33 results on '"Parman M"'
Search Results
2. Test Driven domain modelling.
- Author
-
Piho, G., Tepandi, J., Parman, M., Puusep, V., and Roost, M.
- Published
- 2011
3. From archetypes based domain model via requirements to software: Exemplified by LIMS Software Factory.
- Author
-
Piho, G., Tepandi, J., Roost, M., Parman, M., and Puusep, V.
- Published
- 2011
4. Towards LIMS (Laboratory Information Management Systems) software in global context
- Author
-
Piho, G., Jaak Tepandi, and Parman, M.
5. Test Driven domain modelling
- Author
-
Gunnar Piho, Tepandi, J., Parman, M., Puusep, V., and Roost, M.
6. From archetypes based domain model via requirements to software: Exemplified by LIMS software factory
- Author
-
Gunnar Piho, Tepandi, J., Roost, M., Parman, M., and Puusep, V.
7. From archetypes-based domain model of clinical laboratory to LIMS software
- Author
-
Piho, G., Jaak Tepandi, Parman, M., and Perkins, D.
8. Xenon Mixing In A Cesium-Free Dudnikov-Type Hydrogen Ion Source
- Author
-
Jones, Y. D., primary, Copeland, R. P., additional, Parman, M. A., additional, and Baca, E. A., additional
- Published
- 1989
- Full Text
- View/download PDF
9. Redlining and Time to Viral Suppression Among Persons With HIV.
- Author
-
Bassler JR, Ostrenga L, Levitan EB, Kay ES, Long DM, Mugavero MJ, Nassel AF, Parman M, Tate M, Rana A, and Batey DS
- Abstract
Importance: Structural racism in the US is evidenced in the discriminatory practice of historical racial redlining when neighborhoods were valued, in part, based on the community's racial and ethnic compositions. However, the influence of these systemic practices in the context of the HIV epidemic is not well understood., Objective: To assess the effect of redlining on time to viral suppression among people newly diagnosed with HIV., Design, Setting, and Participants: Observational study that included individuals diagnosed with HIV from January 1, 2011, to December 31, 2019, in New Orleans, Louisiana. At the time of their HIV diagnosis, these individuals lived in neighborhoods historically mapped by the Home Owners' Loan Corporation (HOLC). The HOLC lending risk maps classified neighborhoods into 1 of 4 color-coded grades: A (best), B (still desirable), C (definitely declining), and D (hazardous)., Main Outcome and Measures: The primary outcome of interest was time to viral suppression (estimated as the time from the diagnosis date to the date of the first recorded viral load that was <200 copies/mL). Individual-level demographic factors were used to evaluate time to viral suppression along with a neighborhood measure of gentrification (based on US census tract-level characteristics for educational attainment, housing development and value, and household income) and a Cox gamma frailty model with census tract used as the frailty term., Results: Of 1132 individuals newly diagnosed with HIV, 871 (76.9%) were men and 620 (54.8%) were 25 to 44 years of age. Of the 697 individuals living in historically redlined neighborhoods (HOLC grade D), 100 (14.6%) were living in neighborhoods that were gentrifying. The median time to viral suppression was 193 days (95% CI, 167-223 days) for persons with HIV living in redlined neighborhoods compared with 164 days (95% CI, 143-185 days) for the 435 persons with HIV living in HOLC grade A, B, or C (nonredlined) neighborhoods. Among persons with HIV living in gentrifying neighborhoods, those living in redlined neighborhoods had a longer time to viral suppression compared with persons living in nonredlined neighborhoods (hazard ratio, 0.54 [95% CI, 0.36-0.82])., Conclusions and Relevance: These findings suggest the enduring effects of systemic racism on present-day health outcomes among persons with HIV. Regardless of their neighborhood's contemporary level of gentrification, individuals diagnosed with HIV while living in historically redlined neighborhoods may experience a significantly longer time to viral suppression.
- Published
- 2024
- Full Text
- View/download PDF
10. Return to Play at Preinjury Level After Anterior Cruciate Ligament Reconstruction in Divisions II and III National Collegiate Athletic Association Student-Athletes.
- Author
-
Bono OJ, Mousad A, Parman M, Manz E, Byrne J, Ives K, Salzler M, and Shah SS
- Abstract
Background: The rates of return to play (RTP) after anterior cruciate ligament (ACL) reconstruction among professional and National Collegiate Athletic Association (NCAA) Division I athletes are well described in the orthopaedic literature. Less is known about these rates and risk factors for failure to RTP in Division II and III collegiate athletes., Purpose: To determine the RTP rate after ACL reconstruction among Division II and III collegiate athletes and to explore the factors associated with RTP., Study Design: Case series; Level of evidence, 4., Methods: Demographic and RTP data were retrospectively reviewed for collegiate athletes who underwent ACL reconstructions across high-risk sports over 6 years (2015/16 to 2021/22 seasons) at 5 northeastern NCAA Division II and III institutions. Clinical data collected included Patient Acceptable Symptom State (PASS) on the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation questionnaire, graft type, concomitant reparative surgery, reinjury, need for reoperation, and time to RTP and return to preinjury level. Participants completed the survey using a secure web-based questionnaire sent via email or over the telephone at a minimum 6-month follow-up. Descriptive frequencies were calculated for all documented variables, with chi-square and analysis of variance statistics used to assess for associations and significant differences between variables., Results: A total of 61 eligible student-athletes with primary ACL reconstructions were identified in this study period, and 40 knees were enrolled for analysis with a mean time from surgery to survey completion of 45.0 months. The overall RTP rate was 77.5% (31/40) at a mean of 10.1 months. However, only 50.0% (20/40) returned to their preinjury level of competitive play. There was a graft failure rate of 20% (8/40). Of the 32 athletes who did not reinjure their ACL, 81.25% (26/32) demonstrated a PASS on KOOS Sports and Recreation. Graft rerupture ( P < .001) and reoperation ( P = .007) had significant effects on rates of RTP. Concomitant procedures ( P = .010) influenced return to preinjury level of sports. Injury during the active season versus the off-season significantly influenced KOOS PASS status ( P = .038)., Conclusion: This study demonstrated that the rate of RTP after ACL reconstruction in this patient population of Division II and III collegiate athletes was 77.5%, with only 50% returning to their preinjury level of competitive play. The graft failure rate in this population was 20%. Surgical factors, such as concomitant surgeries and reinjury of ACL graft, as well as athlete-specific data, such as injury in the off-season, were statistically significant negative influences on patient outcomes. Further research is needed to evaluate other potential factors that may play a role in RTP after ACL reconstruction., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.P. has received a grant from Arthrex; education payments from Arthrex, Smith+Nephew, and Legacy Ortho LLC; and hospitality payments from Stryker. M.S. has received education payments from Arthrex. S.S.S. has received education payments from Arthrex, Kairos Surgical, and Smith+Nephew; consulting fees from DePuy Synthes, Exactech, Medical Device Business Services, and Kairos Surgical; and hospitality payments from Kairos Surgical, Arthrex, Encore Medical, Exactech, and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)
- Published
- 2024
- Full Text
- View/download PDF
11. Provocative Findings From a Transdiagnostic Counseling Intervention to Improve Psychiatric Comorbidity and HIV Care Engagement Among People With HIV: A Pilot Randomized Clinical Trial.
