CHEST Congress Thailand concluded in Bangkok last month with more than 1,000 attendees from 56 countries. Attendees heard experts speak on several clinical tracks, including lung cancer, severe airway disease, pulmonary infections, interventional pulmonary management, and sleep-related disordered breathing. Panel discussions were held covering controversial topics across pulmonary, critical care, and sleep medicine, and close to 400 submitted abstracts were presented. Registration continues to build for the next CHEST international meeting to be held in conjunction with the Hellenic Thoracic Society in Athens, Greece, June 25-27. This meeting will feature clinicians and academicians providing relevant clinical updates to providers throughout that region in more of a “board review-like” format.

Why is it so important that CHEST spread its brand of education to an international audience?
 

Clinicians are yearning for up-to-date information regardless of geography

Having the opportunity to visit with clinicians from Southeast Asia and Australia, it became clear to me that there is a need for high quality educational opportunities to be shared across the globe. Many attendees in Bangkok had never had the opportunity to attend a CHEST annual meeting within North America; their exposure to state-of-the-art reviews using interactive audience participation was a format that was clearly appreciated. Hands-on educational opportunities through simulation, as well as novel interactive tools such as serious gaming, were modalities not previously available to many attendees and the reviews received were overwhelmingly positive.
 

Access to cutting-edge training in certain areas in the world has become more limited

Resources for international travel have become more limited. Industry sponsorship in certain regions has dwindled and, for certain countries, the ability to access medical meetings within the United States or other areas in Europe or North America has become burdensome, if not logistically impossible. Bringing the CHEST brand of education to members and other practicing providers outside North America within the represented specialties has allowed access to experts and the most effective formats for education without extended travel and excess cost.
 

Smaller international meetings allow for more tailored curricula designed to meet local needs

The ability to build the curriculum around specific requests of a national society has allowed for a more focused educational platform designed to meet the needs of what regional leaders feel is the most critical for the highest prevalence of patients seen in that specific area. The international strategy of CHEST calls for an annual congress outside of North America and at least one smaller “board review-type” meeting in a different region elsewhere across the world each academic year. Co-hosting more meetings will not only help address unmet educational needs outside of the United States and Canada but also extend our reach to participants who may not have otherwise had the ability to participate in the CHEST brand of education. During multiple sessions, there were literally dozens of questions for which there was time to address each in real time. The panel discussions were lively, well-moderated, and also stimulated multiple questions and comments from the audience.
 

Education by podium lecture is fast becoming outdated

Although a compelling lecture using a didactic format from a podium at the front of a room is not going to be replaced completely any time soon, educational delivery trends are moving toward virtual classrooms, use of simulation, problem solving online, serious gaming, and hands-on experiential education. As an innovator and leader in medical education, CHEST will continue to provide a variety of options for delivering education utilizing a variety of platforms. By opening a multimedia production studio at CHEST global headquarters in Glenview, Illinois, this past February, the organization is positioning itself to continue to refine its ability to produce and distribute a variety of courses available to all CHEST members in an archivable, easily accessible format. The Board of Regents has doubled down on its digital strategy toward improving communication across the entire user experience, and offering courses to our international members closer to home is one way to execute this strategy.
 

Networking and new friendships underscore what’s important

Meeting new colleagues from across the globe has made me realize that we are all focused on providing the very best care possible to our patients every day. Ultimately, education is communication. The ability to share how CHEST educates its membership will improve patient care worldwide and foster lifelong friendships with those we meet in other lands. Those opportunities to share ideas on health-care delivery will keep us on the cutting edge technologically and keep us focused on how to use resources responsibly and in a way that best serves the communities where we practice.
 

CHEST Congress Thailand concluded in Bangkok last month with more than 1,000 attendees from 56 countries. Attendees heard experts speak on several clinical tracks, including lung cancer, severe airway disease, pulmonary infections, interventional pulmonary management, and sleep-related disordered breathing. Panel discussions were held covering controversial topics across pulmonary, critical care, and sleep medicine, and close to 400 submitted abstracts were presented. Registration continues to build for the next CHEST international meeting to be held in conjunction with the Hellenic Thoracic Society in Athens, Greece, June 25-27. This meeting will feature clinicians and academicians providing relevant clinical updates to providers throughout that region in more of a “board review-like” format.

Why is it so important that CHEST spread its brand of education to an international audience?
 

Clinicians are yearning for up-to-date information regardless of geography

Having the opportunity to visit with clinicians from Southeast Asia and Australia, it became clear to me that there is a need for high quality educational opportunities to be shared across the globe. Many attendees in Bangkok had never had the opportunity to attend a CHEST annual meeting within North America; their exposure to state-of-the-art reviews using interactive audience participation was a format that was clearly appreciated. Hands-on educational opportunities through simulation, as well as novel interactive tools such as serious gaming, were modalities not previously available to many attendees and the reviews received were overwhelmingly positive.
 

Access to cutting-edge training in certain areas in the world has become more limited

Resources for international travel have become more limited. Industry sponsorship in certain regions has dwindled and, for certain countries, the ability to access medical meetings within the United States or other areas in Europe or North America has become burdensome, if not logistically impossible. Bringing the CHEST brand of education to members and other practicing providers outside North America within the represented specialties has allowed access to experts and the most effective formats for education without extended travel and excess cost.
 

Smaller international meetings allow for more tailored curricula designed to meet local needs

The ability to build the curriculum around specific requests of a national society has allowed for a more focused educational platform designed to meet the needs of what regional leaders feel is the most critical for the highest prevalence of patients seen in that specific area. The international strategy of CHEST calls for an annual congress outside of North America and at least one smaller “board review-type” meeting in a different region elsewhere across the world each academic year. Co-hosting more meetings will not only help address unmet educational needs outside of the United States and Canada but also extend our reach to participants who may not have otherwise had the ability to participate in the CHEST brand of education. During multiple sessions, there were literally dozens of questions for which there was time to address each in real time. The panel discussions were lively, well-moderated, and also stimulated multiple questions and comments from the audience.
 

Education by podium lecture is fast becoming outdated

Although a compelling lecture using a didactic format from a podium at the front of a room is not going to be replaced completely any time soon, educational delivery trends are moving toward virtual classrooms, use of simulation, problem solving online, serious gaming, and hands-on experiential education. As an innovator and leader in medical education, CHEST will continue to provide a variety of options for delivering education utilizing a variety of platforms. By opening a multimedia production studio at CHEST global headquarters in Glenview, Illinois, this past February, the organization is positioning itself to continue to refine its ability to produce and distribute a variety of courses available to all CHEST members in an archivable, easily accessible format. The Board of Regents has doubled down on its digital strategy toward improving communication across the entire user experience, and offering courses to our international members closer to home is one way to execute this strategy.
 

Networking and new friendships underscore what’s important

Meeting new colleagues from across the globe has made me realize that we are all focused on providing the very best care possible to our patients every day. Ultimately, education is communication. The ability to share how CHEST educates its membership will improve patient care worldwide and foster lifelong friendships with those we meet in other lands. Those opportunities to share ideas on health-care delivery will keep us on the cutting edge technologically and keep us focused on how to use resources responsibly and in a way that best serves the communities where we practice.
 

CHEST Congress Thailand concluded in Bangkok last month with more than 1,000 attendees from 56 countries. Attendees heard experts speak on several clinical tracks, including lung cancer, severe airway disease, pulmonary infections, interventional pulmonary management, and sleep-related disordered breathing. Panel discussions were held covering controversial topics across pulmonary, critical care, and sleep medicine, and close to 400 submitted abstracts were presented. Registration continues to build for the next CHEST international meeting to be held in conjunction with the Hellenic Thoracic Society in Athens, Greece, June 25-27. This meeting will feature clinicians and academicians providing relevant clinical updates to providers throughout that region in more of a “board review-like” format.

Why is it so important that CHEST spread its brand of education to an international audience?
 

Clinicians are yearning for up-to-date information regardless of geography

Having the opportunity to visit with clinicians from Southeast Asia and Australia, it became clear to me that there is a need for high quality educational opportunities to be shared across the globe. Many attendees in Bangkok had never had the opportunity to attend a CHEST annual meeting within North America; their exposure to state-of-the-art reviews using interactive audience participation was a format that was clearly appreciated. Hands-on educational opportunities through simulation, as well as novel interactive tools such as serious gaming, were modalities not previously available to many attendees and the reviews received were overwhelmingly positive.
 

