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Tariq SM, Abdallah AO, Goodman A, Sborov D, Mohyuddin GR, Britt A. The Landscape of Currently Enrolling Maintenance Trials in Multiple Myeloma. Clin Hematol Int 2023:10.1007/s44228-023-00044-8. [PMID: 37133718 DOI: 10.1007/s44228-023-00044-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 05/04/2023] Open
Abstract
Maintenance therapies in multiple myeloma improve survival after induction treatment. This study characterizes the strategies for maintenance therapy being employed in currently enrolling clinical trials for patients with multiple myeloma and highlights how high-risk myeloma patients may be assigned to maintenance strategies incongruent with current US guidelines.
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Affiliation(s)
| | - Al-Ola Abdallah
- Division of Hematological Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aaron Goodman
- Division of Hematology and Oncology, University of California San Diego, La Jolla, CA, USA
| | - Douglas Sborov
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, UT, USA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, UT, USA.
| | - Alec Britt
- Division of Hematological Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
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Grewal J, Bortner B, Gregoski M, Cook D, Britt A, Hajj J, Rofael M, Sheidu M, Montovano M, Mehta M, Hajduczok A, Rajapreyar I, Brailovski Y, Genuardi M, Kanwar M, Atluri P, Lander M, Shah P, Hsu S, Kilic A, Houston B, Tedford R. Validation of the Heartmate 3 Risk Score in a Real World Patient Cohort. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ehsan H, Britt A, Voorhees PM, Paul B, Bhutani M, Varga C, Chiad Z, Ragon BK, Abdallah AOA, Ahmed N, Atrash S. Retrospective Review of Outcomes of Multiple Myeloma (MM) Patients With COVID-19 Infection (Two-Center Study). Clin Lymphoma Myeloma Leuk 2023; 23:273-278. [PMID: 36797155 PMCID: PMC9847363 DOI: 10.1016/j.clml.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION COVID-19 has profound effects on patients with multiple myeloma (MM) mainly due to underlying immune dysfunction and associated therapies leading to increased susceptibility to infections. The overall risk of morbidity and mortality (M&M) in MM patients due to COVID-19 infection is unclear with various studies suggesting case fatality rate of 22% to 29%. Additionally, most of these studies did not stratify patients by their molecular risk profile. METHODS Here, we aim to investigate the effects of COVID-19 infection with associated risk factors in MM patients and the effectiveness of newly implemented screening and treatment protocols on outcomes. After obtaining institutional review board approvals from each participating institution, we collected data from MM patients diagnosed with SARS-CoV-2 infection from March 1, 2020, to October 30, 2020, at 2 myeloma centers (Levine Cancer Institute & University of Kansas medical center). RESULTS We identified a total of 162 MM patients who had COVID-19 infection. The majority of patients were males (57%) with a median age of 64 years. Most patients had an associated comorbid condition. Their myeloma disease status and prior autologous stem cell transplant at the time of infection had no impact on hospitalization or mortality. In univariate analysis, chronic kidney disease, hepatic dysfunction, diabetes, and hypertension were associated with an increased risk of hospitalization. In multivariate analysis regarding survival, increased age and lymphopenia were associated with increased COVID-19-related mortality. CONCLUSION Our study supports the use of infection mitigation measures in all MM patients, and adjustment of treatment pathways in MM patients diagnosed with COVID-19.
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Affiliation(s)
- Hamid Ehsan
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Alec Britt
- Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center, Kansas City, KS
| | - Peter M Voorhees
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Barry Paul
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Manisha Bhutani
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Cindy Varga
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Zane Chiad
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Brittany K Ragon
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC
| | - Al-Ola A Abdallah
- Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center, Kansas City, KS
| | - Nausheen Ahmed
- Hematologic Malignancies and Cellular Therapeutics University of Kansas Medical Center, Kansas City, KS
| | - Shebli Atrash
- Department of Hematology/ OncologyMember, Plasma Cell Disorders Program Levine Cancer Institute, Atrium Health/Wake Forest Baptist, Charlotte, NC.
