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Your CHEST Foundation: Supporting communities during COVID-2019
The entire world has been affected by the COVID-19 crisis, yet many of our most vulnerable continue to suffer in silence. The CHEST Foundation is diligently working to help give voice to these all-too-often isolated and forgotten patients. Make a donation today, and help those who need it most: our family, friends, neighbors, and those most vulnerable to this devastating disease.
In addition to providing reliable and educational resources that address COVID-19 for both clinicians and patients, the CHEST Foundation is:
- Launching a series of public service announcement videos to empower patients and caregivers living with COPD and interstitial lung disease by providing information on necessary skills, such as cleaning medical equipment, and helping them stay safe and healthy while coping with isolation;
- Partnering with AMITA Health in Chicago to bring telehealth opportunities to patients and support groups; and
- Providing grant funding, in partnership with the Feldman Family Foundation, that supports projects such as providing supplies and groceries to patients and caregivers, expediting training and the means to get caregivers to NYC, and providing needed technology to continue hosting support group meetings in local communities.
The CHEST Foundation has rebranded and relaunched its website in an effort to make it more user-friendly, patient-focused, and clinician-centered. We’ve upgraded our current content, written new pieces, and carefully curated a complete collection of tools that will help patients, caregivers, and clinicians better navigate the complexities of lung disease. Information on all of the content previously listed will be available on the CHEST Foundation’s website at chestfoundation.org.
Thank you for helping as we fulfill the urgent needs of our community during this crisis. Help support your community by making a donation today.
The entire world has been affected by the COVID-19 crisis, yet many of our most vulnerable continue to suffer in silence. The CHEST Foundation is diligently working to help give voice to these all-too-often isolated and forgotten patients. Make a donation today, and help those who need it most: our family, friends, neighbors, and those most vulnerable to this devastating disease.
In addition to providing reliable and educational resources that address COVID-19 for both clinicians and patients, the CHEST Foundation is:
- Launching a series of public service announcement videos to empower patients and caregivers living with COPD and interstitial lung disease by providing information on necessary skills, such as cleaning medical equipment, and helping them stay safe and healthy while coping with isolation;
- Partnering with AMITA Health in Chicago to bring telehealth opportunities to patients and support groups; and
- Providing grant funding, in partnership with the Feldman Family Foundation, that supports projects such as providing supplies and groceries to patients and caregivers, expediting training and the means to get caregivers to NYC, and providing needed technology to continue hosting support group meetings in local communities.
The CHEST Foundation has rebranded and relaunched its website in an effort to make it more user-friendly, patient-focused, and clinician-centered. We’ve upgraded our current content, written new pieces, and carefully curated a complete collection of tools that will help patients, caregivers, and clinicians better navigate the complexities of lung disease. Information on all of the content previously listed will be available on the CHEST Foundation’s website at chestfoundation.org.
Thank you for helping as we fulfill the urgent needs of our community during this crisis. Help support your community by making a donation today.
The entire world has been affected by the COVID-19 crisis, yet many of our most vulnerable continue to suffer in silence. The CHEST Foundation is diligently working to help give voice to these all-too-often isolated and forgotten patients. Make a donation today, and help those who need it most: our family, friends, neighbors, and those most vulnerable to this devastating disease.
In addition to providing reliable and educational resources that address COVID-19 for both clinicians and patients, the CHEST Foundation is:
- Launching a series of public service announcement videos to empower patients and caregivers living with COPD and interstitial lung disease by providing information on necessary skills, such as cleaning medical equipment, and helping them stay safe and healthy while coping with isolation;
- Partnering with AMITA Health in Chicago to bring telehealth opportunities to patients and support groups; and
- Providing grant funding, in partnership with the Feldman Family Foundation, that supports projects such as providing supplies and groceries to patients and caregivers, expediting training and the means to get caregivers to NYC, and providing needed technology to continue hosting support group meetings in local communities.
The CHEST Foundation has rebranded and relaunched its website in an effort to make it more user-friendly, patient-focused, and clinician-centered. We’ve upgraded our current content, written new pieces, and carefully curated a complete collection of tools that will help patients, caregivers, and clinicians better navigate the complexities of lung disease. Information on all of the content previously listed will be available on the CHEST Foundation’s website at chestfoundation.org.
Thank you for helping as we fulfill the urgent needs of our community during this crisis. Help support your community by making a donation today.
Today’s best bet – Get involved with CHEST!
I am often overheard encouraging colleagues to become involved with CHEST. I am a strong believer that you get far more out of participation than you will ever put into it. I have now been fortunate to have many leadership roles within CHEST and currently serve on the Board of Regents and as Chair of the Council of NetWorks. I have been able to work with a growing number of people, including faculty and CHEST staff. The more invested I have become, the more CHEST truly feels like family.
I understand that while it may be easy for me to tell members to get involved, it often feels much more difficult to actually get appointed to a leadership position. Early in my career, I was given the advice, “When you are given a task, make sure you blow it out of the water. That will only open more doors for you.” Making the most of a position on a NetWork or committee can create future opportunities. We recently had self-nominations for leadership positions within the NetWork steering committees and committees at large. Some positions have one to two openings for 20 applications. It can be frustrating not to get a position the first time around. However, it is common for members to have to apply numerous times prior to being appointed. When applying to these positions, be sure to highlight any prior CHEST involvement, as this may weigh in on an appointment to specific positions. Some of the decisions to appoint a nominee are based on prior engagement with CHEST.
So how can one get involved without holding a leadership position? My first piece of advice is to ensure you are getting CHEST emails. Check them regularly to so that you do not miss any opportunities. Next, be a member of at least one NetWork that is of interest to you. The NetWorks provide a smaller community within CHEST for special interests within our field. You will get emailed updates throughout the year that include any projects in which input is needed. At the CHEST annual meeting, each NetWork holds an Open Forum that functions as their annual face-to-face business meeting. These meetings are open to everyone. This is an excellent way to meet the current steering committee members and become involved in plans for the upcoming year. This year, we have made the dates and times of the NetWork steering committee calls public on the CHEST website. Any NetWork member can join these calls, even if they are not officially on the steering committee. All ongoing projects are discussed on these calls, so participation on the call offers an excellent opportunity to volunteer. You can also get involved with the NetWorks on social media by using the appropriate NetWork hashtags, along with tagging @accpchest to communicate with your NetWork colleagues.
Finally, the easiest way to embrace CHEST, and possibly the most obvious, is to get involved with the CHEST annual meeting. The meeting is at its best when planned and orchestrated by a diverse group of people. Annual meeting planning usually starts in November or December of the prior year. Submitting a proposal for a session at the annual meeting is strongly encouraged. Tips for how to submit a strong, well-rounded session are offered on the submission website. Reviewing these tips first can help strengthen your proposal. An easy way to become involved, even as a student or as a trainee, is to submit an abstract to the annual meeting
Summing up, I would encourage everyone to simply be an active participant: raise your hand to ask questions, introduce yourself to those around you, and attend the social events at CHEST annual meeting. Before you know it, new friends will become old friends, and attending the CHEST annual meeting will start to feel like going to a family reunion.
I am often overheard encouraging colleagues to become involved with CHEST. I am a strong believer that you get far more out of participation than you will ever put into it. I have now been fortunate to have many leadership roles within CHEST and currently serve on the Board of Regents and as Chair of the Council of NetWorks. I have been able to work with a growing number of people, including faculty and CHEST staff. The more invested I have become, the more CHEST truly feels like family.
