Last updated: 8/7/06 - Columbia University



last updated: 5/20/08

Rapid HIV Study

Background / Study Aim

Approximately one out of four New Yorkers who are HIV positive are unaware of their status. Central to this problem is a lack of accessible testing. HIV testing, however, is beginning to change.

For the last two decades, HIV testing has been kept separate from other routine disease screenings, such as those for Hepatitis and Tuberculosis. As the disease becomes less stigmatized and better understood, health care professionals anticipate that HIV screening will soon become incorporated into regular check-ups. As this happens, many believe that HIV testing counselors and clinics will be fazed out of existence.

To prepare for the gradual disappearance of HIV testing counselors and clinics—and further reach out to the approximately 100,000 New Yorkers who are unaware they are HIV positive—the Center for Comprehensive Care (CCC), the St. Luke’s/Roosevelt HIV care program, recently launched a free Rapid HIV testing program for patients admitted to St Luke’s–Roosevelt Hospitals Emergency Departments (SLR ED). This study aims to assess patient attitudes towards, and frequency of enrollment in, the new free Rapid HIV testing program.

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Inclusion Criteria

All patients 18 years or older who receive care in the SLRH ED and whose ultimate disposition (admission to the hospital, discharge home, etc.) is determined and entered into the EMSTAT system (under column “Dis”) by their physician during the hours of 9am-10am, 1pm-2pm, 5pm-6pm and 9pm-10pm.

Exclusion Criteria

-Patients < 18 years old.

-Patients who cannot read and write English or Spanish.

-Patients who have altered mental status (confused, unconscious, intoxicated, etc.) or in extremis

(extreme pain and /or very ill).

-Prisoners.

AA Role:

1) Watch for patients whose disposition time appears in the “Dis” column in EmStat during the hours of

9am-10am, 1pm-2pm, 5pm-6pm, and 9pm-10pm.

2) Identify patients who are eligible for the survey and approach them.

3) Smile and introduce yourself. Ask if the patient is willing to answer some questions for our survey. Read the script on the survey (“We are evaluating our new, free testing...”).

4) If the patient agrees, hand them a survey and pen and let them know you will be back soon in case there are any questions. Note: Patients must read and fill out the survey themselves.

5) Enter patient name, “HIV survey,” “Y,” and survey # in Excel Patient Screened Spreadsheet.

6) Enter survey data into the HIV_Survey Access Database.

7) Enter appropriate data into the Enrollment Tracking Access Database.

8) Deposit the form into the locked, blue research box. Thanks!!

Intubation/Bougie Study

Very sick patients sometimes have difficulty breathing on their own. In this event, we often assist their breathing by placing a tube in their trachea (“intubation”) and placing them on a ventilator. Endotracheal intubation is not a simple procedure. Sometimes it can be difficult/impossible to see the vocal cords (which are at the top of the trachea and between which we want to place the tube) and therefore difficult to know where to direct the tube. There are many “rescue techniques” that can be used in the event of a very difficult intubation. We often change the patient’s head position, change the laryngoscope blade/tube we are using, or have someone else more experienced attempt the intubation. There is also a tool called a “bougie” that may be used.

Dr. Shah wants to study what techniques physicians are using in the event of a difficult airway and the resulting complications of that difficult airway. Then he wants to see if emergency physicians can successfully use the bougie rescue technique and reduce the number of complications.

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Inclusion Criteria:

Any doctor who attempts an intubation on an adult (>18 y/o) patient should fill out a form

Exclusion Criteria:

None

AA Role:

1) Watch for any intubation occurring in the ED (there is usually quite a bit of commotion around one patient for 15-20 minutes) or any patient on a ventilator. Find out which physician intubated the patient and ask them to complete the study form.

2) Note that the inclusion criteria means EVERY doctor who attempts to intubate should fill out a data form. If one doctor can’t get the tube in and one can, they both fill out sheets. If three try and one of them gets it in, three sheets get filled out. Force them at gunpoint.

3) If you are present for the intubation, you may want to pay attention to how many times the physician had to look in the mouth and if different physicians attempted the procedure (in order to help them if they ask questions while filling out the form). Feel free to ask the physicians what the difficulty was and make sure they document it on the second page of the study form. Any person who attempts and does not succeed even once (regardless of whether they eventually succeed), should be filling out pages 1 AND 2.

4) MAKE SURE A DATE AND TIME ARE WRITTEN ON THE FORM!!!

5) If a bougie is used make sure the 3rd page is completed.

6) Once the form is completed, place it in the blue research box on the wall in the adult ED.

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If there are any problems/concerns/questions, please call Dr. Shah at 646-369-2747.

