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Papadopoulos NG, Custovic A, Deschildre A, Gern JE, Nieto Garcia A, Miligkos M, Phipatanakul W, Wong G, Xepapadaki P, Agache I, Arasi S, Awad El-Sayed Z, Bacharier LB, Bonini M, Braido F, Caimmi D, Castro-Rodriguez JA, Chen Z, Clausen M, Craig T, Diamant Z, Ducharme FM, Ebisawa M, Eigenmann P, Feleszko W, Fierro V, Fiocchi A, Garcia-Marcos L, Goh A, Gómez RM, Gotua M, Hamelmann E, Hedlin G, Hossny EM, Ispayeva Z, Jackson DJ, Jartti T, Jeseňák M, Kalayci O, Kaplan A, Konradsen JR, Kuna P, Lau S, Le Souef P, Lemanske RF, Levin M, Makela MJ, Mathioudakis AG, Mazulov O, Morais-Almeida M, Murray C, Nagaraju K, Novak Z, Pawankar R, Pijnenburg MW, Pite H, Pitrez PM, Pohunek P, Price D, Priftanji A, Ramiconi V, Rivero Yeverino D, Roberts G, Sheikh A, Shen KL, Szepfalusi Z, Tsiligianni I, Turkalj M, Turner S, Umanets T, Valiulis A, Vijveberg S, Wang JY, Winders T, Yon DK, Yusuf OM, Zar HJ. Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO. Pediatr Allergy Immunol 2024; 35:e14129. [PMID: 38664926 DOI: 10.1111/pai.14129] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024]
Abstract
Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization, and natural history review. Numerous factors that may affect disease activity and patient well-being need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even "real-time," monitoring between visits. Following an approach that included needs assessment, evidence appraisal, and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Adnan Custovic
- Department of Pediatrics, Imperial College London, London, UK
| | - Antoine Deschildre
- Univ. Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, Lille cedex, France
| | - James E Gern
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Antonio Nieto Garcia
- Pediatric Pulmonology & Allergy Unit Children's Hospital la Fe, Health Research Institute La Fe, Valencia, Spain
| | - Michael Miligkos
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Wanda Phipatanakul
- Children's Hospital Boston, Pediatric Allergy and Immunology, Boston, Massachusetts, USA
| | - Gary Wong
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioana Agache
- Allergy & Clinical Immunology, Transylvania University, Brasov, Romania
| | - Stefania Arasi
- Allergy Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Zeinab Awad El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Leonard B Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matteo Bonini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Fulvio Braido
- University of Genoa, Genoa, Italy
- Respiratory Diseases and Allergy Department, Research Institute and Teaching Hospital San Martino, Genoa, Italy
- Interasma - Global Asthma Association (GAA)
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Montpellier, France
- IDESP, UA11 INSERM-Universitè de Montpellier, Montpellier, France
| | - Jose A Castro-Rodriguez
- Department of Pediatrics Pulmonology, School of Medicine, Pontifical Universidad Catolica de Chile, Santiago, Chile
| | - Zhimin Chen
- Pulmonology Department, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Michael Clausen
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Timothy Craig
- Department of Allergy and Immunology, Penn State University, Hershey, Pennsylvania, USA
- Vinmec International Hospital, Hanoi, Vietnam
| | - Zuzana Diamant
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center of Groningen and QPS-NL, Groningen, The Netherlands
- Department of Pediatrics and of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Francine M Ducharme
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Motohiro Ebisawa
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - Philippe Eigenmann
- Department of Pediatric Respiratory Diseases and Allergy, The Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Feleszko
- Pediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Vincezo Fierro
- Allergy Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Fiocchi
- Allergy Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luis Garcia-Marcos
- Department of Pediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Anne Goh
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | | | - Maia Gotua
- Children's Center Bethel, Evangelical Hospital Bethel, University of Bielefeld, Bielefeld, Germany
| | - Eckard Hamelmann
- Paediatric Allergy, Centre for Allergy Research, Karolinska Institutet, Solna, Sweden
| | - Gunilla Hedlin
- Department of Allergology and Clinical Immunology, Kazakh National Medical University, Almaty, Kazakhstan
| | - Elham M Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Zhanat Ispayeva
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Daniel J Jackson
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Jartti
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Center for Vaccination in Special Situations, University Hospital in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Miloš Jeseňák
- Department of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Center for Vaccination in Special Situations, University Hospital in Martin, Comenius University in Bratislava, Bratislava, Slovakia
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Omer Kalayci
- Chair Family Physician Airways Group of Canada, Ontario, Canada
| | - Alan Kaplan
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jon R Konradsen
- Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Piotr Kuna
- Charité Universitätsmedizin Berlin, Pediatric Respiratpry Medicine, Immunology and Intensive Care Medicine, Berlin, Germany
| | - Susanne Lau
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Le Souef
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robert F Lemanske
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Michael Levin
- inVIVO Planetary Health Group of the Worldwide Universities Network
- Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika J Makela
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- First Pediatric Department of Pediatrics, National Pirogov Memorial Medical University, Vinnytsia Children's Regional Hospital, Vinnytsia Oblast, Ukraine
| | | | | | - Clare Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | | | - Zoltan Novak
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Ruby Pawankar
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marielle W Pijnenburg
- Allergy Center, CUF Descobertas Hospital and CUF Tejo HospitalInfante Santo Hospital, Lisbon, Portugal
| | - Helena Pite
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Pulmonary Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Paulo M Pitrez
- Pediatric Pulmonology, Pediatric Department, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Pohunek
- University Hospital Motol, Prague, Czech Republic
| | - David Price
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore City, Singapore
| | - Alfred Priftanji
- Department of Allergy, Mother Theresa School of Medicine, University of Tirana, Tirana, Albania
| | - Valeria Ramiconi
- The European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Brussels, Belgium
| | | | - Graham Roberts
- Paediatric Allergy and Respiratory Medicine within Medicine at the University of Southampton, Southampton, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Kun-Ling Shen
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Zsolt Szepfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinologyneumology, Department of Pediatrics and Juvenile Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | | | - Steve Turner
- Medical School of Catholic University of Croatia, Zagreb, Croatia
| | - Tetiana Umanets
- Child Health, Royal Aberdeen Children's Hospital and University of Aberdeen, Aberdeen, UK
- Department of Respiratory Diseases and Respiratory Allergy in Children, SI "Institute of Pediatrics, Obstetrics and Gynecology named after Academician O. Lukjanova of NAMS of Ukraine, Kyiv, Ukraine
| | - Arunas Valiulis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Susanne Vijveberg
- Department of Paediatric Pulmonology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jiu-Yao Wang
- China Medical University Children's Hospital Taichung, Taichung, Taiwan
| | | | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | | | - Heather J Zar
- Department of Pediatrics & Child Health, Director MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Silvera SAN, Goldfarb E, Birnbaum AS, Kaplan A, Bavaro J, Guzman M, Lieberman L. Racial and ethnic differences in perceptions of campus climate related to sexual violence. J Am Coll Health 2024; 72:645-653. [PMID: 35348421 DOI: 10.1080/07448481.2022.2054277] [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] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
Objective: To assess perceptions of university institutional climate related to sexual violence and whether these differed by race/ethnicity. Participants: Matriculated undergraduates > age 18 (n = 1028). Methods: Students were invited via campus email to participate in an online survey. Results: Overall, only 20% agreed that the university is creating an environment in which unwanted sexual experiences seemed common or normal, but these findings differed by race. Black students were more likely than their white peers to feel the university is creating an environment in which unwanted sexual experiences seem common or normal (37.3% vs. 19.7%, p < .001) and creating an environment in which such instances were more likely to occur (33.3% vs. 13.4%, p < .001). Conclusions: Data suggest that while students generally perceive that the university is working to create a positive and safe climate, these perceptions vary by race. Further investigation is necessary to better understand the concerns of students of color.
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Affiliation(s)
- S A N Silvera
- Department of Public Health, Montclair State University, Montclair, New Jersey, USA
| | - E Goldfarb
- Department of Public Health, Montclair State University, Montclair, New Jersey, USA
| | - A S Birnbaum
- Department of Public Health, Montclair State University, Montclair, New Jersey, USA
| | - A Kaplan
- Indiana School of Public Health, Indiana University - Bloomington, Bloomington, Indiana, USA
| | - J Bavaro
- New Jersey YMCA State Alliance, Hamilton, New Jersey, USA
| | - M Guzman
- Department of Public Health, Montclair State University, Montclair, New Jersey, USA
| | - L Lieberman
- Department of Public Health, Montclair State University, Montclair, New Jersey, USA
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Kaplan A, Boivin M, Bouchard J, Kim J, Hayes S, Licskai C. The emerging role of digital health in the management of asthma. Ther Adv Chronic Dis 2023; 14:20406223231209329. [PMID: 38028951 PMCID: PMC10657529 DOI: 10.1177/20406223231209329] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
The most common reasons seen for lack of asthma control include misconceptions about disease control, low controller treatment adherence, poor inhaler technique, and the resulting underuse of controllers and overuse of short-acting beta2 agonists (SABAs). Narrowing these care gaps may be achieved through well-designed patient education that considers the patient's motivation, beliefs, and capabilities regarding their asthma and its management and empowers the patient to become an active participant in treatment decisions. Digital health technologies (DHTs) and digital therapeutic (DT) devices provide new opportunities to monitor treatment behaviors, improve communication between healthcare providers and patients, and generate data that inform educational interactions. DHT and DT have been proven effective in enhancing patient self-management in other chronic conditions, particularly diabetes. Accelerated integration of DHT and DT into the management of asthma patients is facilitated by the use of digital inhalers that employ sensor technology ("smart" inhalers). These devices efficiently provide real-time feedback on controller adherence, SABA use, and inhaler technique that have the strong potential to optimize asthma control.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, 14872 Yonge Street, Aurora, Toronto, ON L4G 1N2, Canada
- Family Physician Airways Group of Canada, Markham, ON, Canada
| | | | | | - James Kim
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Christopher Licskai
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada
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Kerr M, Tarabichi Y, Evans A, Mapel D, Pace W, Carter V, Couper A, Drummond MB, Feigler N, Federman A, Gandhi H, Hanania NA, Kaplan A, Kostikas K, Kruszyk M, van Melle M, Müllerová H, Murray R, Ohar J, Pollack M, Pullen R, Williams D, Wisnivesky J, Han MK, Meldrum C, Price D. Patterns of care in the management of high-risk COPD in the US (2011-2019): an observational study for the CONQUEST quality improvement program. Lancet Reg Health Am 2023; 24:100546. [PMID: 37545746 PMCID: PMC10400879 DOI: 10.1016/j.lana.2023.100546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023]
Abstract
Background In this study, we compare management of patients with high-risk chronic obstructive pulmonary disease (COPD) in the United States to national and international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Methods Patients were identified from the DARTNet Practice Performance Registry and categorized into three high-risk cohorts in each year from 2011 to 2019: newly diagnosed (≤12 months after diagnosis), already diagnosed, and patients with potential undiagnosed COPD. Patients were considered high-risk if they had a history of exacerbations or likely exacerbations (respiratory consult with prescribed medication). Descriptive statistics for 2019 are reported, along with annual trends. Findings In 2019, 10% (n = 16,610/167,197) of patients met high-risk criteria. Evidence of spirometry for diagnosis was low; in 2019, 81% (n = 1228/1523) of patients newly diagnosed at high-risk had no record of spirometry/peak expiratory flow in the 12 months pre- or post-diagnosis and 43% (n = 651/1523) had no record of COPD symptom review. Among those newly and already diagnosed at high-risk, 52% (n = 4830/9350) had no evidence of COPD medication. Interpretation Findings suggest inconsistent adherence to evidence-based guidelines, and opportunities to improve identification, documentation of services, assessment, therapeutic intervention, and follow-up of patients with COPD. Funding This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
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Affiliation(s)
- Margee Kerr
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Yasir Tarabichi
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA
| | | | - Douglas Mapel
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Wilson Pace
- DARTNet Institute, Aurora, USA
- University of Colorado, Denver, CO, USA
| | | | - Amy Couper
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Norbert Feigler
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Alex Federman
- General Internal Medicine, Mount Sinai, New York, NY, USA
| | - Hitesh Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Nicola A. Hanania
- Section of Pulmonary and Critical Care Medicine, and Director of the Airways Clinical Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Alan Kaplan
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Family Physician Airways Group of Canada, Stouffville, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Maja Kruszyk
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Queensland, Australia
| | - Marije van Melle
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Connecting Medical Dots BV, Utrecht, the Netherlands
- ORTEC, Zoetermeer, the Netherlands
| | | | | | - Jill Ohar
- Department of Internal Medicine, WakeForest University, Winston-Salem, NC, USA
| | - Michael Pollack
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Rachel Pullen
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Dennis Williams
- UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Allergy and Asthma Network, Vienna, VA, USA
| | | | | | - Catherine Meldrum
- Division of Pulmonary & Critical Care at University of Michigan Hospital, Ann Arbor, MI, USA
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Şekerci M, Özdoğan H, Kaplan A. A study on the cross-section data of 43,44m,46,47Sc isotopes via (d,x) reactions on natural abundance targets under the effects of deuteron optical models. Appl Radiat Isot 2023; 194:110714. [PMID: 36774823 DOI: 10.1016/j.apradiso.2023.110714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/06/2023]
Abstract
Many studies have investigated the influence of theoretical models and factors involved in the acquisition of cross-section data of a nuclear reaction. The implications of different models of various variables such as level density, gamma strength function, and optical potentials on cross-section calculations whether used solo or jointly are investigated in a significant portion of the works conducted in this perspective. The aim of this particular study is to investigate the influence of different optical models on the cross-section calculations in production of several scandium isotopes, known for various medical uses, from several targets with natural abundances by (d,x) reactions. For this purpose, the cross-section calculations using five available deuteron optical models of TALYS code in natTi(d,x)43Sc, natTi(d,x)44mSc, natTi(d,x)46Sc, natTi(d,x)47Sc, natV(d,x)47Sc and natCr(d,x)47Sc reactions were performed and the obtained calculation results were compared with the experimental cross-section data gathered from the literature. To understand whether there is a significant and consistent relationship between the experimental data and the calculation results, both have been plotted together and analyzed with the naked-eye. In addition, the calculations of the mean standardized deviation, the mean relative deviation, the mean ratio and the mean square logarithmic deviation were performed in order to evaluate the results numerically.
