1
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O'Callaghan M, Duignan J, Tarling EJ, Waters DK, McStay M, O'Carroll O, Bridges JP, Redente EF, Franciosi AN, McGrath EE, Butler MW, Dodd JD, Fabre A, Murphy DJ, Keane MP, McCarthy C. Analysis of tissue lipidomics and computed tomography pulmonary fat attenuation volume (CT PFAV ) in idiopathic pulmonary fibrosis. Respirology 2023; 28:1043-1052. [PMID: 37642207 DOI: 10.1111/resp.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE There is increasing interest in the role of lipids in processes that modulate lung fibrosis with evidence of lipid deposition in idiopathic pulmonary fibrosis (IPF) histological specimens. The aim of this study was to identify measurable markers of pulmonary lipid that may have utility as IPF biomarkers. STUDY DESIGN AND METHODS IPF and control lung biopsy specimens were analysed using a unbiased lipidomic approach. Pulmonary fat attenuation volume (PFAV) was assessed on chest CT images (CTPFAV ) with 3D semi-automated lung density software. Aerated lung was semi-automatically segmented and CTPFAV calculated using a Hounsfield-unit (-40 to -200HU) threshold range expressed as a percentage of total lung volume. CTPFAV was compared to pulmonary function, serum lipids and qualitative CT fibrosis scores. RESULTS There was a significant increase in total lipid content on histological analysis of IPF lung tissue (23.16 nmol/mg) compared to controls (18.66 mol/mg, p = 0.0317). The median CTPFAV in IPF was higher than controls (1.34% vs. 0.72%, p < 0.001) and CTPFAV correlated significantly with DLCO% predicted (R2 = 0.356, p < 0.0001) and FVC% predicted (R2 = 0.407, p < 0.0001) in patients with IPF. CTPFAV correlated with CT features of fibrosis; higher CTPFAV was associated with >10% reticulation (1.6% vs. 0.94%, p = 0.0017) and >10% honeycombing (1.87% vs. 1.12%, p = 0.0003). CTPFAV showed no correlation with serum lipids. CONCLUSION CTPFAV is an easily quantifiable non-invasive measure of pulmonary lipids. In this pilot study, CTPFAV correlates with pulmonary function and radiological features of IPF and could function as a potential biomarker for IPF disease severity assessment.
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Affiliation(s)
- Marissa O'Callaghan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Elizabeth J Tarling
- Division of Cardiology, University of California, Los Angeles, California, USA
| | - Darragh K Waters
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Megan McStay
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Orla O'Carroll
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - James P Bridges
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | | | - Alessandro N Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Emmet E McGrath
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonathan D Dodd
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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2
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Khan J, Moran B, McCarthy C, Butler MW, Franciosi AN. Management of comorbidities in difficult and severe asthma. Breathe (Sheff) 2023; 19:230133. [PMID: 38020342 PMCID: PMC10644109 DOI: 10.1183/20734735.0133-2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians' assessment of asthma treatment efficacy.
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Affiliation(s)
- Jehangir Khan
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Barry Moran
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Cormac McCarthy
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Marcus W. Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
| | - Alessandro N. Franciosi
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
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3
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Franciosi AN, McCarthy N, Gaffney B, Duignan J, Sweeney E, O'Connell N, Murphy K, Áinle FN, Butler MW, Dodd JD, Keane MP, Murphy DJ, Curran KM, McCarthy C. Extended D-dimer Cut-offs and Machine Learning for Ruling Out Pulmonary Embolism in individuals undergoing CTPA. Eur Respir J 2022; 59:13993003.00075-2022. [PMID: 35236722 DOI: 10.1183/13993003.00075-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandro N Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Denotes joint first authorship
| | - Nicholas McCarthy
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Denotes joint first authorship
| | - Brian Gaffney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - John Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Eamon Sweeney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Niall O'Connell
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Karen Murphy
- Department of Haematology, St Vincent's University Hospital, Dublin, Ireland
| | - Fionnuala Ní Áinle
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Haematology, Mater Misericordiae Hospital, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jonathan D Dodd
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - David J Murphy
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland .,School of Medicine, University College Dublin, Dublin 4, Ireland
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4
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O'Carroll O, McCarthy C, Butler MW. Treatments for poorly controlled asthma. BMJ 2021; 375:n2355. [PMID: 34607802 DOI: 10.1136/bmj.n2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Orla O'Carroll
- Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Republic of Ireland
| | - Cormac McCarthy
- Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Republic of Ireland
- School of Medicine, University College Dublin, Dublin, Republic of Ireland
| | - Marcus W Butler
- Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Republic of Ireland
- School of Medicine, University College Dublin, Dublin, Republic of Ireland
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5
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of clinician perceptions regarding the potential role for digital health interventions for the management of COPD. Health Informatics J 2021; 27:1460458221994888. [PMID: 33653189 DOI: 10.1177/1460458221994888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/21/2023]
Abstract
Effective self-management of chronic obstructive pulmonary disease (COPD) can lead to increased patient control and reduced health care costs. However, both patients and healthcare professionals encounter significant challenges. Digital health interventions, such as smart oximeters and COPD self-management applications, promise to enhance the management of COPD, yet, there is little evidence to support their use and user-experience issues are still common. Understanding the needs of healthcare professionals is central for increasing adoption and engagement with digital health interventions but little is known about their perceptions of digital health interventions in COPD. This paper explored the perceptions of healthcare professionals regarding the potential role for DHI in the management of COPD. Snowball sampling was used to recruit the participants (n = 32). Each participant underwent a semi-structured interview. Using NVivo 12 software, thematic analysis was completed. Healthcare professionals perceive digital health interventions providing several potential benefits to the management of COPD including the capture of patient status indicators during the interappointment period, providing new patient data to support the consultation process and perceived digital health interventions as a potential means to improve patient engagement. The findings offer new insights regarding potential future use-cases for digital health interventions in COPD, which can help ease user-experience issues as they align with the needs of healthcare professionals.
