Browsing by Author "Cairns, Charles B."

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    An integrated clinico-metabolomic model improves prediction of death in sepsis
    (American Association for the Advancement of Science, 2013) Langley, Raymond J.; Tsalik, Ephraim L.; van Velkinburgh, Jennifer C.; Glickman, Seth W.; Rice, Brandon J.; Wang, Chunping; Chen, Bo; Carin, Lawrence; Suarez, Arturo; Mohney, Robert P.; Freeman, Debra H.; Wang, Mu; You, Jinsam; Wulff, Jacob; Thompson, J. Will; Moseley, M. Arthur; Reisinger, Stephanie; Edmonds, Brian T.; Grinnell, Brian; Nelson, David R.; Dinwiddie, Darrell L.; Miller, Neil A.; Saunders, Carol J.; Soden, Sarah S.; Rogers, Angela J.; Gazourian, Lee; Fredenburgh, Laura E.; Massaro, Anthony F.; Baron, Rebecca M.; Choi, Augustine M. K.; Corey, G. Ralph; Ginsburg, Geoffrey S.; Cairns, Charles B.; Otero, Ronny M.; Fowler, Vance G., Jr.; Rivers, Emanuel P.; Woods, Christopher W.; Kingsmore, Stephen F.; Medicine, School of Medicine
    Sepsis is a common cause of death, but outcomes in individual patients are difficult to predict. Elucidating the molecular processes that differ between sepsis patients who survive and those who die may permit more appropriate treatments to be deployed. We examined the clinical features and the plasma metabolome and proteome of patients with and without community-acquired sepsis, upon their arrival at hospital emergency departments and 24 hours later. The metabolomes and proteomes of patients at hospital admittance who would ultimately die differed markedly from those of patients who would survive. The different profiles of proteins and metabolites clustered into the following groups: fatty acid transport and β-oxidation, gluconeogenesis, and the citric acid cycle. They differed consistently among several sets of patients, and diverged more as death approached. In contrast, the metabolomes and proteomes of surviving patients with mild sepsis did not differ from survivors with severe sepsis or septic shock. An algorithm derived from clinical features together with measurements of five metabolites predicted patient survival. This algorithm may help to guide the treatment of individual patients with sepsis.
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    Computer-facilitated review of electronic medical records reliably identifies emergency department interventions in older adults
    (Society for Academic Emergency Medicine, 2013-06) Biese, Kevin J.; Forbach, Cory R.; Medlin, Richard P.; Platts- Mills, Timothy F.; Scholer, Matthew J.; McCall, Brenda; Shofer, Frances S.; LaMantia, Michael; Hobgood, Cherri; Kizer, J. S.; Busby-Whitehead, Jan; Cairns, Charles B.; Emergency Medicine, School of Medicine
    OBJECTIVES: An estimated 14% to 25% of all scientific studies in peer-reviewed emergency medicine (EM) journals are medical records reviews. The majority of the chart reviews in these studies are performed manually, a process that is both time-consuming and error-prone. Computer-based text search engines have the potential to enhance chart reviews of electronic emergency department (ED) medical records. The authors compared the efficiency and accuracy of a computer-facilitated medical record review of ED clinical records of geriatric patients with a traditional manual review of the same data and describe the process by which this computer-facilitated review was completed. METHODS: Clinical data from consecutive ED patients age 65 years or older were collected retrospectively by manual and computer-facilitated medical record review. The frequency of three significant ED interventions in older adults was determined using each method. Performance characteristics of each search method, including sensitivity and positive predictive value, were determined, and the overall sensitivities of the two search methods were compared using McNemar's test. RESULTS: For 665 patient visits, there were 49 (7.4%) Foley catheters placed, 36 (5.4%) sedative medications administered, and 15 (2.3%) patients who received positive pressure ventilation. The computer-facilitated review identified more of the targeted procedures (99 of 100, 99%), compared to manual review (74 of 100 procedures, 74%; p < 0.0001). CONCLUSIONS: A practical, non-resource-intensive, computer-facilitated free-text medical record review was completed and was more efficient and accurate than manually reviewing ED records.