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Ehsan H, Britt A, Voorhees PM, Paul B, Bhutani M, Varga C, Chiad Z, Ragon BK, Shahid Z, Shahoud M, Abdallah AOA, Ahmed N, Atrash S. Retrospective review of outcomes of patients with multiple myeloma with COVID-19 infection (two-center study). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8048 Background: Coronavirus-2 has profound effects on patients (pts) with Multiple myeloma (MM). At the beginning of the pandemic, COVID-19 infection resulted an overall mortality around 54% (cook et al. BMJ 2020). Here, we report an updated morbidity and fatality for MM. Methods: After obtaining IRB approvals from each participating institute, retrospectively, between January 1, 2021 and August 30, 2021, we identified pts with MM and COVID-19 in two myeloma centers (Levine Cancer Institute (LCI) & the University of Kansas medical center (KUMC). Results: We identified 162 MM pts who had COVID-19 (LCI n=132, UKMC n=30), including 57% males, with median age of 64 years. Current or former smoking reported in 40% of pts. Most pts have associated comorbid conditions: hypertension (45%), hypogammaglobulinemia (32%), CKD (30%), DM (22%), obesity (16.6%), CHF (14%), and CAD (13.5%). Within 3 months prior to infection, treatment included immunomodulatory combinations in 35%, proteasome inhibitors in 28 %, and Daratumumab in 26.5%. Symptoms are summarized in table. 69% had Mild symptoms (no need for hospitalization), 20 % had moderate symptoms (requiring hospitalization), and 9.8% had severe symptoms (ICU level of care). The 18% of pts required oxygen: 6 pts required invasive oxygenation and 3 pts needed vasopressors. The 32% of pts had RRMM, 29.5% on maintenance, and 12% was getting induction. Regarding MM response: >VGPR in 45% and PD in 18%. The 78 pts had ASCT prior to COVID-19 infection: only 3 pts < 1 year and 3 pts < 6 months. MM response or ASCT did not affect hospitalization or mortality.The case fatality rate (CFR) was 6%. In the univariate analysis, CKD, DM, HTN and hepatic dysfunction were associated with an increased risk of hospitalization. However, in multivariate analysis, only CKD, hepatic dysfunction, and Hypogammaglobulinemia significantly increased the risk of admission with only age and lymphopenia were associated with increased COVID-19 related fatatlity. Conclusions: With implementation of center-specific disease control measures and universal screening, pts might have lower case severity and fatality rate than was initially reported. [Table: see text]
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Affiliation(s)
- Hamid Ehsan
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | | | | | - Manisha Bhutani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute/Carolinas Healthcare System, Charlotte, NC
| | - Cindy Varga
- Levine Cancer Institute-University, Charlotte, NC
| | | | | | | | | | | | - Nausheen Ahmed
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
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El Alayli A, Brignardello Petersen R, Husainat NM, Kalot MA, Aljabiri Y, Turkmani H, Britt A, El-Khechen H, Shahid S, Roller J, Motaghi S, Mansour R, Tosetto A, Abdul-Kadir R, Laffan M, Weyand A, Leebeek FWG, Arapshian A, Kouides P, James P, Connell NT, Flood VH, Mustafa RA. Outcomes of long-term von Willebrand factor prophylaxis use in von Willebrand disease: A systematic literature review. Haemophilia 2022; 28:373-387. [PMID: 35339117 DOI: 10.1111/hae.14550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Von Willebrand Disease (VWD) is a common inherited bleeding disorder. Patients with VWD suffering from severe bleeding may benefit from the use of secondary long-term prophylaxis. AIM Systematically summarize the evidence on the clinical outcomes of secondary long-term prophylaxis in patients with VWD and severe recurrent bleedings. METHODS We searched Medline and EMBASE through October 2019 for relevant randomized clinical trials (RCTs) and comparative observational studies (OS) assessing the effects of secondary long-term prophylaxis in patients with VWD. We used Cochrane Risk of Bias (RoB) tool and the RoB for Non-Randomized Studies of interventions (ROBINS-I) tool to assess the quality of the included studies. We conducted random-effects meta-analyses and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS We included 12 studies. Evidence from one placebo controlled RCT suggested that VWD prophylaxis as compared to no prophylaxis reduced the rate of bleeding episodes (Rate ratio [RR], .24; 95% confidence interval [CI], .17-.35; low certainty evidence), and of epistaxis (RR, .38; 95%CI, .21-.67; moderate certainty evidence), and may increase serious adverse events RR 2.73 (95%CI .12-59.57; low certainty). Evidence from four before-and-after studies in which researchers reported comparative data suggested that VWD prophylaxis reduced the rate of bleeding (RR .34; 95%CI, .25-.46; very low certainty evidence). CONCLUSION VWD prophylaxis treatment seems to reduce the risk of spontaneous bleeding, epistaxis, and hospitalizations. More RCTs should be conducted to increase the certainty in these benefits.
