User login
Apple Watch algorithm brings wearables closer to clinical practice
NEW ORLEANS – , Matthew W. Martinez, MD, medical director of the Sports Cardiology and Hypertrophic Cardiomyopathy Center at the Lehigh Valley Health Network in Allentown, Pa., said in a video interview.
The Apple Heart Study, presented at the annual meeting of the American College of Cardiology, evaluated a mobile app that uses the watch’s existing light sensor technology to detect subtle changes that might indicate an arrhythmia.
The Apple Watch generates a tachogram, which is a plot of time between heart beats. If an abnormal tachogram occurs five out of six times, they are analyzed by an algorithm and sent to the Apple Watch.
The positive predictive value for the tachogram was 71%, and the positive predictive value for the notification was 84%.
Dr. Martinez, who is lead cardiologist for U.S. Major League Soccer and is also heavily involved with the National Football League, said that the study helps clinicians understand the utility of wearable technology.
His take home from the study is that, when people are notified by their watch, they should notify their health care provider, and the provider should take it seriously.
Dr. Martinez was not involved in the Apple Heart Study, and had no relevant disclosures.
NEW ORLEANS – , Matthew W. Martinez, MD, medical director of the Sports Cardiology and Hypertrophic Cardiomyopathy Center at the Lehigh Valley Health Network in Allentown, Pa., said in a video interview.
The Apple Heart Study, presented at the annual meeting of the American College of Cardiology, evaluated a mobile app that uses the watch’s existing light sensor technology to detect subtle changes that might indicate an arrhythmia.
The Apple Watch generates a tachogram, which is a plot of time between heart beats. If an abnormal tachogram occurs five out of six times, they are analyzed by an algorithm and sent to the Apple Watch.
The positive predictive value for the tachogram was 71%, and the positive predictive value for the notification was 84%.
Dr. Martinez, who is lead cardiologist for U.S. Major League Soccer and is also heavily involved with the National Football League, said that the study helps clinicians understand the utility of wearable technology.
His take home from the study is that, when people are notified by their watch, they should notify their health care provider, and the provider should take it seriously.
Dr. Martinez was not involved in the Apple Heart Study, and had no relevant disclosures.
NEW ORLEANS – , Matthew W. Martinez, MD, medical director of the Sports Cardiology and Hypertrophic Cardiomyopathy Center at the Lehigh Valley Health Network in Allentown, Pa., said in a video interview.
The Apple Heart Study, presented at the annual meeting of the American College of Cardiology, evaluated a mobile app that uses the watch’s existing light sensor technology to detect subtle changes that might indicate an arrhythmia.
The Apple Watch generates a tachogram, which is a plot of time between heart beats. If an abnormal tachogram occurs five out of six times, they are analyzed by an algorithm and sent to the Apple Watch.
The positive predictive value for the tachogram was 71%, and the positive predictive value for the notification was 84%.
Dr. Martinez, who is lead cardiologist for U.S. Major League Soccer and is also heavily involved with the National Football League, said that the study helps clinicians understand the utility of wearable technology.
His take home from the study is that, when people are notified by their watch, they should notify their health care provider, and the provider should take it seriously.
Dr. Martinez was not involved in the Apple Heart Study, and had no relevant disclosures.
REPORTING FROM ACC 19
Real-world efficacy with intravascular lithotripsy
washington, dc – A real-world case series suggests intravascular lithotripsy (IVL) is safe and effective when used selectively to treat coronary arterial calcifications, according to data presented at the 2019 Transcatheter Cardiovascular Therapeutics (CRT) meeting.
Relative to other options, “IVL offers a more controlled means of calcium modification and it avoids the no-reflow phenomenon common to atherectomy in patients with a high calcium burden,” reported Julian Yeoh, MBBS, an interventional cardiologist affiliated with King’s College Hospital, London, UK.
On the basis of the DISRUPT CAD study, presented at the 2016 TCT meeting, IVL was approved in Europe for calcified coronary artery disease in May 2018. The Shockwave IVL device (Shockwave Medical) is currently approved in the U.S. only for treatment of calcified lesions associated with peripheral artery disease (PAD).
