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Division of Pulmonary, Critical Care and Sleep Medicine
Pulmonary Disease & Critical Care Medicine Fellowship




 


DIVISION & FELLOWSHIP RESEARCH  PROGRAM

Division Research and Clinical Trials Page

University & Medical Center Institutional Review Board Page

CURRENT SPONSORED CLINICAL TRIALS

PAH QuERI Extension Program – Principal Investigator: Dr. Rehman - 9 patients enrolled

Description: This is a prospective, U.S.-based, multi-center, knowledge translation program tracking patient management over the course of 3 years. The objective of this program is to improve the management of PAH patients through an evidence-based approach aimed at achieving optimal World Health Organization (WHO) functional class (FC) defined as: 1) improvement of FC III or IV to FC II; 2) improvement of FC II to FC I; or 3) maintaining FC II or I. Eligible patients who agree to participate and sign the informed consent will be treated by their physician with a goal of achieving optimal care, as dictated by their standard of care and individual patient's care needs. Information on treatment will be captured at least every 6 months (±2 months) using the Remote Data Entry Platform. All patients will be assessed for: vital signs (blood pressure and heart rate), WHO functional class, and PAH specific and other treatment(s) documented, as part of routine patient care. Patients will be prescribed commercially available medications by their physicians according to a treatment strategy which they believe is in the best interest of their patient. Approximately 800 PAH patients from approximately 80 physician practices will be included in the program. Locally, we anticipate enrolling 10 patients with the possibility of enrolling additional patients with the written approval by the sponsor.

A Phase 2a, Randomized, Double-Blind, Placebo-Controlled, Multicenter, Parallel Group Study of JNJ-38518168 in Symptomatic Adult Subjects with Uncontrolled, Persistent Asthma – Principal Investigator: Dr. Butt - Currently awaiting IRB approval (possibly will make the June 26th meeting)

Description: This is a Phase 2a, multicenter, randomized, double-blind, placebo-controlled, parallel-group, proof-of-concept (POC) study designed to assess the safety and efficacy of JNJ-38518168 which is orally administered to subjects with uncontrolled, eosinophilic, persistent asthma that is inadequately controlled despite current therapy. A total of 160 subjects will be randomized (approximately 80 subjects per group). Subjects are randomly assigned in a 1:1 ratio to receive either placebo or 30 mg of the investigational study agent, JNJ-38518168, once daily through week 24. We anticipate on enrolling approximately 10 subjects locally at ECU.

The study will enroll asthmatic subjects who remain uncontrolled on standard of care (ICS ± LABA ± montelukast). The study will be approximately 32 weeks in duration which is comprised of a screening phase of approximately 4 weeks, a 24-week placebo-controlled treatment phase, and a 4-week follow-up phase. The end of the study is defined as the last follow-up visit of the last subject.

The primary objective is to assess the efficacy (as measured by the change from baseline in prebronchodilator percent-predicted forced expiratory volume in 1 second [FEV1]) of JNJ-38518168 compared with placebo in subjects with eosinophilic persistent asthma that is inadequately controlled despite current treatment. In addition, the secondary objectives are to assess the safety, efficacy (as measured by improvement in asthma control), tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of JNJ-38518168 compared with placebo in subjects with eosinophilic persistent asthma that is inadequately controlled despite current treatment.

The primary hypothesis is that JNJ-38518168 is superior to placebo as measured by the change from baseline in pre-bronchodilator percent-predicted FEV1 at Week 16 in subjects with uncontrolled, eosinophilic, persistent asthma who are inadequately controlled despite current treatment (ICS ± LABA ± montelukast).

Clinical Outcomes Study in Subjects with moderate Chronic Obstructive Pulmonary Disease (COPD). Principal Investigator – Dr. Bowling. IRB Meeting on June 12th

Description: The purpose of this research study is to test the long term effects of fluticasone furoate and vilanterol combination in comparison to fluticasone furoate (FF) alone (a drug approved by the FDA to reduce symptoms of nasal allergies by reducing inflammation), vilanterol (VI) alone (an investigational drug that can relax muscles around the air passages, allowing them to open up) and placebo (inactive substance which looks the same as the active medicine, but contains no active drug) in reducing pulmonary and cardiovascular complications, including death, in subjects with COPD. By doing this research, we hope to learn the effectiveness of these medications in the long term treatment of COPD.

The primary objective of this study is to prospectively evaluate the effect of Fluticasone Furoate (FF)/Vilanterol (VI) inhalation powder 100/25mcg QD compared with placebo on survival in subjects with moderate COPD (≥50 and ≤70 % predicted FEV1) and a history of, or at increased risk for developing, cardiovascular disease.

