Medicine and Health Sciences Commons^™

Association Of Initial Sars-Cov-2 Test Positivity With Patient-Reported Well-Being 3 Months After A Symptomatic Illness., Lauren E Wisk, Michael A Gottlieb, Erica S Spatz, Huihui Yu, Ralph C Wang, B. H. Slovis, Sharon Saydah, Ian D Plumb, Kelli N O'Laughlin, Juan Carlos C Montoy, Samuel A Mcdonald, Zhenqiu Lin, Jin-Mann S Lin, Katherine Koo, Ahamed H Idris, Ryan M Huebinger, Mandy J Hill, Nicole L Gentile, Anna Marie Chang, Jill Anderson, Bala Hota, Arjun K Venkatesh, Robert A Weinstein, Joann G Elmore, Graham Nichol

Department of Emergency Medicine Faculty Papers

IMPORTANCE: Long-term sequelae after symptomatic SARS-CoV-2 infection may impact well-being, yet existing data primarily focus on discrete symptoms and/or health care use.

OBJECTIVE: To compare patient-reported outcomes of physical, mental, and social well-being among adults with symptomatic illness who received a positive vs negative test result for SARS-CoV-2 infection.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a planned interim analysis of an ongoing multicenter prospective longitudinal registry study (the Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]). Participants were enrolled from December 11, 2020, to September 10, 2021, and comprised adults (aged ≥18 years) with acute symptoms suggestive …

Covid-19 Vaccine Equity: Codesigning Public Health Interventions With Community Partners, Eva Varotsis, Lauren Schlegel, B. H. Slovis, Patricia C. Henwood, Sandra E Brooks, Robert S. Pugliese, Bon Ku, Morgan Hutchinson

Department of Emergency Medicine Faculty Papers

No abstract provided.

Emergency Medicine Clinician Experiences Addressing Uncertainty In First-Trimester Bleeding., Garrison Nord, Amanda Doty, Andrew J Monick, Danielle M Mccarthy, Robin J Casten, Amer Z Aldeen, Philip S Nawrocki, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

The purpose of this work is to understand Emergency Department (ED) clinicians' experiences in communicating uncertainty about first-trimester bleeding (FTB) and their need for training on this topic. This cross-sectional study surveyed a national sample of attending physicians and advanced practice providers (APPs). The survey included quantitative and qualitative questions about communicating with patients presenting with FTB. These questions assessed clinicians' frequency encountering challenges, comfort, training, prior experience, and interest in training on the topic. Of 402 respondents, 54% reported that they encountered challenges at least sometimes when discussing FTB with patients where the pregnancy outcome is uncertain. While the …

Using A Human-Centered, Mixed Methods Approach To Understand The Patient Waiting Experience And Its Impact On Medically Underserved Populations, Elizabeth N. Liao, Lara Z. Chehab, Kathryn Neville, Jennifer Liao, Devika Patel, Amanda Sammann

Department of Emergency Medicine Faculty Papers

Purpose: To use a mixed methods approach to investigate the patient waiting experience for a medically underserved population at an outpatient surgical clinic.

Methods: We used lean methodology to perform 96 time-tracked observations of the patient journey in clinic, documenting the duration of activities from arrival to departure. We also used human-centered design (HCD) to perform and analyze 43 semi-structured interviews to understand patients’ unmet needs.

Results: Patients spent an average of 68.5% of their total clinic visit waiting to be seen. While the average visit was 95.8minutes, over a quarter of visits (27%) were over 2hours. Patients waited an …

A Consensus List Of Ultrasound Competencies For Graduating Emergency Medicine Residents, David A Haidar, William J Peterson, Patrick G Minges, Jennifer Carnell, Jason T Nomura, John Bailitz, Jeremy S Boyd, Megan M Leo, E Liang Liu, Youyou Duanmu, Josie Acuña, Ross Kessler, Marco F Elegante, Mathew Nelson, Rachel B Liu, Resa E. Lewiss, Arun Nagdev, Rob D Huang

Department of Emergency Medicine Faculty Papers

Objectives: Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method.

