Publications by authors named "Jamuna Krishnan"

Background: Systemic sclerosis is a chronic and rare connective tissue disease with multiorgan effects, including interstitial lung disease (ILD). Navigating systemic sclerosis-interstitial lung disease presents a challenge for patients due to the gaps in patient education, which can impact patient health and quality of life. This study utilized the nominal group technique to identify priority knowledge gaps among patients with systemic sclerosis-interstitial lung disease and inform future educational interventions and research.

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  • The study explores the current practices and attitudes of interstitial lung disease (ILD) clinicians towards improving health-related quality of life (HRQOL) for patients with Hypersensitivity Pneumonitis (HP).
  • Nearly all respondents (100%) believe that interventions to enhance HRQOL are essential, but only 5% currently use validated HRQOL assessment tools.
  • Most clinicians reported limited knowledge of behavioral interventions, such as peer coaching and cognitive behavioral therapy (CBT), yet a significant majority expressed a desire to educate patients about these methods and reinforce them post-treatment.
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  • The study aimed to address the impact of knowledge gaps on patients' quality of life regarding hypersensitivity pneumonitis (HP) by identifying what information they feel is most lacking.
  • It involved 21 English-speaking patients with HP participating in virtual group sessions to prioritize their information needs.
  • The main knowledge gaps identified were about the disease's natural history, treatment options, epidemiology, coping strategies, symptom management, exposure mitigation, and educational methods for spreading awareness about HP.
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Background: Patients with chronic obstructive pulmonary disease (COPD) often develop other morbidities, suggesting a systemic component to this disease. This retrospective noninterventional cohort study investigated relationships between multimorbidities in COPD and their impact on COPD exacerbations and COPD-related health care resource utilization (HCRU) using real-world evidence from Optum's de-identified Clinformatics® Data Mart Database.

Methods: Demographic and clinical characteristics were assessed.

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Rationale And Objective: Disease-specific health-related quality of life (HRQOL) instruments enable us to capture domains that are most relevant to specific patient populations and are useful when a more individualised approach to patient assessment is desired. In this study, we assessed the validity and reliability of the first instrument specifically developed to measure HRQOL in hypersensitivity pneumonitis (HP).

Methods: A 39-item HP-HRQOL instrument and several anchors were collected from a cohort of patients with HP.

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Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women.

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Most patients with chronic obstructive pulmonary disease (COPD) have at least one additional, clinically relevant chronic disease. Those with the most severe airflow obstruction will die from respiratory failure, but most patients with COPD die from non-respiratory disorders, particularly cardiovascular diseases and cancer. As many chronic diseases have shared risk factors (eg, ageing, smoking, pollution, inactivity, and poverty), we argue that a shift from the current paradigm in which COPD is considered as a single disease with comorbidities, to one in which COPD is considered as part of a multimorbid state-with co-occurring diseases potentially sharing pathobiological mechanisms-is needed to advance disease prevention, diagnosis, and management.

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Rationale: Cardiovascular disease (CVD) affects the prognosis of patients with chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown.

Objectives: We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing health care utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD study sub-cohort.

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  • Fatigue is a significant issue for individuals with interstitial lung disease (ILD), but research on this symptom is limited, hindering the development of treatment interventions.
  • The study aimed to evaluate the Fatigue Severity Scale (FSS) for measuring fatigue in ILD patients by testing its reliability and validity among 1,881 participants in the Pulmonary Fibrosis Foundation Patient Registry.
  • Findings indicate that the FSS has high internal consistency and moderate to strong correlations with certain patient-reported outcomes, but weak correlations with objective physiological measures, highlighting that fatigue is a crucial patient-centered outcome that is not effectively gauged by conventional disease metrics.
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Background: Critical care trainees were integral in the coronavirus disease (COVID-19) pandemic response. Several perspective pieces have provided insight into the pandemic's impact on critical care training. Surveys of program directors and critical care trainees have focused on curricular impact.

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  • The study investigates race- and sex-based differences in mortality among individuals with chronic obstructive pulmonary disease (COPD) using Medicare claims from the REGARDS cohort.
  • The findings reveal no significant differences in overall mortality rates between Black and White individuals with COPD, but cardiovascular disease (CVD) was identified as the leading cause of death across all groups.
  • Specifically, Black women with COPD showed a significantly higher risk of CVD-related mortality compared to White women, highlighting the need for targeted management of CVD comorbidities among Black patients to improve health outcomes.
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Background: It is not known whether an intervention using real-time provider teaching in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) improves provider knowledge and/or patient outcomes.

Objective: To pilot the combination of a novel, real-time provider teaching intervention delivered by subspecialists to Internal Medicine trainees with a traditional patient education and medication reconciliation (PEMR) intervention and to assess the impact of these interventions on provider knowledge regarding COPD and patient care.

Methods: This was a single-center, nonrandomized, quality-improvement study.

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  • The study examined different management strategies for patients with acute respiratory failure (ARF) due to Covid-19, focusing on prolonged observation versus early invasive mechanical ventilation (IMV).
  • Among 632 patients analyzed, early IMV had a 24% mortality rate, while prolonged observation had a 28% mortality rate, with prolonged observation showing lower mortality at lower modified sequential organ failure assessment (mSOFA) scores.
  • The findings suggest that prolonged observation may reduce mortality in patients with lower mSOFA scores, but carries increased risks for those with higher scores compared to early IMV.
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  • * The study analyzed symptom variability using within-subject standard deviation (WS-SD) based on daily questionnaires from participants in the SPIROMICS Exacerbations sub-study, finding that those with higher variability scored worse on quality of life assessments.
  • * WS-SD is a reliable measure of symptom variability in COPD and indicates that greater variability is linked to poorer health-related quality of life, suggesting it needs further validation for clinical relevance.
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African American individuals have worse outcomes in chronic obstructive pulmonary disease (COPD). To assess whether race-specific approaches for estimating lung function contribute to racial inequities by failing to recognize pathological decrements and considering them normal. In a cohort with and at risk for COPD, we assessed whether lung function prediction equations applied in a race-specific versus universal manner better modeled the relationship between FEV, FVC, and other COPD outcomes, including the COPD Assessment Test, St.

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Objective: The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals.

Methods: This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge.

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Psychiatrists rely on language and speech behavior as one of the main clues in psychiatric diagnosis. Descriptive psychopathology and phenomenology form the basis of a common language used by psychiatrists to describe abnormal mental states. This conventional technique of clinical observation informed early studies on disturbances of thought form, speech, and language observed in psychosis and schizophrenia.

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Objective: To explore key sources of stress experienced during training by psychiatry registrars and identify which coping strategies they found helpful or unhelpful.

Method: We used three data sources: a) 'stress' vignettes written by Stage 3 trainees; b) minutes of regular registrar meetings; c) focus groups. We analysed these using abbreviated grounded theory, generating themes.

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  • * The Society of Hospital Medicine advises a protocol-driven approach to discontinuing telemetry monitoring, while the American Heart Association (AHA) has updated Practice Standards for appropriate use, although they are not widely followed.
  • * The text offers an overview of the AHA standards' safety and efficacy, reviews successful case studies for implementation, and provides a blueprint for health care professionals to improve telemetry use in their institutions.
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