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Peter Samuel Kussin

Professor of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
Duke Box 2827, Durham, NC 27710
330 Trent Drive, Room 100A Hanes House, Durham, NC 27710

Selected Publications


Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study.

Journal Article BMJ Open · September 18, 2023 OBJECTIVE: Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya ... Full text Open Access Link to item Cite

Distressed Work: Chronic Imperatives and Distress in Covid-19 Critical Care.

Journal Article Hastings Cent Rep · January 2023 This ethnographic study introduces the term "distressed work" to describe the emergence of chronic frictions between moral imperatives for health care workers to keep working and the dramatic increase in distress during the Covid-19 pandemic. Interviews an ... Full text Open Access Link to item Cite

Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study.

Journal Article Int J Public Health · 2023 Objectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-r ... Full text Open Access Link to item Cite

Prior Tuberculosis and Female Sex Are Major Risk Factors for Chronic Hypoxemia in Kenyan Adults

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2023 Cite

The pandemic is not the great equalizer: front-line labor and rationing in COVID-19 critical care.

Journal Article Public Health Action · December 21, 2022 BACKGROUND: Framed as "the great-equalizer," the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world. OBJECTIVE: To critically investigate how hospital intensive care unit ... Full text Open Access Link to item Cite

Feasibility of Cardiac Rehabilitation Models in Kenya.

Journal Article Ann Glob Health · 2022 BACKGROUND: Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa. Cardiac rehabilitation (CR) is known to improve functional capacity and reduce morbidity associated with HF. Although CR is a low-cost inter ... Full text Link to item Cite

Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries.

Journal Article Frontiers in public health · January 2022 BackgroundTo develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and ... Full text Cite

Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study.

Journal Article J Palliat Med · September 2021 Background: Addressing unmet palliative care needs in high-risk surgical patients in low- and middle-income countries must include innovative approaches to limitations in personnel and culturally acceptable assessment modalities. Objectives: We assessed th ... Full text Link to item Cite

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review.

Journal Article J Glob Health · May 8, 2021 BACKGROUND: Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in ... Full text Open Access Link to item Cite

Where Have All the Heroes Gone?

Journal Article Med Anthropol · April 2021 Full text Open Access Link to item Cite

Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study.

Journal Article Antimicrob Resist Infect Control · March 25, 2021 BACKGROUND: Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine p ... Full text Link to item Cite

Knowledge and Perceptions Regarding Palliative Care Among Religious Leaders in Uasin Gishu County, Kenya: Survey and Focus Group Analysis.

Journal Article Am J Hosp Palliat Care · October 2020 Spirituality and religion are at the core of Kenyan life. Pastoral leaders play a key role in shaping the individual and community's response to living with chronic and life-threatening illnesses. Involvement of religious leaders would therefore be critica ... Full text Link to item Cite

Investigating SOFA, delta-SOFA and MPM-III for mortality prediction among critically ill patients at a private tertiary hospital ICU in Kenya: A retrospective cohort study.

Journal Article PLoS One · 2020 BACKGROUND: Outcomes in well-resourced, intensive care units (ICUs) in Kenya are thought to be comparable to those in high-income countries (HICs) but risk-adjusted mortality data is unavailable. We undertook an evaluation of the Aga Khan University Hospit ... Full text Link to item Cite

Evaluation of Hypoxemia Among Patients Admitted to a Tertiary Referral Hospital in Western Kenya

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

Abstract P120: Feasibility of Cardiac Rehabilitation in Resource Limited Settings

Conference Circulation · March 5, 2019 Background: Heart failure (HF) is a growing driver of morbidity and mortality worldwide. Cardiac rehabilitation in HF improves functional status, quality of life, and depression. Global access to card ... Full text Cite

Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.

Journal Article Ann Am Thorac Soc · November 2018 RATIONALE: The burden of critical care is greatest in resource-limited settings. Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. The present study is timely, given the Kenyan Ministry of Health initiative to expand ICU capacity ... Full text Link to item Cite

Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study.

Journal Article BMJ Open · September 18, 2023 OBJECTIVE: Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya ... Full text Open Access Link to item Cite

Distressed Work: Chronic Imperatives and Distress in Covid-19 Critical Care.

