Lawrence A Deluca

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Scholarly Contributions

Books

• Deluca, L. A. (2000). Defining and analyzing the professional responsibilities of personal trainers. UMI Dissertation Services.
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  2000 Doctoral Dissertation for Doctorate of Education, Boston University, Boston MA, School of Education

Chapters

• Deluca, L. A. (2018). Acute Respiratory Failure and Mechanical Ventilation. In Decker Emergency Medicine (formerly Scientific American Emergency Medicine)(pp Chapter 7). Decker IP.
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  Book chapter including literature review on principles of mechanical ventilation for critically ill patients aimed at Emergency Medicine practitioners.

Journals/Publications

• Barringer, K., Buller, D., Cienki, J., Deluca, L. A., Freeman, M., Grall, K., Johnson, R., Lam, R., Staggs, K., Stoneking, L. R., & Vermilyea, E. (2018). Bouncing Back: Reverse the Victimization Trend and Make Institutional Change. Emergency Medicine News, 40(11). doi:10.1097/01.EEM.0000547702.34226.40
• DeLuca, L. A., Stoneking, L. R., Vermilyea, E., Staggs, K., Lam, R., Johnson, R., Grall, K. H., Freeman, M., Cienki, J. J., Buller, D., & Barringer, K. (2018). Bouncing Back. Emergency medicine news. doi:10.1097/01.eem.0000547702.34226.40
• Deluca, L. A., Grall, K., & Freeman, M. (2018). Why Your Physician Wellness Programs Aren't Working. KevinMD.com.
• DeLuca, L. A., Stoneking, L. R., Larson, W. J., Denninghoff, K. R., Sabb, D., Stolz, U., Gonzaga, M. J., Grall, K. H., Yang, L. M., Davidson, D., & Walsh, P. (2017). Impact and feasibility of an emergency department–based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department. American Journal of Infection Control. doi:10.1016/j.ajic.2016.05.037
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  Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates.This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day.PRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3%), 11 (5.7%), and 6 (3.9%). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50% for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11.VAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.
• Deluca, L. A., Walsh, P., Davidson, D. D., Stoneking, L. R., Yang, L. M., Grall, K. J., Gonzaga, M. J., Larson, W. J., Stolz, U., Sabb, D. M., & Denninghoff, K. R. (2017). Ventilator-Associated Pneumonia Rates Are Significantly Reduced by The Deployment of a VAP Prevention Bundle in an Academic Emergency Department. American Journal of Infection Control, 45(2), 151-157. doi:http://doi.org/10.1016/j.ajic.2016.05.037
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  Published online: September 21, 2016
• Durns, T., Sabb, D., Roward, Z., Pickering, A., Miller, R. C., Durns, T., Deluca, L. A., & Cienki, J. J. (2015). Survey of arizona emergency department infectious disease preparedness for possible ebola patients. Intensive Care Medicine Experimental, 3(1), 1-2. doi:10.1186/2197-425x-3-s1-a349
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  The Ebola epidemic in Africa has reached 24,500 cases, and has spread to the US. The Emergency Department (ED) often serves as the first line of treatment in the US healthcare system. Arizona is the sixth largest state and consists of a few metropolitan areas and many small rural communities that rely on small EDs that lack the resources and personnel of many larger centers.
• Durns, T., Yeaton, J., Roward, Z., Pickering, A., Miller, R. C., Durns, T., Denninghoff, K. R., & Deluca, L. A. (2015). Presenting illness and mortality outcomes for patients intubated in an academic emergency department.. Intensive Care Medicine Experimental, 3(1), 1-2. doi:10.1186/2197-425x-3-s1-a667
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  Patients who are intubated during the course of hospital care have a high mortality rate. 70% of critically ill Emergency Department (ED) patients are intubated in the ED or a prehospital, but little data describes mortality risk. Identification of mortality risk based on presenting illness would allow providers to improve both resuscitative efforts and advanced care planning.
• Durns, T., Yeaton, J., Sabb, D., Roward, Z., Pickering, A., Miller, R. C., Durns, T., Denninghoff, K. R., & Deluca, L. A. (2015). The effect of presenting complaint on the risk of developing ventilator-associated pneumonia for patients intubated in an academic emergency department. Intensive Care Medicine Experimental, 3(1), 1-2. doi:10.1186/2197-425x-3-s1-a99
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  Ventilator associated pneumonia (VAP) is a complication of mechanical ventilation that increased ICU length of stay and mortality. Eckert found 26% of trauma patients intubated in the ED develop VAP as compared to 6.5% of those intubated in the ICU. Green demonstrated that 70% of critically ill patients were intubated pre-hospital or in the ED and 18.2% remained in the ED for more than 4 hours.
• Durns, T., Yeaton, J., Walsh, P., Sabb, D., Pickering, A., Miller, R. C., Durns, T., Denninghoff, K. R., & Deluca, L. A. (2015). 48: REDUCTION OF EARLY VAP AFTER BUNDLE DEPLOYMENT FOR PATIENTS INTUBATED IN THE EMERGENCY DEPARTMENT. Critical Care Medicine, 43, 13. doi:10.1097/01.ccm.0000473876.55708.32
• Stoneking, L. R., DeLuca, L. A., Fiorello, A. B., Denninghoff, K. R., Wolk, D. M., Gaub, M. B., Luman, J. C., Stutz, A., Stolz, U., & Winkler, J. P. (2015). Physician Documentation of Sepsis Syndrome Is Associated with More Aggressive Treatment. Western Journal of Emergency Medicine. doi:10.5811/westjem.2015.3.25529
