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Jacobs JW, Stephens LD, Chooljian DM, Sharma D, Adkins BD, Booth GS. Crizanlizumab and sickle cell disease: When should medications have their approval status revoked? Am J Hematol 2024; 99:1016-1018. [PMID: 38409818 DOI: 10.1002/ajh.27275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - David M Chooljian
- Ethics Consultation Service & Pulmonary & Critical Care Medicine Section, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Deva Sharma
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Garrett S Booth
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Jacobs JW, Binns TC, Chooljian DM, Adkins BD, Woo JS, Stephens LD, Schlafer TD, Savani BN, Booth GS. Blood bans and COVID-19: Government attempts to influence medicine and science threaten us all. Am J Clin Pathol 2023; 160:435-436. [PMID: 37410089 DOI: 10.1093/ajcp/aqad071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
| | | | - David M Chooljian
- Veterans Affairs Loma Linda Healthcare System and Loma Linda University School of Medicine, Loma Linda, CA, US
| | - Brian D Adkins
- University of Texas Southwestern Medical Center, Dallas, TX, US
| | | | | | - T D Schlafer
- Lincoln Memorial University Duncan School of Law, Knoxville, TN, US
| | - Bipin N Savani
- Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, TN, US
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Donovan LM, Hoyos CM, Kimoff RJ, Morrell MJ, Bosch NA, Chooljian DM, McEvoy RD, Sawyer AM, Wagner TH, Al-Lamee RR, Bishop D, Carno MA, Epstein M, Hanson M, Ip MSM, Létourneau M, Pamidi S, Patel SR, Pépin JL, Punjabi NM, Redline S, Thornton JD, Patil SP. Strategies to Assess the Effect of Continuous Positive Airway Pressure on Long-Term Clinically Important Outcomes among Patients with Symptomatic Obstructive Sleep Apnea: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:931-943. [PMID: 37387624 DOI: 10.1513/annalsats.202303-258st] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA). Although CPAP improves symptoms (e.g., daytime sleepiness), there is a lack of high-quality evidence that CPAP prevents many long-term outcomes, including cognitive impairment, myocardial infarction, and stroke. Observational studies suggest that patients with symptoms may be particularly likely to experience these preventive benefits with CPAP, but ethical and practical concerns limited the participation of such patients in prior long-term randomized trials. As a result, there is uncertainty about the full benefits of CPAP, and resolving this uncertainty is a key priority for the field. This workshop assembled clinicians, researchers, ethicists, and patients to identify strategies to understand the causal effects of CPAP on long-term clinically important outcomes among patients with symptomatic OSA. Quasi-experimental designs can provide valuable information and are less time and resource intensive than trials. Under specific conditions and assumptions, quasi-experimental studies may be able to provide causal estimates of CPAP's effectiveness from generalizable observational cohorts. However, randomized trials represent the most reliable approach to understanding the causal effects of CPAP among patients with symptoms. Randomized trials of CPAP can ethically include patients with symptomatic OSA, as long as there is outcome-specific equipoise, adequate informed consent, and a plan to maximize safety while minimizing harm (e.g., monitoring for pathologic sleepiness). Furthermore, multiple strategies exist to ensure the generalizability and practicality of future randomized trials of CPAP. These strategies include reducing the burden of trial procedures, improving patient-centeredness, and engaging historically excluded and underserved populations.
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Jacobs JW, Guarente J, Chooljian DM, Booth GS, Adkins BD. Liquid biopsies in blood donors: Issues in implementing cell-free DNA cancer screening tests in the blood donor population. Am J Hematol 2022; 97:E454-E456. [PMID: 36102805 DOI: 10.1002/ajh.26727] [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] [Received: 08/09/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Abstract
Issues in implementing cell-free DNA cancer screening tests in blood donors.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Juliana Guarente
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David M Chooljian
- Ethics Consultation Service & Pulmonary Section, Medical Service, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern, Dallas, Texas, USA
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Booth GS, Jacobs JW, Stephens LD, Chooljian DM, Savani BN, Gehrie EA. When should we tell patients there may be no blood? Evaluating the 'informed' consent process. Br J Haematol 2022; 198:e8-e10. [PMID: 35315509 DOI: 10.1111/bjh.18156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura D Stephens
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - David M Chooljian
- Ethics Consultation Service & Pulmonary Section, Medical Service, Veterans Affairs Loma Linda Healthcare System, Loma Linda, California, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Bipin N Savani
- Department of Medicine, Hematology, Stem Cell Transplantation and Cellular Therapy Section, Division of Hematology/Oncology, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, Tennessee, USA
| | - Eric A Gehrie
- American Red Cross, National Headquarters, Washington DC, USA
