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CHEST 2019 introduces self-study bundles for additional CME/MOC
This year, in conjunction with CHEST Annual Meeting, CHEST is piloting self-study bundles that will allow attendees to earn additional Continuing Medical Education/Continuing Education credits and American Board of Internal Medicine Maintenance of Certification points, apart from the total credits available for the overall meeting. Attendees will receive complimentary access to the eight self-study bundles, in which they will read articles and answer questions related to the articles, in the following areas:
• Pulmonary Hypertension
• Critical Care
• Sleep
• COPD
• Asthma
• Lung Cancer
• Interstitial Lung Disease
• Transplant
This value-added addition will offer the opportunity to earn three credits CME/CE and the corresponding number of ABIM MOC points for each bundle; if someone completes all eight bundles, they can earn up to 24 credits.
The deadline for completion of and claiming CME/CE for the self-study bundles is the same as the claiming deadline for the CHEST Annual Meeting, February 29, 2020.
This year, in conjunction with CHEST Annual Meeting, CHEST is piloting self-study bundles that will allow attendees to earn additional Continuing Medical Education/Continuing Education credits and American Board of Internal Medicine Maintenance of Certification points, apart from the total credits available for the overall meeting. Attendees will receive complimentary access to the eight self-study bundles, in which they will read articles and answer questions related to the articles, in the following areas:
• Pulmonary Hypertension
• Critical Care
• Sleep
• COPD
• Asthma
• Lung Cancer
• Interstitial Lung Disease
• Transplant
This value-added addition will offer the opportunity to earn three credits CME/CE and the corresponding number of ABIM MOC points for each bundle; if someone completes all eight bundles, they can earn up to 24 credits.
The deadline for completion of and claiming CME/CE for the self-study bundles is the same as the claiming deadline for the CHEST Annual Meeting, February 29, 2020.
This year, in conjunction with CHEST Annual Meeting, CHEST is piloting self-study bundles that will allow attendees to earn additional Continuing Medical Education/Continuing Education credits and American Board of Internal Medicine Maintenance of Certification points, apart from the total credits available for the overall meeting. Attendees will receive complimentary access to the eight self-study bundles, in which they will read articles and answer questions related to the articles, in the following areas:
• Pulmonary Hypertension
• Critical Care
• Sleep
• COPD
• Asthma
• Lung Cancer
• Interstitial Lung Disease
• Transplant
This value-added addition will offer the opportunity to earn three credits CME/CE and the corresponding number of ABIM MOC points for each bundle; if someone completes all eight bundles, they can earn up to 24 credits.
The deadline for completion of and claiming CME/CE for the self-study bundles is the same as the claiming deadline for the CHEST Annual Meeting, February 29, 2020.
This month in the journal CHEST®
Editor’s picks
COMMENTARY
Rare Lung Disease Research: National Heart, Lung, and Blood Institute’s Commitment to Partnership and Progress.
By L. J. Vuga, et al
ORIGINAL RESEARCH
Validation of Predictive Metabolic Syndrome Biomarkers of World Trade Center Lung Injury: A 16-Year Longitudinal Study
By S. Kwon, et al.
Association of Short Sleep Duration and Atrial Fibrillation
By M. W. Genuardi, et al.
Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of 7 or More Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study
By M. Hamilton, et al.
TOPICS IN PRACTICE MANAGEMENT
Clinician Strategies to Improve the Care of Patients Using Supplemental Oxygen
By S. S. Jacobs
Editor’s picks
Editor’s picks
COMMENTARY
Rare Lung Disease Research: National Heart, Lung, and Blood Institute’s Commitment to Partnership and Progress.
By L. J. Vuga, et al
ORIGINAL RESEARCH
Validation of Predictive Metabolic Syndrome Biomarkers of World Trade Center Lung Injury: A 16-Year Longitudinal Study
By S. Kwon, et al.
Association of Short Sleep Duration and Atrial Fibrillation
By M. W. Genuardi, et al.
Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of 7 or More Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study
By M. Hamilton, et al.
TOPICS IN PRACTICE MANAGEMENT
Clinician Strategies to Improve the Care of Patients Using Supplemental Oxygen
By S. S. Jacobs
COMMENTARY
Rare Lung Disease Research: National Heart, Lung, and Blood Institute’s Commitment to Partnership and Progress.
By L. J. Vuga, et al
ORIGINAL RESEARCH
Validation of Predictive Metabolic Syndrome Biomarkers of World Trade Center Lung Injury: A 16-Year Longitudinal Study
By S. Kwon, et al.
Association of Short Sleep Duration and Atrial Fibrillation
By M. W. Genuardi, et al.
Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of 7 or More Days of Mechanical Ventilation: Results From the RECOVER Program, a Secondary Analysis of a Prospective Multicenter Cohort Study
By M. Hamilton, et al.
TOPICS IN PRACTICE MANAGEMENT
Clinician Strategies to Improve the Care of Patients Using Supplemental Oxygen
By S. S. Jacobs
CHEST Annual Meeting 2019 introduces Wellness Zone with tips and tricks to manage stress
Working as a clinician doesn’t always allow for extra time to focus on the wellness of your body and mind. After taking care of patients all day, it’s important to find the time to also take care of yourself.
This year’s CHEST’s Annual Meeting is introducing a new interactive experience that aims to provide physicians with the necessary tools to decompress from the stressors of work. Visit the CHEST Wellness Zone at CHEST Annual Meeting 2019 to learn easy methods to handle stress and relax after a long day at work.
CHEST 2019 attendees will learn tips and tricks geared toward improving health, and consultants will provide attendees with personalized methods to maintain a healthy lifestyle in the workplace and at home. For those who have yet to register for the annual meeting, this new initiative might change your mind.
At the Wellness Zone, you can relax while getting your feet massaged at one of the four massage machine stations. Clinicians are always on the go, and this station will help to relieve the pressures of being on your feet all day at work.
Essential oils will also be on display for you to smell. Experts will show you the best oil combinations to use in and out of the office.
With a daily strenuous workload, clinicians often forget about their own health, which can lead to poor posture. The Wellness Zone is equipped with consultants who will examine your posture to provide you with feedback to improve your stance. You will walk away after an evaluation with before and after pictures from your consult and a full posture analysis report.
Do you want to try meditation? There is a space dedicated to guiding you through a first-time practice equipped with headphones. You can visit this area to learn about guided meditation apps that make it easy to follow along when meditating at work and home.
The Wellness Zone will feature a variety of 15- to 30-minute sessions focused on providing you with the resources to create a new wellness routine after the annual meeting’s conclusion.
Geared toward improving both one’s physical and mental health, these sessions will dive deeper into maintaining a healthy lifestyle while at work and home. You will walk away from the Wellness Zone with new habits that you are encouraged to incorporate into your daily life to keep your stress levels down to avoid burnout.
The Wellness Zone will be located in the lobby/foyer space inside the New Orleans Ernest N. Morial Convention Center and will be open all day October 20-23, except for during the Opening Sessions. Attendees can visit the Wellness Zone at any time with no appointment necessary.
Visit chestmeeting.chestnet.org for a list of sessions that are offered in the Wellness Zone, including Creating Well-Being in the Workplace and more. Plan your visit now to enjoy all the benefits CHEST 2019 has to offer.
Working as a clinician doesn’t always allow for extra time to focus on the wellness of your body and mind. After taking care of patients all day, it’s important to find the time to also take care of yourself.
This year’s CHEST’s Annual Meeting is introducing a new interactive experience that aims to provide physicians with the necessary tools to decompress from the stressors of work. Visit the CHEST Wellness Zone at CHEST Annual Meeting 2019 to learn easy methods to handle stress and relax after a long day at work.
