Journal ArticleJournal of the American College of Cardiology · November 2024
Randomized clinical trials are the gold standard for establishing the efficacy and safety of cardiovascular therapies. However, current pivotal trials are expensive, lengthy, and insufficiently diverse. Emerging artificial intelligence (AI) technologies ca ...
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Journal ArticleEur Respir J · October 10, 2024
RATIONALE: Ansa cervicalis stimulation (ACS) of the infrahyoid muscles has been proposed as a neurostimulation therapy for obstructive sleep apnea (OSA). ACS stabilizes the pharynx by pulling it caudally, but its specific effects on flow limitation caused ...
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Journal ArticleAnn Emerg Med · October 2024
STUDY OBJECTIVE: To evaluate if out-of-hospital administration of fentanyl and intranasal ketamine, compared to fentanyl alone, improves early pain control after injury. METHODS: We conducted an out-of-hospital randomized, placebo-controlled, blinded, para ...
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Journal ArticlePediatr Emerg Care · October 1, 2024
OBJECTIVES: The aim of this study was to compare the guardian-perceived 3-month cosmetic outcome for pediatric lacerations repaired with absorbable sutures, Dermabond, or Steri-Strips. Secondarily, pain and satisfaction with the procedure from both guardia ...
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Journal ArticleJAMA Netw Open · October 1, 2024
IMPORTANCE: The effect of montelukast in reducing symptom duration among outpatients with mild to moderate COVID-19 is uncertain. OBJECTIVE: To assess the effectiveness of montelukast compared with placebo in treating outpatients with mild to moderate COVI ...
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Journal ArticleAnn Emerg Med · September 2024
STUDY OBJECTIVE: Identification of HIV remains a critical health priority for which emergency departments (EDs) are a central focus. The comparative cost-effectiveness of various HIV screening strategies in EDs remains largely unknown. The goal of this stu ...
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Journal ArticleEar Nose Throat J · September 1, 2024
Objectives: Surgical outcomes determine national ranking, reputation, and funding, and are often assessed with objective surgical risk calculators (SRCs). Surgeons' assessments are not considered. This study aims to determine if surgeons or SRCs are more a ...
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Journal ArticleTrials · May 9, 2024
BACKGROUND: Clinical trials often involve some form of interim monitoring to determine futility before planned trial completion. While many options for interim monitoring exist (e.g., alpha-spending, conditional power), nonparametric based interim monitori ...
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Journal ArticleJPEN J Parenter Enteral Nutr · May 2024
BACKGROUND: Poor weight gain has been identified as an independent risk factor for increased surgical morbidity and mortality for patients with single-ventricle physiology undergoing staged surgical palliation. Conversely, excessive weight gain has also em ...
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Journal ArticleJ Am Coll Cardiol · April 9, 2024
BACKGROUND: The primary goals during acute heart failure (AHF) hospitalization are decongestion and guideline-directed medical therapy (GDMT) optimization. Unlike diuretics or other GDMT, early dapagliflozin initiation could achieve both AHF goals. OBJECTI ...
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Journal ArticleJAMA Netw Open · April 1, 2024
IMPORTANCE: The pharmacokinetics of abatacept and the association between abatacept exposure and outcomes in patients with severe COVID-19 are unknown. OBJECTIVE: To characterize abatacept pharmacokinetics, relate drug exposure with clinical outcomes, and ...
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Journal ArticleJAMA Netw Open · February 5, 2024
IMPORTANCE: Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. OBJECTIVE: To e ...
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Journal ArticleTrials · January 19, 2024
BACKGROUND: Robotic-assisted bronchoscopy has recently emerged as an alternative to electromagnetic navigational bronchoscopy for the evaluation of peripheral pulmonary lesions. While robotic-assisted bronchoscopy is proposed to have several advantages, su ...
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Journal ArticleJ Surg Educ · January 2024
OBJECTIVE: Identify what topics are of most interest to patients regarding surgical residents. DESIGN: Survey of general public describing a hypothetical surgery and then assessing comfort level with resident involvement in surgery, reactions to disclosure ...
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Journal ArticleEBioMedicine · January 2024
BACKGROUND: Multiple organ dysfunction syndrome (MODS) disproportionately drives morbidity and mortality among critically ill patients. However, we lack a comprehensive understanding of its pathobiology. Identification of genes associated with a persistent ...
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Journal ArticleJ Clin Transl Sci · 2024
Research articles in the clinical and translational science literature commonly use quantitative data to inform evaluation of interventions, learn about the etiology of disease, or develop methods for diagnostic testing or risk prediction of future events. ...
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Journal ArticleJ Clin Transl Sci · 2024
Composite endpoints can encode multiple pieces of information and are increasingly adopted in clinical trials. Advocacy for using composite endpoints began decades ago in cardiovascular trials, leading to incorporation of patient-oriented outcomes and cons ...
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Journal ArticleJournal of Clinical and Translational Science · 2024
AbstractThe Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Cross-Trial Statistics Group gathered lessons learned from statisticians responsible for the design and analysis of the 11 ACTIV therapeut ...
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Journal ArticleJ Clin Transl Sci · 2024
Accelerating COVID-19 Treatment Interventions and Vaccines (ACTIV) was initiated by the US government to rapidly develop and test vaccines and therapeutics against COVID-19 in 2020. The ACTIV Therapeutics-Clinical Working Group selected ACTIV trial teams a ...
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Journal ArticleJournal of Clinical and Translational Science · 2024
AbstractThis manuscript addresses a critical topic: navigating complexities of conducting clinical trials during a pandemic. Central to this discussion is engaging communities to ensure diverse participation. The manusc ...
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Journal ArticleJAMA · December 26, 2023
IMPORTANCE: The effect of higher-dose fluvoxamine in reducing symptom duration among outpatients with mild to moderate COVID-19 remains uncertain. OBJECTIVE: To assess the effectiveness of fluvoxamine, 100 mg twice daily, compared with placebo, for treatin ...
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Journal ArticleJ Am Coll Clin Pharm · December 2023
INTRODUCTION: Patients with asthma and chronic obstructive pulmonary disease rely on inhaler therapy to reduce disease progression and exacerbation risk. Patients admitted to the hospital are at an increased risk for exacerbations and readmission if their ...
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Journal ArticleChest · November 2023
BackgroundDelayed mortality in sepsis often is linked to a lack of resolution in the inflammatory cascade termed persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Limited research exists on PICS in pediatric patients with ...
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Journal ArticleAm J Prev Med · November 2023
INTRODUCTION: Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association ...
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Journal ArticleN Engl J Med · September 21, 2023
BACKGROUND: The effectiveness of inhaled glucocorticoids in shortening the time to symptom resolution or preventing hospitalization or death among outpatients with mild-to-moderate coronavirus disease 2019 (Covid-19) is unclear. METHODS: We conducted a dec ...
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Journal ArticleJAMA · September 5, 2023
IMPORTANCE: The effects of moderate systolic blood pressure (SBP) lowering after successful recanalization with endovascular therapy for acute ischemic stroke are uncertain. OBJECTIVE: To determine the futility of lower SBP targets after endovascular thera ...
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Journal ArticleInfluenza Other Respir Viruses · September 2023
BACKGROUND: We sought to identify potentially modifiable in-hospital factors associated with global cognition, post-traumatic stress disorder (PTSD) symptoms, and depression symptoms at 12 months. METHODS: This was a multi-center prospective cohort study i ...
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Journal ArticleBiol Psychiatry Glob Open Sci · July 2023
BACKGROUND: Traumatic brain injury (TBI) can alter brain structure and lead to onset of persistent neuropsychological symptoms. This study investigates the relationship between brain injury and psychological distress after mild TBI using multimodal magneti ...
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Journal ArticleBMC Anesthesiol · June 30, 2023
BACKGROUND: Multimodal analgesic strategies that reduce perioperative opioid consumption are well-supported in Enhanced Recovery After Surgery (ERAS) literature. However, the optimal analgesic regimen has not been established, as the contributions of each ...
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Journal ArticleCHEST Crit Care · June 2023
BACKGROUND: Cardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment. ...
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Journal ArticleCommun Med (Lond) · April 17, 2023
Clinical trial endpoints must be carefully and intentionally selected so that the results of the trial can be used to inform policy- and decision-making. The relative importance of potential endpoints often depends on the stakeholder, with patients having ...
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Journal ArticleAnaerobe · April 2023
We analyzed our challenging experience with a randomized controlled trial of misoprostol for prevention of recurrent C. difficile. Despite careful prescreening and thoughtful protocol modifications to facilitate enrollment, we closed the study early after ...
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Journal ArticleJAMA · March 21, 2023
IMPORTANCE: It is unknown whether ivermectin, with a maximum targeted dose of 600 μg/kg, shortens symptom duration or prevents hospitalization among outpatients with mild to moderate COVID-19. OBJECTIVE: To evaluate the effectiveness of ivermectin at a max ...
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Journal ArticleClin Infect Dis · March 21, 2023
BACKGROUND: The COVID-19 pandemic was associated with historically low influenza circulation during the 2020-2021 season, followed by an increase in influenza circulation during the 2021-2022 US season. The 2a.2 subgroup of the influenza A(H3N2) 3C.2a1b su ...
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Journal ArticleInt J Infect Dis · March 2023
OBJECTIVES: Effective and widely available therapies are still needed for outpatients with COVID-19. We aimed to evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) for early treatment of non-hospitalized individuals diagnosed with COVID-19. ME ...
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Journal ArticleJAMA · February 14, 2023
IMPORTANCE: Influenza virus infections declined globally during the COVID-19 pandemic. Loss of natural immunity from lower rates of influenza infection and documented antigenic changes in circulating viruses may have resulted in increased susceptibility to ...
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Journal ArticleClin Infect Dis · February 8, 2023
BACKGROUND: Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding ex ...
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Journal ArticleJAMA Netw Open · February 1, 2023
IMPORTANCE: Sepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant a ...
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Journal ArticleJAMA · January 24, 2023
IMPORTANCE: The effectiveness of fluvoxamine to shorten symptom duration or prevent hospitalization among outpatients with mild to moderate symptomatic COVID-19 is unclear. OBJECTIVE: To evaluate the efficacy of low-dose fluvoxamine (50 mg twice daily) for ...
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Journal ArticleImplement Sci Commun · January 12, 2023
BACKGROUND: Lung cancer screening is a complex clinical process that includes identification of eligible individuals, shared decision-making, tobacco cessation, and management of screening results. Adaptations to the delivery process for lung cancer screen ...
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Journal ArticleJ Clin Transl Sci · 2023
BACKGROUND: Many clinical trials leverage real-world data. Typically, these data are manually abstracted from electronic health records (EHRs) and entered into electronic case report forms (CRFs), a time and labor-intensive process that is also error-prone ...
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Journal ArticleJ Clin Transl Sci · 2023
Despite the availability of vaccinations, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to cause Coronavirus Disease 2019 (COVID-19) infection with a spectrum of disease in the acute setting. Transmission, infection, and severe dis ...
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Journal ArticleFront Health Serv · 2023
INTRODUCTION: To assess healthcare professionals' perceptions of rural barriers and facilitators of lung cancer screening program implementation in a Veterans Health Administration (VHA) setting through a series of one-on-one interviews with healthcare tea ...
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Journal ArticleOpen Forum Infect Dis · January 2023
BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE) studies are increasingly reporting relative VE (rVE) comparing a primary series plus booster doses with a primary series only. Interpretation of rVE differs from traditional studies ...
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Journal ArticlemedRxiv · December 15, 2022
BACKGROUND: Whether ivermectin, with a maximum targeted dose of 600 μg/kg, shortens symptom duration or prevents hospitalization among outpatients with mild to moderate coronavirus disease 2019 (COVID-19) remains unknown. Our objective was to evaluate the ...
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Journal ArticleMed Educ Online · December 2022
PURPOSE: Caring for critically ill patients requires non-technical skills such as teamwork, communication, and task management. The Behaviorally Anchored Rating Scale (BARS) is a brief tool used to assess non-technical skills. The investigators determined ...
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Journal ArticleVaccine · November 15, 2022
BACKGROUND: Test-negative design (TND) studies have produced validated estimates of vaccine effectiveness (VE) for influenza vaccine studies. However, syndrome-negative controls have been proposed for differentiating bias and true estimates in VE evaluatio ...
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Journal ArticleN Engl J Med · November 10, 2022
BACKGROUND: Invasive mechanical ventilation in critically ill adults involves adjusting the fraction of inspired oxygen to maintain arterial oxygen saturation. The oxygen-saturation target that will optimize clinical outcomes in this patient population rem ...
