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Mahmoud M, Nwankwo E, Zhang Z, Matiwala N, Tripathi R, Mohamed I, Barrios C, Syn WK, Hachem C. Low Prevalence of Peptic Ulcer Disease in Hospitalized Patients with Cystic Fibrosis: a national database study. Am J Med Sci 2024:S0002-9629(24)01445-9. [PMID: 39245183 DOI: 10.1016/j.amjms.2024.09.001] [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: 04/09/2024] [Revised: 08/31/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Although cystic fibrosis (CF) is widely considered a lung disease, the prevalence of CF-specific gastrointestinal symptoms and diseases has continued to rise. Peptic ulcer disease (PUD) has not been well-studied among people with CF (PwCF) and may be a common cause of abdominal symptoms. In PwCF, impaired bicarbonate secretion and unbuffered gastric acid production have been attributed to the development of ulcers, although ulcers remain uncommon. The objective of this study was to evaluate the prevalence of PUD in PwCF and assess for possible contributing factors. METHODS This study utilized the National Inpatient Sample (NIS) database. All patients 18 years or older with CF were identified from 2014 to 2019. Relevant patient characteristics and procedures were identified using ICD-9 and ICD-10 codes. Linear trend, bivariate analyses, and multiple regression analysis were performed. The outcomes of interest were peptic ulcer disease, pancreatic insufficiency, and nonalcoholic steatohepatitis or NASH. All analyses accounted for complex sampling scheme of the NIS. RESULTS The total prevalence of PwCF in the National Inpatient Sample (NIS) database was 0.08%, and the number was stable year to year from 2014 to 2019. Hispanic patients were more likely to be diagnosed with PUD than other white (aOR 1.802 [1.311,2.476]). Multiple regression analysis indicated that PUD in PwCF was strongly associated with a diagnosis of NASH (aOR 2.421[1.197, 4.898]). PUD patients were less likely to have pancreatic insufficiency compared to the non-PUD group (aOR 0.583 [0.455, 0.745]). CONCLUSION Although cystic fibrosis has been historically known as a disease of childhood, advancements in therapy have led to prolonged life expectancy and higher prevalence for cystic fibrosis-related digestive diseases. This study revealed a low prevalence of PUD in PwCF. Hispanics and those with NASH are more likely to develop peptic ulcers.
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Affiliation(s)
- Maya Mahmoud
- Department of Internal Medicine, Saint Louis University, St Louis Missouri.
| | - Eugene Nwankwo
- Department of Internal Medicine, Saint Louis University, St Louis Missouri
| | - Zidong Zhang
- Advanced Health Data (AHEAD) Institute, Saint Louis University School of Medicine
| | - Neel Matiwala
- Saint Louis University School of medicine, St Louis Missouri
| | - Rohan Tripathi
- Saint Louis University School of medicine, St Louis Missouri
| | - Islam Mohamed
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas city Missouri
| | - Christopher Barrios
- Division of Pulmonary, Department of Internal Medicine, Saint Louis University, St Louis Missouri
| | - Wing-Kin Syn
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Saint Louis University, St Louis Missouri; Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Vizcaya, Spain
| | - Christine Hachem
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Saint Louis University, St Louis Missouri
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2
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Avery M, Wolfe J, DeCourcey DD. Economic Hardship at the End of Life for Families of Children With Complex Chronic Conditions. J Pain Symptom Manage 2024; 67:e313-e319. [PMID: 38151216 DOI: 10.1016/j.jpainsymman.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
CONTEXT Many children with complex chronic medical conditions (CCC), though living longer, die prematurely. Little is known about family economic hardship during end of life (EOL), nor associated differences in patterns of care. OBJECTIVES To describe the prevalence, experience, and characteristics of families of patients with CCC who report great economic hardship (GEH), and associations with end-of-life care patterns and suffering. METHODS We conducted a 183-item cross-sectional survey of bereaved parents of patients cared for at Boston Children's Hospital and chart reviews for each patient. Fifteen survey items on economic hardship related to financial and material hardships including food, housing, and utility insecurity. RESULTS A total of 114 bereaved parents completed the survey (54% response rate) and economic hardship data was analyzed for 105. Nearly a fifth reported GEH. This group was characterized by fewer two parent households. Children from families with GEH had spent more time hospitalized than those without GEH. CONCLUSION Economic burden on families of children with CCC correlates with higher health care utilization demonstrating the need for ameliorative resources and preventative measures.
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Affiliation(s)
- Madeline Avery
- Pediatric Palliative Care (M.V., J.W.), Department of Pediatrics, Massachusetts General Hospital, Boston Massachusetts, USA.
| | - Joanne Wolfe
- Pediatric Palliative Care (M.V., J.W.), Department of Pediatrics, Massachusetts General Hospital, Boston Massachusetts, USA
| | - Danielle D DeCourcey
- Division of Medical Critical Care (D.D.D.), Department of Pediatrics, Boston Children's Hospital, Boston Massachusetts, USA
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3
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Cheema ZM, Gomez LC, Johnson N, Laflamme OD, Rabin HR, Steele K, Leong J, Cheng SY, Quon BS, Stephenson AL, Wranik WD, Sadatsafavi M, Stanojevic S. Measuring the burden of cystic fibrosis: A scoping review. J Cyst Fibros 2023:S1569-1993(23)01722-8. [PMID: 38044160 DOI: 10.1016/j.jcf.2023.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) contributes a significant economic burden on individuals, healthcare systems, and society. Understanding the economic impact of CF is crucial for planning resource allocation. METHODS We conducted a scoping review of literature published between 1990 and 2022 that reported the cost of illness, and/or economic burden of CF. Costs were adjusted for inflation and reported as United States dollars. RESULTS A total of 39 studies were included. Direct healthcare costs (e.g., medications, inpatient and outpatient care) were the most frequently reported. Most studies estimated the cost of CF using a prevalence-based (n = 18, 46.2 %), bottom-up approach (n = 23, 59 %). Direct non-healthcare costs and indirect costs were seldom included. The most frequently reported direct cost components were medications (n = 34, 87.2 %), inpatient care (n = 33, 84.6 %), and outpatient care (n = 31, 79.5 %). Twenty-eight percent (n = 11) of studies reported the burden of CF from all three perspectives (healthcare system (payer), individual, and society). Indirect costs of CF were reported in approximately 20 % of studies (n = 8). The reported total cost of CF varied widely, ranging from $451 to $160,000 per person per year (2022 US$). The total cost depended on the number of domains and perspectives included in each study. CONCLUSIONS Most studies only reported costs to the healthcare system (i.e., hospitalizations and healthcare encounters) which likely underestimates the total costs of CF. The wide range of costs reported highlights the importance of standardizing perspectives, domains and costs when estimating the economic burden of CF.
