Society News

If you work in an ICU, chances are good that you frequently order IV fluids (IVF). Between resuscitation, maintenance, and medication carriers, nearly all ICU patients receive IVF. Historically, much of this IVF has been 0.9% sodium chloride (“saline” or “normal saline”). Providers in the United States alone administer more than 200 million liters of saline each year (Myburgh JA, et al. N Engl J Med. 2013;369[13]:1243). New evidence, however, suggests that treating your ICU patients with so-called “balanced crystalloids,” rather than saline, may improve patient outcomes.

For over a century, clinicians ordering IV isotonic crystalloids have had two basic options: saline or balanced crystalloids (BC). Saline contains water and 154 mmol/L of sodium chloride (around 50% more chloride than human extracellular fluid). In contrast, BCs, like lactated Ringer’s (LR), Hartman’s solution, and others, contain an amount of chloride resembling human plasma (Table 1). BC substitute an organic anion such as bicarbonate, lactate, acetate, or gluconate, in place of chloride – resulting in lower chloride level and a more neutral pH.

Over the last 2 decades, evidence has slowly accumulated that the different compositions of saline and BC might translate into differences in patient physiology and outcomes. Research in the operating room and ICU found that saline administration caused hyperchloremia and metabolic acidosis. Studies of healthy volunteers found that saline decreased blood flow to the kidney (Chowdhury AH, et al. Ann Surg. 2012;256[1]:18). Animal sepsis models suggested that saline might cause inflammation, low blood pressure, and kidney injury (Zhou F, et al. Crit Care Med. 2014;42[4]:e270). Large observational studies among ICU patients found saline to be associated with increased risk of kidney injury, dialysis, or death (Raghunathan K, et al. Crit Care Med. 2014 Jul;42[7]:1585). These preliminary studies set the stage for a large randomized clinical trial comparing clinical outcomes between BC and saline among acutely ill adults.

Between June 2015 and April 2017, our research group conducted the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) (Semler MW, et al. N Engl J Med. 2018;378[9]:819). SMART was a pragmatic trial in which 15,802 adults in five ICUs were assigned to receive either saline (0.9% sodium chloride) or BC (LR or another branded BC [PlasmaLyte A]). The goal was to determine whether using BC rather than saline would decrease the rates of death, new dialysis, or renal dysfunction lasting through hospital discharge. Patients in the BC group received primarily BC (44% LR and 56% another branded BC [PlasmaLyte A]), whereas patients in the saline group received primarily saline. The rate of death, new dialysis, or renal dysfunction lasting through hospital discharge was lower in the BC group (14.3%) than the saline group (15.4%) (OR: 0.90; 95% CI, 0.82-0.99; P=0.04). The difference between groups was primarily in death and new dialysis, not changes in creatinine. For every 100 patients admitted to an ICU, using BC rather than saline would spare one patient from experiencing death, dialysis, or renal dysfunction lasting to hospital discharge (number needed to treat). The benefits of BC appeared to be greater among patients who received larger volumes of IVF and patients with sepsis. In fact, among patients with sepsis, mortality was significantly lower with BC (25.2%) than with saline (29.4%) (P=.02).

Another trial was conducted in parallel. Saline against LR or another branded BC (PlasmaLyte) in the ED (SALT-ED) compared BC with saline among 13,347 non-critically ill adults treated with IVF in the ED (Self WH, et al. N Engl J Med. 2018;378[9]:829). Like the SMART trial, the SALT-ED trial found a 1% absolute reduction in the risk of death, new dialysis, or renal dysfunction lasting to hospital discharge favoring BC.

The SMART and SALT-ED trials have important limitations. They were conducted at a single academic center, and treating clinicians were not blinded to the assigned fluid. The key outcome was a composite of death, new dialysis, and renal dysfunction lasting to hospital discharge – and the trials were not powered to show differences in each of the individual components of the composite.

Despite these limitations, we now have data from two trials enrolling nearly 30,000 acutely ill patients suggesting that BC may result in better clinical outcomes than saline for acutely ill adults. For clinicians who were already using primarily BC solutions, these results will reinforce their current practice. For clinicians whose default IVF has been saline, these new findings raise challenging questions. Prior to these trials, the ICU in which I practice had always used primarily saline. Some of the questions we faced in considering how to apply the results of the SMART and SALT-ED trials to our practice included:

1. Recent data suggest BC may produce better clinical outcomes than saline for acutely ill adults. Are there any data that saline may produce better clinical outcomes than BC? Currently, there are not.

2. Cost is an important consideration in critical care, are BC more expensive than saline? The cost to produce saline and BC is similar. At our hospital, the cost for a 1L bag of saline, LR, and another branded BC (PlasmaLyte A ) is the exactly the same.

3. Is there a specific population for whom BC might have important adverse effects? Because some BC are hypotonic, the safety of administration of BC to patients with elevated intracranial pressure (e.g., traumatic brain injury) is unknown.

4. Are there practical considerations to using BC in the ICU? Compatibility with medications can pose a challenge. For example, the calcium in LR may be incompatible with ceftriaxone infusion. Although BC are compatible with many of the medication infusions used in the ICU for which testing has been performed, less data on compatibility exist for BC than for saline.

5. Are BC as readily available as saline? The three companies that make the majority of IVF used in the United States produce both saline and BC. Recent damage to production facilities has contributed to shortages in the supply of all of them. Over the long term, however, saline and BC are similar in their availability to hospital pharmacies.

After discussing each of these considerations with our ICU physicians and nurses, consultants, and pharmacists, our ICU collectively decided to switch from using primarily saline to BC. This involved (1) our pharmacy team stocking the medication dispensing cabinets in the ICU with 90% LR and 10% saline; and (2) making BC rather than saline the default in order sets within our electronic order entry system. Based on the results of the SMART trial, making the change from saline to BC might be expected to prevent around 100 deaths in our ICU each year.

Many questions regarding the effect of IV crystalloid solutions on clinical outcomes for critically ill adults remain unanswered. The mechanism by which BC may produce better clinical outcomes than saline is uncertain. Whether acetate-containing BC (eg, PlasmaLyte) produced better outcomes than non-acetate-containing BC (eg, LR) is unknown. The safety and efficacy of BC for specific subgroups of patients (eg, those with hyperkalemia) requires further study. Two ongoing trials comparing BC to saline among critically ill adults are expected to finish in 2021 and may provide additional insights into the best approach to IVF management for critically ill adults. An ongoing pilot trial comparing LR to other branded BC (Plasmalyte/Normosol )may inform the choice between BC.

In summary, IVF administration is ubiquitous in critical care. For decades, much of that fluid has been saline. BC are similar to saline in availability and cost. Two large trials now demonstrate better patient outcomes with BC compared with saline. These data challenge ICU providers, pharmacies, and hospital systems primarily using saline to evaluate the available data, their current IVF prescribing practices, and the logistical barriers to change, to determine whether there are legitimate reasons to continue using saline, or whether the time has come to make BC the first-line fluid therapy for acutely ill adults.

Dr. Semler is with the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine –Vanderbilt University Medical Center, Nashville, Tennessee.

If you work in an ICU, chances are good that you frequently order IV fluids (IVF). Between resuscitation, maintenance, and medication carriers, nearly all ICU patients receive IVF. Historically, much of this IVF has been 0.9% sodium chloride (“saline” or “normal saline”). Providers in the United States alone administer more than 200 million liters of saline each year (Myburgh JA, et al. N Engl J Med. 2013;369[13]:1243). New evidence, however, suggests that treating your ICU patients with so-called “balanced crystalloids,” rather than saline, may improve patient outcomes.

For over a century, clinicians ordering IV isotonic crystalloids have had two basic options: saline or balanced crystalloids (BC). Saline contains water and 154 mmol/L of sodium chloride (around 50% more chloride than human extracellular fluid). In contrast, BCs, like lactated Ringer’s (LR), Hartman’s solution, and others, contain an amount of chloride resembling human plasma (Table 1). BC substitute an organic anion such as bicarbonate, lactate, acetate, or gluconate, in place of chloride – resulting in lower chloride level and a more neutral pH.

