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Masese RV, DeMartino T, Bonnabeau E, Burns EN, Preiss L, Varughese T, Nocek JM, Lasley P, Chen Y, Davila C, Nwosu C, Scott S, Bowman L, Gordon L, Clesca C, Peters-Lawrence M, Melvin C, Shah N, Tanabe P. Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC). J Immigr Minor Health 2020; 23:725-732. [PMID: 33034793 PMCID: PMC8032811 DOI: 10.1007/s10903-020-01102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/27/2022]
Abstract
Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15-45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
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Affiliation(s)
- Rita V Masese
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA.
| | - Terri DeMartino
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Emily Bonnabeau
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Ebony N Burns
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | | - Taniya Varughese
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Judith M Nocek
- Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Yumei Chen
- University of California, San Francisco, Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | - Samantha Scott
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Latanya Bowman
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Lauren Gordon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cindy Clesca
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marlene Peters-Lawrence
- Division of Blood Diseases and Resources, National Institute of Health, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, USA
| | - Nirmish Shah
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Paula Tanabe
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
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Fowler LA, Yingling LR, Brooks AT, Wallen GR, Peters-Lawrence M, McClurkin M, Wiley KL, Mitchell VM, Johnson TD, Curry KE, Johnson AA, Graham AP, Graham LA, Powell-Wiley TM. Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study. JMIR Mhealth Uhealth 2018; 6:e160. [PMID: 30021705 PMCID: PMC6068385 DOI: 10.2196/mhealth.9729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/11/2018] [Accepted: 05/29/2018] [Indexed: 01/18/2023] Open
Abstract
Background A pressing need exists to understand and optimize the use of dietary assessment tools that can be used in community-based participatory research (CBPR) interventions. A digital food record, which uses a mobile device to capture the dietary intake through text and photography inputs, is a particularly promising mobile assessment method. However, little is understood about the acceptability and feasibility of digital food records in CBPR and how to best tailor dietary assessment tools to the needs of a community. Objective The objective of our study was to evaluate the acceptability and feasibility of digital food records among church-based populations in resource-limited wards of Washington, DC, USA, using a mixed-methods approach. Methods This community-based pilot study was conducted as part of the Washington, DC Cardiovascular Health and Needs Assessment. Participants (n=17) received a mobile device (iPod Touch) to photodocument their dietary intake for a 3-day digital food record using a mobile app, FitNinja (Vibrent Health). The acceptability of the digital food record was explored through the thematic analysis of verbatim transcripts from a moderated focus group (n=8). In addition, the feasibility was evaluated by the percentage of participants complying with instructions (ie, capturing both before and after meal photos for at least 2 meals/day for 3 days). Results Qualitative themes identified were related to (1) the feasibility and acceptability of the mobile device and app, including issues in recording the dietary information and difficulty with photodocumentation; (2) suggestions for additional support and training experiences; and (3) comparisons with other mobile apps. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use (eg, participants recorded an average of 5.2, SD 7, consecutive days). Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions. Conclusions This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. Engaging community members in the implementation of novel assessment methods allows for the tailoring of technology to the needs of the community and optimizing community-based interventions. Trial Registration ClinicalTrials.gov NCT01927783; https://www.clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/70WzaFWb6)
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Affiliation(s)
- Lauren A Fowler
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States.,Columbian College of Arts and Sciences, George Washington University, Washington, DC, United States
| | - Leah R Yingling
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Marlene Peters-Lawrence
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Michael McClurkin
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Kenneth L Wiley
- Division of Genomic Sciences, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Valerie M Mitchell
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Twanda D Johnson
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | | | - Allan A Johnson
- College of Nursing and Allied Sciences, Howard University, Washington, DC, United States
| | - Avis P Graham
- College of Nursing and Allied Sciences, Howard University, Washington, DC, United States
| | - Lennox A Graham
- College of Nursing and Allied Sciences, Howard University, Washington, DC, United States
| | - Tiffany M Powell-Wiley
