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More Pearls AfootMore Pearls Afoot FREE TO VIEW

John E. Heffner, MD, FCCP; Steven A. Sahn, MD, FCCP; Susan M. Harding, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr Heffner), Oregon Health & Science University; Providence Portland Medical Center (Dr Heffner); The Oregon Clinic (Dr Heffner); Medical University of South Carolina (Dr Sahn); and Division of Pulmonary, Allergy & Critical Care Medicine (Dr Harding), University of Alabama at Birmingham.

Correspondence to: John E. Heffner, MD, Providence Portland Medical Center, 5050 NE Hoyt St, Ste 540, Portland, OR 97213; e-mail: john_heffner@mac.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):5-7. doi:10.1378/chest.12-1985
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An enduring memory for those of us trained during the 1970s in pulmonary and critical care recalls the daily ritual of concluding bedside rounds by walking to radiology, where we suspended our patients’ cut films on a vast wall of view boxes. As our huddle of physicians moved down the illuminated rows, we trainees were mesmerized by the ability of master attending physicians to synthesize the clinical findings we presented with the shadows they saw to create a cohesive diagnosis and plan. The annual CHEST conference was even more memorable. There, a roomful of attending physicians routinely “solved” the most challenging clinical dilemmas we could throw their way as unknowns. We trainees left both dazzled by the clinical pearls we learned, but also committed to honing our own diagnostic skills. Helping patients by solving tough clinical questions in arguably the most diverse and difficult-to-learn specialty in medicine, pulmonary critical care, is not only professionally gratifying but also a lot of fun. As Sherlock Holmes enthused when facing a new mystery, “Come Watson, come!…The game is afoot.”1

In 1985 at the Medical University of South Carolina, two of us (J. E. H. and S. A. S.) began a handwritten log of interesting cases collected from the CHEST conference with a listing of one or two pearls for each. After a couple of years, the book became swollen with teaching points and dog-eared by the many fellows who used it. We decided that the CHEST conference and its pearls were too good not to share. So in 1988, we published Pulmonary Pearls,2 which was followed over the years by 18 subsequent books in the Pearls series that followed a similar format: case presentation, question posed, answer provided, discussion of the underlying entity, patient follow-up, and listing of the most valuable learning points, which we all know as “pearls.” We were gratified that the “game was [still] afoot” in the minds of many of our readers who enjoyed reading case studies and solving medical mysteries. We think it true that pulmonary/critical care physicians share in common the “Sherlock Holmes gene” that binds our profession together. Because of the readability of the format, some colleagues confessed, when we met them at annual meetings, that they kept the books close at hand near their nightstand or commode. (We took the latter as a compliment.)

Even more satisfying was the invitation in 1992 from Al Soffer, MD, Master FCCP, then the editor-in-chief of CHEST, to reprise our Pearls books into a new Pulmonary and Critical Care Pearls section in the journal. Over the following 2 decades, not only have CHEST readers demonstrated they have the “Holmes gene” by their support of the section, but they have also proven over and over again that they are the true master clinicians. Since November 1992, we have published 335 extraordinary manuscripts authored by CHEST readers from around the world in every practice setting imaginable. These authors face tough clinical problems daily and regularly demonstrate their remarkable problem-solving skills. Reading and editing these manuscripts has been quite a learning experience for the both of us (J. E. H. and S. A. S.), and we sincerely thank our long list of authors.

As radiology became digitized and long rows of view boxes gradually disappeared, our specialty has similarly changed. The satisfaction that physicians gain from solving diagnostic dilemmas remains intact, but pulmonary critical care has become even more challenging and diverse with the inclusion of sleep medicine. Master clinicians versed in mechanical ventilation, pressor support, interstitial lung disease, asthma, and the like, now commonly manage obstructive sleep apnea, central hypoventilation, overlap syndrome, cataplexy, and restless leg syndrome, to name a few. The requisite toolbox of pearls that clinicians must keep at hand has similarly grown in size. For this reason, we are welcoming a new Pearls Section co-editor, Susan Harding, MD, FCCP, to help us expand the scope of the CHEST section, now titled “Pulmonary, Critical Care, and Sleep Pearls.”

