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Medicare intends to limit payment for controversial Alzheimer’s drug
, federal officials announced Jan. 11.
On Dec. 20, 2021, Biogen announced a plan to reduce the annual U.S. cost of the drug by 50% – from $56,000 to $28,200 – as Centers for Medicare & Medicaid Services officials were deciding on Medicare’s coverage policy for the medication.
In making its proposed coverage decision, the CMS announced it will pay for aducanumab, a monoclonal antibody, under its coverage-with-evidence-development (CED) mechanism. In making its decision, the CMS approached aducanumab as the first of a potential new class of monoclonal antibodies for the treatment of Alzheimer’s disease. Food and Drug Administration–approved drugs in this class would be covered for those with Medicare only if they are enrolled in qualifying clinical trials, the CMS said. The agency will accept public comments on this decision for 30 days.
In a statement, CMS Administrator Chiquita Brooks-LaSure said the agency is “committed to providing the American public with a clear, trusted, evidence-based decision that is made only after a thorough analysis of public feedback on the benefits and risks of coverage for Medicare patients.”
As previously reported, the FDA approved aducanumab on June 7, 2021, via an accelerated approval process. The approval, which set off a firestorm of controversy that included resignations of three FDA Peripheral and Central Nervous System Drugs Advisory Committee panel members, was granted based on the medication’s ability to reduce beta-amyloid plaque.
Under the accelerated approval mechanism, Biogen still must deliver solid scientific proof that aducanumab has clinically significant disease-modifying effects. However, the final evidence won’t be in any time soon. In its approval letter, the FDA set a 2030 deadline for a final report on this research.
‘Unusual but appropriate’ step
The Medicare decision marks something of a shift in the agency’s approach to paying for medications. On a call with reporters, Tamara Syrek Jensen, JD, director of CMS’ Coverage and Analysis Group, admitted that the agency had taken an “unusual but appropriate” step in trying to set a national policy regarding payment for a drug.
On the same call, Lee Fleisher, MD, CMS’ chief medical officer, addressed the challenges presented by aducanumab, given the serious need for treatments for Alzheimer’s disease. “As a practicing physician, I cannot overemphasize the need to understand the risks and benefits of a given treatment in order to better inform patients and their families,” Dr. Fleisher said. “We do know based on some of the evidence that there may be potential promise with this treatment. That’s why it is critical for us to pursue additional scientific evidence.”
The coverage-with-evidence program will allow Medicare to aid in gathering data, while protecting patients, Dr. Fleisher noted.
“CMS is using its authority provided by Congress to determine if the drug is considered reasonable and necessary, meaning that the benefits of improvement of cognition outweigh the harms in the Medicare population,” Dr. Fleisher said.
Biogen disappointed
Cambridge, Mass.–based Biogen urged the CMS to reconsider its approach to payment for aducanumab. In a statement, the company said Medicare should cover “the class of amyloid-directed therapies with the populations studied in the respective clinical trials and guided by expert recommendations for appropriate use.
“We believe Alzheimer’s patients should have access consistent with other therapies with FDA accelerated approval,” Biogen said in the release.
In the company’s view, the CED approach will “significantly limit patient access to an FDA-approved treatment, especially for underserved patients as evidenced in other CED determinations.
“CEDs can take months to years to initiate, and hundreds of Alzheimer’s patients – the majority of whom are Medicare beneficiaries – are progressing each day from mild to moderate disease stages, where treatment may no longer be an option,” Biogen said.
Drug makers had been worried about CMS opting for CED even before the draft decision was unveiled.
Others weigh in
BIO, the trade group for biotechnology companies, urged the CMS to provide access to aducanumab without excess restrictions.
There already are concerns among drug makers about CMS efforts “to impose new coverage barriers – and, in particular, coverage with evidence development,” Crystal Kuntz, vice president of policy and research at BIO, and Andy Cosgrove, the organization’s senior director for policy and research, noted in a July 2021 comment about the aducanumab review.
Medicare should instead continue to provide access to medicines for indications that the FDA has approved, with additional flexibility for off-label indications of cancer drugs, they noted. “We believe this should continue to be the case, to ensure that vulnerable Medicare beneficiaries have necessary access to life-altering and lifesaving medications,” the BIO officials wrote.
However, the CMS also received many pleas from physicians asking the agency to limit use of aducanumab at least until there is evidence that it produces a significant clinical benefit.
In a press release, Howard Fillit, MD, cofounder and chief science officer of the Alzheimer’s Drug Discovery Foundation, applauded the decision, describing it as “the right call.
