Acute Care Research

The CCTST Acute Care Research Core (ACRC) hosted its 3rd Annual ACRC Symposium on November 20, 2023. This year’s symposium theme was “Cutting-Edge Research, Innovation and Advancements in Acute Care”. 

The symposium featured keynote speaker, Francis X. Guyette, MD, MS, MPH, from the University of Pittsburgh. Dr. Guyette's presentation was entitled, "Innovating in Prehospital Investigation, Shedding LITES and Making a PACT with PAIN".

Additional events included a presentation from David Ficker, MD, Michael Linke, PhD, and David Robinson, MD entitled, “Minimal Risk Studies in High Risk Clinical Settings”, presentations from previous ACRC awardees (names and presentations listed below), along with a panel discussion regarding consent strategies in acute care research.

Slides from the symposium can be viewed here.

The goal of this annual event is to highlight leadership and innovation in the challenging acute care research setting, and to promote awareness and foster collaboration regarding cutting-edge research being conducted at Cincinnati’s Academic Health Center. Acute care research is defined as research that occurs within 24 hours of a visit to an emergency department or an unscheduled admission, or within 24 hours of identification of a new or worsening condition characterized by sudden onset requiring immediate care.

Previous awardees and presentation titles:

Justin Benoit, MD: Cincinnati Biorepository to Enhance the Acute Resuscitation of Cardiac Arrest Patients (Cincy BEARCAT)

Lane Frasier, MD: Team Performance and Natural Language Processing

Michael Goodman, MD: Early Serum Markers Predict Trauma Patient Outcomes

Christopher Richards, MD: Concordance of Dispatcher and EMS Stroke Recognition


New findings from the Established Status Epilepticus Treatment Trial (ESETT) were released on March 20, 2020 in The Lancet that validate the use of three drugs and give acute care healthcare providers options when it comes to treating patients with refractory status epilepticus across all age groups. The Cincinnati CTSA, Center for Clinical and Translational Science and Training (CCTST) Acute Care Council (ACRC) Co-Director, Lynn Babcock, MD, MS, co-author on the publication, explains that these results, along with other recent related studies, will inform evidence-based status epilepticus management pathways.

Assessment and airway management of a patient having seizures during insitu simulation

Assessment and airway management of a patient having seizures during insitu simulation

As in the parent study published in the November 28, 2019 issue of the New England Journal of Medicine, the three most common treatment options administered in the emergency department for patients who experience refractory status epilepticus: levetiracetam (LEV), fosphenytoin (FOS) and valproate (VPA), are equally effective in each of the three age groups: children (<18 years), adults (18-65 years, and older adults (>65 years). The primary outcome of, was cessation of clinically apparent seizures with improving mental status at 60 minutes after the start of study drug infusion, without administering other anticonvulsant medications (including medications for intubation). Each agent had about a 50% efficacy of refractory status cessation; 52% LEV (95% CI 41%-62%), 49% FOS (95%CI 38%-61%), and 52% VPA (95%CI 41%-63%).

Within each age group, there were no differences in the primary safety outcomes of life-threatening hypotension or cardiac arrhythmia within 60 minutes of the start of study drug infusion. The only secondary safety outcome that differed by drug was within the pediatric age group, where endotracheal intubation within 60 minutes of the start of study drug infusion occurred more frequently in the FOS group: 8% LEV, 33% FOS, and 11% VPA, Fisher’s exact test p-value 0.0001. Other secondary safety outcomes did not differ by drug within each age group (acute seizure recurrence 60 minutes to 12 hours after start of study drug infusion, acute respiratory depression at any time during the study period, and mortality).

Many departments at both University of Cincinnati (UC) and Cincinnati Children’s Hospital Medical Center (CCHMC) were instrumental in the conduct of this study. CCHMC was the second leading pediatric enrollment site. Since this was a time-sensitive study comparing three commonly used agents, this study was conducted using the Exception from Informed Consent (EFIC) process requiring both pre-study Public Disclosure and Community Consultation, and post-study Public Disclosure. UC and CCHMC collaboratively conducted all these activities. For both pre-study and post-study EFIC activities, the study team engaged the CCTST ACRC to develop public disclosure plans and the CCTST Community Engagement Core assisted with community consultation.  

