Browsing by Author "Acra, Sari"

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    Development and Validation of Web-Based Tool to Predict Lamina Propria Fibrosis in Eosinophilic Esophagitis
    (Wolters Kluwer, 2022) Hiremath, Girish; Sun, Lili; Correa, Hernan; Acra, Sari; Collins, Margaret H.; Bonis, Peter; Arva, Nicoleta C.; Capocelli, Kelley E.; Falk, Gary W.; King, Eileen; Gonsalves, Nirmala; Gupta, Sandeep K.; Hirano, Ikuo; Mukkada, Vincent A.; Martin, Lisa J.; Putnam, Philip E.; Spergel, Jonathan M.; Wechsler, Joshua B.; Yang, Guang-Yu; Aceves, Seema S.; Furuta, Glenn T.; Rothenberg, Marc E.; Koyama, Tatsuki; Dellon, Evan S.; Medicine, School of Medicine
    Introduction: Approximately half of esophageal biopsies from patients with eosinophilic esophagitis (EoE) contain inadequate lamina propria, making it impossible to determine the lamina propria fibrosis (LPF). This study aimed to develop and validate a web-based tool to predict LPF in esophageal biopsies with inadequate lamina propria. Methods: Prospectively collected demographic and clinical data and scores for 7 relevant EoE histology scoring system epithelial features from patients with EoE participating in the Consortium of Eosinophilic Gastrointestinal Disease Researchers observational study were used to build the models. Using the least absolute shrinkage and selection operator method, variables strongly associated with LPF were identified. Logistic regression was used to develop models to predict grade and stage of LPF. The grade model was validated using an independent data set. Results: Of 284 patients in the discovery data set, median age (quartiles) was 16 (8-31) years, 68.7% were male patients, and 93.4% were White. Age of the patient, basal zone hyperplasia, dyskeratotic epithelial cells, and surface epithelial alteration were associated with presence of LPF. The area under the receiver operating characteristic curve for the grade model was 0.84 (95% confidence interval: 0.80-0.89) and for stage model was 0.79 (95% confidence interval: 0.74-0.84). Our grade model had 82% accuracy in predicting the presence of LPF in an external validation data set. Discussion: We developed parsimonious models (grade and stage) to predict presence of LPF in esophageal biopsies with inadequate lamina propria and validated our grade model. Our predictive models can be easily used in the clinical setting to include LPF in clinical decisions and determine its effect on treatment outcomes.
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    Structure and Functions of Pediatric Aerodigestive Programs: A Consensus Statement
    (AAP, 2018-03) Boesch, R. Paul; Balakrishnan, Karthik; Acra, Sari; Benscoter, Dan T.; Cofer, Shelagh A.; Collaco, Joseph M.; Dahl, John P.; Daines, Cori L.; DeAlarcon, Alessandro; DeBoer, Emily M.; Deterding, Robin R.; Friedlander, Joel A.; Gold, Benjamin D.; Grothe, Rayna M.; Hart, Catherine K.; Kazachkov, Mikhail; Lefton-Greif, Maureen A.; Miller, Claire Kane; Moore, Paul E.; Pentiuk, Scott; Peterson-Carmichael, Stacey; Piccione, Joseph; Prager, Jeremy D.; Putnam, Philip E.; Rosen, Rachel; Rutter, Michael J.; Ryan, Matthew J.; Skinner, Margaret L.; Torres-Silva, Cherie; Wootten, Christopher T.; Zur, Karen B.; Cotton, Robin T.; Wood, Robert E.; Pediatrics, School of Medicine
    Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or acquired conditions affecting breathing, swallowing, and growth. Although there has been a proliferation of programs, as well as national meetings, interest groups and early research activity, there is, as of yet, no consensus definition of an aerodigestive patient, standardized structure, and functions of an aerodigestive program or a blueprint for research prioritization. The Delphi method was used by a multidisciplinary and multi-institutional panel of aerodigestive providers to obtain consensus on 4 broad content areas related to aerodigestive care: (1) definition of an aerodigestive patient, (2) essential construct and functions of an aerodigestive program, (3) identification of aerodigestive research priorities, and (4) evaluation and recognition of aerodigestive programs and future directions. After 3 iterations of survey, consensus was obtained by either a supermajority of 75% or stability in median ranking on 33 of 36 items. This included a standard definition of an aerodigestive patient, level of participation of specific pediatric disciplines in a program, essential components of the care cycle and functions of the program, feeding and swallowing assessment and therapy, procedural scope and volume, research priorities and outcome measures, certification, coding, and funding. We propose the first consensus definition of the aerodigestive care model with specific recommendations regarding associated personnel, infrastructure, research, and outcome measures. We hope that this may provide an initial framework to further standardize care, develop clinical guidelines, and improve outcomes for aerodigestive patients.