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This Month in CHEST: Editor’s picks
Giants in Chest Medicine – Paul D. Stein, MD, Master FCCP’
Rapidly Improving ARDS in Therapeutic Randomized Controlled Trials. By Dr. E. J. Schenck, et al.
The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis
Based on Individual Participant Data. By Dr. N. Navani, et al.
A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian
Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External
Application in 451,199 Korean Subjects. By Dr. Y-G Li, et al.
A Sleep Medicine Curriculum for Pulmonary and Pulmonary/Critical Care Fellowship
Programs: A Multisociety Expert Panel Report. By Dr. D. A. Schulman, et al.
Giants in Chest Medicine – Paul D. Stein, MD, Master FCCP’
Rapidly Improving ARDS in Therapeutic Randomized Controlled Trials. By Dr. E. J. Schenck, et al.
The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis
Based on Individual Participant Data. By Dr. N. Navani, et al.
A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian
Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External
Application in 451,199 Korean Subjects. By Dr. Y-G Li, et al.
A Sleep Medicine Curriculum for Pulmonary and Pulmonary/Critical Care Fellowship
Programs: A Multisociety Expert Panel Report. By Dr. D. A. Schulman, et al.
Giants in Chest Medicine – Paul D. Stein, MD, Master FCCP’
Rapidly Improving ARDS in Therapeutic Randomized Controlled Trials. By Dr. E. J. Schenck, et al.
The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis
Based on Individual Participant Data. By Dr. N. Navani, et al.
A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian
Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External
Application in 451,199 Korean Subjects. By Dr. Y-G Li, et al.
A Sleep Medicine Curriculum for Pulmonary and Pulmonary/Critical Care Fellowship
Programs: A Multisociety Expert Panel Report. By Dr. D. A. Schulman, et al.
Disaster response, practice operations, transplant, women's health
Disaster Response and Global Health
Epigenetics and Disasters
The configuration of the DNA bordering a gene dictates under what conditions a gene is expressed. Random errors or mutations affecting the neighboring DNA or the gene itself can affect how the gene functions. Epigenetics is an emerging field of science looking at environmental and psychosocial factors that do not directly cause mutations but still affect how genes are expressed with implications for the development and inheritance of disease. These external influences are thought to affect why some segments of DNA become accessible for protein production while other segments may not.
Disasters represent stressors with potential for epigenetic impact. Women who were pregnant during the 1998 Quebec ice storm were found to have a correlation between maternal objective stress and a distinctive pattern of DNA methylation in their children 13 years later (Cao-Lei L, et al. PLoS ONE. 2014;9[9] e10765). Methylation is known to affect the activity of a DNA segment and how genes are expressed. Associations have also been found between the severity of hurricanes and the prevalence of autism in the offspring of pregnant women experiencing these disasters (Kinney DK, et al. J Autism Dev Disord. 2008;38:481).
Anthropogenic hazards may also affect the offspring of survivors as suggested by studies of civil war POWs and Dutch Hunger Winter during WW II (Costa, DL, et al. Proc Nat Acad Sci 2018;. 115:44; Heijmans BT et al. Proc Nat Acad Sci. 2008;105[44]: 17046-9).
Epigenetics represents an area for additional research as natural and man-made disasters increase.
Omesh Toolsie, MBBS
Steering Committee Fellow-in-Training
Practice Operations
Medicare Competitive Bidding Process Update
Medicare’s Competitive Bidding Program (CBP), mandated since 2003, asks providers of specific durable medical equipment (including oxygen) to submit competing proposals for services. The best offer is then awarded a 3-year contract. Recently, several reforms to CBP have been proposed. The payment structure has changed to “lead-item pricing,” where a single bid in each category is selected and payment amounts for each product are then calculated based on pricing ratios and fee schedules (CMS DMEPOS Competitive Bidding).
This is in contrast to the prior method of median pricing, which caused financial difficulty and access concerns (Council for Quality Respiratory Care. The Rationale for Reforming Medicare Home Respiratory Therapy Payment Methodology. 2018). Budget neutrality requirements should relax, and oxygen payment structures improve. These proposed changes also include improved coverage of liquid oxygen and addition of home ventilator supplies.
However, effective January 1, 2019, all CBP is suspended through CMS. During the anticipated 2-year gap, any Medicare-enrolled supplier will be able to provide items until new contracts are awarded. Pricing during the gap period is based on a current single price plus consumer price index. These changes will impact CHEST members and their patients moving forward. During the temporary gap period, some areas are seeing decreased accessibility of some DME due to demand. Once reinstated, the changes to the oxygen payment structure should improve access and reduce out-of-pocket costs. The Practice Operations NetWork will continue to provide updates on this topic as they become available.
Timothy Dempsey, MD, MPH
Steering Committee Fellow-in-Training
Megan Sisk, DO
Steering Committee Member
Transplant
Medicare Part D Plans Can Deny Coverage of Select Immunosuppressant Medications in Solid Organ Transplant Recipients
An alarming problem has emerged with some solid organ transplant recipients experiencing immunosuppressant medication claim denials by Medicare Part D plans. Affected patients are those who convert from some other insurance (ie, private insurance or state Medicaid) to Medicare after their transplant and, therefore, rely on Medicare Part D for immunosuppressant drug coverage.
Insurance companies who offer Medicare Part D plans must follow the rules described in the Medicare Prescription Drug Benefit Manual.1 Although the Manual mandates that all immunosuppressant medications are on plan formularies, Part D plans are only required to cover immunosuppressant medications when used for indications approved by the Food and Drug Administration (FDA) or for off-label indications supported by the Centers for Medicare & Medicaid Services (CMS)-approved compendia (Drugdex® and AHFS Drug Information®).
A recent study examining the extent of the problem demonstrated non-renal organ transplant recipients are frequently prescribed and maintained on at least one medication vulnerable to Medicare Part D claim denials at 1 year posttransplant (lung: 71.1%; intestine: 39.7%; pancreas: 36.8%; liver: 19.7%; heart: 18.5%).2 Lung transplant recipients are most vulnerable since no immunosuppressant is FDA-approved for use in lung transplantation, and CMS-approved compendia only support off-label use for tacrolimus and cyclosporine in this population. Therefore, mycophenolate mofetil, mycophenolic acid, azathioprine, everolimus, and sirolimus are vulnerable to denial by Medicare Part D plans when used in lung transplant recipients. Over 95% of lung transplant recipients are maintained on an anti-metabolite, with the majority (88%) maintained on mycophenolate, so this is frequently impacted.2,3 While the transplant community is aware of this issue and has begun work to correct it, it has yet to be solved.2,4 In the meantime, if transplant recipients have been denied for this off-label and off-compendia reason, and appeals of those decisions have also been denied, options for obtaining the denied immunosuppressant medication include discount programs, foundation/grant funding, and industry-sponsored assistance programs.
Jennifer K. McDermott, PharmD
NetWork Member
1. Prescription Drug Benefit Manual. Centers for Medicare & Medicaid Services. Chapter 6: Part D Drugs and Formulary Requirements. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Part-D-Benefits-Manual-Chapter-6.pdf
2. Potter LM et al. Transplant recipients are vulnerable to coverage denial under Medicare Part D. Am J Transplant. 2018;18:1502.
3. Valapour M et al. OPTN/SRTR 2016 Annual Data Report: Lung. Am J Transplant. 2018;18 (Suppl 1): 363.
4. Immunusuppressant Drug Coverage Under Medicare Part D Benefit. American Society of Transplantation. Available at: www.myast.org/public-policy/key-position-statements/immunosuppressant-drug-coverage-under-medicare-part-d-benefit.
Women’s Health
Cannabis Use Affects Women Differently
As we enter an era of legalization, cannabis use is increasingly prevalent. Variances in the risks for women and men have been observed. For most age groups, men have higher rates of use or dependence on illicit drugs than women. However, women are equally likely as men to progress to a substance use disorder. Women may be more susceptible to craving and relapse , which are key phases of the addiction cycle. A study on use among adolescents concluded there was preliminary evidence of a faster transition from initiation of marijuana use to regular use in women, when compared with men (Schepis, et al. J Addict Med. 2011;5[1]:65).
Research studies suggest that marijuana impairs spatial memory in women more so than in men. Studies have suggested that teenage girls who use marijuana may have a higher risk of brain structural abnormalities associated with regular marijuana exposure than teenage boys (Tapert, et al. Addict Biol. 2009;14[4]:457).
A study published in Psychoneuroendocrinology showed that cannabinoid receptor binding site densities exhibit sex differences and can be modulated by estradiol in several limbic brain regions. These findings may account for the sex differences observed with respect to the effects of cannabinoids (Riebe, et al. Psychoneuroendocrinology. 2010;35[8]:1265).
