Emergency Medicine Commons^™

Adiponectin-Mediated Promotion Of Cd44 Suppresses Diabetic Vascular Inflammatory Effects, Yanru Duan, Shihan Zhang, Yuanyuan Xing, Ye Wu, Wen Zhao, Pinxue Xie, Huina Zhang, Xinxiao Gao, Yanwen Qin, Yajing Wang, Xin-Liang Ma, Yunhui Du, Huirong Liu

Department of Emergency Medicine Faculty Papers

While adiponectin (APN) was known to significantly abolish the diabetic endothelial inflammatory response, the specific mechanisms have yet to be elucidated. Aortic vascular tissues from mice fed normal and high-fat diets (HFD) were analyzed by transcriptome analysis. GO functional annotation showed that APN inhibited vascular endothelial inflammation in an APPL1-dependent manner. We confirmed that activation of the Wnt/β-catenin signaling plays a key role in APN-mediated anti-inflammation. Mechanistically, APN promoted APPL1/reptin complex formation and β-catenin nuclear translocation. Simultaneously, we identified APN promoted the expression of CD44 by activating TCF/LEF in an APPL1-mediated manner. Clinically, the serum levels of APN and CD44 …

Performance Of Six Clinical Physiological Scoring Systems In Predicting In-Hospital Mortality In Elderly And Very Elderly Patients With Acute Upper Gastrointestinal Bleeding In Emergency Department, Po-Han Wu, Shang-Kai Hung, Chien-An Ko, Chia-Peng Chang, Cheng-Ting Hsiao, Jui-Yuan Chung, Hao-Wei Kou, Wan-Hsuan Chen, Chiao-Hsuan Hsieh, Kai-Hsiang Ku, Kai-Hsiang Wu

Faculty, Staff and Student Publications

Background and Objectives: The aim of this study is to compare the performance of six clinical physiological-based scores, including the pre-endoscopy Rockall score, shock index (SI), age shock index (age SI), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS), in predicting in-hospital mortality in elderly and very elderly patients in the emergency department (ED) with acute upper gastrointestinal bleeding (AUGIB). Materials and Methods: Patients older than 65 years who visited the ED with a clinical diagnosis of AUGIB were enrolled prospectively from July 2016 to July 2021. The six scores were calculated …

Evaluating The Usability Of An Emergency Department After Visit Summary: Staged Heuristic Evaluation, Hanna J Barton, Megan E Salwei, Rachel A Rutkowski, Kathryn Wust, Sheryl Krause, Peter Lt Hoonakker, Paula Vw Dail, Denise M Buckley, Alexis Eastman, Brad Ehlenfeldt, Brian W Patterson, Manish N Shah, Barbara J King, Nicole E Werner, Pascale Carayon

Faculty, Staff and Student Publications

BACKGROUND: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients-with the potential to prevent adverse outcomes-is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how …

Variable Shift Lengths Negatively Affect Emergency Medicine Resident Wellness, Marcus Fazzari, Joseph Longobardi, Joseph Mccarthy, Matthew Hysell, Sidney Hann

Journal of Wellness

Introduction: Burnout is very common in emergency medicine and there has been extensive research evaluating factors that contribute to burnout. We sought to examine the contributions of post-graduate year (PGY), shifts worked per month, patients seen per shift, and length of shifts to emergency medicine resident burnout.

Methods: All emergency medicine residents were surveyed with regards to their PGY, shifts worked per month, patients seen per shift, and length of shifts. They were administered the Stanford Wellness Survey and asked to globally rate their degree of burnout. We then modeled whether consideration of the surveyed factors increased the …

Pilot Study Of The Association Between Microbiome And The Development Of Adverse Posttraumatic Neuropsychiatric Sequelae After Traumatic Stress Exposure, Abigail L. Zeamer, Marie-Claire Salive, Xinming An, Stacey L. House, Francesca L. Beaudoin, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Robert A. Swor

Articles

Background Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biologic mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition at the time of trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether baseline the gut microbiomes of trauma-exposed emergency department patients who later develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms.

