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Smirnova N, Lowers J, Magee MJ, Auld SC, Hunt WR, Fitzpatrick A, Lama V, Kavalieratos D. Pulmonary Function and Quality of Life in Adults with Cystic Fibrosis. Lung 2023; 201:635-639. [PMID: 37973684 DOI: 10.1007/s00408-023-00658-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE People living with cystic fibrosis (CF) experience impaired quality of life, but the extent to which pulmonary function is associated with quality of life in CF remains unclear METHODS: Using baseline data from a trial of specialist palliative care in adults with CF, we examined the association between pulmonary obstruction and quality of life (measured with the Functional Assessment of Chronic Illness Therapy Total Score). RESULTS Among 262 participants, median age was 33, and 78% were on modulator therapy. The median quality of life score was higher in those with mild obstruction (135, IQR 110-156) compared to moderate (125, IQR 109-146) and severe obstruction (120, IQR 106-136). In an unadjusted model, we observed a non-significant trend toward lower quality of life with increased obstruction-compared to participants with mild obstruction, those with moderate obstruction had quality of life score 7.46 points lower (95% CI -15.03 to 0.10) and those with severe obstruction had a score 9.98 points lower (95% CI -21.76 to 1.80). However, this association was no longer statistically significant in the adjusted model, which may reflect confounding due to sex, age, BMI, and modulator therapy. Comorbidities (depression and anxiety) and social determinants of health (financial insecurity and education) were also associated with quality of life. CONCLUSION Advancing our understanding of patient-centered markers of quality of life, rather than focusing on pulmonary function alone, may help identify novel interventions to improve quality of life in this patient population.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Matthew J Magee
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sara C Auld
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - William R Hunt
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - Anne Fitzpatrick
- Department of Pediatrics, Emory University, Randall Rollins Building, #R544, 1516 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Vibha Lama
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA.
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Pediatrics, Emory University, Randall Rollins Building, #R544, 1516 Clifton Road, NE, Atlanta, GA, 30322, USA.
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2
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DiFiglia S, Georgiopoulos AM, Portenoy R, Seng E, Berdella M, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Walker P, Wang J, Yonker LM, Buehler B, Chaudhary N, Esposito C, Frantzen T, Henthorne K, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. Palliative care needs among outpatient adults with cystic fibrosis: Baseline data from the Improving Life with CF trial. J Cyst Fibros 2023:S1569-1993(23)01664-8. [PMID: 37951787 DOI: 10.1016/j.jcf.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Little is known about the burden of illness experienced by people with cystic fibrosis (pwCF) since the advent of CF transmembrane conductance regulator (CFTR) modulator therapies. Studies that characterize the nature of illness burden are needed to inform the development and implementation of palliative care programs that can serve this population and address quality of life concerns. METHODS Adults with CF treated at five U.S. CF centers were surveyed to obtain baseline data for the Improving Life with CF primary palliative care implementation trial. Consenting patients completed the Integrated Palliative Care Outcome Scale (IPOS), a multidimensional measure of unmet needs for palliative care. Sociodemographic and clinical information was also obtained. The associations among these variables were examined through bivariate and multivariable analyses. RESULTS Among 256 adults, the most distressing symptoms included not feeling "at peace", communication difficulties with family/friends, anxiety over illness or its treatment, and a lack of energy. In the multivariable analyses, CFTR modulator use was associated with lower IPOS total and physical symptoms scores; female sex and increased hospitalizations were associated with higher scores. Increased age and history of distal intestinal obstructive syndrome were associated with higher IPOS physical symptoms scores. CONCLUSIONS These findings illuminate the nature of illness burden for pwCF in the era of CFTR modulator therapies. Although illness burden is positively affected by modulator therapy, there is a continuing need for palliative care to address physical, emotional, and spiritual distress, and the communication and practical needs experienced by adults with CF.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, New York, NY, United States; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria Berdella
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Janice Wang
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Brian Buehler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Esposito
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Theresa Frantzen
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | | | - Amy Plachta
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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3
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Smirnova N, Trandel ET, Dubin E, Lowers J, Dellon EP, Hempstead S, Faro A, Tallarico E, Kavalieratos D. Clinician perspectives on barriers and solutions to symptom management in cystic fibrosis. J Cyst Fibros 2023; 22:1100-1103. [PMID: 37263825 PMCID: PMC10687299 DOI: 10.1016/j.jcf.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
People living with cystic fibrosis (PLwCF) experience high symptom burden. 146 clinicians completed online surveys regarding barriers and solutions to symptom management between September and October 2020. The surveys contained both closed-ended and free-text entries. The symptom management specialists that CF clinicians most wished to consult included mental health (88, 65%), palliative care (59, 41%), and pain specialists (48, 33%). Barriers to symptom management included concerns about controlled substances prescribed for symptom control causing addiction and precluding transplantation, a lack of trust and collaboration among clinical specialties, a lack of symptom management specialists with CF expertise, and a worry about the affordability of specialist-level symptom management care. Potential solutions included non-pharmacological approaches, expanding access to affordable specialist symptom management care, the creation of clinical care guidelines for symptom management in CF, and having CF clinicians and symptom management specialists work alongside each other in CF clinic to build interdisciplinary trust and education.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States.
| | | | - Ethan Dubin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Elisabeth P Dellon
- Department of Pediatrics, UNC Chapel Hill, Chapel Hill, NC, United States
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | | | - Dio Kavalieratos
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States
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DiFiglia S, Dhingra L, Georgiopoulos AM, Papia K, Sullivan E, Plachta A, Boccio C, Portenoy R, Basile M. Addressing Symptom Burden and Palliative Care Needs in Cystic Fibrosis: A Narrative Review of the Literature. Life (Basel) 2023; 13:1620. [PMID: 37629478 PMCID: PMC10455429 DOI: 10.3390/life13081620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
Among people with cystic fibrosis (CF), illness burden is multifaceted, and symptoms may fluctuate in intensity across a lifespan. Caregivers of people with CF may also experience distressing symptoms. Recent developments in CF care, including the availability of highly effective modulator therapies (HEMTs) and new palliative care guidelines promoting palliative care screening may help alleviate symptoms. The objective of this review was to present a narrative view of the recent literature on symptom burden in CF, new screening approaches informed by the Cystic Fibrosis Foundation (CFF) palliative care guidelines, and early data from studies examining the impact of HEMTs on CF symptom burden. A review of the relevant literature was conducted using Google Scholar and PubMed. Included articles covered approaches to burden assessment in CF and other chronic illnesses, epidemiology of CF symptom burden, the impact of HEMTs on symptom burden, and the CFF palliative care guidelines. A primary palliative care model implementing the CFF guidelines was also described. Results of this review show that while recent developments in CF care have led to a reduction in physical symptoms, mental health symptoms remain prevalent. Ongoing screening and triage can ensure that physical symptoms, psychological symptoms, social needs, practical problems, and communication concerns are addressed by care teams.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Anna M. Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Katherine Papia
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Erin Sullivan
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Amy Plachta
- Cystic Fibrosis Center, Lennox Hill, New York, NY 10021, USA;
| | - Courtney Boccio
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA
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5
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Acaster S, Mukuria C, Rowen D, Brazier JE, Wainwright CE, Quon BS, Duckers J, Quittner AL, Lou Y, Sosnay PR, McGarry LJ. Development of the Cystic Fibrosis Questionnaire-Revised-8 Dimensions: Estimating Utilities From the Cystic Fibrosis Questionnaire-Revised. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:567-578. [PMID: 36509366 DOI: 10.1016/j.jval.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Cystic fibrosis (CF) limits survival and negatively affects health-related quality of life (HRQOL). Cost-effectiveness analysis (CEA) may be used to make reimbursement decisions for new CF treatments; nevertheless, generic utility measures used in CEA, such as EQ-5D, are insensitive to meaningful changes in lung function and HRQOL in CF. Here we develop a new, CF disease-specific, preference-based utility measure based on the adolescent/adult version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely used, CF-specific, patient-reported measure of HRQOL. METHODS Blinded CFQ-R data from 4 clinical trials (NCT02347657, NCT02392234, NCT01807923, and NCT01807949) were used to identify discriminating items for a classification system using psychometric (eg, factor and Rasch) analyses. Thirty-two health states were selected for a time trade-off (TTO) exercise with a representative sample of the UK general population. TTO utilities were used to estimate a preference-based scoring algorithm by regression analysis (tobit models with robust standard errors clustered on participants with censoring at -1). RESULTS A classification system with 8 dimensions (CFQ-R-8 dimensions; physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image) was generated. TTO was completed by 400 participants (mean age, 47.3 years; 49.8% female). Among the regression models evaluated, the tobit heteroscedastic-ordered model was preferred, with a predicted utility range from 0.236 to 1, no logical inconsistencies, and a mean absolute error of 0.032. CONCLUSION The CFQ-R-8 dimensions is the first disease-specific, preference-based scoring algorithm for CF, enabling estimation of disease-specific utilities for CEA based on the well-validated and widely used CFQ-R.
