News From CHEST Physician®

Palliative and end-of-life care

Communicating serious news over video

Critical care consultation using telemedicine is increasingly prevalent. Having serious conversations regarding end-of life care over video can be extremely challenging. Here are some suggestions and sample phrases to make palliative-focused conversations more successful

Prior to initiating the conversation, communicate with the bedside team. Ensure they want you to discuss palliative options and make an outline of discussion topics together. Identify and include all important decision-makers. Family may need to be connected over a digital meeting platform such as Zoom^© or WEBex^© and arrange for interpreter services if needed.

Prepare the virtual meeting place ahead of time. Test the connection, and make sure the audiovisual quality is clear. Have the camera centrally positioned, and ensure adequate lighting to easily see facial expressions. Remove distracting background furniture, and clear your space of confidential material. Have a quiet area planned to avoid interruptions (J Gen Intern Med. 2020 Oct 27:1-4. doi: 10.1007/s11606-020-06278-z. Online ahead of print).

Open the conversation with introductions, and explore perceptions with open-ended questions: “So I know where to begin, tell me about your understanding of what has been happening?” Get a sense of the patient’s previous function, quality of life, and their values as an individual. Maintain good eye contact throughout. When ready to give an update, use simple language and avoid details: “Unfortunately, your condition is worse. You have not been responding to treatments as hoped. Your lungs are needing much more support, and I’m worried they are not going to get better.”Anticipate emotions, and provide empathetic responses: “I wish we had better news. This must be overwhelming for you” (Back, et al. Ann Int Med. 2020;172[11]:759). Finally, offer a recommendation. Most patients and families are interested in your advice and want guidance. Use the patient’s previously stated values to support your recommendation.

Andrew Badke, MD

Steering Committee Member

Respiratory care

COVID-19 pandemic bringing protocols to the forefront

COVID-19 has health care organizations threatened like never before. Staffing requirements, equipment necessities, and personnel training happen in a whirlwind.¹ Information could change daily/hourly, and the need to protocolize guidelines became more evident each day.

While protocols have existed long before COVID-19, many institutions and organizations responded to the ever-changing pandemic by creating clinical practice guidelines (CPGs) to help not only their experienced staff members but also the non-traditional ICU caregivers thrust onto the front lines.3 Organizations worked on PPE protocols, respiratory care management, and ECMO guidelines to name a few.^2,3 Protocols with algorithms and CPGs have been shown to reduce patient harm and improve standardization and communication.

A CPG is a general principle that guides the management of care, in which specific questions are posed, a literature review is completed, and the quality of the research evaluated. The questions are answered using the strength of the available research. CPG decision points are then based on the evidence or on the consensus of experts, resulting in a protocol that are descriptions of detailed behaviors to be followed in specific situations. These behaviors are provided in a list format or a flow diagram. Using a universal language for protocols with algorithms has aided many hospitals ensure effective care for patients and has even helped develop multidisciplinary relationships not present prior to the pandemic (onepagericu.com).

DeDe Gardner, RRT, DrPh, FCCP

Donna Tanner, RRT-ACCS, MBA, FCCP

Steering Committee Members



1. epub JAMA 2/2021.

2. WHO, Guidelines 1/2021.

3. CHEST, Clinical Resources.

4. Curr Treat Options Ped 2015,1:347


 

Sleep medicine

Time to move the dial: Sleep and burnout in health care workers during the COVID-19 pandemic

Although the interaction between sleep, mood disorders, and burnout is well established, many of us are still sleep-deprived. A cross-sectional study of over 800 health care workers during the pandemic stay-at-home orders in March 2020 reported that those working in-person had shorter sleep times and worse mood, while those with longer sleep times had improved mood (Conroy DA, et al. J Clin Sleep Med. 2021;17[2]:185). Even prior to COVID-19, many trainees were facing issues with sleep deprivation and burnout (Sharp M, et al. Chest. 2021;159[2]:733).

One year into the pandemic, we continue to face a unique set of hardships, exacerbating underlying sleep disorders such as insomnia, feelings of burnout, and mental health problems. An international team led by Dr. Joel Goh calculated the cost of burnout and its economic impact on the nation’s health care system and estimated this at $4.6 billion per year (Han S, et al. Ann Intern Med. 2019;170[11]:784). National medical organizations, including the National Academy of Medicine and the American Medical Association, have also placed greater emphasis on clinician well-being and resilience. Practical frameworks for creating wellness during the pandemic exist; however. senior-level executive champions are critical for implementation (Adibe B, et al. N Engl J Med Catalyst. Jun 2020). While the long-term impact remains unknown, the current state of sleep and mental health problems and the cost of burnout should be a warning to health systems and institutions to implement remedial interventions now.(“Taking action against burnout: A systems approach to professional well-being,” National Academies of Sciences, Engineering, and Medicine, October 2019.
 

Nancy H. Stewart, DO, MS, Steering Committee Member

Thoracic oncology

Impact of COVID-19 on lung cancer screening

Lung cancer is the leading cause of cancer-related death worldwide and COVID-19 is making this worse. Prior to the COVID-19 pandemic, despite evidence of improved mortality, the uptake of lung cancer screening (LCS) was quite low with only 4% of those eligible having undergone screening in 2015 (Jemal A, et al. JAMA Oncol. 2017;3[9]:1278).

As the COVID-19 pandemic unfolded, health care resources were re-allocated to critically ill patients and areas, and nonurgent care was postponed. Therefore, LCS programs were halted (Mazzone PJ, et al. Chest. 2020;158[1]:406). This led to concerns that fewer patients would undergo screening and more patients would experience delays in cancer diagnosis.

Using population-based modeling, researchers in England estimated the COVID-19 pandemic will result in decreased lung cancer survival and a subsequent increase in avoidable cancer deaths (Maringe C, et al. Lancet Oncol. 2020;21[8]:1023). And in fact, investigators in Spain found fewer new lung cancer diagnoses during the COVID-19 pandemic compared with the same time-period pre-pandemic, and those that were diagnosed were later stage disease (Reyes R, et al. IASCL World Conference. 2020. A3700).

As we learn more about COVID-19 and communities become vaccinated, it becomes critical to both resume LCS programs and improve participation. While the pandemic has hampered efforts to screening patients, it has also facilitated the uptake of new technologies such as telemedicine. In March 2020, due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services relaxed the rules for telehealth, and now covers shared decisions making (SDM) virtual visits for LCS (Centers for Medicare & Medicaid Services, “Telehealth Services.” ICN MLN901705, March 2020). This new tool, amongst others, could increase access to LCS, facilitate more widespread adoption of screening, and ultimately improve lung cancer outcomes.

Max Wayne, MD, and Jose Cardenas-Garcia, MD

Steering Committee Members

Palliative and end-of-life care

Communicating serious news over video

Critical care consultation using telemedicine is increasingly prevalent. Having serious conversations regarding end-of life care over video can be extremely challenging. Here are some suggestions and sample phrases to make palliative-focused conversations more successful

Prior to initiating the conversation, communicate with the bedside team. Ensure they want you to discuss palliative options and make an outline of discussion topics together. Identify and include all important decision-makers. Family may need to be connected over a digital meeting platform such as Zoom^© or WEBex^© and arrange for interpreter services if needed.

Prepare the virtual meeting place ahead of time. Test the connection, and make sure the audiovisual quality is clear. Have the camera centrally positioned, and ensure adequate lighting to easily see facial expressions. Remove distracting background furniture, and clear your space of confidential material. Have a quiet area planned to avoid interruptions (J Gen Intern Med. 2020 Oct 27:1-4. doi: 10.1007/s11606-020-06278-z. Online ahead of print).

