Society News

Each year, the CHEST Foundation offers grants to worthy research candidates, generous community service volunteers, and distinguished scholars. More than 1,000 recipients worldwide have received more than $10 million in support and recognition of outstanding contributions to chest medicine.

In 2018, the Foundation awarded than $500,000 to researchers who were honored during Sunday’s Opening Session.

Robert C. Hyzy, MD, FCCP, director of the Critical Care Medicine Unit at the University of Michigan, was awarded the 2018 Eli Lilly and Company Distinguished Scholar in Critical Care Medicine grant for his research titled “The Use of Electrical Impedance Tomography to Assess Mechanical Ventilation in Acute Respiratory Distress Syndrome.” The grant, sponsored by Eli Lilly, will further Dr. Hyzy’s research into vetting electrical impedance tomography (EIT).

“EIT is essentially a belt that’s worn around a patient’s chest that creates an image through a low, imperceptible electronic current,” Dr. Hyzy said, noting a CAT scanner can also be used to see how air gets into the lungs, but those are not a practical tool in the ICU. “EIT creates some images, and the images change with regard to how air gets into the lungs, particularly when the patient has ARDS. So the idea here, with this generous grant, would be to build a better mousetrap—to explore this technology as a means to see various ways to push air through the lungs. It’s using the images you get to guide the way mechanical ventilation is provided.”

The Foundation’s grants have made a difference in patients’ lives by aiding young investigators. Many of the supported projects have led to breakthroughs in the treatment of chest diseases and patient care. The Foundation encourages members to apply for grants so that chest medicine will continue to improve and evolve.

Congratulations to all of our 2018 CHEST Foundation grant winners!

Watch for the list of all CHEST 2018 winners in the December issue of CHEST Physician.


 

Each year, the CHEST Foundation offers grants to worthy research candidates, generous community service volunteers, and distinguished scholars. More than 1,000 recipients worldwide have received more than $10 million in support and recognition of outstanding contributions to chest medicine.

In 2018, the Foundation awarded than $500,000 to researchers who were honored during Sunday’s Opening Session.

Robert C. Hyzy, MD, FCCP, director of the Critical Care Medicine Unit at the University of Michigan, was awarded the 2018 Eli Lilly and Company Distinguished Scholar in Critical Care Medicine grant for his research titled “The Use of Electrical Impedance Tomography to Assess Mechanical Ventilation in Acute Respiratory Distress Syndrome.” The grant, sponsored by Eli Lilly, will further Dr. Hyzy’s research into vetting electrical impedance tomography (EIT).

“EIT is essentially a belt that’s worn around a patient’s chest that creates an image through a low, imperceptible electronic current,” Dr. Hyzy said, noting a CAT scanner can also be used to see how air gets into the lungs, but those are not a practical tool in the ICU. “EIT creates some images, and the images change with regard to how air gets into the lungs, particularly when the patient has ARDS. So the idea here, with this generous grant, would be to build a better mousetrap—to explore this technology as a means to see various ways to push air through the lungs. It’s using the images you get to guide the way mechanical ventilation is provided.”

The Foundation’s grants have made a difference in patients’ lives by aiding young investigators. Many of the supported projects have led to breakthroughs in the treatment of chest diseases and patient care. The Foundation encourages members to apply for grants so that chest medicine will continue to improve and evolve.

Congratulations to all of our 2018 CHEST Foundation grant winners!

Watch for the list of all CHEST 2018 winners in the December issue of CHEST Physician.


 

Each year, the CHEST Foundation offers grants to worthy research candidates, generous community service volunteers, and distinguished scholars. More than 1,000 recipients worldwide have received more than $10 million in support and recognition of outstanding contributions to chest medicine.

In 2018, the Foundation awarded than $500,000 to researchers who were honored during Sunday’s Opening Session.

Robert C. Hyzy, MD, FCCP, director of the Critical Care Medicine Unit at the University of Michigan, was awarded the 2018 Eli Lilly and Company Distinguished Scholar in Critical Care Medicine grant for his research titled “The Use of Electrical Impedance Tomography to Assess Mechanical Ventilation in Acute Respiratory Distress Syndrome.” The grant, sponsored by Eli Lilly, will further Dr. Hyzy’s research into vetting electrical impedance tomography (EIT).

“EIT is essentially a belt that’s worn around a patient’s chest that creates an image through a low, imperceptible electronic current,” Dr. Hyzy said, noting a CAT scanner can also be used to see how air gets into the lungs, but those are not a practical tool in the ICU. “EIT creates some images, and the images change with regard to how air gets into the lungs, particularly when the patient has ARDS. So the idea here, with this generous grant, would be to build a better mousetrap—to explore this technology as a means to see various ways to push air through the lungs. It’s using the images you get to guide the way mechanical ventilation is provided.”

