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Andonian BJ, Ross LM, Sudnick AM, Johnson JL, Pieper CF, Belski KB, Counts JD, King AP, Wallis JT, Bennett WC, Gillespie JC, Moertl KM, Richard D, Huebner JL, Connelly MA, Siegler IC, Kraus WE, Bales CW, Porter Starr KN, Huffman KM. Effect of Remotely Supervised Weight Loss and Exercise Training Versus Lifestyle Counseling on Cardiovascular Risk and Clinical Outcomes in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial. ACR Open Rheumatol 2024; 6:124-136. [PMID: 38126260 PMCID: PMC10933621 DOI: 10.1002/acr2.11639] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To compare a remotely supervised weight loss and exercise intervention to lifestyle counseling for effects on cardiovascular disease risk, disease activity, and patient-reported outcomes in older patients with rheumatoid arthritis (RA) and overweight/obesity. METHODS Twenty older (60-80 years), previously sedentary participants with seropositive RA and overweight/obesity were randomized to 16 weeks of either Supervised Weight loss and Exercise Training (SWET) or Counseling Health As Treatment (CHAT). The SWET group completed aerobic training (150 minutes/week moderate-to-vigorous intensity), resistance training (two days/week), and a hypocaloric diet (7% weight loss goal). The CHAT control group completed two lifestyle counseling sessions followed by monthly check-ins. The primary outcome was a composite metabolic syndrome z-score (MSSc) derived from fasting glucose, triglycerides, high density lipoprotein-cholesterol, minimal waist circumference, and mean arterial pressure. Secondary outcomes included RA disease activity and patient-reported outcomes. RESULTS Both groups improved MSSc (absolute change -1.67 ± 0.64 in SWET; -1.34 ± 1.30 in CHAT; P < 0.01 for both groups) with no between-group difference. Compared with CHAT, SWET significantly improved body weight, fat mass, Disease Activity Score-28 C-reactive protein, and patient-reported physical health, physical function, mental health, and fatigue (P < 0.04 for all between-group comparisons). Based on canonical correlations for fat mass, cardiorespiratory fitness, and leg strength, component-specific effects were strongest for (1) weight loss improving MSSc, physical health, and mental health; (2) aerobic training improving physical function and fatigue; and (3) resistance training improving Disease Activity Score-28 C-reactive protein. CONCLUSION In older patients with RA and overweight/obesity, 16 weeks of remotely supervised weight loss, aerobic training, and resistance training improve cardiometabolic health, patient-reported outcomes, and disease activity. Less intensive lifestyle counseling similarly improves cardiovascular disease risk profiles, suggesting an important role for integrative interventions in the routine clinical care of this at-risk RA population.
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Affiliation(s)
- Brian J. Andonian
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
| | - Leanna M. Ross
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Alyssa M. Sudnick
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Johanna L. Johnson
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Carl F. Pieper
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
| | - Kelsey B. Belski
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Julie D. Counts
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | | | | | - William C. Bennett
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Jillian C. Gillespie
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Kaileigh M. Moertl
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Dylan Richard
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Janet L. Huebner
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | | | - Ilene C. Siegler
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
| | - William E. Kraus
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | | | | | - Kim M. Huffman
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
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2
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Bennett WC, Collins KA, Johnson JL, Slentz CA, Willis LH, Bales CW, Huffman KM, Kraus WE. Effects of exercise amount and intensity versus a combined exercise and lifestyle intervention on metabolic syndrome in adults with prediabetes: a STRRIDE-PD randomized trial. Front Physiol 2023; 14:1199763. [PMID: 37520827 PMCID: PMC10375017 DOI: 10.3389/fphys.2023.1199763] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/16/2023] [Indexed: 08/01/2023] Open
Abstract