CHEST 2019 attendees will learn tips and tricks geared toward improving health, and consultants will provide attendees with personalized methods to maintain a healthy lifestyle in the workplace and at home. For those who have yet to register for the annual meeting, this new initiative might change your mind.
At the Wellness Zone, you can relax while getting your feet massaged at one of the four massage machine stations. Clinicians are always on the go, and this station will help to relieve the pressures of being on your feet all day at work.
Essential oils will also be on display for you to smell. Experts will show you the best oil combinations to use in and out of the office.
With a daily strenuous workload, clinicians often forget about their own health, which can lead to poor posture. The Wellness Zone is equipped with consultants who will examine your posture to provide you with feedback to improve your stance. You will walk away after an evaluation with before and after pictures from your consult and a full posture analysis report.
Do you want to try meditation? There is a space dedicated to guiding you through a first-time practice equipped with headphones. You can visit this area to learn about guided meditation apps that make it easy to follow along when meditating at work and home.
The Wellness Zone will feature a variety of 15- to 30-minute sessions focused on providing you with the resources to create a new wellness routine after the annual meeting’s conclusion.
Geared toward improving both one’s physical and mental health, these sessions will dive deeper into maintaining a healthy lifestyle while at work and home. You will walk away from the Wellness Zone with new habits that you are encouraged to incorporate into your daily life to keep your stress levels down to avoid burnout.
The Wellness Zone will be located in the lobby/foyer space inside the New Orleans Ernest N. Morial Convention Center and will be open all day October 20-23, except for during the Opening Sessions. Attendees can visit the Wellness Zone at any time with no appointment necessary.
Visit chestmeeting.chestnet.org for a list of sessions that are offered in the Wellness Zone, including Creating Well-Being in the Workplace and more. Plan your visit now to enjoy all the benefits CHEST 2019 has to offer.
Working as a clinician doesn’t always allow for extra time to focus on the wellness of your body and mind. After taking care of patients all day, it’s important to find the time to also take care of yourself.
This year’s CHEST’s Annual Meeting is introducing a new interactive experience that aims to provide physicians with the necessary tools to decompress from the stressors of work. Visit the CHEST Wellness Zone at CHEST Annual Meeting 2019 to learn easy methods to handle stress and relax after a long day at work.
CHEST 2019 attendees will learn tips and tricks geared toward improving health, and consultants will provide attendees with personalized methods to maintain a healthy lifestyle in the workplace and at home. For those who have yet to register for the annual meeting, this new initiative might change your mind.
At the Wellness Zone, you can relax while getting your feet massaged at one of the four massage machine stations. Clinicians are always on the go, and this station will help to relieve the pressures of being on your feet all day at work.
Essential oils will also be on display for you to smell. Experts will show you the best oil combinations to use in and out of the office.
With a daily strenuous workload, clinicians often forget about their own health, which can lead to poor posture. The Wellness Zone is equipped with consultants who will examine your posture to provide you with feedback to improve your stance. You will walk away after an evaluation with before and after pictures from your consult and a full posture analysis report.
Do you want to try meditation? There is a space dedicated to guiding you through a first-time practice equipped with headphones. You can visit this area to learn about guided meditation apps that make it easy to follow along when meditating at work and home.
The Wellness Zone will feature a variety of 15- to 30-minute sessions focused on providing you with the resources to create a new wellness routine after the annual meeting’s conclusion.
Geared toward improving both one’s physical and mental health, these sessions will dive deeper into maintaining a healthy lifestyle while at work and home. You will walk away from the Wellness Zone with new habits that you are encouraged to incorporate into your daily life to keep your stress levels down to avoid burnout.
The Wellness Zone will be located in the lobby/foyer space inside the New Orleans Ernest N. Morial Convention Center and will be open all day October 20-23, except for during the Opening Sessions. Attendees can visit the Wellness Zone at any time with no appointment necessary.
Visit chestmeeting.chestnet.org for a list of sessions that are offered in the Wellness Zone, including Creating Well-Being in the Workplace and more. Plan your visit now to enjoy all the benefits CHEST 2019 has to offer.
Latent TB testing. High flow nasal cannula. Statins in OSA
Occupational and Environmental Health
New guidelines for latent TB testing in health-care personnel
Latent infection with Mycobacterium tuberculosis (TB) infection is of public health concern because of the lifetime risk of reactivation, a risk highest in the first 2 years after TB infection. Treatment of latent TB infection (LTBI) reduces the risk of reactivation by as much as 90%, and, thus, screening for LTBI in high-risk populations can identify patients eligible for treatment (Horsburgh & Rubin. N Engl J Med. 2011;364[15]:1441). The Centers for Disease Control and Prevention (CDC) previously recommended annual testing for LTBI in health-care personnel (HCP) as a high-risk group for developing LTBI (Jensen et al. MMWR Recomm Rep. 2005;54[No. RR-17]).
The annual national TB rate in the United States has decreased by 73% since 1991 (Stewart et al. MMWR Morb Mortal Wkly Rep. 2018;67[11]:317), and surveillance data show that TB incidence among HCPs does not differ significantly from the general population. The CDC thus formed the National Tuberculosis Controllers Association (NTCA)-CDC work group to revisit the recommendations for LTBI screening in HCPs. A systematic evidence review of all studies of LTBI testing in HCPs since 2005 was performed. Analysis of data from identified studies showed that less than 5% of HCPs converted from baseline negative to positive on routine annual screening.
Based on this, the CDC updated their recommendations from the 2005 guidelines: (1) Serial annual LTBI testing is no longer routinely recommended for all HCPs but may be considered for select HCPs (eg, pulmonologists, infectious disease specialists, respiratory therapists); (2) Treatment is encouraged for all HCPs with positive LTBI testing, unless medically contraindicated; (3) The recommendations for baseline LTBI and postexposure testing in all HCPs remain unchanged (Sosa et al. MMWR Morb Mortal Wkly Rep. 2019;68[19]:439).
Sujith Cherian, MD, FCCP
Steering Committee Member
Amy Ahasic, MD, MPH, FCCP
Chair
Respiratory Care
Aerosol drug delivery via high-flow nasal cannula
As a noninvasive, easy-to-use oxygen device, high-flow nasal cannula (HFNC) meets patients’ inspiratory demands, increases functional residual capacity, and decreases the need for intubation (Rochwerg, et al. Intensive Care Med. 2019;45[5]:563).
Using HFNC for aerosol drug delivery is an innovative approach (Ari, et al. Pediatr Pulmonol. 2011;46[8]:795) and the seven most important things about aerosol delivery via HFNC are listed below for clinicians:
1. Aerosols can be delivered via HFNC in the treatment of patients with respiratory distress through all age groups.
2. Delivery efficiency of mesh nebulizers is greater than jet nebulizers during HFNC. Unlike jet nebulizers, they do not interfere with FiO2 and the function of HFNC by adding extra gas flow to the system.
3. Placing mesh nebulizers before the humidifier improves aerosol delivery via HFNC.
4. Higher inspiratory flow rates with HFNC decreases aerosol delivery due to increased turbulence and impactive loss of aerosols during therapy.
5. While aerosol deposition is greater with the larger prong sizes, its size should not block more than 50% of the cross-sectional area of each nostril to allow gas leakage around the cannula.
6. Although oxygen is commonly used with HFNC, administering aerosolized medications with heliox during HFNC improves lung deposition more than oxygen.
7. Training patients on the closed mouth technique and nasal breathing during therapy may improve aerosol drug delivery via HFNC.