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Affiliation(s)
- M Şekerci
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey
| | - H Özdoğan
- Antalya Bilim University, Vocational School of Health Services, Department of Medical Imaging Techniques, 07190, Antalya, Turkey
| | - A Kaplan
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey.
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Hladky V, Kaplan A, Smetanova J, Havlas V. Assessing Knee Stability in Adolescent Athletes with Osgood-Schlatter Disease Using the Y-Balance Test. Acta Chir Orthop Traumatol Cech 2023; 90:108-115. [PMID: 37155999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.
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Affiliation(s)
- V Hladky
- Department of Orthopaedics and Traumatology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - A Kaplan
- Department of Track and Field, Faculty of Physical Education and Sport, Charles University Prague, Czech Republic
| | - J Smetanova
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - V Havlas
- Department of Orthopaedics and Traumatology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Bleecker ER, Al-Ahmad M, Bjermer L, Caminati M, Canonica GW, Kaplan A, Papadopoulos NG, Roche N, Ryan D, Tohda Y, Yáñez A, Price D. Systemic corticosteroids in asthma: A call to action from World Allergy Organization and Respiratory Effectiveness Group. World Allergy Organ J 2022; 15:100726. [PMID: 36582404 PMCID: PMC9761384 DOI: 10.1016/j.waojou.2022.100726] [Citation(s) in RCA: 9] [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: 08/01/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Systemic corticosteroids (SCS) are a highly effective treatment for acute exacerbations and long-term symptom control in asthma. Long-term SCS use is highly prevalent across all asthma severities, occurring in over 20% of patients with severe or uncontrolled disease globally. It is now well known that exposure to both long-term and repeated acute courses of SCS is associated with a high risk of serious adverse effects (AEs), such as osteoporosis, and metabolic and cardiovascular complications, especially when prescribed onto a background of other corticosteroids. The aim of this call-to-action article, endorsed by the World Allergy Organization and the Respiratory Effectiveness Group, is to review the accumulating evidence on the burden of SCS on patients with asthma and provide an overview of potential strategies for implementing SCS Stewardship. Primary prevention of exacerbations and improvement of asthma control is a key first step in achieving SCS Stewardship, by optimizing maintenance asthma medications and addressing modifiable risk factors, such as adherence and inhaler technique. Other key elements of SCS Stewardship include increasing appropriate specialist referrals for multidisciplinary review, assessment of biomarkers, and consideration of oral corticosteroid-sparing add-on therapies (eg, biologics). In cases where SCS use is deemed clinically justified, it should be tapered to the lowest possible dose. In addition, patients receiving long-term SCS or frequent acute courses should be closely monitored for emergence of SCS-related AEs. Because of the extensive data available on the costly and burdensome AEs associated with SCS use, as well as the range of treatment options now available, there is a need for healthcare providers (HCPs) to carefully evaluate whether the benefits of SCS outweigh the potential harms, to adopt SCS-sparing and Stewardship strategies, and to consider alternative therapies where possible. Development of a structured and collaborative SCS Stewardship approach is urgently required to protect patients from the potential harm of SCS use.
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Affiliation(s)
- Eugene R. Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Alan Kaplan
- Family Physician Airways Group of Canada, Stouffville, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital ‘P&A Kyriakou’, University of Athens, Athens, Greece
| | - Nicolas Roche
- Department of Respiratory Medicine, APHP. Centre Université Paris Cité, Cochin Hospital (AP-HP) and Institute (UMR1016), Paris, France
| | - Dermot Ryan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Yuji Tohda
- Kindai University Hospital, Osaka, Japan
| | - Anahí Yáñez
- Center for Research on Allergies and Respiratory Diseases (InAER), Buenos Aires, Argentina
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Corresponding author. Professor David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06 Midview City, Singapore 573969
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8
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Garcia Bolao I, Gras D, D'Onofrio A, Mark G, Nair D, Lellouche N, Novak M, Lo R, Chew E, Wright D, Kaplan A, Veraghtert S, Hu Y, Yong P, Gardner RS. Strategic management to optimize response to cardiac resynchronization therapy registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is guideline-recommended for the treatment of symptomatic heart failure (HF) in patients (pts) with reduced LVEF and prolonged QRS. Clinical trials report Clinical Composite Score (CCS) response rates from 60 to 75%. However, patients with common comorbidities, such as atrial fibrillation, are often under-represented in clinical trials. The Strategic MAnagement to optimize response to cardiac Resynchronization Therapy (SMART) Registry (NCT03075215) was designed to examine outcomes in CRT patients in the real world.
Methods
The SMART Registry was a global, multicenter, prospective, clinical registry that enrolled subjects undergoing a de novo CRT-D implant or upgrade from pacemaker to CRT-D using a quadripolar LV lead. CCS was assessed at 12 months post-implant.
Results
For study design and CCS outcomes see Figure 1. CCS at 12 months showed that 58.8% of pts improved and 20.1% stabilized. Of the 21.1% of pts that worsened, 8.4% were due to death, 7.8% non-fatal heart failure event, and 5% worsening of NYHA or patient global assessment. Notably, this registry had a high prevalence of pts with NYHA I/II (51%), Non-LBBB (50%), AF (37%), diabetes (35%), and bradycardia (31%) at baseline. Age (>65), diabetes, ischemia, non-LBBB, atrial fibrillation (AF) and renal dysfunction correlated with worsened CCS outcomes. NYHA III/IV patients had significantly higher HF hospitalization (HFH) rates than NYHA I/II (P-value <0.001) (Figure 2a) and patients with AF had higher HFH rates than those without (P-value <0.001) (Figure 2b). Similar effects of NYHA score and AF were seen on mortality. The use of ACE/ARB, or ARNI, and MRA correlated with better outcomes, whereas diuretics and anticoagulants correlated with poorer outcomes.
Conclusions
In this large registry, clinical outcomes across important sub-populations are in line with expectations, with older age, ischemia, renal dysfunction, AF, non-LBBB, and diabetes associated with a lower likelihood of response to CRT. By including these patients, this study provides a clearer picture of the effectiveness of CRT in the real world. Future studies should examine optimization approaches to facilitate CRT effectiveness in these under studied patient populations.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This registry was funded by Boston Scientific (BSC)
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Affiliation(s)
| | - D Gras
- L'Hopital Prive du Confluent , Nantes , France
| | - A D'Onofrio
- AORN Ospedali dei Colli - Monaldi Hospital , Naples , Italy
| | - G Mark
- Cardiology Associates of the Delaware Valley, PA , Haddon Heights , United States of America
| | - D Nair
- Arrhythmia Research Group , Jonesboro , United States of America
| | | | - M Novak
- Faculty Hospital U sv Anny , Brno , Czechia
| | - R Lo
- VA Loma Linda , Loma Linda , United States of America
| | - E Chew
- Belfast City Hospital Trust , Belfast , United Kingdom
| | - D Wright
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - A Kaplan
- Cardiovascular Associates of Mesa , Mesa , United States of America
| | - S Veraghtert
- Boston Scientific Corporation , St. Paul , United States of America
| | - Y Hu
- Boston Scientific Corporation , St. Paul , United States of America
| | - P Yong
- Boston Scientific Corporation , St. Paul , United States of America
| | - R S Gardner
- Golden Jubilee National Hospital, Scottish National Advanced Heart Failure Service , Clydebank , United Kingdom
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9
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Tsaban G, Shalev A, Katz A, Yaskolka Meir A, Rinott E, Zelicha H, Kaplan A, Bluher M, Ceglarek U, Stumvoll M, Stampfer MJ, Shai I. The effect of distinct dietary interventions on proximal aortic stiffness; the DIRECT-PLUS randomized controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Proximal aortic stiffness (PAS) reflects arterial aging and is strongly associated with increased cardiovascular risk. Plant-rich, specifically Mediterranean-style, diets are associated with reduced cardiovascular risk. The effect of dietary interventions on PAS remains unclear.
Methods
We randomized participants with abdominal-obesity/dyslipidemia to healthy-dietary-guidelines (HDG), Mediterranean, or green-Mediterranean diets combined with physical activity (PA). Both Mediterranean diets were similarly hypocaloric and included 28g/day walnuts. The green-Mediterranean group also consumed green tea (3–4 cups/day) and a Wolffia-globosa (Mankai) plant green-shake. PAS was estimated based on aortic-arch pulse-wave-velocity using magnetic resonance imaging (MRI) at baseline and after 18-months.
Results
Among 294 participants [age=51±10.6 years, body-mass-index 31.3±4.0 kg/m2, PAS = 6.1±2.7 m/sec, retention rate = 89.8%], 281 had valid PAS measurements. Higher PAS was mostly associated with aging, hypertension, dyslipidemia, diabetes, and increased visceral adiposity (p<0.05 for all). After 18-months of intervention, all diet groups significantly reduced their PAS ([HDG: −4.8% (interquartile-range [IQR]: −22.3 to 8.7); Mediterranean: −7.3%, IQR (−20.8 to 11.9); green-Mediterranean: −14.0%, IQR (−27.0 to 2.4); p<0.05 for within-groups changes).
Green-Mediterranean dieters had significantly greater PAS reduction than HDG dieters (p=0.007), also after controlling for age, sex, baseline-PAS, and Δweight. Further adjustment to baseline dyslipidemia, diabetes, and hypertension also revealed significant differences in PAS reduction between green-Mediterranean and Mediterranean groups (p=0.027). Specifically, greater green tea consumption was associated with greater PAS regression (p=0.04). ΔPAS was significantly associated with improvements in Δlow-density-lipoprotein cholesterol and Δtotal-cholesterol (p<0.05, multivariable models). All lifestyle intervention showed aortic age regression as compared to the expected (1.8±0.14 years vs.: HDG: −2.9±7.5 years; MED: −4.1±7.4 years; green-MED:-4.9±8.0 years; p<0.001).
