CHEST has been informed of the following members’ deaths. We extend our sincere condolences.

Anthony Cosentino, MD, FCCP (January 2016)

Ben Branscomb, MD (July 2016)

Steven Sahn, MD, FCCP (Aug 2016)

Thomas Aldrich, MD (September 2016)

John C. Baldwin, MD, FCCP (September 2016)

David Cugell, MD, FCCP (December 2016)

CHEST has been informed of the following members’ deaths. We extend our sincere condolences.

Anthony Cosentino, MD, FCCP (January 2016)

Ben Branscomb, MD (July 2016)

Steven Sahn, MD, FCCP (Aug 2016)

Thomas Aldrich, MD (September 2016)

John C. Baldwin, MD, FCCP (September 2016)

David Cugell, MD, FCCP (December 2016)

CHEST has been informed of the following members’ deaths. We extend our sincere condolences.

Anthony Cosentino, MD, FCCP (January 2016)

Ben Branscomb, MD (July 2016)

Steven Sahn, MD, FCCP (Aug 2016)

Thomas Aldrich, MD (September 2016)

John C. Baldwin, MD, FCCP (September 2016)

David Cugell, MD, FCCP (December 2016)

We all know that, with the great success of CHEST 2016, everyone who shared that event is a winner. But, we would especially like to call out some of the special winners who were recognized during our annual meeting.

CHEST Awards

College Medalist Award

Lewis J. Rubin, MD, FCCP

Distinguished Service Award

Kim D. French, MHSA, CAPPM, FCCP

Alfred Soffer Award for Editorial Excellence

Seth J. Koenig, MD, FCCP

Master Clinician Educator Award

Jack D. Buckley, MD, MPH, FCCP

Distinguished Scientist Honor Lecture

Jay Nadel, MD

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture

Suhail Raoof, MBBS, FCCP

Murray Kornfeld Memorial Founders Lecture

Michael Niederman, MD, FCCP Pasquale Ciaglia Memorial Lecture Kevin L. Kovitz, MD, FCCP

Roger C. Bone Memorial Lecture

Robert A. Berg, MD Thomas L. Petty, MD, Master FCCP Memorial Lecture Nicola A. Hanania, MD, MS, FCCP Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation Thomas G. Keens, MD Om P. Sharma, MD, Master FCCP Memorial Lecture Robert P. Baughman, MD, FCCP

Early Career Educator

Gabriel Bosslet, MD, FCCP

CHEST Challenge Championship 2016

1st Place

The University of Arizona

Huthayfa Ateeli, MBBS Naser Mahmoud, MD

Muna Omar, MD, MBBS

PD: James L. Knepler Jr.

2nd Place

New York Methodist Hospital

Anu R. Jacob, MD

Stephen D. Milan, MD

Jordan Taillon, MD

PD: Anthony G. Saleh, MD, FCCP

3rd Place

Interfaith Medical Center

Chidozie C. Agu, MD

Saroj P. Kandel, MBBS Divya Salhan, MD, MBBS

PD: Marie Frances J. Schmidt, MD, FCCP

CHEST Foundation Grant Winners

GlaxoSmithKline Distinguished Scholar in Respiratory Health

Don Hayes Jr., MD, FCCP The Research Institute at Nationwide Children’s Hospital

Implications of the Lung Allocation Score in Prioritizing Critically Ill Patients for Lung Transplantation

Supported by GlaxoSmithKline.

2016 Research Grantees

Alice Turner, MBChB, MRCP, PhD

University of Birmingham, United Kingdom

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency

Improving Access to Augmentation: A Propensity-Matching Study Between the UK AATD Registry and AlphaNet

This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.

Robert Busch, MD

Brigham and Women’s Hospital, Channing Division of Network Medicine

CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease

Methylation Quantitative Trait Loci: Markers of Race-Specific Disparities in African Americans With COPD

This grant is supported by AstraZeneca.

Clemens Grassberger, PhD

Massachusetts General Hospital – Harvard University

CHEST Foundation Research Grant in Lung Cancer

Dynamic FLT-PET as Biomarker for Early Response in Locally Advanced Lung Cancer Patients

This grant is supported by Genentech Inc.

Cristina Russo, MD, PhD

Bambino Gesù Children’s Hospital, Rome, Italy

CHEST Foundation Research Grant in Nontuberculous Mycobacteria

A Proteomic-Metaproteomic Analysis Approach Allows Identification of Drug Target Candidates for the Future Design of Preventive, Diagnostic, and Therapeutic Strategies Against Nontuberculous Mycobacteria Diseases

This grant is supported by Insmed.

Peter Leary, MD, MS

University of Washington

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension

Expression Profiling in Pulmonary Arterial Hypertension

This grant is supported by Actelion Pharmaceuticals, US, Inc.

Brett Ley, MD

University of California, San Francisco

CHEST Foundation Research Grant in Pulmonary Fibrosis

Extracellular Circulation RNAs as Predictors of Disease Progression in Idiopathic Pulmonary Fibrosis

This grant is supported by Boehringer Ingelheim Pharmaceuticals & Genentech Inc.

Sydney Montesi, MD

Massachusetts General Hospital

CHEST Foundation Research Grant in Pulmonary Fibrosis

Gadofosveset-Enhanced Lung MRI to Detect Idiopathic Pulmonary Fibrosis Disease Activity

This grant is supported by Boehringer Ingelheim Pharmaceuticals & Genentech Inc.

Farbod Rahaghi, MD, PhD

Brigham and Women’s Hospital

CHEST Foundation Research Grant in Venous Thromboembolism

CT Scan-Based Markers for Prediction of Outcomes in Acute Pulmonary Embolism

This grant is supported by Daiichi Sankyo.

Catherine Oberg, MD

Icahn School of Medicine at Mount Sinai

CHEST Foundation Research Grant in Women’s Lung Health

Effects of Household Air Pollution on Airway Inflammation, Lung Function, and Respiratory Symptoms

This grant is supported in full by the CHEST Foundation.

2016 Community Service Grantee

Ethel Jane Carter, MD, FCCP

Warren Alpert School of Medicine at Brown University

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP

East African Training Initiative ( EATI) in Pulmonary Medicine

2016 NetWorks Challenge Travel Grantees

Debarsee Banerjee, MS, MD

Women’s Health NetWork

Drew Harris, MD

Occupational and Environmental Health NetWork

Kerry Hena, MD

Occupational and Environmental Health NetWork

Amanpreet Kaur, MD

Women’s Health NetWork

2016 Diversity Travel Grant Winners

John B. Bishara, DO

Renato F. Blanco Jr., MD

Angel Coz-Yataco, MD Sherie A. Gause, MD

Anthony Nebor, MD

James T. Williams, MD

Alfred Soffer Research Award Winners

Kerry Hena, MD

Deepak Pradhan, MD, FCCP

Young Investigator Award Winners

Elizabeth Becker: Clinical Characteristics of Sarcoidosis in World Trade Center (WTC) Exposed Fire Department of the City of New York (FDNY) Firefighters

Daniel Altman, MD : Cost-Effectiveness of Universally Funding Smoking Cessation Pharmacotherapy

Top 3 Poster Winners

Epaminondas Kosmas, MD, PhD, FCCP : Bronchiectasis in Patients With COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype?

Mark Regala, MD, BS : Evaluation of Outcomes of Post-Extubation Dysphagia in Elderly Patients

Massa Zantah, MD : Correlation of Esophageal Dilatation and Pulmonary Fibrosis in Scleroderma

Runner-up: Alev Gurgun, MD : Pulmonary Rehabilitation Response in Elderly and Younger Patients With COPD

Case Report Slide Winners

John Egan, MD, BA : An Unusual Cause of Tracheal Stenosis Due to a Vascular Anomaly Successfully Managed With Silicone Airway Stenting Prior to Definitive Vascular Repair

Harprett Grewal, MD : Bladder PTLD: First Reported Case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the Bladder in a Lung Transplant Recipient

Michael Fingerhood, MD, MPH : Pulmonary Overlap Histiocytosis: A Rare Case of Interstitial Lung Disease Due to Erdheim Chester Disease in a Patient With Langerhans Cell Histiocytosis and Myelodisplastic Syndrome

Yihenew Negatu, MD : Acute ST Elevation Myocardial Infarction Related to Carbon Monoxide Poisoning in a Young Patient Without Coronary Artery Disease

Stephanie Wappel, MD : False-Negative Pet Imaging in Early Stage Malignant Pleural Mesothelioma

Lina Miyakawa, MD : Restrictive EGFR Mutation

Jeffrey Bonenfant, DO : A Unique Case of Follicular Bronchiolitis

Melissa Myers, MD : Seeing the Forest and Not Just the Trees: A Case of Recurrent Fever, Cough, and Respiratory Failure

Carly Fabrizio, DO : An Unusual Case of Submassive Hemoptysis

Meilinh Thi, DO : A Case to Make Your Skin Crawl

Garrett Harp, MD : Lambertosis: A Lung Cancer Mimic

Malik Khan, MD : Pleural Epithelioid Hemangioendothelioma: A Case Report

Priya Patel, MD : A Troubling Trifecta: Pulmonary Alveolar Proteinosis and Pneumocystis Pneumonia in Acute Myeloid Leukemia

Atul Palkar, MD : SGLT2 Inhibitors: Mind the Gap

Ji Yeon Lee, MD : Making Unusual Connections: Fibrosing Mediastinitis Leading to Bronchoesophageal Fistula

Sailm Daouk, MD : A Rare Form of Invasive Aspergillus Infection in a Severely Immunocompromised Host

Venkata Ravi Kumar Angirekula, MD : Vanishing Lung

Stephen Milan, MD : An Unexpected Mass

Lelia Logue, MD : A Rare Cause of Dysphagia

Daniel Hershberger, MD : Rapidly Progressive Hypoxic Respiratory Failure After a Rash: A Case of Clinically Amyopathic Dermatomyositis (CADM)-Associated ILD

Fellow Case Report Poster Winners

Krishna Siva Sai Kakkera

An Unusual Case of Crypotococcal Pleural Effusion

George Cheng

Use of Laparoscopic Suction Irrigator With Rigid Pleuroscope in Medical Thoracoscopy

Matt Koroscil

Wong Type Dermatomyositis Complicated by Interstitial Lung Disease

Derek Hansen

Acute Fibrinous and Organizing Pneumonia Following Hematopoietic Stem Cell Transplantation Responsive to Corticosteroid Therapy

Ala Eddin Sagar

Pulmonary Embolism Caused by Thrombin-Based Hemostatic Matrix After Discectomy

Sandeep Chennadi

Systemic Lupus Erythematosus (SLE) With Refractory Bilateral Chylothorax and Chylous Ascites

Medical Student/Resident Case Report Poster Winners

Justin Fiala

Pulmonary Presentation Without Concurrent Bone Involvement in Erdheim-Chester Disease: A Report of Two Cases

Navitha Ramesh

A Fatal Migration: A Case of Intra-Cardiac Embolization of a Peripheral Stent

Humna Abid Memon

Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient With PAH

Vanessa Ohleyer

A Case of Unusual Anatomy for an Uncommon Mediastinal Tumor

Tanushree Gahlot

Three Unusual Presentations of Job’s Syndrome (Hyper Immunoglobulin E Syndrome)

NetWorks Challenge Winners

Round 1

Women’s Lung Health NetWork

Round 2

Practice and Operations NetWork-1st place

Home-Based Mechanical Ventilation and Neuromuscular Disease NetWorks – 2nd place

Round 3

Home-Based Mechanical Ventilation, Neuromuscular Disease, and the Women’s Lung Health NetWorks

CHEST Bingo Winners

Youseff Anid, MD, FCCP

Karen Cochran, ACNP

Molly Howsware, DO

Katie Jeans, MD

Genovena Medina, RN

Gregory Eisinger, MD

Saurabh Mittal, MD, MBBS

Navitha Ramesh, MD

Dalvinder Dhillon, MD

Teresita Saylor, MD, FCCP

Carl Kaplan, MD, FCCP

Vishal Patel, MBBS, FCCP

Erin Peterson, CNP

Lilian Pereira, DO

We all know that, with the great success of CHEST 2016, everyone who shared that event is a winner. But, we would especially like to call out some of the special winners who were recognized during our annual meeting.

CHEST Awards

College Medalist Award

Lewis J. Rubin, MD, FCCP

Distinguished Service Award

Kim D. French, MHSA, CAPPM, FCCP

Alfred Soffer Award for Editorial Excellence

Seth J. Koenig, MD, FCCP

Master Clinician Educator Award

Jack D. Buckley, MD, MPH, FCCP

Distinguished Scientist Honor Lecture

Jay Nadel, MD

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture

Suhail Raoof, MBBS, FCCP

Murray Kornfeld Memorial Founders Lecture

Michael Niederman, MD, FCCP Pasquale Ciaglia Memorial Lecture Kevin L. Kovitz, MD, FCCP

Roger C. Bone Memorial Lecture

Robert A. Berg, MD Thomas L. Petty, MD, Master FCCP Memorial Lecture Nicola A. Hanania, MD, MS, FCCP Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation Thomas G. Keens, MD Om P. Sharma, MD, Master FCCP Memorial Lecture Robert P. Baughman, MD, FCCP

Early Career Educator

Gabriel Bosslet, MD, FCCP

CHEST Challenge Championship 2016

1st Place

The University of Arizona

Huthayfa Ateeli, MBBS Naser Mahmoud, MD

Muna Omar, MD, MBBS

PD: James L. Knepler Jr.

