124 results on '"Michelle N. Eakin"'
Search Results
2. Comparative Impact of Depressive Symptoms and FEV1% on Chronic Obstructive Pulmonary Disease
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Jacqueline O’Toole, Han Woo, Nirupama Putcha, Christopher B. Cooper, Prescott Woodruff, Richard E. Kanner, Robert Paine, Russell P. Bowler, Alejandro Comellas, Karin F. Hoth, Jerry A. Krishnan, Meilan Han, Mark Dransfield, Anand S. Iyer, David Couper, Stephen P. Peters, Gerard Criner, Victor Kim, R. Graham Barr, Fernando J. Martinez, Nadia N. Hansel, Michelle N. Eakin, Neil E. Alexis, Wayne H. Anderson, Mehrdad Arjomandi, Igor Barjaktarevic, Lori A. Bateman, Surya P. Bhatt, Eugene R. Bleecker, Richard C. Boucher, Stephanie A. Christenson, Alejandro P. Comellas, David J. Couper, Gerard J. Criner, Ronald G. Crystal, Jeffrey L. Curtis, Claire M. Doerschuk, Mark T. Dransfield, Brad Drummond, Christine M. Freeman, Craig Galban, MeiLan K. Han, Annette T. Hastie, Eric A. Hoffman, Yvonne Huang, Robert J. Kaner, Eric C. Kleerup, Lisa M. LaVange, Stephen C. Lazarus, Deborah A. Meyers, Wendy C. Moore, John D. Newell, Laura Paulin, Cheryl Pirozzi, Elizabeth C. Oelsner, Wanda K. O’Neal, Victor E. Ortega, Sanjeev Raman, Stephen I. Rennard, Donald P. Tashkin, J Michael Wells, Robert A. Wise, and Prescott G. Woodruff
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COPD ,business.industry ,Internal medicine ,medicine ,Pulmonary disease ,medicine.disease ,business ,Depressive symptoms ,Depression (differential diagnoses) ,respiratory tract diseases - Abstract
Rationale: Individuals with Chronic Obstructive Pulmonary Disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions. Objectives:...
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- 2022
3. Policy Recommendations to Eliminate Tobacco Use and Improve Health from the American Thoracic Society Tobacco Action Committee
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Thomas Carr, Frank T. Leone, Krishna P. Reddy, Ilona Jaspers, Dona Upson, Theo J. Moraes, Elif Dagli, Anne C. Melzer, Farzad Moazed, Hasmeena Kathuria, Sarah E. Bauer, Gary Ewart, Sucharita Kher, Michelle N. Eakin, and Jamie L. Garfield
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tobacco use ,business.industry ,Health Policy ,Tobacco Use Disorder ,United States ,Tobacco Use ,Policy ,Action (philosophy) ,Family medicine ,Perspective ,Tobacco ,medicine ,Humans ,Smoking Cessation ,business - Published
- 2022
4. Clinically Significant and Comorbid Anxiety and Depression Symptoms Predict Severe Respiratory Exacerbations in Smokers: A Post Hoc Analysis of the COPDGene and SPIROMICS Cohorts
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Anand S. Iyer, Trisha M. Parekh, Jacqueline O’Toole, Surya P. Bhatt, Michelle N. Eakin, Jerry A. Krishnan, Abebaw M. Yohannes, Prescott G. Woodruff, Christopher B. Cooper, Richard E. Kanner, Nicola A. Hanania, Mark T. Dransfield, Elizabeth A. Regan, Karin F. Hoth, Victor Kim, James D. Crapo, Edwin K. Silverman, Barry J. Make, Terri Beaty, Ferdouse Begum, Peter J. Castaldi, Michael Cho, Dawn L. DeMeo, Adel R. Boueiz, Marilyn G. Foreman, Eitan Halper-Stromberg, Lystra P. Hayden, Craig P. Hersh, Jacqueline Hetmanski, Brian D. Hobbs, John E. Hokanson, Nan Laird, Christoph Lange, Sharon M. Lutz, Merry-Lynn McDonald, Margaret M. Parker, Dmitry Prokopenko, Dandi Qiao, Phuwanat Sakornsakolpat, Emily S. Wan, Sungho Won, Juan Pablo Centeno, Jean-Paul Charbonnier, Harvey O. Coxson, Craig J. Galban, MeiLan K. Han, Eric A. Hoffman, Stephen Huries, Francine L. Jacobson, Philip F. Judy, Ella A. Kazerooni, Alex Kluiber, David A. Lynch, Pietro Nardelli, John D. Newell, Aleena Notary, Andrea Oh, James C. Ross, Raul San José Estépar, Joyce Schroeder, Jered Sieren, Berend C. Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, Gonzalo Vegas Sanchez-Ferrero, Lucas Veitel, George R. Washko, Carla G. Wilson, Robert Jensen, Douglas Everett, Jim Crooks, Katherine Pratte, Matt Strand, Gregory Kinney, Kendra A. Young, Jessica Bon, Alejandro A. Diaz, Barry Make, Susan Murray, Elizabeth Regan, Xavier Soler, Russell P. Bowler, Katerina Kechris, Farnoush Banaei-Kashani, Jeffrey L. Curtis, Perry G. Pernicano, Nicola Hanania, Mustafa Atik, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Amit Parulekar, Craig Hersh, George Washko, R. Graham Barr, John Austin, Belinda D’Souza, Byron Thomashow, Neil MacIntyre, H. Page McAdams, Robert Wise, Robert Brown, Nadia N. Hansel, Karen Horton, Allison Lambert, Los Angeles, Richard Casaburi, Alessandra Adami, Matthew Budoff, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Ken M. Kunisaki, Russell Bowler, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D’Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, A. James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M. Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Anand Iyer, Hrudaya Nath, J. Michael Wells, Douglas Conrad, Andrew Yen, Alejandro P. Comellas, John Newell, Brad Thompson, Ella Kazerooni, Wassim Labaki, Craig Galban, Dharshan Vummidi, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Divay Chandra, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E. Ruiz, and Harjinder Singh
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Comorbid anxiety ,business.industry ,Internal medicine ,Post-hoc analysis ,Medicine ,Respiratory system ,business ,Depressive symptoms - Published
- 2022
5. Patterns and predictors of air purifier adherence in children with asthma living in low-income, urban households
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Rachelle Koehl, Michelle N. Eakin, Emily P. Brigham, Kirsten Koehler, Meredith C. McCormack, Parisa Kaviany, Han Woo, Megan Wood, Joseph M. Collaco, Tianshi David Wu, Jessica L. Rice, and Nadia N. Hansel
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Pulmonary and Respiratory Medicine ,Low income ,Pollution ,media_common.quotation_subject ,Article ,03 medical and health sciences ,0302 clinical medicine ,Indoor air quality ,HEPA ,030225 pediatrics ,Environmental health ,Humans ,Immunology and Allergy ,Medicine ,Air purifier ,Child ,Poverty ,Pediatric asthma ,media_common ,Asthma ,business.industry ,medicine.disease ,Air Filters ,030228 respiratory system ,Air Pollution, Indoor ,Pediatrics, Perinatology and Child Health ,Seasons ,business - Abstract
OBJECTIVE: Black children and children from low-income communities are disproportionately affected by asthma, attributed partly to pollution exposure. Air purifiers reduce indoor air pollution and improve asthma symptoms in children. In order to implement air purifier interventions, an understanding of patterns of use and potential barriers is necessary. METHODS: In a home intervention study, 127 children with asthma living in Baltimore were randomized to receive two active or two placebo air purifiers. The 16-week study period included: baseline clinic visit, home visit for air purifier installation (active or placebo) with instruction to use the high or turbo settings, and electronic adherence monitoring of air purifiers. Determinants of adherence were identified using linear regression models. RESULTS: Air purifiers were used 80% of the time, and participants demonstrated adherence to high or turbo settings for 60% of the time. In an adjusted model, season was the major determinant of air purifier adherence, with 21% lower use in the winter (p=0.025) attributed to the cold draft generated by the machine. CONCLUSION: In a clinical trial with electronic adherence monitoring, air purifier use was high and participants were adherent to use of high or turbo settings the majority of the time. Addressing practical barriers to consistent use, such as draft during the winter, in addition to financial barriers may improve air purifier adherence among children with asthma living in low-income, urban households.
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- 2021
6. A National Survey of Burnout and Depression Among Fellows Training in Pulmonary and Critical Care Medicine
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Scott M. Lieberman, Kristin M. Burkart, Kerry L. Neall, Schartess Culpepper Pace, Apostolos Kontzias, Judith A. Furlong, Morgan I. Soffler, Rahul G. Argula, Maria Danila, Mark H. Adelman, Joseph Barney, Lynn M. Petruzzi, Matthew C. Baker, Charles D. Burger, Chadwick R. Johr, Elliot Rosenstein, Robert Vassallo, Stephen Doyle, Gregory P. Downey, Gretchen Winter, Thomas Eckmann, Jeanne Dale, Richard A. Helmers, Stanley Pillemer, Alan Baer, Tamiko Katsumoto, Keith J. Robinson, Amit Sachdev, Robert M. Kotloff, Vasileios C. Kyttaris, Rendell W. Ashton, Rachana Krishna, Sara S. McCoy, Nora Sandorfi, Kristin A. Riekert, Stamatina J. Danielides, Elizabeth R. Volkmann, Heidi Kukla, Timothy Niewold, Donald Bloch, Jennifer W. McCallister, Michelle Sharp, Jerome L. Greene, Robert I. Fox, Malik M. Khurram S. Khan, Sandra E. Zaeh, Michelle N. Eakin, Kristen L. Veraldi, Stuart S. Kassan, Peter H. Lenz, Daniel J. Wallace, Evelyn J. Bromet, Edward L. Treadwell, Robert F. Spiera, Adrian Shifren, Theresa Lawrence Ford, W. Neal Roberts, Jacqueline O’Toole, Senada Arabelovic, Matthew Koslow, Janet Lewis, Philip Cohen, Rebecca C. Keith, Thomas G. Osborn, Sarah Schafer, Justin C. Hewlett, Paul F. Dellaripa, Scott Zashin, Ruben Peredo-Wende, Chokkalingam Siva, Jay H. Ryu, Jeffrey J. Swigris, Lee Daugherty Biddison, Cynthia S. Rand, Barbara Segal, Daniel Small, Gerald W. Staton, Thomas Grader-Beck, Ghaith Noaiseh, Frederick B. Vivino, Tracy Luckhardt, James Gagermeier, Robert W. Ward, James Topilow, Kirsten Koons, and Gabriel T. Bosslet
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Pulmonary and Respiratory Medicine ,Response rate (survey) ,medicine.medical_specialty ,business.industry ,health care facilities, manpower, and services ,Public health ,education ,Graduate medical education ,MEDLINE ,Burnout ,Critical Care and Intensive Care Medicine ,Mental health ,Odds ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,psychological phenomena and processes ,Depression (differential diagnoses) - Abstract
Background The prevalence of burnout and depressive symptoms is high among physician trainees. Research Question What is the burden of burnout and depressive symptoms among fellows training in pulmonary and critical care medicine (PCCM) and what are associated individual fellow, program, and institutional characteristics? Study Design and Methods We conducted a cross-sectional electronic survey of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States to assess burnout and depressive symptoms. Burnout symptoms were measured using the Maslach Burnout Index two-item measure. The two-item Primary Care Evaluation of Mental Disorders Procedure was used to screen for depressive symptoms. For each of the two outcomes (burnout and depressive symptoms), we constructed three multivariate logistic regression models to assess individual fellow characteristics, program structure, and institutional polices associated with either burnout or depressive symptoms. Results Five hundred two of the 976 fellows who received the survey completed it—including both outcome measures—giving a response rate of 51%. Fifty percent of fellows showed positive results for either burnout or depressive symptoms, with 41% showing positive results for depressive symptoms, 32% showing positive results for burnout, and 23% showing positive results for both. Reporting a coverage system in the case of personal illness or emergency (adjusted OR [aOR], 0.44; 95% CI, 0.26-0.73) and access to mental health services (aOR, 0.14; 95% CI, 0.04-0.47) were associated with lower odds of burnout. Financial concern was associated with higher odds of depressive symptoms (aOR, 1.13; 95% CI, 1.05-1.22). Working more than 70 hours in an average clinical week and the burdens of electronic health record (EHR) documentation were associated with a higher odds of both burnout and depressive symptoms. Interpretation Given the high prevalence of burnout and depressive symptoms among fellows training in PCCM, an urgent need exists to identify solutions that address this public health crisis. Strategies such as providing an easily accessible coverage system, access to mental health resources, reducing EHR burden, addressing work hours, and addressing financial concerns among trainees may help to reduce burnout or depressive symptoms and should be studied further by the graduate medical education community.