In what was characterized as a “real-world series,” 14 procedures were performed at Dr. Yeoh’s institution as part of a clinical study, but 40 procedures were completed on an all-comer basis. Many were performed for indications, such as multivessel disease, that would have been excluded from the DISRUPT CAD study.
“We included elderly patients, patients in cardiogenic shock, and patients with chronic total occlusions,” Dr. Yeoh reported. Presenting specific cases, he described using IVL to permit venous access for a transcatheter aortic valve replacement (TAVR), a failed rotational atherectomy, and to salvage a percutaneous angioplasty thwarted by residual calcium calcification.
“Total procedural success in this series was 91% with 100% facilitation of stent delivery,” Dr. Yeoh said. “There have been no cases of coronary perforation and no reflow or 30-day target lesion failure.”
In this series, the mean age of the patients was 75.9 years. On optical coherence tomography (OCT), which was employed in about half of the cases, the mean residual stenosis was approximately 20%.
IVL involves passing a balloon into the target lesion with the same guidewire used for other percutaneous interventions. Once in position, sonic pressure waves fracture the calcium deposit “with no injury to the intimal soft tissue,” according to Dr. Yeoh, who said that there were no serious adverse events associated with IVL in the series he presented.
In DISRUPT CAD, which enrolled 60 patients, procedural success was 95% with a reduction in mean stenosis from 68.1% to 13.1%. The rate of major adverse cardiovascular event (MACE) events was 5% at 30 days.
While DISRUPT CAD-II is an on-going post-market registry collecting data in Europe and other areas of the world where IVL is approved for treatment of coronary artery disease, a pivotal trial called DISRUPT CAD III has been launched to gain an indication for treatment of coronary calcifications in the U.S. The prospective global trial has a planned enrollment of nearly 400 patients with expected completion in August 2020.
SOURCE: Yeoh J et al. 2019 Cardiovascular Research Technologies (CRT) Meeting abstract.
washington, dc – A real-world case series suggests intravascular lithotripsy (IVL) is safe and effective when used selectively to treat coronary arterial calcifications, according to data presented at the 2019 Transcatheter Cardiovascular Therapeutics (CRT) meeting.
Relative to other options, “IVL offers a more controlled means of calcium modification and it avoids the no-reflow phenomenon common to atherectomy in patients with a high calcium burden,” reported Julian Yeoh, MBBS, an interventional cardiologist affiliated with King’s College Hospital, London, UK.
On the basis of the DISRUPT CAD study, presented at the 2016 TCT meeting, IVL was approved in Europe for calcified coronary artery disease in May 2018. The Shockwave IVL device (Shockwave Medical) is currently approved in the U.S. only for treatment of calcified lesions associated with peripheral artery disease (PAD).
In what was characterized as a “real-world series,” 14 procedures were performed at Dr. Yeoh’s institution as part of a clinical study, but 40 procedures were completed on an all-comer basis. Many were performed for indications, such as multivessel disease, that would have been excluded from the DISRUPT CAD study.
“We included elderly patients, patients in cardiogenic shock, and patients with chronic total occlusions,” Dr. Yeoh reported. Presenting specific cases, he described using IVL to permit venous access for a transcatheter aortic valve replacement (TAVR), a failed rotational atherectomy, and to salvage a percutaneous angioplasty thwarted by residual calcium calcification.
“Total procedural success in this series was 91% with 100% facilitation of stent delivery,” Dr. Yeoh said. “There have been no cases of coronary perforation and no reflow or 30-day target lesion failure.”
In this series, the mean age of the patients was 75.9 years. On optical coherence tomography (OCT), which was employed in about half of the cases, the mean residual stenosis was approximately 20%.
IVL involves passing a balloon into the target lesion with the same guidewire used for other percutaneous interventions. Once in position, sonic pressure waves fracture the calcium deposit “with no injury to the intimal soft tissue,” according to Dr. Yeoh, who said that there were no serious adverse events associated with IVL in the series he presented.
