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Help spark scientific breakthroughs with the AGA Research Foundation
The way we diagnose and treat patients is the result of years of research. But securing the future of the field is no small task. A donation to the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation, will help fill the funding gap and contribute to this tradition of discovery.
The foundation provides a key source of funding at a critical juncture in a young investigator’s career.
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Won Jae Huh, MD, whose research will impact the future care of patients.
“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”
“This funding mechanism will secure my research time to investigate signaling pathways involved in the pathogenesis of Ménétrier’s disease, and will provide resources and support to launch my research career. The results from my research project will be helpful for treating Ménétrier’s disease patients.”
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Dr. Won Jae Huh, whose research will impact the future care of patients.
Donate on the foundation’s website at www.gastro.org/donateonline or by mail to 4930 Del Ray Avenue, Bethesda, MD 20814.
The way we diagnose and treat patients is the result of years of research. But securing the future of the field is no small task. A donation to the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation, will help fill the funding gap and contribute to this tradition of discovery.
The foundation provides a key source of funding at a critical juncture in a young investigator’s career.
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Won Jae Huh, MD, whose research will impact the future care of patients.
“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”
“This funding mechanism will secure my research time to investigate signaling pathways involved in the pathogenesis of Ménétrier’s disease, and will provide resources and support to launch my research career. The results from my research project will be helpful for treating Ménétrier’s disease patients.”
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Dr. Won Jae Huh, whose research will impact the future care of patients.
Donate on the foundation’s website at www.gastro.org/donateonline or by mail to 4930 Del Ray Avenue, Bethesda, MD 20814.
The way we diagnose and treat patients is the result of years of research. But securing the future of the field is no small task. A donation to the charitable arm of the American Gastroenterological Association (AGA), the AGA Research Foundation, will help fill the funding gap and contribute to this tradition of discovery.
The foundation provides a key source of funding at a critical juncture in a young investigator’s career.
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Won Jae Huh, MD, whose research will impact the future care of patients.
“As a clinical researcher, funding for investigation is critical in scientific breakthroughs to promote more efficient and robust patient care. My project will provide novel insights into the role of distensibility in the treatment of patients with esophageal eosinophilia, potentially resulting in more efficient treatment selection and disease management.”
“This funding mechanism will secure my research time to investigate signaling pathways involved in the pathogenesis of Ménétrier’s disease, and will provide resources and support to launch my research career. The results from my research project will be helpful for treating Ménétrier’s disease patients.”
Help spark the scientific breakthroughs of today, so clinicians will have the tools to improve care tomorrow. Your tax-deductible donation will make a critical difference in retaining talented GI scientists, like Dr. Won Jae Huh, whose research will impact the future care of patients.
Donate on the foundation’s website at www.gastro.org/donateonline or by mail to 4930 Del Ray Avenue, Bethesda, MD 20814.
This month in the journal CHEST®
Editor’s Picks
Giants in Chest Medicine – Atul C. Mehta, MBBS, FCCP
By Dr. J. K. Stoller
Screening Heroin Smokers Attending Community Drug Services for COPD.
By Dr. H. Burhan, et al.
The NHLBI LAM Registry: Prognostic Physiologic and Radiologic Biomarkers Emerge
From a 15-Year Prospective Longitudinal Analysis.
By Dr. N. Gupta, et al.
Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
By Dr. C. Kniese, et al.
Implications of the Revised Common Rule for Human Participant Research.
By Dr. E. G. DeRenzo, et al.
Editor’s Picks
Giants in Chest Medicine – Atul C. Mehta, MBBS, FCCP
By Dr. J. K. Stoller
Screening Heroin Smokers Attending Community Drug Services for COPD.
By Dr. H. Burhan, et al.
The NHLBI LAM Registry: Prognostic Physiologic and Radiologic Biomarkers Emerge
From a 15-Year Prospective Longitudinal Analysis.
By Dr. N. Gupta, et al.
Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
By Dr. C. Kniese, et al.
Implications of the Revised Common Rule for Human Participant Research.
By Dr. E. G. DeRenzo, et al.
Editor’s Picks
Giants in Chest Medicine – Atul C. Mehta, MBBS, FCCP
By Dr. J. K. Stoller
Screening Heroin Smokers Attending Community Drug Services for COPD.
By Dr. H. Burhan, et al.
The NHLBI LAM Registry: Prognostic Physiologic and Radiologic Biomarkers Emerge
From a 15-Year Prospective Longitudinal Analysis.
By Dr. N. Gupta, et al.
Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
By Dr. C. Kniese, et al.
Implications of the Revised Common Rule for Human Participant Research.
By Dr. E. G. DeRenzo, et al.
Participate in a Retirement Plan
"Tranche" dates -- for completing all the paperwork for the Kai-Zen retirement accelerator program offered through the SVS Affinity Program of expanded benefits -- have been set for 2019. The first dates are Jan. 28, March 11 and May 6. Generally, paperwork can take approximately 30 or more days, but someone who has already started could meet the Jan. 28 date. Kai-Zen combines financing and life insurance, with premiums jointly funded by lenders and the participant (or an employer). It can help members speed investment growth in their life insurance policies, using leverage that provides up to 60 percent more death benefit protection and 60 percent more supplemental retirement income. See a video of how Kai-Zen works here. For more information contact Mark Blocker at [email protected] or at 312-291-4472.
"Tranche" dates -- for completing all the paperwork for the Kai-Zen retirement accelerator program offered through the SVS Affinity Program of expanded benefits -- have been set for 2019. The first dates are Jan. 28, March 11 and May 6. Generally, paperwork can take approximately 30 or more days, but someone who has already started could meet the Jan. 28 date. Kai-Zen combines financing and life insurance, with premiums jointly funded by lenders and the participant (or an employer). It can help members speed investment growth in their life insurance policies, using leverage that provides up to 60 percent more death benefit protection and 60 percent more supplemental retirement income. See a video of how Kai-Zen works here. For more information contact Mark Blocker at [email protected] or at 312-291-4472.
"Tranche" dates -- for completing all the paperwork for the Kai-Zen retirement accelerator program offered through the SVS Affinity Program of expanded benefits -- have been set for 2019. The first dates are Jan. 28, March 11 and May 6. Generally, paperwork can take approximately 30 or more days, but someone who has already started could meet the Jan. 28 date. Kai-Zen combines financing and life insurance, with premiums jointly funded by lenders and the participant (or an employer). It can help members speed investment growth in their life insurance policies, using leverage that provides up to 60 percent more death benefit protection and 60 percent more supplemental retirement income. See a video of how Kai-Zen works here. For more information contact Mark Blocker at [email protected] or at 312-291-4472.
This month in the journal CHEST®Editor’s Picks
Giants in Chest Medicine
Emeritus Professor Peter D. Wagner, MD
By Dr. Tatum S. Simonson
State of the Journal Editorial
Spread the Word About CHEST in 2019: Innovations, Introductions,
and Farewells. By Dr. R. S. Irwin, et al.