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  Timely recognition and treatment of sepsis improves survival. The objective is to examine the association between recognition of sepsis and timeliness of treatments.We identified a retrospective cohort of emergency department (ED) patients with positive blood cultures from May 2007 to January 2009, and reviewed vital signs, imaging, laboratory data, and physician/nursing charts. Patients who met systemic inflammatory response syndrome (SIRS) criteria and had evidence of infection available to the treating clinician at the time of the encounter were classified as having sepsis. Patients were dichotomized as RECOGNIZED if sepsis was explicitly articulated in the patient record or if a sepsis order set was launched, or as UNRECOGNIZED if neither of these two criteria were met. We used median regression to compare time to antibiotic administration and total volume of fluid resuscitation between groups, controlling for age, sex, and sepsis severity.SIRS criteria were present in 228/315 (72.4%) cases. Our record review identified sepsis syndromes in 214 (67.9%) cases of which 118 (55.1%) had sepsis, 64 (29.9%) had severe sepsis, and 32 (15.0%) had septic shock. The treating team contemplated sepsis (RECOGNIZED) in 123 (57.6%) patients. Compared to the UNRECOGNIZED group, the RECOGNIZED group had a higher use of antibiotics in the ED (91.9 vs.75.8%, p=0.002), more patients aged 60 years or older (56.9 vs. 33.0%, p=0.001), and more severe cases (septic shock: 18.7 vs. 9.9%, severe sepsis: 39.0 vs.17.6%, sepsis: 42.3 vs.72.5%; p
• Stoneking, L. R., Winkler, J. P., DeLuca, L. A., Stolz, U., Stutz, A., Luman, J. C., Gaub, M., Wolk, D. M., Fiorello, A. B., & Denninghoff, K. R. (2015). Physician documentation of sepsis syndrome is associated with more aggressive treatment. The western journal of emergency medicine, 16(3), 401-7.
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  Timely recognition and treatment of sepsis improves survival. The objective is to examine the association between recognition of sepsis and timeliness of treatments.
• Durns, T., Gerlach, E., Durns, T., Denninghoff, K. R., Deluca, L. A., & Davidson, D. D. (2014). 391: THE IMPACT OF ADVANCED DIRECTIVES ON NON-SURVIVORS WHO ARE INTUBATED IN THE EMERGENCY DEPARTMENT. Critical Care Medicine, 42, A1454. doi:10.1097/01.ccm.0000457888.21104.a9
• Grall, K. H., Stoneking, L. R., DeLuca, L. A., Waterbrook, A. L., Pritchard, T. G., & Denninghoff, K. R. (2014). An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures. Advances in medical education and practice, 5, 229-36.
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  Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents' procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.
• Grall, K. H., Stoneking, L. R., Deluca, L. A., Waterbrook, A. L., Pritchard, T. G., & Denninghoff, K. R. (2014). An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures. Advances in medical education and practice, 5, 229-36. doi:https://doi.org/10.2147/AMEP.S58073
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  Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents' procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.
• Stoneking, L. R., DeLuca, L. A., Baker, N., Denninghoff, K. R., Munzer, B. W., & Fiorello, A. B. (2014). Alternative Methods to Central Venous Pressure for Assessing Volume Status in Critically Ill Patients. Journal of Emergency Nursing. doi:10.1016/j.jen.2012.04.018
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  Early goal-directed therapy increases survival in persons with sepsis but requires placement of a central line. We evaluate alternative methods to measuring central venous pressure (CVP) to assess volume status, including peripheral venous pressure (PVP) and stroke volume variation (SVV), which may facilitate nurse-driven resuscitation protocols.Patients were enrolled in the emergency department or ICU of an academic medical center. Measurements of CVP, PVP, SVV, shoulder and elbow position, and dichotomous variables Awake, Movement, and Vented were measured and recorded 7 times during a 1-hour period. Regression analysis was used to predict CVP from PVP and/or SVV, shoulder/elbow position, and dichotomous variables.Twenty patients were enrolled, of which 20 had PVP measurements and 11 also had SVV measurements. Multiple regression analysis demonstrated significant predictive relationships for CVP using PVP (CVP = 6.7701 + 0.2312 × PVP - 0.1288 × Shoulder + 12.127 × Movement - 4.4805 × Neck line), SVV (CVP = 14.578 - 0.3951 × SVV + 18.113 × Movement), and SVV and PVP (CVP = 4.2997 - 1.1675 × SVV + 0.3866 × PVP + 18.246 × Awake + 0.1467 × Shoulder = 0.4525 × Elbow + 15.472 × Foot line + 10.202 × Arm line).PVP and SVV are moderately good predictors of CVP. Combining PVP and SVV and adding variables related to body position, movement, ventilation, and sleep/wake state further improves the predictive value of the model. The models illustrate the importance of standardizing patient position, minimizing movement, and placing intravenous lines proximally in the upper extremity or neck.
• Stoneking, L. R., DeLuca, L. A., Pritchard, T. G., Denninghoff, K. R., Waterbrook, A. L., & Grall, K. H. (2014). An innovative longitudinal curriculum to increase emergency medicine residents’ exposure to rarely encountered and technically challenging procedures. Advances in medical education and practice. doi:10.2147/amep.s58073
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  Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents' procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch's stages of procedural competency including 1) knowledge acquisition, 2) experience/technical skill development, and 3) competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation.Fifty percent of our residents (11/22) responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A]) and common (55% SA, 45% A) emergency medicine procedures and increased residents' ability to perform uncommon (55% SA, 45% A) and common (45% SA, 55% A) emergency medical procedures. In addition, survey results indicated that the residents were able to reach their goal numbers.Based on survey results, the procedure series improved our residents' perceived understanding of and perceived ability to perform uncommon and more technically challenging procedures. Further, results suggest that the use of a cognitive curriculum model as developed by Manthey and Fitch is adaptable and could be modified to fit the needs of other medical specialties.