Methods: We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional …

Serum Ctrp9 And High-Molecular Weight Adiponectin Are Associated With Ischemic Stroke., Yan-Qing Zhang, Yan-Wei Zhang, Jian-Li Dai, Chen Li, Wen-Qing Wang, Hai-Feng Zhang, Wayne Bond Lau, Xiao-Ming Wang, Xiao-Gang Liu, Rong Li

Department of Emergency Medicine Faculty Papers

BACKGROUND: C1q/TNF-related protein 9 (CTRP9) and adiponectin (APN) have beneficial metabolic regulatory and vasoprotective effects. This study explored alteration of CTRP9 and APN multimers during onset of ischemic stroke and development, to provide novel clinical and experimental basis for recognition and prevention of ischemic stroke.

METHODS: There were 269 patients with ischemic stroke and 182 control subjects included in this study. Serum levels of CTRP9 and APN multimers in different disease stages were measured.

RESULTS: Serum CTRP9, total APN (tAPN), and high-molecular weight (HMW) APN decreased gradually in stage I (acute stage, within 72 h of onset) of ischemic stroke …

Predicting At-Risk Opioid Use Three Months After Ed Visit For Trauma: Results From The Aurora Study, Brittany E. Punches, Uwe Stolz, Caroline E. Freiermuth, Rachel M. Ancona, Samuel A. Mclean, Stacey L. House, Francesca L. Beaudoin, Xinming An, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Tanja Jovanovic, Sarah D. Linnstaedt, Laura T. Germine, Kenneth A. Bollen, Scott L. Rauch, John P. Haran, Alan B. Storrow, Christopher Lewandowski, Paul I. Musey Jr., Phyllis L. Hendry, Sophia Sheikh, Christopher W. Jones, Michael C. Kurz, Nina T. Gentile, Meghan E. Mcgrath, Lauren A. Hudak, Jose L. Pascual, Mark J. Seamon, Erica Harris, Anna M. Chang, Claire Pearson, David A. Peak, Roland C. Merchant, Robert M. Domeier, Niels K. Rathlev, Brian J. O'Neil, Leon D. Sanchez, Steven E. Bruce, Robert H. Pietrzak, Jutta Joormann, Deanna M. Barch, Diego A. Pizzagalli, Jordan W. Smoller, Beatriz Luna, Steven E. Harte, James M. Elliott, Ronald C. Kessler, Kerry J. Ressler, Karestan C. Koenen, Michael S. Lyons

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.

METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed …

Advanced Triage Protocol: The Role Of An Automated Lactate Order In Expediting Rapid Identification Of Patients At Risk Of Sepsis In The Emergency Department, Andrew Baum, Brendan G Carr, Sarah M Perman, Jennifer Barger, Munish Goyal, David F. Gaieski

Department of Emergency Medicine Faculty Papers

We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.

Design: Prospective cohort study.

Setting: Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr.

Patients: Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED.

Interventions: A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate …

Standardizing Evaluation Of Patient-Specific 3d Printed Models In Surgical Planning: Development Of A Cross-Disciplinary Survey Tool For Physician And Trainee Feedback, Lauren Schlegel, Michelle Ho, M. Fields, Erik Backlund, Robert S. Pugliese, Kristy M. Shine

Department of Emergency Medicine Faculty Papers

Background: 3D printed models are becoming increasingly popular in healthcare as visual and tactile tools to enhance understanding of anatomy and pathology in medical trainee education, provide procedural simulation training, and guide surgical procedures. Patient-specific 3D models are currently being used preoperatively for trainee medical education in planning surgical approaches and intraoperatively to guide decision-making in several specialties. Our study group utilized a modified Delphi process to create a standardized assessment for trainees using patient-specific 3D models as a tool in medical education during pre-surgical planning.

Methods: A literature review was conducted to identify survey questions administered to clinicians in …

Informal And Incidental Learning In The Clinical Learning Environment: Learning Through Complexity And Uncertainty During Covid-19, Dimitrios Papanagnou, Karen E Watkins, Henriette Lundgren, Grace A Alcid, Deborah Ziring, Victoria J Marsick

Department of Emergency Medicine Faculty Papers

In the time of the COVID-19 pandemic, where clinical environments are plagued by both uncertainty and complexity, the importance of the informal and social aspects of learning among health care teams cannot be exaggerated. While there have been attempts to better understand the nuances of informal learning in the clinical environment through descriptions of the tacit or hidden curriculum, incidental learning in medical education has only been partially captured in the research. Understood through concepts borrowed from the Cynefin conceptual framework for sensemaking, the early stages of the pandemic immersed clinical teams in complex and chaotic situations where there was …

