News From CHEST Physician®

Have you shopped at the CHEST Store lately? We’ve recently updated our merchandise to include several new items perfect for staff gifts or for yourself. Along with our old standbys, including lab coats and scrubs, we now feature CHEST-branded scarves, knit caps (perfect for winter), and insulated hot and cold drink mugs. And don’t forget, most items are customizable for a small, additional fee. For the more education-inclined, the store also features the best in CHEST print, including CHEST SEEK^TM volumes, Coding for Chest Medicine, patient education guides, and much more.

Products can be ordered online, and most items are sold on-site at our live learning and board review courses and at the CHEST Annual Meeting. If you can’t purchase in person, visit the store at chestnet.org/store to stock up.

Have you shopped at the CHEST Store lately? We’ve recently updated our merchandise to include several new items perfect for staff gifts or for yourself. Along with our old standbys, including lab coats and scrubs, we now feature CHEST-branded scarves, knit caps (perfect for winter), and insulated hot and cold drink mugs. And don’t forget, most items are customizable for a small, additional fee. For the more education-inclined, the store also features the best in CHEST print, including CHEST SEEK^TM volumes, Coding for Chest Medicine, patient education guides, and much more.

Products can be ordered online, and most items are sold on-site at our live learning and board review courses and at the CHEST Annual Meeting. If you can’t purchase in person, visit the store at chestnet.org/store to stock up.

Have you shopped at the CHEST Store lately? We’ve recently updated our merchandise to include several new items perfect for staff gifts or for yourself. Along with our old standbys, including lab coats and scrubs, we now feature CHEST-branded scarves, knit caps (perfect for winter), and insulated hot and cold drink mugs. And don’t forget, most items are customizable for a small, additional fee. For the more education-inclined, the store also features the best in CHEST print, including CHEST SEEK^TM volumes, Coding for Chest Medicine, patient education guides, and much more.

Products can be ordered online, and most items are sold on-site at our live learning and board review courses and at the CHEST Annual Meeting. If you can’t purchase in person, visit the store at chestnet.org/store to stock up.

CHEST has been informed of the following members’ deaths.

We extend our sincere condolences.

Nagesh V Salian, MD, FCCP (2016)

Ted A Calinog, MD, FCCP (2017)

Azam Ansari, MD (2017)

Arthur E. Schmidt, MD, FCCP (2017)

CHEST has been informed of the following members’ deaths.

We extend our sincere condolences.

Nagesh V Salian, MD, FCCP (2016)

Ted A Calinog, MD, FCCP (2017)

Azam Ansari, MD (2017)

Arthur E. Schmidt, MD, FCCP (2017)

CHEST has been informed of the following members’ deaths.

We extend our sincere condolences.

Nagesh V Salian, MD, FCCP (2016)

Ted A Calinog, MD, FCCP (2017)

Azam Ansari, MD (2017)

Arthur E. Schmidt, MD, FCCP (2017)

Giants In Chest Medicine Professor Nan-shan Zhong, MD.

By Wei-jie Guan.

Original Research

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. By Dr. A. V. Gonzalez, et al.

Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study. By Dr. A. Sánchez-de-la-Torre, et al.

CA-125 in Disease Progression and Treatment of Lymphangioleiomyomatosis. By Dr. C. G. Glasgow, et al.

Evidence-Based Medicine

Cough Due to TB and Other Chronic Infections: CHEST Guideline and Expert Panel Report. By Dr. S. K. Field, et al, on behalf of the CHEST Expert Cough Panel.

Giants In Chest Medicine Professor Nan-shan Zhong, MD.

By Wei-jie Guan.

Original Research

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. By Dr. A. V. Gonzalez, et al.

Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study. By Dr. A. Sánchez-de-la-Torre, et al.

CA-125 in Disease Progression and Treatment of Lymphangioleiomyomatosis. By Dr. C. G. Glasgow, et al.

Evidence-Based Medicine

Cough Due to TB and Other Chronic Infections: CHEST Guideline and Expert Panel Report. By Dr. S. K. Field, et al, on behalf of the CHEST Expert Cough Panel.

Giants In Chest Medicine Professor Nan-shan Zhong, MD.

By Wei-jie Guan.

Original Research

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. By Dr. A. V. Gonzalez, et al.

Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study. By Dr. A. Sánchez-de-la-Torre, et al.

CA-125 in Disease Progression and Treatment of Lymphangioleiomyomatosis. By Dr. C. G. Glasgow, et al.

Evidence-Based Medicine

Cough Due to TB and Other Chronic Infections: CHEST Guideline and Expert Panel Report. By Dr. S. K. Field, et al, on behalf of the CHEST Expert Cough Panel.

Your gift today truly has an immediate impact that makes a difference now.

We also want you to benefit as much as possible from your generosity.