2nd Place

New York Methodist Hospital

Anu R. Jacob, MD

Stephen D. Milan, MD

Jordan Taillon, MD

PD: Anthony G. Saleh, MD, FCCP

3rd Place

Interfaith Medical Center

Chidozie C. Agu, MD

Saroj P. Kandel, MBBS Divya Salhan, MD, MBBS

PD: Marie Frances J. Schmidt, MD, FCCP

CHEST Foundation Grant Winners

GlaxoSmithKline Distinguished Scholar in Respiratory Health

Don Hayes Jr., MD, FCCP The Research Institute at Nationwide Children’s Hospital

Implications of the Lung Allocation Score in Prioritizing Critically Ill Patients for Lung Transplantation

Supported by GlaxoSmithKline.

2016 Research Grantees

Alice Turner, MBChB, MRCP, PhD

University of Birmingham, United Kingdom

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency

Improving Access to Augmentation: A Propensity-Matching Study Between the UK AATD Registry and AlphaNet

This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.

Robert Busch, MD

Brigham and Women’s Hospital, Channing Division of Network Medicine

CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease

Methylation Quantitative Trait Loci: Markers of Race-Specific Disparities in African Americans With COPD

This grant is supported by AstraZeneca.

Clemens Grassberger, PhD

Massachusetts General Hospital – Harvard University

CHEST Foundation Research Grant in Lung Cancer

Dynamic FLT-PET as Biomarker for Early Response in Locally Advanced Lung Cancer Patients

This grant is supported by Genentech Inc.

Cristina Russo, MD, PhD

Bambino Gesù Children’s Hospital, Rome, Italy

CHEST Foundation Research Grant in Nontuberculous Mycobacteria

A Proteomic-Metaproteomic Analysis Approach Allows Identification of Drug Target Candidates for the Future Design of Preventive, Diagnostic, and Therapeutic Strategies Against Nontuberculous Mycobacteria Diseases

This grant is supported by Insmed.

Peter Leary, MD, MS

University of Washington

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension

Expression Profiling in Pulmonary Arterial Hypertension

This grant is supported by Actelion Pharmaceuticals, US, Inc.

Brett Ley, MD

University of California, San Francisco

CHEST Foundation Research Grant in Pulmonary Fibrosis

Extracellular Circulation RNAs as Predictors of Disease Progression in Idiopathic Pulmonary Fibrosis

This grant is supported by Boehringer Ingelheim Pharmaceuticals & Genentech Inc.

Sydney Montesi, MD

Massachusetts General Hospital

CHEST Foundation Research Grant in Pulmonary Fibrosis

Gadofosveset-Enhanced Lung MRI to Detect Idiopathic Pulmonary Fibrosis Disease Activity

This grant is supported by Boehringer Ingelheim Pharmaceuticals & Genentech Inc.

Farbod Rahaghi, MD, PhD

Brigham and Women’s Hospital

CHEST Foundation Research Grant in Venous Thromboembolism

CT Scan-Based Markers for Prediction of Outcomes in Acute Pulmonary Embolism

This grant is supported by Daiichi Sankyo.

Catherine Oberg, MD

Icahn School of Medicine at Mount Sinai

CHEST Foundation Research Grant in Women’s Lung Health

Effects of Household Air Pollution on Airway Inflammation, Lung Function, and Respiratory Symptoms

This grant is supported in full by the CHEST Foundation.

2016 Community Service Grantee

Ethel Jane Carter, MD, FCCP

Warren Alpert School of Medicine at Brown University

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP

East African Training Initiative ( EATI) in Pulmonary Medicine

2016 NetWorks Challenge Travel Grantees

Debarsee Banerjee, MS, MD

Women’s Health NetWork

Drew Harris, MD

Occupational and Environmental Health NetWork

Kerry Hena, MD

Occupational and Environmental Health NetWork

Amanpreet Kaur, MD

Women’s Health NetWork

2016 Diversity Travel Grant Winners

John B. Bishara, DO

Renato F. Blanco Jr., MD

Angel Coz-Yataco, MD Sherie A. Gause, MD

Anthony Nebor, MD

James T. Williams, MD

Alfred Soffer Research Award Winners

Kerry Hena, MD

Deepak Pradhan, MD, FCCP

Young Investigator Award Winners

Elizabeth Becker: Clinical Characteristics of Sarcoidosis in World Trade Center (WTC) Exposed Fire Department of the City of New York (FDNY) Firefighters

Daniel Altman, MD : Cost-Effectiveness of Universally Funding Smoking Cessation Pharmacotherapy

Top 3 Poster Winners

Epaminondas Kosmas, MD, PhD, FCCP : Bronchiectasis in Patients With COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype?

Mark Regala, MD, BS : Evaluation of Outcomes of Post-Extubation Dysphagia in Elderly Patients

Massa Zantah, MD : Correlation of Esophageal Dilatation and Pulmonary Fibrosis in Scleroderma

Runner-up: Alev Gurgun, MD : Pulmonary Rehabilitation Response in Elderly and Younger Patients With COPD

Case Report Slide Winners

John Egan, MD, BA : An Unusual Cause of Tracheal Stenosis Due to a Vascular Anomaly Successfully Managed With Silicone Airway Stenting Prior to Definitive Vascular Repair

Harprett Grewal, MD : Bladder PTLD: First Reported Case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the Bladder in a Lung Transplant Recipient

Michael Fingerhood, MD, MPH : Pulmonary Overlap Histiocytosis: A Rare Case of Interstitial Lung Disease Due to Erdheim Chester Disease in a Patient With Langerhans Cell Histiocytosis and Myelodisplastic Syndrome

Yihenew Negatu, MD : Acute ST Elevation Myocardial Infarction Related to Carbon Monoxide Poisoning in a Young Patient Without Coronary Artery Disease

Stephanie Wappel, MD : False-Negative Pet Imaging in Early Stage Malignant Pleural Mesothelioma

Lina Miyakawa, MD : Restrictive EGFR Mutation

Jeffrey Bonenfant, DO : A Unique Case of Follicular Bronchiolitis

Melissa Myers, MD : Seeing the Forest and Not Just the Trees: A Case of Recurrent Fever, Cough, and Respiratory Failure

Carly Fabrizio, DO : An Unusual Case of Submassive Hemoptysis

Meilinh Thi, DO : A Case to Make Your Skin Crawl

Garrett Harp, MD : Lambertosis: A Lung Cancer Mimic

Malik Khan, MD : Pleural Epithelioid Hemangioendothelioma: A Case Report

Priya Patel, MD : A Troubling Trifecta: Pulmonary Alveolar Proteinosis and Pneumocystis Pneumonia in Acute Myeloid Leukemia

Atul Palkar, MD : SGLT2 Inhibitors: Mind the Gap

Ji Yeon Lee, MD : Making Unusual Connections: Fibrosing Mediastinitis Leading to Bronchoesophageal Fistula

Sailm Daouk, MD : A Rare Form of Invasive Aspergillus Infection in a Severely Immunocompromised Host

Venkata Ravi Kumar Angirekula, MD : Vanishing Lung

Stephen Milan, MD : An Unexpected Mass

Lelia Logue, MD : A Rare Cause of Dysphagia

Daniel Hershberger, MD : Rapidly Progressive Hypoxic Respiratory Failure After a Rash: A Case of Clinically Amyopathic Dermatomyositis (CADM)-Associated ILD

Fellow Case Report Poster Winners

Krishna Siva Sai Kakkera

An Unusual Case of Crypotococcal Pleural Effusion

George Cheng

Use of Laparoscopic Suction Irrigator With Rigid Pleuroscope in Medical Thoracoscopy

Matt Koroscil

Wong Type Dermatomyositis Complicated by Interstitial Lung Disease

Derek Hansen

Acute Fibrinous and Organizing Pneumonia Following Hematopoietic Stem Cell Transplantation Responsive to Corticosteroid Therapy

Ala Eddin Sagar

Pulmonary Embolism Caused by Thrombin-Based Hemostatic Matrix After Discectomy

Sandeep Chennadi

Systemic Lupus Erythematosus (SLE) With Refractory Bilateral Chylothorax and Chylous Ascites

Medical Student/Resident Case Report Poster Winners

Justin Fiala

Pulmonary Presentation Without Concurrent Bone Involvement in Erdheim-Chester Disease: A Report of Two Cases

Navitha Ramesh

A Fatal Migration: A Case of Intra-Cardiac Embolization of a Peripheral Stent

Humna Abid Memon

Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient With PAH

Vanessa Ohleyer

A Case of Unusual Anatomy for an Uncommon Mediastinal Tumor

Tanushree Gahlot

Three Unusual Presentations of Job’s Syndrome (Hyper Immunoglobulin E Syndrome)

NetWorks Challenge Winners

Round 1

Women’s Lung Health NetWork

Round 2

Practice and Operations NetWork-1st place

Home-Based Mechanical Ventilation and Neuromuscular Disease NetWorks – 2nd place

Round 3

Home-Based Mechanical Ventilation, Neuromuscular Disease, and the Women’s Lung Health NetWorks

CHEST Bingo Winners

Youseff Anid, MD, FCCP

Karen Cochran, ACNP

Molly Howsware, DO

Katie Jeans, MD

Genovena Medina, RN

Gregory Eisinger, MD

Saurabh Mittal, MD, MBBS

Navitha Ramesh, MD

Dalvinder Dhillon, MD

Teresita Saylor, MD, FCCP

Carl Kaplan, MD, FCCP

Vishal Patel, MBBS, FCCP

Erin Peterson, CNP

Lilian Pereira, DO

We all know that, with the great success of CHEST 2016, everyone who shared that event is a winner. But, we would especially like to call out some of the special winners who were recognized during our annual meeting.

CHEST Awards

College Medalist Award

Lewis J. Rubin, MD, FCCP

Distinguished Service Award

Kim D. French, MHSA, CAPPM, FCCP

Alfred Soffer Award for Editorial Excellence

Seth J. Koenig, MD, FCCP

Master Clinician Educator Award

Jack D. Buckley, MD, MPH, FCCP

Distinguished Scientist Honor Lecture

Jay Nadel, MD

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture

Suhail Raoof, MBBS, FCCP

Murray Kornfeld Memorial Founders Lecture

Michael Niederman, MD, FCCP Pasquale Ciaglia Memorial Lecture Kevin L. Kovitz, MD, FCCP

Roger C. Bone Memorial Lecture

Robert A. Berg, MD Thomas L. Petty, MD, Master FCCP Memorial Lecture Nicola A. Hanania, MD, MS, FCCP Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation Thomas G. Keens, MD Om P. Sharma, MD, Master FCCP Memorial Lecture Robert P. Baughman, MD, FCCP

Early Career Educator

Gabriel Bosslet, MD, FCCP

CHEST Challenge Championship 2016

1st Place

The University of Arizona

Huthayfa Ateeli, MBBS Naser Mahmoud, MD

Muna Omar, MD, MBBS

PD: James L. Knepler Jr.

2nd Place

New York Methodist Hospital

Anu R. Jacob, MD

Stephen D. Milan, MD

Jordan Taillon, MD

PD: Anthony G. Saleh, MD, FCCP

3rd Place

Interfaith Medical Center

Chidozie C. Agu, MD

Saroj P. Kandel, MBBS Divya Salhan, MD, MBBS

PD: Marie Frances J. Schmidt, MD, FCCP

CHEST Foundation Grant Winners

GlaxoSmithKline Distinguished Scholar in Respiratory Health

Don Hayes Jr., MD, FCCP The Research Institute at Nationwide Children’s Hospital

Implications of the Lung Allocation Score in Prioritizing Critically Ill Patients for Lung Transplantation

Supported by GlaxoSmithKline.

2016 Research Grantees

Alice Turner, MBChB, MRCP, PhD

University of Birmingham, United Kingdom

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency

Improving Access to Augmentation: A Propensity-Matching Study Between the UK AATD Registry and AlphaNet

This grant is jointly supported by the CHEST Foundation and the Alpha-1 Foundation.

Robert Busch, MD

Brigham and Women’s Hospital, Channing Division of Network Medicine

CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease

Methylation Quantitative Trait Loci: Markers of Race-Specific Disparities in African Americans With COPD

This grant is supported by AstraZeneca.

Clemens Grassberger, PhD

Massachusetts General Hospital – Harvard University

CHEST Foundation Research Grant in Lung Cancer

Dynamic FLT-PET as Biomarker for Early Response in Locally Advanced Lung Cancer Patients

This grant is supported by Genentech Inc.

Cristina Russo, MD, PhD

Bambino Gesù Children’s Hospital, Rome, Italy

CHEST Foundation Research Grant in Nontuberculous Mycobacteria

A Proteomic-Metaproteomic Analysis Approach Allows Identification of Drug Target Candidates for the Future Design of Preventive, Diagnostic, and Therapeutic Strategies Against Nontuberculous Mycobacteria Diseases

This grant is supported by Insmed.

Peter Leary, MD, MS

University of Washington

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension

Expression Profiling in Pulmonary Arterial Hypertension

This grant is supported by Actelion Pharmaceuticals, US, Inc.

Brett Ley, MD

University of California, San Francisco

CHEST Foundation Research Grant in Pulmonary Fibrosis

Extracellular Circulation RNAs as Predictors of Disease Progression in Idiopathic Pulmonary Fibrosis

This grant is supported by Boehringer Ingelheim Pharmaceuticals & Genentech Inc.

Sydney Montesi, MD

Massachusetts General Hospital

CHEST Foundation Research Grant in Pulmonary Fibrosis

Gadofosveset-Enhanced Lung MRI to Detect Idiopathic Pulmonary Fibrosis Disease Activity

This grant is supported by Boehringer Ingelheim Pharmaceuticals & Genentech Inc.

