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  1. AU="O'Keefe, Kelly"
  2. AU="Sandri, Maria T"
  3. AU="van Duin, Adri C T"
  4. AU=Woolhandler Steffie
  5. AU="Anerella, M."
  6. AU="Bayliss, Richard"
  7. AU="González-Enseñat, Maria Antònia"
  8. AU=Camara Amadou K S
  9. AU="Luginbuehl, Helena"
  10. AU="Irani, Zubin A"
  11. AU="Santos, H"
  12. AU="Villota-Rivas, Marcela"
  13. AU="Sepe, Thomas"
  14. AU="Prasad, Aman"
  15. AU="Bortz, Cole"
  16. AU="Clarke, Julia R"
  17. AU=Jordan William D Jr
  18. AU="Frangaj, Brulinda"
  19. AU="Oostindjer, Andrew"
  20. AU="Diarra, Zoumana"
  21. AU="Saragoni, V G"

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  1. Artikel ; Online: An evidence-based approach to abnormal vision in the emergency department

    O'Keefe, Kelly / Temple, Sarah

    Emergency medicine practice

    2020  Band 22, Heft 4, Seite(n) 1–28

    Abstract: Patients present to the ED with visual disturbances that may be painful or painless and may include loss of visual acuity, field cuts, diplopia, and headache. A detailed history and complete ocular examination are essential to obtaining the correct ... ...

    Abstract Patients present to the ED with visual disturbances that may be painful or painless and may include loss of visual acuity, field cuts, diplopia, and headache. A detailed history and complete ocular examination are essential to obtaining the correct diagnosis and offering expedited treatment and referral. This review discusses the differential diagnosis for patients experiencing abnormal vision from a nontraumatic or minimally traumatic etiology, and reviews diagnostic and treatment strategies from an evidence-based perspective, including point-of-care ocular ultrasound. Management of the needs of special populations, such as patients with sickle cell disease, HIV, and those with a ventriculo-peritoneal shunt, is reviewed.
    Mesh-Begriff(e) Emergency Service, Hospital/organization & administration ; Humans ; Physical Examination/methods ; Vision Disorders/diagnosis ; Vision Disorders/physiopathology ; Vision Disorders/therapy ; Vision Tests/methods
    Sprache Englisch
    Erscheinungsdatum 2020-04-01
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ISSN 1559-3908
    ISSN (online) 1559-3908
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Tube Thoracostomy Complications in Patients With ARDS Requiring ECMO: Worse in COVID-19 Patients?

    Laverty, Robert B / Ivins-O'Keefe, Kelly M / Adams, Alexandra M / Flatley, Meaghan J / Sobieszczyk, Michal J / Mason, Phillip E / Sams, Valerie G

    Military medicine

    2023  

    Abstract: Introduction: The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to ... ...

    Abstract Introduction: The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to explore differences in tube thoracostomy rates and subsequent complications between patients with and without COVID-19 ARDS on V-V ECMO.
    Materials and methods: This study is a single institution, retrospective cohort study of patients with COVID-19 ARDS requiring V-V ECMO. The control cohort consisted of patients who required V-V ECMO for ARDS-related diagnoses from January 2018 to January 2021. The primary outcome was any complication following initial tube thoracostomy placement. Study approval was obtained from the Brooke Army Medical Center Institutional Review Board (C.2017.152d).
    Results: Twenty-five COVID-19 patients and 38 controls were included. Demographic parameters did not differ between the groups. The incidence of pneumothorax was not significantly different between the two groups (44% COVID-19 vs. 22% control, OR 2.8, 95% CI 0.95-7.9, P = 0.09). Patients with COVID-19 were as likely to receive tube thoracostomy as controls (36% vs. 24%, OR 1.8, 95% CI 0.55-5.7). Complications, however, were more likely to occur in the COVID-19 group (89% vs. 33%, OR 16, 95% CI, 1.6-201, P = 0.0498).
    Conclusions: Tube thoracostomy placement in COVID-19 patients with ARDS requiring V-V ECMO is common, as are complications following initial placement. Clinicians should anticipate the need for re-intervention in this patient population. Small-bore (14Fr and smaller) pigtail catheters appeared to be safe and efficacious in this setting, but further study on tube thoracostomy management in ECMO patients is needed.
    Sprache Englisch
    Erscheinungsdatum 2023-12-11
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usad454
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  3. Artikel ; Online: Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation.

