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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Farina FR, Regan J, Marquez M, An H, O'Loughlin P, Pavithra P, Taddeo M, Knight RC, Bennett M, Lenaert B, Griffith JW. Reducing fear and avoidance of memory loss improves mood and social engagement in community-based older adults: a randomized trial. BMC Geriatr 2023; 23:786. [PMID: 38030988 PMCID: PMC10688470 DOI: 10.1186/s12877-023-04470-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life. METHODS Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up). RESULTS Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants' ability to participate in social activities and well-being were also observed. CONCLUSIONS Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04821960 .
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Affiliation(s)
- Francesca R Farina
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - John Regan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Melissa Marquez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Hosanna An
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | | | | | - Michelle Taddeo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Rachel C Knight
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Marc Bennett
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Bert Lenaert
- Faculty of Psychology, Open University, Heerlen, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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Farina FR, Pavithra P, An H, Marquez M, O'Loughlin P, Regan J, Taddeo M, Bennett M, Lenaert B, Griffith JW. Validation of the Fear and Avoidance of Memory Loss scale in community-based older adults. Alzheimers Dement (Amst) 2023; 15:e12432. [PMID: 37101711 PMCID: PMC10123382 DOI: 10.1002/dad2.12432] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023]
Abstract
Introduction Alzheimer's disease and related dementias (ADRD) are among the most feared conditions. However, research around ADRD-specific fear and avoidance behaviors is lacking. Here, we validated a novel measure of fear and avoidance specific to memory loss, the Fear and Avoidance of Memory Loss (FAM) scale, and examined associations between fear avoidance and psychosocial functioning in older adults. Methods We assessed FAM Scale internal reliability and concurrent validity, and candidate subscales across two samples (total N = 813). We then examined associations between fear avoidance and memory performance, anxiety, depressive symptoms, sleep, social functioning, and quality of life. Results We identified two subscales: fear and avoidance, which yielded strong psychometric validity. Higher fear was associated with memory failures and sleep disturbance. Higher avoidance was associated with memory failures, poorer verbal memory, reduced social functioning, and quality of life. Discussion We present the first measure of fear avoidance specific to memory loss. We propose that targeting fear avoidance can promote ADRD risk reduction and resiliency.
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Affiliation(s)
- Francesca R. Farina
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
- Global Brain Health InstituteTrinity College DublinDublinIreland
- School of PsychologyTrinity College DublinDublinIreland
| | | | - Hosanna An
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Melissa Marquez
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | | | - John Regan
- School of PsychologyTrinity College DublinDublinIreland
| | - Michelle Taddeo
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Marc Bennett
- School of PsychologyUniversity College DublinDublinIreland
| | - Bert Lenaert
- Faculty of PsychologyOpen UniversityHeerlenthe Netherlands
- Faculty of Health, Medicine and Life Sciences, Limburg Brain Injury CentreMaastricht UniversityMaastrichtthe Netherlands
| | - James W. Griffith
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
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Bailey SC, Griffith JW, Vuyyuru C, Batio S, Velazquez E, Carpenter DM, Davis TC, Parker RM, Taddeo M, Wolf MS. Development and Validation of the HL6: a Brief, Technology-Based Remote Measure of Health Literacy. J Gen Intern Med 2023; 38:421-427. [PMID: 35879534 PMCID: PMC9311340 DOI: 10.1007/s11606-022-07739-3] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Most health literacy measures require in-person administration or rely upon self-report. OBJECTIVE We sought to develop and test the feasibility of a brief, objective health literacy measure that could be deployed via text messaging or online survey. DESIGN Participants were recruited from ongoing NIH studies to complete a phone interview and online survey to test candidate items. Psychometric analyses included parallel analysis for dimensionality and item response theory. After 9 months, participants were randomized to receive the final instrument via text messaging or online survey. PARTICIPANTS Three hundred six English and Spanish-speaking adults with ≥ 1 chronic condition MAIN MEASURES: Thirty-three candidate items for the new measure and patient-reported physical function, anxiety, depression, and medication adherence. All participants previously completed the Newest Vital Sign (NVS) in parent NIH studies. KEY RESULTS Participants were older (average 67 years), 69.6% were female, 44.3% were low income, and 22.0% had a high school level of education or less. Candidate items loaded onto a single factor (RMSEA: 0.04, CFI: 0.99, TLI: 0.98, all loadings >.59). Six items were chosen for the final measure, named the HL6. Items demonstrated acceptable internal consistency (α=0.73) and did not display differential item functioning by language. Higher HL6 scores were significantly associated with greater educational attainment (r=0.41), higher NVS scores (r=0.55), greater physical functioning (r=0.26), fewer depressive symptoms (r=-0.20), fewer anxiety symptoms (r=-0.15), and fewer barriers to medication adherence (r=-0.30; all p<.01). In feasibility testing, 75.2% of participants in the text messaging arm completed the HL6 versus 66.2% in the online survey arm (p=0.09). Socioeconomic disparities in completion were more common in the online survey arm. CONCLUSIONS The HL6 demonstrates adequate reliability and validity in both English and Spanish. This performance-based assessment can be administered remotely using commonly available technologies with fewer logistical challenges than assessments requiring in-person administration.
