressed and had severe, persistent suicidal ideation; 80% (53) were female and three-quarters were African American. Thirty reported histories of sexual abuse and were more likely to have attempted suicide in the past.

The ABFT group averaged about nine sessions over a period of 12 weeks, while the community care group averaged about three. Subjects’ progress was assessed by interviews and psychological scoring before, during, and after treatment.

In the end, "everybody got significantly better; [the] ABFT [group] just did better," Dr. Wintersteen said at the annual conference of the American Association of Suicidology.

For example, 87% (30) in the ABFT group met criteria for clinical recovery from suicidal ideation, while only 52% (16) met those criteria in the community care group. Twelve weeks after the end of treatment, 70% (25) in the ABFT group had maintained the benefits; just 35% (11) in the community care group had done the same. The results were statistically significant.

Depression remission rates also were significantly better in the ABFT group (J. Am. Acad. Child Adolesc. Psychiatry 2010;49:122-31).

Outcomes were similar among those who had been sexually abused. "Adolescents responded better to ABFT than community care, regardless of" an abuse history, Dr. Wintersteen and his colleagues concluded.

The finding is significant because "recent studies suggest that cognitive-behavioral therapy [CBT]," a common approach for depressed adolescents, "is less effective for adolescents with [sexual] trauma histories," they wrote in their abstract.

CBT, a more structured, problem-solving approach, seeks to identify and change inaccurate beliefs. If families are involved, it’s usually so parents can help young people with CBT skills at home, not to work on family dynamics, Dr. Wintersteen explained.

That, however, is the point of ABFT. A child might be quizzed about why he doesn’t turn to his parents when he is depressed. A parent might be asked, "When your daughter becomes suicidal, why doesn’t she come to you for help?" Answers help identify problems.

Even a parent’s own upbringing might be explored to identify issues that diminish his or her ability to parent.

"We work with parents about how to listen to their kids, and acknowledge and validate their feelings, as opposed to trying to solve their problems all of the time. Parents become a secure base so kids have a sense of support," Dr. Wintersteen said.

The study was funded by the Centers for Disease Control and Prevention. Dr. Wintersteen said he had no relevant financial disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for reactions, according to Dr. Hugh A. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur's Adacel) that were given between September 2007 and March 2010.

"We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn't anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine," Dr. Sampson said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The five boys and two girls (median age, 11 years; range, 5-17 years) had prior allergic reactions to cow's milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition-ELISA. One vial "clearly had milk protein in it" (30 ng/mL). "The other did not," he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As "with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions," Dr. Sampson said.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, "we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots" that could potentially – if given to a person who is highly milk allergic – cause a reaction, he said.

The problem must be "uncommon or it would have shown up before," and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two.

Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein.

"There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that's why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot," he said.

"I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein," he said.

Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood said he had no relevant financial disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for reactions, according to Dr. Hugh A. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur's Adacel) that were given between September 2007 and March 2010.

"We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn't anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine," Dr. Sampson said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The five boys and two girls (median age, 11 years; range, 5-17 years) had prior allergic reactions to cow's milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition-ELISA. One vial "clearly had milk protein in it" (30 ng/mL). "The other did not," he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As "with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions," Dr. Sampson said.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, "we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots" that could potentially – if given to a person who is highly milk allergic – cause a reaction, he said.

The problem must be "uncommon or it would have shown up before," and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two.

Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein.

"There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that's why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot," he said.

"I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein," he said.

Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood said he had no relevant financial disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for reactions, according to Dr. Hugh A. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur's Adacel) that were given between September 2007 and March 2010.

"We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn't anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine," Dr. Sampson said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The five boys and two girls (median age, 11 years; range, 5-17 years) had prior allergic reactions to cow's milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition-ELISA. One vial "clearly had milk protein in it" (30 ng/mL). "The other did not," he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As "with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions," Dr. Sampson said.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, "we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots" that could potentially – if given to a person who is highly milk allergic – cause a reaction, he said.

The problem must be "uncommon or it would have shown up before," and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two.

Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein.

"There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that's why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot," he said.