Gifts of Appreciated Securities, Mutual Funds, and Investments

If you have owned any of these longer than 1 year and they have appreciated in value, they provide a smart option for gifting. You will avoid the capital gains tax, and you also receive a charitable income tax deduction if you itemize your tax return.
 

The Charitable Individual Retirement Plan Option

If you are 70 1/2, you may distribute funds from your IRA directly to the CHEST Foundation.

You will not pay any income taxes, and it will also qualify for your required minimum withdrawal. You may distribute up to $100,000 per person per year ($200,000 if you are married and both own an IRA).

Retirement Plan Beneficiary Designation

You may also designate a charity as a beneficiary of your IRA, 401K, or 403B.

This will avoid any income tax, so 100% will be directed to the charity of your choice.

For more information on these and other ways to support the CHEST Foundation, confidentially and with no obligation, contact Angela Perillo, CHEST Director of Development & Foundation Operations, at [email protected].

Your gift today truly has an immediate impact that makes a difference now.

We also want you to benefit as much as possible from your generosity.

Gifts of Appreciated Securities, Mutual Funds, and Investments

If you have owned any of these longer than 1 year and they have appreciated in value, they provide a smart option for gifting. You will avoid the capital gains tax, and you also receive a charitable income tax deduction if you itemize your tax return.
 

The Charitable Individual Retirement Plan Option

If you are 70 1/2, you may distribute funds from your IRA directly to the CHEST Foundation.

You will not pay any income taxes, and it will also qualify for your required minimum withdrawal. You may distribute up to $100,000 per person per year ($200,000 if you are married and both own an IRA).

Retirement Plan Beneficiary Designation

You may also designate a charity as a beneficiary of your IRA, 401K, or 403B.

This will avoid any income tax, so 100% will be directed to the charity of your choice.

For more information on these and other ways to support the CHEST Foundation, confidentially and with no obligation, contact Angela Perillo, CHEST Director of Development & Foundation Operations, at [email protected].

Your gift today truly has an immediate impact that makes a difference now.

We also want you to benefit as much as possible from your generosity.

Gifts of Appreciated Securities, Mutual Funds, and Investments

If you have owned any of these longer than 1 year and they have appreciated in value, they provide a smart option for gifting. You will avoid the capital gains tax, and you also receive a charitable income tax deduction if you itemize your tax return.
 

The Charitable Individual Retirement Plan Option

If you are 70 1/2, you may distribute funds from your IRA directly to the CHEST Foundation.

You will not pay any income taxes, and it will also qualify for your required minimum withdrawal. You may distribute up to $100,000 per person per year ($200,000 if you are married and both own an IRA).

Retirement Plan Beneficiary Designation

You may also designate a charity as a beneficiary of your IRA, 401K, or 403B.

This will avoid any income tax, so 100% will be directed to the charity of your choice.

For more information on these and other ways to support the CHEST Foundation, confidentially and with no obligation, contact Angela Perillo, CHEST Director of Development & Foundation Operations, at [email protected].

On December 2, CHEST received Accreditation with Commendation from the Accreditation Council for Continuing Medical Education (ACCME). This achievement grants CHEST accreditation through November 2023, and places the organization in the highest tier of continuing medical education (CME) providers.

“It is a true privilege to serve as a member of our outstanding CHEST Education team. We are very proud of our education program and have worked very hard to provide CHEST members and their health-care team with state-of-the-art learning opportunities,” said Alex Niven, MD, FCCP, current Chair of CHEST’s Education Committee, “ACCME Accreditation with Commendation is an important benchmark of this success, and we look forward to further advancing CHEST’s leadership role in medical education through its simulation, active learning, and other innovative educational offerings.”

To receive accreditation from the ACCME, CHEST met all of the requirements of the ACCME, has transitioned clinician knowledge into action, and has enhanced procedural performance to improve patient outcomes. Accreditation with Commendation is “a reward for going above and beyond requirements--having the absolute best practices and for striving to meet the aspirational goals of medical education,” said William Kelly, MD, FCCP, previous Chair of CHEST’s Education Committee.

In achieving Accreditation with Commendation, CHEST demonstrated compliance with the following:

• Improving the professional practice by consistently integrating CME into CHEST processes.

• Utilization of noneducation strategies such as the CHEST Foundation’s grant programs and disease awareness campaigns, to enhance change as an adjunct to CHEST’s activities/educational interventions.

• Identification of factors that effect patient outcomes and are outside of the provider’s control.

• Implementation of educational strategies, including the offering of additional training to improve procedural capabilities, so as to remove, overcome, or address barriers to physician change.

• Building of bridges with stakeholders such as The France Foundation, National Comprehensive Cancer Network (NCCN), and the American Society for Clinical Pathology (ASCP), through collaboration and cooperation.

• Participation within an institutional framework for health-care quality improvement.

• Positioned to influence the scope and content of activities/educational interventions.

