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Deenadayalan V, Litvin R, Vakil J, Kanemo P, Shaka H, Venkataramanan A, Zia M. Recent national trends in outcomes and economic disparities among adult sickle cell disease-related admissions. Ann Hematol 2023; 102:2659-2669. [PMID: 37522971 DOI: 10.1007/s00277-023-05388-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
Sickle cell disease (SCD) is an inherited disorder caused secondary to a mutation in the hemoglobin beta subunit. There is sparse information regarding the trends in outcomes of SCD admissions in the past decade where rapid advances have been made in treatment. In this study, we wanted to analyze the trends and outcomes of SCD admissions in the United States from 2011 to 2019 and the influence of socio-economic status. Data were obtained from the National Inpatient Sample (NIS) database using the International Classification of Disease (ICD-9) and ICD-10 codes. Trends for primary in-hospital outcomes including mortality, length of stay (LOS), and total hospitalization charges (THC) were assessed. The impact of economic status on these outcomes was also studied. There was an annual percent change (APC) in the number of admissions for SCD of + 2.5% from 2010 to 2015 (95% CI: 1.3-3.8%, p = 0.003). However, there was no significant change in the number of admissions between 2015 and 2019 (95% CI - 1.8-0.7%, p = 0.323). The overall mortality across the years has decreased by about 4% yearly at the population level (p = 0.008, 95% CI 2-8%). However, the inpatient mortality for the high-income group had decreased significantly from 2010 to 2019, whereas there was no difference in the mortality rate for the low-income group across the decade. Despite the advances in the understanding of SCD and its treatment, its benefits have not reached all the people affected. Meaningful progress in healthcare is not achievable unless these economic disparities are addressed. Economic policies to address these inequities are the need of the hour.
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Affiliation(s)
- Vaishali Deenadayalan
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA.
| | - Rafaella Litvin
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Jay Vakil
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Philip Kanemo
- Department of Hospital Medicine, Rapides Regional Medical Center, Alexandria, LA, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Akash Venkataramanan
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Maryam Zia
- Department of Hematology/Oncology, John H Stroger Hospital of Cook County, Chicago, IL, USA
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Ma L, Yang S, Peng Q, Zhang J, Zhang J. CRISPR/Cas9-based gene-editing technology for sickle cell disease. Gene 2023; 874:147480. [PMID: 37182559 DOI: 10.1016/j.gene.2023.147480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
Sickle cell disease (SCD) is the most common monogenic hematologic disorder and is essentially congenital hemolytic anemia caused by an inherited point mutation in the β-globin on chromosome 11. Although the genetic basis of SCD was revealed as early as 1957, treatment options for SCD have been very limited to date. Hematopoietic stem cell transplantation (HSCT) was thought to hold promise as a cure for SCD, but the available donors were still only 15% useful. Gene therapy has advanced rapidly into the 21st century with the promise of a cure for SCD, and gene editing strategies based on the cluster-based regularly interspaced short palindromic repeat sequence (CRISPR)/Cas9 system have revolutionized the field of gene therapy by precisely targeting genes. In this paper, we review the pathogenesis and therapeutic approaches of SCD, briefly summarize the delivery strategies of CRISPR/Cas9, and finally discuss in depth the current status, application barriers, and solution directions of CRISPR/Cas9 in SCD. Through the review in this paper, we hope to provide some references for gene therapy in SCD.
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Affiliation(s)
- Liangliang Ma
- Department of Hematology, Meishan City People's Hospital, Meishan City, Sichuan Province 620000, China
| | - Shanglun Yang
- Department of Hematology, Meishan City People's Hospital, Meishan City, Sichuan Province 620000, China
| | - Qianya Peng
- Department of Hematology, Meishan City People's Hospital, Meishan City, Sichuan Province 620000, China
| | - Jingping Zhang
- Department of Hematology, Meishan City People's Hospital, Meishan City, Sichuan Province 620000, China
| | - Jing Zhang
- Department of Hematology, Meishan City People's Hospital, Meishan City, Sichuan Province 620000, China.
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Albohassan H, Ammen M, Alomran AA, Bu Shehab H, Al Sakkak H, Al Bohassan A. Impact of Hydroxyurea Therapy in Reducing Pain Crises, Hospital Admissions, and Length of Stay Among Sickle Cell Patients in the Eastern Region of Saudi Arabia. Cureus 2022; 14:e31527. [DOI: 10.7759/cureus.31527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
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Vobugari N, Chaturvedi M, Schlam-Camhi IM, Smith HP. Sideroblastic anaemia in a patient with sickle cell disease. BMJ Case Rep 2022; 15:15/2/e246623. [PMID: 35135795 PMCID: PMC8830102 DOI: 10.1136/bcr-2021-246623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sideroblastic anaemia is a rare condition. We report a unique case of concomitant sideroblastic anaemia in a patient with sickle cell disease with long-standing blood transfusion history. Due to a low prevalence of sideroblastic anaemia, the diagnosis of sideroblastic anaemia is often difficult, especially when coexisting with common types of anaemia, including sickle cell disease. This case highlights the detrimental effects of anchoring bias. Rare causes of refractory anaemia should be considered in patients with haemoglobin disorders as the therapeutic approaches for these conditions are different. High suspicion on the part of the clinician and low threshold for workup of anaemia often aids in the diagnosis of coexisting conditions such as sideroblastic anaemia. Early diagnosis and treatment of sideroblastic anaemia improves patient outcomes and prevents long-term complications.
