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Physician as trusted counselor
Pediatricians play many roles as they fulfill their duties and responsibilities. Among these is the role of trusted counselor.
A pediatrician is a risk manager. Not the risk manager at a brokerage firm assessing financial risks. Not the hospital lawyer providing legal advice to minimize lawsuits against the hospital. The pediatrician, as risk manager, is a fiduciary, confidant, partner, and guide for parents seeking to protect and maximize the health of their children.
The practice of pediatrics deals with many low-probability, high-impact threats. This begins before birth. The obstetrician has already ordered a litany of prenatal screens, blood tests, and ultrasounds. Many of these have a positive predictive value of less than 20%. That means the alarming positive results are wrong more than 80% of the time. Tests done purportedly to reassure the parents are likely to falsely terrify them. This devilish process continues immediately after birth. The newborns are subjected to a wide variety of screening tests that they must pass before being stamped USDA Prime baby. Early in my career, a thorough newborn physical exam was the key means of identifying problems. Modern medicine employs a wide variety of blood tests, a hearing screen, a pulse ox check, and a transcutaneous bilirubin test before discharge. It is a gauntlet that few escape unscathed. Even the totally normal infant is going to flunk a handful of these screens. Then the nursery doctor is ready to erect additional hoops to jump through. Too big or too small? You need glucose checks. Breech presentation? A hip ultrasound. Too long in labor? Blood tests. Too pale or too ruddy? Blood tests. Not acting quite right? Temperature too high? Temperature too low? Too irritable? Too lethargic? Baby, you’ve hit the jackpot for extra blood tests, an app to estimate the risk of early-onset sepsis, and maybe a trip to the NICU.
Many of these protocols have poor positive predictive value results that are not easy to explain to lay people. The ideas are not easily taught to medical students. Those results can be even harder to communicate to new parents with health care careers. A little knowledge goes a long ways toward long, sleepless nights of worrying even though the baby is just fine. Even cute. Snuggly. A good baby! Parents, hug your baby! Feed the baby! Let the professional do most of the worrying.
What does a professional worrier offer? First, a comprehension of the science. The professional understands sensitivity and specificity, false-positive rates, prevalence, and positive predictive value. Second, particular knowledge of the various tests involved, including the confirmatory tests and the risk-benefit of treatment. Third, experienced clinical judgment that knows that lotteries are bad investments even though two people are splitting a $600 million lottery win this week. Most people don’t emotionally cope with small risks. Fourth, the ability to do values clarification. There is not a one-size-fits-all bedside approach in pediatrics. Parents have differing expectations, differing levels of risk aversion, and different methods for handling anxiety. First-time parents may be very risk intolerant with their baby. Some people deal with fear by seeking more information. Others are looking for evidence that the expert physician is committed to compassionately providing whatever is best for their child.
How has medicine evolved recently? I will highlight four items. First, as described earlier, there has been a large increase in the number of these screens that will be failed. Typical office practice continues the methodology with well child exams and developmental screening. Second, many screens have been introduced that have very low positive predictive value. This leads to many anxious parents who will benefit from pediatricians with the bedside manner to guide the parents and their precious baby through this maze of scientific interventions. The science is difficult enough to master during training. It takes more time to learn the art of counseling parents, listening to their concerns, and earning their trust. That art is practiced in face-to-face encounters with the parents. The classic approach to residency training limits the opportunity to observe and mentor the knowledge, skills, and empathy of a good bedside manner.
A third evolution, more recent, has been the widespread pollution of scientific knowledge with misinformation and disinformation through social media. I addressed that issue in my columns in January and March 2019.
Fourth, most recently, I believe the pandemic has emphasized to the public that nothing in life is totally risk free. Extreme efforts to reduce risk produce unwanted consequences. There is a window of opportunity here to work with parents and patients to build relationships that help people to assess risks and make more rational and beneficial choices. For example, when is the risk of meningitis in a febrile young infant low enough to manage at home? The risk will never be zero. But admission to the hospital “just in case” is not risk free either. People are acutely aware of that right now.
Health care professionals can position themselves as the trusted source of health information specific to a particular person’s situation. Health care professionals can be competent, committed, and compassionate listeners to what really worries people. In this way, we manage risk. This role also involves addressing the mental health crisis causing so much suicide and addiction. Severe problems should be referred to specialists, but I anticipate in the near future that most pediatricians will require more skills dealing with risk and anxiety rather than microbes.
Dr. Powell is a retired pediatric hospitalist and clinical ethics consultant living in St. Louis. Email him at [email protected].
Pediatricians play many roles as they fulfill their duties and responsibilities. Among these is the role of trusted counselor.
A pediatrician is a risk manager. Not the risk manager at a brokerage firm assessing financial risks. Not the hospital lawyer providing legal advice to minimize lawsuits against the hospital. The pediatrician, as risk manager, is a fiduciary, confidant, partner, and guide for parents seeking to protect and maximize the health of their children.
The practice of pediatrics deals with many low-probability, high-impact threats. This begins before birth. The obstetrician has already ordered a litany of prenatal screens, blood tests, and ultrasounds. Many of these have a positive predictive value of less than 20%. That means the alarming positive results are wrong more than 80% of the time. Tests done purportedly to reassure the parents are likely to falsely terrify them. This devilish process continues immediately after birth. The newborns are subjected to a wide variety of screening tests that they must pass before being stamped USDA Prime baby. Early in my career, a thorough newborn physical exam was the key means of identifying problems. Modern medicine employs a wide variety of blood tests, a hearing screen, a pulse ox check, and a transcutaneous bilirubin test before discharge. It is a gauntlet that few escape unscathed. Even the totally normal infant is going to flunk a handful of these screens. Then the nursery doctor is ready to erect additional hoops to jump through. Too big or too small? You need glucose checks. Breech presentation? A hip ultrasound. Too long in labor? Blood tests. Too pale or too ruddy? Blood tests. Not acting quite right? Temperature too high? Temperature too low? Too irritable? Too lethargic? Baby, you’ve hit the jackpot for extra blood tests, an app to estimate the risk of early-onset sepsis, and maybe a trip to the NICU.
Many of these protocols have poor positive predictive value results that are not easy to explain to lay people. The ideas are not easily taught to medical students. Those results can be even harder to communicate to new parents with health care careers. A little knowledge goes a long ways toward long, sleepless nights of worrying even though the baby is just fine. Even cute. Snuggly. A good baby! Parents, hug your baby! Feed the baby! Let the professional do most of the worrying.
What does a professional worrier offer? First, a comprehension of the science. The professional understands sensitivity and specificity, false-positive rates, prevalence, and positive predictive value. Second, particular knowledge of the various tests involved, including the confirmatory tests and the risk-benefit of treatment. Third, experienced clinical judgment that knows that lotteries are bad investments even though two people are splitting a $600 million lottery win this week. Most people don’t emotionally cope with small risks. Fourth, the ability to do values clarification. There is not a one-size-fits-all bedside approach in pediatrics. Parents have differing expectations, differing levels of risk aversion, and different methods for handling anxiety. First-time parents may be very risk intolerant with their baby. Some people deal with fear by seeking more information. Others are looking for evidence that the expert physician is committed to compassionately providing whatever is best for their child.
How has medicine evolved recently? I will highlight four items. First, as described earlier, there has been a large increase in the number of these screens that will be failed. Typical office practice continues the methodology with well child exams and developmental screening. Second, many screens have been introduced that have very low positive predictive value. This leads to many anxious parents who will benefit from pediatricians with the bedside manner to guide the parents and their precious baby through this maze of scientific interventions. The science is difficult enough to master during training. It takes more time to learn the art of counseling parents, listening to their concerns, and earning their trust. That art is practiced in face-to-face encounters with the parents. The classic approach to residency training limits the opportunity to observe and mentor the knowledge, skills, and empathy of a good bedside manner.
A third evolution, more recent, has been the widespread pollution of scientific knowledge with misinformation and disinformation through social media. I addressed that issue in my columns in January and March 2019.
Fourth, most recently, I believe the pandemic has emphasized to the public that nothing in life is totally risk free. Extreme efforts to reduce risk produce unwanted consequences. There is a window of opportunity here to work with parents and patients to build relationships that help people to assess risks and make more rational and beneficial choices. For example, when is the risk of meningitis in a febrile young infant low enough to manage at home? The risk will never be zero. But admission to the hospital “just in case” is not risk free either. People are acutely aware of that right now.
Health care professionals can position themselves as the trusted source of health information specific to a particular person’s situation. Health care professionals can be competent, committed, and compassionate listeners to what really worries people. In this way, we manage risk. This role also involves addressing the mental health crisis causing so much suicide and addiction. Severe problems should be referred to specialists, but I anticipate in the near future that most pediatricians will require more skills dealing with risk and anxiety rather than microbes.
Dr. Powell is a retired pediatric hospitalist and clinical ethics consultant living in St. Louis. Email him at [email protected].
Pediatricians play many roles as they fulfill their duties and responsibilities. Among these is the role of trusted counselor.
A pediatrician is a risk manager. Not the risk manager at a brokerage firm assessing financial risks. Not the hospital lawyer providing legal advice to minimize lawsuits against the hospital. The pediatrician, as risk manager, is a fiduciary, confidant, partner, and guide for parents seeking to protect and maximize the health of their children.
The practice of pediatrics deals with many low-probability, high-impact threats. This begins before birth. The obstetrician has already ordered a litany of prenatal screens, blood tests, and ultrasounds. Many of these have a positive predictive value of less than 20%. That means the alarming positive results are wrong more than 80% of the time. Tests done purportedly to reassure the parents are likely to falsely terrify them. This devilish process continues immediately after birth. The newborns are subjected to a wide variety of screening tests that they must pass before being stamped USDA Prime baby. Early in my career, a thorough newborn physical exam was the key means of identifying problems. Modern medicine employs a wide variety of blood tests, a hearing screen, a pulse ox check, and a transcutaneous bilirubin test before discharge. It is a gauntlet that few escape unscathed. Even the totally normal infant is going to flunk a handful of these screens. Then the nursery doctor is ready to erect additional hoops to jump through. Too big or too small? You need glucose checks. Breech presentation? A hip ultrasound. Too long in labor? Blood tests. Too pale or too ruddy? Blood tests. Not acting quite right? Temperature too high? Temperature too low? Too irritable? Too lethargic? Baby, you’ve hit the jackpot for extra blood tests, an app to estimate the risk of early-onset sepsis, and maybe a trip to the NICU.
Many of these protocols have poor positive predictive value results that are not easy to explain to lay people. The ideas are not easily taught to medical students. Those results can be even harder to communicate to new parents with health care careers. A little knowledge goes a long ways toward long, sleepless nights of worrying even though the baby is just fine. Even cute. Snuggly. A good baby! Parents, hug your baby! Feed the baby! Let the professional do most of the worrying.
What does a professional worrier offer? First, a comprehension of the science. The professional understands sensitivity and specificity, false-positive rates, prevalence, and positive predictive value. Second, particular knowledge of the various tests involved, including the confirmatory tests and the risk-benefit of treatment. Third, experienced clinical judgment that knows that lotteries are bad investments even though two people are splitting a $600 million lottery win this week. Most people don’t emotionally cope with small risks. Fourth, the ability to do values clarification. There is not a one-size-fits-all bedside approach in pediatrics. Parents have differing expectations, differing levels of risk aversion, and different methods for handling anxiety. First-time parents may be very risk intolerant with their baby. Some people deal with fear by seeking more information. Others are looking for evidence that the expert physician is committed to compassionately providing whatever is best for their child.
How has medicine evolved recently? I will highlight four items. First, as described earlier, there has been a large increase in the number of these screens that will be failed. Typical office practice continues the methodology with well child exams and developmental screening. Second, many screens have been introduced that have very low positive predictive value. This leads to many anxious parents who will benefit from pediatricians with the bedside manner to guide the parents and their precious baby through this maze of scientific interventions. The science is difficult enough to master during training. It takes more time to learn the art of counseling parents, listening to their concerns, and earning their trust. That art is practiced in face-to-face encounters with the parents. The classic approach to residency training limits the opportunity to observe and mentor the knowledge, skills, and empathy of a good bedside manner.
A third evolution, more recent, has been the widespread pollution of scientific knowledge with misinformation and disinformation through social media. I addressed that issue in my columns in January and March 2019.
Fourth, most recently, I believe the pandemic has emphasized to the public that nothing in life is totally risk free. Extreme efforts to reduce risk produce unwanted consequences. There is a window of opportunity here to work with parents and patients to build relationships that help people to assess risks and make more rational and beneficial choices. For example, when is the risk of meningitis in a febrile young infant low enough to manage at home? The risk will never be zero. But admission to the hospital “just in case” is not risk free either. People are acutely aware of that right now.
Health care professionals can position themselves as the trusted source of health information specific to a particular person’s situation. Health care professionals can be competent, committed, and compassionate listeners to what really worries people. In this way, we manage risk. This role also involves addressing the mental health crisis causing so much suicide and addiction. Severe problems should be referred to specialists, but I anticipate in the near future that most pediatricians will require more skills dealing with risk and anxiety rather than microbes.
Dr. Powell is a retired pediatric hospitalist and clinical ethics consultant living in St. Louis. Email him at [email protected].
The death of expertise
Unless your social circle is packed with medical professionals, I suspect you are the go-to gal/guy when there is a question about the pandemic. Seated around the fire pit trying to stay warm and socially distanced, inevitably the discussion will turn to COVID. Someone will report something they have read about vaccine side effects or the appropriate timing of isolation or quarantine and then turn to me assuming that I have inside information and ask: “But Will you know all about that. Tell us what have you heard.”
By now, well into our second year of the pandemic, my friends and neighbors should have come to expect my usual answer. “I don’t really know any more about this than you have read on the Internet or seen on television.” I am flattered that folks keep asking for my observations. I guess old habits die slowly. Although I usually introduce myself as an ex-pediatrician, the “doctor” descriptor still seems to command some respect, whether it is deserved or not.
It is not just my waning ability to speak authoritatively about the pandemic that has put expertise at death’s door. Although my formal medical education is more than a half-century old, like most physicians I have tried to stay abreast of what’s happening in health care. Keeping up to date with the new developments in pathophysiology and pharmacology does take some work, but the pandemic has shone a spotlight on how quickly these changes can occur.
With the pandemic, a sense of urgency has thrust onto the world stage opinions that in the past might have been quietly held theories based on preliminary studies. However, even the most careful scientists who might otherwise have been content to patiently wait for peer review are sharing their findings prematurely with international news sources and on social media. Not surprisingly, this rush to share has generated confusion and concern and in many cases resulted in retractions or corrections. Even more importantly, it has made us all skeptical about who these “experts” are, making often disproven pronouncements.
While my friends still persist in politely asking my opinion based on the same reports we are all reading on the Internet, I sense the nation as a whole has become wary of claimed expertise. I haven’t done a Google search but I wouldn’t be surprised if “expert” gets far fewer hits than the term “so-called expert.”
Even before we were engulfed by the pandemic, there has been an unfortunate phenomenon in which health care providers and other scientists are parlaying their degrees to promote products with little if any proven efficacy. Of course, this country has a long history of snake oil salesmen making their rounds. However, the electronic media and the Internet have increased the power to persuade so that we are awash in so-called experts. Many good scientists, in an attempt to be helpful, have succumbed to the sin of impatience. And there are a few who had never earned the moniker “expert.”
I hope that expertise returns to the landscape when the pandemic abates. But, I fear it may be a while.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Unless your social circle is packed with medical professionals, I suspect you are the go-to gal/guy when there is a question about the pandemic. Seated around the fire pit trying to stay warm and socially distanced, inevitably the discussion will turn to COVID. Someone will report something they have read about vaccine side effects or the appropriate timing of isolation or quarantine and then turn to me assuming that I have inside information and ask: “But Will you know all about that. Tell us what have you heard.”
By now, well into our second year of the pandemic, my friends and neighbors should have come to expect my usual answer. “I don’t really know any more about this than you have read on the Internet or seen on television.” I am flattered that folks keep asking for my observations. I guess old habits die slowly. Although I usually introduce myself as an ex-pediatrician, the “doctor” descriptor still seems to command some respect, whether it is deserved or not.
It is not just my waning ability to speak authoritatively about the pandemic that has put expertise at death’s door. Although my formal medical education is more than a half-century old, like most physicians I have tried to stay abreast of what’s happening in health care. Keeping up to date with the new developments in pathophysiology and pharmacology does take some work, but the pandemic has shone a spotlight on how quickly these changes can occur.
With the pandemic, a sense of urgency has thrust onto the world stage opinions that in the past might have been quietly held theories based on preliminary studies. However, even the most careful scientists who might otherwise have been content to patiently wait for peer review are sharing their findings prematurely with international news sources and on social media. Not surprisingly, this rush to share has generated confusion and concern and in many cases resulted in retractions or corrections. Even more importantly, it has made us all skeptical about who these “experts” are, making often disproven pronouncements.
