1
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Kopp BT, Ross SE, Bojja D, Guglani L, Chandler JD, Tirouvanziam R, Thompson M, Slaven JE, Chmiel JF, Siracusa C, Sanders DB. Nasal airway inflammatory responses and pathogen detection in infants with cystic fibrosis. J Cyst Fibros 2023:S1569-1993(23)01670-3. [PMID: 37977937 DOI: 10.1016/j.jcf.2023.10.020] [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: 06/29/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Detecting airway inflammation non-invasively in infants with cystic fibrosis (CF) is difficult. We hypothesized that markers of inflammation in CF [IL-1β, IL-6, IL-8, IL-10, IL-17A, neutrophil elastase (NE) and tumor necrosis factor (TNF-α)] could be measured in infants with CF from nasal fluid and would be elevated during viral infections or clinician-defined pulmonary exacerbations (PEx). METHODS We collected nasal fluid, nasal swabs, and hair samples from 34 infants with CF during monthly clinic visits, sick visits, and hospitalizations. Nasal fluid was isolated and analyzed for cytokines. Respiratory viral detection on nasal swabs was performed using the Luminex NxTAG® Respiratory Pathogen Panel. Hair samples were analyzed for nicotine concentration by reverse-phase high-performance liquid chromatography. We compared nasal cytokine concentrations between the presence and absence of detected respiratory viruses, PEx, and smoke exposure. RESULTS A total of 246 samples were analyzed. Compared to measurements in the absence of respiratory viruses, mean concentrations of IL-6, IL-8, TNF-α, and NE were significantly increased while IL-17A was significantly decreased in infants positive for respiratory viruses. IL-17A was significantly decreased and NE increased in those with a PEx. IL-8 and NE were significantly increased in infants with enteric pathogen positivity on airway cultures, but not P. aeruginosa or S. aureus. Compared to those with no smoke exposure, there were significantly higher levels of IL-6, IL-10, and NE in infants with detectable levels of nicotine. CONCLUSIONS Noninvasive collection of nasal fluid may identify inflammation in infants with CF during changing clinical or environmental exposures.
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Affiliation(s)
- Benjamin T Kopp
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sydney E Ross
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dinesh Bojja
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lokesh Guglani
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joshua D Chandler
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rabindra Tirouvanziam
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Misty Thompson
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James E Slaven
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James F Chmiel
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children's Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Don B Sanders
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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2
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Hjelm M, Hente E, Miller J, Moore S, Peugh J, Swetland DV, Tadesse DG, Hossain MM, Siracusa C, Filigno SS. Longitudinal mental health trends in cystic fibrosis. J Cyst Fibros 2023; 22:1093-1099. [PMID: 37393160 DOI: 10.1016/j.jcf.2023.06.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Mental health screening in accordance with consensus guidelines became routine clinical practice in our cystic fibrosis (CF) Center in 2015. We hypothesized improvement in anxiety and depression symptoms over time and associations between elevated screening scores and disease severity. We aimed to observe the impact of the COVID-19 pandemic and modulator use on mental health symptoms. METHODS Retrospective chart reviews were conducted for people 12 years and older with at least one Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9) screening for six years. Descriptive statistics were used to summarize demographic variables and logistic regression and linear mixed models were used to evaluate the relationship between screening scores and clinical variables. RESULTS Analyses included 150 participants (ages 12-22 years). The percentage of minimal to no symptom scores increased over time for anxiety and depression. Increased mental health visits and CFRD were associated with higher PHQ-9 and GAD-7 scores. Higher FEV1pp was associated with lower GAD-7 and PHQ-9 scores. More effective modulator use was associated with lower PHQ-9 scores. Mean PHQ-9 and GAD-7 scores were not significantly different when comparing pre-pandemic and pandemic scores. CONCLUSION Disruptions in screening during the pandemic were minimal and symptom scores remained stable. Individuals with higher mental health screening scores were more likely to have CFRD and utilization of mental health services. Consistent mental health monitoring and support is needed so individuals with CF can endure anticipated and unanticipated stressors including changes in physical health, healthcare, and societal stressors such as COVID-19 pandemic.
