1st Place

Ohio State University

Elie Homsy, MD

Rachel Quaney, MD

Ryan Story, MD

Program Director: Jennifer McCallister, MD, FCCP
 

2nd Place

Walter Reed National Military Medical Center

Jeannette Collins, MD

Ian Grasso, MD

Arthur Holtzcalw, MD

Program Director: Aaron Holley, MD, FCCP


3rd Place

Maimonides Medical Center

Sushil Gupta, MBBS

Ankur Sinha, MD

Vignesh Ponnusamy, MD

Program Directors: Yizhek Kupfer, MD, and Stephan Kamholz, MD, FCCP

1st Place

Ohio State University

Elie Homsy, MD

Rachel Quaney, MD

Ryan Story, MD

Program Director: Jennifer McCallister, MD, FCCP
 

2nd Place

Walter Reed National Military Medical Center

Jeannette Collins, MD

Ian Grasso, MD

Arthur Holtzcalw, MD

Program Director: Aaron Holley, MD, FCCP


3rd Place

Maimonides Medical Center

Sushil Gupta, MBBS

Ankur Sinha, MD

Vignesh Ponnusamy, MD

Program Directors: Yizhek Kupfer, MD, and Stephan Kamholz, MD, FCCP

1st Place

Ohio State University

Elie Homsy, MD

Rachel Quaney, MD

Ryan Story, MD

Program Director: Jennifer McCallister, MD, FCCP
 

2nd Place

Walter Reed National Military Medical Center

Jeannette Collins, MD

Ian Grasso, MD

Arthur Holtzcalw, MD

Program Director: Aaron Holley, MD, FCCP


3rd Place

Maimonides Medical Center

Sushil Gupta, MBBS

Ankur Sinha, MD

Vignesh Ponnusamy, MD

Program Directors: Yizhek Kupfer, MD, and Stephan Kamholz, MD, FCCP

At CHEST 2019 in New Orleans, the CHEST Foundation was pleased to formally welcome to its Board of Trustees new CHEST President Stephanie Levine, MD, FCCP, and Executive Committee Chair of the Council of Global Governors, Sai Haranath, MBBS, MPH, FCCP – who were appointed to their positions – as well as Roozehra Khan, DO, FCCP; Burton Lesnick, MD, FCCP; and Jill Popovich – who were elected to their positions. Guided by life-changing experiences with public service, memories of loved ones struggling with lung disease, and a pure and overwhelming desire to help the most vulnerable populations around the world acquire the resources they need to survive, the new CHEST Foundation Board members understand enhancing the CHEST Foundation’s impact on global health over the coming years to be their greatest shared priority.

At CHEST 2019 in New Orleans, the CHEST Foundation was pleased to formally welcome to its Board of Trustees new CHEST President Stephanie Levine, MD, FCCP, and Executive Committee Chair of the Council of Global Governors, Sai Haranath, MBBS, MPH, FCCP – who were appointed to their positions – as well as Roozehra Khan, DO, FCCP; Burton Lesnick, MD, FCCP; and Jill Popovich – who were elected to their positions. Guided by life-changing experiences with public service, memories of loved ones struggling with lung disease, and a pure and overwhelming desire to help the most vulnerable populations around the world acquire the resources they need to survive, the new CHEST Foundation Board members understand enhancing the CHEST Foundation’s impact on global health over the coming years to be their greatest shared priority.

At CHEST 2019 in New Orleans, the CHEST Foundation was pleased to formally welcome to its Board of Trustees new CHEST President Stephanie Levine, MD, FCCP, and Executive Committee Chair of the Council of Global Governors, Sai Haranath, MBBS, MPH, FCCP – who were appointed to their positions – as well as Roozehra Khan, DO, FCCP; Burton Lesnick, MD, FCCP; and Jill Popovich – who were elected to their positions. Guided by life-changing experiences with public service, memories of loved ones struggling with lung disease, and a pure and overwhelming desire to help the most vulnerable populations around the world acquire the resources they need to survive, the new CHEST Foundation Board members understand enhancing the CHEST Foundation’s impact on global health over the coming years to be their greatest shared priority.

CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners! In this limited series, we introduce you to several of them - beginning with finalist Dr. Ernest Chan.

Name: Ernest G. Chan, MD, MPH

Institutional Affiliation: Department of Cardiothoracic Surgery at the University of Pittsburgh Medical Center

Position: PGY-4 Integrated Cardiothoracic Surgery Resident

Brief Summary of Submission:

My innovative idea for the CHEST FISH Bowl Competition 2019 was a device that monitors the use of the incentive spirometry, as well as makes its use interactive with a postoperative surgical patient. Our device would have several modules that monitor the frequency, volume, and quality of each breath. All of the information will be sent to the electronic medical records, so patients can get feedback from the surgical team in real time. There will also be programmable alarms so that we can create unique treatment plans personalized to each patient. All of these functions will ultimately allow us as physicians to study this incentive spirometry better.


1. What inspired your innovation?

What inspired my innovation is the world we live in today. Everything is automated from your toaster oven to self-driving cars. This automation allows for improved adherence and minimization of confounding variables.


2. Who do you think can benefit most from it, and why?

I think the people who would benefit most are the patients. When you are at your most vulnerable state after surgery, it is important to feel like someone is looking after you. Right now with incentive spirometry, you are given the device, someone tells you how to use it one time, and you are supposed to use it correctly. With our device, not only are you constantly reminded of using the device, as well as using correctly, the medical team is being fed these data to ensure what you are doing maximizes the benefits.


3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome?

I think the initial challenge will be the acceptance in spending more money. Physiologically and scientifically, the use of the incentive spirometry should help decrease postoperative pulmonary complications, but the current data are controversial, at best. I think that if we can show improvement in these postoperative complications, taking on extra upfront cost in investing in our device will ultimately pay off in the end.


4. Why was it meaningful for you to emerge as a finalist in FISH Bowl 2019?

I believe CHEST to be one of if not the most premiere medical organizations in the world. To become a finalist in the inaugural FISH Bowl Competition is a complete honor. Throughout every CHEST annual conference, there is innovation in every corner and every presentation. I hope that becoming a finalist at the FISH Bowl competition is just the first in my participation with CHEST.


5. What future do you envision for your innovation beyond FISH Bowl 2019?

I hope that my innovation will inspire young thinkers to look at any medical device/procedure/protocol and say, “How can I apply technology to this to make this better/safer/more efficient?” Because the future generations are exposed at the youngest of ages to technology that is exponentially getting better each day, they will be the ones to come up with the greatest of ideas.

CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners! In this limited series, we introduce you to several of them - beginning with finalist Dr. Ernest Chan.

Name: Ernest G. Chan, MD, MPH

Institutional Affiliation: Department of Cardiothoracic Surgery at the University of Pittsburgh Medical Center

Position: PGY-4 Integrated Cardiothoracic Surgery Resident

Brief Summary of Submission:

My innovative idea for the CHEST FISH Bowl Competition 2019 was a device that monitors the use of the incentive spirometry, as well as makes its use interactive with a postoperative surgical patient. Our device would have several modules that monitor the frequency, volume, and quality of each breath. All of the information will be sent to the electronic medical records, so patients can get feedback from the surgical team in real time. There will also be programmable alarms so that we can create unique treatment plans personalized to each patient. All of these functions will ultimately allow us as physicians to study this incentive spirometry better.


1. What inspired your innovation?

What inspired my innovation is the world we live in today. Everything is automated from your toaster oven to self-driving cars. This automation allows for improved adherence and minimization of confounding variables.


2. Who do you think can benefit most from it, and why?

I think the people who would benefit most are the patients. When you are at your most vulnerable state after surgery, it is important to feel like someone is looking after you. Right now with incentive spirometry, you are given the device, someone tells you how to use it one time, and you are supposed to use it correctly. With our device, not only are you constantly reminded of using the device, as well as using correctly, the medical team is being fed these data to ensure what you are doing maximizes the benefits.


3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome?

I think the initial challenge will be the acceptance in spending more money. Physiologically and scientifically, the use of the incentive spirometry should help decrease postoperative pulmonary complications, but the current data are controversial, at best. I think that if we can show improvement in these postoperative complications, taking on extra upfront cost in investing in our device will ultimately pay off in the end.


4. Why was it meaningful for you to emerge as a finalist in FISH Bowl 2019?

I believe CHEST to be one of if not the most premiere medical organizations in the world. To become a finalist in the inaugural FISH Bowl Competition is a complete honor. Throughout every CHEST annual conference, there is innovation in every corner and every presentation. I hope that becoming a finalist at the FISH Bowl competition is just the first in my participation with CHEST.


5. What future do you envision for your innovation beyond FISH Bowl 2019?

I hope that my innovation will inspire young thinkers to look at any medical device/procedure/protocol and say, “How can I apply technology to this to make this better/safer/more efficient?” Because the future generations are exposed at the youngest of ages to technology that is exponentially getting better each day, they will be the ones to come up with the greatest of ideas.

CHEST 2019 marked the inaugural FISH Bowl competition for attendees. Inspired by Shark Tank, our kinder, gentler, yet still competitive and cutting-edge FISH Bowl (Furthering Innovation and Science for Health) featured CHEST members disrupting our beliefs about how clinical care and education are performed. As health-care providers, they presented innovative ideas pertaining to education and clinical disease for pulmonary, critical care, and sleep medicine. Six finalists were chosen from dozens of submissions, and three emerged winners! In this limited series, we introduce you to several of them - beginning with finalist Dr. Ernest Chan.

Name: Ernest G. Chan, MD, MPH

Institutional Affiliation: Department of Cardiothoracic Surgery at the University of Pittsburgh Medical Center

Position: PGY-4 Integrated Cardiothoracic Surgery Resident

Brief Summary of Submission:

My innovative idea for the CHEST FISH Bowl Competition 2019 was a device that monitors the use of the incentive spirometry, as well as makes its use interactive with a postoperative surgical patient. Our device would have several modules that monitor the frequency, volume, and quality of each breath. All of the information will be sent to the electronic medical records, so patients can get feedback from the surgical team in real time. There will also be programmable alarms so that we can create unique treatment plans personalized to each patient. All of these functions will ultimately allow us as physicians to study this incentive spirometry better.


1. What inspired your innovation?

What inspired my innovation is the world we live in today. Everything is automated from your toaster oven to self-driving cars. This automation allows for improved adherence and minimization of confounding variables.


2. Who do you think can benefit most from it, and why?

I think the people who would benefit most are the patients. When you are at your most vulnerable state after surgery, it is important to feel like someone is looking after you. Right now with incentive spirometry, you are given the device, someone tells you how to use it one time, and you are supposed to use it correctly. With our device, not only are you constantly reminded of using the device, as well as using correctly, the medical team is being fed these data to ensure what you are doing maximizes the benefits.


3. What do you see as challenges to your innovation gaining widespread acceptance? How can they be overcome?

I think the initial challenge will be the acceptance in spending more money. Physiologically and scientifically, the use of the incentive spirometry should help decrease postoperative pulmonary complications, but the current data are controversial, at best. I think that if we can show improvement in these postoperative complications, taking on extra upfront cost in investing in our device will ultimately pay off in the end.


4. Why was it meaningful for you to emerge as a finalist in FISH Bowl 2019?

I believe CHEST to be one of if not the most premiere medical organizations in the world. To become a finalist in the inaugural FISH Bowl Competition is a complete honor. Throughout every CHEST annual conference, there is innovation in every corner and every presentation. I hope that becoming a finalist at the FISH Bowl competition is just the first in my participation with CHEST.


5. What future do you envision for your innovation beyond FISH Bowl 2019?

I hope that my innovation will inspire young thinkers to look at any medical device/procedure/protocol and say, “How can I apply technology to this to make this better/safer/more efficient?” Because the future generations are exposed at the youngest of ages to technology that is exponentially getting better each day, they will be the ones to come up with the greatest of ideas.

Nine dimensions of wellness help nurses set self-care goals, seek resources, and support others.

Since nursing is a high-stress profession, it’s important to recognize signs of post-traumatic stress disorder (PTSD) in yourself or your fellow nurses.