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- 2021
7. Socioeconomic determinants and disparities in sarcoidosis
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Marjolein Drent, Michelle N. Eakin, and Michelle Sharp
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Pulmonary and Respiratory Medicine ,Gerontology ,Sarcoidosis ,Social Determinants of Health ,MEDLINE ,Psychological intervention ,PERCEIVED STRESS ,Affect (psychology) ,White People ,socioeconomic ,Race (biology) ,Sex Factors ,Quality of life (healthcare) ,QUALITY-OF-LIFE ,parasitic diseases ,gender ,Humans ,Medicine ,Healthcare Disparities ,race ,Socioeconomic status ,health disparities ,AFRICAN-AMERICANS ,Intersectionality ,GENDER-DIFFERENCES ,business.industry ,MORTALITY ,ASSOCIATION ,Health Status Disparities ,United States ,Health equity ,Black or African American ,Hospitalization ,VARIABILITY ,SEVERITY ,Dyspnea ,Social Class ,Socioeconomic Factors ,DISCRIMINATION ,Quality of Life ,HEALTH ,business - Abstract
Purpose of review The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities. Recent findings Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and females. Worse dyspnea, lower health-related quality of life, and higher rates of mortality and hospitalization are more common among those who are Black, female, or of low socioeconomic status. Summary Health disparities in sarcoidosis by socioeconomic status, race, and gender have been described for decades. In this review, we describe potential contributors to health disparities including stress and propose interventions to address disparities including creating educational programs accessible for low-income patients and caregivers, targeting medication adherence and trust in physicians and the medical system, and ensuring access to high-quality care for all patients. As clinicians and researchers, we owe it to our patients to not only describe the health disparities that exist but also stimulate to achieve improvement in sarcoidosis.
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- 2020
8. Proposal for smoke-free public housing: a systematic review of attitudes and preferences from residents of multi-unit housing
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Meredith C. McCormack, Panagis Galiatsatos, Nadia N. Hansel, Rachelle Koehl, Frank T. Leone, Cynthia S. Rand, Michelle N. Eakin, Christine Caufield-Noll, and Emily P. Brigham
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Medical sociology ,medicine.medical_specialty ,Public economics ,Public housing ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,Public policy ,Environmental health ,medicine ,Multi unit ,Business ,Smoking ban ,Enforcement ,Social policy - Abstract
A policy proposal to ban public housing smoking indoors has received support, but it is unclear how certain affected groups, specifically smokers in housing units, perceive such a policy. To review the literature on attitudes and perceptions of housing unit tenants towards an indoor smoke-free housing policy, using various databases, we searched articles for attitudes towards smoking ban enforcement in housing units. We identified fourteen articles. Non-smokers heavily favored indoor policies and current smokers heavily opposed them. Current smokers represented a substantial minority in the reviewed articles, resulting in overall outcomes of the surveys driven by non-smokers. Studies investigating attitudes about housing smoking bans largely represent the views of non-smokers and lack data about barriers and concerns of tenants who do not support a smoke-free policy. Future studies should investigate if such a discrepancy impacts the efficacy of smoke-free housing policies.
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- 2020
9. Evaluating provider communication in pediatric chronic kidney disease care using a global coding system
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Barbara A. Fivush, Susan R. Mendley, Shayna S. Coburn, Wynne Callon, Shamir Tuchman, Kristin A. Riekert, Tammy M. Brady, Michelle N. Eakin, and Cozumel S. Pruette
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Male ,medicine.medical_specialty ,Adolescent ,Subspecialty ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Patient-Centered Care ,medicine ,Humans ,030212 general & internal medicine ,Rating system ,Renal Insufficiency, Chronic ,Young adult ,Child ,business.industry ,Communication ,030503 health policy & services ,General Medicine ,medicine.disease ,humanities ,Coding system ,Caregivers ,Tape Recording ,Family medicine ,Female ,Communication skills ,0305 other medical science ,business ,Patient centered ,Kidney disease - Abstract
Objective Among adolescents and young adults (AYAs) with chronic illness, effective provider communication is essential for patient-centered care during a sensitive developmental period. However, communication in chronic illness care for AYAs is not well studied. Our objectives were to describe the provider communication skills in pediatric chronic kidney disease (CKD) care visits; and determine if communication skills differ by AYA characteristics. Methods We adapted a global consultation rating system for pediatric subspecialty care using audiotaped clinic encounters of 18 pediatric nephrologists with 99 AYAs (age M(SD) = 14.9(2.6)) with CKD stages 1–5 and 96 caregivers. We hypothesized that provider communication skills would differ by AYA characteristics (age, gender, and race). Results The strongest provider skills included initiating the session and developing rapport; lowest rated skills were asking patient’s perspective and checking understanding. Communication scores did not consistently differ by AYA age or race, but were rated higher with female AYAs in several domains (ps Conclusions Pediatric providers generally had adequate or good communication scores with AYAs, but improvement in certain skills, particularly with male AYAs, may further support patient-centered care. Practice implications To achieve consistent, patient-centered communication with AYAs, an observation-based global assessment may identify areas for provider improvement.
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- 2020
10. Quantifying heterogeneity of physical and mental health-related quality of life in chronic obstructive pulmonary disease patients in the United States
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Jennifer Y. So, Julia F. Slejko, Zafar Zafari, Chintal H. Shah, Ester Villalonga-Olives, Robert M. Reed, and Michelle N. Eakin
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pulmonary disease ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Humans ,Immunology and Allergy ,Medicine ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Aged, 80 and over ,Health related quality of life ,COPD ,business.industry ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,Mental health ,United States ,humanities ,030228 respiratory system ,Quality of Life ,Female ,business - Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogenous condition. This study aims to quantify the heterogeneity of Health-related Quality of Life (HRQoL), and identify subgroups with the lowest HRQoL, in COPD patients in the United States (US). Methods Data from 2008-2015 Medical Expenditure Panel Survey were used to examine the heterogeneity of HRQoL between different COPD subgroups using mixed-effects modeling and G-computation. The Physical Composite Summary (PCS) and Mental Composite Summary (MCS) scores from the Short-Form-12 questionnaire were utilized. We also compared the heterogeneity of HRQoL in our COPD cohort against that in a matched non-COPD cohort. Results The final sample consisted of 1,866 (weighted = 19,952,143) COPD patients with a mean age of 63.2 years (Standard error (SE):0.38), mean MCS score of 46.84 (SE:0.35), and mean PCS score of 35.65 (SE:0.32). The adjusted MCS and PCS scores ranged from 36.19 to 53.06, and from 25.52 to 48.27, respectively, for COPD subgroups. COPD patients had statistically significantly lower MCS and PCS scores by 4.61, and 5.86 points, respectively, compared to the matched non-COPD cohort, and MCS scores showed a wider variability in the COPD cohort. Conclusion Our study quantifies substantial heterogeneity of HRQoL in COPD in the US and provides evidence for prioritizing COPD subgroups with the lowest HRQoL for targeted interventions.
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- 2020
11. Indoor Air Quality Prior to and Following School Building Renovation in a Mid-Atlantic School District
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Tianshi David Wu, Meghan F. Davis, Marc L. Stein, Thomas Eckmann, Ike Diibor, Kirsten Koehler, Dorothy Clemons-Erby, Christine E. Gummerson, Meredith C. McCormack, Sandra E. Zaeh, Michelle N. Eakin, Ana M. Rule, Christopher Wohn, Ehsan Majd, Timothy Green, and Megan Wood
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Health, Toxicology and Mutagenesis ,Air pollution ,Context (language use) ,School district ,medicine.disease_cause ,World health ,Article ,Building renovation ,renovation ,Indoor air quality ,Environmental health ,Air Pollution ,medicine ,Humans ,Child ,Air quality index ,Air Pollutants ,Schools ,business.industry ,Public Health, Environmental and Occupational Health ,Air conditioning ,Air Pollution, Indoor ,Environmental science ,Medicine ,business ,indoor air quality ,Environmental Monitoring - Abstract
Children spend the majority of their time indoors, and a substantial portion of this time in the school environment. Air pollution has been shown to adversely impact lung development and has effects that extend beyond respiratory health. The goal of this study was to evaluate the indoor environment in public schools in the context of an ongoing urban renovation program to investigate the impact of school building renovation and replacement on indoor air quality. Indoor air quality (CO2, PM2.5, CO, and temperature) was assessed for two weeks during fall, winter, and spring seasons in 29 urban public schools between December 2015 and March 2020. Seven schools had pre- and post-renovation data available. Linear mixed models were used to examine changes in air quality outcomes by renovation status in the seven schools with pre- and post-renovation data. Prior to renovation, indoor CO measurements were within World Health Organization (WHO) guidelines, and indoor PM2.5 measurements rarely exceeded them. Within the seven schools with pre- and post-renovation data, over 30% of indoor CO2 measurements and over 50% of indoor temperatures exceeded recommended guidelines from the American Society of Heating, Refrigerating, and Air Conditioning Engineers. Following renovation, 10% of indoor CO2 measurements and 28% of indoor temperatures fell outside of the recommended ranges. Linear mixed models showed significant improvement in CO2, indoor PM2.5, and CO following school renovation. Even among schools that generally met recommendations on key guidelines, school renovation improved the indoor air quality. Our findings suggest that school renovation may benefit communities of children, particularly those in low-income areas with aging school infrastructure, through improvements in the indoor environment.