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Journal ArticlemedRxiv · November 1, 2022
BACKGROUND: The effectiveness of fluvoxamine to shorten symptom duration or prevent hospitalization among outpatients in the US with mild to moderate symptomatic coronavirus disease 2019 (COVID-19) is unclear. DESIGN: ACTIV-6 is an ongoing, decentralized, ...
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Journal ArticleBMJ Open · November 1, 2022
INTRODUCTION: Long-term cognitive impairment is one of the most common complications of critical illness among survivors who receive mechanical ventilation. Recommended oxygen targets during mechanical ventilation vary among international guidelines. Diffe ...
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Journal ArticleChest · November 2022
BACKGROUND: Convalescent plasma has been one of the most common treatments for COVID-19, but most clinical trial data to date have not supported its efficacy. RESEARCH QUESTION: Is rigorously selected COVID-19 convalescent plasma with neutralizing anti-SAR ...
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Journal ArticleInfluenza Other Respir Viruses · November 2022
BACKGROUND: During the COVID-19 pandemic, self-reported COVID-19 vaccination might facilitate rapid evaluations of vaccine effectiveness (VE) when source documentation (e.g., immunization information systems [IIS]) is not readily available. We evaluated th ...
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Journal ArticleJAMA · October 25, 2022
IMPORTANCE: The effectiveness of ivermectin to shorten symptom duration or prevent hospitalization among outpatients in the US with mild to moderate symptomatic COVID-19 is unknown. OBJECTIVE: To evaluate the efficacy of ivermectin, 400 μg/kg, daily for 3 ...
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Journal ArticleBMJ · October 11, 2022
OBJECTIVE: To compare the effectiveness of a primary covid-19 vaccine series plus booster doses with a primary series alone for the prevention of hospital admission with omicron related covid-19 in the United States. DESIGN: Multicenter observational case- ...
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Journal ArticleClin Infect Dis · October 3, 2022
Background . Adults in the United States (US) began receiving the adenovirus vector coronavirus disease 2019 (COVID-19) vaccine, Ad26.COV2.S (Johnson & Johnson [Janssen]), in February 2021. We evaluated Ad26.COV2.S vaccine effectiveness (VE) against COVID- ...
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Journal ArticleChest · October 2022
Mortality historically has been the primary outcome of choice for acute and critical care clinical trials. However, undue reliance on mortality can limit the scope of trials that can be performed. Large sample sizes are usually needed for trials powered fo ...
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Journal ArticleJ Infect Dis · September 13, 2022
BACKGROUND: The study objective was to evaluate 2- and 3-dose coronavirus disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients. METHODS: We conducted a 21-site ca ...
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Journal ArticleJ Neurotrauma · September 2022
Balanced crystalloids may improve outcomes compared with saline for some critically ill adults. Lower tonicity of balanced crystalloids could worsen cerebral edema in patients with intracranial pathology. The effect of balanced crystalloids versus saline o ...
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Journal ArticleAnn Surg · August 1, 2022
OBJECTIVE: In a multicenter, international cohort, we aimed to validate a modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale, hypothesized as comparable to the Glasgow Coma Scale (GCS)-based Sequential Organ Fa ...
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Journal ArticleJAMA · July 19, 2022
IMPORTANCE: Hypotension is common during tracheal intubation of critically ill adults and increases the risk of cardiac arrest and death. Whether administering an intravenous fluid bolus to critically ill adults undergoing tracheal intubation prevents seve ...
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Journal ArticleCrit Care · July 11, 2022
BACKGROUND: Multiple organ dysfunction syndrome (MODS) is a critical driver of sepsis morbidity and mortality in children. Early identification of those at risk of death and persistent organ dysfunctions is necessary to enrich patients for future trials of ...
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Journal ArticleJAMA Netw Open · July 1, 2022
IMPORTANCE: Effective methods for engaging clinicians in continuing education for learning-based practice improvement remain unknown. OBJECTIVE: To determine whether a smartphone-based app using spaced education with retrieval practice is an effective meth ...
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Journal ArticleInfluenza Other Respir Viruses · July 2022
BACKGROUND: We sought to assess whether persistent COVID-19 symptoms beyond 6 months (Long-COVID) among patients with mild COVID-19 is associated with poorer health status, quality of life, and psychological distress. METHODS: This was a multicenter prospe ...
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Journal ArticleJAMA Intern Med · June 1, 2022
IMPORTANCE: Awake prone positioning may improve hypoxemia among patients with COVID-19, but whether it is associated with improved clinical outcomes remains unknown. OBJECTIVE: To determine whether the recommendation of awake prone positioning is associate ...
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Journal ArticleJ Infect Dis · May 16, 2022
Vaccine effectiveness (VE) against COVID-19 hospitalization was evaluated among immunocompetent adults (≥18 years) during March-August 2021 using a case-control design. Among 1669 hospitalized COVID-19 cases (11% fully vaccinated) and 1950 RT-PCR-negative ...
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Journal ArticleClin Infect Dis · May 3, 2022
BACKGROUND: As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination coverage increases in the United States, there is a need to understand the real-world effectiveness against severe coronavirus disease 2019 (COVID-19) and among people ...
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Journal ArticleTrials · April 8, 2022
BACKGROUND: Coronavirus disease 2019 (COVID-19) has a heterogeneous outcome in individuals from remaining asymptomatic to death. In a majority of cases, mild symptoms are present that do not require hospitalization and can be successfully treated in the ou ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · March 25, 2022
COVID-19 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]) are effective at preventing COVID-19-associated hospitalization (1-3). However, how well mRNA vaccines protect against the most severe outcomes of these hospitalizations, including ...
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Journal ArticleBMJ · March 9, 2022
OBJECTIVES: To characterize the clinical severity of covid-19 associated with the alpha, delta, and omicron SARS-CoV-2 variants among adults admitted to hospital and to compare the effectiveness of mRNA vaccines to prevent hospital admissions related to ea ...
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Journal ArticleBMJ Open Qual · February 2022
BACKGROUND: Based on clinical staff safety within a learning healthcare system, the purpose of this study was to test an innovative model of care for addressing disruptive behaviour in hospitalised patients to determine whether it should be scaled up at th ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · January 28, 2022
COVID-19 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]) provide protection against infection with SARS-CoV-2, the virus that causes COVID-19, and are highly effective against COVID-19-associated hospitalization among eligible persons wh ...
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Journal ArticleJ Clin Transl Sci · 2022
INTRODUCTION: As clinical trials were rapidly initiated in response to the COVID-19 pandemic, Data and Safety Monitoring Boards (DSMBs) faced unique challenges overseeing trials of therapies never tested in a disease not yet characterized. Traditionally, i ...
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Journal ArticleJ Clin Transl Sci · 2022
BACKGROUND: The Clinical and Translational Science Award Program (CTSA) Trial Innovation Network (TIN) was launched in 2016 to increase the efficiency and effectiveness of multisite trials by supporting the development of national infrastructure. With the ...
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Journal ArticleJ Clin Transl Sci · 2022
Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event a ...
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Journal ArticleInt J Radiat Oncol Biol Phys · January 1, 2022
PURPOSE: We sought to determine whether a more widely accessible, noninvasive, frameless approach to radiosurgical thalamotomy would improve objective measures of refractory essential or parkinsonian tremor without added toxicity compared with reports of f ...
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Journal ArticleJ Clin Transl Sci · 2022
BACKGROUND: Coronavirus Disease 2019 (COVID-19) instigated a flurry of clinical research activity. The unprecedented pace with which trials were launched left an early void in data standardization, limiting the potential for subsequent data pooling. To fac ...
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Journal ArticleCrit Care Explor · January 2022
UNLABELLED: To test the hypothesis that relatively lower clot strength on thromboelastography maximum amplitude (MA) is associated with development of venous thromboembolism (VTE) in critically ill patients with COVID-19. DESIGN: Prospective, observational ...
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Journal ArticleJAMA · December 28, 2021
IMPORTANCE: For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube intr ...
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Journal ArticleJ Infect Dis · December 15, 2021
BACKGROUND: Test-negative design studies for evaluating influenza vaccine effectiveness (VE) enroll patients with acute respiratory infection. Enrollment typically occurs before influenza status is determined, resulting in over-enrollment of influenza-nega ...
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Journal ArticleJAMA · November 23, 2021
IMPORTANCE: A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people. OBJ ...
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Journal ArticleInt J Qual Health Care · November 20, 2021
BACKGROUND: Triage is a critical first step in appropriately caring for patients in the emergency department (ED). Patients' assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cau ...
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Journal ArticleTrials · November 8, 2021
BACKGROUND: Targeted normoxia (SpO2 90-96% or PaO2 60-100 mmHg) may help to conserve oxygen and improve outcomes in critically ill patients by avoiding potentially harmful hyperoxia. However, the role of normoxia for critically ill trauma patients remains ...
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Journal ArticleTrials · October 30, 2021
BACKGROUND: Patients with substance use disorders are overrepresented among general hospital inpatients, and their admissions are associated with longer lengths of stay and increased readmission rates. Amid the national opioid crisis, increased attention h ...
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Journal ArticleBMJ Open · October 28, 2021
INTRODUCTION: Mechanical ventilation of intensive care unit (ICU) patients universally involves titration of the fraction of inspired oxygen to maintain arterial oxygen saturation (SpO2). However, the optimal SpO2 target remains unknown. METHODS AND ANALYS ...
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Journal ArticleClin Infect Dis · October 20, 2021
BACKGROUND: Influenza vaccine effectiveness (VE) against a spectrum of severe disease, including critical illness and death, remains poorly characterized. METHODS: We conducted a test-negative study in an intensive care unit (ICU) network at 10 US hospital ...
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Journal ArticleNeurocrit Care · October 2021
BACKGROUND: Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · September 24, 2021
Three COVID-19 vaccines are authorized or approved for use among adults in the United States (1,2). Two 2-dose mRNA vaccines, mRNA-1273 from Moderna and BNT162b2 from Pfizer-BioNTech, received Emergency Use Authorization (EUA) by the Food and Drug Administ ...
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Journal ArticleJ Neurotrauma · September 15, 2021
Recent biomarker innovations hold potential for transforming diagnosis, prognostic modeling, and precision therapeutic targeting of traumatic brain injury (TBI). However, many biomarkers, including brain imaging, genomics, and proteomics, involve vast quan ...
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Journal ArticleAcad Med · September 1, 2021
PROBLEM: In an ideal learning health care system (LHS), clinicians learn from what they do and do what they learn, closing the evidence-to-practice gap. In operationalizing an LHS, great strides have been made in knowledge generation. Yet, considerable cha ...
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Journal ArticleAcad Med · September 1, 2021
Different models of learning health systems are emerging. At Vanderbilt University Medical Center, the Learning Health Care System (LHS) Platform was established with the goal of creating generalizable knowledge. This differentiates the LHS Platform from o ...
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Journal ArticleCrit Care Med · September 1, 2021
OBJECTIVES: To describe rehabilitation practice patterns among critically ill children with prolonged ICU stays and explore the association between institution-level utilization of rehabilitative services and patient outcomes. DESIGN: Retrospective cohort ...
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Journal ArticleAssessment · September 2021
This study aimed to elucidate the structure of the Rivermead Postconcussion Symptoms Questionnaire (RPQ) and evaluate its longitudinal and group variance. Factor structures were developed and compared in 1,011 patients with mild traumatic brain injury (mTB ...
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Journal ArticleJAMA Neurol · September 1, 2021
IMPORTANCE: A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT ...
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Journal ArticleVaccine · August 31, 2021
INTRODUCTION: Understanding patient factors associated with not being vaccinated is essential for successful implementation of influenza vaccination programs. METHODS: We enrolled adults hospitalized with severe acute respiratory illness at 10 United State ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · August 27, 2021
Real-world evaluations have demonstrated high effectiveness of vaccines against COVID-19-associated hospitalizations (1-4) measured shortly after vaccination; longer follow-up is needed to assess durability of protection. In an evaluation at 21 hospitals i ...
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Journal ArticleAm J Respir Crit Care Med · August 1, 2021
Rationale: Respiratory support (noninvasive ventilation or high-flow nasal cannula) applied at the time of extubation has been reported to reduce reintubation rates, but concerns regarding effectiveness have limited uptake into practice.Objectives: To dete ...
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Journal ArticleJAMA Neurol · August 1, 2021
IMPORTANCE: Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US and worldwide. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after ms ...
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Journal ArticleClin Infect Dis · July 15, 2021
BACKGROUND: Because of the increased risk for severe coronavirus disease 2019 (COVID-19), the Advisory Committee on Immunization Practices (ACIP) initially prioritized COVID-19 vaccination for persons in long-term care facilities (LTCF), persons aged ≥65 y ...
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Journal ArticlemedRxiv · July 8, 2021
BACKGROUND: As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe Covid-19 and among people at increased risk for poor outcomes. METHODS: In a multicenter case-cont ...
