NEW YORK (Reuters Health) - Higher-volume hospitals do better in treatment of obstructive hypertrophic cardiomyopathy (HCM), but more efforts are needed to direct patients to these centers, according to New York-based researchers.

In an April 27 online paper in JAMA Cardiology, they note that recommendations are that the treatments, septal myectomy (SM) and alcohol septal ablation (ASA), be performed only by experienced operators with dedicated HCM clinical programs.

"Our study demonstrates that a significant number of cases of septal myectomy and alcohol septal ablation are not being performed at centers of excellence despite the guideline," Dr. Luke K. Kim, of Weill Cornell Medical College, told Reuters Health by email.

Dr. Kim and colleagues investigated compliance and its influence on outcome by examining nationwide data from 2003 to 2009 on 6,386 patients who underwent SM and 4,862 who had ASA. During this period almost 60% of institutions performed 10 or fewer SM procedures. The corresponding proportion for ASAs was 67%.

The incidence of in-hospital death after SM was significantly lower in hospitals in the highest volume tertile (3.8%) than those in the middle (9.6%) and lowest tertiles (15.6%). Corresponding proportions for ASA were 0.6%, 0.8% and 2.3%. There was a similar pattern for acute renal failure after ASA (2.4%, 7.6% and 6.2%).

After adjustment, being in the lowest tertile of SM volume was an independent predictor of in-hospital all-cause mortality (odds ratio, 3.11) and bleeding (OR, 3.77). However, being in the lowest volume for ASA was not independently associated with an increased risk of adverse post-procedural events.

In addition, hospitalization at a high-volume center was associated with a shorter stay and lower costs for both procedures.

However, over the study period, wrote the investigators, "Most centers that provide septal reduction therapy performed few SM and ASA procedures" and were "below the threshold recommended."

In particular, they concluded "Low SM volume was associated with worse outcomes, including higher mortality, longer length of stay, and higher costs. More efforts are needed to encourage referral of patients to centers of excellence for septal reduction therapy."

Commenting on the findings by email, Dr. Steve R. Ommen, coauthor of an accompanying invited opinion, told Reuters Health that "patients deserve to be offered the best care and outcomes possible and that appears to be possible only at centers with focused expertise in the management of HCM. Simply being a high-volume facility does not translate into achieving the safety nor the success observed at expert centers."

Dr. Ommen of the Mayo Clinic, Rochester, Minnesota, added that "Success takes a comprehensive understanding of the underlying HCM disease process. That is really the main take-home message from my point of view."

The other really astonishing finding," he concluded, "was that the median number of procedures performed was only one per year per hospital in the study."

The Michael Wolk Heart Foundation and the New York Cardiac Center supported this research. Two coauthors reported disclosures.

NEW YORK (Reuters Health) - Higher-volume hospitals do better in treatment of obstructive hypertrophic cardiomyopathy (HCM), but more efforts are needed to direct patients to these centers, according to New York-based researchers.

In an April 27 online paper in JAMA Cardiology, they note that recommendations are that the treatments, septal myectomy (SM) and alcohol septal ablation (ASA), be performed only by experienced operators with dedicated HCM clinical programs.

"Our study demonstrates that a significant number of cases of septal myectomy and alcohol septal ablation are not being performed at centers of excellence despite the guideline," Dr. Luke K. Kim, of Weill Cornell Medical College, told Reuters Health by email.

Dr. Kim and colleagues investigated compliance and its influence on outcome by examining nationwide data from 2003 to 2009 on 6,386 patients who underwent SM and 4,862 who had ASA. During this period almost 60% of institutions performed 10 or fewer SM procedures. The corresponding proportion for ASAs was 67%.

The incidence of in-hospital death after SM was significantly lower in hospitals in the highest volume tertile (3.8%) than those in the middle (9.6%) and lowest tertiles (15.6%). Corresponding proportions for ASA were 0.6%, 0.8% and 2.3%. There was a similar pattern for acute renal failure after ASA (2.4%, 7.6% and 6.2%).

After adjustment, being in the lowest tertile of SM volume was an independent predictor of in-hospital all-cause mortality (odds ratio, 3.11) and bleeding (OR, 3.77). However, being in the lowest volume for ASA was not independently associated with an increased risk of adverse post-procedural events.

In addition, hospitalization at a high-volume center was associated with a shorter stay and lower costs for both procedures.

However, over the study period, wrote the investigators, "Most centers that provide septal reduction therapy performed few SM and ASA procedures" and were "below the threshold recommended."

In particular, they concluded "Low SM volume was associated with worse outcomes, including higher mortality, longer length of stay, and higher costs. More efforts are needed to encourage referral of patients to centers of excellence for septal reduction therapy."

Commenting on the findings by email, Dr. Steve R. Ommen, coauthor of an accompanying invited opinion, told Reuters Health that "patients deserve to be offered the best care and outcomes possible and that appears to be possible only at centers with focused expertise in the management of HCM. Simply being a high-volume facility does not translate into achieving the safety nor the success observed at expert centers."

Dr. Ommen of the Mayo Clinic, Rochester, Minnesota, added that "Success takes a comprehensive understanding of the underlying HCM disease process. That is really the main take-home message from my point of view."

The other really astonishing finding," he concluded, "was that the median number of procedures performed was only one per year per hospital in the study."

The Michael Wolk Heart Foundation and the New York Cardiac Center supported this research. Two coauthors reported disclosures.

NEW YORK (Reuters Health) - Higher-volume hospitals do better in treatment of obstructive hypertrophic cardiomyopathy (HCM), but more efforts are needed to direct patients to these centers, according to New York-based researchers.

In an April 27 online paper in JAMA Cardiology, they note that recommendations are that the treatments, septal myectomy (SM) and alcohol septal ablation (ASA), be performed only by experienced operators with dedicated HCM clinical programs.

"Our study demonstrates that a significant number of cases of septal myectomy and alcohol septal ablation are not being performed at centers of excellence despite the guideline," Dr. Luke K. Kim, of Weill Cornell Medical College, told Reuters Health by email.

Dr. Kim and colleagues investigated compliance and its influence on outcome by examining nationwide data from 2003 to 2009 on 6,386 patients who underwent SM and 4,862 who had ASA. During this period almost 60% of institutions performed 10 or fewer SM procedures. The corresponding proportion for ASAs was 67%.

The incidence of in-hospital death after SM was significantly lower in hospitals in the highest volume tertile (3.8%) than those in the middle (9.6%) and lowest tertiles (15.6%). Corresponding proportions for ASA were 0.6%, 0.8% and 2.3%. There was a similar pattern for acute renal failure after ASA (2.4%, 7.6% and 6.2%).

After adjustment, being in the lowest tertile of SM volume was an independent predictor of in-hospital all-cause mortality (odds ratio, 3.11) and bleeding (OR, 3.77). However, being in the lowest volume for ASA was not independently associated with an increased risk of adverse post-procedural events.

In addition, hospitalization at a high-volume center was associated with a shorter stay and lower costs for both procedures.

However, over the study period, wrote the investigators, "Most centers that provide septal reduction therapy performed few SM and ASA procedures" and were "below the threshold recommended."

In particular, they concluded "Low SM volume was associated with worse outcomes, including higher mortality, longer length of stay, and higher costs. More efforts are needed to encourage referral of patients to centers of excellence for septal reduction therapy."

Commenting on the findings by email, Dr. Steve R. Ommen, coauthor of an accompanying invited opinion, told Reuters Health that "patients deserve to be offered the best care and outcomes possible and that appears to be possible only at centers with focused expertise in the management of HCM. Simply being a high-volume facility does not translate into achieving the safety nor the success observed at expert centers."

Dr. Ommen of the Mayo Clinic, Rochester, Minnesota, added that "Success takes a comprehensive understanding of the underlying HCM disease process. That is really the main take-home message from my point of view."

The other really astonishing finding," he concluded, "was that the median number of procedures performed was only one per year per hospital in the study."

The Michael Wolk Heart Foundation and the New York Cardiac Center supported this research. Two coauthors reported disclosures.

Elotuzumab (Empliciti)

Photo courtesy of

Bristol-Myers Squibb

The European Commission (EC) has approved elotuzumab (Empliciti) for use in combination with lenalidomide and dexamethasone to treat patients with multiple myeloma (MM) who have received at least one prior therapy.