I understand that while it may be easy for me to tell members to get involved, it often feels much more difficult to actually get appointed to a leadership position. Early in my career, I was given the advice, “When you are given a task, make sure you blow it out of the water. That will only open more doors for you.” Making the most of a position on a NetWork or committee can create future opportunities. We recently had self-nominations for leadership positions within the NetWork steering committees and committees at large. Some positions have one to two openings for 20 applications. It can be frustrating not to get a position the first time around. However, it is common for members to have to apply numerous times prior to being appointed. When applying to these positions, be sure to highlight any prior CHEST involvement, as this may weigh in on an appointment to specific positions. Some of the decisions to appoint a nominee are based on prior engagement with CHEST.
So how can one get involved without holding a leadership position? My first piece of advice is to ensure you are getting CHEST emails. Check them regularly to so that you do not miss any opportunities. Next, be a member of at least one NetWork that is of interest to you. The NetWorks provide a smaller community within CHEST for special interests within our field. You will get emailed updates throughout the year that include any projects in which input is needed. At the CHEST annual meeting, each NetWork holds an Open Forum that functions as their annual face-to-face business meeting. These meetings are open to everyone. This is an excellent way to meet the current steering committee members and become involved in plans for the upcoming year. This year, we have made the dates and times of the NetWork steering committee calls public on the CHEST website. Any NetWork member can join these calls, even if they are not officially on the steering committee. All ongoing projects are discussed on these calls, so participation on the call offers an excellent opportunity to volunteer. You can also get involved with the NetWorks on social media by using the appropriate NetWork hashtags, along with tagging @accpchest to communicate with your NetWork colleagues.
Finally, the easiest way to embrace CHEST, and possibly the most obvious, is to get involved with the CHEST annual meeting. The meeting is at its best when planned and orchestrated by a diverse group of people. Annual meeting planning usually starts in November or December of the prior year. Submitting a proposal for a session at the annual meeting is strongly encouraged. Tips for how to submit a strong, well-rounded session are offered on the submission website. Reviewing these tips first can help strengthen your proposal. An easy way to become involved, even as a student or as a trainee, is to submit an abstract to the annual meeting
Summing up, I would encourage everyone to simply be an active participant: raise your hand to ask questions, introduce yourself to those around you, and attend the social events at CHEST annual meeting. Before you know it, new friends will become old friends, and attending the CHEST annual meeting will start to feel like going to a family reunion.
I am often overheard encouraging colleagues to become involved with CHEST. I am a strong believer that you get far more out of participation than you will ever put into it. I have now been fortunate to have many leadership roles within CHEST and currently serve on the Board of Regents and as Chair of the Council of NetWorks. I have been able to work with a growing number of people, including faculty and CHEST staff. The more invested I have become, the more CHEST truly feels like family.
I understand that while it may be easy for me to tell members to get involved, it often feels much more difficult to actually get appointed to a leadership position. Early in my career, I was given the advice, “When you are given a task, make sure you blow it out of the water. That will only open more doors for you.” Making the most of a position on a NetWork or committee can create future opportunities. We recently had self-nominations for leadership positions within the NetWork steering committees and committees at large. Some positions have one to two openings for 20 applications. It can be frustrating not to get a position the first time around. However, it is common for members to have to apply numerous times prior to being appointed. When applying to these positions, be sure to highlight any prior CHEST involvement, as this may weigh in on an appointment to specific positions. Some of the decisions to appoint a nominee are based on prior engagement with CHEST.
So how can one get involved without holding a leadership position? My first piece of advice is to ensure you are getting CHEST emails. Check them regularly to so that you do not miss any opportunities. Next, be a member of at least one NetWork that is of interest to you. The NetWorks provide a smaller community within CHEST for special interests within our field. You will get emailed updates throughout the year that include any projects in which input is needed. At the CHEST annual meeting, each NetWork holds an Open Forum that functions as their annual face-to-face business meeting. These meetings are open to everyone. This is an excellent way to meet the current steering committee members and become involved in plans for the upcoming year. This year, we have made the dates and times of the NetWork steering committee calls public on the CHEST website. Any NetWork member can join these calls, even if they are not officially on the steering committee. All ongoing projects are discussed on these calls, so participation on the call offers an excellent opportunity to volunteer. You can also get involved with the NetWorks on social media by using the appropriate NetWork hashtags, along with tagging @accpchest to communicate with your NetWork colleagues.
Finally, the easiest way to embrace CHEST, and possibly the most obvious, is to get involved with the CHEST annual meeting. The meeting is at its best when planned and orchestrated by a diverse group of people. Annual meeting planning usually starts in November or December of the prior year. Submitting a proposal for a session at the annual meeting is strongly encouraged. Tips for how to submit a strong, well-rounded session are offered on the submission website. Reviewing these tips first can help strengthen your proposal. An easy way to become involved, even as a student or as a trainee, is to submit an abstract to the annual meeting
Summing up, I would encourage everyone to simply be an active participant: raise your hand to ask questions, introduce yourself to those around you, and attend the social events at CHEST annual meeting. Before you know it, new friends will become old friends, and attending the CHEST annual meeting will start to feel like going to a family reunion.
Meet the FISH Bowl finalists
CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners! In this new Meet the FISH Bowl Finalists series, CHEST introduces you to many of them – including winner Dr. Rachel Quaney.
Name: Rachel Quaney, MD
Institutional Affiliation: The Ohio State University
Position: Pulmonary and Critical Care Medicine Fellow
Title: Teaching Assessment Committee (TAC)
Brief Summary of Submission: Teaching Assessment Committee (TAC) is a novel approach to faculty feedback. We are modeling it after the success of the Clinical Competency Committees, but, in reverse, as fellows will give group-consensus-based feedback to faculty members.
Fellows will meet twice yearly with trained facilitators who help elicit constructive, nuanced feedback. The group setting ensures personal anonymity, which will serve to encourage more honest feedback. Then delivering this consensus-based information to program leadership and faculty members will hopefully provide helpful feedback regarding what is going well and what could be improved.
This pilot feasibility project is being employed at three fellowship programs this academic year. The goal will be to improve the feedback that faculty receive, while simultaneously increasing both faculty and fellow satisfaction with the process and the learning environment.
1. What inspired your innovation? More like who – and that would be the esteemed Dr. Gabe Bosslet of Indiana University. He brought the faculty perspective that attendings want better feedback. And, I supplied the fellow perspective—that even those of us who prioritize all things medical education often do a subpar job at providing effective feedback.
2. Who do you think can benefit most from it, and why? With some variation, almost all graduate medical education programs could benefit from the TAC method of faculty feedback. However, the most benefit would likely be seen in small programs or those that struggle with anonymity using current feedback methods.
3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome? I foresee two main challenges to implementation: time and buy-in. Fellows and residents are busy individuals with plenty on their plates, and this would require asking them for more time. This barrier could be solved by program and leadership buy-in or be exacerbated if it is lacking. If the process is endorsed by departmental and program leadership, this will provide credibility and ensure the necessary time is allotted.