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Affiliation(s)
- Stacy Cooper Bailey
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chandana Vuyyuru
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephanie Batio
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Evelyn Velazquez
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Ruth M Parker
- Center for Ethics, Emory University, Atlanta, GA, USA
| | - Michelle Taddeo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Center of Applied Health Research on Aging, Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Lou TM, Zhang KL, Slesinger NC, Taddeo M, Serrano E, Begolka WS, Capozza K, Paller AS, Griffith JW, Fishbein AB. Positive Psychology Themes in Interviews of Children With Atopic Dermatitis: Qualitative Study. JMIR Pediatr Parent 2022; 5:e38725. [PMID: 36103242 PMCID: PMC9520397 DOI: 10.2196/38725] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atopic dermatitis is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with atopic dermatitis may promote coping strategies to improve quality of life. Positive psychology is one strategy that can be used to strengthen resiliency. OBJECTIVE Our objective was to identify positive psychology concepts mentioned by children with atopic dermatitis and their parent to inform strategies to strengthen resiliency in children with atopic dermatitis. METHODS A total of 20 patient-parent dyads were interviewed to share their experience with atopic dermatitis to help develop a novel psychologic intervention for atopic dermatitis. Patients were 8 to 17 years old and diagnosed with atopic dermatitis. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman's PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations was captured. Transcripts were also separately coded for resiliency, which is the ultimate goal of PERMA. RESULTS Positive psychology concepts were mentioned by 100% (20/20) of children and 95% (19/20) of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (14/20, 70%) and parents (13/20, 65%). Emotion elicited the most negative comments from children (19/20, 95%) and parents (17/20, 85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code mentioned PERMA concepts 9.1 (SD 4.7) times compared to those who mentioned none (mean 5.9, SD 4.6) (P=.14). When participants were stratified by disease severity, on average, more positive psychology concepts were mentioned by patients with mild atopic dermatitis (mean 13, SD 3.0) than those with moderate symptoms (mean 6.2, SD 4.9) or severe symptoms (mean 6.1, SD 4.0) (P=.03). CONCLUSIONS Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with atopic dermatitis. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial well-being and resiliency in pediatric atopic dermatitis. Future directions will look at incorporating "positive medicine" into atopic dermatitis treatment to not only relieve symptoms but also strengthen positive aspects of life.
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Affiliation(s)
- Terry M Lou
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
| | - Kenneth L Zhang
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
| | - Noël C Slesinger
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michelle Taddeo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eloisa Serrano
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, CA, United States
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Anna B Fishbein
- Department of Pediatrics, Ann & Robert Lurie Children's Hospital, Chicago, IL, United States.,Division of Pediatric Allergy & Immunology, Northwestern University, Chicago, IL, United States
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Glaser AP, Mansfield S, Smith AR, Helfand BT, Lai HH, Sarma A, Yang CC, Taddeo M, Clemens JQ, Cameron AP, Flynn KE, Andreev V, Fraser MO, Erickson BA, Kirkali Z, Griffith JW. Impact of Sleep Disturbance, Physical Function, Depression and Anxiety on Male Lower Urinary Tract Symptoms: Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). J Urol 2022; 208:155-163. [DOI: 10.1097/ju.0000000000002493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander P. Glaser
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - Sarah Mansfield
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Brian T. Helfand
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, Illinois
| | - H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Aruna Sarma
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Claire C. Yang
- Department of Urology, University of Washington, Seattle, Washington
| | - Michelle Taddeo
- Department of Medical Social Sciences, Northwestern University–Feinberg School of Medicine, Chicago, Illinois
| | - J. Quentin Clemens
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
- Dow Division of Health Services Research, University of Michigan, Ann Arbor, Michigan
| | - Anne P. Cameron
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Victor Andreev
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Matthew O. Fraser
