Current Newsletter

• September 2024

Previous Study Updates

• March 2024
• November 2023
• August 2023
• March 2023
• October 2022
• July 2022
• April 2022
• November 2021
• May 2021
• January 2021
• October 2020
• April 2020
• January 2020
• August 2019

• Strategies to Innovate EmeRgENcy Care Clinical Trials Network (SIREN)
• Pediatric Readiness in the Emergency Care of Children
• EMERGEncy IDNet

Interested in expanding your career to include Emergency Care Research? CPR-EM offers a variety of training programs for many experiential levels. Learn about all of our opportunities here, or click on a link below to be directed to that specific program. 

• EM Research Fellowship
• OHSU Fellowship for Diversity in Research
• CRISP
• Summer Internships with CPR-EM

January/February/March 2025

D-dimer Levels in Acute, Medically Ill, Hospitalized Patients: A Large, Prospective, Multicenter Study in the United States. Richardson JS, Clark CL, Bastani A, Shams AH, Fermann GJ, Hiestand BC, Kea B, Mace SE, Peacock WF, Yang A, Welker JA. Clin Appl Thromb Hemost. 2025 Jan Dec;31:10760296251320406. doi: 10.1177/10760296251320406. PMID: 39943869 

Evidence-Based Anticoagulation Choice for Acute Pulmonary Embolism. Maughan BC, Kabrhel C, Jarman AF. JAMA Netw Open. 2025 Jan 2;8(1):e2452850. doi: 10.1001/jamanetworkopen.2024.52850. PMID: 39752164 

Impact of an Oregon health policy aimed at strengthening adolescent linkage to outpatient mental health care from the emergency department. Kraynov L, Charlesworth C, Choo E, McConnell KJ. Acad Emerg Med. 2025 Jan 16. doi: 10.1111/acem.15063. Online ahead of print. PMID: 39822070

Sudden Cardiac Arrest Associated with Hemodialysis: A Community-Based Study. Tri Tai Truyen TT, Uy-Evanado A, Holmstrom L, Reinier K, Chugh H, Jui J, Herzog CA, Chugh SS. Kidney360. 2025 Jan 17. doi: 10.34067/KID.0000000705. Online ahead of print. PMID: 39823188

A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles. Stolldorf DP, Storrow AB, Liu D, Jenkins CA, Hilton RA, Miller KF, Kim J, Boopathy D, Gunaga S, Kea B, Miller J, Collins SP. BMC Health Serv Res. 2025 Jan 27;25(1):147. doi: 10.1186/s12913-024-12102-9. PMID: 39865238 

Virtual Neonatal Resuscitation Curriculum for Emergency Medical Services (EMS) to Improve Out-of-Hospital Newborn Care. Huynh TK, Smith JD, Neth M, Overton-Harris P, Daya MR, Guise JM, Meckler GD, Hansen ML. Prehosp Emerg Care. 2025 Jan 28:1-7. doi: 10.1080/10903127.2025.2450074. Online ahead of print. PMID: 39786751

Chronic Opioid Use After Implementation of Oregon's Medicaid Back Pain Policy. Hartung DM, El Ibrahimi S, Livingston CJ, Charlesworth CJ, McConnell KJ, Choo EK. Am J Prev Med. 2025 Feb;68(2):272-280. doi: 10.1016/j.amepre.2024.10.004. Epub 2024 Oct 17. PMID: 39424208

Characteristics of Fentanyl Toxicity in Very Young Children. Temple C, Cassidy E, Hendrickson RG. J Pediatr. 2025 Feb;277:114409. doi: 10.1016/j.jpeds.2024.114409. Epub 2024 Nov 16. PMID: 39551091

Pediatric exposure to illicit fentanyl is associated with drug availability in the community. Hendrickson RG, Lin AL, Temple C. Clin Toxicol (Phila). 2025 Feb;63(2):115-117. doi: 10.1080/15563650.2024.2438271. Epub 2024 Dec 11. PMID: 39660995

Gaps in Public Access Defibrillation: Analysis of International Legislation. Kovoor JG, Jerrow R, Cork S, Page GJ, Jui J, Chugh SS, Finn CM, Kovoor P. JACC Adv. 2025 Feb;4(2):101573. doi: 10.1016/j.jacadv.2024.101573. PMID: 40021268

EMS Agency Characteristics and Adverse Events in Pediatric Out-of-Hospital Cardiac Arrest Among 49 U.S. EMS Agencies. Hansen ML, Walker-Stevenson G, Bahr N, Harrod T, Meckler G, Eriksson C, Idris A, Aufderheide TP, Daya MR, Fink EL, Jui J, Luetje M, Martin-Gill C, Mcgaughey S, Pelletier JH, Thomas D, Guise JM. Prehosp Emerg Care. 2025 Feb 10:1-7. doi: 10.1080/10903127.2025.2461284. Online ahead of print. PMID: 39907300