Original Research
Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. By Dr. D. Bedard, et al.
Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung
Screening Trial. By Dr. A. A. Balekian, et al.
Evidence-Based Medicine
Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report. By Dr. A. Moore, et al.
Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. By Dr. A. T. Hill, et al.
Giants in Chest Medicine
Emeritus Professor Peter D. Wagner, MD
By Dr. Tatum S. Simonson
State of the Journal Editorial
Spread the Word About CHEST in 2019: Innovations, Introductions,
and Farewells. By Dr. R. S. Irwin, et al.
Original Research
Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. By Dr. D. Bedard, et al.
Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung
Screening Trial. By Dr. A. A. Balekian, et al.
Evidence-Based Medicine
Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report. By Dr. A. Moore, et al.
Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. By Dr. A. T. Hill, et al.
Giants in Chest Medicine
Emeritus Professor Peter D. Wagner, MD
By Dr. Tatum S. Simonson
State of the Journal Editorial
Spread the Word About CHEST in 2019: Innovations, Introductions,
and Farewells. By Dr. R. S. Irwin, et al.
Original Research
Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. By Dr. D. Bedard, et al.
Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung
Screening Trial. By Dr. A. A. Balekian, et al.
Evidence-Based Medicine
Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report. By Dr. A. Moore, et al.
Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. By Dr. A. T. Hill, et al.
Seeking the Wisdom of the CHEST Crowd
The wisdom of the crowd is the collective opinion of a group of individuals rather than that of a single expert. At CHEST, the makeup of our membership is diverse and energetic, and it comprises individuals with unique expertise who not only serve as faculty but who are also eager for opportunities themselves to learn. That collective wisdom, leveraged over the entire membership, is what the leadership of CHEST will be listening to this year as we create new educational products and continuously improve the annual meeting and other courses held throughout the year. From broad-based general overviews such as CHEST’s board reviews, to more specific courses such as training in bedside ultrasound or ventilator management, each are geared to make all of us better clinicians who will recognize and provide the latest and most effective treatments for our patients. If you had the opportunity to attend my opening address at the CHEST annual meeting in San Antonio in October, you heard me talk about the innate wisdom of “the crowd.” We all have various “crowds” in our lives -- our work colleagues, families, and relationships in professional societies. I reminded the audience that if we take the time to listen to each of these “crowds,” they usually know the answers. In the coming year, we, as a leadership team for CHEST, will be focusing on being better listeners and utilizing “our crowd” of members to better connect in order to develop educational products that will train clinicians, educators, and researchers in the very latest and most effective care in pulmonary, critical care, and sleep medicine.
Here are just a few initiatives planned this year that have come in response to member comments and suggestions:
•Digital Strategy Task Force – This multidisciplinary group, composed of both volunteer members and association staff, has been assigned to evaluate the user experience associated with existing CHEST content delivery platforms and highlight opportunities for improvements. In this effort, they will identify trends that will enable the organization to better execute on the digital-dependent strategies in the organization’s strategic plan in a successful way. The group will be making recommendations to the Board of Regents that will include timelines, goals, and specific objectives, define organizational voice and brand messaging present on web and other platforms, and create specific metrics to measure the user experience on an ongoing basis.
•Optimizing Board Review Courses – CHEST will be looking at ways to present some content on digital platforms that are difficult to teach in a classic didactic format. Topics such as acid-base disturbances and biostatistics are more effectively presented using a digital, problem-based format. Efforts will be made to shorten board review courses slightly without compromising quality or jeopardizing coverage of content and to incorporate succinct bulleted summaries of each topic covered. In addition, plans are in place to create new courses that will train learners the techniques for passing the new “low stakes” board examination offered by the ABIM.
•Making membership more affordable for international colleagues – New discounted membership rates have been launched to allow international members to obtain the “Enhanced” level of membership to be eligible for fellowship in the association (ie, the FCCP designation). Volume discounts have been introduced for regional chapters and organizations to allow health-care team members from around the world to join CHEST in conjunction with their local society at a fraction of the cost of a single member rate.
•Patient education modules from the CHEST Foundation – A variety of patient education modules are now available to providers, as well as to the general public for information on a wide array of topics – from correct use of inhalers to state-of-the-art therapies for COPD or lung cancer.
Improved opportunities for member participation -- From improved instructions for joining a CHEST NetWork to specific orientation instructions for new members of the Board of Regents, improved communications have become available to help members become better acquainted with the framework of the organization and allow them to become more effective once they begin new leadership roles.
•Embracing innovation -- This year, the organization will launch CHEST Inspiration, a program that involves development of an environmental scan to be shared with our members regarding how CHEST can be a differentiator in an environment where quality education is becoming more accessible and, as a result, more competitive. As part of this initiative, CHEST will plan to host a series of focus group sessions to act on the environmental scan and will also roll out an innovation competition at the 2019 annual meeting in New Orleans in October.
•Expanded international strategy – CHEST is responding to the requests from member groups in countries within Asia, Europe, Latin America, and the Middle East to hold a CHEST Congress each spring to bring the best of the CHEST annual meeting to our colleagues from around the world who may not be able to travel to the meeting held in the U.S., as well as a more intimate board review-like meeting each summer in various regions of the world. For example, this year, the College will host a CHEST Congress in Bangkok, Thailand, April 10-12, and a regional meeting in Athens, Greece, June 27-29.
We are committed to improving communication with our members and encouraging innovation regardless of their prior participation levels. CHEST will continue to bring its brand of education focused on more hands-on learning and team-based knowledge using simulation, serious gaming, and artificial intelligence in the years ahead. CHEST leaders have begun to be active on social media, and we will be introducing new platforms for all members to better understand what is happening from a leadership perspective. Together, we will be able to harness the collective wisdom of our talented and innovative members in order to make a lasting difference for our patients.
The wisdom of the crowd is the collective opinion of a group of individuals rather than that of a single expert. At CHEST, the makeup of our membership is diverse and energetic, and it comprises individuals with unique expertise who not only serve as faculty but who are also eager for opportunities themselves to learn. That collective wisdom, leveraged over the entire membership, is what the leadership of CHEST will be listening to this year as we create new educational products and continuously improve the annual meeting and other courses held throughout the year. From broad-based general overviews such as CHEST’s board reviews, to more specific courses such as training in bedside ultrasound or ventilator management, each are geared to make all of us better clinicians who will recognize and provide the latest and most effective treatments for our patients. If you had the opportunity to attend my opening address at the CHEST annual meeting in San Antonio in October, you heard me talk about the innate wisdom of “the crowd.” We all have various “crowds” in our lives -- our work colleagues, families, and relationships in professional societies. I reminded the audience that if we take the time to listen to each of these “crowds,” they usually know the answers. In the coming year, we, as a leadership team for CHEST, will be focusing on being better listeners and utilizing “our crowd” of members to better connect in order to develop educational products that will train clinicians, educators, and researchers in the very latest and most effective care in pulmonary, critical care, and sleep medicine.