Over the last 2 decades, evidence has slowly accumulated that the different compositions of saline and BC might translate into differences in patient physiology and outcomes. Research in the operating room and ICU found that saline administration caused hyperchloremia and metabolic acidosis. Studies of healthy volunteers found that saline decreased blood flow to the kidney (Chowdhury AH, et al. Ann Surg. 2012;256[1]:18). Animal sepsis models suggested that saline might cause inflammation, low blood pressure, and kidney injury (Zhou F, et al. Crit Care Med. 2014;42[4]:e270). Large observational studies among ICU patients found saline to be associated with increased risk of kidney injury, dialysis, or death (Raghunathan K, et al. Crit Care Med. 2014 Jul;42[7]:1585). These preliminary studies set the stage for a large randomized clinical trial comparing clinical outcomes between BC and saline among acutely ill adults.

Between June 2015 and April 2017, our research group conducted the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) (Semler MW, et al. N Engl J Med. 2018;378[9]:819). SMART was a pragmatic trial in which 15,802 adults in five ICUs were assigned to receive either saline (0.9% sodium chloride) or BC (LR or another branded BC [PlasmaLyte A]). The goal was to determine whether using BC rather than saline would decrease the rates of death, new dialysis, or renal dysfunction lasting through hospital discharge. Patients in the BC group received primarily BC (44% LR and 56% another branded BC [PlasmaLyte A]), whereas patients in the saline group received primarily saline. The rate of death, new dialysis, or renal dysfunction lasting through hospital discharge was lower in the BC group (14.3%) than the saline group (15.4%) (OR: 0.90; 95% CI, 0.82-0.99; P=0.04). The difference between groups was primarily in death and new dialysis, not changes in creatinine. For every 100 patients admitted to an ICU, using BC rather than saline would spare one patient from experiencing death, dialysis, or renal dysfunction lasting to hospital discharge (number needed to treat). The benefits of BC appeared to be greater among patients who received larger volumes of IVF and patients with sepsis. In fact, among patients with sepsis, mortality was significantly lower with BC (25.2%) than with saline (29.4%) (P=.02).

Another trial was conducted in parallel. Saline against LR or another branded BC (PlasmaLyte) in the ED (SALT-ED) compared BC with saline among 13,347 non-critically ill adults treated with IVF in the ED (Self WH, et al. N Engl J Med. 2018;378[9]:829). Like the SMART trial, the SALT-ED trial found a 1% absolute reduction in the risk of death, new dialysis, or renal dysfunction lasting to hospital discharge favoring BC.

The SMART and SALT-ED trials have important limitations. They were conducted at a single academic center, and treating clinicians were not blinded to the assigned fluid. The key outcome was a composite of death, new dialysis, and renal dysfunction lasting to hospital discharge – and the trials were not powered to show differences in each of the individual components of the composite.

Despite these limitations, we now have data from two trials enrolling nearly 30,000 acutely ill patients suggesting that BC may result in better clinical outcomes than saline for acutely ill adults. For clinicians who were already using primarily BC solutions, these results will reinforce their current practice. For clinicians whose default IVF has been saline, these new findings raise challenging questions. Prior to these trials, the ICU in which I practice had always used primarily saline. Some of the questions we faced in considering how to apply the results of the SMART and SALT-ED trials to our practice included:

1. Recent data suggest BC may produce better clinical outcomes than saline for acutely ill adults. Are there any data that saline may produce better clinical outcomes than BC? Currently, there are not.

2. Cost is an important consideration in critical care, are BC more expensive than saline? The cost to produce saline and BC is similar. At our hospital, the cost for a 1L bag of saline, LR, and another branded BC (PlasmaLyte A ) is the exactly the same.

3. Is there a specific population for whom BC might have important adverse effects? Because some BC are hypotonic, the safety of administration of BC to patients with elevated intracranial pressure (e.g., traumatic brain injury) is unknown.

4. Are there practical considerations to using BC in the ICU? Compatibility with medications can pose a challenge. For example, the calcium in LR may be incompatible with ceftriaxone infusion. Although BC are compatible with many of the medication infusions used in the ICU for which testing has been performed, less data on compatibility exist for BC than for saline.

5. Are BC as readily available as saline? The three companies that make the majority of IVF used in the United States produce both saline and BC. Recent damage to production facilities has contributed to shortages in the supply of all of them. Over the long term, however, saline and BC are similar in their availability to hospital pharmacies.

After discussing each of these considerations with our ICU physicians and nurses, consultants, and pharmacists, our ICU collectively decided to switch from using primarily saline to BC. This involved (1) our pharmacy team stocking the medication dispensing cabinets in the ICU with 90% LR and 10% saline; and (2) making BC rather than saline the default in order sets within our electronic order entry system. Based on the results of the SMART trial, making the change from saline to BC might be expected to prevent around 100 deaths in our ICU each year.

Many questions regarding the effect of IV crystalloid solutions on clinical outcomes for critically ill adults remain unanswered. The mechanism by which BC may produce better clinical outcomes than saline is uncertain. Whether acetate-containing BC (eg, PlasmaLyte) produced better outcomes than non-acetate-containing BC (eg, LR) is unknown. The safety and efficacy of BC for specific subgroups of patients (eg, those with hyperkalemia) requires further study. Two ongoing trials comparing BC to saline among critically ill adults are expected to finish in 2021 and may provide additional insights into the best approach to IVF management for critically ill adults. An ongoing pilot trial comparing LR to other branded BC (Plasmalyte/Normosol )may inform the choice between BC.

In summary, IVF administration is ubiquitous in critical care. For decades, much of that fluid has been saline. BC are similar to saline in availability and cost. Two large trials now demonstrate better patient outcomes with BC compared with saline. These data challenge ICU providers, pharmacies, and hospital systems primarily using saline to evaluate the available data, their current IVF prescribing practices, and the logistical barriers to change, to determine whether there are legitimate reasons to continue using saline, or whether the time has come to make BC the first-line fluid therapy for acutely ill adults.

Dr. Semler is with the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine –Vanderbilt University Medical Center, Nashville, Tennessee.

If you work in an ICU, chances are good that you frequently order IV fluids (IVF). Between resuscitation, maintenance, and medication carriers, nearly all ICU patients receive IVF. Historically, much of this IVF has been 0.9% sodium chloride (“saline” or “normal saline”). Providers in the United States alone administer more than 200 million liters of saline each year (Myburgh JA, et al. N Engl J Med. 2013;369[13]:1243). New evidence, however, suggests that treating your ICU patients with so-called “balanced crystalloids,” rather than saline, may improve patient outcomes.

For over a century, clinicians ordering IV isotonic crystalloids have had two basic options: saline or balanced crystalloids (BC). Saline contains water and 154 mmol/L of sodium chloride (around 50% more chloride than human extracellular fluid). In contrast, BCs, like lactated Ringer’s (LR), Hartman’s solution, and others, contain an amount of chloride resembling human plasma (Table 1). BC substitute an organic anion such as bicarbonate, lactate, acetate, or gluconate, in place of chloride – resulting in lower chloride level and a more neutral pH.

Over the last 2 decades, evidence has slowly accumulated that the different compositions of saline and BC might translate into differences in patient physiology and outcomes. Research in the operating room and ICU found that saline administration caused hyperchloremia and metabolic acidosis. Studies of healthy volunteers found that saline decreased blood flow to the kidney (Chowdhury AH, et al. Ann Surg. 2012;256[1]:18). Animal sepsis models suggested that saline might cause inflammation, low blood pressure, and kidney injury (Zhou F, et al. Crit Care Med. 2014;42[4]:e270). Large observational studies among ICU patients found saline to be associated with increased risk of kidney injury, dialysis, or death (Raghunathan K, et al. Crit Care Med. 2014 Jul;42[7]:1585). These preliminary studies set the stage for a large randomized clinical trial comparing clinical outcomes between BC and saline among acutely ill adults.