• Stoneking, L., Deluca, L. A., Fiorello, A. B., Munzer, B., Baker, N., & Denninghoff, K. R. (2014). Alternative methods to central venous pressure for assessing volume status in critically ill patients. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, 40(2), 115-23.
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  Early goal-directed therapy increases survival in persons with sepsis but requires placement of a central line. We evaluate alternative methods to measuring central venous pressure (CVP) to assess volume status, including peripheral venous pressure (PVP) and stroke volume variation (SVV), which may facilitate nurse-driven resuscitation protocols.
• DeLuca, L. A., St John, A., Stolz, U., Matheson, L., Simpson, A., & Denninghoff, K. R. (2013). The distribution of the h-index among academic emergency physicians in the United States. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 20(10), 997-1003.
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  Hirsch's h-index (h) attempts to measure the combined academic impact and productivity of a scientist by counting the number of publications by an author, ranked in descending order by number of citations, until the paper number equals the number of citations. This approach provides a natural number or index of the number of publications and the number of citations per publication. H was first described in physics and was demonstrated to be highly predictive of continued academic activity, including recognized measures of scientific excellence such as membership in the National Academy of Sciences and being a Nobel laureate. Citation rates, research environments, and years of experience all affect h, making any comparisons appropriate only for scientists working in the same field for a similar time period. The authors are unaware of any report describing the distribution of h among academic emergency physicians (AEPs).
• Grall, K. H., Yang, L. M., Stoneking, L. R., Sabb, D., Munzer, B., Grall, K., Gonzaga, J., Denninghoff, K. R., & Deluca, L. A. (2013). 814: Incidence of Ventilator-Associated Pneumonia compared to Ventilator-Associated Events in the ED. Critical Care Medicine, 41, A203. doi:10.1097/01.ccm.0000440052.76840.db
• Stolz, U., DeLuca, L. A., St. John, A., Matheson, L., Simpson, A., & Denninghoff, K. R. (2013). The Distribution of the H-index Among Academic Emergency Physicians in the United States. Academic Emergency Medicine, 20(10), 997-1003. doi:10.1111/acem.12226
• Chipman, R. A., Voss, K., Ririe, T., Munzer, B., Juan, B., Hendryx, J., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2012). 210: RAPID DEVELOPMENT OF SEPTIC SHOCK IN A SWINE MODEL USING CECAL LIGATION AND PERFORATION PLUS FECAL INOCULATION. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424430.13172.8e
• Chipman, R. A., Voss, K., Ririe, T., Munzer, B., Juan, B., Hendryx, J., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2012). 269: MEASUREMENT OF RETINAL VENOUS OXYGEN SATURATION DURING PROGRESSIVE HYPOXIA IN SWINE IN VIVO USING THE BLUE-GREEN MINIMA TECHNIQUE. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424487.10425.e3
• Chipman, R. A., Voss, K., Ririe, T., Munzer, B., Juan, B., Hendryx, J., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2012). 273: LACK OF AGREEMENT BETWEEN SWAN GANZ CONTINUOUS CARDIAC OUTPUT AND FLOTRAC VIGILEO CARDIAC OUTPUT IN A SWINE MODEL OF SEPTIC SHOCK. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424491.63790.72
• Cienki, J. J., & DeLuca, L. A. (2012). Agreement between emergency medical services and expert blood pressure measurements. The Journal of emergency medicine, 43(1), 64-8.
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  Emergency Medical Services (EMS)-measured blood pressures (BPs) are utilized for administering medications in the field and for triage decisions. Retrospective work has demonstrated poor agreement between EMS and Emergency Department (ED) BP but has lacked a valid, reliable reference standard.
• DeLuca, L. A. (2012). Emergency Medicine / Critical Care Medicine and the Need for a Practice Track: Are we Cutting off our Certification at the Root?. Emergency medicine. doi:10.4172/2165-7548.1000e125
• DeLuca, L. A., & Cienki, J. J. (2012). Agreement between Emergency Medical Services and Expert Blood Pressure Measurements. The Journal of emergency medicine. doi:10.1016/j.jemermed.2011.02.018
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  Emergency Medical Services (EMS)-measured blood pressures (BPs) are utilized for administering medications in the field and for triage decisions. Retrospective work has demonstrated poor agreement between EMS and Emergency Department (ED) BP but has lacked a valid, reliable reference standard.To compare EMS BP measurements with those of trained research assistants (RA) and observe measurement technique for sources of error.A prospective study was performed with a large urban EMS. BP measurements were made by RA within 5 min of patients presenting to the ED. EMS personnel were asked about technique. EMS personnel were then observed while RA simultaneously measured BP. Analysis was performed using methods outlined by Bland and Altman.There were 100 patients enrolled for each phase. In the first phase, the mean difference in systolic BP was -3.8 ± 18.6 mm Hg (95% confidence interval [CI] -8.3 to 0.59), and the mean difference in diastolic BP was 0.42 ± 13.8 mm Hg (95% CI -3.3 to 4.1). In the second phase, the mean difference in systolic BP was -4.6 ± 10.1 mm Hg (95% CI -6.6 to -2.6) and the mean difference in diastolic BP was -3.6 ± 10.6 mm Hg (95% CI -3.6 to -0.2). EMS personnel failed to properly place the cuff or deflate it 2-3 mm Hg/s in over 90% of the readings. They failed to properly inflate the cuff in 74% of the patients, and failed to properly place the stethoscope in 40%. EMS personnel demonstrated a significant preference for the terminal digit of "0" (p < 0.0001).EMS and expert BP measurements showed smaller discrepancies than those previously noted, especially with simultaneous measurements. However, EMS demonstrated poor adherence to American Heart Association recommendations for measuring BP. EMS also showed terminal digit preference.
