Scholars@Duke
Harry Wells Severance Jr.

Harry Wells Severance Jr.

Adjunct Assistant Professor in the Department of Medicine
Medicine, Cardiology
harry.severance@duke.edu
Box 3096 Med Ctr, Durham, NC 27710
0682 Hosp North, Durham, NC 27710

Selected Publications

More Hospitals are Closing.

Report · December 11, 2023 The wave of increasing hospital closures and service line cutbacks continues to sweep the U.S. ... Link to item Cite

More Hospitals are Closing

Journal Article ACEP Now · December 11, 2023 The wave of increasing hospital closures and service line cutbacks continues to sweep the U.S. Worsening Doctor/Nursing Shortages Playing a Significant Role! ... Open Access Link to item Cite

A Manager's Perspective on Healthcare Unionization — Her response was not at all what I expected.

Other MedPage-Today · June 11, 2023 Unexpected support for healthcare unionization ... Link to item Cite

The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

Other KevinMD.com · June 2, 2023 Violence within our health care workplaces has been a steadily rising and critical problem over the past decade – now further fueled by issues such as fallout from the COVID pandemic – including a political-issue-motivated demonization of health care worke ... Link to item Cite

An unspoken truth about non-compete clauses in medicine

Other KevinMD.com · March 15, 2023 One of the least discussed but more destructive aspects of non-compete clauses is that of “family and social disruption.” Many might say that family/social conditions are not part of workplace activities, and it’s up to the employee to “make it work.” But, ... Link to item Cite

Should You Stay or Should You Go? Strategies for stabilizing your curent job or migrating to a new career if it's time to leave.

Other Emergency Physicians Monthly · June 21, 2022 Strategies for stabilizing your current job or migrating to a new career if it’s time to leave. ... Open Access Link to item Cite

‘Burnout’ and the Healthcare Workplace

Other lEmergency Physician's Monthly · May 8, 2022 Burnout is a systemic issue perpetuated by the disruptive state of many of our healthcare workplaces. To promote burnout as a condition of individual resiliency does a disservice to our healthcare workers and perpetuates an avoidance of addressing the real ... Open Access Link to item Cite

Feasibility of combining serial smartphone single-lead electrocardiograms for the diagnosis of ST-elevation myocardial infarction.

Journal Article Am Heart J · March 2020 BACKGROUND: The rate-limiting step in STEMI diagnosis often is the availability of a 12-lead electrocardiogram (ECG) and its interpretation. The potential may exist to speed the availability of 12-lead ECG information by using commonly available mobile tec ... Full text Open Access Link to item Cite

Smartphone ECG for evaluation of ST-segment elevation myocardial infarction (STEMI): Design of the ST LEUIS International Multicenter Study.

Journal Article J Electrocardiol · 2018 In patients experiencing an ST-elevation myocardial infarction (STEMI), rapid diagnosis and immediate access to reperfusion therapy leads to optimal clinical outcomes. The rate-limiting step in STEMI diagnosis is the availability and performance of a 12-le ... Full text Open Access Link to item Cite

Changes in Medical Therapy and Lifestyle After Anatomical or Functional Testing for Coronary Artery Disease.

Journal Article J Am Heart Assoc · October 12, 2016 BACKGROUND: Diagnostic testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medication ... Full text Open Access Link to item Cite

Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.

Journal Article Ann Intern Med · July 19, 2016 BACKGROUND: PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) found that initial use of at least 64-slice multidetector computed tomography angiography (CTA) versus functional diagnostic testing strategies did not improve clinica ... Full text Open Access Link to item Cite

The Prtotocol-Provided Clinical Research Model as an Evolving Research Opportunity for Community-Based Hospitals and Health Care Facilities

Journal Article Technology and Innovation · 2016 There is an evolving model of protocol-provided clinical research that has become more standardized as a research pathway over the last several decades. This model, with reduced research-specific infrastructure requirements and whose trial processes, manag ... Full text Open Access Cite

The Effect of Emergency Medicine Residents on Clinical Efficiency and Staffing Requirements.

Conference Acad Emerg Med · January 2016 OBJECTIVES: The effect of emergency medicine (EM) residents on the clinical efficiency of attending physicians is controversial. The authors hypothesized that implementing a new EM residency program would result in an increase in relative value units (RVUs ... Full text Link to item Cite

Changes in Medical Therapy and Lifestyle After Anatomical Versus Functional Testing for Coronary Artery Disease: The PROMISE Trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain)

Conference · November 10, 2015 Introduction: Diagnostic testing may represent a “teachable moment” for patients newly presenting with symptoms suggestive of CAD and requiring further evaluation, and may influence risk factor management, independent of test results. However, little is kn ... Open Access Link to item Cite

Identifying Barriers and Practical Solutions to Conducting Site-Based Research in North America: Exploring Acute Heart Failure Trials As a Case Study.

