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  1. Article ; Online: Patient mistreatment of health care professionals.

    Mahoney, David A / Gopisetty, Divya / Osterberg, Lars / Nudelman, Matthew J R / Smith-Coggins, Rebecca

    BMC medical education

    2022  Volume 22, Issue 1, Page(s) 133

    Abstract: Background: Mistreatment of health care professionals by patients is an ongoing problem. We aimed to construct and evaluate a curriculum that would prepare health care professionals for mistreatment by patients.: Methods: Lessons learned from 15 ... ...

    Abstract Background: Mistreatment of health care professionals by patients is an ongoing problem. We aimed to construct and evaluate a curriculum that would prepare health care professionals for mistreatment by patients.
    Methods: Lessons learned from 15 interviews and 2 focus groups with health care professionals were distilled into a multi-modal curriculum including didactics, simulation videos and role-play scenarios aimed to improve confidence in addressing mistreatment. This curriculum was disseminated at five educational workshops to health care professionals of various training groups and experience levels. Pre- and post-surveys were distributed to assess changes in participant's perspectives on readiness to address mistreatment. The signed-rank test was implemented to compare pre- and post- data.
    Results: Participants were more likely to agree post-workshop that they had the right words to say, had a plan for what to do, and were more willing to speak up when they themselves or someone else was mistreated (p < .001). They were also more likely to agree post-workshop that there was something they could do to address patient mistreatment (p < .001).
    Conclusions: Participant familiarity and confidence in responding to patient mistreatment increased. Our curriculum may serve as a foundation for institutions seeking to equip their educators, health care professionals, and trainees with strategies for addressing this important issue.
    MeSH term(s) Curriculum ; Focus Groups ; Health Personnel ; Humans ; Surveys and Questionnaires
    Language English
    Publishing date 2022-03-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-022-03198-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Effect of Delayed Cord Clamping on Umbilical Blood Gas Values in Term Newborns: A Systematic Review.

    Nudelman, Matthew J R / Belogolovsky, Esther / Jegatheesan, Priya / Govindaswami, Balaji / Song, Dongli

    Obstetrics and gynecology

    2020  Volume 135, Issue 3, Page(s) 576–582

    Abstract: Objective: To compare the effect of delayed cord clamping on cord blood gas values in vaginally delivered, healthy, term singletons.: Data source: We used MEDLINE, CINAHL, CENTRAL, EMBASE, and ClinicalTrials.gov databases.: Methods of study ... ...

    Abstract Objective: To compare the effect of delayed cord clamping on cord blood gas values in vaginally delivered, healthy, term singletons.
    Data source: We used MEDLINE, CINAHL, CENTRAL, EMBASE, and ClinicalTrials.gov databases.
    Methods of study selection: Eligible studies included randomized controlled trials (RCTs) comparing cord blood gas values obtained from early compared with delayed cord clamping groups and observational studies using serial cord blood gas from the same umbilical cord. We described the difference in means of cord blood gas parameters and comparative descriptive statistics when a difference in means was not available. We used a domain-based risk bias tool to extract methodologic details and assess potential risk of bias.
    Tabulation, integration, and results: This review included two RCTs and three observational studies. These studies included a total of 234 newborns with early cord clamping and 218 newborns with delayed cord clamping. The observational studies showed that 45-90 seconds delayed cord clamping was associated with mean decreases in umbilical arterial pH (0.02-0.03), HCO3 (0.3-0.8 mmol/L) and increases in base deficit (0.3-1.3 mmol/L) compared with early cord clamping. One observational study showed that delayed cord clamping was associated with decreases in umbilical venous pH (0.01) and HCO3 (0.2 mmol/L) and increase in venous base deficit (0.1-0.3 mmol/L) compared with early cord clamping. These changes were not observed in the two RCTs.
    Conclusion: Delayed cord clamping up to 120 seconds has either no effect or only a small effect on cord blood acid-base balance; overall, the magnitude of these changes is not clinically significant in vaginally delivered, healthy, term singletons.
    Systematic review registration: PROSPERO, CRD42019135779.
    MeSH term(s) Blood Gas Analysis ; Delivery, Obstetric/methods ; Female ; Humans ; Infant, Newborn/blood ; Pregnancy ; Umbilical Cord
    Language English
    Publishing date 2020-01-09
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000003663
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Are preterm birth and very low birth weight rates altered in the early COVID (2020) SARS-CoV-2 era?