“This decision supports conducting additional clinical trials, which are needed to obtain further insights into the clinical efficacy and safety profile of this drug in real-world populations. This decision has implications for other drugs in this class in late-stage development. If these trials show more clear and robust clinical efficacy, then it is possible the FDA will give these amyloid monoclonal antibodies full approval, and Medicare would be likely to provide full payment,” he added.
A version of this article first appeared on Medscape.com.
, federal officials announced Jan. 11.
On Dec. 20, 2021, Biogen announced a plan to reduce the annual U.S. cost of the drug by 50% – from $56,000 to $28,200 – as Centers for Medicare & Medicaid Services officials were deciding on Medicare’s coverage policy for the medication.
In making its proposed coverage decision, the CMS announced it will pay for aducanumab, a monoclonal antibody, under its coverage-with-evidence-development (CED) mechanism. In making its decision, the CMS approached aducanumab as the first of a potential new class of monoclonal antibodies for the treatment of Alzheimer’s disease. Food and Drug Administration–approved drugs in this class would be covered for those with Medicare only if they are enrolled in qualifying clinical trials, the CMS said. The agency will accept public comments on this decision for 30 days.
In a statement, CMS Administrator Chiquita Brooks-LaSure said the agency is “committed to providing the American public with a clear, trusted, evidence-based decision that is made only after a thorough analysis of public feedback on the benefits and risks of coverage for Medicare patients.”
As previously reported, the FDA approved aducanumab on June 7, 2021, via an accelerated approval process. The approval, which set off a firestorm of controversy that included resignations of three FDA Peripheral and Central Nervous System Drugs Advisory Committee panel members, was granted based on the medication’s ability to reduce beta-amyloid plaque.
Under the accelerated approval mechanism, Biogen still must deliver solid scientific proof that aducanumab has clinically significant disease-modifying effects. However, the final evidence won’t be in any time soon. In its approval letter, the FDA set a 2030 deadline for a final report on this research.
‘Unusual but appropriate’ step
The Medicare decision marks something of a shift in the agency’s approach to paying for medications. On a call with reporters, Tamara Syrek Jensen, JD, director of CMS’ Coverage and Analysis Group, admitted that the agency had taken an “unusual but appropriate” step in trying to set a national policy regarding payment for a drug.
On the same call, Lee Fleisher, MD, CMS’ chief medical officer, addressed the challenges presented by aducanumab, given the serious need for treatments for Alzheimer’s disease. “As a practicing physician, I cannot overemphasize the need to understand the risks and benefits of a given treatment in order to better inform patients and their families,” Dr. Fleisher said. “We do know based on some of the evidence that there may be potential promise with this treatment. That’s why it is critical for us to pursue additional scientific evidence.”
The coverage-with-evidence program will allow Medicare to aid in gathering data, while protecting patients, Dr. Fleisher noted.
“CMS is using its authority provided by Congress to determine if the drug is considered reasonable and necessary, meaning that the benefits of improvement of cognition outweigh the harms in the Medicare population,” Dr. Fleisher said.
Biogen disappointed
Cambridge, Mass.–based Biogen urged the CMS to reconsider its approach to payment for aducanumab. In a statement, the company said Medicare should cover “the class of amyloid-directed therapies with the populations studied in the respective clinical trials and guided by expert recommendations for appropriate use.
“We believe Alzheimer’s patients should have access consistent with other therapies with FDA accelerated approval,” Biogen said in the release.
In the company’s view, the CED approach will “significantly limit patient access to an FDA-approved treatment, especially for underserved patients as evidenced in other CED determinations.
“CEDs can take months to years to initiate, and hundreds of Alzheimer’s patients – the majority of whom are Medicare beneficiaries – are progressing each day from mild to moderate disease stages, where treatment may no longer be an option,” Biogen said.
Drug makers had been worried about CMS opting for CED even before the draft decision was unveiled.
Others weigh in
BIO, the trade group for biotechnology companies, urged the CMS to provide access to aducanumab without excess restrictions.
There already are concerns among drug makers about CMS efforts “to impose new coverage barriers – and, in particular, coverage with evidence development,” Crystal Kuntz, vice president of policy and research at BIO, and Andy Cosgrove, the organization’s senior director for policy and research, noted in a July 2021 comment about the aducanumab review.
Medicare should instead continue to provide access to medicines for indications that the FDA has approved, with additional flexibility for off-label indications of cancer drugs, they noted. “We believe this should continue to be the case, to ensure that vulnerable Medicare beneficiaries have necessary access to life-altering and lifesaving medications,” the BIO officials wrote.
