Networks

Occupational and Environmental Health

Incident sarcoidosis

The history of sarcoidosis dates back to 1869, when Dr. Jonathan Hutchinson described symmetrical purple skin plaques on the legs and hands of a coal-wharf worker (James and Sharma. Curr Opin Pulm Med. 2002;8[5]:416). However, despite its distant beginning, much remains unknown. It has been hypothesized that environmental factors play a pivotal role in disease onset and course, as is evidenced by the notable exposure in the first historical case.

Research has shown environmental factors, such as wood smoke, tree pollen, insecticides, and mold; as well as occupational exposures, such as flight deck work on aircraft carriers, metalworking, construction, and firefighting, carry increased risk of sarcoidosis (Newman et al. Am J Respir Crit Care Med. 2004;170[12]:1324; Newman and Newman. Curr Opin Allergy Clin Immunol. 2012;12[2]:145). A significantly high annual incidence of sarcoidosis was first demonstrated in FDNY firefighters between 1985 and 1998; 12.9/100,000, as compared with 2.5 to 7.6/100,000 for U.S. white men (Prezant et al. Chest. 1999;116[5]:1183).

Following the attack of the World Trade Center (WTC) on September 11, 2001, a further increase in sarcoidosis incidence was found in FDNY firefighters exposed to WTC “dust” during the collapse and rescue/recovery effort (Izbicki et al. Chest. 2007;131[5]:1414). As of 2015, a total of 75 FDNY firefighters have been identified as having new post-9/11 sarcoidosis.

Since the WTC-exposed FDNY firefighters with new-onset sarcoidosis since September 11, 2001 can be considered to have had a WTC “trigger,” we have a unique opportunity to define the clinical patterns and outcomes of incident sarcoidosis following a distinct exposure. Members of the Occupational and Environmental NetWork Steering Committee are currently investigating this aim and others in a National Institute of Occupational Safety and Health (NIOSH)-granted cohort study. We hypothesize that the patterns of organ involvement, and time course of disease progression or resolution, may significantly differ in this group as compared with the general population. Preliminary results of our study of WTC-exposed FDNY firefighters will be presented at CHEST 2016 in Los Angeles.

Kerry Hena, MD

Physician-in-Training Member

Palliative and End-of-Life Care

Integrated palliative care for mechanical circulatory support

Patients with advanced heart failure (AHF) have well-documented needs for comprehensive supportive care services in the critical care setting. Notable symptom burden, high morbidity and mortality, prognostic uncertainty, and need for care coordination across hospital settings pave the way for palliative care (PC) teams to work symbiotically with advanced heart failure specialists and intensivists. Furthermore, the expanded availability of mechanical circulatory support (MCS) technology extends these clinical and ethical challenges to balancing longevity, quality of life, and resource utilization, most prominently in the ICU.

To date, collaborations between PC, AHF specialists, and critical care have tended to be reactive, not proactive – palliative consultation usually occurs after a medical or surgical crisis (for example, the massive stroke, MCS thrombus, sepsis, and multiorgan failure) or after a prolonged ICU stay without clear improvement in patient function or prognosis. This reactive consult may be misperceived by patient and family as “giving up.”

At our institution, we have worked to develop a model of seamless integration of interdisciplinary palliative care consultation upstream in advanced heart failure patient care that aims to preempt many dilemmas in the ICU around complex medical decision making and end-of-life care. Through development of therapeutic supportive care relationships, preparedness planning, and discussions of goals of care early in treatment pathways involving critical care resources – including MCS evaluation and cardiac transplantation – this model purports to strengthen appropriate critical care delivery for patients with advanced heart failure. This model has evolved to where PC consultation becomes a structured part of the preoperative evaluation of all candidates for left-ventricular assist device as destination therapy (LVAD-DT). The result is a collaborative approach where patients and families see PC as part of the continuum of whole-person AHF care, rather than a negative alternative.

MCS implantation is on the rise. While MCS technology continues to evolve, its recipients remain seriously ill. Normalizing and integrating PC consultation as part of high quality AHF and critical care sends an important message to patients and families: regardless of clinical outcome, relief from suffering matters throughout the trajectory of the illness experience.

