Vytas Petras Karalius

All Publications

• A descriptive analysis of emergency medicine residency scholarly tracks faculty workforce. AEM education and training Mariorenzi, A., Beaulieu, A., Lotterman, S., Karalius, V., Awad, E., Chung, A., Jordan, J. 2025; 9 (1): e70002

  Abstract

  Scholarly tracks typically consist of longitudinal subspecialty-specific curricula and mentorship for residents. Roughly one in five emergency medicine (EM) residency programs offer scholarly tracks, allowing residents to explore a niche and develop skills to prepare them for their future careers. There is limited information on the faculty workforce that leads scholarly tracks. Our objective was to understand the workforce characteristics of EM track leaders, specifically their effort and compensation.We performed a cross-sectional survey study of EM scholarly track leaders who were identified by reviewing program websites and directly contacting program coordinators. Participants completed an electronic survey consisting of multiple-choice and completion items. We calculated descriptive statistics.There were 112 of 276 (40%) track leaders who completed the survey, including 63 (57.3%) males and 47 (42.7%) females. The mean (±SD) age was 42.6 (±7.5) years. A majority (62.5%) had completed fellowship. Participants supervise a mean of 2.6 residents per year and spend a median (range) of 7.6 (4-10.7) hours per month on track activities. A total of 57.1% of participants received no compensation for their role. Nonmonetary benefits included career satisfaction (87.6%), intellectual stimulation (76.4%), departmental recognition (41.6%), and increased scholarly productivity (33.7%). Overall, 71.7% of faculty track leaders would recommend the role to a colleague.This study characterizes the current EM scholarly track leader workforce in terms of demographics, activities, time and effort, and compensation. It sheds light on this key educational role and on the opportunity to provide better support to faculty track leaders. These results may inform decision making of current and would-be scholarly track leaders as well as institutional leadership.

  View details for DOI 10.1002/aet2.70002

  View details for PubMedID 39991620

  View details for PubMedCentralID PMC11843722

• The Windlass Tourniquet: Is It Taking the Wind Out of the "Stop the Bleed" Sails? The Journal of surgical research Schlanser, V. L., Tatebe, L. C., Karalius, V. P., Liesen, E., Pekarek, S., Impens, A., Ivkovic, K., Bajani, F., Khalifa, A., Dennis, A. J. 2022; 271: 91-97

  Abstract

  Civilians are often first-line responders in hemorrhage control; however, windlass tourniquets are not intuitive. Untrained users reading enclosed instructions failed in 38.2% of tourniquet applications. This prospective follow-up study replicated testing following Stop the Bleed (STB) training.One and six months following STB, first-year medical students were randomly assigned a windlass tourniquet with enclosed instructions. Each was given one minute to read instructions and two minutes to apply the windlass tourniquet on the TraumaFX HEMO trainer. Demographics, time to read instructions and stop bleeding, blood loss, and simulation success were analyzed.100 students received STB training. 31 and 34 students completed tourniquet testing at one month and six months, respectively. At both intervals, 38% of students were unable to control hemorrhage (P = 0.97). When compared to the pilot study without STB training (median 48 sec, IQR 33-60 sec), the time taken to read the instructions was shorter one month following STB (P <0.001), but there was no difference at 6 months (P = 0.1). Incorrect placement was noted for 19.4% and 23.5% of attempts at 1 and 6 months. Male participants were more successful in effective placement at one month (93.3% versus 31.3%, P = 0.004) and at six months (77.8% versus 43.8%, p = 0.04).Skills decay for tourniquet application was observed between 1 and 6 months following STB. Instruction review and STB produced the same hemorrhage control rates as reading enclosed instructions without prior training. Training efforts must continue; but an intuitive tourniquet relying less on mechanical advantage is needed.

  View details for DOI 10.1016/j.jss.2021.09.033

  View details for PubMedID 34856457

• UME-to-GME PandEMonium in COVID-19: Large-Scale Implementation of a Virtual ACGME Milestone-Based Curriculum for Senior Medical Students Matched Into Emergency Medicine. Journal of graduate medical education McLean, M. E., Cotarelo, A. A., Huls, T. A., Husain, A., Hillman, E. A., Cygan, L. D., Archer, L. O., Beck-Esmay, J., Burke, S. M., Carrick, A. I., Chen, A. S., Hyde, R. J., Karalius, V. P., Lee, E., Park, J. C., Pugliese, A. M., Wilbanks, M. D., Young, A., Kulkarni, M. L. 2021; 13 (6): 848-857

