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Meet the new CHEST Physician Editor in Chief
Angel O. Coz Yataco, MD, FCCP, is a Pulmonary and Critical Care specialist at the Respiratory Institute at the Cleveland Clinic. He previously served as the Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center and was an Associate Professor of Medicine at the University of Kentucky. Dr. Coz received his medical degree from Universidad Peruana Cayetano Heredia in Lima, Peru. He completed residency training in internal medicine and did his fellowship training in pulmonary and critical care medicine at Henry Ford Hospital.
Dr. Coz was a member of the 2021 Surviving Sepsis Campaign Guidelines panel and serves on the American Board of Internal Medicine Governance – Critical Care Medicine examination board. He holds multiple leadership positions at CHEST—Chair of the Council of NetWorks; a member of the Guidelines Oversight Committee; and served as the Critical Care Section Editor for CHEST Physician since 2018. He has been awarded the Distinguished CHEST Educator (DCE) designation every year since its inception in 2018 and received the CHEST Presidential Citation Award in 2021.
Dr. Coz has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international level. He has published several peer-reviewed articles and serves as ad hoc reviewer for CHEST, Journal of Critical Care, Critical Care Medicine, Critical Connections, Intensive Care Medicine, and Annals of Pharmacotherapy, among others.
Angel O. Coz Yataco, MD, FCCP, is a Pulmonary and Critical Care specialist at the Respiratory Institute at the Cleveland Clinic. He previously served as the Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center and was an Associate Professor of Medicine at the University of Kentucky. Dr. Coz received his medical degree from Universidad Peruana Cayetano Heredia in Lima, Peru. He completed residency training in internal medicine and did his fellowship training in pulmonary and critical care medicine at Henry Ford Hospital.
Dr. Coz was a member of the 2021 Surviving Sepsis Campaign Guidelines panel and serves on the American Board of Internal Medicine Governance – Critical Care Medicine examination board. He holds multiple leadership positions at CHEST—Chair of the Council of NetWorks; a member of the Guidelines Oversight Committee; and served as the Critical Care Section Editor for CHEST Physician since 2018. He has been awarded the Distinguished CHEST Educator (DCE) designation every year since its inception in 2018 and received the CHEST Presidential Citation Award in 2021.
Dr. Coz has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international level. He has published several peer-reviewed articles and serves as ad hoc reviewer for CHEST, Journal of Critical Care, Critical Care Medicine, Critical Connections, Intensive Care Medicine, and Annals of Pharmacotherapy, among others.
Angel O. Coz Yataco, MD, FCCP, is a Pulmonary and Critical Care specialist at the Respiratory Institute at the Cleveland Clinic. He previously served as the Medical Director of the Intensive Care Unit at the Lexington Veterans Affairs Medical Center and was an Associate Professor of Medicine at the University of Kentucky. Dr. Coz received his medical degree from Universidad Peruana Cayetano Heredia in Lima, Peru. He completed residency training in internal medicine and did his fellowship training in pulmonary and critical care medicine at Henry Ford Hospital.
Dr. Coz was a member of the 2021 Surviving Sepsis Campaign Guidelines panel and serves on the American Board of Internal Medicine Governance – Critical Care Medicine examination board. He holds multiple leadership positions at CHEST—Chair of the Council of NetWorks; a member of the Guidelines Oversight Committee; and served as the Critical Care Section Editor for CHEST Physician since 2018. He has been awarded the Distinguished CHEST Educator (DCE) designation every year since its inception in 2018 and received the CHEST Presidential Citation Award in 2021.
Dr. Coz has given multiple talks on critical care, sepsis, and pulmonary topics at the national and international level. He has published several peer-reviewed articles and serves as ad hoc reviewer for CHEST, Journal of Critical Care, Critical Care Medicine, Critical Connections, Intensive Care Medicine, and Annals of Pharmacotherapy, among others.
Welcome our new board members
Humayun Anjum, MD
Dr. Anjum is currently working as a pulmonary and critical care physician at Baylor Scott & White Medical Center- Grapevine in Dallas, Texas.
He is an Adjunct Clinical Assistant Professor at University of Houston and University of North Texas. He recently moved to Dallas from Corpus Christi, Texas where, he served as the core faculty for the Internal Medicine residency program and the Pulmonary Disease fellowship program. He is passionate about learning and teaching and has been very intricately involved with CHEST and the CHEST Foundation for the last few years. Currently, he serves as the chair of the Practice Operations Network steering committee. Dr. Anjum is particularly interested in medical practice management and administration and hopes to continue sharing his knowledge through various platforms to help his fellow physicians.
Loren J. Harris, MD FACS FCCP
Dr. Harris is the Chairman of the Department of Surgery and Chief of Thoracic Surgery at Richmond University Medical Center in Staten Island, NY.
He has been in clinical surgical practice for over 20 years and also has over 20 years of experience teaching both medical students and surgical residents and fellows. In addition, he served as Program Director of the general surgery residency program at Maimonides Medical Center from 2014 to 2017. Dr. Harris has published and presented throughout his career both nationally and internationally. His main research and clinical interests are in the appropriate staging and treatment of non-small cell lung cancer. He served as the Chair of the CHEST Marketing Committee; was the editor Pulmonary Perspectives; and is a co-author on two chapters in the most recent edition of the Diagnosis and Management Guidelines for Lung Cancer published by CHEST in 2013. Dr. Harris has also received several prestigious awards including the CHEST Soffer Award for Editorial Excellence.
Diego Maselli, MD
Dr. Maselli is an Associate Professor of Medicine in the Division of Pulmonary Diseases & Critical Care Medicine at UT Health in San Antonio.
He is the director of the Severe Asthma Program at UT Health and his research focuses on severe asthma, COPD, and bronchiectasis. Dr. Maselli has been designated a Distinguished CHEST Educator since 2017 when the program was initiated. He serves on the steering committee of the Airways Network.
Daniel R. Ouellette, MD
Dr. Ouellette has been a clinician, teacher, and researcher in pulmonary and critical care medicine for 35 years.
He is currently a Senior Staff Physician at Henry Ford Hospital in Detroit where he is the Medical Director for the Pulmonary Ward. He is also an Associate Clinical Professor of Medicine at the Wayne State University School of Medicine, and the Medical Director of the Respiratory Therapy program at Oakland Community College. Dr. Ouellette has over 20 years of military service and was the Consultant to the US Army Surgeon General for Pulmonary Medicine during the last several years of his military career. An active CHEST leader, he has chaired the Guideline Oversight Committee, the Clinical Pulmonary Network, and the Council of Governors, has been a member of the Board of Regents, and held many leadership roles with CHEST and other societies in the development of evidence-based clinical practice guidelines. Dr. Ouellette’s clinical areas of interest include general pulmonary and critical care medicine and evidence-based practice.
Saiprakash Venkateshiah, MD, FCCP
Dr. Venkateshiah is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University, Atlanta, GA.
He is a clinician educator and a “general pulmonologist” practicing the entire gamut of pulmonary, critical care, and sleep medicine. Dr. Venkateshiah has been a CHEST member for close to 2 decades. He has been involved with CHEST NetWork leadership since 2012, starting as steering committee member of Clinical Pulmonary Medicine Network transitioning to Vice-Chair and Chair. He was previously a member of the Executive Committee of the Council of Networks and the Scientific Program Committee for CHEST 2019 and CHEST 2020. He is currently a steering committee member of the education committees of CHEST and American Academy of Sleep Medicine. He is also a steering committee member of the CHEST Sleep NetWork.
Humayun Anjum, MD
Dr. Anjum is currently working as a pulmonary and critical care physician at Baylor Scott & White Medical Center- Grapevine in Dallas, Texas.
He is an Adjunct Clinical Assistant Professor at University of Houston and University of North Texas. He recently moved to Dallas from Corpus Christi, Texas where, he served as the core faculty for the Internal Medicine residency program and the Pulmonary Disease fellowship program. He is passionate about learning and teaching and has been very intricately involved with CHEST and the CHEST Foundation for the last few years. Currently, he serves as the chair of the Practice Operations Network steering committee. Dr. Anjum is particularly interested in medical practice management and administration and hopes to continue sharing his knowledge through various platforms to help his fellow physicians.
Loren J. Harris, MD FACS FCCP
Dr. Harris is the Chairman of the Department of Surgery and Chief of Thoracic Surgery at Richmond University Medical Center in Staten Island, NY.
He has been in clinical surgical practice for over 20 years and also has over 20 years of experience teaching both medical students and surgical residents and fellows. In addition, he served as Program Director of the general surgery residency program at Maimonides Medical Center from 2014 to 2017. Dr. Harris has published and presented throughout his career both nationally and internationally. His main research and clinical interests are in the appropriate staging and treatment of non-small cell lung cancer. He served as the Chair of the CHEST Marketing Committee; was the editor Pulmonary Perspectives; and is a co-author on two chapters in the most recent edition of the Diagnosis and Management Guidelines for Lung Cancer published by CHEST in 2013. Dr. Harris has also received several prestigious awards including the CHEST Soffer Award for Editorial Excellence.
Diego Maselli, MD
Dr. Maselli is an Associate Professor of Medicine in the Division of Pulmonary Diseases & Critical Care Medicine at UT Health in San Antonio.
He is the director of the Severe Asthma Program at UT Health and his research focuses on severe asthma, COPD, and bronchiectasis. Dr. Maselli has been designated a Distinguished CHEST Educator since 2017 when the program was initiated. He serves on the steering committee of the Airways Network.
Daniel R. Ouellette, MD
Dr. Ouellette has been a clinician, teacher, and researcher in pulmonary and critical care medicine for 35 years.
He is currently a Senior Staff Physician at Henry Ford Hospital in Detroit where he is the Medical Director for the Pulmonary Ward. He is also an Associate Clinical Professor of Medicine at the Wayne State University School of Medicine, and the Medical Director of the Respiratory Therapy program at Oakland Community College. Dr. Ouellette has over 20 years of military service and was the Consultant to the US Army Surgeon General for Pulmonary Medicine during the last several years of his military career. An active CHEST leader, he has chaired the Guideline Oversight Committee, the Clinical Pulmonary Network, and the Council of Governors, has been a member of the Board of Regents, and held many leadership roles with CHEST and other societies in the development of evidence-based clinical practice guidelines. Dr. Ouellette’s clinical areas of interest include general pulmonary and critical care medicine and evidence-based practice.
Saiprakash Venkateshiah, MD, FCCP
Dr. Venkateshiah is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University, Atlanta, GA.
He is a clinician educator and a “general pulmonologist” practicing the entire gamut of pulmonary, critical care, and sleep medicine. Dr. Venkateshiah has been a CHEST member for close to 2 decades. He has been involved with CHEST NetWork leadership since 2012, starting as steering committee member of Clinical Pulmonary Medicine Network transitioning to Vice-Chair and Chair. He was previously a member of the Executive Committee of the Council of Networks and the Scientific Program Committee for CHEST 2019 and CHEST 2020. He is currently a steering committee member of the education committees of CHEST and American Academy of Sleep Medicine. He is also a steering committee member of the CHEST Sleep NetWork.
Humayun Anjum, MD
Dr. Anjum is currently working as a pulmonary and critical care physician at Baylor Scott & White Medical Center- Grapevine in Dallas, Texas.
He is an Adjunct Clinical Assistant Professor at University of Houston and University of North Texas. He recently moved to Dallas from Corpus Christi, Texas where, he served as the core faculty for the Internal Medicine residency program and the Pulmonary Disease fellowship program. He is passionate about learning and teaching and has been very intricately involved with CHEST and the CHEST Foundation for the last few years. Currently, he serves as the chair of the Practice Operations Network steering committee. Dr. Anjum is particularly interested in medical practice management and administration and hopes to continue sharing his knowledge through various platforms to help his fellow physicians.
Loren J. Harris, MD FACS FCCP
Dr. Harris is the Chairman of the Department of Surgery and Chief of Thoracic Surgery at Richmond University Medical Center in Staten Island, NY.
He has been in clinical surgical practice for over 20 years and also has over 20 years of experience teaching both medical students and surgical residents and fellows. In addition, he served as Program Director of the general surgery residency program at Maimonides Medical Center from 2014 to 2017. Dr. Harris has published and presented throughout his career both nationally and internationally. His main research and clinical interests are in the appropriate staging and treatment of non-small cell lung cancer. He served as the Chair of the CHEST Marketing Committee; was the editor Pulmonary Perspectives; and is a co-author on two chapters in the most recent edition of the Diagnosis and Management Guidelines for Lung Cancer published by CHEST in 2013. Dr. Harris has also received several prestigious awards including the CHEST Soffer Award for Editorial Excellence.
Diego Maselli, MD
Dr. Maselli is an Associate Professor of Medicine in the Division of Pulmonary Diseases & Critical Care Medicine at UT Health in San Antonio.
He is the director of the Severe Asthma Program at UT Health and his research focuses on severe asthma, COPD, and bronchiectasis. Dr. Maselli has been designated a Distinguished CHEST Educator since 2017 when the program was initiated. He serves on the steering committee of the Airways Network.
Daniel R. Ouellette, MD
Dr. Ouellette has been a clinician, teacher, and researcher in pulmonary and critical care medicine for 35 years.
He is currently a Senior Staff Physician at Henry Ford Hospital in Detroit where he is the Medical Director for the Pulmonary Ward. He is also an Associate Clinical Professor of Medicine at the Wayne State University School of Medicine, and the Medical Director of the Respiratory Therapy program at Oakland Community College. Dr. Ouellette has over 20 years of military service and was the Consultant to the US Army Surgeon General for Pulmonary Medicine during the last several years of his military career. An active CHEST leader, he has chaired the Guideline Oversight Committee, the Clinical Pulmonary Network, and the Council of Governors, has been a member of the Board of Regents, and held many leadership roles with CHEST and other societies in the development of evidence-based clinical practice guidelines. Dr. Ouellette’s clinical areas of interest include general pulmonary and critical care medicine and evidence-based practice.
Saiprakash Venkateshiah, MD, FCCP
Dr. Venkateshiah is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University, Atlanta, GA.
He is a clinician educator and a “general pulmonologist” practicing the entire gamut of pulmonary, critical care, and sleep medicine. Dr. Venkateshiah has been a CHEST member for close to 2 decades. He has been involved with CHEST NetWork leadership since 2012, starting as steering committee member of Clinical Pulmonary Medicine Network transitioning to Vice-Chair and Chair. He was previously a member of the Executive Committee of the Council of Networks and the Scientific Program Committee for CHEST 2019 and CHEST 2020. He is currently a steering committee member of the education committees of CHEST and American Academy of Sleep Medicine. He is also a steering committee member of the CHEST Sleep NetWork.
Staying home, staying connected
Fundraising in a virtual environment
When the United States went into a 2-week quarantine to slow the spread of the COVID-19 coronavirus in March 2020, everything changed. In the months following, social distancing, working from home, and wearing masks became the norm, and life needed to find a way to go on.
The world adapted to a virtual environment, but some of the hardest hit by this change were non-profit organizations that relied on in-person contact to encourage donations that support their worthwhile missions.
This was even more challenging for the CHEST Foundation as our donors work on the front lines of the pandemic.
“It was important for us to not only stay engaged with our donors but also to recognize what those on the front lines are dealing with,” says Angela Perillo, Director, Development & Foundation Operations at the American College of Chest Physicians. “Through these events, we wanted to provide some respite from the stresses of their long days.”
The CHEST Foundation is about championing lung health, and there was no greater awareness of the need than now. It was time to get creative.
Viva la vino
A well-known “secret” is CHEST CEO Bob Mussachio’s love of wine, and he’s not alone in his passion for the grape. Perillo put this knowledge to good use creating a wine tasting series that took people around the world one bottle at a time.
The online Viva La Vino evening gatherings serve to bring donors together for a night of good wines and good conversation. A benefit to the virtual wine nights is that no one has to travel but that it keeps the group together and keeps the Foundation at the forefront of everyone’s minds.
“I love attending the wine nights. They are so interesting, and I get to see people who don’t live in New York – it’s just great,” says regular participant Ilene (Lenie) Rosen.
The wines are shipped directly to the participants’ homes and during the online Zoom session, Mussachio guides the tasting by scrolling through a presentation on the wine’s background and what to expect from the taste. As the wines are tasted, the participants have a chance to share their review.
“It’s always enthralling to me how much our members know about wine. It makes for a really fun evening listening to their critiques and even learning a bit myself. These events have provided a great platform to stay engaged with our donors and enjoy an evening at home with company,” says Perillo.
Doubling down on a good cause
After hosting its in-person event in the first week of March 2020, the Irv Feldman Texas Hold ’Em poker tournament also shifted to a virtual environment to stay engaged with its players.
Supported by the CHEST Foundation, the Feldman Family Foundation created a series of poker tournaments through an online platform that worked with Zoom to retain the engagement offered by in-person events. Through the Zoom call, players are able to talk to each other either in the main room or in breakout rooms created for each table.
Poker player and recent winner of one of the tournaments, Kim Coles started playing professionally during the pandemic and enjoys playing in an online environment.
“I had participated in charity poker tournaments before, but it wasn’t until I joined Poker Power—a group focused on teaching women how to play poker—that I really came to the table ready to compete,” says Coles. “Playing in an online setting is a lot more accessible for a lot of people, especially for women. A traditional poker tournament can be intimidating to a new player, but online has a way of evening the playing field.”
In an online setting, Feldman and Coles both note that buying in is a lot easier and lends itself well to fundraising.
“There is no fumbling around for your wallet or having to swipe your credit card,” says Coles. “It’s just the press of a button, and your credit card is already linked. It’s all going to a good cause, so it makes sense to keep buying in to keep playing.”
Looking into the future, while Feldman says that the virtual events have been successful, there’s nothing like in-person.
“Through our virtual events, we were able to expand our network of players beyond the Chicagoland area, and these individuals have expressed their interest in attending our live events,” says Feldman. “With this extended network, I am very much looking forward to being able to get together in-person again for what I expect be one of our best tournaments to date.”
The 8th Annual Irv Feldman Texas Hold ‘Em Annual Tournament & Casino Night will be held in early April 2022 in the Chicago suburbs, and all are welcome to attend. Visit the CHEST Foundation’s website to learn more about the tournament and upcoming events at chestfoundation.org.
Fundraising in a virtual environment
Fundraising in a virtual environment
When the United States went into a 2-week quarantine to slow the spread of the COVID-19 coronavirus in March 2020, everything changed. In the months following, social distancing, working from home, and wearing masks became the norm, and life needed to find a way to go on.
The world adapted to a virtual environment, but some of the hardest hit by this change were non-profit organizations that relied on in-person contact to encourage donations that support their worthwhile missions.
This was even more challenging for the CHEST Foundation as our donors work on the front lines of the pandemic.
“It was important for us to not only stay engaged with our donors but also to recognize what those on the front lines are dealing with,” says Angela Perillo, Director, Development & Foundation Operations at the American College of Chest Physicians. “Through these events, we wanted to provide some respite from the stresses of their long days.”
The CHEST Foundation is about championing lung health, and there was no greater awareness of the need than now. It was time to get creative.
Viva la vino
A well-known “secret” is CHEST CEO Bob Mussachio’s love of wine, and he’s not alone in his passion for the grape. Perillo put this knowledge to good use creating a wine tasting series that took people around the world one bottle at a time.
The online Viva La Vino evening gatherings serve to bring donors together for a night of good wines and good conversation. A benefit to the virtual wine nights is that no one has to travel but that it keeps the group together and keeps the Foundation at the forefront of everyone’s minds.
“I love attending the wine nights. They are so interesting, and I get to see people who don’t live in New York – it’s just great,” says regular participant Ilene (Lenie) Rosen.