Conclusions
Higher PAS is strongly related to aging and is associated with traditional cardiovascular risk factors. Lifestyle intervention promotes PAS reduction. Green-Mediterranean diet may be associated with more remarkable aortic rejuvenation.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Deutsche Forschungsgemeinschaft (DFG, German Research Foundation); the Israel Ministry of Health
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Affiliation(s)
- G Tsaban
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Shalev
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - A Katz
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - A Yaskolka Meir
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - E Rinott
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - H Zelicha
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - A Kaplan
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
| | - M Bluher
- University of Leipzig, Department of Medicine , Leipzig , Germany
| | - U Ceglarek
- University of Leipzig, Department of Medicine , Leipzig , Germany
| | - M Stumvoll
- University of Leipzig, Department of Medicine , Leipzig , Germany
| | - M J Stampfer
- Harvard T. H. Chan School of Public Health, Division of Network Medicine , Boston , United States of America
| | - I Shai
- Ben Gurion University of the Negev, Faculty of Health Sciences , Beer Sheva , Israel
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10
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Moshkovits Y, Tiosano S, Kaplan A, Kalstein M, Bayshtok G, Kivity S, Segev S, Grossman E, Segev A, Maor E, Fardman A. Serum uric acid levels significantly improve the accuracy of cardiovascular risk score models. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study evaluated the impact of serum uric acid (sUA) on the accuracy of atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations (PCE) model, Systematic Coronary Risk Evaluation score 2 (SCORE2) and SCORE2-Older Persons (OP).
Methods
We evaluated 19,789 asymptomatic self-referred adults aged 40–79 years who were screened annually in a preventive healthcare setting. All subjects were free of cardiovascular disease and diabetes at baseline. sUA levels were expressed as a continuous as well as dichotomous variable (categorized into sex-specific tertiles, with the upper tertiles defined as high sUA). Mortality and cancer data were available for all subjects from nationwide registries. The primary endpoint was the composite of death, acute coronary syndrome and stroke, after excluding subjects diagnosed with lymphatic spread cancer during follow up.
Results
Mean age of study population was 50±8 years and 69% were men. During median follow up of 6 years [2.0–13.1], 1,658 (8%) subjects reached the study endpoint. ASCVD, SCORE2 risk and high sUA were all independently associated with the study endpoint in the multivariable Cox regression model (p<0.001 for all). Continuous net reclassification improvement analysis showed an improvement of 13% in the accuracy of classification when high sUA was added to the PCE and SCORE2 models (p<0.001 for both). sUA remained independently associated with the study endpoint among normal-weight subjects in the SCORE 2 model (HR 1.3, 95% CI 1.1–1.6) but not among overweight individuals (p for interaction = 0.01). Addition of sUA to the models in normal-weight subgroup (N=6,624) resulted in a significant 20% improvement in the model performance for both SCORE2 and ASCVD when sUA was incorporated as dichotomous variable (p<0.001 for ASCVD and p=0.026 for SCORE2 model).
Conclusions
sUA significantly improves classification accuracy of PCE and SCORE 2 models. This effect is especially pronounced among normal weight subjects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Tiosano
- Sheba Medical Center , Tel Aviv , Israel
| | - A Kaplan
- Sheba Medical Center , Tel Aviv , Israel
| | - M Kalstein
- Sheba Medical Center , Tel Aviv , Israel
| | | | - S Kivity
- Tel Aviv University , Tel Aviv , Israel
| | - S Segev
- Sheba Medical Center , Tel Aviv , Israel
| | - E Grossman
- Sheba Medical Center , Tel Aviv , Israel
| | - A Segev
- Sheba Medical Center , Tel Aviv , Israel
| | - E Maor
- Sheba Medical Center , Tel Aviv , Israel
| | - A Fardman
- Sheba Medical Center , Tel Aviv , Israel
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11
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Coster D, Kodesh A, Fardman A, Tiosano S, Moshkovits Y, Bernstein D, Kaplan A, Shamir R, Maor E. Decreasing albumin within normal range is associated with increased likelihood of ischemic heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Albumin (ALB) is a known biomarker of frailty, and cardiovascular disease and frailty are interdependent. Epidemiological evidence demonstrates that low serum albumin levels are linked to events of ischemic heart disease (IHD), venous thromboembolism, heart failure, atrial fibrillation, and stroke.
Purpose
We aimed to investigate the association of variations in ALB levels that are within normal range with IHD events among apparently healthy adults.
Methods
A case-control retrospective study of self-referred adults participating in an executive screening program between 2002 and 2017. All subjects were free of IHD and diabetes at baseline and had their ALB documented in each visit. Only subjects with at least two ALB measurements and whose ALB levels were within the normal range at all visits were included. Relationships between ALB trend and occurrence of IHD (acute coronary syndrome or percutaneous coronary intervention) within 2 years from the last visit were investigated.
Results
The final study cohort included 16,386 subjects. Median age was 53 (IQR 45–60), 11,461 (70%) were men. Analysis included a total of 99,127 visits. Median number of visits per subject was 5 (IQR 3–9, median inter-visit time 1.02 years) and median ALB level was 4.4 (IQR 4.2–4.6). IHD within 2 years was diagnosed in 545 (3%) subjects. Of those, only 36 were female and they tended to have lower variations in ALB throughout the years. Hence, we conducted an analysis of the 509 males only, and created an equal-size age-matched cohort of IHD-free subjects. Our analysis demonstrated a progressive and significant decrease in ALB levels among IHD cases, but not among controls (mean decrease of 0.021 g/DL vs. 0.004 g/DL per year, p<0.01; OR [CI] = 0.82 [0.72–0.93]; Figure 1). Similar results were found among subjects with at least 3 or 4 visits (0.015 g/DL vs. 0.006 g/DL per year, p=0.027, and 0.009 g/DL vs. 0.003 g/DL per year, p=0.045, respectively).
Conclusions
Kinetics of ALB within the normal range can identify men at risk for IHD in preventive healthcare screening programs.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Coster
- Tel Aviv University, Computer Science , Tel Aviv , Israel
| | - A Kodesh
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - A Fardman
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - S Tiosano
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - Y Moshkovits
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - D Bernstein
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - A Kaplan
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - R Shamir
- Tel Aviv University, Computer Science , Tel Aviv , Israel
| | - E Maor
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
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12
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Paprcka S, Sridhar S, Goshayeshi A, Park E, Liu S, Flores R, Rocha L, Miles D, Lamani M, Cho S, Wang N, Guan Y, Chandrasekar S, Kushwaha R, Jafri S, Kaplan A, Stagnaro E, Seitz L, Kline J, Fernandez-Salas E. AB801 is a potent and selective AXL inhibitor that demonstrates significant anti-tumor activity in combination with standard of care therapeutics. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Ellis AK, Foran V, Kaplan A, Mitchell PD. Clarifying SABA overuse: Translating Canadian Thoracic Society guidelines into clinical practice. Allergy Asthma Clin Immunol 2022; 18:48. [PMID: 35690850 PMCID: PMC9188246 DOI: 10.1186/s13223-022-00690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022]
Abstract
Patients with asthma frequently over rely on short-acting beta-agonists (SABA) to treat acute symptoms. This can adversely impact quality of life and increase the risk of exacerbations. SABA overuse is also associated with an increased risk of mortality. In their 2021 update on the diagnosis and management of mild asthma, the Canadian Thoracic Society (CTS) newly recommended that a combination inhaled corticosteroid (ICS) and long-acting beta-agonist, specifically budesonide/formoterol, may be used as-needed (PRN) as an alternative reliever to SABA. The CTS developed an algorithm as a guide for deciding for whom PRN budesonide/formoterol versus PRN SABA is appropriate as a reliever. While the CTS algorithm provides necessary and precise guidance, the somewhat complicated requirements for determining control and exacerbation risk may still end up leaving some patients at-risk of SABA overreliance. This communication simplifies the reliever decision algorithm developed by the CTS for application in daily practice. A 30-s evaluation of 2 simple questions related to reliever use can usually accurately assess if a patient’s asthma is controlled: How many SABA canisters do you use a year AND how many times do you use SABA a week? If the patient indicates use of > 2 SABA canisters per year or > 2 administrations of SABA per week for any reason, the patient does not have controlled asthma and PRN SABA is not an appropriate treatment regimen. Similarly, for patients using PRN ICS/formoterol, more than 2 administrations per week indicates a clinical review and reevaluation of their management, including augmentation. An education process is essential to inform patients, caregivers, and healthcare providers that overuse of any reliever is not acceptable and is potentially harmful.
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Affiliation(s)
- Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
| | | | - Alan Kaplan
- York Region, and Respiratory Effectiveness Group, York region, ON, Canada
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14
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Özdoğan H, Üncü Y, Şekerci M, Kaplan A. Mass excess estimations using artificial neural networks. Appl Radiat Isot 2022; 184:110162. [DOI: 10.1016/j.apradiso.2022.110162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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15
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Kaplan A, Cheng J, Suzuki M, Kumar D, Malhotra M, Moline M, Pappadopulos E. 0454 Response to Lemborexant in Older Subjects with Insomnia Disorder and Comorbid Pain at Baseline. Sleep 2022. [DOI: 10.1093/sleep/zsac079.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The reciprocal relationship between pain and poor sleep has been well established. Pain interferes with sleep, and insomnia increases pain sensitivity, thus reducing quality of life. Therefore, it is of clinical importance to evaluate whether a sleep-promoting drug such as the dual orexin receptor antagonist, lemborexant (LEM; approved in multiple countries to treat adults with insomnia) can improve sleep in older patients, in whom both sleep and ongoing pain are prevalent.
Methods
Study 304 (NCT02783729), was a 1-month, double-blind, PBO- and active-controlled study in subjects age ≥55y with insomnia (full analysis set [FAS]=1006). Those who also endorsed some/severe pain at baseline on the pain/discomfort dimension of the EuroQual-5 Dimension-3 Level scale (EQ-5D-3L; no problems/some problems/extreme problems) at baseline were eligible for these post-hoc analyses. Medical history of pain conditions and/or ongoing therapy were not required for eligibility and were not evaluated. Subjects were randomized to bedtime doses of placebo, LEM 5mg (LEM5),10mg (LEM10) or zolpidem tartrate extended release (not reported here). Changes from baseline (CFB) in objective sleep parameters assessed by polysomnography (latency to persistent sleep [LPS]; wake after sleep onset [WASO]) were analyzed by mixed-effect repeated measures analyses adjusted for relevant factors.
Results
Approximately 18% of the FAS reported some or extreme pain at baseline (PBO=55; LEM5=78; LEM10=50). For LPS, baseline median values (minutes) were 31.0, 29.4 and 42.1 for PBO, LEM5 and LEM10, respectively. Median CFB for LPS were larger and statistically significantly different for both LEM doses compared with PBO at the beginning of treatment (mean of Nights 1/2: +2.5; -8.4, -15.8; P<0.005); and were (mean of Nights 29/30: -7.1,-9.9, -9.0) at the end of treatment LEM5 (P=0.031), LEM10 (P=0.054). For WASO, baseline median values (minutes) were 101.0, 103.6 and 111.1 for PBO, LEM5 and LEM10, respectively. Median CFB for WASO were larger and statistically significantly different (P<0.001) for both LEM doses compared with PBO at the beginning (Nights 1/2; -1.5; -41.5, -64.4) and end of treatment (Nights 29/30; -1.1, -37.9, -52.5).
Conclusion
These data suggest that lemborexant can effectively treat insomnia in older adults with concomitant painful conditions.
Support (If Any)
Eisai Inc.