  Abstract

  The COVID-19 pandemic displaced newly matched emergency medicine "pre-interns" from in-person educational experiences at the end of medical school. This called for novel remote teaching modalities.This study assesses effectiveness of a multisite Accreditation Council for Graduate Medical Education (ACGME) sub-competency-based curricular implementation on Slack during the first wave of the COVID-19 pandemic in the United States.Emergency medicine residency programs were recruited via national organization listservs. Programs designated instructors to manage communications and teaching for the senior medical students who had matched to their programs (pre-interns) in spring/summer 2020. Pre- and post-surveys of trainees and instructors assessed perceived preparedness for residency, perceived effectiveness of common virtual educational modalities, and concern for the pandemic's effects on medical education utilizing a Likert scale of 1 (very unconcerned) to 5 (very concerned). Data were analyzed using descriptive statistics and the t test.Of 276 possible residency programs, 28 enrolled. Of 324 possible pre-interns, 297 (91.7%) completed pre-surveys in April/May and 249 (76.9%) completed post-surveys in June/July. The median weeks since performing a physical examination was 8 (IQR 7-12), since attending in-person didactics was 10 (IQR 8-15) and of rotation displacement was 4 (IQR 2-6). Perceived preparedness increased both overall and for 14 of 21 ACGME Milestone topics taught. Instructors reported higher mean concern (4.32, 95% CI 4.23-4.41) than pre-interns (2.88, 95% CI 2.74-3.02) regarding the pandemic's negative effects on medical education.Pre-interns reported improvements in residency preparedness after participating in this ACGME sub-competency-based curriculum on Slack.

  View details for DOI 10.4300/JGME-D-21-00620.1

  View details for PubMedID 35070098

  View details for PubMedCentralID PMC8672831

• Emergency Department Patient Experiences During the COVID-19 Pandemic. Journal of patient experience Karalius, V. P., Kaskar, S. B., Levine, D. A., Darling, T. A., Loftus, T. M., McCarthy, D. M. 2021; 8: 23743735211033752

  Abstract

  Emergency department (ED) utilization changed notably during the coronavirus disease 2019 (COVID-19) pandemic in the United States. The purpose of the study was to gain a more thorough understanding of ED patient experience during the early stages of the COVID-19 pandemic. This study used the consensual qualitative approach to analyze open-ended responses from post-ED patient experience surveys from February through July 2020. Comments were included in the analysis if they pertained to care during the pandemic (eg, mentioned "the virus," "masks," "PPE"). A total of 242 COVID-specific comments from 192 unique patients were analyzed (median age 49 years; 69% female). Six themes were identified: visually observed changes, experiences of process changes, expressions of understanding or appreciation, sense of security, COVID-19 disease-specific comments, and "classic" satisfaction comments that align with previous literature on patient experience. The COVID-19 pandemic has challenged health care systems across the world in unique and unprecedented ways. This study identified six themes that better elucidate ED patient experience during an unprecedented public health crisis.

  View details for DOI 10.1177/23743735211033752

  View details for PubMedID 34368429

  View details for PubMedCentralID PMC8317244

• Measuring Sensitivity and Precision of Real-Time Location Systems (RTLS): Definition, Protocol and Demonstration for Clinical Relevance. Journal of medical systems Koenig, K. R., Pasupathy, K. S., Hellmich, T. R., Hawthorne, H. J., Karalius, V. P., Sir, M., Das, D., Heaton, H. A., Nestler, D. M. 2021; 45 (1): 15

  Abstract

  The ability of a Real Time Location System (RTLS) to provide correct information in a clinical environment is an important consideration in evaluating the effectiveness of the technology. While past efforts describe how well the technology performed in a lab environment, the performance of such technology has not been specifically defined or evaluated in a practice setting involving workflow and movement. Clinical environments pose complexity owing to various layouts and various movements. Further, RTL systems are not equipped to provide true negative information (where an entity is not located). Hence, this study defined sensitivity and precision in this context, and developed a simulation protocol to serve as a systematic testing framework using actors in a clinical environment. The protocol was used to measure the sensitivity and precision of an RTL system in the emergency department space of a quaternary care medical center. The overall sensitivity and precision were determined to be 84 and 93% respectively. These varied for patient rooms, staff area, hallway and other rooms.

  View details for DOI 10.1007/s10916-020-01606-6

  View details for PubMedID 33411118

  View details for PubMedCentralID 3872592

• Online modules as an alternative to hands-on point-of-care ultrasound curriculum at resource-limited PA programs. JAAPA : official journal of the American Academy of Physician Assistants Neri, S. C., Adler, R., Kunes, R., McCauley, M., Ireland, A., Karalius, V. P. 2020; 33 (12): 1

  View details for DOI 10.1097/01.JAA.0000723168.60044.16

  View details for PubMedID 33496500

• Bordetella parapertussis outbreak in Southeastern Minnesota and the United States, 2014. Medicine Karalius, V. P., Rucinski, S. L., Mandrekar, J. N., Patel, R. 2017; 96 (20): e6730

