Alfred Soffer Research Award Winners
Johnathan Chung: EVALUATING CLINICAL UTILITY OF A UIP GENOMIC CLASSIFIER IN SUBJECTS WITH AND WITHOUT A HRCT PATTERN OF UIP
Girish Nair, MD: QUANTITATIVE LUNG FUNCTION IMAGING USING NOVEL INTEGRATED JACOBIAN VENTILATION METHOD IN A HEALTHY COHORT WITH NO RESPIRATORY SYMPTOMS

Young Investigator Award Winners
Marvi Bikak, MD: APPLICATION OF MARKOV MODELING TO ASSESS OUTCOMES IN COPD
Arunima Bera, MD: SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 (ICAM-1) PREDICTS MORTALITY IN CHILDREN WITH ARDS AND SEPSIS

Top Abstract Poster
Winner: Rachel Naramore: CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD
Runner-up: Arjun Srinivasan: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS

Case Report Slide Winners
Catherine A. Gao, MD: NOCARDIA ABSCESS AND PULMONARY ALVEOLAR PROTEINOSIS MASQUERADING AS LUNG CANCER WITH LYMPHANGITIC SPREAD IN A 57-YO PATIENT WITH 80 PY SMOKING HISTORY, in Fellows session - Interesting Presentations of Infectious Diseases

Sangita Goel, MD: SUCCESSFUL SINGLE LUNG TRANSPLANT OF A HEPATITIS C POSITIVE DONOR TO AN HIV SEROPOSITIVE RECIPIENT WITH PULMONARY FIBROSIS, in Fellows session, – Pulmonary Pathology

Matthew Lyons, MD: FAMILIAL PULMONARY FIBROSIS SECONDARY TO SHORT TELOMERE SYNDROME, in Medical Student/Resident session – Diffuse Lung Disease

Sarika Savajiyani, DO: MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY, in Fellows session – Clinical Conundrums in ECMO

Chase A. Baxter, DO: POLYBIOPSY FULMINANS: PULMONARY LYMPHOMATOID GRANULOMATOSIS, in Medical Student/Resident session – Pulmonary Pathology

Jason Low, MBBS: THE HURRICANE EFFECT: AN UNUSUAL PHENOMENON IN THE PULMONARY ARTERY, in Fellows session – Bronchoscopic Procedures

Jacob Hupp, MD: ECMO-RELATED HEMOLYTIC ANEMIA: A CASE SERIES ILLUSTRATING THE ROLE OF PLASMAPHERESIS IN MANAGEMENT, in Fellows session – Plasmapheresis to the Rescue

Nichole A. Smith, MD: BILATERAL CHYLOTHORAX SECONDARY TO SPONTANEOUS THORACIC DUCT ANEURYSM, in Fellows session – Disorders of the Pleura

Ritu Modi, MD: A FLORIST’S OCCUPATIONAL EXPOSURE, in Fellows session – Chest Infections: Find the Fungus

Ly Tran, DO: A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER, in Medical Student/Resident session – Lung Cancer: Unusual Presentations

Abdelhamid Ben Selma, MD: PRIMARY SYNOVIAL SARCOMA OF THE LUNG COMPLICATED WITH POST BIOPSY TUMOR SPREAD TO THE TRACHEAL WALL, in Medical Student/Resident session – Pulmonary Pathology II

Dhaval Thakkar, MD: A CURIOUS MANIFESTATION OF SARCOIDOSIS, in Fellows session – Pulmonary Manifestations of Systemic Disease

Isaac N. Biney, MBChB: ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY, in Fellows session – Pulmonary Vascular Disease

Tie: José Antonio J. Meade Aguilar: CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT and Abigayle R. Sullivan, DO: A RARE CASE OF CULTURE-NEGATIVE WHIPPLE’S ENDOCARDITIS, in Medical Student/Resident session - Cardiovascular Cases

Yameena T. Jawed: BLUE INSIDE AND OUT: A NOVEL CASE OF HYPOTHERMIC SHOCK SALVAGED BY METHYLENE BLUE, in Fellows session – Unusual Cases and Treatments in the ICU

Rahul Dasgupta, MD: SUPERIOR VENA CAVA (SVC) –TRACHEAL FISTULA: AN UNUSUAL CASE OF HEMOPTYSIS, in Medical Student/Resident session – Lung Cancer: Expect the Unexpected

Akshay Bhatnagar, MD: A CASE OF CLINICALLY AMYOPATHIC DERMATOMYOSITIS-RELATED INTERSTITIAL LUNG DISEASE DUE TO ANTI-MDA5 ANTIBODY AND HEPATITIS B INFECTION, in Fellows session – Diffuse Lung Diseases

Kathleen Twomey, MD: A CASE OF RECURRENT ENCEPHALOPATHY IN A GASTRIC BYPASS PATIENT, in Medical Student/Resident session – Critical Care Complications

Jennifer Sunny, DO: MASSIVE BEE ENVENOMATION TREATED BY PLASMAPHERESIS, in Medical Student/Resident session – Critical Care Devices

Hafiz B. Mahboob, MD: PAZOPANIB ASSOCIATED SECONDARY SPONTANEOUS PNEUMOTHORAX: NATURAL DISEASE PROGRESSION OR DRUG SAFETY CONCERN? in Fellows session – Lung Cancer

Tie: Andrew DeMaio, MD, A CASE OF PULMONARY TUBERCULOSIS AND PERSISTENT INTESTINAL INFLAMMATION AND HEMORRHAGE: TB OR NOT TB? and Joanna M. Scoon: ATTACK OF THE WILD BOARS, in Fellows session – Chest Infections

Danielle El Haddad, MD: A RIGHT TO LEFT EXTRACARDIAC SHUNT FROM A CHRONIC SUPERIOR VENA CAVA THROMBUS IN A PROTHROMBOTIC PATIENT, in Medical Student/Resident session – Pulmonary Vascular Disease

John Shumar, DO: MAKE NO BONES ABOUT IT: A RARE CASE OF OSSEOUS SARCOIDOSIS PRESENTING TWENTY YEARS AFTER INITIAL DIAGNOSIS, in Medical Student/Resident session – Pulmonary Manifestations of Systemic Disease


Case Report Poster Winners
Jad Sargi, MD: ATYPICAL PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES SYNDROME)

Ankur Sinha, MBBS: LISTERIA MONOCYTOGENES BRAIN ABSCESS IN AN IMMUNOCOMPETENT ADULT

Carla Emille D. Barbon, MD: GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL THORACOTOMY

Hope F. Johnson, RRT: BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

Humna Abid Memon, MD: AUTOLOGOUS STEM CELL TRANSPLANTATION: A POSSIBLE TREATMENT FOR PULMONARY HYPERTENSION IN POEMS SYNDROME

Jordanna Hostler, MD, FCCP: BEYOND STEROIDS: MEPOLIZUMAB FOR CHRONIC EOSINOPHILIC PNEUMONIA

Zahra Zia, MD, MBBS: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR EMERGENT SURGICAL TREATMENT OF ANAEROBIC PURULENT PERICARDITIS CAUSING CARDIAC TAMPONADE, BRONCHOMEDIASTINAL FISTULA, AND ARDS

Brooke A. McDonald: FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

Mary E. Richert, MD: A CASE OF RASBURICASE-INDUCED METHEMOGLOBINEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY TREATED WITH HYPERBARIC OXYGEN THERAPY

Shiva M. Arjun, MD: AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

Harshwant Grover, MD: BLACK MEDIASTINUM: PRIMARY MEDIASTINAL MELANOMA

Neha Agarwal, MD: POSTTRANSPLANT PULMONARY KAPOSI SARCOMA PRESENTING AS CHYLOTHORAX

Alfred Soffer Research Award Winners
Johnathan Chung: EVALUATING CLINICAL UTILITY OF A UIP GENOMIC CLASSIFIER IN SUBJECTS WITH AND WITHOUT A HRCT PATTERN OF UIP
Girish Nair, MD: QUANTITATIVE LUNG FUNCTION IMAGING USING NOVEL INTEGRATED JACOBIAN VENTILATION METHOD IN A HEALTHY COHORT WITH NO RESPIRATORY SYMPTOMS

Young Investigator Award Winners
Marvi Bikak, MD: APPLICATION OF MARKOV MODELING TO ASSESS OUTCOMES IN COPD
Arunima Bera, MD: SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 (ICAM-1) PREDICTS MORTALITY IN CHILDREN WITH ARDS AND SEPSIS

Top Abstract Poster
Winner: Rachel Naramore: CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD
Runner-up: Arjun Srinivasan: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS

Case Report Slide Winners
Catherine A. Gao, MD: NOCARDIA ABSCESS AND PULMONARY ALVEOLAR PROTEINOSIS MASQUERADING AS LUNG CANCER WITH LYMPHANGITIC SPREAD IN A 57-YO PATIENT WITH 80 PY SMOKING HISTORY, in Fellows session - Interesting Presentations of Infectious Diseases

Sangita Goel, MD: SUCCESSFUL SINGLE LUNG TRANSPLANT OF A HEPATITIS C POSITIVE DONOR TO AN HIV SEROPOSITIVE RECIPIENT WITH PULMONARY FIBROSIS, in Fellows session, – Pulmonary Pathology

Matthew Lyons, MD: FAMILIAL PULMONARY FIBROSIS SECONDARY TO SHORT TELOMERE SYNDROME, in Medical Student/Resident session – Diffuse Lung Disease

Sarika Savajiyani, DO: MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY, in Fellows session – Clinical Conundrums in ECMO

Chase A. Baxter, DO: POLYBIOPSY FULMINANS: PULMONARY LYMPHOMATOID GRANULOMATOSIS, in Medical Student/Resident session – Pulmonary Pathology

Jason Low, MBBS: THE HURRICANE EFFECT: AN UNUSUAL PHENOMENON IN THE PULMONARY ARTERY, in Fellows session – Bronchoscopic Procedures

Jacob Hupp, MD: ECMO-RELATED HEMOLYTIC ANEMIA: A CASE SERIES ILLUSTRATING THE ROLE OF PLASMAPHERESIS IN MANAGEMENT, in Fellows session – Plasmapheresis to the Rescue

Nichole A. Smith, MD: BILATERAL CHYLOTHORAX SECONDARY TO SPONTANEOUS THORACIC DUCT ANEURYSM, in Fellows session – Disorders of the Pleura

Ritu Modi, MD: A FLORIST’S OCCUPATIONAL EXPOSURE, in Fellows session – Chest Infections: Find the Fungus

Ly Tran, DO: A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER, in Medical Student/Resident session – Lung Cancer: Unusual Presentations

Abdelhamid Ben Selma, MD: PRIMARY SYNOVIAL SARCOMA OF THE LUNG COMPLICATED WITH POST BIOPSY TUMOR SPREAD TO THE TRACHEAL WALL, in Medical Student/Resident session – Pulmonary Pathology II

Dhaval Thakkar, MD: A CURIOUS MANIFESTATION OF SARCOIDOSIS, in Fellows session – Pulmonary Manifestations of Systemic Disease

Isaac N. Biney, MBChB: ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY, in Fellows session – Pulmonary Vascular Disease

Tie: José Antonio J. Meade Aguilar: CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT and Abigayle R. Sullivan, DO: A RARE CASE OF CULTURE-NEGATIVE WHIPPLE’S ENDOCARDITIS, in Medical Student/Resident session - Cardiovascular Cases

Yameena T. Jawed: BLUE INSIDE AND OUT: A NOVEL CASE OF HYPOTHERMIC SHOCK SALVAGED BY METHYLENE BLUE, in Fellows session – Unusual Cases and Treatments in the ICU

Rahul Dasgupta, MD: SUPERIOR VENA CAVA (SVC) –TRACHEAL FISTULA: AN UNUSUAL CASE OF HEMOPTYSIS, in Medical Student/Resident session – Lung Cancer: Expect the Unexpected

Akshay Bhatnagar, MD: A CASE OF CLINICALLY AMYOPATHIC DERMATOMYOSITIS-RELATED INTERSTITIAL LUNG DISEASE DUE TO ANTI-MDA5 ANTIBODY AND HEPATITIS B INFECTION, in Fellows session – Diffuse Lung Diseases

Kathleen Twomey, MD: A CASE OF RECURRENT ENCEPHALOPATHY IN A GASTRIC BYPASS PATIENT, in Medical Student/Resident session – Critical Care Complications

Jennifer Sunny, DO: MASSIVE BEE ENVENOMATION TREATED BY PLASMAPHERESIS, in Medical Student/Resident session – Critical Care Devices

Hafiz B. Mahboob, MD: PAZOPANIB ASSOCIATED SECONDARY SPONTANEOUS PNEUMOTHORAX: NATURAL DISEASE PROGRESSION OR DRUG SAFETY CONCERN? in Fellows session – Lung Cancer

Tie: Andrew DeMaio, MD, A CASE OF PULMONARY TUBERCULOSIS AND PERSISTENT INTESTINAL INFLAMMATION AND HEMORRHAGE: TB OR NOT TB? and Joanna M. Scoon: ATTACK OF THE WILD BOARS, in Fellows session – Chest Infections

Danielle El Haddad, MD: A RIGHT TO LEFT EXTRACARDIAC SHUNT FROM A CHRONIC SUPERIOR VENA CAVA THROMBUS IN A PROTHROMBOTIC PATIENT, in Medical Student/Resident session – Pulmonary Vascular Disease

John Shumar, DO: MAKE NO BONES ABOUT IT: A RARE CASE OF OSSEOUS SARCOIDOSIS PRESENTING TWENTY YEARS AFTER INITIAL DIAGNOSIS, in Medical Student/Resident session – Pulmonary Manifestations of Systemic Disease


Case Report Poster Winners
Jad Sargi, MD: ATYPICAL PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES SYNDROME)

Ankur Sinha, MBBS: LISTERIA MONOCYTOGENES BRAIN ABSCESS IN AN IMMUNOCOMPETENT ADULT

Carla Emille D. Barbon, MD: GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL THORACOTOMY

Hope F. Johnson, RRT: BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

Humna Abid Memon, MD: AUTOLOGOUS STEM CELL TRANSPLANTATION: A POSSIBLE TREATMENT FOR PULMONARY HYPERTENSION IN POEMS SYNDROME

Jordanna Hostler, MD, FCCP: BEYOND STEROIDS: MEPOLIZUMAB FOR CHRONIC EOSINOPHILIC PNEUMONIA

Zahra Zia, MD, MBBS: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR EMERGENT SURGICAL TREATMENT OF ANAEROBIC PURULENT PERICARDITIS CAUSING CARDIAC TAMPONADE, BRONCHOMEDIASTINAL FISTULA, AND ARDS

Brooke A. McDonald: FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

Mary E. Richert, MD: A CASE OF RASBURICASE-INDUCED METHEMOGLOBINEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY TREATED WITH HYPERBARIC OXYGEN THERAPY

Shiva M. Arjun, MD: AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

Harshwant Grover, MD: BLACK MEDIASTINUM: PRIMARY MEDIASTINAL MELANOMA

Neha Agarwal, MD: POSTTRANSPLANT PULMONARY KAPOSI SARCOMA PRESENTING AS CHYLOTHORAX

Alfred Soffer Research Award Winners
Johnathan Chung: EVALUATING CLINICAL UTILITY OF A UIP GENOMIC CLASSIFIER IN SUBJECTS WITH AND WITHOUT A HRCT PATTERN OF UIP
Girish Nair, MD: QUANTITATIVE LUNG FUNCTION IMAGING USING NOVEL INTEGRATED JACOBIAN VENTILATION METHOD IN A HEALTHY COHORT WITH NO RESPIRATORY SYMPTOMS

Young Investigator Award Winners
Marvi Bikak, MD: APPLICATION OF MARKOV MODELING TO ASSESS OUTCOMES IN COPD
Arunima Bera, MD: SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 (ICAM-1) PREDICTS MORTALITY IN CHILDREN WITH ARDS AND SEPSIS

Top Abstract Poster
Winner: Rachel Naramore: CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD
Runner-up: Arjun Srinivasan: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS

Case Report Slide Winners
Catherine A. Gao, MD: NOCARDIA ABSCESS AND PULMONARY ALVEOLAR PROTEINOSIS MASQUERADING AS LUNG CANCER WITH LYMPHANGITIC SPREAD IN A 57-YO PATIENT WITH 80 PY SMOKING HISTORY, in Fellows session - Interesting Presentations of Infectious Diseases

Sangita Goel, MD: SUCCESSFUL SINGLE LUNG TRANSPLANT OF A HEPATITIS C POSITIVE DONOR TO AN HIV SEROPOSITIVE RECIPIENT WITH PULMONARY FIBROSIS, in Fellows session, – Pulmonary Pathology

Matthew Lyons, MD: FAMILIAL PULMONARY FIBROSIS SECONDARY TO SHORT TELOMERE SYNDROME, in Medical Student/Resident session – Diffuse Lung Disease

Sarika Savajiyani, DO: MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY, in Fellows session – Clinical Conundrums in ECMO

Chase A. Baxter, DO: POLYBIOPSY FULMINANS: PULMONARY LYMPHOMATOID GRANULOMATOSIS, in Medical Student/Resident session – Pulmonary Pathology

Jason Low, MBBS: THE HURRICANE EFFECT: AN UNUSUAL PHENOMENON IN THE PULMONARY ARTERY, in Fellows session – Bronchoscopic Procedures

Jacob Hupp, MD: ECMO-RELATED HEMOLYTIC ANEMIA: A CASE SERIES ILLUSTRATING THE ROLE OF PLASMAPHERESIS IN MANAGEMENT, in Fellows session – Plasmapheresis to the Rescue

