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Article ; Online: Revelation of mindlines in the setting of crisis.

Suh, Edward Hyun / Wyer, Peter C

Journal of evaluation in clinical practice

2023 Volume 30, Issue 1, Page(s) 60–67

Abstract: During the devastating early months of the unfolding COVID-19 pandemic in New York, healthcare systems and clinicians dynamically adapted to drastically changing everyday practice despite having little guidance from formal research evidence in the face ... ...

Abstract	During the devastating early months of the unfolding COVID-19 pandemic in New York, healthcare systems and clinicians dynamically adapted to drastically changing everyday practice despite having little guidance from formal research evidence in the face of a novel virus. Through new, silo-breaking networks of communication, clinical teams transformed and synthesized provisional recommendations, rudimentary published research findings and numerous other sources of knowledge to address the immediate patient care needs they faced during the pandemic surge. These experiences illustrated underlying social processes that are always at play as clinicians integrate information from various sources, including research and published guidelines, with their own tacit knowledge to develop shared yet personal approaches to practice. In this article, we provide a narrative account of personal experience during the COVID-19 surge. We draw on the concept of mindlines as developed by Gabbay and Le May as a conceptual framework for interpreting that experience from the standpoint of how early information from research and guidelines was drawn on and transformed in the course of day-to-day struggle with the crisis in New York City emergency rooms. Finally, briefly referencing the challenges to conventional models of healthcare knowledge creation and translation through research and guideline production posed by COVID-19 crisis, we offer a provisional perspective on current and future developments.
MeSH term(s)	Humans ; Pandemics ; Delivery of Health Care ; COVID-19/epidemiology
Language	English
Publishing date	2023-06-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1327355-3
ISSN	1365-2753 ; 1356-1294
ISSN (online)	1365-2753
ISSN	1356-1294
DOI	10.1111/jep.13881
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 4464: Show issues

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Article ; Online: Flexible-Interval High-Sensitivity Troponin Velocity for the Detection of Acute Coronary Syndromes.

Suh, Edward Hyun / Probst, Marc A / Tichter, Aleksandr M / Ranard, Lauren S / Amaranto, Andrew / Chang, Betty C / Huynh, Phong Anh / Kratz, Alexander / Lee, Rebekah J / Rabbani, Leroy E / Sacco, Dana L / Einstein, Andrew J

The American journal of cardiology

2023 Volume 203, Page(s) 240–247

Abstract: Many algorithms for emergency department (ED) evaluation of acute coronary syndrome (ACS) using high-sensitivity troponin assays rely on the detection of a "delta," the difference in concentration over a predetermined interval, but collecting specimens ... ...

Abstract	Many algorithms for emergency department (ED) evaluation of acute coronary syndrome (ACS) using high-sensitivity troponin assays rely on the detection of a "delta," the difference in concentration over a predetermined interval, but collecting specimens at specific times can be difficult in the ED. We evaluate the use of troponin "velocity," the rate of change of troponin concentration over a flexible short interval for the prediction of major adverse cardiac events (MACEs) at 30 days. We conducted a prospective, observational study on a convenience sample of 821 patients who underwent ACS evaluation at a high-volume, urban ED. We determined the diagnostic performance of a novel velocity-based algorithm and compared the performance of 1- and 2-hour algorithms adapted from the European Society of Cardiology (ESC) using delta versus velocity. A total of 7 of 332 patients (2.1%) classified as low risk by the velocity-based algorithm experienced a MACE by 30 days compared with 35 of 221 (13.8%) of patients classified as greater than low risk, yielding a sensitivity of 83.3% (95% confidence interval [CI] 68.6% to 93.0%) and negative predictive value (NPV) of 97.9% (95% CI 95.9% to 98.9%). The ESC-derived algorithms using delta or velocity had NPVs ranging from 98.4% (95% CI 96.4% to 99.3%) to 99.6% (95% CI 97.0% to 99.9%) for 30-day MACEs. The NPV of the novel velocity-based algorithm for MACE at 30 days was borderline, but the substitution of troponin velocity for delta in the framework of the ESC algorithms performed well. In conclusion, specimen collection within strict time intervals may not be necessary for rapid evaluation of ACS with high-sensitivity troponin.
MeSH term(s)	Humans ; Troponin ; Acute Coronary Syndrome/diagnosis ; Myocardial Infarction/diagnosis ; Prospective Studies ; Predictive Value of Tests ; Emergency Service, Hospital ; Troponin T ; Biomarkers ; Algorithms
Chemical Substances	Troponin ; Troponin T ; Biomarkers
Language	English
Publishing date	2023-07-26
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.06.080
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Article ; Online: Individual Variability Is More Important Than Analytical Methods When Calculating Relative Speed of Beverage Bioavailability.