“Nurses and PTSD: Combine Professional Care With Self-Care,” in American Nurse Today notes that one in four nurses will experience PTSD at some point. Symptoms can include agitation, irritability, self-destructive behavior, social isolation, fear, loneliness, and severe anxiety.

Nurse leaders can support their staff by seeking resources, advocating for assistance, and engaging with them. “When you listen, encourage, and support them, you develop trust, which can go a long way toward getting them the help they need,” the article adds.

Within the article is a link to “Wellness 101,” a self-care series that details nine dimensions of wellness to help nurses set goals for the well-being of themselves and others. “Wellness 101: 9 dimensions of wellness,” an introductory article in the series, summarizes each type of wellness:

Physical: Exercise, eat healthy, reduce stress, address medical issues and maintain healthy practices every day.

Emotional: Cognitive behavioral skills and mindfulness can relieve stress and anxiety.

Financial: Plan well and control spending to change how you feel.

Intellectual: Learn a new skill or concept, understand different viewpoints or exercise your mind with puzzles and games.

Career: Engage in work that provides satisfaction and matches your values.

Social: Build a support network based on mutual respect and trust among friends, family and co-workers.

Creative: Doodle, dance or sing without worrying about whether you’re doing it well.

Environmental: Appreciate your responsibility to preserve and protect the environment and connect to nature.

Spiritual: Be open to quiet self-reflection, reading and dialogue. Explore your beliefs and respect those of others.
 

Nine dimensions of wellness help nurses set self-care goals, seek resources, and support others.

Since nursing is a high-stress profession, it’s important to recognize signs of post-traumatic stress disorder (PTSD) in yourself or your fellow nurses.

“Nurses and PTSD: Combine Professional Care With Self-Care,” in American Nurse Today notes that one in four nurses will experience PTSD at some point. Symptoms can include agitation, irritability, self-destructive behavior, social isolation, fear, loneliness, and severe anxiety.

Nurse leaders can support their staff by seeking resources, advocating for assistance, and engaging with them. “When you listen, encourage, and support them, you develop trust, which can go a long way toward getting them the help they need,” the article adds.

Within the article is a link to “Wellness 101,” a self-care series that details nine dimensions of wellness to help nurses set goals for the well-being of themselves and others. “Wellness 101: 9 dimensions of wellness,” an introductory article in the series, summarizes each type of wellness:

Physical: Exercise, eat healthy, reduce stress, address medical issues and maintain healthy practices every day.

Emotional: Cognitive behavioral skills and mindfulness can relieve stress and anxiety.

Financial: Plan well and control spending to change how you feel.

Intellectual: Learn a new skill or concept, understand different viewpoints or exercise your mind with puzzles and games.

Career: Engage in work that provides satisfaction and matches your values.

Social: Build a support network based on mutual respect and trust among friends, family and co-workers.

Creative: Doodle, dance or sing without worrying about whether you’re doing it well.

Environmental: Appreciate your responsibility to preserve and protect the environment and connect to nature.

Spiritual: Be open to quiet self-reflection, reading and dialogue. Explore your beliefs and respect those of others.
 

Nine dimensions of wellness help nurses set self-care goals, seek resources, and support others.

Since nursing is a high-stress profession, it’s important to recognize signs of post-traumatic stress disorder (PTSD) in yourself or your fellow nurses.

“Nurses and PTSD: Combine Professional Care With Self-Care,” in American Nurse Today notes that one in four nurses will experience PTSD at some point. Symptoms can include agitation, irritability, self-destructive behavior, social isolation, fear, loneliness, and severe anxiety.

Nurse leaders can support their staff by seeking resources, advocating for assistance, and engaging with them. “When you listen, encourage, and support them, you develop trust, which can go a long way toward getting them the help they need,” the article adds.

Within the article is a link to “Wellness 101,” a self-care series that details nine dimensions of wellness to help nurses set goals for the well-being of themselves and others. “Wellness 101: 9 dimensions of wellness,” an introductory article in the series, summarizes each type of wellness:

Physical: Exercise, eat healthy, reduce stress, address medical issues and maintain healthy practices every day.

Emotional: Cognitive behavioral skills and mindfulness can relieve stress and anxiety.

Financial: Plan well and control spending to change how you feel.

Intellectual: Learn a new skill or concept, understand different viewpoints or exercise your mind with puzzles and games.

Career: Engage in work that provides satisfaction and matches your values.

Social: Build a support network based on mutual respect and trust among friends, family and co-workers.

Creative: Doodle, dance or sing without worrying about whether you’re doing it well.

Environmental: Appreciate your responsibility to preserve and protect the environment and connect to nature.

Spiritual: Be open to quiet self-reflection, reading and dialogue. Explore your beliefs and respect those of others.
 

Editorials
Right Ventricle to Left Ventricle Ratio at CTPA Predicts Mortality in Interstitial Lung Disease
By Dr. S. Gaine, et al.

Lung Ultrasound for the Diagnosis of Acute Heart Failure in the Emergency Department: A Step Forward
By Dr. P. Le Conte, et al.

Original research
The Burden of Substance Abuse-Related Admissions to the Medical ICU
By Dr. D. Westerhausen, et al.

Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the Emergency Department: A Multicenter Prospective Study
By Dr. T. Choulhed, et al.

Editorials
Right Ventricle to Left Ventricle Ratio at CTPA Predicts Mortality in Interstitial Lung Disease
By Dr. S. Gaine, et al.

Lung Ultrasound for the Diagnosis of Acute Heart Failure in the Emergency Department: A Step Forward
By Dr. P. Le Conte, et al.

Original research
The Burden of Substance Abuse-Related Admissions to the Medical ICU
By Dr. D. Westerhausen, et al.

Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the Emergency Department: A Multicenter Prospective Study
By Dr. T. Choulhed, et al.

Editorials
Right Ventricle to Left Ventricle Ratio at CTPA Predicts Mortality in Interstitial Lung Disease
By Dr. S. Gaine, et al.

Lung Ultrasound for the Diagnosis of Acute Heart Failure in the Emergency Department: A Step Forward
By Dr. P. Le Conte, et al.

Original research
The Burden of Substance Abuse-Related Admissions to the Medical ICU
By Dr. D. Westerhausen, et al.

Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the Emergency Department: A Multicenter Prospective Study
By Dr. T. Choulhed, et al.

Alfred Soffer Research Award Winners
Johnathan Chung: EVALUATING CLINICAL UTILITY OF A UIP GENOMIC CLASSIFIER IN SUBJECTS WITH AND WITHOUT A HRCT PATTERN OF UIP
Girish Nair, MD: QUANTITATIVE LUNG FUNCTION IMAGING USING NOVEL INTEGRATED JACOBIAN VENTILATION METHOD IN A HEALTHY COHORT WITH NO RESPIRATORY SYMPTOMS

Young Investigator Award Winners
Marvi Bikak, MD: APPLICATION OF MARKOV MODELING TO ASSESS OUTCOMES IN COPD
Arunima Bera, MD: SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 (ICAM-1) PREDICTS MORTALITY IN CHILDREN WITH ARDS AND SEPSIS

Top Abstract Poster
Winner: Rachel Naramore: CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD
Runner-up: Arjun Srinivasan: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS

Case Report Slide Winners
Catherine A. Gao, MD: NOCARDIA ABSCESS AND PULMONARY ALVEOLAR PROTEINOSIS MASQUERADING AS LUNG CANCER WITH LYMPHANGITIC SPREAD IN A 57-YO PATIENT WITH 80 PY SMOKING HISTORY, in Fellows session - Interesting Presentations of Infectious Diseases

Sangita Goel, MD: SUCCESSFUL SINGLE LUNG TRANSPLANT OF A HEPATITIS C POSITIVE DONOR TO AN HIV SEROPOSITIVE RECIPIENT WITH PULMONARY FIBROSIS, in Fellows session, – Pulmonary Pathology

Matthew Lyons, MD: FAMILIAL PULMONARY FIBROSIS SECONDARY TO SHORT TELOMERE SYNDROME, in Medical Student/Resident session – Diffuse Lung Disease

Sarika Savajiyani, DO: MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY, in Fellows session – Clinical Conundrums in ECMO

Chase A. Baxter, DO: POLYBIOPSY FULMINANS: PULMONARY LYMPHOMATOID GRANULOMATOSIS, in Medical Student/Resident session – Pulmonary Pathology

Jason Low, MBBS: THE HURRICANE EFFECT: AN UNUSUAL PHENOMENON IN THE PULMONARY ARTERY, in Fellows session – Bronchoscopic Procedures

Jacob Hupp, MD: ECMO-RELATED HEMOLYTIC ANEMIA: A CASE SERIES ILLUSTRATING THE ROLE OF PLASMAPHERESIS IN MANAGEMENT, in Fellows session – Plasmapheresis to the Rescue

Nichole A. Smith, MD: BILATERAL CHYLOTHORAX SECONDARY TO SPONTANEOUS THORACIC DUCT ANEURYSM, in Fellows session – Disorders of the Pleura

Ritu Modi, MD: A FLORIST’S OCCUPATIONAL EXPOSURE, in Fellows session – Chest Infections: Find the Fungus

Ly Tran, DO: A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER, in Medical Student/Resident session – Lung Cancer: Unusual Presentations

Abdelhamid Ben Selma, MD: PRIMARY SYNOVIAL SARCOMA OF THE LUNG COMPLICATED WITH POST BIOPSY TUMOR SPREAD TO THE TRACHEAL WALL, in Medical Student/Resident session – Pulmonary Pathology II

Dhaval Thakkar, MD: A CURIOUS MANIFESTATION OF SARCOIDOSIS, in Fellows session – Pulmonary Manifestations of Systemic Disease

Isaac N. Biney, MBChB: ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY, in Fellows session – Pulmonary Vascular Disease

Tie: José Antonio J. Meade Aguilar: CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT and Abigayle R. Sullivan, DO: A RARE CASE OF CULTURE-NEGATIVE WHIPPLE’S ENDOCARDITIS, in Medical Student/Resident session - Cardiovascular Cases

Yameena T. Jawed: BLUE INSIDE AND OUT: A NOVEL CASE OF HYPOTHERMIC SHOCK SALVAGED BY METHYLENE BLUE, in Fellows session – Unusual Cases and Treatments in the ICU

Rahul Dasgupta, MD: SUPERIOR VENA CAVA (SVC) –TRACHEAL FISTULA: AN UNUSUAL CASE OF HEMOPTYSIS, in Medical Student/Resident session – Lung Cancer: Expect the Unexpected

Akshay Bhatnagar, MD: A CASE OF CLINICALLY AMYOPATHIC DERMATOMYOSITIS-RELATED INTERSTITIAL LUNG DISEASE DUE TO ANTI-MDA5 ANTIBODY AND HEPATITIS B INFECTION, in Fellows session – Diffuse Lung Diseases

Kathleen Twomey, MD: A CASE OF RECURRENT ENCEPHALOPATHY IN A GASTRIC BYPASS PATIENT, in Medical Student/Resident session – Critical Care Complications

Jennifer Sunny, DO: MASSIVE BEE ENVENOMATION TREATED BY PLASMAPHERESIS, in Medical Student/Resident session – Critical Care Devices

Hafiz B. Mahboob, MD: PAZOPANIB ASSOCIATED SECONDARY SPONTANEOUS PNEUMOTHORAX: NATURAL DISEASE PROGRESSION OR DRUG SAFETY CONCERN? in Fellows session – Lung Cancer

Tie: Andrew DeMaio, MD, A CASE OF PULMONARY TUBERCULOSIS AND PERSISTENT INTESTINAL INFLAMMATION AND HEMORRHAGE: TB OR NOT TB? and Joanna M. Scoon: ATTACK OF THE WILD BOARS, in Fellows session – Chest Infections

Danielle El Haddad, MD: A RIGHT TO LEFT EXTRACARDIAC SHUNT FROM A CHRONIC SUPERIOR VENA CAVA THROMBUS IN A PROTHROMBOTIC PATIENT, in Medical Student/Resident session – Pulmonary Vascular Disease

John Shumar, DO: MAKE NO BONES ABOUT IT: A RARE CASE OF OSSEOUS SARCOIDOSIS PRESENTING TWENTY YEARS AFTER INITIAL DIAGNOSIS, in Medical Student/Resident session – Pulmonary Manifestations of Systemic Disease


