Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in Current Psychiatry. All submissions to Readers’ Forum undergo peer review and are subject to editing for length and style.

The second-generation antipsychotic quetiapine is commonly used to treat several psychiatric disorders, including bipolar disorder (BD) and insomnia. In this case report, we discuss a patient with a history of unipolar depression and initial signs of mania who experienced an exacerbation of manic symptoms following administration of low-dose quetiapine. This case underscores the need for careful monitoring of patients receiving quetiapine, especially at lower doses, and the potential limitations of its efficacy in controlling manic symptoms.

Depressed with racing thoughts

Mr. X, age 58, is an Army veteran who lives with his wife of 29 years and works as a contractor. He has a history of depression and a suicide attempt 10 years ago by self-inflicted gunshot wound to the head, which left him with a bullet lodged in his sinus cavity and residual dysarthria after tongue surgery. After the suicide attempt, Mr. X was medically hospitalized, but not psychiatrically hospitalized. Shortly after, he self-discontinued all psychotropic medications and follow-up.

Mr. X has no other medical history and takes no other medications or supplements. His family history includes a mother with schizoaffective disorder, 1 brother with BD, and another brother with developmental delay.

Mr. X remained euthymic until his brother died. Soon after, he began to experience low mood, heightened anxiety, racing thoughts, tearfulness, and mild insomnia. He was prescribed quetiapine 25 mg/d at bedtime and instructed to titrate up to 50 mg/d.

Ten days later, Mr. X was brought to the hospital by his wife, who reported that after starting quetiapine, her husband began to act erratically. He had disorganized and racing thoughts, loose associations, labile affect, hyperactivity/restlessness, and was not sleeping. In the morning before presenting to the hospital, Mr. X had gone to work, laid down on the floor, began mumbling to himself, and would not respond to coworkers. Upon evaluation, Mr. X was noted to have pressured speech, disorganized speech, delusions, anxiety, and hallucinations. A CT scan of his head was normal, and a complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, B12, folate, and hemoglobin A1c were within normal limits. Mr. X’s vitamin D level was low at 22 ng/mL, and a syphilis screen was negative.

Mr. X was admitted to the hospital for his safety. The treatment team discontinued quetiapine and started risperidone 3 mg twice a day for psychotic symptoms and mood stabilization. At the time of discharge 7 days later, Mr. X was no longer experiencing any hallucinations or delusions, his thought process was linear and goal-directed, his mood was stable, and his insomnia had improved. Based on the temporal relationship between the initiation of quetiapine and the onset of Mr. X’s manic symptoms, along with an absence of organic causes, the treatment team suspected Mr. X had experienced a worsening of manic symptoms induced by quetiapine. Before starting quetiapine, he had presented with an initial manic symptom of racing thoughts.

At his next outpatient appointment, Mr. X exhibited significant akathisia. The treatment team initiated propranolol 20 mg twice a day but Mr. X did not experience much improvement. Risperidone was reduced to 1 mg twice a day and Mr. X was started on clonazepam 0.5 mg twice a day. The akathisia resolved. The treatment team decided to discontinue all medications and observe Mr. X for any recurrence of symptoms. One year after his manic episode. Mr. X remained euthymic. He was able to resume full-time work and began psychotherapy to process the grief over the loss of his brother.

Quetiapine’s unique profile

This case sheds light on the potential limitations of quetiapine, especially at lower doses, for managing manic symptoms. Quetiapine exhibits antidepressant effects, even at doses as low as 50 mg/d.¹ At higher doses, quetiapine acts as an antagonist at serotonin (5-HT1A and 5-HT2A), dopamine (D1 and D2), histamine H1, and adrenergic receptors.² At doses <300 mg/d, there is an absence of dopamine receptor blockade and a higher affinity for 5-HT2A receptors, which could explain why higher doses are generally necessary for treating mania and psychotic symptoms.^3-5 High 5-HT2A antagonism may disinhibit the dopaminergic system and paradoxically increase dopaminergic activity, which could be the mechanism responsible for lack of control of manic symptoms with low doses of quetiapine.² Another possible explanation is that the metabolite of quetiapine, N-desalkylquetiapine, acts as a norepine­phrine reuptake blocker and partial 5-HT1Aantagonist, which acts as an antidepressant, and antidepressants are known to induce mania in vulnerable patients.⁴

The antimanic property of most antipsychotics (except possibly clozapine) is attributed to their D2 antagonistic potency. Because quetiapine is among the weaker D2 antagonists, its inability to prevent the progression of mania, especially at 50 mg/d, is not unexpected. Mr. X’s subsequent need for a stronger D2 antagonist—risperidone—at a significant dose further supports this observation. A common misconception is that quetiapine’s sedating effects make it effective for treating mania, but that is not the case. Clinicians should be cautious when prescribing quetiapine, especially at lower doses, to patients who exhibit signs of mania. Given the potential risk, clinicians should consider alternative treatments before resorting to low-dose quetiapine for insomnia. Regular monitoring for manic symptoms is crucial for all patients receiving quetiapine. If patients present with signs of mania or hypomania, a therapeutic dose range of 600 to 800 mg/d is recommended.⁶

Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in Current Psychiatry. All submissions to Readers’ Forum undergo peer review and are subject to editing for length and style.

The second-generation antipsychotic quetiapine is commonly used to treat several psychiatric disorders, including bipolar disorder (BD) and insomnia. In this case report, we discuss a patient with a history of unipolar depression and initial signs of mania who experienced an exacerbation of manic symptoms following administration of low-dose quetiapine. This case underscores the need for careful monitoring of patients receiving quetiapine, especially at lower doses, and the potential limitations of its efficacy in controlling manic symptoms.