Journal Article Heart Fail Clin · October 2015 Although the prognosis of ambulatory heart failure (HF) has improved dramatically there have been few advances in the management of acute HF (AHF). Despite regional differences in patient characteristics, background therapy, and event rates, AHF clinical t ... Full text Open Access Link to item Cite

Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study.

Journal Article J Electrocardiol · 2015 BACKGROUND: 12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension ... Full text Open Access Link to item Cite

Cardiac injury due to accidental discharge of nail gun.

Journal Article J Emerg Med · February 2013 BACKGROUND: Since 1991, the incidence of injuries associated with pneumatic and explosive powered nail guns has steadily been rising due to increasing use of these devices by the untrained consumer. The vast majority of injuries involve the extremities, bu ... Full text Open Access Link to item Cite

Risk stratification in chest pain patients undergoing nuclear stress testing: the Erlanger Stress Score.

Journal Article Crit Pathw Cardiol · December 2012 BACKGROUND: Studies have individually reported the relationship of age, cardiac risk factors, and history of preexisting coronary artery disease (CAD) for predicting acute coronary syndromes in chest pain patients undergoing cardiac stress testing. In this ... Full text Link to item Cite

Use of pulse co-oximetry as a screening and monitoring tool in mass carbon monoxide poisoning.

Journal Article Prehosp Emerg Care · 2010 Carbon monoxide (CO) poisoning remains a common cause of poisoning in the United States. We describe a case where responding fire department personnel encountered a sick employee with a headache at an automotive brake manufacturing plant. Using both atmosp ... Full text Open Access Link to item Cite

Proposing short-term observation units for the management of decompression illness.

Journal Article Undersea Hyperb Med · 2006 Decompression illness (DCI) is a potentially life-threatening disease, often requiring hyperbaric oxygen therapy (HBO2) for symptom resolution. Once treated, current guidelines recommend an observation period of at least six hours for patients with neurolo ... Link to item Cite

Ice storm-related carbon monoxide poisonings in North Carolina: a reminder.

Journal Article South Med J · November 2004 Severe winter weather, such as ice storms, that results in loss of electrical power, is frequently mentioned as a contributing factor in acute carbon monoxide (CO) poisoning. However, in our literature review, such events are infrequently reported. This ar ... Full text Open Access Link to item Cite

Mass-casualty victim "surge" management. Preparing for bombings and blast-related injuries with possibility of hazardous materials exposure.

Journal Article N C Med J · 2002 Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore t ... Open Access Link to item Cite

Identification of chest pain patients appropriate for an emergency department observation unit.

Journal Article Emerg Med Clin North Am · February 2001 There are no perfect tests or algorithms to exclude ACI. Because acute coronary occlusion often occurs in patients with low-grade coronary stenosis, the diagnostic goal of a chest pain diagnostic protocol is not to identify patients with CAD, but rather to ... Full text Open Access Link to item Cite

Comparison of an automated thrombolytic predictive instrument to both diagnostic software and an expert cardiologist for diagnosis of an ST elevation acute myocardial infarction.

Journal Article J Electrocardiol · 2000 Because the electrocardiograms (ECGs) of patients with symptoms suggesting an acute thrombotic coronary occlusion are typically read by physicians relatively inexperienced in this skill, it is important to develop automated decision support. A Thrombolytic ... Full text Link to item Cite

Ballistic Wounding

Journal Article Critical Decisions in Emergency Medicine · March 1, 1999 Open Access Cite

Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study.

Journal Article Am J Cardiol · September 1, 1997 This study examines the question of whether chest pain observation units increase the proportion of chest pain patients with an extended evaluation for cardiac ischemia ("rule out myocardial infarction [MI] evaluation"), decrease the number of missed MIs, ... Full text Link to item Cite

Differences between chest pain observation service patients and admitted "rule-out myocardial infarction" patients.

Journal Article Acad Emerg Med · July 1997 OBJECTIVE: To compare and contrast the patient characteristics of ED patients at low risk for acute cardiac ischemia who were assigned to a chest pain observation service vs those admitted to a monitored inpatient bed for "rule-out acute myocardial infarct ... Full text Open Access Link to item Cite

Sickle cell vaso-occlusive pain crisis in adults: alternative strategies for management in the emergency department.