The wines are shipped directly to the participants’ homes and during the online Zoom session, Mussachio guides the tasting by scrolling through a presentation on the wine’s background and what to expect from the taste. As the wines are tasted, the participants have a chance to share their review.
“It’s always enthralling to me how much our members know about wine. It makes for a really fun evening listening to their critiques and even learning a bit myself. These events have provided a great platform to stay engaged with our donors and enjoy an evening at home with company,” says Perillo.
Doubling down on a good cause
After hosting its in-person event in the first week of March 2020, the Irv Feldman Texas Hold ’Em poker tournament also shifted to a virtual environment to stay engaged with its players.
Supported by the CHEST Foundation, the Feldman Family Foundation created a series of poker tournaments through an online platform that worked with Zoom to retain the engagement offered by in-person events. Through the Zoom call, players are able to talk to each other either in the main room or in breakout rooms created for each table.
Poker player and recent winner of one of the tournaments, Kim Coles started playing professionally during the pandemic and enjoys playing in an online environment.
“I had participated in charity poker tournaments before, but it wasn’t until I joined Poker Power—a group focused on teaching women how to play poker—that I really came to the table ready to compete,” says Coles. “Playing in an online setting is a lot more accessible for a lot of people, especially for women. A traditional poker tournament can be intimidating to a new player, but online has a way of evening the playing field.”
In an online setting, Feldman and Coles both note that buying in is a lot easier and lends itself well to fundraising.
“There is no fumbling around for your wallet or having to swipe your credit card,” says Coles. “It’s just the press of a button, and your credit card is already linked. It’s all going to a good cause, so it makes sense to keep buying in to keep playing.”
Looking into the future, while Feldman says that the virtual events have been successful, there’s nothing like in-person.
“Through our virtual events, we were able to expand our network of players beyond the Chicagoland area, and these individuals have expressed their interest in attending our live events,” says Feldman. “With this extended network, I am very much looking forward to being able to get together in-person again for what I expect be one of our best tournaments to date.”
The 8th Annual Irv Feldman Texas Hold ‘Em Annual Tournament & Casino Night will be held in early April 2022 in the Chicago suburbs, and all are welcome to attend. Visit the CHEST Foundation’s website to learn more about the tournament and upcoming events at chestfoundation.org.
When the United States went into a 2-week quarantine to slow the spread of the COVID-19 coronavirus in March 2020, everything changed. In the months following, social distancing, working from home, and wearing masks became the norm, and life needed to find a way to go on.
The world adapted to a virtual environment, but some of the hardest hit by this change were non-profit organizations that relied on in-person contact to encourage donations that support their worthwhile missions.
This was even more challenging for the CHEST Foundation as our donors work on the front lines of the pandemic.
“It was important for us to not only stay engaged with our donors but also to recognize what those on the front lines are dealing with,” says Angela Perillo, Director, Development & Foundation Operations at the American College of Chest Physicians. “Through these events, we wanted to provide some respite from the stresses of their long days.”
The CHEST Foundation is about championing lung health, and there was no greater awareness of the need than now. It was time to get creative.
Viva la vino
A well-known “secret” is CHEST CEO Bob Mussachio’s love of wine, and he’s not alone in his passion for the grape. Perillo put this knowledge to good use creating a wine tasting series that took people around the world one bottle at a time.
The online Viva La Vino evening gatherings serve to bring donors together for a night of good wines and good conversation. A benefit to the virtual wine nights is that no one has to travel but that it keeps the group together and keeps the Foundation at the forefront of everyone’s minds.
“I love attending the wine nights. They are so interesting, and I get to see people who don’t live in New York – it’s just great,” says regular participant Ilene (Lenie) Rosen.
The wines are shipped directly to the participants’ homes and during the online Zoom session, Mussachio guides the tasting by scrolling through a presentation on the wine’s background and what to expect from the taste. As the wines are tasted, the participants have a chance to share their review.
“It’s always enthralling to me how much our members know about wine. It makes for a really fun evening listening to their critiques and even learning a bit myself. These events have provided a great platform to stay engaged with our donors and enjoy an evening at home with company,” says Perillo.
Doubling down on a good cause
After hosting its in-person event in the first week of March 2020, the Irv Feldman Texas Hold ’Em poker tournament also shifted to a virtual environment to stay engaged with its players.
Supported by the CHEST Foundation, the Feldman Family Foundation created a series of poker tournaments through an online platform that worked with Zoom to retain the engagement offered by in-person events. Through the Zoom call, players are able to talk to each other either in the main room or in breakout rooms created for each table.
Poker player and recent winner of one of the tournaments, Kim Coles started playing professionally during the pandemic and enjoys playing in an online environment.
“I had participated in charity poker tournaments before, but it wasn’t until I joined Poker Power—a group focused on teaching women how to play poker—that I really came to the table ready to compete,” says Coles. “Playing in an online setting is a lot more accessible for a lot of people, especially for women. A traditional poker tournament can be intimidating to a new player, but online has a way of evening the playing field.”
In an online setting, Feldman and Coles both note that buying in is a lot easier and lends itself well to fundraising.
“There is no fumbling around for your wallet or having to swipe your credit card,” says Coles. “It’s just the press of a button, and your credit card is already linked. It’s all going to a good cause, so it makes sense to keep buying in to keep playing.”
Looking into the future, while Feldman says that the virtual events have been successful, there’s nothing like in-person.
“Through our virtual events, we were able to expand our network of players beyond the Chicagoland area, and these individuals have expressed their interest in attending our live events,” says Feldman. “With this extended network, I am very much looking forward to being able to get together in-person again for what I expect be one of our best tournaments to date.”
The 8th Annual Irv Feldman Texas Hold ‘Em Annual Tournament & Casino Night will be held in early April 2022 in the Chicago suburbs, and all are welcome to attend. Visit the CHEST Foundation’s website to learn more about the tournament and upcoming events at chestfoundation.org.
Our CHEST 2021 Award Recipients
ANNUAL AWARDS
Master FCCP
Curtis N. Sessler, MD, Master FCCP
College Medalist Award
Margaret Pisani, MD, MPH, FCCP
Distinguished Service Award
Christopher Carroll, MD, FCCP
Master Clinician Educator
Doreen Addrizzo-Harris, MD, FCCP
Early Career Clinician Educator
Matthew C. Miles, MD, FCCP
Alfred Soffer Award for Editorial Excellence
Scott Manaker, MD, PhD, FCCP
Presidential Citation
COVID-19 Task Force
Ryan Maves, MD, FCCP
Christopher Carroll, MD, FCCP
Neha Dangayach, MD
Jeffrey Dichter, MD, FCCP
Alice Gallo De Moraes, MD
James Geiling, MD, MPH, FCCP
Holly Keyt, MD, FCCP
Stephanie M. Levine, MD, FCCP
Septimu Murgu, MD, FCCP
Marcos Restrepo, MD, PhD, FCCP
Steven Q. Simpson, MD, FCCP
Angel Coz Yataco, MD, FCCP
Staff: Katlyn Froslan, Heather Watkins, Robb Rabito, CHCP, Lilly Rodriguez, Karla Velilla
HONOR LECTURE AND MEMORIAL AWARDS
Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
KENNETH I. BERGER, MD, FCCP
Probing the Small Airways in the Assessment of Dyspnea
The lecture is generously funded by the CHEST Foundation.
Presidential Honor Lecture
CURTIS N. SESSLER, MD, Master FCCP
Navigating the Road to Well-Being in the ICU
Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation
DEBRA WEESE-MAYER, MD
Artificial Ventilation, a True Life-Saver for Children with CCHS & ROHHAD
The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.
RICHARD S. IRWIN, MD, MASTER FCCP HONOR LECTURE
PETER J. MAZZONE, MD, MPH, FCCP
Shared Decision Making in the Evaluation and Management of Early Stage Lung Cancer
The lecture is generously funded by the CHEST Foundation.
Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
DIANE E. STOVER, MD, FCCP
The Many Faces of Organizing Pneumonia—What’s the O(O)P With That?
The lecture is generously funded by the CHEST Foundation.
Pasquale Ciaglia Memorial Lecture in Interventional Medicine
MICHAEL J. SIMOFF, MD, FCCP
Robotic Bronchoscopy: Platform to the Future?
The lecture is generously funded by the CHEST Foundation.
Roger C. Bone Memorial Lecture in Critical Care
OGNJEN GAJIC, MD, FCCP
Patient Comes First: Prioritizing Relevant From Irrelevant in Critical Care Medicine
The lecture is generously funded by the CHEST Foundation.
Thomas L. Petty, MD, Master FCCP Memorial Lecture
JEAN BOURBEAU, MD, FCCP
Pulmonary Rehabilitation and Self-Management in COPD: Understanding the Past to Build the Future
The lecture is generously funded by the CHEST Foundation.
CHEST FOUNDATION GRANT AWARDS
CHEST Foundation Research Grant in Lung Cancer
This grant is supported by the CHEST Foundation.
Daniel Ryan, MD, Royal College of Surgeons Ireland, Dublin, Ireland
Microbial Signatures Associated With Malignant Pleural Effusions in Lung Cancer
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is jointly supported by the CHEST Foundation and RHA.
Miguel Divo, MD, Brigham and Women’s Hospital, Boston, MA
Biomarker Profiles in Smokers Who Are at Risk of Developing Chronic Obstructive Pulmonary Disease (COPD)
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is supported by AstraZeneca LP.
Stephen Milne, MBBS, Woolcock Institute of Medical Research, Vancouver, BC, Canada
The Oral Metagenome in COPD: Towards a Biomarker of Exacerbation Risk
CHEST Foundation Research Grant in Critical Care
This grant is supported by the CHEST Foundation.
Jacqueline Stocking, PhD, University of California, Davis, Davis, CA
University of California Critical Care Research Collaborative: Predictive Model and Risk Calculator for Early and Late Postoperative Respiratory Failure
CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.
John Charles Rotondo, PhD, University of Ferrara, Ferrara, Italy
Alpha-1 Antitrypsin Protein as a Possible Marker of Disease Progression in COVID-19 Patients
CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
This grant is supported by Insmed Incorporated.
Edward Chan, MD, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
Visualization and Quantitation of Azithromycin, Clofazimine, and Amikacin Distribution in Surgically Removed Lung Tissues From Patients With Nontuberculous Mycobacterial Lung Disease
CHEST Foundation Research Grant in Cystic Fibrosis
This grant is supported by Vertex Pharmaceuticals Incorporated.
Shahid Sheikh, MD, FCCP, Nationwide Children’s Hospital, Columbus, OH
Impact of CFTR Modulator Therapy Elexacaftor-Tezacaftor-Ivacaftor on CF- Related Chronic Sinus Disease
John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
This grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.
Maneesh Bhargava, MD, PhD, FCCP, Minneapolis VA Health Care System, Minneapolis, MN
Inflammatory Protein Panel for Sarcoidosis Diagnosis and Prognosis
CHEST Foundation Research Grant in Severe Asthma
This grant is supported by the CHEST Foundation.
Felix Reyes, MD, Montefiore Medical Center, Bronx, NY
Design and Implementation of an Asthma Action Plan Generator: A Pilot Study Assessing User Satisfaction and Clinical Impact
CHEST Foundation Research Grant in Pulmonary Fibrosis
These grants are supported by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Genentech, Inc.
Marco Mura, MD, PhD, Western University, London, Ontario, Canada
Validation of the Risk Stratification Score in Idiopathic Pulmonary Fibrosis
Janelle Pugashetti, MD, University of California, Davis, Davis, CA
Determining Biomarkers of Immunosuppressant Responsiveness in Patients With CTD-ILD
CHEST Foundation Research Grant in Pulmonary Hypertension
These grants are supported by the CHEST Foundation.
Michael Lee, MD, University of California San Francisco, San Francisco, CA
Transpulmonary Metabolomic Gradients During Exercise in Systemic Sclerosis-Associated Pulmonary Hypertension
Navneet Singh, MD, Warren Alpert School of Medicine at Brown University, Providence, RI
Mitochondrial Dysfunction and Oxidative Stress in Pulmonary Hypertension
CHEST Foundation Research Grant in Sleep Medicine
These grants are funded by Jazz Pharmaceuticals, Inc.
Shahid Karim, MBChB, Mayo Clinic, Rochester, MN
Effects of OSA on Atrial and Ventricular Arrhythmia in HCM: An Incidence Study
Thomas Tolbert, MD, Mount Sinai Hospital, New York, NY
Performance Characteristics of Obstructive Sleep Apnea Physiologic Traits Measured by Phenotyping Using Polysomnography
CHEST Foundation and American Academy of Sleep Medicine Foundation Research Grant in Sleep Medicine
This grant is jointly supported by the CHEST Foundation and AASM Foundation.
Marta Kaminska, MD, McGill University Health Centre, Montreal, QC, Canada
Long-term Noninvasive Ventilation in COPD: Impact on Health Care Utilization
CHEST Foundation and APCCMPD Research Grant in Medical Education
This grant is jointly supported by the CHEST Foundation and APCCMPD.
Mark Adelman, MD, NYU School of Medicine, New York, NY
Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies
CHEST Foundation Research Grant in COVID-19
These grants are supported by the CHEST Foundation.
Marlene Cano, MD, PhD, Washington University, St. Louis, MO
Circulating Mitochondrial DNA Is a Potential Biomarker for Severe Illness in COVID-19
Brandon Walsh, MD, New York University, New York, NY
How Would Existing Ventilator Allocation Guidelines Perform During the COVID-19 Pandemic: A Retrospective Observational Simulated Cohort Study
CHEST Foundation and ATS Research Grant in COVID-19 and Diversity
These grants are jointly supported by the CHEST Foundation and ATS.
Navitha Ramesh, MD, FCCP, UPMC Harrisburg, Harrisburg, PA
Improving Lung Health in the Nepali- Bhutanese Refugee Community in Harrisburg, PA
Inderjit Singh, MBBCh, Yale University, New Haven, CT
Dynamic Invasive Hemodynamic, Echocardiographic, and Plasma Biomarker Phenotyping in Post-COVID-19 Long Hauler Syndrome
CHEST Foundation Community Service Grants Honoring D. Robert McCaffree, MD, Master FCCP
Valerie Andrews, BS, The JUDAHH Project, Sacramento, CA
Asthma Mitigation Project
Chanda Holsey, DrPh, National Medical Association, Silver Spring, MD
Providing Lung Health Education to At Risk Communities
Arzu Ari, PhD, FCCP, Texas State University, San Marcos, TX
Training Future Respiratory Care Practitioners in Turkey: A Path to Successful Disease Management in Pulmonary Medicine
Panagis Galiatsatos, MD, MPH, John Hopkins University, Baltimore, MD
The Lung Health Ambassador Program: A Health Equity Initiative for Cystic Fibrosis
Patricia George, MD, National Jewish Health, Denver, CO
Development of Breathe Strong PH: An Informational Website About Pulmonary Hypertension and Related Diseases
Nishant Gupta, MD, MS, University of Cincinnati, Cincinnati, OH
Global Dissemination of the Lymphangioleiomyomatosis (LAM) Clinical Practice Guidelines
Syed Naqvi, MD, MBBS, Hoag Hospital Newport Beach, Newport Beach, CA
Asthma Managment in Rural Pakistan
These grants are supported by the CHEST Foundation.
Alfred Soffer Research Award Winners
Mathieu Saint-Pierre, MD: Methacholine Challenge Testing: A Clinical Prediction Model Utilizing Demographic Data And Spirometry Results
Tie: Milind K Bhagat, MD: High Flow Nasal Cannula Fio2 Cutoffs Identified Early In The Hospital Course Are Associated With Increased Mortality Risk In Hospitalized Patients With COVID-19
Amber J Meservey, MD: Outcomes Of Patients Across The Spectrum Of Pulmonary Hypertension Groups Prescribed Inhaled Treprostinil
Young Investigator Award Winners
William B. Feldman, MD: COPD Exacerbations And Pneumonia Hospitalizations In New Users Of Combination Maintenance Inhalers: A Comparative Effectiveness And Safety Study
Christopher Streiler, MD: Community Pulmonologist Access To Multidisciplinary Discussion At An Academic Referral Center Leads To Changes In Management Of Interstitial Lung Disease
Top 5 Abstract Posters
Winner: Riley Kermanian: Management Of Coronary Artery Calcification In Patients Enrolled In A Low-Dose Computerized Tomography Lung Cancer Screening Program
Winner: Rohit Reddy: Outcomes Of Extracorporeal Membrane Oxygenation In ARDS Due To Covid-19: Comparison Of The First And The Second Wave
Winner: Taylor A. Intihar, BA: Light Patterns Of The Medical ICU: Are We Disrupting Circadian Rhythms?
Runner up: Jason Wong, MD: Completion Of Pulmonary Rehabilitation Is Associated With Improvement In Depression Scores And Other Quality Of Life Measures In Patients With Interstitial Lung Disease
Runner up: Harshil Shah, MD: Impact Of Sepsis On Outcomes Of Hospitalizations Due To COPD
Case Report Session Winners
Remarkable Pulmonary Cases: Mena Botros, MD: Clinical Outcomes In Lung Transplant Recipients With SARS-COV2
Bacterial Infections: Benjamin Carmel, DO: Cotton Swab Today, Brain Abscess Tomorrow
Challenging Critical Care Cases: Rajaninder Sharma, MD: Pulmonary Tumor Thrombotic Microangiopathy: The Rare And Fatal Association Of Adenocarcinoma And Right Ventricular Failure
Diffuse Lung Diseases: Rizwana RR Rana, MBBS: A Rare Cause Of Pulmonary Nodules
Viruses, Fungi, and Parasites Infections: Michelle Forson, MD: Strongyloidiasis-Related Eosinophilic Pleural Effusion: An Unexpected Differential For Post-Cardiac Injury Syndrome
Critical Care Cases: Act Quickly: Christina Jee Ah Rhee, MD: Airway Implications Of Cricoarytenoid Arthritis: A Report And Review Of The Literature
Airway Issues: Benadin Varajic, MD: An Unusual And Life-Threatening Complication Of Endotracheal Intubation
Miscellaneous Cases 1: Shrey Shah, MD: A Case Of Pulmonary Arterial Hypertension From Vitamin C Deficiency
Miscellaneous Cases 2: Glenn W. Pottmeyer, DO, MPH: Biliary Stent Migration: A Rare Cause Of Right-Sided Pulmonary Abscess
Case Report Poster Winners
Advanced Cancer Case Report Posters: Sangita Goel, MD: Let’s Meet in the Middle: Simultaneous Endoscopic and Bronchoscopic Suture Repair to Close a Left Main-Stem Malignant Broncho-Esophageal Fistula
Cardiovascular Case Report Posters: Marianna Weaver, DO: Swan-Ganz And Intra-Pericardial Pressure Guided Pericardiocentesis in Scleroderma-Associated PAH
Remarkable Cases Posters 1: Katie Capp, MD: Humidifier-Associated Hypersensitivity Pneumonitis
Remarkable Cases Posters 2: Sahar Samani, MD: Artifactual Hypoxemia in Patients With Hydroxyurea-Induced Blue Lunula Fingernails
CHEST 2021 CHEST Challenge
1st Place
The Ohio State University
Sarah Cohen, MD
Gregory Eisinger, MD
Kyle Stinehart, MD
Program Director: Jennifer McCallister, MD, FCCP
2nd Place
SUNY Buffalo
Arjun Saradna, MBBS
Rajesh Kunadharaju, MD
Ahmed Munir, MBBS
Program Director: Jeffrey Mador, MD
3rd Place
Interfaith Medical Center
Tahmina Jahir, MD
Ruby Risal, MD
Binav Shrestha, MBBS
Program Director: Marie Frances Schmidt, MD, FCCP
ANNUAL AWARDS
Master FCCP
Curtis N. Sessler, MD, Master FCCP
College Medalist Award
Margaret Pisani, MD, MPH, FCCP
Distinguished Service Award
Christopher Carroll, MD, FCCP
Master Clinician Educator
Doreen Addrizzo-Harris, MD, FCCP
Early Career Clinician Educator
Matthew C. Miles, MD, FCCP
Alfred Soffer Award for Editorial Excellence
Scott Manaker, MD, PhD, FCCP
Presidential Citation
COVID-19 Task Force
Ryan Maves, MD, FCCP
Christopher Carroll, MD, FCCP
Neha Dangayach, MD
Jeffrey Dichter, MD, FCCP
Alice Gallo De Moraes, MD
James Geiling, MD, MPH, FCCP
Holly Keyt, MD, FCCP
Stephanie M. Levine, MD, FCCP
Septimu Murgu, MD, FCCP
Marcos Restrepo, MD, PhD, FCCP
Steven Q. Simpson, MD, FCCP
Angel Coz Yataco, MD, FCCP
Staff: Katlyn Froslan, Heather Watkins, Robb Rabito, CHCP, Lilly Rodriguez, Karla Velilla
HONOR LECTURE AND MEMORIAL AWARDS
Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
KENNETH I. BERGER, MD, FCCP
Probing the Small Airways in the Assessment of Dyspnea
The lecture is generously funded by the CHEST Foundation.