Further research is needed to expand our understanding of the interactions between cannabinoids and sex steroids. Detoxification treatments tailored toward women and men with cannabis addiction show a promising future and necessitate further research.
Anita Rajagopal, MD
Steering Committee Member
Disaster Response and Global Health
Epigenetics and Disasters
The configuration of the DNA bordering a gene dictates under what conditions a gene is expressed. Random errors or mutations affecting the neighboring DNA or the gene itself can affect how the gene functions. Epigenetics is an emerging field of science looking at environmental and psychosocial factors that do not directly cause mutations but still affect how genes are expressed with implications for the development and inheritance of disease. These external influences are thought to affect why some segments of DNA become accessible for protein production while other segments may not.
Disasters represent stressors with potential for epigenetic impact. Women who were pregnant during the 1998 Quebec ice storm were found to have a correlation between maternal objective stress and a distinctive pattern of DNA methylation in their children 13 years later (Cao-Lei L, et al. PLoS ONE. 2014;9[9] e10765). Methylation is known to affect the activity of a DNA segment and how genes are expressed. Associations have also been found between the severity of hurricanes and the prevalence of autism in the offspring of pregnant women experiencing these disasters (Kinney DK, et al. J Autism Dev Disord. 2008;38:481).
Anthropogenic hazards may also affect the offspring of survivors as suggested by studies of civil war POWs and Dutch Hunger Winter during WW II (Costa, DL, et al. Proc Nat Acad Sci 2018;. 115:44; Heijmans BT et al. Proc Nat Acad Sci. 2008;105[44]: 17046-9).
Epigenetics represents an area for additional research as natural and man-made disasters increase.
Omesh Toolsie, MBBS
Steering Committee Fellow-in-Training
Practice Operations
Medicare Competitive Bidding Process Update
Medicare’s Competitive Bidding Program (CBP), mandated since 2003, asks providers of specific durable medical equipment (including oxygen) to submit competing proposals for services. The best offer is then awarded a 3-year contract. Recently, several reforms to CBP have been proposed. The payment structure has changed to “lead-item pricing,” where a single bid in each category is selected and payment amounts for each product are then calculated based on pricing ratios and fee schedules (CMS DMEPOS Competitive Bidding).
This is in contrast to the prior method of median pricing, which caused financial difficulty and access concerns (Council for Quality Respiratory Care. The Rationale for Reforming Medicare Home Respiratory Therapy Payment Methodology. 2018). Budget neutrality requirements should relax, and oxygen payment structures improve. These proposed changes also include improved coverage of liquid oxygen and addition of home ventilator supplies.
However, effective January 1, 2019, all CBP is suspended through CMS. During the anticipated 2-year gap, any Medicare-enrolled supplier will be able to provide items until new contracts are awarded. Pricing during the gap period is based on a current single price plus consumer price index. These changes will impact CHEST members and their patients moving forward. During the temporary gap period, some areas are seeing decreased accessibility of some DME due to demand. Once reinstated, the changes to the oxygen payment structure should improve access and reduce out-of-pocket costs. The Practice Operations NetWork will continue to provide updates on this topic as they become available.
Timothy Dempsey, MD, MPH
Steering Committee Fellow-in-Training
Megan Sisk, DO
Steering Committee Member
Transplant
Medicare Part D Plans Can Deny Coverage of Select Immunosuppressant Medications in Solid Organ Transplant Recipients
An alarming problem has emerged with some solid organ transplant recipients experiencing immunosuppressant medication claim denials by Medicare Part D plans. Affected patients are those who convert from some other insurance (ie, private insurance or state Medicaid) to Medicare after their transplant and, therefore, rely on Medicare Part D for immunosuppressant drug coverage.
Insurance companies who offer Medicare Part D plans must follow the rules described in the Medicare Prescription Drug Benefit Manual.1 Although the Manual mandates that all immunosuppressant medications are on plan formularies, Part D plans are only required to cover immunosuppressant medications when used for indications approved by the Food and Drug Administration (FDA) or for off-label indications supported by the Centers for Medicare & Medicaid Services (CMS)-approved compendia (Drugdex® and AHFS Drug Information®).
A recent study examining the extent of the problem demonstrated non-renal organ transplant recipients are frequently prescribed and maintained on at least one medication vulnerable to Medicare Part D claim denials at 1 year posttransplant (lung: 71.1%; intestine: 39.7%; pancreas: 36.8%; liver: 19.7%; heart: 18.5%).2 Lung transplant recipients are most vulnerable since no immunosuppressant is FDA-approved for use in lung transplantation, and CMS-approved compendia only support off-label use for tacrolimus and cyclosporine in this population. Therefore, mycophenolate mofetil, mycophenolic acid, azathioprine, everolimus, and sirolimus are vulnerable to denial by Medicare Part D plans when used in lung transplant recipients. Over 95% of lung transplant recipients are maintained on an anti-metabolite, with the majority (88%) maintained on mycophenolate, so this is frequently impacted.2,3 While the transplant community is aware of this issue and has begun work to correct it, it has yet to be solved.2,4 In the meantime, if transplant recipients have been denied for this off-label and off-compendia reason, and appeals of those decisions have also been denied, options for obtaining the denied immunosuppressant medication include discount programs, foundation/grant funding, and industry-sponsored assistance programs.
Jennifer K. McDermott, PharmD
NetWork Member
1. Prescription Drug Benefit Manual. Centers for Medicare & Medicaid Services. Chapter 6: Part D Drugs and Formulary Requirements. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Part-D-Benefits-Manual-Chapter-6.pdf
2. Potter LM et al. Transplant recipients are vulnerable to coverage denial under Medicare Part D. Am J Transplant. 2018;18:1502.
3. Valapour M et al. OPTN/SRTR 2016 Annual Data Report: Lung. Am J Transplant. 2018;18 (Suppl 1): 363.
4. Immunusuppressant Drug Coverage Under Medicare Part D Benefit. American Society of Transplantation. Available at: www.myast.org/public-policy/key-position-statements/immunosuppressant-drug-coverage-under-medicare-part-d-benefit.
Women’s Health
Cannabis Use Affects Women Differently
As we enter an era of legalization, cannabis use is increasingly prevalent. Variances in the risks for women and men have been observed. For most age groups, men have higher rates of use or dependence on illicit drugs than women. However, women are equally likely as men to progress to a substance use disorder. Women may be more susceptible to craving and relapse , which are key phases of the addiction cycle. A study on use among adolescents concluded there was preliminary evidence of a faster transition from initiation of marijuana use to regular use in women, when compared with men (Schepis, et al. J Addict Med. 2011;5[1]:65).
Research studies suggest that marijuana impairs spatial memory in women more so than in men. Studies have suggested that teenage girls who use marijuana may have a higher risk of brain structural abnormalities associated with regular marijuana exposure than teenage boys (Tapert, et al. Addict Biol. 2009;14[4]:457).
A study published in Psychoneuroendocrinology showed that cannabinoid receptor binding site densities exhibit sex differences and can be modulated by estradiol in several limbic brain regions. These findings may account for the sex differences observed with respect to the effects of cannabinoids (Riebe, et al. Psychoneuroendocrinology. 2010;35[8]:1265).
Further research is needed to expand our understanding of the interactions between cannabinoids and sex steroids. Detoxification treatments tailored toward women and men with cannabis addiction show a promising future and necessitate further research.
Anita Rajagopal, MD
Steering Committee Member
Disaster Response and Global Health
Epigenetics and Disasters
The configuration of the DNA bordering a gene dictates under what conditions a gene is expressed. Random errors or mutations affecting the neighboring DNA or the gene itself can affect how the gene functions. Epigenetics is an emerging field of science looking at environmental and psychosocial factors that do not directly cause mutations but still affect how genes are expressed with implications for the development and inheritance of disease. These external influences are thought to affect why some segments of DNA become accessible for protein production while other segments may not.
Disasters represent stressors with potential for epigenetic impact. Women who were pregnant during the 1998 Quebec ice storm were found to have a correlation between maternal objective stress and a distinctive pattern of DNA methylation in their children 13 years later (Cao-Lei L, et al. PLoS ONE. 2014;9[9] e10765). Methylation is known to affect the activity of a DNA segment and how genes are expressed. Associations have also been found between the severity of hurricanes and the prevalence of autism in the offspring of pregnant women experiencing these disasters (Kinney DK, et al. J Autism Dev Disord. 2008;38:481).
Anthropogenic hazards may also affect the offspring of survivors as suggested by studies of civil war POWs and Dutch Hunger Winter during WW II (Costa, DL, et al. Proc Nat Acad Sci 2018;. 115:44; Heijmans BT et al. Proc Nat Acad Sci. 2008;105[44]: 17046-9).
