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New sleep apnea guidelines offer evidence-based recommendations
New guidelines on treating obstructive sleep apnea with positive airway pressure include recommendations for using positive airway pressure (PAP) versus no therapy, using either continuous PAP (CPAP) or automatic PAP (APAP) for ongoing treatment, and providing educational interventions to patients starting PAP. The complete guidelines, issued by the American Academy of Sleep Medicine, were published in the Journal of Clinical Sleep Medicine.
The guidelines were driven by improvements in PAP adherence and device technology, wrote lead author Susheel P. Patil, MD, of Johns Hopkins University, Baltimore, and his colleagues.
The guidelines begin with a pair of Good Practice Statements to ensure effective and appropriate management of obstructive sleep apnea (OSA) in adults. First, “Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing.” Second, “Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA.”
The nine recommendations, approved by the AASM board of directors, include four strong recommendations that clinicians should follow under most circumstances, and five conditional recommendations that are suggested but lack strong clinical support for their appropriateness for all patients in all circumstances.
The first of the strong recommendations, for using PAP versus no therapy to treat adults with OSA and excessive sleepiness, was based on a high level of evidence from a meta-analysis of 38 randomized, controlled trials and the conclusion that the benefits of PAP outweighed the harms.
The second strong recommendation for using either CPAP or APAP for ongoing treatment was based on data from 26 trials that showed no clinically significant difference between the two. The third strong recommendation that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities was supported by a meta-analysis of 10 trials that showed no clinically significant difference between at-home and laboratory initiation, and that each option has its benefits. The authors noted that “the majority of well-informed adult patients with OSA and without significant comorbidities would prefer initiation of PAP using the most rapid, convenient, and cost-effective strategy.” This comment supports the fourth strong recommendation for providing educational interventions to patients starting PAP.
The conditional recommendations include using PAP versus no therapy for adults with OSA and impaired quality of life related to poor sleep, such as insomnia, snoring, morning headaches, and daytime fatigue. Other conditional recommendations include using PAP versus no therapy for adults with OSA and comorbid hypertension, choosing CPAP or APAP over bilateral PAP for routine treatment of OSA in adults, providing behavioral interventions or troubleshooting during patients’ initial use of PAP, and using telemonitoring-guided interventions to monitor patients during their initial use of PAP.
“The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources,” the authors noted.
“When implementing the recommendations, providers should consider additional strategies that will maximize the individual patient’s comfort and adherence such as nasal/intranasal over oronasal mask interface and heated humidification,” they added.
The guidelines were developed by a task force commissioned by the AASM that included board-certified sleep specialists and experts in PAP use, and will be reviewed and updated as new information surfaces, the authors wrote.
Dr. Patil reported no financial conflicts; several coauthors reported conflicts that were managed by their not voting on guidelines related to those conflicts.
SOURCE: Patil SP et al. J Clin Sleep Med. 2018 Feb 15;15(2):335-43.
Octavian C. Ioachimescu, MD, FCCP, comments: The last guidelines and practice parameters for the use of positive airway pressure (PAP) as therapy for adult patients with obstructive sleep apnea, were published in 2006 and 2008, respectively. Since then, new technological advances, an ever-growing body of literature, and shifting practice patterns led to an acute need for a thorough reassessment, a comprehensive update of the previous recommendations, and the potential of issuing new ones for emerging areas. As such, the American Academy of Sleep Medicine commissioned a task force of content experts to review the existing evidence, to issue new guidelines and to publish an associated systematic review and a meta-analysis of the literature on this topic.
A welcome recommendation is the endorsement by the task force of the use of telemedicine capabilities in monitoring patients’ adherence to PAP therapy. Another interesting aspect is that, while our literature is represented by a mix of both randomized and nonrandomized controlled trials, occasionally there seems to be an interesting dichotomy in the results: Randomized trials tend to point in one direction, while nonrandomized studies pooled in the meta-analysis seem to point to the contrary or to give the impression of more definitive effects. While this is clearly not the place to make an extensive analysis of the strengths and the potential pitfalls of randomized versus nonrandomized studies, this clearly raises some issues. One is that our randomized studies are typically small, underpowered, and hence with nonconvincing risk or hazard reduction assessments. Second, the dichotomy in the results may be driven by publication bias, expense, and difficulty in performing adequately-powered, long-term trials that essentially may be studying small effects.
Guidelines are not intended to be used in an Occam’s razor approach, but in a fashion that would allow individualization of therapy while critically appraising the existing evidence for various interventions in specific conditions and maintaining a very stringent and critical view on generalizability, expected results, and adequate management of reasonable expectations. In addition, the areas that are unclear, with conflicting evidence or in which the guidelines allow “too much” latitude to the treating clinician, may be seen as either an invitation to remain “creative,” or one for abstaining from action in the name of equipoise. I would advise that both extremes are to be avoided.
Octavian C. Ioachimescu, MD, FCCP, comments: The last guidelines and practice parameters for the use of positive airway pressure (PAP) as therapy for adult patients with obstructive sleep apnea, were published in 2006 and 2008, respectively. Since then, new technological advances, an ever-growing body of literature, and shifting practice patterns led to an acute need for a thorough reassessment, a comprehensive update of the previous recommendations, and the potential of issuing new ones for emerging areas. As such, the American Academy of Sleep Medicine commissioned a task force of content experts to review the existing evidence, to issue new guidelines and to publish an associated systematic review and a meta-analysis of the literature on this topic.
A welcome recommendation is the endorsement by the task force of the use of telemedicine capabilities in monitoring patients’ adherence to PAP therapy. Another interesting aspect is that, while our literature is represented by a mix of both randomized and nonrandomized controlled trials, occasionally there seems to be an interesting dichotomy in the results: Randomized trials tend to point in one direction, while nonrandomized studies pooled in the meta-analysis seem to point to the contrary or to give the impression of more definitive effects. While this is clearly not the place to make an extensive analysis of the strengths and the potential pitfalls of randomized versus nonrandomized studies, this clearly raises some issues. One is that our randomized studies are typically small, underpowered, and hence with nonconvincing risk or hazard reduction assessments. Second, the dichotomy in the results may be driven by publication bias, expense, and difficulty in performing adequately-powered, long-term trials that essentially may be studying small effects.
Guidelines are not intended to be used in an Occam’s razor approach, but in a fashion that would allow individualization of therapy while critically appraising the existing evidence for various interventions in specific conditions and maintaining a very stringent and critical view on generalizability, expected results, and adequate management of reasonable expectations. In addition, the areas that are unclear, with conflicting evidence or in which the guidelines allow “too much” latitude to the treating clinician, may be seen as either an invitation to remain “creative,” or one for abstaining from action in the name of equipoise. I would advise that both extremes are to be avoided.
Octavian C. Ioachimescu, MD, FCCP, comments: The last guidelines and practice parameters for the use of positive airway pressure (PAP) as therapy for adult patients with obstructive sleep apnea, were published in 2006 and 2008, respectively. Since then, new technological advances, an ever-growing body of literature, and shifting practice patterns led to an acute need for a thorough reassessment, a comprehensive update of the previous recommendations, and the potential of issuing new ones for emerging areas. As such, the American Academy of Sleep Medicine commissioned a task force of content experts to review the existing evidence, to issue new guidelines and to publish an associated systematic review and a meta-analysis of the literature on this topic.
A welcome recommendation is the endorsement by the task force of the use of telemedicine capabilities in monitoring patients’ adherence to PAP therapy. Another interesting aspect is that, while our literature is represented by a mix of both randomized and nonrandomized controlled trials, occasionally there seems to be an interesting dichotomy in the results: Randomized trials tend to point in one direction, while nonrandomized studies pooled in the meta-analysis seem to point to the contrary or to give the impression of more definitive effects. While this is clearly not the place to make an extensive analysis of the strengths and the potential pitfalls of randomized versus nonrandomized studies, this clearly raises some issues. One is that our randomized studies are typically small, underpowered, and hence with nonconvincing risk or hazard reduction assessments. Second, the dichotomy in the results may be driven by publication bias, expense, and difficulty in performing adequately-powered, long-term trials that essentially may be studying small effects.
Guidelines are not intended to be used in an Occam’s razor approach, but in a fashion that would allow individualization of therapy while critically appraising the existing evidence for various interventions in specific conditions and maintaining a very stringent and critical view on generalizability, expected results, and adequate management of reasonable expectations. In addition, the areas that are unclear, with conflicting evidence or in which the guidelines allow “too much” latitude to the treating clinician, may be seen as either an invitation to remain “creative,” or one for abstaining from action in the name of equipoise. I would advise that both extremes are to be avoided.
New guidelines on treating obstructive sleep apnea with positive airway pressure include recommendations for using positive airway pressure (PAP) versus no therapy, using either continuous PAP (CPAP) or automatic PAP (APAP) for ongoing treatment, and providing educational interventions to patients starting PAP. The complete guidelines, issued by the American Academy of Sleep Medicine, were published in the Journal of Clinical Sleep Medicine.
The guidelines were driven by improvements in PAP adherence and device technology, wrote lead author Susheel P. Patil, MD, of Johns Hopkins University, Baltimore, and his colleagues.
The guidelines begin with a pair of Good Practice Statements to ensure effective and appropriate management of obstructive sleep apnea (OSA) in adults. First, “Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing.” Second, “Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA.”
The nine recommendations, approved by the AASM board of directors, include four strong recommendations that clinicians should follow under most circumstances, and five conditional recommendations that are suggested but lack strong clinical support for their appropriateness for all patients in all circumstances.
The first of the strong recommendations, for using PAP versus no therapy to treat adults with OSA and excessive sleepiness, was based on a high level of evidence from a meta-analysis of 38 randomized, controlled trials and the conclusion that the benefits of PAP outweighed the harms.
The second strong recommendation for using either CPAP or APAP for ongoing treatment was based on data from 26 trials that showed no clinically significant difference between the two. The third strong recommendation that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities was supported by a meta-analysis of 10 trials that showed no clinically significant difference between at-home and laboratory initiation, and that each option has its benefits. The authors noted that “the majority of well-informed adult patients with OSA and without significant comorbidities would prefer initiation of PAP using the most rapid, convenient, and cost-effective strategy.” This comment supports the fourth strong recommendation for providing educational interventions to patients starting PAP.
The conditional recommendations include using PAP versus no therapy for adults with OSA and impaired quality of life related to poor sleep, such as insomnia, snoring, morning headaches, and daytime fatigue. Other conditional recommendations include using PAP versus no therapy for adults with OSA and comorbid hypertension, choosing CPAP or APAP over bilateral PAP for routine treatment of OSA in adults, providing behavioral interventions or troubleshooting during patients’ initial use of PAP, and using telemonitoring-guided interventions to monitor patients during their initial use of PAP.
“The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources,” the authors noted.
“When implementing the recommendations, providers should consider additional strategies that will maximize the individual patient’s comfort and adherence such as nasal/intranasal over oronasal mask interface and heated humidification,” they added.
The guidelines were developed by a task force commissioned by the AASM that included board-certified sleep specialists and experts in PAP use, and will be reviewed and updated as new information surfaces, the authors wrote.
Dr. Patil reported no financial conflicts; several coauthors reported conflicts that were managed by their not voting on guidelines related to those conflicts.
SOURCE: Patil SP et al. J Clin Sleep Med. 2018 Feb 15;15(2):335-43.
New guidelines on treating obstructive sleep apnea with positive airway pressure include recommendations for using positive airway pressure (PAP) versus no therapy, using either continuous PAP (CPAP) or automatic PAP (APAP) for ongoing treatment, and providing educational interventions to patients starting PAP. The complete guidelines, issued by the American Academy of Sleep Medicine, were published in the Journal of Clinical Sleep Medicine.
The guidelines were driven by improvements in PAP adherence and device technology, wrote lead author Susheel P. Patil, MD, of Johns Hopkins University, Baltimore, and his colleagues.
The guidelines begin with a pair of Good Practice Statements to ensure effective and appropriate management of obstructive sleep apnea (OSA) in adults. First, “Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing.” Second, “Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA.”
The nine recommendations, approved by the AASM board of directors, include four strong recommendations that clinicians should follow under most circumstances, and five conditional recommendations that are suggested but lack strong clinical support for their appropriateness for all patients in all circumstances.
The first of the strong recommendations, for using PAP versus no therapy to treat adults with OSA and excessive sleepiness, was based on a high level of evidence from a meta-analysis of 38 randomized, controlled trials and the conclusion that the benefits of PAP outweighed the harms.