Balog, Edward M / Golloshi, Mateo / Suh, HyunGyu / Millard-Stafford, Melinda

International journal of sport nutrition and exercise metabolism

2023 Volume 33, Issue 2, Page(s) 102–111

Abstract: Deuterium oxide (D2O) appearance in blood is a marker of fluid bioavailability. However, whether biomarker robustness (e.g., relative fluid delivery speed) is consistent across analytical methods (e.g., cavity ring-down spectroscopy) remains unclear. ... ...

Abstract	Deuterium oxide (D2O) appearance in blood is a marker of fluid bioavailability. However, whether biomarker robustness (e.g., relative fluid delivery speed) is consistent across analytical methods (e.g., cavity ring-down spectroscopy) remains unclear. Fourteen men ingested fluid (6 ml/kg body mass) containing 0.15 g/kg D2O followed by 45 min blood sampling. Plasma (D2O) was detected (n = 8) by the following: isotope-ratio mass spectrometry after vapor equilibration (IRMS-equilibrated water) or distillation (IRMS-plasma) and cavity ring-down spectroscopy. Two models calculated D2O halftime to peak (t1/2max): sigmoid curve fit versus asymmetric triangle (TRI). Background (D2O) differed (p < .001, η2 = .98) among IRMS-equilibrated water, IRMS-plasma, and cavity ring-down spectroscopy (152.2 ± 0.8, 147.2 ± 1.5, and 137.7 ± 2.2 ppm), but did not influence (p > .05) D2O appearance (Δppm), time to peak, or t1/2max. Stratifying participants based on mean t1/2max (12 min) into "slow" versus "fast" subgroups resulted in a 5.8 min difference (p < .001, η2 = .73). Significant t1/2max model (p = .01, η2 = .44) and Model × Speed Subgroup interaction (p = .005, η2 = .50) effects were observed. Bias between TRI and sigmoid curve fit increased with t1/2max speed: no difference (p = .75) for fast (9.0 min vs. 9.2 min, respectively) but greater t1/2max (p = .001) with TRI for the slow subgroup (16.1 min vs. 13.7 min). Fluid bioavailability markers are less influenced by which laboratory method is used to measure D2O as compared with the individual variability effects that influence models for calculating t1/2max. Thus, TRI model may not be appropriate for individuals with slow fluid delivery speeds.
MeSH term(s)	Male ; Humans ; Biological Availability ; Water ; Beverages ; Biomarkers
Chemical Substances	Water (059QF0KO0R) ; Biomarkers
Language	English
Publishing date	2023-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1101115-4
ISSN	1543-2742 ; 1050-1606 ; 1526-484X
ISSN (online)	1543-2742
ISSN	1050-1606 ; 1526-484X
DOI	10.1123/ijsnem.2022-0153
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Zs.A 4143: Show issues

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Article ; Online: Crisis clinical pathway for COVID-19.

Suh, Edward Hyun / Bodnar, David J / Melville, Laura D / Sharma, Manish / Farmer, Brenna M

Emergency medicine journal : EMJ

2020 Volume 37, Issue 11, Page(s) 700–704

Abstract: The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, ... ...

Abstract	The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This 'crisis clinical pathway' focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Critical Pathways ; Decision Making ; Emergency Service, Hospital/organization & administration ; Humans ; New York City/epidemiology ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Resource Allocation ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-09-10
Publishing country	England
Document type	Editorial
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2020-209933
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: 13

Singh, Jaspal / Suh, Eul Hyun / Sharma, Gaurav / Chen, Jun / Hackett, Edward P / Wen, Xiaodong / Sherry, A Dean / Khemtong, Chalermchai / Malloy, Craig R / Park, Jae Mo / Kovacs, Zoltan

Analysis & sensing

2021 Volume 1, Issue 4, Page(s) 156–160

Abstract: The TCA cycle is a central metabolic pathway for energy production and biosynthesis. A major control point of metabolic flux through the cycle is the decarboxylation of 2-ketoglutarate by the TCA cycle enzyme 2-ketoglutarate dehydrogenase (2-KGDH). In ... ...

Abstract	The TCA cycle is a central metabolic pathway for energy production and biosynthesis. A major control point of metabolic flux through the cycle is the decarboxylation of 2-ketoglutarate by the TCA cycle enzyme 2-ketoglutarate dehydrogenase (2-KGDH). In this project, we developed
Language	English
Publishing date	2021-08-09
Publishing country	Germany
Document type	Journal Article
ISSN	2629-2742
ISSN (online)	2629-2742
DOI	10.1002/anse.202100021
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Article ; Online: Impact of a rapid high-sensitivity troponin pathway on patient flow in an urban emergency department.