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Journal ArticleMed Sci Monit · June 29, 2021
BACKGROUND Research indicates intermittent theta burst stimulation (iTBS) is a potential treatment of post-stroke aphasia. MATERIAL AND METHODS In this double-blind, sham-controlled trial (NCT01512264) participants were randomized to receive 3 weeks of sha ...
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Journal ArticleBMJ Open · May 25, 2021
INTRODUCTION: Intubation-related complications are less frequent when intubation is successful on the first attempt. The rate of first attempt success in the emergency department (ED) and intensive care unit (ICU) is typically less than 90%. The bougie, a ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · May 7, 2021
Adults aged ≥65 years are at increased risk for severe outcomes from COVID-19 and were identified as a priority group to receive the first COVID-19 vaccines approved for use under an Emergency Use Authorization (EUA) in the United States (1-3). In an evalu ...
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Journal ArticleClin Infect Dis · May 4, 2021
With rapid and accurate molecular influenza testing now widely available in clinical settings, influenza vaccine effectiveness (VE) studies can prospectively select participants for enrollment based on real-time results rather than enrolling all eligible p ...
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Journal ArticleClin Infect Dis · May 4, 2021
Among 249 healthcare personnel who worked in hospital units with COVID-19 patients for 1 month, 19 (7.6%) tested positive for SARS-CoV-2 antibodies. Only 11 (57.9%) of the 19 personnel with positive serology reported symptoms of a prior illness, suggesting ...
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Journal ArticleCrit Care Med · May 1, 2021
Sepsis is defined as a dysregulated host response to infection that leads to life-threatening acute organ dysfunction. It afflicts approximately 50 million people worldwide annually and is often deadly, even when evidence-based guidelines are applied promp ...
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Journal ArticleClin Imaging · May 2021
INTRODUCTION: The Veterans Affairs Partnership to increase Access to Lung Screening (VA-PALS) is an enterprise-wide initiative to implement lung cancer screening programs at VA medical centers (VAMCs). VA-PALS will be using implementation strategies that i ...
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Journal ArticleInfluenza Other Respir Viruses · May 2021
BACKGROUND: Symptoms of mild COVID-19 illness are non-specific and may persist for prolonged periods. Effects on quality of life of persistent poor physical or mental health associated with COVID-19 are not well understood. METHODS: Adults aged ≥18 years w ...
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Journal ArticleJAMA Netw Open · April 1, 2021
IMPORTANCE: Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment of these patients. OBJECTIVE: To identify sex-related differences in symptom recovery from mTBI; secondarily, to explore ...
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Journal ArticleTrials · March 20, 2021
BACKGROUND: Convalescent plasma is being used widely as a treatment for coronavirus disease 2019 (COVID-19). However, the clinical efficacy of COVID-19 convalescent plasma is unclear. METHODS: The Passive Immunity Trial for Our Nation (PassITON) is a multi ...
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Journal ArticleJAMA Netw Open · March 1, 2021
IMPORTANCE: Heterogeneity across patients with traumatic brain injury (TBI) presents challenges for clinical care and intervention design. Identifying distinct clinical phenotypes of TBI soon after injury may inform patient selection for precision medicine ...
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Journal ArticleBiol Psychiatry Cogn Neurosci Neuroimaging · March 2021
BACKGROUND: Brain volumes in regions such as the hippocampus and amygdala have been associated with risk for the development of posttraumatic stress disorder (PTSD). The objective of this study was to determine whether a set of regional brain volumes, meas ...
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Journal ArticleCrit Care Explor · March 2021
OBJECTIVES: Given finite ICU bed capacity, knowledge of ICU bed utilization during the coronavirus disease 2019 pandemic is critical to ensure future strategies for resource allocation and utilization. We sought to examine ICU census trends in relation to ...
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Journal ArticleJAMA · February 23, 2021
IMPORTANCE: Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. OBJECTIVE: To determine whether a combination o ...
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Journal ArticleBMC Nephrol · February 5, 2021
BACKGROUND: Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury re ...
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Journal ArticleAm Heart J · February 2021
BACKGROUND: Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces cardiovascular death and worsening heart failure in patients with chronic heart failure and reduced ejection fraction. Early initiation during an acute heart failure (AHF) hospi ...
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Journal ArticleJ Am Coll Emerg Physicians Open · February 2021
OBJECTIVE: From the perspective of percutaneous coronary intervention (PCI) centers, locations of ST-segment elevation myocardial infarction (STEMI) diagnosis can include a referring facility, emergency medical services (EMS) transporting to a PCI center, ...
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Journal ArticleJ Clin Transl Sci · 2021
Rigorous scientific review of research protocols is critical to making funding decisions, and to the protection of both human and non-human research participants. Given the increasing complexity of research designs and data analysis methods, quantitative e ...
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Journal ArticleFront Neurol · 2021
Background: It is unclear what factors clinicians consider when deciding about endovascular thrombectomy (EVT) in acute ischemic stroke patients with a pre-existing disability. We aimed to explore international practice patterns and preferences for EVT in ...
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Journal ArticleFront Genet · 2021
Repurposing is an increasingly attractive method within the field of drug development for its efficiency at identifying new therapeutic opportunities among approved drugs at greatly reduced cost and time of more traditional methods. Repurposing has generat ...
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Journal ArticlePLoS One · 2021
OBJECTIVE: To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. METHODS: We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposu ...
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Journal ArticleCrit Care Med · January 1, 2021
OBJECTIVES: We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs ...
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Journal ArticlePrehosp Emerg Care · 2021
Research on the management of acute pain in the prehospital setting is fraught with challenges. The prehospital setting is complex due to constrained time, resources, and training. Research activities must not interfere with the underlying clinical priorit ...
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Journal ArticlePrehosp Emerg Care · 2021
Objective: Acute pain management is fundamental in prehospital trauma care. Early pain control may decrease the risk of developing post-traumatic stress disorder (PTSD) and chronic pain. Fentanyl and ketamine are frequently used off-label, but there is a p ...
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Journal ArticleJAMA · December 1, 2020
IMPORTANCE: Data on the efficacy of hydroxychloroquine for the treatment of coronavirus disease 2019 (COVID-19) are needed. OBJECTIVE: To determine whether hydroxychloroquine is an efficacious treatment for adults hospitalized with COVID-19. DESIGN, SETTIN ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · November 27, 2020
Most persons infected with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), develop virus-specific antibodies within several weeks, but antibody titers might decline over time. Understanding the timeline of antibody decline is importa ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · November 6, 2020
Since March 2020, large-scale efforts to reduce transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), have continued. Mitigation measures to reduce workplace exposures have included work site policies to support flexible wo ...
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Journal ArticleJAMA Netw Open · November 2, 2020
IMPORTANCE: Saline (0.9% sodium chloride), the fluid most commonly used to treat diabetic ketoacidosis (DKA), can cause hyperchloremic metabolic acidosis. Balanced crystalloids, an alternative class of fluids for volume expansion, do not cause acidosis and ...
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Journal ArticleAnn Surg · October 2020
OBJECTIVE: We aimed to identify socioeconomic and clinical risk factors for post-intensive care unit (ICU)-related long-term cognitive impairment (LTCI). SUMMARY BACKGROUND DATA: After delirium during ICU stay, LTCI has been increasingly recognized, but wi ...
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Journal ArticleBMJ Open · September 18, 2020
INTRODUCTION: Cardiovascular collapse is a common complication during tracheal intubation of critically ill adults. Whether administration of an intravenous fluid bolus prevents cardiovascular collapse during tracheal intubation remains uncertain. A prior ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · September 11, 2020
Community and close contact exposures continue to drive the coronavirus disease 2019 (COVID-19) pandemic. CDC and other public health authorities recommend community mitigation strategies to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · September 4, 2020
Health care personnel (HCP) caring for patients with coronavirus disease 2019 (COVID-19) might be at high risk for contracting SARS-CoV-2, the virus that causes COVID-19. Understanding the prevalence of and factors associated with SARS-CoV-2 infection amon ...
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Journal ArticleAnn Am Thorac Soc · September 2020
The ORCHID (Outcomes Related to COVID-19 treated with Hydroxychloroquine among In-patients with symptomatic Disease) trial is a multicenter, blinded, randomized trial of hydroxychloroquine versus placebo for the treatment of adults hospitalized with corona ...
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Journal ArticleMed Care · September 2020
BACKGROUND: Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge. OBJECTIVE: To examine the impact of a follow-up telephone call program as a readmission reduction initiative. RE ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · July 31, 2020
Prolonged symptom duration and disability are common in adults hospitalized with severe coronavirus disease 2019 (COVID-19). Characterizing return to baseline health among outpatients with milder COVID-19 illness is important for understanding the full spe ...
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Journal ArticleMMWR Morb Mortal Wkly Rep · July 3, 2020
Descriptions of coronavirus disease 2019 (COVID-19) in the United States have focused primarily on hospitalized patients. Reports documenting exposures to SARS-CoV-2, the virus that causes COVID-19, have generally been described within congregate settings, ...
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Journal ArticleJ Clin Transl Sci · June 19, 2020
INTRODUCTION: Statistical literacy is essential in clinical and translational science (CTS). Statistical competencies have been published to guide coursework design and selection for graduate students in CTS. Here, we describe common elements of graduate c ...
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Journal ArticleTrials · May 24, 2020
BACKGROUND: Disruptive behavior in hospitalized patients has become a priority area of safety concern for clinical staff, and also has consequences for patient management and hospital course. Proactive screening and intervention of patients with behavioral ...
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Journal ArticleJ Clin Transl Sci · April 13, 2020
INTRODUCTION: Acute care research (ACR) is uniquely challenged by the constraints of recruiting participants and conducting research procedures within minutes to hours of an unscheduled critical illness or injury. Existing competencies for clinical researc ...
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Journal ArticleJAMA Cardiol · April 1, 2020
IMPORTANCE: Acute heart failure (AHF) precipitates millions of hospital admissions worldwide, but previous registries have been country or region specific. OBJECTIVE: To conduct a prospective contemporaneous comparison of AHF presentations, etiologic facto ...
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ConferenceJ Am Coll Surg · April 2020
BACKGROUND: Recurrence of adhesive small bowel obstruction (ASBO) can lead to multiple admissions. There is limited knowledge of the role of operative and nonoperative treatment in the long-term recurrence risk for ASBO. We sought to determine the effect o ...
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Journal ArticleAir Med J · 2020
OBJECTIVE: Suboptimal ventilation may impact outcomes in patients with traumatic brain injury (TBI). This study compares the incidence of eucapnia between manually and mechanically ventilated patients with severe TBI during helicopter transport. METHODS: T ...
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Journal ArticleJ Head Trauma Rehabil · 2020
OBJECTIVES: Survivors of moderate and severe traumatic brain injury (TBI) require substantial care, much of which is ultimately provided by friends and family. We sought to describe the unmet needs of informal caregivers. DESIGN: Qualitative, semistructure ...
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Journal ArticleTrials · December 4, 2019
BACKGROUND: Observational research suggests that combined therapy with Vitamin C, thiamine and hydrocortisone may reduce mortality in patients with septic shock. METHODS AND DESIGN: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a multice ...
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Journal ArticleSci Transl Med · November 13, 2019
Sepsis remains a major public health problem with no major therapeutic advances over the last several decades. The clinical and biological heterogeneity of sepsis have limited success of potential new therapies. Accordingly, there is considerable interest ...
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Journal ArticleJAMA Otolaryngol Head Neck Surg · November 1, 2019
IMPORTANCE: Hypoglossal nerve stimulation is a treatment option for patients with obstructive sleep apnea unable to tolerate continuous positive airway pressure. This study evaluates demographic factors that may be associated with greater improvements in p ...
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Journal ArticleJ Pain Symptom Manage · October 2019
CONTEXT: Palliative care interventions have shown promise in improving quality of life and reducing health-care utilization among patients with chronic organ failure. OBJECTIVES: To evaluate the effect of a palliative care intervention for adults with end- ...
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Journal ArticleLancet Neurol · October 2019
BACKGROUND: After traumatic brain injury (TBI), plasma concentration of glial fibrillary acidic protein (GFAP) correlates with intracranial injury visible on CT scan. Some patients with suspected TBI with normal CT findings show pathology on MRI. We assess ...
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Journal ArticleJAMA Neurol · September 1, 2019
IMPORTANCE: Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. OBJECTIVES: To characterize th ...
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Journal ArticleBMJ Open · August 2, 2019
INTRODUCTION: Following extubation from invasive mechanical ventilation, nearly one in seven critically ill adults requires reintubation. Reintubation is independently associated with increased mortality. Postextubation respiratory support (non-invasive ve ...
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Journal ArticleCrit Care · July 23, 2019
BACKGROUND: Intravenous fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate ...