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Ahuja C, Ayers C, Hartz J, Adu-Brimpong J, Thomas S, Mitchell V, Peters-Lawrence M, Sampson D, Brooks AT, Wallen G, Johnson A, Graham L, Graham A, Rivers J, Yingling L, Powell-Wiley TM. Examining relationships between perceptions and objective assessments of neighborhood environment and sedentary time: Data from the Washington, D.C. Cardiovascular Health and Needs Assessment. Prev Med Rep 2018; 9:42-48. [PMID: 29340269 PMCID: PMC5766749 DOI: 10.1016/j.pmedr.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/25/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 12/01/2022] Open
Abstract
Sedentary time (ST) and neighborhood environment (NE) are predictors of cardiovascular (CV) health. However, little is known about ST's relationship with NE. We examined associations of perceived and objective NE with ST in the predominantly African American faith-based population of the Washington, D.C. CV Health and Needs Assessment. After using community-based research principles, participants reported NE perceptions, including sidewalks, recreational areas, and crime presence. Factor analysis was conducted to explore pertinent constructs; factor sums were created and combined as Total Perception Score (TPS) (higher score = more favorable perception). Objective NE was assessed using Google Maps and the Active Neighborhood Checklist (ANC). ST was self-reported. Linear regression determined relationships between TPS and ST, and ANC scores and ST, for 1) overall population, 2) lower median-income D.C. areas, and 3) higher median-income DC and Maryland areas. For the sample (N = 98.9% African-American, 78% female), lower median-income areas had significantly lower mean TPS and ANC scores than higher median-income areas (p < 0.001). Three factors (neighborhood violence, physical/social environment, and social cohesion) were associated with overall NE perception. Among those in lower median-income areas, there was a negative association between TPS and ST that remained after covariate adjustment; this was not observed in higher median-income areas. There was no association between ANC scores and ST. Poorer NE perception is associated with greater ST for those in lower income areas, while objective environment is not related to ST. Multi-level interventions are needed to improve NE perceptions in lower-median income areas, reduce ST, and improve CV health. Lower income areas had worse objective & subjective neighborhood environment score. Neighborhood perception was based on violence, environment, & social cohesion. In low income areas, worse perception was associated with increased sedentary time. Worse objective neighborhood environment was not related to sedentary time.
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Affiliation(s)
- Chaarushi Ahuja
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Colby Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Jacob Hartz
- Children's National Medical Center, Washington, DC 20010, United States
| | - Joel Adu-Brimpong
- Office of Intramural Training and Education, National Institutes of Health, Bethesda, MD 20892, United States
| | - Samantha Thomas
- Office of Intramural Training and Education, National Institutes of Health, Bethesda, MD 20892, United States
| | - Valerie Mitchell
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Marlene Peters-Lawrence
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National, Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Dana Sampson
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD 20892, United States
| | - Gwenyth Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD 20892, United States
| | - Allan Johnson
- Department of Nutritional Sciences, Howard University, Washington, DC 20059, United States
| | - Lennox Graham
- Department of Nutritional Sciences, Howard University, Washington, DC 20059, United States
| | - Avis Graham
- Department of Nutritional Sciences, Howard University, Washington, DC 20059, United States
| | - Joshua Rivers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States
| | - Leah Yingling
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84106, United States
| | - Tiffany M Powell-Wiley
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, United States
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Yingling LR, Mitchell V, Ayers CR, Peters-Lawrence M, Wallen GR, Brooks AT, Troendle JF, Adu-Brimpong J, Thomas S, Henry J, Saygbe JN, Sampson DM, Johnson AA, Graham AP, Graham LA, Wiley KL, Powell-Wiley T. Adherence with physical activity monitoring wearable devices in a community-based population: observations from the Washington, D.C., Cardiovascular Health and Needs Assessment. Transl Behav Med 2017; 7:719-730. [PMID: 28097627 PMCID: PMC5684058 DOI: 10.1007/s13142-016-0454-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Wearable mobile health (mHealth) technologies offer approaches for targeting physical activity (PA) in resource-limited, community-based interventions. We sought to explore user characteristics of PA tracking, wearable technology among a community-based population within a health and needs assessment. In 2014-2015, we conducted the Washington, D.C., Cardiovascular Health and Needs Assessment in predominantly African-American churches among communities with higher obesity rates and lower household incomes. Participants received a mHealth PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Participants (n = 99) were 59 ± 12 years, 79% female, and 99% African-American, with a mean body mass index of 33 ± 7 kg/m2. Eighty-one percent of participants uploaded PA data to the hub and were termed "PA device users." Though PA device users were more likely to report lower household incomes, no differences existed between device users and non-users for device ownership or technology fluency. Findings suggest that mHealth systems with a wearable device and data collection hub may feasibly target PA in resource-limited communities.