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16
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Şekerci M, Özdoğan H, Kaplan A. Effects of combining some theoretical models in the cross-section calculations of some alpha-induced reactions for natSb. Appl Radiat Isot 2022; 186:110255. [PMID: 35523086 DOI: 10.1016/j.apradiso.2022.110255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
In cases where it is not possible to obtain the cross-section values experimentally due to various factors, the importance of obtaining them with theoretical models has been explained in many studies available in the literature. In this context, the comparison of the cross-section values obtained by using the theoretical models with the experimental data will also be very beneficial for updating and developing these models. Existing studies, which also serve this purpose, have given inspiration to this study and it is aimed to examine the effects of the simultaneous use of the alpha optical model potentials and the level density models on the cross-section calculations for some alpha-particle-induced reactions on natural antimony. The effects of theoretical models on the cross-section calculations were investigated by comparing the obtained calculation results with the experimental data taken from the literature. The TALYS code, which is frequently preferred in the literature, was used in all calculations within the scope of this study. For the comparison of the calculated results with the experimental data, not only a visual analysis by graphing the outcomes, but also a mean-weighted-deviation calculation was used, and the findings were interpreted by accounting for both of them.
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Affiliation(s)
- M Şekerci
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey
| | - H Özdoğan
- Antalya Bilim University, Vocational School of Health Services, Department of Medical Imaging Techniques, 07190, Antalya, Turkey
| | - A Kaplan
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey.
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17
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Kaplan A, Stewart DJ, Batist G, Spadafora S, Sehdev S, Goodman SG. Access Denied? The Unintended Consequences of Pending Drug Pricing Rules. Curr Oncol 2022; 29:2504-2508. [PMID: 35448178 PMCID: PMC9025245 DOI: 10.3390/curroncol29040204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
The government of Canada now plans to bring into force new federal drug pricing regulations on 1 July 2022. We do not take issue with the goal of medication affordability, which is vital in healthcare the world over. Our concern is that the new guidelines are being implemented without due consideration for three major unintended consequences: regulatory changes will lower the number of clinical trials for new medications in Canada, fewer clinical trials will mean lower research and development investments, and changes will reduce patients’ access to new medications. Access to effective medications is a cornerstone of healthcare for Canadian patients. As physicians, our duty to patient care demands that we tell the government to protect the right of Canadians to timely access to life-changing medicines.
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Affiliation(s)
- Alan Kaplan
- Enhanced Care Clinic, Aurora, ON L4G 1N2, Canada
- Correspondence: ; Tel.: +1-905-883-1100
| | - David J. Stewart
- Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (D.J.S.); (S.S.)
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Silvana Spadafora
- Algoma District Cancer Program, Sault Ste. Marie, ON P6B 0A8, Canada;
| | - Sandeep Sehdev
- Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (D.J.S.); (S.S.)
| | - Shaun G. Goodman
- St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
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18
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Fox C, Pace W, Brandt E, Carter V, Chang KL, Edwards C, Evans A, Gaona G, Han MK, Kaplan A, Kent R, Kocks JWH, Kruszyk M, Chantal LL, LiVoti T, Mahle C, Make B, Ratigan A, Shaikh A, Skolnik N, Stanley B, Yawn BP, Price DB. Variation in Demographic and Clinical Characteristics of Patients with COPD Receiving Care in US Primary Care: Data from the Advancing the Patient EXperience (APEX) in COPD Registry. Pragmat Obs Res 2022; 13:17-31. [PMID: 35516162 PMCID: PMC9064065 DOI: 10.2147/por.s342736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Little is known about the variability in chronic obstructive pulmonary disease (COPD) management and how it may be affected by patient characteristics across different healthcare systems in the US. This study aims to describe demographic and clinical characteristics of people with COPD and compare management across five primary care medical groups in the US. Methods This is a retrospective observational registry study utilizing electronic health records stored in the Advancing the Patient Experience (APEX) COPD registry. The APEX registry contains data from five US healthcare organizations located in Texas, Ohio, Colorado, New York, and North Carolina. Data on demographic and clinical characteristics of primary care patients with COPD between December 2019 and January 2020 were extracted and compared. Results A total of 17,192 patients with COPD were included in analysis: Texas (n = 811), Ohio (n = 8722), Colorado (n = 472), New York (n = 1149) and North Carolina (n = 6038). The majority of patients at each location were female (>54%) and overweight/obese (>60%). Inter-location variabilities were noted in terms of age, race/ethnicity, exacerbation frequency, treatment pattern, and prevalence of comorbid conditions. Patients from the Colorado site experienced the lowest number of exacerbations per year while those from the New York site reported the highest number. Hypertension was the most common co-morbidity at 4 of 5 sites with the highest prevalence in New York. Depression was the most common co-morbidity in Ohio. Treatment patterns also varied by site; Colorado had the highest proportion of patients not on any treatment. ICS/LABA was the most commonly prescribed treatment except in Ohio, where ICS/LABA/LAMA was most common. Conclusions and Relevance Our data show heterogeneity in demographic, clinical, and treatment characteristics of patients diagnosed with COPD who are managed in primary care across different healthcare organizations in the US.
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Affiliation(s)
- Chester Fox
- DARTNet Institute, Aurora, CO, USA
- University at Buffalo, Buffalo, NY, USA
| | - Wilson Pace
- DARTNet Institute, Aurora, CO, USA
- University of Colorado, Denver, CO, USA
| | | | - Victoria Carter
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Ku-Lang Chang
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | | | | | - Alan Kaplan
- Observational and Pragmatic Research Institute, Singapore
- Family Physician Airways Group of Canada, Stouffville, Ontario, Canada
- University of Toronto, Toronto, Canada
| | | | - Janwillem W H Kocks
- Observational and Pragmatic Research Institute, Singapore
- General Practitioners Research Institute, Groningen, the Netherlands
- Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maja Kruszyk
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Le Lievre Chantal
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Tessa LiVoti
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore
| | | | - Barry Make
- Department of Medicine, NJH, Denver, CO, USA
| | | | | | - Neil Skolnik
- Abington Jefferson Health, Jenkintown, PA, USA
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - David B Price
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Correspondence: David B Price, Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK, Tel +65 3105 1489, Email
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Kaplan A. Do Youths Aged 10 to 18 Years Old With T2D and Albuminuria Have Increased Cardiovascular Risk and/or Early Cardiovascular Dysfunction Compared With Those With Type 2 Diabetes (T2D) Without Albuminuria? Can J Diabetes 2022. [DOI: 10.1016/j.jcjd.2022.03.008] [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: 11/26/2022]
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20
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Kaplan A, Frank C, Molnar F. Chronic obstructive pulmonary disease and asthma management in older patients. Can Fam Physician 2021; 67:751-752. [PMID: 34649899 DOI: 10.46747/cfp.6710751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Alan Kaplan
- Clinical Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario
| | - Chris Frank
- Family physician specializing in care of the elderly and palliative care at Queen's University in Kingston, Ont
| | - Frank Molnar
- Specialist in geriatric medicine practising in the Department of Medicine at the University of Ottawa in Ontario and at the Ottawa Hospital Research Institute
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21
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Fardman A, Tiosano S, Kaplan A, Kalstein M, Moshkovits Y, Segev S, Klempfner R, Segev A, Grossman E, Maor E. Incident cardiovascular events among middle-age men are associated with increased risk of subsequent prostate cancer diagnosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Prostate cancer is the second most common malignancy in men worldwide, but incidence is highly dependent on screening.
Purpose
We aimed to examine whether incident cardiovascular disease (CVD) events are associated with increased risk of future prostate cancer in middle-aged men.
Methods
We evaluated asymptomatic self-referred men who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.
Results
Final study population included 18,282 subjects. Median age was 47 years (Interquartile range [IQR] 41–54). During median follow up time of 12 years (IQR 4–17) 2,047 (11%) subjects developed CVD, 406 (2.2%) developed prostate cancer and 694 (4%) died. Compared with patients who were free of CVD or prostate cancer during follow up, risk of death was 4, 6 and 15 times higher for patients who developed CVD event, prostate cancer, or both during follow up, respectively (p <.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 60% more likely to develop prostate cancer (95% Confidence Interval [CI] 1.2–2.1, p=.001). However, after multivariable adjustment, this association was no longer significant. Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in middle-aged men (age≤55 years; N=14,473) incident CVD was associated with a significant 70% increased risk of subsequent cancer diagnosis in multivariable model (95% CI 1.13–2.6, p=.011, p for interaction=.002). Exploratory analysis of men younger than 55 showed that independent association of incident CVD with subsequent cancer diagnosis was different among subjects with normal body mass index (BMI) (≤25 kg/m2) compared with those with increased BMI (HR 0.55; 95% CI [0.22–1.42]; p value=0.23 vs. 1.6; 95% CI [1.007–2.54]; p value=.047; p for interaction=.058, respectively).
Conclusion
Incident CVD is independently associated with increased risk of subsequent prostate cancer diagnosis among men ≤55 years. Routine prostate cancer surveillance should be considered after CVD event in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Fardman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Tiosano
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Kaplan
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Kalstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y Moshkovits
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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22
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Kaplan A, Fardman A, Tiosano S, Segev S, Scheinowitz M, Segev A, Klempfner R, Grossman E, Maor E. Predictors of deterioration in cardiorespiratory fitness among healthy adults: the importance of sex and obesity. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cardiorespiratory fitness (CRF) is associated with cardiovascular co-morbidities and is a strong predictor of adverse cardiovascular outcomes. However, data on the natural history of cardiorespiratory fitness among healthy subjects is limited.
Purpose
This study investigated what are the predictors of deterioration in CRF over time.
Methods
We investigated 36,239 men and women who were annually screened in a tertiary medical center and completed an exercise stress test in all visits, with a total of 175,596 annual visits. Subjects who failed to complete maximal exercise stress test according to the Bruce protocol at their first baseline visit were excluded. In addition, subjects with less than five visits to the center or those who developed ischemic heart disease during follow-up were excluded. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time. Change in CRF between the first baseline visit and the fifth visit was used to calculate fitness deterioration. The primary study endpoint was defined as the lower sex-specific quintile of change in metabolic equivalents (METS) between visits 1 and 5. Logistic regression models were applied.
Results
Final study population included 10,841 subjects. The mean age of the study population was 49±10 years, the mean BMI was 26±4, and 8107 (75%) were men. Median METS at baseline were 10.8 (IQR 9–12.6) and 11.1 (IQR 9.4–13) at the first and fifth visit, respectively (p<0.001 for METS between visits). Overall, 2189 (20%) subjects met the study endpoint. CFR deterioration was higher among women as compared to men (p=0.023). Out of obesity, hypertension, fasting blood glucose, LDL, and HDL cholesterol, after adjustments for age, sex, and baseline CFR, only obesity was independently associated with fitness deterioration in the multivariate model (OR=1.4 95% CI 1.2–1.5, p<0.001). The association of obesity with fitness deterioration was modified by sex such that the risk of CRF deterioration was more pronounced in women (OR=1.6 95% CI 1.3–2, p<0.001) than in men (OR=1.3 95% CI 1.1–1.4, p<0.001).
Conclusion
Obesity is an independent predictor of future CRF deterioration. The effect of obesity on future CRF deterioration is more pronounced among women as compared to men.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kaplan
- Sheba Medical Center, Tel Aviv, Israel
| | - A Fardman
- Sheba Medical Center, Tel Aviv, Israel
| | - S Tiosano
- Sheba Medical Center, Tel Aviv, Israel
| | - S Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | - A Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | | | - E Maor
- Sheba Medical Center, Tel Aviv, Israel
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Fardman A, Tiosano S, Kaplan A, Kalstein M, Moshkovits Y, Segev S, Klempfner R, Segev A, Grossman E, Maor E. Incident cardiovascular events among healthy subjects are associated with increased risk of subsequent cancer diagnosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
While Cardiovascular disease (CVD) and cancer share common risk factors, data on the temporal association between the occurrence of CVD and cancer is limited.
Purpose
This study investigated the association between incident CVD events future cancer among apparently healthy subjects.
Methods
We evaluated asymptomatic self-referred adults who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.
Results
Final study population included 26,574 subjects. Median age was 46 years (Interquartile range [IQR] 40–53) and 69% were men. During median follow up time of 10 years (IQR 3–16) 2,463 (9%) subjects developed CVD, 2,040 (8%) developed cancer and 869 (3%) died. Most common cancer types were prostate among men (N=406, 2.2%) and breast among women (N=283, 3.4%). Compared with patients who were free of CVD and cancer during follow up, risk of death was 5, 34 and 54 times higher for patients who developed CVD event, cancer, or both during follow up, respectively (p <.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 50% more likely to develop cancer in a univariate model (95% Confidence Interval [CI] 1.3–1.7, p<.001). Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in younger subjects (≤52 years; N=19,052) incident CVD was associated with a significant 30% increased risk of subsequent cancer diagnosis (95% CI 1.03–1.67, p=.027) while in older subjects incident CVD was not associated with increased risk of cancer in the multivariable model (p for interaction =.018).
