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Kim MJ, Admane S, Chang YK, Shih KSK, Reddy A, Tang M, Cruz MDL, Taylor TP, Bruera E, Hui D. Chatbot Performance in Defining and Differentiating Palliative Care, Supportive Care, Hospice Care. J Pain Symptom Manage 2024; 67:e381-e391. [PMID: 38219964 DOI: 10.1016/j.jpainsymman.2024.01.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
CONTEXT Artificial intelligence (AI) chatbot platforms are increasingly used by patients as sources of information. However, there is limited data on the performance of these platforms, especially regarding palliative care terms. OBJECTIVES We evaluated the accuracy, comprehensiveness, reliability, and readability of three AI platforms in defining and differentiating "palliative care," "supportive care," and "hospice care." METHODS We asked ChatGPT, Microsoft Bing Chat, Google Bard to define and differentiate "palliative care," "supportive care," and "hospice care" and provide three references. Outputs were randomized and assessed by six blinded palliative care physicians using 0-10 scales (10 = best) for accuracy, comprehensiveness, and reliability. Readability was assessed using Flesch Kincaid Grade Level and Flesch Reading Ease scores. RESULTS The mean (SD) accuracy scores for ChatGPT, Bard, and Bing Chat were 9.1 (1.3), 8.7 (1.5), and 8.2 (1.7), respectively; for comprehensiveness, the scores for the three platforms were 8.7 (1.5), 8.1 (1.9), and 5.6 (2.0), respectively; for reliability, the scores were 6.3 (2.5), 3.2 (3.1), and 7.1 (2.4), respectively. Despite generally high accuracy, we identified some major errors (e.g., Bard stated that supportive care had "the goal of prolonging life or even achieving a cure"). We found several major omissions, particularly with Bing Chat (e.g., no mention of interdisciplinary teams in palliative care or hospice care). References were often unreliable. Readability scores did not meet recommended levels for patient educational materials. CONCLUSION We identified important concerns regarding the accuracy, comprehensiveness, reliability, and readability of outputs from AI platforms. Further research is needed to improve their performance.
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Affiliation(s)
- Min Ji Kim
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Sonal Admane
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yuchieh Kathryn Chang
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Akhila Reddy
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Tang
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maxine De La Cruz
- Beth Israel Deaconess Medical Center, Harvard Medical School (M.C.), Boston, Massachusetts, USA
| | - Terry Pham Taylor
- Department of Hospital Medicine, University of Texas MD Anderson Cancer Center (T.P.T.), Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care (M.J.K., S.A., Y.K.C., A.R., M.T., E.B., D.H.), Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kim MJ, Walker H, Clark M, Reddy A. Inpatient Transition from Methadone to Buprenorphine-Naloxone Using a Microdosing Strategy in a Postoperative Cancer Patient: A Case Report. J Palliat Med 2024. [PMID: 38686524 DOI: 10.1089/jpm.2024.0045] [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] [Indexed: 05/02/2024] Open
Abstract
Background: Buprenorphine initiation in opioid-tolerant patients usually requires decreasing the total opioid intake per day due to its potential for precipitating withdrawal. However, this strategy may not be tolerated in patients who require higher amounts of opioids, such as those with cancer pain. Case Presentation: We utilized a buprenorphine microdosing strategy for a postoperative cancer patient who was previously taking buprenorphine-naloxone for chronic noncancer pain, then initiated on methadone for uncontrolled cancer-related pain. He had a planned cancer resection in the hospital. He subsequently underwent a successful transition from methadone to buprenorphine-naloxone through microdosing in one week with close monitoring in the inpatient setting. Conclusions: Using a microdosing strategy to transition from methadone to buprenorphine-naloxone in a span of days was achieved in this case report. More research regarding the feasibility and tolerability of microinductions is needed, especially in the setting of chronic pain or cancer-related pain.
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Affiliation(s)
- Min Ji Kim
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Matthew Clark
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Admane S, Clark M, Bruera E, Reddy A. Caught in the Name Game: Navigating the Data Linkage Conundrum. J Pain Symptom Manage 2024:S0885-3924(24)00716-4. [PMID: 38631649 DOI: 10.1016/j.jpainsymman.2024.04.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Sonal Admane
- Division of Palliative (S.A., M.C., E.B., A.R.), Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA.
| | - Matthew Clark
- Division of Palliative (S.A., M.C., E.B., A.R.), Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Eduardo Bruera
- Division of Palliative (S.A., M.C., E.B., A.R.), Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Akhila Reddy
- Division of Palliative (S.A., M.C., E.B., A.R.), Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
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Onigbinde S, Peng W, Reddy A, Cho BG, Goli M, Solomon J, Adeniyi M, Nwaiwu J, Fowowe M, Daramola O, Purba W, Mechref Y. O-Glycome Profiling of Breast Cancer Cell Lines to Understand Breast Cancer Brain Metastasis. J Proteome Res 2024; 23:1458-1470. [PMID: 38483275 DOI: 10.1021/acs.jproteome.3c00914] [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] [Indexed: 04/06/2024]
Abstract
Breast cancer is the second leading cause of cancer-related death among women and a major source of brain metastases. Despite the increasing incidence of brain metastasis from breast cancer, the underlying mechanisms remain poorly understood. Altered glycosylation is known to play a role in various diseases including cancer metastasis. However, profiling studies of O-glycans and their isomers in breast cancer brain metastasis (BCBM) are scarce. This study analyzed the expression of O-glycans and their isomers in human breast cancer cell lines (MDA-MB-231, MDA-MB-361, HTB131, and HTB22), a brain cancer cell line (CRL-1620), and a brain metastatic breast cancer cell line (MDA-MB-231BR) using nanoLC-MS/MS, identifying 27 O-glycan compositions. We observed significant upregulation in the expression of HexNAc1Hex1NeuAc2 and HexNAc2Hex3, whereas the expression of HexNAc1Hex1NeuAc1 was downregulated in MDA-MB-231BR compared to other cell lines. In our isomeric analysis, we observed notable alterations in the isomeric forms of the O-glycan structure HexNAc1Hex1NeuAc1 in a comparison of different cell lines. Our analysis of O-glycans and their isomers in cancer cells demonstrated that changes in their distribution can be related to the metastatic process. We believe that our investigation will contribute to an enhanced comprehension of the significance of O-glycans and their isomers in BCBM.
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Affiliation(s)
- Sherifdeen Onigbinde
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Wenjing Peng
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Akhila Reddy
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Byeong Gwan Cho
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Mona Goli
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Joy Solomon
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Moyinoluwa Adeniyi
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Judith Nwaiwu
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Mojibola Fowowe
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Oluwatosin Daramola
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Waziha Purba
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061, United States
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Reddy A, Khadanga S, Gupta PK, Tadepalli K. The Burden of Protozoal and Helminth Intestinal Infections and Related Risk Factors Among the Households of Migrant Construction Workers in Bhopal. Cureus 2024; 16:e58413. [PMID: 38756280 PMCID: PMC11098528 DOI: 10.7759/cureus.58413] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
There are a few existing gaps and paucity of literature from Southeast Asia on the prevalence of intestinal parasitic infections among migrant construction workers. The present cross-sectional study was conducted to address this gap among migrant construction workers and their households in Bhopal. The study design included an interview questionnaire survey prior to the enrollment of participants and stool sample collection. The stool samples were processed according to the study protocol of macroscopy, occult blood testing, microscopy techniques combined with modified acid-fast, and sedimentation techniques. Participants were deemed positive if they exhibited microscopic findings in one out of three stool samples per recruit. We recommended clinical consultation for these cases and provided a report. Direct therapeutic intervention was not part of the study. The total recruits were 361. The predominant age group was young, i.e., aged 21 to 30 years (122/361, 33.8%), with the majority of females (55.2%). Most workers were occupied with work of digging soil (47.4%). The majority of participants (93.1%) practiced open field defecation (OFD). The prevalence of intestinal parasitic infections among migrant workers and households was 36.9% (133/361). Monoinfection was 88.7%, with 41% from Entamoeba histolytica/Entamoeba dispar. Monoinfection with Hymenolepis nana (10.2%) was a predominant helminth. The most common coinfection observed was of Giardia intestinalis with Ancylostoma duodenale (26.7%). Hand washing was the only independent predictor with an odds ratio of 3.6. Migrant behavior of the construction workers and their households was the major reason for not reaching the benefits of deworming schemes for children and vulnerability to intestinal parasitic infections.
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Affiliation(s)
- Akhila Reddy
- Preliminary Medicine, United Health Services, New York, USA
| | - Sagar Khadanga
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Karuna Tadepalli
- Microbiology, All India Institute of Medical Sciences, Bhopal, IND
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Panchal K, Reddy A, Paliwal R, Chaurasiya A. Dynamic intervention to enhance the stability of PEGylated Ibrutinib loaded lipidic nano-vesicular systems: transitioning from colloidal dispersion to lyophilized product. Drug Deliv Transl Res 2024:10.1007/s13346-024-01555-4. [PMID: 38457026 DOI: 10.1007/s13346-024-01555-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Liposomes being a promising colloidal system facilitates delivery of drugs with limited pharmacokinetic properties to achieve desirable clinical applications. However, development of a stable liposomal system is always challenging due to multiple complexities involved. Aqueous instability of liposomes and impact of various process and formulation parameters can lead to serious alteration of its therapeutic performance. In the proposed work, the authors aim to develop stable Ibrutinib-loaded liposomes using lyophilization and Quality-by-Design and assess their long-term stability. Ibrutinib-loaded liposomes were developed and optimized using Quality-by-Design technique and were further PEGylated and characterized for the same. Effect of cryoprotectants during lyophilization and other parameters are evaluated to obtain a robust formulation. The stability studies were conducted upto 6 months at various storage conditions to evaluate the effect of lyophilization. The impact of formulation, processing and lyophilization parameters on physicochemical properties of developed liposomal systems were evaluated and are critically discussed. Liquid dispersion exhibited a %degradation of 16-36% at 25 °C/60% RH which was reduced for less than 1% in lyophilized formulation for 6 months. Critical analysis and assessment of various parameters lead to identification of optimum conditions to manufacture this drug product and also opens way forward for further evaluation and translational possibilities.
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Affiliation(s)
- Kanan Panchal
- Translational Pharmaceutics Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, 500078, Hyderabad, Telangana, India
| | - Akhila Reddy
- Translational Pharmaceutics Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, 500078, Hyderabad, Telangana, India
| | - Rishi Paliwal
- Nanomedicine and Bioengineering Research Laboratory, Department of Pharmacy, Indira Gandhi National Tribal University, Amarkantak, India
| | - Akash Chaurasiya
- Translational Pharmaceutics Research Laboratory, Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, 500078, Hyderabad, Telangana, India.
