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Article ; Online: Speaking of pandemics...

Schechter, Michael S

Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society

2021 Volume 20, Issue 4, Page(s) 564–565

MeSH term(s)	Cystic Fibrosis ; Cystic Fibrosis Transmembrane Conductance Regulator ; Humans ; Pandemics
Chemical Substances	Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6)
Language	English
Publishing date	2021-06-05
Publishing country	Netherlands
Document type	Editorial ; Comment
ZDB-ID	2084724-5
ISSN	1873-5010 ; 1569-1993
ISSN (online)	1873-5010
ISSN	1569-1993
DOI	10.1016/j.jcf.2021.04.017
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Article ; Online: Aiming to Improve Equity in Pulmonary Health: Cystic Fibrosis.

Oates, Gabriela R / Schechter, Michael S

Clinics in chest medicine

2023 Volume 44, Issue 3, Page(s) 555–573

Abstract: This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, ... ...

Abstract	This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
MeSH term(s)	Humans ; Female ; Male ; Cystic Fibrosis/therapy ; Gender Identity ; Ethnicity
Language	English
Publishing date	2023-05-08
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	447455-7
ISSN	1557-8216 ; 0272-5231
ISSN (online)	1557-8216
ISSN	0272-5231
DOI	10.1016/j.ccm.2023.03.011
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Article ; Online: Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies.

Oates, Gabriela R / Schechter, Michael S

Expert review of respiratory medicine

2022 Volume 16, Issue 6, Page(s) 637–650

Abstract: Introduction: Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from ... ...

Abstract	Introduction: Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. Areas covered: This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. Expert opinion: Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.
MeSH term(s)	Cystic Fibrosis/diagnosis ; Cystic Fibrosis/epidemiology ; Cystic Fibrosis/therapy ; Exercise ; Humans ; Risk Factors ; Socioeconomic Factors
Language	English
Publishing date	2022-06-23
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2022.2090928
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Article ; Online: Social Inequities and Cystic Fibrosis Outcomes: We Can Do Better.

Oates, Gabriela R / Schechter, Michael S

Annals of the American Thoracic Society

2021 Volume 18, Issue 2, Page(s) 215–217

MeSH term(s)	Adolescent ; Cystic Fibrosis/therapy ; Disease Progression ; Humans ; Insurance Coverage ; Lung ; Young Adult
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202010-1274ED
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Article ; Online: Reevaluating approaches to cystic fibrosis pulmonary exacerbations.

Schechter, Michael S

Pediatric pulmonology

2018 Volume 53, Issue S3, Page(s) S51–S63

Abstract: Cystic Fibrosis (CF) lung disease is characterized by intermittent acute episodes of worsening signs, symptoms, and pulmonary function; these so-called pulmonary exacerbations (PEx) appear to be important drivers of long-term declines in lung function, ... ...

Abstract	Cystic Fibrosis (CF) lung disease is characterized by intermittent acute episodes of worsening signs, symptoms, and pulmonary function; these so-called pulmonary exacerbations (PEx) appear to be important drivers of long-term declines in lung function, quality of life, and life expectancy. Surveillance for development of PEx and their treatment is a fundamental component of chronic CF management, and the merits of novel CF therapies are often judged based on their ability to reduce the frequency of PEx. Given the central role that they play, it is surprising how poorly PEx are understood, how thin is the evidence base for their treatment and how often they are left unrecognized and untreated in clinical practice. This paper reviews what is known and what is unknown regarding the nature of PEx, and discusses the impact of missed recognition and treatment of these episodes as well as the apparent variation in practice across CF care centers. The arguments supporting a liberal, highly sensitive approach to the diagnosis of PEx are presented, as well as recommendation for how care programs can achieve consistency in their early recognition and treatment. A stepwise approach to personalized treatment supported by close follow-up to ensure the successful resolution of all signs and symptoms will lead to the stabilization of patients' lung function and quality of life. Recommendations are made regarding important priorities for research into evidence-based approaches to improving the care of PEx.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Cystic Fibrosis/drug therapy ; Cystic Fibrosis/physiopathology ; Disease Progression ; Humans ; Lung/physiopathology ; Quality of Life ; Respiratory Function Tests
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2018-07-06
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.24125
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Article ; Online: Bronchiolitis therapies and misadventures.

Linssen, Rosalie S N / Schechter, Michael S / Rubin, Bruce K

Paediatric respiratory reviews

2022 Volume 46, Page(s) 49–56

Abstract: Viral bronchiolitis, which is most commonly caused by an infection with the respiratory syncytial virus (RSV), can lead to respiratory difficulties in young children which may require hospitalization. Despite years of research and medical trials, the ... ...

