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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [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] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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2
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Bonakdar RA, Sweeney MM, Garvey C, White AA, VanNoord MU. Case Report: Initial Successful Treatment of Migraine and Irritable Bowel Syndrome With a Low-FODMAP Diet. J Am Nutr Assoc 2024; 43:339-344. [PMID: 38108544 DOI: 10.1080/27697061.2023.2288081] [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: 03/14/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Migraine and irritable bowel syndrome (IBS) can be difficult-to-treat comorbidities that may be driven by underlying gut-brain axis dysfunction. This report describes utilization of a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (LFD) in a patient with refractory migraine and co-occurring IBS. METHODS After unremarkable physical and neurological examinations, a 57-year-old woman with IBS and chronic migraine was started on a LFD under the guidance of a registered dietician. Psychometrically validated surveys administered at baseline and initial follow-up assessed patient-reported outcomes related to migraine and IBS symptoms. RESULTS At baseline, the patient reported 80/90 migraine days with average pain of 8/10, a Migraine Disability Assessment (MIDAS) score of 33, and Headache Impact Test-6 (HIT-6) score of 64, the latter 2 scores indicating severe disability. Baseline IBS symptom severity was noted at 9/10. Within 1 week on a LFD, the patient's IBS symptoms and migraines improved in both frequency and intensity of episodes. After 5 weeks on a LFD elimination, the patient's clinical improvement continued and she reported significant reduction in migraines, with average pain of 1/10 and IBS severity of 3/10. The patient also improved from severe to minimal levels of disability on validated measures (MIDAS, HIT-6, and IBS Patient Global Impression of Change). CONCLUSION This is the first case report detailing successful initial treatment of migraine and co-occurring IBS utilizing a dietician-guided LFD. There are a number of important reasons for potential improvement in these gut-brain axis disorders which are reviewed as well as an implication for long-term management and food reintroduction. Larger, randomized trials evaluating a LFD in diverse individuals with migraine and co-occurring IBS are warranted to help confirm these results.
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Affiliation(s)
- Robert A Bonakdar
- Center for Integrative Medicine, Scripps Clinic, La Jolla, California, USA
| | - Megan M Sweeney
- Center for Integrative Medicine, Scripps Clinic, La Jolla, California, USA
| | - Cathy Garvey
- Center for Integrative Medicine, Scripps Clinic, La Jolla, California, USA
| | - Andrew A White
- Department of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California, USA
| | - Michelle U VanNoord
- Department of Neurology, Dalessio Headache Center, Scripps Clinic, La Jolla, California, USA
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3
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Imam KH, Abud EM, White AA. Systemic Contact Dermatitis to Cinnamon: A Case Report. Dermatitis 2024. [PMID: 38634837 DOI: 10.1089/derm.2023.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Kamran H Imam
- Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA
| | - Edsel M Abud
- Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA
- Scripps Research Translational Institute, Scripps Research, San Diego, CA, USA
| | - Andrew A White
- Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA
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4
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Palmer JN, Adappa ND, Chandra RK, Davis GE, Mahdavinia M, Messina J, Ow RA, Patel ZM, Peters AT, Sacks H, Schlosser RJ, Sindwani R, Soler ZM, White AA, Wise SK, Mahmoud RA. Efficacy of EDS-FLU for Chronic Rhinosinusitis: Two Randomized Controlled Trials (ReOpen1 and ReOpen2). J Allergy Clin Immunol Pract 2024; 12:1049-1061. [PMID: 38244014 DOI: 10.1016/j.jaip.2023.12.016] [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: 08/29/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease. No medications are Food and Drug Administration-approved for the most common form, CRS without nasal polyps (also called "chronic sinusitis"). Novel biomechanics of the exhalation delivery system deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard-delivery nasal sprays. OBJECTIVE Assess EDS-FLU efficacy for CRS (irrespective of nasal polyps). METHODS Two randomized, EDS-placebo-controlled trials in adults with CRS irrespective of polyps (ReOpen1) or exclusively without polyps (ReOpen2) were conducted at 120 sites in 13 countries. Patients received EDS-FLU 1 or 2 sprays/nostril, or EDS-placebo, twice daily for 24 weeks. Coprimary measures were composite symptom score through week 4 and ethmoid/maxillary sinus percent opacification by computed tomography at week 24. RESULTS ReOpen1 (N = 332) composite symptom score least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -1.58 and -1.60 versus -0.62 (P < .001, P < .001); ReOpen2 (N = 223), -1.54 and -1.74 versus -0.81 (P = .011, P = .001). In ReOpen1, sinus opacification least-squares mean change for EDS-FLU 1 or 2 sprays/nostril versus EDS-placebo was -5.58 and -6.20 versus -1.60 (P = .045, P = .018), and in ReOpen2, -7.00 and -5.14 versus +1.19 (P < .001, P = .009). Acute disease exacerbations were reduced by 56% to 66% with EDS-FLU versus EDS-placebo (P = .001). There were significant, and similar magnitude, symptom reductions in patients using standard-delivery nasal steroid products just before entering the study (P < .001). Adverse events were similar to standard-delivery intranasal steroids. CONCLUSIONS EDS-FLU is the first nonsurgical treatment demonstrated to reduce symptoms, intrasinus opacification, and exacerbations in replicate randomized clinical trials in CRS, regardless of polyp status.
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Affiliation(s)
- James N Palmer
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pa.
| | - Nithin D Adappa
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pa
| | | | | | | | | | - Randall A Ow
- Sacramento Ear Nose Throat Medical & Surgical Group, Roseville, Calif
| | - Zara M Patel
- Stanford University School of Medicine, Stanford, Calif
| | - Anju T Peters
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | | | | | | | - Sarah K Wise
- Emory University School of Medicine, Atlanta, Ga
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5
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Huang J, White AA. Symptoms and treatment of eosinophilic esophagitis prior to, during, and after pregnancy. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00334-9. [PMID: 38556046 DOI: 10.1016/j.jaip.2024.03.041] [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] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/06/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Jenny Huang
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif.
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
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6
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Conway AE, White AA, Borish L, Shaker M, Lee MW. Eicosanoids, innate immunity, and alarmins in aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00138-8. [PMID: 38432553 DOI: 10.1016/j.anai.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California
| | - Larry Borish
- Departments of Medicine and Microbiology, Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, Virginia
| | - Marcus Shaker
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Michael W Lee
- Department of Medical Education, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
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7
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Huang J, Imam K, Criado JR, Luskin KT, Liu Y, Puglisi LH, Lyons JJ, White AA. Hereditary alpha-tryptasemia in patients with postural orthostatic tachycardia syndrome. J Allergy Clin Immunol Pract 2024; 12:528-529.e1. [PMID: 37918652 PMCID: PMC10922344 DOI: 10.1016/j.jaip.2023.10.043] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Jenny Huang
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - Kamran Imam
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - Jose R Criado
- Division of Neurology, Scripps Clinic, San Diego, Calif
| | - Kathleen T Luskin
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - Yihui Liu
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Md
| | - Leah H Puglisi
- Scripps Department of Research & Development, Scripps Health, San Diego, Calif
| | - Jonathan J Lyons
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Md
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif.