Depressed with racing thoughts

Mr. X, age 58, is an Army veteran who lives with his wife of 29 years and works as a contractor. He has a history of depression and a suicide attempt 10 years ago by self-inflicted gunshot wound to the head, which left him with a bullet lodged in his sinus cavity and residual dysarthria after tongue surgery. After the suicide attempt, Mr. X was medically hospitalized, but not psychiatrically hospitalized. Shortly after, he self-discontinued all psychotropic medications and follow-up.

Mr. X has no other medical history and takes no other medications or supplements. His family history includes a mother with schizoaffective disorder, 1 brother with BD, and another brother with developmental delay.

Mr. X remained euthymic until his brother died. Soon after, he began to experience low mood, heightened anxiety, racing thoughts, tearfulness, and mild insomnia. He was prescribed quetiapine 25 mg/d at bedtime and instructed to titrate up to 50 mg/d.

Ten days later, Mr. X was brought to the hospital by his wife, who reported that after starting quetiapine, her husband began to act erratically. He had disorganized and racing thoughts, loose associations, labile affect, hyperactivity/restlessness, and was not sleeping. In the morning before presenting to the hospital, Mr. X had gone to work, laid down on the floor, began mumbling to himself, and would not respond to coworkers. Upon evaluation, Mr. X was noted to have pressured speech, disorganized speech, delusions, anxiety, and hallucinations. A CT scan of his head was normal, and a complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, B12, folate, and hemoglobin A1c were within normal limits. Mr. X’s vitamin D level was low at 22 ng/mL, and a syphilis screen was negative.

Mr. X was admitted to the hospital for his safety. The treatment team discontinued quetiapine and started risperidone 3 mg twice a day for psychotic symptoms and mood stabilization. At the time of discharge 7 days later, Mr. X was no longer experiencing any hallucinations or delusions, his thought process was linear and goal-directed, his mood was stable, and his insomnia had improved. Based on the temporal relationship between the initiation of quetiapine and the onset of Mr. X’s manic symptoms, along with an absence of organic causes, the treatment team suspected Mr. X had experienced a worsening of manic symptoms induced by quetiapine. Before starting quetiapine, he had presented with an initial manic symptom of racing thoughts.

At his next outpatient appointment, Mr. X exhibited significant akathisia. The treatment team initiated propranolol 20 mg twice a day but Mr. X did not experience much improvement. Risperidone was reduced to 1 mg twice a day and Mr. X was started on clonazepam 0.5 mg twice a day. The akathisia resolved. The treatment team decided to discontinue all medications and observe Mr. X for any recurrence of symptoms. One year after his manic episode. Mr. X remained euthymic. He was able to resume full-time work and began psychotherapy to process the grief over the loss of his brother.

Quetiapine’s unique profile

This case sheds light on the potential limitations of quetiapine, especially at lower doses, for managing manic symptoms. Quetiapine exhibits antidepressant effects, even at doses as low as 50 mg/d.¹ At higher doses, quetiapine acts as an antagonist at serotonin (5-HT1A and 5-HT2A), dopamine (D1 and D2), histamine H1, and adrenergic receptors.² At doses <300 mg/d, there is an absence of dopamine receptor blockade and a higher affinity for 5-HT2A receptors, which could explain why higher doses are generally necessary for treating mania and psychotic symptoms.^3-5 High 5-HT2A antagonism may disinhibit the dopaminergic system and paradoxically increase dopaminergic activity, which could be the mechanism responsible for lack of control of manic symptoms with low doses of quetiapine.² Another possible explanation is that the metabolite of quetiapine, N-desalkylquetiapine, acts as a norepine­phrine reuptake blocker and partial 5-HT1Aantagonist, which acts as an antidepressant, and antidepressants are known to induce mania in vulnerable patients.⁴

The antimanic property of most antipsychotics (except possibly clozapine) is attributed to their D2 antagonistic potency. Because quetiapine is among the weaker D2 antagonists, its inability to prevent the progression of mania, especially at 50 mg/d, is not unexpected. Mr. X’s subsequent need for a stronger D2 antagonist—risperidone—at a significant dose further supports this observation. A common misconception is that quetiapine’s sedating effects make it effective for treating mania, but that is not the case. Clinicians should be cautious when prescribing quetiapine, especially at lower doses, to patients who exhibit signs of mania. Given the potential risk, clinicians should consider alternative treatments before resorting to low-dose quetiapine for insomnia. Regular monitoring for manic symptoms is crucial for all patients receiving quetiapine. If patients present with signs of mania or hypomania, a therapeutic dose range of 600 to 800 mg/d is recommended.⁶

Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in Current Psychiatry. All submissions to Readers’ Forum undergo peer review and are subject to editing for length and style.

The second-generation antipsychotic quetiapine is commonly used to treat several psychiatric disorders, including bipolar disorder (BD) and insomnia. In this case report, we discuss a patient with a history of unipolar depression and initial signs of mania who experienced an exacerbation of manic symptoms following administration of low-dose quetiapine. This case underscores the need for careful monitoring of patients receiving quetiapine, especially at lower doses, and the potential limitations of its efficacy in controlling manic symptoms.

Depressed with racing thoughts

Mr. X, age 58, is an Army veteran who lives with his wife of 29 years and works as a contractor. He has a history of depression and a suicide attempt 10 years ago by self-inflicted gunshot wound to the head, which left him with a bullet lodged in his sinus cavity and residual dysarthria after tongue surgery. After the suicide attempt, Mr. X was medically hospitalized, but not psychiatrically hospitalized. Shortly after, he self-discontinued all psychotropic medications and follow-up.

Mr. X has no other medical history and takes no other medications or supplements. His family history includes a mother with schizoaffective disorder, 1 brother with BD, and another brother with developmental delay.

Mr. X remained euthymic until his brother died. Soon after, he began to experience low mood, heightened anxiety, racing thoughts, tearfulness, and mild insomnia. He was prescribed quetiapine 25 mg/d at bedtime and instructed to titrate up to 50 mg/d.

