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19. Merging cultures: Palliative care specialists in the medical intensive care unit

Author

Montgomery P, Alexandra F. M. Cist, Dahlin C, Bauman J, Billings Ja, Wise M, Thompson Bt, Coakley E, and Keeley A

Subjects
Education, Continuing, Palliative care, Attitude of Health Personnel, Psychological intervention, Nursing Staff, Hospital, Critical Care and Intensive Care Medicine, law.invention, Nursing, Ambulatory care, law, Intensive care, Critical care nursing, Humans, Medicine, Family, Cooperative Behavior, Terminal Care, business.industry, Palliative Care, Family meetings, Visitors to Patients, Intensive care unit, Intensive Care Units, Outcome and Process Assessment, Health Care, Medical intensive care unit, business
Abstract

We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork. Additional problems were noted but not well addressed, particularly routine communication with families and continuity of care for complex patients leaving the ICU.

Published
2006

25. P0908 : Adherence to ombitasvir/paritaprevir/r, dasabuvir, and ribavirin is >98% in the Sapphire-I and Sapphire-II trials

Author

Hassanein, T., primary, Roberts, S., additional, Shafran, S.D., additional, Makara, M., additional, Bennett, M., additional, Müllhaupt, B., additional, Poordad, F., additional, Ryder, S., additional, Di Bisceglie, A.M., additional, Fu, B., additional, Coakley, E., additional, McGovern, B.H., additional, and Foster, G.R., additional

Published
2015
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26. M12-999:ABT-450/r/ABT-267+ABT-333+Ribavirin in Liver Transplant Recipients With Recurrent HCV Genotype 1 Infection.

Author

Mantry, P., primary, Kwo, P., additional, Coakley, E., additional, Te, H., additional, Vargas, H., additional, Brown, R., additional, Gordon, F., additional, Levitsky, J., additional, Terrault, N., additional, Burton, J., additional, Xie, W., additional, Setze, C., additional, Badri, P., additional, Vilchez, R., additional, and Forns, X., additional

Published
2014
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27. O114 RESULTS OF THE PHASE 2 STUDY M12-999: INTERFERON-FREE REGIMEN OF ABT-450/R/ABT-267 + ABT-333 + RIBAVIRIN IN LIVER TRANSPLANT RECIPIENTS WITH RECURRENT HCV GENOTYPE 1 INFECTION

Author

Kwo, P., primary, Mantry, P., additional, Coakley, E., additional, Te, H., additional, Vargas, H., additional, Brown, R., additional, Gordon, F., additional, Levitsky, J., additional, Terrault, N., additional, Burton, J., additional, Xie, W., additional, Setze, C., additional, Badri, P., additional, Vilchez, R.A., additional, and Forns, X., additional

Published
2014
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29. O60 SAPPHIRE I: PHASE 3 PLACEBO-CONTROLLED STUDY OF INTERFERON-FREE, 12-WEEK REGIMEN OF ABT-450/R/ABT-267, ABT-333, AND RIBAVIRIN IN 631 TREATMENT-NAIVE ADULTS WITH HEPATITIS C VIRUS GENOTYPE 1

Author

Feld, J.J., primary, Kowdley, K.V., additional, Coakley, E., additional, Sigal, S., additional, Nelson, D., additional, Crawford, D., additional, Weiland, O., additional, Aguilar, H., additional, Xiong, J., additional, DaSilva-Tillmann, B., additional, Larsen, L., additional, and Podsadecki, T., additional

Published
2014
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31. Association of HIV-1 replication capacity with treatment outcomes in patients with virologic treatment failure.

Author

De Luca, Andrea, Weidler, J, Di Giambenedetto, Simona, Coakley, E, Cingolani, Antonella, Bates, M, Lie, Y, Pesano, R, Cauda, Roberto, Schapiro, J., De Luca, Andrea (ORCID:0000-0002-8311-6935), Di Giambenedetto, Simona (ORCID:0000-0001-6990-5076), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Cauda, Roberto (ORCID:0000-0002-1498-4229), De Luca, Andrea, Weidler, J, Di Giambenedetto, Simona, Coakley, E, Cingolani, Antonella, Bates, M, Lie, Y, Pesano, R, Cauda, Roberto, Schapiro, J., De Luca, Andrea (ORCID:0000-0002-8311-6935), Di Giambenedetto, Simona (ORCID:0000-0001-6990-5076), Cingolani, Antonella (ORCID:0000-0002-3793-2755), and Cauda, Roberto (ORCID:0000-0002-1498-4229)

