Aluko Hope - Academia.edu (original) (raw)

Papers by Aluko Hope

Research paper thumbnail of Toward Personalizing Family Support in the ICU

Research paper thumbnail of Toward Understanding the Use of Gastrostomy in Critically Ill Adults

Annals of the American Thoracic Society, 2019

RESUMO: É um desafio atender aos alunos, em suas diversas necessidades especiais. Diferentemente ... more RESUMO: É um desafio atender aos alunos, em suas diversas necessidades especiais. Diferentemente das deficiências, há poucas pesquisas no Brasil sobre estudantes com doenças crônicas e suas especificidades, na escola. O objetivo do presente estudo foi identificar as necessidades especiais de escolares com diabetes mellitus tipo 1. Participaram 37 familiares de escolares em tratamento ambulatorial de uma faculdade paulista, por meio de entrevista semiestruturada, gravada em áudio e transcrita para análise. Os resultados mostraram que todos comunicaram a escola a respeito da doença do filho, mas, mesmo assim, 29,7% relatam dificuldade de inclusão ou acesso à escola, como desconhecimento do professor para o controle do diabetes, merenda escolar inadequada, preconceito dos colegas e da diretora ou vergonha por parte do aluno. As faltas ocorrem com 70,3% dos alunos, principalmente devido às consultas médicas. Necessidades especiais foram identificadas por 32,4%, incluindo a alimentação, o desempenho escolar e a necessidade de profissionais da escola mais bem informados sobre a doença. Além disso, 72,9% referem algum tipo de apoio para enfrentar o diabetes, principalmente de profissionais de saúde. Dos familiares, 51,3% apresentam sugestões para um melhor desenvolvimento do filho na escola, incluindo alimentação escolar adequada e melhor preparo da escola para lidar com o diabetes, como palestras e treinamento aos professores. Sugerimos a aproximação entre a escola e a área da saúde, porém, o primeiro passo para a integração intersetorial é identificar as necessidades desses alunos com doenças crônicas, como foi possível com este trabalho, ao enfocar o diabetes mellitus e suas repercussões escolares.

Research paper thumbnail of 1039: Novel Program to Improve Medical Residents’ Comfort and Skill in Effective Communication in the Icu

Critical Care Medicine, 2020

Research paper thumbnail of Conundrums in the Conscientious Use of Current Best Evidence

American Journal of Critical Care, 2019

Research paper thumbnail of What Special Considerations Are Needed for Treating Patients With Chronic Liver Disease?

Evidence-Based Practice in Palliative Medicine, 2013

Research paper thumbnail of Chrysotile asbestos fibers mediate homologous recombination in Rat2λ fibroblasts: implications for carcinogenesis

Mutation Research/Environmental Mutagenesis and Related Subjects, 1996

Asbestos fibers are widespread environmental carcinogens whose mutagenicity is now established. N... more Asbestos fibers are widespread environmental carcinogens whose mutagenicity is now established. Nonetheless, the molecular nature of these mutations and the mechanisms by which they accelerate carcinogenesis remain poorly understood. We have assessed the ability of asbestos fibers to promote homologous recombination, a potent mechanism for generating intrachromosomal rearrangements, such as deletions, and mitotic recombination. For this, we have developed a new assay which determines the extent to which a marker gene present in DNA introduced by asbestos can recombine with homologous genes residing in a transfected cell. We have demonstrated that Calidria chrysotile fibers are mutagenic and are able to mediate transfection of molecularly marked mutant lacI genes in a manner that results in their preferential recombination with homologous wild-type genes in the transfected cell. Asbestos induced recombination events may play a significant role in asbestos mutagenesis and carcinogenesis, and promotion of recombination may underlie the well-recognized synergy of asbestos with other carcinogens.

Research paper thumbnail of Changes in Health-Related Quality of Life among African-Americans in a lifestyle weight loss program