Farbod Rahaghi, MD, PhD

Brigham and Women’s Hospital

CHEST Foundation Research Grant in Venous Thromboembolism

CT Scan-Based Markers for Prediction of Outcomes in Acute Pulmonary Embolism

This grant is supported by Daiichi Sankyo.

Catherine Oberg, MD

Icahn School of Medicine at Mount Sinai

CHEST Foundation Research Grant in Women’s Lung Health

Effects of Household Air Pollution on Airway Inflammation, Lung Function, and Respiratory Symptoms

This grant is supported in full by the CHEST Foundation.

2016 Community Service Grantee

Ethel Jane Carter, MD, FCCP

Warren Alpert School of Medicine at Brown University

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP

East African Training Initiative ( EATI) in Pulmonary Medicine

2016 NetWorks Challenge Travel Grantees

Debarsee Banerjee, MS, MD

Women’s Health NetWork

Drew Harris, MD

Occupational and Environmental Health NetWork

Kerry Hena, MD

Occupational and Environmental Health NetWork

Amanpreet Kaur, MD

Women’s Health NetWork

2016 Diversity Travel Grant Winners

John B. Bishara, DO

Renato F. Blanco Jr., MD

Angel Coz-Yataco, MD Sherie A. Gause, MD

Anthony Nebor, MD

James T. Williams, MD

Alfred Soffer Research Award Winners

Kerry Hena, MD

Deepak Pradhan, MD, FCCP

Young Investigator Award Winners

Elizabeth Becker: Clinical Characteristics of Sarcoidosis in World Trade Center (WTC) Exposed Fire Department of the City of New York (FDNY) Firefighters

Daniel Altman, MD : Cost-Effectiveness of Universally Funding Smoking Cessation Pharmacotherapy

Top 3 Poster Winners

Epaminondas Kosmas, MD, PhD, FCCP : Bronchiectasis in Patients With COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype?

Mark Regala, MD, BS : Evaluation of Outcomes of Post-Extubation Dysphagia in Elderly Patients

Massa Zantah, MD : Correlation of Esophageal Dilatation and Pulmonary Fibrosis in Scleroderma

Runner-up: Alev Gurgun, MD : Pulmonary Rehabilitation Response in Elderly and Younger Patients With COPD

Case Report Slide Winners

John Egan, MD, BA : An Unusual Cause of Tracheal Stenosis Due to a Vascular Anomaly Successfully Managed With Silicone Airway Stenting Prior to Definitive Vascular Repair

Harprett Grewal, MD : Bladder PTLD: First Reported Case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the Bladder in a Lung Transplant Recipient

Michael Fingerhood, MD, MPH : Pulmonary Overlap Histiocytosis: A Rare Case of Interstitial Lung Disease Due to Erdheim Chester Disease in a Patient With Langerhans Cell Histiocytosis and Myelodisplastic Syndrome

Yihenew Negatu, MD : Acute ST Elevation Myocardial Infarction Related to Carbon Monoxide Poisoning in a Young Patient Without Coronary Artery Disease

Stephanie Wappel, MD : False-Negative Pet Imaging in Early Stage Malignant Pleural Mesothelioma

Lina Miyakawa, MD : Restrictive EGFR Mutation

Jeffrey Bonenfant, DO : A Unique Case of Follicular Bronchiolitis

Melissa Myers, MD : Seeing the Forest and Not Just the Trees: A Case of Recurrent Fever, Cough, and Respiratory Failure

Carly Fabrizio, DO : An Unusual Case of Submassive Hemoptysis

Meilinh Thi, DO : A Case to Make Your Skin Crawl

Garrett Harp, MD : Lambertosis: A Lung Cancer Mimic

Malik Khan, MD : Pleural Epithelioid Hemangioendothelioma: A Case Report

Priya Patel, MD : A Troubling Trifecta: Pulmonary Alveolar Proteinosis and Pneumocystis Pneumonia in Acute Myeloid Leukemia

Atul Palkar, MD : SGLT2 Inhibitors: Mind the Gap

Ji Yeon Lee, MD : Making Unusual Connections: Fibrosing Mediastinitis Leading to Bronchoesophageal Fistula

Sailm Daouk, MD : A Rare Form of Invasive Aspergillus Infection in a Severely Immunocompromised Host

Venkata Ravi Kumar Angirekula, MD : Vanishing Lung

Stephen Milan, MD : An Unexpected Mass

Lelia Logue, MD : A Rare Cause of Dysphagia

Daniel Hershberger, MD : Rapidly Progressive Hypoxic Respiratory Failure After a Rash: A Case of Clinically Amyopathic Dermatomyositis (CADM)-Associated ILD

Fellow Case Report Poster Winners

Krishna Siva Sai Kakkera

An Unusual Case of Crypotococcal Pleural Effusion

George Cheng

Use of Laparoscopic Suction Irrigator With Rigid Pleuroscope in Medical Thoracoscopy

Matt Koroscil

Wong Type Dermatomyositis Complicated by Interstitial Lung Disease

Derek Hansen

Acute Fibrinous and Organizing Pneumonia Following Hematopoietic Stem Cell Transplantation Responsive to Corticosteroid Therapy

Ala Eddin Sagar

Pulmonary Embolism Caused by Thrombin-Based Hemostatic Matrix After Discectomy

Sandeep Chennadi

Systemic Lupus Erythematosus (SLE) With Refractory Bilateral Chylothorax and Chylous Ascites

Medical Student/Resident Case Report Poster Winners

Justin Fiala

Pulmonary Presentation Without Concurrent Bone Involvement in Erdheim-Chester Disease: A Report of Two Cases

Navitha Ramesh

A Fatal Migration: A Case of Intra-Cardiac Embolization of a Peripheral Stent

Humna Abid Memon

Use of Extracorporeal Membrane Oxygenation in Postpartum Management of a Patient With PAH

Vanessa Ohleyer

A Case of Unusual Anatomy for an Uncommon Mediastinal Tumor

Tanushree Gahlot

Three Unusual Presentations of Job’s Syndrome (Hyper Immunoglobulin E Syndrome)

NetWorks Challenge Winners

Round 1

Women’s Lung Health NetWork

Round 2

Practice and Operations NetWork-1st place

Home-Based Mechanical Ventilation and Neuromuscular Disease NetWorks – 2nd place

Round 3

Home-Based Mechanical Ventilation, Neuromuscular Disease, and the Women’s Lung Health NetWorks

CHEST Bingo Winners

Youseff Anid, MD, FCCP

Karen Cochran, ACNP

Molly Howsware, DO

Katie Jeans, MD

Genovena Medina, RN

Gregory Eisinger, MD

Saurabh Mittal, MD, MBBS

Navitha Ramesh, MD

Dalvinder Dhillon, MD

Teresita Saylor, MD, FCCP

Carl Kaplan, MD, FCCP

Vishal Patel, MBBS, FCCP

Erin Peterson, CNP

Lilian Pereira, DO

Basel, Switzerland June 7-9

Join leaders in CHEST medicine for a program designed by clinicians for clinicians.

The Joint Congress organized by CHEST and the Swiss Society of Pneumology will be held from June 7-9 in Basel, Switzerland. The program has been designed by more than 140 faculty members from both the United States and Europe, and it aims to provide a robust overview of all aspects of respiratory medicine through interactive sessions, plenary discussions, critical appraisals on controversial topics, and a review of the last year of published works.

The Joint Congress also provides the opportunity to take part in hands-on simulation in areas such as lung function techniques including body plethysmography, N2 washout techniques, and respiratory physiotherapy. Another hands-on opportunity is the interventional pneumology CHEST experience course, which will be held from 8:00 AM-11:00 AM on June 7 and 8 on site. This course will provide an overview of conventional and EBUS-guided TBNA, an anatomy identification of airway nodes, management of airway bleeding, and management of pneumothorax. This course is ideal for clinicians and health-care professionals with specialties in pulmonary, critical care, and intensive care medicine, as well as thoracic surgery.

The program at the Joint CHEST-SGP Congress aims to improve the patient care abilities of every attendee, as well as provide an ideal environment for networking with leaders in your field.

The call for abstracts remains open until January 24, 2017. The abstract topic areas are:

• Airway disease
• Interstitial lung disease
• Sleep/Breathing
• Lung cancer
• Epidemiology/Rehabilitation
• Interventional pneumology
• Pulmonary hypertension
• Basic science
• Thoracic surgery
• Pediatrics

All abstracts must be submitted via the Joint Congress abstracts web portal www.chest-sgp-switzerland2017.org.

CHEST recognizes the value of international outreach, and this Joint Congress advances that initiative. CHEST aims to standardize the patient care across borders and to encourage international collaboration to build the future of chest medicine. To further this mission, an application has been made to the European Accreditation Council for Continuing Medical Education (EACCME®) for CME accreditation of this event. Additionally, an application has been made to the European Board for Accreditation in Pneumology (EBAP) to provide quality assurance and CME for the event.

For more information or to register, visit the CHEST Joint Congress website www.chest-sgp-switzerland2017.org. Early registration ends on March 16, 2017.

Basel, Switzerland June 7-9

Join leaders in CHEST medicine for a program designed by clinicians for clinicians.

The Joint Congress organized by CHEST and the Swiss Society of Pneumology will be held from June 7-9 in Basel, Switzerland. The program has been designed by more than 140 faculty members from both the United States and Europe, and it aims to provide a robust overview of all aspects of respiratory medicine through interactive sessions, plenary discussions, critical appraisals on controversial topics, and a review of the last year of published works.

The Joint Congress also provides the opportunity to take part in hands-on simulation in areas such as lung function techniques including body plethysmography, N2 washout techniques, and respiratory physiotherapy. Another hands-on opportunity is the interventional pneumology CHEST experience course, which will be held from 8:00 AM-11:00 AM on June 7 and 8 on site. This course will provide an overview of conventional and EBUS-guided TBNA, an anatomy identification of airway nodes, management of airway bleeding, and management of pneumothorax. This course is ideal for clinicians and health-care professionals with specialties in pulmonary, critical care, and intensive care medicine, as well as thoracic surgery.

The program at the Joint CHEST-SGP Congress aims to improve the patient care abilities of every attendee, as well as provide an ideal environment for networking with leaders in your field.

The call for abstracts remains open until January 24, 2017. The abstract topic areas are:

• Airway disease
• Interstitial lung disease
• Sleep/Breathing
• Lung cancer
• Epidemiology/Rehabilitation
• Interventional pneumology
• Pulmonary hypertension
• Basic science
• Thoracic surgery
• Pediatrics

All abstracts must be submitted via the Joint Congress abstracts web portal www.chest-sgp-switzerland2017.org.

CHEST recognizes the value of international outreach, and this Joint Congress advances that initiative. CHEST aims to standardize the patient care across borders and to encourage international collaboration to build the future of chest medicine. To further this mission, an application has been made to the European Accreditation Council for Continuing Medical Education (EACCME®) for CME accreditation of this event. Additionally, an application has been made to the European Board for Accreditation in Pneumology (EBAP) to provide quality assurance and CME for the event.

For more information or to register, visit the CHEST Joint Congress website www.chest-sgp-switzerland2017.org. Early registration ends on March 16, 2017.

Basel, Switzerland June 7-9

Join leaders in CHEST medicine for a program designed by clinicians for clinicians.

The Joint Congress organized by CHEST and the Swiss Society of Pneumology will be held from June 7-9 in Basel, Switzerland. The program has been designed by more than 140 faculty members from both the United States and Europe, and it aims to provide a robust overview of all aspects of respiratory medicine through interactive sessions, plenary discussions, critical appraisals on controversial topics, and a review of the last year of published works.

The Joint Congress also provides the opportunity to take part in hands-on simulation in areas such as lung function techniques including body plethysmography, N2 washout techniques, and respiratory physiotherapy. Another hands-on opportunity is the interventional pneumology CHEST experience course, which will be held from 8:00 AM-11:00 AM on June 7 and 8 on site. This course will provide an overview of conventional and EBUS-guided TBNA, an anatomy identification of airway nodes, management of airway bleeding, and management of pneumothorax. This course is ideal for clinicians and health-care professionals with specialties in pulmonary, critical care, and intensive care medicine, as well as thoracic surgery.

The program at the Joint CHEST-SGP Congress aims to improve the patient care abilities of every attendee, as well as provide an ideal environment for networking with leaders in your field.

The call for abstracts remains open until January 24, 2017. The abstract topic areas are:

• Airway disease
• Interstitial lung disease
• Sleep/Breathing
• Lung cancer
• Epidemiology/Rehabilitation
• Interventional pneumology
• Pulmonary hypertension
• Basic science
• Thoracic surgery
• Pediatrics

All abstracts must be submitted via the Joint Congress abstracts web portal www.chest-sgp-switzerland2017.org.

CHEST recognizes the value of international outreach, and this Joint Congress advances that initiative. CHEST aims to standardize the patient care across borders and to encourage international collaboration to build the future of chest medicine. To further this mission, an application has been made to the European Accreditation Council for Continuing Medical Education (EACCME®) for CME accreditation of this event. Additionally, an application has been made to the European Board for Accreditation in Pneumology (EBAP) to provide quality assurance and CME for the event.

For more information or to register, visit the CHEST Joint Congress website www.chest-sgp-switzerland2017.org. Early registration ends on March 16, 2017.

SAN DIEGO – Dual therapy with lenalidomide and epoetin alfa was safe and led to freedom from transfusion significantly more often than lenalidomide alone in patients with erythropoietin-refractory, lower-risk, non-del(5q) myelodysplastic syndromes, according to a randomized phase III head-to-head trial.

After 16 weeks of treatment, 33% of patients who received both lenalidomide and epoetin alfa met International Working Group 2000 criteria for major erythroid response, compared with only 14% of patients receiving lenalidomide monotherapy (P = .03), Alan F. List, MD, reported at the annual meeting of the American Society of Hematology.