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Affiliation(s)
- Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Nedaa M Husainat
- Department of Internal Medicine, St. Mary's Hospital, Saint Louis, Missouri, USA
| | - Mohamad A Kalot
- The State University of New York at Buffalo Department of Internal Medicine, Buffalo, New York, USA
| | - Yazan Aljabiri
- Lincoln Medical and Mental Health Center, The Bronx, New York, USA
| | - Hani Turkmani
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alec Britt
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hussein El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shaneela Shahid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - John Roller
- Department of Hematology/Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Razan Mansour
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alberto Tosetto
- Hemophilia and Thrombosis Center, Hematology Department, S. Bortolo Hospital, Vicenza, Italy
| | - Rezan Abdul-Kadir
- The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
| | - Angela Weyand
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Peter Kouides
- Mary M. Gooley Hemophilia Treatment Center, University of Rochester, Rochester, New York, USA
| | - Paula James
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nathan T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Veronica H Flood
- Department of Pediatrics, Medical College of Wisconsin, Versiti Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Brignardello-Petersen R, El Alayli A, Husainat N, Kalot MA, Shahid S, Aljabirii Y, Britt A, Alturkmani H, El-Khechen H, Motaghi S, Roller J, Abdul-Kadir R, Couper S, Kouides P, Lavin M, Ozelo MC, Weyand A, James PD, Connell NT, Flood VH, Mustafa RA. Gynecologic and obstetric management of women with von Willebrand disease: summary of 3 systematic reviews of the literature. Blood Adv 2022; 6:228-237. [PMID: 34673921 PMCID: PMC8753192 DOI: 10.1182/bloodadvances.2021005589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
von Willebrand disease (VWD) disproportionately affects women because of the potential for heavy menstrual bleeding (HMB), delivery complications, and postpartum hemorrhage (PPH). To systematically synthesize the evidence regarding first-line management of HMB, treatment of women requiring or desiring neuraxial analgesia, and management of PPH. We searched Medline and EMBASE through October 2019 for randomized trials, comparative observational studies, and case series comparing the effects of desmopressin, hormonal therapy, and tranexamic acid (TxA) on HMB; comparing different von Willebrand factor (VWF) levels in women with VWD who were undergoing labor and receiving neuraxial anesthesia; and measuring the effects of TxA on PPH. We conducted duplicate study selection, data abstraction, and appraisal of risk of bias. Whenever possible, we conducted meta-analyses. We assessed the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. We included 1 randomized trial, 3 comparative observational studies, and 10 case series. Moderate-certainty evidence showed that desmopressin resulted in a smaller reduction of menstrual blood loss (difference in mean change from baseline, 41.6 [95% confidence interval, 16.6-63.6] points in a pictorial blood assessment chart score) as compared with TxA. There was very-low-certainty evidence about how first-line treatments compare against each other, the effects of different VWF levels in women receiving neuraxial anesthesia, and the effects of postpartum administration of TxA. Most of the evidence relevant to the gynecologic and obstetric management of women with VWD addressed by most guidelines is very low quality. Future studies that address research priorities will be key when updating such guidelines.
