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Article ; Online: A New Way of Looking at an Old Problem.

King, Christopher S

2020 Volume 158, Issue 1, Page(s) 31–32

MeSH term(s)	Humans ; Pulmonary Embolism ; Thrombosis ; Vascular Diseases
Language	English
Publishing date	2020-07-02
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.02.053
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Article ; Online: The role of stigma in cannabis use disclosure: an exploratory study.

King, Daniel D / Gill, Christopher J / Cadieux, Carey S / Singh, Neha

Harm reduction journal

2024 Volume 21, Issue 1, Page(s) 21

Abstract: Background: Although cannabis use incidence, societal acceptance, and legislation all trend positively, cannabis remains federally illegal in the USA. Prior studies have revealed that patients are reluctant to disclose their cannabis use history in the ... ...

Abstract	Background: Although cannabis use incidence, societal acceptance, and legislation all trend positively, cannabis remains federally illegal in the USA. Prior studies have revealed that patients are reluctant to disclose their cannabis use history in the healthcare system, which can negatively impact patient care. This study reports the frequency of cannabis use disclosure with special considerations for stigmatization. To better understand the limitations, providers face in providing collaborative, comprehensive, and informed care, this study evaluated four domains of stigma: perceived, anticipated, enacted, and internalized. Methods: This study used a descriptive exploratory design. Data collection occurred using an anonymous, online national survey with a convenience sample in the USA. Recruitment relied on electronic media and occurred between July and December 2022. Participants were adults older than 21 years and self-identified as having used cannabis and accessed the healthcare system within the last five years. The survey measured demographic characteristics, cannabis use, and disclosure patterns. Stigma was measured using the Stigma Use Stigma Mechanism Scale (SU-SMS) and Substance Abuse Use Self-Stigma Scale (SASSS) with language modifications for cannabis. Ordinal logistic regression models were performed to evaluate associations between the frequency of cannabis use disclosure patterns and each stigma category. Associations were assessed using Chi-squared or Fisher's exact tests. Results: Data were available for 249 respondents. Most participants (57.1%) reported initiating a conversation about cannabis with their healthcare provider; 27.8% of the time, cannabis is never discussed, and healthcare providers initiate only 15.1% of related discussions. Anticipated stigma [95% CI 1.045-1.164] and total stigma [95% CI 1.001-1.039] had statistically significant associations with nondisclosure. Annual household income (p = .04), chronicity of cannabis use (p = .03), frequency of cannabis use (p = .02), and a known amount of CBD in products consumed (p = .01) had statistically significant associations with the frequency of cannabis use disclosure. Conclusions: Patients who use cannabis experience stigmatization in the healthcare setting that may limit disclosure of cannabis use history. Future studies would be well served to explore anticipated stigma more deeply. Healthcare providers should be knowledgeable to lead such conversations relating to cannabis while maintaining an unbiased perspective.
MeSH term(s)	Adult ; Humans ; Cannabis ; Social Stigma ; Stereotyping ; Disclosure ; Surveys and Questionnaires
Language	English
Publishing date	2024-01-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-024-00929-8
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Article ; Online: Pulmonary Hypertension in Interstitial Lung Disease: Updates in Disease, Diagnosis, and Therapeutics.

Haynes, Zachary A / Chandel, Abhimanyu / King, Christopher S

Cells

2023 Volume 12, Issue 19

Abstract: Pulmonary hypertension is a debilitating condition that frequently develops in the setting of interstitial lung disease, likely related to chronic alveolar hypoxemia and pulmonary vascular remodeling. This disease process is likely to be identified more ... ...