Conclusion
Incident CVD is independently associated with increased risk of subsequent cancer diagnosis among young adults. Active cancer surveillance should be considered among young patients recovering from a CVD event.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Fardman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Tiosano
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Kaplan
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Kalstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y Moshkovits
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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24
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Şekerci M, Özdoğan H, Kaplan A. Effects of deuteron optical models on the cross-section calculations of deuteron induced reactions on natural germanium. Appl Radiat Isot 2021; 176:109875. [PMID: 34311220 DOI: 10.1016/j.apradiso.2021.109875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023]
Abstract
A common feature of scientific studies is that when experimental observation data are not available, theoretical calculations are used to obtain information about the subject under investigation. In this context, many parameters and theoretical models have been developed that can be used in nuclear physics studies just as it is in other branches of sciences. It is intended that by doing so, theoretical models can be improved using recent experimental data while also learning about outcomes where experimental data is unavailable or difficult to access. Among the many theoretical models available, there are also deuteron optical models whose effects are examined in this study. The objective of this study is to examine the effects of different deuteron optical models on the cross-section calculations of deuteron induced reactions on natural germanium. The cross-section values of natGe(d,x)70As, natGe(d,x)71As, natGe(d,x)72As, natGe(d,x)73As, natGe(d,x)74As and natGe(d,x)76As reactions were calculated using five deuteron optical models in the TALYS code's v1.95 for this aim, and the results were compared to the experimental data available in the database known as Experimental Nuclear Reaction Data (EXFOR) library. Graphics and quantitative analyses were also used to present the findings and interpretations of the outcomes.
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Affiliation(s)
- M Şekerci
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey
| | - H Özdoğan
- Antalya Bilim University, Vocational School, Department of Medical Imaging Techniques Program, 07190, Antalya, Turkey
| | - A Kaplan
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey.
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25
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Mathioudakis AG, Miligkos M, Boccabella C, Alimani GS, Custovic A, Deschildre A, Ducharme FM, Kalayci O, Murray C, Garcia AN, Phipatanakul W, Price D, Sheikh A, Agache IO, Bacharier L, Beloukas A, Bentley A, Bonini M, Castro-Rodriguez JA, De Carlo G, Craig T, Diamant Z, Feleszko W, Felton T, Gern JE, Grigg J, Hedlin G, Hossny EM, Ierodiakonou D, Jartti T, Kaplan A, Lemanske RF, Le Souëf PN, Mäkelä MJ, Mathioudakis GA, Matricardi P, Mitrogiorgou M, Morais-Almeida M, Nagaraju K, Papageorgiou E, Pité H, Pitrez PMC, Pohunek P, Roberts G, Tsiligianni I, Turner S, Vijverberg S, Winders TA, Wong GW, Xepapadaki P, Zar HJ, Papadopoulos NG. Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank. BMJ Open 2021; 11:e048338. [PMID: 34215609 PMCID: PMC8256789 DOI: 10.1136/bmjopen-2020-048338] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted. METHODS AND ANALYSIS Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence. ETHICS AND DISSEMINATION Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank. PROSPERO REGISTRATION NUMBERS CRD42020132990, CRD42020171624.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Athens Breath Centre, Athens, Greece
| | - Michael Miligkos
- First Department of Pediatrics, "Aghia Sofia" Children's Hospital, University of Athens, Athens, Attica, Greece
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
| | - Gioulinta S Alimani
- Athens Breath Centre, Athens, Greece
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, UK
| | - A Deschildre
- Unité de Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHU Lille, Lille, Hauts-de-France, France
| | | | - Omer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe Universitesi, Ankara, Turkey
| | - Clare Murray
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Antonio Nieto Garcia
- Pulmonology and Allergy Unity, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Leonard Bacharier
- Department of Allergy, Immunology, and Pulmonary Medicine, University of Washington, Seattle, Washington, USA
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Andrew Bentley
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Acute Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Giuseppe De Carlo
- Allergy and Airway Diseases Patient's Associations, European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium
| | - Timothy Craig
- Allergy, Asthma and Immunology, Penn State University, Hershey, Pennsylvania, USA
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital Lund Hematological Clinic, Lund, Skåne, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center of Groningen and QPS-NL, Groningen, Netherlands
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warszawa, Poland
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - James E Gern
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Elham M Hossny
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Tuomas Jartti
- Department of Paediatrics, University of Turku, Turku, Finland
| | - Alan Kaplan
- Family Physician, Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
| | - Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peter N Le Souëf
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Mika J Mäkelä
- Department of Allergy, University of Helsinki, Helsinki, Uusimaa, Finland
| | | | - Paolo Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine, Berlin, Germany
| | - Marina Mitrogiorgou
- Third Department of Paediatrics, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | | | | | - Effie Papageorgiou
- Department of Biomedical Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Helena Pité
- Allergy Center, Hospital CUF Descobertas, Lisboa, Portugal
- Allergy Center, CUF Infante Santo Hospital, Lisbon, Portugal
- Chronic Diseases Research Center (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paulo M C Pitrez
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Petr Pohunek
- Paediatric Department, Motol University Hospital, Praha, Czech Republic
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton, Southampton, UK
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethimno, Greece
| | - Stephen Turner
- Department of Child Health, University of Aberdeen, Aberdeen, Aberdeen, UK
| | - Susanne Vijverberg
- Department of Respiratory Medicine and Department of Pediatric Pulmonology, University of Amsterdam, Amsterdam, Netherlands
| | - Tonya A Winders
- Allergy & Asthma, Global Patient Platform, Virginia, Virginia, USA
| | - Gary Wk Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
- Unit on Child and Adolescent Health, Medical Reaserch Council, Cape Town, South Africa
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Attica, Greece
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Murray CS, Lucas SJ, Blakey J, Kaplan A, Papi A, Paton J, Phipatanakul W, Price D, Teoh OH, Thomas M, Turner S, Papadopoulos NG. A real-life comparative effectiveness study into the addition of antibiotics to the management of asthma exacerbations in primary care. Eur Respir J 2021; 58:13993003.03599-2020. [PMID: 33419889 DOI: 10.1183/13993003.03599-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/07/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma exacerbations are major contributors to asthma morbidity and mortality. They are usually managed with bronchodilators and oral corticosteroids (OCS), but clinical trial evidence suggests that antibiotics could be beneficial. We aimed to assess whether treatment of asthma exacerbations with antibiotics in addition to OCS improved outcomes in larger, more representative routine-care populations. METHOD A retrospective comparative effectiveness study into managing asthma exacerbations with OCS alone versus OCS plus antibiotics was conducted using the Optimum Patient Care Research Database. The dataset included 28 637 patients; following propensity score matching 20 024 adults and 4184 children were analysed. RESULTS Antibiotics in addition to OCS were prescribed for the treatment of asthma exacerbations in 45% of adults and 32% of children. Compared to OCS alone, OCS plus antibiotics was associated with reduced risk of having an asthma/wheeze consultation in the following 2 weeks (children hazard ratio (HR) 0.84 (95% CI 0.73-0.96), p=0.012; adults HR 0.86 (95% CI 0.81-0.91), p<0.001), but an increase in risk of a further OCS prescription for a new/ongoing exacerbation within 6 weeks in adults (HR 1.11 (95% CI 1.01-1.21), p=0.030), but not children. Penicillins, but not macrolides, were associated with a reduction in the odds of a subsequent asthma/wheeze consultation compared to OCS alone, in both adults and children. CONCLUSION Antibiotics were frequently prescribed in relation to asthma exacerbations, contrary to guideline recommendations. Overall, the routine addition of antibiotics to OCS in the management of asthma exacerbations appeared to confer little clinical benefit, especially when considering the risks of antibiotic overuse.
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Affiliation(s)
- Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - John Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, Curtin University, Perth, Australia
| | - Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Thornhill, ON, Canada
| | - Alberto Papi
- Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - James Paton
- School of Medicine, University of Glasgow, Glasgow, UK
| | | | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Oon Hoe Teoh
- Dept of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mike Thomas
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK .,Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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Roman-Rodriguez M, Kaplan A. GOLD 2021 Strategy Report: Implications for Asthma-COPD Overlap. Int J Chron Obstruct Pulmon Dis 2021; 16:1709-1715. [PMID: 34163155 PMCID: PMC8214338 DOI: 10.2147/copd.s300902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
In its 2021 strategy report, the Global Initiative for Chronic Obstructive Lung Disease states: “we no longer refer to asthma-COPD overlap (ACO), instead we emphasize that asthma and COPD are different disorders, although they may […] coexist in an individual patient. If a concurrent diagnosis of asthma is suspected, pharmacotherapy should primarily follow asthma guidelines, but pharmacological and non-pharmacological approaches may also be needed for their COPD.” What does this mean for the treating physician? In this review, we explore the implications of this new guidance on treating patients with chronic obstructive pulmonary disease, arguing for a personalized approach to treatment.
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Affiliation(s)
- Miguel Roman-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain
| | - Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
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Papadopoulos NG, Mathioudakis AG, Custovic A, Deschildre A, Phipatanakul W, Wong G, Xepapadaki P, Abou‐Taam R, Agache I, Castro‐Rodriguez JA, Chen Z, Cros P, Dubus J, El‐Sayed ZA, El‐Owaidy R, Feleszko W, Fierro V, Fiocchi A, Garcia‐Marcos L, Goh A, Hossny EM, Huerta Villalobos YR, Jartti T, Le Roux P, Levina J, López García AI, Ramos ÁM, Morais‐Almeida M, Murray C, Nagaraju K, Nagaraju MK, Navarrete Rodriguez EM, Namazova‐Baranova L, Nieto Garcia A, Pozo Beltrán CF, Ratchataswan T, Rivero Yeverino D, Rodríguez Zagal E, Schweitzer CE, Tulkki M, Wasilczuk K, Xu D, Alekseeva A, Almeida B, Andre M, Arimova P, Blonde A, Cunningham A, Da Mota S, Efendieva K, Kalugina V, Kiefer S, Klein A, López CGC, López JJR, Moratellti C, Fuentes Pérez M, Simermann M, Tapia JSP, Tatopoulos A, Vishneva E, Volkov Κ, Bacharier L, Bonini M, Craig T, Diamant Z, Ducharme FM, Gern JE, Grigg J, Hamelmann EH, Hedlin G, Jartti T, Kalayci O, Kaplan A, Konradsen J, Kuna P, Lau S, Le Souef P, Lemanske RF, Makela MJ, Matricardi PM, Gómez R, Miligkos M, Pitrez PMC, Price D, Pohunek P, Roberts GC, Sheikh A, Tsiligianni I, Turner S, Valiulis A, Winders T, Yusuf OM, Zar H. Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort. Allergy 2021; 76:1765-1775. [PMID: 33608919 PMCID: PMC8013557 DOI: 10.1111/all.14787] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 10/29/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Background The interplay between COVID‐19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID‐19 pandemic on childhood asthma outcomes. Methods The PeARL multinational cohort included 1,054 children with asthma and 505 non‐asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID‐19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control. Results During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty‐six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre‐bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non‐asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged. Conclusion Childhood asthma outcomes, including control, were improved during the first wave of the COVID‐19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID‐19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.