Pulling resources and blocking access to key scientific data will cause untold long term harm. Choo E. BMJ. 2025 Feb 11;388:r288. doi: 10.1136/bmj.r288. PMID: 39933758

Quantitative analysis of recreational psychoactive mushroom gummies in Portland, Oregon. Correia MS, Gonzaga MJ, Temple C, Gerona RR. Clin Toxicol (Phila). 2025 Feb 20:1-6. doi: 10.1080/15563650.2025.2450240. Online ahead of print. PMID: 39977248

Introduction to the AEM special issue on the science of errors in emergency care, 2025. Griffey RT, Kline JA, Maughan BC, Samuels-Kalow ME. Acad Emerg Med. 2025 Mar;32(3):198-199. doi: 10.1111/acem.15122. Epub 2025 Feb 4. PMID: 39905578 

Amiodarone vs lidocaine in adult out-of-hospital cardiac arrest, is there a clear winner? Overton-Harris P, Lupton JR. Resuscitation. 2025 Mar;208:110547. doi: 10.1016/j.resuscitation.2025.110547. Epub 2025 Feb 17. PMID: 39970980 

Targeted Normoxemia and Supplemental Oxygen-Free Days in Critically Injured Adults: A Stepped-Wedge Cluster Randomized Clinical Trial. Douin DJ, Rice JD, Anderson EL, Jackson CL, Cheng AC, Xiao M, Cwik J, Beaty LE, Wild JL, Daya MR, Doshi PB, Eastham SC, Goodman MD, Gunn SR, Haukoos JS, Hudson JA, Jansen JO, McMullan JT, Rizzo JA, Schreiber MA, Self WH, Semler MW, Steinwand A, Werner N, Bebarta VS, Schauer SG, Ginde AA; Strategy to Avoid Excessive Oxygen (SAVE-O2) Investigators. JAMA Netw Open. 2025 Mar 3;8(3):e252093. doi: 10.1001/jamanetworkopen.2025.2093. PMID: 40163121 Clinical Trial.

Severe hypoglycemia and hypothermia in massive metformin overdose. Horowitz KM, Dorey A, Horowitz BZ. Clin Toxicol (Phila). 2025 Mar 6:1-3. doi: 10.1080/15563650.2025.2472948. Online ahead of print. PMID: 40047521

Cuts to scientific funding will be detrimental to the US, achieving the opposite to Trump's stated aims. Barocas J, Choo E. BMJ. 2025 Mar 7;388:r476. doi: 10.1136/bmj.r476. PMID: 40054877

Post-Dobbs Decision Changes in Obstetrics and Gynecology Clinical Workforce in States With Abortion Restrictions. Zhu JM, Huntington A, McConnell KJ, Whelan AM, Aaron R, Rodriguez MI. JAMA Intern Med. 2025 Mar 10:e248149. doi: 10.1001/jamainternmed.2024.8149. Online ahead of print. PMID: 40063044

One poison center's experience with "snake" firework ingestions. Correia MS, Hughes A, Hendrickson RG. Clin Toxicol (Phila). 2025 Mar 12:1-4. doi: 10.1080/15563650.2025.2474563. Online ahead of print. PMID: 40071478

Emergency department use during pregnancy by medicaid type. Hersh AR, Acevedo AM, Mandelbaum A, Choo E, I Rodriguez M. BMC Pregnancy Childbirth. 2025 Mar 17;25(1):303. doi: 10.1186/s12884-025-07390-w. PMID: 40097938

Medicaid managed care organizations' experiences with network adequacy. Zhu JM, Rowland R, Polsky D, Suneson I, Haeder SF, Cohen DJ, McConnell KJ. Health Aff Sch. 2025 Mar 13;3(4):qxaf049. doi: 10.1093/haschl/qxaf049. eCollection 2025 Apr. PMID: 40190698 

Director, Center for Policy & Research in Emergency Medicine

As an emergency physician and physician-scientist, Dr. Newgard has ample experience studying, evaluating, and seeking to improve emergency care. He is the Director of the Center for Policy and Research in Emergency Medicine at OHSU, a position that bridges emergency care research and health policy. To date, his research has focused on EMS, field trauma triage, trauma systems, and the use of advanced statistical methods to evaluate these areas. Dr. Newgard has been continuously funded through federal research grants for over 20 years and has been very involved in large, collaborative, multi-site research efforts during this time.  

1. Improving emergency services and trauma care for children and adults.

Emergency services and trauma systems have had large gaps in the evidence base for patients at the extremes of age, namely children and older adults. Differences in these populations are due to unique responses to injury, differences in clinical management, the need for different provider training, comorbidity burdens, plus different trajectories and outcomes after injury. Dr. Newgard has worked to fill this void through multi-site research linking records across multiple phases of care and hundreds of hospitals, targeting key aspects of emergency care for children and adults.