"I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein," he said.

Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood said he had no relevant financial disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for allergic reactions, according to Dr. Hugh A. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur’s Adacel) that were given between September 2007 and March 2010.

"We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn’t anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine," Dr. Sampson said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The five boys and two girls (median age, 11 years; range, 5-17 years) had prior allergic reactions to cow’s milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition-ELISA. One vial "clearly had milk protein in it" (30 ng/mL). "The other did not," he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As "with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions," Dr. Sampson said.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, "we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots" that could potentially – if given to a person who is highly milk allergic – cause a reaction, he said.

The problem must be "uncommon or it would have shown up before," and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two.

Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein.

"There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that’s why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot," he said.

"I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein," he said.

Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood said he had no relevant financial disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for allergic reactions, according to Dr. Hugh A. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur’s Adacel) that were given between September 2007 and March 2010.

"We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn’t anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine," Dr. Sampson said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The five boys and two girls (median age, 11 years; range, 5-17 years) had prior allergic reactions to cow’s milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition-ELISA. One vial "clearly had milk protein in it" (30 ng/mL). "The other did not," he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As "with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions," Dr. Sampson said.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, "we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots" that could potentially – if given to a person who is highly milk allergic – cause a reaction, he said.

The problem must be "uncommon or it would have shown up before," and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two.

Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein.

"There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that’s why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot," he said.

"I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein," he said.

Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood said he had no relevant financial disclosures.

SAN FRANCISCO – Some lots of tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine may contain milk protein, which puts milk-allergic children at risk for allergic reactions, according to Dr. Hugh A. Sampson, professor of pediatrics, allergy and immunology and dean for translational biomedical sciences at the Mount Sinai School of Medicine, New York.

Seven milk-allergic children in his practice had severe anaphylactic reactions to either primary or booster shots of the Tdap vaccine (Sanofi Pasteur’s Adacel) that were given between September 2007 and March 2010.

"We were struck by the fact that just in our practice we had seven patients with milk allergy who reacted. You wouldn’t anticipate that kind of number from one single practice. We believe it is due to contamination of milk protein in this vaccine," Dr. Sampson said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The five boys and two girls (median age, 11 years; range, 5-17 years) had prior allergic reactions to cow’s milk, including five severe reactions and four reactions to trace exposures. One was diagnosed with milk allergy based on serologic testing.

Dr. Sampson and his colleagues suspect it was milk protein in the vaccine after testing two vials from two lots by inhibition-ELISA. One vial "clearly had milk protein in it" (30 ng/mL). "The other did not," he said.

Bacterial growth media that are used to produce the vaccine contain casamino acids, according to Adacel labeling. These are derived from the milk protein casein.

As "with any process, there can be some variation, lots that for some reason seem to be higher in milk protein. Apparently, there were enough lots that we had seven children end up with anaphylactic reactions," Dr. Sampson said.

He and his colleagues confirmed that two patients received shots from the same vaccine lot, but the vials used on the children were not available for testing.

Even so, "we certainly have circumstantial evidence that there is the possibility of sufficient milk protein in certain lots" that could potentially – if given to a person who is highly milk allergic – cause a reaction, he said.

The problem must be "uncommon or it would have shown up before," and there are no reports yet in the literature, said Dr. Robert A. Wood, a professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center in Baltimore.

The children all had elevated, milk-specific IgE levels (most over 100 kUA/L) within 2 years of their reactions.

Each had symptoms consistent with anaphylaxis promptly after getting the shot, including wheezing and urticaria in five; sneezing, nasal congestion, and angioedema in three; and repetitive cough in two.

Five were treated with antihistamines, three with epinephrine, three with inhaled beta-agonists, and two with corticosteroids.

Dr. Sampson and his colleagues are continuing to test additional vaccine lots for milk protein.

"There used to be a tremendous variation in the amount of egg protein in flu vaccine, and I think that’s why, in egg-allergic children receiving flu shots, some of them had bad reactions [and] some of them did not. It just depended on the content of the egg protein in the lot," he said.