Between June 2015 and April 2017, our research group conducted the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) (Semler MW, et al. N Engl J Med. 2018;378[9]:819). SMART was a pragmatic trial in which 15,802 adults in five ICUs were assigned to receive either saline (0.9% sodium chloride) or BC (LR or another branded BC [PlasmaLyte A]). The goal was to determine whether using BC rather than saline would decrease the rates of death, new dialysis, or renal dysfunction lasting through hospital discharge. Patients in the BC group received primarily BC (44% LR and 56% another branded BC [PlasmaLyte A]), whereas patients in the saline group received primarily saline. The rate of death, new dialysis, or renal dysfunction lasting through hospital discharge was lower in the BC group (14.3%) than the saline group (15.4%) (OR: 0.90; 95% CI, 0.82-0.99; P=0.04). The difference between groups was primarily in death and new dialysis, not changes in creatinine. For every 100 patients admitted to an ICU, using BC rather than saline would spare one patient from experiencing death, dialysis, or renal dysfunction lasting to hospital discharge (number needed to treat). The benefits of BC appeared to be greater among patients who received larger volumes of IVF and patients with sepsis. In fact, among patients with sepsis, mortality was significantly lower with BC (25.2%) than with saline (29.4%) (P=.02).

Another trial was conducted in parallel. Saline against LR or another branded BC (PlasmaLyte) in the ED (SALT-ED) compared BC with saline among 13,347 non-critically ill adults treated with IVF in the ED (Self WH, et al. N Engl J Med. 2018;378[9]:829). Like the SMART trial, the SALT-ED trial found a 1% absolute reduction in the risk of death, new dialysis, or renal dysfunction lasting to hospital discharge favoring BC.

The SMART and SALT-ED trials have important limitations. They were conducted at a single academic center, and treating clinicians were not blinded to the assigned fluid. The key outcome was a composite of death, new dialysis, and renal dysfunction lasting to hospital discharge – and the trials were not powered to show differences in each of the individual components of the composite.

Despite these limitations, we now have data from two trials enrolling nearly 30,000 acutely ill patients suggesting that BC may result in better clinical outcomes than saline for acutely ill adults. For clinicians who were already using primarily BC solutions, these results will reinforce their current practice. For clinicians whose default IVF has been saline, these new findings raise challenging questions. Prior to these trials, the ICU in which I practice had always used primarily saline. Some of the questions we faced in considering how to apply the results of the SMART and SALT-ED trials to our practice included:

1. Recent data suggest BC may produce better clinical outcomes than saline for acutely ill adults. Are there any data that saline may produce better clinical outcomes than BC? Currently, there are not.

2. Cost is an important consideration in critical care, are BC more expensive than saline? The cost to produce saline and BC is similar. At our hospital, the cost for a 1L bag of saline, LR, and another branded BC (PlasmaLyte A ) is the exactly the same.

3. Is there a specific population for whom BC might have important adverse effects? Because some BC are hypotonic, the safety of administration of BC to patients with elevated intracranial pressure (e.g., traumatic brain injury) is unknown.

4. Are there practical considerations to using BC in the ICU? Compatibility with medications can pose a challenge. For example, the calcium in LR may be incompatible with ceftriaxone infusion. Although BC are compatible with many of the medication infusions used in the ICU for which testing has been performed, less data on compatibility exist for BC than for saline.

5. Are BC as readily available as saline? The three companies that make the majority of IVF used in the United States produce both saline and BC. Recent damage to production facilities has contributed to shortages in the supply of all of them. Over the long term, however, saline and BC are similar in their availability to hospital pharmacies.

After discussing each of these considerations with our ICU physicians and nurses, consultants, and pharmacists, our ICU collectively decided to switch from using primarily saline to BC. This involved (1) our pharmacy team stocking the medication dispensing cabinets in the ICU with 90% LR and 10% saline; and (2) making BC rather than saline the default in order sets within our electronic order entry system. Based on the results of the SMART trial, making the change from saline to BC might be expected to prevent around 100 deaths in our ICU each year.

Many questions regarding the effect of IV crystalloid solutions on clinical outcomes for critically ill adults remain unanswered. The mechanism by which BC may produce better clinical outcomes than saline is uncertain. Whether acetate-containing BC (eg, PlasmaLyte) produced better outcomes than non-acetate-containing BC (eg, LR) is unknown. The safety and efficacy of BC for specific subgroups of patients (eg, those with hyperkalemia) requires further study. Two ongoing trials comparing BC to saline among critically ill adults are expected to finish in 2021 and may provide additional insights into the best approach to IVF management for critically ill adults. An ongoing pilot trial comparing LR to other branded BC (Plasmalyte/Normosol )may inform the choice between BC.

In summary, IVF administration is ubiquitous in critical care. For decades, much of that fluid has been saline. BC are similar to saline in availability and cost. Two large trials now demonstrate better patient outcomes with BC compared with saline. These data challenge ICU providers, pharmacies, and hospital systems primarily using saline to evaluate the available data, their current IVF prescribing practices, and the logistical barriers to change, to determine whether there are legitimate reasons to continue using saline, or whether the time has come to make BC the first-line fluid therapy for acutely ill adults.

Dr. Semler is with the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine –Vanderbilt University Medical Center, Nashville, Tennessee.

Disaster Response

Ebola virus outbreak preparedness

The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa highlighted the global reach of emerging infectious diseases and shattered a sense of complacency in an increasingly interconnected world. Consequently, a subsequent outbreak of EVD in the Democratic Republic of the Congo (DRC) in early May 2018 triggered a swift response. International agencies and workers benefited from increased experience with the disease, new investigational vaccines, including the rVSV-ZEBOV vaccine, and novel therapies, including ZMapp, favipiravir, and remdesivir (GS-5734).

However, are health-care providers and facilities outside of outbreak areas truly more prepared to handle high-risk pathogens today than they were in 2014? The answer, at least in the United States, seems to be “yes,” due to a regional concentration of funding and resources. The US Department of Health and Human Services (HHS) has identified treatment centers for Ebola and other special pathogens nationwide.¹ The National Ebola Training and Education Center (NETEC) trains health systems to implement disease management plans.² The Centers for Disease Control and Prevention (CDC) has prepared recommendations for public health planners.³

In nonreferral centers, providers should always obtain a travel history, remain cognizant of emerging diseases,⁴ and optimize supportive care. Early collaboration with public health authorities and appropriate infection control precautions are necessary for rapid confirmation of a suspected high-risk pathogen and for ensuring patient and staff safety. Most centers will not need to care for a patient with EVD for an extended period, but the ability to recognize, contain, and refer is essential for good outcomes.

Ryan Maves, MD, FCCP
Cristian Madar, MD
Steering Committee Members

References

1. www.hhs.gov/about/news/2016/06/14/hhs-selects-regional-ebola-treatment-center-southwestern-us.html. Accessed July 18, 2018.

2. www.netec.org. Accessed July 18, 2018.

3. www.cdc.gov/vhf/ebola/public-health-planners. Accessed July 18, 2018.

4. www.cdc.gov/travel/notices. Accessed July 18, 2018.
 

Practice Operations

Current impact of social media on health care

In an age of connectivity, social media websites pose many challenges. Not immune to this are the physicians and their health-care practices, particularly their online presence to their patients. Many of these sites publish user-submitted patient appreciation or complaints. These postings are generally viewable to the public and often not moderated or restricted in content. With value-based care at the front lines, these posts may be detrimental to the success of the practice. Public postings exist regardless of providers’ awareness or management of them.

There is limited training on social media presence, handling negative reviews, addressing patient-specific posts online, or mediating conflicts. This includes legal issues related to licensing, privacy, litigation, and fraud. Compliance to ethical requirements and protecting patient privacy online still remains crucial in the heavily regulated health-care industry. The burden of social media remains a widely unacknowledged impediment to growing physicians’ practice. While several organizations have published guidelines to help ensure success and to better inform physicians, these are not widely practiced or well known.