HFNC is a promising tool in aerosol therapy, and developing clinical guidelines on aerosol delivery via HFNC is needed to improve its effectiveness in drug delivery.
Arzu Ari, PhD, RRT
Steering Committee Member
Jessica Overgoner, RRT
NetWork Member
Sleep Medicine
Statins in OSA
Obstructive sleep apnea is linked with cardiovascular disease (CVD) (Wolk R, et al. Circulation. 2003;108[1]:9), and the primary treatment of OSA, ie, continuous positive airway pressure (CPAP), may reverse the adverse CVD sequelae associated with OSA. However, recent randomized controlled trials, including SAVE and RICCADSA, fail to show significant reductions in CVD events with CPAP therapy (McEvoy RD, et al. J Thorac Dis. 2010;2[3]:138; Peker Y, et al. Am J Respir Crit Care Med. 2016;194[5]:613). Although numerous reasons are postulated for these unexpected trial findings, one potential explanation is that individuals in these trials were already on CVD protective drugs. One such drug category is statins. Statins are prescribed for their lipid lowering effects; however, they have pleiotropic properties including reduction in vascular inflammation and oxidative stress. Statins also enhance endothelial function and improve blood pressure. In animal studies, statins prevented the adverse effects of chronic intermittent hypoxemia on systolic blood pressure, endothelial function, and carotid artery compliance. Human studies confirm some of the aforementioned animal study findings. In a study of patients with OSA, statin therapy preserved the anti-inflammatory cell surface proteins that are typically reduced in these patients (Emin M, et al. Sci Transl Med. 2016;8[320]:320ra1). In a randomized controlled trial of patients with OSA, statin therapy significantly improved systolic blood pressure but did not improve reactive hyperemia index, which is a marker of endothelial dysfunction (Joyeux-Faure M, et al. Mediators Inflamm. 2014 Aug 25. doi: 10.1155/2014/423120).
Therefore, the jury is still out regarding the independent impact of statin therapy on CVD risk reduction in patients with OSA. Yet, there is select evidence suggesting there may be a role for statins in patients with OSA to mitigate the CVD risk associated with OSA. It remains unknown whether statins work synergistically with CPAP to further reduce CVD risk.
Neomi Shah, MD
Steering Committee Member
Occupational and Environmental Health
New guidelines for latent TB testing in health-care personnel
Latent infection with Mycobacterium tuberculosis (TB) infection is of public health concern because of the lifetime risk of reactivation, a risk highest in the first 2 years after TB infection. Treatment of latent TB infection (LTBI) reduces the risk of reactivation by as much as 90%, and, thus, screening for LTBI in high-risk populations can identify patients eligible for treatment (Horsburgh & Rubin. N Engl J Med. 2011;364[15]:1441). The Centers for Disease Control and Prevention (CDC) previously recommended annual testing for LTBI in health-care personnel (HCP) as a high-risk group for developing LTBI (Jensen et al. MMWR Recomm Rep. 2005;54[No. RR-17]).
The annual national TB rate in the United States has decreased by 73% since 1991 (Stewart et al. MMWR Morb Mortal Wkly Rep. 2018;67[11]:317), and surveillance data show that TB incidence among HCPs does not differ significantly from the general population. The CDC thus formed the National Tuberculosis Controllers Association (NTCA)-CDC work group to revisit the recommendations for LTBI screening in HCPs. A systematic evidence review of all studies of LTBI testing in HCPs since 2005 was performed. Analysis of data from identified studies showed that less than 5% of HCPs converted from baseline negative to positive on routine annual screening.
Based on this, the CDC updated their recommendations from the 2005 guidelines: (1) Serial annual LTBI testing is no longer routinely recommended for all HCPs but may be considered for select HCPs (eg, pulmonologists, infectious disease specialists, respiratory therapists); (2) Treatment is encouraged for all HCPs with positive LTBI testing, unless medically contraindicated; (3) The recommendations for baseline LTBI and postexposure testing in all HCPs remain unchanged (Sosa et al. MMWR Morb Mortal Wkly Rep. 2019;68[19]:439).
Sujith Cherian, MD, FCCP
Steering Committee Member
Amy Ahasic, MD, MPH, FCCP
Chair
Respiratory Care
Aerosol drug delivery via high-flow nasal cannula
As a noninvasive, easy-to-use oxygen device, high-flow nasal cannula (HFNC) meets patients’ inspiratory demands, increases functional residual capacity, and decreases the need for intubation (Rochwerg, et al. Intensive Care Med. 2019;45[5]:563).
Using HFNC for aerosol drug delivery is an innovative approach (Ari, et al. Pediatr Pulmonol. 2011;46[8]:795) and the seven most important things about aerosol delivery via HFNC are listed below for clinicians:
1. Aerosols can be delivered via HFNC in the treatment of patients with respiratory distress through all age groups.
2. Delivery efficiency of mesh nebulizers is greater than jet nebulizers during HFNC. Unlike jet nebulizers, they do not interfere with FiO2 and the function of HFNC by adding extra gas flow to the system.
3. Placing mesh nebulizers before the humidifier improves aerosol delivery via HFNC.
4. Higher inspiratory flow rates with HFNC decreases aerosol delivery due to increased turbulence and impactive loss of aerosols during therapy.
5. While aerosol deposition is greater with the larger prong sizes, its size should not block more than 50% of the cross-sectional area of each nostril to allow gas leakage around the cannula.
6. Although oxygen is commonly used with HFNC, administering aerosolized medications with heliox during HFNC improves lung deposition more than oxygen.
7. Training patients on the closed mouth technique and nasal breathing during therapy may improve aerosol drug delivery via HFNC.
HFNC is a promising tool in aerosol therapy, and developing clinical guidelines on aerosol delivery via HFNC is needed to improve its effectiveness in drug delivery.
Arzu Ari, PhD, RRT
Steering Committee Member
Jessica Overgoner, RRT
NetWork Member
Sleep Medicine
Statins in OSA
Obstructive sleep apnea is linked with cardiovascular disease (CVD) (Wolk R, et al. Circulation. 2003;108[1]:9), and the primary treatment of OSA, ie, continuous positive airway pressure (CPAP), may reverse the adverse CVD sequelae associated with OSA. However, recent randomized controlled trials, including SAVE and RICCADSA, fail to show significant reductions in CVD events with CPAP therapy (McEvoy RD, et al. J Thorac Dis. 2010;2[3]:138; Peker Y, et al. Am J Respir Crit Care Med. 2016;194[5]:613). Although numerous reasons are postulated for these unexpected trial findings, one potential explanation is that individuals in these trials were already on CVD protective drugs. One such drug category is statins. Statins are prescribed for their lipid lowering effects; however, they have pleiotropic properties including reduction in vascular inflammation and oxidative stress. Statins also enhance endothelial function and improve blood pressure. In animal studies, statins prevented the adverse effects of chronic intermittent hypoxemia on systolic blood pressure, endothelial function, and carotid artery compliance. Human studies confirm some of the aforementioned animal study findings. In a study of patients with OSA, statin therapy preserved the anti-inflammatory cell surface proteins that are typically reduced in these patients (Emin M, et al. Sci Transl Med. 2016;8[320]:320ra1). In a randomized controlled trial of patients with OSA, statin therapy significantly improved systolic blood pressure but did not improve reactive hyperemia index, which is a marker of endothelial dysfunction (Joyeux-Faure M, et al. Mediators Inflamm. 2014 Aug 25. doi: 10.1155/2014/423120).
Therefore, the jury is still out regarding the independent impact of statin therapy on CVD risk reduction in patients with OSA. Yet, there is select evidence suggesting there may be a role for statins in patients with OSA to mitigate the CVD risk associated with OSA. It remains unknown whether statins work synergistically with CPAP to further reduce CVD risk.