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Davis MP, McPherson ML, Reddy A, Case AA. Conversion ratios: Why is it so challenging to construct opioid conversion tables? J Opioid Manag 2024; 20:169-179. [PMID: 38700396 DOI: 10.5055/jom.0853] [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: 05/05/2024]
Abstract
Standardizing opioid management is challenging due to the absence of a ceiling dose, the unknown ideal therapeutic plasma level, and the lack of an clear relationship between dose and therapeutic response. Opioid rotation or conversion, which is switching from one opioid, route of administration, or both, to another, to improve therapeutic response and reduce toxicities, occurs in 20-40 percent of patients treated with opioids. Opioid conversion is often needed when there are adverse effects, toxicities, or inability to tolerate a certain opioid formulation. A majority of patients benefit from opioid conversion, leading to improved analgesia and less adverse effects. There are different published ways of converting opioids in the literature. This review of 20 years of literature is centered on opioid conversions and aims to discuss the complexity of converting opioids. We discuss study designs, outcomes and measures, pain phenotypes, patient characteristics, comparisons of equivalent doses between opioids, reconciling conversion ratios between opioids, routes, directional differences, half-lives and metabolites, interindividual variability, and comparison to package insert information. Palliative care specialists have not yet come to a consensus on the ideal opioid equianalgesic table; however, we discuss a recently updated table, based on retrospective evidence, that may serve as a gold standard for practical use in the palliative care population. More robust, well-designed studies are needed to validate and guide future opioid conversion data.
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Affiliation(s)
- Mellar P Davis
- Geisinger Medical Center, Danville, Pennsylvania. ORCID: https://orcid.org/0000-0002-7903-3993
| | - Mary Lynn McPherson
- University of Maryland School of Pharmacy, Baltimore, Maryland. ORCID: https://orcid.org/0000-0001-6098-2112
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas. ORCID: https://orcid.org/0000-0002-7628-8675
| | - Amy A Case
- Department of Palliative and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Dev R, Agosta M, Fellman B, Reddy A, Baldwin S, Arthur J, Haider A, Carmack C, Hui D, Bruera E. Coping Strategies and Associated Symptom Burden Among Patients With Advanced Cancer. Oncologist 2024; 29:166-175. [PMID: 37669020 PMCID: PMC10836315 DOI: 10.1093/oncolo/oyad253] [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: 05/03/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Few studies examine how patients with advanced cancer cope with stress. The objective of our study was to evaluate coping strategies adopted by patients with cancer and their relationship with symptom burden. METHODS A secondary data analysis of a prospective cross-sectional survey of patients with cancer and tobacco use was conducted, which examined demographics, symptom burden (Edmonton Symptom Assessment System), and coping strategies (the Brief COPE Questionnaire). Demographic characteristics were summarized by standard summary statistics; we also examined associations between patient characteristics and coping strategies using t-test, rank-sum test, chi-squared test, or Fisher's exact test depending on the distribution of data. RESULTS Among 399 patients, the majority were female (60%), Caucasian (70%), the mean age was 56.5 (±12.0) years, and the most common malignancies were gastrointestinal (21%) and breast (19%). Patients with cancer adopted multiple adaptive coping strategies, most frequently acceptance (86.7%) and emotional support (79.9%), with humor (18.5%) being the least. Common maladaptive strategies included venting (14.5%) and self-distraction (36.6%), while substance use (1.0%) was infrequently reported. Of the adaptive strategies, female gender was significantly associated with higher engagement with emotional and instrumental support, positive reframing, religious coping, and acceptance (P < .05 for all). College educated patients reported significantly higher implementation of humor, planning, and acceptance. Maladaptive coping strategies such as denial were associated with increased pain and depression, while patients adopting emotional-focused strategies rated decreased emotional distress. CONCLUSIONS The majority of patients with advanced cancer reported adopting multiple, adaptive coping strategies, and a minority utilized maladaptive or avoidant strategies, rarely substance use, and may need additional psychological support.
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Affiliation(s)
- Rony Dev
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monica Agosta
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Baldwin
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Arthur
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ali Haider
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cindy Carmack
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pawate V, Davila JSA, Reddy A, Bruera E. Routine Monitoring of QTc Interval as a Barrier for Efficient Use of Methadone in Palliative Care. J Pain Symptom Manage 2024; 67:e147-e150. [PMID: 37863373 DOI: 10.1016/j.jpainsymman.2023.10.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Methadone is a commonly prescribed opioid amongst cancer patients. It has unique pharmacological properties which can benefit in treating complex pain syndromes and neuropathic pain. However, strict guidelines have been created in a generalized manner for chronic pain and long-term survival patients. These guidelines, such as QT interval monitoring can lead to limitations for methadone use in patients with comfort-associated goals. We present two cases of patients with metastatic cancer who were treated for pain with methadone and had to undergo opioid rotation due to abnormal QT intervals. CASE DESCRIPTION Case one was a female with open ulcerated wounds due to metastatic breast cancer who presented with uncontrolled pain on her current opioid regimen. She achieved pain relief when rotated to methadone but a repeat electrocardiogram a few months later showed QTc prolongation. She underwent opioid rotation with different medications, but her pain remained poorly controlled. Case two was a female with poorly controlled pain in the setting of bilateral breast cancer. She presented with concerns for opioid-induced neurotoxicity and was rotated to methadone. She achieved optimal pain relief. A few weeks later, her machine read QT interval was prolonged and she was rotated off methadone. The electrocardiogram was manually read which showed a normal QT interval and she was restarted on methadone with pain relief. CONCLUSION In the palliative care setting, monitoring QTc per chronic pain guidelines may lead to uncontrolled pain and a significant impact on quality of life.
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Affiliation(s)
- Varsha Pawate
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jaya Sheela Amaram Davila
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Admane S, Clark M, Reddy A, Narayanan S, Bruera E. Safely Prescribing Opioids With Nirmatrelvir/Ritonavir - Case Report and Management Recommendations. J Pain Symptom Manage 2024; 67:e99-e104. [PMID: 37797677 DOI: 10.1016/j.jpainsymman.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Sonal Admane
- Division of Palliative, Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA.
| | - Matthew Clark
- Division of Palliative, Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Akhila Reddy
- Division of Palliative, Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Santhosshi Narayanan
- Division of Palliative, Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Eduardo Bruera
- Division of Palliative, Integrative, and Rehabilitation Medicine - University of Texas MD Anderson Cancer Center, Houston Texas, USA
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Reddy A, González JB, Rizvi A, Nortje N, Dalal S, Haider A, Amaram-Davila JS, Bramati P, Chen M, Hui D, Bruera E. Impact of an Institution-Wide Goals of Care Program on the Timing of Referrals to Outpatient Palliative Care. J Pain Symptom Manage 2023; 66:e666-e671. [PMID: 37643654 DOI: 10.1016/j.jpainsymman.2023.08.019] [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: 06/15/2023] [Revised: 08/10/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT Palliative care has received increased interest since the COVID-19 pandemic due to its role in guiding goals of care (GOC) discussions. OBJECTIVES We assessed the change in the timing of outpatient palliative care referrals before and after implementing an institution-wide multicomponent interdisciplinary GOC (myGOC) program. METHODS We reviewed 200 random supportive care center (SCC) consult visits each from June to November 2019 (before myGOC) and June to November 2020 (after myGOC). Data regarding Edmonton Symptom Assessment Scale (ESAS) scores, time from hospital registration to SCC visit, SCC visit until death/last follow-up, and advance care planning (ACP) notes were collected. Kaplan-Meier curves were used to evaluate overall survival (OS). RESULTS The median OS from the SCC consult visit was 15.2 months (95% CI:11.7-19.7) before and 14.0 months (95% CI:10.8-17.9) after the myGOC program (P = 0.646). There were no significant differences in the median time between the SCC consult visit to death/last follow-up (11.95 vs. 12.0 months after myGOC; P = 0.841) and the first visits to our cancer center and SCC (6.1 vs. 5.29 months after myGOC; P = 0.689). Patients seen after myGOC had significantly lower ESAS symptom scores, better performance status (2 [1-2] vs. 2 [1-3]; P = 0.018], and more ACP notes composed by medical oncology teams (25.5% vs. 4.5%; P < 0.001). CONCLUSION There were no significant differences in OS among patients seen in the SCC before and after myGOC, likely related to a ceiling effect. More oncologists had ACP discussions with patients, and patients had lower symptom scores on ESAS after myGOC, likely indicating that more patients were referred for GOC discussions and ACP rather than for symptom distress.
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Affiliation(s)
- Akhila Reddy
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Joannis Baez González
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ali Rizvi
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nico Nortje
- Section of Integrated Ethics (N.N.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shalini Dalal
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ali Haider
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jaya Sheela Amaram-Davila
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patricia Bramati
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minxing Chen
- Department of Biostatistics (M.C.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Departments of Palliative, Rehabilitation, and Integrative Medicine, Critical Care Medicine, (A.R., J.B.G., A.R., S.D., A.H., J.S.A.D., P.B., D.H., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Kellett S, Petrushkin H, Ashworth J, Connor A, McLoone E, Schmoll C, Sharma S, Agorogiannis E, Williams J, Choi J, Injarie A, Puvanachandra N, Watts P, Shafi A, Millar E, Long V, Kumar A, Hughes E, Ritchie A, Gonzalez-Martin J, Pradeep A, Anwar S, Warrior K, Muthusamy B, Pilling R, Benzimra J, Reddy A, Bush K, Pharoah D, Falzon K, O'Colmain U, Knowles R, Tadic V, Dick A, Rahi J, Solebo AL. 2 Pathways to detection of non-infectious childhood uveitis in the UK: findings from the UNICORN cohort study. BMJ Open Ophthalmol 2023; 8:A1. [PMID: 37797997 DOI: 10.1136/bmjophth-2023-biposa.2] [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: 10/07/2023] Open
Abstract
INTRODUCTION Prompt detection of childhood uveitis is key to minimising negative impact. From an internationally unique inception cohort, we report pathways to disease detection.UNICORNS is a national childhood non-infectious uveitis study with longitudinal collection of a standardised clinical dataset and patient reported outcomes. Descriptive analysis of baseline characteristics are reported.Amongst 150 recruited children (51% female, 31% non-white ethnicity) age at detection ranged from 2-18yrs (median 10). In 69%, uveitis was diagnosed following onset of symptoms: time from first symptoms to uveitis detection ranged from 0-739days (median 7days), with longer time to detection for those presenting initially to their general practitioner. Non symptomatic children were detected through JIA/other disease surveillance (16%), routine optometry review (5%) or child visual health screening (1%). Commonest underlying diagnoses at uveitis detection were JIA (17%), TINU (9%, higher than pre-pandemic reported UK disease frequency) and sarcoid (1%). 60% had no known systemic disease at uveitis detection. At disease detection, in at least one eye: 34% had structural complications (associated with greater time to detection - 17 days versus 4 days for uncomplicated presentation).The larger relative proportions of children with non-JIA uveitis reported here increase the importance of improving awareness of childhood uveitis amongst the wider clinical communities. There is scope for improvement of pathways to detection. Forthcoming analysis on the full cohort (251 recruited to date across 33 hospitals and 4 nations) will provide nationally representative data on management and the determinants of visual and broader developmental/well-being outcomes.
