Research Interests: Pediatrics, Quality Improvement, Asthma, Medicine, Humans, and 15 moreChild, Psychological Intervention, Feedback, Patient Admission, Medline, Interdisciplinary Communication, Cross Sectional Studies, Cooperative Behavior, Medical Audit, Randomized Controlled Trials as Topic, Guideline Adherence, Decision Support Techniques, Psychology and Cognitive Sciences, Pharmaceutical Services, and Medical and Health Sciences
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Learning Objectives: Post-operative pulmonary complications (PPCs) cause high morbidity, mortality and healthcare expenditures. Treatment of patients at high risk of PPCs with aggressive pulmonary management may help prevent these... more
Learning Objectives: Post-operative pulmonary complications (PPCs) cause high morbidity, mortality and healthcare expenditures. Treatment of patients at high risk of PPCs with aggressive pulmonary management may help prevent these complications. The MetaNeb® System is a device that delivers continuous highfrequency oscillation (CHFO) and positive expiratory pressure (CPEP) to facilitate pulmonary mucus clearance and provide lung expansion. The aim of this multiinstitutional prospective trial was to evaluate the impact of MetaNeb® therapy on the rate of PPCs in high-risk surgical patients. Methods: In Phase I, CPT and ICD codes were queried to identify patients who underwent thoracic, upper abdominal, or aortic open surgical procedures at three institutions (n = 210) from December 2014 to April 2016. Patients were randomly selected at each site and screened for age, comorbidities, and ASA score to estimate PPC rates. In Phase II, 207 subjects were enrolled prospectively from the 3 sites over a 9-month period from October 2016 to July 2017 using the same entry criteria. Subjects in the Phase II cohort received treatment with The MetaNeb® System, in addition to standard respiratory therapy. The rate of PPCs, [defined as prolonged mechanical ventilation, prolonged high-level respiratory support, pneumonia, and/or readmission the intensive care unit (ICU) for pulmonary complications] was compared between the two cohorts. We also compared time on ventilator, ICU length of stay (LOS) and hospital LOS using t-tests. Data are mean±SD. Results: There were a total of 417 subjects enrolled. Phase II subjects were more likely to be older (61.1 ± 13.8 vs. 57.4 ± 15.5), male (62.8% vs. 54.8%) and have higher ASA scores (ASA 4&5 24.2% vs. 17.6%). Treatment with MetaNeb® resulted in decreased PPCs from 22.9% (Phase I) to 16.4% (Phase II) (34/207) (p = 0.099). Similarly, MetaNeb® treatment led to reduction in time on ventilator (23.7 ± 107.5 to 8.4 ± 27.5 hours, p < 0.05), ICU LOS (2.1 ± 6.0 to 1.2 ± 2.6 days, p < 0.05) and hospital LOS (8.4 ± 7.9 to 6.8 ± 5.1 days, p < 0.05). Conclusions: Our results suggest that aggressive pulmonary treatment with The MetaNeb® System reduces PPCs and resource use in high-risk patients.
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Organophosphate esters (OPE) are flame retardants and plasticizers used in a wide range of consumer products. Despite their widespread use, few studies have characterized pediatric exposures. We assessed variability and predictors of OPE... more
Organophosphate esters (OPE) are flame retardants and plasticizers used in a wide range of consumer products. Despite their widespread use, few studies have characterized pediatric exposures. We assessed variability and predictors of OPE exposures in a cohort panel study of 179 predominantly Black school-aged children in Baltimore City, MD. The study design included up to four seasonal week-long in-home study visits with urine sample collection on days 4 and 7 of each visit (nsamples = 618). We quantified concentrations of 9 urinary OPE biomarkers: bis(2-chloroethyl) phosphate (BCEtp), bis(1-chloro-2-propyl) phosphate, bis(1,3-dichloro-2-propyl) phosphate (BDCPP), di-benzyl phosphate (DBuP), di-benzyl phosphate, di-o-cresylphosphate, di-p-cresylphosphate (DPCP), di-(2-propylheptyl) phthalate (DPHP), 2,3,4,5-tetrabromo benzoic acid. We assessed potential predictors of exposure, including demographic factors, household characteristics, and cleaning behaviors. We calculated Spearman/tetrachoric correlations and intraclass correlation coefficients (ICCs) to examine within-week and seasonal intra-individual variability, respectively. We assessed OPE predictors using linear models for continuous log2 concentrations (BDCPP and DPHP) and logistic models for odds of detection (BCEtP, DBuP, DPCP), with generalized estimating equations to account for repeated measures. For all OPEs, we observed moderate within-week correlations (rs: 0.31-0.63) and weak to moderate seasonal reliability (ICC: 0.18-0.38). BDCPP and DPHP concentrations were higher in the summer compared to other seasons. DPHP concentrations were lower among males than females (%diff: -53.5%; 95% CI: -62.7, -42.0) and among participants spending >12 h/day indoors compared to ≤12 h (%diff: -20.7%; 95% CI: -32.2, -7.3). BDCPP concentrations were lower among children aged 8-10 years compared to 5-7 years (%diff: -39.1%; 95% CI: -55.9, -15.9) and higher among children riding in a vehicle the day of sample collection compared to those who had not (%diff: 28.5%; 95% CI: 3.4, 59.8). This study is the first to characterize within-week and seasonal variability and identify predictors of OPE biomarkers among Black school-aged children with asthma, a historically understudied population.