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29
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Price D, Jones R, Pfister P, Cao H, Carter V, Kemppinen A, Holzhauer B, Kaplan A, Clark A, Halpin DMG, Pinnock H, Chalmers JD, van Boven JFM, Beeh KM, Kostikas K, Roche N, Usmani O, Mastoridis P. Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes. Pragmat Obs Res 2021; 12:25-35. [PMID: 34079422 PMCID: PMC8163732 DOI: 10.2147/por.s302809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background Poor treatment adherence in COPD patients is associated with poor clinical outcomes and increased healthcare burden. Personalized approaches for adherence management, supported with technology-based interventions, may offer benefits to patients and providers but are currently unproven in terms of clinical outcomes as opposed to adherence outcomes. Methods Maximizing Adherence and Gaining New Information For Your COPD (MAGNIFY COPD study), a pragmatic cluster randomized trial, aims to evaluate the impact of an adherence technology package (interventional package), comprising an adherence review, ongoing provision of a dual bronchodilator but with an add-on inhaler sensor device and a connected mobile application. This will compare time to treatment failure and other clinical outcomes in patients identified at high risk of exacerbations with historic poor treatment adherence as measured by prescription collection to mono/dual therapy over one year (1312 patients) versus usual care. Treatment failure is defined as the first occurrence of one of the following: (1) moderate/severe COPD exacerbation, (2) prescription of triple therapy (inhaled corticosteroid/long-acting β2-agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]), (3) prescription of additional chronic therapy for COPD, or (4) respiratory-related death. Adherence, moderate/severe exacerbations, respiratory-related healthcare resource utilization and costs, and intervention package acceptance rate will also be assessed. Eligible primary care practices (N=176) participating in the Optimum Patient Care Quality Improvement Program will be randomized (1:1) to either adherence support cluster arm (suitable patients already receiving or initiated Ultibro® Breezhaler® [indacaterol/glycopyrronium] will be offered interventional package) or the control cluster arm (suitable patients continue to receive usual clinical care). Patients will be identified and outcomes collected from anonymized electronic medical records within the Optimum Patient Care Research Database. On study completion, electronic medical record data will be re-extracted to analyze outcomes in both study groups. Registration Number ISRCTN10567920. Conclusion MAGNIFY will explore patient benefits of technology-based interventions for electronic adherence monitoring.
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Affiliation(s)
- David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Victoria Carter
- Observational and Pragmatic Research International Ltd, Stubbs House Stubbs Green, London, Norwich, UK
| | - Anu Kemppinen
- Observational and Pragmatic Research International Ltd, Stubbs House Stubbs Green, London, Norwich, UK
| | | | - Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kai M Beeh
- Clinical Research, Insaf Respiratory Research Institute, Wiesbaden, Germany
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Nicolas Roche
- Cochin Hospital and Institute, APHP Centre, University of Paris, Paris, France
| | - Omar Usmani
- National Heart & Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
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Tsaban G, Yaskolka-Meir A, Rinott E, Zelicha H, Kaplan A, Shalev A, Katz A, Shai I. Metabolic determinants of proximal aortic stiffness among healthy people with abdominal obesity. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): (1) the Deutsche Forschungsgemeinschaft; (2) Israel Ministry of Health
Background
Increased proximal aortic stiffness (PAS) is directly associated with cardiovascular risk. Likewise, metabolic syndrome (MS) and abdominal obesity are associated with cardiovascular risk. The direct association between MS determinants and PAS among a healthy population with abdominal obesity remains to be examined.
Purpose
To examine the association between MS determinants and PAS among healthy participants with abdominal obesity.
Methods
We utilized the cross-sectional baseline data of the DIRECT-PLUS study (clinicaltrials.gov NCT03020186), where we recruited healthy participants with abdominal obesity/dyslipidemia. Along with anthropometric measurements and blood tests, all participants underwent magnetic-resonance-imaging from which PAS we assessed by calculating the aortic arch pulse-wave-velocity (from the ascending to the descending aorta). We defined MS according to the NCEP-ATP-III criteria.
Results
Of 282 participants who had a valid PAS estimation [mean-age: 51.0, 88.3% male, mean-body-mass-index: 31.2kg/m2, mean-waist circumference (WC): 109.5cm] 171 (60.9%) had MS. PAS was mainly associated with age (r = 0.735, p < 0.001). PAS was associated with an increased 10-year Framingham Risk Score (β=0.165,p = 0.008 after adjustment for age and gender). Participants with MS had higher PAS than non-MS participants (6.6m/sec vs. 5.4m/sec, p = 0.002 after adjusting for age and gender). PAS increased along with cumulative number of MS criteria (p-of-trend < 0.001). In multivariate models, adjusted for gender, age, and dichotomous-components of the MS, worse PAS remained significantly associated with high-density lipoprotein cholesterol (HDL-c; β=0.-116,p = 0.007) and increased blood-pressure (β=0.165,p < 0.001), but not with fasting-glucose, waist-circumference or plasma-triglycerides (p > 0.05 for all). In models adjusted for age, gender, and continuous determinants of MS, worse PAS remained associated with mean-arterial pressure (β=0.218,p < 0.001) and HDL-c (β=0.-126,p = 0.004).
Conclusions
Among a healthy population with abdominal obesity, reduced HDL-c levels and increased blood pressure might be the more dominant predictors of poor PAS state, out of the MS components.
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Affiliation(s)
- G Tsaban
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
| | - A Yaskolka-Meir
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
| | - E Rinott
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
| | - H Zelicha
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
| | - A Kaplan
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
| | - A Shalev
- Soroka University Medical Center, Beer Sheva, Israel
| | - A Katz
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
| | - I Shai
- Ben Gurion University of the Negev, Medicine & Public Health, Beer Sheva, Israel
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31
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Kaplan A. The Myth of Mild: Severe Exacerbations in Mild Asthma: An Underappreciated, but Preventable Problem. Adv Ther 2021; 38:1369-1381. [PMID: 33474708 PMCID: PMC7816833 DOI: 10.1007/s12325-020-01598-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022]
Abstract
Asthma is a common, chronic inflammatory airway disease, characterised by unpredictable episodes of worsening symptoms, or exacerbations. Causes of asthma exacerbations include viral infections, exposure to allergen and air pollution, all of which increase the underlying inflammation that typifies asthma. Most (50-75%) patients are classed as having mild asthma, with symptoms that can be readily controlled with available inhaled medications. Paradoxically, for the past 30 years, the first treatment recommended in asthma management guidelines was short-acting β2-agonists (SABA), which not only have no anti-inflammatory properties but may, in fact, worsen inflammation. The Global Initiative for Asthma (GINA) 2019/2020 broke with this paradox by stating clearly that SABA should no longer be used alone as a reliever, for safety reasons. Instead, GINA now recommends an anti-inflammatory rescue/reliever approach for adult and adolescent patients, based on the combination of an inhaled corticosteroid with a rapid onset β2-agonist such as formoterol. This commentary highlights the fact that even patients with well-controlled mild asthma are at risk of severe, potentially life-threatening exacerbations, similar to those in patients with moderate or severe asthma, and therefore 'mild asthma', is a misnomer. The commentary describes the case history of a patient with mild asthma to illustrate how increasing use of SABA alone can worsen and prolong exacerbations when they occur. The author goes on to describe how the management of this patient's exacerbation could have been improved, and provides up-to-date advice on broader aspects of the management of mild asthma and exacerbations, supported by the recent changes to the GINA recommendations.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
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Kaplan A, Cao H, FitzGerald JM, Iannotti N, Yang E, Kocks JWH, Kostikas K, Price D, Reddel HK, Tsiligianni I, Vogelmeier CF, Pfister P, Mastoridis P. Artificial Intelligence/Machine Learning in Respiratory Medicine and Potential Role in Asthma and COPD Diagnosis. J Allergy Clin Immunol Pract 2021; 9:2255-2261. [PMID: 33618053 DOI: 10.1016/j.jaip.2021.02.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 02/09/2023]
Abstract
Artificial intelligence (AI) and machine learning, a subset of AI, are increasingly used in medicine. AI excels at performing well-defined tasks, such as image recognition; for example, classifying skin biopsy lesions, determining diabetic retinopathy severity, and detecting brain tumors. This article provides an overview of the use of AI in medicine and particularly in respiratory medicine, where it is used to evaluate lung cancer images, diagnose fibrotic lung disease, and more recently is being developed to aid the interpretation of pulmonary function tests and the diagnosis of a range of obstructive and restrictive lung diseases. The development and validation of AI algorithms requires large volumes of well-structured data, and the algorithms must work with variable levels of data quality. It is important that clinicians understand how AI can function in the context of heterogeneous conditions such as asthma and chronic obstructive pulmonary disease where diagnostic criteria overlap, how AI use fits into everyday clinical practice, and how issues of patient safety should be addressed. AI has a clear role in providing support for doctors in the clinical workplace, but its relatively recent introduction means that confidence in its use still has to be fully established. Overall, AI is expected to play a key role in aiding clinicians in the diagnosis and management of respiratory diseases in the future, and it will be exciting to see the benefits that arise for patients and doctors from its use in everyday clinical practice.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, Canada.
| | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Nick Iannotti
- Novartis Institutes for Biomedical Research, Cambridge, Mass
| | - Eric Yang
- Novartis Institutes for Biomedical Research, Cambridge, Mass
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands; Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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Ryan D, Heatley H, Heaney LG, Jackson DJ, Pfeffer PE, Busby J, Menzies-Gow AN, Jones R, Tran TN, Al-Ahmad M, Backer V, Belhassen M, Bosnic-Anticevich S, Bourdin A, Bulathsinhala L, Carter V, Chaudhry I, Eleangovan N, FitzGerald JM, Gibson PG, Hosseini N, Kaplan A, Murray RB, Rhee CK, Van Ganse E, Price DB. Potential Severe Asthma Hidden in UK Primary Care. J Allergy Clin Immunol Pract 2020; 9:1612-1623.e9. [PMID: 33309935 DOI: 10.1016/j.jaip.2020.11.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe asthma may be underrecognized in primary care. OBJECTIVE Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care. METHODS This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared. RESULTS Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA. CONCLUSIONS Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
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Affiliation(s)
- Dermot Ryan
- Usher Institute, University of Edinburgh, United Kingdom
| | - Heath Heatley
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom
| | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, United Kingdom
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | | | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Vibeke Backer
- Department of ENT & Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Manon Belhassen
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Montpellier University Hospitals, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | | | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Alan Kaplan
- Family Physician Airways Group of Canada, Stouffville, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eric Van Ganse
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
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34
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Javor D, Kaplan H, Kaplan A, Puchner SB, Krestan C, Baltzer P. Deep learning analysis provides accurate COVID-19 diagnosis on chest computed tomography. Eur J Radiol 2020; 133:109402. [PMID: 33190102 PMCID: PMC7641539 DOI: 10.1016/j.ejrad.2020.109402] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Computed Tomography is an essential diagnostic tool in the management of COVID-19. Considering the large amount of examinations in high case-load scenarios, an automated tool could facilitate and save critical time in the diagnosis and risk stratification of the disease. METHODS A novel deep learning derived machine learning (ML) classifier was developed using a simplified programming approach and an open source dataset consisting of 6868 chest CT images from 418 patients which was split into training and validation subsets. The diagnostic performance was then evaluated and compared to experienced radiologists on an independent testing dataset. Diagnostic performance metrics were calculated using Receiver Operating Characteristics (ROC) analysis. Operating points with high positive (>10) and low negative (<0.01) likelihood ratios to stratify the risk of COVID-19 being present were identified and validated. RESULTS The model achieved an overall accuracy of 0.956 (AUC) on an independent testing dataset of 90 patients. Both rule-in and rule out thresholds were identified and tested. At the rule-in operating point, sensitivity and specificity were 84.4 % and 93.3 % and did not differ from both radiologists (p > 0.05). At the rule-out threshold, sensitivity (100 %) and specificity (60 %) differed significantly from the radiologists (p < 0.05). Likelihood ratios and a Fagan nomogram provide prevalence independent test performance estimates. CONCLUSION Accurate diagnosis of COVID-19 using a basic deep learning approach is feasible using open-source CT image data. In addition, the machine learning classifier provided validated rule-in and rule-out criteria could be used to stratify the risk of COVID-19 being present.