However, significant potential benefits to social media include marketing opportunities, education, and connection with patients. Social media has been key for support group networks amongst patients. Similar to professionals in other fields, it is recommended that providers separate their public and private social media accounts or use alternate names. For more information about social media and answers to many legal questions, attend the Practice Operations NetWork Featured Lecture at the CHEST Annual Meeting on Monday, October 8, at 1:30 PM.

Megan Sisk, DO
Fellow-in-Training Member

Humayun Anjum, MD
Steering Committee Member
 

Transplant

Implications of the opioid crisis on organ donation for lung transplantation

The opioid epidemic in the United States claims a substantial number of lives annually, with overdose-related deaths increasing five times between 2000 and2016.¹ In the midst of this national crisis, perhaps one solace is an increase in organ donation for thoracic transplantation. In fact, data show that patients dying of overdose have the highest donation rates,² and a staggering 10 times increase in the proportion of eligible donors dying of overdose has been witnessed over this period (1.2% of donors in 2000, 13.7% in 2016),³ with a parallel increase in transplants performed.⁴

Despite this, transplant program organ utilization in overdose deaths falls well short of expected, in part due to disease transmission concerns, supported by the observation that these donors are two to five times more likely designated as “PHS-Increased-Risk” Criteria for transmission of HBV, HCV, and HIV.^2,5 In lung transplantation, additional concerns over donor quality often exist, including aspiration, edema, or other opioid-induced injuries. Although a disturbing premise, as the health-care community and lawmakers attempt to curtail the opioid epidemic, it is important to recognize opportunities for improvement in organ utilization, which offers potential to help many patients with cardiopulmonary disease. In addition to community-wide organ donation campaigns, this may stem from dissemination of knowledge of the low infectious risks in PHS-increased-risk donors,⁵ as well as analyses showing similar survival among recipients of allografts from overdose-death donors compared with donors from other causes.³ Use of HCV-positive organs, particularly in the modern era of infectious testing and therapies, offers additional potential,⁶ as does fine-tuning technologies such as ex-vivo lung perfusion, which may enhance organ quality making lungs suitable for transplant.

Anupam Kumar, MD
Fellow-in-Training Member

Siddhartha G. Kapnadak, MD
Steering Committee Member

References

1. Rudd RA, et al. MMWR Morb Mortal Wkly Rep. 2016;Dec 30;65(5051):1445.

2. Goldberg DS, et al. Am J Transplant. 2016 Oct; 16(10): 2836.

3. Mehra MR, et al. N Engl J Med. 2018 May 17;378(20):1943.

4. Durand CM, et al. Ann Intern Med. 2018 May 15;168(10):702.

5. Sibulesky L, et al. Clin Transplant. 2015 Sep;29(9):724.

6. Abdelbasit A, et al. Am J Respir Crit Care Med. 2018 Jun 1;197(11):1492.
 

Women’s Health

Sex and gender in pulmonary disease

On September 18-19, 2017, the National Heart, Lung, and Blood Institute convened a workshop of investigators with the National Institutes of Health, the Office of Research on Women’s Health, and the Office of Rare Diseases Research to discuss the role of sex and gender in pulmonary disease. The findings of this workshop, published online ahead of print (Han MK, et al. Am J Respir Crit Care Med. 2018 May 10. doi: 10.1164/rccm.201801-0168WS. [Epub ahead of print]), outline important future directions for research in pulmonary medicine.

The group identified several areas in which there are substantial sex-specific differences in clinical presentation and treatment outcomes in pulmonary diseases, including tobacco cessation, circadian rhythms and sleep-disordered breathing, COPD, asthma, cystic fibrosis, and interstitial lung disease.

In addition to defining the terms sex and gender, the committee called for standardization of the reporting of sex as a variable in animal and cellular models. Given the observed relationship between sex hormones and the development of lung disease, a collaboration across disciplines, including endocrinology, would be useful to understand this relationship at a basic and clinical science level. Furthermore, in the era of big data research, sex and gender should be included as co-variates when possible to better clarify the contributions of these variables in pulmonary disease.

The workshop also highlighted the need to educate clinicians about these differences. Just as trainees are taught that women can present with atypical symptoms for a heart attack, so should they be taught about the differences in management of chronic lung disease and tobacco dependence between men and women.

Nikita Desai, MD
Fellow-in-Training Member


 

Disaster Response

Ebola virus outbreak preparedness

The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa highlighted the global reach of emerging infectious diseases and shattered a sense of complacency in an increasingly interconnected world. Consequently, a subsequent outbreak of EVD in the Democratic Republic of the Congo (DRC) in early May 2018 triggered a swift response. International agencies and workers benefited from increased experience with the disease, new investigational vaccines, including the rVSV-ZEBOV vaccine, and novel therapies, including ZMapp, favipiravir, and remdesivir (GS-5734).

However, are health-care providers and facilities outside of outbreak areas truly more prepared to handle high-risk pathogens today than they were in 2014? The answer, at least in the United States, seems to be “yes,” due to a regional concentration of funding and resources. The US Department of Health and Human Services (HHS) has identified treatment centers for Ebola and other special pathogens nationwide.¹ The National Ebola Training and Education Center (NETEC) trains health systems to implement disease management plans.² The Centers for Disease Control and Prevention (CDC) has prepared recommendations for public health planners.³

In nonreferral centers, providers should always obtain a travel history, remain cognizant of emerging diseases,⁴ and optimize supportive care. Early collaboration with public health authorities and appropriate infection control precautions are necessary for rapid confirmation of a suspected high-risk pathogen and for ensuring patient and staff safety. Most centers will not need to care for a patient with EVD for an extended period, but the ability to recognize, contain, and refer is essential for good outcomes.

Ryan Maves, MD, FCCP
Cristian Madar, MD
Steering Committee Members

References

1. www.hhs.gov/about/news/2016/06/14/hhs-selects-regional-ebola-treatment-center-southwestern-us.html. Accessed July 18, 2018.

2. www.netec.org. Accessed July 18, 2018.

3. www.cdc.gov/vhf/ebola/public-health-planners. Accessed July 18, 2018.

4. www.cdc.gov/travel/notices. Accessed July 18, 2018.
 

Practice Operations

Current impact of social media on health care

In an age of connectivity, social media websites pose many challenges. Not immune to this are the physicians and their health-care practices, particularly their online presence to their patients. Many of these sites publish user-submitted patient appreciation or complaints. These postings are generally viewable to the public and often not moderated or restricted in content. With value-based care at the front lines, these posts may be detrimental to the success of the practice. Public postings exist regardless of providers’ awareness or management of them.

There is limited training on social media presence, handling negative reviews, addressing patient-specific posts online, or mediating conflicts. This includes legal issues related to licensing, privacy, litigation, and fraud. Compliance to ethical requirements and protecting patient privacy online still remains crucial in the heavily regulated health-care industry. The burden of social media remains a widely unacknowledged impediment to growing physicians’ practice. While several organizations have published guidelines to help ensure success and to better inform physicians, these are not widely practiced or well known.

However, significant potential benefits to social media include marketing opportunities, education, and connection with patients. Social media has been key for support group networks amongst patients. Similar to professionals in other fields, it is recommended that providers separate their public and private social media accounts or use alternate names. For more information about social media and answers to many legal questions, attend the Practice Operations NetWork Featured Lecture at the CHEST Annual Meeting on Monday, October 8, at 1:30 PM.

