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Toyoda T, Thomae B, Kandula V, Manerikar A, Kaiho T, Yagi Y, Cerier E, Bharat A, Kurihara C. Association of Acute Kidney Injury Grade with Primary Graft Dysfunction Grade after Lung Transplantation: A Cohort Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Yagi Y, Cerier E, Toyoda T, Manerikar A, Thomae B, Kandula V, Bharat A, Kurihara C. Pre-Transplantation Recipient Blood Transfusions Increase the Risk of Primary Graft Dysfunction Following Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Yagi Y, Cerier E, Toyoda T, Dhaliwal B, Tomic R, Bharat A, Kurihara C. Lung Transplantation in a Patient with End-Stage Lung Disease and Suspected Early-Stage Lung Cancer: A Case Report. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Toyoda T, Thomae B, Kandula V, Manerikar A, Kaiho T, Yagi Y, Cerier E, Bharat A, Kurihara C. Association of Acute Kidney Injury Grade with Chronic Kidney Disease after Lung Transplantation: A Cohort Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Toyoda T, Lysne J, Thomae B, Kandula V, Manerikar A, Kaiho T, Yagi Y, Cerier E, Tomic R, Budinger G, Bharat A, Kurihara C. Cytomegalovirus Serologic Mismatch Impact Long-Term Outcomes after Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Peterson SW, Demczuk W, Martin I, Adam H, Bharat A, Mulvey MR. Identification of bacterial and fungal pathogens directly from clinical blood cultures using whole genome sequencing. Genomics 2023; 115:110580. [PMID: 36792020 DOI: 10.1016/j.ygeno.2023.110580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/17/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
Bloodstream infections are a major cause of morbidity and mortality worldwide. Early administration of appropriate antimicrobial therapy can improve patient survival and prevent antimicrobial resistance (AMR). Whole genome sequencing (WGS) can provide information for pathogen identification, AMR prediction and sequence typing earlier than current phenotypic diagnostic methods. WGS was performed on 97 clinical blood specimens and matched culture isolate pairs. Specimen/isolate pairs were MLST sequence-typed and further characterization was performed on Streptococcus species. WGS correctly identified 91.7% of clinical specimens and 93.2% of matched isolates representing 35 different microbial species. MLST types were assigned for 89.9% of matched cultures and 21.7% of blood specimens, with higher success for blood culture specimens extracted within 3 days (52% characterized) than 7 days (9.3%). This study demonstrates the potential use of WGS for identification and characterization of pathogens directly from blood culture specimens to facilitate timely initiation of appropriate antimicrobial therapies.
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Affiliation(s)
- S W Peterson
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - W Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - I Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - H Adam
- Diagnostic Services, Shared Health Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - A Bharat
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - M R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Toyoda T, Kurihara C, Garza-Castillon R, Bharat A. A Case Report of ECMO Patient with Cerebrovascular Complication Caused by a Broken Dual Lumen Cannula. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Toyoda T, Manerikar A, Kandula V, Bharat A, Kurihara C. Recipient, Surgical, and Donor Factors Leading to Primary Graft Dysfunction Following Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cerier E, Manerikar A, Bharat A, Kurihara C. Post-Reperfusion Pulmonary Artery Pressure is a Clinical Marker of Primary Graft Dysfunction Risk Following Lung Transplant. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kurihara C, Bharat A. First Successful Lung Transplantation for Pulmonary Fibrosis Due to Severe COVID-19 Infection in the US. J Heart Lung Transplant 2021. [PMCID: PMC7979372 DOI: 10.1016/j.healun.2021.01.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Lung transplantation can potentially be a life-saving treatment for patients with non-resolving COVID-19 acute respiratory distress syndrome. Concerns limiting transplant include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viral-mediated injury to the native lung. Here, we report the first successful lung transplantation in a patient with non-resolving COVID-19 associated acute respiratory distress syndrome in the United States. Case Report The recipient was a 28-year old female with past medical history of neuromyelitis optica treated with mycophenolate and rituximab who developed COVID pneumonia leading acute respiratory distress syndrome. The patient was intubated for 8 days with prone prior to initiation of VV ECMO. Her ECMO course was complicated by right sided pneumothorax requiring multiple pleural tubes and the development of Serratia marcescens pneumonia with left lower lung necrosis, and a liver capsular bleed necessitating emergent exploratory laparotomy. (Figure1a, b) She received antibiotics, remdesivir, hydroxychloroquine, tocilizumab, and convalescent plasma. However there was no signs of recovery and she was listed for lung transplantation after ECMO support for 32 days . Implantation was supported with central VA ECMO, and there was severe dense vascular adhesions bilaterally with severe distortion of hilar. (Figure1c) Explanted Lungs damaged by COVID-19 were free of virus but pathology showed extensive evidence of acute interstitial inflammation with fibrosis which consistence with end-stage pulmonary fibrosis. (Figure1d, e) The patient was decannulated from VV ECMO on POD 17, and was discharged on POD 27. (Figure1f) Four months after transplantation, she is at home with oxygen saturations above 98% on room air. Summary Our experience suggest that lung transplant is the only option for survival for some patients with severe COVID-19 develop fibrotic lung.