While my friends still persist in politely asking my opinion based on the same reports we are all reading on the Internet, I sense the nation as a whole has become wary of claimed expertise. I haven’t done a Google search but I wouldn’t be surprised if “expert” gets far fewer hits than the term “so-called expert.”
Even before we were engulfed by the pandemic, there has been an unfortunate phenomenon in which health care providers and other scientists are parlaying their degrees to promote products with little if any proven efficacy. Of course, this country has a long history of snake oil salesmen making their rounds. However, the electronic media and the Internet have increased the power to persuade so that we are awash in so-called experts. Many good scientists, in an attempt to be helpful, have succumbed to the sin of impatience. And there are a few who had never earned the moniker “expert.”
I hope that expertise returns to the landscape when the pandemic abates. But, I fear it may be a while.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Unless your social circle is packed with medical professionals, I suspect you are the go-to gal/guy when there is a question about the pandemic. Seated around the fire pit trying to stay warm and socially distanced, inevitably the discussion will turn to COVID. Someone will report something they have read about vaccine side effects or the appropriate timing of isolation or quarantine and then turn to me assuming that I have inside information and ask: “But Will you know all about that. Tell us what have you heard.”
By now, well into our second year of the pandemic, my friends and neighbors should have come to expect my usual answer. “I don’t really know any more about this than you have read on the Internet or seen on television.” I am flattered that folks keep asking for my observations. I guess old habits die slowly. Although I usually introduce myself as an ex-pediatrician, the “doctor” descriptor still seems to command some respect, whether it is deserved or not.
It is not just my waning ability to speak authoritatively about the pandemic that has put expertise at death’s door. Although my formal medical education is more than a half-century old, like most physicians I have tried to stay abreast of what’s happening in health care. Keeping up to date with the new developments in pathophysiology and pharmacology does take some work, but the pandemic has shone a spotlight on how quickly these changes can occur.
With the pandemic, a sense of urgency has thrust onto the world stage opinions that in the past might have been quietly held theories based on preliminary studies. However, even the most careful scientists who might otherwise have been content to patiently wait for peer review are sharing their findings prematurely with international news sources and on social media. Not surprisingly, this rush to share has generated confusion and concern and in many cases resulted in retractions or corrections. Even more importantly, it has made us all skeptical about who these “experts” are, making often disproven pronouncements.
While my friends still persist in politely asking my opinion based on the same reports we are all reading on the Internet, I sense the nation as a whole has become wary of claimed expertise. I haven’t done a Google search but I wouldn’t be surprised if “expert” gets far fewer hits than the term “so-called expert.”
Even before we were engulfed by the pandemic, there has been an unfortunate phenomenon in which health care providers and other scientists are parlaying their degrees to promote products with little if any proven efficacy. Of course, this country has a long history of snake oil salesmen making their rounds. However, the electronic media and the Internet have increased the power to persuade so that we are awash in so-called experts. Many good scientists, in an attempt to be helpful, have succumbed to the sin of impatience. And there are a few who had never earned the moniker “expert.”
I hope that expertise returns to the landscape when the pandemic abates. But, I fear it may be a while.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Pediatric depression and parents
In October of 2021, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association jointly declared a National State of Emergency in Children’s Mental Health and called on policy makers to address a host of challenges that have impeded access to effective mental health care for youth.
In November, we wrote about how pediatricians may increase their use of screening for adolescent depression and initiate treatment when appropriate.
Now we complement that piece with guidance you may offer the parents of your depressed adolescent patients. Adolescent depression is a common pediatric disorder, especially in the COVID-19 era when so many relationships and activities have been limited or cut off. With treatment, most adolescents recover. Accepting that it may be taking longer to find a therapist, you can make treatment recommendations, support the teenager and parents, address safety concerns and, if the depression is of moderate or more serious severity, start medications. Parents are your natural partners as they are concerned about their children’s health and safety and eager for guidance on how to best support their recovery.
Adolescence is a time in which parents transition to more of a consulting than a controlling posture with their children, but illness calls for a shift toward setting rules and routines that will support health and healing. Prepare both the teenager (in a 1:1 discussion) and parents for this temporary shift, and for some teenagers, expect resistance. Depression will make the teenager more unhappy and irritable. It also causes withdrawal, by sapping energy and making one feel unwelcome at activities, believing his or her presence will be a burden to others. Treatment includes something called “behavioral activation,” or continuous nudging, to keep the patient involved in social, intellectual, and physical activities. Parents (and siblings) are the keys to this behavioral activation, whether nudging to participate in a board game or a walk. Reassure parents they should not take it personally when their teen resists, and not be discouraged if they fail sometimes. Their focus is on calmly, warmly, and repeatedly prompting their children with nudges toward these routines and activities. They should be ready to remind them why they are “nagging,” framing these efforts explicitly as supporting recovery from depression. If possible, applying these rules to everyone at home will help. They need to avoid being drawn into conflict, focusing instead on staying connected to their teens. Their task is to keep planning and cajoling, giving their children multiple opportunities to participate, pushing back against depression’s gravitational pull for total withdrawal.
Sleep
One of the most important thing parents can do for their depressed adolescents is to support their healthy restful sleep. During adolescence, the timing of sleep naturally shifts later, and the need for restful sleep increases. Working against the demands of homework, extracurricular activities, and social connections, sleep often suffers during adolescence. Further sleep disruptions, including difficulty falling asleep and frequent awakening during sleep or in the early morning, are typical of depression. Restful sleep is instrumental to recovery, and parents need to help their depressed teens set good sleep habits. This includes setting a time for bed that is realistic and consistent and turning off screens 30 minutes before lights out. A soothing, consistent bedtime routine, including a hot shower and reading in bed, is a powerful cue for sleep. Getting daily exercise and avoiding a heavy meal and caffeine in the hours before bed supports both falling and staying asleep. Having light reading near bed (magazines or comics) instead of screens can provide a way to pass 30 minutes if they wake up during the night (ideally reading out of bed), one that will not make it harder for them to go back to sleep. Finally, teens should not be allowed to spend all day in bed or nap in the afternoon. This may be the hardest task for parents, as adolescents naturally treat their beds like their center of operations and depression lowers their energy and initiative. If parents set these rules and routines for all members of the family, it can improve the chances that their depressed adolescents may begin to return to healthy sleep.
Exercise
Vigorous exercise (for 20 minutes three times weekly) is as effective as SSRIs in treating mild to moderate depression. Even in severe depression, exercise may accelerate recovery and certainly contributes to returning to restful sleep and a feeling of improved energy. Inviting their depressed teens to join them on a trip to the gym may seem like a fool’s errand to parents, but they should prioritize getting their children moving. Don’t offer choices or ask what activity they would like to do. Most invitations will be met with “no, thanks” (or probably something less polite). Instead, initiate simple activities and then cajole the children with “let’s go!” They should use loving persistence to get them out the door. Parents are the experts on their children and will know if there is an activity that they are more likely to enjoy. Make any activities group ones, easy to start and not too long. They could initiate family walks or bike rides in their neighborhood. If it helps, they can blame you, “these are doctor’s orders!” This approach of warm persistence should be applied across the board, helping their depressed teens participate in mealtimes and other activities. Prepare parents that this can feel unnatural, if they have been letting their healthy teenagers have more space and independence and less time in family activities.
Social connections
Behavioral activation includes keeping a depressed teen engaged in social activities. Friendships are a potent motivator in the lives of healthy adolescents. If depressed teens can stay connected to close friends, it is a powerful force for recovery. Find out if their friends know about their depression, whom do they trust to tell about it? Help them find comfortable language to speak about their depression with trusted friends. Parents can use their behavioral activation strategies to prompt their teenagers to participate in social activities. If texting, video chatting, or social media platforms are how they stay connected with close friends, support their use of these platforms. But be mindful that social media promotes social comparison over connection, and depression sets them up to feel less than others even without assistance. Parents should support real time with their friends in small groups, for short periods during the time of day when they have the most energy.
Safety
Suicide is the second leading cause of death for adolescents in the United States, and the rate of attempted and completed suicide in adolescents has been steadily climbing over the past decade according to the CDC. The rate is higher in older adolescents, though thankfully relatively uncommon (about 1 in 10,000 a year), and, although we know risk factors, no one has been able to predict reliably the risk for an individual teenager at a point in time. In a clinically referred sample, 85% of depressed adolescents will have suicidal ideation and 32% will make a suicide attempt. The risk is higher in those adolescents with more than one psychiatric diagnosis and with a history of impulsive behaviors, substance abuse, prior suicide attempts, and a family history of suicide. It is important that parents hear that asking about suicidal thoughts will not cause them. On the contrary, preserving open communication and a warm relationship is very protective. Adolescent suicide attempts are likely to be impulsive, so helping the family to consider ways to “put up obstacles” that would slow down any possible attempt is an effective way to improve safety. Ask your patients about suicidal thoughts, plans, and what keeps them safe. Find out if they worry about sharing these thoughts with their parents and why. Ask if there are ways their parents can check on them that “aren’t too annoying.” Determine if there are guns in the home, and if so, are they safely stored (locked, separate from ammunition)? More than 50% of completed adolescent suicides involve firearms, so this question is critical. What about access to medications that could be dangerous in overdose in your home or a relative’s home they may visit? Discussing these facts with your patients and their parents together will make it easier for them to continue the conversation outside of your office and can make an enormous difference in their recovery.
Dr. Swick is physician in chief at Ohana, Center for Child and Adolescent Behavioral Health, Community Hospital of the Monterey (Calif.) Peninsula. Dr. Jellinek is professor emeritus of psychiatry and pediatrics, Harvard Medical School, Boston. Email them at [email protected].
Reference
Kovacs M et al. J Am Acad Child Adolesc Psychiatry. 1993 Jan;32(1):8-20.
In October of 2021, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association jointly declared a National State of Emergency in Children’s Mental Health and called on policy makers to address a host of challenges that have impeded access to effective mental health care for youth.
In November, we wrote about how pediatricians may increase their use of screening for adolescent depression and initiate treatment when appropriate.
Now we complement that piece with guidance you may offer the parents of your depressed adolescent patients. Adolescent depression is a common pediatric disorder, especially in the COVID-19 era when so many relationships and activities have been limited or cut off. With treatment, most adolescents recover. Accepting that it may be taking longer to find a therapist, you can make treatment recommendations, support the teenager and parents, address safety concerns and, if the depression is of moderate or more serious severity, start medications. Parents are your natural partners as they are concerned about their children’s health and safety and eager for guidance on how to best support their recovery.
Adolescence is a time in which parents transition to more of a consulting than a controlling posture with their children, but illness calls for a shift toward setting rules and routines that will support health and healing. Prepare both the teenager (in a 1:1 discussion) and parents for this temporary shift, and for some teenagers, expect resistance. Depression will make the teenager more unhappy and irritable. It also causes withdrawal, by sapping energy and making one feel unwelcome at activities, believing his or her presence will be a burden to others. Treatment includes something called “behavioral activation,” or continuous nudging, to keep the patient involved in social, intellectual, and physical activities. Parents (and siblings) are the keys to this behavioral activation, whether nudging to participate in a board game or a walk. Reassure parents they should not take it personally when their teen resists, and not be discouraged if they fail sometimes. Their focus is on calmly, warmly, and repeatedly prompting their children with nudges toward these routines and activities. They should be ready to remind them why they are “nagging,” framing these efforts explicitly as supporting recovery from depression. If possible, applying these rules to everyone at home will help. They need to avoid being drawn into conflict, focusing instead on staying connected to their teens. Their task is to keep planning and cajoling, giving their children multiple opportunities to participate, pushing back against depression’s gravitational pull for total withdrawal.
Sleep
One of the most important thing parents can do for their depressed adolescents is to support their healthy restful sleep. During adolescence, the timing of sleep naturally shifts later, and the need for restful sleep increases. Working against the demands of homework, extracurricular activities, and social connections, sleep often suffers during adolescence. Further sleep disruptions, including difficulty falling asleep and frequent awakening during sleep or in the early morning, are typical of depression. Restful sleep is instrumental to recovery, and parents need to help their depressed teens set good sleep habits. This includes setting a time for bed that is realistic and consistent and turning off screens 30 minutes before lights out. A soothing, consistent bedtime routine, including a hot shower and reading in bed, is a powerful cue for sleep. Getting daily exercise and avoiding a heavy meal and caffeine in the hours before bed supports both falling and staying asleep. Having light reading near bed (magazines or comics) instead of screens can provide a way to pass 30 minutes if they wake up during the night (ideally reading out of bed), one that will not make it harder for them to go back to sleep. Finally, teens should not be allowed to spend all day in bed or nap in the afternoon. This may be the hardest task for parents, as adolescents naturally treat their beds like their center of operations and depression lowers their energy and initiative. If parents set these rules and routines for all members of the family, it can improve the chances that their depressed adolescents may begin to return to healthy sleep.
Exercise
Vigorous exercise (for 20 minutes three times weekly) is as effective as SSRIs in treating mild to moderate depression. Even in severe depression, exercise may accelerate recovery and certainly contributes to returning to restful sleep and a feeling of improved energy. Inviting their depressed teens to join them on a trip to the gym may seem like a fool’s errand to parents, but they should prioritize getting their children moving. Don’t offer choices or ask what activity they would like to do. Most invitations will be met with “no, thanks” (or probably something less polite). Instead, initiate simple activities and then cajole the children with “let’s go!” They should use loving persistence to get them out the door. Parents are the experts on their children and will know if there is an activity that they are more likely to enjoy. Make any activities group ones, easy to start and not too long. They could initiate family walks or bike rides in their neighborhood. If it helps, they can blame you, “these are doctor’s orders!” This approach of warm persistence should be applied across the board, helping their depressed teens participate in mealtimes and other activities. Prepare parents that this can feel unnatural, if they have been letting their healthy teenagers have more space and independence and less time in family activities.
Social connections
Behavioral activation includes keeping a depressed teen engaged in social activities. Friendships are a potent motivator in the lives of healthy adolescents. If depressed teens can stay connected to close friends, it is a powerful force for recovery. Find out if their friends know about their depression, whom do they trust to tell about it? Help them find comfortable language to speak about their depression with trusted friends. Parents can use their behavioral activation strategies to prompt their teenagers to participate in social activities. If texting, video chatting, or social media platforms are how they stay connected with close friends, support their use of these platforms. But be mindful that social media promotes social comparison over connection, and depression sets them up to feel less than others even without assistance. Parents should support real time with their friends in small groups, for short periods during the time of day when they have the most energy.
Safety
Suicide is the second leading cause of death for adolescents in the United States, and the rate of attempted and completed suicide in adolescents has been steadily climbing over the past decade according to the CDC. The rate is higher in older adolescents, though thankfully relatively uncommon (about 1 in 10,000 a year), and, although we know risk factors, no one has been able to predict reliably the risk for an individual teenager at a point in time. In a clinically referred sample, 85% of depressed adolescents will have suicidal ideation and 32% will make a suicide attempt. The risk is higher in those adolescents with more than one psychiatric diagnosis and with a history of impulsive behaviors, substance abuse, prior suicide attempts, and a family history of suicide. It is important that parents hear that asking about suicidal thoughts will not cause them. On the contrary, preserving open communication and a warm relationship is very protective. Adolescent suicide attempts are likely to be impulsive, so helping the family to consider ways to “put up obstacles” that would slow down any possible attempt is an effective way to improve safety. Ask your patients about suicidal thoughts, plans, and what keeps them safe. Find out if they worry about sharing these thoughts with their parents and why. Ask if there are ways their parents can check on them that “aren’t too annoying.” Determine if there are guns in the home, and if so, are they safely stored (locked, separate from ammunition)? More than 50% of completed adolescent suicides involve firearms, so this question is critical. What about access to medications that could be dangerous in overdose in your home or a relative’s home they may visit? Discussing these facts with your patients and their parents together will make it easier for them to continue the conversation outside of your office and can make an enormous difference in their recovery.
Dr. Swick is physician in chief at Ohana, Center for Child and Adolescent Behavioral Health, Community Hospital of the Monterey (Calif.) Peninsula. Dr. Jellinek is professor emeritus of psychiatry and pediatrics, Harvard Medical School, Boston. Email them at [email protected].
Reference
Kovacs M et al. J Am Acad Child Adolesc Psychiatry. 1993 Jan;32(1):8-20.
In October of 2021, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association jointly declared a National State of Emergency in Children’s Mental Health and called on policy makers to address a host of challenges that have impeded access to effective mental health care for youth.
In November, we wrote about how pediatricians may increase their use of screening for adolescent depression and initiate treatment when appropriate.