Elotuzumab is an immunostimulatory antibody that specifically targets signaling lymphocyte activation molecule family member 7 (SLAMF7), a cell-surface glycoprotein expressed on myeloma cells, natural killer (NK) cells, plasma cells, and specific immune cell subsets of differentiated cells in the hematopoietic lineage.

Elotuzumab has a dual mechanism of action. It directly activates the immune system through NK cells via the SLAMF7 pathway, and it targets SLAMF7 on myeloma cells, tagging them for NK-cell-mediated destruction via antibody-dependent cellular toxicity.

Elotuzumab is the first immunostimulatory antibody approved to treat MM in the European Union.

Bristol-Myers Squibb and AbbVie are co-developing elotuzumab, with Bristol-Myers Squibb solely responsible for commercial activities.

Phase 3 trial

The EC approved elotuzumab based on data from the phase 3 ELOQUENT-2 trial, which were presented at ASCO 2015 and published in NEJM.

The trial included 646 MM patients who had received 1 to 3 prior therapies.

The patients were randomized 1:1 to receive either elotuzumab at 10 mg/kg in combination with lenalidomide and dexamethasone (len-dex) or len-dex alone in 4-week cycles until disease progression or unacceptable toxicity.

Baseline patient demographics and disease characteristics were well balanced between treatment arms.

The minimum follow-up for all study subjects was 24 months. The co-primary endpoints were progression-free survival (PFS) and overall response rate.

The overall response rate was 78.5% in the elotuzumab arm and 65.5% in the len-dex arm (P=0.0002).

The median PFS was 19.4 months in the elotuzumab arm and 14.9 months in the len-dex arm (P=0.0004). At 1 year, the PFS was 68% in the elotuzumab arm and 57% in the len-dex arm. At 2 years, the PFS was 41% and 27%, respectively.

The most common adverse events in the elotuzumab arm and len-dex arm, respectively, were fatigue (61.6% vs 51.7%), diarrhea (46.9% vs 36.0%), pyrexia (37.4% vs 24.6%), constipation (35.5% vs 27.1%), cough (34.3% vs 18.9%), peripheral neuropathy (26.7% vs 20.8%), nasopharyngitis (24.5% vs 19.2%), upper respiratory tract infection (22.6% vs 17.4%), decreased appetite (20.8% vs 12.6%), and pneumonia (20.1% vs 14.2%).

Serious adverse events occurred in 65.4% of patients in the elotuzumab arm and 56.5% in the len-dex arm. The most frequent events were pneumonia, pyrexia, respiratory tract infection, anemia, pulmonary embolism, and acute renal failure.

Elotuzumab (Empliciti)

Photo courtesy of

Bristol-Myers Squibb

The European Commission (EC) has approved elotuzumab (Empliciti) for use in combination with lenalidomide and dexamethasone to treat patients with multiple myeloma (MM) who have received at least one prior therapy.

Elotuzumab is an immunostimulatory antibody that specifically targets signaling lymphocyte activation molecule family member 7 (SLAMF7), a cell-surface glycoprotein expressed on myeloma cells, natural killer (NK) cells, plasma cells, and specific immune cell subsets of differentiated cells in the hematopoietic lineage.

Elotuzumab has a dual mechanism of action. It directly activates the immune system through NK cells via the SLAMF7 pathway, and it targets SLAMF7 on myeloma cells, tagging them for NK-cell-mediated destruction via antibody-dependent cellular toxicity.

Elotuzumab is the first immunostimulatory antibody approved to treat MM in the European Union.

Bristol-Myers Squibb and AbbVie are co-developing elotuzumab, with Bristol-Myers Squibb solely responsible for commercial activities.

Phase 3 trial

The EC approved elotuzumab based on data from the phase 3 ELOQUENT-2 trial, which were presented at ASCO 2015 and published in NEJM.

The trial included 646 MM patients who had received 1 to 3 prior therapies.

The patients were randomized 1:1 to receive either elotuzumab at 10 mg/kg in combination with lenalidomide and dexamethasone (len-dex) or len-dex alone in 4-week cycles until disease progression or unacceptable toxicity.

Baseline patient demographics and disease characteristics were well balanced between treatment arms.

The minimum follow-up for all study subjects was 24 months. The co-primary endpoints were progression-free survival (PFS) and overall response rate.

The overall response rate was 78.5% in the elotuzumab arm and 65.5% in the len-dex arm (P=0.0002).

The median PFS was 19.4 months in the elotuzumab arm and 14.9 months in the len-dex arm (P=0.0004). At 1 year, the PFS was 68% in the elotuzumab arm and 57% in the len-dex arm. At 2 years, the PFS was 41% and 27%, respectively.

The most common adverse events in the elotuzumab arm and len-dex arm, respectively, were fatigue (61.6% vs 51.7%), diarrhea (46.9% vs 36.0%), pyrexia (37.4% vs 24.6%), constipation (35.5% vs 27.1%), cough (34.3% vs 18.9%), peripheral neuropathy (26.7% vs 20.8%), nasopharyngitis (24.5% vs 19.2%), upper respiratory tract infection (22.6% vs 17.4%), decreased appetite (20.8% vs 12.6%), and pneumonia (20.1% vs 14.2%).

Serious adverse events occurred in 65.4% of patients in the elotuzumab arm and 56.5% in the len-dex arm. The most frequent events were pneumonia, pyrexia, respiratory tract infection, anemia, pulmonary embolism, and acute renal failure.

Elotuzumab (Empliciti)

Photo courtesy of

Bristol-Myers Squibb

The European Commission (EC) has approved elotuzumab (Empliciti) for use in combination with lenalidomide and dexamethasone to treat patients with multiple myeloma (MM) who have received at least one prior therapy.

Elotuzumab is an immunostimulatory antibody that specifically targets signaling lymphocyte activation molecule family member 7 (SLAMF7), a cell-surface glycoprotein expressed on myeloma cells, natural killer (NK) cells, plasma cells, and specific immune cell subsets of differentiated cells in the hematopoietic lineage.

Elotuzumab has a dual mechanism of action. It directly activates the immune system through NK cells via the SLAMF7 pathway, and it targets SLAMF7 on myeloma cells, tagging them for NK-cell-mediated destruction via antibody-dependent cellular toxicity.

Elotuzumab is the first immunostimulatory antibody approved to treat MM in the European Union.

Bristol-Myers Squibb and AbbVie are co-developing elotuzumab, with Bristol-Myers Squibb solely responsible for commercial activities.

Phase 3 trial

The EC approved elotuzumab based on data from the phase 3 ELOQUENT-2 trial, which were presented at ASCO 2015 and published in NEJM.

The trial included 646 MM patients who had received 1 to 3 prior therapies.

The patients were randomized 1:1 to receive either elotuzumab at 10 mg/kg in combination with lenalidomide and dexamethasone (len-dex) or len-dex alone in 4-week cycles until disease progression or unacceptable toxicity.

Baseline patient demographics and disease characteristics were well balanced between treatment arms.

The minimum follow-up for all study subjects was 24 months. The co-primary endpoints were progression-free survival (PFS) and overall response rate.

The overall response rate was 78.5% in the elotuzumab arm and 65.5% in the len-dex arm (P=0.0002).

The median PFS was 19.4 months in the elotuzumab arm and 14.9 months in the len-dex arm (P=0.0004). At 1 year, the PFS was 68% in the elotuzumab arm and 57% in the len-dex arm. At 2 years, the PFS was 41% and 27%, respectively.

The most common adverse events in the elotuzumab arm and len-dex arm, respectively, were fatigue (61.6% vs 51.7%), diarrhea (46.9% vs 36.0%), pyrexia (37.4% vs 24.6%), constipation (35.5% vs 27.1%), cough (34.3% vs 18.9%), peripheral neuropathy (26.7% vs 20.8%), nasopharyngitis (24.5% vs 19.2%), upper respiratory tract infection (22.6% vs 17.4%), decreased appetite (20.8% vs 12.6%), and pneumonia (20.1% vs 14.2%).

Serious adverse events occurred in 65.4% of patients in the elotuzumab arm and 56.5% in the len-dex arm. The most frequent events were pneumonia, pyrexia, respiratory tract infection, anemia, pulmonary embolism, and acute renal failure.