Presidential Honor Lecture
CURTIS N. SESSLER, MD, Master FCCP
Navigating the Road to Well-Being in the ICU
Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation
DEBRA WEESE-MAYER, MD
Artificial Ventilation, a True Life-Saver for Children with CCHS & ROHHAD
The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.
RICHARD S. IRWIN, MD, MASTER FCCP HONOR LECTURE
PETER J. MAZZONE, MD, MPH, FCCP
Shared Decision Making in the Evaluation and Management of Early Stage Lung Cancer
The lecture is generously funded by the CHEST Foundation.
Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
DIANE E. STOVER, MD, FCCP
The Many Faces of Organizing Pneumonia—What’s the O(O)P With That?
The lecture is generously funded by the CHEST Foundation.
Pasquale Ciaglia Memorial Lecture in Interventional Medicine
MICHAEL J. SIMOFF, MD, FCCP
Robotic Bronchoscopy: Platform to the Future?
The lecture is generously funded by the CHEST Foundation.
Roger C. Bone Memorial Lecture in Critical Care
OGNJEN GAJIC, MD, FCCP
Patient Comes First: Prioritizing Relevant From Irrelevant in Critical Care Medicine
The lecture is generously funded by the CHEST Foundation.
Thomas L. Petty, MD, Master FCCP Memorial Lecture
JEAN BOURBEAU, MD, FCCP
Pulmonary Rehabilitation and Self-Management in COPD: Understanding the Past to Build the Future
The lecture is generously funded by the CHEST Foundation.
CHEST FOUNDATION GRANT AWARDS
CHEST Foundation Research Grant in Lung Cancer
This grant is supported by the CHEST Foundation.
Daniel Ryan, MD, Royal College of Surgeons Ireland, Dublin, Ireland
Microbial Signatures Associated With Malignant Pleural Effusions in Lung Cancer
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is jointly supported by the CHEST Foundation and RHA.
Miguel Divo, MD, Brigham and Women’s Hospital, Boston, MA
Biomarker Profiles in Smokers Who Are at Risk of Developing Chronic Obstructive Pulmonary Disease (COPD)
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is supported by AstraZeneca LP.
Stephen Milne, MBBS, Woolcock Institute of Medical Research, Vancouver, BC, Canada
The Oral Metagenome in COPD: Towards a Biomarker of Exacerbation Risk
CHEST Foundation Research Grant in Critical Care
This grant is supported by the CHEST Foundation.
Jacqueline Stocking, PhD, University of California, Davis, Davis, CA
University of California Critical Care Research Collaborative: Predictive Model and Risk Calculator for Early and Late Postoperative Respiratory Failure
CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.
John Charles Rotondo, PhD, University of Ferrara, Ferrara, Italy
Alpha-1 Antitrypsin Protein as a Possible Marker of Disease Progression in COVID-19 Patients
CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
This grant is supported by Insmed Incorporated.
Edward Chan, MD, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
Visualization and Quantitation of Azithromycin, Clofazimine, and Amikacin Distribution in Surgically Removed Lung Tissues From Patients With Nontuberculous Mycobacterial Lung Disease
CHEST Foundation Research Grant in Cystic Fibrosis
This grant is supported by Vertex Pharmaceuticals Incorporated.
Shahid Sheikh, MD, FCCP, Nationwide Children’s Hospital, Columbus, OH
Impact of CFTR Modulator Therapy Elexacaftor-Tezacaftor-Ivacaftor on CF- Related Chronic Sinus Disease
John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
This grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.
Maneesh Bhargava, MD, PhD, FCCP, Minneapolis VA Health Care System, Minneapolis, MN
Inflammatory Protein Panel for Sarcoidosis Diagnosis and Prognosis
CHEST Foundation Research Grant in Severe Asthma
This grant is supported by the CHEST Foundation.
Felix Reyes, MD, Montefiore Medical Center, Bronx, NY
Design and Implementation of an Asthma Action Plan Generator: A Pilot Study Assessing User Satisfaction and Clinical Impact
CHEST Foundation Research Grant in Pulmonary Fibrosis
These grants are supported by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Genentech, Inc.
Marco Mura, MD, PhD, Western University, London, Ontario, Canada
Validation of the Risk Stratification Score in Idiopathic Pulmonary Fibrosis
Janelle Pugashetti, MD, University of California, Davis, Davis, CA
Determining Biomarkers of Immunosuppressant Responsiveness in Patients With CTD-ILD
CHEST Foundation Research Grant in Pulmonary Hypertension
These grants are supported by the CHEST Foundation.
Michael Lee, MD, University of California San Francisco, San Francisco, CA
Transpulmonary Metabolomic Gradients During Exercise in Systemic Sclerosis-Associated Pulmonary Hypertension
Navneet Singh, MD, Warren Alpert School of Medicine at Brown University, Providence, RI
Mitochondrial Dysfunction and Oxidative Stress in Pulmonary Hypertension
CHEST Foundation Research Grant in Sleep Medicine
These grants are funded by Jazz Pharmaceuticals, Inc.
Shahid Karim, MBChB, Mayo Clinic, Rochester, MN
Effects of OSA on Atrial and Ventricular Arrhythmia in HCM: An Incidence Study
Thomas Tolbert, MD, Mount Sinai Hospital, New York, NY
Performance Characteristics of Obstructive Sleep Apnea Physiologic Traits Measured by Phenotyping Using Polysomnography
CHEST Foundation and American Academy of Sleep Medicine Foundation Research Grant in Sleep Medicine
This grant is jointly supported by the CHEST Foundation and AASM Foundation.
Marta Kaminska, MD, McGill University Health Centre, Montreal, QC, Canada
Long-term Noninvasive Ventilation in COPD: Impact on Health Care Utilization
CHEST Foundation and APCCMPD Research Grant in Medical Education
This grant is jointly supported by the CHEST Foundation and APCCMPD.
Mark Adelman, MD, NYU School of Medicine, New York, NY
Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies
CHEST Foundation Research Grant in COVID-19
These grants are supported by the CHEST Foundation.
Marlene Cano, MD, PhD, Washington University, St. Louis, MO
Circulating Mitochondrial DNA Is a Potential Biomarker for Severe Illness in COVID-19
Brandon Walsh, MD, New York University, New York, NY
How Would Existing Ventilator Allocation Guidelines Perform During the COVID-19 Pandemic: A Retrospective Observational Simulated Cohort Study
CHEST Foundation and ATS Research Grant in COVID-19 and Diversity
These grants are jointly supported by the CHEST Foundation and ATS.
Navitha Ramesh, MD, FCCP, UPMC Harrisburg, Harrisburg, PA
Improving Lung Health in the Nepali- Bhutanese Refugee Community in Harrisburg, PA
Inderjit Singh, MBBCh, Yale University, New Haven, CT
Dynamic Invasive Hemodynamic, Echocardiographic, and Plasma Biomarker Phenotyping in Post-COVID-19 Long Hauler Syndrome
CHEST Foundation Community Service Grants Honoring D. Robert McCaffree, MD, Master FCCP
Valerie Andrews, BS, The JUDAHH Project, Sacramento, CA
Asthma Mitigation Project
Chanda Holsey, DrPh, National Medical Association, Silver Spring, MD
Providing Lung Health Education to At Risk Communities
Arzu Ari, PhD, FCCP, Texas State University, San Marcos, TX
Training Future Respiratory Care Practitioners in Turkey: A Path to Successful Disease Management in Pulmonary Medicine
Panagis Galiatsatos, MD, MPH, John Hopkins University, Baltimore, MD
The Lung Health Ambassador Program: A Health Equity Initiative for Cystic Fibrosis
Patricia George, MD, National Jewish Health, Denver, CO
Development of Breathe Strong PH: An Informational Website About Pulmonary Hypertension and Related Diseases
Nishant Gupta, MD, MS, University of Cincinnati, Cincinnati, OH
Global Dissemination of the Lymphangioleiomyomatosis (LAM) Clinical Practice Guidelines
Syed Naqvi, MD, MBBS, Hoag Hospital Newport Beach, Newport Beach, CA
Asthma Managment in Rural Pakistan
These grants are supported by the CHEST Foundation.
Alfred Soffer Research Award Winners
Mathieu Saint-Pierre, MD: Methacholine Challenge Testing: A Clinical Prediction Model Utilizing Demographic Data And Spirometry Results
Tie: Milind K Bhagat, MD: High Flow Nasal Cannula Fio2 Cutoffs Identified Early In The Hospital Course Are Associated With Increased Mortality Risk In Hospitalized Patients With COVID-19
Amber J Meservey, MD: Outcomes Of Patients Across The Spectrum Of Pulmonary Hypertension Groups Prescribed Inhaled Treprostinil
Young Investigator Award Winners
William B. Feldman, MD: COPD Exacerbations And Pneumonia Hospitalizations In New Users Of Combination Maintenance Inhalers: A Comparative Effectiveness And Safety Study
Christopher Streiler, MD: Community Pulmonologist Access To Multidisciplinary Discussion At An Academic Referral Center Leads To Changes In Management Of Interstitial Lung Disease
Top 5 Abstract Posters
Winner: Riley Kermanian: Management Of Coronary Artery Calcification In Patients Enrolled In A Low-Dose Computerized Tomography Lung Cancer Screening Program
Winner: Rohit Reddy: Outcomes Of Extracorporeal Membrane Oxygenation In ARDS Due To Covid-19: Comparison Of The First And The Second Wave
Winner: Taylor A. Intihar, BA: Light Patterns Of The Medical ICU: Are We Disrupting Circadian Rhythms?
Runner up: Jason Wong, MD: Completion Of Pulmonary Rehabilitation Is Associated With Improvement In Depression Scores And Other Quality Of Life Measures In Patients With Interstitial Lung Disease
Runner up: Harshil Shah, MD: Impact Of Sepsis On Outcomes Of Hospitalizations Due To COPD
Case Report Session Winners
Remarkable Pulmonary Cases: Mena Botros, MD: Clinical Outcomes In Lung Transplant Recipients With SARS-COV2
Bacterial Infections: Benjamin Carmel, DO: Cotton Swab Today, Brain Abscess Tomorrow
Challenging Critical Care Cases: Rajaninder Sharma, MD: Pulmonary Tumor Thrombotic Microangiopathy: The Rare And Fatal Association Of Adenocarcinoma And Right Ventricular Failure
Diffuse Lung Diseases: Rizwana RR Rana, MBBS: A Rare Cause Of Pulmonary Nodules
Viruses, Fungi, and Parasites Infections: Michelle Forson, MD: Strongyloidiasis-Related Eosinophilic Pleural Effusion: An Unexpected Differential For Post-Cardiac Injury Syndrome
Critical Care Cases: Act Quickly: Christina Jee Ah Rhee, MD: Airway Implications Of Cricoarytenoid Arthritis: A Report And Review Of The Literature
Airway Issues: Benadin Varajic, MD: An Unusual And Life-Threatening Complication Of Endotracheal Intubation
Miscellaneous Cases 1: Shrey Shah, MD: A Case Of Pulmonary Arterial Hypertension From Vitamin C Deficiency
Miscellaneous Cases 2: Glenn W. Pottmeyer, DO, MPH: Biliary Stent Migration: A Rare Cause Of Right-Sided Pulmonary Abscess
Case Report Poster Winners
Advanced Cancer Case Report Posters: Sangita Goel, MD: Let’s Meet in the Middle: Simultaneous Endoscopic and Bronchoscopic Suture Repair to Close a Left Main-Stem Malignant Broncho-Esophageal Fistula
Cardiovascular Case Report Posters: Marianna Weaver, DO: Swan-Ganz And Intra-Pericardial Pressure Guided Pericardiocentesis in Scleroderma-Associated PAH
Remarkable Cases Posters 1: Katie Capp, MD: Humidifier-Associated Hypersensitivity Pneumonitis
Remarkable Cases Posters 2: Sahar Samani, MD: Artifactual Hypoxemia in Patients With Hydroxyurea-Induced Blue Lunula Fingernails
CHEST 2021 CHEST Challenge
1st Place
The Ohio State University
Sarah Cohen, MD
Gregory Eisinger, MD
Kyle Stinehart, MD
Program Director: Jennifer McCallister, MD, FCCP
2nd Place
SUNY Buffalo
Arjun Saradna, MBBS
Rajesh Kunadharaju, MD
Ahmed Munir, MBBS
Program Director: Jeffrey Mador, MD
3rd Place
Interfaith Medical Center
Tahmina Jahir, MD
Ruby Risal, MD
Binav Shrestha, MBBS
Program Director: Marie Frances Schmidt, MD, FCCP
ANNUAL AWARDS
Master FCCP
Curtis N. Sessler, MD, Master FCCP
College Medalist Award
Margaret Pisani, MD, MPH, FCCP
Distinguished Service Award
Christopher Carroll, MD, FCCP
Master Clinician Educator
Doreen Addrizzo-Harris, MD, FCCP
Early Career Clinician Educator
Matthew C. Miles, MD, FCCP
Alfred Soffer Award for Editorial Excellence
Scott Manaker, MD, PhD, FCCP
Presidential Citation
COVID-19 Task Force
Ryan Maves, MD, FCCP
Christopher Carroll, MD, FCCP
Neha Dangayach, MD
Jeffrey Dichter, MD, FCCP
Alice Gallo De Moraes, MD
James Geiling, MD, MPH, FCCP
Holly Keyt, MD, FCCP
Stephanie M. Levine, MD, FCCP
Septimu Murgu, MD, FCCP
Marcos Restrepo, MD, PhD, FCCP
Steven Q. Simpson, MD, FCCP
Angel Coz Yataco, MD, FCCP
Staff: Katlyn Froslan, Heather Watkins, Robb Rabito, CHCP, Lilly Rodriguez, Karla Velilla
HONOR LECTURE AND MEMORIAL AWARDS
Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
KENNETH I. BERGER, MD, FCCP
Probing the Small Airways in the Assessment of Dyspnea
The lecture is generously funded by the CHEST Foundation.
Presidential Honor Lecture
CURTIS N. SESSLER, MD, Master FCCP
Navigating the Road to Well-Being in the ICU
Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation
DEBRA WEESE-MAYER, MD
Artificial Ventilation, a True Life-Saver for Children with CCHS & ROHHAD
The Margaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.
RICHARD S. IRWIN, MD, MASTER FCCP HONOR LECTURE
PETER J. MAZZONE, MD, MPH, FCCP
Shared Decision Making in the Evaluation and Management of Early Stage Lung Cancer
The lecture is generously funded by the CHEST Foundation.
Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
DIANE E. STOVER, MD, FCCP
The Many Faces of Organizing Pneumonia—What’s the O(O)P With That?
The lecture is generously funded by the CHEST Foundation.
Pasquale Ciaglia Memorial Lecture in Interventional Medicine
MICHAEL J. SIMOFF, MD, FCCP
Robotic Bronchoscopy: Platform to the Future?
The lecture is generously funded by the CHEST Foundation.
Roger C. Bone Memorial Lecture in Critical Care
OGNJEN GAJIC, MD, FCCP
Patient Comes First: Prioritizing Relevant From Irrelevant in Critical Care Medicine
The lecture is generously funded by the CHEST Foundation.
Thomas L. Petty, MD, Master FCCP Memorial Lecture
JEAN BOURBEAU, MD, FCCP
Pulmonary Rehabilitation and Self-Management in COPD: Understanding the Past to Build the Future
The lecture is generously funded by the CHEST Foundation.
CHEST FOUNDATION GRANT AWARDS
CHEST Foundation Research Grant in Lung Cancer
This grant is supported by the CHEST Foundation.
Daniel Ryan, MD, Royal College of Surgeons Ireland, Dublin, Ireland
Microbial Signatures Associated With Malignant Pleural Effusions in Lung Cancer
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is jointly supported by the CHEST Foundation and RHA.
Miguel Divo, MD, Brigham and Women’s Hospital, Boston, MA
Biomarker Profiles in Smokers Who Are at Risk of Developing Chronic Obstructive Pulmonary Disease (COPD)
CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
This grant is supported by AstraZeneca LP.
Stephen Milne, MBBS, Woolcock Institute of Medical Research, Vancouver, BC, Canada
The Oral Metagenome in COPD: Towards a Biomarker of Exacerbation Risk
CHEST Foundation Research Grant in Critical Care
This grant is supported by the CHEST Foundation.
Jacqueline Stocking, PhD, University of California, Davis, Davis, CA
University of California Critical Care Research Collaborative: Predictive Model and Risk Calculator for Early and Late Postoperative Respiratory Failure
CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.
John Charles Rotondo, PhD, University of Ferrara, Ferrara, Italy
Alpha-1 Antitrypsin Protein as a Possible Marker of Disease Progression in COVID-19 Patients
CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
This grant is supported by Insmed Incorporated.
Edward Chan, MD, Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
Visualization and Quantitation of Azithromycin, Clofazimine, and Amikacin Distribution in Surgically Removed Lung Tissues From Patients With Nontuberculous Mycobacterial Lung Disease
CHEST Foundation Research Grant in Cystic Fibrosis
This grant is supported by Vertex Pharmaceuticals Incorporated.
Shahid Sheikh, MD, FCCP, Nationwide Children’s Hospital, Columbus, OH
Impact of CFTR Modulator Therapy Elexacaftor-Tezacaftor-Ivacaftor on CF- Related Chronic Sinus Disease
John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
This grant is in honor of John R. Addrizzo, MD, FCCP and is jointly supported by the Addrizzo family and the CHEST Foundation.
Maneesh Bhargava, MD, PhD, FCCP, Minneapolis VA Health Care System, Minneapolis, MN
Inflammatory Protein Panel for Sarcoidosis Diagnosis and Prognosis
CHEST Foundation Research Grant in Severe Asthma
This grant is supported by the CHEST Foundation.
Felix Reyes, MD, Montefiore Medical Center, Bronx, NY
Design and Implementation of an Asthma Action Plan Generator: A Pilot Study Assessing User Satisfaction and Clinical Impact
CHEST Foundation Research Grant in Pulmonary Fibrosis
These grants are supported by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Genentech, Inc.
Marco Mura, MD, PhD, Western University, London, Ontario, Canada
Validation of the Risk Stratification Score in Idiopathic Pulmonary Fibrosis
Janelle Pugashetti, MD, University of California, Davis, Davis, CA
Determining Biomarkers of Immunosuppressant Responsiveness in Patients With CTD-ILD
CHEST Foundation Research Grant in Pulmonary Hypertension
These grants are supported by the CHEST Foundation.