This is a randomized, double-blind, parallel-group, multi-center, placebo-controlled study to evaluate the long term efficacy and safety of FF/VI Inhalation powder 100/25mcg QD, FF Inhalation powder 100mcg QD and VI Inhalation powder 25mcg QD when administered via the Novel Dry Powder Inhaler. Once daily dosing will occur in the morning (with the exception of the first treatment visit).

The target enrolment is approximately 16,000 randomized subjects at approximately 1100 study centers globally. We plan to enroll approximately 20 patients locally at our site. Based on current assumptions of the event rate, the total duration of subject participation will be approximately between 15 and 44 months, consisting of a 4-10 day run-in period, variable treatment period and a 1-week follow-up period. Subjects will be randomized to treatment after a 4-10 day run-in period. Prior to the Run-in period, subjects will discontinue the use of specific COPD medications.

A RANDOMIZED, OPEN-LABEL, MULTICENTER, CONTROLLED STUDY TO ASSESS SAFETY AND EFFICACY OF ELAD® IN SUBJECTS WITH ALCOHOLINDUCED LIVER DECOMPENSATION (AILD) – Principal Investigator: Dr. McCarthy - Awaiting ancillary committee review

Description: This research is being done to determine the safety and the effectiveness (how well the system works) of the ELAD® system. The ELAD system is experimental, and it is not an approved "treatment" for any disease or medical condition.

Patients enrolled will be in the hospital and are experiencing signs and symptoms of Alcohol-Induced Liver Decompensation (AILD). AILD is a worsening of the chronic liver disease.

ELAD is designed to provide liver support continuously to a subject with liver failure, allowing time for the subject's own liver to regenerate or to stabilize. The ELAD system is similar to kidney hemodialysis (the procedure where waste products normally removed by the kidney are removed from the blood by passing the blood through a special filter in patients with kidney failure). ELAD is different than kidney dialysis in that blood will be passed through a filter separating out some of the liquid in the blood making what is called "ultrafiltrate". The ultrafiltrate is then passed through four cartridges containing live human liver cells grown in a laboratory. Once the ultrafiltrate passes through the cartridges, it is returned to the patient by the system. The liver cells in the cartridges may be able to provide some of the vital functions that a normal healthy liver performs such as the breakdown of certain waste products and harmful chemicals or toxins and the making of essential proteins, thereby possibly providing temporary liver function to the patient.

The substudy that is voluntary that is related to the study is for tracking economic data of subjects participating in the protocol VTI-208. The impact of ELAD must be assessed financially by looking at the length of hospital stay, hospital charges, and the number and costs of revisits after hospital discharge. Only those patients enrolled in the ELAD main study can participate in the substudy.

A Multi-Center, Randomized, Controlled, Pivotal Study To Assess the Safety and Efficacy of A Selective Cytopheretic Device (SCD) In Patients with Acute Kidney Injury (AKI) Principal Investigator – Dr. McCarthy

Description: This is a pivotal study that will evaluate the clinical and statistical improvement on all-cause mortality through Day 60 post randomization of Continuous Renal Replacement Therapy (CRRT) + Selective Cytopheretic Device (SCD) treatment compared to CRRT alone. To assess the effect of SCD treatment on various measures of patient clinical outcome and to evaluate the integrity of the SCD-ARF and patient safety in SCD treatments from the time of initiation of therapy to as many as seven consecutive 24-hour SCD treatments.

RESEARCH CURRICULUM                           

COMPONENTS

The research curriculum has several components:

  1. Research Projects
  2. Research Rotations
  3. Presentations
  4. Journal Clubs
  5. Lecture Series
  6. Publications
  7. National Meetings

OVERVIEW

In addition to clinical training, fellows will participate in the division research program and complete a minimum of 6 blocks of research time. There are a wide variety of potential projects ranging from basic science in the Lung Cell Biology Law4boratory to clinical studies to epidemiological studies. During the first year the fellow will choose a mentor and begin working on a research program. In addition to longitudinal big picture projects there are a number of different smaller projects that can be accomplished during the time the fellow is on the clinical services. As a minimum, each fellow is expected to present their work in progress at the monthly research meeting and to prepare and present at least one abstract at a national meeting as well as yearly presentations at the Internal Medicine Research Day. The fellow will be expected to make a presentation at the end of each research block.