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Affiliation(s)
| | - Clara Mukuria
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - Donna Rowen
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - John E Brazier
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - Claire E Wainwright
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Bradley S Quon
- Centre for Heart Lung Innovation, St. Paul's Hospital, and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jamie Duckers
- Department of Respiratory Medicine, Cardiff and Vale University Health Board, NHS Wales, Cardiff, Wales, UK
| | | | - Yiyue Lou
- Biostatistics, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Patrick R Sosnay
- Clincal Development, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Lisa J McGarry
- Health Economics and Outcomes Research, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
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6
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Almulhem M, Harnett N, Graham S, Haq I, Visram S, Ward C, Brodlie M. Exploring the impact of elexacaftor-tezacaftor-ivacaftor treatment on opinions regarding airway clearance techniques and nebulisers: TEMPO a qualitative study in children with cystic fibrosis, their families and healthcare professionals. BMJ Open Respir Res 2022; 9:9/1/e001420. [PMID: 36207030 PMCID: PMC9557266 DOI: 10.1136/bmjresp-2022-001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Cystic fibrosis (CF) is a genetic condition caused by variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that primarily impacts the lungs. Treatments historically have been symptomatic to improve airway clearance and treat infection. However, CFTR modulator drugs have recently been developed that target the underlying defect. The triple combination of elexacaftor-tezacaftor-ivacaftor (ETI) was approved in 2020 in England for over 80% of people with CF aged over 12 years and in 2022 extended to those over 6 years. ETI treatment is associated with substantial improvements in lung function. The experience of children with CF starting on ETI or their views regarding future treatments have not been well studied. This study aimed to explore the opinions of children with CF, their parents/carers and healthcare professionals (HCPs) on the impact of ETI, airway clearance techniques (ACTs) and nebulised treatments. Methods Semistructured qualitative interviews were performed with 10 children with CF, 7 parents/carers and 10 HCPs. Audio recordings were transcribed and analysed using reflexive thematic analysis. Results Four main themes were identified: ‘Kaftrio changed my life’, ‘Your entire life is dictated by the CF timetable’, ‘Simplifying treatment-hopes and fears’ and ‘Kaftrio is a game-changer’ along with several subthemes and an overarching theme of ‘I still can’t get my head around how three tablets can do what Kaftrio done’. Conclusions Despite the highly positive impact of ETI on the health of children with CF some concerns remain about the longer-term outcomes of reducing ACTs or nebulised treatments. ETI has prompted a shift in treatment for many and offers an opportunity to personalise approaches.
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Affiliation(s)
- Maryam Almulhem
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK,College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Nuala Harnett
- Physiotherapy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Graham
- Physiotherapy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Iram Haq
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shelina Visram
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Ward
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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7
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Kinaupenne M, De Craemer M, Schaballie H, Vandekerckhove K, Van Biervliet S, Demeyer H. Physical activity and its correlates in people with cystic fibrosis: a systematic review. Eur Respir Rev 2022; 31:220010. [PMID: 38743505 DOI: 10.1183/16000617.0010-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
Abstract
Cystic fibrosis (CF) is a life-shortening genetic disease, affecting multiple life domains including physical activity (PA). Although higher PA levels are associated with multiple health benefits, little insight exists on the PA level of people with CF (PwCF) compared to healthy peers. Evidence on the influencing factors (i.e. correlates) of PA in this clinical population is scarce, but essential to fully understand their PA behaviour. Therefore, the present review aims to provide an overview of the PA level of PwCF compared to healthy peers, and the correlates of PA in PwCF. A systematic search of three databases resulted in 46 included studies. Analysis of 16 studies showed that the CF population is equally active compared to healthy peers, but there is a trend towards less high-intensity PA in youths with CF. Furthermore, PA is positively associated with quality of life, lung function, (maximal) exercise capacity, bone mineral density and quadriceps force. Also, PA was lower on weekdays compared to weekend days and lower when experiencing pulmonary exacerbations. More high-quality research is required in PwCF, particularly longitudinal studies that further explore the correlates of PA, with PA investigated as a primary outcome and measured objectively.
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Affiliation(s)
- Manon Kinaupenne
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Marieke De Craemer
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Heidi Schaballie
- Dept of Pediatric Pulmonology, Infectious Diseases and Primary Immunodeficiencies, Ghent University Hospital, Ghent, Belgium
| | | | | | - Heleen Demeyer
- Dept of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
- Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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8
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Lowers J, Dellon EP, Stephenson A, Arnold R, Althouse A, Jeong K, Dubin E, Soodalter J, Hovater C, Bakitas M, Goggin J, Hunt W, Ladores S, Curseen K, Winter G, Solomon G, Ailon J, Conrad D, Kavalieratos D. Integrating specialist palliative care to improve care and reduce suffering: cystic fibrosis (InSPIRe:CF) - study protocol for a multicentre randomised clinical trial. BMJ Open Respir Res 2022; 9:9/1/e001381. [PMID: 36126995 PMCID: PMC9490626 DOI: 10.1136/bmjresp-2022-001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Cystic fibrosis (CF) is a life-limiting genetic disorder estimated to affect more than 160 000 individuals and their families worldwide. People living with CF commonly experience significant physical and emotional symptom burdens, disruptions to social roles and complex treatment decision making. While palliative care (PC) interventions have been shown to relieve many such burdens in other serious illnesses, no rigorous evidence exists for palliative care in CF. Thus, this study aims to compare the effect of specialist palliative care plus usual CF care vs usual CF care alone on patient quality of life. Methods and analysis This is a five-site, two-arm, partially masked, randomised superiority clinical trial. 264 adults with CF will be randomly assigned to usual CF care or usual CF care plus a longitudinal palliative care intervention delivered by a palliative care specialist. The trial’s primary outcome is patient quality of life (measured with the Functional Assessment of Chronic Illness Therapy-Palliative care instrument). Secondary outcomes include symptom burden, satisfaction with care and healthcare utilisation. Outcomes will be measured at 12 months (primary endpoint) and 15 months (secondary endpoint). In addition, we will conduct qualitative interviews with patient participants, caregivers, and palliative care and CF care team members to explore perceptions of the intervention’s impact and barriers and facilitators to dissemination. Ethics and dissemination Human subjects research ethics approval was obtained from all participating sites, and all study participants gave informed consent. We will publish the results of this trial in a peer-reviewed journal. Trial registration number ISRCTN53323164.
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Affiliation(s)
- Jane Lowers
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Elisabeth P Dellon
- Pediatrics, The University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Robert Arnold
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew Althouse
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kwonho Jeong
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethan Dubin
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse Soodalter
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Cade Hovater
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Marie Bakitas
- School of Nursing, The University of Alabama, Birmingham, Alabama, USA
| | - Jessica Goggin
- Medicine, University of California, La Jolla, California, USA
| | | | - Sigrid Ladores
- School of Nursing, The University of Alabama, Birmingham, Alabama, USA
| | - Kimberly Curseen
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | | | - George Solomon
- Medicine, The University of Alabama, Birmingham, AL, USA
| | - Jonathan Ailon
- Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Douglas Conrad
- Medicine, University of California, La Jolla, California, USA
| | - Dio Kavalieratos
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
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9
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Dubin E, Lowers J, Dellon EP, Hempstead S, Faro A, Tallarico E, Fitzpatrick A, Hunt WR, Kavalieratos D. Prevalence of unmet pain and symptom management needs in adults with cystic fibrosis. J Cyst Fibros 2022; 22:352-355. [PMID: 35973901 DOI: 10.1016/j.jcf.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although people living with CF (PLwCF) commonly report pain and other symptoms, little is known regarding their experiences of living with and accessing treatment for burdensome symptoms. METHODS PLwCF completed online questionnaires assessing symptom prevalence and distress and were also asked about experiences accessing pain and symptom treatment, using both closed-ended and free-text entries. RESULTS Pain was the most prevalent symptom experienced among the 55 participants (76%) and the symptom that most commonly caused distress (64%). PLwCF not on CFTR modulator therapy were likelier to endorse pain as distressing (p = 0.007). Respondents expressed that their pain was commonly underrecognized and undermanaged, they desired a multi-modal approach to treatment, and noted concerns about disease progression affecting their symptom management options. CONCLUSIONS Our study suggests that PLwCF often have unmet symptom management needs that may impair quality of life.
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Affiliation(s)
- Ethan Dubin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Elisabeth P Dellon
- Department of Pediatrics, UNC Chapel Hill, Chapel Hill, NC, United States
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | | | - Anne Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - William R Hunt
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Dio Kavalieratos
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States.
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10
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Landau EC, Verkleij M, Graziano S, Quittner AL, Georgiopoulos AM, Smith BA, Schechter MS, Abbott J. Mental health screening in Cystic Fibrosis as an intervention: Patient and caregiver feedback on improving these processes. Respir Med 2022; 202:106955. [DOI: 10.1016/j.rmed.2022.106955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
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11
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Shelley J, Dawson EA, Boddy LM, Stewart CE, Frost F, Nazareth D, Walshaw MJ, Knowles ZR. Developing an ecological approach to physical activity promotion in adults with Cystic fibrosis. PLoS One 2022; 17:e0272355. [PMID: 35914006 PMCID: PMC9342769 DOI: 10.1371/journal.pone.0272355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background There are few examples of interventions designed to promote physical activity (PA) in adults with Cystic fibrosis (CF). Increasing levels of habitual PA may be more feasible and result in greater compliance than conventional exercise training inventions which give little or no attention to long-term PA behaviour. Despite this there is limited research exploring perceptions of PA among adults with CF. The study aimed to understand the ecological correlates of PA in adults with CF and to involve individuals with CF, their families (where applicable) and clinicians in a formative process to inform the development of an ecological approach to PA promotion in this population. Methods An iterative approach was utilised, whereby findings from earlier phases of the research informed subsequent phases. Semi-structured interviews were conducted to explore patients’ perceptions of PA, devised using the PRECEDE component of the PRECEDE-PROCEED model. Followed by, focus groups to discuss the perceived barriers, facilitators and opportunities for PA participation and how this information could inform the development and delivery of a PA intervention. Separate focus groups were conducted with individuals with CF (n = 11) and their families and CF MDT members. Thematic analysis was used to construct themes. Results Physical and mental wellbeing manifested as both barriers and facilitators of PA. CF is characterised by a progressive decline in physical function, which presents as a number of challenging symptoms and set-backs for an individual with CF. PA represents an opportunity for participants to slow the rate of this decline and manage the symptoms associated with the condition. Enjoyment was an important facilitator of PA. Exercise professionals and family reinforce PA behaviour, particularly during adolescence. Conclusions PA promotion should form part of routine CF care with additional exercise professional support during adolescence.