The purpose of this secondary analysis was to determine what portion of the effects of a Diabetes Prevention Program-like intervention on metabolic syndrome (MetS) could be achieved with exercise alone, as well as to determine the relative importance of exercise intensity and amount to the total exercise effect on MetS. Sedentary, overweight adults with prediabetes were randomly assigned to one of four 6-month interventions: 1) low-amount/moderate-intensity (10 kcal/kg/week at 50% peak V ˙ O 2 ); 2) high-amount/moderate-intensity (16 kcal/kg/week at 50% peak V ˙ O 2 ); 3) high-amount/vigorous-intensity (16 kcal/kg/week at 75% peak V ˙ O 2 ); or 4) diet (7% weight loss) plus low-amount/moderate-intensity (10 kcal/kg/week at 50% peak V ˙ O 2 ). The primary outcome of this secondary analysis was change in the MetS z-score. A total of 130 participants had complete data for all five Adult Treatment Panel (ATP) III MetS criteria. The diet-and-exercise group statistically outperformed the MetS z-score and the ATP III score compared to the exercise alone group. Aerobic exercise alone achieved 24%-50% of the total effect of the combined diet-and-exercise intervention on the MetS score. Low-amount moderate-intensity exercise quantitatively performed equal to or better than the interventions of high-amount moderate-intensity or high-amount vigorous-intensity exercise in improving the MetS score. The combined diet-and-exercise intervention remains more efficacious in improving the MetS z-score. However, all three exercise interventions alone showed improvements in the MetS z-score, suggesting that a modest amount of moderate-intensity exercise is all that is required to achieve approximately half the effect of a diet-and-exercise intervention on the MetS. Clinical Trial Registration: clinicaltrials.gov, identifier NCT00962962.
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Affiliation(s)
- William C. Bennett
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Katherine A. Collins
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Johanna L. Johnson
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Cris A. Slentz
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Leslie H. Willis
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Connie W. Bales
- Divison of Geriatrics, Department of Medicine, Durham VA Medical Center, Duke University School of Medicine, Durham, NC, United States
| | - Kim M. Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - William E. Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
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3
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Bennett WC, Garbarine IC, Mostellar M, Lipman J, Sanchez-Casalongue M, Farrell T, Zhou R. Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019. Surg Endosc 2023; 37:3728-3738. [PMID: 36653536 DOI: 10.1007/s00464-022-09796-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/28/2022] [Accepted: 11/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is now the most performed bariatric surgery, though gastric bypass (GB) and duodenal switch (DS) remain common, especially as conversion/revision (C/R) procedures. This analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset was queried for SG, GB, and DS cases from 2015 to 2019. Multivariable logistic regression calculated crude and adjusted odds ratios for surgical site infection (SSI), reoperation, and readmission at 30 days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities. RESULTS Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]), and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively. C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]), and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]). CONCLUSIONS Early complications are comparable between GB and DS, and greater than SG. In C/R procedures, GB and DS demonstrate greater risk than SG. Overall, C/R procedures demonstrate greater risk of most, but not all, early postoperative complications.
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Affiliation(s)
- William C Bennett
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA. .,Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ian C Garbarine
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Murphy Mostellar
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA
| | - Jeffrey Lipman
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.,Hernia Center, NYC Health + Hospitals / Bellevue, New York, NY, USA
| | - Manuel Sanchez-Casalongue
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Rush Copley Medical Center, Rush University, Aurora, IL, USA
| | - Timothy Farrell
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA
| | - Randal Zhou
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Division of Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA
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4