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Affiliation(s)
- Nikitha Vobugari
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Mansi Chaturvedi
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ilana Miriam Schlam-Camhi
- Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
- Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hedy Patricia Smith
- Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC, USA
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Edge NB. Breaking the Cycle: Care Coordination Interventions and Sickle Cell Readmissions. Prof Case Manag 2022; 27:12-18. [PMID: 34846319 DOI: 10.1097/ncm.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE/OBJECTIVES Approximately 100,000 people in the United States are affected by sickle cell disease (SCD). Sickle cell disease represents one of the highest readmitting diagnoses at this organization. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD. PRIMARY PRACTICE SETTING The setting for conducting the interventions took place at the flagship hospital of a seven hospital system in Houston, TX. The hospital is a not-for-profit, faith-based, 907-bed academic facility that provides highly specialized health services to the community and the world. The population of focus was adult patients (18 years of age and older) admitted to the hospital with a primary diagnosis of SCD. FINDINGS/CONCLUSION Two interventions were implemented: Disease-specific discharge education and scheduling postdischarge follow-up appointments prior to discharge. These interventions were conducted by bedside nurses, case managers, and SCD champions over a 6-month period. The 30-day readmission rate for SCD was reduced by 22%. There was also a 0.9-day reduction in length of stay and a 17% reduction in emergency, observation, and inpatient encounters of patients with SCD. IMPLICATIONS FOR CASE MANAGEMENT PRACTICES This project found that implementing evidence-based care coordination interventions can reduce the 30-day readmission rate for patients with SCD. Implementation of effective evidence-based care coordination is a key aspect to reducing hospital readmissions of patients with SCD. Partnering with community networks is also important in addressing readmission risk factors including management of social determinants of health that increase hospital visits. Consistent, patient-centered education using simple and convenient tools helps improve understanding, applicability, and self-care management.
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Affiliation(s)
- Naph'tali B Edge
- Naph'tali B. Edge, DNP, MBA, MSN, BSN, is a vice president of care coordination & operations at a large academic, safety net, Level 1 trauma center in Atlanta, GA. His work includes case management and social work operations, transfer center, bed management, patient flow, and other aspects of hospital operations throughout the continuum of care. He is now on the Board and Board President for the Sickle Cell Association of Houston
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Oudin Doglioni D, Pham-Hung D’Alexandry D’Orengiani AL, Galactéros F, Gay MC. Psychometric characteristics of the Revised Illness Perception Questionnaire (IPQ-R) in adults with sickle cell disease. Health Psychol Behav Med 2021; 10:60-80. [PMID: 34993006 PMCID: PMC8725854 DOI: 10.1080/21642850.2021.2016411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is the most frequent monogenic disease worldwide. Psychological and behavioural factors are often reported as playing a significant role in predicting SCD health outcomes. When focusing on adaptation to a specific health condition and its treatment, the Common Sense Model of Health and Illness (CSM) has proven to be of heuristic value. In other health conditions, illness outcomes are directly influenced by illness perception. Therefore, the aim of this study is to explore the psychometric proprieties of the Revised Illness Perception Questionnaire (IPQ-R). DESIGN We performed a cross-sectional assessment on 517 adult patients with sickle cell disease and collected the results of 406 IPQ-R. With these data, we verified the factor structure of the Belief scale and proposed modifications to improve its fit to the data with a confirmatory factor analysis. In addition, we explored the factorial structure of the Causal attribution scale with an exploratory factor analysis. RESULTS The initial model showed poor fit with the data. After structural modifications, elimination of two items with a low loading (model 2), covariance added between items (model 3) and items reallocation (model 4), the last model proposed presented a correct fit with the data. Before doing this model specification, we reviewed and compiled the nine studies that explored the psychometric properties of the IPQ-R in order to highlight all the modifications made by the other authors who have adapted the IPQ-R to a specific population and to allow a comparison with our own modifications. CONCLUSION Considering previous findings, this research suggests further work is needed on the structure of the dimensions of the IPQ-R.
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Affiliation(s)
- Damien Oudin Doglioni
- Institut Pasteur, Emerging diseases Unit (Global Health Department), Paris, France
- Paris Nanterre University, EA4430 EvaCliPsy/ED139, Nanterre, France
| | | | - Frédéric Galactéros
- Teaching Hospital Henri Mondor, Red blood cell Genetic Diseases Unit (UMGGR), Créteil, France
- French National Referral Centre for sickle cell disease (MCGRE), Créteil, France
| | - Marie-Claire Gay
- Paris Nanterre University, EA4430 EvaCliPsy/ED139, Nanterre, France
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Osborne JC, Osakwe Z, Odlum M. Opioid Use in Adults With Sickle Cell Disease Hospitalized During Vaso-Occlusive Crisis: A Systematic Review. J Hematol 2021; 10:46-52. [PMID: 34007365 PMCID: PMC8110229 DOI: 10.14740/jh828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background While pain is the hallmark of sickle cell disease (SCD), healthcare personnel are often ill-equipped to adequately treat patients who present in vaso-occlusive crisis (VOC). Although symptom severity varies from individual to individual, SCD is characterized by intervallic pain as a result of oxygen deprivation in tissues and organs. Regardless of pain severity, SCD patients are often viewed as drug seekers by healthcare personnel who have concerns regarding patients’ dependence on opioids which may lead to addiction. The objective was to assess the types and amount of opioids used to treat VOC in comparison to Centers for Disease Control opioid prescription guidelines. Methods Literature search was conducted using CINAHL, PubMed, the Cochrane Library, Web of Science and hand search. Data were analyzed from 1999 to 2018. Randomized trials, observational, and case studies involved hospitalized adults with SCD who were prescribed opioids to treat VOC. Quality assessment was conducted using Downs and Black checklist. Meta-analysis was not conducted. Results Five studies were conducted in the USA, Arabia and the Netherlands, and the USA and Canada were included. Participants were treated with either morphine or morphine milligram equivalent (MME). No study used the same method of opioid administration. Conclusions Patients with SCD who are hospitalized secondary to VOC mostly received opioids for pain well within the Centers for Disease Control and Prevention prescription guidelines. No uniform method exists. Additional research is warranted.