The second strong recommendation for using either CPAP or APAP for ongoing treatment was based on data from 26 trials that showed no clinically significant difference between the two. The third strong recommendation that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities was supported by a meta-analysis of 10 trials that showed no clinically significant difference between at-home and laboratory initiation, and that each option has its benefits. The authors noted that “the majority of well-informed adult patients with OSA and without significant comorbidities would prefer initiation of PAP using the most rapid, convenient, and cost-effective strategy.” This comment supports the fourth strong recommendation for providing educational interventions to patients starting PAP.
The conditional recommendations include using PAP versus no therapy for adults with OSA and impaired quality of life related to poor sleep, such as insomnia, snoring, morning headaches, and daytime fatigue. Other conditional recommendations include using PAP versus no therapy for adults with OSA and comorbid hypertension, choosing CPAP or APAP over bilateral PAP for routine treatment of OSA in adults, providing behavioral interventions or troubleshooting during patients’ initial use of PAP, and using telemonitoring-guided interventions to monitor patients during their initial use of PAP.
“The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources,” the authors noted.
“When implementing the recommendations, providers should consider additional strategies that will maximize the individual patient’s comfort and adherence such as nasal/intranasal over oronasal mask interface and heated humidification,” they added.
The guidelines were developed by a task force commissioned by the AASM that included board-certified sleep specialists and experts in PAP use, and will be reviewed and updated as new information surfaces, the authors wrote.
Dr. Patil reported no financial conflicts; several coauthors reported conflicts that were managed by their not voting on guidelines related to those conflicts.
SOURCE: Patil SP et al. J Clin Sleep Med. 2018 Feb 15;15(2):335-43.
FROM THE JOURNAL OF CLINICAL SLEEP MEDICINE
May 2019 – ICYMI
Gastroenterology
How to write an effective business plan in medicine. Jazayeri A; Park KT. 2019 April;156(5):1243-7.
doi.org/10.1053/j.gastro.2019.03.003 https://www.gastrojournal.org/article/S0016-5085(19)32513-2/fulltext
How to deliver safer and effective patient care: Tips for team leaders and educators. Shah BJ. 2019 March;156(4):852-5.
doi.org/10.1053/j.gastro.2019.02.017 https://www.gastrojournal.org/article/S0016-5085(19)30390-7/fulltext
AGA Clinical Practice Update on diagnosis and monitoring of celiac disease – changing utility of serology and histologic measures: expert review. Husby S; Murray JA; Kattzka DA. 2019 March;156(4):885-9.
doi.org/10.1053/j.gastro.2018.12.010 https://www.gastrojournal.org/article/S0016-5085(18)35408-8/fulltext
How to get involved in global health. Proctor DD. 2019 Feb;156(3):542-4.
doi.org/10.1053/j.gastro.2019.01.012 https://www.gastrojournal.org/article/S0016-5085(19)30033-2/fulltext
AGA Clinical Practice Guidelines on the management of mild-to-moderate ulcerative colitis. Ko CW; Singh S; Feuerstein JD; Falck-Yytter C; Falck-Ytter Y; Cross RK; on behalf of the American Gastroenterological Association Institute Clinical Guidelines Committee. 2019 Feb;156(3);748-64.
doi.org/10.1053/j.gastro.2018.12.009 https://www.gastrojournal.org/article/S0016-5085(18)35407-6/fulltext
Clin Gastro Hepatol
Translating best practices to meaningful quality measures: From measure conceptualization to implementation. Adams MA; Allen JI; Saini SD. 2019 April;17(5):805-8.
doi.org/10.1016/j.cgh.2018.10.027 https://www.cghjournal.org/article/S1542-3565(18)31149-2/fulltext
Switching between biologics and biosimilars in inflammatory bowel diseases. Raffals LE; Nguyen GC; Rubin DT. 2019 April;17(5):818-23.
doi.org/10.1016/j.cgh.2018.08.064 https://www.cghjournal.org/article/S1542-3565(18)30943-1/fulltext
Preventive medicine in inflammatory bowel disease. Weaver KN; Long MD. 2019 April;17(5):824-8.
doi.org/10.1016/j.cgh.2018.11.054 https://www.cghjournal.org/article/S1542-3565(18)31331-4/fulltext
Innovating in your practice: Overcoming barriers to create new opportunities. Muthusamy VR; Komanduri S. 2019 March;17(4):580-3.
doi.org/10.1016/j.cgh.2018.09.016 https://www.cghjournal.org/article/S1542-3565(18)30978-9/fulltext
Incorporating advanced practice providers into gastroenterology practice. Nandwani MDR; Clarke JO. 2019 Feb;17(3):365-9.
doi.org/10.1016/j.cgh.2018.09.015 https://www.cghjournal.org/article/S1542-3565(18)30977-7/fulltext
AGA Clinical Practice Update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: expert review. Colombel J-F; Shin A; Gibson PR. 2019 Feb;17(3):380-90.
doi.org/10.1016/j.cgh.2018.08.001 https://www.cghjournal.org/article/S1542-3565(18)30810-3/fulltext
Gastroenterology
How to write an effective business plan in medicine. Jazayeri A; Park KT. 2019 April;156(5):1243-7.
doi.org/10.1053/j.gastro.2019.03.003 https://www.gastrojournal.org/article/S0016-5085(19)32513-2/fulltext
How to deliver safer and effective patient care: Tips for team leaders and educators. Shah BJ. 2019 March;156(4):852-5.
doi.org/10.1053/j.gastro.2019.02.017 https://www.gastrojournal.org/article/S0016-5085(19)30390-7/fulltext
AGA Clinical Practice Update on diagnosis and monitoring of celiac disease – changing utility of serology and histologic measures: expert review. Husby S; Murray JA; Kattzka DA. 2019 March;156(4):885-9.
doi.org/10.1053/j.gastro.2018.12.010 https://www.gastrojournal.org/article/S0016-5085(18)35408-8/fulltext
How to get involved in global health. Proctor DD. 2019 Feb;156(3):542-4.
doi.org/10.1053/j.gastro.2019.01.012 https://www.gastrojournal.org/article/S0016-5085(19)30033-2/fulltext
AGA Clinical Practice Guidelines on the management of mild-to-moderate ulcerative colitis. Ko CW; Singh S; Feuerstein JD; Falck-Yytter C; Falck-Ytter Y; Cross RK; on behalf of the American Gastroenterological Association Institute Clinical Guidelines Committee. 2019 Feb;156(3);748-64.
doi.org/10.1053/j.gastro.2018.12.009 https://www.gastrojournal.org/article/S0016-5085(18)35407-6/fulltext
Clin Gastro Hepatol
Translating best practices to meaningful quality measures: From measure conceptualization to implementation. Adams MA; Allen JI; Saini SD. 2019 April;17(5):805-8.
doi.org/10.1016/j.cgh.2018.10.027 https://www.cghjournal.org/article/S1542-3565(18)31149-2/fulltext
Switching between biologics and biosimilars in inflammatory bowel diseases. Raffals LE; Nguyen GC; Rubin DT. 2019 April;17(5):818-23.
doi.org/10.1016/j.cgh.2018.08.064 https://www.cghjournal.org/article/S1542-3565(18)30943-1/fulltext
Preventive medicine in inflammatory bowel disease. Weaver KN; Long MD. 2019 April;17(5):824-8.
doi.org/10.1016/j.cgh.2018.11.054 https://www.cghjournal.org/article/S1542-3565(18)31331-4/fulltext
Innovating in your practice: Overcoming barriers to create new opportunities. Muthusamy VR; Komanduri S. 2019 March;17(4):580-3.
doi.org/10.1016/j.cgh.2018.09.016 https://www.cghjournal.org/article/S1542-3565(18)30978-9/fulltext
Incorporating advanced practice providers into gastroenterology practice. Nandwani MDR; Clarke JO. 2019 Feb;17(3):365-9.
doi.org/10.1016/j.cgh.2018.09.015 https://www.cghjournal.org/article/S1542-3565(18)30977-7/fulltext
AGA Clinical Practice Update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: expert review. Colombel J-F; Shin A; Gibson PR. 2019 Feb;17(3):380-90.
doi.org/10.1016/j.cgh.2018.08.001 https://www.cghjournal.org/article/S1542-3565(18)30810-3/fulltext
Gastroenterology
How to write an effective business plan in medicine. Jazayeri A; Park KT. 2019 April;156(5):1243-7.
doi.org/10.1053/j.gastro.2019.03.003 https://www.gastrojournal.org/article/S0016-5085(19)32513-2/fulltext
How to deliver safer and effective patient care: Tips for team leaders and educators. Shah BJ. 2019 March;156(4):852-5.
doi.org/10.1053/j.gastro.2019.02.017 https://www.gastrojournal.org/article/S0016-5085(19)30390-7/fulltext
AGA Clinical Practice Update on diagnosis and monitoring of celiac disease – changing utility of serology and histologic measures: expert review. Husby S; Murray JA; Kattzka DA. 2019 March;156(4):885-9.
doi.org/10.1053/j.gastro.2018.12.010 https://www.gastrojournal.org/article/S0016-5085(18)35408-8/fulltext
How to get involved in global health. Proctor DD. 2019 Feb;156(3):542-4.
doi.org/10.1053/j.gastro.2019.01.012 https://www.gastrojournal.org/article/S0016-5085(19)30033-2/fulltext
AGA Clinical Practice Guidelines on the management of mild-to-moderate ulcerative colitis. Ko CW; Singh S; Feuerstein JD; Falck-Yytter C; Falck-Ytter Y; Cross RK; on behalf of the American Gastroenterological Association Institute Clinical Guidelines Committee. 2019 Feb;156(3);748-64.
doi.org/10.1053/j.gastro.2018.12.009 https://www.gastrojournal.org/article/S0016-5085(18)35407-6/fulltext
Clin Gastro Hepatol
Translating best practices to meaningful quality measures: From measure conceptualization to implementation. Adams MA; Allen JI; Saini SD. 2019 April;17(5):805-8.
doi.org/10.1016/j.cgh.2018.10.027 https://www.cghjournal.org/article/S1542-3565(18)31149-2/fulltext
Switching between biologics and biosimilars in inflammatory bowel diseases. Raffals LE; Nguyen GC; Rubin DT. 2019 April;17(5):818-23.
doi.org/10.1016/j.cgh.2018.08.064 https://www.cghjournal.org/article/S1542-3565(18)30943-1/fulltext
Preventive medicine in inflammatory bowel disease. Weaver KN; Long MD. 2019 April;17(5):824-8.
doi.org/10.1016/j.cgh.2018.11.054 https://www.cghjournal.org/article/S1542-3565(18)31331-4/fulltext
Innovating in your practice: Overcoming barriers to create new opportunities. Muthusamy VR; Komanduri S. 2019 March;17(4):580-3.
doi.org/10.1016/j.cgh.2018.09.016 https://www.cghjournal.org/article/S1542-3565(18)30978-9/fulltext
Incorporating advanced practice providers into gastroenterology practice. Nandwani MDR; Clarke JO. 2019 Feb;17(3):365-9.
doi.org/10.1016/j.cgh.2018.09.015 https://www.cghjournal.org/article/S1542-3565(18)30977-7/fulltext
AGA Clinical Practice Update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: expert review. Colombel J-F; Shin A; Gibson PR. 2019 Feb;17(3):380-90.
doi.org/10.1016/j.cgh.2018.08.001 https://www.cghjournal.org/article/S1542-3565(18)30810-3/fulltext
AGA News
Meet a rising star in fecal incontinence research
The AGA Research Foundation offers its flagship grant, the AGA Research Scholar Award, to the most promising early career investigators. Kyle Staller, MD, MPH, assistant professor of medicine at Harvard Medical School in Boston, is no exception. We’re thrilled to highlight Dr. Staller – a 2016 AGA Research Scholar Award winner – as our AGA Research Foundation researcher of the month.
The Staller lab’s AGA-funded project is specifically focused on the risk factors for fecal incontinence, which have not been well studied. One in 10 women over age 80 suffers from this debilitating condition. Dr. Staller looked at the lifestyles and dietary factors of female study participants in research databases to determine whether they were predisposed to developing fecal incontinence beyond the usual risk factors such as childbirth, which can cause injury to the pelvic floor, and diabetes. Dr. Staller believes that understanding and modifying risk factors could decrease the chance of women developing this condition, or could even prevent it.
With his AGA Research Foundation grant, Dr. Staller found that consumption of dietary fiber in higher quantities, and an increase of moderate exercise up to a point, lowered the risk of developing fecal incontinence. “This tells us that not only is fiber healthy but also preventative to fecal incontinence,” he said.