2. Improving the process, efficiency and understanding of out-of-hospital trauma triage.

Trauma is the most common reason for 911 EMS transports, which is directed by national guidelines for field triage, one of the few aspects of EMS care that has national guidelines. Dr Newgard published a large body of work seeking to understand the process, outcomes, and costs associated with field triage, including the only prospective validation and cost-effectiveness analysis of the national guidelines. Many of these aspects have been poorly understood prior to this work. Five publications were cited in the 2011 revision of the national guidelines for field triage (the most recent revision), helping to shape the day-to-day practice of out-of-hospital care for injured patients across the U.S.

3. Statistics and methodology of emergency care research.

Dr. Newgard has helped catalyze the integration of several advanced statistical methods into the field of emergency care research. While these methods had been developed and used in other fields (biostatistics, econometrics), they have been under-utilized in emergency care research. The topics include multiple imputation of missing values, probabilistic linkage (combining disparate datasets without a unique identifier), and the use of electronic health records for EMS research. His methodologic expertise combined with an intimate understanding of emergency care delivery systems has been utilized in multiple federally-funded research projects.

4. Generating large, multi-site data registries to catalyze scientific discovery in emergency care.

Dr. Newgard has used his methodological skills and interest in large, population-based data to develop multiple data registries in emergency care. Two of these registries were developed through the NHLBI-funded Resuscitation Outcomes Consortium (ROC) and generated over 40 original research publications through the ROC network. Several of these publications have been integrated to national and international guidelines (e.g., National Guidelines for Field Triage and the AHA Advanced Cardiac Life Support algorithm) and serve as the basis for national quality improvement efforts (e.g., ACS Trauma Quality Improvement Project). Development of these registries demonstrates “team science” through collaboration with large inter-disciplinary teams.

Complete List of Published Work in: MyBibliography:  https://www.ncbi.nlm.nih.gov/myncbi/craig.newgard.1/bibliography/public/

Dr. Choo is an emergency medicine physician and core research faculty in the Center for Policy & Research, Department of Emergency Medicine, Oregon Health & Science University. She has considerable expertise in employing quantitative, qualitative, and mixed-method study designs to examine the experience of patients, clinicians, and administrators in emergency and primary care systems. One of Dr. Choo's focused interests has been on the impact of gender on emergency presentations and care. She co-founded the Division of Sex and Gender in Emergency Care at Brown University, including establishing the division’s two-year research fellowship that trains early investigators in methodologic approaches to gender-related research. Dr. Choo is the health services fellowship director in the Center for Policy and Research in Emergency Medicine at OHSU. 

1. Investigating epidemiologic data related to opioid and cannabis use and drug use policy. Dr. Choo has applied her skill set to examining large, complex state and national datasets to examine trends in drug use, particularly related to opioid and marijuana use, gaining experience in managing and analyzing such data to inform policy and shape future areas of research.

2. Understanding the influence of gender on emergency care interventions. Emergency care drug and alcohol interventions have largely failed to include gender-specific considerations or common co-existing problems. Her research has focused on the differences between men and women with substance use disorders and the influence of co-existing violence involvement and substance use disorders on screening and interventions. By drawing attention to the important role of gender and violence in the development of substance use disorders, specific barriers to treatment and recovery, and differential responsiveness to ED-based interventions based on gender and violence involvement, my body of work has supported interventions specific to these factors. Dr. Choo developed a Web-based brief intervention for women with drug use and IPV, using interviews with the target population to guide the language, content, and format of the intervention. 

3. Establishing gender-focused technology-based screening interventions for drug use and violence in the emergency care setting. Dr. Choo's work has included integrated qualitative and quantitative research to develop technology-based screening and behavioral interventions for the emergency care setting and to evaluate their feasibility and acceptability. She has used tailored Web-based screening assessments and developed videos incorporating women with coexisting disorders to increase the relevance and human connection of interventions delivered through a Web-based medium. 

4. Investigating epidemiologic data related to opioid and cannabis use and drug use policy. Dr. Choo completed fellowship training in health services and health policy research. She has applied this skill set to examining large, complex state and national datasets to examine trends in drug use, particularly related to opioid and marijuana use, gaining experience in managing and analyzing such data to inform policy and shape future areas of research. 

5. Understanding influences on the careers of women in medicine.  Dr. Choo's research has included investigations of the persistent gender gaps in the careers of women in medicine and science, including experiences of discrimination and the sequelae on mental health and burnout.

Complete List of Published Work in MyBibliography:  

http://www.ncbi.nlm.nih.gov/sites/myncbi/18wl1r9G6ga5g/bibliography/43034531/public/?sort=date&direction=ascending

Dr. Hansen is a physician-scientist dual-boarded in Emergency Medicine and Pediatric Emergency Medicine. Dr. Hansen has research funding from AHRQ and NHLBI to study prehospital care for critically ill children with a focus on airway management, cardiac arrest, and respiratory emergencies. Other interests include medical technology development and global health systems development.

