Browsing by Author "Matson, Scott M."

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    Treatment outcomes for rheumatoid arthritis associated interstitial lung disease; a real-world, multisite study of the impact of immunosuppression on pulmonary function trajectory
    (Elsevier, 2023-04) Matson, Scott M.; Baqir, Misbah; Moua, Teng; Marll, Michael; Kent, Jessica; Iannazzo, Nicholas S.; Boente, Ryan D.; Donatelli, John M.; Dai, Junqiang; Diaz, Francisco J.; Demoruelle, M. Kristen; Hamblin, Mark B.; Mathai, Susan K.; Ryu, Jay H.; Pope, Kristen; Walker, Christopher M.; Lee, Joyce S.; Medicine, School of Medicine
    Background Rheumatoid arthritis (RA) associated interstitial lung disease (ILD) is common in patients with RA and leads to significant morbidity and mortality. There are no randomized, placebo-controlled data to support the role of immunosuppression to treat RA-ILD despite being widely used in clinical practice. Research Question How does immunosuppression impact pulmonary function trajectory in a multi-site retrospective cohort of RA-ILD patients? Study Design and Methods Patients with RA who started treatment for ILD with mycophenolate, azathioprine, or rituximab were retrospectively identified from five ILD centers. Change in lung function before and after treatment was analyzed using a linear spline mixed effect model with random intercept. Prespecified secondary analyses examined the impact of radiologic pattern of ILD (i.e., usual interstitial pneumonia [UIP] vs non-UIP) on treatment trajectory. Results 212 patients were included in the analysis: 92 (43.4%) were treated with azathioprine, 77 (36.3%) with mycophenolate mofetil and 43 (20.3%) with rituximab. In the combined analysis of all three agents, there was an improvement in forced vital capacity (FVC) % predicted after 12 months of treatment compared to the potential 12-month response without treatment [+3.90%, p=< 0.001; 95% CI, (1.95, 5.84)]. Diffusing capacity for carbon monoxide (DLCO) % predicted also improved at 12 months [+4.53%, p=<0.001; (2.12, 6.94)]. Neither the UIP pattern of ILD or choice of immunosuppressive agent significantly impacted the pulmonary function trajectory on immunosuppression. Interpretation Immunosuppression was associated with an improved trajectory in FVC and DLCO compared to the pre-treatment pulmonary function trajectory. Prospective, randomized trials are required to validate these findings.
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    Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey
    (Wolters Kluwer, 2022) Burns, Karen E.A.; Moss, Marc; Lorens, Edmund; Jose, Elizabeth Karin Ann; Martin, Claudio M.; Viglianti, Elizabeth M.; Fox-Robichaud, Alison; Mathews, Kusum S.; Akgun, Kathleen; Jain, Snigdha; Gershengorn, Hayley; Mehta, Sangeeta; Han, Jenny E.; Martin, Gregory S.; Liebler, Janice M.; Stapleton, Renee D.; Trachuk, Polina; Vranas, Kelly C.; Chua, Abigail; Herridge, Margaret S.; Tsang, Jennifer L.Y.; Biehl, Michelle; Burnham, Ellen L.; Chen, Jen-Ting; Attia, Engi F.; Mohamed, Amira; Harkins, Michelle S.; Soriano, Sheryll M.; Maddux, Aline; West, Julia C.; Badke, Andrew R.; Bagshaw, Sean M.; Binnie, Alexandra; Carlos, W. Graham; Çoruh, Başak; Crothers, Kristina; D'Aragon, Frederick; Denson, Joshua Lee; Drover, John W.; Eschun, Gregg; Geagea, Anna; Griesdale, Donald; Hadler, Rachel; Hancock, Jennifer; Hasmatali, Jovan; Kaul, Bhavika; Kerlin, Meeta Prasad; Kohn, Rachel; Kutsogiannis, D. James; Matson, Scott M.; Morris, Peter E.; Paunovic, Bojan; Peltan, Ithan D.; Piquette, Dominique; Pirzadeh, Mina; Pulchan, Krishna; Schnapp, Lynn M.; Sessler, Curtis N.; Smith, Heather; Sy, Eric; Thirugnanam, Subarna; McDonald, Rachel K.; McPherson, Katie A.; Kraft, Monica; Spiegel, Michelle; Dodek, Peter M.; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society; Medicine, School of Medicine
    Objectives: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. Design: Cross-sectional survey using four validated instruments. Setting: Sixty-two sites in Canada and the United States. Subjects: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. Intervention: None. Measurements and main results: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. Conclusions: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.