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Reeves PT, Bennett WC, McCown MY, Welsh SK, McDonald CM, Beker L, Robbins S, Vitale DS, Siracusa C, Brownell JN, Sellers ZM, Echelmeyer S, Livezey J, Barnes DM. The Cystic Fibrosis Action Plan: A low health literacy, pictographic self-management tool with clinical automation. Pediatr Pulmonol 2022; 57:2847-2850. [PMID: 35811375 DOI: 10.1002/ppul.26071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, USA
| | - William C Bennett
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Y McCown
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sebastian K Welsh
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas, USA
| | | | - Leila Beker
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sandra Robbins
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David S Vitale
- Division of Pediatric Pulmonology, incinnati Childnre's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Siracusa
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pediatric Pulmonology, incinnati Childnre's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jefferson N Brownell
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Zachary M Sellers
- Department of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Stanford University, Palo Alto, California, USA
| | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jeffrey Livezey
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Danielle M Barnes
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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5
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Pavlovich SS, Bennett WC, Terinte-Balcan G, Hladik G, Jain K. Infective Endocarditis-Associated Pauci-Immune Glomerulonephritis in a Patient With Cryoglobulinemia. Cureus 2022; 14:e27560. [PMID: 36059292 PMCID: PMC9428425 DOI: 10.7759/cureus.27560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
Small-vessel vasculitis has a broad differential with similar clinical presentation and laboratory abnormalities, including petechial rashes, neurologic symptoms, glomerulonephritis, and abnormal inflammatory markers. Biopsy-based diagnosis is critical as the treatment varies by etiology. We report a case of a 41-year-old man with diagnosed cryoglobulinemia and hepatitis C presenting with a petechial rash, altered mental status, and acute kidney injury and ultimately found to have proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis secondary to infective endocarditis. Skin biopsy was consistent with resolving, but nonspecific vasculitis and MRI showed foci of hemosiderin deposition concerning vasculitic lesions. Blood cultures grew Enterococcus faecalis, and he was treated with IV antibiotics. Kidney biopsy showed pauci-immune necrotizing focal segmental glomerulonephritis (GN) and diffuse acute tubular necrosis (ATN). After blood cultures cleared, he was initially treated with mycophenolate for worsening renal function. When the patient stopped antibiotics unexpectedly, his kidney function worsened and improved only after immunosuppression was stopped and antibiotics were restarted. This case highlights the importance of renal biopsy in patients with multiple potential etiologies of GN. The case resolution also reinforces that patients with infective endocarditis causing ANCA-associated GN should be treated with antibiotics in addition to, and possibly instead of, immunosuppression.
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6
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Kong X, Bennett WC, Jania CM, Chason KD, German Z, Adouli J, Budney SD, Oby BT, van Heusden C, Lazarowski ER, Jaspers I, Randell SH, Hedgespeth BA, Cruse G, Hua X, Schworer SA, Smith GJ, Kelada SN, Tilley SL. Identification of an ATP/P2X7/mast cell pathway mediating ozone-induced bronchial hyperresponsiveness. JCI Insight 2021; 6:140207. [PMID: 34546976 PMCID: PMC8663556 DOI: 10.1172/jci.insight.140207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/13/2020] [Accepted: 09/16/2021] [Indexed: 11/20/2022] Open
Abstract
Ozone is a highly reactive environmental pollutant with well-recognized adverse effects on lung health. Bronchial hyperresponsiveness (BHR) is one consequence of ozone exposure, particularly for individuals with underlying lung disease. Our data demonstrated that ozone induced substantial ATP release from human airway epithelia in vitro and into the airways of mice in vivo and that ATP served as a potent inducer of mast cell degranulation and BHR, acting through P2X7 receptors on mast cells. Both mast cell–deficient and P2X7 receptor–deficient (P2X7–/–) mice demonstrated markedly attenuated BHR to ozone. Reconstitution of mast cell–deficient mice with WT mast cells and P2X7–/– mast cells restored ozone-induced BHR. Despite equal numbers of mast cells in reconstituted mouse lungs, mice reconstituted with P2X7–/– mast cells demonstrated significantly less robust BHR than mice reconstituted with WT mast cells. These results support a model where P2X7 on mast cells and other cell types contribute to ozone-induced BHR.