Hunter Groninger, MD

Steering Committee Member

Respiratory Care NetWork

Professional relationships in RC

At the 2015 meeting of the American Association for Respiratory Care (AARC) in Tampa, there were more than 20 presentations given by FCCPs! Also, a majority of CHEST’s Respiratory Care NetWork’s steering committee was in attendance at the meeting. To other members of CHEST, that might seem rather unusual. However, many CHEST members have connections with the field of respiratory care. In addition, CHEST as an organization has a professional relationship with the respiratory care field. CHEST has more than 10 official liaisons to respiratory care professional organizations.

Those organizations include: The Commission for Accreditation for Respiratory Care, which credentials all RC educational programs; The National Board for Respiratory Care, which provides the credentialing examinations for all RC practitioners in the United States; The National Association for Medical Direction for Respiratory Care (NAMDRC); the Board of Medical Advisors to the AARC; and the Respiratory Compromise Institute.

The Respiratory Care NetWork has the responsibility of identifying and nominating CHEST members for these liaison positions. These volunteer positions do involve work, yet past and present liaisons have enthusiastically fulfilled their respective roles. As one recently noted, “This work has been some of the most important endeavors of my professional career.”

We are always seeking volunteers for these positions, which vary in time commitment and type of work involved. Please contact the Respiratory Care NetWork ([email protected]) for further information. These organizations accomplish the type of things that made us all want to get into medicine. Be a part of those important efforts!

Thomas Fuhrman, MD, FCCP

Steering Committee Member

Sleep Medicine

Listening to patient voices: Sleep Apnea Patient-Centered Outcomes Network (MyApnea.org)

The US Department of Transportation’s (DOT) Federal Motor Carrier Safety Administration (FMCSA) and Federal Railroad Administration (FRA) recently called for input for obstructive sleep apnea screening and treatment for transportation workers. The DOT (https://www.transportation.gov) encouraged input from the public regarding this important transportation safety issue. This concept of engaging the public (which includes patients) with sleep disorders is gaining momentum as patients are increasingly partnering with researchers, clinicians, and policy makers to improve the delivery of care and research efforts in sleep medicine.

A remarkable example of such an effort is the Sleep Apnea Patient-Centered Outcomes Network (SAPCON; MyApnea.Org) (Redline et al. JCSM. 2016;12[7]:1053). This patient-powered research network was initiated in 2013 to improve the diagnosis and treatment of sleep apnea through the active engagement of patients, families, researchers, and healthcare providers in a virtual community that facilitates patient-centered research. The need for such an initiative reflects the paucity of patient-centric evidence from large populations to inform insurers, public policy makers, medical schools, and clinicians on the best ways to screen, diagnose, and treat patients with sleep apnea.

As of August 2016, over 8,000 individuals across the globe have joined SAPCON. There are approximately 500 unique visitors to the site per day, with over 2,500 posts on over 250 topics, including blogs on a variety of emerging research and public health topics. Among these topics are driving and general transportation safety concerns. Further engagement of patients and key stakeholders through forums and patient-centered networks can promote the “patient voice” in public policy, while linking patient needs for better information with responsive research and policy development.

Neomi Shah, MD, MPH

Steering Committee Member

Occupational and Environmental Health

Incident sarcoidosis

The history of sarcoidosis dates back to 1869, when Dr. Jonathan Hutchinson described symmetrical purple skin plaques on the legs and hands of a coal-wharf worker (James and Sharma. Curr Opin Pulm Med. 2002;8[5]:416). However, despite its distant beginning, much remains unknown. It has been hypothesized that environmental factors play a pivotal role in disease onset and course, as is evidenced by the notable exposure in the first historical case.

Research has shown environmental factors, such as wood smoke, tree pollen, insecticides, and mold; as well as occupational exposures, such as flight deck work on aircraft carriers, metalworking, construction, and firefighting, carry increased risk of sarcoidosis (Newman et al. Am J Respir Crit Care Med. 2004;170[12]:1324; Newman and Newman. Curr Opin Allergy Clin Immunol. 2012;12[2]:145). A significantly high annual incidence of sarcoidosis was first demonstrated in FDNY firefighters between 1985 and 1998; 12.9/100,000, as compared with 2.5 to 7.6/100,000 for U.S. white men (Prezant et al. Chest. 1999;116[5]:1183).

Following the attack of the World Trade Center (WTC) on September 11, 2001, a further increase in sarcoidosis incidence was found in FDNY firefighters exposed to WTC “dust” during the collapse and rescue/recovery effort (Izbicki et al. Chest. 2007;131[5]:1414). As of 2015, a total of 75 FDNY firefighters have been identified as having new post-9/11 sarcoidosis.