Abstract

BACKGROUND: The extent to which HIV-1 replication capacity (RC) influences the response to therapy remains to be established. METHODS: Phenotypic susceptibility and RC of baseline isolates (n = 139) from patients enrolled in the ARGENTA trial were measured and correlated to treatment outcomes over 36 months. RESULTS: RC in baseline isolates correlated with the number of phenotypically active drugs (R = 0.34, P < 0.001). Crude viral RC did not predict treatment outcomes. When viral RC was adjusted by baseline CD4 cell counts, HIV-1 RNA levels, and phenotypic susceptibility to the rescue regimen, it showed significant association with the immunologic outcome (per log10 RC higher, mean difference in 36 months' time-averaged change from baseline CD4 count = -68 cells/microL; P = 0.020). In the subgroup of patients with 3 or more phenotypically active drugs in the salvage regimen (n = 35, median RC = 65%), subjects carrying isolates with RC < or =65% as compared to those with RC >65% had better time-averaged HIV-1 RNA responses (mean: -1.04 vs. -0.32 log10 copies/mL; P = 0.012) and CD4 cell responses (mean: 132 vs. -7 cells/microL; P = 0.006). Among patients with HIV-1 RNA levels persistently >500 copies/mL (n = 61), RC, on a log10 basis, was inversely associated with time-averaged 36-month CD4 cell responses (beta = -0.26; P = 0.046). CONCLUSION: After normalizing for viral susceptibility to the employed regimen or in patient subsets with suboptimal virologic response, higher viral RC may predict worse subsequent treatment outcomes.

Published
2007

32. Can physical activity minimize weight gain in women after smoking cessation?

Author

Kawachi, I., Troisi, R. J., Rotnitzky, A. G., Coakley, E. H., and Graham Colditz

Subjects
Research Article
Abstract

OBJECTIVES. The purpose of this study was to examine prospectively whether exercise can modify weight gain after smoking cessation in women. METHODS. Data were analyzed from a 2-year follow-up period (1986-1988) in the Nurses' Health Study, an ongoing cohort of 121,700 US women aged 40 to 75 in 1986. RESULTS. The average weight gain over 2 years was 3.0 kg in the 1474 women who stopped smoking, and 0.6 kg among the 7832 women who continued smoking. Among women smoking 1 to 24 cigarettes per day, those who quit without changing their levels of exercise gained an average of 2.3 kg more (95% confidence interval [CI] = 1.9, 2.6) than women who continued smoking. Women who quit and increased exercise by between 8 to 16 MET-hours (the work metabolic rate divided by the resting metabolic rate) per week gained 1.8 kg (95% CI = 1.0, 2.5), and the excess weight gain was only 1.3 kg (95% CI = 0.7, 1.9) in women who increased exercise by more than 16 MET-hours per week. CONCLUSIONS. Smoking cessation is associated with a net excess weight gain of about 2.4 kg in middle-aged women. However, this weight gain is minimized if smoking cessation is accompanied by a moderate increase in the level of physical activity.

Published
1996

38. HIV Type 1 Chemokine Coreceptor Use among Antiretroviral-Experienced Patients Screened for a Clinical Trial of a CCR5 Inhibitor: AIDS Clinical Trial Group A5211

Author

Wilkin, T. J., primary, Su, Z., additional, Kuritzkes, D. R., additional, Hughes, M., additional, Flexner, C., additional, Gross, R., additional, Coakley, E., additional, Greaves, W., additional, Godfrey, C., additional, Skolnik, P. R., additional, Timpone, J., additional, Rodriguez, B., additional, and Gulick, R. M., additional

Published
2007
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46. Response to vicriviroc in treatment-experienced subjects, as determined by an enhanced-sensitivity coreceptor tropism assay: reanalysis of AIDS clinical trials group A5211.