Epigenetics represents an area for additional research as natural and man-made disasters increase.
Omesh Toolsie, MBBS
Steering Committee Fellow-in-Training
Practice Operations
Medicare Competitive Bidding Process Update
Medicare’s Competitive Bidding Program (CBP), mandated since 2003, asks providers of specific durable medical equipment (including oxygen) to submit competing proposals for services. The best offer is then awarded a 3-year contract. Recently, several reforms to CBP have been proposed. The payment structure has changed to “lead-item pricing,” where a single bid in each category is selected and payment amounts for each product are then calculated based on pricing ratios and fee schedules (CMS DMEPOS Competitive Bidding).
This is in contrast to the prior method of median pricing, which caused financial difficulty and access concerns (Council for Quality Respiratory Care. The Rationale for Reforming Medicare Home Respiratory Therapy Payment Methodology. 2018). Budget neutrality requirements should relax, and oxygen payment structures improve. These proposed changes also include improved coverage of liquid oxygen and addition of home ventilator supplies.
However, effective January 1, 2019, all CBP is suspended through CMS. During the anticipated 2-year gap, any Medicare-enrolled supplier will be able to provide items until new contracts are awarded. Pricing during the gap period is based on a current single price plus consumer price index. These changes will impact CHEST members and their patients moving forward. During the temporary gap period, some areas are seeing decreased accessibility of some DME due to demand. Once reinstated, the changes to the oxygen payment structure should improve access and reduce out-of-pocket costs. The Practice Operations NetWork will continue to provide updates on this topic as they become available.
Timothy Dempsey, MD, MPH
Steering Committee Fellow-in-Training
Megan Sisk, DO
Steering Committee Member
Transplant
Medicare Part D Plans Can Deny Coverage of Select Immunosuppressant Medications in Solid Organ Transplant Recipients
An alarming problem has emerged with some solid organ transplant recipients experiencing immunosuppressant medication claim denials by Medicare Part D plans. Affected patients are those who convert from some other insurance (ie, private insurance or state Medicaid) to Medicare after their transplant and, therefore, rely on Medicare Part D for immunosuppressant drug coverage.
Insurance companies who offer Medicare Part D plans must follow the rules described in the Medicare Prescription Drug Benefit Manual.1 Although the Manual mandates that all immunosuppressant medications are on plan formularies, Part D plans are only required to cover immunosuppressant medications when used for indications approved by the Food and Drug Administration (FDA) or for off-label indications supported by the Centers for Medicare & Medicaid Services (CMS)-approved compendia (Drugdex® and AHFS Drug Information®).
A recent study examining the extent of the problem demonstrated non-renal organ transplant recipients are frequently prescribed and maintained on at least one medication vulnerable to Medicare Part D claim denials at 1 year posttransplant (lung: 71.1%; intestine: 39.7%; pancreas: 36.8%; liver: 19.7%; heart: 18.5%).2 Lung transplant recipients are most vulnerable since no immunosuppressant is FDA-approved for use in lung transplantation, and CMS-approved compendia only support off-label use for tacrolimus and cyclosporine in this population. Therefore, mycophenolate mofetil, mycophenolic acid, azathioprine, everolimus, and sirolimus are vulnerable to denial by Medicare Part D plans when used in lung transplant recipients. Over 95% of lung transplant recipients are maintained on an anti-metabolite, with the majority (88%) maintained on mycophenolate, so this is frequently impacted.2,3 While the transplant community is aware of this issue and has begun work to correct it, it has yet to be solved.2,4 In the meantime, if transplant recipients have been denied for this off-label and off-compendia reason, and appeals of those decisions have also been denied, options for obtaining the denied immunosuppressant medication include discount programs, foundation/grant funding, and industry-sponsored assistance programs.
Jennifer K. McDermott, PharmD
NetWork Member
1. Prescription Drug Benefit Manual. Centers for Medicare & Medicaid Services. Chapter 6: Part D Drugs and Formulary Requirements. Available at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Part-D-Benefits-Manual-Chapter-6.pdf
2. Potter LM et al. Transplant recipients are vulnerable to coverage denial under Medicare Part D. Am J Transplant. 2018;18:1502.
3. Valapour M et al. OPTN/SRTR 2016 Annual Data Report: Lung. Am J Transplant. 2018;18 (Suppl 1): 363.
4. Immunusuppressant Drug Coverage Under Medicare Part D Benefit. American Society of Transplantation. Available at: www.myast.org/public-policy/key-position-statements/immunosuppressant-drug-coverage-under-medicare-part-d-benefit.
Women’s Health
Cannabis Use Affects Women Differently
As we enter an era of legalization, cannabis use is increasingly prevalent. Variances in the risks for women and men have been observed. For most age groups, men have higher rates of use or dependence on illicit drugs than women. However, women are equally likely as men to progress to a substance use disorder. Women may be more susceptible to craving and relapse , which are key phases of the addiction cycle. A study on use among adolescents concluded there was preliminary evidence of a faster transition from initiation of marijuana use to regular use in women, when compared with men (Schepis, et al. J Addict Med. 2011;5[1]:65).
Research studies suggest that marijuana impairs spatial memory in women more so than in men. Studies have suggested that teenage girls who use marijuana may have a higher risk of brain structural abnormalities associated with regular marijuana exposure than teenage boys (Tapert, et al. Addict Biol. 2009;14[4]:457).
A study published in Psychoneuroendocrinology showed that cannabinoid receptor binding site densities exhibit sex differences and can be modulated by estradiol in several limbic brain regions. These findings may account for the sex differences observed with respect to the effects of cannabinoids (Riebe, et al. Psychoneuroendocrinology. 2010;35[8]:1265).
Further research is needed to expand our understanding of the interactions between cannabinoids and sex steroids. Detoxification treatments tailored toward women and men with cannabis addiction show a promising future and necessitate further research.
Anita Rajagopal, MD
Steering Committee Member
CHEST Foundation’s NetWorks Challenge is just around the corner
The NetWorks Challenge is an annual fundraising competition that encourages NetWork members to contribute to the CHEST Foundation - supporting clinical research grants and community service programs and creating patient education materials - while earning travel grants for their NetWork members to the CHEST Annual Meeting 2019 in New Orleans. Because of your generosity throughout the 2018 NetWorks Challenge, the CHEST Foundation was able to send 59 early career clinicians to CHEST 2018 in San Antonio - marked growth from the 25 clinicians who received the travel grants in 2017.
As we further improve this program based on feedback from NetWorks members, a few elements of the fundraiser are changing in 2019.
Length: This year, the NetWorks Challenge will span 3 months. Contributions made between April 1 and June 30 count toward your NetWork’s fundraising total! Just be sure to list your NetWork when making your contribution on chestfoundation.org/donate. Each month has a unique theme related to CHEST, so be sure to watch our social media profiles to engage with us and each other during the drive.
Additionally, ANY contributions made to the CHEST Foundation during your membership renewal will count toward your NetWorks total amount raised - no matter when your membership is up for renewal. Contributions made in this manner after June 30 will count toward your Network’s 2020 amount raised.
Prizes: This year, every NetWork is eligible to receive travel grants to CHEST 2019 in New Orleans based on the amount raised by the NetWork. Our final winners – the NetWork with the highest amount raised, and the NetWork with the highest percentage of participation from their NetWork, will each receive two additional travel grants to CHEST 2019. Plus, the NetWork with the highest amount raised over the course of the challenge receives an additional prize – a seat in a CHEST Live Learning course of the winner’s choosing, offered at CHEST’s Innovation, Simulation, and Training Center in Glenview, Illinois.
Visit chestfoundation.org/nc for more detailed information.
The NetWorks Challenge is an annual fundraising competition that encourages NetWork members to contribute to the CHEST Foundation - supporting clinical research grants and community service programs and creating patient education materials - while earning travel grants for their NetWork members to the CHEST Annual Meeting 2019 in New Orleans. Because of your generosity throughout the 2018 NetWorks Challenge, the CHEST Foundation was able to send 59 early career clinicians to CHEST 2018 in San Antonio - marked growth from the 25 clinicians who received the travel grants in 2017.
As we further improve this program based on feedback from NetWorks members, a few elements of the fundraiser are changing in 2019.
Length: This year, the NetWorks Challenge will span 3 months. Contributions made between April 1 and June 30 count toward your NetWork’s fundraising total! Just be sure to list your NetWork when making your contribution on chestfoundation.org/donate. Each month has a unique theme related to CHEST, so be sure to watch our social media profiles to engage with us and each other during the drive.
Additionally, ANY contributions made to the CHEST Foundation during your membership renewal will count toward your NetWorks total amount raised - no matter when your membership is up for renewal. Contributions made in this manner after June 30 will count toward your Network’s 2020 amount raised.