4. What impact has winning FISH Bowl 2019 had on your vision for the innovation? The big picture vision I have for my innovation has not changed, but I am more acutely aware of the challenges and opportunities I will have to navigate, thanks to Drs. Morris, Niven, and Schulman. I am simultaneously more excited about this project but also feel the pressure to not disappoint!
5. How do you think your success at FISH Bowl 2019 will continue to impact your career overall in the months and years to come? It’s hard to imagine in what exact ways my career will be impacted, but I feel strongly that it will be positively influenced by this experience. I had the privilege of meeting a lot of individuals who feel passionate about medical education, both those established in our field and those at the beginning of their careers. These connections will likely lead to future collaborations and innovations.
CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners! In this new Meet the FISH Bowl Finalists series, CHEST introduces you to many of them – including winner Dr. Rachel Quaney.
Name: Rachel Quaney, MD
Institutional Affiliation: The Ohio State University
Position: Pulmonary and Critical Care Medicine Fellow
Title: Teaching Assessment Committee (TAC)
Brief Summary of Submission: Teaching Assessment Committee (TAC) is a novel approach to faculty feedback. We are modeling it after the success of the Clinical Competency Committees, but, in reverse, as fellows will give group-consensus-based feedback to faculty members.
Fellows will meet twice yearly with trained facilitators who help elicit constructive, nuanced feedback. The group setting ensures personal anonymity, which will serve to encourage more honest feedback. Then delivering this consensus-based information to program leadership and faculty members will hopefully provide helpful feedback regarding what is going well and what could be improved.
This pilot feasibility project is being employed at three fellowship programs this academic year. The goal will be to improve the feedback that faculty receive, while simultaneously increasing both faculty and fellow satisfaction with the process and the learning environment.
1. What inspired your innovation? More like who – and that would be the esteemed Dr. Gabe Bosslet of Indiana University. He brought the faculty perspective that attendings want better feedback. And, I supplied the fellow perspective—that even those of us who prioritize all things medical education often do a subpar job at providing effective feedback.
2. Who do you think can benefit most from it, and why? With some variation, almost all graduate medical education programs could benefit from the TAC method of faculty feedback. However, the most benefit would likely be seen in small programs or those that struggle with anonymity using current feedback methods.
3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome? I foresee two main challenges to implementation: time and buy-in. Fellows and residents are busy individuals with plenty on their plates, and this would require asking them for more time. This barrier could be solved by program and leadership buy-in or be exacerbated if it is lacking. If the process is endorsed by departmental and program leadership, this will provide credibility and ensure the necessary time is allotted.
4. What impact has winning FISH Bowl 2019 had on your vision for the innovation? The big picture vision I have for my innovation has not changed, but I am more acutely aware of the challenges and opportunities I will have to navigate, thanks to Drs. Morris, Niven, and Schulman. I am simultaneously more excited about this project but also feel the pressure to not disappoint!
5. How do you think your success at FISH Bowl 2019 will continue to impact your career overall in the months and years to come? It’s hard to imagine in what exact ways my career will be impacted, but I feel strongly that it will be positively influenced by this experience. I had the privilege of meeting a lot of individuals who feel passionate about medical education, both those established in our field and those at the beginning of their careers. These connections will likely lead to future collaborations and innovations.
CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners! In this new Meet the FISH Bowl Finalists series, CHEST introduces you to many of them – including winner Dr. Rachel Quaney.
Name: Rachel Quaney, MD
Institutional Affiliation: The Ohio State University
Position: Pulmonary and Critical Care Medicine Fellow
Title: Teaching Assessment Committee (TAC)
Brief Summary of Submission: Teaching Assessment Committee (TAC) is a novel approach to faculty feedback. We are modeling it after the success of the Clinical Competency Committees, but, in reverse, as fellows will give group-consensus-based feedback to faculty members.
Fellows will meet twice yearly with trained facilitators who help elicit constructive, nuanced feedback. The group setting ensures personal anonymity, which will serve to encourage more honest feedback. Then delivering this consensus-based information to program leadership and faculty members will hopefully provide helpful feedback regarding what is going well and what could be improved.
This pilot feasibility project is being employed at three fellowship programs this academic year. The goal will be to improve the feedback that faculty receive, while simultaneously increasing both faculty and fellow satisfaction with the process and the learning environment.
1. What inspired your innovation? More like who – and that would be the esteemed Dr. Gabe Bosslet of Indiana University. He brought the faculty perspective that attendings want better feedback. And, I supplied the fellow perspective—that even those of us who prioritize all things medical education often do a subpar job at providing effective feedback.
2. Who do you think can benefit most from it, and why? With some variation, almost all graduate medical education programs could benefit from the TAC method of faculty feedback. However, the most benefit would likely be seen in small programs or those that struggle with anonymity using current feedback methods.
3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome? I foresee two main challenges to implementation: time and buy-in. Fellows and residents are busy individuals with plenty on their plates, and this would require asking them for more time. This barrier could be solved by program and leadership buy-in or be exacerbated if it is lacking. If the process is endorsed by departmental and program leadership, this will provide credibility and ensure the necessary time is allotted.
4. What impact has winning FISH Bowl 2019 had on your vision for the innovation? The big picture vision I have for my innovation has not changed, but I am more acutely aware of the challenges and opportunities I will have to navigate, thanks to Drs. Morris, Niven, and Schulman. I am simultaneously more excited about this project but also feel the pressure to not disappoint!
5. How do you think your success at FISH Bowl 2019 will continue to impact your career overall in the months and years to come? It’s hard to imagine in what exact ways my career will be impacted, but I feel strongly that it will be positively influenced by this experience. I had the privilege of meeting a lot of individuals who feel passionate about medical education, both those established in our field and those at the beginning of their careers. These connections will likely lead to future collaborations and innovations.
COVID-19 and the cardiovascular system. Thrombotic events in COVID-19. Interprofessional collaboration.
Cardiovascular medicine and surgery
COVID-19 and the cardiovascular system
With the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ongoing, there is increased awareness of the cardiovascular manifestations and implications of COVID-19. Approximately 20% of inpatients with COVID-19 have acute cardiac injury (defined as cardiac troponin elevation) (Shi S, et al. JAMA Cardiol. 2020 Mar 25. doi: 10.1001/jamacardio.2020.0950). Moreover, in one cohort, both acute cardiac injury and preexisting cardiovascular disease (CVD) were associated with COVID-19 hospital mortality: 69% with elevated troponin levels and underlying CVD vs 7.6% with neither (Guo T, et al. JAMA Cardiol. 2020 Mar 27. doi: 10.1001/jamacardio.2020.1017). Moreover, case reports suggest COVID-19 may present as myopericarditis, cardiomyopathy, acute on chronic decompensated heart failure, and acute coronary syndrome (Fried JA, et al. Circulation. 2020 Apr 3. doi: 10.1161/circulationaha.120.047164). Adding to this clinical variability, one case series suggests that electrocardiographic ST-segment elevation may not reliably identify obstructive coronary disease (Bangalore S, et al. N Engl J Med. 2020 Apr 17. doi: 10.1056/NEJMc2009020). Intriguingly, the angiotensin-converting enzyme 2 (ACE2) protein is the functional receptor for SARS-CoV-2 cell entry, and ACE2 is highly expressed in pulmonary and cardiac cells (Driggin E, et al. J Am Coll Cardiol. 2020;75[18]:2352). Given the central role of ACE2 and the renin-angiotensin-aldosterone (RAAS) system in cardiovascular pathophysiology and pharmacotherapy, RAAS modulation could have beneficial and/or detrimental effects with COVID-19 (Vaduganathan M, et al. N Engl J Med. 2020;382:1653). Available evidence and societal guidelines support continuing RAAS antagonists in patients per established clinical practice (Mancia G, et al. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2006923); (Mehra MR, et al. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2007621). A better understanding of the direct and indirect effect of SARS-CoV-2 on the cardiovascular system will require additional evidence.