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Affiliation(s)
- Xiaomei Kong
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - William C Bennett
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Corey M Jania
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Kelly D Chason
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Zachary German
- Marsico Lung Institute and.,Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Adouli
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Samuel D Budney
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Brandon T Oby
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Catharina van Heusden
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Eduardo R Lazarowski
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Ilona Jaspers
- Department of Pediatrics and Center for Environmental Medicine, Asthma, and Lung Biology and
| | - Scott H Randell
- Marsico Lung Institute and.,Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Barry A Hedgespeth
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Glenn Cruse
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Xiaoyang Hua
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Otolaryngology - Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Stephen A Schworer
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.,Division of Allergy and Immunology, Department of Pediatrics, and
| | - Gregory J Smith
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samir Np Kelada
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen L Tilley
- Marsico Lung Institute and.,Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
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7
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Duscha BD, Johnson JL, Bennett WC, Ball KN, Mae Fos LB, Reaves MA, Kraus WE. Cardiopulmonary Exercise Testing in the Coronavirus Disease - 2019 Era: Safety and Protocol Considerations. Curr Sports Med Rep 2021; 20:259-265. [PMID: 33908913 DOI: 10.1249/jsr.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Cardiopulmonary exercise testing (CPX) is a valuable tool in both clinical practice and research settings. Therefore, it is advantageous for human performance laboratories to continue operating during the coronavirus disease 2019 (COVID-19) pandemic. All institutions should adhere to general COVID-19 guidelines provided by the Centers for Disease Control. Because of the testing environment, CPX laboratories must consider additional precautionary safety measures. This article provides recommendations for modifying the CPX protocol to ensure safety for all stakeholders during the pandemic. These modifications are universal across all populations, types of institutions and testing modalities. Preliminary measures include careful review of federal, local, and institutional mandates. The description outlines how to evaluate a testing environment and alter workflow. Guidelines are provided on what specific personal protective equipment should be acquired; as well as necessary actions before, during, and after the CPX test. These precautions will limit the possibility of both clients and staff from contracting or spreading the disease while maintaining testing volume in the laboratory.
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8
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Bui J, Bennett WC, Long J, Strassle PD, Haithcock B. Recent Trends in Cardiothoracic Surgery Training: Data from the National Resident Matching Program. J Surg Educ 2021; 78:672-678. [PMID: 32928698 DOI: 10.1016/j.jsurg.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/11/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In 2008, integrated thoracic residency programs (IP) for cardiothoracic (CT) training were created in response to a decline in CT trainees. However, few studies have reported on trends in the CT training pathway since the inception of IPs. This manuscript examines the current trends related to the overall number of surgical trainees entering CT surgery training following the introduction of IPs into the National Resident Match Program (NRMP). DESIGN Main and specialty match data were gathered from NRMP annual reports between 2008 and 2018. Descriptive statistics were used to analyze program size, applications, and filled and unfilled positions for IPs and traditional CT residency programs. Pearson's correlation coefficient was used to determine associations between program variables. SETTING NRMP main and specialty match in 2008 to 2018. PARTICIPANTS Participants of the NRMP main and specialty match in 2008 to 2018. RESULTS IPs increased from 2 programs offering 3 positions in 2008 to 28 programs offering 36 positions in 2018. However, during the same time period, the number of available traditional CT residency positions have decreased by 29% (130 to 92). As the number of IPs increased, there was a significant decrease in the number of traditional CT residency positions (ρ = -0.95, p < 0.001). Although, the overall number of CT residency programs (traditional and IP) remained largely unchanged, the proportion of filled CT residency positions increased from 67.7% in 2008 up to 97.7% in 2018. CONCLUSION The IP training format has shown success in increasing the number of trainees entering into CT training programs. Consideration should be given to increasing the number of IP positions or increase interest in CT among general surgery residents to increase the number of CT surgery trainees with the goal of increasing the size of the future CT workforce.
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Affiliation(s)
- Jenny Bui
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - William C Bennett
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jason Long
- Department of Surgery, Division of Cardiothoracic Surgery, Chapel Hill, North Carolina
| | | | - Benjamin Haithcock
- Department of Surgery, Division of Cardiothoracic Surgery, Chapel Hill, North Carolina.