Michael Lee, MD, University of California San Francisco, San Francisco, CA
Transpulmonary Metabolomic Gradients During Exercise in Systemic Sclerosis-Associated Pulmonary Hypertension
Navneet Singh, MD, Warren Alpert School of Medicine at Brown University, Providence, RI
Mitochondrial Dysfunction and Oxidative Stress in Pulmonary Hypertension
CHEST Foundation Research Grant in Sleep Medicine
These grants are funded by Jazz Pharmaceuticals, Inc.
Shahid Karim, MBChB, Mayo Clinic, Rochester, MN
Effects of OSA on Atrial and Ventricular Arrhythmia in HCM: An Incidence Study
Thomas Tolbert, MD, Mount Sinai Hospital, New York, NY
Performance Characteristics of Obstructive Sleep Apnea Physiologic Traits Measured by Phenotyping Using Polysomnography
CHEST Foundation and American Academy of Sleep Medicine Foundation Research Grant in Sleep Medicine
This grant is jointly supported by the CHEST Foundation and AASM Foundation.
Marta Kaminska, MD, McGill University Health Centre, Montreal, QC, Canada
Long-term Noninvasive Ventilation in COPD: Impact on Health Care Utilization
CHEST Foundation and APCCMPD Research Grant in Medical Education
This grant is jointly supported by the CHEST Foundation and APCCMPD.
Mark Adelman, MD, NYU School of Medicine, New York, NY
Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies
CHEST Foundation Research Grant in COVID-19
These grants are supported by the CHEST Foundation.
Marlene Cano, MD, PhD, Washington University, St. Louis, MO
Circulating Mitochondrial DNA Is a Potential Biomarker for Severe Illness in COVID-19
Brandon Walsh, MD, New York University, New York, NY
How Would Existing Ventilator Allocation Guidelines Perform During the COVID-19 Pandemic: A Retrospective Observational Simulated Cohort Study
CHEST Foundation and ATS Research Grant in COVID-19 and Diversity
These grants are jointly supported by the CHEST Foundation and ATS.
Navitha Ramesh, MD, FCCP, UPMC Harrisburg, Harrisburg, PA
Improving Lung Health in the Nepali- Bhutanese Refugee Community in Harrisburg, PA
Inderjit Singh, MBBCh, Yale University, New Haven, CT
Dynamic Invasive Hemodynamic, Echocardiographic, and Plasma Biomarker Phenotyping in Post-COVID-19 Long Hauler Syndrome
CHEST Foundation Community Service Grants Honoring D. Robert McCaffree, MD, Master FCCP
Valerie Andrews, BS, The JUDAHH Project, Sacramento, CA
Asthma Mitigation Project
Chanda Holsey, DrPh, National Medical Association, Silver Spring, MD
Providing Lung Health Education to At Risk Communities
Arzu Ari, PhD, FCCP, Texas State University, San Marcos, TX
Training Future Respiratory Care Practitioners in Turkey: A Path to Successful Disease Management in Pulmonary Medicine
Panagis Galiatsatos, MD, MPH, John Hopkins University, Baltimore, MD
The Lung Health Ambassador Program: A Health Equity Initiative for Cystic Fibrosis
Patricia George, MD, National Jewish Health, Denver, CO
Development of Breathe Strong PH: An Informational Website About Pulmonary Hypertension and Related Diseases
Nishant Gupta, MD, MS, University of Cincinnati, Cincinnati, OH
Global Dissemination of the Lymphangioleiomyomatosis (LAM) Clinical Practice Guidelines
Syed Naqvi, MD, MBBS, Hoag Hospital Newport Beach, Newport Beach, CA
Asthma Managment in Rural Pakistan
These grants are supported by the CHEST Foundation.
Alfred Soffer Research Award Winners
Mathieu Saint-Pierre, MD: Methacholine Challenge Testing: A Clinical Prediction Model Utilizing Demographic Data And Spirometry Results
Tie: Milind K Bhagat, MD: High Flow Nasal Cannula Fio2 Cutoffs Identified Early In The Hospital Course Are Associated With Increased Mortality Risk In Hospitalized Patients With COVID-19
Amber J Meservey, MD: Outcomes Of Patients Across The Spectrum Of Pulmonary Hypertension Groups Prescribed Inhaled Treprostinil
Young Investigator Award Winners
William B. Feldman, MD: COPD Exacerbations And Pneumonia Hospitalizations In New Users Of Combination Maintenance Inhalers: A Comparative Effectiveness And Safety Study
Christopher Streiler, MD: Community Pulmonologist Access To Multidisciplinary Discussion At An Academic Referral Center Leads To Changes In Management Of Interstitial Lung Disease
Top 5 Abstract Posters
Winner: Riley Kermanian: Management Of Coronary Artery Calcification In Patients Enrolled In A Low-Dose Computerized Tomography Lung Cancer Screening Program
Winner: Rohit Reddy: Outcomes Of Extracorporeal Membrane Oxygenation In ARDS Due To Covid-19: Comparison Of The First And The Second Wave
Winner: Taylor A. Intihar, BA: Light Patterns Of The Medical ICU: Are We Disrupting Circadian Rhythms?
Runner up: Jason Wong, MD: Completion Of Pulmonary Rehabilitation Is Associated With Improvement In Depression Scores And Other Quality Of Life Measures In Patients With Interstitial Lung Disease
Runner up: Harshil Shah, MD: Impact Of Sepsis On Outcomes Of Hospitalizations Due To COPD
Case Report Session Winners
Remarkable Pulmonary Cases: Mena Botros, MD: Clinical Outcomes In Lung Transplant Recipients With SARS-COV2
Bacterial Infections: Benjamin Carmel, DO: Cotton Swab Today, Brain Abscess Tomorrow
Challenging Critical Care Cases: Rajaninder Sharma, MD: Pulmonary Tumor Thrombotic Microangiopathy: The Rare And Fatal Association Of Adenocarcinoma And Right Ventricular Failure
Diffuse Lung Diseases: Rizwana RR Rana, MBBS: A Rare Cause Of Pulmonary Nodules
Viruses, Fungi, and Parasites Infections: Michelle Forson, MD: Strongyloidiasis-Related Eosinophilic Pleural Effusion: An Unexpected Differential For Post-Cardiac Injury Syndrome
Critical Care Cases: Act Quickly: Christina Jee Ah Rhee, MD: Airway Implications Of Cricoarytenoid Arthritis: A Report And Review Of The Literature
Airway Issues: Benadin Varajic, MD: An Unusual And Life-Threatening Complication Of Endotracheal Intubation
Miscellaneous Cases 1: Shrey Shah, MD: A Case Of Pulmonary Arterial Hypertension From Vitamin C Deficiency
Miscellaneous Cases 2: Glenn W. Pottmeyer, DO, MPH: Biliary Stent Migration: A Rare Cause Of Right-Sided Pulmonary Abscess
Case Report Poster Winners
Advanced Cancer Case Report Posters: Sangita Goel, MD: Let’s Meet in the Middle: Simultaneous Endoscopic and Bronchoscopic Suture Repair to Close a Left Main-Stem Malignant Broncho-Esophageal Fistula
Cardiovascular Case Report Posters: Marianna Weaver, DO: Swan-Ganz And Intra-Pericardial Pressure Guided Pericardiocentesis in Scleroderma-Associated PAH
Remarkable Cases Posters 1: Katie Capp, MD: Humidifier-Associated Hypersensitivity Pneumonitis
Remarkable Cases Posters 2: Sahar Samani, MD: Artifactual Hypoxemia in Patients With Hydroxyurea-Induced Blue Lunula Fingernails
CHEST 2021 CHEST Challenge
1st Place
The Ohio State University
Sarah Cohen, MD
Gregory Eisinger, MD
Kyle Stinehart, MD
Program Director: Jennifer McCallister, MD, FCCP
2nd Place
SUNY Buffalo
Arjun Saradna, MBBS
Rajesh Kunadharaju, MD
Ahmed Munir, MBBS
Program Director: Jeffrey Mador, MD
3rd Place
Interfaith Medical Center
Tahmina Jahir, MD
Ruby Risal, MD
Binav Shrestha, MBBS
Program Director: Marie Frances Schmidt, MD, FCCP
This month in the journal CHEST®
Editor’s picks
Revisiting mild asthma: current knowledge and future needs. By Dr. A. Mohan, et al.
Treatment of Mycobacterium abscessus pulmonary disease. By Dr. D. Griffith, et al.
The utility of the rapid shallow breathing index in predicting successful extubation: A systematic review and meta-analysis. By Dr. K. Burns, et al.
National temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis in the United States between 2007 – 2018. By Dr. N. Obi Ogugua, et al.
How I Do It: Considering lung transplantation for patients with COVID-19. By Dr. S. Nathan.
Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. By Dr. N. Bhakta, et al.
Editor’s picks
Editor’s picks
Revisiting mild asthma: current knowledge and future needs. By Dr. A. Mohan, et al.
Treatment of Mycobacterium abscessus pulmonary disease. By Dr. D. Griffith, et al.
The utility of the rapid shallow breathing index in predicting successful extubation: A systematic review and meta-analysis. By Dr. K. Burns, et al.
National temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis in the United States between 2007 – 2018. By Dr. N. Obi Ogugua, et al.
How I Do It: Considering lung transplantation for patients with COVID-19. By Dr. S. Nathan.
Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. By Dr. N. Bhakta, et al.
Revisiting mild asthma: current knowledge and future needs. By Dr. A. Mohan, et al.
Treatment of Mycobacterium abscessus pulmonary disease. By Dr. D. Griffith, et al.
The utility of the rapid shallow breathing index in predicting successful extubation: A systematic review and meta-analysis. By Dr. K. Burns, et al.
National temporal trends in hospitalization and inpatient mortality in patients with pulmonary sarcoidosis in the United States between 2007 – 2018. By Dr. N. Obi Ogugua, et al.
How I Do It: Considering lung transplantation for patients with COVID-19. By Dr. S. Nathan.
Addressing race in pulmonary function testing by aligning intent and evidence with practice and perception. By Dr. N. Bhakta, et al.
The people’s paper
With this issue, we usher in a new era for CHEST Physician, as I hand over the reins of Editor-in-Chief to Angel Coz, MD, FCCP. I have had the pleasure of serving in this role over the last 4 years, and though I will still have the privilege of appearing within these pages with some frequency as I move into my new role as CHEST President, I would like to mark this milestone by passing along a few thoughts on how CHEST Physician has developed over the last few years, and reflecting on the goals I set for us way back in the January 2018 issue (on page 46 of that issue, for those of you holding on to our back issues).
I’ve always viewed CHEST Physician as “the People’s Paper” of CHEST. While we don’t feature first-run scientific manuscripts and authors aren’t likely to reference our articles in other publications, your editorial board and our partners at Frontline aim to give our readers a broad overview of recent publications and presentations in pulmonary, critical care, and sleep medicine, along with expert commentary about how those developments might affect the care we provide to our patients. I can’t thank our editorial board members enough for the hours they spend selecting a small number of items to feature among all of the new medical developments each month.
One of the main goals we had established over the last few years was to create more opportunities for CHEST Physician to serve as the voice of the members and leaders of the American College of Chest Physicians. We achieved the latter part of this goal, with leadership penning quarterly columns on actions of the Board of Regents, developments within the annual meeting, as well as ongoing columns from our NetWorks. And, we have also provided a more reliable voice for our members, with authors of our Sleep Strategies, Critical Care Commentary, and Pulmonary Perspectives columns providing a broader and more representative sample of our membership than ever before.
One of the areas where I would love to see more progress is with reader engagement. It has been a delight to receive feedback from CHEST members, even when the author is taking issue with something we have published. CHEST Physician will be a better publication than it already is with your ongoing input. Please, if you see something that we write that you particularly like (or don’t!) or if there’s something you’d like to see that we haven’t written, please reach out to us! You can always reach us at [email protected].
In closing, I want to thank all of the steadfast CHEST Physician readers for making my 4 years as Editor-in-Chief enjoyable and meaningful. While I am so pleased with the current state of this publication, I cannot wait to see its ongoing evolution under the leadership of Dr. Coz and his editorial board.
With this issue, we usher in a new era for CHEST Physician, as I hand over the reins of Editor-in-Chief to Angel Coz, MD, FCCP. I have had the pleasure of serving in this role over the last 4 years, and though I will still have the privilege of appearing within these pages with some frequency as I move into my new role as CHEST President, I would like to mark this milestone by passing along a few thoughts on how CHEST Physician has developed over the last few years, and reflecting on the goals I set for us way back in the January 2018 issue (on page 46 of that issue, for those of you holding on to our back issues).
I’ve always viewed CHEST Physician as “the People’s Paper” of CHEST. While we don’t feature first-run scientific manuscripts and authors aren’t likely to reference our articles in other publications, your editorial board and our partners at Frontline aim to give our readers a broad overview of recent publications and presentations in pulmonary, critical care, and sleep medicine, along with expert commentary about how those developments might affect the care we provide to our patients. I can’t thank our editorial board members enough for the hours they spend selecting a small number of items to feature among all of the new medical developments each month.
One of the main goals we had established over the last few years was to create more opportunities for CHEST Physician to serve as the voice of the members and leaders of the American College of Chest Physicians. We achieved the latter part of this goal, with leadership penning quarterly columns on actions of the Board of Regents, developments within the annual meeting, as well as ongoing columns from our NetWorks. And, we have also provided a more reliable voice for our members, with authors of our Sleep Strategies, Critical Care Commentary, and Pulmonary Perspectives columns providing a broader and more representative sample of our membership than ever before.
One of the areas where I would love to see more progress is with reader engagement. It has been a delight to receive feedback from CHEST members, even when the author is taking issue with something we have published. CHEST Physician will be a better publication than it already is with your ongoing input. Please, if you see something that we write that you particularly like (or don’t!) or if there’s something you’d like to see that we haven’t written, please reach out to us! You can always reach us at [email protected].
In closing, I want to thank all of the steadfast CHEST Physician readers for making my 4 years as Editor-in-Chief enjoyable and meaningful. While I am so pleased with the current state of this publication, I cannot wait to see its ongoing evolution under the leadership of Dr. Coz and his editorial board.
With this issue, we usher in a new era for CHEST Physician, as I hand over the reins of Editor-in-Chief to Angel Coz, MD, FCCP. I have had the pleasure of serving in this role over the last 4 years, and though I will still have the privilege of appearing within these pages with some frequency as I move into my new role as CHEST President, I would like to mark this milestone by passing along a few thoughts on how CHEST Physician has developed over the last few years, and reflecting on the goals I set for us way back in the January 2018 issue (on page 46 of that issue, for those of you holding on to our back issues).
I’ve always viewed CHEST Physician as “the People’s Paper” of CHEST. While we don’t feature first-run scientific manuscripts and authors aren’t likely to reference our articles in other publications, your editorial board and our partners at Frontline aim to give our readers a broad overview of recent publications and presentations in pulmonary, critical care, and sleep medicine, along with expert commentary about how those developments might affect the care we provide to our patients. I can’t thank our editorial board members enough for the hours they spend selecting a small number of items to feature among all of the new medical developments each month.
One of the main goals we had established over the last few years was to create more opportunities for CHEST Physician to serve as the voice of the members and leaders of the American College of Chest Physicians. We achieved the latter part of this goal, with leadership penning quarterly columns on actions of the Board of Regents, developments within the annual meeting, as well as ongoing columns from our NetWorks. And, we have also provided a more reliable voice for our members, with authors of our Sleep Strategies, Critical Care Commentary, and Pulmonary Perspectives columns providing a broader and more representative sample of our membership than ever before.
One of the areas where I would love to see more progress is with reader engagement. It has been a delight to receive feedback from CHEST members, even when the author is taking issue with something we have published. CHEST Physician will be a better publication than it already is with your ongoing input. Please, if you see something that we write that you particularly like (or don’t!) or if there’s something you’d like to see that we haven’t written, please reach out to us! You can always reach us at [email protected].
In closing, I want to thank all of the steadfast CHEST Physician readers for making my 4 years as Editor-in-Chief enjoyable and meaningful. While I am so pleased with the current state of this publication, I cannot wait to see its ongoing evolution under the leadership of Dr. Coz and his editorial board.
Clinical Edge Journal Scan Commentary: Migraine January 2022
Ferrari et al1provided information on an open label extension to the “LIBERTY” study which investigated the use of erenumab in subjects with episodic migraine that have failed multiple prior preventive medications. The initial Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) studies excluded more refractory patients. Most commercial insurances in the United States have a “step” policy that relates to use of these and other newer medications, meaning that the majority of patient in the US who receive these medications have previously tried other preventive medications. This raised the question whether migraine refractoriness is a negative predictive factor for erenumab.
This long-term open label study is more like the real-world use of erenumab, and as such the results are similar to what many practitioners are seeing in their clinical experience. Approximately 25% of subjects discontinued erenumab, mostly due to ineffectiveness. Adverse events were mild, and although erenumab has warnings for constipation and hypertension, this study did not show either as increasing over 2 years. Erenumab appeared to be tolerable over time. There were no newly noted safety signals in this study.
The efficacy of erenumab also appeared to be stable over time, without the development of tolerance to the medication. There is a slight decrease in the 50% responder rate at 2 years when these more refractory patients are compared to those that did not have multiple treatment failures. This study also looked at “functional parameters,” such as Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6), both of which were significantly improved over time.
Although there are some significant limitations in this study-primarily the fact that it is open label—this does give a more representative and real-world sample of patients who will be prescribed erenumab in the United States. Most practitioners will be glad to find that the long-term use of erenumab appears safe, and the efficacy remains stable, even in a more difficult-to-treat population.
A randomized controlled international study investigated the preventive use of occipital nerve blocks in migraine without aura.2 The majority of the literature for the use of occipital nerve blocks is for acute treatment, and arguably the most significant study prior to this was Friedman et al3 investigating the use of this procedure in the emergency ward. Prior occipital nerve studies have been inconclusive, and although occipital nerve blocks are considered standard of care for specific conditions in most headache centers, reimbursement is usually very limited. Insurance companies have quoted prior preventive occipital nerve studies to justify non-coverage of these procedures, making access to them for many patients very limited.
Occipital nerve blocks are not performed uniformly, both regarding the medications used—some practitioners use no steroids, some use lidocaine and bupivocaine—and regarding the placement of the injections. In this a small cohort study, 55 subjects were divided into four groups for intervention—one of which was a control group of saline—and all were given one 2.5 mL injection at a point in between the occipital protuberance and the mastoid process bilaterally. Due to adverse events (alopecia and cutaneous atrophy) in two of the triamcinolone groups, recruitment was halted for those two groups. Patients were assessed based on headache duration, frequency, and severity over a 4-week course.
Compared to baseline all interventional groups had significantly decreased headache severity, which did return closer to baseline during the final week. Headache duration was decreased in the first 2 weeks post-injection. Headache frequency was seen to return to baseline at week 4, but prior to that the groups injected with lidocaine had a significant decrease in migraine frequency, with an average decrease in headache days.
Occipital nerve blocks are performed frequently for migraine, occipital neuralgia, cervicogenic headache, and many other conditions with noted tenderness over the occiput. As noted above, they are not performed uniformly—sometimes they are given for acute headache pain or status migranosus, and other times they are used in regular intervals for prevention. This data does finally show a preventive benefit with occipital nerve blocks, and this may allow for modifications in how occipital nerve blocks are currently performed. Based on this study, if given preventively, occipital nerve blocks should only contain topical anesthetics, not steroids, and should be performed on an every 2-3 week basis.
The limitations of this study are significant as well. This is a very small cohort, and the injections were performed in only one manner (one bilateral injection), whereas many practitioners will target the greater and lesser branches of the occipital nerve individually. There were no exclusion criteria for subjects that already had occipital nerve blocks performed—those patients would be unblinded as there is a different sensation when injected with a topical anesthetic versus normal saline (normal saline does not cause burning subcutaneously).