Benjamin B. Kenigsberg, MD
Fellow-in-Training Steering Committee Member
Thrombotic events in COVID-19: Implications and evolving practice recommendations
A startling potential complication of infection with SARS-CoV2 has been the reported predisposition to thrombotic events. Mortality in COVID-19 patients is associated with notable increases in hemostatic parameters such as levels of
Vascular societies led by International Society on Thrombosis and Haemostasis (ISTH) have published consensus recommendations for guidance. If no contraindications exist, pharmacologic venous thromboembolism (VTE) prophylaxis with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended for hospitalized patients with moderate or severe COVID-19 without disseminated intravascular coagulation (DIC). VTE prophylaxis should also be considered for patients with moderate or severe COVID-19 and in DIC but without overt bleeding. There is insufficient evidence to consider routine therapeutic or intermediate-dose parenteral anticoagulation with UFH or LMWH. Many institutions have developed protocols advising therapeutic-intensity anticoagulation when certain thresholds of
Saiprakash B. Venkateshiah, MD, FCCP,
Chair
Gabriela Magda, MD
Fellow-in-Training Steering Committee Member
Interprofessional Team
Quality of interprofessional collaboration in the medical intensive care unit: perceptions by caregivers
A recent study examining caregivers’ perceptions of team interactions and interprofessional collaborative practice (IPCP) behaviors offers new, exciting insights on the importance of interprofessional team functioning in the medical intensive care unit (MICU) (Chen DW, et al. J Gen Intern Med. 2018;33[10]:1708).
The Support Person Jefferson Teamwork Observation Guide (JTOG)TM survey was administered to 161 random caregivers of patients hospitalized in a single large urban academic medical center MICU between May 2016 and December 2016. The survey tool was designed to elicit the perceptions of caregivers regarding team functioning. Survey questions were directly mapped to the 2011 Interprofessional Education Collaborative (IPEC) Expert Panel core competencies for IPCP and divided into four domains (values/ethics; interprofessional communication; roles/responsibilities; teams/teamwork).
Also appended to the surveys were additional follow-up questions that addressed the overall satisfaction with the team and general attitudes regarding the importance of interprofessional team-based care. Caregivers agreed on the importance of health-care professionals working together as a team to provide patient care (3.97/4.00 Likert scale 4 = extremely important). Caregivers expressed satisfaction with the MICU team (3.74/4.00). Furthermore, caregivers agreed that the MICU team demonstrated competencies in all four domains of IPCP: values/ethics (3.55/4.00), interprofessional communication (3.58/4.00), roles/responsibilities (3.61/4.00), and teams/teamwork (3.64/4.00). Caregivers felt the MICU team provided patient/family-centered care (sub-competency 3.58/4.00). Notably, the overall caregiver survey scores detailing how well each MICU team functioned were positively correlated to overall satisfaction with the MICU team (r = 0.596 P < .01).
Limitations of the study included:
1. The sample is from a single institution, and perceptions of caregivers cannot be applied to all populations.
2. No information regarding patient, such as diagnosis, was obtained.
3. Caregivers satisfied with care might be more likely to participate.
4. No distinction was made between data collected from caregivers surveyed in the resident-fellow staffed MICU vs NP-staffed MICU.
It has been described that ineffective teamwork and team communication in health care settings are associated with increased patient harm and sentinel events (Kohn LT et al. Washington (DC): National Academies Press(US); 2000); (Page A, Washington (DC): National Academies Press (US); (The Joint Commission. Sentinel Event Alert 2008, 40); (Brennan TA, et al. N Engl J Med. 1991;324:370). Cultural differences between members of the health-care team and established hierarchies of control have been identified as barriers to communication and teamwork in ICUs (Alexanian JA, et al. J Crit Care Med. 2015;43[9]:1880); (Manias E, Street A. Int J Nurs Stud. 2001;38[2]:129).
Overall, the findings from this study emphasize the importance of interprofessional communication and teamwork in the MICU and delivery of patient/family-centered care from the caregivers’ perspective. The unique insight into caregivers’ perspectives on specific team behaviors may be the basis for future quality improvement initiatives.
Justin K. Lui, MD,
Mary Jo Farmer, MD, PhD, FCCP
Kristina E. Ramirez, RRT, MPH, FCCP
Cardiovascular medicine and surgery
COVID-19 and the cardiovascular system
With the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ongoing, there is increased awareness of the cardiovascular manifestations and implications of COVID-19. Approximately 20% of inpatients with COVID-19 have acute cardiac injury (defined as cardiac troponin elevation) (Shi S, et al. JAMA Cardiol. 2020 Mar 25. doi: 10.1001/jamacardio.2020.0950). Moreover, in one cohort, both acute cardiac injury and preexisting cardiovascular disease (CVD) were associated with COVID-19 hospital mortality: 69% with elevated troponin levels and underlying CVD vs 7.6% with neither (Guo T, et al. JAMA Cardiol. 2020 Mar 27. doi: 10.1001/jamacardio.2020.1017). Moreover, case reports suggest COVID-19 may present as myopericarditis, cardiomyopathy, acute on chronic decompensated heart failure, and acute coronary syndrome (Fried JA, et al. Circulation. 2020 Apr 3. doi: 10.1161/circulationaha.120.047164). Adding to this clinical variability, one case series suggests that electrocardiographic ST-segment elevation may not reliably identify obstructive coronary disease (Bangalore S, et al. N Engl J Med. 2020 Apr 17. doi: 10.1056/NEJMc2009020). Intriguingly, the angiotensin-converting enzyme 2 (ACE2) protein is the functional receptor for SARS-CoV-2 cell entry, and ACE2 is highly expressed in pulmonary and cardiac cells (Driggin E, et al. J Am Coll Cardiol. 2020;75[18]:2352). Given the central role of ACE2 and the renin-angiotensin-aldosterone (RAAS) system in cardiovascular pathophysiology and pharmacotherapy, RAAS modulation could have beneficial and/or detrimental effects with COVID-19 (Vaduganathan M, et al. N Engl J Med. 2020;382:1653). Available evidence and societal guidelines support continuing RAAS antagonists in patients per established clinical practice (Mancia G, et al. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2006923); (Mehra MR, et al. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2007621). A better understanding of the direct and indirect effect of SARS-CoV-2 on the cardiovascular system will require additional evidence.