Now we complement that piece with guidance you may offer the parents of your depressed adolescent patients. Adolescent depression is a common pediatric disorder, especially in the COVID-19 era when so many relationships and activities have been limited or cut off. With treatment, most adolescents recover. Accepting that it may be taking longer to find a therapist, you can make treatment recommendations, support the teenager and parents, address safety concerns and, if the depression is of moderate or more serious severity, start medications. Parents are your natural partners as they are concerned about their children’s health and safety and eager for guidance on how to best support their recovery.
Adolescence is a time in which parents transition to more of a consulting than a controlling posture with their children, but illness calls for a shift toward setting rules and routines that will support health and healing. Prepare both the teenager (in a 1:1 discussion) and parents for this temporary shift, and for some teenagers, expect resistance. Depression will make the teenager more unhappy and irritable. It also causes withdrawal, by sapping energy and making one feel unwelcome at activities, believing his or her presence will be a burden to others. Treatment includes something called “behavioral activation,” or continuous nudging, to keep the patient involved in social, intellectual, and physical activities. Parents (and siblings) are the keys to this behavioral activation, whether nudging to participate in a board game or a walk. Reassure parents they should not take it personally when their teen resists, and not be discouraged if they fail sometimes. Their focus is on calmly, warmly, and repeatedly prompting their children with nudges toward these routines and activities. They should be ready to remind them why they are “nagging,” framing these efforts explicitly as supporting recovery from depression. If possible, applying these rules to everyone at home will help. They need to avoid being drawn into conflict, focusing instead on staying connected to their teens. Their task is to keep planning and cajoling, giving their children multiple opportunities to participate, pushing back against depression’s gravitational pull for total withdrawal.
Sleep
One of the most important thing parents can do for their depressed adolescents is to support their healthy restful sleep. During adolescence, the timing of sleep naturally shifts later, and the need for restful sleep increases. Working against the demands of homework, extracurricular activities, and social connections, sleep often suffers during adolescence. Further sleep disruptions, including difficulty falling asleep and frequent awakening during sleep or in the early morning, are typical of depression. Restful sleep is instrumental to recovery, and parents need to help their depressed teens set good sleep habits. This includes setting a time for bed that is realistic and consistent and turning off screens 30 minutes before lights out. A soothing, consistent bedtime routine, including a hot shower and reading in bed, is a powerful cue for sleep. Getting daily exercise and avoiding a heavy meal and caffeine in the hours before bed supports both falling and staying asleep. Having light reading near bed (magazines or comics) instead of screens can provide a way to pass 30 minutes if they wake up during the night (ideally reading out of bed), one that will not make it harder for them to go back to sleep. Finally, teens should not be allowed to spend all day in bed or nap in the afternoon. This may be the hardest task for parents, as adolescents naturally treat their beds like their center of operations and depression lowers their energy and initiative. If parents set these rules and routines for all members of the family, it can improve the chances that their depressed adolescents may begin to return to healthy sleep.
Exercise
Vigorous exercise (for 20 minutes three times weekly) is as effective as SSRIs in treating mild to moderate depression. Even in severe depression, exercise may accelerate recovery and certainly contributes to returning to restful sleep and a feeling of improved energy. Inviting their depressed teens to join them on a trip to the gym may seem like a fool’s errand to parents, but they should prioritize getting their children moving. Don’t offer choices or ask what activity they would like to do. Most invitations will be met with “no, thanks” (or probably something less polite). Instead, initiate simple activities and then cajole the children with “let’s go!” They should use loving persistence to get them out the door. Parents are the experts on their children and will know if there is an activity that they are more likely to enjoy. Make any activities group ones, easy to start and not too long. They could initiate family walks or bike rides in their neighborhood. If it helps, they can blame you, “these are doctor’s orders!” This approach of warm persistence should be applied across the board, helping their depressed teens participate in mealtimes and other activities. Prepare parents that this can feel unnatural, if they have been letting their healthy teenagers have more space and independence and less time in family activities.
Social connections
Behavioral activation includes keeping a depressed teen engaged in social activities. Friendships are a potent motivator in the lives of healthy adolescents. If depressed teens can stay connected to close friends, it is a powerful force for recovery. Find out if their friends know about their depression, whom do they trust to tell about it? Help them find comfortable language to speak about their depression with trusted friends. Parents can use their behavioral activation strategies to prompt their teenagers to participate in social activities. If texting, video chatting, or social media platforms are how they stay connected with close friends, support their use of these platforms. But be mindful that social media promotes social comparison over connection, and depression sets them up to feel less than others even without assistance. Parents should support real time with their friends in small groups, for short periods during the time of day when they have the most energy.
Safety
Suicide is the second leading cause of death for adolescents in the United States, and the rate of attempted and completed suicide in adolescents has been steadily climbing over the past decade according to the CDC. The rate is higher in older adolescents, though thankfully relatively uncommon (about 1 in 10,000 a year), and, although we know risk factors, no one has been able to predict reliably the risk for an individual teenager at a point in time. In a clinically referred sample, 85% of depressed adolescents will have suicidal ideation and 32% will make a suicide attempt. The risk is higher in those adolescents with more than one psychiatric diagnosis and with a history of impulsive behaviors, substance abuse, prior suicide attempts, and a family history of suicide. It is important that parents hear that asking about suicidal thoughts will not cause them. On the contrary, preserving open communication and a warm relationship is very protective. Adolescent suicide attempts are likely to be impulsive, so helping the family to consider ways to “put up obstacles” that would slow down any possible attempt is an effective way to improve safety. Ask your patients about suicidal thoughts, plans, and what keeps them safe. Find out if they worry about sharing these thoughts with their parents and why. Ask if there are ways their parents can check on them that “aren’t too annoying.” Determine if there are guns in the home, and if so, are they safely stored (locked, separate from ammunition)? More than 50% of completed adolescent suicides involve firearms, so this question is critical. What about access to medications that could be dangerous in overdose in your home or a relative’s home they may visit? Discussing these facts with your patients and their parents together will make it easier for them to continue the conversation outside of your office and can make an enormous difference in their recovery.
Dr. Swick is physician in chief at Ohana, Center for Child and Adolescent Behavioral Health, Community Hospital of the Monterey (Calif.) Peninsula. Dr. Jellinek is professor emeritus of psychiatry and pediatrics, Harvard Medical School, Boston. Email them at [email protected].
Reference
Kovacs M et al. J Am Acad Child Adolesc Psychiatry. 1993 Jan;32(1):8-20.
Meet the new CHEST Physician Editor in Chief
Angel O. Coz Yataco, MD, FCCP, is a Pulmonary and Critical Care specialist at the Respiratory Institute at the Cleveland Clinic. He previously served as the Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center and was an Associate Professor of Medicine at the University of Kentucky. Dr. Coz received his medical degree from Universidad Peruana Cayetano Heredia in Lima, Peru. He completed residency training in internal medicine and did his fellowship training in pulmonary and critical care medicine at Henry Ford Hospital.
Dr. Coz was a member of the 2021 Surviving Sepsis Campaign Guidelines panel and serves on the American Board of Internal Medicine Governance – Critical Care Medicine examination board. He holds multiple leadership positions at CHEST—Chair of the Council of NetWorks; a member of the Guidelines Oversight Committee; and served as the Critical Care Section Editor for CHEST Physician since 2018. He has been awarded the Distinguished CHEST Educator (DCE) designation every year since its inception in 2018 and received the CHEST Presidential Citation Award in 2021.
Dr. Coz has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international level. He has published several peer-reviewed articles and serves as ad hoc reviewer for CHEST, Journal of Critical Care, Critical Care Medicine, Critical Connections, Intensive Care Medicine, and Annals of Pharmacotherapy, among others.
Angel O. Coz Yataco, MD, FCCP, is a Pulmonary and Critical Care specialist at the Respiratory Institute at the Cleveland Clinic. He previously served as the Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center and was an Associate Professor of Medicine at the University of Kentucky. Dr. Coz received his medical degree from Universidad Peruana Cayetano Heredia in Lima, Peru. He completed residency training in internal medicine and did his fellowship training in pulmonary and critical care medicine at Henry Ford Hospital.
Dr. Coz was a member of the 2021 Surviving Sepsis Campaign Guidelines panel and serves on the American Board of Internal Medicine Governance – Critical Care Medicine examination board. He holds multiple leadership positions at CHEST—Chair of the Council of NetWorks; a member of the Guidelines Oversight Committee; and served as the Critical Care Section Editor for CHEST Physician since 2018. He has been awarded the Distinguished CHEST Educator (DCE) designation every year since its inception in 2018 and received the CHEST Presidential Citation Award in 2021.
Dr. Coz has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international level. He has published several peer-reviewed articles and serves as ad hoc reviewer for CHEST, Journal of Critical Care, Critical Care Medicine, Critical Connections, Intensive Care Medicine, and Annals of Pharmacotherapy, among others.
Angel O. Coz Yataco, MD, FCCP, is a Pulmonary and Critical Care specialist at the Respiratory Institute at the Cleveland Clinic. He previously served as the Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center and was an Associate Professor of Medicine at the University of Kentucky. Dr. Coz received his medical degree from Universidad Peruana Cayetano Heredia in Lima, Peru. He completed residency training in internal medicine and did his fellowship training in pulmonary and critical care medicine at Henry Ford Hospital.
Dr. Coz was a member of the 2021 Surviving Sepsis Campaign Guidelines panel and serves on the American Board of Internal Medicine Governance – Critical Care Medicine examination board. He holds multiple leadership positions at CHEST—Chair of the Council of NetWorks; a member of the Guidelines Oversight Committee; and served as the Critical Care Section Editor for CHEST Physician since 2018. He has been awarded the Distinguished CHEST Educator (DCE) designation every year since its inception in 2018 and received the CHEST Presidential Citation Award in 2021.
Dr. Coz has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international level. He has published several peer-reviewed articles and serves as ad hoc reviewer for CHEST, Journal of Critical Care, Critical Care Medicine, Critical Connections, Intensive Care Medicine, and Annals of Pharmacotherapy, among others.
Welcome our new board members
Humayun Anjum, MD
Dr. Anjum is currently working as a pulmonary and critical care physician at Baylor Scott & White Medical Center- Grapevine in Dallas, Texas.
He is an Adjunct Clinical Assistant Professor at University of Houston and University of North Texas. He recently moved to Dallas from Corpus Christi, Texas where, he served as the core faculty for the Internal Medicine residency program and the Pulmonary Disease fellowship program. He is passionate about learning and teaching and has been very intricately involved with CHEST and the CHEST Foundation for the last few years. Currently, he serves as the chair of the Practice Operations Network steering committee. Dr. Anjum is particularly interested in medical practice management and administration and hopes to continue sharing his knowledge through various platforms to help his fellow physicians.
Loren J. Harris, MD FACS FCCP
Dr. Harris is the Chairman of the Department of Surgery and Chief of Thoracic Surgery at Richmond University Medical Center in Staten Island, NY.
He has been in clinical surgical practice for over 20 years and also has over 20 years of experience teaching both medical students and surgical residents and fellows. In addition, he served as Program Director of the general surgery residency program at Maimonides Medical Center from 2014 to 2017. Dr. Harris has published and presented throughout his career both nationally and internationally. His main research and clinical interests are in the appropriate staging and treatment of non-small cell lung cancer. He served as the Chair of the CHEST Marketing Committee; was the editor Pulmonary Perspectives; and is a co-author on two chapters in the most recent edition of the Diagnosis and Management Guidelines for Lung Cancer published by CHEST in 2013. Dr. Harris has also received several prestigious awards including the CHEST Soffer Award for Editorial Excellence.
Diego Maselli, MD
Dr. Maselli is an Associate Professor of Medicine in the Division of Pulmonary Diseases & Critical Care Medicine at UT Health in San Antonio.
He is the director of the Severe Asthma Program at UT Health and his research focuses on severe asthma, COPD, and bronchiectasis. Dr. Maselli has been designated a Distinguished CHEST Educator since 2017 when the program was initiated. He serves on the steering committee of the Airways Network.
Daniel R. Ouellette, MD
Dr. Ouellette has been a clinician, teacher, and researcher in pulmonary and critical care medicine for 35 years.
He is currently a Senior Staff Physician at Henry Ford Hospital in Detroit where he is the Medical Director for the Pulmonary Ward. He is also an Associate Clinical Professor of Medicine at the Wayne State University School of Medicine, and the Medical Director of the Respiratory Therapy program at Oakland Community College. Dr. Ouellette has over 20 years of military service and was the Consultant to the US Army Surgeon General for Pulmonary Medicine during the last several years of his military career. An active CHEST leader, he has chaired the Guideline Oversight Committee, the Clinical Pulmonary Network, and the Council of Governors, has been a member of the Board of Regents, and held many leadership roles with CHEST and other societies in the development of evidence-based clinical practice guidelines. Dr. Ouellette’s clinical areas of interest include general pulmonary and critical care medicine and evidence-based practice.
Saiprakash Venkateshiah, MD, FCCP
Dr. Venkateshiah is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University, Atlanta, GA.
He is a clinician educator and a “general pulmonologist” practicing the entire gamut of pulmonary, critical care, and sleep medicine. Dr. Venkateshiah has been a CHEST member for close to 2 decades. He has been involved with CHEST NetWork leadership since 2012, starting as steering committee member of Clinical Pulmonary Medicine Network transitioning to Vice-Chair and Chair. He was previously a member of the Executive Committee of the Council of Networks and the Scientific Program Committee for CHEST 2019 and CHEST 2020. He is currently a steering committee member of the education committees of CHEST and American Academy of Sleep Medicine. He is also a steering committee member of the CHEST Sleep NetWork.
Humayun Anjum, MD
Dr. Anjum is currently working as a pulmonary and critical care physician at Baylor Scott & White Medical Center- Grapevine in Dallas, Texas.
He is an Adjunct Clinical Assistant Professor at University of Houston and University of North Texas. He recently moved to Dallas from Corpus Christi, Texas where, he served as the core faculty for the Internal Medicine residency program and the Pulmonary Disease fellowship program. He is passionate about learning and teaching and has been very intricately involved with CHEST and the CHEST Foundation for the last few years. Currently, he serves as the chair of the Practice Operations Network steering committee. Dr. Anjum is particularly interested in medical practice management and administration and hopes to continue sharing his knowledge through various platforms to help his fellow physicians.
Loren J. Harris, MD FACS FCCP
Dr. Harris is the Chairman of the Department of Surgery and Chief of Thoracic Surgery at Richmond University Medical Center in Staten Island, NY.
He has been in clinical surgical practice for over 20 years and also has over 20 years of experience teaching both medical students and surgical residents and fellows. In addition, he served as Program Director of the general surgery residency program at Maimonides Medical Center from 2014 to 2017. Dr. Harris has published and presented throughout his career both nationally and internationally. His main research and clinical interests are in the appropriate staging and treatment of non-small cell lung cancer. He served as the Chair of the CHEST Marketing Committee; was the editor Pulmonary Perspectives; and is a co-author on two chapters in the most recent edition of the Diagnosis and Management Guidelines for Lung Cancer published by CHEST in 2013. Dr. Harris has also received several prestigious awards including the CHEST Soffer Award for Editorial Excellence.
Diego Maselli, MD
Dr. Maselli is an Associate Professor of Medicine in the Division of Pulmonary Diseases & Critical Care Medicine at UT Health in San Antonio.
He is the director of the Severe Asthma Program at UT Health and his research focuses on severe asthma, COPD, and bronchiectasis. Dr. Maselli has been designated a Distinguished CHEST Educator since 2017 when the program was initiated. He serves on the steering committee of the Airways Network.
Daniel R. Ouellette, MD
Dr. Ouellette has been a clinician, teacher, and researcher in pulmonary and critical care medicine for 35 years.
He is currently a Senior Staff Physician at Henry Ford Hospital in Detroit where he is the Medical Director for the Pulmonary Ward. He is also an Associate Clinical Professor of Medicine at the Wayne State University School of Medicine, and the Medical Director of the Respiratory Therapy program at Oakland Community College. Dr. Ouellette has over 20 years of military service and was the Consultant to the US Army Surgeon General for Pulmonary Medicine during the last several years of his military career. An active CHEST leader, he has chaired the Guideline Oversight Committee, the Clinical Pulmonary Network, and the Council of Governors, has been a member of the Board of Regents, and held many leadership roles with CHEST and other societies in the development of evidence-based clinical practice guidelines. Dr. Ouellette’s clinical areas of interest include general pulmonary and critical care medicine and evidence-based practice.
Saiprakash Venkateshiah, MD, FCCP
Dr. Venkateshiah is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University, Atlanta, GA.
He is a clinician educator and a “general pulmonologist” practicing the entire gamut of pulmonary, critical care, and sleep medicine. Dr. Venkateshiah has been a CHEST member for close to 2 decades. He has been involved with CHEST NetWork leadership since 2012, starting as steering committee member of Clinical Pulmonary Medicine Network transitioning to Vice-Chair and Chair. He was previously a member of the Executive Committee of the Council of Networks and the Scientific Program Committee for CHEST 2019 and CHEST 2020. He is currently a steering committee member of the education committees of CHEST and American Academy of Sleep Medicine. He is also a steering committee member of the CHEST Sleep NetWork.