• DeLuca, L. A., Simpson, A., Beskind, D., Grall, K., Stoneking, L., Stolz, U., Spaite, D. W., Panchal, A. R., & Denninghoff, K. R. (2012). Analysis of automated external defibrillator device failures reported to the Food and Drug Administration. Annals of emergency medicine, 59(2), 103-11.
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  Automated external defibrillators are essential for treatment of cardiac arrest by lay rescuers and must determine when to shock and if they are functioning correctly. We seek to characterize automated external defibrillator failures reported to the Food and Drug Administration (FDA) and whether battery failures are properly detected by automated external defibrillators.
• Cienki, J. J., Deluca, L. A., & Feaster, D. J. (2011). Course of untreated high blood pressure in the emergency department. The western journal of emergency medicine, 12(4), 421-5.
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  No clear understanding exists about the course of a patient's blood pressure (BP) during an emergency department (ED) visit. Prior investigations have demonstrated that BP can be reduced by removing patients from treatment areas or by placing patients supine and observing them for several hours. However, modern EDs are chaotic and noisy places where patients and their families wait for long periods in an unfamiliar environment. We sought to determine the stability of repeated BP measurements in the ED environment.
• DeLuca, L. A., Chipman, R. A., Ririe, T., Hendryx, J., Sieluzycka, K. B., & Denninghoff, K. R. (2011). Retinal oximeter for the blue-green oximetry technique. Journal of Biomedical Optics. doi:10.1117/1.3638134
• Denninghoff, K. R., Sieluzycka, K. B., Hendryx, J. K., Ririe, T. J., Deluca, L., & Chipman, R. A. (2011). Retinal oximeter for the blue-green oximetry technique. Journal of biomedical optics, 16(10), 107004.
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  Retinal oximetry offers potential for noninvasive assessment of central venous oxyhemoglobin saturation (SO(2)) via the retinal vessels but requires a calibrated accuracy of ±3% saturation in order to be clinically useful. Prior oximeter designs have been hampered by poor saturation calibration accuracy. We demonstrate that the blue-green oximetry (BGO) technique can provide accuracy within ±3% in swine when multiply scattered light from blood within a retinal vessel is isolated. A noninvasive on-axis scanning retinal oximeter (ROx-3) is constructed that generates a multiwavelength image in the range required for BGO. A field stop in the detection pathway is used in conjunction with an anticonfocal bisecting wire to remove specular vessel reflections and isolate multiply backscattered light from the blood column within a retinal vessel. This design is tested on an enucleated swine eye vessel and a retinal vein in a human volunteer with retinal SO(2) measurements of ∼1 and ∼65%, respectively. These saturations, calculated using the calibration line from earlier work, are internally consistent with a standard error of the mean of ±2% SO(2). The absolute measures are well within the expected saturation range for the site (-1 and 63%). This is the first demonstration of noninvasive on-axis BGO retinal oximetry.
• Stoneking, L. R., DeLuca, L. A., Munger, B. S., Keim, S. M., & Denninghoff, K. R. (2011). Sepsis Bundles and Compliance With Clinical Guidelines. Journal of Intensive Care Medicine. doi:10.1177/0885066610387988
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  Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that prevent adoption of new professional standards. In an attempt to improve patient care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement created the resuscitation and management bundles for patients with severe sepsis and septic shock. These bundles have been accepted as best practice by many clinicians since multiple clinical trials have produced similar positive results when they were implemented. However, transferring these research outcomes-based guidelines to the clinical practice arena has been associated with poor compliance due to important barriers to implementation. Delays in the adoption of sepsis bundles are not surprising since the time from validation to implementation of a new clinical practice is typically 17 years. Using sepsis bundles as a model, this article explores why guidelines are important, examines physician adherence to protocols, and reviews the literature on strategies to improve clinical compliance and enhance knowledge translation.
• Stoneking, L., Denninghoff, K., Deluca, L., Keim, S. M., & Munger, B. (2011). Sepsis bundles and compliance with clinical guidelines. Journal of intensive care medicine, 26(3), 172-82.
