William Chiang - Academia.edu (original) (raw)

Papers by William Chiang

Clinical Toxicology, May 13, 2020

Journal of Pharmacy Practice, Jun 3, 2021

The toxicokinetics of pediatric intravenous (IV) acetaminophen (APAP) in overdose is not well des... more The toxicokinetics of pediatric intravenous (IV) acetaminophen (APAP) in overdose is not well described and few case reports with serial APAP concentrations allowing for calculations of half-life exist. Here, we report toxicokinetic data from a case of an unintentional IV APAP overdose in a 12-month-old male who was treated with NAC. Case Report: A 12-month-old (former 24 week gestational age), 8.7 kg male was hospitalized after an uneventful colostomy reversal. In the postoperative unit, the patient unintentionally received 1000 mg IV (114.9 mg/kg) acetaminophen instead of the intended 100 mg IV. Serial acetaminophen concentrations were drawn. The patient received IV Nacetylcysteine and ultimately had no adverse outcomes. Discussion: This case report adds to the existing literature regarding toxicokinetics of IV APAP in infants. Our patient had a calculated ke of 0.263 h-1, correlating with a half-life of 2.63 hours. Based on current available data, the half-life of IV APAP in infants varies (2.6 to 4.9 hours). The reason for this variation is unknown and further research is needed in this area.

Annals of Emergency Medicine, 2005

Annals of Emergency Medicine, 2013

Annals of Emergency Medicine, 2012

Journal of Surgical Research

JAMA Network Open

IMPORTANCE In the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which... more IMPORTANCE In the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which found antibiotics to be noninferior, approximately half of participants randomized to receive antibiotics had outpatient management with hospital discharge within 24 hours. If outpatient management is safe, it could increase convenience and decrease health care use and costs.

Annals of emergency medicine, Jan 24, 2017

The incidence of Clostridium difficile infection has increased and has been observed among person... more The incidence of Clostridium difficile infection has increased and has been observed among persons from the community who have not been exposed to antibiotics or health care settings. Our aims are to determine prevalence of C difficile infection among emergency department (ED) patients with diarrhea and the prevalence among patients without traditional risk factors. We conducted a prospective observational study of patients aged 2 years or older with diarrhea (≥3 episodes/24 hours) and no vomiting in 10 US EDs (2010 to 2013). We confirmed C difficile infection by positive stool culture result and toxin assay. C difficile infection risk factors were antibiotic use or overnight health care stay in the previous 3 months or previous C difficile infection. We typed strains with pulsed-field gel electrophoresis. Of 422 participants, median age was 46 years (range 2 to 94 years), with median illness duration of 3.0 days and 43.4% having greater than or equal to 10 episodes of diarrhea duri...

The Journal of Applied Laboratory Medicine

Background The management of patients with acetaminophen (APAP) toxicity is largely informed by t... more Background The management of patients with acetaminophen (APAP) toxicity is largely informed by the blood concentration. We sought to assess the analytical characteristics of past and current commercial APAP assays in the United States. Methods We systematically reviewed the analytical characteristics of APAP assays cleared by the Food and Drug Administration’s (FDA) 510(k) premarket notification process by searching the Clinical Laboratory Improvement Amendments (CLIA) database. We collected the following data where available: test principle, precision near 10 mg/L, precision near 150 mg/L, limits of detection, and limits of quantitation. Results For all assays, absolute analytical precision decreased as analyte concentration increased. Near [APAP] = 10 mg/L, the most precise assays had a standard deviation (SD) of 0.2 mg/L or coefficient of variation (CV) of 1% and the least precise assays had a SD of 1.8 mg/L or a CV of 10%. Near [APAP] = 150 mg/L, the most precise assay had a SD...

New England Journal of Medicine, 2021

Annals of Emergency Medicine, 2009

patients (91.5%) who were intubated out-of-hospitally: 94% of the CA group, 94% of the RSI group ... more patients (91.5%) who were intubated out-of-hospitally: 94% of the CA group, 94% of the RSI group and 85% of the I group. Patients in the CA and RSI groups were significantly more likely to be intubated than those in the I group (pϽ0.05 for both comparisons). Conclusion: Although rates approached significance, we found no difference in rates of "successful" intubation in the three groups. In terms of "overall" intubation rates, paramedics have higher intubation rates in patients with a pulse when utilizing RSI, and the success rate of RSI approaches that of patients in CA. This suggests that RSI is an effective adjunct to intubation for patients with a pulse. Prospective, outcome-based studies are needed to determine the true impact of RSI in our group of paramedics.