Micrograph showing MDS

The production of two components of hemoglobin may be out of sync in Diamond Blackfan anemia (DBA) and myelodysplastic syndromes (MDS), according to a new study.

Researchers found that, in samples from patients with DBA or MDS, ribosome dysfunction delayed globin production, while heme synthesis proceeded normally.

This disruption in heme-globin coordination led to a buildup of toxic heme that killed red blood cell (RBC) precursors.

However, treating patient samples with a compound that blocks heme synthesis increased RBC production in both DBA and MDS.

Zhantao Yang, MD, of the University of Washington in Seattle, and his colleagues reported these findings in Science Translational Medicine.

Both DBA and MDS have been linked to defects in ribosome assembly, which is critical to protein production, but how this leads to anemia remains unknown.

To find out, Dr Yang and his colleagues analyzed bone marrow cells from patients with DBA (n=3) or MDS with del(5q) (n=6).

The researchers found that globin translation proceeded slowly in these samples, but heme synthesis proceeded normally.

This resulted in insufficient globin, excess heme, and excess reactive oxygen species in early erythroid precursors and, ultimately, the death of colony-forming unit–erythroid/proerythroblast cells.

The cells that were able to rapidly export heme or slow its synthesis survived and matured into RBCs, but the other colony-forming unit–erythroid cells/early proerythroblasts died.

The researchers noted that it is not clear how excess heme induces cell death in RBC precursors, but they said it likely involves both ferroptosis and apoptosis.

Regardless of the mechanism of cell death, the team found that treating the patients’ cells with succinylacetone (10 mM), a compound that blocks heme synthesis, improved RBC production.

The treatment improved RBC production in DBA and del(5q) MDS marrow cultures by 68% to 95% (P=0.03 to 0.05). In comparison, RBC production in control marrow cultures decreased by 4% to 13%.

The researchers said their experiments revealed additional important findings. First, they found that erythroid differentiation in the marrow cultures “excellently” phenocopied erythroid differentiation in vivo. This suggests these cultures can serve as a reliable platform in preclinical studies.

Second, the team said the fact that epigenetic differences between RBC precursors can lead to their preferential death or survival has broad implications. And querying the cells that preferentially survive could provide important insights.

Micrograph showing MDS

The production of two components of hemoglobin may be out of sync in Diamond Blackfan anemia (DBA) and myelodysplastic syndromes (MDS), according to a new study.

Researchers found that, in samples from patients with DBA or MDS, ribosome dysfunction delayed globin production, while heme synthesis proceeded normally.

This disruption in heme-globin coordination led to a buildup of toxic heme that killed red blood cell (RBC) precursors.

However, treating patient samples with a compound that blocks heme synthesis increased RBC production in both DBA and MDS.

Zhantao Yang, MD, of the University of Washington in Seattle, and his colleagues reported these findings in Science Translational Medicine.

Both DBA and MDS have been linked to defects in ribosome assembly, which is critical to protein production, but how this leads to anemia remains unknown.

To find out, Dr Yang and his colleagues analyzed bone marrow cells from patients with DBA (n=3) or MDS with del(5q) (n=6).

The researchers found that globin translation proceeded slowly in these samples, but heme synthesis proceeded normally.

This resulted in insufficient globin, excess heme, and excess reactive oxygen species in early erythroid precursors and, ultimately, the death of colony-forming unit–erythroid/proerythroblast cells.

The cells that were able to rapidly export heme or slow its synthesis survived and matured into RBCs, but the other colony-forming unit–erythroid cells/early proerythroblasts died.

The researchers noted that it is not clear how excess heme induces cell death in RBC precursors, but they said it likely involves both ferroptosis and apoptosis.

Regardless of the mechanism of cell death, the team found that treating the patients’ cells with succinylacetone (10 mM), a compound that blocks heme synthesis, improved RBC production.

The treatment improved RBC production in DBA and del(5q) MDS marrow cultures by 68% to 95% (P=0.03 to 0.05). In comparison, RBC production in control marrow cultures decreased by 4% to 13%.

The researchers said their experiments revealed additional important findings. First, they found that erythroid differentiation in the marrow cultures “excellently” phenocopied erythroid differentiation in vivo. This suggests these cultures can serve as a reliable platform in preclinical studies.

Second, the team said the fact that epigenetic differences between RBC precursors can lead to their preferential death or survival has broad implications. And querying the cells that preferentially survive could provide important insights.

Micrograph showing MDS

The production of two components of hemoglobin may be out of sync in Diamond Blackfan anemia (DBA) and myelodysplastic syndromes (MDS), according to a new study.

Researchers found that, in samples from patients with DBA or MDS, ribosome dysfunction delayed globin production, while heme synthesis proceeded normally.

This disruption in heme-globin coordination led to a buildup of toxic heme that killed red blood cell (RBC) precursors.

However, treating patient samples with a compound that blocks heme synthesis increased RBC production in both DBA and MDS.

Zhantao Yang, MD, of the University of Washington in Seattle, and his colleagues reported these findings in Science Translational Medicine.

Both DBA and MDS have been linked to defects in ribosome assembly, which is critical to protein production, but how this leads to anemia remains unknown.

To find out, Dr Yang and his colleagues analyzed bone marrow cells from patients with DBA (n=3) or MDS with del(5q) (n=6).

The researchers found that globin translation proceeded slowly in these samples, but heme synthesis proceeded normally.

This resulted in insufficient globin, excess heme, and excess reactive oxygen species in early erythroid precursors and, ultimately, the death of colony-forming unit–erythroid/proerythroblast cells.

The cells that were able to rapidly export heme or slow its synthesis survived and matured into RBCs, but the other colony-forming unit–erythroid cells/early proerythroblasts died.

The researchers noted that it is not clear how excess heme induces cell death in RBC precursors, but they said it likely involves both ferroptosis and apoptosis.

Regardless of the mechanism of cell death, the team found that treating the patients’ cells with succinylacetone (10 mM), a compound that blocks heme synthesis, improved RBC production.

The treatment improved RBC production in DBA and del(5q) MDS marrow cultures by 68% to 95% (P=0.03 to 0.05). In comparison, RBC production in control marrow cultures decreased by 4% to 13%.

The researchers said their experiments revealed additional important findings. First, they found that erythroid differentiation in the marrow cultures “excellently” phenocopied erythroid differentiation in vivo. This suggests these cultures can serve as a reliable platform in preclinical studies.

Second, the team said the fact that epigenetic differences between RBC precursors can lead to their preferential death or survival has broad implications. And querying the cells that preferentially survive could provide important insights.

Endothelial cells

Image courtesy of NIH

Chronic exposure to proton pump inhibitors (PPIs) accelerates biological aging in human endothelial cells, according to preclinical research.

Investigators said this finding, published in Circulation Research, supports recent epidemiological and retrospective studies that revealed associations between the long-term use of PPIs and an increased risk of heart attack, renal failure, and dementia.

“When we exposed human endothelial cells over a period of time to these PPIs, we observed accelerated aging of the cells,” said John P. Cooke, MD, PhD, of the Houston Methodist Research Institute in Texas.

“The PPIs also reduce acidity in lysosomes of the endothelial cell. The lysosomes are like cellular garbage disposals and need acid to work properly. We observed cellular garbage accumulating in the endothelial cells, which sped up the aging process.”

Dr Cooke suspects this may be the unifying mechanism that explains the increased risk of heart attack, renal failure, and dementia observed in long-term PPI users.

“These drugs do not seem to adversely affect the heart and blood vessels when taken for a few weeks,” he said. “However, we urgently need studies to assess the impact of long-term use of these drugs on vascular health in a broad patient population. We also need to consider if these drugs should be so accessible without medical supervision.”

Dr Cooke and his colleagues noted that, while PPIs like esomeprazole (Nexium) were shown to affect vascular aging, H2 blockers like ranitidine (Zantac) did not adversely affect the endothelium.

Therefore, other approaches to long-term treatment that should be considered for gastroesophageal reflux disease include H2 antagonists, lifestyle modifications, and, in severe cases, surgical approaches.

The investigators also pointed out that this study had some limitations. Although two different PPIs were tested, only one of these, esomeprazole, is commercially available.

In addition, the study did not show how PPIs actually impair the lysosome’s ability to produce enough acid to clear waste.

Finally, since this study was conducted in a laboratory setting, it did not show whether PPIs act in the same way within the human body as they do in vitro.