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9
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Ghodke A, Ives TJ, Austin AE, Bennett WC, Patel NY, Eshet SA, Chelminski PR. Pain Agreements and Time-to-Event Analysis of Substance Misuse in a Primary Care Chronic Pain Program. Pain Med 2020; 21:2154-2162. [PMID: 32186725 DOI: 10.1093/pm/pnaa033] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Types and correlates of pain medication agreement (PMA) violations in the primary care setting have not been analyzed. METHODS A retrospective analysis was completed to examine patient characteristics and correlates of PMA violations, a proxy for substance misuse, over a 15-year period in an outpatient General Medicine Pain Service within the Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill. Patients who signed the PMA were managed for chronic pain from 2002 through 2017 (N = 1,210). The incidence of PMA violations was measured over a 15-year span. Substance misuse was defined a priori in the study as urine toxicology screen positive for illicit or nonprescribed controlled substances, patient engagement in prescription alteration, doctor-shopping, or diversion. RESULTS Most patients received a prescription for a controlled substance (77.4%). During enrollment, 488 (40.3%) patients had one or more violations of their PMA. One-third (33.4%) of pain service patients had a violation within 365 days of signing the agreement. Active tobacco smokers had double the incidence of agreement violation within the first 30 days of enrollment. Almost one-half (49.8%) of violations were due to inconsistent use of controlled substances. Patients with any prior DWI/DUI or drug-related offense had a significantly increased rate of substance misuse (P < 0.0001). CONCLUSIONS PMA violations were common among a population of patients managed for chronic nonmalignant pain. Universal opioid prescribing precautions, including PMAs, require further investigation to assess their roles in mitigating the potential patient and societal harms associated with opioid prescribing.
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Affiliation(s)
- Ameer Ghodke
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy J Ives
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna E Austin
- Injury Prevention Research Center, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William C Bennett
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Naishal Y Patel
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sharon A Eshet
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul R Chelminski
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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10
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Bennett WC, Collins KA, Slentz CA, Bateman LA, Willis LH, Piner LW, Huffman KM, Houmard JA, Kraus WIE. The Effects Of Aerobic And/Or Resistance Training On The Sf-36 Health Survey From Strride-AT/RT. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000682680.43631.dc] [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: 11/21/2022]
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11
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Beck Dallaghan GL, Byerley JS, Howard N, Bennett WC, Gilliland KO. Medical School Resourcing of USMLE Step 1 Preparation: Questioning the Validity of Step 1. Med Sci Educ 2019; 29:1141-1145. [PMID: 34457594 PMCID: PMC8368791 DOI: 10.1007/s40670-019-00822-1] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Gary L. Beck Dallaghan
- Office of Medical Education, University of North Carolina School of Medicine, 108 Taylor Hall, CB#7321, Chapel Hill, NC 27599-7321 USA
| | - Julie Story Byerley
- Office of Medical Education, University of North Carolina School of Medicine, 108 Taylor Hall, CB#7321, Chapel Hill, NC 27599-7321 USA
| | - Neva Howard
- Office of Medical Education, University of North Carolina School of Medicine, 108 Taylor Hall, CB#7321, Chapel Hill, NC 27599-7321 USA
| | - William C. Bennett
- Office of Medical Education, University of North Carolina School of Medicine, 108 Taylor Hall, CB#7321, Chapel Hill, NC 27599-7321 USA
| | - Kurt O. Gilliland
- Office of Medical Education, University of North Carolina School of Medicine, 108 Taylor Hall, CB#7321, Chapel Hill, NC 27599-7321 USA
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12
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Grossberg AJ, Mohamed ASR, Elhalawani H, Bennett WC, Smith KE, Nolan TS, Williams B, Chamchod S, Heukelom J, Kantor ME, Browne T, Hutcheson KA, Gunn GB, Garden AS, Morrison WH, Frank SJ, Rosenthal DI, Freymann JB, Fuller CD. Author Correction: Imaging and clinical data archive for head and neck squamous cell carcinoma patients treated with radiotherapy. Sci Data 2018; 5:1. [PMID: 30482902 PMCID: PMC6300048 DOI: 10.1038/s41597-018-0002-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aaron J Grossberg
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA. .,Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, 97238, USA.
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, 21321, Egypt
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - William C Bennett
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, USA
| | - Kirk E Smith
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, USA
| | - Tracy S Nolan
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, USA
| | - Bowman Williams
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Sasikarn Chamchod
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.,Radiation Oncology Unit, Chulabhorn Hospital, Bangkok, 10210, Thailand
| | - Jolien Heukelom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.,Department of Radiation Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands
| | - Michael E Kantor
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Theodora Browne
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - John B Freymann
- Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, 20892, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.
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13
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Clark AM, Cowell HR, McCraken AA, Bennett WC, Adams DW. A survey of Down Syndrome at the Hospital for the Mentally Retarded, Georgetown, Delaware. Del Med J 1978; 50:13-23. [PMID: 147187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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