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Farroni JS, Tumilty E, Mukherjee D, McCammon S, Chooljian DM, Eves MM. Emerging Roles of Clinical Ethicists. The Journal of Clinical Ethics 2019. [DOI: 10.1086/jce2019303262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Gasho CJ, Torralba KD, Chooljian DM, Cohen A, Dinh VA. Impact of a lung ultrasound course for rheumatology specialists (IMPACT-2). Clin Exp Rheumatol 2019; 37:380-384. [PMID: 30183605] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) plays an increasing role in diagnosis and monitoring of interstitial lung disease (ILD). Connective tissue disorders (CTD) frequently cause ILD, and often presents symptomatically after irreversible fibrosis has ensued. As point-of-care musculoskeletal ultrasound (US) is commonly utilised by rheumatologists, translating this US expertise towards LUS places the rheumatologist in a position to screen for ILD. However, a standardised curriculum for the rheumatology community is lacking. The aim of this study is to determine the effectiveness of a formalised lung US training course for rheumatologists. METHODS Four rheumatology fellows and four board-certified rheumatologists participated in a 4-hour training session. Pre-course, post-course and 6-month follow-up surveys evaluated perceptions towards previous US experience, training, clinical utility and attitudes toward lung US. Didactics explained the protocols utilised in ILD evaluation. Evaluation of knowledge in US physiology, lung anatomy, artifact and pathology recognition were done through written exams before, after training, and at 6 months and through a practical exam using live models and simulation. RESULTS Temporally there was overall improvement in written test scores. Improvement was noted in overall practical skill score following training course (17.4% vs. 92.9%, p<0.001), in written test scores 49.3% vs. 72.5% p<0.001), and pathology identification (26.5% vs. 79.6%, p<0.001). Six-month follow assessments were similar to post-test results revealing similar written scores (70.6%) and practical scores (89.7%). CONCLUSIONS This formalised lung ultrasound training course was effective in improving skills and knowledge of rheumatology specialists.
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Affiliation(s)
- Christopher J Gasho
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - David M Chooljian
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University; and Section of Pulmonology and Critical Care, Loma Linda Veterans Affairs Hospital, Loma Linda, CA, USA
| | - Avi Cohen
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Vi Am Dinh
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, and Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
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Farroni JS, Tumilty E, Mukherjee D, McCammon S, Chooljian DM, Eves MM. Emerging Roles of Clinical Ethicists. J Clin Ethics 2019; 30:262-269. [PMID: 31573971] [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: 06/10/2023]
Abstract
Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders' relationships, and patient-centered care.
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Affiliation(s)
- Jeffrey S Farroni
- Associate Professor and Director of the Institutional Ethics Program at the Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas USA.
| | - Emily Tumilty
- Clinical Ethicist at University of Texas Medical Branch Health and Assistant Professor at Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas USA.
| | - Debjani Mukherjee
- Director of the Donnelley Ethics Program at the Shirley Ryan AbilityLab and Associate Professor of Physical Medicine and Rehabilitation and of Medical Education at Northwestern University Feinberg School of Medicine in Chicago, Illinois USA.
| | - Susan McCammon
- Professor of Otolaryngology-Head and Neck Surgery and Assistant Director of the Center for Palliative and Supportive Care at the University of Alabama at Birmingham in Birmingham, Alabama USA.
| | - David M Chooljian
- Chief of the Ethics Consultation Service for the Veterans Affairs Loma Linda Healthcare System and Faculty of the Schools of Medicine and Religion of Loma Linda University in Loma Linda, California USA.
| | - Margot M Eves
- Director of the Clinical Ethics Immersion Program and Staff in the Center for Bioethics at the Cleveland Clinic in Cleveland, Ohio USA.
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Chooljian DM, Hallenbeck J, Ezeji-Okoye SC, Sebesta R, Iqbal H, Kuschner WG. Emotional Support for Health Care Professionals: A Therapeutic Role for the Hospital Ethics Committee. J Soc Work End Life Palliat Care 2016; 12:277-288. [PMID: 27462956 DOI: 10.1080/15524256.2016.1200519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in the case presented.
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Affiliation(s)
- David M Chooljian
- a Pulmonary Section, Medical Service, Veterans Affairs Loma Linda VA Healthcare System; and Division of Pulmonary and Critical Care Medicine, Department of Medicine , Loma Linda University School of Medicine , Loma Linda , California , USA
| | - James Hallenbeck
- b Extended Care (Nursing Home Care, Home Care, Hospice and Palliative Care), Veterans Affairs Palo Alto Health Care System; and Division of General Medical Disciplines, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
| | - Stephen C Ezeji-Okoye
- c Director's Office Veterans Affairs Palo Alto Healthcare System; and Division of General Medical Disciplines, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
| | - Robert Sebesta
- d Social Work Service , Central Texas Veterans Health Care System , Temple , Texas , USA
| | - Hasan Iqbal
- e Pulmonary Section, Medical Service , Veterans Affairs Palo Alto Health Care System , Palo Alto , California , USA
| | - Ware G Kuschner
- f Pulmonary Section, Medical Service, Veterans Affairs Palo Alto Health Care System; and Division of Pulmonary and Critical Care Medicine, Department of Medicine , Stanford University School of Medicine , Palo Alto , California , USA
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