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Kurihara C, Manerikar A, Kandula V, Bharat A. Impact of Prophylactic Ureaplasma-Directed Antimicrobials in Lung Donors. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Roberts S, Bharat A, Kurihara C, Ison M. Infection with Ureaplasma spp in Lung Transplant Recipients is Donor-Derived. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shi B, Wang W, Wei J, Bhattacharyya S, Korman B, Marangoni R, Xu D, Miller S, Akbarpour M, Bharat A, Kamp D, Cheresh P, Procissi D, de Olivera G, Chini E, Varga J. 700 Targeting SIRT/CD38/NAD+ homeostasis to mitigate fibrosis in scleroderma. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kurihara C, Walter J, Karim A, Wunderink R, Budinger GGRS, Bharat A. Feasibility and Safety of Systemic Anticoagulation-Free Veno-Venous Extracorporeal Membrane Oxygenation in Adults Respiratory Failure Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Kurihara C, Fernandez R, Safaeinili N, Budinger G, DeCamp M, Bharat A. Impact of Cytomegalovirus Transmission on Lung Allograft Survival in the United States. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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16
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Takahashi T, Hsiao HM, Tanaka S, Li W, Higashikubo R, Scozzi D, Bharat A, Ritter JH, Krupnick AS, Gelman AE, Kreisel D. PD-1 expression on CD8 + T cells regulates their differentiation within lung allografts and is critical for tolerance induction. Am J Transplant 2018; 18:216-225. [PMID: 28730633 PMCID: PMC5739961 DOI: 10.1111/ajt.14437] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/18/2017] [Accepted: 07/11/2017] [Indexed: 01/25/2023]
Abstract
Immunological requirements for rejection and tolerance induction differ between various organs. While memory CD8+ T cells are considered a barrier to immunosuppression-mediated acceptance of most tissues and organs, tolerance induction after lung transplantation is critically dependent on central memory CD8+ T lymphocytes. Here we demonstrate that costimulation blockade-mediated tolerance after lung transplantation is dependent on programmed cell death 1 (PD-1) expression on CD8+ T cells. In the absence of PD-1 expression, CD8+ T cells form prolonged interactions with graft-infiltrating CD11c+ cells; their differentiation is skewed towards an effector memory phenotype and grafts are rejected acutely. These findings extend the notion that requirements for tolerance induction after lung transplantation differ from other organs. Thus, immunosuppressive strategies for lung transplant recipients need to be tailored based on the unique immunological properties of this organ.
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Affiliation(s)
- T Takahashi
- Department of Surgery, Washington University in St. Louis
| | - HM Hsiao
- Department of Surgery, Washington University in St. Louis
| | - S Tanaka
- Department of Surgery, Washington University in St. Louis
| | - W Li
- Department of Surgery, Washington University in St. Louis
| | - R Higashikubo
- Department of Surgery, Washington University in St. Louis
| | - D Scozzi
- Department of Surgery, Washington University in St. Louis
| | - A Bharat
- Department of Surgery, Northwestern University
| | - JH Ritter
- Department of Pathology & Immunology, Washington University in St. Louis
| | - AS Krupnick
- Department of Surgery, University of Virginia
| | - AE Gelman
- Department of Surgery, Washington University in St. Louis,Department of Pathology & Immunology, Washington University in St. Louis
| | - D Kreisel
- Department of Surgery, Washington University in St. Louis,Department of Pathology & Immunology, Washington University in St. Louis,Corresponding author: Daniel Kreisel, M.D., Ph.D., Professor of Surgery, Pathology & Immunology, Campus Box 8234, 660 South Euclid Avenue, Washington University School of Medicine, St. Louis, MO 63110, Tel: (314) 362-6021, Fax: (314) 367-8459,
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Haim MS, Di Gregorio S, Galanternik L, Lubovich S, Vázquez M, Bharat A, Zaheer R, Golding GR, Graham M, Van Domselaar G, Cardona ST, Mollerach M. First description of rpsJ and mepA mutations associated with tigecycline resistance in Staphylococcus aureus isolated from a cystic fibrosis patient during antibiotic therapy. Int J Antimicrob Agents 2017; 50:739-741. [PMID: 29038088 DOI: 10.1016/j.ijantimicag.2017.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/04/2017] [Accepted: 10/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M S Haim
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - S Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - L Galanternik
- Microbiología, Laboratorio Central, Hospital de Niños 'Dr Ricardo Gutiérrez', Buenos Aires, Argentina
| | - S Lubovich
- Centro Respiratorio, Hospital de Niños 'Dr Ricardo Gutiérrez', Buenos Aires, Argentina
| | - M Vázquez
- Microbiología, Laboratorio Central, Hospital de Niños 'Dr Ricardo Gutiérrez', Buenos Aires, Argentina
| | - A Bharat
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - R Zaheer
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - G R Golding
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada; Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - M Graham
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada; Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - G Van Domselaar
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada; Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - S T Cardona
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Canada; Department of Microbiology, University of Manitoba, Winnipeg, Canada
| | - M Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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Singh JA, Herbey I, Bharat A, Dinnella JE, Pullman-Mooar S, Eisen S, Ivankova N. Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives. Arthritis Care Res (Hoboken) 2017; 69:1724-1732. [PMID: 28118526 DOI: 10.1002/acr.23202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore gout self-management and associated challenges and solutions in African Americans. METHODS We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. RESULTS Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources. CONCLUSION Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout.