Nichole A. Smith, MD: BILATERAL CHYLOTHORAX SECONDARY TO SPONTANEOUS THORACIC DUCT ANEURYSM, in Fellows session – Disorders of the Pleura

Ritu Modi, MD: A FLORIST’S OCCUPATIONAL EXPOSURE, in Fellows session – Chest Infections: Find the Fungus

Ly Tran, DO: A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER, in Medical Student/Resident session – Lung Cancer: Unusual Presentations

Abdelhamid Ben Selma, MD: PRIMARY SYNOVIAL SARCOMA OF THE LUNG COMPLICATED WITH POST BIOPSY TUMOR SPREAD TO THE TRACHEAL WALL, in Medical Student/Resident session – Pulmonary Pathology II

Dhaval Thakkar, MD: A CURIOUS MANIFESTATION OF SARCOIDOSIS, in Fellows session – Pulmonary Manifestations of Systemic Disease

Isaac N. Biney, MBChB: ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY, in Fellows session – Pulmonary Vascular Disease

Tie: José Antonio J. Meade Aguilar: CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT and Abigayle R. Sullivan, DO: A RARE CASE OF CULTURE-NEGATIVE WHIPPLE’S ENDOCARDITIS, in Medical Student/Resident session - Cardiovascular Cases

Yameena T. Jawed: BLUE INSIDE AND OUT: A NOVEL CASE OF HYPOTHERMIC SHOCK SALVAGED BY METHYLENE BLUE, in Fellows session – Unusual Cases and Treatments in the ICU

Rahul Dasgupta, MD: SUPERIOR VENA CAVA (SVC) –TRACHEAL FISTULA: AN UNUSUAL CASE OF HEMOPTYSIS, in Medical Student/Resident session – Lung Cancer: Expect the Unexpected

Akshay Bhatnagar, MD: A CASE OF CLINICALLY AMYOPATHIC DERMATOMYOSITIS-RELATED INTERSTITIAL LUNG DISEASE DUE TO ANTI-MDA5 ANTIBODY AND HEPATITIS B INFECTION, in Fellows session – Diffuse Lung Diseases

Kathleen Twomey, MD: A CASE OF RECURRENT ENCEPHALOPATHY IN A GASTRIC BYPASS PATIENT, in Medical Student/Resident session – Critical Care Complications

Jennifer Sunny, DO: MASSIVE BEE ENVENOMATION TREATED BY PLASMAPHERESIS, in Medical Student/Resident session – Critical Care Devices

Hafiz B. Mahboob, MD: PAZOPANIB ASSOCIATED SECONDARY SPONTANEOUS PNEUMOTHORAX: NATURAL DISEASE PROGRESSION OR DRUG SAFETY CONCERN? in Fellows session – Lung Cancer

Tie: Andrew DeMaio, MD, A CASE OF PULMONARY TUBERCULOSIS AND PERSISTENT INTESTINAL INFLAMMATION AND HEMORRHAGE: TB OR NOT TB? and Joanna M. Scoon: ATTACK OF THE WILD BOARS, in Fellows session – Chest Infections

Danielle El Haddad, MD: A RIGHT TO LEFT EXTRACARDIAC SHUNT FROM A CHRONIC SUPERIOR VENA CAVA THROMBUS IN A PROTHROMBOTIC PATIENT, in Medical Student/Resident session – Pulmonary Vascular Disease

John Shumar, DO: MAKE NO BONES ABOUT IT: A RARE CASE OF OSSEOUS SARCOIDOSIS PRESENTING TWENTY YEARS AFTER INITIAL DIAGNOSIS, in Medical Student/Resident session – Pulmonary Manifestations of Systemic Disease


Case Report Poster Winners
Jad Sargi, MD: ATYPICAL PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES SYNDROME)

Ankur Sinha, MBBS: LISTERIA MONOCYTOGENES BRAIN ABSCESS IN AN IMMUNOCOMPETENT ADULT

Carla Emille D. Barbon, MD: GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL THORACOTOMY

Hope F. Johnson, RRT: BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

Humna Abid Memon, MD: AUTOLOGOUS STEM CELL TRANSPLANTATION: A POSSIBLE TREATMENT FOR PULMONARY HYPERTENSION IN POEMS SYNDROME

Jordanna Hostler, MD, FCCP: BEYOND STEROIDS: MEPOLIZUMAB FOR CHRONIC EOSINOPHILIC PNEUMONIA

Zahra Zia, MD, MBBS: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR EMERGENT SURGICAL TREATMENT OF ANAEROBIC PURULENT PERICARDITIS CAUSING CARDIAC TAMPONADE, BRONCHOMEDIASTINAL FISTULA, AND ARDS

Brooke A. McDonald: FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

Mary E. Richert, MD: A CASE OF RASBURICASE-INDUCED METHEMOGLOBINEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY TREATED WITH HYPERBARIC OXYGEN THERAPY

Shiva M. Arjun, MD: AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

Harshwant Grover, MD: BLACK MEDIASTINUM: PRIMARY MEDIASTINAL MELANOMA

Neha Agarwal, MD: POSTTRANSPLANT PULMONARY KAPOSI SARCOMA PRESENTING AS CHYLOTHORAX

ANNUAL AWARDS

Master FCCP
Darcy Marciniuk, MD, Master FCCP

Distinguished Service Award
Doreen Addrizzo-Harris, MD, FCCP

Master Clinician Educator
Eric Edell, MD, FCCP

Early Career Clinician Educator
Cassie Kennedy, MD, FCCP
Paru Patrawalla, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Richard Irwin, MD, Master FCCP

Presidential Citation
Lawrence Mohr, Jr., MD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
Dare We Discuss the Cure for Stage IV Lung Cancer? Next- Generation Sequencing and Immune Checkpoint Inhibitors!
James Jett, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice
Eduardo Bossone, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Drug-Induced Lung Disease: Watchful Eyes
Andrew Limper, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
The NHI Phase 3 Trial to Treat Central Sleep Apnea in Heart Failure With Low-Flow Oxygen
Shahrokh Javaheri, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Home-Based Mechanical VentilationChildren Are Not Just Little Adults – Except Sometimes
Howard Panitch, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.

Pasquale Ciaglia Memorial Lecture in Interventional Medicine
Medical Thoracoscopy: Past, Present, and Future
Pyng Lee, MD, PhD
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareReducing Mortality in Sepsis: The History of Performance Measures
Mitchell Levy, MD
The lecture is generously funded by the CHEST Foundation.

Murray Kornfeld Memorial Founders Lecture
Is It Infection, Inflammation, or…Cancer?
Diane Stover, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Om P. Sharma, MD, Master FCCP Memorial Lecture
Common Pitfalls in Sarcoidosis
Michael Iannuzzi, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Mark J. Rosen, MD, Master FCCP Memorial Lecture
Remembering a Giant in Chest Medicine: The Mark J. Rosen Memorial Lecture
Lisa Moores, MD, FCCP

 

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health
Kamran Mahmood, MBBS, FCCP
Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung CancerThis grant is supported by an endowed fund from GlaxoSmithKline.

CHEST Foundation Research Grant in Lung Cancer
James Tsay, MD
Effect of the Inflammasone Signaling Pathway on Lung Microbiome and Lung Cancer
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Mona Alotaibi, MD
Metabolic Derangements Underlying SSc-PAH
This grant supported in full by the CHEST Foundation.

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
Derek Russell, MD
Neutrophil-Elastase Positive Exosomes and Emphysema in Alpha-1 Antitrypsin Deficiency
This grant supported by the Alpha-1 Foundation and the CHEST Foundation.

CHEST Foundation Research Grant in Women’s Lung Health
Neelima Navuluri, MD, MPH
Evaluation of Chronic Hypoxemia From Cardiopulmonary Disease Among Patients in Western Kenya and Perspectives on Oxygen Therapy
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Fibrosis
Eric Abston, MD
Noninvasive Quantification of Pulmonary Fibrosis Due to Radiation Induced Lung Injury Using [68Ga]CBP8 Type 1 Collagen Probe
 

Karthik Suresh, MD
Safety and Efficacy of High-Flow Air for Long-term Oxygen Therapy Delivery in Patients With Pulmonary Fibrosis

These grants are supported by a scientific advancement agreement from Boehringer Ingelheim Pharmaceuticals, Inc and by a grant from Genentech.


CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
Chris Mosher, MD
Identifying Treatment Outcomes and Early Predictors of Failure in 600 Hospitalized Patients With Acute Exacerbation of COPD Treated with Noninvasive Ventilation
Grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
Elsje Pienaar, PhD
A Computational Bridge Between In Vitro MIC and In Vivo Efficacy of Antibiotics Against MAC Infection

Elisa Ignatius, MD
Early Bactericidal Activity of Standard Drugs Used to Treat Mycobacterium Avium Complex: A Pilot Study

Supported by a research award grant by Insmed Incorporated.


CHEST Foundation Research Grant in Venous Thromboembolism
Mitchell Cahan, MD
A Translational Approach to Understanding Venous Thromboembolism in Post-Surgical Patients Using MicroRNAs in the American Black Bear
This grant supported in full by the CHEST Foundation.


CHEST Foundation Research Grant in Severe Asthma
Vickram Tejwani, MD
Peripheral Immune Cell Landscape in Obese Children With Severe Asthma

Sunita Sharma, MD, MPH
Predictors of Anti-IL-5 Treatment Failure in Severe Asthmatics

Supported by an independent educational grant from AstraZeneca LP.

CHEST Foundation Research Grant in Cystic Fibrosis
Kathleen Ramos, MD, MS
Underweight Individuals With Cystic Fibrosis and Implications for Lung Transplantation
This grant supported by Vertex Pharmaceuticals Incorporated.

John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
Divya Patel, DO
Pharmacogenetic Predictors of Therapeutic Response to Methotrexate in Patients With Sarcoidosis

Nicholas Arger, MD
Using Serum Interferon-Induced Chemokines to Predict Sarcoidosis Outcomes
This grant is in honor of John R. Addrizzo, MD, and is supported in full by the Addrizzo Family, their friends, and the CHEST Foundation.

CHEST Foundation Research Grant in Sleep Medicine
Irene Telias, MD
Influence of Sleep-Wakefulness Abnormalities on Patient-Ventilator Dyssynchrony: A Step Towards Improvement of Sleep Quality in Critically Ill Patients

Sushmita Pamidi, MD, MSc
Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Children: A Follow-Up Study of the 3D Pregnancy and Birth Cohort
This grant supported by Apria Healthcare and Jazz Pharmaceuticals.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Hans Lee, MD, FCCP
Uganda Bronchoscopy and Pleuroscopy (UBP) Project

Panagis Galiatsatos, MD, MHS
The Lung Health Ambassador Program

Paul Sonenthal, MD
Improving Critical Care Capacity in Sierra Leone

Dana Hickman, ARNP-C, FNP-BC
Living With COPD: Empowering Individuals, Families, and Caregivers

Ann Salvator, MS
Pediatric Asthma Screenings and Education on the Navajo Reservation

Tisha Wang, MD
PAP Foundation Education Days: A Project to Reach Patients, Caregivers, and Physicians

Grants supported in full by the CHEST Foundation.

ANNUAL AWARDS

Master FCCP
Darcy Marciniuk, MD, Master FCCP

Distinguished Service Award
Doreen Addrizzo-Harris, MD, FCCP

Master Clinician Educator
Eric Edell, MD, FCCP

Early Career Clinician Educator
Cassie Kennedy, MD, FCCP
Paru Patrawalla, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Richard Irwin, MD, Master FCCP

Presidential Citation
Lawrence Mohr, Jr., MD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
Dare We Discuss the Cure for Stage IV Lung Cancer? Next- Generation Sequencing and Immune Checkpoint Inhibitors!
James Jett, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice
Eduardo Bossone, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Drug-Induced Lung Disease: Watchful Eyes
Andrew Limper, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
The NHI Phase 3 Trial to Treat Central Sleep Apnea in Heart Failure With Low-Flow Oxygen
Shahrokh Javaheri, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Home-Based Mechanical VentilationChildren Are Not Just Little Adults – Except Sometimes
Howard Panitch, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.

Pasquale Ciaglia Memorial Lecture in Interventional Medicine
Medical Thoracoscopy: Past, Present, and Future
Pyng Lee, MD, PhD
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareReducing Mortality in Sepsis: The History of Performance Measures
Mitchell Levy, MD
The lecture is generously funded by the CHEST Foundation.

Murray Kornfeld Memorial Founders Lecture
Is It Infection, Inflammation, or…Cancer?
Diane Stover, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Om P. Sharma, MD, Master FCCP Memorial Lecture
Common Pitfalls in Sarcoidosis
Michael Iannuzzi, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Mark J. Rosen, MD, Master FCCP Memorial Lecture
Remembering a Giant in Chest Medicine: The Mark J. Rosen Memorial Lecture
Lisa Moores, MD, FCCP

 

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health
Kamran Mahmood, MBBS, FCCP
Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung CancerThis grant is supported by an endowed fund from GlaxoSmithKline.

CHEST Foundation Research Grant in Lung Cancer
James Tsay, MD
Effect of the Inflammasone Signaling Pathway on Lung Microbiome and Lung Cancer
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Mona Alotaibi, MD
Metabolic Derangements Underlying SSc-PAH
This grant supported in full by the CHEST Foundation.

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
Derek Russell, MD
Neutrophil-Elastase Positive Exosomes and Emphysema in Alpha-1 Antitrypsin Deficiency
This grant supported by the Alpha-1 Foundation and the CHEST Foundation.

CHEST Foundation Research Grant in Women’s Lung Health
Neelima Navuluri, MD, MPH
Evaluation of Chronic Hypoxemia From Cardiopulmonary Disease Among Patients in Western Kenya and Perspectives on Oxygen Therapy
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Fibrosis
Eric Abston, MD
Noninvasive Quantification of Pulmonary Fibrosis Due to Radiation Induced Lung Injury Using [68Ga]CBP8 Type 1 Collagen Probe
 

Karthik Suresh, MD
Safety and Efficacy of High-Flow Air for Long-term Oxygen Therapy Delivery in Patients With Pulmonary Fibrosis

These grants are supported by a scientific advancement agreement from Boehringer Ingelheim Pharmaceuticals, Inc and by a grant from Genentech.


CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
Chris Mosher, MD
Identifying Treatment Outcomes and Early Predictors of Failure in 600 Hospitalized Patients With Acute Exacerbation of COPD Treated with Noninvasive Ventilation
Grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
Elsje Pienaar, PhD
A Computational Bridge Between In Vitro MIC and In Vivo Efficacy of Antibiotics Against MAC Infection

Elisa Ignatius, MD
Early Bactericidal Activity of Standard Drugs Used to Treat Mycobacterium Avium Complex: A Pilot Study

Supported by a research award grant by Insmed Incorporated.


CHEST Foundation Research Grant in Venous Thromboembolism
Mitchell Cahan, MD
A Translational Approach to Understanding Venous Thromboembolism in Post-Surgical Patients Using MicroRNAs in the American Black Bear
This grant supported in full by the CHEST Foundation.


CHEST Foundation Research Grant in Severe Asthma
Vickram Tejwani, MD
Peripheral Immune Cell Landscape in Obese Children With Severe Asthma

Sunita Sharma, MD, MPH
Predictors of Anti-IL-5 Treatment Failure in Severe Asthmatics

Supported by an independent educational grant from AstraZeneca LP.

CHEST Foundation Research Grant in Cystic Fibrosis
Kathleen Ramos, MD, MS
Underweight Individuals With Cystic Fibrosis and Implications for Lung Transplantation
This grant supported by Vertex Pharmaceuticals Incorporated.

John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
Divya Patel, DO
Pharmacogenetic Predictors of Therapeutic Response to Methotrexate in Patients With Sarcoidosis

Nicholas Arger, MD
Using Serum Interferon-Induced Chemokines to Predict Sarcoidosis Outcomes
This grant is in honor of John R. Addrizzo, MD, and is supported in full by the Addrizzo Family, their friends, and the CHEST Foundation.

CHEST Foundation Research Grant in Sleep Medicine
Irene Telias, MD
Influence of Sleep-Wakefulness Abnormalities on Patient-Ventilator Dyssynchrony: A Step Towards Improvement of Sleep Quality in Critically Ill Patients

Sushmita Pamidi, MD, MSc
Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Children: A Follow-Up Study of the 3D Pregnancy and Birth Cohort
This grant supported by Apria Healthcare and Jazz Pharmaceuticals.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Hans Lee, MD, FCCP
Uganda Bronchoscopy and Pleuroscopy (UBP) Project

Panagis Galiatsatos, MD, MHS
The Lung Health Ambassador Program

Paul Sonenthal, MD
Improving Critical Care Capacity in Sierra Leone

Dana Hickman, ARNP-C, FNP-BC
Living With COPD: Empowering Individuals, Families, and Caregivers

Ann Salvator, MS
Pediatric Asthma Screenings and Education on the Navajo Reservation

Tisha Wang, MD
PAP Foundation Education Days: A Project to Reach Patients, Caregivers, and Physicians

Grants supported in full by the CHEST Foundation.

