2024
Early Warning Scores With and Without Artificial Intelligence
Edelson D, Churpek M, Carey K, Lin Z, Huang C, Siner J, Johnson J, Krumholz H, Rhodes D. Early Warning Scores With and Without Artificial Intelligence. JAMA Network Open 2024, 7: e2438986. PMID: 39405061, PMCID: PMC11544488, DOI: 10.1001/jamanetworkopen.2024.38986.Peer-Reviewed Original ResearchConceptsEarly Warning ScoreWarning ScoreCohort studyYale New Haven Health SystemClinical deterioration eventsHigh-risk thresholdHealth systemRetrospective cohort studyPatient encountersDeteriorating patientsOverall PPVMain OutcomesInpatient encountersEDI scoresHospital encountersDeterioration eventsClinical deteriorationIntensive care unitEarly warning toolCare unitDecision support toolArtificial intelligenceScoresReceiver operating characteristic curveNEWS2
2021
Clinical characteristics and outcomes for 7,995 patients with SARS-CoV-2 infection
McPadden J, Warner F, Young HP, Hurley NC, Pulk RA, Singh A, Durant TJS, Gong G, Desai N, Haimovich A, Taylor RA, Gunel M, Dela Cruz CS, Farhadian SF, Siner J, Villanueva M, Churchwell K, Hsiao A, Torre CJ, Velazquez EJ, Herbst RS, Iwasaki A, Ko AI, Mortazavi BJ, Krumholz HM, Schulz WL. Clinical characteristics and outcomes for 7,995 patients with SARS-CoV-2 infection. PLOS ONE 2021, 16: e0243291. PMID: 33788846, PMCID: PMC8011821, DOI: 10.1371/journal.pone.0243291.Peer-Reviewed Original ResearchConceptsSARS-CoV-2 infectionYale New Haven HealthSARS-CoV-2Hospital mortalityRisk of admissionMale sexRisk factorsSARS-CoV-2 testingInvasive mechanical ventilationSevere acute respiratory syndrome virusBurden of diseaseRT-PCR testingAcademic health systemDiverse patient populationsRespiratory syndrome virusEthnic groupsAdult patientsClinical characteristicsDischarge dispositionRespiratory supportPrimary outcomeTreatment guidelinesMechanical ventilationRetrospective studyPatient populationIntermediate‐dose anticoagulation, aspirin, and in‐hospital mortality in COVID‐19: A propensity score‐matched analysis
Meizlish ML, Goshua G, Liu Y, Fine R, Amin K, Chang E, DeFilippo N, Keating C, Liu Y, Mankbadi M, McManus D, Wang SY, Price C, Bona RD, Chaar C, Chun HJ, Pine AB, Rinder HM, Siner JM, Neuberg DS, Owusu KA, Lee AI. Intermediate‐dose anticoagulation, aspirin, and in‐hospital mortality in COVID‐19: A propensity score‐matched analysis. American Journal Of Hematology 2021, 96: 471-479. PMID: 33476420, PMCID: PMC8013588, DOI: 10.1002/ajh.26102.Peer-Reviewed Original ResearchConceptsProphylactic-dose anticoagulationAntiplatelet therapyHospital deathCumulative incidenceMultivariable regression modelsHospital mortalityHospitalized adult COVID-19 patientsAdult COVID-19 patientsPropensity score-matched patientsPropensity score-matched analysisCOVID-19Intensive antithrombotic therapyIntermediate-dose anticoagulationCohort of patientsCOVID-19 patientsPatient-specific covariatesAnticoagulation cohortAspirin cohortDose anticoagulationAntithrombotic therapyThrombotic complicationsHospitalized patientsPrimary outcomeIllness severityRegression models
2020
Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure
Langmore SE, Krisciunas GP, Warner H, White SD, Dvorkin D, Fink D, McNally E, Scheel R, Higgins C, Levitt JE, McKeehan J, Deane S, Siner JM, Vojnik R, Moss M. Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure. Dysphagia 2020, 36: 831-841. PMID: 33156398, DOI: 10.1007/s00455-020-10199-8.Peer-Reviewed Original ResearchConceptsAcute respiratory failureRespiratory failureARF survivorsMechanical ventilationMultivariable analysisUniversity-based tertiary medical centerPenetration-Aspiration Scale scoresUpper airway edemaProspective cohort studyTertiary medical centerLaryngeal structuresFlexible endoscopic evaluationAirway edemaARF patientsSecondary outcomesCohort studyFunction abnormalitiesPrimary outcomeEndoscopic evaluationPharyngeal weaknessSwallowing examinationSwallowing functionIntensive carePhysiologic abnormalitiesUnivariate analysisVentilator Sharing Using Volume-controlled Ventilation during the COVID-19 Pandemic
Milner A, Siner JM, Balcezak T, Fajardo E. Ventilator Sharing Using Volume-controlled Ventilation during the COVID-19 Pandemic. American Journal Of Respiratory And Critical Care Medicine 2020, 202: 1317-1319. PMID: 32744456, PMCID: PMC7605199, DOI: 10.1164/rccm.202006-2452le.Peer-Reviewed Case Reports and Technical NotesThe Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors.