Here are just a few initiatives planned this year that have come in response to member comments and suggestions:
•Digital Strategy Task Force – This multidisciplinary group, composed of both volunteer members and association staff, has been assigned to evaluate the user experience associated with existing CHEST content delivery platforms and highlight opportunities for improvements. In this effort, they will identify trends that will enable the organization to better execute on the digital-dependent strategies in the organization’s strategic plan in a successful way. The group will be making recommendations to the Board of Regents that will include timelines, goals, and specific objectives, define organizational voice and brand messaging present on web and other platforms, and create specific metrics to measure the user experience on an ongoing basis.
•Optimizing Board Review Courses – CHEST will be looking at ways to present some content on digital platforms that are difficult to teach in a classic didactic format. Topics such as acid-base disturbances and biostatistics are more effectively presented using a digital, problem-based format. Efforts will be made to shorten board review courses slightly without compromising quality or jeopardizing coverage of content and to incorporate succinct bulleted summaries of each topic covered. In addition, plans are in place to create new courses that will train learners the techniques for passing the new “low stakes” board examination offered by the ABIM.
•Making membership more affordable for international colleagues – New discounted membership rates have been launched to allow international members to obtain the “Enhanced” level of membership to be eligible for fellowship in the association (ie, the FCCP designation). Volume discounts have been introduced for regional chapters and organizations to allow health-care team members from around the world to join CHEST in conjunction with their local society at a fraction of the cost of a single member rate.
•Patient education modules from the CHEST Foundation – A variety of patient education modules are now available to providers, as well as to the general public for information on a wide array of topics – from correct use of inhalers to state-of-the-art therapies for COPD or lung cancer.
Improved opportunities for member participation -- From improved instructions for joining a CHEST NetWork to specific orientation instructions for new members of the Board of Regents, improved communications have become available to help members become better acquainted with the framework of the organization and allow them to become more effective once they begin new leadership roles.
•Embracing innovation -- This year, the organization will launch CHEST Inspiration, a program that involves development of an environmental scan to be shared with our members regarding how CHEST can be a differentiator in an environment where quality education is becoming more accessible and, as a result, more competitive. As part of this initiative, CHEST will plan to host a series of focus group sessions to act on the environmental scan and will also roll out an innovation competition at the 2019 annual meeting in New Orleans in October.
•Expanded international strategy – CHEST is responding to the requests from member groups in countries within Asia, Europe, Latin America, and the Middle East to hold a CHEST Congress each spring to bring the best of the CHEST annual meeting to our colleagues from around the world who may not be able to travel to the meeting held in the U.S., as well as a more intimate board review-like meeting each summer in various regions of the world. For example, this year, the College will host a CHEST Congress in Bangkok, Thailand, April 10-12, and a regional meeting in Athens, Greece, June 27-29.
We are committed to improving communication with our members and encouraging innovation regardless of their prior participation levels. CHEST will continue to bring its brand of education focused on more hands-on learning and team-based knowledge using simulation, serious gaming, and artificial intelligence in the years ahead. CHEST leaders have begun to be active on social media, and we will be introducing new platforms for all members to better understand what is happening from a leadership perspective. Together, we will be able to harness the collective wisdom of our talented and innovative members in order to make a lasting difference for our patients.
The wisdom of the crowd is the collective opinion of a group of individuals rather than that of a single expert. At CHEST, the makeup of our membership is diverse and energetic, and it comprises individuals with unique expertise who not only serve as faculty but who are also eager for opportunities themselves to learn. That collective wisdom, leveraged over the entire membership, is what the leadership of CHEST will be listening to this year as we create new educational products and continuously improve the annual meeting and other courses held throughout the year. From broad-based general overviews such as CHEST’s board reviews, to more specific courses such as training in bedside ultrasound or ventilator management, each are geared to make all of us better clinicians who will recognize and provide the latest and most effective treatments for our patients. If you had the opportunity to attend my opening address at the CHEST annual meeting in San Antonio in October, you heard me talk about the innate wisdom of “the crowd.” We all have various “crowds” in our lives -- our work colleagues, families, and relationships in professional societies. I reminded the audience that if we take the time to listen to each of these “crowds,” they usually know the answers. In the coming year, we, as a leadership team for CHEST, will be focusing on being better listeners and utilizing “our crowd” of members to better connect in order to develop educational products that will train clinicians, educators, and researchers in the very latest and most effective care in pulmonary, critical care, and sleep medicine.
Here are just a few initiatives planned this year that have come in response to member comments and suggestions:
•Digital Strategy Task Force – This multidisciplinary group, composed of both volunteer members and association staff, has been assigned to evaluate the user experience associated with existing CHEST content delivery platforms and highlight opportunities for improvements. In this effort, they will identify trends that will enable the organization to better execute on the digital-dependent strategies in the organization’s strategic plan in a successful way. The group will be making recommendations to the Board of Regents that will include timelines, goals, and specific objectives, define organizational voice and brand messaging present on web and other platforms, and create specific metrics to measure the user experience on an ongoing basis.
•Optimizing Board Review Courses – CHEST will be looking at ways to present some content on digital platforms that are difficult to teach in a classic didactic format. Topics such as acid-base disturbances and biostatistics are more effectively presented using a digital, problem-based format. Efforts will be made to shorten board review courses slightly without compromising quality or jeopardizing coverage of content and to incorporate succinct bulleted summaries of each topic covered. In addition, plans are in place to create new courses that will train learners the techniques for passing the new “low stakes” board examination offered by the ABIM.
•Making membership more affordable for international colleagues – New discounted membership rates have been launched to allow international members to obtain the “Enhanced” level of membership to be eligible for fellowship in the association (ie, the FCCP designation). Volume discounts have been introduced for regional chapters and organizations to allow health-care team members from around the world to join CHEST in conjunction with their local society at a fraction of the cost of a single member rate.
•Patient education modules from the CHEST Foundation – A variety of patient education modules are now available to providers, as well as to the general public for information on a wide array of topics – from correct use of inhalers to state-of-the-art therapies for COPD or lung cancer.
Improved opportunities for member participation -- From improved instructions for joining a CHEST NetWork to specific orientation instructions for new members of the Board of Regents, improved communications have become available to help members become better acquainted with the framework of the organization and allow them to become more effective once they begin new leadership roles.
•Embracing innovation -- This year, the organization will launch CHEST Inspiration, a program that involves development of an environmental scan to be shared with our members regarding how CHEST can be a differentiator in an environment where quality education is becoming more accessible and, as a result, more competitive. As part of this initiative, CHEST will plan to host a series of focus group sessions to act on the environmental scan and will also roll out an innovation competition at the 2019 annual meeting in New Orleans in October.