Methods We performed metagenomic analysis on stool samples (n=51) from a subset of adults enrolled in the Advancing …

Indication Of Mobility Aids And Training Of Older Patients In A Geriatric Emergency Department: Abiding By International Guidelines, Mario C. De Andrade Junior, Christian V. Morinaga, Christina M M Brito, Igor G. Moraes, Wellington P. Yamaguti, Pedro K. Curiati

Journal of Geriatric Emergency Medicine

Falls are the main cause of injuries, hospitalization, and loss of functionality among adults over 65 years of age. Thus, proper indication of assistive gait devices should be part of multidimensional fall prevention. However, many patients receive little or no professional assistance when selecting a mobility aid, and inadequate selection and use can result in a poor gait pattern.

All patients admitted to our emergency department (ED) undergo a medical evaluation, in which, based on their clinical condition, the protocol for indication and training in the use of walking aids can be triggered. Patients need to be clinically stable and …

Patterns Of Care Partner Communication For Persons Living With Dementia In The Emergency Department, Adrian D. Haimovich, Aidan Gilson, Evangeline Gao, Ling Chi, Cameron J. Gettel, Mara Schonberg, Ula Hwang, Richard A. Taylor

Journal of Geriatric Emergency Medicine

Abstract

Background:

Nearly half of all persons living with dementia (PLwD) will visit the emergency department (ED) in any given year and ED visits by PLwD are associated with short-term adverse outcomes. Care partner engagement is critical in the care of PLwD, but little is known about their patterns of communication with ED clinicians.

Methods:

We performed a retrospective electronic health record (EHR) review of a random sampling of patients ≥ 65 years with a historical diagnosis code of dementia who visited an ED within a large

regional health network between 1/2014 and 1/2022. ED notes within the EHRs were …

Geriatric Emergency Departments As Laboratories For Innovation, Brian W. Patterson, Manish N. Shah

Journal of Geriatric Emergency Medicine

n/a for editorial

Association Of Symptoms And Mode Of Transportation To Emergency Department In Patients With Acute Coronary Syndrome, Leslie L. Davis, Thomas P. Mccoy, Barbara Riegel, Sharon Mckinley, Lynn V. Doering, Debra K. Moser

UK CARES Faculty Publications

Background: Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not.

Objective: To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay.

Methods: This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an …

Heterotopic Pregnancy: A Difficult And Rarely Considered Diagnosis., Joseph M Crum, Howard W Levitin

Women’s Health Articles

A 34-year-old pregnant female presented to the emergency department (ED) with complaints of abdominal pain and vaginal bleeding for two days. The day prior, she was evaluated by her obstetrician and gynecologist with a transvaginal ultrasound demonstrating an intrauterine pregnancy at approximately six weeks gestation. After treatment of symptoms and reassuring laboratory testing, she went home. However, she returned two days later with worsening complaints. It was discovered that the patient had a heterotopic pregnancy, or a concomitant intrauterine and extrauterine pregnancy, resulting from natural conception in the absence of identifiable risk factors. While exceedingly rare, this diagnosis is frequently …

An Artificial Neural Network For Nasogastric Tube Position Decision Support, Ignat Drozdov, Rachael Dixon, Benjamin Szubert, Jessica Dunn, Darren Green, Nicola Hall, Arman Shirandami, Sofia Rosas, Ryan Grech, Srikanth Puttagunta, Mark Hall, David J Lowe

Faculty, Staff and Student Publications

PURPOSE: To develop and validate a deep learning model for detection of nasogastric tube (NGT) malposition on chest radiographs and assess model impact as a clinical decision support tool for junior physicians to help determine whether feeding can be safely performed in patients (feed/do not feed).