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Affiliation(s)
| | - Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
| | - Nedaa Husainat
- Department of Internal Medicine, St. Mary’s Hospital, St. Louis, MO
| | - Mohamad A. Kalot
- Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Shaneela Shahid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Alec Britt
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Hani Alturkmani
- Department of Cardiovascular Medicine University of Arkansas for Medical Sciences, Little Rock, AR
| | - Hussein El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - John Roller
- Department of Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Rezan Abdul-Kadir
- The Royal Free National Health Service Foundation (NHS) Hospital and Institute for Women’s Health, University College London, London, United Kingdom
| | | | - Peter Kouides
- Mary M. Gooley Hemophilia Treatment Center, University of Rochester, Rochester, NY
| | - Michelle Lavin
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St. James’ Hospital, Dublin, Ireland
| | | | - Angela Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Paula D. James
- Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Nathan T. Connell
- Hematology Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Veronica H. Flood
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; and
- Versiti Blood Research Institute, Milwaukee, WI
| | - Reem A. Mustafa
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
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Brignardello-Petersen R, El Alayli A, Husainat N, Kalot M, Shahid S, Aljabirii Y, Britt A, Alturkmani H, El-Khechen H, Motaghi S, Roller J, Dimassi A, Abughanimeh O, Madoukh B, Arapshian A, Grow JM, Kouides P, Laffan M, Leebeek FWG, O’Brien SH, Tosetto A, James PD, Connell NT, Flood V, Mustafa RA. Surgical management of patients with von Willebrand disease: summary of 2 systematic reviews of the literature. Blood Adv 2022; 6:121-128. [PMID: 34654053 PMCID: PMC8753200 DOI: 10.1182/bloodadvances.2021005666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/20/2021] [Indexed: 01/19/2023] Open
Abstract
von Willebrand disease (VWD) is the most common inherited bleeding disorder. The management of patients with VWD who are undergoing surgeries is crucial to prevent bleeding complications. We systematically summarized the evidence on the management of patients with VWD who are undergoing major and minor surgeries to support the development of practice guidelines. We searched Medline and EMBASE from inception through October 2019 for randomized clinical trials (RCTs), comparative observational studies, and case series that compared maintaining factor VIII (FVIII) levels or von Willebrand factor (VWF) levels at >0.50 IU/mL for at least 3 days in patients undergoing major surgery, and those with options for perioperative management of patients undergoing minor surgery. Two authors screened and abstracted data and assessed the risk of bias. We conducted meta-analyses when possible. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We included 7 case series for major surgeries and 2 RCTs and 12 case series for minor surgeries. Very-low-certainty evidence showed that maintaining FVIII levels or VWF levels of >0.50 IU/mL for at least 3 consecutive days showed excellent hemostatic efficacy (as labeled by the researchers) after 74% to 100% of major surgeries. Low- to very-low-certainty evidence showed that prescribing tranexamic acid and increasing VWF levels to 0.50 IU/mL resulted in fewer bleeding complications after minor procedures compared with increasing VWF levels to 0.50 IU/mL alone. Given the low-quality evidence for guiding management decisions, a shared-decision model leading to individualized therapy plans will be important in patients with VWD who are undergoing surgical and invasive procedures.
