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This month in the journal CHEST®
Editor’s picks
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.
Editor’s picks
Editor’s picks
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 2021 moves to Orlando and online – the choice is yours
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. Interstitial and diffuse lung disease. Practice operations. Transplant. Women’s lung health.
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.
I reflected back on the last pandemic in 2009, H1N1, and remembered when the new vaccine developed in 174 days was first released to pregnant women and children after phase 3 trials. How did we get here? What do we do to fix it?
This misinformation is labeled as the “COVID-19 infodemic.” In the last year, we have seen the media, more specifically social platforms, quickly spread medical misinformation. In the book “Made to Stick: Why Some Ideas Survive and Some Die,” the authors described core elements that make an idea “sticky.” Use of those exact same sticky techniques can be used to circulate accurate information and to halt the spread of this infodemic. Although, numerous media companies, including Twitter, are making an effort to remove the false content from their platforms, their efforts require a lengthy process and are delayed. Therefore, it is crucial for the public health figures and community at large in partnership with various national organizations to establish a robust connection with the social platforms in a dynamic and timely fashion to help spread the verified information across social media, digital and traditional media outlets.
The UN has launched an initiate called “Verified.” This is a worldwide effort to help individuals spread reliable information regarding COVID-19 to their friends and families via social platforms as various media platforms and businesses have partnered with Verified. Also, we encourage our members to access the CHEST COVID-19 resource center and benefit from the various clinical and practice management tools along with validated patient information materials.
Roozera Khan, DO, FCCP
Steering Committee Member
Humayun Anjum, MD, FCCP
Chair
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).
Lung transplant in the setting of COVID-19 fibrosis increases surgical complexity as well, with case reports of dense adhesions and distortion of regular surgical planes (Bharat, et al. Sci. Transl. Med. 2020; Lang, et al. Lancet Respir Med. 2020;8:1057). Recognizing the difficulty with deciding to use transplantation after an infectious disease, The International Society for Heart and Lung Transplant (ISHLT) has created guidelines regarding indications for transplantation (ISHLT.org). Continued research will be necessary to identify those at the highest likelihood for success from transplantation, preparation for the increased complexity, and long-term outcomes. Further information is available in a CHEST webinar titled “Lung Transplantation in the Era of COVID-19” .
Clauden Louis, MD
Grant Turner, MD
Fellows-in-Training NetWork Members
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.
There are several considerations in this setting, including the need for careful drug safety and monitoring, creating a plan of action for possible decline in lung function while off certain CF-related medications, and counseling on drug interactions during lactation. In our experience with women becoming pregnant while receiving Trikafta or contemplating pregnancy, all have opted to discontinue modulator therapy with declines in lung function. Trikafta does not report teratogenicity based on animal studies of the individual components of the drug; however, ivacaftor is known to cause impairment in fertility and reproductive indices, including nonviable embryos and implantation failure in a rat model at five times the maximum recommended human dose, dosed prior to and during early embryogenesis. Small mammal models have decreased birth weight at high doses of elexacaftor, tezacaftor and ivacaftor administered individually. There is evidence of placental transfer of ivacaftor and breast milk concentrations of tezacaftor and ivacaftor are higher than plasma concentrations in rats. There are no human data in parturient or lactating women or infants. Three women became pregnant during the phase 3 clinical study of Trikafta, one with elective termination, one pregnancy was carried to full term with normal birth outcome, and one ended in a spontaneous abortion, which was deemed not to be related to the study drug. Translating this information into recommendations for patients has important implications.
Debasree Banerjee, MD, MS
Steering Committee Member
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.
I reflected back on the last pandemic in 2009, H1N1, and remembered when the new vaccine developed in 174 days was first released to pregnant women and children after phase 3 trials. How did we get here? What do we do to fix it?
This misinformation is labeled as the “COVID-19 infodemic.” In the last year, we have seen the media, more specifically social platforms, quickly spread medical misinformation. In the book “Made to Stick: Why Some Ideas Survive and Some Die,” the authors described core elements that make an idea “sticky.” Use of those exact same sticky techniques can be used to circulate accurate information and to halt the spread of this infodemic. Although, numerous media companies, including Twitter, are making an effort to remove the false content from their platforms, their efforts require a lengthy process and are delayed. Therefore, it is crucial for the public health figures and community at large in partnership with various national organizations to establish a robust connection with the social platforms in a dynamic and timely fashion to help spread the verified information across social media, digital and traditional media outlets.
The UN has launched an initiate called “Verified.” This is a worldwide effort to help individuals spread reliable information regarding COVID-19 to their friends and families via social platforms as various media platforms and businesses have partnered with Verified. Also, we encourage our members to access the CHEST COVID-19 resource center and benefit from the various clinical and practice management tools along with validated patient information materials.
Roozera Khan, DO, FCCP
Steering Committee Member
Humayun Anjum, MD, FCCP
Chair
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).
Lung transplant in the setting of COVID-19 fibrosis increases surgical complexity as well, with case reports of dense adhesions and distortion of regular surgical planes (Bharat, et al. Sci. Transl. Med. 2020; Lang, et al. Lancet Respir Med. 2020;8:1057). Recognizing the difficulty with deciding to use transplantation after an infectious disease, The International Society for Heart and Lung Transplant (ISHLT) has created guidelines regarding indications for transplantation (ISHLT.org). Continued research will be necessary to identify those at the highest likelihood for success from transplantation, preparation for the increased complexity, and long-term outcomes. Further information is available in a CHEST webinar titled “Lung Transplantation in the Era of COVID-19” .