Case Report Poster Winners
Jad Sargi, MD: ATYPICAL PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES SYNDROME)

Ankur Sinha, MBBS: LISTERIA MONOCYTOGENES BRAIN ABSCESS IN AN IMMUNOCOMPETENT ADULT

Carla Emille D. Barbon, MD: GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL THORACOTOMY

Hope F. Johnson, RRT: BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

Humna Abid Memon, MD: AUTOLOGOUS STEM CELL TRANSPLANTATION: A POSSIBLE TREATMENT FOR PULMONARY HYPERTENSION IN POEMS SYNDROME

Jordanna Hostler, MD, FCCP: BEYOND STEROIDS: MEPOLIZUMAB FOR CHRONIC EOSINOPHILIC PNEUMONIA

Zahra Zia, MD, MBBS: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR EMERGENT SURGICAL TREATMENT OF ANAEROBIC PURULENT PERICARDITIS CAUSING CARDIAC TAMPONADE, BRONCHOMEDIASTINAL FISTULA, AND ARDS

Brooke A. McDonald: FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

Mary E. Richert, MD: A CASE OF RASBURICASE-INDUCED METHEMOGLOBINEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY TREATED WITH HYPERBARIC OXYGEN THERAPY

Shiva M. Arjun, MD: AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

Harshwant Grover, MD: BLACK MEDIASTINUM: PRIMARY MEDIASTINAL MELANOMA

Neha Agarwal, MD: POSTTRANSPLANT PULMONARY KAPOSI SARCOMA PRESENTING AS CHYLOTHORAX

Alfred Soffer Research Award Winners
Johnathan Chung: EVALUATING CLINICAL UTILITY OF A UIP GENOMIC CLASSIFIER IN SUBJECTS WITH AND WITHOUT A HRCT PATTERN OF UIP
Girish Nair, MD: QUANTITATIVE LUNG FUNCTION IMAGING USING NOVEL INTEGRATED JACOBIAN VENTILATION METHOD IN A HEALTHY COHORT WITH NO RESPIRATORY SYMPTOMS

Young Investigator Award Winners
Marvi Bikak, MD: APPLICATION OF MARKOV MODELING TO ASSESS OUTCOMES IN COPD
Arunima Bera, MD: SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 (ICAM-1) PREDICTS MORTALITY IN CHILDREN WITH ARDS AND SEPSIS

Top Abstract Poster
Winner: Rachel Naramore: CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD
Runner-up: Arjun Srinivasan: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS

Case Report Slide Winners
Catherine A. Gao, MD: NOCARDIA ABSCESS AND PULMONARY ALVEOLAR PROTEINOSIS MASQUERADING AS LUNG CANCER WITH LYMPHANGITIC SPREAD IN A 57-YO PATIENT WITH 80 PY SMOKING HISTORY, in Fellows session - Interesting Presentations of Infectious Diseases

Sangita Goel, MD: SUCCESSFUL SINGLE LUNG TRANSPLANT OF A HEPATITIS C POSITIVE DONOR TO AN HIV SEROPOSITIVE RECIPIENT WITH PULMONARY FIBROSIS, in Fellows session, – Pulmonary Pathology

Matthew Lyons, MD: FAMILIAL PULMONARY FIBROSIS SECONDARY TO SHORT TELOMERE SYNDROME, in Medical Student/Resident session – Diffuse Lung Disease

Sarika Savajiyani, DO: MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY, in Fellows session – Clinical Conundrums in ECMO

Chase A. Baxter, DO: POLYBIOPSY FULMINANS: PULMONARY LYMPHOMATOID GRANULOMATOSIS, in Medical Student/Resident session – Pulmonary Pathology

Jason Low, MBBS: THE HURRICANE EFFECT: AN UNUSUAL PHENOMENON IN THE PULMONARY ARTERY, in Fellows session – Bronchoscopic Procedures

Jacob Hupp, MD: ECMO-RELATED HEMOLYTIC ANEMIA: A CASE SERIES ILLUSTRATING THE ROLE OF PLASMAPHERESIS IN MANAGEMENT, in Fellows session – Plasmapheresis to the Rescue

Nichole A. Smith, MD: BILATERAL CHYLOTHORAX SECONDARY TO SPONTANEOUS THORACIC DUCT ANEURYSM, in Fellows session – Disorders of the Pleura

Ritu Modi, MD: A FLORIST’S OCCUPATIONAL EXPOSURE, in Fellows session – Chest Infections: Find the Fungus

Ly Tran, DO: A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER, in Medical Student/Resident session – Lung Cancer: Unusual Presentations

Abdelhamid Ben Selma, MD: PRIMARY SYNOVIAL SARCOMA OF THE LUNG COMPLICATED WITH POST BIOPSY TUMOR SPREAD TO THE TRACHEAL WALL, in Medical Student/Resident session – Pulmonary Pathology II

Dhaval Thakkar, MD: A CURIOUS MANIFESTATION OF SARCOIDOSIS, in Fellows session – Pulmonary Manifestations of Systemic Disease

Isaac N. Biney, MBChB: ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY, in Fellows session – Pulmonary Vascular Disease

Tie: José Antonio J. Meade Aguilar: CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT and Abigayle R. Sullivan, DO: A RARE CASE OF CULTURE-NEGATIVE WHIPPLE’S ENDOCARDITIS, in Medical Student/Resident session - Cardiovascular Cases

Yameena T. Jawed: BLUE INSIDE AND OUT: A NOVEL CASE OF HYPOTHERMIC SHOCK SALVAGED BY METHYLENE BLUE, in Fellows session – Unusual Cases and Treatments in the ICU

Rahul Dasgupta, MD: SUPERIOR VENA CAVA (SVC) –TRACHEAL FISTULA: AN UNUSUAL CASE OF HEMOPTYSIS, in Medical Student/Resident session – Lung Cancer: Expect the Unexpected

Akshay Bhatnagar, MD: A CASE OF CLINICALLY AMYOPATHIC DERMATOMYOSITIS-RELATED INTERSTITIAL LUNG DISEASE DUE TO ANTI-MDA5 ANTIBODY AND HEPATITIS B INFECTION, in Fellows session – Diffuse Lung Diseases

Kathleen Twomey, MD: A CASE OF RECURRENT ENCEPHALOPATHY IN A GASTRIC BYPASS PATIENT, in Medical Student/Resident session – Critical Care Complications

Jennifer Sunny, DO: MASSIVE BEE ENVENOMATION TREATED BY PLASMAPHERESIS, in Medical Student/Resident session – Critical Care Devices

Hafiz B. Mahboob, MD: PAZOPANIB ASSOCIATED SECONDARY SPONTANEOUS PNEUMOTHORAX: NATURAL DISEASE PROGRESSION OR DRUG SAFETY CONCERN? in Fellows session – Lung Cancer

Tie: Andrew DeMaio, MD, A CASE OF PULMONARY TUBERCULOSIS AND PERSISTENT INTESTINAL INFLAMMATION AND HEMORRHAGE: TB OR NOT TB? and Joanna M. Scoon: ATTACK OF THE WILD BOARS, in Fellows session – Chest Infections

Danielle El Haddad, MD: A RIGHT TO LEFT EXTRACARDIAC SHUNT FROM A CHRONIC SUPERIOR VENA CAVA THROMBUS IN A PROTHROMBOTIC PATIENT, in Medical Student/Resident session – Pulmonary Vascular Disease

John Shumar, DO: MAKE NO BONES ABOUT IT: A RARE CASE OF OSSEOUS SARCOIDOSIS PRESENTING TWENTY YEARS AFTER INITIAL DIAGNOSIS, in Medical Student/Resident session – Pulmonary Manifestations of Systemic Disease


Case Report Poster Winners
Jad Sargi, MD: ATYPICAL PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES SYNDROME)

Ankur Sinha, MBBS: LISTERIA MONOCYTOGENES BRAIN ABSCESS IN AN IMMUNOCOMPETENT ADULT

Carla Emille D. Barbon, MD: GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL THORACOTOMY

Hope F. Johnson, RRT: BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

Humna Abid Memon, MD: AUTOLOGOUS STEM CELL TRANSPLANTATION: A POSSIBLE TREATMENT FOR PULMONARY HYPERTENSION IN POEMS SYNDROME

Jordanna Hostler, MD, FCCP: BEYOND STEROIDS: MEPOLIZUMAB FOR CHRONIC EOSINOPHILIC PNEUMONIA

Zahra Zia, MD, MBBS: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR EMERGENT SURGICAL TREATMENT OF ANAEROBIC PURULENT PERICARDITIS CAUSING CARDIAC TAMPONADE, BRONCHOMEDIASTINAL FISTULA, AND ARDS

Brooke A. McDonald: FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

Mary E. Richert, MD: A CASE OF RASBURICASE-INDUCED METHEMOGLOBINEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY TREATED WITH HYPERBARIC OXYGEN THERAPY

Shiva M. Arjun, MD: AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

Harshwant Grover, MD: BLACK MEDIASTINUM: PRIMARY MEDIASTINAL MELANOMA

Neha Agarwal, MD: POSTTRANSPLANT PULMONARY KAPOSI SARCOMA PRESENTING AS CHYLOTHORAX

Alfred Soffer Research Award Winners
Johnathan Chung: EVALUATING CLINICAL UTILITY OF A UIP GENOMIC CLASSIFIER IN SUBJECTS WITH AND WITHOUT A HRCT PATTERN OF UIP
Girish Nair, MD: QUANTITATIVE LUNG FUNCTION IMAGING USING NOVEL INTEGRATED JACOBIAN VENTILATION METHOD IN A HEALTHY COHORT WITH NO RESPIRATORY SYMPTOMS

Young Investigator Award Winners
Marvi Bikak, MD: APPLICATION OF MARKOV MODELING TO ASSESS OUTCOMES IN COPD
Arunima Bera, MD: SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 (ICAM-1) PREDICTS MORTALITY IN CHILDREN WITH ARDS AND SEPSIS

Top Abstract Poster
Winner: Rachel Naramore: CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD
Runner-up: Arjun Srinivasan: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS

Case Report Slide Winners
Catherine A. Gao, MD: NOCARDIA ABSCESS AND PULMONARY ALVEOLAR PROTEINOSIS MASQUERADING AS LUNG CANCER WITH LYMPHANGITIC SPREAD IN A 57-YO PATIENT WITH 80 PY SMOKING HISTORY, in Fellows session - Interesting Presentations of Infectious Diseases

Sangita Goel, MD: SUCCESSFUL SINGLE LUNG TRANSPLANT OF A HEPATITIS C POSITIVE DONOR TO AN HIV SEROPOSITIVE RECIPIENT WITH PULMONARY FIBROSIS, in Fellows session, – Pulmonary Pathology

Matthew Lyons, MD: FAMILIAL PULMONARY FIBROSIS SECONDARY TO SHORT TELOMERE SYNDROME, in Medical Student/Resident session – Diffuse Lung Disease

Sarika Savajiyani, DO: MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY, in Fellows session – Clinical Conundrums in ECMO

Chase A. Baxter, DO: POLYBIOPSY FULMINANS: PULMONARY LYMPHOMATOID GRANULOMATOSIS, in Medical Student/Resident session – Pulmonary Pathology

Jason Low, MBBS: THE HURRICANE EFFECT: AN UNUSUAL PHENOMENON IN THE PULMONARY ARTERY, in Fellows session – Bronchoscopic Procedures

Jacob Hupp, MD: ECMO-RELATED HEMOLYTIC ANEMIA: A CASE SERIES ILLUSTRATING THE ROLE OF PLASMAPHERESIS IN MANAGEMENT, in Fellows session – Plasmapheresis to the Rescue

Nichole A. Smith, MD: BILATERAL CHYLOTHORAX SECONDARY TO SPONTANEOUS THORACIC DUCT ANEURYSM, in Fellows session – Disorders of the Pleura

Ritu Modi, MD: A FLORIST’S OCCUPATIONAL EXPOSURE, in Fellows session – Chest Infections: Find the Fungus

Ly Tran, DO: A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER, in Medical Student/Resident session – Lung Cancer: Unusual Presentations