Since the WTC-exposed FDNY firefighters with new-onset sarcoidosis since September 11, 2001 can be considered to have had a WTC “trigger,” we have a unique opportunity to define the clinical patterns and outcomes of incident sarcoidosis following a distinct exposure. Members of the Occupational and Environmental NetWork Steering Committee are currently investigating this aim and others in a National Institute of Occupational Safety and Health (NIOSH)-granted cohort study. We hypothesize that the patterns of organ involvement, and time course of disease progression or resolution, may significantly differ in this group as compared with the general population. Preliminary results of our study of WTC-exposed FDNY firefighters will be presented at CHEST 2016 in Los Angeles.

Kerry Hena, MD

Physician-in-Training Member

Palliative and End-of-Life Care

Integrated palliative care for mechanical circulatory support

Patients with advanced heart failure (AHF) have well-documented needs for comprehensive supportive care services in the critical care setting. Notable symptom burden, high morbidity and mortality, prognostic uncertainty, and need for care coordination across hospital settings pave the way for palliative care (PC) teams to work symbiotically with advanced heart failure specialists and intensivists. Furthermore, the expanded availability of mechanical circulatory support (MCS) technology extends these clinical and ethical challenges to balancing longevity, quality of life, and resource utilization, most prominently in the ICU.

To date, collaborations between PC, AHF specialists, and critical care have tended to be reactive, not proactive – palliative consultation usually occurs after a medical or surgical crisis (for example, the massive stroke, MCS thrombus, sepsis, and multiorgan failure) or after a prolonged ICU stay without clear improvement in patient function or prognosis. This reactive consult may be misperceived by patient and family as “giving up.”

At our institution, we have worked to develop a model of seamless integration of interdisciplinary palliative care consultation upstream in advanced heart failure patient care that aims to preempt many dilemmas in the ICU around complex medical decision making and end-of-life care. Through development of therapeutic supportive care relationships, preparedness planning, and discussions of goals of care early in treatment pathways involving critical care resources – including MCS evaluation and cardiac transplantation – this model purports to strengthen appropriate critical care delivery for patients with advanced heart failure. This model has evolved to where PC consultation becomes a structured part of the preoperative evaluation of all candidates for left-ventricular assist device as destination therapy (LVAD-DT). The result is a collaborative approach where patients and families see PC as part of the continuum of whole-person AHF care, rather than a negative alternative.

MCS implantation is on the rise. While MCS technology continues to evolve, its recipients remain seriously ill. Normalizing and integrating PC consultation as part of high quality AHF and critical care sends an important message to patients and families: regardless of clinical outcome, relief from suffering matters throughout the trajectory of the illness experience.

Hunter Groninger, MD

Steering Committee Member

Respiratory Care NetWork

Professional relationships in RC

At the 2015 meeting of the American Association for Respiratory Care (AARC) in Tampa, there were more than 20 presentations given by FCCPs! Also, a majority of CHEST’s Respiratory Care NetWork’s steering committee was in attendance at the meeting. To other members of CHEST, that might seem rather unusual. However, many CHEST members have connections with the field of respiratory care. In addition, CHEST as an organization has a professional relationship with the respiratory care field. CHEST has more than 10 official liaisons to respiratory care professional organizations.

Those organizations include: The Commission for Accreditation for Respiratory Care, which credentials all RC educational programs; The National Board for Respiratory Care, which provides the credentialing examinations for all RC practitioners in the United States; The National Association for Medical Direction for Respiratory Care (NAMDRC); the Board of Medical Advisors to the AARC; and the Respiratory Compromise Institute.

The Respiratory Care NetWork has the responsibility of identifying and nominating CHEST members for these liaison positions. These volunteer positions do involve work, yet past and present liaisons have enthusiastically fulfilled their respective roles. As one recently noted, “This work has been some of the most important endeavors of my professional career.”

We are always seeking volunteers for these positions, which vary in time commitment and type of work involved. Please contact the Respiratory Care NetWork ([email protected]) for further information. These organizations accomplish the type of things that made us all want to get into medicine. Be a part of those important efforts!