The Foundation’s grants have made a difference in patients’ lives by aiding young investigators. Many of the supported projects have led to breakthroughs in the treatment of chest diseases and patient care. The Foundation encourages members to apply for grants so that chest medicine will continue to improve and evolve.

Congratulations to all of our 2018 CHEST Foundation grant winners!

Watch for the list of all CHEST 2018 winners in the December issue of CHEST Physician.


 

Wow, what an incredible year this has been! Serving as CHEST President from the end of CHEST 2017 until the CHEST Annual Meeting in San Antonio—in early October 2018--means I’ve served one of the shortest presidencies in CHEST history. I must say, however, that it has been a phenomenal year for me personally, highlighted not only by the accomplishments outlined below, but by the opportunity to meet so many new people and to grow existing relationships both for myself and for CHEST. I am so proud and excited by the meaningful work being done by our volunteers, staff, and leadership. Thank you for the incredibly humbling opportunity to work with you and to serve CHEST this year.

Since joining CHEST in 1982, I’ve had the opportunity to observe and learn from so many great leaders, each with different strengths and styles of leadership. I also have learned so much from members of our staff at all levels, as well as members of our leadership who serve as committee chairs, NetWork leaders, faculty representatives, and more, all giving so unselfishly of their time and talent to this organization. In addition, I was blessed this year to work with a special Board of Regents—experienced, engaged, professional in their approach, supportive, strategic, representing diversity of thought and passionate about this organization.

Throughout the 2017-2018 fiscal year, CHEST’s Board of Regents worked tirelessly to refine CHEST’s mission and vision and to develop goals, strategies, and key performance indicators to develop a new, 5-year strategic plan. Our organizational goals going forward are focused on several broad areas of achievement. To achieve these goals, we need to continue investing in and expanding our efforts in key areas like Membership, Education, and Publishing. We need to focus our attention on key groups like clinician educators, young leaders and young members, and embracing diversity of thought and meaningful inclusion, paying attention to gaps, barriers, and opportunities.

As I look to our updated CHEST mission--“To champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research”—as I look at the areas of achievement over the past year, and as I look to the strategic plan and what lies ahead, in my opinion there is no finish line, and there will always be more work to do.

Thank you to the CHEST volunteers, staff, leadership, and partners for your unwavering support of CHEST and our mission. We could not be successful without you.

First released as a Thought Leaders Blog on chestnet.org, September 30, 2018.




 

Wow, what an incredible year this has been! Serving as CHEST President from the end of CHEST 2017 until the CHEST Annual Meeting in San Antonio—in early October 2018--means I’ve served one of the shortest presidencies in CHEST history. I must say, however, that it has been a phenomenal year for me personally, highlighted not only by the accomplishments outlined below, but by the opportunity to meet so many new people and to grow existing relationships both for myself and for CHEST. I am so proud and excited by the meaningful work being done by our volunteers, staff, and leadership. Thank you for the incredibly humbling opportunity to work with you and to serve CHEST this year.

Since joining CHEST in 1982, I’ve had the opportunity to observe and learn from so many great leaders, each with different strengths and styles of leadership. I also have learned so much from members of our staff at all levels, as well as members of our leadership who serve as committee chairs, NetWork leaders, faculty representatives, and more, all giving so unselfishly of their time and talent to this organization. In addition, I was blessed this year to work with a special Board of Regents—experienced, engaged, professional in their approach, supportive, strategic, representing diversity of thought and passionate about this organization.

Throughout the 2017-2018 fiscal year, CHEST’s Board of Regents worked tirelessly to refine CHEST’s mission and vision and to develop goals, strategies, and key performance indicators to develop a new, 5-year strategic plan. Our organizational goals going forward are focused on several broad areas of achievement. To achieve these goals, we need to continue investing in and expanding our efforts in key areas like Membership, Education, and Publishing. We need to focus our attention on key groups like clinician educators, young leaders and young members, and embracing diversity of thought and meaningful inclusion, paying attention to gaps, barriers, and opportunities.

As I look to our updated CHEST mission--“To champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research”—as I look at the areas of achievement over the past year, and as I look to the strategic plan and what lies ahead, in my opinion there is no finish line, and there will always be more work to do.

Thank you to the CHEST volunteers, staff, leadership, and partners for your unwavering support of CHEST and our mission. We could not be successful without you.

First released as a Thought Leaders Blog on chestnet.org, September 30, 2018.




