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Research paper thumbnail of The Symptom Burden of Chronic Lung Disease Compared to Lung Cancer at the Time of Referral for Palliative Care Consultation

Annals of the American Thoracic Society, 2015

A growing evidence base supports provision of palliative care services alongside life-prolonging ... more A growing evidence base supports provision of palliative care services alongside life-prolonging care, particularly in non-small cell lung cancer. While palliative care processes have been implemented widely in cancer care, the same is not true for progressive non-malignant disease like chronic lung diseases (CLD). Compare the symptom burden of patients with CLD to those with lung cancer at the time of initial palliative care consultation. Data were abstracted from the Carolinas Palliative Care Consortium's Quality Data Collection Tool, an electronic database utilized by 9 academic and community palliative care practices in multiple states for quality improvement purposes. We analyzed data from first palliative care encounter collected during a 2-year period, including the primary diagnosis of CLD or lung cancer, unresolved symptoms, setting of initial palliative care encounter, palliative performance status, and estimated prognosis for survival. We compared key clinical variables between CLD and lung cancer using Kruskall-Wallis and Chi-squared tests. 152 patients with lung cancer and 86 patients with CLD were identified. 53% of the patients were female and 87% were white, neither of which differed with diagnosis. Patients with CLD were more likely than those with lung cancer to have the initial palliative care encounter occur in the ICU (17% v. 6%, p=0.005) and less likely as an outpatient (20% v 56%, p<0.0001). CLD patients were also less likely to have a high performance status (14% v. 30%; p=0.009), but more likely to have an estimated prognosis for survival >6 months (51% v. 28%; p=0.002). The most prevalent symptoms were dyspnea (55% v. 42%) and pain (40% v. 52%), neither of which differed between groups (p=0.08). Patients with CLD have symptom burdens similar to those with lung cancer at time of first palliative care encounter. Given the population burden of CLD and limitations in the palliative care workforce, attention should be focused on ensuring that pulmonologists are prepared to assess and manage common palliative care needs among patients with CLD.

Research paper thumbnail of Cryptococcal Pneumonia In A Patient Treated With Ruxolitinib, A Novel Janus Kinase Inhibitor

D65. CASE REPORTS OF UNUSUAL PULMONARY INFECTIONS, 2012

Research paper thumbnail of Untangling Health Trajectories among Patients with Sepsis

Annals of the American Thoracic Society, 2015

Research paper thumbnail of Long-Term Persistence Of Quality Improvements For An ICU Communication Initiative: Mixed Performance At 3 Years

D102. QUALITY IMPROVEMENT IN CRITICAL CARE MEDICINE, 2012

Research paper thumbnail of Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation

Annals of Intensive Care, 2015

Background: Web-based decision aids are increasingly important in medical research and clinical c... more Background: Web-based decision aids are increasingly important in medical research and clinical care. However, few have been studied in an intensive care unit setting. The objectives of this study were to develop a Web-based decision aid for family members of patients receiving prolonged mechanical ventilation and to evaluate its usability and acceptability.

Research paper thumbnail of Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness

Current opinion in critical care, 2014

Prediction models in critical illness are generally limited to short-term mortality and uncommonl... more Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with int...

Research paper thumbnail of An Opportunistic Infection Associated With Ruxolitinib, a Novel Janus Kinase 1,2 Inhibitor

CHEST Journal, 2013

We report a case of Cryptococcus neoformans pneumonia in a patient taking ruxolitinib, a janus ki... more We report a case of Cryptococcus neoformans pneumonia in a patient taking ruxolitinib, a janus kinase 1,2 inhibitor approved for the treatment of myelofibrosis. We hypothesize that ruxolitinib contributed to this infection through its effects on cell-mediated immunity. Clinicians should be aware of the potential for intracellular or opportunistic infections associated with this novel drug class.

Research paper thumbnail of Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy

a b s t r a c t a r t i c l e i n f o Keywords: Communication Family satisfaction Quality of heal... more a b s t r a c t a r t i c l e i n f o Keywords: Communication Family satisfaction Quality of health care End-of-life care Critical care Outcome and process assessment(health care)

Research paper thumbnail of Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity

Journal of pain and symptom management, Jan 21, 2015

Measurement of dyspnea is important for clinical care and research. To characterize the relations... more Measurement of dyspnea is important for clinical care and research. To characterize the relationship between the 0-10 numerical rating scale (NRS) and four-level categorical verbal descriptor scale (VDS) for dyspnea assessment. This was a substudy of a double-blind, randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness. Dyspnea was assessed with both a 0-10 NRS and a four-level categorical VDS over the one-week trial. NRS and VDS responses were analyzed in cross-section and longitudinally. Relationships between NRS and VDS responses were portrayed using descriptive statistics and visual representations. Two hundred twenty-six participants contributed responses. At baseline, "mild" and "moderate" levels of breathlessness were reported by 41.9% and 44.6% of participants, respectively. NRS scores demonstrated increasing mean and median levels for increasing VDS intensity, fr...

