Dr. Piantino joined the program July 1, 2017.
Juan Piantino, MD
Assistant Professor; Director, inpatient Child Neurology, Department of Pediatrics
Dr. Piantino is an Associate Professor of Pediatrics, section of Child Neurology at OHSU. He received his MD at the Universidad de Buenos Aires and completed his residency in Child Neurology at the University of Chicago. He continued his training with fellowships in Pediatric Neurocritical Care at Northwestern University, and Clinical Neurophysiology at the University of Washington. He joined OHSU in 2016 as the Director of Inpatient Pediatric Neurology. He is also the co-director of the Pediatric Neurocritical Care Program at Doernbecher Children's hospital –OHSU.
Dr. Piantino's research focuses on the use of novel technology to assess the integrity of the central and autonomic nervous systems in critically ill children, particularly those with traumatic brain injury (TBI). In the United States, approximately 17,000 children and adolescents die annually of unintentional and intentional injuries. Despite improvements to trauma care, several barriers to improving outcomes in this population remain. Some of these barriers include difficulty with early recognition of serious injury, the lack of individualized therapies, and reliable prognostic measures. In recent years, novel technology has allowed physicians to obtain early electroencephalographic (EEG) recordings in patients in the Emergency Department (ED). Simultaneous EEG and electrocardiographic (ECG) monitoring may hold the key to understanding the natural course and correlation between central and autonomic nervous system dysfunction in pediatric trauma, as well as opportunities for early intervention to improve outcomes.
To understand the effects of TBI on central and autonomic nervous system function, Dr. Piantino designed an observational study to test the hypothesis that in children with trauma, early (i.e. in the ED) decrease in heart rate variability (a marker of autonomic dysfunction) correlates with EEG abnormalities (a marker of central nervous system dysfunction) and with more traditional measures of injury severity. He will then study the association between short-term functional outcome, and early autonomic/central nervous system dysfunction.
Mentors: Craig Newgard, MD, MPH; Bonnie Nagel, PhD; Anna
Wilson, PhD; Mark Wainwright, MD, PhD; Yoon-Jae Cho, MD
Dr. Vranas joined the program July 1, 2017.
Kelly C. Vranas, MD
Assistant Professor of Medicine
Dr. Vranas became an Assistant Professor of Medicine in the Division of Pulmonary and Critical Care July 1, 2017. She received her M.D. from Cornell University, and completed residency training in Internal Medicine at the University of Pennsylvania. She went on to complete two years of fellowship training in Pulmonary and Critical Care Medicine at Stanford University where she also spent a year as a research fellow at the Clinical Excellence Research Center investigating new methods of critical care delivery designed to improve the value, quality, and experience of care. She completed her fellowship in June 2017 and is currently enrolled in the Human Investigations Program, working towards a Master's Degree in Clinical Research.
Dr. Vranas' research interests focus on improving the quality, efficiency, and value of critical care through innovations in the care delivery process. Dr. Vranas was recently awarded a Medical Research Foundation grant to study the association of ICU acuity with clinical outcomes of ICU patients at low risk of dying. She is also interested in studying mechanisms to improve end-of-life care, and was recently awarded a grant from the Collins Medical Trust to examine the association of documented care preferences with inpatient healthcare resource utilization and receipt of care consistent with patients' goals. As a K12 scholar, Dr. Vranas will be using a mixed-methods approach to 1) examine the variability in ICU admitting patterns for common critical care diagnoses across the VA Healthcare system; 2) evaluate the association of ICU utilization for these patients with clinical outcomes; and 3) qualitatively identify previously unmeasured, modifiable features of hospital healthcare delivery systems that are associated with variation in ICU admitting practice. Dr. Vranas hopes to generate insights into why comparable patients may be treated differently merely as a function of where they are hospitalized, with the goal of using this information to generate validated ICU admission standards applicable to patients with different risk profiles.
Mentors: Chris Slatore MD, MS; David Jacoby, M.D.; Don Sullivan MD, MA; Meeta P Kerlin MD, MSCE; Scott D. Halpern MD, PhD
Matt Hansen, M.D.
Assistant Professor of Emergency Medicine
Dr. Hansen is an Assistant Professor of Emergency Medicine at OHSU. He received an MD degree from Case Western Reserve University in Cleveland, Ohio. Dr. Hansen completed an Emergency Medicine residency, a Pediatric Emergency Medicine fellowship, and a Master of Clinical Research at OHSU. Since joining the faculty in 2012, Dr. Hansen has served as an Assistant Program Director for the Emergency Medicine residency program.
Dr. Hansen's research interests focus on resuscitation and stabilization of ill and injured children in the prehospital and Emergency Department settings. There is very little evidence to guide care of children in the prehospital setting and the EMS system is largely structured to care for adults who are a majority of EMS transports. However, injury is the leading cause of death in children and EMS care has the potential to have a high impact on outcomes given the importance of care in the first minutes following a significant injury.
Since 2012, Dr. Hansen has been a co-investigator in the Children's Safety Initiative-EMS (CHI-EMS) which is the largest study to date evaluating patient safety in the prehospital care of children. Dr. Hansen is particularly interested in studying pediatric airway and respiratory management in the prehospital setting which are critical components of resuscitation in many common pediatric emergencies from both medical and traumatic causes. Dr. Hansen completed the OHSU Emergency Medicine K12 program with work focused on understanding the epidemiology of airway emergencies in the prehospital setting and describing the nature of airway related safety events. Dr. Hansen was awarded a K23 from NHLBI to continue his prehospital pediatric airway management research through studies that assess supraglottic airway devices, describe the decision-making process of pediatric prehospital airway management, and assess the effect of airway interventions on pediatric cardiac arrest resuscitation.