Open the conversation with introductions, and explore perceptions with open-ended questions: “So I know where to begin, tell me about your understanding of what has been happening?” Get a sense of the patient’s previous function, quality of life, and their values as an individual. Maintain good eye contact throughout. When ready to give an update, use simple language and avoid details: “Unfortunately, your condition is worse. You have not been responding to treatments as hoped. Your lungs are needing much more support, and I’m worried they are not going to get better.”Anticipate emotions, and provide empathetic responses: “I wish we had better news. This must be overwhelming for you” (Back, et al. Ann Int Med. 2020;172[11]:759). Finally, offer a recommendation. Most patients and families are interested in your advice and want guidance. Use the patient’s previously stated values to support your recommendation.

Andrew Badke, MD

Steering Committee Member

Respiratory care

COVID-19 pandemic bringing protocols to the forefront

COVID-19 has health care organizations threatened like never before. Staffing requirements, equipment necessities, and personnel training happen in a whirlwind.¹ Information could change daily/hourly, and the need to protocolize guidelines became more evident each day.

While protocols have existed long before COVID-19, many institutions and organizations responded to the ever-changing pandemic by creating clinical practice guidelines (CPGs) to help not only their experienced staff members but also the non-traditional ICU caregivers thrust onto the front lines.3 Organizations worked on PPE protocols, respiratory care management, and ECMO guidelines to name a few.^2,3 Protocols with algorithms and CPGs have been shown to reduce patient harm and improve standardization and communication.

A CPG is a general principle that guides the management of care, in which specific questions are posed, a literature review is completed, and the quality of the research evaluated. The questions are answered using the strength of the available research. CPG decision points are then based on the evidence or on the consensus of experts, resulting in a protocol that are descriptions of detailed behaviors to be followed in specific situations. These behaviors are provided in a list format or a flow diagram. Using a universal language for protocols with algorithms has aided many hospitals ensure effective care for patients and has even helped develop multidisciplinary relationships not present prior to the pandemic (onepagericu.com).

DeDe Gardner, RRT, DrPh, FCCP

Donna Tanner, RRT-ACCS, MBA, FCCP

Steering Committee Members



1. epub JAMA 2/2021.

2. WHO, Guidelines 1/2021.

3. CHEST, Clinical Resources.

4. Curr Treat Options Ped 2015,1:347


 

Sleep medicine

Time to move the dial: Sleep and burnout in health care workers during the COVID-19 pandemic

Although the interaction between sleep, mood disorders, and burnout is well established, many of us are still sleep-deprived. A cross-sectional study of over 800 health care workers during the pandemic stay-at-home orders in March 2020 reported that those working in-person had shorter sleep times and worse mood, while those with longer sleep times had improved mood (Conroy DA, et al. J Clin Sleep Med. 2021;17[2]:185). Even prior to COVID-19, many trainees were facing issues with sleep deprivation and burnout (Sharp M, et al. Chest. 2021;159[2]:733).

One year into the pandemic, we continue to face a unique set of hardships, exacerbating underlying sleep disorders such as insomnia, feelings of burnout, and mental health problems. An international team led by Dr. Joel Goh calculated the cost of burnout and its economic impact on the nation’s health care system and estimated this at $4.6 billion per year (Han S, et al. Ann Intern Med. 2019;170[11]:784). National medical organizations, including the National Academy of Medicine and the American Medical Association, have also placed greater emphasis on clinician well-being and resilience. Practical frameworks for creating wellness during the pandemic exist; however. senior-level executive champions are critical for implementation (Adibe B, et al. N Engl J Med Catalyst. Jun 2020). While the long-term impact remains unknown, the current state of sleep and mental health problems and the cost of burnout should be a warning to health systems and institutions to implement remedial interventions now.(“Taking action against burnout: A systems approach to professional well-being,” National Academies of Sciences, Engineering, and Medicine, October 2019.
 

Nancy H. Stewart, DO, MS, Steering Committee Member

Thoracic oncology

Impact of COVID-19 on lung cancer screening

Lung cancer is the leading cause of cancer-related death worldwide and COVID-19 is making this worse. Prior to the COVID-19 pandemic, despite evidence of improved mortality, the uptake of lung cancer screening (LCS) was quite low with only 4% of those eligible having undergone screening in 2015 (Jemal A, et al. JAMA Oncol. 2017;3[9]:1278).

As the COVID-19 pandemic unfolded, health care resources were re-allocated to critically ill patients and areas, and nonurgent care was postponed. Therefore, LCS programs were halted (Mazzone PJ, et al. Chest. 2020;158[1]:406). This led to concerns that fewer patients would undergo screening and more patients would experience delays in cancer diagnosis.

Using population-based modeling, researchers in England estimated the COVID-19 pandemic will result in decreased lung cancer survival and a subsequent increase in avoidable cancer deaths (Maringe C, et al. Lancet Oncol. 2020;21[8]:1023). And in fact, investigators in Spain found fewer new lung cancer diagnoses during the COVID-19 pandemic compared with the same time-period pre-pandemic, and those that were diagnosed were later stage disease (Reyes R, et al. IASCL World Conference. 2020. A3700).

As we learn more about COVID-19 and communities become vaccinated, it becomes critical to both resume LCS programs and improve participation. While the pandemic has hampered efforts to screening patients, it has also facilitated the uptake of new technologies such as telemedicine. In March 2020, due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services relaxed the rules for telehealth, and now covers shared decisions making (SDM) virtual visits for LCS (Centers for Medicare & Medicaid Services, “Telehealth Services.” ICN MLN901705, March 2020). This new tool, amongst others, could increase access to LCS, facilitate more widespread adoption of screening, and ultimately improve lung cancer outcomes.

Max Wayne, MD, and Jose Cardenas-Garcia, MD

Steering Committee Members

Palliative and end-of-life care

Communicating serious news over video

Critical care consultation using telemedicine is increasingly prevalent. Having serious conversations regarding end-of life care over video can be extremely challenging. Here are some suggestions and sample phrases to make palliative-focused conversations more successful

Prior to initiating the conversation, communicate with the bedside team. Ensure they want you to discuss palliative options and make an outline of discussion topics together. Identify and include all important decision-makers. Family may need to be connected over a digital meeting platform such as Zoom^© or WEBex^© and arrange for interpreter services if needed.

Prepare the virtual meeting place ahead of time. Test the connection, and make sure the audiovisual quality is clear. Have the camera centrally positioned, and ensure adequate lighting to easily see facial expressions. Remove distracting background furniture, and clear your space of confidential material. Have a quiet area planned to avoid interruptions (J Gen Intern Med. 2020 Oct 27:1-4. doi: 10.1007/s11606-020-06278-z. Online ahead of print).

Open the conversation with introductions, and explore perceptions with open-ended questions: “So I know where to begin, tell me about your understanding of what has been happening?” Get a sense of the patient’s previous function, quality of life, and their values as an individual. Maintain good eye contact throughout. When ready to give an update, use simple language and avoid details: “Unfortunately, your condition is worse. You have not been responding to treatments as hoped. Your lungs are needing much more support, and I’m worried they are not going to get better.”Anticipate emotions, and provide empathetic responses: “I wish we had better news. This must be overwhelming for you” (Back, et al. Ann Int Med. 2020;172[11]:759). Finally, offer a recommendation. Most patients and families are interested in your advice and want guidance. Use the patient’s previously stated values to support your recommendation.

Andrew Badke, MD

Steering Committee Member

Respiratory care

COVID-19 pandemic bringing protocols to the forefront

COVID-19 has health care organizations threatened like never before. Staffing requirements, equipment necessities, and personnel training happen in a whirlwind.¹ Information could change daily/hourly, and the need to protocolize guidelines became more evident each day.

While protocols have existed long before COVID-19, many institutions and organizations responded to the ever-changing pandemic by creating clinical practice guidelines (CPGs) to help not only their experienced staff members but also the non-traditional ICU caregivers thrust onto the front lines.3 Organizations worked on PPE protocols, respiratory care management, and ECMO guidelines to name a few.^2,3 Protocols with algorithms and CPGs have been shown to reduce patient harm and improve standardization and communication.