- Author
-
Pence BW, Darnell D, Ranna-Stewart M, Psaros C, Gaynes BN, Grimes L, Henderson S, Parman M, Filipowicz TR, Gaddis K, Dorsey S, and Mugavero MJ
- Subjects
- Humans, Male, Female, Pilot Projects, Middle Aged, Adult, Mental Disorders therapy, Mental Disorders epidemiology, Depression therapy, Depression epidemiology, Substance-Related Disorders complications, Substance-Related Disorders therapy, Anxiety therapy, Anxiety epidemiology, Stress Disorders, Post-Traumatic therapy, Stress Disorders, Post-Traumatic epidemiology, HIV Infections complications, HIV Infections psychology, Counseling, Comorbidity
- Abstract
Background: Depression, anxiety, post-traumatic stress, and alcohol/substance use disorders are prevalent among people with HIV (PWH), commonly co-occur, and predict worse HIV care outcomes. Transdiagnostic counseling approaches simultaneously address multiple co-occurring mental health disorders., Methods: We conducted a pilot individually randomized trial of the Common Elements Treatment Approach adapted for people with HIV (CETA-PWH), a transdiagnostic counseling intervention, compared with usual care at a large academic medical center in the southern United States. Participants were adults with HIV; at risk for HIV care disengagement; and with elevated symptoms of depression, anxiety, post-traumatic stress, and/or alcohol/substance use. Mental health and HIV care engagement were assessed at 4 and 9 months., Results: Among participants (n = 60), follow-up was high at 4 (92%) and 9 (85%) months. Intervention engagement was challenging: 93% attended ≥1 session, 43% attended ≥6 sessions in 3 months ("moderate dose"), and 30% completed treatment. Although not powered for effectiveness, mental health outcomes and HIV appointment attendance improved in CETA-PWH relative to usual care in intent-to-treat analyses; those receiving a moderate dose and completers showed progressively greater improvement. Viral load showed small differences between arms. The dose-response pattern was not explained by differences between those who did and did not complete treatment., Conclusions: This pilot trial provides preliminary evidence for the potential of CETA-PWH to simultaneously address co-occurring mental health comorbidities and support HIV appointment attendance among PWH. Additional strategies may be an important part of ensuring that clients can engage in the full course of treatment and realize its full benefits., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
12. Costs and Timing of Surgery in the Management of Meniscal Tears.
- Author
-
Nin DZ, Chen YW, Mandalia K, Parman M, Shah SS, Ramappa AJ, Chang DC, and Matzkin EG
- Abstract
Background: Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood., Purpose: To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery., Study Design: Cross-sectional study; Level of evidence, 3., Methods: This study was conducted using the MarketScan databases. Patients diagnosed with a meniscal tear without concomitant knee osteoarthritis between January 1 and December 31, 2017, were included. The primary outcome was the total cost of meniscal tear-related procedures-including insurance deductibles, coinsurance, and net insurance payments-in the 2 years after diagnosis. Procedures included were as follows: (1) surgery-including meniscectomy or meniscal repair; (2) physical therapy; (3) medication-including nonsteroidal anti-inflammatories, opioids, and acetaminophen; (4) intra-articular injections-including professional fee, hyaluronic acid, and corticosteroids; (5) imaging; and (6) clinic visits to orthopaedic specialists. Patients were grouped as having undergone early surgery (ES) (≤3 months of diagnosis), late surgery (LS) (>3 months after diagnosis), or no surgery (NS). Multivariate logistic regression was performed to determine the likelihood of undergoing surgery early and failing nonoperative treatment., Results: The study population included 29,924 patients with a mean age of 43.9 ± 12.9 years (ES: n = 9507 (31.8%); LS: n = 2021 (6.8%); NS: n = 18,396 (61.5%)). Complex (36.6%) and medial (58.8%) meniscal tears were the most common type and location of injuries, respectively. The mean cost of management per patient was $3835 ± $4795. Costs were lower in the NS group ($1905 ± $3175) compared with the ES group ($6759 ± $5155), while the highest costs were observed in the LS group ($7649 ± $5913) ( P < .001). Patients who were men, >40 years, and with a bucket-handle or lateral meniscal tear were more likely to undergo surgery early. Patients who were men, <30 years, and with a complex tear or tear to the lateral meniscus were more likely to fail nonoperative management., Conclusion: Nonoperative management had the lowest cost burden and should be recommended for patients with appropriate indications. However, if surgery is necessary, it should be performed earlier., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.P. has received grant support from Arthrex; education payments from Arthrex, Smith+Nephew, and Legacy Ortho; and hospitality payments from Stryker. S.S.S. has received education payments from Arthrex and Smith+Nephew; consulting fees from DePuy Synthes and Exactech; and hospitality payments from Encore Medical. A.J.R. has received education payments from Arthrex. E.G.M. has received education payments and nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)
- Published
- 2024
- Full Text
- View/download PDF
13. A Study Protocol to Increase Engagement in Evidence Based Hospital and Community Based Care Using a Serious Injection Related Infections (SIRI) Checklist and Enhanced Peer for Hospitalized PWID (ShaPe).
- Author
-
Baldwin M, Jeziorski M, Parman M, Gagnon K, Nichols MA, Bradford D, Crockett K, and Eaton E
- Abstract
Background: With the opioid crisis, surging methamphetamine use, and healthcare disruptions due to SARS-CoV-2, serious injection related infections (SIRIs), like endocarditis, have increased significantly. Hospitalizations for SIRI provide a unique opportunity for persons who inject drugs (PWID) to engage in addiction treatment and infection prevention, yet many providers miss opportunities for evidence-based care due to busy inpatient services and lack of awareness. To improve hospital care, we developed a 5-item SIRI Checklist for providers as a standardized reminder to offer medication for opioid use disorder (MOUD), HIV and HCV screening, harm reduction counseling, and referral to community-based care. We also formalized an Intensive Peer Recovery Coach protocol to support PWID on discharge. We hypothesized that the SIRI Checklist and Intensive Peer Intervention would increase use of hospital-based services (HIV, HCV screening, MOUD) and linkage to community-based care: PrEP prescription, MOUD prescription, and related outpatient visit(s)., Methods: This is a feasibility study and randomized control trial of a checklist and intensive peer intervention for hospitalized PWID with SIRI admitted to UAB Hospital. We will recruit 60 PWID who will be randomized to one of 4 groups (SIRI Checklist, SIRI Checklist + Enhanced Peer, Enhanced Peer, and Standard of Care). Results will be analyzed using a 2x2 factorial design. We will use surveys to collect data on drug use behaviors, stigma, HIV risk, and PrEP interest and awareness. Our primary outcome of feasibility will include the ability to recruit hospitalized PWID and retain them in the study to determine post-discharge clinical outcomes. Additionally, we will explore clinical outcomes using a combination of patient surveys and electronic medical record data (HIV, HCV testing, MOUD and PrEP prescriptions).This study is approved by UAB IRB #300009134., Discussion: This feasibility study is a necessary step in designing and testing patient-centered interventions to improve public health for rural and Southern PWID. By testing low barrier interventions that are accessible and reproducible in states without access to Medicaid expansion and robust public health infrastructure, we aim to identify models of care that promote linkage and engagement in community care., Trial Registration: NCT05480956., Competing Interests: Competing interests The authors have no relevant conflicts of interest.