Clauden Louis, MD
Grant Turner, MD
Fellows-in-Training NetWork Members
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.
There are several considerations in this setting, including the need for careful drug safety and monitoring, creating a plan of action for possible decline in lung function while off certain CF-related medications, and counseling on drug interactions during lactation. In our experience with women becoming pregnant while receiving Trikafta or contemplating pregnancy, all have opted to discontinue modulator therapy with declines in lung function. Trikafta does not report teratogenicity based on animal studies of the individual components of the drug; however, ivacaftor is known to cause impairment in fertility and reproductive indices, including nonviable embryos and implantation failure in a rat model at five times the maximum recommended human dose, dosed prior to and during early embryogenesis. Small mammal models have decreased birth weight at high doses of elexacaftor, tezacaftor and ivacaftor administered individually. There is evidence of placental transfer of ivacaftor and breast milk concentrations of tezacaftor and ivacaftor are higher than plasma concentrations in rats. There are no human data in parturient or lactating women or infants. Three women became pregnant during the phase 3 clinical study of Trikafta, one with elective termination, one pregnancy was carried to full term with normal birth outcome, and one ended in a spontaneous abortion, which was deemed not to be related to the study drug. Translating this information into recommendations for patients has important implications.
Debasree Banerjee, MD, MS
Steering Committee Member
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.
I reflected back on the last pandemic in 2009, H1N1, and remembered when the new vaccine developed in 174 days was first released to pregnant women and children after phase 3 trials. How did we get here? What do we do to fix it?
This misinformation is labeled as the “COVID-19 infodemic.” In the last year, we have seen the media, more specifically social platforms, quickly spread medical misinformation. In the book “Made to Stick: Why Some Ideas Survive and Some Die,” the authors described core elements that make an idea “sticky.” Use of those exact same sticky techniques can be used to circulate accurate information and to halt the spread of this infodemic. Although, numerous media companies, including Twitter, are making an effort to remove the false content from their platforms, their efforts require a lengthy process and are delayed. Therefore, it is crucial for the public health figures and community at large in partnership with various national organizations to establish a robust connection with the social platforms in a dynamic and timely fashion to help spread the verified information across social media, digital and traditional media outlets.
The UN has launched an initiate called “Verified.” This is a worldwide effort to help individuals spread reliable information regarding COVID-19 to their friends and families via social platforms as various media platforms and businesses have partnered with Verified. Also, we encourage our members to access the CHEST COVID-19 resource center and benefit from the various clinical and practice management tools along with validated patient information materials.
Roozera Khan, DO, FCCP
Steering Committee Member
Humayun Anjum, MD, FCCP
Chair
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).
Lung transplant in the setting of COVID-19 fibrosis increases surgical complexity as well, with case reports of dense adhesions and distortion of regular surgical planes (Bharat, et al. Sci. Transl. Med. 2020; Lang, et al. Lancet Respir Med. 2020;8:1057). Recognizing the difficulty with deciding to use transplantation after an infectious disease, The International Society for Heart and Lung Transplant (ISHLT) has created guidelines regarding indications for transplantation (ISHLT.org). Continued research will be necessary to identify those at the highest likelihood for success from transplantation, preparation for the increased complexity, and long-term outcomes. Further information is available in a CHEST webinar titled “Lung Transplantation in the Era of COVID-19” .
Clauden Louis, MD
Grant Turner, MD
Fellows-in-Training NetWork Members
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.
There are several considerations in this setting, including the need for careful drug safety and monitoring, creating a plan of action for possible decline in lung function while off certain CF-related medications, and counseling on drug interactions during lactation. In our experience with women becoming pregnant while receiving Trikafta or contemplating pregnancy, all have opted to discontinue modulator therapy with declines in lung function. Trikafta does not report teratogenicity based on animal studies of the individual components of the drug; however, ivacaftor is known to cause impairment in fertility and reproductive indices, including nonviable embryos and implantation failure in a rat model at five times the maximum recommended human dose, dosed prior to and during early embryogenesis. Small mammal models have decreased birth weight at high doses of elexacaftor, tezacaftor and ivacaftor administered individually. There is evidence of placental transfer of ivacaftor and breast milk concentrations of tezacaftor and ivacaftor are higher than plasma concentrations in rats. There are no human data in parturient or lactating women or infants. Three women became pregnant during the phase 3 clinical study of Trikafta, one with elective termination, one pregnancy was carried to full term with normal birth outcome, and one ended in a spontaneous abortion, which was deemed not to be related to the study drug. Translating this information into recommendations for patients has important implications.
Debasree Banerjee, MD, MS
Steering Committee Member
President’s report
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.
One of those ways, of course, was the COVID-19 pandemic, which wrought so many things – face masks, social distancing, steep learning curves, over 300,000 excess deaths, and new vaccines. For CHEST, it meant that two of our most important educational opportunities of the year, board review and the annual meeting, were held virtually. Dr. Levine has already written about the board reviews, so I’ll focus on the annual meeting, held in late October.
In many ways, the meeting was a success. We had over 6,800 attendees. There were 88 live online sessions, 22 that were semi-live, and 160 prerecorded sessions. For presenters, this was simultaneously both easy and difficult. They had to ensure that their recording equipment and their Internet access were of sufficient quality, and if prerecorded, the sessions had to be finished weeks ahead of time. But the presentations could be given from presenters’ homes or from their normal work offices. For attendees, the ability for nonsimultaneous playback allowed for fitting the meeting into a work-life schedule. In fact, at least one friend related that he watched sessions with a grandchild on his lap. However, it meant a lack of opportunities to ask clarifying questions of the presenters, which is a common activity at the end of a session, and the opportunity to see and catch up with old friends and colleagues was missing. Simulations, of course, could not be hands-on, but virtual educational games matured significantly. The satisfaction scores from both attendees and faculty were good, if slightly below our usual scores for live meetings. They told us that we all prefer our in-person meetings, but that content is deliverable and receivable in an online format. Overall, we have to consider the CHEST 2020 online platform to be a successful endeavor.