Benjamin B. Kenigsberg, MD
Fellow-in-Training Steering Committee Member
Thrombotic events in COVID-19: Implications and evolving practice recommendations
A startling potential complication of infection with SARS-CoV2 has been the reported predisposition to thrombotic events. Mortality in COVID-19 patients is associated with notable increases in hemostatic parameters such as levels of
Vascular societies led by International Society on Thrombosis and Haemostasis (ISTH) have published consensus recommendations for guidance. If no contraindications exist, pharmacologic venous thromboembolism (VTE) prophylaxis with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended for hospitalized patients with moderate or severe COVID-19 without disseminated intravascular coagulation (DIC). VTE prophylaxis should also be considered for patients with moderate or severe COVID-19 and in DIC but without overt bleeding. There is insufficient evidence to consider routine therapeutic or intermediate-dose parenteral anticoagulation with UFH or LMWH. Many institutions have developed protocols advising therapeutic-intensity anticoagulation when certain thresholds of
Saiprakash B. Venkateshiah, MD, FCCP,
Chair
Gabriela Magda, MD
Fellow-in-Training Steering Committee Member
Interprofessional Team
Quality of interprofessional collaboration in the medical intensive care unit: perceptions by caregivers
A recent study examining caregivers’ perceptions of team interactions and interprofessional collaborative practice (IPCP) behaviors offers new, exciting insights on the importance of interprofessional team functioning in the medical intensive care unit (MICU) (Chen DW, et al. J Gen Intern Med. 2018;33[10]:1708).
The Support Person Jefferson Teamwork Observation Guide (JTOG)TM survey was administered to 161 random caregivers of patients hospitalized in a single large urban academic medical center MICU between May 2016 and December 2016. The survey tool was designed to elicit the perceptions of caregivers regarding team functioning. Survey questions were directly mapped to the 2011 Interprofessional Education Collaborative (IPEC) Expert Panel core competencies for IPCP and divided into four domains (values/ethics; interprofessional communication; roles/responsibilities; teams/teamwork).
Also appended to the surveys were additional follow-up questions that addressed the overall satisfaction with the team and general attitudes regarding the importance of interprofessional team-based care. Caregivers agreed on the importance of health-care professionals working together as a team to provide patient care (3.97/4.00 Likert scale 4 = extremely important). Caregivers expressed satisfaction with the MICU team (3.74/4.00). Furthermore, caregivers agreed that the MICU team demonstrated competencies in all four domains of IPCP: values/ethics (3.55/4.00), interprofessional communication (3.58/4.00), roles/responsibilities (3.61/4.00), and teams/teamwork (3.64/4.00). Caregivers felt the MICU team provided patient/family-centered care (sub-competency 3.58/4.00). Notably, the overall caregiver survey scores detailing how well each MICU team functioned were positively correlated to overall satisfaction with the MICU team (r = 0.596 P < .01).
Limitations of the study included:
1. The sample is from a single institution, and perceptions of caregivers cannot be applied to all populations.
2. No information regarding patient, such as diagnosis, was obtained.
3. Caregivers satisfied with care might be more likely to participate.
4. No distinction was made between data collected from caregivers surveyed in the resident-fellow staffed MICU vs NP-staffed MICU.
It has been described that ineffective teamwork and team communication in health care settings are associated with increased patient harm and sentinel events (Kohn LT et al. Washington (DC): National Academies Press(US); 2000); (Page A, Washington (DC): National Academies Press (US); (The Joint Commission. Sentinel Event Alert 2008, 40); (Brennan TA, et al. N Engl J Med. 1991;324:370). Cultural differences between members of the health-care team and established hierarchies of control have been identified as barriers to communication and teamwork in ICUs (Alexanian JA, et al. J Crit Care Med. 2015;43[9]:1880); (Manias E, Street A. Int J Nurs Stud. 2001;38[2]:129).
Overall, the findings from this study emphasize the importance of interprofessional communication and teamwork in the MICU and delivery of patient/family-centered care from the caregivers’ perspective. The unique insight into caregivers’ perspectives on specific team behaviors may be the basis for future quality improvement initiatives.
Justin K. Lui, MD,
Mary Jo Farmer, MD, PhD, FCCP
Kristina E. Ramirez, RRT, MPH, FCCP
Cardiovascular medicine and surgery
COVID-19 and the cardiovascular system
With the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ongoing, there is increased awareness of the cardiovascular manifestations and implications of COVID-19. Approximately 20% of inpatients with COVID-19 have acute cardiac injury (defined as cardiac troponin elevation) (Shi S, et al. JAMA Cardiol. 2020 Mar 25. doi: 10.1001/jamacardio.2020.0950). Moreover, in one cohort, both acute cardiac injury and preexisting cardiovascular disease (CVD) were associated with COVID-19 hospital mortality: 69% with elevated troponin levels and underlying CVD vs 7.6% with neither (Guo T, et al. JAMA Cardiol. 2020 Mar 27. doi: 10.1001/jamacardio.2020.1017). Moreover, case reports suggest COVID-19 may present as myopericarditis, cardiomyopathy, acute on chronic decompensated heart failure, and acute coronary syndrome (Fried JA, et al. Circulation. 2020 Apr 3. doi: 10.1161/circulationaha.120.047164). Adding to this clinical variability, one case series suggests that electrocardiographic ST-segment elevation may not reliably identify obstructive coronary disease (Bangalore S, et al. N Engl J Med. 2020 Apr 17. doi: 10.1056/NEJMc2009020). Intriguingly, the angiotensin-converting enzyme 2 (ACE2) protein is the functional receptor for SARS-CoV-2 cell entry, and ACE2 is highly expressed in pulmonary and cardiac cells (Driggin E, et al. J Am Coll Cardiol. 2020;75[18]:2352). Given the central role of ACE2 and the renin-angiotensin-aldosterone (RAAS) system in cardiovascular pathophysiology and pharmacotherapy, RAAS modulation could have beneficial and/or detrimental effects with COVID-19 (Vaduganathan M, et al. N Engl J Med. 2020;382:1653). Available evidence and societal guidelines support continuing RAAS antagonists in patients per established clinical practice (Mancia G, et al. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2006923); (Mehra MR, et al. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2007621). A better understanding of the direct and indirect effect of SARS-CoV-2 on the cardiovascular system will require additional evidence.
Benjamin B. Kenigsberg, MD
Fellow-in-Training Steering Committee Member
Thrombotic events in COVID-19: Implications and evolving practice recommendations
A startling potential complication of infection with SARS-CoV2 has been the reported predisposition to thrombotic events. Mortality in COVID-19 patients is associated with notable increases in hemostatic parameters such as levels of
Vascular societies led by International Society on Thrombosis and Haemostasis (ISTH) have published consensus recommendations for guidance. If no contraindications exist, pharmacologic venous thromboembolism (VTE) prophylaxis with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended for hospitalized patients with moderate or severe COVID-19 without disseminated intravascular coagulation (DIC). VTE prophylaxis should also be considered for patients with moderate or severe COVID-19 and in DIC but without overt bleeding. There is insufficient evidence to consider routine therapeutic or intermediate-dose parenteral anticoagulation with UFH or LMWH. Many institutions have developed protocols advising therapeutic-intensity anticoagulation when certain thresholds of
Saiprakash B. Venkateshiah, MD, FCCP,
Chair
Gabriela Magda, MD
Fellow-in-Training Steering Committee Member
Interprofessional Team
Quality of interprofessional collaboration in the medical intensive care unit: perceptions by caregivers
A recent study examining caregivers’ perceptions of team interactions and interprofessional collaborative practice (IPCP) behaviors offers new, exciting insights on the importance of interprofessional team functioning in the medical intensive care unit (MICU) (Chen DW, et al. J Gen Intern Med. 2018;33[10]:1708).
