Ongoing Studies

First Medical Contact to ECG Time

Description: The aim of this study is to determine if variables such as gender, age, and chief complaint are able to influence the time of first medical contact by EMS to pre-hospital ECG administration.

Current Progress: We are currently in the process of formalizing the rough draft for subsequent submission.

Future Goals:We hope to find that data shows a preference for a specific difference regarding gender, age, and/or chief complaint in regards to differences in time from first medical contact to pre-hospital ECG administration and display our findings to improve/prepare for future scenarios regarding such conditions for EMS personnel.

Members Involved:Jeffrey Luk MD, Vicken Totten MD; Katherine Chen, Wenjing Du, Winston Eng

Sexual Assault Victims in the Emergency Department: Retrospective Analysis by Situational, Personal, and Interpersonal Predictors

Description: This is a retrospective analysis of vulnerability to, and incidence of, rape among sexual assault victims presenting to the emergency room. We will study situational, personal, and interpersonal levels of vulnerability factors that may influence vulnerability to sexual assault using case files compiled through the Sexual Assault Nurse Examiner (SANE) Program at University Hospitals. Temporal and spatial factors associated with rape will be analyzed, as well as personal factors including demographics, medical history, and social history. We will also examine the victim-perpetrator relationship (if any) to determine potential vulnerability.

Current Progress: Data collection has been completed and includes information regarding certain personal, situation and interpersonal factors, such as victim and perpetrator age, gender and race and the location and time of day that the sexual assault incident occurred. Approximately 300 adult (victims 12 years or older) and 160 pediatric (victims less than 12 years of age) cases are currently included in this study.

Future Goals: In the near future, we will begin the statistical analysis portion of this study and will work on the manuscript write-up soon.

Members Involved: PI: Michelle Menegay (PI), Rebecca Chen (PI), Priya Sharma (RA), Jamie Shah (RA), Sabina Kumar (STATS), Vicken Totten MD (Senior I)

Compartment Syndrome

Description: Compartment syndrome is a condition resulting from a painful build-up of pressure in the muscle compartments of the body. Current methods to measure compartment pressure are expensive and usually exclusive to the hospital. This study aims to test a low-cost, disposable device to measure compartment pressure that can be used in unstable settings.

Current Progress: We are currently developing a compartment syndrome model to test our device idea. At the moment, we are experimenting with different muscle and fascia models, such as with meat types and different forms of casing.

Future Goals: The study group hopes to finalize the compartment syndrome model and begin testing the device in the near future. We are looking for whether the device we developed is able to measure compartment pressure as accurately as current devices used in hospitals.

Members Involved: William Qu, Ardi Dand, Samir Shah, Aditya Joshi, Dr. Michelson (PI), Dr. Totten (Senior I)

Effects of Using a Mid-Level Practitioner in ED Triage

Description: This study examines whether placing a mid-level practitioner (MLP) at triage in the ED reduces the number of level 3 patients that left without being seen. It also examines the effects on ED throughput and length of stay, with implications for hospital revenues and overcrowding.

Current Progress: We are in the process of writing up a comprehensive literature review for publication.

Future Goals: We hope to have a final draft of the document by mid-December 2013.

Members Involved: Lilliana Viera-Ortiz MD (PI), Sabina Kumar (PI), Mary Lee (RA), Ardi Dand (RA), Anna Hirsch (RA)

History, physical exam, and laboratory findings associated with sexually transmitted diseases and urinary tract infections in the ED

Description: We are looking at patient history, physical exam, and laboratory findings that are associated with STD and UTI in the ED, and trying to determine the efficacy of physician diagnosis of STDs and UTIs in the ED.

Current Progress:Protocol written, awaiting IRB approval.

Future Goals:Conduct a chart review

Members Involved: PI: Dr. Sheele; Residents: Dr. Bernstein, Dr. Mendoza; EMRD RAs: Aditya Joshi, Hardik Dand

End Tidal CO2

Description: We are using End Tidal CO2 values to compare the efficiency of Endotracheal Intubation, the King LT Superglotic Airway, and the Combitube. We are trying to show that the King LT and Combitube are not as efficient as Intubation.

Current Progress: We have retrospective data from Air Evac, an air evacuation company which has about 40-50% of the market share on medical helicopter transportation and are compiling the data into usable form. We are waiting for a letter from this company saying we are allowed to use their data. The IRB will be submitted as soon as we get this letter.

Future Goals: The next step, once the data is compiled, is to analyze the data and look at the End Tidal CO2 values for the various types of airway management.