Ten days later, Mr. X was brought to the hospital by his wife, who reported that after starting quetiapine, her husband began to act erratically. He had disorganized and racing thoughts, loose associations, labile affect, hyperactivity/restlessness, and was not sleeping. In the morning before presenting to the hospital, Mr. X had gone to work, laid down on the floor, began mumbling to himself, and would not respond to coworkers. Upon evaluation, Mr. X was noted to have pressured speech, disorganized speech, delusions, anxiety, and hallucinations. A CT scan of his head was normal, and a complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, B12, folate, and hemoglobin A1c were within normal limits. Mr. X’s vitamin D level was low at 22 ng/mL, and a syphilis screen was negative.

Mr. X was admitted to the hospital for his safety. The treatment team discontinued quetiapine and started risperidone 3 mg twice a day for psychotic symptoms and mood stabilization. At the time of discharge 7 days later, Mr. X was no longer experiencing any hallucinations or delusions, his thought process was linear and goal-directed, his mood was stable, and his insomnia had improved. Based on the temporal relationship between the initiation of quetiapine and the onset of Mr. X’s manic symptoms, along with an absence of organic causes, the treatment team suspected Mr. X had experienced a worsening of manic symptoms induced by quetiapine. Before starting quetiapine, he had presented with an initial manic symptom of racing thoughts.

At his next outpatient appointment, Mr. X exhibited significant akathisia. The treatment team initiated propranolol 20 mg twice a day but Mr. X did not experience much improvement. Risperidone was reduced to 1 mg twice a day and Mr. X was started on clonazepam 0.5 mg twice a day. The akathisia resolved. The treatment team decided to discontinue all medications and observe Mr. X for any recurrence of symptoms. One year after his manic episode. Mr. X remained euthymic. He was able to resume full-time work and began psychotherapy to process the grief over the loss of his brother.

Quetiapine’s unique profile

This case sheds light on the potential limitations of quetiapine, especially at lower doses, for managing manic symptoms. Quetiapine exhibits antidepressant effects, even at doses as low as 50 mg/d.¹ At higher doses, quetiapine acts as an antagonist at serotonin (5-HT1A and 5-HT2A), dopamine (D1 and D2), histamine H1, and adrenergic receptors.² At doses <300 mg/d, there is an absence of dopamine receptor blockade and a higher affinity for 5-HT2A receptors, which could explain why higher doses are generally necessary for treating mania and psychotic symptoms.^3-5 High 5-HT2A antagonism may disinhibit the dopaminergic system and paradoxically increase dopaminergic activity, which could be the mechanism responsible for lack of control of manic symptoms with low doses of quetiapine.² Another possible explanation is that the metabolite of quetiapine, N-desalkylquetiapine, acts as a norepine­phrine reuptake blocker and partial 5-HT1Aantagonist, which acts as an antidepressant, and antidepressants are known to induce mania in vulnerable patients.⁴

The antimanic property of most antipsychotics (except possibly clozapine) is attributed to their D2 antagonistic potency. Because quetiapine is among the weaker D2 antagonists, its inability to prevent the progression of mania, especially at 50 mg/d, is not unexpected. Mr. X’s subsequent need for a stronger D2 antagonist—risperidone—at a significant dose further supports this observation. A common misconception is that quetiapine’s sedating effects make it effective for treating mania, but that is not the case. Clinicians should be cautious when prescribing quetiapine, especially at lower doses, to patients who exhibit signs of mania. Given the potential risk, clinicians should consider alternative treatments before resorting to low-dose quetiapine for insomnia. Regular monitoring for manic symptoms is crucial for all patients receiving quetiapine. If patients present with signs of mania or hypomania, a therapeutic dose range of 600 to 800 mg/d is recommended.⁶

Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in Current Psychiatry . All submissions to Readers’ Forum undergo peer review and are subject to editing for length and style.

Working closely with individuals with substance use disorders (SUDs), we’ve observed a worrisome trend of patients leaving the hospital against medical advice (AMA). This issue is not only prevalent in psychiatric settings, but also in emergency departments, medical and surgical floors, and even intensive care units.¹

Compared to individuals without such disorders, individuals with SUDs—particularly those with opioid use disorders—are up to 3 times more likely to leave the hospital AMA.^1,2 Leaving AMA can lead to multiple complications, including an increased risk of readmission, suboptimal treatment outcomes, and an increased use of health care resources.^1-3

It is critical to understand why patients elect to leave a hospital AMA. In a qualitative study, Simon et al¹ found that individuals with SUDs often leave AMA due to uncontrolled withdrawal symptoms and pain, perceived stigma and discrimination, and dissatisfaction with care. Predictors of patients leaving the hospital AMA include the severity of their drug dependence and previous negative treatment experiences.⁴ A systematic review found housing instability and a lack of social support influence an individual’s decision to leave AMA.⁵

Recommendations for managing patients who leave AMA

Enhancing your understanding of withdrawal symptoms may allow you to offer patients more effective symptom control, possibly with methadone or buprenorphine.² Injectable opioid agonist treatment may also help to retain a patient in care. In a case report, a 47-year-old man with a severe opioid use disorder who had left the hospital AMA due to uncontrolled opioid withdrawal was readmitted, treated with IV hydromorphone, and enrolled in ongoing community injectable opioid agonist treatment.⁶

Clinicians must address the stigma and discrimination patients with SUDs often face in health care institutions. Additional training for clinicians to improve their understanding of these disorders and foster a more compassionate and nonjudgmental approach to care may be beneficial.

Like most medicolegal conflicts, leaving AMA is often a clinical and interpersonal problem disguised as a legal one. When assessing these patients’ decision-making capacity, we often find they are angry and dissatisfied with the care they have (or have not) received. The most useful intervention may be to restore communication between the patient and their treatment team.