These results should pave the way for further investigations in the use of occipital and other nerve blocks in the prevention of migraine. This should allow better access for our patients and the possibility of performing these procedures more uniformly in the future.
It can be challenging for many practitioners to determine which medication is ideal for individual situations. This is especially true when treating chronic migraine, where many potential complicating factors can influence positive to negative responses to treatment. The investigators here sought to determine which factors may potentially predict a positive response to galcanezumab.4
This is an observational study, where 156 subjects with a diagnosis of chronic migraine were enrolled. There was a 1-month run-in period where the following characteristics were collected: monthly headache days, monthly abortive medication intake, clinical features of migraine, and disability scores (MIDAS and HIT-6). These were tracked over a 3-month period after starting glacanezumab.
Approximately 40% of subjects experienced a 50% reduction in headache frequency. The better responders had a lower body mass index, fewer previously failed preventive medications, unilateral headache pain, and previous good response to triptan use. Surprisingly, the presence of medication overuse was associated with persistent improvement at 3 months as well, with over 60% of subjects with medication overuse no longer overusing acute medications at 3 months.
This study is helpful in identifying specific features that may allow a practitioner to better recommend CGRP mAb medications, such as galcanezumab. Chronic migraine can offer a challenge to even the best trained clinicians. Patients will often have multiple factors that have led to a conversion from episodic to chronic migraine, and a history of medication failures or intolerances. These patients are often referred specifically due to these challenges.
When deciding on a preventive medication for patients with chronic migraine, we often first consider which oral preventive medications may allow us to treat migraine in addition to another underlying issue—such as insomnia, depression, or hypertension. Although the oral class can improve other comorbidities, intolerance is significantly higher for most of these medications as well. The CGRP mAb class is somewhat more ideal for prevention of migraine; the focus when using this class is for migraine prevention alone, and the side effect profile is more tolerable for most patients. That said, if predictive factors were known a more individualized approach to migraine prevention would be possible.
The authors’ recognition of the factors associated with improvement in patients using glacanezumab allows this better individualization. Based on these results, patients with more unilateral pain, lower BMI, and good response to triptans could be recommended glacanuzumab with a great degree of confidence. This should be irrespective of even high frequency use of acute medications, as most of subjects in this study with medication overuse reverted after 3 months.
There is never a single ideal preventive or acute treatment for migraine in any population, however, recognizing factors that allow for an individualized approach improves the quality of life for our patients, and leaves them less disabled by migraine.
References
- Ferrari MD et al. Two-year efficacy and safety of erenumab in participants with episodic migraine and 2–4 prior preventive treatment failures: results from the LIBERTY study. J Neurol Neurosurg Psychiatry. 2021(Nov 29).
- Malekian N et al. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double‐blind placebo‐controlled clinical trial. Cephalalgia. 2021(Nov 17).
- Friedman BW et al. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache. 2018(Oct);58(9):1427-34. https://doi.org/10.1111/head.13395.
- Vernieri F et al. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol. 2021(Nov 26).
Ferrari et al1provided information on an open label extension to the “LIBERTY” study which investigated the use of erenumab in subjects with episodic migraine that have failed multiple prior preventive medications. The initial Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) studies excluded more refractory patients. Most commercial insurances in the United States have a “step” policy that relates to use of these and other newer medications, meaning that the majority of patient in the US who receive these medications have previously tried other preventive medications. This raised the question whether migraine refractoriness is a negative predictive factor for erenumab.
This long-term open label study is more like the real-world use of erenumab, and as such the results are similar to what many practitioners are seeing in their clinical experience. Approximately 25% of subjects discontinued erenumab, mostly due to ineffectiveness. Adverse events were mild, and although erenumab has warnings for constipation and hypertension, this study did not show either as increasing over 2 years. Erenumab appeared to be tolerable over time. There were no newly noted safety signals in this study.
The efficacy of erenumab also appeared to be stable over time, without the development of tolerance to the medication. There is a slight decrease in the 50% responder rate at 2 years when these more refractory patients are compared to those that did not have multiple treatment failures. This study also looked at “functional parameters,” such as Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6), both of which were significantly improved over time.
Although there are some significant limitations in this study-primarily the fact that it is open label—this does give a more representative and real-world sample of patients who will be prescribed erenumab in the United States. Most practitioners will be glad to find that the long-term use of erenumab appears safe, and the efficacy remains stable, even in a more difficult-to-treat population.
A randomized controlled international study investigated the preventive use of occipital nerve blocks in migraine without aura.2 The majority of the literature for the use of occipital nerve blocks is for acute treatment, and arguably the most significant study prior to this was Friedman et al3 investigating the use of this procedure in the emergency ward. Prior occipital nerve studies have been inconclusive, and although occipital nerve blocks are considered standard of care for specific conditions in most headache centers, reimbursement is usually very limited. Insurance companies have quoted prior preventive occipital nerve studies to justify non-coverage of these procedures, making access to them for many patients very limited.
Occipital nerve blocks are not performed uniformly, both regarding the medications used—some practitioners use no steroids, some use lidocaine and bupivocaine—and regarding the placement of the injections. In this a small cohort study, 55 subjects were divided into four groups for intervention—one of which was a control group of saline—and all were given one 2.5 mL injection at a point in between the occipital protuberance and the mastoid process bilaterally. Due to adverse events (alopecia and cutaneous atrophy) in two of the triamcinolone groups, recruitment was halted for those two groups. Patients were assessed based on headache duration, frequency, and severity over a 4-week course.
Compared to baseline all interventional groups had significantly decreased headache severity, which did return closer to baseline during the final week. Headache duration was decreased in the first 2 weeks post-injection. Headache frequency was seen to return to baseline at week 4, but prior to that the groups injected with lidocaine had a significant decrease in migraine frequency, with an average decrease in headache days.
Occipital nerve blocks are performed frequently for migraine, occipital neuralgia, cervicogenic headache, and many other conditions with noted tenderness over the occiput. As noted above, they are not performed uniformly—sometimes they are given for acute headache pain or status migranosus, and other times they are used in regular intervals for prevention. This data does finally show a preventive benefit with occipital nerve blocks, and this may allow for modifications in how occipital nerve blocks are currently performed. Based on this study, if given preventively, occipital nerve blocks should only contain topical anesthetics, not steroids, and should be performed on an every 2-3 week basis.
The limitations of this study are significant as well. This is a very small cohort, and the injections were performed in only one manner (one bilateral injection), whereas many practitioners will target the greater and lesser branches of the occipital nerve individually. There were no exclusion criteria for subjects that already had occipital nerve blocks performed—those patients would be unblinded as there is a different sensation when injected with a topical anesthetic versus normal saline (normal saline does not cause burning subcutaneously).
These results should pave the way for further investigations in the use of occipital and other nerve blocks in the prevention of migraine. This should allow better access for our patients and the possibility of performing these procedures more uniformly in the future.
It can be challenging for many practitioners to determine which medication is ideal for individual situations. This is especially true when treating chronic migraine, where many potential complicating factors can influence positive to negative responses to treatment. The investigators here sought to determine which factors may potentially predict a positive response to galcanezumab.4
This is an observational study, where 156 subjects with a diagnosis of chronic migraine were enrolled. There was a 1-month run-in period where the following characteristics were collected: monthly headache days, monthly abortive medication intake, clinical features of migraine, and disability scores (MIDAS and HIT-6). These were tracked over a 3-month period after starting glacanezumab.
Approximately 40% of subjects experienced a 50% reduction in headache frequency. The better responders had a lower body mass index, fewer previously failed preventive medications, unilateral headache pain, and previous good response to triptan use. Surprisingly, the presence of medication overuse was associated with persistent improvement at 3 months as well, with over 60% of subjects with medication overuse no longer overusing acute medications at 3 months.
This study is helpful in identifying specific features that may allow a practitioner to better recommend CGRP mAb medications, such as galcanezumab. Chronic migraine can offer a challenge to even the best trained clinicians. Patients will often have multiple factors that have led to a conversion from episodic to chronic migraine, and a history of medication failures or intolerances. These patients are often referred specifically due to these challenges.
When deciding on a preventive medication for patients with chronic migraine, we often first consider which oral preventive medications may allow us to treat migraine in addition to another underlying issue—such as insomnia, depression, or hypertension. Although the oral class can improve other comorbidities, intolerance is significantly higher for most of these medications as well. The CGRP mAb class is somewhat more ideal for prevention of migraine; the focus when using this class is for migraine prevention alone, and the side effect profile is more tolerable for most patients. That said, if predictive factors were known a more individualized approach to migraine prevention would be possible.
The authors’ recognition of the factors associated with improvement in patients using glacanezumab allows this better individualization. Based on these results, patients with more unilateral pain, lower BMI, and good response to triptans could be recommended glacanuzumab with a great degree of confidence. This should be irrespective of even high frequency use of acute medications, as most of subjects in this study with medication overuse reverted after 3 months.
There is never a single ideal preventive or acute treatment for migraine in any population, however, recognizing factors that allow for an individualized approach improves the quality of life for our patients, and leaves them less disabled by migraine.
References
- Ferrari MD et al. Two-year efficacy and safety of erenumab in participants with episodic migraine and 2–4 prior preventive treatment failures: results from the LIBERTY study. J Neurol Neurosurg Psychiatry. 2021(Nov 29).
- Malekian N et al. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double‐blind placebo‐controlled clinical trial. Cephalalgia. 2021(Nov 17).
- Friedman BW et al. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache. 2018(Oct);58(9):1427-34. https://doi.org/10.1111/head.13395.
- Vernieri F et al. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol. 2021(Nov 26).
Ferrari et al1provided information on an open label extension to the “LIBERTY” study which investigated the use of erenumab in subjects with episodic migraine that have failed multiple prior preventive medications. The initial Calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) studies excluded more refractory patients. Most commercial insurances in the United States have a “step” policy that relates to use of these and other newer medications, meaning that the majority of patient in the US who receive these medications have previously tried other preventive medications. This raised the question whether migraine refractoriness is a negative predictive factor for erenumab.
This long-term open label study is more like the real-world use of erenumab, and as such the results are similar to what many practitioners are seeing in their clinical experience. Approximately 25% of subjects discontinued erenumab, mostly due to ineffectiveness. Adverse events were mild, and although erenumab has warnings for constipation and hypertension, this study did not show either as increasing over 2 years. Erenumab appeared to be tolerable over time. There were no newly noted safety signals in this study.
The efficacy of erenumab also appeared to be stable over time, without the development of tolerance to the medication. There is a slight decrease in the 50% responder rate at 2 years when these more refractory patients are compared to those that did not have multiple treatment failures. This study also looked at “functional parameters,” such as Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6), both of which were significantly improved over time.
Although there are some significant limitations in this study-primarily the fact that it is open label—this does give a more representative and real-world sample of patients who will be prescribed erenumab in the United States. Most practitioners will be glad to find that the long-term use of erenumab appears safe, and the efficacy remains stable, even in a more difficult-to-treat population.
A randomized controlled international study investigated the preventive use of occipital nerve blocks in migraine without aura.2 The majority of the literature for the use of occipital nerve blocks is for acute treatment, and arguably the most significant study prior to this was Friedman et al3 investigating the use of this procedure in the emergency ward. Prior occipital nerve studies have been inconclusive, and although occipital nerve blocks are considered standard of care for specific conditions in most headache centers, reimbursement is usually very limited. Insurance companies have quoted prior preventive occipital nerve studies to justify non-coverage of these procedures, making access to them for many patients very limited.
Occipital nerve blocks are not performed uniformly, both regarding the medications used—some practitioners use no steroids, some use lidocaine and bupivocaine—and regarding the placement of the injections. In this a small cohort study, 55 subjects were divided into four groups for intervention—one of which was a control group of saline—and all were given one 2.5 mL injection at a point in between the occipital protuberance and the mastoid process bilaterally. Due to adverse events (alopecia and cutaneous atrophy) in two of the triamcinolone groups, recruitment was halted for those two groups. Patients were assessed based on headache duration, frequency, and severity over a 4-week course.
Compared to baseline all interventional groups had significantly decreased headache severity, which did return closer to baseline during the final week. Headache duration was decreased in the first 2 weeks post-injection. Headache frequency was seen to return to baseline at week 4, but prior to that the groups injected with lidocaine had a significant decrease in migraine frequency, with an average decrease in headache days.
Occipital nerve blocks are performed frequently for migraine, occipital neuralgia, cervicogenic headache, and many other conditions with noted tenderness over the occiput. As noted above, they are not performed uniformly—sometimes they are given for acute headache pain or status migranosus, and other times they are used in regular intervals for prevention. This data does finally show a preventive benefit with occipital nerve blocks, and this may allow for modifications in how occipital nerve blocks are currently performed. Based on this study, if given preventively, occipital nerve blocks should only contain topical anesthetics, not steroids, and should be performed on an every 2-3 week basis.
The limitations of this study are significant as well. This is a very small cohort, and the injections were performed in only one manner (one bilateral injection), whereas many practitioners will target the greater and lesser branches of the occipital nerve individually. There were no exclusion criteria for subjects that already had occipital nerve blocks performed—those patients would be unblinded as there is a different sensation when injected with a topical anesthetic versus normal saline (normal saline does not cause burning subcutaneously).
These results should pave the way for further investigations in the use of occipital and other nerve blocks in the prevention of migraine. This should allow better access for our patients and the possibility of performing these procedures more uniformly in the future.
It can be challenging for many practitioners to determine which medication is ideal for individual situations. This is especially true when treating chronic migraine, where many potential complicating factors can influence positive to negative responses to treatment. The investigators here sought to determine which factors may potentially predict a positive response to galcanezumab.4
This is an observational study, where 156 subjects with a diagnosis of chronic migraine were enrolled. There was a 1-month run-in period where the following characteristics were collected: monthly headache days, monthly abortive medication intake, clinical features of migraine, and disability scores (MIDAS and HIT-6). These were tracked over a 3-month period after starting glacanezumab.
Approximately 40% of subjects experienced a 50% reduction in headache frequency. The better responders had a lower body mass index, fewer previously failed preventive medications, unilateral headache pain, and previous good response to triptan use. Surprisingly, the presence of medication overuse was associated with persistent improvement at 3 months as well, with over 60% of subjects with medication overuse no longer overusing acute medications at 3 months.
This study is helpful in identifying specific features that may allow a practitioner to better recommend CGRP mAb medications, such as galcanezumab. Chronic migraine can offer a challenge to even the best trained clinicians. Patients will often have multiple factors that have led to a conversion from episodic to chronic migraine, and a history of medication failures or intolerances. These patients are often referred specifically due to these challenges.
When deciding on a preventive medication for patients with chronic migraine, we often first consider which oral preventive medications may allow us to treat migraine in addition to another underlying issue—such as insomnia, depression, or hypertension. Although the oral class can improve other comorbidities, intolerance is significantly higher for most of these medications as well. The CGRP mAb class is somewhat more ideal for prevention of migraine; the focus when using this class is for migraine prevention alone, and the side effect profile is more tolerable for most patients. That said, if predictive factors were known a more individualized approach to migraine prevention would be possible.
The authors’ recognition of the factors associated with improvement in patients using glacanezumab allows this better individualization. Based on these results, patients with more unilateral pain, lower BMI, and good response to triptans could be recommended glacanuzumab with a great degree of confidence. This should be irrespective of even high frequency use of acute medications, as most of subjects in this study with medication overuse reverted after 3 months.
There is never a single ideal preventive or acute treatment for migraine in any population, however, recognizing factors that allow for an individualized approach improves the quality of life for our patients, and leaves them less disabled by migraine.
References
- Ferrari MD et al. Two-year efficacy and safety of erenumab in participants with episodic migraine and 2–4 prior preventive treatment failures: results from the LIBERTY study. J Neurol Neurosurg Psychiatry. 2021(Nov 29).
- Malekian N et al. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double‐blind placebo‐controlled clinical trial. Cephalalgia. 2021(Nov 17).
- Friedman BW et al. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache. 2018(Oct);58(9):1427-34. https://doi.org/10.1111/head.13395.
- Vernieri F et al. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol. 2021(Nov 26).
Much lower risk of false-positive breast screen in Norway versus U.S.
Nearly 1 in 5 women who receive the recommended 10 biennial screening rounds for breast cancer in Norway will get a false positive result, and 1 in 20 women will receive a false positive result that leads to an invasive procedure, a new analysis shows.
While the risk may seem high, it is actually much lower than what researchers have reported in the U.S., the study authors note in their paper, published online Dec. 21 in Cancer.
“I am proud about the low rate of recalls we have in Norway and Europe – and hope we can keep it that low for the future,” said senior author Solveig Hofvind, PhD, head of BreastScreen Norway, a nationwide screening program that invites women aged 50 to 69 to mammographic screening every other year.
“The double reading in Europe is probably the main reason for the lower rate in Europe compared to the U.S., where single reading is used,” she said in an interview.
Until now, Dr. Hofvind and her colleagues say, no studies have been performed using exclusively empirical data to describe the cumulative risk of experiencing a false positive screening result in Europe because of the need for long-term follow-up and complete data registration.
For their study, the researchers turned to the Cancer Registry of Norway, which administers BreastScreen Norway. They focused on data from 1995 to 2019 on women aged 50 to 69 years who had attended one or more screening rounds and could potentially attend all 10 screening examinations over the 20-year period.
Women were excluded if they were diagnosed with breast cancer before attending screening, participated in interventional research, self-referred for screening, were recalled due to self-reported symptoms or technically inadequate mammograms, or declined follow-up after a positive screen.
Among more than 421,000 women who underwent nearly 1.9 million screening examinations, 11.3% experienced at least one false positive result and 3.3% experienced at least one false positive involving an invasive procedure, such as fine-needle aspiration cytology, core-needle biopsy, or open biopsy.
The cumulative risk of experiencing a first false positive screen was 18.0% and that of experiencing a false positive that involved an invasive procedure was 5.01%. Adjusting for irregular attendance, age at screening, or the number of screens attended had little effect on the estimates.
The results closely match earlier findings from Norway that have been based on assumptions rather than exclusively empirical data. However, these findings differ from results reported in U.S. studies, which have relied largely on data from the Breast Cancer Surveillance Consortium, the researchers say.
“The latter have indicated that, for women who initiate biennial screening at the age of 50 years, the cumulative risk after 10 years is 42% for experiencing at least one false-positive screening result and 6.4% for experiencing at least one false-positive screening result involving an invasive procedure,” Dr. Hofvind and her colleagues write.
Several principal investigators with the Breast Cancer Surveillance Consortium did not respond or were unavailable for comment when contacted by this news organization.
However, the study authors highlighted several factors that could help explain the discrepancy between the U.S. and European results.
In addition to double mammogram reading, “European guidelines recommend that breast radiologists read 3,500 to 11,000 mammograms annually, whereas 960 every 2 years are required by the U.S. Mammography Quality Standards Act,” the researchers note. They also point out that previous screening mammograms are readily available in Norway, whereas this is not always the case in the U.S.
“False-positive screening results are a part of the screening for breast cancer – and the women need to be informed about the risk,” Dr. Hofvind concluded. “The screening programs should aim to keep the rate as low as possible for the women [given] the costs.”
The study was supported by the Dam Foundation via the Norwegian Breast Cancer Society.
A version of this article first appeared on Medscape.com.
Nearly 1 in 5 women who receive the recommended 10 biennial screening rounds for breast cancer in Norway will get a false positive result, and 1 in 20 women will receive a false positive result that leads to an invasive procedure, a new analysis shows.
While the risk may seem high, it is actually much lower than what researchers have reported in the U.S., the study authors note in their paper, published online Dec. 21 in Cancer.