A CPG is a general principle that guides the management of care, in which specific questions are posed, a literature review is completed, and the quality of the research evaluated. The questions are answered using the strength of the available research. CPG decision points are then based on the evidence or on the consensus of experts, resulting in a protocol that are descriptions of detailed behaviors to be followed in specific situations. These behaviors are provided in a list format or a flow diagram. Using a universal language for protocols with algorithms has aided many hospitals ensure effective care for patients and has even helped develop multidisciplinary relationships not present prior to the pandemic (onepagericu.com).

DeDe Gardner, RRT, DrPh, FCCP

Donna Tanner, RRT-ACCS, MBA, FCCP

Steering Committee Members



1. epub JAMA 2/2021.

2. WHO, Guidelines 1/2021.

3. CHEST, Clinical Resources.

4. Curr Treat Options Ped 2015,1:347


 

Sleep medicine

Time to move the dial: Sleep and burnout in health care workers during the COVID-19 pandemic

Although the interaction between sleep, mood disorders, and burnout is well established, many of us are still sleep-deprived. A cross-sectional study of over 800 health care workers during the pandemic stay-at-home orders in March 2020 reported that those working in-person had shorter sleep times and worse mood, while those with longer sleep times had improved mood (Conroy DA, et al. J Clin Sleep Med. 2021;17[2]:185). Even prior to COVID-19, many trainees were facing issues with sleep deprivation and burnout (Sharp M, et al. Chest. 2021;159[2]:733).

One year into the pandemic, we continue to face a unique set of hardships, exacerbating underlying sleep disorders such as insomnia, feelings of burnout, and mental health problems. An international team led by Dr. Joel Goh calculated the cost of burnout and its economic impact on the nation’s health care system and estimated this at $4.6 billion per year (Han S, et al. Ann Intern Med. 2019;170[11]:784). National medical organizations, including the National Academy of Medicine and the American Medical Association, have also placed greater emphasis on clinician well-being and resilience. Practical frameworks for creating wellness during the pandemic exist; however. senior-level executive champions are critical for implementation (Adibe B, et al. N Engl J Med Catalyst. Jun 2020). While the long-term impact remains unknown, the current state of sleep and mental health problems and the cost of burnout should be a warning to health systems and institutions to implement remedial interventions now.(“Taking action against burnout: A systems approach to professional well-being,” National Academies of Sciences, Engineering, and Medicine, October 2019.
 

Nancy H. Stewart, DO, MS, Steering Committee Member

Thoracic oncology

Impact of COVID-19 on lung cancer screening

Lung cancer is the leading cause of cancer-related death worldwide and COVID-19 is making this worse. Prior to the COVID-19 pandemic, despite evidence of improved mortality, the uptake of lung cancer screening (LCS) was quite low with only 4% of those eligible having undergone screening in 2015 (Jemal A, et al. JAMA Oncol. 2017;3[9]:1278).

As the COVID-19 pandemic unfolded, health care resources were re-allocated to critically ill patients and areas, and nonurgent care was postponed. Therefore, LCS programs were halted (Mazzone PJ, et al. Chest. 2020;158[1]:406). This led to concerns that fewer patients would undergo screening and more patients would experience delays in cancer diagnosis.

Using population-based modeling, researchers in England estimated the COVID-19 pandemic will result in decreased lung cancer survival and a subsequent increase in avoidable cancer deaths (Maringe C, et al. Lancet Oncol. 2020;21[8]:1023). And in fact, investigators in Spain found fewer new lung cancer diagnoses during the COVID-19 pandemic compared with the same time-period pre-pandemic, and those that were diagnosed were later stage disease (Reyes R, et al. IASCL World Conference. 2020. A3700).

As we learn more about COVID-19 and communities become vaccinated, it becomes critical to both resume LCS programs and improve participation. While the pandemic has hampered efforts to screening patients, it has also facilitated the uptake of new technologies such as telemedicine. In March 2020, due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services relaxed the rules for telehealth, and now covers shared decisions making (SDM) virtual visits for LCS (Centers for Medicare & Medicaid Services, “Telehealth Services.” ICN MLN901705, March 2020). This new tool, amongst others, could increase access to LCS, facilitate more widespread adoption of screening, and ultimately improve lung cancer outcomes.

Max Wayne, MD, and Jose Cardenas-Garcia, MD

Steering Committee Members

The relationship between asthma and cardiovascular disease: An examination of the Framingham offspring study. By Dr M. Pollevick, et al.

Projecting long-term health and economic burden of chronic obstructive pulmonary disease in the United States. By Dr. Z. Zafari, et al.



How I do it: Dosing fluids in early septic shock. By Dr. D. Chaudhuri, et al.



Essential components of an interstitial lung disease clinic: Results from a Delphi survey and patient focus group analysis. By Dr. B. A. Graney, et al.



Change: Leadership essentials for chest medicine professionals. By Dr. J. Stoller, et al.



Race correction and spirometry: Why history matters. By Dr. L. Braun.

The relationship between asthma and cardiovascular disease: An examination of the Framingham offspring study. By Dr M. Pollevick, et al.

Projecting long-term health and economic burden of chronic obstructive pulmonary disease in the United States. By Dr. Z. Zafari, et al.



How I do it: Dosing fluids in early septic shock. By Dr. D. Chaudhuri, et al.



Essential components of an interstitial lung disease clinic: Results from a Delphi survey and patient focus group analysis. By Dr. B. A. Graney, et al.



Change: Leadership essentials for chest medicine professionals. By Dr. J. Stoller, et al.



Race correction and spirometry: Why history matters. By Dr. L. Braun.

The relationship between asthma and cardiovascular disease: An examination of the Framingham offspring study. By Dr M. Pollevick, et al.

Projecting long-term health and economic burden of chronic obstructive pulmonary disease in the United States. By Dr. Z. Zafari, et al.



How I do it: Dosing fluids in early septic shock. By Dr. D. Chaudhuri, et al.



Essential components of an interstitial lung disease clinic: Results from a Delphi survey and patient focus group analysis. By Dr. B. A. Graney, et al.



Change: Leadership essentials for chest medicine professionals. By Dr. J. Stoller, et al.



Race correction and spirometry: Why history matters. By Dr. L. Braun.

With the confidence that comes from 25 years of strong guidance and inspired leadership, the CHEST Foundation is ready to step into a new role as conversation starters, access granters, and change makers. The Foundation will spend this anniversary year celebrating the past and sharing the bold future ahead with our community.

Leaders of the past

Founded on the promise of delivering grants and branching into education and outreach, the Foundation’s accomplishments are endless:

• Creating engaging tobacco cessation and educational programming.
• Launching the “Beyond Our Walls” campaign to support CHEST’s Simulation Center.
• Partnering with the Popovich family to secure a substantial ILD endowment.
• Providing COVID-19 microgrants aimed at community outreach.
• Launching a Listening Tours campaign to address health disparities.
• Producing a complimentary oxygen toolkit for patients across the United States.

Trailblazers of the future

The CHEST Foundation is rising to a new level of philanthropic work by – creating premier patient education tools, aggressively tackling health disparities in marginalized communities, awarding millions in community grants, and partnering with physicians to offer better resources to patients.

While we remember the journey here, it’s now time to blaze into the future. We hope you’ll join us by learning more about our anniversary, attending our virtual events, and getting involved with the Foundation.

Visit chestfoundation.org/25th-anniversary to learn more.



Title: Share Our Story on Social Media

Paragraph: Follow the hashtag #CHESTFoundation25 on Twitter, Instagram, and Facebook. We’ll be asking questions every month and would love to hear from you!


 

With the confidence that comes from 25 years of strong guidance and inspired leadership, the CHEST Foundation is ready to step into a new role as conversation starters, access granters, and change makers. The Foundation will spend this anniversary year celebrating the past and sharing the bold future ahead with our community.

Leaders of the past

Founded on the promise of delivering grants and branching into education and outreach, the Foundation’s accomplishments are endless:

• Creating engaging tobacco cessation and educational programming.
• Launching the “Beyond Our Walls” campaign to support CHEST’s Simulation Center.
• Partnering with the Popovich family to secure a substantial ILD endowment.
• Providing COVID-19 microgrants aimed at community outreach.
• Launching a Listening Tours campaign to address health disparities.
• Producing a complimentary oxygen toolkit for patients across the United States.