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Affiliation(s)
- Jasvinder A Singh
- VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | | | - Janet E Dinnella
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sally Pullman-Mooar
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seth Eisen
- Washington University School of Medicine and St. Louis VA Medical Center, St. Louis, Missouri
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Singh JA, Bharat A, Khanna D, Aquino-Beaton C, Persselin JE, Duffy E, Elashoff D, Khanna PP. Health care utilization in patients with gout: a prospective multicenter cohort study. BMC Musculoskelet Disord 2017; 18:233. [PMID: 28569193 PMCID: PMC5452408 DOI: 10.1186/s12891-017-1573-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All published studies of health care utilization in gout have been cross-sectional to date, and most used a patient-reported diagnosis of gout. Our objective was to assess health care utilization and its predictors in patients with physician-confirmed gout in a prospective cohort study. METHODS In a multi-center prospective cohort study of U.S. veterans with rheumatologist-confirmed gout (N = 186; two centers), we assessed patient self-reported overall and gout-specific health care utilization with the Gout Assessment Questionnaire (GAQ) every 3-months for a 9-month period. Comparisons were made using the student's t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Mixed effects Poisson regression was used to assess potential correlates of gout-related health care utilization. RESULTS Mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 32% were African-American, 6% did not graduate high school, mean serum urate was 8.3 and mean Deyo-Charlson score was 3.1. During the past year, mean gout-related visits were as follows: rheumatologist, 1.5; primary care physician, 2 visits; ≥1 inpatient visits, 7%; ≥1 ER visits, 26%; and urgent care/walk-in visit, 33%. In longitudinal analyses, African-American race and gout flares in the last 3 months were associated with significantly higher rate ratio of gout-related outpatient visits. African-American race and lack of college education were associated with significantly higher rate ratio for gout-related urgent visits and overnight stays. CONCLUSIONS African-American race and recent gout flares were associated with higher outpatient utilization and African-American race and no college education with higher urgent or inpatient utilization. Future studies should examine whether modifiable predictors of utilization can be targeted to reduce healthcare utilization in patients with gout.
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Affiliation(s)
- Jasvinder A Singh
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, 35294, AL, USA. .,Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Aseem Bharat
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA
| | | | | | - Jay E Persselin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Erin Duffy
- University of California, Los Angeles, CA, USA
| | | | - Puja P Khanna
- University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Yen PY, Lara B, Lopetegui M, Bharat A, Ardoin S, Johnson B, Mathur P, Embi PJ, Curtis JR. Usability and Workflow Evaluation of "RhEumAtic Disease activitY" (READY). A Mobile Application for Rheumatology Patients and Providers. Appl Clin Inform 2016; 7:1007-1024. [PMID: 27803949 DOI: 10.4338/aci-2016-03-ra-0036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND RhEumAtic Disease activitY (READY) is a mobile health (mHealth) application that aims to create a shared platform integrating data from both patients and physicians, with a particular emphasis on arthritis disease activity. METHODS We made READY available on an iPad and pilot implemented it at a rheumatology outpatient clinic. We conducted 1) a usability evaluation study to explore patients' and physicians' interactions with READY, and 2) a time motion study (TMS) to observe the clinical workflow before and after the implementation. RESULTS A total of 33 patients and 15 physicians participated in the usability evaluation. We found usability problems in navigation, data entry, pain assessment, documentation, and instructions along with error messages. Despite these issues, 25 (75,76%) patients reported they liked READY. Physicians provided mixed feedback because they were concerned about the impact of READY on clinical workflow. Six physicians participated in the TMS. We observed 47 patient visits (44.72 hours) in the pre-implementation phase, and 42 patient visits (37.82 hours) in the post-implementation phase. We found that patients spent more time on READY than paper (4.39mins vs. 2.26mins), but overall, READY did not delay the workflow (pre = 52.08 mins vs. post = 45.46 mins). This time difference may be compensated with READY eliminating a workflow step for the staff. CONCLUSION Patients preferred READY to paper documents. Many found it easier to input information because of the larger font size and the ease of 'tapping' rather than writing-out or circling answers. Even though patients spent more time on READY than using paper documents, the longer usage of READY was mainly due to when troubleshooting was needed. Most patients did not have problems after receiving initial support from the staff. This study not only enabled improvements to the software but also serves as good reference for other researchers or institutional decision makers who are interested in implementing such a technology.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey R Curtis
- Jeffrey R. Curtis, MD, MS, MPH, University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, 510 20th Street South, FOT 802D Birmingham AL 35294, Tel. 205-975-2176, E-mail:
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Singh JA, Bharat A, Khanna D, Aquino-Beaton C, Persselin JE, Duffy E, Elashoff D, Khanna PP. Racial differences in health-related quality of life and functional ability in patients with gout. Rheumatology (Oxford) 2016; 56:103-112. [PMID: 28028159 DOI: 10.1093/rheumatology/kew356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. METHODS In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits). RESULTS Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P < 0.01). African Americans with gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds. CONCLUSIONS African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center .,Department of Medicine, School of Medicine.,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Aseem Bharat
- Department of Medicine, School of Medicine.,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Jay E Persselin
- Department of Biostatistics, VA Greater Los Angeles Healthcare System
| | - Erin Duffy
- Department of Medicine, University of California, Los Angeles, CA
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, CA
| | - Puja P Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI.,Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Curtis JR, Xie F, Mackey D, Gerber N, Bharat A, Beukelman T, Saag KG, Chen L, Nowell B, Ginsberg S. Patient's experience with subcutaneous and oral methotrexate for the treatment of rheumatoid arthritis. BMC Musculoskelet Disord 2016; 17:405. [PMID: 27669978 PMCID: PMC5037591 DOI: 10.1186/s12891-016-1254-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
Background Despite the prominent position of methotrexate (MTX) in Rheumatoid Arthiris (RA) therapeutics, its real-world effectiveness may be influenced by a relative lack of tolerability or other side effects that physicians may not be aware of but that are bothersome to patients. The aim of this study is to identify suboptimal patient experience with MTX and to raise awareness for clinicians to identify opportunities to mitigate bothersome symptoms and side effects and optimize response to MTX. Methods We conducted a prospective, cross-sectional, online survey among RA patients who were members of Creakyjoints, a large arthritis patient community. Eligible participants must have recently initiated a new biologic, subcutaneous (SQ) MTX, or oral MTX in the last 12 months and were uniquely assigned to one of these 3 groups. Descriptive statistics were used to compare patient-reported side effects and tolerability related to MTX use in the 3 medication groups (SQ MTX, oral MTX, and biologic). Results A total of 382 (85 %) of 448 eligible patients completed the survey and were grouped as: biologic (n = 218), SQ MTX (n = 49), and oral MTX (n = 115). Demographics were mean standard deviation (SD) age 48 (10) years, 92 % white, 91 % women. Symptoms significantly more prevalent in the SQ and oral MTX groups included diarrhea, fatigue, malaise, and hair loss. Injection related pain was lower with SQ MTX compared to SQ biologics. Out of a total of 8 potential symptoms and side effects examined, higher dose MTX (> = 20 mg/week) was associated with a 2.26 (1.25–4.09) greater likelihood of more side effects referent to < =10 mg/week. Conclusion Results from this real-world RA patient cohort suggest that MTX is accompanied by many patient-reported side effects and tolerability problems that may be under-recognized by physicians. These may impact both treatment satisfaction and medication adherence.
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Affiliation(s)
- J R Curtis
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA.
| | - F Xie
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - D Mackey
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - N Gerber
- Global Healthy Living Foundation, Upper Nyack, NY, 10960, USA
| | - A Bharat
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - T Beukelman
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - K G Saag
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - L Chen
- University of Alabama at Birmingham, 510 20th Street South, FOT 802, Birmingham, AL, 35294, USA
| | - B Nowell
- Global Healthy Living Foundation, Upper Nyack, NY, 10960, USA
| | - S Ginsberg
- Global Healthy Living Foundation, Upper Nyack, NY, 10960, USA
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Curtis JR, Bharat A, Chen L, Greenberg JD, Harrold L, Kremer JM, Sommers T, Pappas D. Agreement between Rheumatologist and Patient-reported Adherence to Methotrexate in a US Rheumatoid Arthritis Registry. J Rheumatol 2016; 43:1027-9. [PMID: 27134256 DOI: 10.3899/jrheum.151136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Rheumatologists have limited tools to assess medication adherence. The extent to which methotrexate (MTX) adherence is overestimated by rheumatologists is unknown. METHODS We deployed an Internet survey to patients with rheumatoid arthritis (RA) participating in a US registry. Patient self-report was the gold standard compared to MTX recorded in the registry. RESULTS Response rate to the survey was 44%. Of 228 patients whose rheumatologist reported current MTX at the time of the most recent registry visit, 45 (19.7%) had discontinued (n = 19, 8.3%) or missed ≥ 1 dose in the last month (n = 26, 11.4%). For the subgroup whose rheumatologist also confirmed at the next visit that they were still taking MTX (n = 149), only 2.6% reported not taking it, and 10.7% had missed at least 1 dose. CONCLUSION MTX use was misclassified for 13%-20% of patients, mainly because of 1 or more missed doses rather than overt discontinuation. Clinicians should be aware of suboptimal adherence when assessing MTX response.