Prizes: This year, every NetWork is eligible to receive travel grants to CHEST 2019 in New Orleans based on the amount raised by the NetWork. Our final winners – the NetWork with the highest amount raised, and the NetWork with the highest percentage of participation from their NetWork, will each receive two additional travel grants to CHEST 2019. Plus, the NetWork with the highest amount raised over the course of the challenge receives an additional prize – a seat in a CHEST Live Learning course of the winner’s choosing, offered at CHEST’s Innovation, Simulation, and Training Center in Glenview, Illinois.
Visit chestfoundation.org/nc for more detailed information.
The NetWorks Challenge is an annual fundraising competition that encourages NetWork members to contribute to the CHEST Foundation - supporting clinical research grants and community service programs and creating patient education materials - while earning travel grants for their NetWork members to the CHEST Annual Meeting 2019 in New Orleans. Because of your generosity throughout the 2018 NetWorks Challenge, the CHEST Foundation was able to send 59 early career clinicians to CHEST 2018 in San Antonio - marked growth from the 25 clinicians who received the travel grants in 2017.
As we further improve this program based on feedback from NetWorks members, a few elements of the fundraiser are changing in 2019.
Length: This year, the NetWorks Challenge will span 3 months. Contributions made between April 1 and June 30 count toward your NetWork’s fundraising total! Just be sure to list your NetWork when making your contribution on chestfoundation.org/donate. Each month has a unique theme related to CHEST, so be sure to watch our social media profiles to engage with us and each other during the drive.
Additionally, ANY contributions made to the CHEST Foundation during your membership renewal will count toward your NetWorks total amount raised - no matter when your membership is up for renewal. Contributions made in this manner after June 30 will count toward your Network’s 2020 amount raised.
Prizes: This year, every NetWork is eligible to receive travel grants to CHEST 2019 in New Orleans based on the amount raised by the NetWork. Our final winners – the NetWork with the highest amount raised, and the NetWork with the highest percentage of participation from their NetWork, will each receive two additional travel grants to CHEST 2019. Plus, the NetWork with the highest amount raised over the course of the challenge receives an additional prize – a seat in a CHEST Live Learning course of the winner’s choosing, offered at CHEST’s Innovation, Simulation, and Training Center in Glenview, Illinois.
Visit chestfoundation.org/nc for more detailed information.
Subscribe to SVS Student Newsletters
The SVS has recently re-vamped its newsletters geared towards future vascular surgeons. These provide residents, students and vascular trainees with up-to-date information on upcoming events, awards and scholarships, open positions and more. These are sent on a bi-weekly and monthly basis, depending on what content you are interested in. Learn more and subscribe here. They will also be posted on the SVS future vascular surgeon’s Twitter and Facebook.
The SVS has recently re-vamped its newsletters geared towards future vascular surgeons. These provide residents, students and vascular trainees with up-to-date information on upcoming events, awards and scholarships, open positions and more. These are sent on a bi-weekly and monthly basis, depending on what content you are interested in. Learn more and subscribe here. They will also be posted on the SVS future vascular surgeon’s Twitter and Facebook.
The SVS has recently re-vamped its newsletters geared towards future vascular surgeons. These provide residents, students and vascular trainees with up-to-date information on upcoming events, awards and scholarships, open positions and more. These are sent on a bi-weekly and monthly basis, depending on what content you are interested in. Learn more and subscribe here. They will also be posted on the SVS future vascular surgeon’s Twitter and Facebook.
More Items Added to ‘Spectacular’ Auction
We’re still a few months away from the Vascular Spectacular Gala at VAM, but excitement is growing concurrently with the list of items contributed to the event's live and silent auctions. You’ll definitely leave VAM with new professional connections and inspiration, but perhaps you’ll also take home a one-week stay in Camden, Maine. Or maybe you’ll be anticipating a new charbroiled oyster kit, vouchers to one of the nation's best botanical gardens, jewelry or free registration for next year’s VAM. These are just a few of the items our generous donors have added to our growing list. If you can't make it to the gala or VAM, you can still join in on the fun by donating an item or bidding online. All gala proceeds benefit the SVS Foundation.
We’re still a few months away from the Vascular Spectacular Gala at VAM, but excitement is growing concurrently with the list of items contributed to the event's live and silent auctions. You’ll definitely leave VAM with new professional connections and inspiration, but perhaps you’ll also take home a one-week stay in Camden, Maine. Or maybe you’ll be anticipating a new charbroiled oyster kit, vouchers to one of the nation's best botanical gardens, jewelry or free registration for next year’s VAM. These are just a few of the items our generous donors have added to our growing list. If you can't make it to the gala or VAM, you can still join in on the fun by donating an item or bidding online. All gala proceeds benefit the SVS Foundation.
We’re still a few months away from the Vascular Spectacular Gala at VAM, but excitement is growing concurrently with the list of items contributed to the event's live and silent auctions. You’ll definitely leave VAM with new professional connections and inspiration, but perhaps you’ll also take home a one-week stay in Camden, Maine. Or maybe you’ll be anticipating a new charbroiled oyster kit, vouchers to one of the nation's best botanical gardens, jewelry or free registration for next year’s VAM. These are just a few of the items our generous donors have added to our growing list. If you can't make it to the gala or VAM, you can still join in on the fun by donating an item or bidding online. All gala proceeds benefit the SVS Foundation.
SVSConnect App is Ready
You can now log in to SVSConnect conveniently from your phone and tablet. This gives you easy access to field-related discussions, resources from other users and the SVS member directory. You can do everything on the app that you can on your desktop and it only takes a few minutes to set up. Follow the steps in this flier to download. If you encounter difficulties, email [email protected] or call 312-334-2300.
You can now log in to SVSConnect conveniently from your phone and tablet. This gives you easy access to field-related discussions, resources from other users and the SVS member directory. You can do everything on the app that you can on your desktop and it only takes a few minutes to set up. Follow the steps in this flier to download. If you encounter difficulties, email [email protected] or call 312-334-2300.
You can now log in to SVSConnect conveniently from your phone and tablet. This gives you easy access to field-related discussions, resources from other users and the SVS member directory. You can do everything on the app that you can on your desktop and it only takes a few minutes to set up. Follow the steps in this flier to download. If you encounter difficulties, email [email protected] or call 312-334-2300.
VAM Registration Opens Soon
The time has almost come to register for the 2019 Vascular Annual Meeting. This month, you’ll be able to register for the can’t-miss event of the year for vascular care professionals. This year’s event will be held on June 12-15 in National Harbor, Md., (near Washington, D.C.) As always, attendees will learn about cutting-edge vascular research, attend innovative education sessions, have the opportunity to network with other thought leaders in the field and do much more. Reservations for VAM housing open at the same time. For more information about VAM registration and housing, visit our meeting website.
The time has almost come to register for the 2019 Vascular Annual Meeting. This month, you’ll be able to register for the can’t-miss event of the year for vascular care professionals. This year’s event will be held on June 12-15 in National Harbor, Md., (near Washington, D.C.) As always, attendees will learn about cutting-edge vascular research, attend innovative education sessions, have the opportunity to network with other thought leaders in the field and do much more. Reservations for VAM housing open at the same time. For more information about VAM registration and housing, visit our meeting website.
The time has almost come to register for the 2019 Vascular Annual Meeting. This month, you’ll be able to register for the can’t-miss event of the year for vascular care professionals. This year’s event will be held on June 12-15 in National Harbor, Md., (near Washington, D.C.) As always, attendees will learn about cutting-edge vascular research, attend innovative education sessions, have the opportunity to network with other thought leaders in the field and do much more. Reservations for VAM housing open at the same time. For more information about VAM registration and housing, visit our meeting website.
Top AGA Community patient cases
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) 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. Ileoclonic Crohn’s in VA patient
A 77-year-old patient with chronic kidney disease, dementia and congestive heart failure was seen to evaluate chronic diarrhea. His colonoscopy revealed active inflammation and a stricture at the anastomosis, which prevented the physician from bypassing with a pediatric colonoscope. The patient’s diarrhea improved once he was started on budesonide. The discussion in the AGA Community forum outlined next steps and the best course of treatment for this complicated patient.
2. H. pylori in a penicillin allergic patient
A patient diagnosed with H. pylori during an endoscopy has a history of a severe penicillin allergy and has used clarithromycin in the past year. Antibiotic resistance testing revealed genetic pattern suggesting resistance to clarithromycin, fluoroquinolones and metronidazole. Recommendations from GIs included combination therapy with proton pump inhibitors (PPIs), antacids and antibiotics.
