Christopher H Goss

University of Washington Seattle, Seattle, Washington, United States

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Publications (111)611.9 Total impact

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    ABSTRACT: Obese patients with Idiopathic Pulmonary Fibrosis (IPF) have a higher 90-day mortality after lung transplantation. We sought to investigate whether body mass index (BMI) differentially modified the effect of transplant procedure type on 90-day mortality in IPF patients. We analyzed data from the Organ Procurement and Transplantation Network (OPTN) for all patients with IPF who were transplanted between 2000-2010. Post-transplant survival was examined using Kaplan Meier estimates. Multivariable logistic regression modeling was used to determine the difference in 90-day survival. The primary variable of interest was the interaction term between BMI and transplant type. A total of 3,389 (58% single lung transplant [SLT]; 42% bilateral lung transplant) [BLT]) subjects were included. Multivariable logistic regression modeling demonstrated a statistically significant interaction between BMI and transplant type (p=0.047). Patients with a BMI>30 kg/m2 who received a BLT are 1.71 times (95% CI [1.03, 2.85], p=0.038) more likely to die within 90-days than BLT recipients with a BMI of 18.5-30 kg/m2. Our results suggest that obese patients who receive a BLT may be at higher risk of 90-day mortality compared to patients of normal weight. Future studies that evaluate more detailed information about co-morbidities and other risk factors for early death not included in the OPTN database are warranted.
    The Journal of Heart and Lung Transplantation. 09/2014;
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    ABSTRACT: People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns.
    Thorax 09/2014; · 8.38 Impact Factor
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    ABSTRACT: Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza.
    Critical care medicine. 08/2014;
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    ABSTRACT: Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs.
    Annals of internal medicine 08/2014; 161(4):233-241. · 13.98 Impact Factor
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    ABSTRACT: Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study.
    Journal of general internal medicine. 07/2014;
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    ABSTRACT: Objective To examine the prevalence of symptoms of depression and anxiety among patients with cystic fibrosis (CF) followed at the University of Washington Adult CF Clinic and to identify sociodemographic and clinical factors associated with symptoms. Methods 178 CF adults were asked to complete the Patient Health Questionnaire-9 (PHQ-9) for depression and General Anxiety Disorder-7 (GAD-7) for anxiety when clinically stable. Clinically significant symptoms of depression and anxiety were defined in two ways: 1) symptom definition: presence of moderate-to-severe symptoms based on the questionnaires; 2) composite definition: symptom definition or the use of psychiatric medications to manage symptoms. Associations between PHQ-9 and GAD-7 scores with sociodemographic (gender, age, age of CF diagnosis, vocation, spousal status) and clinical factors (forced expiratory volume in 1 second (FEV1), body mass index, CF-related diabetes on insulin) were examined. Results 153 of 178 (85%) patients completed the screening questionnaires. Based on the symptom definition, 7% of patients had symptoms of depression and 5% had symptoms of anxiety. Using the composite definition, 22% of patients had symptoms of depression and 10% had symptoms of anxiety. Based on the PHQ-9, 5% of patients reported suicidal thoughts. In multiple linear regression analysis, only FEV1% predicted was independently associated with PHQ-9 depression scores and no sociodemographic or clinical factors were associated with GAD-7 anxiety scores. Conclusions We conclude that all CF adults should be screened for symptoms of depression and anxiety given the difficulty in identifying strong clinical risk factors and the unexpected high rates of suicidal ideation.
    Psychosomatics 06/2014; · 1.73 Impact Factor
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    Journal of Cystic Fibrosis 06/2014; 13:S15. · 2.87 Impact Factor
  • Bradley S Quon, Christopher H Goss, Bonnie W Ramsey
