Richard D Gerkin

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Journals/Publications

• Abdouni, R., Reyburn-Orne, T., Youssef, T. H., Haddad, I. Y., & Gerkin, R. D. (2017). Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 21(1), 54-65.
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  To determine whether utilization of a hospital-based clinical practice guideline for the care of pediatric iatrogenic opioid dependence (IOD) would promote a decrease in opioid exposure and improve management of opioid abstinence syndrome (AS).
• Bolstad-Johnson, D. M., Burgess, J. L., Crutchfield, C. D., Storment, S., Gerkin, R., & Wilson, J. R. (2017). Characterization of firefighter exposures during fire overhaul. AIHAJ : a journal for the science of occupational and environmental health and safety, 61(5), 636-41.
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  Previous studies have characterized firefighter exposures during fire suppression. However, minimal information is available regarding firefighter exposures during overhaul, when firefighters look for hidden fire inside attics, ceilings, and walls, often without respiratory protection. A comprehensive air monitoring study was conducted to characterize City of Phoenix firefighter exposures during the overhaul phase of 25 structure fires. Personal samples were collected for aldehydes; benzene; toluene; ethyl benzene; xylene; hydrochloric acid; polynuclear aromatic hydrocarbons (PNA); respirable dust; and hydrogen cyanide (HCN). Gas analyzers were employed to continuously monitor carbon monoxide (CO), HCN, nitrogen dioxide (NO2), and sulfur dioxide (SO2). Area samples were collected for asbestos, metals (Cd, Cr, Pb), and total dust. During overhaul the following exceeded published ceiling values: acrolein (American Conference of Governmental Industrial Hygienists [ACGIH] 0.1 ppm) at 1 fire; CO (National Institute for Occupational Safety and Health [NIOSH] 200 ppm) at 5 fires; formaldehyde (NIOSH 0.1 ppm) at 22 fires; and glutaraldehyde (ACGIH 0.05 ppm) at 5 fires. In addition, the following exceeded published short-term exposure limit values: benzene (NIOSH 1 ppm) at two fires, NO2 (NIOSH 1 ppm) at two fires, and SO2 (ACGIH 5 ppm) at five fires. On an additive effects basis, PNA concentrations exceeded the NIOSH recommended exposure limits (0.1 mg/M3) for coal tar pitch volatiles at two fires. Maximum concentrations of other sampled substances were below their respective permissible exposure limits. Initial 10-min average CO concentrations did not predict concentrations of other products of combustion. The results indicate that firefighters should use respiratory protection during overhaul. In addition, these findings suggest that CO should not be used as an indicator gas for other contaminants found in this atmosphere.
• Bosak, A., Brooks, D. E., Welch, S., Padilla-Jones, A., & Gerkin, R. D. (2017). A retrospective review of 911 calls to a regional poison control center. Journal of family medicine and primary care, 4(4), 546-50.
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  There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings.
• Coorg, V., Levitan, R. D., Gerkin, R. D., Muenzer, J., & Ruha, A. M. (2016). Clinical Presentation and Outcomes Associated with Different Treatment Modalities for Pediatric Bark Scorpion Envenomation. Journal of medical toxicology : official journal of the American College of Medical Toxicology.
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  Scorpion envenomation is potentially life-threatening and affects children in the Southwestern USA. An FDA-approved antivenom is available, but its high cost has led to use of off-label antivenom dosing or supportive care alone as alternatives to FDA-recommended dosing. This study sought to determine whether treatment approach influences outcomes in envenomated children.
• Khurana, H. S., Groves, R. H., Simons, M. P., Martin, M., Stoffer, B., Kou, S., Gerkin, R., Reiman, E., & Parthasarathy, S. (2016). Real-Time Automated Sampling of Electronic Medical Records Predicts Hospital Mortality. The American journal of medicine, 129(7), 688-698.e2.
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  Real-time automated continuous sampling of electronic medical record data may expeditiously identify patients at risk for death and enable prompt life-saving interventions. We hypothesized that a real-time electronic medical record-based alert could identify hospitalized patients at risk for mortality.
• Levine, M., O'Connor, A. D., Padilla-Jones, A., & Gerkin, R. (2016). Comparison of Prothrombin Time and Aspartate Aminotransferase in Predicting Hepatotoxicity After Acetaminophen Overdose: a Response. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 12(2), 218.
• Levine, M., O'Connor, A. D., Padilla-Jones, A., & Gerkin, R. D. (2016). Comparison of Prothrombin Time and Aspartate Aminotransferase in Predicting Hepatotoxicity After Acetaminophen Overdose. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 12(1), 100-6.