- Department of Surgery, Division of Urology, Duke University, Durham, North Carolina
| | - Bradley A. Erickson
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - James W. Griffith
- Department of Medical Social Sciences, Northwestern University–Feinberg School of Medicine, Chicago, Illinois
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O'Loughlin P, Pavithra P, Regan J, Bennett M, Knight R, Lenaert B, Marquez M, Taddeo M, Griffith J, Shapiro R, Farina F. A Randomized Controlled Trial Investigating the Feasibility of a Low-Intensity Psychological Intervention for Fear of Memory Loss and Quality of Life in Older Adults: Protocol for the Reducing Fear and Avoidance of Memory Loss (REFRAME) Study. JMIR Res Protoc 2021; 10:e30514. [PMID: 34328428 PMCID: PMC8367123 DOI: 10.2196/30514] [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: 05/18/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022] Open
Abstract
Background Dementia is the most feared disease associated with aging. Prolonged fears about memory loss and dementia can have harmful consequences even in the absence of cognitive decline. Fear of dementia is associated with poorer health outcomes and psychological well-being and increased memory failures in older adults. Objective We will conduct a randomized controlled trial to determine the feasibility of a tailored, web-based mindfulness program to reduce fear of memory loss and increase quality of life in older adults experiencing heightened fear. Methods Eighty participants will be recruited and divided into 2 groups (40 in each group). One group will receive psychoeducation plus mindfulness training. A second group will receive psychoeducation, mindfulness training, and additional modules targeting maladaptive behavioral avoidance (ie, social and cognitive withdrawal). Results Our recent etiological model posits that maladaptive behavioral avoidance strategies critically underlie psychosocial dysfunction associated with fear of memory loss. Thus, we predict better outcomes in the second group, including reduced fear of memory loss (primary outcome), Alzheimer disease, anxiety, and subjective memory failures, and increased quality of life (secondary outcomes). Outcome measures will be applied at 5 time points (before, baseline, interim, and after the intervention, and at 3-month follow-up). Data will be analyzed using mixed models and correlations. Conclusions Results from this study will contribute to the current literature on dementia-related fear and improve our understanding of how to effectively address and reduce these fears. Trial Registration ClinicalTrials.gov NCT04821960; https://clinicaltrials.gov/ct2/show/NCT04821960. International Registered Report Identifier (IRRID) PRR1-10.2196/30514
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Affiliation(s)
| | | | - John Regan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Marc Bennett
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Rachel Knight
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Bert Lenaert
- Faculty of Health, Medicine and Life Sciences, Limburg Brain Injury Centre, Maastricht University, Netherlands
| | - Melissa Marquez
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michelle Taddeo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Griffith
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rita Shapiro
- VA Chicago Health Care System, Chicago, IL, United States
| | - Francesca Farina
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
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Creelan B, Teer J, Toloza E, Mullinax J, Landin A, Gray J, Tanvetyanon T, Taddeo M, Noyes D, Kelley L, Fang B, Koomen J, Sarnaik A, Kim S, Haura E, Antonia S. OA05.03 Safety and Clinical Activity of Adoptive Cell Transfer Using Tumor Infiltrating Lymphocytes (TIL) Combined with Nivolumab in NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lubrano E, Astorri D, Taddeo M, Salzmann A, Cesarano E, Brunese L, Giganti M, Spadaro A. Rehabilitation and surgical management of ankylosing spondylitis. Musculoskelet Surg 2013; 97 Suppl 2:S191-S195. [PMID: 23949941 DOI: 10.1007/s12306-013-0285-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease which, if untreated, may progress to severe damage of the spine with functional impairment, disability and poor quality of life. An increased mortality has been reported in AS patients compared to the general population. AS requires combined management (pharmacological and non-pharmacological) and advice by different health professionals. Even the pharmacological treatment in the last decade has dramatically changed the outcome, the severity of the disease might require a surgical approach for the hip involvement with total hip replacement, or the corrective spinal surgery. However, this surgery deserves some careful approaches since the complexity of the disease. Rehabilitation still represents a cornerstone of the global management of AS patients. The present review summarizes the state of art of surgical management of these two diseases.