Neomi Shah, MD
Steering Committee Member
Occupational and Environmental Health
New guidelines for latent TB testing in health-care personnel
Latent infection with Mycobacterium tuberculosis (TB) infection is of public health concern because of the lifetime risk of reactivation, a risk highest in the first 2 years after TB infection. Treatment of latent TB infection (LTBI) reduces the risk of reactivation by as much as 90%, and, thus, screening for LTBI in high-risk populations can identify patients eligible for treatment (Horsburgh & Rubin. N Engl J Med. 2011;364[15]:1441). The Centers for Disease Control and Prevention (CDC) previously recommended annual testing for LTBI in health-care personnel (HCP) as a high-risk group for developing LTBI (Jensen et al. MMWR Recomm Rep. 2005;54[No. RR-17]).
The annual national TB rate in the United States has decreased by 73% since 1991 (Stewart et al. MMWR Morb Mortal Wkly Rep. 2018;67[11]:317), and surveillance data show that TB incidence among HCPs does not differ significantly from the general population. The CDC thus formed the National Tuberculosis Controllers Association (NTCA)-CDC work group to revisit the recommendations for LTBI screening in HCPs. A systematic evidence review of all studies of LTBI testing in HCPs since 2005 was performed. Analysis of data from identified studies showed that less than 5% of HCPs converted from baseline negative to positive on routine annual screening.
Based on this, the CDC updated their recommendations from the 2005 guidelines: (1) Serial annual LTBI testing is no longer routinely recommended for all HCPs but may be considered for select HCPs (eg, pulmonologists, infectious disease specialists, respiratory therapists); (2) Treatment is encouraged for all HCPs with positive LTBI testing, unless medically contraindicated; (3) The recommendations for baseline LTBI and postexposure testing in all HCPs remain unchanged (Sosa et al. MMWR Morb Mortal Wkly Rep. 2019;68[19]:439).
Sujith Cherian, MD, FCCP
Steering Committee Member
Amy Ahasic, MD, MPH, FCCP
Chair
Respiratory Care
Aerosol drug delivery via high-flow nasal cannula
As a noninvasive, easy-to-use oxygen device, high-flow nasal cannula (HFNC) meets patients’ inspiratory demands, increases functional residual capacity, and decreases the need for intubation (Rochwerg, et al. Intensive Care Med. 2019;45[5]:563).
Using HFNC for aerosol drug delivery is an innovative approach (Ari, et al. Pediatr Pulmonol. 2011;46[8]:795) and the seven most important things about aerosol delivery via HFNC are listed below for clinicians:
1. Aerosols can be delivered via HFNC in the treatment of patients with respiratory distress through all age groups.
2. Delivery efficiency of mesh nebulizers is greater than jet nebulizers during HFNC. Unlike jet nebulizers, they do not interfere with FiO2 and the function of HFNC by adding extra gas flow to the system.
3. Placing mesh nebulizers before the humidifier improves aerosol delivery via HFNC.
4. Higher inspiratory flow rates with HFNC decreases aerosol delivery due to increased turbulence and impactive loss of aerosols during therapy.
5. While aerosol deposition is greater with the larger prong sizes, its size should not block more than 50% of the cross-sectional area of each nostril to allow gas leakage around the cannula.
6. Although oxygen is commonly used with HFNC, administering aerosolized medications with heliox during HFNC improves lung deposition more than oxygen.
7. Training patients on the closed mouth technique and nasal breathing during therapy may improve aerosol drug delivery via HFNC.
HFNC is a promising tool in aerosol therapy, and developing clinical guidelines on aerosol delivery via HFNC is needed to improve its effectiveness in drug delivery.
Arzu Ari, PhD, RRT
Steering Committee Member
Jessica Overgoner, RRT
NetWork Member
Sleep Medicine
Statins in OSA
Obstructive sleep apnea is linked with cardiovascular disease (CVD) (Wolk R, et al. Circulation. 2003;108[1]:9), and the primary treatment of OSA, ie, continuous positive airway pressure (CPAP), may reverse the adverse CVD sequelae associated with OSA. However, recent randomized controlled trials, including SAVE and RICCADSA, fail to show significant reductions in CVD events with CPAP therapy (McEvoy RD, et al. J Thorac Dis. 2010;2[3]:138; Peker Y, et al. Am J Respir Crit Care Med. 2016;194[5]:613). Although numerous reasons are postulated for these unexpected trial findings, one potential explanation is that individuals in these trials were already on CVD protective drugs. One such drug category is statins. Statins are prescribed for their lipid lowering effects; however, they have pleiotropic properties including reduction in vascular inflammation and oxidative stress. Statins also enhance endothelial function and improve blood pressure. In animal studies, statins prevented the adverse effects of chronic intermittent hypoxemia on systolic blood pressure, endothelial function, and carotid artery compliance. Human studies confirm some of the aforementioned animal study findings. In a study of patients with OSA, statin therapy preserved the anti-inflammatory cell surface proteins that are typically reduced in these patients (Emin M, et al. Sci Transl Med. 2016;8[320]:320ra1). In a randomized controlled trial of patients with OSA, statin therapy significantly improved systolic blood pressure but did not improve reactive hyperemia index, which is a marker of endothelial dysfunction (Joyeux-Faure M, et al. Mediators Inflamm. 2014 Aug 25. doi: 10.1155/2014/423120).
Therefore, the jury is still out regarding the independent impact of statin therapy on CVD risk reduction in patients with OSA. Yet, there is select evidence suggesting there may be a role for statins in patients with OSA to mitigate the CVD risk associated with OSA. It remains unknown whether statins work synergistically with CPAP to further reduce CVD risk.
Neomi Shah, MD
Steering Committee Member
Getting to know our incoming CHEST President
Stephanie M. Levine, MD, FCCP, is an expert in lung transplantation, and pulmonary and critical care issues in pregnancy and women’s lung health. She is a Professor of Medicine in the Division of Pulmonary Diseases and Critical Care Medicine at the University of Texas Health Science Center in San Antonio, Texas; the Program Director of the Pulmonary and Critical Care Fellowship at the University of Texas Health Science Center; and the Co-Director of the Medical Intensive Care Unit at the University Hospital. She is also a staff physician at the Audie Murphy Veteran Administration Hospital.
Dr. Levine has been Editor for both CHEST SEEK Critical Care Medicine and Pulmonary Medicine editions. In 2009 she received the CHEST Presidential Citation Award; in 2010, the CHEST Distinguished Service Award; and in 2017, the Master Clinician Educator Award. She has also been recognized as a Distinguished CHEST Educator in 2017, 2018, and 2019.
Dr. Levine has been active in CHEST international activities with CHEST World Congress meetings, the 2017 Basel Joint CHEST/SPG Congress in collaboration with the Swiss Lung Association, and with the pulmonary/critical care subspecialty training programs being developed in China. She was President and Chair of the CHEST Foundation from 2010-2014 and is currently on the CHEST Board of Regents.
We asked Dr. Levine for some thoughts on her upcoming CHEST presidency.
What would you like to accomplish as President of CHEST?