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Affiliation(s)
- Michelle Hjelm
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Elizabeth Hente
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Jamie Miller
- Division of Social Services, CCHMC, Cincinnati, OH, USA
| | - Susan Moore
- Division of Social Services, CCHMC, Cincinnati, OH, USA
| | - James Peugh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Epidemiology and Biostatistics, CCHMC, Cincinnati, OH, USA
| | - David V Swetland
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Md Monir Hossain
- Division of Epidemiology and Biostatistics, CCHMC, Cincinnati, OH, USA
| | - Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephanie S Filigno
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, CCHMC, Cincinnati, OH, USA
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3
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Siracusa C, Boat T. Additional considerations for CF nutritional guidelines. J Cyst Fibros 2023; 22:1133-1134. [PMID: 37788965 DOI: 10.1016/j.jcf.2023.09.012] [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] [Received: 08/04/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
| | - Thomas Boat
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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4
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Gecili E, Brokamp C, Rasnick E, Afonso PM, Andrinopoulou ER, Dexheimer JW, Clancy JP, Keogh RH, Ni Y, Palipana A, Pestian T, Vancil A, Zhou GC, Su W, Siracusa C, Ryan P, Szczesniak RD. Built environment factors predictive of early rapid lung function decline in cystic fibrosis. Pediatr Pulmonol 2023; 58:1501-1513. [PMID: 36775890 PMCID: PMC10121820 DOI: 10.1002/ppul.26352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND The extent to which environmental exposures and community characteristics of the built environment collectively predict rapid lung function decline, during adolescence and early adulthood in cystic fibrosis (CF), has not been examined. OBJECTIVE To identify built environment characteristics predictive of rapid CF lung function decline. METHODS We performed a retrospective, single-center, longitudinal cohort study (n = 173 individuals with CF aged 6-20 years, 2012-2017). We used a stochastic model to predict lung function, measured as forced expiratory volume in 1 s (FEV1 ) of % predicted. Traditional demographic/clinical characteristics were evaluated as predictors. Built environmental predictors included exposure to elemental carbon attributable to traffic sources (ECAT), neighborhood material deprivation (poverty, education, housing, and healthcare access), greenspace near the home, and residential drivetime to the CF center. MEASUREMENTS AND MAIN RESULTS The final model, which included ECAT, material deprivation index, and greenspace, alongside traditional demographic/clinical predictors, significantly improved fit and prediction, compared with only demographic/clinical predictors (Likelihood Ratio Test statistic: 26.78, p < 0.0001; the difference in Akaike Information Criterion: 15). An increase of 0.1 μg/m3 of ECAT was associated with 0.104% predicted/yr (95% confidence interval: 0.024, 0.183) more rapid decline. Although not statistically significant, material deprivation was similarly associated (0.1-unit increase corresponded to additional decline of 0.103% predicted/year [-0.113, 0.319]). High-risk regional areas of rapid decline and age-related heterogeneity were identified from prediction mapping. CONCLUSION Traffic-related air pollution exposure is an important predictor of rapid pulmonary decline that, coupled with community-level material deprivation and routinely collected demographic/clinical characteristics, enhance CF prognostication and enable personalized environmental health interventions.