In DISRUPT CAD, which enrolled 60 patients, procedural success was 95% with a reduction in mean stenosis from 68.1% to 13.1%. The rate of major adverse cardiovascular event (MACE) events was 5% at 30 days.
While DISRUPT CAD-II is an on-going post-market registry collecting data in Europe and other areas of the world where IVL is approved for treatment of coronary artery disease, a pivotal trial called DISRUPT CAD III has been launched to gain an indication for treatment of coronary calcifications in the U.S. The prospective global trial has a planned enrollment of nearly 400 patients with expected completion in August 2020.
SOURCE: Yeoh J et al. 2019 Cardiovascular Research Technologies (CRT) Meeting abstract.
washington, dc – A real-world case series suggests intravascular lithotripsy (IVL) is safe and effective when used selectively to treat coronary arterial calcifications, according to data presented at the 2019 Transcatheter Cardiovascular Therapeutics (CRT) meeting.
Relative to other options, “IVL offers a more controlled means of calcium modification and it avoids the no-reflow phenomenon common to atherectomy in patients with a high calcium burden,” reported Julian Yeoh, MBBS, an interventional cardiologist affiliated with King’s College Hospital, London, UK.
On the basis of the DISRUPT CAD study, presented at the 2016 TCT meeting, IVL was approved in Europe for calcified coronary artery disease in May 2018. The Shockwave IVL device (Shockwave Medical) is currently approved in the U.S. only for treatment of calcified lesions associated with peripheral artery disease (PAD).
In what was characterized as a “real-world series,” 14 procedures were performed at Dr. Yeoh’s institution as part of a clinical study, but 40 procedures were completed on an all-comer basis. Many were performed for indications, such as multivessel disease, that would have been excluded from the DISRUPT CAD study.
“We included elderly patients, patients in cardiogenic shock, and patients with chronic total occlusions,” Dr. Yeoh reported. Presenting specific cases, he described using IVL to permit venous access for a transcatheter aortic valve replacement (TAVR), a failed rotational atherectomy, and to salvage a percutaneous angioplasty thwarted by residual calcium calcification.
“Total procedural success in this series was 91% with 100% facilitation of stent delivery,” Dr. Yeoh said. “There have been no cases of coronary perforation and no reflow or 30-day target lesion failure.”
In this series, the mean age of the patients was 75.9 years. On optical coherence tomography (OCT), which was employed in about half of the cases, the mean residual stenosis was approximately 20%.
IVL involves passing a balloon into the target lesion with the same guidewire used for other percutaneous interventions. Once in position, sonic pressure waves fracture the calcium deposit “with no injury to the intimal soft tissue,” according to Dr. Yeoh, who said that there were no serious adverse events associated with IVL in the series he presented.
In DISRUPT CAD, which enrolled 60 patients, procedural success was 95% with a reduction in mean stenosis from 68.1% to 13.1%. The rate of major adverse cardiovascular event (MACE) events was 5% at 30 days.
While DISRUPT CAD-II is an on-going post-market registry collecting data in Europe and other areas of the world where IVL is approved for treatment of coronary artery disease, a pivotal trial called DISRUPT CAD III has been launched to gain an indication for treatment of coronary calcifications in the U.S. The prospective global trial has a planned enrollment of nearly 400 patients with expected completion in August 2020.
SOURCE: Yeoh J et al. 2019 Cardiovascular Research Technologies (CRT) Meeting abstract.
REPORTING FROM CRT 2019
Financial assistance programs may speed treatment for cervical cancer
HONOLULU – Financial assistance programs may help lower-income cervical cancer patients complete treatment in a timely manner, according to research presented at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
In a retrospective study, lower-income patients who used financial assistance programs were able to complete treatment for cervical cancer in a similar timeframe as higher-income patients.
Lower-income patients who registered for disability benefits saw a significant improvement in time to treatment completion.
Additionally, there was a trend toward improved time to treatment completion among lower-income patients who registered for federally funded breast and cervical cancer treatment.
“Identification of patients who qualify for disability and/or breast/cervical cancer Medicaid, and providing assistance for registration in these programs may help them complete therapy in a more appropriate timeframe,” said study investigator Jessica Gillen, MD, of The University of Oklahoma in Oklahoma City.