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Affiliation(s)
- James Shelley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Department of Respiratory Medicine, Liverpool, United Kingdom
| | - Ellen A. Dawson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynne M. Boddy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire E. Stewart
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Freddy Frost
- Liverpool Heart and Chest Hospital, Department of Respiratory Medicine, Liverpool, United Kingdom
- Institute of Infection and Global health, University of Liverpool, Liverpool, United Kingdom
| | - Dilip Nazareth
- Liverpool Heart and Chest Hospital, Department of Respiratory Medicine, Liverpool, United Kingdom
- Institute of Infection and Global health, University of Liverpool, Liverpool, United Kingdom
| | - Martin J. Walshaw
- Liverpool Heart and Chest Hospital, Department of Respiratory Medicine, Liverpool, United Kingdom
- Institute of Infection and Global health, University of Liverpool, Liverpool, United Kingdom
| | - Zoe R. Knowles
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
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12
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Dury S, Perotin JM, Ravoninjatovo B, Llerena C, Ancel J, Mulette P, Griffon M, Carré S, Perrin A, Lebargy F, Deslée G, Launois C. Identifying specific needs in adult cystic fibrosis patients: a pilot study using a custom questionnaire. BMC Pulm Med 2021; 21:270. [PMID: 34404378 PMCID: PMC8371823 DOI: 10.1186/s12890-021-01613-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adult patients with cystic fibrosis (CF) experience daily physical symptoms and disabilities that can be challenging to address for health care teams. Methods We sought to identify the most frequent topics that CF adults need to discuss with health care teams using a custom questionnaire including 62 items. Results Fifty patients were included, 70% men, mean age 27.6 years, with a mean body mass index of 21.8 kg/m2. Mean FEV1% was 64% of predicted value. Forty-two percent of patients selected at least one topic. The most frequently selected topics were fatigue (20%), professional or scholar worries (18%), procreation (16%), physical activities (16%) and evolution of CF disease (16%). Women were more frequently concerned about fatigue, procreation and profession/school. Conclusions Using a custom questionnaire, we identified that CF adults express various unmet needs that extend beyond usual respiratory and nutritional concerns or treatment adherence. The interest of this questionnaire by health care team for improving therapeutic management of CF patients remains to be validated. Trial registration: The study was registered on ClinicalTrials.gov (NCT02924818) on 5th October 2016.
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Affiliation(s)
- Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France. .,EA 4683 Medical and Pharmacological, University of Reims, Reims, France.
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France.,INSERM UMRS 1250, Reims University Hospital, Reims, France
| | - Bruno Ravoninjatovo
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France
| | - Catherine Llerena
- Department of Pediatrics, Grenoble University Hospital, Grenoble, France
| | - Julien Ancel
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France
| | - Pauline Mulette
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France
| | - Muriel Griffon
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France
| | - Sophie Carré
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France
| | - Amélie Perrin
- Department of Pediatrics, Nantes University Hospital, Nantes, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France.,EA 4683 Medical and Pharmacological, University of Reims, Reims, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France.,INSERM UMRS 1250, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, rue de Cognacq-Jay, 51 092, Reims cedex, France
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13
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Ataluren-Promising Therapeutic Premature Termination Codon Readthrough Frontrunner. Pharmaceuticals (Basel) 2021; 14:ph14080785. [PMID: 34451881 PMCID: PMC8398184 DOI: 10.3390/ph14080785] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
Around 12% of hereditary disease-causing mutations are in-frame nonsense mutations. The expression of genes containing nonsense mutations potentially leads to the production of truncated proteins with residual or virtually no function. However, the translation of transcripts containing premature stop codons resulting in full-length protein expression can be achieved using readthrough agents. Among them, only ataluren was approved in several countries to treat nonsense mutation Duchenne muscular dystrophy (DMD) patients. This review summarizes ataluren’s journey from its identification, via first in vitro activity experiments, to clinical trials in DMD, cystic fibrosis, and aniridia. Additionally, data on its pharmacokinetics and mechanism of action are presented. The range of diseases with underlying nonsense mutations is described for which ataluren therapy seems to be promising. What is more, experiments in which ataluren did not show its readthrough activity are also included, and reasons for their failures are discussed.
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14
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McLeod C, Wood J, Tong A, Schultz A, Norman R, Smith S, Blyth CC, Webb S, Smyth AR, Snelling TL. The measurement properties of tests and tools used in cystic fibrosis studies: a systematic review. Eur Respir Rev 2021; 30:200354. [PMID: 33980667 PMCID: PMC9489019 DOI: 10.1183/16000617.0354-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/26/2020] [Indexed: 11/05/2022] Open
Abstract
There is no consensus on how best to measure responses to interventions among children and adults with cystic fibrosis (CF). We have systematically reviewed and summarised the characteristics and measurement properties of tests and tools that have been used to capture outcomes in studies among people with CF, including their reliability, validity and responsiveness. This review is intended to guide researchers when selecting tests or tools for measuring treatment effects in CF trials. A consensus set of these tests and tools could improve consistency in how outcomes are captured and thereby facilitate comparisons and synthesis of evidence across studies.
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Affiliation(s)
- Charlie McLeod
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Nedlands, Australia
- Infectious Diseases Dept, Perth Children's Hospital, Nedlands, Australia
| | - Jamie Wood
- Physiotherapy Dept, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, Australia
| | - Sherie Smith
- Evidence Based Child Health Group, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Nedlands, Australia
- Infectious Diseases Dept, Perth Children's Hospital, Nedlands, Australia
- Pathwest Laboratory Medicine WA, QEII Medical Centre, Nedlands, Australia
| | - Steve Webb
- St John of God Hospital, Subiaco, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alan R Smyth
- Evidence Based Child Health Group, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Thomas L Snelling
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Australia
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15
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Psychological distress in adults with and without cystic fibrosis during the COVID-19 lockdown. J Cyst Fibros 2021; 20:198-204. [PMID: 33384222 PMCID: PMC7834149 DOI: 10.1016/j.jcf.2020.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hundreds of papers have been published on the COVID-19 pandemic, and several of them on psychological themes connected with it, but very little is so far known on how adult patients with Cystic Fibrosis (pwCFs) are coping with this dramatic event. METHODS An online questionnaire was developed according to the Italian validated COVID-19 Peritraumatic Distress Index (CPDI) and addressed to the general population (GP). A similar questionnaire, augmented with CF specific questions, targeted pwCFs. The two web-based surveys were accessible for some weeks during the lockdown mandated by the Italian government. RESULTS The CF questionnaire was completed by 712 adult pwCFs (422 females), matched for sex and age with a 1/5 ratio to GP questionnaire respondents. Mild or medium distress affected 40.2% of pwCFs and 43.9% of GP controls, severe distress 5.3% of pwCFs and 6.2% of GP controls. The level of psychological distress was not correlated with the degree of pulmonary function impairment. When symptoms of anxiety and depression, and physical manifestations were independently analyzed, the control group featured a 55% higher level of mild-moderate anxiety symptoms. Signs of psychological distress, symptoms of anxiety and depression, and physical manifestations were significantly more frequent in female pwCFs compared to males, similarly to GP. CONCLUSION Adult pwCFs seem to have equal, and in some domains, lower levels of psychological distress than GP controls. This might be sustained by lifelong experiences in coping with the demands of their chronic disease. These results may orient future psychological interventions.
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16
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Verkleij M, Georgiopoulos AM, Friedman D. Development and evaluation of an internet-based cognitive behavioral therapy intervention for anxiety and depression in adults with cystic fibrosis (eHealth CF-CBT): An international collaboration. Internet Interv 2021; 24:100372. [PMID: 33816126 PMCID: PMC8010637 DOI: 10.1016/j.invent.2021.100372] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/05/2020] [Accepted: 01/15/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Individuals with cystic fibrosis (CF) are at increased risk for anxiety and depression, with negative consequences for adherence, health, and quality of life. New approaches to prevent and treat anxiety and depression that are tailored to the concerns of this population are needed. A CF-specific internet-based cognitive-behavioral therapy (CBT) intervention was developed to increase access to evidence-based mental health care and decrease cost and burden of care for people with CF. OBJECTIVE To evaluate the usability and acceptability of "eHealth CF-CBT," an internet-based program integrating therapist-guided online self-management modules with in-person or virtual sessions. METHODS Dutch adults with CF (N = 16) and CF health care providers (N = 16) systematically tested all sessions of the eHealth CF-CBT program, provided qualitative feedback, and completed measures including eHealth Impact Questionnaire (eHIQ), and System Usability Scale (SUS). RESULTS Patient and provider ratings of their overall impression of the eHealth CF-CBT program were high, with scores (mean; SD) of 8.3; 0.6 and 8.2; 0.8 respectively on a 10-point scale. Mean ratings of usability by patients (77.0/100) and providers (73.4/100) surpassed the SUS cut point for good favorability. Ratings (pooled mean; SD) on the assessed eHIQ domains Motivation and Confidence to Act (71.3; 10.0), Information and Presentation (78.9; 9.6), and Identification (62.0; 15.1) were positive, as were assessments of specific elements of session content and format. CONCLUSIONS eHealth CF-CBT is the first therapist-guided internet-delivered CBT-based intervention for adults with CF. Initial evaluation with key stakeholders demonstrated high levels of acceptability and usability and provided input that was integrated to strengthen the program. Effectiveness testing in the Netherlands will be the next step, as well as future international adaptation and dissemination.
