Reposting this from last year as the LRP deadline comes up 11/16:
Category Archives: Research
Updates to severe CAP recommendations and the microbiome
Thanks to Dr. Szabo and Dr. Pickens for a fantastic grand rounds covering the new updated recommendations to severe CAP! [https://link.springer.com/article/10.1007/s00134-023-07033-8]
1) Suggest adding multiplex PCR to lower respiratory sample (very low evidence)
ResPOC trial [https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30120-0/fulltext] – 720 patients presenting to ED with resp symptoms ran multiplex PCR and given information to clinical team -> slightly less abx (one dose vs 48hrs) and shorter LOS and good identification of viruses -> results 48-72hrs earlier than cultures, can quickly de-escalate or target resistance
Sputum biofires more often positive than BAL biofire (72% vs 49% and more likely polymicrobial, and also common discrepancy with cultures)
2) Consider HFNC instead of regular oxygen
RCT of standard oxygen facemask, HFNC, NIV [Frat NEJM 2015 https://pubmed.ncbi.nlm.nih.gov/25981908/] -> mortality benefit in those who got HFNC [though NIV might’ve been confounded because they targeted high tidal volumes]
3) Steroids? Based on their own meta-analysis, recommended if shock is concurrently present.
Didn’t include CAPE COD study, and driven by Meduri VA study [?confounded by gender]
Interesting thoughts on environmental ecology – examining the microbe in its true environment interacting with other bugs rather than taking it out and isolating it on a plate!
First, identify all microbes present [Human Microbiome Project – https://hmpdacc.org/]; there’s been a lot of interest recently!
The upper respiratory tract is different from the lower respiratory tract when you’re sick. Some features like bacterial burden or composition/diversity are associated with different outcomes!
Thanks, Dr. Szabo and Dr. Pickens!
19th Annual Respiratory Disease Young Investigators’ Forum
Applications are open for the 19th Annual Respiratory Disease Young Investigators’ Forum! Due June 12th. A great opportunity and event for fellows and junior faculty interested in research – last year, Joe Bailey, Gabby Liu, and I went; previous attendees have included Luisa, Xander, and more!
LRP cycle open! Insight from Dr. Marc Sala on the process
The NIH LRP application cycle for this year has just opened, and I wanted to remind everyone of this amazing opportunity to help with those hundreds of thousands of dollars of debt you are burdened with. The NIH Loan Repayment Program helps to counteract that financial pressure by repaying $100,000/award period for research health professionals.
I had the opportunity to sit down with NIH LRP recipient, Dr. Marc Sala (@MarcSala_MD), to discuss the process.
“Of course, the first step in getting an LRP is even knowing the program exists. Which means that by reading this, you’re already ahead of the curve,” Dr. Sala says, “The LRP is a very under-recognized source of debt relief for young academic faculty which helps reduce your monthly expenses and reduce your debt much faster than you would otherwise. I was successful at getting it, but only on my 3rd attempt. There was a lesson to be learned in that experience about calling the program officer every cycle for feedback because you don’t receive critiques as you would with other funding sources. After I got my feedback, I was able to achieve success by correcting the discrete deficiencies in the proposal.”
Tips for the process that he emphasized were, “to start the process, read and re-read the instructions on the LRP website and then it always behooves you to ask peers for their successful LRP proposals to mock-up the overall structure of your grant if you’re not used to writing grants. You need to collect a lot of loan servicer information, so start on that early (what is your current balance, where do you download your statements, what are your account numbers, etc).”
What about his mentors and project itself? “My mentor at the start of my LRP was Manu Jain when I was working on more cystic fibrosis related work and then changed to Ravi Kalhan as my focus shifted to Long COVID. The work in my proposal was derived from projects I had a good amount of preliminary data on, but your mentorship and institutional support and collaborators are probably far more important than the project aims and innovation of the idea for the LRP. Putting a grant together from scratch always takes a huge up front time investment, especially if you have multiple mentors who will be providing feedback. Things like equipment and institutional environment do not always need to be written from scratch if others have similar text blocks. Make sure for your letters of support that you give the courtesy of plenty advanced notice and usually scaffold basic text for them where appropriate to minimize resistance in getting them submitted on time.” It certainly feels like an overwhelming amount of paperwork at first, but dividing pieces up and tackling a small amount every day helps, and will also help with future grant applications!
To conclude, Dr. Sala said, “In the end, I only needed one cycle (2 years) of LRP to help pay off my debt and I used PSLF for the remainder, but you can renew for as long as you need to pay off your remaining loan balance (private and public loans are both eligible). It’s a wonderful program and can make or break one’s academic career if finances are tight, so I really encourage people in a such a situation to apply — you only can hit a ball if you take a swing…or three.”
Thanks to Dr. Sala for discussing the process with us! I was also fortunate enough to receive an LRP funded this last cycle. Both of us are happy to answer any questions you might have about the process, and encourage young investigators to take advantage of this great support opportunity!
Congratulations, Dr. Nandita Nadig!