Megan Sisk, DO
Fellow-in-Training Member

Humayun Anjum, MD
Steering Committee Member
 

Transplant

Implications of the opioid crisis on organ donation for lung transplantation

The opioid epidemic in the United States claims a substantial number of lives annually, with overdose-related deaths increasing five times between 2000 and2016.¹ In the midst of this national crisis, perhaps one solace is an increase in organ donation for thoracic transplantation. In fact, data show that patients dying of overdose have the highest donation rates,² and a staggering 10 times increase in the proportion of eligible donors dying of overdose has been witnessed over this period (1.2% of donors in 2000, 13.7% in 2016),³ with a parallel increase in transplants performed.⁴

Despite this, transplant program organ utilization in overdose deaths falls well short of expected, in part due to disease transmission concerns, supported by the observation that these donors are two to five times more likely designated as “PHS-Increased-Risk” Criteria for transmission of HBV, HCV, and HIV.^2,5 In lung transplantation, additional concerns over donor quality often exist, including aspiration, edema, or other opioid-induced injuries. Although a disturbing premise, as the health-care community and lawmakers attempt to curtail the opioid epidemic, it is important to recognize opportunities for improvement in organ utilization, which offers potential to help many patients with cardiopulmonary disease. In addition to community-wide organ donation campaigns, this may stem from dissemination of knowledge of the low infectious risks in PHS-increased-risk donors,⁵ as well as analyses showing similar survival among recipients of allografts from overdose-death donors compared with donors from other causes.³ Use of HCV-positive organs, particularly in the modern era of infectious testing and therapies, offers additional potential,⁶ as does fine-tuning technologies such as ex-vivo lung perfusion, which may enhance organ quality making lungs suitable for transplant.

Anupam Kumar, MD
Fellow-in-Training Member

Siddhartha G. Kapnadak, MD
Steering Committee Member

References

1. Rudd RA, et al. MMWR Morb Mortal Wkly Rep. 2016;Dec 30;65(5051):1445.

2. Goldberg DS, et al. Am J Transplant. 2016 Oct; 16(10): 2836.

3. Mehra MR, et al. N Engl J Med. 2018 May 17;378(20):1943.

4. Durand CM, et al. Ann Intern Med. 2018 May 15;168(10):702.

5. Sibulesky L, et al. Clin Transplant. 2015 Sep;29(9):724.

6. Abdelbasit A, et al. Am J Respir Crit Care Med. 2018 Jun 1;197(11):1492.
 

Women’s Health

Sex and gender in pulmonary disease

On September 18-19, 2017, the National Heart, Lung, and Blood Institute convened a workshop of investigators with the National Institutes of Health, the Office of Research on Women’s Health, and the Office of Rare Diseases Research to discuss the role of sex and gender in pulmonary disease. The findings of this workshop, published online ahead of print (Han MK, et al. Am J Respir Crit Care Med. 2018 May 10. doi: 10.1164/rccm.201801-0168WS. [Epub ahead of print]), outline important future directions for research in pulmonary medicine.

The group identified several areas in which there are substantial sex-specific differences in clinical presentation and treatment outcomes in pulmonary diseases, including tobacco cessation, circadian rhythms and sleep-disordered breathing, COPD, asthma, cystic fibrosis, and interstitial lung disease.

In addition to defining the terms sex and gender, the committee called for standardization of the reporting of sex as a variable in animal and cellular models. Given the observed relationship between sex hormones and the development of lung disease, a collaboration across disciplines, including endocrinology, would be useful to understand this relationship at a basic and clinical science level. Furthermore, in the era of big data research, sex and gender should be included as co-variates when possible to better clarify the contributions of these variables in pulmonary disease.

The workshop also highlighted the need to educate clinicians about these differences. Just as trainees are taught that women can present with atypical symptoms for a heart attack, so should they be taught about the differences in management of chronic lung disease and tobacco dependence between men and women.

Nikita Desai, MD
Fellow-in-Training Member


 

Disaster Response

Ebola virus outbreak preparedness

The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa highlighted the global reach of emerging infectious diseases and shattered a sense of complacency in an increasingly interconnected world. Consequently, a subsequent outbreak of EVD in the Democratic Republic of the Congo (DRC) in early May 2018 triggered a swift response. International agencies and workers benefited from increased experience with the disease, new investigational vaccines, including the rVSV-ZEBOV vaccine, and novel therapies, including ZMapp, favipiravir, and remdesivir (GS-5734).

However, are health-care providers and facilities outside of outbreak areas truly more prepared to handle high-risk pathogens today than they were in 2014? The answer, at least in the United States, seems to be “yes,” due to a regional concentration of funding and resources. The US Department of Health and Human Services (HHS) has identified treatment centers for Ebola and other special pathogens nationwide.¹ The National Ebola Training and Education Center (NETEC) trains health systems to implement disease management plans.² The Centers for Disease Control and Prevention (CDC) has prepared recommendations for public health planners.³

In nonreferral centers, providers should always obtain a travel history, remain cognizant of emerging diseases,⁴ and optimize supportive care. Early collaboration with public health authorities and appropriate infection control precautions are necessary for rapid confirmation of a suspected high-risk pathogen and for ensuring patient and staff safety. Most centers will not need to care for a patient with EVD for an extended period, but the ability to recognize, contain, and refer is essential for good outcomes.

Ryan Maves, MD, FCCP
Cristian Madar, MD
Steering Committee Members

References

1. www.hhs.gov/about/news/2016/06/14/hhs-selects-regional-ebola-treatment-center-southwestern-us.html. Accessed July 18, 2018.

2. www.netec.org. Accessed July 18, 2018.

3. www.cdc.gov/vhf/ebola/public-health-planners. Accessed July 18, 2018.

4. www.cdc.gov/travel/notices. Accessed July 18, 2018.
 

Practice Operations

Current impact of social media on health care

In an age of connectivity, social media websites pose many challenges. Not immune to this are the physicians and their health-care practices, particularly their online presence to their patients. Many of these sites publish user-submitted patient appreciation or complaints. These postings are generally viewable to the public and often not moderated or restricted in content. With value-based care at the front lines, these posts may be detrimental to the success of the practice. Public postings exist regardless of providers’ awareness or management of them.

There is limited training on social media presence, handling negative reviews, addressing patient-specific posts online, or mediating conflicts. This includes legal issues related to licensing, privacy, litigation, and fraud. Compliance to ethical requirements and protecting patient privacy online still remains crucial in the heavily regulated health-care industry. The burden of social media remains a widely unacknowledged impediment to growing physicians’ practice. While several organizations have published guidelines to help ensure success and to better inform physicians, these are not widely practiced or well known.

However, significant potential benefits to social media include marketing opportunities, education, and connection with patients. Social media has been key for support group networks amongst patients. Similar to professionals in other fields, it is recommended that providers separate their public and private social media accounts or use alternate names. For more information about social media and answers to many legal questions, attend the Practice Operations NetWork Featured Lecture at the CHEST Annual Meeting on Monday, October 8, at 1:30 PM.

Megan Sisk, DO
Fellow-in-Training Member

Humayun Anjum, MD
Steering Committee Member
 

Transplant

Implications of the opioid crisis on organ donation for lung transplantation

The opioid epidemic in the United States claims a substantial number of lives annually, with overdose-related deaths increasing five times between 2000 and2016.¹ In the midst of this national crisis, perhaps one solace is an increase in organ donation for thoracic transplantation. In fact, data show that patients dying of overdose have the highest donation rates,² and a staggering 10 times increase in the proportion of eligible donors dying of overdose has been witnessed over this period (1.2% of donors in 2000, 13.7% in 2016),³ with a parallel increase in transplants performed.⁴

Despite this, transplant program organ utilization in overdose deaths falls well short of expected, in part due to disease transmission concerns, supported by the observation that these donors are two to five times more likely designated as “PHS-Increased-Risk” Criteria for transmission of HBV, HCV, and HIV.^2,5 In lung transplantation, additional concerns over donor quality often exist, including aspiration, edema, or other opioid-induced injuries. Although a disturbing premise, as the health-care community and lawmakers attempt to curtail the opioid epidemic, it is important to recognize opportunities for improvement in organ utilization, which offers potential to help many patients with cardiopulmonary disease. In addition to community-wide organ donation campaigns, this may stem from dissemination of knowledge of the low infectious risks in PHS-increased-risk donors,⁵ as well as analyses showing similar survival among recipients of allografts from overdose-death donors compared with donors from other causes.³ Use of HCV-positive organs, particularly in the modern era of infectious testing and therapies, offers additional potential,⁶ as does fine-tuning technologies such as ex-vivo lung perfusion, which may enhance organ quality making lungs suitable for transplant.