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- 2021
12. Abstract T2: Agreement Between Attended Home Blood Pressure Measurements And Ambulatory Blood Pressure Monitoring
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Trevor Glenn, Cyd K. Eaton, Cozumel S. Pruette, Michelle N. Eakin, Kevin J. Psoter, Kristin A. Riekert, and Tammy M. Brady
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Ambulatory blood pressure ,Blood pressure ,business.industry ,Anesthesia ,Internal Medicine ,Medicine ,business - Abstract
Objectives: Compare attended home blood pressure (BP) measurements (HBPM) with ambulatory BP monitor (ABPM) readings and examine if level of agreement between the measurement approaches differ overall and by subgroup. Methods: This was a secondary analysis of data from a 2-yr observational study of children 11-19 yrs (mean 15, SD=2.69) with chronic kidney disease. Participants had 3 standardized resting oscillometric home BPs taken by staff followed by 24-hr ABPM within 2 weeks of home BP. BP indices (measured BP/95%ile BP) were calculated for the mean triplicate attended HBPM and mean daytime ABPM readings. All paired HBPM and ABPM measurements taken during any of 5 study visits were compared using linear regression with robust standard errors. Generalized estimating equations-based logistic regression determined the sensitivity, specificity, negative, and positive predictive values with ABPM as the gold standard. Analyses were conducted for the group overall and by subgroup. Results: There were 103 participants who contributed 251 paired measurements. Indexed systolic BP did not differ between modalities (mean difference -0.002; 95% CI: -0.006, 0.003), and the difference in indexed diastolic BP was minimal (mean difference -0.033; 95% CI: -0.040, -0.025). The overall agreement between HBPM and ABPM in identifying abnormal BP was high (88.5%), and findings were consistent in each subgroup (Table). Conclusions: Attended HBPM may be a reasonable substitute for ABPM when monitoring BP. The greater accessibility and feasibility of attended HBPM has the potential to improve BP control among at-risk youth.
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- 2021
13. Family management of asthma in Head Start preschool children
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Elizabeth Ruvalcaba, Kristin A. Riekert, Monica A. Lu, Thomas Eckmann, Michelle N. Eakin, Cynthia S. Rand, and Elizabeth L. McQuaid
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Pulmonary and Respiratory Medicine ,Family management ,medicine.medical_specialty ,Immunology ,Population ,Article ,Quality of life ,immune system diseases ,Asthma control ,Surveys and Questionnaires ,medicine ,Immunology and Allergy ,Humans ,education ,Child ,Pediatric asthma ,Asthma ,education.field_of_study ,business.industry ,medicine.disease ,respiratory tract diseases ,Test (assessment) ,Caregivers ,Family medicine ,Head start ,Child, Preschool ,Quality of Life ,business - Abstract
Urban minority preschool children are disproportionately affected by asthma with increased asthma morbidity and mortality. It is important to understand how families manage asthma in preschool children to improve asthma control.To evaluate family asthma management and asthma outcomes among a low-income urban minority population of Head Start preschool children.The family asthma management system scale (FAMSS) evaluates how families manage a child's asthma. A total of 388 caregivers completed the FAMSS at baseline. Asthma outcomes were evaluated at baseline and prospectively at 6 months, including asthma control (based on the Test for Respiratory and Asthma Control in Kids), courses of oral corticosteroids (OCSs) required, and caregiver health-related quality of life (Pediatric Asthma Caregiver's Quality of Life Questionnaire [PACQLQ]). Multiple regression models evaluated the relationship between the FAMSS total score, FAMSS subscales, and asthma outcomes.Higher FAMSS total scores were associated with fewer courses of OCSs required (b = -0.23, P.01) and higher PACQLQ scores (b = 0.07, P.05). At baseline, higher integration subscale scores (b = -0.19, P.05) were associated with fewer courses of OCSs required, and higher family response scores were associates with higher PACQLQ scores (b = 0.06, P.05). Nevertheless, higher collaboration scores were associated with lower PACQLQ at baseline (b = -0.06, P.05) and 6 months (b = -0.07, P.05).Among this population of low-income minority preschool children, understanding how a family manages their child's asthma may help identify gaps for education to possibly improve caregiver asthma-related quality of life and reduce courses of OCSs.ClinicalTrials.gov Identifier: NCT01519453 (https://clinicaltrials.gov/ct2/show/NCT01519453); protocol available from meakin1@jhmi.edu.
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- 2021
14. Symptoms of Depression and Anxiety in Patients with COPD: A Network Analysis
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G.L. Kinney, M. Belvederi Murri, Robert A. Wise, Anand S Iyer, Surya P. Bhatt, Karin F. Hoth, E.A. Regan, Michelle N. Eakin, Victor Kim, Nicola A. Hanania, and Abebaw Mengistu Yohannes
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medicine.medical_specialty ,COPD ,business.industry ,medicine ,Anxiety ,In patient ,medicine.symptom ,Psychiatry ,medicine.disease ,business ,Depression (differential diagnoses) - Published
- 2021
15. What are the mechanisms underlying vaping-induced lung injury?
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Amy L. Bellinghausen, Laura E. Crotty Alexander, and Michelle N. Eakin
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,business.industry ,Vaping ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Poison control ,Lung Injury ,General Medicine ,Lung injury ,Suicide prevention ,Occupational safety and health ,Viewpoint ,Injury prevention ,medicine ,Humans ,Intensive care medicine ,business ,Lung - Published
- 2020
16. The Role of Patient-Physician Communication on the Use of Hydroxyurea in Adult Patients with Sickle Cell Disease
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Sophie Lanzkron, Sara Beachy, Sarah M. Jabour, Michelle N. Eakin, and Shayna S. Coburn
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Sociology and Political Science ,media_common.quotation_subject ,Decision Making ,Anemia, Sickle Cell ,Disease ,Health Services Accessibility ,Article ,03 medical and health sciences ,0302 clinical medicine ,Antisickling Agents ,Informed consent ,Epidemiology ,Humans ,Hydroxyurea ,Medicine ,Active listening ,030212 general & internal medicine ,Qualitative Research ,media_common ,Physician-Patient Relations ,030505 public health ,Adult patients ,business.industry ,Communication ,Health Policy ,Public Health, Environmental and Occupational Health ,Middle Aged ,Feeling ,Anthropology ,Family medicine ,Female ,Thematic analysis ,0305 other medical science ,business ,Decision Making, Shared ,Qualitative research - Abstract
OBJECTIVE: This qualitative study analyzed the perspective of patients living with sickle cell disease (SCD) on their process of deciding whether to take hydroxyurea (HU), and the role of physician communication in patients’ decision-making process. METHODS: From October 2015- July 2016, we conducted semi-structured interviews among patients with SCD (N=20) that were audio-recorded and transcribed. Participants were ≥ 18 years old, a patient of an urban adult sickle cell center, able to provide informed consent, and English-speaking. We iteratively developed codes and used thematic analysis to organize the key themes. RESULTS: Most participants were female (65%), middle aged (M=44, SD=12.2), and 55% were prescribed HU for an average of 10.4 (SD=4.7) years. Participants described 3 key factors that influenced their decision regarding HU treatment: 1) Lifestyle, 2) Health status, and 3) HU characteristics. Four themes emerged about provider communication and HU treatment decisions: 1) Provider’s advisement, 2) Shared-decision making, 3) “Wrestled,” and 4) Not feeling heard. CONCLUSION: Providers who engaged in shared-decision making empowered participants to decide whether to start HU treatment. Participants who felt their providers were not listening to their concerns expressed disengaging from HU treatment. During discussions about HU with patients living with SCD, providers must understand the multi-faceted aspects that impact patients’ decision and empower patients to engage in such discussions. Further research is needed to understand the role of shared-decision making among patients with SCD to improve management of SCD.
- Published
- 2019
17. Acute Respiratory Failure Survivors’ Physical, Cognitive, and Mental Health Outcomes: Quantitative Measures versus Semistructured Interviews
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Ramona O. Hopkins, Jacqueline O’Toole, Mohammed Nabeel, Archana Nelliot, Victor D. Dinglas, Yashika Patel, Dale M. Needham, Lisa Aronson Friedman, Michelle N. Eakin, Catherine L. Hough, and Pedro A. Mendez-Tellez
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Anxiety ,Interviews as Topic ,Stress Disorders, Post-Traumatic ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Humans ,Medicine ,Acute respiratory failure ,Survivors ,030212 general & internal medicine ,Intensive care medicine ,Qualitative Research ,Original Research ,Respiratory Distress Syndrome ,Depression ,business.industry ,Follow up studies ,Outcome measures ,Middle Aged ,Mental health ,Mental Health ,030228 respiratory system ,Critical illness ,Quality of Life ,Female ,business ,Qualitative research - Abstract
Rationale: Increasingly, patients are surviving acute respiratory failure (ARF), prompting the need to better understand standardized outcome measures commonly used during ARF follow-up studies. Objectives: Investigate standardized outcome measures (patient-reported physical and mental health measures, and cognitive testing) compared with findings from semistructured, qualitative interviews. Methods: As part of two ARF multicenter follow-up studies, standardized outcome measures were obtained, followed by qualitative evaluation via an in-depth, semistructured interview conducted and coded by two independent researchers. Qualitative interviews revealed the following post-ARF survivorship themes: physical impairment; anxiety, depression, and post-traumatic stress disorder symptoms; and cognitive impairment. Scores from standardized measures related to these themes were compared for ARF survivors reporting versus not reporting these themes in their qualitative interviews. Results: Of 59 invited ARF survivors, 48 (81%) completed both standardized outcome measures and qualitative interviews. Participants’ median (interquartile range) age was 53 (43–64) years; 54% were female, and 88% were living independently before hospitalization. The two independent reviewers classifying the presence or absence of themes from the qualitative interviews had excellent agreement (κ = 0.80). There were significantly worse scores on standardized outcome measures for survivors reporting (vs. not reporting) physical and mental health impairments in their qualitative interviews. However, standardized cognitive test scores did not differ between patients reporting versus not reporting cognitive impairments in their qualitative interviews. Conclusions: These findings support the use of recommended, commonly used standardized outcome measures for physical and mental health impairments in ARF survivorship research. However, caution is needed in interpreting self-reported cognitive function compared with standardized cognitive testing.