Quality of Life Research, 2010

The aim of this study was to evaluate the changes in health-related quality of life in patients w... more The aim of this study was to evaluate the changes in health-related quality of life in patients with coronary heart disease according to age, gender, and treatment method. Material and methods. The study enrolled 167 patients after acute myocardial infarction (MI), percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG). The mean age was 59.3 years; there were 71.9% of males. General health-related quality of life was measured using the SF-36 questionnaire. Patients were examined at the beginning of rehabilitation and after 6-, 12-, 18-, and 24-month follow-up. Effect sizes were computed to assess the changes in health-related quality of life over time. Results. Health-related quality of life significantly improved at 6 months, but improvements did not continue over time. The largest effect size was seen in the pain domain. Effect sizes were greater in the physical health domains among male patients and among female patients in the mental health domain. With regard to age, effect sizes were greater in the physical functioning domain among older patients. With regard to treatment method, at baseline, the CABG patients had the poorest healthrelated quality of life; however, the largest effect sizes were seen in this group. Conclusions. Health-related quality of life improved over 2 years; the greatest improvement was seen at 6 months. Males better improved on the physical component summary domain; there was no significant improvement in the mental component summary domain in males and females. Older patients improved better on the physical activity and physical component summary domains. Changes in health-related quality of life were related to treatment method.

Research paper thumbnail of Teaching medical ethics and law within medical education: a model for the UK core curriculum

Journal of Medical Ethics, 1998

Teaching medical ethics Teaching medical ethics and law within medical education: a model for the... more Teaching medical ethics Teaching medical ethics and law within medical education: a model for the UK core curriculum Consensus statement by teachers of medical ethics and law in UK medical schools* The General Medical Council has stated that medical ethics and law should constitute one of the core components of the medical curriculum.' The practice of good medicine inevitably raises both ethical and legal issues and demands an understanding of both. In this document, teachers of medical ethics and law in medical schools throughout the UK now offer their own consensus statement about the issues, concepts, arguments, skills and attitudes that all medical students should understand and know how to apply in practice by the time they qualify. This consensus proposes a minimal core undergraduate programme of work which we believe to be consistent with the stated objective of the General Medical Council that students should acquire a knowledge and understanding of "ethical and legal issues relevant to the practice of medicine" and an "ability to understand and analyse ethical problems so as to enable patients, their families, society and the doctor to have proper regard to such problems in reaching decisions".' Some organisational principles are also summarised which we believe to be crucial for the successful implementation of our proposed undergraduate programme.

Research paper thumbnail of Association of Vitamin C, Thiamine, and Hydrocortisone Infusion With Long-term Cognitive, Psychological, and Functional Outcomes in Sepsis Survivors

JAMA Network Open

ImportanceSepsis is associated with long-term cognitive impairment and worse psychological and fu... more ImportanceSepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant and anti-inflammatory therapy on cognitive, psychological, and functional outcomes in sepsis survivors.ObjectiveTo describe observed differences in long-term cognitive, psychological, and functional outcomes of vitamin C, thiamine, and hydrocortisone between the intervention and control groups in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized clinical trial.Design, Setting, and ParticipantsThis prespecified secondary analysis reports the 6-month outcomes of the multicenter, double-blind, placebo-controlled VICTAS randomized clinical trial, which was conducted between August 2018 and July 2019. Adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction who survived to discharge or day 30 were ...

Research paper thumbnail of Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study

BMJ Open

ObjectivesSocial determinants of health (SDoH) contribute to health outcomes. We identified SDoH ... more ObjectivesSocial determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness.DesignIn-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections.Setting14 hospital sites in the USA, UK and Australia.ParticipantsPatients and caregivers, who had been admitted to critical care from three continents.Results86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alon...

Research paper thumbnail of Supplemental Material, Appendix.r1 - Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit

Supplemental Material, Appendix.r1 for Race and Ethnicity and Satisfaction With Communication in ... more Supplemental Material, Appendix.r1 for Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit by Elizabeth Chuang, Ryan J. Fiter, Omar C. Sanon, Ann Wang, Aluko A. Hope, Clyde B. Schechter and Michelle N. Gong in American Journal of Hospice and Palliative Medicine®

Research paper thumbnail of Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19

JAMA Network Open, 2021

IMPORTANCE Obesity, diabetes, and hypertension are common comorbidities in patients with severe C... more IMPORTANCE Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome. OBJECTIVE To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as Ն3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021. EXPOSURES Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS). RESULTS Among 46 441 patients hospitalized with COVID-19, 29 040 patients (mean [SD] age, 61.2 [17.8] years; 13 059 [45.0%] women and 15713 [54.1%] men; 6797 Black patients [23.4%], 5325 Hispanic patients [18.3%], and 16 507 White patients [57.8%]) met inclusion criteria. A total of 5069 patients (17.5%) with metabolic syndrome were compared with 23 971 control patients (82.5%) without metabolic syndrome. In adjusted analyses, metabolic syndrome was associated with

Research paper thumbnail of 328: Does Pre-Hospital Functional Impairment Predict Short-Term Outcomes in Critically Ill Adults?