Anupam Kumar, MD
Fellow-in-Training Member

Siddhartha G. Kapnadak, MD
Steering Committee Member

References

1. Rudd RA, et al. MMWR Morb Mortal Wkly Rep. 2016;Dec 30;65(5051):1445.

2. Goldberg DS, et al. Am J Transplant. 2016 Oct; 16(10): 2836.

3. Mehra MR, et al. N Engl J Med. 2018 May 17;378(20):1943.

4. Durand CM, et al. Ann Intern Med. 2018 May 15;168(10):702.

5. Sibulesky L, et al. Clin Transplant. 2015 Sep;29(9):724.

6. Abdelbasit A, et al. Am J Respir Crit Care Med. 2018 Jun 1;197(11):1492.
 

Women’s Health

Sex and gender in pulmonary disease

On September 18-19, 2017, the National Heart, Lung, and Blood Institute convened a workshop of investigators with the National Institutes of Health, the Office of Research on Women’s Health, and the Office of Rare Diseases Research to discuss the role of sex and gender in pulmonary disease. The findings of this workshop, published online ahead of print (Han MK, et al. Am J Respir Crit Care Med. 2018 May 10. doi: 10.1164/rccm.201801-0168WS. [Epub ahead of print]), outline important future directions for research in pulmonary medicine.

The group identified several areas in which there are substantial sex-specific differences in clinical presentation and treatment outcomes in pulmonary diseases, including tobacco cessation, circadian rhythms and sleep-disordered breathing, COPD, asthma, cystic fibrosis, and interstitial lung disease.

In addition to defining the terms sex and gender, the committee called for standardization of the reporting of sex as a variable in animal and cellular models. Given the observed relationship between sex hormones and the development of lung disease, a collaboration across disciplines, including endocrinology, would be useful to understand this relationship at a basic and clinical science level. Furthermore, in the era of big data research, sex and gender should be included as co-variates when possible to better clarify the contributions of these variables in pulmonary disease.

The workshop also highlighted the need to educate clinicians about these differences. Just as trainees are taught that women can present with atypical symptoms for a heart attack, so should they be taught about the differences in management of chronic lung disease and tobacco dependence between men and women.

Nikita Desai, MD
Fellow-in-Training Member


 

The Society for Vascular Surgery needs members to participate in guideline writing groups on three topics: Enhanced Recovery After Surgery, Trauma and Genetic Aneurysms/Dissections. SVS welcomes applicants with expertise and experience in diverse practice settings. Visit here for more information and the survey/application forms for each guideline. Completed forms are due Aug. 15.

The Society for Vascular Surgery needs members to participate in guideline writing groups on three topics: Enhanced Recovery After Surgery, Trauma and Genetic Aneurysms/Dissections. SVS welcomes applicants with expertise and experience in diverse practice settings. Visit here for more information and the survey/application forms for each guideline. Completed forms are due Aug. 15.

The Society for Vascular Surgery needs members to participate in guideline writing groups on three topics: Enhanced Recovery After Surgery, Trauma and Genetic Aneurysms/Dissections. SVS welcomes applicants with expertise and experience in diverse practice settings. Visit here for more information and the survey/application forms for each guideline. Completed forms are due Aug. 15.

Do you have an idea for an informative session at the 2019 Vascular Annual Meeting? The Society for Vascular Surgery is seeking proposals for invited sessions — postgraduate courses; breakfast, concurrent or small-group sessions; and/or Tips and Tricks and Ask the Experts sessions — for next year’s meeting. Suggestions are due by Aug. 27. See more information and find the submission form here. The 2019 VAM will be June 12-15 at the Gaylord National Resort and Convention Center in National Harbor, Md., just outside Washington, D.C.

Do you have an idea for an informative session at the 2019 Vascular Annual Meeting? The Society for Vascular Surgery is seeking proposals for invited sessions — postgraduate courses; breakfast, concurrent or small-group sessions; and/or Tips and Tricks and Ask the Experts sessions — for next year’s meeting. Suggestions are due by Aug. 27. See more information and find the submission form here. The 2019 VAM will be June 12-15 at the Gaylord National Resort and Convention Center in National Harbor, Md., just outside Washington, D.C.

Do you have an idea for an informative session at the 2019 Vascular Annual Meeting? The Society for Vascular Surgery is seeking proposals for invited sessions — postgraduate courses; breakfast, concurrent or small-group sessions; and/or Tips and Tricks and Ask the Experts sessions — for next year’s meeting. Suggestions are due by Aug. 27. See more information and find the submission form here. The 2019 VAM will be June 12-15 at the Gaylord National Resort and Convention Center in National Harbor, Md., just outside Washington, D.C.

The six investigators awarded AGA’s flagship research grant are working on impressive research projects that address important unmet needs for GI patients.

In partnership with generous supporters, the AGA Research Foundation provided more than $2 million in research funding to 41 investigators in 2018. The AGA Research Scholar Award was given to 6 exceptional early-career investigators who represent the future of GI research. Read about their research projects below.
 

Sarah Andres, PhD

University of Pennsylvania, Philadelphia

Project title: The mRNA binding protein IMP1 regulates intestinal epithelial exosome biology during homeostasis and metastasis

Swathi Eluri, MD, MSCR

University of North Carolina at Chapel Hill

Project title: Improving Barrett’s esophagus screening practices in primary care

Jill Hoffman, PhD

University of California, Los Angeles

AGA-Takeda Pharmaceuticals Research Scholar Award in IBD

Project title: Characterization of CRHR₂-mediated enteric glial cell function during colitis

Dr. Hoffman will use her AGA-Takeda funding to define a role for corticotropin-releasing hormone (CRH) signaling in enteric glial cell function, and determine CRHR₂-dependent crosstalk between enteric glial cells and the intestinal epithelium during inflammation. Through research aiming to understand the basic mechanisms of cell-to-cell signaling during intestinal inflammation, Dr. Hoffman hopes to determine how to harness these pathways to limit inflammation and promote repair in patients with IBD.
 

Elizabeth Jensen, MPH, PhD

Wake Forest University, Winston-Salem, NC

Project title: Early life factors, gene-environment interaction, and eosinophilic esophagitis (EoE)

With this funding, Dr. Jensen will conduct the largest study to date on early life factors and EoE, using data that have been collected prospectively through population-based registries in Denmark. Ultimately, Dr. Jensen hopes her research will lead to advancements in our understanding of etiologic factors for development of immune-mediated GI diseases, such as EoE, and will lead to the identification of modifiable factors for disease prevention.
 

Sumera Rizvi, MD

Mayo Clinic, Rochester, MN

Project title: Necrosis enhances tumor immunogenicity and augments cholangiocarcinoma tumor suppression in combination with PD-L1 blockade

Niels Vande Casteele, PhD

University of California, San Diego

Project title: Identifying optimal thresholds and personalized dosing regimens of infliximab to maximize endoscopic remission rates in patients with ulcerative colitis

[email protected]

The six investigators awarded AGA’s flagship research grant are working on impressive research projects that address important unmet needs for GI patients.

In partnership with generous supporters, the AGA Research Foundation provided more than $2 million in research funding to 41 investigators in 2018. The AGA Research Scholar Award was given to 6 exceptional early-career investigators who represent the future of GI research. Read about their research projects below.
 