Dr. Gillen and her colleagues conducted this single-center, retrospective study of patients with squamous cell, adenocarcinoma, or adenosquamous cancer of the cervix.
The investigators identified 116 evaluable patients who received chemoradiation from January 1, 2015, to July 31, 2018. Most of these 106 patients completed treatment in 63 days or less.
The patients’ median household income was $45,782 (range, $19,771–$96,222). The investigators defined “high-income” patients as those whose household incomes were at or above the median, and “low-income” patients as those with incomes below the median.
On average, the patients used 1.24 assistance programs, which included financial assistance (primarily help with clinic visit copays), assistance with medication costs, disability benefits, Medicaid, access to emergency funds, low-cost or free lodging, and transportation.
Dr. Gillen noted that 10% of low-income patients did not use any financial assistance programs.
She and her colleagues found that low-income patients who used assistance programs completed treatment in a similar timeframe as the high-income patients. The median time to treatment completion was 56.5 days and 50 days, respectively.
Registering for disability benefits was significantly associated with improved time to treatment completion (P less than .001).
There were no other significant associations between financial assistance programs and time to treatment completion. However, there was a trend toward improved time to treatment completion among patients who registered for federally funded breast and cervical cancer Medicaid (P = .06).
“[I]t was encouraging to see that enrollment in federally and state-funded programs makes a difference in patients’ ability to complete treatment,” Dr. Gillen said.
She and her colleagues said these data suggest financial assistance programs may help cervical cancer patients overcome barriers to care. Dr. Gillen had no financial disclosures.
SOURCE: Gillen J et al. SGO 2019. Abstract 9.
HONOLULU – Financial assistance programs may help lower-income cervical cancer patients complete treatment in a timely manner, according to research presented at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
In a retrospective study, lower-income patients who used financial assistance programs were able to complete treatment for cervical cancer in a similar timeframe as higher-income patients.
Lower-income patients who registered for disability benefits saw a significant improvement in time to treatment completion.
Additionally, there was a trend toward improved time to treatment completion among lower-income patients who registered for federally funded breast and cervical cancer treatment.
“Identification of patients who qualify for disability and/or breast/cervical cancer Medicaid, and providing assistance for registration in these programs may help them complete therapy in a more appropriate timeframe,” said study investigator Jessica Gillen, MD, of The University of Oklahoma in Oklahoma City.
Dr. Gillen and her colleagues conducted this single-center, retrospective study of patients with squamous cell, adenocarcinoma, or adenosquamous cancer of the cervix.
The investigators identified 116 evaluable patients who received chemoradiation from January 1, 2015, to July 31, 2018. Most of these 106 patients completed treatment in 63 days or less.
The patients’ median household income was $45,782 (range, $19,771–$96,222). The investigators defined “high-income” patients as those whose household incomes were at or above the median, and “low-income” patients as those with incomes below the median.
On average, the patients used 1.24 assistance programs, which included financial assistance (primarily help with clinic visit copays), assistance with medication costs, disability benefits, Medicaid, access to emergency funds, low-cost or free lodging, and transportation.
Dr. Gillen noted that 10% of low-income patients did not use any financial assistance programs.
She and her colleagues found that low-income patients who used assistance programs completed treatment in a similar timeframe as the high-income patients. The median time to treatment completion was 56.5 days and 50 days, respectively.
Registering for disability benefits was significantly associated with improved time to treatment completion (P less than .001).
There were no other significant associations between financial assistance programs and time to treatment completion. However, there was a trend toward improved time to treatment completion among patients who registered for federally funded breast and cervical cancer Medicaid (P = .06).
“[I]t was encouraging to see that enrollment in federally and state-funded programs makes a difference in patients’ ability to complete treatment,” Dr. Gillen said.
She and her colleagues said these data suggest financial assistance programs may help cervical cancer patients overcome barriers to care. Dr. Gillen had no financial disclosures.
SOURCE: Gillen J et al. SGO 2019. Abstract 9.