Journal Article Hastings Cent Rep · January 2023 This ethnographic study introduces the term "distressed work" to describe the emergence of chronic frictions between moral imperatives for health care workers to keep working and the dramatic increase in distress during the Covid-19 pandemic. Interviews an ... Full text Open Access Link to item Cite

Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study.

Journal Article Int J Public Health · 2023 Objectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-r ... Full text Open Access Link to item Cite

Prior Tuberculosis and Female Sex Are Major Risk Factors for Chronic Hypoxemia in Kenyan Adults

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2023 Cite

The pandemic is not the great equalizer: front-line labor and rationing in COVID-19 critical care.

Journal Article Public Health Action · December 21, 2022 BACKGROUND: Framed as "the great-equalizer," the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world. OBJECTIVE: To critically investigate how hospital intensive care unit ... Full text Open Access Link to item Cite

Feasibility of Cardiac Rehabilitation Models in Kenya.

Journal Article Ann Glob Health · 2022 BACKGROUND: Heart failure (HF), is a leading cause of cardiovascular morbidity and mortality in Sub-Saharan Africa. Cardiac rehabilitation (CR) is known to improve functional capacity and reduce morbidity associated with HF. Although CR is a low-cost inter ... Full text Link to item Cite

Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries.

Journal Article Frontiers in public health · January 2022 BackgroundTo develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and ... Full text Cite

Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study.

Journal Article J Palliat Med · September 2021 Background: Addressing unmet palliative care needs in high-risk surgical patients in low- and middle-income countries must include innovative approaches to limitations in personnel and culturally acceptable assessment modalities. Objectives: We assessed th ... Full text Link to item Cite

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review.

Journal Article J Glob Health · May 8, 2021 BACKGROUND: Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in ... Full text Open Access Link to item Cite

Where Have All the Heroes Gone?

Journal Article Med Anthropol · April 2021 Full text Open Access Link to item Cite

Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study.

Journal Article Antimicrob Resist Infect Control · March 25, 2021 BACKGROUND: Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine p ... Full text Link to item Cite

Knowledge and Perceptions Regarding Palliative Care Among Religious Leaders in Uasin Gishu County, Kenya: Survey and Focus Group Analysis.

Journal Article Am J Hosp Palliat Care · October 2020 Spirituality and religion are at the core of Kenyan life. Pastoral leaders play a key role in shaping the individual and community's response to living with chronic and life-threatening illnesses. Involvement of religious leaders would therefore be critica ... Full text Link to item Cite

Investigating SOFA, delta-SOFA and MPM-III for mortality prediction among critically ill patients at a private tertiary hospital ICU in Kenya: A retrospective cohort study.

Journal Article PLoS One · 2020 BACKGROUND: Outcomes in well-resourced, intensive care units (ICUs) in Kenya are thought to be comparable to those in high-income countries (HICs) but risk-adjusted mortality data is unavailable. We undertook an evaluation of the Aga Khan University Hospit ... Full text Link to item Cite

Evaluation of Hypoxemia Among Patients Admitted to a Tertiary Referral Hospital in Western Kenya

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

Abstract P120: Feasibility of Cardiac Rehabilitation in Resource Limited Settings

Conference Circulation · March 5, 2019 Background: Heart failure (HF) is a growing driver of morbidity and mortality worldwide. Cardiac rehabilitation in HF improves functional status, quality of life, and depression. Global access to card ... Full text Cite

Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya.

Journal Article Ann Am Thorac Soc · November 2018 RATIONALE: The burden of critical care is greatest in resource-limited settings. Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. The present study is timely, given the Kenyan Ministry of Health initiative to expand ICU capacity ... Full text Link to item Cite

Validation of spirometry prediction equations in western Kenya.

Journal Article Int J Tuberc Lung Dis · January 1, 2018 SETTING: Community of Eldoret, Kenya. OBJECTIVE: To test the performance of three commonly used spirometry prediction equations in a healthy Kenyan population. DESIGN: Cross-sectional assessment of healthy adults in Eldoret. RESULTS: Of the 331 subjects en ... Full text Link to item Cite

Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa - A survey based approach.

Journal Article J Clin Neurosci · August 2017 There is no published literature regarding sub-Saharan health-care providers' understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimiz ... Full text Link to item Cite

Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa.