•Expanded international strategy – CHEST is responding to the requests from member groups in countries within Asia, Europe, Latin America, and the Middle East to hold a CHEST Congress each spring to bring the best of the CHEST annual meeting to our colleagues from around the world who may not be able to travel to the meeting held in the U.S., as well as a more intimate board review-like meeting each summer in various regions of the world. For example, this year, the College will host a CHEST Congress in Bangkok, Thailand, April 10-12, and a regional meeting in Athens, Greece, June 27-29.
We are committed to improving communication with our members and encouraging innovation regardless of their prior participation levels. CHEST will continue to bring its brand of education focused on more hands-on learning and team-based knowledge using simulation, serious gaming, and artificial intelligence in the years ahead. CHEST leaders have begun to be active on social media, and we will be introducing new platforms for all members to better understand what is happening from a leadership perspective. Together, we will be able to harness the collective wisdom of our talented and innovative members in order to make a lasting difference for our patients.
NIH funds project of CHEST Foundation grant winner Drew Harris
While in San Antonio for CHEST 2018, CHEST Foundation caught up with the recipient of our 2017 CHEST Foundation Research Grant in Asthma, Drew Harris, MD, to learn about the impact of winning a CHEST Foundation Research grant had on his community and career. Dr. Harris’ project created a medical-legal partnership to target many of the social determinants of asthma and help address them beyond the typical scope a provider can offer in a traditional visit.
“Currently, we have a full-time lawyer, two social workers, and people in Public Health Sciences program as well as law students at The University of Virginia (UVA) all working together to address the needs of the community,” Harris stated. “Public health students conduct asthma screenings in any of the four clinics we partner with within the UVA system and bring their findings to the larger group. From there, we figure out how to best intervene for these people and connect them with our lawyer if there are housing or workplace discrimination concerns.”
Dr. Harris recently received NIH funding for his approach and has since expanded this medical-legal partnership at the University of Virginia. “The grant I received last year from the CHEST Foundation funded a pilot version of my project that I then was able to share with a larger audience and ultimately secure federal funding for,” Dr. Harris shared.
“The NIH grant was awarded through the lens of implementation science. We know what works in asthma medication and environmental and social factors that help improve patients’ lives. But we do a poor job on actually DOING it. Our project addresses barriers to fixing these social needs and brings a team together to help fix these other problems that are hard for just a medical provider to address.” Dr. Harris continued, “Social needs and determinants of health are starting to receive more attention in pulmonary medicine, so we are really hitting the ground at the right time. Everyone understands that these are important determinants of health, but they lack the tools to help improve patients’ lives. We are creating those.”
Your donations support clinical research projects like this grant for Dr.Harris. Please consider making a donation to support next year’s grants. https://foundation.chestnet.org/donate/
“A middle-aged textile worker who entered Charlottesville as a Syrian refugee several years ago had been unable to work much in Charlottesville due to work-related asthma. She was denied disability due to insufficient work time. Without a network of friends or family to turn to, this family was struggling in poverty with housing and food insecurity. By connecting with this CHEST Foundation-supported program, this patient received needed advocacy and support of doctors, social workers, and legal aid attorneys. She is now supported in an application for a monthly subsidy to help her immediate social needs while we work towards a more permanent solution. Our program has also helped patients with health-harming social needs, including lack of access to care (by helping patients apply for and enroll in Medicaid, for example), housing issues (such as mold and unresponsive landlords), and intimate partner violence. Working together as a team, we are able to provide advocacy to improve the health and well-being of our vulnerable community members. This program addresses issues that are important to my community. Without the hard work and dedication of my colleagues, the community at large, and all those committed to confronting these problems, many families would not get what they need to thrive. I am proud and feel lucky to dedicate my time to support my patients and my community. Thank you to the CHEST Foundation and all those who support it to ensure that ALL patients receive the care they deserve.”
—Drew Harris, MD
While in San Antonio for CHEST 2018, CHEST Foundation caught up with the recipient of our 2017 CHEST Foundation Research Grant in Asthma, Drew Harris, MD, to learn about the impact of winning a CHEST Foundation Research grant had on his community and career. Dr. Harris’ project created a medical-legal partnership to target many of the social determinants of asthma and help address them beyond the typical scope a provider can offer in a traditional visit.
“Currently, we have a full-time lawyer, two social workers, and people in Public Health Sciences program as well as law students at The University of Virginia (UVA) all working together to address the needs of the community,” Harris stated. “Public health students conduct asthma screenings in any of the four clinics we partner with within the UVA system and bring their findings to the larger group. From there, we figure out how to best intervene for these people and connect them with our lawyer if there are housing or workplace discrimination concerns.”
Dr. Harris recently received NIH funding for his approach and has since expanded this medical-legal partnership at the University of Virginia. “The grant I received last year from the CHEST Foundation funded a pilot version of my project that I then was able to share with a larger audience and ultimately secure federal funding for,” Dr. Harris shared.
“The NIH grant was awarded through the lens of implementation science. We know what works in asthma medication and environmental and social factors that help improve patients’ lives. But we do a poor job on actually DOING it. Our project addresses barriers to fixing these social needs and brings a team together to help fix these other problems that are hard for just a medical provider to address.” Dr. Harris continued, “Social needs and determinants of health are starting to receive more attention in pulmonary medicine, so we are really hitting the ground at the right time. Everyone understands that these are important determinants of health, but they lack the tools to help improve patients’ lives. We are creating those.”
Your donations support clinical research projects like this grant for Dr.Harris. Please consider making a donation to support next year’s grants. https://foundation.chestnet.org/donate/
“A middle-aged textile worker who entered Charlottesville as a Syrian refugee several years ago had been unable to work much in Charlottesville due to work-related asthma. She was denied disability due to insufficient work time. Without a network of friends or family to turn to, this family was struggling in poverty with housing and food insecurity. By connecting with this CHEST Foundation-supported program, this patient received needed advocacy and support of doctors, social workers, and legal aid attorneys. She is now supported in an application for a monthly subsidy to help her immediate social needs while we work towards a more permanent solution. Our program has also helped patients with health-harming social needs, including lack of access to care (by helping patients apply for and enroll in Medicaid, for example), housing issues (such as mold and unresponsive landlords), and intimate partner violence. Working together as a team, we are able to provide advocacy to improve the health and well-being of our vulnerable community members. This program addresses issues that are important to my community. Without the hard work and dedication of my colleagues, the community at large, and all those committed to confronting these problems, many families would not get what they need to thrive. I am proud and feel lucky to dedicate my time to support my patients and my community. Thank you to the CHEST Foundation and all those who support it to ensure that ALL patients receive the care they deserve.”