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Affiliation(s)
| | - Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
| | - Nedaa Husainat
- Department of Internal Medicine, St. Mary’s Hospital, St. Louis, MO
| | - Mohamad Kalot
- Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Shaneela Shahid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Alec Britt
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Hani Alturkmani
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Hussein El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - John Roller
- Department of Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Ahmad Dimassi
- Department of Internal Medicine, Lebanese American University Medical Center, Ashrafiye, Beirut, Lebanon
| | - Omar Abughanimeh
- Division of Oncology and Hematology, University of Nebraska Medical Center-Fred & Pamela Buffett Cancer Center, Omaha, NE
| | - Bader Madoukh
- Department of Internal Medicine, State University of New York-Upstate Medical University, Syracuse, NY
| | | | - Jean M. Grow
- Department of Strategic Communication, Marquette University, Milwaukee, WI
| | - Peter Kouides
- University of Rochester, Mary M. Gooley Hemophilia Treatment Center, Rochester, NY
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Frank W. G. Leebeek
- Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sarah H. O’Brien
- Division of Hematology/Oncology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Alberto Tosetto
- Hematology Department, Hemophilia and Thrombosis Center, S. Bortolo Hospital, Vicenza, Italy
| | - Paula D. James
- Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Nathan T. Connell
- Hematology Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Veronica Flood
- Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, WI; and
- Versiti Blood Research Institute, Milwaukee, WI
| | - Reem A. Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
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Britt A, Mohyuddin GR, McClune B, Singh A, Lin T, Ganguly S, Abhyankar S, Shune L, McGuirk J, Skikne B, Godwin A, Pessetto Z, Golem S, Divine C, Dias A. Acute myeloid leukemia or myelodysplastic syndrome with chromosome 17 abnormalities and long-term outcomes with or without hematopoietic stem cell transplantation. Leuk Res 2020; 95:106402. [PMID: 32590108 DOI: 10.1016/j.leukres.2020.106402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chromosome 17 abnormalities, especially disorders of the 17p region and including TP53 gene mutations, result in very low rates of cure for patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) treated with conventional chemotherapy or allogeneic hematopoietic cell transplant (allo-HCT). Our retrospective study analyzed outcomes in patients with chromosome 17 (ch17) abnormalities who received conventional chemotherapy followed by allo-HCT versus those who did not receive a transplant. We analyzed whether poor outcomes extend to patients with all types of ch17 abnormalities and the impact of concomitant TP53 gene mutations assessed by next-generation sequencing (NGS) on prognosis. METHODS We retrospectively analyzed diagnostic and outcome data on 98 patients treated at our institution from 2012 to 2018 with AML or MDS who possessed ch17 abnormalities by cytogenetic analysis. The presence of TP53 mutations was analyzed by NGS. Primary endpoint of our study was overall survival (OS). RESULTS 61 patients with AML and 37 with MDS were included. Complete remission (CR) with first line treatment was similar between induction chemotherapy or hypomethylating agents (HMA), 22.9 % versus 21.6 % (p = 0.33). Median OS for all patients (with or without transplant) was 10 months. Patients with abnormal ch17 in conjunction with any TP53 mutation(s) exhibited worse OS compared to patients without a TP53 mutation (10 versus 23 months, p = 0.02). 30 patients (19 AML, 11 MDS) underwent HCT, with a median OS of 11 months. For AML patients who underwent allo-HCT, 18 were in CR (13 with cytogenetic remission) and 1 had persistent disease at transplant. In the MDS cohort, 3 patients were in CR (2 with cytogenetic remission) and 8 had stable disease. Post allo-HCT survival of AML and MDS cohorts did not differ (p = 0.6), although cytogenetic CR at time of HCT trended towards improved OS (17 versus 8 months; p = 0.6). CONCLUSIONS AML/MDS patients with ch17 abnormalities have poor outcomes with or without HCT. Our results show that patients with ch17 abnormalities and TP53 mutations have a significantly poorer survival compared to patients who have ch17 abnormalities but no TP53 mutations. Drugs targeting abnormalities of the p53 pathway, improvement in depth of response prior to HCT, and novel maintenance strategies are needed for improved outcomes in these patients.