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Affiliation(s)
| | | | - John Cullen
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Ireland.,St. Vincent's University Hospital, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
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6
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Watchorn D, O'Shea D, Butler MW. Asthma Exacerbations in Individuals on Glucagon-like Peptide-1 Receptor Agonists for Type 2 Diabetes. Am J Respir Crit Care Med 2021; 203:923-924. [PMID: 33508209 PMCID: PMC8017582 DOI: 10.1164/rccm.202011-4162le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David Watchorn
- University College Dublin School of Medicine Dublin, Ireland and
| | - Donal O'Shea
- St. Vincent's University Hospital, Dublin, Ireland
| | - Marcus W Butler
- University College Dublin School of Medicine Dublin, Ireland and.,St. Vincent's University Hospital, Dublin, Ireland
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7
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O'Carroll O, MacCann R, O'Reilly A, Dunican EM, Feeney ER, Ryan S, Cotter A, Mallon PW, Keane MP, Butler MW, McCarthy C. Remote monitoring of oxygen saturation in individuals with COVID-19 pneumonia. Eur Respir J 2020; 56:13993003.01492-2020. [PMID: 32616588 PMCID: PMC7331654 DOI: 10.1183/13993003.01492-2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 01/16/2023]
Abstract
Coronavirus disease 2019 (COVID-19), an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has spread rapidly worldwide, resulting in significant mortality and placing major strain on healthcare systems. Although the clinical course is variable, one in five patients will require hospitalisation for management, with older age and the presence of comorbidities increasing the risk of more severe disease [1–3]. The median time from first onset of symptoms to development of acute respiratory distress syndrome in those who progress to severe disease is estimated to be 8.0 days [4]. Remote monitoring of oxygen saturation in cases of COVID-19 pneumonia may facilitate discharge, relieving burden on bed demand and allowing safe follow-up for this disease in which the sequelae are unknownhttps://bit.ly/3cTXnZU
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Affiliation(s)
- Orla O'Carroll
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Rachel MacCann
- Dept of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife O'Reilly
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Eleanor M Dunican
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Eoin R Feeney
- Dept of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Patrick W Mallon
- Dept of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland .,School of Medicine, University College Dublin, Dublin, Ireland
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8
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McCarthy C, Savinelli S, Feeney ER, Butler MW, O'Broin C, Ryan S, O'Neill L, Murphy DJ, Gallagher CG, McKone EF, Waqas S, Cotter A, Doran P, Keane MP, Mallon PW. Tocilizumab therapy in individuals with COVID-19 infection and hyperinflammatory state. Respirology 2020; 25:1090-1094. [PMID: 32696570 PMCID: PMC7404856 DOI: 10.1111/resp.13912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Stefano Savinelli
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Eoin R Feeney
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cathal O'Broin
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Lorraine O'Neill
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Charles G Gallagher
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Edward F McKone
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Sarmad Waqas
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick W Mallon
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
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9
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Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, McCarthy C. Prevalence of comorbid asthma in COVID-19 patients. J Allergy Clin Immunol 2020; 146:334-335. [PMID: 32553599 PMCID: PMC7284278 DOI: 10.1016/j.jaci.2020.04.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Marcus W Butler
- St Vincent's University Hospital, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | - Aoife O'Reilly
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Eleanor M Dunican
- St Vincent's University Hospital, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Mallon
- St Vincent's University Hospital, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Eoin R Feeney
- St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Michael P Keane
- St Vincent's University Hospital, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- St Vincent's University Hospital, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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10
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. Exploring the barriers and facilitators for the use of digital health technologies for the management of COPD: a qualitative study of clinician perceptions. QJM 2020; 113:163-172. [PMID: 31545374 DOI: 10.1093/qjmed/hcz241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Digital health technology (DHT) promises to support patients and healthcare professionals (HCPs) to optimize the management of chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence demonstrating the effectiveness of DHT for the management of COPD. One reason for this is the lack of user-involvement in the development of DHT interventions in COPD meaning their needs and preferences are rarely accounted for in the design phase. Although HCP adoption issues have been identified in relation to DHT, little is known about the challenges perceived by HCPs providing care to COPD patients. Therefore, this study aims to qualitatively explore the barriers and facilitators HCPs perceive for the use of DHT in the management of COPD. METHODS Participants (n = 32) were recruited using snowball sampling from two university hospitals and several general practitioner clinics. A semi-structured interview was conducted with each participant. NVivo 12 software was used to complete thematic analysis on the data. RESULTS Themes identified include: data quality; evidence-based care; resource constraints; and digital literacy presented as barriers; and facilitators include the following themes: digital health training and education; improving HCP digital literacy; and Personalized prescribing. Patient-centered approaches, such as pulmonary rehabilitation and shared decision-making were suggested as implementation strategies to ease the adoption of digital health for the management of COPD. CONCLUSION These findings contribute new insights about the needs and preferences of HCPs working in COPD regarding DHT. The findings can be used to help mitigate user-experience issues by informing the design of person-centered implementation and adoption strategies for future digital health interventions in COPD.
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Affiliation(s)
- P Slevin
- From the The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - T Kessie
- From the The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - J Cullen
- Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - M W Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - S C Donnelly
- Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - B Caulfield
- From the The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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11
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of chronic obstructive pulmonary disease patient perceptions of the barriers and facilitators to adopting digital health technology. Digit Health 2019; 5:2055207619871729. [PMID: 31489206 PMCID: PMC6710666 DOI: 10.1177/2055207619871729] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
Objective Non-adherence to self-management plans in chronic obstructive pulmonary
disease (COPD) results in poorer outcomes for patients. Digital health
technology (DHT) promises to support self-management by enhancing the sense
of control patients possess over their disease. COPD digital health studies
have yet to show significant evidence of improved outcomes for patients,
with many user-adoption issues still present in the literature. To help
better address the adoption needs of COPD patients, this paper explores
their perceived barriers and facilitators to the adoption of DHT. Methods A sample of convenience was chosen and patients (n = 30)
were recruited from two Dublin university hospitals. Each patient completed
a qualitative semi-structured interview. Thematic analysis of the data was
performed using NVivo 12 software. Results Barrier sub-themes included lack of perceived usefulness, digital literacy,
illness perception, and social context; facilitator sub-themes included
existing digital self-efficacy, personalised education, and community-based
support. Conclusion The findings represent a set of key considerations for researchers and
clinicians to inform the design of patient-centred study protocols that aim
to account for the needs and preferences of patients in the development of
implementation and adoption strategies for DHT in COPD.
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Affiliation(s)
- Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Ireland
| | - Threase Kessie
- The Insight Centre for Data Analytics, University College Dublin, Ireland
| | - John Cullen
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Brian Caulfield
- The Insight Centre for Data Analytics, University College Dublin, Ireland
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12
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. Exploring the potential benefits of digital health technology for the management of COPD: a qualitative study of patient perceptions. ERJ Open Res 2019; 5:00239-2018. [PMID: 31111039 PMCID: PMC6513035 DOI: 10.1183/23120541.00239-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/08/2019] [Indexed: 11/05/2022] Open
Abstract
Engaging chronic obstructive pulmonary disease (COPD) patients to actively participate in self-management has proven difficult. Digital health technology (DHT) promises to facilitate a patient-centred care model for the management of COPD by empowering patients to self-manage effectively. However, digital health studies in COPD have yet to demonstrate significant patient outcomes, suggesting that this research has still to adequately address the needs of patients in the intervention development process. The current study explored COPD patients' perceptions of the potential benefits of DHT in the self-management and treatment of their disease. A sample of convenience was chosen and participants (n=30) were recruited from two Dublin university hospitals and each underwent a qualitative semi-structured interview. Thematic analysis of the data was completed using NVivo 12 software. Six themes were identified: symptom management, anxiety management, interaction with physician, care management, personalising care and preventative intervention. In our findings, patients reported a willingness to take a more active role in self-management using DHT. They perceived DHT potentially enhancing their self-management by improving self-efficacy and engagement and by supporting healthcare professionals to practise preventative care provision. The findings can be used to inform patient-centred COPD digital interventions for researchers and clinicians who wish to develop study aims that align with the needs and preferences of patients.
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Affiliation(s)
- Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Threase Kessie
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - John Cullen
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Dublin, Ireland.,St Vincent's University Hospital, Dublin, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Brian Caulfield
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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13
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Lambe G, Linnane N, Callanan I, Butler MW. Cleaning up the paper trail - our clinical notes in open view. Int J Health Care Qual Assur 2018; 31:228-236. [PMID: 29687753 DOI: 10.1108/ijhcqa-09-2016-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Ireland's physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present. Design/methodology/approach A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley's location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded. Findings During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses' station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more. Practical implications This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information. Originality/value While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary's favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.