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Affiliation(s)
- Zain M Cheema
- Department of Medicine, McMaster University, Hamilton, Canada; Cystic Fibrosis Canada, Toronto, Canada
| | - Lilian C Gomez
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Noah Johnson
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Olivier D Laflamme
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Harvey R Rabin
- Department of Medicine, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | | | - Jeanette Leong
- Department of Medicine, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | | | - Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Anne L Stephenson
- Division of Respirology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - W Dominika Wranik
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada; Department of Public and International Affairs, Faculty of Management, Dalhousie University, Halifax, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Sanja Stanojevic
- Department of Community Health, and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.
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4
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Uytun S, Cinel G, Eryılmaz Polat S, Özkan Tabakçı S, Kiper N, Yalçın E, Ademhan Tural D, Özsezen B, Şen V, Selimoğlu Şen H, Ufuk Altıntaş D, Çokuğraş H, Kılınç AA, Başkan AK, Yazan H, Çollak A, Uzuner S, Ünal G, Yılmaz Aİ, Çağlar HT, Damadoğlu E, Irmak İ, Demir E, Kartal Öztürk G, Bingöl A, Başaran E, Sapan N, Canıtez Y, Tana Aslan A, Asfuroğlu P, Harmancı K, Köse M, Hangül M, Özdemir A, Çobanoğlu N, Özcan G, Keskin Ö, Yüksel H, Özdoğan Ş, Topal E, Çaltepe G, Can D, Korkmaz Ekren P, Kılıç M, Emiralioğlu N, Şişmanlar Eyüboğlu T, Pekcan S, Çakır E, Özçelik U, Doğru D. Patients with cystic fibrosis who could not receive the CFTR modulator treatment: What did they lose in 1 year? Pediatr Pulmonol 2023; 58:2505-2512. [PMID: 37278544 DOI: 10.1002/ppul.26535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder caused by CF transmembrane conductance regulator (CFTR) genetic variants. CFTR modulators improve pulmonary function and reduce respiratory infections in CF. This study investigated the clinical and laboratory follow-up parameters over 1 year in patients with CF who could not receive this treatment. METHODS This retrospective cohort study included 2018 and 2019 CF patient data from the CF registry of Turkey. Demographic and clinical characteristics of 294 patients were assessed, who had modulator treatment indications in 2018 but could not reach the treatment. RESULTS In 2019, patients younger than 18 years had significantly lower BMI z-scores than in 2018. During the 1-year follow-up, forced expiratory volumes (FEV1) and FEV1 z-scores a trend toward a decrease. In 2019, chronic Staphylococcus aureus colonization, inhaled antipseudomonal antibiotic use for more than 3 months, oral nutritional supplement requirements, and oxygen support need increased. CONCLUSIONS Patients who had indications for modulator treatments but were unable to obtain them worsened even after a year of follow-up. This study emphasized the importance of using modulator treatments for patients with CF in our country, as well as in many countries worldwide.
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Affiliation(s)
- Salih Uytun
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Güzin Cinel
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | | | - Nural Kiper
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçın
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan Tural
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Beste Özsezen
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Şen
- Division of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Hadice Selimoğlu Şen
- Department of Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Derya Ufuk Altıntaş
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Haluk Çokuğraş
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Azer Kılıç Başkan
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Abdulhamit Çollak
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Gökçen Ünal
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aslı İmran Yılmaz
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hanife Tuğçe Çağlar
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ebru Damadoğlu
- Department of Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlim Irmak
- Department of Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Esen Demir
- Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Gökçen Kartal Öztürk
- Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ayşen Bingöl
- Division of Pediatric Pulmonology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Erdem Başaran
- Division of Pediatric Pulmonology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Nihat Sapan
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Yakup Canıtez
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ayşe Tana Aslan
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pelin Asfuroğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Koray Harmancı
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mehmet Köse
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Melih Hangül
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Özdemir
- Division of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Nazan Çobanoğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gizem Özcan
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem Keskin
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Hasan Yüksel
- Division of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Şebnem Özdoğan
- Division of Pediatric Pulmonology, Sarıyer Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Erdem Topal
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Gönül Çaltepe
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Demet Can
- Division of Pediatric Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | | | - Mehmet Kılıç
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Nagehan Emiralioğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Erkan Çakır
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Uğur Özçelik
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Doğru
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Noah TL, Tolleson-Rinehart S, Esther CR, Peterson-Carmichael SL, Davis SD, Moore PE. The future of pediatric pulmonology: A survey of division directors, assessment of current research funding, and discussion of workforce trends. Pediatr Pulmonol 2023; 58:653-661. [PMID: 33325144 DOI: 10.1002/ppul.25228] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles R Esther
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul E Moore
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
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6