3. Reintroduction of azathioprine after moderate leukopenia
This 48-year-old patient has a history of ulcerative colitis pancolitis and developed antibodies to Humira monotherapy. Her GI is adjusting her azathioprine dose and repeating lab work to recover her white blood cell counts and is soliciting advice from the practice community on using methotrexate for combination therapy.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) 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. Ileoclonic Crohn’s in VA patient
A 77-year-old patient with chronic kidney disease, dementia and congestive heart failure was seen to evaluate chronic diarrhea. His colonoscopy revealed active inflammation and a stricture at the anastomosis, which prevented the physician from bypassing with a pediatric colonoscope. The patient’s diarrhea improved once he was started on budesonide. The discussion in the AGA Community forum outlined next steps and the best course of treatment for this complicated patient.
2. H. pylori in a penicillin allergic patient
A patient diagnosed with H. pylori during an endoscopy has a history of a severe penicillin allergy and has used clarithromycin in the past year. Antibiotic resistance testing revealed genetic pattern suggesting resistance to clarithromycin, fluoroquinolones and metronidazole. Recommendations from GIs included combination therapy with proton pump inhibitors (PPIs), antacids and antibiotics.
3. Reintroduction of azathioprine after moderate leukopenia
This 48-year-old patient has a history of ulcerative colitis pancolitis and developed antibodies to Humira monotherapy. Her GI is adjusting her azathioprine dose and repeating lab work to recover her white blood cell counts and is soliciting advice from the practice community on using methotrexate for combination therapy.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org/discussions) 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. Ileoclonic Crohn’s in VA patient
A 77-year-old patient with chronic kidney disease, dementia and congestive heart failure was seen to evaluate chronic diarrhea. His colonoscopy revealed active inflammation and a stricture at the anastomosis, which prevented the physician from bypassing with a pediatric colonoscope. The patient’s diarrhea improved once he was started on budesonide. The discussion in the AGA Community forum outlined next steps and the best course of treatment for this complicated patient.
2. H. pylori in a penicillin allergic patient
A patient diagnosed with H. pylori during an endoscopy has a history of a severe penicillin allergy and has used clarithromycin in the past year. Antibiotic resistance testing revealed genetic pattern suggesting resistance to clarithromycin, fluoroquinolones and metronidazole. Recommendations from GIs included combination therapy with proton pump inhibitors (PPIs), antacids and antibiotics.
3. Reintroduction of azathioprine after moderate leukopenia
This 48-year-old patient has a history of ulcerative colitis pancolitis and developed antibodies to Humira monotherapy. Her GI is adjusting her azathioprine dose and repeating lab work to recover her white blood cell counts and is soliciting advice from the practice community on using methotrexate for combination therapy.
More clinical cases and discussions are at https://community.gastro.org/discussions.
New guideline provides recommendations for the treatment of mild to moderate UC
Most patients with ulcerative colitis (UC) have mild to moderate disease characterized by periods of activity or remission, but practice variations exist in disease management. A new clinical guideline from AGA published in Gastroenterology, the official journal of AGA, addresses the medical management of these patients, focusing on use of both oral and topical 5-aminosalicylates (5-ASA) medications, rectal corticosteroids, and oral budesonide, to promote high-quality care.
AGA’s new clinical guideline is meant to help with the management of patients with mild to moderate UC, but not all patients will effectively respond to the outlined therapies. In those cases, there may be a need to escalate treatment to systemic corticosteroids, immunomodulators, and/or biologic therapies for induction and maintenance of remission. However, the use of biologic therapies and/or immunomodulators are not specifically addressed within the guideline.
Mild to moderate UC was defined as patients with fewer than four to six bowel movements per day, mild or moderate rectal bleeding, absence of constitutional symptoms, low overall inflammatory burden, and absence of features suggestive of high inflammatory activity. Although disease activity exists on a spectrum, patients in the mild to moderate category who have more frequent bowel movements, more prominent rectal bleeding, or greater overall inflammatory burden should be considered to have moderate disease.
The guideline recommends the following for the medical management of mild-to-moderate ulcerative colitis:
1. Use either standard-dose mesalamine (2-3 grams/day) or diazo-bonded 5-ASA rather than low-dose mesalamine, sulfasalazine, or no treatment in patients with extensive mild-moderate UC. (Strong recommendation, moderate-quality evidence)
2. In patients with extensive or left-sided mild-moderate UC, add rectal mesalamine to oral 5-ASA. (Conditional recommendation, moderate quality evidence)
3. In patients with mild–moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, use high-dose mesalamine (more than 3 grams/day) with rectal mesalamine. (Conditional recommendation, moderate-quality evidence [induction of remission], low-quality evidence [maintenance of remission])
4. In patients with mild–moderate UC being treated with oral mesalamine, use once-daily dosing rather than multiple times per day dosing. (Conditional recommendation, moderate-quality evidence)
5. In patients with mild–moderate UC, use standard-dose oral mesalamine or diazo-bonded 5-ASA, rather than budesonide MMX or controlled ileal-release budesonide for induction of remission. (Conditional recommendation, low quality of evidence)
6. In patients with mild–moderate ulcerative proctosigmoiditis or proctitis, use mesalamine enemas (or suppositories) rather than oral mesalamine. (Conditional recommendation, very-low-quality evidence)
7. In patients with mild–moderate ulcerative proctosigmoiditis who choose rectal therapy over oral therapy, use mesalamine enemas rather than rectal corticosteroids.(Conditional recommendation, moderate-quality evidence)
8. In patients with mild–moderate ulcerative proctitis who choose rectal therapy over oral therapy, use mesalamine suppositories. (Strong recommendation, moderate-quality evidence)
9. In patients with mild–moderate ulcerative proctosigmoiditis or proctitis being treated with rectal therapy who are intolerant of or refractory to mesalamine suppositories, use rectal corticosteroid therapy rather than no therapy for induction of remission. (Conditional recommendation, low-quality evidence)
10. In patients with mild–moderate UC refractory to optimized oral and rectal 5-ASA, regardless of disease extent, add either oral prednisone or budesonide MMX. (Conditional recommendation, low-quality evidence)
11. In patients with mild–moderate UC, AGA makes no recommendation for use of probiotics. (No recommendation, knowledge gap)
12. In patients with mild–moderate UC despite 5-ASA therapy, AGA makes no recommendation for use of curcumin. (No recommendation, knowledge gap)
13. In patients with mild–moderate UC without Clostridium difficile infection, AGA recommends fecal microbiota transplantation be performed only in the context of a clinical trial. (No recommendation for treatment of ulcerative colitis, knowledge gap)
The guideline is accompanied by a technical review that is a compilation of the clinical evidence based on which these recommendations were framed.
Most patients with ulcerative colitis (UC) have mild to moderate disease characterized by periods of activity or remission, but practice variations exist in disease management. A new clinical guideline from AGA published in Gastroenterology, the official journal of AGA, addresses the medical management of these patients, focusing on use of both oral and topical 5-aminosalicylates (5-ASA) medications, rectal corticosteroids, and oral budesonide, to promote high-quality care.
AGA’s new clinical guideline is meant to help with the management of patients with mild to moderate UC, but not all patients will effectively respond to the outlined therapies. In those cases, there may be a need to escalate treatment to systemic corticosteroids, immunomodulators, and/or biologic therapies for induction and maintenance of remission. However, the use of biologic therapies and/or immunomodulators are not specifically addressed within the guideline.
Mild to moderate UC was defined as patients with fewer than four to six bowel movements per day, mild or moderate rectal bleeding, absence of constitutional symptoms, low overall inflammatory burden, and absence of features suggestive of high inflammatory activity. Although disease activity exists on a spectrum, patients in the mild to moderate category who have more frequent bowel movements, more prominent rectal bleeding, or greater overall inflammatory burden should be considered to have moderate disease.
