This award from the CCTST's translational grant program for junior investigators is steeply contested, with many applications having been received from across UC and CCHMC. The award recognizes Dr. Adeoye as one of the foremost up-and-coming researchers at the Academic Health Center.

This two-year career development award from the Emergency Medicine Foundation will provide him with the resources needed to continue his research training as well as to answer questions about how to mitigate transient negative effects of implementing a new electronic medical record system.

Point-of-care testing (POCT) is thought to improve emergency department (ED) efficiency and therefore patient throughput by decreasing time spent by physicians waiting for traditional laboratory testing. In a study lead by Dr. John Deledda, the ED implemented POCT for cardiac biomarkers at UC Health University Hospital in August 2006 and determined whether it improved patient throughput for all patients and specifically those patients thought to active coronary artery disease. We analyzed data for about 54,000 patients, and on average we decreased overall patient throughput time by 17 minutes. We decreased that time by 26 minutes for our cardiac patients. This is most important for these cardiac patients where definitive treatment is so dependent on efficient multidisciplinary care teams starting in the ED, extending to the cardiac catheterization laboratory, and ultimately the cardiovascular intensive care unit.

The immune cells in our body are not only involved with fighting infections, but are also responsible for causing heart and vascular disease. In a new study to be published in the Journal of Inflammation, Dr. Blomkalns and her colleagues describe how these cells act in a dual role, helping us and harming us at the same time. This study demonstrates how these immune functions might be separated so that doctors could treat vascular disease, but at the same time allowing are immune system to fight infections.

The goal of treating patients suffering heart attacks is to open a clogged cardiac artery as soon as possible. For a certain type of heart attack, called a STEMI, the American Heart Association and American College of Cardiologists have set a goal of 30 minutes if a clot-buster drug is given (fibrinolysis) or 90 minutes if a stent is to be placed (percutaneous coronary intervention, or PCI). While all Emergency Departments have access to fibrinolysis, not every hospital is capable of PCI. As a result, many people are transferred to a PCI-hospital to receive a stent, and a helicopter is frequently used to make that transfer as fast as possible. In a recent study published in Annals of Emergency Medicine, University Hospital researchers found that only 1 in 5 are treated with fibrinolytics prior to transfer, and of those, less than half are treated within the 30-minute goal. Of those transferred for PCI, only 4% received treatment within the 90-minute goal, and more than half were treated after two hours.

A recent article in Circulation, the Journal for the American heart Association, outlines current care for acute heart failure in the Emergency Department setting. However, in the findings co-authored by Dr. Sean Collins, there is an apparent paucity of evidence behind this clinical care and a lack of a cohesive research strategy between stakeholders. To rectify this issue, the authors recommend subsequent studies and research which will fill in these knowledge gaps, with a focus on the role as ED physicians as 'gatekeepers' of heart failure patients and the impact of short term care on long term outcomes.

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.

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..

Second-year medical student and former Clinical Study Assistant Research Fellow Nitin Ubhayakar has been highlighted in the June 2010 issue of Findings. The success of Mr. Ubhayakar in both his current academic career, as well as the national publication of his research findings, is worthy of heartfelt congratulations. To read the entire article on Mr. Ubhayakar and the CSA Fellow program, please click here.

Time is of the essence when evaluating and treating neurologic emergencies. A review paper recently published by UC Health Physicians and University of Cincinnati scientists outlines the challenges of diagnosis and highlights the need for improved testing methods. The analysis by Drs. Jason McMullan, William Knight, and Arthur Pancioli concludes that the development of time sensitive technologies appropriate for use with neurologically ill patient are needed to improve therapies and outcomes.

In a study recently presented at the annual meeting of the Pediatric Academic Societies, Dr. Carolyn Holland uncovered a demonstrable disparity between the care provided to patients of different racial backgrounds. After examining 352 ED visits, Dr. Holland found that emergency room physicians are more likely to document sexual histories of black teen girls with symptoms of sexually transmitted infections than white teen girls with the same symptoms. The result is that emergency physicians may be providing comparatively poorer treatment for white teen girls than black.