On December 2, CHEST received Accreditation with Commendation from the Accreditation Council for Continuing Medical Education (ACCME). This achievement grants CHEST accreditation through November 2023, and places the organization in the highest tier of continuing medical education (CME) providers.

“It is a true privilege to serve as a member of our outstanding CHEST Education team. We are very proud of our education program and have worked very hard to provide CHEST members and their health-care team with state-of-the-art learning opportunities,” said Alex Niven, MD, FCCP, current Chair of CHEST’s Education Committee, “ACCME Accreditation with Commendation is an important benchmark of this success, and we look forward to further advancing CHEST’s leadership role in medical education through its simulation, active learning, and other innovative educational offerings.”

To receive accreditation from the ACCME, CHEST met all of the requirements of the ACCME, has transitioned clinician knowledge into action, and has enhanced procedural performance to improve patient outcomes. Accreditation with Commendation is “a reward for going above and beyond requirements--having the absolute best practices and for striving to meet the aspirational goals of medical education,” said William Kelly, MD, FCCP, previous Chair of CHEST’s Education Committee.

In achieving Accreditation with Commendation, CHEST demonstrated compliance with the following:

• Improving the professional practice by consistently integrating CME into CHEST processes.

• Utilization of noneducation strategies such as the CHEST Foundation’s grant programs and disease awareness campaigns, to enhance change as an adjunct to CHEST’s activities/educational interventions.

• Identification of factors that effect patient outcomes and are outside of the provider’s control.

• Implementation of educational strategies, including the offering of additional training to improve procedural capabilities, so as to remove, overcome, or address barriers to physician change.

• Building of bridges with stakeholders such as The France Foundation, National Comprehensive Cancer Network (NCCN), and the American Society for Clinical Pathology (ASCP), through collaboration and cooperation.

• Participation within an institutional framework for health-care quality improvement.

• Positioned to influence the scope and content of activities/educational interventions.

On December 2, CHEST received Accreditation with Commendation from the Accreditation Council for Continuing Medical Education (ACCME). This achievement grants CHEST accreditation through November 2023, and places the organization in the highest tier of continuing medical education (CME) providers.

“It is a true privilege to serve as a member of our outstanding CHEST Education team. We are very proud of our education program and have worked very hard to provide CHEST members and their health-care team with state-of-the-art learning opportunities,” said Alex Niven, MD, FCCP, current Chair of CHEST’s Education Committee, “ACCME Accreditation with Commendation is an important benchmark of this success, and we look forward to further advancing CHEST’s leadership role in medical education through its simulation, active learning, and other innovative educational offerings.”

To receive accreditation from the ACCME, CHEST met all of the requirements of the ACCME, has transitioned clinician knowledge into action, and has enhanced procedural performance to improve patient outcomes. Accreditation with Commendation is “a reward for going above and beyond requirements--having the absolute best practices and for striving to meet the aspirational goals of medical education,” said William Kelly, MD, FCCP, previous Chair of CHEST’s Education Committee.

In achieving Accreditation with Commendation, CHEST demonstrated compliance with the following:

• Improving the professional practice by consistently integrating CME into CHEST processes.

• Utilization of noneducation strategies such as the CHEST Foundation’s grant programs and disease awareness campaigns, to enhance change as an adjunct to CHEST’s activities/educational interventions.

• Identification of factors that effect patient outcomes and are outside of the provider’s control.

• Implementation of educational strategies, including the offering of additional training to improve procedural capabilities, so as to remove, overcome, or address barriers to physician change.

• Building of bridges with stakeholders such as The France Foundation, National Comprehensive Cancer Network (NCCN), and the American Society for Clinical Pathology (ASCP), through collaboration and cooperation.

• Participation within an institutional framework for health-care quality improvement.

• Positioned to influence the scope and content of activities/educational interventions.

In April 2016, Facebook launched Facebook Live, a tool for live streaming to a Facebook page to share live video with their followers on Facebook. At CHEST 2016, the CHEST New Media team began to experiment with live video with some early success. The CHEST 2017 team made the decision, based on the organization’s goal to help educate clinicians to improve patient care, to live stream complete sessions from CHEST 2017. With the help of the CHEST 2017 Education Committee and the Social Media Work Group, more than 25 sessions were selected and live streamed.

CHEST’s efforts on Facebook Live resulted in the following:

• Total people reached: 133,737
• Total video views: 34,449
• Total minutes watched: 30,786 (or 513 hours, or 21 days)
• Total interactions: 1,050 (eg, likes, loves, hahas, etc)
• Total shares: 302

The content concept was well received, and comments ranged from followers chiming in with their location, appreciation for live streaming, and even comments from patients.