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Basile MJ, Dhingra L, DiFiglia S, Polo J, Portenoy R, Wang J, Walker P, Middour-Oxler B, Linnemann RW, Kier C, Friedman D, Berdella M, Abdullah R, Yonker LM, Markovitz M, Hadjiliadis D, Shiffman M, Fischer F, Pollinger S, Hardcastle M, Chaudhary N, Georgiopoulos AM. Development of a Cystic Fibrosis Primary Palliative Care Intervention: Qualitative Analysis of Patient and Family Caregiver Preferences. J Patient Exp 2023; 10:23743735231161486. [PMID: 36936380 PMCID: PMC10021085 DOI: 10.1177/23743735231161486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
To prevent or mitigate chronic illness burden, people with cystic fibrosis (pwCF) and their family caregivers need primary (generalist-level) palliative care from the time of diagnosis forward. We used qualitative methods to explore their preferences about a screening-and-triage model ("Improving Life with CF") developed to standardize this care. We purposively sampled and interviewed 14 pwCF and caregivers from 5 Improving Life with CF study sites. Thematic analysis was guided by a priori codes using the National Consensus Project's Guidelines for Quality Palliative Care. Participants included 7 adults and 2 adolescents with CF (3 with advanced disease), 4 parents, 1 partner (7 women; 5 people of color). Few were familiar with palliative care. Illness burden was described in multiple domains, including physical (e.g., dyspnea, pain), psychological (e.g., anxiety), and social (e.g., family well-being; impact on work/school). Most preferred survey-based screening with care coordination by the CF team. Preferences for screening approaches varied. PwCF and caregivers experience illness burden and are receptive to a CF-team delivered primary palliative care screening-and-triage model with flexible processes.
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Affiliation(s)
- Melissa J Basile
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
- Melissa J Basile, Center for Health
Innovations and Outcomes Research, Feinstein Institutes for Medical Research,
Northwell Health, New York, NY, USA.
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | | | - Jennifer Polo
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine, Department of Neurology,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | - Janice Wang
- Division of Pulmonary, Critical Care and Sleep Medicine,
Donald and
Barbara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY, USA
| | - Patricia Walker
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brandi Middour-Oxler
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Rachel W Linnemann
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
| | - Maria Berdella
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Robert Abdullah
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Lael M Yonker
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Pulmonary Division, Massachusetts General Hospital for Children,
Boston, MA, USA
| | - Martha Markovitz
- Keck Medicine of University of Southern California, Los Angeles,
California, USA (retired)
| | - Denis Hadjiliadis
- Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Hospital of
the University of Pennsylvania,
Philadelphia, PA, USA
| | | | | | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
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7
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Shi N, Wang Z, Zhu H, Liu W, Zhao M, Jiang X, Zhao J, Ren C, Zhang Y, Luo L. Research progress on drugs targeting the TGF-β signaling pathway in fibrotic diseases. Immunol Res 2022; 70:276-288. [PMID: 35147920 PMCID: PMC9197809 DOI: 10.1007/s12026-022-09267-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Tissue fibrosis is a key factor leading to disability and death worldwide; however, thus far, there are no approved treatments for fibrosis. Transforming growth factor (TGF)-β is a major pro-fibrotic cytokine, which is expected to become a target in the treatment of fibrosis; however, since TGF-β has a wide range of biological functions involving a variety of biological processes in the body, a slight change in TGF-β may have a systematic effect. Indiscriminate inhibition of TGF-β can lead to adverse reactions, which can affect the efficacy of treatment. Therefore, it has become very important to explore how both the TGF-β signaling pathway is inhibited and the safe and efficient TGF-β small molecule inhibitors or neutralizing antibodies are designed in the treatment of fibrotic diseases. In this review, we mainly discuss the key role of the TGF-β signaling pathway in fibrotic diseases, as well as the development of fibrotic drugs in recent years, and explore potential targets in the treatment of fibrotic diseases in order to guide subsequent drug development.
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Affiliation(s)
- Ning Shi
- Department of Neurosurgery, Cancer Research Institute, School of Basic Medical Science, Xiangya Hospital, Central South University, Changsha, 410008, China
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health and the Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Central South University, Changsha, 410008, China
| | - Zhihong Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Taiping Road #27, Beijing, 100850, China
| | - Hecheng Zhu
- Changsha Kexin Cancer Hospital, Changsha, 410205, Hunan, China
| | - Weidong Liu
- Department of Neurosurgery, Cancer Research Institute, School of Basic Medical Science, Xiangya Hospital, Central South University, Changsha, 410008, China
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health and the Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Central South University, Changsha, 410008, China
| | - Ming Zhao
- Changsha Kexin Cancer Hospital, Changsha, 410205, Hunan, China
| | - Xingjun Jiang
- Department of Neurosurgery, Cancer Research Institute, School of Basic Medical Science, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jin Zhao
- Department of Neurosurgery, Cancer Research Institute, School of Basic Medical Science, Xiangya Hospital, Central South University, Changsha, 410008, China
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health and the Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Central South University, Changsha, 410008, China
| | - Caiping Ren
- Department of Neurosurgery, Cancer Research Institute, School of Basic Medical Science, Xiangya Hospital, Central South University, Changsha, 410008, China.
- The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health and the Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Central South University, Changsha, 410008, China.
| | - Yan Zhang
- Department of Obstetrics and Gynecology, First Medical Center, General Hospital of Chinese PLA, Beijing, China.
| | - Longlong Luo
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Taiping Road #27, Beijing, 100850, China.