- Published
- 2023
- Full Text
- View/download PDF
14. Using Principles of an Adaptation Framework to Adapt a Transdiagnostic Psychotherapy for People With HIV to Improve Mental Health and HIV Treatment Engagement: Focus Groups and Formative Research Study.
- Author
-
Darnell D, Ranna-Stewart M, Psaros C, Filipowicz TR, Grimes L, Henderson S, Parman M, Gaddis K, Gaynes BN, Mugavero MJ, Dorsey S, and Pence BW
- Abstract
Background: HIV treatment engagement is critical for people with HIV; however, behavioral health comorbidities and HIV-related stigma are key barriers to engagement. Treatments that address these barriers and can be readily implemented in HIV care settings are needed., Objective: We presented the process for adapting transdiagnostic cognitive behavioral psychotherapy, the Common Elements Treatment Approach (CETA), for people with HIV receiving HIV treatment at a Southern US HIV clinic. Behavioral health targets included posttraumatic stress, depression, anxiety, substance use, and safety concerns (eg, suicidality). The adaptation also included ways to address HIV-related stigma and a component based on Life-Steps, a brief cognitive behavioral intervention to support patient HIV treatment engagement., Methods: We applied principles of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, Testing model, a framework for adapting evidence-based HIV interventions, and described our adaptation process, which included adapting the CETA manual based on expert input; conducting 3 focus groups, one with clinic social workers (n=3) and 2 with male (n=3) and female (n=4) patients to obtain stakeholder input for the adapted therapy; revising the manual according to this input; and training 2 counselors on the adapted protocol, including a workshop held over the internet followed by implementing the therapy with 3 clinic patients and receiving case-based consultation for them. For the focus groups, all clinic social workers were invited to participate, and patients were referred by clinic social workers if they were adults receiving services at the clinic and willing to provide written informed consent. Social worker focus group questions elicited reactions to the adapted therapy manual and content. Patient focus group questions elicited experiences with behavioral health conditions and HIV-related stigma and their impacts on HIV treatment engagement. Transcripts were reviewed by 3 team members to catalog participant commentary according to themes relevant to adapting CETA for people with HIV. Coauthors independently identified themes and met to discuss and reach a consensus on them., Results: We successfully used principles of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, Testing framework to adapt CETA for people with HIV. The focus group with social workers indicated that the adapted therapy made conceptual sense and addressed common behavioral health concerns and practical and cognitive behavioral barriers to HIV treatment engagement. Key considerations for CETA for people with HIV obtained from social worker and patient focus groups were related to stigma, socioeconomic stress, and instability experienced by the clinic population and some patients' substance use, which can thwart the stability needed to engage in care., Conclusions: The resulting brief, manualized therapy is designed to help patients build skills that promote HIV treatment engagement and reduce symptoms of common behavioral health conditions that are known to thwart HIV treatment engagement., (©Doyanne Darnell, Minu Ranna-Stewart, Christina Psaros, Teresa R Filipowicz, LaKendra Grimes, Savannah Henderson, Mariel Parman, Kathy Gaddis, Bradley Neil Gaynes, Michael J Mugavero, Shannon Dorsey, Brian W Pence. Originally published in JMIR Formative Research (https://formative.jmir.org), 30.05.2023.)
- Published
- 2023
- Full Text
- View/download PDF
15. Development and implementation of a distributed data network between an academic institution and state health departments to investigate variation in time to HIV viral suppression in the Deep South.
- Author
-
Bassler JR, Cagle I, Crear D, Kay ES, Long DM, Mugavero MJ, Nassel AF, Ostrenga L, Parman M, Preg S, Wang X, Batey DS, Rana A, and Levitan EB
- Subjects
- United States epidemiology, Humans, Schools, Universities, Centers for Disease Control and Prevention, U.S., HIV Infections epidemiology, Acquired Immunodeficiency Syndrome
- Abstract
Background: Achieving early and sustained viral suppression (VS) following diagnosis of HIV infection is critical to improving outcomes for persons with HIV (PWH). The Deep South of the United States (US) is a region that is disproportionately impacted by the domestic HIV epidemic. Time to VS, defined as time from diagnosis to initial VS, is substantially longer in the South than other regions of the US. We describe the development and implementation of a distributed data network between an academic institution and state health departments to investigate variation in time to VS in the Deep South., Methods: Representatives of state health departments, the Centers for Disease Control and Prevention (CDC), and the academic partner met to establish core objectives and procedures at the beginning of the project. Importantly, this project used the CDC-developed Enhanced HIV/AIDS Reporting System (eHARS) through a distributed data network model that maintained the confidentiality and integrity of the data. Software programs to build datasets and calculate time to VS were written by the academic partner and shared with each public health partner. To develop spatial elements of the eHARS data, health departments geocoded residential addresses of each newly diagnosed individual in eHARS between 2012-2019, supported by the academic partner. Health departments conducted all analyses within their own systems. Aggregate results were combined across states using meta-analysis techniques. Additionally, we created a synthetic eHARS data set for code development and testing., Results: The collaborative structure and distributed data network have allowed us to refine the study questions and analytic plans to conduct investigations into variation in time to VS for both research and public health practice. Additionally, a synthetic eHARS data set has been created and is publicly available for researchers and public health practitioners., Conclusions: These efforts have leveraged the practice expertise and surveillance data within state health departments and the analytic and methodologic expertise of the academic partner. This study could serve as an illustrative example of effective collaboration between academic institutions and public health agencies and provides resources to facilitate future use of the US HIV surveillance system for research and public health practice., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
16. HIV and Addiction Services for People Who Inject Drugs: Healthcare Provider Perceptions on Integrated Care in the U.S. South.
- Author
-
Bradford D, Parman M, Levy S, Turner WH, Li L, Leisch L, Eaton E, and Crockett KB
- Subjects
- Humans, Health Personnel, Substance Abuse, Intravenous complications, Drug Users, HIV Infections prevention & control, Opioid-Related Disorders therapy, Delivery of Health Care, Integrated
- Abstract
This qualitative study evaluates physician training and experience with treatment and prevention services for people who inject drugs (PWID) including medications for opioid use disorder (MOUD) and HIV pre-exposure prophylaxis (PrEP). The Behavioral Model of Healthcare Utilization for Vulnerable Populations was applied as a framework for data analysis and interpretation. Two focus groups were conducted, one with early career physicians (n = 6) and one with mid- to late career physicians (n = 3). Focus group transcripts were coded and analyzed using thematic analysis to identify factors affecting implementation of treatment and prevention services for PWID. Respondents identified that increasing the availability of providers prescribing MOUD was a critical enabling factor for PWID seeking and receiving care. Integrated, interdisciplinary services were identified as an additional resource although these remain fragmented in the current healthcare system. Barriers to care included provider awareness, stigma associated with substance use, and access limitations. Providers identified the interwoven risk factors associated with injection drug use that must be addressed, including the risk of HIV acquisition, notably more at the forefront in the minds of early career physicians. Additional research is needed addressing the medical education curriculum, health system, and healthcare policy to address the addiction and HIV crises in the U.S. South.