"I think, with the Tdap vaccine, we are seeing basically the same thing. There are lots that for some reason seem to be higher in milk protein," he said.

Dr. Sampson is a consultant for Genentech and holds shares in Herbal Springs LLC. Dr. Wood said he had no relevant financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – A poster about suicide prevention that hung in four emergency departments in New York State – plus a two-page guide to reinforce its message – increased clinicians’ recognition and engagement of suicidal patients, according to Dr. Glenn W. Currier.

Surveyed after the poster hung for a month, clinicians in the four EDs were more likely than those in a fifth ED that did not get the poster and guide to ask patients they were worried about whether they were suicidal, and to ask them about risk factors. Providers who worked in the area of the poster also were more confident about detecting concealed ideation and managing suicidal patients.

"It did better than I would have expected in a thousand years for a brief intervention. It’s a project that has some practical value," said Dr. Currier, a psychiatrist at the University of Rochester (N.Y.) Medical Center.

The benefit seemed "to span across all types of providers – physicians, residents, midlevels, and nurses – and it was essentially a free thing to do. We don’t think there’s any downside to [doing] this at your local site," he said at the annual conference of the American Association of Suicidology .

The American Association for Emergency Psychiatry, American Association of Suicidology, Emergency Nurses Association, and other groups cooperated in developing the 11- by 17-inch poster and the guide, both of which were tested among various clinicians for utility. "It was a fairly rigorous formative evaluation process," said Dr. David A. Litts, director of science and policy at the Suicide Prevention Resource Center (SPRC), which funded the project.

Signs of acute risk listed on the poster, which is titled "Is Your Patient Suicidal?" include purposelessness, anxiety or agitation, substance abuse, and mood changes.

The poster then lists questions to ask when such problems are noted, including "Have you ever thought about death or dying?" and "Have you ever attempted suicide?"

If patients say they have never thought about dying, chances are, they are not being truthful, because death is a universal human concern, Dr. Litts said.

The poster includes the National Suicide Prevention Lifeline phone number (800-273-TALK [8255]) and concludes by noting that "10% of all ED patients are thinking of suicide, but most don’t tell you. Ask questions – save a life."

The accompanying guide, titled "Suicide Risk: A Guide for ED Evaluation and Triage," includes the poster information as well as advice on evaluation, triage, interventions, ED elopement, and discharge planning.

Posters were hung in the break rooms, chart rooms, or bathrooms of the four EDs, which spanned the spectrum from rural to academic departments. All of the EDs seemed to benefit. Guides were either handed out at staff meetings or placed in clinicians’ mailboxes. There was no additional training on suicide prevention.

Clinicians were surveyed before the posters and guides were distributed, then a month later. Their answers were compared with those from clinicians in the fifth, control ED. In all, 362 clinicians completed the initial survey, and 250 completed the follow-up survey.

In EDs that got the poster and guide, 73% of clinicians in the follow-up survey said they always ask patients they are concerned about whether they are suicidal; 59% in the control ED did likewise.

Similarly, 58% of clinicians in the poster-and-guide EDs said that when they are worried about a patient, they always ask about suicide risk factors; 41% in the control ED said they did the same.

Also, 52% of clinicians in the poster-and-guide EDs said they had suspected concealed suicidal ideation in a patient who presented in the past month without a mental health chief complaint, compared with 18% in the control ED.

In the poster-and-guide EDs, 74% of clinicians thought their department had good protocols for managing suicidal patients; 53% of clinicians in the control ED felt the same.

Clinicians in the poster-and-guide EDs also were more likely to ask family and friends for more information when they suspected that patients were suicidal; more likely to ask patients whether they were suicidal; and more comfortable talking to patients about suicide, among other findings, all of which were statistically significant.

About half of clinicians thought that the poster and guide "increased or improved knowledge and skills regarding identification and treatment of suicidality."

Dr. Currier and Dr. Litts concluded in their abstract that "significant improvements in self-reported practice patterns can be achieved through the simple intervention of hanging a wall poster and distributing a [two-] page clinical guide to ED clinicians."

The next step is "to get this into a pocket guide," Dr. Litts said.