Every 5 years, the Board of Regents sets forth a new 5-year strategic plan, which is re-evaluated annually. We try to make sure all our decisions and actions align with this strategic plan. As President, I will promote the vision and mission of CHEST while guiding our organization to succeed in our 2018-2022 strategic plan. What will this include? This will include developing new innovative, evidenced-based, education and educational products in the areas of pulmonary, critical care, and sleep medicine; producing evidence-based guidelines; and expanding our educational expertise both nationally and globally. I am committed to actively engage and retain our fellows-in-training (being a longstanding program director), and to mentor our future leaders. I will reach out to engage and educate advanced practice providers, who are an integral part of our patient care teams. We will grow the CHEST Foundation in the areas of patient education and access, clinical research funding, and community service. On the global front, we will continue with our new global strategy of holding congresses based on the annual meeting content and smaller board review format regional conferences in different parts of the world seeking education in pulmonary, critical care, and sleep medicine. Our next meeting is in Bologna, Italy, in June of 2020. I will build on our collaborative inter-societal relationships with our related societies. Some of the specific areas I plan to focus on are defining the true value of CHEST membership, engaging all members of the health-care team, and revisiting the structure and function of our NetWorks to ensure the maximum opportunities for leadership and engagement.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
Our greatest strengths are the education we deliver; the people at all levels who deliver, learn from, and support the delivery of this core component of our vision and mission; and the culture in which this all takes place. These people include leaders, volunteers, faculty, members and all clinicians on the health-care team, and our top-notch staff (our EVP/CEO, Executive and Operations Team and staff at all levels). To build upon this, we need to strive for continued educational innovation and relevance and creative delivery of our educational products.
What are some challenges facing CHEST, and how will you address these challenges?
Ironically, maintaining our greatest strengths in the setting of a changing health-care environment can also be one of the greatest challenges. We must continue to make our education vibrant, relevant, and experiential. To do this, we need to ensure innovative, year-round education, whether at the annual meeting or through our e-learning platforms, simulation activities, SEEK, state-of the-art guidelines, board review courses, and courses and meetings at CHEST Global Headquarters in Glenview, Illinois, or at a global destination. We also need to stay relevant from the point of view of the value of membership and engagement. We must be cognizant of what members and others who engage with CHEST are looking for and ensure that we are meeting those ongoing expectations. Also, the need to identify, attract, develop, and retain talented and diverse members, volunteers, faculty, and future leaders and staff is imperative. As a program director, I am particularly interested in the retention of our fellows-in-training.
And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?
Get involved and stay involved. There are so many opportunities to do this! Attend the CHEST Annual Meeting. Join a NetWork. Submit articles to the journal CHEST or abstracts and case reports to the meeting. Participate in a Board Review Course or one of our e-learning opportunities. Come to a live course at headquarters or at a global destination. Participate in a simulation experience. Network at a meeting or a course. Engage with the CHEST Foundation. Connect with us on social media. Sign up to be a moderator and/or grader at the CHEST Annual Meeting. Become an FCCP. Apply for leadership openings, and if you don’t get it the first time, try again! You will be impressed with all that CHEST has to offer!!
Stephanie M. Levine, MD, FCCP, is an expert in lung transplantation, and pulmonary and critical care issues in pregnancy and women’s lung health. She is a Professor of Medicine in the Division of Pulmonary Diseases and Critical Care Medicine at the University of Texas Health Science Center in San Antonio, Texas; the Program Director of the Pulmonary and Critical Care Fellowship at the University of Texas Health Science Center; and the Co-Director of the Medical Intensive Care Unit at the University Hospital. She is also a staff physician at the Audie Murphy Veteran Administration Hospital.
Dr. Levine has been Editor for both CHEST SEEK Critical Care Medicine and Pulmonary Medicine editions. In 2009 she received the CHEST Presidential Citation Award; in 2010, the CHEST Distinguished Service Award; and in 2017, the Master Clinician Educator Award. She has also been recognized as a Distinguished CHEST Educator in 2017, 2018, and 2019.
Dr. Levine has been active in CHEST international activities with CHEST World Congress meetings, the 2017 Basel Joint CHEST/SPG Congress in collaboration with the Swiss Lung Association, and with the pulmonary/critical care subspecialty training programs being developed in China. She was President and Chair of the CHEST Foundation from 2010-2014 and is currently on the CHEST Board of Regents.
We asked Dr. Levine for some thoughts on her upcoming CHEST presidency.
What would you like to accomplish as President of CHEST?
Every 5 years, the Board of Regents sets forth a new 5-year strategic plan, which is re-evaluated annually. We try to make sure all our decisions and actions align with this strategic plan. As President, I will promote the vision and mission of CHEST while guiding our organization to succeed in our 2018-2022 strategic plan. What will this include? This will include developing new innovative, evidenced-based, education and educational products in the areas of pulmonary, critical care, and sleep medicine; producing evidence-based guidelines; and expanding our educational expertise both nationally and globally. I am committed to actively engage and retain our fellows-in-training (being a longstanding program director), and to mentor our future leaders. I will reach out to engage and educate advanced practice providers, who are an integral part of our patient care teams. We will grow the CHEST Foundation in the areas of patient education and access, clinical research funding, and community service. On the global front, we will continue with our new global strategy of holding congresses based on the annual meeting content and smaller board review format regional conferences in different parts of the world seeking education in pulmonary, critical care, and sleep medicine. Our next meeting is in Bologna, Italy, in June of 2020. I will build on our collaborative inter-societal relationships with our related societies. Some of the specific areas I plan to focus on are defining the true value of CHEST membership, engaging all members of the health-care team, and revisiting the structure and function of our NetWorks to ensure the maximum opportunities for leadership and engagement.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
Our greatest strengths are the education we deliver; the people at all levels who deliver, learn from, and support the delivery of this core component of our vision and mission; and the culture in which this all takes place. These people include leaders, volunteers, faculty, members and all clinicians on the health-care team, and our top-notch staff (our EVP/CEO, Executive and Operations Team and staff at all levels). To build upon this, we need to strive for continued educational innovation and relevance and creative delivery of our educational products.
What are some challenges facing CHEST, and how will you address these challenges?
Ironically, maintaining our greatest strengths in the setting of a changing health-care environment can also be one of the greatest challenges. We must continue to make our education vibrant, relevant, and experiential. To do this, we need to ensure innovative, year-round education, whether at the annual meeting or through our e-learning platforms, simulation activities, SEEK, state-of the-art guidelines, board review courses, and courses and meetings at CHEST Global Headquarters in Glenview, Illinois, or at a global destination. We also need to stay relevant from the point of view of the value of membership and engagement. We must be cognizant of what members and others who engage with CHEST are looking for and ensure that we are meeting those ongoing expectations. Also, the need to identify, attract, develop, and retain talented and diverse members, volunteers, faculty, and future leaders and staff is imperative. As a program director, I am particularly interested in the retention of our fellows-in-training.
And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?
Get involved and stay involved. There are so many opportunities to do this! Attend the CHEST Annual Meeting. Join a NetWork. Submit articles to the journal CHEST or abstracts and case reports to the meeting. Participate in a Board Review Course or one of our e-learning opportunities. Come to a live course at headquarters or at a global destination. Participate in a simulation experience. Network at a meeting or a course. Engage with the CHEST Foundation. Connect with us on social media. Sign up to be a moderator and/or grader at the CHEST Annual Meeting. Become an FCCP. Apply for leadership openings, and if you don’t get it the first time, try again! You will be impressed with all that CHEST has to offer!!
Stephanie M. Levine, MD, FCCP, is an expert in lung transplantation, and pulmonary and critical care issues in pregnancy and women’s lung health. She is a Professor of Medicine in the Division of Pulmonary Diseases and Critical Care Medicine at the University of Texas Health Science Center in San Antonio, Texas; the Program Director of the Pulmonary and Critical Care Fellowship at the University of Texas Health Science Center; and the Co-Director of the Medical Intensive Care Unit at the University Hospital. She is also a staff physician at the Audie Murphy Veteran Administration Hospital.