    Rodriguez, Kayla / Nudelman, Matthew J / Jegatheesan, Priya / Huang, Angela / Devarajan, Kamakshi / Haas, Jessica E / Cervantes, Rosemarie / Falbo, Kelle / Narasimhan, Sudha Rani / Cormier, Machelnil / Stewart, Mary Beth / Patel, Rupalee / Govindaswami, Balaji

    Frontiers in pediatrics

    2023  Volume 10, Page(s) 1093371

    Abstract: Objective: We evaluated the prevalence of preterm birth (PTB) and very low birth weight (VLBW) during Jan-Dec 2,020 (early COVID era) at 5 hospitals (2 in West Virginia, 3 in California) compared to Jan 2017-Dec 2019 (pre-COVID) inclusive of 2 regional ... ...

    Abstract Objective: We evaluated the prevalence of preterm birth (PTB) and very low birth weight (VLBW) during Jan-Dec 2,020 (early COVID era) at 5 hospitals (2 in West Virginia, 3 in California) compared to Jan 2017-Dec 2019 (pre-COVID) inclusive of 2 regional perinatal centers (1 in Huntington, WV and 1 in San Jose, CA) and 3 community hospitals (1 each in Cabell, Los Angeles and Santa Clara counties).
    Design/methods: We examined PTB and VLBW rates of live births at 5 US hospitals from Jan 2017-Dec 2020. We compared PTB and VLBW rates in 2020 to 2017-2019 using Poisson regression and rate ratio with a 95% confidence interval. We stratified live births by gestational age (GA) (<37, 33-36, and <33 weeks) and birth weight (≤1,500 g, >1,001 g to ≤1,500 g, ≤1,000 g). We examined PTB rates at 4 of the hospitals during Jan-Dec 2020 and compared them to the prior period of Jan 2017-Dec 2019 using Statistical Process Control (SPC) for quarterly data.
    Results: We examined PTB and VLBW rates in 34,599 consecutive live births born Jan 2017-Dec 2019 to rates of 9,691 consecutive live births in 2020. There was no significant change in PTB (<37 weeks GA) rate, 10.6% in 2017-2019 vs. 11.0% in 2020 (
    Conclusion: We found no significant change in the rates of PTB or VLBW when combining the live birth data of 5 US hospitals in 3 different counties.
    Language English
    Publishing date 2023-01-09
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2022.1093371
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department.

    Mitarai, Tsuyoshi / Gordon, Alexandra June / Nudelman, Matthew J R / Urdaneta, Alfredo E / Nesbitt, Jason Lawrence / Niknam, Kian / Graber-Naidich, Anna / Wilson, Jennifer G / Kohn, Michael A

    Critical care medicine

    2023  Volume 51, Issue 6, Page(s) 731–741

    Abstract: Objectives: To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED).: Design: Single-center, ... ...

    Abstract Objectives: To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED).
    Design: Single-center, retrospective cohort study using ED-visit data between 2015 and 2019.
    Setting: Tertiary academic medical center.
    Patients: Adult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival.
    Interventions: Dedicated bedside critical care for medical ICU patients by an ED-based intensivist following initial resuscitation by the ED team.
    Measurements and main results: Primary outcomes were inhospital mortality and the proportion of patients downgraded to non-ICU status while in the ED within 6 hours of the critical care admission order (ED downgrade <6 hr). A difference-in-differences (DiD) analysis compared the change in outcomes for patients arriving during ECCP hours (2 pm to midnight, weekdays) between the preintervention period (2015-2017) and the intervention period (2017-2019) to the change in outcomes for patients arriving during non-ECCP hours (all other hours). Adjustment for severity of illness was performed using the emergency critical care Sequential Organ Failure Assessment (eccSOFA) score. The primary cohort included 2,250 patients. The DiDs for the eccSOFA-adjusted inhospital mortality decreased by 6.0% (95% CI, -11.9 to -0.1) with largest difference in the intermediate illness severity group (DiD, -12.2%; 95% CI, -23.1 to -1.3). The increase in ED downgrade less than 6 hours was not statistically significant (DiD, 4.8%; 95% CI, -0.7 to 10.3%) except in the intermediate group (DiD, 8.8%; 95% CI, 0.2-17.4).
    Conclusions: The implementation of a novel ECCP was associated with a significant decrease in inhospital mortality among critically ill medical ED patients, with the greatest decrease observed in patients with intermediate severity of illness. Early ED downgrades also increased, but the difference was statistically significant only in the intermediate illness severity group.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Critical Illness/therapy ; Critical Care ; Emergency Service, Hospital ; Hospitalization ; Hospital Mortality ; Intensive Care Units
    Language English
    Publishing date 2023-04-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005835
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: eccSOFA: SOFA illness severity score adapted to predict in-hospital mortality in emergency critical care patients.