Trailblazers of the future

The CHEST Foundation is rising to a new level of philanthropic work by – creating premier patient education tools, aggressively tackling health disparities in marginalized communities, awarding millions in community grants, and partnering with physicians to offer better resources to patients.

While we remember the journey here, it’s now time to blaze into the future. We hope you’ll join us by learning more about our anniversary, attending our virtual events, and getting involved with the Foundation.

Visit chestfoundation.org/25th-anniversary to learn more.



Title: Share Our Story on Social Media

Paragraph: Follow the hashtag #CHESTFoundation25 on Twitter, Instagram, and Facebook. We’ll be asking questions every month and would love to hear from you!


 

With the confidence that comes from 25 years of strong guidance and inspired leadership, the CHEST Foundation is ready to step into a new role as conversation starters, access granters, and change makers. The Foundation will spend this anniversary year celebrating the past and sharing the bold future ahead with our community.

Leaders of the past

Founded on the promise of delivering grants and branching into education and outreach, the Foundation’s accomplishments are endless:

• Creating engaging tobacco cessation and educational programming.
• Launching the “Beyond Our Walls” campaign to support CHEST’s Simulation Center.
• Partnering with the Popovich family to secure a substantial ILD endowment.
• Providing COVID-19 microgrants aimed at community outreach.
• Launching a Listening Tours campaign to address health disparities.
• Producing a complimentary oxygen toolkit for patients across the United States.

Trailblazers of the future

The CHEST Foundation is rising to a new level of philanthropic work by – creating premier patient education tools, aggressively tackling health disparities in marginalized communities, awarding millions in community grants, and partnering with physicians to offer better resources to patients.

While we remember the journey here, it’s now time to blaze into the future. We hope you’ll join us by learning more about our anniversary, attending our virtual events, and getting involved with the Foundation.

Visit chestfoundation.org/25th-anniversary to learn more.



Title: Share Our Story on Social Media

Paragraph: Follow the hashtag #CHESTFoundation25 on Twitter, Instagram, and Facebook. We’ll be asking questions every month and would love to hear from you!


 

Thinking about best option for attending CHEST 2021 – in-person or online? There are advantages to both.

Courtesy Orange County Convention Center

For attendees who can’t travel because of restrictions, you will have access to all the learning that will take place from Oct 17-20 at CHEST 2021. You can view the sessions through live streaming and access them on demand. CHEST is building an even better delivery platform based on the highly successful online conference last year. Compete in the Players Hub and take part in simulations. We watched last year as participants shared images on social media, showing how they joined the conference. If online is the best option for you, CHEST 2021 will deliver all the learning whenever you can attend.

Joining us in Orlando provides you the opportunity to network with your colleagues, discuss and learn informally, stop by the poster presentations, and visit with exhibitors to hear what’s new to help you in your clinical practice.
 

Conference center and hotels

CHEST 2021 will be held at the Orange County Convention Center, which has 1.1 million square feet of meeting and exhibition space. This means ample room for social distancing and the ability to adhere to CDC safety protocols. We anticipate there will be changes in guidelines as vaccinations roll out across the country, but CHEST is planning based on procedures currently in place. And we are taking full advantage of all the square footage with wider pathways in the exhibit hall. The Orange County Convention Center is surrounded by hotels, four of them connecting directly to the convention center. Hilton Orlando will serve as the official conference hotel.

Visiting local attractions

You don’t go to Orlando without having a few destinations in mind. If you are planning to visit Disney World, Universal Studio, or SeaWorld, reservations are required. Each park has implemented a reservation system requiring guests and pass members to secure a specific day for their visit in advance. All ticket holders – including single day visitors, multi-day ticket holders, group ticket holders, complimentary ticket holders, seasonal and annual pass members and Fun Card holders – are required to make a reservation at each park before they visit. This is to limit the total number of people in the parks at one time. Same-day reservations may be possible but should not be counted on if visiting the parks is high on your list of things to do.

When it comes to dining and shopping, International Drive – which encompasses the Orange County Convention Center – has a diverse selection of restaurants and entertainment options, ensuring something for everyone. Whether it’s eating at the AAA Four Diamond restaurants at Rosen Shingle Creek or going casual and enjoying the authentically prepared and internationally inspired foods at the Wheelhouse in ICON Park, you’ll find something that satisfies.

Looking for something different? Try an airboat ride across the wetlands of central Florida. See alligators, turtles, birds, and more in their natural environment. Trips include day tours and night adventures. Or take a guided cruise through three of the seven lakes and two narrow canals on the tranquil Winter Park chain.

And, if a few hours in the sunshine chasing a little white ball are to your liking, just down the road from the convention center is a newly redesigned championship golf course by Arnold Palmer Design Company, the Shingle Creek Golf Club. Bring your clubs or rent them at the course.

Grab your friends and colleagues for some fun and try out a few of these places. Maybe even invite the family to join you before or after the conference, and enjoy the getaway.

Thinking about best option for attending CHEST 2021 – in-person or online? There are advantages to both.

Courtesy Orange County Convention Center

For attendees who can’t travel because of restrictions, you will have access to all the learning that will take place from Oct 17-20 at CHEST 2021. You can view the sessions through live streaming and access them on demand. CHEST is building an even better delivery platform based on the highly successful online conference last year. Compete in the Players Hub and take part in simulations. We watched last year as participants shared images on social media, showing how they joined the conference. If online is the best option for you, CHEST 2021 will deliver all the learning whenever you can attend.

Joining us in Orlando provides you the opportunity to network with your colleagues, discuss and learn informally, stop by the poster presentations, and visit with exhibitors to hear what’s new to help you in your clinical practice.
 

Conference center and hotels

CHEST 2021 will be held at the Orange County Convention Center, which has 1.1 million square feet of meeting and exhibition space. This means ample room for social distancing and the ability to adhere to CDC safety protocols. We anticipate there will be changes in guidelines as vaccinations roll out across the country, but CHEST is planning based on procedures currently in place. And we are taking full advantage of all the square footage with wider pathways in the exhibit hall. The Orange County Convention Center is surrounded by hotels, four of them connecting directly to the convention center. Hilton Orlando will serve as the official conference hotel.

Visiting local attractions

You don’t go to Orlando without having a few destinations in mind. If you are planning to visit Disney World, Universal Studio, or SeaWorld, reservations are required. Each park has implemented a reservation system requiring guests and pass members to secure a specific day for their visit in advance. All ticket holders – including single day visitors, multi-day ticket holders, group ticket holders, complimentary ticket holders, seasonal and annual pass members and Fun Card holders – are required to make a reservation at each park before they visit. This is to limit the total number of people in the parks at one time. Same-day reservations may be possible but should not be counted on if visiting the parks is high on your list of things to do.

When it comes to dining and shopping, International Drive – which encompasses the Orange County Convention Center – has a diverse selection of restaurants and entertainment options, ensuring something for everyone. Whether it’s eating at the AAA Four Diamond restaurants at Rosen Shingle Creek or going casual and enjoying the authentically prepared and internationally inspired foods at the Wheelhouse in ICON Park, you’ll find something that satisfies.

Looking for something different? Try an airboat ride across the wetlands of central Florida. See alligators, turtles, birds, and more in their natural environment. Trips include day tours and night adventures. Or take a guided cruise through three of the seven lakes and two narrow canals on the tranquil Winter Park chain.

And, if a few hours in the sunshine chasing a little white ball are to your liking, just down the road from the convention center is a newly redesigned championship golf course by Arnold Palmer Design Company, the Shingle Creek Golf Club. Bring your clubs or rent them at the course.

Grab your friends and colleagues for some fun and try out a few of these places. Maybe even invite the family to join you before or after the conference, and enjoy the getaway.

Thinking about best option for attending CHEST 2021 – in-person or online? There are advantages to both.