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    ABSTRACT: Inhaled antibiotics have been used to treat chronic airway infections since the 1940s. The earliest experience with inhaled antibiotics involved aerosolizing antibiotics designed for parenteral administration. These formulations caused significant bronchial irritation due to added preservatives and nonphysiologic chemical composition. A major therapeutic advance took place in 1997, when tobramycin designed for inhalation was approved by the U.S. Food and Drug Administration (FDA) for use in patients with cystic fibrosis (CF) with chronic Pseudomonas aeruginosa infection. Attracted by the clinical benefits observed in CF and the availability of dry powder antibiotic formulations, there has been a growing interest in the use of inhaled antibiotics in other lower respiratory tract infections, such as non-CF bronchiectasis, ventilator-associated pneumonia, chronic obstructive pulmonary disease, mycobacterial disease, and in the post-lung transplant setting over the past decade. Antibiotics currently marketed for inhalation include nebulized and dry powder forms of tobramycin and colistin and nebulized aztreonam. Although both the U.S. Food and Drug Administration and European Medicines Agency have approved their use in CF, they have not been approved in other disease areas due to lack of supportive clinical trial evidence. Injectable formulations of gentamicin, tobramycin, amikacin, ceftazidime, and amphotericin are currently nebulized "off-label" to manage non-CF bronchiectasis, drug-resistant nontuberculous mycobacterial infections, ventilator-associated pneumonia, and post-transplant airway infections. Future inhaled antibiotic trials must focus on disease areas outside of CF with sample sizes large enough to evaluate clinically important endpoints such as exacerbations. Extrapolating from CF, the impact of eradicating organisms such as P. aeruginosa in non-CF bronchiectasis should also be evaluated.
    Annals of the American Thoracic Society. 03/2014; 11(3):425-34.
  • BMJ quality & safety 01/2014; · 2.39 Impact Factor
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    ABSTRACT: Studies seeking to estimate the burden of influenza among hospitalized adults often use case definitions that require presence of pneumonia. The goal of this study was to assess the extent to which restricting influenza testing to adults hospitalized with pneumonia could underestimate the total burden of hospitalized influenza disease. We conducted a modelling study using the complete State Inpatient Databases from Arizona, California, and Washington and regional influenza surveillance data acquired from CDC from January 2003 through March 2009. The exposures of interest were positive laboratory tests for influenza A (H1N1), influenza A (H3N2), and influenza B from two contiguous US Federal Regions encompassing the study area. We identified the two outcomes of interest by ICD-9-CM code: respiratory and circulatory hospitalizations, as well as critical illness hospitalizations (acute respiratory failure, severe sepsis, and in-hospital death). We linked the hospitalization datasets with the virus surveillance datasets by geographic region and month of hospitalization. We used negative binomial regression models to estimate the number of influenza-associated events for the outcomes of interest. We sub-categorized these events to include all outcomes with or without pneumonia diagnosis codes. We estimated that there were 80,834 (95% CI 29,214-174,033) influenza-associated respiratory and circulatory hospitalizations and 26,760 (95% CI 14,541-47,464) influenza-associated critical illness hospitalizations. When a pneumonia diagnosis was excluded, the estimated number of influenza-associated respiratory and circulatory hospitalizations was 24,816 (95% CI 6,342-92,624). The estimated number of influenza-associated critical illness hospitalizations was 8,213 (95% CI 3,764-20,799). Around 30% of both influenza-associated respiratory and circulatory hospitalizations, as well as influenza-associated critical illness hospitalizations did not have pneumonia diagnosis codes. Surveillance studies which only consider hospitalizations that include a diagnosis of pneumonia may underestimate the total burden of influenza hospitalizations.
    PLoS ONE 01/2014; 9(11):e113903. · 3.53 Impact Factor
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    ABSTRACT: Since the earliest days of cystic fibrosis (CF) treatment, patient data have been recorded and reviewed in order to identify the factors that lead to more favourable outcomes. Large data repositories, such as the US Cystic Fibrosis Registry, which was established in the 1960s, enabled successful treatments and patient outcomes to be recognized and improvement programmes to be implemented in specialist CF centres. Over the past decades, the greater volumes of data becoming available through Centre databases and patient registries led to the possibility of making comparisons between different therapies, approaches to care and indeed data recording. The quality of care for individuals with CF has become a focus at several levels: patient, centre, regional, national and international. This paper reviews the quality management and improvement issues at each of these levels with particular reference to indicators of health, the role of CF Centres, regional networks, national health policy, and international data registration and comparisons.
    Journal of Cystic Fibrosis. 01/2014; 13:S43–S59.