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Affiliation(s)
- S Kellett
- University College London, Institute of Child Health, UK
| | - H Petrushkin
- University College London, Institute of Child Health, UK
| | - J Ashworth
- University College London, Institute of Child Health, UK
| | - A Connor
- University College London, Institute of Child Health, UK
| | - E McLoone
- University College London, Institute of Child Health, UK
| | - C Schmoll
- University College London, Institute of Child Health, UK
| | - S Sharma
- University College London, Institute of Child Health, UK
| | - E Agorogiannis
- University College London, Institute of Child Health, UK
| | - J Williams
- University College London, Institute of Child Health, UK
| | - J Choi
- University College London, Institute of Child Health, UK
| | - A Injarie
- University College London, Institute of Child Health, UK
| | | | - P Watts
- University College London, Institute of Child Health, UK
| | - A Shafi
- University College London, Institute of Child Health, UK
| | - E Millar
- University College London, Institute of Child Health, UK
| | - V Long
- University College London, Institute of Child Health, UK
| | - A Kumar
- University College London, Institute of Child Health, UK
| | - E Hughes
- University College London, Institute of Child Health, UK
| | - A Ritchie
- University College London, Institute of Child Health, UK
| | | | - A Pradeep
- University College London, Institute of Child Health, UK
| | - S Anwar
- University College London, Institute of Child Health, UK
| | - K Warrior
- University College London, Institute of Child Health, UK
| | - B Muthusamy
- University College London, Institute of Child Health, UK
| | - R Pilling
- University College London, Institute of Child Health, UK
| | - J Benzimra
- University College London, Institute of Child Health, UK
| | - A Reddy
- University College London, Institute of Child Health, UK
| | - K Bush
- University College London, Institute of Child Health, UK
| | - D Pharoah
- University College London, Institute of Child Health, UK
| | - K Falzon
- University College London, Institute of Child Health, UK
| | - U O'Colmain
- University College London, Institute of Child Health, UK
| | - R Knowles
- University College London, Institute of Child Health, UK
| | - V Tadic
- University College London, Institute of Child Health, UK
| | - A Dick
- University College London, Institute of Child Health, UK
| | - J Rahi
- University College London, Institute of Child Health, UK
| | - A L Solebo
- University College London, Institute of Child Health, UK
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Cappelli L, Uppendahl A, Gardner C, Dejarlais A, Reddy A, Khan M, Kayne A, Poiset SJ, Zhan T, Judy K, Andrews DW, Simone NL, Alnahhas I, Shi W. Body Mass Index (BMI) at Time of Diagnosis as a Prognostic Indicator in Patients with Newly Diagnosed Glioblastoma (GBM). Int J Radiat Oncol Biol Phys 2023; 117:e93. [PMID: 37786217 DOI: 10.1016/j.ijrobp.2023.06.853] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Glioblastoma (GBM) is the most common primary brain cancer in adults with very poor prognosis. Metabolic drivers of tumorigenesis are highly relevant within the central nervous system, where glucose is the sole source of energy. The impact of obesity on survival outcomes in patients with GBM has not been well reported and some initial results are inconsistent. This study investigates the factor of body mass index (BMI) in patients diagnosed with GBM. This study evaluated the prognostic association of BMI with survival outcomes in patients with newly diagnosed GBM. MATERIALS/METHODS Patientswith newly diagnosed GBM at our institution from 2015-2022 were included in this study. All patients were >18 years of age and received 60 Gy of radiation therapy with concurrent and adjuvant temozolomide following maximal safe resection. Through retrospective chart review, patient BMI at the time of diagnosis and overall survival (OS) were recorded. Analysis was done between patient groups of underweight/normal weight (BMI <25) and overweight/obese (BMI ≥ 25.00). The subgroup of overweight patients was also divided into subgroups of overweight (BMI 25.00-29.99) and obese (BMI≥30.00). A difference in clinical outcomes of overall survival was evaluated between the groups using Gehan-Breslow-Wilcoxon and log-rank tests. RESULTS Atotal of 393 patients met inclusion criteria. Median age 57.3 years, range 18.8-92.7. 185 female and 208 were male. 120 patients had a BMI <25 and 273 had a BMI ≥ 25.00. Median survival in patients with BMI <25 was 24.90 months and in patients with BMI ≥ 25.00, 18.20 months (p = 0.0001; HR 0.6552, 95% CI 0.5299-0.8101). We further divided patients with BMI ≥ 25.00 to 25-29.99 (n = 152) and BMI≥30.00 (n = 121). Both groups' OS were significantly worse than patients with BMI < 25 (p = 0.006). There was no difference in survival outcomes between patients with a BMI 25.00-29.99 and BMI≥30.00, with median OS 19.0 months and 18.1 months, respectively. CONCLUSION Patient baseline BMI <25 appears to be a prognostic indicator and correlates to improves overall survival for patients with newly diagnosed GBM. This study adds to the existing literature supporting overweight/obesity is associated with worse survival for GBM patients. Additional studies are warranted for further analysis of BMI and survival outcomes in GBM patients across patient demographics.
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Affiliation(s)
- L Cappelli
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - A Uppendahl
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
| | - C Gardner
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
| | - A Dejarlais
- Drexel College of Medicine, Philadelphia, PA
| | - A Reddy
- The College of New Jersey, Ewing, NJ
| | - M Khan
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
| | - A Kayne
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA
| | - S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - T Zhan
- Dept of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - K Judy
- Dept of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - D W Andrews
- Department of Neurosurgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - N L Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - I Alnahhas
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
| | - W Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Amaram-Davila J, Bramati P, Gammon L, Mallipeddi T, Jastrzemski O, Clark MD, Arthur J, Reddy A, Bruera E. Deficiencies with CAGE-AID questionnaire in identifying nonmedical opioid use-a report of two cases. Ann Palliat Med 2023; 12:976-980. [PMID: 37691336 DOI: 10.21037/apm-23-192] [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] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The CAGE-AID questionnaire (Cut-down, Annoyed, Guilty, Eye-opener scale Adapted to Include Drugs) is used to screen patients for substance use disorder and nonmedical opioid use (NMOU). Major pain guidelines encourage using such screening tools for all patients including cancer patients before initiating opioids. We present two cases where the CAGE-AID results did not accurately identify the risk for NMOU. CASE DESCRIPTION Patient 1 is a male in his 60s with metastatic prostate cancer was admitted for uncontrolled pain. Imaging revealed extensive spinal metastasis, needing initiation of methadone and hydromorphone. The CAGE-AID score was positive, placing him at risk for NMOU. This likely biased the providers, delaying opioid titration. Subsequently, doses were adjusted, and he was discharged with adequate pain control and no evidence of NMOU. Patient 2 is a male in his 40s with metastatic cholangiocarcinoma admitted for uncontrolled abdominal pain. The patient had multiple hospitalizations at different facilities with similar symptoms. The CAGE-AID score was negative. Despite this, the patient demonstrated behaviors such as demanding intravenous opioids, dose escalation, or interventions such as nerve blocks. The workup did not identify any etiology for the increased pain. The patient left the hospital against medical advice when his demands for intravenous opioids were not met. CONCLUSIONS The CAGE-AID questionnaire alone does not accurately identify risks for NMOU. Screening tools must always be accompanied by a thorough clinical assessment of behaviors and pain mechanism. More research is needed to better characterize CAGE-AID false positives and negatives among patients with cancer pain.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia Bramati
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Gammon
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Tarun Mallipeddi
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Olivia Jastrzemski
- University of New Mexico Health Science Center College of Medicine, Albuquerque, NM, USA
| | - Matthew D Clark
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Amaram-Davila J, Reddy A, Clark MD, Nancherla A, Arthur J, Bruera E. Reliability of urine drug testing among patients on buprenorphine transdermal patch. Palliat Support Care 2023:1-3. [PMID: 37525588 PMCID: PMC10830884 DOI: 10.1017/s147895152300086x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results. CASE DESCRIPTION A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU. DISCUSSION Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient-physician relationships. CONCLUSION In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew D. Clark
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Nancherla
- University of the incarnate word, Feik school of Pharmacy, San Antonio, Tx, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Nortje N, Zachariah F, Reddy A. Advance Care Planning conversations: What constitutes best practice and the way forward: Advance Care Planning-Gespräche: Was Best Practice ausmacht und wie es weitergehen kann. Z Evid Fortbild Qual Gesundhwes 2023; 180:8-15. [PMID: 37438167 DOI: 10.1016/j.zefq.2023.05.008] [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] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Advance Care Planning (ACP) conversations are a cornerstone of modern health care and need to be supported. However, research indicates that the uptake thereof is limited, regardless of various campaigns. ACP conversations are complex and specific elements thereof should be discussed at various timepoints during the illness trajectory. OBJECTIVE This narrative review delineates what ACP conversation should entail, and a way forward. METHODS A PEO (Population, Exposure, Outcome) search was performed using relevant keywords, and 615 articles were identified. Through screening and coding, this number was reduced to 24 articles. All the authors were involved in the final selection of the articles. RESULTS Various themes developed throughout the review which include timing early on in the disease trajectory; incorporating beliefs and culturally relevant contexts; conversations needing to be iterative and short; involving surrogates and family; applying various media formats. DISCUSSION ACP conversations are relevant. ACP is not static and needs to be dynamic as patients' illness trajectories and goals change. The care team needs to guard themselves against having ACP conversations to satisfy a metric and should instead be guided by the patient's expressed values and wishes. A system-wide operational plan will help alleviate common barriers in having appropriate ACP conversations.