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Affiliation(s)
- Emrah Gecili
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Cole Brokamp
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Erika Rasnick
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Pedro M. Afonso
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Judith W. Dexheimer
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - John P. Clancy
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Cystic Fibrosis Foundation, 4550 Montgomery Ave, Bethesda, MD, USA
| | - Ruth H. Keogh
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Yizhao Ni
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Anushka Palipana
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Teresa Pestian
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Andrew Vancil
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Grace Chen Zhou
- Division of Statistics and Data Science, Department of Mathematics, University of Cincinnati, 155B McMicken Hall, Cincinnati, OH, USA
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Weiji Su
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Patrick Ryan
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Rhonda D. Szczesniak
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
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5
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Reeves PT, Bennett WC, McCown MY, Welsh SK, McDonald CM, Beker L, Robbins S, Vitale DS, Siracusa C, Brownell JN, Sellers ZM, Echelmeyer S, Livezey J, Barnes DM. The Cystic Fibrosis Action Plan: A low health literacy, pictographic self-management tool with clinical automation. Pediatr Pulmonol 2022; 57:2847-2850. [PMID: 35811375 DOI: 10.1002/ppul.26071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, USA
| | - William C Bennett
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Y McCown
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sebastian K Welsh
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, USA
| | | | - Leila Beker
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sandra Robbins
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David S Vitale
- Division of Pediatric Pulmonology, incinnati Childnre's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Siracusa
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pediatric Pulmonology, incinnati Childnre's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jefferson N Brownell
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Zachary M Sellers
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Stanford University, Palo Alto, California, USA
| | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jeffrey Livezey
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Danielle M Barnes
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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6
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Dress C, Hente E, Swegheimer K, Hjelm M, Siracusa C, Hardie W, Boat T. 198 Weight and body composition of school-aged children with cystic fibrosis and extended modulator therapy. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00888-8] [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: 11/07/2022]
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7
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Siracusa C, Saulitis A, Collins L, Mirus K, Patel N, George C, Sabadosa K, Riekert K. 304 Using network learning models to facilitate best practices for successful conversations prompted from the daily care check-in. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00994-8] [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: 11/05/2022]
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8
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Hjelm M, Hente E, Peugh J, Siracusa C, Filigno S. 293 Longitudinal mental health trends in pediatric cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00983-3] [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: 11/07/2022]
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9
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Filigno S, Hente E, Hjelm M, Siracusa C. 288 Treatment targets in the psychological care of youth with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00978-x] [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: 11/07/2022]
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10
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Chapman M, Siracusa C, Jenny M, Lisa M, Good K, Arrasmith D, Gramke J, Chiarenzelli J, Givens N. 124: Development and implementation of 2-sample OGTT in the outpatient CF clinic. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01549-6] [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: 10/20/2022]
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11
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Filigno S, Hente E, Lisa M, Siracusa C. 335: Greater access to mental health care with CF team psychologist through telemedicine during COVID-19. J Cyst Fibros 2021. [PMCID: PMC8518446 DOI: 10.1016/s1569-1993(21)01759-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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12
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Ross S, Kopp B, Siracusa C, Chmiel J, Sanders D. 538: Noninvasive measurement of inflammation using nasal filter paper. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01961-5] [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: 11/29/2022]
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13
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Hente E, Weiland J, Mullen L, Hawke J, Schuler CL, Filigno SS, Siracusa C. Assessment of treatment burden and complexity in cystic fibrosis: A quality improvement project. Pediatr Pulmonol 2021; 56:1992-1999. [PMID: 33675286 DOI: 10.1002/ppul.25361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment regimens for cystic fibrosis (CF) continue to evolve and grow in complexity. Treatment regimen burden, and associated sequelae, are incompletely understood. OBJECTIVE Quality improvement (QI) methods were used to investigate treatment burden of CF care, family and care team partnerships, and potential interventions to reduce burden. METHODS Patients 6-24 years with CF and caregivers of patients 6-13 years were surveyed. Portions of validated tools and existing surveys measured burden and family-care team partnership. An automated report calculated treatment complexity. Plan-do-study-act cycles tested survey administration during CF visits and run charts tracked progress. Interventions to reduce burden were tracked, and bidirectional assessments explored partnerships among patients, families and clinicians. RESULTS Over 6 months, 110 patients and 62 caregivers completed assessments. Caregivers reported lower burden/higher quality of life (74.0, range 22.2-100) than patients (66.5, range 16.7-100). The mean treatment complexity score was 17.2 (range 6-34). Treatment complexity and burden increased with patient age (p < .05 and p < .01 respectively). Lower lung function correlated with higher patient-reported burden (p < .01) and higher treatment complexity (p < .0001). As burden increased, providers more often performed select interventions (discussed combining treatments, simplified regimens, or involved other team members (p < .05 for each)). Families reported high partnership (mean scores 4.7-4.8, 5 = high), and providers reported high utilization of partnership tools (tool used in 77% of encounters). CONCLUSION We assessed, quantified, and responded to treatment burden and complexity in real-time during outpatient CF visits. Systematic and individualized assessments of treatment complexity and burden may enhance treatment adherence while preserving quality of life.