Members Involved: Dr. Jeffrey Luk (PI), Aditya Joshi (SH), Samir Shah (RA)

Development of an Abdominal Tourniquet to Prevent Post-Partum Hemorrhage in Rural Africa

Description: In order to prevent post-partum hemorrhage, techniques used in the developed world are unavailable to those in low-income and rural areas worldwide. The short-term goal of this study is to develop an easy-to-apply abdominal tourniquet that will occlude blood flow to the uterus. Ultrasound will be used to measure the occlusion of blood flow.

Current Progress: Currently, we're trying to ultrasound a few female volunteers using our technique, which would allow us to go farther. This will hopefully be done in the next two weeks.

Future Goals: To get this method published: this will hopefully pave the road for another group to try this in action.

Members Involved: Dr. Totten, Michael Sawin, Angelique Do, Maureen O’Reilly (Study Head), William Qu (RA), Anna Hirsch (RA).

Bed Bug Prevalence in University Hospitals Emergency Department

Description: This study aims to determine how often the UHCMC ED closes a patient room due to suspected bed bug outbreak, how long the room is out of commission, and what methods are taken to return the room to a usable state.

Current Progress: We are currently in data collection.

Future Goals: We hope to complete 3 months of data in the near future.

Members Involved: Wyatt Hoch (PI), Anna Hirsch (RA), Maureen O’Reilly (RA), Ardi Dand (RA), Samir Shah (RA)

Knowledge and Discussions of End-of-Life Decisions in the ED

Description: This project is intended to evaluate whether the occurrence of end-of-life discussions or advance directives has changed since the 1991 Patient Self-Determination Act, to explore why some patients are unwilling to talk about end-of-life care, to assess whether the ED is a practical place to have end-of-life discussions, to educate patients about advance directives and their options regarding end-of-life care, and to encourage a dialogue between patient and physician about end-of-life care.

Current Progress:We have trained RAs and will be testing their knowledge one final time before data collection begins in early January (when students return from break).

Future Goals:We hope to get ~300 surveys by roughly March 2015.

Members Involved:PI: Amy Pound, Resident: Shuo Cui, Study Coordinator: Anna Hirsch, RAs: all EMRD members

Palliative Care Study. A Statistical Analysis of percent admission, readmission, and length of emergency department and hospital stay among elderly nursing home patients with and without DNAR’s

Description: This is an observational study looking to compare the readmission rates of patients coming from nursing homes based on their DNAR status (end-of-life care). The study began out of an idea for actually comparing the efficacy of end-of-life planning in the ED. What we hope to do is to make comparisons between the readmission rates and ED stay for groups of patients based on nursing home status and DNAR status.

Current Progress: We are currently working on revising the protocol, so that we can successfully submit it through the IRB process.

Future Goals:Once submitted and accepted through the IRB, we will utilize ED patient data to do the analysis necessary to compare the different groups of patients, and then write up the results of the study.

Members Involved: Wesley Madox, Nikhil Mallipedi, Christine Koniaris MD, Stefan Gravenstein MD

Vaginal Bleeding in Early Pregnancy and Subsequent Preterm Birth Prospective Cohort

Description: Vaginal bleeding is relatively common during pregnancy, but it can also be a significant risk factor for preterm birth. This study aims to examine women who experience vaginal bleeding in their early pregnancy (6-20 weeks). Patient assessment of blood loss and analysis of D-dimer and fibrin split products from a simple blood draw will be conducted. These measurements will be later correlated to the occurrence of preterm birth, which may help determine a quantitative method for predicting the risk of preterm birth in women who experience vaginal bleeding in their early pregnancy.

Current Progress:We are currently enrolling patients into this study.

Future Goals:We aim to complete patient enrollment (200 total patients) within the next two years. Following patient enrollment, we will be analyzing for any correlations between the amount of blood loss or the levels of D-dimer and fibrin split products and the occurrence of preterm birth.

Members Involved:Study Coordinator: William Qu, RAs: all EMRD members PI: David Hackney MD

Development of a smoking cessation program

Description: Interventional and Survey Study in which we provide a pre-packet survey asking questions about patient's demographics and smoking habits. We then give the Informational packet to the patient that contains Information on risks of smoking, resources to quit smoking, and pictures of what smoking can do to peoples' bodies. We then give a post-packet survey to observe responses in comparison to pre-survey responses. We ask for their contact info to follow-up with patients in a month.

Current Progress: We have a draft of our protocol, informational packet, and both pre- and post-packet survey questions.

Future Goals: To run our drafts past EMRD and patients in the ED and to conduct intervention once approved by the IRB.