Abstract	Pulmonary hypertension is a debilitating condition that frequently develops in the setting of interstitial lung disease, likely related to chronic alveolar hypoxemia and pulmonary vascular remodeling. This disease process is likely to be identified more frequently by providers given recent advancements in definitions and diagnostic modalities, and provides practitioners with emerging opportunities to improve patient outcomes and quality of life. Despite years of data suggesting against the efficacy of pulmonary vasodilator therapy in patients with pulmonary hypertension due to interstitial lung disease, new data have emerged identifying promising advancements in therapeutics. The authors present to you a comprehensive review of pulmonary hypertension in interstitial lung disease, reviewing our current understanding of pathophysiology, updates in diagnostic approaches, and highlights of recent clinical trials which provide an effective approach for medical management.
MeSH term(s)	Humans ; Hypertension, Pulmonary/complications ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/therapy ; Quality of Life ; Lung Diseases, Interstitial/complications ; Lung Diseases, Interstitial/diagnosis ; Lung Diseases, Interstitial/therapy ; Lung
Language	English
Publishing date	2023-10-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2661518-6
ISSN	2073-4409 ; 2073-4409
ISSN (online)	2073-4409
ISSN	2073-4409
DOI	10.3390/cells12192394
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Article: Pulmonary Hypertension in Interstitial Lung Disease: Management Options to Move Beyond Supportive Care.

Fabyan, Kimberly D / Chandel, Abhimanyu / King, Christopher S

Current pulmonology reports

2023 , Page(s) 1–8

Abstract: Purpose of review: This review delineates current diagnostic and management strategies for pulmonary hypertension due to interstitial lung disease (PH-ILD).: Recent findings: The INCREASE trial, a phase III multicenter, randomized, placebo-controlled ...

Abstract	Purpose of review: This review delineates current diagnostic and management strategies for pulmonary hypertension due to interstitial lung disease (PH-ILD). Recent findings: The INCREASE trial, a phase III multicenter, randomized, placebo-controlled trial demonstrated both improved 6-min walk distance and decreased disease progression with inhaled treprostinil. This pivotal trial led to inhaled treprostinil becoming the first FDA approved medication for treatment of PH-ILD. The availability of this treatment has generated subsequent recommendations for the screening for PH in patients with ILD. As a result, it is becoming increasingly important for clinicians to gain awareness and familiarity with the evolving management options for PH-ILD. Summary: The management of PH-ILD has its roots in goal-directed treatment of the underlying lung disease. However, recent medication advances and ongoing clinical studies are opening opportunities for more disease-specific treatment.
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2199-2428
ISSN	2199-2428
DOI	10.1007/s13665-023-00311-2
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Article ; Online: Multi-view representation learning for tabular data integration using inter-feature relationships.

Tripathi, Sandhya / Fritz, Bradley A / Abdelhack, Mohamed / Avidan, Michael S / Chen, Yixin / King, Christopher R

Journal of biomedical informatics

2024 Volume 151, Page(s) 104602

Abstract: Objective: An applied problem facing all areas of data science is harmonizing data sources. Joining data from multiple origins with unmapped and only partially overlapping features is a prerequisite to developing and testing robust, generalizable ... ...

Abstract	Objective: An applied problem facing all areas of data science is harmonizing data sources. Joining data from multiple origins with unmapped and only partially overlapping features is a prerequisite to developing and testing robust, generalizable algorithms, especially in healthcare. This integrating is usually resolved using meta-data such as feature names, which may be unavailable or ambiguous. Our goal is to design methods that create a mapping between structured tabular datasets derived from electronic health records independent of meta-data. Methods: We evaluate methods in the challenging case of numeric features without reliable and distinctive univariate summaries, such as nearly Gaussian and binary features. We assume that a small set of features are a priori mapped between two datasets, which share unknown identical features and possibly many unrelated features. Inter-feature relationships are the main source of identification which we expect. We compare the performance of contrastive learning methods for feature representations, novel partial auto-encoders, mutual-information graph optimizers, and simple statistical baselines on simulated data, public datasets, the MIMIC-III medical-record changeover, and perioperative records from before and after a medical-record system change. Performance was evaluated using both mapping of identical features and reconstruction accuracy of examples in the format of the other dataset. Results: Contrastive learning-based methods overall performed the best, often substantially beating the literature baseline in matching and reconstruction, especially in the more challenging real data experiments. Partial auto-encoder methods showed on-par matching with contrastive methods in all synthetic and some real datasets, along with good reconstruction. However, the statistical method we created performed reasonably well in many cases, with much less dependence on hyperparameter tuning. When validating feature match output in the EHR dataset we found that some mistakes were actually a surrogate or related feature as reviewed by two subject matter experts. Conclusion: In simulation studies and real-world examples, we find that inter-feature relationships are effective at identifying matching or closely related features across tabular datasets when meta-data is not available. Decoder architectures are also reasonably effective at imputing features without an exact match.
MeSH term(s)	Algorithms ; Computer Simulation ; Electronic Health Records ; Data Science ; Motivation
Language	English
Publishing date	2024-02-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2057141-0
ISSN	1532-0480 ; 1532-0464
ISSN (online)	1532-0480
ISSN	1532-0464
DOI	10.1016/j.jbi.2024.104602
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Article: Patient Satisfaction in Neurosurgery Clinic.