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Affiliation(s)
- Elizabeth Hente
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeanne Weiland
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa Mullen
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jesse Hawke
- James M. Anderson Center for Clinical Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christine L Schuler
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephanie S Filigno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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14
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Nusbaum K, Filigno SS, Feldstein J, Hente E, Koch E, Mullen L, Weiland J, Boat T, Siracusa C. Assessing and responding to stress related to pulmonary function testing in cystic fibrosis through quality improvement. Pediatr Pulmonol 2020; 55:1139-1146. [PMID: 32040891 PMCID: PMC8864550 DOI: 10.1002/ppul.24673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pulmonary function tests (PFTs) are performed routinely to evaluate lung function in patients with cystic fibrosis (CF). Staff at the Cincinnati Children's Hospital Medical Center CF Center observed stress in patients before PFTs. An interdisciplinary quality improvement (QI) team was assembled to address this clinical issue. METHODS The Plan-Do-Study-Act method of QI was used to investigate feasibility of assessing stress and offering brief interventions to reduce stress before PFTs. Interventions included listening to music, covering the PFT screen, or doing breathing meditation before PFTs. Patients rated stress levels on a 1 to 5 Likert scale before and after testing. RESULTS Of 75 patient encounters, interventions were trialed in 20. Fifteen patients who tried an intervention reported wanting to use the intervention again (five encounters had missing data); patients reported that the intervention benefited performance on PFTs in eight encounters (40%). The average pre-PFT stress rating for encounters that trialed an intervention was 2.1 and post-PFT rating was 2.0. Average stress pre-PFT and post-PFT ratings were 1.7 and 1.6 respectively, for encounters that did not trial an intervention. Median length of PFT encounter was 15 minutes regardless of whether intervention was trialed. CONCLUSION Some patients with CF utilized interventions, while many opted out. This QI effort identified feasible outpatient clinic interventions that did not negatively impact clinic flow. Finding ways to reduce stress associated with PFTs could have a meaningful impact on patient performance and emotional well-being for a subset of patients.
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Affiliation(s)
- Kelsey Nusbaum
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Stephanie S Filigno
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Julie Feldstein
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Elizabeth Hente
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Elizabeth Koch
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Lisa Mullen
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Jeanne Weiland
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Thomas Boat
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio.,Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Christopher Siracusa
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio.,Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
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15
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Borschuk AP, Molitor S, Everhart RS, Siracusa C, Filigno SS. Executive functioning in pediatric cystic fibrosis: A preliminary study and conceptual model. Pediatr Pulmonol 2020; 55:939-947. [PMID: 31951324 DOI: 10.1002/ppul.24648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research has shown that broad cognitive functioning in individuals with CF is intact. Specific executive functioning (EF) deficits have been identified, however, and adults with CF report more symptoms of ADHD than the general population. EF skills are critical to the management of a complex disease like CF although studies have not adequately examined EF mechanisms in CF. This manuscript (a) described EF in a small sample of children with CF, (b) summarized relations found between EF and psychosocial variables, and (c) presented a conceptual model by which to understand EF's impact on adherence in CF. METHODS Data for this preliminary study were collected from 19 children with CF and their caregivers (ages, 6-18). Caregivers completed questionnaires assessing their child's physical and mental health, their own functioning, and overall family functioning. EF was measured using a parent-report rating scale. Patient health data were collected from the electronic medical record. RESULTS This sample did not demonstrate elevated levels of EF impairment. Worse EF was related to poor family communication/cohesion, as well as higher treatment burden, worse lung function, poorer adherence, and older age. From these findings, a preliminary model was developed describing EF in the context of CF and adherence. CONCLUSIONS Findings from this preliminary study suggest that the CF regimen and associated symptoms may overload otherwise adequate EF skills. Reducing disease burden and preventing burnout should be a focus of treatment. A better understanding of EF in CF and the impact on adherence would allow for better clinical management and effective design of interventions.