Both the poster and guide are on the SPRC Web site, and can be found by searching on their titles.

Dr. Litts and Dr. Currier reported no financial disclosures.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

PORTLAND, ORE. – Daily, electronic questionnaires about self-harm thoughts and responses reminding adolescents to use coping skills that they learned while hospitalized for suicidal behavior appeared beneficial, a study has shown.

Eighty-four adolescents aged 13-17, most of whom were white and female, were given Palm PDAs (personal digital assistants) at discharge. The adolescents were asked to fill out a questionnaire on the device each day.

It asked whether they had thoughts about harming themselves that day, what coping strategies they used if so, and how much these strategies helped. The questions took less than 5 minutes to answer, and the answers were stored in the devices. The data were collected at 6 weeks when the subjects returned for a debriefing on their experiences.

The original goals of the project were to see whether the Palms collected useful data, and to see whether adolescents used their coping strategies, said Nicole Klaus, Ph.D., a clinical psychologist at the University of Kansas, Wichita. The answer to both of those questions turned out to be yes, plus 26 of the 43 kids (60%) who completed the project said filling out the questionnaires reminded them to use the strategies.

And they are using a lot of strategies, Dr. Klaus said, according to data captured on the Palms.

Most often, the adolescents deflected harmful thoughts with pleasant activities; after that came reflecting on reasons to live, relaxation techniques, talking with family members, and counting blessings. Engaging in pleasant activities also was rated the most useful strategy, followed by reflecting on reasons to live; talking with a doctor, therapist, or family member; and physical activity.

Photo credit: © kertlis/istockphoto.com.

The Palms handed out to the adolescents were older, refurbished models worth about $30. They could do only one thing – record the answers to the questionnaire.

Still, "teenagers loved the idea of getting [them]," Dr. Klaus said; 95% of those asked agreed to participate in the project.

"I think this has implications for intervention development. If there is some technological way to prompt teenagers to use their coping skills, I think they will be excited about it," she said at the annual conference of the American Association of Suicidology.

On average, adolescents completed about 66% of the daily questionnaires. Some filled them out almost every day; others barely touched their Palm after getting home from the hospital. Part of that might have had to do with problems with the devices. Some crashed and had to be reset; others had battery issues. Better technology might result in higher completion rates, Dr. Klaus said.

Among the 43 kids whose data has been analyzed, 14 (33%) had at some point admitted to their Palm that they had thought about hurting themselves, but they did not admit that to interviewers at the 6-week debriefing.

That suggests that information captured by the Palms might be more reliable than that culled from interviews. During their debriefings, teens were "either holding back or had simply forgotten what happened a month ago," Dr. Klaus said.

Adolescents said next time they would prefer having a questionnaire texted to their cell phones, with better graphics, and someone on the other end to give advice when necessary. A reward for sticking to the game plan would be nice, too, they said.

Dr. Klaus said she had no relevant financial disclosures. The project was funded by the Kansas Bioscience Authority.

SAN FRANCISCO – Oral immunotherapy bested sublingual immunotherapy for pediatric milk allergies in the first head-to-head comparison of the two desensitization techniques.

"The results are quite striking in that we found that both groups had significant increases in the amount of milk they could tolerate, but the oral immunotherapy group had a far greater increase," said senior investigator Dr. Robert A. Wood, professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center, Baltimore, Md.

However, oral therapy – in which powdered milk extract is put in food and taken as a daily treatment – had more frequent adverse events.

Twelve girls and eighteen boys aged 6-17 years participated in the trial. At baseline, they reacted to less than half a teaspoon of milk and had a median baseline milk-IgE of 37.8 kUa/L, with a range 1.1-572 kUa/L.

Ten randomized to sublingual therapy were gradually escalated to maintenance doses of 7 mg of milk extract per day placed under their tongues, held for a few minutes, then swallowed.

Ten children in the oral group were gradually escalated to daily maintenance doses of 1,000 mg, ten others to 2,000 mg.

One girl dropped out because she had a severe eczema flair, but the others reached the maintenance dose and completed milk challenges.

After 3 months of maintenance, children in the sublingual group tolerated a median of 940 mg of milk – a little less than an ounce – with a range of 40-8,140 mg.