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  Despite decades of experience with acetaminophen (APAP) overdoses, it remains unclear whether elevated hepatic transaminases or coagulopathy develop first. Furthermore, comparison of the predictive value of these two variables in determining hepatic toxicity following APAP overdoses has been poorly elucidated. The primary objective of this study is to determine the test characteristics of the aspartate aminotransferase (AST) and the prothrombin time (PT) in patients with APAP toxicity. A retrospective chart review of APAP overdoses treated with IV N-acetylcysteine at a tertiary care referral center was performed. Of the 304 subjects included in the study, 246 with an initial AST less than 1000 were analyzed to determine predictors of hepatic injury, defined as an AST exceeding 1000 IU/L. The initial AST >50 was 79.5 % sensitive and 82.6 % specific for predicting hepatic injury. The corresponding negative and positive predictive values were 95.5 and 46.3 %, respectively. In contrast, an initial abnormal PT had a sensitivity of 82.1 % and a specificity of 63.6 %. The negative and positive predictive values for initial PT were 94.9 and 30.2 %, respectively. Although the two tests performed similarly for predicting a composite endpoint of death or liver transplant, neither was a useful predictor. Initial AST performed better than the initial PT for predicting hepatic injury in this series of patients with APAP overdose.
• Skolnik, A. B., Chai, P. R., Dameff, C., Gerkin, R., Monas, J., Padilla-Jones, A., & Curry, S. (2016). Teletoxicology: Patient Assessment Using Wearable Audiovisual Streaming Technology. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 12(4), 358-364.
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  Audiovisual streaming technologies allow detailed remote patient assessment and have been suggested to change management and enhance triage. The advent of wearable, head-mounted devices (HMDs) permits advanced teletoxicology at a relatively low cost. A previously published pilot study supports the feasibility of using the HMD Google Glass® (Google Inc.; Mountain View, CA) for teletoxicology consultation. This study examines the reliability, accuracy, and precision of the poisoned patient assessment when performed remotely via Google Glass®.
• Buckley, M. S., Park, A. S., Anderson, C. S., Barletta, J. F., Bikin, D. S., Gerkin, R. D., O'Malley, C. W., Wicks, L. M., Garcia-Orr, R., & Kane-Gill, S. L. (2015). Impact of a clinical pharmacist stress ulcer prophylaxis management program on inappropriate use in hospitalized patients. The American journal of medicine, 128(8), 905-13.
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  Appropriate utilization of stress ulcer prophylaxis should be limited to high-risk, intensive care unit (ICU) patients. However, inappropriate stress ulcer prophylaxis use among all hospitalized patients remains a concern. The purpose of this study was to evaluate the clinical and economic impact of a novel pharmacist-managed stress ulcer prophylaxis program in ICU and general ward patients.
• Bush, S. P., Ruha, A. M., Seifert, S. A., Morgan, D. L., Lewis, B. J., Arnold, T. C., Clark, R. F., Meggs, W. J., Toschlog, E. A., Borron, S. W., Figge, G. R., Sollee, D. R., Shirazi, F. M., Wolk, R., de Chazal, I., Quan, D., García-Ubbelohde, W., Alagón, A., Gerkin, R. D., & Boyer, L. V. (2015). Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clinical toxicology (Philadelphia, Pa.), 53(1), 37-45.
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  Crotalidae Polyvalent Immune Fab (Ovine) has been the only antivenom commercially available in the US since 2007 for treatment of Crotalinae envenomation. Late coagulopathy can occur or recur after clearance of Fab antivenom, often after hospital discharge, lasting in some cases more than 2 weeks. There have been serious, even fatal, bleeding complications associated with recurrence phenomena. Frequent follow-up is required, and additional intervention or hospitalization is often necessary. F(ab')2 immunoglobulin derivatives have longer plasma half life than do Fab. We hypothesized that F(ab')2 antivenom would be superior to Fab in the prevention of late coagulopathy following treatment of patients with Crotalinae envenomation.
• Curry, S. C., Brooks, D. E., Skolnik, A. B., Gerkin, R. D., & Glenn, S. (2015). Effect of a medical toxicology admitting service on length of stay, cost, and mortality among inpatients discharged with poisoning-related diagnoses. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 11(1), 65-72.