Access to cutting-edge training in certain areas in the world has become more limited

Resources for international travel have become more limited. Industry sponsorship in certain regions has dwindled and, for certain countries, the ability to access medical meetings within the United States or other areas in Europe or North America has become burdensome, if not logistically impossible. Bringing the CHEST brand of education to members and other practicing providers outside North America within the represented specialties has allowed access to experts and the most effective formats for education without extended travel and excess cost.
 

Smaller international meetings allow for more tailored curricula designed to meet local needs

The ability to build the curriculum around specific requests of a national society has allowed for a more focused educational platform designed to meet the needs of what regional leaders feel is the most critical for the highest prevalence of patients seen in that specific area. The international strategy of CHEST calls for an annual congress outside of North America and at least one smaller “board review-type” meeting in a different region elsewhere across the world each academic year. Co-hosting more meetings will not only help address unmet educational needs outside of the United States and Canada but also extend our reach to participants who may not have otherwise had the ability to participate in the CHEST brand of education. During multiple sessions, there were literally dozens of questions for which there was time to address each in real time. The panel discussions were lively, well-moderated, and also stimulated multiple questions and comments from the audience.
 

Education by podium lecture is fast becoming outdated

Although a compelling lecture using a didactic format from a podium at the front of a room is not going to be replaced completely any time soon, educational delivery trends are moving toward virtual classrooms, use of simulation, problem solving online, serious gaming, and hands-on experiential education. As an innovator and leader in medical education, CHEST will continue to provide a variety of options for delivering education utilizing a variety of platforms. By opening a multimedia production studio at CHEST global headquarters in Glenview, Illinois, this past February, the organization is positioning itself to continue to refine its ability to produce and distribute a variety of courses available to all CHEST members in an archivable, easily accessible format. The Board of Regents has doubled down on its digital strategy toward improving communication across the entire user experience, and offering courses to our international members closer to home is one way to execute this strategy.
 

Networking and new friendships underscore what’s important

Meeting new colleagues from across the globe has made me realize that we are all focused on providing the very best care possible to our patients every day. Ultimately, education is communication. The ability to share how CHEST educates its membership will improve patient care worldwide and foster lifelong friendships with those we meet in other lands. Those opportunities to share ideas on health-care delivery will keep us on the cutting edge technologically and keep us focused on how to use resources responsibly and in a way that best serves the communities where we practice.
 

Get a glimpse of the rich southern culture of New Orleans this October by checking out a few of these locations and events.

Visit a Mini Museum – Backstreet Cultural Museum

The Backstreet Cultural Museum is located in a small, former funeral home in the historic Treme neighborhood. The museum displays the permanent collection of Mardi Gras Indians costumes, second-line parade outfits, jazz funeral photos, and music memorabilia from curator Sylvester Francis. Interested in upcoming parades and festivals happening nearly every weekend in New Orleans? Learn about these at the museum, as well as more NOLA arts and traditions.
 

View the Local Art in Jackson Square

Jackson Square is an area where you’ll see tarot readers, street performers, and artists. It has an open-air artist community where their works are hung on the iron railings around the square. Spend time getting your portrait done, buy a new art piece from a local, or have fun watching a street performance.
 

Enjoy the architecture of the French Quarter

Explore New Orleans’ oldest neighborhood, The French Quarter, with its mix of French Creole and Spanish influenced architecture. You’ll find hints of this on old tiled street names and the French Fleur de Lys emblem noticeable all around the city. There are also Caribbean, African, and other European influences throughout the area. Take in the gorgeous mansions, the colorful Creole houses with their porches and swing chairs, the townhouses with beautiful ironwork balconies, and more!
 

Head to Oktoberfest

New Orleans also has a rich German history. You can celebrate this October with the city’s own version of Oktoberfest, which takes place the first three weekends in the month. Experience some of the best of German culture by drinking a rare beer, trying authentic cuisine, and listening to live music during this celebration.
 

New Orleans Film Festival

From October 16-24, the New Orleans Film Society will be hosting the 2019 New Orleans Film Festival (NOFF). You can check out showings in different venues throughout the city. Local filmmakers are showcased during the festival, and their films and any shown during NOFF can qualify for the Oscars in all three Academy-accredited categories: Narrative Short, Documentary Short, and Animated Short.



Check out more things you can do in NOLA (https://tinyurl.com/yxnqswv5).

Get a glimpse of the rich southern culture of New Orleans this October by checking out a few of these locations and events.

Visit a Mini Museum – Backstreet Cultural Museum

The Backstreet Cultural Museum is located in a small, former funeral home in the historic Treme neighborhood. The museum displays the permanent collection of Mardi Gras Indians costumes, second-line parade outfits, jazz funeral photos, and music memorabilia from curator Sylvester Francis. Interested in upcoming parades and festivals happening nearly every weekend in New Orleans? Learn about these at the museum, as well as more NOLA arts and traditions.
 

View the Local Art in Jackson Square

Jackson Square is an area where you’ll see tarot readers, street performers, and artists. It has an open-air artist community where their works are hung on the iron railings around the square. Spend time getting your portrait done, buy a new art piece from a local, or have fun watching a street performance.
 

Enjoy the architecture of the French Quarter

Explore New Orleans’ oldest neighborhood, The French Quarter, with its mix of French Creole and Spanish influenced architecture. You’ll find hints of this on old tiled street names and the French Fleur de Lys emblem noticeable all around the city. There are also Caribbean, African, and other European influences throughout the area. Take in the gorgeous mansions, the colorful Creole houses with their porches and swing chairs, the townhouses with beautiful ironwork balconies, and more!
 

Head to Oktoberfest

New Orleans also has a rich German history. You can celebrate this October with the city’s own version of Oktoberfest, which takes place the first three weekends in the month. Experience some of the best of German culture by drinking a rare beer, trying authentic cuisine, and listening to live music during this celebration.
 

New Orleans Film Festival

From October 16-24, the New Orleans Film Society will be hosting the 2019 New Orleans Film Festival (NOFF). You can check out showings in different venues throughout the city. Local filmmakers are showcased during the festival, and their films and any shown during NOFF can qualify for the Oscars in all three Academy-accredited categories: Narrative Short, Documentary Short, and Animated Short.



Check out more things you can do in NOLA (https://tinyurl.com/yxnqswv5).

Get a glimpse of the rich southern culture of New Orleans this October by checking out a few of these locations and events.

Visit a Mini Museum – Backstreet Cultural Museum

The Backstreet Cultural Museum is located in a small, former funeral home in the historic Treme neighborhood. The museum displays the permanent collection of Mardi Gras Indians costumes, second-line parade outfits, jazz funeral photos, and music memorabilia from curator Sylvester Francis. Interested in upcoming parades and festivals happening nearly every weekend in New Orleans? Learn about these at the museum, as well as more NOLA arts and traditions.
 

View the Local Art in Jackson Square

Jackson Square is an area where you’ll see tarot readers, street performers, and artists. It has an open-air artist community where their works are hung on the iron railings around the square. Spend time getting your portrait done, buy a new art piece from a local, or have fun watching a street performance.
 

Enjoy the architecture of the French Quarter

Explore New Orleans’ oldest neighborhood, The French Quarter, with its mix of French Creole and Spanish influenced architecture. You’ll find hints of this on old tiled street names and the French Fleur de Lys emblem noticeable all around the city. There are also Caribbean, African, and other European influences throughout the area. Take in the gorgeous mansions, the colorful Creole houses with their porches and swing chairs, the townhouses with beautiful ironwork balconies, and more!
 

Head to Oktoberfest

New Orleans also has a rich German history. You can celebrate this October with the city’s own version of Oktoberfest, which takes place the first three weekends in the month. Experience some of the best of German culture by drinking a rare beer, trying authentic cuisine, and listening to live music during this celebration.
 

New Orleans Film Festival

From October 16-24, the New Orleans Film Society will be hosting the 2019 New Orleans Film Festival (NOFF). You can check out showings in different venues throughout the city. Local filmmakers are showcased during the festival, and their films and any shown during NOFF can qualify for the Oscars in all three Academy-accredited categories: Narrative Short, Documentary Short, and Animated Short.



Check out more things you can do in NOLA (https://tinyurl.com/yxnqswv5).

Editor’s Picks

By Richard S. Irwin, MD, Master FCCP



Giants in Chest Medicine

John Heffner, MD, FCCP



ORIGINAL RESEARCH

The Landscape of US Lung Cancer Screening Services-Figure 1By M. S. Kale, et al.



Systemic Markers of Inflammation in Smokers With Symptoms Despite Preserved

Spirometry in SPIROMICSBy S. Garudadri, et al.Prevalence of Atrial Fibrillation in Hospital Encounters With End-Stage COPD on

Home Oxygen:

National Trends in the United States

By X. Xiao, et al.