- Published
- 2023
- Full Text
- View/download PDF
17. Patient Weight Should Be Included on All Medication Prescriptions.
- Author
-
Lubsch L, Kimler K, Passerrello N, Parman M, Dunn A, and Meyers R
- Abstract
Medication prescriptions for both children and adults often require the patient's current weight to determine a safe and effective dose. Medication orders in the inpatient setting typically require a patient weight be recorded prior to order verification. However, in the ambulatory setting a very different standard exists; weights are not required on prescriptions and are rarely provided by practitioners. Without this information, the community pharmacist must either ask the caregiver, who may not know an accurate weight, or simply assume that the prescriber used a current and accurate weight and calculated the dose correctly. Standard doses are prescribed for most adult prescriptions, which makes it possible for the pharmacist to identify a dosing error. Without a current patient weight, the pharmacist is not able to provide the same level of patient care to pediatric patients or adults whose prescriptions require weight-based doses. The Pediatric Pharmacy Association recommends that patient weight, recorded in kilograms, be required on all medication prescriptions in both the inpatient and outpatient settings., Competing Interests: Disclosure. The authors declare no conflicts or financial interest in any product or service mentioned in this manuscript., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: membership@pediatricpharmacy.org.)
- Published
- 2023
- Full Text
- View/download PDF
18. Effectiveness of a smoking cessation algorithm integrated into HIV primary care: Study protocol for a randomized controlled trial.
- Author
-
McKetchnie SM, O'Cleirigh C, Crane HM, Hill SV, Prior D, Peretti M, Parman M, Levy DE, Long D, and Cropsey K
- Subjects
- Adult, Algorithms, Humans, Primary Health Care, Randomized Controlled Trials as Topic, Tobacco Use Cessation Devices, HIV Infections drug therapy, Smoking Cessation
- Abstract
Background: While addressing smoking cessation in the context of HIV primary care may increase the acceptability of smoking cessation treatment for patients, HIV care providers have not been trained in offering these treatments. Tools that aid providers in treatment selection, such as computer-generated algorithms, may address barriers to providing effective and efficient treatment options to their patients., Objective: To test the effectiveness of a computer-generated smoking cessation pharmacotherapy recommendation algorithm fully integrated into HIV primary care against an enhanced usual care condition., Methods: Six hundred adult smokers living with HIV will be recruited from 3 medical clinics that provide HIV care in Birmingham, AL, Seattle, WA, and Boston, MA. Participants will be asked to complete a baseline visit and 4 follow-up visits, which will include self-report assessments and carbon monoxide monitoring. Additionally, participants have the option to respond to weekly text-message based surveys sent over an 11-week period between baseline and end of treatment. Participants randomized to the AT condition will have a tailored, algorithm-generated smoking cessation pharmacotherapy recommendation delivered to their HIV care provider via EHR, with the potential to receive up to 12 weeks of smoking cessation pharmacotherapy., Conclusions: A smoking cessation pharmacotherapy recommendation algorithm integrated into HIV primary care may increase treatment utilization and smoking abstinence among smokers living with HIV. If successful, the intervention would be ready for use across the entire CFAR Network of Integrated Clinical Systems network and, more broadly, in HIV clinics that utilize an EHR system., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
19. Integrating geriatric assessment into routine gastrointestinal (GI) consultation: The Cancer and Aging Resilience Evaluation (CARE).
- Author
-
Williams GR, Kenzik KM, Parman M, Al-Obaidi M, Francisco L, Rocque GB, McDonald A, Paluri R, Navari RM, Nandagopal L, Gbolahan O, Young-Smith C, Robertson M, and Bhatia S
- Subjects
- Activities of Daily Living, Aged, Aging, Geriatric Assessment, Humans, Referral and Consultation, Gastrointestinal Neoplasms therapy, Neoplasms therapy
- Abstract
Background: Integrating Geriatric Assessment (GA) in the management of older adults with cancer is recommended, yet rarely practiced in routine oncologic care. Our objective was to assess the feasibility of integrating routine GA in the management of older adults with gastrointestinal (GI) malignancies and characterize impairments in this population., Methods: Patients ≥60yo referred for consultation to the GI Oncology clinic were asked to complete the Cancer and Aging Resilience Evaluation (CARE) on their first visit. CARE was adapted from the Cancer and Aging Research Group GA with modifications to create a completely patient-reported version of the GA. Feasibility was defined as completion of CARE by ≥80% of eligible patients during the initial consultation., Results: Of the eligible 354 new patients seen in the GI Oncology Clinic, 323 (91.2%) completed the CARE survey. Most patients (83.1%) felt the length of time to complete was appropriate (median time of 10 min [IQR 10-15.7 min]). GA impairments were prevalent: 54.7% reported dependence in Instrumental Activities of Daily Living, 15.5% reported dependence in Activities of Daily Living, 20.9% reported ≥1 fall, 35.9% reported a performance status ≥2, 55.7% were limited in walking one block, 74.0% reported polypharmacy (≥4 medications), and 36.4% had ≥3 comorbidities., Conclusions: Performing a GA in the routine care of older adults with GI malignancies is feasible, and GA impairments are common among this population. A fully patient-reported GA such as the CARE may facilitate broader incorporation of GA in the routine clinic work flow., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
20. Pain in older survivors of hematologic malignancies after blood or marrow transplantation: A BMTSS report.
- Author
-
Farrukh N, Hageman L, Chen Y, Wu J, Ness E, Kung M, Francisco L, Parman M, Landier W, Arora M, Armenian S, Bhatia S, and Williams GR
- Subjects
- Aged, Aged, 80 and over, Analgesics therapeutic use, Cancer Pain drug therapy, Cohort Studies, Female, Frailty, Humans, Male, Middle Aged, Risk Factors, Blood Transfusion, Bone Marrow Transplantation, Cancer Pain complications, Cancer Survivors, Hematologic Neoplasms complications, Hematologic Neoplasms therapy
- Abstract
Background: Blood or marrow transplantation (BMT) is increasingly offered to older adults with hematologic malignancies; however, their risk for severe pain is poorly understood. Using the Bone Marrow Transplant Survivor Study, the current study investigated the prevalence and predictors of pain after BMT (allogeneic or autologous) as well as its association with physical performance impairments and frailty., Methods: The cohort included 736 patients with hematologic malignancies who underwent BMT at an age ≥ 60 years at 1 of 3 transplant centers between 1974 and 2014 and survived ≥2 years after BMT; 183 unaffected siblings also participated. Study participants reported on 4 pain domains (nonminor everyday pain, moderate to severe bodily pain, prolonged pain, and moderate to extreme pain interference), and the presence of 1 or more domains was indicative of a severe and/or life-interfering pain composite variable., Results: Overall, 39.4% of the BMT survivors reported severe pain with 2.6-fold greater odds of reporting pain in comparison with sibling controls. Among BMT recipients, those with less education, lower incomes, and active chronic graft-versus-host disease had higher odds of reporting pain. In multivariable analyses, BMT survivors with pain were more likely to have impaired physical performance and were more likely to meet the frailty criteria. BMT survivors reported higher use of pain medications (17.8% vs 9.3%) and opioid pain medications (6.5% vs 2.2%) in comparison with sibling controls., Conclusions: Nearly 40% of older BMT survivors who were followed for a median of 5 years after BMT reported pain, and BMT survivors had 2.6-fold higher odds of reporting severe, nonminor or life-interfering pain in comparison with siblings., (© 2020 American Cancer Society.)