Abstract	Viral bronchiolitis, which is most commonly caused by an infection with the respiratory syncytial virus (RSV), can lead to respiratory difficulties in young children which may require hospitalization. Despite years of research and medical trials, the mainstay of bronchiolitis treatment remains supportive only. This review provides an overview of the history of different treatments for bronchiolitis, including those that failed, as well as new therapies that are under study. Future studies for the treatment of bronchiolitis should consider different age-groups, important subgroups (i.e., those with a prior history of wheezing, those with a family history of asthma and those with non-RSV viral etiologies) whose response to treatment may differ from that of the composite group.
MeSH term(s)	Child ; Humans ; Infant ; Child, Preschool ; Respiratory Syncytial Virus Infections/therapy ; Respiratory Syncytial Virus Infections/complications ; Bronchiolitis/therapy ; Respiratory Syncytial Virus, Human ; Asthma/complications ; Bronchiolitis, Viral/therapy ; Respiratory Sounds/etiology
Language	English
Publishing date	2022-09-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2147664-0
ISSN	1526-0550 ; 1526-0542
ISSN (online)	1526-0550
ISSN	1526-0542
DOI	10.1016/j.prrv.2022.09.003
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Article ; Online: Comparing effectiveness and outcomes in asthma and cystic fibrosis.

Schechter, Michael S

Paediatric respiratory reviews

2017 Volume 24, Page(s) 24–28

Abstract: As technology yields new treatments, pediatric pulmonologists need determine how best to use them and how to decide which ones are best for any specific group or individual patient. Physicians have always customized therapies based upon patient response, ...

Abstract	As technology yields new treatments, pediatric pulmonologists need determine how best to use them and how to decide which ones are best for any specific group or individual patient. Physicians have always customized therapies based upon patient response, but the new concept of "Personalized (or precision) medicine" focuses attention to a greater degree on the individual needs of patients based on their genetic, biomarker, phenotypic, or psychosocial characteristics. The newly developed biologics for treatment of asthma and CFTR modulators for treatment of cystic fibrosis (CF) highlight this newer approach. As we have more treatments available, new approaches to testing efficacy and effectiveness of these new therapies is necessary in order to efficiently bring them to market and compare their benefits in real world practice. While comparative effectiveness can be tested in pragmatic clinic trials, the most common approaches make use of observational data such as administrative databases and patient registries but their use for this is fraught with pitfalls that may or may not be methodologically surmountable. Once new therapies have been shown to be efficacious and effective, it is important to be cognizant of methods for ensuring that all patients actually receive the treatments that will be best for them. Comparisons of the effectiveness of clinical practice in the form of benchmarking is helpful for this, and consideration of costs and cost-effectiveness is essential to judging the best treatment for patients in a real-world setting.
Language	English
Publishing date	2017-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2147664-0
ISSN	1526-0550 ; 1526-0542
ISSN (online)	1526-0550
ISSN	1526-0542
DOI	10.1016/j.prrv.2017.06.002
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Article ; Online: Nocturnal High-Flow Nasal Cannula Therapy and Sinonasal Symptoms During Cystic Fibrosis Exacerbations.

Davis, Michael D / Brockbank, Justin / Hayden, Ryan / Schechter, Michael S / Rubin, Bruce K

Respiratory care

2023 Volume 68, Issue 11, Page(s) 1527–1531

Abstract: Background: Both nasal obstruction and sleep disturbance are common in patients with cystic fibrosis (CF). In patients with obstructive sleep apnea (OSA), studies suggest that these conditions are related and that nasal congestion improves with CPAP ... ...