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8
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Abud EM, White AA. Mast Cells in Aspirin-Exacerbated Respiratory Disease. Curr Allergy Asthma Rep 2024; 24:73-80. [PMID: 38217825 DOI: 10.1007/s11882-024-01125-1] [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] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE OF REVIEW Aspirin-exacerbated respiratory disease (AERD) is a syndrome of high type 2 inflammation and is known to critically involve mast cell activation. The mast cell is an important cell in the baseline inflammatory processes in the upper and lower airway by maintaining and amplifying type 2 inflammation. But it also is prominent in the hypersensitivity reaction to COX-1 inhibition which defines this condition. RECENT FINDINGS Recent work highlights the mast cell as a focal point in AERD pathogenesis. Using AERD as a specific model of both high type 2 asthma and chronic sinusitis, the role of mast cell activity can be better understood in other aspects of airway inflammation. Further dissecting out the mechanism of COX-1-mediated mast cell activation in AERD will be an important next phase in our understanding of NSAID-induced hypersensitivity as well as AERD pathophysiology.
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Affiliation(s)
- Edsel M Abud
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, USA
- Scripps Research Translational Institute, Scripps Research, San Diego, USA
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, USA.
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9
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Laidlaw TM, White AA. Should Biologics Be Used Before Aspirin Desensitization in Aspirin-Exacerbated Respiratory Disease? J Allergy Clin Immunol Pract 2024; 12:79-84. [PMID: 37778627 PMCID: PMC10842409 DOI: 10.1016/j.jaip.2023.09.019] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
There has been a paradigm shift in the management of aspirin-exacerbated respiratory disease (AERD). It started in 2015 when the first biologic was Food and Drug Administration (FDA) approved for severe eosinophilic asthma. Thus, there emerged a new era in the treatment of patients with type 2-mediated airway diseases. This has led to an increasing number of options for patients, undoubtably a great thing, but has left clinicians without a clear answer for how to balance the therapies that exist for AERD, what to recommend for treatment, and how to best assess the benefits and risks of each therapy. This paper aims to explore these benefits and risks, and to provide a roadmap for future studies.
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Affiliation(s)
- Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
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10
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Wangberg H, Willis MJH, Lindsey D, Schmidgal EC, White AA. A familial case of diffuse cutaneous mastocytosis. J Allergy Clin Immunol Pract 2023; 11:3802-3803. [PMID: 37598730 DOI: 10.1016/j.jaip.2023.08.019] [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] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/31/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Hannah Wangberg
- Department of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - Mary J H Willis
- Department of Pediatrics, Navy Medical Center, San Diego, Calif
| | - Diana Lindsey
- Department of Allergy and Immunology, Navy Medical Center, San Diego, Calif
| | - E Chad Schmidgal
- Department of Dermatology, Navy Medical Center, San Diego, Calif
| | - Andrew A White
- Department of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif.
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11
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Badrani JH, Cavagnero K, Eastman JJ, Kim AS, Strohm A, Yan C, Deconde A, Zuraw BL, White AA, Christiansen SC, Doherty TA. Lower serum 15-HETE level predicts nasal ILC2 accumulation during COX-1 inhibition in AERD. J Allergy Clin Immunol 2023; 152:1330-1335.e1. [PMID: 37543185 PMCID: PMC10938261 DOI: 10.1016/j.jaci.2023.06.028] [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: 03/24/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) is associated with high levels of cysteinyl leukotrienes, prostaglandin D2, and low levels of prostaglandin E2. Further, 15-hydroxyeicosatetraenoic acid (15-HETE) levels may have predictive value in therapeutic outcomes of aspirin desensitization. Accumulation of nasal group 2 innate lymphoid cells (ILC2s) has been demonstrated during COX-1 inhibition in AERD, although the relationships between tissue ILC2 accumulation, reaction symptom severity, and novel lipid biomarkers are unknown. OBJECTIVE We sought to determine whether novel lipid mediators are predictive of nasal ILC2 accumulation and symptom scores during COX-1 inhibitor challenge in patients with AERD. METHODS Blood and nasal scraping samples from patients with AERD were collected at baseline and COX-1 inhibitor reaction and then processed for flow cytometry for nasal ILC2s and serum for lipidomic analysis. RESULTS Eight patients with AERD who were undergoing aspirin desensitization were recruited. Of the 161 eicosanoids tested, 42 serum mediators were detected. Baseline levels of 15-HETE were negatively correlated with the change in numbers of airway ILC2s (r = -0.6667; P = .0428). Docosahexaenoic acid epoxygenase metabolite 19,20-dihydroxy-4Z,7Z,10Z,13Z,16Z-docosapentaenoic acid (19,20-diHDPA) was positively correlated with both changes in airway ILC2s (r = 0.7143; P = .0305) and clinical symptom scores (r = 0.5000; P = .0081). CONCLUSION Low levels of baseline 15-HETE predicted a greater accumulation of airway ILC2s in patients with AERD who were receiving COX-1 inhibition. Further, increases in the cytochrome P pathway metabolite 19,20-dihydroxy-4Z,7Z,10Z,13Z,16Z-docosapentaenoic acid (19,20-diHDPA) were associated with increased symptoms and nasal ILC2 accumulation. Future studies to assess how these mediators might control ILC2s may improve the understanding of AERD pathogenesis.
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Affiliation(s)
- Jana H Badrani
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif; Veterans Affairs San Diego Healthcare System, La Jolla, Calif
| | - Kellen Cavagnero
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Jacqueline J Eastman
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Alex S Kim
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Allyssa Strohm
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif; Veterans Affairs San Diego Healthcare System, La Jolla, Calif
| | - Carol Yan
- Department of Otolaryngology, University of California, San Diego, Calif
| | - Adam Deconde
- Department of Otolaryngology, University of California, San Diego, Calif
| | - Bruce L Zuraw
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif; Veterans Affairs San Diego Healthcare System, La Jolla, Calif
| | - Andrew A White
- Divison of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, Calif
| | - Sandra C Christiansen
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Taylor A Doherty
- Section of Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, Calif; Veterans Affairs San Diego Healthcare System, La Jolla, Calif.