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8
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Gastrointestinal Factors Associated With Hospitalization in Infants With Cystic Fibrosis: Results From the Baby Observational and Nutrition Study. J Pediatr Gastroenterol Nutr 2021; 73:395-402. [PMID: 34016873 PMCID: PMC8780884 DOI: 10.1097/mpg.0000000000003173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify factors that increase the risk of gastrointestinal-related (GI-related) hospitalization of infants with cystic fibrosis (CF) during the first year of life. METHODS The Baby Observational and Nutrition Study was a longitudinal, observational cohort of 231 infants diagnosed with CF by newborn screening. We performed a post-hoc assessment of the frequency and indications for GI-related admissions during the first year of life. RESULTS Sixty-five participants had at least one admission in the first 12 months of life. High pancreatic enzyme replacement therapy (PERT) dosing (>2000 lipase units/kg per meal; hazard ratio [HR] = 14.75, P = 0.0005) and use of acid suppressive medications (HR = 4.94, P = 0.01) during the study period were positively associated with subsequent GI-related admissions. High levels of fecal calprotectin (fCP) (>200 μg/g) and higher relative abundance of fecal Klebsiella pneumoniae were also positively associated with subsequent GI-related admissions (HR = 2.64, P = 0.033 and HR = 4.49, P = 0.002, respectively). During the first 12 months of life, participants with any admission had lower weight-for-length z scores (WLZ) (P = 0.01). The impact of admission on WLZ was particularly evident in participants with a GI-related admission (P < 0.0001). CONCLUSIONS Factors associated with a higher risk for GI-related admission during the first 12 months include high PERT dosing, exposure to acid suppressive medications, higher fCP levels, and/or relative abundance of fecal K pneumoniae early in life. Infants with CF requiring GI-related hospitalization had lower WLZ at 12 months of age than those not admitted as well as those admitted for non-GI-related indications.
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Abstract
ABSTRACT Cystic fibrosis is an autosomal recessive genetic disorder that causes a lifetime of debilitating and potentially fatal complications affecting the lungs and other organ systems. Over 1,700 gene mutations that cause this rare disorder have been identified. This article describes the current treatment landscape for adults with CF, including the 2019 FDA approval of a breakthrough triple-drug combination therapy that may significantly improve the quality of life for an estimated 90% of patients with CF.
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Wendekier C, Wendekier-Raybuck K. Cystic fibrosis: A changing landscape. Nursing 2021; 51:32-38. [PMID: 34014874 DOI: 10.1097/01.nurse.0000751344.57701.75] [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: 11/26/2022]
Abstract
ABSTRACT Cystic fibrosis (CF) is an autosomal recessive genetic disorder that causes a lifetime of debilitating and life-threatening complications affecting the lungs and other organ systems. Over 1,700 gene mutations that cause this rare disorder have been identified. This article describes the current treatment landscape for adults with CF, including the 2019 FDA approval of a breakthrough triple-drug combination therapy that may significantly improve the quality of life for an estimated 90% of patients with CF.
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Affiliation(s)
- Camille Wendekier
- Camille Wendekier is program director, leadership/education at Saint Francis University in Loretto, Pa., and Katheryn Wendekier-Raybuck is a pharmacist in Pittsburgh, Pa
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11
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Ritchie H, Nahikian-Nelms M, Roberts K, Gemma S, Shaikhkhalil A. The prevalence of aberrations in body composition in pediatric cystic fibrosis patients and relationships with pulmonary function, bone mineral density, and hospitalizations. J Cyst Fibros 2021; 20:837-842. [PMID: 33933345 DOI: 10.1016/j.jcf.2021.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Body mass index (BMI) correlates with clinical outcomes in cystic fibrosis but has limitations. Body composition aberrations in CF are multifactorial. We sought to evaluate body composition and relationships with pulmonary function, bone health, and hospital admissions. Other aims included defining body composition indices in a cohort of children with CF. METHODS We conducted a retrospective review of patients with CF, age 8-18 years, seen at Nationwide Children's Hospital (2015-2020). Indices of body composition measured by dual-energy x-ray absorptiometry(DXA) scans. Data included fat mass, fat-free mass (FFM), forced expiratory volume in one second (FEV1%), bone mineral density (BMD), and hospital admissions. NWA was defined as BMI 5th-85th percentile, body fat percentage >85th percentile. FFMD defined as FFMI <10th percentile. STATISTICS T-tests compared NWA, FFMD and clinical measurements. Pearson correlations analyzed fat-free mass index (FFMI), fat mass index (FMI), BMI and clinical measurements. RESULTS This study included 114 patients. Mean age 12 years, 72 female. A high prevalence of FFMD existed (n=66, 38.6%). FMI and FFMI correlated with FEV1% (r: 0.23, p:0.01, r: 0.36, p<0.001, respectively) and BMD (r: 0.29, p:0.002). FMI and hospital admissions were related (r:-0.23,p:0.01). FFMD was associated with 9.5% lower FEV1% (p=0.001) and lower BMD Z-score by 1.1 (p<0.001) when compared to no FFMD. CONCLUSION This cohort of children with CF had a high prevalence of FFMD and low prevalence of NWA. FFMD was associated with worsened clinical measurements. Patients with FFMD need additional exercise or nutritional intervention. Heterogeneity of body composition definitions creates need for more research.
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Affiliation(s)
- Hannah Ritchie
- The Ohio State University, School of Health and Rehabilitation Sciences, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | - Marcia Nahikian-Nelms
- The Ohio State University, School of Health and Rehabilitation Sciences, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | - Kristen Roberts
- The Ohio State University, School of Health and Rehabilitation Sciences, 453 W. 10th Avenue, Columbus, OH, 43210, USA; The Ohio State University Wexner Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, 2nd Floor Doan Office Tower, 395 W. 12th Ave., Columbus, OH 43210-1228, USA.
| | - Susan Gemma
- Nationwide Children's Hospital, Division of Pulmonary Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Ala Shaikhkhalil
- Nationwide Children's Hospital, Division of Gastroenterology, Hepatology, and Nutrition, 700 Children's Drive, Columbus, OH 43205, USA.