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Affiliation(s)
- E Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
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Gould L, Vacek T, Muller R, Taddeo M, Betzu R. Effects of two cocktails on left ventricular diastolic function in normal men. Angiology 1989; 40:613-9. [PMID: 2742206 DOI: 10.1177/000331978904000702] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effects of alcohol on diastolic function in normal males are unknown. Therefore, 12 male physicians had a Doppler echocardiogram performed in order to assess left ventricular diastolic performance. They then drank 4 ounces of whiskey, and forty-five minutes later a repeat Doppler echocardiogram was obtained. All the Doppler indexes of diastolic performance differed significantly after the ingestion of alcohol. The mean control D-F interval was 203 +/- 26 ms and after alcohol it was 237 +/- 51 (p less than 0.01). The mean control EF slope was 4.4 +/- 0.35 m/s2 and after alcohol it was 3.2 +/- 0.73 (p less than 0.01). The control E-F interval was 114 +/- 30 ms and it increased after alcohol to 150 +/- 37 (p less than 0.001). The mean control E wave was 0.54 +/- 0.10 m/s and after alcohol it was 0.43 +/- 0.07 (p less than 0.01). The mean control A wave was 0.30 +/- 0.04 m/s and after alcohol it was 0.35 +/- 0.04 (p less than 0.01). The mean control E/A ratio was 1.80 +/- 0.20 and it fell to 1.25 +/- 0.23 after alcohol ingestion (p less than 0.001). Thus, the results suggest that 4 ounces of whiskey can produce, in normal males, a significant impairment in diastolic function.
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Affiliation(s)
- L Gould
- Methodist Hospital, Department of Medicine, Brooklyn, New York
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Abstract
This case describes a 69-year-old male who had a permanent pacemaker implanted for sick sinus syndrome. He was struck by a car with a resultant failure of the pulse generator. Trauma-related failure of a pulse generator is a rare event. Its recognition is imperative in the overall management of the trauma patient.
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Affiliation(s)
- L Gould
- Department of Medicine, Methodist Hospital, Brooklyn, NY 11215
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Gould L, Betzu R, Judge D, Lee J, Taddeo M. Routine reduction of pulse generator voltage. Angiology 1988; 39:409-12. [PMID: 3377264 DOI: 10.1177/000331978803900501] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The porous-tip electrode has led to a significant advancement in pacing system technology. Experience with 38 patients with unipolar tined CPI porous endocardial electrodes, is reported. All patients had programmable pulse generators, CPI model number 531. The voltage in this pulse generator can be reduced from 5 to 2.5 volts. The pulse width threshold (PWT) at implantation was 0.06 ms at 5 volts in all 38 patients, and the PWT at implantation varied between 0.06 and 0.16 ms at 2.5 volts, with a mean PWT of 0.092 +/- 0.026 ms. The 38 patients were restudied six months later. The mean PWT measured at 5 volts was 0.076 +/- 0.018 ms. The PWT measured at 2.5 volts varied between 0.08 and 0.30 ms with a mean PWT of 0.178 +/- 0.067 ms. Twenty-three patients were restudied one year after lead implantation. The PWT measured at 2.5 volts varied between 0.08 and 0.30 ms with a mean PWT of 0.156 +/- 0.061 ms. All of the pulse generators were reprogrammed to 2.5 volts. This permitted a substantial prolongation of the pulse generator life (three to five years) with an improvement in the cost effectiveness of the pulse generator.
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Affiliation(s)
- L Gould
- Methodist Hospital, Brooklyn, New York
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Gould LA, Betzu R, Judge D, Lee J, Taddeo M, Yang D. The resting cardiointegram: correlation with stress thallium perfusion studies. Angiology 1988; 39:375-80. [PMID: 3364804 DOI: 10.1177/000331978803900408] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The cardiointegram is a noninvasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage versus time format by a series of integrations. The stress thallium perfusion study is a widely used test for the detection of coronary artery disease. In order to evaluate the correlation between the resting cardiointegram and the stress thallium 201 perfusion study, 20 patients with normal resting electrocardiograms underwent stress thallium tests and resting cardiointegrams. The cardiointegram was determined on two resting complexes of leads I, II, V4, V5, and V6 and called abnormal if five of ten complexes deviated outside a normalized template. There was concordance of the cardiointegram and the thallium study in 16 of 20 patients (80%). The sensitivity for the detection of coronary artery disease was 71%, and the specificity was 80%. The overall accuracy was 74%. Thus in patients with normal electrocardiograms, the cardiointegram is a useful noninvasive test for the detection of coronary artery disease.
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Affiliation(s)
- L A Gould
- Methodist Hospital, Brooklyn, New York
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Gould LA, Betzu R, Lin CS, Judge D, Taddeo M, Lee J. Aneurysm of the membranous ventricular septum. N Y State J Med 1988; 88:157. [PMID: 3357619] [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: 01/05/2023]
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Gould LA, Betzu R, Lee J, Judge D, Taddeo M. Persistence of enlarged pulmonary arteries--22 years after atrial septal defect closure. JAMA 1987; 258:1475-6. [PMID: 3625942 DOI: 10.1001/jama.1987.03400110057014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
A fifty-five-year-old male demonstrated over a three-year period marked enlargement of pulmonary aneurysms. This can be a fatal condition owing to rupture of the aneurysms.
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