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Kaur N, Xie X, Korogodina A, Ayesha B, Cleven K, Kumthekar A. AB1421 IMPACT OF HOSPITALIZATION ON CLINICAL OUTCOMES IN PATIENTS WITH CONNECTIVE TISSUE DISEASE ASSOCIATED INTERSTITIAL LUNG DISEASE (CTD-ILD) - A SINGLE CENTER OBSERVATIONAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.104] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundInterstitial lung disease(ILD) is major cause of morbidity and mortality in patients with connective tissue disease (CTD). Hospitalization is being increasingly recognized as poor prognostic indicator in these patients.ObjectivesThe objective of our study was to assess the impact of hospitalization on clinical outcomes in patients with CTD-ILD.MethodsWe conducted a retrospective chart review of patients with radiologically or biopsy proven ILD associated with rheumatologist diagnosed CTD who were seen at Montefiore Medical Center between January 2007 and December 2018. Patients with age>18 years who had either 2 CT scans of the chest and/or 2 sets of pulmonary function tests (PFT) atleast 6 months apart were included in the study. Clinical demographics, cause of hospitalization, length of stay, use of immunosuppression and mortality were identified. Patients were stratified into 2 cohorts; non-hospitalized and hospitalized patients. The latter cohort was further sub-stratified into patients with cardiopulmonary vs. non-cardiopulmonary hospitalization (Figure 1). Two-sample t-tests and Wilcoxon’s rank sum tests were used for comparing the continuous variables. Chi-square tests and Fisher’s exact tests were used for comparing the categorical variables as appropriate. Kaplan-Meier method was used for calculating the survival probabilities, and log-rank tests were used to compare differences between the groups.ResultsDuring the study period, we identified 213 patients with CTD-ILD using ICD 9/10 code. Of the 213 patients, 96 met our inclusion criteria and 73 (76%) had at least 1 hospitalization (Figure 1). Both groups were similar in baseline clinical characteristics but we identified significantly higher transplant referrals in the hospitalized group(23.9%) vs. non-hospitalized group(0%) (Table 1). Overall rheumatoid arthritis (29.2%) was the most common CTD associated ILD followed by inflammatory myositis (21.9%) and scleroderma (14.6%). Median time from diagnosis of ILD to first hospitalization was 1.42 years.Table 1.Baseline Characteristics of patients with CTD-ILDCharacteristicEntire Cohort (n = 96)Patients with CTD-ILD and hospitalization (n = 73)Patients with CTD-ILD and no hospitalization (n = 23)p-valueAge(mean ± SD)54.15 ± 13.9754.82 ± 13.7752.00 ± 14.710.40Female, n (%)76 (79.2)56 (76.7)20 (87.0)0.39Race, % (n)0.10 Black38 (39.6)31 (42.5)7 (30.4) White4 (4.2)3 (4.1)1 (4.4) Others54 (56.2)39(53.4)15(65.3)Ethnicity, % (n) (Hispanic)44 (53.7)35 (53.0)9 (56.3)0.82Former or active smoker, % (n)41 (42.7)34 (46.6)7 (30.4)0.17Pulmonary hypertension, % (n)28 (31.1)24 (33.3)4 (22.2)0.36FVC, n (%)0.37Moderately severe(47.1-64.2)37 (44.6)26 (40.6)11 (57.9)Severe(24.3-47.0)7 (8.4)6 (9.4)1 (5.3)DLCO, n(%)0.30Moderate26(31.7)23(37.1)3(15.0)Severe25(30.5)17(27.4)8(40.0)Immunosuppression, n(%)78 (81.3)59 (80.8)19 (82.6)1.00Transplant referral, n(%)17 (18.3)17 (23.9)0 (0)0.01The patients hospitalized for cardiopulmonary cause were significantly older(57.2 ±13.1 years) than those admitted with non-cardiopulmonary cause(49.2±14.8 years)(Mean±SD). Older age (HR 1.95, p=0.02) and length of stay greater than 7 days for cardiopulmonary cause(HR 4.82,p=0.01) was associated with higher risk of mortality.Kaplan Meier curve analysis showed that hospitalization (p-value=0.02) was associated with statistically significant increased risk of death.Conclusion-Hospitalization in CTD-ILD patients especially length of stay more than 7 days due to cardiopulmonary causes was associated with statistically significant increased risk of death.Male gender and older age was associated with a worse prognosis in patients who were hospitalized.References[1]Ratwani AP, Ahmad KI, Barnett SD, Nathan SD, Brown AW. Connective tissue disease-associated interstitial lung disease and outcomes after hospitalization: A cohort study. Respiratory Medicine. 2019;154:1-5. doi:10.1016/j.rmed.2019.05.020Disclosure of InterestsNone declared
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Davis P, Edie AH, Rushton S, Cleven K. Quality improvement project to increase screening and referral for biologic therapy for patients with uncontrolled asthma. J Asthma 2022; 59:2386-2394. [PMID: 34929114 DOI: 10.1080/02770903.2021.2020814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Asthma is a treatable chronic disease of airway inflammation with varying levels of control and severity. Biological therapy is an effective evidence-based treatment for patients with allergic and eosinophilic phenotypes of asthma who are classified as poorly controlled moderate to severe asthma. Yet, evidence-based treatments are infrequently used to support effective care of poorly controlled moderate and severe asthma. This quality improvement (QI) project aimed to increase the number of patients with uncontrolled moderate to severe asthma at an outpatient asthma center who are screened and referred for biologic therapy when appropriate. METHODS A guideline-based biologic screening protocol was implemented using plan-do-study-act (PDSA) methodology allowing for a systematic approach for implementation, monitoring and making adjustments. A pre- and post-independent groups comparative design was utilized to evaluate screening and referral data. RESULTS Screening improved significantly from pre- (n = 30, 23.8%) to post-implementation (n = 17, 70.8%), p < 0.001; phi = .372. Referrals to biologics also improved from 42.4% (n = 28) to 93.3% (n = 14), p < 0.001; phi = .396. Providers reported increased knowledge, confidence, and satisfaction with the asthma screening protocol at post-implementation. CONCLUSIONS The implementation of an asthma screening protocol for asthma patients in an ambulatory center is an effective way of increasing screening for eligibility for biologic therapy. Adhering to the standard of care based on evidence-based guidelines increased access to biologic therapy with a higher percentage of patients being referred for therapy.