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12
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Basile M, Jojan L, Hobler MR, Dellon EP, Georgiopoulos AM, Goggin JL, Chen E, Goss CH, Hempstead SE, Faro A, Kavalieratos D. Assessing Practices, Beliefs, and Attitudes about Palliative Care among People with Cystic Fibrosis, Their Caregivers, and Clinicians: Results of a Content Analysis. J Palliat Med 2021; 24:1650-1656. [PMID: 33885355 DOI: 10.1089/jpm.2020.0725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with cystic fibrosis (CF) experience symptoms affecting quality of life and may benefit from palliative care (PC). Objectives: To present results of content analysis from open-ended survey questions assessing knowledge and experiences with PC among CF stakeholders. Design, Setting, Subjects: Online surveys were sent to CF stakeholders through CF-specific listservs predominantly in the United States. Measurements: Responses to five open-ended questions about CF PC-delivery, health care provider training, and lung transplant-underwent content analysis. Responses were coded using NVivo12 Software™. Results: Forty-eight CF adults, 59 caregivers, and 229 providers responded to the open-ended survey questions. Analysis showed 5 primary categories related to CF PC: (1) stakeholder perceptions of PC for CF, (2) delivering PC to people with CF, (3) conversations about PC for CF, (4) perceptions that PC services are underutilized for people with CF, and (5) beliefs that PC services are critical for people with CF considering or pursuing lung transplant. Analysis showed variation among and within groups in defining PC for CF, when, and how to deliver it. Many respondents felt PC was underutilized in CF. Most saw PC as particularly important when considering lung transplant, managing anxiety around transplant, and for goals of care discussions. Some believed PC and lung transplant were mutually exclusive. Conclusion: Respondents felt PC is underutilized for CF, and that people with CF may miss out on the benefits of PC. Among stakeholders, respondents felt people with CF would benefit from access to primary and secondary PC services.
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Affiliation(s)
| | - Lincy Jojan
- Molloy College, Rockville Centre, New York, USA
| | | | | | | | | | - Elaine Chen
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
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Dauber-Decker KL, Basile M, King D, Polo J, Calise K, Khan S, Solomon J, Dunne D, Hajizadeh N. Developing a Decision Aid to Facilitate Informed Decision Making About Invasive Mechanical Ventilation and Lung Transplantation Among Adults With Cystic Fibrosis: Usability Testing. JMIR Hum Factors 2021; 8:e21270. [PMID: 33851921 PMCID: PMC8082389 DOI: 10.2196/21270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/08/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background Cystic fibrosis (CF) is a life-limiting genetic disease that causes chronic lung infections. We developed an internet-based decision aid (DA) to help patients with CF make better informed decisions regarding treatments and advance care planning. We built the DA around two major treatment decisions: whether to have a lung transplant and whether to agree to invasive mechanical ventilation (intubation). Objective This study aims to conduct usability testing of the InformedChoices CF DA among key stakeholder groups. Methods We performed a patient needs assessment using think-aloud usability testing with patients with CF, their surrogates, and CF clinicians. Think-aloud participants provided feedback while navigating the DA, and after viewing, they answered surveys. Transcripts from the think-aloud sessions and survey results were categorized into common, generalizable themes and optimizations for improving content, comprehension, and navigation. We assessed the ease of use of the DA (System Usability Scale) and also assessed the participants’ perceptions regarding the overall tone, with an emphasis on emotional reactions to the DA content, level of detail, and usefulness of the information for making decisions about either intubation or lung transplantation, including how well they understood the information and were able to apply it to their own decision-making process. We also assessed the DA’s ease of navigation, esthetics, and whether participants were able to complete a series of usability tasks (eg, locating specific information in the DA or using the interactive survival estimates calculator) to ensure that the website was easy to navigate during the clinic-based advance care planning discussions. Results A total of 12 participants from 3 sites were enrolled from March 9 to August 30, 2018, for the usability testing: 5 CF clinicians (mean age 48.2, SD 12.0 years), 5 adults with CF, and 2 family and surrogate caregivers of people with CF (mean age of CF adults and family and surrogate caregivers 38.8, SD 10.8 years). Among the 12 participants, the average System Usability Scale score for the DA was 88.33 (excellent). Think-aloud analysis identified 3 themes: functionality, visibility and navigation, and content and usefulness. Areas for improvement included reducing repetition, enhancing comprehension, and changing the flow. Several changes to improve the content and usefulness of the DA were recommended, including adding information about alternatives to childbearing, such as adoption and surrogacy. On the basis of survey responses, we found that the navigation of the site was easy for clinicians, patients, and surrogates who participated in usability testing. Conclusions Usability testing revealed areas of potential improvement. Testing also yielded positive feedback, suggesting the DA’s future success. Integrating changes before implementation should improve the DA’s comprehension, navigation, and usefulness and lead to greater adoption.
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Affiliation(s)
- Katherine L Dauber-Decker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
| | - Melissa Basile
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
| | - D'Arcy King
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
| | - Jennifer Polo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
| | - Karina Calise
- School of Health Professions and Human Services, Hofstra University, Hempstead, NY, United States
| | - Sundas Khan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
| | - Jeffrey Solomon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
| | - Daniel Dunne
- iDEAL Institute, Loyola Marymount University, Los Angeles, CA, United States
| | - Negin Hajizadeh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, Manhasset, NY, United States
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14
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Tice JA, Kuntz KM, Wherry K, Seidner M, Rind DM, Pearson SD. The effectiveness and value of novel treatments for cystic fibrosis. J Manag Care Spec Pharm 2021; 27:276-280. [PMID: 33506736 PMCID: PMC10391049 DOI: 10.18553/jmcp.2021.27.2.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, America's Health Insurance Plans, Anthem, Allergan, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare. Seidner, Rind, and Pearson are employed by ICER. Tice reports contracts to his institution, University of California, San Francisco, from ICER during the conduct of this study. Wherry has nothing to disclose.