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Affiliation(s)
- Jennel C Osborne
- Long Island University Harriet Rothkopf Heilbrunn School of Nursing, Brooklyn, NY, USA
| | - Zainab Osakwe
- Adelphi University College of Nursing and Public Health, Garden City, NY, USA
| | - Michelle Odlum
- Columbia University Irving Medical Center, New York, NY, USA
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Ramsay ZJA, Bartlett RE, Clarke CA, Asnani MR, Knight-Madden JM, Gordon-Strachan GM. How Free Is Free Health Care? An Assessment of Universal Health Coverage Among Jamaicans with Sickle Cell Disease. Health Equity 2021; 5:210-217. [PMID: 33937607 PMCID: PMC8080932 DOI: 10.1089/heq.2021.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: In an effort to transition toward universal health coverage (UHC), Jamaica abolished user fees at all public health facilities in 2008. We aimed to determine the extent of out-of-pocket payments (OPPs) and the other cost barriers to UHC among patients with sickle cell disease (SCD). Methods: Patients presenting to the Sickle Cell Unit in Kingston, Jamaica, for routine care between October 2019 and August 2020 were consecutively recruited and interviewed about their latest hospitalization within the previous 4 weeks. Parents or guardians completed the questionnaire on behalf of pediatric patients. The questionnaire included the Patient Satisfaction Questionnaire Short Form (PSQ)-18 and the health module of the Jamaica Survey of Living Conditions. Results: There were 103 patients with ages ranging from 7 months to 56 years (51.5% female, 60.2% public hospitalizations, and 54.4% pediatric). The modal income (J$6200-$11,999 per week) was similar to the minimum wage and 48.5% lived in overcrowded households. Government drug-subsidy cards were owned by 39.8%. OPPs were made by 19.4% of persons for items and tests that were unavailable at public facilities. There were no costs reported by 69.6%, who visited public pharmacies. Similarly, the cost of admission to public hospitals was free for 95.4% of subjects. Using public transportation, private hospitalization, and having more disease complications were predictive of a perception that health care is unaffordable. Conclusion: Most SCD subjects reported no expense with public hospitalizations; however, approximately one in five reported OPPs. Efforts are needed to increase the availability of subsidized items, and the use of drug-subsidy cards, to improve UHC.
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Affiliation(s)
- Zachary J A Ramsay
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Rachel E Bartlett
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Christine A Clarke
- The Department of Economics, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Monika R Asnani
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Jennifer M Knight-Madden
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Georgiana M Gordon-Strachan
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
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Patel U, Desai R, Hanna B, Patel D, Akbar S, Zubair M, Kumar G, Sachdeva R. Sickle cell disease-associated arrhythmias and in-hospital outcomes: Insights from the National Inpatient Sample. J Arrhythm 2020; 36:1068-1073. [PMID: 33335626 PMCID: PMC7733582 DOI: 10.1002/joa3.12418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The frequency and temporal trend in the prevalence of arrhythmias and associated in-hospital outcomes in patients with sickle cell disease (SCD) have never been quantified. METHODS Our study cohort of SCD patients and sub-types of arrhythmias were derived from the 2010-2014 National Inpatient Sample using relevant diagnostic codes. The frequency and trends of arrhythmia and odds of inpatient mortality were measured. RESULTS A total of 891 450 hospitalized SCD patients were identified, of which, 55 616 (6.2%) patients experienced arrhythmias. The SCD cohort with arrhythmia demonstrated higher all-cause mortality (2.7% vs 0.4%; adjusted OR 2.53, 95% CI 2.15-2.97, P < .001), prolonged hospital stays (6.9 vs 5.0 days) and higher hospital charges ($53 871 vs $30 905) relative to those without arrhythmias (P < .001).The frequency of supraventricular arrhythmia (AFib, SVT, and AF) and ventricular arrhythmia (VFib and VT) were 1893 and 362 per 100 000 SCD-related admissions, respectively. Unspecified arrhythmias (4126) were seen most frequently followed by AFib (1622) per 100 000 SCD-related admissions. From 2010 to 2014, the frequency of any arrhythmias and atrial fibrillation in hospitalized SCD patients relatively increased by 29.6% and 38.5%, respectively. There was nearly a twofold (2.4% in 2010 to 5.0% in 2014) increase in the frequency of arrhythmia among patients aged <18 years. The frequency of arrhythmias in hospitalized male and female SCD patients relatively increased by 28.8% and 31.4%, respectively (P trend < .001). CONCLUSIONS The frequency of arrhythmias among SCD patients is on the rise with worse hospitalization outcomes, including higher in-hospital mortality and higher resource utilization as compared to those without arrhythmias.
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Affiliation(s)
- Upenkumar Patel
- Department of Internal MedicineNassau University Medical CenterEast MeadowNYUSA
| | - Rupak Desai
- Division of CardiologyAtlanta VA Medical CenterDecaturGAUSA
| | - Bishoy Hanna
- Division of CardiologyMorehouse School of MedicineAtlantaGAUSA
| | - Dhruval Patel
- AMC MET Medical CollegeL.G HospitalAhmedabadGujaratIndia
| | - Shahzad Akbar
- Department of Internal MedicineNassau University Medical CenterEast MeadowNYUSA
| | - Mohammed Zubair
- Department of Internal MedicineNassau University Medical CenterEast MeadowNYUSA
| | - Gautam Kumar
- Division of CardiologyAtlanta VA Medical CenterDecaturGAUSA
- Division of CardiologyEmory University School of MedicineAtlantaGAUSA
| | - Rajesh Sachdeva
- Division of CardiologyAtlanta VA Medical CenterDecaturGAUSA
- Division of CardiologyMorehouse School of MedicineAtlantaGAUSA
- Division of CardiologyMedical College of GeorgiaAugustaGAUSA
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Lee S, Vania DK, Bhor M, Revicki D, Abogunrin S, Sarri G. Patient-Reported Outcomes and Economic Burden of Adults with Sickle Cell Disease in the United States: A Systematic Review. Int J Gen Med 2020; 13:361-377. [PMID: 32753936 PMCID: PMC7354084 DOI: 10.2147/ijgm.s257340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To systematically estimate the patient-reported outcomes (PROs) and economic burden of sickle cell disease (SCD) among adults in the United States (US). Patients and Methods Two systematic literature reviews (SLRs), one each for the PROs and economic topics, were performed using MEDLINE and Embase to identify observational studies of adults with SCD. Included studies were published between 2007 and 2018 and evaluated health-related quality of life (HRQL), function, healthcare resource utilization (HCRU), or costs. Given the high degree of clinical and methodological heterogeneity, findings were summarized qualitatively. Results The SLRs identified 7 studies evaluating the PROs and 15 studies evaluating the economic burden meeting the pre-specified selection criteria. The PRO evidence showed the prevalence of depression and anxiety to be 21–33% and 7–36%, respectively, in adults with SCD. The mean SF-36 physical summary scores ranged from 33.6 to 59.0 and from 46.3 to 61.5 for the mental summary scores. Overall HRQL for adults with SCD was poor and significantly worse in those with opioid use. Adult SCD patients were found to have varying rates of emergency department (ED) utilization (0.3–3.5 annual ED visits), hospitalizations (0.5–27.9 per patient per year), and/or readmission (12–41%). Key factors associated with significant HCRU were age, dental infection, and SCD-related complications. SCD specialized care settings and SCD intensive management strategy were reported to significantly decrease the number of hospitalizations. Conclusion This systematic evidence synthesis found that disease burden measured by PROs and economic burden of SCD on adults in the US are substantial despite the availability of approved SCD treatments during 2007–2018. The use of hydroxyurea, optimal management with opioids, and employing intensive treatment strategies may help decrease the overall burden to patients and healthcare systems. Published data on costs associated with SCD are limited and highlight the need for more economic studies to characterize the full burden of the disease.