Endothelial cells

Image courtesy of NIH

Chronic exposure to proton pump inhibitors (PPIs) accelerates biological aging in human endothelial cells, according to preclinical research.

Investigators said this finding, published in Circulation Research, supports recent epidemiological and retrospective studies that revealed associations between the long-term use of PPIs and an increased risk of heart attack, renal failure, and dementia.

“When we exposed human endothelial cells over a period of time to these PPIs, we observed accelerated aging of the cells,” said John P. Cooke, MD, PhD, of the Houston Methodist Research Institute in Texas.

“The PPIs also reduce acidity in lysosomes of the endothelial cell. The lysosomes are like cellular garbage disposals and need acid to work properly. We observed cellular garbage accumulating in the endothelial cells, which sped up the aging process.”

Dr Cooke suspects this may be the unifying mechanism that explains the increased risk of heart attack, renal failure, and dementia observed in long-term PPI users.

“These drugs do not seem to adversely affect the heart and blood vessels when taken for a few weeks,” he said. “However, we urgently need studies to assess the impact of long-term use of these drugs on vascular health in a broad patient population. We also need to consider if these drugs should be so accessible without medical supervision.”

Dr Cooke and his colleagues noted that, while PPIs like esomeprazole (Nexium) were shown to affect vascular aging, H2 blockers like ranitidine (Zantac) did not adversely affect the endothelium.

Therefore, other approaches to long-term treatment that should be considered for gastroesophageal reflux disease include H2 antagonists, lifestyle modifications, and, in severe cases, surgical approaches.

The investigators also pointed out that this study had some limitations. Although two different PPIs were tested, only one of these, esomeprazole, is commercially available.

In addition, the study did not show how PPIs actually impair the lysosome’s ability to produce enough acid to clear waste.

Finally, since this study was conducted in a laboratory setting, it did not show whether PPIs act in the same way within the human body as they do in vitro.

Endothelial cells

Image courtesy of NIH

Chronic exposure to proton pump inhibitors (PPIs) accelerates biological aging in human endothelial cells, according to preclinical research.

Investigators said this finding, published in Circulation Research, supports recent epidemiological and retrospective studies that revealed associations between the long-term use of PPIs and an increased risk of heart attack, renal failure, and dementia.

“When we exposed human endothelial cells over a period of time to these PPIs, we observed accelerated aging of the cells,” said John P. Cooke, MD, PhD, of the Houston Methodist Research Institute in Texas.

“The PPIs also reduce acidity in lysosomes of the endothelial cell. The lysosomes are like cellular garbage disposals and need acid to work properly. We observed cellular garbage accumulating in the endothelial cells, which sped up the aging process.”

Dr Cooke suspects this may be the unifying mechanism that explains the increased risk of heart attack, renal failure, and dementia observed in long-term PPI users.

“These drugs do not seem to adversely affect the heart and blood vessels when taken for a few weeks,” he said. “However, we urgently need studies to assess the impact of long-term use of these drugs on vascular health in a broad patient population. We also need to consider if these drugs should be so accessible without medical supervision.”

Dr Cooke and his colleagues noted that, while PPIs like esomeprazole (Nexium) were shown to affect vascular aging, H2 blockers like ranitidine (Zantac) did not adversely affect the endothelium.

Therefore, other approaches to long-term treatment that should be considered for gastroesophageal reflux disease include H2 antagonists, lifestyle modifications, and, in severe cases, surgical approaches.

The investigators also pointed out that this study had some limitations. Although two different PPIs were tested, only one of these, esomeprazole, is commercially available.

In addition, the study did not show how PPIs actually impair the lysosome’s ability to produce enough acid to clear waste.

Finally, since this study was conducted in a laboratory setting, it did not show whether PPIs act in the same way within the human body as they do in vitro.

Antihemophilic factor

The European Commission (EC) has approved albutrepenonacog alfa (Idelvion) to treat and prevent bleeding in children and adults with hemophilia B.

Albutrepenonacog alfa is a long-acting albumin fusion protein linking recombinant coagulation factor IX with recombinant albumin.

The product is now approved for use as routine prophylaxis, for on-demand control of bleeding, and for the perioperative management of bleeding.

Appropriate patients age 12 and older can go up to 14 days between albutrepenonacog alfa infusions. This dosing interval has been achieved while maintaining high levels of factor IX activity—above 5% over 14 days at 75 IU/kg.

“Offering 14-day dosing, Idelvion helps patients maintain higher factor IX levels over a long period of time, providing them with greater freedom from frequent infusions,” said Elena Santagostino, MD, PhD, of the University of Milan/IRCCS Maggiore Hospital in Italy.

“This is an important attribute for my patients who require a prophylactic regimen but don’t want treatment to disrupt their active lives.”

Albutrepenonacog alfa is being developed by CSL Behring. The company said the product will be launched in European markets in the coming months, as market access and pricing are obtained.

Phase 3 trial

The EC approved albutrepenonacog alfa based on results of the PROLONG-9FP clinical development program. PROLONG-9FP includes phase 1, 2, and 3 studies evaluating the safety and efficacy of albutrepenonacog alfa in adults and children (ages 1 to 61) with hemophilia B.

Data from the phase 3 study were recently published in Blood. This study included 63 previously treated male patients with severe hemophilia B. They had a mean age of 33 (range, 12 to 61).

The patients were divided into 2 groups. Group 1 (n=40) received routine prophylaxis with albutrepenonacog alfa once every 7 days for 26 weeks,

followed by a 7-, 10-, or 14-day prophylaxis regimen for a mean of 50, 38, or 51 weeks, respectively.

Group 2 received on-demand treatment with albutrepenonacog alfa for bleeding episodes for 26 weeks (n=23) and then switched to a 7-day prophylaxis regimen for a mean of 45 weeks (n=19).

The median annualized bleeding rate (ABR) was 2.0 in the prophylaxis arm (group 1) and 23.5 in the on-demand treatment arm (group 2). The median spontaneous ABRs were 0.0 and 17.0, respectively.

For patients in group 2, there was a significant reduction in median ABRs when patients switched from on-demand treatment to prophylaxis—19.22 and 1.58, respectively (P<0.0001). And there was a significant reduction in median spontaneous ABRs—15.43 and 0.00, respectively (P<0.0001).

Overall, 98.6% of bleeding episodes were treated successfully, including 93.6% that were treated with a single injection of albutrepenonacog alfa.

None of the patients developed inhibitors or experienced thromboembolic events, anaphylaxis, or life-threatening adverse events (AEs).

There were 347 treatment-emergent AEs reported in 54 (85.7%) patients. The most common were nasopharyngitis (25.4%), headache (23.8%), arthralgia (4.3%), and influenza (11.1%).

Eleven mild/moderate AEs in 5 patients (7.9%) were considered possibly related to albutrepenonacog alfa. Two patients discontinued treatment due to AEs—1 with hypersensitivity and 1 with headache.

Antihemophilic factor

The European Commission (EC) has approved albutrepenonacog alfa (Idelvion) to treat and prevent bleeding in children and adults with hemophilia B.

Albutrepenonacog alfa is a long-acting albumin fusion protein linking recombinant coagulation factor IX with recombinant albumin.

The product is now approved for use as routine prophylaxis, for on-demand control of bleeding, and for the perioperative management of bleeding.

Appropriate patients age 12 and older can go up to 14 days between albutrepenonacog alfa infusions. This dosing interval has been achieved while maintaining high levels of factor IX activity—above 5% over 14 days at 75 IU/kg.

“Offering 14-day dosing, Idelvion helps patients maintain higher factor IX levels over a long period of time, providing them with greater freedom from frequent infusions,” said Elena Santagostino, MD, PhD, of the University of Milan/IRCCS Maggiore Hospital in Italy.

“This is an important attribute for my patients who require a prophylactic regimen but don’t want treatment to disrupt their active lives.”

Albutrepenonacog alfa is being developed by CSL Behring. The company said the product will be launched in European markets in the coming months, as market access and pricing are obtained.

Phase 3 trial

The EC approved albutrepenonacog alfa based on results of the PROLONG-9FP clinical development program. PROLONG-9FP includes phase 1, 2, and 3 studies evaluating the safety and efficacy of albutrepenonacog alfa in adults and children (ages 1 to 61) with hemophilia B.