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  Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that prevent adoption of new professional standards. In an attempt to improve patient care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement created the resuscitation and management bundles for patients with severe sepsis and septic shock. These bundles have been accepted as best practice by many clinicians since multiple clinical trials have produced similar positive results when they were implemented. However, transferring these research outcomes-based guidelines to the clinical practice arena has been associated with poor compliance due to important barriers to implementation. Delays in the adoption of sepsis bundles are not surprising since the time from validation to implementation of a new clinical practice is typically 17 years. Using sepsis bundles as a model, this article explores why guidelines are important, examines physician adherence to protocols, and reviews the literature on strategies to improve clinical compliance and enhance knowledge translation.
• DeLuca, L. A., McEwen, M. M., & Keim, S. M. (2010). United States–Mexico Border Crossing: Experiences and Risk Perceptions of Undocumented Male Immigrants. Journal of Immigrant and Minority Health. doi:10.1007/s10903-008-9197-4
• DeLuca, L. A., McEwen, M. M., & Keim, S. M. (2010). United States-Mexico border crossing: experiences and risk perceptions of undocumented male immigrants. Journal of immigrant and minority health / Center for Minority Public Health, 12(1), 113-23.
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  Undocumented immigrants crossing the US-Mexico border face many hazards as they attempt to enter the United States, including heat and cold injury, dehydration, and wild animal encounters. In the Tucson sector of the US-Mexico border, there are over 100 deaths a year from heat-related injuries alone. Public awareness campaigns have been undertaken to disseminate information on the dangers inherent in crossing. Little is known, however, about the ways in which undocumented immigrants actually receive information regarding the risks of crossing the border, how such information impacts their preparation for crossing or how the journey itself effects their motivation to cross again in the future. A qualitative descriptive method was used to describe and analyze information from adult males who had attempted to illegally cross the US-Mexico Border and had recently been returned to Mexico. Semi-structured interviews were conducted, and responses were classified into several broad themes. Interviews were conducted and analyzed iteratively until thematic saturation was achieved. The responses validated the established risks as being commonplace. A total of eight (8) male undocumented immigrants participated in the interviews. Individuals sought information prior to crossing from the media, their families and friends, and acquaintances in border towns. They did not appear to value any particular information source over any other. New areas of risk were identified, such as traveling with others who might have new or existing medical problems. There was also substantial concern for the family unit as both a source of inspiration and motivation. The family emerged as an additional at-risk unit due to the destabilization and financial strain of having one of its members leave to attempt to immigrate to the US for work. While many planned to cross again, the majority of the men in our sample had no intention of seeking permanent residence in the US, instead planning to work and then return to their families in Mexico. This preliminary study found that individuals crossing the US-Mexico border appear willing to put themselves and their families at substantial perceived risk in order to seek economic opportunity. Future public awareness campaigns may choose to shift focus solely from the individual risk of the crossing to the additional risks to family and community.
• Leeson, K., Keim, S. M., Deluca, L. A., & Bitar, J. (2008). Risk Perception of US-Mexico Border Crossers. Western Journal of Emergency Medicine, 9(1). doi:https://doi.org/10.1007/s10903-008-9197-4
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  . 18 Risk Perception of US-Mexico Border Crossers Lawrence DeLuca, MD, EdD; Jamil Bitar, MD; Kimberly eeson, MD; Samuel M. Keim, MD. L The University of Arizona Background: This study focused on risk perception of US-Mexico border crossers and builds on current research programs at The University of Arizona. No published studies have addressed specific risk processes (defined as perceived risk, intra-border crosser risk communications, Mexican government originated risk communications, and risk control actions) in US-Mexico border crossers. Objectives: This project seeks to describe, analyze, and interpret border-crosser risk processes; and develop a Western Journal of Emergency Medicine multidimensional model to describe border-crosser perceived risk and risk communications. Additionally, the main motivation for crossing will be investigated. Methods: The project used rigorously coded qualitative but anonymous interview data obtained from up to 10 recent border-crossers to elicit information about domains of perceived risk and risk communications that can be incorporated into a proposed model and used for future research and refinement of border-crosser behavior models. Because of the qualitative design, thematic saturation occurred before 10 subjects were entered. Interview data were translated from Spanish to English and data extracted in an attempt to reach thematic saturation. Results: A model of risk processes was created and suggestions for future behavioral interventions to reduce border crosser heat and injury related morbidity and mortality are presented. Conclusions: Risk perception of US-Mexico border-crossers can be modeled using a qualitative methodology. Themes derived that were most important included desires of border- crossers to be re-united with family members living in the US regardless of risk and the state of limbo of recently deported border crossers.