• “Thank you for sharing this live presentation.”
• “Here from Mexico !!”
• “Here from Natal/RN, Brazil”
• “Here from Milan, Italy.”
• “Appreciate this live streaming on important sessions, big service for those who couldn’t attend!!”
• “My brother survived after six days on ECMO. I am so glad to have him.”
• “It’s a great chance for physicians working in pulmonology and general practice to get the pearls of guidelines from American College to improve clinical practice. Now distance doesn’t matter”

Plans are underway for live streaming from CHEST 2018 in San Antonio. To view the CHEST 2017 live stream videos, visit CHEST’s Facebook page, facebook.com/accpchest.

In April 2016, Facebook launched Facebook Live, a tool for live streaming to a Facebook page to share live video with their followers on Facebook. At CHEST 2016, the CHEST New Media team began to experiment with live video with some early success. The CHEST 2017 team made the decision, based on the organization’s goal to help educate clinicians to improve patient care, to live stream complete sessions from CHEST 2017. With the help of the CHEST 2017 Education Committee and the Social Media Work Group, more than 25 sessions were selected and live streamed.

CHEST’s efforts on Facebook Live resulted in the following:

• Total people reached: 133,737
• Total video views: 34,449
• Total minutes watched: 30,786 (or 513 hours, or 21 days)
• Total interactions: 1,050 (eg, likes, loves, hahas, etc)
• Total shares: 302

The content concept was well received, and comments ranged from followers chiming in with their location, appreciation for live streaming, and even comments from patients.

• “Thank you for sharing this live presentation.”
• “Here from Mexico !!”
• “Here from Natal/RN, Brazil”
• “Here from Milan, Italy.”
• “Appreciate this live streaming on important sessions, big service for those who couldn’t attend!!”
• “My brother survived after six days on ECMO. I am so glad to have him.”
• “It’s a great chance for physicians working in pulmonology and general practice to get the pearls of guidelines from American College to improve clinical practice. Now distance doesn’t matter”

Plans are underway for live streaming from CHEST 2018 in San Antonio. To view the CHEST 2017 live stream videos, visit CHEST’s Facebook page, facebook.com/accpchest.

In April 2016, Facebook launched Facebook Live, a tool for live streaming to a Facebook page to share live video with their followers on Facebook. At CHEST 2016, the CHEST New Media team began to experiment with live video with some early success. The CHEST 2017 team made the decision, based on the organization’s goal to help educate clinicians to improve patient care, to live stream complete sessions from CHEST 2017. With the help of the CHEST 2017 Education Committee and the Social Media Work Group, more than 25 sessions were selected and live streamed.

CHEST’s efforts on Facebook Live resulted in the following:

• Total people reached: 133,737
• Total video views: 34,449
• Total minutes watched: 30,786 (or 513 hours, or 21 days)
• Total interactions: 1,050 (eg, likes, loves, hahas, etc)
• Total shares: 302

The content concept was well received, and comments ranged from followers chiming in with their location, appreciation for live streaming, and even comments from patients.

• “Thank you for sharing this live presentation.”
• “Here from Mexico !!”
• “Here from Natal/RN, Brazil”
• “Here from Milan, Italy.”
• “Appreciate this live streaming on important sessions, big service for those who couldn’t attend!!”
• “My brother survived after six days on ECMO. I am so glad to have him.”
• “It’s a great chance for physicians working in pulmonology and general practice to get the pearls of guidelines from American College to improve clinical practice. Now distance doesn’t matter”

Plans are underway for live streaming from CHEST 2018 in San Antonio. To view the CHEST 2017 live stream videos, visit CHEST’s Facebook page, facebook.com/accpchest.

Editorial

Introducing the CHEST Teaching, Education, and Career Hub

Dr. G. T. Bosslet and Dr. M. Miles
 

Training, Education, and Career Hub - TEaCH

Commentary

Higher Priced Older Pharmaceuticals: How Should We Respond?

Dr. R. S. Irwin, et al.
 

Giants in Chest Medicine

Jeffrey M. Drazen, MD, FCCP

Dr. A. S. Slutsky

Evidence-based MedicineClassification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report

Dr. R. S. Irwin, et al.
 

Original Research

Three-Hour Bundle Compliance and Outcomes in Patients With Undiagnosed Severe Sepsis

Dr. A. S. Deis, et al.



A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis

Dr. I. O. Rosas, et al.

Editorial

Introducing the CHEST Teaching, Education, and Career Hub

Dr. G. T. Bosslet and Dr. M. Miles
 

Training, Education, and Career Hub - TEaCH

Commentary

Higher Priced Older Pharmaceuticals: How Should We Respond?

Dr. R. S. Irwin, et al.
 

Giants in Chest Medicine

Jeffrey M. Drazen, MD, FCCP

Dr. A. S. Slutsky

Evidence-based MedicineClassification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report

Dr. R. S. Irwin, et al.
 

Original Research

Three-Hour Bundle Compliance and Outcomes in Patients With Undiagnosed Severe Sepsis

Dr. A. S. Deis, et al.