  Abstract

  Whooping cough is traditionally ascribed to Bordetella pertussis; however, Bordetella parapertussis can cause a similar clinical syndrome. This study describes an outbreak of B. parapertussis in Southeastern Minnesota and the United States (US) in 2014. This was a retrospective analysis of Mayo Clinic and Mayo Medical Laboratories patients who tested positive for B. parapertussis from 2012 to 2014. The medical records of Mayo Clinic patients who tested positive in 2014 were reviewed for demographic information, presenting symptoms, disease course, and vaccination history. In Southeast Minnesota, 81% of the 31 patients who tested positive for B. parapertussis in 2014 were found to be positive from October through December. Their mean age was 5.9 years. Five reported "exposure to pertussis." Two pairs of siblings were affected. Patients reported having had symptoms for an average of 2.6 weeks before nasopharyngeal specimen collection for B. parapertussis testing. Cough was the primary symptom reported. Forty percent reported posttussive vomiting, 40% coryza, 32% apnea/sleep disturbance, and 12% sore throat. All were current with pertussis vaccination. Based on the review of national data, an outbreak occurred nationally in the Northeast and Midwest US over the same time period. In 2014, there was an outbreak of B. parapertussis in Southeastern Minnesota and likely other parts of the US. The presenting illness was similar to that of B. pertussis. All patients were vaccinated against pertussis, suggesting that pertussis vaccination is ineffective against B. parapertussis.

  View details for DOI 10.1097/MD.0000000000006730

  View details for PubMedID 28514288

  View details for PubMedCentralID PMC5440125

• The Utility of Routine Postoperative Radiographs After Pinning of Pediatric Supracondylar Humerus Fractures. Journal of pediatric orthopedics Karalius, V. P., Stanfield, J., Ashley, P., Lewallen, L. W., DeDeugd, C. M., Walker, J., Larson, A. N., Milbrandt, T. A. 2017; 37 (5): e309-e312

  Abstract

  The purpose of this study was to determine the frequency with which postoperative radiographs resulted in a change in management following closed reduction and percutaneous pinning of displaced pediatric supracondylar humerus fractures. We hypothesize that only the initial postoperative radiograph will lead to changes in management of operative supracondylar humerus fractures.A retrospective review was performed at 2 level I pediatric trauma centers. Inclusion criteria were patients below 18 years of age who sustained supracondylar humerus fractures (Gartland type II, III, IV) who were operatively treated from 2008 to 2013 with adequate radiographic follow-up. Patients with flexion type, intra-articular, transphyseal, and open fractures were excluded from the study. Routine radiographs were taken at initial follow-up (1 wk postoperatively) and at pin removal (3 to 4 wk postoperatively).The final analysis included 572 patients. Initial postoperative radiographs changed treatment in 9 patients (1.6%), including revision surgeries, 2 pin adjustments, and 2 early pin removals. At the time of pin removal, 20 (3.5%) patients required further immobilization. There were no changes to the initial plan for continued nonoperative treatment at final follow-up (6 to 8 wk postoperatively).In this large retrospective series of patients treated with closed reduction and percutaneous pinning of displaced supracondylar humerus fractures, radiographs at 3 weeks do not reveal a need to return to the operating room or other significant pathology. These findings suggest that radiographs should be obtained within 7 to 10 days postoperatively for type III fractures and may only need to be repeated if the clinical situation warrants it, such as severe fracture pattern, persistent pain, or clinical deformity.Level IV-case series.

  View details for DOI 10.1097/BPO.0000000000001000

  View details for PubMedID 28441278

• Factors related to caregiving for individuals with spinal cord injury compared to caregiving for individuals with other neurologic conditions. The journal of spinal cord medicine LaVela, S. L., Landers, K., Etingen, B., Karalius, V. P., Miskevics, S. 2015; 38 (4): 505-14

  Abstract

  To compare outcomes among caregivers of adults with spinal cord injuries (SCIs) to caregivers of adults with other neurological conditions, and determine if caregiving for SCI is associated with poor health status and chronic conditions.Secondary data analysis of 2009/2010 Behavioral Risk Factor Surveillance System survey.Informal caregivers of adults with neurological conditions.Sociodemographics, caregiving factors (e.g. role, emotional support, life satisfaction), lifestyle behaviors, chronic conditions, and health status.Demographics and lifestyle behaviors did not differ in caregivers of adults with SCI vs. caregivers of adults with other neurological conditions (except younger age of SCI caregivers). Greater proportions of caregivers of adults with SCI had coronary heart disease (CHD) (12% vs. 6%, P = 0.06) and were obese (43% vs. 28%, P = 0.03). Frequent physical distress was reported by 20% of caregivers of persons with SCI (vs. 12% of other caregivers, P = 0.09), but mental health did not differ between caregiver groups. A greater proportion of caregivers of adults with SCI experienced insufficient sleep (47% vs. 30%, P = 0.008) and more days without enough sleep (13 vs. 9 days, P = 0.008). Odds of being younger, caregiver of a spouse, having CHD, and being obese were associated with being a caregiver of an adult with SCI.Caregivers of adults with SCI report similar mental health status, but more poor sleep, and have increased odds of CHD and obesity. Interventions to address physical distress, improve sleep, and address CHD and obesity are needed in this cohort.