Since the early research of A. J. Block that explored the pathophysiologic roots of obstructive sleep apnea, sleep medicine has grown into a complex field with >90 sleep-related disorders, each of which has a unique set of diagnostic and management strategies. Because sleep disorders affect respiratory function and outcomes in the ICU, it comes as no surprise that two-thirds of board-certified sleep physicians are pulmonologists.3 In response, CHEST, under the stewardship of Richard Irwin, MD, Master FCCP, its editor-in-chief, and Nancy Collop, MD, FCCP, an associate editor with considerable sleep-medicine expertise, has successfully moved toward becoming a leading journal in sleep medicine. Adding sleep to the Pearls Section will further strengthen the educational value of the journal.

Sleep deprivation impacts society to a remarkable degree. New observations appear almost daily that link sleep disorders with hypertension, cardiovascular disease, diabetes, and even cancer, which underscore the central importance of sleep to health and the mechanistic role of abnormal sleep in causing or contributing to disease.4 We anticipate receiving a wealth of challenging sleep-medicine manuscripts. A word to potential authors: Keep in mind that we seek interesting cases, from the routine to the arcane, that challenge readers with figures that display polysomnographic epochs, imaging studies, actigraphs, or other sleep-related laboratory findings. Previously unreported observations belong in in the Selected Reports section of CHEST; we will be looking for illustrative examples of known entities. It is all about the “pearls” and homing in on clinical problem-solving skills. In preparing manuscripts for Sleep Medicine Pearls, please be sure to review the instructions to authors (http://journal.publications.chestnet.org/ss/forauthors.aspx#PulmonaryCritCareSleepPearls) and use the formatting that Pearls manuscripts require.

It has been a wonderful experience having the privilege for 2 decades to tap the wealth of knowledge our CHEST authors possess and publish their “lessons learned” as pulmonary and critical care pearls. With the addition of sleep medicine, we look forward to publishing an even broader array of medical mysteries to stimulate our readers’ “Holmes gene.” We keenly await discovering what sleep-related pearls we will read, and how they will help us all become master clinicians. The game is afoot!

References

Doyle AC. The Adventure of the Abbey Grange. Educational Technology Clearinghouse. University of South Florida website.http://etc.usf.edu/lit2go/178/the-return-of-sherlock-holmes/3238/chapter-xii-the-adventure-of-the-abbey-grange/. Accessed August 5, 2012.
 
Sahn SA, Heffner JE. Pulmonary Pearls. Philadelphia, PA: Hanley & Belfus; 1988.
 
Quan SF, Buysse DJ, Ward SL, et al. Development and growth of a large multispecialty certification examination: sleep medicine certification—results of the first three examinations. J Clin Sleep Med. 2012;8(2):221-224. [PubMed]
 
Redline S, Quan SF Sleep apnea: a common mechanism for the deadly triad—cardiovascular disease, diabetes, and cancer?. Am J Respir Crit Care Med. 2012;186(2):123-124. [CrossRef] [PubMed]
 

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References

Doyle AC. The Adventure of the Abbey Grange. Educational Technology Clearinghouse. University of South Florida website.http://etc.usf.edu/lit2go/178/the-return-of-sherlock-holmes/3238/chapter-xii-the-adventure-of-the-abbey-grange/. Accessed August 5, 2012.
 
Sahn SA, Heffner JE. Pulmonary Pearls. Philadelphia, PA: Hanley & Belfus; 1988.
 
Quan SF, Buysse DJ, Ward SL, et al. Development and growth of a large multispecialty certification examination: sleep medicine certification—results of the first three examinations. J Clin Sleep Med. 2012;8(2):221-224. [PubMed]
 
Redline S, Quan SF Sleep apnea: a common mechanism for the deadly triad—cardiovascular disease, diabetes, and cancer?. Am J Respir Crit Care Med. 2012;186(2):123-124. [CrossRef] [PubMed]
 
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