Sarah Andres, PhD

University of Pennsylvania, Philadelphia

Project title: The mRNA binding protein IMP1 regulates intestinal epithelial exosome biology during homeostasis and metastasis

Swathi Eluri, MD, MSCR

University of North Carolina at Chapel Hill

Project title: Improving Barrett’s esophagus screening practices in primary care

Jill Hoffman, PhD

University of California, Los Angeles

AGA-Takeda Pharmaceuticals Research Scholar Award in IBD

Project title: Characterization of CRHR₂-mediated enteric glial cell function during colitis

Dr. Hoffman will use her AGA-Takeda funding to define a role for corticotropin-releasing hormone (CRH) signaling in enteric glial cell function, and determine CRHR₂-dependent crosstalk between enteric glial cells and the intestinal epithelium during inflammation. Through research aiming to understand the basic mechanisms of cell-to-cell signaling during intestinal inflammation, Dr. Hoffman hopes to determine how to harness these pathways to limit inflammation and promote repair in patients with IBD.
 

Elizabeth Jensen, MPH, PhD

Wake Forest University, Winston-Salem, NC

Project title: Early life factors, gene-environment interaction, and eosinophilic esophagitis (EoE)

With this funding, Dr. Jensen will conduct the largest study to date on early life factors and EoE, using data that have been collected prospectively through population-based registries in Denmark. Ultimately, Dr. Jensen hopes her research will lead to advancements in our understanding of etiologic factors for development of immune-mediated GI diseases, such as EoE, and will lead to the identification of modifiable factors for disease prevention.
 

Sumera Rizvi, MD

Mayo Clinic, Rochester, MN

Project title: Necrosis enhances tumor immunogenicity and augments cholangiocarcinoma tumor suppression in combination with PD-L1 blockade

Niels Vande Casteele, PhD

University of California, San Diego

Project title: Identifying optimal thresholds and personalized dosing regimens of infliximab to maximize endoscopic remission rates in patients with ulcerative colitis

[email protected]

The six investigators awarded AGA’s flagship research grant are working on impressive research projects that address important unmet needs for GI patients.

In partnership with generous supporters, the AGA Research Foundation provided more than $2 million in research funding to 41 investigators in 2018. The AGA Research Scholar Award was given to 6 exceptional early-career investigators who represent the future of GI research. Read about their research projects below.
 

Sarah Andres, PhD

University of Pennsylvania, Philadelphia

Project title: The mRNA binding protein IMP1 regulates intestinal epithelial exosome biology during homeostasis and metastasis

Swathi Eluri, MD, MSCR

University of North Carolina at Chapel Hill

Project title: Improving Barrett’s esophagus screening practices in primary care

Jill Hoffman, PhD

University of California, Los Angeles

AGA-Takeda Pharmaceuticals Research Scholar Award in IBD

Project title: Characterization of CRHR₂-mediated enteric glial cell function during colitis

Dr. Hoffman will use her AGA-Takeda funding to define a role for corticotropin-releasing hormone (CRH) signaling in enteric glial cell function, and determine CRHR₂-dependent crosstalk between enteric glial cells and the intestinal epithelium during inflammation. Through research aiming to understand the basic mechanisms of cell-to-cell signaling during intestinal inflammation, Dr. Hoffman hopes to determine how to harness these pathways to limit inflammation and promote repair in patients with IBD.
 

Elizabeth Jensen, MPH, PhD

Wake Forest University, Winston-Salem, NC

Project title: Early life factors, gene-environment interaction, and eosinophilic esophagitis (EoE)

With this funding, Dr. Jensen will conduct the largest study to date on early life factors and EoE, using data that have been collected prospectively through population-based registries in Denmark. Ultimately, Dr. Jensen hopes her research will lead to advancements in our understanding of etiologic factors for development of immune-mediated GI diseases, such as EoE, and will lead to the identification of modifiable factors for disease prevention.
 

Sumera Rizvi, MD

Mayo Clinic, Rochester, MN

Project title: Necrosis enhances tumor immunogenicity and augments cholangiocarcinoma tumor suppression in combination with PD-L1 blockade

Niels Vande Casteele, PhD

University of California, San Diego

Project title: Identifying optimal thresholds and personalized dosing regimens of infliximab to maximize endoscopic remission rates in patients with ulcerative colitis

[email protected]

Whether you attended VAM18 or not, if you need more meeting, we have you covered. All things VAM are available here. For example:

• Find link to CME claim info
• Watch on-site videos and enjoy slide shows
• Find a link to the full schedule, with abstracts, moderators, faculty bios, exhibitors

VAM On Demand slides and videos will soon be available for purchase; watch Pulse and/or your inbox for the announcement!

Whether you attended VAM18 or not, if you need more meeting, we have you covered. All things VAM are available here. For example:

• Find link to CME claim info
• Watch on-site videos and enjoy slide shows
• Find a link to the full schedule, with abstracts, moderators, faculty bios, exhibitors

VAM On Demand slides and videos will soon be available for purchase; watch Pulse and/or your inbox for the announcement!

Whether you attended VAM18 or not, if you need more meeting, we have you covered. All things VAM are available here. For example:

• Find link to CME claim info
• Watch on-site videos and enjoy slide shows
• Find a link to the full schedule, with abstracts, moderators, faculty bios, exhibitors

VAM On Demand slides and videos will soon be available for purchase; watch Pulse and/or your inbox for the announcement!

The deadline to submit applications for the SVS Foundation Research Career Development Travel Award is Aug. 15. This award aims to develop strong leaders in vascular surgery. Awardees are assigned an SVS research mentor and are provided with funds to attend an establish research career development course.

The deadline to submit applications for the SVS Foundation Research Career Development Travel Award is Aug. 15. This award aims to develop strong leaders in vascular surgery. Awardees are assigned an SVS research mentor and are provided with funds to attend an establish research career development course.

The deadline to submit applications for the SVS Foundation Research Career Development Travel Award is Aug. 15. This award aims to develop strong leaders in vascular surgery. Awardees are assigned an SVS research mentor and are provided with funds to attend an establish research career development course.

The deadline for applications for the SVS International Scholars Program has been extended to Sept. 1. The program provides up to four scholarships to qualified young vascular surgeons from countries other than the United States or Canada. Awardees receive $5,000 each, to attend the 2019 Vascular Annual Meeting and to visit clinical, teaching and research facilities in the U.S. and Canada. Apply today.

The deadline for applications for the SVS International Scholars Program has been extended to Sept. 1. The program provides up to four scholarships to qualified young vascular surgeons from countries other than the United States or Canada. Awardees receive $5,000 each, to attend the 2019 Vascular Annual Meeting and to visit clinical, teaching and research facilities in the U.S. and Canada. Apply today.

The deadline for applications for the SVS International Scholars Program has been extended to Sept. 1. The program provides up to four scholarships to qualified young vascular surgeons from countries other than the United States or Canada. Awardees receive $5,000 each, to attend the 2019 Vascular Annual Meeting and to visit clinical, teaching and research facilities in the U.S. and Canada. Apply today.

“AGA is pushing the envelope in a number of areas,” said outgoing AGA President Sheila E. Crowe MD, AGAF, during the AGA Presidential Plenary at Digestive Disease Week^® (DDW). “And in a changing world, there are battlefronts where we must continue to work toward innovative solutions.”

The association continues to push reform in maintenance of certification (MOC). The Gastroenterologist-accountable Professionalism in Practice (G-APP) alternative certification pathway introduced 2 years ago created a strong platform to continue guiding the American Board of Internal Medicine (ABIM) to adapt its own MOC process to be more flexible, less costly, and more reflective of the realities of clinical practice.

“ABIM has responded to our pressure by unveiling the 2-year check-in,” Dr. Crowe said. “This is progress, but it still fails to address all the concerns we have expressed to ABIM. AGA will continue to work collaboratively, but forcefully, to make sure that recertification is convenient, relevant, and meaningful.”

AGA has successfully pushed for improvements to the Medicare Quality Payments program. Dr. Crowe said the association remains committed to reducing the regulatory hoops, red tape, and associated costs that practices must navigate.

The continuing push to ease regulatory burdens of practice is buoyed by successes in other areas.

AGA built a new partnership with the Crohn’s and Colitis Foundation and launched the first annual Crohn’s & Colitis Congress™ earlier this year. Registration for the 2019 Congress opens later this month.