The Support Person Jefferson Teamwork Observation Guide (JTOG)TM survey was administered to 161 random caregivers of patients hospitalized in a single large urban academic medical center MICU between May 2016 and December 2016. The survey tool was designed to elicit the perceptions of caregivers regarding team functioning. Survey questions were directly mapped to the 2011 Interprofessional Education Collaborative (IPEC) Expert Panel core competencies for IPCP and divided into four domains (values/ethics; interprofessional communication; roles/responsibilities; teams/teamwork).
Also appended to the surveys were additional follow-up questions that addressed the overall satisfaction with the team and general attitudes regarding the importance of interprofessional team-based care. Caregivers agreed on the importance of health-care professionals working together as a team to provide patient care (3.97/4.00 Likert scale 4 = extremely important). Caregivers expressed satisfaction with the MICU team (3.74/4.00). Furthermore, caregivers agreed that the MICU team demonstrated competencies in all four domains of IPCP: values/ethics (3.55/4.00), interprofessional communication (3.58/4.00), roles/responsibilities (3.61/4.00), and teams/teamwork (3.64/4.00). Caregivers felt the MICU team provided patient/family-centered care (sub-competency 3.58/4.00). Notably, the overall caregiver survey scores detailing how well each MICU team functioned were positively correlated to overall satisfaction with the MICU team (r = 0.596 P < .01).
Limitations of the study included:
1. The sample is from a single institution, and perceptions of caregivers cannot be applied to all populations.
2. No information regarding patient, such as diagnosis, was obtained.
3. Caregivers satisfied with care might be more likely to participate.
4. No distinction was made between data collected from caregivers surveyed in the resident-fellow staffed MICU vs NP-staffed MICU.
It has been described that ineffective teamwork and team communication in health care settings are associated with increased patient harm and sentinel events (Kohn LT et al. Washington (DC): National Academies Press(US); 2000); (Page A, Washington (DC): National Academies Press (US); (The Joint Commission. Sentinel Event Alert 2008, 40); (Brennan TA, et al. N Engl J Med. 1991;324:370). Cultural differences between members of the health-care team and established hierarchies of control have been identified as barriers to communication and teamwork in ICUs (Alexanian JA, et al. J Crit Care Med. 2015;43[9]:1880); (Manias E, Street A. Int J Nurs Stud. 2001;38[2]:129).
Overall, the findings from this study emphasize the importance of interprofessional communication and teamwork in the MICU and delivery of patient/family-centered care from the caregivers’ perspective. The unique insight into caregivers’ perspectives on specific team behaviors may be the basis for future quality improvement initiatives.
Justin K. Lui, MD,
Mary Jo Farmer, MD, PhD, FCCP
Kristina E. Ramirez, RRT, MPH, FCCP
This month in the journal CHEST®
Editor’s picks
Preparing for the COVID-19 Pandemic: Our Experience in New York.By Dr. H. Zubair, et al.
The Utility of Electronic Inhaler Monitoring in COPD Management: Promises and Challenges.By Dr. A. H. Attaway, et al.
Patterns of Use of Adjunctive Therapies in Patients With Early Moderate-Severe Acute Respiratory Distress Syndrome: Insights From the LUNG SAFE Study.By Dr. A. Duggal, et al.
Clinical Evaluation of Deployed Military Personnel with Chronic Respiratory Symptoms: STAMPEDE III (Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures). By Dr. M. J. Morris, et al.
Editor’s picks
Editor’s picks
Preparing for the COVID-19 Pandemic: Our Experience in New York.By Dr. H. Zubair, et al.
The Utility of Electronic Inhaler Monitoring in COPD Management: Promises and Challenges.By Dr. A. H. Attaway, et al.
Patterns of Use of Adjunctive Therapies in Patients With Early Moderate-Severe Acute Respiratory Distress Syndrome: Insights From the LUNG SAFE Study.By Dr. A. Duggal, et al.
Clinical Evaluation of Deployed Military Personnel with Chronic Respiratory Symptoms: STAMPEDE III (Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures). By Dr. M. J. Morris, et al.
Preparing for the COVID-19 Pandemic: Our Experience in New York.By Dr. H. Zubair, et al.
The Utility of Electronic Inhaler Monitoring in COPD Management: Promises and Challenges.By Dr. A. H. Attaway, et al.
Patterns of Use of Adjunctive Therapies in Patients With Early Moderate-Severe Acute Respiratory Distress Syndrome: Insights From the LUNG SAFE Study.By Dr. A. Duggal, et al.
Clinical Evaluation of Deployed Military Personnel with Chronic Respiratory Symptoms: STAMPEDE III (Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures). By Dr. M. J. Morris, et al.
Top AGA Community patient cases
The AGA Community (https://community.gastro.org) received a makeover – 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 the most popular clinical discussions happening in the newsfeed:
- UC patient with new diagnosis of breast cancer (https://community.gastro.org/posts/20142)
- COVID testing before elective procedures (https://community.gastro.org/posts/21106)
- Remdesivir and hepatic failure (https://community.gastro.org/posts/21130)
- Doses of antibiotics for IBS-D patient (https://community.gastro.org/posts/19749)
- Vedolizumab and sinus migraines (https://community.gastro.org/posts/20204)
Follow and ask experts your questions in Roundtable:
- Resumption of elective endoscopy during COVID-19
- COVID-19 and GI: Caring for IBD
- Q&A with EoE guideline authors
- Q&A with the U.S. Multi-Society Task Force on Colorectal Cancer: follow-up after normal colonoscopy and polypectomy
View all upcoming Roundtables in the community at https://community.gastro.org/discussions.
The AGA Community (https://community.gastro.org) received a makeover – 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 the most popular clinical discussions happening in the newsfeed:
- UC patient with new diagnosis of breast cancer (https://community.gastro.org/posts/20142)
- COVID testing before elective procedures (https://community.gastro.org/posts/21106)
- Remdesivir and hepatic failure (https://community.gastro.org/posts/21130)
- Doses of antibiotics for IBS-D patient (https://community.gastro.org/posts/19749)
- Vedolizumab and sinus migraines (https://community.gastro.org/posts/20204)
Follow and ask experts your questions in Roundtable:
- Resumption of elective endoscopy during COVID-19
- COVID-19 and GI: Caring for IBD
- Q&A with EoE guideline authors
- Q&A with the U.S. Multi-Society Task Force on Colorectal Cancer: follow-up after normal colonoscopy and polypectomy
View all upcoming Roundtables in the community at https://community.gastro.org/discussions.
The AGA Community (https://community.gastro.org) received a makeover – 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 the most popular clinical discussions happening in the newsfeed:
- UC patient with new diagnosis of breast cancer (https://community.gastro.org/posts/20142)
- COVID testing before elective procedures (https://community.gastro.org/posts/21106)
- Remdesivir and hepatic failure (https://community.gastro.org/posts/21130)
- Doses of antibiotics for IBS-D patient (https://community.gastro.org/posts/19749)
- Vedolizumab and sinus migraines (https://community.gastro.org/posts/20204)
Follow and ask experts your questions in Roundtable:
- Resumption of elective endoscopy during COVID-19
- COVID-19 and GI: Caring for IBD
- Q&A with EoE guideline authors
- Q&A with the U.S. Multi-Society Task Force on Colorectal Cancer: follow-up after normal colonoscopy and polypectomy
View all upcoming Roundtables in the community at https://community.gastro.org/discussions.