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Affiliation(s)
- Soyon Lee
- Novartis, East Hanover, New Jersey, USA
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Gaut D, Jones J, Chen C, Ghafouri S, Leng M, Quinn R. Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis. Ann Hematol 2020; 99:1217-1223. [DOI: 10.1007/s00277-020-04050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/20/2020] [Indexed: 12/29/2022]
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Krishnamurti L, Ross D, Sinha C, Leong T, Bakshi N, Mittal N, Veludhandi D, Pham AP, Taneja A, Gupta K, Nwanze J, Matthews AM, Joshi S, Vazquez Olivieri V, Arjunan S, Okonkwo I, Lukombo I, Lane P, Bakshi N, Loewenstein G. Comparative Effectiveness of a Web-Based Patient Decision Aid for Therapeutic Options for Sickle Cell Disease: Randomized Controlled Trial. J Med Internet Res 2019; 21:e14462. [PMID: 31799940 PMCID: PMC6934048 DOI: 10.2196/14462] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/18/2019] [Accepted: 09/04/2019] [Indexed: 01/30/2023] Open
Abstract
Background Hydroxyurea, chronic blood transfusions, and bone marrow transplantation are efficacious, disease-modifying therapies for sickle cell disease but involve complex risk-benefit trade-offs and decisional dilemma compounded by the lack of comparative studies. A patient decision aid can inform patients about their treatment options, the associated risks and benefits, help them clarify their values, and allow them to participate in medical decision making. Objective The objective of this study was to develop a literacy-sensitive Web-based patient decision aid based on the Ottawa decision support framework, and through a randomized clinical trial estimate the effectiveness of the patient decision aid in improving patient knowledge and their involvement in decision making. Methods We conducted population decisional needs assessments in a nationwide sample of patients, caregivers, community advocates, policy makers, and health care providers using qualitative interviews to identify decisional conflict, knowledge and expectations, values, support and resources, decision types, timing, stages and learning, and personal clinical characteristics. Interview transcripts were coded using QSR NVivo 10. Alpha testing of the patient decision aid prototype was done to establish usability and the accuracy of the information it conveyed, and then was followed by iterative cycles of beta testing. We conducted a randomized clinical trial of adults and of caregivers of pediatric patients to evaluate the efficacy of the patient decision aid. Results In a decisional needs assessment, 223 stakeholders described their preferences, helping to guide the development of the patient decision aid, which then underwent alpha testing by 30 patients and 38 health care providers and iterative cycles of beta testing by 87 stakeholders. In a randomized clinical trial, 120 participants were assigned to either the patient decision aid or standard care (SC) arm. Qualitative interviews revealed high levels of usability, acceptability, and utility of the patient decision aid in education, values clarification, and preparation for decision making. On the acceptability survey, 72% (86/120) of participants rated the patient decision aid as good or excellent. Participants on the patient decision aid arm compared to the SC arm demonstrated a statistically significant improvement in decisional self-efficacy (P=.05) and a reduction in the informed sub-score of decisional conflict (P=.003) at 3 months, with an improvement in preparation for decision making (P<.001) at 6 months. However, there was no improvement in terms of the change in knowledge, the total or other domain scores of decisional conflicts, or decisional self-efficacies at 6 months. The large amount of missing data from survey completion limited our ability to draw conclusions about the effectiveness of the patient decision aid. The patient decision aid met 61 of 62 benchmarks of the international patient decision aid collaboration standards for content, development process, and efficacy. Conclusions We have developed a patient decision aid for sickle cell disease with extensive input from stakeholders and in a randomized clinical trial demonstrated its acceptability and utility in education and decision making. We were unable to demonstrate its effectiveness in improving patient knowledge and involvement in decision making. Trial Registration ClinicalTrials.gov NCT03224429; https://clinicaltrials.gov/ct2/show/NCT03224429 and ClinicalTrials.gov NCT02326597; https://clinicaltrials.gov/ct2/show/NCT02326597
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Affiliation(s)
- Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Diana Ross
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Cynthia Sinha
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Namita Bakshi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nonita Mittal
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Divya Veludhandi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Anh-Phuong Pham
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Alankrita Taneja
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kamesh Gupta
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Julum Nwanze
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrea Marie Matthews
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Saumya Joshi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Veronica Vazquez Olivieri
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Santhi Arjunan
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Ifechi Okonkwo
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Ines Lukombo
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Peter Lane
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - George Loewenstein
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Center for Behavioral Decision Research, Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, United States
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13
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Agarwal MA, Shah M, Patel B, Nolan VG, Reed GL, Oudiz RJ, Choudhary G, Maron BA. Association between Pulmonary Hypertension and Clinical Outcomes in Hospitalized Patients with Sickle Cell Disease. Am J Respir Crit Care Med 2019; 198:534-537. [PMID: 29648884 DOI: 10.1164/rccm.201802-0261le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Manyoo A Agarwal
- 1 University of Tennessee Health Science Center Memphis, Tennessee
| | - Mahek Shah
- 2 Lehigh Valley Healthcare Network Allentown, Pennsylvania
| | - Brijesh Patel