However, the CMS also received many pleas from physicians asking the agency to limit use of aducanumab at least until there is evidence that it produces a significant clinical benefit.
In a press release, Howard Fillit, MD, cofounder and chief science officer of the Alzheimer’s Drug Discovery Foundation, applauded the decision, describing it as “the right call.
“This decision supports conducting additional clinical trials, which are needed to obtain further insights into the clinical efficacy and safety profile of this drug in real-world populations. This decision has implications for other drugs in this class in late-stage development. If these trials show more clear and robust clinical efficacy, then it is possible the FDA will give these amyloid monoclonal antibodies full approval, and Medicare would be likely to provide full payment,” he added.
A version of this article first appeared on Medscape.com.
, federal officials announced Jan. 11.
On Dec. 20, 2021, Biogen announced a plan to reduce the annual U.S. cost of the drug by 50% – from $56,000 to $28,200 – as Centers for Medicare & Medicaid Services officials were deciding on Medicare’s coverage policy for the medication.
In making its proposed coverage decision, the CMS announced it will pay for aducanumab, a monoclonal antibody, under its coverage-with-evidence-development (CED) mechanism. In making its decision, the CMS approached aducanumab as the first of a potential new class of monoclonal antibodies for the treatment of Alzheimer’s disease. Food and Drug Administration–approved drugs in this class would be covered for those with Medicare only if they are enrolled in qualifying clinical trials, the CMS said. The agency will accept public comments on this decision for 30 days.
In a statement, CMS Administrator Chiquita Brooks-LaSure said the agency is “committed to providing the American public with a clear, trusted, evidence-based decision that is made only after a thorough analysis of public feedback on the benefits and risks of coverage for Medicare patients.”
As previously reported, the FDA approved aducanumab on June 7, 2021, via an accelerated approval process. The approval, which set off a firestorm of controversy that included resignations of three FDA Peripheral and Central Nervous System Drugs Advisory Committee panel members, was granted based on the medication’s ability to reduce beta-amyloid plaque.
Under the accelerated approval mechanism, Biogen still must deliver solid scientific proof that aducanumab has clinically significant disease-modifying effects. However, the final evidence won’t be in any time soon. In its approval letter, the FDA set a 2030 deadline for a final report on this research.
‘Unusual but appropriate’ step
The Medicare decision marks something of a shift in the agency’s approach to paying for medications. On a call with reporters, Tamara Syrek Jensen, JD, director of CMS’ Coverage and Analysis Group, admitted that the agency had taken an “unusual but appropriate” step in trying to set a national policy regarding payment for a drug.
On the same call, Lee Fleisher, MD, CMS’ chief medical officer, addressed the challenges presented by aducanumab, given the serious need for treatments for Alzheimer’s disease. “As a practicing physician, I cannot overemphasize the need to understand the risks and benefits of a given treatment in order to better inform patients and their families,” Dr. Fleisher said. “We do know based on some of the evidence that there may be potential promise with this treatment. That’s why it is critical for us to pursue additional scientific evidence.”
The coverage-with-evidence program will allow Medicare to aid in gathering data, while protecting patients, Dr. Fleisher noted.
“CMS is using its authority provided by Congress to determine if the drug is considered reasonable and necessary, meaning that the benefits of improvement of cognition outweigh the harms in the Medicare population,” Dr. Fleisher said.
Biogen disappointed
Cambridge, Mass.–based Biogen urged the CMS to reconsider its approach to payment for aducanumab. In a statement, the company said Medicare should cover “the class of amyloid-directed therapies with the populations studied in the respective clinical trials and guided by expert recommendations for appropriate use.
“We believe Alzheimer’s patients should have access consistent with other therapies with FDA accelerated approval,” Biogen said in the release.
In the company’s view, the CED approach will “significantly limit patient access to an FDA-approved treatment, especially for underserved patients as evidenced in other CED determinations.
“CEDs can take months to years to initiate, and hundreds of Alzheimer’s patients – the majority of whom are Medicare beneficiaries – are progressing each day from mild to moderate disease stages, where treatment may no longer be an option,” Biogen said.
Drug makers had been worried about CMS opting for CED even before the draft decision was unveiled.
Others weigh in
BIO, the trade group for biotechnology companies, urged the CMS to provide access to aducanumab without excess restrictions.
There already are concerns among drug makers about CMS efforts “to impose new coverage barriers – and, in particular, coverage with evidence development,” Crystal Kuntz, vice president of policy and research at BIO, and Andy Cosgrove, the organization’s senior director for policy and research, noted in a July 2021 comment about the aducanumab review.
