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Now accepting applications for summer undergraduate research award
Eight undergraduate students from groups traditionally underrepresented in biomedical research will have the opportunity to perform 10 weeks of research related to digestive diseases alongside an established investigator. Recipients will also receive a $5,400 stipend and funding to offset travel and meal expenses.
Students may independently secure support from an AGA member mentor or choose from our list of participating mentors. Past recipients are eligible to apply!
Additional information about the award, including application requirements and a downloadable preview, are available in the request for applications. Please see important dates below.
- Dec. 14, 2022 - Online applications close at 11:59 p.m. ET.
- March 2023 - Applicants are notified of their status.
- May-August 2023 - Recipients perform summer research with mentors.
AGA gratefully acknowledges the Aman Armaan Ahmed Family for supporting this program.
Eight undergraduate students from groups traditionally underrepresented in biomedical research will have the opportunity to perform 10 weeks of research related to digestive diseases alongside an established investigator. Recipients will also receive a $5,400 stipend and funding to offset travel and meal expenses.
Students may independently secure support from an AGA member mentor or choose from our list of participating mentors. Past recipients are eligible to apply!
Additional information about the award, including application requirements and a downloadable preview, are available in the request for applications. Please see important dates below.
- Dec. 14, 2022 - Online applications close at 11:59 p.m. ET.
- March 2023 - Applicants are notified of their status.
- May-August 2023 - Recipients perform summer research with mentors.
AGA gratefully acknowledges the Aman Armaan Ahmed Family for supporting this program.
Eight undergraduate students from groups traditionally underrepresented in biomedical research will have the opportunity to perform 10 weeks of research related to digestive diseases alongside an established investigator. Recipients will also receive a $5,400 stipend and funding to offset travel and meal expenses.
Students may independently secure support from an AGA member mentor or choose from our list of participating mentors. Past recipients are eligible to apply!
Additional information about the award, including application requirements and a downloadable preview, are available in the request for applications. Please see important dates below.
- Dec. 14, 2022 - Online applications close at 11:59 p.m. ET.
- March 2023 - Applicants are notified of their status.
- May-August 2023 - Recipients perform summer research with mentors.
AGA gratefully acknowledges the Aman Armaan Ahmed Family for supporting this program.
AGA to host women’s regional workshops across the U.S. this fall
The AGA Women in GI Regional Workshops –
Registration is now open for the Midwest and Northeast workshops.
Each workshop is an opportunity to gain new knowledge from a unique lineup of experts and various topics. Select attendees also have the opportunity to participate in the Women’s Leadership Collaboration Conference at AGA Headquarters (Dec. 2-3, 2022) to advance the work from the regional events nationally. To register and for more information on the regional workshops, please visit www.gastro.org/AGAWomensRegional.
The AGA Women in GI Regional Workshops –
Registration is now open for the Midwest and Northeast workshops.
Each workshop is an opportunity to gain new knowledge from a unique lineup of experts and various topics. Select attendees also have the opportunity to participate in the Women’s Leadership Collaboration Conference at AGA Headquarters (Dec. 2-3, 2022) to advance the work from the regional events nationally. To register and for more information on the regional workshops, please visit www.gastro.org/AGAWomensRegional.
The AGA Women in GI Regional Workshops –
Registration is now open for the Midwest and Northeast workshops.
Each workshop is an opportunity to gain new knowledge from a unique lineup of experts and various topics. Select attendees also have the opportunity to participate in the Women’s Leadership Collaboration Conference at AGA Headquarters (Dec. 2-3, 2022) to advance the work from the regional events nationally. To register and for more information on the regional workshops, please visit www.gastro.org/AGAWomensRegional.
Memorial and honorary gifts: A special tribute
Honor a family member, friend, or colleague while supporting the work of our mission through a gift to the AGA Research Foundation. Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit. The AGA Research Awards program recruits, retains, and supports the most promising investigators in gastroenterology and hepatology.
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help support researchers working toward developing new treatments and diagnostics for patients with GI conditions. Your gift will assist in fostering a new pipeline of scientists – the next generation of leaders in GI. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly, a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one.
Conclusion
Your gift directly supports talented young researchers working to advance our understanding of digestive diseases. Make a tax-deductible donation to help spur innovation. Donate today at www.gastro.org/donateonline.
Honor a family member, friend, or colleague while supporting the work of our mission through a gift to the AGA Research Foundation. Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit. The AGA Research Awards program recruits, retains, and supports the most promising investigators in gastroenterology and hepatology.
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help support researchers working toward developing new treatments and diagnostics for patients with GI conditions. Your gift will assist in fostering a new pipeline of scientists – the next generation of leaders in GI. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly, a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one.
Conclusion
Your gift directly supports talented young researchers working to advance our understanding of digestive diseases. Make a tax-deductible donation to help spur innovation. Donate today at www.gastro.org/donateonline.
Honor a family member, friend, or colleague while supporting the work of our mission through a gift to the AGA Research Foundation. Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit. The AGA Research Awards program recruits, retains, and supports the most promising investigators in gastroenterology and hepatology.
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help support researchers working toward developing new treatments and diagnostics for patients with GI conditions. Your gift will assist in fostering a new pipeline of scientists – the next generation of leaders in GI. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly, a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one.
Conclusion
Your gift directly supports talented young researchers working to advance our understanding of digestive diseases. Make a tax-deductible donation to help spur innovation. Donate today at www.gastro.org/donateonline.
CMS releases proposed payment rule
On July 15, for calendar year 2023.
AGA, along with the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy, have identified the following top three takeaways:
Slight increase in ASC payments – The proposed ASC conversion factor increases 2.7% to $51.315 for ASCs that meet quality reporting requirements.
Slight increase in facility fees payments – Hospitals that meet quality reporting requirements also receive a 2.7% proposed increase, which translates to $86.785 – a stark difference from the ASC payment.
18% cuts to some motility and G-tube codes – Hospital outpatient facility payments for motility codes 91117 and 91122 and G-tube codes 43761-43763 could decrease by 18% because of proposed changes to their Ambulatory Payment Classification (APC) family.
On July 15, for calendar year 2023.
AGA, along with the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy, have identified the following top three takeaways:
Slight increase in ASC payments – The proposed ASC conversion factor increases 2.7% to $51.315 for ASCs that meet quality reporting requirements.
Slight increase in facility fees payments – Hospitals that meet quality reporting requirements also receive a 2.7% proposed increase, which translates to $86.785 – a stark difference from the ASC payment.
18% cuts to some motility and G-tube codes – Hospital outpatient facility payments for motility codes 91117 and 91122 and G-tube codes 43761-43763 could decrease by 18% because of proposed changes to their Ambulatory Payment Classification (APC) family.
On July 15, for calendar year 2023.
AGA, along with the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy, have identified the following top three takeaways:
Slight increase in ASC payments – The proposed ASC conversion factor increases 2.7% to $51.315 for ASCs that meet quality reporting requirements.
Slight increase in facility fees payments – Hospitals that meet quality reporting requirements also receive a 2.7% proposed increase, which translates to $86.785 – a stark difference from the ASC payment.
18% cuts to some motility and G-tube codes – Hospital outpatient facility payments for motility codes 91117 and 91122 and G-tube codes 43761-43763 could decrease by 18% because of proposed changes to their Ambulatory Payment Classification (APC) family.
Partnering for pulmonary fibrosis
The CHEST Foundation raises awareness for the most common interstitial lung disease.
On August 27, the CHEST Foundation and the Feldman Family Foundation will be hosting the 9th annual Irv Feldman Texas Hold ‘Em Tournament & Casino Night fundraiser supporting patient access and the provision of better quality of life for patients battling the interstitial lung disease – pulmonary fibrosis.
“My dad, Irv, had pulmonary fibrosis and deeply loved to play poker. It was always a family activity, and it continued through when he got sick. We played at his kitchen table when he couldn’t leave the house, and we even brought cards and chips to his hospital and rehab rooms,” said Mitch Feldman, President of the Feldman Family Foundation and member of the CHEST Foundation Board of Trustees. “During these few hours of poker play, he all but forgot about his illness and showed virtually no symptoms of the disease. In his honor, we created an event where people would come together to have fun playing poker while raising money for the disease [that] so deeply impacted our family.”
Through years of hosting the event, the Feldman family and the CHEST Foundation secured funding to develop a pulmonary fibrosis patient education resource hub that serves as a resource for those newly diagnosed and living with this disease. The Feldman Family and the CHEST Foundation continue to raise funds to support both early diagnosis and closing the gap between diagnosis and beginning treatment.
Partnering to address gaps
Affecting around 400,000 people in the United States, ILDs are frequently misdiagnosed as more common lung diseases. Some studies show that reaching an appropriate diagnosis for rarer lung diseases can take upwards of several years.
To begin addressing the issue of delays in diagnosis, the American College of Chest Physicians (CHEST) and Three Lakes Foundation are collaborating on a multiphase educational initiative aiming to reduce the time it takes to identify interstitial lung diseases like pulmonary fibrosis.
The initiative is called “Bridging SpecialtiesTM: Timely Diagnosis for ILD Patients” to highlight the collaboration of pulmonary and primary care medicine. A steering committee of medical experts – including pulmonologists, primary care physicians, and a nursing professional – will work to create materials that will aid in identifying and diagnosing complex lung diseases quicker.
“By having experts from both pulmonary and primary care medicine as members of the steering committee, we are bringing together the pieces of the puzzle that is a complex diagnosis,” said Bridging Specialties steering committee member and family medicine physician, Dr. William Lago. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”
To learn more about the Bridging SpecialtiesTM: Timely Diagnosis for ILD Patients initiative and to sign up for updates, visit https://tinyurl.com/2p92ha6r.
For ticket and donation information to the Irv Feldman Texas Hold ‘Em Tournament & Casino Night, visit the CHEST Foundation website at foundation.chestnet.org.
The CHEST Foundation raises awareness for the most common interstitial lung disease.
On August 27, the CHEST Foundation and the Feldman Family Foundation will be hosting the 9th annual Irv Feldman Texas Hold ‘Em Tournament & Casino Night fundraiser supporting patient access and the provision of better quality of life for patients battling the interstitial lung disease – pulmonary fibrosis.
“My dad, Irv, had pulmonary fibrosis and deeply loved to play poker. It was always a family activity, and it continued through when he got sick. We played at his kitchen table when he couldn’t leave the house, and we even brought cards and chips to his hospital and rehab rooms,” said Mitch Feldman, President of the Feldman Family Foundation and member of the CHEST Foundation Board of Trustees. “During these few hours of poker play, he all but forgot about his illness and showed virtually no symptoms of the disease. In his honor, we created an event where people would come together to have fun playing poker while raising money for the disease [that] so deeply impacted our family.”
Through years of hosting the event, the Feldman family and the CHEST Foundation secured funding to develop a pulmonary fibrosis patient education resource hub that serves as a resource for those newly diagnosed and living with this disease. The Feldman Family and the CHEST Foundation continue to raise funds to support both early diagnosis and closing the gap between diagnosis and beginning treatment.
Partnering to address gaps
Affecting around 400,000 people in the United States, ILDs are frequently misdiagnosed as more common lung diseases. Some studies show that reaching an appropriate diagnosis for rarer lung diseases can take upwards of several years.
To begin addressing the issue of delays in diagnosis, the American College of Chest Physicians (CHEST) and Three Lakes Foundation are collaborating on a multiphase educational initiative aiming to reduce the time it takes to identify interstitial lung diseases like pulmonary fibrosis.
The initiative is called “Bridging SpecialtiesTM: Timely Diagnosis for ILD Patients” to highlight the collaboration of pulmonary and primary care medicine. A steering committee of medical experts – including pulmonologists, primary care physicians, and a nursing professional – will work to create materials that will aid in identifying and diagnosing complex lung diseases quicker.
“By having experts from both pulmonary and primary care medicine as members of the steering committee, we are bringing together the pieces of the puzzle that is a complex diagnosis,” said Bridging Specialties steering committee member and family medicine physician, Dr. William Lago. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”
To learn more about the Bridging SpecialtiesTM: Timely Diagnosis for ILD Patients initiative and to sign up for updates, visit https://tinyurl.com/2p92ha6r.
For ticket and donation information to the Irv Feldman Texas Hold ‘Em Tournament & Casino Night, visit the CHEST Foundation website at foundation.chestnet.org.
The CHEST Foundation raises awareness for the most common interstitial lung disease.
On August 27, the CHEST Foundation and the Feldman Family Foundation will be hosting the 9th annual Irv Feldman Texas Hold ‘Em Tournament & Casino Night fundraiser supporting patient access and the provision of better quality of life for patients battling the interstitial lung disease – pulmonary fibrosis.
“My dad, Irv, had pulmonary fibrosis and deeply loved to play poker. It was always a family activity, and it continued through when he got sick. We played at his kitchen table when he couldn’t leave the house, and we even brought cards and chips to his hospital and rehab rooms,” said Mitch Feldman, President of the Feldman Family Foundation and member of the CHEST Foundation Board of Trustees. “During these few hours of poker play, he all but forgot about his illness and showed virtually no symptoms of the disease. In his honor, we created an event where people would come together to have fun playing poker while raising money for the disease [that] so deeply impacted our family.”
Through years of hosting the event, the Feldman family and the CHEST Foundation secured funding to develop a pulmonary fibrosis patient education resource hub that serves as a resource for those newly diagnosed and living with this disease. The Feldman Family and the CHEST Foundation continue to raise funds to support both early diagnosis and closing the gap between diagnosis and beginning treatment.
Partnering to address gaps
Affecting around 400,000 people in the United States, ILDs are frequently misdiagnosed as more common lung diseases. Some studies show that reaching an appropriate diagnosis for rarer lung diseases can take upwards of several years.
To begin addressing the issue of delays in diagnosis, the American College of Chest Physicians (CHEST) and Three Lakes Foundation are collaborating on a multiphase educational initiative aiming to reduce the time it takes to identify interstitial lung diseases like pulmonary fibrosis.
The initiative is called “Bridging SpecialtiesTM: Timely Diagnosis for ILD Patients” to highlight the collaboration of pulmonary and primary care medicine. A steering committee of medical experts – including pulmonologists, primary care physicians, and a nursing professional – will work to create materials that will aid in identifying and diagnosing complex lung diseases quicker.
“By having experts from both pulmonary and primary care medicine as members of the steering committee, we are bringing together the pieces of the puzzle that is a complex diagnosis,” said Bridging Specialties steering committee member and family medicine physician, Dr. William Lago. “Patients first see their family medicine or primary care clinicians and, all too often, the most complex lung diseases present in ways that are indistinguishable from more common conditions like asthma and COPD. Bringing together experts in both fields will yield the best results in creating a path to diagnosis.”
To learn more about the Bridging SpecialtiesTM: Timely Diagnosis for ILD Patients initiative and to sign up for updates, visit https://tinyurl.com/2p92ha6r.
For ticket and donation information to the Irv Feldman Texas Hold ‘Em Tournament & Casino Night, visit the CHEST Foundation website at foundation.chestnet.org.
Diffuse Lung Disease & Transplant Network
Interstitial Lung Disease Section
Diagnosis of idiopathic pulmonary fibrosis: Is tissue still an issue?
Per ATS/ERS/JRS/ALAT guidelines, diagnosis of IPF requires exclusion of known causes of interstitial lung disease (ILD) and either the presence of a usual interstitial pneumonia (UIP) or probable UIP pattern on HRCT scan or specific combinations of HRCT scan and histopathologic patterns. Surgical lung biopsy (SLB) is the gold standard for histopathologic diagnosis.
The recent update (Raghu, et al. Am J Respir Crit Care Med. 2022;205[9]:1084-92) made a conditional recommendation for transbronchial lung cryobiopsy (TBLC) as an acceptable alternative to SLB in patients with undetermined ILD. Systematic analysis revealed a diagnostic yield of 79% (85% when ≥ 3 sites were sampled) by TBLC compared with 90% on SLB. With consideration of this diagnostic yield vs the risk of pneumothorax, severe bleeding, and procedural mortality, TBLC is an attractive tool compared with SLB. Overall, the utility of TBLC remains limited to experienced centers due to dependence on proceduralist and pathologist skills for optimal success and more data are awaited.
No recommendation was made for or against the use of genomic classifiers (GC) for the diagnosis of UIP in patients with undetermined ILD undergoing transbronchial biopsy. Although, meta-analysis revealed a specificity of 92%, this may be driven by patient enrichment with a high probability for UIP population. GC has the potential to reduce SLB-associated risks and provide diagnostic information for multidisciplinary discussion in certain scenarios. However, limitations arise from the inability to distinguish specific ILD subtype associated with the UIP pattern; further improvement in sensitivity and understanding of downstream consequences of false-negative results is necessary.
Kevin Dsouza, MD
Fellow-in-Training
Interstitial Lung Disease Section
Diagnosis of idiopathic pulmonary fibrosis: Is tissue still an issue?
Per ATS/ERS/JRS/ALAT guidelines, diagnosis of IPF requires exclusion of known causes of interstitial lung disease (ILD) and either the presence of a usual interstitial pneumonia (UIP) or probable UIP pattern on HRCT scan or specific combinations of HRCT scan and histopathologic patterns. Surgical lung biopsy (SLB) is the gold standard for histopathologic diagnosis.
The recent update (Raghu, et al. Am J Respir Crit Care Med. 2022;205[9]:1084-92) made a conditional recommendation for transbronchial lung cryobiopsy (TBLC) as an acceptable alternative to SLB in patients with undetermined ILD. Systematic analysis revealed a diagnostic yield of 79% (85% when ≥ 3 sites were sampled) by TBLC compared with 90% on SLB. With consideration of this diagnostic yield vs the risk of pneumothorax, severe bleeding, and procedural mortality, TBLC is an attractive tool compared with SLB. Overall, the utility of TBLC remains limited to experienced centers due to dependence on proceduralist and pathologist skills for optimal success and more data are awaited.
No recommendation was made for or against the use of genomic classifiers (GC) for the diagnosis of UIP in patients with undetermined ILD undergoing transbronchial biopsy. Although, meta-analysis revealed a specificity of 92%, this may be driven by patient enrichment with a high probability for UIP population. GC has the potential to reduce SLB-associated risks and provide diagnostic information for multidisciplinary discussion in certain scenarios. However, limitations arise from the inability to distinguish specific ILD subtype associated with the UIP pattern; further improvement in sensitivity and understanding of downstream consequences of false-negative results is necessary.
Kevin Dsouza, MD
Fellow-in-Training
Interstitial Lung Disease Section
Diagnosis of idiopathic pulmonary fibrosis: Is tissue still an issue?
Per ATS/ERS/JRS/ALAT guidelines, diagnosis of IPF requires exclusion of known causes of interstitial lung disease (ILD) and either the presence of a usual interstitial pneumonia (UIP) or probable UIP pattern on HRCT scan or specific combinations of HRCT scan and histopathologic patterns. Surgical lung biopsy (SLB) is the gold standard for histopathologic diagnosis.
The recent update (Raghu, et al. Am J Respir Crit Care Med. 2022;205[9]:1084-92) made a conditional recommendation for transbronchial lung cryobiopsy (TBLC) as an acceptable alternative to SLB in patients with undetermined ILD. Systematic analysis revealed a diagnostic yield of 79% (85% when ≥ 3 sites were sampled) by TBLC compared with 90% on SLB. With consideration of this diagnostic yield vs the risk of pneumothorax, severe bleeding, and procedural mortality, TBLC is an attractive tool compared with SLB. Overall, the utility of TBLC remains limited to experienced centers due to dependence on proceduralist and pathologist skills for optimal success and more data are awaited.
No recommendation was made for or against the use of genomic classifiers (GC) for the diagnosis of UIP in patients with undetermined ILD undergoing transbronchial biopsy. Although, meta-analysis revealed a specificity of 92%, this may be driven by patient enrichment with a high probability for UIP population. GC has the potential to reduce SLB-associated risks and provide diagnostic information for multidisciplinary discussion in certain scenarios. However, limitations arise from the inability to distinguish specific ILD subtype associated with the UIP pattern; further improvement in sensitivity and understanding of downstream consequences of false-negative results is necessary.
Kevin Dsouza, MD
Fellow-in-Training
Thoracic Oncology & Chest Procedures Network
Ultrasound and Chest Imaging Section
Advanced critical care echocardiography: A noninvasive tool for hemodynamic assessment in critically ill patients
Hemodynamic assessments in critically ill patients are important to guide accurate management; however, traditional invasive methods of measuring cardiac output have significant limitations, including risks of infection and bleeding. ACCE can provide a multitude of hemodynamic measurements from cardiac output (CO) to right ventricular systolic pressure (RVSP) and left atrial pressure (LAP). Combinations of left ventricular function parameters, along with estimation of filling pressures, can help distinguish between types of shock. Schmidt and colleagues (Sci Rep. 2022;12[1]:7187) demonstrated that measurement of these indices in the majority of patients helped elucidate the cause for hemodynamic compromise. They found presence of a cardiac index (CI) < 2.5/min.m2 was associated with a doubling of ICU mortality as compared with predictions based on severity of illness scores in otherwise hemodynamically stable patients. Hollenberg and colleagues (Am J Cardiol. 2021;153:135-39) demonstrated the feasibility of a simpler stratification using the left ventricular ejection fraction (LVEF) and CI in coronavirus disease 2019 patients with shock, where low CI despite having a preserved LVEF was associated with worse outcomes.
Quick, reliable data are an intensivist’s friend. Utilizing ACCE at the bedside adds another tool in our arsenal to provide real-time hemodynamic data that can be used to manage patients in the ICU. ACCE also allows repeated measurements to determine changes based on therapeutic interventions initiated.
In recognition of the importance of ACCE as a tool for intensivists, the National Board of Echocardiography (NBE) now offers a pathway toward board certification with the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM). CHEST continues to offer cutting-edge courses in ACCE, as well as a board review course for learners interested in sitting for the CCEeXAM.
Amik Sodhi, MD, FCCP
Gul Zaidi, MD, FCCP
Members-at-Large
Ultrasound and Chest Imaging Section
Advanced critical care echocardiography: A noninvasive tool for hemodynamic assessment in critically ill patients
Hemodynamic assessments in critically ill patients are important to guide accurate management; however, traditional invasive methods of measuring cardiac output have significant limitations, including risks of infection and bleeding. ACCE can provide a multitude of hemodynamic measurements from cardiac output (CO) to right ventricular systolic pressure (RVSP) and left atrial pressure (LAP). Combinations of left ventricular function parameters, along with estimation of filling pressures, can help distinguish between types of shock. Schmidt and colleagues (Sci Rep. 2022;12[1]:7187) demonstrated that measurement of these indices in the majority of patients helped elucidate the cause for hemodynamic compromise. They found presence of a cardiac index (CI) < 2.5/min.m2 was associated with a doubling of ICU mortality as compared with predictions based on severity of illness scores in otherwise hemodynamically stable patients. Hollenberg and colleagues (Am J Cardiol. 2021;153:135-39) demonstrated the feasibility of a simpler stratification using the left ventricular ejection fraction (LVEF) and CI in coronavirus disease 2019 patients with shock, where low CI despite having a preserved LVEF was associated with worse outcomes.
Quick, reliable data are an intensivist’s friend. Utilizing ACCE at the bedside adds another tool in our arsenal to provide real-time hemodynamic data that can be used to manage patients in the ICU. ACCE also allows repeated measurements to determine changes based on therapeutic interventions initiated.
In recognition of the importance of ACCE as a tool for intensivists, the National Board of Echocardiography (NBE) now offers a pathway toward board certification with the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM). CHEST continues to offer cutting-edge courses in ACCE, as well as a board review course for learners interested in sitting for the CCEeXAM.
Amik Sodhi, MD, FCCP
Gul Zaidi, MD, FCCP
Members-at-Large
Ultrasound and Chest Imaging Section
Advanced critical care echocardiography: A noninvasive tool for hemodynamic assessment in critically ill patients
Hemodynamic assessments in critically ill patients are important to guide accurate management; however, traditional invasive methods of measuring cardiac output have significant limitations, including risks of infection and bleeding. ACCE can provide a multitude of hemodynamic measurements from cardiac output (CO) to right ventricular systolic pressure (RVSP) and left atrial pressure (LAP). Combinations of left ventricular function parameters, along with estimation of filling pressures, can help distinguish between types of shock. Schmidt and colleagues (Sci Rep. 2022;12[1]:7187) demonstrated that measurement of these indices in the majority of patients helped elucidate the cause for hemodynamic compromise. They found presence of a cardiac index (CI) < 2.5/min.m2 was associated with a doubling of ICU mortality as compared with predictions based on severity of illness scores in otherwise hemodynamically stable patients. Hollenberg and colleagues (Am J Cardiol. 2021;153:135-39) demonstrated the feasibility of a simpler stratification using the left ventricular ejection fraction (LVEF) and CI in coronavirus disease 2019 patients with shock, where low CI despite having a preserved LVEF was associated with worse outcomes.
Quick, reliable data are an intensivist’s friend. Utilizing ACCE at the bedside adds another tool in our arsenal to provide real-time hemodynamic data that can be used to manage patients in the ICU. ACCE also allows repeated measurements to determine changes based on therapeutic interventions initiated.
In recognition of the importance of ACCE as a tool for intensivists, the National Board of Echocardiography (NBE) now offers a pathway toward board certification with the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM). CHEST continues to offer cutting-edge courses in ACCE, as well as a board review course for learners interested in sitting for the CCEeXAM.
Amik Sodhi, MD, FCCP
Gul Zaidi, MD, FCCP
Members-at-Large
Thoracic Oncology & Chest Procedures Network
Interventional Procedures Section
Mind the gap: Improving adherence to lung cancer screening follow-up
The gap in adherence rates between a disciplined clinical trial and the heterogenous patchwork of U.S. health care is hardly unusual, but as lung cancer remains the number one cancer killer both worldwide and in the United States, one such disparity bears closer scrutiny.
In 2011, the National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality with the implementation of low dose CT scan screening with 95% adherence to CT scan follow-up within 15 months of initial screening imaging (Aberle, et al. N Engl J Med. 2011;365[5]:395-409). Unfortunately, estimates of real-world adherence to lung cancer screening (LCS) follow-up fall to 51% even within an extended 18-month window (Hirsch, et al. Ann Am Thorac Soc. 2019;16[10]:1329-32).
Recent studies compared adherence to LCS follow-up between centralized and decentralized screening programs. Centralized programs used dedicated program coordinators and a tracking system, while decentralized programs relied on primary care providers.(Sakoda, et al. JAMA Network Open. 2021;4[4]:e218559). A subsequent study demonstrated adherence of 70% vs 41% among patients in centralized vs decentralized programs, respectively (Smith, et al. Chest. 2022;161[3]:818-25).
This gap is even more pronounced in majority-Black populations. Kunitomo and colleagues showed 33% lower odds of adherence to LCS follow-up compared with White patients (Kunitomo, et al. Chest. 2022;161[1]:266-75). Another study in a diverse, majority-Black patient population showed only 31% adherence to LCS follow-up at 1 year (Erkmen, et al. Cancer Causes Control. 2021;32[3]:291-8).
How could we close this gap? Centralized LCS programs show promise of increasing adherence to LCS follow-up. Heightened awareness of and targeted investment to mitigate racial inequities in LCS is imperative.
Jose De Cardenas MD
John Howe, MD
Members-at-Large
Interventional Procedures Section
Mind the gap: Improving adherence to lung cancer screening follow-up
The gap in adherence rates between a disciplined clinical trial and the heterogenous patchwork of U.S. health care is hardly unusual, but as lung cancer remains the number one cancer killer both worldwide and in the United States, one such disparity bears closer scrutiny.
In 2011, the National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality with the implementation of low dose CT scan screening with 95% adherence to CT scan follow-up within 15 months of initial screening imaging (Aberle, et al. N Engl J Med. 2011;365[5]:395-409). Unfortunately, estimates of real-world adherence to lung cancer screening (LCS) follow-up fall to 51% even within an extended 18-month window (Hirsch, et al. Ann Am Thorac Soc. 2019;16[10]:1329-32).
Recent studies compared adherence to LCS follow-up between centralized and decentralized screening programs. Centralized programs used dedicated program coordinators and a tracking system, while decentralized programs relied on primary care providers.(Sakoda, et al. JAMA Network Open. 2021;4[4]:e218559). A subsequent study demonstrated adherence of 70% vs 41% among patients in centralized vs decentralized programs, respectively (Smith, et al. Chest. 2022;161[3]:818-25).
This gap is even more pronounced in majority-Black populations. Kunitomo and colleagues showed 33% lower odds of adherence to LCS follow-up compared with White patients (Kunitomo, et al. Chest. 2022;161[1]:266-75). Another study in a diverse, majority-Black patient population showed only 31% adherence to LCS follow-up at 1 year (Erkmen, et al. Cancer Causes Control. 2021;32[3]:291-8).
How could we close this gap? Centralized LCS programs show promise of increasing adherence to LCS follow-up. Heightened awareness of and targeted investment to mitigate racial inequities in LCS is imperative.
Jose De Cardenas MD
John Howe, MD
Members-at-Large
Interventional Procedures Section
Mind the gap: Improving adherence to lung cancer screening follow-up
The gap in adherence rates between a disciplined clinical trial and the heterogenous patchwork of U.S. health care is hardly unusual, but as lung cancer remains the number one cancer killer both worldwide and in the United States, one such disparity bears closer scrutiny.
In 2011, the National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality with the implementation of low dose CT scan screening with 95% adherence to CT scan follow-up within 15 months of initial screening imaging (Aberle, et al. N Engl J Med. 2011;365[5]:395-409). Unfortunately, estimates of real-world adherence to lung cancer screening (LCS) follow-up fall to 51% even within an extended 18-month window (Hirsch, et al. Ann Am Thorac Soc. 2019;16[10]:1329-32).
Recent studies compared adherence to LCS follow-up between centralized and decentralized screening programs. Centralized programs used dedicated program coordinators and a tracking system, while decentralized programs relied on primary care providers.(Sakoda, et al. JAMA Network Open. 2021;4[4]:e218559). A subsequent study demonstrated adherence of 70% vs 41% among patients in centralized vs decentralized programs, respectively (Smith, et al. Chest. 2022;161[3]:818-25).
This gap is even more pronounced in majority-Black populations. Kunitomo and colleagues showed 33% lower odds of adherence to LCS follow-up compared with White patients (Kunitomo, et al. Chest. 2022;161[1]:266-75). Another study in a diverse, majority-Black patient population showed only 31% adherence to LCS follow-up at 1 year (Erkmen, et al. Cancer Causes Control. 2021;32[3]:291-8).
How could we close this gap? Centralized LCS programs show promise of increasing adherence to LCS follow-up. Heightened awareness of and targeted investment to mitigate racial inequities in LCS is imperative.
Jose De Cardenas MD
John Howe, MD
Members-at-Large
Sleep Medicine Network
Home-based Mechanical Ventilation and Neuromuscular Disease Section
Navigating the latest device supply chain challenge: Mechanical airway clearance
(distal airways). Cough augmentation techniques provide lung volume recruitment on the insufflation phase, in addition to mobilization of secretions with augmentation of the peak expiratory flow rate to >160 L/min on the exhalation phase.
A mechanical insufflation-exsufflation (MI-E) device (T70 Cough Assist - Phillips) is now on indefinite backorder. This creates a dangerous situation for our patients requiring cough augmentation for survival. Alternative options that provide both MI-E and high frequency oscillation include two systems (Synclara Cough System – Hill-rom and the Biwaze Cough System-ABM Respiratory Care).
The Synclara can only be obtained in a direct-to-patient model, contracting with individual respiratory therapists, outside of the standard durable medical equipment model. The final MI-E model option is the VOCSYN multifunctional ventilator (ventilator, cough assist, nebulizer, oxygen concentrator, suction). This multifunction ventilator has had variable acceptance with HCPCS code E0467. If the VOCSYN is chosen, the patient cannot have been issued any component devices or have reached the 36-month cap for oxygen equipment (CR 10854 special payment rule, 42 CFR414.222).
As the supply of devices is exhausted, we will need to shift to evidence-based manual options. Manual cough augmentation can be done effectively with a bag-valve mask, using breath stacking to achieve maximal lung insufflation, optimizing the length tension relationship of elastic recoil on exhalation to increase peak cough flow (PCF).
This can be done alone but is more effective when combined with manually assisted cough (Bach JR. Chest. 1993;104[5]:1553-62). These interventions require training of the caregivers, using resources such as those found at www.canventottawa.ca.
With continued supply chain instability, manual airway clearance techniques should be considered in patients with less advanced cough impairment (PCF 160-270 L/min), to save the remaining devices for those with PCF of <160 L/min.
Jeanette Brown, MD, PhD
Karin Provost, DO, PhD
Members-at-Large
Home-based Mechanical Ventilation and Neuromuscular Disease Section
Navigating the latest device supply chain challenge: Mechanical airway clearance
(distal airways). Cough augmentation techniques provide lung volume recruitment on the insufflation phase, in addition to mobilization of secretions with augmentation of the peak expiratory flow rate to >160 L/min on the exhalation phase.
A mechanical insufflation-exsufflation (MI-E) device (T70 Cough Assist - Phillips) is now on indefinite backorder. This creates a dangerous situation for our patients requiring cough augmentation for survival. Alternative options that provide both MI-E and high frequency oscillation include two systems (Synclara Cough System – Hill-rom and the Biwaze Cough System-ABM Respiratory Care).
The Synclara can only be obtained in a direct-to-patient model, contracting with individual respiratory therapists, outside of the standard durable medical equipment model. The final MI-E model option is the VOCSYN multifunctional ventilator (ventilator, cough assist, nebulizer, oxygen concentrator, suction). This multifunction ventilator has had variable acceptance with HCPCS code E0467. If the VOCSYN is chosen, the patient cannot have been issued any component devices or have reached the 36-month cap for oxygen equipment (CR 10854 special payment rule, 42 CFR414.222).
As the supply of devices is exhausted, we will need to shift to evidence-based manual options. Manual cough augmentation can be done effectively with a bag-valve mask, using breath stacking to achieve maximal lung insufflation, optimizing the length tension relationship of elastic recoil on exhalation to increase peak cough flow (PCF).
This can be done alone but is more effective when combined with manually assisted cough (Bach JR. Chest. 1993;104[5]:1553-62). These interventions require training of the caregivers, using resources such as those found at www.canventottawa.ca.
With continued supply chain instability, manual airway clearance techniques should be considered in patients with less advanced cough impairment (PCF 160-270 L/min), to save the remaining devices for those with PCF of <160 L/min.
Jeanette Brown, MD, PhD
Karin Provost, DO, PhD
Members-at-Large
Home-based Mechanical Ventilation and Neuromuscular Disease Section
Navigating the latest device supply chain challenge: Mechanical airway clearance
(distal airways). Cough augmentation techniques provide lung volume recruitment on the insufflation phase, in addition to mobilization of secretions with augmentation of the peak expiratory flow rate to >160 L/min on the exhalation phase.
A mechanical insufflation-exsufflation (MI-E) device (T70 Cough Assist - Phillips) is now on indefinite backorder. This creates a dangerous situation for our patients requiring cough augmentation for survival. Alternative options that provide both MI-E and high frequency oscillation include two systems (Synclara Cough System – Hill-rom and the Biwaze Cough System-ABM Respiratory Care).
The Synclara can only be obtained in a direct-to-patient model, contracting with individual respiratory therapists, outside of the standard durable medical equipment model. The final MI-E model option is the VOCSYN multifunctional ventilator (ventilator, cough assist, nebulizer, oxygen concentrator, suction). This multifunction ventilator has had variable acceptance with HCPCS code E0467. If the VOCSYN is chosen, the patient cannot have been issued any component devices or have reached the 36-month cap for oxygen equipment (CR 10854 special payment rule, 42 CFR414.222).
As the supply of devices is exhausted, we will need to shift to evidence-based manual options. Manual cough augmentation can be done effectively with a bag-valve mask, using breath stacking to achieve maximal lung insufflation, optimizing the length tension relationship of elastic recoil on exhalation to increase peak cough flow (PCF).
This can be done alone but is more effective when combined with manually assisted cough (Bach JR. Chest. 1993;104[5]:1553-62). These interventions require training of the caregivers, using resources such as those found at www.canventottawa.ca.
With continued supply chain instability, manual airway clearance techniques should be considered in patients with less advanced cough impairment (PCF 160-270 L/min), to save the remaining devices for those with PCF of <160 L/min.
Jeanette Brown, MD, PhD
Karin Provost, DO, PhD
Members-at-Large
Airways Disorders Network
Asthma and COPD Section
Go TEAM! Shared decision-making tool for patient-clinician collaboration in severe asthma
Shared decision-making is associated with improved medication adherence in adults (Wilson, et al. Am J Respir Crit Care Med. 2010;181[6]:566-77) and quality of life and asthma control in children (Taylor, et al. J Asthma. 2018;55[6]:675-83). The Global Initiative for Asthma committee recommends a patient-clinician partnership. Activated and engaged patients play a major role in their asthma management (https://ginasthma.org/gina-reports). Shared decision-making discussions should include potential benefits and harms of the therapeutic options, patient’s values and lifestyle preferences, and addressing concerns.
The CHEST Foundation, the Allergy and Asthma Network, and the American College of Allergy, Asthma, and Immunology developed an online shared decision- making tool for severe asthma (https://asthma.chestnet.org/sdm-tool).
This tool utilizes patient’s values, specifics about triggers, asthma control, medication side effects, and lifestyle preferences to identify personalized management options. The tool provides information about recommended therapeutic options in simple terms, including potential benefits, possible side effects, expected treatment frequency and duration, and financial aid information. The treatment options currently explained in this tool include anti-immunoglobulin E, anti-interleukin-5, anti-interleukin-4/13, bronchial thermoplasty, long-acting muscarinic antagonist, macrolides, oral corticosteroids, and standard of care.
As a team, the patient and the health care professional can use this tool during office visits to help guide management. Figure 1 shows a suggested workflow to utilize the tool in clinical practice.
Potential barriers include excess time and increased human resources. Barrier mitigation may include reviewing the tool and reconciling the medications before the clinician enters the room. With these interventions, many clinician encounters may be completed in 10 to 15 minutes.
Farrukh Abbas, MBBS
Fellow-in-Training
Asthma and COPD Section
Go TEAM! Shared decision-making tool for patient-clinician collaboration in severe asthma
Shared decision-making is associated with improved medication adherence in adults (Wilson, et al. Am J Respir Crit Care Med. 2010;181[6]:566-77) and quality of life and asthma control in children (Taylor, et al. J Asthma. 2018;55[6]:675-83). The Global Initiative for Asthma committee recommends a patient-clinician partnership. Activated and engaged patients play a major role in their asthma management (https://ginasthma.org/gina-reports). Shared decision-making discussions should include potential benefits and harms of the therapeutic options, patient’s values and lifestyle preferences, and addressing concerns.
The CHEST Foundation, the Allergy and Asthma Network, and the American College of Allergy, Asthma, and Immunology developed an online shared decision- making tool for severe asthma (https://asthma.chestnet.org/sdm-tool).
This tool utilizes patient’s values, specifics about triggers, asthma control, medication side effects, and lifestyle preferences to identify personalized management options. The tool provides information about recommended therapeutic options in simple terms, including potential benefits, possible side effects, expected treatment frequency and duration, and financial aid information. The treatment options currently explained in this tool include anti-immunoglobulin E, anti-interleukin-5, anti-interleukin-4/13, bronchial thermoplasty, long-acting muscarinic antagonist, macrolides, oral corticosteroids, and standard of care.
As a team, the patient and the health care professional can use this tool during office visits to help guide management. Figure 1 shows a suggested workflow to utilize the tool in clinical practice.
Potential barriers include excess time and increased human resources. Barrier mitigation may include reviewing the tool and reconciling the medications before the clinician enters the room. With these interventions, many clinician encounters may be completed in 10 to 15 minutes.
Farrukh Abbas, MBBS
Fellow-in-Training
Asthma and COPD Section
Go TEAM! Shared decision-making tool for patient-clinician collaboration in severe asthma
Shared decision-making is associated with improved medication adherence in adults (Wilson, et al. Am J Respir Crit Care Med. 2010;181[6]:566-77) and quality of life and asthma control in children (Taylor, et al. J Asthma. 2018;55[6]:675-83). The Global Initiative for Asthma committee recommends a patient-clinician partnership. Activated and engaged patients play a major role in their asthma management (https://ginasthma.org/gina-reports). Shared decision-making discussions should include potential benefits and harms of the therapeutic options, patient’s values and lifestyle preferences, and addressing concerns.
The CHEST Foundation, the Allergy and Asthma Network, and the American College of Allergy, Asthma, and Immunology developed an online shared decision- making tool for severe asthma (https://asthma.chestnet.org/sdm-tool).
This tool utilizes patient’s values, specifics about triggers, asthma control, medication side effects, and lifestyle preferences to identify personalized management options. The tool provides information about recommended therapeutic options in simple terms, including potential benefits, possible side effects, expected treatment frequency and duration, and financial aid information. The treatment options currently explained in this tool include anti-immunoglobulin E, anti-interleukin-5, anti-interleukin-4/13, bronchial thermoplasty, long-acting muscarinic antagonist, macrolides, oral corticosteroids, and standard of care.
As a team, the patient and the health care professional can use this tool during office visits to help guide management. Figure 1 shows a suggested workflow to utilize the tool in clinical practice.
Potential barriers include excess time and increased human resources. Barrier mitigation may include reviewing the tool and reconciling the medications before the clinician enters the room. With these interventions, many clinician encounters may be completed in 10 to 15 minutes.
Farrukh Abbas, MBBS
Fellow-in-Training