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Article ; Online: Individual Variation of Spirometry Before and After Deployment From the STAMPEDE II Cohort.

Morris, Michael J / Aden, James K / Holley, Aaron B

2020 Volume 65, Issue 7, Page(s) 1053–1054

MeSH term(s)	Cohort Studies ; Humans ; Military Personnel ; Spirometry
Language	English
Publishing date	2020-06-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.07820
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Article ; Online: Response.

Collen, Jacob F / Holley, Aaron B / Moores, Lisa K

Chest

2018 Volume 154, Issue 3, Page(s) 735

MeSH term(s)	Fellowships and Scholarships ; Humans ; Mentors
Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2018.06.030
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Article ; Online: Working With a Mentor: Effective Strategies During Fellowship and Early Career.

Moores, Lisa K / Holley, Aaron B / Collen, Jacob F

Chest

2018 Volume 153, Issue 4, Page(s) 799–804

MeSH term(s)	Career Mobility ; Fellowships and Scholarships ; Humans ; Interprofessional Relations ; Mentors ; Professional Role ; Vocational Guidance
Language	English
Publishing date	2018-03-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2018.02.016
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Article ; Online: Thromboprophylaxis in Patients With COVID-19: A Brief Update to the CHEST Guideline and Expert Panel Report.

Moores, Lisa K / Tritschler, Tobias / Brosnahan, Shari / Carrier, Marc / Collen, Jacob F / Doerschug, Kevin / Holley, Aaron B / Iaccarino, Jonathan / Jimenez, David / LeGal, Gregoire / Rali, Parth / Wells, Philip

Chest

2022 Volume 162, Issue 1, Page(s) 213–225

Abstract: Background: Patients hospitalized with COVID-19 often exhibit markers of a hypercoagulable state and have an increased incidence of VTE. In response, CHEST issued rapid clinical guidance regarding prevention of VTE. Over the past 18 months the quality ... ...

Abstract	Background: Patients hospitalized with COVID-19 often exhibit markers of a hypercoagulable state and have an increased incidence of VTE. In response, CHEST issued rapid clinical guidance regarding prevention of VTE. Over the past 18 months the quality of the evidence has improved. We thus sought to incorporate this evidence and update our recommendations as necessary. Study design and methods: This update focuses on the optimal approach to thromboprophylaxis in hospitalized patients. The original questions were used to guide the search, using MEDLINE via PubMed. Eight randomized controlled trials and one observational study were included. Meta-analysis, using a random effects model, was performed. The panel created summaries using the GRADE Evidence-to-Decision framework. Updated guidance statements were drafted, and a modified Delphi approach was used to obtain consensus. Results: We provide separate guidance statements for VTE prevention for hospitalized patients with acute (moderate) illness and critically ill patients in the ICU. However, we divided each original question and resulting recommendation into two questions: standard prophylaxis vs therapeutic (or escalated dose) prophylaxis and standard prophylaxis vs intermediate dose prophylaxis. This led to a change in one recommendation, and an upgrading of three additional recommendations based upon higher quality evidence. Conclusions: Advances in care for patients with COVID-19 have improved overall outcomes. Despite this, rates of VTE in these patients remain elevated. Critically ill patients should receive standard thromboprophylaxis for VTE, and moderately ill patients with a low bleeding risk might benefit from therapeutic heparin. We see no role for intermediate dose thromboprophylaxis in either setting.
MeSH term(s)	Anticoagulants/therapeutic use ; COVID-19 ; Critical Illness ; Heparin/therapeutic use ; Humans ; Observational Studies as Topic ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
Chemical Substances	Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2022-02-12
Publishing country	United States
Document type	Meta-Analysis ; Practice Guideline ; Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2022.02.006
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Article ; Online: Split-Night Polysomnography Overestimates Apnea-Hypopnea Index in High-Risk Professions.

Rouse, Jessica K / Shirley, Sean R / Holley, Aaron B / Mysliwiec, Vincent / Walter, Robert J

Military medicine

2018 Volume 184, Issue 5-6, Page(s) e137–e140

Abstract: Introduction: According to the American Academy of Sleep Medicine (AASM) guidelines, split-night polysomnography (SN-PSG) is an acceptable alternative to full-night PSG (FN-PSG) and may be considered in patients with an apnea-hypopnea index (AHI) ≥20/hr ...