Even after a patient leaves AMA, the treatment team may experience countertransference issues, such as heightened emotional reactions or biases, that could compromise their clinical judgment. Addressing these dynamics may require team debriefings, supervision, or further training in managing transference and countertransference, particularly since patients who leave AMA may return for subsequent care.⁷

Integrated care models, which feature close collaboration between clinicians from different specialties, can help ensure that a patient’s diverse health needs are met and reduce the likelihood of them leaving AMA. Integrated care models may be particularly effective for patients with co-occurring conditions such as HIV and SUDs.⁸

Implementing these recommendations can be challenging. Barriers to addressing AMA departures span several domains, including patient-specific barriers (eg, stigma and discrimination), clinical barriers (eg, lack of resources and training for clinicians), institutional hurdles (eg, systemic inefficiencies), and broader social barriers (eg, housing instability and inadequate social support). Overcoming these barriers requires a multifaceted approach involving clinicians, policymakers, and the community that considers medical, psychological, and social factors.

Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in Current Psychiatry . All submissions to Readers’ Forum undergo peer review and are subject to editing for length and style.

Working closely with individuals with substance use disorders (SUDs), we’ve observed a worrisome trend of patients leaving the hospital against medical advice (AMA). This issue is not only prevalent in psychiatric settings, but also in emergency departments, medical and surgical floors, and even intensive care units.¹

Compared to individuals without such disorders, individuals with SUDs—particularly those with opioid use disorders—are up to 3 times more likely to leave the hospital AMA.^1,2 Leaving AMA can lead to multiple complications, including an increased risk of readmission, suboptimal treatment outcomes, and an increased use of health care resources.^1-3

It is critical to understand why patients elect to leave a hospital AMA. In a qualitative study, Simon et al¹ found that individuals with SUDs often leave AMA due to uncontrolled withdrawal symptoms and pain, perceived stigma and discrimination, and dissatisfaction with care. Predictors of patients leaving the hospital AMA include the severity of their drug dependence and previous negative treatment experiences.⁴ A systematic review found housing instability and a lack of social support influence an individual’s decision to leave AMA.⁵

Recommendations for managing patients who leave AMA

Enhancing your understanding of withdrawal symptoms may allow you to offer patients more effective symptom control, possibly with methadone or buprenorphine.² Injectable opioid agonist treatment may also help to retain a patient in care. In a case report, a 47-year-old man with a severe opioid use disorder who had left the hospital AMA due to uncontrolled opioid withdrawal was readmitted, treated with IV hydromorphone, and enrolled in ongoing community injectable opioid agonist treatment.⁶

Clinicians must address the stigma and discrimination patients with SUDs often face in health care institutions. Additional training for clinicians to improve their understanding of these disorders and foster a more compassionate and nonjudgmental approach to care may be beneficial.

Like most medicolegal conflicts, leaving AMA is often a clinical and interpersonal problem disguised as a legal one. When assessing these patients’ decision-making capacity, we often find they are angry and dissatisfied with the care they have (or have not) received. The most useful intervention may be to restore communication between the patient and their treatment team.

Even after a patient leaves AMA, the treatment team may experience countertransference issues, such as heightened emotional reactions or biases, that could compromise their clinical judgment. Addressing these dynamics may require team debriefings, supervision, or further training in managing transference and countertransference, particularly since patients who leave AMA may return for subsequent care.⁷

Integrated care models, which feature close collaboration between clinicians from different specialties, can help ensure that a patient’s diverse health needs are met and reduce the likelihood of them leaving AMA. Integrated care models may be particularly effective for patients with co-occurring conditions such as HIV and SUDs.⁸

Implementing these recommendations can be challenging. Barriers to addressing AMA departures span several domains, including patient-specific barriers (eg, stigma and discrimination), clinical barriers (eg, lack of resources and training for clinicians), institutional hurdles (eg, systemic inefficiencies), and broader social barriers (eg, housing instability and inadequate social support). Overcoming these barriers requires a multifaceted approach involving clinicians, policymakers, and the community that considers medical, psychological, and social factors.

Editor’s note: Readers’ Forum is a department for correspondence from readers that is not in response to articles published in Current Psychiatry . All submissions to Readers’ Forum undergo peer review and are subject to editing for length and style.

Working closely with individuals with substance use disorders (SUDs), we’ve observed a worrisome trend of patients leaving the hospital against medical advice (AMA). This issue is not only prevalent in psychiatric settings, but also in emergency departments, medical and surgical floors, and even intensive care units.¹

Compared to individuals without such disorders, individuals with SUDs—particularly those with opioid use disorders—are up to 3 times more likely to leave the hospital AMA.^1,2 Leaving AMA can lead to multiple complications, including an increased risk of readmission, suboptimal treatment outcomes, and an increased use of health care resources.^1-3

It is critical to understand why patients elect to leave a hospital AMA. In a qualitative study, Simon et al¹ found that individuals with SUDs often leave AMA due to uncontrolled withdrawal symptoms and pain, perceived stigma and discrimination, and dissatisfaction with care. Predictors of patients leaving the hospital AMA include the severity of their drug dependence and previous negative treatment experiences.⁴ A systematic review found housing instability and a lack of social support influence an individual’s decision to leave AMA.⁵

Recommendations for managing patients who leave AMA

Enhancing your understanding of withdrawal symptoms may allow you to offer patients more effective symptom control, possibly with methadone or buprenorphine.² Injectable opioid agonist treatment may also help to retain a patient in care. In a case report, a 47-year-old man with a severe opioid use disorder who had left the hospital AMA due to uncontrolled opioid withdrawal was readmitted, treated with IV hydromorphone, and enrolled in ongoing community injectable opioid agonist treatment.⁶

Clinicians must address the stigma and discrimination patients with SUDs often face in health care institutions. Additional training for clinicians to improve their understanding of these disorders and foster a more compassionate and nonjudgmental approach to care may be beneficial.

