Jiwoon Chang

All Publications

• First in human Phase I Clinical Trial of Stereotactic Irradiation to Achieve Lung Volume Reduction (SILVR) in Severe Emphysema. International journal of radiation oncology, biology, physics Kamtam, D. N., Binkley, M. S., Kapula, N., Sadeghi, C., Nesbit, S., Md, H. H., Chang, J., Maxim, P. G., Diehn, M., Loo, B. W., Shrager, J. B. 2024

  Abstract

  Only a subset of patients with severe emphysema qualify for lung volume reduction surgery or endobronchial valves. We previously demonstrated that Stereotactic Ablative Radiotherapy (SABR) of lung tumors reduces lung volume in treated lobes by creating localized lung fibrosis. We aimed to determine the safety and, secondarily, explore the efficacy of Stereotactic Irradiation for Lung Volume Reduction (SILVR) over 18 months following intervention in patients with severe emphysema.We conducted a single-arm prospective clinical trial in eligible patients with severe emphysema treated with unilateral SABR (45 Gy in three fractions) to a target within the most emphysematous region. Primary outcome was safety i.e., incidence of grade≥3 adverse events. Secondary outcomes of efficacy were also explored.Eight subjects received the intervention. Median (range) baseline characteristics were age 73 years (63-78), FEV1% 28.5% (19.0-42.0), DLCO% 40% (24.0-67.0), and BODE index 5.5 (5-9). The incidence of grade≥3 adverse events was 3/8 (37.5%). The relative Δtarget lobe volume was -23.1% (-1.6,-41.5) and -26.5% (-20.6,-40.8) at six and 18 months, respectively. Absolute ΔFEV1% was greater in subjects with BODE index ≤5 vs. ≥6 (+12.0% vs. -2.0%). The mean baseline lung density (in Hounsfield units, reflecting the amount of preserved parenchyma) within the intermediate dose volume (V60BED3) correlated with the absolute Δtarget lobe volume at 18 months.Stereotactic Irradiation for Lung Volume Reduction appears to be safe, with a signal for efficacy as a novel therapeutic alternative for patients with severe emphysema. SILVR may be most safe/effective in patients with lower BODE index and/or less parenchymal destruction.

  View details for DOI 10.1016/j.ijrobp.2024.03.049

  View details for PubMedID 38615887

• Tranexamic Acid in the Treatment Paradigm for Hemoptysis. Chest Chang, J., Ma, K. C. 2023; 163 (5): 1011-1012

  View details for DOI 10.1016/j.chest.2022.12.011

  View details for PubMedID 37164570

• Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL : the journal of teaching and learning resources Dali, S., Atasuntseva, A., Shankar, M., Ayeroff, E., Holmes, M., Johnson, C., Terkawi, A. S., Beadle, B., Chang, J., Boyd, K., Dunn, T. 2022; 18: 11284

  Abstract

  Names are a reflection of identity and often have personal meaning. The chronic mispronunciation of names can undermine one's identity and be experienced as a microaggression. This workshop aims to provide historical context for names as well as resources for correct name pronunciation.We developed a 60-minute interactive virtual workshop with didactics, small-group sharing of personal experiences, and case discussions. We used an anonymous postworkshop survey to evaluate workshop effectiveness.We presented the workshop at one local academic conference and two local educational conferences to learners of all levels from medical students to faculty. We collected postworkshop survey results from 78 participants of diverse racial and ethnic backgrounds. Participants reported learning historical context, ways to ask about correct name pronunciation, correcting name mispronunciation, documenting pronunciation, and sources for applications to practice. The main barriers to implementing workshop lessons included personal and structural factors.This workshop effectively fills an educational gap by addressing the importance of correct name pronunciation in order to provide a more inclusive environment for clinicians and patients alike.

  View details for DOI 10.15766/mep_2374-8265.11284

  View details for PubMedID 36524099

  View details for PubMedCentralID PMC9705275

• Bleeding risk with combination intrapleural fibrinolytic and enzyme therapy in pleural infection - an international, multicenter, retrospective cohort study. Chest Akulian, J., Bedawi, E. O., Abbas, H., Argento, C., Arnold, D. T., Balwan, A., Batra, H., Uribe Becerra, J. P., Belanger, A., Berger, K., Burks, A. C., Chang, J., Chrissian, A. A., DiBardino, D. M., Fuentes, X. F., Gesthalter, Y. B., Gilbert, C. R., Glisinski, K., Godfrey, M., Gorden, J. A., Grosu, H., Gupta, M., Kheir, F., Ma, K. C., Majid, A., Maldonado, F., Maskell, N. A., Mehta, H., Mercer, J., Mullon, J., Nelson, D., Nguyen, E., Pickering, E. M., Puchalski, J., Reddy, C., Revelo, A. E., Roller, L., Sachdeva, A., Sanchez, T., Sathyanarayan, P., Semaan, R., Senitko, M., Shojaee, S., Story, R., Thiboutot, J., Wahidi, M., Wilshire, C. L., Yu, D., Zouk, A., Rahman, N. M., Yarmus, L., Interventional Pulmonary Outcomes Group (IPOG) 2022

  Abstract

  BACKGROUND: Combination intrapleural fibrinolytic and enzyme therapy (IET) has been established as a therapeutic option in pleural infection. Despite demonstrated efficacy, there is a sparsity of studies specifically designed and adequately powered to address complications. The safety profile, the effects of concurrent therapeutic anticoagulation and the nature/extent of non-bleeding complications remain poorly defined.RESEARCH QUESTION: What is the bleeding complication risk associated with IET use in pleural infection?STUDY DESIGN AND METHODS: This was a multicenter, retrospective observational study conducted in 24 centers across the United States and the United Kingdom. Protocolized data collection on 1851 patients treated with at least one dose of combination IET for pleural infection between January 2012 and May 2019 was undertaken. The primary outcome was the overall incidence of pleural bleeding defined using pre-hoc criteria.RESULTS: Overall pleural bleeding incidence was 76/1833=4.1% (95%CI 3.0% to 5.0%). Using a half-dose regimen (tPA 5mg) did not significantly change this risk (6/172=3.5%; p=0.68). Therapeutic anticoagulation (AC) alongside IET was associated with increased bleeding rates (19/197=9.6%) compared to temporarily withholding AC prior to administration of IET (3/118=2.6%, p=0.017). As well as systemic AC, increasing RAPID score, an elevated serum urea and platelets <100x109 L were associated with a significant increase in bleeding risk. However, only RAPID score and use of systemic AC were independently predictive. Apart from pain, non-bleed complications were rare.INTERPRETATION: IET use in pleural infection confers a low overall bleeding risk. Increased rates of pleural bleeding are associated with concurrent use of AC but can be mitigated by withholding AC prior to IET. Concomitant administration of IET and therapeutic AC should be avoided. Parameters related to higher IET related bleeding have been identified which may lead to altered risk thresholds for treatment.

  View details for DOI 10.1016/j.chest.2022.06.008

  View details for PubMedID 35716828

• COVID-19 Test Correlation Between Nasopharyngeal Swab and Bronchoalveolar Lavage in Asymptomatic Patients. Chest Chang, J. n., Swenson, K. E., Sung, A. n., Bedi, H. n. 2020

  View details for DOI 10.1016/j.chest.2020.11.006

  View details for PubMedID 33217415