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  There are no published studies that have compared quality outcomes of hospitalized poisoned patients primarily under the care of physician medical toxicologists to patients treated by non-toxicologists. We hypothesized that inpatients primarily cared for by medical toxicologists would exhibit shorter lengths of stay (LOS), lower costs, and decreased mortality. Patients discharged in 2010 and 2011 from seven hospitals within the same health care system and greater metropolitan area with Medicare severity diagnosis-related groups for "poisoning and toxic effects of drugs" with and without major comorbidities or complications (917 & 918, respectively) were identified from a Premier® database. The database contained severity-weighted comparisons between expected and observed outcomes for each patient. Outcome parameters were differences between expected and observed LOS, cost, and percent mortality. These were then compared among groups of patients primarily admitted and cared for by (1) medical toxicologists at one hospital (Banner Good Samaritan Medical Center, BGS), (2) non-toxicologists at BGS, and (3) non-toxicologists at six other hospitals. Records of 3,581 patients contained complete data for assessment of at least one outcome measure. Patients cared for by medical toxicologists experienced favorable differences in LOS, costs, and mortality compared with other patient groups (p 
• Curry, S. C., Padilla-Jones, A., O'Connor, A. D., Ruha, A. M., Bikin, D. S., Wilkins, D. G., Rollins, D. E., Slawson, M. H., Gerkin, R. D., & , A. A. (2015). Prolonged Acetaminophen-Protein Adduct Elimination During Renal Failure, Lack of Adduct Removal by Hemodiafiltration, and Urinary Adduct Concentrations After Acetaminophen Overdose. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 11(2), 169-78.
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  Elevated concentrations of serum acetaminophen-protein adducts, measured as protein-derived acetaminophen-cysteine (APAP-CYS), have been used to support a diagnosis of APAP-induced liver injury when histories and APAP levels are unhelpful. Adducts have been reported to undergo first-order elimination, with a terminal half-life of about 1.6 days. We wondered whether renal failure would affect APAP-CYS elimination half-life and whether continuous venovenous hemodiafiltration (CVVHDF), commonly used in liver failure patients, would remove adducts to lower their serum concentrations. Terminal elimination half-lives of serum APAP-CYS were compared between subjects with and without renal failure in a prospective cohort study of 168 adults who had ingested excessive doses of APAP. APAP-CYS concentrations were measured in plasma ultrafiltrate during CVVHDF at times of elevated serum adduct concentrations. Paired samples of urine and serum APAP-CYS concentrations were examined to help understand the potential importance of urinary elimination of serum adducts. APAP-CYS elimination half-life was longer in 15 renal failure subjects than in 28 subjects with normal renal function (41.3 ± 2.2 h versus 26.8 ± 1.1 h [mean ± SEM], respectively, p 
• Goldberg, A., Gerkin, R. D., & Young, M. (2015). Medical Prevention of Barrett's Esophagus: Effects of Statins, Aspirin, Non-aspirin NSAIDs, Calcium, and Multivitamins. Digestive diseases and sciences, 60(7), 2058-62.
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  Barrett's esophagus (BE) is a complication of gastroesophageal reflux disease (GERD) that is a precursor to esophageal adenocarcinoma. There is limited information regarding whether medications can reduce the risk of developing BE.
• Ludtke, K. A., Stanley, K. S., Yount, N. L., & Gerkin, R. D. (2015). Retrospective Review of Critically Ill Patients Experiencing Alcohol Withdrawal: Dexmedetomidine Versus Propofol and/or Lorazepam Continuous Infusions. Hospital pharmacy, 50(3), 208-13.
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  Alcohol withdrawal symptoms can be difficult to manage and may lead to an intensive care unit (ICU) admission. Patients experiencing severe alcohol withdrawal often require high doses of sedatives, which can lead to respiratory depression and the need for endotracheal intubation. Dexmedetomidine, an alpha-2 adrenoreceptor agonist, provides adequate sedation with little effect on respiratory function when compared to other sedatives.
• O'Connor, A. D., Padilla-Jones, A., Gerkin, R. D., & Levine, M. (2015). Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 11(2), 195-200.