H. Lee Moffitt Cancer Center

SAN DIEGO – Dual therapy with lenalidomide and epoetin alfa was safe and led to freedom from transfusion significantly more often than lenalidomide alone in patients with erythropoietin-refractory, lower-risk, non-del(5q) myelodysplastic syndromes, according to a randomized phase III head-to-head trial.

After 16 weeks of treatment, 33% of patients who received both lenalidomide and epoetin alfa met International Working Group 2000 criteria for major erythroid response, compared with only 14% of patients receiving lenalidomide monotherapy (P = .03), Alan F. List, MD, reported at the annual meeting of the American Society of Hematology.

H. Lee Moffitt Cancer Center

SAN DIEGO – Dual therapy with lenalidomide and epoetin alfa was safe and led to freedom from transfusion significantly more often than lenalidomide alone in patients with erythropoietin-refractory, lower-risk, non-del(5q) myelodysplastic syndromes, according to a randomized phase III head-to-head trial.

After 16 weeks of treatment, 33% of patients who received both lenalidomide and epoetin alfa met International Working Group 2000 criteria for major erythroid response, compared with only 14% of patients receiving lenalidomide monotherapy (P = .03), Alan F. List, MD, reported at the annual meeting of the American Society of Hematology.

H. Lee Moffitt Cancer Center

First-year residents may be permitted to work up to 24 consecutive hours – 8 hours longer than they can now – under a proposal from a task force of the Accreditation Council for Graduate Medical Education (ACGME).

The ACGME Duty Hour Task Force proposes to raise first-year trainees’ work hour limit from 16 hours, reverting to the 24-hour maximum that remained in effect until 2011 – and the existing limit in place for all other residents.

“There is better team continuity of care provided with less micromanagement of resident duty hours,” said Thomas J. Nasca, MD, ACGME chief executive and vice chairman of the task force.

The ACGME instituted the 16-hour cap for first-year residents in the wake of a December 2008 report released by the Institute of Medicine (IOM), “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.” The ACGME also prohibited 30-hour shifts, which some trainees had been clocking.

“Every 5 years, the ACGME reviews its program requirements,” Dr. Nasca said. “That’s a promise we made to the community and to the public” in July 2003. The most recent changes occurred in July 2011.

Since then, some faculty have contended that shorter work hour limits for the first-year residents are accelerating the frequency of patient transitions and disrupting continuity of care. Many educators also noted that residents would gain more knowledge by monitoring a hospitalized patient during the initial 24 hours.

The American College of Physicians “approves and commends ACGME for explicitly addressing [resident] well being in the Common Program Requirements,” ACP President Nitin S. Damle, MD, said in a statement. “We support ACGME in removing the standard limiting duty hours for PGY-1 residents to no more than 16 hours. By mandating different hours for PGY-residents and more senior residents, the old standard disrupted the continuity of the resident team and resulted in considerable unintended consequences without commensurate improvement in patient safety or educational outcomes.”

The ACP does not support a proposed additional 4-hour extension to the current 4-hour extension to a 24-hour call shift. “We believe that the [current] 24+ rule adequately addresses all clinical and educational needs,” Dr. Damle said in the statement. “The new standard places residents at risk for 28 consecutive hours of duty.”

The proposed revisions to training requirements also include phasing out the term “duty” hours in favor of “clinical experience and education,” highlighting that residents’ responsibility to patients takes precedence over any adherence to a schedule or clock. Working a certain number of hospital hours is only one aspect of delivering safe and quality care, the ACGME Duty Hour Task Force noted in its proposal.

The proposal does not change the following, which all are averaged over a period of 4 weeks: a maximum of 80 hours per week, 1 day free from clinical experience or education in 7, and in-house call no more often than every third night.

“It is important to note that the absence of a common 16-hour limit does not imply that programs may no longer configure their clinical schedules in 16-hour increments if that is the preferred option for a given setting or clinical context,” Dr. Nasca wrote in a Nov. 4 letter to the graduate medical education community.

In its December 2008 report, the IOM noted that revamping residents’ work hours alone offered no guarantee of patient safety. It called for increased supervision by seasoned physicians, restrictions on patient caseloads based on residents’ levels of experience and specialty, overlap in schedules around shift changes to decrease the possibility of error in transitioning patients from one provider to another, and broad-based research to examine the outcomes from these changes.

“Surgical residents, when they’re operating, come under very direct supervision by attending physicians,” said Jay Bhattacharya, MD, professor of medicine at Stanford (Calif.) University, who served on the 2008 IOM committee. “That supervision is generally pretty good. Even for a tired resident, the supervision makes it so that the fatigue the trainee faces doesn’t endanger the patient.”

Acknowledging the emerging evidence that physicians are at heightened risk for burnout and perhaps depression, the proposal underscores the need for residency programs and institutions to prioritize the well-being of residents as well as nurses and other hospital personnel.

“Burnout and depression impair a physician’s ability to provide excellent care. Self-care is an important aspect of professionalism, and a skill that must be learned and nurtured under the guidance and role modeling of faculty members,” Dr. Nasca wrote in his Nov. 4 letter.

If the proposal is approved by the ACGME board of directors in February, the changes will be rolled out in July.

The ACGME accepted comments on the proposal through Dec. 19; comments will be reviewed and considered before a final set of proposed requirements are sent to the ACGME board for approval.

“We’re here to serve the public, and so the focus is on the comments that reflect the most recent and comprehensive evidence and educational outcomes rather than the individual opinions we receive,” Dr. Nasca said.

First-year residents may be permitted to work up to 24 consecutive hours – 8 hours longer than they can now – under a proposal from a task force of the Accreditation Council for Graduate Medical Education (ACGME).

The ACGME Duty Hour Task Force proposes to raise first-year trainees’ work hour limit from 16 hours, reverting to the 24-hour maximum that remained in effect until 2011 – and the existing limit in place for all other residents.

“There is better team continuity of care provided with less micromanagement of resident duty hours,” said Thomas J. Nasca, MD, ACGME chief executive and vice chairman of the task force.

The ACGME instituted the 16-hour cap for first-year residents in the wake of a December 2008 report released by the Institute of Medicine (IOM), “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.” The ACGME also prohibited 30-hour shifts, which some trainees had been clocking.

“Every 5 years, the ACGME reviews its program requirements,” Dr. Nasca said. “That’s a promise we made to the community and to the public” in July 2003. The most recent changes occurred in July 2011.

Since then, some faculty have contended that shorter work hour limits for the first-year residents are accelerating the frequency of patient transitions and disrupting continuity of care. Many educators also noted that residents would gain more knowledge by monitoring a hospitalized patient during the initial 24 hours.

The American College of Physicians “approves and commends ACGME for explicitly addressing [resident] well being in the Common Program Requirements,” ACP President Nitin S. Damle, MD, said in a statement. “We support ACGME in removing the standard limiting duty hours for PGY-1 residents to no more than 16 hours. By mandating different hours for PGY-residents and more senior residents, the old standard disrupted the continuity of the resident team and resulted in considerable unintended consequences without commensurate improvement in patient safety or educational outcomes.”

The ACP does not support a proposed additional 4-hour extension to the current 4-hour extension to a 24-hour call shift. “We believe that the [current] 24+ rule adequately addresses all clinical and educational needs,” Dr. Damle said in the statement. “The new standard places residents at risk for 28 consecutive hours of duty.”

The proposed revisions to training requirements also include phasing out the term “duty” hours in favor of “clinical experience and education,” highlighting that residents’ responsibility to patients takes precedence over any adherence to a schedule or clock. Working a certain number of hospital hours is only one aspect of delivering safe and quality care, the ACGME Duty Hour Task Force noted in its proposal.

The proposal does not change the following, which all are averaged over a period of 4 weeks: a maximum of 80 hours per week, 1 day free from clinical experience or education in 7, and in-house call no more often than every third night.

“It is important to note that the absence of a common 16-hour limit does not imply that programs may no longer configure their clinical schedules in 16-hour increments if that is the preferred option for a given setting or clinical context,” Dr. Nasca wrote in a Nov. 4 letter to the graduate medical education community.

In its December 2008 report, the IOM noted that revamping residents’ work hours alone offered no guarantee of patient safety. It called for increased supervision by seasoned physicians, restrictions on patient caseloads based on residents’ levels of experience and specialty, overlap in schedules around shift changes to decrease the possibility of error in transitioning patients from one provider to another, and broad-based research to examine the outcomes from these changes.

“Surgical residents, when they’re operating, come under very direct supervision by attending physicians,” said Jay Bhattacharya, MD, professor of medicine at Stanford (Calif.) University, who served on the 2008 IOM committee. “That supervision is generally pretty good. Even for a tired resident, the supervision makes it so that the fatigue the trainee faces doesn’t endanger the patient.”

Acknowledging the emerging evidence that physicians are at heightened risk for burnout and perhaps depression, the proposal underscores the need for residency programs and institutions to prioritize the well-being of residents as well as nurses and other hospital personnel.

“Burnout and depression impair a physician’s ability to provide excellent care. Self-care is an important aspect of professionalism, and a skill that must be learned and nurtured under the guidance and role modeling of faculty members,” Dr. Nasca wrote in his Nov. 4 letter.

If the proposal is approved by the ACGME board of directors in February, the changes will be rolled out in July.

The ACGME accepted comments on the proposal through Dec. 19; comments will be reviewed and considered before a final set of proposed requirements are sent to the ACGME board for approval.

“We’re here to serve the public, and so the focus is on the comments that reflect the most recent and comprehensive evidence and educational outcomes rather than the individual opinions we receive,” Dr. Nasca said.

First-year residents may be permitted to work up to 24 consecutive hours – 8 hours longer than they can now – under a proposal from a task force of the Accreditation Council for Graduate Medical Education (ACGME).

The ACGME Duty Hour Task Force proposes to raise first-year trainees’ work hour limit from 16 hours, reverting to the 24-hour maximum that remained in effect until 2011 – and the existing limit in place for all other residents.

“There is better team continuity of care provided with less micromanagement of resident duty hours,” said Thomas J. Nasca, MD, ACGME chief executive and vice chairman of the task force.

The ACGME instituted the 16-hour cap for first-year residents in the wake of a December 2008 report released by the Institute of Medicine (IOM), “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.” The ACGME also prohibited 30-hour shifts, which some trainees had been clocking.

“Every 5 years, the ACGME reviews its program requirements,” Dr. Nasca said. “That’s a promise we made to the community and to the public” in July 2003. The most recent changes occurred in July 2011.

Since then, some faculty have contended that shorter work hour limits for the first-year residents are accelerating the frequency of patient transitions and disrupting continuity of care. Many educators also noted that residents would gain more knowledge by monitoring a hospitalized patient during the initial 24 hours.

The American College of Physicians “approves and commends ACGME for explicitly addressing [resident] well being in the Common Program Requirements,” ACP President Nitin S. Damle, MD, said in a statement. “We support ACGME in removing the standard limiting duty hours for PGY-1 residents to no more than 16 hours. By mandating different hours for PGY-residents and more senior residents, the old standard disrupted the continuity of the resident team and resulted in considerable unintended consequences without commensurate improvement in patient safety or educational outcomes.”

The ACP does not support a proposed additional 4-hour extension to the current 4-hour extension to a 24-hour call shift. “We believe that the [current] 24+ rule adequately addresses all clinical and educational needs,” Dr. Damle said in the statement. “The new standard places residents at risk for 28 consecutive hours of duty.”

The proposed revisions to training requirements also include phasing out the term “duty” hours in favor of “clinical experience and education,” highlighting that residents’ responsibility to patients takes precedence over any adherence to a schedule or clock. Working a certain number of hospital hours is only one aspect of delivering safe and quality care, the ACGME Duty Hour Task Force noted in its proposal.

The proposal does not change the following, which all are averaged over a period of 4 weeks: a maximum of 80 hours per week, 1 day free from clinical experience or education in 7, and in-house call no more often than every third night.

“It is important to note that the absence of a common 16-hour limit does not imply that programs may no longer configure their clinical schedules in 16-hour increments if that is the preferred option for a given setting or clinical context,” Dr. Nasca wrote in a Nov. 4 letter to the graduate medical education community.

In its December 2008 report, the IOM noted that revamping residents’ work hours alone offered no guarantee of patient safety. It called for increased supervision by seasoned physicians, restrictions on patient caseloads based on residents’ levels of experience and specialty, overlap in schedules around shift changes to decrease the possibility of error in transitioning patients from one provider to another, and broad-based research to examine the outcomes from these changes.

“Surgical residents, when they’re operating, come under very direct supervision by attending physicians,” said Jay Bhattacharya, MD, professor of medicine at Stanford (Calif.) University, who served on the 2008 IOM committee. “That supervision is generally pretty good. Even for a tired resident, the supervision makes it so that the fatigue the trainee faces doesn’t endanger the patient.”

Acknowledging the emerging evidence that physicians are at heightened risk for burnout and perhaps depression, the proposal underscores the need for residency programs and institutions to prioritize the well-being of residents as well as nurses and other hospital personnel.

“Burnout and depression impair a physician’s ability to provide excellent care. Self-care is an important aspect of professionalism, and a skill that must be learned and nurtured under the guidance and role modeling of faculty members,” Dr. Nasca wrote in his Nov. 4 letter.

If the proposal is approved by the ACGME board of directors in February, the changes will be rolled out in July.

The ACGME accepted comments on the proposal through Dec. 19; comments will be reviewed and considered before a final set of proposed requirements are sent to the ACGME board for approval.

“We’re here to serve the public, and so the focus is on the comments that reflect the most recent and comprehensive evidence and educational outcomes rather than the individual opinions we receive,” Dr. Nasca said.