Critical Care Medicine, 2015

Research paper thumbnail of Key Mechanisms by Which Post-ICU Activities Can Improve In-ICU Care: Results of the International Thrive Collaborative

SSRN Electronic Journal, 2019

Research paper thumbnail of 335: Pre-Hospital Functional Status in the Critically Ill:Agreement Between Patient and Proxy Responses

Critical Care Medicine, 2015

Research paper thumbnail of Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis

JAMA, 2021

Importance Sepsis is a common syndrome with substantial morbidity and mortality. A combination of... more Importance Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. Objective To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis. Design, Setting, and Participants Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020. Interventions Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone. Main Outcomes and Measures The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality. Results Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group. Conclusions and Relevance Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference. Trial Registration ClinicalTrials.gov Identifier: NCT03509350.

Research paper thumbnail of 540: Early Palliative Care in Acute Respiratory Failure Patients Treated by Critical Care Outside the ICU

Critical Care Medicine, 2020

Research paper thumbnail of Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?

Critical Care Explorations, 2020

Objectives: To understand from the perspective of patients who did, and did not attend ICU recove... more Objectives: To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized. Design: International, qualitative study. Setting: Fourteen hospitals in the United States, United Kingdom, and Australia. Patients: We conducted 66 semi-structured interviews with a diverse group of patients, 52 of whom had used an ICU recovery program and 14 whom had not. Interventions: None. Measurements and Main Results: Using content analysis, prevalent themes were documented to understand what improved their outcomes. Contrasting quotes from patients who had not received certain aspects of care were used to identify perceived differential effectiveness. Successful ICU recovery programs had five key components: 1) Continuity of care; 2) Improving symptom status; 3) Normalization and expectation management; 4) Internal and external validation of progress; and 5) Reducing feel...

Research paper thumbnail of Pre-Hospital Physical and Cognitive Leisure Activity is Associated with Reduced Incidence of Delirium During Early Hospitalization: A Prospective Cohort Study

Research paper thumbnail of “I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

Journal of Pain and Symptom Management, 2017

Context-Terminally ill hospitalized patients and their families consistently rank effective commu... more Context-Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance Practice Providers such as Physician Assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs' current experiences in their daily practices.

Research paper thumbnail of Toward Personalizing Family Support in the ICU

Research paper thumbnail of Toward Understanding the Use of Gastrostomy in Critically Ill Adults

Annals of the American Thoracic Society, 2019

RESUMO: É um desafio atender aos alunos, em suas diversas necessidades especiais. Diferentemente ... more RESUMO: É um desafio atender aos alunos, em suas diversas necessidades especiais. Diferentemente das deficiências, há poucas pesquisas no Brasil sobre estudantes com doenças crônicas e suas especificidades, na escola. O objetivo do presente estudo foi identificar as necessidades especiais de escolares com diabetes mellitus tipo 1. Participaram 37 familiares de escolares em tratamento ambulatorial de uma faculdade paulista, por meio de entrevista semiestruturada, gravada em áudio e transcrita para análise. Os resultados mostraram que todos comunicaram a escola a respeito da doença do filho, mas, mesmo assim, 29,7% relatam dificuldade de inclusão ou acesso à escola, como desconhecimento do professor para o controle do diabetes, merenda escolar inadequada, preconceito dos colegas e da diretora ou vergonha por parte do aluno. As faltas ocorrem com 70,3% dos alunos, principalmente devido às consultas médicas. Necessidades especiais foram identificadas por 32,4%, incluindo a alimentação, o desempenho escolar e a necessidade de profissionais da escola mais bem informados sobre a doença. Além disso, 72,9% referem algum tipo de apoio para enfrentar o diabetes, principalmente de profissionais de saúde. Dos familiares, 51,3% apresentam sugestões para um melhor desenvolvimento do filho na escola, incluindo alimentação escolar adequada e melhor preparo da escola para lidar com o diabetes, como palestras e treinamento aos professores. Sugerimos a aproximação entre a escola e a área da saúde, porém, o primeiro passo para a integração intersetorial é identificar as necessidades desses alunos com doenças crônicas, como foi possível com este trabalho, ao enfocar o diabetes mellitus e suas repercussões escolares.