Medicare should instead continue to provide access to medicines for indications that the FDA has approved, with additional flexibility for off-label indications of cancer drugs, they noted. “We believe this should continue to be the case, to ensure that vulnerable Medicare beneficiaries have necessary access to life-altering and lifesaving medications,” the BIO officials wrote.
However, the CMS also received many pleas from physicians asking the agency to limit use of aducanumab at least until there is evidence that it produces a significant clinical benefit.
In a press release, Howard Fillit, MD, cofounder and chief science officer of the Alzheimer’s Drug Discovery Foundation, applauded the decision, describing it as “the right call.
“This decision supports conducting additional clinical trials, which are needed to obtain further insights into the clinical efficacy and safety profile of this drug in real-world populations. This decision has implications for other drugs in this class in late-stage development. If these trials show more clear and robust clinical efficacy, then it is possible the FDA will give these amyloid monoclonal antibodies full approval, and Medicare would be likely to provide full payment,” he added.
A version of this article first appeared on Medscape.com.
‘Highly encouraging’ MRD results for zanubrutinib add-on in CLL
Treatment was stopped in the single-arm phase 2 trial when patients reached undetectable MRD, a novel use of MRD to guide treatment duration. At a median of 16 months after discontinuation, MRD remained undetectable in 31 of 33 patients (94%).
The team also found that a reduction to 1/400 of baseline MRD (delta-MRD400) by day 1 of cycle five predicted undetectable bone marrow MRD within eight treatment cycles.
delta-MRD400 is “a potential biomarker” to identify patients who’ll do well with a shorter treatment and flag others who require longer courses of therapy, said investigators led by Jacob Soumerai, MD, a hematologist/oncologist at Massachusetts General Hospital, Boston.
Overall, the results “are highly encouraging,” they said, with efficacy and safety comparing favorably to trials that added other BTK inhibitors – namely ibrutinib and acalabrutinib – to the standard obinutuzumab/venetoclax backbone, with a shorter treatment duration.
They said the novel triplet warrants further study in the first line and noted that they also “plan to prospectively validate early-MRD-response kinetics as a biomarker to guide treatment duration.” The study was published recently in The Lancet Haematology.
Two editorialists – Davide Rossi, MD, PhD, and Joyce Marques De Almeida, both of the of the Oncology Institute of Southern Switzerland, Bellinzona – were encouraged by the findings and wanted future research to assess how well MRD-guided treatment duration works in patients with tumor protein p53-disrupted disease, who “benefit less from time-limited therapies” then patients with wild-type TP53; the trial was too small to address the issue.
There was a two-cycle lead-in with zanubrutinib and obinutuzumab then venetoclax ramp-up starting at cycle 3, with each cycle running 28 days.
Zanubrutinib is approved in the U.S. for mantle cell lymphoma, Waldenström’s macroglobulinemia, and marginal zone lymphoma.
In a previous phase 2 trial of ibrutinib add-on to venetoclax-obinutuzumab for 14 cycles followed by ibrutinib monotherapy, the rate of undetectable MRD in both peripheral blood and bone marrow was 67%. The rate of bone marrow undetectable MRD was 77% in another phase 2 trial of acalabrutinib, venetoclax, and obinutuzumab for at least 15 cycles.
Dr. Soumerai and his team cautioned, however, that “comparisons across trials are fraught with selection bias resulting in differences in treated patient populations, and randomized data are needed to establish the optimal BTK inhibitor to combine with venetoclax with or without obinutuzumab, and to establish whether” the zanubrutinib triplet “improves progression-free survival and overall survival compared with current standard first-line therapy.”
There was grade 3 or worse neutropenia in 18% of subjects (7/39), one episode of febrile neutropenia (3%), lung infections in three patients (8%) patients, and five cases of hypertension (13%).
The editorialists characterized the numbers as low and the regimen as well tolerated. Past studies of ibrutinib, a first generation BTK, with venetoclax and obinutuzumab have pegged grade 3 or worse neutropenia at 56% and the hypertension incidence at 48%.
Granulocyte colony-stimulating factor administration “could partially account for the low incidence of severe neutropenia” in the trial, the investigators said.
The study was funded by zanubrutinib marketer Beigene as well as Genentech, the National Cancer Institute, and others. Many of the authors had industry ties, including Dr. Soumerai who reported being a consultant and researcher for Beigene and other companies. Dr. Rossi reported honoraria and research grants from AbbVie, AstraZeneca, and Janssen.