—Drew Harris, MD
While in San Antonio for CHEST 2018, CHEST Foundation caught up with the recipient of our 2017 CHEST Foundation Research Grant in Asthma, Drew Harris, MD, to learn about the impact of winning a CHEST Foundation Research grant had on his community and career. Dr. Harris’ project created a medical-legal partnership to target many of the social determinants of asthma and help address them beyond the typical scope a provider can offer in a traditional visit.
“Currently, we have a full-time lawyer, two social workers, and people in Public Health Sciences program as well as law students at The University of Virginia (UVA) all working together to address the needs of the community,” Harris stated. “Public health students conduct asthma screenings in any of the four clinics we partner with within the UVA system and bring their findings to the larger group. From there, we figure out how to best intervene for these people and connect them with our lawyer if there are housing or workplace discrimination concerns.”
Dr. Harris recently received NIH funding for his approach and has since expanded this medical-legal partnership at the University of Virginia. “The grant I received last year from the CHEST Foundation funded a pilot version of my project that I then was able to share with a larger audience and ultimately secure federal funding for,” Dr. Harris shared.
“The NIH grant was awarded through the lens of implementation science. We know what works in asthma medication and environmental and social factors that help improve patients’ lives. But we do a poor job on actually DOING it. Our project addresses barriers to fixing these social needs and brings a team together to help fix these other problems that are hard for just a medical provider to address.” Dr. Harris continued, “Social needs and determinants of health are starting to receive more attention in pulmonary medicine, so we are really hitting the ground at the right time. Everyone understands that these are important determinants of health, but they lack the tools to help improve patients’ lives. We are creating those.”
Your donations support clinical research projects like this grant for Dr.Harris. Please consider making a donation to support next year’s grants. https://foundation.chestnet.org/donate/
“A middle-aged textile worker who entered Charlottesville as a Syrian refugee several years ago had been unable to work much in Charlottesville due to work-related asthma. She was denied disability due to insufficient work time. Without a network of friends or family to turn to, this family was struggling in poverty with housing and food insecurity. By connecting with this CHEST Foundation-supported program, this patient received needed advocacy and support of doctors, social workers, and legal aid attorneys. She is now supported in an application for a monthly subsidy to help her immediate social needs while we work towards a more permanent solution. Our program has also helped patients with health-harming social needs, including lack of access to care (by helping patients apply for and enroll in Medicaid, for example), housing issues (such as mold and unresponsive landlords), and intimate partner violence. Working together as a team, we are able to provide advocacy to improve the health and well-being of our vulnerable community members. This program addresses issues that are important to my community. Without the hard work and dedication of my colleagues, the community at large, and all those committed to confronting these problems, many families would not get what they need to thrive. I am proud and feel lucky to dedicate my time to support my patients and my community. Thank you to the CHEST Foundation and all those who support it to ensure that ALL patients receive the care they deserve.”
—Drew Harris, MD
Pneumonia, PIONEER-HF, malignant pleural effusion
Cardiovascular Medicine and Surgery
PIONEER-HF trial: Changing practice in patients hospitalized for heart failure
Renin-angiotensin system (RAS) inhibition forms a pivotal part of guideline-recommended therapy for patients with heart failure with reduced ejection fraction (HFrEF).1 Inhibition of the neutral endopeptidase neprilysin increases levels of several vasoactive peptides that inhibit progression of HF.2 The randomized PARADIGM HF trial compared sacubitril/valsartan (angiotensin receptor neprilysin inhibition, ARNI) to enalapril in 8,434 patients with HFrEF and demonstrated a 20% reduction in the primary outcome of cardiovascular death or HF hospitalization (HR 0.80; CI 0.73– 0.87; P <.001) in patients treated with ARNI; mortality and rehospitalization were decreased significantly, as well.3 Importantly, patients had to be clinically stable and complete a sequential run-in period to be eligible for randomization. On this basis, the 2017 HF guideline update recommended transition from RAS inhibition to ARNI in trial-eligible patients.4
The recent PIONEER-HF trial now provides important evidence to support safety of careful initiation of sacubitril-valsartan for hospitalized patients with and without prior exposure to RAS.5 Hemodynamically stable patients were started on a regimen of sacubitril-valsartan, usually at doses half of those used in PARADIGM-HF. The primary endpoint of a decrease in BNP levels was improved significantly with sacubitril-valsartan (ratio 0.71, CI 0.63–0.81; P<.001), and this translated into a significant decrease in the important patient-centered secondary endpoint of rehospitalization.5 ARNI are underutilized in eligible patients; complexity of outpatient drug initiation may contribute.6
Data from this important trial suggest that clinicians should consider initiation of ARNI during hospitalization for acute heart failure. This could increase the number of patients receiving a guideline-recommended therapy that improves outcomes.
Steven M. Hollenberg, MD, FCCP
Steering Committee Chair
References:
1. Yancy CW et al. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147.
2. Vardeny O et al. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2:663.
3. McMurray JJ, et al. Angiotensin– neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993.
4. Yancy CW, et al. 2017 ACC/ AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776.
5. Velasquez EJ, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2018 Nov 11. doi: 10.1056/NEJMoa1812851. Epub ahead of print.
6. Luo N, et al. Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC Heart Fail. 2017; 5:305.
Chest Infections
Pneumonia: It is NOW time to act!
The upper part of the globe is going through another winter season and this brings large numbers of patients visiting emergency departments and requiring admission to the hospital due to pneumonia and influenza. It is concerning to see that despite our knowledge that these events will occur during this season every year, there are no significant improvements in place compared to the prior year. But the most concerning aspect of all is lack of perception that pneumonia and influenza remain among the most important diseases resulting in morbidity and mortality to both children and adults (GBD 2016 Lower Respiratory Infections Collaborators. Lancet Infect Dis 2018; S1473-3099[18]30310).
Every year we read, listen or watch the alarming news regarding the increasing number of cases of influenza and pneumonia, the number of deaths, the lack of vaccine protection, the concerns about human-to-human transmission, the development of resistance, and the lack of resources to deal with this problem. We wonder why we tolerate this difficult situation over and over again? What can we do as a society to help fight this problem? What else needs to happen so we take this issue seriously? Why can we not improve the care of patients who suffer from pneumonia? We as part of the Chest Infections NetWork would like to raise the awareness of the pneumonia and influenza problem and unite with our communities to address this calamity once and for all! A recent editorial proposes a series of strategic solutions to address this situation that include increasing the overall resources, more funding for research, and the development of advocacy groups and education programs (Aliberti S, et al. Lancet Respir Med. 2018;S2213-2600(18):30470).
Marcos I. Restrepo, MD, MSc, PhD.