Congratulations are in order for Dr. Nandita Nadig, MD, MSCR, who was recently awarded both the NUCATS Dixon Translational Research Grant and the Eleanor Wood-Prince Grant. The Dixon Grants fund “innovative, multi-disciplinary clinical and translational research collaborations…that can make an impact in medical science at a national level,” established after a $20 million pledge from Suzanne and Wesley Dixon, the largest contribution for a single program in hospital history. The Eleanor Wood-Prince Grant Initiatives are a project of The Women’s Board of Northwestern Medicine, and has awarded over $1.7 million to recipients since 2001.
As the Medical Director of Critical Care Integration, Dr. Nadig’s research and clinical interests have focused on reducing healthcare disparities in ICU transfers and right-sizing care using telehealth and regional outreach approaches. She was a 2019 Parker B. Francis fellow and has also recently been awarded the Diversity Grant from the American Thoracic Society for her project, “Inter-ICU Transfer Telehealth Tool (IITT)-Family Centered Care through Telehealth”.
We had the pleasure of speaking with Dr. Nadig on her recent accomplishments and advice she has for fellows and junior faculty. She described having found these opportunities on the NUCATS website, which “seemed to be a good fit and the right avenue to build a new team”. She feels like the often quoted, “success begets more success” oversimplifies reality, because “people who are successful have in fact participated more, have had more failures, more rejections, more experiential learning.” She encourages everyone to “persist, practice resilience, incorporate feedback and adapt as it will serve you well not only in your research but in your career!”
As she “look[s] forward to embedding healthcare equity principles while developing and implementing the vision for critical care integration,” we too look forward to seeing her work develop further and appreciate her guidance and mentorship!
Highlights from Gabby Liu’s BMJ State of the Art review on pulmonary fibrosis!
Amazing work by Gabby Liu (@gliunit, PCCM Fellowship Class of 2022) on this BMJ State of the Art Review: https://www.bmj.com/content/377/bmj-2021-066354
Advances in the management of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis
Highlights from the review, kindly summarized for us by the author:
- Discusses the conceptualization and pathophysiology of progressive pulmonary fibrosis
- 2022 ATS/ERS/JRS/ALAT guidelines define how to identify progressive pulmonary fibrosis:
- ILD dx other than IPF
- Radiologic evidence of pulmonary fibrosis
- Evidence of progression, defined as meeting at least two of three criteria within the previous year with no alternative explanation:
- Absolute decline in FVC >/=5% predicted or absolute decline in DLCOc >/=10% predicted
- Worsening respiratory symptoms
- Radiologic evidence of progression
- Therapies in the pipeline for treatment of IPF, undergoing phase 3 clinical trials:
- Recombinant human pentraxin 2 – rhPTX
- Inhibits recruitment of monocyte derived alveolar macrophages to areas of fibrosis
- Pamrevlumab
- Anti-CTGF antibody
- CTGF mediates tissue remodeling, acting downstream of TGF-beta
- Inhaled treprostinil
- Prostacyclin analog approved for treatment of PAH and pHTN associated with ILD
- NAC among IPF patients with TOLLIP TT genotype
- Tripeptide precursor of glutathione that has antioxidant effects
- Recombinant human pentraxin 2 – rhPTX
- Treatment of inflammatory ILDs:
- Only RCT data supporting immunosuppression comes from studies of patients with SSc-ILD
- Tocilizumab is the only immunosuppressive drug approved by FDA for treatment of SSc-ILD
- Based on FaSScinate and focuSSced trials
- Cyclophosphamide (CYC) and MMF are not approved by FDA for treatment of SSc-ILD but use is supported by Scleroderma Lung Studies I and II
- SLS I : CYC reduced decline in FVC compared to placebo
- SLS II: MMF non-inferior to CYC
- Treatment of progressive pulmonary fibrosis:
- Nintedanib, supported by 2 RCTs:
- SENSCIS: patients with SSc-ILD, no evidence of disease progression required for enrollment
- Nintedanib reduced rate of FVC decline compared to placebo
- ½ of patients on MMF at enrollment, nintedanib effective regardless of MMF use
- INBUILD: Patients with non-IPF progressive fibrosing ILD, not allowed to be on immunosuppression
- Nintedanib reduced rate of FVC decline compared to placebo
- SENSCIS: patients with SSc-ILD, no evidence of disease progression required for enrollment
- Pirfenidone, data less robust, RCTs ongoing
- Nintedanib, supported by 2 RCTs:
- Emerging diagnostics:
- Envisia genomic classifier can help differentiate UIP from non-UIP histologic patterns from transbronchial lung biopsy and lung cryobiopsy by recognizing transcriptomic signature of UIP
Great work, Gabby!
Annual Landsberg Research Day abstract submission
Abstract submissions opening soon for Landsberg Research Day, a campuswide event scheduled for September 15, 2022. Prizes for winning posters, and anyone affiliated with Feinberg School of Medicine (residents, fellows, grad students, postdocs, faculty, students) can submit!
Abstract submission window 7/28-8/11!
https://www.feinberg.northwestern.edu/research/events/research-day/