1. Pediatric Patient Safety in Out-of-Hospital Care:  Dr. Hansen's primary interest is in improving out-of-hospital care for severely ill or injured children. He recently published a paper in JAMA Open describing critical differences in adult and pediatric cardiac arrest resuscitation quality using a simulation model. He also completed a study published in JAMA pediatrics that identifies a previously unrecognized problem in safety dosing epinephrine to children suffering a cardiac arrest and subsequently published a paper in JAMA Open detailing an intervention that solved this problem. Dr. Hansen has had a sustained focus on improving out-of-hospital pediatric airway management. He is a co-investigator in the recently funded PEDI-PART trial, which is a landmark randomized trial of pediatric airway devices in EMS. In a prior study, he identified critical challenges in monitoring pediatric vital signs during prehospital airway management procedures. Finally, he conducted a medical record review that identified the significant types and rates of safety events that take place during out-of-hospital pediatric airway management.

2. Out-of-Hospital Cardiac Arrest Resuscitation Science: One of his publications (“a” below) was a key article cited in changes to the 2019 American Heart Association Pediatric Advanced Life Support guidelines where BVM recommended as reasonable for Pediatric OHCA. Overall, Dr. Hansen has an interest in identifying interventions or changes in practice that can improve outcomes for patients who have suffered an out-of-hospital cardiac arrest. He has focused work on airway management in these patients and has conducted work finding that intubation is associated with poorer outcomes from cardiac arrest. In addition, he led a study that found shorter times to the first dose of epinephrine was associated with improved survival from cardiac arrest from non-shockable rhythms.

3. Pediatric prehospital readiness: Dr. Hansen's current R01 grant from AHRQ focuses on identifying the potential benefits of improving pediatric readiness among EMS agencies. He is partnering with the HRSA-funded National Prehospital Pediatric Readiness Project (NPRP), who developed a readiness assessment tool that will be deployed nationwide. This work builds from recent studies showing that improved pediatric ED readiness is associated with higher survival from critical emergencies.

4. Medical Technology Development: Dr. Hansen co-developed a technology to measure capillary refill time (CRT) electronically. CRT is an important marker of microcirculatory function. A company he co-founded, Promedix Inc., is currently in the process of obtaining FDA clearance and gathering clinical evidence on electronically measured CRT and sepsis.

Complete List of Published Work in MyBibliography:  

http://www.ncbi.nlm.nih.gov/myncbi/browse/collection/46823959/?sort=date&direction=descending

Biography: Joshua Lupton, MD, MPH, MPhil, is a cardiac arrest survivor, emergency physician, and researcher who studies ways to improve treatment and increase survival for patients suffering out-of-hospital cardiac arrest. After receiving his undergraduate degree from the University of Oregon, Dr. Lupton was selected as a Marshall Scholar and received an MPH from the London School of Hygiene and Tropical Medicine and an MPhil from the University of Cambridge. After medical school at Johns Hopkins University School of Medicine, Dr. Lupton completed his residency in Emergency Medicine and a fellowship in Emergency Care Research at Oregon Health and Science University. Dr. Lupton coordinates the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry), working closely with regional emergency medical services agencies and hospitals.

Dr. Lupton’s Research Interests: Dr. Lupton focuses on observational and interventional research to optimize the care of out-of-hospital cardiac arrest patients so as to increase the proportion of patients surviving with a good outcome. Currently, only 10% of patients suffering out-of-hospital cardiac arrest survive across the United States. However, this survival can range significantly with higher performing systems of care having significantly greater survival. Focusing on this natural variation, Dr. Lupton aims to explore the specific aspects of care – and the optimal delivery of these – to maximize survival.

Dr. Lupton coordinates the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry), a continuation of the Portland metropolitan Resuscitation Outcomes Consortium Registry that has been active since 2005. This registry allows for detailed observational studies to generate hypothesis for testable interventions in future trials.

Complete List of Published Work in MyBibliography:

https://www.ncbi.nlm.nih.gov/myncbi/joshua.lupton.1/bibliography/public/

Dr. Kea is an Associate Professor in Emergency Medicine in the Dept of Emergency at OHSU, and a physician-scientist focused on improving acute neuroscience and cardiovascular care through evidence-based guidelines and novel treatment strategies to improve clinical outcomes. She is the Director of Clinical Trials for emergency medicine at OHSU, and has been the site PI for multiple diagnostic and interventional studies, and collaborated with other departments and institutions to enroll patients for sepsis, COVID, and heart failure studies. She is also the Co-PI of the OHSU Hub for SIREN (NINDS/NHLBI), a network of hospitals performing emergency care research.  She is a product of the NIH training pipeline, beginning with an initial week-long exposure to NIH for underserved undergraduates students, subsequent NHGRI summer undergraduate research experience, followed by an NHLBI-funded ROC fellowship at OHSU, NHLBI K12 institutional scholar, NHLBI K08, and now an NHLBI Early Stage Investigator R01. Her R01 is a multi-centered stepped wedge cluster randomized clinical trial multi-centered stepped-wedge randomized clinical trial utilizing a novel clinical decision support tool to improve stroke prevention in patients with atrial fibrillation. This mixed-method study enrolls patients and providers and uses large databases to collect quantitative data.