Krisciunas GP, Langmore SE, Gomez-Taborda S, Fink D, Levitt JE, McKeehan J, McNally E, Scheel R, Rubio AC, Siner JM, Vojnik R, Warner H, White SD, Moss M. The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors. Critical Care Medicine 2020, 48: 1604-1611. PMID: 32804785, PMCID: PMC7644217, DOI: 10.1097/ccm.0000000000004554.Peer-Reviewed Original ResearchConceptsEndotracheal tube sizeFlexible endoscopic evaluationSilent aspirationEndoscopic evaluationMedical recordsEndotracheal tubeGranulation tissueAcademic tertiary care medical centerAcute respiratory failure survivorsTertiary care medical centerPenetration-Aspiration Scale scoresAcute respiratory failureModifiable risk factorsProspective cohort studyThird of patientsHours of extubationRisk of aspirationSmall endotracheal tubePatients' medical recordsHospital outcomesRespiratory failureCohort studyPatient demographicsSwallowing examinationMultivariable analysisDevelopment of an Accurate Bedside Swallowing Evaluation Decision Tree Algorithm for Detecting Aspiration in Acute Respiratory Failure Survivors
Moss M, White SD, Warner H, Dvorkin D, Fink D, Gomez-Taborda S, Higgins C, Krisciunas GP, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Vojnik R, Langmore SE. Development of an Accurate Bedside Swallowing Evaluation Decision Tree Algorithm for Detecting Aspiration in Acute Respiratory Failure Survivors. CHEST Journal 2020, 158: 1923-1933. PMID: 32721404, PMCID: PMC7674978, DOI: 10.1016/j.chest.2020.07.051.Peer-Reviewed Original ResearchConceptsAcute respiratory failure survivorsNegative predictive valueHigh riskMulticenter prospective studyRisk of aspirationFlexible endoscopic evaluationRecursive partitioning analysisDetection of aspirationARF survivorsEndoscopic evaluationAirway safetyMechanical ventilationMedian timeAspiration riskProspective studyPatientsPredictive valueStudy designFinal analysisStudy proceduresGold standard evaluationSurvivorsThin liquidsExtubationPartitioning analysisEndotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study
Goshua G, Pine AB, Meizlish ML, Chang CH, Zhang H, Bahel P, Baluha A, Bar N, Bona RD, Burns AJ, Dela Cruz CS, Dumont A, Halene S, Hwa J, Koff J, Menninger H, Neparidze N, Price C, Siner JM, Tormey C, Rinder HM, Chun HJ, Lee AI. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. The Lancet Haematology 2020, 7: e575-e582. PMID: 32619411, PMCID: PMC7326446, DOI: 10.1016/s2352-3026(20)30216-7.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBetacoronavirusBiomarkersBlood Coagulation DisordersCoronavirus InfectionsCOVID-19Critical IllnessCross-Sectional StudiesEndothelium, VascularFemaleFollow-Up StudiesHumansIntensive Care UnitsMaleMiddle AgedPandemicsPneumonia, ViralPrognosisSARS-CoV-2Vascular DiseasesYoung AdultConceptsCOVID-19-associated coagulopathyNon-ICU patientsIntensive care unitKaplan-Meier analysisSoluble P-selectinCross-sectional studyPlatelet activationHospital dischargeICU patientsSoluble thrombomodulinEndothelial cellsVWF antigenCOVID-19P-selectinSingle-center cross-sectional studyLaboratory-confirmed COVID-19Medical intensive care unitSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesisVon Willebrand factor antigenSoluble thrombomodulin concentrationsVWF antigen concentrationEndothelial cell injurySoluble CD40 ligandMicrovascular complicationsAdult patients
2019
Evaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours?