MATERIALS AND METHODS: A neural network ensemble was pretrained on 1 132 142 retrospectively collected (June 2007-August 2019) frontal chest radiographs and further fine-tuned on 7081 chest radiographs labeled by three radiologists. Clinical relevance was assessed on an independent set of 335 images. Five junior emergency medicine physicians assessed chest radiographs and made feed/do …

Metallic Implant-Related Osteosarcoma, Frawa Mohsin, Mustafa Bin Ali Zubairi, Kulsoom Fatima, Muhammad Asad Diwan

Department of Radiology

Orthopedic metallic prostheses are commonly used in the current practice of orthopedic surgery. Although, biomaterials used in these implants are generally considered to be biologically inert, there have been consequences of foreign body reactions and potential carcinogenesis. Majority of implant-related malignancies are high grade, and develop in bone or soft tissue around the implant site. No clear association has been identified between the biomaterial implanted and the type of sarcoma. We report the case of a 36-year-old male who underwent intramedullary nailing of femur for mid-shaft fracture secondary to trauma and presented with osteogenic sarcoma of femur 14 months later.

A Case Of Malignant Atrophic Papulosis With Septic Complications, Mengjiao Tao, Kaiwen Zhuang, Yaowen Jiang, Wayne Bond Lau, Yarong He

Department of Emergency Medicine Faculty Papers

No abstract provided.

Emergency Department Throughput: The Impact Of Vertical Care, Marc Wirtz

Providence Nursing Research Conference 2023 – Present

References

Garrett JS, Berry C, Wong H, Qin H, Kline JA. The effect of vertical split-flow patient management on emergency department throughput and efficiency. Am J Emerg Med. 2018 Sep;36(9):1581-1584. doi: 10.1016/j.ajem.2018.01.035. Epub 2018 Jan 11. PMID: 29352674.

Hsieh A, Arena A, Oraha A, Cotarelo A, McLean M, Hsieh A, Hsieh A, Chen I, Mok N, Milizia R. Implementation of Vertical Split Flow Model for Patient Throughput at a Community Hospital Emergency Department. J Emerg Med. 2023 Jan 12:S0736-4679(22)00570-4. doi: 10.1016/j.jemermed.2022.10.007. Epub ahead of print. PMID: 36641257.

Rationale And Design Of The Restore Trial: A Multicenter, Randomized, Double-Blinded, Parallel-Group, Placebo-Controlled Trial To Evaluate The Effect Of Shenfu Injection On Myocardial Injury In Stemi Patients After Primary Pci, Xiao Wang, Ruifeng Guo, Yingying Guo, Qian Guo, Yan Yan, Wei Gong, Wen Zheng, Hui Wang, Lei Xu, Hui Ai, Bin Que, Xiaoyan Yan, Xin-Liang Ma, Shaoping Nie

Department of Emergency Medicine Faculty Papers

BACKGROUND: The mortality following ST-segment elevation myocardial infarction (STEMI) remains substantial in the reperfusion era. Shenfu injection, as a traditional Chinese herbal formula, can alleviate ischemia-reperfusion injury through multiple pharmacologic effects. However, no robust data are available regarding the role of Shenfu injection in reducing infarct size for patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).

METHODS/DESIGN: This RESTORE trial is a multicenter, randomized, double-blind, parallel-group, placebo-controlled trial (NCT04493840). A total of 326 eligible patients with first-time anterior STEMI undergoing PPCI within 12 h of symptom onset will be enrolled from 10 centers in mainland China. Patients are randomized …

Lipoprotein(A) In Atherosclerotic Cardiovascular Disease And Aortic Stenosis: A European Atherosclerosis Society Consensus Statement, Florian Kronenberg, Samia Mora, Erik S G Stroes, Brian Ference Ference Ference, Benoit J. Arsenault, Lars Berglund, Marc R. Dweck, Marlys Koschinsky, Gilles Lambert, Salim S. Virani

Office of the Provost

This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis, provides clinical guidance for testing and treating elevated Lp(a) levels, and considers its inclusion in global risk estimation. Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes in different ethnicities; elevated Lp(a) is a risk factor even at very low levels of low-density lipoprotein cholesterol. High Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. Current findings do …

Examination Of Geriatric Care Processes Implemented In Level 1 And Level 2 Geriatric Emergency Departments, Ilianna Santangelo, Surriya Ahmad, Shan Liu, Lauren Southerland, Christopher Carpenter, Ula Hwang, Adriane Lesser, Nicole Tidwell, Kevin Biese, Maura Kennedy

Journal of Geriatric Emergency Medicine

Background: Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes.