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Affiliation(s)
- Nico Nortje
- Section of Integrated Ethics, Department of Critical Care Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa.
| | - Finly Zachariah
- Department of Supportive Care Medicine, City of Hope, CA, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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18
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Loggers ET, Case AA, Chwistek M, Dale W, Delgado Guay MO, Edge SB, Grossman SR, Gustin J, Nelson J, Rajasekhara S, Reddy A, Tulsky JA, Zachariah F, Landrum KM. ADCC's Improving Goal Concordant Care Initiative: Implementing Primary Palliative Care Principles. J Pain Symptom Manage 2023; 66:e283-e297. [PMID: 37257523 DOI: 10.1016/j.jpainsymman.2023.05.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND High-quality, timely goals of care communication (GOCC) may improve patient and caregiver outcomes and promote care that is consistent with patient preferences. PROBLEM Cancer patients, and their loved ones, appreciate GOCC; however, oncologists often lack formal communication training, institutional support and structures necessary to promote the delivery, documentation, and longitudinal follow-up of GOCC. PROPOSED SOLUTION The Alliance of Dedicated Cancer Centers (ADCC), representing 10 U.S. academic cancer hospitals, undertook the Improving Goal Concordant Care Initiative (IGCC). This national, 3-year implementation initiative was designed in Fall 2019 by a workgroup of quality, oncology, and palliative care leaders, as well as patient and family advisory committee members (PFAC). IGCC addresses systemic gaps by requiring four core components for participation: 1) Implementation of a formal communication skills training (CST) program, 2) Structured GOCC documentation in the electronic medical record that is visible to all clinicians, 3) Expectations regarding the timing and patient populations for GOCC, and 4) Implementation of a measurement framework. METHOD Dyads of palliative and oncology leaders committed to attend regularly scheduled, ADCC-led, virtual meetings during the design and implementation phase, incorporating PFAC feedback at every stage. Using the RE-AIM framework, we describe process and outcome evaluation measures defined by implementation and measures workgroups and collected routinely, including: CST completion; trainee evaluation response rate, trainee-reported quality of CST, trainee changes in self-efficacy and distress; percent of high-priority patients participating in GOCC, and patient-reported response to the "Heard and Understood" scale (HU). IGCC's impact will be assessed using claims-based utilization metrics near the end of life (EOLM) and followed longitudinally. Qualitative evaluations near the completion of IGCC will provide insight into perceived barriers, enabling factors, and sustainability. OUTCOMES Implementation of all IGCC components has begun at all sites. ADCC-wide, 35% of MD/DOs have completed CST (range by site: 8%-100%). CST is highly rated; in Quarter 3, 2022, 93%-100%, 90%-100% and 87%-100% of respondents reported above average to excellent CST quality, likelihood to use the skills and likelihood to recommend CST to others, respectively. Clinician self-efficacy and distress ratings are expected in late 2023. All sites have identified patient populations and continue to refine automated triggers and timelines; uptake of GOCC documentation has been slow. Eight of 10 sites have submitted patient-reported HU data. EOLM data are expected for all sites in early 2024. LESSONS LEARNED Flexibility in implementation with shared definitions, measures, and learnings about approaches optimizes the ability of all centers to collaborate and make progress in improving GOCC. Flexibility adds to the complexity of understanding intervention effectiveness, the critical intervention components and the fidelity necessary to achieve specific outcomes.
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Affiliation(s)
- Elizabeth T Loggers
- Clinical Research Division, Fred Hutchinson Cancer Center, Division of Oncology (E.T.L.), University of Washington, Seattle, WA, USA.
| | - Amy A Case
- Roswell Park Comprehensive Cancer Center, Chair Dept Supportive & Palliative Care (A.A.C.), Buffalo, NY, USA
| | - Marcin Chwistek
- Supportive Oncology and Palliative Care Program (M.C.), Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - William Dale
- Supportive Care Medicine (W.D.), City of Hope, Duarte, CA, USA
| | - Marvin O Delgado Guay
- Department of Palliative, Rehabilitation, and Integrative Medicine (M.O.D.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Edge
- VP System Quality and Outcome, Roswell Park Comprehensive Cancer Center (S.B.E.), Buffalo, NY, USA
| | - Steven R Grossman
- USC Norris Comprehensive Cancer Center (S.R.G.), University of Southern California, Los Angeles, CA, USA
| | - Jillian Gustin
- Division of Palliative Medicine (J.G.), The Ohio State University Comprehensive Cancer Caner-Arthur G James Cancer Hospital, Columbus, OH, USA
| | - Judith Nelson
- Memorial Sloan Kettering Cancer Center (J.N.), New York, NY, USA
| | | | | | - James A Tulsky
- Poorvu Jaffe Chair, Psychosocial Oncology and Palliative Care (J.A.T.), Dana-Farber Cancer Institute
| | - Finly Zachariah
- Informatics & Value-Based Supportive Care (F.Z.), City of Hope, CA, USA
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Hui D, Mastroleo GS, Rozman De Morales A, Peek A, Reddy A, Zhukovsky DS, Joy M, Ali S, Bruera E. Implementation of Patient Reported Outcomes in Outpatient Palliative Care: From Paper to Computer. J Pain Symptom Manage 2023; 66:e197-e203. [PMID: 37080480 DOI: 10.1016/j.jpainsymman.2023.04.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND This quality improvement project aimed to transition completion of Edmonton Symptom Assessment System (ESAS) at our supportive care clinic from paper to electronic format. MEASURES Proportion of patients who completed electronic ESAS (eESAS). INTERVENTION Starting July 2018, patients could complete eESAS 24h before check-in (eESAS-before), eESAS after check-in (eESAS-after) or on paper (pESAS). OUTCOMES A total of 6631 cancer patients had 25,767 clinic visits between July 13, 2018 and November 5, 2021. The ESAS completion rate was 100%. eESAS uptake gradually increased over time, first reaching ≥75% eESAS completion in 5/2019 (eESAS-after 61.9%; eESAS-before 14.0%; pESAS 24.1%). We observed a sharp uptake in eESAS-before since adoption of telehealth during the pandemic (May 2020) and the ≥75% eESAS target was consistently achieved from November 2020 onwards (eESAS-after 0.6%; eESAS-before 76.7%; pESAS 22.7%). In an anonymous survey, we identified several modifiable barriers to implementing eESAS. CONCLUSIONS Transition to eESAS was a gradual process and was catalyzed by the pandemic.
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Affiliation(s)
- David Hui
- Department of Palliative (D.H., A.R.D-M., A.R., D.S.Z., M.J., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | | | - Aline Rozman De Morales
- Department of Palliative (D.H., A.R.D-M., A.R., D.S.Z., M.J., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angela Peek
- Clinical & Access Applications (A.P.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative (D.H., A.R.D-M., A.R., D.S.Z., M.J., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donna S Zhukovsky
- Department of Palliative (D.H., A.R.D-M., A.R., D.S.Z., M.J., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manju Joy
- Department of Palliative (D.H., A.R.D-M., A.R., D.S.Z., M.J., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sara Ali
- Enterprise Data Engineering & Analytics (S.A.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative (D.H., A.R.D-M., A.R., D.S.Z., M.J., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tang M, Clark M, Reddy A, Bruera E. Fentanyl Toxicity Related to Concomitant Use of Ciprofloxacin and its Effects as a CYP3A4 Inhibitor. J Pain Symptom Manage 2023; 66:e307-e309. [PMID: 37150364 DOI: 10.1016/j.jpainsymman.2023.04.024] [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: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Michael Tang
- Department of Palliative (M.T., A.R., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Matthew Clark
- Department of Pharmacy (M.C.), MD Anderson Cancer Center, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative (M.T., A.R., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative (M.T., A.R., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chauhan R, Singh N, Reddy A, Singh A. The role of dexmedetomidine in post cranioplasty refractory status epilepticus. Anaesth Rep 2023; 11:e12246. [PMID: 37736063 PMCID: PMC10511152 DOI: 10.1002/anr3.12246] [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] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
Cranioplasty, specifically a repair of the skull defect resulting from a previous decompressive craniectomy, is a relatively simple procedure associated with a minimal rate of complications. Even though seizures are seen in up to 30% of the patients postoperatively, status epilepticus is not commonly described. Cerebral oedema, ischaemia and neuro-inflammation have been reported as putative causes of seizures in this population. Here, we report a case of refractory status epilepticus unresponsive to standard anti-epileptic and anaesthetic agents. The use of dexmedetomidine helped terminate the episode and led to a favourable outcome. Most of the standard anti-epileptic and anaesthetic agents act through potentiation of GABAergic transmission or sodium channel blockade and postsynaptic adrenoceptor activation by dexmedetomidine may help potentiate their effect. Further studies are needed to investigate its anticonvulsant effect on post-traumatic brain injury and elaborate on optimal dosage.