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Journal ArticleTrials · April 5, 2019
BACKGROUND: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Int ...
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Journal ArticleJAMA Psychiatry · March 1, 2019
IMPORTANCE: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric seq ...
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Journal ArticleAm J Health Syst Pharm · February 9, 2019
PURPOSE: Failure to obtain an accurate medication history can adversely affect patient care in the emergency department (ED) and propagate errors into the inpatient and outpatient settings. Obtaining an accurate medication history in the ED is challenging, ...
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Journal ArticlePrehosp Emerg Care · 2019
Background: Advanced airways (endotracheal tubes, supraglottic airways) are frequently placed by Emergency Medical Services (EMS) in patients with out-of-hospital cardiac arrest (OHCA). However, if an airway is to be placed, it is unknown whether this shou ...
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ConferenceJ Head Trauma Rehabil · 2019
OBJECTIVE: To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives ...
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Journal ArticleJ Head Trauma Rehabil · 2019
OBJECTIVE: To evaluate the relationship between satisfaction with life (SWL) and functional outcome after traumatic brain injury (TBI). SETTING AND PARTICIPANTS: The Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study (TRACK- ...
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Journal ArticleMhealth · 2019
BACKGROUND: Injury is a leading cause of child morbidity and mortality worldwide. Delivering injury prevention programs via mobile platforms, such as applications (apps), may reduce risky behaviors. iBsafe is an "interactive Bike and Bite safety" mobile ga ...
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Journal ArticleAm J Emerg Med · December 2018
OBJECTIVES: Hypertension is a leading cause of morbidity and mortality. The emergency department (ED) frequently serves populations with unmet health needs and could have a greater and more systematic role in secondary prevention for hypertension. This stu ...
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Journal ArticleAm J Emerg Med · December 2018
OBJECTIVE: We aim to evaluate the effectiveness of a broadly inclusive, comparatively low intensity intervention linking ED patients to a primary care home. METHODS: This retrospective cohort study evaluated ED patients referred for primary care linkage in ...
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Journal ArticleProduction and Operations Management · December 1, 2018
The healthcare industry has invested heavily in electronic health records and other clinical information systems in order to improve caregivers' access to information and ability to share information with other care providers. It has been shown that these ...
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Journal ArticleJAMA Netw Open · May 18, 2018
IMPORTANCE: Mild traumatic brain injury (mTBI) affects millions of Americans each year. Lack of consistent clinical practice raises concern that many patients with mTBI may not receive adequate follow-up care. OBJECTIVE: To characterize the provision of fo ...
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Journal ArticleCrit Care Med · March 2018
OBJECTIVE: We previously identified septic shock endotypes A and B based on 100 genes reflecting adaptive immunity and glucocorticoid receptor signaling. The endotypes differ with respect to outcome and corticosteroid responsiveness. We determined whether ...
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Journal ArticleN Engl J Med · March 1, 2018
BACKGROUND: Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU). METHODS: We conducted a single-center, pragmatic, multiple-crossover tria ...
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Journal ArticleRestor Neurol Neurosci · 2018
BACKGROUND: Recovery from stroke-induced aphasia is typically protracted and involves complex functional reorganization. The relative contributions of the lesioned and non-lesioned hemispheres to this process have been examined in several cross-sectional s ...
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Journal ArticleCrit Care Med · December 2017
OBJECTIVES: Recent transcriptomic studies describe two subgroups of adults with sepsis differentiated by a sepsis response signature. The implied biology and related clinical associations are comparable with recently reported pediatric sepsis endotypes, la ...
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Journal ArticleCurr HIV Res · November 23, 2017
BACKGROUND: Healthcare settings screen broadly for HIV. Public health settings use social network and partner testing ("Transmission Network Targeting (TNT)") to select high-risk individuals based on their contacts. HIV screening and TNT systems are not in ...
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Journal ArticleAm J Respir Crit Care Med · August 15, 2017
RATIONALE: We previously derived and validated the Pediatric Sepsis Biomarker Risk Model (PERSEVERE) to estimate baseline mortality risk in children with septic shock. The PERSEVERE biomarkers are serum proteins selected from among the proteins directly re ...
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Journal ArticleJ Clin Transl Sci · June 2017
INTRODUCTION: It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from 'fundame ...
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Journal ArticleResuscitation · June 2017
BACKGROUND: Bystander compression-only cardiopulmonary resuscitation (CPR) improves survival after out-of-hospital cardiac arrest. To broaden CPR training, 1-2min ultra-brief videos have been disseminated via the Internet and television. Our objective was ...
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Journal ArticleAm J Emerg Med · June 2017
Patients with mild traumatic brain injury (mTBI) with associated intracranial injury, or complicated mTBI, are at risk of deterioration. Clinical management differs within and between institutions. We conducted an exploratory analysis to determine which of ...
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Journal ArticleAm J Emerg Med · May 2017
INTRODUCTION: We assessed multiple examinations and assessment tools to develop a standardized measurement of alcohol intoxication to aid medical decision making in the Emergency Department. METHODS: Volunteers underwent an alcohol challenge. Pre- and post ...
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Journal ArticleAcad Med · February 2017
PURPOSE: To learn the size, composition, and scholarly output of biostatistics, epidemiology, and research design (BERD) units in U.S. academic health centers (AHCs). METHOD: Each year for four years, the authors surveyed all BERD units in U.S. AHCs that w ...
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ConferenceAir Med J · 2017
BACKGROUND: Many health systems rely on helicopter EMS (HEMS) to transfer ST-elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI) to a hospital with a catheterization laboratory. Mortality rates increase with the ti ...
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Journal ArticlePLoS One · 2017
BACKGROUND: Traumatic brain injury (TBI) is a complex disorder that is traditionally stratified based on clinical signs and symptoms. Recent imaging and molecular biomarker innovations provide unprecedented opportunities for improved TBI precision medicine ...
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Journal ArticleAm J Hematol · December 2016
Hemolysis is a key feature of sickle cell anemia (HbSS). Direct quantitation of hemolysis could be used as an objective outcome in clinical trials of new therapeutics for HbSS and would also enable better human studies of the pathogenesis of complications ...
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Journal ArticleShock · December 2016
INTRODUCTION: Selecting participants for research based on their risk is an enrichment strategy with potential for enhancing clinical trials in sepsis. Adult Septic Shock Information and Stratification (ASSIST) is a tool for estimating mortality risk that ...
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Journal ArticleCrit Care Med · November 2016
OBJECTIVE: The Pediatric Sepsis Biomarker Risk Model (PERSEVERE), a pediatric sepsis risk model, uses biomarkers to estimate baseline mortality risk for pediatric septic shock. It is unknown how PERSEVERE performs within distinct septic shock phenotypes. W ...
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Journal ArticleCrit Care Med · October 2016
OBJECTIVES: Prognostic and predictive enrichment strategies are fundamental tools of precision medicine. Identifying children with septic shock who may benefit from corticosteroids remains a challenge. We combined prognostic and predictive strategies to id ...
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Journal ArticleJ Trauma Acute Care Surg · September 2016
BACKGROUND: Hemorrhage is a leading cause of death in traumatically injured patients. Currently, the importance of earlier administration of packed red blood cells (pRBC) to improve outcomes is limited. We evaluated the association of earlier pRBC administ ...
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Journal ArticleMil Med · August 2016
OBJECTIVES: The optimal amount of oxygen to deploy with pararescue personnel for combat casualty care is currently unknown. The purpose of this prospective observational trial was to determine the proportion of trauma patients requiring supplemental oxygen ...
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ConferenceAnn Emerg Med · August 2016
STUDY OBJECTIVE: Opioid abuse and overdose constitute an ongoing health emergency. Many presume opioids have little potential for iatrogenic addiction when used as directed, particularly in short courses, as is typical of the emergency department (ED) sett ...
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Journal ArticleCrit Pathw Cardiol · June 2016
BACKGROUND: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS). However, there is increasing concern that current practice results in over ...
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Journal ArticleAcad Emerg Med · June 2016
BACKGROUND: The Clinical and Translational Science Award (CTSA) program aims to strengthen and support translational research by accelerating the process of translating laboratory discoveries into treatments for patients, training a new generation of clini ...
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Journal ArticleJ Stroke Cerebrovasc Dis · June 2016
BACKGROUND: Blood biomarkers for ischemic and hemorrhagic stroke diagnosis remain elusive. Recent investigations suggested that apolipoprotein (Apo), matrix metalloproteinase (MMP), and paraoxonase-1 may be associated with stroke. We hypothesized that Apo ...
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Journal ArticleAcad Emerg Med · April 2016
OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose ...
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Journal ArticleCrit Pathw Cardiol · March 2016
OBJECTIVES: The emergency department evaluation for suspected acute coronary syndrome (ACS) is common, costly, and challenging. Risk scores may help standardize clinical care and screening for research studies. The Thrombolysis in Myocardial Infarction (TI ...
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Journal ArticleAm Stat · 2016
Given the increasing level and scope of biostatistics expertise needed at academic health centers today, we developed best practices guidelines for biostatistics units to be more effective in providing biostatistical support to their institutions, and in f ...
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Journal ArticleAcad Emerg Med · January 2016
OBJECTIVES: The objective of this study was to evaluate operational policies that may improve the proportion of eligible stroke patients within a population who would receive intravenous recombinant tissue plasminogen activator (rt-PA) and minimize time to ...
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Journal ArticleEBioMedicine · December 2015
The temporal version of the pediatric sepsis biomarker risk model (tPERSEVERE) estimates the risk of a complicated course in children with septic shock based on biomarker changes from days 1 to 3 of septic shock. We validated tPERSEVERE performance in a pr ...
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Journal ArticleAnn Surg Oncol · December 2015
BACKGROUND: Circulating ('blood-borne') tissue factor (TF) is implicated in the pathogenesis of several chronic conditions, most notably cardiovascular disease, diabetes, and cancer. Full-length TF is an integral membrane protein, while alternatively splic ...
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Journal ArticleJ Emerg Med · December 2015
BACKGROUND: Incidence of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in complicated skin and skin structure infection (cSSSI) presenting to emergency departments (EDs). Treatment is heterogeneous and can require inpatient admission to ...
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Journal ArticleAcad Med · October 2015
Criteria for evaluating faculty are traditionally based on a triad of scholarship, teaching, and service. Research scholarship is often measured by first or senior authorship on peer-reviewed scientific publications and being principal investigator on extr ...
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Journal ArticleJACC Heart Fail · October 2015
OBJECTIVES: No prospectively derived or validated decision tools identify emergency department (ED) patients with acute heart failure (AHF) at low risk for 30-day adverse events who are thus potential candidates for safe ED discharge. This study sought to ...
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Journal ArticleMed Sci Monit · September 24, 2015
BACKGROUND: To provide a preliminary estimate of efficacy of constraint-induced aphasia therapy (CIAT) when compared to no-intervention in patients with chronic (>1 year) post-stroke aphasia in order to plan an appropriately powered randomized controlled t ...
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Journal ArticleJ Pediatr · September 2015
OBJECTIVE: To determine if troponin I is more often elevated in children with suspected nonaccidental trauma (NAT) compared with uninjured children of similar age, and describe associations between troponin I elevation and NAT injuries. STUDY DESIGN: Prosp ...
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Chapter · August 31, 2015
Multiple correlated time-to-event endpoints often occur in clinical trials and some time-to-event endpoints are more important than others. Most weighted multiple testing adjustment methods have been proposed to control family-wise type I error rates eithe ...
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Journal ArticleCrit Care Med · August 2015
OBJECTIVE: The development of acute kidney injury in patients with sepsis is associated with worse outcomes. Identifying those at risk for septic acute kidney injury could help to inform clinical decision making. We derived and tested a multibiomarker-base ...
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Journal ArticleAm J Emerg Med · July 2015
OBJECTIVES: Emergency department (ED) HIV screening is recommended but challenging to implement and of uncertain effectiveness in pediatric EDs (PEDs). We sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohor ...
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Journal ArticleGlob Health Sci Pract · March 2015
Patient flow analysis (PFA), a simple quality improvement tool to identify patient flow patterns, can be used in resource-limited settings to inform service delivery improvements. A PFA at a Ghanaian hospital found that personnel constraints and a mismatch ...
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Journal ArticleBiomarkers · March 2015
CONTEXT: We recently derived and validated a multi-biomarker-based model (ASSIST) to stratify patients with sepsis based on initial mortality risk. OBJECTIVE: The objective of this study was to compare the performance of ASSIST to interleukin-6 (IL6) and p ...
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Journal ArticleAnn Emerg Med · March 2015
STUDY OBJECTIVE: Emergency medical services (EMS) personnel frequently use the Glasgow Coma Scale (GCS) to assess injured and critically ill patients. This study assesses the accuracy of EMS providers' GCS scoring, as well as the improvement in GCS score a ...
