Emergency Medicine Commons^™

Danshen-Chuanxiong-Honghua Ameliorates Cerebral Impairment And Improves Spatial Cognitive Deficits After Transient Focal Ischemia And Identification Of Active Compounds., Xianhua Zhang, Wan Zheng, Tingrui Wang, Ping Ren, Fushun Wang, Xin-Liang Ma, Jian Wang, Xi Huang

Department of Emergency Medicine Faculty Papers

Previously, we only apply a traditional Chinese medicine (TCM) Danshen-Chuanxiong-Honghua (DCH) for cardioprotection via anti-inflammation in rats of acute myocardial infarction by occluding coronary artery. Presently, we select not only DCH but also its main absorbed compound ferulic acid (FA) for cerebra protection via similar action of mechanism above in animals of the transient middle cerebral artery occlusion (tMCAO). We investigated whether oral administration of DCH and FA could ameliorate MCAO-induced brain lesions in animals. By using liquid chromatography-tandem mass spectrometry (LC-MS/MS), we analyzed four compounds, including tanshinol, salvianolic acid B, hydroxysafflor yellow A and especially FA as the ...

Emergency Department Super-Utilizer Program Involvement: Pilot Data And Methods Challenges, Colette Houssan, Arlene S. Ash, Rachel Davis-Martin, Laurel Banach, Eric W. Dickson, Edwin D. Boudreaux

Edwin D. Boudreaux

Super-utilizers are patients who use extreme amounts of medical services, often due to comorbid medical, social, and mental health issues. The MyLink Evaluation Project (MEP) studies MyLink, a program that connects super-utilizers with community support workers (CSWs) to improve the patient experience and reduce costs. The MEP-eligible population is ≥18 years old with at least 5 Emergency Department (ED) visits within 12 months and no other exclusions (e.g., language barriers, living out-of-region). During MEP’s pilot, among 58 eligible patients, 28 consented to being referred to MyLink and followed up. Of these, 7 could not be located for follow-up ...

Emergency Department Super-Utilizer Program Involvement: Pilot Data And Methods Challenges, Colette Houssan, Arlene S. Ash, Rachel Davis-Martin, Laurel Banach, Eric W. Dickson, Edwin D. Boudreaux

Arlene S. Ash

Super-utilizers are patients who use extreme amounts of medical services, often due to comorbid medical, social, and mental health issues. The MyLink Evaluation Project (MEP) studies MyLink, a program that connects super-utilizers with community support workers (CSWs) to improve the patient experience and reduce costs. The MEP-eligible population is ≥18 years old with at least 5 Emergency Department (ED) visits within 12 months and no other exclusions (e.g., language barriers, living out-of-region). During MEP’s pilot, among 58 eligible patients, 28 consented to being referred to MyLink and followed up. Of these, 7 could not be located for follow-up ...

Implementing An Undergraduate, Team-Based, First Aid Education Course, Valerie O'Toole-Baker, Carol A. Amann, Stephanie N. Mcelhaney, Michael Mccarthy, Jestin N. Carlson

International Journal of First Aid Education

Abstract

First aid (FA) skills, including Cardiopulmonary Resuscitation (CPR) are the foundation of first responder care. Best practice guidelines to educate FA trainees are lacking. The current structure of FA training programs is based on pedagogy, derived indirectly from hospital-based and Emergency Medical Services training models. Most FA training programs focus on educating the participant to function as the sole provider of care; however there may be instances when individuals providing FA find themselves suddenly engaged as functioning members of teams caring for an individual in need. Findings indicate that patients are safer and receive higher quality care when providers ...

Predictors Of Hospitalization Among Newly Admitted Skilled Nursing Facility Residents: Rethinking The Role Of Functional Decline, Sun J. Kim, Joo H. Lee, Shunichi Nakagawa, Elizabeth Bukowy, Ankoor Biswas, Boram Han, Yeilim Cho, Hyun Phil Shin, Ji Won Yoo

Aurora Internal Medicine Residents

Purpose: Hospital transfer from a skilled nursing facility (SNF) is costly, and many are potentially preventable. This study examines: 1) whether functional decline is a predictor of hospital transfer, and 2) the magnitude of relationships between predictors (functional impairment and chronic medical illness) and hospital transfer from SNFs.

Methods: We used Minimum Data Set (MDS) Version 2.0 in the state of Michigan between 2007 and 2009. In total, 196,662 new SNF admissions were observed. Multilevel generalized estimating equations and regression models were performed for each functional and clinical domain while adjusting for demographic variables and change in activities ...

