Dr. Shaw and his lab were recently awarded a subcontract to Columbia University’s SPOTRIAS proposal ‘NeuSTART.’ This is a prospective clinical trial of lovastatin, an HMG-CoA reductase inhibitor, in the treatment of acute stroke. The task of the subcontract is to determine the effect of lovastatin on the lytic efficacy of recombinant tissue plasminogen activator (rt-PA) in an in-vitro human clot model. If there is no change in the lytic efficacy of combination rt-PA and lovastatin, this would suggest that such combination therapy may be safe in the clinical treatment setting, opening up the possibility of new treatments for acute stroke patients.

Currently, the only FDA approved therapy for acute ischemic stroke is the administration of tissue plasminogen activator (rt-PA). However, this therapy can have the side effect of intra-cerebral hemorrhage; this has led to interest in alternative or adjunctive therapies such as ultrasound enhanced thrombolysis (UET) and/or added medications such as GP IIb-IIIa inhibitors. In a recent study conducted by by Dr. George Shaw, he and his lab measured the in-vitro thrombolytic efficacy of combined eptifibatide (a GP IIb-IIIa inhibitor) and recombinant tissue plasminogen activator (rt-PA) in an in-vitro human clot model. They found that clot lysis, or the breaking up of a blood clot, was maximized for a range of rt-PA and eptifibatide concentrations that correspond well with those expected in human subjects treated with rt-PA and eptifibatide in clinical trials (such as CLEAR-ER), suggesting these therapies may be effective treatments. Further details on the results of this study are now in press in Thrombosis Research.

A statement from the American Heart Association in 2009 re-defined TIA as transient neurological dysfunction without acute infarction. MRI/DWI was recommended as the preferred imaging method. In a paper that is now in press with the journal Stroke, Drs. Opeolu Adeoye and Laura Heitsch examined how much more frequently MRI would be used if all TIA patients had MRI performed. Their findings suggest MRI use would more than double based on current practice. Given the current economic climate, further study of the use of neuroimaging in TIA patients is warranted.

Simulation is an increasingly important component of physician training and debriefing sessions are widely considered an important component of the simulation experience. There is much that remains unknown though about the optimal use and application of debriefing sessions. The types of training that benefit most from debriefing are unclear. Dr. Frank Fernandez of the Emergency Department has recently received a University of Cincinnati grant in order to evaluate the effect of debriefing sessions on procedural training, specifically training on the insertion of central venous catheters. Research to better identify the effects of debriefing sessions in this setting will be conducted over the coming year. Dr. Fernandez hopes that the results will help improve the design and effectiveness of future simulation training.

Because chest pain can be caused by serious illnesses, doctors tend to play it safe and use expensive resources to keep watch on these patients once they get admitted to a hospital. However, new research suggests that many of these patients don't need to be watched, but they still get the higher bill for the extra monitoring they got. In a paper to be published in Academic Emergency Medicine, Dr. Michael Ward and his colleagues compared the risks and benefits of using monitored beds for chest pain patients, and they have identified a group of patients that it may be more cost-effective to admit without using the expensive monitoring resources. One of the side effects of a decision to use the cheaper resource will be that these patients will no longer compete with other truly sick patients for the monitored beds.

A recent meeting at the National Heart, Lung and Blood Institute assessed the challenges and opportunities related to Emergency Department management of Acute Heart Failure Syndromes (AHFS). The assembled faculty, which included UC Emergency Department physicians, represented a large cross section of medical professionals spanning the medical management continuum of patients presenting with acute heart failure and included heart failure cardiologists, emergency physicians, laboratory medicine specialists, nurses, and bench scientists. Their recommendations include proposals regarding the design and conduct of emergency department-based clinical trials, suggestions regarding the development of improved methods for early detection and monitoring of AHFS, and potential needs for expanding translational and applied AHFS focused research and biotechnology. More about Dr. Collins and this important new discovery can be read at http://healthnews.uc.edu/news/?/11077/

Patients who present to the emergency department with shortness of breath often present a diagnostic dilemma. In recent years, b-type natriuretic peptide (BNP) has been found to be helpful in a subset of patients where the diagnosis is not clear after the standard work-up which often consist of a chest x-ray and blood work. However, intermediate BNP levels (100-500 pg/ml) are often present and do not help in determining the correct diagnosis. The results of this study, which include contributions from UC Emergency Department physician Dr. Sean Collins, suggest the presence of the S3, an abnormal heart sound, improves the clinician’s ability to diagnose heart failure when intermediate BNP levels are present. These results are now in press with the American Journal of Emergency Medicine.

Observation Units (OUs) for Acute Heart Failure Syndromes (AHFS) have proven to be effective in reducing HF admissions and may reduce costs. Direct and inherent costs for treating AHFS are expected to total 34.8 billion dollars in 2008 with 75% of AHFS-related costs being incurred in the first 48 hours after presentation. As more than 80% of AHFS patients present to the emergency department (ED), significant pressures exist to manage these patients efficiently in the acute-care environment. Selected patients may be eligible to receive care for AHFS in an observation unit (OU) which may provide a safe and effective means to lower costs by providing an alternative to an inpatient stay. This article reviews the latest literature on the subject and serves to describe the framework by which an OU can be used to effectively manage patients with AHFS.

Research by Dr. Stewart Wright on clinical treatment guidelines was recently the subject of a moderated session at the 2010 Society for Academic Emergency Medicine Annual Meeting . Dr. Wright’s work on ‘knowledge translation’ through online guides, order sets, and treatment flowcharts was also the subject of a recent UC HealthNews article, which you can read HERE. Congratulations to Dr. Wright, and all of the other 2010 SAEM Conference presenters!

The Department of Emergency Medicine was well represented at this year's national conference with a whole host of presentations by emergency medicine residents and faculty from Cincinnati. There were five didactic sessions, a moderated medical education session, eight posters, and an oral research presentation. Our offerings were well received and well attended; there was standing room only as Dr. Virginia Culyer talked about her study on blood pressure management in SAH with people lined up in the hallways trying to get in. Congratulations to everyone who participated, and a special thank you to Dr. Andra Blomkalns, Chair of the Program Committee, for organizing such a successful event..