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Journal ArticleWest J Emerg Med · March 2015
INTRODUCTION: The degree to which individual patients use multiple emergency departments (EDs) is not well-characterized. We determined the degree of overlap in ED population between three geographically proximate hospitals. METHODS: This retrospective coh ...
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Journal ArticleAnn Allergy Asthma Immunol · March 2015
BACKGROUND: Angiotensin-converting enzyme inhibitor-induced angioedema (ACEI-AE) is mediated by bradykinin. There remains an unmet treatment need because these patients, when presenting to the emergency department (ED), do not respond to conventional thera ...
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Journal ArticleClin Transl Sci · February 2015
INTRODUCTION: Statistics is an essential training component for a career in clinical and translational science (CTS). Given the increasing complexity of statistics, learners may have difficulty selecting appropriate courses. Our question was: what depth of ...
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Journal ArticleAm J Respir Crit Care Med · February 1, 2015
RATIONALE: Using microarray data, we previously identified gene expression-based subclasses of septic shock with important phenotypic differences. The subclass-defining genes correspond to adaptive immunity and glucocorticoid receptor signaling. Identifyin ...
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Journal ArticleAm J Hematol · January 2015
HbA1c is commonly used to monitor glycemic control. However, there is growing evidence that the relationship between HbA1c and mean blood glucose (MBG) is influenced by variation in red blood cell (RBC) lifespan in hematologically normal individuals. Corre ...
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Journal ArticleAm J Emerg Med · January 2015
BACKGROUND: Status epilepticus is a life-threatening, time-sensitive emergency. Acquiring an electroencephalogram (EEG) in the emergency department (ED) could impact therapeutic and disposition decisions for patients with suspected status epilepticus. OBJE ...
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Journal ArticleAnn Emerg Med · December 2014
STUDY OBJECTIVE: Emergency departments (EDs) with both low- and high-acuity treatment areas often have fixed allocation of resources, regardless of demand. We demonstrate the utility of discrete-event simulation to evaluate flexible partitioning between lo ...
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Journal ArticleAcad Emerg Med · October 2014
OBJECTIVES: Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center's standard practice has been to obtain a repeat head computed tomogr ...
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Journal ArticleAm J Public Health · September 2014
OBJECTIVES: We estimated the seroprevalence of both acute and chronic HIV infection by using a random sample of emergency department (ED) patients from a region of the United States with low-to-moderate HIV prevalence. METHODS: This cross-sectional seropre ...
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Journal ArticleAm J Emerg Med · August 2014
OBJECTIVE: Mild traumatic brain injury (mTBI) patients are frequently admitted to high levels of care despite limited evidence suggesting benefit. Such decisions may contribute to the significant cost of caring for mTBI patients. Understanding the factors ...
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Journal ArticleAm J Emerg Med · August 2014
OBJECTIVES: Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that ca ...
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Journal ArticleTransfus Med Rev · July 2014
The goal of this review is to summarize and critically assess information concerning the biotin method to label red blood cells (RBC) for use in studies of RBC and transfusion biology-information that will prove useful to a broad audience of clinicians and ...
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Journal ArticleExpert Rev Anti Infect Ther · July 2014
Sepsis remains a major cause of morbidity and mortality in adult and pediatric intensive care units. Heterogeneity of demographics, comorbidities, biological mechanisms, and severity of illness leads to difficulty in determining which patients are at highe ...
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Journal ArticleCrit Care Med · April 2014
OBJECTIVES: Clinical trials in septic shock continue to fail due, in part, to inequitable and sometimes unknown distribution of baseline mortality risk between study arms. Investigators advocate that interventional trials in septic shock require effective ...
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Journal ArticleAcad Emerg Med · April 2014
Despite its relatively common occurrence and life-threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from ...
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Journal ArticleAnn Emerg Med · March 2014
STUDY OBJECTIVE: Little is known about the transient and sustained operational effects of electronic health records on emergency department (ED) performance. We quantify how the implementation of a comprehensive electronic health record was associated with ...
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Journal ArticleCrit Care Med · February 2014
OBJECTIVE: Observed associations between fluid balance and septic shock outcomes are likely confounded by initial mortality risk. We conducted a risk-stratified analysis of the association between post-ICU admission fluid balance and pediatric septic shock ...
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Journal ArticlePLoS One · 2014
BACKGROUND: We previously derived and validated a risk model to estimate mortality probability in children with septic shock (PERSEVERE; PEdiatRic SEpsis biomarkEr Risk modEl). PERSEVERE uses five biomarkers and age to estimate mortality probability. After ...
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Journal ArticleJ Int Assoc Provid AIDS Care · 2014
This cross-sectional study approached emergency department (ED) patients after the treating physician's disposition decision to measure patient understanding of whether or not they had received an HIV test during their ED encounter. Of the 300 respondents, ...
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Journal ArticlePLoS One · 2014
BACKGROUND: The potential benefits of corticosteroids for septic shock may depend on initial mortality risk. OBJECTIVE: We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality r ...
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Journal ArticleStroke Res Treat · 2014
Several devices and medications have been used to address poststroke spasticity. Yet, spasticity's impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regress ...
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Journal ArticlePLoS One · 2014
BACKGROUND: PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation. OBJECTIVE: Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) ...
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Journal ArticleJ Stroke Cerebrovasc Dis · November 2013
Elevated blood pressure is common in patients with acute subarachnoid hemorrhage (SAH). American Heart Association guidelines do not specify a blood pressure target, but limited data suggest that systolic blood pressure (SBP)≥160 mmHg is associated with in ...
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Journal ArticleAcad Emerg Med · November 2013
OBJECTIVES: Serum levels of soluble ST2, a member of the interleukin-1 receptor family, predict mortality in emergency department (ED) patients with dyspnea secondary to acute heart failure and acute coronary syndrome. Elevated levels of ST2 have also been ...
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Journal ArticleShock · November 2013
PURPOSE: We previously identified interleukin 27 (IL-27) as a sepsis diagnostic biomarker in critically ill children. The current study tested the performance of IL-27 alone and in combination with procalcitonin (PCT) for diagnosing sepsis in critically il ...
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Journal ArticleJ Acquir Immune Defic Syndr · November 1, 2013
OBJECTIVE: Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct compari ...
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Journal ArticleMil Med · October 2013
OBJECTIVE: This study estimates the prevalence of injured patients requiring prehospital supplemental oxygen based on existing recommendations, and determines whether actual use exceeds those recommendations. PATIENTS AND METHODS: Prehospital oxygen use an ...
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Journal ArticleJ Trauma Acute Care Surg · October 2013
BACKGROUND: This study aimed to determine the efficacy of a video-based dog bite prevention intervention at increasing child knowledge and describe any associated factors and to assess the acceptability of providing this intervention in a pediatric emergen ...
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Journal ArticleEpilepsy Res · October 2013
STUDY OBJECTIVE: Non-convulsive seizures/status epilepticus occur in approximately 20% of comatose, non-cardiac arrest intensive care unit (ICU) patients, and are associated with increased mortality. The prevalence and clinical significance of seizures in ...
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Journal ArticleJ Med Toxicol · September 2013
The availability of 20-h N-acetylcysteine (NAC) infusion for low-risk acetaminophen (APAP) overdose enabled our center to implement an Emergency Department observation unit (OU) protocol as an alternative to hospitalization. Our objective was to evaluate o ...
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Journal ArticleAm J Emerg Med · July 2013
OBJECTIVE: Operational data are often used to make systems changes in real time. Inaccurate data, however, transiently, can result in inappropriate operational decision making. Implementing electronic health records (EHRs) is fraught with the possibility o ...
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Journal ArticleAcad Emerg Med · May 2013
OBJECTIVES: Recombinant tissue plasminogen activator (rt-PA) is a lytic medication widely used in the emergency department to treat acute thrombotic disorders such as ischemic stroke and myocardial infarction. It is known in the clinical use of this drug t ...
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Journal ArticleAcad Med · April 2013
Biostatistics--the application of statistics to understanding health and biology-provides powerful tools for developing research questions, designing studies, refining measurements, analyzing data, and interpreting findings. Biostatistics plays an importan ...
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ConferenceAllergy Asthma Proc · 2013
Angiotensin-converting enzyme inhibitor (ACE-I)-induced angioedema can be life-threatening without emergent intervention. The putative mediator is believed to be bradykinin, similar to hereditary angioedema, so these patients respond poorly to corticostero ...
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Journal ArticleAJOB Prim Res · 2013
BACKGROUND: Strict criteria for manuscript authorship exist to guide decisions on who should be considered an author. Less is known about how authorship for scientific meetings is determined. Our goal was to explore factors that influence decisions about a ...
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Journal ArticleAnn Emerg Med · December 2012
STUDY OBJECTIVE: Descriptions of emergency department (ED) census often do not differentiate between patients and encounters, and there is no guidance about which unit of analysis is most appropriate. We explore differences between patient- and encounter-l ...
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Journal ArticleAm Heart J · December 2012
BACKGROUND: A critical challenge for physicians facing patients presenting with signs and symptoms of acute heart failure (AHF) is how and where to best manage them. Currently, most patients evaluated for AHF are admitted to the hospital, yet not all warra ...
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Journal ArticleBiomarkers · December 2012
BACKGROUND: Galectin 3 (G3) is a mediator of fibrosis and remodeling in heart failure. METHODS: Patients diagnosed with and treated for Acute Heart Failure Syndromes were prospectively enrolled in the Decision Making in Acute Decompensated Heart Failure mu ...
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Journal ArticleBrain Behav · November 2012
Previous studies have shown that self-generated information is better remembered than information that has been read passively. To further examine this subsequent memory effect, we investigated the effect of five different linguistic relationships on memor ...
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Journal ArticleCrit Care · October 1, 2012
INTRODUCTION: The intrinsic heterogeneity of clinical septic shock is a major challenge. For clinical trials, individual patient management, and quality improvement efforts, it is unclear which patients are least likely to survive and thus benefit from alt ...
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Journal ArticleAm J Clin Oncol · October 2012
BACKGROUND: Recent studies questioning the benefit of prostate-specific antigen (PSA) screening have increased the need for evaluating factors contributing to variance in levels and their clinical relevance. An inverse relationship between body mass index ...
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Journal ArticleCortex · October 2012
OBJECTIVE: To test the existence of sex differences in cortical activation during verb generation when performance is controlled for. METHODS: Twenty male and 20 female healthy adults underwent functional magnetic resonance imaging (fMRI) using a covert bl ...
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Journal ArticleTher Hypothermia Temp Manag · September 2012
The potential for hypothermia as a neuroprotectant during stroke has led to its increase in clinical use. At the same time, combination pharmaceutical therapies for ischemic stroke using recombinant tissue plasminogen activator (rt-PA), and GP IIb-IIIa inh ...
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Journal ArticleEur J Heart Fail · September 2012
AIMS: Reliable detectors of worsening renal function (WRF) in Emergency Department (ED) patients with acute heart failure (AHF) are limited. We hypothesized that initial urinary neutrophil gelatinase-associated lipocalcin (NGAL) levels, and changes in urin ...
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Journal ArticleJ Am Coll Cardiol · August 28, 2012
Heart failure requiring urgent therapy represents a burgeoning health care burden. Although acute heart failure syndromes are commonly defined as a change in chronic heart failure signs and symptoms requiring urgent therapy, the presentation, development, ...
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Journal ArticleCurr Neurovasc Res · August 2012
High-dose hydroxymethylglutaryl coenzyme. A reductase inhibitor (statin) administration reduces neuronal injury and improves outcomes in experimental models of acute ischemic stroke, and has been shown to be safe in a phase 1 dose-escalation study using lo ...
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Journal ArticleAm Heart J · August 2012
Over the last 2 decades, early treatment for patients presenting with acute heart failure syndromes (AHFS) has changed very little. Despite strikingly different underlying disease pathophysiology, presenting signs and symptoms, and precipitants of AHFS, mo ...
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Journal ArticleStroke · August 2012
BACKGROUND AND PURPOSE: Initial stroke severity is one of the strongest predictors of eventual stroke outcome. However, predictors of initial stroke severity have not been well-described within a population. We hypothesized that poorer patients would have ...
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Journal ArticleWorld J Emerg Med · June 12, 2012
BACKGROUND: Numerous medical conditions require timely medication administration in the emergency department (ED). Automated dispensing systems (ADSs) store premixed common doses at the point-of-care to minimize time to administration, but the use of such ...
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Journal ArticlePoint of Care · June 1, 2012
Background: Point-of-care (POC) testing can reduce cardiac biomarker assay turnaround time for patients with suspected acute coronary syndromes (ACSs). However, equivalent reductions in patient throughput have not been realized. To better understand how PO ...