1. With respect to clinical trials methodology, Dr. Kea has contributed with her early research and her most recent experiences as a site co-I and PI. Dr. Kea's early research sought to determine a genetic basis for dermatomyositis (DM) as there was little knowledge about DM or its treatment options. She has recruited, enrolled, and collected skin biopsies from both healthy controls and patients with dermatomyositis. She developed the protocol for RNA extraction (still in use at Stanford) and gene expression analysis on gene chips developed by our lab (Dr. Patrick Brown).  This work laid the foundation for determining the biologic signatures for DM and potential gene targets for treatment. Most recently, Dr. Kea has assisted the PETAL-network (an NIH-sponsored network for pulmonary critical care) as a site co-investigator for randomized-controlled clinical trials for patients with acute respiratory distress using an early neuromuscular blockade as well as for sepsis care with a variety of interventions (including vitamin D, high volume vs. low volume fluid resuscitation, and vitamin C, thiamine and steroid). For SIREN, Dr. Kea was the site PI of the Clinical Trial of COVID-19 Convalescent Plasma in Outpatients (4^th highest enrolling site in the network). She is also leading two OHSU sites in enrolling patients (257 patients) to determine the utility of COVID-19 antigen testing. She has collaborated with nursing, hospital medicine, blood bank, subspecialty groups, and therapeutic committees. She also educates clinicians, nurses, and pharmacists on the studies, assists in recruiting patients and troubleshoot to increase enrollment and improves integration into clinical workflow. OHSU is often the top enroller in these network studies.
2. Atrial fibrillation (AF) is a common arrhythmia that presents to the Emergency Department (ED) with wide inter-variation of EM management globally. Dr. Kea has used different methodologies to determine current prescribing practices of EM providers and practices gaps from current professional AF guidelines on both a local and national level, and provider barriers to optimal oral anticoagulation (OACs) prescribing. And initial chart review study informed the design of her NHLBI K08 and the decision to obtain a larger sample of patients from a network of hospitals. On a national level, she obtained a representative cohort of Medicare beneficiaries from 2011-2012. The results were subsequently published in the Journal of American College of Cardiology. To further understand practice gaps, Dr. Kea undertook a qualitative study interviewing both ED providers and patients regarding barriers to optimal AF management, and more specifically around OACs. Other than editorials, this was the first qualitative study addressing EM provider barriers to ED AF management and OAC prescribing. Her K08 work with Kaiser Northern California’s 21 hospitals has similarly demonstrated low amounts of ED prescribing, with women less likely to receive appropriate stroke prophylaxis compared to men (submitted to Ann of EM). Using the GLORIA-AF database, Dr. Kea's team also found variability in prescribing anticoagulants internationally (in press). These data laid the groundwork for her R01, a multi-centered stepped wedge cluster randomized clinical trial utilizing a novel clinical decision support tool to improve stroke prevention in patients with atrial fibrillation (1R01HL157598).
3.  In order to improve the reliability of manuscripts and create a more informed and discriminating reader, she and her colleagues wrote a two-part series on bias in studies of diagnostic tests.  The ability to recognize and discern different types of bias is important to understanding the relevance, flaws, and applicability of a study to the reader’s population.  They created examples that an emergency provider would encounter and whether renowned studies would apply to those examples, and flaws within them. Dr. Kea and colleagues also discussed that sometimes bias may be necessary due to the ethics of a study, but does not discount the study. In all, they are a practical and readily usable methods of recognizing bias. 
4. Opioid abuse is a well-known epidemic, and emergency populations are potentially at high risk for abuse. To determine the contribution of ED to the epidemic of opioid prescribing, she described the trends of ED opioid prescribing using a multistage, probability sample of US ED visits. This data of 502.4 million ED discharges from 2006-2010, showed no increasing trends in ED prescribing and contributed the national EM discussion on the role EM in opioid prescribing.    
5. Dr. Kea has contributed to the derivation of two clinical decision instruments by playing a key role in the data analysis phase using recursive partitioning: (1) a pilot study on the development of a clinical decision instrument for endocarditis in intravenous drugs users, and (2) derivation of criteria for selective chest x-ray imaging in blunt trauma. This second project led to funding from a CTSI grant, which she used to develop a multi-center study to determine the utility of chest CT in blunt trauma patients. During this project, Dr. Kea managed many research assistants, performed data management of a large data set, communicated with other institutions, and performed statistical analyses, and manuscript composition. This study was awarded the American College of Emergency Physician’s Best Resident Paper in 2011, and has prompted a larger multi-center study on a clinical decision instrument for selective chest CT in blunt trauma.