Review the PDF of the fact sheet on transient benign neonatal skin findings with board-relevant, easy-to-review material. This fact sheet lists benign findings that can be seen in neonates and infants.

Practice Questions

1. The parents of a 2-month-old infant present with their child. They are worried because the infant has “acne” that is not going away. Friends told them to try gentle cleansers and they have avoided using lotions or cream on her face. However, the bumps will not go away. On examination she has papules and pustules. Comedones cannot be identified. What are your next steps?

a. adapalene cream 0.1% every night at bedtime
b. benzoyl peroxide cream 4%
c. benzoyl peroxide wash 2.5%
d. erythromycin gel 2%
e. ketoconazole cream 2% twice daily

2. While in the newborn nursery prior to discharge, the attending pediatrician notices a rash on a 2-day-old neonate who is otherwise completely healthy. The pediatrician consults a dermatologist for his/her opinion. The dermatologist sees erythematous macules with central pustules located predominately on the trunk and proximal extremities. A pustule is unroofed with a blade, the contents smeared on a glass slide, and a Giemsa stain is performed. What is the predominant cell type you would expect to see on histological examination?

a. eosinophils
b. Langerhans cells
c. lymphocytes
d. neutrophils
e. no cells are visualized

3. Shortly after delivery, the pediatricians notice that the baby has numerous hyperpigmented macules on the back. No other primary lesions are seen. The neonate is otherwise normal in appearance and nontoxic appearing. A dermatologist is consulted for a recommendation for further workup or potential biopsy. The dermatologist examines the newborn. He is a well-appearing black boy with skin that is otherwise intact. A few pustules on the back are present that have a collarette of scale. The dermatologist reviews the mother’s prenatal history and the review shows that she was screened for syphilis and had a negative screening test with no other history of infectious diseases. What is the most appropriate next step to confirm your suspicions?

a. do a swab of a pustule and send it for viral culture
b. have his blood drawn and check for signs of neonatal herpes simplex virus infection
c. perform a biopsy of a pustule
d. perform a Giemsa stain on a smear of the pustule
e. start treatment with permethrin

4. Which intraoral cysts occur on the alveolar ridge of a neonate?

a. Bohn nodule
b. branchial cleft cyst
c. Epstein pearls
d. median raphe cyst
e. palatal cysts of the newborn

5. Miliaria rubra is associated with inflammation of the sweat glands in what portion of the skin?

a. basement membrane zone
b. dermis
c. dermoepidermal junction
d. intraepidermal
e. subcutis

Answers to practice questions provided on next page

Practice Question Answers

1. The parents of a 2-month-old infant present with their child. They are worried because the infant has “acne” that is not going away. Friends told them to try gentle cleansers and they have avoided using lotions or cream on her face. However, the bumps will not go away. On examination she has papules and pustules. Comedones cannot be identified. What are your next steps?

a. adapalene cream 0.1% every night at bedtime
b. benzoyl peroxide cream 4%
c. benzoyl peroxide wash 2.5%
d. erythromycin gel 2%
e. ketoconazole cream 2% twice daily

2. While in the newborn nursery prior to discharge, the attending pediatrician notices a rash on a 2-day-old neonate who is otherwise completely healthy. The pediatrician consults a dermatologist for his/her opinion. The dermatologist sees erythematous macules with central pustules located predominately on the trunk and proximal extremities. A pustule is unroofed with a blade, the contents smeared on a glass slide, and a Giemsa stain is performed. What is the predominant cell type you would expect to see on histological examination?

a. eosinophils
b. Langerhans cells
c. lymphocytes
d. neutrophils
e. no cells are visualized

3. Shortly after delivery, the pediatricians notice that the baby has numerous hyperpigmented macules on the back. No other primary lesions are seen. The neonate is otherwise normal in appearance and nontoxic appearing. A dermatologist is consulted for a recommendation for further workup or potential biopsy. The dermatologist examines the newborn. He is a well-appearing black boy with skin that is otherwise intact. A few pustules on the back are present that have a collarette of scale. The dermatologist reviews the mother’s prenatal history and the review shows that she was screened for syphilis and had a negative screening test with no other history of infectious diseases. What is the most appropriate next step to confirm your suspicions?

a. do a swab of a pustule and send it for viral culture
b. have his blood drawn and check for signs of neonatal herpes simplex virus infection
c. perform a biopsy of a pustule
d. perform a Giemsa stain on a smear of the pustule
e. start treatment with permethrin

4. Which intraoral cysts occur on the alveolar ridge of a neonate?

a. Bohn nodule
b. branchial cleft cyst
c. Epstein pearls
d. median raphe cyst
e. palatal cysts of the newborn

5. Miliaria rubra is associated with inflammation of the sweat glands in what portion of the skin?

a. basement membrane zone
b. dermis
c. dermoepidermal junction
d. intraepidermal
e. subcutis

Review the PDF of the fact sheet on transient benign neonatal skin findings with board-relevant, easy-to-review material. This fact sheet lists benign findings that can be seen in neonates and infants.

Practice Questions

1. The parents of a 2-month-old infant present with their child. They are worried because the infant has “acne” that is not going away. Friends told them to try gentle cleansers and they have avoided using lotions or cream on her face. However, the bumps will not go away. On examination she has papules and pustules. Comedones cannot be identified. What are your next steps?

a. adapalene cream 0.1% every night at bedtime
b. benzoyl peroxide cream 4%
c. benzoyl peroxide wash 2.5%
d. erythromycin gel 2%
e. ketoconazole cream 2% twice daily

2. While in the newborn nursery prior to discharge, the attending pediatrician notices a rash on a 2-day-old neonate who is otherwise completely healthy. The pediatrician consults a dermatologist for his/her opinion. The dermatologist sees erythematous macules with central pustules located predominately on the trunk and proximal extremities. A pustule is unroofed with a blade, the contents smeared on a glass slide, and a Giemsa stain is performed. What is the predominant cell type you would expect to see on histological examination?

a. eosinophils
b. Langerhans cells
c. lymphocytes
d. neutrophils
e. no cells are visualized

3. Shortly after delivery, the pediatricians notice that the baby has numerous hyperpigmented macules on the back. No other primary lesions are seen. The neonate is otherwise normal in appearance and nontoxic appearing. A dermatologist is consulted for a recommendation for further workup or potential biopsy. The dermatologist examines the newborn. He is a well-appearing black boy with skin that is otherwise intact. A few pustules on the back are present that have a collarette of scale. The dermatologist reviews the mother’s prenatal history and the review shows that she was screened for syphilis and had a negative screening test with no other history of infectious diseases. What is the most appropriate next step to confirm your suspicions?

a. do a swab of a pustule and send it for viral culture
b. have his blood drawn and check for signs of neonatal herpes simplex virus infection
c. perform a biopsy of a pustule
d. perform a Giemsa stain on a smear of the pustule
e. start treatment with permethrin

4. Which intraoral cysts occur on the alveolar ridge of a neonate?

a. Bohn nodule
b. branchial cleft cyst
c. Epstein pearls
d. median raphe cyst
e. palatal cysts of the newborn

5. Miliaria rubra is associated with inflammation of the sweat glands in what portion of the skin?

a. basement membrane zone
b. dermis
c. dermoepidermal junction
d. intraepidermal
e. subcutis

Answers to practice questions provided on next page

Practice Question Answers

1. The parents of a 2-month-old infant present with their child. They are worried because the infant has “acne” that is not going away. Friends told them to try gentle cleansers and they have avoided using lotions or cream on her face. However, the bumps will not go away. On examination she has papules and pustules. Comedones cannot be identified. What are your next steps?

a. adapalene cream 0.1% every night at bedtime
b. benzoyl peroxide cream 4%
c. benzoyl peroxide wash 2.5%
d. erythromycin gel 2%
e. ketoconazole cream 2% twice daily

2. While in the newborn nursery prior to discharge, the attending pediatrician notices a rash on a 2-day-old neonate who is otherwise completely healthy. The pediatrician consults a dermatologist for his/her opinion. The dermatologist sees erythematous macules with central pustules located predominately on the trunk and proximal extremities. A pustule is unroofed with a blade, the contents smeared on a glass slide, and a Giemsa stain is performed. What is the predominant cell type you would expect to see on histological examination?

a. eosinophils
b. Langerhans cells
c. lymphocytes
d. neutrophils
e. no cells are visualized

3. Shortly after delivery, the pediatricians notice that the baby has numerous hyperpigmented macules on the back. No other primary lesions are seen. The neonate is otherwise normal in appearance and nontoxic appearing. A dermatologist is consulted for a recommendation for further workup or potential biopsy. The dermatologist examines the newborn. He is a well-appearing black boy with skin that is otherwise intact. A few pustules on the back are present that have a collarette of scale. The dermatologist reviews the mother’s prenatal history and the review shows that she was screened for syphilis and had a negative screening test with no other history of infectious diseases. What is the most appropriate next step to confirm your suspicions?

a. do a swab of a pustule and send it for viral culture
b. have his blood drawn and check for signs of neonatal herpes simplex virus infection
c. perform a biopsy of a pustule
d. perform a Giemsa stain on a smear of the pustule
e. start treatment with permethrin

4. Which intraoral cysts occur on the alveolar ridge of a neonate?

a. Bohn nodule
b. branchial cleft cyst
c. Epstein pearls
d. median raphe cyst
e. palatal cysts of the newborn

5. Miliaria rubra is associated with inflammation of the sweat glands in what portion of the skin?

a. basement membrane zone
b. dermis
c. dermoepidermal junction
d. intraepidermal
e. subcutis

Review the PDF of the fact sheet on transient benign neonatal skin findings with board-relevant, easy-to-review material. This fact sheet lists benign findings that can be seen in neonates and infants.

Practice Questions

1. The parents of a 2-month-old infant present with their child. They are worried because the infant has “acne” that is not going away. Friends told them to try gentle cleansers and they have avoided using lotions or cream on her face. However, the bumps will not go away. On examination she has papules and pustules. Comedones cannot be identified. What are your next steps?

a. adapalene cream 0.1% every night at bedtime
b. benzoyl peroxide cream 4%
c. benzoyl peroxide wash 2.5%
d. erythromycin gel 2%
e. ketoconazole cream 2% twice daily

2. While in the newborn nursery prior to discharge, the attending pediatrician notices a rash on a 2-day-old neonate who is otherwise completely healthy. The pediatrician consults a dermatologist for his/her opinion. The dermatologist sees erythematous macules with central pustules located predominately on the trunk and proximal extremities. A pustule is unroofed with a blade, the contents smeared on a glass slide, and a Giemsa stain is performed. What is the predominant cell type you would expect to see on histological examination?

a. eosinophils
b. Langerhans cells
c. lymphocytes
d. neutrophils
e. no cells are visualized

3. Shortly after delivery, the pediatricians notice that the baby has numerous hyperpigmented macules on the back. No other primary lesions are seen. The neonate is otherwise normal in appearance and nontoxic appearing. A dermatologist is consulted for a recommendation for further workup or potential biopsy. The dermatologist examines the newborn. He is a well-appearing black boy with skin that is otherwise intact. A few pustules on the back are present that have a collarette of scale. The dermatologist reviews the mother’s prenatal history and the review shows that she was screened for syphilis and had a negative screening test with no other history of infectious diseases. What is the most appropriate next step to confirm your suspicions?

a. do a swab of a pustule and send it for viral culture
b. have his blood drawn and check for signs of neonatal herpes simplex virus infection
c. perform a biopsy of a pustule
d. perform a Giemsa stain on a smear of the pustule
e. start treatment with permethrin

4. Which intraoral cysts occur on the alveolar ridge of a neonate?

a. Bohn nodule
b. branchial cleft cyst
c. Epstein pearls
d. median raphe cyst
e. palatal cysts of the newborn

5. Miliaria rubra is associated with inflammation of the sweat glands in what portion of the skin?

a. basement membrane zone
b. dermis
c. dermoepidermal junction
d. intraepidermal
e. subcutis

Answers to practice questions provided on next page

Practice Question Answers

1. The parents of a 2-month-old infant present with their child. They are worried because the infant has “acne” that is not going away. Friends told them to try gentle cleansers and they have avoided using lotions or cream on her face. However, the bumps will not go away. On examination she has papules and pustules. Comedones cannot be identified. What are your next steps?

a. adapalene cream 0.1% every night at bedtime
b. benzoyl peroxide cream 4%
c. benzoyl peroxide wash 2.5%
d. erythromycin gel 2%
e. ketoconazole cream 2% twice daily

2. While in the newborn nursery prior to discharge, the attending pediatrician notices a rash on a 2-day-old neonate who is otherwise completely healthy. The pediatrician consults a dermatologist for his/her opinion. The dermatologist sees erythematous macules with central pustules located predominately on the trunk and proximal extremities. A pustule is unroofed with a blade, the contents smeared on a glass slide, and a Giemsa stain is performed. What is the predominant cell type you would expect to see on histological examination?

a. eosinophils
b. Langerhans cells
c. lymphocytes
d. neutrophils
e. no cells are visualized

3. Shortly after delivery, the pediatricians notice that the baby has numerous hyperpigmented macules on the back. No other primary lesions are seen. The neonate is otherwise normal in appearance and nontoxic appearing. A dermatologist is consulted for a recommendation for further workup or potential biopsy. The dermatologist examines the newborn. He is a well-appearing black boy with skin that is otherwise intact. A few pustules on the back are present that have a collarette of scale. The dermatologist reviews the mother’s prenatal history and the review shows that she was screened for syphilis and had a negative screening test with no other history of infectious diseases. What is the most appropriate next step to confirm your suspicions?

a. do a swab of a pustule and send it for viral culture
b. have his blood drawn and check for signs of neonatal herpes simplex virus infection
c. perform a biopsy of a pustule
d. perform a Giemsa stain on a smear of the pustule
e. start treatment with permethrin

4. Which intraoral cysts occur on the alveolar ridge of a neonate?

a. Bohn nodule
b. branchial cleft cyst
c. Epstein pearls
d. median raphe cyst
e. palatal cysts of the newborn

5. Miliaria rubra is associated with inflammation of the sweat glands in what portion of the skin?

a. basement membrane zone
b. dermis
c. dermoepidermal junction
d. intraepidermal
e. subcutis

The New Year brings new leadership in the United States, with President-elect Donald Trump taking office later this month. With a Republican-controlled Congress, party leaders have the opportunity to shape the nation’s policies around conservative ideals. This includes health care.