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  Synthetic cathinones have emerged as popular drugs of abuse and produce sympathomimetic toxicity. It is unknown if rhabdomyolysis occurs more frequently following the use of synthetic cathinones compared to other stimulants. This retrospective study sought to determine the prevalence of rhabdomyolysis in patients with sympathomimetic toxicity and compare rates among patients using specific agents. Patients greater than 14 years of age with sympathomimetic toxicity and detection of a stimulant agent in urine via gas chromatography-mass spectroscopy (GC-MS) were included. Patients were excluded if clinical sympathomimetic toxicity was not present, a serum creatine kinase (CK) was not measured, or urine GC-MS was not performed. Rhabdomyolysis and severe rhabdomyolysis were defined as CK > 1000 and 10,000 IU/L, respectively. Prevalence of rhabdomyolysis and severe rhabdomyolysis were reported. Logistic regression was performed to determine the relative effect in single-agent exposures of a synthetic cathinone compared to other sympathomimetics on rhabdomyolysis. A secondary outcome, a composite endpoint defined as need for mechanical ventilation, renal replacement therapy, development of compartment syndrome, or death, was also analyzed. One hundred two subjects met inclusion criteria; median age (IQR) was 32 (25-42) years with a range of 14-65 years; 74 % were male. Rhabdomyolysis occurred in 42 % (43/102) of subjects. Patients whose sympathomimetic toxicity could be ascribed to a single agent were considered for further statistical analysis and placed into four groups: methamphetamine (n = 55), synthetic cathinone (n = 19), cocaine (n = 9), and other sympathomimetic (n = 6). In 89 subjects with single stimulant exposure, the prevalence of rhabdomyolysis was as follows: synthetic cathinone, 12/19 (63 %); methamphetamine, 22/55 (40 %); cocaine, 3/9 (33 %); and other single agent, 0/6 (0 %). The occurrence of severe rhabdomyolysis (CK > 10,000 IU/L) for each of the four groups was synthetic cathinone with 5/19 (26 %), methamphetamine with 2/55 (3.6 %), cocaine with 1/9 (11 %), and other with 0/6 (0 %). Median maximal CK (range) by groups was as follows: synthetic cathinone, 2638 (62-350,000+) IU/L; methamphetamine, 665 (61-50,233) IU/L; cocaine, 276 (87-25,614) IU/L; and other, 142 (51-816) IU/L. A statistically significant difference (p = 0.004) was found when comparing maximal CK among the four groups. Exposure to a synthetic cathinone compared with other sympathomimetics was associated with increased risk of developing rhabdomyolysis and severe rhabdomyolysis with odds ratios of 3.09 and 7.98, respectively. In this cohort of patients with sympathomimetic toxicity, 42 % developed rhabdomyolysis. Synthetic cathinones were associated with an increased risk of rhabdomyolysis and severe rhabdomyolysis compared with other stimulants.
• Tussey, C. M., Botsios, E., Gerkin, R. D., Kelly, L. A., Gamez, J., & Mensik, J. (2015). Reducing Length of Labor and Cesarean Surgery Rate Using a Peanut Ball for Women Laboring With an Epidural. The Journal of perinatal education, 24(1), 16-24.
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  One strategy for reducing the primary cesarean surgery rate and length of labor is using a peanut-shaped exercise ball for women laboring under epidural analgesia. A randomized, controlled study was conducted to determine whether use of a "peanut ball" decreased length of labor and increased the rate of vaginal birth. Women who used the peanut ball (n = 107) versus those who did not (n = 91) demonstrated shorter first stage labor by 29 min (p = .053) and second stage labor by 11 min (p < .001). The intervention was associated with a significantly lower incidence of cesarean surgery (OR = 0.41, p = .04). The peanut ball is potentially a successful nursing intervention to help progress labor and support vaginal birth for women laboring under epidural analgesia.
• Edwards, R. K., Ingersoll, M., Gerkin, R. D., Bodea-Braescu, A. V., & Lin, M. G. (2014). Carboxymethylcellulose adhesion barrier placement at primary cesarean delivery and outcomes at repeat cesarean delivery. Obstetrics and gynecology, 123(5), 923-8.
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  To assess associations of a commercially available carboxymethylcellulose adhesion barrier placed during primary cesarean delivery with clinical outcomes of repeat cesarean deliveries.
• Kelly, L. A., Wicker, T. L., & Gerkin, R. D. (2014). The relationship of training and education to leadership practices in frontline nurse leaders. The Journal of nursing administration, 44(3), 158-63.
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  Although organizations strive to develop transformational leaders, frontline nurse managers and directors are often inadequately prepared and lack transformational leadership (TL) behaviors.
• Levine, M., Ruha, A. M., Padilla-Jones, A., Gerkin, R., & Thomas, S. H. (2014). Bleeding following rattlesnake envenomation in patients with preenvenomation use of antiplatelet or anticoagulant medications. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 21(3), 301-7.
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  Rattlesnake envenomations commonly produce coagulopathy and thrombocytopenia, yet clinically significant bleeding is uncommon. It is unknown if patients who use antiplatelet or anticoagulant medications prior to envenomation are at increased risk for bleeding after envenomation.
