Emergency Medicine Commons^™

Phylogenetic Inference From Single-Cell Rna-Seq Data, Xuan Liu, Jason I Griffiths, Isaac Bishara, Jiayi Liu, Andrea H Bild, Jeffrey T Chang

Faculty, Staff and Student Publications

Tumors are comprised of subpopulations of cancer cells that harbor distinct genetic profiles and phenotypes that evolve over time and during treatment. By reconstructing the course of cancer evolution, we can understand the acquisition of the malignant properties that drive tumor progression. Unfortunately, recovering the evolutionary relationships of individual cancer cells linked to their phenotypes remains a difficult challenge. To address this need, we have developed PhylinSic, a method that reconstructs the phylogenetic relationships among cells linked to their gene expression profiles from single cell RNA-sequencing (scRNA-Seq) data. This method calls nucleotide bases using a probabilistic smoothing approach and then …

Pediatric Firearm Injury Epidemiology At A Level 1 Trauma Center From 2019 To 2021: Including Time Of The Covid-19 Pandemic, Cynthia Orantes, Hei Kit Chan, Daniel Walter, Summer Chavez, Irma T Ugalde

Faculty, Staff and Student Publications

BACKGROUND: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

RESULTS: The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years …

Effectiveness Of An Emergency Department-Based Machine Learning Clinical Decision Support Tool To Prevent Outpatient Falls Among Older Adults: Protocol For A Quasi-Experimental Study, Daniel J Hekman, Amy L Cochran, Apoorva P Maru, Hanna J Barton, Manish N Shah, Douglas Wiegmann, Maureen A Smith, Frank Liao, Brian W Patterson

Faculty, Staff and Student Publications

Background

Emergency department (ED) providers are important collaborators in preventing falls for older adults because they are often the first health care providers to see a patient after a fall and because at-home falls are often preceded by previous ED visits. Previous work has shown that ED referrals to falls interventions can reduce the risk of an at-home fall by 38%. Screening patients at risk for a fall can be time-consuming and difficult to implement in the ED setting. Machine learning (ML) and clinical decision support (CDS) offer the potential of automating the screening process. However, it remains unclear whether …

The Initial Psychometric Evaluation Of A New Emergency Department Patient-Reported Experience Measure (Ed Prem), Claudia Bull, Julia Crilly, Sharon Latimer, Emma Hall, Brigid M. Gillespie

Patient Experience Journal

Patient-reported experience measures (PREMs) are critical to evaluating the person-centeredness, safety, and quality of healthcare services internationally. The aim of this study was to describe the initial psychometric evaluation of a new Emergency Department (ED) PREM. Adult patients presenting to the ED of a tertiary hospital in southeast Queensland, Australia during January 2022 were recruited in-person. Participants selected their preferred ED PREM mode of administration from online, telephone, or postal, and had 14 days from recruitment to complete the survey. Item reduction, structural validity, discriminant validity, and internal consistency reliability were assessed. A sample of 349 (68.4%) was achieved. Item …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Effect Of Body Mass Index Percentile On Complicated Appendicitis, Postoperative Complications And Health Service Utilization Among Pediatric Patients In The United States, Nutan Hebballi

Dissertations and Theses (Open Access)

While overweight and obesity have been extensively studied for complicated appendicitis, postoperative complications, and health service utilization, the effects of being underweight are unknown. This dissertation assesses the associations between the body mass index (BMI) spectrum with complicated appendicitis, postoperative complications, and healthcare service utilization in pediatric patients.  A retrospective review of pediatric patients who underwent appendectomy surgery (01/01/2016-12/31/2020) was conducted using the National Surgical Quality Improvement Program database. Computed age and gender-specific BMI percentiles were categorized into underweight, normal weight, overweight and obese. The 30-day postoperative complications were grouped into minor, major, and any. Healthcare service utilizations were compared …

A Previously Healthy Infant With Lemierre Syndrome In The Emergency Department: Case Report, Adeola Adekunbi Kosoko, Omoyeni O Clement

Faculty, Staff and Student Publications

INTRODUCTION: Lemierre syndrome (LS) is a rare condition with a high mortality risk. It is well described in older children and young adults involving bacteremia, thrombophlebitis, and metastatic abscess commonly due to Fusobacterium infections. Young, pre-verbal children are also susceptible to LS; thus, careful attention must be given to their pattern of symptoms and history to identify this condition in the emergency department (ED).