Courtesy Orange County Convention Center

For attendees who can’t travel because of restrictions, you will have access to all the learning that will take place from Oct 17-20 at CHEST 2021. You can view the sessions through live streaming and access them on demand. CHEST is building an even better delivery platform based on the highly successful online conference last year. Compete in the Players Hub and take part in simulations. We watched last year as participants shared images on social media, showing how they joined the conference. If online is the best option for you, CHEST 2021 will deliver all the learning whenever you can attend.

Joining us in Orlando provides you the opportunity to network with your colleagues, discuss and learn informally, stop by the poster presentations, and visit with exhibitors to hear what’s new to help you in your clinical practice.
 

Conference center and hotels

CHEST 2021 will be held at the Orange County Convention Center, which has 1.1 million square feet of meeting and exhibition space. This means ample room for social distancing and the ability to adhere to CDC safety protocols. We anticipate there will be changes in guidelines as vaccinations roll out across the country, but CHEST is planning based on procedures currently in place. And we are taking full advantage of all the square footage with wider pathways in the exhibit hall. The Orange County Convention Center is surrounded by hotels, four of them connecting directly to the convention center. Hilton Orlando will serve as the official conference hotel.

Visiting local attractions

You don’t go to Orlando without having a few destinations in mind. If you are planning to visit Disney World, Universal Studio, or SeaWorld, reservations are required. Each park has implemented a reservation system requiring guests and pass members to secure a specific day for their visit in advance. All ticket holders – including single day visitors, multi-day ticket holders, group ticket holders, complimentary ticket holders, seasonal and annual pass members and Fun Card holders – are required to make a reservation at each park before they visit. This is to limit the total number of people in the parks at one time. Same-day reservations may be possible but should not be counted on if visiting the parks is high on your list of things to do.

When it comes to dining and shopping, International Drive – which encompasses the Orange County Convention Center – has a diverse selection of restaurants and entertainment options, ensuring something for everyone. Whether it’s eating at the AAA Four Diamond restaurants at Rosen Shingle Creek or going casual and enjoying the authentically prepared and internationally inspired foods at the Wheelhouse in ICON Park, you’ll find something that satisfies.

Looking for something different? Try an airboat ride across the wetlands of central Florida. See alligators, turtles, birds, and more in their natural environment. Trips include day tours and night adventures. Or take a guided cruise through three of the seven lakes and two narrow canals on the tranquil Winter Park chain.

And, if a few hours in the sunshine chasing a little white ball are to your liking, just down the road from the convention center is a newly redesigned championship golf course by Arnold Palmer Design Company, the Shingle Creek Golf Club. Bring your clubs or rent them at the course.

Grab your friends and colleagues for some fun and try out a few of these places. Maybe even invite the family to join you before or after the conference, and enjoy the getaway.

Adherence to Asthma Biologics: Implications for Patient Selection, Step Therapy and Outcomes. By Dr. Rank, et al.

Long-term Benefits of Pulmonary Rehabilitation in COPD Patients: A 2-Year Follow-up Study. By Dr. A. Yohannes, et al.



Impact of Corticosteroids in COVID-19 Outcomes: Systematic Review and Meta-Analysis. By Dr. E. Cano, et al.



Leadership Essentials for the Chest Physician: Models, Attributes, and Styles. By Dr. J. K. Stoller.



Incidence of Venous Thromboembolism and Bleeding Among Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis. By Dr. D. Jiménez, et al.



Disparities in Sleep Health and Potential Intervention Models: A Focused Review. By Dr. S. Sharma, et al.

Adherence to Asthma Biologics: Implications for Patient Selection, Step Therapy and Outcomes. By Dr. Rank, et al.

Long-term Benefits of Pulmonary Rehabilitation in COPD Patients: A 2-Year Follow-up Study. By Dr. A. Yohannes, et al.



Impact of Corticosteroids in COVID-19 Outcomes: Systematic Review and Meta-Analysis. By Dr. E. Cano, et al.



Leadership Essentials for the Chest Physician: Models, Attributes, and Styles. By Dr. J. K. Stoller.



Incidence of Venous Thromboembolism and Bleeding Among Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis. By Dr. D. Jiménez, et al.



Disparities in Sleep Health and Potential Intervention Models: A Focused Review. By Dr. S. Sharma, et al.

Adherence to Asthma Biologics: Implications for Patient Selection, Step Therapy and Outcomes. By Dr. Rank, et al.

Long-term Benefits of Pulmonary Rehabilitation in COPD Patients: A 2-Year Follow-up Study. By Dr. A. Yohannes, et al.



Impact of Corticosteroids in COVID-19 Outcomes: Systematic Review and Meta-Analysis. By Dr. E. Cano, et al.



Leadership Essentials for the Chest Physician: Models, Attributes, and Styles. By Dr. J. K. Stoller.



Incidence of Venous Thromboembolism and Bleeding Among Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis. By Dr. D. Jiménez, et al.



Disparities in Sleep Health and Potential Intervention Models: A Focused Review. By Dr. S. Sharma, et al.

CHEST is excited to announce that CHEST 2021 will be held in Orlando, Florida, from October 17-21 at the Orange County Convention Center. CHEST 2021 will be offered as both an in-person and online experience. Since travel restrictions remain unknown, CHEST is working to ensure that everyone has access to the same top-tier learning – wherever they are.

“Learning together as a community is an important aspect of the CHEST annual meeting. Whether we are face-to-face or online, the knowledge gained from expert presenters, simulations and games, and talking with one another can’t be duplicated elsewhere. In whatever way you can attend, join us at CHEST 2021 to discuss the critically relevant topics affecting our patients and chest medicine,” said CHEST President Steve Simpson, MD, FCCP.

It is also essential that those who cannot travel can still avail themselves of the engaging and interactive learning offered at the CHEST conference. Everyone – whether online or in-person – will be able to experience the meeting in real-time, including expert faculty presentations, simulated learning experiences, gaming, and more.
 

What to expect

Through bite-sized, immersive learning, experts in the field will cover the latest updates in pulmonary, critical care, and sleep medicine. CHEST 2021 offers you the opportunity to learn from a diverse set of knowledgeable educators representing different viewpoints and experiences.

Team-based learning is an indispensable component of the annual meeting. The activities support collaborative discovery and help you build relationships with your peers. Known for its development of simulation courses, at CHEST 2021, you can take part in the latest in “hands-on” learning. In addition, gaming will allow for friendly competition among colleagues, whether playing from home or on-site.
 

Getting involved

Make your mark by submitting your original abstracts and case reports to be presented at CHEST 2021. Because of the past year’s challenges, new discoveries were made in the treatment and approaches to managing chest medicine diseases. This work is important and will inform the way patients receive care in the future.

Showcase COVID-19 research, among other topics you are working on, for a chance to share your findings with colleagues, gain feedback from expert faculty, collaborate with other professionals in the field, and expand your professional portfolio. The deadline to submit is April 28. [link]
 

Keeping safe

It’s been a long time since in-person conferences were possible. CHEST is closely monitoring the status of the pandemic throughout the planning process. The Orange County Convention Center was selected because the venue is large enough to support social distancing. The CHEST team is establishing protocols that limit the number of individuals in a space, promote good traffic flow, require the wearing of masks, and other safety measures. All on-site participants and CHEST support staff will be required to attest to having received a COVID-19 vaccination to attend.

Continue to watch for more information. Registration for CHEST 2021 will open in May. We’ve missed you, and we look forward to seeing you in Orlando, Florida, October 17-20.

CHEST is excited to announce that CHEST 2021 will be held in Orlando, Florida, from October 17-21 at the Orange County Convention Center. CHEST 2021 will be offered as both an in-person and online experience. Since travel restrictions remain unknown, CHEST is working to ensure that everyone has access to the same top-tier learning – wherever they are.