Suh, Edward Hyun / Tichter, Aleksandr M / Ranard, Lauren S / Amaranto, Andrew / Chang, Betty C / Huynh, Phong Anh / Kratz, Alexander / Lee, Rebekah Jihae / Rabbani, LeRoy E / Sacco, Dana / Einstein, Andrew J

Journal of the American College of Emergency Physicians open

2022 Volume 3, Issue 3, Page(s) e12739

Abstract: Study objective: To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow ... ...

Abstract	Study objective: To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow without changing the rate of "missed" major adverse cardiac events (MACE), compared to use of conventional cardiac troponin with an associated 3-hour pathway. Methods: This was a prospective, uncontrolled observational study conducted before and after implementation of a 1-hour hs-TnT pathway at a high-volume urban ED. Patients undergoing evaluation for ACS in the ED were enrolled during their initial visit and clinical outcomes were assessed at 30 and 90 days. Throughput markers were extracted from the electronic medical record and compared. The primary outcome was provider-to-disposition decision time. Results: A total of 1892 patients were enrolled, 1071 patients while using conventional troponin and 821 after introduction of hs-TnT. With the new assay and pathway, median interval between troponin tests decreased from 4.7 hours (interquartile range [IQR] 3.9-5.7 hours) to 2.3 hours (IQR 1.5-3.4 hours) ( Conclusion: Introduction of a 1-hour hs-TnT ACS evaluation pathway reduced the troponin collection interval but did not reduce provider to disposition time. There was no difference in rate of 30-day MACE in patients discharged from the ED.
Language	English
Publishing date	2022-05-05
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12739
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: In vivo assessment of increased oxidation of branched-chain amino acids in glioblastoma.

Suh, Eul Hyun / Hackett, Edward P / Wynn, R Max / Chuang, David T / Zhang, Bo / Luo, Weibo / Sherry, A Dean / Park, Jae Mo

Scientific reports

2019 Volume 9, Issue 1, Page(s) 340

Abstract: Altered branched-chain amino acids (BCAAs) metabolism is a distinctive feature of various cancers and plays an important role in sustaining tumor proliferation and aggressiveness. Despite the therapeutic and diagnostic potentials, the role of BCAA ... ...

Abstract	Altered branched-chain amino acids (BCAAs) metabolism is a distinctive feature of various cancers and plays an important role in sustaining tumor proliferation and aggressiveness. Despite the therapeutic and diagnostic potentials, the role of BCAA metabolism in cancer and the activities of associated enzymes remain unclear. Due to its pivotal role in BCAA metabolism and rapid cellular transport, hyperpolarized
MeSH term(s)	Amino Acids, Branched-Chain/metabolism ; Animals ; Cell Line, Tumor ; Disease Models, Animal ; Glioblastoma/pathology ; Histocytochemistry ; Isotope Labeling ; Leucine/metabolism ; Magnetic Resonance Imaging ; Neoplasm Transplantation ; Oxidation-Reduction ; Rats
Chemical Substances	Amino Acids, Branched-Chain ; Leucine (GMW67QNF9C)
Language	English
Publishing date	2019-01-23
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-018-37390-0
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Crisis clinical pathway for COVID-19

Suh, Edward Hyun / Bodnar, David J / Melville, Laura D / Sharma, Manish / Farmer, Brenna M

Emerg Med J

Abstract	The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This 'crisis clinical pathway' focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #760265
Database	COVID19

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Book ; Online: Crisis clinical pathway for COVID-19

Suh, Edward Hyun / Bodnar, David J / Melville, Laura D / Sharma, Manish / Farmer, Brenna M

2020

Abstract	The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This ‘crisis clinical pathway’ focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.
Keywords	Concepts ; covid19
Language	English
Publishing date	2020-11-01 00:00:00.0
Publisher	BMJ Publishing Group Ltd
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Crisis clinical pathway for COVID-19

Suh, Edward Hyun / Bodnar, David J / Melville, Laura D / Sharma, Manish / Farmer, Brenna M

Emergency Medicine Journal

2020 Volume 37, Issue 11, Page(s) 700–704

Abstract	The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This ‘crisis clinical pathway’ focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.
Keywords	Critical Care and Intensive Care Medicine ; Emergency Medicine ; General Medicine ; covid19
Language	English
Publisher	BMJ
Publishing country	uk
Document type	Article ; Online
ZDB-ID	2040124-3
ISSN	1472-0205
ISSN	1472-0205
DOI	10.1136/emermed-2020-209933
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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