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Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, University of California, San Francisco
| | | | - Kael Wherry
- School of Public Health, University of Minnesota
| | - Matt Seidner
- Institute for Clinical and Economic Review, Boston, MA
| | - David M Rind
- Institute for Clinical and Economic Review, Boston, MA
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Stephan EM, Nemastil CJ, Salvator A, Gemma S, Dilaveris CJ, Rice A, Sakellaris KT, Novak KJ, McCoy KS. Practitioner Due Diligence: Real-World Lumacaftor/Ivacaftor Use. J Pediatr Pharmacol Ther 2020; 25:431-436. [PMID: 32641913 DOI: 10.5863/1551-6776-25.5.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous trials evaluated the efficacy of lumacaftor/ivacaftor in Phe508del homozygotes. These trials are limited by manufacturer sponsorship and were conducted under strict protocol. Additionally, this therapy is costly and does not allow for reduction in daily cystic fibrosis therapies. This study assessed the efficacy of lumacaftor/ivacaftor therapy and its effect on health care utilization in a real-world setting. METHODS Retrospective chart review comparing the first 12 months of therapy to the 24 months prior was conducted to evaluate the impact of lumacaftor/ivacaftor on pulmonary function following a streamlined process for therapy introduction. The impact on body mass index and healthcare utilization were also evaluated. The following measurements were assessed: percent predicted forced expiratory volume in 1 second, body mass index and z-scores, number of admissions, length of stay, number of emergency department visits. RESULTS Mean ppFEV1 was improved for the first 12 months on lumacaftor/ivacaftor treatment when compared with the 24 months prior: 78.8 (95% CI: 72.6, 84.9) vs 76.2 (95% CI: 70.1, 82.3) (p = 0.03). Body mass index significantly improved (patients ≥20 years), but improvement in BMI z-score (patients <20 years) was not significant. Number of admissions and LOS were significantly decreased, but ED visits were not. CONCLUSIONS Lumacaftor/ivacaftor is effective for improving ppFEV1 and BMI and for reducing health care utilization. However, this small reduction does not overcome the financial cost of treatment. Long-term outcomes and use must be studied to determine the overall effect of this therapy on cystic fibrosis interventions and their costs.
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Boullata JI, Clarke JL, Stone A, Skoufalos A, Nash DB. Optimizing Clinical and Cost Outcomes for Patients on Enteral Nutrition Support for Treatment of Exocrine Pancreatic Insufficiency: Proceedings from an Expert Advisory Board Meeting. Popul Health Manag 2020; 22:S1-S10. [PMID: 31066618 PMCID: PMC6537119 DOI: 10.1089/pop.2019.0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Joseph I Boullata
- 1 Department of Nutrition Sciences, Drexel University, Philadelphia, Pennsylvania.,2 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janice L Clarke
- 3 Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - Archie Stone
- 4 Alcresta Therapeutics, Inc., Newton, Massachusetts
| | - Alexis Skoufalos
- 3 Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - David B Nash
- 3 Jefferson College of Population Health, Philadelphia, Pennsylvania
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17
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Marsteller NL, Nussbaum E, Morphew T, Randhawa IS. Cystic fibrosis patients at risk for disease progression marked by decline in FEV1% predicted: development of the cystic fibrosis risk of disease progression score. J Thorac Dis 2020; 11:5557-5565. [PMID: 32030275 DOI: 10.21037/jtd.2019.11.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cystic fibrosis (CF) is one of the most common recessively inherited disorders diagnosed in early childhood in the United States. Determining the phenotype of CF patients likely to experience a significant drop in FEV1% predicted will help target efforts for mitigating this deleterious disorder. Methods This retrospective cohort study evaluated potential risk variables that account for the decline in FEV1% predicted in 81 CF patients treated at Miller Children's and Women's Hospital, CA. Cystic fibrosis risk of disease progression (CF RD-Pro) score was evaluated as a tool to identify high-risk patients for accelerated disease progression (event = drop in FEV1% predicted ≥10 percentage points) based on risk variables identified as significant. Results ROC analysis determined classification of high versus low-moderate risk of FEV1% decline during year two based on RD-Pro score. Scores ≥2 applied as threshold for high-risk revealed relatively good validity estimates: sensitivity =82.8%, specificity =66.7%, PVP =77.4%, PVN =73.7%, and correct classification =76%. Patients with CF RD-Pro scores suggestive of high (≥2 points) vs. low-moderate (<2 points) risk were nearly 10 times more likely to experience significant disease progression (OR 9.6, 95% CI, 2.6-36.1, P=0.001). Conclusions Identification of patients at high risk for significant decline in lung function will enable address of potential therapeutic modalities, environmental exposures, and behavioral variants that may improve outcomes in these patients. The power of the CF RD-Pro Score lies in its simplicity. Our study provides a novel readily available score, which incorporates body mass index (BMI) and Staphylococcus aureus infection, both being alterable targets for slowing CF progression.