FELLOWSHIP RESEARCH OUTPUT  (TO BE UPDATED JUNE 2013)

ABSTRACTS PUBLISHED AND PRESENTED BY FELLOWS
JULY THROUGH DECEMBER 2010
AlbustamiOM, Tribble RW; Petit SJ; Huizar I, Sharma S. Obstructive Sleep Apnea Risk Factors and Postoperative Complications in Patients Undergoing Elective Coronary Artery Bypass Graft Surgery. Chest. 2010; 138:502A.
Barber LC, Lee NS; Kataria Y; Kavuru M, Arce S.Correlations Between T Cell Levels of NF-kB/p65 Protein and Variables of Disease Activity in Sarcoidosis. Chest2010; 138: 740A.
Green DE, Bangley C, Pancoast TC, Mazer M. Barriers to the Paired Use of Standard Spontaneous Awakening Trials and Spontaneous Breathing Trials To Improve Outcomes in a Community Hospital. Chest 2010; 138: 301A.
Islam MM, Albustami OM, Judy JS, Sharma S. Clinical Predictors of Obstructive Sleep Apnea in Patients With BMI Greater Than or Equal to 35. Chest 2010; 138: 610A.
Rahman KY, Barber L, Huizar I, Shaw R.Acute Lung Injury in Minimally Invasive Mitral Valve Repair Surgery: Identifying Patients at High Risk for Acute Respiratory Failure Following the Surgery. Chest2010; 138: 498A.

PAPERS PUBLISHED WITH FELLOW AS AUTHOR OR COAUTHOR

JULY 2009 THROUGH JUNE 2010

Dawson BC, Kasa D, Mazer MA.Pancreatic pseudocyst rupture into the portal vein. South Med J. 2009 Jul;102(7):728-32.

ABSTRACTS PUBLISHED AND PRESENTED BY FELLOWS
JULY 2009 THROUGH JUNE 2010
Lodeserto, Frank, Hadi Chohan, Kurian D. Kasa, and Thomson C. Pancoast. Accuracy of daily weights and fluid balance in medical intensive care unit patients with the intervention of electronic medical records and electronic bedside weight measurements. Chest Meeting Abstracts 2009 136: 15S. Chest 2009, October 31 - November 5, 2009 San Diego, CA

Barber, Laura C. and Mark A. Mazer. Head of bed angle effects tidal volume in mechanically ventilated patients in the intensive care unit. Chest Meeting Abstracts 2009 136: 16S-g. Chest 2009, October 31 - November 5, 2009 San Diego, CA.

Kanchwala, Ali A., Hiren Mehta, Tatsiana Valasiuk, Kate Hensley, and Maria Javaid. Facial vein thrombophlebitis in a patient with herpes zoster involving the mandibular distribution of the trigeminal nerve. Chest Meeting Abstracts 2009 136: 13S-e. Chest 2009, October 31 - November 5, 2009 San Diego, CA.

Kanchwala, Ali A., Barbara P. Barna, Ravinder J. Singh, Daniel A. Culver, Anagha Malur, Susamma Abraham, Irene Marshall, Mani Kavuru, and Mary J. Thomassen. Deficiencies of cathelicidin and vitamin d accompany disease severity in sarcoidosis. Chest Meeting Abstracts 2009 136: 127S-a. Chest 2009, October 31 - November 5, 2009 San Diego, CA.

Kanchwala, Ali A., Obaid Awan, and Maria Javiad  coexistence of hereditary hemorrhagic telangiectasia and rheumatoid arthritis in a young man with normal parental genotype. Chest Meeting Abstracts 2009 136: 20S-d-21S-d. Chest 2009, October 31 - November 5, 2009 San Diego, CA.

REGIONAL & LOCAL POSTERS & PRESENTATIONS BY FELLOWS
JULY 2009 THROUGH JUNE 2010
Chagarlamudi, Arjun, Charles Bangley; Hadi Chohan; Frank Lodeserto; Kurian Kasa; Thomson Pancoast. Walk It Off: Improved Ventilator Outcomes With Ambulation by Implementing a Multidisciplinary Approach in a Specialized Respiratory Unit. American College of Physicians North Carolina Chapter 2010 Scientific Session, January 29-30, 2010.

Lodeseto, Frank, Hadi Chohan, Kurian Kasa, Thomson Pancoast. Wet or Dry? How Are We Doing Monitoring Fluid Balance in Hospitalized Patients With the Use of the Electronic Medical Records? American College of Physicians North Carolina Chapter 2010 Scientific Session, January 29-30, 2010.

Chohan, Hadi; Frank Lodeserto; Kurian D. Kasa; Thomson Pancoast. Furosemide Within Twenty Four Hours Prior to Extubation Improves Outcomes in Mechanically Ventilated Patients. American College of Physicians North Carolina Chapter 2010 Scientific Session, January 29-30, 2010.

Islam M, Pancoast T, Bangley C. Experience And Outcomes With An Acute Care Ventilator Weaning Unit. Brody School of Medicine Kataria Internal Medicine Research Day, May 12, 2010

Green D, Bangley C, Pancoast T, Mazer M. Barriers to the paired use of standard spontaneous awakening trials and spontaneous breathing trials to improve outcomes in a community hospital. Brody School of Medicine Kataria Internal Medicine Research Day, May 12, 2010.