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Objective: To determine how much of the variation in physician group profiling for asthma care can be attributed to physician groups and how reliable those profiling indicators are. Study design: Cross-sectional study. Variations... more
Objective: To determine how much of the variation in physician group profiling for asthma care can be attributed to physician groups and how reliable those profiling indicators are. Study design: Cross-sectional study. Variations attributable to physician groups are presented using the intraclass correlation coefficient (ICC). The reliability of profiling results was determined using the ICC and sample size of the physician group. Participants and settings: Between July 1998 and February 1999, patients with asthma from 20 California physician groups were randomly selected to be surveyed; 2515 patients responded. Main outcome measures: Quality indicators for physician group profiling were (1) National Asthma Education and Prevention Program guideline-based processes of care, including accessibility of asthma care, self-management knowledge about asthma care, use of inhaled bronchodilators, and use of inhaled corticosteroids, and (2) patient outcomes, including satisfaction with asthma care, improvement in health status, and emergency department visits and hospitalizations attributable to asthma. Results: The variations attributable to physician group were small (< 10%) for process and outcome indicators. For process indicators, self-management knowledge had the highest ICC (9.83%), and use of inhaled bronchodilators had the lowest ICC (3.08%). For outcome indicators, satisfaction with asthma care had the highest ICC (9.53%), and hospitalization had the lowest ICC (1.35%). Despite low ICCs, a large sample size per physician group (n = 126) yielded acceptable reliability (> or = 0.80) for most profiling results. Conclusions: The selected indicators for profiling asthma care at the physician group level were generally reliable. Sampling a sufficient number of cases is key to achieving useful results from profiling.
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Research Interests: Asthma, Health insurance, Medicine, Applied Economics, Medical Decision Making, and 15 moreCalifornia, Humans, Female, Statistic, Male, Patient Satisfaction, Health Status, Middle Aged, Adult, Public health systems and services research, Risk Adjustment, Cross Sectional Studies, Logistic Models, Group practice, and Severity of Illness Index
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Research Interests: Asthma, General Internal Medicine, Medicine, Humans, Female, and 15 moreMale, Psychological Intervention, African Americans, Clinical Sciences, Middle Aged, Adult, Cross Section, Odds ratio, European Continental Ancestry Group, Patient Participation, Clinical Competence, Cross Sectional Studies, Cohort Studies, Managed Care Organization, and ORIGINAL ARTICLE
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Research Interests: Asthma, Benchmarking, Medicine, Logistic Regression, California, and 15 moreHumans, Health Services, Female, Male, Regression Analysis, Patient Satisfaction, Propensity Score, Propensity Score Matching, Middle Aged, Profiling, Adult, Public health systems and services research, Cross Sectional Studies, Group practice, and quality assurance in health care
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/ Thematic Poster Session / Tuesday, May 17/8:15 AM-4:30 PM / Area F, C33 CLINICAL PROFILES AND SEVERITY OF ASTHMA ... Hall B (Upper Level), Colorado Convention Center ... Ingestion Of Raw Broccoli Sprout Sandwiches: A Feasible Method Of... more
/ Thematic Poster Session / Tuesday, May 17/8:15 AM-4:30 PM / Area F, C33 CLINICAL PROFILES AND SEVERITY OF ASTHMA ... Hall B (Upper Level), Colorado Convention Center ... Ingestion Of Raw Broccoli Sprout Sandwiches: A Feasible Method Of Sulphoraphane Delivery
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Research Interests: Pediatrics, Quality Improvement, Asthma, Medicine, Humans, and 15 moreChild, Psychological Intervention, Feedback, Patient Admission, Medline, Interdisciplinary Communication, Cross Sectional Studies, Cooperative Behavior, Medical Audit, Randomized Controlled Trials as Topic, Guideline Adherence, Decision Support Techniques, Psychology and Cognitive Sciences, Pharmaceutical Services, and Medical and Health Sciences
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RationaleIndoor particulate matter is associated with worse chronic obstructive pulmonary disease (COPD) outcomes. It remains unknown whether reductions of indoor pollutants improve respiratory morbidity.ObjectivesTo determine whether... more
RationaleIndoor particulate matter is associated with worse chronic obstructive pulmonary disease (COPD) outcomes. It remains unknown whether reductions of indoor pollutants improve respiratory morbidity.ObjectivesTo determine whether placement of active portable high-efficiency particulate air cleaners can improve respiratory morbidity in former smokers.MethodsEligible former smokers with moderate-to-severe COPD received active or sham portable high-efficiency particulate absolute air cleaners and were followed for 6 months in this blinded randomized controlled trial. The primary outcome was 6-month change in St. George’s Respiratory Questionnaire (SGRQ). Secondary outcomes were exacerbation risk, respiratory symptoms, rescue medication use, and 6-minute-walk distance (6MWD). Intention-to-treat analysis included all subjects, and per-protocol analysis included adherent participants (greater than 80% use of air cleaner).Measurements and Main ResultsA total of 116 participants were randomized, of which 84.5% completed the study. There was no statistically significant difference in total SGRQ score, but the active filter group had greater reduction in SGRQ symptom subscale (β, −7.7 [95% confidence interval (CI), −15.0 to −0.37]) and respiratory symptoms (Breathlessness, Cough, and Sputum Scale, β, −0.8 [95% CI, −1.5 to −0.1]); and lower rate of moderate exacerbations (incidence rate ratio, 0.32 [95% CI, 0.12–0.91]) and rescue medication use (incidence rate ratio, 0.54 [95% CI, 0.33–0.86]) compared with sham group (all P < 0.05). In per-protocol analysis, there was a statistically significant difference in primary outcome between the active filter versus sham group (SGRQ, β −4.76 [95% CI, −9.2 to −0.34]) and in moderate exacerbation risk, Breathlessness, Cough, and Sputum Scale, and 6MWD. Participants spending more time indoors were more likely to have treatment benefit.ConclusionsThis is the first environmental intervention study conducted among former smokers with COPD showing potential health benefits of portable high-efficiency particulate absolute air cleaners, particularly among those with greater adherence and spending a greater time indoors.