Since the Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to repeal and replace it. This could be their opportunity.

However, “there is no clear coalescence around specific policy reforms that would replace the Affordable Care Act,” says Christine Eibner, PhD, a senior economist at Rand and a professor at the Pardee Rand Graduate School.

As a candidate, Trump did little to advance policy ideas around health care. Meanwhile, House Speaker Paul Ryan (R-Wis.) and others have, over the years, proposed reforms with which Trump may or may not agree.

Where we stand January 2017

Whether the Republicans can or will repeal the ACA in its entirety and improve it remains unknown. But, the experts say, the landmark law has left its mark on the American health care system.

“Everyone is complaining about the uncertainty created by the election, but we have been dealing with a highly uncertain environment for many years,” says Ron Greeno, MD, FCCP, MHM, senior advisor for medical affairs at TeamHealth, chair of the SHM Public Policy Committee, and SHM president-elect. “There will be changes, but things were going to change no matter the outcome of the election. It continues to require tolerance for change and tolerance for uncertainty.”

In an analysis for the Commonwealth Fund, Dr. Eibner investigated the economic implications of aspects of Trump’s plans as a candidate. Using a computer model that incorporates economic theory and data to simulate the effects of health policy changes, Dr. Eibner found that Trump’s plans (full repeal alone or repeal with tax deductions for health care premiums, Medicaid block grants, or selling health insurance across state lines) would increase the number of uninsured people by 16 million to 25 million, disproportionately impact low-income and sicker patients, expose individual market enrollees to higher out-of-pocket costs, and increase the federal deficit by $0.5 billion to $41 billion.¹ The Congressional Budget Office (CBO) estimates full repeal could increase the federal deficit by $137 billion to $353 billion by 2025.² Rep. Ryan’s plan, A Better Way, proposes providing people more control over their health care, giving tax credits instead of subsidies for premiums, capping the employer-sponsored health insurance tax exclusion, and expanding use of health savings accounts.³ However, Rep. Ryan’s plan “doesn’t reduce the cost of health care. It puts more onus on individuals, and their costs go up,” Ms. Hoffman says. “The weight of that will be more on people who have preexisting conditions.”

Key provisions: A delicate balance

Many people equate the ACA with the individual mandate, which requires nearly all Americans to purchase health insurance or pay a fine. The federal government provides subsidies to enrollees between 138% and 400% of the federal poverty level so their out-of-pocket costs never exceed a defined threshold even if premiums go up. These could be on the chopping block.

“The last bill Congress passed to repeal the Affordable Care Act, which Obama vetoed, repealed the individual mandate and subsidies for people to buy insurance,” Ms. Hoffman says. “If they do repeal it, private insurance through the exchanges will crumble.”

Mr. Trump’s tax deductions to offset premium costs are based on income, making them more generous for higher-income earners than low-income ones, Hoffman adds.

And … Medicare

The other entitlement program facing abrupt change is Medicare, typically considered the third rail of American politics.

“This is the hot political moment,” Ms. Hoffman says. “This is the point where the Republicans think they can tick off their wish list. For many Republicans, this kind of entitlement program is the opposite of what they believe in.”

Though Mr. Trump has said before he would not alter Medicare, he remained quiet on this point in the aftermath of the election. Repealing the ACA would affect Medicare by potentially reopening the Part D prescription drug doughnut hole and eliminating some of the savings provisions in the law. In fact, the CBO estimates Medicare’s direct spending would increase $802 billion between 2016 and 2025.¹ Rep. Ryan has talked about privatizing Medicare by offering seniors who rely on it vouchers to apply toward private insurance.

“At the highest level, it’s moving Medicare from a defined benefit to a defined contribution program,” Ms. Hoffman says. “It shifts financial risk from the federal government onto beneficiaries. If Medicare spending continues to grow faster than the rest of the economy, Medicare beneficiaries will pay more and more.”

Seniors may also find themselves rationing or skimping on care.

Despite Rep. Ryan’s statements to the contrary, Medicare is not broken because of the ACA, Ms. Hoffman says. Its solvency has been prolonged, and though the reasons are not clear, Medicare spending has slowed since the passage of the ACA.⁶

MACRA launch

Another key factor in the health care policy landscape is MACRA, the Medicare Access and CHIP Reauthorization Act, which fundamentally shifts the way the government administrates and reimburses physicians for health care. MACRA begins in 2017. Dr. Greeno is concerned that changes to the ACA will impact the testing of payment models CMS is testing.

“There are hundreds of hospitals and thousands of physicians already invested in different models, so I don’t expect anybody has any desire to pull the rug from under physicians who are testing alternative payment models [APMs],” he says. “MACRA was passed on a strong bipartisan vote, and it created an APM track. Obviously, Congress intended APM models to continue to expand.”

Dr. Greeno says hospitalists are helping “shape these models,” working with the CMS and the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “to ensure physicians participate in APMs and feel engaged rather than being a worker in a model someone else controls.”

On the campaign trail, Mr. Trump spoke of importing pharmaceuticals from overseas in an effort to control high prices. This policy is no longer part of his online plan. He also proposes allowing the sale of health insurance across state lines.

“It would be giving enrollees in states with stricter regulations the opportunity to circumvent to a looser state, which undermines the state with the stricter regulations,” Dr. Eibner says. “That would really create winners and losers. People who are healthy can buy a policy in a state with looser regulations, and their costs would likely fall. But someone sicker and older, it would be harder.”

Ms. Hoffman defines such a plan as a “race to the bottom.” Without well-established networks of physicians and hospitals, startup costs in new states are prohibitive, and many insurers may not wish to compete across state lines, she adds.

Repeal of the ACA could also limit some of the health benefits it required of plans on the individual market. For example, policymakers might be allowed to strip the contraceptive coverage regulation, which provides for free birth control.

“The reality is a lot of things changing in health care now were changing before the Affordable Care Act passed – PQRS, value-based purchasing, hospital-acquired infections,” Dr. Greeno says. “MACRA will continue the journey away from fee-for-service toward outcome-based models.”

At such a pivotal time, he strongly encourages hospitalists to join SHM if they are not already members and to get involved in SHM’s Grassroots Network.

“For a society of our age – young – and size, we’ve been tremendously impactful in helping with delivery system reform,” Dr. Greeno says. “I think it’s because we’re supporting change, not trying to stop it. We just want it to be intelligent change.”

He also is “convinced” hospitalists will be “critical to the redesign of the health care system. Since we are going to be taking care of the majority of hospitalized adult patients in hospitals, hospitalists want to have our say.” 

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Eibner C. Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. The Commonweath Fund website. Available at: http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/trump-presidential-health-care-proposal. Accessed Nov. 17, 2016.

2. Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Available at: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf. Accessed Nov. 15, 2016.

3. Our vision for a confident America. A Better Way website. Available at: http://abetterway.speaker.gov. Accessed Nov. 17, 2016.

4. Pollitz K. High-risk pools for uninsurable individuals. Kaiser Family Foundation website. Available at: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/. Accessed Nov. 17, 2016.

5. How accessible is individual health insurance for consumers in less-than-ideal health? Kaiser Family Foundation website. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf. Accessed Nov. 17, 2016.

6. The Affordable Care Act and Medicare. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act Accessed Nov. 17, 2016.

The New Year brings new leadership in the United States, with President-elect Donald Trump taking office later this month. With a Republican-controlled Congress, party leaders have the opportunity to shape the nation’s policies around conservative ideals. This includes health care.

Since the Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to repeal and replace it. This could be their opportunity.

However, “there is no clear coalescence around specific policy reforms that would replace the Affordable Care Act,” says Christine Eibner, PhD, a senior economist at Rand and a professor at the Pardee Rand Graduate School.

As a candidate, Trump did little to advance policy ideas around health care. Meanwhile, House Speaker Paul Ryan (R-Wis.) and others have, over the years, proposed reforms with which Trump may or may not agree.

Where we stand January 2017

Whether the Republicans can or will repeal the ACA in its entirety and improve it remains unknown. But, the experts say, the landmark law has left its mark on the American health care system.

“Everyone is complaining about the uncertainty created by the election, but we have been dealing with a highly uncertain environment for many years,” says Ron Greeno, MD, FCCP, MHM, senior advisor for medical affairs at TeamHealth, chair of the SHM Public Policy Committee, and SHM president-elect. “There will be changes, but things were going to change no matter the outcome of the election. It continues to require tolerance for change and tolerance for uncertainty.”

In an analysis for the Commonwealth Fund, Dr. Eibner investigated the economic implications of aspects of Trump’s plans as a candidate. Using a computer model that incorporates economic theory and data to simulate the effects of health policy changes, Dr. Eibner found that Trump’s plans (full repeal alone or repeal with tax deductions for health care premiums, Medicaid block grants, or selling health insurance across state lines) would increase the number of uninsured people by 16 million to 25 million, disproportionately impact low-income and sicker patients, expose individual market enrollees to higher out-of-pocket costs, and increase the federal deficit by $0.5 billion to $41 billion.¹ The Congressional Budget Office (CBO) estimates full repeal could increase the federal deficit by $137 billion to $353 billion by 2025.² Rep. Ryan’s plan, A Better Way, proposes providing people more control over their health care, giving tax credits instead of subsidies for premiums, capping the employer-sponsored health insurance tax exclusion, and expanding use of health savings accounts.³ However, Rep. Ryan’s plan “doesn’t reduce the cost of health care. It puts more onus on individuals, and their costs go up,” Ms. Hoffman says. “The weight of that will be more on people who have preexisting conditions.”

Key provisions: A delicate balance

Many people equate the ACA with the individual mandate, which requires nearly all Americans to purchase health insurance or pay a fine. The federal government provides subsidies to enrollees between 138% and 400% of the federal poverty level so their out-of-pocket costs never exceed a defined threshold even if premiums go up. These could be on the chopping block.

“The last bill Congress passed to repeal the Affordable Care Act, which Obama vetoed, repealed the individual mandate and subsidies for people to buy insurance,” Ms. Hoffman says. “If they do repeal it, private insurance through the exchanges will crumble.”

Mr. Trump’s tax deductions to offset premium costs are based on income, making them more generous for higher-income earners than low-income ones, Hoffman adds.

And … Medicare

The other entitlement program facing abrupt change is Medicare, typically considered the third rail of American politics.

“This is the hot political moment,” Ms. Hoffman says. “This is the point where the Republicans think they can tick off their wish list. For many Republicans, this kind of entitlement program is the opposite of what they believe in.”

Though Mr. Trump has said before he would not alter Medicare, he remained quiet on this point in the aftermath of the election. Repealing the ACA would affect Medicare by potentially reopening the Part D prescription drug doughnut hole and eliminating some of the savings provisions in the law. In fact, the CBO estimates Medicare’s direct spending would increase $802 billion between 2016 and 2025.¹ Rep. Ryan has talked about privatizing Medicare by offering seniors who rely on it vouchers to apply toward private insurance.

“At the highest level, it’s moving Medicare from a defined benefit to a defined contribution program,” Ms. Hoffman says. “It shifts financial risk from the federal government onto beneficiaries. If Medicare spending continues to grow faster than the rest of the economy, Medicare beneficiaries will pay more and more.”

Seniors may also find themselves rationing or skimping on care.

Despite Rep. Ryan’s statements to the contrary, Medicare is not broken because of the ACA, Ms. Hoffman says. Its solvency has been prolonged, and though the reasons are not clear, Medicare spending has slowed since the passage of the ACA.⁶

MACRA launch

Another key factor in the health care policy landscape is MACRA, the Medicare Access and CHIP Reauthorization Act, which fundamentally shifts the way the government administrates and reimburses physicians for health care. MACRA begins in 2017. Dr. Greeno is concerned that changes to the ACA will impact the testing of payment models CMS is testing.

“There are hundreds of hospitals and thousands of physicians already invested in different models, so I don’t expect anybody has any desire to pull the rug from under physicians who are testing alternative payment models [APMs],” he says. “MACRA was passed on a strong bipartisan vote, and it created an APM track. Obviously, Congress intended APM models to continue to expand.”

Dr. Greeno says hospitalists are helping “shape these models,” working with the CMS and the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “to ensure physicians participate in APMs and feel engaged rather than being a worker in a model someone else controls.”

On the campaign trail, Mr. Trump spoke of importing pharmaceuticals from overseas in an effort to control high prices. This policy is no longer part of his online plan. He also proposes allowing the sale of health insurance across state lines.

“It would be giving enrollees in states with stricter regulations the opportunity to circumvent to a looser state, which undermines the state with the stricter regulations,” Dr. Eibner says. “That would really create winners and losers. People who are healthy can buy a policy in a state with looser regulations, and their costs would likely fall. But someone sicker and older, it would be harder.”

Ms. Hoffman defines such a plan as a “race to the bottom.” Without well-established networks of physicians and hospitals, startup costs in new states are prohibitive, and many insurers may not wish to compete across state lines, she adds.