Dr. Chan facilitating an insitu simulation of an ESETT eligible patient in the Emergency Department

Dr. Chan facilitating an insitu simulation of an ESETT eligible patient in the Emergency Department

Both the UC and CCHMC Emergency Departments Research Teams want to thank all who were involved. This was a truly collaborative, multidisciplinary study that involved emergency medicine doctors, neurologists, pediatricians, internists, intensivists, pharmacologists and biostatisticians all contributing their expertise.  This also serves as a reminder of the valuable contributions that our late CCHMC Pediatric Emergency Medicine colleague, Dr. Steven Chan, made to advance the care of children. His efforts were instrumental to the smooth operation of this study at CCHMC.  


The first annual Residents and Fellows Acute Care Research Showcase, held on March 6, 2020 in the UC Medical Sciences Building, had 80 researchers in attendance from across the Academic Health Center (AHC).  Conference participants were immersed in all-things acute are research through remarkable research posters, keynote addresses, and abstract presentations.

With support from the CCTST Acute Care Research Council, the showcase was designed by faculty from UC Emergency Medicine to highlight basic, translational, and clinical acute care research performed by residents, fellows, and other trainees at the AHC. With a focus on research that aims to advance the care delivered in acute settings, the event organizers hope this annual event will inspire a commitment to acute care research at the very early stages in a researcher’s career.

The keynote addresses offered unique insight into the personal journeys of two accomplished acute care researchers, each using humor and transparency to share the hurtles and lessons learned that shaped their careers.

KEYNOTE ADDRESSES: Resiliency in Acute Care Research - How to battle deadlines, denials and doubts – and succeed!

  • Translational Research: It Takes a Village
    Laura Ngwenya, MD, PhD 
    Director, UCGNI Neurotrauma Center 
    Assistant Professor, Neurosurgery 
    Co-Director of the Collaborative for Research on Acute Neurological Injuries (CRANI)
    University of Cincinnati

  •  Research in Academic Medicine: Defining your own SuccessMichelle Eckerle, MD, MPH
    Assistant Professor, Division of Emergency Medicine 
    Director, Pediatric Emergency Medicine Fellowship Program 
    Cincinnati Children’s Hospital Medical Center

ORAL PRESENTATIONS:

Oral presentations were also given by researchers with the five top rated abstract submissions:

  •  GFAP, but not UCH-L1, correlates significantly with cognitive outcome after traumatic brain injury
    Christopher Shaw, MD, Resident, Department of Emergency Medicine, University of Cincinnati

  • FeO2 as a Measure of Preoxygenation before Rapid Sequence Intubation in the Pediatric Emergency Department
    Katherine Edmunds, MD, Fellow, Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center

  • Evaluation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Detecting Necrotizing Soft Tissue Infections in Diabetic Patients with Lower Extremity Infection
    Lance Johnson, MD, Resident, Department of Podiatric Medicine & Surgery, University of Cincinnati

  • Comparing Proximate Measures of Unrecognized Clinical Deterioration
    Tina Sosa, MD, Fellow, Division of Pediatric Hospital Medicine, Cincinnati Children’s Hospital Medical Center

  • Save It Don't Waste It! Maximizing Utilization of Erythrocytes from Previously Stored Whole Blood  
    Kasiemobi Pulliam, MD, Resident, Department of General Surgery, University of Cincinnati

The showcase concluded with awards for best oral presentation and best research poster presented to the audience’s top-rated nominees. Congratulations to:

  • Best Oral Presentation – Kasiemobi Pulliam, MD, Resident, UC Department of Surgery; “Save It Don't Waste It! Maximizing Utilization of Erythrocytes from Previously Stored Whole Blood”

  • Best Poster – Maxon Knott, undergraduate, UC College of Medicine; “Point of Care versus Formal Laboratory Urinary Neutrophil Glutamate Receptor Expression After Traumatic Brain Injury In A Rat Model Of Depression”   

The participation of each attendee, speaker, poster presenter, and judge contributed to the success of this event. The engagement of senior administrators demonstrated the AHC’s investment in guiding future acute care researchers. We look forward to coming together next year to support our research trainees with another successful ACR Showcase!