Research paper thumbnail of 1039: Novel Program to Improve Medical Residents’ Comfort and Skill in Effective Communication in the Icu

Critical Care Medicine, 2020

Research paper thumbnail of Conundrums in the Conscientious Use of Current Best Evidence

American Journal of Critical Care, 2019

Research paper thumbnail of What Special Considerations Are Needed for Treating Patients With Chronic Liver Disease?

Evidence-Based Practice in Palliative Medicine, 2013

Research paper thumbnail of Chrysotile asbestos fibers mediate homologous recombination in Rat2λ fibroblasts: implications for carcinogenesis

Mutation Research/Environmental Mutagenesis and Related Subjects, 1996

Asbestos fibers are widespread environmental carcinogens whose mutagenicity is now established. N... more Asbestos fibers are widespread environmental carcinogens whose mutagenicity is now established. Nonetheless, the molecular nature of these mutations and the mechanisms by which they accelerate carcinogenesis remain poorly understood. We have assessed the ability of asbestos fibers to promote homologous recombination, a potent mechanism for generating intrachromosomal rearrangements, such as deletions, and mitotic recombination. For this, we have developed a new assay which determines the extent to which a marker gene present in DNA introduced by asbestos can recombine with homologous genes residing in a transfected cell. We have demonstrated that Calidria chrysotile fibers are mutagenic and are able to mediate transfection of molecularly marked mutant lacI genes in a manner that results in their preferential recombination with homologous wild-type genes in the transfected cell. Asbestos induced recombination events may play a significant role in asbestos mutagenesis and carcinogenesis, and promotion of recombination may underlie the well-recognized synergy of asbestos with other carcinogens.

Research paper thumbnail of Changes in Health-Related Quality of Life among African-Americans in a lifestyle weight loss program

Quality of Life Research, 2010

The aim of this study was to evaluate the changes in health-related quality of life in patients w... more The aim of this study was to evaluate the changes in health-related quality of life in patients with coronary heart disease according to age, gender, and treatment method. Material and methods. The study enrolled 167 patients after acute myocardial infarction (MI), percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG). The mean age was 59.3 years; there were 71.9% of males. General health-related quality of life was measured using the SF-36 questionnaire. Patients were examined at the beginning of rehabilitation and after 6-, 12-, 18-, and 24-month follow-up. Effect sizes were computed to assess the changes in health-related quality of life over time. Results. Health-related quality of life significantly improved at 6 months, but improvements did not continue over time. The largest effect size was seen in the pain domain. Effect sizes were greater in the physical health domains among male patients and among female patients in the mental health domain. With regard to age, effect sizes were greater in the physical functioning domain among older patients. With regard to treatment method, at baseline, the CABG patients had the poorest healthrelated quality of life; however, the largest effect sizes were seen in this group. Conclusions. Health-related quality of life improved over 2 years; the greatest improvement was seen at 6 months. Males better improved on the physical component summary domain; there was no significant improvement in the mental component summary domain in males and females. Older patients improved better on the physical activity and physical component summary domains. Changes in health-related quality of life were related to treatment method.

Research paper thumbnail of Teaching medical ethics and law within medical education: a model for the UK core curriculum

Journal of Medical Ethics, 1998

Teaching medical ethics Teaching medical ethics and law within medical education: a model for the... more Teaching medical ethics Teaching medical ethics and law within medical education: a model for the UK core curriculum Consensus statement by teachers of medical ethics and law in UK medical schools* The General Medical Council has stated that medical ethics and law should constitute one of the core components of the medical curriculum.' The practice of good medicine inevitably raises both ethical and legal issues and demands an understanding of both. In this document, teachers of medical ethics and law in medical schools throughout the UK now offer their own consensus statement about the issues, concepts, arguments, skills and attitudes that all medical students should understand and know how to apply in practice by the time they qualify. This consensus proposes a minimal core undergraduate programme of work which we believe to be consistent with the stated objective of the General Medical Council that students should acquire a knowledge and understanding of "ethical and legal issues relevant to the practice of medicine" and an "ability to understand and analyse ethical problems so as to enable patients, their families, society and the doctor to have proper regard to such problems in reaching decisions".' Some organisational principles are also summarised which we believe to be crucial for the successful implementation of our proposed undergraduate programme.

