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NetWorks: Uranium mining, hyperoxia, palliative care education, OSA impact
Health effects of uranium mining
Decay series of U 238
Prior to 1900, uranium was used only for coloring glass. After discovery of radium by Madame Curie in 1898, uranium was widely mined to obtain radium (a decay product of uranium).
While uranium was not directly mined until 1900, uranium contaminates were in the ore in silver and cobalt mines in Czechoslovakia, which were heavily mined in the 18th and 19th centuries.
There were no reports (written in English) of lung cancer associated with radiation until 1942; but in 1944, these results were called into question in a monograph from the National Cancer Institute. The carcinogenicity of radon was confirmed in 1951; however, this remained an internal government document until 1980. By 1967, the increased prevalence of lung cancer in uranium miners was widely known. By 1970, new ventilation standards for uranium mines were established.
Lung cancer risk associated with uranium mining is the result of exposure to radon gas and specifically radon progeny of Polonium 218 and 210. These radon progeny remain suspended in air, attached to ambient particles (diesel exhaust, silica) and are then inhaled into the lung, where they tend to precipitate on the major airways. Polonium 218 and 210 are alpha emitters, which have a 20-fold increase in energy compared with gamma rays (the primary radiation source in radiation therapy). Given the mass of alpha particles (two protons and two neutrons), they interact with superficial tissues; thus, once deposited in the large airways, a large radiation dose is directed to the respiratory epithelium of these airways.
Occupational control of exposure to radon and radon progeny is accomplished primarily by ventilation. In high-grade deposits of uranium, such as the 20% ore grades in the Athabasca Basin of Saskatchewan, remote control mining is performed.
Smoking, in combination with occupational exposure to radon progeny, carries a greater than additive but less than multiplicative risk of lung cancer.
In addition to the lung cancer risk associated with radon progeny exposure, uranium miners share the occupational risks of other miners: exposure to silica and diesel exhaust. Miners are also at risk for traumatic injuries, including electrocution.
Health effects associated with uranium milling, enrichment, and tailings will be discussed in a subsequent CHEST Physician article.
Richard B. Evans, MD, MPH, FCCP
Steering Committee Chair
Hyperoxia in critically ill patients: What’s the verdict?
Oxygen saturation is considered to be the “fifth vital sign,” and current guidelines recommend target oxygen saturation (SpO2) between 94% and 98%, with lower targets for patients at risk for hypercapnic respiratory failure (O’Driscoll BR et al. Thorax. 2008;63(suppl):vi1). Oxygen toxicity is well-demonstrated in experimental animal studies. While its incidence and impact on outcomes is difficult to determine in the clinical setting, increases in-hospital mortality have been associated with hyperoxia in patients with cardiac arrest, acute myocardial infarction, and stroke (Kligannon et al. JAMA. 2010;303[21]:2165; Stub et al. Circulation. 2015;131[24]:2143; Rincon et al. Crit Care Med. 2014;42[2]:387).
Complementing the findings of Girardis and colleagues, a recent analysis of more than 14,000 critically ill patients, found that time spent at PaO2 > 200 mm Hg was associated with excess mortality and fewer ventilator-free days (Helmerhorst et al. Crit Care Med. 2017;45[2]:187).
While other trials demonstrated safety and feasibility of conservative oxygen therapy in critically ill patients (Panwar et al. Am J Respir Crit Care Med. 2016;193[1]:43; Helmerhorst et al. Crit Care Med. 2016; 44[3]:554; Suzuki et al. Crit Care Med. 2014;42[6]:1414), they did not find significant differences between conservative and liberal oxygen therapy with regards to new organ dysfunction or mortality. However, the degree of hyperoxia was usually more modest than in either the Girardis trial or the Helmerhorst (2017) analysis.
Amanpreet Kaur, MD
Steering Committee Fellow-in-Training
David L. Bowton, MD, FCCP
Steering Committee Chair
Education in palliative medicine
Prompted by concerns that the Affordable Care Act would be instituting “death panels” as part of cost-containment measures, “Dying in America” (a 2015 report of the Institute of Medicine [IOM]) identified compassionate, affordable, and effective care for patients at the end of their lives as a “national priority” in American health care. The IOM identified the education of all primary care providers in the delivery of basic palliative care, specifically commenting that all clinicians who manage patients with serious, life-threatening illnesses should be “competent in basic palliative care” (IOM, The National Academies Press 2015).
Check out our NetWork Storify page later this year for links to the ongoing discussion surrounding palliative care in medicine and for useful tools in the effort to provide palliative care to all our patients.
Laura Johnson, MD, FCCP
Steering Committee Vice Chair
The impact of sleep apnea: Why should we care?
With recent large trials such as the SAVE and the SERVE-HF studies challenging the cardiovascular benefits of treating sleep-disordered breathing in specific patient subsets, many physicians may start to question, “Why all the fuss?” The Sleep NetWork is bringing the leaders in the field to CHEST 2017 to discuss their take on where we stand with the connection between sleep-disordered breathing and cardiovascular disease, so stay tuned!
Our relationships, general health, and work productivity can be affected by untreated OSA. The effect on daily life may not be initially obvious. Patients often present only at the insistence of their partner or physician, only to be surprised at how much better they feel once treated. Symptoms of OSA are associated with a higher rate of impaired work performance, sick leave, and divorce (Grunstein et al. Sleep. 1995;18[8]:635). A recent survey estimates an $86.9 billion loss of workplace productivity due to sleep apnea in 2015 (Frost & Sullivan. Hidden health crisis costing America billions. AASM; 2016. http://www.aasmnet.org/Resources/pdf/sleep-apnea-economic-crisis.pdf. Accessed March 21, 2017.). The same survey found that among those who are employed, treating OSA was associated with a decline in absences by 1.8 days per year and an increase in productivity 17.3% on average. Considering that the majority of OSA remains undiagnosed, this could have tremendous economic impact.
OSA is an important public health burden. The Sleep NetWork is committed to increasing awareness among individuals (patients and clinicians) and institutions (transportation agencies, government) of the impact of sleep-disordered breathing on society.
Aneesa Das, MD, FCCP
Steering Committee Chair
Health effects of uranium mining
Decay series of U 238
Prior to 1900, uranium was used only for coloring glass. After discovery of radium by Madame Curie in 1898, uranium was widely mined to obtain radium (a decay product of uranium).
While uranium was not directly mined until 1900, uranium contaminates were in the ore in silver and cobalt mines in Czechoslovakia, which were heavily mined in the 18th and 19th centuries.
There were no reports (written in English) of lung cancer associated with radiation until 1942; but in 1944, these results were called into question in a monograph from the National Cancer Institute. The carcinogenicity of radon was confirmed in 1951; however, this remained an internal government document until 1980. By 1967, the increased prevalence of lung cancer in uranium miners was widely known. By 1970, new ventilation standards for uranium mines were established.
Lung cancer risk associated with uranium mining is the result of exposure to radon gas and specifically radon progeny of Polonium 218 and 210. These radon progeny remain suspended in air, attached to ambient particles (diesel exhaust, silica) and are then inhaled into the lung, where they tend to precipitate on the major airways. Polonium 218 and 210 are alpha emitters, which have a 20-fold increase in energy compared with gamma rays (the primary radiation source in radiation therapy). Given the mass of alpha particles (two protons and two neutrons), they interact with superficial tissues; thus, once deposited in the large airways, a large radiation dose is directed to the respiratory epithelium of these airways.
Occupational control of exposure to radon and radon progeny is accomplished primarily by ventilation. In high-grade deposits of uranium, such as the 20% ore grades in the Athabasca Basin of Saskatchewan, remote control mining is performed.
Smoking, in combination with occupational exposure to radon progeny, carries a greater than additive but less than multiplicative risk of lung cancer.
In addition to the lung cancer risk associated with radon progeny exposure, uranium miners share the occupational risks of other miners: exposure to silica and diesel exhaust. Miners are also at risk for traumatic injuries, including electrocution.
Health effects associated with uranium milling, enrichment, and tailings will be discussed in a subsequent CHEST Physician article.
Richard B. Evans, MD, MPH, FCCP
Steering Committee Chair
Hyperoxia in critically ill patients: What’s the verdict?
Oxygen saturation is considered to be the “fifth vital sign,” and current guidelines recommend target oxygen saturation (SpO2) between 94% and 98%, with lower targets for patients at risk for hypercapnic respiratory failure (O’Driscoll BR et al. Thorax. 2008;63(suppl):vi1). Oxygen toxicity is well-demonstrated in experimental animal studies. While its incidence and impact on outcomes is difficult to determine in the clinical setting, increases in-hospital mortality have been associated with hyperoxia in patients with cardiac arrest, acute myocardial infarction, and stroke (Kligannon et al. JAMA. 2010;303[21]:2165; Stub et al. Circulation. 2015;131[24]:2143; Rincon et al. Crit Care Med. 2014;42[2]:387).
Complementing the findings of Girardis and colleagues, a recent analysis of more than 14,000 critically ill patients, found that time spent at PaO2 > 200 mm Hg was associated with excess mortality and fewer ventilator-free days (Helmerhorst et al. Crit Care Med. 2017;45[2]:187).
While other trials demonstrated safety and feasibility of conservative oxygen therapy in critically ill patients (Panwar et al. Am J Respir Crit Care Med. 2016;193[1]:43; Helmerhorst et al. Crit Care Med. 2016; 44[3]:554; Suzuki et al. Crit Care Med. 2014;42[6]:1414), they did not find significant differences between conservative and liberal oxygen therapy with regards to new organ dysfunction or mortality. However, the degree of hyperoxia was usually more modest than in either the Girardis trial or the Helmerhorst (2017) analysis.
Amanpreet Kaur, MD
Steering Committee Fellow-in-Training
David L. Bowton, MD, FCCP
Steering Committee Chair
Education in palliative medicine
Prompted by concerns that the Affordable Care Act would be instituting “death panels” as part of cost-containment measures, “Dying in America” (a 2015 report of the Institute of Medicine [IOM]) identified compassionate, affordable, and effective care for patients at the end of their lives as a “national priority” in American health care. The IOM identified the education of all primary care providers in the delivery of basic palliative care, specifically commenting that all clinicians who manage patients with serious, life-threatening illnesses should be “competent in basic palliative care” (IOM, The National Academies Press 2015).
Check out our NetWork Storify page later this year for links to the ongoing discussion surrounding palliative care in medicine and for useful tools in the effort to provide palliative care to all our patients.
Laura Johnson, MD, FCCP
Steering Committee Vice Chair
The impact of sleep apnea: Why should we care?
With recent large trials such as the SAVE and the SERVE-HF studies challenging the cardiovascular benefits of treating sleep-disordered breathing in specific patient subsets, many physicians may start to question, “Why all the fuss?” The Sleep NetWork is bringing the leaders in the field to CHEST 2017 to discuss their take on where we stand with the connection between sleep-disordered breathing and cardiovascular disease, so stay tuned!
Our relationships, general health, and work productivity can be affected by untreated OSA. The effect on daily life may not be initially obvious. Patients often present only at the insistence of their partner or physician, only to be surprised at how much better they feel once treated. Symptoms of OSA are associated with a higher rate of impaired work performance, sick leave, and divorce (Grunstein et al. Sleep. 1995;18[8]:635). A recent survey estimates an $86.9 billion loss of workplace productivity due to sleep apnea in 2015 (Frost & Sullivan. Hidden health crisis costing America billions. AASM; 2016. http://www.aasmnet.org/Resources/pdf/sleep-apnea-economic-crisis.pdf. Accessed March 21, 2017.). The same survey found that among those who are employed, treating OSA was associated with a decline in absences by 1.8 days per year and an increase in productivity 17.3% on average. Considering that the majority of OSA remains undiagnosed, this could have tremendous economic impact.
OSA is an important public health burden. The Sleep NetWork is committed to increasing awareness among individuals (patients and clinicians) and institutions (transportation agencies, government) of the impact of sleep-disordered breathing on society.
Aneesa Das, MD, FCCP
Steering Committee Chair
Health effects of uranium mining
Decay series of U 238
Prior to 1900, uranium was used only for coloring glass. After discovery of radium by Madame Curie in 1898, uranium was widely mined to obtain radium (a decay product of uranium).
While uranium was not directly mined until 1900, uranium contaminates were in the ore in silver and cobalt mines in Czechoslovakia, which were heavily mined in the 18th and 19th centuries.
There were no reports (written in English) of lung cancer associated with radiation until 1942; but in 1944, these results were called into question in a monograph from the National Cancer Institute. The carcinogenicity of radon was confirmed in 1951; however, this remained an internal government document until 1980. By 1967, the increased prevalence of lung cancer in uranium miners was widely known. By 1970, new ventilation standards for uranium mines were established.
Lung cancer risk associated with uranium mining is the result of exposure to radon gas and specifically radon progeny of Polonium 218 and 210. These radon progeny remain suspended in air, attached to ambient particles (diesel exhaust, silica) and are then inhaled into the lung, where they tend to precipitate on the major airways. Polonium 218 and 210 are alpha emitters, which have a 20-fold increase in energy compared with gamma rays (the primary radiation source in radiation therapy). Given the mass of alpha particles (two protons and two neutrons), they interact with superficial tissues; thus, once deposited in the large airways, a large radiation dose is directed to the respiratory epithelium of these airways.
Occupational control of exposure to radon and radon progeny is accomplished primarily by ventilation. In high-grade deposits of uranium, such as the 20% ore grades in the Athabasca Basin of Saskatchewan, remote control mining is performed.
Smoking, in combination with occupational exposure to radon progeny, carries a greater than additive but less than multiplicative risk of lung cancer.
In addition to the lung cancer risk associated with radon progeny exposure, uranium miners share the occupational risks of other miners: exposure to silica and diesel exhaust. Miners are also at risk for traumatic injuries, including electrocution.
Health effects associated with uranium milling, enrichment, and tailings will be discussed in a subsequent CHEST Physician article.
Richard B. Evans, MD, MPH, FCCP
Steering Committee Chair
Hyperoxia in critically ill patients: What’s the verdict?
Oxygen saturation is considered to be the “fifth vital sign,” and current guidelines recommend target oxygen saturation (SpO2) between 94% and 98%, with lower targets for patients at risk for hypercapnic respiratory failure (O’Driscoll BR et al. Thorax. 2008;63(suppl):vi1). Oxygen toxicity is well-demonstrated in experimental animal studies. While its incidence and impact on outcomes is difficult to determine in the clinical setting, increases in-hospital mortality have been associated with hyperoxia in patients with cardiac arrest, acute myocardial infarction, and stroke (Kligannon et al. JAMA. 2010;303[21]:2165; Stub et al. Circulation. 2015;131[24]:2143; Rincon et al. Crit Care Med. 2014;42[2]:387).
Complementing the findings of Girardis and colleagues, a recent analysis of more than 14,000 critically ill patients, found that time spent at PaO2 > 200 mm Hg was associated with excess mortality and fewer ventilator-free days (Helmerhorst et al. Crit Care Med. 2017;45[2]:187).
While other trials demonstrated safety and feasibility of conservative oxygen therapy in critically ill patients (Panwar et al. Am J Respir Crit Care Med. 2016;193[1]:43; Helmerhorst et al. Crit Care Med. 2016; 44[3]:554; Suzuki et al. Crit Care Med. 2014;42[6]:1414), they did not find significant differences between conservative and liberal oxygen therapy with regards to new organ dysfunction or mortality. However, the degree of hyperoxia was usually more modest than in either the Girardis trial or the Helmerhorst (2017) analysis.
Amanpreet Kaur, MD
Steering Committee Fellow-in-Training
David L. Bowton, MD, FCCP
Steering Committee Chair
Education in palliative medicine
Prompted by concerns that the Affordable Care Act would be instituting “death panels” as part of cost-containment measures, “Dying in America” (a 2015 report of the Institute of Medicine [IOM]) identified compassionate, affordable, and effective care for patients at the end of their lives as a “national priority” in American health care. The IOM identified the education of all primary care providers in the delivery of basic palliative care, specifically commenting that all clinicians who manage patients with serious, life-threatening illnesses should be “competent in basic palliative care” (IOM, The National Academies Press 2015).
Check out our NetWork Storify page later this year for links to the ongoing discussion surrounding palliative care in medicine and for useful tools in the effort to provide palliative care to all our patients.
Laura Johnson, MD, FCCP
Steering Committee Vice Chair
The impact of sleep apnea: Why should we care?
With recent large trials such as the SAVE and the SERVE-HF studies challenging the cardiovascular benefits of treating sleep-disordered breathing in specific patient subsets, many physicians may start to question, “Why all the fuss?” The Sleep NetWork is bringing the leaders in the field to CHEST 2017 to discuss their take on where we stand with the connection between sleep-disordered breathing and cardiovascular disease, so stay tuned!
Our relationships, general health, and work productivity can be affected by untreated OSA. The effect on daily life may not be initially obvious. Patients often present only at the insistence of their partner or physician, only to be surprised at how much better they feel once treated. Symptoms of OSA are associated with a higher rate of impaired work performance, sick leave, and divorce (Grunstein et al. Sleep. 1995;18[8]:635). A recent survey estimates an $86.9 billion loss of workplace productivity due to sleep apnea in 2015 (Frost & Sullivan. Hidden health crisis costing America billions. AASM; 2016. http://www.aasmnet.org/Resources/pdf/sleep-apnea-economic-crisis.pdf. Accessed March 21, 2017.). The same survey found that among those who are employed, treating OSA was associated with a decline in absences by 1.8 days per year and an increase in productivity 17.3% on average. Considering that the majority of OSA remains undiagnosed, this could have tremendous economic impact.
OSA is an important public health burden. The Sleep NetWork is committed to increasing awareness among individuals (patients and clinicians) and institutions (transportation agencies, government) of the impact of sleep-disordered breathing on society.
Aneesa Das, MD, FCCP
Steering Committee Chair
In Memoriam
Sandra K. Willsie, DO, FCCP, died on March 26, 2017, after a courageous battle with brain cancer. As an osteopathic physician with board certification in internal medicine, pulmonary diseases, and critical care medicine, Sandra worked diligently for over 30 years to further scientific discovery and health-care education.
An NIH-funded career academic awardee, a Macy Institute scholar, and an invited faculty member on health-care leadership at Harvard University, Sandra was very involved in academic medicine. She served as professor of medicine, interim chair of medicine and docent at the University of Missouri–Kansas City School of Medicine; and as provost, dean, vice-dean, and department chair at Kansas City University of Osteopathic Medicine. Sandra earned a master’s degree in bioethics and health policy focusing on research ethics from Loyola University of Chicago Stritch School of Medicine. She made countless scholarly presentations and published regularly.
Sandra made eight pro bono trips to provide physicians in Honduras, Panama, Costa Rica, and the Dominican Republic the latest research updates on asthma and COPD research. She was honored to serve as president of Women Executives in Science and Healthcare and as board president of the American Heart Association’s Midwest Affiliate. She had been volunteering for over 30 years at the KC CARE Clinic in downtown Kansas City, Missouri, and was a committee member of the FDA advisory panel on respiratory and anesthesiology devices.
Sandra devoted many years of active participation to the American College of Chest Physicians and will be missed by so many colleagues and friends. She served on the Board of Regents and on the US and Canadian Council of Governors, was a member of numerous committees, including Education, Ethics, Marketing, Nominating, and Chair of the Scientific Presentations and Awards Committee. A staunch supporter of the CHEST Foundation, she was instrumental in its creation and served as a board and committee member. We extend our heartfelt condolences to her husband, Tom, and her family and many friends.
Sandra K. Willsie, DO, FCCP, died on March 26, 2017, after a courageous battle with brain cancer. As an osteopathic physician with board certification in internal medicine, pulmonary diseases, and critical care medicine, Sandra worked diligently for over 30 years to further scientific discovery and health-care education.
An NIH-funded career academic awardee, a Macy Institute scholar, and an invited faculty member on health-care leadership at Harvard University, Sandra was very involved in academic medicine. She served as professor of medicine, interim chair of medicine and docent at the University of Missouri–Kansas City School of Medicine; and as provost, dean, vice-dean, and department chair at Kansas City University of Osteopathic Medicine. Sandra earned a master’s degree in bioethics and health policy focusing on research ethics from Loyola University of Chicago Stritch School of Medicine. She made countless scholarly presentations and published regularly.
Sandra made eight pro bono trips to provide physicians in Honduras, Panama, Costa Rica, and the Dominican Republic the latest research updates on asthma and COPD research. She was honored to serve as president of Women Executives in Science and Healthcare and as board president of the American Heart Association’s Midwest Affiliate. She had been volunteering for over 30 years at the KC CARE Clinic in downtown Kansas City, Missouri, and was a committee member of the FDA advisory panel on respiratory and anesthesiology devices.
Sandra devoted many years of active participation to the American College of Chest Physicians and will be missed by so many colleagues and friends. She served on the Board of Regents and on the US and Canadian Council of Governors, was a member of numerous committees, including Education, Ethics, Marketing, Nominating, and Chair of the Scientific Presentations and Awards Committee. A staunch supporter of the CHEST Foundation, she was instrumental in its creation and served as a board and committee member. We extend our heartfelt condolences to her husband, Tom, and her family and many friends.
Sandra K. Willsie, DO, FCCP, died on March 26, 2017, after a courageous battle with brain cancer. As an osteopathic physician with board certification in internal medicine, pulmonary diseases, and critical care medicine, Sandra worked diligently for over 30 years to further scientific discovery and health-care education.
An NIH-funded career academic awardee, a Macy Institute scholar, and an invited faculty member on health-care leadership at Harvard University, Sandra was very involved in academic medicine. She served as professor of medicine, interim chair of medicine and docent at the University of Missouri–Kansas City School of Medicine; and as provost, dean, vice-dean, and department chair at Kansas City University of Osteopathic Medicine. Sandra earned a master’s degree in bioethics and health policy focusing on research ethics from Loyola University of Chicago Stritch School of Medicine. She made countless scholarly presentations and published regularly.
Sandra made eight pro bono trips to provide physicians in Honduras, Panama, Costa Rica, and the Dominican Republic the latest research updates on asthma and COPD research. She was honored to serve as president of Women Executives in Science and Healthcare and as board president of the American Heart Association’s Midwest Affiliate. She had been volunteering for over 30 years at the KC CARE Clinic in downtown Kansas City, Missouri, and was a committee member of the FDA advisory panel on respiratory and anesthesiology devices.
Sandra devoted many years of active participation to the American College of Chest Physicians and will be missed by so many colleagues and friends. She served on the Board of Regents and on the US and Canadian Council of Governors, was a member of numerous committees, including Education, Ethics, Marketing, Nominating, and Chair of the Scientific Presentations and Awards Committee. A staunch supporter of the CHEST Foundation, she was instrumental in its creation and served as a board and committee member. We extend our heartfelt condolences to her husband, Tom, and her family and many friends.
Critical Care Commentary: Sepsis resuscitation in a post-EGDT age
We must admit that we are all imperfect beings and, as such, we are all incorrect from time to time. In order to evolve to proverbial ‘higher planes of enlightenment,’ we must accept our cognitive errors – sometimes as individuals and other times as a collective entity. Within this framework of improvement through critical reflection, evidence-based medicine has been born. In this commentary, the authors address an area of smoldering contention and conflicting evidence—the role of EGDT in managing sepsis. If their call for an individualized approach to therapy is ultimately the ideal strategy, it may vindicate us all by simultaneously proving us all wrong.
Lee E. Morrow, MD, FCCP
The approach to sepsis resuscitation is emblematic of the challenges and opportunities of the evolution in this transition. There was no standardized approach to early sepsis resuscitation in the 20th century, and mortality from the disease approached 50% in many studies. This changed in 2001 with the publication of the landmark early-goal-directed therapy (EGDT) trial (Rivers et al. N Engl J Med. 2001;345[19]:1368). This single center trial demonstrated a dramatic 16% absolute decrease in mortality secondary to usage of an aggressive protocol for sepsis resuscitation within the first 6 hours after presentation to the ED. In addition to early cultures and antibiotic therapy in patients randomized to both EGDT and “usual care,” EGDT involved a number of mandatory elements, including placing both an arterial catheter and a central venous catheter capable of measuring continuous central venous oxygen saturation (ScvO2). Patients received crystalloid or colloid until a predetermined central venous pressure was obtained, and if their mean arterial pressure was still below 65 mm Hg, therapy with pressors was initiated. If their ScvO2 was not 70% or greater, patients were transfused until their hematocrit was greater than 30%, and, if this still did not bring their ScvO2 up, patients were started on a regimen of dobutamine. Multiple trials of varying design subsequently demonstrated efficacy in this approach, which was rapidly adopted worldwide in many centers managing patients with sepsis.
However, many questions remained. All patients were managed the same in EGDT, with no capacity to individualize care, regardless of clinical situation (comorbidities, age, origin of sepsis). In addition, it was never clear which specific elements of the EGDT protocol were responsible for its success, as a bundled protocol could potentially simultaneously include beneficial, harmful, and neutral components. Further, many of the elements of EGDT have not been demonstrated to be beneficial in isolation. For example, multiple studies demonstrate that patients not receiving transfusions until their hemoglobin value reaches 7 g/dL is at least as effective as receiving transfusions to a hemoglobin value of 10 g/dL. Also, there is a wealth of data suggesting that central venous pressure is not an accurate surrogate for intravascular volume.
The difference between the original Rivers trial (demonstrating a huge benefit of EGDT) and the three subsequent trials leads (showing no benefit) was striking and leads to the obvious questions of (a) why were the results so disparate and (b) what should we do for our patients moving forward? Perhaps the most obvious difference in the trials is the baseline mortality in the “usual care” groups between the studies. In the original Rivers study, in-hospital mortality was 46.5% for the “usual care” group. For ARISE, ProCESS, and ProMISe, 60- to 90-day mortality ranged from 18.8% to 29.2% in the “usual care” group. This means either that the patients in the original EGDT trial were significantly sicker or that something fundamental has changed over time. A closer review of the papers reveals it is likely the latter as, in actuality, the “usual care” group in the three NEJM trials looked a lot like the EGDT group in the original trial. Most patients received significant volume resuscitation in these studies prior to enrollment, and the original ScvO2 was 71% in ProCESS (as opposed to 49% in the original Rivers trial). This suggested that increasing awareness of sepsis that occurred during the 15 years between the EGDT trial and the subsequent three trials – likely due to the Surviving Sepsis Campaign, as well as other efforts from both advocacy groups as well as medical organizations – led to better sepsis care on patient presentation. In essence, what was “usual care” in the time of the original EGDT study had become inappropriate care in the modern era, and much of what was protocolized in EGDT had been transformed into “usual care,” even if a specific protocol was not being used. In the setting in which “usual care” had dramatically improved, the original EGDT protocol was not helpful if implemented on all comers. One key reason is that many patients simply improved with volume and antibiotics (which had become “usual care”) and did not need additional interventions. Another reason is that some of the interventions in EGDT (blood transfusion, continuous ScvO2 monitoring) are likely not beneficial in the majority of cases.
These studies have led to significant changes in recommendations in sepsis management guidelines. The 2016 Surviving Sepsis Campaign guidelines – published after ARISE, ProCESS and ProMISe trials – still recommend antibiotics, cultures, adequate volume resuscitation (without specifying how to do so), targeting an initial mean arterial pressure of 65 mm Hg, and vasopressors if a patient remains hypotensive despite adequate fluids (Rhodes et al. Crit Care Med. 2017; 45). However, no recommendations are made regarding mandatory placement of a central venous catheter, measuring central venous pressure, transfusing to higher hemoglobin, etc.
In many ways, the last 15 years of fluid resuscitation in sepsis represents the triumph of evidence-based medicine over opinion-based medicine and the challenges of moving toward precision medicine. When “usual care” was highly variable without a consistent scientific rationale, EGDT markedly improved outcomes – a clear victory of evidence-based medicine that likely saved thousands of lives. However, when EGDT effectively became “usual care,” each individual element of EGDT bundled together failed to further improve outcome. The new evidence suggested that for all comers, EGDT is no better than the new normal, and, thus, newer guidelines do not recommend most of its components.
Moving forward, what is the best way to resuscitate newly identified patients with sepsis? A big fear in eliminating EGDT in its entirety is that practitioners will not have any guidance on how to manage resuscitation in sepsis and so will revert to less rigorous practice patterns. While we acknowledge that concern, we are optimistic that the future will continue to yield decreases in sepsis mortality. Optimally, volume status will be assessed on an individual basis. Rather than resuscitating every patient with a one-size-fits-all parameter that is fairly crude at best and inaccurate at worst (central venous pressure), bedside caregivers should use whatever tools are most appropriate to their individual patient and expertise. This could include bedside ultrasound, stroke volume variation, esophageal Doppler, passive leg raise, etc, depending on the clinical situation. The concept of appropriate volume resuscitation raised in EGDT continues to be 100% valid, but the implementation is now patient-specific and will vary upon available technology, provider skill, and bedside factors that might make one method superior to the other. Similarly, the failure of EGDT to improve survival in the ARISE, ProCESS, and ProMISe trials does not mean there is never a role for checking venous blood gases and measuring ScvO2. From our point of view, this would be a gross misinterpretation of the trials, as the finding that all elements of EGDT combined fail to benefit all patients with sepsis on arrival should assuredly not be interpreted as none of the elements of EGDT can ever be beneficial in any patients with sepsis. While we can – and should – learn from the data as they pertain to “all comers,” we equally can – and should – look at each individual patient and determine where they align with what is known (and unknown) in the literature and simultaneously attempt to both personalize and optimize their care utilizing our general knowledge of physiology and individual information that is unique to the patient.
In the future, we hope that sepsis resuscitation will be performed in an analogous fashion to cancer therapy. Understanding a patient’s response at the organ level and cellular and subcellular levels will allow us to individualize initial therapy. For instance, an “omics” evaluation of a patient’s immune system may be helpful for guiding treatment. Distinct patterns of gene and protein expression could potentially demonstrate in advance how different patients will respond differently to the same therapy and, in a dynamic manner, determine whether they are responding according to the expected trajectory. Unfortunately, since this is impractical today, the best we can do is to follow recommendations that are applicable to large populations (the Surviving Sepsis bundles) while simultaneously individualizing therapy when no clear data are available. Further, it is critical to assess and reassess the response at the bedside to optimize outcomes. While it is frustrating that no clear guidance can be given on the best way to measure volume status or fluid responsiveness or when there is utility in measuring ScvO2, there is comfort in knowing that best practice has evolved over the past 15 years such that the majority of EGDT is now “usual care.” Moving forward, the challenges in transitioning sepsis resuscitation from population-based evidence-based medicine to individualized therapy are real, but the opportunities for improved outcomes in this deadly disease are enormous.
Dr. Head is with the Department of Anesthesiology, and Dr. Coopersmith is with the Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.
We must admit that we are all imperfect beings and, as such, we are all incorrect from time to time. In order to evolve to proverbial ‘higher planes of enlightenment,’ we must accept our cognitive errors – sometimes as individuals and other times as a collective entity. Within this framework of improvement through critical reflection, evidence-based medicine has been born. In this commentary, the authors address an area of smoldering contention and conflicting evidence—the role of EGDT in managing sepsis. If their call for an individualized approach to therapy is ultimately the ideal strategy, it may vindicate us all by simultaneously proving us all wrong.
Lee E. Morrow, MD, FCCP
The approach to sepsis resuscitation is emblematic of the challenges and opportunities of the evolution in this transition. There was no standardized approach to early sepsis resuscitation in the 20th century, and mortality from the disease approached 50% in many studies. This changed in 2001 with the publication of the landmark early-goal-directed therapy (EGDT) trial (Rivers et al. N Engl J Med. 2001;345[19]:1368). This single center trial demonstrated a dramatic 16% absolute decrease in mortality secondary to usage of an aggressive protocol for sepsis resuscitation within the first 6 hours after presentation to the ED. In addition to early cultures and antibiotic therapy in patients randomized to both EGDT and “usual care,” EGDT involved a number of mandatory elements, including placing both an arterial catheter and a central venous catheter capable of measuring continuous central venous oxygen saturation (ScvO2). Patients received crystalloid or colloid until a predetermined central venous pressure was obtained, and if their mean arterial pressure was still below 65 mm Hg, therapy with pressors was initiated. If their ScvO2 was not 70% or greater, patients were transfused until their hematocrit was greater than 30%, and, if this still did not bring their ScvO2 up, patients were started on a regimen of dobutamine. Multiple trials of varying design subsequently demonstrated efficacy in this approach, which was rapidly adopted worldwide in many centers managing patients with sepsis.
However, many questions remained. All patients were managed the same in EGDT, with no capacity to individualize care, regardless of clinical situation (comorbidities, age, origin of sepsis). In addition, it was never clear which specific elements of the EGDT protocol were responsible for its success, as a bundled protocol could potentially simultaneously include beneficial, harmful, and neutral components. Further, many of the elements of EGDT have not been demonstrated to be beneficial in isolation. For example, multiple studies demonstrate that patients not receiving transfusions until their hemoglobin value reaches 7 g/dL is at least as effective as receiving transfusions to a hemoglobin value of 10 g/dL. Also, there is a wealth of data suggesting that central venous pressure is not an accurate surrogate for intravascular volume.
The difference between the original Rivers trial (demonstrating a huge benefit of EGDT) and the three subsequent trials leads (showing no benefit) was striking and leads to the obvious questions of (a) why were the results so disparate and (b) what should we do for our patients moving forward? Perhaps the most obvious difference in the trials is the baseline mortality in the “usual care” groups between the studies. In the original Rivers study, in-hospital mortality was 46.5% for the “usual care” group. For ARISE, ProCESS, and ProMISe, 60- to 90-day mortality ranged from 18.8% to 29.2% in the “usual care” group. This means either that the patients in the original EGDT trial were significantly sicker or that something fundamental has changed over time. A closer review of the papers reveals it is likely the latter as, in actuality, the “usual care” group in the three NEJM trials looked a lot like the EGDT group in the original trial. Most patients received significant volume resuscitation in these studies prior to enrollment, and the original ScvO2 was 71% in ProCESS (as opposed to 49% in the original Rivers trial). This suggested that increasing awareness of sepsis that occurred during the 15 years between the EGDT trial and the subsequent three trials – likely due to the Surviving Sepsis Campaign, as well as other efforts from both advocacy groups as well as medical organizations – led to better sepsis care on patient presentation. In essence, what was “usual care” in the time of the original EGDT study had become inappropriate care in the modern era, and much of what was protocolized in EGDT had been transformed into “usual care,” even if a specific protocol was not being used. In the setting in which “usual care” had dramatically improved, the original EGDT protocol was not helpful if implemented on all comers. One key reason is that many patients simply improved with volume and antibiotics (which had become “usual care”) and did not need additional interventions. Another reason is that some of the interventions in EGDT (blood transfusion, continuous ScvO2 monitoring) are likely not beneficial in the majority of cases.
These studies have led to significant changes in recommendations in sepsis management guidelines. The 2016 Surviving Sepsis Campaign guidelines – published after ARISE, ProCESS and ProMISe trials – still recommend antibiotics, cultures, adequate volume resuscitation (without specifying how to do so), targeting an initial mean arterial pressure of 65 mm Hg, and vasopressors if a patient remains hypotensive despite adequate fluids (Rhodes et al. Crit Care Med. 2017; 45). However, no recommendations are made regarding mandatory placement of a central venous catheter, measuring central venous pressure, transfusing to higher hemoglobin, etc.
In many ways, the last 15 years of fluid resuscitation in sepsis represents the triumph of evidence-based medicine over opinion-based medicine and the challenges of moving toward precision medicine. When “usual care” was highly variable without a consistent scientific rationale, EGDT markedly improved outcomes – a clear victory of evidence-based medicine that likely saved thousands of lives. However, when EGDT effectively became “usual care,” each individual element of EGDT bundled together failed to further improve outcome. The new evidence suggested that for all comers, EGDT is no better than the new normal, and, thus, newer guidelines do not recommend most of its components.
Moving forward, what is the best way to resuscitate newly identified patients with sepsis? A big fear in eliminating EGDT in its entirety is that practitioners will not have any guidance on how to manage resuscitation in sepsis and so will revert to less rigorous practice patterns. While we acknowledge that concern, we are optimistic that the future will continue to yield decreases in sepsis mortality. Optimally, volume status will be assessed on an individual basis. Rather than resuscitating every patient with a one-size-fits-all parameter that is fairly crude at best and inaccurate at worst (central venous pressure), bedside caregivers should use whatever tools are most appropriate to their individual patient and expertise. This could include bedside ultrasound, stroke volume variation, esophageal Doppler, passive leg raise, etc, depending on the clinical situation. The concept of appropriate volume resuscitation raised in EGDT continues to be 100% valid, but the implementation is now patient-specific and will vary upon available technology, provider skill, and bedside factors that might make one method superior to the other. Similarly, the failure of EGDT to improve survival in the ARISE, ProCESS, and ProMISe trials does not mean there is never a role for checking venous blood gases and measuring ScvO2. From our point of view, this would be a gross misinterpretation of the trials, as the finding that all elements of EGDT combined fail to benefit all patients with sepsis on arrival should assuredly not be interpreted as none of the elements of EGDT can ever be beneficial in any patients with sepsis. While we can – and should – learn from the data as they pertain to “all comers,” we equally can – and should – look at each individual patient and determine where they align with what is known (and unknown) in the literature and simultaneously attempt to both personalize and optimize their care utilizing our general knowledge of physiology and individual information that is unique to the patient.
In the future, we hope that sepsis resuscitation will be performed in an analogous fashion to cancer therapy. Understanding a patient’s response at the organ level and cellular and subcellular levels will allow us to individualize initial therapy. For instance, an “omics” evaluation of a patient’s immune system may be helpful for guiding treatment. Distinct patterns of gene and protein expression could potentially demonstrate in advance how different patients will respond differently to the same therapy and, in a dynamic manner, determine whether they are responding according to the expected trajectory. Unfortunately, since this is impractical today, the best we can do is to follow recommendations that are applicable to large populations (the Surviving Sepsis bundles) while simultaneously individualizing therapy when no clear data are available. Further, it is critical to assess and reassess the response at the bedside to optimize outcomes. While it is frustrating that no clear guidance can be given on the best way to measure volume status or fluid responsiveness or when there is utility in measuring ScvO2, there is comfort in knowing that best practice has evolved over the past 15 years such that the majority of EGDT is now “usual care.” Moving forward, the challenges in transitioning sepsis resuscitation from population-based evidence-based medicine to individualized therapy are real, but the opportunities for improved outcomes in this deadly disease are enormous.
Dr. Head is with the Department of Anesthesiology, and Dr. Coopersmith is with the Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.
We must admit that we are all imperfect beings and, as such, we are all incorrect from time to time. In order to evolve to proverbial ‘higher planes of enlightenment,’ we must accept our cognitive errors – sometimes as individuals and other times as a collective entity. Within this framework of improvement through critical reflection, evidence-based medicine has been born. In this commentary, the authors address an area of smoldering contention and conflicting evidence—the role of EGDT in managing sepsis. If their call for an individualized approach to therapy is ultimately the ideal strategy, it may vindicate us all by simultaneously proving us all wrong.
Lee E. Morrow, MD, FCCP
The approach to sepsis resuscitation is emblematic of the challenges and opportunities of the evolution in this transition. There was no standardized approach to early sepsis resuscitation in the 20th century, and mortality from the disease approached 50% in many studies. This changed in 2001 with the publication of the landmark early-goal-directed therapy (EGDT) trial (Rivers et al. N Engl J Med. 2001;345[19]:1368). This single center trial demonstrated a dramatic 16% absolute decrease in mortality secondary to usage of an aggressive protocol for sepsis resuscitation within the first 6 hours after presentation to the ED. In addition to early cultures and antibiotic therapy in patients randomized to both EGDT and “usual care,” EGDT involved a number of mandatory elements, including placing both an arterial catheter and a central venous catheter capable of measuring continuous central venous oxygen saturation (ScvO2). Patients received crystalloid or colloid until a predetermined central venous pressure was obtained, and if their mean arterial pressure was still below 65 mm Hg, therapy with pressors was initiated. If their ScvO2 was not 70% or greater, patients were transfused until their hematocrit was greater than 30%, and, if this still did not bring their ScvO2 up, patients were started on a regimen of dobutamine. Multiple trials of varying design subsequently demonstrated efficacy in this approach, which was rapidly adopted worldwide in many centers managing patients with sepsis.
However, many questions remained. All patients were managed the same in EGDT, with no capacity to individualize care, regardless of clinical situation (comorbidities, age, origin of sepsis). In addition, it was never clear which specific elements of the EGDT protocol were responsible for its success, as a bundled protocol could potentially simultaneously include beneficial, harmful, and neutral components. Further, many of the elements of EGDT have not been demonstrated to be beneficial in isolation. For example, multiple studies demonstrate that patients not receiving transfusions until their hemoglobin value reaches 7 g/dL is at least as effective as receiving transfusions to a hemoglobin value of 10 g/dL. Also, there is a wealth of data suggesting that central venous pressure is not an accurate surrogate for intravascular volume.
The difference between the original Rivers trial (demonstrating a huge benefit of EGDT) and the three subsequent trials leads (showing no benefit) was striking and leads to the obvious questions of (a) why were the results so disparate and (b) what should we do for our patients moving forward? Perhaps the most obvious difference in the trials is the baseline mortality in the “usual care” groups between the studies. In the original Rivers study, in-hospital mortality was 46.5% for the “usual care” group. For ARISE, ProCESS, and ProMISe, 60- to 90-day mortality ranged from 18.8% to 29.2% in the “usual care” group. This means either that the patients in the original EGDT trial were significantly sicker or that something fundamental has changed over time. A closer review of the papers reveals it is likely the latter as, in actuality, the “usual care” group in the three NEJM trials looked a lot like the EGDT group in the original trial. Most patients received significant volume resuscitation in these studies prior to enrollment, and the original ScvO2 was 71% in ProCESS (as opposed to 49% in the original Rivers trial). This suggested that increasing awareness of sepsis that occurred during the 15 years between the EGDT trial and the subsequent three trials – likely due to the Surviving Sepsis Campaign, as well as other efforts from both advocacy groups as well as medical organizations – led to better sepsis care on patient presentation. In essence, what was “usual care” in the time of the original EGDT study had become inappropriate care in the modern era, and much of what was protocolized in EGDT had been transformed into “usual care,” even if a specific protocol was not being used. In the setting in which “usual care” had dramatically improved, the original EGDT protocol was not helpful if implemented on all comers. One key reason is that many patients simply improved with volume and antibiotics (which had become “usual care”) and did not need additional interventions. Another reason is that some of the interventions in EGDT (blood transfusion, continuous ScvO2 monitoring) are likely not beneficial in the majority of cases.
These studies have led to significant changes in recommendations in sepsis management guidelines. The 2016 Surviving Sepsis Campaign guidelines – published after ARISE, ProCESS and ProMISe trials – still recommend antibiotics, cultures, adequate volume resuscitation (without specifying how to do so), targeting an initial mean arterial pressure of 65 mm Hg, and vasopressors if a patient remains hypotensive despite adequate fluids (Rhodes et al. Crit Care Med. 2017; 45). However, no recommendations are made regarding mandatory placement of a central venous catheter, measuring central venous pressure, transfusing to higher hemoglobin, etc.
In many ways, the last 15 years of fluid resuscitation in sepsis represents the triumph of evidence-based medicine over opinion-based medicine and the challenges of moving toward precision medicine. When “usual care” was highly variable without a consistent scientific rationale, EGDT markedly improved outcomes – a clear victory of evidence-based medicine that likely saved thousands of lives. However, when EGDT effectively became “usual care,” each individual element of EGDT bundled together failed to further improve outcome. The new evidence suggested that for all comers, EGDT is no better than the new normal, and, thus, newer guidelines do not recommend most of its components.
Moving forward, what is the best way to resuscitate newly identified patients with sepsis? A big fear in eliminating EGDT in its entirety is that practitioners will not have any guidance on how to manage resuscitation in sepsis and so will revert to less rigorous practice patterns. While we acknowledge that concern, we are optimistic that the future will continue to yield decreases in sepsis mortality. Optimally, volume status will be assessed on an individual basis. Rather than resuscitating every patient with a one-size-fits-all parameter that is fairly crude at best and inaccurate at worst (central venous pressure), bedside caregivers should use whatever tools are most appropriate to their individual patient and expertise. This could include bedside ultrasound, stroke volume variation, esophageal Doppler, passive leg raise, etc, depending on the clinical situation. The concept of appropriate volume resuscitation raised in EGDT continues to be 100% valid, but the implementation is now patient-specific and will vary upon available technology, provider skill, and bedside factors that might make one method superior to the other. Similarly, the failure of EGDT to improve survival in the ARISE, ProCESS, and ProMISe trials does not mean there is never a role for checking venous blood gases and measuring ScvO2. From our point of view, this would be a gross misinterpretation of the trials, as the finding that all elements of EGDT combined fail to benefit all patients with sepsis on arrival should assuredly not be interpreted as none of the elements of EGDT can ever be beneficial in any patients with sepsis. While we can – and should – learn from the data as they pertain to “all comers,” we equally can – and should – look at each individual patient and determine where they align with what is known (and unknown) in the literature and simultaneously attempt to both personalize and optimize their care utilizing our general knowledge of physiology and individual information that is unique to the patient.
In the future, we hope that sepsis resuscitation will be performed in an analogous fashion to cancer therapy. Understanding a patient’s response at the organ level and cellular and subcellular levels will allow us to individualize initial therapy. For instance, an “omics” evaluation of a patient’s immune system may be helpful for guiding treatment. Distinct patterns of gene and protein expression could potentially demonstrate in advance how different patients will respond differently to the same therapy and, in a dynamic manner, determine whether they are responding according to the expected trajectory. Unfortunately, since this is impractical today, the best we can do is to follow recommendations that are applicable to large populations (the Surviving Sepsis bundles) while simultaneously individualizing therapy when no clear data are available. Further, it is critical to assess and reassess the response at the bedside to optimize outcomes. While it is frustrating that no clear guidance can be given on the best way to measure volume status or fluid responsiveness or when there is utility in measuring ScvO2, there is comfort in knowing that best practice has evolved over the past 15 years such that the majority of EGDT is now “usual care.” Moving forward, the challenges in transitioning sepsis resuscitation from population-based evidence-based medicine to individualized therapy are real, but the opportunities for improved outcomes in this deadly disease are enormous.
Dr. Head is with the Department of Anesthesiology, and Dr. Coopersmith is with the Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA.
AATS Centennial Highlights
AATS Week 2017 is fast approaching, and we hope you are planning to participate in the wide variety of educational opportunities available across all areas of thoracic surgery.
The week opens with the two-day AATS Mitral Conclave, which will be held on Thursday, April 27, and Friday, April 28, in New York. You will have the chance to attend an exceptional program created by Director David H. Adams, MD, and the program com ntations, expert technique/video sessions and breakout sessions.
As we look back on the last 100 years and enter our second century as an Association for Thoracic Surgery, the 2017 meeting will provide again, as it always does, an extraordinary variety of educational opportunities across all areas of our specialty. The meeting’s theme of “Always Learning” is a testament to the drive for lifelong learning among attendees, and we commit to making certain that your time is well spent.
The meeting will include many of the most popular program components, including Saturday’s skills courses and Sunday’s Postgraduate Symposia. Saturday will also include hands-on sessions, the well-received Member for a Day Program as well as Survival Guide: Your First Night on Call. The abstract presentations were selected to provide you with new insights that are applicable to your practice and that benefit your patients as well as encourage rich discussions inside and outside of the sessions.
In addition to the programs with which you have become familiar, a number of sessions will be of interest to all members of the surgical team. The Association has long recognized the essential nature of a multidisciplinary approach to care of the cardiothoracic surgical patient as is reflected in the organization’s original membership roster, and the more recent addition of a postgraduate symposium for the Interprofessional Cardiothoracic Team. As always, we look forward to participation from nurses, perfusionists, anesthesiologists, and others in the program and as faculty. This year, we have taken another step forward by holding our meeting in conjunction with the American Society for ExtraCorporeal Technology (AmSECT) 55th International Conference.
It is fitting that we are holding such a historic meeting in a city like Boston, where you will be able to experience the city’s rich culture and history. We have planned a variety of special events and features in honor of the Centennial anniversary of the founding of the Association for Thoracic Surgery. I would like to thank meeting Co-Chairs, Robert D. Jaquiss. MD, and Bryan F. Meyers, MD, for their work to make this meeting represent the highest caliber in promoting leadership, scholarship, mentoring, excellence in patient care, integrity, and professionalism. Please visit the AATS website, watch your email for updates, and download the AATS Week Mobile App for all the information you need to make the most of the experience.
AATS Week 2017 is fast approaching, and we hope you are planning to participate in the wide variety of educational opportunities available across all areas of thoracic surgery.
The week opens with the two-day AATS Mitral Conclave, which will be held on Thursday, April 27, and Friday, April 28, in New York. You will have the chance to attend an exceptional program created by Director David H. Adams, MD, and the program com ntations, expert technique/video sessions and breakout sessions.
As we look back on the last 100 years and enter our second century as an Association for Thoracic Surgery, the 2017 meeting will provide again, as it always does, an extraordinary variety of educational opportunities across all areas of our specialty. The meeting’s theme of “Always Learning” is a testament to the drive for lifelong learning among attendees, and we commit to making certain that your time is well spent.
The meeting will include many of the most popular program components, including Saturday’s skills courses and Sunday’s Postgraduate Symposia. Saturday will also include hands-on sessions, the well-received Member for a Day Program as well as Survival Guide: Your First Night on Call. The abstract presentations were selected to provide you with new insights that are applicable to your practice and that benefit your patients as well as encourage rich discussions inside and outside of the sessions.
In addition to the programs with which you have become familiar, a number of sessions will be of interest to all members of the surgical team. The Association has long recognized the essential nature of a multidisciplinary approach to care of the cardiothoracic surgical patient as is reflected in the organization’s original membership roster, and the more recent addition of a postgraduate symposium for the Interprofessional Cardiothoracic Team. As always, we look forward to participation from nurses, perfusionists, anesthesiologists, and others in the program and as faculty. This year, we have taken another step forward by holding our meeting in conjunction with the American Society for ExtraCorporeal Technology (AmSECT) 55th International Conference.
It is fitting that we are holding such a historic meeting in a city like Boston, where you will be able to experience the city’s rich culture and history. We have planned a variety of special events and features in honor of the Centennial anniversary of the founding of the Association for Thoracic Surgery. I would like to thank meeting Co-Chairs, Robert D. Jaquiss. MD, and Bryan F. Meyers, MD, for their work to make this meeting represent the highest caliber in promoting leadership, scholarship, mentoring, excellence in patient care, integrity, and professionalism. Please visit the AATS website, watch your email for updates, and download the AATS Week Mobile App for all the information you need to make the most of the experience.
AATS Week 2017 is fast approaching, and we hope you are planning to participate in the wide variety of educational opportunities available across all areas of thoracic surgery.
The week opens with the two-day AATS Mitral Conclave, which will be held on Thursday, April 27, and Friday, April 28, in New York. You will have the chance to attend an exceptional program created by Director David H. Adams, MD, and the program com ntations, expert technique/video sessions and breakout sessions.
As we look back on the last 100 years and enter our second century as an Association for Thoracic Surgery, the 2017 meeting will provide again, as it always does, an extraordinary variety of educational opportunities across all areas of our specialty. The meeting’s theme of “Always Learning” is a testament to the drive for lifelong learning among attendees, and we commit to making certain that your time is well spent.
The meeting will include many of the most popular program components, including Saturday’s skills courses and Sunday’s Postgraduate Symposia. Saturday will also include hands-on sessions, the well-received Member for a Day Program as well as Survival Guide: Your First Night on Call. The abstract presentations were selected to provide you with new insights that are applicable to your practice and that benefit your patients as well as encourage rich discussions inside and outside of the sessions.
In addition to the programs with which you have become familiar, a number of sessions will be of interest to all members of the surgical team. The Association has long recognized the essential nature of a multidisciplinary approach to care of the cardiothoracic surgical patient as is reflected in the organization’s original membership roster, and the more recent addition of a postgraduate symposium for the Interprofessional Cardiothoracic Team. As always, we look forward to participation from nurses, perfusionists, anesthesiologists, and others in the program and as faculty. This year, we have taken another step forward by holding our meeting in conjunction with the American Society for ExtraCorporeal Technology (AmSECT) 55th International Conference.
It is fitting that we are holding such a historic meeting in a city like Boston, where you will be able to experience the city’s rich culture and history. We have planned a variety of special events and features in honor of the Centennial anniversary of the founding of the Association for Thoracic Surgery. I would like to thank meeting Co-Chairs, Robert D. Jaquiss. MD, and Bryan F. Meyers, MD, for their work to make this meeting represent the highest caliber in promoting leadership, scholarship, mentoring, excellence in patient care, integrity, and professionalism. Please visit the AATS website, watch your email for updates, and download the AATS Week Mobile App for all the information you need to make the most of the experience.
From the Vascular Community
In memoriam: Edward B. Diethrich
Edward B. Diethrich, MD, the world-renowned cardiovascular/endovascular surgeon, inventor, and philanthropist, succumbed after a brave fight with a brain tumor on February 23, 2017, at the age of 81.
Dr. Diethrich was a pioneer in noninvasive cardiovascular and vascular disease diagnosis and innovative in surgical and endovascular therapy. He obtained his undergraduate and medical degrees at the University of Michigan and completed his surgical residency at St. Joseph’s Mercy Hospital in Ann Arbor and the Henry Ford Hospital in Detroit. He went on to complete his cardiovascular surgery training under Michael DeBakey at the Baylor College of Medicine in Houston, where he played an important role in the development of human heart transplantation.
One of his first accomplishments was the invention of the sternal saw in 1962, which is still used today for open-chest surgery. He also contributed to the development of a preservation chamber for heart transplantation and established one of the first ultrasound companies. Dr. Diethrich spent a lifetime developing new technologies, from a bubble oxygenator for open-heart surgery to developing and manufacturing stent grafts for aortic aneurysms. He remained actively involved in advancing the practice of vascular surgery and keeping it up-to-date with the changing times: He founded a company that develops and manufactures endoluminal grafts, established a Translational Research Center that is dedicated to clinical research and developing new technologies, and started a company devoted to the prevention and management of cardiovascular disease. His contributions to surgical education are also legendary. He organized an annual meeting that attracted physicians from all over the world and show-cased state-of-the-art techniques and innovations. He authored over 400 scientific articles, several textbooks, and lay publications and produced hundreds of educational videos and films. In fact, he organized the first live international telecast of open-heart surgery. Above all, Dr. Diethrich trained several hundred surgeons and other specialists in cardiovascular surgery and endovascular techniques, and traveled the world to demonstrate his techniques and teach local physicians. He recently endowed the Edward B. Diethrich Research Professorship in Biomedical Engineering and Vascular Surgery at the University of Michigan to recognize the collaboration that is required between surgeons and engineers.
Dr. Diethrich has received several honors, such as the Frederick A. Coller Award; Presidency of the Denton A. Cooley Cardiovascular Surgical Society; the Medal for Innovation in Vascular Surgery from the Society for Vascular Surgery; the Medal of Independence from King Hussein of Jordan; and an honorary fellowship from the Royal College of Surgeons, Glasgow. The Edward B. Diethrich Vascular Surgical Society was established by several hundred of his trainees. I was honored to serve as the first President of that society.
It’s ironic that Dr. Diethrich was an early supporter of ceiling-mounted radiographic equipment, which is essential to endovascular interventions. Even with the most advanced radiation protection, Dr. Diethrich paid the ultimate price for his nearly daily exposure to radiation, which led to his 4-year battle with glioma, and, ultimately, his death. But true to form, he even used this unfortunate illness to educate others by working with the Organization for Occupational Radiation Safety in Interventional Fluoroscopy to produce a documentary on the ill effects of radiation.
Dr. Diethrich recently completed his memoirs (SLED: The Serendipitous Life of Edward Diethrich), which recounts his extraordinary 50-year career, from his early days of working and training with the world’s most renowned surgeons to his legendary international success as a cardiovascular surgeon and innovator.
In summary, Dr. Diethrich was a multifaceted, passionate, and charismatic man: a sportsman, musician, scientist, inventor, author, film producer, media personality, along with many others. His confidence, dexterity, and technical expertise were evident in both the operating room and the endovascular suite. Dr. Diethrich was a world-renowned leader and pioneer in Vascular Surgery. He was an eloquent speaker, prolific innovative scholar, and dedicated teacher. His energy was endless, and his manners were impeccable. He will be sorely missed, but his legendary contributions to medicine/vascular surgery, his trainees, and the many people he influenced will live on.
Dr. Diethrich is survived by his wife of 61 years, Gloria; daughter Lynne; son Tad; son-in-law Joe Jackson; daughter-in-law Terri Diethrich, and grandchildren Danielle Diethrich-Vargas, Courtney, Reese, and Trey Diethrich; Mackenzie, Tatum, Peyton, and Zack Jackson.
A celebration of his life will be planned in the near future. Details will be posted at drteddiethrich.com.
In memoriam: Edward B. Diethrich
Edward B. Diethrich, MD, the world-renowned cardiovascular/endovascular surgeon, inventor, and philanthropist, succumbed after a brave fight with a brain tumor on February 23, 2017, at the age of 81.
Dr. Diethrich was a pioneer in noninvasive cardiovascular and vascular disease diagnosis and innovative in surgical and endovascular therapy. He obtained his undergraduate and medical degrees at the University of Michigan and completed his surgical residency at St. Joseph’s Mercy Hospital in Ann Arbor and the Henry Ford Hospital in Detroit. He went on to complete his cardiovascular surgery training under Michael DeBakey at the Baylor College of Medicine in Houston, where he played an important role in the development of human heart transplantation.
One of his first accomplishments was the invention of the sternal saw in 1962, which is still used today for open-chest surgery. He also contributed to the development of a preservation chamber for heart transplantation and established one of the first ultrasound companies. Dr. Diethrich spent a lifetime developing new technologies, from a bubble oxygenator for open-heart surgery to developing and manufacturing stent grafts for aortic aneurysms. He remained actively involved in advancing the practice of vascular surgery and keeping it up-to-date with the changing times: He founded a company that develops and manufactures endoluminal grafts, established a Translational Research Center that is dedicated to clinical research and developing new technologies, and started a company devoted to the prevention and management of cardiovascular disease. His contributions to surgical education are also legendary. He organized an annual meeting that attracted physicians from all over the world and show-cased state-of-the-art techniques and innovations. He authored over 400 scientific articles, several textbooks, and lay publications and produced hundreds of educational videos and films. In fact, he organized the first live international telecast of open-heart surgery. Above all, Dr. Diethrich trained several hundred surgeons and other specialists in cardiovascular surgery and endovascular techniques, and traveled the world to demonstrate his techniques and teach local physicians. He recently endowed the Edward B. Diethrich Research Professorship in Biomedical Engineering and Vascular Surgery at the University of Michigan to recognize the collaboration that is required between surgeons and engineers.
Dr. Diethrich has received several honors, such as the Frederick A. Coller Award; Presidency of the Denton A. Cooley Cardiovascular Surgical Society; the Medal for Innovation in Vascular Surgery from the Society for Vascular Surgery; the Medal of Independence from King Hussein of Jordan; and an honorary fellowship from the Royal College of Surgeons, Glasgow. The Edward B. Diethrich Vascular Surgical Society was established by several hundred of his trainees. I was honored to serve as the first President of that society.
It’s ironic that Dr. Diethrich was an early supporter of ceiling-mounted radiographic equipment, which is essential to endovascular interventions. Even with the most advanced radiation protection, Dr. Diethrich paid the ultimate price for his nearly daily exposure to radiation, which led to his 4-year battle with glioma, and, ultimately, his death. But true to form, he even used this unfortunate illness to educate others by working with the Organization for Occupational Radiation Safety in Interventional Fluoroscopy to produce a documentary on the ill effects of radiation.
Dr. Diethrich recently completed his memoirs (SLED: The Serendipitous Life of Edward Diethrich), which recounts his extraordinary 50-year career, from his early days of working and training with the world’s most renowned surgeons to his legendary international success as a cardiovascular surgeon and innovator.
In summary, Dr. Diethrich was a multifaceted, passionate, and charismatic man: a sportsman, musician, scientist, inventor, author, film producer, media personality, along with many others. His confidence, dexterity, and technical expertise were evident in both the operating room and the endovascular suite. Dr. Diethrich was a world-renowned leader and pioneer in Vascular Surgery. He was an eloquent speaker, prolific innovative scholar, and dedicated teacher. His energy was endless, and his manners were impeccable. He will be sorely missed, but his legendary contributions to medicine/vascular surgery, his trainees, and the many people he influenced will live on.
Dr. Diethrich is survived by his wife of 61 years, Gloria; daughter Lynne; son Tad; son-in-law Joe Jackson; daughter-in-law Terri Diethrich, and grandchildren Danielle Diethrich-Vargas, Courtney, Reese, and Trey Diethrich; Mackenzie, Tatum, Peyton, and Zack Jackson.
A celebration of his life will be planned in the near future. Details will be posted at drteddiethrich.com.
In memoriam: Edward B. Diethrich
Edward B. Diethrich, MD, the world-renowned cardiovascular/endovascular surgeon, inventor, and philanthropist, succumbed after a brave fight with a brain tumor on February 23, 2017, at the age of 81.
Dr. Diethrich was a pioneer in noninvasive cardiovascular and vascular disease diagnosis and innovative in surgical and endovascular therapy. He obtained his undergraduate and medical degrees at the University of Michigan and completed his surgical residency at St. Joseph’s Mercy Hospital in Ann Arbor and the Henry Ford Hospital in Detroit. He went on to complete his cardiovascular surgery training under Michael DeBakey at the Baylor College of Medicine in Houston, where he played an important role in the development of human heart transplantation.
One of his first accomplishments was the invention of the sternal saw in 1962, which is still used today for open-chest surgery. He also contributed to the development of a preservation chamber for heart transplantation and established one of the first ultrasound companies. Dr. Diethrich spent a lifetime developing new technologies, from a bubble oxygenator for open-heart surgery to developing and manufacturing stent grafts for aortic aneurysms. He remained actively involved in advancing the practice of vascular surgery and keeping it up-to-date with the changing times: He founded a company that develops and manufactures endoluminal grafts, established a Translational Research Center that is dedicated to clinical research and developing new technologies, and started a company devoted to the prevention and management of cardiovascular disease. His contributions to surgical education are also legendary. He organized an annual meeting that attracted physicians from all over the world and show-cased state-of-the-art techniques and innovations. He authored over 400 scientific articles, several textbooks, and lay publications and produced hundreds of educational videos and films. In fact, he organized the first live international telecast of open-heart surgery. Above all, Dr. Diethrich trained several hundred surgeons and other specialists in cardiovascular surgery and endovascular techniques, and traveled the world to demonstrate his techniques and teach local physicians. He recently endowed the Edward B. Diethrich Research Professorship in Biomedical Engineering and Vascular Surgery at the University of Michigan to recognize the collaboration that is required between surgeons and engineers.
Dr. Diethrich has received several honors, such as the Frederick A. Coller Award; Presidency of the Denton A. Cooley Cardiovascular Surgical Society; the Medal for Innovation in Vascular Surgery from the Society for Vascular Surgery; the Medal of Independence from King Hussein of Jordan; and an honorary fellowship from the Royal College of Surgeons, Glasgow. The Edward B. Diethrich Vascular Surgical Society was established by several hundred of his trainees. I was honored to serve as the first President of that society.
It’s ironic that Dr. Diethrich was an early supporter of ceiling-mounted radiographic equipment, which is essential to endovascular interventions. Even with the most advanced radiation protection, Dr. Diethrich paid the ultimate price for his nearly daily exposure to radiation, which led to his 4-year battle with glioma, and, ultimately, his death. But true to form, he even used this unfortunate illness to educate others by working with the Organization for Occupational Radiation Safety in Interventional Fluoroscopy to produce a documentary on the ill effects of radiation.
Dr. Diethrich recently completed his memoirs (SLED: The Serendipitous Life of Edward Diethrich), which recounts his extraordinary 50-year career, from his early days of working and training with the world’s most renowned surgeons to his legendary international success as a cardiovascular surgeon and innovator.
In summary, Dr. Diethrich was a multifaceted, passionate, and charismatic man: a sportsman, musician, scientist, inventor, author, film producer, media personality, along with many others. His confidence, dexterity, and technical expertise were evident in both the operating room and the endovascular suite. Dr. Diethrich was a world-renowned leader and pioneer in Vascular Surgery. He was an eloquent speaker, prolific innovative scholar, and dedicated teacher. His energy was endless, and his manners were impeccable. He will be sorely missed, but his legendary contributions to medicine/vascular surgery, his trainees, and the many people he influenced will live on.
Dr. Diethrich is survived by his wife of 61 years, Gloria; daughter Lynne; son Tad; son-in-law Joe Jackson; daughter-in-law Terri Diethrich, and grandchildren Danielle Diethrich-Vargas, Courtney, Reese, and Trey Diethrich; Mackenzie, Tatum, Peyton, and Zack Jackson.
A celebration of his life will be planned in the near future. Details will be posted at drteddiethrich.com.
Purchase On-Demand Library at VAM Registration
Don't forget you can take VAM home with you! You can pre-purchase all VAM PowerPoint slides, audio and a limited selection of assorted videotaped sessions in the On-Demand Library.
This valuable resource of almost 400 individual presentations will be available shortly following the meeting’s conclusion, with access continued for up to one year.
Cost is just $99. For those who have already registered and now want to add the On-Demand Library, simply return to the registration page and add the library separately.
Register here for VAM and make housing reservations here.
Don't forget you can take VAM home with you! You can pre-purchase all VAM PowerPoint slides, audio and a limited selection of assorted videotaped sessions in the On-Demand Library.
This valuable resource of almost 400 individual presentations will be available shortly following the meeting’s conclusion, with access continued for up to one year.
Cost is just $99. For those who have already registered and now want to add the On-Demand Library, simply return to the registration page and add the library separately.
Register here for VAM and make housing reservations here.
Don't forget you can take VAM home with you! You can pre-purchase all VAM PowerPoint slides, audio and a limited selection of assorted videotaped sessions in the On-Demand Library.
This valuable resource of almost 400 individual presentations will be available shortly following the meeting’s conclusion, with access continued for up to one year.
Cost is just $99. For those who have already registered and now want to add the On-Demand Library, simply return to the registration page and add the library separately.
Register here for VAM and make housing reservations here.
AGA offers free patient education tools on IBS
Approximately 35 million Americans are affected by irritable bowel syndrome (IBS). April is IBS Awareness Month, which is a perfect time to ensure you have the resources to care for your IBS patients.
To help your IBS patients, AGA provides credible, accessible education information on the following topics in English and Spanish.
- • What is irritable bowel syndrome?
- • Symptoms
- • Getting tested
- • Newly diagnosed
- • Treatment
- • Complications
Visit www.gastro.org/IBS to access our patient materials.
Approximately 35 million Americans are affected by irritable bowel syndrome (IBS). April is IBS Awareness Month, which is a perfect time to ensure you have the resources to care for your IBS patients.
To help your IBS patients, AGA provides credible, accessible education information on the following topics in English and Spanish.
- • What is irritable bowel syndrome?
- • Symptoms
- • Getting tested
- • Newly diagnosed
- • Treatment
- • Complications
Visit www.gastro.org/IBS to access our patient materials.
Approximately 35 million Americans are affected by irritable bowel syndrome (IBS). April is IBS Awareness Month, which is a perfect time to ensure you have the resources to care for your IBS patients.
To help your IBS patients, AGA provides credible, accessible education information on the following topics in English and Spanish.
- • What is irritable bowel syndrome?
- • Symptoms
- • Getting tested
- • Newly diagnosed
- • Treatment
- • Complications
Visit www.gastro.org/IBS to access our patient materials.
A gift in your will: Getting started
A simple, flexible and versatile way to ensure The AGA Research Foundation can continue our work for years to come is a gift in your will or living trust, known as a charitable bequest. To make a charitable bequest, you need a current will or living trust.
Your gift can be made as a percentage of your estate. Or you can make a specific bequest by giving a certain amount of cash, securities, or property. After your lifetime, the AGA Research Foundation receives your gift.
We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise, and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”
When planning a future gift, it’s sometimes difficult to determine what size donation will make sense. Emergencies happen, and you need to make sure your family is financially taken care of first. Including a bequest of a percentage of your estate ensures that your gift will remain proportionate no matter how your estate’s value fluctuates over the years.
Whether you would like to put your donation to work today or benefit us after your lifetime, you can find a charitable plan that lets you provide for your family and support the AGA Research Foundation.
Please contact us for more information at [email protected] or visit http://gastro.planmylegacy.org/.
A simple, flexible and versatile way to ensure The AGA Research Foundation can continue our work for years to come is a gift in your will or living trust, known as a charitable bequest. To make a charitable bequest, you need a current will or living trust.
Your gift can be made as a percentage of your estate. Or you can make a specific bequest by giving a certain amount of cash, securities, or property. After your lifetime, the AGA Research Foundation receives your gift.
We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise, and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”
When planning a future gift, it’s sometimes difficult to determine what size donation will make sense. Emergencies happen, and you need to make sure your family is financially taken care of first. Including a bequest of a percentage of your estate ensures that your gift will remain proportionate no matter how your estate’s value fluctuates over the years.
Whether you would like to put your donation to work today or benefit us after your lifetime, you can find a charitable plan that lets you provide for your family and support the AGA Research Foundation.
Please contact us for more information at [email protected] or visit http://gastro.planmylegacy.org/.
A simple, flexible and versatile way to ensure The AGA Research Foundation can continue our work for years to come is a gift in your will or living trust, known as a charitable bequest. To make a charitable bequest, you need a current will or living trust.
Your gift can be made as a percentage of your estate. Or you can make a specific bequest by giving a certain amount of cash, securities, or property. After your lifetime, the AGA Research Foundation receives your gift.
We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise, and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”
When planning a future gift, it’s sometimes difficult to determine what size donation will make sense. Emergencies happen, and you need to make sure your family is financially taken care of first. Including a bequest of a percentage of your estate ensures that your gift will remain proportionate no matter how your estate’s value fluctuates over the years.
Whether you would like to put your donation to work today or benefit us after your lifetime, you can find a charitable plan that lets you provide for your family and support the AGA Research Foundation.
Please contact us for more information at [email protected] or visit http://gastro.planmylegacy.org/.
See you at DDW and the AGA Postgraduate course
AGA looks forward to seeing our members at Digestive Disease Week® (DDW) 2017, May 6-9 in Chicago. If you’re not yet registered for the meeting, visit www.ddw.org to reserve your spot.
Please also join us for the 2017 AGA Postgraduate Course. The 2017 course is set for May 6 and 7, 2017, in conjunction with DDW. This 1.5-day course is designed to help you step beyond basic learning and get the full scope of GI advances. You will measure, learn, and apply the newest advances that will help you make confident decisions for your patients.
The course will feature six general sessions:
- • Hot Topics (abdominal pain and opioid therapy, microbiome and obesity, viral hepatitis, and fecal microbiota transplantation)
- • IBD: It’s a Beautiful Day (IBD) to discuss Inflammatory Bowel Disease (IBD)
- • The Biliary Tree and Pancreas
- • Love the Liver
- • All Guts and Glory: Esophagus, Stomach and Small Intestine
- • Bringing Up the Rear: Disorders of the Colon and Rectum
The course will also include 29 breakout sessions. These focused, small-group sessions allow you to delve deeper into specific clinical topics and provide direct access to internationally renowned faculty.
To learn more about the AGA Postgraduate course, visit pgcourse.gastro.org.
AGA looks forward to seeing our members at Digestive Disease Week® (DDW) 2017, May 6-9 in Chicago. If you’re not yet registered for the meeting, visit www.ddw.org to reserve your spot.
Please also join us for the 2017 AGA Postgraduate Course. The 2017 course is set for May 6 and 7, 2017, in conjunction with DDW. This 1.5-day course is designed to help you step beyond basic learning and get the full scope of GI advances. You will measure, learn, and apply the newest advances that will help you make confident decisions for your patients.
The course will feature six general sessions:
- • Hot Topics (abdominal pain and opioid therapy, microbiome and obesity, viral hepatitis, and fecal microbiota transplantation)
- • IBD: It’s a Beautiful Day (IBD) to discuss Inflammatory Bowel Disease (IBD)
- • The Biliary Tree and Pancreas
- • Love the Liver
- • All Guts and Glory: Esophagus, Stomach and Small Intestine
- • Bringing Up the Rear: Disorders of the Colon and Rectum
The course will also include 29 breakout sessions. These focused, small-group sessions allow you to delve deeper into specific clinical topics and provide direct access to internationally renowned faculty.
To learn more about the AGA Postgraduate course, visit pgcourse.gastro.org.
AGA looks forward to seeing our members at Digestive Disease Week® (DDW) 2017, May 6-9 in Chicago. If you’re not yet registered for the meeting, visit www.ddw.org to reserve your spot.
Please also join us for the 2017 AGA Postgraduate Course. The 2017 course is set for May 6 and 7, 2017, in conjunction with DDW. This 1.5-day course is designed to help you step beyond basic learning and get the full scope of GI advances. You will measure, learn, and apply the newest advances that will help you make confident decisions for your patients.
The course will feature six general sessions:
- • Hot Topics (abdominal pain and opioid therapy, microbiome and obesity, viral hepatitis, and fecal microbiota transplantation)
- • IBD: It’s a Beautiful Day (IBD) to discuss Inflammatory Bowel Disease (IBD)
- • The Biliary Tree and Pancreas
- • Love the Liver
- • All Guts and Glory: Esophagus, Stomach and Small Intestine
- • Bringing Up the Rear: Disorders of the Colon and Rectum
The course will also include 29 breakout sessions. These focused, small-group sessions allow you to delve deeper into specific clinical topics and provide direct access to internationally renowned faculty.
To learn more about the AGA Postgraduate course, visit pgcourse.gastro.org.
AGA announces appointment of new Governing Board members
AGA is pleased to announce new AGA Institute Governing Board designate-elects for 2017-2018.
Hashem B. El-Serag, MD, MPH, AGAF, is the vice president-elect designate. Dr. El-Serag is professor and chair of medicine, Baylor College of Medicine, Houston, TX. He is the editor of Clinical Gastroenterology and Hepatology until July 2017, and serves on the AGA Institute Leadership and Publications Committee.
Lawrence S. Kim, MD, AGAF, is the secretary/treasurer-elect designate. Dr. Kim is a partner at South Denver Gastroenterology, P.C., Littleton, CO. He currently serves on the AGA Institute Clinical Practice Updates, Audit, and Finance and Operations Committees. Dr. Kim has previously served as an AGA Institute Private Practice Councillor.
Dr. El-Serag and Dr. Kim begin their terms immediately following Digestive Disease Week® (DDW) 2017.
AGA is pleased to announce new AGA Institute Governing Board designate-elects for 2017-2018.
Hashem B. El-Serag, MD, MPH, AGAF, is the vice president-elect designate. Dr. El-Serag is professor and chair of medicine, Baylor College of Medicine, Houston, TX. He is the editor of Clinical Gastroenterology and Hepatology until July 2017, and serves on the AGA Institute Leadership and Publications Committee.
Lawrence S. Kim, MD, AGAF, is the secretary/treasurer-elect designate. Dr. Kim is a partner at South Denver Gastroenterology, P.C., Littleton, CO. He currently serves on the AGA Institute Clinical Practice Updates, Audit, and Finance and Operations Committees. Dr. Kim has previously served as an AGA Institute Private Practice Councillor.
Dr. El-Serag and Dr. Kim begin their terms immediately following Digestive Disease Week® (DDW) 2017.
AGA is pleased to announce new AGA Institute Governing Board designate-elects for 2017-2018.
Hashem B. El-Serag, MD, MPH, AGAF, is the vice president-elect designate. Dr. El-Serag is professor and chair of medicine, Baylor College of Medicine, Houston, TX. He is the editor of Clinical Gastroenterology and Hepatology until July 2017, and serves on the AGA Institute Leadership and Publications Committee.
Lawrence S. Kim, MD, AGAF, is the secretary/treasurer-elect designate. Dr. Kim is a partner at South Denver Gastroenterology, P.C., Littleton, CO. He currently serves on the AGA Institute Clinical Practice Updates, Audit, and Finance and Operations Committees. Dr. Kim has previously served as an AGA Institute Private Practice Councillor.
Dr. El-Serag and Dr. Kim begin their terms immediately following Digestive Disease Week® (DDW) 2017.