Complete List of Published Work in MyBibliography:   https://www.ncbi.nlm.nih.gov/myncbi/bory.kea.1/bibliography/public/  

Dr. Maughan completed a two- year research fellowship in the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania. His research training primarily focused on epidemiology, study design, regression analysis, and experimental quantitative methods for health services research. Dr. Maughan's long-term career goal is to become an independently funded physician-scientist with expertise in identifying biological (sex-based) and behavioral (gender-based) differences in diagnosis and treatment of acute cardiopulmonary disease in the emergency care setting, with the aim of developing interventions to improve patient outcomes and equity of care. He studies these elements to regard to the care of pulmonary embolism (PE), the third leading cardiovascular cause of death in the US and a frequent diagnostic consideration in emergency department (ED) patients with chest pain or shortness of breath. Diagnosis of PE is challenging since only 1-2% of the 16 million annual ED patients with these common symptoms have PE. Insufficient testing can result in harm from missed PE diagnosis, while overtesting leads to wasteful resource use and unnecessary radiation exposure from diagnostic imaging such as CT pulmonary angiography (CTPA). To reduce these harms, guidelines recommend physicians use d-dimer, a plasma biomarker of thrombosis, to initially screen patients who have concerning symptoms but are not at high risk for PE. While PE incidence is similar by sex, women undergo PE testing nearly twice as often as men, suggesting risks of missed diagnosis in men and harms of overtesting in women.

1. Pulmonary embolism (PE) is the third leading cardiovascular cause of death in the United States and is a frequent diagnostic consideration in emergency department (ED) patients with chest pain or shortness of breath. Historically, treatment options for PE were rather narrow in scope and typically require hospital admission, yet recent advances have broadened the available treatments for both high-risk (i.e., severe) and low-risk PE.  Dr. Maughan's research summarized recent advances in PE treatment and identified key unmet research needs for future investigation.
2. Over 75,000 people die of opioid overdoses each year in the United States. A key strategy for reducing opioid-related mortality includes a reduction in the quantity and duration of opioid analgesic prescriptions, especially for patients in whom pain can be treated effectively with other analgesics. As a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania, Dr. Maughan explored opioid use patterns in these populations. First, with grant support from the Leonard Davis Institute for Health Economics, he conducted a pilot randomized trial that assessed the quantity of opioid analgesic used after dental surgery (wisdom tooth extraction) and assessed patient response to an educational intervention regarding disposal of unused pills. Dr. Maughan helped identify that more than half (54%) of opioids prescribed in this setting were not used, suggesting that oral surgeons could substantially reduce opioid prescribing and reduce the risk of drug misuse or diversion. Dr. Maughan also examined prescription opioid use patterns among women following the delivery of an infant. Using a large national claims dataset that included 870,000 postpartum women, they found a 7-fold variation (7.6–53.4%) in the proportion of women who filled opioid prescriptions within four days of uncomplicated vaginal delivery. Another important policy strategy for reducing overdose morbidity is to identify patients with substance use disorders who are at especially high risk for overdose. In collaboration with the Texas Department of State Health Services, Dr. Maughan conducted two record-linkage studies to assess short-term overdose death rates among patients recently discharged from substance abuse treatment programs. They identified that drug-related death was significantly higher after treatment discharge among patients who used opioids, particularly after completion of residential therapy.
3. Although nearly all states have established prescription drug monitoring programs (PDMPs) to improve the safety of high-risk prescription medications, the effect of these programs on rates of fatal and nonfatal overdose was unclear. Using Drug Abuse Warning Network public use files in a generalized estimating equations framework, Dr. Maughan conducted two analyses to measure the impact of these programs on rates of emergency department visits for opioid-related and benzodiazepine-related overdose. An important policy consideration in PDMP implementation is selecting who can access the database. Some state health departments required PDMP use for routine opioid prescriptions yet restricted PDMP access to a narrow set of clinicians. To inform further policy development, Dr. Maughan conducted a study to measure the time burden and financial cost of mandating physician PDMP use rather than permitting the delegation of this task to other clinical staff members. The analysis concluded that PDMP use could be maintained yet costs to the health system could be reduced by over 60% if policies were adopted to permit other clinical staff to use these data.
4. Payment for healthcare services has a major impact on the availability and quality of care. Bundled payment models for Medicare have successfully reduced payments for services, yet policymakers have raised concerns that the financial incentives of these programs could restrict access to care or result in poorer outcomes for patients with vulnerabilities such as low socioeconomic status or dementia. Dr. Maughan analyzed the Bundled Payment for Care Improvement (BPCI) program, an alternative Medicare payment model authorized by the Affordable Care Act, and our research identified that this program was not associated with reductions in quality of care for patients with vulnerabilities.
5. Choosing Wisely is a national program from the American Board of Internal Medicine Foundation that is designed to improve medical resource stewardship by promoting discussions between physicians and patients regarding the value of medical tests and treatment. The emergency department is a high-risk clinical environment in which physicians often must make time-sensitive decisions on the use of expensive medical resources for patients with whom they have no existing relationship. Dr. Maughan measured awareness of the Choosing Wisely program among leaders in the emergency medicine community and identified opportunities for emergency physicians to collaborate with other specialists on reducing unnecessary testing and improving the value of emergency care.