The CCTST’s Acute Care Research Council (ACRC) was created in 2015 to develop a community of researchers engaged in pre-hospital, emergency and critical care settings with a common focus on accelerating clinical and translational research by reducing systems barriers and generating economics of scale through process improvement, resource sharing and development of best practices.

From the onset, the ACRC recognized the importance of highly trained clinical research professionals (CRPs) that can ensure rapid and proper research subject identification, consent, enrollment, and conduct of study procedures. Because of the constraints of ACR, the ACRC determined that ACR-CRPs required additional competencies beyond those of CRPs engaged in other types of clinical research. Moreover, developing such competencies is timely given the current focus on CRP workforce development.

The ACRC developed 28 competencies for ACR that can serve as a training guide for CRPs to be prepared for the challenges of conducting research within this vulnerable population. The competencies suggest a combination of competency-based training, behavioral-based hiring practices and continuing professional development will be essential to ACR success. Hiring, training, and supporting the development of this workforce is foundational to clinical research in this challenging setting...read more. 


Over 100 researchers across the Academic Health Center (AHC) participated in the 2nd Annual Acute Care Research Symposium, held on November 25, 2019, at Cincinnati Children’s Hospital Sabin Auditorium. The symposium theme - Sepsis, ARDS, and other Life-Threatening Conditions – brought together world-class speakers and panelists sharing global and local perspectives on research that has the potential to impact care delivered in acute settings.

The symposium included two keynote addresses:

  • Precision Critical Care Medicine for Sepsis
    Hector Wong, MD
    Professor, UC Department of Pediatrics and Director
    CCHMC Division of Critical Care Medicine

  • Improving Outcomes in ARDS: Pushing the Envelope?
    R. Duncan Hite, MD, FCCP, FACP
    Mark A. and Alice W. Brown Chair & Professor of UC Internal Medicine
    Director of UC Medical Intensive Care

Video recordings of symposium presentations are available here.

During the event, conference participants were given the opportunity to view an impressive display of research posters and attend an awards program celebrating acute care research champions.

Congratulations to the following awardees:

  • Benjamin Kerrey, MD, MS – Innovation Award

  • Katie Cabrera-Thurman, BSN, RN II – Partner Award

  • Olga Semenova, HBEc – CRP Champion Award

  • Brandon Henry, MD – Student Award

  • Stephen Standage, MD – Excellent Investigator Award

  • Jalen Harvey, UC Medical Student – Best Poster

  • Kyle Walsh, MD, MS – Best Platform Presentation

 
 

The Acute Care Research Council plans to continue to foster and advance this type of cutting-edge collaboration in order to speed the arrival of answers to our most urgent acute care research questions. Mark your calendar today for ACR Symposium 2020, to be held on Monday, November 23, 2020, 8:00 am – 12:00 pm, returning to Sabin Auditorium.

 


Call for Nominations! The CCTST’s Acute Care Research Leadership & Innovations Awards honor leadership, innovation, and engagement in acute care research that advances the mission of the Acute Care Research Council.

Nominations are due by Wednesday, November 6, 2019. Winners and nominators will be notified the week of November 18th. Awardees will be recognized at the Acute Care Research Symposium.

Award categories include:

  • Acute Care Research Innovation Award

  • Acute Care Research Partner Award

  • Acute Care Research CRP Champion Award

  • Acute Care Research Student Award

  • Acute Care Research Excellent Investigator Award

Click here to make a nomination. 


Hite-Duncan.jpg

This summer, R. Duncan Hite, MD, joined the University of Cincinnati (UC) College of Medicine Division of Pulmonary, Critical Care and Sleep Medicine as professor and Mark A. and Alice W. Brown Chair in Internal Medicine, and medical director of the Medical Intensive Care Unit (MICU) at UC Medical Center. Dr. Hite previously worked at Cleveland Clinic as chair and director of research for the department of critical care medicine in the Cleveland Clinic Respiratory Institute.