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Affiliation(s)
- Jeffrey R Curtis
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC.
| | - Aseem Bharat
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
| | - Lang Chen
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
| | - Jeffrey D Greenberg
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
| | - Leslie Harrold
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
| | - Joel M Kremer
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
| | - Tanya Sommers
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
| | - Dimitrios Pappas
- From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC
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Curtis JR, Chen L, Bharat A, Delzell E, Greenberg JD, Harrold L, Kremer J, Setoguchi S, Solomon DH, Xie F, Yun H. Linkage of a de-identified United States rheumatoid arthritis registry with administrative data to facilitate comparative effectiveness research. Arthritis Care Res (Hoboken) 2015; 66:1790-8. [PMID: 24905637 DOI: 10.1002/acr.22377] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 05/27/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Linkages between registries and administrative data may provide a valuable resource for comparative effectiveness research. However, personal identifiers that uniquely identify individuals are not always available. Here we describe methods to link a de-identified arthritis registry and US Medicare data. The linked data set was also used to evaluate the generalizability of the registry to the US Medicare population. METHODS Rheumatoid arthritis (RA) patients participating in the Consortium of Rheumatology Researchers of North America (CORRONA) registry were linked to Medicare data restricted to rheumatology claims or claims for RA. Deterministic linkage was performed using age, sex, provider identification number, and geographic location of the CORRONA site. We then searched for visit dates in Medicare matching visit dates in CORRONA, requiring ≥1 exact matching date. Linkage accuracy was quantified as a positive predictive value in a subcohort (n = 1,581) with more precise identifiers. RESULTS CORRONA participants with self-reported Medicare (n = 11,001) were initially matched to 30,943 Medicare beneficiaries treated by CORRONA physicians. A total of 8,431 CORRONA participants matched on ≥1 visit; 5,317 matched uniquely on all visits. The number of patients who linked and linkage accuracy (from the subcohort) were high for patients with >2 visits (n = 3,458, 98% accuracy), exactly 2 visits (n = 822, 96% accuracy), and 1 visit (n = 1,037, 79% accuracy) that matched exactly on calendar date. Demographics and comorbidity profiles of registry participants were similar to nonparticipants, except participants were more likely to take disease-modifying antirheumatic drugs and biologic agents. CONCLUSION Linkage between a national, de-identified outpatient arthritis registry and Medicare data on multiple nonunique identifiers appears feasible and valid.
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Subramanian V, Ramachandran S, Banan B, Bharat A, Wang X, Benshoff N, Kreisel D, Gelman AE, Mohanakumar T. Immune response to tissue-restricted self-antigens induces airway inflammation and fibrosis following murine lung transplantation. Am J Transplant 2014; 14:2359-66. [PMID: 25220332 PMCID: PMC4169463 DOI: 10.1111/ajt.12908] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 04/08/2014] [Accepted: 04/13/2014] [Indexed: 01/25/2023]
Abstract
Immune responses against lung-associated self-antigens (self-Ags) are hypothesized to play a role in the development of chronic lung graft rejection. We determined whether immune responses to lung self-Ags, K-alpha-1-tubulin (Kα1T) and Collagen V (Col-V) in the absence of alloimmunity, could promote airway inflammation and fibrosis. Following syngeneic murine orthotopic lung transplantation (LTx) we administered antibodies (Abs) to either Kα1T or Col-V or in combination to both of these self-Ags. As compared to recipients of isotype control Abs, Kα1T Abs and/or Col-V Abs-treated recipients had marked lung graft cellular infiltration and bronchiolar fibrosis. This inflammation was also associated the accumulation of Kα1T and Col-V-specific interferon-γ+ and IL-17+ T cells. Notably, the administration of Abs to Kα1T led to cellular and humoral immune responses to Col-V prior to development of fibrosis, and vice versa, indicating that epitope spreading can occur rapidly in an alloantigen independent manner. Collectively, these data support a model of chronic LTx rejection where the progressive loss of self-tolerance through epitope spreading promotes airway fibrosis. Strategies that target autoreactive Abs may be useful to inhibit chronic rejection of lung grafts.