    Niknam, Kian / Nesbitt, Jason / Mitarai, Tsuyoshi / Nudelman, Matthew J R / Gordon, Alexandra June / Wilson, Jennifer G / Kohn, Michael A

    The American journal of emergency medicine

    2020  Volume 41, Page(s) 145–151

    Abstract: Background: Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most ... ...

    Abstract Background: Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most existing illness severity scores are based on data that is not available at the time of the hospital admission decision or cannot be extracted from the electronic health record (EHR). We adapted the SOFA score to create a new illness severity score (eccSOFA) that can be calculated at the time of ICU admission order entry in the ED using EHR data. We evaluated this score in a cohort of emergency critical care (ECC) patients at a single academic center over a period of 3 years.
    Methods: This was a retrospective cohort study using EHR data to assess predictive accuracy of eccSOFA for estimating in-hospital mortality risk. The patient population included all adult patients who had a critical care admission order entered while in the ED of an academic medical center between 10/24/2013 and 9/30/2016. eccSOFA's discriminatory ability for in-hospital mortality was assessed using ROC curves.
    Results: Of the 3912 patients whose in-hospital mortality risk was estimated, 2260 (57.8%) were in the low-risk group (scores 0-3), 1203 (30.8%) in the intermediate-risk group (scores 4-7), and 449 (11.5%) in the high-risk group (scores 8+). In-hospital mortality for the low-, intermediate, and high-risk groups was 4.2% (95%CI: 3.4-5.1), 15.5% (95% CI 13.5-17.6), and 37.9% (95% CI 33.4-42.3) respectively. The AUROC was 0.78 (95%CI: 0.75-0.80) for the integer score and 0.75 (95% CI: 0.72-0.77) for the categorical eccSOFA.
    Conclusions: As a predictor of in-hospital mortality, eccSOFA can be calculated based on variables that are commonly available at the time of critical care admission order entry in the ED and has discriminatory ability that is comparable to other commonly used illness severity scores. Future studies should assess the calibration of our absolute risk predictions.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Critical Care ; Emergency Service, Hospital ; Female ; Forecasting ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Organ Dysfunction Scores ; Retrospective Studies
    Language English
    Publishing date 2020-12-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2020.12.018
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  6. Article ; Online: Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients.

    Nesbitt, Jason / Mitarai, Tsuyoshi / Chan, Garrett K / Wilson, Jennifer G / Niknam, Kian / Nudelman, Matthew J R / Cinkowski, Cristopher / Kohn, Michael A

    The American journal of emergency medicine

    2020  Volume 41, Page(s) 120–124

    Abstract: Study hypothesis: We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED.: Methods: This was a retrospective before-after cohort study using ...

    Abstract Study hypothesis: We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED.
    Methods: This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality between the pre- and post-intervention periods and between non-prolonged (≤6 h) boarding time and prolonged (>6 h) boarding time. In-hospital mortality was stratified by illness severity (eccSOFA category) and adjusted using logistic regression.
    Results: Severity-adjusted in-hospital mortality decreased from 12.8% pre-intervention to 12.3% post-intervention (-0.5% (95% CI, -3.1% to 2.1%), which was not statistically significant. This was despite a concurrent increase in ED and hospital crowding. The proportion of ECC patients downgraded to a lower level of care while still in the ED increased from 6.4% in the pre-intervention period to 17.0% in the post-intervention period. (+10.6%, 8.2% to 13.0%, p < 0.001). Severity-adjusted mortality was 12.8% in the non-prolonged group vs. 11.3% in the prolonged group (p = 0.331).
    Conclusions: During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Critical Care Nursing/organization & administration ; Critical Illness/mortality ; Emergency Nursing/organization & administration ; Emergency Service, Hospital/organization & administration ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors
    Language English
    Publishing date 2020-12-28
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2020.12.067
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  7. Article: Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study.