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Journal ArticleJ Cardiol · May 2012
BACKGROUND: Accurate electrocardiographic (ECG) differentiation of ventricular tachycardia (VT) from supraventricular tachycardia with aberrancy (SVT-A) on ECG is key to therapeutic decision-making in the emergency department (ED) setting. OBJECTIVE: The g ...
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Journal ArticleHeart Fail Rev · May 2012
Clinical trials for acute heart failure syndromes (AHFS) have traditionally enrolled patients well after emergency department (ED) presentation. We hypothesized a large proportion of patients would undergo changes in clinical profiles during the first 24Â h ...
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Journal ArticleAm J Epidemiol · April 15, 2012
Targeted screening remains an important approach to human immunodeficiency virus (HIV) testing. The authors aimed to derive and validate an instrument to accurately identify patients at risk for HIV infection, using patient data from a metropolitan sexuall ...
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Journal ArticleEpilepsy Behav · March 2012
Continuous electroencephalography (cEEG) is increasingly used to detect both clinical and subclinical seizures in patients with traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH). We assess whether EEG findings predict outcomes in TBI/SAH patien ...
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Journal ArticleJ Psychosom Res · March 2012
OBJECTIVES: Little is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ...
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Journal ArticleJ Pediatr · February 2012
OBJECTIVES: To determine what children know about preventing dog bites and to identify parental desires for dog bite prevention education. STUDY DESIGN: This cross-sectional study sampled 5- to 15-year-olds and their parents/guardians presenting to a pedia ...
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Journal ArticleStroke · February 2012
BACKGROUND AND PURPOSE: Severely elevated blood pressure (BP) and aggressive BP reduction are both associated with poor outcome in acute ischemic stroke (AIS). In nontissue-type plasminogen activator patients, the American Heart Association recommends anti ...
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Journal ArticleAcad Emerg Med · February 2012
OBJECTIVES:   ST-segment elevation myocardial infarction (STEMI) care is time-dependent. Many STEMI patients require interhospital helicopter transfer for percutaneous coronary intervention (PCI) if ground emergency medical services (EMS) initially transpo ...
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Journal ArticleBMJ Open · 2012
OBJECTIVES: The primary purpose was to compare the odds of acute coronary syndrome-pertinent diagnostic testing between self-reported cocaine users and non-users at the turn of the century. The secondary purpose was to compare the odds of acute coronary sy ...
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Journal ArticleAm J Emerg Med · January 2012
OBJECTIVE: To determine whether ultrasound changes emergency physicians' estimated likelihood of acute ureterolithiasis in patients with flank pain. METHODS: This prospective, observational study enrolled patients awaiting computed tomographic (CT) scan fo ...
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Journal ArticleCongest Heart Fail · 2012
The authors sought to compare and contrast the clinical criterion standards currently used in a cohort of emergency department (ED) patients to diagnose acute heart failure syndromes (AHFS). In a prospective observational study of patients with signs and s ...
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Journal ArticleAm J Emerg Med · January 2012
BACKGROUND: A delay in diagnosis of sepsis and appropriate treatment increases subsequent mortality. An association with the degree of bandemia, or the presence of immature neutrophils in the white blood cell count, has not been explored in septic patients ...
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Journal ArticleCongest Heart Fail · 2012
Biomarker changes may provide physicians with objective evidence of treatment efficacy in patients with acute decompensated heart failure (ADHF) and facilitate early hospital discharge. The authors hypothesize that mid-regional-pro-adrenomedullin (MR-proAD ...
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Journal ArticleCurr Neurovasc Res · November 2011
Incidence of intra-cranial hemorrhage linked to treatment of ischemic stroke with recombinant tissue plasminogen activator (rt-PA) has led to interest in adjuvant therapies such as ultrasound (US) or plasminogen, to enhance rt-PA efficacy and improve patie ...
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Journal ArticleStat Med · October 15, 2011
Increasing demands for evidence-based medicine and for the translation of biomedical research into individual and public health benefit have been accompanied by the proliferation of special units that offer expertise in biostatistics, epidemiology, and res ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVE: Controversy surrounds the linkage of prevention counseling with emergency department (ED)-based HIV testing. Further, the effectiveness and feasibility of prevention counseling in the ED setting is unknown. We investigate these issues by conduct ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVES: Estimating the prevalence of undiagnosed HIV in emergency departments (EDs) is not straightforward. Regional epidemiologic data are unlikely to translate directly to a single ED setting, and the prevalence of undiagnosed HIV likely differs betw ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVES: Casual review of existing literature reveals a multitude of individualized approaches to emergency department (ED) HIV testing. Cataloging the operational options of each approach could assist translation by disseminating existing knowledge, en ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVES: We characterize HIV testing practices and programs in US emergency departments (EDs) in 2009. METHODS: A national Web-based survey of members of the National ED HIV Testing Consortium, participants in the 2007 Centers for Disease Control and Pr ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVE: Differences in the prevalence of undiagnosed HIV between different types of emergency departments (EDs) are not well understood. We seek to define missed opportunities for HIV diagnosis within 3 geographically proximate EDs serving different pat ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVE: The lack of well-described population-level outcome measures for emergency department (ED) HIV testing is one barrier to translation of screening into practice. We demonstrate the impact of an ED diagnostic testing and targeted screening program ...
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Journal ArticleAnn Emerg Med · July 2011
OBJECTIVE: Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV ...
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ConferenceAcad Emerg Med · June 2011
OBJECTIVES: Risk stratification of patients with potential acute coronary syndrome (ACS) is difficult. Patients with prior revascularization are considered higher risk, but they can also have symptoms from noncardiac causes. This study evaluated whether th ...
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Journal ArticleJ Grad Med Educ · June 2011
BACKGROUND: Recent efforts to increase insurance coverage have revealed limits in primary care capacity, in part due to physician maldistribution. Of interest to policymakers and educators is the impact of nontraditional curricula, including global health ...
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Journal ArticleAm J Emerg Med · May 2011
STUDY OBJECTIVE: Reimbursement for ultrasound-guided central lines requires documenting the needle entering the vessel lumen. We hypothesized that physicians often successfully perform ultrasound-guided internal jugular (IJ) cannulation without visualizing ...
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Journal ArticleAm J Emerg Med · May 2011
Screening for HIV in the emergency department (ED) is recommended by the Centers for Disease Control and Prevention. The relative importance of efforts to increase consent among those who currently decline screening is not well understood. We compared the ...
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Journal ArticleJ Pediatr Gastroenterol Nutr · April 2011
OBJECTIVE: Recent changes in the epidemiology of Clostridium difficile infection include an increase in the incidence of C difficile-associated disease (CDAD) and the identification of patients with inflammatory bowel disease (IBD) as a group at risk. In a ...
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Journal ArticleAnn Emerg Med · March 2011
STUDY OBJECTIVE: Early reperfusion portends better outcomes for ST-segment elevation myocardial infarction (STEMI) patients. This investigation estimates the proportions of STEMI patients transported by a hospital-based helicopter emergency medical service ...
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Journal ArticlePoint of Care · March 1, 2011
Background: Implementing point-of-care testing (POCT) is thought to improve emergency department (ED) patient throughput by decreasing time to disposition, but evidence is lacking. We implemented POCT for cardiac biomarkers and determined whether it improv ...
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Journal ArticleAm J Emerg Med · February 2011
INTRODUCTION: Troponin concentrations rising above an institutional cutpoint are used to define acute myocardial necrosis, yet it is uncertain what outcomes are associated with fluctuations in troponin that do not exceed this level. We evaluate the associa ...
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Journal ArticleCerebrovasc Dis · 2011
INTRODUCTION: 'Exception from informed consent for research' (EFIC) is a rigorous procedure regulated by the FDA that requires community assent but allows enrollment without patient or family consent. Recently, several acute stroke trials have explored the ...
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Journal ArticleJ Pediatr Orthop · 2011
BACKGROUND: Forearm shaft fractures are the third most common fracture in children. Although closed reduction and casting is the preferred treatment; outcomes remain variable. The purpose of this study was to identify factors associated with failure of non ...
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Journal ArticleAm J Emerg Med · November 2010
OBJECTIVE: The National Council on Radiation Protection (NCRP) limits health care-associated occupational exposures to radiation to 5000 mrem/y. Previous studies suggested that emergency physicians were not exposed over this limit. Their relevance to conte ...
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Journal ArticleEur J Heart Fail · November 2010
AIMS: Results from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acut ...
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Journal ArticleThromb Res · October 2010
INTRODUCTION: Recombinant tissue plasminogen activator (rt-PA) is the only FDA approved lytic therapy for acute ischemic stroke. However, there can be complications such as intra-cerebral hemorrhage. This has led to interest in adjuncts such as GP IIb-IIIa ...
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Journal ArticleEmerg Med J · September 2010
BACKGROUND: The authors previously described an acoustic cardiographic model that predicted echocardiographic correlates of elevated left ventricular (LV) filling pressure. This study evaluated this bedside acoustic cardiographic model against invasive mea ...
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Journal ArticleAccount Res · July 2010
Conflicts of interest (COIs) can impact the integrity of scientific research. While public imagination has focused on scientists, regulatory discourse recognizes a broader range of individuals who might have financial COIs. This essay asks, for personnel w ...
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Journal ArticleFemale Pelvic Med Reconstr Surg · July 2010
OBJECTIVE: : The objective of this study is to systematically review the literature regarding the efficacy of sacral neuromodulation (InterStim) for treatment of nonobstructive urinary retention. METHODS: : Eligible studies were selected through an electro ...
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Journal ArticleAm J Emerg Med · June 2010
INTRODUCTION: Many studies show that a major barrier to short-term treatment of stroke is patient or bystander delay in responding to stroke symptoms. Most studies have found that less than half of stroke/transient ischemic attack (TIA) events result in a ...
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Journal ArticleAcad Emerg Med · June 2010
OBJECTIVES: Over the past decade, emergency medicine ultrasound (US) fellowships have proliferated, yet there are no published data describing employment trends among fellowship graduates. This study sought to assess factors motivating emergency physicians ...
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Journal ArticleEpilepsy Behav · April 2010
In a minority of patients with idiopathic generalized epilepsies (IGEs), seizures continue despite appropriate treatment. We sought to determine the clinical and EEG factors associated with medication response in these patients. All patients with IGEs eval ...
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Journal ArticleNeurocrit Care · April 2010
BACKGROUND: Anti-epileptic drugs are commonly used for seizure prophylaxis after neurological injury. We performed a study comparing intravenous (IV) levetiracetam (LEV) to IV phenytoin (PHT) for seizure prophylaxis after neurological injury. METHODS: In t ...
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Journal ArticleJ Pediatr Orthop · December 2009
BACKGROUND: The purpose of our study was to perform a large cross-sectional study aimed at determining the postnatal growth pattern of the clavicle from birth to 18 years of age. METHODS: We analyzed the digital chest radiographs of a convenience sample of ...
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Journal ArticleCurr HIV Res · November 2009
Screening everyone for HIV at least once is estimated to be cost-effective. Screening in health care settings is recommended to help achieve that goal. Health care settings often encounter the same patient repeatedly, and it is unknown if limited resources ...
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Journal ArticleAcad Emerg Med · October 2009
Research networks can enable the inclusion of large, diverse patient populations in different settings. However, the optimal measures of a research network's failure or success are not well defined or standardized. To define a framework for metrics used to ...
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Journal ArticleAm J Emerg Med · September 2009
OBJECTIVE: We compared the performance characteristics of the 12-lead electrocardiography (ECG) with body surface mapping (BSM) in patients presenting for evaluation of symptoms suggestive of acute coronary syndromes. METHODS: The diagnostic test character ...
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Journal ArticleCrit Pathw Cardiol · September 2009
INTRODUCTION: Risk-stratification in acute heart failure syndromes (AHFS) is problematic. A recent set of recommendations describes emergency department (ED) patients with AHFS who do not fulfill high-risk criteria and may be good candidates for observatio ...
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Journal ArticlePoint of Care · September 1, 2009
Effects of point-of-care testing for serum markers of cardiac necrosis on the process and outcomes of patient care in the emergency department (ED) have yet to be fully elucidated. We conducted this systematic review to summarize the current state of knowl ...
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Journal ArticleJ Card Fail · August 2009
BACKGROUND: Clinical trials involving novel therapies treating acute heart failure syndromes (AHFS) have shown limited success with regard to both efficacy and safety. As a direct result, outcomes have changed little over time and AHFS remains a disease pr ...
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Journal ArticleAcad Emerg Med · August 2009
OBJECTIVES: The value of unstructured physician estimate of risk for disease processes, other than acute coronary syndrome (ACS), has been demonstrated. The authors sought to evaluate the predictive value of unstructured physician estimate of risk for ACS ...
