Publications by authors named "Wesley Self"
Background: (pneumococcus) causes invasive pneumococcal disease (IPD) and non-invasive acute respiratory infections (ARIs). Three pneumococcal conjugate vaccines (PCVs) are recommended in the United States with additional products in clinical trials. We aimed to estimate 1) proportions of IPD cases and pneumococcal ARIs caused by serotypes targeted by existing and pipeline PCVs and 2) annual U.
View Article and Find Full Text PDFImportance: Receipt of fluid and vasopressors, common treatments in septic shock, may affect cardiac function.
Objectives: We sought to determine whether a liberal or restrictive fluid resuscitation strategy was associated with changes in cardiac function.
Design: We prospectively studied a subset of patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, performing echocardiography at baseline and at 24 hours after randomization.
Article Synopsis
- - The EPIC study analyzed data from 2,272 adults hospitalized for pneumonia to understand the prevalence of Mycoplasma pneumoniae (Mp) using PCR testing on throat swabs from 2010 to 2012.
- - Only 43 patients (1.8%) tested positive for Mp, primarily affecting younger adults (median age: 45), with some experiencing severe cases leading to ICU admissions, but no in-hospital deaths were reported.
- - Factors linked to higher Mp detection included being younger and having certain radiographic findings, indicating the need for better testing methods to improve diagnosis and treatment options for pneumonia patients.
Creating a sustainable residency research program is necessary to develop a sustainable research pipeline, as highlighted by the recent Society for Academic Emergency Medicine 2024 Consensus Conference. We sought to describe the implementation of a novel, immersive research program for first-year emergency medicine residents. We describe the curriculum development, rationale, implementation process, and lessons learned from the implementation of a year-long research curriculum for first-year residents.
View Article and Find Full Text PDFBackground: Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.
Methods: Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement.
Article Synopsis
Because 20-30% of patients with sepsis deteriorate to critical illness, biomarkers that provide accurate early prognosis may identify which patients need more intensive treatment versus safe early discharge. The objective was to test the performance of sVEGFR2, suPAR and PCT, alone or combined with clinical signs and symptoms, for the prediction of clinical deterioration. This prospective observational study enrolled patients with suspected infection who met SIRS criteria without organ dysfunction (delta SOFA <2 from baseline) from 16 emergency departments.
View Article and Find Full Text PDFRationale: For critically ill adults receiving invasive mechanical ventilation, the ventilator mode determines how breaths are delivered. Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown. To compare the effects of three common ventilator modes (volume control, pressure control, and adaptive pressure control) on death and duration of mechanical ventilation.
View Article and Find Full Text PDFBackground: COVID-19 is a strong risk factor for venous thromboembolism (VTE). Few studies have evaluated the effectiveness of COVID-19 vaccination in preventing hospitalization for COVID-19 with VTE.
Methods: Adults hospitalized at 21 sites between March 2021 and October 2022 with symptoms of acute respiratory illness were assessed for COVID-19, completion of the original monovalent mRNA COVID-19 vaccination series, and VTE.
Study Objective: To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.
Methods: We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).
Background: Few studies have investigated the use of anti-obesity medications (AOMs) before bariatric surgery and how prior use impacts patients' goals and expectations for surgery.
Objectives: This study investigated associations between patients' experiences with AOMs and weight loss expectations before bariatric surgery.
Settings: Single tertiary university hospital.
Article Synopsis
- - The study aimed to understand patient attitudes toward participating in a trial comparing the use of antibiotics versus a placebo for treating acute diverticulitis, particularly since antibiotics may not be necessary for treatment.
- - Researchers conducted interviews and surveys to gauge patients’ willingness to participate, finding that many were motivated by a desire to help others, although they also expressed concerns about the effectiveness of non-antibiotic treatments.
- - The results revealed that 62% of surveyed patients were open to participating in the trial, with their decisions heavily influenced by their doctor's opinions and personal experiences with the condition, indicating the potential feasibility of the study.
Article Synopsis
- PheMIME is an interactive visualization tool developed to analyze and characterize multimorbidity patterns across different populations using data from large-scale electronic health record (EHR) systems.
- It integrates data from institutions like Vanderbilt University and Mass General Brigham, allowing users to explore complex disease relationships through dynamic, multi-faceted visualizations and analyses.
- The tool enhances our understanding of patient health by making it easier to identify disease associations, ultimately contributing to more personalized healthcare strategies.
Article Synopsis
- The study assessed the effectiveness of the updated 2023-2024 COVID-19 vaccine against hospitalization for two variant lineages, XBB and JN, in hospitalized patients across 26 hospitals in the U.S. between October 2023 and March 2024.
- The results indicated a vaccine effectiveness (VE) of 54.2% against XBB and 32.7% against JN, suggesting that the JN lineage may have some level of immune escape.
- However, the severity of cases with the JN lineage was not significantly worse compared to those with the XBB lineage, indicating similar risks of severe outcomes like ICU admission and death.
Article Synopsis
- * A study conducted between September 2018 and October 2022 in Tennessee and Georgia found that 12.1% of hospitalized adults with CAP had Streptococcus pneumoniae detected, with the most common serotypes being 3, 22F, 19A, and others.
- * Findings suggest that a significant portion of detected serotypes, approximately one-third, are not covered by current vaccines like PCV15 and PCV20, indicating the need for new vaccines with broader serotype coverage to reduce disease occurrence.
Background: Assessing COVID-19 vaccine effectiveness (VE) and severity of SARS-CoV-2 variants can inform public health risk assessments and decisions about vaccine composition. BA.2.
View Article and Find Full Text PDFArticle Synopsis
- In a study involving critically ill adults undergoing tracheal intubation, researchers compared preoxygenation methods: noninvasive ventilation versus oxygen mask.
- The findings revealed that hypoxemia occurred significantly less in the noninvasive-ventilation group (9.1%) compared to the oxygen-mask group (18.5%).
- Additionally, the incidence of cardiac arrest was lower with noninvasive ventilation (0.2%) compared to the oxygen-mask group (1.1%).
In absence of a "gold standard", a standardized clinical adjudication process was developed for a registrational trial of a transcriptomic host response (HR) test. Two physicians independently reviewed clinical data to adjudicate presence and source of bacterial and viral infections in emergency department patients. Discordant cases were resolved by a third physician.
View Article and Find Full Text PDFArticle Synopsis
- * The CDC's National SARS-CoV-2 Strain Surveillance (NS3) program analyzed SARS-CoV-2 samples to understand the evolution of these variants and their spike mutations from May 2021 to February 2023.
- * The study found that some subvariants have significantly evaded neutralizing antibodies from post-vaccination sera, indicating a need for ongoing research to evaluate the effectiveness of current vaccines and inform future updates.
Background: For every critically ill adult receiving invasive mechanical ventilation, clinicians must select a mode of ventilation. The mode of ventilation determines whether the ventilator directly controls the tidal volume or the inspiratory pressure. Newer hybrid modes allow clinicians to set a target tidal volume; the ventilator controls and adjusts the inspiratory pressure.
View Article and Find Full Text PDFObjectives: Sepsis is one of the most common, costly, and misdiagnosed conditions in U.S. emergency departments (EDs).
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