Children in the 1,000 mg oral group tolerated a median of 6,140 mg with a range of 2,540-8,140 mg. Those in the 2,000 mg group tolerated 8,140 mg of milk with a range of 4,140-8,140 mg. The findings were statistically significant.

Six children in the sublingual group repeated the challenge at 14 months; one tolerated 8,000 mg, but the rest tolerated less than 1,000 mg and were switched to oral therapy, Dr. Wood said.

Skin prick tests decreased and milk-IgG4 increased in all the groups. Milk-IgE decreased only after oral immunotherapy. Milk-IgE or milk-IgG4 did not predict food challenge outcomes.

Side effects were similar between the sublingual and oral groups, but more severe in the oral groups. Antihistamines were needed with only about 1% of the sublingual doses, but with 18% of the oral doses. Epinephrine was used twice during sublingual therapy but four times during oral therapy.

Oral therapy’s greater side effects didn’t surprise coinvestigator Dr. Wesley Burks, chief of the division of pediatric allergy and immunology at Duke University Medical Center, Durham, N.C.

"In general, oral has more side effects." In immunotherapy trials, "about 15% of children cannot tolerate the procedure at all. They have too many [gastrointestinal] symptoms," he said.

Although promising, Dr. Wood noted the results are preliminary.

His study, as well as immunotherapy trials for peanuts and other allergens, have "very small numbers where we are trying to figure out the right doses and right way to do it. We are hopeful in the next few years we will be comfortable enough with the approach to be able to do some larger studies," he said.

Dr. Wood said he had no relevant financial disclosures. Dr. Burks disclosed that he is a consultant for Actogenix, Dannon, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough (now part of Merck), and Nutricia. He is a minority stockholder in Allertein Therapeutics and Mast Cell Pharmaceuticals Inc. 

SAN FRANCISCO – Oral immunotherapy bested sublingual immunotherapy for pediatric milk allergies in the first head-to-head comparison of the two desensitization techniques.

"The results are quite striking in that we found that both groups had significant increases in the amount of milk they could tolerate, but the oral immunotherapy group had a far greater increase," said senior investigator Dr. Robert A. Wood, professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center, Baltimore, Md.

However, oral therapy – in which powdered milk extract is put in food and taken as a daily treatment – had more frequent adverse events.

Twelve girls and eighteen boys aged 6-17 years participated in the trial. At baseline, they reacted to less than half a teaspoon of milk and had a median baseline milk-IgE of 37.8 kUa/L, with a range 1.1-572 kUa/L.

Ten randomized to sublingual therapy were gradually escalated to maintenance doses of 7 mg of milk extract per day placed under their tongues, held for a few minutes, then swallowed.

Ten children in the oral group were gradually escalated to daily maintenance doses of 1,000 mg, ten others to 2,000 mg.

One girl dropped out because she had a severe eczema flair, but the others reached the maintenance dose and completed milk challenges.

After 3 months of maintenance, children in the sublingual group tolerated a median of 940 mg of milk – a little less than an ounce – with a range of 40-8,140 mg.

Children in the 1,000 mg oral group tolerated a median of 6,140 mg with a range of 2,540-8,140 mg. Those in the 2,000 mg group tolerated 8,140 mg of milk with a range of 4,140-8,140 mg. The findings were statistically significant.

Six children in the sublingual group repeated the challenge at 14 months; one tolerated 8,000 mg, but the rest tolerated less than 1,000 mg and were switched to oral therapy, Dr. Wood said.

Skin prick tests decreased and milk-IgG4 increased in all the groups. Milk-IgE decreased only after oral immunotherapy. Milk-IgE or milk-IgG4 did not predict food challenge outcomes.

Side effects were similar between the sublingual and oral groups, but more severe in the oral groups. Antihistamines were needed with only about 1% of the sublingual doses, but with 18% of the oral doses. Epinephrine was used twice during sublingual therapy but four times during oral therapy.

Oral therapy’s greater side effects didn’t surprise coinvestigator Dr. Wesley Burks, chief of the division of pediatric allergy and immunology at Duke University Medical Center, Durham, N.C.