Like most medicolegal conflicts, leaving AMA is often a clinical and interpersonal problem disguised as a legal one. When assessing these patients’ decision-making capacity, we often find they are angry and dissatisfied with the care they have (or have not) received. The most useful intervention may be to restore communication between the patient and their treatment team.

Even after a patient leaves AMA, the treatment team may experience countertransference issues, such as heightened emotional reactions or biases, that could compromise their clinical judgment. Addressing these dynamics may require team debriefings, supervision, or further training in managing transference and countertransference, particularly since patients who leave AMA may return for subsequent care.⁷

Integrated care models, which feature close collaboration between clinicians from different specialties, can help ensure that a patient’s diverse health needs are met and reduce the likelihood of them leaving AMA. Integrated care models may be particularly effective for patients with co-occurring conditions such as HIV and SUDs.⁸

Implementing these recommendations can be challenging. Barriers to addressing AMA departures span several domains, including patient-specific barriers (eg, stigma and discrimination), clinical barriers (eg, lack of resources and training for clinicians), institutional hurdles (eg, systemic inefficiencies), and broader social barriers (eg, housing instability and inadequate social support). Overcoming these barriers requires a multifaceted approach involving clinicians, policymakers, and the community that considers medical, psychological, and social factors.

In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.

Courtesy Dr. Eric Esrailian

Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.

Because storytelling is an important part of raising awareness, in 2016 Dr. Esrailian and partners produced two films about stories of perseverance, endurance, and the inextinguishable fire of the human spirit. The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.

“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.

His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”

In this interview, he tells us more about his work.
 

Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.

Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.

If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
 

Q: What has been your most rewarding accomplishment?

Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.

Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
 

Q: What should be the role of physicians in supporting human rights?

Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.

Lightning round

Do you prefer texting or talking?  
Talking

How many cups of coffee do you drink each day?
Two

What was the last movie you watched?
Mission Impossible

If you weren’t a gastroenterologist, what would you be?  
Entrepreneur

Who inspires you?  
My family

In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.

Courtesy Dr. Eric Esrailian

Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.

Because storytelling is an important part of raising awareness, in 2016 Dr. Esrailian and partners produced two films about stories of perseverance, endurance, and the inextinguishable fire of the human spirit. The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.

“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.

His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”

In this interview, he tells us more about his work.
 

Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.

Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.

If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
 

Q: What has been your most rewarding accomplishment?

Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.

Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
 

Q: What should be the role of physicians in supporting human rights?

Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.

Lightning round

Do you prefer texting or talking?  
Talking

How many cups of coffee do you drink each day?
Two

What was the last movie you watched?
Mission Impossible

If you weren’t a gastroenterologist, what would you be?  
Entrepreneur

Who inspires you?  
My family

In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.

Courtesy Dr. Eric Esrailian

Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.

Because storytelling is an important part of raising awareness, in 2016 Dr. Esrailian and partners produced two films about stories of perseverance, endurance, and the inextinguishable fire of the human spirit. The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.

“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.

His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”

In this interview, he tells us more about his work.
 

Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.

Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.

If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
 

Q: What has been your most rewarding accomplishment?

Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.

Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
 

Q: What should be the role of physicians in supporting human rights?

Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.

Lightning round

Do you prefer texting or talking?  
Talking

How many cups of coffee do you drink each day?
Two

What was the last movie you watched?
Mission Impossible

If you weren’t a gastroenterologist, what would you be?  
Entrepreneur

Who inspires you?  
My family

When we launched GIHN’s monthly Member Spotlight column in January of this year, our vision was to provide a platform to recognize AGA members’ unique accomplishments across all career stages and practice settings, highlight the diversity of our membership, and build a sense of community by learning more about one another.

As physicians, we are fortunate to have the opportunity to meaningfully impact the lives of our patients through the practice of clinical medicine, or by spearheading groundbreaking research that improves patient outcomes. However, some physicians arguably make their greatest mark outside of medicine.

To close out the inaugural year of our Member Spotlight feature, we introduce you to gastroenterologist Eric Esrailian, MD, MPH, chair of the division of gastroenterology at UCLA. He is an Emmy-nominated film producer and distinguished human rights advocate. His story is inspirational, and poignantly highlights how one’s impact as a physician can extend far beyond the walls of the hospital. We hope to continue to feature exceptional individuals like Dr. Esrailian who leverage their unique talents for societal good. We appreciate your continued nominations as we plan our 2024 coverage.

Also in the December issue, we summarize the results of a pivotal, head-to-head trial of risankizumab (Skyrizi) and ustekinumab (Stelara) for Crohn’s disease, which was presented in October at United European Gastroenterology (UEG) Week in Copenhagen.

We also highlight the FDA’s recent approval of vonoprazan, a new pharmacologic treatment for erosive esophagitis expected to be available in the U.S. sometime this month. Finally, Dr. Lauren Feld explains how gastroenterologists can advocate for more robust parental leave and return to work policies at their institutions and why it matters.

We wish you all a wonderful holiday season and look forward to seeing you again in the New Year.

Megan A. Adams, MD, JD, MSc
Editor-in-Chief

When we launched GIHN’s monthly Member Spotlight column in January of this year, our vision was to provide a platform to recognize AGA members’ unique accomplishments across all career stages and practice settings, highlight the diversity of our membership, and build a sense of community by learning more about one another.

As physicians, we are fortunate to have the opportunity to meaningfully impact the lives of our patients through the practice of clinical medicine, or by spearheading groundbreaking research that improves patient outcomes. However, some physicians arguably make their greatest mark outside of medicine.