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12
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Ramos CL, Thakrar H, Walters K, Waldram J, White AA. Characterization of alcohol-induced respiratory symptoms in aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2023; 131:382-384. [PMID: 37302527 PMCID: PMC10528382 DOI: 10.1016/j.anai.2023.06.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Courtney L Ramos
- Department of Allergy and Immunology, Scripps Clinic, 3811 Valley Centre Drive, San Diego, California 92130.
| | - Hiral Thakrar
- Department of Allergy and Immunology, Allergy, Asthma and Immunology Associates, LTD, Department of Allergy and Immunology, Scottsdale, Arizona
| | - Kristen Walters
- Department of Allergy and Immunology, Rady's Children's Hospital and Allergy & Asthma Medical Group and Research Center, San Diego, California
| | - Jeremy Waldram
- Department of Allergy and Immunology, The Allergy Group- Asthma and Allergy, Boise, Illinois
| | - Andrew A White
- Department of Allergy and Immunology, Scripps Clinic, 3811 Valley Centre Drive, San Diego, California 92130.
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13
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Bernstein JA, White AA, Han JK, Lang DM, Elkayam D, Baroody FM. Review of evidence supporting the use of nasal corticosteroid irrigation for chronic rhinosinusitis. Ann Allergy Asthma Immunol 2023; 130:46-57. [PMID: 36116748 DOI: 10.1016/j.anai.2022.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/13/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze published reports on the efficacy and safety of CSI in CRS and evaluate the clinical implications of current gaps in evidence. Corticosteroid irrigation (CSI) is commonly used for management of chronic rhinosinusitis (CRS) with nasal polyps; however, such use is not approved by the US Food and Drug Administration (FDA). DATA SOURCES Publications were obtained through PubMed searches through January 2022. STUDY SELECTION Searches were conducted using 2 terms: "chronic rhinosinusitis" or "nasal polyps" as the first term and "corticosteroid irrigation," "steroid nasal lavage," or "sinus rinse" as the second term. We reviewed relevant, peer-reviewed literature (19 original research [9 controlled, 10 uncontrolled trials], 7 reviews, and 1 meta-analysis) reporting safety and efficacy of CSI in patients with CRS. RESULTS Studies were difficult to compare because they used a variety of solution volumes (60 mL to 125 mL per nostril), corticosteroid agents (budesonide, betamethasone, mometasone, or fluticasone), corticosteroid doses, preparation protocols (by compounding pharmacy or by patient), and administration (frequency, time of day, body positioning). It is difficult to determine which parameters might substantially influence clinical effects because studies were generally small, showed marginal benefits, and rarely assessed safety. To date, no studies evaluating CSI have shown statistically significant differences in a type-I error-controlled primary end point over any comparator, possibly owing to small sample sizes. CONCLUSION Designing more robust clinical trials may help determine whether CSI is a valid treatment option. Until more evidence supporting CSI use exists, health care professionals should strongly consider choosing FDA-approved therapies for the treatment of CRS.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Immunology-Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, California
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Elkayam
- Bellingham Asthma, Allergy and Immunology Clinic, Bellingham, Washington
| | - Fuad M Baroody
- Department of Surgery (Otolaryngology-Head and Neck Surgery) and Pediatrics, University of Chicago Medicine and the Comer Children's Hospital, Chicago, Illinois
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14
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Wang SXY, Horomanski A, Tooley JE, Reejhsinghani R, White AA. A change of heart. J Hosp Med 2022; 18:444-448. [PMID: 36479928 DOI: 10.1002/jhm.13016] [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: 06/28/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Samantha X Y Wang
- Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Audra Horomanski
- Department of Medicine, Division of Immunology & Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - James E Tooley
- Department of Medicine, Division of Cardiology, UCSF School of Medicine, San Francisco, California, USA
| | - Risheen Reejhsinghani
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J, Khan DA, Golden DBK, Shaker M, Stukus DR, Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol 2022; 150:1333-1393. [PMID: 36122788 DOI: 10.1016/j.jaci.2022.08.028] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Aleena Banerji
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Roland Solensky
- Corvallis Clinic, Oregon State University/Oregon Health Science University College of Pharmacy, Corvallis, Ore
| | - Andrew A White
- Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Matthew J Greenhawt
- Food Challenge and Research Unit Section of Allergy and Immunology, Children's Hospital Colorado University of Colorado School of Medicine, Aurora, Colo
| | - Caroline C Horner
- Department of Pediatrics, Division of Allergy Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla; James A. Haley Veterans Affairs Hospital, Tampa, Fla
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee Health Science Center, Memphis, Tenn
| | - John Oppenheimer
- Division of Allergy, Rutgers New Jersey Medical School, Rutgers, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Dana Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Guyer AC, Macy E, White AA, Kuruvilla ME, Robison RG, Kumar S, Khan DA, Phillips EJ, Ramsey A, Blumenthal K. Allergy Electronic Health Record Documentation: A 2022 Work Group Report of the AAAAI Adverse Reactions to Drugs, Biologicals, and Latex Committee. J Allergy Clin Immunol Pract 2022; 10:2854-2867. [PMID: 36151034 DOI: 10.1016/j.jaip.2022.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 05/03/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 06/16/2023]
Abstract
The allergy section of the electronic health record (EHR) is ideally reviewed and updated by health care workers during routine outpatient visits, emergency room visits, inpatient hospitalizations, and surgical procedures. This EHR section has the potential to help proactively and comprehensively avoid exposures to drugs, contact irritants, foods, and other agents for which, based on an individual's medical history and/or genetics, there is increased risk for adverse outcomes with future exposures. Because clinical decisions are made and clinical decision support is triggered based on allergy details from the EHR, the allergy module needs to provide meaningful, accurate, timely, and comprehensive allergy information. Although the allergy section of the EHR must meet these requirements to guide appropriate clinical decisions and treatment plans, current EHR allergy modules have not achieved this standard. We urge EHR vendors to collaborate with allergists to optimize and modernize allergy documentation. A work group within the Adverse Reactions to Drugs, Biologicals, and Latex Committee of the American Academy of Allergy, Asthma & Immunology was formed to create recommendations for allergy documentation in the EHR. Whereas it is recognized that the term "allergy" is often used incorrectly because most adverse drug reactions (ADRs) are not true immune-mediated hypersensitivity reactions, "allergy" in this article includes allergies and hypersensitivities as well as side effects and intolerances. Our primary objective is to provide guidance for the current state of allergy documentation in the EHR. This guidance includes clarification of the definition of specific ADR types, reconciliation of confirmed ADRs, and removal of disproved or erroneous ADRs. This document includes a proposal for the creation, education, and implementation of a drug allergy labeling system that may allow for more accurate EHR documentation for improved patient safety.
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Affiliation(s)
| | - Eric Macy
- Allergy Department, Kaiser San Diego Medical Center, Permanente Southern California, San Diego, Calif
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - Merin E Kuruvilla
- Division of Pulmonary, Allergy, and Critical Care, Emory University School of Medicine, Atlanta, Ga
| | - Rachel G Robison
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Santhosh Kumar
- Department of Pediatrics, Division of Allergy and Immunology, Virginia Commonwealth University Health Systems, Richmond, Va
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Allison Ramsey
- Rochester Regional Health, Rochester, NY; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass.