Research paper thumbnail of The Symptom Burden of Chronic Lung Disease Compared to Lung Cancer at the Time of Referral for Palliative Care Consultation

Annals of the American Thoracic Society, 2015

A growing evidence base supports provision of palliative care services alongside life-prolonging ... more A growing evidence base supports provision of palliative care services alongside life-prolonging care, particularly in non-small cell lung cancer. While palliative care processes have been implemented widely in cancer care, the same is not true for progressive non-malignant disease like chronic lung diseases (CLD). Compare the symptom burden of patients with CLD to those with lung cancer at the time of initial palliative care consultation. Data were abstracted from the Carolinas Palliative Care Consortium's Quality Data Collection Tool, an electronic database utilized by 9 academic and community palliative care practices in multiple states for quality improvement purposes. We analyzed data from first palliative care encounter collected during a 2-year period, including the primary diagnosis of CLD or lung cancer, unresolved symptoms, setting of initial palliative care encounter, palliative performance status, and estimated prognosis for survival. We compared key clinical variables between CLD and lung cancer using Kruskall-Wallis and Chi-squared tests. 152 patients with lung cancer and 86 patients with CLD were identified. 53% of the patients were female and 87% were white, neither of which differed with diagnosis. Patients with CLD were more likely than those with lung cancer to have the initial palliative care encounter occur in the ICU (17% v. 6%, p=0.005) and less likely as an outpatient (20% v 56%, p<0.0001). CLD patients were also less likely to have a high performance status (14% v. 30%; p=0.009), but more likely to have an estimated prognosis for survival >6 months (51% v. 28%; p=0.002). The most prevalent symptoms were dyspnea (55% v. 42%) and pain (40% v. 52%), neither of which differed between groups (p=0.08). Patients with CLD have symptom burdens similar to those with lung cancer at time of first palliative care encounter. Given the population burden of CLD and limitations in the palliative care workforce, attention should be focused on ensuring that pulmonologists are prepared to assess and manage common palliative care needs among patients with CLD.

Research paper thumbnail of Cryptococcal Pneumonia In A Patient Treated With Ruxolitinib, A Novel Janus Kinase Inhibitor

D65. CASE REPORTS OF UNUSUAL PULMONARY INFECTIONS, 2012

Research paper thumbnail of Untangling Health Trajectories among Patients with Sepsis

Annals of the American Thoracic Society, 2015

Research paper thumbnail of Long-Term Persistence Of Quality Improvements For An ICU Communication Initiative: Mixed Performance At 3 Years

D102. QUALITY IMPROVEMENT IN CRITICAL CARE MEDICINE, 2012

Research paper thumbnail of Development and usability testing of a Web-based decision aid for families of patients receiving prolonged mechanical ventilation

Annals of Intensive Care, 2015

Background: Web-based decision aids are increasingly important in medical research and clinical c... more Background: Web-based decision aids are increasingly important in medical research and clinical care. However, few have been studied in an intensive care unit setting. The objectives of this study were to develop a Web-based decision aid for family members of patients receiving prolonged mechanical ventilation and to evaluate its usability and acceptability.

Research paper thumbnail of Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness

Current opinion in critical care, 2014

Prediction models in critical illness are generally limited to short-term mortality and uncommonl... more Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with int...

Research paper thumbnail of An Opportunistic Infection Associated With Ruxolitinib, a Novel Janus Kinase 1,2 Inhibitor

CHEST Journal, 2013

We report a case of Cryptococcus neoformans pneumonia in a patient taking ruxolitinib, a janus ki... more We report a case of Cryptococcus neoformans pneumonia in a patient taking ruxolitinib, a janus kinase 1,2 inhibitor approved for the treatment of myelofibrosis. We hypothesize that ruxolitinib contributed to this infection through its effects on cell-mediated immunity. Clinicians should be aware of the potential for intracellular or opportunistic infections associated with this novel drug class.

Research paper thumbnail of Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy

a b s t r a c t a r t i c l e i n f o Keywords: Communication Family satisfaction Quality of heal... more a b s t r a c t a r t i c l e i n f o Keywords: Communication Family satisfaction Quality of health care End-of-life care Critical care Outcome and process assessment(health care)

Research paper thumbnail of Practical Dyspnea Assessment: Relationship Between the 0-10 Numerical Rating Scale and the Four-Level Categorical Verbal Descriptor Scale of Dyspnea Intensity

Journal of pain and symptom management, Jan 21, 2015

Measurement of dyspnea is important for clinical care and research. To characterize the relations... more Measurement of dyspnea is important for clinical care and research. To characterize the relationship between the 0-10 numerical rating scale (NRS) and four-level categorical verbal descriptor scale (VDS) for dyspnea assessment. This was a substudy of a double-blind, randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness. Dyspnea was assessed with both a 0-10 NRS and a four-level categorical VDS over the one-week trial. NRS and VDS responses were analyzed in cross-section and longitudinally. Relationships between NRS and VDS responses were portrayed using descriptive statistics and visual representations. Two hundred twenty-six participants contributed responses. At baseline, "mild" and "moderate" levels of breathlessness were reported by 41.9% and 44.6% of participants, respectively. NRS scores demonstrated increasing mean and median levels for increasing VDS intensity, fr...