Dr. Hite has a robust laboratory and clinical research program focused on acute lung injury and ICU clinical trials, and is the principal investigator for the Ohio Consortium Clinical Center for the National Health Lung and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network. He also spent 20 years at Wake Forest University School of Medicine, where he was chief of the section on pulmonary, critical care and allergy and director of the MICU at Wake Forest Baptist Medical Center.

Q: What can you share with us about your background?

My father worked in the oil industry, so my childhood was spent in a unique combination of Oklahoma, Texas and London, England. After England, I returned to Texas for college at Southern Methodist University, and medical school at the University of Texas Medical School at Houston. My wife and I met in college and were married in Houston, then moved to Virginia for residency in internal medicine at the University of Virginia Medical Center and fellowship in pulmonary and critical care medicine at the University of California, San Diego Medical Center. My first faculty appointment was with Wake Forest University, where I was fortunate to be offered many opportunities that helped grow my career. In 2013, I accepted the opportunity to become the inaugural chair for the new department of critical care medicine in the Respiratory Institute at the Cleveland Clinic, and helped grow and deliver high quality critical care and critical care research across a large healthcare delivery system.

Q: What are your goals for the MICU at UC Medical Center?

My first priority from the start and throughout my time at UC Health will be to assure that the Medical ICU performs as a high-functioning clinical unit that consistently serves to optimize the care it provides to patients, and provides a positive experience to the patients and their loved ones. Patient care in an ICU requires the contributions and coordination of care being delivered by a wide variety of care providers including doctors, nurses and many more. To achieve hiqh quality and reliability, our unit must create a work environment in which all those providers feel supported and respected. One factor that contributed to my decision to accept this position is that the Medical ICU already had several of these pieces well established. Of course, I have a reputation for and a lot of passion to grow research around critical care, but that research requires a high-functioning clinical operation that excites everyone including the providers and leadership.

Throughout my life, I played a lot of sports and was always more excited about the team sports than the individual sports. Critical care is very much a team sport because none of us work 24 hours a day, seven days a week. When someone comes into the ICU, what they need in the way of care is 24/7 and you’re always going to be handing patients off to other providers, and those handoffs need to provide a seamless, consistent standard of care.

Q: What impact do you see yourself having in critical care at UC?

I think I’ll be able to offer some opportunities to help galvanize the team and make sure people are functioning in a cohesive way. When you pull it all together and the work of all disciplines becomes more synchronized, the environment becomes even more work-friendly and capable to develop novel approaches for the delivery of critical care. Once at this level, we will have maximized our ability to strengthen our reputation as a regional, national and international leader in critical care delivery and research. Another unique attraction that drew me to this position at UC Medical Center is the opportunities for our Medical ICU team to collaborate with other national critical care leaders including emergency medicine and acute care surgery.

I have also been fortunate enough to lead and participate in over 50 clinical research trials focused on identifying new treatments and improving outcomes for patients with critical illness. Those experiences have helped me develop relationships with thought leaders from the National Institutes of Health, U.S. Department of Defense, medical foundations and the pharmaceutical industry. Most importantly, I have had wonderful opportunities to collaborate with and develop friendships with countless other critical care leaders across the U.S. and abroad. Those experiences and relationships provide a large pool of resources from which our team at UC Medical Center can draw when trying to overcome a new challenge or develop a new, more effective approach to the care of our patients.

Q: What can you share about your family?

My wife, Dana, is a native of Southern California, and we celebrated our 35th wedding anniversary shortly before our move to Cincinnati. Our two daughters were born during my fellowship in San Diego, and were raised in Winston-Salem, North Carolina. Audrey and her husband, Elliott, live in New Orleans. She is an educator at the Louisiana Children’s Museum, and he is an assistant professor of economics at Tulane University. Corinne is a fourth year medical student at the UC College of Medicine, and her long term goal is a career in pediatric medicine. We are a very close family, and I owe each of them endless gratitude for their unwavering support throughout my career.

Story and photo released by UC Health Media Room - Click here to see other stories posted in the UC Health Media Room. 