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Affiliation(s)
- R. Chauhan
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - N. Singh
- Department of AnaesthesiologySanjay Gandhi Postgraduate Institute of Medical Sciences and ResearchLucknowIndia
| | - A. Reddy
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - A. Singh
- Department of NeurosurgeryPostgraduate Institute of Medical Education and ResearchChandigarhIndia
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Arthur J, Pawate V, Lu Z, Yennurajalingam S, Azhar A, Reddy A, Epner D, Hui D, Tanco K, Delgado Guay MO, Vidal M, Chen M, Bruera E. Helpfulness of Question Prompt Sheet for Patient-Physician Communication Among Patients With Advanced Cancer: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2311189. [PMID: 37129892 PMCID: PMC10155065 DOI: 10.1001/jamanetworkopen.2023.11189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Importance There are few robust evaluations of disease-specific question prompt sheets (QPS) in patient-physician communication among patients with advanced cancer. Objective To compare the patient perception of helpfulness, global evaluation, and preference for the QPS vs a general information sheet (GIS), and to examine the effect of the QPS on participants' anxiety, participants' speaking time, number of questions asked, and length of the clinical encounter. Design, Setting, and Participants This controlled, double-blind randomized clinical trial was conducted at an outpatient palliative and supportive care clinic in a cancer center in the US. Eligible patients were 18 years or older, had a cancer diagnosis, and were undergoing their first outpatient consultation visit with a palliative care physician from September 1, 2017, to May 31, 2019. Data analysis used a modified intention-to-treat design. Data were analyzed from May 18 to June 27, 2022. Intervention QPS, a 25-item list of questions developed by expert palliative care clinicians using a Delphi process and tested among ambulatory advanced cancer patients. The control was GIS, generic information material given routinely to patients seen at the supportive care clinic. Main Outcomes and Measures The main outcome was patient perception of helpfulness. Secondary outcomes included global evaluation and preference of QPS compared with GIS immediately after the encounter. Results A total of 130 patients (mean [SD] age, 58.6 [13.3] years; 79 [60.8%] female) were randomized to receive either QPS (67 patients [51.5%]) or GIS (63 patients [48.5%]). Patients considered QPS and GIS equally helpful, with no statistically significant difference (mean [SD] helpfulness score, 7.2 [2.3] points vs 7.1 [2.7] points; P = .79). The QPS group, compared with the GIS group, had a higher global positive view of the material (mean [SD] global perception score, 7.1 [1.3] vs 6.5 [1.7]; P = .03) and felt it prompted them more to generate new questions (mean [SD] rating, 7.0 [2.9] vs 5.3 [3.5]; P = .005). Of 47 patients asked their preference between the items, more participants preferred the QPS to the GIS in communicating with their physicians (24 patients [51.1%] vs 7 patients [14.9%]; P = .01) at the 4-week follow-up. No significant differences between the QPS and GIS groups were observed regarding participant anxiety, speaking time, number of questions asked, or consultation length (eg, mean [SD] anxiety rating, 2.3 [3.7] vs 1.6 [2.7]; P = .19). Conclusions and Relevance In this randomized clinical trial, participants perceived both QPS and GIS as equally helpful, but they had a more positive global view of and preferred the QPS. QPS facilitated generation of new questions without increasing patient anxiety nor prolonging the consultation. The findings provide support for increased adoption and integration of QPS into routine oncologic care. Trial Registration ClinicalTrials.gov Identifier: NCT03287492.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Varsha Pawate
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Zhanni Lu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Ahsan Azhar
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Akhila Reddy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Daniel Epner
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Marvin Omar Delgado Guay
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Marieberta Vidal
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston
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Amaram-Davila J, Reddy A, Arthur J, Narayanan S, Gogineni M, Mallipeddi T, Moraes ARD, Maddi R, Shelal Z, Urbauer D, Chen M, Bruera E. Efforts to Improve Naloxone Co-Prescription for Patients with Cancer Pain at Risk of Opioid Overdose. J Palliat Med 2023. [PMID: 37074064 DOI: 10.1089/jpm.2022.0389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Importance: Naloxone can be lifesaving in an opioid-related overdose (OD). However, the co-prescription of take-home naloxone (THN) is not widely adopted in routine clinical practice. We implemented a pilot program focused on increasing clinicians' awareness of THN and observed if this impacts THN prescriptions for our patients with cancer pain receiving opioids. Intervention: In January 2020, we initiated an educational program by twice-weekly video presentations and installed pamphlets in all clinic workstations highlighting the risk factors for ODs. We retrospectively reviewed electronic health records (EHR) of randomly selected patient visits, 200 each from eight weeks before intervention (BI) and eight weeks after the intervention (AI). Data on patient characteristics, risk factors for ODs, and THN prescriptions were collected. Results: In all, 380 unique patients were eligible for analysis. The median age was 60, 53% female, and 70% Caucasian. Eighty-two percent (152) BI and 73% (142) AI carried risk factors for ODs (p = 0.13). THN was prescribed to 21% (32/152) BI and 26% (37/142) AI (p = 0.53). Morphine-equivalent daily dose (MEDD) ≥100 mg (30%) and pulmonary disease (25%) were the most prevalent risk factors. The patient's likelihood of receiving a THN prescription increased by 0.9% for every 1-milligram increase in MEDD (p < 0.001, 95% confidence interval: 1.006-1.011). Conclusion: The educational intervention did not significantly increase the frequency of THN prescriptions. More direct interventions, including automatic EHR triggers, may need to be tested in future trials.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Meghana Gogineni
- The University of Texas, University of Southwestern School of Medicine, Dallas, Texas, USA
| | - Tarun Mallipeddi
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aline Rozman De Moraes
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Rama Maddi
- Department of Leukemia, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
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Amaram-Davila J, Kim MJ, Reddy A, Edwards T, Dai J, Urbauer D, Shelal Z, Ross Y, Hosain M, Bruera E, Arthur J. Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain. J Palliat Med 2023; 26:248-252. [PMID: 36476019 PMCID: PMC9894589 DOI: 10.1089/jpm.2022.0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 09/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Data on health care providers' (HCPs') perceptions about patients with cancer pain and nonmedical opioid use (NMOU) are lacking. We examined the perceptions and attitudes of HCPs and assessed the usefulness of an interdisciplinary opioid stewardship program (OSP) while caring for these patients. Methods: An anonymous cross-sectional survey was conducted among the supportive care HCPs between September and November 2021. Results: Of 85 HCPs, 64 responded (75%) to the survey. Participants perceived that NMOU is underdiagnosed (42/64; 67%), and caring for such patients is difficult (58/64, 91%) and time consuming (54/64, 87%). A majority (50/51, 98%) were aware of the OSP, and (48/51; 94%) found it helpful. Conclusion: HCPs reported that NMOU is underdiagnosed and is challenging to manage. They endorsed the utility of an OSP in managing patients with concurrent cancer pain and NMOU. Future research should identify ways to standardize care and integrate OSP in routine supportive oncology practice.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Min Ji Kim
- Department of Supportive and Palliative Care, Baylor University Medical Center, Dallas, Texas, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Tonya Edwards
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Yvette Ross
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Monawar Hosain
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
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Reddy A, Taylor M, Batson B, Islam E. Pleural invasion in non-small cell lung cancer: a case report. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00254-9] [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: 01/28/2023]
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Reddy A, Haider A, Arthur J, Hui D, Dalal S, Dev R, Tanco K, Amaram-Davila J, Hernandez F, Chavez P, De Moraes AR, Wu J, Nguyen K, Subbiah I, Epner D, Shelal Z, Guay MOD, Mallipeddi T, Bruera E. Levorphanol as a Second Line Opioid in Cancer Patients Presenting to an Outpatient Supportive Care Center: An Open-label Study. J Pain Symptom Manage 2023; 65:e683-e690. [PMID: 36720398 DOI: 10.1016/j.jpainsymman.2023.01.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 01/30/2023]
Abstract
CONTEXT Levorphanol is a potent opioid agonist and NMDA receptor blocker with minimal drug interactions, and there are few reports of its use in cancer patients. OBJECTIVES We aimed to determine the frequency of successful opioid rotation (OR) to levorphanol and the median opioid rotation ratio (ORR) from Morphine Equivalent Daily Dose (MEDD). METHODS This is a prospective, single-group, interventional study. Cancer outpatients requiring an OR and receiving a MEDD of 60-300 mg were rotated to levorphanol using a ratio of 10:1 and assessed daily for 10-day. Successful OR was defined as a 2-point improvement in the Edmonton Symptom Assessment System (ESAS) pain score on day 10 or achieving the personalized pain goal between days 3-10 in patients with uncontrolled pain or resolution of opioid side effects (OSE) in those undergoing OR for OSE alone. The ORR to levorphanol was calculated using net-MEDD (MEDD before OR minus the MEDD of the breakthrough opioid used along with levorphanol after OR). RESULTS Forty patients underwent OR to levorphanol, and uncontrolled pain 35/40 (87.5%) was the most common indication. The median net-MEDD and levorphanol doses were 95 and 10 mg, respectively, and 33/40 (82.5%) had a successful OR with a median (IQR) ORR of 8.56 (7.5-10). Successful OR was associated with significant improvement in ESAS and OSE scale scores. There was a strong association between MEDD and levorphanol dose. CONCLUSION This study provided preliminary data that cancer patients could be successfully rotated to levorphanol using an ORR of 8.5. Levorphanol was associated with improved pain and symptom control and was well- tolerated.
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Affiliation(s)
- Akhila Reddy
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Ali Haider
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberson Tanco
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jaya Amaram-Davila
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farley Hernandez
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul Chavez
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aline Rozman De Moraes
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jimin Wu
- Department of Biostatistics (J.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristy Nguyen
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ishwaria Subbiah
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Epner
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marvin Omar Delgado Guay
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tarun Mallipeddi
- University of Tennessee Health Science Center College of Medicine (T.M.), Memphis, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine (A.R., A.H., J.A. D.H., S.D., R.D., K.T., J.A-D., F.H., P.C., A.R.D.M., K.N., I.S., D.E., Z.S., M.O.D.G., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hui D, Nortje N, George M, Wilson K, Urbauer DL, Lenz CA, Wallace SK, Andersen CR, Mendoza T, Haque S, Ahmed S, Delgado-Guay M, Dalal S, Rathi N, Reddy A, McQuade J, Flowers C, Pisters P, Aloia T, Bruera E. Impact of an Interdisciplinary Goals-of-Care Program Among Medical Inpatients at a Comprehensive Cancer Center During the COVID-19 Pandemic: A Propensity Score Analysis. J Clin Oncol 2023; 41:579-589. [PMID: 36201711 PMCID: PMC9870226 DOI: 10.1200/jco.22.00849] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/28/2022] [Accepted: 08/24/2022] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Many hospitals have established goals-of-care programs in response to the coronavirus disease 2019 pandemic; however, few have reported their outcomes. We examined the impact of a multicomponent interdisciplinary goals-of-care program on intensive care unit (ICU) mortality and hospital outcomes for medical inpatients with cancer. METHODS This single-center study with a quasi-experimental design included consecutive adult patients with cancer admitted to medical units at the MD Anderson Cancer Center, TX, during the 8-month preimplementation (May 1, 2019-December 31, 2019) and postimplementation period (May 1, 2020-December 31, 2020). The primary outcome was ICU mortality. Secondary outcomes included ICU length of stay, hospital mortality, and proportion/timing of care plan documentation. Propensity score weighting was used to adjust for differences in potential covariates, including age, sex, cancer diagnosis, race/ethnicity, and Sequential Organ Failure Assessment score. RESULTS This study involved 12,941 hospitalized patients with cancer (pre n = 6,977; post n = 5,964) including 1,365 ICU admissions (pre n = 727; post n = 638). After multicomponent goals-of-care program initiation, we observed a significant reduction in ICU mortality (28.2% v 21.9%; change -6.3%, 95% CI, -9.6 to -3.1; P = .0001). We also observed significant decreases in length of ICU stay (mean change -1.4 days, 95% CI, -2.0 to -0.7; P < .0001) and in-hospital mortality (7% v 6.1%, mean change -0.9%, 95% CI, -1.5 to -0.3; P = .004). The proportion of hospitalized patients with an in-hospital do-not-resuscitate order increased significantly from 14.7% to 19.6% after implementation (odds ratio, 1.4; 95% CI, 1.3 to 1.5; P < .0001), and do-not-resuscitate order was established earlier (mean difference -3.0 days, 95% CI, -3.9 to -2.1; P < .0001). CONCLUSION This study showed improvement in hospital outcomes and care plan documentation after implementation of a system-wide, multicomponent goals-of-care intervention.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nico Nortje
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa
| | - Marina George
- Division of Internal Medicine, Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kaycee Wilson
- Department of Inpatient Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana L. Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Caitlin A. Lenz
- Department of Inpatient Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susannah Kish Wallace
- Enterprise Data Engineering and Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clark R. Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sajid Haque
- Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marvin Delgado-Guay
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalini Dalal
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nisha Rathi
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Akhila Reddy
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter Pisters
- President's Office, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Narayanan S, Liu W, Lopez G, Fellman B, Reddy A, Subbiah IM, Cohen L, Bruera E. Practice Patterns on the Incorporation of Integrative Medicine Into the Oncologic Care of Patients With Cancer. Integr Cancer Ther 2023; 22:15347354231213045. [PMID: 37978821 PMCID: PMC10657516 DOI: 10.1177/15347354231213045] [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: 05/04/2023] [Revised: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND With rising interest in complementary approaches to symptom management, awareness of real-world practice patterns in the incorporation of integrative oncology (IO) into cancer care is limited. Therefore, we examined the reasons for referral, symptom burdens, and clinical outcomes for cancer patients who underwent initial IO consultations. METHODS The records of adult patients with cancer who underwent initial outpatient IO consultations at our cancer center for a representative 10-day period at the start of each month for 12 months starting January 1, 2017, were reviewed retrospectively. Patient demographic and medical characteristics and outpatient IO consultation details, including patient-reported outcome measures of symptom burden, were extracted. Descriptive summary statistics and logistic regression were used to analyze the data. RESULTS Among the 473 study patients, 71% were women, breast cancer (42%) was the most common cancer type, and 31% had metastatic cancer. Referring clinicians listed an integrative approach (57%) as the most common reason for referral, followed by diet (26%), pain (19%), discussion of herbs and supplements (18%), and stress (18%). In comparison, patients listed their primary concerns as diet (16%), pain (15%), and an integrative approach to overall health (11%). After the IO consultations, the highest likelihood of subsequent recommendations were acupuncture for hot flashes (odds ratio [OR], P = .002) or peripheral neuropathy (OR = 6.59, P < .001), oncology massage for pain (OR = 3.04, P < .001), psychology referral for patient's self-reported anxiety (OR = 2.35, P < .001), and mind-body therapies for stress (OR = 2.57, P < .001). CONCLUSION Cancer patients' top concerns regarding IO consultation may not always match providers' reasons for referral. Longitudinal data analysis is needed to determine the effect of integrative interventions on symptom burden.