A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis

Dr. I. O. Rosas, et al.

Editorial

Introducing the CHEST Teaching, Education, and Career Hub

Dr. G. T. Bosslet and Dr. M. Miles
 

Training, Education, and Career Hub - TEaCH

Commentary

Higher Priced Older Pharmaceuticals: How Should We Respond?

Dr. R. S. Irwin, et al.
 

Giants in Chest Medicine

Jeffrey M. Drazen, MD, FCCP

Dr. A. S. Slutsky

Evidence-based MedicineClassification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report

Dr. R. S. Irwin, et al.
 

Original Research

Three-Hour Bundle Compliance and Outcomes in Patients With Undiagnosed Severe Sepsis

Dr. A. S. Deis, et al.



A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis

Dr. I. O. Rosas, et al.

The Elk Grove Village, Illinois, Board of Trustees passed the “Tobacco 21” ordinance that will raise the tobacco purchasing age to 21, which includes nicotine vaping. The policy, which will go into effect January 1, 2018, will protect young people from beginning a lifetime of addiction and, ultimately, save their lives.

Kevin L Kovitz MD, MBA, FCCP, attended the Village Board meeting to advocate for “Tobacco 21.” He is a Sustaining Member of the CHEST Foundation, continually exemplifying what it is to be a lung health champion.

Dr. Kovitz noted, “This policy will protect our kids from the scourge of Big Tobacco and save funding for health-care costs and, most importantly, will ultimately save lives. The ordinance will protect the most vulnerable parts of our population, our children. Raising the legal age puts tobacco products on par with alcohol and protects young adults from developing a dangerous lifelong habit.”

Five US states have also passed Tobacco 21; they include California, Hawaii, Maine, New Jersey, and Oregon. There are many local ordinances around the country but more are needed.

Advocating for this ordinance demonstrates the effectiveness of grassroots advocacy in our local communities.

The Elk Grove Village, Illinois, Board of Trustees passed the “Tobacco 21” ordinance that will raise the tobacco purchasing age to 21, which includes nicotine vaping. The policy, which will go into effect January 1, 2018, will protect young people from beginning a lifetime of addiction and, ultimately, save their lives.

Kevin L Kovitz MD, MBA, FCCP, attended the Village Board meeting to advocate for “Tobacco 21.” He is a Sustaining Member of the CHEST Foundation, continually exemplifying what it is to be a lung health champion.

Dr. Kovitz noted, “This policy will protect our kids from the scourge of Big Tobacco and save funding for health-care costs and, most importantly, will ultimately save lives. The ordinance will protect the most vulnerable parts of our population, our children. Raising the legal age puts tobacco products on par with alcohol and protects young adults from developing a dangerous lifelong habit.”

Five US states have also passed Tobacco 21; they include California, Hawaii, Maine, New Jersey, and Oregon. There are many local ordinances around the country but more are needed.

Advocating for this ordinance demonstrates the effectiveness of grassroots advocacy in our local communities.

The Elk Grove Village, Illinois, Board of Trustees passed the “Tobacco 21” ordinance that will raise the tobacco purchasing age to 21, which includes nicotine vaping. The policy, which will go into effect January 1, 2018, will protect young people from beginning a lifetime of addiction and, ultimately, save their lives.

Kevin L Kovitz MD, MBA, FCCP, attended the Village Board meeting to advocate for “Tobacco 21.” He is a Sustaining Member of the CHEST Foundation, continually exemplifying what it is to be a lung health champion.

Dr. Kovitz noted, “This policy will protect our kids from the scourge of Big Tobacco and save funding for health-care costs and, most importantly, will ultimately save lives. The ordinance will protect the most vulnerable parts of our population, our children. Raising the legal age puts tobacco products on par with alcohol and protects young adults from developing a dangerous lifelong habit.”

Five US states have also passed Tobacco 21; they include California, Hawaii, Maine, New Jersey, and Oregon. There are many local ordinances around the country but more are needed.

Advocating for this ordinance demonstrates the effectiveness of grassroots advocacy in our local communities.

Cardiovascular Medicine and Surgery

The Holy Grail of Blood Pressure Management?
 

Blood pressure treatment recommendations have been confusing over the past few years. The Joint National Committee (JNC) 8 stirred up controversy in 2014 because they raised the recommended tolerating systolic blood pressures, in certain people aged 60 and above, up to 150 mm Hg [James, et al. JAMA. 2014;311(5):507-520]. The new AHA/ACC hypertension guidelines cosponsored by 11 societies generated controversy because they changed the definition of hypertension (normal <120/80 mm Hg, elevated 120-129/80-89, stage 1 130-139/80-89, or stage 2 >140/90) [Whelton et al. J Am Coll Cardiol. 2017 pii:S0735-1097(17)41519-1]. The SPRINT trial [Wright, et al. N Engl J Med. 2015;373:2103-2116] largely influenced these recommendations. SPRINT demonstrated a 25% relative risk reduction of heart attack, stroke, cardiovascular death, or decompensated heart failure with more aggressive blood pressure management (BP goal <120/90 vs <140/90).