Journal Article Glob Public Health · May 2017 The concept of brain death (BD), defined as irreversible loss of function of the brain including the brainstem, is accepted in the medical literature and in legislative policy worldwide. However, in most of Sub-Saharan Africa (SSA) there are no legal guide ... Full text Open Access Link to item Cite

Biogas Stoves Reduce Firewood Use, Household Air Pollution, and Hospital Visits in Odisha, India.

Journal Article Environ Sci Technol · January 3, 2017 Traditional cooking using biomass is associated with ill health, local environmental degradation, and regional climate change. Clean stoves (liquefied petroleum gas (LPG), biogas, and electric) are heralded as a solution, but few studies have demonstrated ... Full text Link to item Cite

Pulmonary function and adverse cardiovascular outcomes: Can cardiac function explain the link?

Journal Article Respir Med · December 2016 BACKGROUND: The complex interaction between pulmonary function, cardiac function and adverse cardiovascular events has only been partially described. We sought to describe the association between pulmonary function with left heart structure and function, a ... Full text Link to item Cite

Physician subsidies for tobacco advertising.

Journal Article Am J Respir Crit Care Med · January 15, 2006 Full text Link to item Cite

Thinks curriculum model a start in right direction - Response

Journal Article JAVMA-JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION · June 15, 2004 Link to item Cite

Thinks curriculum model a start in right direction.

Journal Article J Am Vet Med Assoc · June 15, 2004 Link to item Cite

Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions.

Journal Article J Am Geriatr Soc · May 2000 OBJECTIVE: We evaluated prospectively the use of acute hemodialysis among hospitalized patients to identify demographic and clinical predictors of and chart documentation concerning dialysis withheld and withdrawn. DESIGN: Prospective cohort study. SETTING ... Full text Link to item Cite

Withholding versus withdrawing life-sustaining treatment: Patient factors and documentation associated with dialysis decisions

Journal Article Journal of the American Geriatrics Society · 2000 OBJECTIVE: We evaluated prospectively the use of acute hemodialysis among hospitalized patients to identify demographic and clinical predictors of and chart documentation concerning dialysis withheld and withdrawn. DESIGN: Prospective cohort study. SETTING ... Cite

A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma.

Journal Article Cancer · June 25, 1999 BACKGROUND: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. The authors prospectively compared the sensitivity of endobronchial needle aspiration (EBNA) and immediate cytologic assessment with bronchial biopsy ... Full text Link to item Cite

Outcomes, preferences for resuscitation, and physician-patient communication among patients with metastatic colorectal cancer. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Journal Article Am J Med · September 1998 PURPOSE: To describe characteristics, outcomes, and decision making in patients with colorectal cancer metastatic to the liver, and to examine the relationship of doctor-patient communication with patient understanding of prognosis and physician understand ... Full text Link to item Cite

Relationship between cancer patients' predictions of prognosis and their treatment preferences.

Journal Article JAMA · June 3, 1998 CONTEXT: Previous studies have documented that cancer patients tend to overestimate the probability of long-term survival. If patient preferences about the trade-offs between the risks and benefits associated with alternative treatment strategies are based ... Full text Link to item Cite

Virtual bronchoscopy for directing transbronchial needle aspiration of hilar and mediastinal lymph nodes: a pilot study.

Journal Article AJR Am J Roentgenol · May 1998 OBJECTIVE: We conducted a preliminary investigation of virtual bronchoscopy as a guide for transbronchial needle aspiration of hilar or mediastinal lymph nodes to assess the usefulness of this technique. CONCLUSION: Virtual bronchoscopic images derived fro ... Full text Link to item Cite

Lung transplantation for Williams-Campbell syndrome.

Journal Article Chest · February 1998 Williams-Campbell syndrome is a rare disorder characterized by a deficiency of cartilage in subsegmental bronchi leading to distal airway collapse and bronchiectasis. We report the first case of lung transplantation in a patient with end-stage lung disease ... Full text Link to item Cite

Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators. The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments.

Journal Article Crit Care Med · December 1997 OBJECTIVE: To determine if body mass Index (BMI = weight [kg]/height [m]2), predictive of mortality in longitudinal epidemiologic studies, was also predictive of mortality in a sample of seriously ill hospitalized subjects. DESIGN: Prospective, multicenter ... Full text Link to item Cite

High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results.