Treatment was stopped in the single-arm phase 2 trial when patients reached undetectable MRD, a novel use of MRD to guide treatment duration. At a median of 16 months after discontinuation, MRD remained undetectable in 31 of 33 patients (94%).
The team also found that a reduction to 1/400 of baseline MRD (delta-MRD400) by day 1 of cycle five predicted undetectable bone marrow MRD within eight treatment cycles.
delta-MRD400 is “a potential biomarker” to identify patients who’ll do well with a shorter treatment and flag others who require longer courses of therapy, said investigators led by Jacob Soumerai, MD, a hematologist/oncologist at Massachusetts General Hospital, Boston.
Overall, the results “are highly encouraging,” they said, with efficacy and safety comparing favorably to trials that added other BTK inhibitors – namely ibrutinib and acalabrutinib – to the standard obinutuzumab/venetoclax backbone, with a shorter treatment duration.
They said the novel triplet warrants further study in the first line and noted that they also “plan to prospectively validate early-MRD-response kinetics as a biomarker to guide treatment duration.” The study was published recently in The Lancet Haematology.
Two editorialists – Davide Rossi, MD, PhD, and Joyce Marques De Almeida, both of the of the Oncology Institute of Southern Switzerland, Bellinzona – were encouraged by the findings and wanted future research to assess how well MRD-guided treatment duration works in patients with tumor protein p53-disrupted disease, who “benefit less from time-limited therapies” then patients with wild-type TP53; the trial was too small to address the issue.
There was a two-cycle lead-in with zanubrutinib and obinutuzumab then venetoclax ramp-up starting at cycle 3, with each cycle running 28 days.
Zanubrutinib is approved in the U.S. for mantle cell lymphoma, Waldenström’s macroglobulinemia, and marginal zone lymphoma.
In a previous phase 2 trial of ibrutinib add-on to venetoclax-obinutuzumab for 14 cycles followed by ibrutinib monotherapy, the rate of undetectable MRD in both peripheral blood and bone marrow was 67%. The rate of bone marrow undetectable MRD was 77% in another phase 2 trial of acalabrutinib, venetoclax, and obinutuzumab for at least 15 cycles.
Dr. Soumerai and his team cautioned, however, that “comparisons across trials are fraught with selection bias resulting in differences in treated patient populations, and randomized data are needed to establish the optimal BTK inhibitor to combine with venetoclax with or without obinutuzumab, and to establish whether” the zanubrutinib triplet “improves progression-free survival and overall survival compared with current standard first-line therapy.”
There was grade 3 or worse neutropenia in 18% of subjects (7/39), one episode of febrile neutropenia (3%), lung infections in three patients (8%) patients, and five cases of hypertension (13%).
The editorialists characterized the numbers as low and the regimen as well tolerated. Past studies of ibrutinib, a first generation BTK, with venetoclax and obinutuzumab have pegged grade 3 or worse neutropenia at 56% and the hypertension incidence at 48%.
Granulocyte colony-stimulating factor administration “could partially account for the low incidence of severe neutropenia” in the trial, the investigators said.
The study was funded by zanubrutinib marketer Beigene as well as Genentech, the National Cancer Institute, and others. Many of the authors had industry ties, including Dr. Soumerai who reported being a consultant and researcher for Beigene and other companies. Dr. Rossi reported honoraria and research grants from AbbVie, AstraZeneca, and Janssen.
Treatment was stopped in the single-arm phase 2 trial when patients reached undetectable MRD, a novel use of MRD to guide treatment duration. At a median of 16 months after discontinuation, MRD remained undetectable in 31 of 33 patients (94%).
The team also found that a reduction to 1/400 of baseline MRD (delta-MRD400) by day 1 of cycle five predicted undetectable bone marrow MRD within eight treatment cycles.
delta-MRD400 is “a potential biomarker” to identify patients who’ll do well with a shorter treatment and flag others who require longer courses of therapy, said investigators led by Jacob Soumerai, MD, a hematologist/oncologist at Massachusetts General Hospital, Boston.
Overall, the results “are highly encouraging,” they said, with efficacy and safety comparing favorably to trials that added other BTK inhibitors – namely ibrutinib and acalabrutinib – to the standard obinutuzumab/venetoclax backbone, with a shorter treatment duration.
They said the novel triplet warrants further study in the first line and noted that they also “plan to prospectively validate early-MRD-response kinetics as a biomarker to guide treatment duration.” The study was published recently in The Lancet Haematology.