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Affiliation(s)
- Gerard Lambe
- Acute Medical Assessment Unit, St James's Hospital, Dublin, Ireland
| | - Niall Linnane
- Department of Paediatric Surgery, Children's University Hospital , Dublin, Ireland
| | - Ian Callanan
- Clinical Audit Department, St Vincent's University Hospital , Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital , Dublin, Ireland and University College Dublin , Dublin, Ireland
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Khan F, Mat A, Hogan AE, Kent BD, Eigenheer S, Corrigan MA, O'Shea D, Butler MW. Preliminary asthma-related outcomes following glucagon-like peptide 1 agonist therapy. QJM 2017; 110:853-854. [PMID: 28673015 DOI: 10.1093/qjmed/hcx125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Khan
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
- Respiratory Department, University College Dublin, Dublin, Ireland
| | - A Mat
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - A E Hogan
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - B D Kent
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - S Eigenheer
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - M A Corrigan
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - D O'Shea
- Endocrine Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
- Endocrine Department, University College Dublin, Dublin, Ireland
| | - M W Butler
- From the Respiratory Department, Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
- Respiratory Department, University College Dublin, Dublin, Ireland
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Fabre A, Treacy A, Lavelle LP, Narski M, Faheem N, Healy D, Dodd JD, Keane MP, Egan JJ, Jebrak G, Mal H, Butler MW. Smoking-Related Interstitial Fibrosis: Evidence of Radiologic Regression with Advancing Age and Smoking Cessation. COPD 2017; 14:603-609. [DOI: 10.1080/15412555.2017.1378631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aurélie Fabre
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Ann Treacy
- Department of Histopathology, Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Lisa P Lavelle
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Maciek Narski
- Department of Cardio-Thoracic Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Nazia Faheem
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - David Healy
- Department of Cardio-Thoracic Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Jonathan D. Dodd
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Michael P. Keane
- Department of Respiratory Medicine, St Vincent's University Hospital and University College Dublin School of Medicine, Dublin, 4, Ireland
| | - James J. Egan
- National Lung Transplant Programme, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gilles Jebrak
- Service de pneumologie B et de transplantations pulmonaires, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France
| | - Hervé Mal
- Service de pneumologie B et de transplantations pulmonaires, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France
| | - Marcus W. Butler
- Department of Respiratory Medicine, St Vincent's University Hospital and University College Dublin School of Medicine, Dublin, 4, Ireland
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Abrahamian FM, Aldape MJ, Aldasoro E, Allen UD, Al-Sum H, Anadkat MJ, Anders K, Angelakis E, Angus BJ, Antoniadou A, Arena F, Arends JE, Arribas JR, Artenstein AW, Atherton JC, Aucott JN, Aw TC, Babcock HM, Bailey R, Bailey TC, Banks AZ, Barillo DJ, Barrette EP, Bauer MP, Bayston R, Beard CB, Beardsley J, Beeching NJ, Bégué RE, Beldi G, Benson CA, Berbari EF, Berenger JM, Berger C, Bernardino JI, Bille J, Billioux AC, Bitnun A, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Blum J, Blumberg EA, Bonomo RA, Bonten MJ, Bourayou R, Bouza E, Brandt KA, Bretelle F, Brisse S, Britton WJ, Brook I, Brouwer MC, Browne SK, Bryant AE, Bühler S, Bulger EM, Buller RML, Burke LA, Burri C, Butler MW, Calandra T, Calfee DP, Calvo-Cano A, Cameron DW, Carcillo JA, Carson G, Chambers ST, Charrel RN, Nguyen VCV, Chevaliez S, Chiller TM, Christaki E, Chung KK, Clifford DB, Clumeck N, Cohen J, Collinge J, Conlon CP, Conrad C, Cooke FJ, Cope JR, Corey GR, Cross JH, Cunha BA, Cunha CB, D'Journo B, Daikos GL, Daniels JM, Davidson RN, Day NP, De Cock KM, de Silva TI, de Vries HJ, de Wit S, Delaloye J, Denning DW, Dennis DT, Dhanireddy S, Dielubanza EJ, Diemert DJ, Doganay M, Doherty T, Dolecek C, Dondorp AM, Douglas A, Drancourt M, Dubourg G, Dudley MN, Durand G, Eckhardt BJ, Efstratiou A, Ekkelenkamp MB, Eranki A, Erdem H, Escota GV, Evans HL, Eziefula AC, Fenollar F, Fenwick A, Fierer J, Finch RG, Fleckenstein JM, Forstner C, Foschi F, Fournier PE, French MA, Gage KL, Garcia LS, Gascon J, Gastañaduy AS, Gautret P, Geisler WM, Ghanem KG, Giani T, Giannella M, Gilliam BL, Gilliet M, Glaser CA, Glupczynski Y, Gnann JW, Goldstein EJ, Gottstein B, Gouriet F, Gravitt PE, Green MD, Green ST, Groll AH, Gulick RM, Gupta A, Habib G, Harbarth S, Harris M, Hayden FG, Hetem DJ, Hill PC, Hirschel B, Hodowanec AC, Hoffart L, Hoffmann C, Holland SM, Horby PW, Horne DJ, Hraiech S, Hull MW, Huttner A, Ingram RJ, Islam J, Ison MG, James SH, Jenkins C, Jenkins SG, Jensen JS, Johnston C, Jones TB, Jordan SJ, Julian KG, Kato Y, Kauffman CA, Kaye KS, Keane MP, Keeney J, Kelly P, Kent SJ, Kern WV, Keynan Y, Kim AA, Koné-Paut I, Kosmidis C, Kroes AC, Kroon FP, Ksiazek TG, Kuhlmann FM, Kuijper EJ, Kwon JH, Kyei GB, Lacombe K, Lagacé-Wiens P, Lagier JC, Lamagni T, Landraud L, Lanternier F, LaPlante KL, Lawn SD, Lawrence SJ, Leblebicioglu H, Lee N, Leggett JE, Lehours P, Levy PY, Leyh RG, Lillis RA, Limmathurotsakul D, Lin J, Lindquist HA, Lipsky BA, Liscynesky C, Looney D, Lortholary O, Lowy FD, Luft BJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Mallon PW, Mangino JE, Manuel O, Marchetti O, Marks KM, Marr KA, Marrazzo J, Marschall J, Martin DH, Matonti F, Matulewicz RS, Mayer KH, McCulloh RJ, McGready R, Mdodo R, Mead S, Mégraud F, Meintjes G, Metcalf SC, Michaels MG, Migliori GB, Miles MA, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Misch EA, Mitreva M, Montaner JS, Moore CB, Muñoz P, Muñoz J, Murray CK, Musso D, Mutengo M, Mutizwa MM, Naber KG, Natarajan P, Neme S, Newton PN, Nichols RA, Nicolle LE, Nosten F, Notarangelo LD, Nutman TB, Nyirjesy P, O'Connell PR, Opal SM, Ormerod LP, Osmon DR, Pankert MB, Pantaleo G, Papazian L, Parente DM, Parola P, Parsaei S, Pascual MA, Patel R, Patrozou E, Pawlotsky JM, Peacock SJ, Pechère JC, Pelegrin I, Peters BS, Peters EJ, Petersen JM, Petersen LR, Petraitis V, Pham LL, Picado A, Pilatz A, Pilmis B, Pinazo MJ, Pletz MW, Pogue JM, Polgreen EL, Polgreen PM, Posfay-Barbe KM, Powderly WG, Presti R, Prod'hom G, Puolakkainen M, Quinn TC, Raoult D, Razonable RR, Read RC, Redfield RR, Rentenaar RJ, Reynolds SJ, Ribi C, Richardson MD, Ritter ML, Roch A, Rockstroh JK, Rojek A, Romero JR, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rossolini GM, Rubinstein E, Ryan G, Safren SA, Sahasrabuddhe VV, Saikku PA, Sajadi MM, Salvaggio MR, Santos CA, Satlin MJ, Schaeffer AJ, Schimmer C, Schooley RT, Schumacher RF, Sha BE, Shapiro DS, Sheehan G, Shlaes DM, Shoham S, Simmons CP, Simon DW, Simon MS, Simonsen KA, Slack MP, Smith TT, Sobel JD, Souli M, Sridhar S, Steckelberg JM, Stevens DL, Strah H, Sturm AW, Sungkanuparph S, Tabrizi SJ, Tacconelli E, Tan CS, Taplitz RA, Thomas G, Thomas LD, Thuny F, Thwaites G, Tissot F, Tønjum T, Torriani FJ, Toso C, Tulkens PM, Tunkel AR, Turner CE, Ustianowski AP, van Bambeke F, van Crevel R, van de Beek D, van Delden C, van der Eerden MM, van der Meer JW, van der Poll T, van Ingen J, van Putten J, Vaudaux BP, Vermund SH, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wald A, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Watkins RR, Weatherall DJ, Weber R, Weidner W, White JR, White PJ, Whitehorn J, Whitley RJ, Whitty CJ, Wiersinga WJ, Wilcox MH, Williams TN, Wilson CC, Wilson ME, Wisplinghoff H, Wood R, Wunderink RG, Wyles D, Yang ZT, Yoder JS, Zaidi NA, Zimmer AJ, Zuckerman JN, Zumla A. List of Contributors. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00234-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Brady D, Lavelle LP, McEvoy SH, Murphy DJ, Gallagher A, Gibney B, Butler MW, Shortt F, McMullan M, Fabre A, Lynch DA, Abbara S, Donnelly SC, Dodd JD. Assessing fibrosis in pulmonary sarcoidosis: late-enhanced MRI compared to anatomic HRCT imaging. QJM 2016; 109:257-64. [PMID: 26537956 DOI: 10.1093/qjmed/hcv200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/05/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- D Brady