Barber L, Mazer M, Wu Q. Effect of Head of Bed Angle on Ventilatory Weaning Parameters. Brody School of Medicine Kataria Internal Medicine Research Day, May 12, 2010.

PAPERS PUBLISHED WITH FELLOW AS AUTHOR OR COAUTHOR

JULY 2008 THROUGH JUNE 2009

Barna BP, Malur A, Dalrymple H, Karnekar R, Culver DA, Abraham S, Singh RJ, Brescia D, Kavuru MS, Thomassen MJ. A novel 1,25-dihydroxyvitamin D-activin A pathway in human alveolar macrophages is dysfunctional in patients with pulmonary alveolar proteinosis (PAP). Autoimmunity. 2009 Jan;42(1):56-62. 

ABSTRACTS PUBLISHED AND PRESENTED BY FELLOWS
JULY 2008 THROUGH JUNE 2009
A.A. Kanchwala, H. Mehta, M.S. Kavuru, T. Pancoast. Utilization of Computed Tomography Pulmonary Angiography To Evaluate Patients with Chest Pain and/or Dyspnea,  Am. J. Respir. Crit. Care Med., Apr 2009;179: A3315.

A.A. Kanchwala, Barna BP, Culver DA, Malur A, Abraham S, Marshall I, Kavuru MS, Thomassen MJ. Cathelicidin Deficiency and Its Association with Disease Severity in Patients with Sarcoidosis,  Am. J. Respir. Crit. Care Med., Apr 2009;179: A3997.

Kasa KD, Lodeserto F, Manthous CA, Kavuru MS, Mazer  M, Pancoast TC. Fluid Balance Correlates with Outcomes in Mechanically Ventilated Patients. Am. J. Respir. Crit. Care Med., Apr 2009;179: A3798.

D. Brescia, MD, M. Kavuru, MD, M. Mazer, MD, T. Pancoast, MD, Greenville, NC.  Development of a New Assessment and Educational Tool for Mechanical Ventilation and Its Use To Evaluate Medical Resident Knowledge about Mechanical Ventilation,  Am. J. Respir. Crit. Care Med., Apr 2009;179: A3820.

Brescia D, Dobbs L, Wingard C, Barna B, Mccoy AJ, Malur A, Kukoly C, Kavuru M, Thomassen MJ. A Carbon Nanotube Model of Pulmonary Granuloma in Wild-Type and PPARγ Knock Out (KO) Mice,  Am. J. Respir. Crit. Care Med., Apr 2009;179: A5252.

Brescia D, Dalrymple H, Malur A, Arce S, Lucas A, Gagnon G, Marshall I, Barna B, Kavuru M, Thomassen MJ. Efficacy of Rituximab Therapy in Pulmonary Alveolar Proteinosis,  Am. J. Respir. Crit. Care Med., Apr 2009;179: A1131.

Donald Brescia, Thomson C. Pancoast, Mani Kavuru, and Mark Mazer  A survey of fellowship education in mechanical ventilation. Chest Meeting Abstracts 2008 134: s62004 

REGIONAL & LOCAL POSTERS & PRESENTATIONS BY FELLOWS
JULY 2008 THROUGH JUNE 2009
Brescia, Donald M.  Physiologically Targeted Diuresis to Expedite Liberation from Mechanical Ventilation. 2008 Atlantic Coast Regional Thoracic Conference

Lodeserto, Frank.  Volume Status In Respiratory Failure Patients Requiring Mechanical Ventilation.2009 North Carolina ACP Annual Scientific Conference

D Brescia, M Kavuru, M Mazer, T Pancoast.   Development of a new assessment and educational tool for mechanical ventilation and its use to evaluate medical resident knowledge about mechanical ventilation. 2009 Internal Medicine Annual Yash P. Kataria Research Day

LC Barber, MA Mazer.  Effect of head of bed angle on tidal volume of mechanically ventilated patients. 2009 Internal Medicine Annual Yash P. Kataria Research Day

K  Kasa, F Lodeserto,C Manthous, M Kavuru, M Mazer, and T Pancoast.  Fluid balance correlates with outcomes in mechanically ventilated patients. 2009 Internal Medicine Annual Yash P. Kataria Research Day

F Lodeserto, H Chohan, K Kasa, T Pancoast.   Inaccuracy of daily weights and intake/output data in medical intensive care unit patients. 2009 Internal Medicine Annual Yash P. Kataria Research Day

H Mehta, A Kanchwala, T Pancoast, M Kavuru.  Utilization of computed tomography pulmonary angiography to evaluate patients with chest pain, dyspnea and hypoxia. 2009 Internal Medicine Annual Yash P. Kataria Research Day