Dr. Staller says that he became interested in this area of study after patients, who were getting excited about their impending retirement or enjoying their retirement years, developed this life-altering condition. His compassion for his patients inspired him to study the factors leading to fecal incontinence, which will likely become more prevalent as the U.S. population ages.
Dr. Staller is using the baseline data from his AGA Research Foundation grant to support his application for a 5-year NIH grant designed to help young investigators learn new research skills to further their careers.
“This is the next step in my career,” he said. “If I didn’t have the AGA Research Foundation grant, I don’t know if the opportunity would be there for me to go on to the next level. The AGA grant gives you the opportunity to get that baseline data so you can become a competitive applicant for longer-term grants.”
Another benefit of Dr. Staller’s AGA Research Foundation grant: It got him involved with AGA. In March 2019, Dr. Staller joined the new class of AGA Future Leaders, AGA’s competitive leadership development program designed to prepare early career GIs for future leadership roles in AGA, at their home institutions, and within the field of digestive diseases. The program kicked off at AGA’s inaugural leadership development conference.
“It is a true honor to participate in the AGA Future Leaders Program. During the AGA Leadership Development Conference, we learned concrete tips about effective leadership strategies across the spectrum of GI practice from research to clinical practice. Among our mentors were prominent researchers, clinical innovators, and division and department heads from across the U.S. – there was no shortage of inspiration. Perhaps most importantly, I was able to form what I hope to be career-long connections with both my fellow future leaders program participants and our mentors,” he said.
Dr. Staller’s qualifications as a clinician and researcher of bowel issues are put to good use as a father of two boys, ages 4 and 6, who are at the peak of the potty humor stage.
“They’re interested in the GI tract as well,” Dr. Staller said with a laugh. “My mom likes to say I never got out of the potty phase and made it a career. It’s important to feel comfortable talking about these uncomfortable topics. That’s what people want from their physician. If you can talk about this and the physician doesn’t bat an eyelash, that’s a good setup to have a good therapeutic relationship.”
‘Put your own oxygen mask on first’
Takeaways from the leadership conference stress the importance of self-care, emotional intelligence and remaining optimistic.
“Leadership 101: Put your own oxygen mask on first @DarwinConwell #AGAleads #AGAForward @AmerGastroAssn”– Dr Michelle T. Long (@DrMTLong)
The inaugural Leadership Development Conference combined participants from three AGA programs for a weekend of networking, mentorship and mapping out goals and initiatives.
Attendees included the 2020 class of AGA Future Leaders and mentors, Women’s Leadership Conference participants, and mentors and scholars of the new AGA FORWARD Program, an National Institutes of Health–funded initiative that supports underrepresented minority physicians and scientists.
“Got to meet one of my tweeps heroes today! She’s even more awesome in real life!! #AGALeads #WomenInMedicine #WomenInGI @drfolamay @AmerGastroAssn” – Dr Aline Charabaty (@DCharabaty)
“Dr. Boland (Lynch syndrome) discussing career success in an ever changing scientific environment #AGALeads #AGAForward” – Eric J. Vargas M.D. (@EricJVargasMD)
“7 AGA Presidents, moderated by Dr. Anandasabapathy on Pathways to Leadership and Overcoming Challenges of the Era Presidential Panel @AmerGastroAssn Leadership conference program @SeragHashem @BCMDeptMedicine @KanwalFasiha @Aketwaroo @richashukla84” – Ruben Hernaez (@ruben_hernaez)
The event coincided with International Women’s Day, giving Women’s Leadership Conference attendees the chance to celebrate their journeys and grow into leadership roles with other #WomenInGI.
“#AGALeads #womenleadershipconference #womeninGI #InternationWomensDay with some amazing ladies in GI!! @AmerGastroAssn @AlisonGoldinMD @ibddocmaria @joanwchen” – ReezwanaCMD (@reezwanc)
“#AGAleads #WomeninGI women negotiating in a group are perceived favorably-Ellen Zimmerman, MD”
– Fazia Mir-Shaffi, MD (@Faiziya) March 9, 2019
“What I learned at @AmerGastroAssn #womeninGI Leadership course (after waiting a bit to see what stuck w me)
1. If you say yes to a request, you’re saying yes to doing it well.
2. Knowing your limitations will serve you better than being great at everything” – Laura Targownik (@UofM_GI_Head)
Aline Charabaty Pishvaian, MD, shared some takeaways in the AGA Community forum (community.gastro.org) about challenges women in GI face – a breakout discussion from the Women’s Leadership Conference.
View more insight and takeaways from participants on Twitter using #AGALeads.
Dr. Vaibhav Wadhwa advocates for step therapy reform in Florida
Vaibhav Wadhwa, MD, met with Ms. Laurie Flink, deputy district director for Rep. Debbie Wasserman Schultz (FL-23), to discuss AGA’s legislative priorities.
Dr. Wadhwa thanked Ms. Flink for Rep. Wasserman Schultz’s support of the Removing Barriers to Colorectal Screening Act and NIH funding. Dr. Wadhwa also mentioned that Rep. Wasserman Schultz is not a cosponsor of the Restoring the Patient’s Voice Act and explained in detail about why this is an important resolution that needs to be passed.
Dr. Wadhwa gave examples of patients from his own practice and discussed the challenges they face. Ms. Flink was very interested in hearing about patients with chronic conditions such as inflammatory bowel disease (IBD) not being able to get the appropriate regimen because of the barriers created by step therapy. Ms. Flink was very appreciative of the visit and stated that these in-person visits along with personal stories about these issues go a long way in helping congressional offices understand the implications that these bills have.
Ms. Flink assured Dr. Wadhwa that she will raise these points with Rep. Wasserman Schultz and will discuss cosponsoring the Restoring the Patient’s Voice Act once it is reintroduced.
Dr. Wadhwa is a fellow at the Cleveland Clinic Florida in Weston, and is the AGA Congressional Advocates Program state leader for Florida. He is interested in therapeutic endoscopy and advocating for appropriate reimbursement for endoscopic procedures.
How to get involved in advocacy
Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as 5 minutes.
Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their representatives in Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress, or on issues being advanced by federal agencies that have a great impact on gastroenterology. AGA’s ongoing letter writing campaigns can always be found at gastro.org, but be sure to keep an eye out for advocacy emails, AGA eDigest, and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.
Meetings with members of Congress. In-person meetings are an excellent opportunity to share with your representatives in Congress, or their staff, how the issues that impact gastroenterology affect you, your patients, and your practice. AGA has a plethora of resources to help you set up such meetings, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, D.C., or in your home state. If you are interested in arranging such a meeting, please contact AGA Public Policy Coordinator Jonathan Sollish, at [email protected] or 240-482-3228.
AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. It is the only political action committee supported by a national gastroenterology society, and its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections, and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager Navneet Buttar, at [email protected] or 240-482-3221.
Congressional Advocates Program. This grassroots program is aimed at establishing a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state, and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community, and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
Introducing the AGA Future Leaders class of 2020
AGA has announced the 18 early career physicians and scientists selected to participate in its Future Leaders Program, which was created in 2015 to provide a pathway for leadership development within AGA for early career physicians and scientists who have the potential to make a significant impact on the specialty. These 18 participants will embark on an 18-month-long program designed to develop the skills necessary to become future leaders in the AGA, at their home institutions, and within the field of digestive diseases.
“The 2020 class of AGA Future Leaders represents the next generation of leaders in our field,” said Darrell S. Pardi, MD, MSc, AGAF, co–program chair for the AGA Future Leaders Program. “Along with my cochair, Sheryl Pfeil, MD, AGAF, and the esteemed mentors and faculty participating in this program, we look forward to cultivating these rising stars who stand out for their current achievements, commitment to advancing the field, and potential for future success.”
Class of 2020 Future Leaders
- Christen Klochan Dilly, MD, MEHP, Indiana University School of Medicine and Roudebush VA Medical Center
- Daniel Freedberg, MD, MS, Columbia University
- Wendy A. Henderson, PhD, National Institutes of Health
- Ruben Hernaez, MD, MPH, PhD, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
- Animesh Jain, MD, University of North Carolina at Chapel Hill
- Avinash Ketwaroo, MD, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
- Bharati Kochar, MD, MSCR, University of North Carolina at Chapel Hill
- David Leiman, MD, MSHP, Duke University Medical Center
- James Lin, MD, City of Hope National Medical Center in Duarte
- Michelle Long, MD, Boston Medical Center
- Aimee Lucas, MD, MS, Icahn School of Medicine at Mount Sinai
- Miguel Malespin, MD, Tampa General Hospital
- Simon C. Mathews, MD, Johns Hopkins Medicine
- Karthik Ravi, MD, Mayo Clinic (Rochester, Minnesota)
- Florian Rieder, MD, Cleveland Clinic Foundation
- Kyle Staller, MD, MPH, Harvard Medical School
- Christina Twyman-Saint Victor, MD, University of Pennsylvania Perelman School of Medicine
- Ryan Ungaro, MD, MS, Icahn School of Medicine at Mount Sinai
View Future Leader Bios
The AGA Future Leaders Program will kick off with the AGA Leadership Development Conference March 8-10, 2019, at the Hilton Rockville Executive conference center in Rockville, Maryland, and will continue through Digestive Disease Week® (DDW) 2020 in Chicago, Illinois. Throughout the course of the program, participants will work closely with AGA mentors on projects linked to AGA’s Strategic Plan.
Learn more about the AGA Future Leaders Program.
Sessions at DDW® 2019 designed for fellows and early career GIs
AGA has an agenda of special sessions at Digestive Disease Week® (DDW) 2019 to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.
With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Visit AGA University for a full list and additional details.
- AGA Postgraduate Course Saturday, May 18, and Sunday, May 19
- Introduction to GI Practice: A Trainee Boot Camp, Monday, May 20, 10-11:30 a.m.
- AGA Board Review CourseMonday, May 20, 1:30-5:30 p.m.
- Advancing Clinical Practice: GI Fellow-Directed Quality Improvement ProjectsMonday, May 20, 2-3:30 p.m.
- GI in the Digital Age, Monday, May 20, 4-5:30 p.m.
DDW Trainee and Early Career Lounge
Included with the cost of DDW registration, trainee and early career GI attendees have access to this lounge in the Sails Pavilion. It’s a great way to meet and network with peers from around the world over a cup of coffee and will feature new programming in 2019. Meet with experts to have your questions answered about practical issues of career choice, contracting, or how to write a manuscript.
Meet a rising star in fecal incontinence research
The AGA Research Foundation offers its flagship grant, the AGA Research Scholar Award, to the most promising early career investigators. Kyle Staller, MD, MPH, assistant professor of medicine at Harvard Medical School in Boston, is no exception. We’re thrilled to highlight Dr. Staller – a 2016 AGA Research Scholar Award winner – as our AGA Research Foundation researcher of the month.
The Staller lab’s AGA-funded project is specifically focused on the risk factors for fecal incontinence, which have not been well studied. One in 10 women over age 80 suffers from this debilitating condition. Dr. Staller looked at the lifestyles and dietary factors of female study participants in research databases to determine whether they were predisposed to developing fecal incontinence beyond the usual risk factors such as childbirth, which can cause injury to the pelvic floor, and diabetes. Dr. Staller believes that understanding and modifying risk factors could decrease the chance of women developing this condition, or could even prevent it.
With his AGA Research Foundation grant, Dr. Staller found that consumption of dietary fiber in higher quantities, and an increase of moderate exercise up to a point, lowered the risk of developing fecal incontinence. “This tells us that not only is fiber healthy but also preventative to fecal incontinence,” he said.
Dr. Staller says that he became interested in this area of study after patients, who were getting excited about their impending retirement or enjoying their retirement years, developed this life-altering condition. His compassion for his patients inspired him to study the factors leading to fecal incontinence, which will likely become more prevalent as the U.S. population ages.
Dr. Staller is using the baseline data from his AGA Research Foundation grant to support his application for a 5-year NIH grant designed to help young investigators learn new research skills to further their careers.
“This is the next step in my career,” he said. “If I didn’t have the AGA Research Foundation grant, I don’t know if the opportunity would be there for me to go on to the next level. The AGA grant gives you the opportunity to get that baseline data so you can become a competitive applicant for longer-term grants.”
Another benefit of Dr. Staller’s AGA Research Foundation grant: It got him involved with AGA. In March 2019, Dr. Staller joined the new class of AGA Future Leaders, AGA’s competitive leadership development program designed to prepare early career GIs for future leadership roles in AGA, at their home institutions, and within the field of digestive diseases. The program kicked off at AGA’s inaugural leadership development conference.