Dr. Levine has been Editor for both CHEST SEEK Critical Care Medicine and Pulmonary Medicine editions. In 2009 she received the CHEST Presidential Citation Award; in 2010, the CHEST Distinguished Service Award; and in 2017, the Master Clinician Educator Award. She has also been recognized as a Distinguished CHEST Educator in 2017, 2018, and 2019.
Dr. Levine has been active in CHEST international activities with CHEST World Congress meetings, the 2017 Basel Joint CHEST/SPG Congress in collaboration with the Swiss Lung Association, and with the pulmonary/critical care subspecialty training programs being developed in China. She was President and Chair of the CHEST Foundation from 2010-2014 and is currently on the CHEST Board of Regents.
We asked Dr. Levine for some thoughts on her upcoming CHEST presidency.
What would you like to accomplish as President of CHEST?
Every 5 years, the Board of Regents sets forth a new 5-year strategic plan, which is re-evaluated annually. We try to make sure all our decisions and actions align with this strategic plan. As President, I will promote the vision and mission of CHEST while guiding our organization to succeed in our 2018-2022 strategic plan. What will this include? This will include developing new innovative, evidenced-based, education and educational products in the areas of pulmonary, critical care, and sleep medicine; producing evidence-based guidelines; and expanding our educational expertise both nationally and globally. I am committed to actively engage and retain our fellows-in-training (being a longstanding program director), and to mentor our future leaders. I will reach out to engage and educate advanced practice providers, who are an integral part of our patient care teams. We will grow the CHEST Foundation in the areas of patient education and access, clinical research funding, and community service. On the global front, we will continue with our new global strategy of holding congresses based on the annual meeting content and smaller board review format regional conferences in different parts of the world seeking education in pulmonary, critical care, and sleep medicine. Our next meeting is in Bologna, Italy, in June of 2020. I will build on our collaborative inter-societal relationships with our related societies. Some of the specific areas I plan to focus on are defining the true value of CHEST membership, engaging all members of the health-care team, and revisiting the structure and function of our NetWorks to ensure the maximum opportunities for leadership and engagement.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
Our greatest strengths are the education we deliver; the people at all levels who deliver, learn from, and support the delivery of this core component of our vision and mission; and the culture in which this all takes place. These people include leaders, volunteers, faculty, members and all clinicians on the health-care team, and our top-notch staff (our EVP/CEO, Executive and Operations Team and staff at all levels). To build upon this, we need to strive for continued educational innovation and relevance and creative delivery of our educational products.
What are some challenges facing CHEST, and how will you address these challenges?
Ironically, maintaining our greatest strengths in the setting of a changing health-care environment can also be one of the greatest challenges. We must continue to make our education vibrant, relevant, and experiential. To do this, we need to ensure innovative, year-round education, whether at the annual meeting or through our e-learning platforms, simulation activities, SEEK, state-of the-art guidelines, board review courses, and courses and meetings at CHEST Global Headquarters in Glenview, Illinois, or at a global destination. We also need to stay relevant from the point of view of the value of membership and engagement. We must be cognizant of what members and others who engage with CHEST are looking for and ensure that we are meeting those ongoing expectations. Also, the need to identify, attract, develop, and retain talented and diverse members, volunteers, faculty, and future leaders and staff is imperative. As a program director, I am particularly interested in the retention of our fellows-in-training.
And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?
Get involved and stay involved. There are so many opportunities to do this! Attend the CHEST Annual Meeting. Join a NetWork. Submit articles to the journal CHEST or abstracts and case reports to the meeting. Participate in a Board Review Course or one of our e-learning opportunities. Come to a live course at headquarters or at a global destination. Participate in a simulation experience. Network at a meeting or a course. Engage with the CHEST Foundation. Connect with us on social media. Sign up to be a moderator and/or grader at the CHEST Annual Meeting. Become an FCCP. Apply for leadership openings, and if you don’t get it the first time, try again! You will be impressed with all that CHEST has to offer!!
Broad cross section of clinical topics highlights NAMDRC 2020 Conference
NAMDRC will host its Annual Educational Conference at the Scottsdale Resort at McCormick Ranch in Scottsdale, Arizona, March 12-14, 2020, and features a wide cross section of clinical, management, and health policy issues.
The NAMDRC Educational Conference is unlike other medical conferences you have attended. Conference sessions begin early each day and conclude by 12:30 so attendees, spouses, and guests can enjoy the venue, this year in Scottsdale, Arizona. All registrants and their guests enjoy numerous complimentary meals, and speakers and corporate partners invariably linger with the attendees during receptions for those more casual opportunities for conversations and less formal Q&A.
The Program Committee has announced its plans to focus the first day of the 3-day event on lung cancer, severe asthma, and pulmonary hypertension. Speakers include Maxwell Smith, MD from the Mayo Clinic, Arizona; James Herman, MD, Co-Director of the Lung Cancer Program at UPMC, and Colleen Channick, MD, FCCP, Director of Interventional Pulmonary at UCLA Medical Center to address timely updates on lung cancer diagnosis and treatment. The morning sessions also include a presentation on severe asthma by Monica Kraft, MD, FCCP, University of Arizona; and Richard Channick, MD, Geffen School of Medicine, UCLA, examining pulmonary hypertension with a concentration on current approaches to diagnosis and treatment.
On Friday, March 13, the focus shifts from the clinical to the changing landscape in the delivery of medicine, with a concentrated focus on innovation and new tools available to guide physicians in treatment of their patients. Claibe Yarbrough, MD, National Program Director of Pulmonary, Critical Care and Sleep at the VA, University of Texas, will examine the growth of telemedicine in the ICU. Steve Peters, MD, FCCP, a past President of NAMDRC and a current Board member, will look at artificial intelligence and the future of medicine. Dr. Peters will also present a practice management update in partnership with Alan Plummer, MD, FCCP, as he addresses coding changes in the practice of pulmonary, critical care, and sleep medicine effective 2020-21.
Shifting back to a clinical focus, the Walter J. O’Donohue memorial lecture will be given by Gerald Criner, MD, FCCP, Temple University, to examine endobronchial valve therapy for emphysema. Rounding out the presentations will be luncheon speaker Susan Tanski, MD, looking at electronic nicotine delivery systems.
On Saturday, the topics turn to sleep and mechanical ventilation. Insomnia is the subject matter for Jennifer Martin, MD, Geffen School of Medicine at UCLA; Sairam Parthasarathy, MD, at the University of Arizona, will address sleep and noninvasive mechanical ventilation. And, in a corollary presentation, home mechanical ventilation is the topic for John Hansen-Flaschen, MD, FCCP, Hospital of the University of Pennsylvania.
The final morning rounds out with controversies in septic shock, Rodrigo Cartin-Ceba, MD, at the Mayo Clinic in Scottsdale, and palliative care in the ICU, Mark Edwin, also from the Mayo Clinic.
For more information about membership in NAMDRC and conference information, visit its website at www.namdrc.org.
NAMDRC will host its Annual Educational Conference at the Scottsdale Resort at McCormick Ranch in Scottsdale, Arizona, March 12-14, 2020, and features a wide cross section of clinical, management, and health policy issues.
The NAMDRC Educational Conference is unlike other medical conferences you have attended. Conference sessions begin early each day and conclude by 12:30 so attendees, spouses, and guests can enjoy the venue, this year in Scottsdale, Arizona. All registrants and their guests enjoy numerous complimentary meals, and speakers and corporate partners invariably linger with the attendees during receptions for those more casual opportunities for conversations and less formal Q&A.