"In general, oral has more side effects." In immunotherapy trials, "about 15% of children cannot tolerate the procedure at all. They have too many [gastrointestinal] symptoms," he said.

Although promising, Dr. Wood noted the results are preliminary.

His study, as well as immunotherapy trials for peanuts and other allergens, have "very small numbers where we are trying to figure out the right doses and right way to do it. We are hopeful in the next few years we will be comfortable enough with the approach to be able to do some larger studies," he said.

Dr. Wood said he had no relevant financial disclosures. Dr. Burks disclosed that he is a consultant for Actogenix, Dannon, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough (now part of Merck), and Nutricia. He is a minority stockholder in Allertein Therapeutics and Mast Cell Pharmaceuticals Inc. 

SAN FRANCISCO – Oral immunotherapy bested sublingual immunotherapy for pediatric milk allergies in the first head-to-head comparison of the two desensitization techniques.

"The results are quite striking in that we found that both groups had significant increases in the amount of milk they could tolerate, but the oral immunotherapy group had a far greater increase," said senior investigator Dr. Robert A. Wood, professor of pediatrics and chief of the division of allergy and immunology at Johns Hopkins Children’s Center, Baltimore, Md.

However, oral therapy – in which powdered milk extract is put in food and taken as a daily treatment – had more frequent adverse events.

Twelve girls and eighteen boys aged 6-17 years participated in the trial. At baseline, they reacted to less than half a teaspoon of milk and had a median baseline milk-IgE of 37.8 kUa/L, with a range 1.1-572 kUa/L.

Ten randomized to sublingual therapy were gradually escalated to maintenance doses of 7 mg of milk extract per day placed under their tongues, held for a few minutes, then swallowed.

Ten children in the oral group were gradually escalated to daily maintenance doses of 1,000 mg, ten others to 2,000 mg.

One girl dropped out because she had a severe eczema flair, but the others reached the maintenance dose and completed milk challenges.

After 3 months of maintenance, children in the sublingual group tolerated a median of 940 mg of milk – a little less than an ounce – with a range of 40-8,140 mg.

Children in the 1,000 mg oral group tolerated a median of 6,140 mg with a range of 2,540-8,140 mg. Those in the 2,000 mg group tolerated 8,140 mg of milk with a range of 4,140-8,140 mg. The findings were statistically significant.

Six children in the sublingual group repeated the challenge at 14 months; one tolerated 8,000 mg, but the rest tolerated less than 1,000 mg and were switched to oral therapy, Dr. Wood said.

Skin prick tests decreased and milk-IgG4 increased in all the groups. Milk-IgE decreased only after oral immunotherapy. Milk-IgE or milk-IgG4 did not predict food challenge outcomes.

Side effects were similar between the sublingual and oral groups, but more severe in the oral groups. Antihistamines were needed with only about 1% of the sublingual doses, but with 18% of the oral doses. Epinephrine was used twice during sublingual therapy but four times during oral therapy.

Oral therapy’s greater side effects didn’t surprise coinvestigator Dr. Wesley Burks, chief of the division of pediatric allergy and immunology at Duke University Medical Center, Durham, N.C.

"In general, oral has more side effects." In immunotherapy trials, "about 15% of children cannot tolerate the procedure at all. They have too many [gastrointestinal] symptoms," he said.

Although promising, Dr. Wood noted the results are preliminary.

His study, as well as immunotherapy trials for peanuts and other allergens, have "very small numbers where we are trying to figure out the right doses and right way to do it. We are hopeful in the next few years we will be comfortable enough with the approach to be able to do some larger studies," he said.

Dr. Wood said he had no relevant financial disclosures. Dr. Burks disclosed that he is a consultant for Actogenix, Dannon, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough (now part of Merck), and Nutricia. He is a minority stockholder in Allertein Therapeutics and Mast Cell Pharmaceuticals Inc. 

SAN FRANCISCO – Sublingual immunotherapy desensitized 11 children to peanut allergies in a double-blind, placebo-controlled trial.