This new classification would label 46% of Americans, or 103.3 million people, as hypertensive. However, there is uncertainty in how broadly applicable the SPRINT results are, particularly in those under the age of 45. The majority of large clinical trials, including SPRINT, have limited numbers of patients who were less than 50 years old and, therefore, it is unknown if younger patients benefit to the same degree. The absolute improvement is also questionable because as an editorial points out [Welch, “Don’t Let New Blood Pressure Guidelines Raise Yours” NY Times. Nov. 15, 2017], the primary endpoint in SPRINT only occurred in less than or equal to 8% of patients.

These guidelines reinforce the need to measure ambulatory blood pressures, perform proper in-office blood pressure measurements, and emphasize lifestyle modifications. Whether aggressive blood pressure management is worth the potential risks and the degree to which ideal blood pressure measurement can be applied to real world practices, remains uncertain.

David J. Nagel, MD, PhD Steering Committee Member

Chest Infections

Candida auris

Invasive fungal infections are frequently managed by ICU physicians and are a leading cause of mortality among critically ill patients. Invasive candidiasis is associated with an attributable mortality rate of up to 49%. Historically, the majority of these infections has been caused by Candida albicans, but this may be changing.

The first outbreak of Candida auris in the Americas (18 patients) occurred in the ICU of a hospital in Venezuela. Resistance to common azoles was documented, and half of the isolates showed decreased susceptibility to amphotericin B. As of August 2017, a total 153 clinical cases of C auris infection have been reported to CDC from 10 US states; most have occurred in New York and New Jersey.

What has been learned from these cases is that close contacts can be colonized, colonization can be persistent (approximately 9 months), the yeast can survive in the hospital environment, bleach or sporicide is needed for elimination, isolation precautions are recommended as for MDRO bacteria, and serial resistance to echinocandins has been observed.

Principal takeaways:
 

1Candida auris isolates are often MDR, with some strains having elevated MICs to drugs in all the three major classes of antifungal medications.

2The isolates are difficult to identify and require specialized methods, such as MALDI-TOF or molecular identification based on sequencing.

3Misidentification may lead to inappropriate treatment.

4C auris has the propensity to cause outbreaks in health-care settings, as has been reported in several countries, and resistance may result in treatment failure.

Richard Winn, MD, MS, FCCPImmediate Past Chair

References

1. Sarma S. Current perspective on emergence, diagnosis and drug resistance in Candida auris. Infect Drug Resistance. 2017;10:155–165.

2. Pan American Health Organization/World Health Organization. Epidemiological Alert: Candida auris outbreaks in health care services. October 3, Washington, DC: PAHO/WHO; 2016.

3. Centers for Disease Control and Prevention. Global emergence of invasive infections caused by the multidrug-resistant yeast Candida auris. CDC; 2016 [updated June 24, 2016]

Cardiovascular Medicine and Surgery

The Holy Grail of Blood Pressure Management?
 

Blood pressure treatment recommendations have been confusing over the past few years. The Joint National Committee (JNC) 8 stirred up controversy in 2014 because they raised the recommended tolerating systolic blood pressures, in certain people aged 60 and above, up to 150 mm Hg [James, et al. JAMA. 2014;311(5):507-520]. The new AHA/ACC hypertension guidelines cosponsored by 11 societies generated controversy because they changed the definition of hypertension (normal <120/80 mm Hg, elevated 120-129/80-89, stage 1 130-139/80-89, or stage 2 >140/90) [Whelton et al. J Am Coll Cardiol. 2017 pii:S0735-1097(17)41519-1]. The SPRINT trial [Wright, et al. N Engl J Med. 2015;373:2103-2116] largely influenced these recommendations. SPRINT demonstrated a 25% relative risk reduction of heart attack, stroke, cardiovascular death, or decompensated heart failure with more aggressive blood pressure management (BP goal <120/90 vs <140/90).

This new classification would label 46% of Americans, or 103.3 million people, as hypertensive. However, there is uncertainty in how broadly applicable the SPRINT results are, particularly in those under the age of 45. The majority of large clinical trials, including SPRINT, have limited numbers of patients who were less than 50 years old and, therefore, it is unknown if younger patients benefit to the same degree. The absolute improvement is also questionable because as an editorial points out [Welch, “Don’t Let New Blood Pressure Guidelines Raise Yours” NY Times. Nov. 15, 2017], the primary endpoint in SPRINT only occurred in less than or equal to 8% of patients.