Emergency Department Communication In Persons Living With Dementia And Care Partners: A Scoping Review, Christopher R Carpenter, Jesseca Leggett, Fernanda Bellolio, Marian Betz, Ryan M Carnahan, David Carr, Michelle Doering, Jennie Chin Hansen, Eric D Isaacs, Deborah Jobe, Kathleen Kelly, Nancy Morrow-Howell, Beth Prusaczyk, Bob Savage, Joe Suyama, Allan S Vann, Kristin L Rising, Ula Hwang, Manish N Shah

Department of Emergency Medicine Faculty Papers

OBJECTIVES: To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research.

DESIGN: Systematic scoping review.

SETTINGS AND PARTICIPANTS: PLWD and their care partners in the ED setting.

METHODS: Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for …

Endothelial Autophagy In Coronary Microvascular Dysfunction And Cardiovascular Disease, Fujie Zhao, Ganesh Satyanarayana, Zheng Zhang, Jianli Zhao, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Coronary microvascular dysfunction (CMD) refers to a subset of structural and/or functional disorders of coronary microcirculation that lead to impaired coronary blood flow and eventually myocardial ischemia. Amid the growing knowledge of the pathophysiological mechanisms and the development of advanced tools for assessment, CMD has emerged as a prevalent cause of a broad spectrum of cardiovascular diseases (CVDs), including obstructive and nonobstructive coronary artery disease, diabetic cardiomyopathy, and heart failure with preserved ejection fraction. Of note, the endothelium exerts vital functions in regulating coronary microvascular and cardiac function. Importantly, insufficient or uncontrolled activation of endothelial autophagy facilitates the pathogenesis of …

Finding Acute Coronary Syndrome With Serial Troponin Testing For Rapid Assessment Of Cardiac Ischemic Symptoms (Fast-Trac): A Study Protocol, W Frank Peacock, Alan S Maisel, Christian Mueller, Stefan D Anker, Fred S Apple, Robert H Christenson, Paul Collinson, Lori B Daniels, Deborah B Diercks, Salvatore Di Somma, Gerasimos Filippatos, Gary Headden, Brian Hiestand, Judd Hollander, Juan C Kaski, Joshua M Kosowsky, John T Nagurney, Richard M Nowak, Donald Schreiber, Gary M Vilke, Marvin A Wayne, Martin Than

Department of Emergency Medicine Faculty Papers

Objective: To determine the utility of a highly sensitive troponin assay when utilized in the emergency department.

Methods: The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin. These include a very early presenting population in whom prospective data collection of risk score parameters and the physician's clinical impression of the probability of acute coronary syndrome before any troponin data were available. Furthermore, two gold standard diagnostic …

Extracellular Vesicle-Derived Mir-144 As A Novel Mechanism For Chronic Intermittent Hypoxia-Induced Endothelial Dysfunction, Huina Zhang, Lu Peng, Yifan Wang, Wen Zhao, Wayne Bond Lau, Yajing Wang, Yu Li, Yunhui Du, Linyi Li, Yu Huang, Shaoping Nie, Yanwen Qin, Xinliang Ma, Yongxiang Wei

Department of Emergency Medicine Faculty Papers

Rationale: Extracellular vesicles (EVs) play a significant role in cell-cell communication. However, whether and how extracellular vesicles are involved in chronic intermittent hypoxia-induced endothelial dysfunction is unknown. Methods: Comparative transcriptomics analysis and miRNA screening were used to identify the possible pathways or target molecules mediating chronic intermittent hypoxia-induced endothelial function. Serum- or erythrocyte-derived EVs were isolated through ultracentrifugation plus filtration. After in vitro or in vivo treatment with EVs, aortic rings were treated with dihydroethidium staining for superoxidative anion measurement or mounted with wire myography to measure isometric forces. Immunoblotting and qPCR were used for evaluating the molecular mechanism mediating …

Promotion Of Covid-19 Va(X)Ccination In The Emergency Department-Procovaxed: Study Protocol For A Cluster Randomized Controlled Trial., Robert M Rodriguez, Kelli O'Laughlin, Stephanie A Eucker, Anna Marie Chang, Kristin L. Rising, Graham Nichol, Alena Pauley, Hemal Kanzaria, Alexzandra Gentsch, Cindy Li, Herbie Duber, Jonathan Butler, Vidya Eswaran, Dave Glidden

Department of Emergency Medicine Faculty Papers

Background: We conducted in-depth interviews to characterize reasons for COVID-19 vaccine hesitancy in emergency department (ED) patients and developed messaging platforms that may address their concerns. In this trial, we seek to determine whether provision of these COVID-19 vaccine messaging platforms in EDs will be associated with greater COVID-19 vaccine acceptance and uptake in unvaccinated ED patients.