- Published
- 2020
- Full Text
- View/download PDF
21. Risk of venous thromboembolism in patients with non-Hodgkin lymphoma surviving blood or marrow transplantation.
- Author
-
Gangaraju R, Chen Y, Hageman L, Wu J, Francisco L, Kung M, Ness E, Parman M, Weisdorf DJ, Forman SJ, Arora M, Armenian SH, and Bhatia S
- Subjects
- Aged, Blood Transfusion, Bone Marrow Transplantation adverse effects, Bone Marrow Transplantation methods, Female, Follow-Up Studies, Humans, Incidence, Lymphoma, Non-Hodgkin therapy, Male, Middle Aged, Risk Assessment, Risk Factors, Siblings, Venous Thromboembolism prevention & control, Lymphoma, Non-Hodgkin complications, Lymphoma, Non-Hodgkin epidemiology, Venous Thromboembolism epidemiology, Venous Thromboembolism etiology
- Abstract
Background: Patients with non-Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE), particularly when they are receiving treatment. Blood or marrow transplantation (BMT) is recommended for relapsed/refractory NHL, and the risk of VTE after these patients undergo BMT is uncertain., Methods: Patients with NHL who survived 2 years or longer after BMT were surveyed for long-term health outcomes, including VTE. The median follow-up was 8.1 years (interquartile range, 5.6-12.9 years). The risk of VTE in 734 patients with NHL versus 897 siblings without a history of cancer and the risk factors associated with VTE were analyzed., Results: BMT survivors of NHL were at increased risk for VTE in comparison with siblings (odds ratio for allogeneic BMT survivors, 4.61; P < .0001; odds ratio for autologous BMT survivors, 1.75; P = .035). The cumulative incidence of VTE was 6.3% ± 0.9% at 5 years after BMT and 8.1% ± 1.1% at 10 years after BMT. In allogeneic BMT recipients, an increased body mass index (BMI; hazard ratio [HR] for BMI of 25-30 kg/m
2 , 3.52; 95% confidence interval [CI], 1.43-8.64; P = .006; HR for BMI > 30 kg/m2 , 3.44; 95% CI, 1.15-10.23; P = .027) and a history of chronic graft-versus-host disease (HR, 3.33; 95% CI, 1.59-6.97; P = .001) were associated with an increased risk of VTE. Among autologous BMT recipients, a diagnosis of coronary artery disease (HR, 5.94; 95% CI, 1.7-20.71; P = .005) and prior treatment with carmustine (HR, 4.91; 95% CI, 1.66-14.51; P = .004) were associated with increased VTE risk., Conclusions: Patients with NHL who survive BMT are at risk for developing late occurring VTE, and ongoing vigilance for this complication is required. Future studies assessing the role of thromboprophylaxis in high-risk patients with NHL are needed., (© 2019 American Cancer Society.)- Published
- 2019
- Full Text
- View/download PDF
22. Late mortality after bone marrow transplant for chronic myelogenous leukemia in the context of prior tyrosine kinase inhibitor exposure: A Blood or Marrow Transplant Survivor Study (BMTSS) report.
- Author
-
Wu J, Chen Y, Hageman L, Francisco L, Ness EC, Parman M, Kung M, Watson JA, Weisdorf DJ, Snyder DS, McGlave PB, Forman SJ, Arora M, Armenian SH, Bhatia R, and Bhatia S
- Subjects
- Adolescent, Adult, Aged, Bone Marrow Transplantation adverse effects, Bone Marrow Transplantation methods, Cause of Death, Child, Child, Preschool, Combined Modality Therapy, Female, Graft vs Host Disease etiology, Humans, Leukemia, Myelogenous, Chronic, BCR-ABL Positive therapy, Male, Middle Aged, Prognosis, Protein Kinase Inhibitors administration & dosage, Protein Kinase Inhibitors adverse effects, Protein Kinase Inhibitors therapeutic use, Transplantation, Homologous, Treatment Outcome, Young Adult, Leukemia, Myelogenous, Chronic, BCR-ABL Positive mortality
- Abstract
Background: Late mortality was investigated in patients with chronic myelogenous leukemia (CML) who underwent blood or bone marrow transplant (BMT) with or without prior tyrosine kinase inhibitor (TKI) therapy., Methods: By using data from the Blood or Marrow Transplant Survivor Study, the authors examined late mortality in 447 patients with CML who underwent BMT between 1974 and 2010, conditional on surviving ≥2 years post-BMT. For vital status information, the medical records, the National Death Index, and the Accurint database were used. Standardized mortality ratios (SMRs) were calculated using general population age-specific, sex-specific, and calendar-specific mortality rates. Kaplan-Meier techniques and Cox regression were used for all-cause mortality analyses. Cumulative incidence and proportional subdistribution hazards models for competing risks were used for cause-specific mortality analyses., Results: The 10-year overall survival rate was 65.7% and 73% for those who underwent transplant with and without pre-BMT exposure to TKI therapy, respectively. Patients who underwent transplant with and without pre-BMT TKI experienced SMRs of 6.4 and 6.4, respectively (P = .8); and the SMRs were 11.6 and 8.1, respectively, for those with high-risk disease (P = .2). Independent predictors of non-CML-related mortality included chronic graft-versus-host disease (hazard ratio [HR], 2.8; 95% CI, 1.8-4.4) and busulfan/cyclophosphamide conditioning (HR, 0.5; 95% CI, 0.3-0.9; reference, total body irradiation/cyclophosphamide conditioning). The 20-year cumulative incidence of CML-related and non-CML-related mortality was 6% and 36%, respectively, for the entire cohort. Both CML-related mortality (HR, 1.0; 95% CI, 0.1-12.6) and non-CML-related mortality (HR, 1.3; 95% CI, 0.6-3.1) were comparable for those with and without pre-BMT TKI therapy., Conclusions: The similar late mortality experienced by patients with CML who undergo transplantation with or without pre-BMT TKIs suggests that allogeneic BMT can be considered in the context of TKI intolerance or nonadherence. The prevention of post-BMT non-CML-related mortality could favorably affect long-term survival., (© 2019 American Cancer Society.)
- Published
- 2019
- Full Text
- View/download PDF
23. Venous Thromboembolism in Autologous Blood or Marrow Transplantation Survivors: A Report from the Blood or Marrow Transplant Survivor Study.