Leder SB, Warner HL, Suiter DM, Young NO, Bhattacharya B, Siner JM, Davis KA, Maerz LL, Rosenbaum SH, Marshall PS, Pisani MA, Siegel MD, Brennan JJ, Schuster KM. Evaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours? Annals Of Otology Rhinology & Laryngology 2019, 128: 619-624. PMID: 30841709, DOI: 10.1177/0003489419836115.Peer-Reviewed Original ResearchConceptsIntensive care unitSwallow evaluationDifferent intensive care unitsRe-intubation rateYale Swallow ProtocolMajority of patientsPost-extubation dysphagiaIntubation durationNosocomial pneumoniaPost extubationLonger hospitalizationCare unitProspective InvestigationSwallow ProtocolSwallowingHoursDysphagiaHospitalizationIntubationPneumoniaPatientsIncidenceEvaluationRelationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure
Borders JC, Fink D, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Taborda SG, Vojnik R, Warner H, White SD, Langmore SE, Moss M, Krisciunas GP. Relationship Between Laryngeal Sensation, Length of Intubation, and Aspiration in Patients with Acute Respiratory Failure. Dysphagia 2019, 34: 521-528. PMID: 30694412, PMCID: PMC6660370, DOI: 10.1007/s00455-019-09980-1.Peer-Reviewed Original ResearchConceptsLaryngeal adductor reflexLength of intubationLaryngeal sensationMechanical ventilationDiet recommendationsAbsent laryngeal adductor reflexAcute respiratory failure patientsIntensive care unit admissionLaryngeal sensory deficitsAcute respiratory failureCare unit admissionRespiratory failure patientsPost-extubation dysphagiaFlexible endoscopic evaluationPresence of secretionsUnit admissionRespiratory failureAirway protectionFailure patientsSecondary outcomesEndoscopic evaluationHospitalized patientsMultivariable analysisPoor outcomeSensory deficits
2016
FIRST, “KNOW” HARM: Response to Letter to the Editor
Bizzarro MJ, Lefton-Greif MA, McGinley BM, Siner JM. FIRST, “KNOW” HARM: Response to Letter to the Editor. Dysphagia 2016, 31: 783-785. PMID: 27638423, DOI: 10.1007/s00455-016-9748-0.Peer-Reviewed Original Research“Deterioration to Door Time”: An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients
Sankey CB, McAvay G, Siner JM, Barsky CL, Chaudhry SI. “Deterioration to Door Time”: An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients. Journal Of General Internal Medicine 2016, 31: 895-900. PMID: 26969311, PMCID: PMC4945556, DOI: 10.1007/s11606-016-3654-x.Peer-Reviewed Original ResearchConceptsMedical intensive care unitEscalation of careIntensive care unitClinical deteriorationCare escalationHospitalized patientsCare unitDoor timeInpatient medicineRetrospective cohort studySeverity of illnessRisk of deathAcademic medical centerHospital mortalityICU transferCohort studyInpatient floorInpatient settingMedical CenterGeneral floorPatientsCareMortalityCurrent eraPrevious studies
2015
Protocol-Based Care versus Individualized Management of Patients in the Intensive Care Unit
Siner JM, Connors GR. Protocol-Based Care versus Individualized Management of Patients in the Intensive Care Unit. Seminars In Respiratory And Critical Care Medicine 2015, 36: 870-877. PMID: 26595047, DOI: 10.1055/s-0035-1566157.BooksConceptsIntensive care unitCare unitGeneral practiceEvidence-based careStandard of careHealth care deliveryIndividualized managementPhysicians' concernsHigh-acuity environmentCare deliveryMedical careCareLoss of autonomyCare placesCorrect interventionCorrect careComplete penetranceMedical traineesUniform practiceConsistent practiceDeliveryPatientsHospitalAimBest protocolOral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula
Leder SB, Siner JM, Bizzarro MJ, McGinley BM, Lefton-Greif MA. Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula. Dysphagia 2015, 31: 154-159. PMID: 26590570, DOI: 10.1007/s00455-015-9669-3.Peer-Reviewed Original ResearchConceptsOral alimentationOral feedingNasal cannulaMedical conditionsIntensive care unit settingPatient-specific determinantsAdult ICU patientsHigh-flow oxygenUnderlying medical conditionsFunctional swallowSwallow testingAdult patientsCohort studyRespiratory supportICU patientsICU inpatientsFlow oxygenUnit settingRespiratory issuesPatientsAdult populationHigh acuityParticipant characteristicsSuccessful resumptionAlimentationProtocols and Hospital Mortality in Critically Ill Patients
Sevransky JE, Checkley W, Herrera P, Pickering BW, Barr J, Brown SM, Chang SY, Chong D, Kaufman D, Fremont RD, Girard TD, Hoag J, Johnson SB, Kerlin MP, Liebler J, O’Brien J, O’Keefe T, Park PK, Pastores SM, Patil N, Pietropaoli AP, Putman M, Rice TW, Rotello L, Siner J, Sajid S, Murphy DJ, Martin GS. Protocols and Hospital Mortality in Critically Ill Patients. Critical Care Medicine 2015, 43: 2076-2084. PMID: 26110488, PMCID: PMC5673100, DOI: 10.1097/ccm.0000000000001157.Peer-Reviewed Original ResearchConceptsHospital mortalityIll patientsProtocol complianceClinical protocolsUnited States Critical IllnessAcute respiratory distress syndromeSpontaneous breathing trialLung-protective ventilationRespiratory distress syndromeLength of stayComplete outcome dataPatients 1 dayVentilator management protocolsSuperior patient outcomesLack of associationSingle variable analysisDesirable therapyBreathing trialProtective ventilationCritical illnessDistress syndromeICU protocolPrimary outcomeMechanical ventilationMultivariable analysisClinical Reasoning and Risk in the Intensive Care Unit
Connors GR, Siner JM. Clinical Reasoning and Risk in the Intensive Care Unit. Clinics In Chest Medicine 2015, 36: 449-459. PMID: 26304282, DOI: 10.1016/j.ccm.2015.05.016.BooksAdverse Event Reporting and Quality Improvement in the Intensive Care Unit
Heavner JJ, Siner JM. Adverse Event Reporting and Quality Improvement in the Intensive Care Unit. Clinics In Chest Medicine 2015, 36: 461-467. PMID: 26304283, DOI: 10.1016/j.ccm.2015.05.005.BooksProspective Validation of Central Line–Days Derived From an Electronic Medical Record System
Boyce JM, Paci G, Feidner C, Hubbard L, Devin L, Reilly L, Gentile A, Siner JM. Prospective Validation of Central Line–Days Derived From an Electronic Medical Record System. Infection Control And Hospital Epidemiology 2015, 36: 1098-1099. PMID: 26054019, DOI: 10.1017/ice.2015.137.Peer-Reviewed Original ResearchAttitudes of Pulmonary and Critical Care Training Program Directors toward Quality Improvement Education
Kahn JM, Feemster LC, Fruci CM, Hyzy RC, Savant AP, Siner JM, Weiss CH, Patel B. Attitudes of Pulmonary and Critical Care Training Program Directors toward Quality Improvement Education. Annals Of The American Thoracic Society 2015, 12: 587-590. PMID: 25723649, PMCID: PMC5466183, DOI: 10.1513/annalsats.201501-061bc.Peer-Reviewed Original Research
2014
Structure, Process, and Annual ICU Mortality Across 69 Centers
Checkley W, Martin GS, Brown SM, Chang SY, Dabbagh O, Fremont RD, Girard TD, Rice TW, Howell MD, Johnson SB, O’Brien J, Park PK, Pastores SM, Patil NT, Pietropaoli AP, Putman M, Rotello L, Siner J, Sajid S, Murphy DJ, Sevransky JE. Structure, Process, and Annual ICU Mortality Across 69 Centers. Critical Care Medicine 2014, 42: 344-356. PMID: 24145833, PMCID: PMC4035482, DOI: 10.1097/ccm.0b013e3182a275d7.Peer-Reviewed Original ResearchConceptsChronic Health Evaluation IIICU mortalityProcess of careAcute PhysiologyUse of protocolsClinical outcomesNurse ratioEvaluation IICare reviewChronic Health Evaluation II scoreUnited States Critical IllnessAverage Acute PhysiologyHospital-level variationMultivariable linear regressionHouse intensivistICU statusIntensivist staffingMixed ICUII scoreCritical illnessMedical ICUSurgical ICUICU patientsIllness severityIntensivist coverage