“I am proud about the low rate of recalls we have in Norway and Europe – and hope we can keep it that low for the future,” said senior author Solveig Hofvind, PhD, head of BreastScreen Norway, a nationwide screening program that invites women aged 50 to 69 to mammographic screening every other year.
“The double reading in Europe is probably the main reason for the lower rate in Europe compared to the U.S., where single reading is used,” she said in an interview.
Until now, Dr. Hofvind and her colleagues say, no studies have been performed using exclusively empirical data to describe the cumulative risk of experiencing a false positive screening result in Europe because of the need for long-term follow-up and complete data registration.
For their study, the researchers turned to the Cancer Registry of Norway, which administers BreastScreen Norway. They focused on data from 1995 to 2019 on women aged 50 to 69 years who had attended one or more screening rounds and could potentially attend all 10 screening examinations over the 20-year period.
Women were excluded if they were diagnosed with breast cancer before attending screening, participated in interventional research, self-referred for screening, were recalled due to self-reported symptoms or technically inadequate mammograms, or declined follow-up after a positive screen.
Among more than 421,000 women who underwent nearly 1.9 million screening examinations, 11.3% experienced at least one false positive result and 3.3% experienced at least one false positive involving an invasive procedure, such as fine-needle aspiration cytology, core-needle biopsy, or open biopsy.
The cumulative risk of experiencing a first false positive screen was 18.0% and that of experiencing a false positive that involved an invasive procedure was 5.01%. Adjusting for irregular attendance, age at screening, or the number of screens attended had little effect on the estimates.
The results closely match earlier findings from Norway that have been based on assumptions rather than exclusively empirical data. However, these findings differ from results reported in U.S. studies, which have relied largely on data from the Breast Cancer Surveillance Consortium, the researchers say.
“The latter have indicated that, for women who initiate biennial screening at the age of 50 years, the cumulative risk after 10 years is 42% for experiencing at least one false-positive screening result and 6.4% for experiencing at least one false-positive screening result involving an invasive procedure,” Dr. Hofvind and her colleagues write.
Several principal investigators with the Breast Cancer Surveillance Consortium did not respond or were unavailable for comment when contacted by this news organization.
However, the study authors highlighted several factors that could help explain the discrepancy between the U.S. and European results.
In addition to double mammogram reading, “European guidelines recommend that breast radiologists read 3,500 to 11,000 mammograms annually, whereas 960 every 2 years are required by the U.S. Mammography Quality Standards Act,” the researchers note. They also point out that previous screening mammograms are readily available in Norway, whereas this is not always the case in the U.S.
“False-positive screening results are a part of the screening for breast cancer – and the women need to be informed about the risk,” Dr. Hofvind concluded. “The screening programs should aim to keep the rate as low as possible for the women [given] the costs.”
The study was supported by the Dam Foundation via the Norwegian Breast Cancer Society.
A version of this article first appeared on Medscape.com.
Nearly 1 in 5 women who receive the recommended 10 biennial screening rounds for breast cancer in Norway will get a false positive result, and 1 in 20 women will receive a false positive result that leads to an invasive procedure, a new analysis shows.
While the risk may seem high, it is actually much lower than what researchers have reported in the U.S., the study authors note in their paper, published online Dec. 21 in Cancer.
“I am proud about the low rate of recalls we have in Norway and Europe – and hope we can keep it that low for the future,” said senior author Solveig Hofvind, PhD, head of BreastScreen Norway, a nationwide screening program that invites women aged 50 to 69 to mammographic screening every other year.
“The double reading in Europe is probably the main reason for the lower rate in Europe compared to the U.S., where single reading is used,” she said in an interview.
Until now, Dr. Hofvind and her colleagues say, no studies have been performed using exclusively empirical data to describe the cumulative risk of experiencing a false positive screening result in Europe because of the need for long-term follow-up and complete data registration.
For their study, the researchers turned to the Cancer Registry of Norway, which administers BreastScreen Norway. They focused on data from 1995 to 2019 on women aged 50 to 69 years who had attended one or more screening rounds and could potentially attend all 10 screening examinations over the 20-year period.
Women were excluded if they were diagnosed with breast cancer before attending screening, participated in interventional research, self-referred for screening, were recalled due to self-reported symptoms or technically inadequate mammograms, or declined follow-up after a positive screen.
Among more than 421,000 women who underwent nearly 1.9 million screening examinations, 11.3% experienced at least one false positive result and 3.3% experienced at least one false positive involving an invasive procedure, such as fine-needle aspiration cytology, core-needle biopsy, or open biopsy.
The cumulative risk of experiencing a first false positive screen was 18.0% and that of experiencing a false positive that involved an invasive procedure was 5.01%. Adjusting for irregular attendance, age at screening, or the number of screens attended had little effect on the estimates.
The results closely match earlier findings from Norway that have been based on assumptions rather than exclusively empirical data. However, these findings differ from results reported in U.S. studies, which have relied largely on data from the Breast Cancer Surveillance Consortium, the researchers say.
“The latter have indicated that, for women who initiate biennial screening at the age of 50 years, the cumulative risk after 10 years is 42% for experiencing at least one false-positive screening result and 6.4% for experiencing at least one false-positive screening result involving an invasive procedure,” Dr. Hofvind and her colleagues write.
Several principal investigators with the Breast Cancer Surveillance Consortium did not respond or were unavailable for comment when contacted by this news organization.
However, the study authors highlighted several factors that could help explain the discrepancy between the U.S. and European results.
In addition to double mammogram reading, “European guidelines recommend that breast radiologists read 3,500 to 11,000 mammograms annually, whereas 960 every 2 years are required by the U.S. Mammography Quality Standards Act,” the researchers note. They also point out that previous screening mammograms are readily available in Norway, whereas this is not always the case in the U.S.
“False-positive screening results are a part of the screening for breast cancer – and the women need to be informed about the risk,” Dr. Hofvind concluded. “The screening programs should aim to keep the rate as low as possible for the women [given] the costs.”
The study was supported by the Dam Foundation via the Norwegian Breast Cancer Society.
A version of this article first appeared on Medscape.com.
Progress still needed for pregnant and postpartum gastroenterologists
Despite increasing numbers joining the field, women remain a minority group in gastroenterology, where they constitute only 18% of these physicians.1 Additionally, women continue to be underrepresented among senior faculty and in leadership roles in both academic and private practice settings.2 While women now make up a majority of medical school matriculants3,4 women trainees are frequently dissuaded from pursuing specialty fellowships following residency, particularly in procedurally based fields like gastroenterology, because of perceived incompatibility with childbearing and child-rearing.5-8 For many who choose to enter the field despite these challenges, gastroenterology training and early practice often coincide with childbearing years.910 These structural impediments may contribute to the “leaky pipeline” and female physician attrition during the first decade of independent practice after fellowship.11-13 Urgent changes are needed in order to retain and support clinicians and physician-scientists through this period so that they, their offspring, their patients, and the field are able to thrive.
Fertility and pregnancy
The decision to have a child is a major milestone for many physicians and often occurs during gastroenterology training or early practice.10 Medical-training and early-career environments are not yet optimized to support women who become pregnant. At baseline, the formative years of a career are challenging ones, punctuated by long hours and both intellectually and emotionally demanding work. They are also often physically grueling, particularly while one is learning and becoming efficient in endoscopy. The ergonomics in the endoscopy suite (as in other areas of medicine) are not optimized for physicians of shorter stature, smaller hand sizes, and those who may have difficulty pushing a several-hundred-pound endoscopy cart bedside, all of which contribute to increased injury risk for female proceduralists.7,14-16 Methods to reduce endoscopic injuries in pregnant endoscopists have not yet been studied. Additionally, the existence of maternity and gender bias has been well-documented, in our field and beyond.17-20 Not surprisingly, women in gastroenterology commonly report delayed childbearing, with expected consequences, including increased infertility rates, compared with nonphysician peers.21 After 5 and 10 years as attendings, female gastroenterologists continue to report fewer children than male colleagues.22,23 Once pregnant, there are a number of field-specific challenges to navigate. These include decisions about the safety of performing procedures involving fluoroscopy or high infectious risk, particularly early in pregnancy when organogenesis occurs.7,24 Additionally, engaging in appropriate obstetric care can be challenging given the need for regular physician and ultrasound appointments.
Simple, cost-efficient interventions may be effective in decreasing infertility rates, pregnancy loss, and poor physician experiences during pregnancy. For one, all gastroenterology divisions could craft written policies that include a no-tolerance approach to expressions of maternity bias against pregnant or postpartum trainees and faculty.12,25 Additionally, ergonomic improvements, such as standing pads, dial extenders, and adjusted screen heights may decrease injury rates and increase comfort for female endoscopists.26,27 There should also be a no-penalty, no-questions-asked approach for any female endoscopist who defers performance of an obstetrically high-risk procedure to a nonpregnant colleague. Additionally, pregnant gastroenterologists should be supported in obtaining high-quality obstetric care. At an individual level, nonpregnant gastroenterologists, and particularly male allies, can support pregnant colleagues by agreeing to perform higher-risk procedures, stepping in if a fellow is unable to perform endoscopy because of pregnancy, and by offering to push the endoscopy cart on behalf of a pregnant colleague to bedside, if necessary.10,28
Parental leave
Following delivery, parental leave presents an additional challenge for the physician parent. Paid maternal leave has been associated with improved child and maternal outcomes and is widely available to physicians outside the United States.29,30 At present, duration of leave varies significantly by career stage (fellows versus attending), practice setting (academic center versus private practice), and geographic location. The American Academy of Pediatrics recommends a minimum of 12 weeks of leave.31 This length has been associated with lower rates of postpartum depression and higher rates of sustained breastfeeding, with subsequent improved health outcomes for mother and child.32-34 An increasing number of states have passed laws mandating minimum paid and unpaid parental leave time (for example, in Massachusetts, gastroenterology trainees and faculty are afforded 12 weeks of leave, in accordance with state law).35 Recent changes to board eligibility and training requirements via the American Board of Medical Specialties and the American Council for Graduate Medical Education now provide 6 weeks for parental leave. This is an improvement over prior policies which rendered many physician-parents board-ineligible if they took more than 4 weeks of leave, although it must be noted that even the revised policies allow for less time than either that of Obstetricians and Gynecologists or than the American Academy of Pediatrics recommends.
Our data, presented at the 2021 ACG conference, suggest that many trainees report receiving 4 weeks or less of parental leave, despite the ACGME and ABMS policies described above. We also found that physicians were frequently not aware of their institution or division leave policies.10 Ideally, all gastroenterology divisions in the United States would follow the recommended leave duration set forth by the medical societies of specialties that care for pregnant and postpartum mothers and their infants. Additionally, the impact of leave time on graduation and board eligibility, as well as academic and practice promotion, should be made clear at the time of leave and should minimize adverse consequences for the careers of pregnant and postpartum gastroenterologists. Gastroenterology trainees and faculty should be educated in the existence and details of their institution or practice policies, and these policies should be made readily available to all physicians and administrators.
Postpartum period
The transition back to work is a challenging one for mothers in all fields of medicine, particularly for those returning to procedurally based subspecialties such as gastroenterology. This is especially true for trainees and faculty who have returned to work sooner than the recommended 12 weeks and for those who are post cesarean section, for whom physical healing may not be complete. Long days performing endoscopy may be physically challenging or impossible for some women during the postpartum period. Additionally, expressing breast milk, a metabolically intensive activity, also necessitates time, space, and privacy to perform and is frequently made more difficult by insufficient lactation accommodations. The COVID-19 pandemic has increased logistic challenges for lactating mothers, because of the need for well-ventilated lactation spaces to minimize infectious risk.19 Our colleagues have reported pumping in their vehicles, in supply closets, and in spaces that require so much travel time (in addition to time required to express milk, store milk, and clean pump equipment) that the practice was unsustainable, and the physician stopped breastfeeding prematurely.36
The benefits of breastfeeding for mother and infant are well-established, and exclusive breastfeeding for the first 6 months of life is supported by the American College of Obstetricians and Gynecologists, whose position statement reads as follows: “Policies that protect the right of a woman and her child to breastfeed ... and that accommodate milk expression, such as ... paid maternity leave, on-site childcare, break time for expressing milk, and a clean, private location for expressing milk, are essential to sustaining breastfeeding.”37 We would add to these recommendations provision of dedicated milk storage space and establishment of clear, supportive policies that allow lactating physicians to breastfeed and express breast milk if they choose without career penalty. Several institutions offer scheduled protected clinical time and modified work relative value units (RVU) for lactating physicians, such that returning parents can have protected time for expressing breast milk and still meet RVU targets.38 Additionally, many academic institutions offer productivity adjustments for tenure-track faculty who have recently had children.
Creating a more supportive environment for women gastroenterologists who desire children allows the field to be more representative of our patient population and has been shown to positively impact outcomes from improved colorectal cancer screening rates to more guideline-directed informed consent conversations.39-41 Gastroenterology should comprise a physician workforce predicated on clinical and research excellence alone and should not require its practitioners to delay or abstain from pregnancy and child rearing. Robust, clear, and generous parental leave and postpartum accommodations will allow the field to retain and promote talented physicians, who will then contribute to the betterment of patients and the field over decades.
Dr. Rabinowitz is a faculty member in the department of medicine and division of gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Dr. Feld is a transplant hepatology fellow, division of gastroenterology, department of medicine, University of Washington, Seattle. Dr. Rabinowitz and Dr. Feld have no conflicts of interest to disclose.
References
1. AAMC. Diversity in Medicine: Facts and Figures 2019. 2018.
2. Colleges AoAM. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2015-2016. 2016. www.aamc.org/download/481206/data/2015table11.pdf.
3. AAMC. Table B-3: Total U.S. Medical School Enrollment by Race/Ethnicity and Sex, 2014-2015 through 2018-2019, 2019.
4. Rabinowitz LG. Recognizing blind spots – a remedy for gender bias in medicine? (N Engl. J Med. 2018; 378[24]: 2253-5).
5. Douglas PS et al. Career preferences and perceptions of cardiology among US internal medicine trainees: Factors influencing cardiology career choice. JAMA Cardiol 2018; 3(8):682-91.
6. Stack SW et al. Childbearing decisions in residency: A multicenter survey of female residents. Acad Med 2020;95(10):1550-7.
7. David YN et al. Pregnancy and the working gastroenterologist: Perceptions, realities, and systemic challenges. Gastroenterology 2021;161(3):756-60.
8. Rembacken BJ et al. Barriers and bias standing in the way of female trainees wanting to learn advanced endoscopy. United European Gastroenterol J. 2019;7(8):1141-5.
9. Arlow FL et al. Gastroenterology training and career choices: A prospective longitudinal study of the impact of gender and of managed care. Am J Gastroenterol. 2002;97(2):459-69.
10. Feld L et al. Parental leave for gastroenterology fellows: A national survey of current fellows. Am J Gastroenterol. 2021;116:S611-2.
11. Rabinowitz LG et al. Addressing gender in gastroenterology: opportunities for change. Gastrointest Endosc. 2020;91(1):155-61.
12. Feld LD. Baby steps in the right direction: Toward a parental leave policy for gastroenterology fellows. Am J Gastroenterol. 2021;116(3):505-8.
13. Feld LD. Interviewing for two. Am J Gastroenterol. 2020;116(3):445-6
14. Rabinowitz LG et al. Gender dynamics in education and practice of gastroenterology. Gastrointest Endosc. 2021;93(5):1047-56.e5.
15. Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol. 2014;48(7):590-4.
16. LabX Oecs. www.labx.com/product/endoscopy-cart (accessed 2021 Nov 19.
17. Heilman ME and Okimoto TG. Motherhood: A potential source of bias in employment decisions. J Appl Psychol. 2008;93(1):189-98.
18. Robinson K et al. Racism, bias, and discrimination as modifiable barriers to breastfeeding for African American women: A scoping review of the literature. J Midwifery Womens Health. 2019;64(6):734-42.
19. Rabinowitz LG and Rabinowitz DG. Women on the Frontline: A Changed Workforce and the Fight Against COVID-19. Acad Med. 2021 Jun 1;96(6):808-12.
20. Rabinowitz LG et al. Gender in the endoscopy suite. Lancet Gastroenterol Hepatol. 2020 Dec;5(12):1032-4.
21. Stentz NC et al. Fertility and childbearing among American female physicians. J Womens Health. 2016; 25(10):1059-65.
22. Burke CA et al. Gender disparity in the practice of gastroenterology: The first 5 years of a career. Am J Gastroenterol. 2005;100(2):259-64.
23. Singh A et al. Women in gastroenterology committee of American College of G. Do gender disparities persist in gastroenterology after 10 years of practice? Am J Gastroenterol. 2008;103(7):1589-95.
24. Krueger KJ and Hoffman BJ. Radiation exposure during gastroenterologic fluoroscopy: Risk assessment for pregnant workers. Am J Gastroenterol. 1992;87(4):429-31.
25. Krause ML et al. Impact of pregnancy and gender on internal medicine resident evaluations: A retrospective cohort study. J Gen Intern Med. 2017;32(6):648-53.
26. Pawa S et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol. 2021;116(3):530-8.
27. David YN et al. Gender-specific factors influencing gastroenterologists to pursue careers in advanced endoscopy: perceptions vs reality. Am J Gastroenterol. 2021;116(3):539-50.
28. Bilal M et al. The need for allyship in achieving gender equity in gastroenterology. Am J Gastroenterol. 2021 Oct 19. doi: 10.14309/ajg.0000000000001508. Online ahead of print.
29. Jou J et al. Paid maternity leave in the United States: Associations with maternal and infant health. Matern Child Health J. 2018;22(2):216-25.
30. Aitken Z et al. The maternal health outcomes of paid maternity leave: A systematic review. Soc Sci Med. 2015;130:32-41.
31. Dodson NA and Talib HJ. Paid parental leave for mothers and fathers can improve physician wellness. AAP News. 2020 Jul 1. https://publications.aap.org/aapnews/news/12432.
32. Kornfeind KR and Sipsma HL. Exploring the link between maternity leave and postpartum depression. Womens Health Issues 2018;28(4):321-6.
33. Navarro-Rosenblatt D and Garmendia ML. Maternity leave and its impact on breastfeeding: A review of the literature. Breastfeed Med 2018;13(9):589-97.
34. Stack SW et al. Maternity leave in residency: A multicenter study of determinants and wellness outcomes. Acad Med. 2019;94(11):1738-45.
35. Mass.gov. Paid Family and Medical Leave Information for Massachusetts Employers. 2020.
36. Ares Segura S et al. en representacion del Comite de Lactancia Materna de la Asociacion Espanola de P. [The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements?]. An Pediatr. (Barc) 2016;84(6):347 e1-7.
37. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Committee Opinion No. 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice. Obstet Gynecol. 2016;127(2):e86-92.
38. Porter KK et al. A lactation credit model to support breastfeeding in radiology: The new gold standard to support “liquid gold.” Clin Imaging 2021;80:16-8.
39. Davis J et al. Clinical practice patterns suggest female patients prefer female endoscopists. Dig Dis Sci. 2015;60(10):3149-50.
40. Menees SB et al. Women patients’ preference for women physicians is a barrier to colon cancer screening. Gastrointest Endosc. 2005;62(2):219-23.
41. Feld LD et al. Management of code status in the periendoscopic period: A national survey of current practices and beliefs of U.S. gastroenterologists. Gastrointest Endosc. 2021;94(1):172-7.e2.