- Published
- 2019
18. In-Home Secondhand Smoke Exposure Among Urban Children With Asthma: Contrasting Households With and Without Residential Smokers
- Author
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Cynthia S. Rand, Emily P. Brigham, Meredith C. McCormack, Nadia N. Hansel, Tianshi David Wu, Gregory B. Diette, and Michelle N. Eakin
- Subjects
Male ,medicine.medical_specialty ,Urban Population ,Context (language use) ,Article ,Odds ,Cohort Studies ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Quality of life ,Environmental health ,Epidemiology ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Family Characteristics ,Smokers ,030505 public health ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Environmental Exposure ,Odds ratio ,Asthma ,Child, Preschool ,Baltimore ,Cohort ,Female ,Tobacco Smoke Pollution ,0305 other medical science ,business ,Psychosocial - Abstract
CONTEXT Secondhand smoke exposure (SHSe) affects up to half of all children in the United States. Many studies have identified factors associated with in-home SHSe, but few have contrasted these factors between households with and without residential smokers. In the latter case, exposure occurs from only external sources that enter the home, such as visitors or environmental incursion. OBJECTIVE Among children with SHSe at home, to examine demographic and psychosocial differences between households with and without residential smokers. DESIGN Baseline analysis of an observational cohort. SETTING Baltimore City, Maryland. PARTICIPANTS A total of 157 children with asthma, aged 5 to 12 years. MEASURES At-home airborne nicotine, caregiver-reported depression, asthma-related quality of life, functional social support, and demographics. Univariable comparisons were performed between SHS-exposed households with and without residential smokers. Multivariable logistic regression models were fit to examine associations between measured factors and absence of residential smokers. RESULTS Children (78.3%) had at-home SHSe. Of these, 40.7% lived in households without residential smokers. Compared with households with residential smokers, these caregivers endorsed stronger beliefs in SHS harms and also worse functional social support and asthma-related stress, despite no differences in asthma morbidity. In adjusted models, SHS-exposed children with caregivers in the lowest tertile of functional social support (adjusted odds ratio, 3.50; 95% confidence interval, 1.12-10.99), asthma-related quality of life (2.90; 1.06-7.95), and those living alone (5.28; 1.26-22.15) had at least twice higher odds of having exclusively external SHSe than the highest tertile (P trends < .05). CONCLUSIONS In-home SHS exposure remains alarmingly high in urban environments. However, a substantial proportion of this exposure appears to be occurring only from external sources that enter the home. Caregivers in these homes had higher desire but lower agency to avoid SHSe, driven by lack of functional support and physical isolation. Public policies targeting these factors may help remediate exposure in this especially vulnerable population.
- Published
- 2019
19. Responses to a Daughter’s Question about Prognosis When the Patient Is Expected to Die: A Qualitative Analysis
- Author
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Sandra E. Zaeh, Alison E. Turnbull, Michelle N. Eakin, and Scott T. Vasher
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Critical Care ,media_common.quotation_subject ,MEDLINE ,Truth Disclosure ,01 natural sciences ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Qualitative analysis ,Randomized controlled trial ,law ,Professional-Family Relations ,medicine ,Humans ,030212 general & internal medicine ,Letters ,0101 mathematics ,Practice Patterns, Physicians' ,Proxy (statistics) ,Qualitative Research ,media_common ,Daughter ,business.industry ,Extramural ,Communication ,010102 general mathematics ,Prognosis ,Proxy ,Death ,Intensive Care Units ,Family medicine ,business ,Qualitative research - Published
- 2019
20. Family Caregiver Marginalization is Associated With Decreased Primary and Subspecialty Asthma Care in Head Start Children
- Author
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Elizabeth C. Matsui, Kristin A. Riekert, S. Christy Sadreameli, Michelle N. Eakin, and Cynthia S. Rand
- Subjects
Adult ,Male ,Parents ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Psychological intervention ,Subspecialty ,Article ,Young Adult ,03 medical and health sciences ,Allergists ,0302 clinical medicine ,030225 pediatrics ,Health care ,Early Intervention, Educational ,medicine ,Humans ,Poverty ,Asthma ,Motivation ,Primary Health Care ,business.industry ,Emergency department ,Odds ratio ,medicine.disease ,respiratory tract diseases ,Black or African American ,Pulmonologists ,Caregivers ,030228 respiratory system ,Child, Preschool ,Family medicine ,Head start ,Pediatrics, Perinatology and Child Health ,Social Marginalization ,Female ,Emergency Service, Hospital ,business ,Medicaid - Abstract
BACKGROUND: Urban minority children are at risk for poor asthma outcomes and may not receive appropriate primary or subspecialty care. OBJECTIVE: We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and more likely to have had a recent emergency department (ED) visit for asthma. METHODS: The Barriers to Care Questionnaire (BCQ) measures expectations, knowledge, marginalization, pragmatics, and skills. We assessed asthma control via TRACK and these outcomes: PCP visits for asthma in past six months, subspecialty care (allergist or pulmonologist) in past two years, and ED visits in past three months. RESULTS: 395 caregivers (96% African-American, 82% low-income, 96% Medicaid) completed the BCQ. Sixty percent(N=236) of children had uncontrolled asthma, 86% had seen a PCP, 23% had seen a subspecialist, and 29% had an ED visit. Barriers related to marginalization were associated with decreased likelihood of PCP (OR 0.95, p=0.014) and subspecialty visits (OR 0.92, p=0.019). Overall BCQ score was associated with decreased likelihood of subspecialty care (OR 0.98, p=0.027). Barriers related to expectations, knowledge, pragmatics, and skills were not associated with any of the care outcomes. CONCLUSIONS: Among low-income, predominantly African-American preschool children with asthma, primary and subspecialty care were less likely if caregivers reported past negative experiences with the healthcare system (marginalization). Clinicians who serve at-risk populations should be sensitive to families’ past experiences and should consider designing interventions to target the most commonly reported barriers. WHAT’S NEW: In a group of preschool-age, urban, predominantly African-American children with asthma, caregiver-reported barriers related to marginalization were associated with decreased likelihood of primary and subspecialty asthma care, indicating a potential target for future interventions to improve asthma outcomes.
- Published
- 2018
21. Recommendations for the Appropriate Structure, Communication, and Investigation of Tobacco Harm Reduction Claims. An Official American Thoracic Society Policy Statement
- Author
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Frank T. Leone, Laura E. Crotty Alexander, Sharon A. McGrath-Morrow, Michelle N. Eakin, Alfred Munzer, Hasmeena Kathuria, David P.L. Sachs, Jonathan M. Samet, Beth S. Sufian, Shane McDermott, Smita Pakhale, Sarah Evers-Casey, Enid Neptune, David M. Chooljian, Farzad Moazed, Karen Latzka, Frank C. Detterbeck, Patricia Folan, Kai-Håkon Carlsen, Dona Upson, and Harold J. Farber
- Subjects
Pulmonary and Respiratory Medicine ,Statement (logic) ,media_common.quotation_subject ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Harm Reduction ,Tobacco ,Humans ,Medicine ,030212 general & internal medicine ,Societies, Medical ,media_common ,American Thoracic Society Documents ,Structure (mathematical logic) ,Tobacco harm reduction ,Vague language ,business.industry ,Health Policy ,Smoking ,Certainty ,United States ,Health Communication ,Law ,business - Abstract
Rationale: The tobacco harm reduction literature is replete with vague language, far-reaching claims, and unwarranted certainty. The American Thoracic Society has increasingly recognized the need for a framework for reliably making such claims. Evidence-based standards improving the scientific value and transparency of harm reduction claims are expected to improve their trustworthiness, clarity, and consistency. Methods: Experts from relevant American Thoracic Society committees identified key topic areas for discussion. Literature search strategy included English language articles across Medline, Google Scholar, and the Cochrane Collaborative databases, with expanded search terms including tobacco, addiction, smoking, cigarettes, nicotine, and harm reduction. Workgroup members synthesized their evidentiary summaries into a list of candidate topics suitable for inclusion in the final report. Breakout groups developed detailed content maps of each topic area, including points to be considered for suggested recommendations. Successive draft recommendations were modified using an iterative consensus process until unanimous approval was achieved. Patient representatives ensured the document’s relevance to the lay public. Results: Fifteen recommendations were identified, organized into four framework elements dealing with: estimating harm reduction among individuals, making claims on the basis of population impact, appropriately careful use of language, and ethical considerations in harm reduction. Discussion: This statement clarifies important principles guiding valid direct and inferential harm reduction claims. Ideals for effective communication with the lay public and attention to unique ethical concerns are also delineated. The authors call for formal systems of grading harm reduction evidence and regulatory assurances of longitudinal surveillance systems to document the impact of harm reduction policies.
- Published
- 2018
22. 'It is kind of like a responsibility thing': transitional challenges in asthma medication adherence among adolescents and young adults
- Author
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Monica A. Lu, Christabelle Ayensu-Asiedu, Sandra E. Zaeh, Kathryn V. Blake, Elizabeth Ruvalcaba, Robert A. Wise, Janet T. Holbrook, and Michelle N. Eakin
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Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Adolescent ,Article ,Medication Adherence ,Young Adult ,immune system diseases ,Immunology and Allergy ,Medicine ,Humans ,Young adult ,Asthma ,Medication use ,Self-management ,business.industry ,Nebulizers and Vaporizers ,Asthma symptoms ,Asthma medication ,medicine.disease ,humanities ,respiratory tract diseases ,Caregivers ,Family medicine ,Pediatrics, Perinatology and Child Health ,business ,Qualitative research - Abstract
Nonadherence to asthma medications is prevalent among adolescents and young adults (AYAs) with asthma, leading to worsened control of asthma symptoms and more frequent exacerbations. AYAs have unique developmental transitional challenges that may alter medication adherence. We aimed to use a socio-ecological framework to explore the effect of transitional challenges from adolescence to young adulthood on asthma controller medication adherence and to identify possible strategies to promote medication adherence.We conducted qualitative semi-structured interviews by phone with 7 adolescents (14 to 17 years), their respective caregivers, and 7 young adults (18 to 30 years). Participants were recruited from a respiratory clinical trial network and pulmonary clinics in 4 states at 6 different sites through convenience sampling. Interviews were audio recorded, transcribed and coded using thematic analyses.Participants identified personal challenges affecting adherence to asthma medications during the transition from adolescence to young adulthood including responsibility for asthma self-management, understanding of asthma condition and severity, embarrassment, and life demands. Health systems factors including medication cost, challenges with insurance, difficulties obtaining refills, and difficulty with access to medications at school also impacted asthma medication adherence. Participants recommended adherence strategies including improved access to inhalers, incorporating asthma medications into daily routines, and using reminders.Focusing on the transitional challenges of AYAs during the time period from adolescence to young adulthood is necessary for supporting their asthma medication adherence and creating future interventions. Socio-ecological and systems factors should also be targeted for improved asthma medication adherence.Supplemental data for this article can be accessed online at https://doi.org/10.1080/02770903.2021.1897836.