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Grants
- HHSN268201400023C NHGRI NIH HHS
- ZIA HL006168 Intramural NIH HHS
- ZIA HL006168 Intramural NIH HHS
- ZIA HL006168 Intramural NIH HHS
- Division of Intramural Research, National Heart, Lung, and Blood Insitute, USA
- Division of Intramural Research, National Heart, Lung, and Blood Institute, USA
- Office of Intramural Training and Education, National Institutes of Health, USA
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Affiliation(s)
- Leah R Yingling
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Valerie Mitchell
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Colby R Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlene Peters-Lawrence
- Office of the Clinical Director, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - James F Troendle
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Adu-Brimpong
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Samantha Thomas
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - JaWanna Henry
- Office of the National Coordinator for Health Information Technology, Washington, DC, USA
| | - Johnetta N Saygbe
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Dana M Sampson
- Office of Minority Health, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Allan A Johnson
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Avis P Graham
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Lennox A Graham
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Kenneth L Wiley
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany Powell-Wiley
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA.
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Thomas S, Yingling L, Adu-Brimpong J, Mitchell V, Ayers CR, Wallen GR, Peters-Lawrence M, Brooks AT, Sampson DM, Wiley KL, Saygbe J, Henry J, Johnson A, Graham A, Graham L, Powell-Wiley TM. Mobile Health Technology Can Objectively Capture Physical Activity (PA) Targets Among African-American Women Within Resource-Limited Communities-the Washington, D.C. Cardiovascular Health and Needs Assessment. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0290-4. [PMID: 27913983 PMCID: PMC5457361 DOI: 10.1007/s40615-016-0290-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/09/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Little is understood about using mobile health (mHealth) technology to improve cardiovascular (CV) health among African-American women in resource-limited communities. METHODS We conducted the Washington, D.C. CV Health and Needs Assessment in predominantly African-American churches in city wards 5, 7, and 8 with the lowest socioeconomic status based on community-based participatory research (CBPR) principles. The assessment measured CV health factors: body mass index (BMI), fasting blood glucose and cholesterol, blood pressure, fruit/vegetable (F/V) intake, physical activity (PA), and smoking. Participants were trained to use a PA monitoring wristband to measure 30 days of PA, wirelessly upload the PA data to hubs at the participating churches, and access their data from a church/home computer. CV health factors were compared across weight classes. RESULTS Among females (N = 78; 99 % African-American; mean age = 59 years), 90 % had a BMI categorized as overweight/obese. Across weight classes, PA decreased and self-reported sedentary time (ST) increased (p ≤ 0.05). Diastolic blood pressure and glucose increased across weight classes (p ≤ 0.05); however, cholesterol, glucose, and BP were near intermediate CV health goals. CONCLUSIONS Decreased PA and increased ST are potential community intervention targets for overweight and obese African-American women in resource-limited Washington D.C. areas. mHealth technology can assist in adapting CBPR intervention resources to improve PA for African-American women in resource-limited communities.
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Affiliation(s)
- S Thomas
- Office of Intramural Training and Education, National Institutes of Health, Bethesda, MD, 20892, USA
| | - L Yingling
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Room 5-3340, Bethesda, MD, 20892, USA
| | - J Adu-Brimpong
- Office of Intramural Training and Education, National Institutes of Health, Bethesda, MD, 20892, USA
| | - V Mitchell
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Room 5-3340, Bethesda, MD, 20892, USA
| | - C R Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - G R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - M Peters-Lawrence
- Division of Intramural Research - Hematology Branch, National Heart Lung and Blood Institute, NIH, Bethesda, MD, 20892, USA
| | - A T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - D M Sampson
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, MD, 20892, USA
| | - K L Wiley
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - J Saygbe
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Room 5-3340, Bethesda, MD, 20892, USA
| | - J Henry
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, 21201, USA
| | - A Johnson
- Department of Nutritional Sciences, Howard University, Washington, DC, 20059, USA
| | - A Graham
- Department of Nutritional Sciences, Howard University, Washington, DC, 20059, USA
| | - L Graham
- Department of Nutritional Sciences, Howard University, Washington, DC, 20059, USA
| | - T M Powell-Wiley
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Room 5-3340, Bethesda, MD, 20892, USA.