HONOLULU – Financial assistance programs may help lower-income cervical cancer patients complete treatment in a timely manner, according to research presented at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
In a retrospective study, lower-income patients who used financial assistance programs were able to complete treatment for cervical cancer in a similar timeframe as higher-income patients.
Lower-income patients who registered for disability benefits saw a significant improvement in time to treatment completion.
Additionally, there was a trend toward improved time to treatment completion among lower-income patients who registered for federally funded breast and cervical cancer treatment.
“Identification of patients who qualify for disability and/or breast/cervical cancer Medicaid, and providing assistance for registration in these programs may help them complete therapy in a more appropriate timeframe,” said study investigator Jessica Gillen, MD, of The University of Oklahoma in Oklahoma City.
Dr. Gillen and her colleagues conducted this single-center, retrospective study of patients with squamous cell, adenocarcinoma, or adenosquamous cancer of the cervix.
The investigators identified 116 evaluable patients who received chemoradiation from January 1, 2015, to July 31, 2018. Most of these 106 patients completed treatment in 63 days or less.
The patients’ median household income was $45,782 (range, $19,771–$96,222). The investigators defined “high-income” patients as those whose household incomes were at or above the median, and “low-income” patients as those with incomes below the median.
On average, the patients used 1.24 assistance programs, which included financial assistance (primarily help with clinic visit copays), assistance with medication costs, disability benefits, Medicaid, access to emergency funds, low-cost or free lodging, and transportation.
Dr. Gillen noted that 10% of low-income patients did not use any financial assistance programs.
She and her colleagues found that low-income patients who used assistance programs completed treatment in a similar timeframe as the high-income patients. The median time to treatment completion was 56.5 days and 50 days, respectively.
Registering for disability benefits was significantly associated with improved time to treatment completion (P less than .001).
There were no other significant associations between financial assistance programs and time to treatment completion. However, there was a trend toward improved time to treatment completion among patients who registered for federally funded breast and cervical cancer Medicaid (P = .06).
“[I]t was encouraging to see that enrollment in federally and state-funded programs makes a difference in patients’ ability to complete treatment,” Dr. Gillen said.
She and her colleagues said these data suggest financial assistance programs may help cervical cancer patients overcome barriers to care. Dr. Gillen had no financial disclosures.
SOURCE: Gillen J et al. SGO 2019. Abstract 9.
REPORTING FROM SGO 2019
Brachytherapy proves beneficial regardless of treatment duration
, according to a retrospective study.
Researchers found that patients who received brachytherapy in addition to chemotherapy and external beam radiation therapy had better overall survival than patients who received chemoradiation alone.
Although the best overall survival was observed in patients who received brachytherapy within the recommended 8 weeks, patients who received brachytherapy outside that timeframe also had better overall survival than patients treated with chemoradiation alone.
Travis-Riley K. Korenaga, MD, of University of California, San Francisco, presented these findings at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
To examine the use of brachytherapy, Dr. Korenaga and his colleagues analyzed patients from the U.S. National Cancer Database who had stage II-IVA cervical cancer and were diagnosed between 2004 and 2015.
The researchers identified 18,592 patients who received at least 4,500 cGy of external beam radiation therapy and concurrent chemotherapy as their primary treatment. In this group, there were 17,150 patients who had data on brachytherapy use and time to treatment completion.
A majority of patients (n = 13,642) received brachytherapy, and roughly half of those (n = 6,871) received it within the recommended 8 weeks.
“This is a pretty low rate of adherence to standard of care; 36.9% of women receive brachytherapy and complete it within that 8-week timeframe,” Dr. Korenaga said. “And that 36.9% of women do have a superior overall survival that blows everything else out of the water.”
The median overall survival was:
- 113.7 months (95% confidence interval [CI], 103.3-121.3) in patients who received brachytherapy within 8 weeks
- 75.7 months (95% CI, 69.7-82.4) in those who received brachytherapy for more than 8 weeks
- 58.5 months (95% CI, 48.3-74.2) in patients who received only chemoradiation within 8 weeks
- 46.2 months (95% CI, 39.8-56.4) in those who received only chemoradiation for more than 8 weeks.