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Journal ArticleThromb Res · July 2009
BACKGROUND AND PURPOSE: Currently, the only FDA-approved therapy for acute ischemic stroke is the administration of recombinant tissue plasminogen activator (tPA). Echogenic liposomes (ELIP), phospholipid vesicles filled with gas and fluid, can be manufact ...
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ConferenceAnn Emerg Med · July 2009
STUDY OBJECTIVE: Patient-reported penicillin allergies are often unreliable and can result in unnecessary changes in antibiotic therapy. Although penicillin allergy skin testing is commonly performed in allergy clinics, it has not been used in emergency de ...
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Journal ArticleAnn Emerg Med · June 2009
STUDY OBJECTIVE: Dyspneic emergency department (ED) patients present a diagnostic dilemma. Recent technologic advances have made it possible to capture information about pathologic heart sounds at ECG recording. This study evaluates the effect of an S3 cap ...
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Journal ArticleAm J Emerg Med · May 2009
BACKGROUND: Patients presenting with acute dyspnea are often a diagnostic dilemma. A bedside tool that accurately and rapidly identifies increased left ventricular (LV) filling pressure would be helpful. We evaluated acoustic electrocardiography for this p ...
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ConferenceAnn Emerg Med · March 2009
STUDY OBJECTIVE: Point-of-care testing reduces time to cardiac marker results in patients evaluated for acute coronary syndromes, yet evidence this translates to a decreased length of stay is lacking. We hypothesized that point-of-care testing decreases le ...
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Journal ArticlePoint of Care · March 1, 2009
Background: Lactate has prognostic use in critically ill medical and trauma patients. Although some centers use lactate in the initial evaluation of patients with obvious severe trauma, it has not been investigated as a triage tool in the initial emergency ...
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Journal ArticleAm J Emerg Med · February 2009
OBJECTIVES: Emergency medical services (EMS) use by stroke patients varies from 38% to 65%. In an epidemiological study, we determined the proportion of stroke patients who used EMS, hypothesizing that demographics, stroke severity, stroke type, and locati ...
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Journal ArticleAcad Emerg Med · February 2009
Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain exp ...
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Journal ArticleStroke · February 2009
BACKGROUND AND PURPOSE: We sought to build models that address questions of interest to patients and families by predicting short- and long-term mortality and functional outcome after ischemic stroke, while allowing for risk restratification as comorbid ev ...
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Journal ArticleJ Med Screen · 2009
OBJECTIVES: Outcomes in an episodic care setting like an emergency department (ED) are traditionally evaluated in comparison with the number of visits as opposed to the number of unique patients, although patients commonly present to the ED multiple times. ...
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Journal ArticleThromb Res · 2009
INTRODUCTION: Fibrinolytics such as recombinant tissue plasminogen activator (rt-PA) are used to treat thrombotic disease such as acute myocardial infarction (AMI) and ischemic stroke. Interest in increasing efficacy and reducing side effects has led to th ...
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ConferenceBMC Health Serv Res · December 18, 2008
BACKGROUND: Little is known about the relationship between types of healthcare providers and outcomes in patients with epilepsy. This study compares the relative effects of provider type (epileptologist vs. other neurologist) and pharmacologic treatment (n ...
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Journal ArticleBlood · November 15, 2008
Although red blood cell (RBC) life span is a known determinant of percentage hemoglobin A1c (HbA1c), its variation has been considered insufficient to affect clinical decisions in hematologically normal persons. However, an unexplained discordance between ...
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Journal ArticleUltrasound Med Biol · November 2008
It has been known for some time that the application of ultrasound can enhance the efficacy of thrombolytic medications such as recombinant tissue plasminogen activator (rt-PA). Potential clinical applications of this ultrasound-enhanced thrombolysis (UET) ...
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Journal ArticleEmerg Med J · October 2008
INTRODUCTION: Sickle cell patients commonly present to the emergency department (ED). Identifying those requiring admission and those who can safely be discharged is difficult. It was hypothesised that ED variables predictive of 96-h adverse sickle cell pa ...
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Journal ArticleAm J Emerg Med · September 2008
OBJECTIVES: Our objective was to determine if the biomarker for axonal injury, serum cleaved tau (C-tau), predicts postconcussion syndrome (PCS) in adults after mild traumatic brain injury (mTBI). METHODS: C-tau was measured from blood obtained in the emer ...
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Journal ArticleDiabetes · September 2008
OBJECTIVE: To determine whether interindividual heterogeneity in the erythrocyte (red blood cell [RBC]) transmembrane glucose gradient might explain discordances between A1C and glycemic control based on measured fructosamine. RESEARCH DESIGN AND METHODS: ...
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Journal ArticleHealth Soc Care Community · September 2008
Homeless adults have a higher rate of morbidity and mortality than their housed counterparts. Improving the health of homeless adults is a complex problem because of the overlay of individual risk factors, social issues and lack of economic resources. Due ...
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Journal ArticleEmerg Med J · August 2008
OBJECTIVES: To describe the presenting characteristics and risk stratification of patients presenting to the emergency department with chest pain who have a normal initial troponin level followed by a raised troponin level within 12 h (evolving myocardial ...
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Journal ArticleBMC Public Health · June 25, 2008
OBJECTIVE: Early HIV diagnosis reduces transmission and improves health outcomes; screening in non-traditional settings is increasingly advocated. We compared test venues by the number of new diagnoses successfully linked to the regional HIV treatment cent ...
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Journal ArticleAm J Hematol · June 2008
New methods for labeling red blood cells (RBC) and monitoring their survival have made it possible to explore changes in the properties of RBC as they age in the circulation. We have adapted a method, originally developed for studying wild animals, to calc ...
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Journal ArticleBMC Infect Dis · May 24, 2008
BACKGROUND: Moxifloxacin is a respiratory fluoroquinolone with a community acquired pneumonia indication. Unlike other fluoroquinolones used in our healthcare system, moxifloxacin's urinary excretion is low and thus we hypothesized that increased use of mo ...
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Journal ArticleAm J Emerg Med · May 2008
INTRODUCTION: Patients intubated in the emergency department (ED) often have extended ED stays. We hypothesize that ED intubated patients receive inadequate postintubation anxiolysis and analgesia after rapid sequence induction (RSI). METHODS: This was a r ...
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Journal ArticlePediatrics · April 2008
OBJECTIVES: In the absence of a gold standard, clinicians and researchers often categorize their opinions of the likelihood of inflicted injury using several ordinal scales. The objective of this protocol was to determine the reliability of expert ratings ...
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Journal ArticleStroke · March 2008
BACKGROUND AND PURPOSE: Current US estimates of recombinant tissue plasminogen activator (rt-PA) use have been based either on extrapolation of regional studies or on administrative database estimates, both of which may have inherent biases. We sought to c ...
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Journal ArticleEur Heart J · March 2008
Dyspnoea is the most common presenting symptom amongst patients with acute heart failure syndromes (AHFS). It is distressing to patients and therefore an important target for treatment in clinical practice, clinical trials, and for regulatory approval of n ...
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Journal ArticleEmerg Med J · February 2008
BACKGROUND: Hospitalised patients requiring cardiopulmonary resuscitation (CPR) have better outcomes in intensive care units (ICUs) than wards. Survival could potentially be improved for patients at high risk for CPR if they can be identified while in the ...
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Journal ArticleAnn Emerg Med · January 2008
STUDY OBJECTIVE: The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of re ...
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Journal ArticleCerebrovasc Dis · 2008
BACKGROUND: The stroke volume among black ischemic stroke patients in phase I of the population-based Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) was smaller than reported among acute stroke studies, with a median stroke volume of 2.5 cm. Ho ...
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Journal ArticleJournal of Addictions Nursing · January 1, 2008
Problem alcohol and drug use by adult homeless persons may put them at higher risk for other health problems and impact their access to health care. The purpose of this study was to determine if those with a positive screen for problem alcohol or drug use ...
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Journal ArticleEpilepsy Behav · January 2008
Functional magnetic resonance imaging (fMRI) has the potential to replace the intracarotid amobarbital procedure (IAP) in presurgical evaluation of patients with epilepsy. In this study, we compared fMRI verb generation (VG) and semantic decision/tone deci ...
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Journal ArticleBMC Emerg Med · October 31, 2007
BACKGROUND: The rising incidence of methicillin resistant Staph. aureus (MRSA) infections is a concern for emergency practitioners. While studies have examined MRSA in inpatients, few have focused on emergency department populations. We sought to describe ...
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Journal ArticleBMC Health Serv Res · October 15, 2007
BACKGROUND: HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a p ...
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ConferenceAcad Emerg Med · August 2007
OBJECTIVES: To describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). METHODS: This was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Synd ...
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ConferenceAcad Emerg Med · August 2007
BACKGROUND: Endothelial microparticles (EMPs) are <2-microm membranous blebs from endothelial cell membranes that have been demonstrated to be elevated in vasculopathic conditions. One study has demonstrated elevated EMPs in acute ischemic stroke (AIS) ver ...
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Journal ArticleBMC Emerg Med · June 15, 2007
BACKGROUND: Patient satisfaction is of growing importance to providers of emergency medical services (EMS). Prior reports of patient satisfaction have frequently used resource-intensive telephone follow-up to assess satisfaction. We determine the feasibili ...
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Journal ArticlePrev Med · June 2007
BACKGROUND: Coronary artery disease (CAD) is the single largest killer of both males and females in the United States. The Emergency Department (ED) represents a unique environment in which patient education may improve coronary artery disease risk factor ...
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Journal ArticleFam Med · April 2007
BACKGROUND AND OBJECTIVES: While medical students' interest in family medicine declines, and residency programs face recruiting challenges, interest in international health is increasing. We studied the influence of offering an international health track ( ...
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Journal ArticleUltrasound Med Biol · April 2007
Combined ultrasound and tissue plasminogen activator (rt-PA) therapy, or ultrasound enhanced thrombolysis (UET), has been shown to improve recanalization in patients with acute ischemic stroke. We measured the effect of ultrasound duty cycle on the lytic e ...
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Journal ArticleAnn Emerg Med · February 2007
STUDY OBJECTIVE: We seek to determine whether cardiac risk factor burden (defined as the number of conventional cardiac risk factors present) is useful for the diagnosis of acute coronary syndromes in the emergency department (ED) setting. METHODS: This wa ...
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Journal ArticlePublic Health Rep · 2007
On September 22, 2006, the Centers for Disease Control and Prevention (CDC) announced recommendations to expand the role of health-care providers in human immunodeficiency virus (HIV) testing. These clearlyjustified guidelines aim to remove traditional tes ...
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Journal ArticleCongest Heart Fail · 2007
The significance of a history of heart failure (HF) in patients presenting with acute coronary syndromes and elevated cardiac markers is unclear. The authors performed an analysis of patients enrolled in the Internet Tracking Registry of Acute Coronary Syn ...
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Journal ArticleAm Heart J · December 2006
BACKGROUND: Dyslipidemia is not routinely evaluated in emergency department (ED) patients. We hypothesized that many ED patients would qualify for lipid therapy and that methods of follow-up for patients would not achieve adequate treatment goals. METHODS: ...
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Journal ArticleAnn Emerg Med · December 2006
STUDY OBJECTIVE: Observational studies of well-described patient populations presenting to emergency departments (EDs) with suspicion of acute coronary syndrome are necessary to understand the relationships between patients' signs and symptoms, cardiac ris ...
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Journal ArticleAnn Emerg Med · December 2006
STUDY OBJECTIVE: We evaluate associations between pairs of discordant cardiac biomarkers (positive MB band of creatine kinase [CKMB] with negative creatine kinase, positive CKMB with negative cardiac troponin, and positive troponin with negative CKMB) and ...
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Journal ArticleBMC Emerg Med · November 14, 2006
BACKGROUND: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10-20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED. METHODS: We analyzed a ...
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Journal ArticleBMC Health Serv Res · October 19, 2006
BACKGROUND: Sleepiness is a significant problem among residents due to chronic sleep deprivation. Recent studies have highlighted medical errors due to resident sleep deprivation. We hypothesized residents routinely use pharmacologic sleep aids to manage t ...
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Journal ArticleBMC Med Educ · October 5, 2006
BACKGROUND: This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. METHODS: Seven of 12 EM residents in their first postgraduate ye ...
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Journal ArticleStroke · October 2006
BACKGROUND AND PURPOSE: Biochemical markers of acute neuronal injury may aid in the diagnosis and management of acute ischemic stroke. Serum samples from the National Institute for Neurological Disorders and Stroke (NINDS) recombinant tissue plasminogen ac ...