“It is a true honor to participate in the AGA Future Leaders Program. During the AGA Leadership Development Conference, we learned concrete tips about effective leadership strategies across the spectrum of GI practice from research to clinical practice. Among our mentors were prominent researchers, clinical innovators, and division and department heads from across the U.S. – there was no shortage of inspiration. Perhaps most importantly, I was able to form what I hope to be career-long connections with both my fellow future leaders program participants and our mentors,” he said.
Dr. Staller’s qualifications as a clinician and researcher of bowel issues are put to good use as a father of two boys, ages 4 and 6, who are at the peak of the potty humor stage.
“They’re interested in the GI tract as well,” Dr. Staller said with a laugh. “My mom likes to say I never got out of the potty phase and made it a career. It’s important to feel comfortable talking about these uncomfortable topics. That’s what people want from their physician. If you can talk about this and the physician doesn’t bat an eyelash, that’s a good setup to have a good therapeutic relationship.”
‘Put your own oxygen mask on first’
Takeaways from the leadership conference stress the importance of self-care, emotional intelligence and remaining optimistic.
“Leadership 101: Put your own oxygen mask on first @DarwinConwell #AGAleads #AGAForward @AmerGastroAssn”– Dr Michelle T. Long (@DrMTLong)
The inaugural Leadership Development Conference combined participants from three AGA programs for a weekend of networking, mentorship and mapping out goals and initiatives.
Attendees included the 2020 class of AGA Future Leaders and mentors, Women’s Leadership Conference participants, and mentors and scholars of the new AGA FORWARD Program, an National Institutes of Health–funded initiative that supports underrepresented minority physicians and scientists.
“Got to meet one of my tweeps heroes today! She’s even more awesome in real life!! #AGALeads #WomenInMedicine #WomenInGI @drfolamay @AmerGastroAssn” – Dr Aline Charabaty (@DCharabaty)
“Dr. Boland (Lynch syndrome) discussing career success in an ever changing scientific environment #AGALeads #AGAForward” – Eric J. Vargas M.D. (@EricJVargasMD)
“7 AGA Presidents, moderated by Dr. Anandasabapathy on Pathways to Leadership and Overcoming Challenges of the Era Presidential Panel @AmerGastroAssn Leadership conference program @SeragHashem @BCMDeptMedicine @KanwalFasiha @Aketwaroo @richashukla84” – Ruben Hernaez (@ruben_hernaez)
The event coincided with International Women’s Day, giving Women’s Leadership Conference attendees the chance to celebrate their journeys and grow into leadership roles with other #WomenInGI.
“#AGALeads #womenleadershipconference #womeninGI #InternationWomensDay with some amazing ladies in GI!! @AmerGastroAssn @AlisonGoldinMD @ibddocmaria @joanwchen” – ReezwanaCMD (@reezwanc)
“#AGAleads #WomeninGI women negotiating in a group are perceived favorably-Ellen Zimmerman, MD”
– Fazia Mir-Shaffi, MD (@Faiziya) March 9, 2019
“What I learned at @AmerGastroAssn #womeninGI Leadership course (after waiting a bit to see what stuck w me)
1. If you say yes to a request, you’re saying yes to doing it well.
2. Knowing your limitations will serve you better than being great at everything” – Laura Targownik (@UofM_GI_Head)
Aline Charabaty Pishvaian, MD, shared some takeaways in the AGA Community forum (community.gastro.org) about challenges women in GI face – a breakout discussion from the Women’s Leadership Conference.
View more insight and takeaways from participants on Twitter using #AGALeads.
Dr. Vaibhav Wadhwa advocates for step therapy reform in Florida
Vaibhav Wadhwa, MD, met with Ms. Laurie Flink, deputy district director for Rep. Debbie Wasserman Schultz (FL-23), to discuss AGA’s legislative priorities.
Dr. Wadhwa thanked Ms. Flink for Rep. Wasserman Schultz’s support of the Removing Barriers to Colorectal Screening Act and NIH funding. Dr. Wadhwa also mentioned that Rep. Wasserman Schultz is not a cosponsor of the Restoring the Patient’s Voice Act and explained in detail about why this is an important resolution that needs to be passed.
Dr. Wadhwa gave examples of patients from his own practice and discussed the challenges they face. Ms. Flink was very interested in hearing about patients with chronic conditions such as inflammatory bowel disease (IBD) not being able to get the appropriate regimen because of the barriers created by step therapy. Ms. Flink was very appreciative of the visit and stated that these in-person visits along with personal stories about these issues go a long way in helping congressional offices understand the implications that these bills have.
Ms. Flink assured Dr. Wadhwa that she will raise these points with Rep. Wasserman Schultz and will discuss cosponsoring the Restoring the Patient’s Voice Act once it is reintroduced.
Dr. Wadhwa is a fellow at the Cleveland Clinic Florida in Weston, and is the AGA Congressional Advocates Program state leader for Florida. He is interested in therapeutic endoscopy and advocating for appropriate reimbursement for endoscopic procedures.
How to get involved in advocacy
Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as 5 minutes.
Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their representatives in Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress, or on issues being advanced by federal agencies that have a great impact on gastroenterology. AGA’s ongoing letter writing campaigns can always be found at gastro.org, but be sure to keep an eye out for advocacy emails, AGA eDigest, and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.
Meetings with members of Congress. In-person meetings are an excellent opportunity to share with your representatives in Congress, or their staff, how the issues that impact gastroenterology affect you, your patients, and your practice. AGA has a plethora of resources to help you set up such meetings, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, D.C., or in your home state. If you are interested in arranging such a meeting, please contact AGA Public Policy Coordinator Jonathan Sollish, at [email protected] or 240-482-3228.
AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. It is the only political action committee supported by a national gastroenterology society, and its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections, and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager Navneet Buttar, at [email protected] or 240-482-3221.
Congressional Advocates Program. This grassroots program is aimed at establishing a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state, and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community, and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
Introducing the AGA Future Leaders class of 2020
AGA has announced the 18 early career physicians and scientists selected to participate in its Future Leaders Program, which was created in 2015 to provide a pathway for leadership development within AGA for early career physicians and scientists who have the potential to make a significant impact on the specialty. These 18 participants will embark on an 18-month-long program designed to develop the skills necessary to become future leaders in the AGA, at their home institutions, and within the field of digestive diseases.
“The 2020 class of AGA Future Leaders represents the next generation of leaders in our field,” said Darrell S. Pardi, MD, MSc, AGAF, co–program chair for the AGA Future Leaders Program. “Along with my cochair, Sheryl Pfeil, MD, AGAF, and the esteemed mentors and faculty participating in this program, we look forward to cultivating these rising stars who stand out for their current achievements, commitment to advancing the field, and potential for future success.”
Class of 2020 Future Leaders
- Christen Klochan Dilly, MD, MEHP, Indiana University School of Medicine and Roudebush VA Medical Center
- Daniel Freedberg, MD, MS, Columbia University
- Wendy A. Henderson, PhD, National Institutes of Health
- Ruben Hernaez, MD, MPH, PhD, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
- Animesh Jain, MD, University of North Carolina at Chapel Hill
- Avinash Ketwaroo, MD, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
- Bharati Kochar, MD, MSCR, University of North Carolina at Chapel Hill
- David Leiman, MD, MSHP, Duke University Medical Center
- James Lin, MD, City of Hope National Medical Center in Duarte
- Michelle Long, MD, Boston Medical Center
- Aimee Lucas, MD, MS, Icahn School of Medicine at Mount Sinai
- Miguel Malespin, MD, Tampa General Hospital
- Simon C. Mathews, MD, Johns Hopkins Medicine
- Karthik Ravi, MD, Mayo Clinic (Rochester, Minnesota)
- Florian Rieder, MD, Cleveland Clinic Foundation
- Kyle Staller, MD, MPH, Harvard Medical School
- Christina Twyman-Saint Victor, MD, University of Pennsylvania Perelman School of Medicine
- Ryan Ungaro, MD, MS, Icahn School of Medicine at Mount Sinai
View Future Leader Bios
The AGA Future Leaders Program will kick off with the AGA Leadership Development Conference March 8-10, 2019, at the Hilton Rockville Executive conference center in Rockville, Maryland, and will continue through Digestive Disease Week® (DDW) 2020 in Chicago, Illinois. Throughout the course of the program, participants will work closely with AGA mentors on projects linked to AGA’s Strategic Plan.
Learn more about the AGA Future Leaders Program.
Sessions at DDW® 2019 designed for fellows and early career GIs
AGA has an agenda of special sessions at Digestive Disease Week® (DDW) 2019 to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.
With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Visit AGA University for a full list and additional details.
- AGA Postgraduate Course Saturday, May 18, and Sunday, May 19
- Introduction to GI Practice: A Trainee Boot Camp, Monday, May 20, 10-11:30 a.m.
- AGA Board Review CourseMonday, May 20, 1:30-5:30 p.m.
- Advancing Clinical Practice: GI Fellow-Directed Quality Improvement ProjectsMonday, May 20, 2-3:30 p.m.
- GI in the Digital Age, Monday, May 20, 4-5:30 p.m.
DDW Trainee and Early Career Lounge
Included with the cost of DDW registration, trainee and early career GI attendees have access to this lounge in the Sails Pavilion. It’s a great way to meet and network with peers from around the world over a cup of coffee and will feature new programming in 2019. Meet with experts to have your questions answered about practical issues of career choice, contracting, or how to write a manuscript.
Meet a rising star in fecal incontinence research
The AGA Research Foundation offers its flagship grant, the AGA Research Scholar Award, to the most promising early career investigators. Kyle Staller, MD, MPH, assistant professor of medicine at Harvard Medical School in Boston, is no exception. We’re thrilled to highlight Dr. Staller – a 2016 AGA Research Scholar Award winner – as our AGA Research Foundation researcher of the month.
The Staller lab’s AGA-funded project is specifically focused on the risk factors for fecal incontinence, which have not been well studied. One in 10 women over age 80 suffers from this debilitating condition. Dr. Staller looked at the lifestyles and dietary factors of female study participants in research databases to determine whether they were predisposed to developing fecal incontinence beyond the usual risk factors such as childbirth, which can cause injury to the pelvic floor, and diabetes. Dr. Staller believes that understanding and modifying risk factors could decrease the chance of women developing this condition, or could even prevent it.
With his AGA Research Foundation grant, Dr. Staller found that consumption of dietary fiber in higher quantities, and an increase of moderate exercise up to a point, lowered the risk of developing fecal incontinence. “This tells us that not only is fiber healthy but also preventative to fecal incontinence,” he said.
Dr. Staller says that he became interested in this area of study after patients, who were getting excited about their impending retirement or enjoying their retirement years, developed this life-altering condition. His compassion for his patients inspired him to study the factors leading to fecal incontinence, which will likely become more prevalent as the U.S. population ages.
Dr. Staller is using the baseline data from his AGA Research Foundation grant to support his application for a 5-year NIH grant designed to help young investigators learn new research skills to further their careers.
“This is the next step in my career,” he said. “If I didn’t have the AGA Research Foundation grant, I don’t know if the opportunity would be there for me to go on to the next level. The AGA grant gives you the opportunity to get that baseline data so you can become a competitive applicant for longer-term grants.”
Another benefit of Dr. Staller’s AGA Research Foundation grant: It got him involved with AGA. In March 2019, Dr. Staller joined the new class of AGA Future Leaders, AGA’s competitive leadership development program designed to prepare early career GIs for future leadership roles in AGA, at their home institutions, and within the field of digestive diseases. The program kicked off at AGA’s inaugural leadership development conference.
“It is a true honor to participate in the AGA Future Leaders Program. During the AGA Leadership Development Conference, we learned concrete tips about effective leadership strategies across the spectrum of GI practice from research to clinical practice. Among our mentors were prominent researchers, clinical innovators, and division and department heads from across the U.S. – there was no shortage of inspiration. Perhaps most importantly, I was able to form what I hope to be career-long connections with both my fellow future leaders program participants and our mentors,” he said.
Dr. Staller’s qualifications as a clinician and researcher of bowel issues are put to good use as a father of two boys, ages 4 and 6, who are at the peak of the potty humor stage.
“They’re interested in the GI tract as well,” Dr. Staller said with a laugh. “My mom likes to say I never got out of the potty phase and made it a career. It’s important to feel comfortable talking about these uncomfortable topics. That’s what people want from their physician. If you can talk about this and the physician doesn’t bat an eyelash, that’s a good setup to have a good therapeutic relationship.”