  View details for DOI 10.1179/2045772314Y.0000000240

  View details for PubMedID 24993244

  View details for PubMedCentralID PMC4612206

• Prevalence of risk of deficiency and inadequacy of 25-hydroxyvitamin D in US children: NHANES 2003-2006. Journal of pediatric endocrinology & metabolism : JPEM Karalius, V. P., Zinn, D., Wu, J., Cao, G., Minutti, C., Luke, A., Kramer, H., Durazo-Arvizu, R. 2014; 27 (5-6): 461-6

  Abstract

  To assess prevalence and population estimates of increased risk of 25-hydroxyvitamin D [25(OH)D] deficiency and inadequacy in US children based on the current Institute of Medicine Committee to Review Dietary References Intakes for Vitamin D and Calcium guidelines.The analysis was limited to a nationally representative sample of non-institutionalized US children and adolescents aged 6-18 years who participated in the National Health and Nutrition Examination Survey completed in 2003-2006 and had complete data on 25(OH)D measurements (n=2877). The 25(OH)D levels were adjusted for assay drift and prevalence, and population estimates of increased risk of 25(OH)D deficiency (<12 ng/mL), risk of inadequacy (<16 ng/mL), and adequacy (>20 ng/mL) were calculated.Overall, 4.61% of children and adolescents are at increased risk of deficiency (population estimate 2.5 million) and 10.3% are at risk of inadequacy (population estimate 5.5 million) based on the Institute of Medicine guidelines.Approximately 10.3% of US children aged 6-18 years (population estimate 5.5 million) have 25(OH)D levels <16 ng/mL.

  View details for DOI 10.1515/jpem-2013-0246

  View details for PubMedID 24620012

• Bisphenol A (BPA) Found in Humans and Water in Three Geographic Regions with Distinctly Different Levels of Economic Development. Environmental health insights Karalius, V. P., Harbison, J. E., Plange-Rhule, J., van Breemen, R. B., Li, G., Huang, K., Durazo-Arvizu, R. A., Mora, N., Dugas, L. R., Vail, L., Tuchman, N. C., Forrester, T., Luke, A. 2014; 8: 1-3

  Abstract

  The suspected endocrine disruptor bisphenol A (BPA) is associated with the manufacture, distribution, and use of epoxy resins and polycarbonate plastics; thus, studies of this compound have focused primarily on urban areas in developed countries. This small study investigating urinary BPA of 109 people was conducted in the urban United States, urban Jamaica, and rural Ghana. Additionally, local drinking and surface water samples were collected and analyzed from areas near study participants. Levels of BPA in both urine and water were comparable among all three sites. Thus, future studies of BPA should consider expanding investigations to rural areas not typically associated with the compound.

  View details for DOI 10.4137/EHI.S13130

  View details for PubMedID 24453495

  View details for PubMedCentralID PMC3891657

• Dietary sugar and artificial sweetener intake and chronic kidney disease: a review. Advances in chronic kidney disease Karalius, V. P., Shoham, D. A. 2013; 20 (2): 157-64

  Abstract

  Sugar consumption, especially in the form of fructose, has been hypothesized to cause kidney disease. This review provides an overview of the epidemiologic evidence that sugar consumption increases CKD risk. Research supports a causal role of sugar in several kidney disease risk factors, including increasing serum uric acid levels, diabetes, and obesity. Sugar may also harm the kidney via other mechanisms. There is no evidence that sucrose is any safer for the kidney than high fructose corn syrup (HFCS) because both are similar in composition. To date, 5 epidemiologic studies have directly evaluated the relationship between sugar consumption (in the form of sugar-sweetened beverages) and CKD. Although most studies suggest that the risk of CKD is elevated among consumers of sugar-sweetened beverages, only 2 studies report statistically significant associations. Three studies have also examined diet soda consumption, with two reporting positive and significant associations. Confounding by unmeasured lifestyle factors may play a role in the positive results whereas poor measurement of sugar and artificial sweetener intake could explain null results. Nevertheless, the hypothesis that sugar causes kidney disease remains plausible, and alternative research designs may be needed.

  View details for DOI 10.1053/j.ackd.2012.12.005

  View details for PubMedID 23439375