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Hena KM, Yip J, Jaber N, Goldfarb D, Fullam K, Cleven K, Moir W, Zeig-Owens R, Webber MP, Spevack DM, Judson MA, Maier L, Krumerman A, Aizer A, Spivack SD, Berman J, Aldrich TK, Prezant DJ. Clinical Course of Sarcoidosis in World Trade Center-Exposed Firefighters. Chest 2017; 153:114-123. [PMID: 29066387 DOI: 10.1016/j.chest.2017.10.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is believed to represent a genetically primed, abnormal immune response to an antigen exposure or inflammatory trigger, with both genetic and environmental factors playing a role in disease onset and phenotypic expression. In a population of firefighters with post-World Trade Center (WTC) 9/11/2001 (9/11) sarcoidosis, we have a unique opportunity to describe the clinical course of incident sarcoidosis during the 15 years postexposure and, on average, 8 years following diagnosis. METHODS Among the WTC-exposed cohort, 74 firefighters with post-9/11 sarcoidosis were identified through medical records review. A total of 59 were enrolled in follow-up studies. For each participant, the World Association of Sarcoidosis and Other Granulomatous Diseases organ assessment tool was used to categorize the sarcoidosis involvement of each organ system at time of diagnosis and at follow-up. RESULTS The incidence of sarcoidosis post-9/11 was 25 per 100,000. Radiographic resolution of intrathoracic involvement occurred in 24 (45%) subjects. Lung function for nearly all subjects was within normal limits. Extrathoracic involvement increased, most prominently joints (15%) and cardiac (16%) involvement. There was no evidence of calcium dysmetabolism. Few subjects had ocular (5%) or skin (2%) involvement, and none had beryllium sensitization. Most (76%) subjects did not receive any treatment. CONCLUSIONS Extrathoracic disease was more prevalent in WTC-related sarcoidosis than reported for patients with sarcoidosis without WTC exposure or for other exposure-related granulomatous diseases (beryllium disease and hypersensitivity pneumonitis). Cardiac involvement would have been missed if evaluation stopped after ECG, 48-h recordings, and echocardiogram. Our results also support the need for advanced cardiac screening in asymptomatic patients with strenuous, stressful, public safety occupations, given the potential fatality of a missed diagnosis.
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Affiliation(s)
- Kerry M Hena
- Pulmonary & Critical Care Division, Department of Medicine, NYU School of Medicine, New York, NY
| | - Jennifer Yip
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - David Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Kelly Fullam
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Krystal Cleven
- Pulmonary Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
| | - William Moir
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Daniel M Spevack
- Cardiology Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
| | - Marc A Judson
- Pulmonary & Critical Care Division, Albany Medical College, Albany, NY
| | - Lisa Maier
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, CO
| | - Andrew Krumerman
- Cardiology Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
| | - Anthony Aizer
- Cardiology Division, Department of Medicine, NYU School of Medicine, New York, NY
| | - Simon D Spivack
- Pulmonary Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
| | - Jessica Berman
- Rheumatology Division, Hospital for Special Surgery, New York, NY
| | - Thomas K Aldrich
- Pulmonary Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY; Pulmonary Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
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Hena K, Yip J, Jaber N, Goldfarb D, Fullam K, Cleven K, Christodoulou V, Moir W, Hena Z, Crosse T, Zeig-Owens R, Webber M, Plotycia S, Gritz D, Spevack D, Soghier I, Prezant D, Aldrich T. Clinical Characteristics of Sarcoidosis in World Trade Center (WTC) Exposed Fire Department of the City of New York (FDNY) Firefighters. Chest 2016. [DOI: 10.1016/j.chest.2016.08.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Cleven K, healy L, Wei M, Koenig S, Mayo P, Narasimhan M, Oks M. Safety of Phenobarbital Use for Alcohol Withdrawal Syndrome in the Medical Intensive Care Unit. Chest 2015. [DOI: 10.1378/chest.2281283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lutgendorf SK, Antoni MH, Ironson G, Klimas N, Kumar M, Starr K, McCabe P, Cleven K, Fletcher MA, Schneiderman N. Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. J Consult Clin Psychol 1997; 65:31-43. [PMID: 9103732 DOI: 10.1037/0022-006x.65.1.31] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [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: 02/04/2023]
Abstract
This study tested the effects of a 10-week group cognitive-behavioral stress management (CBSM) intervention on mood and immunologic parameters in HIV-seropositive gay men whose disease had progressed to a symptomatic stage. Men were randomized to either CBSM or a modified waiting-list control group. The CBSM intervention significantly decreased self-reported dysphoria, anxiety, and total distress. Individuals who practiced relaxation more consistently had significantly greater drops in dysphoria. The intervention also decreased herpes simplex virus-Type 2 (HSV-2) immunoglobulin G antibody titers. The control group showed no significant changes in either mood or antibody titers. Individual difference analyses revealed that decreases in dysphoria significantly predicted lower HSV-2 antibody titers by the end of the 10-week period. Neither group displayed changes in HSV-Type 1 antibody titers or in CD4+ or CD8+ cell numbers.
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Affiliation(s)
- S K Lutgendorf
- Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA
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