Yanina Purim-Shem-Tov - Academia.edu (original) (raw)

Papers by Yanina Purim-Shem-Tov

Circulation, 2014

Circulation, Nov 8, 2022

Introduction: In comparison to conventional cardiac troponin (cTn), high sensitivity cardiac trop... more Introduction: In comparison to conventional cardiac troponin (cTn), high sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). From literature review, resource utilization seems variable across institutions. This study sought to determine the effect of converting to hs-cTn on hospital resources. Hypothesis: hs-cTn is associated with overall decrease in resource utilization Methods: We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center (Chicago, IL) over the period of transition (July 6, 2021) from a cTn to hs-cTn assay using data extracted from the electronic health record. Inclusion criteria included Emergency Department (ED) encounters between January 1, 2021 and December 31, 2021 with chief complaints of “chest pain” or “dyspnea” with an associated troponin order. The primary endpoints were percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered including troponins, electrocardiograms (ECG), echocardiograms, stress tests, and coronary angiograms. Univariable comparisons of these endpoints were performed using Student’s t-test for continuous variables and Chi-square tests for binary/categorical variables. Results: A total of 5113 encounters were analyzed. hs-cTn was associated with an overall increased ED discharge in patients with negative troponin tests (44.1% vs. 29.9%, P<0.01). In terms of cardiac testing per encounter, hs-cTn compared to cTn was associated with a marginal increase in number of troponin tests (1.9 vs. 1.6, P<0.01), electrocardiograms (3.0 vs. 2.9, P=0.01), Echocardiograms (0.5 vs. 0.4, P<0.01). There was a decrease in the utilization of stress testing (0.21 vs 0.26, P<0.01). There was a trend towards increased coronary angiography per encounter (0.11 vs. 0.09, P=0.05) and an increase in total coronary angiography use during the hs-cTn period compared to cTn (227//2471 (9.2%) vs. 195/2642 (7.4%, P=0.02)) Conclusion: Transitioning from cTn to hs-cTn was associated with increased ED discharges, marginal increase in troponin tests, ECGs, echocardiograms. There was a decrease in stress testing but increase in total coronary angiography.

Annals of Emergency Medicine, 2020

Administering prophylactic antibiotics after cardiac arrest is not associated with differences in... more Administering prophylactic antibiotics after cardiac arrest is not associated with differences in overall survival, survival with good neurologic outcome, critical care length of stay, days receiving mechanical ventilation, or incidence of pneumonia.

Annals of Emergency Medicine, Dec 1, 2019

TAKE-HOME MESSAGE Epinephrine is associated with improved overall survival rates, but no differen... more TAKE-HOME MESSAGE Epinephrine is associated with improved overall survival rates, but no difference noted in favorable neurologic outcomes.

Journal of Health Psychology, Aug 27, 2018

Few studies have assessed the integrated psychosocial processes underlying acute pain. As observe... more Few studies have assessed the integrated psychosocial processes underlying acute pain. As observed with clinical pain conditions, women also appear to be disproportionately vulnerable to acute pain, which may be associated with their social landscape.We examined whether positive and negative social processes (i.e., social support and social undermining) are associated with acute pain, and if these processes are linked to pain by influencing negative cognitive appraisal and emotion (i.e., pain catastrophizing, hyperarousal, and anger). Psychosocial variables were assessed in inner-city women (N=375) presenting to an Emergency Department with acute pain. The latent cognitive-emotion variable fully mediated effects of social undermining and support on pain, with undermining showing greater impact. Results suggest that pain may potentially be alleviated by limiting negative social interactions, reducing catastrophizing, and addressing psychological distress, mitigating the risks of alternative pharmacological interventions.

American journal of disaster medicine, Nov 1, 2010

Critical pathways in cardiology, Jun 1, 2014

There has been considerable emphasis on the care of patients with ST-elevation myocardial infarct... more There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac catheterization laboratory for percutaneous coronary intervention. However, a small but important number of patients with STEMI develop ST-elevation while hospitalized for another medical problem. A single-center, retrospective chart review was performed on 172 consecutive patients with STEMI who underwent emergency percutaneous coronary intervention. One hundred thirty-seven patients presenting to the ED with STEMI and 35 patients who developed STEMI while hospitalized were compared. Hospitalized patients with STEMI had delayed reperfusion, longer hospitalization, greater rates of stent thrombosis, and greater 30-day and 1-year mortality compared with these in patients presenting with STEMI to the ED. Optimized clinical pathways for prevention, early diagnosis, and expedited reperfusion of inpatients with STEMI are urgently needed.