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Affiliation(s)
| | - Wenli Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Murali-Nanavati S, Pathak R, Chitkara G, Reddy A, Nair N, Joshi S, Thakkar P, Parmar V, Gupta S, Sarin R, Badwe R. Unusual ocular manifestations of breast carcinoma: A single institute case series in the Indian population. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01534-9] [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: 11/19/2022]
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Gaines JJ, Gilbert BC, Gossage JR, Parker W, Reddy A, Forseen SE. Schizencephaly in Hereditary Hemorrhagic Telangiectasia. AJNR Am J Neuroradiol 2022; 43:1603-1607. [PMID: 36265891 PMCID: PMC9731247 DOI: 10.3174/ajnr.a7677] [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] [Received: 05/23/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The presence of malformations of cortical development in patients with hereditary hemorrhagic telangiectasia has been reported on previous occasions. We evaluated a sample of adults with hereditary hemorrhagic telangiectasia for the presence of malformations of cortical development, spatial coincidence of malformations of cortical development and AVMs, and the coincidence of brain and pulmonary AVMs. MATERIALS AND METHODS A total of 141 patients 18 years of age or older who were referred to the Augusta University hereditary hemorrhagic telangiectasia clinic and underwent brain MR imaging between January 19, 2018, and December 3, 2020, were identified. MR imaging examinations were reviewed retrospectively by 2 experienced neuroradiologists, and the presence of malformations of cortical development and AVMs was confirmed by consensus. Demographic and clinical information was collected for each case, including age, sex, hereditary hemorrhagic telangiectasia status by the Curacao Criteria, mutation type, presence of malformations of cortical development, presence of brain AVMs, presence of pulmonary AVMs, and a history of seizures or learning disabilities. RESULTS Five of 141 (3.5%) patients with hereditary hemorrhagic telangiectasia had malformations of cortical development. Two of the 5 patients with polymicrogyria also had closed-lip schizencephaly. One of the patients had a porencephalic cavity partially lined with heterotopic GM. The incidence of spatially coincident polymicrogyria and brain AVMs was 40% (2/5 cases). Of the patients with hereditary hemorrhagic telangiectasia and malformations of cortical development, 4/5 (80%) had pulmonary AVMs and 2/5 (40%) had brain AVMs. CONCLUSIONS To our knowledge, we are the first group to report the presence of schizencephaly in patients with hereditary hemorrhagic telangiectasia. The presence of schizencephaly and porencephaly lends support to the hypothesis of regional in utero cerebral hypoxic events as the etiology of malformations of cortical development in hereditary hemorrhagic telangiectasia.
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Affiliation(s)
- J J Gaines
- Department of Medicine, Medical College of Georgia (J.J.G.) at Augusta University, Augusta, Georgia
| | - B C Gilbert
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
| | - J R Gossage
- Department of Hereditary Hemorrhagic Telangiectasia (J.R.G.), Section of Pulmonary Diseases
| | - W Parker
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
| | - A Reddy
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
| | - S E Forseen
- From the Neuroradiology Section (B.C.G., W.P., A.R., S.E.F.), Department of Radiology and Imaging
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Velu U, Sharan K, Singh A, Salins S, Reddy A. The Effectiveness of PAlliative Split COurse RAdiotherapy (PASCORA) Regimen in Non-Metastatic Head and Neck Cancer Patients Who are Treated with Palliative Intent – A Retrospective Single Center Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1369] [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: 11/15/2022]
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Chen K, Raleigh D, Sneed P, Fogh S, Nakamura J, Boreta L, Reddy A, Banerjee A, Mueller S, Auguste K, Gupta N, Braunstein S. Radiosurgery for Primary and Metastatic CNS Malignancies in the Pediatric Population. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1741] [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: 10/31/2022]
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Arthur JA, Edwards T, Lu Z, Tang M, Amaram-Davila J, Reddy A, Hui D, Yennurajalingam S, Anderson AE, Jennings K, Reddy S, Bruera E. Interdisciplinary intervention for the management of nonmedical opioid use among patients with cancer pain. Cancer 2022; 128:3718-3726. [PMID: 35997289 PMCID: PMC10304363 DOI: 10.1002/cncr.34392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/04/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention. METHODS A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained. RESULTS NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13). CONCLUSIONS Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior.
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Affiliation(s)
- Joseph A. Arthur
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Tonya Edwards
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Zhanni Lu
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Michael Tang
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - David Hui
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Aimee E. Anderson
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
| | - Suresh Reddy
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas,
USA
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Reddy A, Sinclair C, Crawford GB, McPherson ML, Mercadante S, Hui D, Haider A, Arthur J, Tanco K, Dalal S, Dev R, Amaram-Davila J, Adile C, Liu D, Schuler U, Jammi S, Shelal Z, Del Fabbro E, Davis M, Bruera E. Opioid Rotation and Conversion Ratios Used by Palliative Care Professionals: An International Survey. J Palliat Med 2022; 25:1557-1562. [PMID: 35930252 PMCID: PMC9836667 DOI: 10.1089/jpm.2022.0266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Accepted: 06/13/2022] [Indexed: 01/22/2023] Open
Abstract
Background: The opioid rotation ratios (ORRs) and conversion ratios (CRs) used worldwide among palliative care (PC) professionals to perform opioid rotations (ORs) and route conversions may have a wide variation. Methods: We surveyed PC professionals on opioid ratios used through email to the Multinational Association of Supportive Care in Cancer's PC study group and Twitter and Facebook posts between September and November 2020. Results: We received 370 responses from respondents from 53 countries: 276 (76%) were physicians, 46 (13%) advanced practice providers, 39 (11%) pharmacists, and 9 respondents did not report their profession. There were statistically significant variations in median CR from intravenous (IV) to oral morphine (2-3), IV to oral hydromorphone (2-4.5), ORR from IV hydromorphone to oral morphine (10-20), and ORR from transdermal fentanyl mcg/hour to oral morphine (2-3.5) across various groups. Conclusion: This survey highlights the wide variation in ORRs and CRs among PC clinicians worldwide and the need for further research to standardize practice.
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Affiliation(s)
- Akhila Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christian Sinclair
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gregory B. Crawford
- Northern Adelaide Local Health Network, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Mary Lynn McPherson
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Sebastiano Mercadante
- Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ali Haider
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberson Tanco
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jaya Amaram-Davila
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claudio Adile
- Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ulrich Schuler
- Universitätsklinikum Carl Gustav Carus, PalliativCentrum & Medizinische Klinik, Dresden, Germany
| | - Sheetal Jammi
- Candidate for Bachelor of Science in Biology and Bachelor of Science in Psychology, University of Houston, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Egidio Del Fabbro
- Department of Internal Medicine, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Mellar Davis
- Department of Palliative Care, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Badarinarayana V, Terzo E, Apte S, Padhye S, Rashed S, Austin W, Caponegro M, Reddy A, Wang C, Clark R, Sidransky D, Modur V. A novel class of Ribosome Modulating Agents (RMAs) targets ribosome heterogeneity in a subset of colorectal cancers. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00997-2] [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: 11/15/2022]
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Kucheria A, Reddy A, Bahl R, Ahluwalia V, Sadighi A. 454 Sinus of Valsalva Rupture. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.103] [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: 11/06/2022]
Abstract
Abstract
Background
Sinus of Valsalva (SVA) rupture is a rare cardiac pathology which is important to recognise and diagnose early.
Case Summary
This case report details a 30-year-old gentleman who presented with a 3-day history of dyspnoea and palpitations on a background of previous congenital heart disease. The patient's examination highlighted a continuous harsh pan-systolic murmur as well as an ECG finding of sinus tachycardia. Transthoracic echocardiography identified a ruptured Sinus of Valsalva. The patient was transferred to a cardiothoracic surgery centre and definitively treated with an aortic root and ventricular septal defect repair.
Discussion
This case highlights the clinical findings of a patient with an acute left to right shunt and the importance of early diagnosis and urgent surgery. This case emphasises the factors required to decide which surgical approach is appropriate such as the presence of aortic valvular pathology size, size of Sinus of Valsalva aneurysm, any simultaneous cardiac anomaly and the cardiac chamber involved.