To close out the inaugural year of our Member Spotlight feature, we introduce you to gastroenterologist Eric Esrailian, MD, MPH, chair of the division of gastroenterology at UCLA. He is an Emmy-nominated film producer and distinguished human rights advocate. His story is inspirational, and poignantly highlights how one’s impact as a physician can extend far beyond the walls of the hospital. We hope to continue to feature exceptional individuals like Dr. Esrailian who leverage their unique talents for societal good. We appreciate your continued nominations as we plan our 2024 coverage.

Also in the December issue, we summarize the results of a pivotal, head-to-head trial of risankizumab (Skyrizi) and ustekinumab (Stelara) for Crohn’s disease, which was presented in October at United European Gastroenterology (UEG) Week in Copenhagen.

We also highlight the FDA’s recent approval of vonoprazan, a new pharmacologic treatment for erosive esophagitis expected to be available in the U.S. sometime this month. Finally, Dr. Lauren Feld explains how gastroenterologists can advocate for more robust parental leave and return to work policies at their institutions and why it matters.

We wish you all a wonderful holiday season and look forward to seeing you again in the New Year.

Megan A. Adams, MD, JD, MSc
Editor-in-Chief

When we launched GIHN’s monthly Member Spotlight column in January of this year, our vision was to provide a platform to recognize AGA members’ unique accomplishments across all career stages and practice settings, highlight the diversity of our membership, and build a sense of community by learning more about one another.

As physicians, we are fortunate to have the opportunity to meaningfully impact the lives of our patients through the practice of clinical medicine, or by spearheading groundbreaking research that improves patient outcomes. However, some physicians arguably make their greatest mark outside of medicine.

To close out the inaugural year of our Member Spotlight feature, we introduce you to gastroenterologist Eric Esrailian, MD, MPH, chair of the division of gastroenterology at UCLA. He is an Emmy-nominated film producer and distinguished human rights advocate. His story is inspirational, and poignantly highlights how one’s impact as a physician can extend far beyond the walls of the hospital. We hope to continue to feature exceptional individuals like Dr. Esrailian who leverage their unique talents for societal good. We appreciate your continued nominations as we plan our 2024 coverage.

Also in the December issue, we summarize the results of a pivotal, head-to-head trial of risankizumab (Skyrizi) and ustekinumab (Stelara) for Crohn’s disease, which was presented in October at United European Gastroenterology (UEG) Week in Copenhagen.

We also highlight the FDA’s recent approval of vonoprazan, a new pharmacologic treatment for erosive esophagitis expected to be available in the U.S. sometime this month. Finally, Dr. Lauren Feld explains how gastroenterologists can advocate for more robust parental leave and return to work policies at their institutions and why it matters.

We wish you all a wonderful holiday season and look forward to seeing you again in the New Year.

Megan A. Adams, MD, JD, MSc
Editor-in-Chief

Pulmonary rehabilitation (PR) is an invaluable program typically set in structured in-person environments for individuals living with chronic respiratory conditions. It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).

Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).

Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.

While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).

Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.

While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).

PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
 

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.

Pulmonary rehabilitation (PR) is an invaluable program typically set in structured in-person environments for individuals living with chronic respiratory conditions. It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).

Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).

Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.

While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).

Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.

While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).

PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
 

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.

Pulmonary rehabilitation (PR) is an invaluable program typically set in structured in-person environments for individuals living with chronic respiratory conditions. It offers a comprehensive approach to improving lung health and overall quality of life using a combination of tailored exercise routines, educational sessions, and emotional support. It empowers our patients to better manage their conditions, improve their fitness level, and regain a sense of control over their lives. However, the response to the COVID-19 pandemic increased the use of telemedicine as a method for providing health care (Shaver J. Prim Care. 2022;49[4]:517).

Many patients have welcomed the convenience offered by virtual care, and studies have demonstrated high levels of patient satisfaction (Polinski JM, et al. Gen Intern Med. 2016;31[3]:269). Geography also drives telehealth use. In urban areas in the United States, the median travel distance is 7.5 miles one way with a resulting travel time of 3 to 25 minutes. In rural areas, the estimated travel distance is three times as long. Distance and travel time have been recognized as major barriers to attending PR (Keating A, et al. Chron Respir Dis. 2011;8[2]:89).

Access to PR is also hindered by lack of program availability. As of 2019, there were only 831 pulmonary rehab centers in the United States serving roughly 24 million patients with COPD. Only 561 of these centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, leaving only one certified center for every 43,000 patients with COPD (Chan L, et al. J Rural Health. 2006;22[2]:140). As such, virtual PR is one option for augmenting availability and accessibility.

While virtual PR programs offer numerous advantages, including accessibility and convenience, there are inherent risks and challenges. There is also concern that they are inferior to in-person PR. They offer less supervision by trained health care professionals and no immediate access to medical assistance. Combined with the absence of real-time monitoring of vitals or symptoms, there may be a higher risk of adverse events despite the incorporation of safety measures. Furthermore, the lack of accountability forces an increased reliance on self-motivation, which may hinder progress (Spruit MA, et al. Am J Respir Crit Care Med. 2013;188[8]:e13).

Although the digital divide is narrowing rapidly, reliable access to technology, combined with poor internet connections or computer literacy, will prevent adoption by some patients. Even in well-resourced areas, technical issues can disrupt continuity. Finally, virtual PR lacks the intangible benefits from in-person group sessions. Social interactions in this already isolated subset of patients are lost in virtual PR, and the cultivation of motivation and support to seek a common goal goes unrealized.