ANNUAL AWARDS

Master FCCP
Darcy Marciniuk, MD, Master FCCP

Distinguished Service Award
Doreen Addrizzo-Harris, MD, FCCP

Master Clinician Educator
Eric Edell, MD, FCCP

Early Career Clinician Educator
Cassie Kennedy, MD, FCCP
Paru Patrawalla, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Richard Irwin, MD, Master FCCP

Presidential Citation
Lawrence Mohr, Jr., MD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
Dare We Discuss the Cure for Stage IV Lung Cancer? Next- Generation Sequencing and Immune Checkpoint Inhibitors!
James Jett, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice
Eduardo Bossone, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Drug-Induced Lung Disease: Watchful Eyes
Andrew Limper, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
The NHI Phase 3 Trial to Treat Central Sleep Apnea in Heart Failure With Low-Flow Oxygen
Shahrokh Javaheri, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Home-Based Mechanical VentilationChildren Are Not Just Little Adults – Except Sometimes
Howard Panitch, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.

Pasquale Ciaglia Memorial Lecture in Interventional Medicine
Medical Thoracoscopy: Past, Present, and Future
Pyng Lee, MD, PhD
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareReducing Mortality in Sepsis: The History of Performance Measures
Mitchell Levy, MD
The lecture is generously funded by the CHEST Foundation.

Murray Kornfeld Memorial Founders Lecture
Is It Infection, Inflammation, or…Cancer?
Diane Stover, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Om P. Sharma, MD, Master FCCP Memorial Lecture
Common Pitfalls in Sarcoidosis
Michael Iannuzzi, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Mark J. Rosen, MD, Master FCCP Memorial Lecture
Remembering a Giant in Chest Medicine: The Mark J. Rosen Memorial Lecture
Lisa Moores, MD, FCCP

 

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health
Kamran Mahmood, MBBS, FCCP
Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung CancerThis grant is supported by an endowed fund from GlaxoSmithKline.

CHEST Foundation Research Grant in Lung Cancer
James Tsay, MD
Effect of the Inflammasone Signaling Pathway on Lung Microbiome and Lung Cancer
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Mona Alotaibi, MD
Metabolic Derangements Underlying SSc-PAH
This grant supported in full by the CHEST Foundation.

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
Derek Russell, MD
Neutrophil-Elastase Positive Exosomes and Emphysema in Alpha-1 Antitrypsin Deficiency
This grant supported by the Alpha-1 Foundation and the CHEST Foundation.

CHEST Foundation Research Grant in Women’s Lung Health
Neelima Navuluri, MD, MPH
Evaluation of Chronic Hypoxemia From Cardiopulmonary Disease Among Patients in Western Kenya and Perspectives on Oxygen Therapy
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Fibrosis
Eric Abston, MD
Noninvasive Quantification of Pulmonary Fibrosis Due to Radiation Induced Lung Injury Using [68Ga]CBP8 Type 1 Collagen Probe
 

Karthik Suresh, MD
Safety and Efficacy of High-Flow Air for Long-term Oxygen Therapy Delivery in Patients With Pulmonary Fibrosis

These grants are supported by a scientific advancement agreement from Boehringer Ingelheim Pharmaceuticals, Inc and by a grant from Genentech.


CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
Chris Mosher, MD
Identifying Treatment Outcomes and Early Predictors of Failure in 600 Hospitalized Patients With Acute Exacerbation of COPD Treated with Noninvasive Ventilation
Grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
Elsje Pienaar, PhD
A Computational Bridge Between In Vitro MIC and In Vivo Efficacy of Antibiotics Against MAC Infection

Elisa Ignatius, MD
Early Bactericidal Activity of Standard Drugs Used to Treat Mycobacterium Avium Complex: A Pilot Study

Supported by a research award grant by Insmed Incorporated.


CHEST Foundation Research Grant in Venous Thromboembolism
Mitchell Cahan, MD
A Translational Approach to Understanding Venous Thromboembolism in Post-Surgical Patients Using MicroRNAs in the American Black Bear
This grant supported in full by the CHEST Foundation.


CHEST Foundation Research Grant in Severe Asthma
Vickram Tejwani, MD
Peripheral Immune Cell Landscape in Obese Children With Severe Asthma

Sunita Sharma, MD, MPH
Predictors of Anti-IL-5 Treatment Failure in Severe Asthmatics

Supported by an independent educational grant from AstraZeneca LP.

CHEST Foundation Research Grant in Cystic Fibrosis
Kathleen Ramos, MD, MS
Underweight Individuals With Cystic Fibrosis and Implications for Lung Transplantation
This grant supported by Vertex Pharmaceuticals Incorporated.

John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
Divya Patel, DO
Pharmacogenetic Predictors of Therapeutic Response to Methotrexate in Patients With Sarcoidosis

Nicholas Arger, MD
Using Serum Interferon-Induced Chemokines to Predict Sarcoidosis Outcomes
This grant is in honor of John R. Addrizzo, MD, and is supported in full by the Addrizzo Family, their friends, and the CHEST Foundation.

CHEST Foundation Research Grant in Sleep Medicine
Irene Telias, MD
Influence of Sleep-Wakefulness Abnormalities on Patient-Ventilator Dyssynchrony: A Step Towards Improvement of Sleep Quality in Critically Ill Patients

Sushmita Pamidi, MD, MSc
Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Children: A Follow-Up Study of the 3D Pregnancy and Birth Cohort
This grant supported by Apria Healthcare and Jazz Pharmaceuticals.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Hans Lee, MD, FCCP
Uganda Bronchoscopy and Pleuroscopy (UBP) Project

Panagis Galiatsatos, MD, MHS
The Lung Health Ambassador Program

Paul Sonenthal, MD
Improving Critical Care Capacity in Sierra Leone

Dana Hickman, ARNP-C, FNP-BC
Living With COPD: Empowering Individuals, Families, and Caregivers

Ann Salvator, MS
Pediatric Asthma Screenings and Education on the Navajo Reservation

Tisha Wang, MD
PAP Foundation Education Days: A Project to Reach Patients, Caregivers, and Physicians

Grants supported in full by the CHEST Foundation.

Did you notice that your practice slows down in February? In fact, if you plot your patient census over a few years, you may find that it dips every February. And you will discover other slow periods, perhaps in December, and busy months during other parts of the year.

Seasonality is yet another of those basic business concepts that most physicians have never heard of, because of the conspicuous lack of business training in medical schools. Seasonal fluctuations exist in one form or another in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January or February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are out of school, and summer slumps to vacationing customers. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change, by running some ads, or doing an e-mail blast; but unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep pockets game requiring long, expensive campaigns that are only practical for large corporations.

For example, soup was traditionally consumed during the winter months since time immemorial. After years of pervasive advertising extolling its nutritional virtues (remember “Soup is Good Food”?), the soup industry succeeded in convincing the public to use their product year-round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean there is nothing we can do about our practices’ seasonal variations? Not at all; but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

First, you need to know what that behavior is, because it varies from practice to practice, even within the same state or city. Plotting your seasonality is easy; you can make a graph on Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2 or 3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively you can plot patient visits per month, if you wish; I do both.

Once you know your seasonality, review your options. Modify your own habits when necessary. If you typically take a vacation in August, for example, that’s not a great idea if August is one of your busiest months; consider vacationing during predictable slow periods instead.

Though I have said that you can’t change most seasonal behavior, it is possible to “retrain” some of your long-time, loyal patients to come in during your slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November each year, urging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive; why not advertise during slow periods to fill those empty slots? But once again, you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response to their ads. So don’t try to move the mountain to Mohammed. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

In short, then, try to “flatten” your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, your seasonal peaks. Once in your practice, some of them can then be shifted into your slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Did you notice that your practice slows down in February? In fact, if you plot your patient census over a few years, you may find that it dips every February. And you will discover other slow periods, perhaps in December, and busy months during other parts of the year.

Seasonality is yet another of those basic business concepts that most physicians have never heard of, because of the conspicuous lack of business training in medical schools. Seasonal fluctuations exist in one form or another in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January or February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are out of school, and summer slumps to vacationing customers. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change, by running some ads, or doing an e-mail blast; but unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep pockets game requiring long, expensive campaigns that are only practical for large corporations.

For example, soup was traditionally consumed during the winter months since time immemorial. After years of pervasive advertising extolling its nutritional virtues (remember “Soup is Good Food”?), the soup industry succeeded in convincing the public to use their product year-round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean there is nothing we can do about our practices’ seasonal variations? Not at all; but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

First, you need to know what that behavior is, because it varies from practice to practice, even within the same state or city. Plotting your seasonality is easy; you can make a graph on Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2 or 3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively you can plot patient visits per month, if you wish; I do both.

Once you know your seasonality, review your options. Modify your own habits when necessary. If you typically take a vacation in August, for example, that’s not a great idea if August is one of your busiest months; consider vacationing during predictable slow periods instead.

Though I have said that you can’t change most seasonal behavior, it is possible to “retrain” some of your long-time, loyal patients to come in during your slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November each year, urging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive; why not advertise during slow periods to fill those empty slots? But once again, you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response to their ads. So don’t try to move the mountain to Mohammed. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

In short, then, try to “flatten” your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, your seasonal peaks. Once in your practice, some of them can then be shifted into your slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Did you notice that your practice slows down in February? In fact, if you plot your patient census over a few years, you may find that it dips every February. And you will discover other slow periods, perhaps in December, and busy months during other parts of the year.

Seasonality is yet another of those basic business concepts that most physicians have never heard of, because of the conspicuous lack of business training in medical schools. Seasonal fluctuations exist in one form or another in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January or February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are out of school, and summer slumps to vacationing customers. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change, by running some ads, or doing an e-mail blast; but unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep pockets game requiring long, expensive campaigns that are only practical for large corporations.

For example, soup was traditionally consumed during the winter months since time immemorial. After years of pervasive advertising extolling its nutritional virtues (remember “Soup is Good Food”?), the soup industry succeeded in convincing the public to use their product year-round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean there is nothing we can do about our practices’ seasonal variations? Not at all; but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

First, you need to know what that behavior is, because it varies from practice to practice, even within the same state or city. Plotting your seasonality is easy; you can make a graph on Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2 or 3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively you can plot patient visits per month, if you wish; I do both.

Once you know your seasonality, review your options. Modify your own habits when necessary. If you typically take a vacation in August, for example, that’s not a great idea if August is one of your busiest months; consider vacationing during predictable slow periods instead.

Though I have said that you can’t change most seasonal behavior, it is possible to “retrain” some of your long-time, loyal patients to come in during your slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November each year, urging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive; why not advertise during slow periods to fill those empty slots? But once again, you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response to their ads. So don’t try to move the mountain to Mohammed. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

In short, then, try to “flatten” your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, your seasonal peaks. Once in your practice, some of them can then be shifted into your slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

LOS ANGELES – Mounting evidence suggests that decreasing muscle mass with aging is associated with increased cardiometabolic risk.

Doug Brunk/MDedge News

“Loss of lean body mass and function with aging decreases the amount of metabolically active tissue, which can lead to insulin resistance,” Elena Volpi, MD, said at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. “Insulin resistance reduces muscle protein anabolism and accelerates sarcopenia, perpetuating a vicious cycle.”

Sarcopenia, the involuntary loss of muscle mass and function that occurs with aging, is an ICD-10 codable condition that can be diagnosed by measuring muscle strength and quality, said Dr. Volpi, director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. In the Health, Aging and Body Composition Study (Health ABC), researchers followed 2,292 relatively healthy adults aged 70-79 years for an average of 4.9 years (J Gerontol A Biol Sci Med. 2006;61[1]:72-7). The researchers used isokinetic dynamometry to measure knee extension strength, isometric dynamometry to measure grip strength, CT scan to measure thigh muscle area, and dual X-ray absorptiometry to determine leg and arm lean soft-tissue mass. “Those individuals who started with the highest levels of muscle strength had the greatest survival, while those who had the lowest levels of muscle strength died earlier,” said Dr. Volpi, who was not affiliated with the study. “That was true for both men and women.”

More recently, researchers conducted a pooled analysis of nine cohort studies involving 34,485 community-dwelling older individuals who were tested with gait speed and followed for 6-21 years (JAMA. 2011;305[1]:50-8). They found that a higher gait speed was associated with higher survival at 5 and 10 years (P less than .001). “Muscle mass also appears to be associated in part with mortality and survival, although the association is not as strong as measures of strength and gait speed,” Dr. Volpi said.

Data from the 2009 Korea National Health and Nutrition Examination Survey of 1,537 participants, aged 65 years and older, found that sarcopenia is independently associated with cardiovascular disease (PLoS One. 2013 Mar 22. doi: 10.1371/journal.pone.0060119). Most of the risk factors for cardiovascular disease – such as age, waist circumference, body mass index, fasting plasma glucose, and total cholesterol – showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with cardiovascular disease, independent of other well-documented risk factors, renal function, and medications (odds ratio, 1.77; P = .025).

In addition, data from the British Regional Heart Study, which followed 4,252 older men for a mean of 11.3 years, found an association of sarcopenia and adiposity with cardiovascular mortality and all-cause mortality (J Am Geriatr Soc. 2014;62[2]:253-60). Specifically, all-cause mortality risk was significantly greater in men in the sarcopenic and obese groups (HRs, 1.41 and 1.21, respectively), compared with those in the optimal reference group, with the highest risk in sarcopenic obese individuals (HR, 1.72) after adjustment for lifestyle characteristics.

“Diabetes also accelerates loss of lean body mass in older adults,” added Dr. Volpi. “Data from the Health ABC study showed that individuals who did not have diabetes at the beginning of the 6-year observation period ... lost the least amount of muscle, compared with those who had undiagnosed or already diagnosed diabetes.”

The precise way in which sarcopenia is linked to metabolic disease remains elusive, she continued, but current evidence suggests that sarcopenia is characterized by a reduction in the protein synthetic response to metabolic stimulation by amino acids, exercise, and insulin in skeletal muscle. “This reduction in the anabolic response to protein synthesis is called anabolic resistance of aging, and it is mediated by reduced acute activation of mTORC1 [mTOR complex 1] signaling,” Dr. Volpi said. “There’s another step upstream of the mTORC1, in which the amino acids and insulin have to cross the blood-muscle barrier. Amino acids need to be transported into the muscle actively, like glucose. That is an important unexplored area that may contribute to sarcopenia.”

Dr. Volpi went on to note that endothelial dysfunction underlies muscle anabolic resistance and cardiovascular risk and is likely to be a fundamental cause of both problems. Recent studies have shown that increased levels of physical activity improve endothelial function, enhance insulin sensitivity and anabolic sensitivity to nutrients, and reduce cardiovascular risk.

For example, in a cohort of 45 nonfrail older adults with a mean age of 72 years, Dr. Volpi and colleagues carried out a phase 1, double-blind, placebo-controlled, randomized clinical trial to determine if chronic essential amino acid supplementation, aerobic exercise training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis over the course of 24 weeks (J Gerontol A Biol Sci Med Sci. 2019;74[10]:1598-604). “We found that exercise supervised three times per week on a treadmill for 6 months improved physical function in both groups randomized to exercise,” Dr. Volpi said. “Disappointingly, there was no change in total lean mass with any of the interventions. There was a decrease in fat mass with exercise alone, and no change with exercise and amino acids. [Of note is that] the individuals who were randomized to the amino acids plus exercise group had a significant increase in leg strength, whereas the others did not.”

Preliminary findings from ongoing work by Dr. Volpi and colleagues suggest that, in diabetes, muscle protein synthesis and blood flow really “are not different in response to insulin in healthy older adults and diabetic older adults because they don’t change at all. However, we did find alterations in amino acid trafficking in diabetes. We found that older individuals with type 2 diabetes had a reduction of amino acid transport and a higher intracellular amino acid concentration, compared with age-matched, healthier individuals. The intracellular amino acid clearance improved in the healthy, nondiabetic older adults with hyperinsulinemia, whereas it did not change in diabetic older adults. As a result, the net muscle protein balance improved a little in the nondiabetic patients, but did not change in the diabetic patients.”

The researchers are evaluating older patients with type 2 diabetes to see whether there are alterations in vascular reactivity and protein synthesis and whether those can be overcome by resistance-exercise training. “Preliminary results show that flow-mediated dilation can actually increase in an older diabetic patient with resistance exercise training three times a week for 3 months,” she said. “Exercise can improve both endothelial dysfunction and sarcopenia and therefore improve physical function and reduce cardiovascular risk.”

Dr. Volpi reported having no relevant disclosures.

[email protected]

LOS ANGELES – Mounting evidence suggests that decreasing muscle mass with aging is associated with increased cardiometabolic risk.

Doug Brunk/MDedge News

“Loss of lean body mass and function with aging decreases the amount of metabolically active tissue, which can lead to insulin resistance,” Elena Volpi, MD, said at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. “Insulin resistance reduces muscle protein anabolism and accelerates sarcopenia, perpetuating a vicious cycle.”

Sarcopenia, the involuntary loss of muscle mass and function that occurs with aging, is an ICD-10 codable condition that can be diagnosed by measuring muscle strength and quality, said Dr. Volpi, director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. In the Health, Aging and Body Composition Study (Health ABC), researchers followed 2,292 relatively healthy adults aged 70-79 years for an average of 4.9 years (J Gerontol A Biol Sci Med. 2006;61[1]:72-7). The researchers used isokinetic dynamometry to measure knee extension strength, isometric dynamometry to measure grip strength, CT scan to measure thigh muscle area, and dual X-ray absorptiometry to determine leg and arm lean soft-tissue mass. “Those individuals who started with the highest levels of muscle strength had the greatest survival, while those who had the lowest levels of muscle strength died earlier,” said Dr. Volpi, who was not affiliated with the study. “That was true for both men and women.”