Two editorialists – Davide Rossi, MD, PhD, and Joyce Marques De Almeida, both of the of the Oncology Institute of Southern Switzerland, Bellinzona – were encouraged by the findings and wanted future research to assess how well MRD-guided treatment duration works in patients with tumor protein p53-disrupted disease, who “benefit less from time-limited therapies” then patients with wild-type TP53; the trial was too small to address the issue.
There was a two-cycle lead-in with zanubrutinib and obinutuzumab then venetoclax ramp-up starting at cycle 3, with each cycle running 28 days.
Zanubrutinib is approved in the U.S. for mantle cell lymphoma, Waldenström’s macroglobulinemia, and marginal zone lymphoma.
In a previous phase 2 trial of ibrutinib add-on to venetoclax-obinutuzumab for 14 cycles followed by ibrutinib monotherapy, the rate of undetectable MRD in both peripheral blood and bone marrow was 67%. The rate of bone marrow undetectable MRD was 77% in another phase 2 trial of acalabrutinib, venetoclax, and obinutuzumab for at least 15 cycles.
Dr. Soumerai and his team cautioned, however, that “comparisons across trials are fraught with selection bias resulting in differences in treated patient populations, and randomized data are needed to establish the optimal BTK inhibitor to combine with venetoclax with or without obinutuzumab, and to establish whether” the zanubrutinib triplet “improves progression-free survival and overall survival compared with current standard first-line therapy.”
There was grade 3 or worse neutropenia in 18% of subjects (7/39), one episode of febrile neutropenia (3%), lung infections in three patients (8%) patients, and five cases of hypertension (13%).
The editorialists characterized the numbers as low and the regimen as well tolerated. Past studies of ibrutinib, a first generation BTK, with venetoclax and obinutuzumab have pegged grade 3 or worse neutropenia at 56% and the hypertension incidence at 48%.
Granulocyte colony-stimulating factor administration “could partially account for the low incidence of severe neutropenia” in the trial, the investigators said.
The study was funded by zanubrutinib marketer Beigene as well as Genentech, the National Cancer Institute, and others. Many of the authors had industry ties, including Dr. Soumerai who reported being a consultant and researcher for Beigene and other companies. Dr. Rossi reported honoraria and research grants from AbbVie, AstraZeneca, and Janssen.
FROM THE LANCET HEMATOLOGY
Sorting out sleep complaints in children with AD can be complex
according to Stephen H. Sheldon, DO.
“They wake up frequently,” Dr. Sheldon, professor of pediatrics and neurology at Northwestern University, Chicago, said during the Revolutionizing Atopic Dermatitis symposium. “They may not stay up for long periods of time, but they move about often. There’s a loss of about 50 minutes of sleep per night in children with AD. This loss can result in significant sleep debt the following day. They have difficulty settling at night. Once they get into bed, they have difficulty falling asleep, and many of them have difficulty staying asleep.”
At the sleep medicine center at Lurie Children’s Hospital of Chicago, he and his colleagues have observed that some children with AD complain of difficulty with limb movements. “Part of the issue has been that they have been diagnosed with different sleep-related disorders, such as period limb movement disorder, restless leg syndrome, and growing pain,” Dr. Sheldon said. “Often, they do not know how to describe the manifestations of their leg discomfort in restless leg syndrome and period limb movement disorder and limb movements of sleep.”
Children who complain of growing pains say that their legs hurt, he continued. Sometimes they’ll say that they feel like spiders are crawling on their legs, or that their legs itch, but they often say they have pain in their legs that wakes them up and keeps them from keeping their legs still.
According to the American Academy of Sleep Medicine, periodic limb movement disorder of sleep is characterized by frequent limb movements that last at least 0.5 seconds and are separated by no more than 90 seconds. “They’re four movements in a row that are at least 5 seconds apart,” Dr. Sheldon said.
Interestingly, he added, children who have limb movement disorder have symptoms during the day, similar to adults. “But we see many children with periodic limb movements of sleep whose arms and legs are moving all night, and they don’t have many symptoms during the day.” These children may have difficulty falling or staying asleep, but do not fulfill all of the American Academy of Sleep Medicine criteria for diagnosis of periodic limb movement disorder, he added.
In 2018, Lourdes M. DelRosso, MD, EdD, of Seattle Children’s Hospital, and colleagues described a new sleep problem they termed restless sleep disorder: those who do not fit the criteria for any other sleep disorder but have daytime impairment.
“On video they have very frequent movements – more than five movements an hour of major body activity,” Dr. Sheldon explained. “They’ll move their trunk, their legs, and reposition themselves. We have found that there are many children who presented to the sleep disorder center with restless sleep, limb movement disorder, periodic limb movements of sleep, and daytime symptoms that would fulfill the criteria of periodic limb movement disorder but also have atopic dermatitis.”