Computer Administered Safety Planning For Individuals At Risk For Suicide: Development And Usability Testing, Edwin D. Boudreaux, Gregory K. Brown, Barbara Stanley, Rajani S. Sadasivam, Carlos A. Camargo Jr, Ivan W. Miller

Rajani S. Sadasivam

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan.

OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application.

METHODS: We employed a user-centered software design strategy led by a ...

Computer Administered Safety Planning For Individuals At Risk For Suicide: Development And Usability Testing, Edwin D. Boudreaux, Gregory K. Brown, Barbara Stanley, Rajani S. Sadasivam, Carlos A. Camargo Jr, Ivan W. Miller

Edwin D. Boudreaux

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan.

OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application.

METHODS: We employed a user-centered software design strategy led by a ...

Heart Failure In Patients Presenting With Dyspnoea To The Emergency Department In The Asia Pacific Region: An Observational Study, Gerben Keijzers, Anne-Maree Kelly, Louise Cullen, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Anna Holdgate, Charles Lawoko, Said Laribi

Gerben Keijzers

OBJECTIVES: To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. DESIGN: Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). SETTING: 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. PARTICIPANTS: Patients with an ED diagnosis of heart failure. OUTCOME MEASURES: Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay ...

Heart Failure In Patients Presenting With Dyspnoea To The Emergency Department In The Asia Pacific Region: An Observational Study, Gerben Keijzers, Anne-Maree Kelly, Louise Cullen, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Anna Holdgate, Charles Lawoko, Said Laribi

Gerben Keijzers

OBJECTIVES: To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. DESIGN: Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). SETTING: 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. PARTICIPANTS: Patients with an ED diagnosis of heart failure. OUTCOME MEASURES: Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay ...

Ctrp3 Is A Novel Biomarker For Diabetic Retinopathy And Inhibits Hghl-Induced Vcam-1 Expression In An Ampk-Dependent Manner., Zheyi Yan, Jianli Zhao, Lu Gan, Yanqing Zhang, Rui Guo, Xiaoming Cao, Wayne Bond Lau, Xin Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

OBJECTIVES: Diabetic retinopathy (DR) is a severe complication of chronic diabetes. The C1q/TNF-related protein family (CTRPs) has been demonstrated to exert protective effects against obesity and atherosclerosis in animal studies. Heretofore, the association between circulating CTRPs and DR patients has been unexplored. In the current study, we attempt to define this association, as well as the effect of CTRPs upon DR pathophysiology.

DESIGN: The present investigation is a case control study that enrolled control subjects and type 2 diabetes mellitus (T2DM) patients diagnosed with DR. Serum CTRPs and sVACM-1 were determined by ELISA.

RESULTS: Serum CTRP3 and CTRP5 levels ...

The Role Of The Heart Score And Clinical Decision Units In Ed Patients With Chest Pain, Gregory Jasani, Jesse M. Pines, Caitlin Carter

Center for Health Care Quality

Every year, millions of patients present to Emergency Departments across the country complaining of chest pain. Even after traditional ED testing which includes electrocardiograms, laboratory testing, and chest radiography, chest pain patients still have a small but real risk of serious illness. The HEART score is a new tool that has been validated to help risk-stratify patients. Clinical Decision Units decrease cost and length of stay without compromising patient safety, allowing for complete evaluations of these patients.

Emergency Department Super-Utilizer Program Involvement: Pilot Data And Methods Challenges, Colette Houssan, Arlene S. Ash, Rachel Davis-Martin, Laurel Banach, Eric W. Dickson, Edwin D. Boudreaux

UMass Center for Clinical and Translational Science Research Retreat

Super-utilizers are patients who use extreme amounts of medical services, often due to comorbid medical, social, and mental health issues. The MyLink Evaluation Project (MEP) studies MyLink, a program that connects super-utilizers with community support workers (CSWs) to improve the patient experience and reduce costs. The MEP-eligible population is ≥18 years old with at least 5 Emergency Department (ED) visits within 12 months and no other exclusions (e.g., language barriers, living out-of-region). During MEP’s pilot, among 58 eligible patients, 28 consented to being referred to MyLink and followed up. Of these, 7 could not be located for follow-up ...

Teen Distracted Reality An Interactive Virtual Education (D.R.I.V.E.): Experience And Impact On Teenage Drivers, Jonathan Green, Gregory Keefe, Rachelle N. Damle, Pradeep P. Nazarey, Jeremy T. Aidlen, Mariann M. Manno, Michael P. Hirsh

UMass Center for Clinical and Translational Science Research Retreat

Introduction: In 2013, 2,163 teens in the United States ages 16–19 were killed and 243,243 were treated in emergency departments for injuries from motor vehicle crashes. distracted driving (i.e. texting, loud music, or phone conversations) and impaired driving (driving under the influence) play a role in these motor vehicle crashes. Prevention efforts aimed at high-risk teenager driving behavior may encourage safe driving habits.