• Glogan, D., Levitan, R. D., Brooks, D. E., & Gerkin, R. D. (2013). Unintentional use of mistaken insulin products: a retrospective review of poison center data. The Journal of emergency medicine, 45(4), 547-53.
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  There are no guidelines for the management of accidental insulin administration. We hypothesized that home monitoring of asymptomatic patients (pts) was safe following unintentionally insulin administration.
• Macias, J. D., Gerkin, R. D., Locke, D., & Macias, M. P. (2013). Differential gene expression in cholesteatoma by DNA chip analysis. The Laryngoscope, 123 Suppl S5, S1-21.
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  In contrast to normal epithelium, the desquamating stratified squamous epithelium of temporal bone cholesteatoma characteristically exhibits sustained hyperproliferative growth and a capacity for bone erosion. We conducted genome-wide microarray analyses to determine the molecular nature of cholesteatoma's biological processes and identify disease-associated, altered gene activity. We tested the hypothesis that genes contributing to the pathophysiology of cholesteatoma are differentially expressed compared to control tissue.
• Ota, K. S., Beutler, D. S., Gerkin, R. D., Weiss, J. L., & Loli, A. I. (2013). Physician-directed heart failure transitional care program: a retrospective case review. Journal of clinical medicine research, 5(5), 335-42.
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  Despite a variety of national efforts to improve transitions of care for patients at risk for rehospitalization, 30-day rehospitalization rates for patients with heart failure have remained largely unchanged.
• Bagdade, J. D., Knight-Gibson, C., Simpson, N., Gerkin, R., Alaupovic, P., & Reardon, C. (2012). CETP-mediated cholesteryl ester enrichment of apoB subclasses in type 1 diabetes. European journal of clinical investigation, 42(7), 709-16.
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    Accelerated cholesteryl ester transfer (CET) in patients with types 1 (T1D) and 2 diabetes enhances the atherogenicity of the apoB-containing CE acceptor lipoproteins. The study of lipoprotein density fractions cannot identify which of the five immunologically distinct apoB subclasses function as CE acceptors because they are heterogeneous and present in very low-, intermediate- and low density lipoproteins (VLDL, IDL and LDL, respectively). In order to design lipid-modifying therapies that specifically target these CE-enriched lipoprotein particles, it is necessary to first characterize their CE acceptor function.
• Barney, E. J., Little, E. C., Gerkin, R. D., Ramos, A. X., Kahn, J., Wong, M., Kolli, G., & Manch, R. (2012). Coated transjugular intrahepatic portosystemic shunt does not improve thrombocytopenia in patients with liver cirrhosis. Digestive diseases and sciences, 57(9), 2430-7.
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  Thrombocytopenia is a common complication of chronic liver disease. The theory of portal decompression to improve thrombocytopenia due to hypersplenism has led to the study of transjugular intrahepatic portosystemic shunt (TIPS) as a potential therapy. However, there is a paucity of data and results have been conflicting. The aim of this study was to determine whether platelet counts improved in cirrhotic patients after placement of the new polytetrafluoroethylene (PTFE)-coated TIPS, developed in 2004.
• Burgess, J. L., Kurzius-Spencer, M., Gerkin, R. D., Fleming, J. L., Peate, W. F., & Allison, M. (2012). Risk factors for subclinical atherosclerosis in firefighters. Journal of occupational and environmental medicine, 54(3), 328-35.
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  Heart disease is the leading cause of firefighter line-of-duty deaths. The study objectives were to identify early atherosclerotic disease through ultrasound measurement of carotid intima-media thickness (CIMT) and risk factors predicting increased CIMT and carotid plaque.
• Shah, D. K., Karasek, V., Gerkin, R. D., Ramirez, F. C., & Young, M. A. (2011). Sex preferences for colonoscopists and GI physicians among patients and health care professionals. Gastrointestinal endoscopy, 74(1), 122-127.e2.
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  There are indications that many women prefer female health care providers.
• Canning, J., Brooks, D. E., & Gerkin, R. D. (2010). Identifying patients with cocaine-related chest pain at true risk for beta-blocker toxicity. Archives of internal medicine, 170(20), 1859; author reply 1860.
• Swearingen, A., Ghaemmaghami, V., Loftus, T., Swearingen, C. J., Salisbury, H., Gerkin, R. D., & Ferrara, J. (2010). Extreme blood alcohol level is associated with increased resource use in trauma patients. The American surgeon, 76(1), 20-4.