Recently, Dr. Sheldon and his colleagues used polysomnographic variables to study children who presented to Lurie Children’s Hospital with AD and symptoms such as difficulty maintaining sleep and snoring with allergic rhinitis. They found that there were increased periods of being awake after the onset of sleep, “meaning the children fell asleep fairly easily in the beginning of the night but they had significant wake after they fell asleep,” he said. “They would wake up in the middle of the night and stay awake for long periods of time – either one long session or multiple shorter sessions throughout the night. They had increased total limb movements per hour of sleep. This means that their limb movements were greater than five events per hour of sleep and it resulted in restless sleep and limb movements that would fulfill the criteria of periodic limb movement disorder.”
Most of these children had mild to moderate AD, he continued. “We feel that the sensory afferent loop in these youngsters doesn’t really turn off completely when they’re asleep. This is ripe for further study, but it makes intuitive sense that if the sensory afferent loop continues during sleep, it may affect the arousal system significantly.”
Dr. Sheldon recommended that any child who presents with a diagnosis of periodic limb movement disorder, periodic limb movements of sleep, or restless sleep disorder should be evaluated for AD. “The treatment then, would first require differentiation between periodic limb movement disorder of sleep and AD. Both should be addressed at the same time in order to solve the child’s daytime AD problem as well as the sleep-related issues that occur with an AD diagnosis.”
He reported having no financial disclosures.
according to Stephen H. Sheldon, DO.
“They wake up frequently,” Dr. Sheldon, professor of pediatrics and neurology at Northwestern University, Chicago, said during the Revolutionizing Atopic Dermatitis symposium. “They may not stay up for long periods of time, but they move about often. There’s a loss of about 50 minutes of sleep per night in children with AD. This loss can result in significant sleep debt the following day. They have difficulty settling at night. Once they get into bed, they have difficulty falling asleep, and many of them have difficulty staying asleep.”
At the sleep medicine center at Lurie Children’s Hospital of Chicago, he and his colleagues have observed that some children with AD complain of difficulty with limb movements. “Part of the issue has been that they have been diagnosed with different sleep-related disorders, such as period limb movement disorder, restless leg syndrome, and growing pain,” Dr. Sheldon said. “Often, they do not know how to describe the manifestations of their leg discomfort in restless leg syndrome and period limb movement disorder and limb movements of sleep.”
Children who complain of growing pains say that their legs hurt, he continued. Sometimes they’ll say that they feel like spiders are crawling on their legs, or that their legs itch, but they often say they have pain in their legs that wakes them up and keeps them from keeping their legs still.
According to the American Academy of Sleep Medicine, periodic limb movement disorder of sleep is characterized by frequent limb movements that last at least 0.5 seconds and are separated by no more than 90 seconds. “They’re four movements in a row that are at least 5 seconds apart,” Dr. Sheldon said.
Interestingly, he added, children who have limb movement disorder have symptoms during the day, similar to adults. “But we see many children with periodic limb movements of sleep whose arms and legs are moving all night, and they don’t have many symptoms during the day.” These children may have difficulty falling or staying asleep, but do not fulfill all of the American Academy of Sleep Medicine criteria for diagnosis of periodic limb movement disorder, he added.
In 2018, Lourdes M. DelRosso, MD, EdD, of Seattle Children’s Hospital, and colleagues described a new sleep problem they termed restless sleep disorder: those who do not fit the criteria for any other sleep disorder but have daytime impairment.
“On video they have very frequent movements – more than five movements an hour of major body activity,” Dr. Sheldon explained. “They’ll move their trunk, their legs, and reposition themselves. We have found that there are many children who presented to the sleep disorder center with restless sleep, limb movement disorder, periodic limb movements of sleep, and daytime symptoms that would fulfill the criteria of periodic limb movement disorder but also have atopic dermatitis.”
Recently, Dr. Sheldon and his colleagues used polysomnographic variables to study children who presented to Lurie Children’s Hospital with AD and symptoms such as difficulty maintaining sleep and snoring with allergic rhinitis. They found that there were increased periods of being awake after the onset of sleep, “meaning the children fell asleep fairly easily in the beginning of the night but they had significant wake after they fell asleep,” he said. “They would wake up in the middle of the night and stay awake for long periods of time – either one long session or multiple shorter sessions throughout the night. They had increased total limb movements per hour of sleep. This means that their limb movements were greater than five events per hour of sleep and it resulted in restless sleep and limb movements that would fulfill the criteria of periodic limb movement disorder.”