CASE REPORT: A 12-month-old previously healthy boy with a recent diagnosis of acute otitis media and viral illness presented to the ED with a complaint of fever. Additional symptoms developed at the head and neck and …

The Hylefm Gene In Phylefm Of Enterococcus Faecium Is Not Required In Pathogenesis Of Murine Peritonitis, Victoria H Wu, Bryan S Yung, Farhoud Faraji, Robert Saddawi-Konefka, Zhiyong Wang, Alexander T Wenzel, Miranda J Song, Meghana S Pagadala, Lauren M Clubb, Joshua Chiou, Sanju Sinha, Marin Matic, Francesco Raimondi, Thomas S Hoang, Rebecca Berdeaux, Dario A A Vignali, Ramiro Iglesias-Bartolome, Hannah Carter, Eytan Ruppin, Jill P Mesirov, J Silvio Gutkind

Faculty, Staff and Student Publications

Immune checkpoint blockade (ICB) targeting PD-1 and CTLA-4 has revolutionized cancer treatment. However, many cancers do not respond to ICB, prompting the search for additional strategies to achieve durable responses. G-protein-coupled receptors (GPCRs) are the most intensively studied drug targets but are underexplored in immuno-oncology. Here, we cross-integrated large singe-cell RNA-sequencing datasets from CD8+ T cells covering 19 distinct cancer types and identified an enrichment of Gαs-coupled GPCRs on exhausted CD8+ T cells. These include EP2, EP4, A2AR, β1AR and β2AR, all of which promote T cell dysfunction. We also developed transgenic mice expressing a chemogenetic CD8-restricted Gαs–DREADD to activate …

A Chinese Scoring System For Predicting Successful Retrograde Collateral Traverse In Patients With Chronic Total Coronary Occlusion, Qiu Yu Li, Xiao Long Lin, Fan Qi Li, Zi Chao Cheng, Jia Yu Tian, Dong Hui Zhao, Wayne Bond Lau, Jing Hua Liu, Qian Fan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Retrograde approach technique has been challenging in percutaneous coronary interventional treatment of chronic total occlusion (CTO) coronary disease. The present study endeavors to determine a novel Chinese scoring system for predicting successful collateral channels traverse via retrograde approach.

METHODS: The demographic characteristics and angiographic characteristics of 309 CTO patient were analyzed by univariable and multivariable analysis for selecting potential predictors. And the nomogram was used to establish the scoring system. Then it was evaluated by the internal and external validation.

RESULTS: The predictors of Age, Connections between collateral channels and recipient vessels, and Channel Tortuosity (ACT) were identified with …

Sindrom Respons Inflamasi Sistemik, Yefta Moenadjat

Department of Surgery Teaching Materials and Monographs

Materi perkuliahan memuat uraian respons inflamasi pascatrauma yang berkembang menjadi sindrom respons inflamasi sistemik, berakhir dengan kegagalan organ multipel ditinjau dari aspek biomolekuler.

Buku ini merupakan bagian pertama dari seri inflamasi yang disusun dalam bentuk digital dan dipublikasi menurut konsep lisensi Commons Attribution-NonCommercial 4.0 International License untuk tujuan diseminasi.

Abatacept, Cenicriviroc, Or Infliximab For Treatment Of Adults Hospitalized With Covid-19 Pneumonia: A Randomized Clinical Trial, Jane A O'Halloran, Emily R Ko, Kevin J Anstrom, Eyal Kedar, Matthew W Mccarthy, Reynold A Panettieri, Martin Maillo, Patricia Segura Nunez, Anne M Lachiewicz, Cynthia Gonzalez, P Brian Smith, Sabina Mendivil-Tuchia De Tai, Akram Khan, Alfredo J Mena Lora, Matthias Salathe, Gerardo Capo, Daniel Rodríguez Gonzalez, Thomas F Patterson, Christopher Palma, Horacio Ariza, Maria Patelli Lima, John Blamoun, Esteban C Nannini, Eduardo Sprinz, Analia Mykietiuk, Radica Alicic, Adriana M Rauseo, Cameron R Wolfe, Britta Witting, Jennifer P Wang, Luis Parra-Rodriguez, Tatyana Der, Kate Willsey, Jun Wen, Adam Silverstein, Sean M O'Brien, Hussein R Al-Khalidi, Michael A Maldonado, Richard Melsheimer, William G Ferguson, Steven E Mcnulty, Pearl Zakroysky, Susan Halabi, Daniel K Benjamin, Sandra Butler, Jane C Atkinson, Stacey J Adam, Soju Chang, Lisa Lavange, Michael Proschan, Samuel A Bozzette, William G Powderly, Activ-1 Im Study Group Members