Steering Committee Vice-Chair
Clinical Research
Guidelines for the management of malignant pleural effusion
A multisociety multidisciplinary panel developed recommendations for management of malignant pleural effusions (MPE) by using the PICO (Population, Intervention, Comparator, and Outcomes) format. As per these guidelines, definitive therapy is aimed at
minimizing symptoms, re-accumulation and repeated pleural interventions, and risk of interventions in asymptomatic MPE outweighing benefits. Pleural interventions were suggested for indications such as clinical staging, obtaining molecular markers, etc. (Tremblay A. J Bronchology Interv Pulmonol. 2007;14:98). Large-volume thoracentesis is suggested for symptomatic patients and for those where lung entrapment is a concern (Lan RS. Ann Intern Med. 1997;126:768). In light of available evidence, the panel noted that the outcomes of definitive therapy for symptomatic MPE are equivocal between indwelling pleural catheter (IPC) and pleurodesis. IPC, which was restricted to un-expandable lungs in the previous guidelines, are now suggested for both expandable and un-expandable lungs (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). Talc, being the most effective and widely use pleurodesis agent, is suggested to be delivered by poudrage or slurry. Higher treatment failure rates with chemical pleurodesis, as well as low Incidence rates of IPC-related cellulitis and pleural space infections, led the panel to suggest IPC for un-expanded lungs, treatment failures, and residual symptomatic loculated effusions. In patients with IPC-related infections, treatment of the infection rather than removal of the catheter was suggested unless in events where the infection failed to respond (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). In view of evidence suggesting improved safety outcomes with ultrasound-guided pleural interventions (Abusedera M, et al. J Bronchology Interv Pulmonol. 2016;23:138), ultrasound guidance was recommended.
Bharat Bajantri, MD
Steering Committee Fellow-in-Training
Interprofessional Team
Difficult-to-control asthma, defined as: uncontrolled asthma despite use of maximum dose inhaled corticosteroids or chronic oral corticosteroids with daily asthma symptoms, frequent exacerbations, and/or hospitalization results in a substantial medical and financial burden with a resultant decrease in quality-of-life. Extrapulmonary co-morbidities, such as obesity, nicotine use, GERD, allergic rhinitis, chronic rhinosinusitis, sleep apnea, anxiety/depression, females of older age, vocal cord dysfunction (VCD), and type 2 diabetes mellitus (T2DM) have been shown to increase exacerbation frequency, missed days of school/work, and lessened quality-of life. Of these comorbidities, that latter has garnered recent attention as a focal point for asthma management.
As many as one in six asthmatics has T2DM, and the obvious impact of oral/systemic corticosteroids runs counter to the treatment armamentarium for difficult-to-control asthma. Furthermore, patients with concomitant T2DM and asthma have poor glycemic control, higher risk of pneumococcal pneumonia, and poor quality-adjusted life expectancy (Black MH et al. Pediatrics. 2014;128:e839-47) Of growing interest is the use of metformin in the treatment of Type 2 diabetes mellitus in patients with asthma. Metformin attenuates eosinophilic airway inflammation and theoretically inhibits airway remodeling through AMP-activated protein kinase (Li, et al. Respirology. 2016;21:1210).
The management of this heterogeneous group of patients with difficult-to-control asthma and the aforementioned comorbidities underscores the need for interdisciplinary collaboration as well as orchestration with specialty providers (family/internal medicine, GI, ENT, endocrine, psych/mental health, et al). Further studies are needed to evaluate the anti-inflammatory properties of metformin and its role in asthma management and improvement in outcome.
David W. Unkle, MSN, APRN, FCCP
Steering Committee Chair
Cardiovascular Medicine and Surgery
PIONEER-HF trial: Changing practice in patients hospitalized for heart failure
Renin-angiotensin system (RAS) inhibition forms a pivotal part of guideline-recommended therapy for patients with heart failure with reduced ejection fraction (HFrEF).1 Inhibition of the neutral endopeptidase neprilysin increases levels of several vasoactive peptides that inhibit progression of HF.2 The randomized PARADIGM HF trial compared sacubitril/valsartan (angiotensin receptor neprilysin inhibition, ARNI) to enalapril in 8,434 patients with HFrEF and demonstrated a 20% reduction in the primary outcome of cardiovascular death or HF hospitalization (HR 0.80; CI 0.73– 0.87; P <.001) in patients treated with ARNI; mortality and rehospitalization were decreased significantly, as well.3 Importantly, patients had to be clinically stable and complete a sequential run-in period to be eligible for randomization. On this basis, the 2017 HF guideline update recommended transition from RAS inhibition to ARNI in trial-eligible patients.4
The recent PIONEER-HF trial now provides important evidence to support safety of careful initiation of sacubitril-valsartan for hospitalized patients with and without prior exposure to RAS.5 Hemodynamically stable patients were started on a regimen of sacubitril-valsartan, usually at doses half of those used in PARADIGM-HF. The primary endpoint of a decrease in BNP levels was improved significantly with sacubitril-valsartan (ratio 0.71, CI 0.63–0.81; P<.001), and this translated into a significant decrease in the important patient-centered secondary endpoint of rehospitalization.5 ARNI are underutilized in eligible patients; complexity of outpatient drug initiation may contribute.6
Data from this important trial suggest that clinicians should consider initiation of ARNI during hospitalization for acute heart failure. This could increase the number of patients receiving a guideline-recommended therapy that improves outcomes.
Steven M. Hollenberg, MD, FCCP
Steering Committee Chair
References:
1. Yancy CW et al. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147.
2. Vardeny O et al. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2:663.
3. McMurray JJ, et al. Angiotensin– neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993.
4. Yancy CW, et al. 2017 ACC/ AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776.
5. Velasquez EJ, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2018 Nov 11. doi: 10.1056/NEJMoa1812851. Epub ahead of print.
6. Luo N, et al. Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC Heart Fail. 2017; 5:305.
Chest Infections
Pneumonia: It is NOW time to act!
The upper part of the globe is going through another winter season and this brings large numbers of patients visiting emergency departments and requiring admission to the hospital due to pneumonia and influenza. It is concerning to see that despite our knowledge that these events will occur during this season every year, there are no significant improvements in place compared to the prior year. But the most concerning aspect of all is lack of perception that pneumonia and influenza remain among the most important diseases resulting in morbidity and mortality to both children and adults (GBD 2016 Lower Respiratory Infections Collaborators. Lancet Infect Dis 2018; S1473-3099[18]30310).
Every year we read, listen or watch the alarming news regarding the increasing number of cases of influenza and pneumonia, the number of deaths, the lack of vaccine protection, the concerns about human-to-human transmission, the development of resistance, and the lack of resources to deal with this problem. We wonder why we tolerate this difficult situation over and over again? What can we do as a society to help fight this problem? What else needs to happen so we take this issue seriously? Why can we not improve the care of patients who suffer from pneumonia? We as part of the Chest Infections NetWork would like to raise the awareness of the pneumonia and influenza problem and unite with our communities to address this calamity once and for all! A recent editorial proposes a series of strategic solutions to address this situation that include increasing the overall resources, more funding for research, and the development of advocacy groups and education programs (Aliberti S, et al. Lancet Respir Med. 2018;S2213-2600(18):30470).