Members Involved: Vid Yogeswaran, Vashti Aguilar, Sabina Kumar, Jamie Shah, Will Qu, Priya Sharma

Evaluation of Transport Destination Decisions of Intoxicated Undergraduate Students by Undergraduate Emergency Medical Services Agencies: Protocolized transport policy for intoxicated students on university campuses

Description: This is a survey study, a comparison of policies regarding transport of intoxicated college students by university EMS around the country.

Current Progress: Our IRB addendum is to be submitted.

Future Goals: We are waiting for feedback from the IRB regarding stipulations.

Members Involved: Jeffrey Luk (PI), Edward Michelson (PI), Jamie Shah (RA), William Qu (RA)

POSED Opioids

Description: To describe and catalog the demographics and general clinical characteristics of a sample of emergency department patients who receive opioid analgesic medication at the time of discharge, to identify the common diagnoses associated with ED opioid prescribing and to further characterize the quantity and dose of opioids prescribed, and to compare our findings to the National Hospital Ambulatory Medical Care Survey.

Current Progress: We are waiting for feedback from the IRB concerning our protocol.

Future Goals: Our future goals are to begin data collection.

Members Involved: Totten V, Wyatt Hoch (PI), Anna Rosenstone (PI)

Disaster Education

Description:The goal of this study was to assess the effects of an hour-long lecture on third-year medical students’ knowledge and perceptions of disaster medicine in order to gauge the necessity of including disaster medicine in the medical school curriculum.

Current Progress:An abstract of the study has been written up and is currently being submitted to conferences.

Future Goals:We plan to write up the rest of the paper and submit it to journals.

Members Involved:RAs: Mary Lee, Aditya Joshi

Intimate Relationships Among Patients in the Emergency Department

Description: The purpose of this study is to conduct a rough prevalence study of intimate partner violence of emergency room patients. We will study whether there are any associations between relationship functioning, emotional regulation strategies, and stress in daily life, with violence and conflict in the relationship. By surveying emergency room patients for information on relationship health and abuse, we hope to determine which relationship factors are related to IPV. This may also help us to determine if there is any association between relationship health and emergency related stress and whether screening for IPV in the ED should be improved and standardized. It may also stress implementation of interventions and resources in the ED.

Current Progress: Revising to resubmit to the IRB.

Future Goals:Wait for IRB approval and then begin data collection

Members Involved:PI: Gunnur Karakurt Ph.D, LMFT; RA: Mary Lee, PI: Erkan Gunay MD

DURATA Practice Project

Description: We are working with Durata Therapeutics to analyze the factors that determine which treatments are delivered to patients with Acute Bacterial Skin and Soft Tissue infections (ABSSI). This is a retrospective chart review study on patients admitted to our ED with ABSSI in the last year.

Current Progress:We are currently in the final stages of the IRB process.

Future Goals:Once we get final IRB approval, we will go ahead with enrolling patients who meet our inclusion criteria in an online database called PRISM.

Members Involved: PI: Johnathan Sheele MD, Study Coordinator: Sapna Sundar, RAs: Brianna Arko, Anna Hirsch, Rohan Peer, Samir Shah Natasha Mohanty, William Qu, Nikhil Mallipeddi, Aishwarya Kumar

Number and Life Stage of Bed Bugs Found in UHCMC and ED

Description: The aim of this project is to determine the correlation between sex of bed bugs, month/season of discovery and their reproductive age.

Current Progress: Currently data collecting.

Future Goals:Expect to collect data for the next several months 200-300 bed bugs.

Members Involved:PI: Johnathan Sheele MD, Study Coordinator: Erika Barrett, RA: Katarina Coppolino

Implementation of Qualitative Rapid HCV testing in the University Hospitals Emergency Department for Diagnosis of HCV in High Risk Patients

Description: This study aims to provide rapid care administration of the first FDA-approved & CDC recommended HCV test to identify patients who may have HEP C or screen patients who are at high risk for contracting Hepatitus C. We aim to evaluate the effectiveness of this testing routine as a point of care test, determine the prevelance rate of HCV in the UH ED population, and use this sample size to make statistically signficant deductions on the prevelance rate of this disease in the Greater Cleveland Area.

Current Progress:Working through the grant application process.

Future Goals:We hope that this study will stand as a guide for future implementation of HCV screening regimes within other institutions and emergency departments.

Members Involved:PI: Johnathan Sheele MD, Study Coordinator: Pranav Singh, RAs: Julie Welch, Nikhil Mallipeddi

Insulin Misuse


Current Progress:

Future Goals:

Members Involved:Anna Hirsch, Anise Bowman

Ivermectin and Bedbugs


Current Progress:

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Members Involved:Katarina Copollino