These guidelines reinforce the need to measure ambulatory blood pressures, perform proper in-office blood pressure measurements, and emphasize lifestyle modifications. Whether aggressive blood pressure management is worth the potential risks and the degree to which ideal blood pressure measurement can be applied to real world practices, remains uncertain.

David J. Nagel, MD, PhD Steering Committee Member

Chest Infections

Candida auris

Invasive fungal infections are frequently managed by ICU physicians and are a leading cause of mortality among critically ill patients. Invasive candidiasis is associated with an attributable mortality rate of up to 49%. Historically, the majority of these infections has been caused by Candida albicans, but this may be changing.

The first outbreak of Candida auris in the Americas (18 patients) occurred in the ICU of a hospital in Venezuela. Resistance to common azoles was documented, and half of the isolates showed decreased susceptibility to amphotericin B. As of August 2017, a total 153 clinical cases of C auris infection have been reported to CDC from 10 US states; most have occurred in New York and New Jersey.

What has been learned from these cases is that close contacts can be colonized, colonization can be persistent (approximately 9 months), the yeast can survive in the hospital environment, bleach or sporicide is needed for elimination, isolation precautions are recommended as for MDRO bacteria, and serial resistance to echinocandins has been observed.

Principal takeaways:
 

1Candida auris isolates are often MDR, with some strains having elevated MICs to drugs in all the three major classes of antifungal medications.

2The isolates are difficult to identify and require specialized methods, such as MALDI-TOF or molecular identification based on sequencing.

3Misidentification may lead to inappropriate treatment.

4C auris has the propensity to cause outbreaks in health-care settings, as has been reported in several countries, and resistance may result in treatment failure.

Richard Winn, MD, MS, FCCPImmediate Past Chair

References

1. Sarma S. Current perspective on emergence, diagnosis and drug resistance in Candida auris. Infect Drug Resistance. 2017;10:155–165.

2. Pan American Health Organization/World Health Organization. Epidemiological Alert: Candida auris outbreaks in health care services. October 3, Washington, DC: PAHO/WHO; 2016.

3. Centers for Disease Control and Prevention. Global emergence of invasive infections caused by the multidrug-resistant yeast Candida auris. CDC; 2016 [updated June 24, 2016]

Cardiovascular Medicine and Surgery

The Holy Grail of Blood Pressure Management?
 

Blood pressure treatment recommendations have been confusing over the past few years. The Joint National Committee (JNC) 8 stirred up controversy in 2014 because they raised the recommended tolerating systolic blood pressures, in certain people aged 60 and above, up to 150 mm Hg [James, et al. JAMA. 2014;311(5):507-520]. The new AHA/ACC hypertension guidelines cosponsored by 11 societies generated controversy because they changed the definition of hypertension (normal <120/80 mm Hg, elevated 120-129/80-89, stage 1 130-139/80-89, or stage 2 >140/90) [Whelton et al. J Am Coll Cardiol. 2017 pii:S0735-1097(17)41519-1]. The SPRINT trial [Wright, et al. N Engl J Med. 2015;373:2103-2116] largely influenced these recommendations. SPRINT demonstrated a 25% relative risk reduction of heart attack, stroke, cardiovascular death, or decompensated heart failure with more aggressive blood pressure management (BP goal <120/90 vs <140/90).

This new classification would label 46% of Americans, or 103.3 million people, as hypertensive. However, there is uncertainty in how broadly applicable the SPRINT results are, particularly in those under the age of 45. The majority of large clinical trials, including SPRINT, have limited numbers of patients who were less than 50 years old and, therefore, it is unknown if younger patients benefit to the same degree. The absolute improvement is also questionable because as an editorial points out [Welch, “Don’t Let New Blood Pressure Guidelines Raise Yours” NY Times. Nov. 15, 2017], the primary endpoint in SPRINT only occurred in less than or equal to 8% of patients.

These guidelines reinforce the need to measure ambulatory blood pressures, perform proper in-office blood pressure measurements, and emphasize lifestyle modifications. Whether aggressive blood pressure management is worth the potential risks and the degree to which ideal blood pressure measurement can be applied to real world practices, remains uncertain.

David J. Nagel, MD, PhD Steering Committee Member

Chest Infections

Candida auris

Invasive fungal infections are frequently managed by ICU physicians and are a leading cause of mortality among critically ill patients. Invasive candidiasis is associated with an attributable mortality rate of up to 49%. Historically, the majority of these infections has been caused by Candida albicans, but this may be changing.

The first outbreak of Candida auris in the Americas (18 patients) occurred in the ICU of a hospital in Venezuela. Resistance to common azoles was documented, and half of the isolates showed decreased susceptibility to amphotericin B. As of August 2017, a total 153 clinical cases of C auris infection have been reported to CDC from 10 US states; most have occurred in New York and New Jersey.