Humayun Anjum, MD
Dr. Anjum is currently working as a pulmonary and critical care physician at Baylor Scott & White Medical Center- Grapevine in Dallas, Texas.
He is an Adjunct Clinical Assistant Professor at University of Houston and University of North Texas. He recently moved to Dallas from Corpus Christi, Texas where, he served as the core faculty for the Internal Medicine residency program and the Pulmonary Disease fellowship program. He is passionate about learning and teaching and has been very intricately involved with CHEST and the CHEST Foundation for the last few years. Currently, he serves as the chair of the Practice Operations Network steering committee. Dr. Anjum is particularly interested in medical practice management and administration and hopes to continue sharing his knowledge through various platforms to help his fellow physicians.
Loren J. Harris, MD FACS FCCP
Dr. Harris is the Chairman of the Department of Surgery and Chief of Thoracic Surgery at Richmond University Medical Center in Staten Island, NY.
He has been in clinical surgical practice for over 20 years and also has over 20 years of experience teaching both medical students and surgical residents and fellows. In addition, he served as Program Director of the general surgery residency program at Maimonides Medical Center from 2014 to 2017. Dr. Harris has published and presented throughout his career both nationally and internationally. His main research and clinical interests are in the appropriate staging and treatment of non-small cell lung cancer. He served as the Chair of the CHEST Marketing Committee; was the editor Pulmonary Perspectives; and is a co-author on two chapters in the most recent edition of the Diagnosis and Management Guidelines for Lung Cancer published by CHEST in 2013. Dr. Harris has also received several prestigious awards including the CHEST Soffer Award for Editorial Excellence.
Diego Maselli, MD
Dr. Maselli is an Associate Professor of Medicine in the Division of Pulmonary Diseases & Critical Care Medicine at UT Health in San Antonio.
He is the director of the Severe Asthma Program at UT Health and his research focuses on severe asthma, COPD, and bronchiectasis. Dr. Maselli has been designated a Distinguished CHEST Educator since 2017 when the program was initiated. He serves on the steering committee of the Airways Network.
Daniel R. Ouellette, MD
Dr. Ouellette has been a clinician, teacher, and researcher in pulmonary and critical care medicine for 35 years.
He is currently a Senior Staff Physician at Henry Ford Hospital in Detroit where he is the Medical Director for the Pulmonary Ward. He is also an Associate Clinical Professor of Medicine at the Wayne State University School of Medicine, and the Medical Director of the Respiratory Therapy program at Oakland Community College. Dr. Ouellette has over 20 years of military service and was the Consultant to the US Army Surgeon General for Pulmonary Medicine during the last several years of his military career. An active CHEST leader, he has chaired the Guideline Oversight Committee, the Clinical Pulmonary Network, and the Council of Governors, has been a member of the Board of Regents, and held many leadership roles with CHEST and other societies in the development of evidence-based clinical practice guidelines. Dr. Ouellette’s clinical areas of interest include general pulmonary and critical care medicine and evidence-based practice.
Saiprakash Venkateshiah, MD, FCCP
Dr. Venkateshiah is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University, Atlanta, GA.
He is a clinician educator and a “general pulmonologist” practicing the entire gamut of pulmonary, critical care, and sleep medicine. Dr. Venkateshiah has been a CHEST member for close to 2 decades. He has been involved with CHEST NetWork leadership since 2012, starting as steering committee member of Clinical Pulmonary Medicine Network transitioning to Vice-Chair and Chair. He was previously a member of the Executive Committee of the Council of Networks and the Scientific Program Committee for CHEST 2019 and CHEST 2020. He is currently a steering committee member of the education committees of CHEST and American Academy of Sleep Medicine. He is also a steering committee member of the CHEST Sleep NetWork.
Staying home, staying connected
Fundraising in a virtual environment
When the United States went into a 2-week quarantine to slow the spread of the COVID-19 coronavirus in March 2020, everything changed. In the months following, social distancing, working from home, and wearing masks became the norm, and life needed to find a way to go on.
The world adapted to a virtual environment, but some of the hardest hit by this change were non-profit organizations that relied on in-person contact to encourage donations that support their worthwhile missions.
This was even more challenging for the CHEST Foundation as our donors work on the front lines of the pandemic.
“It was important for us to not only stay engaged with our donors but also to recognize what those on the front lines are dealing with,” says Angela Perillo, Director, Development & Foundation Operations at the American College of Chest Physicians. “Through these events, we wanted to provide some respite from the stresses of their long days.”
The CHEST Foundation is about championing lung health, and there was no greater awareness of the need than now. It was time to get creative.
Viva la vino
A well-known “secret” is CHEST CEO Bob Mussachio’s love of wine, and he’s not alone in his passion for the grape. Perillo put this knowledge to good use creating a wine tasting series that took people around the world one bottle at a time.
The online Viva La Vino evening gatherings serve to bring donors together for a night of good wines and good conversation. A benefit to the virtual wine nights is that no one has to travel but that it keeps the group together and keeps the Foundation at the forefront of everyone’s minds.
“I love attending the wine nights. They are so interesting, and I get to see people who don’t live in New York – it’s just great,” says regular participant Ilene (Lenie) Rosen.
The wines are shipped directly to the participants’ homes and during the online Zoom session, Mussachio guides the tasting by scrolling through a presentation on the wine’s background and what to expect from the taste. As the wines are tasted, the participants have a chance to share their review.
“It’s always enthralling to me how much our members know about wine. It makes for a really fun evening listening to their critiques and even learning a bit myself. These events have provided a great platform to stay engaged with our donors and enjoy an evening at home with company,” says Perillo.
Doubling down on a good cause
After hosting its in-person event in the first week of March 2020, the Irv Feldman Texas Hold ’Em poker tournament also shifted to a virtual environment to stay engaged with its players.
Supported by the CHEST Foundation, the Feldman Family Foundation created a series of poker tournaments through an online platform that worked with Zoom to retain the engagement offered by in-person events. Through the Zoom call, players are able to talk to each other either in the main room or in breakout rooms created for each table.
Poker player and recent winner of one of the tournaments, Kim Coles started playing professionally during the pandemic and enjoys playing in an online environment.
“I had participated in charity poker tournaments before, but it wasn’t until I joined Poker Power—a group focused on teaching women how to play poker—that I really came to the table ready to compete,” says Coles. “Playing in an online setting is a lot more accessible for a lot of people, especially for women. A traditional poker tournament can be intimidating to a new player, but online has a way of evening the playing field.”
In an online setting, Feldman and Coles both note that buying in is a lot easier and lends itself well to fundraising.
“There is no fumbling around for your wallet or having to swipe your credit card,” says Coles. “It’s just the press of a button, and your credit card is already linked. It’s all going to a good cause, so it makes sense to keep buying in to keep playing.”
Looking into the future, while Feldman says that the virtual events have been successful, there’s nothing like in-person.
“Through our virtual events, we were able to expand our network of players beyond the Chicagoland area, and these individuals have expressed their interest in attending our live events,” says Feldman. “With this extended network, I am very much looking forward to being able to get together in-person again for what I expect be one of our best tournaments to date.”
The 8th Annual Irv Feldman Texas Hold ‘Em Annual Tournament & Casino Night will be held in early April 2022 in the Chicago suburbs, and all are welcome to attend. Visit the CHEST Foundation’s website to learn more about the tournament and upcoming events at chestfoundation.org.
Fundraising in a virtual environment
Fundraising in a virtual environment
When the United States went into a 2-week quarantine to slow the spread of the COVID-19 coronavirus in March 2020, everything changed. In the months following, social distancing, working from home, and wearing masks became the norm, and life needed to find a way to go on.
The world adapted to a virtual environment, but some of the hardest hit by this change were non-profit organizations that relied on in-person contact to encourage donations that support their worthwhile missions.
This was even more challenging for the CHEST Foundation as our donors work on the front lines of the pandemic.
“It was important for us to not only stay engaged with our donors but also to recognize what those on the front lines are dealing with,” says Angela Perillo, Director, Development & Foundation Operations at the American College of Chest Physicians. “Through these events, we wanted to provide some respite from the stresses of their long days.”
The CHEST Foundation is about championing lung health, and there was no greater awareness of the need than now. It was time to get creative.
Viva la vino
A well-known “secret” is CHEST CEO Bob Mussachio’s love of wine, and he’s not alone in his passion for the grape. Perillo put this knowledge to good use creating a wine tasting series that took people around the world one bottle at a time.
The online Viva La Vino evening gatherings serve to bring donors together for a night of good wines and good conversation. A benefit to the virtual wine nights is that no one has to travel but that it keeps the group together and keeps the Foundation at the forefront of everyone’s minds.
“I love attending the wine nights. They are so interesting, and I get to see people who don’t live in New York – it’s just great,” says regular participant Ilene (Lenie) Rosen.
The wines are shipped directly to the participants’ homes and during the online Zoom session, Mussachio guides the tasting by scrolling through a presentation on the wine’s background and what to expect from the taste. As the wines are tasted, the participants have a chance to share their review.
“It’s always enthralling to me how much our members know about wine. It makes for a really fun evening listening to their critiques and even learning a bit myself. These events have provided a great platform to stay engaged with our donors and enjoy an evening at home with company,” says Perillo.
Doubling down on a good cause
After hosting its in-person event in the first week of March 2020, the Irv Feldman Texas Hold ’Em poker tournament also shifted to a virtual environment to stay engaged with its players.
Supported by the CHEST Foundation, the Feldman Family Foundation created a series of poker tournaments through an online platform that worked with Zoom to retain the engagement offered by in-person events. Through the Zoom call, players are able to talk to each other either in the main room or in breakout rooms created for each table.
Poker player and recent winner of one of the tournaments, Kim Coles started playing professionally during the pandemic and enjoys playing in an online environment.
“I had participated in charity poker tournaments before, but it wasn’t until I joined Poker Power—a group focused on teaching women how to play poker—that I really came to the table ready to compete,” says Coles. “Playing in an online setting is a lot more accessible for a lot of people, especially for women. A traditional poker tournament can be intimidating to a new player, but online has a way of evening the playing field.”
In an online setting, Feldman and Coles both note that buying in is a lot easier and lends itself well to fundraising.
“There is no fumbling around for your wallet or having to swipe your credit card,” says Coles. “It’s just the press of a button, and your credit card is already linked. It’s all going to a good cause, so it makes sense to keep buying in to keep playing.”
Looking into the future, while Feldman says that the virtual events have been successful, there’s nothing like in-person.
“Through our virtual events, we were able to expand our network of players beyond the Chicagoland area, and these individuals have expressed their interest in attending our live events,” says Feldman. “With this extended network, I am very much looking forward to being able to get together in-person again for what I expect be one of our best tournaments to date.”
The 8th Annual Irv Feldman Texas Hold ‘Em Annual Tournament & Casino Night will be held in early April 2022 in the Chicago suburbs, and all are welcome to attend. Visit the CHEST Foundation’s website to learn more about the tournament and upcoming events at chestfoundation.org.
When the United States went into a 2-week quarantine to slow the spread of the COVID-19 coronavirus in March 2020, everything changed. In the months following, social distancing, working from home, and wearing masks became the norm, and life needed to find a way to go on.
The world adapted to a virtual environment, but some of the hardest hit by this change were non-profit organizations that relied on in-person contact to encourage donations that support their worthwhile missions.
This was even more challenging for the CHEST Foundation as our donors work on the front lines of the pandemic.
“It was important for us to not only stay engaged with our donors but also to recognize what those on the front lines are dealing with,” says Angela Perillo, Director, Development & Foundation Operations at the American College of Chest Physicians. “Through these events, we wanted to provide some respite from the stresses of their long days.”
The CHEST Foundation is about championing lung health, and there was no greater awareness of the need than now. It was time to get creative.
Viva la vino
A well-known “secret” is CHEST CEO Bob Mussachio’s love of wine, and he’s not alone in his passion for the grape. Perillo put this knowledge to good use creating a wine tasting series that took people around the world one bottle at a time.
The online Viva La Vino evening gatherings serve to bring donors together for a night of good wines and good conversation. A benefit to the virtual wine nights is that no one has to travel but that it keeps the group together and keeps the Foundation at the forefront of everyone’s minds.
“I love attending the wine nights. They are so interesting, and I get to see people who don’t live in New York – it’s just great,” says regular participant Ilene (Lenie) Rosen.
The wines are shipped directly to the participants’ homes and during the online Zoom session, Mussachio guides the tasting by scrolling through a presentation on the wine’s background and what to expect from the taste. As the wines are tasted, the participants have a chance to share their review.
“It’s always enthralling to me how much our members know about wine. It makes for a really fun evening listening to their critiques and even learning a bit myself. These events have provided a great platform to stay engaged with our donors and enjoy an evening at home with company,” says Perillo.
Doubling down on a good cause
After hosting its in-person event in the first week of March 2020, the Irv Feldman Texas Hold ’Em poker tournament also shifted to a virtual environment to stay engaged with its players.
Supported by the CHEST Foundation, the Feldman Family Foundation created a series of poker tournaments through an online platform that worked with Zoom to retain the engagement offered by in-person events. Through the Zoom call, players are able to talk to each other either in the main room or in breakout rooms created for each table.
Poker player and recent winner of one of the tournaments, Kim Coles started playing professionally during the pandemic and enjoys playing in an online environment.
“I had participated in charity poker tournaments before, but it wasn’t until I joined Poker Power—a group focused on teaching women how to play poker—that I really came to the table ready to compete,” says Coles. “Playing in an online setting is a lot more accessible for a lot of people, especially for women. A traditional poker tournament can be intimidating to a new player, but online has a way of evening the playing field.”
In an online setting, Feldman and Coles both note that buying in is a lot easier and lends itself well to fundraising.
“There is no fumbling around for your wallet or having to swipe your credit card,” says Coles. “It’s just the press of a button, and your credit card is already linked. It’s all going to a good cause, so it makes sense to keep buying in to keep playing.”
Looking into the future, while Feldman says that the virtual events have been successful, there’s nothing like in-person.
“Through our virtual events, we were able to expand our network of players beyond the Chicagoland area, and these individuals have expressed their interest in attending our live events,” says Feldman. “With this extended network, I am very much looking forward to being able to get together in-person again for what I expect be one of our best tournaments to date.”
The 8th Annual Irv Feldman Texas Hold ‘Em Annual Tournament & Casino Night will be held in early April 2022 in the Chicago suburbs, and all are welcome to attend. Visit the CHEST Foundation’s website to learn more about the tournament and upcoming events at chestfoundation.org.
Our CHEST 2021 Award Recipients
ANNUAL AWARDS
Master FCCP
Curtis N. Sessler, MD, Master FCCP
College Medalist Award
Margaret Pisani, MD, MPH, FCCP
Distinguished Service Award
Christopher Carroll, MD, FCCP
Master Clinician Educator
Doreen Addrizzo-Harris, MD, FCCP
Early Career Clinician Educator
Matthew C. Miles, MD, FCCP
Alfred Soffer Award for Editorial Excellence
Scott Manaker, MD, PhD, FCCP
Presidential Citation
COVID-19 Task Force
Ryan Maves, MD, FCCP
Christopher Carroll, MD, FCCP
Neha Dangayach, MD
Jeffrey Dichter, MD, FCCP
Alice Gallo De Moraes, MD
James Geiling, MD, MPH, FCCP
Holly Keyt, MD, FCCP
Stephanie M. Levine, MD, FCCP
Septimu Murgu, MD, FCCP
Marcos Restrepo, MD, PhD, FCCP
Steven Q. Simpson, MD, FCCP
Angel Coz Yataco, MD, FCCP
Staff: Katlyn Froslan, Heather Watkins, Robb Rabito, CHCP, Lilly Rodriguez, Karla Velilla
HONOR LECTURE AND MEMORIAL AWARDS
Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
KENNETH I. BERGER, MD, FCCP
Probing the Small Airways in the Assessment of Dyspnea
The lecture is generously funded by the CHEST Foundation.
Presidential Honor Lecture
CURTIS N. SESSLER, MD, Master FCCP
Navigating the Road to Well-Being in the ICU
Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation
DEBRA WEESE-MAYER, MD
Artificial Ventilation, a True Life-Saver for Children with CCHS & ROHHAD
The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.
RICHARD S. IRWIN, MD, MASTER FCCP HONOR LECTURE
PETER J. MAZZONE, MD, MPH, FCCP
Shared Decision Making in the Evaluation and Management of Early Stage Lung Cancer
The lecture is generously funded by the CHEST Foundation.
Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
DIANE E. STOVER, MD, FCCP
The Many Faces of Organizing Pneumonia—What’s the O(O)P With That?
The lecture is generously funded by the CHEST Foundation.