- Published
- 2021
23. Smoking and COVID-19: The Real Deal
- Author
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Enid Neptune and Michelle N. Eakin
- Subjects
Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Smoking ,COVID-19 ,Virology ,Perspective ,Tobacco Smoking ,Medicine ,Humans ,business - Published
- 2021
24. The influence of social support on COPD outcomes mediated by depression
- Author
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David Couper, Prescott G. Woodruff, MeiLan K. Han, Robert Paine, Laura M. Paulin, Eugene R. Bleecker, Leonard Turnier, Mark T. Dransfield, Stephen P. Peters, Robert A. Wise, Richard E. Kanner, Fernando J. Martinez, Christopher B. Cooper, Nadia N. Hansel, Jerry A. Krishnan, Graham Barr, Russell P. Bowler, Nirupama Putcha, Michelle N. Eakin, Karina Romero, Alejandro P. Comellas, Brad Drummond, Han Woo, and Trisha M. Parekh
- Subjects
Questionnaires ,Male ,Pulmonology ,Epidemiology ,Logistic regression ,01 natural sciences ,010104 statistics & probability ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Medical Conditions ,Informed consent ,Surveys and Questionnaires ,Medicine and Health Sciences ,Public and Occupational Health ,Longitudinal Studies ,Depression (differential diagnoses) ,Aged, 80 and over ,COPD ,Multidisciplinary ,Depression ,Statistics ,Middle Aged ,Research Design ,Physical Sciences ,Medicine ,Female ,Behavioral and Social Aspects of Health ,Clinical psychology ,Research Article ,Adult ,Mediation (statistics) ,Science ,Chronic Obstructive Pulmonary Disease ,Research and Analysis Methods ,Odds ,03 medical and health sciences ,Social support ,Respiratory Disorders ,Quality of life (healthcare) ,medicine ,Confidence Intervals ,Humans ,0101 mathematics ,Aged ,Survey Research ,business.industry ,Social Support ,medicine.disease ,Health Care ,Dyspnea ,Cross-Sectional Studies ,Logistic Models ,030228 respiratory system ,Medical Risk Factors ,Quality of Life ,Health Statistics ,Morbidity ,business ,Mathematics - Abstract
BackgroundThe purpose of this study was to explore the association between perceived social support and COPD outcomes and to determine whether the associations are mediated by depressive symptoms.MethodsSubjects with COPD who were enrolled as part of SPIROMICS were included in this analysis. Questionnaires relating to quality of life, symptom burden, and functional status were administered at annual clinic visits for over a 3 year period. In both cross-sectional and longitudinal analyses, we examined the association of social support as measured by the FACIT-F with COPD outcomes. Cross sectional analyses used multivariable linear or logistic regression, adjusting for covariates. For longitudinal analyses, generalized linear mixed models with random intercepts were used. Models were adjusted with and without depressive symptoms and mediation analyses performed.ResultsOf the 1831 subjects with COPD, 1779 completed the FACIT- F questionnaire. In adjusted cross-sectional analysis without depressive symptoms, higher perceived social support was associated with better quality of life, well-being, 6 minute walk distance, and less dyspnea. When also adjusting for depressive symptoms, all associations between social support and COPD outcomes were attenuated and no longer statistically significant. Mediation analysis suggested that depressive symptoms explained the majority (> = 85%) of the association between social support and measured COPD outcomes. Results of the longitudinal analysis were consistent with the cross-sectional analyses. There was no association between social support and odds of exacerbations.ConclusionHigher social support was associated with better COPD outcomes across several measures of morbidity including quality of life, respiratory symptoms, and functional status. In addition, these associations were largely attenuated when accounting for depressive symptoms suggesting that the beneficial association of social support with COPD outcomes may be largely mediated by the association between social support and depression.Trial registrationSPIROMICS was approved by Institutional Review Boards at each center and all participants provided written informed consent (clinicaltrials.gov:NCT01969344).
- Published
- 2021
25. Randomized Clinical Trial of Air Cleaners to Improve Indoor Air Quality and COPD Health: Results of the CLEAN AIR STUDY
- Author
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Ana M. Rule, Michelle N. Eakin, Roger D. Peng, Nadia N. Hansel, Ashraf Fawzy, Meghan F. Davis, Nirupama Putcha, Gregory B. Diette, Han Woo, Kirsten Koehler, Karina Romero, Robert A. Wise, Patrick N. Breysse, and Meredith C. McCormack
- Subjects
COPD ,medicine.medical_specialty ,Intention-to-treat analysis ,Exacerbation ,business.industry ,medicine.disease ,Lower risk ,Institutional review board ,law.invention ,Clinical trial ,Randomized controlled trial ,law ,Informed consent ,Family medicine ,Medicine ,business - Abstract
Background: Indoor particulate matter is associated with worse outcomes in adults with COPD. It remains unknown whether reductions of indoor pollutants can improve respiratory morbidity. Methods: Eligible former smokers with moderate-severe COPD received active or sham portable HEPA air cleaners and were followed for 6 months in this blinded randomized controlled trial. The primary outcome was 6-month change in Saint George’s Respiratory Questionnaire (SGRQ) . Secondary outcomes were exacerbation risk, respiratory symptoms, rescue medication use and 6MWD. Intention to treat analysis included all subjects and per protocol analysis included adherent participants (greater than 80% use of air cleaner). Findings: 116 participants were randomized of which 84.5% completed study. There was no statistically significant difference in improvement of total SGRQ, but the active filter group had greater reduction in SGRQ symptom subscale (s -7.7 [95% CI, -15.0 to -0.37]) and respiratory symptoms (BCSS, s -0.8 [95% CI, -1.5 to -0.1); and lower risk of moderate exacerbations (IRR 0.32 [95% CI, 0.12-0.91]) and rescue medication use (IRR 0.54 [95% CI, 0.33-0.86]) compared to sham group (all p
- Published
- 2021
26. Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up!
- Author
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Julie Quinn, Michele C. Balas, Archana Nelliot, J. Redivo, Sapna R. Kudchadkar, Michelle N. Eakin, Beth Wieczorek, Ayse P. Gurses, Dale M. Needham, and Ruchit Patel
- Subjects
Occupational therapy ,medicine.medical_specialty ,medicine.medical_treatment ,Psychological intervention ,MEDLINE ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Phone ,Medicine ,Humans ,Family ,Child ,Early Ambulation ,Qualitative Research ,Rehabilitation ,business.industry ,Stakeholder ,030208 emergency & critical care medicine ,Pediatrics, Perinatology and Child Health ,Thematic analysis ,business ,Qualitative research - Abstract
Objectives To identify staff-reported factors and perceptions that influenced implementation and sustainability of an early mobilization program (PICU Up!) in the PICU. Design A qualitative study using semistructured phone interviews to characterize interprofessional staff perspectives of the PICU Up! program. Following data saturation, thematic analysis was performed on interview transcripts. Setting Tertiary-care PICU in the Johns Hopkins Hospital, Baltimore, MD. Subjects Interprofessional PICU staff. Interventions None. Measurements and main results Fifty-two staff members involved in PICU mobilization across multiple disciplines were interviewed. Three constructs emerged that reflected the different stages of PICU Up! program execution: 1) factors influencing the implementation process, 2) staff perceptions of PICU Up!, and 3) improvements in program integration. Themes were developed within these constructs, addressing facilitators for PICU Up! implementation, cultural changes for unitwide integration, positive impressions toward early mobility, barriers to program sustainability, and refinements for more robust staff and family engagement. Conclusions Three years after implementation, PICU Up! remains well-received by staff, positively influencing role satisfaction and PICU team dynamics. Furthermore, patients and family members are perceived to be enthusiastic about mobility efforts, driving staff support. Through an ongoing focus on stakeholder buy-in, interprofessional engagement, and bundled care to promote mobility, the program has become part of the culture in the Johns Hopkins Hospital PICU. However, several barriers remain that prevent consistent execution of early mobility, including challenges with resource management, sedation decisions, and patient heterogeneity. Characterizing these staff perceptions can facilitate the development of solutions that use institutional strengths to grow and sustain PICU mobility initiatives.
- Published
- 2020
27. Implementing Change in the Heat of the Moment
- Author
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Michelle N. Eakin, Chad Hochberg, and David N. Hager
- Subjects
Adult ,Hot Temperature ,Leadership and Management ,business.industry ,SARS-CoV-2 ,Health Policy ,Brief Report ,COVID-19 ,General Medicine ,Assessment and Diagnosis ,Moment (mathematics) ,Classical mechanics ,Editorial ,Medicine ,Humans ,Fundamentals and skills ,business ,Care Planning - Abstract
As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)–related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.
- Published
- 2020
28. Effectiveness of a Home- and School-Based Asthma Educational Program for Head Start Children With Asthma: A Randomized Clinical Trial
- Author
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Kristin A. Riekert, Michelle N. Eakin, Marisa E. Hilliard, Elizabeth Ruvalcaba, Thomas Eckmann, Cynthia S. Rand, and Sandra E. Zaeh
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Psychological intervention ,MEDLINE ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Patient Education as Topic ,law ,030225 pediatrics ,medicine ,Early Intervention, Educational ,Humans ,030212 general & internal medicine ,Anti-Asthmatic Agents ,Child ,Asthma ,Original Investigation ,School Health Services ,business.industry ,Odds ratio ,medicine.disease ,Test (assessment) ,Caregivers ,Head start ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Baltimore ,Female ,business ,Educational program ,Program Evaluation - Abstract
IMPORTANCE: Asthma is the most common chronic childhood disease, with Black children experiencing worse morbidity and mortality. It is important to evaluate the effectiveness of efficacious interventions in community settings that have the greatest likelihood of serving at-risk families. OBJECTIVE: To evaluate the effectiveness of a multilevel home- and school (Head Start)–based asthma educational program compared with a Head Start–based asthma educational program alone in improving asthma outcomes in children. DESIGN, SETTING, AND PARTICIPANT: This randomized clinical trial included 398 children with asthma enrolled in Head Start preschool programs in Baltimore, Maryland, and their primary caregivers. Participants were recruited from April 1, 2011, to November 31, 2016, with final data collection ending December 31, 2017. Data were analyzed from March 18 to August 30, 2018. INTERVENTIONS: Asthma Basic Care (ABC) family education combined with Head Start asthma education compared with Head Start asthma education alone. MAIN OUTCOMES AND MEASURES: Asthma control as measured by the Test for Respiratory and Asthma Control in Kids (TRACK) score. RESULTS: Among the 398 children included in the analysis (247 boys [62.1%]; mean [SD] age, 4.2 [0.7] years), the ABC plus Head Start program improved asthma control (β = 6.26; 95% CI, 1.77 to 10.75; P
- Published
- 2020
29. Engagement and Affective Communication During Pediatric Nephrology Clinic Visits: Associations with Medication Adherence
- Author
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Susan R. Mendley, Tammy M. Brady, Cyd K. Eaton, Kristin A. Riekert, Michelle N. Eakin, Debra L. Roter, Shamir Tuchman, Barbara A. Fivush, Cozumel S. Pruette, and Trevor Glenn
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Medication adherence ,Affect (psychology) ,Ambulatory Care Facilities ,Article ,Medication Adherence ,03 medical and health sciences ,Affective communication ,Young Adult ,0302 clinical medicine ,Ambulatory Care ,Medicine ,Pediatric nephrology ,Outpatient clinic ,Humans ,030212 general & internal medicine ,Young adult ,Pediatric nephrology clinic ,Child ,Physician-Patient Relations ,business.industry ,030503 health policy & services ,Communication ,General Medicine ,medicine.disease ,humanities ,Nephrology ,Family medicine ,Female ,0305 other medical science ,business ,Kidney disease - Abstract
Objective To evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence. Methods AYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence. Results AYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider. Conclusions Post-visit adherence was higher when AYAs were rated as more engaged and providers as less negative. Practice Implications AYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.