Which brings me to our plans for future meetings. The Board of Regents discussed the alternatives for CHEST 2021. Should we hold a live meeting in Vancouver, as planned? Should we hold another online meeting like the one we just discussed? None of us has the crystal ball that tells us exactly how COVID-19 is going to develop. We don’t know exactly how many people will be vaccinated either north or south of the U.S.-Canada border. While those of us who care for patients in the United States have had the opportunity to be vaccinated, we don’t know if the professional staff from CHEST headquarters who travel to the annual meeting will be vaccinated, even though that prospect is currently looking very reasonable. We don’t know if the Canadian government will be allowing U.S. residents to visit Canada without quarantine. There are just quite a few things that we can’t know. However, convention centers need to know if we will be there, and we needed to decide.
In the end, a couple of things swayed us—the unexpected availability of a U.S. convention center and uncertainty about travel to Canada. We are planning to hold CHEST 2021 in Orlando, Florida, during our usual late October time frame. CHEST 2021 is slated to be the first in-person pulmonary, critical care, and sleep conference to be held in the United States in 2 years. The Executive Program Committee has met, and program selections have been made. Very soon, invitations will go to our prospective faculty, and we will be underway. We are planning CHEST 2021 as what we call a “hybrid” meeting, a meeting that will provide an excellent experience whether one attends in person at the Orlando Convention Center or partakes of the meeting from home. Some sessions will be broadcast live and others will be prerecorded. Needless to say, the experience will not be equal for in-person and at-home learners, but it will be equitable. Regardless of how you choose to partake, CHEST 2021 will have excellent content to suit your needs. This plan also allows us the ability to convert to a fully online meeting, should the COVID-19 circumstances dictate that we must. Having sat in on the program committee meetings, I am excited about what we have to offer. So, dig around and find your old mouse ears or your red forehead scar. CHEST 2021 will be a dynamite experience for us all to share.
Our board review sessions, which are also among the most highly valued of CHEST activities, will be different out of necessity. Again, decisions had to be made many months ahead of time, and we have chosen to hold our board reviews online again this year. COVID-19 uncertainties certainly play into our decision to not put attendees in a room together. However, the ability to play and replay, slow down and speed up video content, and ability to watch any session any time are all well suited to reviewing for an examination. We think this is the appropriate decision for 2021, but we may be back together again for future sessions. Frankly, we are listening to hear which format our attendees like more. And, we are plotting how to make the online platform review even better.
The Board of Regents has been hard at work on a lot of fronts, but I want to focus on one of them, for now. It is important to the Board of Regents and to me, personally, that CHEST be the single most inclusive and diverse professional medical society, bar none. It is of utmost importance that we remove any barriers that might have inadvertently been put into place that would hamper the success of any of our members or their patients. In other words, we hope to find any implicit biases in attitude and behavior and to illuminate and remedy them. We have begun the process by focusing on what CHEST is all about – making a difference with our patients and corporate self and being an inclusive and diverse professional organization.
We believe that we must look at ourselves in three separate, but related, ways. We must examine our patient-facing side and the ways in which we help our members to serve their patients. We must examine our headquarters and our hiring, working, and promoting practices to ensure an inclusive and welcoming environment for the staff who do our day to day business. Finally, we must examine ourselves and our member-based organization, to ensure that all can participate freely in CHEST opportunities and, for those who aspire to lead our organization, to ensure that there are no implicit biases that hold them back.
We began the process with a series of regional listening sessions across the United States, sponsored by the CHEST Foundation, in which we heard from both patients and community leaders of color. We learned of challenges that our patients face in accessing care, communicating with their doctors, and obtaining the medications they need for their illness. Our professional staff has organized an anti-racism task force and is working to ensure that we can be proud of a diverse and inclusive work environment. For our members, we have held two board development sessions, so that our Board of Regents can examine us and our attitudes toward race and toward inclusiveness in our organization. We will soon be holding a listening session with CHEST members of color with the express purpose of allowing those of us who are not persons of color to better understand the challenges faced by our members and to understand where organizational changes could be necessary to help make their professional lives better. As a long time CHEST member, I believe that CHEST is not purposefully exclusive of anyone. We are, nevertheless, a part of the larger fabric of society, and because of that, we are subject to having implicit biases and practices as an organization. Our best path to be aware of them and to deal with them is to hear from our members who experience them, and we shall.
I will end on a note that is somber but important. In the past year, we have all lost friends and colleagues with whom we worked side by side, to COVID-19. Many of them have been CHEST members. Because of the pandemic, we have often not been able to mourn those we have cared about in the same ways that we normally would, in the company of friends and family. Yet, it is important for us to remember our colleagues and to share our memories. So, we established CHEST Remembers, a memorial wall on the CHEST website where we can post the news of our friends’ passing, along with our remembrances of them. If your friend or colleague has died of COVID-19, please feel free to share with the CHEST community. You can find the link to do that at www.chestnet.org.
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.
One of those ways, of course, was the COVID-19 pandemic, which wrought so many things – face masks, social distancing, steep learning curves, over 300,000 excess deaths, and new vaccines. For CHEST, it meant that two of our most important educational opportunities of the year, board review and the annual meeting, were held virtually. Dr. Levine has already written about the board reviews, so I’ll focus on the annual meeting, held in late October.