Learning Points
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Affiliation(s)
- A Kucheria
- Royal Berkshire Hospital , Reading , United Kingdom
| | - A Reddy
- Northwick Park Hospital , London , United Kingdom
| | - R Bahl
- Chelsea and Westminster Hospital , London , United Kingdom
| | - V Ahluwalia
- Chelsea and Westminster Hospital , London , United Kingdom
| | - A Sadighi
- West Middlesex University Hospital , London , United Kingdom
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Colvenkar S, Kumari V S, Reddy V, Khan MK, Reddy A. Three-Appointment Technique to Fabricate Duplicate Denture From Patients Existing Denture. Cureus 2022; 14:e26094. [PMID: 35875296 PMCID: PMC9298672 DOI: 10.7759/cureus.26094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 12/04/2022] Open
Abstract
The duplicating procedure copies most of the features of the existing denture. When a patient gets accustomed to the old dentures, it becomes difficult to adjust to the new set of dentures. That’s the time fabricating duplicate dentures helps. This article describes an easy, cost-effective technique to make duplicate dentures with materials readily available in dental setup. The intaglio surface of the denture was intact which increased patient satisfaction. The reduced vertical dimension was corrected with a new set of teeth. Dentures were delivered to the patient superfast within three days. The patient was totally satisfied with the copy dentures.
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Olatunbode O, Rangarajan S, Russell V, Viswanath YKS, Reddy A. A quantitative study to explore functional outcomes following laparoscopic ventral mesh rectopexy for rectal prolapse. Ann R Coll Surg Engl 2022; 104:449-455. [PMID: 34939835 PMCID: PMC9158073 DOI: 10.1308/rcsann.2021.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Rectal prolapse is a life-altering problem and laparoscopic ventral mesh rectopexy (LVMR) is emerging as the surgical intervention of choice. However, the literature is ambiguous on its effect on bowel function and sparse as regards bladder and sexual function. This study assesses short-term functional outcomes following LVMR. MATERIALS AND METHODS This quantitative retrospective study with a pretest-post-test design included 130 adults who had undergone LVMR from October 2010 to December 2018 in a tertiary centre. Analysis with paired-samples t-test and Wilcoxon matched pairs test was done using SPSS (v26). RESULTS The median age was 58 years (interquartile range, 48-74 years); 123 (94.6%) were female. The median length of stay was two days (interquartile range, 1-2 days). A total of 104 (80%) sets of medical notes were reviewed. One patient had recurrence of rectal prolapse. Synthetic mesh was used in 24 patients (23.1%) and biological mesh in 80 (76.9%). One patient had extrusion of a synthetic mesh and required surgery; 31(23.8%) completed the Electronic Patient Assessment Questionnaire for Pelvic Floor. Overall, the improvement in bladder function was not statistically significant (p = 0.670). A statistically significant improvement was seen for all bowel symptoms (p = 0.002) excluding constipation (p = 0.295). Irritable bowel symptoms associated with rectal prolapse improved significantly following LVMR (p = 0.001). Vaginal prolapse (p < 0.0005), dyspareunia (p = 0.001) and bowel symptoms affecting sexual intercourse (p = 0.01) improved, but improvement in overall sexual function was not statistically significant (p = 0.081). CONCLUSIONS LVMR improves bowel function overall, although it can worsen constipation. It has the potential to improve sexual function but makes negligible difference to bladder function.
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Affiliation(s)
- O Olatunbode
- James Cook University Hospital, Middlesbrough, UK
| | - S Rangarajan
- James Cook University Hospital, Middlesbrough, UK
| | - V Russell
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Vadukapuram R, Trivedi C, Mansuri Z, Shah K, Reddy A, Jain S. Bullying victimization in children and adolescents and its impact on academic outcomes. Eur Psychiatry 2022. [PMCID: PMC9567400 DOI: 10.1192/j.eurpsy.2022.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Bullying is a serious problem in schools because of the negative impact on a child’s educational outcomes, especially academic achievement. However, the underlying mechanisms and causes are unknown. Objectives To evaluate the educational outcomes, and psychiatric comorbidities in children and adolescents who are victims of bullying Methods We used 2018–2019 Nationwide Survey of Children’s Health (NSCH) dataset for the study. The participants were children and adolescents (age: 6-17 years, n = 42,790). Data was stratified into two groups: 1) never bullied 2) bullied more than once. Prevalence of different educational outcomes were compared between the groups. Results In the never bullied group 21,015 participants were included, and in the bullied more than once group 21,775 participants were included. More females were in the bullied group compared to never bullied group (50.4% vs 47.5%, p=0.006). More White non- Hispanic individuals were in bullied group in contrast to never bullied group (56.7% vs 43.9%, p< 0.001). Individuals whose health status was fair, or poor were bullied more (2.4% vs 1.4%, p=<0.001). Individuals in bullied group were more likely to be repeating the grades compared to the never bullied group (7.1% vs 5.9%, p:0.039). Individuals who were missing >=11 school days, and sometimes or never engaged in school were observed more in bullied group compared to never bullied group (5.9% vs 3.2% and 20.3% vs 10.6% p < 0.001). Conclusions Our findings suggest that bullying victimization could be a risk factor and associated with decreased academic outcomes. Disclosure No significant relationships.
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Vadukapuram R, Trivedi C, Mansuri Z, Shah K, Reddy A. Bright Light Therapy for MDD in Children and Adolescents: a narrative review of literature. Eur Psychiatry 2022. [PMCID: PMC9567062 DOI: 10.1192/j.eurpsy.2022.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Major Depressive Disorder (MDD) is a common mood disorder diagnosed in children and adolescents. Bright light therapy has been effective for seasonal affective disorders, however its role in the treatment of MDD is under studied. Objectives Our objective is to evaluate if bright light therapy (BLT) is a practical approach in treating Child and Adolescents having MDD. Methods We performed an extensive literature search using a wide range of MeSH terms in PubMed, PubMed Central and Google Scholar. We reviewed the literature for studies (published between 1983-2021) assessing the efficacy of BLT in the treatment of MDD in children and adolescents. Results
The final search results yielded 8 randomized clinical trials and 1 case report from 1983 to 2021. BLT showed a superior effect in children and adolescents with MDD compared to the control group in the majority of the randomized trials and a case report. In six studies BLT showed good effect, however in a study by Magnusson et al. and Sonis et al., found a milder degree of improvement in depression symptoms when compared to the control group. In the majority of the studies, patients’ age range was 7 years 18 and in most of the studies, patients were not on antidepressants. Conclusions
The use of BLT in children and adolescents suffering from MDD can be a promising alternative method of biological treatment, which is effective as well as well tolerated. Future long-term studies on large sample size are necessary in this field. Disclosure No significant relationships.
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Bajpai J, Kashyap L, Vallathol D, Pathak R, Rath S, Sekar A, Mohanta S, Reddy A, Joshi S, Wadasadawala T, Nair N, Parmar V, Desai S, Shet T, Thakur M, Sarin R, Gupta S, Badwe R, Das A, Singh M. 100P Outcomes of non-metastatic triple negative breast cancers: Real-world data from a large Indian cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.116] [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: 11/01/2022] Open
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Tang M, Reddy A. Telemedicine and Its Past, Present, and Future Roles in Providing Palliative Care to Advanced Cancer Patients. Cancers (Basel) 2022; 14:cancers14081884. [PMID: 35454791 PMCID: PMC9032063 DOI: 10.3390/cancers14081884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/08/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary The health care delivery model has dramatically changed due to the emergence of the global pandemic coronavirus disease (COVID-19). This can be seen in the innovative adoption of telemedicine in the delivery of palliative care to patients with advanced cancer. We provide an update on the adoption, delivery, benefits, and challenges faced in this model of health care delivery. Abstract The landscape of healthcare delivery has considerably changed due to the emergence of coronavirus disease 2019 (COVID-19). This is nowhere more evident than in the care of advanced cancer patients receiving palliative care. This population is susceptible to the severe complications of COVID-19, and immediate measures had to be taken to ensure their safety. Thus, the adoption of telemedicine as a health care delivery model emerged. This model provides many benefits, such as improved access to care while maintaining social distancing; however, there exist challenges to this model, including health care disparities, reimbursement, and monitoring of opioids in high-risk populations. This narrative review provides an overview of the unique benefits and barriers of telemedicine in palliative care patients.
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Abstract
Radon is an established human lung carcinogen naturally released as an odorless, colorless gas from soil and rocks. It is a major environmental source of ionizing radiation and can cause oxidative damage to DNA, increasing the risk of lung cancer. Although the association between radon and lung cancer is well established, the association between radon and other cancers is not. Based on reported studies, there is no consistent evidence indicating an association between radon and non-solid and solid cancers, but limited literature, heterogenous study design, and confounding variables preclude definitive conclusions. More research is needed to evaluate the association between residential radon and non-lung cancers, particularly with regard to skin cancer, central nervous system (CNS) cancer, renal, and stomach cancer, in which existing literature suggests potential associations with residential radon may exist. However, the literature largely demonstrates that lung cancer is the primary concern associated with residential radon exposure; the lack of association with nonlung cancers could reflect the lack of studies which have an adequate sample size, establish accurate levels of radon exposure, and control for confounders. These results should be considered in residential radon mitigation efforts which should focus on smokers with high radon exposures.
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Convertino M, Reddy A, Liu Y, Munoz-Zanzi C. Eco-epidemiological scaling of Leptospirosis: Vulnerability mapping and early warning forecasts. Sci Total Environ 2021; 799:149102. [PMID: 34388889 DOI: 10.1016/j.scitotenv.2021.149102] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Infectious disease epidemics are plaguing the world and a lot of research is focused on the development of models to reproduce disease dynamics for eco-environmental and biological investigation, and disease management. Leptospirosis is an example of a neglected zoonosis strongly mediated by ecohydrological dynamics with emerging endemic and epidemic patterns worldwide in both animal and human populations. By accounting for large heterogeneities of affected areas we show how exponential endemics and scale-free epidemics are largely predictable and linked to common socio-environmental features via scaling laws with different exponents that inform about vulnerability factors. This led to the development of a novel pattern-oriented integrated model that can be used as an early-warning signal (EWS) tool for endemic-epidemic regime classification, risk determinant attribution, and near real-time forecast of outbreaks. Forecasts are grounded on expected outbreak recurrence time dependent on exceedance probabilities and statistical EWS that sense outbreak onset. A stochastic spatially-explicit model is shown to comprehensively predict outbreak dynamics (early sensing, timing, magnitude, decay, and eco-environmental determinants) and derive a spreading factor characterizing endemics and epidemics, where average over maximum rainfall is the critical factor characterizing disease transitions. Dynamically, case cross-correlation considering neighboring communities senses 2-weeks in advance outbreaks. Eco-environmental scaling relationships highlight how predicted host suitability and topographic index can be used as epidemiological footprints to effectively distinguish and control Leptospirosis regimes and areas dependent on hydro-climatological dynamics as the main trigger. The spatio-temporal scale-invariance of epidemics - underpinning persistent criticality and neutrality or independence among areas - is emphasized by the high accuracy in reproducing sequence and magnitude of cases via reliable surveillance. Further investigations of robustness and universality of eco-environmental determinants are required; nonetheless a comprehensive and computationally simple EWS method for the full characterization of Leptospirosis is provided. The tool is extendable to other climate-sensitive zoonoses to define vulnerability factors and predict outbreaks useful for optimal disease risk prevention and control.