Abdelhamid Ben Selma, MD: PRIMARY SYNOVIAL SARCOMA OF THE LUNG COMPLICATED WITH POST BIOPSY TUMOR SPREAD TO THE TRACHEAL WALL, in Medical Student/Resident session – Pulmonary Pathology II

Dhaval Thakkar, MD: A CURIOUS MANIFESTATION OF SARCOIDOSIS, in Fellows session – Pulmonary Manifestations of Systemic Disease

Isaac N. Biney, MBChB: ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY, in Fellows session – Pulmonary Vascular Disease

Tie: José Antonio J. Meade Aguilar: CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT and Abigayle R. Sullivan, DO: A RARE CASE OF CULTURE-NEGATIVE WHIPPLE’S ENDOCARDITIS, in Medical Student/Resident session - Cardiovascular Cases

Yameena T. Jawed: BLUE INSIDE AND OUT: A NOVEL CASE OF HYPOTHERMIC SHOCK SALVAGED BY METHYLENE BLUE, in Fellows session – Unusual Cases and Treatments in the ICU

Rahul Dasgupta, MD: SUPERIOR VENA CAVA (SVC) –TRACHEAL FISTULA: AN UNUSUAL CASE OF HEMOPTYSIS, in Medical Student/Resident session – Lung Cancer: Expect the Unexpected

Akshay Bhatnagar, MD: A CASE OF CLINICALLY AMYOPATHIC DERMATOMYOSITIS-RELATED INTERSTITIAL LUNG DISEASE DUE TO ANTI-MDA5 ANTIBODY AND HEPATITIS B INFECTION, in Fellows session – Diffuse Lung Diseases

Kathleen Twomey, MD: A CASE OF RECURRENT ENCEPHALOPATHY IN A GASTRIC BYPASS PATIENT, in Medical Student/Resident session – Critical Care Complications

Jennifer Sunny, DO: MASSIVE BEE ENVENOMATION TREATED BY PLASMAPHERESIS, in Medical Student/Resident session – Critical Care Devices

Hafiz B. Mahboob, MD: PAZOPANIB ASSOCIATED SECONDARY SPONTANEOUS PNEUMOTHORAX: NATURAL DISEASE PROGRESSION OR DRUG SAFETY CONCERN? in Fellows session – Lung Cancer

Tie: Andrew DeMaio, MD, A CASE OF PULMONARY TUBERCULOSIS AND PERSISTENT INTESTINAL INFLAMMATION AND HEMORRHAGE: TB OR NOT TB? and Joanna M. Scoon: ATTACK OF THE WILD BOARS, in Fellows session – Chest Infections

Danielle El Haddad, MD: A RIGHT TO LEFT EXTRACARDIAC SHUNT FROM A CHRONIC SUPERIOR VENA CAVA THROMBUS IN A PROTHROMBOTIC PATIENT, in Medical Student/Resident session – Pulmonary Vascular Disease

John Shumar, DO: MAKE NO BONES ABOUT IT: A RARE CASE OF OSSEOUS SARCOIDOSIS PRESENTING TWENTY YEARS AFTER INITIAL DIAGNOSIS, in Medical Student/Resident session – Pulmonary Manifestations of Systemic Disease


Case Report Poster Winners
Jad Sargi, MD: ATYPICAL PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES SYNDROME)

Ankur Sinha, MBBS: LISTERIA MONOCYTOGENES BRAIN ABSCESS IN AN IMMUNOCOMPETENT ADULT

Carla Emille D. Barbon, MD: GIANT PRIMARY LIPOSARCOMA OF THE PLEURA RESECTED THROUGH HEMI-CLAMSHELL THORACOTOMY

Hope F. Johnson, RRT: BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

Humna Abid Memon, MD: AUTOLOGOUS STEM CELL TRANSPLANTATION: A POSSIBLE TREATMENT FOR PULMONARY HYPERTENSION IN POEMS SYNDROME

Jordanna Hostler, MD, FCCP: BEYOND STEROIDS: MEPOLIZUMAB FOR CHRONIC EOSINOPHILIC PNEUMONIA

Zahra Zia, MD, MBBS: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR EMERGENT SURGICAL TREATMENT OF ANAEROBIC PURULENT PERICARDITIS CAUSING CARDIAC TAMPONADE, BRONCHOMEDIASTINAL FISTULA, AND ARDS

Brooke A. McDonald: FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

Mary E. Richert, MD: A CASE OF RASBURICASE-INDUCED METHEMOGLOBINEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY TREATED WITH HYPERBARIC OXYGEN THERAPY

Shiva M. Arjun, MD: AORTOBRONCHIAL FISTULA DUE TO GRAFT FAILURE: A RARE CAUSE OF HEMOPTYSIS

Harshwant Grover, MD: BLACK MEDIASTINUM: PRIMARY MEDIASTINAL MELANOMA

Neha Agarwal, MD: POSTTRANSPLANT PULMONARY KAPOSI SARCOMA PRESENTING AS CHYLOTHORAX

ANNUAL AWARDS

Master FCCP
Darcy Marciniuk, MD, Master FCCP

Distinguished Service Award
Doreen Addrizzo-Harris, MD, FCCP

Master Clinician Educator
Eric Edell, MD, FCCP

Early Career Clinician Educator
Cassie Kennedy, MD, FCCP
Paru Patrawalla, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Richard Irwin, MD, Master FCCP

Presidential Citation
Lawrence Mohr, Jr., MD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
Dare We Discuss the Cure for Stage IV Lung Cancer? Next- Generation Sequencing and Immune Checkpoint Inhibitors!
James Jett, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice
Eduardo Bossone, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Drug-Induced Lung Disease: Watchful Eyes
Andrew Limper, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
The NHI Phase 3 Trial to Treat Central Sleep Apnea in Heart Failure With Low-Flow Oxygen
Shahrokh Javaheri, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Home-Based Mechanical VentilationChildren Are Not Just Little Adults – Except Sometimes
Howard Panitch, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.

Pasquale Ciaglia Memorial Lecture in Interventional Medicine
Medical Thoracoscopy: Past, Present, and Future
Pyng Lee, MD, PhD
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareReducing Mortality in Sepsis: The History of Performance Measures
Mitchell Levy, MD
The lecture is generously funded by the CHEST Foundation.

Murray Kornfeld Memorial Founders Lecture
Is It Infection, Inflammation, or…Cancer?
Diane Stover, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Om P. Sharma, MD, Master FCCP Memorial Lecture
Common Pitfalls in Sarcoidosis
Michael Iannuzzi, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Mark J. Rosen, MD, Master FCCP Memorial Lecture
Remembering a Giant in Chest Medicine: The Mark J. Rosen Memorial Lecture
Lisa Moores, MD, FCCP

 

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health
Kamran Mahmood, MBBS, FCCP
Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung CancerThis grant is supported by an endowed fund from GlaxoSmithKline.

CHEST Foundation Research Grant in Lung Cancer
James Tsay, MD
Effect of the Inflammasone Signaling Pathway on Lung Microbiome and Lung Cancer
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Mona Alotaibi, MD
Metabolic Derangements Underlying SSc-PAH
This grant supported in full by the CHEST Foundation.

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
Derek Russell, MD
Neutrophil-Elastase Positive Exosomes and Emphysema in Alpha-1 Antitrypsin Deficiency
This grant supported by the Alpha-1 Foundation and the CHEST Foundation.

CHEST Foundation Research Grant in Women’s Lung Health
Neelima Navuluri, MD, MPH
Evaluation of Chronic Hypoxemia From Cardiopulmonary Disease Among Patients in Western Kenya and Perspectives on Oxygen Therapy
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Fibrosis
Eric Abston, MD
Noninvasive Quantification of Pulmonary Fibrosis Due to Radiation Induced Lung Injury Using [68Ga]CBP8 Type 1 Collagen Probe
 

Karthik Suresh, MD
Safety and Efficacy of High-Flow Air for Long-term Oxygen Therapy Delivery in Patients With Pulmonary Fibrosis

These grants are supported by a scientific advancement agreement from Boehringer Ingelheim Pharmaceuticals, Inc and by a grant from Genentech.


CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
Chris Mosher, MD
Identifying Treatment Outcomes and Early Predictors of Failure in 600 Hospitalized Patients With Acute Exacerbation of COPD Treated with Noninvasive Ventilation
Grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
Elsje Pienaar, PhD
A Computational Bridge Between In Vitro MIC and In Vivo Efficacy of Antibiotics Against MAC Infection

Elisa Ignatius, MD
Early Bactericidal Activity of Standard Drugs Used to Treat Mycobacterium Avium Complex: A Pilot Study

Supported by a research award grant by Insmed Incorporated.


CHEST Foundation Research Grant in Venous Thromboembolism
Mitchell Cahan, MD
A Translational Approach to Understanding Venous Thromboembolism in Post-Surgical Patients Using MicroRNAs in the American Black Bear
This grant supported in full by the CHEST Foundation.


CHEST Foundation Research Grant in Severe Asthma
Vickram Tejwani, MD
Peripheral Immune Cell Landscape in Obese Children With Severe Asthma

Sunita Sharma, MD, MPH
Predictors of Anti-IL-5 Treatment Failure in Severe Asthmatics

Supported by an independent educational grant from AstraZeneca LP.

CHEST Foundation Research Grant in Cystic Fibrosis
Kathleen Ramos, MD, MS
Underweight Individuals With Cystic Fibrosis and Implications for Lung Transplantation
This grant supported by Vertex Pharmaceuticals Incorporated.

John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
Divya Patel, DO
Pharmacogenetic Predictors of Therapeutic Response to Methotrexate in Patients With Sarcoidosis

Nicholas Arger, MD
Using Serum Interferon-Induced Chemokines to Predict Sarcoidosis Outcomes
This grant is in honor of John R. Addrizzo, MD, and is supported in full by the Addrizzo Family, their friends, and the CHEST Foundation.

CHEST Foundation Research Grant in Sleep Medicine
Irene Telias, MD
Influence of Sleep-Wakefulness Abnormalities on Patient-Ventilator Dyssynchrony: A Step Towards Improvement of Sleep Quality in Critically Ill Patients

Sushmita Pamidi, MD, MSc
Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Children: A Follow-Up Study of the 3D Pregnancy and Birth Cohort
This grant supported by Apria Healthcare and Jazz Pharmaceuticals.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Hans Lee, MD, FCCP
Uganda Bronchoscopy and Pleuroscopy (UBP) Project

Panagis Galiatsatos, MD, MHS
The Lung Health Ambassador Program

Paul Sonenthal, MD
Improving Critical Care Capacity in Sierra Leone

Dana Hickman, ARNP-C, FNP-BC
Living With COPD: Empowering Individuals, Families, and Caregivers

Ann Salvator, MS
Pediatric Asthma Screenings and Education on the Navajo Reservation

Tisha Wang, MD
PAP Foundation Education Days: A Project to Reach Patients, Caregivers, and Physicians

Grants supported in full by the CHEST Foundation.

ANNUAL AWARDS

Master FCCP
Darcy Marciniuk, MD, Master FCCP

Distinguished Service Award
Doreen Addrizzo-Harris, MD, FCCP

Master Clinician Educator
Eric Edell, MD, FCCP

Early Career Clinician Educator
Cassie Kennedy, MD, FCCP
Paru Patrawalla, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Richard Irwin, MD, Master FCCP

Presidential Citation
Lawrence Mohr, Jr., MD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
Dare We Discuss the Cure for Stage IV Lung Cancer? Next- Generation Sequencing and Immune Checkpoint Inhibitors!
James Jett, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice
Eduardo Bossone, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Drug-Induced Lung Disease: Watchful Eyes
Andrew Limper, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
The NHI Phase 3 Trial to Treat Central Sleep Apnea in Heart Failure With Low-Flow Oxygen
Shahrokh Javaheri, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Home-Based Mechanical VentilationChildren Are Not Just Little Adults – Except Sometimes
Howard Panitch, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.

Pasquale Ciaglia Memorial Lecture in Interventional Medicine
Medical Thoracoscopy: Past, Present, and Future
Pyng Lee, MD, PhD
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareReducing Mortality in Sepsis: The History of Performance Measures
Mitchell Levy, MD
The lecture is generously funded by the CHEST Foundation.