What has been learned from these cases is that close contacts can be colonized, colonization can be persistent (approximately 9 months), the yeast can survive in the hospital environment, bleach or sporicide is needed for elimination, isolation precautions are recommended as for MDRO bacteria, and serial resistance to echinocandins has been observed.

Principal takeaways:
 

1Candida auris isolates are often MDR, with some strains having elevated MICs to drugs in all the three major classes of antifungal medications.

2The isolates are difficult to identify and require specialized methods, such as MALDI-TOF or molecular identification based on sequencing.

3Misidentification may lead to inappropriate treatment.

4C auris has the propensity to cause outbreaks in health-care settings, as has been reported in several countries, and resistance may result in treatment failure.

Richard Winn, MD, MS, FCCPImmediate Past Chair

References

1. Sarma S. Current perspective on emergence, diagnosis and drug resistance in Candida auris. Infect Drug Resistance. 2017;10:155–165.

2. Pan American Health Organization/World Health Organization. Epidemiological Alert: Candida auris outbreaks in health care services. October 3, Washington, DC: PAHO/WHO; 2016.

3. Centers for Disease Control and Prevention. Global emergence of invasive infections caused by the multidrug-resistant yeast Candida auris. CDC; 2016 [updated June 24, 2016]

David A. Schulman, MD, FCCP, is the new Editor in Chief of CHEST Physician. He is a Professor in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University in Atlanta, where he also directs the pulmonary and critical care fellowship program. He has served on the CHEST Sleep NetWork and the Education Committee and currently serves on the Training and Transitions Committee and the Board of Regents. Dr. Schulman’s primary area of academic interest is on faculty development in the domains of teaching and assessment. He will serve as the Chair of the CHEST 2018 Scientific Program Committee, where he will focus on crafting novel, interactive programming that will improve attendee engagement and retention.

1. Improve interactivity between CHEST Physician and its readership, to improve our ability to craft the publication that best meets the needs of its readers.

2. Create more opportunities for CHEST Physician to serve as the voice of CHEST members, by increasing space for members and leaders to write for the publication.

3. Build on the incredibly successful work of my predecessor, Dr. Vera DePalo.

CHEST extends very special thanks to the following CHEST Physician editors for their 3 years of dedicated service in the following roles:

Vera de Palo, MD, FCCP – Editor in Chief

Lee Morrow, MD, FCCP – Section Editor for Critical Care Commentary

Jeremy Weingarten, MD, FCCP – Section Editor for Sleep Strategies

David A. Schulman, MD, FCCP, is the new Editor in Chief of CHEST Physician. He is a Professor in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University in Atlanta, where he also directs the pulmonary and critical care fellowship program. He has served on the CHEST Sleep NetWork and the Education Committee and currently serves on the Training and Transitions Committee and the Board of Regents. Dr. Schulman’s primary area of academic interest is on faculty development in the domains of teaching and assessment. He will serve as the Chair of the CHEST 2018 Scientific Program Committee, where he will focus on crafting novel, interactive programming that will improve attendee engagement and retention.

1. Improve interactivity between CHEST Physician and its readership, to improve our ability to craft the publication that best meets the needs of its readers.

2. Create more opportunities for CHEST Physician to serve as the voice of CHEST members, by increasing space for members and leaders to write for the publication.

3. Build on the incredibly successful work of my predecessor, Dr. Vera DePalo.

CHEST extends very special thanks to the following CHEST Physician editors for their 3 years of dedicated service in the following roles:

Vera de Palo, MD, FCCP – Editor in Chief

Lee Morrow, MD, FCCP – Section Editor for Critical Care Commentary

Jeremy Weingarten, MD, FCCP – Section Editor for Sleep Strategies

David A. Schulman, MD, FCCP, is the new Editor in Chief of CHEST Physician. He is a Professor in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at Emory University in Atlanta, where he also directs the pulmonary and critical care fellowship program. He has served on the CHEST Sleep NetWork and the Education Committee and currently serves on the Training and Transitions Committee and the Board of Regents. Dr. Schulman’s primary area of academic interest is on faculty development in the domains of teaching and assessment. He will serve as the Chair of the CHEST 2018 Scientific Program Committee, where he will focus on crafting novel, interactive programming that will improve attendee engagement and retention.

1. Improve interactivity between CHEST Physician and its readership, to improve our ability to craft the publication that best meets the needs of its readers.

2. Create more opportunities for CHEST Physician to serve as the voice of CHEST members, by increasing space for members and leaders to write for the publication.

3. Build on the incredibly successful work of my predecessor, Dr. Vera DePalo.

CHEST extends very special thanks to the following CHEST Physician editors for their 3 years of dedicated service in the following roles:

Vera de Palo, MD, FCCP – Editor in Chief

Lee Morrow, MD, FCCP – Section Editor for Critical Care Commentary

Jeremy Weingarten, MD, FCCP – Section Editor for Sleep Strategies