Thomas Fuhrman, MD, FCCP

Steering Committee Member

Sleep Medicine

Listening to patient voices: Sleep Apnea Patient-Centered Outcomes Network (MyApnea.org)

The US Department of Transportation’s (DOT) Federal Motor Carrier Safety Administration (FMCSA) and Federal Railroad Administration (FRA) recently called for input for obstructive sleep apnea screening and treatment for transportation workers. The DOT (https://www.transportation.gov) encouraged input from the public regarding this important transportation safety issue. This concept of engaging the public (which includes patients) with sleep disorders is gaining momentum as patients are increasingly partnering with researchers, clinicians, and policy makers to improve the delivery of care and research efforts in sleep medicine.

A remarkable example of such an effort is the Sleep Apnea Patient-Centered Outcomes Network (SAPCON; MyApnea.Org) (Redline et al. JCSM. 2016;12[7]:1053). This patient-powered research network was initiated in 2013 to improve the diagnosis and treatment of sleep apnea through the active engagement of patients, families, researchers, and healthcare providers in a virtual community that facilitates patient-centered research. The need for such an initiative reflects the paucity of patient-centric evidence from large populations to inform insurers, public policy makers, medical schools, and clinicians on the best ways to screen, diagnose, and treat patients with sleep apnea.

As of August 2016, over 8,000 individuals across the globe have joined SAPCON. There are approximately 500 unique visitors to the site per day, with over 2,500 posts on over 250 topics, including blogs on a variety of emerging research and public health topics. Among these topics are driving and general transportation safety concerns. Further engagement of patients and key stakeholders through forums and patient-centered networks can promote the “patient voice” in public policy, while linking patient needs for better information with responsive research and policy development.

Neomi Shah, MD, MPH

Steering Committee Member

Occupational and Environmental Health

Incident sarcoidosis

The history of sarcoidosis dates back to 1869, when Dr. Jonathan Hutchinson described symmetrical purple skin plaques on the legs and hands of a coal-wharf worker (James and Sharma. Curr Opin Pulm Med. 2002;8[5]:416). However, despite its distant beginning, much remains unknown. It has been hypothesized that environmental factors play a pivotal role in disease onset and course, as is evidenced by the notable exposure in the first historical case.

Research has shown environmental factors, such as wood smoke, tree pollen, insecticides, and mold; as well as occupational exposures, such as flight deck work on aircraft carriers, metalworking, construction, and firefighting, carry increased risk of sarcoidosis (Newman et al. Am J Respir Crit Care Med. 2004;170[12]:1324; Newman and Newman. Curr Opin Allergy Clin Immunol. 2012;12[2]:145). A significantly high annual incidence of sarcoidosis was first demonstrated in FDNY firefighters between 1985 and 1998; 12.9/100,000, as compared with 2.5 to 7.6/100,000 for U.S. white men (Prezant et al. Chest. 1999;116[5]:1183).

Following the attack of the World Trade Center (WTC) on September 11, 2001, a further increase in sarcoidosis incidence was found in FDNY firefighters exposed to WTC “dust” during the collapse and rescue/recovery effort (Izbicki et al. Chest. 2007;131[5]:1414). As of 2015, a total of 75 FDNY firefighters have been identified as having new post-9/11 sarcoidosis.

Since the WTC-exposed FDNY firefighters with new-onset sarcoidosis since September 11, 2001 can be considered to have had a WTC “trigger,” we have a unique opportunity to define the clinical patterns and outcomes of incident sarcoidosis following a distinct exposure. Members of the Occupational and Environmental NetWork Steering Committee are currently investigating this aim and others in a National Institute of Occupational Safety and Health (NIOSH)-granted cohort study. We hypothesize that the patterns of organ involvement, and time course of disease progression or resolution, may significantly differ in this group as compared with the general population. Preliminary results of our study of WTC-exposed FDNY firefighters will be presented at CHEST 2016 in Los Angeles.

Kerry Hena, MD

Physician-in-Training Member

Palliative and End-of-Life Care

Integrated palliative care for mechanical circulatory support

Patients with advanced heart failure (AHF) have well-documented needs for comprehensive supportive care services in the critical care setting. Notable symptom burden, high morbidity and mortality, prognostic uncertainty, and need for care coordination across hospital settings pave the way for palliative care (PC) teams to work symbiotically with advanced heart failure specialists and intensivists. Furthermore, the expanded availability of mechanical circulatory support (MCS) technology extends these clinical and ethical challenges to balancing longevity, quality of life, and resource utilization, most prominently in the ICU.