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17
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White AA, King AM, D'Addario AE, Brigham KB, Dintzis S, Fay EE, Gallagher TH, Mazor KM. Effects of Practicing With and Obtaining Crowdsourced Feedback From the Video-Based Communication Assessment App on Resident Physicians' Adverse Event Communication Skills: Pre-post Trial. JMIR Med Educ 2022; 8:e40758. [PMID: 36190751 PMCID: PMC9577713 DOI: 10.2196/40758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND US residents require practice and feedback to meet Accreditation Council for Graduate Medical Education mandates and patient expectations for effective communication after harmful errors. Current instructional approaches rely heavily on lectures, rarely provide individualized feedback to residents about communication skills, and may not assure that residents acquire the skills desired by patients. The Video-based Communication Assessment (VCA) app is a novel tool for simulating communication scenarios for practice and obtaining crowdsourced assessments and feedback on physicians' communication skills. We previously established that crowdsourced laypeople can reliably assess residents' error disclosure skills with the VCA app. However, its efficacy for error disclosure training has not been tested. OBJECTIVE We aimed to evaluate the efficacy of using VCA practice and feedback as a stand-alone intervention for the development of residents' error disclosure skills. METHODS We conducted a pre-post study in 2020 with pathology, obstetrics and gynecology, and internal medicine residents at an academic medical center in the United States. At baseline, residents each completed 2 specialty-specific VCA cases depicting medical errors. Audio responses were rated by at least 8 crowdsourced laypeople using 6 items on a 5-point scale. At 4 weeks, residents received numerical and written feedback derived from layperson ratings and then completed 2 additional cases. Residents were randomly assigned cases at baseline and after feedback assessments to avoid ordinal effects. Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2×3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings. RESULTS In total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents' communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents' communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6%). CONCLUSIONS Residents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ann M King
- National Board of Medical Examiners, Philadelphia, PA, United States
| | | | - Karen Berg Brigham
- Collaborative for Accountability and Improvement, University of Washington, Seattle, WA, United States
| | - Suzanne Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Emily E Fay
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas H Gallagher
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States
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18
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Laidlaw TM, Chu DK, Stevens WW, White AA. Controversies in Allergy: Aspirin Desensitization or Biologics for Aspirin-Exacerbated Respiratory Disease-How to Choose. J Allergy Clin Immunol Pract 2022; 10:1462-1467. [PMID: 34999274 DOI: 10.1016/j.jaip.2021.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 05/10/2023]
Abstract
Aspirin-exacerbated respiratory disease (AERD) can be a frustratingly complex syndrome to treat. Until recently, standard medical and surgical therapies for patients' asthma and chronic rhinosinusitis with nasal polyposis were the primary treatment modalities available, combined with either complete avoidance of all aspirin and nonsteroidal anti-inflammatory medications, or aspirin desensitization and initiation of high-dose aspirin therapy. There are now several targeted respiratory biologics added to the available armament for patients with AERD and choosing between this ever-growing list of options can be daunting for both patients and their clinicians. This review includes our understanding and interpretation of the existing data for each option, along with our own approach to weighing the pros and cons of each treatment for individual patients.
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Affiliation(s)
- Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Derek K Chu
- Department of Medicine, Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada; Department Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Whitney W Stevens
- Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
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19
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White AA, Lang DM. Aspirin/NSAID Challenge Should Be Performed Routinely in Patients With Self-Reported Aspirin/NSAID Allergy. J Allergy Clin Immunol Pract 2022; 10:1293-1294. [PMID: 35526866 DOI: 10.1016/j.jaip.2022.01.049] [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] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Andrew A White
- Department of Medicine, Division of Allergy, Asthma, and Immunology, Scripps Clinic and Research Foundation, La Jolla, Calif
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
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20
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White AA, King AM, D'Addario AE, Brigham KB, Dintzis S, Fay EE, Gallagher TH, Mazor KM. Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory. JMIR Med Educ 2022; 8:e30988. [PMID: 35486423 PMCID: PMC9107044 DOI: 10.2196/30988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/19/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. OBJECTIVE We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. METHODS Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents' error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. RESULTS Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates' and crowdsourced laypeople's ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. CONCLUSIONS Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ann M King
- National Board of Medical Examiners, Philadelphia, PA, United States
| | | | - Karen Berg Brigham
- Collaborative for Accountability and Improvement, University of Washington, Seattle, WA, United States
| | - Suzanne Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Emily E Fay
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas H Gallagher
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States
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21
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Liao JM, Bai G, Forman HP, White AA, Lee CI. JACR Health Policy Expert Panel: Hospital Price Transparency. J Am Coll Radiol 2022; 19:792-794. [PMID: 35460605 DOI: 10.1016/j.jacr.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Joshua M Liao
- Director of the Value and Systems Science Lab and Associate Chair for Health Systems, Department of Medicine at the University of Washington, and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Gei Bai
- Johns Hopkins Carey Business School, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Howard P Forman
- Department of Diagnostic Radiology, Yale University School of Medicine; Yale School of Management; Department of Economics, Yale College; and Yale School of Public Health, New Haven, Connecticut, and is Director of Clinical Leadership Development for Yale New Haven Health System and Faculty Director for Finance, Department of Radiology
| | - Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, and is Director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington and Deputy Editor of JACR
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22
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Wheeler C, Pacheco JM, Kim AC, Camacho-Santiago M, Kalafut MA, Ahern T, White AA, Patay B, Criado JR. Cardiovascular Autonomic Regulation, ETCO 2 and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance. Appl Psychophysiol Biofeedback 2022; 47:107-119. [PMID: 35171410 DOI: 10.1007/s10484-022-09536-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
Chronic orthostatic intolerance (COI) is defined by changes in heart rate (HR), blood pressure (BP), respiration, symptoms of cerebral hypoperfusion and sympathetic overactivation. Postural tachycardia syndrome (POTS) is the most common form of COI in young adults and is defined by an orthostatic increase in heart rate (HR) of ≥ 30 bpm in the absence of orthostatic hypotension. However, some patients referred for evaluation of COI symptoms do not meet the orthostatic HR response criterion of POTS despite debilitating symptoms. Such patients are ill defined, posing diagnostic and therapeutic challenges. This study explored the relationship among cardiovascular autonomic control, the orthostatic HR response, EtCO2 and the severity of orthostatic symptoms and fatigue in patients referred for evaluation of COI. Patients (N = 108) performed standardized testing protocol of the Autonomic Reflex Screen and completed the Composite Autonomic Symptom Score (COMPASS-31) and the Fatigue Severity Scale (FSS). Greater severity of COI was associated with younger age, larger phase IV amplitude in the Valsalva maneuver and lower adrenal baroreflex sensitivity. Greater fatigue severity was associated with a larger reduction in ETCO2 during 10 min of head-up tilt (HUT) and reduced low-frequency (LF) power of heart rate variability. This study suggests that hemodynamic changes associated with the baroreflex response and changes in EtCO2 show a stronger association with the severity of orthostatic symptoms and fatigue than the overall orthostatic HR response in patients with COI.