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - L P Lavelle
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S H McEvoy
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Gallagher
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - B Gibney
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Shortt
- Department of Radiology, St Vincent's Private Hospital, Elm Park, Dublin 4, Ireland
| | - M McMullan
- Department of Radiology, St Vincent's Private Hospital, Elm Park, Dublin 4, Ireland
| | - A Fabre
- Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - S Abbara
- Department of Radiology, UT Southwestern, Dallas, TX, USA
| | - S C Donnelly
- Department of Respiratory Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J D Dodd
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Walsh SM, Gallagher A, Gallagher R, Barnes E, Doherty GA, Dodd JD, Butler MW. First do no harm: nasogastric tube placement and confirmation. QJM 2016; 109:219. [PMID: 26319701 DOI: 10.1093/qjmed/hcv160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S M Walsh
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - A Gallagher
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - R Gallagher
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - E Barnes
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - G A Doherty
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - J D Dodd
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - M W Butler
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
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Nicholson TT, Franciosi A, Landers S, Butler MW. Assessing potential risks of treatment with long-term azithromycin in COPD patients: long-term oxygen users beware? Ir J Med Sci 2015; 185:993-997. [PMID: 26502012 DOI: 10.1007/s11845-015-1372-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/21/2015] [Accepted: 10/10/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Long-term daily azithromycin therapy reduces the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) in a randomized controlled clinical trial setting. Concerns exist regarding arrhythmic and auditory toxicities from chronic use in the real-world setting. We hypothesized that risk factors for adverse drug reactions to azithromycin would be more frequent than previously reported, that certain specific subgroups would have different frequencies of these risk factors and that the whispered voice test would be a useful test with which to test for hearing deficits. METHODS Following ethical approval, 47 consecutive hospital-based patients with a mean age 69 years ± 8.2, and with physician-diagnosed COPD (mean FEV1 45.1 ± 18 % predicted), were screened for subjective hearing impairment (screening questions and whispered voice test) and by electrocardiogram for prolonged QTc. Other potential risk factors and contraindications to long-term daily azithromycin were sought. RESULTS In total, 38 patients (80.9 %) had at least one risk factor or contraindication to azithromycin treatment. 19 patients (40.4 % of total) had subjective hearing impairment. 17 (36.1 %) had prolonged QTc intervals. 4 patients (8.51 %) had contraindicating co-morbidities. Those on long-term oxygen therapy were significantly more likely to have at least one risk factors or contraindications to azithromycin (p = 0.0025). CONCLUSION In a COPD population who would otherwise potentially be candidates for long-term daily azithromycin therapy, over 80 % had risk factors for complications from long-term daily azithromycin. Preventative treatment with long-term daily azithromycin may be appropriate for fewer COPD patients than previously thought, especially in those on long-term oxygen therapy.
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Affiliation(s)
- T T Nicholson
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland
| | - A Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland
| | - S Landers
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland
| | - M W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital and University College Dublin, Dublin 4, Ireland.
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Mitchell PD, Das JP, Murphy DJ, Keane MP, Donnelly SC, Dodd JD, Butler MW. Idiopathic pulmonary fibrosis with emphysema: evidence of synergy among emphysema and idiopathic pulmonary fibrosis in smokers. Respir Care 2014; 60:259-68. [PMID: 25389350 DOI: 10.4187/respcare.03389] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Emphysema and fibrosis, typically the idiopathic pulmonary fibrosis (IPF) form of usual interstitial pneumonia (UIP), can co-exist as combined pulmonary fibrosis emphysema (CPFE). It is unknown whether there is a pathobiologic basis for CPFE beyond the coexistence of fibrosis and emphysema. The aim of this study was to ascertain radiologic differences in severity of fibrosis and emphysema in smokers with IPF versus other forms of UIP. METHODS Computed tomography thorax images were prospectively rescored in retrospectively identified smokers (minimum 5-pack-year history) with radiologic UIP (any etiology). Radiologic severity (emphysema/fibrosis/reticulation) was scored in consensus by two radiologists, blinded to clinical details, across 5 lung regional levels, and then correlated with clinical data. RESULTS For the whole cohort (IPF, n=102; non-IPF UIP [mainly rheumatoid arthritis/asbestosis/scleroderma], n=30), IPF and non-IPF UIP smokers were similar regarding pack-year, age, gender, and lung function (P>.1). IPF smokers had greater whole lung fibrosis and reticulation scores (P<.04 in all cases). CPFE was present in n=61 (IPF, n=49; non-IPF UIP, n=12). Compared with smokers with non-IPF CPFE, smokers with IPF and emphysema (IPFE) were similar regarding confounders (P>.1). There were significantly greater regional reticulation severity (P=.009), cumulative emphysema severity (P=.04), and cumulative reticulation severity (P<.001) scores in IPFE versus non-IPF CPFE. CONCLUSIONS When controlled for confounders, smokers with IPFE have worse radiologic CPFE than other smokers with non-IPF UIP and emphysema, suggesting an interactive synergy among IPF, emphysema, and smoking, with more extensive emphysema due to either inherent susceptibility and/or traction effects. IPFE should be considered separately from other CPFE in future work. It is currently unknown whether CPFE is a distinct pathobiologic entity; therefore, we identified subjects with radiologic UIP (any etiology) who had been similarly exposed to smoke, and asked whether there are differences in the extent/severity of radiologic fibrosis and/or emphysema in those with IPF versus individuals with non-IPF UIP. Although relevant confounders were similar, IPF smokers had greater whole lung fibrosis and reticulation scores than smokers with secondary forms of UIP, and in the CPFE subgroup, smokers with IPF/emphysema had worse radiologic CPFE findings than smokers with non-IPF UIP/emphysema. It is shown for the first time that relevant confounding variables do not explain the observed excess radiologic severity of emphysema and fibrosis in smokers with IPF compared with smokers with non-IPF UIP, lending support to the hypothesis that there is a pathobiologic mechanism or synergy involved in IPF with emphysema that is distinct from the mere co-existence of UIP and emphysematous processes.