More recently, researchers conducted a pooled analysis of nine cohort studies involving 34,485 community-dwelling older individuals who were tested with gait speed and followed for 6-21 years (JAMA. 2011;305[1]:50-8). They found that a higher gait speed was associated with higher survival at 5 and 10 years (P less than .001). “Muscle mass also appears to be associated in part with mortality and survival, although the association is not as strong as measures of strength and gait speed,” Dr. Volpi said.

Data from the 2009 Korea National Health and Nutrition Examination Survey of 1,537 participants, aged 65 years and older, found that sarcopenia is independently associated with cardiovascular disease (PLoS One. 2013 Mar 22. doi: 10.1371/journal.pone.0060119). Most of the risk factors for cardiovascular disease – such as age, waist circumference, body mass index, fasting plasma glucose, and total cholesterol – showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with cardiovascular disease, independent of other well-documented risk factors, renal function, and medications (odds ratio, 1.77; P = .025).

In addition, data from the British Regional Heart Study, which followed 4,252 older men for a mean of 11.3 years, found an association of sarcopenia and adiposity with cardiovascular mortality and all-cause mortality (J Am Geriatr Soc. 2014;62[2]:253-60). Specifically, all-cause mortality risk was significantly greater in men in the sarcopenic and obese groups (HRs, 1.41 and 1.21, respectively), compared with those in the optimal reference group, with the highest risk in sarcopenic obese individuals (HR, 1.72) after adjustment for lifestyle characteristics.

“Diabetes also accelerates loss of lean body mass in older adults,” added Dr. Volpi. “Data from the Health ABC study showed that individuals who did not have diabetes at the beginning of the 6-year observation period ... lost the least amount of muscle, compared with those who had undiagnosed or already diagnosed diabetes.”

The precise way in which sarcopenia is linked to metabolic disease remains elusive, she continued, but current evidence suggests that sarcopenia is characterized by a reduction in the protein synthetic response to metabolic stimulation by amino acids, exercise, and insulin in skeletal muscle. “This reduction in the anabolic response to protein synthesis is called anabolic resistance of aging, and it is mediated by reduced acute activation of mTORC1 [mTOR complex 1] signaling,” Dr. Volpi said. “There’s another step upstream of the mTORC1, in which the amino acids and insulin have to cross the blood-muscle barrier. Amino acids need to be transported into the muscle actively, like glucose. That is an important unexplored area that may contribute to sarcopenia.”

Dr. Volpi went on to note that endothelial dysfunction underlies muscle anabolic resistance and cardiovascular risk and is likely to be a fundamental cause of both problems. Recent studies have shown that increased levels of physical activity improve endothelial function, enhance insulin sensitivity and anabolic sensitivity to nutrients, and reduce cardiovascular risk.

For example, in a cohort of 45 nonfrail older adults with a mean age of 72 years, Dr. Volpi and colleagues carried out a phase 1, double-blind, placebo-controlled, randomized clinical trial to determine if chronic essential amino acid supplementation, aerobic exercise training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis over the course of 24 weeks (J Gerontol A Biol Sci Med Sci. 2019;74[10]:1598-604). “We found that exercise supervised three times per week on a treadmill for 6 months improved physical function in both groups randomized to exercise,” Dr. Volpi said. “Disappointingly, there was no change in total lean mass with any of the interventions. There was a decrease in fat mass with exercise alone, and no change with exercise and amino acids. [Of note is that] the individuals who were randomized to the amino acids plus exercise group had a significant increase in leg strength, whereas the others did not.”

Preliminary findings from ongoing work by Dr. Volpi and colleagues suggest that, in diabetes, muscle protein synthesis and blood flow really “are not different in response to insulin in healthy older adults and diabetic older adults because they don’t change at all. However, we did find alterations in amino acid trafficking in diabetes. We found that older individuals with type 2 diabetes had a reduction of amino acid transport and a higher intracellular amino acid concentration, compared with age-matched, healthier individuals. The intracellular amino acid clearance improved in the healthy, nondiabetic older adults with hyperinsulinemia, whereas it did not change in diabetic older adults. As a result, the net muscle protein balance improved a little in the nondiabetic patients, but did not change in the diabetic patients.”

The researchers are evaluating older patients with type 2 diabetes to see whether there are alterations in vascular reactivity and protein synthesis and whether those can be overcome by resistance-exercise training. “Preliminary results show that flow-mediated dilation can actually increase in an older diabetic patient with resistance exercise training three times a week for 3 months,” she said. “Exercise can improve both endothelial dysfunction and sarcopenia and therefore improve physical function and reduce cardiovascular risk.”

Dr. Volpi reported having no relevant disclosures.

[email protected]

LOS ANGELES – Mounting evidence suggests that decreasing muscle mass with aging is associated with increased cardiometabolic risk.

Doug Brunk/MDedge News

“Loss of lean body mass and function with aging decreases the amount of metabolically active tissue, which can lead to insulin resistance,” Elena Volpi, MD, said at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. “Insulin resistance reduces muscle protein anabolism and accelerates sarcopenia, perpetuating a vicious cycle.”

Sarcopenia, the involuntary loss of muscle mass and function that occurs with aging, is an ICD-10 codable condition that can be diagnosed by measuring muscle strength and quality, said Dr. Volpi, director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. In the Health, Aging and Body Composition Study (Health ABC), researchers followed 2,292 relatively healthy adults aged 70-79 years for an average of 4.9 years (J Gerontol A Biol Sci Med. 2006;61[1]:72-7). The researchers used isokinetic dynamometry to measure knee extension strength, isometric dynamometry to measure grip strength, CT scan to measure thigh muscle area, and dual X-ray absorptiometry to determine leg and arm lean soft-tissue mass. “Those individuals who started with the highest levels of muscle strength had the greatest survival, while those who had the lowest levels of muscle strength died earlier,” said Dr. Volpi, who was not affiliated with the study. “That was true for both men and women.”

More recently, researchers conducted a pooled analysis of nine cohort studies involving 34,485 community-dwelling older individuals who were tested with gait speed and followed for 6-21 years (JAMA. 2011;305[1]:50-8). They found that a higher gait speed was associated with higher survival at 5 and 10 years (P less than .001). “Muscle mass also appears to be associated in part with mortality and survival, although the association is not as strong as measures of strength and gait speed,” Dr. Volpi said.

Data from the 2009 Korea National Health and Nutrition Examination Survey of 1,537 participants, aged 65 years and older, found that sarcopenia is independently associated with cardiovascular disease (PLoS One. 2013 Mar 22. doi: 10.1371/journal.pone.0060119). Most of the risk factors for cardiovascular disease – such as age, waist circumference, body mass index, fasting plasma glucose, and total cholesterol – showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with cardiovascular disease, independent of other well-documented risk factors, renal function, and medications (odds ratio, 1.77; P = .025).

In addition, data from the British Regional Heart Study, which followed 4,252 older men for a mean of 11.3 years, found an association of sarcopenia and adiposity with cardiovascular mortality and all-cause mortality (J Am Geriatr Soc. 2014;62[2]:253-60). Specifically, all-cause mortality risk was significantly greater in men in the sarcopenic and obese groups (HRs, 1.41 and 1.21, respectively), compared with those in the optimal reference group, with the highest risk in sarcopenic obese individuals (HR, 1.72) after adjustment for lifestyle characteristics.

“Diabetes also accelerates loss of lean body mass in older adults,” added Dr. Volpi. “Data from the Health ABC study showed that individuals who did not have diabetes at the beginning of the 6-year observation period ... lost the least amount of muscle, compared with those who had undiagnosed or already diagnosed diabetes.”

The precise way in which sarcopenia is linked to metabolic disease remains elusive, she continued, but current evidence suggests that sarcopenia is characterized by a reduction in the protein synthetic response to metabolic stimulation by amino acids, exercise, and insulin in skeletal muscle. “This reduction in the anabolic response to protein synthesis is called anabolic resistance of aging, and it is mediated by reduced acute activation of mTORC1 [mTOR complex 1] signaling,” Dr. Volpi said. “There’s another step upstream of the mTORC1, in which the amino acids and insulin have to cross the blood-muscle barrier. Amino acids need to be transported into the muscle actively, like glucose. That is an important unexplored area that may contribute to sarcopenia.”

Dr. Volpi went on to note that endothelial dysfunction underlies muscle anabolic resistance and cardiovascular risk and is likely to be a fundamental cause of both problems. Recent studies have shown that increased levels of physical activity improve endothelial function, enhance insulin sensitivity and anabolic sensitivity to nutrients, and reduce cardiovascular risk.

For example, in a cohort of 45 nonfrail older adults with a mean age of 72 years, Dr. Volpi and colleagues carried out a phase 1, double-blind, placebo-controlled, randomized clinical trial to determine if chronic essential amino acid supplementation, aerobic exercise training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis over the course of 24 weeks (J Gerontol A Biol Sci Med Sci. 2019;74[10]:1598-604). “We found that exercise supervised three times per week on a treadmill for 6 months improved physical function in both groups randomized to exercise,” Dr. Volpi said. “Disappointingly, there was no change in total lean mass with any of the interventions. There was a decrease in fat mass with exercise alone, and no change with exercise and amino acids. [Of note is that] the individuals who were randomized to the amino acids plus exercise group had a significant increase in leg strength, whereas the others did not.”

Preliminary findings from ongoing work by Dr. Volpi and colleagues suggest that, in diabetes, muscle protein synthesis and blood flow really “are not different in response to insulin in healthy older adults and diabetic older adults because they don’t change at all. However, we did find alterations in amino acid trafficking in diabetes. We found that older individuals with type 2 diabetes had a reduction of amino acid transport and a higher intracellular amino acid concentration, compared with age-matched, healthier individuals. The intracellular amino acid clearance improved in the healthy, nondiabetic older adults with hyperinsulinemia, whereas it did not change in diabetic older adults. As a result, the net muscle protein balance improved a little in the nondiabetic patients, but did not change in the diabetic patients.”

The researchers are evaluating older patients with type 2 diabetes to see whether there are alterations in vascular reactivity and protein synthesis and whether those can be overcome by resistance-exercise training. “Preliminary results show that flow-mediated dilation can actually increase in an older diabetic patient with resistance exercise training three times a week for 3 months,” she said. “Exercise can improve both endothelial dysfunction and sarcopenia and therefore improve physical function and reduce cardiovascular risk.”

Dr. Volpi reported having no relevant disclosures.

[email protected]

The time shared during clinical encounters provides small peeks into patients’ lives that get documented as episodic snapshots in electronic health records. But there is little information about how patients are doing outside of the office. With increasing emphasis on filling out mandatory parts of the EHR, there is less time available for in-depth, in-office conversations and phone follow-ups.

At the same time, it has become clear that it is not just the medicines we prescribe that affect our patients’ lives. Their behaviors outside of the office – being physically active, eating well, getting a good night’s rest, and adhering to medications – also impact their health outcomes.

The explosion of technology and personal data in our increasingly connected world provides powerful new sources of health and behavior information that generate new understanding of patients’ lives in their everyday settings.

The ubiquity and remarkable technological progress of personal computing devices – including wearables, smartphones, and tablets – along with the multitude of sensor modalities embedded within these devices, has enabled us to establish a continuous connection with people who want to share information about their behavior and daily life.

Such rich, longitudinal information, known as person-generated health data (PGHD), can be searched for physiological and behavioral signatures that can be used in combination with traditional clinical information to predict, diagnose, and treat disease. It can also be used to understand the safety and effectiveness of medical interventions.

PGHD is defined as wellness and/or health-related data created, recorded, or gathered by individuals. It reflects events and interactions that occur during an person’s everyday life. Systematically gathering this information and organizing it to better understand patients’ approach to their health or their unique experience living with disease provides meaningful insights that complement the data traditionally collected as part of clinical trials or periodic office visits.

PGHD can produce a rich picture of a person’s health or symptom burden with disease. It allows the opportunity to measure the real human burden of a patient’s disease and how it changes over time, with an opportunity to detect changes in symptoms in real time.

PGHD can also enable participation in health research.

An example would be the work of Evidation Health in San Mateo, Calif. Evidation provides a platform to run research studies utilizing technology and systems to measure health in everyday life. Its app, Achievement, collects continuous behavior-related data from smartphones, wearables, connected devices, and apps. That provides opportunities for participants to join research studies that develop novel measures designed to quantify health outcomes in a way that more accurately reflects an individual’s day-to-day activities and experience. All data collected are at the direction of and with the permission of the individual.

“Achievers” are given points for taking health-related actions such as tracking steps or their sleep, which convert to cash that can be kept or donated to their favorite charities. Achievement’s 3.5 million diverse participants also receive offers to join research studies. This paradigm shift dramatically expands access to research to increase diversity, shortens the time to first data through rapid recruitment, and enhances retention rates by making it easier to engage. To date, more than 1 million users have chosen to participate in research studies. The technology is bringing new data and insights to health research; it supports important questions about quality of life, medical products’ real-world effectiveness, and the development of hyperpersonalized health care services.

This new type of data is transforming medical research by creating real-world studies of unprecedented size, such as the Apple Heart Study – a virtual study with more than 400,000 enrolled participants – which was designed to test the accuracy of Apple Watches in safely identifying atrial fibrillation. The FDA has cleared two features on the Apple Watch: the device’s ability to detect and notify the user of an irregular heart rhythm, and the ability to take a single-lead EKG feature that can provide a rhythm strip for a clinician to review.

The FDA clearance letters specify that the apps are “not intended to replace traditional methods of diagnosis or treatment.” They provide extra information, and that information might be helpful – but the apps won’t replace a doctor’s visit. It remains to be seen how these data will be used, but they have the potential to identify atrial fibrillation early, leading to treatment that may prevent devastating strokes.

Another example of home-generated health data is a tool that has obtained FDA clearance as a diagnostic device with insurance reimbursement: WatchPAT, a portable sleep apnea diagnostic device. WatchPAT is worn like a simple wristwatch, with no need for belts, wires, or nasal cannulas.

Over time, in-home tests like these that are of minimal inconvenience to the patient and reflect a real-world experience may eclipse traditional sleep studies that require patients to spend the night in a clinic while attached to wires and monitors.

Health data generated by connected populations will yield novel insights that may help us better predict, diagnose, and treat disease. These are examples of innovations that can extend clinicians’ abilities to remotely monitor or diagnose health conditions, and we can expect that more will continue to be integrated into the clinical and research settings in the near future.

In part 2 of this series, we will discuss novel digital measures and studies utilizing PGHD to impact population health.
 

Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and associate director, family medicine residency program, Abington (Pa.) Jefferson Health. Dr. Foschini is cofounder and chief data scientist at Evidation Health in San Mateo, Calif. Bray Patrick-Lake is a patient thought leader and director, strategic partnerships, at Evidation Health.

References

Determining real-world data’s fitness for use and the role of reliability, September 2019. Duke-Margolis Center for Health Policy.

N Engl J Med. 2019 Nov 14;381(20):1909-17.

The time shared during clinical encounters provides small peeks into patients’ lives that get documented as episodic snapshots in electronic health records. But there is little information about how patients are doing outside of the office. With increasing emphasis on filling out mandatory parts of the EHR, there is less time available for in-depth, in-office conversations and phone follow-ups.

At the same time, it has become clear that it is not just the medicines we prescribe that affect our patients’ lives. Their behaviors outside of the office – being physically active, eating well, getting a good night’s rest, and adhering to medications – also impact their health outcomes.

The explosion of technology and personal data in our increasingly connected world provides powerful new sources of health and behavior information that generate new understanding of patients’ lives in their everyday settings.

The ubiquity and remarkable technological progress of personal computing devices – including wearables, smartphones, and tablets – along with the multitude of sensor modalities embedded within these devices, has enabled us to establish a continuous connection with people who want to share information about their behavior and daily life.

Such rich, longitudinal information, known as person-generated health data (PGHD), can be searched for physiological and behavioral signatures that can be used in combination with traditional clinical information to predict, diagnose, and treat disease. It can also be used to understand the safety and effectiveness of medical interventions.

PGHD is defined as wellness and/or health-related data created, recorded, or gathered by individuals. It reflects events and interactions that occur during an person’s everyday life. Systematically gathering this information and organizing it to better understand patients’ approach to their health or their unique experience living with disease provides meaningful insights that complement the data traditionally collected as part of clinical trials or periodic office visits.

PGHD can produce a rich picture of a person’s health or symptom burden with disease. It allows the opportunity to measure the real human burden of a patient’s disease and how it changes over time, with an opportunity to detect changes in symptoms in real time.

PGHD can also enable participation in health research.

An example would be the work of Evidation Health in San Mateo, Calif. Evidation provides a platform to run research studies utilizing technology and systems to measure health in everyday life. Its app, Achievement, collects continuous behavior-related data from smartphones, wearables, connected devices, and apps. That provides opportunities for participants to join research studies that develop novel measures designed to quantify health outcomes in a way that more accurately reflects an individual’s day-to-day activities and experience. All data collected are at the direction of and with the permission of the individual.

“Achievers” are given points for taking health-related actions such as tracking steps or their sleep, which convert to cash that can be kept or donated to their favorite charities. Achievement’s 3.5 million diverse participants also receive offers to join research studies. This paradigm shift dramatically expands access to research to increase diversity, shortens the time to first data through rapid recruitment, and enhances retention rates by making it easier to engage. To date, more than 1 million users have chosen to participate in research studies. The technology is bringing new data and insights to health research; it supports important questions about quality of life, medical products’ real-world effectiveness, and the development of hyperpersonalized health care services.

This new type of data is transforming medical research by creating real-world studies of unprecedented size, such as the Apple Heart Study – a virtual study with more than 400,000 enrolled participants – which was designed to test the accuracy of Apple Watches in safely identifying atrial fibrillation. The FDA has cleared two features on the Apple Watch: the device’s ability to detect and notify the user of an irregular heart rhythm, and the ability to take a single-lead EKG feature that can provide a rhythm strip for a clinician to review.