To date, collaborations between PC, AHF specialists, and critical care have tended to be reactive, not proactive – palliative consultation usually occurs after a medical or surgical crisis (for example, the massive stroke, MCS thrombus, sepsis, and multiorgan failure) or after a prolonged ICU stay without clear improvement in patient function or prognosis. This reactive consult may be misperceived by patient and family as “giving up.”

At our institution, we have worked to develop a model of seamless integration of interdisciplinary palliative care consultation upstream in advanced heart failure patient care that aims to preempt many dilemmas in the ICU around complex medical decision making and end-of-life care. Through development of therapeutic supportive care relationships, preparedness planning, and discussions of goals of care early in treatment pathways involving critical care resources – including MCS evaluation and cardiac transplantation – this model purports to strengthen appropriate critical care delivery for patients with advanced heart failure. This model has evolved to where PC consultation becomes a structured part of the preoperative evaluation of all candidates for left-ventricular assist device as destination therapy (LVAD-DT). The result is a collaborative approach where patients and families see PC as part of the continuum of whole-person AHF care, rather than a negative alternative.

MCS implantation is on the rise. While MCS technology continues to evolve, its recipients remain seriously ill. Normalizing and integrating PC consultation as part of high quality AHF and critical care sends an important message to patients and families: regardless of clinical outcome, relief from suffering matters throughout the trajectory of the illness experience.

Hunter Groninger, MD

Steering Committee Member

Respiratory Care NetWork

Professional relationships in RC

At the 2015 meeting of the American Association for Respiratory Care (AARC) in Tampa, there were more than 20 presentations given by FCCPs! Also, a majority of CHEST’s Respiratory Care NetWork’s steering committee was in attendance at the meeting. To other members of CHEST, that might seem rather unusual. However, many CHEST members have connections with the field of respiratory care. In addition, CHEST as an organization has a professional relationship with the respiratory care field. CHEST has more than 10 official liaisons to respiratory care professional organizations.

Those organizations include: The Commission for Accreditation for Respiratory Care, which credentials all RC educational programs; The National Board for Respiratory Care, which provides the credentialing examinations for all RC practitioners in the United States; The National Association for Medical Direction for Respiratory Care (NAMDRC); the Board of Medical Advisors to the AARC; and the Respiratory Compromise Institute.

The Respiratory Care NetWork has the responsibility of identifying and nominating CHEST members for these liaison positions. These volunteer positions do involve work, yet past and present liaisons have enthusiastically fulfilled their respective roles. As one recently noted, “This work has been some of the most important endeavors of my professional career.”

We are always seeking volunteers for these positions, which vary in time commitment and type of work involved. Please contact the Respiratory Care NetWork ([email protected]) for further information. These organizations accomplish the type of things that made us all want to get into medicine. Be a part of those important efforts!

Thomas Fuhrman, MD, FCCP

Steering Committee Member

Sleep Medicine

Listening to patient voices: Sleep Apnea Patient-Centered Outcomes Network (MyApnea.org)

The US Department of Transportation’s (DOT) Federal Motor Carrier Safety Administration (FMCSA) and Federal Railroad Administration (FRA) recently called for input for obstructive sleep apnea screening and treatment for transportation workers. The DOT (https://www.transportation.gov) encouraged input from the public regarding this important transportation safety issue. This concept of engaging the public (which includes patients) with sleep disorders is gaining momentum as patients are increasingly partnering with researchers, clinicians, and policy makers to improve the delivery of care and research efforts in sleep medicine.

A remarkable example of such an effort is the Sleep Apnea Patient-Centered Outcomes Network (SAPCON; MyApnea.Org) (Redline et al. JCSM. 2016;12[7]:1053). This patient-powered research network was initiated in 2013 to improve the diagnosis and treatment of sleep apnea through the active engagement of patients, families, researchers, and healthcare providers in a virtual community that facilitates patient-centered research. The need for such an initiative reflects the paucity of patient-centric evidence from large populations to inform insurers, public policy makers, medical schools, and clinicians on the best ways to screen, diagnose, and treat patients with sleep apnea.

As of August 2016, over 8,000 individuals across the globe have joined SAPCON. There are approximately 500 unique visitors to the site per day, with over 2,500 posts on over 250 topics, including blogs on a variety of emerging research and public health topics. Among these topics are driving and general transportation safety concerns. Further engagement of patients and key stakeholders through forums and patient-centered networks can promote the “patient voice” in public policy, while linking patient needs for better information with responsive research and policy development.

Neomi Shah, MD, MPH

Steering Committee Member