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Affiliation(s)
| | | | | | - Michael P Keane
- St Vincent's University Hospital, Dublin University College Dublin, Dublin, Republic of Ireland
| | - Seamas C Donnelly
- St Vincent's University Hospital, Dublin University College Dublin, Dublin, Republic of Ireland
| | | | - Marcus W Butler
- St Vincent's University Hospital, Dublin University College Dublin, Dublin, Republic of Ireland
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Abstract
PURPOSE The purpose of this paper is to examine the recording of clinical indication for prescribed sedative/hypnotic (SH) medications in a large, acute tertiary referral hospital. DESIGN/METHODOLOGY/APPROACH All hospital inpatients' medications (n = 367) were audited for prescription details regarding SH medications. Medical notes were then examined for evidence of a recorded indication for such medications. FINDINGS SH medications were prescribed to many hospital inpatients (42.5 per cent) during admission. An indication was documented in the nursing or medical records for 24.4 per cent of patients who were prescribed such medications. Nurses rather than by doctors prescribed most SH medications (74 vs 26 per cent, respectively, p = 0.003). Some patients receiving SH medications were both over 65 and impaired in their mobility (19.2 per cent). The treatment indication was documented in 47 per cent. PRACTICAL IMPLICATIONS Most patients prescribed SH medications have nothing in their medical record explaining why these drugs are being used, including half of the elderly, less mobile patients. All health professionals dealing with SH medications and doctors in particular need to justify the use of such medications in the medical record. For the particularly high-risk groups where SH medications are potentially more dangerous, explicit guidance on why and how such medications are to be used must be provided by prescribers. ORIGINALITY/VALUE For the first time, data are presented on documentation rates for clinical indication of prescribed SH medications across a large acute hospital, and highlights significant shortcomings in practice. This study should inform other organisations of the need to be mindful of facilitating greater compliance with good prescribing practice.
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McCarthy CJ, O'Neill AC, McEvoy SH, Kilcoyne A, Butler MW, Keane MP, Dodd JD. Poststernotomy lymphadenopathy: prevalence, size, and location on chest CT. Diagn Interv Radiol 2014; 19:208-12. [PMID: 23302285 DOI: 10.5152/dir.2013.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to determine the prevalence of enlarged lymph nodes (LNs) in chest computed tomography (CT) scans of patients with a history of sternotomy. MATERIALS AND METHODS The chest CT scans of 271 patients with a history of sternotomy (mean age, 68.3±14.4 years; range, 15-93 years; 178 males) were retrospectively scored in a blind and random manner for the presence, size, and location of enlarged LNs. Scans with known etiologies for enlarged LNs were excluded. Serial scans were available for 15 patients with enlarged LNs. Twenty patients (mean age, 61.2±7.0 years; range, 54-64 years; 15 males) that had cardiac CT data with no cardiac surgery were included as controls. RESULTS Of the 271 patients, 189 had other identifiable etiologies for enlarged LNs. Of the remaining 82 patients, 36 (44%) demonstrated enlarged LNs. None of the control patients presented with enlarged LNs (n=20). The mean size of the enlarged nodes was 13.0±2.0 mm. Enlargement of the lymph nodes in station 4R was most common (n=18, 50%; size, 13.1±2.0 mm), followed by the enlargement of nodes in station 7 (n=16, 44%; size, 12.3±2.2 mm). The majority of patients had one (n=20, 56%) or two (n=12, 33%) nodal stations that showed enlargement. We did not observe any significant association between the number or types of grafts and enlarged LNs. Serial CT scans did not show any significant changes in LN enlargement for any nodal station. CONCLUSIONS Enlarged mediastinal and/or hilar LNs are common in patients with a history of previous sternotomy. It is important for radiologists to be aware of this association to avoid misdiagnosis and further unnecessary procedures for nodal sampling.
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Affiliation(s)
- Colin J McCarthy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
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Fearon C, Fabre A, Heffernan EJ, Skehan SJ, Swan N, Keane MP, Butler MW. Metastatic chordoma detected by endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2013; 5:90-3. [PMID: 23372955 DOI: 10.3978/j.issn.2072-1439.2012.12.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/03/2012] [Indexed: 12/15/2022]
Abstract
Chordomas are rare, slow-growing malignant bone tumours arising from cellular remnants of the notochord. These tumours are locally invasive but have also a metastastic potential.Chordomas are characterized by the presence of physaliferous cells in a myxofibrillary stromal background. In cytological aspirates, these characteristic cells are usually absent, revealing only clusters of cells with varying degrees of vacuolation. This makes definitive diagnosis of chordoma difficult as the tumor can mimic other myxoid neoplasms including renal cell carcinomas and well-differentiated chondrosarcomas. In such situations, a confident diagnosis of chordoma requires comparison with histology of the primary tumor.We describe the first case of metastatic chordoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
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Affiliation(s)
- Conor Fearon
- Saint Vincent's University Hospital, Education and Research Center, Elm Park, Dublin 4, Ireland
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Hackett NR, Butler MW, Shaykhiev R, Salit J, Omberg L, Rodriguez-Flores JL, Mezey JG, Strulovici-Barel Y, Wang G, Didon L, Crystal RG. RNA-Seq quantification of the human small airway epithelium transcriptome. BMC Genomics 2012; 13:82. [PMID: 22375630 PMCID: PMC3337229 DOI: 10.1186/1471-2164-13-82] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/29/2012] [Indexed: 01/04/2023] Open
Abstract
Background The small airway epithelium (SAE), the cell population that covers the human airway surface from the 6th generation of airway branching to the alveoli, is the major site of lung disease caused by smoking. The focus of this study is to provide quantitative assessment of the SAE transcriptome in the resting state and in response to chronic cigarette smoking using massive parallel mRNA sequencing (RNA-Seq). Results The data demonstrate that 48% of SAE expressed genes are ubiquitous, shared with many tissues, with 52% enriched in this cell population. The most highly expressed gene, SCGB1A1, is characteristic of Clara cells, the cell type unique to the human SAE. Among other genes expressed by the SAE are those related to Clara cell differentiation, secretory mucosal defense, and mucociliary differentiation. The high sensitivity of RNA-Seq permitted quantification of gene expression related to infrequent cell populations such as neuroendocrine cells and epithelial stem/progenitor cells. Quantification of the absolute smoking-induced changes in SAE gene expression revealed that, compared to ubiquitous genes, more SAE-enriched genes responded to smoking with up-regulation, and those with the highest basal expression levels showed most dramatic changes. Smoking had no effect on SAE gene splicing, but was associated with a shift in molecular pattern from Clara cell-associated towards the mucus-secreting cell differentiation pathway with multiple features of cancer-associated molecular phenotype. Conclusions These observations provide insights into the unique biology of human SAE by providing quantit-ative assessment of the global transcriptome under physiological conditions and in response to the stress of chronic cigarette smoking.
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Affiliation(s)
- Neil R Hackett
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA.
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Cahalane AM, Kelly RM, O'Neill A, Moran D, Butler MW, Keane MP, Lawler L, Dodd JD. Bronchopleural Cutaneous Fistula after Pulmonary Radiofrequency Ablation: Treatment with Low-Adherent Paraffin Gauze Dressing. J Vasc Interv Radiol 2012; 23:283-5. [DOI: 10.1016/j.jvir.2011.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/23/2011] [Accepted: 10/24/2011] [Indexed: 11/17/2022] Open
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Butler MW, Hackett NR, Salit J, Strulovici-Barel Y, Omberg L, Mezey J, Crystal RG. Glutathione S-transferase copy number variation alters lung gene expression. Eur Respir J 2011; 38:15-28. [PMID: 21349909 DOI: 10.1183/09031936.00029210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The glutathione S-transferase (GST) enzymes catalyse the conjugation of xenobiotics to glutathione. Based on reports that inherited copy number variations (CNVs) modulate some GST gene expression levels, and that the small airway epithelium (SAE) and alveolar macrophages (AMs) are involved early in the pathogenesis of smoking-induced lung disease, we asked: do germline CNVs modulate GST expression levels in SAE and AMs? Microarrays were used to survey GST gene expression and determine CNVs genotypes in SAE and AMs obtained by bronchoscopy from current smokers and nonsmokers. 26% of subjects were null for both GSTM1 alleles, with reduced GSTM1 mRNA levels seen in both SAE and AMs. 30% of subjects had homozygous deletions of GSTT1, with reduced mRNA levels in both tissues. Interestingly, GSTT2B exhibited homozygous deletion in the blood of 27% of subjects and was not expressed in SAE in the remainder of subjects, but was expressed in AMs of heterozygotes and wild-type subjects, proportionate to genotype. These data show a germline CNV-mediated linear relationship of genotype with expression level, suggesting minimal compensation of gene expression levels in heterozygotes, consistent with GST polymorphisms playing a role in the risk of smoking-associated, xenobiotic-induced lung disease.