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Affiliation(s)
- Adrienne P Borschuk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen Molitor
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher Siracusa
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie S Filigno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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16
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Simpson R, Myer IV C, Siracusa C. Acute Respiratory Distress Syndrome immediately following the removal of an aspirated foreign body. Respir Med Case Rep 2020; 29:100978. [PMID: 31886126 PMCID: PMC6921229 DOI: 10.1016/j.rmcr.2019.100978] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/19/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) is a form of diffuse lung injury with many potential etiologies, pneumonia being the most common cause developing outside of the hospital. Foreign body (FB) aspiration is a risk factor for pneumonia, and therefore, ARDS. Although these associations exist, the development of ARDS immediately following the removal of an aspirated FB appears quite rare. We present the case of an 11 year old male who was found to have a right-sided, post-obstructive pneumonia secondary to an aspirated FB obstructing the bronchus intermedius. Relief of the obstruction allowed for rapid, endobronchial spread of infection and within 6 hours of FB removal, our patient developed severe ARDS requiring initiation of extracorporeal membrane oxygenation (ECMO). Streptococcus constellatus was isolated from lower respiratory cultures obtained during initial bronchoscopy.
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Affiliation(s)
- Ryne Simpson
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, MLC 7041, Cincinnati, OH, 45229-3026, USA
- Corresponding author.
| | - Charles Myer IV
- Department of Otolaryngology, Cincinnati Children's Hospital, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, MLC 7041, Cincinnati, OH, 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, MLC 7041, Cincinnati, OH, 45229-3026, USA
| | - Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, MLC 7041, Cincinnati, OH, 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, MLC 7041, Cincinnati, OH, 45229-3026, USA
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17
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Downes KJ, Abulebda K, Siracusa C, Moore R, Staat MA, Poynter SE. Non-typeable Haemophilus influenzae purulent pericarditis in a child with cystic fibrosis. Pediatr Int 2016; 58:607-9. [PMID: 26842501 DOI: 10.1111/ped.12850] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/18/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Abstract
Early airway colonization and infection with Haemophilus influenzae in children with cystic fibrosis (CF) is common. Although the pathogenicity of non-typeable H. influenzae (NTHi) in patients with CF is controversial, this organism can cause both upper and lower respiratory tract infections. Extra-pulmonary disease, however, is rare. Purulent pericarditis is a suppurative complication of bacterial infection of the pericardial space that can arise as a result of direct extension from an adjacent infection. We describe a case of purulent pericarditis due to NTHi in a young child with CF that developed as a complication of inadequately treated bronchopneumonia.
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Affiliation(s)
- Kevin J Downes
- Divisions of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kamal Abulebda
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Siracusa
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ryan Moore
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mary A Staat
- Divisions of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sue E Poynter
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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18
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Siracusa C, Di Nardo A, Serpell J, Iannetti L, Podaliri M, Trentini R, Villa PD. A comparison between a direct and an indirect method for assessing aggressiveness in dogs. J Vet Behav 2010. [DOI: 10.1016/j.jveb.2009.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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