“Learning together as a community is an important aspect of the CHEST annual meeting. Whether we are face-to-face or online, the knowledge gained from expert presenters, simulations and games, and talking with one another can’t be duplicated elsewhere. In whatever way you can attend, join us at CHEST 2021 to discuss the critically relevant topics affecting our patients and chest medicine,” said CHEST President Steve Simpson, MD, FCCP.

It is also essential that those who cannot travel can still avail themselves of the engaging and interactive learning offered at the CHEST conference. Everyone – whether online or in-person – will be able to experience the meeting in real-time, including expert faculty presentations, simulated learning experiences, gaming, and more.
 

What to expect

Through bite-sized, immersive learning, experts in the field will cover the latest updates in pulmonary, critical care, and sleep medicine. CHEST 2021 offers you the opportunity to learn from a diverse set of knowledgeable educators representing different viewpoints and experiences.

Team-based learning is an indispensable component of the annual meeting. The activities support collaborative discovery and help you build relationships with your peers. Known for its development of simulation courses, at CHEST 2021, you can take part in the latest in “hands-on” learning. In addition, gaming will allow for friendly competition among colleagues, whether playing from home or on-site.
 

Getting involved

Make your mark by submitting your original abstracts and case reports to be presented at CHEST 2021. Because of the past year’s challenges, new discoveries were made in the treatment and approaches to managing chest medicine diseases. This work is important and will inform the way patients receive care in the future.

Showcase COVID-19 research, among other topics you are working on, for a chance to share your findings with colleagues, gain feedback from expert faculty, collaborate with other professionals in the field, and expand your professional portfolio. The deadline to submit is April 28. [link]
 

Keeping safe

It’s been a long time since in-person conferences were possible. CHEST is closely monitoring the status of the pandemic throughout the planning process. The Orange County Convention Center was selected because the venue is large enough to support social distancing. The CHEST team is establishing protocols that limit the number of individuals in a space, promote good traffic flow, require the wearing of masks, and other safety measures. All on-site participants and CHEST support staff will be required to attest to having received a COVID-19 vaccination to attend.

Continue to watch for more information. Registration for CHEST 2021 will open in May. We’ve missed you, and we look forward to seeing you in Orlando, Florida, October 17-20.

CHEST is excited to announce that CHEST 2021 will be held in Orlando, Florida, from October 17-21 at the Orange County Convention Center. CHEST 2021 will be offered as both an in-person and online experience. Since travel restrictions remain unknown, CHEST is working to ensure that everyone has access to the same top-tier learning – wherever they are.

“Learning together as a community is an important aspect of the CHEST annual meeting. Whether we are face-to-face or online, the knowledge gained from expert presenters, simulations and games, and talking with one another can’t be duplicated elsewhere. In whatever way you can attend, join us at CHEST 2021 to discuss the critically relevant topics affecting our patients and chest medicine,” said CHEST President Steve Simpson, MD, FCCP.

It is also essential that those who cannot travel can still avail themselves of the engaging and interactive learning offered at the CHEST conference. Everyone – whether online or in-person – will be able to experience the meeting in real-time, including expert faculty presentations, simulated learning experiences, gaming, and more.
 

What to expect

Through bite-sized, immersive learning, experts in the field will cover the latest updates in pulmonary, critical care, and sleep medicine. CHEST 2021 offers you the opportunity to learn from a diverse set of knowledgeable educators representing different viewpoints and experiences.

Team-based learning is an indispensable component of the annual meeting. The activities support collaborative discovery and help you build relationships with your peers. Known for its development of simulation courses, at CHEST 2021, you can take part in the latest in “hands-on” learning. In addition, gaming will allow for friendly competition among colleagues, whether playing from home or on-site.
 

Getting involved

Make your mark by submitting your original abstracts and case reports to be presented at CHEST 2021. Because of the past year’s challenges, new discoveries were made in the treatment and approaches to managing chest medicine diseases. This work is important and will inform the way patients receive care in the future.

Showcase COVID-19 research, among other topics you are working on, for a chance to share your findings with colleagues, gain feedback from expert faculty, collaborate with other professionals in the field, and expand your professional portfolio. The deadline to submit is April 28. [link]
 

Keeping safe

It’s been a long time since in-person conferences were possible. CHEST is closely monitoring the status of the pandemic throughout the planning process. The Orange County Convention Center was selected because the venue is large enough to support social distancing. The CHEST team is establishing protocols that limit the number of individuals in a space, promote good traffic flow, require the wearing of masks, and other safety measures. All on-site participants and CHEST support staff will be required to attest to having received a COVID-19 vaccination to attend.

Continue to watch for more information. Registration for CHEST 2021 will open in May. We’ve missed you, and we look forward to seeing you in Orlando, Florida, October 17-20.

Disaster response and global health

One step forward, two back…

No adult alive today will live to see global gender parity. The 2020 World Economic Forum Global Gender Gap Report, published December 2019, assessed four dimensions of gender inequality – health, economic opportunities, educational advancement, and political empowerment.

The report stated that despite some advances, overall global gender parity would not be reached for 99 years. The gender gap is not solely a developing nation’s problem. The US standing as the 51st in gender parity fell to 53rd during the previous 2-year period. And these numbers were before Covid COVID-19.

Disasters, including pandemics, negatively affect female subjects disproportionately. Covid COVID-19 has unmasked and exacerbated both gender and minority disparity. Global health care workers (HCW) are overwhelmingly female, exposing them to a higher risk of contagion. This risk was exceptionally high among Black, Asian, and minority ethnic HCW (Nguyen et al. Lancet Public Health. 2020;5[9]:E475). The gender pay gap, where women are paid 80% of their male counterparts and women of color make 63%, has led to a greater financial burden among female HCW during Covid COVID-19. Women, including HCW, provide the majority of the unpaid work, i.e., childcare, elder care, and home care. 2020 saw an unprecedented loss of women in the workplace, including health care. Both clinical practice and research have been affected. The long- term effect on women HCW careers is unknown at present. Global gross domestic product growth loss due to this decline in the female workforce is estimated at 1 trillion USD over the next decade.

Disaster and gender parity are entwined. Covid COVID-19 has revealed the persistence of inequalities that nees to be considered in future disaster planning.

Mary Jane Reed, MD, FCCP

Steering Committee Ex-Officio


 

Interstitial and diffuse lung disease

Emergence and benefits of home monitoring and telemedicine for patients with ILD

Patients with interstitial lung disease (ILD) require regular monitoring with outpatient clinic visits and pulmonary function tests.

The emergence of COVID-19 forced an unprecedented transition to telemedicine and a new reliance on home monitoring. Home spirometry enables quick detection of rapidly progressive disease and is more sensitive than hospital-based spirometry in predicting prognosis (Russel, et al. Am J Respir Crit Care Med. 2016;194[8]:989). Patients with idiopathic pulmonary fibrosis randomized to a home monitoring program had improved psychological wellbeing and higher patient satisfaction with individually tailored treatment decisions (Moor, et al. Am J Respir Crit Care Med. 2020;202[3]:393). However, there are some inaccuracies in home monitoring. For instance, pulse oximetry is less reliable in African American patients receiving supplemental oxygen (Sjoding, et al. N Engl J Med. 2020;383:2477). It is critical to protect ILD patients from potential COVID-19 exposure given the high risk of serious complications. Telemedicine should be offered to all patients and may actually increase access to care in ILD patients, a population with disabling dyspnea and supplemental oxygen needs that requires specialist care unavailable in many geographic regions. African American patients, those older than 65, and patients with lower socioeconomic status are less willing to engage in videoconferencing (Fischer, et al. JAMA Netw Open. 2020;3[10]:e2022302). It is essential that telephone visits be offered to minimize disparities in access to care. Many telemedicine platforms enable caregivers and family members to attend visits from separate locations and provide a unique opportunity to address advance care planning. In-person visits should be arranged for patients with no access to internet or telephone or those with poor medical literacy or insufficient social support to conduct a productive remote visit. Telemedicine and home monitoring have proved invaluable during the COVID-19 pandemic and have the potential to continually increase access to and quality of care.

