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1. Ambulatory Training Program to Expand Procedural Skills in Primary Care

Author

Robert J. Fortuna, Bethany Marston, Susan Messing, Gunnar Wagoner, Tiffany L. Pulcino, Todd Bingemann, Enrico Caiola, Steven Scofield, Karen Nead, and Brett W Robbins

Subjects
Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

Introduction: Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. Methods: A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. Results: Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; P

Published
2019
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2. Virus-induced Gene Silencing (VIGS) in Barley Seedling Leaves

Author

Lokanadha Gunupuru, Shahin Ali, Fiona Doohan, and Steven Scofield

Subjects
Biology (General), QH301-705.5
Abstract

Virus induced gene silencing (VIGS) is one of the most potent reverse genetics technologies for gene functional characterisation. This method exploits a dsRNA-mediated antiviral defence mechanism in plants. Using this method allows researchers to generate rapid phenotypic data in a relatively rapid time frame as compared to the generation of stable transformants. Here we describe a simple method for silencing a target gene in barley seedling leaves using vectors based on the Barley Stripe Mosaic Virus (BSMV).

Published
2015
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3. Discontinuation versus continuation of hypertonic saline or dornase alfa in modulator treated people with cystic fibrosis (SIMPLIFY): results from two parallel, multicentre, open-label, randomised, controlled, non-inferiority trials

Author

Nicole Mayer-Hamblett, Felix Ratjen, Renee Russell, Scott H Donaldson, Kristin A Riekert, Gregory S Sawicki, Katherine Odem-Davis, Julia K Young, Daniel Rosenbluth, Jennifer L Taylor-Cousar, Christopher H Goss, George Retsch-Bogart, John Paul Clancy, Alan Genatossio, Brian P O'Sullivan, Ariel Berlinski, Susan L Millard, Gregory Omlor, Colby A Wyatt, Kathryn Moffett, David P Nichols, Alex H Gifford, Margaret Kloster, Katie Weaver, Claire Chapdu, Jing Xie, Michelle Skalland, Melita Romasco, Sonya Heltshe, Noah Simon, Jill VanDalfsen, Anna Mead, Rachael Buckingham, Kathy Seidel, Nikita Midamba, Laurel Couture, Brooke Zappone Case, Wendy Au, Elsie Rockers, Diane Cooke, Amber Olander, Irene Bondick, Miya Johnson, Lisya VanHousen, Boris Nicholson, Michelle Parrish, Dion Roberts, Jillian Head, Jessica Carey, Lindsay Caverly, Joy Dangerfield, Rachel Linnemann, Jason Fullmer, Chelsea Roman, Peter Mogayzel, Deanne Reyes, Amy Harmala, Jerimiah Lysinger, Jonathan Bergeron, Isabel Virella-Lowell, Perry Brown, Lejla Godusevic, Alicia Casey, Lauren Paquette, Thomas Lahiri, Julie Sweet, Scott Donaldson, Joshua Harris, Shelia Parnell, Sylvia Szentpetery, Deborah Froh, Erica Tharrington, Manu Jain, Rachel Nelson, Sharon Kadon, Gary McPhail, Kimberly McBennett, Tia Rone, Elliott Dasenbrook, Dave Weaver, Terri Johnson, Karen McCoy, Raksha Jain, Maria Mcleod, Mary Klosterman, Preeti Sharma, Amy Jones, Gary Mueller, Rachel Janney, Jennifer Taylor-Cousar, Mary Cross, Jordana Hoppe, James Cahill, Zubin Mukadam, Jill Finto, Karen Schultz, Silvia Delgado Villalta, Alexa Smith, Susan Millard, Thomas Symington, Gavin Graff, Diane Kitch, Don Sanders, Misty Thompson, Tahuanty Pena, Mary Teresi, Jennifer Gafford, David Schaeffer, Joel Mermis, Lawrence Scott, Hugo Escobar, Kristen Williams, Dana Dorman, Brian O'Sullivan, Ryan Bethay, Zoran Danov, Kat Turbeville, Jimmy Johannes, Angelica Rodriguez, Bridget Marra, Robert Zanni, Ronald Morton, Terri Simeon, Andrew Braun, Nicole Dondlinger, Julie Biller, Erin Hubertz, Nicholas Antos, Laura Roth, Joanne Billings, Catherine Larson, Priya Balaji, John McNamara, Tammy Clark, Rebecca Griffith, Nancy Martinez, Sabiha Hussain, Halina Malveaux, Marie Egan, Catalina Guzman, Joan DeCelie-Germana, Susan Galvin, Adrienne Savant, Nicole Falgout, Patricia Walker, Teresa Demarco, Emily DiMango, Maria Ycaza, Julie Ballo, Pornchai Tirakitsoontorn, Daniel Layish, Desiree Serr, Floyd Livingston, Sherry Wooldridge, Carlos Milla, Jacquelyn Spano, Rebecca Davis, Okan Elidemir, Subramanyam Chittivelu, Ashley Scott, Sarah Alam, Daniel Dorgan, Matt Butoryak, Daniel Weiner, Harmony Renna, Colby Wyatt, Brendan Klein, Anne Stone, Meg Lessard, Michael S. Schechter, Barbara Johnson, Steven Scofield, Theodore Liou, Jane Vroom, Kathryn Akong, Marissa Gil, Legna Betancourt, Jonathan Singer, Ngoc Ly, Courtney Moreno, Moira Aitken, Teresa Gambol, Ronald Gibson, Allison Lambert, Joan Milton, Sarah Smith, Deanna Green, Diana Hodge, Christopher Fortner, Mary Forell, Rachel Karlnoski, Kapil Patel, Cori Daines, Elizabeth Ryan, Rodolfo Amaro-Galvez, Elizabeth Dohanich, Alison Lennox, Zachary Messer, Holly Hanes, Kay Powell, and Deepika Polineni