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Affiliation(s)
- D Javor
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - H Kaplan
- Deepinsights Study Group for Artificial Intelligence, Vienna, Austria
| | - A Kaplan
- Deepinsights Study Group for Artificial Intelligence, Vienna, Austria
| | - S B Puchner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - C Krestan
- Department of Radiology, Sozialmedizinisches Zentrum Süd - Kaiser-Franz-Josef Spital, Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Soriano JB, Anzueto A, Bosnic Anticevich S, Kaplan A, Miravitlles M, Usmani O, Papadopoulos NG, Puggioni F, Canonica GW, Roche N. Face masks, respiratory patients and COVID-19. Eur Respir J 2020; 56:13993003.03325-2020. [PMID: 32994197 PMCID: PMC7525001 DOI: 10.1183/13993003.03325-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Joan B Soriano
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, Spain .,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio Anzueto
- Division of Pulmonary Diseases and Critical Care Medicine, The University of Texas Health, San Antonio, TX, USA.,Pulmonary Diseases Section, Audie L. Murphy Memorial VA Hospital, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Sinthia Bosnic Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Alan Kaplan
- Dept of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Marc Miravitlles
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Omar Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Nicolas Roche
- Respiratory Medicine, Hôpital Cochin, APHP Centre, Université de Paris (UMR1016, Institut Cochin), Paris, France
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Rothschild E, Baruch G, Kaplan A, Kapusta L, Topilsky Y. Right ventricular strain for prediction of mortality in patients with preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Right Ventricular (RV) dysfunction is highly prevalent and has major prognostic implication in patients with Heart Failure (HF) with Preserved Ejection Fraction (HFpEF). Different functional indices have been proposed to evaluate RV function, most common are TEI-index, TAPSE and RVFAC%. Recent works suggested that 2-dimensional speckle tracking echocardiography (2DSTE) for RV global longitudinal strain (RVGLS) and free wall strain (RVFWS) are more sensitive in evaluating RV (dys)function than other functional and hemodynamic parameters in specific populations, such as HF with reduced EF.
Purpose
We aimed to assess if endocardial RVGLS, RVFWS, and RV Septal Wall Strain (RVSWS), might have a prognostic and additive value (on top of the conventional measurements) on the outcome of patients with preserved EF.
Methods
Retrospective analysis of RV parameters including Peak and End Systolic Strain of RVGLS, RVFWS and RVSWS, RV functional indices (RVFAC% and Machine like TAPSE), Systolic Pulmonary Artery Pressure, in 375 consecutive patients with Preserved Ejection Fraction (EF ≥50%; age 69.1±19; 51% female; Co-morbidity Charlson index 1 (3)). Multivariate Cox regression hazards model was used to determine the association between RV strain parameters to all-cause mortality.
Results
RVFWS, RVSWS and RVFAC% were strong predictors of mortality in univariate analysis (HR 1.07 [1.03–1.1]; p≤0.0001, HR 1.08 [1.05–1.12]; p≤0.0001, HR 0.97 [0.95–0.99]; p≤0.0002, respectively). Moreover, after adjustment for clinical (age, gender, Charlson index) and echocardiographic parameters (LA volume, E/e' average, systolic pulmonary pressure), all three parameters remained statistically significant predictors of all-cause mortality (p=0.004, p=0.024, p=0.026, respectively).
The best strain univariate predictor of mortality was RVGLS (HR 1.09 [1.05–1.13]; p≤0.0001), being superior to other RV functional indices and systolic pulmonary pressure. Also, after multivariate analysis it remained a statistically significant predictor of mortality (p=0.007).
All measurements had good intra-observer and inter-observer reproducibility (Single Measures ICC = 0.90 and ICC = 0.88, respectively).
Conclusions
2DSTE of RVGLS, RVFWS, RVSWS provides significant prognostic value to predict overall mortality in patients with Preserved Ejection Fraction with excellent reproducibility, incremental to routine clinical, hemodynamic and diastolic parameters.
Moreover, the strain results of the septal wall showed to be significant, thereover challenging the known hypothesis that the septal wall is mainly influenced by LV function.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Rothschild
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
| | - G.N Baruch
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
| | - A Kaplan
- Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
| | - L Kapusta
- Tel Aviv Sourasky Medical Center, Paediatric Cardiology, Tel Aviv, Israel
| | - Y Topilsky
- Tel Aviv Sourasky Medical Center, Cardiology, Tel Aviv, Israel
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Anzueto A, Kaplan A. Dual bronchodilators in chronic obstructive pulmonary disease: Evidence from randomized controlled trials and real-world studies. Respiratory Medicine: X 2020. [DOI: 10.1016/j.yrmex.2020.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kaplan A, Chang KL. Tiotropium in asthma - perspectives for the primary care physician. Postgrad Med 2020; 133:552-564. [PMID: 32896185 DOI: 10.1080/00325481.2020.1816329] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Asthma is a heterogeneous disease characterized by airway inflammation resulting from complex interactions between multiple hosts as well as environmental factors. As a chronic respiratory condition, asthma exerts a significant impact on patients and the healthcare system. Per the Global Initiative for Asthma (GINA), inhaled corticosteroids (ICS) with/without long-acting beta2-agonists (LABAs) should be used as the preferred controllers for the management of asthma. Despite a range of therapeutic options, many patients with asthma remain uncontrolled, resulting in an increased risk of hospitalization and emergency room visits and a worsened quality of life. Tiotropium (Spiriva®, Boehringer Ingelheim Pharmaceuticals, Inc; 1.25 µg, two puffs, once daily), delivered via the Respimat® inhaler (Boehringer Ingelheim Pharmaceuticals, Inc.), was the first long-acting muscarinic antagonist to be approved as an add-on maintenance treatment option for patients with asthma aged ≥6 years at GINA steps 4 and 5. By binding to the muscarinic receptors M1 and M3 in the bronchial airways, tiotropium antagonizes the action of acetylcholine, leading to smooth muscle relaxation and reduced mucus secretion.The efficacy and safety of tiotropium add-on to ICS±LABA maintenance treatment have been evaluated in randomized controlled trials (RCTs) involving patients with a range of asthma severities (mild, moderate, and severe) and across age groups (children, adolescents, and adults). Add-on tiotropium was found to be well tolerated and efficacious in all RCTs. Moreover, the findings from real-world studies complement results from RCTs, showing beneficial effects of tiotropium in reducing exacerbations, hospitalization, emergency room visits, and asthma worsening.In this review article, we discuss the pathophysiology of asthma and the role of tiotropium in the management of asthma from the perspective of a primary care physician.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ku-Lang Chang
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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Kerkhof M, Chaudhry I, Pavord ID, Miravitlles M, Kook Rhee C, Halpin DM, Usmani OS, Jones R, Kocks J, Alacqua M, Morris T, Kaplan A, Price DB. Blood eosinophil count predicts treatment failure and hospital readmission for COPD. ERJ Open Res 2020; 6:00188-2020. [PMID: 33693048 PMCID: PMC7927786 DOI: 10.1183/23120541.00188-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/28/2020] [Indexed: 11/05/2022] Open
Abstract
We examined associations between blood eosinophil counts (BEC) and risk of treatment failure or hospital readmission following acute oral corticosteroid (OCS)-treated COPD exacerbations. We conducted studies from the Optimum Patient Care Research Database (OPCRD) (www.optimumpatientcare.org/opcrd) and Clinical Practice Research Datalink (CPRD) (www.cprd.com/home/), validated databases for medical research, with linked Hospital Episode Statistics (HES) data for ∼20 000 COPD patients aged ≥40 years. For patients with OCS-treated COPD exacerbations treated in primary care, with BECs recorded on first day of OCS treatment (Cohort 1), we assessed treatment failure (COPD-related hospitalisations and OCS prescriptions beyond index OCS course). For patients hospitalised for COPD exacerbations, with BEC measured over an exacerbation-free period during the year prior to admission (Cohort 2), we assessed readmission rate. Cox proportional hazards regression analysis was adjusted for confounders to estimate the association between BEC and treatment outcomes. Of patients treated with OCS for COPD exacerbations in primary care (Cohort 1), 44% experienced treatment failure following single OCS courses, and 10% (255/2482) were hospitalised for ≤6 weeks. Greater BEC was associated with reduced hospital-admission risk (hazard ratio [HR]=0.26; 95% CI: 0.12-0.56, per 100 cells·µL-1 increase). BEC increases of ≥200 cells·µL-1 from exacerbation-free periods to exacerbations were associated with least hospitalisation risk (HR=0.32; 95% CI: 0.15-0.71) versus no BEC change. For patients hospitalised for COPD exacerbations (Cohort 2), 4-week hospital readmission was 12% (1189/10 245). BEC increases during an exacerbation-free period within the past year were associated with reduced risk of short-term readmission (HR=0.78; 95% CI: 0.63-0.96). Greater BEC predicted better outcomes for patients with OCS-treated COPD exacerbations, whether community or hospital managed. Eosinopenia predicted worse outcomes.
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Affiliation(s)
- Marjan Kerkhof
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Ian D. Pavord
- Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Chin Kook Rhee
- College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - David M.G. Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Rupert Jones
- The Peninsula College of Medicine and Dentistry, Plymouth, UK
| | - Janwillem Kocks
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | | | - Alan Kaplan
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Family Physician Airways Group of Canada, Richmond Hill, ON, Canada
| | - David B. Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- University of Aberdeen, Aberdeen, UK
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Özdoğan H, Şekerci M, Kaplan A. Photo-neutron cross-section calculations of 54,56Fe, 90,91,92,94Zr, 93Nb and 107Ag Isotopes with newly obtained Giant Dipole Resonance parameters. Appl Radiat Isot 2020; 165:109356. [PMID: 32810729 DOI: 10.1016/j.apradiso.2020.109356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/29/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022]
Abstract
The knowledge of the interaction of photons with matter is of vital importance to investigate fundamental nuclear physics problems. Giant dipole resonance (GDR) mechanism is dominant up to 30 MeV at photo-absorption cross-section. The photo-absorption cross-section curve against the photon energy displays one or multi-peak Lorentzian functions according to the deformation of the nucleus. Theoretical photo-absorption cross-section calculations generally focus on the estimation of GDR parameters. Theoretical reaction codes use GDR parameters to reproduce photon-induced nuclear reactions. In this study, photo-neutron cross-section calculations of 54,56Fe, 90,91,92,94Zr, 93Nb, and 107Ag isotopes have been done with the TALYS 1.8 and EMPIRE 3.2.2 nuclear reaction codes in the GDR region. During these calculations, both codes were firstly operated by using the predefined and existing GDR parameters within the codes. Later on, a new set of GDR parameters have been obtained by running a Lorentzian model based code in where the available experimental data are also considered. Levenberg-Marquardt algorithm has been used with 10-6 function tolerances and 400 iterations for optimization. These new obtained GDR parameters then replaced with the existing GDR parameters within the TALYS code and the photo-neutron cross-section calculations for the investigated isotopes have been repeated. Ultimately, in order to discuss the outcomes and the effects of using new GDR parameters, obtained results were analyzed by comparing them with the experimental data from the Experimental Nuclear Reaction Data (EXFOR) library.
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Affiliation(s)
- H Özdoğan
- Antalya Bilim University, Vocational School of Health Services, Department of Medical Imaging Techniques, 07190, Antalya, Turkey
| | - M Şekerci
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey
| | - A Kaplan
- Süleyman Demirel University, Department of Physics, 32260, Isparta, Turkey.
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Chan AHY, Katzer CB, Horne R, Haughney J, Correia de Sousa J, Williams S, Kaplan A. SABA Reliance Questionnaire (SRQ): Identifying Patient Beliefs Underpinning Reliever Overreliance in Asthma. J Allergy Clin Immunol Pract 2020; 8:3482-3489.e1. [PMID: 32702517 DOI: 10.1016/j.jaip.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient overreliance on short-acting beta2 agonists (SABA), with concomitant underuse of inhaled corticosteroids (ICS), is associated with poor asthma control and increased risk of asthma attacks. OBJECTIVE To develop and validate a brief questionnaire to elicit patients' perceptions of SABA (eg, belief that asthma is best managed by SABA alone) that could lead them to be overly reliant on SABA. METHODS The 5-item SABA Reliance Questionnaire (SRQ) was adapted from the well-validated Beliefs about Medicines Questionnaire assessing patient perceptions of the importance of, and necessity for, SABA in managing their asthma. The psychometric properties of the questionnaire were studied using Amazon Mechanical Turk, an online survey platform, in 446 people with self-reported asthma. Internal reliability and criterion-related validity were assessed on the basis of relationships between SRQ scores and other variables, including self-reported adherence to ICSs and perceived importance of reliever inhalers. RESULTS Internal reliability was good with Cronbach α = 0.74. Criterion-related validity was demonstrated by an inverse correlation between SRQ scores and self-reported adherence to ICSs (r = -0.291; P < .0001), and significant correlation between SRQ scores and perceived reliever importance (r = 0.216; P < .0001), as well as by significant differences in SRQ scores between those with high and those with low self-reported ICS adherence (adherence to ICS t = 4.825; P < .0001). CONCLUSIONS The SRQ demonstrated acceptable internal reliability, and criterion validity, supporting its potential use as a pragmatic tool for identifying patients whose beliefs are indicative of overreliance on SABA for asthma.