Murray Kornfeld Memorial Founders Lecture
Is It Infection, Inflammation, or…Cancer?
Diane Stover, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Om P. Sharma, MD, Master FCCP Memorial Lecture
Common Pitfalls in Sarcoidosis
Michael Iannuzzi, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Mark J. Rosen, MD, Master FCCP Memorial Lecture
Remembering a Giant in Chest Medicine: The Mark J. Rosen Memorial Lecture
Lisa Moores, MD, FCCP

 

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health
Kamran Mahmood, MBBS, FCCP
Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung CancerThis grant is supported by an endowed fund from GlaxoSmithKline.

CHEST Foundation Research Grant in Lung Cancer
James Tsay, MD
Effect of the Inflammasone Signaling Pathway on Lung Microbiome and Lung Cancer
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Mona Alotaibi, MD
Metabolic Derangements Underlying SSc-PAH
This grant supported in full by the CHEST Foundation.

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
Derek Russell, MD
Neutrophil-Elastase Positive Exosomes and Emphysema in Alpha-1 Antitrypsin Deficiency
This grant supported by the Alpha-1 Foundation and the CHEST Foundation.

CHEST Foundation Research Grant in Women’s Lung Health
Neelima Navuluri, MD, MPH
Evaluation of Chronic Hypoxemia From Cardiopulmonary Disease Among Patients in Western Kenya and Perspectives on Oxygen Therapy
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Fibrosis
Eric Abston, MD
Noninvasive Quantification of Pulmonary Fibrosis Due to Radiation Induced Lung Injury Using [68Ga]CBP8 Type 1 Collagen Probe
 

Karthik Suresh, MD
Safety and Efficacy of High-Flow Air for Long-term Oxygen Therapy Delivery in Patients With Pulmonary Fibrosis

These grants are supported by a scientific advancement agreement from Boehringer Ingelheim Pharmaceuticals, Inc and by a grant from Genentech.


CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
Chris Mosher, MD
Identifying Treatment Outcomes and Early Predictors of Failure in 600 Hospitalized Patients With Acute Exacerbation of COPD Treated with Noninvasive Ventilation
Grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
Elsje Pienaar, PhD
A Computational Bridge Between In Vitro MIC and In Vivo Efficacy of Antibiotics Against MAC Infection

Elisa Ignatius, MD
Early Bactericidal Activity of Standard Drugs Used to Treat Mycobacterium Avium Complex: A Pilot Study

Supported by a research award grant by Insmed Incorporated.


CHEST Foundation Research Grant in Venous Thromboembolism
Mitchell Cahan, MD
A Translational Approach to Understanding Venous Thromboembolism in Post-Surgical Patients Using MicroRNAs in the American Black Bear
This grant supported in full by the CHEST Foundation.


CHEST Foundation Research Grant in Severe Asthma
Vickram Tejwani, MD
Peripheral Immune Cell Landscape in Obese Children With Severe Asthma

Sunita Sharma, MD, MPH
Predictors of Anti-IL-5 Treatment Failure in Severe Asthmatics

Supported by an independent educational grant from AstraZeneca LP.

CHEST Foundation Research Grant in Cystic Fibrosis
Kathleen Ramos, MD, MS
Underweight Individuals With Cystic Fibrosis and Implications for Lung Transplantation
This grant supported by Vertex Pharmaceuticals Incorporated.

John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
Divya Patel, DO
Pharmacogenetic Predictors of Therapeutic Response to Methotrexate in Patients With Sarcoidosis

Nicholas Arger, MD
Using Serum Interferon-Induced Chemokines to Predict Sarcoidosis Outcomes
This grant is in honor of John R. Addrizzo, MD, and is supported in full by the Addrizzo Family, their friends, and the CHEST Foundation.

CHEST Foundation Research Grant in Sleep Medicine
Irene Telias, MD
Influence of Sleep-Wakefulness Abnormalities on Patient-Ventilator Dyssynchrony: A Step Towards Improvement of Sleep Quality in Critically Ill Patients

Sushmita Pamidi, MD, MSc
Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Children: A Follow-Up Study of the 3D Pregnancy and Birth Cohort
This grant supported by Apria Healthcare and Jazz Pharmaceuticals.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Hans Lee, MD, FCCP
Uganda Bronchoscopy and Pleuroscopy (UBP) Project

Panagis Galiatsatos, MD, MHS
The Lung Health Ambassador Program

Paul Sonenthal, MD
Improving Critical Care Capacity in Sierra Leone

Dana Hickman, ARNP-C, FNP-BC
Living With COPD: Empowering Individuals, Families, and Caregivers

Ann Salvator, MS
Pediatric Asthma Screenings and Education on the Navajo Reservation

Tisha Wang, MD
PAP Foundation Education Days: A Project to Reach Patients, Caregivers, and Physicians

Grants supported in full by the CHEST Foundation.

ANNUAL AWARDS

Master FCCP
Darcy Marciniuk, MD, Master FCCP

Distinguished Service Award
Doreen Addrizzo-Harris, MD, FCCP

Master Clinician Educator
Eric Edell, MD, FCCP

Early Career Clinician Educator
Cassie Kennedy, MD, FCCP
Paru Patrawalla, MD, FCCP

Alfred Soffer Award for Editorial Excellence
Richard Irwin, MD, Master FCCP

Presidential Citation
Lawrence Mohr, Jr., MD, FCCP
 

HONOR LECTURE AND MEMORIAL AWARDS

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Honor Lecture
Dare We Discuss the Cure for Stage IV Lung Cancer? Next- Generation Sequencing and Immune Checkpoint Inhibitors!
James Jett, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Distinguished Scientist Honor Lecture in Cardiopulmonary Physiology
Exercise-Induced Pulmonary Hypertension: Translating Pathophysiological Concepts Into Clinical Practice
Eduardo Bossone, MD, PhD, FCCP
The lecture is generously funded by the CHEST Foundation.

Presidential Honor Lecture
Drug-Induced Lung Disease: Watchful Eyes
Andrew Limper, MD, FCCP

Thomas L. Petty, MD, Master FCCP Memorial Lecture
The NHI Phase 3 Trial to Treat Central Sleep Apnea in Heart Failure With Low-Flow Oxygen
Shahrokh Javaheri, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Margaret Pfrommer Memorial Lecture in Home-Based Mechanical VentilationChildren Are Not Just Little Adults – Except Sometimes
Howard Panitch, MD, FCCP
The Margaret Pfrommer Memorial Lecture in Home-Based Mechanical Ventilation is generously supported by International Ventilator Users Network of Post-Polio Health International and the CHEST Foundation.

Pasquale Ciaglia Memorial Lecture in Interventional Medicine
Medical Thoracoscopy: Past, Present, and Future
Pyng Lee, MD, PhD
The lecture is generously funded by the CHEST Foundation.

Roger C. Bone Memorial Lecture in Critical CareReducing Mortality in Sepsis: The History of Performance Measures
Mitchell Levy, MD
The lecture is generously funded by the CHEST Foundation.

Murray Kornfeld Memorial Founders Lecture
Is It Infection, Inflammation, or…Cancer?
Diane Stover, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Om P. Sharma, MD, Master FCCP Memorial Lecture
Common Pitfalls in Sarcoidosis
Michael Iannuzzi, MD, FCCP
The lecture is generously funded by the CHEST Foundation.

Mark J. Rosen, MD, Master FCCP Memorial Lecture
Remembering a Giant in Chest Medicine: The Mark J. Rosen Memorial Lecture
Lisa Moores, MD, FCCP

 

CHEST FOUNDATION GRANT AWARDS

The GlaxoSmithKline Distinguished Scholar in Respiratory Health
Kamran Mahmood, MBBS, FCCP
Lymphocyte Exhaustion Markers in Malignant Pleural Effusions of Lung CancerThis grant is supported by an endowed fund from GlaxoSmithKline.

CHEST Foundation Research Grant in Lung Cancer
James Tsay, MD
Effect of the Inflammasone Signaling Pathway on Lung Microbiome and Lung Cancer
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Arterial Hypertension
Mona Alotaibi, MD
Metabolic Derangements Underlying SSc-PAH
This grant supported in full by the CHEST Foundation.

CHEST Foundation and the Alpha-1 Foundation Research Grant in Alpha-1 Antitrypsin Deficiency
Derek Russell, MD
Neutrophil-Elastase Positive Exosomes and Emphysema in Alpha-1 Antitrypsin Deficiency
This grant supported by the Alpha-1 Foundation and the CHEST Foundation.

CHEST Foundation Research Grant in Women’s Lung Health
Neelima Navuluri, MD, MPH
Evaluation of Chronic Hypoxemia From Cardiopulmonary Disease Among Patients in Western Kenya and Perspectives on Oxygen Therapy
This grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Pulmonary Fibrosis
Eric Abston, MD
Noninvasive Quantification of Pulmonary Fibrosis Due to Radiation Induced Lung Injury Using [68Ga]CBP8 Type 1 Collagen Probe
 

Karthik Suresh, MD
Safety and Efficacy of High-Flow Air for Long-term Oxygen Therapy Delivery in Patients With Pulmonary Fibrosis

These grants are supported by a scientific advancement agreement from Boehringer Ingelheim Pharmaceuticals, Inc and by a grant from Genentech.


CHEST Foundation Research Grant in Chronic Obstructive Pulmonary Disease
Chris Mosher, MD
Identifying Treatment Outcomes and Early Predictors of Failure in 600 Hospitalized Patients With Acute Exacerbation of COPD Treated with Noninvasive Ventilation
Grant supported in full by the CHEST Foundation.

CHEST Foundation Research Grant in Nontuberculous Mycobacteria Diseases
Elsje Pienaar, PhD
A Computational Bridge Between In Vitro MIC and In Vivo Efficacy of Antibiotics Against MAC Infection

Elisa Ignatius, MD
Early Bactericidal Activity of Standard Drugs Used to Treat Mycobacterium Avium Complex: A Pilot Study

Supported by a research award grant by Insmed Incorporated.


CHEST Foundation Research Grant in Venous Thromboembolism
Mitchell Cahan, MD
A Translational Approach to Understanding Venous Thromboembolism in Post-Surgical Patients Using MicroRNAs in the American Black Bear
This grant supported in full by the CHEST Foundation.


CHEST Foundation Research Grant in Severe Asthma
Vickram Tejwani, MD
Peripheral Immune Cell Landscape in Obese Children With Severe Asthma

Sunita Sharma, MD, MPH
Predictors of Anti-IL-5 Treatment Failure in Severe Asthmatics

Supported by an independent educational grant from AstraZeneca LP.

CHEST Foundation Research Grant in Cystic Fibrosis
Kathleen Ramos, MD, MS
Underweight Individuals With Cystic Fibrosis and Implications for Lung Transplantation
This grant supported by Vertex Pharmaceuticals Incorporated.

John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis
Divya Patel, DO
Pharmacogenetic Predictors of Therapeutic Response to Methotrexate in Patients With Sarcoidosis

Nicholas Arger, MD
Using Serum Interferon-Induced Chemokines to Predict Sarcoidosis Outcomes
This grant is in honor of John R. Addrizzo, MD, and is supported in full by the Addrizzo Family, their friends, and the CHEST Foundation.

CHEST Foundation Research Grant in Sleep Medicine
Irene Telias, MD
Influence of Sleep-Wakefulness Abnormalities on Patient-Ventilator Dyssynchrony: A Step Towards Improvement of Sleep Quality in Critically Ill Patients

Sushmita Pamidi, MD, MSc
Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Children: A Follow-Up Study of the 3D Pregnancy and Birth Cohort
This grant supported by Apria Healthcare and Jazz Pharmaceuticals.

CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP
Hans Lee, MD, FCCP
Uganda Bronchoscopy and Pleuroscopy (UBP) Project

Panagis Galiatsatos, MD, MHS
The Lung Health Ambassador Program

Paul Sonenthal, MD
Improving Critical Care Capacity in Sierra Leone

Dana Hickman, ARNP-C, FNP-BC
Living With COPD: Empowering Individuals, Families, and Caregivers

Ann Salvator, MS
Pediatric Asthma Screenings and Education on the Navajo Reservation

Tisha Wang, MD
PAP Foundation Education Days: A Project to Reach Patients, Caregivers, and Physicians

Grants supported in full by the CHEST Foundation.