 

Wow, what an incredible year this has been! Serving as CHEST President from the end of CHEST 2017 until the CHEST Annual Meeting in San Antonio—in early October 2018--means I’ve served one of the shortest presidencies in CHEST history. I must say, however, that it has been a phenomenal year for me personally, highlighted not only by the accomplishments outlined below, but by the opportunity to meet so many new people and to grow existing relationships both for myself and for CHEST. I am so proud and excited by the meaningful work being done by our volunteers, staff, and leadership. Thank you for the incredibly humbling opportunity to work with you and to serve CHEST this year.

Since joining CHEST in 1982, I’ve had the opportunity to observe and learn from so many great leaders, each with different strengths and styles of leadership. I also have learned so much from members of our staff at all levels, as well as members of our leadership who serve as committee chairs, NetWork leaders, faculty representatives, and more, all giving so unselfishly of their time and talent to this organization. In addition, I was blessed this year to work with a special Board of Regents—experienced, engaged, professional in their approach, supportive, strategic, representing diversity of thought and passionate about this organization.

Throughout the 2017-2018 fiscal year, CHEST’s Board of Regents worked tirelessly to refine CHEST’s mission and vision and to develop goals, strategies, and key performance indicators to develop a new, 5-year strategic plan. Our organizational goals going forward are focused on several broad areas of achievement. To achieve these goals, we need to continue investing in and expanding our efforts in key areas like Membership, Education, and Publishing. We need to focus our attention on key groups like clinician educators, young leaders and young members, and embracing diversity of thought and meaningful inclusion, paying attention to gaps, barriers, and opportunities.

As I look to our updated CHEST mission--“To champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research”—as I look at the areas of achievement over the past year, and as I look to the strategic plan and what lies ahead, in my opinion there is no finish line, and there will always be more work to do.

Thank you to the CHEST volunteers, staff, leadership, and partners for your unwavering support of CHEST and our mission. We could not be successful without you.

First released as a Thought Leaders Blog on chestnet.org, September 30, 2018.




 

Editor’s picks
 

ORIGINAL RESEARCH
Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes.
By Dr. C. L. Ofstead, et al.


Lower Glucose Target Is Associated With Improved 30-Day Mortality in Cardiac and Cardiothoracic Patients.
By Dr. A. M. Hersh, et al.


Sarcoidosis Diagnostic Score: A Systematic Evaluation to Enhance the Diagnosis of Sarcoidosis.
By Dr. A. N. Bickett, et al.


EVIDENCE-BASED MEDICINE
Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.
By Dr. G. Y. H. Lip, et al.

Editor’s picks
 

ORIGINAL RESEARCH
Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes.
By Dr. C. L. Ofstead, et al.


Lower Glucose Target Is Associated With Improved 30-Day Mortality in Cardiac and Cardiothoracic Patients.
By Dr. A. M. Hersh, et al.


Sarcoidosis Diagnostic Score: A Systematic Evaluation to Enhance the Diagnosis of Sarcoidosis.
By Dr. A. N. Bickett, et al.


EVIDENCE-BASED MEDICINE
Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.
By Dr. G. Y. H. Lip, et al.

Editor’s picks
 

ORIGINAL RESEARCH
Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes.
By Dr. C. L. Ofstead, et al.


Lower Glucose Target Is Associated With Improved 30-Day Mortality in Cardiac and Cardiothoracic Patients.
By Dr. A. M. Hersh, et al.


Sarcoidosis Diagnostic Score: A Systematic Evaluation to Enhance the Diagnosis of Sarcoidosis.
By Dr. A. N. Bickett, et al.


EVIDENCE-BASED MEDICINE
Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.
By Dr. G. Y. H. Lip, et al.

The Society for Vascular Surgery is creating a private online community, SVSConnect, with a number of resources for SVS members and their peers. This new collaborative online community will let members connect and engage with, and learn from, fellow members and peers on an infinite number of topics. It is expected to launch by late 2018. Users will enjoy a member directory search, forums, mentor match programs and resource sharing. More information will be communicated to members soon via Pulse newsletters, emails and the SVS Website.

The Society for Vascular Surgery is creating a private online community, SVSConnect, with a number of resources for SVS members and their peers. This new collaborative online community will let members connect and engage with, and learn from, fellow members and peers on an infinite number of topics. It is expected to launch by late 2018. Users will enjoy a member directory search, forums, mentor match programs and resource sharing. More information will be communicated to members soon via Pulse newsletters, emails and the SVS Website.

The Society for Vascular Surgery is creating a private online community, SVSConnect, with a number of resources for SVS members and their peers. This new collaborative online community will let members connect and engage with, and learn from, fellow members and peers on an infinite number of topics. It is expected to launch by late 2018. Users will enjoy a member directory search, forums, mentor match programs and resource sharing. More information will be communicated to members soon via Pulse newsletters, emails and the SVS Website.