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Affiliation(s)
- Carmen Wheeler
- Division of Cardiology Clinical Research, Scripps Clinic, La Jolla, CA, 92037, USA
| | - Jannay M Pacheco
- Department of Applied and Integrated Neurosciences, Pontifical Catholic University of Puerto Rico, Ponce, PR, 00717, USA
| | - Anna C Kim
- Vascular Laboratory, Scripps Clinic, La Jolla, CA, 92037, USA
| | | | - Mary A Kalafut
- Division of Neurology, Autonomic Neuro Lab, Scripps Clinic, 9898 Genesee Ave., La Jolla, CA, 92037, USA
| | - Thomas Ahern
- Division of Cardiology, Scripps Clinic, La Jolla, CA, 92037, USA
| | - Andrew A White
- Division of Allergy/Immunology, Scripps Clinic, La Jolla, CA, 92037, USA
| | - Bradley Patay
- Division of Internal Medicine, Scripps Clinic, La Jolla, CA, 92037, USA
| | - José R Criado
- Division of Neurology, Autonomic Neuro Lab, Scripps Clinic, 9898 Genesee Ave., La Jolla, CA, 92037, USA.
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23
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Wangberg H, Spierling Bagsic SR, Osuna L, White AA. Appraisal of the Real-World Effectiveness of Biologic Therapies in Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract 2022; 10:478-484.e3. [PMID: 34597850 PMCID: PMC8837666 DOI: 10.1016/j.jaip.2021.09.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are no head-to-head studies for patients with aspirin-exacerbated respiratory disease (AERD) comparing any of the 5 Food and Drug Administration-approved respiratory biologic therapies. OBJECTIVE Explore outcomes in subjects with AERD using biologic therapies in a real-world clinic setting. METHODS A retrospective pilot study was conducted for subjects with AERD who had been prescribed omalizumab (anti-IgE), mepolizumab (anti-IL-5), reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor alpha [anti-IL-5Rα]), or dupilumab (anti-IL-4 receptor alpha [anti-IL-4Rα]). Clinical outcomes pre- versus postinitiation of biologic therapy were explored including symptoms, 22-item sino-nasal outcome test scores, systemic corticosteroid and antibiotic prescriptions, and emergency room visits related to AERD. RESULTS Of the 74 subjects, 58.1% (n = 43) had used 1 biologic, though many (41.9%, n = 31) trialed more than 1 biologic. Of the 50 subjects who had used anti-IL-4Rα therapy, 98% (49 of 50) still had this therapy prescribed at study completion compared with 48.6% (17 of 35) and 26.9% (7 of 26) of those who used anti-IgE and anti-IL-5 and anti-IL-5 receptor alpha (anti-IL-5/IL-5Rα) therapy, respectively. Among those on anti-IL-4Rα therapy, there was a significant reduction in median total 22-item sino-nasal outcome test scores (51 to 19, P = .0002), corticosteroid bursts (2 to 0, P < .0001), and median number of antibiotic courses for respiratory disease (1 to 0, P = .0469) prebiologic versus postbiologic initiation. No statistically significant difference in those outcomes was observed for individuals on anti-IgE or anti-IL-5/IL-5Rα therapy. CONCLUSIONS Anti-IL-4Rα therapy led to significantly higher rates of clinical improvement in AERD when compared with anti-IL-5/IL-5Rα and anti-IgE biologic therapies. Prospective studies would help clarify best practices for the use of biologic therapies in AERD.
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Affiliation(s)
- Hannah Wangberg
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | | | - Lilliana Osuna
- Scripps Health, Scripps Whittier Diabetes Institute, San Diego, Calif
| | - Andrew A. White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
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24
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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25
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Haque R, White AA, Jackson DJ, Hopkins C. Clinical evaluation and diagnosis of aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2021; 148:283-291. [PMID: 34364538 DOI: 10.1016/j.jaci.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022]
Abstract
Aspirin-exacerbated respiratory disease (AERD) is a condition composed of chronic rhinosinusitis with nasal polyposis and asthma that is defined by respiratory hypersensitivity reactions to the cyclooxygenase 1-inhibitory effects of nonsteroidal anti-inflammatory drugs. It is diagnosed in 5% to 15% of patients with asthma and is even more common in those with comorbid nasal polyposis. Diagnosis is confirmed after an aspirin challenge procedure, yet many patients present with all components and can reliably be diagnosed by history. Patients with AERD commonly experience severe uncontrolled nasal polyposis and require multispecialty evaluation to properly stage and treat this condition. The presence of nasal polyposis plays a large component in the diminished quality of life in patients with AERD. In the last decade, multiple new therapeutic areas have been approved for type 2 airway diseases, offering patients with AERD many more options for control. This makes an early and accurate diagnosis of AERD important in the care of the larger population of type 2 airway diseases.
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Affiliation(s)
- Rubaiyat Haque
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Andrew A White
- Division of Asthma, Allergy and Immunology, Scripps Clinic, San Diego, Calif
| | - David J Jackson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Claire Hopkins
- Ear, Nose and Throat Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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26
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Bhasin A, Lee CK, Shulman S, White AA, Stanley M. An A-Peeling Diagnosis. J Hosp Med 2021; 16:jhm.3567. [PMID: 34328832 DOI: 10.12788/jhm.3567] [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: 05/29/2020] [Accepted: 11/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Ajay Bhasin
- Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Division of Hospital-Based Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Chicago, Illinois
| | - Cheryl K Lee
- Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Division of Hospital-Based Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Chicago, Illinois
| | - Stanford Shulman
- Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Chicago, Illinois
| | - Andrew A White
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Marion Stanley
- Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois
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Ball LL, Velasquez SA, Al Jammal OM, White AA, Akuthota P. Atypical eosinophilic granulomatosis with polyangiitis with spontaneous aspirin reactivity and immunoglobulin E-mediated anaphylaxis. Ann Allergy Asthma Immunol 2021; 127:506-507. [PMID: 34273484 DOI: 10.1016/j.anai.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Laurel L Ball
- School of Medicine, University of California, San Diego, La Jolla, California.