- Published
- 2020
30. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline
- Author
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Panagis Galiatsatos, Dona Upson, Kelly K O'Brien, Hasmeena Kathuria, A. Eden Evins, Smita Pakhale, Luciane Cruz-Lopes, David P.L. Sachs, Dan Xiao, Manuel C Pacheco, Benjamin A. Toll, Kathleen Fennig, Stephen P. Kantrow, Thomas Lamphere, Patricia Folan, Frank T. Leone, Michelle N. Eakin, Izabela Fulone, Sarah Evers-Casey, Sureka Pavalagantharajah, Meng Zhu, Stephanie Ross, Yuan Zhang, Rachael L Murray, Harold J. Farber, David J. Prezant, Hyma Gogineni, Joelle T. Fathi, Enid Neptune, and Yuqing Zhang
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Nicotine patch ,medicine.medical_treatment ,Psychological intervention ,Critical Care and Intensive Care Medicine ,tobacco ,smoking ,03 medical and health sciences ,chemistry.chemical_compound ,pharmacotherapy ,0302 clinical medicine ,Pharmacotherapy ,medicine ,Humans ,030212 general & internal medicine ,Varenicline ,Bupropion ,Aged ,Aged, 80 and over ,American Thoracic Society Documents ,Smoking Cessation Agents ,treatment ,business.industry ,Guideline ,Tobacco Use Disorder ,dependence ,Middle Aged ,United States ,Systematic review ,030228 respiratory system ,chemistry ,Family medicine ,Practice Guidelines as Topic ,Smoking cessation ,Female ,business ,medicine.drug - Abstract
Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.
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- 2020
31. Patient Perspectives on Prescribing Practices in Chronic Obstructive Pulmonary Disease
- Author
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M. Krishnan, E. Ruvalcaba, J. O'Toole, and Michelle N. Eakin
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Pulmonary disease ,Intensive care medicine ,business - Published
- 2020
32. Patient Experiences of Uncertainty in the Diagnosis, Disease Course and Treatment of Sarcoidosis: A Qualitative Study
- Author
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A. Moale, Michelle Sharp, Taylor Brown, Michelle N. Eakin, N. Camick, and Edward S. Chen
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Sarcoidosis ,Intensive care medicine ,business ,medicine.disease ,Disease course ,Qualitative research - Published
- 2020
33. Predicting Physical and Mental Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in the United States
- Author
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Michelle N. Eakin, Chintal H. Shah, R.M. Reed, and Zafar Zafari
- Subjects
medicine.medical_specialty ,Quality of life (healthcare) ,business.industry ,Medicine ,Pulmonary disease ,In patient ,business ,Intensive care medicine ,Mental health - Published
- 2020
34. The Lung Health Ambassador Program: A Community-Engagement Initiative Tackling Lung-Related Health Disparities
- Author
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C.S. Rand, Meredith C. McCormack, Panagis Galiatsatos, Rachelle Koehl, Michelle N. Eakin, E. Judge, and Nadia N. Hansel
- Subjects
medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,Community engagement ,business.industry ,Lung health ,Family medicine ,Medicine ,business ,Health equity - Published
- 2020
35. Maintaining Emotional Well-Being During the COVID-19 Pandemic: A Resource for Your Patients
- Author
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Michelle N. Eakin, Sara Latham, Jamie L. Sullivan, and Stephanie Williams
- Subjects
Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Resource (biology) ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Brief Communication ,Emotional well-being ,Pandemic ,medicine ,Intensive care medicine ,business - Published
- 2020
36. Executive functioning, caregiver monitoring, and medication adherence over time in adolescents with chronic kidney disease
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Kara M. Duraccio, Tammy M. Brady, Susan R. Mendley, Kristin A. Riekert, Shamir Tuchman, Michelle N. Eakin, Cozumel S. Pruette, Barbara A. Fivush, Thomas Eckmann, and Cyd K. Eaton
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Medication adherence ,PsycINFO ,Negative association ,Article ,Medication Adherence ,03 medical and health sciences ,Executive Function ,Young Adult ,Pharmacotherapy ,medicine ,Pediatric nephrology ,Humans ,Renal Insufficiency, Chronic ,Psychiatry ,Child ,Applied Psychology ,030505 public health ,business.industry ,Cognitive effort ,medicine.disease ,Psychiatry and Mental health ,Caregivers ,Adherence monitoring ,Female ,0305 other medical science ,business ,Kidney disease - Abstract
OBJECTIVE The purpose of this study was to evaluate associations between executive functioning and caregiver adherence monitoring with objective antihypertensive medication adherence over 24 months in adolescents with chronic kidney disease (CKD). METHODS Adolescents (N = 97, 11-20 years old) with CKD taking antihypertensive medication and their caregivers were recruited from three pediatric nephrology clinics. At baseline, adolescents and caregivers reported on adolescents' executive functioning and caregivers reported on their adherence monitoring. Antihypertensive medication adherence was objectively assessed via electronic monitoring at baseline and every 6 months after for 24 months. Associations between executive functioning, caregiver monitoring, and longitudinal adherence were evaluated with linear mixed models. RESULTS Up to 38% of adolescents had elevated executive functioning scores indicating more severe impairments, with rates varying by scale and reporter (adolescent vs. caregiver). Caregiver monitoring showed a significant, negative association with adherence, but adolescents' executive functioning was not significantly associated with adherence. Neither variable was associated with the rate of change in adherence over time. CONCLUSIONS Given that adolescents' executive functioning was not associated with antihypertensive medication adherence or changes in adherence over time, adherence to daily pill-form medications may involve less cognitive effort than more complex medical regimens. Higher levels of caregiver monitoring were unexpectedly associated with lower adherence levels. This unanticipated finding may reflect increased caregiver monitoring efforts when faced with adolescents' medication nonadherence, but this finding warrants further investigation. Adolescents with CKD who are nonadherent may benefit from medication adherence-promoting strategies beyond increasing caregiver monitoring. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
- Published
- 2020
37. Association Between Participant Contact Attempts and Reports of Being Bothered in a National, Longitudinal Cohort Study of ARDS Survivors
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Ramona O. Hopkins, Megan M. Hosey, Victor D. Dinglas, Thomas Eckmann, Ayodele A. Akinremi, Michelle N. Eakin, and Dale M. Needham
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,Longitudinal study ,media_common.quotation_subject ,Population ,Aftercare ,Critical Care and Intensive Care Medicine ,Gee ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Survivors ,Prospective cohort study ,education ,Research question ,media_common ,Original Research ,education.field_of_study ,Respiratory Distress Syndrome ,business.industry ,Communication ,Professional-Patient Relations ,Middle Aged ,Mental health ,030228 respiratory system ,Feeling ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Clinical psychology - Abstract
Background Participant retention is a major challenge in clinical research, especially in studies with multiple, longitudinal research assessments. Despite the importance of retention methods, there is little empirical research on how cohort retention efforts are perceived by study participants. Research Question To evaluate the association between the number of attempts undertaken to contact participants for research assessments in a longitudinal cohort study and participants' feeling of being bothered regarding such contact attempts. Study Design and Methods Secondary analysis of 315 ARDS survivors participating in a prospective study using comprehensive strategies for participant follow-up at 6 and 12 months that achieved > 95% participant retention. After completing a 242-question research assessment lasting 20 to 40 min, participants were surveyed for feedback. Results At 6 and 12 months, only 5% and 8% of participants, respectively, reported being bothered "more than a little bit" by the study contact attempts, with an OR of 1.06 (95% CI, 1.02-1.10) for each contact attempt. Participants' mental health symptoms at follow-up assessment were not associated with reports of being bothered. Interpretation Comprehensive cohort retention efforts can achieve > 95% retention rates in a national longitudinal study, with most participants reporting little or no bother by contact attempts. Despite a high frequency of mental health symptoms in this population, such symptoms were not associated with participant feedback regarding contact attempts. Careful training of research staff may be important in achieving such results.
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- 2020
38. Projecting Long-term Health and Economic Burden of COPD in the United States
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Michelle N. Eakin, Zafar Zafari, Robert M. Reed, Martine Bellanger, and Shukai Li
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Pulmonary and Respiratory Medicine ,Adult ,Male ,Psychological intervention ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,03 medical and health sciences ,Indirect costs ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Cost of Illness ,Environmental health ,medicine ,Prevalence ,Population growth ,Humans ,030212 general & internal medicine ,health care economics and organizations ,Disease burden ,Aged ,COPD ,business.industry ,Smoking ,Health Care Costs ,Middle Aged ,medicine.disease ,Symptom Flare Up ,Markov Chains ,United States ,Quality-adjusted life year ,030228 respiratory system ,Cohort ,Absenteeism ,Female ,Quality-Adjusted Life Years ,Cardiology and Cardiovascular Medicine ,business ,Monte Carlo Method ,Forecasting - Abstract
Background In the United States, COPD is a leading cause of mortality, with a substantial societal health and economic burden. With anticipated population growth, it is important for various stakeholders to have an estimate for the projected burden of disease. Research Question The goal of this study was to model the 20-year health and economic burden of COPD, from 2019 to 2038, in the United States. Study Design and Methods Using country-specific data from published literature and publicly available datasets, a dynamic open cohort Markov model was developed in a probabilistic Monte Carlo simulation. Population growth was modeled across different subgroups of age, sex, and smoking. The COPD prevalence rates were calibrated for different subgroups, and distributions of severity grades were modeled based on smoking status. Direct costs, indirect absenteeism costs, losses of quality-adjusted life years (QALYs), and number of exacerbations and deaths associated with COPD were projected. Results The 20-year discounted direct medical costs attributable to COPD were estimated to be $800.90 billion (95% credible interval [CrI], 565.29 billion-1,081.29 billion), with an expected $337.13 billion in male subjects and $463.77 billion in female subjects. The 20-year discounted indirect absenteeism costs were projected to be $101.30 billion (70.82 billion-137.41 billion). The 20-year losses of QALYs, number of exacerbations, and number of deaths associated with COPD were 45.38 million (8.63 million-112.07 million), 315.08 million (228.59 million-425.33 million), and 9.42 million (8.93 million-9.93 million), respectively. The proportion of disease burden attributable to continued smoking was 34% in direct medical costs, 35% in indirect absenteeism costs, and 37% in losses of QALYs over 20 years. Interpretation This study projects the substantial burden of COPD that the American society is expected to incur with current patterns for treatments and smoking rates. Mitigating such burden requires targeted budget appropriations and cost-effective interventions.