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    ABSTRACT: Purpose To evaluate the effects of oral N-acetylcysteine (NAC), which replenishes systemic glutathione, on decreasing inflammation and improving lung function in CF airways. Methods A multicenter, randomized, double-blind proof of concept study in which 70 CF subjects received NAC or placebo orally thrice daily for 24 weeks. Endpoints: primary, change in sputum human neutrophil elastase (HNE) activity; secondary, FEV1 and other clinical lung function measures; and safety, the safety and tolerability of NAC and the potential of NAC to promote pulmonary hypertension in subjects with CF. Results Lung function (FEV1 and FEF25–75%) remained stable or increased slightly in the NAC group but decreased in the placebo group (p = 0.02 and 0.02). Log10 HNE activity remained equal between cohorts (difference 0.21, 95% CI − 0.07 to 0.48, p = 0.14). Conclusions NAC recipients maintained their lung function while placebo recipients declined (24 week FEV1 treatment effect = 150 mL, p < 0.02). However no effect on HNE activity and other selected biomarkers of neutrophilic inflammation were detected. Further studies on mechanism and clinical outcomes are warranted.
    Journal of Cystic Fibrosis. 01/2014;
  • Christopher H Goss, Nicole Mayer-Hamblett
    American Journal of Respiratory and Critical Care Medicine 11/2013; 188(10):1181-3. · 11.04 Impact Factor
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    ABSTRACT: Acute pulmonary exacerbations are central events in the lives of individuals with cystic fibrosis (CF). Pulmonary Exacerbations lead to impaired lung function, worse quality of life, and shorter survival. We hypothesized that aggressive early treatment of acute pulmonary exacerbation may improve clinical outcomes. Describe the rationale of an ongoing trial designed to determine the efficacy of home monitoring of both lung function measurements and symptoms for early detection and subsequent early treatment of acute CF pulmonary exacerbations. A randomized, non-blinded, multi-center trial in 320 individuals with CF age 14years and older. The study compares usual care to a twice a week assessment of home spirometry and CF respiratory symptoms using an electronic device with data transmission to the research personnel to identify and trigger early treatment of CF pulmonary exacerbation. Participants will be enrolled in the study for 12months. The primary endpoint is change in FEV1 (L) from baseline to 12months determined by a linear mixed effects model incorporating all quarterly FEV1 measurements. Secondary endpoints include time to first acute protocol-defined pulmonary exacerbation, number of acute pulmonary exacerbations, number of hospitalization days for acute pulmonary exacerbation, time from the end of acute pulmonary exacerbation to onset of subsequent pulmonary exacerbation, change in Health related quality of life, change in treatment burden, change in CF respiratory symptoms, and adherence to the study protocol. This study is a first step in establishing alternative approaches to the care of CF pulmonary exacerbations. We hypothesize that early treatment of pulmonary exacerbations has the potential to slow lung function decline, reduce respiratory symptoms and improve the quality of life for individuals with CF.
    Contemporary clinical trials 09/2013; · 1.51 Impact Factor
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    ABSTRACT: Current definitions of pulmonary exacerbation (PE) in cystic fibrosis are based on studies in participants with significant lung disease and may not reflect the spectrum of findings observed in younger patients with early lung disease. We used data from a recent trial assessing the efficacy of azithromycin in children to study signs and symptoms associated with PEs and related changes in lung function and weight. While increased cough was present in all PEs, acute weight loss and reduction in oxygen saturation were not observed. Changes in lung function did not differ between subjects who did experience a PE and those who were exacerbation-free. Cough was the predominant symptom in CF patients with early lung disease experiencing a PE. There was no significant difference in mean 6-month change in lung function or weight among subjects with one or more exacerbations and those without an exacerbation.
    Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 09/2013; · 3.19 Impact Factor
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    Irl B Hirsch, Mary M Janci, Christopher H Goss, Moira L Aitken
    Diabetes care 08/2013; 36(8):e121-2. · 7.74 Impact Factor
  • Christopher H Goss, Nathan Tefft
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    ABSTRACT: Recent initiatives have increased focus on medical research that explores robust comparisons of clinical approaches broadly defined as comparative effectiveness research (CER). Federal mandates have generated definitions, established priorities, and offered organizational approaches for coordinating and conducting CER. This review will summarize the various definitions of CER, the role of cost assessment, and key study components of CER including study populations, study design, the use of secondary data, comparators employed in studies, outcome measures, and how results of CER should be disseminated.