    Ivins-O'Keefe, Kelly M / Cahill, Michael S / Mielke, Arthur R / Sobieszczyk, Michal J / Sams, Valerie G / Mason, Phillip E / Read, Matthew D

    ASAIO journal (American Society for Artificial Internal Organs : 1992)

    2022  Band 68, Heft 12, Seite(n) 1483–1489

    Abstract: Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of ... ...

    Abstract Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of percutaneous mechanical circulatory support devices for concurrent right heart and respiratory failure are limited. This series describes the percutaneous cannulation of the pulmonary artery for conversion from veno-venous to veno-pulmonary artery return ECMO in 21 patients who developed secondary RHF. All patients cannulated between May 2019 and September 2021 were included. Either a 19 or 21 French venous cannula was placed percutaneously into the pulmonary artery via the internal jugular or subclavian vein, providing a total of 821 days of support (median 23 [4-71] days per patient) with flows up to 6 L/min. Five patients underwent cannulation at the bedside, with the remainder performed in the cardiac catheterization laboratory. Pulmonary artery cannulation occurred after 12 [8.5-23.5] days of ECMO support. Vasoactive infusion requirements decreased significantly within 24 hours of pulmonary artery cannula placement (p = 0.0004). Nonetheless, 75% of these patients expired after a median of 12 [4-63] days of support, with three patients found to have had significant pericardial effusions peri-arrest. This cannulation technique may be an effective alternative to veno-arterial ECMO cannulation or the placement of a dual-lumen cannula for the treatment of RHF.
    Sprache Englisch
    Erscheinungsdatum 2022-03-14
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 759982-1
    ISSN 1538-943X ; 0162-1432 ; 1058-2916
    ISSN (online) 1538-943X
    ISSN 0162-1432 ; 1058-2916
    DOI 10.1097/MAT.0000000000001692
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  4. Artikel: Emergency Departments: Preparing for a New War.

    Chauhan, Vivek / Secor-Jones, Sarah / Paladino, Lorenzo / Sardesai, Indrani / Ratnayake, Amila / Stawicki, Stanislaw P / Papadimos, Thomas J / O'Keefe, Kelly / Galwankar, Sagar C

    Journal of emergencies, trauma, and shock

    2022  Band 15, Heft 4, Seite(n) 157–161

    Sprache Englisch
    Erscheinungsdatum 2022-12-07
    Erscheinungsland India
    Dokumenttyp Journal Article
    ZDB-ID 2461111-6
    ISSN 0974-519X ; 0974-2700
    ISSN (online) 0974-519X
    ISSN 0974-2700
    DOI 10.4103/jets.jets_143_22
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  5. Artikel ; Online: Argatroban for Anticoagulation in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019.

    Sattler, Lauren A / Boster, Joshua M / Ivins-O'Keefe, Kelly M / Sobieszczyk, Michal J / Reel, Bradley A / Mason, Phillip E / Walter, Robert J / Sams, Valerie G

    Critical care explorations

    2021  Band 3, Heft 9, Seite(n) e0530

    Abstract: A significant proportion of patients with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation at our institution demonstrated heparin resistance, which in combination with a heparin shortage resulted in the transition to ... ...

    Abstract A significant proportion of patients with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation at our institution demonstrated heparin resistance, which in combination with a heparin shortage resulted in the transition to argatroban with or without aspirin as an alternative anticoagulation strategy. The optimal anticoagulation strategy for coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation is unknown, and therefore, we sought to evaluate the efficacy and safety of argatroban with or without aspirin as an alternative anticoagulation strategy in this patient population.
    Design: Retrospective cohort.
    Setting: Single-center tertiary-care facility in Fort Sam Houston, TX, from 2020 to 2021.
    Patients: Twenty-four patients who were cannulated for venovenous extracorporeal membrane oxygenation due to respiratory failure secondary to coronavirus disease 2019.
    Interventions: Argatroban, with or without aspirin, was substituted for heparin in coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation.
    Measurements and main results: Eighty percent of our coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation demonstrated heparin resistance, and patients who were initially started on heparin were significantly more likely to require a change to argatroban than vice versa due to difficulty achieving or maintaining therapeutic anticoagulation goals (93.4% vs 11.1%;
    Conclusions: Argatroban, with or without aspirin, is an effective anticoagulation strategy for patients who require venovenous extracorporeal membrane oxygenation support secondary to coronavirus disease 2019. In comparison with heparin, this anticoagulation strategy was not associated with a significant difference in bleeding or thrombotic complications, and was associated with a significantly decreased time to therapeutic anticoagulation goal, likely as a result of high rates of heparin resistance observed in this patient population.
    Sprache Englisch
    Erscheinungsdatum 2021-09-07
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000530
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel: Brief report: do individuals with autism spectrum disorder think they know their own minds?