Data from the phase 3 study were recently published in Blood. This study included 63 previously treated male patients with severe hemophilia B. They had a mean age of 33 (range, 12 to 61).

The patients were divided into 2 groups. Group 1 (n=40) received routine prophylaxis with albutrepenonacog alfa once every 7 days for 26 weeks,

followed by a 7-, 10-, or 14-day prophylaxis regimen for a mean of 50, 38, or 51 weeks, respectively.

Group 2 received on-demand treatment with albutrepenonacog alfa for bleeding episodes for 26 weeks (n=23) and then switched to a 7-day prophylaxis regimen for a mean of 45 weeks (n=19).

The median annualized bleeding rate (ABR) was 2.0 in the prophylaxis arm (group 1) and 23.5 in the on-demand treatment arm (group 2). The median spontaneous ABRs were 0.0 and 17.0, respectively.

For patients in group 2, there was a significant reduction in median ABRs when patients switched from on-demand treatment to prophylaxis—19.22 and 1.58, respectively (P<0.0001). And there was a significant reduction in median spontaneous ABRs—15.43 and 0.00, respectively (P<0.0001).

Overall, 98.6% of bleeding episodes were treated successfully, including 93.6% that were treated with a single injection of albutrepenonacog alfa.

None of the patients developed inhibitors or experienced thromboembolic events, anaphylaxis, or life-threatening adverse events (AEs).

There were 347 treatment-emergent AEs reported in 54 (85.7%) patients. The most common were nasopharyngitis (25.4%), headache (23.8%), arthralgia (4.3%), and influenza (11.1%).

Eleven mild/moderate AEs in 5 patients (7.9%) were considered possibly related to albutrepenonacog alfa. Two patients discontinued treatment due to AEs—1 with hypersensitivity and 1 with headache.

Antihemophilic factor

The European Commission (EC) has approved albutrepenonacog alfa (Idelvion) to treat and prevent bleeding in children and adults with hemophilia B.

Albutrepenonacog alfa is a long-acting albumin fusion protein linking recombinant coagulation factor IX with recombinant albumin.

The product is now approved for use as routine prophylaxis, for on-demand control of bleeding, and for the perioperative management of bleeding.

Appropriate patients age 12 and older can go up to 14 days between albutrepenonacog alfa infusions. This dosing interval has been achieved while maintaining high levels of factor IX activity—above 5% over 14 days at 75 IU/kg.

“Offering 14-day dosing, Idelvion helps patients maintain higher factor IX levels over a long period of time, providing them with greater freedom from frequent infusions,” said Elena Santagostino, MD, PhD, of the University of Milan/IRCCS Maggiore Hospital in Italy.

“This is an important attribute for my patients who require a prophylactic regimen but don’t want treatment to disrupt their active lives.”

Albutrepenonacog alfa is being developed by CSL Behring. The company said the product will be launched in European markets in the coming months, as market access and pricing are obtained.

Phase 3 trial

The EC approved albutrepenonacog alfa based on results of the PROLONG-9FP clinical development program. PROLONG-9FP includes phase 1, 2, and 3 studies evaluating the safety and efficacy of albutrepenonacog alfa in adults and children (ages 1 to 61) with hemophilia B.

Data from the phase 3 study were recently published in Blood. This study included 63 previously treated male patients with severe hemophilia B. They had a mean age of 33 (range, 12 to 61).

The patients were divided into 2 groups. Group 1 (n=40) received routine prophylaxis with albutrepenonacog alfa once every 7 days for 26 weeks,

followed by a 7-, 10-, or 14-day prophylaxis regimen for a mean of 50, 38, or 51 weeks, respectively.

Group 2 received on-demand treatment with albutrepenonacog alfa for bleeding episodes for 26 weeks (n=23) and then switched to a 7-day prophylaxis regimen for a mean of 45 weeks (n=19).

The median annualized bleeding rate (ABR) was 2.0 in the prophylaxis arm (group 1) and 23.5 in the on-demand treatment arm (group 2). The median spontaneous ABRs were 0.0 and 17.0, respectively.

For patients in group 2, there was a significant reduction in median ABRs when patients switched from on-demand treatment to prophylaxis—19.22 and 1.58, respectively (P<0.0001). And there was a significant reduction in median spontaneous ABRs—15.43 and 0.00, respectively (P<0.0001).

Overall, 98.6% of bleeding episodes were treated successfully, including 93.6% that were treated with a single injection of albutrepenonacog alfa.

None of the patients developed inhibitors or experienced thromboembolic events, anaphylaxis, or life-threatening adverse events (AEs).

There were 347 treatment-emergent AEs reported in 54 (85.7%) patients. The most common were nasopharyngitis (25.4%), headache (23.8%), arthralgia (4.3%), and influenza (11.1%).

Eleven mild/moderate AEs in 5 patients (7.9%) were considered possibly related to albutrepenonacog alfa. Two patients discontinued treatment due to AEs—1 with hypersensitivity and 1 with headache.

Are you a clinical trials investigator with unused capacity? Would you like to refer patients to participate in groundbreaking clinical trials?

The CHEST Clinical Trials Registry is a free service that connects physicians to information about clinical trials in respiratory disease conducted by participating pharmaceutical companies.

Ongoing groundbreaking research could have a measurable impact on patient care, but a lack of clinical trial participants is significantly slowing research and threatening the development of new treatments. Recruiting and retaining trial participants are the greatest challenges to developing the next generation of treatment options.

Participation in clinical trials provides an opportunity to advance and accelerate medical research and contribute to an improved health outlook for future generations. Use our registry to get immediate information on how you can be involved in a clinical trial.

Access to learn more: chestnet.org/Guidelines-and-Resources/Clinical-Trials/Clinical-Trials-Registry.

Are you a clinical trials investigator with unused capacity? Would you like to refer patients to participate in groundbreaking clinical trials?

The CHEST Clinical Trials Registry is a free service that connects physicians to information about clinical trials in respiratory disease conducted by participating pharmaceutical companies.

Ongoing groundbreaking research could have a measurable impact on patient care, but a lack of clinical trial participants is significantly slowing research and threatening the development of new treatments. Recruiting and retaining trial participants are the greatest challenges to developing the next generation of treatment options.

Participation in clinical trials provides an opportunity to advance and accelerate medical research and contribute to an improved health outlook for future generations. Use our registry to get immediate information on how you can be involved in a clinical trial.

Access to learn more: chestnet.org/Guidelines-and-Resources/Clinical-Trials/Clinical-Trials-Registry.

Are you a clinical trials investigator with unused capacity? Would you like to refer patients to participate in groundbreaking clinical trials?

The CHEST Clinical Trials Registry is a free service that connects physicians to information about clinical trials in respiratory disease conducted by participating pharmaceutical companies.

Ongoing groundbreaking research could have a measurable impact on patient care, but a lack of clinical trial participants is significantly slowing research and threatening the development of new treatments. Recruiting and retaining trial participants are the greatest challenges to developing the next generation of treatment options.

Participation in clinical trials provides an opportunity to advance and accelerate medical research and contribute to an improved health outlook for future generations. Use our registry to get immediate information on how you can be involved in a clinical trial.

Access to learn more: chestnet.org/Guidelines-and-Resources/Clinical-Trials/Clinical-Trials-Registry.

Lawrence H. Cohn, MD, FCCP, a past president of the American College of Chest Physicians (1986-1987), pioneering cardiac surgeon and devoted educator, former chief of the Division of Cardiac Surgery at Brigham and Women’s Hospital, and the Virginia and James Hubbard Chair in Cardiac Surgery at Harvard Medical School, died Jan. 9, 2016. An internationally renowned surgeon, he was a pioneer in minimally invasive procedures to fix heart valves.

He aso performed more than 11,000 cardiac surgeries, including being part of the team for New England’s first heart transplant, which took place at the Brigham hospital. Dr. Cohn published more than 500 peer-reviewed publications, 105 book chapters, and 12 books, including four editions of “Cardiac Surgery in the Adult.” CHEST extends its heartfelt condolences to the entire Cohn family.

Lawrence H. Cohn, MD, FCCP, a past president of the American College of Chest Physicians (1986-1987), pioneering cardiac surgeon and devoted educator, former chief of the Division of Cardiac Surgery at Brigham and Women’s Hospital, and the Virginia and James Hubbard Chair in Cardiac Surgery at Harvard Medical School, died Jan. 9, 2016. An internationally renowned surgeon, he was a pioneer in minimally invasive procedures to fix heart valves.