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Affiliation(s)
- V. Subramanian
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - S. Ramachandran
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - A. Bharat
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - X. Wang
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - N. Benshoff
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D. Kreisel
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - A. E. Gelman
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - T. Mohanakumar
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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Singh J, Bharat A, Edwards L. AB0833 An Internet Survey of Common Treatments Used by Patients with Gout. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bharat A, Subramanian V, Decamp M, Kriesel D, Gelman A, Mohanakumar T. Tissue-Restricted Autoimmunity Leads to the Development of Lung Allograft Rejection. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Curtis JR, Wright NC, Xie F, Chen L, Zhang J, Saag KG, Bharat A, Kremer J, Cofield S, Winthrop K, Delzell E. Use of health plan combined with registry data to predict clinical trial recruitment. Clin Trials 2013; 11:96-101. [PMID: 24346611 DOI: 10.1177/1740774513512185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Large pragmatic clinical trials (PCTs) are increasingly used to conduct comparative effectiveness research. In the context of planning a safety PCT of the live herpes zoster vaccine in rheumatoid arthritis (RA) patients aged ≥ 50 years receiving anti-tumor necrosis factor (TNF) therapy, we evaluated the use of health plan combined with registry data to assess the feasibility of recruiting the 4000 patients needed for the trial and to facilitate site selection. METHODS Using national US data from Medicare, we identified older RA patients who received anti-TNF therapy in the last quarter of 2009. Extrapolations were made from the Medicare patient population to younger patients and those with other types of insurance using the Consortium of Rheumatology Researchers of North America (CORRONA) disease registry. Patients' treating rheumatologists were grouped into practices and sorted by size from the greatest to the least number of eligible patients. RESULTS Approximately 50,000 RA patients receiving anti-TNF therapy were identified in the Medicare data, distributed across 1980 physician practices. After augmenting Medicare data with information from CORRONA and extrapolating to younger patients and those with other types of insurance, more than 12,000 potentially eligible study subjects were identified from the 50 largest rheumatology practices. CONCLUSION Health plan and registry databases appear useful to assess feasibility of large pragmatic trials and to assist in selection of recruitment sites with the greatest number of potentially eligible patients. This novel approach is applicable to trials with simple inclusion/exclusion criteria that can be readily assessed in these data sources.
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Affiliation(s)
- Jeffrey R Curtis
- aDivision of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Singh JA, Kalore NV, Bharat A. Perioperative interventions for smoking cessation in hip and knee arthroplasty for osteoarthritis and other non-traumatic diseases. Hippokratia 2013. [DOI: 10.1002/14651858.cd010674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical Center; Department of Medicine; Faculty Office Tower 805B 510 20th Street South Birmingham USA AL 35294
| | - Niraj V Kalore
- Chester Orthopedics and Sports Medicine Center; Department of Orthopaedic Surgery; 1 Medical Park Drive, Building 4, Suite B, Chester South Carolina USA 29706
| | - Aseem Bharat
- University of Alabama; Department of Medicine; 510 20th street south Birmingham AL USA 35294
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Curtis JR, Sharma P, Arora T, Bharat A, Barnes I, Morrisey MA, Kilgore M, Saag KG, Wright NC, Yun HG, Delzell E. Physicians' explanations for apparent gaps in the quality of rheumatology care: results from the US Medicare Physician Quality Reporting System. Arthritis Care Res (Hoboken) 2013; 65:235-43. [PMID: 22556118 DOI: 10.1002/acr.21713] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/09/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The metrics used to assess quality of care and pay for performance in rheumatology are increasingly important. The Centers for Medicare and Medicaid Services established the Physician Quality Reporting System (PQRS) to allow physicians to report performance measures for many conditions, including osteoporosis and rheumatoid arthritis (RA). We described the frequency and nature of physician-reported reasons why recommended care for individual osteoporosis and RA patients was not provided. METHODS Using national data on Medicare fee-for-service beneficiaries (2007-2009), we identified health care providers reporting on quality of care for any of 3 osteoporosis or 3 RA measures. PQRS reason codes allowed physicians to submit explanations why recommended care was not given. RESULTS In 2009, 1,775 physicians reported on ≥1 osteoporosis PQRS measure and 630 physicians reported on ≥1 RA measure. For the older women whose physician reported on lifetime dual x-ray absorptiometry screening at least once since the age of 60 years via PQRS, 76% received such screening. Among the patients with physician-diagnosed osteoporosis reported via PQRS, 82% received prescription osteoporosis medication in the preceding year. For RA medication use reported via PQRS, 89% of patients received a disease-modifying antirheumatic drug or a biologic agent. For the remaining 11-24% of osteoporosis and RA patients, physicians reported medical, patient, system, or other reasons why care was considered but not provided. CONCLUSION A substantial fraction of Medicare enrollees who did not receive recommended osteoporosis or RA care had physician-documented reasons for why care was not provided. For Medicare and other health plans that implement penalties for apparent nonperformance or delivery of suboptimal care, it will be important to allow physicians to provide reasons that care was considered medically inappropriate, refused, or otherwise not feasible.