Pasquale Ciaglia Memorial Lecture in Interventional Medicine
MICHAEL J. SIMOFF, MD, FCCP
Robotic Bronchoscopy: Platform to the Future?
The lecture is generously funded by the CHEST Foundation.
Roger C. Bone Memorial Lecture in Critical Care
OGNJEN GAJIC, MD, FCCP
Patient Comes First: Prioritizing Relevant From Irrelevant in Critical Care Medicine
The lecture is generously funded by the CHEST Foundation.
Thomas L. Petty, MD, Master FCCP Memorial Lecture
JEAN BOURBEAU, MD, FCCP
Pulmonary Rehabilitation and Self-Management in COPD: Understanding the Past to Build the Future
The lecture is generously funded by the CHEST Foundation.
CHEST FOUNDATION GRANT AWARDS
CHEST Foundation Research Grant in Lung Cancer
This grant is supported by the CHEST Foundation.
Daniel Ryan, MD, Royal College of Surgeons Ireland, Dublin, Ireland
Microbial Signatures Associated With Malignant Pleural Effusions in Lung Cancer
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is jointly supported by the CHEST Foundation and RHA.
Miguel Divo, MD, Brigham and Women’s Hospital, Boston, MA
Biomarker Profiles in Smokers Who Are at Risk of Developing Chronic Obstructive Pulmonary Disease (COPD)
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is supported by AstraZeneca LP.
Stephen Milne, MBBS, Woolcock Institute of Medical Research, Vancouver, BC, Canada
The Oral Metagenome in COPD: Towards a Biomarker of Exacerbation Risk
CHEST Foundation Research Grant in Critical Care
This grant is supported by the CHEST Foundation.
Jacqueline Stocking, PhD, University of California, Davis, Davis, CA
University of California Critical Care Research Collaborative: Predictive Model and Risk Calculator for Early and Late Postoperative Respiratory Failure
CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.
John Charles Rotondo, PhD, University of Ferrara, Ferrara, Italy
Alpha-1 Antitrypsin Protein as a Possible Marker of Disease Progression in COVID-19 Patients
CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
This grant is supported by Insmed Incorporated.
Edward Chan, MD, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
Visualization and Quantitation of Azithromycin, Clofazimine, and Amikacin Distribution in Surgically Removed Lung Tissues From Patients With Nontuberculous Mycobacterial Lung Disease
CHEST Foundation Research Grant in Cystic Fibrosis
This grant is supported by Vertex Pharmaceuticals Incorporated.
Shahid Sheikh, MD, FCCP, Nationwide Children’s Hospital, Columbus, OH
Impact of CFTR Modulator Therapy Elexacaftor-Tezacaftor-Ivacaftor on CF- Related Chronic Sinus Disease
John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
This grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.
Maneesh Bhargava, MD, PhD, FCCP, Minneapolis VA Health Care System, Minneapolis, MN
Inflammatory Protein Panel for Sarcoidosis Diagnosis and Prognosis
CHEST Foundation Research Grant in Severe Asthma
This grant is supported by the CHEST Foundation.
Felix Reyes, MD, Montefiore Medical Center, Bronx, NY
Design and Implementation of an Asthma Action Plan Generator: A Pilot Study Assessing User Satisfaction and Clinical Impact
CHEST Foundation Research Grant in Pulmonary Fibrosis
These grants are supported by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Genentech, Inc.
Marco Mura, MD, PhD, Western University, London, Ontario, Canada
Validation of the Risk Stratification Score in Idiopathic Pulmonary Fibrosis
Janelle Pugashetti, MD, University of California, Davis, Davis, CA
Determining Biomarkers of Immunosuppressant Responsiveness in Patients With CTD-ILD
CHEST Foundation Research Grant in Pulmonary Hypertension
These grants are supported by the CHEST Foundation.
Michael Lee, MD, University of California San Francisco, San Francisco, CA
Transpulmonary Metabolomic Gradients During Exercise in Systemic Sclerosis-Associated Pulmonary Hypertension
Navneet Singh, MD, Warren Alpert School of Medicine at Brown University, Providence, RI
Mitochondrial Dysfunction and Oxidative Stress in Pulmonary Hypertension
CHEST Foundation Research Grant in Sleep Medicine
These grants are funded by Jazz Pharmaceuticals, Inc.
Shahid Karim, MBChB, Mayo Clinic, Rochester, MN
Effects of OSA on Atrial and Ventricular Arrhythmia in HCM: An Incidence Study
Thomas Tolbert, MD, Mount Sinai Hospital, New York, NY
Performance Characteristics of Obstructive Sleep Apnea Physiologic Traits Measured by Phenotyping Using Polysomnography
CHEST Foundation and American Academy of Sleep Medicine Foundation Research Grant in Sleep Medicine
This grant is jointly supported by the CHEST Foundation and AASM Foundation.
Marta Kaminska, MD, McGill University Health Centre, Montreal, QC, Canada
Long-term Noninvasive Ventilation in COPD: Impact on Health Care Utilization
CHEST Foundation and APCCMPD Research Grant in Medical Education
This grant is jointly supported by the CHEST Foundation and APCCMPD.
Mark Adelman, MD, NYU School of Medicine, New York, NY
Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies
CHEST Foundation Research Grant in COVID-19
These grants are supported by the CHEST Foundation.
Marlene Cano, MD, PhD, Washington University, St. Louis, MO
Circulating Mitochondrial DNA Is a Potential Biomarker for Severe Illness in COVID-19
Brandon Walsh, MD, New York University, New York, NY
How Would Existing Ventilator Allocation Guidelines Perform During the COVID-19 Pandemic: A Retrospective Observational Simulated Cohort Study
CHEST Foundation and ATS Research Grant in COVID-19 and Diversity
These grants are jointly supported by the CHEST Foundation and ATS.
Navitha Ramesh, MD, FCCP, UPMC Harrisburg, Harrisburg, PA
Improving Lung Health in the Nepali- Bhutanese Refugee Community in Harrisburg, PA
Inderjit Singh, MBBCh, Yale University, New Haven, CT
Dynamic Invasive Hemodynamic, Echocardiographic, and Plasma Biomarker Phenotyping in Post-COVID-19 Long Hauler Syndrome
CHEST Foundation Community Service Grants Honoring D. Robert McCaffree, MD, Master FCCP
Valerie Andrews, BS, The JUDAHH Project, Sacramento, CA
Asthma Mitigation Project
Chanda Holsey, DrPh, National Medical Association, Silver Spring, MD
Providing Lung Health Education to At Risk Communities
Arzu Ari, PhD, FCCP, Texas State University, San Marcos, TX
Training Future Respiratory Care Practitioners in Turkey: A Path to Successful Disease Management in Pulmonary Medicine
Panagis Galiatsatos, MD, MPH, John Hopkins University, Baltimore, MD
The Lung Health Ambassador Program: A Health Equity Initiative for Cystic Fibrosis
Patricia George, MD, National Jewish Health, Denver, CO
Development of Breathe Strong PH: An Informational Website About Pulmonary Hypertension and Related Diseases
Nishant Gupta, MD, MS, University of Cincinnati, Cincinnati, OH
Global Dissemination of the Lymphangioleiomyomatosis (LAM) Clinical Practice Guidelines
Syed Naqvi, MD, MBBS, Hoag Hospital Newport Beach, Newport Beach, CA
Asthma Managment in Rural Pakistan
These grants are supported by the CHEST Foundation.
Alfred Soffer Research Award Winners
Mathieu Saint-Pierre, MD: Methacholine Challenge Testing: A Clinical Prediction Model Utilizing Demographic Data And Spirometry Results
Tie: Milind K Bhagat, MD: High Flow Nasal Cannula Fio2 Cutoffs Identified Early In The Hospital Course Are Associated With Increased Mortality Risk In Hospitalized Patients With COVID-19
Amber J Meservey, MD: Outcomes Of Patients Across The Spectrum Of Pulmonary Hypertension Groups Prescribed Inhaled Treprostinil
Young Investigator Award Winners
William B. Feldman, MD: COPD Exacerbations And Pneumonia Hospitalizations In New Users Of Combination Maintenance Inhalers: A Comparative Effectiveness And Safety Study
Christopher Streiler, MD: Community Pulmonologist Access To Multidisciplinary Discussion At An Academic Referral Center Leads To Changes In Management Of Interstitial Lung Disease
Top 5 Abstract Posters
Winner: Riley Kermanian: Management Of Coronary Artery Calcification In Patients Enrolled In A Low-Dose Computerized Tomography Lung Cancer Screening Program
Winner: Rohit Reddy: Outcomes Of Extracorporeal Membrane Oxygenation In ARDS Due To Covid-19: Comparison Of The First And The Second Wave
Winner: Taylor A. Intihar, BA: Light Patterns Of The Medical ICU: Are We Disrupting Circadian Rhythms?
Runner up: Jason Wong, MD: Completion Of Pulmonary Rehabilitation Is Associated With Improvement In Depression Scores And Other Quality Of Life Measures In Patients With Interstitial Lung Disease
Runner up: Harshil Shah, MD: Impact Of Sepsis On Outcomes Of Hospitalizations Due To COPD
Case Report Session Winners
Remarkable Pulmonary Cases: Mena Botros, MD: Clinical Outcomes In Lung Transplant Recipients With SARS-COV2
Bacterial Infections: Benjamin Carmel, DO: Cotton Swab Today, Brain Abscess Tomorrow
Challenging Critical Care Cases: Rajaninder Sharma, MD: Pulmonary Tumor Thrombotic Microangiopathy: The Rare And Fatal Association Of Adenocarcinoma And Right Ventricular Failure
Diffuse Lung Diseases: Rizwana RR Rana, MBBS: A Rare Cause Of Pulmonary Nodules
Viruses, Fungi, and Parasites Infections: Michelle Forson, MD: Strongyloidiasis-Related Eosinophilic Pleural Effusion: An Unexpected Differential For Post-Cardiac Injury Syndrome
Critical Care Cases: Act Quickly: Christina Jee Ah Rhee, MD: Airway Implications Of Cricoarytenoid Arthritis: A Report And Review Of The Literature
Airway Issues: Benadin Varajic, MD: An Unusual And Life-Threatening Complication Of Endotracheal Intubation
Miscellaneous Cases 1: Shrey Shah, MD: A Case Of Pulmonary Arterial Hypertension From Vitamin C Deficiency
Miscellaneous Cases 2: Glenn W. Pottmeyer, DO, MPH: Biliary Stent Migration: A Rare Cause Of Right-Sided Pulmonary Abscess
Case Report Poster Winners
Advanced Cancer Case Report Posters: Sangita Goel, MD: Let’s Meet in the Middle: Simultaneous Endoscopic and Bronchoscopic Suture Repair to Close a Left Main-Stem Malignant Broncho-Esophageal Fistula
Cardiovascular Case Report Posters: Marianna Weaver, DO: Swan-Ganz And Intra-Pericardial Pressure Guided Pericardiocentesis in Scleroderma-Associated PAH
Remarkable Cases Posters 1: Katie Capp, MD: Humidifier-Associated Hypersensitivity Pneumonitis
Remarkable Cases Posters 2: Sahar Samani, MD: Artifactual Hypoxemia in Patients With Hydroxyurea-Induced Blue Lunula Fingernails
CHEST 2021 CHEST Challenge
1st Place
The Ohio State University
Sarah Cohen, MD
Gregory Eisinger, MD
Kyle Stinehart, MD
Program Director: Jennifer McCallister, MD, FCCP
2nd Place
SUNY Buffalo
Arjun Saradna, MBBS
Rajesh Kunadharaju, MD
Ahmed Munir, MBBS
Program Director: Jeffrey Mador, MD
3rd Place
Interfaith Medical Center
Tahmina Jahir, MD
Ruby Risal, MD
Binav Shrestha, MBBS
Program Director: Marie Frances Schmidt, MD, FCCP
ANNUAL AWARDS
Master FCCP
Curtis N. Sessler, MD, Master FCCP
College Medalist Award
Margaret Pisani, MD, MPH, FCCP
Distinguished Service Award
Christopher Carroll, MD, FCCP
Master Clinician Educator
Doreen Addrizzo-Harris, MD, FCCP
Early Career Clinician Educator
Matthew C. Miles, MD, FCCP
Alfred Soffer Award for Editorial Excellence
Scott Manaker, MD, PhD, FCCP
Presidential Citation
COVID-19 Task Force
Ryan Maves, MD, FCCP
Christopher Carroll, MD, FCCP
Neha Dangayach, MD
Jeffrey Dichter, MD, FCCP
Alice Gallo De Moraes, MD
James Geiling, MD, MPH, FCCP
Holly Keyt, MD, FCCP
Stephanie M. Levine, MD, FCCP
Septimu Murgu, MD, FCCP
Marcos Restrepo, MD, PhD, FCCP
Steven Q. Simpson, MD, FCCP
Angel Coz Yataco, MD, FCCP
Staff: Katlyn Froslan, Heather Watkins, Robb Rabito, CHCP, Lilly Rodriguez, Karla Velilla
HONOR LECTURE AND MEMORIAL AWARDS
Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
KENNETH I. BERGER, MD, FCCP
Probing the Small Airways in the Assessment of Dyspnea
The lecture is generously funded by the CHEST Foundation.
Presidential Honor Lecture
CURTIS N. SESSLER, MD, Master FCCP
Navigating the Road to Well-Being in the ICU
Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation
DEBRA WEESE-MAYER, MD
Artificial Ventilation, a True Life-Saver for Children with CCHS & ROHHAD
The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.
RICHARD S. IRWIN, MD, MASTER FCCP HONOR LECTURE
PETER J. MAZZONE, MD, MPH, FCCP
Shared Decision Making in the Evaluation and Management of Early Stage Lung Cancer
The lecture is generously funded by the CHEST Foundation.
Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
DIANE E. STOVER, MD, FCCP
The Many Faces of Organizing Pneumonia—What’s the O(O)P With That?
The lecture is generously funded by the CHEST Foundation.
Pasquale Ciaglia Memorial Lecture in Interventional Medicine
MICHAEL J. SIMOFF, MD, FCCP
Robotic Bronchoscopy: Platform to the Future?
The lecture is generously funded by the CHEST Foundation.
Roger C. Bone Memorial Lecture in Critical Care
OGNJEN GAJIC, MD, FCCP
Patient Comes First: Prioritizing Relevant From Irrelevant in Critical Care Medicine
The lecture is generously funded by the CHEST Foundation.
Thomas L. Petty, MD, Master FCCP Memorial Lecture
JEAN BOURBEAU, MD, FCCP
Pulmonary Rehabilitation and Self-Management in COPD: Understanding the Past to Build the Future
The lecture is generously funded by the CHEST Foundation.
CHEST FOUNDATION GRANT AWARDS
CHEST Foundation Research Grant in Lung Cancer
This grant is supported by the CHEST Foundation.
Daniel Ryan, MD, Royal College of Surgeons Ireland, Dublin, Ireland
Microbial Signatures Associated With Malignant Pleural Effusions in Lung Cancer
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is jointly supported by the CHEST Foundation and RHA.
Miguel Divo, MD, Brigham and Women’s Hospital, Boston, MA
Biomarker Profiles in Smokers Who Are at Risk of Developing Chronic Obstructive Pulmonary Disease (COPD)
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is supported by AstraZeneca LP.
Stephen Milne, MBBS, Woolcock Institute of Medical Research, Vancouver, BC, Canada
The Oral Metagenome in COPD: Towards a Biomarker of Exacerbation Risk
CHEST Foundation Research Grant in Critical Care
This grant is supported by the CHEST Foundation.
Jacqueline Stocking, PhD, University of California, Davis, Davis, CA
University of California Critical Care Research Collaborative: Predictive Model and Risk Calculator for Early and Late Postoperative Respiratory Failure
CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.
John Charles Rotondo, PhD, University of Ferrara, Ferrara, Italy
Alpha-1 Antitrypsin Protein as a Possible Marker of Disease Progression in COVID-19 Patients
CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
This grant is supported by Insmed Incorporated.
Edward Chan, MD, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
Visualization and Quantitation of Azithromycin, Clofazimine, and Amikacin Distribution in Surgically Removed Lung Tissues From Patients With Nontuberculous Mycobacterial Lung Disease
CHEST Foundation Research Grant in Cystic Fibrosis
This grant is supported by Vertex Pharmaceuticals Incorporated.
Shahid Sheikh, MD, FCCP, Nationwide Children’s Hospital, Columbus, OH
Impact of CFTR Modulator Therapy Elexacaftor-Tezacaftor-Ivacaftor on CF- Related Chronic Sinus Disease
John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
This grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.
Maneesh Bhargava, MD, PhD, FCCP, Minneapolis VA Health Care System, Minneapolis, MN
Inflammatory Protein Panel for Sarcoidosis Diagnosis and Prognosis
CHEST Foundation Research Grant in Severe Asthma
This grant is supported by the CHEST Foundation.