Did you notice that your practice slows down in February? In fact, if you plot your patient census over a few years, you may find that it dips every February. And you will discover other slow periods, perhaps in December, and busy months during other parts of the year.

Seasonality is yet another of those basic business concepts that most physicians have never heard of, because of the conspicuous lack of business training in medical schools. Seasonal fluctuations exist in one form or another in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January or February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are out of school, and summer slumps to vacationing customers. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change, by running some ads, or doing an e-mail blast; but unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep pockets game requiring long, expensive campaigns that are only practical for large corporations.

For example, soup was traditionally consumed during the winter months since time immemorial. After years of pervasive advertising extolling its nutritional virtues (remember “Soup is Good Food”?), the soup industry succeeded in convincing the public to use their product year-round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean there is nothing we can do about our practices’ seasonal variations? Not at all; but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

First, you need to know what that behavior is, because it varies from practice to practice, even within the same state or city. Plotting your seasonality is easy; you can make a graph on Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2 or 3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively you can plot patient visits per month, if you wish; I do both.

Once you know your seasonality, review your options. Modify your own habits when necessary. If you typically take a vacation in August, for example, that’s not a great idea if August is one of your busiest months; consider vacationing during predictable slow periods instead.

Though I have said that you can’t change most seasonal behavior, it is possible to “retrain” some of your long-time, loyal patients to come in during your slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November each year, urging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive; why not advertise during slow periods to fill those empty slots? But once again, you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response to their ads. So don’t try to move the mountain to Mohammed. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

In short, then, try to “flatten” your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, your seasonal peaks. Once in your practice, some of them can then be shifted into your slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at dermnews@mdedge.com.

Did you notice that your practice slows down in February? In fact, if you plot your patient census over a few years, you may find that it dips every February. And you will discover other slow periods, perhaps in December, and busy months during other parts of the year.

Seasonality is yet another of those basic business concepts that most physicians have never heard of, because of the conspicuous lack of business training in medical schools. Seasonal fluctuations exist in one form or another in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January or February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are out of school, and summer slumps to vacationing customers. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change, by running some ads, or doing an e-mail blast; but unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep pockets game requiring long, expensive campaigns that are only practical for large corporations.

For example, soup was traditionally consumed during the winter months since time immemorial. After years of pervasive advertising extolling its nutritional virtues (remember “Soup is Good Food”?), the soup industry succeeded in convincing the public to use their product year-round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean there is nothing we can do about our practices’ seasonal variations? Not at all; but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

First, you need to know what that behavior is, because it varies from practice to practice, even within the same state or city. Plotting your seasonality is easy; you can make a graph on Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2 or 3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively you can plot patient visits per month, if you wish; I do both.

Once you know your seasonality, review your options. Modify your own habits when necessary. If you typically take a vacation in August, for example, that’s not a great idea if August is one of your busiest months; consider vacationing during predictable slow periods instead.

Though I have said that you can’t change most seasonal behavior, it is possible to “retrain” some of your long-time, loyal patients to come in during your slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November each year, urging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive; why not advertise during slow periods to fill those empty slots? But once again, you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response to their ads. So don’t try to move the mountain to Mohammed. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

In short, then, try to “flatten” your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, your seasonal peaks. Once in your practice, some of them can then be shifted into your slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at dermnews@mdedge.com.

Did you notice that your practice slows down in February? In fact, if you plot your patient census over a few years, you may find that it dips every February. And you will discover other slow periods, perhaps in December, and busy months during other parts of the year.

Seasonality is yet another of those basic business concepts that most physicians have never heard of, because of the conspicuous lack of business training in medical schools. Seasonal fluctuations exist in one form or another in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January or February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are out of school, and summer slumps to vacationing customers. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change, by running some ads, or doing an e-mail blast; but unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep pockets game requiring long, expensive campaigns that are only practical for large corporations.

For example, soup was traditionally consumed during the winter months since time immemorial. After years of pervasive advertising extolling its nutritional virtues (remember “Soup is Good Food”?), the soup industry succeeded in convincing the public to use their product year-round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean there is nothing we can do about our practices’ seasonal variations? Not at all; but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

First, you need to know what that behavior is, because it varies from practice to practice, even within the same state or city. Plotting your seasonality is easy; you can make a graph on Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2 or 3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively you can plot patient visits per month, if you wish; I do both.

Once you know your seasonality, review your options. Modify your own habits when necessary. If you typically take a vacation in August, for example, that’s not a great idea if August is one of your busiest months; consider vacationing during predictable slow periods instead.

Though I have said that you can’t change most seasonal behavior, it is possible to “retrain” some of your long-time, loyal patients to come in during your slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November each year, urging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive; why not advertise during slow periods to fill those empty slots? But once again, you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response to their ads. So don’t try to move the mountain to Mohammed. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

In short, then, try to “flatten” your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, your seasonal peaks. Once in your practice, some of them can then be shifted into your slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at dermnews@mdedge.com.

LOS ANGELES – Mounting evidence suggests that decreasing muscle mass with aging is associated with increased cardiometabolic risk.

Doug Brunk/MDedge News

“Loss of lean body mass and function with aging decreases the amount of metabolically active tissue, which can lead to insulin resistance,” Elena Volpi, MD, said at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. “Insulin resistance reduces muscle protein anabolism and accelerates sarcopenia, perpetuating a vicious cycle.”

Sarcopenia, the involuntary loss of muscle mass and function that occurs with aging, is an ICD-10 codable condition that can be diagnosed by measuring muscle strength and quality, said Dr. Volpi, director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. In the Health, Aging and Body Composition Study (Health ABC), researchers followed 2,292 relatively healthy adults aged 70-79 years for an average of 4.9 years (J Gerontol A Biol Sci Med. 2006;61[1]:72-7). The researchers used isokinetic dynamometry to measure knee extension strength, isometric dynamometry to measure grip strength, CT scan to measure thigh muscle area, and dual X-ray absorptiometry to determine leg and arm lean soft-tissue mass. “Those individuals who started with the highest levels of muscle strength had the greatest survival, while those who had the lowest levels of muscle strength died earlier,” said Dr. Volpi, who was not affiliated with the study. “That was true for both men and women.”

More recently, researchers conducted a pooled analysis of nine cohort studies involving 34,485 community-dwelling older individuals who were tested with gait speed and followed for 6-21 years (JAMA. 2011;305[1]:50-8). They found that a higher gait speed was associated with higher survival at 5 and 10 years (P less than .001). “Muscle mass also appears to be associated in part with mortality and survival, although the association is not as strong as measures of strength and gait speed,” Dr. Volpi said.

Data from the 2009 Korea National Health and Nutrition Examination Survey of 1,537 participants, aged 65 years and older, found that sarcopenia is independently associated with cardiovascular disease (PLoS One. 2013 Mar 22. doi: 10.1371/journal.pone.0060119). Most of the risk factors for cardiovascular disease – such as age, waist circumference, body mass index, fasting plasma glucose, and total cholesterol – showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with cardiovascular disease, independent of other well-documented risk factors, renal function, and medications (odds ratio, 1.77; P = .025).

In addition, data from the British Regional Heart Study, which followed 4,252 older men for a mean of 11.3 years, found an association of sarcopenia and adiposity with cardiovascular mortality and all-cause mortality (J Am Geriatr Soc. 2014;62[2]:253-60). Specifically, all-cause mortality risk was significantly greater in men in the sarcopenic and obese groups (HRs, 1.41 and 1.21, respectively), compared with those in the optimal reference group, with the highest risk in sarcopenic obese individuals (HR, 1.72) after adjustment for lifestyle characteristics.

“Diabetes also accelerates loss of lean body mass in older adults,” added Dr. Volpi. “Data from the Health ABC study showed that individuals who did not have diabetes at the beginning of the 6-year observation period ... lost the least amount of muscle, compared with those who had undiagnosed or already diagnosed diabetes.”

The precise way in which sarcopenia is linked to metabolic disease remains elusive, she continued, but current evidence suggests that sarcopenia is characterized by a reduction in the protein synthetic response to metabolic stimulation by amino acids, exercise, and insulin in skeletal muscle. “This reduction in the anabolic response to protein synthesis is called anabolic resistance of aging, and it is mediated by reduced acute activation of mTORC1 [mTOR complex 1] signaling,” Dr. Volpi said. “There’s another step upstream of the mTORC1, in which the amino acids and insulin have to cross the blood-muscle barrier. Amino acids need to be transported into the muscle actively, like glucose. That is an important unexplored area that may contribute to sarcopenia.”

Dr. Volpi went on to note that endothelial dysfunction underlies muscle anabolic resistance and cardiovascular risk and is likely to be a fundamental cause of both problems. Recent studies have shown that increased levels of physical activity improve endothelial function, enhance insulin sensitivity and anabolic sensitivity to nutrients, and reduce cardiovascular risk.

For example, in a cohort of 45 nonfrail older adults with a mean age of 72 years, Dr. Volpi and colleagues carried out a phase 1, double-blind, placebo-controlled, randomized clinical trial to determine if chronic essential amino acid supplementation, aerobic exercise training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis over the course of 24 weeks (J Gerontol A Biol Sci Med Sci. 2019;74[10]:1598-604). “We found that exercise supervised three times per week on a treadmill for 6 months improved physical function in both groups randomized to exercise,” Dr. Volpi said. “Disappointingly, there was no change in total lean mass with any of the interventions. There was a decrease in fat mass with exercise alone, and no change with exercise and amino acids. [Of note is that] the individuals who were randomized to the amino acids plus exercise group had a significant increase in leg strength, whereas the others did not.”

Preliminary findings from ongoing work by Dr. Volpi and colleagues suggest that, in diabetes, muscle protein synthesis and blood flow really “are not different in response to insulin in healthy older adults and diabetic older adults because they don’t change at all. However, we did find alterations in amino acid trafficking in diabetes. We found that older individuals with type 2 diabetes had a reduction of amino acid transport and a higher intracellular amino acid concentration, compared with age-matched, healthier individuals. The intracellular amino acid clearance improved in the healthy, nondiabetic older adults with hyperinsulinemia, whereas it did not change in diabetic older adults. As a result, the net muscle protein balance improved a little in the nondiabetic patients, but did not change in the diabetic patients.”

The researchers are evaluating older patients with type 2 diabetes to see whether there are alterations in vascular reactivity and protein synthesis and whether those can be overcome by resistance-exercise training. “Preliminary results show that flow-mediated dilation can actually increase in an older diabetic patient with resistance exercise training three times a week for 3 months,” she said. “Exercise can improve both endothelial dysfunction and sarcopenia and therefore improve physical function and reduce cardiovascular risk.”

Dr. Volpi reported having no relevant disclosures.

dbrunk@mdedge.com

LOS ANGELES – Mounting evidence suggests that decreasing muscle mass with aging is associated with increased cardiometabolic risk.

Doug Brunk/MDedge News

“Loss of lean body mass and function with aging decreases the amount of metabolically active tissue, which can lead to insulin resistance,” Elena Volpi, MD, said at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. “Insulin resistance reduces muscle protein anabolism and accelerates sarcopenia, perpetuating a vicious cycle.”

Sarcopenia, the involuntary loss of muscle mass and function that occurs with aging, is an ICD-10 codable condition that can be diagnosed by measuring muscle strength and quality, said Dr. Volpi, director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. In the Health, Aging and Body Composition Study (Health ABC), researchers followed 2,292 relatively healthy adults aged 70-79 years for an average of 4.9 years (J Gerontol A Biol Sci Med. 2006;61[1]:72-7). The researchers used isokinetic dynamometry to measure knee extension strength, isometric dynamometry to measure grip strength, CT scan to measure thigh muscle area, and dual X-ray absorptiometry to determine leg and arm lean soft-tissue mass. “Those individuals who started with the highest levels of muscle strength had the greatest survival, while those who had the lowest levels of muscle strength died earlier,” said Dr. Volpi, who was not affiliated with the study. “That was true for both men and women.”