Congratulations to Mr. Steven Chrzanowksi, an undergraduate student in Dr. George Shaw's lab, who was recently named as the 2010 Outstanding Research Co-op Student for Biomedical Engineering by the Division of Professional Practice. Mr. Chrzanowksi has been working on POCENT, an NIH/NIBIB funded study to develop a non-invasive neurologic sensor, since 2009. His work has resulted in two abstracts, two invention disclosures, and the issuance of a provisional patent in November 2009. He will attend the University of Florida medical school as a student in their MD/PhD program in Fall 2010 on a full scholarship.

Congratulations are in order to Greater Cincinnati Stroke Team member Dr. William Knight on being awarded the EMBRS research grant for 2010-2011. This grant from the Emergency Medicine Foundation is highly competitive, and is awarded to the best research project submitted by all attendees at the Emergency Medicine Basic Research Skills courses during the year. Dr Knight’s proposed research regarding the incidence of non-convulsive seizures in patients undergoing therapeutic hypothermia for cardiac arrest has the potential has the potential to beneficially impact care for those patients critically ill from heart attacks, and help physicians understand the treatment options they have. Once again the department congratulates Dr. Knight at being awarded the EMBRS research grant, and looks forward to his continued success.

Galectin-3 is a novel marker of inflammation released by cardiac macrophages which is known to impair cardiac function. It is currently unknown how initial galectin-3 levels, obtained in the Emergency Department, can help to identify risk I patients of 5- and 30-day cardiac events, such as a heart attack. Researchers will study 250 ED patients with acute heart to determine the ability of Galectin-3 to predict possible future heart problems, potentially giving doctors a new and valuable diagnostic measure.

Angiodema, a dangerous and severe swelling that can potentially cause airway obstruction, has been noted as a possible side effect in some patients on particular kinds of blood pressure medications called ACE inhibitors. As ACE inhibitors are often the drugs of first choice in treating conditions such as heart failure and hypertension, being able to treat potential cases angiodema is critical. Under the leadership of Dr. Jonathan Bernstein and Dr. Joseph Moellman, the Emergency Departments at both University Hospital and Jewish Hospital have begun screening for patients with signs and symptoms of Angioedema caused by ACE inhibitors to study a new drug to combat this condition.

HIV prevention efforts are increasingly focused on screening in non-traditional healthcare settings, such as emergency rooms. Among the many barriers to HIV screening is patient refusal when testing is offered. Medical student and former CSA Fellow Nitin Ubhayakar found that patients who declined HIV testing in the emergency room had risk equal to those who consented. This evidence supports the need for increasing consent rates for testing, as might be achieved using the consent methods recommended by the CDC.

Dr. Jordan Bonomo has successfully enrolled the first patient in an important trial to detect the presence of cerebral vasosapsams – deadly contractions in the blood vessels of the brain – in patients that have suffered severe traumatic brain injury (TBI). This trial is the first ever look at the use of CAT scans to identify the presence of cerebral vasospasms, and also looks to identify cerebral spinal fluid markers that may predict vasospasm occurrence in the TBI patient.

With millions of Americans suffering from neurological emergencies each year, it becomes imperative to be able to diagnose to these critical disorders as quickly as possible. Devastating issues such as acute strokes, severe traumatic brain injury, and spinal coord injury can become progressively more troublesome as delays in diagnosis occur. As a result, POC (point of care) testing for neurological emergencies has the potential to speed accurate diagnosis, and improve the possible outcomes. Dr. McMullan’s paper takes a close look at a number of approaches being used in the POC-CENT study to provide this kind of POC testing for these serious injuries, and the potential they provide in assisting diagnosis.

