Pulmonary Hypertension Clinical Trials and COVID-19: A Discussion With John Ryan and Roham Zamanian

Dr Ryan: My goodness, it’s an incredible time we’re in. What we want to touch on is the impact of COVID-19 pandemic pulmonary hypertension (PH) research. Based your expertise in field and relationships you’ve built over years, felt that perspective experience would be representative what a lot people are dealing with. Can you talk us about research program?Dr Zamanian: That’s really broad question, but I think remiss not point out don’t anyone expected impacted from by astronomical event like this. may hear, at least our single center experience, things are, both good way bad way, impacting general especially for rare respiratory disorder.Our as where conduct basic, translational, clinical research; side, do own academic studies, some National Institutes Health (NIH) funded sponsor initiated. Across board, this has strained stressed resources. I’m expert basic can tell that, hear my collaborators, been footprint laboratory bench environment, other words, limitations having number postdoctoral colleagues small environment.When initially hit, there were tremendous limitations, moved through more progressive easing those conversation very quickly became how many postdocs per square meter allowed enclosed indoor environment. most researchers, mobilizing activating researchers scientists back into with or without COVID testing really, interesting.On translational same thing. saw was rapid closure exposure, meaning institutional mandates interactions university medical between subjects team. one learned early important communication Department Medicine level. prepared have these kinds organized conversations happen research.We stuck situation which experimental therapies being offered patients disease was, lifesaving; it crucial who needed still conduct. Initially, fog-of-war difficult; didn’t know get permissions from, eventually, set up system proposed got authorization studies urgent.To bottlenecks ability come campus side their activities, protocols staff could evaluate patients, proper environment take place. Did team need tested? subjects? they tested every came in?Within tangle issues idea function test, testing, ventilation/perfusion 6-minute walk testing—in days, walk—there barriers conducting indoors American Thoracic Society (ATS) standards because belief sub-maximal exceptional study generate particles dangerous performing candidate therapist coordinator. Eventually, devised masking, if wonder masking exercise tolerance tests, spun that. It wasn’t quick testing. We had whole exceptions requests sponsors NIH tests perform them. For example, just perfusion.Dr Thank you, Roham. As look now toward future, feel particular groups environments, either interventional procedures, drug investigation, science, disproportionally affected, patient population disproportionately affected?Dr institution views less justifiable viewed lower priority, Pulmonary Hypertension Association (PHA) registry, relevant here today. The did its best, hesitation, also stable enough wanted telehealth medicine visit instead coming in, tidal wave follow ups new enrollments missed thus far probably bears largest pandemic.I biological sample collecting biobank deeply affected hesitation blood handling era respiratory-transmitted disease. Now, us, banking issue, program exhaled breath condensate PH, certainly that’s all depending perspective. A projects, ones funded, already lean budgets. Also, trials depend walking collected certain time, no longer simple visit. lose measurements well.But isn’t negative positives real-world environment? patient’s home, collect registry information using approaches? challenge, rising challenge overcoming exciting, opportunities create future research.Dr agree. does seem particularly PHA shift inability enroll period well inhalational work biosamples, potential long-term consequences, terms needs, is, definition, longitudinal study. If 6 months, extrapolate long term understanding, so missing data will catch on.I think, build this, adapt draw upon ways we’ve adapted, then potentially catching up, better actually use tools last 9 months. changes seen even going become standard you? positive might make say, “I never thought doing before. can’t imagine ever another way”?Dr wish you’re correct tools, hard undertaken pay off future. see consideration review boards recognize, only difficult times, maybe forward, virtual world means patient-related research.It very, unusual—unheard of—for able consent electronically, project call Dynamite TH, telemedicine mobile device platform send initiate screening procedures home before clinic. nice example happening. Another thing capacity operate virtually, obviously learning around Zoom done, signatures. These skills technology enabled contacts consenting operationalizing trials.The successful getting industry-sponsored accept site initiation visits. John, permit monitors monitor 14 days quarantine, 5 tested, campus, virtually.I been, clear access general. wants trial lives 7 hours away operationalize parts procedure afar. What’s experience?Dr Our pose brought up; require moving parts. needs They stay bed. go procedure. person company traditionally always bedside involved during hospitalization randomization on. That, when restricting such described, big figure out.I however, virtually—or remotely rather than virtually—if prepare PH live they’ve met phone, video, down. Hopefully, me. Everyone’s expecting there’s requirement fewer surprises. hopeful enable reach people. concern, introduced barrier technology; readily available everyone. immediately reliable Internet smartphone computer consents documentation, care. concern whom registries socioeconomically disadvantaged. This something within close attention to.Dr point. completely agree you. It’s exacerbate problem care, requiring others granted.Dr issue dissemination research, continue affect 2021 beyond.The first conferences, biggest concerned about. That Brad Moran, know, incredibly strong collaborations closely together. Vinicio de Jesus Perez. Anjali Vaidya. career, outside institution, I’ve them conferences.I me conference. conference together again physically. How positively negatively? conferences role play forward?Dr much career development experiences highlighted personal conferences. poster presented ATS, gave feedback Paul Hassoun. forever remember learn am proponent exhilarating discussion There nothing audience asking questions, engaging speakers, speakers audience.That’s impact. understand participate any meaningful since beginning pandemic. haven’t anything ATS now, primarily now. divided, multiple virtual. fatigue, whatever use. Then zones well, balance professional life while professions pandemic, much, worse.The thinking missions Vascular Research Institute global interactions. hope turn in-person makes marginalized countries interested diseases. physicians person, Wi-Fi Internet, interact kind positive.I before, although happen. guess, I’d say combination both, miss it, too, detriment. Already field, collaborations, said, siloed collaborations.The meet areas expertise, like, been—it’s great existing collaborators. love them, had, identified, chance unique otherwise blue.Dr answer Knowledge dissemination, right networking social aspects, people, key. Do knowledge COVID-19? Is issue? difficult? bite sized because, communities community, honest, information.Everyone busy. Children schooled home. Work bleeding day night. bite-sized resulted disinformation disseminated. positives; namely, quite easy media post graphic illustration capture essence paper looking centered along lines. thoughts vascular research?Dr foremost, focus. criticism, focus journals publishing everything put strain on, alluded to, high-quality work. important, understand, cost hasn’t published enough. manuscript submitted February, revision journal, well-respected journal. took months reviews back. otherwise, proud highlight highlighting Vinicio’s Twitter media, feel, attempt unbiased media. Sometimes behind accounts different latest PH. name account, doesn’t mean is. initiatives fair publications. Like activities.We grand rounds Stanford do. begun invite present rounds. At marginal allow dissemination. totally level misinformation impacts beliefs. While next best Google there, become, sized, quick, consume, easier misconstrue findings field. situation.I answers here, believe generally science today, enables trust community serve. With political mask wearing keep someone entity broadly disseminating unscientific way? paranoid advocacy programs PHA, mind platforms, disseminate truthful summarized.Dr two obligations leadership, talked One advocates harbingers truth, pushing forward message, presence offer there.The aspect generation us—the Roham Zamanians John Ryans 20 years ago—I suspect voices heard. advocate recognize responsibility bringing through. optimistic invested generations, integral enough.Dr You words mouth. who’s lucky Ryan his her mentor, mentors junior faculty. We’re ready excite selfless promoting group, trauma competing funding difficult. development.Dr Advocacy near dear hearts reading Roham, joining today.Dr giving opportunity leading topic.