The guideline recommends the following for the medical management of mild-to-moderate ulcerative colitis:
1. Use either standard-dose mesalamine (2-3 grams/day) or diazo-bonded 5-ASA rather than low-dose mesalamine, sulfasalazine, or no treatment in patients with extensive mild-moderate UC. (Strong recommendation, moderate-quality evidence)
2. In patients with extensive or left-sided mild-moderate UC, add rectal mesalamine to oral 5-ASA. (Conditional recommendation, moderate quality evidence)
3. In patients with mild–moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, use high-dose mesalamine (more than 3 grams/day) with rectal mesalamine. (Conditional recommendation, moderate-quality evidence [induction of remission], low-quality evidence [maintenance of remission])
4. In patients with mild–moderate UC being treated with oral mesalamine, use once-daily dosing rather than multiple times per day dosing. (Conditional recommendation, moderate-quality evidence)
5. In patients with mild–moderate UC, use standard-dose oral mesalamine or diazo-bonded 5-ASA, rather than budesonide MMX or controlled ileal-release budesonide for induction of remission. (Conditional recommendation, low quality of evidence)
6. In patients with mild–moderate ulcerative proctosigmoiditis or proctitis, use mesalamine enemas (or suppositories) rather than oral mesalamine. (Conditional recommendation, very-low-quality evidence)
7. In patients with mild–moderate ulcerative proctosigmoiditis who choose rectal therapy over oral therapy, use mesalamine enemas rather than rectal corticosteroids.(Conditional recommendation, moderate-quality evidence)
8. In patients with mild–moderate ulcerative proctitis who choose rectal therapy over oral therapy, use mesalamine suppositories. (Strong recommendation, moderate-quality evidence)
9. In patients with mild–moderate ulcerative proctosigmoiditis or proctitis being treated with rectal therapy who are intolerant of or refractory to mesalamine suppositories, use rectal corticosteroid therapy rather than no therapy for induction of remission. (Conditional recommendation, low-quality evidence)
10. In patients with mild–moderate UC refractory to optimized oral and rectal 5-ASA, regardless of disease extent, add either oral prednisone or budesonide MMX. (Conditional recommendation, low-quality evidence)
11. In patients with mild–moderate UC, AGA makes no recommendation for use of probiotics. (No recommendation, knowledge gap)
12. In patients with mild–moderate UC despite 5-ASA therapy, AGA makes no recommendation for use of curcumin. (No recommendation, knowledge gap)
13. In patients with mild–moderate UC without Clostridium difficile infection, AGA recommends fecal microbiota transplantation be performed only in the context of a clinical trial. (No recommendation for treatment of ulcerative colitis, knowledge gap)
The guideline is accompanied by a technical review that is a compilation of the clinical evidence based on which these recommendations were framed.
Most patients with ulcerative colitis (UC) have mild to moderate disease characterized by periods of activity or remission, but practice variations exist in disease management. A new clinical guideline from AGA published in Gastroenterology, the official journal of AGA, addresses the medical management of these patients, focusing on use of both oral and topical 5-aminosalicylates (5-ASA) medications, rectal corticosteroids, and oral budesonide, to promote high-quality care.
AGA’s new clinical guideline is meant to help with the management of patients with mild to moderate UC, but not all patients will effectively respond to the outlined therapies. In those cases, there may be a need to escalate treatment to systemic corticosteroids, immunomodulators, and/or biologic therapies for induction and maintenance of remission. However, the use of biologic therapies and/or immunomodulators are not specifically addressed within the guideline.
Mild to moderate UC was defined as patients with fewer than four to six bowel movements per day, mild or moderate rectal bleeding, absence of constitutional symptoms, low overall inflammatory burden, and absence of features suggestive of high inflammatory activity. Although disease activity exists on a spectrum, patients in the mild to moderate category who have more frequent bowel movements, more prominent rectal bleeding, or greater overall inflammatory burden should be considered to have moderate disease.
The guideline recommends the following for the medical management of mild-to-moderate ulcerative colitis:
1. Use either standard-dose mesalamine (2-3 grams/day) or diazo-bonded 5-ASA rather than low-dose mesalamine, sulfasalazine, or no treatment in patients with extensive mild-moderate UC. (Strong recommendation, moderate-quality evidence)
2. In patients with extensive or left-sided mild-moderate UC, add rectal mesalamine to oral 5-ASA. (Conditional recommendation, moderate quality evidence)
3. In patients with mild–moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, use high-dose mesalamine (more than 3 grams/day) with rectal mesalamine. (Conditional recommendation, moderate-quality evidence [induction of remission], low-quality evidence [maintenance of remission])
4. In patients with mild–moderate UC being treated with oral mesalamine, use once-daily dosing rather than multiple times per day dosing. (Conditional recommendation, moderate-quality evidence)
5. In patients with mild–moderate UC, use standard-dose oral mesalamine or diazo-bonded 5-ASA, rather than budesonide MMX or controlled ileal-release budesonide for induction of remission. (Conditional recommendation, low quality of evidence)
6. In patients with mild–moderate ulcerative proctosigmoiditis or proctitis, use mesalamine enemas (or suppositories) rather than oral mesalamine. (Conditional recommendation, very-low-quality evidence)
7. In patients with mild–moderate ulcerative proctosigmoiditis who choose rectal therapy over oral therapy, use mesalamine enemas rather than rectal corticosteroids.(Conditional recommendation, moderate-quality evidence)
8. In patients with mild–moderate ulcerative proctitis who choose rectal therapy over oral therapy, use mesalamine suppositories. (Strong recommendation, moderate-quality evidence)
9. In patients with mild–moderate ulcerative proctosigmoiditis or proctitis being treated with rectal therapy who are intolerant of or refractory to mesalamine suppositories, use rectal corticosteroid therapy rather than no therapy for induction of remission. (Conditional recommendation, low-quality evidence)
10. In patients with mild–moderate UC refractory to optimized oral and rectal 5-ASA, regardless of disease extent, add either oral prednisone or budesonide MMX. (Conditional recommendation, low-quality evidence)
11. In patients with mild–moderate UC, AGA makes no recommendation for use of probiotics. (No recommendation, knowledge gap)
12. In patients with mild–moderate UC despite 5-ASA therapy, AGA makes no recommendation for use of curcumin. (No recommendation, knowledge gap)
13. In patients with mild–moderate UC without Clostridium difficile infection, AGA recommends fecal microbiota transplantation be performed only in the context of a clinical trial. (No recommendation for treatment of ulcerative colitis, knowledge gap)
The guideline is accompanied by a technical review that is a compilation of the clinical evidence based on which these recommendations were framed.
GI leaders recognized by AGA’s prestigious recognition awards
AGA has announced the 2019 recipients of the annual recognition awards, given in honor of outstanding contributions and achievements in gastroenterology.
“AGA members honor their colleagues and peers for outstanding contributions to the field of gastroenterology by nominating them for the AGA Recognition Awards,” said David A. Lieberman, MD, AGAF, president of the AGA Institute. “We are proud to announce the 2019 AGA Recognition Prize winners, who are just a few of the distinguished and talented members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representative of AGA.”
The AGA Recognition Awards will be presented during Digestive Disease Week® 2019, May 18-21, 2019, in San Diego.
Julius Friedenwald Medal
AGA bequeaths its highest honor, the Julius Friedenwald Medal, to John I. Allen, MD, MBA, AGAF, for his incredible contributions to the field of gastroenterology and AGA over several decades. The Julius Friedenwald Medal, presented annually since 1941, recognizes a physician for lifelong contributions to the field of gastroenterology.
Dr. Allen is internationally renowned for bringing unique and critical knowledge about health care delivery and health care economics to the field of gastroenterology, as well as for his decades of AGA leadership. His experience is unique within the national gastroenterology community, encompassing private practice, nonacademic health systems, and leadership within two academic medical centers. As AGA Institute President, he led the development of AGA’s 5-year strategic plan and made AGA a national player at the federal, state, and local levels during a time of massive health care delivery transformation. Dr. Allen is a clinical professor of medicine in the division of gastroenterology and hepatology and chief clinical officer of the University of Michigan Medical Group at the University of Michigan School of Medicine, Ann Arbor.
Distinguished Achievement Award In Basic Science
AGA honors Harry B. Greenberg, MD, with the AGA Distinguished Achievement Award in Basic Science, for his major accomplishments in basic science research, which have significantly advanced the science and practice of gastroenterology. Throughout his career, Dr. Greenberg’s incredible contributions over several decades contributed to the development of rotavirus vaccines and increased physicians’ understanding of viral pathogenesis, particularly rotavirus, norovirus, and hepatitis. Dr. Greenberg is an associate dean for research at Stanford University School of Medicine, Palo Alto, California.
William Beaumont Prize
AGA honors Timothy C. Wang, MD, AGAF, with the William Beaumont Prize in gastroenterology, which recognizes an individual who has made a unique, outstanding contribution of major importance to the field of gastroenterology. Dr. Wang’s extraordinary contribution to the understanding and practice of modern gastroenterology and digestive science are exemplified through his work, which includes defining the mechanisms and cellular origins of Barrett’s esophagus and gastroesophageal cancer. Dr. Wang, who has served AGA in numerous positions, including as president of the AGA Institute, is currently chief of the division of digestive and liver diseases at Columbia University Medical Center and as the Dorothy L. and Daniel H. Silberberg Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Distinguished Educator Award
AGA recognizes and honors Deborah D. Proctor, MD, AGAF, with the Distinguished Educator Award, which recognizes an individual who has made outstanding contributions as an educator in gastroenterology on both local and national levels, over a lifelong career. Dr. Proctor is a national expert in gastroenterology training and education who has taught and inspired generations of future gastroenterologists, nurses and physician assistants. Currently serving as the AGA Institute Education & Training Councillor, Dr. Proctor is a professor of medicine, and the medical director of the inflammatory bowel disease program, at Yale School of Medicine, New Haven, Connecticut.