Research paper thumbnail of Association of Vitamin C, Thiamine, and Hydrocortisone Infusion With Long-term Cognitive, Psychological, and Functional Outcomes in Sepsis Survivors

JAMA Network Open

ImportanceSepsis is associated with long-term cognitive impairment and worse psychological and fu... more ImportanceSepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant and anti-inflammatory therapy on cognitive, psychological, and functional outcomes in sepsis survivors.ObjectiveTo describe observed differences in long-term cognitive, psychological, and functional outcomes of vitamin C, thiamine, and hydrocortisone between the intervention and control groups in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized clinical trial.Design, Setting, and ParticipantsThis prespecified secondary analysis reports the 6-month outcomes of the multicenter, double-blind, placebo-controlled VICTAS randomized clinical trial, which was conducted between August 2018 and July 2019. Adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction who survived to discharge or day 30 were ...

Research paper thumbnail of Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study

BMJ Open

ObjectivesSocial determinants of health (SDoH) contribute to health outcomes. We identified SDoH ... more ObjectivesSocial determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness.DesignIn-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections.Setting14 hospital sites in the USA, UK and Australia.ParticipantsPatients and caregivers, who had been admitted to critical care from three continents.Results86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alon...

Research paper thumbnail of Supplemental Material, Appendix.r1 - Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit

Supplemental Material, Appendix.r1 for Race and Ethnicity and Satisfaction With Communication in ... more Supplemental Material, Appendix.r1 for Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit by Elizabeth Chuang, Ryan J. Fiter, Omar C. Sanon, Ann Wang, Aluko A. Hope, Clyde B. Schechter and Michelle N. Gong in American Journal of Hospice and Palliative Medicine®

Research paper thumbnail of Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19

JAMA Network Open, 2021

IMPORTANCE Obesity, diabetes, and hypertension are common comorbidities in patients with severe C... more IMPORTANCE Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome. OBJECTIVE To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as Ն3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021. EXPOSURES Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS). RESULTS Among 46 441 patients hospitalized with COVID-19, 29 040 patients (mean [SD] age, 61.2 [17.8] years; 13 059 [45.0%] women and 15713 [54.1%] men; 6797 Black patients [23.4%], 5325 Hispanic patients [18.3%], and 16 507 White patients [57.8%]) met inclusion criteria. A total of 5069 patients (17.5%) with metabolic syndrome were compared with 23 971 control patients (82.5%) without metabolic syndrome. In adjusted analyses, metabolic syndrome was associated with

Research paper thumbnail of 328: Does Pre-Hospital Functional Impairment Predict Short-Term Outcomes in Critically Ill Adults?

Critical Care Medicine, 2015

Research paper thumbnail of Key Mechanisms by Which Post-ICU Activities Can Improve In-ICU Care: Results of the International Thrive Collaborative

SSRN Electronic Journal, 2019

Research paper thumbnail of 335: Pre-Hospital Functional Status in the Critically Ill:Agreement Between Patient and Proxy Responses

Critical Care Medicine, 2015

Research paper thumbnail of Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis

JAMA, 2021

Importance Sepsis is a common syndrome with substantial morbidity and mortality. A combination of... more Importance Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. Objective To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis. Design, Setting, and Participants Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020. Interventions Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone. Main Outcomes and Measures The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality. Results Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group. Conclusions and Relevance Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference. Trial Registration ClinicalTrials.gov Identifier: NCT03509350.

Research paper thumbnail of 540: Early Palliative Care in Acute Respiratory Failure Patients Treated by Critical Care Outside the ICU

Critical Care Medicine, 2020

Research paper thumbnail of Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?

Critical Care Explorations, 2020

Objectives: To understand from the perspective of patients who did, and did not attend ICU recove... more Objectives: To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized. Design: International, qualitative study. Setting: Fourteen hospitals in the United States, United Kingdom, and Australia. Patients: We conducted 66 semi-structured interviews with a diverse group of patients, 52 of whom had used an ICU recovery program and 14 whom had not. Interventions: None. Measurements and Main Results: Using content analysis, prevalent themes were documented to understand what improved their outcomes. Contrasting quotes from patients who had not received certain aspects of care were used to identify perceived differential effectiveness. Successful ICU recovery programs had five key components: 1) Continuity of care; 2) Improving symptom status; 3) Normalization and expectation management; 4) Internal and external validation of progress; and 5) Reducing feel...

Research paper thumbnail of Pre-Hospital Physical and Cognitive Leisure Activity is Associated with Reduced Incidence of Delirium During Early Hospitalization: A Prospective Cohort Study

Research paper thumbnail of “I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

Journal of Pain and Symptom Management, 2017

Context-Terminally ill hospitalized patients and their families consistently rank effective commu... more Context-Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance Practice Providers such as Physician Assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs' current experiences in their daily practices.