Abstract	Background: Both nasal obstruction and sleep disturbance are common in patients with cystic fibrosis (CF). In patients with obstructive sleep apnea (OSA), studies suggest that these conditions are related and that nasal congestion improves with CPAP therapy. We hypothesized that subjects admitted to hospital for therapy of an exacerbation of CF would have both nasal symptoms and sleep disturbance and that these would improve with the initiation of nocturnal high-flow nasal cannula therapy (HFNC). Methods: Twenty-five subjects with an exacerbation of CF were enrolled to randomly receive either 5 d of nocturnal HFNC at 20 L/min in the treatment group or 5 L/min of nocturnal nasal cannula air at ambient temperature and humidity in the low-flow group. On the first and last day of the study, the Sino-Nasal Outcome Test (SNOT-20) was administered to evaluate nasal symptoms, and sleep quality was measured using the Actiwatch 2. Results: Fifteen subjects completed the study (6 HFNC, 9 low flow). We confirmed that subjects had significant sleep disturbance that did not improve over the 5 d of the study. Subjects also had disturbing nasal symptoms that significantly improved only in those receiving HFNC (pre 14 [20] vs post 6 [13], Conclusions: Similar to what has been reported in older subjects with OSA, nocturnal HFNC improves sinonasal symptoms in subjects with an exacerbation of CF. There was no measurable effect on sleep quality, which may be due to the short duration of the study, or to subjects being evaluated while being treated in a hospital setting.
MeSH term(s)	Humans ; Aged ; Cannula ; Cystic Fibrosis/complications ; Cystic Fibrosis/therapy ; Oxygen Inhalation Therapy ; Sleep Apnea, Obstructive/therapy ; Continuous Positive Airway Pressure
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.09890
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Article ; Online: An emotional journey: caregiver experiences with gastrostomy tube decision-making for children with cystic fibrosis.

Dickinson, Kimberly M / Smith, Brandon M / Green, Deanna M / Nasr, Samya / Sawicki, Gregory S / Schechter, Michael S / Riekert, Kristin A

Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society

2024

Abstract: Background: Nutritional challenges are common in early CF care and stressful for caregivers of children with CF (cwCF) to navigate. Gastrostomy tube (G-tube) placement can improve weight gain, however the decision to proceed with placement is ... ...

Abstract	Background: Nutritional challenges are common in early CF care and stressful for caregivers of children with CF (cwCF) to navigate. Gastrostomy tube (G-tube) placement can improve weight gain, however the decision to proceed with placement is personalized and preference-sensitive. Little is known about the experiences of caregivers of cwCF and the G-tube decision-making process. Objectives: The present study used a qualitative approach to explore the perceptions and experiences of caregivers of cwCF with G-tube introductions and recommendations, as well as factors influencing G-tube decision-making. Methods: Caregivers of cwCF aged ≤ 10 years completed audio-taped, semi-structured interviews describing their experiences with G-tube placement discussions. Interviews were transcribed and two independent researchers coded the transcripts and conducted content and thematic analysis using an inductive approach. Results: Participants included 43 caregivers, 84 % were mothers (36/43). CwCF had a mean age of 4 years (SD=2.6), 84 % were White (36/43), and 60 % reported weights below <50th percentile (26/43). All caregivers knew about G-tubes, 44 % (19/43) were recommended a G-tube and 35 % (15/43) had a G-tube placed. Major findings included descriptions of the stages of G-tube decision-making from a heads up, to the game plan, to making a first difficult decision and finally living with the decision to pursue G-tube placement. Conclusion: G-tube decision-making is an emotional and personalized journey for caregivers of cwCF. Efforts to explore the values and priorities of caregivers is imperative to supporting families making difficult decisions in CF care.
Language	English
Publishing date	2024-02-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2084724-5
ISSN	1873-5010 ; 1569-1993
ISSN (online)	1873-5010
ISSN	1569-1993
DOI	10.1016/j.jcf.2024.01.007
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Article ; Online: The impact of switching to race-neutral reference equations on FEV

Rosenfeld, Margaret / Cromwell, Elizabeth A / Schechter, Michael S / Ren, Clement / Flume, Patrick A / Szczesniak, Rhonda D / Morgan, Wayne J / Jain, Raksha

Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society

2024

Abstract: ... forced expiratory volume in one second (ppFEV: Objective(s): To quantify the impact of switching from Global Lung ...

Abstract	Rationale: The American Thoracic Society recommended switching to race-neutral spirometry reference equations, as race is a social construct and to avoid normalizing disparities in lung function due to structural racism. Understanding the impact of the race-neutral equations on percent predicted forced expiratory volume in one second (ppFEV Objective(s): To quantify the impact of switching from Global Lung Initiative (GLI) 2012 race-specific to GLI 2022 Global race-neutral reference equations on the distribution of ppFEV Methods: Cross-sectional analysis of FEV Results: With the switch to GLI Global, ppFEV Conclusions: Switching from GLI 2012 race-specific reference equations to GLI 2022 Global race-neutral equations will result in larger reductions in ppFEV
Language	English
Publishing date	2024-03-30
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2084724-5
ISSN	1873-5010 ; 1569-1993
ISSN (online)	1873-5010
ISSN	1569-1993
DOI	10.1016/j.jcf.2024.03.013
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