Repeal of the ACA could also limit some of the health benefits it required of plans on the individual market. For example, policymakers might be allowed to strip the contraceptive coverage regulation, which provides for free birth control.

“The reality is a lot of things changing in health care now were changing before the Affordable Care Act passed – PQRS, value-based purchasing, hospital-acquired infections,” Dr. Greeno says. “MACRA will continue the journey away from fee-for-service toward outcome-based models.”

At such a pivotal time, he strongly encourages hospitalists to join SHM if they are not already members and to get involved in SHM’s Grassroots Network.

“For a society of our age – young – and size, we’ve been tremendously impactful in helping with delivery system reform,” Dr. Greeno says. “I think it’s because we’re supporting change, not trying to stop it. We just want it to be intelligent change.”

He also is “convinced” hospitalists will be “critical to the redesign of the health care system. Since we are going to be taking care of the majority of hospitalized adult patients in hospitals, hospitalists want to have our say.” 

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Eibner C. Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. The Commonweath Fund website. Available at: http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/trump-presidential-health-care-proposal. Accessed Nov. 17, 2016.

2. Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Available at: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf. Accessed Nov. 15, 2016.

3. Our vision for a confident America. A Better Way website. Available at: http://abetterway.speaker.gov. Accessed Nov. 17, 2016.

4. Pollitz K. High-risk pools for uninsurable individuals. Kaiser Family Foundation website. Available at: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/. Accessed Nov. 17, 2016.

5. How accessible is individual health insurance for consumers in less-than-ideal health? Kaiser Family Foundation website. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf. Accessed Nov. 17, 2016.

6. The Affordable Care Act and Medicare. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act Accessed Nov. 17, 2016.

The New Year brings new leadership in the United States, with President-elect Donald Trump taking office later this month. With a Republican-controlled Congress, party leaders have the opportunity to shape the nation’s policies around conservative ideals. This includes health care.

Since the Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to repeal and replace it. This could be their opportunity.

However, “there is no clear coalescence around specific policy reforms that would replace the Affordable Care Act,” says Christine Eibner, PhD, a senior economist at Rand and a professor at the Pardee Rand Graduate School.

As a candidate, Trump did little to advance policy ideas around health care. Meanwhile, House Speaker Paul Ryan (R-Wis.) and others have, over the years, proposed reforms with which Trump may or may not agree.

Where we stand January 2017

Whether the Republicans can or will repeal the ACA in its entirety and improve it remains unknown. But, the experts say, the landmark law has left its mark on the American health care system.

“Everyone is complaining about the uncertainty created by the election, but we have been dealing with a highly uncertain environment for many years,” says Ron Greeno, MD, FCCP, MHM, senior advisor for medical affairs at TeamHealth, chair of the SHM Public Policy Committee, and SHM president-elect. “There will be changes, but things were going to change no matter the outcome of the election. It continues to require tolerance for change and tolerance for uncertainty.”

In an analysis for the Commonwealth Fund, Dr. Eibner investigated the economic implications of aspects of Trump’s plans as a candidate. Using a computer model that incorporates economic theory and data to simulate the effects of health policy changes, Dr. Eibner found that Trump’s plans (full repeal alone or repeal with tax deductions for health care premiums, Medicaid block grants, or selling health insurance across state lines) would increase the number of uninsured people by 16 million to 25 million, disproportionately impact low-income and sicker patients, expose individual market enrollees to higher out-of-pocket costs, and increase the federal deficit by $0.5 billion to $41 billion.¹ The Congressional Budget Office (CBO) estimates full repeal could increase the federal deficit by $137 billion to $353 billion by 2025.² Rep. Ryan’s plan, A Better Way, proposes providing people more control over their health care, giving tax credits instead of subsidies for premiums, capping the employer-sponsored health insurance tax exclusion, and expanding use of health savings accounts.³ However, Rep. Ryan’s plan “doesn’t reduce the cost of health care. It puts more onus on individuals, and their costs go up,” Ms. Hoffman says. “The weight of that will be more on people who have preexisting conditions.”

Key provisions: A delicate balance

Many people equate the ACA with the individual mandate, which requires nearly all Americans to purchase health insurance or pay a fine. The federal government provides subsidies to enrollees between 138% and 400% of the federal poverty level so their out-of-pocket costs never exceed a defined threshold even if premiums go up. These could be on the chopping block.

“The last bill Congress passed to repeal the Affordable Care Act, which Obama vetoed, repealed the individual mandate and subsidies for people to buy insurance,” Ms. Hoffman says. “If they do repeal it, private insurance through the exchanges will crumble.”

Mr. Trump’s tax deductions to offset premium costs are based on income, making them more generous for higher-income earners than low-income ones, Hoffman adds.

And … Medicare

The other entitlement program facing abrupt change is Medicare, typically considered the third rail of American politics.

“This is the hot political moment,” Ms. Hoffman says. “This is the point where the Republicans think they can tick off their wish list. For many Republicans, this kind of entitlement program is the opposite of what they believe in.”

Though Mr. Trump has said before he would not alter Medicare, he remained quiet on this point in the aftermath of the election. Repealing the ACA would affect Medicare by potentially reopening the Part D prescription drug doughnut hole and eliminating some of the savings provisions in the law. In fact, the CBO estimates Medicare’s direct spending would increase $802 billion between 2016 and 2025.¹ Rep. Ryan has talked about privatizing Medicare by offering seniors who rely on it vouchers to apply toward private insurance.

“At the highest level, it’s moving Medicare from a defined benefit to a defined contribution program,” Ms. Hoffman says. “It shifts financial risk from the federal government onto beneficiaries. If Medicare spending continues to grow faster than the rest of the economy, Medicare beneficiaries will pay more and more.”

Seniors may also find themselves rationing or skimping on care.

Despite Rep. Ryan’s statements to the contrary, Medicare is not broken because of the ACA, Ms. Hoffman says. Its solvency has been prolonged, and though the reasons are not clear, Medicare spending has slowed since the passage of the ACA.⁶

MACRA launch

Another key factor in the health care policy landscape is MACRA, the Medicare Access and CHIP Reauthorization Act, which fundamentally shifts the way the government administrates and reimburses physicians for health care. MACRA begins in 2017. Dr. Greeno is concerned that changes to the ACA will impact the testing of payment models CMS is testing.

“There are hundreds of hospitals and thousands of physicians already invested in different models, so I don’t expect anybody has any desire to pull the rug from under physicians who are testing alternative payment models [APMs],” he says. “MACRA was passed on a strong bipartisan vote, and it created an APM track. Obviously, Congress intended APM models to continue to expand.”

Dr. Greeno says hospitalists are helping “shape these models,” working with the CMS and the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “to ensure physicians participate in APMs and feel engaged rather than being a worker in a model someone else controls.”

On the campaign trail, Mr. Trump spoke of importing pharmaceuticals from overseas in an effort to control high prices. This policy is no longer part of his online plan. He also proposes allowing the sale of health insurance across state lines.

“It would be giving enrollees in states with stricter regulations the opportunity to circumvent to a looser state, which undermines the state with the stricter regulations,” Dr. Eibner says. “That would really create winners and losers. People who are healthy can buy a policy in a state with looser regulations, and their costs would likely fall. But someone sicker and older, it would be harder.”

Ms. Hoffman defines such a plan as a “race to the bottom.” Without well-established networks of physicians and hospitals, startup costs in new states are prohibitive, and many insurers may not wish to compete across state lines, she adds.

Repeal of the ACA could also limit some of the health benefits it required of plans on the individual market. For example, policymakers might be allowed to strip the contraceptive coverage regulation, which provides for free birth control.

“The reality is a lot of things changing in health care now were changing before the Affordable Care Act passed – PQRS, value-based purchasing, hospital-acquired infections,” Dr. Greeno says. “MACRA will continue the journey away from fee-for-service toward outcome-based models.”

At such a pivotal time, he strongly encourages hospitalists to join SHM if they are not already members and to get involved in SHM’s Grassroots Network.

“For a society of our age – young – and size, we’ve been tremendously impactful in helping with delivery system reform,” Dr. Greeno says. “I think it’s because we’re supporting change, not trying to stop it. We just want it to be intelligent change.”

He also is “convinced” hospitalists will be “critical to the redesign of the health care system. Since we are going to be taking care of the majority of hospitalized adult patients in hospitals, hospitalists want to have our say.” 

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Eibner C. Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. The Commonweath Fund website. Available at: http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/trump-presidential-health-care-proposal. Accessed Nov. 17, 2016.

2. Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Available at: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf. Accessed Nov. 15, 2016.

3. Our vision for a confident America. A Better Way website. Available at: http://abetterway.speaker.gov. Accessed Nov. 17, 2016.

4. Pollitz K. High-risk pools for uninsurable individuals. Kaiser Family Foundation website. Available at: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/. Accessed Nov. 17, 2016.

5. How accessible is individual health insurance for consumers in less-than-ideal health? Kaiser Family Foundation website. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf. Accessed Nov. 17, 2016.

6. The Affordable Care Act and Medicare. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act Accessed Nov. 17, 2016.

Over the last 2 decades, the number of teen females involved in competitive sports has skyrocketed. Research studies continue to show that girls involved in sports have better self-esteem and reduce the risk of obesity.But this involvement in competitive sports has not come without a cost. Recent studies have shown that females are four to six times more likely to tear their anterior cruciate ligament (ACL) than are their male counterparts playing the same sport.^1,2 But why is this? And can it be prevented?

Researchers have spent countless hours studying videos to better determine why females are at greater risk. Their findings showed that there were many contributing factors for the difference between the sexes. The general mechanics that put the ACL at risk are landing on an extended knee, the center of mass being off the base, and internal rotation and adduction of the knee. These combined movements put the ACL at its most vulnerable position.

Reference

1. Pediatrics. 2014 May;133(5):e1437-50

2. Bull Hosp Jt Dis. 2000;59(4):217-26

3. Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1060-6

4. Am J Phys Med Rehabil. 2005 Feb;84(2):122-30

5. Am J Sports Med. 2008 Aug;36(8):1476-83

6. Curr Womens Health Rep. 2001 Dec;1(3):218-24

Dr. Pearce is a pediatrician in Frankfort, Ill. Email her at [email protected].

Over the last 2 decades, the number of teen females involved in competitive sports has skyrocketed. Research studies continue to show that girls involved in sports have better self-esteem and reduce the risk of obesity.But this involvement in competitive sports has not come without a cost. Recent studies have shown that females are four to six times more likely to tear their anterior cruciate ligament (ACL) than are their male counterparts playing the same sport.^1,2 But why is this? And can it be prevented?

Researchers have spent countless hours studying videos to better determine why females are at greater risk. Their findings showed that there were many contributing factors for the difference between the sexes. The general mechanics that put the ACL at risk are landing on an extended knee, the center of mass being off the base, and internal rotation and adduction of the knee. These combined movements put the ACL at its most vulnerable position.

Reference

1. Pediatrics. 2014 May;133(5):e1437-50

2. Bull Hosp Jt Dis. 2000;59(4):217-26

3. Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1060-6

4. Am J Phys Med Rehabil. 2005 Feb;84(2):122-30

5. Am J Sports Med. 2008 Aug;36(8):1476-83

6. Curr Womens Health Rep. 2001 Dec;1(3):218-24

Dr. Pearce is a pediatrician in Frankfort, Ill. Email her at [email protected].

Over the last 2 decades, the number of teen females involved in competitive sports has skyrocketed. Research studies continue to show that girls involved in sports have better self-esteem and reduce the risk of obesity.But this involvement in competitive sports has not come without a cost. Recent studies have shown that females are four to six times more likely to tear their anterior cruciate ligament (ACL) than are their male counterparts playing the same sport.^1,2 But why is this? And can it be prevented?

Researchers have spent countless hours studying videos to better determine why females are at greater risk. Their findings showed that there were many contributing factors for the difference between the sexes. The general mechanics that put the ACL at risk are landing on an extended knee, the center of mass being off the base, and internal rotation and adduction of the knee. These combined movements put the ACL at its most vulnerable position.

Reference

1. Pediatrics. 2014 May;133(5):e1437-50

2. Bull Hosp Jt Dis. 2000;59(4):217-26

3. Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1060-6

4. Am J Phys Med Rehabil. 2005 Feb;84(2):122-30

5. Am J Sports Med. 2008 Aug;36(8):1476-83

6. Curr Womens Health Rep. 2001 Dec;1(3):218-24

Dr. Pearce is a pediatrician in Frankfort, Ill. Email her at [email protected].

NEW ORLEANS – Depression increases the risk of stroke in patients with atrial fibrillation, Bruno B. Lima, MD, reported at the American Heart Association scientific sessions.

This novel finding from what’s believed to be the first prospective observational study to examine the association between depression and stroke risk in patients with atrial fibrillation (AF) raises the exciting possibility that systematic screening for depression and provision of effective antidepressant therapy in affected AF patients could reduce their risk of stroke. But clinical trials will be necessary to answer that question, noted Dr. Lima of the University of Pittsburgh.

[email protected]

NEW ORLEANS – Depression increases the risk of stroke in patients with atrial fibrillation, Bruno B. Lima, MD, reported at the American Heart Association scientific sessions.

This novel finding from what’s believed to be the first prospective observational study to examine the association between depression and stroke risk in patients with atrial fibrillation (AF) raises the exciting possibility that systematic screening for depression and provision of effective antidepressant therapy in affected AF patients could reduce their risk of stroke. But clinical trials will be necessary to answer that question, noted Dr. Lima of the University of Pittsburgh.

[email protected]

NEW ORLEANS – Depression increases the risk of stroke in patients with atrial fibrillation, Bruno B. Lima, MD, reported at the American Heart Association scientific sessions.