- 2 Lehigh Valley Healthcare Network Allentown, Pennsylvania
| | | | - Guy L Reed
- 4 University of Arizona College of Medicine Phoenix, Arizona
| | - Ronald J Oudiz
- 5 LA Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California
| | - Gaurav Choudhary
- 6 Brown University Providence, Rhode Island.,7 Providence VA Medical Center Providence, Rhode Island
| | - Bradley A Maron
- 8 Brigham and Women's Hospital Boston, Massachusetts and.,9 Boston VA Medical Center Boston, Massachusetts
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14
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Riley TR, Riley TT. Profile of crizanlizumab and its potential in the prevention of pain crises in sickle cell disease: evidence to date. J Blood Med 2019; 10:307-311. [PMID: 31507334 PMCID: PMC6720158 DOI: 10.2147/jbm.s191423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
Sickle cell disease (SCD) is one of the most common inherited blood disorders globally. It is a grouping of autosomal recessive genetic disorders identified by a genetic mutation that replaces glutamic acid with valine at the sixth amino acid on the hemoglobin β-globin chain. Millions of people around the world live with a severe genotype of SCD that is often associated with occlusion of the microvasculature resulting in episodes of severe pain and multiple organ system dysfunction. These episodes, commonly categorized as vaso-occlusive crises (VOC), are a distinctive clinical presentation of SCD which represents the majority of SCD morbidity and associated hospitalizations. Though the complete process by which these crises occur is complex and not fully outlined, evidence reveals this process to be multifactorial and heterocellular. For nearly two decades, hydroxyurea was the only FDA-approved therapy for SCD. Evidence to date shows that hydroxyurea treatment significantly reduces the rate of VOC, hospitalizations, and mortality. Despite these benefits, adherence remains problematic due to a variety of adverse effects and interpatient variability connected with hydroxyurea therapy. Crizanlizumab, an adhesion inhibitor of sickled red blood cells, was recently granted breakthrough therapy designation. Results of a phase 2 study have reported a successful reduction in annual rates of vaso-occlusive crisis with a favorable safety profile. This paper reviews the available literature concerning crizanlizumab use in patients with SCD.
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Affiliation(s)
- Tanya R Riley
- Wingate University School of Pharmacy, Hendersonville, NC28739, USA
| | - Treavor T Riley
- Wingate University School of Pharmacy, Hendersonville, NC28739, USA
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15
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Thi Nhat Ho A, Shmelev A, Joshi A, Ho N. Trends in Hospitalizations for Sickle Cell Disease Related-Complications in USA 2004 - 2012. J Hematol 2019; 8:11-16. [PMID: 32300435 PMCID: PMC7153675 DOI: 10.14740/jh475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/26/2019] [Indexed: 01/05/2023] Open
Abstract
Background Sickle cell disease (SCD) affects 100,000 patients in the USA. However, no recent data was available for annual national trends in hospitalization rates, in-hospital mortality, hospital length of stay (LOS) and costs of SCD admissions due to its complications. Methods This study was conducted to study the trends of hospitalization rates, in-hospital mortality, LOS and hospital charges due to SCD-related complications in African American (AA) patients from 2004 to 2012 in the USA. Complications included acute chest syndrome, splenic sequestration, bacterial pneumonia, sepsis, stroke, deep vein thrombosis (DVT) or pulmonary embolism, retinal circulation complications, priapism, disorders related to biliary stones, or those required blood transfusions. We obtained the study population from the Nationwide Inpatient Sample. Results Hospital admission rate rose steadily from 106 per 100,000 AA population in 2004 to 137 in 2012. Seasonal and trend decomposition revealed the highest hospitalization rate in January. Hospital LOS decreased from 7.1 ± 7.65 days in 2004 to 6.23 ± 6.42 days in 2012. Hospital charges increased from 15.35 (8.99 - 27.57) thousand dollars per admission in 2004 to 24.78 (14.37 - 45.24) in 2012. Medicaid remained the primary payer in the highest number of patients in 9 years. In-hospital mortality did not change significantly, being 1.03% in 2004 and 1.02% in 2012, with no significant seasonal variation in mortality. Most common complications were acute pain crisis and blood transfusion requirement. Biliary pathology was the only complication that decreased over time. Admissions for each complication were initially uprising with a decline from 2010 to 2012, except for DVT/pulmonary embolism with a significant uptrend. Conclusions Overall, from 2004 to 2012, hospital admission rates and charges increased, and hospital LOS decreased, while in-hospital mortality remained unchanged.
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Affiliation(s)
| | | | | | - Nghi Ho
- MedStar Harbor Hospital, Baltimore, MD, USA
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16
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Williams H, Silva RNS, Cline D, Freiermuth C, Tanabe P. Social and Behavioral Factors in Sickle Cell Disease: Employment Predicts Decreased Health Care Utilization. J Health Care Poor Underserved 2019; 29:814-829. [PMID: 29805142 DOI: 10.1353/hpu.2018.0060] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
THE PURPOSE to determine frequency of health care encounters among people with sickle cell disease (SCD) seeking treatment for a vaso-occlusive crisis (VOC). Health care encounters are categorized by visit type (day hospital, ED visit, hospitalization), prevalence of self-reported behavioral and social factors, and any associations between behavioral and social factors and health care encounters. Ninety-five people with SCD were enrolled in a prospective descriptive study in North Carolina. Patients were interviewed concerning behavioral-social factors, and a report of health care encounters was produced, generated by ICD codes associated with VOCs between October 2011 and March 2014. Among 95 patients, there were a total of 839 day hospital and 1,990 ED visits, and 1,101 hospital admissions. Prevalent behavioral and social factors were depression (29%), anxiety (34%), illicit drug use (6%); unstable home situation (17%); and unemployment (81%). Employment and stable home were significantly associated with decreased frequency of health care encounters.