He aso performed more than 11,000 cardiac surgeries, including being part of the team for New England’s first heart transplant, which took place at the Brigham hospital. Dr. Cohn published more than 500 peer-reviewed publications, 105 book chapters, and 12 books, including four editions of “Cardiac Surgery in the Adult.” CHEST extends its heartfelt condolences to the entire Cohn family.

Lawrence H. Cohn, MD, FCCP, a past president of the American College of Chest Physicians (1986-1987), pioneering cardiac surgeon and devoted educator, former chief of the Division of Cardiac Surgery at Brigham and Women’s Hospital, and the Virginia and James Hubbard Chair in Cardiac Surgery at Harvard Medical School, died Jan. 9, 2016. An internationally renowned surgeon, he was a pioneer in minimally invasive procedures to fix heart valves.

He aso performed more than 11,000 cardiac surgeries, including being part of the team for New England’s first heart transplant, which took place at the Brigham hospital. Dr. Cohn published more than 500 peer-reviewed publications, 105 book chapters, and 12 books, including four editions of “Cardiac Surgery in the Adult.” CHEST extends its heartfelt condolences to the entire Cohn family.

Dr. Barbara Phillips, MSPH, FCCP

CHEST President 2015-2016

Nancy MacRae

Senior Vice President, Governance and Operations

Jenny Nemkovich, CAE

Chief Strategy Officer, Executive Office

Ever wonder how decisions get made and work gets done at CHEST? It all starts with our strategic plan (www.chestnet.org/About/Overview/Strategic-Plan), which was developed by the Board of Regents and other key stakeholders. The development of the strategic plan was informed by our vision to be the global leader in advancing best patient outcomes through innovative chest medicine, education, clinical research, and team-based care, as well as our mission and values. As a result of our strategic planning, CHEST is all about clinical education, which is our “hedgehog,” in organization-speak (1), but we also have goals in guideline development, global impact, membership recruitment and retention, and (of course) fiscal health. We follow progress toward our goals with measurable, relevant key performance indicators (KPIs), and the board reviews progress toward KPIs and goals at nearly every meeting, making recommendations for adjustments, as needed.

But how do decisions get made? CHEST volunteer and staff leadership work together to initiate and execute projects consistent with our plan and respond to requests from others to explore collaborative opportunities to advance our goals.

An example of a process that was initiated by leadership was the development of our new membership model. The Community and Engagement Work Group, along with key staff and other stakeholders, reviewed environmental scans, their personal knowledge and situations, and data from surveys of CHEST members, as well as association trends. They then proposed a new membership model to the Board of Regents (BoR). The BoR reviewed the proposal, along with other important information, and expressed concerns about several key constituent groups, such as global members and members in training, along with several other issues. In fact, the BoR sent the proposal back to the Work Group. Twice. As with any new project, the BoR makes a concerted effort to focus on the strategic plan in these types of deliberations and was guided particularly by the strategy to “optimize new membership model to increase engagement of all clinicians on the health-care team.” The final proposal, implemented in May 2015, truly reflects input and concerns from the BoR, key staff, the Membership Committee, and those CHEST members who responded to the surveys.

An example of a request by another organization to sign on, endorse, cosponsor, or otherwise support a guideline or project is the Campaign for Tobacco-Free Kids contacting us asking us to sign on to a letter to all members of the United States Senate and House of Representatives supporting the tobacco control measure included in the Trans-Pacific Partnership (TPP) trade agreement. The provision will protect the rights of nations participating in the TPP to adopt public health measures that reduce tobacco use without fear of facing lengthy and expensive trade disputes under the TPP initiated by tobacco companies.

Our process in these situations is to gather as much input as possible from CHEST members and experts. Again, using our strategic plan as guidance, in this specific instance, we are expanding our global impact, using targeted strategic alliances, so the decision was made to support this initiative. The CHEST name and brand are valuable assets, and we take endorsement of any project or document very seriously.

Key to our organizational success is our outstanding volunteer/staff partnership that fosters teamwork in translating the strategic vision, mission, and goals of the organization, engaging in a deliberative process that considers organizational history, data, trends, and expert opinion – all to help inform leadership in its decision-making. This collaboration between our content experts and our association professionals is a huge asset to our organization and one that will continue to propel CHEST to achieve our goals.

1. Collins J. Good to Great and the Social Sectors: A Monograph to Accompany Good to Great. New York, NY: HarperCollins Publishers; 2005.

Dr. Barbara Phillips, MSPH, FCCP

CHEST President 2015-2016

Nancy MacRae

Senior Vice President, Governance and Operations

Jenny Nemkovich, CAE

Chief Strategy Officer, Executive Office

Ever wonder how decisions get made and work gets done at CHEST? It all starts with our strategic plan (www.chestnet.org/About/Overview/Strategic-Plan), which was developed by the Board of Regents and other key stakeholders. The development of the strategic plan was informed by our vision to be the global leader in advancing best patient outcomes through innovative chest medicine, education, clinical research, and team-based care, as well as our mission and values. As a result of our strategic planning, CHEST is all about clinical education, which is our “hedgehog,” in organization-speak (1), but we also have goals in guideline development, global impact, membership recruitment and retention, and (of course) fiscal health. We follow progress toward our goals with measurable, relevant key performance indicators (KPIs), and the board reviews progress toward KPIs and goals at nearly every meeting, making recommendations for adjustments, as needed.

But how do decisions get made? CHEST volunteer and staff leadership work together to initiate and execute projects consistent with our plan and respond to requests from others to explore collaborative opportunities to advance our goals.

An example of a process that was initiated by leadership was the development of our new membership model. The Community and Engagement Work Group, along with key staff and other stakeholders, reviewed environmental scans, their personal knowledge and situations, and data from surveys of CHEST members, as well as association trends. They then proposed a new membership model to the Board of Regents (BoR). The BoR reviewed the proposal, along with other important information, and expressed concerns about several key constituent groups, such as global members and members in training, along with several other issues. In fact, the BoR sent the proposal back to the Work Group. Twice. As with any new project, the BoR makes a concerted effort to focus on the strategic plan in these types of deliberations and was guided particularly by the strategy to “optimize new membership model to increase engagement of all clinicians on the health-care team.” The final proposal, implemented in May 2015, truly reflects input and concerns from the BoR, key staff, the Membership Committee, and those CHEST members who responded to the surveys.

An example of a request by another organization to sign on, endorse, cosponsor, or otherwise support a guideline or project is the Campaign for Tobacco-Free Kids contacting us asking us to sign on to a letter to all members of the United States Senate and House of Representatives supporting the tobacco control measure included in the Trans-Pacific Partnership (TPP) trade agreement. The provision will protect the rights of nations participating in the TPP to adopt public health measures that reduce tobacco use without fear of facing lengthy and expensive trade disputes under the TPP initiated by tobacco companies.

Our process in these situations is to gather as much input as possible from CHEST members and experts. Again, using our strategic plan as guidance, in this specific instance, we are expanding our global impact, using targeted strategic alliances, so the decision was made to support this initiative. The CHEST name and brand are valuable assets, and we take endorsement of any project or document very seriously.

Key to our organizational success is our outstanding volunteer/staff partnership that fosters teamwork in translating the strategic vision, mission, and goals of the organization, engaging in a deliberative process that considers organizational history, data, trends, and expert opinion – all to help inform leadership in its decision-making. This collaboration between our content experts and our association professionals is a huge asset to our organization and one that will continue to propel CHEST to achieve our goals.

1. Collins J. Good to Great and the Social Sectors: A Monograph to Accompany Good to Great. New York, NY: HarperCollins Publishers; 2005.

Dr. Barbara Phillips, MSPH, FCCP

CHEST President 2015-2016

Nancy MacRae

Senior Vice President, Governance and Operations

Jenny Nemkovich, CAE

Chief Strategy Officer, Executive Office

Ever wonder how decisions get made and work gets done at CHEST? It all starts with our strategic plan (www.chestnet.org/About/Overview/Strategic-Plan), which was developed by the Board of Regents and other key stakeholders. The development of the strategic plan was informed by our vision to be the global leader in advancing best patient outcomes through innovative chest medicine, education, clinical research, and team-based care, as well as our mission and values. As a result of our strategic planning, CHEST is all about clinical education, which is our “hedgehog,” in organization-speak (1), but we also have goals in guideline development, global impact, membership recruitment and retention, and (of course) fiscal health. We follow progress toward our goals with measurable, relevant key performance indicators (KPIs), and the board reviews progress toward KPIs and goals at nearly every meeting, making recommendations for adjustments, as needed.