By the time you receive this issue, we will know election results. The effects on medical care, medical coverage, Medicare, and Medicaid will be profound. American medicine is integrally linked to Congress and the Supreme Court because on July 30, 1965, Lyndon Johnson signed Title 18 of the Social Security Act and created Medicare – a move that took medical care out of personal law and into public law.

In November, CMS will publish its “final rule” about documentation and reimbursement changes, site of service reimbursement, and several other impactful policy changes. We have an extended article from the AGA Partners in Value conference about these potential changes.

This month we highlight the medical home concept for IBD – an idea that is gaining traction. More intense colon cancer screening may be needed for families with nonhereditary colon cancer. An interesting article from JAMA suggests that obesity may play a role in colon cancer rates in young women.

Antibiotic resistance in H. pylori infections is reaching alarming levels and this information may alter our practice. We feature an “In Focus” section on endosopic treatment for obese patients. We also continue highlighting some popular and interesting discussion chains emanating from the AGA Community.

Please stay involved as leaders in health care economics, delivery, and politics. We need thoughtful discussions and we need to bring patient stories to our politicians. It often seems that our advocacy does little to alter the national debate but who better to speak for the people that entrust us with their care?

John I. Allen, MD, MBA, AGAF
Editor in Chief

By the time you receive this issue, we will know election results. The effects on medical care, medical coverage, Medicare, and Medicaid will be profound. American medicine is integrally linked to Congress and the Supreme Court because on July 30, 1965, Lyndon Johnson signed Title 18 of the Social Security Act and created Medicare – a move that took medical care out of personal law and into public law.

In November, CMS will publish its “final rule” about documentation and reimbursement changes, site of service reimbursement, and several other impactful policy changes. We have an extended article from the AGA Partners in Value conference about these potential changes.

This month we highlight the medical home concept for IBD – an idea that is gaining traction. More intense colon cancer screening may be needed for families with nonhereditary colon cancer. An interesting article from JAMA suggests that obesity may play a role in colon cancer rates in young women.

Antibiotic resistance in H. pylori infections is reaching alarming levels and this information may alter our practice. We feature an “In Focus” section on endosopic treatment for obese patients. We also continue highlighting some popular and interesting discussion chains emanating from the AGA Community.

Please stay involved as leaders in health care economics, delivery, and politics. We need thoughtful discussions and we need to bring patient stories to our politicians. It often seems that our advocacy does little to alter the national debate but who better to speak for the people that entrust us with their care?

John I. Allen, MD, MBA, AGAF
Editor in Chief

By the time you receive this issue, we will know election results. The effects on medical care, medical coverage, Medicare, and Medicaid will be profound. American medicine is integrally linked to Congress and the Supreme Court because on July 30, 1965, Lyndon Johnson signed Title 18 of the Social Security Act and created Medicare – a move that took medical care out of personal law and into public law.

In November, CMS will publish its “final rule” about documentation and reimbursement changes, site of service reimbursement, and several other impactful policy changes. We have an extended article from the AGA Partners in Value conference about these potential changes.

This month we highlight the medical home concept for IBD – an idea that is gaining traction. More intense colon cancer screening may be needed for families with nonhereditary colon cancer. An interesting article from JAMA suggests that obesity may play a role in colon cancer rates in young women.

Antibiotic resistance in H. pylori infections is reaching alarming levels and this information may alter our practice. We feature an “In Focus” section on endosopic treatment for obese patients. We also continue highlighting some popular and interesting discussion chains emanating from the AGA Community.

Please stay involved as leaders in health care economics, delivery, and politics. We need thoughtful discussions and we need to bring patient stories to our politicians. It often seems that our advocacy does little to alter the national debate but who better to speak for the people that entrust us with their care?

John I. Allen, MD, MBA, AGAF
Editor in Chief

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both CHEST members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST Physician. One of the authors (DRM) was the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new AMA delegate. 

The American Medical Association (AMA) had its Annual Meeting of the House of Delegates (HOD) from May 9-13.  This meeting was attended by over 1,000 physicians who  are delegates from all geographic societies, ie, state societies and specialties and subspecialties, as well as the uniformed services. 

Policy and resolutions 

Process: 
Policies originate via resolutions submitted by individuals or societies.  These resolutions then go to one of several Reference Committees for open discussion.  These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House.  The diagram below explains the flow of resolutions to policies.

Chest/Allergy Section Council  (which is composed of CHEST, ATS, SCCM, AASM, and several allergy specialty organizations) meets prior to the voting in the House to discuss the pending business. The Specialty and Service Society (SSS) is the largest caucus in the AMA’s House of Delegates and is composed of all the delegates from the specialty societies, as well as the uniformed services.  
There are two categories of groups in the SSS: those societies that have seats in the HOD and those seeking admission to the house.