- Author
-
Gangaraju R, Chen Y, Hageman L, Wu J, Francisco L, Battles K, Kung M, Ness E, Parman M, Weisdorf DJ, Forman SJ, Arora M, Armenian SH, and Bhatia S
- Subjects
- Adult, Aged, Disease-Free Survival, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Siblings, Survival Rate, Transplantation, Autologous, Venous Thromboembolism etiology, Venous Thromboembolism prevention & control, Bone Marrow Transplantation, Peripheral Blood Stem Cell Transplantation, Venous Thromboembolism mortality
- Abstract
Hemostatic complications are commonly encountered in blood or marrow transplantation (BMT) recipients, increasing their morbidity and mortality and are well described in the immediate post-transplantation period. The risk of venous thromboembolism (VTE) in long-term survivors of autologous BMT has not been studied previously. Patients who underwent autologous BMT between January 1, 1974, and December 31, 2010 for a hematologic malignancy, lived 2 years or more after transplantation, and were age ≥18 years were surveyed for long-term outcomes. The median duration of follow-up was 9.8 years (interquartile range, 6.4 to 14.3 years). We analyzed the risk of VTE in 820 autologous BMT recipients who survived for ≥2 years, compared with 644 siblings. BMT survivors were at a 2.6-fold higher risk of VTE compared with siblings (95% confidence interval [CI], 1.6 to 4.4; P =.0004), after adjusting for sociodemographic characteristics. Conditional on surviving for ≥2 years after BMT, the mean cumulative incidence of VTE was 3.9 ± .8% at 5 years and 6.1 ± 1.1% at 10 years. A diagnosis of plasma cell disorder (hazard ratio [HR], 2.37; 95% CI, 1.3 to 4.2; P = .004) and annual household income ≤$50,000 (HR, 2.02; 95% CI, 1.2 to 3.6; P = .015) were associated with increased VTE risk. Our data indicate that autologous BMT survivors are at elevated risk for developing late-occurring VTE. The development of risk prediction models to identify autologous BMT survivors at greatest risk for VTE and thromboprophylaxis may help decrease the morbidity and mortality associated with VTE., (Copyright © 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
24. Late mortality in blood or marrow transplant survivors with venous thromboembolism: report from the Blood or Marrow Transplant Survivor Study.
- Author
-
Gangaraju R, Chen Y, Hageman L, Wu J, Francisco L, Kung M, Ness E, Parman M, Weisdorf DJ, Forman SJ, Arora M, Armenian SH, and Bhatia S
- Subjects
- Adult, Allografts, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Bone Marrow Transplantation, Hematopoietic Stem Cell Transplantation, Venous Thromboembolism etiology, Venous Thromboembolism mortality
- Published
- 2019
- Full Text
- View/download PDF
25. Late Mortality after Allogeneic Bone Marrow Transplantation in Childhood for Bone Marrow Failure Syndromes and Severe Aplastic Anemia.
- Author
-
Holmqvist AS, Chen Y, Wu J, Battles K, Francisco L, Hageman L, Kung M, Ness E, Parman M, Winther JF, Rosenthal J, Arora M, Armenian SH, and Bhatia S
- Subjects
- Adolescent, Adult, Anemia, Aplastic mortality, Bone Marrow Failure Disorders mortality, Bone Marrow Transplantation mortality, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Mortality, Transplantation, Homologous mortality, Young Adult, Anemia, Aplastic therapy, Bone Marrow Failure Disorders therapy, Bone Marrow Transplantation methods, Transplantation, Homologous methods
- Abstract
Children with bone marrow failure syndromes and severe aplastic anemia (SAA) are treated with allogeneic blood or marrow transplantation (BMT). However, there is a paucity of studies examining late mortality risk after allogeneic BMT performed in childhood for bone marrow failure syndromes and SAA and evaluating how this risk differs between these diseases. We investigated cause-specific late mortality in 2-year survivors of allogeneic BMT for bone marrow failure syndromes and SAA performed before age 22years between 1974 and 2010 at 2 US transplantation centers. Vital status information was collected from medical records, the National Death Index, and Accurint databases. Overall survival was calculated using Kaplan-Meier techniques. The standardized mortality ratio (SMR) was calculated using age- sex-, and calendar-specific mortality rates from the Centers for Disease Control and Prevention. Among the 2-year survivors of bone marrow failure syndromes (n = 120) and SAA (n = 147), there were 15 and 19 deaths, respectively, yielding an overall survival of 86.4% for bone marrow failure syndromes and 93.1% for SAA at 15years post-BMT. Compared with the general population, patients with bone marrow failure syndromes were at a higher risk for premature death (SMR, 22.7; 95% CI, 13.1 to 36.2) compared with those with SAA (SMR, 4.5; 95% CI, 2.8 to 7.0) (P < .0001). The elevated relative risk persisted at ≥15years after BMT for both diseases. The hazard of all-cause late mortality was 2.9-fold (95% CI, 1.1 to 7.3) higher in patients with bone marrow failure syndromes compared with those with SAA. The high late mortality risk in recipients of allogeneic BMT in childhood for bone marrow failure syndromes calls for intensified life-long follow-up., (Copyright © 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
26. Late Mortality after Allogeneic Blood or Marrow Transplantation for Inborn Errors of Metabolism: A Report from the Blood or Marrow Transplant Survivor Study-2 (BMTSS-2).
- Author
-
Wadhwa A, Chen Y, Holmqvist A, Wu J, Ness E, Parman M, Kung M, Hageman L, Francisco L, Braunlin E, Miller W, Lund T, Armenian S, Arora M, Orchard P, and Bhatia S
- Subjects
- Adolescent, Adrenoleukodystrophy therapy, Adult, Child, Child, Preschool, Disease-Free Survival, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Leukodystrophy, Metachromatic therapy, Male, Middle Aged, Mucopolysaccharidosis I therapy, Retrospective Studies, Survival Rate, Transplantation, Homologous, Adrenoleukodystrophy mortality, Bone Marrow Transplantation, Hematopoietic Stem Cell Transplantation, Leukodystrophy, Metachromatic mortality, Mucopolysaccharidosis I mortality
- Abstract
Allogeneic blood or marrow transplantation (BMT) is currently considered the standard of care for patients with specific inborn errors of metabolism (IEM). However, there is a paucity of studies describing long-term survival and cause-specific late mortality after BMT in these patients with individual types of IEM. We studied 273 patients who had survived ≥2 years after allogeneic BMT for IEM performed between 1974 and 2014. The most prevalent IEM in our cohort were X-linked adrenoleukodystrophy (ALD; 37.3%), Hurler syndrome (35.1%), and metachromatic leukodystrophy (MLD; 10.2%). Conditional on surviving ≥2 years after BMT, the overall survival for the entire cohort was 85.5 ± 2.4% at 10 years and 73.5 ± 3.7% at 20 years. The cohort had a 29-fold increased risk of late death compared with an age- and sex-matched cohort from the general US population (95% CI, 22- to 38-fold). The increased relative mortality was highest in the 2- to 5-year period after BMT (standardized mortality ratio [SMR], 207; 95% confidence interval [CI], 130 to 308) and declined with increasing time from BMT, but remained elevated for ≥21 years after BMT (SMR, 9; 95% CI, 4 to 18). Sequelae from the progression of primary disease were the most common causes of late mortality in this cohort (76%). The use of T cell-depleted grafts in patients with ALD and Hurler syndrome was a risk factor for late mortality. Younger age at BMT and use of busulfan and cyclosporine were protective in patients with Hurler syndrome. Our findings demonstrate relatively favorable overall survival in ≥2-year survivors of allogeneic BMT for IEM, although primary disease progression continues to be responsible for the majority of late deaths., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2019