In many ways, the meeting was a success. We had over 6,800 attendees. There were 88 live online sessions, 22 that were semi-live, and 160 prerecorded sessions. For presenters, this was simultaneously both easy and difficult. They had to ensure that their recording equipment and their Internet access were of sufficient quality, and if prerecorded, the sessions had to be finished weeks ahead of time. But the presentations could be given from presenters’ homes or from their normal work offices. For attendees, the ability for nonsimultaneous playback allowed for fitting the meeting into a work-life schedule. In fact, at least one friend related that he watched sessions with a grandchild on his lap. However, it meant a lack of opportunities to ask clarifying questions of the presenters, which is a common activity at the end of a session, and the opportunity to see and catch up with old friends and colleagues was missing. Simulations, of course, could not be hands-on, but virtual educational games matured significantly. The satisfaction scores from both attendees and faculty were good, if slightly below our usual scores for live meetings. They told us that we all prefer our in-person meetings, but that content is deliverable and receivable in an online format. Overall, we have to consider the CHEST 2020 online platform to be a successful endeavor.
Which brings me to our plans for future meetings. The Board of Regents discussed the alternatives for CHEST 2021. Should we hold a live meeting in Vancouver, as planned? Should we hold another online meeting like the one we just discussed? None of us has the crystal ball that tells us exactly how COVID-19 is going to develop. We don’t know exactly how many people will be vaccinated either north or south of the U.S.-Canada border. While those of us who care for patients in the United States have had the opportunity to be vaccinated, we don’t know if the professional staff from CHEST headquarters who travel to the annual meeting will be vaccinated, even though that prospect is currently looking very reasonable. We don’t know if the Canadian government will be allowing U.S. residents to visit Canada without quarantine. There are just quite a few things that we can’t know. However, convention centers need to know if we will be there, and we needed to decide.
In the end, a couple of things swayed us—the unexpected availability of a U.S. convention center and uncertainty about travel to Canada. We are planning to hold CHEST 2021 in Orlando, Florida, during our usual late October time frame. CHEST 2021 is slated to be the first in-person pulmonary, critical care, and sleep conference to be held in the United States in 2 years. The Executive Program Committee has met, and program selections have been made. Very soon, invitations will go to our prospective faculty, and we will be underway. We are planning CHEST 2021 as what we call a “hybrid” meeting, a meeting that will provide an excellent experience whether one attends in person at the Orlando Convention Center or partakes of the meeting from home. Some sessions will be broadcast live and others will be prerecorded. Needless to say, the experience will not be equal for in-person and at-home learners, but it will be equitable. Regardless of how you choose to partake, CHEST 2021 will have excellent content to suit your needs. This plan also allows us the ability to convert to a fully online meeting, should the COVID-19 circumstances dictate that we must. Having sat in on the program committee meetings, I am excited about what we have to offer. So, dig around and find your old mouse ears or your red forehead scar. CHEST 2021 will be a dynamite experience for us all to share.
Our board review sessions, which are also among the most highly valued of CHEST activities, will be different out of necessity. Again, decisions had to be made many months ahead of time, and we have chosen to hold our board reviews online again this year. COVID-19 uncertainties certainly play into our decision to not put attendees in a room together. However, the ability to play and replay, slow down and speed up video content, and ability to watch any session any time are all well suited to reviewing for an examination. We think this is the appropriate decision for 2021, but we may be back together again for future sessions. Frankly, we are listening to hear which format our attendees like more. And, we are plotting how to make the online platform review even better.
The Board of Regents has been hard at work on a lot of fronts, but I want to focus on one of them, for now. It is important to the Board of Regents and to me, personally, that CHEST be the single most inclusive and diverse professional medical society, bar none. It is of utmost importance that we remove any barriers that might have inadvertently been put into place that would hamper the success of any of our members or their patients. In other words, we hope to find any implicit biases in attitude and behavior and to illuminate and remedy them. We have begun the process by focusing on what CHEST is all about – making a difference with our patients and corporate self and being an inclusive and diverse professional organization.
We believe that we must look at ourselves in three separate, but related, ways. We must examine our patient-facing side and the ways in which we help our members to serve their patients. We must examine our headquarters and our hiring, working, and promoting practices to ensure an inclusive and welcoming environment for the staff who do our day to day business. Finally, we must examine ourselves and our member-based organization, to ensure that all can participate freely in CHEST opportunities and, for those who aspire to lead our organization, to ensure that there are no implicit biases that hold them back.
We began the process with a series of regional listening sessions across the United States, sponsored by the CHEST Foundation, in which we heard from both patients and community leaders of color. We learned of challenges that our patients face in accessing care, communicating with their doctors, and obtaining the medications they need for their illness. Our professional staff has organized an anti-racism task force and is working to ensure that we can be proud of a diverse and inclusive work environment. For our members, we have held two board development sessions, so that our Board of Regents can examine us and our attitudes toward race and toward inclusiveness in our organization. We will soon be holding a listening session with CHEST members of color with the express purpose of allowing those of us who are not persons of color to better understand the challenges faced by our members and to understand where organizational changes could be necessary to help make their professional lives better. As a long time CHEST member, I believe that CHEST is not purposefully exclusive of anyone. We are, nevertheless, a part of the larger fabric of society, and because of that, we are subject to having implicit biases and practices as an organization. Our best path to be aware of them and to deal with them is to hear from our members who experience them, and we shall.