    Mitchell, Peter / O'Keefe, Kelly

    Journal of autism and developmental disorders

    2008  Band 38, Heft 8, Seite(n) 1591–1597

    Abstract: How much do individuals with autism spectrum disorder (ASD) think they know about their inner states? To find out, we asked 24 participants with ASD and 24 non-clinical participants to rate how well they knew about six topics of self knowledge; they also ...

    Abstract How much do individuals with autism spectrum disorder (ASD) think they know about their inner states? To find out, we asked 24 participants with ASD and 24 non-clinical participants to rate how well they knew about six topics of self knowledge; they also rated how well a comparison individual knew these things about them. Participants with ASD differed from the non-clinical participants in assigning about the same amount of knowledge to the comparison individual as to themselves. Non-clinical participants, in contrast, assigned relatively more knowledge to themselves. The findings are consistent with the possibility that individuals with ASD do not appreciate the value of having first-person privileged access to their own inner states.
    Mesh-Begriff(e) Adolescent ; Adult ; Asperger Syndrome/diagnosis ; Asperger Syndrome/psychology ; Autistic Disorder/diagnosis ; Autistic Disorder/psychology ; Awareness ; Culture ; Emotions ; Female ; Humans ; Male ; Middle Aged ; Personal Construct Theory ; Self Concept
    Sprache Englisch
    Erscheinungsdatum 2008-02-29
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 391999-7
    ISSN 1573-3432 ; 0162-3257
    ISSN (online) 1573-3432
    ISSN 0162-3257
    DOI 10.1007/s10803-007-0530-x
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  7. Artikel ; Online: Innovative research methods for studying treatments for rare diseases: methodological review.

    Gagne, Joshua J / Thompson, Lauren / O'Keefe, Kelly / Kesselheim, Aaron S

    BMJ (Clinical research ed.)

    2014  Band 349, Seite(n) g6802

    Abstract: Objective: To examine methods for generating evidence on health outcomes in patients with rare diseases.: Design: Methodological review of existing literature.: Setting: PubMed, Embase, and Academic Search Premier searched for articles describing ... ...

    Abstract Objective: To examine methods for generating evidence on health outcomes in patients with rare diseases.
    Design: Methodological review of existing literature.
    Setting: PubMed, Embase, and Academic Search Premier searched for articles describing innovative approaches to randomized trial design and analysis methods and methods for conducting observational research in patients with rare diseases.
    Main outcome measures: We assessed information related to the proposed methods, the specific rare disease being studied, and outcomes from the application of the methods. We summarize methods with respect to their advantages in studying health outcomes in rare diseases and provide examples of their application.
    Results: We identified 46 articles that proposed or described methods for studying patient health outcomes in rare diseases. Articles covered a wide range of rare diseases and most (72%) were published in 2008 or later. We identified 16 research strategies for studying rare disease. Innovative clinical trial methods minimize sample size requirements (n=4) and maximize the proportion of patients who receive active treatment (n=2), strategies crucial to studying small populations of patients with limited treatment choices. No studies describing unique methods for conducting observational studies in patients with rare diseases were identified.
    Conclusions: Though numerous studies apply unique clinical trial designs and considerations to assess patient health outcomes in rare diseases, less attention has been paid to innovative methods for studying rare diseases using observational data.
    Mesh-Begriff(e) Case-Control Studies ; Evidence-Based Medicine/methods ; Humans ; Observational Studies as Topic ; Outcome Assessment (Health Care) ; Randomized Controlled Trials as Topic ; Rare Diseases ; Research Design
    Sprache Englisch
    Erscheinungsdatum 2014-11-24
    Erscheinungsland England
    Dokumenttyp Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.g6802
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  8. Artikel: Preparing emergency physicians for malpractice litigation: a joint emergency medicine residency-law school mock trial competition.