    Paediatric Respiratory Reviews 07/2013; · 2.77 Impact Factor
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    ABSTRACT: Rationale: The incidence of influenza-associated acute respiratory failure is unknown. Objectives: We conducted this study to estimate the population-based incidence of influenza-associated acute respiratory failure hospitalizations. Methods: This is a cohort study from January 2003 through March 2009 using hospitalization databases for Arizona, California, and Washington from the Healthcare Cost and Utilization Project and influenza surveillance data for regions encompassing these states. Acute respiratory failure requiring mechanical ventilation was defined by ICD-9-CM code. We used negative-binomial regression modeling to estimate the incidence of influenza-associated events. Measurements and Main Results: The incidence of influenza-associated acute respiratory failure was 2.7 per 100,000 person-years (95% CI 0.2, 23.5), and during the influenza season, 3.8% of all respiratory failure hospitalizations were attributable to influenza. Compared with adults aged 18-49 years, the incidence rate ratio (IRR) for influenza-associated acute respiratory failure was lower among children aged 1-4 years (0.9) and 5-17 years (0.3). However, the IRR was higher among adults aged 50-64 years (4.8), 65-74 years (10.4), 75-84 years (19.9), and 85 years and older (33.7). Results were similar with more sensitive and specific outcome definitions and in a sensitivity analysis using only Arizona-specific outcome and surveillance data. Conclusion: Our data indicate that influenza was an important contributor to respiratory failure hospitalizations during 2003-2009. Physicians should consider influenza testing and empiric antiviral therapy for hospitalized patients with severe acute respiratory disease during periods of influenza activity. Influenza has a greater effect on respiratory failure in the elderly, for whom better prevention measures are needed.
    American Journal of Respiratory and Critical Care Medicine 07/2013; · 11.04 Impact Factor
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    ABSTRACT: RATIONALE: Arikace is a liposomal amikacin preparation for aerosol delivery with potent Pseudomonas aeruginosa killing and prolonged lung deposition. OBJECTIVES: To examine the safety and efficacy of 28 days of once-daily Arikace in cystic fibrosis (CF) patients chronically infected with P aeruginosa. METHODS: 105 subjects were evaluated in double-blind, placebo-controlled studies. Subjects were randomised to once-daily Arikace (70, 140, 280 and 560 mg; n=7, 5, 21 and 36 subjects) or placebo (n=36) for 28 days. Primary outcomes included safety and tolerability. Secondary outcomes included lung function (forced expiratory volume at one second (FEV1)), P aeruginosa density in sputum, and the Cystic Fibrosis Quality of Life Questionnaire-Revised (CFQ-R). RESULTS: The adverse event profile was similar among Arikace and placebo subjects. The relative change in FEV1 was higher in the 560 mg dose group at day 28 (p=0.033) and at day 56 (28 days post-treatment, 0.093L±0.203 vs -0.032L±0.119; p=0.003) versus placebo. Sputum P aeruginosa density decreased >1 log in the 560 mg group versus placebo (days 14, 28 and 35; p=0.021). The Respiratory Domain of the CFQ-R increased by the Minimal Clinically Important Difference (MCID) in 67% of Arikace subjects (560 mg) versus 36% of placebo (p=0.006), and correlated with FEV1 improvements at days 14, 28 and 42 (p<0.05). An open-label extension (560 mg Arikace) for 28 days followed by 56 days off over six cycles confirmed durable improvements in lung function and sputum P aeruginosa density (n=49). CONCLUSIONS: Once-daily Arikace demonstrated acute tolerability, safety, biologic activity and efficacy in patients with CF with P aeruginosa infection.
    Thorax 06/2013; · 8.38 Impact Factor
  • Christopher H Goss, Felix Ratjen
    American Journal of Respiratory and Critical Care Medicine 05/2013; 187(9):915-9. · 11.04 Impact Factor

Publication Stats

2k Citations
611.90 Total Impact Points

Institutions

  • 2002–2014
    • University of Washington Seattle
      • • Department of Psychiatry and Behavioral Sciences
      • • Division of Pulmonary and Critical Care Medicine
      • • Department of Medicine
      Seattle, Washington, United States
  • 2013
    • PATH
      Seattle, Washington, United States
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, MD, United States
    • University of Kentucky
      • Department of Pediatrics
      Lexington, Kentucky, United States
  • 2010–2013
    • University of Wisconsin, Madison
      • Department of Pediatrics
      Madison, MS, United States
    • Seattle Children's Hospital
      • Department of Pediatrics
      Seattle, Washington, United States
    • Memorial Sloan-Kettering Cancer Center
      • Epidemiology & Biostatistics Group
      New York City, NY, United States
  • 2010–2012
    • Columbia University
      • Department of Pediatrics
      New York City, NY, United States