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Affiliation(s)
- Alec Britt
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Ghulam Rehman Mohyuddin
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States.
| | - Brian McClune
- Huntsman Cancer Center, Division of Hematology, University of Utah, United States
| | - Anurag Singh
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Tara Lin
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States; University of Kansas Medical Center, Department of Pathology, United States
| | - Siddhartha Ganguly
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Sunil Abhyankar
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Leyla Shune
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Joseph McGuirk
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Barry Skikne
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Andrew Godwin
- University of Kansas Medical Center, Department of Pathology, United States
| | - Ziyan Pessetto
- University of Kansas Medical Center, Department of Pathology, United States
| | - Shivani Golem
- University of Kansas Medical Center, Department of Pathology, United States
| | - Clint Divine
- University of Kansas Medical Center, Division of Hematologic Malignancies and Biomolecular Therapeutics, Kansas City, KS, United States
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, United States
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Mohyuddin GR, Aziz M, Britt A, Wade L, Sun W, Baranda J, Al-Rajabi R, Saeed A, Kasi A. Similar response rates and survival with PARP inhibitors for patients with solid tumors harboring somatic versus Germline BRCA mutations: a Meta-analysis and systematic review. BMC Cancer 2020; 20:507. [PMID: 32493233 PMCID: PMC7267765 DOI: 10.1186/s12885-020-06948-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND PARP inhibitors (PARPi) have recently been approved for various malignancies based on the results of several clinical trials. However, these trials have mostly recruited patients with germline BRCA mutations, and it is unclear whether PARPi have similar efficacy in patients with somatic BRCA mutations. Our study aimed to determine the efficacy of PARPi in patients with somatic BRCA mutations. METHODS We performed a meta-analysis comparing overall response rate to PARPi in patients harboring somatic versus germline BRCA mutations. We looked at studies including somatic and germline mutations in BRCA patients that received PARPi. RESULTS After screening and removing duplicates, 18 studies met our criteria for including both somatic and germline BRCA mutations. Only 8 studies reported response rates for both somatic and germline BRCA mutations. In those studies, 24 out of 43 patients with somatic BRCA mutations (55.8%), and 69 out of 157 (43.9%) patients with germline BRCA patients had a response to therapy to PARPi. This difference was not statistically significant (p = 0.399). In all five studies that reported progression-free survival, there was no obvious difference in outcomes between somatic versus germline BRCA patients, however a precise statistical analysis could not be performed. CONCLUSION Our meta-analysis and systematic review of the literature indicates similar response rates of PARPi therapy in patients with somatic and germline BRCA mutations. Investigation of use of PARPi therapy in a broader patient population, and the inclusion of somatic BRCA mutations in further clinical trials is paramount in improving therapeutic options for our patients.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Internal Medicine, University of Toledo, Toledo, USA
| | - Alec Britt
- Department of Internal Medicine, University of Kansas, Kansas City, USA
| | - Lee Wade
- University of Toledo Libraries, Toledo, USA
| | - Weijing Sun
- Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, USA
| | - Joaquina Baranda
- Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, USA
| | - Raed Al-Rajabi
- Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, USA
| | - Anwaar Saeed
- Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, USA
| | - Anup Kasi
- Division of Medical Oncology, University of Kansas Cancer Center, Kansas City, USA.
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Mohyuddin GR, Aziz M, Britt A, Wade L, Sun W, Baranda JC, Al-Rajabi RMT, Saeed A, Kasi A. Similar response rates and survival with PARPi treatments for patients harboring somatic versus germline BRCA mutations: A meta-analysis and systematic review. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16802 Background: PARP inhibitor (PARPi) has recently been approved for various cancers. However, trials have mostly recruited pts with germline BRCA (gBRCA) mutations, and it is unclear whether PARPi have similar efficacy in pts with somatic BRCA (sBRCA) mutations. We aimed to determine the efficacy of PARPi in pts with sBRCA mutations. Methods: Per PRISMA guidelines, systematic review of PubMed, Embase, Cochrane RCT, and Web of Science Collection was performed from inception thru Jan 2020 to identify studies. Our inclusion criteria were clinical trials and retrospective studies that reported use of PARPi in pts with both s and g BRCA mutations. We performed a meta-analysis comparing overall response rate and PFS with PARPi in pts with s versus g BRCA mutations. Results: After screening, 18 studies met our criteria for including both s and g BRCA mutations. Only 8 studies reported response rates for both s and g BRCA mutations (Table). In those studies, 24 out of 43 pts with sBRCA mutations (55.8%), and 69 out of 157 (43.9%) pts with gBRCA had a response to PARPi (pooled OR 1.13, p value = 0.399, I2 = 0). In all five studies that reported PFS, there was no obvious difference in outcomes between sBRCA (HR in these studies ranged 0.23 to 0.27) versus gBRCA (HR ranged 0.17 to 0.27), however a precise statistical analysis could not be done. Conclusions: Our meta-analysis and systematic review of the literature indicates similar outcomes of PARPi therapy in pts with s and g BRCA mutations. Investigation of use of PARPi therapy in a broader patient population, and the inclusion of sBRCA mutations in future clinical trials is essential. [Table: see text]