While these concerns are appreciated, PR is currently highly underutilized and essentially unavailable to most pulmonary patients. As such, further study is needed to shape the future design of quality virtual PR programs. In the March 2023 issue of the journal CHEST, Huynh and colleagues published an observational cohort study comparing virtual with traditional PR programs (Huynh VC, et al. Chest. 2023; Mar;163[3]:529). Of the 554 participants in the study, 171 were enrolled in virtual and 383 to in-person PR. Attendance and drop-out rates did not differ, CAT scores significantly improved in both programs, and there were no adverse events during virtual PR. Participants in the virtual group received a TheraBand and were required to have a sturdy chair, three large step-lengths of empty space surrounding their chair, and access to internet/Zoom. They had one-on-one Zoom meetings but relied mostly on staff-made or online videos. These results replicate past investigations that have demonstrated low adverse event rates, positive overall patient satisfaction, and noninferiority in patient-centered outcomes with PR. The total volume of data remains limited though (Cox NS, et al. Cochrane Database Syst Rev. 2021;Issue 1;Art No: CD013040).

PR is an essential resource for the management of chronic lung diseases. Given existing barriers and the growing number of eligible patients, we must embrace alternative delivery strategies, all the while ensuring that a quality and useful product is deployed (Rochester CL, et al. Am J Respir Crit Care Med. 2015;192[11]:1373). Additional study is needed to standardize and validate the implementation of virtual PR. Ultimately, virtual and alternative methods of care delivery may help optimize outcomes for our patients where more traditional methods fall short.
 

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the U.S. government. Dr. Cagle and Dr. Gartman are with the Warren Alpert Medical School of Brown University and Providence VA Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine. Providence, R.I.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes^®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address president@chestnet.org is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes^®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address president@chestnet.org is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes^®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address president@chestnet.org is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But a new study suggests testing for certain biomarkers may identify long COVID with accuracy approaching 80%.

Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.

Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.

Researchers at Cardiff (Wales) University, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.

In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular – Ba, iC3b, C5a, and TCC – predicted the presence of long COVID with 78.5% accuracy.

“I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers,” says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. “It’s a combination that we showed was predictive of long COVID.” 

The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2. 

In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.

“Anything that could help to better diagnose patients with long COVID is research we’re greatly appreciative of within the clinical community,” said Nisha Viswanathan, MD, director of the University of California, Los Angeles, Long COVID program at UCLA Health. 

Testing for biomarkers highlighted in the study, as well as others like serotonin and cortisol, may help doctors separate patients who have long COVID from patients who have similar symptoms caused by other conditions, said Dr. Viswanathan. For example, a recent study published in the journal Cell found lower serotonin levels in long COVID patients, compared with patients who were diagnosed with acute COVID-19 but recovered from the condition.

Dr. Viswanathan cautions that the biomarker test does not answer all the questions about diagnosing long COVID. For example, Dr. Viswanathan said scientists don’t know whether complement dysregulation is caused by long COVID and not another underlying medical issue that patients had prior to infection, because “we don’t know where patients’ levels were prior to developing long COVID.” For example, those with autoimmune issues are more likely to develop long COVID, which means their levels could have been elevated prior to a COVID infection.

It is increasingly likely, said Dr. Viswanathan, that long COVID is an umbrella term for a host of conditions that could be caused by different impacts of the virus. Other research has pointed to the different phenotypes of long COVID. For example, some are focused on cardiopulmonary issues and others on fatigue and gastrointestinal problems. 

“It looks like these different phenotypes have a different mechanism for disease,” she said. This means that it’s less likely to be a one-size-fits-all condition and the next step in the research should be identifying which biomarker is aligned with which phenotype of the disease. 

Better diagnostics will open the door to better treatments, Dr. Zelek said. The more doctors understand about the mechanism causing immune dysregulation in long COVID patients, the more they can treat it with existing medications. Dr. Zelek’s lab has been studying certain medications like pegcetacoplan (C3 blocker), danicopan (anti-factor D), and iptacopan (anti-factor B) that can be used to break the body’s cycle of inflammation and reduce symptoms experienced in those with long COVID. 

These drugs are approved by the U.S. Food and Drug Administration for the treatment of a rare blood disease called paroxysmal nocturnal hemoglobinuria. The C5 inhibitor zilucoplan has also been used in patients hospitalized with COVID-19 and researchers have found that the drug lowered serum C5 and interleukin-8 concentration in the blood, seeming to reduce certain aspects of the immune system’s inflammatory response to the virus. 

The Cardiff University research is one of the most detailed studies to highlight long COVID biomarkers to date, said infectious disease specialist Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, Ohio. The research needs to be duplicated in a larger study population that might include the other biomarkers like serotonin and cortisol to see if they’re related, she said. 

Researchers are learning more everyday about the various biomarkers that may be linked to long COVID, she added. This Cardiff study showed that a huge percentage of those patients had elevated levels of certain complements. The next step, said Dr. McComsey, “is to put all these puzzle pieces together” so that clinicians have a common diagnostic tool or tools that provide patients with some peace of mind in starting their road to recovery.

A version of this article first appeared on Medscape.com.

One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But a new study suggests testing for certain biomarkers may identify long COVID with accuracy approaching 80%.

Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.

Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.

Researchers at Cardiff (Wales) University, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.

In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular – Ba, iC3b, C5a, and TCC – predicted the presence of long COVID with 78.5% accuracy.

“I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers,” says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. “It’s a combination that we showed was predictive of long COVID.” 

The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2. 

In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.

“Anything that could help to better diagnose patients with long COVID is research we’re greatly appreciative of within the clinical community,” said Nisha Viswanathan, MD, director of the University of California, Los Angeles, Long COVID program at UCLA Health. 

Testing for biomarkers highlighted in the study, as well as others like serotonin and cortisol, may help doctors separate patients who have long COVID from patients who have similar symptoms caused by other conditions, said Dr. Viswanathan. For example, a recent study published in the journal Cell found lower serotonin levels in long COVID patients, compared with patients who were diagnosed with acute COVID-19 but recovered from the condition.