‘Put your own oxygen mask on first’
Takeaways from the leadership conference stress the importance of self-care, emotional intelligence and remaining optimistic.
“Leadership 101: Put your own oxygen mask on first @DarwinConwell #AGAleads #AGAForward @AmerGastroAssn”– Dr Michelle T. Long (@DrMTLong)
The inaugural Leadership Development Conference combined participants from three AGA programs for a weekend of networking, mentorship and mapping out goals and initiatives.
Attendees included the 2020 class of AGA Future Leaders and mentors, Women’s Leadership Conference participants, and mentors and scholars of the new AGA FORWARD Program, an National Institutes of Health–funded initiative that supports underrepresented minority physicians and scientists.
“Got to meet one of my tweeps heroes today! She’s even more awesome in real life!! #AGALeads #WomenInMedicine #WomenInGI @drfolamay @AmerGastroAssn” – Dr Aline Charabaty (@DCharabaty)
“Dr. Boland (Lynch syndrome) discussing career success in an ever changing scientific environment #AGALeads #AGAForward” – Eric J. Vargas M.D. (@EricJVargasMD)
“7 AGA Presidents, moderated by Dr. Anandasabapathy on Pathways to Leadership and Overcoming Challenges of the Era Presidential Panel @AmerGastroAssn Leadership conference program @SeragHashem @BCMDeptMedicine @KanwalFasiha @Aketwaroo @richashukla84” – Ruben Hernaez (@ruben_hernaez)
The event coincided with International Women’s Day, giving Women’s Leadership Conference attendees the chance to celebrate their journeys and grow into leadership roles with other #WomenInGI.
“#AGALeads #womenleadershipconference #womeninGI #InternationWomensDay with some amazing ladies in GI!! @AmerGastroAssn @AlisonGoldinMD @ibddocmaria @joanwchen” – ReezwanaCMD (@reezwanc)
“#AGAleads #WomeninGI women negotiating in a group are perceived favorably-Ellen Zimmerman, MD”
– Fazia Mir-Shaffi, MD (@Faiziya) March 9, 2019
“What I learned at @AmerGastroAssn #womeninGI Leadership course (after waiting a bit to see what stuck w me)
1. If you say yes to a request, you’re saying yes to doing it well.
2. Knowing your limitations will serve you better than being great at everything” – Laura Targownik (@UofM_GI_Head)
Aline Charabaty Pishvaian, MD, shared some takeaways in the AGA Community forum (community.gastro.org) about challenges women in GI face – a breakout discussion from the Women’s Leadership Conference.
View more insight and takeaways from participants on Twitter using #AGALeads.
Dr. Vaibhav Wadhwa advocates for step therapy reform in Florida
Vaibhav Wadhwa, MD, met with Ms. Laurie Flink, deputy district director for Rep. Debbie Wasserman Schultz (FL-23), to discuss AGA’s legislative priorities.
Dr. Wadhwa thanked Ms. Flink for Rep. Wasserman Schultz’s support of the Removing Barriers to Colorectal Screening Act and NIH funding. Dr. Wadhwa also mentioned that Rep. Wasserman Schultz is not a cosponsor of the Restoring the Patient’s Voice Act and explained in detail about why this is an important resolution that needs to be passed.
Dr. Wadhwa gave examples of patients from his own practice and discussed the challenges they face. Ms. Flink was very interested in hearing about patients with chronic conditions such as inflammatory bowel disease (IBD) not being able to get the appropriate regimen because of the barriers created by step therapy. Ms. Flink was very appreciative of the visit and stated that these in-person visits along with personal stories about these issues go a long way in helping congressional offices understand the implications that these bills have.
Ms. Flink assured Dr. Wadhwa that she will raise these points with Rep. Wasserman Schultz and will discuss cosponsoring the Restoring the Patient’s Voice Act once it is reintroduced.
Dr. Wadhwa is a fellow at the Cleveland Clinic Florida in Weston, and is the AGA Congressional Advocates Program state leader for Florida. He is interested in therapeutic endoscopy and advocating for appropriate reimbursement for endoscopic procedures.
How to get involved in advocacy
Interested in advocacy but not sure how or whether you have time in your busy schedule? AGA has an array of options for how you can be active in advocacy. Some take as little as 5 minutes.
Letter writing. AGA uses GovPredict, an online advocacy platform that allows members to contact their representatives in Congress with just a few clicks. AGA develops messages on significant pieces of legislation, key efforts in Congress, or on issues being advanced by federal agencies that have a great impact on gastroenterology. AGA’s ongoing letter writing campaigns can always be found at gastro.org, but be sure to keep an eye out for advocacy emails, AGA eDigest, and social media, so you do not miss your opportunity to take action on timely issues. AGA encourages its members to share letter writing campaigns with their colleagues, as well as posting them on social media.
Meetings with members of Congress. In-person meetings are an excellent opportunity to share with your representatives in Congress, or their staff, how the issues that impact gastroenterology affect you, your patients, and your practice. AGA has a plethora of resources to help you set up such meetings, including up-to-date issue briefs, tips and tricks for productive meetings, and webinars on how to host an on-site visit. AGA staff is always more than happy to help you arrange a meeting either in Washington, D.C., or in your home state. If you are interested in arranging such a meeting, please contact AGA Public Policy Coordinator Jonathan Sollish, at [email protected] or 240-482-3228.
AGA PAC. AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA. It is the only political action committee supported by a national gastroenterology society, and its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates who support our policy priorities, such as fair reimbursement, cutting regulatory red tape, supporting patient protections, and access to specialty care, and sustained federal funding of digestive disease research. If you are interested in learning more, contact AGA Government and Political Affairs Manager Navneet Buttar, at [email protected] or 240-482-3221.
Congressional Advocates Program. This grassroots program is aimed at establishing a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state, and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with members of Congress. Members of the Congressional Advocates Program are mentored and receive advocacy training by AGA leadership and staff. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community, and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
Introducing the AGA Future Leaders class of 2020
AGA has announced the 18 early career physicians and scientists selected to participate in its Future Leaders Program, which was created in 2015 to provide a pathway for leadership development within AGA for early career physicians and scientists who have the potential to make a significant impact on the specialty. These 18 participants will embark on an 18-month-long program designed to develop the skills necessary to become future leaders in the AGA, at their home institutions, and within the field of digestive diseases.
“The 2020 class of AGA Future Leaders represents the next generation of leaders in our field,” said Darrell S. Pardi, MD, MSc, AGAF, co–program chair for the AGA Future Leaders Program. “Along with my cochair, Sheryl Pfeil, MD, AGAF, and the esteemed mentors and faculty participating in this program, we look forward to cultivating these rising stars who stand out for their current achievements, commitment to advancing the field, and potential for future success.”
Class of 2020 Future Leaders
- Christen Klochan Dilly, MD, MEHP, Indiana University School of Medicine and Roudebush VA Medical Center
- Daniel Freedberg, MD, MS, Columbia University
- Wendy A. Henderson, PhD, National Institutes of Health
- Ruben Hernaez, MD, MPH, PhD, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
- Animesh Jain, MD, University of North Carolina at Chapel Hill
- Avinash Ketwaroo, MD, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
- Bharati Kochar, MD, MSCR, University of North Carolina at Chapel Hill
- David Leiman, MD, MSHP, Duke University Medical Center
- James Lin, MD, City of Hope National Medical Center in Duarte
- Michelle Long, MD, Boston Medical Center
- Aimee Lucas, MD, MS, Icahn School of Medicine at Mount Sinai
- Miguel Malespin, MD, Tampa General Hospital
- Simon C. Mathews, MD, Johns Hopkins Medicine
- Karthik Ravi, MD, Mayo Clinic (Rochester, Minnesota)
- Florian Rieder, MD, Cleveland Clinic Foundation
- Kyle Staller, MD, MPH, Harvard Medical School
- Christina Twyman-Saint Victor, MD, University of Pennsylvania Perelman School of Medicine
- Ryan Ungaro, MD, MS, Icahn School of Medicine at Mount Sinai
View Future Leader Bios
The AGA Future Leaders Program will kick off with the AGA Leadership Development Conference March 8-10, 2019, at the Hilton Rockville Executive conference center in Rockville, Maryland, and will continue through Digestive Disease Week® (DDW) 2020 in Chicago, Illinois. Throughout the course of the program, participants will work closely with AGA mentors on projects linked to AGA’s Strategic Plan.
Learn more about the AGA Future Leaders Program.
Sessions at DDW® 2019 designed for fellows and early career GIs
AGA has an agenda of special sessions at Digestive Disease Week® (DDW) 2019 to meet the unique needs of physicians who are new to the field. Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.
With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Visit AGA University for a full list and additional details.
- AGA Postgraduate Course Saturday, May 18, and Sunday, May 19
- Introduction to GI Practice: A Trainee Boot Camp, Monday, May 20, 10-11:30 a.m.
- AGA Board Review CourseMonday, May 20, 1:30-5:30 p.m.
- Advancing Clinical Practice: GI Fellow-Directed Quality Improvement ProjectsMonday, May 20, 2-3:30 p.m.
- GI in the Digital Age, Monday, May 20, 4-5:30 p.m.
DDW Trainee and Early Career Lounge
Included with the cost of DDW registration, trainee and early career GI attendees have access to this lounge in the Sails Pavilion. It’s a great way to meet and network with peers from around the world over a cup of coffee and will feature new programming in 2019. Meet with experts to have your questions answered about practical issues of career choice, contracting, or how to write a manuscript.
Reviews of Audiovisual Materials
The Evolution of the Micrographic Surgery and Dermatologic Oncology Fellowship
Originating in 1968, the dermatologic surgery fellowship is as young as many dermatologists in practice today. Not surprisingly, the blossoming fellowship has undergone its fair share of both growth and growing pains over the last 5 decades.
A Brief History
The first dermatologic surgery fellowship was born in 1968 when Dr. Perry Robins established a program at the New York University Medical Center for training in chemosurgery.1 The fellowship quickly underwent notable change with the rising popularity of the fresh tissue technique, which was first performed by Dr. Fred Mohs in 1953 and made popular following publication of a series of landmark articles on the technique by Drs. Sam Stegman and Theodore Tromovitch in the late 1960s and early 1970s. The fellowship correspondingly saw a rise in fresh tissue technique training, accompanied by a decline in chemosurgery training. In 1974, Dr. Daniel Jones coined the term micrographic surgery to describe the favored technique, and at the 1985 annual meeting of the American College of Chemosurgery, the name of the technique was changed to Mohs micrographic surgery.1
By 1995, the fellowship was officially named Procedural Dermatology, and programs were exclusively accredited by the American College of Mohs Surgery (ACMS). A 1-year Procedural Dermatology fellowship gained accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.2 Beginning in July 2013, all fellowship programs in the United States fell under the governance of the ACGME; however, the ACMS has remained the sponsor of the matching process.3 In 2014, the ACGME changed the name of the fellowship to Micrographic Surgery and Dermatologic Oncology (MSDO).2 Fellowship training today is centered on the core elements of cutaneous oncologic surgery, cutaneous reconstructive surgery, and dermatologic oncology; however, the scope of training in technologies and techniques offered has continued to broaden.4 Many programs now offer additional training in cosmetic and other procedural dermatology. To date, there are 76 accredited MSDO fellowship training programs in the United States and more than 1500 fellowship-trained micrographic surgeons.2,4
Trends in Program and Match Statistics
As the role of dermatologic surgery within the field of dermatology continues to expand, the MSDO fellowship has become increasingly popular over the last decade. From 2005 to 2018, applicants participating in the fellowship match increased by 34%.3 Despite the fellowship’s growing popularity, programs participating in the match have remained largely stable from 2005 to 2018, with 50 positions offered in 2005 and 58 in 2018. The match rate has correspondingly decreased from 66.2% in 2005 to 61.1% in 2018.3
Changes in the Match Process
The fellowship match is processed by the SF Match and sponsored by the ACMS. Over the last decade, programs have increasingly opted for exemptions from participation in the SF Match. In 2005, there were 8 match exemptions. In 2018, there were 20.4 Despite the increasing popularity of match exemptions, in October 2018 the ACMS Board of Directors approved a new policy that eliminated match exemptions, with the exception of applicants on active military duty and international (non-Canadian) applicants. All other applicants applying for a fellowship position for the 2020-2021 academic year must participate in the match.4 This new policy attempts to ensure a fair match process, especially for applicants who have trained at a program without an affiliated MSDO fellowship.