Editor’s Picks

By Richard S. Irwin, MD, Master FCCP



Giants in Chest Medicine

John Heffner, MD, FCCP



ORIGINAL RESEARCH

The Landscape of US Lung Cancer Screening Services-Figure 1By M. S. Kale, et al.



Systemic Markers of Inflammation in Smokers With Symptoms Despite Preserved

Spirometry in SPIROMICSBy S. Garudadri, et al.Prevalence of Atrial Fibrillation in Hospital Encounters With End-Stage COPD on

Home Oxygen:

National Trends in the United States

By X. Xiao, et al.

Editor’s Picks

By Richard S. Irwin, MD, Master FCCP



Giants in Chest Medicine

John Heffner, MD, FCCP



ORIGINAL RESEARCH

The Landscape of US Lung Cancer Screening Services-Figure 1By M. S. Kale, et al.



Systemic Markers of Inflammation in Smokers With Symptoms Despite Preserved

Spirometry in SPIROMICSBy S. Garudadri, et al.Prevalence of Atrial Fibrillation in Hospital Encounters With End-Stage COPD on

Home Oxygen:

National Trends in the United States

By X. Xiao, et al.

Few advanced alternative payment models plus the sunsetting bonus for participation couple to keep physician interest in value-based payment low, physician groups told the Senate Finance Committee.

Courtesy Senate Finance Committee

“One important goal of MACRA [Medicare Access and CHIP Reauthorization Act] was to provide busy physicians with a path to transition into new, innovated payment models,” Barbara McAneny, MD, president of the American Medical Association testified during a May 8 hearing to review the first 2 years of Medicare’s Quality Payment Program (QPP).

MACRA – the law that created QPP – provided a 5% bonus to physicians and other professionals who participate in the first 6 years of the program; the payment was designed to help cover expenses needed to transition to value-based care.

“Unfortunately, during the first 3 years of the program, too few APM [advanced alternative payment model] options were available for physicians, and now only 3 years remain, which is not enough time for physicians to transition to an APM,” Dr. McAneny said, calling on Congress to extend the APM incentive for an additional 6 years.

John Cullen, MD, president of the American Academy of Family Physicians, also called on legislators to extend the APM bonus for at least 3-5 years.

He also advocated for changes to QPP’s Merit-based Incentive Program (MIPS), calling for the exceptional performance bonus to reward year-over-year improvement versus simply scoring high on MIPS criteria in a given year.

MIPS “has created a burdensome and extremely complex program that has increased practice costs and is contributing to physician burnout, Dr. Cullen testified. “Understanding the requirements and scoring for each MIPS performance category and reporting the required data to CMS is a complex task and detracts from physicians’ ability to focus on patients.”

Dr. McAneny put the costs and rewards of MIPS into perspective for lawmakers.

She testified that, in 2017, her small practice was a participant in MIPS and was able to achieve the highest MIPS score of 100. That score qualified the practice for an exceptional performance bonus, which ended up being a 1.88% bonus to Medicare payments.

“After the adjustment that occurred after that, it lowered that increase to where the entire change that I got was $34,000,” she said. “When I added up how much I had to pay my EMR [electronic medical record] to submit that data, when I added up everything that I had to do in terms of paying staff overtime to make sure the data was accurate, I lost $100,000 to score that perfect score. So we need to modify that. That’s, I think, a great example of why the lower-volume practices need to be kept out of this process so they can continue to use their resources on patient care.”

Scott Hines, MD, member of the AMGA board of directors testified differently, arguing that less exclusion from participation is needed, because with around half of eligible physicians not required to participate, the pool for exceptional performance bonuses is significantly smaller than what would be the maximum available of up to 9% in 2023 as the years in the program advanced.

Between the low-volume exclusion and the budget neutrality of the program, there is little incentive to participate, he noted.

[email protected]

Few advanced alternative payment models plus the sunsetting bonus for participation couple to keep physician interest in value-based payment low, physician groups told the Senate Finance Committee.

Courtesy Senate Finance Committee

“One important goal of MACRA [Medicare Access and CHIP Reauthorization Act] was to provide busy physicians with a path to transition into new, innovated payment models,” Barbara McAneny, MD, president of the American Medical Association testified during a May 8 hearing to review the first 2 years of Medicare’s Quality Payment Program (QPP).

MACRA – the law that created QPP – provided a 5% bonus to physicians and other professionals who participate in the first 6 years of the program; the payment was designed to help cover expenses needed to transition to value-based care.

“Unfortunately, during the first 3 years of the program, too few APM [advanced alternative payment model] options were available for physicians, and now only 3 years remain, which is not enough time for physicians to transition to an APM,” Dr. McAneny said, calling on Congress to extend the APM incentive for an additional 6 years.

John Cullen, MD, president of the American Academy of Family Physicians, also called on legislators to extend the APM bonus for at least 3-5 years.

He also advocated for changes to QPP’s Merit-based Incentive Program (MIPS), calling for the exceptional performance bonus to reward year-over-year improvement versus simply scoring high on MIPS criteria in a given year.

MIPS “has created a burdensome and extremely complex program that has increased practice costs and is contributing to physician burnout, Dr. Cullen testified. “Understanding the requirements and scoring for each MIPS performance category and reporting the required data to CMS is a complex task and detracts from physicians’ ability to focus on patients.”

Dr. McAneny put the costs and rewards of MIPS into perspective for lawmakers.

She testified that, in 2017, her small practice was a participant in MIPS and was able to achieve the highest MIPS score of 100. That score qualified the practice for an exceptional performance bonus, which ended up being a 1.88% bonus to Medicare payments.

“After the adjustment that occurred after that, it lowered that increase to where the entire change that I got was $34,000,” she said. “When I added up how much I had to pay my EMR [electronic medical record] to submit that data, when I added up everything that I had to do in terms of paying staff overtime to make sure the data was accurate, I lost $100,000 to score that perfect score. So we need to modify that. That’s, I think, a great example of why the lower-volume practices need to be kept out of this process so they can continue to use their resources on patient care.”

Scott Hines, MD, member of the AMGA board of directors testified differently, arguing that less exclusion from participation is needed, because with around half of eligible physicians not required to participate, the pool for exceptional performance bonuses is significantly smaller than what would be the maximum available of up to 9% in 2023 as the years in the program advanced.

Between the low-volume exclusion and the budget neutrality of the program, there is little incentive to participate, he noted.

[email protected]

Few advanced alternative payment models plus the sunsetting bonus for participation couple to keep physician interest in value-based payment low, physician groups told the Senate Finance Committee.

Courtesy Senate Finance Committee

“One important goal of MACRA [Medicare Access and CHIP Reauthorization Act] was to provide busy physicians with a path to transition into new, innovated payment models,” Barbara McAneny, MD, president of the American Medical Association testified during a May 8 hearing to review the first 2 years of Medicare’s Quality Payment Program (QPP).

MACRA – the law that created QPP – provided a 5% bonus to physicians and other professionals who participate in the first 6 years of the program; the payment was designed to help cover expenses needed to transition to value-based care.

“Unfortunately, during the first 3 years of the program, too few APM [advanced alternative payment model] options were available for physicians, and now only 3 years remain, which is not enough time for physicians to transition to an APM,” Dr. McAneny said, calling on Congress to extend the APM incentive for an additional 6 years.

John Cullen, MD, president of the American Academy of Family Physicians, also called on legislators to extend the APM bonus for at least 3-5 years.

He also advocated for changes to QPP’s Merit-based Incentive Program (MIPS), calling for the exceptional performance bonus to reward year-over-year improvement versus simply scoring high on MIPS criteria in a given year.

MIPS “has created a burdensome and extremely complex program that has increased practice costs and is contributing to physician burnout, Dr. Cullen testified. “Understanding the requirements and scoring for each MIPS performance category and reporting the required data to CMS is a complex task and detracts from physicians’ ability to focus on patients.”

Dr. McAneny put the costs and rewards of MIPS into perspective for lawmakers.

She testified that, in 2017, her small practice was a participant in MIPS and was able to achieve the highest MIPS score of 100. That score qualified the practice for an exceptional performance bonus, which ended up being a 1.88% bonus to Medicare payments.

“After the adjustment that occurred after that, it lowered that increase to where the entire change that I got was $34,000,” she said. “When I added up how much I had to pay my EMR [electronic medical record] to submit that data, when I added up everything that I had to do in terms of paying staff overtime to make sure the data was accurate, I lost $100,000 to score that perfect score. So we need to modify that. That’s, I think, a great example of why the lower-volume practices need to be kept out of this process so they can continue to use their resources on patient care.”

