Browsing by Author "Shapiro, Nathan I"
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Item Open Access A Randomized Trial of Protocol-Based Care for Early Septic Shock(New England Journal of Medicine, 2014-05) ProCESS Investigators; Yealy, Donald M; Kellum, John A; Huang, David T; Barnato, Amber E; Weissfeld, Lisa A; Pike, Francis; Terndrup, Thomas; Wang, Henry E; Hou, Peter C; LoVecchio, Frank; Filbin, Michael R; Shapiro, Nathan I; Angus, Derek CItem Open Access Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance(Perioperative Medicine, 2020-12) Martin, Greg S; Kaufman, David A; Marik, Paul E; Shapiro, Nathan I; Levett, Denny ZH; Whittle, John; MacLeod, David B; Chappell, Desiree; Lacey, Jonathan; Woodcock, Tom; Mitchell, Kay; Malbrain, Manu LNG; Woodcock, Tom M; Martin, Daniel; Imray, Chris HE; Manning, Michael W; Howe, Henry; Grocott, Michael PW; Mythen, Monty G; Gan, Tong J; Miller, Timothy EItem Open Access Sepsis Subclasses: A Framework for Development and Interpretation.(Critical care medicine, 2021-05) DeMerle, Kimberley M; Angus, Derek C; Baillie, J Kenneth; Brant, Emily; Calfee, Carolyn S; Carcillo, Joseph; Chang, Chung-Chou H; Dickson, Robert; Evans, Idris; Gordon, Anthony C; Kennedy, Jason; Knight, Julian C; Lindsell, Christopher J; Liu, Vincent; Marshall, John C; Randolph, Adrienne G; Scicluna, Brendon P; Shankar-Hari, Manu; Shapiro, Nathan I; Sweeney, Timothy E; Talisa, Victor B; Tang, Benjamin; Thompson, B Taylor; Tsalik, Ephraim L; van der Poll, Tom; van Vught, Lonneke A; Wong, Hector R; Yende, Sachin; Zhao, Huiying; Seymour, Christopher WSepsis is defined as a dysregulated host response to infection that leads to life-threatening acute organ dysfunction. It afflicts approximately 50 million people worldwide annually and is often deadly, even when evidence-based guidelines are applied promptly. Many randomized trials tested therapies for sepsis over the past 2 decades, but most have not proven beneficial. This may be because sepsis is a heterogeneous syndrome, characterized by a vast set of clinical and biologic features. Combinations of these features, however, may identify previously unrecognized groups, or "subclasses" with different risks of outcome and response to a given treatment. As efforts to identify sepsis subclasses become more common, many unanswered questions and challenges arise. These include: 1) the semantic underpinning of sepsis subclasses, 2) the conceptual goal of subclasses, 3) considerations about study design, data sources, and statistical methods, 4) the role of emerging data types, and 5) how to determine whether subclasses represent "truth." We discuss these challenges and present a framework for the broader study of sepsis subclasses. This framework is intended to aid in the understanding and interpretation of sepsis subclasses, provide a mechanism for explaining subclasses generated by different methodologic approaches, and guide clinicians in how to consider subclasses in bedside care.Item Open Access Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?(Acad Emerg Med, 2016-10) Limkakeng, Alexander T; Monte, Andrew A; Kabrhel, Christopher; Puskarich, Michael; Heitsch, Laura; Tsalik, Ephraim L; Shapiro, Nathan IPrecision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users.