Despite increasing numbers joining the field, women remain a minority group in gastroenterology, where they constitute only 18% of these physicians.1 Additionally, women continue to be underrepresented among senior faculty and in leadership roles in both academic and private practice settings.2 While women now make up a majority of medical school matriculants3,4 women trainees are frequently dissuaded from pursuing specialty fellowships following residency, particularly in procedurally based fields like gastroenterology, because of perceived incompatibility with childbearing and child-rearing.5-8 For many who choose to enter the field despite these challenges, gastroenterology training and early practice often coincide with childbearing years.910 These structural impediments may contribute to the “leaky pipeline” and female physician attrition during the first decade of independent practice after fellowship.11-13 Urgent changes are needed in order to retain and support clinicians and physician-scientists through this period so that they, their offspring, their patients, and the field are able to thrive.
Fertility and pregnancy
The decision to have a child is a major milestone for many physicians and often occurs during gastroenterology training or early practice.10 Medical-training and early-career environments are not yet optimized to support women who become pregnant. At baseline, the formative years of a career are challenging ones, punctuated by long hours and both intellectually and emotionally demanding work. They are also often physically grueling, particularly while one is learning and becoming efficient in endoscopy. The ergonomics in the endoscopy suite (as in other areas of medicine) are not optimized for physicians of shorter stature, smaller hand sizes, and those who may have difficulty pushing a several-hundred-pound endoscopy cart bedside, all of which contribute to increased injury risk for female proceduralists.7,14-16 Methods to reduce endoscopic injuries in pregnant endoscopists have not yet been studied. Additionally, the existence of maternity and gender bias has been well-documented, in our field and beyond.17-20 Not surprisingly, women in gastroenterology commonly report delayed childbearing, with expected consequences, including increased infertility rates, compared with nonphysician peers.21 After 5 and 10 years as attendings, female gastroenterologists continue to report fewer children than male colleagues.22,23 Once pregnant, there are a number of field-specific challenges to navigate. These include decisions about the safety of performing procedures involving fluoroscopy or high infectious risk, particularly early in pregnancy when organogenesis occurs.7,24 Additionally, engaging in appropriate obstetric care can be challenging given the need for regular physician and ultrasound appointments.
Simple, cost-efficient interventions may be effective in decreasing infertility rates, pregnancy loss, and poor physician experiences during pregnancy. For one, all gastroenterology divisions could craft written policies that include a no-tolerance approach to expressions of maternity bias against pregnant or postpartum trainees and faculty.12,25 Additionally, ergonomic improvements, such as standing pads, dial extenders, and adjusted screen heights may decrease injury rates and increase comfort for female endoscopists.26,27 There should also be a no-penalty, no-questions-asked approach for any female endoscopist who defers performance of an obstetrically high-risk procedure to a nonpregnant colleague. Additionally, pregnant gastroenterologists should be supported in obtaining high-quality obstetric care. At an individual level, nonpregnant gastroenterologists, and particularly male allies, can support pregnant colleagues by agreeing to perform higher-risk procedures, stepping in if a fellow is unable to perform endoscopy because of pregnancy, and by offering to push the endoscopy cart on behalf of a pregnant colleague to bedside, if necessary.10,28
Parental leave
Following delivery, parental leave presents an additional challenge for the physician parent. Paid maternal leave has been associated with improved child and maternal outcomes and is widely available to physicians outside the United States.29,30 At present, duration of leave varies significantly by career stage (fellows versus attending), practice setting (academic center versus private practice), and geographic location. The American Academy of Pediatrics recommends a minimum of 12 weeks of leave.31 This length has been associated with lower rates of postpartum depression and higher rates of sustained breastfeeding, with subsequent improved health outcomes for mother and child.32-34 An increasing number of states have passed laws mandating minimum paid and unpaid parental leave time (for example, in Massachusetts, gastroenterology trainees and faculty are afforded 12 weeks of leave, in accordance with state law).35 Recent changes to board eligibility and training requirements via the American Board of Medical Specialties and the American Council for Graduate Medical Education now provide 6 weeks for parental leave. This is an improvement over prior policies which rendered many physician-parents board-ineligible if they took more than 4 weeks of leave, although it must be noted that even the revised policies allow for less time than either that of Obstetricians and Gynecologists or than the American Academy of Pediatrics recommends.
Our data, presented at the 2021 ACG conference, suggest that many trainees report receiving 4 weeks or less of parental leave, despite the ACGME and ABMS policies described above. We also found that physicians were frequently not aware of their institution or division leave policies.10 Ideally, all gastroenterology divisions in the United States would follow the recommended leave duration set forth by the medical societies of specialties that care for pregnant and postpartum mothers and their infants. Additionally, the impact of leave time on graduation and board eligibility, as well as academic and practice promotion, should be made clear at the time of leave and should minimize adverse consequences for the careers of pregnant and postpartum gastroenterologists. Gastroenterology trainees and faculty should be educated in the existence and details of their institution or practice policies, and these policies should be made readily available to all physicians and administrators.
Postpartum period
The transition back to work is a challenging one for mothers in all fields of medicine, particularly for those returning to procedurally based subspecialties such as gastroenterology. This is especially true for trainees and faculty who have returned to work sooner than the recommended 12 weeks and for those who are post cesarean section, for whom physical healing may not be complete. Long days performing endoscopy may be physically challenging or impossible for some women during the postpartum period. Additionally, expressing breast milk, a metabolically intensive activity, also necessitates time, space, and privacy to perform and is frequently made more difficult by insufficient lactation accommodations. The COVID-19 pandemic has increased logistic challenges for lactating mothers, because of the need for well-ventilated lactation spaces to minimize infectious risk.19 Our colleagues have reported pumping in their vehicles, in supply closets, and in spaces that require so much travel time (in addition to time required to express milk, store milk, and clean pump equipment) that the practice was unsustainable, and the physician stopped breastfeeding prematurely.36
The benefits of breastfeeding for mother and infant are well-established, and exclusive breastfeeding for the first 6 months of life is supported by the American College of Obstetricians and Gynecologists, whose position statement reads as follows: “Policies that protect the right of a woman and her child to breastfeed ... and that accommodate milk expression, such as ... paid maternity leave, on-site childcare, break time for expressing milk, and a clean, private location for expressing milk, are essential to sustaining breastfeeding.”37 We would add to these recommendations provision of dedicated milk storage space and establishment of clear, supportive policies that allow lactating physicians to breastfeed and express breast milk if they choose without career penalty. Several institutions offer scheduled protected clinical time and modified work relative value units (RVU) for lactating physicians, such that returning parents can have protected time for expressing breast milk and still meet RVU targets.38 Additionally, many academic institutions offer productivity adjustments for tenure-track faculty who have recently had children.
Creating a more supportive environment for women gastroenterologists who desire children allows the field to be more representative of our patient population and has been shown to positively impact outcomes from improved colorectal cancer screening rates to more guideline-directed informed consent conversations.39-41 Gastroenterology should comprise a physician workforce predicated on clinical and research excellence alone and should not require its practitioners to delay or abstain from pregnancy and child rearing. Robust, clear, and generous parental leave and postpartum accommodations will allow the field to retain and promote talented physicians, who will then contribute to the betterment of patients and the field over decades.
Dr. Rabinowitz is a faculty member in the department of medicine and division of gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Dr. Feld is a transplant hepatology fellow, division of gastroenterology, department of medicine, University of Washington, Seattle. Dr. Rabinowitz and Dr. Feld have no conflicts of interest to disclose.
References
1. AAMC. Diversity in Medicine: Facts and Figures 2019. 2018.
2. Colleges AoAM. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2015-2016. 2016. www.aamc.org/download/481206/data/2015table11.pdf.
3. AAMC. Table B-3: Total U.S. Medical School Enrollment by Race/Ethnicity and Sex, 2014-2015 through 2018-2019, 2019.
4. Rabinowitz LG. Recognizing blind spots – a remedy for gender bias in medicine? (N Engl. J Med. 2018; 378[24]: 2253-5).
5. Douglas PS et al. Career preferences and perceptions of cardiology among US internal medicine trainees: Factors influencing cardiology career choice. JAMA Cardiol 2018; 3(8):682-91.
6. Stack SW et al. Childbearing decisions in residency: A multicenter survey of female residents. Acad Med 2020;95(10):1550-7.
7. David YN et al. Pregnancy and the working gastroenterologist: Perceptions, realities, and systemic challenges. Gastroenterology 2021;161(3):756-60.
8. Rembacken BJ et al. Barriers and bias standing in the way of female trainees wanting to learn advanced endoscopy. United European Gastroenterol J. 2019;7(8):1141-5.
9. Arlow FL et al. Gastroenterology training and career choices: A prospective longitudinal study of the impact of gender and of managed care. Am J Gastroenterol. 2002;97(2):459-69.
10. Feld L et al. Parental leave for gastroenterology fellows: A national survey of current fellows. Am J Gastroenterol. 2021;116:S611-2.
11. Rabinowitz LG et al. Addressing gender in gastroenterology: opportunities for change. Gastrointest Endosc. 2020;91(1):155-61.
12. Feld LD. Baby steps in the right direction: Toward a parental leave policy for gastroenterology fellows. Am J Gastroenterol. 2021;116(3):505-8.
13. Feld LD. Interviewing for two. Am J Gastroenterol. 2020;116(3):445-6
14. Rabinowitz LG et al. Gender dynamics in education and practice of gastroenterology. Gastrointest Endosc. 2021;93(5):1047-56.e5.
15. Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol. 2014;48(7):590-4.
16. LabX Oecs. www.labx.com/product/endoscopy-cart (accessed 2021 Nov 19.
17. Heilman ME and Okimoto TG. Motherhood: A potential source of bias in employment decisions. J Appl Psychol. 2008;93(1):189-98.
18. Robinson K et al. Racism, bias, and discrimination as modifiable barriers to breastfeeding for African American women: A scoping review of the literature. J Midwifery Womens Health. 2019;64(6):734-42.
19. Rabinowitz LG and Rabinowitz DG. Women on the Frontline: A Changed Workforce and the Fight Against COVID-19. Acad Med. 2021 Jun 1;96(6):808-12.
20. Rabinowitz LG et al. Gender in the endoscopy suite. Lancet Gastroenterol Hepatol. 2020 Dec;5(12):1032-4.
21. Stentz NC et al. Fertility and childbearing among American female physicians. J Womens Health. 2016; 25(10):1059-65.
22. Burke CA et al. Gender disparity in the practice of gastroenterology: The first 5 years of a career. Am J Gastroenterol. 2005;100(2):259-64.
23. Singh A et al. Women in gastroenterology committee of American College of G. Do gender disparities persist in gastroenterology after 10 years of practice? Am J Gastroenterol. 2008;103(7):1589-95.
24. Krueger KJ and Hoffman BJ. Radiation exposure during gastroenterologic fluoroscopy: Risk assessment for pregnant workers. Am J Gastroenterol. 1992;87(4):429-31.
25. Krause ML et al. Impact of pregnancy and gender on internal medicine resident evaluations: A retrospective cohort study. J Gen Intern Med. 2017;32(6):648-53.
26. Pawa S et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol. 2021;116(3):530-8.
27. David YN et al. Gender-specific factors influencing gastroenterologists to pursue careers in advanced endoscopy: perceptions vs reality. Am J Gastroenterol. 2021;116(3):539-50.
28. Bilal M et al. The need for allyship in achieving gender equity in gastroenterology. Am J Gastroenterol. 2021 Oct 19. doi: 10.14309/ajg.0000000000001508. Online ahead of print.
29. Jou J et al. Paid maternity leave in the United States: Associations with maternal and infant health. Matern Child Health J. 2018;22(2):216-25.
30. Aitken Z et al. The maternal health outcomes of paid maternity leave: A systematic review. Soc Sci Med. 2015;130:32-41.
31. Dodson NA and Talib HJ. Paid parental leave for mothers and fathers can improve physician wellness. AAP News. 2020 Jul 1. https://publications.aap.org/aapnews/news/12432.
32. Kornfeind KR and Sipsma HL. Exploring the link between maternity leave and postpartum depression. Womens Health Issues 2018;28(4):321-6.
33. Navarro-Rosenblatt D and Garmendia ML. Maternity leave and its impact on breastfeeding: A review of the literature. Breastfeed Med 2018;13(9):589-97.
34. Stack SW et al. Maternity leave in residency: A multicenter study of determinants and wellness outcomes. Acad Med. 2019;94(11):1738-45.
35. Mass.gov. Paid Family and Medical Leave Information for Massachusetts Employers. 2020.
36. Ares Segura S et al. en representacion del Comite de Lactancia Materna de la Asociacion Espanola de P. [The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements?]. An Pediatr. (Barc) 2016;84(6):347 e1-7.
37. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Committee Opinion No. 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice. Obstet Gynecol. 2016;127(2):e86-92.
38. Porter KK et al. A lactation credit model to support breastfeeding in radiology: The new gold standard to support “liquid gold.” Clin Imaging 2021;80:16-8.
39. Davis J et al. Clinical practice patterns suggest female patients prefer female endoscopists. Dig Dis Sci. 2015;60(10):3149-50.
40. Menees SB et al. Women patients’ preference for women physicians is a barrier to colon cancer screening. Gastrointest Endosc. 2005;62(2):219-23.
41. Feld LD et al. Management of code status in the periendoscopic period: A national survey of current practices and beliefs of U.S. gastroenterologists. Gastrointest Endosc. 2021;94(1):172-7.e2.
Despite increasing numbers joining the field, women remain a minority group in gastroenterology, where they constitute only 18% of these physicians.1 Additionally, women continue to be underrepresented among senior faculty and in leadership roles in both academic and private practice settings.2 While women now make up a majority of medical school matriculants3,4 women trainees are frequently dissuaded from pursuing specialty fellowships following residency, particularly in procedurally based fields like gastroenterology, because of perceived incompatibility with childbearing and child-rearing.5-8 For many who choose to enter the field despite these challenges, gastroenterology training and early practice often coincide with childbearing years.910 These structural impediments may contribute to the “leaky pipeline” and female physician attrition during the first decade of independent practice after fellowship.11-13 Urgent changes are needed in order to retain and support clinicians and physician-scientists through this period so that they, their offspring, their patients, and the field are able to thrive.
Fertility and pregnancy
The decision to have a child is a major milestone for many physicians and often occurs during gastroenterology training or early practice.10 Medical-training and early-career environments are not yet optimized to support women who become pregnant. At baseline, the formative years of a career are challenging ones, punctuated by long hours and both intellectually and emotionally demanding work. They are also often physically grueling, particularly while one is learning and becoming efficient in endoscopy. The ergonomics in the endoscopy suite (as in other areas of medicine) are not optimized for physicians of shorter stature, smaller hand sizes, and those who may have difficulty pushing a several-hundred-pound endoscopy cart bedside, all of which contribute to increased injury risk for female proceduralists.7,14-16 Methods to reduce endoscopic injuries in pregnant endoscopists have not yet been studied. Additionally, the existence of maternity and gender bias has been well-documented, in our field and beyond.17-20 Not surprisingly, women in gastroenterology commonly report delayed childbearing, with expected consequences, including increased infertility rates, compared with nonphysician peers.21 After 5 and 10 years as attendings, female gastroenterologists continue to report fewer children than male colleagues.22,23 Once pregnant, there are a number of field-specific challenges to navigate. These include decisions about the safety of performing procedures involving fluoroscopy or high infectious risk, particularly early in pregnancy when organogenesis occurs.7,24 Additionally, engaging in appropriate obstetric care can be challenging given the need for regular physician and ultrasound appointments.
Simple, cost-efficient interventions may be effective in decreasing infertility rates, pregnancy loss, and poor physician experiences during pregnancy. For one, all gastroenterology divisions could craft written policies that include a no-tolerance approach to expressions of maternity bias against pregnant or postpartum trainees and faculty.12,25 Additionally, ergonomic improvements, such as standing pads, dial extenders, and adjusted screen heights may decrease injury rates and increase comfort for female endoscopists.26,27 There should also be a no-penalty, no-questions-asked approach for any female endoscopist who defers performance of an obstetrically high-risk procedure to a nonpregnant colleague. Additionally, pregnant gastroenterologists should be supported in obtaining high-quality obstetric care. At an individual level, nonpregnant gastroenterologists, and particularly male allies, can support pregnant colleagues by agreeing to perform higher-risk procedures, stepping in if a fellow is unable to perform endoscopy because of pregnancy, and by offering to push the endoscopy cart on behalf of a pregnant colleague to bedside, if necessary.10,28
Parental leave
Following delivery, parental leave presents an additional challenge for the physician parent. Paid maternal leave has been associated with improved child and maternal outcomes and is widely available to physicians outside the United States.29,30 At present, duration of leave varies significantly by career stage (fellows versus attending), practice setting (academic center versus private practice), and geographic location. The American Academy of Pediatrics recommends a minimum of 12 weeks of leave.31 This length has been associated with lower rates of postpartum depression and higher rates of sustained breastfeeding, with subsequent improved health outcomes for mother and child.32-34 An increasing number of states have passed laws mandating minimum paid and unpaid parental leave time (for example, in Massachusetts, gastroenterology trainees and faculty are afforded 12 weeks of leave, in accordance with state law).35 Recent changes to board eligibility and training requirements via the American Board of Medical Specialties and the American Council for Graduate Medical Education now provide 6 weeks for parental leave. This is an improvement over prior policies which rendered many physician-parents board-ineligible if they took more than 4 weeks of leave, although it must be noted that even the revised policies allow for less time than either that of Obstetricians and Gynecologists or than the American Academy of Pediatrics recommends.
Our data, presented at the 2021 ACG conference, suggest that many trainees report receiving 4 weeks or less of parental leave, despite the ACGME and ABMS policies described above. We also found that physicians were frequently not aware of their institution or division leave policies.10 Ideally, all gastroenterology divisions in the United States would follow the recommended leave duration set forth by the medical societies of specialties that care for pregnant and postpartum mothers and their infants. Additionally, the impact of leave time on graduation and board eligibility, as well as academic and practice promotion, should be made clear at the time of leave and should minimize adverse consequences for the careers of pregnant and postpartum gastroenterologists. Gastroenterology trainees and faculty should be educated in the existence and details of their institution or practice policies, and these policies should be made readily available to all physicians and administrators.
Postpartum period
The transition back to work is a challenging one for mothers in all fields of medicine, particularly for those returning to procedurally based subspecialties such as gastroenterology. This is especially true for trainees and faculty who have returned to work sooner than the recommended 12 weeks and for those who are post cesarean section, for whom physical healing may not be complete. Long days performing endoscopy may be physically challenging or impossible for some women during the postpartum period. Additionally, expressing breast milk, a metabolically intensive activity, also necessitates time, space, and privacy to perform and is frequently made more difficult by insufficient lactation accommodations. The COVID-19 pandemic has increased logistic challenges for lactating mothers, because of the need for well-ventilated lactation spaces to minimize infectious risk.19 Our colleagues have reported pumping in their vehicles, in supply closets, and in spaces that require so much travel time (in addition to time required to express milk, store milk, and clean pump equipment) that the practice was unsustainable, and the physician stopped breastfeeding prematurely.36
The benefits of breastfeeding for mother and infant are well-established, and exclusive breastfeeding for the first 6 months of life is supported by the American College of Obstetricians and Gynecologists, whose position statement reads as follows: “Policies that protect the right of a woman and her child to breastfeed ... and that accommodate milk expression, such as ... paid maternity leave, on-site childcare, break time for expressing milk, and a clean, private location for expressing milk, are essential to sustaining breastfeeding.”37 We would add to these recommendations provision of dedicated milk storage space and establishment of clear, supportive policies that allow lactating physicians to breastfeed and express breast milk if they choose without career penalty. Several institutions offer scheduled protected clinical time and modified work relative value units (RVU) for lactating physicians, such that returning parents can have protected time for expressing breast milk and still meet RVU targets.38 Additionally, many academic institutions offer productivity adjustments for tenure-track faculty who have recently had children.