The Road to Board Certification
Further growth during the fellowship’s mid-adult years centered on the long-contested debate on subspecialty board certification. In 2009, an American Society for Dermatologic Surgery membership survey demonstrated an overwhelming majority in opposition. In 2014, the debate resurfaced. At the 2016 American Society for Dermatologic Surgery annual meeting, former American Academy of Dermatology presidents Brett Coldiron, MD, and Darrell S. Rigel, MD, MS, conveyed opposing positions, after which an audience survey demonstrated a 69% opposition rate. Proponents continued to argue that board certification would decrease divisiveness in the specialty, create a better brand, help to obtain a Medicare specialty designation that could help prevent exclusion of Mohs surgeons from insurance networks, give allopathic dermatologists the same opportunity for certification as osteopathic counterparts, and demonstrate competence to the public. Those in opposition argued that the term dermatologic oncology erroneously suggests general dermatologists are not experts in the treatment of skin cancers, practices may be restricted by carriers misusing the new credential, and subspecialty certification would actually create division among practicing dermatologists.5
Following years of debate, the American Board of Dermatology’s proposal to offer subspecialty certification in Micrographic Dermatologic Surgery was submitted to the American Board of Medical Specialties and approved on October 26, 2018. The name of the new subspecialty (Micrographic Dermatologic Surgery) is different than that of the fellowship (Micrographic Surgery and Dermatologic Oncology), a decision reached in response to diplomats indicating discomfort with the term oncology potentially misleading the public that general dermatologists do not treat skin cancer. Per the American Board of Dermatology official website, the first certification examination likely will take place in about 2 years. A maintenance of certification examination for the subspecialty will be required every 10 years.6
Final Thoughts
During its short history, the MSDO fellowship has undergone a notable evolution in recognition, popularity among residents, match process, and board certification, which attests to its adaptability over time and growing prominence.
- Robins P, Ebede TL, Hale EK. The evolution of Mohs micrographic surgery. Skin Cancer Foundation website. https://www.skincancer.org/skin-cancer-information/mohs-surgery/evolution-of-mohs. Updated July 13, 2016. Accessed April 17, 2019.
- Micrographic surgery and dermatologic oncology. American Board of Dermatology website. https://www.abderm.org/residents-and-fellows/fellowship-training/micrographic-surgery-and-dermatologic-oncology.aspx. Accessed April 9, 2019.
- Micrographic Surgery and Dermatologic Oncology Fellowship. San Francisco Match website. https://sfmatch.org/SpecialtyInsideAll.aspx?id=10&typ=1&name=Micrographic%20Surgery%20and%20Dermatologic%20Oncology. Accessed April 9, 2019.
- ACMS fellowship training. American College of Mohs Surgery website. https://www.mohscollege.org/fellowship-training. Accessed April 9, 2019.
- Should the ABD offer a Mohs surgery sub-certification? Dermatology World. April 26, 2017. https://www.aad.org/dw/dw-weekly/should-the-abd-offer-a-mohs-surgery-sub-certification. Accessed April 9, 2019.
- ABD Micrographic Dermatologic Surgery (MDS) subspecialty certification. American Board of Dermatology website. https://www.abderm.org/residents-and-fellows/fellowship-training/micrographic-dermatologic-surgery-mds-questions-and-answers-1.aspx. Accessed April 9, 2019.
Originating in 1968, the dermatologic surgery fellowship is as young as many dermatologists in practice today. Not surprisingly, the blossoming fellowship has undergone its fair share of both growth and growing pains over the last 5 decades.
A Brief History
The first dermatologic surgery fellowship was born in 1968 when Dr. Perry Robins established a program at the New York University Medical Center for training in chemosurgery.1 The fellowship quickly underwent notable change with the rising popularity of the fresh tissue technique, which was first performed by Dr. Fred Mohs in 1953 and made popular following publication of a series of landmark articles on the technique by Drs. Sam Stegman and Theodore Tromovitch in the late 1960s and early 1970s. The fellowship correspondingly saw a rise in fresh tissue technique training, accompanied by a decline in chemosurgery training. In 1974, Dr. Daniel Jones coined the term micrographic surgery to describe the favored technique, and at the 1985 annual meeting of the American College of Chemosurgery, the name of the technique was changed to Mohs micrographic surgery.1
By 1995, the fellowship was officially named Procedural Dermatology, and programs were exclusively accredited by the American College of Mohs Surgery (ACMS). A 1-year Procedural Dermatology fellowship gained accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.2 Beginning in July 2013, all fellowship programs in the United States fell under the governance of the ACGME; however, the ACMS has remained the sponsor of the matching process.3 In 2014, the ACGME changed the name of the fellowship to Micrographic Surgery and Dermatologic Oncology (MSDO).2 Fellowship training today is centered on the core elements of cutaneous oncologic surgery, cutaneous reconstructive surgery, and dermatologic oncology; however, the scope of training in technologies and techniques offered has continued to broaden.4 Many programs now offer additional training in cosmetic and other procedural dermatology. To date, there are 76 accredited MSDO fellowship training programs in the United States and more than 1500 fellowship-trained micrographic surgeons.2,4
Trends in Program and Match Statistics
As the role of dermatologic surgery within the field of dermatology continues to expand, the MSDO fellowship has become increasingly popular over the last decade. From 2005 to 2018, applicants participating in the fellowship match increased by 34%.3 Despite the fellowship’s growing popularity, programs participating in the match have remained largely stable from 2005 to 2018, with 50 positions offered in 2005 and 58 in 2018. The match rate has correspondingly decreased from 66.2% in 2005 to 61.1% in 2018.3
Changes in the Match Process
The fellowship match is processed by the SF Match and sponsored by the ACMS. Over the last decade, programs have increasingly opted for exemptions from participation in the SF Match. In 2005, there were 8 match exemptions. In 2018, there were 20.4 Despite the increasing popularity of match exemptions, in October 2018 the ACMS Board of Directors approved a new policy that eliminated match exemptions, with the exception of applicants on active military duty and international (non-Canadian) applicants. All other applicants applying for a fellowship position for the 2020-2021 academic year must participate in the match.4 This new policy attempts to ensure a fair match process, especially for applicants who have trained at a program without an affiliated MSDO fellowship.
The Road to Board Certification
Further growth during the fellowship’s mid-adult years centered on the long-contested debate on subspecialty board certification. In 2009, an American Society for Dermatologic Surgery membership survey demonstrated an overwhelming majority in opposition. In 2014, the debate resurfaced. At the 2016 American Society for Dermatologic Surgery annual meeting, former American Academy of Dermatology presidents Brett Coldiron, MD, and Darrell S. Rigel, MD, MS, conveyed opposing positions, after which an audience survey demonstrated a 69% opposition rate. Proponents continued to argue that board certification would decrease divisiveness in the specialty, create a better brand, help to obtain a Medicare specialty designation that could help prevent exclusion of Mohs surgeons from insurance networks, give allopathic dermatologists the same opportunity for certification as osteopathic counterparts, and demonstrate competence to the public. Those in opposition argued that the term dermatologic oncology erroneously suggests general dermatologists are not experts in the treatment of skin cancers, practices may be restricted by carriers misusing the new credential, and subspecialty certification would actually create division among practicing dermatologists.5
Following years of debate, the American Board of Dermatology’s proposal to offer subspecialty certification in Micrographic Dermatologic Surgery was submitted to the American Board of Medical Specialties and approved on October 26, 2018. The name of the new subspecialty (Micrographic Dermatologic Surgery) is different than that of the fellowship (Micrographic Surgery and Dermatologic Oncology), a decision reached in response to diplomats indicating discomfort with the term oncology potentially misleading the public that general dermatologists do not treat skin cancer. Per the American Board of Dermatology official website, the first certification examination likely will take place in about 2 years. A maintenance of certification examination for the subspecialty will be required every 10 years.6
Final Thoughts
During its short history, the MSDO fellowship has undergone a notable evolution in recognition, popularity among residents, match process, and board certification, which attests to its adaptability over time and growing prominence.
Originating in 1968, the dermatologic surgery fellowship is as young as many dermatologists in practice today. Not surprisingly, the blossoming fellowship has undergone its fair share of both growth and growing pains over the last 5 decades.
A Brief History
The first dermatologic surgery fellowship was born in 1968 when Dr. Perry Robins established a program at the New York University Medical Center for training in chemosurgery.1 The fellowship quickly underwent notable change with the rising popularity of the fresh tissue technique, which was first performed by Dr. Fred Mohs in 1953 and made popular following publication of a series of landmark articles on the technique by Drs. Sam Stegman and Theodore Tromovitch in the late 1960s and early 1970s. The fellowship correspondingly saw a rise in fresh tissue technique training, accompanied by a decline in chemosurgery training. In 1974, Dr. Daniel Jones coined the term micrographic surgery to describe the favored technique, and at the 1985 annual meeting of the American College of Chemosurgery, the name of the technique was changed to Mohs micrographic surgery.1
By 1995, the fellowship was officially named Procedural Dermatology, and programs were exclusively accredited by the American College of Mohs Surgery (ACMS). A 1-year Procedural Dermatology fellowship gained accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.2 Beginning in July 2013, all fellowship programs in the United States fell under the governance of the ACGME; however, the ACMS has remained the sponsor of the matching process.3 In 2014, the ACGME changed the name of the fellowship to Micrographic Surgery and Dermatologic Oncology (MSDO).2 Fellowship training today is centered on the core elements of cutaneous oncologic surgery, cutaneous reconstructive surgery, and dermatologic oncology; however, the scope of training in technologies and techniques offered has continued to broaden.4 Many programs now offer additional training in cosmetic and other procedural dermatology. To date, there are 76 accredited MSDO fellowship training programs in the United States and more than 1500 fellowship-trained micrographic surgeons.2,4
Trends in Program and Match Statistics
As the role of dermatologic surgery within the field of dermatology continues to expand, the MSDO fellowship has become increasingly popular over the last decade. From 2005 to 2018, applicants participating in the fellowship match increased by 34%.3 Despite the fellowship’s growing popularity, programs participating in the match have remained largely stable from 2005 to 2018, with 50 positions offered in 2005 and 58 in 2018. The match rate has correspondingly decreased from 66.2% in 2005 to 61.1% in 2018.3
Changes in the Match Process
The fellowship match is processed by the SF Match and sponsored by the ACMS. Over the last decade, programs have increasingly opted for exemptions from participation in the SF Match. In 2005, there were 8 match exemptions. In 2018, there were 20.4 Despite the increasing popularity of match exemptions, in October 2018 the ACMS Board of Directors approved a new policy that eliminated match exemptions, with the exception of applicants on active military duty and international (non-Canadian) applicants. All other applicants applying for a fellowship position for the 2020-2021 academic year must participate in the match.4 This new policy attempts to ensure a fair match process, especially for applicants who have trained at a program without an affiliated MSDO fellowship.
The Road to Board Certification
Further growth during the fellowship’s mid-adult years centered on the long-contested debate on subspecialty board certification. In 2009, an American Society for Dermatologic Surgery membership survey demonstrated an overwhelming majority in opposition. In 2014, the debate resurfaced. At the 2016 American Society for Dermatologic Surgery annual meeting, former American Academy of Dermatology presidents Brett Coldiron, MD, and Darrell S. Rigel, MD, MS, conveyed opposing positions, after which an audience survey demonstrated a 69% opposition rate. Proponents continued to argue that board certification would decrease divisiveness in the specialty, create a better brand, help to obtain a Medicare specialty designation that could help prevent exclusion of Mohs surgeons from insurance networks, give allopathic dermatologists the same opportunity for certification as osteopathic counterparts, and demonstrate competence to the public. Those in opposition argued that the term dermatologic oncology erroneously suggests general dermatologists are not experts in the treatment of skin cancers, practices may be restricted by carriers misusing the new credential, and subspecialty certification would actually create division among practicing dermatologists.5
Following years of debate, the American Board of Dermatology’s proposal to offer subspecialty certification in Micrographic Dermatologic Surgery was submitted to the American Board of Medical Specialties and approved on October 26, 2018. The name of the new subspecialty (Micrographic Dermatologic Surgery) is different than that of the fellowship (Micrographic Surgery and Dermatologic Oncology), a decision reached in response to diplomats indicating discomfort with the term oncology potentially misleading the public that general dermatologists do not treat skin cancer. Per the American Board of Dermatology official website, the first certification examination likely will take place in about 2 years. A maintenance of certification examination for the subspecialty will be required every 10 years.6
Final Thoughts
During its short history, the MSDO fellowship has undergone a notable evolution in recognition, popularity among residents, match process, and board certification, which attests to its adaptability over time and growing prominence.