The AGA Community (community.gastro.org) became a vibrant hub for clinicians to discuss their most difficult cases. Most recently, AGA made its patient education materials freely available online through the AGA GI Patient Center (patient.gastro.org). All educational pieces are available in both English and Spanish.

Research has been a top priority since AGA was founded 121 years ago, Dr. Crowe added.

“We are proud to be part of a coalition that aggressively advocated for increases at NIH and were pleased that a $3 billion increase was secured in the budget,” she said. “It was a big win in a tough environment.”

To help bridge the continuing shortfall in federal funding, the AGA Research Foundation launched an active year of fundraising and funding. The Foundation provided $2 million in research funding to 41 young investigators in the past year. An expanded awards program provided more pilot awards and more research scholar awards (RSA).

The past year also saw the launch of the AGA Fecal Microbiota Transplantation (FMT) National Registry. The new registry will assess the short- and long-term patient outcomes associated with FMT. In addition, AGA created a clinical research registry for endoscopic suturing procedures. The annual AGA Tech Summit continues to push for innovation in all areas of GI. The ultimate goal, Dr. Crowe said, is to put the most effective innovations into the hands of clinicians as quickly as possible.

During the plenary, Dr. Crowe presented the annual Julius Friedenwald Medal to Loren Laine, MD, AGAF. In addition to a distinguished academic career, Dr. Laine helped create the AGA Center for Gut Microbiome Research and Education while he was AGA president and helped establish AGA’s guideline development process.
 

[email protected]

“AGA is pushing the envelope in a number of areas,” said outgoing AGA President Sheila E. Crowe MD, AGAF, during the AGA Presidential Plenary at Digestive Disease Week^® (DDW). “And in a changing world, there are battlefronts where we must continue to work toward innovative solutions.”

The association continues to push reform in maintenance of certification (MOC). The Gastroenterologist-accountable Professionalism in Practice (G-APP) alternative certification pathway introduced 2 years ago created a strong platform to continue guiding the American Board of Internal Medicine (ABIM) to adapt its own MOC process to be more flexible, less costly, and more reflective of the realities of clinical practice.

“ABIM has responded to our pressure by unveiling the 2-year check-in,” Dr. Crowe said. “This is progress, but it still fails to address all the concerns we have expressed to ABIM. AGA will continue to work collaboratively, but forcefully, to make sure that recertification is convenient, relevant, and meaningful.”

AGA has successfully pushed for improvements to the Medicare Quality Payments program. Dr. Crowe said the association remains committed to reducing the regulatory hoops, red tape, and associated costs that practices must navigate.

The continuing push to ease regulatory burdens of practice is buoyed by successes in other areas.

AGA built a new partnership with the Crohn’s and Colitis Foundation and launched the first annual Crohn’s & Colitis Congress™ earlier this year. Registration for the 2019 Congress opens later this month.

The AGA Community (community.gastro.org) became a vibrant hub for clinicians to discuss their most difficult cases. Most recently, AGA made its patient education materials freely available online through the AGA GI Patient Center (patient.gastro.org). All educational pieces are available in both English and Spanish.

Research has been a top priority since AGA was founded 121 years ago, Dr. Crowe added.

“We are proud to be part of a coalition that aggressively advocated for increases at NIH and were pleased that a $3 billion increase was secured in the budget,” she said. “It was a big win in a tough environment.”

To help bridge the continuing shortfall in federal funding, the AGA Research Foundation launched an active year of fundraising and funding. The Foundation provided $2 million in research funding to 41 young investigators in the past year. An expanded awards program provided more pilot awards and more research scholar awards (RSA).

The past year also saw the launch of the AGA Fecal Microbiota Transplantation (FMT) National Registry. The new registry will assess the short- and long-term patient outcomes associated with FMT. In addition, AGA created a clinical research registry for endoscopic suturing procedures. The annual AGA Tech Summit continues to push for innovation in all areas of GI. The ultimate goal, Dr. Crowe said, is to put the most effective innovations into the hands of clinicians as quickly as possible.

During the plenary, Dr. Crowe presented the annual Julius Friedenwald Medal to Loren Laine, MD, AGAF. In addition to a distinguished academic career, Dr. Laine helped create the AGA Center for Gut Microbiome Research and Education while he was AGA president and helped establish AGA’s guideline development process.
 

[email protected]

“AGA is pushing the envelope in a number of areas,” said outgoing AGA President Sheila E. Crowe MD, AGAF, during the AGA Presidential Plenary at Digestive Disease Week^® (DDW). “And in a changing world, there are battlefronts where we must continue to work toward innovative solutions.”

The association continues to push reform in maintenance of certification (MOC). The Gastroenterologist-accountable Professionalism in Practice (G-APP) alternative certification pathway introduced 2 years ago created a strong platform to continue guiding the American Board of Internal Medicine (ABIM) to adapt its own MOC process to be more flexible, less costly, and more reflective of the realities of clinical practice.

“ABIM has responded to our pressure by unveiling the 2-year check-in,” Dr. Crowe said. “This is progress, but it still fails to address all the concerns we have expressed to ABIM. AGA will continue to work collaboratively, but forcefully, to make sure that recertification is convenient, relevant, and meaningful.”

AGA has successfully pushed for improvements to the Medicare Quality Payments program. Dr. Crowe said the association remains committed to reducing the regulatory hoops, red tape, and associated costs that practices must navigate.

The continuing push to ease regulatory burdens of practice is buoyed by successes in other areas.

AGA built a new partnership with the Crohn’s and Colitis Foundation and launched the first annual Crohn’s & Colitis Congress™ earlier this year. Registration for the 2019 Congress opens later this month.

The AGA Community (community.gastro.org) became a vibrant hub for clinicians to discuss their most difficult cases. Most recently, AGA made its patient education materials freely available online through the AGA GI Patient Center (patient.gastro.org). All educational pieces are available in both English and Spanish.

Research has been a top priority since AGA was founded 121 years ago, Dr. Crowe added.

“We are proud to be part of a coalition that aggressively advocated for increases at NIH and were pleased that a $3 billion increase was secured in the budget,” she said. “It was a big win in a tough environment.”

To help bridge the continuing shortfall in federal funding, the AGA Research Foundation launched an active year of fundraising and funding. The Foundation provided $2 million in research funding to 41 young investigators in the past year. An expanded awards program provided more pilot awards and more research scholar awards (RSA).

The past year also saw the launch of the AGA Fecal Microbiota Transplantation (FMT) National Registry. The new registry will assess the short- and long-term patient outcomes associated with FMT. In addition, AGA created a clinical research registry for endoscopic suturing procedures. The annual AGA Tech Summit continues to push for innovation in all areas of GI. The ultimate goal, Dr. Crowe said, is to put the most effective innovations into the hands of clinicians as quickly as possible.

During the plenary, Dr. Crowe presented the annual Julius Friedenwald Medal to Loren Laine, MD, AGAF. In addition to a distinguished academic career, Dr. Laine helped create the AGA Center for Gut Microbiome Research and Education while he was AGA president and helped establish AGA’s guideline development process.
 

[email protected]

Applications are due by Aug. 2 for the SVS International Scholars Program, which provides up to four scholarships to qualified young vascular surgeons from countries other than the United States or Canada. Awardees receive $5,000 each, to attend the 2019 Vascular Annual Meeting and to visit clinical, teaching and research facilities in the U.S. and Canada.

Applications are due by Aug. 2 for the SVS International Scholars Program, which provides up to four scholarships to qualified young vascular surgeons from countries other than the United States or Canada. Awardees receive $5,000 each, to attend the 2019 Vascular Annual Meeting and to visit clinical, teaching and research facilities in the U.S. and Canada.

Applications are due by Aug. 2 for the SVS International Scholars Program, which provides up to four scholarships to qualified young vascular surgeons from countries other than the United States or Canada. Awardees receive $5,000 each, to attend the 2019 Vascular Annual Meeting and to visit clinical, teaching and research facilities in the U.S. and Canada.