Abstract	Introduction: According to the American Academy of Sleep Medicine (AASM) guidelines, split-night polysomnography (SN-PSG) is an acceptable alternative to full-night PSG (FN-PSG) and may be considered in patients with an apnea-hypopnea index (AHI) ≥20/hr within the first 2 hours of the study. While SN-PSGs are an accurate approximation of moderate-to-severe obstructive sleep apnea (OSA), there remains the potential to misclassify the severity of sleep disordered breathing. Risks associated with the misclassification of OSA severity may be significant in high-risk professions such as active duty service members (ADSMs). The purpose of our study was to determine the accuracy of split-night polysomnography (SN-PSG) in a cohort of ADSMs. Materials and methods: We conducted a retrospective review of ADSMs undergoing FN-PSG with approval by our institution's Department of Clinical Investigation. FN-PSG data were processed using t-test, ANOVA, Chi-Squared, and logistical regression using JMP v12.0 to obtain partial-night data for the first 2 and 3 hours of recording. Significance was established with p-value less than 0.05. OSA severity was determined by calculating the AHI of each subject's FN-PSG and SN-PSG. Results: Three-hundred patients were included in the study. Overall 79% were male with a mean age of 37.6 ± 8.4 years and mean BMI of 28.5 ± 3.3 kg/m2. Of our cohort, 112 patients (37%) would have qualified for a SN-PSG, of which 94 (84%) were appropriately classified and 18 patients (16%) were misclassified. Conclusions: In the relatively young, non-obese ADSM population, the majority did not qualify for a SN-PSG. The 3-hour SN-PSG accurately determined OSA severity in those with moderate-severe OSA; however, some patients with mild OSA would have been misclassified which can result in unnecessary duty limitations. A SN-PSG may not be ideal for this population.
MeSH term(s)	Adult ; Apnea/diagnosis ; Apnea/physiopathology ; Body Mass Index ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Polysomnography/methods ; Polysomnography/standards ; Polysomnography/statistics & numerical data ; Retrospective Studies ; Severity of Illness Index ; Sleep Apnea, Obstructive/classification ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/physiopathology
Language	English
Publishing date	2018-11-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usy317
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Article ; Online: All That Glitters Is Not Gold in Pursuing the Diagnosis of Pulmonary Embolism: Response.

Moores, Lisa K / King, Christopher S / Holley, Aaron B

Chest

2012 Volume 141, Issue 1, Page(s) 277–278

Language	English
Publishing date	2012-01-15
Publishing country	United States
Document type	Letter
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1378/chest.11-2285
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Article ; Online: Study of Active Duty Military Personnel for Environmental Deployment Exposures: Pre- and Post-Deployment Spirometry (STAMPEDE II).

Morris, Michael J / Skabelund, Andrew J / Rawlins, Frederic A / Gallup, Roger A / Aden, James K / Holley, Aaron B

Respiratory care

2019 Volume 64, Issue 5, Page(s) 536–544

Abstract: Background: There is significant concern about the respiratory health of deployed military service members given the reported airborne hazards in southwest Asia, which range from geologic dusts, burn pit emissions, chemical exposures, and increased ... ...