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Affiliation(s)
- M Convertino
- Institute of Environment and Ecology, Tsinghua Shenzhen International Graduate School (Tsinghua SIGS), Tsinghua University, Shenzhen, China.
| | - A Reddy
- UnitedHealth Group, Minneapolis, MN, USA
| | - Y Liu
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene and Tropical Medicine, UK
| | - C Munoz-Zanzi
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota Twin-Cities, Minneapolis, MN, USA
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Vasudevan H, LaStella S, Sale M, Casey-Clyde T, Lucas C, Magill S, Liu S, Chen W, Braunstein S, Reddy A, Perry A, Jacques L, Pekmezci M, Raleigh D, McCormick F. Genomic Analysis and Biochemical Investigation Reveal Mechanisms of Schwann Cell Transformation and Treatment Resistance in Malignant Peripheral Nerve Sheath Tumors (MPNSTs). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.208] [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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Reddy A, Nethercott SL, Teh W, De Bie EMD, Pepke-Zaba J, Sheares KK, Cannon J, Taboada D, Hadinnapola C, Martin CA, Toshner MR. Prevalence and clinical impact of atrioventricular conduction disease in patients with idiopathic pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although bradycardia-related sudden death is common in patients with idiopathic pulmonary arterial hypertension (IPAH), the prevalence and prognostic significance of atrioventricular (AV) conduction disease in this patient group is not well-established.
Objectives
– Determine the prevalence of AV conduction disorders in patients with IPAH
– Investigate the relationship between AV block and functional outcomes and mortality.
Method
12-lead electrocardiograms (ECGs) of patients with IPAH were analysed. Patients were categorised according to the presence or absence of AV block. Demographic, pulmonary haemodynamic, cardiac structural characteristics and expression of genes associated with cardiac conduction were compared and functional and mortality outcomes analysed between groups.
Student's t-tests and χ2 tests were used to compare data. Survival was estimated using Kaplan-Meier analyses. Initial exploratory covariates were included in a univariate analysis and those terms with P-value of <0.1 were then used to generate a Cox proportional-hazards multivariate model.
Results
135 IPAH patients (mean age 55±16 years, 28.1% male) were eligible for analysis. Median follow up was 9 years (interquartile range 4–14 years).
AV block was seen in 34.8% of patients with IPAH compared to 10.8% of matched comparators (p<0.001), drawn from patients attending hospital for non-PAH related reasons.
IPAH patients with conduction disease were more likely to be older (59±16 vs 53±17 years, p=0.038). AV block was associated with more severe right ventricular (RV) basal dilatation (5.1±1.0 vs 4.3±0.7cm, p=0.013) and worse RV function (fractional area change 26±9% vs 31±9%, p=0.14). Pulmonary haemodynamics, right atrial size and resting and exertional oxygen saturations were not significantly different. Expression of HCN1, HCN2, SCN1B, SCN5A, CAV1, and KCN2 genes in peripheral blood from a subcohort was similar between those with and without AV block.
Lower 6 minute walk distances (344±153 vs 408±140m, p=0.035) and worse CAMPHOR scores across all 3 domains were seen in those with AV block (figure 1), and mortality was significantly higher (36.2 vs 13.6%, p=0.002) (figure 2). On multivariate analysis the presence of bundle branch block (BBB) was independently associated with a 2.1-fold increased risk of death (95% CI 1.89–4.85, p=0.045).
Conclusions
AV conduction disorders are more prevalent in IPAH than the general population, and are associated with worse prognosis and functional status. Prospective study is required to validate this finding.
In our cohort AV block could not be explained by hypoxia, differences in pulmonary haemodynamics nor, in a small subgroup, by differential expression of specific transmembrane ion channels implicated in cardiac conduction. More detailed investigation into causal mechanisms of AV block in IPAH could establish whether improved prognosis could be achieved by treatment of AV block.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- A Reddy
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - W Teh
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - E M D De Bie
- University of Cambridge, Cambridge, United Kingdom
| | - J Pepke-Zaba
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - K K Sheares
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - J Cannon
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - D Taboada
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - C A Martin
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - M R Toshner
- Royal Papworth Hospital, Cambridge, United Kingdom
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Reddy A, Bhandary A, Shetty SR, Harish BG. Comparative study between an ultrasound-guided transversus abdominis plane block and an ultrasound-guided caudal block for postoperative analgesia in children undergoing lower abdominal surgeries – a prospective randomised study. Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.5.2489] [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: 11/05/2022]
Affiliation(s)
- A Reddy
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
| | - A Bhandary
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
| | - SR Shetty
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
| | - BG Harish
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
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Liu W, Qdaisat A, Lopez G, Narayanan S, Underwood S, Spano M, Reddy A, Guo Y, Yeung SC, Bruera E, Cohen L. Association Between Acupoint Selection, Target Symptoms, and Traditional Chinese Medicine Diagnosis in Real-Time Clinical Practice in a Comprehensive Cancer Center. Integr Cancer Ther 2021; 19:1534735420928490. [PMID: 32508209 PMCID: PMC7287401 DOI: 10.1177/1534735420928490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Acupuncture intervention in actual practice is rarely
reported and may be different from that applied in acupuncture research.
Objectives: To review acupuncture practice in an integrative
medicine clinic and characterize the association between targeted symptoms,
traditional Chinese medicine (TCM) diagnosis, and acupoint selection.
Methods: We reviewed outpatient acupuncture records from March
2016 to April 2018. Statistical analyses were applied to characterize referral
symptoms and associated TCM diagnosis as well as acupoint selection.
Results: The final analysis included 5393 acupuncture records
(1264 patients). Twelve TCM diagnosis components were identified in the referral
symptoms of pain, neuropathy, xerostomia, and hot flashes. Pain was associated
with 78 different TCM diagnoses (combinations of TCM diagnosis components).
Total of 217 different acupoints were used in the acupuncture treatments (1739)
for neuropathy. The acupoint yintang was used in 73.8% of the visits for
neuropathy, yet only in 26.5% (P < .001) of the treatments
when patients had a TCM diagnosis of qi deficiency, qi stagnation, and blood
stagnation. Similarly, both consistencies and variations were seen in acupoint
selection with each targeted symptom and its associated TCM diagnoses.
Conclusions: TCM diagnosis was not homogeneous among
acupuncture treatments for a single referral symptom. In contrast to most of the
research on acupuncture for symptom control, there were considerable variations
in acupoint selection among treatments for the same symptom in a clinical
setting. Future research is needed to examine the clinical relevance of a fixed
intervention structure in acupuncture research and the value of individualized
acupuncture treatment.
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Affiliation(s)
- Wenli Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aiham Qdaisat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan Underwood
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Spano
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Guo
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sai-Ching Yeung
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Haider A, Azhar A, Tanco KC, Epner M, Naqvi SMAA, Abdelghani E, Reddy A, Dev R, Wu J, Bruera E. Oncology patients' perception of physicians who use an integrated electronic health record (EHR) during clinic visits: PRIME-EHR double-blind, randomized controlled trial. Cancer 2021; 127:3967-3974. [PMID: 34264520 DOI: 10.1002/cncr.33778] [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: 12/12/2020] [Revised: 03/16/2021] [Accepted: 04/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with cancer prefer and positively perceive physicians who communicate face-to-face without the use of a computer. However, the use of electronic health records (EHRs) in the examination room remains a practical necessity. On the basis of existing literature, the authors developed and tested an integration model, PRIME-EHR, that focuses on the best-practice guidelines. To their knowledge, no randomized controlled trials (RCTs) have been conducted to test the effectiveness of such models. METHODS In this double-blind, crossover RCT, 120 eligible patients with cancer were enrolled between April 1, 2019 and February 15, 2020 at The University of Texas MD Anderson Cancer Center. The objectives were to compare patients' perceptions of physicians' skills and their overall preference after they watched 2 standardized, scripted video vignettes of physicians: 1 portraying the use of a standard EHR and the other portraying the use of a PRIME-EHR. Actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. Validated questionnaires to rate physicians' compassion (0 = best, 50 = worst), communication skills (14 = poor, 70 = excellent), and professionalism (4 = poor, 20 = very good) were used. RESULTS PRIME-EHR, compared with the standard EHR, resulted in better scores for physician compassion (median score, 5 [interquartile range, 0-10] vs 12 [interquartile range, 4-25]; P = .0009), communication skills (median score, 69 [interquartile range, 63-70] vs 61 [interquartile range, 50-69]; P = .0026), and professionalism (median score, 20 [interquartile range, 18-20] vs 18 [interquartile range, 14-20]; P = .0058). The majority of patients preferred physicians who used PRIME-EHR (n = 70 [77%] vs n = 21 [23%]; P < .0001). CONCLUSIONS The PRIME-EHR approach significantly improved patients' perceptions of and preference for the physicians. This integrated model of health care delivery has the potential to improve communication and compassion in cancer care.
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Affiliation(s)
- Ali Haider
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahsan Azhar
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberson C Tanco
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Margeaux Epner
- The University of Texas Health Science Center, McGovern Medical School, Houston, Texas
| | - Syed Mussadiq Ali Akber Naqvi
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eman Abdelghani
- Department of Lymphoma/Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Akhila Reddy
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rony Dev
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Amaram-Davila JS, Arthur J, Reddy A, Bruera E. Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth. J Pain Symptom Manage 2021; 62:192-196. [PMID: 33515659 PMCID: PMC8274019 DOI: 10.1016/j.jpainsymman.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 01/10/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Jaya Sheela Amaram-Davila
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA.
| | - Akhila Reddy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
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