Most of these children had mild to moderate AD, he continued. “We feel that the sensory afferent loop in these youngsters doesn’t really turn off completely when they’re asleep. This is ripe for further study, but it makes intuitive sense that if the sensory afferent loop continues during sleep, it may affect the arousal system significantly.”
Dr. Sheldon recommended that any child who presents with a diagnosis of periodic limb movement disorder, periodic limb movements of sleep, or restless sleep disorder should be evaluated for AD. “The treatment then, would first require differentiation between periodic limb movement disorder of sleep and AD. Both should be addressed at the same time in order to solve the child’s daytime AD problem as well as the sleep-related issues that occur with an AD diagnosis.”
He reported having no financial disclosures.
according to Stephen H. Sheldon, DO.
“They wake up frequently,” Dr. Sheldon, professor of pediatrics and neurology at Northwestern University, Chicago, said during the Revolutionizing Atopic Dermatitis symposium. “They may not stay up for long periods of time, but they move about often. There’s a loss of about 50 minutes of sleep per night in children with AD. This loss can result in significant sleep debt the following day. They have difficulty settling at night. Once they get into bed, they have difficulty falling asleep, and many of them have difficulty staying asleep.”
At the sleep medicine center at Lurie Children’s Hospital of Chicago, he and his colleagues have observed that some children with AD complain of difficulty with limb movements. “Part of the issue has been that they have been diagnosed with different sleep-related disorders, such as period limb movement disorder, restless leg syndrome, and growing pain,” Dr. Sheldon said. “Often, they do not know how to describe the manifestations of their leg discomfort in restless leg syndrome and period limb movement disorder and limb movements of sleep.”
Children who complain of growing pains say that their legs hurt, he continued. Sometimes they’ll say that they feel like spiders are crawling on their legs, or that their legs itch, but they often say they have pain in their legs that wakes them up and keeps them from keeping their legs still.
According to the American Academy of Sleep Medicine, periodic limb movement disorder of sleep is characterized by frequent limb movements that last at least 0.5 seconds and are separated by no more than 90 seconds. “They’re four movements in a row that are at least 5 seconds apart,” Dr. Sheldon said.
Interestingly, he added, children who have limb movement disorder have symptoms during the day, similar to adults. “But we see many children with periodic limb movements of sleep whose arms and legs are moving all night, and they don’t have many symptoms during the day.” These children may have difficulty falling or staying asleep, but do not fulfill all of the American Academy of Sleep Medicine criteria for diagnosis of periodic limb movement disorder, he added.
In 2018, Lourdes M. DelRosso, MD, EdD, of Seattle Children’s Hospital, and colleagues described a new sleep problem they termed restless sleep disorder: those who do not fit the criteria for any other sleep disorder but have daytime impairment.
“On video they have very frequent movements – more than five movements an hour of major body activity,” Dr. Sheldon explained. “They’ll move their trunk, their legs, and reposition themselves. We have found that there are many children who presented to the sleep disorder center with restless sleep, limb movement disorder, periodic limb movements of sleep, and daytime symptoms that would fulfill the criteria of periodic limb movement disorder but also have atopic dermatitis.”
Recently, Dr. Sheldon and his colleagues used polysomnographic variables to study children who presented to Lurie Children’s Hospital with AD and symptoms such as difficulty maintaining sleep and snoring with allergic rhinitis. They found that there were increased periods of being awake after the onset of sleep, “meaning the children fell asleep fairly easily in the beginning of the night but they had significant wake after they fell asleep,” he said. “They would wake up in the middle of the night and stay awake for long periods of time – either one long session or multiple shorter sessions throughout the night. They had increased total limb movements per hour of sleep. This means that their limb movements were greater than five events per hour of sleep and it resulted in restless sleep and limb movements that would fulfill the criteria of periodic limb movement disorder.”
Most of these children had mild to moderate AD, he continued. “We feel that the sensory afferent loop in these youngsters doesn’t really turn off completely when they’re asleep. This is ripe for further study, but it makes intuitive sense that if the sensory afferent loop continues during sleep, it may affect the arousal system significantly.”
Dr. Sheldon recommended that any child who presents with a diagnosis of periodic limb movement disorder, periodic limb movements of sleep, or restless sleep disorder should be evaluated for AD. “The treatment then, would first require differentiation between periodic limb movement disorder of sleep and AD. Both should be addressed at the same time in order to solve the child’s daytime AD problem as well as the sleep-related issues that occur with an AD diagnosis.”
He reported having no financial disclosures.
FROM RAD 2021
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