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  This study aims to examine resource utilization and outcomes of trauma patients with extremely high blood alcohol concentrations. We hypothesized that higher blood alcohol concentration (BAC) predicts greater resource utilization and poorer outcomes. A retrospective analysis was performed on trauma patients admitted to an urban Level I trauma center over a 5-year period. Admission BAC categories were constructed using standard laboratory norms and legal definitions. Demographic data, premorbid conditions, injury severity scores (ISS), resource utilization (intensive care unit (ICU) admission rates/length of stay, total hospital days, use of consultants), and mortality were analyzed. Positive BAC on admission was associated with increased ISS (P < 0.001), length of stay (P < 0.003), and total ICU days (P < 0.001). Increased BAC admission level of patients was associated with a decreased ISS score (P = 0.0073), a higher probability of ICU admission (P = 0.0013), and an increased percentage of ICU days (P = 0.001). A positive BAC at admission was a significant predictor of both ICU admission and mortality (odds ratios 1.72 and 1.27, respectively). This study demonstrates that a positive BAC is associated with increased ISS, increased resource utilization, and worsened outcomes. Extreme levels of BAC are associated with increased resource utilization despite lower injury severity scores.
• Ruha, A. M., Curry, S. C., Gerkin, R. D., Caldwell, K. L., Osterloh, J. D., & Wax, P. M. (2009). Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters. Archives of pathology & laboratory medicine, 133(1), 87-92.
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  Public awareness of methylmercury in fish has caused patients to seek testing for mercury poisoning. In some patients, the diagnosis of mercury poisoning has been made based on urine mercury excretions following oral dosing of meso-dimercaptosuccinic acid (DMSA), a metal chelator. However, studies comparing urine mercury excretion following DMSA in healthy non-fish eaters with healthy fish eaters could not be located.
• Lo Vecchio, F., Gerkin, R. D., & Curry, S. C. (2008). CO poisoning and hyperbaric oxygen therapy: more studies need to be done. American journal of respiratory and critical care medicine, 178(3), 314; author reply 314-5.
• Trussell, J., Gerkin, R., Coates, B., Brandenberger, J., Tibi, P., Keuth, J., Montefour, K., Salisbury, H., & Ferrara, J. (2008). Impact of a patient care pathway protocol on surgical site infection rates in cardiothoracic surgery patients. American journal of surgery, 196(6), 883-9; discussion 889.
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  We hypothesized that implementing a quality care initiative, including peri-incisional antibiotic administration, tight blood glucose control, and hair removal with clippers would reduce surgical site infection (SSI) rates in patients undergoing coronary artery bypass grafting (CABG), with or without valve replacement.
• Chen, K., Reiman, E. M., Alexander, G. E., Caselli, R. J., Gerkin, R., Bandy, D., Domb, A., Osborne, D., Fox, N., Crum, W. R., Saunders, A. M., & Hardy, J. (2007). Correlations between apolipoprotein E epsilon4 gene dose and whole brain atrophy rates. The American journal of psychiatry, 164(6), 916-21.
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  The purpose of this study was to characterize the relationship between whole brain atrophy rates and three levels of genetic risk for Alzheimer's disease in cognitively normal persons. The authors previously found accelerated whole brain atrophy rates in patients with probable Alzheimer's disease by computing changes in brain volume from sequential magnetic resonance images (MRIs).
• Macias, J. D., Massingale, S., & Gerkin, R. D. (2005). Efficacy of vestibular rehabilitation therapy in reducing falls. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 133(3), 323-5.
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  To assess the short-term effectiveness of vestibular rehabilitation therapy in reducing fall risk in an at-risk population.
• Burgess, J. L., Fierro, M. A., Lantz, R. C., Hysong, T. A., Fleming, J. E., Gerkin, R., Hnizdo, E., Conley, S. M., & Klimecki, W. (2004). Longitudinal decline in lung function: evaluation of interleukin-10 genetic polymorphisms in firefighters. Journal of occupational and environmental medicine, 46(10), 1013-22.
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  During annual medical monitoring, some firefighters are found to have rates of decline in forced expiratory volume in one second (FEV1) far exceeding their peers. Interleukin-10 (IL-10) suppresses inflammation, and single nucleotide polymorphisms (SNPs) in the IL-10 gene may confer variable susceptibility to more rapid decline in lung function. In 1204 firefighters with at least six annual FEV1 measurements, increased age and greater initial FEV1 were associated with more rapid decline in lung function. DNA collected from 379 of these firefighters was screened for IL-10 SNPs at -1117, -854, 919, 1668, and 1812. A statistically significant difference in decline in lung function was found based on genotyping at the 1668 SNP. Evaluation of gene polymorphisms regulating lung inflammation may help to explain some of the variation in rate of decline in lung function in firefighters.