• DeLuca, L. A., Burger, M., Johnson, R. E., & Glass, S. G. (2006). Description and Evaluation of a Canine Volunteer Blood Donor Program. Journal of Applied Animal Welfare Science. doi:10.1207/s15327604jaws0902_3
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  Human volunteer blood donor programs are commonplace, but the concept of nonhuman animal blood banking is relatively new. Few studies exist regarding efficacy, donor screening, and safety for volunteer companion animals. This retrospective study evaluated a nonprofit, community-based canine volunteer donor program using community blood drives. Of 98 potential donors, 14 were ineligible to donate, including 4 who tested seropositive for blood-borne pathogens. Of 84 donors, 45 were Dog Erythrocyte Antigen (DEA) 1.1 positive and 39 were DEA1.1 negative. Donations totaling 143 included 29 repeat donors (35%). No serious adverse events occurred. Minor adverse events included acute donor reaction (2.8%), hematoma (4.2%), rebleeding (2.1%), and skin irritation (0.7%). Adverse event rates were comparable to data for human blood donations. A substantial fraction of donors donated multiple times, suggesting that volunteer donors and their guardians perceived the donation process to be safe and effective. This article discusses the issue of donor consent and use of the term volunteer. This study indicates that nonprofit, community-based canine volunteer donor programs for animal blood banks can be successful while maintaining high safety standards and ethical treatment of volunteers.
• DeLuca, L. A., Glass, S. G., Johnson, R. E., & Burger, M. (2006). Description and evaluation of a canine volunteer blood donor program. Journal of applied animal welfare science : JAAWS, 9(2), 129-41.
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  Human volunteer blood donor programs are commonplace, but the concept of nonhuman animal blood banking is relatively new. Few studies exist regarding efficacy, donor screening, and safety for volunteer companion animals. This retrospective study evaluated a nonprofit, community-based canine volunteer donor program using community blood drives. Of 98 potential donors, 14 were ineligible to donate, including 4 who tested seropositive for blood-borne pathogens. Of 84 donors, 45 were Dog Erythrocyte Antigen (DEA) 1.1 positive and 39 were DEA1.1 negative. Donations totaling 143 included 29 repeat donors (35%). No serious adverse events occurred. Minor adverse events included acute donor reaction (2.8%), hematoma (4.2%), rebleeding (2.1%), and skin irritation (0.7%). Adverse event rates were comparable to data for human blood donations. A substantial fraction of donors donated multiple times, suggesting that volunteer donors and their guardians perceived the donation process to be safe and effective. This article discusses the issue of donor consent and use of the term volunteer. This study indicates that nonprofit, community-based canine volunteer donor programs for animal blood banks can be successful while maintaining high safety standards and ethical treatment of volunteers.
• Cienki, J. J., DeLuca, L. A., & Daniel, N. (2004). The validity of emergency department triage blood pressure measurements. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(3), 237-43.
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  Automated blood pressure (ABP) devices are ubiquitous at emergency department (ED) triage. Previous studies failed to evaluate ABP devices against accepted reference standards or demonstrate triage readings as accurate reflections of blood pressure (BP). This study evaluated ED triage measurements made using an ABP device and assessed agreement between triage BP and BP taken under recommended conditions.
• DeLuca, L. A., Daniel, N., & Cienki, J. J. (2004). The Validity of Emergency Department Triage Blood Pressure Measurements. Academic Emergency Medicine. doi:10.1111/j.1553-2712.2004.tb02203.x
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  Automated blood pressure (ABP) devices are ubiquitous at emergency department (ED) triage. Previous studies failed to evaluate ABP devices against accepted reference standards or demonstrate triage readings as accurate reflections of blood pressure (BP). This study evaluated ED triage measurements made using an ABP device and assessed agreement between triage BP and BP taken under recommended conditions.A prospective study was conducted at an urban teaching hospital. Patients were enrolled by convenience sampling. Simultaneous automated and manual triage BPs were obtained using one BP cuff with a Y-tube connector. Research assistants were certified in obtaining manual BP as described by the British Hypertension Society (BHS). Patients were placed in a quiet setting, and manual BP was repeated by American Heart Association (AHA) standards. Data analysis was performed using methods described by Bland and Altman. The ABP device was assessed using Association for the Advancement of Medical Instrumentation (AAMI) and BHS criteria.One hundred seventy-one patients were enrolled. Systolic BP (sBP) range was 81 to 218 mm Hg; diastolic BP (dBP) range was 43 to 130 mm Hg. Automated vs. manual sBP difference was 3.8 +/- 11.2 mm Hg (95% confidence interval [CI] = 2.1 to 5.4); dBP difference was 6.6 +/- 9.0 mm Hg (95% CI = -7.9 to -5.2). Manual triage BP vs. AHA standard SBP difference was 11.6 +/- 12.8 mm Hg (95% CI = 9.1 to 14.1); dBP difference was 9.9 +/- 10.4 mm Hg (95% CI = 7.9 to 12.0). The ABP device failed to meet AAMI criteria and received a BHS rating of "D." Poor operator technique and extraneous patient and operator movement appeared to hamper accuracy.ABP triage measurements show significant discrepancies from a reference standard. Repeat measurements following AHA standards demonstrate significant decreases in the measured blood pressures.