Author

Su Z, Gulick RM, Krambrink A, Coakley E, Hughes MD, Han D, Flexner C, Wilkin TJ, Skolnik PR, Greaves WL, Kuritzkes DR, Reeves JD, AIDS Clinical Trials Group A5211 Team, Su, Zhaohui, Gulick, Roy M, Krambrink, Amy, Coakley, Eoin, Hughes, Michael D, Han, Dong, and Flexner, Charles

Abstract

The enhanced-sensitivity Trofile assay (Monogram Biosciences) was used to retest coreceptor use at both study screening and study entry for 118 treatment-experienced subjects in AIDS Clinical Trials Group A5211 who had CCR5-tropic (R5) virus detected by the original Trofile assay at study screening. Among 90 recipients of vicriviroc, a significantly (P< .001) greater mean reduction in HIV-1 RNA was observed in 72 subjects with R5 virus versus 15 subjects reclassified as having dual/mixed-tropic viruses at screening: -1.11 versus -0.09 log(10) copies/mL at day 14 and -1.91 versus -0.57 log(10) copies/mL at week 24, respectively. Results suggest that the enhanced-sensitivity assay is a better screening tool for determining patient eligibility for CCR5 antagonist therapy. [ABSTRACT FROM AUTHOR]

Published
2009
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47. The probable source of both the primary multidrug-resistant (MDR) HIV-1 strain found in a patient with rapid progression to AIDS and a second recombinant MDR strain found in a chronically HIV-1-infected patient.

Author

Blick G, Kagan RM, Coakley E, Petropoulos C, Maroldo L, Greiger-Zanlungo P, Gretz S, and Garton T

Abstract

Background. Rapid progression to AIDS after acute infection with a multidrug-resistant (MDR), dual-tropic strain of human immunodeficiency virus type 1 (HIV-1) was reported in a New York City man (hereafter referred to as 'NYC') who has sex with men. The probable source of this HIV-1 (hereafter referred to as 'CT01') and the development of a recombinant MDR HIV-1 in the source's partner (hereafter referred to as 'CT02') are described.Methods. After identification of the epidemiological link of CT01 and CT02 to NYC, viral sequences and phenotypic analyses were compared. Confirmatory genotypic and phenotypic analyses, replicative capacity, and viral coreceptor use were assessed. Viral recombination was assessed using a sliding window technique and phylogenetic tree analysis.Results. NYC and CT01 were linked historically and epidemiologically and were genetically confirmed from CT01's samples acquired 2 days before and subsequent to the transmission event. Genotypic, recombination, and phylogenetic analyses suggest CT02 became superinfected by CT01 with subsequent production of a recombinant panresistant HIV-1.Conclusion. The probable source of a dual-tropic, MDR HIV-1 that was associated with rapid progression to AIDS is illustrated, suggesting progression was not explained by the HIV-1 variant alone. A probable second finding of a chronically infected host becoming superinfected with MDR HIV-1 with subsequent formation of a panresistant recombinant HIV-1 is described. This case illustrates the public health implications of unsafe sex between serodiscordant and seroconcordant partners. Copyright © 2007 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

Published
2007
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48. PRISM-E: comparison of integrated care and enhanced specialty referral models in depression outcomes.

Author

Krahn DD, Bartels SJ, Coakley E, Oslin DW, Chen H, McIntyre J, Chung H, Maxwell J, Ware J, and Levkoff SE

Abstract

OBJECTIVE: This study, entitled Primary Care Research in Substance Abuse and Mental Health for the Elderly, examined six-month outcomes for older primary care patients with depression who received different models of treatment. METHODS: Clinical outcomes were compared for patients who were randomly assigned to integrated care or enhanced specialty referral. Integrated care consisted of mental health services co-located in primary care in collaboration with primary care physicians. Enhanced specialty referral consisted of referral to physically separate, clearly identified mental health or substance abuse clinics. RESULTS: A total of 1,531 patients were included; their mean age was 73.9 years. Remission rates and symptom reduction for all depressive disorders were similar for the two models at the three- and six-month follow-ups. For the subgroup with major depression, the enhanced specialty referral model was associated with a greater reduction in depression severity than integrated care, but rates of remission and change in function did not differ across models of care for major depression. CONCLUSIONS: Six-month outcomes were comparable for the two models. For the subgroup with major depression, reduction in symptom severity was superior for those randomly assigned to the enhanced specialty referral group. [ABSTRACT FROM AUTHOR]

Published
2006
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