Complete List of Published Works in MyBibliography:

https://www.ncbi.nlm.nih.gov/myncbi/brandon.maughan.1/bibliography/public/

Dr. Nikolai Schnittke is a graduate of the Tufts University MSTP program where his research focused on neuronal regeneration of the olfactory epithelial system after injury. This interest in acute injury led him to training in Emergency Medicine at the University of Wisconsin where he discovered the power point-of-care ultrasound as a rapid diagnostic assay to assess patients with acute pathology.

He is particularly interested in ways that ultrasound can be brought outside of the typical hospital environment such as to the prehospital and global health settings. A common barrier in many of these settings is the lack of trained personnel to obtain and interpret ultrasound images at an expert level. In 2020, Nikolai joined a federally funded partnership with BARDA (The Biomedical Advanced Research Development Authority) and the Center for Regenerative Medicine at OHSU to focus on machine learning approaches to ultrasound training and image interpretation. He is the principal investigator for a multi-center study to develop and validate machine learning algorithms to improve FAST exam image acquisition and interpretation, and is a co-investigator for similar approaches to lung ultrasound automated tools. The goal is to bring ultrasound directly to the bedside, so that it can be accessible to all patients who need it in real time to make time-sensitive treatment and management decisions.

Nikolai's other interests include global health resident education through leading a "Global Health and Limited Resource Medicine" education track and exploring ways to reduce barriers to ultrasound use by ED physicians.

When not covered in ultrasound gel or waving his hands to show how to move an ultrasound probe, Nikolai enjoys wandering the mountains and coast of the Pacific Northwest with his family and friends.

Complete List of Published Work in MyBibliography:

https://scholar.google.com/citations?user=E7MlbsMAAAAJ&hl=en

Dr. Sheridan is a pediatric emergency physician and a physician-scientist in the Oregon Health & Science University Department of Emergency Medicine, with a joint appointment in the Department of Pediatrics. In addition to his clinical training, he earned a Master’s degree in Clinical Research (MCR), which provided coursework in epidemiology, biostatistics, clinical trial design, implementation science, and data analysis. Dr. Sheridan's research includes publications mainly in emergency care around adolescent mental health, development of new technology, evaluation of new interventions, observational research, and randomized controlled trials. Much of his work has focused on medical device development as an academic physician-scientist. He has filed 7 patents and one technology has become an OHSU startup company. Through this innovation work Dr. Sheridan has had to learn first-hand the processes and methods for moving a device from concept to commercialization.

1. Adolescent Mental Health Crises and Emergency Care

Through problem-based innovation in the ED, Dr. Sheridan has recognized the critical need for improved emergency care research in adolescent mental health. There has been a paucity of literature on adolescent children presenting to EDs in crisis, which my work has begun to address. Dr. Sheridan's foundational work has shown evidence of a rapidly growing population of children presenting to EDs in crisis, the prevalence of adolescent suicidality and care received in the ED, and the need for improved outpatient monitoring. His K12 project was aimed at providing a foundation in this area and his K23 is exploring it further in a more rigorous approach. The current study focuses on EMA, machine learning and wearable technology to assess dynamic changes in acute adolescent suicidality.   

2. Device Development in Pediatric Emergency Care

Medical devices are often created by industry with little clinician involvement, resulting in technology that is often too expensive, not indicated, or ineffective. Dr. Sheridan has founded an innovation division in our department that has developed infrastructure for combining physicians and engineers to develop technology through an innovation based process. This has resulted in funding, intellectual property and prototypes in clinical testing. One technology has been spun out of OHSU as a startup company.  

3. New Imaging Modalities with Decreased Risk for Acute Pediatric Head Trauma

Pediatric head injuries account for millions of ED visits per year and carry significant morbidity and mortality in children. The current imaging test of choice is a CT scan, but this entails significant radiation exposure that can result in future malignancy at a risk of approximately 1:1000 scans. “Quick brain” MRI has introduced the possibility of obtaining rapid-sequence neuroimaging without radiation. Dr. Sheridan completed a retrospective study showing 100% sensitivity of MRI to detect injuries that catalyzed a prospective observational study at our pediatric trauma center evaluating the diagnostic utility of quick brain MRI versus head CT among children presenting with acute head trauma. As the PI, he brought together 5 specialties across the institution to collaborate on the trial resulting in a publication that has resulted in practice guidelines for neuroimaging in pediatric trauma.