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Affiliation(s)
| | | | | | - Lee Wade
- University of Toledo, Toledo, OH
| | - Weijing Sun
- University of Kansas Medical Center, Kansas City, KS
| | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
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Britt A, Sethpati VR, McGuirk JP, Abhyankar S, Singh AK, Shune L, Lin T, Phadnis M, Cui W, Ganguly S. An Exploratory Trial to Estimate the Proportion of Patients with Tumor Cell Contaminated, Flow Positive Leukapheresis Products Collected with and without Bortezomib As in-Vivo Purging Prior to Autologous Stem Cell Harvest for Multiple Myeloma. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abbasi S, Britt A, McClune B, Shune L, Kambhampati S, Mohyuddin GR. Inpatient hospitalization's associated cost and mortality in myeloma patients undergoing autologous stem cell transplant: a 13-year analysis of the National Inpatient Sample. Leuk Lymphoma 2020; 61:1254-1256. [PMID: 32031039 DOI: 10.1080/10428194.2020.1719094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Saqib Abbasi
- Division of Hematologic Malignancies and Biomolecular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alec Britt
- Division of Hematologic Malignancies and Biomolecular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian McClune
- Division of Hematologic Malignancies and Biomolecular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Leyla Shune
- Division of Hematologic Malignancies and Biomolecular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Ghulam Rehman Mohyuddin
- Division of Hematologic Malignancies and Biomolecular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
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Fagan M, Blackwell M, Swint C, Britt A, Duberstein K. PSXVI-24 Effects of sericea lespedeza on parasite load and oxidative stress in mature horses. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Fagan
- University of Georgia,Athens, GA, United States
| | - M Blackwell
- University of Georgia,Athens, GA, United States
| | - C Swint
- University of Georgia,Athens, GA, United States
| | - A Britt
- University of Georgia,Athens, GA, United States
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Deavenport-Saman A, Britt A, Smith K, Jacobs RA. Milestones and controversies in maternal and child health: examining a brief history of micronutrient fortification in the US. J Perinatol 2017; 37:1180-1184. [PMID: 28749486 DOI: 10.1038/jp.2017.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/26/2017] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
Abstract
Fortification of our food and drinking supply has decreased morbidity rates related to micronutrient deficiencies among mothers and their children, particularly during the perinatal and neonatal periods of development. The purpose of this historical review is to examine the impact of public policy changes related to micronutrient fortification. We provide a historical investigation of achievements and controversies related to iodine, vitamin D, fluoride and folic acid fortifications in our food and drinking supply. We also discuss the current status of fortification recommendations and their significance to maternal and child health.
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Affiliation(s)
- A Deavenport-Saman
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
| | - A Britt
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
| | - K Smith
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Center for Excellence in Developmental Disabilities, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
| | - R A Jacobs
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Keck School of Medicine, Los Angeles, CA, USA
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Britt A. Diet and feeding behaviour of the black-and-white ruffed lemur (Varecia variegata variegata) in the Betampona Reserve, eastern Madagascar. Folia Primatol (Basel) 2000; 71:133-41. [PMID: 10828690 DOI: 10.1159/000021741] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The feeding behaviour and diet of the black-and-white ruffed lemur (Varecia variegata variegata) was investigated in the Betampona Reserve, eastern Madagascar. The highly frugivorous diet of this subspecies was confirmed - feeding on fruits accounting for 92.0% of feeding records. Most feeding at Betampona was observed at 10-25 m above the forest floor amongst flexible, small (0.5-5.0 cm diameter) and oblique/horizontal (0-45 degrees ) supports. The Varecia spent on average 21.7% (+/- 1.5) of their daily activity budget feeding and employ a variety of postures that enable them to harvest fruits in the rain forest canopy. The suspensory postures were the most important in allowing Varecia to compete with other smaller-bodied frugivores.