More recently, researchers conducted a pooled analysis of nine cohort studies involving 34,485 community-dwelling older individuals who were tested with gait speed and followed for 6-21 years (JAMA. 2011;305[1]:50-8). They found that a higher gait speed was associated with higher survival at 5 and 10 years (P less than .001). “Muscle mass also appears to be associated in part with mortality and survival, although the association is not as strong as measures of strength and gait speed,” Dr. Volpi said.

Data from the 2009 Korea National Health and Nutrition Examination Survey of 1,537 participants, aged 65 years and older, found that sarcopenia is independently associated with cardiovascular disease (PLoS One. 2013 Mar 22. doi: 10.1371/journal.pone.0060119). Most of the risk factors for cardiovascular disease – such as age, waist circumference, body mass index, fasting plasma glucose, and total cholesterol – showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with cardiovascular disease, independent of other well-documented risk factors, renal function, and medications (odds ratio, 1.77; P = .025).

In addition, data from the British Regional Heart Study, which followed 4,252 older men for a mean of 11.3 years, found an association of sarcopenia and adiposity with cardiovascular mortality and all-cause mortality (J Am Geriatr Soc. 2014;62[2]:253-60). Specifically, all-cause mortality risk was significantly greater in men in the sarcopenic and obese groups (HRs, 1.41 and 1.21, respectively), compared with those in the optimal reference group, with the highest risk in sarcopenic obese individuals (HR, 1.72) after adjustment for lifestyle characteristics.

“Diabetes also accelerates loss of lean body mass in older adults,” added Dr. Volpi. “Data from the Health ABC study showed that individuals who did not have diabetes at the beginning of the 6-year observation period ... lost the least amount of muscle, compared with those who had undiagnosed or already diagnosed diabetes.”

The precise way in which sarcopenia is linked to metabolic disease remains elusive, she continued, but current evidence suggests that sarcopenia is characterized by a reduction in the protein synthetic response to metabolic stimulation by amino acids, exercise, and insulin in skeletal muscle. “This reduction in the anabolic response to protein synthesis is called anabolic resistance of aging, and it is mediated by reduced acute activation of mTORC1 [mTOR complex 1] signaling,” Dr. Volpi said. “There’s another step upstream of the mTORC1, in which the amino acids and insulin have to cross the blood-muscle barrier. Amino acids need to be transported into the muscle actively, like glucose. That is an important unexplored area that may contribute to sarcopenia.”

Dr. Volpi went on to note that endothelial dysfunction underlies muscle anabolic resistance and cardiovascular risk and is likely to be a fundamental cause of both problems. Recent studies have shown that increased levels of physical activity improve endothelial function, enhance insulin sensitivity and anabolic sensitivity to nutrients, and reduce cardiovascular risk.

For example, in a cohort of 45 nonfrail older adults with a mean age of 72 years, Dr. Volpi and colleagues carried out a phase 1, double-blind, placebo-controlled, randomized clinical trial to determine if chronic essential amino acid supplementation, aerobic exercise training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis over the course of 24 weeks (J Gerontol A Biol Sci Med Sci. 2019;74[10]:1598-604). “We found that exercise supervised three times per week on a treadmill for 6 months improved physical function in both groups randomized to exercise,” Dr. Volpi said. “Disappointingly, there was no change in total lean mass with any of the interventions. There was a decrease in fat mass with exercise alone, and no change with exercise and amino acids. [Of note is that] the individuals who were randomized to the amino acids plus exercise group had a significant increase in leg strength, whereas the others did not.”

Preliminary findings from ongoing work by Dr. Volpi and colleagues suggest that, in diabetes, muscle protein synthesis and blood flow really “are not different in response to insulin in healthy older adults and diabetic older adults because they don’t change at all. However, we did find alterations in amino acid trafficking in diabetes. We found that older individuals with type 2 diabetes had a reduction of amino acid transport and a higher intracellular amino acid concentration, compared with age-matched, healthier individuals. The intracellular amino acid clearance improved in the healthy, nondiabetic older adults with hyperinsulinemia, whereas it did not change in diabetic older adults. As a result, the net muscle protein balance improved a little in the nondiabetic patients, but did not change in the diabetic patients.”

The researchers are evaluating older patients with type 2 diabetes to see whether there are alterations in vascular reactivity and protein synthesis and whether those can be overcome by resistance-exercise training. “Preliminary results show that flow-mediated dilation can actually increase in an older diabetic patient with resistance exercise training three times a week for 3 months,” she said. “Exercise can improve both endothelial dysfunction and sarcopenia and therefore improve physical function and reduce cardiovascular risk.”

Dr. Volpi reported having no relevant disclosures.

dbrunk@mdedge.com

LOS ANGELES – Mounting evidence suggests that decreasing muscle mass with aging is associated with increased cardiometabolic risk.

Doug Brunk/MDedge News

“Loss of lean body mass and function with aging decreases the amount of metabolically active tissue, which can lead to insulin resistance,” Elena Volpi, MD, said at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. “Insulin resistance reduces muscle protein anabolism and accelerates sarcopenia, perpetuating a vicious cycle.”

Sarcopenia, the involuntary loss of muscle mass and function that occurs with aging, is an ICD-10 codable condition that can be diagnosed by measuring muscle strength and quality, said Dr. Volpi, director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. In the Health, Aging and Body Composition Study (Health ABC), researchers followed 2,292 relatively healthy adults aged 70-79 years for an average of 4.9 years (J Gerontol A Biol Sci Med. 2006;61[1]:72-7). The researchers used isokinetic dynamometry to measure knee extension strength, isometric dynamometry to measure grip strength, CT scan to measure thigh muscle area, and dual X-ray absorptiometry to determine leg and arm lean soft-tissue mass. “Those individuals who started with the highest levels of muscle strength had the greatest survival, while those who had the lowest levels of muscle strength died earlier,” said Dr. Volpi, who was not affiliated with the study. “That was true for both men and women.”

More recently, researchers conducted a pooled analysis of nine cohort studies involving 34,485 community-dwelling older individuals who were tested with gait speed and followed for 6-21 years (JAMA. 2011;305[1]:50-8). They found that a higher gait speed was associated with higher survival at 5 and 10 years (P less than .001). “Muscle mass also appears to be associated in part with mortality and survival, although the association is not as strong as measures of strength and gait speed,” Dr. Volpi said.

Data from the 2009 Korea National Health and Nutrition Examination Survey of 1,537 participants, aged 65 years and older, found that sarcopenia is independently associated with cardiovascular disease (PLoS One. 2013 Mar 22. doi: 10.1371/journal.pone.0060119). Most of the risk factors for cardiovascular disease – such as age, waist circumference, body mass index, fasting plasma glucose, and total cholesterol – showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with cardiovascular disease, independent of other well-documented risk factors, renal function, and medications (odds ratio, 1.77; P = .025).

In addition, data from the British Regional Heart Study, which followed 4,252 older men for a mean of 11.3 years, found an association of sarcopenia and adiposity with cardiovascular mortality and all-cause mortality (J Am Geriatr Soc. 2014;62[2]:253-60). Specifically, all-cause mortality risk was significantly greater in men in the sarcopenic and obese groups (HRs, 1.41 and 1.21, respectively), compared with those in the optimal reference group, with the highest risk in sarcopenic obese individuals (HR, 1.72) after adjustment for lifestyle characteristics.

“Diabetes also accelerates loss of lean body mass in older adults,” added Dr. Volpi. “Data from the Health ABC study showed that individuals who did not have diabetes at the beginning of the 6-year observation period ... lost the least amount of muscle, compared with those who had undiagnosed or already diagnosed diabetes.”

The precise way in which sarcopenia is linked to metabolic disease remains elusive, she continued, but current evidence suggests that sarcopenia is characterized by a reduction in the protein synthetic response to metabolic stimulation by amino acids, exercise, and insulin in skeletal muscle. “This reduction in the anabolic response to protein synthesis is called anabolic resistance of aging, and it is mediated by reduced acute activation of mTORC1 [mTOR complex 1] signaling,” Dr. Volpi said. “There’s another step upstream of the mTORC1, in which the amino acids and insulin have to cross the blood-muscle barrier. Amino acids need to be transported into the muscle actively, like glucose. That is an important unexplored area that may contribute to sarcopenia.”

Dr. Volpi went on to note that endothelial dysfunction underlies muscle anabolic resistance and cardiovascular risk and is likely to be a fundamental cause of both problems. Recent studies have shown that increased levels of physical activity improve endothelial function, enhance insulin sensitivity and anabolic sensitivity to nutrients, and reduce cardiovascular risk.

For example, in a cohort of 45 nonfrail older adults with a mean age of 72 years, Dr. Volpi and colleagues carried out a phase 1, double-blind, placebo-controlled, randomized clinical trial to determine if chronic essential amino acid supplementation, aerobic exercise training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis over the course of 24 weeks (J Gerontol A Biol Sci Med Sci. 2019;74[10]:1598-604). “We found that exercise supervised three times per week on a treadmill for 6 months improved physical function in both groups randomized to exercise,” Dr. Volpi said. “Disappointingly, there was no change in total lean mass with any of the interventions. There was a decrease in fat mass with exercise alone, and no change with exercise and amino acids. [Of note is that] the individuals who were randomized to the amino acids plus exercise group had a significant increase in leg strength, whereas the others did not.”

Preliminary findings from ongoing work by Dr. Volpi and colleagues suggest that, in diabetes, muscle protein synthesis and blood flow really “are not different in response to insulin in healthy older adults and diabetic older adults because they don’t change at all. However, we did find alterations in amino acid trafficking in diabetes. We found that older individuals with type 2 diabetes had a reduction of amino acid transport and a higher intracellular amino acid concentration, compared with age-matched, healthier individuals. The intracellular amino acid clearance improved in the healthy, nondiabetic older adults with hyperinsulinemia, whereas it did not change in diabetic older adults. As a result, the net muscle protein balance improved a little in the nondiabetic patients, but did not change in the diabetic patients.”

The researchers are evaluating older patients with type 2 diabetes to see whether there are alterations in vascular reactivity and protein synthesis and whether those can be overcome by resistance-exercise training. “Preliminary results show that flow-mediated dilation can actually increase in an older diabetic patient with resistance exercise training three times a week for 3 months,” she said. “Exercise can improve both endothelial dysfunction and sarcopenia and therefore improve physical function and reduce cardiovascular risk.”

Dr. Volpi reported having no relevant disclosures.

dbrunk@mdedge.com

The time shared during clinical encounters provides small peeks into patients’ lives that get documented as episodic snapshots in electronic health records. But there is little information about how patients are doing outside of the office. With increasing emphasis on filling out mandatory parts of the EHR, there is less time available for in-depth, in-office conversations and phone follow-ups.

At the same time, it has become clear that it is not just the medicines we prescribe that affect our patients’ lives. Their behaviors outside of the office – being physically active, eating well, getting a good night’s rest, and adhering to medications – also impact their health outcomes.

The explosion of technology and personal data in our increasingly connected world provides powerful new sources of health and behavior information that generate new understanding of patients’ lives in their everyday settings.

The ubiquity and remarkable technological progress of personal computing devices – including wearables, smartphones, and tablets – along with the multitude of sensor modalities embedded within these devices, has enabled us to establish a continuous connection with people who want to share information about their behavior and daily life.

Such rich, longitudinal information, known as person-generated health data (PGHD), can be searched for physiological and behavioral signatures that can be used in combination with traditional clinical information to predict, diagnose, and treat disease. It can also be used to understand the safety and effectiveness of medical interventions.

PGHD is defined as wellness and/or health-related data created, recorded, or gathered by individuals. It reflects events and interactions that occur during an person’s everyday life. Systematically gathering this information and organizing it to better understand patients’ approach to their health or their unique experience living with disease provides meaningful insights that complement the data traditionally collected as part of clinical trials or periodic office visits.

PGHD can produce a rich picture of a person’s health or symptom burden with disease. It allows the opportunity to measure the real human burden of a patient’s disease and how it changes over time, with an opportunity to detect changes in symptoms in real time.

PGHD can also enable participation in health research.