The FDA clearance letters specify that the apps are “not intended to replace traditional methods of diagnosis or treatment.” They provide extra information, and that information might be helpful – but the apps won’t replace a doctor’s visit. It remains to be seen how these data will be used, but they have the potential to identify atrial fibrillation early, leading to treatment that may prevent devastating strokes.

Another example of home-generated health data is a tool that has obtained FDA clearance as a diagnostic device with insurance reimbursement: WatchPAT, a portable sleep apnea diagnostic device. WatchPAT is worn like a simple wristwatch, with no need for belts, wires, or nasal cannulas.

Over time, in-home tests like these that are of minimal inconvenience to the patient and reflect a real-world experience may eclipse traditional sleep studies that require patients to spend the night in a clinic while attached to wires and monitors.

Health data generated by connected populations will yield novel insights that may help us better predict, diagnose, and treat disease. These are examples of innovations that can extend clinicians’ abilities to remotely monitor or diagnose health conditions, and we can expect that more will continue to be integrated into the clinical and research settings in the near future.

In part 2 of this series, we will discuss novel digital measures and studies utilizing PGHD to impact population health.
 

Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and associate director, family medicine residency program, Abington (Pa.) Jefferson Health. Dr. Foschini is cofounder and chief data scientist at Evidation Health in San Mateo, Calif. Bray Patrick-Lake is a patient thought leader and director, strategic partnerships, at Evidation Health.

References

Determining real-world data’s fitness for use and the role of reliability, September 2019. Duke-Margolis Center for Health Policy.

N Engl J Med. 2019 Nov 14;381(20):1909-17.

The time shared during clinical encounters provides small peeks into patients’ lives that get documented as episodic snapshots in electronic health records. But there is little information about how patients are doing outside of the office. With increasing emphasis on filling out mandatory parts of the EHR, there is less time available for in-depth, in-office conversations and phone follow-ups.

At the same time, it has become clear that it is not just the medicines we prescribe that affect our patients’ lives. Their behaviors outside of the office – being physically active, eating well, getting a good night’s rest, and adhering to medications – also impact their health outcomes.

The explosion of technology and personal data in our increasingly connected world provides powerful new sources of health and behavior information that generate new understanding of patients’ lives in their everyday settings.

The ubiquity and remarkable technological progress of personal computing devices – including wearables, smartphones, and tablets – along with the multitude of sensor modalities embedded within these devices, has enabled us to establish a continuous connection with people who want to share information about their behavior and daily life.

Such rich, longitudinal information, known as person-generated health data (PGHD), can be searched for physiological and behavioral signatures that can be used in combination with traditional clinical information to predict, diagnose, and treat disease. It can also be used to understand the safety and effectiveness of medical interventions.

PGHD is defined as wellness and/or health-related data created, recorded, or gathered by individuals. It reflects events and interactions that occur during an person’s everyday life. Systematically gathering this information and organizing it to better understand patients’ approach to their health or their unique experience living with disease provides meaningful insights that complement the data traditionally collected as part of clinical trials or periodic office visits.

PGHD can produce a rich picture of a person’s health or symptom burden with disease. It allows the opportunity to measure the real human burden of a patient’s disease and how it changes over time, with an opportunity to detect changes in symptoms in real time.

PGHD can also enable participation in health research.

An example would be the work of Evidation Health in San Mateo, Calif. Evidation provides a platform to run research studies utilizing technology and systems to measure health in everyday life. Its app, Achievement, collects continuous behavior-related data from smartphones, wearables, connected devices, and apps. That provides opportunities for participants to join research studies that develop novel measures designed to quantify health outcomes in a way that more accurately reflects an individual’s day-to-day activities and experience. All data collected are at the direction of and with the permission of the individual.

“Achievers” are given points for taking health-related actions such as tracking steps or their sleep, which convert to cash that can be kept or donated to their favorite charities. Achievement’s 3.5 million diverse participants also receive offers to join research studies. This paradigm shift dramatically expands access to research to increase diversity, shortens the time to first data through rapid recruitment, and enhances retention rates by making it easier to engage. To date, more than 1 million users have chosen to participate in research studies. The technology is bringing new data and insights to health research; it supports important questions about quality of life, medical products’ real-world effectiveness, and the development of hyperpersonalized health care services.

This new type of data is transforming medical research by creating real-world studies of unprecedented size, such as the Apple Heart Study – a virtual study with more than 400,000 enrolled participants – which was designed to test the accuracy of Apple Watches in safely identifying atrial fibrillation. The FDA has cleared two features on the Apple Watch: the device’s ability to detect and notify the user of an irregular heart rhythm, and the ability to take a single-lead EKG feature that can provide a rhythm strip for a clinician to review.

The FDA clearance letters specify that the apps are “not intended to replace traditional methods of diagnosis or treatment.” They provide extra information, and that information might be helpful – but the apps won’t replace a doctor’s visit. It remains to be seen how these data will be used, but they have the potential to identify atrial fibrillation early, leading to treatment that may prevent devastating strokes.

Another example of home-generated health data is a tool that has obtained FDA clearance as a diagnostic device with insurance reimbursement: WatchPAT, a portable sleep apnea diagnostic device. WatchPAT is worn like a simple wristwatch, with no need for belts, wires, or nasal cannulas.

Over time, in-home tests like these that are of minimal inconvenience to the patient and reflect a real-world experience may eclipse traditional sleep studies that require patients to spend the night in a clinic while attached to wires and monitors.

Health data generated by connected populations will yield novel insights that may help us better predict, diagnose, and treat disease. These are examples of innovations that can extend clinicians’ abilities to remotely monitor or diagnose health conditions, and we can expect that more will continue to be integrated into the clinical and research settings in the near future.

In part 2 of this series, we will discuss novel digital measures and studies utilizing PGHD to impact population health.
 

Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and associate director, family medicine residency program, Abington (Pa.) Jefferson Health. Dr. Foschini is cofounder and chief data scientist at Evidation Health in San Mateo, Calif. Bray Patrick-Lake is a patient thought leader and director, strategic partnerships, at Evidation Health.

References

Determining real-world data’s fitness for use and the role of reliability, September 2019. Duke-Margolis Center for Health Policy.

N Engl J Med. 2019 Nov 14;381(20):1909-17.

A new and simple model for predicting risk of severe neutropenia in advanced lung cancer could ease the evaluation process and help inform patient management decisions, according to investigators.

The model, based on 10 pretreatment variables, appears to overcome limitations of a comprehensive risk prediction model that is not specific to lung cancer, according to Xiaowen Cao of Duke University, Durham, N.C., and coinvestigators.

“We believe that this model, once validated, will help oncologists accurately identify those patients with lung cancer who are at a high risk of developing severe neutropenia, based on simple, readily available information,” the researchers said in a report on their work, which appears in the journal Lung Cancer.

Oncologists could then make “proactive” decisions about monitoring of high-risk patients, modifying the dose of chemotherapy, and using prophylactic growth factors, the authors added.

Accurate, lung cancer–specific prediction models would be useful to estimate risk of neutropenia, which the investigators acknowledged as a serious chemotherapy-induced toxicity linked to life-threatening infections, dose delays, and reductions that can compromise treatment efficacy, and reduced health-related quality of life.

There are other, previously developed models to predict chemotherapy-induced neutropenia, but those have significant limitations, including development based on small patient sample sizes, according to the researchers.

A comprehensive risk model for neutropenic complications has been developed by Gary H. Lyman, MD, and colleagues, based on a large, prospective cohort including nearly 3,800 patients. That model performs well and had a 90% sensitivity and 96% predictive value; however, it’s not lung cancer specific, and hasn’t been externally validated, according to Ms. Cao and coauthors.

Accordingly, they set out to develop a new risk prediction model based on a lung cancer data set encompassing 11,352 patients from 67 phase 2 or 3 cooperative group studies conducted between 1991 and 2010.

The Lyman model in this data set had an area under the curve (AUC) of 0.8772 in patients with small cell lung cancer (SCLC), but an AUC of just 0.6787 in non–small cell lung cancer (NSCLC), suggesting “much better predictive performance in the SCLC,” the researchers noted.

They used stepwise logistic regression and lasso regression to develop a new model, which was derived based on about two-thirds of the patients, randomly selected, while the validation was conducted using the remaining third.

Variables included in the final model included age, gender, weight, BMI, insurance status, disease stage, number of metastatic sites, chemotherapy agents used, number of chemotherapy agents, planned growth factor use, duration of planned therapy, pleural effusion, presence of symptoms, and performance status.

That model had a good AUC, according to investigators, in both the training set and the testing set (0.8348 and 0.8234, respectively).

“It is worth noticing that our final model compensated for the deficiency of Lyman’s risk model in NSCLC patients,” the researchers noted in a discussion of their results.

The study was supported in part by grants from the National Institutes of Health, the National Center for Advancing Translational Sciences, and the Health and Medical Research Fund of Hong Kong. One study coauthor reported a conflict of interest outside the submitted work related to Genentech.

SOURCE: Cao X et al. Lung Cancer 2020 Jan 5. doi: 10.1016/j.lungcan.2020.01.004.

A new and simple model for predicting risk of severe neutropenia in advanced lung cancer could ease the evaluation process and help inform patient management decisions, according to investigators.

The model, based on 10 pretreatment variables, appears to overcome limitations of a comprehensive risk prediction model that is not specific to lung cancer, according to Xiaowen Cao of Duke University, Durham, N.C., and coinvestigators.

“We believe that this model, once validated, will help oncologists accurately identify those patients with lung cancer who are at a high risk of developing severe neutropenia, based on simple, readily available information,” the researchers said in a report on their work, which appears in the journal Lung Cancer.

Oncologists could then make “proactive” decisions about monitoring of high-risk patients, modifying the dose of chemotherapy, and using prophylactic growth factors, the authors added.

Accurate, lung cancer–specific prediction models would be useful to estimate risk of neutropenia, which the investigators acknowledged as a serious chemotherapy-induced toxicity linked to life-threatening infections, dose delays, and reductions that can compromise treatment efficacy, and reduced health-related quality of life.

There are other, previously developed models to predict chemotherapy-induced neutropenia, but those have significant limitations, including development based on small patient sample sizes, according to the researchers.

A comprehensive risk model for neutropenic complications has been developed by Gary H. Lyman, MD, and colleagues, based on a large, prospective cohort including nearly 3,800 patients. That model performs well and had a 90% sensitivity and 96% predictive value; however, it’s not lung cancer specific, and hasn’t been externally validated, according to Ms. Cao and coauthors.

Accordingly, they set out to develop a new risk prediction model based on a lung cancer data set encompassing 11,352 patients from 67 phase 2 or 3 cooperative group studies conducted between 1991 and 2010.

The Lyman model in this data set had an area under the curve (AUC) of 0.8772 in patients with small cell lung cancer (SCLC), but an AUC of just 0.6787 in non–small cell lung cancer (NSCLC), suggesting “much better predictive performance in the SCLC,” the researchers noted.

They used stepwise logistic regression and lasso regression to develop a new model, which was derived based on about two-thirds of the patients, randomly selected, while the validation was conducted using the remaining third.

Variables included in the final model included age, gender, weight, BMI, insurance status, disease stage, number of metastatic sites, chemotherapy agents used, number of chemotherapy agents, planned growth factor use, duration of planned therapy, pleural effusion, presence of symptoms, and performance status.

That model had a good AUC, according to investigators, in both the training set and the testing set (0.8348 and 0.8234, respectively).

“It is worth noticing that our final model compensated for the deficiency of Lyman’s risk model in NSCLC patients,” the researchers noted in a discussion of their results.

The study was supported in part by grants from the National Institutes of Health, the National Center for Advancing Translational Sciences, and the Health and Medical Research Fund of Hong Kong. One study coauthor reported a conflict of interest outside the submitted work related to Genentech.

SOURCE: Cao X et al. Lung Cancer 2020 Jan 5. doi: 10.1016/j.lungcan.2020.01.004.

A new and simple model for predicting risk of severe neutropenia in advanced lung cancer could ease the evaluation process and help inform patient management decisions, according to investigators.

The model, based on 10 pretreatment variables, appears to overcome limitations of a comprehensive risk prediction model that is not specific to lung cancer, according to Xiaowen Cao of Duke University, Durham, N.C., and coinvestigators.

“We believe that this model, once validated, will help oncologists accurately identify those patients with lung cancer who are at a high risk of developing severe neutropenia, based on simple, readily available information,” the researchers said in a report on their work, which appears in the journal Lung Cancer.

Oncologists could then make “proactive” decisions about monitoring of high-risk patients, modifying the dose of chemotherapy, and using prophylactic growth factors, the authors added.

Accurate, lung cancer–specific prediction models would be useful to estimate risk of neutropenia, which the investigators acknowledged as a serious chemotherapy-induced toxicity linked to life-threatening infections, dose delays, and reductions that can compromise treatment efficacy, and reduced health-related quality of life.

There are other, previously developed models to predict chemotherapy-induced neutropenia, but those have significant limitations, including development based on small patient sample sizes, according to the researchers.

A comprehensive risk model for neutropenic complications has been developed by Gary H. Lyman, MD, and colleagues, based on a large, prospective cohort including nearly 3,800 patients. That model performs well and had a 90% sensitivity and 96% predictive value; however, it’s not lung cancer specific, and hasn’t been externally validated, according to Ms. Cao and coauthors.

Accordingly, they set out to develop a new risk prediction model based on a lung cancer data set encompassing 11,352 patients from 67 phase 2 or 3 cooperative group studies conducted between 1991 and 2010.

The Lyman model in this data set had an area under the curve (AUC) of 0.8772 in patients with small cell lung cancer (SCLC), but an AUC of just 0.6787 in non–small cell lung cancer (NSCLC), suggesting “much better predictive performance in the SCLC,” the researchers noted.

They used stepwise logistic regression and lasso regression to develop a new model, which was derived based on about two-thirds of the patients, randomly selected, while the validation was conducted using the remaining third.

Variables included in the final model included age, gender, weight, BMI, insurance status, disease stage, number of metastatic sites, chemotherapy agents used, number of chemotherapy agents, planned growth factor use, duration of planned therapy, pleural effusion, presence of symptoms, and performance status.

That model had a good AUC, according to investigators, in both the training set and the testing set (0.8348 and 0.8234, respectively).

“It is worth noticing that our final model compensated for the deficiency of Lyman’s risk model in NSCLC patients,” the researchers noted in a discussion of their results.

The study was supported in part by grants from the National Institutes of Health, the National Center for Advancing Translational Sciences, and the Health and Medical Research Fund of Hong Kong. One study coauthor reported a conflict of interest outside the submitted work related to Genentech.

SOURCE: Cao X et al. Lung Cancer 2020 Jan 5. doi: 10.1016/j.lungcan.2020.01.004.

Relative to serous borderline ovarian tumors, the proportion of low-grade serous ovarian cancers has decreased in recent years, paralleled by a trend toward decreased survival, results of a large, population-based study suggest.

The number of low-grade serous ovarian cancer (LGSOC) cases declined by almost 26% in the retrospective analysis of registry data from 1998 to 2000, with a relative decrease of survival by nearly 29% over that time period.

Those decreases in LGSOC incidence and survival may be explained by a “diagnosis shift” toward versus serous borderline ovarian tumors (SBOTs) over time, though it could also be due to earlier detection of SBOT, which may be a precursor lesion of LGSOC, said authors of the study, led by oncology researcher Koji Matsuo, MD, PhD, of the University of Southern California, Los Angeles.

Taken together, the findings support the need to distinguish between LGSOC and SBOT, given their “distinctly different” oncologic outcomes and treatment approaches, according to Dr. Matsuo and colleagues.

“Making a proper diagnosis for LGSOC versus SBOT is paramount, as it impacts surgical and postoperative management,” the authors wrote in their report on the study, which appears in Gynecologic Oncology.

The retrospective, population-based, observational study, based on data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, included women with LGSOC or SBOT diagnosed between 1988 and 2000 in the United States. A total of 4,712 cases were analyzed.

The number of LGSOC from 23.2% in 1988 down to 17.2% by 2000, or a relative decrease of 25.9%, Dr. Matsuo and coauthors reported. The decrease was even more pronounced in stage I disease, with a relative decrease of 37.6% versus 21.1% for stage II-IV.

As compared with women with SBOT, women with LGSOC were more likely to be older, more likely to have stage II-IV disease at diagnosis, more likely to have undergone hysterectomy, and less likely to be residents of the western United States, results of a multivariable analysis showed.

There was a downward trend in 15-year overall survival among women with LGSOC, from 53.3% to 38.0% by 2000, representing a relative decrease of 28.7%, according to the investigators. By contrast, overall survival was unchanged in the SBOT cohort, at 76.7% in 1988 and 78.7% by 2000, for a relative increase of about 2.5%.

Gradual changes in diagnostic classification over time may explain these trends, according to the investigators.

That shift would have started with the recognition of borderline ovarian tumors as a separate entity by the World Health Organization until 1971, leading to an increasing number of SBOTs over time as diagnostic practice patterns gradually changed. Later, it would have been fueled by the recognition of LGSOC as a new classification in the mid-1980s, which may have accelerated the shift by enhanced discrimination of SBOT from other serous tumors, the investigators wrote.