Scott Hines, MD, member of the AMGA board of directors testified differently, arguing that less exclusion from participation is needed, because with around half of eligible physicians not required to participate, the pool for exceptional performance bonuses is significantly smaller than what would be the maximum available of up to 9% in 2023 as the years in the program advanced.

Between the low-volume exclusion and the budget neutrality of the program, there is little incentive to participate, he noted.

[email protected]

PHILADELPHIA – Galcanezumab reduces weekly attack frequency in patients with episodic cluster headache, according to study results presented at the annual meeting of the American Academy of Neurology. The treatment has a similar safety profile in this patient population as it has among people with episodic or chronic migraine, said the researchers.

Calcitonin gene-related peptide (CGRP) has an important role in the pathogenesis of cluster headache. Galcanezumab (Emgality)is a humanized monoclonal antibody that binds to CGRP. Eli Lilly & Co. developed the molecule as a treatment for migraine. Cluster headache is characterized by recurrent unilateral headache attacks accompanied by autonomic symptoms. The most common acute treatments for cluster headache are sumatriptan (Imitrex) and high-flow oxygen, but some patients do not respond to these therapies.

David W. Dodick, MD, director of the headache, sports neurology, and concussion programs at Mayo Clinic in Phoenix, and colleagues conducted a trial to evaluate the efficacy and safety of galcanezumab in patients with episodic cluster headache.

After screening, participants underwent a prospective baseline diary phase for 7 consecutive days. The investigators subsequently randomized patients in equal groups to galcanezumab (300 mg subcutaneously) or placebo. Treatment was administered subcutaneously once monthly. The double-blind treatment period lasted for 8 weeks, and a washout period followed. The trial’s primary endpoint was the overall mean change from baseline in weekly cluster headache attack frequency during weeks 1-3, as recorded in patient diaries. The main secondary endpoint was the proportion of patients who had a reduction in weekly cluster headache attack frequency of 50% or more at week 3.

In all, 49 patients were randomized to galcanezumab, and 57 were randomized to placebo. Mean age was 45-47 years. Between 82% and 84% of patients were male. The mean number of weekly cluster headache attacks at baseline was approximately 17.5 in both groups.

During weeks 1-3, the mean change in weekly attack frequency was −8.7 in the galcanezumab group and −5.2 for controls. The difference between groups was statistically significant. The percentage of participants with a reduction in weekly attack frequency of at least 50% at week 3 was 76% for galcanezumab versus 57% for placebo. The between-group differences in these endpoints were statistically significant.

The discontinuation rate was 8% (4 participants) in the galcanezumab group and 21% (12 participants) in the placebo group. Eight participants (14%) in the placebo group discontinued treatment because of lack of efficacy, compared with one participant (2%) in the galcanezumab group. The researchers observed no clinically meaningful differences between treatment groups on tolerability or safety parameters except for a greater incidence of injection-site pain with galcanezumab versus placebo (8.2% vs. 0%).

Eli Lilly and Co. sponsored the study. Dr. Dodick has a consulting relationship with the company.

[email protected]

SOURCE: Bardos JN et al. AAN 2019, Abstract 02.004.

PHILADELPHIA – Galcanezumab reduces weekly attack frequency in patients with episodic cluster headache, according to study results presented at the annual meeting of the American Academy of Neurology. The treatment has a similar safety profile in this patient population as it has among people with episodic or chronic migraine, said the researchers.

Calcitonin gene-related peptide (CGRP) has an important role in the pathogenesis of cluster headache. Galcanezumab (Emgality)is a humanized monoclonal antibody that binds to CGRP. Eli Lilly & Co. developed the molecule as a treatment for migraine. Cluster headache is characterized by recurrent unilateral headache attacks accompanied by autonomic symptoms. The most common acute treatments for cluster headache are sumatriptan (Imitrex) and high-flow oxygen, but some patients do not respond to these therapies.

David W. Dodick, MD, director of the headache, sports neurology, and concussion programs at Mayo Clinic in Phoenix, and colleagues conducted a trial to evaluate the efficacy and safety of galcanezumab in patients with episodic cluster headache.

After screening, participants underwent a prospective baseline diary phase for 7 consecutive days. The investigators subsequently randomized patients in equal groups to galcanezumab (300 mg subcutaneously) or placebo. Treatment was administered subcutaneously once monthly. The double-blind treatment period lasted for 8 weeks, and a washout period followed. The trial’s primary endpoint was the overall mean change from baseline in weekly cluster headache attack frequency during weeks 1-3, as recorded in patient diaries. The main secondary endpoint was the proportion of patients who had a reduction in weekly cluster headache attack frequency of 50% or more at week 3.

In all, 49 patients were randomized to galcanezumab, and 57 were randomized to placebo. Mean age was 45-47 years. Between 82% and 84% of patients were male. The mean number of weekly cluster headache attacks at baseline was approximately 17.5 in both groups.

During weeks 1-3, the mean change in weekly attack frequency was −8.7 in the galcanezumab group and −5.2 for controls. The difference between groups was statistically significant. The percentage of participants with a reduction in weekly attack frequency of at least 50% at week 3 was 76% for galcanezumab versus 57% for placebo. The between-group differences in these endpoints were statistically significant.

The discontinuation rate was 8% (4 participants) in the galcanezumab group and 21% (12 participants) in the placebo group. Eight participants (14%) in the placebo group discontinued treatment because of lack of efficacy, compared with one participant (2%) in the galcanezumab group. The researchers observed no clinically meaningful differences between treatment groups on tolerability or safety parameters except for a greater incidence of injection-site pain with galcanezumab versus placebo (8.2% vs. 0%).

Eli Lilly and Co. sponsored the study. Dr. Dodick has a consulting relationship with the company.

[email protected]

SOURCE: Bardos JN et al. AAN 2019, Abstract 02.004.

PHILADELPHIA – Galcanezumab reduces weekly attack frequency in patients with episodic cluster headache, according to study results presented at the annual meeting of the American Academy of Neurology. The treatment has a similar safety profile in this patient population as it has among people with episodic or chronic migraine, said the researchers.

Calcitonin gene-related peptide (CGRP) has an important role in the pathogenesis of cluster headache. Galcanezumab (Emgality)is a humanized monoclonal antibody that binds to CGRP. Eli Lilly & Co. developed the molecule as a treatment for migraine. Cluster headache is characterized by recurrent unilateral headache attacks accompanied by autonomic symptoms. The most common acute treatments for cluster headache are sumatriptan (Imitrex) and high-flow oxygen, but some patients do not respond to these therapies.

David W. Dodick, MD, director of the headache, sports neurology, and concussion programs at Mayo Clinic in Phoenix, and colleagues conducted a trial to evaluate the efficacy and safety of galcanezumab in patients with episodic cluster headache.

After screening, participants underwent a prospective baseline diary phase for 7 consecutive days. The investigators subsequently randomized patients in equal groups to galcanezumab (300 mg subcutaneously) or placebo. Treatment was administered subcutaneously once monthly. The double-blind treatment period lasted for 8 weeks, and a washout period followed. The trial’s primary endpoint was the overall mean change from baseline in weekly cluster headache attack frequency during weeks 1-3, as recorded in patient diaries. The main secondary endpoint was the proportion of patients who had a reduction in weekly cluster headache attack frequency of 50% or more at week 3.

In all, 49 patients were randomized to galcanezumab, and 57 were randomized to placebo. Mean age was 45-47 years. Between 82% and 84% of patients were male. The mean number of weekly cluster headache attacks at baseline was approximately 17.5 in both groups.

During weeks 1-3, the mean change in weekly attack frequency was −8.7 in the galcanezumab group and −5.2 for controls. The difference between groups was statistically significant. The percentage of participants with a reduction in weekly attack frequency of at least 50% at week 3 was 76% for galcanezumab versus 57% for placebo. The between-group differences in these endpoints were statistically significant.

The discontinuation rate was 8% (4 participants) in the galcanezumab group and 21% (12 participants) in the placebo group. Eight participants (14%) in the placebo group discontinued treatment because of lack of efficacy, compared with one participant (2%) in the galcanezumab group. The researchers observed no clinically meaningful differences between treatment groups on tolerability or safety parameters except for a greater incidence of injection-site pain with galcanezumab versus placebo (8.2% vs. 0%).

Eli Lilly and Co. sponsored the study. Dr. Dodick has a consulting relationship with the company.

[email protected]

SOURCE: Bardos JN et al. AAN 2019, Abstract 02.004.