Proceedings Publications

• DeLuca, L. A., Cienki, J. J., Sabb, D., Miller, R. S., Durns, T., Roward, Z., & Pickering, A. (2016, Spring). Survey of Arizona Emergency Department Infectious Disease Preparedness for Possible Ebola Patients. In Western Regional Society for Academic Emergency Medicine.

Presentations

• Deluca, L. A. (2023, Fall). Rebuilding Your Hospital:  The COVID Experience and “The Next Normal". Happy Doc Hawaii (Happy Doc Summer Camp 2023). Kona, Hawaii: Happy Doc Summer Camp/Angels of Hippocrates.
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  In this hour we used the Medscape 2023 Physician Burnout survey to highlight the disconnect between the issues physicians identify as causes of burnout and the solutions they expect their practice environment to decide.We explore the role of institutional factors in both burnout and resilience, and discuss ways in which institutional change can be within reach at all levels, as well as identifying perhaps small but high-yield changes that can lessen job stress.
• Deluca, L. A. (2023, Fall). Developing Action Plans. Happy Doc Summer Camp (Happy Doc Hawaii 2023). Kona, Hawaii: Happy Doc Summer Camp/Angels of Hippocrates.
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  We discuss the difference between goals and objectives and how to structure an action plan.  Participants will work individually or in small groups to develop an action plan for both individual resilience and systemic change.  At the end the group will come together and share (or not) to the extent that anyone wishes to.
• Deluca, L. A. (2023, Spring). Treatment of Sepsis on the Human Side:  A Presentation as Part of a Panel on Sepsis in Veterinary Medicine. American College of Veterinary Internal Medicine Annual Forum / Veterinary Comparative Clinical Immunology Society (VCCIS) Special Interest Group Meeting. Philadelphia, Pennsylvania: VCCIS/ACVIM.
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  I was an invited speaker on the management of sepsis in human patients and participated as part of an panel on the management of sepsis in veterinary medicine.
• Deluca, L. A., Grall, K. H., & Vermilyea, E. (2023, Fall). I was stronger than I thought: A Narrative Response to Addressing Compassion Fatigue - Successes . Happy Doc Hawaii (Happy Doc Summer Camp 2023). Kona, Hawaii: Happy Doc Summer Camp/Angels of Hippocrates.
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  Facilitated group discussion in which participants were introduced to and self-administered the Pro-QOL (a tool for self-assessing traumatic stress and burnout) and interpreting the results.
• Deluca, L. A., Grall, K. H., & Vermilyea, E. (2023, Fall).  Emergence and Empowerment:  Reframing, Reinterpreting, Realization . Happy Doc Hawaii (Happy Doc Summer Camp 2023). Kona, Hawaii: Happy Doc Summer Camp/Angels of Hippocrates.
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  We will summarize and expand upon the lessons learned in the past two days, with attention to changing the narrative.  Are we victimizing ourselves with our own language for describing burnout and moral injury?  We will discuss choice and action even in an environment where options appear limited.How do we change not just ourselves but the world around us?
• Deluca, L. A., Johnson, R., Grall, K., Barringer, K., Brakema, R., Buller, D., Freeman, M., Hiller, K. M., Stoneking, L. R., Holowaychuk, M., & Keyko, L. (2018, May). Happy Doc Summer Camp: An Integrated Wellness, Self-Care, and Adventure Experience to Combat Provider Fatigue and Burnout. SAEM IGNITE!. Indianapolis, IN: SAEM.
• Deluca, L. A., Durns, T., Miller, R., Roward, Z., Pickering, A., Yeaton, J., & Denninghoff, K. R. (2016, March). Effect of Presenting Complaint on the Risk of Developing Ventilator-Associated Pneumonia for Patients Intubated in an Academic Emergency Department. SAEM Western Regional Meeting. Los Angeles, CA: Society for Academic Emergency Medicine.
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  Analysis of chief complaints (medical vs. surgical) and subsequent VAP risk.
• Deluca, L. A., Durns, T., Miller, R., Yeaton, J., Pickering, A., Roward, Z., Sabb, D., & Denninghoff, K. R. (2016, March). Presenting Illness and Mortality Outcomes for Patients Intubated in an Academic Emergency Department. SAEM Western Regional Meeting. Los Angeles, CA: Society for Academic Emergency Medicine.
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  Analysis of chief complaints (medical vs. surgical) and risk of mortality during subsequent hospital admission.
• Deluca, L. A., Walsh, P., Davidson, D. D., Stoneking, L. R., Yang, L. M., Grall, K., Gonzaga, M. J., Larson, W. J., Durns, T., Miller, R., Pickering, A., Yeaton, J., Stolz, U., Sabb, D. M., & Denninghoff, K. R. (2016, March). VAP Rates are Significantly Reduced by an ED-Based VAP Prevention. SAEM Western Regional Meeting. Los Angeles, CA: Society for Academic Emergency Medicine.
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  ED-Based VAP prevention lowers VAP rates.
• Deluca, L. A., Durns, T., Davidson, D., Gerlach, E., & Denninghoff, K. (2015, January). The Impact of Advanced Directives on Non-Survivors who are Intubated in the Emergency Department. Society for Critical Care Medicine Annual Congress. Phoenix, AZ.