When challenged with peanut after a year of treatment, they tolerated a median of 1,710 mg (about seven peanuts), while 7 children in the placebo arm tolerated a median of 85 mg (about one-fifth of a peanut), a 20-fold difference (P = .011).

Photo credit: © mates/Fotolia.com

The results were so impressive that the interim analysis was cut short to switch placebo children to active therapy, said senior investigator Dr. Wesley Burks, professor of pediatrics and chief of the division of pediatric allergy and immunology at Duke University Medical Center, Durham, N.C.

But however promising these results, and those of other immunotherapy trials, Dr. Burks cautioned that additional efficacy and safety verification are needed.

In some immunotherapy trials, children who seemed to tolerate gradual exposure and desensitization to their particular allergens had unexpected anaphylactic reactions, especially if they came down with a viral illness. A significant proportion of children also can't tolerate oral immunotherapy, he said.

Those points are often missed in news reports that suggest immunotherapy cures food allergies. Until more is known, immunotherapy "is not the right thing to do right now. We don’t put people on immunotherapy unless it’s in a study," he said.

Children in the trial were aged 1- to 11-years-old and had histories of peanut reactions plus elevated peanut IgE levels.

Treated children were dose escalated over a period of 6 months to a total of 2,000 mcg of peanut protein daily, then maintenance dosed for the next 6 months. The peanut extract was placed under their tongues, held for a couple minutes, then swallowed; 2,500-mg peanut challenges came at the 1-year mark.

Although the median was 1,710 mg, "there was a pretty wide range in how much [treated children] tolerated," Dr. Burks said, with some able to handle the entire 2,500 mg, others only 200 mg.

Peanut-specific IgE increased over the first 4 months of treatment (P = .002), then steadily decreased over the remaining 8 months (P = .003). Peanut-specific IgG4 increased over the entire year of therapy (P = .014).

"Their skin-prick tests [also] went down in the first 6 months [of treatment] and stayed down" versus placebo, Dr. Burks said. Treated children had wheal sizes significantly smaller than children in the placebo group (P = .020).

The findings "suggest a significant change in the allergic response," Dr. Burks concluded.

Dosing side effects were mostly oropharyngeal and seldom required treatment.

Children in the placebo group were switched to sublingual therapy following the peanut challenges. After a year of treatment, five of the seven now tolerate 2,500 mg of peanut, with the other two tolerating between 1,500 and 2,000 mg, Dr. Burks said.

Dr. Burks disclosed that he is a consultant for Actogenix, Dannon, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough (now a part of Merck), and Nutricia. He is a minority stockholder in Allertein Therapeutics and Mast Cell Pharmaceuticals.

SAN FRANCISCO – Sublingual immunotherapy desensitized 11 children to peanut allergies in a double-blind, placebo-controlled trial.

When challenged with peanut after a year of treatment, they tolerated a median of 1,710 mg (about seven peanuts), while 7 children in the placebo arm tolerated a median of 85 mg (about one-fifth of a peanut), a 20-fold difference (P = .011).

Photo credit: © mates/Fotolia.com

The results were so impressive that the interim analysis was cut short to switch placebo children to active therapy, said senior investigator Dr. Wesley Burks, professor of pediatrics and chief of the division of pediatric allergy and immunology at Duke University Medical Center, Durham, N.C.

But however promising these results, and those of other immunotherapy trials, Dr. Burks cautioned that additional efficacy and safety verification are needed.

In some immunotherapy trials, children who seemed to tolerate gradual exposure and desensitization to their particular allergens had unexpected anaphylactic reactions, especially if they came down with a viral illness. A significant proportion of children also can't tolerate oral immunotherapy, he said.

Those points are often missed in news reports that suggest immunotherapy cures food allergies. Until more is known, immunotherapy "is not the right thing to do right now. We don’t put people on immunotherapy unless it’s in a study," he said.

Children in the trial were aged 1- to 11-years-old and had histories of peanut reactions plus elevated peanut IgE levels.

Treated children were dose escalated over a period of 6 months to a total of 2,000 mcg of peanut protein daily, then maintenance dosed for the next 6 months. The peanut extract was placed under their tongues, held for a couple minutes, then swallowed; 2,500-mg peanut challenges came at the 1-year mark.