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Affiliation(s)
- Marieke Verkleij
- Department of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Corresponding author at: Amsterdam UMC, location VU University Medical Center, Department of Pediatric Psychology, Reception L, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
| | | | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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17
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Henderson D, Moore V, MacMorran K, Castellini J, Hay K, Keegan V, Reid D, Curtin D, Tay G. A Cohort Study of Sleep Quality in Adult Patients with Acute Pulmonary Exacerbations of Cystic Fibrosis. Intern Med J 2020; 52:63-68. [PMID: 33025684 DOI: 10.1111/imj.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The impact of an acute pulmonary exacerbation of CF on sleep quality has not been established. Patients have greater burden of symptoms, higher intensity of therapy, and are often admitted to hospital outside of their usual sleeping environment. METHODS This prospective, observational study determined the prevalence of impaired sleep quality and associated factors in adult patients admitted to a single CF unit with an acute pulmonary exacerbation of CF. Sleep quality was defined by the Pittsburgh Sleep Quality Index (PSQI), with >5 indicating poor sleep quality. Data was obtained through patient questionnaires, chart review, and examination. RESULTS Sixty-six percent of patients had impaired sleep quality. Patients with poor sleep had more sleep disruption due to pain (median response "mild sleep disruption" vs "no sleep disruption" p=0.003) and insomnia (mean insomnia severity index (ISI) 13 vs 5, p<0.001). In patients with symptoms of restless legs, poor sleepers had worse symptoms (mean IRLSS 15 vs 5, p=0.029). Univariate modelling showed relationships between PSQI and symptoms of depression and anxiety as well as with sleep disruption due to pain, general noise, and nursing observations. In a multivariable model, ISI was the only variable that remained significantly associated with PSQI. Mean PSQI score increased 0.58 units for each 1 unit increase in ISI (95% CI 0.42-0.73, p<0.001). CONCLUSIONS Poor sleep quality is common among patients admitted with an acute exacerbation of CF and is strongly associated with insomnia symptoms in this cohort. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Vanessa Moore
- Clinical Nurse Consultant, The Prince Charles Hospital
| | | | | | - Karen Hay
- Statistics Unit QIMR Berghofer Medical Research Institute
| | | | - David Reid
- Director of Adult Cystic Fibrosis Centre, The Prince Charles Hospital
| | - Deanne Curtin
- Director of Sleep Disorders Centre, The Prince Charles Hospital
| | - George Tay
- Sleep and Thoracic Physician, The Prince Charles Hospital
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18
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Miller M. Living and dying with cystic fibrosis. BMJ Support Palliat Care 2020; 11:86-88. [PMID: 32917651 DOI: 10.1136/bmjspcare-2020-002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Mary Miller
- Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Honorary Senior Clinical Lecturer, Nuffield Department of Medicine, Oxford University, Oxford, UK
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19
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Trandel ET, Kavalieratos D, Basile M, Hobler MR, Georgiopoulos AM, Chen E, Goggin JL, Goss CH, Hempstead SE, Faro A, Dellon EP. Palliative care skills in CF: Perspectives of adults with CF, caregivers, and CF care team members. Pediatr Pulmonol 2020; 55:2017-2024. [PMID: 32384215 PMCID: PMC8597706 DOI: 10.1002/ppul.24806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND The role of cystic fibrosis (CF) care team members in delivering palliative care (PC) remains undefined. We aimed to understand the PC skills of CF care teams. METHODS CF care team members ("clinicians"), adults with CF ("patients"), and family caregivers ("caregivers") rated the ability of CF clinicians to provide aspects of PC using a five-point scale ("poor" to "excellent"). Median ratings were compared between groups. RESULTS A total of 70 patients, 100 caregivers, and 350 clinicians participated. Clinicians consistently rated their PC skills higher than patients or caregivers rated them, particularly for advanced PC skills. While clinicians, patients, and caregivers rated clinicians as "very good" at basic pain assessment and "good" at discussing prognostic uncertainty, clinicians rated themselves more highly at providing most skills, including simultaneous PC and standard CF care (P < .0001), basic depression assessment (P < .001), and discussing transplant, advance directives, end of life, code status, and hospice (all P < .0001). Respondents affiliated with adult CF care teams rated clinicians more highly than respondents affiliated with pediatric CF care teams at discussing lung transplant (P < .001), end of life (P = .006), advance directives (P < .001), code status (P = .012), and hospice (P = .016). Most patients (69%) and caregivers (60%) felt CF clinicians should receive more PC training. CONCLUSIONS Discrepancies exist among patient/caregiver and clinician perceptions of PC skills in CF, and skills of adult and pediatric teams may differ. Patients and caregivers feel clinicians' more advanced PC skills are lacking. CF clinicians may benefit from PC training to enhance skills and to understand how and when to utilize specialty PC services.
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Affiliation(s)
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine, Division of Palliative Medicine, Emory University, Atlanta, Georgia
| | - Melissa Basile
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Mara R Hobler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | | | - Elaine Chen
- Department of Internal Medicine, Pulmonary, Critical Care, and Palliative Medicine, Rush University Medical Center, Chicago, Illinois
| | - Jessica L Goggin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Elisabeth P Dellon
- Department of Pediatrics, Division of Pulmonology, University of North Carolina, Chapel Hill, North Carolina
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20
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Perez AA, Hays SR, Soong A, Gao Y, Greenland JR, Leard LE, Shah RJ, Golden J, Kukreja J, Venado A, Kleinhenz ME, Singer JP. Improvements in frailty contribute to substantial improvements in quality of life after lung transplantation in patients with cystic fibrosis. Pediatr Pulmonol 2020; 55:1406-1413. [PMID: 32237273 PMCID: PMC8048765 DOI: 10.1002/ppul.24747] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 03/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND While lung transplantation (LTx) improves health-related quality of life (HRQL) in cystic fibrosis (CF), the determinants of this improvement are unknown. In other populations, frailty-a syndrome of vulnerability to physiologic stressors-is associated with disability and poor HRQL. We hypothesized that improvements in frailty would be associated with improved disability and HRQL in adults with CF undergoing LTx. METHODS In a single-center prospective cohort study from 2010 to 2017, assessments of frailty, disability, and HRQL were performed before and at 3- and 6-months after LTx. We assessed frailty by the short physical performance battery (SPPB). We assessed disability with the Lung Transplant Valued Life Activities scale (LT-VLA) and HRQL by the Medical Outcomes Study Short Form Physical and Mental Component Summary scales (SF12-PCS, -MCS), the Airway Questionnaire 20-Revised (AQ20R), and the Euroqol 5D (EQ5D). We tested the association of concurrent changes in frailty and lung function on disability and HRQL by linear mixed-effects models adjusted for sex and body mass index. RESULTS Among 23 participants with CF, improvements in frailty and lung function were independently associated with improved disability and some HRQL measures. For example, each 1-point improvement in SPPB or 200 mL improvement in FEV1 was associated with improved LT-VLA disability by 0.14 (95%CI: 0.08-0.20) and 0.07 (95%CI: 0.05-0.09) points and improved EQ5D by 0.05 (95%CI: 0.03 to 0.07) and 0.02 (95%CI: 0.01-0.03) points, respectively. CONCLUSION Improvement in frailty is a novel determinant of improved disability and HRQL in adults with CF undergoing LTx.
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Affiliation(s)
- Alyssa A Perez
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Steven R Hays
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Allison Soong
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Ying Gao
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - John R Greenland
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Lorriana E Leard
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Rupal J Shah
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jeffrey Golden
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jasleen Kukreja
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Aida Venado
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Mary Ellen Kleinhenz
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jonathan P Singer
- Department of Medicine, University of California San Francisco, San Francisco, California
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Active Video Games as a Training Tool for Individuals With Chronic Respiratory Diseases: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2020; 39:85-90. [PMID: 29485524 PMCID: PMC6407826 DOI: 10.1097/hcr.0000000000000320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Active video games offer an enjoyable way to exercise for patients with chronic respiratory disease. This review examined whether active video games can achieve comparable physiological and clinical effects as traditional exercise training in this population. Video game training induced peak heart rate and dyspnea levels comparable with traditional training. Purpose: Exercise is an effective treatment for reducing symptom severity and improving quality of life for patients with chronic respiratory diseases. Active video games offer a new and enjoyable way to exercise and have gained popularity in a rehabilitation setting. However, it is unclear whether they achieve comparable physiological and clinical effects as traditional exercise training. Methods: A systematic literature search was performed to identify studies that included an active video game component as a form of exercise training and a comparator group in chronic respiratory disease. Two assessors independently reviewed study quality using the Cochrane risk of bias tool and extracted data for exercise capacity, quality of life, and preference of exercise model. Results: Six studies were included in this review. Because of the heterogeneity of the populations, study designs, length of intervention, and outcome measures, meta-analysis could not be performed. Active video game training resulted in comparable training maximal heart rate and dyspnea levels to those achieved when exercising using a treadmill or cycle (n = 5). There was insufficient evidence (n = 3) to determine whether active video game training improved exercise capacity as measured by 6-min walk test or treadmill endurance walking. Conclusions: Although the quality of evidence was low, in a small number of studies active video games induced peak heart rates and dyspnea levels comparable with traditional exercise training. Larger and longer-term randomized controlled trials are needed to establish the impact of video game training for individuals with chronic respiratory diseases.
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22
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Lange AV, Rueschhoff A, Terauchi S, Cohen L, Reisch J, Jain R, Finklea JD. End-of-Life Care in Cystic Fibrosis: Comparing Provider Practices Based on Lung Transplant Candidacy. J Palliat Med 2020; 23:1606-1612. [PMID: 32380886 DOI: 10.1089/jpm.2019.0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The optimal timing to introduce palliative care (PC) and end-of-life (EOL) conversations into the lives of people with cystic fibrosis (CF) has not been established. Objective: Compare EOL care practices for people with CF who died without a lung transplant (LT), are living without an LT, and those who received an LT. Design: Retrospective chart review. Setting/Subjects: People with CF who received care from 2012 to 2017 at the University of Texas Southwestern Medical Center. Measurements: Primary outcomes were (1) EOL discussion with a pulmonologist, (2) time of EOL discussion before death or LT, (3) evaluation by PC, and (4) documentation of advanced directive or medical power of attorney. Results: Twenty-three patients died without LT, 40 patients received an LT, and 222 were living without an LT. Among LT recipients, 10% had EOL conversations compared with 74% of deceased patients and 5% of living patients without LT (p = 0.001). Among deceased patients, 39% had EOL conversations more than six months before death, while 5% of transplanted patients had EOL conversation more than six months before LT (p < 0.001). Deceased patients were more likely to have seen PC (57%) than either patients who received LT (2%) or those living without LT (3%, p = 0.0001). Conclusions: Patients who died without LT were more likely to have seen PC and had an EOL conversation than patients who received LT or who are living without LT. Further research should explore the optimal timing to discuss EOL care and the best timing to involve PC.