I will end on a note that is somber but important. In the past year, we have all lost friends and colleagues with whom we worked side by side, to COVID-19. Many of them have been CHEST members. Because of the pandemic, we have often not been able to mourn those we have cared about in the same ways that we normally would, in the company of friends and family. Yet, it is important for us to remember our colleagues and to share our memories. So, we established CHEST Remembers, a memorial wall on the CHEST website where we can post the news of our friends’ passing, along with our remembrances of them. If your friend or colleague has died of COVID-19, please feel free to share with the CHEST community. You can find the link to do that at www.chestnet.org.
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.
One of those ways, of course, was the COVID-19 pandemic, which wrought so many things – face masks, social distancing, steep learning curves, over 300,000 excess deaths, and new vaccines. For CHEST, it meant that two of our most important educational opportunities of the year, board review and the annual meeting, were held virtually. Dr. Levine has already written about the board reviews, so I’ll focus on the annual meeting, held in late October.
In many ways, the meeting was a success. We had over 6,800 attendees. There were 88 live online sessions, 22 that were semi-live, and 160 prerecorded sessions. For presenters, this was simultaneously both easy and difficult. They had to ensure that their recording equipment and their Internet access were of sufficient quality, and if prerecorded, the sessions had to be finished weeks ahead of time. But the presentations could be given from presenters’ homes or from their normal work offices. For attendees, the ability for nonsimultaneous playback allowed for fitting the meeting into a work-life schedule. In fact, at least one friend related that he watched sessions with a grandchild on his lap. However, it meant a lack of opportunities to ask clarifying questions of the presenters, which is a common activity at the end of a session, and the opportunity to see and catch up with old friends and colleagues was missing. Simulations, of course, could not be hands-on, but virtual educational games matured significantly. The satisfaction scores from both attendees and faculty were good, if slightly below our usual scores for live meetings. They told us that we all prefer our in-person meetings, but that content is deliverable and receivable in an online format. Overall, we have to consider the CHEST 2020 online platform to be a successful endeavor.
Which brings me to our plans for future meetings. The Board of Regents discussed the alternatives for CHEST 2021. Should we hold a live meeting in Vancouver, as planned? Should we hold another online meeting like the one we just discussed? None of us has the crystal ball that tells us exactly how COVID-19 is going to develop. We don’t know exactly how many people will be vaccinated either north or south of the U.S.-Canada border. While those of us who care for patients in the United States have had the opportunity to be vaccinated, we don’t know if the professional staff from CHEST headquarters who travel to the annual meeting will be vaccinated, even though that prospect is currently looking very reasonable. We don’t know if the Canadian government will be allowing U.S. residents to visit Canada without quarantine. There are just quite a few things that we can’t know. However, convention centers need to know if we will be there, and we needed to decide.
In the end, a couple of things swayed us—the unexpected availability of a U.S. convention center and uncertainty about travel to Canada. We are planning to hold CHEST 2021 in Orlando, Florida, during our usual late October time frame. CHEST 2021 is slated to be the first in-person pulmonary, critical care, and sleep conference to be held in the United States in 2 years. The Executive Program Committee has met, and program selections have been made. Very soon, invitations will go to our prospective faculty, and we will be underway. We are planning CHEST 2021 as what we call a “hybrid” meeting, a meeting that will provide an excellent experience whether one attends in person at the Orlando Convention Center or partakes of the meeting from home. Some sessions will be broadcast live and others will be prerecorded. Needless to say, the experience will not be equal for in-person and at-home learners, but it will be equitable. Regardless of how you choose to partake, CHEST 2021 will have excellent content to suit your needs. This plan also allows us the ability to convert to a fully online meeting, should the COVID-19 circumstances dictate that we must. Having sat in on the program committee meetings, I am excited about what we have to offer. So, dig around and find your old mouse ears or your red forehead scar. CHEST 2021 will be a dynamite experience for us all to share.
Our board review sessions, which are also among the most highly valued of CHEST activities, will be different out of necessity. Again, decisions had to be made many months ahead of time, and we have chosen to hold our board reviews online again this year. COVID-19 uncertainties certainly play into our decision to not put attendees in a room together. However, the ability to play and replay, slow down and speed up video content, and ability to watch any session any time are all well suited to reviewing for an examination. We think this is the appropriate decision for 2021, but we may be back together again for future sessions. Frankly, we are listening to hear which format our attendees like more. And, we are plotting how to make the online platform review even better.
The Board of Regents has been hard at work on a lot of fronts, but I want to focus on one of them, for now. It is important to the Board of Regents and to me, personally, that CHEST be the single most inclusive and diverse professional medical society, bar none. It is of utmost importance that we remove any barriers that might have inadvertently been put into place that would hamper the success of any of our members or their patients. In other words, we hope to find any implicit biases in attitude and behavior and to illuminate and remedy them. We have begun the process by focusing on what CHEST is all about – making a difference with our patients and corporate self and being an inclusive and diverse professional organization.
We believe that we must look at ourselves in three separate, but related, ways. We must examine our patient-facing side and the ways in which we help our members to serve their patients. We must examine our headquarters and our hiring, working, and promoting practices to ensure an inclusive and welcoming environment for the staff who do our day to day business. Finally, we must examine ourselves and our member-based organization, to ensure that all can participate freely in CHEST opportunities and, for those who aspire to lead our organization, to ensure that there are no implicit biases that hold them back.