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Bharat A, Xie F, Baddley JW, Beukelman T, Chen L, Calabrese L, Delzell E, Grijalva CG, Patkar NM, Saag K, Winthrop KL, Curtis JR. Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases. Arthritis Care Res (Hoboken) 2012; 64:612-5. [PMID: 22162369 DOI: 10.1002/acr.21564] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To ascertain the incidence of progressive multifocal leukoencephalopathy (PML) in patients with selected rheumatic diseases, to describe the characteristics of PML cases occurring in this setting, and to evaluate the extent to which such cases occurred in the context of biologic therapies such as rituximab or tumor necrosis factor antagonists. METHODS We conducted a large population-based study to describe the incidence and risk factors for PML among patients with rheumatoid arthritis, psoriatic arthritis, psoriasis, juvenile idiopathic arthritis, inflammatory bowel disease, and ankylosing spondylitis using national inpatient and outpatient administrative data from the entire Center for Medicare and Medicaid Services from 2000-2009. Suspected PML cases were identified using hospital discharge diagnosis codes. Risk factors for PML were evaluated using outpatient data ≥6 months prior to PML diagnosis. RESULTS Among 2,030,578 patients with autoimmune diseases of interest, a total of 53 PML cases were identified (2.6 per 100,000 patients). Most PML cases had human immunodeficiency virus (HIV) and/or cancer. Nine PML cases had evidence for biologic use prior to PML hospitalization, of which 3 had neither HIV nor malignancy and were exposed to biologics within 12 (rituximab) or 6 months (all other biologics) prior to PML diagnosis. PML occurred at an estimated incidence of 0.2 per 100,000 patients with autoimmune diseases who did not have HIV or malignancy. CONCLUSION PML occurs at a very low incidence among patients with rheumatic diseases but can occur even in the absence of HIV or malignancy.
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Affiliation(s)
- A Bharat
- University of Alabama at Birmingham, AL, USA
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Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, Moreland LW, O'Dell J, Winthrop KL, Beukelman T, Bridges SL, Chatham WW, Paulus HE, Suarez-Almazor M, Bombardier C, Dougados M, Khanna D, King CM, Leong AL, Matteson EL, Schousboe JT, Moynihan E, Kolba KS, Jain A, Volkmann ER, Agrawal H, Bae S, Mudano AS, Patkar NM, Saag KG. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64:625-39. [PMID: 22473917 DOI: 10.1002/acr.21641] [Citation(s) in RCA: 1184] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham.510 20th Street South, Birmingham, AL 35294, USA.
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Bharat A, Epstein D, Faro A, Michelson P, Sweet S, Huddleston C. 391 Lung Transplantation Is a Viable Treatment Option in Patients with Congenital or Acquired Pulmonary Vein Stenosis. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bharat A, Subramanian V, Trulock E, Patterson G, Mohanakumar T. 231 Respiratory Viruses Convert CD4+CD25+Foxp3+Regulatory T Cells (Tregs) into Th-17 Cells: Role in Promoting Autoimmunity and Chronic Lung Allograft Rejection. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bharat A, Kuo E, Hachem R, Trulock E, Patterson G, Meyers B, Mohanakumar T. 39-OR: Immunological link between primary lung allograft dysfunction (PGD) and chronic rejection (BOS). Hum Immunol 2007. [DOI: 10.1016/j.humimm.2007.08.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bharat A, Fields RC, Steward N, Trulock EP, Patterson GA, Mohanakumar T. CD4+25+ regulatory T cells limit Th1-autoimmunity by inducing IL-10 producing T cells following human lung transplantation. Am J Transplant 2006; 6:1799-808. [PMID: 16889540 DOI: 10.1111/j.1600-6143.2006.01383.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic human lung allograft rejection is manifested by bronchiolitis obliterans syndrome (BOS). BOS has a multifactorial etiology. Previous studies have indicated that both cellular and humoral alloimmunity play a significant role in the pathogenesis of BOS. Recently, autoimmunity has also been demonstrated to contribute to lung allograft rejection in animal models. However, the significance of autoimmunity in BOS remains unknown. In this report, we investigated the role of naturally occurring CD4(+)CD25(+) regulatory T cells (T-regs) in modulating cellular autoimmunity to collagen type V (col-V), a 'sequestered' yet immunogenic self-protein present in the lung tissue, following lung transplantation (LT). We demonstrated that col-V reactive CD4(+) T cells could be detected in the peripheral blood of lung transplant recipients. There was a predominance of IL-10 producing T cells (T(IL-10)) reactive to col-V with significantly lower levels of IFN-gamma and IL-2 producing T cells (Th1 cells). The col-V specific T(IL-10) cells suppressed the proliferation and expansion of col-V specific Th1 cells by IL-10-dependent and contact-independent pathways. The T(IL-10) cells were distinct but their development was dependent on the presence of T-regs. Furthermore, during chronic lung allograft rejection there was a significant decline of T(IL-10) cells with concomitant expansion of col-V-specific IFN-gammaproducing Th1 cells.