Distinguished Clinician Awards
The AGA Distinguished Clinician Award recognizes members of the practicing community who, by example, combine the art of medicine with the skills demanded by the scientific body of knowledge in service to their patients.
AGA presents the Distinguished Clinician Award, Private Practice, to Naresh T. Gunaratnam, MD, AGAF. Dr. Gunaratnam has made a huge impact on patient care in his community and improved gastroenterology-oncology care by starting the endoscopic ultrasound & interventional GI program at St. Joseph Mercy Ann Arbor hospital in Ypsilanti, Michigan. Dr. Gunaratnam is a director of research and obesity management at Huron Gastro.
AGA is honored to present the Distinguished Clinician Award, Clinical Academic Practice, to Edward V. Loftus Jr., MD, AGAF. Dr. Loftus is an outstanding role model in practice, an effective researcher and a recognized leader who is devoted to treating patients with ulcerative colitis and Crohn’s disease with quality clinical care, including understanding the predictors of treatment response. Dr. Loftus is a practicing gastroenterologist at the Mayo Clinic and a professor of medicine at the Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Distinguished Mentor Award
AGA bestows the Distinguished Mentor Award to Fred S. Gorelick, MD, which recognizes an individual who has made a lifelong effort dedicated to the mentoring of trainees in the field of gastroenterology and for achievements as outstanding mentors throughout their careers. Dr. Gorelick has been an inspiration to generations of trainees, many of whom have gone on to successful academic careers as faculty members, section chiefs, program directors, department chairs, and institute directors. Dr. Gorelick is a professor of medicine and cell biology at Yale School of Medicine, and deputy director of the Yale MD-PhD Program, New Haven, Connecticut.
Research Service Award
AGA honors Ann G. Zauber, PhD, with the Research Service Award, which recognizes individuals whose work has significantly advanced gastroenterogical science and research. Dr. Zauber’s accomplishments have changed and advanced the practice of gastroenterology. Her work involving colorectal cancer screening and surveillance studies has had far-reaching effects on public policy. She is well-known for her leadership role in the development of colorectal cancer screening guidelines in the U.S., which has significantly reduced mortality and incidence rates. Dr. Zauber is an attending biostatistician in the department of epidemiology & biostatistics at the Memorial Sloan Kettering Cancer Center, New York, New York.
Young Investigator Awards
The AGA Young Investigator Award recognizes two young investigators, one in basic science and one in clinical science, for outstanding research achievements.
AGA honors Sonia S. Kupfer, MD, with the Young Investigator Award in Clinical Science. Dr. Kupfer is nationally and internationally recognized as an expert in colorectal cancer in high-risk populations including individuals with hereditary cancer syndromes and African Americans. During her clinical and translational research to better understand factors that increase the risk of colorectal cancer, Dr. Kupfer identified distinctions in African-American population compared with Caucasians. Dr. Kupfer is an associate professor of medicine at the University of Chicago, and director of the Gastrointestinal Cancer Risk and Prevention Clinic, Illinois.
AGA honors Costas A. Lyssiotis, PhD, with the Young Investigator Award in Basic Science. His research, work ethic, and innovative approaches have made Dr. Lyssiotis a distinguished leader in pancreatic cancer. His work has broad implications for harnessing the power of the immune system to treat the disease and his laboratory is working to develop new drug therapies that target a pancreatic cancer metabolism-specific enzyme. Dr. Lyssiotis is an assistant professor in the department of molecular and integrative physiology in the division of gastroenterology at University of Michigan Medical School, Ann Arbor.
AGA has announced the 2019 recipients of the annual recognition awards, given in honor of outstanding contributions and achievements in gastroenterology.
“AGA members honor their colleagues and peers for outstanding contributions to the field of gastroenterology by nominating them for the AGA Recognition Awards,” said David A. Lieberman, MD, AGAF, president of the AGA Institute. “We are proud to announce the 2019 AGA Recognition Prize winners, who are just a few of the distinguished and talented members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representative of AGA.”
The AGA Recognition Awards will be presented during Digestive Disease Week® 2019, May 18-21, 2019, in San Diego.
Julius Friedenwald Medal
AGA bequeaths its highest honor, the Julius Friedenwald Medal, to John I. Allen, MD, MBA, AGAF, for his incredible contributions to the field of gastroenterology and AGA over several decades. The Julius Friedenwald Medal, presented annually since 1941, recognizes a physician for lifelong contributions to the field of gastroenterology.
Dr. Allen is internationally renowned for bringing unique and critical knowledge about health care delivery and health care economics to the field of gastroenterology, as well as for his decades of AGA leadership. His experience is unique within the national gastroenterology community, encompassing private practice, nonacademic health systems, and leadership within two academic medical centers. As AGA Institute President, he led the development of AGA’s 5-year strategic plan and made AGA a national player at the federal, state, and local levels during a time of massive health care delivery transformation. Dr. Allen is a clinical professor of medicine in the division of gastroenterology and hepatology and chief clinical officer of the University of Michigan Medical Group at the University of Michigan School of Medicine, Ann Arbor.
Distinguished Achievement Award In Basic Science
AGA honors Harry B. Greenberg, MD, with the AGA Distinguished Achievement Award in Basic Science, for his major accomplishments in basic science research, which have significantly advanced the science and practice of gastroenterology. Throughout his career, Dr. Greenberg’s incredible contributions over several decades contributed to the development of rotavirus vaccines and increased physicians’ understanding of viral pathogenesis, particularly rotavirus, norovirus, and hepatitis. Dr. Greenberg is an associate dean for research at Stanford University School of Medicine, Palo Alto, California.
William Beaumont Prize
AGA honors Timothy C. Wang, MD, AGAF, with the William Beaumont Prize in gastroenterology, which recognizes an individual who has made a unique, outstanding contribution of major importance to the field of gastroenterology. Dr. Wang’s extraordinary contribution to the understanding and practice of modern gastroenterology and digestive science are exemplified through his work, which includes defining the mechanisms and cellular origins of Barrett’s esophagus and gastroesophageal cancer. Dr. Wang, who has served AGA in numerous positions, including as president of the AGA Institute, is currently chief of the division of digestive and liver diseases at Columbia University Medical Center and as the Dorothy L. and Daniel H. Silberberg Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Distinguished Educator Award
AGA recognizes and honors Deborah D. Proctor, MD, AGAF, with the Distinguished Educator Award, which recognizes an individual who has made outstanding contributions as an educator in gastroenterology on both local and national levels, over a lifelong career. Dr. Proctor is a national expert in gastroenterology training and education who has taught and inspired generations of future gastroenterologists, nurses and physician assistants. Currently serving as the AGA Institute Education & Training Councillor, Dr. Proctor is a professor of medicine, and the medical director of the inflammatory bowel disease program, at Yale School of Medicine, New Haven, Connecticut.
Distinguished Clinician Awards
The AGA Distinguished Clinician Award recognizes members of the practicing community who, by example, combine the art of medicine with the skills demanded by the scientific body of knowledge in service to their patients.
AGA presents the Distinguished Clinician Award, Private Practice, to Naresh T. Gunaratnam, MD, AGAF. Dr. Gunaratnam has made a huge impact on patient care in his community and improved gastroenterology-oncology care by starting the endoscopic ultrasound & interventional GI program at St. Joseph Mercy Ann Arbor hospital in Ypsilanti, Michigan. Dr. Gunaratnam is a director of research and obesity management at Huron Gastro.
AGA is honored to present the Distinguished Clinician Award, Clinical Academic Practice, to Edward V. Loftus Jr., MD, AGAF. Dr. Loftus is an outstanding role model in practice, an effective researcher and a recognized leader who is devoted to treating patients with ulcerative colitis and Crohn’s disease with quality clinical care, including understanding the predictors of treatment response. Dr. Loftus is a practicing gastroenterologist at the Mayo Clinic and a professor of medicine at the Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Distinguished Mentor Award
AGA bestows the Distinguished Mentor Award to Fred S. Gorelick, MD, which recognizes an individual who has made a lifelong effort dedicated to the mentoring of trainees in the field of gastroenterology and for achievements as outstanding mentors throughout their careers. Dr. Gorelick has been an inspiration to generations of trainees, many of whom have gone on to successful academic careers as faculty members, section chiefs, program directors, department chairs, and institute directors. Dr. Gorelick is a professor of medicine and cell biology at Yale School of Medicine, and deputy director of the Yale MD-PhD Program, New Haven, Connecticut.