Journal Article South Med J · August 1992 The gene for sickle cell disease is carried by 8% of the African-American population in the United States. The primary care physician is often called upon to recognize and treat one of the major sequelae of sickle cell disease--vaso-occlusive pain crisis. ... Full text Open Access Link to item Cite

Observation medicine: an annotated bibliography.

Journal Article Am J Emerg Med · January 1992 Full text Link to item Cite

Treatment of pyelonephritis in an observation unit.

Journal Article Ann Emerg Med · March 1991 STUDY OBJECTIVE: To determine the feasibility of managing patients with acute pyelonephritis as outpatients after initial treatment with IV antibiotics in an emergency department observation unit. DESIGN: Prospective and uncontrolled. SETTING: ED observati ... Full text Link to item Cite

Emergency department analgesia without narcotics for adults with acute sickle cell pain crisis: case reports and review of crisis management.

Journal Article J Emerg Med · 1991 Vaso-occlusive crises are one of the most debilitating features of sickle cell disease. There appears to be no standardization of care for adults with pain crisis, and some commonly utilized regimens, such as those employing intramuscular meperidine, are p ... Full text Link to item Cite

Assault rifles; definitions, evolutionary history and medical consequences.

Journal Article J Miss State Med Assoc · December 1990 In summary, the evolutionary history of assault rifles may be of interest to some medical practitioners. It is important to realize that the term "assault rifle" is incorrectly and overused in the lay press. As a rough generalization, the wounds from such ... Open Access Link to item Cite

Sialolithiasis: case studies and review.

Journal Article J Emerg Med · 1990 Three cases of sialolithiasis are presented, each representative of acute and chronic presentations of this problem. The evaluation and treatment of salivary gland and duct stones are outlined. The primary axiom is, "Treat the gland, not the stone," and th ... Full text Link to item Cite

Acute carbon monoxide poisoning: emergency management and hyperbaric oxygen therapy.

Journal Article J Miss State Med Assoc · October 1989 An ice storm in February 1989 resulted in numerous incidences of carbon monoxide poisoning in central Mississippi secondary to exposure to open fires in unventilated living spaces. Sixteen cases were treated during this period at the University of Mississi ... Link to item Cite

MANAGEMENT OF OBSERVATION UNITS

Journal Article ANNALS OF EMERGENCY MEDICINE · December 1, 1988 Link to item Cite

A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction.

Journal Article J Am Coll Cardiol · December 1988 This prospective study compares the outcome of patients with acute myocardial infarction managed by mobile intensive care (paramedic phase) with that of similar patients managed by basic emergency medical care (control phase) in the same community before t ... Full text Link to item Cite

Profound muscle weakness and hypokalemia due to clay ingestion.

Journal Article South Med J · February 1988 We have presented the case of a 43-year-old woman with severe myositis due to clay ingestion and hypokalemia. EMG studies revealed a pattern consistent with myositis, and muscle biopsy showed a nonspecific diffuse myositis. The clay was shown to act as a p ... Full text Open Access Link to item Cite

Basic emergency medical care of patients with acute myocardial infarction: initial prehospital characteristics and in-hospital complications.

Journal Article J Am Coll Cardiol · September 1984 This prospective study documents the natural history of the prehospital phase of 110 patients with acute myocardial infarction transported by a basic emergency medical system during a 22 month period. Ambulances in a mixed urban-rural county were staffed b ... Full text Link to item Cite

Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction.

Journal Article Am J Med · June 1984 Sinus tachycardia often accompanies other indicators of poor prognosis in acute myocardial infarction. This study was performed to evaluate the prognostic significance of early (Days 1 to 3) in-hospital sinus tachycardia (isolated sinus tachycardia) in the ... Full text Link to item Cite

Assessment of out-of-hospital resuscitation.

Journal Article Am J Emerg Med · May 1984 Full text Link to item Cite

Out-of-hospital management of cardiac arrest by basic emergency medical technicians.

Journal Article Am J Cardiol · January 1, 1984 The outcome in 126 consecutive patients with nontraumatic out-of-hospital cardiac arrest was analyzed to determine the effectiveness of a standard ambulance system over 22 months. Therapy was limited to basic life support (that is, administration of oxygen ... Full text Link to item Cite

Rupture of the plantaris--does it exist?

Journal Article J Bone Joint Surg Am · December 1982 Link to item Cite

Criteria for early discharge after acute myocardial infarction: validation in a community hospital.

Journal Article Arch Intern Med · January 1982 All patients admitted to a community hospital coronary care unit during an 18-month-period were studied to validate previously reported criteria for early hospital discharge after myocardial infarction. Factors present during the first four hospital days, ... Link to item Cite