- Full Text
- View/download PDF
27. Assessment of Late Mortality Risk After Allogeneic Blood or Marrow Transplantation Performed in Childhood.
- Author
-
Holmqvist AS, Chen Y, Wu J, Battles K, Bhatia R, Francisco L, Hageman L, Kung M, Ness E, Parman M, Salzman D, Wadhwa A, Winther JF, Rosenthal J, Forman SJ, Weisdorf DJ, Armenian SH, Arora M, and Bhatia S
- Subjects
- Adolescent, Adult, Age of Onset, Blood Transfusion statistics & numerical data, Bone Marrow Transplantation adverse effects, Bone Marrow Transplantation statistics & numerical data, Child, Child, Preschool, Cohort Studies, Female, Graft vs Host Disease etiology, Graft vs Host Disease mortality, Hematologic Neoplasms epidemiology, Hematologic Neoplasms mortality, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation mortality, Hematopoietic Stem Cell Transplantation statistics & numerical data, Humans, Incidence, Infant, Infant, Newborn, Male, Retrospective Studies, Risk Factors, Survival Rate, Transfusion Reaction epidemiology, Transfusion Reaction mortality, Transplantation, Homologous adverse effects, Transplantation, Homologous mortality, Young Adult, Blood Transfusion mortality, Bone Marrow Transplantation mortality
- Abstract
Importance: Allogeneic blood or marrow transplantation (BMT) is a curative option for malignant and nonmalignant diseases of childhood. However, little is known about trends in cause-specific late mortality in this population during the past 3 decades., Objectives: To examine cause-specific late mortality among individuals who have lived 2 years or more after allogeneic BMT performed in childhood and whether rates of late mortality have changed over time., Design, Setting, and Participants: A retrospective cohort study was conducted of individuals who lived 2 years or more after undergoing allogeneic BMT performed in childhood between January 1, 1974, and December 31, 2010. The end of follow-up was December 31, 2016., Exposure: Allogeneic BMT performed in childhood., Main Outcomes and Measures: All-cause mortality, relapse-related mortality, and non-relapse-related mortality. Data on vital status and causes of death were collected using medical records, the National Death Index Plus Program, and Accurint databases., Results: Among 1388 individuals (559 females and 829 males) who lived 2 years or more after allogeneic BMT performed in childhood, the median age at transplantation was 14.6 years (range, 0-21 years). In this cohort, there was a total of 295 deaths, yielding an overall survival rate of 79.3% at 20 years after BMT. The leading causes of death were infection and/or chronic graft-vs-host disease (121 of 244 [49.6%]), primary disease (60 of 244 [24.6%]), and subsequent malignant neoplasms (45 of 244 [18.4%]). Overall, the cohort had a 14.4-fold increased risk for death (95% CI, 12.8-16.1) compared with the general population (292 deaths observed; 20.3 deaths expected). Relative mortality remained elevated at 25 years or more after BMT (standardized mortality ratio, 2.9; 95% CI, 2.0-4.1). The absolute excess risk for death from any cause was 12.0 per 1000 person-years (95% CI, 10.5-13.5). The cumulative incidence of non-relapse-related mortality exceeded that of relapse-related mortality throughout follow-up. The 10-year cumulative incidence of late mortality decreased over time (before 1990, 18.9%; 1990-1999, 12.8%; 2000-2010, 10.9%; P = .002); this decrease remained statistically significant after adjusting for demographic and clinical factors (referent group: <1990; 1990-1999: hazard ratio, 0.64; 95% CI, 0.47-0.89; P = .007; 2000-2010: hazard ratio, 0.49; 95% CI, 0.31-0.76; P = .002; P < .001 for trend)., Conclusions and Relevance: Late mortality among children undergoing allogeneic BMT has decreased during the past 3 decades. However, these patients remain at an elevated risk of late mortality even 25 years or more after transplantation when compared with the general population, necessitating lifelong follow-up.
- Published
- 2018
- Full Text
- View/download PDF
28. Late mortality after allogeneic blood or marrow transplantation in childhood for leukemia: a report from the Blood or Marrow Transplant Survivor Study-2.
- Author
-
Holmqvist AS, Chen Y, Wu J, Kung M, Ness E, Parman M, Francisco L, Hageman L, Battles K, Bhatia R, Salzman D, Winther JF, Rosenthal J, Forman SJ, Weisdorf DJ, Armenian SH, Arora M, and Bhatia S
- Subjects
- Adolescent, Adult, Bone Marrow physiology, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Survivors, Young Adult, Bone Marrow Transplantation mortality, Graft vs Host Disease mortality, Leukemia mortality
- Published
- 2018
- Full Text
- View/download PDF
29. Late mortality after autologous blood or marrow transplantation in childhood: a Blood or Marrow Transplant Survivor Study-2 report.
- Author
-
Holmqvist AS, Chen Y, Wu J, Battles K, Bhatia R, Francisco L, Hageman L, Kung M, Ness E, Parman M, Salzman D, Winther JF, Rosenthal J, Forman SJ, Weisdorf DJ, Arora M, Armenian SH, and Bhatia S
- Subjects
- Adolescent, Adult, Cause of Death, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Incidence, Infant, Kaplan-Meier Estimate, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute therapy, Lymphoma mortality, Lymphoma therapy, Male, Neuroblastoma mortality, Neuroblastoma therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy, Sex Factors, Time Factors, Transplantation, Autologous mortality, Young Adult, Bone Marrow Transplantation mortality
- Abstract
Autologous blood or marrow transplantation (BMT) is a curative option for several types of childhood cancer. However, there is little information regarding the risk of late mortality. We examined all-cause mortality, relapse-related mortality (RRM), and nonrelapse-related mortality (NRM) in 2-year survivors of autologous BMT performed before age 22 between 1980 and 2010 at 1 of 2 US transplant centers. Vital status information was collected using medical records, National Death Index, and Accurint databases. Overall survival was calculated using Kaplan-Meier techniques. Cumulative incidence of mortality used competing risk methods. Standardized mortality ratio (SMR) was calculated using age-, sex-, and calendar-specific mortality rates from Centers for Disease Control and Prevention. Cox regression analysis was used to determine predictors of all-cause late mortality. Among the 345 2-year survivors, 103 deaths were observed, yielding an overall survival of 70.3% 15 years post-BMT. The leading causes of death included primary disease (50.0%), subsequent neoplasm (21.4%), and infection (18.2%). Overall, the cohort was at a 22-fold increased risk of late mortality (SMR, 21.8; 95% CI, 17.9-26.3), compared with the general population. Mortality rates remained elevated among the 10-year survivors (SMR, 20.6; 95% CI, 9.9-37.2) but approached those of the general population ≥15 years post-BMT. The 10-year cumulative incidence of RRM (14.3%) exceeded that of NRM (10.4%). The 10-year cumulative mortality rate declined over time (<1990, 35.1%; 1990-1999, 25.6%; 2000-2010, 21.8%; P = .05). In conclusion, childhood autologous BMT recipients have an increased risk of late mortality, compared with the general population. The late mortality rates have declined over the past 3 decades., (© 2018 by The American Society of Hematology.)