SSS groups in the HOD include:
•    119 national medical specialties
•    2 professional interest medical associations
•    5 military or uniformed service groups (the Public Health Service is “uniformed” but not “military” or “armed”)

The compendium of policies covers the entire range of topics impacting the practice of medicine – ethics, legislation, regulation, public health, individual health, and medical education, among them.  The full range of policies can be found in the AMA’s Policy Manual available on the web site, AMA-assn.org

Some of the issues discussed at the HOD are as follows:
•    Health care as a “right.”  In response to a resolution asking the AMA to support health care as a “right,” the Board of Trustees reaffirmed current policy supporting expanded access to health care for all but stopped short of calling health care a “right.”
•    POLST forms. The Board of Trustees will work with state organizations and others to recognize Physician Orders for Life Sustaining Treatment (POLST) forms and allow for reciprocity between states.
•    Influenza vaccination. The HOD enacted as AMA policy that no health-care worker should be terminated from employment due solely to their refusal to be vaccinated for influenza. 
•    e-Cigarettes and tobacco.

A.    The AMA was instructed to urge federal officials, including but not limited to the US Food and Drug Administration (FDA), to prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling). We will also urge federal officials, including but not limited to the FDA, to require that accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine (new HOD policy). 

B.    Develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. Such a report should consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive, regulatory strategies to ensure compliance with an established standard, and how a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market. American Medical Association consider joining other medical organizations in an amicus brief supporting the American Academy of Pediatrics legal action to compel the US Food and Drug Administration to take timely action to establish effective regulation of e-cigarettes, cigars, and other nicotine tobacco products (Directive to Take Action).

•    Prior authorization for durable medical equipment.  The AMA will advocate that denials of prior authorization for durable medical equipment must be based on true medical necessity not arbitrary time limits or other paperwork issues and will continue to work to improve the prior authorization process for Medicare Managed Care Plans (Directive to Take Action).
•    Medical training (including IMG, Medical students, Residents, and Fellows). 

A.    EHR and Business training during Med Ed and residency 

B.    Fellowship Start Date.  The AMA will survey physicians who have experienced a fellowship start date of August 1 to further evaluate the benefits and drawbacks from this transition (Directive to Take Action).

•    Opioid abuse. Surgeon General Jerome Adams addressed the HOD about several topics but focused on opioid crisis.
•    Physician Burnout and Organizational efficiency. Physician burnout is a health-care crisis in all specialties, and critical care has a very high rate of physician burnout. The AMA has several tools available that can help with physician burnout both in the ICU and outpatient medicine. (https://www.stepsforward.org)

This is just a small sampling of the activities at the HOD.  More information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org. 

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both CHEST members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST Physician. One of the authors (DRM) was the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new AMA delegate. 

The American Medical Association (AMA) had its Annual Meeting of the House of Delegates (HOD) from May 9-13.  This meeting was attended by over 1,000 physicians who  are delegates from all geographic societies, ie, state societies and specialties and subspecialties, as well as the uniformed services. 

Policy and resolutions 

Process: 
Policies originate via resolutions submitted by individuals or societies.  These resolutions then go to one of several Reference Committees for open discussion.  These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House.  The diagram below explains the flow of resolutions to policies.

Chest/Allergy Section Council  (which is composed of CHEST, ATS, SCCM, AASM, and several allergy specialty organizations) meets prior to the voting in the House to discuss the pending business. The Specialty and Service Society (SSS) is the largest caucus in the AMA’s House of Delegates and is composed of all the delegates from the specialty societies, as well as the uniformed services.  
There are two categories of groups in the SSS: those societies that have seats in the HOD and those seeking admission to the house.

SSS groups in the HOD include:
•    119 national medical specialties
•    2 professional interest medical associations
•    5 military or uniformed service groups (the Public Health Service is “uniformed” but not “military” or “armed”)

The compendium of policies covers the entire range of topics impacting the practice of medicine – ethics, legislation, regulation, public health, individual health, and medical education, among them.  The full range of policies can be found in the AMA’s Policy Manual available on the web site, AMA-assn.org

Some of the issues discussed at the HOD are as follows:
•    Health care as a “right.”  In response to a resolution asking the AMA to support health care as a “right,” the Board of Trustees reaffirmed current policy supporting expanded access to health care for all but stopped short of calling health care a “right.”
•    POLST forms. The Board of Trustees will work with state organizations and others to recognize Physician Orders for Life Sustaining Treatment (POLST) forms and allow for reciprocity between states.
•    Influenza vaccination. The HOD enacted as AMA policy that no health-care worker should be terminated from employment due solely to their refusal to be vaccinated for influenza. 
•    e-Cigarettes and tobacco.

A.    The AMA was instructed to urge federal officials, including but not limited to the US Food and Drug Administration (FDA), to prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling). We will also urge federal officials, including but not limited to the FDA, to require that accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine (new HOD policy). 