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17
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Sharma P, McCarty TR, Yadav S, Ngu JN, Njei B. Impact of Bariatric Surgery on Outcomes of Patients with Sickle Cell Disease: a Nationwide Inpatient Sample Analysis, 2004–2014. Obes Surg 2019; 29:1789-1796. [DOI: 10.1007/s11695-019-03780-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Iftikhar F, Ali H, Musharraf SG. Cinchona alkaloids as natural fetal hemoglobin inducing agents in human erythroleukemia cells. RSC Adv 2019; 9:17551-17559. [PMID: 35520581 PMCID: PMC9066308 DOI: 10.1039/c9ra01744e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/28/2019] [Indexed: 01/14/2023] Open
Abstract
Pharmacologically mediated reactivation of γ-globin gene with an increase in fetal hemoglobin production, is a cost effective experimental therapeutic intervention for the management of β-hemoglobinopathies. Investigation of new pharmacological agents as HbF inducers from natural resources is desirable to develop safe and effective HbF inducers. We evaluated selected cinchona alkaloids (cinchonidine and quinidine) for their potential of erythroid differentiation and augmentation of fetal hemoglobin production. K562 cells were used as in vitro experimental model. Erythroid differentiation of K562 cells was studied using a benzidine assay, and total hemoglobin was estimated through a calorimetric method. Whereas, quantitative real-time PCR (qRT-PCR) was used to analyse γ-globin gene expression, and flow cytometry and immunofluorescence microscopy for evaluating HbF production. Cinchona alkaloids showed dose dependent erythroid differentiation, time driven cellular proliferation, with kinetics of hemoglobin accumulation in K562 cells. The findings of qRT-PCR showed an increase in expression of γ-globin mRNA content (3.17-fold in cinchonidine and 2.03-fold increase in quinidine treated K562 cells), accompanied by an increase in fetal hemoglobin production. Altogether, this study demonstrates that cinchona alkaloids can be used as therapeutic agents in treating β-thalassemia after further biological investigation. Pharmacologically mediated reactivation of γ-globin gene and fetal hemoglobin (HbF) induction by cinchona alkaloids; a cost effective experimental therapeutic intervention for the efficient management of β-thalassemia.![]()
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Affiliation(s)
- Fizza Iftikhar
- Dr Panjwani Center for Molecular Medicine and Drug Research
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
| | - Hamad Ali
- Dr Panjwani Center for Molecular Medicine and Drug Research
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
| | - Syed Ghulam Musharraf
- Dr Panjwani Center for Molecular Medicine and Drug Research
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
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19
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Field JJ, Ballas SK, Campbell CM, Crosby LE, Dampier C, Darbari DS, McClish DK, Smith WR, Zempsky WT. AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain. THE JOURNAL OF PAIN 2018; 20:746-759. [PMID: 30578848 DOI: 10.1016/j.jpain.2018.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/14/2022]
Abstract
Acute pain episodes are the most common complication in patients with sickle cell disease (SCD). Classically attributed to vaso-occlusion, recent insights suggest that chronic pain may also contribute to the pathogenesis of acute pain episodes, which adds complexity to their diagnosis and management. A taxonomy, or classification system, for acute pain in patients with SCD would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including SCD. To accomplish this, a working group of experts in SCD and pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific to SCD. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of chronic pain, are proposed to define the types of acute pain observed in patients with SCD. PERSPECTIVE: This article presents a taxonomy for acute pain in patients with SCD. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients with SCD.
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Affiliation(s)
- Joshua J Field
- JJF Medical Sciences Institute, BloodCenter of Wisconsin, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Samir K Ballas
- SKB Department of Medicine,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claudia M Campbell
- CCM Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lori E Crosby
- LEC Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlton Dampier
- CD Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Deepika S Darbari
- DSD Division of Hematology, Children's National Medical Center, Washington, DC
| | - Donna K McClish
- DKM Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Wally R Smith
- WRS Department of Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - William T Zempsky
- WTZ Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
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20
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BMI, Psychosocial Correlates, Pain and Activities of Daily Living in Sickle Cell Disease Patients. PROGRESS IN PREVENTIVE MEDICINE 2018. [DOI: 10.1097/pp9.0000000000000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Smaldone A, Findley S, Manwani D, Jia H, Green NS. HABIT, a Randomized Feasibility Trial to Increase Hydroxyurea Adherence, Suggests Improved Health-Related Quality of Life in Youths with Sickle Cell Disease. J Pediatr 2018; 197:177-185.e2. [PMID: 29571930 PMCID: PMC5970970 DOI: 10.1016/j.jpeds.2018.01.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/29/2017] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the effect of a community health worker (CHW) intervention, augmented by tailored text messages, on adherence to hydroxyurea therapy in youths with sickle cell disease, as well as on generic and disease-specific health-related quality of life (HrQL) and youth-parent self-management responsibility concordance. STUDY DESIGN We conducted a 2-site randomized controlled feasibility study (Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment [HABIT]) with 2:1 intervention allocation. Youths and parents participated as dyads. Intervention dyads received CHW visits and text message reminders. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and growth models adjusting for group assignment, time, and multiple comparisons. Changes in outcomes from 0 to 6 months were compared with their respective minimal clinically important differences. RESULTS A total of 28 dyads (mean age of youths, 14.3 ± 2.6 years; 50% Hispanic) participated (18 in the intervention group, 10 in the control group), with 10.7% attrition. Accounting for group assignment, time, and multiple comparisons, at 6 months intervention youths reported improved generic HrQL total score (9.8 points; 95% CI, 0.4-19.2) and Emotions subscale score (15.0 points; 95% CI, 1.6-28.4); improved disease-specific subscale scores for Worry I (30.0 points; 95% CI, 8.5-51.5), Emotions (37.0 points, 95% CI, 9.4-64.5), and Communication I (17.8 points; 95% CI, 0.5-35.1); and 3-month dyad self-management responsibility concordance (3.5 points; 95% CI, -0.2 to 7.1). There were no differences in parent proxy-reported HrQL measures at 6 months. CONCLUSIONS These findings add to research examining effects of behavioral interventions on HrQL outcomes in youths with sickle cell disease. TRIAL REGISTRATION ClinicalTrials.gov: NCT02029742.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY; College of Dental Medicine, Columbia University Medical Center, New York, NY.