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Journal ArticlePoint of Care · September 1, 2006
We assessed the hypothesis that emergency department point-of-care (POC) testing for myoglobin and cardiac troponin T (cTnT) reduces the time to result with no reduction in diagnostic accuracy for acute coronary syndrome (ACS) compared with standard-of-car ...
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Journal ArticleDiabetes Care · August 2006
OBJECTIVE: HbA(1c) (A1C) is substantially determined by genetic factors not shared in common with glucose. Fractions of the variance in A1C, the glycation gap (GG; previously called the glycosylation gap) and the hemoglobin glycosylation index, correlate w ...
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Journal ArticleStroke · August 2006
BACKGROUND AND PURPOSE: Early hematoma expansion in spontaneous intracerebral hemorrhage (ICH) is associated with worse clinical outcome. We hypothesized that hemodynamic parameters are associated with the increase in hematoma volume owing to their relatio ...
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Journal ArticleStroke · June 2006
BACKGROUND AND PURPOSE: Timely access to medical treatment is critical for patients with acute stroke because acute therapies must be given very quickly after symptom onset. We examined the effect of socioeconomic status on prehospital delays in stroke and ...
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Journal ArticleAm J Emerg Med · May 2006
OBJECTIVE: Appropriate patient selection is critical for maximal observation unit (OU) effectiveness. We hypothesized emergency physicians underuse the OU for admitted patients and overuse the OU for patients who would otherwise be discharged. METHODS: Tre ...
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Journal ArticleJ Card Fail · May 2006
BACKGROUND: Emergency department (ED) patients with undifferentiated dyspnea are a diagnostic dilemma. We hypothesized that electronic detection of an S3 would be more accurate in determining decompensated heart failure than physician auscultation, and tha ...
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Journal ArticleBMC Med Educ · April 25, 2006
BACKGROUND: Mock oral board exams, fashioned after the live patient hour of the American Board of Psychiatry and Neurology exam, are commonly part of resident assessment during residency training. Exams using real patients selected from clinics or hospital ...
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Journal ArticleAm J Med · March 2006
PURPOSE: Chronic kidney disease has been linked to high mortality rates in patients with ST-segment elevation myocardial infarction but has not been well described for patients with non-ST-segment elevation acute coronary syndromes. We examined the treatme ...
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Journal ArticlePrehosp Emerg Care · 2006
OBJECTIVE: To evaluate both factors predicting nontransport and mortality rates in an emergency medical services system with a nontransport policy. METHODS: We reviewed data from 1,581 transported and nontransported patients from October 2001 to July 2003. ...
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Journal ArticleJ Community Health Nurs · 2006
Up to 55% of the homeless population report health problems. They often use the emergency department (ED) to obtain care when the health needs are not urgent. Nurse-managed clinics have the potential to reduce nonurgent ED use and improve the health of the ...
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Journal ArticleThromb Res · 2006
INTRODUCTION: Ischemic stroke causes substantial death and disability. Currently, recombinant tissue plasminogen activator (rt-PA) is the only FDA approved therapy. However, there are dangerous side effects and therapy must start within 3 h of onset. There ...
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Journal ArticleAm J Emerg Med · January 2006
OBJECTIVE: We sought to assess the proportion of ED patients with an electronically detected S(3) or S(4), determine the relation of these heart sounds to heart failure (HF), and analyze how the proportion changes with ED treatment. METHODS: Heart sounds w ...
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ConferenceAm J Emerg Med · January 2006
OBJECTIVE: To describe time to electrocardiogram (ECG) acquisition, identify factors associated with timely acquisition, and evaluate the influence of time to ECG on adverse clinical outcomes. METHODS: We measured the door-to-ECG time for emergency departm ...
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Journal ArticleAnn Emerg Med · January 2006
STUDY OBJECTIVE: Although chest radiography is quick and inexpensive, previous research suggests that it is often misleading in emergency department (ED) patients with decompensated heart failure, resulting in misdiagnosis and inappropriate treatment. This ...
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Journal ArticleEnviron Health Prev Med · November 2005
The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital a ...
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Journal ArticleEnvironmental Health and Preventive Medicine · November 1, 2005
The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital a ...
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Journal ArticleAcad Emerg Med · September 2005
OBJECTIVES: Neurologic complaints are a frequent cause of emergency department visits. The morbidity and mortality of neurologic complaints such as headache and stroke can be extensive. Thus, emergency medicine residency programs should ensure adequate tra ...
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Journal ArticleAm J Emerg Med · July 2005
The purpose of this study was to determine whether long-term and short-term changes in cardiac troponin T (cTnT) were associated with adverse cardiac events (ACEs) in patients with chronic kidney disease. Long-term changes were defined as changes in cTnT b ...
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Journal ArticleAnn Emerg Med · July 2005
STUDY OBJECTIVE: Despite recommendations, emergency department (ED)-based HIV screening is not widespread, and feasibility studies are generally limited to settings with high HIV prevalence (>1%). This investigation was to evaluate an ongoing, publicly fun ...
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ConferenceAcad Emerg Med · May 2005
OBJECTIVES: Most contemporary cardiac risk stratification tools have been derived and validated in mixed-race populations. Their validity in single-race populations has not been tested. The authors sought to compare the performance of a risk stratification ...
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Journal ArticlePrehosp Emerg Care · 2005
OBJECTIVES: To describe the characteristics of patients found to have cardiac arrest and to evaluate the characteristics predictive of survival after cardiac arrest in a paramedic first-responder model. METHODS: All patients who suffered out-of-hospital ca ...
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Journal ArticlePublic Health Rep · 2005
OBJECTIVES: Accessing at-risk and underserved populations for intervention remains a major obstacle for public health programs. Emergency departments (EDs) care for patients not otherwise interacting with the health care system, and represent a venue for s ...
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Journal ArticleJ Stroke Cerebrovasc Dis · 2005
OBJECTIVE: Quantifying stroke severity is essential for interpreting outcomes in stroke studies; severity impacts outcomes. Because outcome studies often enroll patients some time after stroke and there is little standardization of the history and physical ...
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Journal ArticleCongest Heart Fail · 2005
The prevalence of abnormal diastolic heart sounds in asymptomatic adults has been the subject of great debate. The authors determined the prevalence of an electronically detected S3 and S4 in 1329 asymptomatic adults between the ages of 18 and 94. The auth ...
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Journal ArticleCongest Heart Fail · 2005
Emergency-department (ED)-based observation-unit treatment has been shown to reduce inpatient admissions, hospital bed-hours, and costs without adversely affecting outcomes for several conditions. A sequential group design study compared risk-matched, acut ...
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ConferenceAnn Emerg Med · December 2004
STUDY OBJECTIVE: In patients presenting to the emergency department (ED) with an initial diagnostic impression of noncardiac chest pain, we determine the 30-day incidence of adverse cardiac events and characteristics associated with those events. METHODS: ...
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ConferenceAnn Emerg Med · October 2004
STUDY OBJECTIVE: Patients with uncomplicated odontalgia use a significant proportion of emergency department (ED) resources. Some odontalgia patients are unaware that routine dental care is unavailable in most EDs. Using extensive input from regional denti ...
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Journal ArticleAcad Emerg Med · April 2004
OBJECTIVES: Failure to obtain cervical cancer screening can be precipitated by limited knowledge. This study describes understanding of Papanicolaou (Pap) smear testing among women undergoing emergency department (ED) pelvic examination and tests the feasi ...
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ConferenceAcad Emerg Med · April 2004
UNLABELLED: Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist. OBJECTIVES: To determine if insurance status affects quality of care in ...
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Journal ArticleAm J Obstet Gynecol · February 2004
OBJECTIVE: This study was undertaken to determine proportions of very-low-birth-weight (VLBW) multiple birth infants receiving neonatal intensive care whose mothers received various types of infertility treatment and to evaluate infertility treatment-assoc ...
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Journal ArticleAcad Emerg Med · November 2003
OBJECTIVES: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and non interventional treatment. METHODS: Data on adults ...
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Journal ArticleAcad Emerg Med · October 2003
OBJECTIVES: Pennyroyal oil ingestion has been associated with severe hepatotoxicity and death. The primary constituent, R-(+)-pulegone, is metabolized via hepatic cytochrome P450 to toxic intermediates. The purpose of this study was to assess the ability o ...
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Journal ArticleJ Gen Intern Med · September 2003
OBJECTIVES: The dramatic increase in the U.S. elderly population expected over the coming decades will place a heavy strain on the current health care system. General internal medicine (GIM) residents need to be prepared to take care of this population. In ...
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Journal ArticleInt Arch Occup Environ Health · September 2003
OBJECTIVES: To compare vibrotactile thresholds between five international test centres, to determine causes of variability, and to provide normative data for use by health professionals. METHODS: Vibrotactile thresholds were measured on various fingers in ...
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Journal ArticleJ Am Geriatr Soc · July 2003
This report documents the development and growth of geriatric medicine fellowship training in the United States through 2002. A cross-sectional survey of geriatric medicine fellowship programs was conducted in the fall 2001. All allopathic (119) and osteop ...
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ConferenceAcad Emerg Med · July 2003
OBJECTIVES: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. METHODS: Medical records of patients presenting to an urban ED between January 1, ...
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Journal ArticleAcad Emerg Med · March 2003
OBJECTIVES: To determine electrocardiogram (ECG) predictors of positive cardiac markers and short-term adverse cardiac events in an undifferentiated chest pain population presenting to emergency departments (EDs). The authors hypothesized that specific ECG ...
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Journal ArticleAm J Geriatr Psychiatry · 2003
OBJECTIVE: The authors document the development and growth of geriatric psychiatry fellowship training in the United States (U.S.) through 2002. METHODS: A cross-sectional survey of the 62 U.S. geriatric psychiatry fellowship programs was conducted in Fall ...
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Journal ArticleAmerican Journal of Geriatric Psychiatry · January 1, 2003
Objective: The authors document the development and growth of geriatric psychiatry fellowship training in the United States (US.) through 2002. Methods: A cross-sectional survey of the 62 US. geriatric psychiatry fellowship programs was conducted in Fall 2 ...
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Journal ArticleJAMA · November 13, 2002
CONTEXT: By 2030, 20% of the US population will be older than 65 years compared with 12.4% in 2000. The development of geriatric medicine research and training programs to prepare for this increasing number of older individuals is largely dependent on the ...
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Journal ArticleAm J Obstet Gynecol · September 2002
OBJECTIVE: The purpose of this study was to test the hypothesis that benefits of antenatal glucocorticoids to reduce death or major morbidities are similar in very low birth weight multiple and singleton infants. STUDY DESIGN: Infants with birth weight of ...
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Journal ArticleInt Arch Occup Environ Health · January 2002
OBJECTIVES: To assist occupational health professionals to interpret the results of standardised tests for components of the hand-arm vibration syndrome by presenting data for healthy subjects and identifying the effects of some of the confounding variable ...
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Journal ArticleInt Arch Occup Environ Health · July 2001
OBJECTIVES: To compare alternative methods of interpreting the response of finger skin temperature (FST) to cold provocation for the detection of the abnormal cold response observed in vibration-induced white finger (VWF). METHOD: The FST response to cold ...
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Journal ArticleOccup Environ Med · March 2001
OBJECTIVES: To investigate the acute response of finger circulation to vibration with different combinations of magnitude and duration but with the same "energy equivalent" acceleration magnitude according to current standards for hand transmitted vibratio ...
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Journal ArticleOccup Environ Med · June 2000
OBJECTIVES: To investigate the acute effects of the frequency of hand transmitted vibration on finger circulation. A further aim was to investigate whether the frequency weighting assumed in current standards for hand transmitted vibration reflects the hae ...
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Journal ArticleInt Arch Occup Environ Health · September 1999
OBJECTIVES: To quantify neurological dysfunction in workers exposed to hand-transmitted vibration using alternative neurological tests. To relate the neurological findings to the results of vascular tests and the symptoms reported by subjects with vibratio ...
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Journal ArticleScand J Work Environ Health · June 1999
OBJECTIVES: Changes in finger circulation were studied during and after acute exposure to increasing magnitudes of hand-transmitted vibration. METHODS: Finger skin temperature (FST) and finger blood flow (FBF) were measured in the middle fingers of both ha ...
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Journal ArticleScand J Work Environ Health · April 1998
OBJECTIVES: This study investigated changes in finger circulation after different durations of exposure to hand-transmitted vibration. METHODS: Finger skin temperature (FST), finger blood flow (FBF), and finger systolic blood pressure (FSBP) were measured ...
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ConferenceCent Eur J Public Health · 1995
Finger systolic blood pressure measured after cold provocation and ischemia of a digit is used to assist in the diagnosis of vibration-induced white finger, VWF. A reduction in finger systolic blood pressure after cooling is assumed to indicate vascular dy ...
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