We began the process with a series of regional listening sessions across the United States, sponsored by the CHEST Foundation, in which we heard from both patients and community leaders of color. We learned of challenges that our patients face in accessing care, communicating with their doctors, and obtaining the medications they need for their illness. Our professional staff has organized an anti-racism task force and is working to ensure that we can be proud of a diverse and inclusive work environment. For our members, we have held two board development sessions, so that our Board of Regents can examine us and our attitudes toward race and toward inclusiveness in our organization. We will soon be holding a listening session with CHEST members of color with the express purpose of allowing those of us who are not persons of color to better understand the challenges faced by our members and to understand where organizational changes could be necessary to help make their professional lives better. As a long time CHEST member, I believe that CHEST is not purposefully exclusive of anyone. We are, nevertheless, a part of the larger fabric of society, and because of that, we are subject to having implicit biases and practices as an organization. Our best path to be aware of them and to deal with them is to hear from our members who experience them, and we shall.
I will end on a note that is somber but important. In the past year, we have all lost friends and colleagues with whom we worked side by side, to COVID-19. Many of them have been CHEST members. Because of the pandemic, we have often not been able to mourn those we have cared about in the same ways that we normally would, in the company of friends and family. Yet, it is important for us to remember our colleagues and to share our memories. So, we established CHEST Remembers, a memorial wall on the CHEST website where we can post the news of our friends’ passing, along with our remembrances of them. If your friend or colleague has died of COVID-19, please feel free to share with the CHEST community. You can find the link to do that at www.chestnet.org.
CHEST to offer research matching service
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.
President-Designate: Doreen J. Addrizzo-Harris, MD, FCCP
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.
Dr. Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. She is now serving in her 20th year as the Program Director of NYU's Pulmonary and Critical Care Medicine Fellowship. Dr. Addrizzo-Harris received her medical degree and completed her residency and fellowship training at New York University School of Medicine. Since completing her training, she was recruited to stay as a faculty member at NYU, where she has been a critical presence over the past 25 years. She has been instrumental in educating the next generation of pulmonary/critical care physicians and has won a number of awards for her teaching skills, most recently, the 2021 Outstanding Educator Award from the APCCMPD. Dr. Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006-2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as PI. Dr. Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017 and received the Distinguished Service Award in 2019.
During her leadership tenure with CHEST, Dr. Addrizzo-Harris has served on the Marketing Committee, the Health and Science Policy Committee (Chair from 2007-2009), Government Relations Committee, Scientific Program Committee, Education Committee, Governance Committee, Editorial Board for CHEST Physician, Professional Standards Committee (Chair 2016-2018), Board of Regents, and CHEST Foundation Board of Trustees. Most recently, Dr. Addrizzo-Harris served as the President of the CHEST Foundation from 2018-2019 and Co-Chair of the Foundation Awards Committee from 2015-2020. She will serve as the sixth woman to lead the American College of Chest Physicians.
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.
Dr. Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. She is now serving in her 20th year as the Program Director of NYU's Pulmonary and Critical Care Medicine Fellowship. Dr. Addrizzo-Harris received her medical degree and completed her residency and fellowship training at New York University School of Medicine. Since completing her training, she was recruited to stay as a faculty member at NYU, where she has been a critical presence over the past 25 years. She has been instrumental in educating the next generation of pulmonary/critical care physicians and has won a number of awards for her teaching skills, most recently, the 2021 Outstanding Educator Award from the APCCMPD. Dr. Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006-2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as PI. Dr. Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017 and received the Distinguished Service Award in 2019.
During her leadership tenure with CHEST, Dr. Addrizzo-Harris has served on the Marketing Committee, the Health and Science Policy Committee (Chair from 2007-2009), Government Relations Committee, Scientific Program Committee, Education Committee, Governance Committee, Editorial Board for CHEST Physician, Professional Standards Committee (Chair 2016-2018), Board of Regents, and CHEST Foundation Board of Trustees. Most recently, Dr. Addrizzo-Harris served as the President of the CHEST Foundation from 2018-2019 and Co-Chair of the Foundation Awards Committee from 2015-2020. She will serve as the sixth woman to lead the American College of Chest Physicians.
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.
Dr. Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. She is now serving in her 20th year as the Program Director of NYU's Pulmonary and Critical Care Medicine Fellowship. Dr. Addrizzo-Harris received her medical degree and completed her residency and fellowship training at New York University School of Medicine. Since completing her training, she was recruited to stay as a faculty member at NYU, where she has been a critical presence over the past 25 years. She has been instrumental in educating the next generation of pulmonary/critical care physicians and has won a number of awards for her teaching skills, most recently, the 2021 Outstanding Educator Award from the APCCMPD. Dr. Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006-2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as PI. Dr. Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017 and received the Distinguished Service Award in 2019.
During her leadership tenure with CHEST, Dr. Addrizzo-Harris has served on the Marketing Committee, the Health and Science Policy Committee (Chair from 2007-2009), Government Relations Committee, Scientific Program Committee, Education Committee, Governance Committee, Editorial Board for CHEST Physician, Professional Standards Committee (Chair 2016-2018), Board of Regents, and CHEST Foundation Board of Trustees. Most recently, Dr. Addrizzo-Harris served as the President of the CHEST Foundation from 2018-2019 and Co-Chair of the Foundation Awards Committee from 2015-2020. She will serve as the sixth woman to lead the American College of Chest Physicians.
Introducing this year’s Recognition Prize recipients
“AGA Recognition Prizes allow members to honor their contemporaries for their exceptional contributions to the field of gastroenterology and hepatology,” said Hashem B. El-Serag, MD, MPH, AGAF, chair of AGA. “The 2021 AGA Recognition Prize winners represent only a small group of our widely distinguished and exceptional members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representatives of AGA.”
This year the AGA Recognition Prizes will be presented virtually in May 2021.