- Robins P, Ebede TL, Hale EK. The evolution of Mohs micrographic surgery. Skin Cancer Foundation website. https://www.skincancer.org/skin-cancer-information/mohs-surgery/evolution-of-mohs. Updated July 13, 2016. Accessed April 17, 2019.
- Micrographic surgery and dermatologic oncology. American Board of Dermatology website. https://www.abderm.org/residents-and-fellows/fellowship-training/micrographic-surgery-and-dermatologic-oncology.aspx. Accessed April 9, 2019.
- Micrographic Surgery and Dermatologic Oncology Fellowship. San Francisco Match website. https://sfmatch.org/SpecialtyInsideAll.aspx?id=10&typ=1&name=Micrographic%20Surgery%20and%20Dermatologic%20Oncology. Accessed April 9, 2019.
- ACMS fellowship training. American College of Mohs Surgery website. https://www.mohscollege.org/fellowship-training. Accessed April 9, 2019.
- Should the ABD offer a Mohs surgery sub-certification? Dermatology World. April 26, 2017. https://www.aad.org/dw/dw-weekly/should-the-abd-offer-a-mohs-surgery-sub-certification. Accessed April 9, 2019.
- ABD Micrographic Dermatologic Surgery (MDS) subspecialty certification. American Board of Dermatology website. https://www.abderm.org/residents-and-fellows/fellowship-training/micrographic-dermatologic-surgery-mds-questions-and-answers-1.aspx. Accessed April 9, 2019.
- Robins P, Ebede TL, Hale EK. The evolution of Mohs micrographic surgery. Skin Cancer Foundation website. https://www.skincancer.org/skin-cancer-information/mohs-surgery/evolution-of-mohs. Updated July 13, 2016. Accessed April 17, 2019.
- Micrographic surgery and dermatologic oncology. American Board of Dermatology website. https://www.abderm.org/residents-and-fellows/fellowship-training/micrographic-surgery-and-dermatologic-oncology.aspx. Accessed April 9, 2019.
- Micrographic Surgery and Dermatologic Oncology Fellowship. San Francisco Match website. https://sfmatch.org/SpecialtyInsideAll.aspx?id=10&typ=1&name=Micrographic%20Surgery%20and%20Dermatologic%20Oncology. Accessed April 9, 2019.
- ACMS fellowship training. American College of Mohs Surgery website. https://www.mohscollege.org/fellowship-training. Accessed April 9, 2019.
- Should the ABD offer a Mohs surgery sub-certification? Dermatology World. April 26, 2017. https://www.aad.org/dw/dw-weekly/should-the-abd-offer-a-mohs-surgery-sub-certification. Accessed April 9, 2019.
- ABD Micrographic Dermatologic Surgery (MDS) subspecialty certification. American Board of Dermatology website. https://www.abderm.org/residents-and-fellows/fellowship-training/micrographic-dermatologic-surgery-mds-questions-and-answers-1.aspx. Accessed April 9, 2019.
Resident Pearl
- Residents should be aware of recent changes to the Micrographic Surgery and Dermatologic Oncology fellowship: the elimination of fellowship match exemptions for most applicants for the upcoming 2019-2020 academic year, the American Board of Medical Specialties approval of subspecialty certification in Micrographic Dermatologic Surgery, and the likelihood of the first subspecialty certification examination in the next 2 years.
In Memoriam
Decline in CIN2+ in younger women after HPV vaccine introduced
The introduction of human papillomavirus vaccination in the United States in 2006 was associated with a significant decrease in the rates of cervical intraepithelial neoplasia grades 2 and above (CIN2+) in younger women.
The overall rate of CIN2+ declined from an estimated 216,000 cases in 2008 – 55% of which were in women aged 18-29 years – to 196,000 cases in 2016, of which 36% were in women aged 18-29 years, according to analysis of data from the Human Papillomavirus Vaccine Impact Monitoring Program (MMWR. 2019 Apr 19;68:337-43.
In 2008, the highest rates of CIN2+ were seen in women aged 20-24 years and decreased with age, but in 2016, the highest rates were in women aged 25-29 years. The rates of CIN2+ declined significantly in women aged 18-19 years from 2008-2016, but increased in women aged 40-64 years.
In 2008 and 2016, around three-quarters of all CIN2+ cases were attributable to HPV types that are targeted by the HPV vaccine. However the rates of vaccine-preventable CIN2+ declined among women aged 18-24 years, from 52% in 2008 to 30% in 2016.
“Both the estimated number and rates of U.S. CIN2+ cases in this report must be interpreted in the context of cervical cancer prevention strategies, including HPV vaccination and cervical cancer screening,” wrote Nancy M. McClung, PhD, of the Epidemic Intelligence Service at the Centers for Disease Control and Prevention and coauthors.
Notably, the screening interval for cervical cancer was increased from yearly in 2008 to once in 3 years with cytology alone or once in 5 years with cytology plus HPV testing for women aged 30 or above in 2016.
“Older age at screening initiation, longer screening intervals, and more conservative management in young women might be expected to reduce the number of CIN2+ cases detected in younger age groups in whom lesions are most likely to regress and shift detection of some CIN2+ to older age groups, resulting in a transient increase in rates,” Dr. McClung and colleagues wrote.
However they noted that the decrease in HPV 16/18–attributable CIN2+ rates among younger age groups was likely a reflection of the impact of the introduction of the quadrivalent vaccine immunization program.
One author declared personal fees from Merck during the course of the study. No other conflicts of interest were declared.
SOURCE: McClung N et al. MMWR. 2019 Apr 19;68:337-43.
The introduction of human papillomavirus vaccination in the United States in 2006 was associated with a significant decrease in the rates of cervical intraepithelial neoplasia grades 2 and above (CIN2+) in younger women.
The overall rate of CIN2+ declined from an estimated 216,000 cases in 2008 – 55% of which were in women aged 18-29 years – to 196,000 cases in 2016, of which 36% were in women aged 18-29 years, according to analysis of data from the Human Papillomavirus Vaccine Impact Monitoring Program (MMWR. 2019 Apr 19;68:337-43.
In 2008, the highest rates of CIN2+ were seen in women aged 20-24 years and decreased with age, but in 2016, the highest rates were in women aged 25-29 years. The rates of CIN2+ declined significantly in women aged 18-19 years from 2008-2016, but increased in women aged 40-64 years.
In 2008 and 2016, around three-quarters of all CIN2+ cases were attributable to HPV types that are targeted by the HPV vaccine. However the rates of vaccine-preventable CIN2+ declined among women aged 18-24 years, from 52% in 2008 to 30% in 2016.
“Both the estimated number and rates of U.S. CIN2+ cases in this report must be interpreted in the context of cervical cancer prevention strategies, including HPV vaccination and cervical cancer screening,” wrote Nancy M. McClung, PhD, of the Epidemic Intelligence Service at the Centers for Disease Control and Prevention and coauthors.
Notably, the screening interval for cervical cancer was increased from yearly in 2008 to once in 3 years with cytology alone or once in 5 years with cytology plus HPV testing for women aged 30 or above in 2016.
“Older age at screening initiation, longer screening intervals, and more conservative management in young women might be expected to reduce the number of CIN2+ cases detected in younger age groups in whom lesions are most likely to regress and shift detection of some CIN2+ to older age groups, resulting in a transient increase in rates,” Dr. McClung and colleagues wrote.
However they noted that the decrease in HPV 16/18–attributable CIN2+ rates among younger age groups was likely a reflection of the impact of the introduction of the quadrivalent vaccine immunization program.
One author declared personal fees from Merck during the course of the study. No other conflicts of interest were declared.
SOURCE: McClung N et al. MMWR. 2019 Apr 19;68:337-43.
The introduction of human papillomavirus vaccination in the United States in 2006 was associated with a significant decrease in the rates of cervical intraepithelial neoplasia grades 2 and above (CIN2+) in younger women.
The overall rate of CIN2+ declined from an estimated 216,000 cases in 2008 – 55% of which were in women aged 18-29 years – to 196,000 cases in 2016, of which 36% were in women aged 18-29 years, according to analysis of data from the Human Papillomavirus Vaccine Impact Monitoring Program (MMWR. 2019 Apr 19;68:337-43.
In 2008, the highest rates of CIN2+ were seen in women aged 20-24 years and decreased with age, but in 2016, the highest rates were in women aged 25-29 years. The rates of CIN2+ declined significantly in women aged 18-19 years from 2008-2016, but increased in women aged 40-64 years.
In 2008 and 2016, around three-quarters of all CIN2+ cases were attributable to HPV types that are targeted by the HPV vaccine. However the rates of vaccine-preventable CIN2+ declined among women aged 18-24 years, from 52% in 2008 to 30% in 2016.
“Both the estimated number and rates of U.S. CIN2+ cases in this report must be interpreted in the context of cervical cancer prevention strategies, including HPV vaccination and cervical cancer screening,” wrote Nancy M. McClung, PhD, of the Epidemic Intelligence Service at the Centers for Disease Control and Prevention and coauthors.
Notably, the screening interval for cervical cancer was increased from yearly in 2008 to once in 3 years with cytology alone or once in 5 years with cytology plus HPV testing for women aged 30 or above in 2016.
“Older age at screening initiation, longer screening intervals, and more conservative management in young women might be expected to reduce the number of CIN2+ cases detected in younger age groups in whom lesions are most likely to regress and shift detection of some CIN2+ to older age groups, resulting in a transient increase in rates,” Dr. McClung and colleagues wrote.
However they noted that the decrease in HPV 16/18–attributable CIN2+ rates among younger age groups was likely a reflection of the impact of the introduction of the quadrivalent vaccine immunization program.
One author declared personal fees from Merck during the course of the study. No other conflicts of interest were declared.
SOURCE: McClung N et al. MMWR. 2019 Apr 19;68:337-43.
FROM MMWR
A Critical Review of Periodic Health Screening Using Specific Screening Criteria: Part 3: Selected Diseases of the Genitourinary System
Back to the drawing board for MPN combo
NEWPORT BEACH, CALIF. – The combination of ruxolitinib and decitabine will not proceed to a phase 3 trial in patients with accelerated or blast phase myeloproliferative neoplasms (MPNs).
The combination demonstrated activity and tolerability in a phase 2 trial, but outcomes were not optimal, according to Raajit K. Rampal, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York.
“[P]erhaps the outcomes might be favorable compared to standard induction chemotherapy regimens,” Dr. Rampal said. “Nonetheless, it’s clear that we still have a lot of work to do, and the outcomes are not optimal in these patients.”
However, Dr. Rampal and his colleagues are investigating the possibility of combining ruxolitinib and decitabine with other agents to treat patients with accelerated or blast phase MPNs.
Dr. Rampal and his colleagues presented results from the phase 2 trial in a poster at the Acute Leukemia Forum of Hemedicus.
The trial (NCT02076191) enrolled 25 patients, 10 with accelerated phase MPN (10%-19% blasts) and 15 with blast phase MPN (at least 20% blasts). The patients’ median age was 71 years.
Patients had a median disease duration of 72.9 months. Six patients (25%) had received prior ruxolitinib, and two (8.3%) had received prior decitabine.
Treatment and safety
For the first cycle, patients received decitabine at 20 mg/m2 per day on days 8-12 and ruxolitinib at 25 mg twice a day on days 1-35. For subsequent cycles, patients received the same dose of decitabine on days 1-5 and ruxolitinib at 10 mg twice a day on days 6-28. Patients were treated until progression, withdrawal, or unacceptable toxicity.
“The adverse events we saw in this study were typical for this population, including fevers, mostly neutropenic fevers, as well as anemia and thrombocytopenia,” Dr. Rampal said.
Nonhematologic adverse events (AEs) included fatigue, abdominal pain, pneumonia, diarrhea, dizziness, and constipation. Hematologic AEs included anemia, neutropenia, febrile neutropenia, and thrombocytopenia.
Response and survival
Eighteen patients were evaluable for response. Four patients were not evaluable because they withdrew from the study due to secondary AEs and completed one cycle of therapy or less, two patients did not have circulating blasts at baseline, and one patient refused further treatment.
Among the evaluable patients, nine (50%) achieved a partial response, including four patients with accelerated phase MPN and five with blast phase MPN.
Two patients (11.1%), one with accelerated phase MPN and one with blast phase MPN, achieved a complete response with incomplete count recovery.
The remaining seven patients (38.9%), five with blast phase MPN and two with accelerated phase MPN, did not respond.