Subjects
Pulmonary and Respiratory Medicine
Abstract

Reducing treatment burden is a priority for people with cystic fibrosis, whose health has benefited from using new modulators that substantially increase CFTR protein function. The SIMPLIFY study aimed to assess the effects of discontinuing nebulised hypertonic saline or dornase alfa in individuals using the CFTR modulator elexacaftor plus tezacaftor plus ivacaftor (ETI).The SIMPLIFY study included two parallel, multicentre, open-label, randomised, controlled, non-inferiority trials at 80 participating clinics across the USA in the Cystic Fibrosis Therapeutics Development Network. We included individuals with cystic fibrosis aged 12-17 years with percent predicted FEVFrom Aug 25, 2020, to May 25, 2022, a total of 672 unique participants were screened for eligibility for one or both trials, resulting in 847 total random assignments across both trials with 594 unique participants. 370 participants were randomly assigned in the hypertonic saline trial and 477 in the dornase alfa trial. Participants across both trials had an average ppFEVIn individuals with cystic fibrosis on ETI with relatively well preserved pulmonary function, discontinuing daily hypertonic saline or dornase alfa for 6 weeks did not result in clinically meaningful differences in pulmonary function when compared with continuing treatment.

Published
2023

4. A Randomized Clinical Trial of Antimicrobial Duration for Cystic Fibrosis Pulmonary Exacerbation Treatment

Author

Christopher H. Goss, Sonya L. Heltshe, Natalie E. West, Michelle Skalland, Don B. Sanders, Raksha Jain, Tara L. Barto, Barbra Fogarty, Bruce C. Marshall, Donald R. VanDevanter, Patrick A. Flume, Gregory Omlor, Brenda Bourne, Dion Roberts, Vicki Roberts, Samya Nasr, Dawn Kruse, Rachel Linnemann, Tsion Hailemichael, Caralee Forseen, Heidi Stapp, Natalie West, S. Patel, A. Claudio, Jerimiah Lysinger, Amy Harmala, George Solomon, Latona Kersh, Karen Miller, Dixie Durham, Ahmet Uluer, Robert Fowler, Carla Frederick, Nadine Caci, Charlotte Teneback, Julie Sweet, Michael Parkins, Clare Smith, Jennifer Goralski, Kelsey Haywood, Patrick Flume, Caroline Brailsford, Dana Albon, Christie Aderholt, Kimberly McBennett, Cindy Schaefer, Alpa Patel, April Hunt, Lauren Schumacher, Hari Polenakovik, Linda Clark, Jerry Nick, Katie Poch, Dana Kissner, James Cahill, Jorge Lascano, Erin Silverman, John McArdle, Alison Champagne, Robert Vender, Lisa Allwein, Lance Cohen, Norma (Jean) Barton, Tara Barto, Ami Patel, Cynthia Brown, Nia Vorhees, Michael Crosser, Lawrence Scott, Alix Ashare, Barbara Rodgers, Robert Zanni, Lisa Koval, Andrew Braun, Sophia Chiron Stevens, Maria Tupayachi Ortiz, Patricia Graham, Julie Biller, Erin Hubertz, Kathryn Moffett, Tammy Clark, Rebecca Griffith, Nancy Martinez, Sabiha Hussain, Fei Chen, Marie Egan, Catalina Guzman, Janice Wang, Aileen Espinal, Patricia Walker, Anne Kukral, Emily DiMango, Sarah Fracasso Francis, Carlos Milla, Colleen Dunn, Subramanyam