Journal of the American College of Cardiology, Mar 1, 2013

The Journal of emergency medicine, Nov 1, 2012

Critical pathways in cardiology, Dec 1, 2007

Introduction: Screening for Acute Coronary Syndrome in chest pain patients can be initiated with ... more Introduction: Screening for Acute Coronary Syndrome in chest pain patients can be initiated with a 12-lead electrocardiogram (ECG). Current American College of Cardiology/American Heart Association guidelines recommends getting an ECG performed and reviewed within 10 minutes of the time these patients present to the Emergency Department (ED). One innovative method to improve door-to-ECG time is by placing a trained greeter in the triage section of the ED. Methods: This study was conducted over a 3-week period from September to October 2006, in a large urban academic medical center. The greeter was stationed in the triage area, and screened every patient entering the ED for the following symptoms/complaints: chest pain, shortness of breath, acute mental status changes in nursing home patients, dizziness, and nausea with or without vomiting in diabetic patients. The greeter obtained the ECG in the qualified patients, or alerted the triage. Data was collected on ECGs for all ED patients who presented with the above complaints in the absence of a greeter. Results: In the 3 weeks of the study, data was collected on 126 cases. The greeter had obtained 40 ECGs, and 86 ECGs were done without the greeter. The average door-to-ECG times were significantly different between the groups. The study found 8.8 minutes in the greeter group versus 29.6 minutes in the nongreeter group (P ϭ 0.000). Conclusion: ED triage greeter can be effectively used to obtain timely ECGs in suspected Acute Coronary Syndrome patients.

Circulation, Nov 25, 2014

Introduction: Early recognition and rapid revascularization is associated with improved outcomes ... more Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital providers acquire ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG program. Descriptive statistics were used for analysis. Results: Over the study period, 322 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time during the study was 83 minutes, which decreased from an initial baseline of 104 minutes. The median time from FMC to door and from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased too suggesting improved care processes for all patients with STEMI.

Sleep, Apr 1, 2018

However, improvements in these subscales were not sustained at follow-up. No significant differen... more However, improvements in these subscales were not sustained at follow-up. No significant differences were found between groups for the remaining subscales (desire, arousal, satisfaction, and orgasm). An additional sub-analysis examining sexual activity found that of those who indicated not sexually active at baseline, 50% of those in the CBT-I condition became sexually active at post-treatment, compared to 12.5% and 25% of SRT and IC recipients respectively. At follow-up, sexual activity was 27.3%, 25%, and 20% for CBT-I, SRT, and IC respectively. Conclusion: While both CBT-I and SRT reduce insomnia in post-menopausal women, CBT-I may suggest additional benefits for sexual functioning whereas SRT may not. However, these gains only appear acutely, as they were not maintained at 6-month follow-up. Future research should explore what factors unique to CBT-I and not SRT may explain an increase in sexual functioning, and how these increases may be maintained over time. Support (If Any): MENO:R01NR013959.

Sleep, Apr 1, 2018

Introduction: National Sleep Foundation recommends 7-9 hours of sleep for all adults. Women are m... more Introduction: National Sleep Foundation recommends 7-9 hours of sleep for all adults. Women are more likely than men to have difficulty falling and staying asleep. Decreased sleep results in daytime sleepiness, difficulty in concentration and depression. There is lack of data regarding factors affecting sleep duration in women. We studied the influence of socioeconomic and demographic factors on the prevalence of self-reported abnormal sleep duration in women participating in a mobile health clinic in Indiana. Methods: A questionnaire was administered to all participants. They were asked how many hours of sleep they got on most days and were divided into three groups based on their report (Group 1:<6 hours, Group 2: 6-7 hours, Group 3: >7 hours). Socioeconomic and demographic factors were compared between the three groups. Results: Data was collected on 973 participants. Mean age of participants was 39 (SD 16) years. 426 (44%) of participants identified their race as African-American. 252 (26%) participants reported <6 hours of sleep. Logistic regression models were computed to identify significant relationship between duration of sleep and the following variables: age, zip based median household income, race, health insurance, history of relationship abuse, stress/depression/anxiety, and general health. African American women were more likely to have less sleep (Odds ratio: 2.06 (1.51,2.82; p<.0001) than White women. Participants who experienced stress, depression, anxiety or problems with emotions in the past 30 days, were more likely to report less sleep (odds ratio: 1.51 (1.15,1.97, p=0.0028). Participants with less than 6 hours of sleep had lower odds of reporting excellent or good health compared to those with more than 6 hours of sleep (odds ratio: 0.66 (0.49, 0.87, p=.0040). Conclusion: 1 in 4 women reported less than 6 hours of sleep, which is less than the recommended sleep range. African American women and women who experienced anxiety/stress/depression were more likely to have less sleep. Women with less sleep were more likely to report poor health. More studies are needed to identify the cause of less sleep in this vulnerable population. Support (If Any): None.