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Affiliation(s)
- M W Butler
- Dept of Genetic Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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Butler MW, Fukui T, Salit J, Shaykhiev R, Mezey JG, Hackett NR, Crystal RG. Modulation of cystatin A expression in human airway epithelium related to genotype, smoking, COPD, and lung cancer. Cancer Res 2011; 71:2572-81. [PMID: 21325429 DOI: 10.1158/0008-5472.can-10-2046] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cathepsin inhibitor Cystatin A (CSTA) has antiapoptotic properties linked with neoplastic changes in squamous cell epithelium, where it has been proposed as a diagnostic and prognostic marker of lung cancer. Notably, cystatin A is upregulated in dysplastic epithelium, prompting us to hypothesize that it might be modulated in chronic obstructive pulmonary disease (COPD), a small airway epithelial (SAE) disorder that is a risk factor for non-small cell lung cancer (NSCLC) in a subset of smokers. Here we report that genetic variation, smoking, and COPD can all elevate levels of CSTA expression in lung small airway epithelia, with still further upregulation in squamous cell carcinoma (SCC), an NSCLC subtype. We examined SAE gene expression in 178 individuals, including healthy nonsmokers (n = 60), healthy smokers (n = 82), and COPD smokers (n = 36), with corresponding large airway epithelium (LAE) data included in a subset of subjects (n = 52). Blood DNA was genotyped by SNP microarray. Twelve SNPs upstream of the CSTA gene were found to associate with its expression in SAE. Levels were higher in COPD smokers than in healthy smokers, who, in turn, had higher levels than nonsmokers. CSTA gene expression in LAE was also smoking-responsive. Using publicly available NSCLC expression data we also found that CSTA was upregulated in SCC versus LAE and downregulated in adenocarcinoma versus smoke-exposed SAE. All phenotypes were associated with different proportional expression of CSTA to cathepsins. Our findings establish that genetic variability, smoking, and COPD all influence CSTA expression, as does SCC, supporting the concept that CSTA may make pivotal contributions to NSCLC pathogenesis in both early and late stages of disease development.
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Affiliation(s)
- Marcus W Butler
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
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Guyot N, Bergsson G, Butler MW, Greene CM, Weldon S, Kessler E, Levine RL, O'Neill SJ, Taggart CC, McElvaney NG. Functional study of elafin cleaved by Pseudomonas aeruginosa metalloproteinases. Biol Chem 2010; 391:705-16. [PMID: 20370321 DOI: 10.1515/bc.2010.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elafin is a 6-kDa innate immune protein present at several epithelial surfaces including the pulmonary epithelium. It is a canonical protease inhibitor of two neutrophil serine proteases [neutrophil elastase (NE) and proteinase 3] with the capacity to covalently bind extracellular matrix proteins by transglutamination. In addition to these properties, elafin also possesses antimicrobial and immunomodulatory activities. The aim of the present study was to investigate the effect of Pseudomonas aeruginosa proteases on elafin function. We found that P. aeruginosa PAO1-conditioned medium and two purified Pseudomonas metalloproteases, pseudolysin (elastase) and aeruginolysin (alkaline protease), are able to cleave recombinant elafin. Pseudolysin was shown to inactivate the anti-NE activity of elafin by cleaving its protease-binding loop. Interestingly, antibacterial properties of elafin against PAO1 were found to be unaffected after pseudolysin treatment. In contrast to pseudolysin, aeruginolysin failed to inactivate the inhibitory properties of elafin against NE. Aeruginolysin cleaves elafin at the amino-terminal Lys6-Gly7 peptide bond, resulting in a decreased ability to covalently bind purified fibronectin following transglutaminase activity. In conclusion, this study provides evidence that elafin is susceptible to proteolytic cleavage at alternative sites by P. aeruginosa metalloproteinases, which can affect different biological functions of elafin.
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Affiliation(s)
- Nicolas Guyot
- Department of Medicine, Pulmonary Research Division, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland
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Hunter-Zinck H, Musharoff S, Salit J, Al-Ali KA, Chouchane L, Gohar A, Matthews R, Butler MW, Fuller J, Hackett NR, Crystal RG, Clark AG. Population genetic structure of the people of Qatar. Am J Hum Genet 2010; 87:17-25. [PMID: 20579625 DOI: 10.1016/j.ajhg.2010.05.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [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] [Received: 02/14/2010] [Revised: 04/19/2010] [Accepted: 05/21/2010] [Indexed: 11/17/2022] Open
Abstract
People of the Qatar peninsula represent a relatively recent founding by a small number of families from three tribes of the Arabian Peninsula, Persia, and Oman, with indications of African admixture. To assess the roles of both this founding effect and the customary first-cousin marriages among the ancestral Islamic populations in Qatar's population genetic structure, we obtained and genotyped with Affymetrix 500k SNP arrays DNA samples from 168 self-reported Qatari nationals sampled from Doha, Qatar. Principal components analysis was performed along with samples from the Human Genetic Diversity Project data set, revealing three clear clusters of genotypes whose proximity to other human population samples is consistent with Arabian origin, a more eastern or Persian origin, and individuals with African admixture. The extent of linkage disequilibrium (LD) is greater than that of African populations, and runs of homozygosity in some individuals reflect substantial consanguinity. However, the variance in runs of homozygosity is exceptionally high, and the degree of identity-by-descent sharing generally appears to be lower than expected for a population in which nearly half of marriages are between first cousins. Despite the fact that the SNPs of the Affymetrix 500k chip were ascertained with a bias toward SNPs common in Europeans, the data strongly support the notion that the Qatari population could provide a valuable resource for the mapping of genes associated with complex disorders and that tests of pairwise interactions are particularly empowered by populations with elevated LD like the Qatari.
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Affiliation(s)
- Haley Hunter-Zinck
- Program in Computational Biology and Medicine, Cornell University, Ithaca, NY 14850, USA
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Meagher FM, Butler MW, Miller SDW, Costello RW, Conroy RM, McElvaney NG. Predictive validity of measurements of clinical competence using the team objective structured bedside assessment (TOSBA): assessing the clinical competence of final year medical students. Med Teach 2009; 31:e545-e550. [PMID: 19909034 DOI: 10.3109/01421590903095494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The importance of valid and reliable assessment of student competence and performance is gaining increased recognition. Provision of valid patient-based formative assessment is an increasing challenge for clinical teachers in a busy hospital setting. A formative assessment tool that reliably predicts performance in the summative setting would be of value to both students and teachers. AIM This study explores the utility of the team objective structured bedside assessment (TOSBA), a novel ward-based formative assessment tool, in predicting student performance in the final clinical examination. METHODS The performance of a cohort of final year students (n = 191) in the TOSBA was compared with their subsequent performance in the final examination. A comparison was also made between student performance in the existing formative assessment tool, the objective structured long examination record (OSLER) and the final examination. We also examined the relationship between the TOSBA and the components of the final examination using clustering around latent variables analysis. RESULTS There was a clear relationship between student performance in the TOSBA and performance in the final examination (r(2) = 0.35). Student performance in the OSLER showed a poor relationship with performance in the final examination (r(2) = 0.15) compared with the TOSBA. The TOSBA results showed particular correlation with specific components of the final examination which were clinically based. CONCLUSION TOSBA performance is a strong predictor of subsequent performance in the final examination. The clustering of the TOSBA with other assessments of clinical skills underlines its utility. Further research is required to determine whether performance in the TOSBA is predictive of subsequent performance during internship.