B.    Develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. Such a report should consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive, regulatory strategies to ensure compliance with an established standard, and how a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market. American Medical Association consider joining other medical organizations in an amicus brief supporting the American Academy of Pediatrics legal action to compel the US Food and Drug Administration to take timely action to establish effective regulation of e-cigarettes, cigars, and other nicotine tobacco products (Directive to Take Action).

•    Prior authorization for durable medical equipment.  The AMA will advocate that denials of prior authorization for durable medical equipment must be based on true medical necessity not arbitrary time limits or other paperwork issues and will continue to work to improve the prior authorization process for Medicare Managed Care Plans (Directive to Take Action).
•    Medical training (including IMG, Medical students, Residents, and Fellows). 

A.    EHR and Business training during Med Ed and residency 

B.    Fellowship Start Date.  The AMA will survey physicians who have experienced a fellowship start date of August 1 to further evaluate the benefits and drawbacks from this transition (Directive to Take Action).

•    Opioid abuse. Surgeon General Jerome Adams addressed the HOD about several topics but focused on opioid crisis.
•    Physician Burnout and Organizational efficiency. Physician burnout is a health-care crisis in all specialties, and critical care has a very high rate of physician burnout. The AMA has several tools available that can help with physician burnout both in the ICU and outpatient medicine. (https://www.stepsforward.org)

This is just a small sampling of the activities at the HOD.  More information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org. 

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both CHEST members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST Physician. One of the authors (DRM) was the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new AMA delegate. 

The American Medical Association (AMA) had its Annual Meeting of the House of Delegates (HOD) from May 9-13.  This meeting was attended by over 1,000 physicians who  are delegates from all geographic societies, ie, state societies and specialties and subspecialties, as well as the uniformed services. 

Policy and resolutions 

Process: 
Policies originate via resolutions submitted by individuals or societies.  These resolutions then go to one of several Reference Committees for open discussion.  These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House.  The diagram below explains the flow of resolutions to policies.

Chest/Allergy Section Council  (which is composed of CHEST, ATS, SCCM, AASM, and several allergy specialty organizations) meets prior to the voting in the House to discuss the pending business. The Specialty and Service Society (SSS) is the largest caucus in the AMA’s House of Delegates and is composed of all the delegates from the specialty societies, as well as the uniformed services.  
There are two categories of groups in the SSS: those societies that have seats in the HOD and those seeking admission to the house.

SSS groups in the HOD include:
•    119 national medical specialties
•    2 professional interest medical associations
•    5 military or uniformed service groups (the Public Health Service is “uniformed” but not “military” or “armed”)

The compendium of policies covers the entire range of topics impacting the practice of medicine – ethics, legislation, regulation, public health, individual health, and medical education, among them.  The full range of policies can be found in the AMA’s Policy Manual available on the web site, AMA-assn.org

Some of the issues discussed at the HOD are as follows:
•    Health care as a “right.”  In response to a resolution asking the AMA to support health care as a “right,” the Board of Trustees reaffirmed current policy supporting expanded access to health care for all but stopped short of calling health care a “right.”
•    POLST forms. The Board of Trustees will work with state organizations and others to recognize Physician Orders for Life Sustaining Treatment (POLST) forms and allow for reciprocity between states.
•    Influenza vaccination. The HOD enacted as AMA policy that no health-care worker should be terminated from employment due solely to their refusal to be vaccinated for influenza. 
•    e-Cigarettes and tobacco.

A.    The AMA was instructed to urge federal officials, including but not limited to the US Food and Drug Administration (FDA), to prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling). We will also urge federal officials, including but not limited to the FDA, to require that accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine (new HOD policy). 

B.    Develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. Such a report should consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive, regulatory strategies to ensure compliance with an established standard, and how a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market. American Medical Association consider joining other medical organizations in an amicus brief supporting the American Academy of Pediatrics legal action to compel the US Food and Drug Administration to take timely action to establish effective regulation of e-cigarettes, cigars, and other nicotine tobacco products (Directive to Take Action).

•    Prior authorization for durable medical equipment.  The AMA will advocate that denials of prior authorization for durable medical equipment must be based on true medical necessity not arbitrary time limits or other paperwork issues and will continue to work to improve the prior authorization process for Medicare Managed Care Plans (Directive to Take Action).
•    Medical training (including IMG, Medical students, Residents, and Fellows). 

A.    EHR and Business training during Med Ed and residency 

B.    Fellowship Start Date.  The AMA will survey physicians who have experienced a fellowship start date of August 1 to further evaluate the benefits and drawbacks from this transition (Directive to Take Action).