Methods: The Teen D.R.I.V.E. program is a mobile driving simulator that provides teenagers with distracted and impaired driving scenarios. We administered anonymous surveys from April 2015-April 2016 to obtain ...

Oxycodone Ingestion Patterns In Acute Fracture Pain: A Pilot Study Using A Digital Pill, Brendan J. Innes, Peter R. Chai, Stephanie Carreiro, Brittany Chapman, Matthew Griswold, Edward W. Boyer

UMass Center for Clinical and Translational Science Research Retreat

Background: Opioids are prescribed for acute pain as needed, but no data exists on how patients take opioids after discharge from the ED. This places the onus of dosing on the patient and contributes to variable prescribing by ED physicians. ED opioid prescriptions serve as a source for unintentional exposure and contribute to the opioid epidemic. We deployed a digital pill to measure opioid ingestion patterns in individuals discharged after acute fractures.

Methods: This pilot study involved individuals without chronic opioid use (i.e. prescribed opioids > 1 week) who were discharged from the ED following acute fracture. Participants were trained ...

Analytical Testing For Marijuana, Kavita Babu

UMass Center for Clinical and Translational Science Research Retreat

As part of the mini-symposium entitled "The Problems with Marijuana and Driving: Medical, Legal, and Public Health Perspectives," Dr. Babu describes the state of the science on measurement of marijuana in the context of driving impairment.

Shared Decision-Making In The Emergency Department: Patient And Physician Perspectives, Elizabeth Schoenfeld

UMass Center for Clinical and Translational Science Research Retreat

This presentation will explore the perspectives of both ED physicians and ED patients regarding barriers to shared decision-making in the setting of emergency care. It will describe challenges, highlight modifiable barriers, and introduce ongoing research at UMMS Baystate. This presentation is part of the mini-symposium entitled "Building Bridges to "Cross the Quality Chasm": The Challenges of Engaging Clinicians in Patient-Centered Care."

Application Of D-Dimer To Aid In Diagnosis Of Acute Aortic Dissection, Hannah Scarboro, Julia Starkey

Physician Assistant Capstones

Introduction: Acute aortic dissection (AAD) is an emergent, relatively uncommon condition that typically presents with sudden onset severe chest or back pain.1 Advanced imaging, such as computerized tomography, is currently the gold standard to diagnose AAD; this can be expensive and unavailable at all health care centers. D-dimer is a blood test that has been shown in recent studies to be elevated in acute aortic dissection. This may be a more cost-effective way to help the clinician “rule-out” an acute aortic dissection.1

Objective: The purpose of this research was to determine if there is significant data regarding the ...

Diagnostic Effectiveness Of High-Sensitivity Troponins, Sean R. Bodin, Jacqueline Ramirez

Physician Assistant Capstones

Background: Acute myocardial infarctions (AMI) are a leading cause of death in the United States. The key to increasing survivability is early recognition to expedite the proper treatment modalities. In conjunction with the clinical presentation and electrocardiograms, the use of cardiac biomarkers is exponentially important in not only recognizing a cardiac event but also determining the extent of injury. Advancement in laboratory technology has led to the development of high-sensitive troponin (hs-troponin) assays which can detect smaller cardiac troponin serum levels compared to conventional troponin assays. This implies that the use of hs-troponin assays is more effective in the early ...

Computer Administered Safety Planning For Individuals At Risk For Suicide: Development And Usability Testing, Edwin D. Boudreaux, Gregory K. Brown, Barbara Stanley, Rajani S. Sadasivam, Carlos A. Camargo Jr, Ivan W. Miller

University of Massachusetts Medical School Faculty Publications

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan.

OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application.

METHODS: We employed a user-centered software design strategy led by a ...

Implementation Of A Standardized Handoff During Transition Of Care From The Emergency Department To The Intensive Care Unit, Melinda Abbring

Evidence-Based Practice Project Reports

Patient safety and nursing communication are crucial to the nursing handoff during transition of care from the emergency department (ED) to the intensive care unit (ICU). The Institute of Medicine published To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm (2001) highlighting ED handoffs as a safety measure. In 2006, the Joint Commission recognized handoffs with the National Patient Safety Goal 2E. The purpose of this evidence-based practice project was to determine if implementation of a standardized handoff would improve nursing communication and patient safety during transition of care from the ED to the ...