Drs. Adeoye and Shaw have been awarded a $94,000 grant by the Point-of-Care Center for Emerging Neurotechnologies (POC-CENT). The goal of this award is to develop a novel non-invasive neurological monitor. Dr. Adeoye is PI of the award and Dr. Shaw serves as a co-investigator. Other co-investigators include Drs. Matthew Flaherty and Kenneth Wagner of the Department of Neurology.

Understanding and treating the root cause of heart attacks (myocardial infarctions) could change how we care for patients with heart disease. Myocardial infarctions occur when lesions (plaques) in blood vessels rupture, which attracts factors that clog the arteries. While the specific reasons that cause the lesions to form and break apart was thought to be understood, new research shows that the culprits may start on the OUTSIDE of the blood vessel rather than inside as previously thought. Dr. Andra Blomkalns of the Emergency Department and her colleagues propose that fat tissue on the OUTSIDE of blood vessel (called perivascular adipose tissue) may be linked to the rupturing process, opening up a whole new direction for research into understanding heart attacks .

Congratulations to Dr. Stewart Wright on being awarded a $300,000 grant from the Agency for Healthcare Research and Quality (AHRQ), the federal agency charged with improving quality, safety, efficiency and effectiveness of healthcare. This award recognizes Stewart's role as a national leader in evidence based medicine. As the co-PI, he and his colleagues at the New York Academy of Medicine will be instrumental in building the practice of EBM, based on the Cincinnati model: CPQE - Know it, Use it, Love it. The grant will fund a series of conferences and educational activities on knowledge translation over the coming three years.

Emergency Medicine’s Dr. Sarah Ronan-Bentle is the Emergency Medicine investigator for PROMMTT (the Prospective Observational Multi-center Mass Transfusion Study), which began at University Hospital in August. This study is running at nine other leading trauma centers nationwide and aims to improve survival rates for major trauma patients who require blood transfusions. This collaboration between Emergency Medicine and the Division of Trauma is led by Dr. Peter Muskat, who is the Principal Investigator for the University of Cincinnati on this Department of Defense funded study. For more information, go to the PROMMTT website.

Welcome this year’s CSA Fellows Naushad Khakoo, Rupen Baxi and Cameron Collier to the Department. Cameron and Naushad come to us having just completed the MS in Physiology at the University of Cincinnati. Rupen earned an MD from Medical University of America and worked as a surgical resident at The Jewish Hospital. During the 10 month fellowship, all three fellows will be immersed in the clinical environment, screening patients for research studies and attending weekly grand rounds. They will participate in a research education program, and will each design and complete, along with a mentor, a formal research project. This unique fellowship is geared toward students interested in health care or clinical research and helps prepare them for doctoral studies.

Congratulations to Dr. Collins and his team on their publication outlining why it is important to establish a network to support clinical trials in acute heart failure. Importantly, the paper clearly discusses the need for early enrollment in acute heart failure studies, and how this can be achieved by a strong collaboration between Emergency Medicine and Cardiology. Great work Sean! Collins SP, Levy PD, Lindsell CJ, Pang PS, Storrow AB, et al. The Rationale for an Acute Heart Failure Syndromes Clinical Trials Network. J Cardiac Fail 2009;15(6):467-474.

First-year resident Dr. Jeremy Boyd’s first author paper entitled “Emergency Medicine Career Choice: A Profile of Factors and Influences from the Association of American Medical Colleges (AAMC) Graduation Questionnaires.” was just published in Academic Emergency Medicine in June 2009. The study was conducted while Dr. Boyd was a medical student at Brown University. Congratulations, Dr. Boyd. Acad Emerg Med • June 2009, Vol. 16, No. 6 544-549.

Dr. Shaw has successfully enrolled the first patient in the cellulitis imaging protocol, a study designed to investigate novel methods of quantifying infection. Good work, Dr. Shaw.