Objective: The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.

Methods: This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and …

Mortality And Major Adverse Cardiovascular Events In Hospitalized Patients With Atrial Fibrillation With Covid-19, Lucas Wang, Lawrence Hoang, Kristopher Aten, Mujahed Abualfoul, Victor Canela, Sri Prathivada, Michael Vu, Yi Zhao, Manavjot Sidhu

Faculty, Staff and Student Publications

COVID-19 results in increased incidence of cardiac arrhythmias, including atrial fibrillation (AF). However, little is known about the combined effect of AF and COVID-19 on patient outcomes. This study aimed to determine if AF, specifically new-onset AF (NOAF), is associated with increased risk of mortality and major adverse cardiovascular events (MACEs) in hospitalized patients with COVID-19. This multicenter retrospective analysis identified 2,732 patients with COVID-19 admitted between March and December 2020. Data points were manually reviewed in the patients' electronic health records. Multivariate logistic regression was used to assess if AF was associated with death or MACE. Patients with AF …

Adapting International Clinical Trials During Covid-19 And Beyond, Kamala Thriemer, Kamala Thriemer, Mohammad Shafiul Alam, Bipin Adhikari, Rupam Tripura, Mohammad Sharif Hossain, Michael Christian, Najia Bano Ghanchi, Hellen Mnjala, Muhammad Asim

Department of Pathology and Laboratory Medicine

Background: The COVID-19 pandemic and resulting restrictions, particularly travel restrictions, have had significant impact on the conduct of global clinical trials. Our clinical trials programme, which relied on in-person visits for training, monitoring and capacity building across nine low- and middle-income countries, had to adapt to those unprecedented operational challenges. We report the adaptation of our working model with a focus on the operational areas of training, monitoring and cross-site collaboration.
The new working model: Adaptations include changing training strategies from in-person site visits with three or four team members to a multi-pronged virtual approach, with generic online training for …

Risk Factors For Ebola Virus Persistence In Semen Of Survivors In Liberia, Jonathan Dyal, Aaron Kofman, Jomah Z Kollie, John Fankhauser, Romeo Orone, Moses J Soka, Uriah Glaybo, Armah Kiawu, Edna Freeman, Giovanni Giah, Henry D Tony, Mylene Faikai, Mary Jawara, Kuku Kamara, Samuel Kamara, Benjamin Flowers, Mohammed L Kromah, Rodel Desamu-Thorpe, James Graziano, Shelley Brown, Maria E Morales-Betoulle, Deborah L Cannon, Kaihong Su, Susanne L Linderman, Mateusz Plucinski, Eric Rogier, Richard S Bradbury, W Evan Secor, Katherine E Bowden, Christi Phillips, Mary N Carrington, Yeon-Hwa Park, Maureen P Martin, Maria Del Pilar Aguinaga, Robert Mushi, Dana L Haberling, Elizabeth D Ervin, John D Klena, Moses Massaquoi, Tolbert Nyenswah, Stuart T Nichol, David E Chiriboga, Desmond E Williams, Steven H Hinrichs, Rafi Ahmed, Benjamin T Vonhm, Pierre E Rollin, Lawrence J Purpura, Mary J Choi

Faculty, Staff and Student Publications

BACKGROUND: Long-term persistence of Ebola virus (EBOV) in immunologically privileged sites has been implicated in recent outbreaks of Ebola virus disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen.

METHODS: A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with 2 consecutive negative EBOV semen test results by real-time reverse-transcription polymerase chain reaction (rRT-PCR) ≥2 weeks apart within …