“Maximal” application of four different sunscreen formulations resulted in plasma concentrations of ingredients that exceeded the Food and Drug Administration’s threshold for waiving nonclinical toxicology studies for sunscreens, in a phase 1 randomized controlled study of 24 healthy volunteers.

Wavebreakmedia Ltd/Thinkstock

In the open-label study, 24 people (mean age 35.5 years) were randomized to one of four commercially available sunscreens (two sprays, one lotion, or one cream formulation); 2 mg of sunscreen per 1 cm² was applied to 75% of their body surface four times a day for 4 days (described as “maximal use conditions consistent with current sunscreen labeling”), and 30 blood samples were collected over 7 days.

The primary outcome was the maximum plasma concentration of avobenzone, from days 1-7; secondary outcomes were maximum plasma concentrations of sunscreen ingredients oxybenzone, octocrylene, and ecamsule over the same period of time.

All but one participant completed the study. “All four sunscreen active ingredients tested resulted in exposures exceeding 0.5 ng/mL,” reported Murali Matta, PhD, of the FDA’s Center for Drug Evaluation and Research, and coauthors. “The clinical effect of plasma concentrations exceeding 0.5 ng/mL is unknown, necessitating further research,” they added.

According to the study, FDA sunscreen guidance and the proposed rule for over-the-counter sunscreen monograph, nonclinical toxicology studies, such as carcinogenicity and reproductive studies, “may be waived if results of an adequately conducted human pharmacokinetic maximal usage trial show a steady state blood level less than 0.5 ng/mL and an adequately conducted toxicology assessment does not reveal any potential safety concerns.”

The results of this study “do not indicate that individuals should refrain from the use of sunscreen,” the authors concluded, adding that the “systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings.” The study was published in JAMA.

In an accompanying editorial, former FDA commissioner Robert Califf, MD, professor of cardiology, Duke University, Durham, N.C., and JAMA Dermatology Editor Kanade Shinkai, MD, PhD, of the department of dermatology, University of California, San Francisco, noted that “the demonstration of systemic absorption well above the FDA guideline does not mean these ingredients are unsafe” (JAMA. 2019 May 6. doi: 10.1001/jama.2019.5528). But, they added, the results “raise many important questions about sunscreen and the process by which the sunscreen industry, clinicians, specialty organizations, and regulatory agencies evaluate the benefits and risks of this topical OTC medication. First and foremost, it is essential to determine whether systemic absorption of sunscreen poses risks to human health. Second, the effects of different sunscreen formulations, clinical characteristics (that is, skin type, age, presence of skin diseases that disrupt the skin barrier), physical activity level, and exposure to sun and water on systemic sunscreen levels require further study.”

In a statement, former American Academy of Dermatology President Darrel Rigel, MD, of the department of dermatology, New York University, said that he was concerned that the results were misleading. “We have always known that there is a very small amount of absorption of sunscreens in the bloodstream,” and there are no data that this is a problem, he said, adding: “Tens of millions of people use sunscreens in the U.S. every summer weekend for many years with no incidence. Daily use of a broad-spectrum SPF of at least 30 is the best way to protect yourself from skin cancer. For many people, the chemical formulations cited in the study are the only ones that feel cosmetically elegant enough to wear. Consumers should continue to use their preferred formulation if it means they will actually wear it.”

[email protected]

SOURCE: JAMA. 2019 May 6. doi: 10.1001/jama.2019.5586

“Maximal” application of four different sunscreen formulations resulted in plasma concentrations of ingredients that exceeded the Food and Drug Administration’s threshold for waiving nonclinical toxicology studies for sunscreens, in a phase 1 randomized controlled study of 24 healthy volunteers.

Wavebreakmedia Ltd/Thinkstock

In the open-label study, 24 people (mean age 35.5 years) were randomized to one of four commercially available sunscreens (two sprays, one lotion, or one cream formulation); 2 mg of sunscreen per 1 cm² was applied to 75% of their body surface four times a day for 4 days (described as “maximal use conditions consistent with current sunscreen labeling”), and 30 blood samples were collected over 7 days.

The primary outcome was the maximum plasma concentration of avobenzone, from days 1-7; secondary outcomes were maximum plasma concentrations of sunscreen ingredients oxybenzone, octocrylene, and ecamsule over the same period of time.

All but one participant completed the study. “All four sunscreen active ingredients tested resulted in exposures exceeding 0.5 ng/mL,” reported Murali Matta, PhD, of the FDA’s Center for Drug Evaluation and Research, and coauthors. “The clinical effect of plasma concentrations exceeding 0.5 ng/mL is unknown, necessitating further research,” they added.

According to the study, FDA sunscreen guidance and the proposed rule for over-the-counter sunscreen monograph, nonclinical toxicology studies, such as carcinogenicity and reproductive studies, “may be waived if results of an adequately conducted human pharmacokinetic maximal usage trial show a steady state blood level less than 0.5 ng/mL and an adequately conducted toxicology assessment does not reveal any potential safety concerns.”

The results of this study “do not indicate that individuals should refrain from the use of sunscreen,” the authors concluded, adding that the “systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings.” The study was published in JAMA.

In an accompanying editorial, former FDA commissioner Robert Califf, MD, professor of cardiology, Duke University, Durham, N.C., and JAMA Dermatology Editor Kanade Shinkai, MD, PhD, of the department of dermatology, University of California, San Francisco, noted that “the demonstration of systemic absorption well above the FDA guideline does not mean these ingredients are unsafe” (JAMA. 2019 May 6. doi: 10.1001/jama.2019.5528). But, they added, the results “raise many important questions about sunscreen and the process by which the sunscreen industry, clinicians, specialty organizations, and regulatory agencies evaluate the benefits and risks of this topical OTC medication. First and foremost, it is essential to determine whether systemic absorption of sunscreen poses risks to human health. Second, the effects of different sunscreen formulations, clinical characteristics (that is, skin type, age, presence of skin diseases that disrupt the skin barrier), physical activity level, and exposure to sun and water on systemic sunscreen levels require further study.”

In a statement, former American Academy of Dermatology President Darrel Rigel, MD, of the department of dermatology, New York University, said that he was concerned that the results were misleading. “We have always known that there is a very small amount of absorption of sunscreens in the bloodstream,” and there are no data that this is a problem, he said, adding: “Tens of millions of people use sunscreens in the U.S. every summer weekend for many years with no incidence. Daily use of a broad-spectrum SPF of at least 30 is the best way to protect yourself from skin cancer. For many people, the chemical formulations cited in the study are the only ones that feel cosmetically elegant enough to wear. Consumers should continue to use their preferred formulation if it means they will actually wear it.”

[email protected]

SOURCE: JAMA. 2019 May 6. doi: 10.1001/jama.2019.5586

“Maximal” application of four different sunscreen formulations resulted in plasma concentrations of ingredients that exceeded the Food and Drug Administration’s threshold for waiving nonclinical toxicology studies for sunscreens, in a phase 1 randomized controlled study of 24 healthy volunteers.

Wavebreakmedia Ltd/Thinkstock

In the open-label study, 24 people (mean age 35.5 years) were randomized to one of four commercially available sunscreens (two sprays, one lotion, or one cream formulation); 2 mg of sunscreen per 1 cm² was applied to 75% of their body surface four times a day for 4 days (described as “maximal use conditions consistent with current sunscreen labeling”), and 30 blood samples were collected over 7 days.

The primary outcome was the maximum plasma concentration of avobenzone, from days 1-7; secondary outcomes were maximum plasma concentrations of sunscreen ingredients oxybenzone, octocrylene, and ecamsule over the same period of time.

All but one participant completed the study. “All four sunscreen active ingredients tested resulted in exposures exceeding 0.5 ng/mL,” reported Murali Matta, PhD, of the FDA’s Center for Drug Evaluation and Research, and coauthors. “The clinical effect of plasma concentrations exceeding 0.5 ng/mL is unknown, necessitating further research,” they added.

According to the study, FDA sunscreen guidance and the proposed rule for over-the-counter sunscreen monograph, nonclinical toxicology studies, such as carcinogenicity and reproductive studies, “may be waived if results of an adequately conducted human pharmacokinetic maximal usage trial show a steady state blood level less than 0.5 ng/mL and an adequately conducted toxicology assessment does not reveal any potential safety concerns.”

The results of this study “do not indicate that individuals should refrain from the use of sunscreen,” the authors concluded, adding that the “systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings.” The study was published in JAMA.