Mentors: Dr. Jeanne-Marie Guise M.D., M.P.H.;Dr. Craig Warden M.D., M.P.H.;Craig Newgard, M.D., M.P.H., Dr. William Lambert Ph.D. External advisors: Dr. Nathan Kuppermann M.D., M.P.H.;Henry Wang, M.D., M.P.H.
Bory Kea, M.D.Assistant Professor of Emergency Medicine
Dr. Kea is an Assistant Professor of Emergency Medicine at OHSU. She received her M.D. at Stanford University, and completed her residency training in Emergency Medicine at the University of California, San Francisco-San Francisco General Hospital. She obtained a Masters in Clinical Research during a Emergency Medicine Research fellowship at OHSU.
Dr. Kea's current research focuses on optimization of atrial fibrillation (AF) management strategies in the Emergency Department, from rate vs rhythm control, disposition, and oral anticoagulation (OAC) strategies. AF is the most common arrhythmia presenting to the ED, and is associated with significant morbidity and mortality. Although OACs may prevent strokes in appropriately selected AF patients, and is ideally prescribed by a primary care provider (PCP), up to two-thirds of all patients discharged from the ED do not follow up with a PCP within 30 days. Furthermore, current risk stratification and OAC guidelines are based on outpatient studies, and do not provide clear guidance for ED providers treating new-onset AF patients in the acute setting. Thus, significant variability in ED prescribing of OAC and adherence to existing clinical guidelines remains. This project will use national administrative data to (1) measure variability in ED prescribing of OAC in new-onset AF, (2) identify patient, provider, and hospital factors that predict compliance with existing clinical guidelines, and (3) determine how ED OAC prescribing in AF affects patient-centered clinical outcomes. Dr. Kea has been awarded a K08 grant from the NHLBI to continue exploring anticoagulation strategies for acute AF. This research will lead to prospective studies aimed at comparing the effectiveness of current ED strategies on OAC prescribing in recent-onset AF, in addition to acute treatment with rate vs rhythm control, and disposition strategies on important clinical outcomes for AF patients.
Mentors: Ben Sun, M.D., M.P.P., Dr. John McConnell, Ph.D., Dr. Gregory Lip, M.D., Brian Olshansky, M.D., Merritt Raitt, M.D.
Eric Stecker, M.D., M.P.H.
Associate Professor, Knight Cardiovascular Institute
Dr. Stecker is an Associate 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, M.D., M.P.H., Craig Newgard M.D., M.P.H., Jonathan Lindner M.D., and Sumeet Chugh M.D.
Holly Hinson, M.D., M.C.R.
Assistant Professor of Neurology and Neurocritical Care
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, followed by a fellowship in Neurologic Critical Care at Johns Hopkins Hospital. At OHSU, she attends in the Neuroscience Critical Care Unit. In 2012, she was the recipient of the American Brain Foundation Practice Research Training Fellowship for her project entitled Quantifying Paroxysmal Sympathetic Hyperactivity. In 2016, she completed her Masters in Clinical Research (MCR) at OHSU.
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.
To explore the mechanism underpinning early fever after TBI, she designed an observational study to test the hypothesis that early fever after severe TBI was associated with neurologic deterioration, and/or promoted the production of pro-inflammatory cytokines. She was awarded the Oregon Multidisciplinary Training Program for Emergency Medicine Clinical Research K12 for her project, entitled "Fever and Inflammation in Neurotrauma (FAINT)". She submitted an abstract entitled "Differences in Inflammatory Dysregulation in TBI versus Major Trauma" to the 2014 Resuscitation Science Symposium, based on analysis of the first 40 patients enrolled in FAINT. Dr. Hinson received the American Heart Association Young Investigator Award for this abstract. She also presented preliminary findings at the National Neurotrauma Society meeting in 2015 and the International Neurotrauma Society meeting in 2016. Finally, she was selected as 1 of 12 "Emerging Leaders" by the American Academy of Neurology.
Mentors: Dennis Bourdette, M.D., Martin Schreiber, M.D., Mary Stenzel-Poore, Ph.D., and Cynthia Morris, Ph.D., M.P.H.
Susan Rowell, M.D., M.C.R.
Associate Professor in the Division of Trauma, Emergency Surgery, and Acute Care Surgery
Dr. Rowell is an associate 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
Anna Marie Chang, M.D., M.S.C.E.
Assistant Professor and Director of Clinical Research Operations, Department of Emergency Medicine, Thomas Jefferson Hospital
Dr. Chang is currently an Assistant Professor and serves as Director of Clinical
Research Operations in the Department of Emergency Medicine at Thomas Jefferson
Hospital. She received her MD from 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
came to OHSU in 2012 to train as a K12 clinical research scholar, and was an
Assistant Professor in the OHSU Department of Emergency Medicine. She completed
her training in 2015. Dr. Chang's research interests are in studying
patients with acute cardiopulmonary conditions and transitions of care.
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. While on the K12 Dr. Chang examined these unique changes to the model of care, and how they affected ED use for acute cardiopulmonary conditions. She conducted a mixed-methods study to identify CCO, ED and patient level factors that lead to changes in ED utilization and hospitalizations using Oregon All Payers All Claims database to describe variation in repeat ED visit rates within CCOs. Using interviews and surveys, she worked to identify 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, Ph.D., Deborah Cohen, Ph.D., Devan Kansagara, M.D., and Honora Englander, M.D.