Wang, Alice S / Wiginton, James G / Tran, Theo / Yanez, Paulino / King, Christopher / Miulli, Dan E

Cureus

2024 Volume 16, Issue 1, Page(s) e53176

Abstract: Background: National commercial surveys are used to assess patient satisfaction. However, the information obtained does not always correspond to the clinical situation and therefore may be inadequate to help improve a specific patient experience when ... ...

Abstract	Background: National commercial surveys are used to assess patient satisfaction. However, the information obtained does not always correspond to the clinical situation and therefore may be inadequate to help improve a specific patient experience when through no fault of its design, results in low response rates and inadequate specifics. Objective: The objective is to investigate patient satisfaction using real-time in-person patient experience survey responses at the end of a neurosurgical clinic visit and review the results from these survey responses and those from national commercial survey responses provided by the hospital for the ability to affect change. Methods: This is a prospective study from October 2023 to December 2023 during which a paper copy of 10 questionnaires derived from a national commercial outpatient clinical survey was given to every unique patient who was neurologically capable of filling it out at the end of his or her neurosurgery clinic visit. The electronic medical record was used to collect patient demographics and details of the clinic visit. National commercial survey responses from July 2022 to November 2023 provided by the hospital were reviewed. Results: A total of 149 patients were seen in the neurosurgery clinic from October 2023 to December 2023, 121 patients were given the in-person patient satisfaction survey, and the response rate was 100%. The mean age was 46.5 years with females constituted 45.5% of the patient sample. The visit type included 46 (38.0%) new patients, 53 (43.8%) returning patients, and 22 (18.2%) post-op patients, of which 45.5% presented with cranial pathologies. Comparing the patient satisfaction level between those seen by one provider and those seen by two providers, such as resident, or mid-level with attending, patients seen by two providers were less satisfied with "feeling respected by the providers" (4.92 vs. 4.64, p=0.0088), "feeling listened to by the providers" (4.84 vs. 4.50, p=0.0180), and "feeling appreciated that the providers discussed illness prevention" (4.72 vs. 4.29, p=0.0232). Due to a lack of necessary information from our national commercial outpatient clinic survey responses provided by the hospital, a direct comparison between the in-person survey and our national commercial outpatient clinic survey was not made. Conclusions: Patient satisfaction surveys when not given in real-time in-person run the risk of low response rate and lack of specifics to help guide providers in quality improvement. Our data supports the use of real-time in-person patient satisfaction surveys that not only increase response rate but also provide useful information to help improve patient experience.
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.53176
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Article ; Online: Managing pulmonary arterial hypertension: how to select and facilitate successful transplantation.

Khangoora, Vikramjit S / King, Christopher S / Shlobin, Oksana A

Current opinion in organ transplantation

2022 Volume 27, Issue 3, Page(s) 169–176

Abstract: Purpose of review: Despite improvements in available medical therapies, pulmonary arterial hypertension (PAH) remains a progressive, ultimately fatal disorder. Lung transplantation is a viable treatment option for PAH patients with advanced disease.: ... ...