The median overall survival was 7.6 months for the entire cohort, 9.7 months for patients with blast phase MPN, and 5.8 months for patients with accelerated phase MPN.
Based on these results, Dr. Rampal and his colleagues theorized that ruxolitinib plus decitabine might be improved by the addition of other agents. The researchers are currently investigating this possibility.
“The work for this trial really came out of preclinical work in the laboratory where we combined these drugs and saw efficacy in murine models,” Dr. Rampal said. “So we’re going back to the drawing board and looking at those again to see, ‘Can we come up with new rational combinations?’ ”
Dr. Rampal and his colleagues reported having no conflicts of interest. Their study was supported by the National Institutes of Health, the National Cancer Institute, and Incyte Corporation.
The Acute Leukemia Forum is held by Hemedicus, which is owned by the same company as this news organization.
NEWPORT BEACH, CALIF. – The combination of ruxolitinib and decitabine will not proceed to a phase 3 trial in patients with accelerated or blast phase myeloproliferative neoplasms (MPNs).
The combination demonstrated activity and tolerability in a phase 2 trial, but outcomes were not optimal, according to Raajit K. Rampal, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York.
“[P]erhaps the outcomes might be favorable compared to standard induction chemotherapy regimens,” Dr. Rampal said. “Nonetheless, it’s clear that we still have a lot of work to do, and the outcomes are not optimal in these patients.”
However, Dr. Rampal and his colleagues are investigating the possibility of combining ruxolitinib and decitabine with other agents to treat patients with accelerated or blast phase MPNs.
Dr. Rampal and his colleagues presented results from the phase 2 trial in a poster at the Acute Leukemia Forum of Hemedicus.
The trial (NCT02076191) enrolled 25 patients, 10 with accelerated phase MPN (10%-19% blasts) and 15 with blast phase MPN (at least 20% blasts). The patients’ median age was 71 years.
Patients had a median disease duration of 72.9 months. Six patients (25%) had received prior ruxolitinib, and two (8.3%) had received prior decitabine.
Treatment and safety
For the first cycle, patients received decitabine at 20 mg/m2 per day on days 8-12 and ruxolitinib at 25 mg twice a day on days 1-35. For subsequent cycles, patients received the same dose of decitabine on days 1-5 and ruxolitinib at 10 mg twice a day on days 6-28. Patients were treated until progression, withdrawal, or unacceptable toxicity.
“The adverse events we saw in this study were typical for this population, including fevers, mostly neutropenic fevers, as well as anemia and thrombocytopenia,” Dr. Rampal said.
Nonhematologic adverse events (AEs) included fatigue, abdominal pain, pneumonia, diarrhea, dizziness, and constipation. Hematologic AEs included anemia, neutropenia, febrile neutropenia, and thrombocytopenia.
Response and survival
Eighteen patients were evaluable for response. Four patients were not evaluable because they withdrew from the study due to secondary AEs and completed one cycle of therapy or less, two patients did not have circulating blasts at baseline, and one patient refused further treatment.
Among the evaluable patients, nine (50%) achieved a partial response, including four patients with accelerated phase MPN and five with blast phase MPN.
Two patients (11.1%), one with accelerated phase MPN and one with blast phase MPN, achieved a complete response with incomplete count recovery.
The remaining seven patients (38.9%), five with blast phase MPN and two with accelerated phase MPN, did not respond.
The median overall survival was 7.6 months for the entire cohort, 9.7 months for patients with blast phase MPN, and 5.8 months for patients with accelerated phase MPN.
Based on these results, Dr. Rampal and his colleagues theorized that ruxolitinib plus decitabine might be improved by the addition of other agents. The researchers are currently investigating this possibility.
“The work for this trial really came out of preclinical work in the laboratory where we combined these drugs and saw efficacy in murine models,” Dr. Rampal said. “So we’re going back to the drawing board and looking at those again to see, ‘Can we come up with new rational combinations?’ ”
Dr. Rampal and his colleagues reported having no conflicts of interest. Their study was supported by the National Institutes of Health, the National Cancer Institute, and Incyte Corporation.
The Acute Leukemia Forum is held by Hemedicus, which is owned by the same company as this news organization.
NEWPORT BEACH, CALIF. – The combination of ruxolitinib and decitabine will not proceed to a phase 3 trial in patients with accelerated or blast phase myeloproliferative neoplasms (MPNs).
The combination demonstrated activity and tolerability in a phase 2 trial, but outcomes were not optimal, according to Raajit K. Rampal, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York.
“[P]erhaps the outcomes might be favorable compared to standard induction chemotherapy regimens,” Dr. Rampal said. “Nonetheless, it’s clear that we still have a lot of work to do, and the outcomes are not optimal in these patients.”
However, Dr. Rampal and his colleagues are investigating the possibility of combining ruxolitinib and decitabine with other agents to treat patients with accelerated or blast phase MPNs.
Dr. Rampal and his colleagues presented results from the phase 2 trial in a poster at the Acute Leukemia Forum of Hemedicus.
The trial (NCT02076191) enrolled 25 patients, 10 with accelerated phase MPN (10%-19% blasts) and 15 with blast phase MPN (at least 20% blasts). The patients’ median age was 71 years.
Patients had a median disease duration of 72.9 months. Six patients (25%) had received prior ruxolitinib, and two (8.3%) had received prior decitabine.
Treatment and safety
For the first cycle, patients received decitabine at 20 mg/m2 per day on days 8-12 and ruxolitinib at 25 mg twice a day on days 1-35. For subsequent cycles, patients received the same dose of decitabine on days 1-5 and ruxolitinib at 10 mg twice a day on days 6-28. Patients were treated until progression, withdrawal, or unacceptable toxicity.
“The adverse events we saw in this study were typical for this population, including fevers, mostly neutropenic fevers, as well as anemia and thrombocytopenia,” Dr. Rampal said.
Nonhematologic adverse events (AEs) included fatigue, abdominal pain, pneumonia, diarrhea, dizziness, and constipation. Hematologic AEs included anemia, neutropenia, febrile neutropenia, and thrombocytopenia.
Response and survival
Eighteen patients were evaluable for response. Four patients were not evaluable because they withdrew from the study due to secondary AEs and completed one cycle of therapy or less, two patients did not have circulating blasts at baseline, and one patient refused further treatment.
Among the evaluable patients, nine (50%) achieved a partial response, including four patients with accelerated phase MPN and five with blast phase MPN.
Two patients (11.1%), one with accelerated phase MPN and one with blast phase MPN, achieved a complete response with incomplete count recovery.
The remaining seven patients (38.9%), five with blast phase MPN and two with accelerated phase MPN, did not respond.
The median overall survival was 7.6 months for the entire cohort, 9.7 months for patients with blast phase MPN, and 5.8 months for patients with accelerated phase MPN.
Based on these results, Dr. Rampal and his colleagues theorized that ruxolitinib plus decitabine might be improved by the addition of other agents. The researchers are currently investigating this possibility.
“The work for this trial really came out of preclinical work in the laboratory where we combined these drugs and saw efficacy in murine models,” Dr. Rampal said. “So we’re going back to the drawing board and looking at those again to see, ‘Can we come up with new rational combinations?’ ”
Dr. Rampal and his colleagues reported having no conflicts of interest. Their study was supported by the National Institutes of Health, the National Cancer Institute, and Incyte Corporation.
The Acute Leukemia Forum is held by Hemedicus, which is owned by the same company as this news organization.
REPORTING FROM ALF 2019
Polyp detection rates during colonoscopy similar among endoscopists
“We sought to assess the association between endoscopist characteristics and adenoma detection rates [ADRs] and proximal sessile serrated polyp detection rates [pSSPDRs],” wrote Shashank Sarvepalli, MD, MS, of the Cleveland Clinic along with his colleagues. The findings were reported in JAMA Surgery.
The researchers conducted a retrospective cohort study of 16,089 patients who underwent screening colonoscopies that were conducted by 56 endoscopists. Data were obtained from the Cleveland Clinic health system during 2015-2017.
Dr. Sarvepalli and his colleagues analyzed seven surgeon characteristics, including time since completion of training, number of colonoscopies performed annually, specialty, and practice setting. Subsequently, they examined the relationships between ADRs and pSSPDRs and these parameters.
“Only patients undergoing normal-risk screening colonoscopies and colonoscopies performed by clinicians who performed more than 100 normal-risk screening colonoscopies during the study period were included,” the researchers wrote.
After analysis, the researchers found that ADR was not significantly associated with any of the characteristics, while pSSPDR was significantly associated with number of years in practice (odds ratio per increment of 10 years, 0.86; 95% confidence interval, 0.83-0.89; P less than .001) and annual colonoscopies completed (OR per 50 colonoscopies annually, 1.05; 95% CI, 1.01-1.09; P = .02).
“After adjusting for additional factors, no difference in detection based on endoscopist characteristics was found,” they added.
The researchers acknowledged that a key limitation of the study was the retrospective design. As a result, the team reported that the findings could be prone to exclusions and misreporting.
No funding sources were reported, and the authors reported no conflicts of interest.
SOURCE: Sarvepalli S et al. JAMA Surg. 2019 Apr 17. doi: 10.1001/jamasurg.2019.0564.
“We sought to assess the association between endoscopist characteristics and adenoma detection rates [ADRs] and proximal sessile serrated polyp detection rates [pSSPDRs],” wrote Shashank Sarvepalli, MD, MS, of the Cleveland Clinic along with his colleagues. The findings were reported in JAMA Surgery.
The researchers conducted a retrospective cohort study of 16,089 patients who underwent screening colonoscopies that were conducted by 56 endoscopists. Data were obtained from the Cleveland Clinic health system during 2015-2017.
Dr. Sarvepalli and his colleagues analyzed seven surgeon characteristics, including time since completion of training, number of colonoscopies performed annually, specialty, and practice setting. Subsequently, they examined the relationships between ADRs and pSSPDRs and these parameters.
“Only patients undergoing normal-risk screening colonoscopies and colonoscopies performed by clinicians who performed more than 100 normal-risk screening colonoscopies during the study period were included,” the researchers wrote.
After analysis, the researchers found that ADR was not significantly associated with any of the characteristics, while pSSPDR was significantly associated with number of years in practice (odds ratio per increment of 10 years, 0.86; 95% confidence interval, 0.83-0.89; P less than .001) and annual colonoscopies completed (OR per 50 colonoscopies annually, 1.05; 95% CI, 1.01-1.09; P = .02).
“After adjusting for additional factors, no difference in detection based on endoscopist characteristics was found,” they added.
The researchers acknowledged that a key limitation of the study was the retrospective design. As a result, the team reported that the findings could be prone to exclusions and misreporting.
No funding sources were reported, and the authors reported no conflicts of interest.
SOURCE: Sarvepalli S et al. JAMA Surg. 2019 Apr 17. doi: 10.1001/jamasurg.2019.0564.
“We sought to assess the association between endoscopist characteristics and adenoma detection rates [ADRs] and proximal sessile serrated polyp detection rates [pSSPDRs],” wrote Shashank Sarvepalli, MD, MS, of the Cleveland Clinic along with his colleagues. The findings were reported in JAMA Surgery.
The researchers conducted a retrospective cohort study of 16,089 patients who underwent screening colonoscopies that were conducted by 56 endoscopists. Data were obtained from the Cleveland Clinic health system during 2015-2017.
Dr. Sarvepalli and his colleagues analyzed seven surgeon characteristics, including time since completion of training, number of colonoscopies performed annually, specialty, and practice setting. Subsequently, they examined the relationships between ADRs and pSSPDRs and these parameters.
“Only patients undergoing normal-risk screening colonoscopies and colonoscopies performed by clinicians who performed more than 100 normal-risk screening colonoscopies during the study period were included,” the researchers wrote.
After analysis, the researchers found that ADR was not significantly associated with any of the characteristics, while pSSPDR was significantly associated with number of years in practice (odds ratio per increment of 10 years, 0.86; 95% confidence interval, 0.83-0.89; P less than .001) and annual colonoscopies completed (OR per 50 colonoscopies annually, 1.05; 95% CI, 1.01-1.09; P = .02).
“After adjusting for additional factors, no difference in detection based on endoscopist characteristics was found,” they added.
The researchers acknowledged that a key limitation of the study was the retrospective design. As a result, the team reported that the findings could be prone to exclusions and misreporting.
No funding sources were reported, and the authors reported no conflicts of interest.
SOURCE: Sarvepalli S et al. JAMA Surg. 2019 Apr 17. doi: 10.1001/jamasurg.2019.0564.
FROM JAMA SURGERY