| | | | - Omar M Al Jammal
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
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White AA, Cahill KN, Jerschow E, Kuruvilla M, Sehanobish E, Bensko J, Laidlaw TM, Levy JM. COVID-19 in a series of patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol Pract 2021; 9:2900-2903. [PMID: 33965591 PMCID: PMC8130496 DOI: 10.1016/j.jaip.2021.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
| | - Katherine N Cahill
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elina Jerschow
- Department of Medicine, Allergy/Immunology Division, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Merin Kuruvilla
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Ga
| | - Esha Sehanobish
- Department of Medicine, Allergy/Immunology Division, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Jillian Bensko
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Tanya M Laidlaw
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joshua M Levy
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Ga
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Luskin KT, White AA, Lyons JJ. The Genetic Basis and Clinical Impact of Hereditary Alpha-Tryptasemia. J Allergy Clin Immunol Pract 2021; 9:2235-2242. [PMID: 33744473 DOI: 10.1016/j.jaip.2021.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022]
Abstract
Hereditary alpha-tryptasemia (HαT) is an autosomal dominant genetic trait found in 4% to 6% of the general population and defined by excess copies of alpha-tryptase at TPSAB1. Elevated basal serum tryptase (sBT >8 ng/mL) is a defining feature of HαT and appears to result from increased pro-alpha-tryptase synthesis and secretion rather than mast cell activation. It is estimated that approximately one-third of individuals with HαT have associated symptoms, including cutaneous, gastrointestinal, atopic, musculoskeletal, autonomic, and neuropsychiatric manifestations. HαT is found at a disproportionately high rate in systemic mastocytosis and idiopathic anaphylaxis, and is a modifying factor that independently increases the incidence and severity of anaphylaxis. The varied phenotypes associated with HαT may, in part, result from coinheritance of other genetic variants, increased expression of α-/ß-tryptase heterotetramers, and/or overexpression of pro-alpha-tryptase, although further studies are needed. There is an accurate diagnostic test available to confirm HαT in patients that can be used in combination with sBT to help risk-stratify individuals in whom bone marrow biopsy is being considered. There is no specific treatment for symptoms associated with HαT, and management is focused on controlling clinical manifestations with mast cell mediator antagonists, aspirin, inhalers, epinephrine, omalizumab, and involvement of other specialists.
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Affiliation(s)
- Kathleen T Luskin
- Division of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, Calif.
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, Calif
| | - Jonathan J Lyons
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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Jerschow E, White AA. Aspirin Therapy in AERD: "One Size" Might Not Fit All. J Allergy Clin Immunol Pract 2021; 8:3575-3576. [PMID: 33161968 DOI: 10.1016/j.jaip.2020.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Elina Jerschow
- Division of Allergy and Immunology, Montefiore Medical Center, Bronx, NY
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
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31
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Cook KA, White AA. Chronic Urticaria with NSAID-Exacerbated Cutaneous Disease: A (NSAID) Challenge Worth Taking. J Allergy Clin Immunol Pract 2021; 8:3584-3585. [PMID: 33161969 DOI: 10.1016/j.jaip.2020.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Kevin A Cook
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
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32
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White AA, Asero R. NSAID hypersensitivity-the unwitting accomplice in the growing opiate epidemic. J Allergy Clin Immunol 2021; 147:1215-1216. [PMID: 33582114 DOI: 10.1016/j.jaci.2021.02.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
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Cook KA, Domissy A, Simon RA, White AA, Modena BD. Dysbiosis in aspirin-exacerbated respiratory disease. Int Forum Allergy Rhinol 2021; 11:1116-1120. [PMID: 33438331 DOI: 10.1002/alr.22762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Kevin A Cook
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA
| | - Alain Domissy
- Genomics Core, Scripps Research Institute, La Jolla, CA
| | - Ronald A Simon
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA
| | - Brian D Modena
- Division of Allergy, National Jewish Hospital, Denver, CO
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34
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McDonald K, White AA, Cornia PB, Keller C, Quinnan-Hostein L, Starks H, Mookherjee S. Defining a New Normal While Awaiting the Pandemic's Next Wave. J Hosp Med 2021; 16:59-60. [PMID: 33357332 PMCID: PMC7768922 DOI: 10.12788/jhm.3512] [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: 06/05/2020] [Accepted: 07/30/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Kymberly McDonald
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Andrew A White
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Paul B Cornia
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- VA Puget Sound Health Care System, Seattle, Washington
| | - Carolyn Keller
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Laura Quinnan-Hostein
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Helene Starks
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington
| | - Somnath Mookherjee
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Corresponding Author: Somnath Mookherjee, MD;
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Stevens WW, Jerschow E, Baptist AP, Borish L, Bosso JV, Buchheit KM, Cahill KN, Campo P, Cho SH, Keswani A, Levy JM, Nanda A, Laidlaw TM, White AA. The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2020; 147:827-844. [PMID: 33307116 DOI: 10.1016/j.jaci.2020.10.043] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
Aspirin-exacerbated respiratory disease (AERD) is characterized by the clinical triad of chronic rhinosinusitis with nasal polyps, asthma, and an intolerance to medications that inhibit the cycloxgenase-1 enzyme. Patients with AERD on average have more severe respiratory disease compared with patients with chronic rhinosinusitis with nasal polyps and/or asthma alone. Although patients with AERD traditionally develop significant upper and lower respiratory tract symptoms on ingestion of cycloxgenase-1 inhibitors, most of these same patients report clinical benefit when desensitized to aspirin and maintained on daily aspirin therapy. This Work Group Report provides a comprehensive review of aspirin challenges, aspirin desensitizations, and maintenance aspirin therapy in patients with AERD. Identification of appropriate candidates, indications and contraindications, medical and surgical optimization strategies, protocols, medical management during the desensitization, and recommendations for maintenance aspirin therapy following desensitization are reviewed. Also included is a summary of studies evaluating the clinical efficacy of aspirin therapy after desensitization as well as a discussion on the possible cellular and molecular mechanisms explaining how this therapy provides unique benefit to patients with AERD.
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Affiliation(s)
- Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Elina Jerschow
- Division of Allergy and Immunology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Michigan Medical School, Ann Arbor, Mich
| | - Larry Borish
- Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Va
| | - John V Bosso
- Division of Rhinology, Department of Otorhinolaryngology/Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Paloma Campo
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Seong H Cho
- Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Anjeni Keswani
- Division of Allergy/Immunology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Joshua M Levy
- Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Tex; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
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Damask CC, Ryan MW, Casale TB, Castro M, Franzese CB, Lee SE, Levy JM, Lin SY, Lio PA, Peters AT, Platt MP, White AA. Targeted Molecular Therapies in Allergy and Rhinology. Otolaryngol Head Neck Surg 2020; 164:S1-S21. [PMID: 33138725 DOI: 10.1177/0194599820965233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biologic agents, monoclonal antibodies that target highly-specific molecular pathways of inflammation, are becoming integrated into care pathways for multiple disorders that are relevant in otolaryngology and allergy. These conditions share common inflammatory mechanisms of so-called Type 2 inflammation with dysregulation of immunoglobulin E production and eosinophil and mast cell degranulation leading to tissue damage. Biologic agents are now available for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, eosinophilic granulomatosis with polyangiitis (EGPA), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU). This paper summarizes the diagnosis and management of these conditions and critically reviews the clinical trial data that has led to regulatory approval of biologic agents for these conditions.