    Drukteinis, Dainius A / O'Keefe, Kelly / Sanson, Tracy / Orban, David

    The Journal of emergency medicine

    2014  Band 46, Heft 1, Seite(n) 95–103

    Abstract: Background: Fear of malpractice affects the daily life of many emergency physicians. Educational programs to prepare for litigation are lacking.: Objectives: An educational collaboration between an emergency medicine residency and a law school, ... ...

    Abstract Background: Fear of malpractice affects the daily life of many emergency physicians. Educational programs to prepare for litigation are lacking.
    Objectives: An educational collaboration between an emergency medicine residency and a law school, whereby a medical malpractice mock trial competition is used to teach residents basic skills for testifying in legal proceedings.
    Methods: Ten residents in an academic emergency medicine program volunteered as witnesses in a malpractice mock trial competition at a law school. Residents testified two or three times and, after each appearance, were provided feedback to prepare them for subsequent rounds of testimony. They were also given access to videotaped testimony. Judges rated each resident using a nine-question survey scored on a 10-point Likert scale. Scores were compared as a group between rounds of testimony.
    Results: Participants demonstrated significant improvement in seven of nine measured categories. p-Values reached significance in: Worked Well on Direct Examination (p < 0.001), Demeanor/Body Language (p < 0.001), Was Not Arrogant/Did Not Lose Poise on Cross-Examination (p = 0.001), Convincing Witness (p = 0.001), Appeared Knowledgeable (p = 0.012), Courtroom Attire (p = 0.012), and Expressed Themselves Clearly (p = 0.017). In addition, residents anonymously reported broad educational benefit.
    Conclusion: This novel educational collaboration taught residents about the process of litigation. It improved their communication skills and expanded their knowledge of documentation pitfalls, problems with staff interaction, and consequences of medical errors. This mutually beneficial partnership between a medical residency and a law school solidified it as a permanent feature of the residency program.
    Mesh-Begriff(e) Attitude of Health Personnel ; Clothing ; Consumer Behavior ; Emergency Medicine/education ; Emergency Medicine/legislation & jurisprudence ; Empathy ; Expert Testimony/standards ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Internship and Residency/methods ; Kinesics ; Male ; Malpractice/legislation & jurisprudence ; Verbal Behavior
    Sprache Englisch
    Erscheinungsdatum 2014-01
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2013.08.017
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  9. Artikel ; Online: Secreted Thrombospondin-1 Regulates Macrophage Interleukin-1β Production and Activation through CD47.

    Stein, Erica V / Miller, Thomas W / Ivins-O'Keefe, Kelly / Kaur, Sukhbir / Roberts, David D

    Scientific reports

    2016  Band 6, Seite(n) 19684

    Abstract: Thrombospondin-1 regulates inflammation by engaging several cell surface receptors and by modulating activities of other secreted factors. We have uncovered a novel role of thrombospondin-1 in modulating production and activation of the proinflammatory ... ...