Research Service Award
AGA honors Ann G. Zauber, PhD, with the Research Service Award, which recognizes individuals whose work has significantly advanced gastroenterogical science and research. Dr. Zauber’s accomplishments have changed and advanced the practice of gastroenterology. Her work involving colorectal cancer screening and surveillance studies has had far-reaching effects on public policy. She is well-known for her leadership role in the development of colorectal cancer screening guidelines in the U.S., which has significantly reduced mortality and incidence rates. Dr. Zauber is an attending biostatistician in the department of epidemiology & biostatistics at the Memorial Sloan Kettering Cancer Center, New York, New York.
Young Investigator Awards
The AGA Young Investigator Award recognizes two young investigators, one in basic science and one in clinical science, for outstanding research achievements.
AGA honors Sonia S. Kupfer, MD, with the Young Investigator Award in Clinical Science. Dr. Kupfer is nationally and internationally recognized as an expert in colorectal cancer in high-risk populations including individuals with hereditary cancer syndromes and African Americans. During her clinical and translational research to better understand factors that increase the risk of colorectal cancer, Dr. Kupfer identified distinctions in African-American population compared with Caucasians. Dr. Kupfer is an associate professor of medicine at the University of Chicago, and director of the Gastrointestinal Cancer Risk and Prevention Clinic, Illinois.
AGA honors Costas A. Lyssiotis, PhD, with the Young Investigator Award in Basic Science. His research, work ethic, and innovative approaches have made Dr. Lyssiotis a distinguished leader in pancreatic cancer. His work has broad implications for harnessing the power of the immune system to treat the disease and his laboratory is working to develop new drug therapies that target a pancreatic cancer metabolism-specific enzyme. Dr. Lyssiotis is an assistant professor in the department of molecular and integrative physiology in the division of gastroenterology at University of Michigan Medical School, Ann Arbor.
AGA has announced the 2019 recipients of the annual recognition awards, given in honor of outstanding contributions and achievements in gastroenterology.
“AGA members honor their colleagues and peers for outstanding contributions to the field of gastroenterology by nominating them for the AGA Recognition Awards,” said David A. Lieberman, MD, AGAF, president of the AGA Institute. “We are proud to announce the 2019 AGA Recognition Prize winners, who are just a few of the distinguished and talented members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representative of AGA.”
The AGA Recognition Awards will be presented during Digestive Disease Week® 2019, May 18-21, 2019, in San Diego.
Julius Friedenwald Medal
AGA bequeaths its highest honor, the Julius Friedenwald Medal, to John I. Allen, MD, MBA, AGAF, for his incredible contributions to the field of gastroenterology and AGA over several decades. The Julius Friedenwald Medal, presented annually since 1941, recognizes a physician for lifelong contributions to the field of gastroenterology.
Dr. Allen is internationally renowned for bringing unique and critical knowledge about health care delivery and health care economics to the field of gastroenterology, as well as for his decades of AGA leadership. His experience is unique within the national gastroenterology community, encompassing private practice, nonacademic health systems, and leadership within two academic medical centers. As AGA Institute President, he led the development of AGA’s 5-year strategic plan and made AGA a national player at the federal, state, and local levels during a time of massive health care delivery transformation. Dr. Allen is a clinical professor of medicine in the division of gastroenterology and hepatology and chief clinical officer of the University of Michigan Medical Group at the University of Michigan School of Medicine, Ann Arbor.
Distinguished Achievement Award In Basic Science
AGA honors Harry B. Greenberg, MD, with the AGA Distinguished Achievement Award in Basic Science, for his major accomplishments in basic science research, which have significantly advanced the science and practice of gastroenterology. Throughout his career, Dr. Greenberg’s incredible contributions over several decades contributed to the development of rotavirus vaccines and increased physicians’ understanding of viral pathogenesis, particularly rotavirus, norovirus, and hepatitis. Dr. Greenberg is an associate dean for research at Stanford University School of Medicine, Palo Alto, California.
William Beaumont Prize
AGA honors Timothy C. Wang, MD, AGAF, with the William Beaumont Prize in gastroenterology, which recognizes an individual who has made a unique, outstanding contribution of major importance to the field of gastroenterology. Dr. Wang’s extraordinary contribution to the understanding and practice of modern gastroenterology and digestive science are exemplified through his work, which includes defining the mechanisms and cellular origins of Barrett’s esophagus and gastroesophageal cancer. Dr. Wang, who has served AGA in numerous positions, including as president of the AGA Institute, is currently chief of the division of digestive and liver diseases at Columbia University Medical Center and as the Dorothy L. and Daniel H. Silberberg Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Distinguished Educator Award
AGA recognizes and honors Deborah D. Proctor, MD, AGAF, with the Distinguished Educator Award, which recognizes an individual who has made outstanding contributions as an educator in gastroenterology on both local and national levels, over a lifelong career. Dr. Proctor is a national expert in gastroenterology training and education who has taught and inspired generations of future gastroenterologists, nurses and physician assistants. Currently serving as the AGA Institute Education & Training Councillor, Dr. Proctor is a professor of medicine, and the medical director of the inflammatory bowel disease program, at Yale School of Medicine, New Haven, Connecticut.
Distinguished Clinician Awards
The AGA Distinguished Clinician Award recognizes members of the practicing community who, by example, combine the art of medicine with the skills demanded by the scientific body of knowledge in service to their patients.
AGA presents the Distinguished Clinician Award, Private Practice, to Naresh T. Gunaratnam, MD, AGAF. Dr. Gunaratnam has made a huge impact on patient care in his community and improved gastroenterology-oncology care by starting the endoscopic ultrasound & interventional GI program at St. Joseph Mercy Ann Arbor hospital in Ypsilanti, Michigan. Dr. Gunaratnam is a director of research and obesity management at Huron Gastro.
AGA is honored to present the Distinguished Clinician Award, Clinical Academic Practice, to Edward V. Loftus Jr., MD, AGAF. Dr. Loftus is an outstanding role model in practice, an effective researcher and a recognized leader who is devoted to treating patients with ulcerative colitis and Crohn’s disease with quality clinical care, including understanding the predictors of treatment response. Dr. Loftus is a practicing gastroenterologist at the Mayo Clinic and a professor of medicine at the Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Distinguished Mentor Award
AGA bestows the Distinguished Mentor Award to Fred S. Gorelick, MD, which recognizes an individual who has made a lifelong effort dedicated to the mentoring of trainees in the field of gastroenterology and for achievements as outstanding mentors throughout their careers. Dr. Gorelick has been an inspiration to generations of trainees, many of whom have gone on to successful academic careers as faculty members, section chiefs, program directors, department chairs, and institute directors. Dr. Gorelick is a professor of medicine and cell biology at Yale School of Medicine, and deputy director of the Yale MD-PhD Program, New Haven, Connecticut.
Research Service Award
AGA honors Ann G. Zauber, PhD, with the Research Service Award, which recognizes individuals whose work has significantly advanced gastroenterogical science and research. Dr. Zauber’s accomplishments have changed and advanced the practice of gastroenterology. Her work involving colorectal cancer screening and surveillance studies has had far-reaching effects on public policy. She is well-known for her leadership role in the development of colorectal cancer screening guidelines in the U.S., which has significantly reduced mortality and incidence rates. Dr. Zauber is an attending biostatistician in the department of epidemiology & biostatistics at the Memorial Sloan Kettering Cancer Center, New York, New York.
Young Investigator Awards
The AGA Young Investigator Award recognizes two young investigators, one in basic science and one in clinical science, for outstanding research achievements.
AGA honors Sonia S. Kupfer, MD, with the Young Investigator Award in Clinical Science. Dr. Kupfer is nationally and internationally recognized as an expert in colorectal cancer in high-risk populations including individuals with hereditary cancer syndromes and African Americans. During her clinical and translational research to better understand factors that increase the risk of colorectal cancer, Dr. Kupfer identified distinctions in African-American population compared with Caucasians. Dr. Kupfer is an associate professor of medicine at the University of Chicago, and director of the Gastrointestinal Cancer Risk and Prevention Clinic, Illinois.
AGA honors Costas A. Lyssiotis, PhD, with the Young Investigator Award in Basic Science. His research, work ethic, and innovative approaches have made Dr. Lyssiotis a distinguished leader in pancreatic cancer. His work has broad implications for harnessing the power of the immune system to treat the disease and his laboratory is working to develop new drug therapies that target a pancreatic cancer metabolism-specific enzyme. Dr. Lyssiotis is an assistant professor in the department of molecular and integrative physiology in the division of gastroenterology at University of Michigan Medical School, Ann Arbor.