Dr. Viswanathan cautions that the biomarker test does not answer all the questions about diagnosing long COVID. For example, Dr. Viswanathan said scientists don’t know whether complement dysregulation is caused by long COVID and not another underlying medical issue that patients had prior to infection, because “we don’t know where patients’ levels were prior to developing long COVID.” For example, those with autoimmune issues are more likely to develop long COVID, which means their levels could have been elevated prior to a COVID infection.

It is increasingly likely, said Dr. Viswanathan, that long COVID is an umbrella term for a host of conditions that could be caused by different impacts of the virus. Other research has pointed to the different phenotypes of long COVID. For example, some are focused on cardiopulmonary issues and others on fatigue and gastrointestinal problems. 

“It looks like these different phenotypes have a different mechanism for disease,” she said. This means that it’s less likely to be a one-size-fits-all condition and the next step in the research should be identifying which biomarker is aligned with which phenotype of the disease. 

Better diagnostics will open the door to better treatments, Dr. Zelek said. The more doctors understand about the mechanism causing immune dysregulation in long COVID patients, the more they can treat it with existing medications. Dr. Zelek’s lab has been studying certain medications like pegcetacoplan (C3 blocker), danicopan (anti-factor D), and iptacopan (anti-factor B) that can be used to break the body’s cycle of inflammation and reduce symptoms experienced in those with long COVID. 

These drugs are approved by the U.S. Food and Drug Administration for the treatment of a rare blood disease called paroxysmal nocturnal hemoglobinuria. The C5 inhibitor zilucoplan has also been used in patients hospitalized with COVID-19 and researchers have found that the drug lowered serum C5 and interleukin-8 concentration in the blood, seeming to reduce certain aspects of the immune system’s inflammatory response to the virus. 

The Cardiff University research is one of the most detailed studies to highlight long COVID biomarkers to date, said infectious disease specialist Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, Ohio. The research needs to be duplicated in a larger study population that might include the other biomarkers like serotonin and cortisol to see if they’re related, she said. 

Researchers are learning more everyday about the various biomarkers that may be linked to long COVID, she added. This Cardiff study showed that a huge percentage of those patients had elevated levels of certain complements. The next step, said Dr. McComsey, “is to put all these puzzle pieces together” so that clinicians have a common diagnostic tool or tools that provide patients with some peace of mind in starting their road to recovery.

A version of this article first appeared on Medscape.com.

One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But a new study suggests testing for certain biomarkers may identify long COVID with accuracy approaching 80%.

Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.

Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.

Researchers at Cardiff (Wales) University, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.

In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular – Ba, iC3b, C5a, and TCC – predicted the presence of long COVID with 78.5% accuracy.

“I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers,” says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. “It’s a combination that we showed was predictive of long COVID.” 

The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2. 

In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.

“Anything that could help to better diagnose patients with long COVID is research we’re greatly appreciative of within the clinical community,” said Nisha Viswanathan, MD, director of the University of California, Los Angeles, Long COVID program at UCLA Health. 

Testing for biomarkers highlighted in the study, as well as others like serotonin and cortisol, may help doctors separate patients who have long COVID from patients who have similar symptoms caused by other conditions, said Dr. Viswanathan. For example, a recent study published in the journal Cell found lower serotonin levels in long COVID patients, compared with patients who were diagnosed with acute COVID-19 but recovered from the condition.

Dr. Viswanathan cautions that the biomarker test does not answer all the questions about diagnosing long COVID. For example, Dr. Viswanathan said scientists don’t know whether complement dysregulation is caused by long COVID and not another underlying medical issue that patients had prior to infection, because “we don’t know where patients’ levels were prior to developing long COVID.” For example, those with autoimmune issues are more likely to develop long COVID, which means their levels could have been elevated prior to a COVID infection.

It is increasingly likely, said Dr. Viswanathan, that long COVID is an umbrella term for a host of conditions that could be caused by different impacts of the virus. Other research has pointed to the different phenotypes of long COVID. For example, some are focused on cardiopulmonary issues and others on fatigue and gastrointestinal problems. 

“It looks like these different phenotypes have a different mechanism for disease,” she said. This means that it’s less likely to be a one-size-fits-all condition and the next step in the research should be identifying which biomarker is aligned with which phenotype of the disease. 

Better diagnostics will open the door to better treatments, Dr. Zelek said. The more doctors understand about the mechanism causing immune dysregulation in long COVID patients, the more they can treat it with existing medications. Dr. Zelek’s lab has been studying certain medications like pegcetacoplan (C3 blocker), danicopan (anti-factor D), and iptacopan (anti-factor B) that can be used to break the body’s cycle of inflammation and reduce symptoms experienced in those with long COVID. 

These drugs are approved by the U.S. Food and Drug Administration for the treatment of a rare blood disease called paroxysmal nocturnal hemoglobinuria. The C5 inhibitor zilucoplan has also been used in patients hospitalized with COVID-19 and researchers have found that the drug lowered serum C5 and interleukin-8 concentration in the blood, seeming to reduce certain aspects of the immune system’s inflammatory response to the virus. 

The Cardiff University research is one of the most detailed studies to highlight long COVID biomarkers to date, said infectious disease specialist Grace McComsey, MD, who leads the long COVID RECOVER study at University Hospitals Health System in Cleveland, Ohio. The research needs to be duplicated in a larger study population that might include the other biomarkers like serotonin and cortisol to see if they’re related, she said. 

Researchers are learning more everyday about the various biomarkers that may be linked to long COVID, she added. This Cardiff study showed that a huge percentage of those patients had elevated levels of certain complements. The next step, said Dr. McComsey, “is to put all these puzzle pieces together” so that clinicians have a common diagnostic tool or tools that provide patients with some peace of mind in starting their road to recovery.

A version of this article first appeared on Medscape.com.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.