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Affiliation(s)
- A Bharat
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Bharat A, Narayanan K, Benshoff N, Dietz J, Gillanders W, Fleming T, Mohanakumar T. Inducing mammaglobin-A (mamA) specific HLA class I tetramer positive CD8 +cytotoxic T-lymphocytes (CTL) against breast cancer by DNA vaccination. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2522 Background: We recently reported that DNA vaccination using MamA, a highly expressed human (hu) breast cancer specific protein, leads to immunity against breast cancer. Here we demonstrate that the induction of breast cancer immunity following MamA DNA vaccination occurs through the expansion of CD8+ CTL by using HLA class I MamA peptide tetramers. Methods: HLA-A2+huCD8+ double transgenic mice received four (100μg) two-weekly IM injections of PCI-neo vector cloned with hu MamA gene. HLA-A2 tetramers (tet) carrying an immunodominant Mam2.1 peptide (LIYDSSLCDL) were used to monitor development of mam-A specific CD8+ T cells. Specificity of tetramers was tested against CD8+ CTL lines developed in vitro by stimulation of normal hu HLA-A2+ peripheral blood lymphocytes with TAP-2 deficient T2 cells pulsed with pooled MamA HLA-A2 binding peptides. Results: There was a sequential expansion of Mam2.1 tet+CD8+ T cells during stimulation of hu PBLs with MamA peptides in vitro (<1% pre-stimulation to >15% after six stimulations). These Mam2.1 tet+CD8+ T cells were HLA-A2 restricted and MamA specific since they revealed cytotoxicity only towards UACC-822 (HLA-A2+MamA+, 75% lysis) but not MCF-7 (A2+MamA−) or DU-4475 (A2−MamA+) breast cancer cell lines. In contrast, there was no binding of MamA peptide tetramers to control Flu-specific CD8+ CTL lines (<1%). MamA DNA vaccination, but not PCI-neo vector alone, of HLA-A2+huCD8+ mice lead to the expansion of Mam2.1 tet+CD8+ T cells (<0.7% pre-vaccination to >2.5% post-vaccination) in the peripheral blood that revealed in vitro cytotoxicity against UACC-822 (70% lysis) but not against DU-4475 or MCF-7 breast cancer cell lines. Adoptive transfer of both whole splenocytes or fractionated CD8+ T cells from vaccinated mice into immunodeficient SCID-beige mice with previously established subcutaneous hu breast cancer colonies lead to tumor infiltration of tet+CD8+ CTLs and, at 4-weeks, at least 80% tumor regression of UACC-822 but not DU4475 or MCF-7 colonies. Conclusions: MamA DNA vaccination resulted in the expansion of CD8+ CTL. The CD8+ CTL were HLA class I MamA peptide tetramer positive, HLA class I restricted and specifically lysed mamA+ human breast cancer cells both in vitro and in vivo. No significant financial relationships to disclose.
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Affiliation(s)
- A. Bharat
- Washington University, St. Louis, MO
| | | | | | - J. Dietz
- Washington University, St. Louis, MO
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Fields R, Bharat A, Liu W, Patterson G, Mohanakumar T. 246. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bharat A, Fields R, Aloush A, Trulock E, Patterson G, Mohanakumar T. 165. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bharat A, Trulock E, Patterson G, Aloush A, Mohanakumar T. Autoimmunity to collagen-V may lead to chronic rejection after human lung transplantation. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bharat A, Trulock E, Patterson G, Mohanakumar T. Hypersensitivity to self proteins might be a pathoimmunological derangement leading to chronic rejection after lung transplantation. Hum Immunol 2004. [DOI: 10.1016/j.humimm.2004.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bharat A, Vedkumar M, Subhash HS, Abraham OC, Mathai D. Antituberculous therapy-induced toxicity. J Assoc Physicians India 2003; 51:522-4. [PMID: 12974441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Antituberculous drugs are generally safe but can occasionally be associated with life-threatening complications. This is a case report of neurotoxicity, acute respiratory distress syndrome (ARDS) and drug fever, occurring in a patient after initiation of antituberculous therapy (ATT).
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Affiliation(s)
- A Bharat
- Department of Medicine, Unit-1 and Infectious Diseases, Christian Medical College and Hospital, Vellore
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