Felix Reyes, MD, Montefiore Medical Center, Bronx, NY
Design and Implementation of an Asthma Action Plan Generator: A Pilot Study Assessing User Satisfaction and Clinical Impact
CHEST Foundation Research Grant in Pulmonary Fibrosis
These grants are supported by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Genentech, Inc.
Marco Mura, MD, PhD, Western University, London, Ontario, Canada
Validation of the Risk Stratification Score in Idiopathic Pulmonary Fibrosis
Janelle Pugashetti, MD, University of California, Davis, Davis, CA
Determining Biomarkers of Immunosuppressant Responsiveness in Patients With CTD-ILD
CHEST Foundation Research Grant in Pulmonary Hypertension
These grants are supported by the CHEST Foundation.
Michael Lee, MD, University of California San Francisco, San Francisco, CA
Transpulmonary Metabolomic Gradients During Exercise in Systemic Sclerosis-Associated Pulmonary Hypertension
Navneet Singh, MD, Warren Alpert School of Medicine at Brown University, Providence, RI
Mitochondrial Dysfunction and Oxidative Stress in Pulmonary Hypertension
CHEST Foundation Research Grant in Sleep Medicine
These grants are funded by Jazz Pharmaceuticals, Inc.
Shahid Karim, MBChB, Mayo Clinic, Rochester, MN
Effects of OSA on Atrial and Ventricular Arrhythmia in HCM: An Incidence Study
Thomas Tolbert, MD, Mount Sinai Hospital, New York, NY
Performance Characteristics of Obstructive Sleep Apnea Physiologic Traits Measured by Phenotyping Using Polysomnography
CHEST Foundation and American Academy of Sleep Medicine Foundation Research Grant in Sleep Medicine
This grant is jointly supported by the CHEST Foundation and AASM Foundation.
Marta Kaminska, MD, McGill University Health Centre, Montreal, QC, Canada
Long-term Noninvasive Ventilation in COPD: Impact on Health Care Utilization
CHEST Foundation and APCCMPD Research Grant in Medical Education
This grant is jointly supported by the CHEST Foundation and APCCMPD.
Mark Adelman, MD, NYU School of Medicine, New York, NY
Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies
CHEST Foundation Research Grant in COVID-19
These grants are supported by the CHEST Foundation.
Marlene Cano, MD, PhD, Washington University, St. Louis, MO
Circulating Mitochondrial DNA Is a Potential Biomarker for Severe Illness in COVID-19
Brandon Walsh, MD, New York University, New York, NY
How Would Existing Ventilator Allocation Guidelines Perform During the COVID-19 Pandemic: A Retrospective Observational Simulated Cohort Study
CHEST Foundation and ATS Research Grant in COVID-19 and Diversity
These grants are jointly supported by the CHEST Foundation and ATS.
Navitha Ramesh, MD, FCCP, UPMC Harrisburg, Harrisburg, PA
Improving Lung Health in the Nepali- Bhutanese Refugee Community in Harrisburg, PA
Inderjit Singh, MBBCh, Yale University, New Haven, CT
Dynamic Invasive Hemodynamic, Echocardiographic, and Plasma Biomarker Phenotyping in Post-COVID-19 Long Hauler Syndrome
CHEST Foundation Community Service Grants Honoring D. Robert McCaffree, MD, Master FCCP
Valerie Andrews, BS, The JUDAHH Project, Sacramento, CA
Asthma Mitigation Project
Chanda Holsey, DrPh, National Medical Association, Silver Spring, MD
Providing Lung Health Education to At Risk Communities
Arzu Ari, PhD, FCCP, Texas State University, San Marcos, TX
Training Future Respiratory Care Practitioners in Turkey: A Path to Successful Disease Management in Pulmonary Medicine
Panagis Galiatsatos, MD, MPH, John Hopkins University, Baltimore, MD
The Lung Health Ambassador Program: A Health Equity Initiative for Cystic Fibrosis
Patricia George, MD, National Jewish Health, Denver, CO
Development of Breathe Strong PH: An Informational Website About Pulmonary Hypertension and Related Diseases
Nishant Gupta, MD, MS, University of Cincinnati, Cincinnati, OH
Global Dissemination of the Lymphangioleiomyomatosis (LAM) Clinical Practice Guidelines
Syed Naqvi, MD, MBBS, Hoag Hospital Newport Beach, Newport Beach, CA
Asthma Managment in Rural Pakistan
These grants are supported by the CHEST Foundation.
Alfred Soffer Research Award Winners
Mathieu Saint-Pierre, MD: Methacholine Challenge Testing: A Clinical Prediction Model Utilizing Demographic Data And Spirometry Results
Tie: Milind K Bhagat, MD: High Flow Nasal Cannula Fio2 Cutoffs Identified Early In The Hospital Course Are Associated With Increased Mortality Risk In Hospitalized Patients With COVID-19
Amber J Meservey, MD: Outcomes Of Patients Across The Spectrum Of Pulmonary Hypertension Groups Prescribed Inhaled Treprostinil
Young Investigator Award Winners
William B. Feldman, MD: COPD Exacerbations And Pneumonia Hospitalizations In New Users Of Combination Maintenance Inhalers: A Comparative Effectiveness And Safety Study
Christopher Streiler, MD: Community Pulmonologist Access To Multidisciplinary Discussion At An Academic Referral Center Leads To Changes In Management Of Interstitial Lung Disease
Top 5 Abstract Posters
Winner: Riley Kermanian: Management Of Coronary Artery Calcification In Patients Enrolled In A Low-Dose Computerized Tomography Lung Cancer Screening Program
Winner: Rohit Reddy: Outcomes Of Extracorporeal Membrane Oxygenation In ARDS Due To Covid-19: Comparison Of The First And The Second Wave
Winner: Taylor A. Intihar, BA: Light Patterns Of The Medical ICU: Are We Disrupting Circadian Rhythms?
Runner up: Jason Wong, MD: Completion Of Pulmonary Rehabilitation Is Associated With Improvement In Depression Scores And Other Quality Of Life Measures In Patients With Interstitial Lung Disease
Runner up: Harshil Shah, MD: Impact Of Sepsis On Outcomes Of Hospitalizations Due To COPD
Case Report Session Winners
Remarkable Pulmonary Cases: Mena Botros, MD: Clinical Outcomes In Lung Transplant Recipients With SARS-COV2
Bacterial Infections: Benjamin Carmel, DO: Cotton Swab Today, Brain Abscess Tomorrow
Challenging Critical Care Cases: Rajaninder Sharma, MD: Pulmonary Tumor Thrombotic Microangiopathy: The Rare And Fatal Association Of Adenocarcinoma And Right Ventricular Failure
Diffuse Lung Diseases: Rizwana RR Rana, MBBS: A Rare Cause Of Pulmonary Nodules
Viruses, Fungi, and Parasites Infections: Michelle Forson, MD: Strongyloidiasis-Related Eosinophilic Pleural Effusion: An Unexpected Differential For Post-Cardiac Injury Syndrome
Critical Care Cases: Act Quickly: Christina Jee Ah Rhee, MD: Airway Implications Of Cricoarytenoid Arthritis: A Report And Review Of The Literature
Airway Issues: Benadin Varajic, MD: An Unusual And Life-Threatening Complication Of Endotracheal Intubation
Miscellaneous Cases 1: Shrey Shah, MD: A Case Of Pulmonary Arterial Hypertension From Vitamin C Deficiency
Miscellaneous Cases 2: Glenn W. Pottmeyer, DO, MPH: Biliary Stent Migration: A Rare Cause Of Right-Sided Pulmonary Abscess
Case Report Poster Winners
Advanced Cancer Case Report Posters: Sangita Goel, MD: Let’s Meet in the Middle: Simultaneous Endoscopic and Bronchoscopic Suture Repair to Close a Left Main-Stem Malignant Broncho-Esophageal Fistula
Cardiovascular Case Report Posters: Marianna Weaver, DO: Swan-Ganz And Intra-Pericardial Pressure Guided Pericardiocentesis in Scleroderma-Associated PAH
Remarkable Cases Posters 1: Katie Capp, MD: Humidifier-Associated Hypersensitivity Pneumonitis
Remarkable Cases Posters 2: Sahar Samani, MD: Artifactual Hypoxemia in Patients With Hydroxyurea-Induced Blue Lunula Fingernails
CHEST 2021 CHEST Challenge
1st Place
The Ohio State University
Sarah Cohen, MD
Gregory Eisinger, MD
Kyle Stinehart, MD
Program Director: Jennifer McCallister, MD, FCCP
2nd Place
SUNY Buffalo
Arjun Saradna, MBBS
Rajesh Kunadharaju, MD
Ahmed Munir, MBBS
Program Director: Jeffrey Mador, MD
3rd Place
Interfaith Medical Center
Tahmina Jahir, MD
Ruby Risal, MD
Binav Shrestha, MBBS
Program Director: Marie Frances Schmidt, MD, FCCP
ANNUAL AWARDS
Master FCCP
Curtis N. Sessler, MD, Master FCCP
College Medalist Award
Margaret Pisani, MD, MPH, FCCP
Distinguished Service Award
Christopher Carroll, MD, FCCP
Master Clinician Educator
Doreen Addrizzo-Harris, MD, FCCP
Early Career Clinician Educator
Matthew C. Miles, MD, FCCP
Alfred Soffer Award for Editorial Excellence
Scott Manaker, MD, PhD, FCCP
Presidential Citation
COVID-19 Task Force
Ryan Maves, MD, FCCP
Christopher Carroll, MD, FCCP
Neha Dangayach, MD
Jeffrey Dichter, MD, FCCP
Alice Gallo De Moraes, MD
James Geiling, MD, MPH, FCCP
Holly Keyt, MD, FCCP
Stephanie M. Levine, MD, FCCP
Septimu Murgu, MD, FCCP
Marcos Restrepo, MD, PhD, FCCP
Steven Q. Simpson, MD, FCCP
Angel Coz Yataco, MD, FCCP
Staff: Katlyn Froslan, Heather Watkins, Robb Rabito, CHCP, Lilly Rodriguez, Karla Velilla
HONOR LECTURE AND MEMORIAL AWARDS
Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
KENNETH I. BERGER, MD, FCCP
Probing the Small Airways in the Assessment of Dyspnea
The lecture is generously funded by the CHEST Foundation.
Presidential Honor Lecture
CURTIS N. SESSLER, MD, Master FCCP
Navigating the Road to Well-Being in the ICU
Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation
DEBRA WEESE-MAYER, MD
Artificial Ventilation, a True Life-Saver for Children with CCHS & ROHHAD
The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.
RICHARD S. IRWIN, MD, MASTER FCCP HONOR LECTURE
PETER J. MAZZONE, MD, MPH, FCCP
Shared Decision Making in the Evaluation and Management of Early Stage Lung Cancer
The lecture is generously funded by the CHEST Foundation.
Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
DIANE E. STOVER, MD, FCCP
The Many Faces of Organizing Pneumonia—What’s the O(O)P With That?
The lecture is generously funded by the CHEST Foundation.
Pasquale Ciaglia Memorial Lecture in Interventional Medicine
MICHAEL J. SIMOFF, MD, FCCP
Robotic Bronchoscopy: Platform to the Future?
The lecture is generously funded by the CHEST Foundation.
Roger C. Bone Memorial Lecture in Critical Care
OGNJEN GAJIC, MD, FCCP
Patient Comes First: Prioritizing Relevant From Irrelevant in Critical Care Medicine
The lecture is generously funded by the CHEST Foundation.
Thomas L. Petty, MD, Master FCCP Memorial Lecture
JEAN BOURBEAU, MD, FCCP
Pulmonary Rehabilitation and Self-Management in COPD: Understanding the Past to Build the Future
The lecture is generously funded by the CHEST Foundation.
CHEST FOUNDATION GRANT AWARDS
CHEST Foundation Research Grant in Lung Cancer
This grant is supported by the CHEST Foundation.
Daniel Ryan, MD, Royal College of Surgeons Ireland, Dublin, Ireland
Microbial Signatures Associated With Malignant Pleural Effusions in Lung Cancer
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is jointly supported by the CHEST Foundation and RHA.
Miguel Divo, MD, Brigham and Women’s Hospital, Boston, MA
Biomarker Profiles in Smokers Who Are at Risk of Developing Chronic Obstructive Pulmonary Disease (COPD)
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is supported by AstraZeneca LP.
Stephen Milne, MBBS, Woolcock Institute of Medical Research, Vancouver, BC, Canada
The Oral Metagenome in COPD: Towards a Biomarker of Exacerbation Risk
CHEST Foundation Research Grant in Critical Care
This grant is supported by the CHEST Foundation.
Jacqueline Stocking, PhD, University of California, Davis, Davis, CA
University of California Critical Care Research Collaborative: Predictive Model and Risk Calculator for Early and Late Postoperative Respiratory Failure
CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.
John Charles Rotondo, PhD, University of Ferrara, Ferrara, Italy
Alpha-1 Antitrypsin Protein as a Possible Marker of Disease Progression in COVID-19 Patients
CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
This grant is supported by Insmed Incorporated.
Edward Chan, MD, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
Visualization and Quantitation of Azithromycin, Clofazimine, and Amikacin Distribution in Surgically Removed Lung Tissues From Patients With Nontuberculous Mycobacterial Lung Disease
CHEST Foundation Research Grant in Cystic Fibrosis
This grant is supported by Vertex Pharmaceuticals Incorporated.
Shahid Sheikh, MD, FCCP, Nationwide Children’s Hospital, Columbus, OH
Impact of CFTR Modulator Therapy Elexacaftor-Tezacaftor-Ivacaftor on CF- Related Chronic Sinus Disease
John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
This grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.
Maneesh Bhargava, MD, PhD, FCCP, Minneapolis VA Health Care System, Minneapolis, MN
Inflammatory Protein Panel for Sarcoidosis Diagnosis and Prognosis
CHEST Foundation Research Grant in Severe Asthma
This grant is supported by the CHEST Foundation.
Felix Reyes, MD, Montefiore Medical Center, Bronx, NY
Design and Implementation of an Asthma Action Plan Generator: A Pilot Study Assessing User Satisfaction and Clinical Impact
CHEST Foundation Research Grant in Pulmonary Fibrosis
These grants are supported by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Genentech, Inc.
Marco Mura, MD, PhD, Western University, London, Ontario, Canada
Validation of the Risk Stratification Score in Idiopathic Pulmonary Fibrosis
Janelle Pugashetti, MD, University of California, Davis, Davis, CA
Determining Biomarkers of Immunosuppressant Responsiveness in Patients With CTD-ILD
CHEST Foundation Research Grant in Pulmonary Hypertension
These grants are supported by the CHEST Foundation.
Michael Lee, MD, University of California San Francisco, San Francisco, CA
Transpulmonary Metabolomic Gradients During Exercise in Systemic Sclerosis-Associated Pulmonary Hypertension
Navneet Singh, MD, Warren Alpert School of Medicine at Brown University, Providence, RI
Mitochondrial Dysfunction and Oxidative Stress in Pulmonary Hypertension
CHEST Foundation Research Grant in Sleep Medicine
These grants are funded by Jazz Pharmaceuticals, Inc.
Shahid Karim, MBChB, Mayo Clinic, Rochester, MN
Effects of OSA on Atrial and Ventricular Arrhythmia in HCM: An Incidence Study
Thomas Tolbert, MD, Mount Sinai Hospital, New York, NY
Performance Characteristics of Obstructive Sleep Apnea Physiologic Traits Measured by Phenotyping Using Polysomnography
CHEST Foundation and American Academy of Sleep Medicine Foundation Research Grant in Sleep Medicine
This grant is jointly supported by the CHEST Foundation and AASM Foundation.
Marta Kaminska, MD, McGill University Health Centre, Montreal, QC, Canada
Long-term Noninvasive Ventilation in COPD: Impact on Health Care Utilization
CHEST Foundation and APCCMPD Research Grant in Medical Education
This grant is jointly supported by the CHEST Foundation and APCCMPD.
Mark Adelman, MD, NYU School of Medicine, New York, NY
Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies
CHEST Foundation Research Grant in COVID-19
These grants are supported by the CHEST Foundation.
Marlene Cano, MD, PhD, Washington University, St. Louis, MO
Circulating Mitochondrial DNA Is a Potential Biomarker for Severe Illness in COVID-19
Brandon Walsh, MD, New York University, New York, NY
How Would Existing Ventilator Allocation Guidelines Perform During the COVID-19 Pandemic: A Retrospective Observational Simulated Cohort Study
CHEST Foundation and ATS Research Grant in COVID-19 and Diversity
These grants are jointly supported by the CHEST Foundation and ATS.