| | - Sally Findley
- Mailman School of Public Health, Columbia University, New York, NY
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, NY
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY,Mailman School of Public Health, Columbia University, New York, NY
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY
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22
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Youssry I, Abdel-Salam A, Ismail R, Bou-Fakhredin R, Mohamed Samy R, Ezz El-Deen F, Taher AT. Enhancing Effect of Hydroxyurea on Hb F in Sickle Cell Disease: Ten-Year Egyptian Experience. Hemoglobin 2017; 41:267-273. [DOI: 10.1080/03630269.2017.1408646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ilham Youssry
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Faculty of Medicine, Cairo University, Egypt
| | - Amina Abdel-Salam
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Faculty of Medicine, Cairo University, Egypt
| | - Rania Ismail
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Faculty of Medicine, Cairo University, Egypt
| | - Rayan Bou-Fakhredin
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rania Mohamed Samy
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Egypt
| | - Fatma Ezz El-Deen
- Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Faculty of Medicine, Cairo University, Egypt
| | - Ali T. Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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23
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Kunz JB, Cario H, Grosse R, Jarisch A, Lobitz S, Kulozik AE. The epidemiology of sickle cell disease in Germany following recent large-scale immigration. Pediatr Blood Cancer 2017; 64. [PMID: 28383793 DOI: 10.1002/pbc.26550] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/06/2017] [Accepted: 02/23/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The epidemiology of sickle cell disease (SCD) in Germany is currently changing fundamentally with ongoing immigration. Here, we address the challenges resulting from the increased frequency, that is, the morbidity, and mortality of SCD in this population. PROCEDURE The number of immigrants with SCD was estimated based on the data of the German central registry of migrants (2007-2015) and published epidemiologic data. Additional data analysis was based on nationwide aggregated data from the diagnosis-related groups' (DRG) statistics of the German Federal Statistical Office. RESULTS The total number of patients with SCD among migrants was estimated at 2,016 in 2007 and 3,216 in 2015, thus showing a 60% increase, which was particularly remarkable during 2014 and 2015. The countries of origin included those of West sub-Saharan Africa, followed by Syria, and other countries of the Middle East. In parallel, the number of SCD inpatient treatments increased from 780 in 2002 to 1,340 in 2015. Between 2012 and 2014, 42 patients with SCD died in hospital, mostly at an age of less than 5 years (n = 7) or over 30 years (n = 29). CONCLUSION More than 3,000 patients with SCD are estimated to live among the immigrant population in Germany. In addition, the number of SCD patients of German nationality is not known. The increasing number of inpatient treatments and the death of young children from SCD indicate the need for a general newborn screening program and an increased awareness of this disease among medical practitioners in a country in which SCD used to be rare.
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Affiliation(s)
- Joachim B Kunz
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany.,GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Ulm, Germany
| | - Holger Cario
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Ulm, Germany.,GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Ulm, Germany
| | - Regine Grosse
- Universitätsklinikum Hamburg-Eppendorf, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Klinik und Poliklinik für Pädiatrische Hämatologie und Onkologie, Hamburg, Germany.,GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Ulm, Germany
| | - Andrea Jarisch
- Klinikum der Johann-Wolfgang-Goethe-Universität, Zentrum für Kinder- und Jugendmedizin, Klinik III, Schwerpunkt Stammzelltransplantation, Frankfurt am Main, Germany.,GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Ulm, Germany
| | - Stephan Lobitz
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m.S. Onkologie/Hämatologie/KMT, Berlin, Germany.,GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Ulm, Germany
| | - Andreas E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany.,GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Ulm, Germany
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24
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Yu T, Campbell T, Ciuffetelli I, Haywood C, Carroll CP, Resar L, Strouse JJ, Lanzkron S. Symptomatic Avascular Necrosis: An Understudied Risk Factor for Acute Care Utilization by Patients with SCD. South Med J 2017; 109:519-24. [PMID: 27598353 DOI: 10.14423/smj.0000000000000512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Sickle cell disease (SCD) is associated with high healthcare utilization rates and poor outcomes in a subset of patients, although the underlying factors that predict this phenotype are poorly understood. Prior studies suggest that comorbid avascular necrosis (AVN) contributes to high healthcare utilization. We sought to clarify whether AVN independently predicts acute care utilization in adults with SCD and to identify characteristics of those with AVN that predict higher utilization. METHODS We reviewed the medical records of 87 patients with SCD with symptomatic AVN and compared acute care utilization and clinical characteristics with 87 sex- and age-matched patients with SCD without symptomatic AVN. Patients with ≥2 years of follow-up were included. Outcomes were compared using bivariate analysis and multivariate regression. RESULTS Our study included 1381 follow-up years, with a median of 7 years per patient. The AVN cohort had greater median rates of urgent care visits (3.2/year vs 1.3/year; P = 0.0155), admissions (1.3/year vs 0.4/year; P = 0.0002), and admission days (5.1 days/year vs 1.8 days/year; P = 0.0007). History of high utilization (odds ratio [OR] 4.28; P = 0.001), acute chest syndrome (OR 3.12; P = 0.005), pneumonia (OR 3.20; P = 0.023), hydroxyurea therapy (OR 2.23; P = 0.0136), and long-term transfusion (OR 2.33; P = 0.014) were associated with AVN. In a median regression model, AVN, acute chest syndrome, and pneumonia were independently associated with greater urgent care visits and admissions. CONCLUSIONS Symptomatic AVN was found to be an independent risk factor for acute care utilization in patients with SCD. Because this is a potentially modifiable factor, further studies are urgently needed to determine whether AVN prevention/early treatment interventions will alter utilization and improve outcomes for patients with SCD.