Although the median was 1,710 mg, "there was a pretty wide range in how much [treated children] tolerated," Dr. Burks said, with some able to handle the entire 2,500 mg, others only 200 mg.

Peanut-specific IgE increased over the first 4 months of treatment (P = .002), then steadily decreased over the remaining 8 months (P = .003). Peanut-specific IgG4 increased over the entire year of therapy (P = .014).

"Their skin-prick tests [also] went down in the first 6 months [of treatment] and stayed down" versus placebo, Dr. Burks said. Treated children had wheal sizes significantly smaller than children in the placebo group (P = .020).

The findings "suggest a significant change in the allergic response," Dr. Burks concluded.

Dosing side effects were mostly oropharyngeal and seldom required treatment.

Children in the placebo group were switched to sublingual therapy following the peanut challenges. After a year of treatment, five of the seven now tolerate 2,500 mg of peanut, with the other two tolerating between 1,500 and 2,000 mg, Dr. Burks said.

Dr. Burks disclosed that he is a consultant for Actogenix, Dannon, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough (now a part of Merck), and Nutricia. He is a minority stockholder in Allertein Therapeutics and Mast Cell Pharmaceuticals.

SAN FRANCISCO – Sublingual immunotherapy desensitized 11 children to peanut allergies in a double-blind, placebo-controlled trial.

When challenged with peanut after a year of treatment, they tolerated a median of 1,710 mg (about seven peanuts), while 7 children in the placebo arm tolerated a median of 85 mg (about one-fifth of a peanut), a 20-fold difference (P = .011).

Photo credit: © mates/Fotolia.com

The results were so impressive that the interim analysis was cut short to switch placebo children to active therapy, said senior investigator Dr. Wesley Burks, professor of pediatrics and chief of the division of pediatric allergy and immunology at Duke University Medical Center, Durham, N.C.

But however promising these results, and those of other immunotherapy trials, Dr. Burks cautioned that additional efficacy and safety verification are needed.

In some immunotherapy trials, children who seemed to tolerate gradual exposure and desensitization to their particular allergens had unexpected anaphylactic reactions, especially if they came down with a viral illness. A significant proportion of children also can't tolerate oral immunotherapy, he said.

Those points are often missed in news reports that suggest immunotherapy cures food allergies. Until more is known, immunotherapy "is not the right thing to do right now. We don’t put people on immunotherapy unless it’s in a study," he said.

Children in the trial were aged 1- to 11-years-old and had histories of peanut reactions plus elevated peanut IgE levels.

Treated children were dose escalated over a period of 6 months to a total of 2,000 mcg of peanut protein daily, then maintenance dosed for the next 6 months. The peanut extract was placed under their tongues, held for a couple minutes, then swallowed; 2,500-mg peanut challenges came at the 1-year mark.

Although the median was 1,710 mg, "there was a pretty wide range in how much [treated children] tolerated," Dr. Burks said, with some able to handle the entire 2,500 mg, others only 200 mg.

Peanut-specific IgE increased over the first 4 months of treatment (P = .002), then steadily decreased over the remaining 8 months (P = .003). Peanut-specific IgG4 increased over the entire year of therapy (P = .014).

"Their skin-prick tests [also] went down in the first 6 months [of treatment] and stayed down" versus placebo, Dr. Burks said. Treated children had wheal sizes significantly smaller than children in the placebo group (P = .020).

The findings "suggest a significant change in the allergic response," Dr. Burks concluded.

Dosing side effects were mostly oropharyngeal and seldom required treatment.

Children in the placebo group were switched to sublingual therapy following the peanut challenges. After a year of treatment, five of the seven now tolerate 2,500 mg of peanut, with the other two tolerating between 1,500 and 2,000 mg, Dr. Burks said.

Dr. Burks disclosed that he is a consultant for Actogenix, Dannon, Intelliject, McNeil Nutritionals, Novartis, Schering-Plough (now a part of Merck), and Nutricia. He is a minority stockholder in Allertein Therapeutics and Mast Cell Pharmaceuticals.