• Katz, K. D., Curry, S. C., Brooks, D. E., & Gerkin, R. D. (2004). The effect of cyclosporine A on survival time in salicylate-poisoned rats. The Journal of emergency medicine, 26(2), 151-5.
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  Salicylate (SAL) produces mitochondrial membrane permeability transition (MPT) with resultant oxidative phosphorylation uncoupling. Cyclosporine A (CSA) inhibits SAL-induced MPT. This study determined if CSA pretreatment prolonged survival time in SAL-poisoned rats. Twenty-nine rats were randomized to receive pre-treatment with either 30 mg/kg CSA or equal volume of control diluent intraperitoneally (i.p.). Four hours later, all rats received 1700 mg/kg sodium salicylate i.p. Survival time, whole blood CSA ([CSA]), and serum sodium ([Na]), glucose and SAL ([SAL]) concentrations were determined. The results showed median survival time for controls was 18 min (95% CI 14-22 min) and for CSA animals was 14 min (95% CI 13-15 min). Univariate and multivariate analyses and Cox proportional hazard regression revealed CSA treatment was associated with higher [SAL], which was associated with shortened survival times. The CSA group also demonstrated shorter survival times for a given [SAL]. In conclusion, CSA pre-treatment shortened survival in SAL-poisoned rats.
• Macias, J. D., Ellensohn, A., Massingale, S., & Gerkin, R. (2004). Vibration with the canalith repositioning maneuver: a prospective randomized study to determine efficacy. The Laryngoscope, 114(6), 1011-4.
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  The objective was to determine whether the inclusion of vibration and additional treatment cycles has an effect on short- and long-term success rates in the treatment of benign paroxysmal positional vertigo with the canalith repositioning maneuver.
• Burgess, J. L., Witten, M. L., Nanson, C. J., Hysong, T. A., Sherrill, D. L., Quan, S. F., Gerkin, R., & Bernard, A. M. (2003). Serum pneumoproteins: a cross-sectional comparison of firefighters and police. American journal of industrial medicine, 44(3), 246-53.
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  Serum pneumoproteins provide a measure of the permeability of the lower respiratory tract, and have shown promise as a biomarker of acute and chronic exposure to respiratory toxicants.
• Samo, D. G., Bahk, J. K., & Gerkin, R. D. (2003). Effect of firefighter masks on monocular and binocular peripheral vision. Journal of occupational and environmental medicine, 45(4), 428-32.
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  Peripheral vision can impact essential job functions of firefighters and other workers who use Self-Contained Breathing Apparatus and other full face masks. It is important for physicians to know how these masks alter peripheral vision. Also, one must understand the effect of monocular vision on peripheral vision. Using the Goldman Perimeter Machine we measured peripheral vision in the monocular and binocular state, with and without two different types of masks. The results show that monocularity causes an average loss of 23 degrees in the nasal meridian. The use of the masks did not affect this difference. Also, the masks caused an average loss of 28 degrees of peripheral vision in the inferior meridian. How these losses affect the ability of the users of the masks to perform their essential job functions still needs to be researched.
• Burgess, J. L., Nanson, C. J., Hysong, T. A., Gerkin, R., Witten, M. L., & Lantz, R. C. (2002). Rapid decline in sputum IL-10 concentration following occupational smoke exposure. Inhalation toxicology, 14(2), 133-40.
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  The acute effects of smoke exposure on inflammatory mediators such as interleukin-10 (IL-10), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) are not well understood. Our study was designed to measure sputum concentrations of these cytokines in firefighters following low-level smoke exposure. At baseline, participating firefighters underwent blood collection, pulmonary function testing, and sputum induction through inhalation of nebulized hypertonic saline. Study participants later performed overhaul of a structural fire, during which time they wore cartridge respirators and were monitored for smoke exposure. Overhaul involves searching for and extinguishing hidden sources of combustion. One hour following overhaul, blood, pulmonary function data, and induced sputum were again collected. IL-10, IL-8, and TNF-alpha concentrations were measured by enzyme-linked immunosorbent assay (ELISA) in sputum supernatant. In 17 firefighters, baseline sputum IL-10 concentrations were 57.0 +/- 56.8 pg/L, and declined to 16.9 +/- 27.2 pg/L following overhaul (p =.02). No significant changes were observed in sputum IL-8 and TNF-alpha concentrations. Forced vital capacity (FVC) declined significantly in study participants following overhaul. Serum concentrations of Clara-cell protein and surfactant-associated protein A increased significantly following overhaul, indicating increased lung permeability. IL-10 concentrations appear to be exquisitely sensitive to smoke, and studies of IL-10 in sputum should control for recent exposure. Reduced suppression of inflammation by IL-10 may be a mechanism by which low-level smoke exposure causes lung injury.