The Program Committee has announced its plans to focus the first day of the 3-day event on lung cancer, severe asthma, and pulmonary hypertension. Speakers include Maxwell Smith, MD from the Mayo Clinic, Arizona; James Herman, MD, Co-Director of the Lung Cancer Program at UPMC, and Colleen Channick, MD, FCCP, Director of Interventional Pulmonary at UCLA Medical Center to address timely updates on lung cancer diagnosis and treatment. The morning sessions also include a presentation on severe asthma by Monica Kraft, MD, FCCP, University of Arizona; and Richard Channick, MD, Geffen School of Medicine, UCLA, examining pulmonary hypertension with a concentration on current approaches to diagnosis and treatment.
On Friday, March 13, the focus shifts from the clinical to the changing landscape in the delivery of medicine, with a concentrated focus on innovation and new tools available to guide physicians in treatment of their patients. Claibe Yarbrough, MD, National Program Director of Pulmonary, Critical Care and Sleep at the VA, University of Texas, will examine the growth of telemedicine in the ICU. Steve Peters, MD, FCCP, a past President of NAMDRC and a current Board member, will look at artificial intelligence and the future of medicine. Dr. Peters will also present a practice management update in partnership with Alan Plummer, MD, FCCP, as he addresses coding changes in the practice of pulmonary, critical care, and sleep medicine effective 2020-21.
Shifting back to a clinical focus, the Walter J. O’Donohue memorial lecture will be given by Gerald Criner, MD, FCCP, Temple University, to examine endobronchial valve therapy for emphysema. Rounding out the presentations will be luncheon speaker Susan Tanski, MD, looking at electronic nicotine delivery systems.
On Saturday, the topics turn to sleep and mechanical ventilation. Insomnia is the subject matter for Jennifer Martin, MD, Geffen School of Medicine at UCLA; Sairam Parthasarathy, MD, at the University of Arizona, will address sleep and noninvasive mechanical ventilation. And, in a corollary presentation, home mechanical ventilation is the topic for John Hansen-Flaschen, MD, FCCP, Hospital of the University of Pennsylvania.
The final morning rounds out with controversies in septic shock, Rodrigo Cartin-Ceba, MD, at the Mayo Clinic in Scottsdale, and palliative care in the ICU, Mark Edwin, also from the Mayo Clinic.
For more information about membership in NAMDRC and conference information, visit its website at www.namdrc.org.
NAMDRC will host its Annual Educational Conference at the Scottsdale Resort at McCormick Ranch in Scottsdale, Arizona, March 12-14, 2020, and features a wide cross section of clinical, management, and health policy issues.
The NAMDRC Educational Conference is unlike other medical conferences you have attended. Conference sessions begin early each day and conclude by 12:30 so attendees, spouses, and guests can enjoy the venue, this year in Scottsdale, Arizona. All registrants and their guests enjoy numerous complimentary meals, and speakers and corporate partners invariably linger with the attendees during receptions for those more casual opportunities for conversations and less formal Q&A.
The Program Committee has announced its plans to focus the first day of the 3-day event on lung cancer, severe asthma, and pulmonary hypertension. Speakers include Maxwell Smith, MD from the Mayo Clinic, Arizona; James Herman, MD, Co-Director of the Lung Cancer Program at UPMC, and Colleen Channick, MD, FCCP, Director of Interventional Pulmonary at UCLA Medical Center to address timely updates on lung cancer diagnosis and treatment. The morning sessions also include a presentation on severe asthma by Monica Kraft, MD, FCCP, University of Arizona; and Richard Channick, MD, Geffen School of Medicine, UCLA, examining pulmonary hypertension with a concentration on current approaches to diagnosis and treatment.
On Friday, March 13, the focus shifts from the clinical to the changing landscape in the delivery of medicine, with a concentrated focus on innovation and new tools available to guide physicians in treatment of their patients. Claibe Yarbrough, MD, National Program Director of Pulmonary, Critical Care and Sleep at the VA, University of Texas, will examine the growth of telemedicine in the ICU. Steve Peters, MD, FCCP, a past President of NAMDRC and a current Board member, will look at artificial intelligence and the future of medicine. Dr. Peters will also present a practice management update in partnership with Alan Plummer, MD, FCCP, as he addresses coding changes in the practice of pulmonary, critical care, and sleep medicine effective 2020-21.
Shifting back to a clinical focus, the Walter J. O’Donohue memorial lecture will be given by Gerald Criner, MD, FCCP, Temple University, to examine endobronchial valve therapy for emphysema. Rounding out the presentations will be luncheon speaker Susan Tanski, MD, looking at electronic nicotine delivery systems.
On Saturday, the topics turn to sleep and mechanical ventilation. Insomnia is the subject matter for Jennifer Martin, MD, Geffen School of Medicine at UCLA; Sairam Parthasarathy, MD, at the University of Arizona, will address sleep and noninvasive mechanical ventilation. And, in a corollary presentation, home mechanical ventilation is the topic for John Hansen-Flaschen, MD, FCCP, Hospital of the University of Pennsylvania.
The final morning rounds out with controversies in septic shock, Rodrigo Cartin-Ceba, MD, at the Mayo Clinic in Scottsdale, and palliative care in the ICU, Mark Edwin, also from the Mayo Clinic.
For more information about membership in NAMDRC and conference information, visit its website at www.namdrc.org.
17 fellows advancing GI and patient care
These fellows showcased their commitment to advancing our field through their quality improvement projects presented at DDW® 2019.
Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” During the 2019 session, 17 quality improvement initiatives were presented — you can review these abstracts in the July issue of Gastroenterology in the “AGA Section,” www.gastrojournal.org/issue/S0016-5085(19)X0009-8. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.
Manasi Agrawal, MD
Lenox Hill Hospital, New York City
@ManasiAgrawalMD
Jessica Breton, MD
Children’s Hospital of Philadelphia
Adam Faye, MD
Columbia University Medical Center, New York City
@AdamFaye4
Shelly Gurwara, MD
Wake Forest Baptist Health Medical Center, Winston-Salem, N.C.
Afrin Kamal, MD
Stanford University, Calif.
Ani Kardashian, MD
University of California, Los Angeles
@AniKardashianMD
Sonali Palchaudhuri, MD
University of Pennsylvania, Philadelphia
@sopalchaudhuri
Nasim Parsa, MD
University of Missouri Health System, Columbia
Sahil Patel, MD
Drexel University, Philadelphia
@sahilr
Vikram Raghu, MD
Children’s Hospital of Pittsburgh, Pennsylvania
Amit Shah, MD
Children’s Hospital of Philadelphia
Lin Shen, MD
Brigham and Women’s Hospital, Boston
@LinShenMD
Charles Snyder, MD
Icahn School of Medicine at Mount Sinai, New York City
Brian Sullivan, MD
Duke University, Durham, N.C.
Ashley Vachon, MD
University of Colorado Anschutz Medical Campus, Aurora
Ted Walker, MD
Washington University/Barnes Jewish Hospital, St. Louis, Mo.
Xiao Jing Wang, MD
Mayo Clinic, Rochester, Minn.
@IrisWangMD
These fellows showcased their commitment to advancing our field through their quality improvement projects presented at DDW® 2019.
Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” During the 2019 session, 17 quality improvement initiatives were presented — you can review these abstracts in the July issue of Gastroenterology in the “AGA Section,” www.gastrojournal.org/issue/S0016-5085(19)X0009-8. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.
Manasi Agrawal, MD
Lenox Hill Hospital, New York City
@ManasiAgrawalMD
Jessica Breton, MD
Children’s Hospital of Philadelphia
Adam Faye, MD
Columbia University Medical Center, New York City
@AdamFaye4
Shelly Gurwara, MD
Wake Forest Baptist Health Medical Center, Winston-Salem, N.C.