Journal Article Int J Radiat Oncol Biol Phys · October 1, 1996 PURPOSE: The treatment of nonsmall cell lung cancer (NSCLC) with conventional radiotherapy (RT) results in inadequate local tumor control and survival. We report results of a Phase II trial designed to treat patients with a significantly increased total do ... Full text Link to item Cite

Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments).

Journal Article Am J Respir Crit Care Med · October 1996 In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective coh ... Full text Link to item Cite

Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor.

Journal Article Chest · February 1996 STUDY OBJECTIVE: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. Collection of brushing and washing specimens for cytology is common during bronchoscopy for endobronchial abnormality, but it is unknown if colle ... Full text Link to item Cite

The rising tide of asthma. Trends in the epidemiology of morbidity and mortality from asthma.

Journal Article Respir Care Clin N Am · December 1995 The increase in the asthma mortality rate seen in the past decade has stimulated much discussion, research, and controversy. The epidemiology of asthma morbidity is reviewed, with special attention to the roles of demographics, socioeconomic status, and ia ... Link to item Cite

Pathophysiology and management of life-threatening asthma.

Journal Article Respir Care Clin N Am · December 1995 With sound medical management and good patient education, only a small minority of patients with asthma ever experience a life-threatening episode. The pathophysiology, clinical presentation, and management of life-threatening asthma are reviewed. Special ... Link to item Cite

Identification of comatose patients at high risk for death or severe disability. SUPPORT Investigators. Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Journal Article JAMA · June 21, 1995 OBJECTIVE: To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. DESIGN: Prospective cohort study. SETTING: Five geographically ... Link to item Cite

Recurrence of diffuse panbronchiolitis after lung transplantation.

Journal Article Am J Respir Crit Care Med · March 1995 Diffuse panbronchiolitis (DBP) is characterized by chronic inflammation of the upper and lower respiratory tract. DPB has been found almost exclusively in oriental populations. We describe the occurrence of a case of DPB in an African American patient who ... Full text Link to item Cite

The changing relationship between health care professionals and the pharmaceutical industry.

Journal Article Hosp Formul · March 1995 Although UCLA had established policies and procedures for visiting pharmaceutical representatives, changes in both the pharmaceutical business environment and in UCLA's physical environment mandated an update. To deal with the changes, a multidisciplinary ... Link to item Cite

RECURRENCE OF DIFFUSE PANBRONCHIOLITIS AFTER LUNG TRANSPLANTATION

Journal Article AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · March 1, 1995 Link to item Cite

Recurrence of diffuse panbronchiolitis after lung transplantation

Journal Article American Journal of Respiratory and Critical Care Medicine · January 1, 1995 Diffuse panbronchiolitis (DBP) is characterized by chronic inflammation of the upper and lower respiratory tract. DPB has been found almost exclusively in oriental populations. We describe the occurrence of a case of DPB in an African American patient who ... Full text Cite

Pharmacoeconomics and the formulary decision-making process.

Journal Article Hosp Formul · January 1995 What is pharmacoeconomics and why is there growing interest in this concept by those who work in or serve the medical community? This article provides a brief explanation of this concept and its importance from an institutional perspective. Additionally, t ... Link to item Cite

ROLE OF INDUSTRY IN PHARMACOECONOMICS - DISCUSSION

Journal Article HOSPITAL FORMULARY · January 1, 1995 Link to item Cite

Prior capacity of patients lacking decision making ability early in hospitalization: implications for advance directive administration. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Journal Article J Gen Intern Med · October 1994 OBJECTIVE: To investigate the appropriateness of hospitalization as the time to elicit patients' medical care preferences, the authors evaluated the capability of seriously ill patients to participate in decision making early in hospitalization and their d ... Full text Link to item Cite

Mitochondrial myopathy with anemia, cardiomyopathy, and lactic acidosis: a distinct late onset mitochondrial disorder.

Journal Article Am J Med Genet · June 1, 1994 A 40-year-old woman presented with profound muscle weakness resulting in failure to wean from a ventilator and persistent lactic acidosis after having recovered from a pneumonia complicated by adult respiratory distress syndrome, myocardial infarction, ren ... Full text Link to item Cite