Chittivelu, Ashley Scott, Daniel Dorgan, Sharon Ng, Joseph Pilewski, Rose Lanzo, Nauman Chaudary, Ryan Hayden, Steven Scofield, Barb Johnson, Brian Morrissey, Brandt Robinson, Douglas Conrad, Jenna Mielke, Moira Aitken, Chami Sanlors, Ravi Nayak, Freda Branch, Daniel Rosenbluth, Molly Siegel, Anil Ghimire, Mary Forell, Cori Daines, Monica Varela, Leslie Couch, Rebekah Hibbard, Allen Dozor, Armando Ramirez, Victor Ortega, Kathryn Kennedy, David Fish, and Karen Longtine

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Cystic Fibrosis, Exacerbation, Critical Care and Intensive Care Medicine, Cystic fibrosis, law.invention, Randomized controlled trial, law, Internal medicine, medicine, Humans, Pseudomonas Infections, Respiratory system, Respiratory Tract Infections, business.industry, Cystic Fibrosis Pulmonary Exacerbation, Editorials, Respiratory infection, Original Articles, Middle Aged, medicine.disease, Antimicrobial, Anti-Bacterial Agents, Respiratory Function Tests, Clinical trial, Pseudomonas aeruginosa, Disease Progression, Female, business
Abstract

RATIONALE: People with cystic fibrosis (CF) experience acute worsening of respiratory symptoms and lung function known as pulmonary exacerbations. Treatment with intravenous antimicrobials is common; however, there is scant evidence to support a standard treatment duration. OBJECTIVES: To test differing durations of intravenous antimicrobials for CF exacerbations. METHODS: STOP2 (Standardized Treatment of Pulmonary Exacerbations 2) was a multicenter, randomized, controlled clinical trial in exacerbations among adults with CF. After 7–10 days of treatment, participants exhibiting predefined lung function and symptom improvements were randomized to 10 or 14 days’ total antimicrobial duration; all others were randomized to 14 or 21 days’ duration. MEASUREMENTS AND MAIN RESULTS: The primary outcome was percent predicted FEV(1) (ppFEV(1)) change from treatment initiation to 2 weeks after cessation. Among early responders, noninferiority of 10 days to 14 days was tested; superiority of 21 days compared with 14 days was compared for the others. Symptoms, weight, and adverse events were secondary. Among 982 randomized people, 277 met improvement criteria and were randomized to 10 or 14 days of treatment; the remaining 705 received 21 or 14 days of treatment. Mean ppFEV(1) change was 12.8 and 13.4 for 10 and 14 days, respectively, a ‒0.65 difference (95% CI [‒3.3 to 2.0]), excluding the predefined noninferiority margin. The 21- and 14-day arms experienced 3.3 and 3.4 mean ppFEV(1) changes, a difference of ‒0.10 (‒1.3 to 1.1). Secondary endpoints and sensitivity analyses were supportive. CONCLUSIONS: Among adults with CF with early treatment improvement during exacerbation, ppFEV(1) after 10 days of intravenous antimicrobials is not inferior to 14 days. For those with less improvement after one week, 21 days is not superior to 14 days. Clinical trial registered with www.clinicaltrials.gov (NCT02781610).