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Affiliation(s)
- Frances M Meagher
- Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
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Guyot N, Butler MW, McNally P, Weldon S, Greene CM, Levine RL, O'Neill SJ, Taggart CC, McElvaney NG. Elafin, an elastase-specific inhibitor, is cleaved by its cognate enzyme neutrophil elastase in sputum from individuals with cystic fibrosis. J Biol Chem 2008; 283:32377-85. [PMID: 18799464 PMCID: PMC2583315 DOI: 10.1074/jbc.m803707200] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/19/2008] [Indexed: 12/15/2022] Open
Abstract
Elafin is a neutrophil serine protease inhibitor expressed in lung and displaying anti-inflammatory and anti-bacterial properties. Previous studies demonstrated that some innate host defense molecules of the cystic fibrosis (CF) and chronic obstructive pulmonary disease airways are impaired due to increased proteolytic degradation observed during lung inflammation. In light of these findings, we thus focused on the status of elafin in CF lung. We showed in the present study that elafin is cleaved in sputum from individuals with CF. Pseudomonas aeruginosa-positive CF sputum, which was found to contain lower elafin levels and higher neutrophil elastase (NE) activity compared with P. aeruginosa-negative samples, was particularly effective in cleaving recombinant elafin. NE plays a pivotal role in the process as only NE inhibitors are able to inhibit elafin degradation. Further in vitro studies demonstrated that incubation of recombinant elafin with excess of NE leads to the rapid cleavage of the inhibitor. Two cleavage sites were identified at the N-terminal extremity of elafin (Val-5-Lys-6 and Val-9-Ser-10). Interestingly, purified fragments of the inhibitor (Lys-6-Gln-57 and Ser-10-Gln-57) were shown to still be active for inhibiting NE. However, NE in excess was shown to strongly diminish the ability of elafin to bind lipopolysaccharide (LPS) and its capacity to be immobilized by transglutamination. In conclusion, this study provides evidence that elafin is cleaved by its cognate enzyme NE present at excessive concentration in CF sputum and that P. aeruginosa infection promotes this effect. Such cleavage may have repercussions on the innate immune function of elafin.
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Affiliation(s)
- Nicolas Guyot
- Pulmonary Research Division, Department of Medicine, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland
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Ammous Z, Hackett NR, Butler MW, Raman T, Dolgalev I, O'Connor TP, Harvey BG, Crystal RG. Variability in small airway epithelial gene expression among normal smokers. Chest 2008; 133:1344-1353. [PMID: 18339782 DOI: 10.1378/chest.07-2245] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite overwhelming data that cigarette smoking causes COPD, only a minority of long-term smokers are affected, strongly suggesting that genetic factors modify susceptibility to this disease. We hypothesized that individual variations exist in the response to cigarette smoking, with variability among smokers in expression levels of protective/susceptibility genes. METHODS Affymetrix arrays and quantitative polymerase chain reaction were used to assess the variability of gene expression in the small airway epithelium obtained by fiberoptic bronchoscopy of 18 normal nonsmokers, 18 normal smokers, and 18 smokers with COPD. RESULTS We identified 201 probe sets representing 152 smoking-responsive genes that were significantly up-regulated or down-regulated, and assessed the coefficient of variation in expression levels among the study population. Variation was a reproducible property of each gene as assessed by different microarray probe sets and real-time polymerase chain reaction, and was observed in both normal smokers and smokers with COPD. Greater individual variability was found in smokers with COPD than in normal smokers. The majority of these highly variable smoking-responsive genes were in the functional categories of signal transduction, xenobiotic degradation, metabolism, transport, oxidant related, and transcription. A similar pattern of the same highly variable genes was observed in an independent data set. CONCLUSIONS We propose that genetic diversity is likely within this subset of genes, with highly variable individual-to-individual responses of the small airway epithelium to smoking, and that this subset of genes represents putative candidates for assessment of susceptibility/protection from disease in future gene-based epidemiologic studies of smokers' risk for COPD.
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Affiliation(s)
- Zeinab Ammous
- Weill Cornell Medical College in Qatar, Education City, Doha, Qatar
| | - Neil R Hackett
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Marcus W Butler
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Tina Raman
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Igor Dolgalev
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Timothy P O'Connor
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY
| | - Ben-Gary Harvey
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY.
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Miller SDW, Butler MW, Meagher F, Costello RW, McElvaney NG. Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment. Med Teach 2007; 29:156-9. [PMID: 17701626 DOI: 10.1080/01421590701287889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
It can be challenging to teach and assess medical students successfully in the setting of a hospital ward using real patients. We describe a novel method of providing weekly formative clinical assessment and teaching to final year students on an acute medical ward: The Team Objective Structured Bedside Assessment (TOSBA). The TOSBA involves three groups of five students rotating through three ward-based stations (each station consists of an inpatient and facilitator). Each group spends 25 minutes at a bedside station where the facilitator asks consecutive students to perform one of five clinical tasks. Every student receives a standardised grade and is provided with educational feedback at each of the three stations. We report our 15-month experience using the TOSBA format to assess and teach a large number of medical students on a weekly basis. We discuss the advantages and potential drawbacks of our approach.
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Affiliation(s)
- S D W Miller
- Dept. of Clinical Teaching, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Butler MW, Robertson I, Greene CM, O'Neill SJ, Taggart CC, McElvaney NG. Elafin Prevents Lipopolysaccharide-induced AP-1 and NF-κB Activation via an Effect on the Ubiquitin-Proteasome Pathway. J Biol Chem 2006; 281:34730-5. [PMID: 16980310 DOI: 10.1074/jbc.m604844200] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The serine anti-protease elafin is expressed by monocytes, alveolar macrophages, neutrophils, and at mucosal surfaces and possesses antimicrobial activity. It is also known to reduce lipopolysaccharide-induced neutrophil influx into murine alveoli as well as to abrogate lipopolysaccharide-induced production of matrix metalloprotease 9, macrophage inhibitory protein 2, and tumor necrosis factor-alpha by as-yet unidentified mechanisms. In this report we have shown that elafin inhibits the lipopolysaccharide-induced production of monocyte chemoattractant protein-1 in monocytes by inhibiting AP-1 and NF-kappaB activation. Elafin prevented lipopolysaccharide-induced phosphorylation of AP-1, c-Jun, and JNK but had no effect on phosphorylation of p38. The lipopolysaccharide-induced degradation of IL-1R-associated kinase 1, IkappaBalpha, and IkappaBbeta was inhibited by elafin but phosphorylation of IkappaBalpha was unaffected. Polyubiquitinated protein including polyubiquitinated IkappaBalpha was shown to accumulate in the presence of elafin. These results suggest that inhibition by elafin of lipopolysaccharide-induced AP-1 and NF-kappaB activation occurs via an effect on the ubiquitin-proteasome pathway.
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Affiliation(s)
- Marcus W Butler
- Pulmonary Research Division, Department of Medicine, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland
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Butler MW, Saaidin N, Sheikh AA, Fennell JS. Dissatisfaction with Do Not Attempt Resuscitation Orders: A nationwide study of Irish consultant physician practices. Ir Med J 2006; 99:208-10. [PMID: 16986566] [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: 05/11/2023]
Abstract
The legal/ethical status of Do Not Attempt Resuscitation (DNAR) orders in Ireland has not been clarified, nor have national policies been formulated. We questioned 298 consultant physicians in the Republic of Ireland about DNAR orders. 173 replies were received (58%). 85 expressed unsatisfactory understanding of issues relating to Irish DNAR orders (49%). 116 physicians felt that alert patients preferred not to discuss their own resuscitation (67%). 55 physicians felt that if a competent adult patient is the subject of a DNAR order without the patient's knowledge, the reasons for this decision are "almost never" documented in the patient's medical record (32%). 75 consultants "almost never" had advance discussion of resuscitation preferences with the patient (43%). 47 physicians had experienced advance directives for Irish patients (27%). 102 physicians felt that both they and the patient's next of kin had joint responsibility for deciding resuscitation status for an incapacitated patient with no advance directive (59%). 37 respondents described a formal resuscitation policy in their place of work (21%). We feel that physicians require greater national guidance regarding DNAR order-making, and we advocate more widespread use of resuscitation policies.