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Affiliation(s)
- Allison V Lange
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Ali Rueschhoff
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stephanie Terauchi
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Palliative Care Medicine and University of Texas Southwestern, Dallas, Texas, USA
| | - Leah Cohen
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Joan Reisch
- Department of Population and Data Science, University of Texas Southwestern, Dallas, Texas, USA
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - James D Finklea
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
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23
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Prevalence of unmet palliative care needs in adults with cystic fibrosis. J Cyst Fibros 2020; 19:394-401. [DOI: 10.1016/j.jcf.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022]
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24
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Chin M, McIntosh ID, Somayaji R. Overlooking the landscape of palliative care in cystic fibrosis. J Cyst Fibros 2020; 19:336-338. [PMID: 32305179 DOI: 10.1016/j.jcf.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M Chin
- Division of Respirology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON.
| | - I D McIntosh
- Director, Healthcare; Cystic Fibrosis Canada, Toronto, ON.
| | - R Somayaji
- Departments of Medicine; Microbiology, Immunology and Infectious Disease; Community Health Sciences, University of Calgary, Calgary, AB.
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25
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Reiter J, Gileles-Hillel A, Cohen-Cymberknoh M, Rosen D, Kerem E, Gozal D, Forno E. Sleep disorders in cystic fibrosis: A systematic review and meta-analysis. Sleep Med Rev 2020; 51:101279. [PMID: 32145647 DOI: 10.1016/j.smrv.2020.101279] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Cystic fibrosis (CF) is a genetic disorder that leads to airway mucus accumulation, chronic inflammation, and recurrent respiratory infections - all likely impacting sleep. However, controlled studies of sleep in CF patients are limited, and have shown mixed results. We reviewed all publications on CF and sleep indexed in PubMed, CINAHL, and Scopus through April 2019. In the meta-analysis, we calculated pooled weighted mean differences for sleep quality, sleepiness, oximetry, and polysomnographic (PSG) parameters, using fixed or random-effects models as appropriate. A total of 87 manuscripts were reviewed. Compared to controls, children with CF had lower nighttime oxygen saturation nadirs, decreased sleep efficiency and a higher respiratory event index, with no differences in the percentage of REM sleep. Adults with CF had lower oxygen saturation nadirs, with a trend towards reduced sleep efficiency and no differences in REM sleep. In addition, patients with CF cough more during sleep and experience painful events that interfere with sleep. Actigraphy and questionnaires suggest disturbed sleep and daytime sleepiness. Noninvasive ventilation appears to improve gas exchange and symptoms. We conclude that when sleep is evaluated objectively or subjectively in patients with CF, perturbations are common, emphasizing the importance of their identification and treatment and inclusion as part of routine care. Additional research, with larger sample sizes and standardized outcomes, are necessary.
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Affiliation(s)
- Joel Reiter
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Alex Gileles-Hillel
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dennis Rosen
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eitan Kerem
- Pediatric Pulmonary & Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh, PA, USA
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26
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Nap-van der Vlist MM, Dalmeijer GW, Grootenhuis MA, van der Ent CK, van den Heuvel-Eibrink MM, Wulffraat NM, Swart JF, van Litsenburg RRL, van de Putte EM, Nijhof SL. Fatigue in childhood chronic disease. Arch Dis Child 2019; 104:1090-1095. [PMID: 31175124 DOI: 10.1136/archdischild-2019-316782] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/18/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Recently, in adults, the incidence and severity of fatigue was found to exist rather independently from the somatic diagnosis. Since fatigue is distressing when growing up with a chronic disease, we aim to investigate: (1) the prevalence and extent of fatigue among various paediatric chronic diseases and (2) the effect of fatigue on health-related quality of life (HRQoL). DESIGN AND SETTING Cross-sectional study in two children's hospitals. PATIENTS Children and adolescents 2-18 years of age with cystic fibrosis, an autoimmune disease or postcancer treatment visiting the outpatient clinic. OUTCOME MEASURES Fatigue and HRQoL were assessed using the Pediatric Quality of Life Inventory (PedsQL) multidimensional fatigue scale (with lower scores indicating more fatigue) and PedsQL generic core scales, respectively. Linear regression analysis and analysis of covariance were used to compare fatigue scores across disease groups and against two control groups. The effect of fatigue on HRQoL was calculated. Data were adjusted for age, sex and reporting method. RESULTS 481 children and adolescents were assessed (60% participation rate, mean age 10.7±4.9, 42% men). Children and adolescents with chronic disease reported more fatigue than the general population (mean difference -6.6, 95% CI -8.9 to -4.3 (range 0-100)), with a prevalence of severe fatigue of 21.2%. Fatigue scores did not differ significantly between disease groups on any fatigue domain. Fatigue was associated with lower HRQoL on all domains. CONCLUSIONS Fatigue in childhood chronic disease is a common symptom that presents across disease, age and sex groups. Fatigue affects HRQoL. Our findings underscore the need to systematically assess fatigue. Future studies should determine possible biological and psychosocial treatment targets.
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Affiliation(s)
- Merel M Nap-van der Vlist
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertje W Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Cystic Fibrosis Center and Department of Pediatric Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Nico M Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raphaële R L van Litsenburg
- Department of Paediatric Oncology-Hematology, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Elise M van de Putte
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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27
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Dhingra L, Walker P, Berdella M, Plachta A, Chen J, Fresenius A, Balzano J, Barrett M, Bookbinder M, Wilder K, Glajchen M, Langfelder-Schwind E, Portenoy RK. Addressing the burden of illness in adults with cystic fibrosis with screening and triage: An early intervention model of palliative care. J Cyst Fibros 2019; 19:262-270. [PMID: 31471264 DOI: 10.1016/j.jcf.2019.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Novel models that improve generalist-level palliative care for cystic fibrosis (CF) are needed to address the burden of this illness. A screening-and-triage model has the potential to identify clinical problems requiring immediate follow-up by CF professionals. This study describes such a model and its immediate impact on care delivery for CF patients during a two-year period. METHODS Eligible adults completed monthly online screening for sources of distress. If results revealed one or more "indicators of concern" on two consecutive screenings, this triggered an attempted triage by a social worker. Completed triages led to prompt follow-up by CF professionals for clinical problems, if indicated. Process data were summarized and generalized linear mixed models were used to evaluate baseline patient characteristics (symptom distress, quality of life, and sociodemographics) associated with the need for prompt follow-up. RESULTS A total of 1,015 monthly surveys were completed by 74 patients; 634 (66 patients) had >1 indicators of concern; and 164 surveys (46 patients) had >1 indicators for two consecutive surveys (e.g., global distress, pain, dyspnea, and psychological symptoms). The 164 attempted triages yielded 84 completed triages (51.2%), of which 39 (46.4%) required prompt follow-up. In multivariable analyses, older patients and those with higher symptom distress at baseline were more likely to require prompt follow-up (p < .05). CONCLUSIONS Web-based screening that assesses varied domains of distress or burden can identify a subset of CF patients whose clinical problems may benefit from immediate medical or psychological attention. Additional investigations should improve screening efficiency.
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Affiliation(s)
- Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA.
| | - Patricia Walker
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Maria Berdella
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Amy Plachta
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Ashley Fresenius
- Southern Nevada Adult Mental Health Services, 6161 W. Charleston Blvd, Las Vegas, NV 89146, USA
| | - Julie Balzano
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Malcolm Barrett
- University of Southern California, Los Angeles, CA 90007, USA
| | - Marilyn Bookbinder
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Kenya Wilder
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
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28
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Trandel ET, Pilewski JM, Dellon EP, Moreines LT, Yabes JG, Jeong K, Arnold RM, Kavalieratos D. Symptom Burden and Unmet Existential Needs in Adults With Cystic Fibrosis. West J Nurs Res 2019; 41:1448-1464. [DOI: 10.1177/0193945919852585] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although patients with cystic fibrosis (CF) experience many symptoms and impaired quality of life, little is known about existential distress. This multivariable logistic regression evaluated the relationship between symptom burden and five existential needs representing existential distress in 164 adults with CF. Eleven percent of participants reported no symptom burden, 61% mild burden, and 28% moderate/severe burden. The most prevalent existential needs were fears about CF worsening (50%) and uncertainty about the future (39%). Participants with moderate/severe symptom burden were likelier to report needing support with all five needs than participants with no or mild burden. For each six-point increase in burden, there was an increased odds of reporting need for support with learning to feel in control, feelings about death and dying, fears about CF worsening, uncertainty about the future, and concerns about worries of others. CF-specific palliative care support based on these prevalent unmet existential needs should be developed and provided.
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29
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Friedman D, Linnemann RW, Altstein LL, Georgiopoulos AM, Islam S, Bach KT, St John A, Fracchia MS, Neuringer I, Lapey A, Sicilian L, Moskowitz SM, Yonker LM. Effects of a primary palliative care intervention on quality of life and mental health in cystic fibrosis. Pediatr Pulmonol 2019; 54:984-992. [PMID: 30854795 DOI: 10.1002/ppul.24311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the significant impact of chronic symptoms on quality of life with cystic fibrosis (CF), the role of palliative care in management of this disease is not well defined. The coping, goal assessment, and relief from evolving CF symptoms (CF-CARES) model is a primary palliative care intervention designed to provide chronic symptom management at all stages of the disease. The goal of this pilot study was to estimate the effectiveness of the CF-CARES intervention on improving chronic symptoms and quality of life for people living with CF. METHODS A structured assessment was used to guide referral to supportive services intended to address burdensome symptoms. Follow-up assessments were performed approximately 3 and 6 months later. Longitudinal regression analyses of changes in symptoms and quality of life were performed for all participants regardless of utilization of supportive services. Subgroup analyses were performed for subjects participating in mental health and alternative health services. RESULTS Forty-one subjects completed assessment and referral processes. The mean number of CF-associated symptoms decreased over time, as did respiratory symptom-related distress and depressive symptoms. Subjects utilizing alternative health services reported less psychological distress at follow-up. Among subjects with severe disease, mental health, and quality of life improved, especially for those using mental health services. CONCLUSIONS The CF-CARES model resulted in significant mental health and quality-of-life benefits, suggesting the value of integrating symptom management interventions into routine CF care. Moreover, mental health services can play a key role in CF-specific primary palliative care, especially for those with advanced disease.