Congratulations to Dr. Brent Gottesman, whose manuscript entitled “Radiation Exposure in Emergency Physicians Working in an Urban Emergency Department: A Prospective Cohort Study” will be published in an upcoming issue of The American Journal of Emergency Medicine. This very thorough study tracked radiation exposure in physicians working in an urban, academic, emergency department, to discover whether or not the levels of radiation exposure were at or below the guidelines recommended for safety. Dr. Gottesman, a recent graduate of the Emergency Medicine Residency, received funding through the Emergency Medicine Resident Research Grant. Amy Gutman, M.D., Christopher Lindsell, PhD, and Hollynn Larrabee, M.D., co-authored the manuscript.

Breaking news: the NETT team has enrolled their first patient in the RAMPART study. This randomized controlled trial is comparing IM midazolam to IV lorazepam in the pre-hospital treatment of status epilepticus. The participant stopped seizing after being treated in the field, and was transported to hospital. This is a major accomplishment, and is the culmination of a huge amount of work from a host of people. It has taken well over a year of planning, community consultation, and working with EMS and hospitals across the whole region. Congratulations to everyone involved!

In addition to giving sage advice about the dangers of fireworks, Dr. Sean Collins is also in the news lately for his research work. Reuters Health is running a story on his study, which examined the utility of acoustic cardiography in the ED for detecting S3. The manuscript was published in the June issue of Annals of Emergency Medicine. For the full story “Acoustic Cardiography Does Not Improve Diagnostic Accuracy in ED Patients With Dyspnea” visit the webiste. Congratulations Dr. Collins.

In addition to giving sage advice about the dangers of fireworks, Dr. Sean Collins is also in the news lately for his research work. Reuters Health is running a story on his study, which examined the utility of acoustic cardiography in the ED for detecting S3. The manuscript was published in the June issue of Annals of Emergency Medicine. For the full story “Acoustic Cardiography Does Not Improve Diagnostic Accuracy in ED Patients With Dyspnea” visit the webiste. Congratulations Dr. Collins.

Congratulations to Dr. Jordan Bonomo and his research team, who won a $25,000 University Research Council grant for interdisciplinary research. Their project will explore the use of CT-angiography and CT-perfusion in identifying post-traumatic vasospasm in severe TBI, as well as exploring potential biomarkers. The pr

Congratulations Dr. Jason McMullan has been awarded the Best Fellow Presentation by the Society for Academic Emergency Medicine for his presentation at last week's conference. For those unable to make his talk, he was extremely well prepared to discuss the science and implications of his study. His skillful presentation was clearly a head above the rest, a fact now recognized by the Program Committee. Outstanding work Jason!

Congratulations to Dr. Sean Collins and his international team of researchers for their new publication in the American Journal of Emergency Medicine. Validation of a Bedside Acoustic Cardiographic Model to Predict Elevated Left Ventricular Filling Pressure. American Journal of Emergency Medicine (2009) 27, 397–408

Congratulations to Dr. Lyons and the EIP team on publication of a new manuscript in the Journal of Medical Screening that describes how results from ED HIV testing programs change depending on how patients and visits are counted. Comparison of emergency department HIV testing data with visit or patient as the unit of analysis. J Med Screen 2009;16:29–32.

Congratulations to Dr. Adeoye and the stroke team on a new publication in the American Journal of Emergency Medicine describing the use of EMS by stroke patients entitled "Emergency medical services use by stroke patients:a population-based study" (American Journal of Emergency Medicine 2009;27:141–145.)

[4/2009] Congratulations to R4 Dr. April Shackleford who, as the presenting author, won the 3rd Place Research Presentation Award at the recent national Critical Care Transport Medicine Conference in San Antonio, besting some of the biggest names in HEMS. Her winning abstract was Predicted Medical Contact to Balloon Times for ST-Segment Elevation Myocardial Infarction Patients with EMS Activation of Air Medical Transport." Great work April!

[4/2009] Dr. Jason McMullan was just awarded a $10,000 grant from the Cincinnati Center for Clinical and Translational Research (CCTST) to explore exception from informed consent. Dr. McMullan’s grant application, evaluated by 3 senior NIH researchers, received excellent scores of 1.1 and 1.2. Congratulations!