Rebecca Anna Gersten, MD

Steering Committee Member

Practice operations

Use of media platforms to eliminate the COVID-19 infodemic

We were shocked when we read a tweet in December 2020 from a health care worker stating, “My biggest concern is the lack of data and the quick development time. Feels like we are a bunch of guinea pigs” in reference to the new COVID-19 vaccine.

References

1. The Lancet Infectious Diseases-Editorial. The COVID-19 infodemic. Lancet Infect Dis. 2020;20(8):875.

2. Tangcharoensathien V, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22e19659.

3. Verified. https://shareverified.com/en/about. Accessed Feb 18, 2021.




 

Transplant

COVID-19 + lung transplant

The COVID-19 pandemic has created a dilemma for lung transplantation, with a new group of patients with refractory respiratory failure secondary to the viral illness. As transplant centers worldwide receive referrals for COVID-19 related respiratory failure, information regarding evaluation, listing, and posttransplant care continues to be published, but further research will be needed to care for this complex population. 

The first lung transplant for COVID-19 in the United States occurred at Northwestern Hospital on June 5th, 2020,and was publicized for its innovativeness. Information from their three lung transplants completed thus far includes information regarding pathologic findings of the explanted lung tissue; pulmonary fibrosis was the dominant feature, suggesting COVID-19-induced acute respiratory distress syndrome with prolonged time supported by mechanical support may only be survivable with the use of lung transplant (Bharat, et al. Sci Transl Med. 2020;12(574):eabe4282).

Women’s lung health

Pregnancy in cystic fibrosis

The newest in the line of modulator therapy, Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), is expected to improve life expectancy and quality of life for patients with cystic fibrosis (CF). This evolution in therapy will shape how providers care for their patients, particularly women of reproductive age. Conventionally, women with significantly impaired lung function due to CF have been advised to avoid pregnancy due to potential complications for mother and baby. It is likely that now, with improved lung function while receiving Trikafta, more women will feel better equipped to attempt pregnancy.

Disaster response and global health

One step forward, two back…

No adult alive today will live to see global gender parity. The 2020 World Economic Forum Global Gender Gap Report, published December 2019, assessed four dimensions of gender inequality – health, economic opportunities, educational advancement, and political empowerment.

The report stated that despite some advances, overall global gender parity would not be reached for 99 years. The gender gap is not solely a developing nation’s problem. The US standing as the 51st in gender parity fell to 53rd during the previous 2-year period. And these numbers were before Covid COVID-19.

Disasters, including pandemics, negatively affect female subjects disproportionately. Covid COVID-19 has unmasked and exacerbated both gender and minority disparity. Global health care workers (HCW) are overwhelmingly female, exposing them to a higher risk of contagion. This risk was exceptionally high among Black, Asian, and minority ethnic HCW (Nguyen et al. Lancet Public Health. 2020;5[9]:E475). The gender pay gap, where women are paid 80% of their male counterparts and women of color make 63%, has led to a greater financial burden among female HCW during Covid COVID-19. Women, including HCW, provide the majority of the unpaid work, i.e., childcare, elder care, and home care. 2020 saw an unprecedented loss of women in the workplace, including health care. Both clinical practice and research have been affected. The long- term effect on women HCW careers is unknown at present. Global gross domestic product growth loss due to this decline in the female workforce is estimated at 1 trillion USD over the next decade.

Disaster and gender parity are entwined. Covid COVID-19 has revealed the persistence of inequalities that nees to be considered in future disaster planning.

Mary Jane Reed, MD, FCCP

Steering Committee Ex-Officio


 

Interstitial and diffuse lung disease

Emergence and benefits of home monitoring and telemedicine for patients with ILD

Patients with interstitial lung disease (ILD) require regular monitoring with outpatient clinic visits and pulmonary function tests.

The emergence of COVID-19 forced an unprecedented transition to telemedicine and a new reliance on home monitoring. Home spirometry enables quick detection of rapidly progressive disease and is more sensitive than hospital-based spirometry in predicting prognosis (Russel, et al. Am J Respir Crit Care Med. 2016;194[8]:989). Patients with idiopathic pulmonary fibrosis randomized to a home monitoring program had improved psychological wellbeing and higher patient satisfaction with individually tailored treatment decisions (Moor, et al. Am J Respir Crit Care Med. 2020;202[3]:393). However, there are some inaccuracies in home monitoring. For instance, pulse oximetry is less reliable in African American patients receiving supplemental oxygen (Sjoding, et al. N Engl J Med. 2020;383:2477). It is critical to protect ILD patients from potential COVID-19 exposure given the high risk of serious complications. Telemedicine should be offered to all patients and may actually increase access to care in ILD patients, a population with disabling dyspnea and supplemental oxygen needs that requires specialist care unavailable in many geographic regions. African American patients, those older than 65, and patients with lower socioeconomic status are less willing to engage in videoconferencing (Fischer, et al. JAMA Netw Open. 2020;3[10]:e2022302). It is essential that telephone visits be offered to minimize disparities in access to care. Many telemedicine platforms enable caregivers and family members to attend visits from separate locations and provide a unique opportunity to address advance care planning. In-person visits should be arranged for patients with no access to internet or telephone or those with poor medical literacy or insufficient social support to conduct a productive remote visit. Telemedicine and home monitoring have proved invaluable during the COVID-19 pandemic and have the potential to continually increase access to and quality of care.

Rebecca Anna Gersten, MD

Steering Committee Member

Practice operations

Use of media platforms to eliminate the COVID-19 infodemic

We were shocked when we read a tweet in December 2020 from a health care worker stating, “My biggest concern is the lack of data and the quick development time. Feels like we are a bunch of guinea pigs” in reference to the new COVID-19 vaccine.

References

1. The Lancet Infectious Diseases-Editorial. The COVID-19 infodemic. Lancet Infect Dis. 2020;20(8):875.

2. Tangcharoensathien V, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22e19659.

3. Verified. https://shareverified.com/en/about. Accessed Feb 18, 2021.




 

Transplant

COVID-19 + lung transplant

The COVID-19 pandemic has created a dilemma for lung transplantation, with a new group of patients with refractory respiratory failure secondary to the viral illness. As transplant centers worldwide receive referrals for COVID-19 related respiratory failure, information regarding evaluation, listing, and posttransplant care continues to be published, but further research will be needed to care for this complex population. 

The first lung transplant for COVID-19 in the United States occurred at Northwestern Hospital on June 5th, 2020,and was publicized for its innovativeness. Information from their three lung transplants completed thus far includes information regarding pathologic findings of the explanted lung tissue; pulmonary fibrosis was the dominant feature, suggesting COVID-19-induced acute respiratory distress syndrome with prolonged time supported by mechanical support may only be survivable with the use of lung transplant (Bharat, et al. Sci Transl Med. 2020;12(574):eabe4282).

Women’s lung health

Pregnancy in cystic fibrosis

The newest in the line of modulator therapy, Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), is expected to improve life expectancy and quality of life for patients with cystic fibrosis (CF). This evolution in therapy will shape how providers care for their patients, particularly women of reproductive age. Conventionally, women with significantly impaired lung function due to CF have been advised to avoid pregnancy due to potential complications for mother and baby. It is likely that now, with improved lung function while receiving Trikafta, more women will feel better equipped to attempt pregnancy.

Disaster response and global health

One step forward, two back…

No adult alive today will live to see global gender parity. The 2020 World Economic Forum Global Gender Gap Report, published December 2019, assessed four dimensions of gender inequality – health, economic opportunities, educational advancement, and political empowerment.

The report stated that despite some advances, overall global gender parity would not be reached for 99 years. The gender gap is not solely a developing nation’s problem. The US standing as the 51st in gender parity fell to 53rd during the previous 2-year period. And these numbers were before Covid COVID-19.