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Affiliation(s)
- Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Rachel W Linnemann
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lily L Altstein
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Suhayla Islam
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kieu-Tram Bach
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anita St John
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - M Shannon Fracchia
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Isabel Neuringer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Allen Lapey
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Leonard Sicilian
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Samuel M Moskowitz
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lael M Yonker
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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30
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Gill A, Chakraborty A, Selby D. What is Symptom Burden: A Qualitative exploration of Patient Definitions. J Palliat Care 2018. [DOI: 10.1177/082585971202800204] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current definitions of “symptom burden” are largely derived from clinicians, and there are many variations in the way the term is used, defined, and operationalized. The aim of this study was to explore patient perceptions of symptom burden in the context of advanced and incurable disease. A group of 58 cancer patients followed by a palliative care team answered a single open-ended question: “Please define ‘symptom burden.”’ Three authors independently coded and analyzed patient responses using a grounded theory approach. They identified six themes, the most frequently coded of which were: “can't do usual activities,” “psychological suffering,” and “specific severe symptoms.” Our findings indicate that the concept of symptom burden is complex and extends beyond numerical symptom-scoring systems. In addition to inquiring about specific symptoms, it may be important to directly ask patients about their overall burden or experience of symptoms.
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Affiliation(s)
- Ashlinder Gill
- D Selby (corresponding author): Division of Palliative Care, Sunnybrook Health Sciences Centre, Room H354, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Anita Chakraborty
- A Gill, A Chakraborty: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Debbie Selby
- A Gill, A Chakraborty: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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31
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Objective and Subjective Sleep Efficiency in Adult Patients with Cystic Fibrosis and Impact on Quality of Life. Lung 2018; 196:761-767. [DOI: 10.1007/s00408-018-0167-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
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32
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Maras D, Balfour L, Tasca GA, Gaudet E, Aaron SD, Cameron WD, Pakhale S. Breathlessness catastrophizing relates to poorer quality of life in adults with cystic fibrosis. J Cyst Fibros 2018; 18:150-157. [PMID: 30197031 DOI: 10.1016/j.jcf.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cystic Fibrosis (CF) is the most common genetic disease affecting children and young adults in Canada. It is a multi-system disease, however lung disease is largely responsible for mortality. Treatment advances have resulted in increased life expectancy and a subsequent need to better understand psychosocial issues associated with quality of life in adults living with CF. Emerging research suggests that anxiety and depression are related to poorer health-related quality of life (HRQoL) in CF patients, but there is little research examining cognitive processes, such as breathlessness catastrophizing. The present study addresses this gap in the literature. METHODS Participants in this study are based on a convenience sample of patients recruited during their regular CF clinic appointments at a tertiary care center. Forty-five adults (Mage = 30.73 years) completed measures of lung function, depression, anxiety, pain, breathlessness catastrophizing, and HRQoL at one time point. RESULTS Results of a hierarchical multiple regression indicate that increased breathlessness catastrophizing was related to poorer HRQoL, after controlling for lung function, depression, anxiety, and pain (p < .05). Depression, pain, and breathlessness catastrophizing all emerged as significant unique predictors of HRQoL. CONCLUSIONS Breathlessness catastrophizing is a potential target for clinical intervention and might impact HRQoL. Further research on breathlessness catastrophizing in CF is warranted including longitudinal studies to examine the mechanisms by which breathlessness catastrophizing relates to HRQoL and treatment outcomes in CF.
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Affiliation(s)
- Danijela Maras
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada.
| | - Louise Balfour
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada; Psychology, The Ottawa Hospital, Canada; Faculty of Medicine, University of Ottawa, Canada
| | - Giorgio A Tasca
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada
| | - Ena Gaudet
- The Ottawa Hospital Research Institute, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| | - William D Cameron
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| | - Smita Pakhale
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
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33
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Dellon EP, Helms SW, Hailey CE, Shay R, Carney SD, Schmidt HJ, Brown DE, Prieur MG. Exploring knowledge and perceptions of palliative care to inform integration of palliative care education into cystic fibrosis care. Pediatr Pulmonol 2018; 53:1218-1224. [PMID: 29862668 DOI: 10.1002/ppul.24073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/05/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) face the challenges of managing a chronic, progressive disease. While palliative care is a standard of care in serious illnesses, there are no guidelines for its incorporation into CF care. Patients with CF, caregivers, and CF care providers may lack knowledge about palliative care and perceive barriers to integrated care. OBJECTIVES To: 1) explore knowledge and perceptions of palliative care among patients with CF, caregivers, and CF care providers; 2) solicit opinions about incorporating palliative care into routine CF care; and 3) solicit recommendations for CF-specific palliative care education for patients and caregivers. METHODS We conducted semi-structured interviews with adult patients with CF, parents of adolescents with CF, and CF care providers to assess knowledge and perceptions of palliative care. Discussion included suggestions for palliative care education and integration into CF care. The sample was characterized using summary statistics. Key themes were identified using qualitative content analysis. RESULTS Ten patients with CF, ten parents, and eight CF care providers participated. Many had minimal knowledge of palliative care and endorsed the association with end of life as a barrier to palliative care, but after learning more about palliative care, thought it could be helpful, and should be introduced earlier. CONCLUSIONS In this single center study, many patients with CF, caregivers, and providers lacked knowledge about palliative care. These findings warrant replication in a larger, multisite study to inform palliative care educational interventions as a step toward consistent integration of palliative care into routine CF care.
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Affiliation(s)
- Elisabeth P Dellon
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sarah W Helms
- Delores Barr Weaver Policy Center, Jacksonville, Florida
| | - Claire E Hailey
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rosemary Shay
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Scott D Carney
- Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio
| | - Howard Joel Schmidt
- Department of Pediatrics, The Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - David E Brown
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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35
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Prevalence of severe fatigue among adults with cystic fibrosis: A single center study. J Cyst Fibros 2018; 17:368-374. [PMID: 29606526 DOI: 10.1016/j.jcf.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND With life expectancy increasing among patients with cystic fibrosis (CF), the prevalence of complications such as fatigue is also expected to increase. Our aim was to investigate the prevalence of severe fatigue among adults with CF and to identify factors associated with fatigue. METHODS Adult patients with CF receiving treatment at a single center were invited to complete three questionnaires. We then studied the associations between fatigue and clinically measured parameters and between fatigue and patient-reported outcomes. RESULTS A total of 77 patients (age 19-54years; 56% males; mean FEV1: 63%) completed the questionnaires (43% response rate). The prevalence of severe fatigue among these patients was 26%. The variance in fatigue was explained partially by clinically measured parameters. However, patient-reported outcomes were stronger independently associated with fatigue and included the patients' reported respiratory symptoms, emotional functioning, and social functioning. CONCLUSIONS Fatigue is a clinically important and highly prevalent issue among adults with CF and is associated with a significant reduction in health-related quality of life and participation in society. In addition, fatigue is associated more strongly with the patient's perception of symptoms and well-being than with clinically measured parameters.
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Eyns H, De Wachter E, Malfroot A, Vaes P. Acute Pain Perception During Different Sampling Methods for Respiratory Culture in Cystic Fibrosis Patients. J Pain Symptom Manage 2018; 55:872-880. [PMID: 29154891 DOI: 10.1016/j.jpainsymman.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Reliable identification of lower respiratory tract pathogens is crucial in the management of cystic fibrosis (CF). The multitude of treatments and clinical procedures are a considerable burden and are potentially provoking pain. OBJECTIVES As part of another study (NCT02363764), investigating the bacterial yield of three sampling methods, nasal swabs (NSs), cough swabs (CSs), and (induced) sputum samples ([I]SSs), in both expectorating patients (EPs) and non-expectorating patients (NEPs) with CF, the present study aimed to explore the prevalence of respiratory culture sampling-related pain as assessed by self-report within a cohort of children and adults. METHODS Literate patients with CF (aged six years or older) completed a questionnaire on pain perception related to the three aforementioned sampling methods (No/Yes; visual analogue scale for pain [VAS-Pain] [0-10 cm]). In addition, patients were asked to rank these methods by their own preference without taking into account the presumed bacterial yield. RESULTS In total, 119 questionnaires were returned. In the EPs-group, CS was most frequently (n%; mean VAS-Pain if pain [range]) reported as painful method: overall (n = 101; 12.9%; 1.8 [0.2-4.8]), children (n = 41; 22.0%; 1.4 [0.2-2.7]), and adults (n = 60; 6.7%; 2.5 [0.5-4.8]). Highest pain intensity scores were observed with NS overall (3.0%; 2.4 [0.3-6.2]) and in children (4.9%; 3.3 [0.3-6.2]), but not in adults (1.7%; 0.6 [-]).NEPs-children (n = 17) reported ISS most frequently and as most painful sampling method (17.6%; 2.0 [1.0-4.0]). The only NEP-adult did not perceive pain. NEPs preferred NS > CS > ISS (61.1%, 33.3%, 5.6%, respectively [P = 0.001]) as primary sampling method, whereas EPs preferred SS > NS > CS (65.7%, 26.3%, 8.1%, respectively [P < 0.0001]). Patients' preference for a specific method inversely correlated to pain perception and intensity in EPs (φ = -0.155 [P = 0.007] and ρ = -0.926 [P = 0.008], respectively), but not in NEPs (φ = -0.226 [P = 0.097] and ρ = -0.135 [P = 0.798], respectively). CONCLUSION A relatively large range of pain experiences was observed in patients with CF during respiratory culture sampling, which underlines the importance of individual pain assessment. Nevertheless, clinicians can confidently choose the sampling method based on validity over patients' preference.