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Affiliation(s)
- Amy H Y Chan
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom
| | - Caroline B Katzer
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom
| | - Rob Horne
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, United Kingdom; International Primary Care Respiratory Group, London, United Kingdom.
| | - John Haughney
- International Primary Care Respiratory Group, London, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - Jaime Correia de Sousa
- International Primary Care Respiratory Group, London, United Kingdom; Life and Health Sciences Research Institute (ICVS)/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal
| | - Sian Williams
- International Primary Care Respiratory Group, London, United Kingdom
| | - Alan Kaplan
- International Primary Care Respiratory Group, London, United Kingdom; Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
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42
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Humbert M, Bourdin A, Papadopoulos NG, Holgate ST, Hanania NA, Halpin DMG, Chapman KR, Gavornikova M, Price DB, Kaplan A, Heaney LG. Reducing the hidden burden of severe asthma: recognition and referrals from primary practice. J Asthma 2020; 58:849-854. [PMID: 32347748 DOI: 10.1080/02770903.2020.1759084] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Since their introduction many decades ago, systemic corticosteroids have become a mainstay treatment for asthma. Despite being a highly effective therapy, corticosteroids can cause significant adverse effects in patients. This results in a "double hit" for some patients as they suffer the burden of disease as well as the burden of treatment-induced morbidity.This article aims to raise awareness of the potential, harmful side effects of prolonged or repeated exposure to systemic corticosteroids in asthma. It also highlights the importance of referral of the appropriate patients with asthma from primary care for specialist assessment once other considerations such as adherence, inhaler technique and co-morbidity have been evaluated. We propose a simple decision step that may help busy primary care physicians and general practitioners to identify patients who could benefit from specialist assessment.Our decision step suggests that a patient with asthma should be reviewed at least once by an asthma specialist if he/she (i) has received ≥2 courses of oral corticosteroids in the previous year; asthma remains uncontrolled despite good adherence and inhaler technique; or (ii) has attended an emergency department or was hospitalized for asthma care.Such referral could facilitate wider access to diagnostic tools, in-depth assessment of confounding comorbidities, and non-corticosteroid-based therapies as needed, which may be unavailable in primary practice.
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Affiliation(s)
- Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France.,Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Université de Montpellier, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Montpellier, France
| | - Nikolaos G Papadopoulos
- Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK.,The Allergy Department, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Kenneth R Chapman
- Asthma and Airway Centre, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore.,University of Aberdeen, Aberdeen, UK
| | - Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Jones MG, Hillyar CR, Nibber A, Chisholm A, Wilson A, Maher TM, Kaplan A, Price D, Walsh S, Richeldi L. Opportunities to diagnose fibrotic lung diseases in routine care: A primary care cohort study. Respirology 2020; 25:1274-1282. [DOI: 10.1111/resp.13836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Mark G. Jones
- National Institute for Health Research Biomedical Research Centre and Clinical and Experimental Sciences University of Southampton Southampton UK
| | | | - Anjan Nibber
- Medical Sciences Division University of Oxford Oxford UK
| | | | - Andrew Wilson
- Norwich Medical School University of East Anglia Norwich UK
| | - Toby M. Maher
- Interstitial Lung Disease Unit Royal Brompton Hospital London UK
- Fibrosis Research Group, National Heart and Lung Institute Imperial College London London UK
| | - Alan Kaplan
- Department of Family and Community Medicine University of Toronto Toronto ON Canada
| | - David Price
- Centre of Academic Primary Care, Division of Applied Health Sciences University of Aberdeen Aberdeen UK
- Observational and Pragmatic Research Institute Singapore
| | - Simon Walsh
- Fibrosis Research Group, National Heart and Lung Institute Imperial College London London UK
| | - Luca Richeldi
- National Institute for Health Research Biomedical Research Centre and Clinical and Experimental Sciences University of Southampton Southampton UK
- Unità Operativa Complessa di Pneumologia Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli Rome Italy
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Kaplan A, Mitchell PD, Cave AJ, Gagnon R, Foran V, Ellis AK. Effective Asthma Management: Is It Time to Let the AIR out of SABA? J Clin Med 2020; 9:jcm9040921. [PMID: 32230875 PMCID: PMC7230470 DOI: 10.3390/jcm9040921] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/17/2022] Open
Abstract
For years, standard asthma treatment has included short acting beta agonists (SABA), including as monotherapy in patients with mild asthma symptoms. In the Global Initiative for Asthma 2019 strategy for the management of asthma, the authors recommended a significant departure from the traditional treatments. Short acting beta agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy because of significant safety concerns and poor outcomes. Instead, the more appropriate course is the use of a combined inhaled corticosteroid–fast acting beta agonist as a reliever. This paper discusses the issues associated with the use of SABA, the reasons that patients over-use SABA, difficulties that can be expected in overcoming SABA over-reliance in patients, and our evolving understanding of the use of “anti-inflammatory relievers” in our patients with asthma.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, Edmonton, AB T5X 4P8, Canada
- Correspondence:
| | - Patrick D. Mitchell
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Andrew J. Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Remi Gagnon
- Association of Allergists and Immunologists of Québec, Montréal, QC H5B 1G8, Canada;
| | | | - Anne K. Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada;
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Yawn BP, Kaplan A. Value and Timing of Repeat Spirometry or Feno in Children: With Asthma Remains Unclear. Chest 2020; 155:1312-1313. [PMID: 31174654 DOI: 10.1016/j.chest.2019.02.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Barbara P Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, MN; COPD Foundation, Minneapolis, MN.
| | - Alan Kaplan
- Family Physician Airways Group of Canada, Stouffville, ON, Canada; Respiratory Effectiveness Group, Stouffville, ON, Canada
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Roche N, Anzueto A, Bosnic Anticevich S, Kaplan A, Miravitlles M, Ryan D, Soriano JB, Usmani O, Papadopoulos N, Canonica GW. Connected real-life research, a pillar of P4 medicine. Eur Respir J 2020; 55:55/1/1902287. [PMID: 31949104 DOI: 10.1183/13993003.02287-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Nicolas Roche
- Respiratory Medicine, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, AP-HP and Université de Paris (UMR1016), Paris, France .,Respiratory Effectiveness Group, Board of Directors, Ely, UK
| | - Antonio Anzueto
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,University of Texas Health and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Sinthia Bosnic Anticevich
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Woolcock Institute of Medical Research, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Alan Kaplan
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Dept of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Marc Miravitlles
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Pneumology Dept, University Hospital Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Dermot Ryan
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh, UK
| | - Joan B Soriano
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Hospital Universitario de la Princesa, Universidad Autónoma de Madrid and Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Omar Usmani
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Nikos Papadopoulos
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - G Walter Canonica
- Respiratory Effectiveness Group, Board of Directors, Ely, UK.,Respiratory Disease and Allergy Clinic, IRCCS Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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Abstract
The burden of asthma is particularly notable in adolescents, and is associated with higher rates of prevalence and mortality compared with younger children. One factor contributing to inadequate asthma control in adolescents is poor treatment adherence, with many pediatric studies reporting mean adherence rates of 50% or lower. Identifying the reasons for poor disease control and adherence is essential in order to help improve patient quality of life. In this review, we explore the driving factors behind non-adherence in adolescents with asthma, consider their consequences and suggest possible solutions to ensure better disease control. We examine the impact of appropriate inhaler choice and good inhaler technique on adherence, as well as discuss the importance of selecting the right medication, including the possible role of as-needed inhaled corticosteroids/long-acting β2-agonists vs short-acting β2-agonists, for improving outcomes in patients with mild asthma and poor adherence. Effective patient/healthcare practitioner communication also has a significant role to engage and motivate adolescents to take their medication regularly.
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Affiliation(s)
- Alan Kaplan
- University of Toronto Department of Family and Community Medicine, Toronto, ON, Canada.,Family Physician Airways Group of Canada, Edmonton, AB, Canada.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Vogelberg C, Goldstein S, Graham L, Kaplan A, de la Hoz A, Hamelmann E. A comparison of tiotropium, long-acting β 2-agonists and leukotriene receptor antagonists on lung function and exacerbations in paediatric patients with asthma. Respir Res 2020; 21:19. [PMID: 31931792 PMCID: PMC6958672 DOI: 10.1186/s12931-020-1282-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/05/2020] [Indexed: 11/10/2022] Open
Abstract
Diagnosing and treating asthma in paediatric patients remains challenging, with many children and adolescents remaining uncontrolled despite treatment. Selecting the most appropriate pharmacological treatment to add onto inhaled corticosteroids (ICS) in children and adolescents with asthma who remain symptomatic despite ICS can be difficult. This literature review compares the efficacy and safety of long-acting β2-agonists (LABAs), leukotriene receptor antagonists (LTRAs) and long-acting muscarinic antagonists (LAMAs) as add-on treatment to ICS in children and adolescents aged 4-17 years.A literature search identified a total of 29 studies that met the inclusion criteria, including 21 randomised controlled trials (RCTs) of LABAs versus placebo, two RCTs of LAMAs (tiotropium) versus placebo, and four RCTs of LTRA (montelukast), all as add-on to ICS. In these studies, tiotropium and LABAs provided greater improvements in lung function than LTRAs, when compared with placebo as add-on to ICS. Although exacerbation data were difficult to interpret, tiotropium reduced the risk of exacerbations requiring oral corticosteroids when added to ICS, with or without additional controllers. LABAs and LTRAs had a comparable risk of asthma exacerbations with placebo when added to ICS. When adverse events (AEs) or serious AEs were analysed, LABAs, montelukast and tiotropium had a comparable safety profile with placebo.In conclusion, this literature review provides an up-to-date overview of the efficacy and safety of LABAs, LTRAs and LAMAs as add-on to ICS in children and adolescents with asthma. Overall, tiotropium and LABAs have similar efficacy, and provide greater improvements in lung function than montelukast as add-on to ICS. All three controller options have comparable safety profiles.
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Affiliation(s)
- Christian Vogelberg
- Department of Pediatric Pulmonology and Allergy, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
| | - Stanley Goldstein
- Allergy and Asthma Care of Long Island, Rockville Centre, New York, USA
| | - LeRoy Graham
- Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
| | - Alberto de la Hoz
- TA Respiratory/Biosimilars Medicine, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Eckard Hamelmann
- Klinik für Kinder und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld, and Allergy Center of the Ruhr University, Bochum, Germany
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Cevik S, Kaplan A, Katar S. Correlation of Cervical Spinal Degeneration with Rise in Smartphone Usage Time in Young Adults. Niger J Clin Pract 2020; 23:1748-1752. [DOI: 10.4103/njcp.njcp_605_19] [Citation(s) in RCA: 1] [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] [Indexed: 11/04/2022]
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50
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Blair B, Chen C, Glenn A, Kaplan A, Ruz J, Simms L, Wurtz R. Gaussian mixture models as automated particle classifiers for fast neutron detectors. Stat Anal Data Min 2019. [DOI: 10.1002/sam.11432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Brenton Blair
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
| | - Cliff Chen
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
| | - Andrew Glenn
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
| | - Alan Kaplan
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
| | - Jaime Ruz
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
| | - Lance Simms
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
| | - Ron Wurtz
- Computational Engineering Division Lawrence Livermore National Laboratory Livermore California
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