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Yingling LR, Brooks AT, Wallen GR, Peters-Lawrence M, McClurkin M, Cooper-McCann R, Wiley KL, Mitchell V, Saygbe JN, Johnson TD, Curry RKE, Johnson AA, Graham AP, Graham LA, Powell-Wiley TM. Community Engagement to Optimize the Use of Web-Based and Wearable Technology in a Cardiovascular Health and Needs Assessment Study: A Mixed Methods Approach. JMIR Mhealth Uhealth 2016; 4:e38. [PMID: 27113680 PMCID: PMC4861844 DOI: 10.2196/mhealth.4489] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/07/2015] [Accepted: 11/29/2015] [Indexed: 02/06/2023] Open
Abstract
Background Resource-limited communities in Washington, D.C. have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited Internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions. Objective The objective of the study was to use qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and Web-based technology by predominantly African American, church-based populations in resource-limited Washington, D.C. neighborhoods. Methods To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). As their first initiative, the Washington, D.C. Cardiovascular Health and Needs Assessment intends to evaluate cardiovascular health, social determinants of health, and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure Internet account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by Internet account usage, wristband utilization, and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts. Results Study participants (5 males, 3 females) were African American and age 28-70 years. Participant wristbands recorded data on 10.1±1.6 days. Two participants logged cardiovascular health factors on the website. Focus group transcripts revealed that participants felt positively about incorporating the device into their church-based populations, given improvements were made to device training, hub accessibility, and device feedback. Conclusions PA-monitoring wristbands for objectively measuring PA appear to be a feasible and acceptable technology in Washington, D.C., resource-limited communities. User preferences include immediate device feedback, hands-on device training, explicit instructions, improved central hub accessibility, and designation of a church member as a trained point-of-contact. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions, and preferences. ClinicalTrial Trial Registration: ClinicalTrials.gov NCT01927783; https://clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/6f8wL117u)
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Affiliation(s)
- Leah R Yingling
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Minniti CP, Gorbach AM, Xu D, Hon YY, Delaney KM, Seidel M, Malik N, Peters-Lawrence M, Cantilena C, Nichols JS, Mendelsohn L, Conrey A, Grimes G, Kato GJ. Topical sodium nitrite for chronic leg ulcers in patients with sickle cell anaemia: a phase 1 dose-finding safety and tolerability trial. Lancet Haematol 2014; 1:e95-e103. [PMID: 25938131 DOI: 10.1016/s2352-3026(14)00019-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Well-tolerated and effective treatments are needed for chronic leg ulcers in sickle cell anaemia. Topical sodium nitrite, a known nitric oxide donor, enhances blood flow in ulcers and has known bacteriostatic effects. We aimed to assess the safety, tolerability, and pharmacokinetics of topical sodium nitrite in patients with sickle cell disease and chronic leg ulcers. METHODS We enrolled adult patients from an ambulatory clinic at the National Institutes of Health (Bethesda, MD, USA) with sickle cell anaemia with leg ulcers (with a surface area of 2.5-100 cm2) persisting for at least 4 weeks into a safety and tolerability phase 1 dose-escalation trial of topical sodium nitrite. Increasing concentrations of sodium nitrite cream were applied twice weekly for 4 weeks to one ulcer per patient at five dose levels (0.5%, 1%, 1.5%, 1.8%, and 2%). The primary endpoints were safety and tolerability, with secondary endpoints of pharmacokinetics, blood flow, and wound healing. Pain relief was analysed post hoc. Endpoints were analysed over time for the whole study population and according to dose level. This study is registered with ClinicalTrials.gov, number NCT01316796. FINDINGS Between April 4, 2011, and March 19, 2013, we enrolled 18 adult patients with sickle cell anaemia and leg ulcers into our trial. We assigned three patients into each cohort, and each cohort was treated with a different concentration of sodium nitrite cream (cohort 1: 0.5%, cohort 2: 1.0%, cohort 3: 1.5%, and cohort 4: 2.0%). Patients were not enrolled into the next cohort dose until we were able to establish that no dose-limiting toxicities were observed. An additional six patients were enrolled to cohort 3a: 1.8%, after two patients in cohort 4 had asymptomatic drops in diastolic blood pressure. No grade 3-4 adverse events were observed, and there were no serious adverse events or dose-limiting side-effects. Pharmacokinetic analysis showed that systemic absorption of sodium nitrite was very low. Application of topical sodium nitrite was associated with a significant increase in peri-wound cutaneous blood flow measured by laser speckle contrast imaging (p=0.0002), corroborated by increased peri-wound skin temperature by infrared thermography (p=0.0119). We recorded a dose-dependent decrease in leg ulcer size (p=0.0012) and pain (p<0.0001). Ulcers healed completely in three patients who received the highest concentrations of topical sodium nitrite (the 1.8% and 2% cream). In our post-hoc analysis of pain, brief pain inventory scores improved in pain severity (p=0.0048) and pain interference (p=0.0013). INTERPRETATION Our results indicate that topical sodium nitrite 2% cream is suitable for additional clinical trials in adults with sickle cell anaemia to promote healing of leg ulcers. FUNDING National Heart, Lung and Blood Institute Division of Intramural Research (National Institutes of Health).