But how do decisions get made? CHEST volunteer and staff leadership work together to initiate and execute projects consistent with our plan and respond to requests from others to explore collaborative opportunities to advance our goals.

An example of a process that was initiated by leadership was the development of our new membership model. The Community and Engagement Work Group, along with key staff and other stakeholders, reviewed environmental scans, their personal knowledge and situations, and data from surveys of CHEST members, as well as association trends. They then proposed a new membership model to the Board of Regents (BoR). The BoR reviewed the proposal, along with other important information, and expressed concerns about several key constituent groups, such as global members and members in training, along with several other issues. In fact, the BoR sent the proposal back to the Work Group. Twice. As with any new project, the BoR makes a concerted effort to focus on the strategic plan in these types of deliberations and was guided particularly by the strategy to “optimize new membership model to increase engagement of all clinicians on the health-care team.” The final proposal, implemented in May 2015, truly reflects input and concerns from the BoR, key staff, the Membership Committee, and those CHEST members who responded to the surveys.

An example of a request by another organization to sign on, endorse, cosponsor, or otherwise support a guideline or project is the Campaign for Tobacco-Free Kids contacting us asking us to sign on to a letter to all members of the United States Senate and House of Representatives supporting the tobacco control measure included in the Trans-Pacific Partnership (TPP) trade agreement. The provision will protect the rights of nations participating in the TPP to adopt public health measures that reduce tobacco use without fear of facing lengthy and expensive trade disputes under the TPP initiated by tobacco companies.

Our process in these situations is to gather as much input as possible from CHEST members and experts. Again, using our strategic plan as guidance, in this specific instance, we are expanding our global impact, using targeted strategic alliances, so the decision was made to support this initiative. The CHEST name and brand are valuable assets, and we take endorsement of any project or document very seriously.

Key to our organizational success is our outstanding volunteer/staff partnership that fosters teamwork in translating the strategic vision, mission, and goals of the organization, engaging in a deliberative process that considers organizational history, data, trends, and expert opinion – all to help inform leadership in its decision-making. This collaboration between our content experts and our association professionals is a huge asset to our organization and one that will continue to propel CHEST to achieve our goals.

1. Collins J. Good to Great and the Social Sectors: A Monograph to Accompany Good to Great. New York, NY: HarperCollins Publishers; 2005.

The American College of Chest Physicians (CHEST) and the Chinese Association of Chest Physicians (CACP), the respiratory arm of the Chinese Medical Doctor Association (CMDA), have signed an exclusive agreement to collaborate on expanding China’s first-ever fellowship training program, providing clinical education in pulmonary and critical care medicine (PCCM) for Chinese physicians.

This historic announcement came during the opening session of CHEST World Congress 2016 in Shanghai, where approximately 2,000 health care professionals gathered for a 3-day event aimed at connecting clinicians from the United States, China, and around the world for hands-on clinical education in pulmonary, critical care, and sleep medicine. Among those in attendance were fellows and faculty from the 12 institutions that participated in the inaugural offering of the China-CHEST PCCM program, which was developed and implemented over the past 4 years and is expected to grow to dozens of institutions over the next several years.

Since 2012, CHEST has worked with the Chinese Thoracic Society on the development of China’s first fellowship program, offering standardized training in PCCM for Chinese physicians. As a result of these collective efforts, PCCM has now officially earned recognition as a medical subspecialty by the Chinese Ministry of Health – the first subspecialty of its kind in a country where medical training typically ends after a physician completes residency training. Only a decade ago, physicians in China went directly into practice following medical school. The development of a PCCM subspecialty in China – made possible through the engagement of CHEST’s expert faculty and administration – parallels what has occurred over the past 3 decades in the United States, during which the fields of pulmonary and critical care medicine evolved into the combined subspecialty of PCCM.

Through their groundbreaking collaboration announced today, CHEST and the CACP have committed to working exclusively as partners in continuing to advance the PCCM subspecialty in China to improve patient care, expand in-depth clinical training for Chinese physicians, and develop a growing force of expert Chinese faculty. The goal of such training is to ensure that patients receive the best possible care from Chinese physicians who complete the China-CHEST PCCM fellowship program.

“Recognition by the Chinese Ministry of Health of PCCM as this country’s first-ever physician subspecialty is welcomed acknowledgment that we’re making tremendous headway in advancing physician fellowship training in China,” said Barbara Phillips, MD, MPH, FCCP, President of the American College of Chest Physicians. “We are proud to join collaborative partners like the CMDA in these cooperative efforts to prepare Chinese physicians in the PCCM subspecialty, partnering in this historic effort to drive immeasurable improvements in clinical training and the delivery of patient care.”

The American College of Chest Physicians (CHEST) and the Chinese Association of Chest Physicians (CACP), the respiratory arm of the Chinese Medical Doctor Association (CMDA), have signed an exclusive agreement to collaborate on expanding China’s first-ever fellowship training program, providing clinical education in pulmonary and critical care medicine (PCCM) for Chinese physicians.

This historic announcement came during the opening session of CHEST World Congress 2016 in Shanghai, where approximately 2,000 health care professionals gathered for a 3-day event aimed at connecting clinicians from the United States, China, and around the world for hands-on clinical education in pulmonary, critical care, and sleep medicine. Among those in attendance were fellows and faculty from the 12 institutions that participated in the inaugural offering of the China-CHEST PCCM program, which was developed and implemented over the past 4 years and is expected to grow to dozens of institutions over the next several years.

Since 2012, CHEST has worked with the Chinese Thoracic Society on the development of China’s first fellowship program, offering standardized training in PCCM for Chinese physicians. As a result of these collective efforts, PCCM has now officially earned recognition as a medical subspecialty by the Chinese Ministry of Health – the first subspecialty of its kind in a country where medical training typically ends after a physician completes residency training. Only a decade ago, physicians in China went directly into practice following medical school. The development of a PCCM subspecialty in China – made possible through the engagement of CHEST’s expert faculty and administration – parallels what has occurred over the past 3 decades in the United States, during which the fields of pulmonary and critical care medicine evolved into the combined subspecialty of PCCM.

Through their groundbreaking collaboration announced today, CHEST and the CACP have committed to working exclusively as partners in continuing to advance the PCCM subspecialty in China to improve patient care, expand in-depth clinical training for Chinese physicians, and develop a growing force of expert Chinese faculty. The goal of such training is to ensure that patients receive the best possible care from Chinese physicians who complete the China-CHEST PCCM fellowship program.

“Recognition by the Chinese Ministry of Health of PCCM as this country’s first-ever physician subspecialty is welcomed acknowledgment that we’re making tremendous headway in advancing physician fellowship training in China,” said Barbara Phillips, MD, MPH, FCCP, President of the American College of Chest Physicians. “We are proud to join collaborative partners like the CMDA in these cooperative efforts to prepare Chinese physicians in the PCCM subspecialty, partnering in this historic effort to drive immeasurable improvements in clinical training and the delivery of patient care.”

The American College of Chest Physicians (CHEST) and the Chinese Association of Chest Physicians (CACP), the respiratory arm of the Chinese Medical Doctor Association (CMDA), have signed an exclusive agreement to collaborate on expanding China’s first-ever fellowship training program, providing clinical education in pulmonary and critical care medicine (PCCM) for Chinese physicians.

This historic announcement came during the opening session of CHEST World Congress 2016 in Shanghai, where approximately 2,000 health care professionals gathered for a 3-day event aimed at connecting clinicians from the United States, China, and around the world for hands-on clinical education in pulmonary, critical care, and sleep medicine. Among those in attendance were fellows and faculty from the 12 institutions that participated in the inaugural offering of the China-CHEST PCCM program, which was developed and implemented over the past 4 years and is expected to grow to dozens of institutions over the next several years.