Abstract	Purpose of review: Despite improvements in available medical therapies, pulmonary arterial hypertension (PAH) remains a progressive, ultimately fatal disorder. Lung transplantation is a viable treatment option for PAH patients with advanced disease. Recent findings: Recent guidelines from the International Society of Heart and Lung Transplantation (ISHLT) have updated recommendations regarding time of referral and listing for lung transplantation in PAH. The new guidelines emphasize earlier referral for transplant evaluation to ensure adequate time for proper evaluation and listing. They also incorporate objective risk stratification criteria to assist in decision-making regarding timing of referral and listing. With regards to the transplant procedure, bilateral lung transplantation has largely supplanted heart-lung transplantation as the procedure of choice for transplantation for advanced PAH. Exceptions to this include patients with PAH because of congenital heart disease and those with concurrent LV dysfunction. Use of mechanical support via venoarterial ECMO initiated before transplantation and continued into the early postoperative period is emerging as a standard of care and may help to reduce early posttransplant mortality in this population. There has been increased recognition of the importance of WHO Group 3 pulmonary hypertension. Many of the lessons learned from PAH may be applied when transplanting patients with severe WHO Group 3 pulmonary hypertension. Summary: Patients with PAH present unique challenges with regards to transplantation that require a therapeutic approach distinct from other lung disorders. Lung transplantations for PAH are high-risk endeavors best performed at centers with expertise in management of both PAH and extracorporeal support.
MeSH term(s)	Extracorporeal Membrane Oxygenation ; Heart Defects, Congenital ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/surgery ; Lung Transplantation/methods ; Pulmonary Arterial Hypertension
Language	English
Publishing date	2022-05-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1390429-2
ISSN	1531-7013 ; 1087-2418
ISSN (online)	1531-7013
ISSN	1087-2418
DOI	10.1097/MOT.0000000000000980
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Article: Connective tissue disease-associated pulmonary hypertension: A comprehensive review.

Khangoora, Vikramjit / Bernstein, Elana J / King, Christopher S / Shlobin, Oksana A

Pulmonary circulation

2023 Volume 13, Issue 4, Page(s) e12276

Abstract: Connective tissue diseases (CTDs) can be associated with various forms of pulmonary hypertension, including pulmonary arterial hypertension (PAH), pulmonary veno-occlusive disease, pulmonary venous hypertension, interstitial lung disease-associated ... ...

Abstract	Connective tissue diseases (CTDs) can be associated with various forms of pulmonary hypertension, including pulmonary arterial hypertension (PAH), pulmonary veno-occlusive disease, pulmonary venous hypertension, interstitial lung disease-associated pulmonary hypertension, chronic thromboembolic pulmonary hypertension, and sometimes a combination of several processes. The prevalence of PAH varies among the different CTDs, with systemic sclerosis (SSc) having the highest at 8%-12%. The most recent European Society of Cardiology/European Respiratory Society guidelines recommend routine annual screening for PAH in SSc and CTDs with SSc features. As CTDs can be associated with a myriad of presentations of pulmonary hypertension, a thorough evaluation to include a right heart catheterization to clearly delineate the hemodynamic profile is essential in developing an appropriate treatment plan. Treatment strategies will depend on the predominant phenotype of pulmonary vasculopathy. In general, management approach to CTD-PAH mirrors that of idiopathic PAH. Despite this, outcomes of CTD-PAH are inferior to those of idiopathic PAH, with those of SSc-PAH being particularly poor. Reasons for this may include extrapulmonary manifestations of CTDs, including renal disease and gastrointestinal involvement, concurrent interstitial lung disease, and differences in the innate response of the right ventricle to increased pulmonary vascular resistance. Early referral for lung transplant evaluation of patients with CTD-PAH, particularly SSc-PAH, is recommended. It is hoped that in the near future, additional therapies may be added to the armamentarium of effective treatments for CTD-PAH. Ultimately, a better understanding of the pathogenesis of CTD-PAH will be required to develop targeted therapies for this morbid condition.
Language	English
Publishing date	2023-12-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2638089-4
ISSN	2045-8940 ; 2045-8932
ISSN (online)	2045-8940
ISSN	2045-8932
DOI	10.1002/pul2.12276
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Article ; Online: Critical care of patients with pulmonary arterial hypertension.

Aryal, Shambhu / King, Christopher S

Current opinion in pulmonary medicine

2020 Volume 26, Issue 5, Page(s) 414–421

Abstract: Purpose of review: Need for intensive care in the patient with pulmonary arterial hypertension is associated with high mortality. This review will provide an overview of causes of ICU admission for patients with pulmonary hypertension and provide ... ...