Annals of Emergency Medicine, 1999

Study objective: To determine the likelihood ratio (LR) for hematuria in the evaluation of patien... more Study objective: To determine the likelihood ratio (LR) for hematuria in the evaluation of patients with a suspected renal calculi. Methods: A retrospective review of 356 charts was conducted over a 12-month period at an inner-city tertta D' care teaching hospital with an annual census of 85,000 visits. Patients were identified by International Classification of Diseases-ninth revision codes and the renaI colic database of patients who presented to our emergenc)" department with suspected renal colic Inclusion criteria included all patients given a diagnosis of kidney" stone, nephrolithiasis, or ureteral colic. Patients were excluded if their chart was unavailable for review or did not have a confirmatory" test performed to document the presence or absence of a renal calculi. If patients did not have the unnalysis results documented, it was assumed to be negatis'e for statistical evaluation The presence of hematuna was determined by a standard urinalysis. A Fisher's exact test `.`.'as performed to determine the strength of association between the test (a urinalysis) and the disease state (renal calculi) The LR for a positive (LR+) and negative (LR-) test were calculated. Results: Three hundred fifty-six charts were identified with 345 available for review. A 2x2 contingency table was constructed and LP.s were calculated. Two hundred fiftytwo of the 345 (73%) bad confirmed renal calculi. Of these. 208 (83%) bad a positive urinalysis, whereas 44 (17%) had a negative urinalysis for blood. The LRs for a positive and negative test were calculated to be 1.097 and 0.706, respectively A 2-sided Fisher's exact test did not show a significant association (P=.1668) between the presence of hematuria and the presence of a renal calculi. Conclusion: The LP, s indicate that the presence or absence of hematuria has a negligible impact in the evaluation of renal colic.

JAMA Surgery

ImportanceA patient’s belief in the likely success of a treatment may influence outcomes, but thi... more ImportanceA patient’s belief in the likely success of a treatment may influence outcomes, but this has been understudied in surgical trials.ObjectiveTo examine the association between patients’ baseline beliefs about the likelihood of treatment success with outcomes of antibiotics for appendicitis in the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial.Design, Setting, and ParticipantsThis was a secondary analysis of the CODA randomized clinical trial. Participants from 25 US medical centers were enrolled between May 3, 2016, and February 5, 2020. Included in the analysis were participants with appendicitis who were randomly assigned to receive antibiotics in the CODA trial. After informed consent but before randomization, participants who were assigned to receive antibiotics responded to a baseline survey including a question about how successful they believed antibiotics could be in treating their appendicitis.InterventionsParticipants were categorized base...

Journal of Medical Toxicology, 2022

Western Journal of Emergency Medicine, 2021

New England Journal of Medicine, 2020

Police detainees are at high risk for illness or injury after arrest, but often suffer from limit... more Police detainees are at high risk for illness or injury after arrest, but often suffer from limited access to medical care, including disruption of chronic medication use. To describe the medical complications among arrestees in one urban, public hospital after modest improvements in medical screening at the central lock-up, we performed a retrospective chart review of electronic discharge summaries for all detainees admitted to a medical or surgical service during 2006. Among 173 admissions, there was a high rate of underlying chronic medical conditions (most common: substance abuse 68%, hypertension 26%, asthma 15%, and diabetes 14%). The most common reasons for admission were: To evaluate for acute coronary syndrome in the setting of chest pain (25%), drug withdrawal (20%), and trauma (10%). There were fewer serious diabetic complications than had been previously reported, but more work is needed to determine how greater medical access can improve outcomes for this population.

Background: Studies of IV magnesium sulfate as a treatment for acute asthma have had mixed result... more Background: Studies of IV magnesium sulfate as a treatment for acute asthma have had mixed results, with some data suggesting a benefit for acute severe asthma, but not for mild-to-moderate asthma. In a multicenter cohort, this study tests the hypothesis that administration of magnesium sulfate improves pulmonary function in patients with acute severe asthma. Design: Placebo-controlled, double-blind, randomized clinical trial. Setting: Emergency departments (EDs) of eight hospitals. Patients: Patients aged 18 to 60 years presenting with acute asthma and FEV1 < 30% predicted on arrival to the ED. Intervention: All patients received nebulized albuterol at regular intervals and IV methylprednisolone. Two grams of IV magnesium sulfate or placebo were administered 30 min after ED arrival. The primary efficacy end point was FEV1 at 240 min, and the data analysis was intent to treat. Results: Two hundred forty-eight patients were included, and the mean FEV1 on ED arrival was 22.9% predi...

Scientific reports, Jan 5, 2018

Staphylococcus aureus is an opportunistic pathogen that causes a range of serious infections asso... more Staphylococcus aureus is an opportunistic pathogen that causes a range of serious infections associated with significant morbidity, by strains increasingly resistant to antibiotics. However, to date all candidate vaccines have failed to induce protective immune responses in humans. We need a more comprehensive understanding of the antigenic targets important in the context of human infection. To investigate infection-associated immune responses, patients were sampled at initial presentation and during convalescence from three types of clinical infection; skin and soft tissue infection (SSTI), prosthetic joint infection (PJI) and pediatric hematogenous osteomyelitis (PHO). Reactivity of serum IgG was tested with an array of recombinant proteins, representing over 2,652 in-vitro-translated open reading frames (ORFs) from a community-acquired methicillin-resistant S. aureus USA300 strain. High-level reactivity was demonstrated for 104 proteins with serum IgG in all patient samples. Ove...