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- 2020
39. Association of Medication Adherence and Clinical Outcomes in Sarcoidosis
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Michelle Sharp, David R. Moller, Edward S. Chen, Cynthia S. Rand, Michelle N. Eakin, and Taylor Brown
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Sarcoidosis ,Medication adherence ,Spontaneous remission ,Critical Care and Intensive Care Medicine ,White People ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Sarcoidosis, Pulmonary ,Quality of life ,DLCO ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Original Research ,Physician-Patient Relations ,business.industry ,Communication ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Health equity ,Black or African American ,Cross-Sectional Studies ,Socioeconomic Factors ,030228 respiratory system ,Pharmaceutical Preparations ,Cohort ,Quality of Life ,Female ,Observational study ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: Sarcoidosis, one of the most common interstitial lung diseases, has significant health disparities. Approximately 50% of individuals affected with sarcoidosis will undergo spontaneous remission, but those who do not undergo remission often require long-term or lifelong treatment to prevent disease progression. We sought to assess the association between medication adherence and clinical outcomes in sarcoidosis. METHODS: Adult patients in the Johns Hopkins Sarcoidosis Clinic diagnosed with pulmonary sarcoidosis on treatment were eligible for enrollment. Questionnaires were administered to assess medication adherence, health-related quality of life (HRQoL), health-care utilization, and sociodemographic information. Clinical information was abstracted from medical charts including lung function, disease duration, comorbidities, and sarcoidosis organ involvement. RESULTS: A total of 117 participants were enrolled (57% women; 55% black; median age, 57 years). Within the cohort, 66% of individuals reported at least one nonadherent behavior. Higher medication adherence was associated with better HRQoL (P
- Published
- 2020
40. The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes: A Multilevel Approach
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Patrick C. Souverein, David Price, Liset van Dijk, Michelle N. Eakin, Peter Spreeuwenberg, Cynthia S. Rand, Tjard Schermer, Alison Chisholm, Alexandra L. Dima, Hilary Pinnock, Marcia Vervloet, Eric Van Ganse, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and PharmacoTherapy, -Epidemiology and -Economics
- Subjects
Male ,Longitudinal study ,medicine.medical_specialty ,medicine.drug_class ,Inhaled corticosteroids (ICSs) ,Odds ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Adrenal Cortex Hormones ,Administration, Inhalation ,medicine ,Humans ,Immunology and Allergy ,Anti-Asthmatic Agents ,030212 general & internal medicine ,Medical prescription ,Risk domain asthma control ,Asthma ,COPD ,business.industry ,Multilevel model ,OPCRD ,Multilevel modeling ,medicine.disease ,United Kingdom ,030228 respiratory system ,Adherence ,Emergency medicine ,Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] ,Corticosteroid ,business ,Body mass index - Abstract
Background Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences. Objective To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence. Methods Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics. Results In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non–current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation. Conclusions Patients may adapt their ICS use to their current needs without this impacting later RDAC.
- Published
- 2020
41. Housestaff perceptions on training and discussing the Maryland Orders for Life Sustaining Treatment Form (MOLST)
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Margaret M. Hayes, Alison E. Turnbull, Michelle N. Eakin, Cynthia S. Rand, and Sandra E. Zaeh
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Male ,Health Knowledge, Attitudes, Practice ,Palliative care ,Medical Doctors ,Health Care Providers ,Emotions ,Social Sciences ,End of Life Care ,Hospitals, University ,0302 clinical medicine ,Sociology ,Surveys and Questionnaires ,business.product_line ,Medicine and Health Sciences ,Psychology ,030212 general & internal medicine ,Medical Personnel ,media_common ,Resuscitation Orders ,Verbal Communication ,Multidisciplinary ,Palliative Care ,Communication skills training ,Professions ,Feeling ,030220 oncology & carcinogenesis ,Medicine ,Female ,Thematic analysis ,Advance Directives ,End-of-life care ,Research Article ,Adult ,Patients ,media_common.quotation_subject ,Science ,education ,MEDLINE ,Surgical and Invasive Medical Procedures ,Education ,03 medical and health sciences ,Nonverbal communication ,Physicians ,Humans ,Curriculum ,Medical education ,Behavior ,Physician-Patient Relations ,Maryland ,Verbal Behavior ,Biology and Life Sciences ,Cardiopulmonary Resuscitation ,Health Care ,Medical Education ,People and Places ,Population Groupings ,business ,Medical Humanities - Abstract
BackgroundOn-line tutorials are being increasingly used in medical education, including in teaching housestaff skills regarding end of life care. Recently an on-line tutorial incorporating interactive clinical vignettes and communication skills was used to prepare housestaff at Johns Hopkins Hospital to use the Maryland Orders for Life Sustaining Treatment (MOLST) form, which documents patient preferences regarding end of life care. 40% of housestaff who viewed the module felt less than comfortable discussing choices on the MOLST with patients. We sought to understand factors beyond knowledge that contributed to housestaff discomfort in MOLST discussions despite successfully completing an on-line tutorial.MethodsWe conducted semi-structured telephone interviews with 18 housestaff who completed the on-line MOLST training module. Housestaff participants demonstrated good knowledge of legal and regulatory issues related to the MOLST compared to their peers, but reported feeling less than comfortable discussing the MOLST with patients. Transcripts of interviews were coded using thematic analysis to describe barriers to using the MOLST and suggestions for improving housestaff education about end of life care discussions.ResultsQualitative analysis showed three major factors contributing to lack of housestaff comfort completing the MOLST form: [1] physician barriers to completion of the MOLST, [2] perceived patient barriers to completion of the MOLST, and [3] design characteristics of the MOLST form. Housestaff recommended a number of adaptations for improvement, including in-person training to improve their skills conducting conversations regarding end of life preferences with patients.ConclusionsSome housestaff who scored highly on knowledge tests after completing a formal on-line curriculum on the MOLST form reported barriers to using a mandated form despite receiving training. On-line modules may be insufficient for teaching communication skills to housestaff. Additional training opportunities including in-person training mechanisms should be incorporated into housestaff communication skills training related to end of life care.
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- 2020
42. Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study
- Author
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Alexis L Rea, Nicola A. Hanania, Lynn B. Gerald, Anna M Baker, Robert J. Henderson, Anne S Casper, Michelle N. Eakin, Janet T. Holbrook, David A. Kaminsky, Loretta G. Que, Anne M. Mathews, Elizabeth A. Sugar, Robert A. Wise, Abebaw Mengistu Yohannes, and Joe W. Ramsdell
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Health Status ,Cohort Studies ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Cognitive Dysfunction ,030212 general & internal medicine ,Depression (differential diagnoses) ,Aged ,Sleep disorder ,COPD ,medicine.diagnostic_test ,business.industry ,Public Health, Environmental and Occupational Health ,Infant ,Montreal Cognitive Assessment ,Odds ratio ,Mental Status and Dementia Tests ,medicine.disease ,030228 respiratory system ,Anxiety ,medicine.symptom ,business ,Cohort study - Abstract
Introduction: We evaluated risk factors and demographic characteristics of associated with mild cognitive impairment (MCI) in patients with COPD. Methods: 220 individuals with COPD enrolled in a cohort study designed to evaluate anxiety conducted at 16 clinical centers. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA), a cutoff score of Results: The median age was 65 years and 54% of participants were male. 119(54%) of participants had MCI as classified by MoCA. In multivariable logistic regression, higher odds ratios (OR) (95% confidence interval) for MCI (MoCA) Conclusions: COPD patients commonly screen positive for MCI. Characteristics associated with MCI included age, African-American race, sleep disturbance and persistent phlegm.
- Published
- 2020
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43. Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease?
- Author
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Barbara A. Fivush, Shamir Tuchman, Cyd K. Eaton, Cozumel S. Pruette, Shayna S. Coburn, Tammy M. Brady, Susan R. Mendley, Michelle N. Eakin, and Kristin A. Riekert
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,Adolescent ,Concordance ,030232 urology & nephrology ,Disease ,030204 cardiovascular system & hematology ,Drug Prescriptions ,Sensitivity and Specificity ,Article ,Medication Adherence ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,Internal medicine ,medicine ,Electronic Health Records ,Humans ,Longitudinal Studies ,Renal Insufficiency, Chronic ,Young adult ,Child ,Antihypertensive Agents ,business.industry ,medicine.disease ,Identification (information) ,Caregivers ,Hypertension ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Disease Progression ,Medication Nonadherence ,Feasibility Studies ,Female ,Self Report ,business ,Kidney disease - Abstract
BACKGROUND: Medical provider assessment of nonadherence is known to be inaccurate. Researchers have suggested using a multimethod assessment approach; however, no study has demonstrated how to integrate different measures to improve accuracy. This study aimed to determine if using additional measures improves the accurate identification of nonadherence beyond provider assessment alone. METHODS: Eighty-seven adolescents and young adults (AYAs), age 11–19 years, with chronic kidney disease (CKD) [stage 1–5/end-stage renal disease (ESRD)] and prescribed antihypertensive medication, their caregivers, and 17 medical providers participated in the multisite study. Five adherence measures were obtained: provider report, AYA report, caregiver report, electronic medication monitoring (MEMS), and pharmacy refill data [medication possession ratio (MPR)]. Concordance was calculated using kappa statistic. Sensitivity, specificity, positive predictive power, and negative predictive power were calculated using MEMS as the criterion for measuring adherence. RESULTS: There was poor to fair concordance (kappas = 0.12–0.54), with 35–61% of AYAs classified as nonadherent depending on the measure. While both providers and MEMS classified 35% of the AYAs as nonadherent, sensitivity (0.57) and specificity (0.77) demonstrated poor agreement between the two measures on identifying which AYAs were nonadherent. Combining provider report of nonadherence and MPR < 75% resulted in the highest sensitivity for identifying nonadherence (0.90) and negative predictive power (0.88). CONCLUSIONS: Nonadherence is prevalent in AYAs with CKD. Providers inaccurately identify nonadherence, leading to missed opportunities to intervene. Our study demonstrates the benefit to utilizing a multimethod approach to identify nonadherence in patients with chronic disease, an essential first step to reduce nonadherence.