•    Opioid abuse. Surgeon General Jerome Adams addressed the HOD about several topics but focused on opioid crisis.
•    Physician Burnout and Organizational efficiency. Physician burnout is a health-care crisis in all specialties, and critical care has a very high rate of physician burnout. The AMA has several tools available that can help with physician burnout both in the ICU and outpatient medicine. (https://www.stepsforward.org)

This is just a small sampling of the activities at the HOD.  More information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org. 

A new flier on diabetes and vascular disease is now available in English and Spanish as an instant download. This is the second new flier produced by the SVS Foundation as part of its awareness and prevention mission. Please download and share this important information. It’s a good opportunity to remind your patients of the effects of diabetes on their vascular system. We are offering two versions of PDFs on which you can easily type your office contact information. As you share with other physician referrers and your patients, also send them to our Diabetes Information page, where physicians can find the latest vascular and diabetes research, and patients can find useful health information.

A new flier on diabetes and vascular disease is now available in English and Spanish as an instant download. This is the second new flier produced by the SVS Foundation as part of its awareness and prevention mission. Please download and share this important information. It’s a good opportunity to remind your patients of the effects of diabetes on their vascular system. We are offering two versions of PDFs on which you can easily type your office contact information. As you share with other physician referrers and your patients, also send them to our Diabetes Information page, where physicians can find the latest vascular and diabetes research, and patients can find useful health information.

A new flier on diabetes and vascular disease is now available in English and Spanish as an instant download. This is the second new flier produced by the SVS Foundation as part of its awareness and prevention mission. Please download and share this important information. It’s a good opportunity to remind your patients of the effects of diabetes on their vascular system. We are offering two versions of PDFs on which you can easily type your office contact information. As you share with other physician referrers and your patients, also send them to our Diabetes Information page, where physicians can find the latest vascular and diabetes research, and patients can find useful health information.

Two recent studies published in Cell, “Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features” and “Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT,” have received significant media coverage and are causing questions and concern among physicians and patients who use probiotic supplements.

The AGA Center for Gut Microbiome Research and Education provides three reminders for talking to your patient about probiotics:

1. Probiotics are generally thought to be safe for healthy individuals, but we don’t know the long-term consequences. For individuals who have a chronic disease, are immunocompromised, or otherwise vulnerable (such as the elderly), patients should seek guidance from physicians on whether probiotics may be appropriate. In general, probiotics should not be used indiscriminately; potential risk and benefit should be considered as for all human interventions.

2. This research does not conclude that probiotics are unsafe or useless for everyone. However, the results suggest that individuals may respond very differently to the same probiotic product depending on their diet, genetics, microbiome, and other aspects of their health. Experts are trying to better understand which bacteria are best for whom, under which conditions as we transition from an era of empiric medicine to precision medicine.

3. Probiotics currently on the market are foods or dietary supplements. To date, no probiotic products have been approved by the FDA to treat, mitigate, cure, or prevent specific diseases.

AGA has recently developed educational materials for patients on probiotics, which can be accessed at www.gastro.org/probiotics in English and Spanish. Share this resource with your patients by printing it out, emailing or uploading to your patient portal.
 

[email protected]

Two recent studies published in Cell, “Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features” and “Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT,” have received significant media coverage and are causing questions and concern among physicians and patients who use probiotic supplements.

The AGA Center for Gut Microbiome Research and Education provides three reminders for talking to your patient about probiotics:

1. Probiotics are generally thought to be safe for healthy individuals, but we don’t know the long-term consequences. For individuals who have a chronic disease, are immunocompromised, or otherwise vulnerable (such as the elderly), patients should seek guidance from physicians on whether probiotics may be appropriate. In general, probiotics should not be used indiscriminately; potential risk and benefit should be considered as for all human interventions.

2. This research does not conclude that probiotics are unsafe or useless for everyone. However, the results suggest that individuals may respond very differently to the same probiotic product depending on their diet, genetics, microbiome, and other aspects of their health. Experts are trying to better understand which bacteria are best for whom, under which conditions as we transition from an era of empiric medicine to precision medicine.

3. Probiotics currently on the market are foods or dietary supplements. To date, no probiotic products have been approved by the FDA to treat, mitigate, cure, or prevent specific diseases.

AGA has recently developed educational materials for patients on probiotics, which can be accessed at www.gastro.org/probiotics in English and Spanish. Share this resource with your patients by printing it out, emailing or uploading to your patient portal.
 

[email protected]

Two recent studies published in Cell, “Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features” and “Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT,” have received significant media coverage and are causing questions and concern among physicians and patients who use probiotic supplements.