Faculty, Staff and Student Publications

IMPORTANCE: Immune dysregulation contributes to poorer outcomes in COVID-19.

OBJECTIVE: To investigate whether abatacept, cenicriviroc, or infliximab provides benefit when added to standard care for COVID-19 pneumonia.

DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-masked, placebo-controlled clinical trial using a master protocol to investigate immunomodulators added to standard care for treatment of participants hospitalized with COVID-19 pneumonia. The results of 3 substudies are reported from 95 hospitals at 85 clinical research sites in the US and Latin America. Hospitalized patients 18 years or older with confirmed SARS-CoV-2 infection within 14 days and evidence of pulmonary involvement underwent randomization between October 2020 and …

Previous Health Care Experiences’ Influence On Health Care Perceptions Among Residents In Six Homeless Shelters In Seattle, Washington, July–October 2021, Ashley A. Meehan, Sarah N. Cox, Nicholas B. Thuo, Julia H. Rogers, Amy C. Link, Miguel A. Martinez, Natalie K. Lo, Brian J. Manns, Melissa A. Rolfes, Eric J. Chow, Helen Y. Chu, Emily Mosites, Morhaf Al Achkar

Journal of Patient-Centered Research and Reviews

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care.

Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July–October 2021. All residents (age ≥ 18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose.

Results: Participants received health care …

Long Covid Clinical Phenotypes Up To 6 Months After Infection Identified By Latent Class Analysis Of Self-Reported Symptoms, Michael Gottlieb, Erica S. Spatz, Huihui Yu, Lauren E Wisk, Joann G. Elmore, Nicole L. Gentile, Mandy Hill, Ryan M. Huebinger, Ahamed H. Idris, Efrat M. Kean, Katherine Koo, Shu-Xia Li, Samuel Mcdonald, Juan Carlos C Montoy, Graham Nichol, Kelli N. O'Laughlin, Ian D. Plumb, Kristin L. Rising, Michelle Santangelo, Sharon Saydah, Ralph C. Wang, Arjun Venkatesh, Kari A. Stephens, Robert A. Weinstein

Department of Emergency Medicine Faculty Papers

BACKGROUND: The prevalence, incidence, and interrelationships of persistent symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vary. There are limited data on specific phenotypes of persistent symptoms. Using latent class analysis (LCA) modeling, we sought to identify whether specific phenotypes of COVID-19 were present 3 months and 6 months post-infection.

METHODS: This was a multicenter study of symptomatic adults tested for SARS-CoV-2 with prospectively collected data on general symptoms and fatigue-related symptoms up to 6 months postdiagnosis. Using LCA, we identified symptomatically homogenous groups among COVID-positive and COVID-negative participants at each time period for both general and fatigue-related …

A Clinical Review Of Antibiotic Therapy Versus Appendectomy For Treatment Of Acute Uncomplicated Appendicitis, Taylor Mcclard

SIU Journal of Medical Science Scholarly Works

Purpose: The purpose of this manuscript is to review the efficacy of antibiotic therapy in the treatment of acute uncomplicated appendicitis versus standard appendectomy.

Method: A PubMed literature search was conducted with keywords of acute appendicitis, antibiotics, and appendectomy. The publication date was limited to the last five years. Sample size less than 100 people, patient population less than five years of age, and articles examining only acute complicated appendicitis were excluded. Pertinent articles reviewing the efficacy of antibiotics compared to appendectomy serve as the basis for this clinical review.