On the other hand, since SBOT may be a precursor lesion to LGSOC, the shift in diagnosis over time could be caused at least in part by increasing use of transvaginal ultrasonography, leading to more early detection of SBOT before they could progress to LGGOC. “More study is necessary to identify if SBOT can progress to LGSOC,” Dr. Matsuo and coauthors wrote.

The study was funded by the Ensign Endowment for Gynecologic Cancer Research. Dr. Matsuo reported disclosures related to Chugai, Springer, and VBL Therapeutics. His coauthors provided additional disclosures related to Kiyatec, Merck, Biopath, M-Trap, Quantgene, Tesaro, GlaxoSmithKline, Celgene, Johnson & Johnson, Biogin, Clovis Oncology, Novartis, Elsevier, and UpToDate.

SOURCE: Matsuo K et al. Gynecol Oncol. 2020 Jan 15. doi: 10.1016/j.ygyno.2019.08.030.

Relative to serous borderline ovarian tumors, the proportion of low-grade serous ovarian cancers has decreased in recent years, paralleled by a trend toward decreased survival, results of a large, population-based study suggest.

The number of low-grade serous ovarian cancer (LGSOC) cases declined by almost 26% in the retrospective analysis of registry data from 1998 to 2000, with a relative decrease of survival by nearly 29% over that time period.

Those decreases in LGSOC incidence and survival may be explained by a “diagnosis shift” toward versus serous borderline ovarian tumors (SBOTs) over time, though it could also be due to earlier detection of SBOT, which may be a precursor lesion of LGSOC, said authors of the study, led by oncology researcher Koji Matsuo, MD, PhD, of the University of Southern California, Los Angeles.

Taken together, the findings support the need to distinguish between LGSOC and SBOT, given their “distinctly different” oncologic outcomes and treatment approaches, according to Dr. Matsuo and colleagues.

“Making a proper diagnosis for LGSOC versus SBOT is paramount, as it impacts surgical and postoperative management,” the authors wrote in their report on the study, which appears in Gynecologic Oncology.

The retrospective, population-based, observational study, based on data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, included women with LGSOC or SBOT diagnosed between 1988 and 2000 in the United States. A total of 4,712 cases were analyzed.

The number of LGSOC from 23.2% in 1988 down to 17.2% by 2000, or a relative decrease of 25.9%, Dr. Matsuo and coauthors reported. The decrease was even more pronounced in stage I disease, with a relative decrease of 37.6% versus 21.1% for stage II-IV.

As compared with women with SBOT, women with LGSOC were more likely to be older, more likely to have stage II-IV disease at diagnosis, more likely to have undergone hysterectomy, and less likely to be residents of the western United States, results of a multivariable analysis showed.

There was a downward trend in 15-year overall survival among women with LGSOC, from 53.3% to 38.0% by 2000, representing a relative decrease of 28.7%, according to the investigators. By contrast, overall survival was unchanged in the SBOT cohort, at 76.7% in 1988 and 78.7% by 2000, for a relative increase of about 2.5%.

Gradual changes in diagnostic classification over time may explain these trends, according to the investigators.

That shift would have started with the recognition of borderline ovarian tumors as a separate entity by the World Health Organization until 1971, leading to an increasing number of SBOTs over time as diagnostic practice patterns gradually changed. Later, it would have been fueled by the recognition of LGSOC as a new classification in the mid-1980s, which may have accelerated the shift by enhanced discrimination of SBOT from other serous tumors, the investigators wrote.

On the other hand, since SBOT may be a precursor lesion to LGSOC, the shift in diagnosis over time could be caused at least in part by increasing use of transvaginal ultrasonography, leading to more early detection of SBOT before they could progress to LGGOC. “More study is necessary to identify if SBOT can progress to LGSOC,” Dr. Matsuo and coauthors wrote.

The study was funded by the Ensign Endowment for Gynecologic Cancer Research. Dr. Matsuo reported disclosures related to Chugai, Springer, and VBL Therapeutics. His coauthors provided additional disclosures related to Kiyatec, Merck, Biopath, M-Trap, Quantgene, Tesaro, GlaxoSmithKline, Celgene, Johnson & Johnson, Biogin, Clovis Oncology, Novartis, Elsevier, and UpToDate.

SOURCE: Matsuo K et al. Gynecol Oncol. 2020 Jan 15. doi: 10.1016/j.ygyno.2019.08.030.

Relative to serous borderline ovarian tumors, the proportion of low-grade serous ovarian cancers has decreased in recent years, paralleled by a trend toward decreased survival, results of a large, population-based study suggest.

The number of low-grade serous ovarian cancer (LGSOC) cases declined by almost 26% in the retrospective analysis of registry data from 1998 to 2000, with a relative decrease of survival by nearly 29% over that time period.

Those decreases in LGSOC incidence and survival may be explained by a “diagnosis shift” toward versus serous borderline ovarian tumors (SBOTs) over time, though it could also be due to earlier detection of SBOT, which may be a precursor lesion of LGSOC, said authors of the study, led by oncology researcher Koji Matsuo, MD, PhD, of the University of Southern California, Los Angeles.

Taken together, the findings support the need to distinguish between LGSOC and SBOT, given their “distinctly different” oncologic outcomes and treatment approaches, according to Dr. Matsuo and colleagues.

“Making a proper diagnosis for LGSOC versus SBOT is paramount, as it impacts surgical and postoperative management,” the authors wrote in their report on the study, which appears in Gynecologic Oncology.

The retrospective, population-based, observational study, based on data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, included women with LGSOC or SBOT diagnosed between 1988 and 2000 in the United States. A total of 4,712 cases were analyzed.

The number of LGSOC from 23.2% in 1988 down to 17.2% by 2000, or a relative decrease of 25.9%, Dr. Matsuo and coauthors reported. The decrease was even more pronounced in stage I disease, with a relative decrease of 37.6% versus 21.1% for stage II-IV.

As compared with women with SBOT, women with LGSOC were more likely to be older, more likely to have stage II-IV disease at diagnosis, more likely to have undergone hysterectomy, and less likely to be residents of the western United States, results of a multivariable analysis showed.

There was a downward trend in 15-year overall survival among women with LGSOC, from 53.3% to 38.0% by 2000, representing a relative decrease of 28.7%, according to the investigators. By contrast, overall survival was unchanged in the SBOT cohort, at 76.7% in 1988 and 78.7% by 2000, for a relative increase of about 2.5%.

Gradual changes in diagnostic classification over time may explain these trends, according to the investigators.

That shift would have started with the recognition of borderline ovarian tumors as a separate entity by the World Health Organization until 1971, leading to an increasing number of SBOTs over time as diagnostic practice patterns gradually changed. Later, it would have been fueled by the recognition of LGSOC as a new classification in the mid-1980s, which may have accelerated the shift by enhanced discrimination of SBOT from other serous tumors, the investigators wrote.

On the other hand, since SBOT may be a precursor lesion to LGSOC, the shift in diagnosis over time could be caused at least in part by increasing use of transvaginal ultrasonography, leading to more early detection of SBOT before they could progress to LGGOC. “More study is necessary to identify if SBOT can progress to LGSOC,” Dr. Matsuo and coauthors wrote.

The study was funded by the Ensign Endowment for Gynecologic Cancer Research. Dr. Matsuo reported disclosures related to Chugai, Springer, and VBL Therapeutics. His coauthors provided additional disclosures related to Kiyatec, Merck, Biopath, M-Trap, Quantgene, Tesaro, GlaxoSmithKline, Celgene, Johnson & Johnson, Biogin, Clovis Oncology, Novartis, Elsevier, and UpToDate.

SOURCE: Matsuo K et al. Gynecol Oncol. 2020 Jan 15. doi: 10.1016/j.ygyno.2019.08.030.

The pneumonia outbreak in China traced to a novel coronavirus appears to be contained, although at least two cases have appeared in other countries.

CDC/ Dr. Fred Murphy; Sylvia Whitfield

Health authorities in Wuhan, Hubei Province, China, identified the novel coronavirus, 2019-nCoV, responsible for the outbreak of a mysterious pneumonia that resulted in hospitalization of more than 40 patients and one death, according to the Centers for Disease Control and Prevention in a statement on the CDC website.

On Jan. 13, the Thailand’s Ministry of Public Health reported the first imported case of lab-confirmed 2019-nCoV from Wuhan. The Centers for Disease Control and Prevention stated: “The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport, Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.”

Samples from this patient tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction. The genomic sequencing analysis was performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society, and the Thai National Institute of Health. The patient is reported to be in stable condition.

The New York Times has reported a case of 2019-nCoV in Japan in a traveler returning from Wuhan. That patient is reported to have recovered and been discharged.

Chinese health authorities transmitted the full genome of “2019 novel coronavirus,” or “2019-nCoV,” to GenBank, the genetic sequence database managed by the National Institutes of Health, and in the Global Initiative on Sharing All Influenza Data portal.

Coronaviruses are a large family of viruses. Most known human coronaviruses only cause mild respiratory disease, such as the common cold. But several coronaviruses have emerged to infect people and cause severe disease, such as has been seen with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in the Wuhan pneumonia outbreak have tested negative for both SARS and MERS.

The outbreak in Wuhan appears to be contained. The World Health Organization reported that the Wuhan health authorities identified and followed 763 close contacts, including health care workers. No additional cases of infection with the novel coronavirus have been identified. The cluster of cases is linked to the Wuhan South China Seafood City market where – in addition to seafood – chickens, bats, marmots, and other animals were sold. That market has been closed since Jan. 1, 2020, for cleaning and disinfection.

The WHO is monitoring the situation closely and is in close contact with Chinese health authorities.

The CDC has issued a Level 1 travel alert and recommended that travelers to Wuhan, a city of over 19 million people, avoid animal and meat markets, avoid contact with sick people, and wash hands often with soap and water. Travelers who have been in Wuhan recently and who experience respiratory symptoms should notify the local health department immediately.

In addition, the CDC recommends that, for symptomatic patients with a history of travel to Wuhan, caution should be exercised in the health care setting. “Ask such patients to don a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, implement contact and airborne isolation precautions, in addition to standard precautions, until further information becomes available. For additional infection control guidance see: www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”

[email protected]

The pneumonia outbreak in China traced to a novel coronavirus appears to be contained, although at least two cases have appeared in other countries.

CDC/ Dr. Fred Murphy; Sylvia Whitfield

Health authorities in Wuhan, Hubei Province, China, identified the novel coronavirus, 2019-nCoV, responsible for the outbreak of a mysterious pneumonia that resulted in hospitalization of more than 40 patients and one death, according to the Centers for Disease Control and Prevention in a statement on the CDC website.

On Jan. 13, the Thailand’s Ministry of Public Health reported the first imported case of lab-confirmed 2019-nCoV from Wuhan. The Centers for Disease Control and Prevention stated: “The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport, Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.”

Samples from this patient tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction. The genomic sequencing analysis was performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society, and the Thai National Institute of Health. The patient is reported to be in stable condition.

The New York Times has reported a case of 2019-nCoV in Japan in a traveler returning from Wuhan. That patient is reported to have recovered and been discharged.

Chinese health authorities transmitted the full genome of “2019 novel coronavirus,” or “2019-nCoV,” to GenBank, the genetic sequence database managed by the National Institutes of Health, and in the Global Initiative on Sharing All Influenza Data portal.

Coronaviruses are a large family of viruses. Most known human coronaviruses only cause mild respiratory disease, such as the common cold. But several coronaviruses have emerged to infect people and cause severe disease, such as has been seen with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in the Wuhan pneumonia outbreak have tested negative for both SARS and MERS.

The outbreak in Wuhan appears to be contained. The World Health Organization reported that the Wuhan health authorities identified and followed 763 close contacts, including health care workers. No additional cases of infection with the novel coronavirus have been identified. The cluster of cases is linked to the Wuhan South China Seafood City market where – in addition to seafood – chickens, bats, marmots, and other animals were sold. That market has been closed since Jan. 1, 2020, for cleaning and disinfection.

The WHO is monitoring the situation closely and is in close contact with Chinese health authorities.

The CDC has issued a Level 1 travel alert and recommended that travelers to Wuhan, a city of over 19 million people, avoid animal and meat markets, avoid contact with sick people, and wash hands often with soap and water. Travelers who have been in Wuhan recently and who experience respiratory symptoms should notify the local health department immediately.

In addition, the CDC recommends that, for symptomatic patients with a history of travel to Wuhan, caution should be exercised in the health care setting. “Ask such patients to don a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, implement contact and airborne isolation precautions, in addition to standard precautions, until further information becomes available. For additional infection control guidance see: www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”

[email protected]

The pneumonia outbreak in China traced to a novel coronavirus appears to be contained, although at least two cases have appeared in other countries.

CDC/ Dr. Fred Murphy; Sylvia Whitfield

Health authorities in Wuhan, Hubei Province, China, identified the novel coronavirus, 2019-nCoV, responsible for the outbreak of a mysterious pneumonia that resulted in hospitalization of more than 40 patients and one death, according to the Centers for Disease Control and Prevention in a statement on the CDC website.

On Jan. 13, the Thailand’s Ministry of Public Health reported the first imported case of lab-confirmed 2019-nCoV from Wuhan. The Centers for Disease Control and Prevention stated: “The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport, Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.”

Samples from this patient tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction. The genomic sequencing analysis was performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society, and the Thai National Institute of Health. The patient is reported to be in stable condition.

The New York Times has reported a case of 2019-nCoV in Japan in a traveler returning from Wuhan. That patient is reported to have recovered and been discharged.

Chinese health authorities transmitted the full genome of “2019 novel coronavirus,” or “2019-nCoV,” to GenBank, the genetic sequence database managed by the National Institutes of Health, and in the Global Initiative on Sharing All Influenza Data portal.

Coronaviruses are a large family of viruses. Most known human coronaviruses only cause mild respiratory disease, such as the common cold. But several coronaviruses have emerged to infect people and cause severe disease, such as has been seen with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in the Wuhan pneumonia outbreak have tested negative for both SARS and MERS.

The outbreak in Wuhan appears to be contained. The World Health Organization reported that the Wuhan health authorities identified and followed 763 close contacts, including health care workers. No additional cases of infection with the novel coronavirus have been identified. The cluster of cases is linked to the Wuhan South China Seafood City market where – in addition to seafood – chickens, bats, marmots, and other animals were sold. That market has been closed since Jan. 1, 2020, for cleaning and disinfection.

The WHO is monitoring the situation closely and is in close contact with Chinese health authorities.

The CDC has issued a Level 1 travel alert and recommended that travelers to Wuhan, a city of over 19 million people, avoid animal and meat markets, avoid contact with sick people, and wash hands often with soap and water. Travelers who have been in Wuhan recently and who experience respiratory symptoms should notify the local health department immediately.

In addition, the CDC recommends that, for symptomatic patients with a history of travel to Wuhan, caution should be exercised in the health care setting. “Ask such patients to don a surgical mask as soon as they are identified. Conduct their evaluation in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, implement contact and airborne isolation precautions, in addition to standard precautions, until further information becomes available. For additional infection control guidance see: www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.”

[email protected]

Declines in death rates for lung cancer and melanoma have gained momentum in recent years, fueling a record drop in cancer mortality, the American Cancer Society says.

Lung cancer death rates, which were falling by 3% in men and 2% in women annually in 2008 through 2013, dropped by 5% in men and nearly 4% per year in women annually from 2013 to 2017, according to the society’s 2020 statistical report.

Those accelerating reductions in death rates helped fuel the biggest-ever single year decline in overall cancer mortality, of 2.2%, from 2016 to 2017, their report shows.

According to the investigators, the decline in melanoma death rates escalated to 6.9% per year among 20- to 49-year-olds over 2013-2017, compared with a decline of just 2.9% per year during 2006-2010. Likewise, the melanoma death rate decline was 7.2% annually for the more recent time period, compared with just 1.3% annually in the earlier time period. The finding was even more remarkable for those 65 years of age and older, according to investigators, since the declines in melanoma death rates reached 6.2% annually, compared with a 0.9% annual increase in the years before immunotherapy.

Smoking cessation has been the main driver of progress in cutting lung cancer death rates, according to the report, while in melanoma, death rates have dropped after the introduction of immune checkpoint inhibitors and targeted therapies.

By contrast, reductions in death rates have slowed for colorectal cancers and female breast cancers, and have stabilized for prostate cancer, Ms. Siegel and coauthors stated, adding that racial and geographic disparities persist in preventable cancers, including those of the lung and cervix.

“Increased investment in both the equitable application of existing cancer control interventions and basic and clinical research to further advance treatment options would undoubtedly accelerate progress against cancer,” said the investigators. The report appears in CA: A Cancer Journal for Clinicians.

While the decline in lung cancer death rates is good news, the disease remains a major killer, responsible for more deaths than breast, colorectal, and ovarian cancer combined, said Jacques P. Fontaine, MD, a thoracic surgeon at Moffitt Cancer Center in Tampa, Fla.

“Five-year survival rates are still around the 18%-20% range, which is much lower than breast and prostate cancer,” Dr. Fontaine said in an interview. “Nonetheless, we’ve made a little dent in that, and we’re improving.”

Two other factors that have helped spur that improvement, according to Dr. Fontaine, are the reduced incidence of squamous cell carcinomas, which are linked to smoking, and the increased use of lung cancer screening with low-dose computed tomography.

Squamous cell carcinomas tend to be a central rather than peripheral, which makes the tumors harder to resect: “Surgery is sometimes not an option, and even to this day in 2020, the single most effective treatment for lung cancer remains surgical resection,” said Dr. Fontaine.

Likewise, centrally located tumors may preclude giving high-dose radiation and may result in more “collateral damage” to healthy tissue, he added.