Published
2021

7. Ambulatory Training Program to Expand Procedural Skills in Primary Care

Author

Todd Bingemann, Gunnar Wagoner, Karen Nead, Tiffany Pulcino, Steven Scofield, Brett W. Robbins, Bethany Marston, Enrico Caiola, Robert J. Fortuna, and Susan Messing

Subjects
020205 medical informatics, Procedural training, ambulatory, 02 engineering and technology, Primary care, Education, 03 medical and health sciences, Outpatient procedures, primary care, 0302 clinical medicine, Procedural skill, Component (UML), 0202 electrical engineering, electronic engineering, information engineering, Medicine, joint injection, 030212 general & internal medicine, procedures, Curriculum, Original Research, Medical education, lcsh:LC8-6691, lcsh:R5-920, lcsh:Special aspects of education, business.industry, ultrasound, Ambulatory, Training program, business, lcsh:Medicine (General)
Abstract

Introduction: Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. Methods: A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. Results: Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; P Conclusions: A longitudinal ambulatory-based procedural curriculum can increase resident and faculty physician understanding and comfort performing primary-care-based procedures. This, in turn, increased the total number of procedures performed.

Published
2019

8. Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

Author

Kevin Fiscella, Amna Idris, Steven Scofield, Shirley X. L. Li, Paul Winters, Samantha Hendren, Sharon G. Humiston, Patricia Ford, and Robert J. Fortuna

Subjects
Adult, Male, medicine.medical_specialty, Randomization, Reminder Systems, New York, Psychological intervention, Colonoscopy, Breast Neoplasms, Health Promotion, law.invention, Breast cancer, Randomized controlled trial, law, Cancer screening, Internal Medicine, Medicine, Mammography, Humans, Early Detection of Cancer, Aged, Original Research, medicine.diagnostic_test, business.industry, Telephone call, Capsule Commentary, Middle Aged, Patient Acceptance of Health Care, medicine.disease, Correspondence as Topic, Telephone, Socioeconomic Factors, Family medicine, Physical therapy, Female, Colorectal Neoplasms, business
Abstract

Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. Pragmatic randomized trial. Men and women aged 50–74 years past due for CRC screen and women aged 40–74 years past due for BC screening. We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2–4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1–3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1–3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0–3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.

Published
2013

9. Lymphangitis, Lymphedema, & Cystic Hygroma

Author

Steven Scofield

Subjects
medicine.medical_specialty, Lymphedema, Lymphangitis, business.industry, Medicine, Cystic hygroma, business, medicine.disease, Dermatology
Published
2007