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Affiliation(s)
- A Britt
- Department of Human Anatomy and Cell Biology, University of Liverpool, and North of England Zoological Society, Chester Zoo, Chester, UK.
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Britt A, Jiang CZ. Generation, identification, and characterization of repair-defective mutants of Arabidopsis. Methods Mol Biol 1999; 113:31-40. [PMID: 10443409 DOI: 10.1385/1-59259-675-4:31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- A Britt
- Section of Plant Biology, University of California, Davis, USA
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Abstract
Most venomous snakes in the United States are of the Crotalidae family. Another family of snakes, the Elapidae, are not so common, but their bites may be a threat to zoo keepers and persons who have exotic snakes as pets. Because Elapidae envenomation is not common, signs and symptoms of such envenomation may not be recognized. Elapidae venom, because of a curare-like property, can produce respiratory compromise followed by death within 10 minutes. Antivenin, cholinesterase inhibitors, and mechanical ventilation are treatments to consider in such envenomations. Unlike Crotalidae antivenin, Elapidae antivenin may not confer protection against species not used in its preparation. Identification of the involved snake, by family and specie, should be an early priority. Correct management of the envenomated patient is dependent on the prompt administration of the most specific antivenin available when indicated.
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Affiliation(s)
- A Britt
- Pennsylvania State University, Milton Hershey Medical Center, USA
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Britt A, Søreng O. [Many rare diagnoses collected in Sunaas. Interview by Per Flakstad]. Jordmorbladet 1997:14-17. [PMID: 9392257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Burkhart KK, Britt A, Petrini G, O'Donnell S, Donovan JW. Pulmonary toxicity following exposure to an aerosolized leather protector. J Toxicol Clin Toxicol 1996; 34:21-4. [PMID: 8632508 DOI: 10.3109/15563659609020228] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An aerosol spray for leather protection was reformulated to remove trichloroethane. The new formulation contained isobutane, n-heptane, ethyl acetate and fluoroaliphatics. RETROSPECTIVE REVIEW Thirty-nine patients reported symptoms to the regional poison center. Respiratory symptoms developed within hours of exposure. Most symptoms resolved within two days. Abnormal pulmonary function tests, including obstructive disease or diminished diffusing capacity, were demonstrated in three of the four tested patients. CONCLUSIONS The mechanism for the pulmonary toxicity has not been determined.
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Affiliation(s)
- K K Burkhart
- Center for Emergency Medical Services, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, USA
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Chang A, Zeledon-Friendly A, Britt A, Ewing B. Management of illness and temporary disability in children enrolled in day-care centers. The Health House experience. Am J Dis Child 1988; 142:651-5. [PMID: 3369404 DOI: 10.1001/archpedi.1988.02150060085038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Alternative care arrangements are often necessary when children enrolled in day-care centers experience illness or temporary disability. To meet this need, a new facility named Health House was established by the Child Development Program of the Pomona (Calif) Unified School District. This report describes the organization, operation, and costs of the program, and reviews the management of 179 episodes of illness or temporary disability in 99 children served by the program during the 1983-1984 school year. The medical conditions of patients cared for were comparable with those seen in physicians' offices as reported in a national survey. The daily cost of care per child for the sponsoring agency was $38. The service enabled an average daily salary saving of $39.80 for the working parent. Health House may serve as a model for the management of illness or temporary disability in children enrolled in day-care centers.
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Affiliation(s)
- A Chang
- Division of Population and Family Health, UCLA School of Public Health 90024
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