Abstract	Background: There is significant concern about the respiratory health of deployed military service members given the reported airborne hazards in southwest Asia, which range from geologic dusts, burn pit emissions, chemical exposures, and increased rates of smoking. There has been no previous comparison of pre- and post-deployment lung function in these individuals. Methods: Military personnel who deployed to southwest Asia in support of ongoing military operations were recruited from the Soldier Readiness Processing Center at Fort Hood, Texas, from 2011 to 2014. The participants were asked to complete a brief survey on their respiratory health and perform both spirometry and impulse oscillometry studies at baseline with repeated survey and testing after deployment. Results: Of the 1,693 deployed personnel who completed baseline examinations, 843 (50%) completed post-deployment testing. Post-deployment values demonstrated no statistical or clinical change in spirometry, with an increase in mean ± SD FEV Discussion: To our knowledge, this was the first prospective evaluation of deploying military by using spirometry as an indicator for the possible development of pulmonary disease related to environmental exposures. Pre-deployment testing with spirometry and impulse oscillometry was unable to detect any significant change. In those with abnormal spirometry pre-deployment or asthma history, there was also not identifiable change that indicated worsening lung function. Conclusions: Utilization of spirometry for the deploying military population had little benefit and did not identify individuals with lung disease after deployment. Routine use was not warranted before or after deployment in the absence of pulmonary symptoms.
MeSH term(s)	Adult ; Afghan Campaign 2001- ; Female ; Forced Expiratory Volume ; Humans ; Male ; Military Personnel ; Occupational Exposure ; Oscillometry ; Prospective Studies ; Respiratory System/physiopathology ; Spirometry ; Surveys and Questionnaires ; United States ; Vital Capacity ; Young Adult
Language	English
Publishing date	2019-01-08
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.06396
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Article ; Online: Moving toward a more ideal anticoagulant: the oral direct thrombin and factor Xa inhibitors.

King, Christopher S / Holley, Aaron B / Moores, Lisa K

Chest

2013 Volume 143, Issue 4, Page(s) 1106–1116

Abstract: Thromboembolic diseases are common. Heparins and the vitamin K antagonists have been the mainstay ... as effective and safe as heparin and vitamin K antagonists but should also be available in both a parenteral ...

Abstract	Thromboembolic diseases are common. Heparins and the vitamin K antagonists have been the mainstay of therapy for > 60 years, but both classes of agents have limitations. The "ideal" anticoagulant should be as effective and safe as heparin and vitamin K antagonists but should also be available in both a parenteral and an oral formulation, have predictable pharmacokinetics, and lack significant toxicities unrelated to the anticoagulant activity. Moreover, it should target a specific coagulation factor and have an antidote that leads to rapid reversal. There are now agents that fulfill some of these criteria. Here we review the pharmacology and effectiveness of the oral activated factor X inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran. These agents have undergone extensive phase 3 testing and are currently approved for various indications in the United States, Canada, or Europe. Rivaroxaban is approved in the United States for VTE prevention after major orthopedic surgery and for stroke prevention in atrial fibrillation and is approved in Europe and Canada for secondary prevention of VTE. Apixaban is currently under review by the US Food and Drug Administration for stroke prevention and is approved in Europe for VTE prevention following major orthopedic surgery. Dabigatran is approved in the United States for stroke prevention in nonvalvular atrial fibrillation and is being reviewed for secondary prevention of VTE.
MeSH term(s)	Administration, Oral ; Anticoagulants/administration & dosage ; Anticoagulants/therapeutic use ; Benzimidazoles/administration & dosage ; Benzimidazoles/therapeutic use ; Dabigatran ; Factor Xa Inhibitors ; Humans ; Morpholines/administration & dosage ; Morpholines/therapeutic use ; Pulmonary Embolism/prevention & control ; Pyrazoles/administration & dosage ; Pyrazoles/therapeutic use ; Pyridones/administration & dosage ; Pyridones/therapeutic use ; Rivaroxaban ; Thiophenes/administration & dosage ; Thiophenes/therapeutic use ; Thrombin/antagonists & inhibitors ; beta-Alanine/administration & dosage ; beta-Alanine/analogs & derivatives ; beta-Alanine/therapeutic use
Chemical Substances	Anticoagulants ; Benzimidazoles ; Factor Xa Inhibitors ; Morpholines ; Pyrazoles ; Pyridones ; Thiophenes ; beta-Alanine (11P2JDE17B) ; apixaban (3Z9Y7UWC1J) ; Rivaroxaban (9NDF7JZ4M3) ; Thrombin (EC 3.4.21.5) ; Dabigatran (I0VM4M70GC)
Language	English
Publishing date	2013-04
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	10.1378/chest.12-1362
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Article ; Online: Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report.

Moores, Lisa K / Tritschler, Tobias / Brosnahan, Shari / Carrier, Marc / Collen, Jacob F / Doerschug, Kevin / Holley, Aaron B / Jimenez, David / Le Gal, Gregoire / Rali, Parth / Wells, Philip

Chest

2020 Volume 158, Issue 3, Page(s) 1143–1163

Abstract: Background: Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated by a significant coagulopathy, that likely manifests in the form of both microthrombosis and VTE. This recognition has led to the urgent need for ... ...