In an accompanying editorial, former FDA commissioner Robert Califf, MD, professor of cardiology, Duke University, Durham, N.C., and JAMA Dermatology Editor Kanade Shinkai, MD, PhD, of the department of dermatology, University of California, San Francisco, noted that “the demonstration of systemic absorption well above the FDA guideline does not mean these ingredients are unsafe” (JAMA. 2019 May 6. doi: 10.1001/jama.2019.5528). But, they added, the results “raise many important questions about sunscreen and the process by which the sunscreen industry, clinicians, specialty organizations, and regulatory agencies evaluate the benefits and risks of this topical OTC medication. First and foremost, it is essential to determine whether systemic absorption of sunscreen poses risks to human health. Second, the effects of different sunscreen formulations, clinical characteristics (that is, skin type, age, presence of skin diseases that disrupt the skin barrier), physical activity level, and exposure to sun and water on systemic sunscreen levels require further study.”

In a statement, former American Academy of Dermatology President Darrel Rigel, MD, of the department of dermatology, New York University, said that he was concerned that the results were misleading. “We have always known that there is a very small amount of absorption of sunscreens in the bloodstream,” and there are no data that this is a problem, he said, adding: “Tens of millions of people use sunscreens in the U.S. every summer weekend for many years with no incidence. Daily use of a broad-spectrum SPF of at least 30 is the best way to protect yourself from skin cancer. For many people, the chemical formulations cited in the study are the only ones that feel cosmetically elegant enough to wear. Consumers should continue to use their preferred formulation if it means they will actually wear it.”

[email protected]

SOURCE: JAMA. 2019 May 6. doi: 10.1001/jama.2019.5586

NASHVILLE, TENN. – The unintended pregnancy rate is declining after years of hovering at close to 50%.

While the rates among women of color remain high – currently at 58 and 79 per 1,000 women aged 15-44 years for Hispanic and black women, respectively – they have declined from 79 and 92 per 1,000 Hispanic and black women in that age group in 2008, and the overall rate is now at about 45%, Eve Espey, MD, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Considering the scope and number of women affected by unplanned pregnancy, this is actually a huge public health achievement,” said Dr. Espey, professor and chair of the department of obstetrics & gynecology at the University of New Mexico, Albuquerque.

The declines in unintended pregnancies are largely attributable to “better and more consistent use of contraceptives, and, interestingly, increased abstinence,” she noted, adding that “another enormous determinant of this decrease in unintended pregnancy is the use of long-acting reversible contraception [LARC].” About 2% of women used contraceptives in 2002, and now, based on the latest cycle of data from 2015-2017, 16% of women use contraceptives.

In this video interview, Dr. Espey discusses the main points of her talk entitled “Contraceptives: What you need to know in 2019,” including:

• The importance of “following reproductive justice–based principles and counseling” when it comes to prescribing contraceptives.
• The latest data showing that certain LARC methods remain safe and effective beyond their approved duration of use.
• Trends with respect to tubal ligation and salpingectomy.
• The value of the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria (MEC) for evidence-based guidance on selecting contraceptives based on patients’ individual needs.

“[MEC] is something every ob.gyn. should consider using,” she said, noting that access is available through a free app. “As our patients are more complex and have more comorbidities, it’s particularly helpful for matching up patients and their conditions with recommendations for specific contraceptive methods.”

Dr. Espey reported having no financial disclosures.

[email protected]

NASHVILLE, TENN. – The unintended pregnancy rate is declining after years of hovering at close to 50%.

While the rates among women of color remain high – currently at 58 and 79 per 1,000 women aged 15-44 years for Hispanic and black women, respectively – they have declined from 79 and 92 per 1,000 Hispanic and black women in that age group in 2008, and the overall rate is now at about 45%, Eve Espey, MD, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Considering the scope and number of women affected by unplanned pregnancy, this is actually a huge public health achievement,” said Dr. Espey, professor and chair of the department of obstetrics & gynecology at the University of New Mexico, Albuquerque.

The declines in unintended pregnancies are largely attributable to “better and more consistent use of contraceptives, and, interestingly, increased abstinence,” she noted, adding that “another enormous determinant of this decrease in unintended pregnancy is the use of long-acting reversible contraception [LARC].” About 2% of women used contraceptives in 2002, and now, based on the latest cycle of data from 2015-2017, 16% of women use contraceptives.

In this video interview, Dr. Espey discusses the main points of her talk entitled “Contraceptives: What you need to know in 2019,” including:

• The importance of “following reproductive justice–based principles and counseling” when it comes to prescribing contraceptives.
• The latest data showing that certain LARC methods remain safe and effective beyond their approved duration of use.
• Trends with respect to tubal ligation and salpingectomy.
• The value of the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria (MEC) for evidence-based guidance on selecting contraceptives based on patients’ individual needs.

“[MEC] is something every ob.gyn. should consider using,” she said, noting that access is available through a free app. “As our patients are more complex and have more comorbidities, it’s particularly helpful for matching up patients and their conditions with recommendations for specific contraceptive methods.”

Dr. Espey reported having no financial disclosures.

[email protected]

NASHVILLE, TENN. – The unintended pregnancy rate is declining after years of hovering at close to 50%.

While the rates among women of color remain high – currently at 58 and 79 per 1,000 women aged 15-44 years for Hispanic and black women, respectively – they have declined from 79 and 92 per 1,000 Hispanic and black women in that age group in 2008, and the overall rate is now at about 45%, Eve Espey, MD, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Considering the scope and number of women affected by unplanned pregnancy, this is actually a huge public health achievement,” said Dr. Espey, professor and chair of the department of obstetrics & gynecology at the University of New Mexico, Albuquerque.

The declines in unintended pregnancies are largely attributable to “better and more consistent use of contraceptives, and, interestingly, increased abstinence,” she noted, adding that “another enormous determinant of this decrease in unintended pregnancy is the use of long-acting reversible contraception [LARC].” About 2% of women used contraceptives in 2002, and now, based on the latest cycle of data from 2015-2017, 16% of women use contraceptives.

In this video interview, Dr. Espey discusses the main points of her talk entitled “Contraceptives: What you need to know in 2019,” including:

• The importance of “following reproductive justice–based principles and counseling” when it comes to prescribing contraceptives.
• The latest data showing that certain LARC methods remain safe and effective beyond their approved duration of use.
• Trends with respect to tubal ligation and salpingectomy.
• The value of the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria (MEC) for evidence-based guidance on selecting contraceptives based on patients’ individual needs.

“[MEC] is something every ob.gyn. should consider using,” she said, noting that access is available through a free app. “As our patients are more complex and have more comorbidities, it’s particularly helpful for matching up patients and their conditions with recommendations for specific contraceptive methods.”

Dr. Espey reported having no financial disclosures.

[email protected]

Former athletes with a history of concussion averaged higher levels of total tau in their cerebrospinal fluid than did healthy controls, and those with the highest levels showed signs of reduced cognitive function in a case-control study.

solar22/Thinkstock

Chronic traumatic encephalopathy (CTE) remains a postmortem diagnosis, but “the potential for treating postconcussion degeneration such as CTE depends on being able to detect the in vivo pathology at an early stage to intervene before the disease progresses to an irreversible stage,” wrote Foad Taghdiri, MD, of the University of Toronto and colleagues.

In a study published in Neurology, the researchers measured concentrations of phosphorylated tau181, total tau (t-tau), and beta-amyloid in the cerebrospinal fluid (CSF) of three groups: 22 former professional athletes who had suffered multiple concussions, 5 healthy controls, and 12 individuals diagnosed with Alzheimer’s disease (AD). The average ages of the groups were 56 years, 57 years, and 60 years, respectively. All the athletes were male, and their sports included snowboarding, hockey, and football.

The average t-tau level in the CSF of the athletes was significantly higher than that of controls (349.3 pg/mL vs. 188.8 pg/mL) and significantly lower than that of AD patients (857.0 pg/mL).

Normal CSF t-tau was defined as 300 pg/mL, and 12 former athletes (45%) had high t-tau levels, with an average of 499.3 pg/mL. In this group of high t-tau former athletes, the average score on the Trail Making Test (TMT) Part B was significantly lower than the average score among the 10 former athletes with normal CSF t-tau levels (t scores 45.6 vs. 62.3; P = .017).

In addition, results from MRI scans showed that fractional anisotropy values across all the tracts were significantly lower for those with high CSF t-tau levels, compared with those who had normal CSF t-tau levels (P = .036).

The findings were limited by several factors, including the small sample size, lack of female athletes, and limited ability to compare white matter integrity between high and normal CSF t-tau groups, the researchers noted.

However, the results suggest that “multiple concussive or subconcussive events may trigger neurodegeneration to a greater degree than expected on the basis of age alone,” they said. Although the study did not allow for diagnosing the participants with CTE, “we are engaged in longitudinal studies to track neurologic and neuropsychological function, CSF biomarkers, and structural brain changes over time to further assess the delayed effects of multiple concussions on the brain,” the researchers wrote.