10. Contributors

Author

Barbara L. Asselin, Georgianne Arnold, Sherry L. Bayliff, Christopher E. Belcher, Deena Berkowitz, Jeffrey Blake, Christopher F. Bolling, Deborah Borchers, Brittanny Liam Boulanger, Peter N. Bowers, Paula K. Braverman, Carmelita V. Britton, Robert A. Broughton, Ann Buchanan, Gale R. Burstein, James R. Campbell, Kathleen M. Campbell, Lynn R. Campbell, Margaret‐Ann Carno, Patrick L. Carolan, Mary T. Caserta, Heidi A. Castillo, Kathryn Castle, Peter Chang, Sharon F. Chen, Eulalia R.Y. Cheng, Elizabeth K. Cherot, Patricia R. Chess, Olivia Chiang, Barbara A. Chini, Jill M. Cholette, Cynthia Christy, Emma Ciafaloni, Carolyn Cleary, Lisa Loeb Colton, Gregory P. Conners, Heidi V. Connolly, Stephen Cook, Christopher Copenhaver, Elliott L. Crow, Therese Cvetkovich, David Cywinski, Kristen Smith Danielson, Dorothy M. Delisle, Larry Denk, Lee A. Denson, George T. Drugas, Carolyn Piver Dukarm, Jason G. Emmick, Gus Gibbons Emmick, Oscar Escobar, Anna F. Fakadej, Richard A. Falcone, S. Nichole Feeney, Thomas J. Fischer, Donna J. Fisher, Amy Fix, Chin‐To Fong, Cynthia L. Fox, D. Steven Fox, Robert J. Freishtat, Madelyn Garcia, Lynn C. Garfunkel, Matthew D. Gearinger, Mary Ellen Gellerstedt, John Girotto, Michelle A. Grenier, Alka Goyal, Maryellen E. Gusic, Caroline B. Hall, Jill S. Halterman, David W. Hannon, William G. Harmon, J. Peter Harris, Amy Heneghan, Neil E. Herendeen, Joeli Hettler, John L. Hick, Andrea S. Hinkle, Alejandro Hoberman, Christopher H. Hodgman, Allison L. Holm, Mark A. Hostetler, Cynthia R. Howard, Stephanie Sansoni Hsu, William C. Hulbert, Robert Humphreys, Jon Hutchinson, Susan Hyman, Carolyn Jacobs Parks, Andree Jacobs‐Perkins, Sandra H. Jee, Nicholas Jospe, Steven Joyce, Jeffrey M. Kaczorowski, Indra Kancitis, James W. Kendig, John Knight, David N. Korones, Peter A. Kouides, Richard Kreipe, Diana Barnett Kudes, Jennifer M. Kwon, Marc S. Lampell, Meredith Landorf, Nancy E. Lanphear, Jeffrey H. Lee, Lucia H. Lee, Thomas J.A. Lehman, Paul Lehoullier, Norma B. Lerner, Gregory S. Liptak, Ann M. Loeffler, K. Makoroff, Elizabeth Mannick, Christina M. Mccann, Carol A. Mccarthy, Michael E. Mcconnell, Alan M. Mendelsohn, Ram K. Menon, Robert A. Mevorach, Ayesa N. Mian, Heather Michalak, Daniel E. Miga, Nicole L. Mihalopoulos, Jonathan W. Mink, M. Susan Moyer, Suzanne Fredrickson Mullin, Charles M. Myer, Ran Namgung, Jonathan F. Nasser, Robert Needlman, Joseph A. Nicholas, Maureen Novak, Samuel Nurko, Craig Orlowski, Ponrat Pakpreo, James Palis, Murray H. Passo, Joanne Pedro‐Carroll, Walter Pegoli, Karen S. Powers, Susan Haller Psaila, Ronald Rabinowitz, Marc A. Raslich, Karen L. Resch, Meredith E. Reynolds, Matthew Richardson, Brett Robbins, Mark Roddy, Dennis Roy, Leticia Manning Ryan, Sheryl A. Ryan, Stanley J. Schaffer, Lora L. Schauer, Charles Schubert, George J. Schwartz, Steven Scofield, George B. Segel, Edgard A. Segura, Lorna M. Seybolt, Nader Shaikh, Ronald L. Sham, Laura Jean Shipley, Benjamin L. Shneider, David M. Siegel, Mark Scott Smith, R. Dennis Steed, Moira A. Szilagyi, Susanne E. Tanski, Danielle Thomas‐Taylor, Svetlana Tisma‐Dupanovic, John J. Treanor, C. Elizabeth Trefts, William T. Tsai, Reginald Tsang, Elise W. Van Der Jagt, Jon A. Vanderhoof, William S. Varade, Kathleen M. Ventre, Michael K. Visick, Brad W. Warner, Geoffrey A. Weinberg, Melanie Wellington, David R. White, Susan Wiley, Robert R. Wittler, Bryan J. Wolhwend, Jonathan P. Wood, Kimberly A. Workowski, Daniel Yawman, Roger A. Yeager, and Rosemary J. Young

Published
2007

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