Landmark studies show that low-dose CT scans reduce lung cancer deaths by 20% or more; however, screening can have false-positive results that lead to unnecessary biopsies and other harms, suggesting that the procedures should be done in centers of excellence that provide high-quality, responsible screening for early lung cancer, Dr. Fontaine said.

While the drop in melanoma death rates is encouraging and, not surprising in light of new cutting-edge therapies, an ongoing unmet treatment need still exists, according to Vishal Anil Patel, MD, director of cutaneous oncology at the George Washington Cancer Center in Washington.

“We still have a lot to learn, and a way to go, because we’ve really just made the first breakthrough,” Dr. Patel said in an interview.

SOURCE: Siegel RL et al. CA Cancer J Clin. 2020;70(1):7-30. doi: 10.3322/caac.21590.

Declines in death rates for lung cancer and melanoma have gained momentum in recent years, fueling a record drop in cancer mortality, the American Cancer Society says.

Lung cancer death rates, which were falling by 3% in men and 2% in women annually in 2008 through 2013, dropped by 5% in men and nearly 4% per year in women annually from 2013 to 2017, according to the society’s 2020 statistical report.

Those accelerating reductions in death rates helped fuel the biggest-ever single year decline in overall cancer mortality, of 2.2%, from 2016 to 2017, their report shows.

According to the investigators, the decline in melanoma death rates escalated to 6.9% per year among 20- to 49-year-olds over 2013-2017, compared with a decline of just 2.9% per year during 2006-2010. Likewise, the melanoma death rate decline was 7.2% annually for the more recent time period, compared with just 1.3% annually in the earlier time period. The finding was even more remarkable for those 65 years of age and older, according to investigators, since the declines in melanoma death rates reached 6.2% annually, compared with a 0.9% annual increase in the years before immunotherapy.

Smoking cessation has been the main driver of progress in cutting lung cancer death rates, according to the report, while in melanoma, death rates have dropped after the introduction of immune checkpoint inhibitors and targeted therapies.

By contrast, reductions in death rates have slowed for colorectal cancers and female breast cancers, and have stabilized for prostate cancer, Ms. Siegel and coauthors stated, adding that racial and geographic disparities persist in preventable cancers, including those of the lung and cervix.

“Increased investment in both the equitable application of existing cancer control interventions and basic and clinical research to further advance treatment options would undoubtedly accelerate progress against cancer,” said the investigators. The report appears in CA: A Cancer Journal for Clinicians.

While the decline in lung cancer death rates is good news, the disease remains a major killer, responsible for more deaths than breast, colorectal, and ovarian cancer combined, said Jacques P. Fontaine, MD, a thoracic surgeon at Moffitt Cancer Center in Tampa, Fla.

“Five-year survival rates are still around the 18%-20% range, which is much lower than breast and prostate cancer,” Dr. Fontaine said in an interview. “Nonetheless, we’ve made a little dent in that, and we’re improving.”

Two other factors that have helped spur that improvement, according to Dr. Fontaine, are the reduced incidence of squamous cell carcinomas, which are linked to smoking, and the increased use of lung cancer screening with low-dose computed tomography.

Squamous cell carcinomas tend to be a central rather than peripheral, which makes the tumors harder to resect: “Surgery is sometimes not an option, and even to this day in 2020, the single most effective treatment for lung cancer remains surgical resection,” said Dr. Fontaine.

Likewise, centrally located tumors may preclude giving high-dose radiation and may result in more “collateral damage” to healthy tissue, he added.

Landmark studies show that low-dose CT scans reduce lung cancer deaths by 20% or more; however, screening can have false-positive results that lead to unnecessary biopsies and other harms, suggesting that the procedures should be done in centers of excellence that provide high-quality, responsible screening for early lung cancer, Dr. Fontaine said.

While the drop in melanoma death rates is encouraging and, not surprising in light of new cutting-edge therapies, an ongoing unmet treatment need still exists, according to Vishal Anil Patel, MD, director of cutaneous oncology at the George Washington Cancer Center in Washington.

“We still have a lot to learn, and a way to go, because we’ve really just made the first breakthrough,” Dr. Patel said in an interview.

SOURCE: Siegel RL et al. CA Cancer J Clin. 2020;70(1):7-30. doi: 10.3322/caac.21590.

Declines in death rates for lung cancer and melanoma have gained momentum in recent years, fueling a record drop in cancer mortality, the American Cancer Society says.

Lung cancer death rates, which were falling by 3% in men and 2% in women annually in 2008 through 2013, dropped by 5% in men and nearly 4% per year in women annually from 2013 to 2017, according to the society’s 2020 statistical report.

Those accelerating reductions in death rates helped fuel the biggest-ever single year decline in overall cancer mortality, of 2.2%, from 2016 to 2017, their report shows.

According to the investigators, the decline in melanoma death rates escalated to 6.9% per year among 20- to 49-year-olds over 2013-2017, compared with a decline of just 2.9% per year during 2006-2010. Likewise, the melanoma death rate decline was 7.2% annually for the more recent time period, compared with just 1.3% annually in the earlier time period. The finding was even more remarkable for those 65 years of age and older, according to investigators, since the declines in melanoma death rates reached 6.2% annually, compared with a 0.9% annual increase in the years before immunotherapy.

Smoking cessation has been the main driver of progress in cutting lung cancer death rates, according to the report, while in melanoma, death rates have dropped after the introduction of immune checkpoint inhibitors and targeted therapies.

By contrast, reductions in death rates have slowed for colorectal cancers and female breast cancers, and have stabilized for prostate cancer, Ms. Siegel and coauthors stated, adding that racial and geographic disparities persist in preventable cancers, including those of the lung and cervix.

“Increased investment in both the equitable application of existing cancer control interventions and basic and clinical research to further advance treatment options would undoubtedly accelerate progress against cancer,” said the investigators. The report appears in CA: A Cancer Journal for Clinicians.

While the decline in lung cancer death rates is good news, the disease remains a major killer, responsible for more deaths than breast, colorectal, and ovarian cancer combined, said Jacques P. Fontaine, MD, a thoracic surgeon at Moffitt Cancer Center in Tampa, Fla.

“Five-year survival rates are still around the 18%-20% range, which is much lower than breast and prostate cancer,” Dr. Fontaine said in an interview. “Nonetheless, we’ve made a little dent in that, and we’re improving.”

Two other factors that have helped spur that improvement, according to Dr. Fontaine, are the reduced incidence of squamous cell carcinomas, which are linked to smoking, and the increased use of lung cancer screening with low-dose computed tomography.

Squamous cell carcinomas tend to be a central rather than peripheral, which makes the tumors harder to resect: “Surgery is sometimes not an option, and even to this day in 2020, the single most effective treatment for lung cancer remains surgical resection,” said Dr. Fontaine.

Likewise, centrally located tumors may preclude giving high-dose radiation and may result in more “collateral damage” to healthy tissue, he added.

Landmark studies show that low-dose CT scans reduce lung cancer deaths by 20% or more; however, screening can have false-positive results that lead to unnecessary biopsies and other harms, suggesting that the procedures should be done in centers of excellence that provide high-quality, responsible screening for early lung cancer, Dr. Fontaine said.

While the drop in melanoma death rates is encouraging and, not surprising in light of new cutting-edge therapies, an ongoing unmet treatment need still exists, according to Vishal Anil Patel, MD, director of cutaneous oncology at the George Washington Cancer Center in Washington.

“We still have a lot to learn, and a way to go, because we’ve really just made the first breakthrough,” Dr. Patel said in an interview.

SOURCE: Siegel RL et al. CA Cancer J Clin. 2020;70(1):7-30. doi: 10.3322/caac.21590.

Over the past 10 years, much has changed in the world of pediatric hospital medicine. The annual national PHM conference sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics (AAP), and the Academic Pediatric Association (APA) is robust; textbooks and journal articles in the field abound; and networks and training in research, quality improvement, and education are successful and ongoing.

Much of this did not exist or was in its infancy back in 2010. Since then, it has grown and greatly evolved. In parallel, medicine and society have changed. These influences on health care, along with the growth of the field over time, prompted a review and revision of the 2010 PHM Core Competencies published by SHM. With support from the society, the Pediatric Hospital Medicine Special Interest Group launched the plan for revision of the PHM Core Competencies.

The selected editors included Sandra Gage, MD, PhD, SFHM, of Phoenix Children’s Hospital; Erin Stucky Fisher, MD, MHM, of UCSD/Rady Children’s Hospital in San Diego; Jennifer Maniscalco, MD, MPH, of Johns Hopkins All Children’s Hospital in St. Petersburg, Fla.; and Sofia Teferi, MD, SFHM, a pediatric hospitalist based at Bon Secours St. Mary’s Hospital in Richmond, Va. They began their work in 2017 along with six associate editors, meeting every 2 weeks via conference call, dividing the work accordingly.

Dr. Teferi served in a new and critical role as contributing editor. She described her role as a “sweeper” of sorts, bringing her unique perspective to the process. “The other three members are from academic settings, and I’m from a community setting, which is very different,” Dr. Teferi said. “I went through all the chapters to ensure they were inclusive of the community setting.”

According to Dr. Gage, “the purpose of the original PHM Core Competencies was to define the roles and responsibilities of a PHM practitioner. In the intervening 10 years, the field has changed and matured, and we have solidified our role since then.”

Today’s pediatric hospitalists, for instance, may coordinate care in EDs, provide inpatient consultations, engage or lead quality improvement programs, and teach. The demands for pediatric hospital care today go beyond the training provided in a standard pediatric residency. The core competencies need to provide the information necessary, therefore, to ensure pediatric hospital medicine is practiced at its most informed level.
 

A profession transformed

At the time of the first set of core competencies, there were over 2,500 members in three core societies in which pediatric hospitalists were members: the AAP, the APA, and SHM. As of 2017, those numbers have swelled as the care for children in the hospital setting has shifted away from these patients’ primary care providers.

The original core competencies included 54 chapters, designed to be used independent of the others. They provided a foundation for the creation of pediatric hospital medicine and served to standardize and improve inpatient training practices.

For the new core competencies, every single chapter was reviewed line by line, Dr. Gage said. Many chapters had content modified, and new chapters were added to reflect the evolution of the field and of medicine. “We added about 14 new chapters, adjusted the titles of others, and significantly changed the content of over half,” Dr. Gage explained. “They are fairly broad changes, related to the breadth of the practice today.”

Dr. Teferi noted that practitioners can use the updated competencies with additions to the service lines that have arisen since the last version. “These include areas like step down and newborn nursery, things that weren’t part of our portfolio 10 years ago,” she said. “This reflects the fact that often you’ll see a hospital leader who might want to add to a hospitalist’s portfolio of services because there is no one else to do it. Or maybe community pediatrics no longer want to treat babies, so we add that. The settings vary widely today and we need the competencies to address that.”

Practices within these settings can also vary widely. Teaching, palliative care, airway management, critical care, and anesthesia may all come into play, among other factors. Research opportunities throughout the field also continue to expand.

Dr. Fisher said that the editors and associate editors kept in mind the fact that not every hospital would have all the resources necessary at its fingertips. “The competencies must reflect the realities of the variety of community settings,” she said. “Also, on a national level, the majority of pediatric patients are not seen in a children’s hospital. Community sites are where pediatric hospitalists are not only advocates for care, but can be working with limited resources – the ‘lone soldiers.’ We wanted to make sure the competencies reflect that reality and environment community site or not; academic site or not; tertiary care site or not; rural or not – these are overlapping but independent considerations for all who practice pediatric hospital medicine – a Venn diagram, and the PHM core competencies try to attend to all of those.”

This made Dr. Teferi’s perspective all the more important. “While many, including other editors and associate editors, work in community sites, Dr. Teferi has this as her unique and sole focus. She brought a unique viewpoint to the table,” Dr. Fisher said.

A goal of the core competencies is to make it possible for a pediatric hospitalist to move to a different practice environment and still provide the same level of high-quality care. “It’s difficult but important to grasp the concepts and competencies of various settings,” Dr. Fisher said. “In this way, our competencies are a parallel model to the adult hospitalist competencies.”

The editors surveyed practitioners across the country to gather their input on content, and brought on topic experts to write the new chapters. “If we didn’t have an author for a specific chapter or area from the last set of competencies, we came to a consensus on who the new one should be,” Dr. Gage explained. “We looked for known and accepted experts in the field by reviewing the literature and conference lecturers at all major PHM meetings.”

Once the editors and associate editors worked with authors to refine their chapter(s), the chapters were sent to multiple external reviewers including subgroups of SHM, AAP, and APA, as well as a variety of other associations. They provided input that the editors and associate editors collated, reviewed, and incorporated according to consensus and discussion with the authors.
 

A preview

As far as the actual changes go, some of new chapters include four common clinical, two core skills, three specialized services, and five health care systems, with many others undergoing content changes, according to Dr. Gage.

Major considerations in developing the new competencies include the national trend of rising mental health issues among young patients. According to the AAP, over the last decade the number of young people aged 6-17 years requiring mental health care has risen from 9% to more than 14%. In outpatient settings, many pediatricians report that half or more of their visits are dedicated to these issues, a number that may spill out into the hospital setting as well.

According to Dr. Fisher, pediatric hospitalists today see increasing numbers of chronic and acute diseases accompanied by mental and behavioral health issues. “We wanted to underscore this complexity in the competencies,” she explained. “We needed to focus new attention on how to identify and treat children with behavioral or psychiatric diagnoses or needs.”

Other new areas of focus include infection care and antimicrobial stewardship. “We see kids on antibiotics in hospital settings and we need to focus on narrowing choices, decreasing use, and shortening duration,” Dr. Gage said.

Dr. Maniscalco said that, overall, the changes represent the evolution of the field. “Pediatric hospitalists are taking on far more patients with acute and complex issues,” she explained. “Our skill set is coming into focus.”

Dr. Gage added that there is an increased need for pediatric hospitalists to be adept at “managing acute psychiatric care and navigating the mental health care arena.”

There’s also the growing need for an understanding of neonatal abstinence and opioid withdrawal syndrome. “This is definitely a hot topic and one that most hospitalists must address today,” Dr. Gage said. “That wasn’t the case a decade ago.”

Hospital care for pediatrics today often means a team effort, including pediatric hospitalists, surgeons, mental health professionals, and others. Often missing from the picture today are primary care physicians, who instead refer a growing percentage of their patients to hospitalists. The pediatric hospitalist’s role has evolved and grown from what it was 10 years ago, as reflected in the competencies.

“We are very much coordinating care and collaborating today in ways we weren’t 10 years ago,” said Dr. Gage. “There’s a lot more attention on creating partnerships. While we may not always be the ones performing procedures, we will most likely take part in patient care, especially as surgeons step farther away from care outside of the OR.”

The field has also become more family centered, said Dr. Gage. “All of health care today is more astute about the participation of families in care,” she said. “We kept that in mind in developing the competencies.”

Also important in this set of competencies was the concept of high-value care using evidence-based medicine.
 

Into the field

How exactly the core competencies will be utilized from one hospital or setting to the next will vary, said Dr. Fisher. “For some sites, they can aid existing teaching programs, and they will most likely adapt their curriculum to address the new competencies, informing how they teach.”

Even in centers where there isn’t a formal academic role, teaching still occurs. “Pediatric hospitalists have roles on committees and projects, and giving a talk to respiratory therapists, having group meetings – these all involve teaching in some form,” Dr. Fisher said. “Most physicians will determine how they wish to insert the competencies into their own education, as well as use them to educate others.”

Regardless of how they may be used locally, Dr. Fisher anticipates that the entire pediatric hospitalist community will appreciate the updates. “The competencies address our rapidly changing health care environment,” she said. “We believe the field will benefit from the additions and changes.”

Indeed, the core competencies will help standardize and improve consistency of care across the board. Improved efficiencies, economics, and practices are all desired and expected outcomes from the release of the revised competencies.

To ensure that the changes to the competencies are highlighted in settings nationwide, the editors and associate editors hope to present about them at upcoming conferences, including at the SHM 2020 Annual Conference, the Pediatric Hospital Medicine conference, the Pediatric Academic Societies conference, and the American Pediatric Association.

“We want to present to as many venues as possible to bring people up to speed and ensure they are aware of the changes,” Dr. Teferi said. “We’ll be including workshops with visual aids, along with our presentations.”

While this update represents a 10-year evolution, the editors and the SHM Pediatric Special Interest Group do not have an exact time frame for when the core competencies will need another revision. As quickly as the profession is developing, it may be as few as 5 years, but may also be another full decade.

“Like most fields, we will continue to evolve as our roles become better defined and we gain more knowledge,” Dr. Maniscalco said. “The core competencies represent the field whether a senior pediatric hospitalist, a fellow, or an educator. They bring the field together and provide education for everyone. That’s their role.”

Over the past 10 years, much has changed in the world of pediatric hospital medicine. The annual national PHM conference sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics (AAP), and the Academic Pediatric Association (APA) is robust; textbooks and journal articles in the field abound; and networks and training in research, quality improvement, and education are successful and ongoing.

Much of this did not exist or was in its infancy back in 2010. Since then, it has grown and greatly evolved. In parallel, medicine and society have changed. These influences on health care, along with the growth of the field over time, prompted a review and revision of the 2010 PHM Core Competencies published by SHM. With support from the society, the Pediatric Hospital Medicine Special Interest Group launched the plan for revision of the PHM Core Competencies.

The selected editors included Sandra Gage, MD, PhD, SFHM, of Phoenix Children’s Hospital; Erin Stucky Fisher, MD, MHM, of UCSD/Rady Children’s Hospital in San Diego; Jennifer Maniscalco, MD, MPH, of Johns Hopkins All Children’s Hospital in St. Petersburg, Fla.; and Sofia Teferi, MD, SFHM, a pediatric hospitalist based at Bon Secours St. Mary’s Hospital in Richmond, Va. They began their work in 2017 along with six associate editors, meeting every 2 weeks via conference call, dividing the work accordingly.

Dr. Teferi served in a new and critical role as contributing editor. She described her role as a “sweeper” of sorts, bringing her unique perspective to the process. “The other three members are from academic settings, and I’m from a community setting, which is very different,” Dr. Teferi said. “I went through all the chapters to ensure they were inclusive of the community setting.”

According to Dr. Gage, “the purpose of the original PHM Core Competencies was to define the roles and responsibilities of a PHM practitioner. In the intervening 10 years, the field has changed and matured, and we have solidified our role since then.”

Today’s pediatric hospitalists, for instance, may coordinate care in EDs, provide inpatient consultations, engage or lead quality improvement programs, and teach. The demands for pediatric hospital care today go beyond the training provided in a standard pediatric residency. The core competencies need to provide the information necessary, therefore, to ensure pediatric hospital medicine is practiced at its most informed level.
 

A profession transformed

At the time of the first set of core competencies, there were over 2,500 members in three core societies in which pediatric hospitalists were members: the AAP, the APA, and SHM. As of 2017, those numbers have swelled as the care for children in the hospital setting has shifted away from these patients’ primary care providers.

The original core competencies included 54 chapters, designed to be used independent of the others. They provided a foundation for the creation of pediatric hospital medicine and served to standardize and improve inpatient training practices.

For the new core competencies, every single chapter was reviewed line by line, Dr. Gage said. Many chapters had content modified, and new chapters were added to reflect the evolution of the field and of medicine. “We added about 14 new chapters, adjusted the titles of others, and significantly changed the content of over half,” Dr. Gage explained. “They are fairly broad changes, related to the breadth of the practice today.”

Dr. Teferi noted that practitioners can use the updated competencies with additions to the service lines that have arisen since the last version. “These include areas like step down and newborn nursery, things that weren’t part of our portfolio 10 years ago,” she said. “This reflects the fact that often you’ll see a hospital leader who might want to add to a hospitalist’s portfolio of services because there is no one else to do it. Or maybe community pediatrics no longer want to treat babies, so we add that. The settings vary widely today and we need the competencies to address that.”

Practices within these settings can also vary widely. Teaching, palliative care, airway management, critical care, and anesthesia may all come into play, among other factors. Research opportunities throughout the field also continue to expand.

Dr. Fisher said that the editors and associate editors kept in mind the fact that not every hospital would have all the resources necessary at its fingertips. “The competencies must reflect the realities of the variety of community settings,” she said. “Also, on a national level, the majority of pediatric patients are not seen in a children’s hospital. Community sites are where pediatric hospitalists are not only advocates for care, but can be working with limited resources – the ‘lone soldiers.’ We wanted to make sure the competencies reflect that reality and environment community site or not; academic site or not; tertiary care site or not; rural or not – these are overlapping but independent considerations for all who practice pediatric hospital medicine – a Venn diagram, and the PHM core competencies try to attend to all of those.”

This made Dr. Teferi’s perspective all the more important. “While many, including other editors and associate editors, work in community sites, Dr. Teferi has this as her unique and sole focus. She brought a unique viewpoint to the table,” Dr. Fisher said.

A goal of the core competencies is to make it possible for a pediatric hospitalist to move to a different practice environment and still provide the same level of high-quality care. “It’s difficult but important to grasp the concepts and competencies of various settings,” Dr. Fisher said. “In this way, our competencies are a parallel model to the adult hospitalist competencies.”

The editors surveyed practitioners across the country to gather their input on content, and brought on topic experts to write the new chapters. “If we didn’t have an author for a specific chapter or area from the last set of competencies, we came to a consensus on who the new one should be,” Dr. Gage explained. “We looked for known and accepted experts in the field by reviewing the literature and conference lecturers at all major PHM meetings.”

Once the editors and associate editors worked with authors to refine their chapter(s), the chapters were sent to multiple external reviewers including subgroups of SHM, AAP, and APA, as well as a variety of other associations. They provided input that the editors and associate editors collated, reviewed, and incorporated according to consensus and discussion with the authors.
 

A preview

As far as the actual changes go, some of new chapters include four common clinical, two core skills, three specialized services, and five health care systems, with many others undergoing content changes, according to Dr. Gage.

Major considerations in developing the new competencies include the national trend of rising mental health issues among young patients. According to the AAP, over the last decade the number of young people aged 6-17 years requiring mental health care has risen from 9% to more than 14%. In outpatient settings, many pediatricians report that half or more of their visits are dedicated to these issues, a number that may spill out into the hospital setting as well.

According to Dr. Fisher, pediatric hospitalists today see increasing numbers of chronic and acute diseases accompanied by mental and behavioral health issues. “We wanted to underscore this complexity in the competencies,” she explained. “We needed to focus new attention on how to identify and treat children with behavioral or psychiatric diagnoses or needs.”

Other new areas of focus include infection care and antimicrobial stewardship. “We see kids on antibiotics in hospital settings and we need to focus on narrowing choices, decreasing use, and shortening duration,” Dr. Gage said.

Dr. Maniscalco said that, overall, the changes represent the evolution of the field. “Pediatric hospitalists are taking on far more patients with acute and complex issues,” she explained. “Our skill set is coming into focus.”

Dr. Gage added that there is an increased need for pediatric hospitalists to be adept at “managing acute psychiatric care and navigating the mental health care arena.”

There’s also the growing need for an understanding of neonatal abstinence and opioid withdrawal syndrome. “This is definitely a hot topic and one that most hospitalists must address today,” Dr. Gage said. “That wasn’t the case a decade ago.”

Hospital care for pediatrics today often means a team effort, including pediatric hospitalists, surgeons, mental health professionals, and others. Often missing from the picture today are primary care physicians, who instead refer a growing percentage of their patients to hospitalists. The pediatric hospitalist’s role has evolved and grown from what it was 10 years ago, as reflected in the competencies.

“We are very much coordinating care and collaborating today in ways we weren’t 10 years ago,” said Dr. Gage. “There’s a lot more attention on creating partnerships. While we may not always be the ones performing procedures, we will most likely take part in patient care, especially as surgeons step farther away from care outside of the OR.”

The field has also become more family centered, said Dr. Gage. “All of health care today is more astute about the participation of families in care,” she said. “We kept that in mind in developing the competencies.”

Also important in this set of competencies was the concept of high-value care using evidence-based medicine.
 

Into the field

How exactly the core competencies will be utilized from one hospital or setting to the next will vary, said Dr. Fisher. “For some sites, they can aid existing teaching programs, and they will most likely adapt their curriculum to address the new competencies, informing how they teach.”

Even in centers where there isn’t a formal academic role, teaching still occurs. “Pediatric hospitalists have roles on committees and projects, and giving a talk to respiratory therapists, having group meetings – these all involve teaching in some form,” Dr. Fisher said. “Most physicians will determine how they wish to insert the competencies into their own education, as well as use them to educate others.”

Regardless of how they may be used locally, Dr. Fisher anticipates that the entire pediatric hospitalist community will appreciate the updates. “The competencies address our rapidly changing health care environment,” she said. “We believe the field will benefit from the additions and changes.”

Indeed, the core competencies will help standardize and improve consistency of care across the board. Improved efficiencies, economics, and practices are all desired and expected outcomes from the release of the revised competencies.

To ensure that the changes to the competencies are highlighted in settings nationwide, the editors and associate editors hope to present about them at upcoming conferences, including at the SHM 2020 Annual Conference, the Pediatric Hospital Medicine conference, the Pediatric Academic Societies conference, and the American Pediatric Association.

“We want to present to as many venues as possible to bring people up to speed and ensure they are aware of the changes,” Dr. Teferi said. “We’ll be including workshops with visual aids, along with our presentations.”

While this update represents a 10-year evolution, the editors and the SHM Pediatric Special Interest Group do not have an exact time frame for when the core competencies will need another revision. As quickly as the profession is developing, it may be as few as 5 years, but may also be another full decade.

“Like most fields, we will continue to evolve as our roles become better defined and we gain more knowledge,” Dr. Maniscalco said. “The core competencies represent the field whether a senior pediatric hospitalist, a fellow, or an educator. They bring the field together and provide education for everyone. That’s their role.”

Over the past 10 years, much has changed in the world of pediatric hospital medicine. The annual national PHM conference sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics (AAP), and the Academic Pediatric Association (APA) is robust; textbooks and journal articles in the field abound; and networks and training in research, quality improvement, and education are successful and ongoing.

Much of this did not exist or was in its infancy back in 2010. Since then, it has grown and greatly evolved. In parallel, medicine and society have changed. These influences on health care, along with the growth of the field over time, prompted a review and revision of the 2010 PHM Core Competencies published by SHM. With support from the society, the Pediatric Hospital Medicine Special Interest Group launched the plan for revision of the PHM Core Competencies.

The selected editors included Sandra Gage, MD, PhD, SFHM, of Phoenix Children’s Hospital; Erin Stucky Fisher, MD, MHM, of UCSD/Rady Children’s Hospital in San Diego; Jennifer Maniscalco, MD, MPH, of Johns Hopkins All Children’s Hospital in St. Petersburg, Fla.; and Sofia Teferi, MD, SFHM, a pediatric hospitalist based at Bon Secours St. Mary’s Hospital in Richmond, Va. They began their work in 2017 along with six associate editors, meeting every 2 weeks via conference call, dividing the work accordingly.

Dr. Teferi served in a new and critical role as contributing editor. She described her role as a “sweeper” of sorts, bringing her unique perspective to the process. “The other three members are from academic settings, and I’m from a community setting, which is very different,” Dr. Teferi said. “I went through all the chapters to ensure they were inclusive of the community setting.”

According to Dr. Gage, “the purpose of the original PHM Core Competencies was to define the roles and responsibilities of a PHM practitioner. In the intervening 10 years, the field has changed and matured, and we have solidified our role since then.”

Today’s pediatric hospitalists, for instance, may coordinate care in EDs, provide inpatient consultations, engage or lead quality improvement programs, and teach. The demands for pediatric hospital care today go beyond the training provided in a standard pediatric residency. The core competencies need to provide the information necessary, therefore, to ensure pediatric hospital medicine is practiced at its most informed level.
 

A profession transformed

At the time of the first set of core competencies, there were over 2,500 members in three core societies in which pediatric hospitalists were members: the AAP, the APA, and SHM. As of 2017, those numbers have swelled as the care for children in the hospital setting has shifted away from these patients’ primary care providers.

The original core competencies included 54 chapters, designed to be used independent of the others. They provided a foundation for the creation of pediatric hospital medicine and served to standardize and improve inpatient training practices.

For the new core competencies, every single chapter was reviewed line by line, Dr. Gage said. Many chapters had content modified, and new chapters were added to reflect the evolution of the field and of medicine. “We added about 14 new chapters, adjusted the titles of others, and significantly changed the content of over half,” Dr. Gage explained. “They are fairly broad changes, related to the breadth of the practice today.”

Dr. Teferi noted that practitioners can use the updated competencies with additions to the service lines that have arisen since the last version. “These include areas like step down and newborn nursery, things that weren’t part of our portfolio 10 years ago,” she said. “This reflects the fact that often you’ll see a hospital leader who might want to add to a hospitalist’s portfolio of services because there is no one else to do it. Or maybe community pediatrics no longer want to treat babies, so we add that. The settings vary widely today and we need the competencies to address that.”

Practices within these settings can also vary widely. Teaching, palliative care, airway management, critical care, and anesthesia may all come into play, among other factors. Research opportunities throughout the field also continue to expand.

Dr. Fisher said that the editors and associate editors kept in mind the fact that not every hospital would have all the resources necessary at its fingertips. “The competencies must reflect the realities of the variety of community settings,” she said. “Also, on a national level, the majority of pediatric patients are not seen in a children’s hospital. Community sites are where pediatric hospitalists are not only advocates for care, but can be working with limited resources – the ‘lone soldiers.’ We wanted to make sure the competencies reflect that reality and environment community site or not; academic site or not; tertiary care site or not; rural or not – these are overlapping but independent considerations for all who practice pediatric hospital medicine – a Venn diagram, and the PHM core competencies try to attend to all of those.”

This made Dr. Teferi’s perspective all the more important. “While many, including other editors and associate editors, work in community sites, Dr. Teferi has this as her unique and sole focus. She brought a unique viewpoint to the table,” Dr. Fisher said.

A goal of the core competencies is to make it possible for a pediatric hospitalist to move to a different practice environment and still provide the same level of high-quality care. “It’s difficult but important to grasp the concepts and competencies of various settings,” Dr. Fisher said. “In this way, our competencies are a parallel model to the adult hospitalist competencies.”

The editors surveyed practitioners across the country to gather their input on content, and brought on topic experts to write the new chapters. “If we didn’t have an author for a specific chapter or area from the last set of competencies, we came to a consensus on who the new one should be,” Dr. Gage explained. “We looked for known and accepted experts in the field by reviewing the literature and conference lecturers at all major PHM meetings.”

Once the editors and associate editors worked with authors to refine their chapter(s), the chapters were sent to multiple external reviewers including subgroups of SHM, AAP, and APA, as well as a variety of other associations. They provided input that the editors and associate editors collated, reviewed, and incorporated according to consensus and discussion with the authors.
 

A preview

As far as the actual changes go, some of new chapters include four common clinical, two core skills, three specialized services, and five health care systems, with many others undergoing content changes, according to Dr. Gage.

Major considerations in developing the new competencies include the national trend of rising mental health issues among young patients. According to the AAP, over the last decade the number of young people aged 6-17 years requiring mental health care has risen from 9% to more than 14%. In outpatient settings, many pediatricians report that half or more of their visits are dedicated to these issues, a number that may spill out into the hospital setting as well.

According to Dr. Fisher, pediatric hospitalists today see increasing numbers of chronic and acute diseases accompanied by mental and behavioral health issues. “We wanted to underscore this complexity in the competencies,” she explained. “We needed to focus new attention on how to identify and treat children with behavioral or psychiatric diagnoses or needs.”

Other new areas of focus include infection care and antimicrobial stewardship. “We see kids on antibiotics in hospital settings and we need to focus on narrowing choices, decreasing use, and shortening duration,” Dr. Gage said.

Dr. Maniscalco said that, overall, the changes represent the evolution of the field. “Pediatric hospitalists are taking on far more patients with acute and complex issues,” she explained. “Our skill set is coming into focus.”

Dr. Gage added that there is an increased need for pediatric hospitalists to be adept at “managing acute psychiatric care and navigating the mental health care arena.”

There’s also the growing need for an understanding of neonatal abstinence and opioid withdrawal syndrome. “This is definitely a hot topic and one that most hospitalists must address today,” Dr. Gage said. “That wasn’t the case a decade ago.”

Hospital care for pediatrics today often means a team effort, including pediatric hospitalists, surgeons, mental health professionals, and others. Often missing from the picture today are primary care physicians, who instead refer a growing percentage of their patients to hospitalists. The pediatric hospitalist’s role has evolved and grown from what it was 10 years ago, as reflected in the competencies.

“We are very much coordinating care and collaborating today in ways we weren’t 10 years ago,” said Dr. Gage. “There’s a lot more attention on creating partnerships. While we may not always be the ones performing procedures, we will most likely take part in patient care, especially as surgeons step farther away from care outside of the OR.”

The field has also become more family centered, said Dr. Gage. “All of health care today is more astute about the participation of families in care,” she said. “We kept that in mind in developing the competencies.”

Also important in this set of competencies was the concept of high-value care using evidence-based medicine.
 

Into the field

How exactly the core competencies will be utilized from one hospital or setting to the next will vary, said Dr. Fisher. “For some sites, they can aid existing teaching programs, and they will most likely adapt their curriculum to address the new competencies, informing how they teach.”

Even in centers where there isn’t a formal academic role, teaching still occurs. “Pediatric hospitalists have roles on committees and projects, and giving a talk to respiratory therapists, having group meetings – these all involve teaching in some form,” Dr. Fisher said. “Most physicians will determine how they wish to insert the competencies into their own education, as well as use them to educate others.”

Regardless of how they may be used locally, Dr. Fisher anticipates that the entire pediatric hospitalist community will appreciate the updates. “The competencies address our rapidly changing health care environment,” she said. “We believe the field will benefit from the additions and changes.”

Indeed, the core competencies will help standardize and improve consistency of care across the board. Improved efficiencies, economics, and practices are all desired and expected outcomes from the release of the revised competencies.

To ensure that the changes to the competencies are highlighted in settings nationwide, the editors and associate editors hope to present about them at upcoming conferences, including at the SHM 2020 Annual Conference, the Pediatric Hospital Medicine conference, the Pediatric Academic Societies conference, and the American Pediatric Association.

“We want to present to as many venues as possible to bring people up to speed and ensure they are aware of the changes,” Dr. Teferi said. “We’ll be including workshops with visual aids, along with our presentations.”

While this update represents a 10-year evolution, the editors and the SHM Pediatric Special Interest Group do not have an exact time frame for when the core competencies will need another revision. As quickly as the profession is developing, it may be as few as 5 years, but may also be another full decade.

“Like most fields, we will continue to evolve as our roles become better defined and we gain more knowledge,” Dr. Maniscalco said. “The core competencies represent the field whether a senior pediatric hospitalist, a fellow, or an educator. They bring the field together and provide education for everyone. That’s their role.”