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Affiliation(s)
- Hanneke Eyns
- Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Elke De Wachter
- Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels
| | - Anne Malfroot
- Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels
| | - Peter Vaes
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Allgood SJ, Kozachik S, Alexander KA, Thaxton A, Vera M, Lechtzin N. Descriptions of the Pain Experience in Adults and Adolescents with Cystic Fibrosis. Pain Manag Nurs 2018; 19:340-347. [PMID: 29501357 DOI: 10.1016/j.pmn.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND People living with cystic fibrosis experience pain that is associated with decreased quality of life, poorer health outcomes, and increased mortality. Though pain is highly prevalent as a symptom, it is currently unknown how persons with CF describe their pain experiences or the ways those experiences impact their lives. AIMS To explore and describe ways adolescents and adults with CF experience pain. Design/Setting/Subjects/Methods: An exploratory descriptive design was implemented to perform interviews with 10 individuals with CF and self-reported moderate to severe pain. The interviews explored their pain experiences within five domains: Pain Characteristics, Activities, Relationships, Work/School Life, and Health Care Team. Transcribed interviews underwent a content analysis with team-based constant comparisons. RESULTS Individuals with CF identify the disease as being painful; express how pain negatively affects all aspects of their lives, including loss of functionality and productivity; and are able to disclose their pain to those with whom they have relationships. Adolescents feel an emotional toll from the loss of socialization as a result of pain and feel their health care team adequately supports their pain. Adults express a unique emotional pain component to CF and feel stigmatized and unsupported by their health care team when asking for pain management solutions. CONCLUSION There are differences in how pain is perceived by adolescents and adults with CF that have otherwise not been reported in the current literature. Further explorations of pain across the lifespan and health care provider attitudes toward pain management are needed to guide the development of effective pain management interventions for those with CF.
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Affiliation(s)
- Sarah J Allgood
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
| | - Sharon Kozachik
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Kamila A Alexander
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Abigail Thaxton
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Marc Vera
- Children's Hospital Vanderbilt, Nashville, Tennessee
| | - Noah Lechtzin
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Orava C, Fitzgerald J, Figliomeni S, Lam D, Naccarato A, Szego E, Yoshida K, Fox P, Sykes J, Wu K. Relationship between Physical Activity and Fatigue in Adults with Cystic Fibrosis. Physiother Can 2018; 70:42-48. [PMID: 29434417 DOI: 10.3138/ptc.2016-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: We examined the relationship between the amount of physical activity and level of fatigue in adults with cystic fibrosis (CF). Method: Participants were recruited from the Toronto Adult Cystic Fibrosis Centre at St. Michael's Hospital. Participants completed the Habitual Activity Estimation Scale, the Multidimensional Fatigue Inventory, and the Depression subscale of the Hospital Anxiety and Depression Scale, in that order. Descriptive statistics and linear and multiple regressions were computed. Results: Over a 6-month period, 51 individuals were approached, and 22 (10 men, 12 women) participated in this study. The participants' median age was 33, and forced expiratory volume in 1 second (FEV1) was 64% predicted. When holding both FEV1 and depression constant, a significant negative correlation was found between total active hours per weekday and general fatigue (β=-0.735, p=0.03); there was a negative trend between total active hours per weekday and physical fatigue (β=-0.579, p=0.09). Conclusions: This study is the first to demonstrate that among adults with CF, a higher level of physical activity is associated with a lower level of general and physical fatigue when controlling for lung function and level of depression. Physical activity may be used as a means of mitigating the levels of general and physical fatigue in people with CF.
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Affiliation(s)
| | | | | | | | | | - Erika Szego
- Department of Physical Therapy.,Toronto Adult Cystic Fibrosis Centre, Respirology Program
| | - Karen Yoshida
- Department of Physical Therapy.,Rehabilitation Science Institute, Faculty of Medicine, University of Toronto
| | - Pat Fox
- Department of Physical Therapy.,Mobility Program Clinical Research Unit, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Jenna Sykes
- Toronto Adult Cystic Fibrosis Centre, Respirology Program
| | - Kenneth Wu
- Department of Physical Therapy.,Toronto Adult Cystic Fibrosis Centre, Respirology Program
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Hobler MR, Engelberg RA, Curtis JR, Ramos KJ, Zander MI, Howard SS, Goss CH, Aitken ML. Exploring Opportunities for Primary Outpatient Palliative Care for Adults with Cystic Fibrosis: A Mixed-Methods Study of Patients' Needs. J Palliat Med 2018; 21:513-521. [PMID: 29298400 DOI: 10.1089/jpm.2017.0259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons with cystic fibrosis (CF) experience high morbidity and mortality, yet little is known about their palliative care needs and how clinicians may address these needs. OBJECTIVES (1) To identify palliative care and advance care planning needs of patients with CF and their families; and (2) to identify clinicians' potential roles in meeting these needs. METHODS A mixed-methods study of adult patients (age ≥18 years) with moderate-to-severe CF [forced expiratory volume in the first second (FEV1) <65% predicted] were recruited from a CF Center. Semi-structured interviews (30-60 minutes) and questionnaires were administered in person or by phone. Grounded theory was used to analyze the interviews. Questionnaires were analyzed descriptively. RESULTS Forty-nine patients (FEV1 % range = 19%-63%) participated; the participation rate was 80% for eligible patients. Three main domains of palliative care needs were identified: (1) to be listened to, feel heard, and be "seen"; (2) understanding the context around CF and its trajectory, with the goal of preparing for the future; and (3) information about, and potential solutions to, practical and current circumstances that cause stress. In questionnaires, few patients (4.3%) reported talking with their clinician about their wishes for care if they were to become sicker, but mixed-methods data demonstrated that more than half of participants were willing to receive palliative care services provided those services were adapted to CF. CONCLUSION Patients expressed a need for and openness to palliative care services, as well as some reluctance. They appreciated clinician communication that was open, forthcoming, and attuned to individualized concerns.
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Affiliation(s)
- Mara R Hobler
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - Ruth A Engelberg
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - J Randall Curtis
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - Kathleen J Ramos
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - Miriam I Zander
- 3 Touro College of Osteopathic Medicine , New York, New York
| | - Shacole S Howard
- 4 Sports Medicine Center, University of Washington Medical Center , Seattle, Washington
| | - Christopher H Goss
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington.,5 Seattle Children's Hospital , Seattle, Washington.,6 Pediatric Pulmonology, Department of Pediatrics, University of Washington , Seattle, Washington
| | - Moira L Aitken
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
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High-Frequency Distortion-Product Otoacoustic Emission Repeatability in a Patient Population. Ear Hear 2018; 39:85-100. [DOI: 10.1097/aud.0000000000000465] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Friedman D, Linnemann RW, Altstein LL, Islam S, Bach KT, Lamb C, Volpe J, Doolittle C, St. John A, O'Malley PJ, Sawicki GS, Georgiopoulos AM, Yonker LM, Moskowitz SM. The CF-CARES primary palliative care model: A CF-specific structured assessment of symptoms, distress, and coping. J Cyst Fibros 2018; 17:71-77. [DOI: 10.1016/j.jcf.2017.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 11/27/2022]
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Abstract
ABSTRACTObjectives:Little is known about the experience of family caregivers of adults with cystic fibrosis (CF). This information is important for the identification of caregivers at risk for burden. METHODS This was a longitudinal analysis of survey data obtained from caregivers of adult CF patients participating in an early intervention palliative care trial. Caregivers completed the validated Brief Assessment Scale for Caregivers (BASC) repeatedly over a 28-month period. Mixed-effects modeling evaluated multivariate associations with positive and negative caregiver perceptions over time. RESULTS Of the 54 caregivers, 47.9% were spouses. The mean age was 50.9 years (SD = 13.2); 72.2% were women; 75.9% were married; and 63.0% were employed. At baseline, the BASC revealed large variations in positive and negative perceptions of caregiving. Although average scores over time were unchanging, variation was greater across caregivers than within caregivers (0.49 vs. 0.27, respectively). At baseline, the positive impact of caregiving in the sample was higher than the negative impact. Multivariate analysis revealed that patients' baseline pulmonary function and their full-time employment status predicted caregiver burden over time. SIGNIFICANCE OF RESULTS Caregivers of CF patients varied in their positive and negative caregiving experiences, although burden levels in individual caregivers were stable over time. When the disease was advanced, caregivers of CF patients experienced more overall burden but also more positive impact. This suggests that the role of caregivers may become more meaningful as disease severity worsens. In addition, full-time patient employment was associated with lower caregiver burden regardless of disease severity. This suggests that burden in CF caregivers may be predicted by financial strain or benefits conferred by patient employment. These associations require further investigation to determine whether highly burdened caregivers can be identified and assisted using tailored interventions.
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Chen E, Homa K, Goggin J, Sabadosa KA, Hempstead S, Marshall BC, Faro A, Dellon EP. End-of-life practice patterns at U.S. adult cystic fibrosis care centers: A national retrospective chart review. J Cyst Fibros 2017; 17:S1569-1993(17)30873-1. [PMID: 28917611 DOI: 10.1016/j.jcf.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are many challenges to providing end-of-life care (EOLC) to people with cystic fibrosis (CF). METHODS Chart abstraction was used to examine EOLC in adults with CF who died between 2011 and 2013. RESULTS We reviewed 248 deaths from 71 CF care centers. Median age at death was 29years (range 18-73). While median FEV1 was in the severe lung disease category (FEV1<40%), 38% had mild or moderate lung disease in the year preceding death. The most common location of death was the intensive care unit (ICU, 39%), and 12% of decedents were listed for lung transplant. Fewer of those dying in the ICU personally participated in advance care planning or utilized hospice or Palliative Care Services (p<0.05). CONCLUSIONS Adults dying with CF in the United States most commonly die in an ICU, with limited and variable use of hospice and Palliative Care Services. Palliative care and advance care planning are recommended as a routine part of CF care.
