Dr. Hinson and Dr. Stecker joined the program on July 1, 2013.
Holly Hinson, MD
Dr. Hinson is an Assistant Professor of Neurology and Neurocritical Care at OHSU. She received her MD at the University of Texas in San Antonio and completed internship and residency training in Neurology at the University of Maryland in Baltimore. While in Baltimore, she also finished a fellowship in Neurologic Critical Care at Johns Hopkins Hospital. At OHSU, she attends in the Neuroscience Critical Care unit and serves as the associate fellowship director. In 2012, she was the recipient of the American Brain Foundation Practice Research Training Fellowship for her project entitled Quantifying Paroxysmal Sympathetic Hyperactivity.
Dr. Hinson's research focuses on autonomic nervous system dysfunction after acute brain injury, especially after traumatic brain injury (TBI). Despite advances in both prevention and treatment, TBI remains one of the most burdensome diseases; 2% of the US population currently lives with disabilities resulting from TBI. Primary brain injury occurs at the time of the trauma as a direct result of the physical forces acting on the body and can only be avoided by injury prevention. However, secondary brain injury, resulting from a complex sequence of events that begins at the initial insult and continues into the acute hospitalization, may be mitigated by intervention.
One possible source of secondary brain injury may be fever, or hyperthermia. Hyperthermia is associated with worse outcome in TBI patients, as well as in experimental models of TBI. Dr. Hinson's hypothesis is that systemic release of pro-inflammatory cytokines is associated with early hyperthermia (i.e. neurogenic fever) in a subset of TBI patients and that the combination of inflammatory cytokines and increased metabolic demands of fever are associated with secondary brain injury. The practical implications of this hypothesis are that early treatment of fever and use of anti-inflammatory interventions might reduce secondary brain injury in these patients and result in improved outcomes. Her work will form the foundation for mechanistic treatment approaches to reduce secondary brain injury in the emergency care setting.
Mentors: Dennis Bourdette, MD, Martin Schreiber, MD, Mary Stenzel-Poore, PhD, and Cynthia Morris, PhD, MPH
Eric Stecker, MD, MPH
Dr. Stecker is an Assistant Professor in the Knight Cardiovascular Institute at OHSU. He received an MD from the University of Wisconsin School of Medicine and Public Health as well as an MPH from the University of Michigan School of Public Health. He completed an Internal Medicine residency, a Cardiovascular Medicine fellowship, and an Electrophysiology fellowship at Oregon Health & Science University.
Dr. Stecker has worked with the Oregon Sudden Unexpected Death Study (SUDS) since 2002. Early work defining the role of ejection fraction in sudden cardiac death risk led to him receiving the 2005 American College of Cardiology's Young Investigator Award. Dr. Stecker's current research focuses on the role of underlying cardiac pathophysiology on survival after resuscitation of sudden cardiac arrest. He will use logistic modeling as well as binary recursive partitioning methods to test hypotheses regarding the importance of coronary artery disease and left ventricular dysfunction. Dr. Stecker hopes to identify factors that may allow for resuscitation efforts tailored to underlying causes of sudden cardiac arrest with the goal of improving survival.
Mentors: Jon Jui, MD, MPH, Craig Newgard MD, MPH, Jonathan Lindner MD, and Sumeet Chugh MD
Dr. Chang and Dr. Rowell joined the program in July, 2012.
Anna Marie Chang, MD, MSCE
Dr. Chang joined the faculty in the Department of Emergency Medicine as an Assistant Professor in July 2012. She is a graduate of the Northwestern University Feinberg School of Medicine and completed a Master of Science in Clinical Epidemiology at the University of Pennsylvania Perelman School of Medicine.
Dr. Chang's research interests are in studying patients with acute cardiopulmonary conditions and transitions of care. Heart failure, asthma, chronic obstructive pulmonary disease (COPD), and ischemic heart disease account for a significant proportion of emergency department (ED) visits, hospital admissions (up to 70% of these patients are admitted through the ED) and repeat ED visits, and have a high rate of readmissions (up to 25% within 30 days). Furthermore, Medicaid enrollees less than 64 years old had 45.8 ED visits per 100 enrollees compared with 24.0 visits per 100 for privately insured people. Thus, reducing ED utilization and admissions for these conditions in the Medicaid population will greatly impact overall ED use, and present research has identified a lack of quality connections and transitions from hospital-to-home for patients with these specific conditions.
In 2012, the state of Oregon restructured its Medicaid program into Coordinated Care Organizations, which are local health entities that are accountable for health outcomes of the entire population they serve. Thus, Dr. Chang hopes to examine these unique changes to the model of care, and how they affect ED use for acute cardiopulmonary conditions. She will conduct a mixed-methods study to identify CCO, ED and patient level factors that lead to changes in ED utilization and hospitalizations. She will use the Oregon All Payers All Claims database to describe variation in repeat ED visit rates within CCOs. Using interviews and surveys, she will identify the key strategies as proposed by CCOs to reduce ED visits for asthma, heart failure, and COPD. Further interviews and surveys will determine how these key strategies are being implemented at the ED level.
Mentors: John McConnell, PhD, Deborah Cohen, PhD, Devan Kansagara, MD, and Honora Englander, MD
Susan Rowell, MD, MCR
Dr. Rowell is an Assistant Professor in the Division of Trauma, Emergency Surgery, and Acute Care Surgery at OHSU. A graduate of the University of California Davis School of Medicine, she completed a residency in surgery at UC Davis and served as Chief Resident there before coming to OHSU in 2006. At OHSU, she completed a fellowship in Surgical Critical Care, joining the faculty in 2007. She serves as Director of OHSU's Surgical Critical Care Fellowship Training Program. In 2011 she chaired the committee for the Eastern Association for the Surgery of Trauma, which re-wrote national guidelines for the management of mild traumatic brain injury.
Dr. Rowell's research interests focus on coagulation changes after traumatic brain injury (TBI), the number one cause of death and disability due to trauma. Management of TBI focuses on preventing secondary brain injury. Therefore, Dr. Rowell's initial study will examine the hypothesis that TBI induces an early and significant hypocoagulable state that can be characterized by thromboelastography, and that the severity of the derangement in coagulation is associated with progression of intracerebral hemorrhage. She will test this hypothesis in a prospective observational study of adult patients admitted to the Trauma Intensive Care Unit at Oregon Health & Science University with blunt TBI. The second aspect of this study will begin to explore the mechanism involved in TBI-associated coagulopathy using samples collected from the initial phase of the study. In addition to support from this K12, Dr. Rowell received the American Association for the Surgery of Trauma Research Fellowship Award.
Mentors: Nabil Alkayed, MD, PhD and David Farrell, PhD