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Affiliation(s)
- Nathan L Marsteller
- The Translational Pulmonary and Immunology Research Center (TPIRC), Long Beach, CA, USA.,MemorialCare Health System, Long Beach, CA, USA
| | - Eliezer Nussbaum
- MemorialCare Health System, Long Beach, CA, USA.,Pediatric Pulmonology Division, Miller Children's Hospital, Long Beach, CA, USA.,University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Tricia Morphew
- MemorialCare Health System, Long Beach, CA, USA.,Morphew Consulting, LLC, Bothell, WA, USA
| | - Inderpal S Randhawa
- The Translational Pulmonary and Immunology Research Center (TPIRC), Long Beach, CA, USA.,MemorialCare Health System, Long Beach, CA, USA.,Pediatric Pulmonology Division, Miller Children's Hospital, Long Beach, CA, USA.,University of California, Irvine School of Medicine, Irvine, CA, USA
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18
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Basile M, Andrews J, Wang J, Hadjiliadis D, Henthorne K, Fields S, Kozikowski A, Huamantla J, Hajizadeh N. Using qualitative methods to inform the design of a decision aid for people with advanced cystic fibrosis: The InformedChoices CF patient decision aid. PATIENT EDUCATION AND COUNSELING 2019; 102:1985-1990. [PMID: 31248766 DOI: 10.1016/j.pec.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess information needs of adults with Cystic Fibrosis and their families toward designing a patient decision aid about invasive mechanical ventilation (IMV) and lung transplant. METHODS Focus groups and in-depth interviews explored participants' knowledge, prior clinical conversations, and decisions about IMV and lung transplant. Interviews and focus groups were recorded and transcribed for analysis. RESULTS N = 24 participants were recruited. Themes identified were: prior communication with clinicians, decision-making process, and living with CF. Participants having prior conversations with CF clinicians regarding: lung transplant (N = 17/74%), and IMV (N = 3/13%). Most 15(65%) felt it was important to hear patients' real-life experience, others (3/13%) relied on their CF doctors for information. Most people (16/70%) believed hearing prognosis was helpful, but 5(22%) found this information frightening. High degrees of social isolation and a desire for more interaction with other CF adults were found. CONCLUSIONS Qualitative methods helped identify areas important for decision making about IMV and LT for CF adults. Future directions include usability and feasibility testing of the decision aid. PRACTICE IMPLICATIONS Because IMV is rarely discussed with CF adults, clinicians might approach this topic, as with transplant, as lung function begins to decline. CF-care teams should also foster CF patient-level information exchange.
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Affiliation(s)
- Melissa Basile
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, 600 Community Drive, Suite 403, Manhasset NY, 11030, United States.
| | - Johanna Andrews
- Center for Health Disparities Research, School of Community Health Sciences, University of Nevada, Las Vegas, United States.
| | - Janice Wang
- Adult Cystic Fibrosis Center, Hofstra Northwell School of Medicine, United States.
| | - Denis Hadjiliadis
- Perelman School of Medicine at the University of Pennsylvania, Division of Pulmonary, Allergy and Critical Care, United States.
| | - Katherine Henthorne
- Adult Pulmonary Medicine and Cystic Fibrosis Center, Division of Long Island Jewish Medical Center, United States.
| | | | | | | | - Negin Hajizadeh
- Department of Medicine, Hofstra Northwell School of Medicine, United States.
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Trandafir LM, Leon MM, Frasinariu O, Baciu G, Dodi G, Cojocaru E. Current Practices and Potential Nanotechnology Perspectives for Pain Related to Cystic Fibrosis. J Clin Med 2019; 8:jcm8071023. [PMID: 31336857 PMCID: PMC6678759 DOI: 10.3390/jcm8071023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Pain is a complex, multidimensional process that negatively affects physical and mental functioning, clinical outcomes, quality of life, and productivity for cystic fibrosis (CF) patients. CF is an inherited multi-system disease that requires a complete approach in order to evaluate, monitor and treat patients. The landscape in CF care has changed significantly, with currently more adult patients than children worldwide. Despite the great advances in supportive care and in our understanding regarding its pathophysiology, there are still numerous aspects of CF pain that are not fully explained. This review aims to provide a critical overview of CF pain research that focuses on pain assessment, prevalence, characteristics, clinical association and the impact of pain in children and adults, along with innovative nanotechnology perspectives for CF management. Specifically, the paper evaluates the pain symptoms associated with CF and examines the relationship between pain symptoms and disease severity. The particularities of gastrointestinal, abdominal, musculoskeletal, pulmonary and chest pain, as well as pain associated with medical procedures are investigated in patients with CF. Disease-related pain is common for patients with CF, suggesting that pain assessment should be a routine part of their clinical care. A summary of the use of nanotechnology in CF and CF-related pain is also given. Further research is clearly needed to better understand the sources of pain and how to improve patients’ quality of life.
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Affiliation(s)
- Laura M Trandafir
- Pediatric Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Magdalena M Leon
- Medical I Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Otilia Frasinariu
- Pediatric Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Ginel Baciu
- Pediatric Department, "Dunărea de Jos" University of Galati, 800008 Galati, Romania
| | - Gianina Dodi
- Advanced Centre for Research-Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania.
| | - Elena Cojocaru
- Morpho-Functional Sciences Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
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Bono-Neri F, Romano C, Isedeh A. Cystic Fibrosis: Advancing Along the Continuum. J Pediatr Health Care 2019; 33:242-254. [PMID: 30529125 DOI: 10.1016/j.pedhc.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/09/2018] [Accepted: 08/19/2018] [Indexed: 12/12/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disorder resulting from a mutation in the gene which encodes a cellular transmembrane protein channel known as the CF transmembrane conductance regulator. Located systemically on the surface of numerous cells, these altered channels yield multisystem dysfunction. Typical manifestations seen are chronic, progressive, obstructive lung disease, pancreatic insufficiency, CF-related diabetes mellitus, malabsorption and malnutrition, liver disease, and infertility.Once considered a pediatric disorder, through developments in innovative care and therapeutic modalities, CF now spans the life continuum and has established itself as an ageless disease. Facing management of maturing-life issues, advanced practice nurses (APNs) in pediatrics now find themselves needing to collaborate with or facilitate transition of care to other APNs, such as nurse midwives and adult APNs, as well as their counterpart specialists in medicine, all while maintaining open communication with the patient, family and managing CF center.