Since 2012, CHEST has worked with the Chinese Thoracic Society on the development of China’s first fellowship program, offering standardized training in PCCM for Chinese physicians. As a result of these collective efforts, PCCM has now officially earned recognition as a medical subspecialty by the Chinese Ministry of Health – the first subspecialty of its kind in a country where medical training typically ends after a physician completes residency training. Only a decade ago, physicians in China went directly into practice following medical school. The development of a PCCM subspecialty in China – made possible through the engagement of CHEST’s expert faculty and administration – parallels what has occurred over the past 3 decades in the United States, during which the fields of pulmonary and critical care medicine evolved into the combined subspecialty of PCCM.

Through their groundbreaking collaboration announced today, CHEST and the CACP have committed to working exclusively as partners in continuing to advance the PCCM subspecialty in China to improve patient care, expand in-depth clinical training for Chinese physicians, and develop a growing force of expert Chinese faculty. The goal of such training is to ensure that patients receive the best possible care from Chinese physicians who complete the China-CHEST PCCM fellowship program.

“Recognition by the Chinese Ministry of Health of PCCM as this country’s first-ever physician subspecialty is welcomed acknowledgment that we’re making tremendous headway in advancing physician fellowship training in China,” said Barbara Phillips, MD, MPH, FCCP, President of the American College of Chest Physicians. “We are proud to join collaborative partners like the CMDA in these cooperative efforts to prepare Chinese physicians in the PCCM subspecialty, partnering in this historic effort to drive immeasurable improvements in clinical training and the delivery of patient care.”

When you imagine Los Angeles, you probably envision images of glamorous Hollywood celebrities and ritzy beaches featured on television shows. While LA does, indeed, allure visitors with its high-end environment, there are also many opportunities to unwind and recharge in the Golden State. With mild temperatures and sunshine nearly 300 days a year, Los Angeles provides a haven for outdoor activities. While you’re attending CHEST 2016 from October 22 to 26, we encourage you to trade your stilettos for hiking boots or athletic shoes, and get outside during your free time.

The San Gabriel Mountains are about an hour’s drive from the Los Angeles Convention Center. Visitors can hike, picnic, and enjoy equestrian trails. Our favorite LA experts – CHEST members – have recommended renting a mountain bike and riding up to Mount Wilson. You can also hike the Eaton Canyon Trail and find the Eaton Canyon Waterfall, a 40-foot waterfall with a pool at its base. You can find more mountain ranges and hiking opportunities in the Santa Monica mountains, as well. Find more tips on trails and hiking at discoverlosangeles.com.

If you’re not interested in retreating from Los Angeles’s urban oasis, but you still want to enjoy some fresh air and exercise, you have a couple options closer to downtown. Runyon Canyon is about a 20-minute drive from the convention center. It features a gently paved path for beginners, a rugged outer path for a more intense workout, free yoga near the Fuller Avenue entrance, a great setting for watching the sunset, and strong possibilities of celebrity sightings. You can also rent a bike and cycle along the beaches. You can stop off for a bite to eat, some sand volleyball, or just to do some people watching.

And if you’re a golf enthusiast, there is a bevy of options for golfing in and around LA. The most iconic golf course is the Trump National Golf Club located on the Palos Verdes Peninsula, about a 40-minute drive from the convention center. You’ll experience uncompromising luxury overlooking the beautiful Pacific Ocean. If you’d like to stay close to the convention center but still get out to play 9 holes, you may want to check out Wilshire Country Club (20-minute drive) or Monterey Park Golf Club (12-minute drive).

While Los Angeles refreshes you with outdoor beauty and sunshine, CHEST 2016 will energize and recharge you with the latest information in chest medicine. You’ll connect with an international community of the best minds in pulmonary, critical care, and sleep medicine. Find everything you need to know to make the best clinical decisions and inspire your patient care. Learn more at chestmeeting.chestnet.org.

When you imagine Los Angeles, you probably envision images of glamorous Hollywood celebrities and ritzy beaches featured on television shows. While LA does, indeed, allure visitors with its high-end environment, there are also many opportunities to unwind and recharge in the Golden State. With mild temperatures and sunshine nearly 300 days a year, Los Angeles provides a haven for outdoor activities. While you’re attending CHEST 2016 from October 22 to 26, we encourage you to trade your stilettos for hiking boots or athletic shoes, and get outside during your free time.

The San Gabriel Mountains are about an hour’s drive from the Los Angeles Convention Center. Visitors can hike, picnic, and enjoy equestrian trails. Our favorite LA experts – CHEST members – have recommended renting a mountain bike and riding up to Mount Wilson. You can also hike the Eaton Canyon Trail and find the Eaton Canyon Waterfall, a 40-foot waterfall with a pool at its base. You can find more mountain ranges and hiking opportunities in the Santa Monica mountains, as well. Find more tips on trails and hiking at discoverlosangeles.com.

If you’re not interested in retreating from Los Angeles’s urban oasis, but you still want to enjoy some fresh air and exercise, you have a couple options closer to downtown. Runyon Canyon is about a 20-minute drive from the convention center. It features a gently paved path for beginners, a rugged outer path for a more intense workout, free yoga near the Fuller Avenue entrance, a great setting for watching the sunset, and strong possibilities of celebrity sightings. You can also rent a bike and cycle along the beaches. You can stop off for a bite to eat, some sand volleyball, or just to do some people watching.

And if you’re a golf enthusiast, there is a bevy of options for golfing in and around LA. The most iconic golf course is the Trump National Golf Club located on the Palos Verdes Peninsula, about a 40-minute drive from the convention center. You’ll experience uncompromising luxury overlooking the beautiful Pacific Ocean. If you’d like to stay close to the convention center but still get out to play 9 holes, you may want to check out Wilshire Country Club (20-minute drive) or Monterey Park Golf Club (12-minute drive).

While Los Angeles refreshes you with outdoor beauty and sunshine, CHEST 2016 will energize and recharge you with the latest information in chest medicine. You’ll connect with an international community of the best minds in pulmonary, critical care, and sleep medicine. Find everything you need to know to make the best clinical decisions and inspire your patient care. Learn more at chestmeeting.chestnet.org.

When you imagine Los Angeles, you probably envision images of glamorous Hollywood celebrities and ritzy beaches featured on television shows. While LA does, indeed, allure visitors with its high-end environment, there are also many opportunities to unwind and recharge in the Golden State. With mild temperatures and sunshine nearly 300 days a year, Los Angeles provides a haven for outdoor activities. While you’re attending CHEST 2016 from October 22 to 26, we encourage you to trade your stilettos for hiking boots or athletic shoes, and get outside during your free time.

The San Gabriel Mountains are about an hour’s drive from the Los Angeles Convention Center. Visitors can hike, picnic, and enjoy equestrian trails. Our favorite LA experts – CHEST members – have recommended renting a mountain bike and riding up to Mount Wilson. You can also hike the Eaton Canyon Trail and find the Eaton Canyon Waterfall, a 40-foot waterfall with a pool at its base. You can find more mountain ranges and hiking opportunities in the Santa Monica mountains, as well. Find more tips on trails and hiking at discoverlosangeles.com.

If you’re not interested in retreating from Los Angeles’s urban oasis, but you still want to enjoy some fresh air and exercise, you have a couple options closer to downtown. Runyon Canyon is about a 20-minute drive from the convention center. It features a gently paved path for beginners, a rugged outer path for a more intense workout, free yoga near the Fuller Avenue entrance, a great setting for watching the sunset, and strong possibilities of celebrity sightings. You can also rent a bike and cycle along the beaches. You can stop off for a bite to eat, some sand volleyball, or just to do some people watching.

And if you’re a golf enthusiast, there is a bevy of options for golfing in and around LA. The most iconic golf course is the Trump National Golf Club located on the Palos Verdes Peninsula, about a 40-minute drive from the convention center. You’ll experience uncompromising luxury overlooking the beautiful Pacific Ocean. If you’d like to stay close to the convention center but still get out to play 9 holes, you may want to check out Wilshire Country Club (20-minute drive) or Monterey Park Golf Club (12-minute drive).

While Los Angeles refreshes you with outdoor beauty and sunshine, CHEST 2016 will energize and recharge you with the latest information in chest medicine. You’ll connect with an international community of the best minds in pulmonary, critical care, and sleep medicine. Find everything you need to know to make the best clinical decisions and inspire your patient care. Learn more at chestmeeting.chestnet.org.