Navitha Ramesh, MD, FCCP, UPMC Harrisburg, Harrisburg, PA
Improving Lung Health in the Nepali- Bhutanese Refugee Community in Harrisburg, PA
Inderjit Singh, MBBCh, Yale University, New Haven, CT
Dynamic Invasive Hemodynamic, Echocardiographic, and Plasma Biomarker Phenotyping in Post-COVID-19 Long Hauler Syndrome
CHEST Foundation Community Service Grants Honoring D. Robert McCaffree, MD, Master FCCP
Valerie Andrews, BS, The JUDAHH Project, Sacramento, CA
Asthma Mitigation Project
Chanda Holsey, DrPh, National Medical Association, Silver Spring, MD
Providing Lung Health Education to At Risk Communities
Arzu Ari, PhD, FCCP, Texas State University, San Marcos, TX
Training Future Respiratory Care Practitioners in Turkey: A Path to Successful Disease Management in Pulmonary Medicine
Panagis Galiatsatos, MD, MPH, John Hopkins University, Baltimore, MD
The Lung Health Ambassador Program: A Health Equity Initiative for Cystic Fibrosis
Patricia George, MD, National Jewish Health, Denver, CO
Development of Breathe Strong PH: An Informational Website About Pulmonary Hypertension and Related Diseases
Nishant Gupta, MD, MS, University of Cincinnati, Cincinnati, OH
Global Dissemination of the Lymphangioleiomyomatosis (LAM) Clinical Practice Guidelines
Syed Naqvi, MD, MBBS, Hoag Hospital Newport Beach, Newport Beach, CA
Asthma Managment in Rural Pakistan
These grants are supported by the CHEST Foundation.
Alfred Soffer Research Award Winners
Mathieu Saint-Pierre, MD: Methacholine Challenge Testing: A Clinical Prediction Model Utilizing Demographic Data And Spirometry Results
Tie: Milind K Bhagat, MD: High Flow Nasal Cannula Fio2 Cutoffs Identified Early In The Hospital Course Are Associated With Increased Mortality Risk In Hospitalized Patients With COVID-19
Amber J Meservey, MD: Outcomes Of Patients Across The Spectrum Of Pulmonary Hypertension Groups Prescribed Inhaled Treprostinil
Young Investigator Award Winners
William B. Feldman, MD: COPD Exacerbations And Pneumonia Hospitalizations In New Users Of Combination Maintenance Inhalers: A Comparative Effectiveness And Safety Study
Christopher Streiler, MD: Community Pulmonologist Access To Multidisciplinary Discussion At An Academic Referral Center Leads To Changes In Management Of Interstitial Lung Disease
Top 5 Abstract Posters
Winner: Riley Kermanian: Management Of Coronary Artery Calcification In Patients Enrolled In A Low-Dose Computerized Tomography Lung Cancer Screening Program
Winner: Rohit Reddy: Outcomes Of Extracorporeal Membrane Oxygenation In ARDS Due To Covid-19: Comparison Of The First And The Second Wave
Winner: Taylor A. Intihar, BA: Light Patterns Of The Medical ICU: Are We Disrupting Circadian Rhythms?
Runner up: Jason Wong, MD: Completion Of Pulmonary Rehabilitation Is Associated With Improvement In Depression Scores And Other Quality Of Life Measures In Patients With Interstitial Lung Disease
Runner up: Harshil Shah, MD: Impact Of Sepsis On Outcomes Of Hospitalizations Due To COPD
Case Report Session Winners
Remarkable Pulmonary Cases: Mena Botros, MD: Clinical Outcomes In Lung Transplant Recipients With SARS-COV2
Bacterial Infections: Benjamin Carmel, DO: Cotton Swab Today, Brain Abscess Tomorrow
Challenging Critical Care Cases: Rajaninder Sharma, MD: Pulmonary Tumor Thrombotic Microangiopathy: The Rare And Fatal Association Of Adenocarcinoma And Right Ventricular Failure
Diffuse Lung Diseases: Rizwana RR Rana, MBBS: A Rare Cause Of Pulmonary Nodules
Viruses, Fungi, and Parasites Infections: Michelle Forson, MD: Strongyloidiasis-Related Eosinophilic Pleural Effusion: An Unexpected Differential For Post-Cardiac Injury Syndrome
Critical Care Cases: Act Quickly: Christina Jee Ah Rhee, MD: Airway Implications Of Cricoarytenoid Arthritis: A Report And Review Of The Literature
Airway Issues: Benadin Varajic, MD: An Unusual And Life-Threatening Complication Of Endotracheal Intubation
Miscellaneous Cases 1: Shrey Shah, MD: A Case Of Pulmonary Arterial Hypertension From Vitamin C Deficiency
Miscellaneous Cases 2: Glenn W. Pottmeyer, DO, MPH: Biliary Stent Migration: A Rare Cause Of Right-Sided Pulmonary Abscess
Case Report Poster Winners
Advanced Cancer Case Report Posters: Sangita Goel, MD: Let’s Meet in the Middle: Simultaneous Endoscopic and Bronchoscopic Suture Repair to Close a Left Main-Stem Malignant Broncho-Esophageal Fistula
Cardiovascular Case Report Posters: Marianna Weaver, DO: Swan-Ganz And Intra-Pericardial Pressure Guided Pericardiocentesis in Scleroderma-Associated PAH
Remarkable Cases Posters 1: Katie Capp, MD: Humidifier-Associated Hypersensitivity Pneumonitis
Remarkable Cases Posters 2: Sahar Samani, MD: Artifactual Hypoxemia in Patients With Hydroxyurea-Induced Blue Lunula Fingernails
CHEST 2021 CHEST Challenge
1st Place
The Ohio State University
Sarah Cohen, MD
Gregory Eisinger, MD
Kyle Stinehart, MD
Program Director: Jennifer McCallister, MD, FCCP
2nd Place
SUNY Buffalo
Arjun Saradna, MBBS
Rajesh Kunadharaju, MD
Ahmed Munir, MBBS
Program Director: Jeffrey Mador, MD
3rd Place
Interfaith Medical Center
Tahmina Jahir, MD
Ruby Risal, MD
Binav Shrestha, MBBS
Program Director: Marie Frances Schmidt, MD, FCCP
This month in the journal CHEST®
Editor’s picks
Revisiting mild asthma: current knowledge and future needs. By Dr. A. Mohan, et al.
Treatment of Mycobacterium abscessus pulmonary disease. By Dr. D. Griffith, et al.
The utility of the rapid shallow breathing index in predicting successful extubation: A systematic review and meta-analysis. By Dr. K. Burns, et al.
National temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis in the United States between 2007 – 2018. By Dr. N. Obi Ogugua, et al.
How I Do It: Considering lung transplantation for patients with COVID-19. By Dr. S. Nathan.
Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. By Dr. N. Bhakta, et al.
Editor’s picks
Editor’s picks
Revisiting mild asthma: current knowledge and future needs. By Dr. A. Mohan, et al.
Treatment of Mycobacterium abscessus pulmonary disease. By Dr. D. Griffith, et al.
The utility of the rapid shallow breathing index in predicting successful extubation: A systematic review and meta-analysis. By Dr. K. Burns, et al.
National temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis in the United States between 2007 – 2018. By Dr. N. Obi Ogugua, et al.
How I Do It: Considering lung transplantation for patients with COVID-19. By Dr. S. Nathan.
Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. By Dr. N. Bhakta, et al.
Revisiting mild asthma: current knowledge and future needs. By Dr. A. Mohan, et al.
Treatment of Mycobacterium abscessus pulmonary disease. By Dr. D. Griffith, et al.
The utility of the rapid shallow breathing index in predicting successful extubation: A systematic review and meta-analysis. By Dr. K. Burns, et al.
National temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis in the United States between 2007 – 2018. By Dr. N. Obi Ogugua, et al.
How I Do It: Considering lung transplantation for patients with COVID-19. By Dr. S. Nathan.
Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. By Dr. N. Bhakta, et al.
The people’s paper
With this issue, we usher in a new era for CHEST Physician, as I hand over the reins of Editor-in-Chief to Angel Coz, MD, FCCP. I have had the pleasure of serving in this role over the last 4 years, and though I will still have the privilege of appearing within these pages with some frequency as I move into my new role as CHEST President, I would like to mark this milestone by passing along a few thoughts on how CHEST Physician has developed over the last few years, and reflecting on the goals I set for us way back in the January 2018 issue (on page 46 of that issue, for those of you holding on to our back issues).
I’ve always viewed CHEST Physician as “the People’s Paper” of CHEST. While we don’t feature first-run scientific manuscripts and authors aren’t likely to reference our articles in other publications, your editorial board and our partners at Frontline aim to give our readers a broad overview of recent publications and presentations in pulmonary, critical care, and sleep medicine, along with expert commentary about how those developments might affect the care we provide to our patients. I can’t thank our editorial board members enough for the hours they spend selecting a small number of items to feature among all of the new medical developments each month.
One of the main goals we had established over the last few years was to create more opportunities for CHEST Physician to serve as the voice of the members and leaders of the American College of Chest Physicians. We achieved the latter part of this goal, with leadership penning quarterly columns on actions of the Board of Regents, developments within the annual meeting, as well as ongoing columns from our NetWorks. And, we have also provided a more reliable voice for our members, with authors of our Sleep Strategies, Critical Care Commentary, and Pulmonary Perspectives columns providing a broader and more representative sample of our membership than ever before.
One of the areas where I would love to see more progress is with reader engagement. It has been a delight to receive feedback from CHEST members, even when the author is taking issue with something we have published. CHEST Physician will be a better publication than it already is with your ongoing input. Please, if you see something that we write that you particularly like (or don’t!) or if there’s something you’d like to see that we haven’t written, please reach out to us! You can always reach us at [email protected].
In closing, I want to thank all of the steadfast CHEST Physician readers for making my 4 years as Editor-in-Chief enjoyable and meaningful. While I am so pleased with the current state of this publication, I cannot wait to see its ongoing evolution under the leadership of Dr. Coz and his editorial board.
With this issue, we usher in a new era for CHEST Physician, as I hand over the reins of Editor-in-Chief to Angel Coz, MD, FCCP. I have had the pleasure of serving in this role over the last 4 years, and though I will still have the privilege of appearing within these pages with some frequency as I move into my new role as CHEST President, I would like to mark this milestone by passing along a few thoughts on how CHEST Physician has developed over the last few years, and reflecting on the goals I set for us way back in the January 2018 issue (on page 46 of that issue, for those of you holding on to our back issues).
I’ve always viewed CHEST Physician as “the People’s Paper” of CHEST. While we don’t feature first-run scientific manuscripts and authors aren’t likely to reference our articles in other publications, your editorial board and our partners at Frontline aim to give our readers a broad overview of recent publications and presentations in pulmonary, critical care, and sleep medicine, along with expert commentary about how those developments might affect the care we provide to our patients. I can’t thank our editorial board members enough for the hours they spend selecting a small number of items to feature among all of the new medical developments each month.
One of the main goals we had established over the last few years was to create more opportunities for CHEST Physician to serve as the voice of the members and leaders of the American College of Chest Physicians. We achieved the latter part of this goal, with leadership penning quarterly columns on actions of the Board of Regents, developments within the annual meeting, as well as ongoing columns from our NetWorks. And, we have also provided a more reliable voice for our members, with authors of our Sleep Strategies, Critical Care Commentary, and Pulmonary Perspectives columns providing a broader and more representative sample of our membership than ever before.
One of the areas where I would love to see more progress is with reader engagement. It has been a delight to receive feedback from CHEST members, even when the author is taking issue with something we have published. CHEST Physician will be a better publication than it already is with your ongoing input. Please, if you see something that we write that you particularly like (or don’t!) or if there’s something you’d like to see that we haven’t written, please reach out to us! You can always reach us at [email protected].
In closing, I want to thank all of the steadfast CHEST Physician readers for making my 4 years as Editor-in-Chief enjoyable and meaningful. While I am so pleased with the current state of this publication, I cannot wait to see its ongoing evolution under the leadership of Dr. Coz and his editorial board.
With this issue, we usher in a new era for CHEST Physician, as I hand over the reins of Editor-in-Chief to Angel Coz, MD, FCCP. I have had the pleasure of serving in this role over the last 4 years, and though I will still have the privilege of appearing within these pages with some frequency as I move into my new role as CHEST President, I would like to mark this milestone by passing along a few thoughts on how CHEST Physician has developed over the last few years, and reflecting on the goals I set for us way back in the January 2018 issue (on page 46 of that issue, for those of you holding on to our back issues).
I’ve always viewed CHEST Physician as “the People’s Paper” of CHEST. While we don’t feature first-run scientific manuscripts and authors aren’t likely to reference our articles in other publications, your editorial board and our partners at Frontline aim to give our readers a broad overview of recent publications and presentations in pulmonary, critical care, and sleep medicine, along with expert commentary about how those developments might affect the care we provide to our patients. I can’t thank our editorial board members enough for the hours they spend selecting a small number of items to feature among all of the new medical developments each month.
One of the main goals we had established over the last few years was to create more opportunities for CHEST Physician to serve as the voice of the members and leaders of the American College of Chest Physicians. We achieved the latter part of this goal, with leadership penning quarterly columns on actions of the Board of Regents, developments within the annual meeting, as well as ongoing columns from our NetWorks. And, we have also provided a more reliable voice for our members, with authors of our Sleep Strategies, Critical Care Commentary, and Pulmonary Perspectives columns providing a broader and more representative sample of our membership than ever before.
One of the areas where I would love to see more progress is with reader engagement. It has been a delight to receive feedback from CHEST members, even when the author is taking issue with something we have published. CHEST Physician will be a better publication than it already is with your ongoing input. Please, if you see something that we write that you particularly like (or don’t!) or if there’s something you’d like to see that we haven’t written, please reach out to us! You can always reach us at [email protected].
In closing, I want to thank all of the steadfast CHEST Physician readers for making my 4 years as Editor-in-Chief enjoyable and meaningful. While I am so pleased with the current state of this publication, I cannot wait to see its ongoing evolution under the leadership of Dr. Coz and his editorial board.
Clinical Edge Journal Scan Commentary: Migraine January 2022
Ferrari et al1provided information on an open label extension to the “LIBERTY” study which investigated the use of erenumab in subjects with episodic migraine that have failed multiple prior preventive medications. The initial Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) studies excluded more refractory patients. Most commercial insurances in the United States have a “step” policy that relates to use of these and other newer medications, meaning that the majority of patient in the US who receive these medications have previously tried other preventive medications. This raised the question whether migraine refractoriness is a negative predictive factor for erenumab.
This long-term open label study is more like the real-world use of erenumab, and as such the results are similar to what many practitioners are seeing in their clinical experience. Approximately 25% of subjects discontinued erenumab, mostly due to ineffectiveness. Adverse events were mild, and although erenumab has warnings for constipation and hypertension, this study did not show either as increasing over 2 years. Erenumab appeared to be tolerable over time. There were no newly noted safety signals in this study.
The efficacy of erenumab also appeared to be stable over time, without the development of tolerance to the medication. There is a slight decrease in the 50% responder rate at 2 years when these more refractory patients are compared to those that did not have multiple treatment failures. This study also looked at “functional parameters,” such as Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6), both of which were significantly improved over time.
Although there are some significant limitations in this study-primarily the fact that it is open label—this does give a more representative and real-world sample of patients who will be prescribed erenumab in the United States. Most practitioners will be glad to find that the long-term use of erenumab appears safe, and the efficacy remains stable, even in a more difficult-to-treat population.
A randomized controlled international study investigated the preventive use of occipital nerve blocks in migraine without aura.2 The majority of the literature for the use of occipital nerve blocks is for acute treatment, and arguably the most significant study prior to this was Friedman et al3 investigating the use of this procedure in the emergency ward. Prior occipital nerve studies have been inconclusive, and although occipital nerve blocks are considered standard of care for specific conditions in most headache centers, reimbursement is usually very limited. Insurance companies have quoted prior preventive occipital nerve studies to justify non-coverage of these procedures, making access to them for many patients very limited.
Occipital nerve blocks are not performed uniformly, both regarding the medications used—some practitioners use no steroids, some use lidocaine and bupivocaine—and regarding the placement of the injections. In this a small cohort study, 55 subjects were divided into four groups for intervention—one of which was a control group of saline—and all were given one 2.5 mL injection at a point in between the occipital protuberance and the mastoid process bilaterally. Due to adverse events (alopecia and cutaneous atrophy) in two of the triamcinolone groups, recruitment was halted for those two groups. Patients were assessed based on headache duration, frequency, and severity over a 4-week course.
Compared to baseline all interventional groups had significantly decreased headache severity, which did return closer to baseline during the final week. Headache duration was decreased in the first 2 weeks post-injection. Headache frequency was seen to return to baseline at week 4, but prior to that the groups injected with lidocaine had a significant decrease in migraine frequency, with an average decrease in headache days.