An example would be the work of Evidation Health in San Mateo, Calif. Evidation provides a platform to run research studies utilizing technology and systems to measure health in everyday life. Its app, Achievement, collects continuous behavior-related data from smartphones, wearables, connected devices, and apps. That provides opportunities for participants to join research studies that develop novel measures designed to quantify health outcomes in a way that more accurately reflects an individual’s day-to-day activities and experience. All data collected are at the direction of and with the permission of the individual.

“Achievers” are given points for taking health-related actions such as tracking steps or their sleep, which convert to cash that can be kept or donated to their favorite charities. Achievement’s 3.5 million diverse participants also receive offers to join research studies. This paradigm shift dramatically expands access to research to increase diversity, shortens the time to first data through rapid recruitment, and enhances retention rates by making it easier to engage. To date, more than 1 million users have chosen to participate in research studies. The technology is bringing new data and insights to health research; it supports important questions about quality of life, medical products’ real-world effectiveness, and the development of hyperpersonalized health care services.

This new type of data is transforming medical research by creating real-world studies of unprecedented size, such as the Apple Heart Study – a virtual study with more than 400,000 enrolled participants – which was designed to test the accuracy of Apple Watches in safely identifying atrial fibrillation. The FDA has cleared two features on the Apple Watch: the device’s ability to detect and notify the user of an irregular heart rhythm, and the ability to take a single-lead EKG feature that can provide a rhythm strip for a clinician to review.

The FDA clearance letters specify that the apps are “not intended to replace traditional methods of diagnosis or treatment.” They provide extra information, and that information might be helpful – but the apps won’t replace a doctor’s visit. It remains to be seen how these data will be used, but they have the potential to identify atrial fibrillation early, leading to treatment that may prevent devastating strokes.

Another example of home-generated health data is a tool that has obtained FDA clearance as a diagnostic device with insurance reimbursement: WatchPAT, a portable sleep apnea diagnostic device. WatchPAT is worn like a simple wristwatch, with no need for belts, wires, or nasal cannulas.

Over time, in-home tests like these that are of minimal inconvenience to the patient and reflect a real-world experience may eclipse traditional sleep studies that require patients to spend the night in a clinic while attached to wires and monitors.

Health data generated by connected populations will yield novel insights that may help us better predict, diagnose, and treat disease. These are examples of innovations that can extend clinicians’ abilities to remotely monitor or diagnose health conditions, and we can expect that more will continue to be integrated into the clinical and research settings in the near future.

In part 2 of this series, we will discuss novel digital measures and studies utilizing PGHD to impact population health.
 

Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and associate director, family medicine residency program, Abington (Pa.) Jefferson Health. Dr. Foschini is cofounder and chief data scientist at Evidation Health in San Mateo, Calif. Bray Patrick-Lake is a patient thought leader and director, strategic partnerships, at Evidation Health.

References

Determining real-world data’s fitness for use and the role of reliability, September 2019. Duke-Margolis Center for Health Policy.

N Engl J Med. 2019 Nov 14;381(20):1909-17.

The time shared during clinical encounters provides small peeks into patients’ lives that get documented as episodic snapshots in electronic health records. But there is little information about how patients are doing outside of the office. With increasing emphasis on filling out mandatory parts of the EHR, there is less time available for in-depth, in-office conversations and phone follow-ups.

At the same time, it has become clear that it is not just the medicines we prescribe that affect our patients’ lives. Their behaviors outside of the office – being physically active, eating well, getting a good night’s rest, and adhering to medications – also impact their health outcomes.

The explosion of technology and personal data in our increasingly connected world provides powerful new sources of health and behavior information that generate new understanding of patients’ lives in their everyday settings.

The ubiquity and remarkable technological progress of personal computing devices – including wearables, smartphones, and tablets – along with the multitude of sensor modalities embedded within these devices, has enabled us to establish a continuous connection with people who want to share information about their behavior and daily life.

Such rich, longitudinal information, known as person-generated health data (PGHD), can be searched for physiological and behavioral signatures that can be used in combination with traditional clinical information to predict, diagnose, and treat disease. It can also be used to understand the safety and effectiveness of medical interventions.

PGHD is defined as wellness and/or health-related data created, recorded, or gathered by individuals. It reflects events and interactions that occur during an person’s everyday life. Systematically gathering this information and organizing it to better understand patients’ approach to their health or their unique experience living with disease provides meaningful insights that complement the data traditionally collected as part of clinical trials or periodic office visits.

PGHD can produce a rich picture of a person’s health or symptom burden with disease. It allows the opportunity to measure the real human burden of a patient’s disease and how it changes over time, with an opportunity to detect changes in symptoms in real time.

PGHD can also enable participation in health research.

An example would be the work of Evidation Health in San Mateo, Calif. Evidation provides a platform to run research studies utilizing technology and systems to measure health in everyday life. Its app, Achievement, collects continuous behavior-related data from smartphones, wearables, connected devices, and apps. That provides opportunities for participants to join research studies that develop novel measures designed to quantify health outcomes in a way that more accurately reflects an individual’s day-to-day activities and experience. All data collected are at the direction of and with the permission of the individual.

“Achievers” are given points for taking health-related actions such as tracking steps or their sleep, which convert to cash that can be kept or donated to their favorite charities. Achievement’s 3.5 million diverse participants also receive offers to join research studies. This paradigm shift dramatically expands access to research to increase diversity, shortens the time to first data through rapid recruitment, and enhances retention rates by making it easier to engage. To date, more than 1 million users have chosen to participate in research studies. The technology is bringing new data and insights to health research; it supports important questions about quality of life, medical products’ real-world effectiveness, and the development of hyperpersonalized health care services.

This new type of data is transforming medical research by creating real-world studies of unprecedented size, such as the Apple Heart Study – a virtual study with more than 400,000 enrolled participants – which was designed to test the accuracy of Apple Watches in safely identifying atrial fibrillation. The FDA has cleared two features on the Apple Watch: the device’s ability to detect and notify the user of an irregular heart rhythm, and the ability to take a single-lead EKG feature that can provide a rhythm strip for a clinician to review.

The FDA clearance letters specify that the apps are “not intended to replace traditional methods of diagnosis or treatment.” They provide extra information, and that information might be helpful – but the apps won’t replace a doctor’s visit. It remains to be seen how these data will be used, but they have the potential to identify atrial fibrillation early, leading to treatment that may prevent devastating strokes.

Another example of home-generated health data is a tool that has obtained FDA clearance as a diagnostic device with insurance reimbursement: WatchPAT, a portable sleep apnea diagnostic device. WatchPAT is worn like a simple wristwatch, with no need for belts, wires, or nasal cannulas.

Over time, in-home tests like these that are of minimal inconvenience to the patient and reflect a real-world experience may eclipse traditional sleep studies that require patients to spend the night in a clinic while attached to wires and monitors.

Health data generated by connected populations will yield novel insights that may help us better predict, diagnose, and treat disease. These are examples of innovations that can extend clinicians’ abilities to remotely monitor or diagnose health conditions, and we can expect that more will continue to be integrated into the clinical and research settings in the near future.

In part 2 of this series, we will discuss novel digital measures and studies utilizing PGHD to impact population health.
 

Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and associate director, family medicine residency program, Abington (Pa.) Jefferson Health. Dr. Foschini is cofounder and chief data scientist at Evidation Health in San Mateo, Calif. Bray Patrick-Lake is a patient thought leader and director, strategic partnerships, at Evidation Health.

References

Determining real-world data’s fitness for use and the role of reliability, September 2019. Duke-Margolis Center for Health Policy.

N Engl J Med. 2019 Nov 14;381(20):1909-17.

The time shared during clinical encounters provides small peeks into patients’ lives that get documented as episodic snapshots in electronic health records. But there is little information about how patients are doing outside of the office. With increasing emphasis on filling out mandatory parts of the EHR, there is less time available for in-depth, in-office conversations and phone follow-ups.

At the same time, it has become clear that it is not just the medicines we prescribe that affect our patients’ lives. Their behaviors outside of the office – being physically active, eating well, getting a good night’s rest, and adhering to medications – also impact their health outcomes.

The explosion of technology and personal data in our increasingly connected world provides powerful new sources of health and behavior information that generate new understanding of patients’ lives in their everyday settings.

The ubiquity and remarkable technological progress of personal computing devices – including wearables, smartphones, and tablets – along with the multitude of sensor modalities embedded within these devices, has enabled us to establish a continuous connection with people who want to share information about their behavior and daily life.

Such rich, longitudinal information, known as person-generated health data (PGHD), can be searched for physiological and behavioral signatures that can be used in combination with traditional clinical information to predict, diagnose, and treat disease. It can also be used to understand the safety and effectiveness of medical interventions.

PGHD is defined as wellness and/or health-related data created, recorded, or gathered by individuals. It reflects events and interactions that occur during an person’s everyday life. Systematically gathering this information and organizing it to better understand patients’ approach to their health or their unique experience living with disease provides meaningful insights that complement the data traditionally collected as part of clinical trials or periodic office visits.

PGHD can produce a rich picture of a person’s health or symptom burden with disease. It allows the opportunity to measure the real human burden of a patient’s disease and how it changes over time, with an opportunity to detect changes in symptoms in real time.

PGHD can also enable participation in health research.

An example would be the work of Evidation Health in San Mateo, Calif. Evidation provides a platform to run research studies utilizing technology and systems to measure health in everyday life. Its app, Achievement, collects continuous behavior-related data from smartphones, wearables, connected devices, and apps. That provides opportunities for participants to join research studies that develop novel measures designed to quantify health outcomes in a way that more accurately reflects an individual’s day-to-day activities and experience. All data collected are at the direction of and with the permission of the individual.

“Achievers” are given points for taking health-related actions such as tracking steps or their sleep, which convert to cash that can be kept or donated to their favorite charities. Achievement’s 3.5 million diverse participants also receive offers to join research studies. This paradigm shift dramatically expands access to research to increase diversity, shortens the time to first data through rapid recruitment, and enhances retention rates by making it easier to engage. To date, more than 1 million users have chosen to participate in research studies. The technology is bringing new data and insights to health research; it supports important questions about quality of life, medical products’ real-world effectiveness, and the development of hyperpersonalized health care services.

This new type of data is transforming medical research by creating real-world studies of unprecedented size, such as the Apple Heart Study – a virtual study with more than 400,000 enrolled participants – which was designed to test the accuracy of Apple Watches in safely identifying atrial fibrillation. The FDA has cleared two features on the Apple Watch: the device’s ability to detect and notify the user of an irregular heart rhythm, and the ability to take a single-lead EKG feature that can provide a rhythm strip for a clinician to review.

The FDA clearance letters specify that the apps are “not intended to replace traditional methods of diagnosis or treatment.” They provide extra information, and that information might be helpful – but the apps won’t replace a doctor’s visit. It remains to be seen how these data will be used, but they have the potential to identify atrial fibrillation early, leading to treatment that may prevent devastating strokes.

Another example of home-generated health data is a tool that has obtained FDA clearance as a diagnostic device with insurance reimbursement: WatchPAT, a portable sleep apnea diagnostic device. WatchPAT is worn like a simple wristwatch, with no need for belts, wires, or nasal cannulas.

Over time, in-home tests like these that are of minimal inconvenience to the patient and reflect a real-world experience may eclipse traditional sleep studies that require patients to spend the night in a clinic while attached to wires and monitors.

Health data generated by connected populations will yield novel insights that may help us better predict, diagnose, and treat disease. These are examples of innovations that can extend clinicians’ abilities to remotely monitor or diagnose health conditions, and we can expect that more will continue to be integrated into the clinical and research settings in the near future.

In part 2 of this series, we will discuss novel digital measures and studies utilizing PGHD to impact population health.
 

Dr. Skolnik is professor of family and community medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and associate director, family medicine residency program, Abington (Pa.) Jefferson Health. Dr. Foschini is cofounder and chief data scientist at Evidation Health in San Mateo, Calif. Bray Patrick-Lake is a patient thought leader and director, strategic partnerships, at Evidation Health.

References

Determining real-world data’s fitness for use and the role of reliability, September 2019. Duke-Margolis Center for Health Policy.

N Engl J Med. 2019 Nov 14;381(20):1909-17.