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Affiliation(s)
- M W Butler
- Dept. of Medicine, St. Columcille's Hospital, Loughlinstown, Dublin
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Butler MW, O'Mahony MJ, Donnelly SC, McDonnell TJ. Managing exacerbations of COPD: room for improvement. Ir Med J 2004; 97:108-10. [PMID: 15200219] [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: 04/29/2023]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major cause of hospital admissions. Because of the consequent morbidity, mortality and burden on hospital resources, COPD management guidelines have been formulated. We reviewed 62 consecutive patients with AECOPD admitted from September 1st to December 18th 2000 in St. Vincents University Hospital, Ireland, including 3 months follow-up data, to evaluate the quality of care and in particular to assess the care of such patients by respiratory and non-respiratory physicians. There was a frequent failure to objectively confirm the diagnosis of COPD by spirometry (completed in 39 of the 51 patients who, at admission, had been previously labelled with COPD (76%), and in 53 out of 62 patients (85%) at the end of the study period), or to estimate severity by quantifying the FEV1 as a percentage of the normal predicted range (estimated in only 21 of the 39 patients who had spirometry previously performed (53%)). Those patients managed with input from respiratory physicians were more likely to have their diagnosis of COPD confirmed with spirometry (p < 0.05). They were also more likely to have out-patient follow-up arranged at discharge (p < 0.05). There was a trend towards the more frequent prescribing of oxygen to hypoxic patients in "respiratory" than in "non-respiratory" managed cases (p = 0.182) and a shorter hospital stay (0.1 < p < 0.5). 4 out of 11 severely hypoxaemic patients at admission (PO2 < 7.3kPa) were not screened at discharge for possible long term oxygen therapy (36%). 20 patients received combination antibiotic therapy with no infiltrate on CXR (32%). Pulmonary rehabilitation was offered to 12 patients (19%). 5 out of 18 current smokers had documented smoking cessation advice (28%) and none received smoking cessation pharmacotherapy. Finally we noted that the Hospital In-Patient Enquiry (HIPE) data and casualty department admission books were frequently misleading or medical records unlocatable (in 30 out of 92 cases (33%)). We conclude that the management of AECOPD at St. Vincent's University Hospital is frequently suboptimal, and may be managed better with respiratory physician involvement. In particular, there could be more frequent spirometric confirmation of the diagnosis of COPD, better screening for long term oxygen therapy and more conservative use of antibiotics. Audit is complicated by difficulty accessing relevant data.
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Affiliation(s)
- M W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4
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Abstract
BACKGROUND Hydatid disease is rare in Ireland and its incidence and prevalence are unknown. Most cases are diagnosed by a combination of clinical findings, morphological features on imaging and by serological testing. AIMS We describe an Irish case of pulmonary hydatid disease detected at bronchoscopy by bronchoalveolar lavage, and discuss the diagnosis and treatment of the disorder. CONCLUSION The diagnosis of this rare disease requires a high index of suspicion. Treatment is primarily surgical, with a role for antihelminthic agents.
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Affiliation(s)
- M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
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Abstract
BACKGROUND Quinolones have traditionally had limited application in the area of community-acquired respiratory tract infections due to poor cover against Streptococcus pneumoniae. This trend is changing with the broader spectrum of newer fluoroquinolones. A rare serious side effect of fluoroquinolones is tendinopathy. AIMS This study describes two cases of levofloxacin-associated tendinopathy in patients with severe chronic obstructive pulmonary disease (COPD) and the implications and mechanisms involved are discussed. CONCLUSIONS The finding of two cases of levofloxacin-induced tendinopathy in our patients suggests that the problem may be more frequent than previously considered. Patients with COPD treated with fluoroquinolones may have other risk factors for tendinopathy such as advanced age, corticosteroid use and renal impairment and merit vigilance for signs of tendonitis.
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Affiliation(s)
- M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
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Butler MW, Lazar EL, Smerling AJ, Stolar CJ. Differential effects of inhaled nitric oxide on normoxic and hypoxic isolated in situ neonatal pig lungs perfused by extracorporeal membrane oxygenation. J Pediatr Surg 1994; 29:275-8; discussion 279. [PMID: 8176605 DOI: 10.1016/0022-3468(94)90332-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Inhaled nitric oxide (NO) is effective as a selective pulmonary vasodilator, but its effects on uninjured lungs subjected to normoxia and hypoxia have not been fully studied. The authors sought the response of pulmonary vascular resistance (PVR) to inhaled NO in piglet lungs devoid of ischemic injury in a model of reversible pulmonary hypertension. If the changes were dose-responsive, the authors asked whether the PVR changes were related to normoxia or hypoxia, and hypothesized that the change would be more pronounced for hypoxia than normoxia. In situ isolated piglet lungs were prepared by occlusive tracheostomy and ligation of the ductus arteriosus and aorta. Cannulae positioned in the left atrium and pulmonary artery were connected to a standard extracorporeal membrane oxygenation (ECMO) circuit, and flow was increased to approximate cardiac output. After stabilization, piglets (aged 5 to 14 days, weighing 3.2 to 6.4 kg) were divided into two groups of four each: normoxic (FIO2 0.30, normal PVR) and hypoxic (FIO2 0.07, increased PVR). NO was administered at 10 to 80 parts per million (ppm) in increments of 10 ppm, for 5 minutes at each concentration, with a return to baseline before each new dose. Flow, pulmonary arterial (PA) and left atrial (LA) pressures were continuously monitored, from which PVR was calculated (PVR = [PPA - PLA]/flow) and expressed as log delta PVR. Data were analyzed statistically by repeated measures of analysis of variance, comparing log delta PVR to baseline at each dose of NO, and comparing log delta PVR for normoxic and hypoxic lungs at each dose of NO.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M W Butler
- Division of Pediatric Surgery, Columbia University, College of Physicians and Surgeons, New York, NY
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Abstract
Despite advances in infant transport and intensive care, congenital diaphragmatic hernia (CDH) still poses a serious threat to life during the neonatal period. Only with the introduction of extracorporeal membrane oxygenation (ECMO) has mortality declined significantly. Understanding the pathophysiology of CDH and its devastating effect on the lungs' bronchial and vascular development assists the clinician in rational management during the perioperative period. Successful treatment demands prompt diagnosis, informed preoperative assessment and preparation, carefully timed surgical repair, and aggressive postoperative intensive care with a thorough understanding of the role of ECMO. Improvements in ventilatory support and pharmacologic management of pulmonary hypertension have allowed surgeons to delay repair until circulatory hemodynamics, electrolytes, and oxygenation can be optimized, even resorting to preoperative ECMO in selected cases if needed. Patients with severe bilateral pulmonary hypoplasia pose serious dilemmas in terms of selection for ECMO, as well as for surgical repair. Long-term follow-up of patients after CDH repair reveals persistent hypoperfusion of the involved lung but no debilitating pulmonary disease. Future therapies may include early fetal intervention or lung transplantation, although these areas remain controversial and experimental, and clinical experience is limited.
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Affiliation(s)
- M W Butler
- Division of Pediatric Surgery, Babies Hospital, Columbia-Presbyterian Medical Center, New York, New York 10032
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