- Michael Camilleri, MD, AGAF, Julius Friedenwald Medal
- Byron Cryer, MD, Distinguished Service Award in Diversity, Equity and Inclusion
- Sandra Quezada, MD, MS, Distinguished Service Award in Diversity, Equity and Inclusion
- Kim Barrett, Distinguished Achievement Award in Basic Science
- David Y. Graham, William Beaumont Prize
- Griffin Rodgers, MD, MACP, Research Service Award
- Lin Chang, Distinguished Educator Award
- Nimish Vakil, MD, AGAF, FASGE, Distinguished Clinician Award in Private Practice
- Peter H.R. Green, Distinguished Clinician Award in Academic Practice
- Vay Liang “Bill” Go, MD, AGAF, Distinguished Mentor Award
- Shahnaz Sultan, MD, MHSc, AGAF, Outstanding Service Award
- Osama Altayar, MD, Outstanding Service Award
- Perica Davitkov, MD, Outstanding Service Award
- Joseph D. Feuerstein, MD, Outstanding Service Award
- Shazia M. Siddique, MD, MSHP, Outstanding Service Award
- Yngve T. Falck-Ytter, MD, AGAF, Outstanding Service Award
- Joseph K. Lim, MD, AGAF, Outstanding Service Award
To learn more about our 2021 AGA recognition prize recipients, visit https://gastro.org/2021awards.
“AGA Recognition Prizes allow members to honor their contemporaries for their exceptional contributions to the field of gastroenterology and hepatology,” said Hashem B. El-Serag, MD, MPH, AGAF, chair of AGA. “The 2021 AGA Recognition Prize winners represent only a small group of our widely distinguished and exceptional members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representatives of AGA.”
This year the AGA Recognition Prizes will be presented virtually in May 2021.
- Michael Camilleri, MD, AGAF, Julius Friedenwald Medal
- Byron Cryer, MD, Distinguished Service Award in Diversity, Equity and Inclusion
- Sandra Quezada, MD, MS, Distinguished Service Award in Diversity, Equity and Inclusion
- Kim Barrett, Distinguished Achievement Award in Basic Science
- David Y. Graham, William Beaumont Prize
- Griffin Rodgers, MD, MACP, Research Service Award
- Lin Chang, Distinguished Educator Award
- Nimish Vakil, MD, AGAF, FASGE, Distinguished Clinician Award in Private Practice
- Peter H.R. Green, Distinguished Clinician Award in Academic Practice
- Vay Liang “Bill” Go, MD, AGAF, Distinguished Mentor Award
- Shahnaz Sultan, MD, MHSc, AGAF, Outstanding Service Award
- Osama Altayar, MD, Outstanding Service Award
- Perica Davitkov, MD, Outstanding Service Award
- Joseph D. Feuerstein, MD, Outstanding Service Award
- Shazia M. Siddique, MD, MSHP, Outstanding Service Award
- Yngve T. Falck-Ytter, MD, AGAF, Outstanding Service Award
- Joseph K. Lim, MD, AGAF, Outstanding Service Award
To learn more about our 2021 AGA recognition prize recipients, visit https://gastro.org/2021awards.
“AGA Recognition Prizes allow members to honor their contemporaries for their exceptional contributions to the field of gastroenterology and hepatology,” said Hashem B. El-Serag, MD, MPH, AGAF, chair of AGA. “The 2021 AGA Recognition Prize winners represent only a small group of our widely distinguished and exceptional members who help make AGA such an accomplished organization. We are honored that such esteemed individuals are representatives of AGA.”
This year the AGA Recognition Prizes will be presented virtually in May 2021.
- Michael Camilleri, MD, AGAF, Julius Friedenwald Medal
- Byron Cryer, MD, Distinguished Service Award in Diversity, Equity and Inclusion
- Sandra Quezada, MD, MS, Distinguished Service Award in Diversity, Equity and Inclusion
- Kim Barrett, Distinguished Achievement Award in Basic Science
- David Y. Graham, William Beaumont Prize
- Griffin Rodgers, MD, MACP, Research Service Award
- Lin Chang, Distinguished Educator Award
- Nimish Vakil, MD, AGAF, FASGE, Distinguished Clinician Award in Private Practice
- Peter H.R. Green, Distinguished Clinician Award in Academic Practice
- Vay Liang “Bill” Go, MD, AGAF, Distinguished Mentor Award
- Shahnaz Sultan, MD, MHSc, AGAF, Outstanding Service Award
- Osama Altayar, MD, Outstanding Service Award
- Perica Davitkov, MD, Outstanding Service Award
- Joseph D. Feuerstein, MD, Outstanding Service Award
- Shazia M. Siddique, MD, MSHP, Outstanding Service Award
- Yngve T. Falck-Ytter, MD, AGAF, Outstanding Service Award
- Joseph K. Lim, MD, AGAF, Outstanding Service Award
To learn more about our 2021 AGA recognition prize recipients, visit https://gastro.org/2021awards.
How a gift of stock to the AGA Research Foundation can be a win-win
If you own stock that’s increased in value since you purchased it (and you’ve owned it for at least 1 year), you have a unique opportunity for philanthropy. When you donate securities to the AGA Research Foundation, you receive the same income tax savings (if you itemize) that you would if you wrote the AGA Research Foundation a check, but with the added benefit of eliminating capital gains taxes on the transfer, which can be as high as 20%.
Making a gift of securities to support the AGA Research Foundation’s mission to raise funds to support young researchers in gastroenterology and hepatology is as easy as instructing your broker to transfer the shares. Using assets other than cash also allows you more flexibility when planning your gift.