- Published
- 2018
44. The Telemedicine Experience for Individuals with Sickle Cell Disease
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Sara Weiss, Michelle N. Eakin, Sejean Yang, Shu Zhang, Mandy David, and Sophie Lanzkron
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medicine.medical_specialty ,Telemedicine ,business.industry ,Immunology ,Medicine ,Cell Biology ,Hematology ,Disease ,business ,Intensive care medicine ,Biochemistry ,901.Health Services Research-Non-Malignant Conditions - Abstract
Introduction Individuals with Sickle Cell Disease (SCD) require regular, and specialized treatment to manage their health. The COVID-19 pandemic disrupted in person medical visits for all individuals, with a rapid transition to telemedicine to provide medical care. Emerging data shows that the use of telemedicine may provide easier access to care and remove barriers to clinic attendance and improve access to appropriate medical care. Objective The purpose of this study was to use qualitative methods to understand the patients' experiences with telemedicine, identify patient preferences for type of appointment, and possible suggestions to improve telemedicine care. Methods Patients from the Johns Hopkins Sickle Cell Center for Adults who had at least one telemedicine visit were invited to participate in a semi structured interview via zoom meeting or telephone. The interview asked participants about their satisfaction with telemedicine care, barriers to telemedicine, benefits and risks of telemedicine and possible telemedicine improvements. Interviews were recorded, transcribed and coded by two independent raters using thematic analyses to understand the experiences of telemedicine during the COVID-19 pandemic. Results Overall, 30 adults with SCD who had at least one telemedicine visit were invited to participate and completed their interview (mean age 41 years ± xx, 67% female, 93% Black/African American, 3% Multi-Race, 3% Other). "...I can't ignore the convenience of not having to worry about transportation ... that there's nothing to stop me from getting there." During a SCD pain crisis it can it challenging to move and receive treatment as one participant reported "Maybe sometimes I might have pain...then moving around makes it difficult. So, getting in the car and finding somebody to drive you to a hospital or to whatever clinic would be difficult". Being able to access specialized SCD care even while in pain is important. Having the option of either having telemedicine or in person visits was important to SCD patients "I could treat my crisis here at home. I don't have to go to the emergency room for it. So, if I can see my doctor in the tele-visit appointment and it's going to be constantly every day ... And when it's getting worse, then I could go to the emergency room more if needed. If it's not needed, I don't even need to go". Another emerging theme amongst participants was despite the benefits from telemedicine, they also wanted to continue having in-person visits when they needed. SCD participants felt due to their SCD they still needed to see their doctor in person but it did not have to be for every visit "Well, I think telemedicine, for me, can be used in a setting where there's no such an emergency. Like if I'm having a routine exam, I don't mind having the telemedicine. But if ... I'm not feeling well ... I don't want to be having a telemedicine". SCD participants felt they needed a physical exam periodically. "The only thing I didn't like about it was if I'm having some discomfort or some pain... there was no way for the physician to physically examine me". Along with the lack of physical exam, there were concerns about the lack of vital signs "... the drawbacks would be the lack of the vitals being taken or there's not the personal touch and stuff". Conclusion The COVID-19 pandemic has presented many obstacles for patients to receive care. People living with SCD found telemedicine to be a positive tool to receive treatment. Patients reported the desire to continue with telemedicine even after the COVID -19 pandemic. Telemedicine allows for more accessibility for a group of individuals who already have numerous barriers to treatment. Future research can seek to identify the impact that telemedicine has on no-show rates, health care utilization, and the impact telemedicine has on patient reported quality of life. Disclosures Lanzkron: Teva: Current holder of individual stocks in a privately-held company; Shire: Research Funding; GBT: Research Funding; CSL Behring: Research Funding; Novo Nordisk: Consultancy; Bluebird Bio: Consultancy; Pfizer: Current holder of individual stocks in a privately-held company; Imara: Research Funding; Novartis: Research Funding.
- Published
- 2021
45. Telemedicine Has Acceptable Usability and High Satisfaction in Patients with Sickle Cell Disease
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Elizabeth Ruvalcaba, Sara Weiss, Michelle N. Eakin, Sophie Lanzkron, Mandy David, Shu Zhang, Taylor Brown, and Eric Boorman
- Subjects
Telemedicine ,business.industry ,Immunology ,medicine ,In patient ,Usability ,Cell Biology ,Hematology ,Disease ,Medical emergency ,medicine.disease ,business ,Biochemistry - Abstract
Introduction: The COVID-19 pandemic presented exceptional challenges to caring for adults with sickle cell disease (SCD) and necessitated a rapid transition to telemedicine, disrupting established care systems within a population that already faces unique and challenging medical needs. Although implementation of telemedicine care assumed reliable patient access to the requisite technology, as well as adequate spaces in which to complete visits, pre-pandemic barriers to in-person visits were also considerable, and many patients lacked access to reliable transportation and childcare or could not afford to miss work to attend clinic. Given the scarcity of research on the acceptability of telemedicine care for SCD patients, the pandemic has provided a critical and necessary opportunity to study patient satisfaction when using telemedicine modalities for regular SCD care. The objective of this study was to identify which patient groups rate telemedicine high in satisfaction and usability. Methods: We surveyed 99 patients of the Sickle Cell Clinic for adults at Johns Hopkins who had any form of SCD, were age 18 or above, and participated in at least one video visit between March-July 2020. Telemedicine satisfaction was assessed by the Telemedicine Satisfaction Questionnaire (TSQ), and usability was assessed by the System Usability Scale (SUS). Patients' engagement in their healthcare was assessed by the Patient Activation Measure (PAM13). We conducted linear regression with TSQ and SUS as outcomes and participant characteristics as predictors. Results: Participant characteristics (briefly, mean age 39, 95% African American, 72% female, and 81% with education level above high school) and their association with TSQ and SUS are shown in Table 1. Mean SUS was 72/100 (SD 15), slightly above the defined average usability of 68; mean TSQ was 4.1 (SD 0.5) on a 5-point Likert scale. Participants tended to prefer video visits for their regular care (mean rating of 6.6/10, SD 2.9) but not for management of acute pain (mean rating of 4.9/10, SD 3.2). Participants who preferred video visits for regular SCD care reported higher SUS (p Conclusions: Our findings suggest that telemedicine has above-average usability and high satisfaction for SCD patients, regardless of age, sex, and income. Patients who were more engaged with their healthcare were more likely to rate telemedicine satisfaction and usability high. Because SUS was negatively associated with disability, lower education level, public insurance, and unemployment, patients within these groups may need more assistance with telemedicine. To improve usability, clinics may consider incorporating support services for patients who have difficulty using telemedicine platforms. Altogether, telemedicine demonstrates promising acceptability to SCD patients across multiple demographic groups and may serve as another method in the toolkit for increasing accessibility to high quality care for these patients. Figure 1 Figure 1. Disclosures Lanzkron: Pfizer: Current holder of individual stocks in a privately-held company; Bluebird Bio: Consultancy; Novo Nordisk: Consultancy; GBT: Research Funding; Teva: Current holder of individual stocks in a privately-held company; Shire: Research Funding; CSL Behring: Research Funding; Novartis: Research Funding; Imara: Research Funding.
- Published
- 2021
46. PROVIDER EXPERIENCE WITH PRONE POSITIONING FOR ARDS DURING COVID-19
- Author
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Chad Hochberg, Michelle N. Eakin, and David N. Hager
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,ARDS ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Critical Care ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Critical Care and Intensive Care Medicine ,medicine.disease ,Prone position ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2021
47. A scoping review of palliative care outcome measures in interstitial lung disease
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Sonye K. Danoff, Bhavna Seth, Michelle N. Eakin, Hannah Brown, Stephen C. Mathai, Amanda C. Moale, Rebecca A. Gersten, and Judith B. Vick
- Subjects
Pulmonary and Respiratory Medicine ,Advance care planning ,medicine.medical_specialty ,Palliative care ,law.invention ,Diseases of the respiratory system ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Prospective cohort study ,RC705-779 ,business.industry ,Palliative Care ,Retrospective cohort study ,Mental health ,Mental Health ,030228 respiratory system ,Quality of Life ,Physical therapy ,Lung Diseases, Interstitial ,business - Abstract
Interstitial lung disease (ILD) confers a high mortality and symptom burden, substantially impacting quality of life. Studies evaluating palliative care in ILD are rapidly expanding. Uniform outcome measures are crucial to assessing the impact of palliative care in ILD. This scoping review evaluates existing outcome measures in general health-related quality of life (HRQoL), physical health, mental health, social health and advance care planning (ACP) domains in patients with ILD. Articles in English with quantitative assessment of at least one measure of general HRQoL, physical health, mental health, social health or ACP in patients with ILD were included. Searches across three databases yielded 3488 non-duplicate articles. 23 met eligibility criteria and included three randomised controlled trials (RCTs) or secondary analysis of an RCT (13%), three cross-sectional studies or secondary analysis of cross-sectional study (13%), one prospective study (4%) and 16 retrospective studies (70%). Among eligible articles, 25 distinct instruments were identified. Six studies assessed general HRQoL (26%), 16 assessed physical health (70%), 11 assessed mental health (48%), six assessed social health (26%) and 16 assessed ACP (70%). The ability to compare results across studies remains challenging given the heterogeneity in outcome measures. Future work is needed to develop core palliative care outcome measures in ILD.
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- 2021
48. Association of Medication Adherence and Patient Reported Outcomes in Sarcoidosis
- Author
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David R. Moller, Kristin A. Riekert, Michelle Sharp, Michelle N. Eakin, Cynthia S. Rand, and Taylor Brown
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Medication adherence ,Sarcoidosis ,medicine.disease ,Association (psychology) ,business - Published
- 2019
49. Contribution of Anxiety and Depression on Chronic Obstructive Pulmonary Disease (COPD) Outcomes
- Author
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Nadia N. Hansel, R.P. Bowler, Jacqueline O’Toole, G.J. Criner, P.G. Woodruff, Richard E. Kanner, D. Couper, Stephen P. Peters, A.P. Comellas, Robert Paine, Michelle N. Eakin, Jerry A. Krishnan, Mark T. Dransfield, Nirupama Putcha, Fernando J. Martinez, A.S. Iyer, R.G. Barr, Christopher B. Cooper, and MeiLan K. Han
- Subjects
medicine.medical_specialty ,COPD ,business.industry ,Internal medicine ,medicine ,Pulmonary disease ,Anxiety ,medicine.symptom ,business ,medicine.disease ,Depression (differential diagnoses) - Published
- 2019
50. Modeling the Health and Economic Burden of Chronic Obstructive Pulmonary Disease in the US
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Robert M. Reed, Shukai Li, Michelle N. Eakin, and Zafar Zafari
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medicine.medical_specialty ,business.industry ,Medicine ,Pulmonary disease ,business ,Intensive care medicine - Published
- 2019
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