Disasters, including pandemics, negatively affect female subjects disproportionately. Covid COVID-19 has unmasked and exacerbated both gender and minority disparity. Global health care workers (HCW) are overwhelmingly female, exposing them to a higher risk of contagion. This risk was exceptionally high among Black, Asian, and minority ethnic HCW (Nguyen et al. Lancet Public Health. 2020;5[9]:E475). The gender pay gap, where women are paid 80% of their male counterparts and women of color make 63%, has led to a greater financial burden among female HCW during Covid COVID-19. Women, including HCW, provide the majority of the unpaid work, i.e., childcare, elder care, and home care. 2020 saw an unprecedented loss of women in the workplace, including health care. Both clinical practice and research have been affected. The long- term effect on women HCW careers is unknown at present. Global gross domestic product growth loss due to this decline in the female workforce is estimated at 1 trillion USD over the next decade.

Disaster and gender parity are entwined. Covid COVID-19 has revealed the persistence of inequalities that nees to be considered in future disaster planning.

Mary Jane Reed, MD, FCCP

Steering Committee Ex-Officio


 

Interstitial and diffuse lung disease

Emergence and benefits of home monitoring and telemedicine for patients with ILD

Patients with interstitial lung disease (ILD) require regular monitoring with outpatient clinic visits and pulmonary function tests.

The emergence of COVID-19 forced an unprecedented transition to telemedicine and a new reliance on home monitoring. Home spirometry enables quick detection of rapidly progressive disease and is more sensitive than hospital-based spirometry in predicting prognosis (Russel, et al. Am J Respir Crit Care Med. 2016;194[8]:989). Patients with idiopathic pulmonary fibrosis randomized to a home monitoring program had improved psychological wellbeing and higher patient satisfaction with individually tailored treatment decisions (Moor, et al. Am J Respir Crit Care Med. 2020;202[3]:393). However, there are some inaccuracies in home monitoring. For instance, pulse oximetry is less reliable in African American patients receiving supplemental oxygen (Sjoding, et al. N Engl J Med. 2020;383:2477). It is critical to protect ILD patients from potential COVID-19 exposure given the high risk of serious complications. Telemedicine should be offered to all patients and may actually increase access to care in ILD patients, a population with disabling dyspnea and supplemental oxygen needs that requires specialist care unavailable in many geographic regions. African American patients, those older than 65, and patients with lower socioeconomic status are less willing to engage in videoconferencing (Fischer, et al. JAMA Netw Open. 2020;3[10]:e2022302). It is essential that telephone visits be offered to minimize disparities in access to care. Many telemedicine platforms enable caregivers and family members to attend visits from separate locations and provide a unique opportunity to address advance care planning. In-person visits should be arranged for patients with no access to internet or telephone or those with poor medical literacy or insufficient social support to conduct a productive remote visit. Telemedicine and home monitoring have proved invaluable during the COVID-19 pandemic and have the potential to continually increase access to and quality of care.

Rebecca Anna Gersten, MD

Steering Committee Member

Practice operations

Use of media platforms to eliminate the COVID-19 infodemic

We were shocked when we read a tweet in December 2020 from a health care worker stating, “My biggest concern is the lack of data and the quick development time. Feels like we are a bunch of guinea pigs” in reference to the new COVID-19 vaccine.

References

1. The Lancet Infectious Diseases-Editorial. The COVID-19 infodemic. Lancet Infect Dis. 2020;20(8):875.

2. Tangcharoensathien V, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22e19659.

3. Verified. https://shareverified.com/en/about. Accessed Feb 18, 2021.




 

Transplant

COVID-19 + lung transplant

The COVID-19 pandemic has created a dilemma for lung transplantation, with a new group of patients with refractory respiratory failure secondary to the viral illness. As transplant centers worldwide receive referrals for COVID-19 related respiratory failure, information regarding evaluation, listing, and posttransplant care continues to be published, but further research will be needed to care for this complex population. 

The first lung transplant for COVID-19 in the United States occurred at Northwestern Hospital on June 5th, 2020,and was publicized for its innovativeness. Information from their three lung transplants completed thus far includes information regarding pathologic findings of the explanted lung tissue; pulmonary fibrosis was the dominant feature, suggesting COVID-19-induced acute respiratory distress syndrome with prolonged time supported by mechanical support may only be survivable with the use of lung transplant (Bharat, et al. Sci Transl Med. 2020;12(574):eabe4282).

Women’s lung health

Pregnancy in cystic fibrosis

The newest in the line of modulator therapy, Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), is expected to improve life expectancy and quality of life for patients with cystic fibrosis (CF). This evolution in therapy will shape how providers care for their patients, particularly women of reproductive age. Conventionally, women with significantly impaired lung function due to CF have been advised to avoid pregnancy due to potential complications for mother and baby. It is likely that now, with improved lung function while receiving Trikafta, more women will feel better equipped to attempt pregnancy.

As I write, it is 1 degree Fahrenheit and dreary in Kansas City, where I live. That’s minus 17 degrees Celsius for many of you. I hope that it is cheerier and bordering on springtime when you’re reading. You’ll understand, though, why I say Happy 2021! 2020 was a humdinger in many ways.

As I write, it is 1 degree Fahrenheit and dreary in Kansas City, where I live. That’s minus 17 degrees Celsius for many of you. I hope that it is cheerier and bordering on springtime when you’re reading. You’ll understand, though, why I say Happy 2021! 2020 was a humdinger in many ways.

As I write, it is 1 degree Fahrenheit and dreary in Kansas City, where I live. That’s minus 17 degrees Celsius for many of you. I hope that it is cheerier and bordering on springtime when you’re reading. You’ll understand, though, why I say Happy 2021! 2020 was a humdinger in many ways.

CHEST Analytics has announced its new resource for members interested in serving as investigators in industry-sponsored clinical trials.

The new program, CHEST Clinical Trials Solutions, will pair members who have indicated their interest in specific research topics with companies seeking investigators. According to CHEST President Steven Q. Simpson, MD, FCCP: “For members who would like to be involved in research and for companies that have defined distinct criteria for their studies, CHEST Analytics can pair qualifying parties to facilitate communication between researcher and sponsor. It’s a great way for young investigators to get started or accomplished members to share their experience while helping industry expedite introducing new products that improve patient care.” More information regarding enrollment will be available at info.chestnet.org/clinical-trials.

CHEST Analytics has announced its new resource for members interested in serving as investigators in industry-sponsored clinical trials.

The new program, CHEST Clinical Trials Solutions, will pair members who have indicated their interest in specific research topics with companies seeking investigators. According to CHEST President Steven Q. Simpson, MD, FCCP: “For members who would like to be involved in research and for companies that have defined distinct criteria for their studies, CHEST Analytics can pair qualifying parties to facilitate communication between researcher and sponsor. It’s a great way for young investigators to get started or accomplished members to share their experience while helping industry expedite introducing new products that improve patient care.” More information regarding enrollment will be available at info.chestnet.org/clinical-trials.

CHEST Analytics has announced its new resource for members interested in serving as investigators in industry-sponsored clinical trials.

The new program, CHEST Clinical Trials Solutions, will pair members who have indicated their interest in specific research topics with companies seeking investigators. According to CHEST President Steven Q. Simpson, MD, FCCP: “For members who would like to be involved in research and for companies that have defined distinct criteria for their studies, CHEST Analytics can pair qualifying parties to facilitate communication between researcher and sponsor. It’s a great way for young investigators to get started or accomplished members to share their experience while helping industry expedite introducing new products that improve patient care.” More information regarding enrollment will be available at info.chestnet.org/clinical-trials.

Doreen J. Addrizzo-Harris, MD, FCCP, is a pulmonary/critical care physician with an extensive background in bronchiectasis and non-tuberculous mycobacterial infection and medical education. 

Doreen J. Addrizzo-Harris, MD, FCCP, is a pulmonary/critical care physician with an extensive background in bronchiectasis and non-tuberculous mycobacterial infection and medical education. 

Doreen J. Addrizzo-Harris, MD, FCCP, is a pulmonary/critical care physician with an extensive background in bronchiectasis and non-tuberculous mycobacterial infection and medical education.