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Affiliation(s)
| | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Stella E Lee
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sandra Y Lin
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Peter A Lio
- Northwestern Medicine, Chicago, Illinois, USA
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38
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White AA, Sage WM, Mazor KM, Gallagher TH. Assessing and Supporting Late Career Practitioners: Four Key Questions. Jt Comm J Qual Patient Saf 2020; 46:591-595. [PMID: 32859507 DOI: 10.1016/j.jcjq.2020.07.001] [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] [Received: 05/03/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
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Russell CJ, White AA. Aspiring to Treat Wisely: Challenges in Diagnosing and Optimizing Antibiotic Therapy for Aspiration Pneumonia. J Hosp Med 2020; 15:445-446. [PMID: 32897854 DOI: 10.12788/jhm.3375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/05/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew A White
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
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White AA, Lee T, Garrison MM, Payne TH. A Randomized Trial of Voice-Generated Inpatient Progress Notes: Effects on Professional Fee Billing. Appl Clin Inform 2020; 11:427-432. [PMID: 32521556 DOI: 10.1055/s-0040-1713134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Prior evaluations of automated speech recognition (ASR) to create hospital progress notes have not analyzed its effect on professional revenue billing codes. As ASR becomes a more common method of entering clinical notes, clinicians, hospital administrators, and payers should understand whether this technology alters charges associated with inpatient physician services. OBJECTIVES This study aimed to measure the difference in professional fee charges between using voice and keyboard to create inpatient progress notes. METHODS In a randomized trial of a novel voice with ASR system, called voice-generated enhanced electronic note system (VGEENS), to generate physician notes, we compared 1,613 notes created using intervention (VGEENS) or control (keyboard with template) created by 31 physicians. We measured three outcomes, as follows: (1) professional fee billing levels assigned by blinded coders, (2) number of elements within each note domain, and (3) frequency of organ system evaluations documented in review of systems (ROS) and physical exam. RESULTS Participants using VGEENS generated a greater portion of high-level (99233) notes than control users (31.8 vs. 24.3%, p < 0.01). After adjustment for clustering by author, the finding persisted; intervention notes were 1.43 times more likely (95% confidence interval [CI]: 1.14-1.79) to receive a high-level code. Notes created using voice contained an average of 1.34 more history of present illness components (95% CI: 0.14-2.54) and 1.62 more review of systems components (95% CI: 0.48-2.76). The number of physical exam components was unchanged. CONCLUSION Using this voice with ASR system as tested slightly increases documentation of patient symptom details without reliance on copy and paste and may raise physician charges. Increased provider reimbursement may encourage hospital and provider group to offer use of voice and ASR to create hospital progress notes as an alternative to usual methods.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Tyler Lee
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Michelle M Garrison
- Department of Health Services, University of Washington School of Public Health, and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, United States
| | - Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
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Abstract
Aspirin-exacerbated respiratory disease (AERD) classically presents with severe asthma, nasal polyposis, and respiratory exacerbations in response to cyclooxygenase (COX)-1 inhibition. Recent advances in our understanding of AERD have revealed multiple facets of immune dysregulation, including diminished prostaglandin E2 (PGE2) function and elevated levels of both cysteinyl leukotrienes (CysLTs) and innate cytokines such as interleukin 33 (IL-33). Inflammatory mediators in AERD heighten the recruitment and activation of innate lymphoid cells type 2 (ILC2), mast cells, eosinophils, and platelet-adherent leukocytes. This contributes to a cyclical pattern of type 2 inflammation. Here, we highlight current understanding of the immunopathogenesis of AERD.
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Affiliation(s)
- Hannah Wangberg
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA, United States
| | - Andrew A White
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA, United States.
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Martens KL, Khalighi PR, Li S, White AA, Silgard E, Frieze D, Estey E, Garcia DA, Hingorani S, Li A. Comparative effectiveness of rasburicase versus allopurinol for cancer patients with renal dysfunction and hyperuricemia. Leuk Res 2020; 89:106298. [DOI: 10.1016/j.leukres.2020.106298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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Velásquez ST, Wang ES, White AA, Chadha J, Mader M, Leykum LK, Pugh J. Hospitalists as Triagists: Description of the Triagist Role across Academic Medical Centers. J Hosp Med 2020; 12:87-90. [PMID: 31634098 DOI: 10.12788/jhm.3327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
From the hospitalist perspective, triaging involves the evaluation of a patient for potential admission to an inpatient service. Although traditionally done by residents, many academic hospitalist groups have assumed the responsibility for triaging. We conducted a cross-sectional survey of 235 adult hospitalists at 10 academic medical centers (AMCs) to describe the similarities and differences in the triagist role and assess the activities and skills associated with the role. Eight AMCs have a defined triagist role; at the others, hospitalists supervise residents/advanced practice providers. The triagist role is generally filled by a faculty physician and shared by all hospitalists.We found significant variability in verbal communication practices (P = .02) and electronic communication practices (P < .0001) between the triagist and the current provider (eg, emergency department, clinic provider), and in the percentage of patients evaluated in person (P < .0001). Communication skills, personal efficiency, and systems knowledge are dominant themes of attributes of an effective triagist.