Abstract	Purpose of review: Need for intensive care in the patient with pulmonary arterial hypertension is associated with high mortality. This review will provide an overview of causes of ICU admission for patients with pulmonary hypertension and provide guidance on management. Recent findings: There is a paucity of evidence-based medical literature on management of patients with pulmonary arterial hypertension. This article will summarize the available literature and expert guidance on the topic. Patients with pulmonary arterial hypertension may require ICU care as a direct consequence of decompensated right heart failure. Alternatively, patients with pulmonary arterial hypertension may be affected by the myriad of maladies encountered every day in the ICU including acute respiratory failure, septic shock, and gastrointestinal bleeding. The treatment plan should focus on identifying and treating the cause for decompensation. In addition, optimization of right ventricular preload, reduction of right ventricular afterload, correction of hypotension and augmentation of right ventricular inotropy should be considered. Summary: The approach to ICU care of patients with pulmonary arterial hypertension requires special consideration with regard to intubation and mechanical ventilation and management of volume status and hemodynamics. Whenever possible, these patients should be transferred to centers with experience in treating this complex, vulnerable population.
MeSH term(s)	Cardiotonic Agents/therapeutic use ; Critical Care ; Gastrointestinal Hemorrhage/complications ; Gastrointestinal Hemorrhage/therapy ; Heart Failure/complications ; Heart Failure/therapy ; Hemodynamics ; Humans ; Palliative Care ; Pulmonary Arterial Hypertension/complications ; Pulmonary Arterial Hypertension/physiopathology ; Pulmonary Arterial Hypertension/therapy ; Respiration, Artificial ; Respiratory Insufficiency/complications ; Respiratory Insufficiency/therapy ; Risk Factors ; Shock, Septic/complications ; Shock, Septic/therapy ; Vasoconstrictor Agents/therapeutic use ; Vasodilator Agents/therapeutic use ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/physiopathology
Chemical Substances	Cardiotonic Agents ; Vasoconstrictor Agents ; Vasodilator Agents
Language	English
Publishing date	2020-06-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1285505-4
ISSN	1531-6971 ; 1070-5287 ; 1078-1641
ISSN (online)	1531-6971
ISSN	1070-5287 ; 1078-1641
DOI	10.1097/MCP.0000000000000713
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Article ; Online: The Trouble With Group 3 Pulmonary Hypertension in Interstitial Lung Disease: Dilemmas in Diagnosis and the Conundrum of Treatment.

King, Christopher S / Shlobin, Oksana A

Chest

2020 Volume 158, Issue 4, Page(s) 1651–1664

Abstract: Pulmonary hypertension (PH) due to interstitial lung disease (ILD; PH-ILD) can complicate a multitude of ILDs, including idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis, and nonspecific interstitial pneumonia. Development of PH-ILD is ...

Abstract	Pulmonary hypertension (PH) due to interstitial lung disease (ILD; PH-ILD) can complicate a multitude of ILDs, including idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis, and nonspecific interstitial pneumonia. Development of PH-ILD is associated with increased need for supplemental oxygen, reduced mobility, and decreased survival. A high index of suspicion is required to make the diagnosis, given the substantial overlap in symptoms with those of ILD without PH. Severely reduced diffusing capacity or 6-min walk test distance, prominent exertional desaturation, and impaired heart rate recovery after exercise are all suggestive of the development of PH-ILD. Traditional transthoracic echocardiography is the most commonly used screening test for PH-ILD, but it lacks sensitivity and specificity. Newer echocardiographic tools involving 3-dimensional assessment of the right ventricle may have a role in both prognosis and the monitoring of patients with PH-ILD. Right-sided heart catheterization remains the gold standard for confirming a diagnosis of PH-ILD. Although there is little debate about the use of supplemental oxygen and diuretic therapy in the treatment of PH-ILD, treatment with pulmonary vasodilator therapy remains controversial. Although several studies have been terminated prematurely for harm, the recently completed INCREASE trial of inhaled treprostinil appears to validate the concept of treating PH-ILD with pulmonary vasodilators and, we hope, will serve as a foundation from which future studies can be developed.
MeSH term(s)	Algorithms ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/therapy ; Lung Diseases, Interstitial/complications ; Lung Diseases, Interstitial/diagnosis ; Lung Diseases, Interstitial/therapy
Language	English
Publishing date	2020-05-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.04.046
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