Creating a more supportive environment for women gastroenterologists who desire children allows the field to be more representative of our patient population and has been shown to positively impact outcomes from improved colorectal cancer screening rates to more guideline-directed informed consent conversations.39-41 Gastroenterology should comprise a physician workforce predicated on clinical and research excellence alone and should not require its practitioners to delay or abstain from pregnancy and child rearing. Robust, clear, and generous parental leave and postpartum accommodations will allow the field to retain and promote talented physicians, who will then contribute to the betterment of patients and the field over decades.
Dr. Rabinowitz is a faculty member in the department of medicine and division of gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Dr. Feld is a transplant hepatology fellow, division of gastroenterology, department of medicine, University of Washington, Seattle. Dr. Rabinowitz and Dr. Feld have no conflicts of interest to disclose.
References
1. AAMC. Diversity in Medicine: Facts and Figures 2019. 2018.
2. Colleges AoAM. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2015-2016. 2016. www.aamc.org/download/481206/data/2015table11.pdf.
3. AAMC. Table B-3: Total U.S. Medical School Enrollment by Race/Ethnicity and Sex, 2014-2015 through 2018-2019, 2019.
4. Rabinowitz LG. Recognizing blind spots – a remedy for gender bias in medicine? (N Engl. J Med. 2018; 378[24]: 2253-5).
5. Douglas PS et al. Career preferences and perceptions of cardiology among US internal medicine trainees: Factors influencing cardiology career choice. JAMA Cardiol 2018; 3(8):682-91.
6. Stack SW et al. Childbearing decisions in residency: A multicenter survey of female residents. Acad Med 2020;95(10):1550-7.
7. David YN et al. Pregnancy and the working gastroenterologist: Perceptions, realities, and systemic challenges. Gastroenterology 2021;161(3):756-60.
8. Rembacken BJ et al. Barriers and bias standing in the way of female trainees wanting to learn advanced endoscopy. United European Gastroenterol J. 2019;7(8):1141-5.
9. Arlow FL et al. Gastroenterology training and career choices: A prospective longitudinal study of the impact of gender and of managed care. Am J Gastroenterol. 2002;97(2):459-69.
10. Feld L et al. Parental leave for gastroenterology fellows: A national survey of current fellows. Am J Gastroenterol. 2021;116:S611-2.
11. Rabinowitz LG et al. Addressing gender in gastroenterology: opportunities for change. Gastrointest Endosc. 2020;91(1):155-61.
12. Feld LD. Baby steps in the right direction: Toward a parental leave policy for gastroenterology fellows. Am J Gastroenterol. 2021;116(3):505-8.
13. Feld LD. Interviewing for two. Am J Gastroenterol. 2020;116(3):445-6
14. Rabinowitz LG et al. Gender dynamics in education and practice of gastroenterology. Gastrointest Endosc. 2021;93(5):1047-56.e5.
15. Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol. 2014;48(7):590-4.
16. LabX Oecs. www.labx.com/product/endoscopy-cart (accessed 2021 Nov 19.
17. Heilman ME and Okimoto TG. Motherhood: A potential source of bias in employment decisions. J Appl Psychol. 2008;93(1):189-98.
18. Robinson K et al. Racism, bias, and discrimination as modifiable barriers to breastfeeding for African American women: A scoping review of the literature. J Midwifery Womens Health. 2019;64(6):734-42.
19. Rabinowitz LG and Rabinowitz DG. Women on the Frontline: A Changed Workforce and the Fight Against COVID-19. Acad Med. 2021 Jun 1;96(6):808-12.
20. Rabinowitz LG et al. Gender in the endoscopy suite. Lancet Gastroenterol Hepatol. 2020 Dec;5(12):1032-4.
21. Stentz NC et al. Fertility and childbearing among American female physicians. J Womens Health. 2016; 25(10):1059-65.
22. Burke CA et al. Gender disparity in the practice of gastroenterology: The first 5 years of a career. Am J Gastroenterol. 2005;100(2):259-64.
23. Singh A et al. Women in gastroenterology committee of American College of G. Do gender disparities persist in gastroenterology after 10 years of practice? Am J Gastroenterol. 2008;103(7):1589-95.
24. Krueger KJ and Hoffman BJ. Radiation exposure during gastroenterologic fluoroscopy: Risk assessment for pregnant workers. Am J Gastroenterol. 1992;87(4):429-31.
25. Krause ML et al. Impact of pregnancy and gender on internal medicine resident evaluations: A retrospective cohort study. J Gen Intern Med. 2017;32(6):648-53.
26. Pawa S et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol. 2021;116(3):530-8.
27. David YN et al. Gender-specific factors influencing gastroenterologists to pursue careers in advanced endoscopy: perceptions vs reality. Am J Gastroenterol. 2021;116(3):539-50.
28. Bilal M et al. The need for allyship in achieving gender equity in gastroenterology. Am J Gastroenterol. 2021 Oct 19. doi: 10.14309/ajg.0000000000001508. Online ahead of print.
29. Jou J et al. Paid maternity leave in the United States: Associations with maternal and infant health. Matern Child Health J. 2018;22(2):216-25.
30. Aitken Z et al. The maternal health outcomes of paid maternity leave: A systematic review. Soc Sci Med. 2015;130:32-41.
31. Dodson NA and Talib HJ. Paid parental leave for mothers and fathers can improve physician wellness. AAP News. 2020 Jul 1. https://publications.aap.org/aapnews/news/12432.
32. Kornfeind KR and Sipsma HL. Exploring the link between maternity leave and postpartum depression. Womens Health Issues 2018;28(4):321-6.
33. Navarro-Rosenblatt D and Garmendia ML. Maternity leave and its impact on breastfeeding: A review of the literature. Breastfeed Med 2018;13(9):589-97.
34. Stack SW et al. Maternity leave in residency: A multicenter study of determinants and wellness outcomes. Acad Med. 2019;94(11):1738-45.
35. Mass.gov. Paid Family and Medical Leave Information for Massachusetts Employers. 2020.
36. Ares Segura S et al. en representacion del Comite de Lactancia Materna de la Asociacion Espanola de P. [The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements?]. An Pediatr. (Barc) 2016;84(6):347 e1-7.
37. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Committee Opinion No. 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice. Obstet Gynecol. 2016;127(2):e86-92.
38. Porter KK et al. A lactation credit model to support breastfeeding in radiology: The new gold standard to support “liquid gold.” Clin Imaging 2021;80:16-8.
39. Davis J et al. Clinical practice patterns suggest female patients prefer female endoscopists. Dig Dis Sci. 2015;60(10):3149-50.
40. Menees SB et al. Women patients’ preference for women physicians is a barrier to colon cancer screening. Gastrointest Endosc. 2005;62(2):219-23.
41. Feld LD et al. Management of code status in the periendoscopic period: A national survey of current practices and beliefs of U.S. gastroenterologists. Gastrointest Endosc. 2021;94(1):172-7.e2.
The etiology of acute otitis media in young children in recent years
Since the COVID-19 pandemic began, pediatricians have been seeing fewer cases of all respiratory illnesses, including acute otitis media (AOM). However, as I prepare this column, an uptick has commenced and likely will continue in an upward trajectory as we emerge from the pandemic into an endemic coronavirus era. Our group in Rochester, N.Y., has continued prospective studies of AOM throughout the pandemic. We found that nasopharyngeal colonization by Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis remained prevalent in our study cohort of children aged 6-36 months. However, with all the precautions of masking, social distancing, hand washing, and quick exclusion from day care when illness occurred, the frequency of detecting these common otopathogens decreased, as one might expect.1
Leading up to the pandemic, we had an abundance of data to characterize AOM etiology and found that the cause of AOM continues to change following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13). Our most recent report on otopathogen distribution and antibiotic susceptibility covered the years 2015-2019.2 A total of 589 children were enrolled prospectively and we collected 495 middle ear fluid samples (MEF) from 319 AOM cases using tympanocentesis. The frequency of isolates was H. influenzae (34%), pneumococcus (24%), and M. catarrhalis (15%). Beta-lactamase–positive H. influenzae strains were identified among 49% of the isolates, rendering them resistant to amoxicillin. PCV13 serotypes were infrequently isolated. However, we did isolate vaccine types (VTs) in some children from MEF, notably serotypes 19F, 19A, and 3. Non-PCV13 pneumococcus serotypes 35B, 23B, and 15B/C emerged as the most common serotypes. Amoxicillin resistance was identified among 25% of pneumococcal strains. Out of 16 antibiotics tested, 9 (56%) showed a significant increase in nonsusceptibility among pneumococcal isolates. 100% of M. catarrhalis isolates were beta-lactamase producers and therefore resistant to amoxicillin.
PCV13 has resulted in a decline in both invasive and noninvasive pneumococcal infections caused by strains expressing the 13 capsular serotypes included in the vaccine. However, the emergence of replacement serotypes occurred after introduction of PCV73,4 and continues to occur during the PCV13 era, as shown from the results presented here. Non-PCV13 serotypes accounted for more than 90% of MEF isolates during 2015-2019, with 35B, 21 and 23B being the most commonly isolated. Other emergent serotypes of potential importance were nonvaccine serotypes 15A, 15B, 15C, 23A and 11A. This is highly relevant because forthcoming higher-valency PCVs – PCV15 (manufactured by Merck) and PCV20 (manufactured by Pfizer) will not include many of the dominant capsular serotypes of pneumococcus strains causing AOM. Consequently, the impact of higher-valency PCVs on AOM will not be as great as was observed with the introduction of PCV7 or PCV13.
Of special interest, 22% of pneumococcus isolates from MEF were serotype 35B, making it the most prevalent. Recently we reported a significant rise in antibiotic nonsusceptibility in Spn isolates, contributed mainly by serotype 35B5 and we have been studying how 35B strains transitioned from commensal to otopathogen in children.6 Because serotype 35B strains are increasingly prevalent and often antibiotic resistant, absence of this serotype from PCV15 and PCV20 is cause for concern.
The frequency of isolation of H. influenzae and M. catarrhalis has remained stable across the PCV13 era as the No. 1 and No. 3 pathogens. Similarly, the production of beta-lactamase among strains causing AOM has remained stable at close to 50% and 100%, respectively. Use of amoxicillin, either high dose or standard dose, would not be expected to kill these bacteria.
Our study design has limitations. The population is derived from a predominantly middle-class, suburban population of children in upstate New York and may not be representative of other types of populations in the United States. The children are 6-36 months old, the age when most AOM occurs. MEF samples that were culture negative for bacteria were not further tested by polymerase chain reaction methods.
Dr. Pichichero is a specialist in pediatric infectious diseases, Center for Infectious Diseases and Immunology, and director of the Research Institute, at Rochester (N.Y.) General Hospital. He has no conflicts of interest to declare.
References
1. Kaur R et al. Front Pediatr. 2021;9:722483.
2. Kaur R et al. Euro J Clin Microbiol Infect Dis. 2021;41:37-44
3. Pelton SI et al. Pediatr Infect Disease J. 2004;23:1015-22.
4. Farrell DJ et al. Pediatr Infect Disease J. 2007;26:123-8..
5. Kaur R et al. Clin Infect Dis 2021;72(5):797-805.
6. Fuji N et al. Front Cell Infect Microbiol. 2021;11:744742.
Since the COVID-19 pandemic began, pediatricians have been seeing fewer cases of all respiratory illnesses, including acute otitis media (AOM). However, as I prepare this column, an uptick has commenced and likely will continue in an upward trajectory as we emerge from the pandemic into an endemic coronavirus era. Our group in Rochester, N.Y., has continued prospective studies of AOM throughout the pandemic. We found that nasopharyngeal colonization by Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis remained prevalent in our study cohort of children aged 6-36 months. However, with all the precautions of masking, social distancing, hand washing, and quick exclusion from day care when illness occurred, the frequency of detecting these common otopathogens decreased, as one might expect.1
Leading up to the pandemic, we had an abundance of data to characterize AOM etiology and found that the cause of AOM continues to change following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13). Our most recent report on otopathogen distribution and antibiotic susceptibility covered the years 2015-2019.2 A total of 589 children were enrolled prospectively and we collected 495 middle ear fluid samples (MEF) from 319 AOM cases using tympanocentesis. The frequency of isolates was H. influenzae (34%), pneumococcus (24%), and M. catarrhalis (15%). Beta-lactamase–positive H. influenzae strains were identified among 49% of the isolates, rendering them resistant to amoxicillin. PCV13 serotypes were infrequently isolated. However, we did isolate vaccine types (VTs) in some children from MEF, notably serotypes 19F, 19A, and 3. Non-PCV13 pneumococcus serotypes 35B, 23B, and 15B/C emerged as the most common serotypes. Amoxicillin resistance was identified among 25% of pneumococcal strains. Out of 16 antibiotics tested, 9 (56%) showed a significant increase in nonsusceptibility among pneumococcal isolates. 100% of M. catarrhalis isolates were beta-lactamase producers and therefore resistant to amoxicillin.
PCV13 has resulted in a decline in both invasive and noninvasive pneumococcal infections caused by strains expressing the 13 capsular serotypes included in the vaccine. However, the emergence of replacement serotypes occurred after introduction of PCV73,4 and continues to occur during the PCV13 era, as shown from the results presented here. Non-PCV13 serotypes accounted for more than 90% of MEF isolates during 2015-2019, with 35B, 21 and 23B being the most commonly isolated. Other emergent serotypes of potential importance were nonvaccine serotypes 15A, 15B, 15C, 23A and 11A. This is highly relevant because forthcoming higher-valency PCVs – PCV15 (manufactured by Merck) and PCV20 (manufactured by Pfizer) will not include many of the dominant capsular serotypes of pneumococcus strains causing AOM. Consequently, the impact of higher-valency PCVs on AOM will not be as great as was observed with the introduction of PCV7 or PCV13.
Of special interest, 22% of pneumococcus isolates from MEF were serotype 35B, making it the most prevalent. Recently we reported a significant rise in antibiotic nonsusceptibility in Spn isolates, contributed mainly by serotype 35B5 and we have been studying how 35B strains transitioned from commensal to otopathogen in children.6 Because serotype 35B strains are increasingly prevalent and often antibiotic resistant, absence of this serotype from PCV15 and PCV20 is cause for concern.
The frequency of isolation of H. influenzae and M. catarrhalis has remained stable across the PCV13 era as the No. 1 and No. 3 pathogens. Similarly, the production of beta-lactamase among strains causing AOM has remained stable at close to 50% and 100%, respectively. Use of amoxicillin, either high dose or standard dose, would not be expected to kill these bacteria.
Our study design has limitations. The population is derived from a predominantly middle-class, suburban population of children in upstate New York and may not be representative of other types of populations in the United States. The children are 6-36 months old, the age when most AOM occurs. MEF samples that were culture negative for bacteria were not further tested by polymerase chain reaction methods.
Dr. Pichichero is a specialist in pediatric infectious diseases, Center for Infectious Diseases and Immunology, and director of the Research Institute, at Rochester (N.Y.) General Hospital. He has no conflicts of interest to declare.
References
1. Kaur R et al. Front Pediatr. 2021;9:722483.
2. Kaur R et al. Euro J Clin Microbiol Infect Dis. 2021;41:37-44
3. Pelton SI et al. Pediatr Infect Disease J. 2004;23:1015-22.
4. Farrell DJ et al. Pediatr Infect Disease J. 2007;26:123-8..
5. Kaur R et al. Clin Infect Dis 2021;72(5):797-805.
6. Fuji N et al. Front Cell Infect Microbiol. 2021;11:744742.
Since the COVID-19 pandemic began, pediatricians have been seeing fewer cases of all respiratory illnesses, including acute otitis media (AOM). However, as I prepare this column, an uptick has commenced and likely will continue in an upward trajectory as we emerge from the pandemic into an endemic coronavirus era. Our group in Rochester, N.Y., has continued prospective studies of AOM throughout the pandemic. We found that nasopharyngeal colonization by Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis remained prevalent in our study cohort of children aged 6-36 months. However, with all the precautions of masking, social distancing, hand washing, and quick exclusion from day care when illness occurred, the frequency of detecting these common otopathogens decreased, as one might expect.1
Leading up to the pandemic, we had an abundance of data to characterize AOM etiology and found that the cause of AOM continues to change following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13). Our most recent report on otopathogen distribution and antibiotic susceptibility covered the years 2015-2019.2 A total of 589 children were enrolled prospectively and we collected 495 middle ear fluid samples (MEF) from 319 AOM cases using tympanocentesis. The frequency of isolates was H. influenzae (34%), pneumococcus (24%), and M. catarrhalis (15%). Beta-lactamase–positive H. influenzae strains were identified among 49% of the isolates, rendering them resistant to amoxicillin. PCV13 serotypes were infrequently isolated. However, we did isolate vaccine types (VTs) in some children from MEF, notably serotypes 19F, 19A, and 3. Non-PCV13 pneumococcus serotypes 35B, 23B, and 15B/C emerged as the most common serotypes. Amoxicillin resistance was identified among 25% of pneumococcal strains. Out of 16 antibiotics tested, 9 (56%) showed a significant increase in nonsusceptibility among pneumococcal isolates. 100% of M. catarrhalis isolates were beta-lactamase producers and therefore resistant to amoxicillin.
PCV13 has resulted in a decline in both invasive and noninvasive pneumococcal infections caused by strains expressing the 13 capsular serotypes included in the vaccine. However, the emergence of replacement serotypes occurred after introduction of PCV73,4 and continues to occur during the PCV13 era, as shown from the results presented here. Non-PCV13 serotypes accounted for more than 90% of MEF isolates during 2015-2019, with 35B, 21 and 23B being the most commonly isolated. Other emergent serotypes of potential importance were nonvaccine serotypes 15A, 15B, 15C, 23A and 11A. This is highly relevant because forthcoming higher-valency PCVs – PCV15 (manufactured by Merck) and PCV20 (manufactured by Pfizer) will not include many of the dominant capsular serotypes of pneumococcus strains causing AOM. Consequently, the impact of higher-valency PCVs on AOM will not be as great as was observed with the introduction of PCV7 or PCV13.
Of special interest, 22% of pneumococcus isolates from MEF were serotype 35B, making it the most prevalent. Recently we reported a significant rise in antibiotic nonsusceptibility in Spn isolates, contributed mainly by serotype 35B5 and we have been studying how 35B strains transitioned from commensal to otopathogen in children.6 Because serotype 35B strains are increasingly prevalent and often antibiotic resistant, absence of this serotype from PCV15 and PCV20 is cause for concern.
The frequency of isolation of H. influenzae and M. catarrhalis has remained stable across the PCV13 era as the No. 1 and No. 3 pathogens. Similarly, the production of beta-lactamase among strains causing AOM has remained stable at close to 50% and 100%, respectively. Use of amoxicillin, either high dose or standard dose, would not be expected to kill these bacteria.
Our study design has limitations. The population is derived from a predominantly middle-class, suburban population of children in upstate New York and may not be representative of other types of populations in the United States. The children are 6-36 months old, the age when most AOM occurs. MEF samples that were culture negative for bacteria were not further tested by polymerase chain reaction methods.
Dr. Pichichero is a specialist in pediatric infectious diseases, Center for Infectious Diseases and Immunology, and director of the Research Institute, at Rochester (N.Y.) General Hospital. He has no conflicts of interest to declare.
References
1. Kaur R et al. Front Pediatr. 2021;9:722483.
2. Kaur R et al. Euro J Clin Microbiol Infect Dis. 2021;41:37-44
3. Pelton SI et al. Pediatr Infect Disease J. 2004;23:1015-22.
4. Farrell DJ et al. Pediatr Infect Disease J. 2007;26:123-8..
5. Kaur R et al. Clin Infect Dis 2021;72(5):797-805.
6. Fuji N et al. Front Cell Infect Microbiol. 2021;11:744742.