Marcos I. Restrepo, MD, MSc, PhD.
Steering Committee Vice-Chair
Clinical Research
Guidelines for the management of malignant pleural effusion
A multisociety multidisciplinary panel developed recommendations for management of malignant pleural effusions (MPE) by using the PICO (Population, Intervention, Comparator, and Outcomes) format. As per these guidelines, definitive therapy is aimed at
minimizing symptoms, re-accumulation and repeated pleural interventions, and risk of interventions in asymptomatic MPE outweighing benefits. Pleural interventions were suggested for indications such as clinical staging, obtaining molecular markers, etc. (Tremblay A. J Bronchology Interv Pulmonol. 2007;14:98). Large-volume thoracentesis is suggested for symptomatic patients and for those where lung entrapment is a concern (Lan RS. Ann Intern Med. 1997;126:768). In light of available evidence, the panel noted that the outcomes of definitive therapy for symptomatic MPE are equivocal between indwelling pleural catheter (IPC) and pleurodesis. IPC, which was restricted to un-expandable lungs in the previous guidelines, are now suggested for both expandable and un-expandable lungs (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). Talc, being the most effective and widely use pleurodesis agent, is suggested to be delivered by poudrage or slurry. Higher treatment failure rates with chemical pleurodesis, as well as low Incidence rates of IPC-related cellulitis and pleural space infections, led the panel to suggest IPC for un-expanded lungs, treatment failures, and residual symptomatic loculated effusions. In patients with IPC-related infections, treatment of the infection rather than removal of the catheter was suggested unless in events where the infection failed to respond (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). In view of evidence suggesting improved safety outcomes with ultrasound-guided pleural interventions (Abusedera M, et al. J Bronchology Interv Pulmonol. 2016;23:138), ultrasound guidance was recommended.
Bharat Bajantri, MD
Steering Committee Fellow-in-Training
Interprofessional Team
Difficult-to-control asthma, defined as: uncontrolled asthma despite use of maximum dose inhaled corticosteroids or chronic oral corticosteroids with daily asthma symptoms, frequent exacerbations, and/or hospitalization results in a substantial medical and financial burden with a resultant decrease in quality-of-life. Extrapulmonary co-morbidities, such as obesity, nicotine use, GERD, allergic rhinitis, chronic rhinosinusitis, sleep apnea, anxiety/depression, females of older age, vocal cord dysfunction (VCD), and type 2 diabetes mellitus (T2DM) have been shown to increase exacerbation frequency, missed days of school/work, and lessened quality-of life. Of these comorbidities, that latter has garnered recent attention as a focal point for asthma management.
As many as one in six asthmatics has T2DM, and the obvious impact of oral/systemic corticosteroids runs counter to the treatment armamentarium for difficult-to-control asthma. Furthermore, patients with concomitant T2DM and asthma have poor glycemic control, higher risk of pneumococcal pneumonia, and poor quality-adjusted life expectancy (Black MH et al. Pediatrics. 2014;128:e839-47) Of growing interest is the use of metformin in the treatment of Type 2 diabetes mellitus in patients with asthma. Metformin attenuates eosinophilic airway inflammation and theoretically inhibits airway remodeling through AMP-activated protein kinase (Li, et al. Respirology. 2016;21:1210).
The management of this heterogeneous group of patients with difficult-to-control asthma and the aforementioned comorbidities underscores the need for interdisciplinary collaboration as well as orchestration with specialty providers (family/internal medicine, GI, ENT, endocrine, psych/mental health, et al). Further studies are needed to evaluate the anti-inflammatory properties of metformin and its role in asthma management and improvement in outcome.
David W. Unkle, MSN, APRN, FCCP
Steering Committee Chair
Cardiovascular Medicine and Surgery
PIONEER-HF trial: Changing practice in patients hospitalized for heart failure
Renin-angiotensin system (RAS) inhibition forms a pivotal part of guideline-recommended therapy for patients with heart failure with reduced ejection fraction (HFrEF).1 Inhibition of the neutral endopeptidase neprilysin increases levels of several vasoactive peptides that inhibit progression of HF.2 The randomized PARADIGM HF trial compared sacubitril/valsartan (angiotensin receptor neprilysin inhibition, ARNI) to enalapril in 8,434 patients with HFrEF and demonstrated a 20% reduction in the primary outcome of cardiovascular death or HF hospitalization (HR 0.80; CI 0.73– 0.87; P <.001) in patients treated with ARNI; mortality and rehospitalization were decreased significantly, as well.3 Importantly, patients had to be clinically stable and complete a sequential run-in period to be eligible for randomization. On this basis, the 2017 HF guideline update recommended transition from RAS inhibition to ARNI in trial-eligible patients.4
The recent PIONEER-HF trial now provides important evidence to support safety of careful initiation of sacubitril-valsartan for hospitalized patients with and without prior exposure to RAS.5 Hemodynamically stable patients were started on a regimen of sacubitril-valsartan, usually at doses half of those used in PARADIGM-HF. The primary endpoint of a decrease in BNP levels was improved significantly with sacubitril-valsartan (ratio 0.71, CI 0.63–0.81; P<.001), and this translated into a significant decrease in the important patient-centered secondary endpoint of rehospitalization.5 ARNI are underutilized in eligible patients; complexity of outpatient drug initiation may contribute.6
Data from this important trial suggest that clinicians should consider initiation of ARNI during hospitalization for acute heart failure. This could increase the number of patients receiving a guideline-recommended therapy that improves outcomes.
Steven M. Hollenberg, MD, FCCP
Steering Committee Chair
References:
1. Yancy CW et al. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147.
2. Vardeny O et al. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2:663.
3. McMurray JJ, et al. Angiotensin– neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993.
4. Yancy CW, et al. 2017 ACC/ AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776.
5. Velasquez EJ, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2018 Nov 11. doi: 10.1056/NEJMoa1812851. Epub ahead of print.
6. Luo N, et al. Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC Heart Fail. 2017; 5:305.
Chest Infections
Pneumonia: It is NOW time to act!
The upper part of the globe is going through another winter season and this brings large numbers of patients visiting emergency departments and requiring admission to the hospital due to pneumonia and influenza. It is concerning to see that despite our knowledge that these events will occur during this season every year, there are no significant improvements in place compared to the prior year. But the most concerning aspect of all is lack of perception that pneumonia and influenza remain among the most important diseases resulting in morbidity and mortality to both children and adults (GBD 2016 Lower Respiratory Infections Collaborators. Lancet Infect Dis 2018; S1473-3099[18]30310).