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Affiliation(s)
- Caterina P Minniti
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Alexander M Gorbach
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Dihua Xu
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Yuen Yi Hon
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Kara-Marie Delaney
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Miles Seidel
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Nitin Malik
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Marlene Peters-Lawrence
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Carly Cantilena
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - James S Nichols
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Laurel Mendelsohn
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Anna Conrey
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - George Grimes
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
| | - Gregory J Kato
- National Heart, Lung and Blood Institute (Prof C P Minniti MD, D Xu PhD, K-M Delaney MD, M Peters-Lawrence RN, C Cantilena BS, J S Nichols RN, L Mendelsohn BS, A Conrey NP, Prof G J Kato MD), Pharmaceutical Development Services, Clinical Center Pharmacy Department (Y Y Hon PharmD, G Grimes PharmD), and Infrared and Thermometry Unit, National Institute of Biomedical Imaging and Bioengineering (A M Gorbach PhD, M Seidel BS, N Malik BS), National Institutes of Health, Bethesda, MD, USA; and Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA (Prof G J Kato)
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8
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Minniti CP, Delaney KMH, Gorbach AM, Xu D, Lee CCR, Malik N, Koroulakis A, Antalek M, Maivelett J, Peters-Lawrence M, Novelli EM, Lanzkron SM, Axelrod KC, Kato GJ. Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia. Am J Hematol 2014; 89:1-6. [PMID: 23963836 DOI: 10.1002/ajh.23571] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 08/09/2013] [Accepted: 08/13/2013] [Indexed: 12/15/2022]
Abstract
Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population.
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Affiliation(s)
| | | | - Alexander M. Gorbach
- Infrared Imaging & Thermometry Unit; NIBIB, National Institutes of Health; Bethesda Maryland
| | - Dihua Xu
- Office of Biostatistics Research; NHLBI, National Institutes of Health; Bethesda Maryland
| | | | - Nitin Malik
- Infrared Imaging & Thermometry Unit; NIBIB, National Institutes of Health; Bethesda Maryland
| | - Antony Koroulakis
- Infrared Imaging & Thermometry Unit; NIBIB, National Institutes of Health; Bethesda Maryland
| | - Matthew Antalek
- Infrared Imaging & Thermometry Unit; NIBIB, National Institutes of Health; Bethesda Maryland
| | - Jordan Maivelett
- Infrared Imaging & Thermometry Unit; NIBIB, National Institutes of Health; Bethesda Maryland
| | | | - Enrico M. Novelli
- Division of Hematology/Oncology; UPMC Cancer Pavilion; Pittsburgh Pennsylvania
| | - Sophie M. Lanzkron
- Division of Hematology, Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Karen C. Axelrod
- Nursing and Patient Care Services; National Institutes of Health; Bethesda Maryland
| | - Gregory J. Kato
- Hematology Branch; NHLBI, National Institutes of Health; Bethesda Maryland
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9
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Darbari DS, Wang Z, Kwak M, Hildesheim M, Nichols J, Allen D, Seamon C, Peters-Lawrence M, Conrey A, Hall MK, Kato GJ, Taylor VI JG. Severe painful vaso-occlusive crises and mortality in a contemporary adult sickle cell anemia cohort study. PLoS One 2013; 8:e79923. [PMID: 24224021 PMCID: PMC3818240 DOI: 10.1371/journal.pone.0079923] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/28/2013] [Indexed: 02/02/2023] Open
Abstract
Background Frequent painful vaso-occlusive crises (VOCs) were associated with mortality in the Cooperative Study of Sickle Cell Disease (CSSCD) over twenty years ago. Modern therapies for sickle cell anemia (SCA) like hydroxyurea are believed to have improved overall patient survival. The current study sought to determine the relevance of the association between more frequent VOCs and death and its relative impact upon overall mortality compared to other known risk factors in a contemporary adult SCA cohort. Methods Two hundred sixty four SCA adults were assigned into two groups based on patient reported outcomes for emergency department (ED) visits or hospitalizations for painful VOC treatment during the 12 months prior to evaluation. Results Higher baseline hematocrit (p = 0.0008), ferritin (p = 0.005), and HDL cholesterol (p = 0.01) were independently associated with 1 or more painful VOCs requiring an ED visit or hospitalization for acute pain. During a median follow-up of 5 years, mortality was higher in the ED visit/hospitalization group (relative risk [RR] 2.68, 95% CI 1.1-6.5, p = 0.03). Higher tricuspid regurgitatant jet velocity (TRV) (RR 2.41, 95% CI 1.5-3.9, p < 0.0001), elevated ferritin (RR 4.00, 95% CI 1.8-9.0, p = 0.001) and lower glomerular filtration rate (RR=2.73, 95% CI 1.6-4.6, p < 0.0001) were also independent risk factors for mortality. Conclusions Severe painful VOCs remain a marker for SCA disease severity and premature mortality in a modern cohort along with other known risk factors for death including high TRV, high ferritin and lower renal function. The number of patient reported pain crises requiring healthcare utilization is an easily obtained outcome that could help to identify high risk patients for disease modifying therapies. Trial Registration ClinicalTrials.gov NCT00011648 http://clinicaltrials.gov/
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Affiliation(s)
- Deepika S. Darbari
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington DC, United States of America
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Zhengyuan Wang
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Minjung Kwak
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mariana Hildesheim
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - James Nichols
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Darlene Allen
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Catherine Seamon
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Marlene Peters-Lawrence
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Anna Conrey
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mary K. Hall
- Critical Care Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Gregory J. Kato
- Sickle Cell Disease Vascular Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - James G. Taylor VI
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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10
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Gladwin MT, Kato GJ, Weiner D, Onyekwere OC, Dampier C, Hsu L, Hagar RW, Howard T, Nuss R, Okam MM, Tremonti CK, Berman B, Villella A, Krishnamurti L, Lanzkron S, Castro O, Gordeuk VR, Coles WA, Peters-Lawrence M, Nichols J, Hall MK, Hildesheim M, Blackwelder WC, Baldassarre J, Casella JF. Nitric oxide for inhalation in the acute treatment of sickle cell pain crisis: a randomized controlled trial. JAMA 2011; 305:893-902. [PMID: 21364138 PMCID: PMC3403835 DOI: 10.1001/jama.2011.235] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Inhaled nitric oxide has shown evidence of efficacy in mouse models of sickle cell disease (SCD), case series of patients with acute chest syndrome, and 2 small placebo-controlled trials for treatment of vaso-occlusive pain crisis (VOC). OBJECTIVE To determine whether inhaled nitric oxide gas reduces the duration of painful crisis in patients with SCD who present to the emergency department or hospital for care. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, double-blind, randomized, placebo-controlled clinical trial for up to 72 hours of inhaled nitric oxide gas vs inhaled nitrogen placebo in 150 participants presenting with VOC of SCD at 11 centers between October 5, 2004, and December 22, 2008. Intervention Inhaled nitric oxide gas vs inhaled nitrogen placebo. MAIN OUTCOME MEASURES The primary end point was the time to resolution of painful crisis, defined by (1) freedom from parenteral opioid use for 5 hours; (2) pain relief as assessed by visual analog pain scale scores of 6 cm or lower (on 0-10 scale); (3) ability to walk; and (4) patient's and family's decision, with physician consensus, that the remaining pain could be managed at home. RESULTS There was no significant change in the primary end point between the nitric oxide and placebo groups, with a median time to resolution of crisis of 73.0 hours (95% confidence interval [CI], 46.0-91.0) and 65.5 hours (95% CI, 48.1-84.0), respectively (P = .87). There were no significant differences in secondary outcome measures, including length of hospitalization, visual analog pain scale scores, cumulative opioid usage, and rate of acute chest syndrome. Inhaled nitric oxide was well tolerated, with no increase in serious adverse events. Increases in venous methemoglobin concentration confirmed adherence and randomization but did not exceed 5% in any study participant. Significant increases in plasma nitrate occurred in the treatment group, but there were no observed increases in plasma or whole blood nitrite. CONCLUSION Among patients with SCD hospitalized with VOC, the use of inhaled nitric oxide compared with placebo did not improve time to crisis resolution. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00094887.
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Affiliation(s)
- Mark T Gladwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, 3459 Fifth Ave, 628 NW, Pittsburgh, PA 15213.
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