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21
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Vasylieva N, Kitamura S, Dong J, Barnych B, Hvorecny KL, Madden DR, Gee SJ, Wolan DW, Morisseau C, Hammock BD. Nanobody-based binding assay for the discovery of potent inhibitors of CFTR inhibitory factor (Cif). Anal Chim Acta 2019; 1057:106-113. [PMID: 30832908 DOI: 10.1016/j.aca.2018.12.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022]
Abstract
Lead identification and optimization are essential steps in the development of a new drug. It requires cost-effective, selective and sensitive chemical tools. Here, we report a novel method using nanobodies that allows the efficient screening for potent ligands. The method is illustrated with the cystic fibrosis transmembrane conductance regulator inhibitory factor (Cif), a virulence factor secreted by the opportunistic pathogen Pseudomonas aeruginosa. 18 nanobodies selective to Cif were isolated by bio-panning from nanobody-phage library constructed from immunized llama. 8 out of 18 nanobodies were identified as potent inhibitors of Cif enzymatic activity with IC50s in the range of 0.3-6.4 μM. A nanobody VHH219 showed high affinity (KD = 0.08 nM) to Cif and the highest inhibitory potency, IC50 = 0.3 μM. A displacement sandwich ELISA (dsELISA) with VHH219 was then developed for classification of synthetic small molecule inhibitors according their inhibitory potency. The developed assay allowed identification of new inhibitor with highest potency reported so far (0.16 ± 0.02 μM). The results from dsELISA assay correlates strongly with a conventional fluorogenic assay (R = 0.9998) in predicting the inhibitory potency of the tested compounds. However, the novel dsELISA is an order of magnitude more sensitive and allows the identification and ranking of potent inhibitors missed by the classic fluorogenic assay method. These data were supported with Octet biolayer interferometry measurements. The novel method described herein relies solely on the binding properties of the specific neutralizing nanobody, and thus is applicable to any pharmacological target for which such a nanobody can be found, independent of any requirement for catalytic activity.
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Affiliation(s)
- Natalia Vasylieva
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States
| | - Seiya Kitamura
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States; Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Jiexian Dong
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States
| | - Bogdan Barnych
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States
| | - Kelli L Hvorecny
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Dean R Madden
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Shirley J Gee
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States
| | - Dennis W Wolan
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Christophe Morisseau
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States.
| | - Bruce D Hammock
- Department of Entomology and Nematology and UCD Comprehensive Cancer Center, University of California, Davis, CA, 95616, United States
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King CS, Brown AW, Aryal S, Ahmad K, Donaldson S. Critical Care of the Adult Patient With Cystic Fibrosis. Chest 2019; 155:202-214. [DOI: 10.1016/j.chest.2018.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/24/2023] Open
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Abstract
Research and application of genomic medicine in lung disease during the past century has clarified our understanding and focus on specific phenotypes, helping clinicians tailor treatment for individual patients. Cystic fibrosis and lung cancer have been researched extensively; specific genotypes have been instrumental in precision medicine to treat these lung diseases. Asthma and chronic obstructive pulmonary disease are more complex and heterogeneous in their pathogenesis, genotypic profile, and phenotypic expression, making treatment more difficult with increasing disease severity. This article focuses on the evolving state of the science of precision medicine in lung cancer, chronic obstructive pulmonary disease, asthma, and cystic fibrosis. The body of knowledge in lung disease is growing related to pharmacogenomics, clinical guidelines, genome editing, and approaches to genomic health that will guide clinical treatment options, reduce risk, and promote health.
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Triclosan Is an Aminoglycoside Adjuvant for Eradication of Pseudomonas aeruginosa Biofilms. Antimicrob Agents Chemother 2018; 62:AAC.00146-18. [PMID: 29661867 DOI: 10.1128/aac.00146-18] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/31/2018] [Indexed: 02/06/2023] Open
Abstract
One of the most important clinical obstacles in cystic fibrosis (CF) treatment is antibiotic treatment failure due to biofilms produced by Pseudomonas aeruginosa The ability of this pathogen to survive eradication by tobramycin and pathoadapt into a hyperbiofilm state leading to chronic infections is key to its success. Retrospective studies have demonstrated that preventing this pathoadaptation by improving eradication is essential to extend the lives of CF patients. To identify adjuvants that enhance tobramycin eradication of P. aeruginosa, we performed a high-throughput screen of 6,080 compounds from four drug-repurposing libraries. We identified that the Food and Drug Administration (FDA)-approved compound triclosan, in combination with tobramycin, resulted in a 100-fold reduction of viable cells within biofilms at 6 h, but neither compound alone had significant antimicrobial activity against biofilms. This synergistic treatment significantly accelerated the killing of biofilms compared to that with tobramycin treatment alone, and the combination was effective against 6/7 CF clinical isolates compared to tobramycin treatment alone, including a tobramycin-resistant strain. Further, triclosan and tobramycin killed persister cells, causing a 100-fold reduction by 8 h and complete eradication by 24 h. Triclosan also enhances tobramycin killing of multiple Burkholderia cenocepacia and Staphylococcus aureus clinical isolates grown as biofilms. Additionally, triclosan showed synergy with other aminoglycosides, such as gentamicin or streptomycin. Triclosan is a well-tolerated aminoglycoside adjuvant shown to be safe for human use that could improve the treatment of biofilm-based infections.
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