Meet Congressman Roger Marshall, MD, R-KS
This article is brought you by AGA PAC, a voluntary, non-partisan political organization affiliated with and supported by AGA and the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions.
The 116th Congress is well represented by the physician community, featuring a total of 17 physicians: 3 in the U.S. Senate and 14 in the House of Representatives. One of the physicians in the House, Rep. Roger Marshall, MD, R-KS, is an OBGYN by trade who is currently serving his second term in Congress. First elected in 2016, he arrived in Washington as one of only two physicians in his freshman class. He actively engaged in health care policy from the very beginning, working across party lines on a range of health care issues facing Capitol Hill. Upon entering Congress, he proactively reached out to AGA as well as other specialty physician organizations to learn our priority issues and expressed his desire to serve as a champion of the physician community.
In addition to the two committees he sits on, Dr. Marshall also serves as the chairman of the health task force for the Republican Study Committee. Additionally, Dr. Marshall is a member of the GOP Doctors Caucus, a coalition of 21 Republican medical providers with a mission statement “to utilize medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.” The GOP Doctors Caucus was instrumental in pushing for a permanent repeal of the sustainable growth rate (SGR) and helped to coalesce bipartisan, bicameral support for repeal legislation in the 113th Congress. The GOP Doctors Caucus continues to be active in the current Congress, advocating for policies that strengthen both the patient and provider communities.
As a member of the GOP Doctors Caucus and as a physician held in high regard by his House colleagues, Dr. Marshall is uniquely situated to advance agendas and legislative priorities that promote sound health care policy. He willingly works across the aisle with his Democratic counterparts on legislation of importance to the physician and patient community. Dr. Marshall recently worked with one of his Democratic, physician colleagues, Rep. Ami Bera, MD, D-CA, on the Improving Seniors Timely Access to Care Act, legislation addressing prior authorization burdens in Medicare Advantage plans. Dr. Marshall has vocalized the importance of physicians getting involved in the political process and to that effect, spoke to AGA members at AGA’s annual Advocacy Day about his experience as a physician running for Congress and the importance of physician advocacy.
Dr. Marshall is running for the open Senate seat in Kansas. Given that Dr. Marshall has reiterated his desire to continue to work with the physician community to ensure access to care for our patients, AGA looks forward to supporting Dr. Marshall’s Senate candidacy and continuing to work with him and his office on issues and initiatives to advance the science and practice of gastroenterology.
This article is brought you by AGA PAC, a voluntary, non-partisan political organization affiliated with and supported by AGA and the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions.
The 116th Congress is well represented by the physician community, featuring a total of 17 physicians: 3 in the U.S. Senate and 14 in the House of Representatives. One of the physicians in the House, Rep. Roger Marshall, MD, R-KS, is an OBGYN by trade who is currently serving his second term in Congress. First elected in 2016, he arrived in Washington as one of only two physicians in his freshman class. He actively engaged in health care policy from the very beginning, working across party lines on a range of health care issues facing Capitol Hill. Upon entering Congress, he proactively reached out to AGA as well as other specialty physician organizations to learn our priority issues and expressed his desire to serve as a champion of the physician community.
In addition to the two committees he sits on, Dr. Marshall also serves as the chairman of the health task force for the Republican Study Committee. Additionally, Dr. Marshall is a member of the GOP Doctors Caucus, a coalition of 21 Republican medical providers with a mission statement “to utilize medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.” The GOP Doctors Caucus was instrumental in pushing for a permanent repeal of the sustainable growth rate (SGR) and helped to coalesce bipartisan, bicameral support for repeal legislation in the 113th Congress. The GOP Doctors Caucus continues to be active in the current Congress, advocating for policies that strengthen both the patient and provider communities.
As a member of the GOP Doctors Caucus and as a physician held in high regard by his House colleagues, Dr. Marshall is uniquely situated to advance agendas and legislative priorities that promote sound health care policy. He willingly works across the aisle with his Democratic counterparts on legislation of importance to the physician and patient community. Dr. Marshall recently worked with one of his Democratic, physician colleagues, Rep. Ami Bera, MD, D-CA, on the Improving Seniors Timely Access to Care Act, legislation addressing prior authorization burdens in Medicare Advantage plans. Dr. Marshall has vocalized the importance of physicians getting involved in the political process and to that effect, spoke to AGA members at AGA’s annual Advocacy Day about his experience as a physician running for Congress and the importance of physician advocacy.
Dr. Marshall is running for the open Senate seat in Kansas. Given that Dr. Marshall has reiterated his desire to continue to work with the physician community to ensure access to care for our patients, AGA looks forward to supporting Dr. Marshall’s Senate candidacy and continuing to work with him and his office on issues and initiatives to advance the science and practice of gastroenterology.
This article is brought you by AGA PAC, a voluntary, non-partisan political organization affiliated with and supported by AGA and the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions.
The 116th Congress is well represented by the physician community, featuring a total of 17 physicians: 3 in the U.S. Senate and 14 in the House of Representatives. One of the physicians in the House, Rep. Roger Marshall, MD, R-KS, is an OBGYN by trade who is currently serving his second term in Congress. First elected in 2016, he arrived in Washington as one of only two physicians in his freshman class. He actively engaged in health care policy from the very beginning, working across party lines on a range of health care issues facing Capitol Hill. Upon entering Congress, he proactively reached out to AGA as well as other specialty physician organizations to learn our priority issues and expressed his desire to serve as a champion of the physician community.
In addition to the two committees he sits on, Dr. Marshall also serves as the chairman of the health task force for the Republican Study Committee. Additionally, Dr. Marshall is a member of the GOP Doctors Caucus, a coalition of 21 Republican medical providers with a mission statement “to utilize medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.” The GOP Doctors Caucus was instrumental in pushing for a permanent repeal of the sustainable growth rate (SGR) and helped to coalesce bipartisan, bicameral support for repeal legislation in the 113th Congress. The GOP Doctors Caucus continues to be active in the current Congress, advocating for policies that strengthen both the patient and provider communities.
As a member of the GOP Doctors Caucus and as a physician held in high regard by his House colleagues, Dr. Marshall is uniquely situated to advance agendas and legislative priorities that promote sound health care policy. He willingly works across the aisle with his Democratic counterparts on legislation of importance to the physician and patient community. Dr. Marshall recently worked with one of his Democratic, physician colleagues, Rep. Ami Bera, MD, D-CA, on the Improving Seniors Timely Access to Care Act, legislation addressing prior authorization burdens in Medicare Advantage plans. Dr. Marshall has vocalized the importance of physicians getting involved in the political process and to that effect, spoke to AGA members at AGA’s annual Advocacy Day about his experience as a physician running for Congress and the importance of physician advocacy.
Dr. Marshall is running for the open Senate seat in Kansas. Given that Dr. Marshall has reiterated his desire to continue to work with the physician community to ensure access to care for our patients, AGA looks forward to supporting Dr. Marshall’s Senate candidacy and continuing to work with him and his office on issues and initiatives to advance the science and practice of gastroenterology.
GI fellows: Go online to access curated learning resources today
AGA just released GI Distance Learning, agau.gastro.org/diweb/catalog/q/GI-Distance-Learning, a new initiative providing AGA trainee members and medical residents a complementary set of curated education and career development resources available online. A part of AGA University, GI Distance Learning enables you to enhance your knowledge in a number of GI-related topics at your own pace from the comfort of home.