Methods: This is a cluster-randomized controlled trial (RCT) evaluating our COVID-19 vaccine messaging platforms in seven hospital EDs (mix of academic, community, and safety-net EDs) in four US cities. Within each study site, we randomized 30 1-week periods to the intervention and 30 …

A Just-In-Time Video Primer On Pneumothorax Pathophysiology And Early Management, Nicholas Macdonald, Jacob Garcia, Gregory C. Kane, Xiao Chi Zhang, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Audience: Emergency medicine residents (interns, junior residents), medical students, and mid-level providers (physician assistants, nurse practitioners).

Introduction: Pneumothorax refersto the presence of gas within the pleuralspace and is a relatively common clinical entity in the emergency department Traumatic pneumothorax results from blunt or penetrating trauma to the thorax. Iatrogenic pneumothorax is a risk inherent to a number of invasive procedures and represents a significant cause of preventable morbidity. Specifically, central venous catheterization (43.8%), thoracentesis (20.1%), and barotrauma due to mechanical ventilation (9.1%) are the most frequent causes. A feared complication of pneumothorax is the development of tension pneumothorax, which involves …

Troponin Is Unrelated To Outcomes In Heart Failure Patients Discharged From The Emergency Department, Gregory J Fermann, Jon W Schrock, Phillip D Levy, Peter Pang, Javed Butler, Anna Marie Chang, Douglas Char, Deborah Diercks, Jin H Han, Brian Hiestand, Chris Hogan, Cathy A Jenkins, Christy Kampe, Yosef Khan, Vijaya A Kumar, Sangil Lee, Joann Lindenfeld, Dandan Liu, Karen F Miller, W Frank Peacock, Carolyn M Reilly, Chad Robichaux, Russell L Rothman, Wesley H Self, Adam J Singer, Sarah A Sterling, Alan B Storrow, William B Stubblefield, Cheryl Walsh, John Wilburn, Sean P Collins

Department of Emergency Medicine Faculty Papers

Background: Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management.

Objective: Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED.

Methods: This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED-HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional …

"You Can't Go Wrong Being Safe": Motivations, Patterns, And Context Surrounding Use Of Fentanyl Test Strips For Heroin And Other Drugs., Megan K Reed, Amanda Guth, Venise J Salcedo, Jeffrey K Hom, Kristin L Rising

Department of Emergency Medicine Faculty Papers

BACKGROUND: Unintentional drug overdose fatalities due to fentanyl contamination continue to increase. Fentanyl test strip (FTS) use has emerged as a valuable harm reduction strategy to detect the presence of fentanyl in drugs. However, motivation for FTS uptake and context surrounding use have not been well characterized in the literature. This study aimed to capture people who use drugs' (PWUD) lived experiences to understand motivations underlying FTS uptake, ongoing use, and actions after testing.

METHODS: We conducted qualitative interviews with PWUD at a harm reduction organization in Philadelphia, PA. Interviews asked about experiences with using FTS. Interviews were audio-recorded, professionally …

Study Protocol For The Innovative Support For Patients With Sars-Cov-2 Infections Registry (Inspire): A Longitudinal Study Of The Medium And Long-Term Sequelae Of Sars-Cov-2 Infection, Kelli N O'Laughlin, Matthew Thompson, Bala Hota, Michael Gottlieb, Ian D Plumb, Anna Marie Chang, Lauren E Wisk, Aron J Hall, Ralph C Wang, Erica S Spatz, Kari A Stephens, Ryan M Huebinger, Samuel A Mcdonald, Arjun Venkatesh, Nikki Gentile, B. H. Slovis, Mandy Hill, Sharon Saydah, Ahamed H Idris, Robert Rodriguez, Harlan M Krumholz, Joann G Elmore, Robert A Weinstein, Graham Nichol

Department of Emergency Medicine Faculty Papers

Background: Reports on medium and long-term sequelae of SARS-CoV-2 infections largely lack quantification of incidence and relative risk. We describe the rationale and methods of the Innovative Support for Patients with SARS-CoV-2 Registry (INSPIRE) that combines patient-reported outcomes with data from digital health records to understand predictors and impacts of SARS-CoV-2 infection.