Our congratulations goes out to ACRC Co-Director, Timothy Pritts, MD, PhD! Professor in the Department of Surgery, Dr. Pritts was recently announced as the recipient of the College of Medicine Office of Research Service Award 2019. A general and trauma surgeon and chief of the Section of General Surgery, Pritts has mentored more than 30 medical students, surgical residents and post-doctoral fellows. Also, he has published more than 150 peer-reviewed publications, chapters and reviews, and he and his team have given more 200 presentations and invited talks globally. Read more.


Congratulations to Angela Molloy, RN, BSN, CCRC, Clinical Research Project Manager, UC Neurology and Rehab Medicine, for her recent graduation of The Community Leaders Institute (CLI). The CCTST’s Acute Care Research Council (ACRC) thanks Angie for representing the council and inspiring the creation of an adult research participant advisory council (RPAC) at UC Health, planned for 2019.

The CLI is an eight-session leadership development training program offered by CCTST’s Community Engagement Program to help community partners and Academic Health Center (AHC) colleagues gain skills in program evaluation, clinical research, and network with other community agencies/practices. To learn more about the CLI, click here.


A postdoctoral position is available in the Neurotrauma Laboratory of Drs. Laura Ngwenya and Jennifer McGuire. Duties will include the experimental design, execution, and analysis of research projects focused on traumatic brain injury. Previous experience working with animal models of brain injury is preferred. For more information, click here - Post Doc Fellow UC Neurotrauma. Interested candidates may email Dr. Laura Ngwenya directly.


Congratulations to ACRC partner, Stacey Ishman, MD, co-recipient of the College of Medicine’s “2019 Excellence in Mentoring Award”. This award is an honor presented for the third year by the UC COM’s Office of Student Affairs to recognize faculty who provide outstanding mentoring for medical students. Ishman is a professor in the Department of Otolaryngology-Head and Neck Surgery and surgical director of the Upper Airway Center at Cincinnati Children’s. Her research is centered on outcomes in adults and children after treatment for obstructive sleep apnea. Nominations from medical students noted her dedication to providing research opportunities and career guidance.


Congratulations to ACRC partner, Laura Ngwenya, MD, PhD, and the UC Neurosurgery Department for the success of the first UC Neurotrauma Symposium! The symposium was held on May 11 at the new UCGNI building. Speakers and attendees noted that the quality/importance of the talks and the overall impact of the syposium was great. Presentations will be posted soon.


The ACRC ‘Challenges & Risks in Acute Care Research’ seminar on April 1, 2019 was well-received, with over 45 researchers across the AHC and evaluations in the ‘very good’ to ‘excellent’ range. Thank you to our speakers and participants for the success of this learning and networking experience focused improving outcomes in the acute care setting.


The UC College of Medicine (UC COM) announced that the Collaborative for Research on Acute Neurological Injuries (CRANI) is the latest recipient of the annual UC COM Team Science Award.

The award letter received November 27, 2018 from Drs. Melanie Cushion and Jack Kues, states, "We commend you for your ability to successfully create and sustain this multi-disciplinary group. The Collaborative for Research on Acute Neurological Injuries, nominated by Dr. Kissela, was selected by a review panel of College of Medicine peer faculty.  As a recipient of this award your team will receive a honorarium of $3,000, recognition at the FY 2019 Research Recognition Awards Program (fall of 2019) and recognition in the College of Medicine FY 2019 Annual Research Report. Congratulations and good luck with your research!"


On Friday, November 16, 2018, the Collaborative for Research on Acute Neurological Injuries (CRANI) was pleased to host speaker Peter Margolis, MD, PhD, a pioneer in the Learning Health Systems approach to clinical care and research. Traditional concepts of research – from bench to phased trials to clinical care – are often inefficient and do not address existing practical clinical problems. Acute brain injuries in particular create unique challenges both for researchers and clinicians. Attendees learned about the development of Learning Health Systems, a networked model of outcomes-based research that allows for flexibility and efficiency in hypothesis testing in order to accelerate the pace of clinical and translational research insights.


Acute Care Research Council (ACRC) partner Rich Ruddy, MD, was named Chief of Staff at Children's Liberty Campus. Dr. Ruddy has been the Medical Director at the Liberty Campus since 2015 and division director of Emergency Medicine prior to that. He holds the appointment as a Professor of Pediatrics in the University of Cincinnati College of Medicine.