    Abstract Thrombospondin-1 regulates inflammation by engaging several cell surface receptors and by modulating activities of other secreted factors. We have uncovered a novel role of thrombospondin-1 in modulating production and activation of the proinflammatory cytokine IL-1β by human and murine macrophages. Physiological concentrations of thrombospondin-1 limit the induction by lipopolysaccharide of IL-1β mRNA and total protein production by human macrophages. This inhibition can be explained by the ability of thrombospondin-1 to disrupt the interaction between CD47 and CD14, thereby limiting activation of NFκB/AP-1 by lipopolysaccharide. Only the CD47-binding domain of thrombospondin-1 exhibits this activity. In contrast, CD47, CD36, and integrin-binding domains of thrombospondin-1 independently enhance the inflammasome-dependent maturation of IL-1β in human THP-1 monocyte-derived macrophages. Correspondingly, mouse bone marrow-derived macrophages that lack either thrombospondin-1 or CD47 exhibit diminished induction of mature IL-1β in response to lipopolysaccharide. Lack of CD47 also limits lipopolysaccharide induction of IL-1β, NLRP3, and caspase-1 mRNAs. These data demonstrate that thrombospondin-1 exerts CD47-dependent and -independent pro-and anti-inflammatory effects on the IL-1β pathway. Therefore, thrombospondin-1 and its receptor CD47 may be useful targets for limiting the pro-inflammatory effects of lipopolysaccharide and for treating endotoxemia.
    Mesh-Begriff(e) Adenosine Triphosphate/metabolism ; Animals ; CD47 Antigen/genetics ; CD47 Antigen/metabolism ; Caspase 1/genetics ; Caspase 1/metabolism ; Cell Line ; Gene Expression ; Humans ; Interleukin-1beta/biosynthesis ; Lipopolysaccharide Receptors/metabolism ; Lipopolysaccharides/immunology ; Macrophage Activation/immunology ; Macrophages/immunology ; Macrophages/metabolism ; Mice ; Mice, Knockout ; Models, Biological ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism ; Protein Binding ; Signal Transduction ; Thrombospondin 1/genetics ; Thrombospondin 1/metabolism ; Toll-Like Receptor 4/metabolism
    Chemische Substanzen CD47 Antigen ; Interleukin-1beta ; Lipopolysaccharide Receptors ; Lipopolysaccharides ; NLR Family, Pyrin Domain-Containing 3 Protein ; Thrombospondin 1 ; Toll-Like Receptor 4 ; Adenosine Triphosphate (8L70Q75FXE) ; Caspase 1 (EC 3.4.22.36)
    Sprache Englisch
    Erscheinungsdatum 2016-01-27
    Erscheinungsland England
    Dokumenttyp Journal Article ; Research Support, N.I.H., Intramural
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/srep19684
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  10. Artikel ; Online: Development and use of new therapeutics for rare diseases: views from patients, caregivers, and advocates.

    Kesselheim, Aaron S / McGraw, Sarah / Thompson, Lauren / O'Keefe, Kelly / Gagne, Joshua J

    The patient

    2014  Band 8, Heft 1, Seite(n) 75–84

    Abstract: Background: Patients with rare diseases experience the health care system differently than patients with more common conditions. They can therefore provide important perspectives on the process of developing therapeutics for their conditions.: Methods! ...

    Abstract Background: Patients with rare diseases experience the health care system differently than patients with more common conditions. They can therefore provide important perspectives on the process of developing therapeutics for their conditions.
    Methods: We conducted three in-person focus groups involving rare disease patients (n = 9), caregivers (n = 8), and advocates (n = 9). Focus group participants were asked to describe their experiences with a rare disease, what they would want to know about a new drug for the disease, what outcomes they believe should be assessed in drug testing, perceptions of off-label use of a drug for treating a rare disease, views on participation in clinical trials, and opinions of the US Food and Drug Administration's (FDA's) function. The coding structure was populated from the transcripts of the sessions, using Atlas.ti qualitative analysis software, and then analyzed for common themes.
    Results: Participants described the challenges of learning to live with a poorly understood condition for which treatment is limited. Rare disease patients were willing to accept certain risks in their care in the hopes of finding some benefit, but also expressed frustrations with the costs of their care and the lack of scientific data about their treatments. They were concerned that the development and testing of therapies should, as quickly as possible, yield effective treatments to advance their quality of life.
    Conclusion: With limited therapeutic options, rare disease patients often considered off-label treatments or novel drugs that posed substantial risk. Nonetheless, rare disease patients generally appreciated the rigor of the research underlying the drugs and supported the FDA's gatekeeping role.
    Mesh-Begriff(e) Caregivers/psychology ; Drug Discovery ; Female ; Focus Groups ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Patient Advocacy/psychology ; Quality of Life ; Rare Diseases/diagnosis ; Rare Diseases/drug therapy ; Rare Diseases/psychology ; United States
    Sprache Englisch
    Erscheinungsdatum 2014-11-02
    Erscheinungsland New Zealand
    Dokumenttyp Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2466680-4
    ISSN 1178-1661 ; 1178-1653
    ISSN (online) 1178-1661
    ISSN 1178-1653
    DOI 10.1007/s40271-014-0096-6
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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