Complete List of Published Work in MyBibliography:

https://www.ncbi.nlm.nih.gov/myncbi/1nAqMLOj0EsAT/bibliography/public/

Dr. Daya is a Professor, board certified in Emergency Medicine with sub-specialty certification in EMS. In addition to actively practicing emergency medicine, Dr. Daya also serves as the medical director of several fire-based EMS agencies in the Portland metro region and is the medical director for the Washington County 911 Center. He is currently a MPI for the OHSU hub of the Strategies to Innovate Emergency Care Clinical Trials Network (SIREN) where he is also the site PI for the SIREN ICECAP study. He is a co-investigator with the Linking Investigations in Trauma and Emergency Services (LITES) network in which he serves as the site PI for the LITES PACT trial. Previously, Dr. Daya was the PI for the Portland Resuscitation Outcomes Consortium site as well as the site PI for the multicenter Think Symptoms Study and the Pragmatic Airway in Resuscitation Trial (PART). Dr. Daya received the EMS Medical Director of the Year award in 2009 and the EMS Impact Award in 2018 from the State of Oregon. In 2017, he ranked 55th nationally among Emergency Medicine investigators in total NIH funding.  

1. Research Focus

Dr. Daya's research focus is on time-critical prehospital emergencies, in particular, out-of-hospital cardiac arrest. He has been involved with multiple clinical trials that have examined interventions such as public access defibrillation, initial CPR strategies, devices that enhance blood flow, airway interventions, as well as the role of medications, especially anti-arrhythmic treatment in shock-refractory VF/VT. As a result of this experience, the route, as well as the timing of anti-arrhythmic drug treatment, have emerged as areas that deserve further investigation to improve survival from sudden cardiac death in the United States.  

2. Focus on EMS intervention for ACS, STEMI, and OHCA

Dr. Daya previously served as a co-investigator with the NIH-NHLBI-funded Rapid Early Action for Coronary Treatment (REACT) study from 1994 to 1998. The REACT study was a community randomized trial designed to reduce delays in time between symptom onset and treatment in patients with suspected ACS, in particular, STEMI. Although the REACT study failed to show a difference in the delay time between control and intervention communities, it did demonstrate an increase in EMS utilization in the intervention communities. Dr. Daya has continued to remain active in the study of ACS and STEMI-related symptoms and patient response, including the use of 911, through collaborative work with two federally funded nurse researchers (Holli Devon PhD, Anne Rosenfeld, PhD) examining symptom differences between men and women.  Following the conclusion of the REACT study, Dr. Daya served as the site PI for the NIH-funded Public Access Defibrillation (PAD) Trial. (2000 to 2002). This randomized controlled clinical trial compared the strategies of community CPR vs. community CPR plus AED deployment on outcomes following out-of-hospital cardiac arrest (OHCA) at high-risk locations. The PAD trial showed a doubling of survival in the CPR plus AED arm, validating the need for the widespread deployment of AEDs in public places. His work in this area has continued through the implementation of the Pulse Point program, which alerts laypersons willing to respond to public cardiac arrests in their immediate vicinity. TV&R, where Dr. Daya serves as medical director, participated in a pilot program for the professional responder Pulse Point app effort in which off-duty fire personnel are alerted to cardiac arrests in nearby public and private settings.

3. Portland Research Outcomes Consortium (ROC)

Dr. Daya was involved with the ROC since its inception in 2004, initially as a co-investigator and subsequently as the Portland Site PI. He served as the lead cardiac arrest study investigator and as a co-investigator in most trauma clinical trials. The Portland ROC site participated in the following ROC clinical trials: PRIMED, ALPS, HS, HYPORESUS, PART, and TXA in TBI. ROC studies often involved the Exception to Informed Consent rule, and as a result, the Portland ROC site researched the impact of this rule extensively in our community and nationally. This work also continued through Portland ROC's participation as a site within the NIH-funded VOICES-3 study.  The ROC also maintained an active population-based epidemiological registry of OHCA incidence and outcome since its inception. In addition to clinical trial monitoring, the ROC EPISTRY served as the foundational basis for measuring and assessing outcomes through strategic interventions such as community CPR efforts, law enforcement CPR/AED deployment, dispatch-assisted CPR, high-performance CPR (rate, depth, complete recoil, minimal interruptions) and protocol guided post-resuscitation care including the use of targeted temperature management and early coronary angiography. As part of ROC, Portland RCC collected real-time monitor defibrillator files and the biomedical signals from some of these files have been analyzed through collaboration with signal processing experts based at the University of the Basque Country in Spain. Following the end of the ROC, the Portland metropolitan region has continued its cardiac arrest registry, now called The PDX Epistry which has added data points to further ongoing resuscitation research.  

Complete List of Published Work:

https://www.researchgate.net/profile/Mohamud-Daya