LP-Ultrasound Study

A lumbar puncture (LP) is generally performed in order to obtain cerebrospinal fluid. Analysis of this fluid can tell us if a patient has encephalitis (infection of the brain), meningitis (infection of the linings of the brain), or subarachnoid hemorrhage (bleeding around the brain). Although frequently easy, this can be a difficult procedure. From a previous study we know that the procedure is more difficult when you cannot see the bumps of the spine with the naked eye. The technique requires passing a needle between the spinous processes (“the bumps”) into the subarachnoid space.

We hope that the ultrasound machine can help us to visualize these bones. Some patients will be ultrasounded and some will not (we will randomly select this). The goal is to see if using the ultrasound does any of the following: reduce the number of needle sticks, reduces the number of red blood cells caused by accidental trauma, reduces the time necessary for the procedure, or reduces the pain.

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Inclusion Criteria:

-Any adult patient (≥18) undergoing lumbar puncture in whom the spine is not visible to the naked eye

Exclusion Criteria:

-Age < 18

-Prisoners

-Anyone in whom the spine is visible to the naked eye

-Altered mental status, e.g. unconsciousness or confusion (therefore unable to consent)

AA Role:

Watch for any patient requiring a lumbar puncture. Common ED complaints that result in LP include headache, headache and fever, stiff neck, and others. Approach the physician caring for the patient and ask if the patient is eligible by REMINDING THE PHYSICIAN OF THE INCLUSION CRITERIA.

Have the physician consent the patient. Only physicians can consent patients for this study. The first two pages of the packet should be signed by the patient, the physician (investigator), and you (witness). Pages 6-13 should be given to the patient.

If the patient consents, open the lowest numbered “LP-U/S” envelope in the cabinet (or filing box at Roosevelt).

-If the number is even, the ultrasound should be used to facilitate the procedure.

-If the number is odd, the ultrasound should not be used. Tell the physician.

Remind the physician to use 5cc of lidocaine. If more is necessary, ask them to document it on the data form.

Use the stopwatch to time the duration of the procedure. Start the timer when then physician enters the room ready to start the procedure (include the time for ultrasound; do not include time to gather materials). Stop the timer after the CSF is collected and the needle is removed from the patient’s back.

Once the data form is completed enter the data into the database, then place the form in the box.

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If there are problems/questions, call Dr. Shah at 646-369-2747 or Dr. Newman at 917-453-8865.

Pregnant Patient Study

Pregnant women frequently come to the emergency department because of vaginal bleeding. When there is bleeding during pregnancy one of the concerns is that the blood of the fetus and the blood of the mom might contact each other, which could result in the mom generating immune system antibodies to the fetal tissue. These antibodies wouldn’t be dangerous to the fetus immediately, but could be dangerous to a fetus during a subsequent pregnancy. Usually, we check these women’s blood type to determine if they could potentially generate these antibodies (only women with “negative” blood types can generate these antibodies). If they have the “negative” blood type we give them Rhogam, a medicine to reduce the chances of the mother generating the antibiodies.

Our goal is to study pregnant patients. We want to know how reliable they are in their knowledge of their blood type. If they’re generally right about their blood type then we may be able to skip the blood type tests that we usually do. We will compare their survey responses to the lab test results we obtain.

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Inclusion Criteria:

Any adult patient (age 18 or older) with a positive pregnancy test who is having blood sent for a type and screen (T & S).

Exclusion Criteria:

Age less than 18 years Prisoners Unable to consent (Altered mental status, confusion, language barrier, etc.)

AA Role:

1. Watch for any female patient with a positive pregnancy test.

2. Ask the physician if the patient is having a type and screen sent and if they may be consented for this study.

3. MAKE SURE THE DOCTOR HAS TOLD THE PATIENT THAT SHE IS PREGNANT BEFORE YOU CONSENT FOR THE SURVEY.

4. Consent the patient. Tell the patient that this is simply a survey to determine how often patients know their blood type. Feel free to tell the patient their blood type AFTER they have completed the survey.

5. Complete the top part of the survey (labeled “academic associates”) after the patient has completed the survey. Also, please ensure that the patient has filled out all parts of the survey.

6. Place the complete form in the blue Research Box. There is no database yet.

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If there are any problems/issues, please contact Dr. Kaushal Shah (646-369-2747) or Dr. Jessica Paisley (347-387-5230).

Syncope Study

Purpose:

Syncope is defined as a sudden transient loss of consciousness with a complete recovery. It has been estimated that approximately one in four people will experience syncope during their lifetime and that syncope patients make up 1% to 2% of all ED visits and hospital admissions There is a ‘Decision Rule’ called the San Francisco Syncope Rule (SFSR) that aims to determine the likelihood that a person will experience a major health problem or death soon after being seen in an emergency department for syncope. Knowing this would help us to decide who should be admitted to the hospital for further testing even when everything initially seems fine, and who can safely go home from the emergency department after a syncopal episode.

The 5 criteria of the SFSR are: BP ................
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