- Published
- 2018
- Full Text
- View/download PDF
30. Outcomes following routine antithrombin III replacement during neonatal extracorporeal membrane oxygenation.
- Author
-
Stansfield BK, Wise L, Ham PB 3rd, Patel P, Parman M, Jin C, Mathur S, Harshfield G, and Bhatia J
- Subjects
- Blood Coagulation Tests, Blood Transfusion, Female, Hemorrhage diagnosis, Hemorrhage etiology, Hemorrhage therapy, Heparin therapeutic use, Humans, Infant, Newborn, Male, Retrospective Studies, Thrombosis diagnosis, Thrombosis etiology, Time Factors, Treatment Outcome, Anticoagulants therapeutic use, Antithrombin III therapeutic use, Extracorporeal Membrane Oxygenation adverse effects, Hemorrhage prevention & control, Respiratory Insufficiency therapy, Thrombosis prevention & control
- Abstract
Background: We sought to examine the effect of routine antithrombin III (AT3) infusion on hemorrhagic and thrombotic complications, blood product utilization, and circuit lifespan in neonatal extracorporeal membrane oxygenation (ECMO)., Methods: We performed a retrospective cohort study of 162 infants placed on ECMO for hypoxic respiratory failure. Infants requiring ECMO for primary cardiac support were excluded. Demographic data, time on ECMO, blood product usage, coagulation profile, and complications were compared between 90 control patients and 72 patients treated with AT3., Results: Infants receiving AT3 during ECMO had less thrombotic and similar bleeding complications as compared to infants receiving standard anticoagulation therapy. Total blood product infusion during ECMO was decreased (54.7±20.1 vs. 67.4±34.9mL/kg per day, p=0.001) in infants receiving AT3 during ECMO. Tighter control of activated clotting time and higher serum heparin anti-Xa levels were observed in the AT3 cohort during the first days of ECMO support. 1st ECMO circuit lifespan did not differ between groups., Conclusions: Routine administration of AT3 in neonates receiving ECMO therapy was associated with tighter control of anticoagulation and a reduction in thrombotic events without increasing unwanted bleeding. However, circuit lifespan was unaffected., Level of Evidence: Level III., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
31. Hammertoe correction with k-wire fixation.
- Author
-
Kramer WC, Parman M, and Marks RM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bone Wires, Female, Humans, Male, Middle Aged, Reoperation, Retrospective Studies, Smoking Cessation, Young Adult, Arthroplasty adverse effects, Hammer Toe Syndrome surgery, Smoking adverse effects, Toe Joint surgery
- Abstract
Background: Kirschner wire (K-wire) fixation for correction of hammertoe deformity is a common, low-cost method for fixation of hammertoes after proximal interphalangeal (PIP) arthroplasty or fusion. Complications of this procedure include pin-tract infection, pin migration, pin bending or breakage, and recurrence of deformity. The investigators reviewed a large experience using K-wire stabilization for hammertoe correction., Methods: All hammertoe corrections performed by a single surgeon from 1999 to 2013 were retrospectively reviewed. A resection arthroplasty of the PIP joint or PIP fusion was performed and fixed with a K-wire. Follow-up duration, preoperative diagnosis, pin duration, concomitant procedures, recurrence rates, and complications were reviewed and analyzed. A total of 1,115 operations were performed on 876 patients, with correction of 2,698 hammertoes. There were 709 female and 167 male patients, with an average age of 57.5 years (range, 14-88 years), followed for an average of 20.8 months (range, 27 days to 12.7 years)., Results: Complications included 94 pin migrations (3.5%), 9 pin-tract infections (0.3%), and 2 pin breakages (0.1%). There were 150 recurrent deformities (5.6%) and 94 toes (3.5%) required revision hammertoe surgery. Malalignment was noted in 55 toes (2.1%). Vascular compromise occurred in 16 toes (0.6%), with 10 (0.4%) requiring amputation. Ninety-four toes (3.5%) required revision surgery because of symptomatic recurrence of deformity. The expected rates and rate ratios (RRs) of patients requiring revision hammertoe correction, compared with the study population as a whole, were statistically significantly higher in patients who underwent an metatarsophalangeal joint capsulotomy (3.10 vs 0.97; RR, 3.20) and those who experienced K-wire-related complications (5.10 vs 1.80, RR, 2.84)., Conclusions: K-wire fixation for the treatment of hammertoe deformities led to good maintenance of correction with a relatively low complication rate, and we believe that it remains an effective, low-cost method of fixation for hammertoe correction., Level of Evidence: Level IV, retrospective case series., (© The Author(s) 2015.)
- Published
- 2015
- Full Text
- View/download PDF
32. Dual transmission grating based imaging radiometer for tokamak edge and divertor plasmas.
- Author
-
Kumar D, Clayton DJ, Parman M, Stutman D, Tritz K, and Finkenthal M
- Abstract
The designs of single transmission grating based extreme ultraviolet (XUV) and vacuum ultraviolet (VUV) imaging spectrometers can be adapted to build an imaging radiometer for simultaneous measurement of both spectral ranges. This paper describes the design of such an imaging radiometer with dual transmission gratings. The radiometer will have an XUV coverage of 20-200 Å with a ∼10 Å resolution and a VUV coverage of 200-2000 Å with a ~50 Å resolution. The radiometer is designed to have a spatial view of 16°, with a 0.33° resolution and a time resolution of ~10 ms. The applications for such a radiometer include spatially resolved impurity monitoring and electron temperature measurements in the tokamak edge and the divertor. As a proof of principle, the single grating instruments were used to diagnose a low temperature reflex discharge and the relevant data is also included in this paper.
- Published
- 2012
- Full Text
- View/download PDF
33. Proceedings: Cephazolin in obstetrics.
- Author
-
Hannay WT, Sharp F, Parman MG, and McAllister TA
- Subjects
- Amniotic Fluid analysis, Cefazolin therapeutic use, Female, Fetal Blood analysis, Fetal Diseases prevention & control, Humans, Pregnancy, Bacterial Infections prevention & control, Cefazolin metabolism, Cephalosporins metabolism, Maternal-Fetal Exchange, Obstetric Labor Complications prevention & control
- Abstract
The pharmacodynamics of a new cephalosporin--cephazolin--have been evaluated in clinical obstetrics with particular reference to antibiotic prophylaxis for the cardiac patient, and the prophylaxis and treatment of choriamnionitis and intrauterine pneumonia. Cephazolin effectively crosses the placental barrier. It slowly concentrates in the amniotic fluid when the fetus is alive. This new drug may be used for phophylactic cover in the above clinical situations.
- Published
- 1975
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.