The study was funded by the Toronto General and Western Hospital Foundation, PSI Foundation, and the Canadian Institute of Health Research. The researchers had no financial conflicts to disclose.

SOURCE: Taghdiri F et al. Neurology. 2019 May 8. doi: 10.1212/WNL.0000000000007608

Former athletes with a history of concussion averaged higher levels of total tau in their cerebrospinal fluid than did healthy controls, and those with the highest levels showed signs of reduced cognitive function in a case-control study.

solar22/Thinkstock

Chronic traumatic encephalopathy (CTE) remains a postmortem diagnosis, but “the potential for treating postconcussion degeneration such as CTE depends on being able to detect the in vivo pathology at an early stage to intervene before the disease progresses to an irreversible stage,” wrote Foad Taghdiri, MD, of the University of Toronto and colleagues.

In a study published in Neurology, the researchers measured concentrations of phosphorylated tau181, total tau (t-tau), and beta-amyloid in the cerebrospinal fluid (CSF) of three groups: 22 former professional athletes who had suffered multiple concussions, 5 healthy controls, and 12 individuals diagnosed with Alzheimer’s disease (AD). The average ages of the groups were 56 years, 57 years, and 60 years, respectively. All the athletes were male, and their sports included snowboarding, hockey, and football.

The average t-tau level in the CSF of the athletes was significantly higher than that of controls (349.3 pg/mL vs. 188.8 pg/mL) and significantly lower than that of AD patients (857.0 pg/mL).

Normal CSF t-tau was defined as 300 pg/mL, and 12 former athletes (45%) had high t-tau levels, with an average of 499.3 pg/mL. In this group of high t-tau former athletes, the average score on the Trail Making Test (TMT) Part B was significantly lower than the average score among the 10 former athletes with normal CSF t-tau levels (t scores 45.6 vs. 62.3; P = .017).

In addition, results from MRI scans showed that fractional anisotropy values across all the tracts were significantly lower for those with high CSF t-tau levels, compared with those who had normal CSF t-tau levels (P = .036).

The findings were limited by several factors, including the small sample size, lack of female athletes, and limited ability to compare white matter integrity between high and normal CSF t-tau groups, the researchers noted.

However, the results suggest that “multiple concussive or subconcussive events may trigger neurodegeneration to a greater degree than expected on the basis of age alone,” they said. Although the study did not allow for diagnosing the participants with CTE, “we are engaged in longitudinal studies to track neurologic and neuropsychological function, CSF biomarkers, and structural brain changes over time to further assess the delayed effects of multiple concussions on the brain,” the researchers wrote.

The study was funded by the Toronto General and Western Hospital Foundation, PSI Foundation, and the Canadian Institute of Health Research. The researchers had no financial conflicts to disclose.

SOURCE: Taghdiri F et al. Neurology. 2019 May 8. doi: 10.1212/WNL.0000000000007608

Former athletes with a history of concussion averaged higher levels of total tau in their cerebrospinal fluid than did healthy controls, and those with the highest levels showed signs of reduced cognitive function in a case-control study.

solar22/Thinkstock

Chronic traumatic encephalopathy (CTE) remains a postmortem diagnosis, but “the potential for treating postconcussion degeneration such as CTE depends on being able to detect the in vivo pathology at an early stage to intervene before the disease progresses to an irreversible stage,” wrote Foad Taghdiri, MD, of the University of Toronto and colleagues.

In a study published in Neurology, the researchers measured concentrations of phosphorylated tau181, total tau (t-tau), and beta-amyloid in the cerebrospinal fluid (CSF) of three groups: 22 former professional athletes who had suffered multiple concussions, 5 healthy controls, and 12 individuals diagnosed with Alzheimer’s disease (AD). The average ages of the groups were 56 years, 57 years, and 60 years, respectively. All the athletes were male, and their sports included snowboarding, hockey, and football.

The average t-tau level in the CSF of the athletes was significantly higher than that of controls (349.3 pg/mL vs. 188.8 pg/mL) and significantly lower than that of AD patients (857.0 pg/mL).

Normal CSF t-tau was defined as 300 pg/mL, and 12 former athletes (45%) had high t-tau levels, with an average of 499.3 pg/mL. In this group of high t-tau former athletes, the average score on the Trail Making Test (TMT) Part B was significantly lower than the average score among the 10 former athletes with normal CSF t-tau levels (t scores 45.6 vs. 62.3; P = .017).

In addition, results from MRI scans showed that fractional anisotropy values across all the tracts were significantly lower for those with high CSF t-tau levels, compared with those who had normal CSF t-tau levels (P = .036).

The findings were limited by several factors, including the small sample size, lack of female athletes, and limited ability to compare white matter integrity between high and normal CSF t-tau groups, the researchers noted.

However, the results suggest that “multiple concussive or subconcussive events may trigger neurodegeneration to a greater degree than expected on the basis of age alone,” they said. Although the study did not allow for diagnosing the participants with CTE, “we are engaged in longitudinal studies to track neurologic and neuropsychological function, CSF biomarkers, and structural brain changes over time to further assess the delayed effects of multiple concussions on the brain,” the researchers wrote.

The study was funded by the Toronto General and Western Hospital Foundation, PSI Foundation, and the Canadian Institute of Health Research. The researchers had no financial conflicts to disclose.

SOURCE: Taghdiri F et al. Neurology. 2019 May 8. doi: 10.1212/WNL.0000000000007608

NASHVILLE, TENN. – By 2020, millennials will comprise more than a third of individuals in the workplace, and that has important implications for employment, communication, and education, according to Patrice M. Weiss, MD.

Each generation brings a unique set of experiences and expectations. Millennials – or members of “Generation Y,” who comprised 18% of the workforce in 2018 and 0% in 2008 – tend to prefer flexible work hours and communication via technology, she said during a session on navigating generational differences in the workplace during the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

They, along with members of “Generation X” (generally those born between 1962 and 1981) and “Generation Z” (generally those born from 1987 on), tend to be technology savvy, whereas the “Silent Generation” (generally those born between 1925 and 1942) and older members of the “Baby Boomer Generation” (generally those born between 1943 and 1961), may prefer printed communication and phone calls, said Dr. Weiss, chief medical officer at the Carilion Clinic in Roanoke, Va.

“It’s not good, it’s not bad – it’s just the way things are changing,” she said, adding that it’s important to look at the strengths that each generation brings to the workplace.

Importantly, the generational differences also affect patient expectations and therefore should guide physician-patient interactions, she said.

In this video interview, she further discusses how generational differences should be considered in medical practice, and how clinicians can adapt to the changing expectations and different needs of patients from different generations.

“Gen Ys want to communicate with us through technology. They don’t want to pick up the phone and schedule an appointment, they want to be able to go online ... through an app and self-schedule an appointment,” she said. “And they want health care when they want it.

“We as health care providers and health care organizations, we need to meet the needs of each generation ... so what we need to do is really identify what are the needs of all the generations as patients.”

During her presentation, Dr. Weiss further noted that these generational differences present a major challenge with respect to teaching, learning, and communicating.

“Rather than becoming frustrated ... let’s hope that we can ... reach across generations, identify what their strengths are, capitalize on those, and then, as health care providers, be more user and consumer friendly to the generations, particularly the millennials [so] that they have access to us and to information.”

Dr. Weiss said she had no relevant financial disclosures.

[email protected]

NASHVILLE, TENN. – By 2020, millennials will comprise more than a third of individuals in the workplace, and that has important implications for employment, communication, and education, according to Patrice M. Weiss, MD.

Each generation brings a unique set of experiences and expectations. Millennials – or members of “Generation Y,” who comprised 18% of the workforce in 2018 and 0% in 2008 – tend to prefer flexible work hours and communication via technology, she said during a session on navigating generational differences in the workplace during the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

They, along with members of “Generation X” (generally those born between 1962 and 1981) and “Generation Z” (generally those born from 1987 on), tend to be technology savvy, whereas the “Silent Generation” (generally those born between 1925 and 1942) and older members of the “Baby Boomer Generation” (generally those born between 1943 and 1961), may prefer printed communication and phone calls, said Dr. Weiss, chief medical officer at the Carilion Clinic in Roanoke, Va.

“It’s not good, it’s not bad – it’s just the way things are changing,” she said, adding that it’s important to look at the strengths that each generation brings to the workplace.

Importantly, the generational differences also affect patient expectations and therefore should guide physician-patient interactions, she said.