Afrin Kamal, MD
Stanford University, Calif.
Ani Kardashian, MD
University of California, Los Angeles
@AniKardashianMD
Sonali Palchaudhuri, MD
University of Pennsylvania, Philadelphia
@sopalchaudhuri
Nasim Parsa, MD
University of Missouri Health System, Columbia
Sahil Patel, MD
Drexel University, Philadelphia
@sahilr
Vikram Raghu, MD
Children’s Hospital of Pittsburgh, Pennsylvania
Amit Shah, MD
Children’s Hospital of Philadelphia
Lin Shen, MD
Brigham and Women’s Hospital, Boston
@LinShenMD
Charles Snyder, MD
Icahn School of Medicine at Mount Sinai, New York City
Brian Sullivan, MD
Duke University, Durham, N.C.
Ashley Vachon, MD
University of Colorado Anschutz Medical Campus, Aurora
Ted Walker, MD
Washington University/Barnes Jewish Hospital, St. Louis, Mo.
Xiao Jing Wang, MD
Mayo Clinic, Rochester, Minn.
@IrisWangMD
These fellows showcased their commitment to advancing our field through their quality improvement projects presented at DDW® 2019.
Each year during Digestive Disease Week®, AGA hosts a session titled “Advancing Clinical Practice: GI Fellow-Directed Quality-Improvement Projects.” During the 2019 session, 17 quality improvement initiatives were presented — you can review these abstracts in the July issue of Gastroenterology in the “AGA Section,” www.gastrojournal.org/issue/S0016-5085(19)X0009-8. Kudos to the promising fellows featured below, who all served as lead authors for their QI projects.
Manasi Agrawal, MD
Lenox Hill Hospital, New York City
@ManasiAgrawalMD
Jessica Breton, MD
Children’s Hospital of Philadelphia
Adam Faye, MD
Columbia University Medical Center, New York City
@AdamFaye4
Shelly Gurwara, MD
Wake Forest Baptist Health Medical Center, Winston-Salem, N.C.
Afrin Kamal, MD
Stanford University, Calif.
Ani Kardashian, MD
University of California, Los Angeles
@AniKardashianMD
Sonali Palchaudhuri, MD
University of Pennsylvania, Philadelphia
@sopalchaudhuri
Nasim Parsa, MD
University of Missouri Health System, Columbia
Sahil Patel, MD
Drexel University, Philadelphia
@sahilr
Vikram Raghu, MD
Children’s Hospital of Pittsburgh, Pennsylvania
Amit Shah, MD
Children’s Hospital of Philadelphia
Lin Shen, MD
Brigham and Women’s Hospital, Boston
@LinShenMD
Charles Snyder, MD
Icahn School of Medicine at Mount Sinai, New York City
Brian Sullivan, MD
Duke University, Durham, N.C.
Ashley Vachon, MD
University of Colorado Anschutz Medical Campus, Aurora
Ted Walker, MD
Washington University/Barnes Jewish Hospital, St. Louis, Mo.
Xiao Jing Wang, MD
Mayo Clinic, Rochester, Minn.
@IrisWangMD
AGA participates in 2019 Alliance of Specialty Medicine Fly In
Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
• Rotonya M. Carr, MD, University of Pennsylvania Health System
• Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Md.
• Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston
• Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore
Prior authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain preapproval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care because of prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs because of devastating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
— @CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
• Rotonya M. Carr, MD, University of Pennsylvania Health System
• Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Md.
• Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston
• Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore
Prior authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain preapproval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care because of prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs because of devastating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
— @CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
Thank you to the following members who joined us to advocate for some of the most pressing issues facing gastroenterologists and our patients at the 2019 Alliance of Specialty Medicine Fly In. Our advocates met with House and Senate offices to push for reducing prior authorization burdens and minimizing the strict constraints of step therapy protocols.
• Rotonya M. Carr, MD, University of Pennsylvania Health System
• Peter Kaufman, MD, AGAF, Capital Digestive Care, Bethesda, Md.
• Avinash G. Ketwaroo, MD, Baylor College of Medicine, Houston
• Simon C. Mathews, MD, Johns Hopkins Medicine, Baltimore
Prior authorization
Prior authorization is a tedious process and management tool that requires physicians to obtain preapproval for medical treatments or tests before rendering care to their patients. Patients experience significant barriers to medically necessary care because of prior authorization requirements for services that are eventually routinely approved. H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would increase transparency and accountability and reduce the burdens of prior authorization.
Step therapy
Step therapy treatment, or “fail first,” requires patients to try and fail medications before insurers agree to cover the initial therapy prescribed by their health care provider. While this protocol may initially act as a cost-containment mechanism, it can ultimately lead to more expensive health care costs because of devastating patient complications. H.R. 2279, the Safe Step Act, would provide a clear and timely appeals process when a patient has been subjected to step therapy.
— @CongressmanRuiz from Cali combats #steptherapy with the bipartisan Safe Step Act (H.R. 2279). #Patients should be given a clear, equitable & transparent appeals process concerning step therapy. Urge your member of Congress to take action:https://t.co/q4ljhuMO9X#specialtydocs pic.twitter.com/B2zvRT6mG5
— AGA (@AmerGastroAssn) July 16, 2019
“Thank you, GI docs. I had colon cancer and a GI surgeon saved my life.” Thank you, @RepMarkGreen, for supporting reducing prior authorization. https://t.co/kc9fWnA8XB #specialtydocs
— AGA (@AmerGastroAssn) July 17, 2019
The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States.
This conference took place July 15-17, 2019, at the Liaison Washington Capitol Hill in Washington, DC.
‘No Surprises Act’ clears House committee
In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.
In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.
In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.
Top AGA Community patient cases
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Combination therapy with Entyvio – The GI community shared their experiences with combination therapy of Entyvio and immunomodulators in patients with ulcerative colitis who have developed antibodies to anti-TNF therapy.
2. Small bowel ulcerations in anemic patient with rheumatoid arthritis – Read an update on this patient with rheumatoid arthritis who was experiencing recurrent abdominal pain associated with iron-deficiency anemia diagnosed with multiple small bowel ulcers.
3. When losing weight is too difficult – How do you approach NAFLD patients who have a difficult time committing to a weight-loss treatment plan?
Access these clinical cases and more discussions at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Combination therapy with Entyvio – The GI community shared their experiences with combination therapy of Entyvio and immunomodulators in patients with ulcerative colitis who have developed antibodies to anti-TNF therapy.
2. Small bowel ulcerations in anemic patient with rheumatoid arthritis – Read an update on this patient with rheumatoid arthritis who was experiencing recurrent abdominal pain associated with iron-deficiency anemia diagnosed with multiple small bowel ulcers.
3. When losing weight is too difficult – How do you approach NAFLD patients who have a difficult time committing to a weight-loss treatment plan?
Access these clinical cases and more discussions at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Combination therapy with Entyvio – The GI community shared their experiences with combination therapy of Entyvio and immunomodulators in patients with ulcerative colitis who have developed antibodies to anti-TNF therapy.
2. Small bowel ulcerations in anemic patient with rheumatoid arthritis – Read an update on this patient with rheumatoid arthritis who was experiencing recurrent abdominal pain associated with iron-deficiency anemia diagnosed with multiple small bowel ulcers.
3. When losing weight is too difficult – How do you approach NAFLD patients who have a difficult time committing to a weight-loss treatment plan?
Access these clinical cases and more discussions at https://community.gastro.org/discussions.