    Mulkerin, William D / Spokoyny, Ilanit / Francisco, Jonathan T / Lima, Brandon / Corry, Megan D / Nudelman, Matthew J R / Niknam, Kian / Brown, Ian P / Kohn, Michael A / Govindarajan, Prasanthi

    Frontiers in neurology

    2021  Volume 12, Page(s) 643356

    Abstract: Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as ... ...

    Abstract Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes.
    Language English
    Publishing date 2021-05-14
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2021.643356
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  8. Article ; Online: Carbohydrate-Restricted Diet: A Successful Strategy for Short-Term Management in Youth with Severe Obesity-An Observational Study.

    Pauley, Meghan / Mays, Chadd / Bailes, James R / Schwartzman, Michal Laniado / Castle, Mark / McCoy, Marji / Patick, Casey / Preston, Deborah / Nudelman, Matthew J R / Denning, Krista L / Bellner, Lars / Werthammer, Joseph

    Metabolic syndrome and related disorders

    2021  Volume 19, Issue 5, Page(s) 281–287

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Diet, Carbohydrate-Restricted ; Female ; Humans ; Male ; Pediatric Obesity/diet therapy ; Prospective Studies ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2021-02-09
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, N.I.H., Extramural
    ZDB-ID 2151220-6
    ISSN 1557-8518 ; 1540-4196
    ISSN (online) 1557-8518
    ISSN 1540-4196
    DOI 10.1089/met.2020.0078
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  9. Article ; Online: Wide-field functional imaging of blood flow and hemoglobin oxygen saturation in the rodent dorsal window chamber.

    Moy, Austin J / White, Sean M / Indrawan, Elmer S / Lotfi, Justin / Nudelman, Matthew J / Costantini, Samantha J / Agarwal, Nikita / Jia, Wangcun / Kelly, Kristen M / Sorg, Brian S / Choi, Bernard

    Microvascular research

    2011  Volume 82, Issue 3, Page(s) 199–209

    Abstract: The rodent dorsal window chamber is a widely used in vivo model of the microvasculature. The model consists of a 1cm region of exposed microvasculature in the rodent dorsal skin that is immobilized by surgically implanted titanium frames, allowing the ... ...

    Abstract The rodent dorsal window chamber is a widely used in vivo model of the microvasculature. The model consists of a 1cm region of exposed microvasculature in the rodent dorsal skin that is immobilized by surgically implanted titanium frames, allowing the skin microvasculature to be visualized. We describe a detailed protocol for surgical implantation of the dorsal window chamber which enables researchers to perform the window chamber implantation surgery. We further describe subsequent wide-field functional imaging of the chamber to obtain hemodynamic information in the form of blood oxygenation and blood flow on a cm size region of interest. Optical imaging techniques, such as intravital microscopy, have been applied extensively to the dorsal window chamber to study microvascular-related disease and conditions. Due to the limited field of view of intravital microscopy, detailed hemodynamic information typically is acquired from small regions of interest, typically on the order of hundreds of μm. The wide-field imaging techniques described herein complement intravital microscopy, allowing researchers to obtain hemodynamic information at both microscopic and macroscopic spatial scales. Compared with intravital microscopy, wide-field functional imaging requires simple instrumentation, is inexpensive, and can give detailed metabolic information over a wide field of view.
    MeSH term(s) Animals ; Cricetinae ; Diagnostic Imaging/instrumentation ; Equipment Design ; Hemorheology ; Image Processing, Computer-Assisted ; Mice ; Microcirculation ; Microvessels/physiology ; Models, Animal ; Oxyhemoglobins/metabolism ; Regional Blood Flow ; Skin/blood supply
    Chemical Substances Oxyhemoglobins
    Language English
    Publishing date 2011-07-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
    ZDB-ID 80307-8
    ISSN 1095-9319 ; 0026-2862
    ISSN (online) 1095-9319
    ISSN 0026-2862
    DOI 10.1016/j.mvr.2011.07.004
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