Results: Antibiotic therapy alone could be a …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Achieving Equity In Emergency Medicine Quality Measures Requires A Sex And Gender Lens, Ynhi T Thomas, Angela F Jarman, Nina G Faynshtayn, Greg B Buehler, Sara Andrabi, Alyson J Mcgregor

Faculty, Staff and Students Publications

BACKGROUND: Quality measures within Emergency Medicine (EM) were developed to standardize and improve care. Their development has been limited by lack of consideration of sex- and gender-based differences. Research has suggested that sex and gender can impact clinical care and treatment. Inclusion of sex and gender differences is needed to create EM quality measures that are equitable to all.

OBJECTIVE: The aim of the review is to provide a brief history of EM quality measures and the value of considering sex- and gender-based evidence in their development to ensure equity, using acute myocardial infarction (AMI) as an example.

DISCUSSION: Current …

Satisfaction Of Older Patients With Emergency Department Care: Psychometric Properties And Construct Validity Of The Consumer Emergency Care Satisfaction Scale, Peter L T Hoonakker, Pascale Carayon, Roger L Brown, Rebecca Schwei, Rebecca K Green, Mackenzie Rabas, Ly Hoang, Kathryn L Wust, Rachel Rutkowski, Megan E Salwei, Hanna J Barton, Manish N Shah, Michael S Pulia, Brian W Patterson, Paula V W Dail, Sheryl Krause, Denise Buckley, Jennifer Hankwitz, Nicole E Werner

Faculty, Staff and Student Publications

BACKGROUND: Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved, including the definition, dimension, and scoring of scales.

PURPOSE: The purpose of this study was to examine the construct validity of the CECSS and make suggestions on how to improve the tool to measure overall satisfaction with ED care.

METHODS: We administered 2 surveys to older adults who presented …

Association Between Sars-Cov-2 Variants And Frequency Of Acute Symptoms: Analysis Of A Multi-Institutional Prospective Cohort Study-December 20, 2020-June 20, 2022., Ralph C, Wang, Michael Gottlieb, Juan Carlos C. Montoy, Robert M. Rodriguez, Huihui Yu, Erica S. Spatz, Christopher W. Chandler, Joann G. Elmore, Paavali A. Hannikainen, Anna Marie Chang, Mandy Hill, Ryan M. Huebinger, Ahamed H. Idris, Katherine Koo, Shu-Xia Li, Samuel Mcdonald, Graham Nichol, Kelli N. O'Laughlin, Ian D. Plumb, Michelle Santangelo, Sharon Saydah, Kari A. Stephens, Arjun K. Venkatesh, Robert A. Weinstein

Department of Emergency Medicine Faculty Papers

Background: While prior work examining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern focused on hospitalization and death, less is known about differences in clinical presentation. We compared the prevalence of acute symptoms across pre-Delta, Delta, and Omicron.

Methods: We conducted an analysis of the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a cohort study enrolling symptomatic SARS-CoV-2-positive participants. We determined the association between the pre-Delta, Delta, and Omicron time periods and the prevalence of 21 coronavirus disease 2019 (COVID-19) acute symptoms.

Results: We enrolled 4113 participants from December 2020 to June 2022. Pre-Delta vs Delta …

Rethinking Resilience Using The R-Factor: Neurobiological Mechanisms Of Static And Dynamic Components Of Resilience Following Trauma, Sanne Van Rooij, Justin Santos, Cecilia A. Hinojosa, Timothy Ely, Nathaniel Harnett, Vishnu P. Murty, Lauren Lebois, Tanja Jovanovic, Stacey House, Robert A. Swor

Articles

Resilience is a dynamic process of recovery after trauma, but in most studies it is conceptualized as the absence of specific psychopathology following trauma. Using the large emergency department AURORA study (n=1,865, 63% women), we took a longitudinal, dynamic and transdiagnostic approach to define a static resilience (r) factor, that could explain >50% of variance in mental wellbeing 6-months following trauma, and a dynamic r-factor, which represented recovery from initial symptoms. We assessed its neurobiological profile across threat, inhibition, and reward processes using fMRI collected 2-weeks post-trauma. Our neuroimaging results suggest that resilience is promoted by activation of higher-level cognitive …