Critical pathways in cardiology, Mar 1, 2012

Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for acade... more Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a catheterization laboratory and the balloon is inflated. Academic hospitals that are located in large urban centers have to deal with staff living long distances from the facility, and therefore, assembling the catheterization team after-hours and on the weekends becomes a difficult task to achieve. There are other factors that contribute to time delays, such as, administering electrocardiograms in timely fashion, having emergency physicians activate the catheterization team, instead of contacting the cardiologist to discuss the case, and other time-sensitive factors. All of the aforementioned issues contribute to the delay. Yet, primary percutaneous coronary intervention is clearly demonstrated as the modality of choice in treatment of STEMI, which improves patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s morbidity and mortality. Therefore, it is imperative that institutions do all they can to improve their protocols and meet the core measures in the treatment of STEMI patients, including the door-to-balloon time of less than 90 minutes. Our institution started a quality improvement program for STEMI care in 1993 and has showed progressive improvement in use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and other medication, culminating in 95% to 100% use of these medications in 2003-2004, when we operated in accordance with the Get With The Guidelines program. Door-to-balloon time in less than 90 minutes became a new phase in our quality improvement process, and we achieved 100% compliance in the last 2 years.

Critical pathways in cardiology, Mar 1, 2015

Introduction: reducing door-to-balloon (DtB) time in St-segment elevation myocardial infarction i... more Introduction: reducing door-to-balloon (DtB) time in St-segment elevation myocardial infarction improves outcomes. Several hospital factors can delay DtB times and lead to increased morbidity and mortality. the effects of hospital design and an interventional platform (iP) on patient care, particularly on the DtB time, are unknown. Methods: We performed a retrospective analysis of consecutive patients presenting to the emergency department of a medical center from September 2010 to February 2014 who met criteria for a St-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention. Patients were divided into 2 groups based on whether they presented before or after the opening of the iP in our new hospital on January 6, 2012. total DtB time and separate systematic intervals were tabulated. Results: Fifty-two patients met our inclusion criteria, 21 pre-iP and 31 post-iP. Both groups had overall similar baseline characteristics. the mean DtB time significantly improved by 11.7 minutes after the opening of the iP (P = 0.016), and all cases had a DtB time 90 minutes or less as compared with 90.4% prior. eighty-nine percent of the overall improvement in DtB happened before the patient reached the catheterization table. important factors were the new emergency department (eD) design that facilitates rapid patient triage and the direct connection between the eD and cath lab. Conclusions: this study showed that the new hospital design had significant effects on immediate patient care by improving the DtB time at our institution. Further study regarding the long-term impact of hospital designs on patient care is needed.

Journal of Behavioral Medicine, Dec 12, 2019

Previous research has shown that African Americans (AA) report higher pain intensity and pain int... more Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants' baseline interview. Structural Equation Modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women's pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES.

The Clinical Journal of Pain, Nov 1, 2018

Background-Given high levels of traumatic stress for low-income, inner-city women, investigating ... more Background-Given high levels of traumatic stress for low-income, inner-city women, investigating the link between PTSD and pain is especially important. Purpose-Using the Conservation of Resources (COR) Theory, we investigated direct and indirect relationships of PTSD symptoms, vulnerability factors (i.e., resource loss, depressive symptoms and social undermining), and resilience factors (i.e., optimism, engagement, and social support) to acute pain reports in a sample of low-income, inner-city women. Method-Participants (N= 341; M Age = 28 years; 58.0% African American) were recruited from an inner-city Emergency Department (ED) following presentation with an acute pain-related complaint. Study data were gathered from psychosocial questionnaires completed at a baseline interview. Results-Structural Equation Modeling examined direct and indirect relationships among PTSD symptoms, vulnerability factors and resilience factors on self-reported pain intensity and pain interference. PTSD symptoms were directly related to higher pain intensity and pain interference and indirectly related through positive associations with vulnerability factors (all p's < .05).