• King, C. H., Fischler, D. F., & Gerkin, R. D. (2002). Will genetic testing alter the management of disease caused by infectious agents? A cost-effectiveness analysis of gene-testing strategies for prevention of rheumatic Fever. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 34(11), 1491-9.
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  Cost-effectiveness analysis was done to evaluate the potential health and economic effects of a genetic screening program to identify individuals at risk for rheumatic fever (RF). The current RF prevention strategy was compared with a new, primary prevention strategy involving early genetic testing and intensive prophylaxis to prevent a first attack among individuals at high risk for RF. When analysis of a hypothetical 2000 birth cohort was done from a societal perspective, the prevention strategy involving genetic screening and prophylaxis for high-risk persons reduced the number of RF cases and increased life span at an estimated discounted cost of $7900 per quality-adjusted life-year gained. Genetic screening became the preferred (least expensive) strategy if the test specificity was >/=98%, the annual cost of prophylaxis was $32,000. When used with available antibiotic prophylaxis, genetic testing has the potential to provide a cost-effective strategy for the primary prevention of RF and its sequelae.
• Ruha, A. M., Curry, S. C., Beuhler, M., Katz, K., Brooks, D. E., Graeme, K. A., Wallace, K., Gerkin, R., Lovecchio, F., Wax, P., & Selden, B. (2002). Initial postmarketing experience with crotalidae polyvalent immune Fab for treatment of rattlesnake envenomation. Annals of emergency medicine, 39(6), 609-15.
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  We describe our postmarketing experience with patients receiving Crotalidae polyvalent immune Fab (CroFab; FabAV) antivenom for treatment of rattlesnake envenomation.
• Ruha, A. M., Tanen, D. A., Graeme, K. A., Curry, S. C., Miller, M. B., Gerkin, R., Reagan, C. G., & Brandon, T. A. (2002). Hypertonic sodium bicarbonate for Taxus media-induced cardiac toxicity in swine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 9(3), 179-85.
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  To determine whether intravenous (IV) hypertonic sodium bicarbonate is effective in the reversal of QRS widening associated with severe Taxus intoxication.
• Burgess, J. L., Nanson, C. J., Bolstad-Johnson, D. M., Gerkin, R., Hysong, T. A., Lantz, R. C., Sherrill, D. L., Crutchfield, C. D., Quan, S. F., Bernard, A. M., & Witten, M. L. (2001). Adverse respiratory effects following overhaul in firefighters. Journal of occupational and environmental medicine, 43(5), 467-73.
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  Overhaul is the stage in which firefighters search for and extinguish possible sources of reignition. It is common practice not to wear respiratory protection during overhaul. Fifty-one firefighters in two groups, 25 without respiratory protection and 26 wearing cartridge respirators, were monitored for exposure to products of combustion and changes in spirometric measurements and lung permeability following overhaul of a structural fire. Testing at baseline and 1 hour after overhaul included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), serum Clara cell protein (CC16), and serum surfactant-associated protein A (SP-A). Overhaul increased CC16 in both groups, indicating increased alveolarcapillary membrane permeability. Contrary to expectations, SP-A increased and FVC and FEV1 decreased in the firefighters wearing cartridge respirators. Changes in FEV1, CC16, and SP-A were associated with concentrations of specific products of combustion or carboxyhemoglobin levels. Firefighter exposures during overhaul have the potential to cause changes in spirometric measurements and lung permeability, and self-contained breathing apparatus should be worn during overhaul to prevent lung injury.

Poster Presentations

• Slaughter, G., Mercer, L., Gerkin Jr, R., & Saunders, K. (2018, 05). Antibiotic Prophylaxis in Surgical Sterilization: Following the Recommendations. ACOG Annual Clinical and Scientific Meeting. Austin, TX.
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  Saunders, Kelley, T., MD, MS; Slaughter, Geoffrey, T.; Mercer, Laura, MD; Gerkin, Richard, MD, MS. Antibiotic Prophylaxis in Surgical Sterilization: Following the Recommendations. Obstetrics & Gynecology: May 2018 - Volume 131 - Issue - p 82S–83Sdoi: 10.1097/01.AOG.0000533379.96988.6a.