Poster Presentations

• Denninghoff, K. R., & Deluca, L. A. (2015, December). REDUCTION OF EARLY VAP AFTER BUNDLE DEPLOYMENT FOR PATIENTS INTUBATED IN THE EMERGENCY DEPARTMENT. Society for Critical Care Medicine Annual meeting. Published in December 2015Critical Care Medicine.

Others

• Deluca, L. A., Grall, K., & Vermilyea, E. (2024, September). Keaohou - A New Beginning:  Happy Doc Sumer Camp 2024 (CME conference). Happy Doc Summer Camp / Outrigger Kaua'i Resort, Kaua'i Hawaii.
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  Keauhou - A New Beginning was Happy Doc Summer Camp's main 2024 offering.  The course was approved for up to 9 AMA Category 1 CME (depending upon attendance).I am the curriculum director for HDSC as well as a presenter.  Dr. Grall (EM) and Dr. Vermilyea (psychology) both presented at the conference and made substantial contributions ot the curriculum.Topics covered included assessment of burnout, quality of life, and response to trauma, constrasting personal wellness and institutional/workplace wellness, and devising appropriate strategies for personal vs institutional problems.We use the ProQOL (proqol.org) for evaluation of professional quality of life and response to trauma, and review survey data such as the Medscape Physician Depression and Burnout survey.This past year I presented the following topics:- Rebuilding Your Hospital: The COVID Experience and "The Next Normal"- Developing Action PlansI was a co-facilitator of the following small group topics:- Measuring Burnout and Traumatic Stress Using the ProQOL-  I was stronger than I thought: A Narrative Response to Addressing Compassion Fatigue and Successes- Emergence and Empowerment: Reframing, Reinterpreting, RealizationWe conclude with a talk on the development of action plans, using the principles outlined by Magee.In addition to designing the overall curriculum I manage the CME applications, recruit speakers, perform logistics (including facilities booking, audio, and video), and manage the websites, registration, and advertising.
• Deluca, L. A., & Grall, K. H. (2023, Fall). Guest Appearance:  "Happy Doc Summer Camp/Docs In The Wild" on the "Remind Yourself" Podcast. Apple Podcasts.
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  We were invited to appear on the Re-Mind Yourself Podcast to discuss Happy Doc Summer Camp programing and our approach to individual and institutional wellness.
• Deluca, L. A., & Grall, K. H. (2023, fall). Ducking Burnout:  Autocorrecting Your Life (Season I) Podcast. (Available on Spotify, Apple Podcasts, Amazon Music, Google Podcasts, iHeartRadio, Overcase, Castbox, and RadioPublic).
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  This podcast discusses current issues related to burnout, wellness, and resilience.  We review recent research and other articles about burnout, and invite guests with specific expertise to speak on these issues.Season 1 episode list:Pilot:  Welcome to Ducking BurnoutS1E2:  Resilience:  More than GritS1E3:  Relationships and BurnoutS1 Bonus Episode:  Happy Doc Says Thank You! (Video)S1:E4:  The Big Island (Audio and Video podcast)S1:E5:  Guest Elizabeth Vermilyea - "No One Asks the Doctor 'How are you?'"S1:E6:  Toxic PositivityS1:E7:  Subtraction and Addition - Editing Your LifeS1:E8:  The Salary Trap
• Deluca, L. A., Durns, T., Davidson, D., Gerlach, E., & Denninghoff, K. R. (2015, June). The Impact of Advanced Directives on Non-Survivors who are Intubated in the Emergency Department. Academic Emergency Medicine.
• Deluca, L. A., Durns, T., Miller, R., Roward, Z., Pickering, A., Yeaton, J., & Denninghoff, K. R. (2015, June). Presenting Illness and Mortality Outcomes for Patients Intubated in an Academic Emergency Department. Intensive Care Medicine.
• Deluca, L. A., Durns, T., Miller, R., Yeaton, J., Pickering, A., Roward, Z., Saab, D., & Denninghoff, K. R. (2015, June). The Effect of Presenting Complaint on the Risk of Developing Ventilator-Associated Pneumonia for Patients Intubated in an Academic Emergency Department. Intensive Care Medicine.
• Deluca, L. A., Pickering, A., Roward, Z., Durns, T., Miller, R., Sabb, D., & Cienki, J. (2015, June). Survey of Arizona Emergency Department Infectious Disease Preparedness for Possible Ebola Patients. Intensive Care Medicine.
• Deluca, L. A., Stoneking, L. R., Grall, K., Tran, A., Rosell, J., Vira, A., Davidson, D., Cox, L., Gerlach, E., Gonzaga, J., Munzer, B., Larson, W., Westergard, A., & Denninghoff, K. R. (2015, June). Ventilator-Associated Pneumonia (VAP) Rates are Significantly Reduced by Deploying the VAP Bundle in an Academic Emergency Department. Academic Emergency Medicine.