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Affiliation(s)
- Sadie Trammell Velásquez
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Emily S Wang
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Andrew A White
- University of Washington School of Medicine, Department of Medicine, Seattle, Washington
| | - Jagriti Chadha
- University of Kentucky, Division of Hospital Medicine, Lexington, Kentucky
| | - Michael Mader
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Luci K Leykum
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
| | - Jacqueline Pugh
- Department of Medicine, Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas
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Marek RL, White AA. Nurturing Sustainability in a Growing Community Pediatric Hospital Medicine Workforce. J Hosp Med 2019; 14:721-722. [PMID: 31433776 DOI: 10.12788/jhm.3293] [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] [Indexed: 11/20/2022]
Affiliation(s)
| | - Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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45
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White AA, McIlraith T, Chivu AM, Cyrus R, Cockerham C, Vora H, Vulgamore P. Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups. J Hosp Med 2019; 14:662-667. [PMID: 31339842 DOI: 10.12788/jhm.3249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue. OBJECTIVE To describe current attitudes and beliefs of hospital executives regarding the value of contributions made by HMGs. DESIGN Thematic content analysis of key informant interviews. PARTICIPANTS Twenty-four healthcare institutional leaders, including hospital presidents, chief medical officers, chief executive officers, and chief financial officers. Participants comprised a diverse sample from all regions in the United States, including rural, suburban, and urban locations, and academic and nonacademic institutions. RESULTS Executives highly valued hospitalist groups that demonstrate alignment with hospital priorities, and often used this concept to summarize the HMG's success across several value domains. Most executives evaluated only a few key HMG metrics, but almost no executives reported calculating the HMG return on investment by summing pertinent quantitative contributions. Respondents described an evolving concept of hospitalist value and believed that HMGs generate substantial value that is difficult to measure financially. CONCLUSIONS Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG's broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Anton M Chivu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Rachel Cyrus
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hardik Vora
- Hospital Medicine Division, Riverside Regional Medical Center, Newport News, Virginia
| | - Patrick Vulgamore
- Temple Center for Population Health, Temple University Health System, Philadelphia, Pennsylvania
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Modena BD, White AA. Can Diet Modification Be an Effective Treatment in Aspirin-Exacerbated Respiratory Disease? J Allergy Clin Immunol Pract 2019; 6:832-833. [PMID: 29747986 DOI: 10.1016/j.jaip.2017.11.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Brian D Modena
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif; Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, Calif
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
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Khalighi PR, Martens KL, White AA, Li S, Silgard E, Frieze D, Garcia DA, Li A. Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification. J Oncol Pharm Pract 2019; 26:529-535. [PMID: 31167612 DOI: 10.1177/1078155219851543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2022]
Abstract
PURPOSE Current guidelines for tumor lysis syndrome management recommend rasburicase for high-risk patients. Adherence to guidelines has not been well studied, and the correlation between uric acid reduction and clinically relevant outcomes, such as acute kidney injury, remains unclear. Our study aims to describe rasburicase utilization patterns and outcomes in cancer patients with varying risks for tumor lysis syndrome. METHODS In this retrospective cohort study, we included cancer inpatients who received rasburicase for tumor lysis syndrome management at two affiliated academic hospitals from 2009 to 2015. Patients were classified by tumor lysis syndrome risk categories prior to drug administration. Primary outcomes included acute kidney injury incidence and renal recovery. Secondary outcomes included uric acid nadir, mortality, and hospital length-of-stay. RESULTS Among 164 patients, 42 (26%) had high-, 63 (38%) had intermediate-, and 59 (36%) had low-risk for tumor lysis syndrome. A total of 94 patients (57%) had existing renal dysfunction prior to rasburicase use. This occurred more frequently in low- (68%) compared to intermediate- (57%) and high- (43%) risk patients (p = 0.044). A greater proportion of patients in the high-risk group (78%) had renal recovery when compared to the intermediate- (61%) or low- (45%) risk groups (p = 0.056). Despite a similar length of stay, the high-risk group had a significantly lower 30-day mortality (10%) when compared to intermediate- (25%) or low- (32%) risk groups (p = 0.029). CONCLUSIONS Our results suggest that rasburicase may be frequently prescribed to treat hyperuricemia unrelated to tumor lysis syndrome in cancer patients. Improved education and adherence to guidelines may improve clinical and economic outcomes associated with rasburicase administration.
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Affiliation(s)
- Parisa R Khalighi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kylee L Martens
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Shan Li
- Pharmacy Services, University of Washington Medical Center, Seattle, WA, USA
| | - Emily Silgard
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Deborah Frieze
- Pharmacy Services, University of Washington Medical Center, Seattle, WA, USA
| | - David A Garcia
- Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ang Li
- Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA
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Nawas MT, Walker EJ, Richie MB, White AA, Hsu G. A Protean Protein. J Hosp Med 2019; 14:117-122. [PMID: 30534640 DOI: 10.12788/jhm.3102] [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] [Indexed: 11/20/2022]
Affiliation(s)
- Miriam T Nawas
- Medical Oncology Fellowship Program, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
| | - Evan J Walker
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Megan B Richie
- Department of Neurology, University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Andrew A White
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Gerald Hsu
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California, USA
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Kowalski ML, Agache I, Bavbek S, Bakirtas A, Blanca M, Bochenek G, Bonini M, Heffler E, Klimek L, Laidlaw TM, Mullol J, Niżankowska‐Mogilnicka E, Park H, Sanak M, Sanchez‐Borges M, Sanchez‐Garcia S, Scadding G, Taniguchi M, Torres MJ, White AA, Wardzyńska A. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)-a EAACI position paper. Allergy 2019; 74:28-39. [PMID: 30216468 DOI: 10.1111/all.13599] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [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: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 01/04/2023]
Abstract
NSAID-exacerbated respiratory disease (N-ERD) is a chronic eosinophilic, inflammatory disorder of the respiratory tract occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP), symptoms of which are exacerbated by NSAIDs, including aspirin. Despite some progress in understanding of the pathophysiology of the syndrome, which affects 1/10 of patients with asthma and rhinosinusitis, it remains a diagnostic and therapeutic challenge. In order to provide evidence-based recommendations for the diagnosis and management of N-ERD, a panel of international experts was called by the EAACI Asthma Section. The document summarizes current knowledge on the pathophysiology and clinical presentation of N-ERD pointing at significant heterogeneity of this syndrome. Critically evaluating the usefulness of diagnostic tools available, the paper offers practical algorithm for the diagnosis of N-ERD. Recommendations for the most effective management of a patient with N-ERD stressing the potential high morbidity and severity of the underlying asthma and rhinosinusitis are discussed and proposed. Newly described sub-phenotypes and emerging sub-endotypes of N-ERD are potentially relevant for new and more specific (eg, biological) treatment modalities. Finally, the document defines major gaps in our knowledge on N-ERD and unmet needs, which should be addressed in the future.
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Affiliation(s)
| | - Ioana Agache
- Medical School Brasov Transylvania University Brasov Romania
| | - Sevim Bavbek
- Division of Allergy and Clinical Immunology Department of Chest Diseases School of Medicine Ankara University Ankara Turkey
| | - Arzu Bakirtas
- Department Pediatric Allergy and Asthma Faculty of Medicine Gazi University Ankara Turkey
| | - Miguel Blanca
- Allergy Service Hospital Infanta Leonor Madrid Spain
| | - Grażyna Bochenek
- Department of Internal Medicine Jagiellonian University Medical College Krakow Poland
| | - Matteo Bonini
- National Heart and Lung Institute Royal Brompton Hospital & Imperial College London London UK
| | - Enrico Heffler
- Department of Biomedical Sciences, Personalized Medicine Asthma and Allergy Clinic Humanitas University Milano Italy
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Tanya M. Laidlaw
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy IDIBAPS, and CIBERES Barcelona Spain
| | | | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon Korea
| | - Marek Sanak
- Division of Molecular Biology and Clinical Genetics Department of Internal Medicine Jagiellonian University Medical College Kraków Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico‐Docente La Trinidad Caracas Venezuela
| | | | - Glenis Scadding
- Department of Allergy & Rhinology Royal National TNE Hospital London UK
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Maria J. Torres
- Allergy Unit Malaga Regional University Hospital‐IBIMA ARADyAL Málaga Spain
| | - Andrew A. White
- Department of Allergy, Asthma and Immunology Scripps Clinic San Diego California
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