Every year we read, listen or watch the alarming news regarding the increasing number of cases of influenza and pneumonia, the number of deaths, the lack of vaccine protection, the concerns about human-to-human transmission, the development of resistance, and the lack of resources to deal with this problem. We wonder why we tolerate this difficult situation over and over again? What can we do as a society to help fight this problem? What else needs to happen so we take this issue seriously? Why can we not improve the care of patients who suffer from pneumonia? We as part of the Chest Infections NetWork would like to raise the awareness of the pneumonia and influenza problem and unite with our communities to address this calamity once and for all! A recent editorial proposes a series of strategic solutions to address this situation that include increasing the overall resources, more funding for research, and the development of advocacy groups and education programs (Aliberti S, et al. Lancet Respir Med. 2018;S2213-2600(18):30470).
Marcos I. Restrepo, MD, MSc, PhD.
Steering Committee Vice-Chair
Clinical Research
Guidelines for the management of malignant pleural effusion
A multisociety multidisciplinary panel developed recommendations for management of malignant pleural effusions (MPE) by using the PICO (Population, Intervention, Comparator, and Outcomes) format. As per these guidelines, definitive therapy is aimed at
minimizing symptoms, re-accumulation and repeated pleural interventions, and risk of interventions in asymptomatic MPE outweighing benefits. Pleural interventions were suggested for indications such as clinical staging, obtaining molecular markers, etc. (Tremblay A. J Bronchology Interv Pulmonol. 2007;14:98). Large-volume thoracentesis is suggested for symptomatic patients and for those where lung entrapment is a concern (Lan RS. Ann Intern Med. 1997;126:768). In light of available evidence, the panel noted that the outcomes of definitive therapy for symptomatic MPE are equivocal between indwelling pleural catheter (IPC) and pleurodesis. IPC, which was restricted to un-expandable lungs in the previous guidelines, are now suggested for both expandable and un-expandable lungs (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). Talc, being the most effective and widely use pleurodesis agent, is suggested to be delivered by poudrage or slurry. Higher treatment failure rates with chemical pleurodesis, as well as low Incidence rates of IPC-related cellulitis and pleural space infections, led the panel to suggest IPC for un-expanded lungs, treatment failures, and residual symptomatic loculated effusions. In patients with IPC-related infections, treatment of the infection rather than removal of the catheter was suggested unless in events where the infection failed to respond (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). In view of evidence suggesting improved safety outcomes with ultrasound-guided pleural interventions (Abusedera M, et al. J Bronchology Interv Pulmonol. 2016;23:138), ultrasound guidance was recommended.
Bharat Bajantri, MD
Steering Committee Fellow-in-Training
Interprofessional Team
Difficult-to-control asthma, defined as: uncontrolled asthma despite use of maximum dose inhaled corticosteroids or chronic oral corticosteroids with daily asthma symptoms, frequent exacerbations, and/or hospitalization results in a substantial medical and financial burden with a resultant decrease in quality-of-life. Extrapulmonary co-morbidities, such as obesity, nicotine use, GERD, allergic rhinitis, chronic rhinosinusitis, sleep apnea, anxiety/depression, females of older age, vocal cord dysfunction (VCD), and type 2 diabetes mellitus (T2DM) have been shown to increase exacerbation frequency, missed days of school/work, and lessened quality-of life. Of these comorbidities, that latter has garnered recent attention as a focal point for asthma management.
As many as one in six asthmatics has T2DM, and the obvious impact of oral/systemic corticosteroids runs counter to the treatment armamentarium for difficult-to-control asthma. Furthermore, patients with concomitant T2DM and asthma have poor glycemic control, higher risk of pneumococcal pneumonia, and poor quality-adjusted life expectancy (Black MH et al. Pediatrics. 2014;128:e839-47) Of growing interest is the use of metformin in the treatment of Type 2 diabetes mellitus in patients with asthma. Metformin attenuates eosinophilic airway inflammation and theoretically inhibits airway remodeling through AMP-activated protein kinase (Li, et al. Respirology. 2016;21:1210).
The management of this heterogeneous group of patients with difficult-to-control asthma and the aforementioned comorbidities underscores the need for interdisciplinary collaboration as well as orchestration with specialty providers (family/internal medicine, GI, ENT, endocrine, psych/mental health, et al). Further studies are needed to evaluate the anti-inflammatory properties of metformin and its role in asthma management and improvement in outcome.
David W. Unkle, MSN, APRN, FCCP
Steering Committee Chair
Resident Research Award Deadline Extended
The SVS Foundation has extended the application deadline for its prestigious Resident Research Award to Tuesday, Jan. 22. This award is one of the most important opportunities for surgical trainees in vascular laboratories and includes the opportunity for the recipient to showcase his or her work in a podium presentation at the 2019 Vascular Annual Meeting. In addition, the recipient receives a $5,000 award. This year’s VAM is June 12 to 15 at the Gaylord National Resort & Convention Center in National Harbor, Md., outside of Washington, D.C. Find award details and guidelines here.
The SVS Foundation has extended the application deadline for its prestigious Resident Research Award to Tuesday, Jan. 22. This award is one of the most important opportunities for surgical trainees in vascular laboratories and includes the opportunity for the recipient to showcase his or her work in a podium presentation at the 2019 Vascular Annual Meeting. In addition, the recipient receives a $5,000 award. This year’s VAM is June 12 to 15 at the Gaylord National Resort & Convention Center in National Harbor, Md., outside of Washington, D.C. Find award details and guidelines here.
The SVS Foundation has extended the application deadline for its prestigious Resident Research Award to Tuesday, Jan. 22. This award is one of the most important opportunities for surgical trainees in vascular laboratories and includes the opportunity for the recipient to showcase his or her work in a podium presentation at the 2019 Vascular Annual Meeting. In addition, the recipient receives a $5,000 award. This year’s VAM is June 12 to 15 at the Gaylord National Resort & Convention Center in National Harbor, Md., outside of Washington, D.C. Find award details and guidelines here.
AAP guidance: How to ask about military service
Knee pathologies predict accelerated knee osteoarthritis, patients with a poor-prognosis cancer have a higher risk of suicide in the first year, and Nuedexta is mainly being prescribed for dementia and Parkinson’s.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Knee pathologies predict accelerated knee osteoarthritis, patients with a poor-prognosis cancer have a higher risk of suicide in the first year, and Nuedexta is mainly being prescribed for dementia and Parkinson’s.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Knee pathologies predict accelerated knee osteoarthritis, patients with a poor-prognosis cancer have a higher risk of suicide in the first year, and Nuedexta is mainly being prescribed for dementia and Parkinson’s.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Prenatal valproate and ADHD
Also today, one expert calls for better ways to preserve beta cell function in youth, synthetic opioids drive a spike in the number of fatal overdoses, and mothers may play a role in the link between depression in fathers and daughters.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, one expert calls for better ways to preserve beta cell function in youth, synthetic opioids drive a spike in the number of fatal overdoses, and mothers may play a role in the link between depression in fathers and daughters.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, one expert calls for better ways to preserve beta cell function in youth, synthetic opioids drive a spike in the number of fatal overdoses, and mothers may play a role in the link between depression in fathers and daughters.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