Abstract	Background: Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated by a significant coagulopathy, that likely manifests in the form of both microthrombosis and VTE. This recognition has led to the urgent need for practical guidance regarding prevention, diagnosis, and treatment of VTE. Methods: A group of approved panelists developed key clinical questions by using the PICO (Population, Intervention, Comparator, Outcome) format that addressed urgent clinical questions regarding the prevention, diagnosis, and treatment of VTE in patients with COVID-19. MEDLINE (via PubMed or Ovid), Embase, and Cochrane Controlled Register of Trials were systematically searched for relevant literature, and references were screened for inclusion. Validated evaluation tools were used to grade the level of evidence to support each recommendation. When evidence did not exist, guidance was developed based on consensus using the modified Delphi process. Results: The systematic review and critical analysis of the literature based on 13 Population, Intervention, Comparator, Outcome questions resulted in 22 statements. Very little evidence exists in the COVID-19 population. The panel thus used expert consensus and existing evidence-based guidelines to craft the guidance statements. Conclusions: The evidence on the optimal strategies to prevent, diagnose, and treat VTE in patients with COVID-19 is sparse but rapidly evolving.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Consensus ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Evidence-Based Medicine/standards ; Humans ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Venous Thromboembolism/diagnosis ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
Keywords	covid19
Language	English
Publishing date	2020-06-02
Publishing country	United States
Document type	Practice Guideline ; Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.05.559
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Article ; Online: Acute Kidney Injury During Hospitalization Increases the Risk of VTE.

McMahon, Maj Michael J / Collen, Col Jacob F / Chung, Col Kevin K / Stewart, Ltc Ian J / Al-Eid, Lcdr Haydar M / Moores, Col R Lisa K / Holley, Col Aaron B

Chest

2020 Volume 159, Issue 2, Page(s) 772–780

Abstract: Background: Kidney disease has been linked to risk for hospitalization-related (HR) VTE, but the effect size and differences across types of kidney disease are described poorly.: Research question: Can the risk for HR VTE among patients with acute ... ...

Abstract	Background: Kidney disease has been linked to risk for hospitalization-related (HR) VTE, but the effect size and differences across types of kidney disease are described poorly. Research question: Can the risk for HR VTE among patients with acute kidney injury (AKI) and chronic kidney disease be quantified, and if so, how? Study design and methods: We prospectively collected data on hospitalized adult patients and documented HR VTE events. We recorded creatinine clearance (CrCl) daily throughout hospitalization and modeled the effects that admission CrCl, peak CrCl, average CrCl, and AKI had on HR VTE. We controlled for known VTE risk factors and daily administration of chemoprophylaxis. Results: Of the 6,552 admissions that met our inclusion criteria, 184 (2.81%) patients experienced an HR VTE. Surgery, AKI, chemical prophylaxis, and admission albumin all were associated with HR VTE in univariate analysis, but neither admission CrCl nor average CrCl (throughout the hospitalization) increased the odds of HR VTE. Kaplan-Meier curves showed AKI, whether it occurred before or during the hospitalization, was associated significantly with time to HR VTE. Cox regression analysis found that AKI was associated independently with HR VTE, as was surgery during admission, enoxaparin dose, and admission albumin. Sensitivity analyses showed that AKI lost significance when only patients with traumatic injuries were assessed. Interpretation: We found that AKI increases the risk for HR VTE in a large, heterogeneous population that included medical and surgical patients. However, this relationship was not seen in patients with traumatic injuries.
MeSH term(s)	Acute Kidney Injury/complications ; Aged ; Anticoagulants/therapeutic use ; Biomarkers/blood ; Chemoprevention ; Creatinine/blood ; Female ; Hospitalization ; Humans ; Kidney Function Tests ; Male ; Middle Aged ; Risk Factors ; Serum Albumin ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
Chemical Substances	Anticoagulants ; Biomarkers ; Serum Albumin ; Creatinine (AYI8EX34EU)
Language	English
Publishing date	2020-10-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.09.257
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