The AGA Center for Gut Microbiome Research and Education provides three reminders for talking to your patient about probiotics:

1. Probiotics are generally thought to be safe for healthy individuals, but we don’t know the long-term consequences. For individuals who have a chronic disease, are immunocompromised, or otherwise vulnerable (such as the elderly), patients should seek guidance from physicians on whether probiotics may be appropriate. In general, probiotics should not be used indiscriminately; potential risk and benefit should be considered as for all human interventions.

2. This research does not conclude that probiotics are unsafe or useless for everyone. However, the results suggest that individuals may respond very differently to the same probiotic product depending on their diet, genetics, microbiome, and other aspects of their health. Experts are trying to better understand which bacteria are best for whom, under which conditions as we transition from an era of empiric medicine to precision medicine.

3. Probiotics currently on the market are foods or dietary supplements. To date, no probiotic products have been approved by the FDA to treat, mitigate, cure, or prevent specific diseases.

AGA has recently developed educational materials for patients on probiotics, which can be accessed at www.gastro.org/probiotics in English and Spanish. Share this resource with your patients by printing it out, emailing or uploading to your patient portal.
 

[email protected]

Each year, we provide more than $2 million in research funding.

What will the practice of gastroenterology look like in 20 years? It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.

How will we get there? New treatments and devices are the result of years of research.

To help make this dream a reality, AGA – through the AGA Research Foundation – has made a commitment to support investigators in GI and hepatology with its Research Awards Program. In the past year, the foundation provided $2.1 million in research funding to 41 highly qualified investigators. These diverse researchers range from young investigators to more seasoned leaders in GI, all embarking on novel research projects that will advance our understanding of digestive conditions and pave the way for future discoveries in the field.

The AGA Research Foundation sincerely thanks all of its donors – without your gifts, this work wouldn’t be possible.

Please join us to help spark the scientific breakthroughs of today so clinicians will have the tools to improve care tomorrow. Donate your tax-deductible gift today at www.gastro.org/donateonline.
 

[email protected]

Each year, we provide more than $2 million in research funding.

What will the practice of gastroenterology look like in 20 years? It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.

How will we get there? New treatments and devices are the result of years of research.

To help make this dream a reality, AGA – through the AGA Research Foundation – has made a commitment to support investigators in GI and hepatology with its Research Awards Program. In the past year, the foundation provided $2.1 million in research funding to 41 highly qualified investigators. These diverse researchers range from young investigators to more seasoned leaders in GI, all embarking on novel research projects that will advance our understanding of digestive conditions and pave the way for future discoveries in the field.

The AGA Research Foundation sincerely thanks all of its donors – without your gifts, this work wouldn’t be possible.

Please join us to help spark the scientific breakthroughs of today so clinicians will have the tools to improve care tomorrow. Donate your tax-deductible gift today at www.gastro.org/donateonline.
 

[email protected]

Each year, we provide more than $2 million in research funding.

What will the practice of gastroenterology look like in 20 years? It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.

How will we get there? New treatments and devices are the result of years of research.

To help make this dream a reality, AGA – through the AGA Research Foundation – has made a commitment to support investigators in GI and hepatology with its Research Awards Program. In the past year, the foundation provided $2.1 million in research funding to 41 highly qualified investigators. These diverse researchers range from young investigators to more seasoned leaders in GI, all embarking on novel research projects that will advance our understanding of digestive conditions and pave the way for future discoveries in the field.

The AGA Research Foundation sincerely thanks all of its donors – without your gifts, this work wouldn’t be possible.

Please join us to help spark the scientific breakthroughs of today so clinicians will have the tools to improve care tomorrow. Donate your tax-deductible gift today at www.gastro.org/donateonline.
 

[email protected]

The Society for Vascular Surgery Community Practice Committee announces the Excellence in Community Service Award, honoring a member who has made contributions not only to the profession but to the community as well. Applications are due Feb. 1, 2019. The recipient will be announced and recognized at the 2019 Vascular Annual Meeting in June. Nominees must have practiced vascular surgery for at least 20 years and been an SVS member for at least five. They also must present evidence of impact on vascular care or community health.

The Society for Vascular Surgery Community Practice Committee announces the Excellence in Community Service Award, honoring a member who has made contributions not only to the profession but to the community as well. Applications are due Feb. 1, 2019. The recipient will be announced and recognized at the 2019 Vascular Annual Meeting in June. Nominees must have practiced vascular surgery for at least 20 years and been an SVS member for at least five. They also must present evidence of impact on vascular care or community health.

The Society for Vascular Surgery Community Practice Committee announces the Excellence in Community Service Award, honoring a member who has made contributions not only to the profession but to the community as well. Applications are due Feb. 1, 2019. The recipient will be announced and recognized at the 2019 Vascular Annual Meeting in June. Nominees must have practiced vascular surgery for at least 20 years and been an SVS member for at least five. They also must present evidence of impact on vascular care or community health.