Benefits:
- Receive an income tax deduction for gifts of securities if you itemize.
- Provide relief from capital gains tax with gifts of securities.
- Help fulfill our mission with your contribution.
Take the next step:
The AGA Research Foundation can help clarify and document the steps to donate stock to us. Contact us at [email protected] to make your donation.
If you own stock that’s increased in value since you purchased it (and you’ve owned it for at least 1 year), you have a unique opportunity for philanthropy. When you donate securities to the AGA Research Foundation, you receive the same income tax savings (if you itemize) that you would if you wrote the AGA Research Foundation a check, but with the added benefit of eliminating capital gains taxes on the transfer, which can be as high as 20%.
Making a gift of securities to support the AGA Research Foundation’s mission to raise funds to support young researchers in gastroenterology and hepatology is as easy as instructing your broker to transfer the shares. Using assets other than cash also allows you more flexibility when planning your gift.
Benefits:
- Receive an income tax deduction for gifts of securities if you itemize.
- Provide relief from capital gains tax with gifts of securities.
- Help fulfill our mission with your contribution.
Take the next step:
The AGA Research Foundation can help clarify and document the steps to donate stock to us. Contact us at [email protected] to make your donation.
If you own stock that’s increased in value since you purchased it (and you’ve owned it for at least 1 year), you have a unique opportunity for philanthropy. When you donate securities to the AGA Research Foundation, you receive the same income tax savings (if you itemize) that you would if you wrote the AGA Research Foundation a check, but with the added benefit of eliminating capital gains taxes on the transfer, which can be as high as 20%.
Making a gift of securities to support the AGA Research Foundation’s mission to raise funds to support young researchers in gastroenterology and hepatology is as easy as instructing your broker to transfer the shares. Using assets other than cash also allows you more flexibility when planning your gift.
Benefits:
- Receive an income tax deduction for gifts of securities if you itemize.
- Provide relief from capital gains tax with gifts of securities.
- Help fulfill our mission with your contribution.
Take the next step:
The AGA Research Foundation can help clarify and document the steps to donate stock to us. Contact us at [email protected] to make your donation.
Registration for DDW® 2021 is now open
Join your colleagues in the digestive disease community at the most prestigious meeting for GI professionals. Registration for Digestive Disease Week® (DDW) 2021 is now open. Register on or before March 31 to receive a discounted rate. AGA member trainees, postdoctoral fellows, medical residents and students also receive complimentary registration during this early bird period.
In 2021, DDW moves online as a fully virtual meeting, taking place May 21–23, 2021. While DDW Virtual™ will look a little different, we’re excited by opportunities the new format provides to learn, share, and connect, such as the following:
- Explore today’s most pressing topics and new developments, shared in oral abstract and ePoster presentations.
- Gain the kind of insight that you can’t get out of a textbook, presented in sessions led by top GI and hepatology experts.
- Network and build connections with your colleagues in an engaging, interactive setting.
Learn more and register at ddw.org.
Join your colleagues in the digestive disease community at the most prestigious meeting for GI professionals. Registration for Digestive Disease Week® (DDW) 2021 is now open. Register on or before March 31 to receive a discounted rate. AGA member trainees, postdoctoral fellows, medical residents and students also receive complimentary registration during this early bird period.
In 2021, DDW moves online as a fully virtual meeting, taking place May 21–23, 2021. While DDW Virtual™ will look a little different, we’re excited by opportunities the new format provides to learn, share, and connect, such as the following:
- Explore today’s most pressing topics and new developments, shared in oral abstract and ePoster presentations.
- Gain the kind of insight that you can’t get out of a textbook, presented in sessions led by top GI and hepatology experts.
- Network and build connections with your colleagues in an engaging, interactive setting.
Learn more and register at ddw.org.
Join your colleagues in the digestive disease community at the most prestigious meeting for GI professionals. Registration for Digestive Disease Week® (DDW) 2021 is now open. Register on or before March 31 to receive a discounted rate. AGA member trainees, postdoctoral fellows, medical residents and students also receive complimentary registration during this early bird period.
In 2021, DDW moves online as a fully virtual meeting, taking place May 21–23, 2021. While DDW Virtual™ will look a little different, we’re excited by opportunities the new format provides to learn, share, and connect, such as the following:
- Explore today’s most pressing topics and new developments, shared in oral abstract and ePoster presentations.
- Gain the kind of insight that you can’t get out of a textbook, presented in sessions led by top GI and hepatology experts.
- Network and build connections with your colleagues in an engaging, interactive setting.
Learn more and register at ddw.org.
Meet the 2021 AGA Fellowship inductees
Join the GI community in a round of applause for the 120 members adding the designation “AGAF” in their professional activities. Along with a recognition pin and certificate of acceptance, American Gastroenterological Association President Bishr Omary commends the group in the AGA Community for their superior professional achievements and contributions to the field of gastroenterology. See the full list and join the discussion at https://community.gastro.org.
Join the GI community in a round of applause for the 120 members adding the designation “AGAF” in their professional activities. Along with a recognition pin and certificate of acceptance, American Gastroenterological Association President Bishr Omary commends the group in the AGA Community for their superior professional achievements and contributions to the field of gastroenterology. See the full list and join the discussion at https://community.gastro.org.
Join the GI community in a round of applause for the 120 members adding the designation “AGAF” in their professional activities. Along with a recognition pin and certificate of acceptance, American Gastroenterological Association President Bishr Omary commends the group in the AGA Community for their superior professional achievements and contributions to the field of gastroenterology. See the full list and join the discussion at https://community.gastro.org.