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Affiliation(s)
- Elaine Chen
- Rush University Medical Center, Chicago, IL, United States.
| | - Karen Homa
- Independent Consultant, Orford, NH, United States
| | | | - Kathryn A Sabadosa
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Elisabeth P Dellon
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
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Beebe KR, Gay CL, Richoux SE, Lee KA. Symptom Experience in Late Pregnancy. J Obstet Gynecol Neonatal Nurs 2017; 46:508-520. [PMID: 28549613 DOI: 10.1016/j.jogn.2017.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the frequency, severity, distress, and correlates of common and rare symptoms reported by nulliparous women during the last month of pregnancy. DESIGN Secondary cross-sectional analysis of data obtained in a larger randomized clinical trial. SETTING San Francisco Bay area. PARTICIPANTS Nulliparous, ethnically diverse, predominantly low-income pregnant women 18 to 47 years of age (N = 151). METHODS Participants at or beyond 36 weeks gestation used the Memorial Symptom Assessment Scale (MSAS) to provide self-reports of general symptom experience. Other symptom measures were also completed for comparison. Demographic characteristics, including gestational weight gain, were also collected. Gestational weight gain was categorized in relation to the Institute of Medicine's 2009 recommendations for weight gain during pregnancy. RESULTS Women endorsed an average of 10.6 ± 5.6 symptoms on the MSAS. Prevalent symptoms (reported by at least half the sample) included lack of energy, pain, difficulty sleeping, worrying, irritability, drowsiness, shortness of breath, and nervousness. Among the women who reported these symptoms, relatively few described them as occurring with high frequency or severity or as causing much distress. One of the most prevalent symptoms (reported by 68% of women) was difficulty sleeping, which also had among the greatest ratings for frequency, severity, and distress. Although few maternal characteristics were associated with symptom experience, women who gained more weight than the Institute of Medicine's recommendation had worse MSAS total scores than women who gained the recommended amount or less. CONCLUSION In nulliparas, symptom frequency, severity, and distress varied and were related to excessive gestational weight gain.
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The psychometric properties of the Leicester Cough Questionnaire and Respiratory Symptoms in CF tool in cystic fibrosis: A preliminary study. J Cyst Fibros 2017; 16:425-432. [DOI: 10.1016/j.jcf.2016.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 01/11/2023]
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Vandeleur M, Walter LM, Armstrong DS, Robinson P, Nixon GM, Horne RSC. How Well Do Children with Cystic Fibrosis Sleep? An Actigraphic and Questionnaire-Based Study. J Pediatr 2017; 182:170-176. [PMID: 28040232 DOI: 10.1016/j.jpeds.2016.11.069] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/26/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To measure sleep patterns and quality, objectively and subjectively, in clinically stable children with cystic fibrosis (CF) and healthy control children, and to examine the relationship between sleep quality and disease severity. STUDY DESIGN Clinically stable children with CF and healthy control children (7-18 years of age) were recruited. Sleep patterns and quality were measured at home with actigraphy (14 days). Overnight peripheral capillary oxygen saturation was measured via the use of pulse oximetry. Daytime sleepiness was evaluated by the Pediatric Daytime Sleepiness Scale (PDSS) and subjective sleep quality by the Sleep Disturbance Scale for Children and Obstructive Sleep Apnea-18. RESULTS A total of 87 children with CF and 55 control children were recruited with no differences in age or sex. Children with CF had significantly lower total sleep time and sleep efficiency than control children due to frequent awakenings and more wake after sleep onset. In children with CF, forced expiratory volume in 1 second and overnight peripheral capillary oxygen saturation nadir correlated positively with total sleep time and sleep efficiency and negatively with frequency of awakenings and wake after sleep onset. Patients with CF had significantly greater Sleep Disturbance Scale for Children (45 vs 35; P < .001), Obstructive Sleep Apnea-18 (35 vs 24; P < .001), and PDSS scores (14 vs 11; P < .001). There was a negative correlation between PDSS and forced expiratory volume in 1 second (r = -0.23; P < .05). CONCLUSIONS Even in periods of clinical stability, children with CF get less sleep than their peers due to more time in wakefulness during the night rather than less time spent in bed. Objective measures of sleep disturbance and subjective daytime sleepiness were related to disease severity. In contrast, parents of children with CF report high levels of sleep disturbance unrelated to disease severity.
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Affiliation(s)
- Moya Vandeleur
- The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Walter
- The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - David S Armstrong
- The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia; Department of Sleep and Respiratory Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Philip Robinson
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia; Department of Sleep and Respiratory Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
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Byun E, Gay CL, Portillo CJ, Pullinger CR, Aouizerat BE, Lee KA. Cytokine polymorphisms are associated with daytime napping in adults living with HIV. Sleep Med 2017; 32:162-170. [PMID: 28366330 DOI: 10.1016/j.sleep.2016.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND Daytime napping longer than one hour has been associated with an increased risk for all-cause mortality. Associations between cytokine polymorphisms and daytime napping in chronic illnesses such as HIV, however, have not been well described. The purpose of this study was to examine cytokine polymorphisms associated with long daytime napping in adults living with HIV. METHODS A cross-sectional analysis was conducted using a convenience sample of 257 adults living with HIV. Daytime napping was assessed with wrist actigraphy data collected over three days. Participants categorized as long nappers (≥60 min) were compared to short nappers and non-nappers (<60 min). Single nucleotide polymorphisms (SNPs) for 15 candidate genes involved in cytokine signaling were analyzed. Genes included: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1B, IL1R, IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factors of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor alpha (TNFA). RESULTS After adjusting for relevant demographic and clinical characteristics, long daytime napping was associated with 12 SNPs from seven genes: 1) IFNG rs2069728; 2) IL1B rs1143642, rs1143627, and rs16944; 3) IL2 rs2069763; 4) IL6 rs4719714, rs1554606, and rs2069845; 5) IL17A rs3819024 and rs8193036; 6) NFKB1 rs4648110; and 7) NFKB2 rs1056890. CONCLUSIONS Cytokine genetic variations may have a role in physiological regulation of daytime napping as well as nocturnal sleep. Cytokine polymorphisms associated with long daytime napping could help identify adults with HIV who may benefit from targeted therapeutic interventions.
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Affiliation(s)
- Eeeseung Byun
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA.
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA, USA; Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Carmen J Portillo
- Department of Community Health Systems, University of California at San Francisco, San Francisco, CA, USA
| | - Clive R Pullinger
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, CA, USA; Cardiovascular Research Institute, University of California at San Francisco, San Francisco, CA, USA
| | - Bradley E Aouizerat
- Department of Oral and Maxillofacial Surgery, New York University, New York, NY, USA
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA, USA
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McNamara C, Johnson M, Read L, Vander Velden H, Thygeson M, Liu M, Gandrud L, McNamara J. Yoga Therapy in Children with Cystic Fibrosis Decreases Immediate Anxiety and Joint Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9429504. [PMID: 28077950 PMCID: PMC5204083 DOI: 10.1155/2016/9429504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
This study was designed to determine whether yoga might alleviate symptoms of pain, sleep disturbance, anxiety, and depression in children with cystic fibrosis (CF). CF is the most common genetic, life-limiting chronic disease among Caucasian populations. It primarily affects the lungs but also many other secretory organs and consequently leads to significant morbidities. Research has shown that children with CF have significantly increased depression, anxiety, and pain compared to their healthy counterparts. Subjects participated in six one-on-one sessions over a 10-week period with a certified instructor who designed each yoga practice based on a preestablished list of 30 yoga asanas. Questionnaires evaluating pain, sleep disturbance, sustained anxiety, immediate anxiety, and depression were administered. Differences between premeasures and postmeasures were evaluated using a two-sided test. Twenty subjects were assessed (12 females/8 males), median age of 11 (7-20) years. Mean immediate anxiety scores decreased (before session to after session 29 to 23.6, respectively, p < 0.001). Joint pain improved (3.25 to 3.65, p = 0.028). CFQ-R emotion subscale improved from 79.2 to 85 (p = 0.073), and the respiratory subscale improved from 66.7 to 79.2 (p = 0.076). Other results were less notable. We conclude that yoga may reduce immediate anxiety and joint pain in patients with CF.
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Affiliation(s)
| | - Mahrya Johnson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Lisa Read
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Megan Thygeson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Meixia Liu
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laura Gandrud
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - John McNamara
- Children's Respiratory and Critical Care Specialists, PA, Minneapolis, MN, USA
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Nicholson TT, Barry PJ, Waterhouse DF, Nolan GM, McKone EF, Gallagher CG. Relationship between pulmonary hyperinflation and dyspnoea severity during acute exacerbations of cystic fibrosis. Respirology 2016; 22:141-148. [DOI: 10.1111/resp.12885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 05/15/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Trevor T. Nicholson
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Peter J. Barry
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Deirdre F. Waterhouse
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Geraldine M. Nolan
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Edward F. McKone
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
| | - Charles G. Gallagher
- Department of Respiratory Medicine; St. Vincent's University Hospital; Dublin Ireland
- National Referral Centre for Adult Cystic Fibrosis; St. Vincent's University Hospital; Dublin Ireland
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Button BM, Wilson C, Dentice R, Cox NS, Middleton A, Tannenbaum E, Bishop J, Cobb R, Burton K, Wood M, Moran F, Black R, Bowen S, Day R, Depiazzi J, Doiron K, Doumit M, Dwyer T, Elliot A, Fuller L, Hall K, Hutchins M, Kerr M, Lee AL, Mans C, O'Connor L, Steward R, Potter A, Rasekaba T, Scoones R, Tarrant B, Ward N, West S, White D, Wilson L, Wood J, Holland AE. Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline. Respirology 2016; 21:656-67. [PMID: 27086904 PMCID: PMC4840479 DOI: 10.1111/resp.12764] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 12/21/2022]
Abstract
Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.
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Affiliation(s)
| | | | | | | | | | | | | | - Robyn Cobb
- Lady Cilento Children's HospitalBrisbane
| | | | | | | | | | | | | | | | | | | | - Tiffany Dwyer
- Royal Prince Alfred HospitalNSW
- University of SydneySydneyNSW
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jamie Wood
- Sir Charles Gairdner Hospital and Institute for Respiratory HealthWestern Australia
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