Through GI Distance Learning, you will have free access until Aug. 1 to the 800+ questions and answers included in the DDSEP® 9 Question Bank. Assess your knowledge, identify gaps in learning, and stay current on the latest advances in GI and liver disease.
To access the Question Bank free of charge:
- Visit AGA University and sign in to your AGA account.
- Go to the DDSEP 9 Question Bank.
- Add the Question Bank to your Cart and Checkout.
- Type DDSEP9Distance in the Discount Code box.
- Apply the discount and submit your order.
- Use the My Courses link to access the Question Bank.
During the COVID-19 pandemic, many of us are struggling with the new normal and changes in our daily routines. Resiliency, emotional intelligence, and strategies for combatting burnout become increasingly important. The following on-demand resources from GI Distance Learning can help.
- Resilient Leadership
- Emotional Intelligence
- Strategies to Combat Burnout in GI and Maintaining Work/Life Balance
Continue to check back regularly at AGA University as we will continue to add resources to GI Distance Learning in the coming weeks.
AGA just released GI Distance Learning, agau.gastro.org/diweb/catalog/q/GI-Distance-Learning, a new initiative providing AGA trainee members and medical residents a complementary set of curated education and career development resources available online. A part of AGA University, GI Distance Learning enables you to enhance your knowledge in a number of GI-related topics at your own pace from the comfort of home.
Through GI Distance Learning, you will have free access until Aug. 1 to the 800+ questions and answers included in the DDSEP® 9 Question Bank. Assess your knowledge, identify gaps in learning, and stay current on the latest advances in GI and liver disease.
To access the Question Bank free of charge:
- Visit AGA University and sign in to your AGA account.
- Go to the DDSEP 9 Question Bank.
- Add the Question Bank to your Cart and Checkout.
- Type DDSEP9Distance in the Discount Code box.
- Apply the discount and submit your order.
- Use the My Courses link to access the Question Bank.
During the COVID-19 pandemic, many of us are struggling with the new normal and changes in our daily routines. Resiliency, emotional intelligence, and strategies for combatting burnout become increasingly important. The following on-demand resources from GI Distance Learning can help.
- Resilient Leadership
- Emotional Intelligence
- Strategies to Combat Burnout in GI and Maintaining Work/Life Balance
Continue to check back regularly at AGA University as we will continue to add resources to GI Distance Learning in the coming weeks.
AGA just released GI Distance Learning, agau.gastro.org/diweb/catalog/q/GI-Distance-Learning, a new initiative providing AGA trainee members and medical residents a complementary set of curated education and career development resources available online. A part of AGA University, GI Distance Learning enables you to enhance your knowledge in a number of GI-related topics at your own pace from the comfort of home.
Through GI Distance Learning, you will have free access until Aug. 1 to the 800+ questions and answers included in the DDSEP® 9 Question Bank. Assess your knowledge, identify gaps in learning, and stay current on the latest advances in GI and liver disease.
To access the Question Bank free of charge:
- Visit AGA University and sign in to your AGA account.
- Go to the DDSEP 9 Question Bank.
- Add the Question Bank to your Cart and Checkout.
- Type DDSEP9Distance in the Discount Code box.
- Apply the discount and submit your order.
- Use the My Courses link to access the Question Bank.
During the COVID-19 pandemic, many of us are struggling with the new normal and changes in our daily routines. Resiliency, emotional intelligence, and strategies for combatting burnout become increasingly important. The following on-demand resources from GI Distance Learning can help.
- Resilient Leadership
- Emotional Intelligence
- Strategies to Combat Burnout in GI and Maintaining Work/Life Balance
Continue to check back regularly at AGA University as we will continue to add resources to GI Distance Learning in the coming weeks.
Win! CMS to pay for phone visits same as in-person appointments
Since the beginning of the pandemic, AGA has objected to the Centers for Medicare & Medicaid Services’ (CMS) low reimbursement rate for evaluation and management (E/M) services provided by telephone. Today, CMS fixed the problem. Retroactive to March 1, 2020, CMS will pay E/M services provided by telephone at the same rate as in-person, office/outpatient E/M services.
Thanks to everyone who helped us push CMS to address this issue. AGA worked together in coalition with other specialties and Congress on resolving this problem from the start of the pandemic.
Here are more details:
- Medicare’s updated guidance to physicians states, “Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
- The CMS press release outlined the new rates for telephone E/M:
- CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
We are pleased CMS listened to our message and has addressed this issue. Join the discussion on the AGA Community.
Since the beginning of the pandemic, AGA has objected to the Centers for Medicare & Medicaid Services’ (CMS) low reimbursement rate for evaluation and management (E/M) services provided by telephone. Today, CMS fixed the problem. Retroactive to March 1, 2020, CMS will pay E/M services provided by telephone at the same rate as in-person, office/outpatient E/M services.
Thanks to everyone who helped us push CMS to address this issue. AGA worked together in coalition with other specialties and Congress on resolving this problem from the start of the pandemic.
Here are more details:
- Medicare’s updated guidance to physicians states, “Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
- The CMS press release outlined the new rates for telephone E/M:
- CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
We are pleased CMS listened to our message and has addressed this issue. Join the discussion on the AGA Community.
Since the beginning of the pandemic, AGA has objected to the Centers for Medicare & Medicaid Services’ (CMS) low reimbursement rate for evaluation and management (E/M) services provided by telephone. Today, CMS fixed the problem. Retroactive to March 1, 2020, CMS will pay E/M services provided by telephone at the same rate as in-person, office/outpatient E/M services.
Thanks to everyone who helped us push CMS to address this issue. AGA worked together in coalition with other specialties and Congress on resolving this problem from the start of the pandemic.
Here are more details:
- Medicare’s updated guidance to physicians states, “Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
- The CMS press release outlined the new rates for telephone E/M:
- CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
We are pleased CMS listened to our message and has addressed this issue. Join the discussion on the AGA Community.
New COVID-19 guidance for gastroenterologists
AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.
Key guidance for gastroenterologists:
- GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).
- However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.
- Monitor patients with new diarrhea, nausea, or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath, or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.
- Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.
For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.
Authors: Shahnaz Sultan, Osama Altayar, Shazia M. Siddique, Perica Davitkov, Joseph D. Feuerstein, Joseph K. Lim, Yngve Falck-Ytter, Hashem B. El-Serag on behalf of the AGA.
AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.
Key guidance for gastroenterologists:
- GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).
- However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.
- Monitor patients with new diarrhea, nausea, or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath, or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.
- Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.
For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.
Authors: Shahnaz Sultan, Osama Altayar, Shazia M. Siddique, Perica Davitkov, Joseph D. Feuerstein, Joseph K. Lim, Yngve Falck-Ytter, Hashem B. El-Serag on behalf of the AGA.
AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.
Key guidance for gastroenterologists:
- GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).
- However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.
- Monitor patients with new diarrhea, nausea, or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath, or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.
- Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.
For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.
Authors: Shahnaz Sultan, Osama Altayar, Shazia M. Siddique, Perica Davitkov, Joseph D. Feuerstein, Joseph K. Lim, Yngve Falck-Ytter, Hashem B. El-Serag on behalf of the AGA.