Journal of the American College of Cardiology, Mar 1, 2013

Background: Creation of a prehospital (PH) program of care necessitates cooperation between multi... more Background: Creation of a prehospital (PH) program of care necessitates cooperation between multiple stakeholders. The City of Chicago Fire Department (CFD) adopted a PH stroke system of care (SSC) in March 2011. In May 2012, CFD launched a PH 12-lead electrocardiogram (ECG) program designed to transport patients with acute ST-segment elevation myocardial infarction (STEMI) to hospitals capable of performing primary percutaneous coronary intervention (pPCI). This project sought to identify lessons learned from the initiation of the SSC that proved instrumental in developing the PH 12-lead ECG program. methods: The Chicago chapter of the American Heart Association, the Chicago EMS System Medical Directors, and CFD leadership were involved in the development of the SSC. Their experiences with the SSC were instrumental and they were polled for the lessons they felt were most instructive in establishing a PH 12-lead ECG program and a comprehensive STEMI-system of care. results: Four lessons proved critical. One, SSC was initiated based on novel Illinois (IL) EMS legislation that created a SSC via a regional stroke advisory committee. Prior attempts to perform PH STEMI triage to PCI capable hospitals had been controversial and politically challenging, necessitating legislation. Two, IL law permits EMS diversion at certain hospital-specific thresholds. A key SSC policy deters time critical stroke patients from being diverted. If the nearest stroke center was on bypass, the patient could be taken to another center only if the 2nd center was < 5 minutes away. This policy helped avoid diversion of patients with PH STEMI recognition. Third, close cooperation between hospitals, EMS system leadership and providers, municipal fire departments, physicians, and regulators was crucial for planning, implementation, and data collection. Lastly, the importance of empowering EMS to identify a time critical patient population in the PH setting through education and triage protocols translated well for STEMI patients. conclusions: Lessons learned from implementation of a PH SSC facilitated implementation of a PH 12-lead ECG program and a comprehensive STEMI system of care for the City of Chicago in May 2012.

Western Journal of Emergency Medicine, Dec 28, 2022

BACKGROUND Graduate medical education residency program funding is increasingly at risk where tea... more BACKGROUND Graduate medical education residency program funding is increasingly at risk where teaching institutions are faced with significant budgetary challenges. 1,2 These funding challenges are compounded by recent revisions by the Accreditation Council for Graduate Medical Education (ACGME) redefining core faculty protected time to a 0.1 full time equivalent (FTE) benchmark. 3 When based on 1,550 clinical hours per year, this represents a decrease in ACGME-required protected time by approximately 0.05 FTE per core faculty. It is imperative for programs to develop systems explicitly tracking time spent on educational activities. 4 Some departments have developed education value units (EVU) to assign time and financial values to educational activities. 5-8 Described as an initiative of the Association of American Medical Colleges to encourage institutions to approach fiscal management based on their missions, the concept of EVUs is borrowed from its clinical equivalent, the relative value unit. 9 Our emergency department (ED), recognized a need to holistically quantify overall faculty effort sustaining our program and incorporate it into the department's fiscal structure. Change management and workplace-based motivational theories, borrowed from the business literature, can inform principles for making such transitions. 10-11 Challenging the status quo requires planning, structure, leadership, individual empowerment, communication, and frequent assessments highlighting wins. Furthermore, many individuals' extrinsic motivators rest on achievement recognition and growth opportunities. Using these concepts to create new systems can lead to successful adaptation and acceptance from faculty stakeholders.

Circulation-cardiovascular Quality and Outcomes, Mar 1, 2016

Introduction: Early recognition and rapid revascularization is associated with improved outcomes ... more Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of hospital arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment (“device”) time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG transmission program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG transmission program. Descriptive statistics were used for analysis. Results: Over the study period, 352 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time over the study period was 83 minutes, which was decreased from a baseline of 104 minutes. The median time from FMC to door and median time from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large urban city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased over implementation, suggesting improved care processes for all patients with STEMI.

Circulation, 2014

Circulation, Nov 8, 2022

Annals of Emergency Medicine, 2020

Annals of Emergency Medicine, Dec 1, 2019

Journal of Health Psychology, Aug 27, 2018

American journal of disaster medicine, Nov 1, 2010

Critical pathways in cardiology, Jun 1, 2014

Journal of the American College of Cardiology, Mar 1, 2013

The Journal of emergency medicine, Nov 1, 2012

Critical pathways in cardiology, Dec 1, 2007

Circulation, Nov 25, 2014

Sleep, Apr 1, 2018

Critical pathways in cardiology, Mar 1, 2012

Critical pathways in cardiology, Mar 1, 2015

Journal of Behavioral Medicine, Dec 12, 2019

The Clinical Journal of Pain, Nov 1, 2018

Journal of the American College of Cardiology, Mar 1, 2013

Western Journal of Emergency Medicine, Dec 28, 2022

Circulation-cardiovascular Quality and Outcomes, Mar 1, 2016

Introduction: Early recognition and rapid revascularization is associated with improved outcomes ... more Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of hospital arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment (“device”) time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG transmission program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG transmission program. Descriptive statistics were used for analysis. Results: Over the study period, 352 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time over the study period was 83 minutes, which was decreased from a baseline of 104 minutes. The median time from FMC to door and median time from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large urban city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased over implementation, suggesting improved care processes for all patients with STEMI.