In this video interview, she further discusses how generational differences should be considered in medical practice, and how clinicians can adapt to the changing expectations and different needs of patients from different generations.

“Gen Ys want to communicate with us through technology. They don’t want to pick up the phone and schedule an appointment, they want to be able to go online ... through an app and self-schedule an appointment,” she said. “And they want health care when they want it.

“We as health care providers and health care organizations, we need to meet the needs of each generation ... so what we need to do is really identify what are the needs of all the generations as patients.”

During her presentation, Dr. Weiss further noted that these generational differences present a major challenge with respect to teaching, learning, and communicating.

“Rather than becoming frustrated ... let’s hope that we can ... reach across generations, identify what their strengths are, capitalize on those, and then, as health care providers, be more user and consumer friendly to the generations, particularly the millennials [so] that they have access to us and to information.”

Dr. Weiss said she had no relevant financial disclosures.

[email protected]

NASHVILLE, TENN. – By 2020, millennials will comprise more than a third of individuals in the workplace, and that has important implications for employment, communication, and education, according to Patrice M. Weiss, MD.

Each generation brings a unique set of experiences and expectations. Millennials – or members of “Generation Y,” who comprised 18% of the workforce in 2018 and 0% in 2008 – tend to prefer flexible work hours and communication via technology, she said during a session on navigating generational differences in the workplace during the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

They, along with members of “Generation X” (generally those born between 1962 and 1981) and “Generation Z” (generally those born from 1987 on), tend to be technology savvy, whereas the “Silent Generation” (generally those born between 1925 and 1942) and older members of the “Baby Boomer Generation” (generally those born between 1943 and 1961), may prefer printed communication and phone calls, said Dr. Weiss, chief medical officer at the Carilion Clinic in Roanoke, Va.

“It’s not good, it’s not bad – it’s just the way things are changing,” she said, adding that it’s important to look at the strengths that each generation brings to the workplace.

Importantly, the generational differences also affect patient expectations and therefore should guide physician-patient interactions, she said.

In this video interview, she further discusses how generational differences should be considered in medical practice, and how clinicians can adapt to the changing expectations and different needs of patients from different generations.

“Gen Ys want to communicate with us through technology. They don’t want to pick up the phone and schedule an appointment, they want to be able to go online ... through an app and self-schedule an appointment,” she said. “And they want health care when they want it.

“We as health care providers and health care organizations, we need to meet the needs of each generation ... so what we need to do is really identify what are the needs of all the generations as patients.”

During her presentation, Dr. Weiss further noted that these generational differences present a major challenge with respect to teaching, learning, and communicating.

“Rather than becoming frustrated ... let’s hope that we can ... reach across generations, identify what their strengths are, capitalize on those, and then, as health care providers, be more user and consumer friendly to the generations, particularly the millennials [so] that they have access to us and to information.”

Dr. Weiss said she had no relevant financial disclosures.

[email protected]

NASHVILLE, TENN. – The decision regarding medical versus surgical management of second trimester fetal demise is one that should be shared between the physician and patient, according to Sara W. Prager, MD.

Information transfer between the physician and patient, as opposed to a provider-driven or patient-driven decision-making process, better ensures that “the best possible decision” will be reached, Dr. Prager, director of the family planning division and family planning fellowship at the University of Washington in Seattle, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Engaging the patient in the process – actively involving and supporting her in health care and treatment decision-making activities – is critically important, especially when dealing with pregnancy loss, which involves an acute sense of powerlessness, she said. Patient engagement is essential for respecting her autonomy, enhancing her agency, improving health status, reducing decisional conflict, and improving overall satisfaction.

Shared decision making requires a discussion about how the two approaches compare, particularly with respect to specific complications associated with each, Dr. Prager said, noting that discussion of values also should be encouraged.

Although surgical management is used more often, both approaches are safe and effective, and in the absence of clear contraindications in settings where both medication and a practitioner skilled in dilatation and evacuation are available, patient preference should honored, she said.

In this video interview, Dr. Prager further explains her position. “Using evidence-based medicine to have a shared decision-making process ... is extremely helpful for patients to feel like they have some control in this out-of-control situation where they’re experiencing a pregnancy loss.”

She also discussed how the use of mifepristone plus misoprostol for medical management of second-trimester loss has the potential to improve access.

“This is medication that, because of stigma surrounding abortion, is not always available ... so actually using it for non–abortion-related activities can be a way to help reduce that stigma around the medication itself, and get it into clinical sites, because it really does meaningfully improve management in the second trimester, as well as in the first trimester.”

In fact, the combination can cut nearly in half the amount of time it takes from the start of an induction until the end of the induction process, she said.

Dr. Prager also discussed surgical training resources and how to advocate for patient access to family planning experts who have the appropriate training.

Dr. Prager said she had no relevant financial disclosures.

[email protected]

NASHVILLE, TENN. – The decision regarding medical versus surgical management of second trimester fetal demise is one that should be shared between the physician and patient, according to Sara W. Prager, MD.

Information transfer between the physician and patient, as opposed to a provider-driven or patient-driven decision-making process, better ensures that “the best possible decision” will be reached, Dr. Prager, director of the family planning division and family planning fellowship at the University of Washington in Seattle, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Engaging the patient in the process – actively involving and supporting her in health care and treatment decision-making activities – is critically important, especially when dealing with pregnancy loss, which involves an acute sense of powerlessness, she said. Patient engagement is essential for respecting her autonomy, enhancing her agency, improving health status, reducing decisional conflict, and improving overall satisfaction.

Shared decision making requires a discussion about how the two approaches compare, particularly with respect to specific complications associated with each, Dr. Prager said, noting that discussion of values also should be encouraged.

Although surgical management is used more often, both approaches are safe and effective, and in the absence of clear contraindications in settings where both medication and a practitioner skilled in dilatation and evacuation are available, patient preference should honored, she said.

In this video interview, Dr. Prager further explains her position. “Using evidence-based medicine to have a shared decision-making process ... is extremely helpful for patients to feel like they have some control in this out-of-control situation where they’re experiencing a pregnancy loss.”

She also discussed how the use of mifepristone plus misoprostol for medical management of second-trimester loss has the potential to improve access.

“This is medication that, because of stigma surrounding abortion, is not always available ... so actually using it for non–abortion-related activities can be a way to help reduce that stigma around the medication itself, and get it into clinical sites, because it really does meaningfully improve management in the second trimester, as well as in the first trimester.”

In fact, the combination can cut nearly in half the amount of time it takes from the start of an induction until the end of the induction process, she said.

Dr. Prager also discussed surgical training resources and how to advocate for patient access to family planning experts who have the appropriate training.

Dr. Prager said she had no relevant financial disclosures.

[email protected]

NASHVILLE, TENN. – The decision regarding medical versus surgical management of second trimester fetal demise is one that should be shared between the physician and patient, according to Sara W. Prager, MD.

Information transfer between the physician and patient, as opposed to a provider-driven or patient-driven decision-making process, better ensures that “the best possible decision” will be reached, Dr. Prager, director of the family planning division and family planning fellowship at the University of Washington in Seattle, said at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Engaging the patient in the process – actively involving and supporting her in health care and treatment decision-making activities – is critically important, especially when dealing with pregnancy loss, which involves an acute sense of powerlessness, she said. Patient engagement is essential for respecting her autonomy, enhancing her agency, improving health status, reducing decisional conflict, and improving overall satisfaction.

Shared decision making requires a discussion about how the two approaches compare, particularly with respect to specific complications associated with each, Dr. Prager said, noting that discussion of values also should be encouraged.

Although surgical management is used more often, both approaches are safe and effective, and in the absence of clear contraindications in settings where both medication and a practitioner skilled in dilatation and evacuation are available, patient preference should honored, she said.

In this video interview, Dr. Prager further explains her position. “Using evidence-based medicine to have a shared decision-making process ... is extremely helpful for patients to feel like they have some control in this out-of-control situation where they’re experiencing a pregnancy loss.”

She also discussed how the use of mifepristone plus misoprostol for medical management of second-trimester loss has the potential to improve access.

“This is medication that, because of stigma surrounding abortion, is not always available ... so actually using it for non–abortion-related activities can be a way to help reduce that stigma around the medication itself, and get it into clinical sites, because it really does meaningfully improve management in the second trimester, as well as in the first trimester.”

In fact, the combination can cut nearly in half the amount of time it takes from the start of an induction until the end of the induction process, she said.

Dr. Prager also discussed surgical training resources and how to advocate for patient access to family planning experts who have the appropriate training.

Dr. Prager said she had no relevant financial disclosures.

[email protected]