“The role change from medical director to being the Liberty Campus chief of staff, I anticipate, will expand my ability to fully partner internally and with our community to establish more integrated services that are convenient and deliver consistent evidence-based care. The connection of our northern strategy with our current expansion in Avondale with the Critical Care Tower is a great opportunity to anticipate the needs of all children who can have better outcomes through our best practices,” said Rich. Read more on CCHMC CenterLink.


The abstract on Acute Care Research competencies for Clinical Research Professionals titled, A Practitioner Inquiry Approach and Assessment, was presented as a poster at the Association for Clinical and Translational Science (ACTS) Translational Science Conference in April 2018 in Washington, D.C. A paper handout of the competencies was also distributed during the poster session.


The Acute Care Research (ACR) Series kicked off with UC’s Heart, Lung, Vascular Institute (HLVI) Lunch & Learn. The Lunch & Learn presentation, The Immortal Cells of Henrietta Lacks (HeLa), was given by ACR Clinical Research Professional (CRP) Advisory Committee member, Becky Ingledue, CCRC.

“Becky is our first volunteer to present in this series. Her passion and enthusiasm for research is contagious!” says Stephanie Schuckman, host of the series and Senior Training Specialist for the Acute Care Research Council (ACRC). Becky chose Henrietta Lacks because ethics and empathy are hallmarks for participants and healthcare professionals to better understand each other’s view about human research. Empathy is the #1 competency for CRPs in the ACR environment, as identified by the ACRC.

Positive evaluations concur: “For a first go around, I think the presentation was great! We discussed as a group the main components in research that are imperative to continuously re-educate those conducting informed consent. Ethics and empathy.”


The first annual Acute Care Research (ACR) Symposium was held April 9, 2018 from 8:00 a.m.–noon in Cincinnati Children’s Location S1.203, in conjunction with University of Cincinnati (UC) Research & Innovation Week 2018.

Presented by the CCTST’s Acute Care Research Council, the Symposium was entitled Driving the Future—Integrity and Innovation in Acute Care Research. Keynote speaker was Neal Dickert, Jr, MD, PhD of the Division of Cardiology and Center for Ethics at Emory University, who discussed Informed Consent for Acute Care Research: Patient-Centered or Pointless?

In addition, Dr. Dickert participated in an ACR informed consent panel discussion led by Michael Linke, PhD, UC IRB chair.

The program also included 30 posters, platform presentations chosen from leading abstracts, and ACR Leadership & Innovation Awards.

Target audience: Critical care stakeholders, physicians, healthcare practitioners, researchers, community health advocates

Objectives:

  1. Discuss the novel mission, accomplishments and aspirations of the Acute Care Research Council

  2. Explain the regulatory and ethical issues involved in acute care research

  3. Assess the role of informed consent in acute care research

The University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Cincinnati designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CRPs, NPs, PAs and RNs can count approved activities certified for 3.5 AMA PRA Category 1 Credits™ for professional credit reporting purposes. Other healthcare professionals should inquire with their certifying or licensing boards.

Presented in conjunction with Research & Innovation Week 2018, organized by the UC Office of Research. Supported by a grant from the UC College of Medicine.

For more information, email ACRC program manager Amy Ewing or call (513) 803-8365.


It was with a mix of appreciation, sadness and celebration that we wished farewell to Chris Lindsell at our June 2017 meeting. These sentiments were shared campus-wide, as expressed so eloquently by Dr. Arthur Pancioli, Professor and Chairman of UC's Department of Medicine (read more).

Whether he was your colleague, supervisor or mentor, you easily 'caught' his fever for collaboration as the key to accelerating research innovation. His special passion for acute care research left us more empowered to reach our ACRC vision of ‘ascending to a nationally-acclaimed best practice program recognized for its unparalleled advancement of acute care research.’

Though Chris’ leadership will be deeply missed, we wish him all the best as he shares his remarkable collaborative spirit with the fortunate folks at Vanderbilt Institute for Clinical and Translational Research - beginning this August.