This novel finding from what’s believed to be the first prospective observational study to examine the association between depression and stroke risk in patients with atrial fibrillation (AF) raises the exciting possibility that systematic screening for depression and provision of effective antidepressant therapy in affected AF patients could reduce their risk of stroke. But clinical trials will be necessary to answer that question, noted Dr. Lima of the University of Pittsburgh.

[email protected]

NEW ORLEANS – Results of a first-of-its-kind nationwide U.K. cardiac disease screening program in the general population of teens and young adults indicate that incorporating a 12-lead ECG alongside history and physical examination not only increases the diagnostic yield for conditions predisposing to sudden cardiac death, but it’s actually cost saving, compared with screening by history and physical exam alone, Harshil Dhutia, MD, said at the American Heart Association scientific sessions.

Current practice in the United Kingdom and most other western countries, including the United States, is to screen for cardiac disease in the general population of young people by history and physical exam alone. Only those with symptoms or a positive family history on the initial screen go on to a more comprehensive evaluation including an ECG. The ECG isn’t part of the initial screen primarily because of cost concerns. However, those concerns are based upon conjecture. The diagnostic and financial implications of routine screening by 12-lead ECG in the general population of young people hadn’t been examined prior to the nationwide U.K. screening program – and the results of the U.K. project indicate it’s time for a change in policy, according to Dr. Dhutia, a cardiology research fellow at St. George’s University in London.

The screening project, known as the Cardiac Risk in the Young Program, included 26,900 subjects aged 14-35 years without known cardiovascular disease who responded to public service announcements and voluntarily presented for screening at schools, community centers, and health centers across the U.K. during 2011-2013. The mean age of the subjects was 19.4 years, roughly two-thirds were male, and 90% were white. All screening was performed by cardiologists who followed the AHA protocol for history-taking, performed the physical exam, and followed the European Society of Cardiology 2010 recommendations for ECG interpretation. Individuals with a positive screen were referred to their local hospital for further investigation. Participants were prospectively followed for 2 years.

“This was the first study of comprehensive cardiovascular screening of young individuals outside competitive sport,” Dr. Dhutia noted.

Among the key findings: 3.5% of subjects were deemed by their screening cardiologist to have an abnormal history and/or physical exam warranting further investigation, 8.1% had an abnormal 12-lead ECG, and 0.5% had both. Overall, 11.7% of subjects underwent echocardiography to confirm or refute a diagnosis of cardiac disease, 1.7% underwent Holter monitoring, 1.7% had an exercise stress test, and 0.9% underwent cardiac MRI.

At 2 years of follow-up, 87 individuals, or 0.3% of the overall study cohort, had been diagnosed with a serious cardiac disease predisposing to sudden cardiac death.

“The vast majority of these individuals were asymptomatic and diagnosed on the basis of an ECG abnormality,” Dr. Dhutia observed.

Indeed, 72 of the 87 patients with serious cardiac disease were diagnosed on the basis on their abnormal ECG. This tool proved particularly helpful in identifying individuals with cardiomyopathies or congenital accessory pathways, such as Wolff-Parkinson-White syndrome or long QT syndrome. At 2 years of follow-up, 42 of these 72 patients were on disease-modifying therapies beyond lifestyle interventions, most commonly ablation procedures or antiarrhythmic medication.

The history and physical exam was useful in identifying young people with channelopathies or Marfan syndrome. Roughly half of individuals identified by history and physical exam as having serious cardiac disease were on antiarrhythmic medication – or, less commonly, pacemaker therapy – at 2 years follow-up.

The overall cost per individual screened using history, physical exam, and ECG amounted to $110 on the basis of U.K. National Health Service rates. The cost per serious cardiac condition identified was $33,927. In contrast, the average cost per serious cardiac diagnosis under the current U.K. protocol of screening youth by history and physical exam only is 67% greater, at $56,597.

“Inclusion of ECG to history and physical examination is associated with a significantly improved diagnostic yield and superior economic profile. These findings have the potential to influence health care policy and certainly suggest that the National Health Service framework in the United Kingdom is counterintuitive and may warrant revision,” he concluded.

Session moderator Nisha Parikh, MD, of the University of California, San Francisco, asked if Dr. Dhutia and his coinvestigators had identified any characteristics associated with serious occult cardiac disease in adolescents and young adults that would permit a more refined, selective approach to screening.

Not in the general population of nearly 27,000 subjects in the U.K. study, he replied. Competitive athletes are a different story, though.

“In competitive athletes, certainly individuals who play stop/start sports such as basketball or football [soccer], appear to be at higher risk, especially those of Afro-Caribbean origin. The incidence of sudden cardiac death in Afro-Caribbean basketball players is 1 in 3,000,” according to Dr. Dhutia, who discussed his findings in a video interview.

He reported receiving a small research grant for his study from the Cardiac Risk in the Young Program, a U.K. charitable organization.

[email protected]
 

NEW ORLEANS – Results of a first-of-its-kind nationwide U.K. cardiac disease screening program in the general population of teens and young adults indicate that incorporating a 12-lead ECG alongside history and physical examination not only increases the diagnostic yield for conditions predisposing to sudden cardiac death, but it’s actually cost saving, compared with screening by history and physical exam alone, Harshil Dhutia, MD, said at the American Heart Association scientific sessions.

Current practice in the United Kingdom and most other western countries, including the United States, is to screen for cardiac disease in the general population of young people by history and physical exam alone. Only those with symptoms or a positive family history on the initial screen go on to a more comprehensive evaluation including an ECG. The ECG isn’t part of the initial screen primarily because of cost concerns. However, those concerns are based upon conjecture. The diagnostic and financial implications of routine screening by 12-lead ECG in the general population of young people hadn’t been examined prior to the nationwide U.K. screening program – and the results of the U.K. project indicate it’s time for a change in policy, according to Dr. Dhutia, a cardiology research fellow at St. George’s University in London.

The screening project, known as the Cardiac Risk in the Young Program, included 26,900 subjects aged 14-35 years without known cardiovascular disease who responded to public service announcements and voluntarily presented for screening at schools, community centers, and health centers across the U.K. during 2011-2013. The mean age of the subjects was 19.4 years, roughly two-thirds were male, and 90% were white. All screening was performed by cardiologists who followed the AHA protocol for history-taking, performed the physical exam, and followed the European Society of Cardiology 2010 recommendations for ECG interpretation. Individuals with a positive screen were referred to their local hospital for further investigation. Participants were prospectively followed for 2 years.

“This was the first study of comprehensive cardiovascular screening of young individuals outside competitive sport,” Dr. Dhutia noted.

Among the key findings: 3.5% of subjects were deemed by their screening cardiologist to have an abnormal history and/or physical exam warranting further investigation, 8.1% had an abnormal 12-lead ECG, and 0.5% had both. Overall, 11.7% of subjects underwent echocardiography to confirm or refute a diagnosis of cardiac disease, 1.7% underwent Holter monitoring, 1.7% had an exercise stress test, and 0.9% underwent cardiac MRI.

At 2 years of follow-up, 87 individuals, or 0.3% of the overall study cohort, had been diagnosed with a serious cardiac disease predisposing to sudden cardiac death.

“The vast majority of these individuals were asymptomatic and diagnosed on the basis of an ECG abnormality,” Dr. Dhutia observed.

Indeed, 72 of the 87 patients with serious cardiac disease were diagnosed on the basis on their abnormal ECG. This tool proved particularly helpful in identifying individuals with cardiomyopathies or congenital accessory pathways, such as Wolff-Parkinson-White syndrome or long QT syndrome. At 2 years of follow-up, 42 of these 72 patients were on disease-modifying therapies beyond lifestyle interventions, most commonly ablation procedures or antiarrhythmic medication.

The history and physical exam was useful in identifying young people with channelopathies or Marfan syndrome. Roughly half of individuals identified by history and physical exam as having serious cardiac disease were on antiarrhythmic medication – or, less commonly, pacemaker therapy – at 2 years follow-up.

The overall cost per individual screened using history, physical exam, and ECG amounted to $110 on the basis of U.K. National Health Service rates. The cost per serious cardiac condition identified was $33,927. In contrast, the average cost per serious cardiac diagnosis under the current U.K. protocol of screening youth by history and physical exam only is 67% greater, at $56,597.

“Inclusion of ECG to history and physical examination is associated with a significantly improved diagnostic yield and superior economic profile. These findings have the potential to influence health care policy and certainly suggest that the National Health Service framework in the United Kingdom is counterintuitive and may warrant revision,” he concluded.

Session moderator Nisha Parikh, MD, of the University of California, San Francisco, asked if Dr. Dhutia and his coinvestigators had identified any characteristics associated with serious occult cardiac disease in adolescents and young adults that would permit a more refined, selective approach to screening.

Not in the general population of nearly 27,000 subjects in the U.K. study, he replied. Competitive athletes are a different story, though.

“In competitive athletes, certainly individuals who play stop/start sports such as basketball or football [soccer], appear to be at higher risk, especially those of Afro-Caribbean origin. The incidence of sudden cardiac death in Afro-Caribbean basketball players is 1 in 3,000,” according to Dr. Dhutia, who discussed his findings in a video interview.

He reported receiving a small research grant for his study from the Cardiac Risk in the Young Program, a U.K. charitable organization.

[email protected]
 

NEW ORLEANS – Results of a first-of-its-kind nationwide U.K. cardiac disease screening program in the general population of teens and young adults indicate that incorporating a 12-lead ECG alongside history and physical examination not only increases the diagnostic yield for conditions predisposing to sudden cardiac death, but it’s actually cost saving, compared with screening by history and physical exam alone, Harshil Dhutia, MD, said at the American Heart Association scientific sessions.

Current practice in the United Kingdom and most other western countries, including the United States, is to screen for cardiac disease in the general population of young people by history and physical exam alone. Only those with symptoms or a positive family history on the initial screen go on to a more comprehensive evaluation including an ECG. The ECG isn’t part of the initial screen primarily because of cost concerns. However, those concerns are based upon conjecture. The diagnostic and financial implications of routine screening by 12-lead ECG in the general population of young people hadn’t been examined prior to the nationwide U.K. screening program – and the results of the U.K. project indicate it’s time for a change in policy, according to Dr. Dhutia, a cardiology research fellow at St. George’s University in London.

The screening project, known as the Cardiac Risk in the Young Program, included 26,900 subjects aged 14-35 years without known cardiovascular disease who responded to public service announcements and voluntarily presented for screening at schools, community centers, and health centers across the U.K. during 2011-2013. The mean age of the subjects was 19.4 years, roughly two-thirds were male, and 90% were white. All screening was performed by cardiologists who followed the AHA protocol for history-taking, performed the physical exam, and followed the European Society of Cardiology 2010 recommendations for ECG interpretation. Individuals with a positive screen were referred to their local hospital for further investigation. Participants were prospectively followed for 2 years.

“This was the first study of comprehensive cardiovascular screening of young individuals outside competitive sport,” Dr. Dhutia noted.

Among the key findings: 3.5% of subjects were deemed by their screening cardiologist to have an abnormal history and/or physical exam warranting further investigation, 8.1% had an abnormal 12-lead ECG, and 0.5% had both. Overall, 11.7% of subjects underwent echocardiography to confirm or refute a diagnosis of cardiac disease, 1.7% underwent Holter monitoring, 1.7% had an exercise stress test, and 0.9% underwent cardiac MRI.

At 2 years of follow-up, 87 individuals, or 0.3% of the overall study cohort, had been diagnosed with a serious cardiac disease predisposing to sudden cardiac death.

“The vast majority of these individuals were asymptomatic and diagnosed on the basis of an ECG abnormality,” Dr. Dhutia observed.

Indeed, 72 of the 87 patients with serious cardiac disease were diagnosed on the basis on their abnormal ECG. This tool proved particularly helpful in identifying individuals with cardiomyopathies or congenital accessory pathways, such as Wolff-Parkinson-White syndrome or long QT syndrome. At 2 years of follow-up, 42 of these 72 patients were on disease-modifying therapies beyond lifestyle interventions, most commonly ablation procedures or antiarrhythmic medication.

The history and physical exam was useful in identifying young people with channelopathies or Marfan syndrome. Roughly half of individuals identified by history and physical exam as having serious cardiac disease were on antiarrhythmic medication – or, less commonly, pacemaker therapy – at 2 years follow-up.

The overall cost per individual screened using history, physical exam, and ECG amounted to $110 on the basis of U.K. National Health Service rates. The cost per serious cardiac condition identified was $33,927. In contrast, the average cost per serious cardiac diagnosis under the current U.K. protocol of screening youth by history and physical exam only is 67% greater, at $56,597.

“Inclusion of ECG to history and physical examination is associated with a significantly improved diagnostic yield and superior economic profile. These findings have the potential to influence health care policy and certainly suggest that the National Health Service framework in the United Kingdom is counterintuitive and may warrant revision,” he concluded.

Session moderator Nisha Parikh, MD, of the University of California, San Francisco, asked if Dr. Dhutia and his coinvestigators had identified any characteristics associated with serious occult cardiac disease in adolescents and young adults that would permit a more refined, selective approach to screening.

Not in the general population of nearly 27,000 subjects in the U.K. study, he replied. Competitive athletes are a different story, though.

“In competitive athletes, certainly individuals who play stop/start sports such as basketball or football [soccer], appear to be at higher risk, especially those of Afro-Caribbean origin. The incidence of sudden cardiac death in Afro-Caribbean basketball players is 1 in 3,000,” according to Dr. Dhutia, who discussed his findings in a video interview.

He reported receiving a small research grant for his study from the Cardiac Risk in the Young Program, a U.K. charitable organization.

[email protected]