Methods: INSPIRE is a prospective, multicenter, longitudinal study of individuals with symptoms of SARS-CoV-2 infection in eight regions across the US. Adults are eligible for enrollment if they are fluent in English or Spanish, reported symptoms suggestive of acute SARS-CoV-2 infection, and if they are within 42 days …

Curriculum Development By Design Thinking: Analyzing A Program For Social Determinants Of Health Screening By Pre-Clerkship Medical Students., Ari M Fish, J Matthew Fields, Deborah Ziring, Gina Mccoy, Paula Ostroff, Geoffrey Hayden

Department of Emergency Medicine Faculty Papers

Problem: Health systems science (HSS) curricula in medical schools facilitate an understanding of social determinants of health (SDOH) and their impact on health outcomes. After implementation of an experiential, patient-centered program based around SDOH screening, however, our medical college noted poor student receptivity and engagement. In order to improve the program, we chose a design thinking approach based on the perceived value of actively engaging learners in the design of education. The role of design thinking in curricular quality improvement, however, remains unclear.

Intervention: We sought to determine if a current educational model for SDOH screening could be improved by …

I Don't Have A Diagnosis For You: Preparing Medical Students To Communicate Diagnostic Uncertainty In The Emergency Department, Maria Poluch, Jordan Feingold-Link, Nethra S. Ankam, Jared Kilpatrick, Kenzie Cameron, Shruti Chandra, Amanda Doty, Matthew Klein, Danielle Mccarthy, Kristin L. Rising, David Salzman, Deborah Ziring, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Introduction: Diagnostic uncertainty abounds in medicine, and communication of that uncertainty is critical to the delivery of high-quality patient care. While there has been training in communicating diagnostic uncertainty directed towards residents, a gap remains in preparing medical students to understand and communicate diagnostic uncertainty. We developed a session to introduce medical students to diagnostic uncertainty and to practice communicating uncertainty using a checklist during role-play patient conversations.

Methods: This virtual session was conducted for third-year medical students at the conclusion of their core clerkships. It consisted of prework, didactic lecture, peer role-play, and debriefing. The prework included reflection prompts …

Principles Of Hypotensive Shock: A Video Introduction To Pathophysiology And Treatment Strategies, Brittany Macdonald, Nicholas Macdonald, Jacob Garcia, Xiao Chi Zhang, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Audience: Emergency medicine interns, medical students, and mid-level providers (physician assistants, nurse practitioners).

Introduction: Shock is defined as a state of global tissue hypoxia and is typically the result of hypotension and circulatory system failure. A variety of disease states may ultimately culminate in hypotensive shock through one or more generally recognized mechanisms – hypovolemic, cardiogenic, obstructive, and/or distributive shock. These mechanisms differ significantly in terms of their pathophysiology and requisite treatment. While the effects of hypotensive shock are initially reversible, untreated hypotensive shock may rapidly progress to multiorgan failure and death. Hence, the ability to promptly recognize a state …

Analyzing The Effect Of Interview Time And Day On Emergency Medicine Residency Interview Scores, Alanna O’Connel, Sean Greco, Peter Tomaselli, Megan Stobart Gallagher, Robin Naples, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Learning Objectives: To analyze whether interview date or time has an effect on residency interview score for applicants to Emergency Medicine residency programs.

The Art Of Sim-Making: What To Learn From Film-Making, Fatimah Lateef, Brad Peckler, Eric Saindon, Shruti Chandra, Indrani Sardesai, Mohamed Alwi Abdul Rahman, S Vimal Krishnan, Afrah Abdul Wahid Ali, Rose V Goncalves, Sagar Galwankar

Department of Emergency Medicine Faculty Papers

The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, "Writing Powerful Narratives," depiction of emotional elements, specific industry-driven developments as well as the "cultural considerations" in both. For medical simulation and simulation-based education, the corresponding stages are as follows: DevelopmentPreproductionProductionPostproduction andDistribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt …