Society News

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:
 

• Patient case: Crohn’s patient with three different strictures (https://community.gastro.org/posts/22491)
• Patient case: Alcoholic hepatitis and positive anti-smooth muscle antibody (https://community.gastro.org/posts/22407)
• COVID-19: The importance of preparedness in independent GI practices (https://community.gastro.org/posts/22340)
• Patient case: Crohn’s patient with no tissue (https://community.gastro.org/posts/22472)

Roundtables (https://community.gastro.org/discussions/)

• Roadmap for the future of colorectal cancer screening in the U.S.
• Windows on Clinical GI lecture series: NAFLD, Crohn’s disease and gastroparesis

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:
 

• Patient case: Crohn’s patient with three different strictures (https://community.gastro.org/posts/22491)
• Patient case: Alcoholic hepatitis and positive anti-smooth muscle antibody (https://community.gastro.org/posts/22407)
• COVID-19: The importance of preparedness in independent GI practices (https://community.gastro.org/posts/22340)
• Patient case: Crohn’s patient with no tissue (https://community.gastro.org/posts/22472)

Roundtables (https://community.gastro.org/discussions/)

• Roadmap for the future of colorectal cancer screening in the U.S.
• Windows on Clinical GI lecture series: NAFLD, Crohn’s disease and gastroparesis

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:
 

• Patient case: Crohn’s patient with three different strictures (https://community.gastro.org/posts/22491)
• Patient case: Alcoholic hepatitis and positive anti-smooth muscle antibody (https://community.gastro.org/posts/22407)
• COVID-19: The importance of preparedness in independent GI practices (https://community.gastro.org/posts/22340)
• Patient case: Crohn’s patient with no tissue (https://community.gastro.org/posts/22472)

Roundtables (https://community.gastro.org/discussions/)

• Roadmap for the future of colorectal cancer screening in the U.S.
• Windows on Clinical GI lecture series: NAFLD, Crohn’s disease and gastroparesis

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Gastroenterology is proud to announce the release of a special collection of colorectal cancer articles. This curated collection includes some of the top colorectal cancer research published over the last 3 years with new research being added to the collection as it’s published.

View the special collection on Gastroenterology’s website, which is designed to help you quickly scan recent colorectal cancer research and easily navigate to studies of interest. Recent articles include:
 

• Use of Artificial Intelligence-Based Analytics From Live Colonoscopies to Optimize the Quality of the Colonoscopy Examination in Real Time: Proof of Concept
• Risk Factors for Early-Onset Colorectal Cancer
• Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

To view all of Gastroenterology’s curated article collections, please visit gastro.org/GastroCollections.

[email protected]

Gastroenterology is proud to announce the release of a special collection of colorectal cancer articles. This curated collection includes some of the top colorectal cancer research published over the last 3 years with new research being added to the collection as it’s published.

View the special collection on Gastroenterology’s website, which is designed to help you quickly scan recent colorectal cancer research and easily navigate to studies of interest. Recent articles include:
 

• Use of Artificial Intelligence-Based Analytics From Live Colonoscopies to Optimize the Quality of the Colonoscopy Examination in Real Time: Proof of Concept
• Risk Factors for Early-Onset Colorectal Cancer
• Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

To view all of Gastroenterology’s curated article collections, please visit gastro.org/GastroCollections.

[email protected]

Gastroenterology is proud to announce the release of a special collection of colorectal cancer articles. This curated collection includes some of the top colorectal cancer research published over the last 3 years with new research being added to the collection as it’s published.

View the special collection on Gastroenterology’s website, which is designed to help you quickly scan recent colorectal cancer research and easily navigate to studies of interest. Recent articles include:
 

• Use of Artificial Intelligence-Based Analytics From Live Colonoscopies to Optimize the Quality of the Colonoscopy Examination in Real Time: Proof of Concept
• Risk Factors for Early-Onset Colorectal Cancer
• Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

To view all of Gastroenterology’s curated article collections, please visit gastro.org/GastroCollections.

[email protected]

The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.



Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.



Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.



Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
 

The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.

The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.



Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.



Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.



Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
 

The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.

The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.



Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.



Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.



Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
 

The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.

Occupational and environmental health

Occupations at risk for COVID-19

As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.

Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.

Mary Beth Scholand, MD, FCCP – Vice-Chair

Jun She, MD, PhD – Steering Committee Member

Palliative and end-of-life care

Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic

The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”

Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:

• Encouraging values assessment and goals of care for alignment of treatment plans.
• Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
• Facilitating multidisciplinary video family meetings and clinical updates.
• Supporting ICU staff to alleviate moral distress and fatigue.
• Developing and distributing bereavement programs and remembrance rituals.
• Training and education on COVID-specific communication tools.
• Expanding outreach to patients/families through telehealth volunteer programs.

This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).

Tara Coles, MD

Hunter Groninger, MD, Vice Chair

Cheryl Hughes, LICSW

Rachel Adams, MD

Respiratory care

Strategies and technology for safer mechanical ventilation

Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.

An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO₂. Fewer nonactionable alarms can result in greater attention when alarms do occur.

Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.

Brian Walsh, PhD, RRT, NetWork Member

Jonathan Waugh, PhD, RRT, Steering Committee Member
 

Sleep medicine

Treatment-emergent central apnea may be a frequent cause of PAP nonadherence

Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).

TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).


TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).

Kara Dupuy-McCauley, MD

Fellow-in-Training Member

Caroline Okorie, MD, MPH

Steering Committee Member
 

Thoracic oncology

Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past

The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).

Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”

Abbie Begnaud, MD

Steering Committee Member

Reading list

Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.

Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.

Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.

Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.

Occupational and environmental health

Occupations at risk for COVID-19

As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.

Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.

Mary Beth Scholand, MD, FCCP – Vice-Chair

Jun She, MD, PhD – Steering Committee Member

Palliative and end-of-life care

Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic

The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”

Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:

• Encouraging values assessment and goals of care for alignment of treatment plans.
• Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
• Facilitating multidisciplinary video family meetings and clinical updates.
• Supporting ICU staff to alleviate moral distress and fatigue.
• Developing and distributing bereavement programs and remembrance rituals.
• Training and education on COVID-specific communication tools.
• Expanding outreach to patients/families through telehealth volunteer programs.

This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).

Tara Coles, MD

Hunter Groninger, MD, Vice Chair

Cheryl Hughes, LICSW

Rachel Adams, MD

Respiratory care

Strategies and technology for safer mechanical ventilation

Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.

An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO₂. Fewer nonactionable alarms can result in greater attention when alarms do occur.

Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.

Brian Walsh, PhD, RRT, NetWork Member

Jonathan Waugh, PhD, RRT, Steering Committee Member
 

Sleep medicine

Treatment-emergent central apnea may be a frequent cause of PAP nonadherence

Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).

TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).


TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).

Kara Dupuy-McCauley, MD

Fellow-in-Training Member

Caroline Okorie, MD, MPH

Steering Committee Member
 

Thoracic oncology

Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past

The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).

Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”

Abbie Begnaud, MD

Steering Committee Member

Reading list

Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.

Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.

Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.

Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.

Occupational and environmental health

Occupations at risk for COVID-19

As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.

Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.

Mary Beth Scholand, MD, FCCP – Vice-Chair

Jun She, MD, PhD – Steering Committee Member

Palliative and end-of-life care

Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic

The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”

Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:

• Encouraging values assessment and goals of care for alignment of treatment plans.
• Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
• Facilitating multidisciplinary video family meetings and clinical updates.
• Supporting ICU staff to alleviate moral distress and fatigue.
• Developing and distributing bereavement programs and remembrance rituals.
• Training and education on COVID-specific communication tools.
• Expanding outreach to patients/families through telehealth volunteer programs.

This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).

Tara Coles, MD

Hunter Groninger, MD, Vice Chair

Cheryl Hughes, LICSW

Rachel Adams, MD

Respiratory care

Strategies and technology for safer mechanical ventilation

Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.

An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO₂. Fewer nonactionable alarms can result in greater attention when alarms do occur.

Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.

Brian Walsh, PhD, RRT, NetWork Member

Jonathan Waugh, PhD, RRT, Steering Committee Member
 

Sleep medicine

Treatment-emergent central apnea may be a frequent cause of PAP nonadherence

Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).

TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).


TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).

Kara Dupuy-McCauley, MD

Fellow-in-Training Member

Caroline Okorie, MD, MPH

Steering Committee Member
 

Thoracic oncology

Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past

The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).

Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”

Abbie Begnaud, MD

Steering Committee Member

Reading list

Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.

Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.

Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.

Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.

Greetings,

As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!

As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”

Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.

Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.

While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.

In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.

We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.

Best,

Victor Test, MD, FCCP

Greetings,

As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!

As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”

Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.

Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.

While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.

In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.

We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.

Best,

Victor Test, MD, FCCP

Greetings,

As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!

As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”

Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.

Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.

While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.

In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.

We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.

Best,

Victor Test, MD, FCCP

As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.

Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.

“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois

As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.

Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.

“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois

As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.

Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.

“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:

• AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (https://community.gastro.org/posts/22199)
• Establishing an acute colitis pathway (https://community.gastro.org/posts/22171)
• Preprocedure COVID testing (https://community.gastro.org/posts/22164)
• Patient case: Gastroesophageal varices (https://community.gastro.org/posts/22098)
• Patient case: IBD with intra-abdominal sepsis (https://community.gastro.org/posts/22055)
• Patient case: Hypervascular pancreatic parenchyma (https://community.gastro.org/posts/22039)

Roundtables (https://community.gastro.org/discussions/)

• Windows on Clinical GI
• Clinical Challenges in IBD: Ulcerative colitis and a fistula
• GI COVID-19 Connection: Implementing an effective long-term telehealth program in a post-COVID world

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:

• AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (https://community.gastro.org/posts/22199)
• Establishing an acute colitis pathway (https://community.gastro.org/posts/22171)
• Preprocedure COVID testing (https://community.gastro.org/posts/22164)
• Patient case: Gastroesophageal varices (https://community.gastro.org/posts/22098)
• Patient case: IBD with intra-abdominal sepsis (https://community.gastro.org/posts/22055)
• Patient case: Hypervascular pancreatic parenchyma (https://community.gastro.org/posts/22039)

Roundtables (https://community.gastro.org/discussions/)

• Windows on Clinical GI
• Clinical Challenges in IBD: Ulcerative colitis and a fistula
• GI COVID-19 Connection: Implementing an effective long-term telehealth program in a post-COVID world

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:

• AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (https://community.gastro.org/posts/22199)
• Establishing an acute colitis pathway (https://community.gastro.org/posts/22171)
• Preprocedure COVID testing (https://community.gastro.org/posts/22164)
• Patient case: Gastroesophageal varices (https://community.gastro.org/posts/22098)
• Patient case: IBD with intra-abdominal sepsis (https://community.gastro.org/posts/22055)
• Patient case: Hypervascular pancreatic parenchyma (https://community.gastro.org/posts/22039)

Roundtables (https://community.gastro.org/discussions/)

• Windows on Clinical GI
• Clinical Challenges in IBD: Ulcerative colitis and a fistula
• GI COVID-19 Connection: Implementing an effective long-term telehealth program in a post-COVID world

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

AGA has released a new Clinical Practice Update providing best practice advice for clinicians screening and diagnosing pancreatic cancer in high-risk individuals. Screening to detect pancreas cancers and their precursor lesions in high-risk patients can improve survival if it facilitates surgical resection for early-stage disease.

In the AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review, published in Gastroenterology’s July issue, the authors provide 13 best practice advice statements to address key issues in clinical management of these patients.

For more information, visit www.gastro.org/PancreasCPU.

[email protected]

AGA has released a new Clinical Practice Update providing best practice advice for clinicians screening and diagnosing pancreatic cancer in high-risk individuals. Screening to detect pancreas cancers and their precursor lesions in high-risk patients can improve survival if it facilitates surgical resection for early-stage disease.

In the AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review, published in Gastroenterology’s July issue, the authors provide 13 best practice advice statements to address key issues in clinical management of these patients.

For more information, visit www.gastro.org/PancreasCPU.

[email protected]

AGA has released a new Clinical Practice Update providing best practice advice for clinicians screening and diagnosing pancreatic cancer in high-risk individuals. Screening to detect pancreas cancers and their precursor lesions in high-risk patients can improve survival if it facilitates surgical resection for early-stage disease.

In the AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review, published in Gastroenterology’s July issue, the authors provide 13 best practice advice statements to address key issues in clinical management of these patients.

For more information, visit www.gastro.org/PancreasCPU.

[email protected]

A new evidence-based review published in Gastroenterology helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for GIs

1. Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

2. Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

• Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases, and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonably select to use N95/N99 respirators or PAPRs.
• Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited because of a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy.

To access the Rapid Review and online tool, visit www.gastro.org/COVID.

[email protected]

A new evidence-based review published in Gastroenterology helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for GIs

1. Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

2. Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

• Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases, and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonably select to use N95/N99 respirators or PAPRs.
• Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited because of a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy.

To access the Rapid Review and online tool, visit www.gastro.org/COVID.

[email protected]

A new evidence-based review published in Gastroenterology helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for GIs

1. Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

2. Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

• Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases, and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonably select to use N95/N99 respirators or PAPRs.
• Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited because of a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy.

To access the Rapid Review and online tool, visit www.gastro.org/COVID.

[email protected]