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Affiliation(s)
- Tiffany Yu
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Timothy Campbell
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Isabella Ciuffetelli
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Carlton Haywood
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Christopher Patrick Carroll
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Linda Resar
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - John J Strouse
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
| | - Sophie Lanzkron
- From the School of Medicine, University of Maryland, Baltimore, the School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, and the Departments of Medicine, Psychiatry and Behavioral Sciences, Oncology, and Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Division of Hematology, Duke University School of Medicine, Durham, North Carolina
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25
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The accuracy of hospital ICD-9-CM codes for determining Sickle Cell Disease genotype. JOURNAL OF RARE DISEASES RESEARCH & TREATMENT 2017; 2:39-45. [PMID: 29202133 PMCID: PMC5709815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sickle cell disease affects more than 100,000 individuals in the United States, among whom disease severity varies considerably. One factor that influences disease severity is the sickle cell disease genotype. For this reason, clinical prevention and treatment guidelines tend to differentiate between genotypes. However, previous research suggests caution when using a claimsbased determination of sickle cell disease genotype in healthcare quality studies. The objective of this study was to describe the extent of miscoding for the major sickle cell disease genotypes in hospital discharge data. Individuals with sickle cell disease were identified through newborn screening results or hemoglobinopathy specialty care centers, along with their sickle cell disease genotypes. These genotypes were compared to the diagnosis codes listed in hospital discharge data to assess the accuracy of the hospital codes in determining sickle cell disease genotype. Eighty-three percent (sickle cell anemia), 23% (Hemoglobin SC), and 31% (Hemoglobin Sβ+ thalassemia) of hospitalizations contained a diagnosis code that correctly reflected the individual's true sickle cell disease genotype. The accuracy of the sickle cell disease genotype coding was indeterminate in 11% (sickle cell anemia), 12% (Hemoglobin SC), and 7% (Hemoglobin Sβ+ thalassemia) and incorrect in 3% (sickle cell anemia), 61% (Hemoglobin SC), and 52% (Hemoglobin Sβ+ thalassemia) of the hospitalizations. The use of ICD-9-CM codes from hospital discharge data for determining specific sickle cell disease genotypes is problematic. Research based solely on these or other types of administrative data could lead to incorrect understanding of the disease.
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Yeruva SLH, Paul Y, Oneal P, Nouraie M. Renal Failure in Sickle Cell Disease: Prevalence, Predictors of Disease, Mortality and Effect on Length of Hospital Stay. Hemoglobin 2016; 40:295-299. [PMID: 27643740 DOI: 10.1080/03630269.2016.1224766] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Renal dysfunction in sickle cell disease is not only a chronic comorbidity but also a mortality risk factor. Though renal dysfunction starts early in life in sickle cell patients, the predictors that can identify sickle cell disease patients at risk of developing renal dysfunction is not known. We used the Truven Health MarketScan® Medicaid Databases from 2007 to 2012. Incidence of new acute renal failure (ARF) and chronic kidney disease (CKD) was calculated in this cohort. There were 9481 patients with a diagnosis of sickle cell disease accounting for 64,201 hospital admissions, during the study period. Both ARF and CKD were associated with higher risk of inpatient mortality, longer duration of the hospital stay and expensive hospitalizations. The yearly incidence of new ARF in sickle cell disease patients was 1.4% and annual CKD incidence was 1.3%. The annual rate of new ARF and CKD in the control group was 0.4 and 0.6%, respectively. The most important predictors of new CKD were proteinuria, ARF and hypertension. Chronic kidney disease, hypertension and sickle cell crisis were the most important predictors of new ARF. The annual rate of incidences of ARF and CKD were 2- to 3-fold higher in sickle cell disease compared to the non sickle cell disease group. Besides the common risk factors for renal disease in the general population, it is imperative to monitor the sickle cell disease patients with more severe disease to prevent them from developing renal dysfunction.
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Affiliation(s)
- Sri L H Yeruva
- a Department of Internal Medicine, Division of Hematology/Oncology , Howard University Hospital , Washington , DC , USA
| | - Yonette Paul
- a Department of Internal Medicine, Division of Hematology/Oncology , Howard University Hospital , Washington , DC , USA
| | - Patricia Oneal
- a Department of Internal Medicine, Division of Hematology/Oncology , Howard University Hospital , Washington , DC , USA
| | - Mehdi Nouraie
- b Department of Medicine and Vascular Medicine Institute , University of Pittsburgh , Pittsburgh , PA , USA
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Creary SE, Chisolm DJ, Koch TL, Zigmont VA, Lu B, O’Brien SH. Hydroxyurea use in Children with Sickle Cell Disease: Do Severely Affected Patients Use It and Does It Impact Hospitalization Outcomes? Pediatr Blood Cancer 2016; 63:844-7. [PMID: 26797936 PMCID: PMC4801693 DOI: 10.1002/pbc.25894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/11/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Expert guidelines recommend that hydroxyurea (HU) be offered to all children with hemoglobin SS and Sβ(0) sickle cell disease (SCD) and be considered for children with clinically severe hemoglobin SC or Sβ(+) . This study aims to determine the rate of HU use in hospitalized children, if HU is differentially used in children with clinically severe SCD, and if HU users have shorter length of stay (LOS), fewer intensive care unit (ICU) admissions, and fewer inpatient transfusions compared to nonusers. PROCEDURE Using the Pediatric Health Information System, we performed a retrospective analysis of children ages 2-18 years with SCD discharged between January 1, 2011 and September 30, 2014. We defined patients as having clinically severe SCD if they had a recent ICU admission or ≥3 admissions in the preceding year. RESULTS Of the 2,665 unique children identified, approximately 80% had an inpatient code indicating HU use. Significantly more (p < 0.001) nonusers (30.1%) had a recent ICU admission compared to HU users (18.7%). More nonusers (33.9%) had a history of ≥3 admissions compared to HU users (21.5%) (p < 0.001). After applying propensity score weighting, the groups did not differ in their LOS, prevalence of ICU admissions, or prevalence of transfusions. CONCLUSIONS HU use is high among hospitalized children with SCD. However, HU is not utilized by many children with clinically severe SCD. These results support that HU be considered in children with SCD to prevent hospitalization rather than as a treatment to improve hospitalization outcomes.
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Affiliation(s)
- Susan E. Creary
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH,Correspondence to: Susan E. Creary, MD, MSc, Division of Pediatric Hematology and Oncology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, , Phone: 614-722-3569
| | - Deena J. Chisolm
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Terah L. Koch
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Victoria A. Zigmont
- The Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH
| | - Bo Lu
- The Ohio State University, College of Public Health, Division of Biostatistics, Columbus, OH
| | - Sarah H. O’Brien
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
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