Occipital nerve blocks are performed frequently for migraine, occipital neuralgia, cervicogenic headache, and many other conditions with noted tenderness over the occiput. As noted above, they are not performed uniformly—sometimes they are given for acute headache pain or status migranosus, and other times they are used in regular intervals for prevention. This data does finally show a preventive benefit with occipital nerve blocks, and this may allow for modifications in how occipital nerve blocks are currently performed. Based on this study, if given preventively, occipital nerve blocks should only contain topical anesthetics, not steroids, and should be performed on an every 2-3 week basis.
The limitations of this study are significant as well. This is a very small cohort, and the injections were performed in only one manner (one bilateral injection), whereas many practitioners will target the greater and lesser branches of the occipital nerve individually. There were no exclusion criteria for subjects that already had occipital nerve blocks performed—those patients would be unblinded as there is a different sensation when injected with a topical anesthetic versus normal saline (normal saline does not cause burning subcutaneously).
These results should pave the way for further investigations in the use of occipital and other nerve blocks in the prevention of migraine. This should allow better access for our patients and the possibility of performing these procedures more uniformly in the future.
It can be challenging for many practitioners to determine which medication is ideal for individual situations. This is especially true when treating chronic migraine, where many potential complicating factors can influence positive to negative responses to treatment. The investigators here sought to determine which factors may potentially predict a positive response to galcanezumab.4
This is an observational study, where 156 subjects with a diagnosis of chronic migraine were enrolled. There was a 1-month run-in period where the following characteristics were collected: monthly headache days, monthly abortive medication intake, clinical features of migraine, and disability scores (MIDAS and HIT-6). These were tracked over a 3-month period after starting glacanezumab.
Approximately 40% of subjects experienced a 50% reduction in headache frequency. The better responders had a lower body mass index, fewer previously failed preventive medications, unilateral headache pain, and previous good response to triptan use. Surprisingly, the presence of medication overuse was associated with persistent improvement at 3 months as well, with over 60% of subjects with medication overuse no longer overusing acute medications at 3 months.
This study is helpful in identifying specific features that may allow a practitioner to better recommend CGRP mAb medications, such as galcanezumab. Chronic migraine can offer a challenge to even the best trained clinicians. Patients will often have multiple factors that have led to a conversion from episodic to chronic migraine, and a history of medication failures or intolerances. These patients are often referred specifically due to these challenges.
When deciding on a preventive medication for patients with chronic migraine, we often first consider which oral preventive medications may allow us to treat migraine in addition to another underlying issue—such as insomnia, depression, or hypertension. Although the oral class can improve other comorbidities, intolerance is significantly higher for most of these medications as well. The CGRP mAb class is somewhat more ideal for prevention of migraine; the focus when using this class is for migraine prevention alone, and the side effect profile is more tolerable for most patients. That said, if predictive factors were known a more individualized approach to migraine prevention would be possible.
The authors’ recognition of the factors associated with improvement in patients using glacanezumab allows this better individualization. Based on these results, patients with more unilateral pain, lower BMI, and good response to triptans could be recommended glacanuzumab with a great degree of confidence. This should be irrespective of even high frequency use of acute medications, as most of subjects in this study with medication overuse reverted after 3 months.
There is never a single ideal preventive or acute treatment for migraine in any population, however, recognizing factors that allow for an individualized approach improves the quality of life for our patients, and leaves them less disabled by migraine.
References
- Ferrari MD et al. Two-year efficacy and safety of erenumab in participants with episodic migraine and 2–4 prior preventive treatment failures: results from the LIBERTY study. J Neurol Neurosurg Psychiatry. 2021(Nov 29).
- Malekian N et al. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double‐blind placebo‐controlled clinical trial. Cephalalgia. 2021(Nov 17).
- Friedman BW et al. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache. 2018(Oct);58(9):1427-34. https://doi.org/10.1111/head.13395.
- Vernieri F et al. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol. 2021(Nov 26).
Ferrari et al1provided information on an open label extension to the “LIBERTY” study which investigated the use of erenumab in subjects with episodic migraine that have failed multiple prior preventive medications. The initial Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) studies excluded more refractory patients. Most commercial insurances in the United States have a “step” policy that relates to use of these and other newer medications, meaning that the majority of patient in the US who receive these medications have previously tried other preventive medications. This raised the question whether migraine refractoriness is a negative predictive factor for erenumab.
This long-term open label study is more like the real-world use of erenumab, and as such the results are similar to what many practitioners are seeing in their clinical experience. Approximately 25% of subjects discontinued erenumab, mostly due to ineffectiveness. Adverse events were mild, and although erenumab has warnings for constipation and hypertension, this study did not show either as increasing over 2 years. Erenumab appeared to be tolerable over time. There were no newly noted safety signals in this study.
The efficacy of erenumab also appeared to be stable over time, without the development of tolerance to the medication. There is a slight decrease in the 50% responder rate at 2 years when these more refractory patients are compared to those that did not have multiple treatment failures. This study also looked at “functional parameters,” such as Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6), both of which were significantly improved over time.
Although there are some significant limitations in this study-primarily the fact that it is open label—this does give a more representative and real-world sample of patients who will be prescribed erenumab in the United States. Most practitioners will be glad to find that the long-term use of erenumab appears safe, and the efficacy remains stable, even in a more difficult-to-treat population.
A randomized controlled international study investigated the preventive use of occipital nerve blocks in migraine without aura.2 The majority of the literature for the use of occipital nerve blocks is for acute treatment, and arguably the most significant study prior to this was Friedman et al3 investigating the use of this procedure in the emergency ward. Prior occipital nerve studies have been inconclusive, and although occipital nerve blocks are considered standard of care for specific conditions in most headache centers, reimbursement is usually very limited. Insurance companies have quoted prior preventive occipital nerve studies to justify non-coverage of these procedures, making access to them for many patients very limited.
Occipital nerve blocks are not performed uniformly, both regarding the medications used—some practitioners use no steroids, some use lidocaine and bupivocaine—and regarding the placement of the injections. In this a small cohort study, 55 subjects were divided into four groups for intervention—one of which was a control group of saline—and all were given one 2.5 mL injection at a point in between the occipital protuberance and the mastoid process bilaterally. Due to adverse events (alopecia and cutaneous atrophy) in two of the triamcinolone groups, recruitment was halted for those two groups. Patients were assessed based on headache duration, frequency, and severity over a 4-week course.
Compared to baseline all interventional groups had significantly decreased headache severity, which did return closer to baseline during the final week. Headache duration was decreased in the first 2 weeks post-injection. Headache frequency was seen to return to baseline at week 4, but prior to that the groups injected with lidocaine had a significant decrease in migraine frequency, with an average decrease in headache days.
Occipital nerve blocks are performed frequently for migraine, occipital neuralgia, cervicogenic headache, and many other conditions with noted tenderness over the occiput. As noted above, they are not performed uniformly—sometimes they are given for acute headache pain or status migranosus, and other times they are used in regular intervals for prevention. This data does finally show a preventive benefit with occipital nerve blocks, and this may allow for modifications in how occipital nerve blocks are currently performed. Based on this study, if given preventively, occipital nerve blocks should only contain topical anesthetics, not steroids, and should be performed on an every 2-3 week basis.
The limitations of this study are significant as well. This is a very small cohort, and the injections were performed in only one manner (one bilateral injection), whereas many practitioners will target the greater and lesser branches of the occipital nerve individually. There were no exclusion criteria for subjects that already had occipital nerve blocks performed—those patients would be unblinded as there is a different sensation when injected with a topical anesthetic versus normal saline (normal saline does not cause burning subcutaneously).
These results should pave the way for further investigations in the use of occipital and other nerve blocks in the prevention of migraine. This should allow better access for our patients and the possibility of performing these procedures more uniformly in the future.
It can be challenging for many practitioners to determine which medication is ideal for individual situations. This is especially true when treating chronic migraine, where many potential complicating factors can influence positive to negative responses to treatment. The investigators here sought to determine which factors may potentially predict a positive response to galcanezumab.4
This is an observational study, where 156 subjects with a diagnosis of chronic migraine were enrolled. There was a 1-month run-in period where the following characteristics were collected: monthly headache days, monthly abortive medication intake, clinical features of migraine, and disability scores (MIDAS and HIT-6). These were tracked over a 3-month period after starting glacanezumab.
Approximately 40% of subjects experienced a 50% reduction in headache frequency. The better responders had a lower body mass index, fewer previously failed preventive medications, unilateral headache pain, and previous good response to triptan use. Surprisingly, the presence of medication overuse was associated with persistent improvement at 3 months as well, with over 60% of subjects with medication overuse no longer overusing acute medications at 3 months.
This study is helpful in identifying specific features that may allow a practitioner to better recommend CGRP mAb medications, such as galcanezumab. Chronic migraine can offer a challenge to even the best trained clinicians. Patients will often have multiple factors that have led to a conversion from episodic to chronic migraine, and a history of medication failures or intolerances. These patients are often referred specifically due to these challenges.
When deciding on a preventive medication for patients with chronic migraine, we often first consider which oral preventive medications may allow us to treat migraine in addition to another underlying issue—such as insomnia, depression, or hypertension. Although the oral class can improve other comorbidities, intolerance is significantly higher for most of these medications as well. The CGRP mAb class is somewhat more ideal for prevention of migraine; the focus when using this class is for migraine prevention alone, and the side effect profile is more tolerable for most patients. That said, if predictive factors were known a more individualized approach to migraine prevention would be possible.
The authors’ recognition of the factors associated with improvement in patients using glacanezumab allows this better individualization. Based on these results, patients with more unilateral pain, lower BMI, and good response to triptans could be recommended glacanuzumab with a great degree of confidence. This should be irrespective of even high frequency use of acute medications, as most of subjects in this study with medication overuse reverted after 3 months.
There is never a single ideal preventive or acute treatment for migraine in any population, however, recognizing factors that allow for an individualized approach improves the quality of life for our patients, and leaves them less disabled by migraine.
References
- Ferrari MD et al. Two-year efficacy and safety of erenumab in participants with episodic migraine and 2–4 prior preventive treatment failures: results from the LIBERTY study. J Neurol Neurosurg Psychiatry. 2021(Nov 29).
- Malekian N et al. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double‐blind placebo‐controlled clinical trial. Cephalalgia. 2021(Nov 17).
- Friedman BW et al. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache. 2018(Oct);58(9):1427-34. https://doi.org/10.1111/head.13395.
- Vernieri F et al. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol. 2021(Nov 26).
Ferrari et al1provided information on an open label extension to the “LIBERTY” study which investigated the use of erenumab in subjects with episodic migraine that have failed multiple prior preventive medications. The initial Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) studies excluded more refractory patients. Most commercial insurances in the United States have a “step” policy that relates to use of these and other newer medications, meaning that the majority of patient in the US who receive these medications have previously tried other preventive medications. This raised the question whether migraine refractoriness is a negative predictive factor for erenumab.
This long-term open label study is more like the real-world use of erenumab, and as such the results are similar to what many practitioners are seeing in their clinical experience. Approximately 25% of subjects discontinued erenumab, mostly due to ineffectiveness. Adverse events were mild, and although erenumab has warnings for constipation and hypertension, this study did not show either as increasing over 2 years. Erenumab appeared to be tolerable over time. There were no newly noted safety signals in this study.
The efficacy of erenumab also appeared to be stable over time, without the development of tolerance to the medication. There is a slight decrease in the 50% responder rate at 2 years when these more refractory patients are compared to those that did not have multiple treatment failures. This study also looked at “functional parameters,” such as Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6), both of which were significantly improved over time.
Although there are some significant limitations in this study-primarily the fact that it is open label—this does give a more representative and real-world sample of patients who will be prescribed erenumab in the United States. Most practitioners will be glad to find that the long-term use of erenumab appears safe, and the efficacy remains stable, even in a more difficult-to-treat population.
A randomized controlled international study investigated the preventive use of occipital nerve blocks in migraine without aura.2 The majority of the literature for the use of occipital nerve blocks is for acute treatment, and arguably the most significant study prior to this was Friedman et al3 investigating the use of this procedure in the emergency ward. Prior occipital nerve studies have been inconclusive, and although occipital nerve blocks are considered standard of care for specific conditions in most headache centers, reimbursement is usually very limited. Insurance companies have quoted prior preventive occipital nerve studies to justify non-coverage of these procedures, making access to them for many patients very limited.
Occipital nerve blocks are not performed uniformly, both regarding the medications used—some practitioners use no steroids, some use lidocaine and bupivocaine—and regarding the placement of the injections. In this a small cohort study, 55 subjects were divided into four groups for intervention—one of which was a control group of saline—and all were given one 2.5 mL injection at a point in between the occipital protuberance and the mastoid process bilaterally. Due to adverse events (alopecia and cutaneous atrophy) in two of the triamcinolone groups, recruitment was halted for those two groups. Patients were assessed based on headache duration, frequency, and severity over a 4-week course.
Compared to baseline all interventional groups had significantly decreased headache severity, which did return closer to baseline during the final week. Headache duration was decreased in the first 2 weeks post-injection. Headache frequency was seen to return to baseline at week 4, but prior to that the groups injected with lidocaine had a significant decrease in migraine frequency, with an average decrease in headache days.
Occipital nerve blocks are performed frequently for migraine, occipital neuralgia, cervicogenic headache, and many other conditions with noted tenderness over the occiput. As noted above, they are not performed uniformly—sometimes they are given for acute headache pain or status migranosus, and other times they are used in regular intervals for prevention. This data does finally show a preventive benefit with occipital nerve blocks, and this may allow for modifications in how occipital nerve blocks are currently performed. Based on this study, if given preventively, occipital nerve blocks should only contain topical anesthetics, not steroids, and should be performed on an every 2-3 week basis.
The limitations of this study are significant as well. This is a very small cohort, and the injections were performed in only one manner (one bilateral injection), whereas many practitioners will target the greater and lesser branches of the occipital nerve individually. There were no exclusion criteria for subjects that already had occipital nerve blocks performed—those patients would be unblinded as there is a different sensation when injected with a topical anesthetic versus normal saline (normal saline does not cause burning subcutaneously).
These results should pave the way for further investigations in the use of occipital and other nerve blocks in the prevention of migraine. This should allow better access for our patients and the possibility of performing these procedures more uniformly in the future.
It can be challenging for many practitioners to determine which medication is ideal for individual situations. This is especially true when treating chronic migraine, where many potential complicating factors can influence positive to negative responses to treatment. The investigators here sought to determine which factors may potentially predict a positive response to galcanezumab.4
This is an observational study, where 156 subjects with a diagnosis of chronic migraine were enrolled. There was a 1-month run-in period where the following characteristics were collected: monthly headache days, monthly abortive medication intake, clinical features of migraine, and disability scores (MIDAS and HIT-6). These were tracked over a 3-month period after starting glacanezumab.
Approximately 40% of subjects experienced a 50% reduction in headache frequency. The better responders had a lower body mass index, fewer previously failed preventive medications, unilateral headache pain, and previous good response to triptan use. Surprisingly, the presence of medication overuse was associated with persistent improvement at 3 months as well, with over 60% of subjects with medication overuse no longer overusing acute medications at 3 months.
This study is helpful in identifying specific features that may allow a practitioner to better recommend CGRP mAb medications, such as galcanezumab. Chronic migraine can offer a challenge to even the best trained clinicians. Patients will often have multiple factors that have led to a conversion from episodic to chronic migraine, and a history of medication failures or intolerances. These patients are often referred specifically due to these challenges.
When deciding on a preventive medication for patients with chronic migraine, we often first consider which oral preventive medications may allow us to treat migraine in addition to another underlying issue—such as insomnia, depression, or hypertension. Although the oral class can improve other comorbidities, intolerance is significantly higher for most of these medications as well. The CGRP mAb class is somewhat more ideal for prevention of migraine; the focus when using this class is for migraine prevention alone, and the side effect profile is more tolerable for most patients. That said, if predictive factors were known a more individualized approach to migraine prevention would be possible.
The authors’ recognition of the factors associated with improvement in patients using glacanezumab allows this better individualization. Based on these results, patients with more unilateral pain, lower BMI, and good response to triptans could be recommended glacanuzumab with a great degree of confidence. This should be irrespective of even high frequency use of acute medications, as most of subjects in this study with medication overuse reverted after 3 months.
There is never a single ideal preventive or acute treatment for migraine in any population, however, recognizing factors that allow for an individualized approach improves the quality of life for our patients, and leaves them less disabled by migraine.
References
- Ferrari MD et al. Two-year efficacy and safety of erenumab in participants with episodic migraine and 2–4 prior preventive treatment failures: results from the LIBERTY study. J Neurol Neurosurg Psychiatry. 2021(Nov 29).
- Malekian N et al. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double‐blind placebo‐controlled clinical trial. Cephalalgia. 2021(Nov 17).
- Friedman BW et al. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache. 2018(Oct);58(9):1427-34. https://doi.org/10.1111/head.13395.
- Vernieri F et al. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol. 2021(Nov 26).