The ‘Art’ of Research in the Emergency Department

Share

Dr. Art Pancioli at a Research Experience hosted by the American Heart Association /American Stroke Association and UCMC. Photo by Cindy Starr / Mayfield Clinic.

When patients are brought into the emergency department, stricken by a stroke, epileptic seizure or other acute illness, they don’t want their doctors guessing about what to do next. But for doctors to be certain of what is best in life-threatening situations, they need data to back them up. And that means research must be conducted in the Emergency Department.

The difficulty in accomplishing this, Art Pancioli, MD, said Wednesday night during a presentation at the Vontz Center for Molecular Studies, is not a matter of asking the right questions. The problem lies in figuring out how to answer them in an environment defined by urgency and the unexpected. “It’s not the what if,” he said. “It’s the how.”

Dr. Pancioli is the Richard C. Levy Professor and Chairman of Emergency Medicine at UC and a member of the UC Stroke Team at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health. Addressing supporters of the American Heart Association / American Stroke Association and the UC Medical Center, he showed a picture that spoke a thousand words about why research in the Emergency Department might be a little bit challenging.


“This is our world,” he said. “This is our reality. It is chaos incarnate. It is abject panic. How do you do research in this?”

Furthermore, to enroll a patient in a clinical trial that might help scientists understand whether treatment A is better than treatment B, a consent form typically must be signed. Dr. Pancioli described a situation in which he asked a family he had known for only 7 minutes whether they would consent for their loved one’s inclusion in a clinical trial. He described “the level of trust that families must have to be willing to participate in research and the great appreciation and sense of duty to that patient and family that clinical researchers feel having received such trust.”

Despite these hurdles, UC’s Department of Emergency Medicine is a national leader in research that tests new therapies and protocols for patients whose lives hang in the balance. And its expertise in the treatment of acute stroke played an important role in the UC Medical Center’s certification, announced yesterday, as an advanced comprehensive stroke center.

The department, which includes 50 faculty members:

•    Produced 90-peer-reviewed publications in 2012, twice the number of the second most prolific research institution;

•    Is the leading enroller of study participants in the national coalition known as the Neurological Emergency Treatment Trials, a permanent research framework led by 22 large university medical centers throughout the United States;

•    Played an important role in the RAMPART study – named study of the year by the Society of Clinical Trials – which determined that an injection of antiepileptic medication in the muscle by paramedics was superior to delivery of the medication by IV;

•    Is currently participating in two additional NETT trials: POINT, which is assessing a treatment for patients who have suffered a minor stroke or transient ischemic attack; and SHINE, which seeks to provide safety data on the use of insulin-infusion therapy for glucose control in patients who have suffered an acute stroke and whose blood sugar is out of control.

•    Played an integral role with the UC Stroke Team in additional NIH-funded studies related ischemic and bleeding stroke, including those under the umbrella of SPOTRIAS, a global network of centers that perform research and share data in an effort to develop new therapies for stroke.

Irene Ewing, RN, BSN, discusses an Emergency Department study with a guest at last Wednesday’s event at the Vontz on the UC Academic Health Center campus.

The UC Department of Emergency Medicine has a long history of excellence and leadership. It developed the very first residency training program in the United States, graduating its first trainee in 1970; it was the first emergency department in the United States to become involved in acute stroke research; and it became the first stroke and neurocritical care training program for emergency physicians in the United States in 2008.

Dr. Pancioli, one of the first emergency medicine specialists on the UC Stroke Team, vividly remembers his first stroke patient. “It was 1991, and we did nothing for her,” he said. “There was nothing we could do.”

Today, there is much Dr. Pancioli and his team do for patients who have suffered a stroke. And there is still much more to be done. “There are not enough hours in the day to answer all the good questions we have,” Dr. Pancioli said, “even with all the good people we have.”

Dr. Pancioli concluded by thanking those in attendance for their support. Without donors and tax dollars, he noted, research cannot move forward for the betterment of humankind.

— Cindy Starr

This entry was posted in UC Gardner Neuroscience Blog and tagged , , , , . Bookmark the permalink. Both comments and trackbacks are currently closed.
  • Print This Page
  • Make an Appointment: Schedule Now
  • Sign up for our newsletter!
  • UCNI Weekly Blog
  • Hope Stories

    • Doug’s Story: Stroke Survivor

      Doug's Story: Stroke SurvivorIt was a weekday evening like any other when a friendly customer service representative named Doug became the ultimate customer. His need? Stroke services, A to Z. Doug, a self-described overweight former smoker with high blood pressure and diabetes, was trying...
    • Charles Sabine’s Story: Huntington’s Disease

      Charles Sabine's Story: Huntington's DiseaseIn 2005 the NBC war correspondent Charles Sabine made the life-altering decision to face up to his family history of Huntington’s disease and undergo genetic testing. The odds, he knew, were 50-50 that he, too, had the gene and would...
    • Jim’s Story: Pituitary Tumor

      Jim's Story: Pituitary Tumor One turn of events led to another, and so it was that Jim, and not his wife, took Jim’s 87-year-old father to his appointment with the dermatologist for the first time. And so it was that the dermatologist was not...
    • Alicia’s Story: Multiple Sclerosis

      Alicia’s Story: Multiple SclerosisAlicia is relishing a life that is filled to the brim: she is a wife, a mother, a runner and a master at living with multiple sclerosis. Diagnosed in the late 1990s, Alicia had “a bumpy ride” in the beginning. But...
    • Sandra’s Story: Glioma

      Sandra's Story: Glioma Sandra (Sandy) is a smiling, breathing reminder that hope exists for patients with even the most challenging type of brain tumors. Nine years ago, when Sandy was first told that she had six months to live, she stared back blankly...
    • Brian’s Story: Vocal Cord Cyst

      Brian's Story: Vocal Cord Cyst One by one, the symptoms of a throat problem tapped on the pastor’s door. Pastor Brian Tome, leader of Crossroads Church and speaker of five weekly messages to a following of 15,000, acknowledged the symptoms and tried to dismiss them....
    • Paula’s Story: Clot-Retriever Success

      Paula's Story: Clot-Retriever Success No one ever wants to suffer a stroke. But when Paula suffered a major, life-threatening stroke in September 2013 while working at a local deli, one might say that her timing was perfect. First and foremost, Paula got to the University...
    • Christine’s Story: Stroke

      Christine's Story: StrokeThere was a sliver of a chance, maybe, and most likely the emergency room doctor thought there was no chance at all. Christine had arrived at the community hospital comatose, brought by her parents, who had come home after working...
    • Dick’s Story: Ischemic Stroke

      Dick's Story: Ischemic Stroke As a firefighter who attends regular EMS drills, Dick Koeniger was well versed in the signs and symptoms of stroke. While driving home with a friend one evening last June, he suddenly noticed that his peripheral vision was slightly impaired....
    • Jeff’s Story: Ruptured Aneurysm, Airway Reconstruction

      Jeff's Story: Ruptured Aneurysm, Airway Reconstruction Jeff’s remarkable story has two parts: recovery and reconstruction. He doesn’t remember the first part -- the recovery from a ruptured aneurysm. But he vividly remembers the second part -- the reconstruction of his airway. He is living the followup to...