“Getting some type of brachytherapy, no matter whether it’s within 8 weeks or beyond 8 weeks, is still associated with an improved overall survival,” Dr. Korenaga noted.
He and his colleagues also identified factors that were significantly associated with a reduced likelihood of receiving brachytherapy within 8 weeks, including:
- Having stage III/IVA disease vs. stage II disease (P less than .0001)
- Being non-Hispanic black vs. non-Hispanic white (P less than .001)
- Having an annual income below $38,000 vs. $63,000 or higher (P less than .0001)
- Having public vs. private insurance (P less than .0001)
- Living 10 to 60 miles (P = .01) or more than 100 miles (P less than .001) from the treatment facility vs. less than 10 miles
- Being treated at a facility with a community cancer program (P = .02) or a comprehensive community cancer program (P less than .0001) vs. an academic research program.
Dr. Korenaga said these results highlight the fact that more work needs to be done to increase the use of brachytherapy in patients with locally advanced cervical cancer.
He and his colleagues have suggested a few measures that might help, including early referrals for brachytherapy, connecting patients with care navigators, and developing centers of excellence for brachytherapy.
Dr. Korenaga had no relevant financial disclosures.
SOURCE: Korenaga TRK et al. SGO 2019. Abstract 10.
, according to a retrospective study.
Researchers found that patients who received brachytherapy in addition to chemotherapy and external beam radiation therapy had better overall survival than patients who received chemoradiation alone.
Although the best overall survival was observed in patients who received brachytherapy within the recommended 8 weeks, patients who received brachytherapy outside that timeframe also had better overall survival than patients treated with chemoradiation alone.
Travis-Riley K. Korenaga, MD, of University of California, San Francisco, presented these findings at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
To examine the use of brachytherapy, Dr. Korenaga and his colleagues analyzed patients from the U.S. National Cancer Database who had stage II-IVA cervical cancer and were diagnosed between 2004 and 2015.
The researchers identified 18,592 patients who received at least 4,500 cGy of external beam radiation therapy and concurrent chemotherapy as their primary treatment. In this group, there were 17,150 patients who had data on brachytherapy use and time to treatment completion.
A majority of patients (n = 13,642) received brachytherapy, and roughly half of those (n = 6,871) received it within the recommended 8 weeks.
“This is a pretty low rate of adherence to standard of care; 36.9% of women receive brachytherapy and complete it within that 8-week timeframe,” Dr. Korenaga said. “And that 36.9% of women do have a superior overall survival that blows everything else out of the water.”
The median overall survival was:
- 113.7 months (95% confidence interval [CI], 103.3-121.3) in patients who received brachytherapy within 8 weeks
- 75.7 months (95% CI, 69.7-82.4) in those who received brachytherapy for more than 8 weeks
- 58.5 months (95% CI, 48.3-74.2) in patients who received only chemoradiation within 8 weeks
- 46.2 months (95% CI, 39.8-56.4) in those who received only chemoradiation for more than 8 weeks.
“Getting some type of brachytherapy, no matter whether it’s within 8 weeks or beyond 8 weeks, is still associated with an improved overall survival,” Dr. Korenaga noted.
He and his colleagues also identified factors that were significantly associated with a reduced likelihood of receiving brachytherapy within 8 weeks, including:
- Having stage III/IVA disease vs. stage II disease (P less than .0001)
- Being non-Hispanic black vs. non-Hispanic white (P less than .001)
- Having an annual income below $38,000 vs. $63,000 or higher (P less than .0001)
- Having public vs. private insurance (P less than .0001)
- Living 10 to 60 miles (P = .01) or more than 100 miles (P less than .001) from the treatment facility vs. less than 10 miles
- Being treated at a facility with a community cancer program (P = .02) or a comprehensive community cancer program (P less than .0001) vs. an academic research program.
Dr. Korenaga said these results highlight the fact that more work needs to be done to increase the use of brachytherapy in patients with locally advanced cervical cancer.
He and his colleagues have suggested a few measures that might help, including early referrals for brachytherapy, connecting patients with care navigators, and developing centers of excellence for brachytherapy.
Dr. Korenaga had no relevant financial disclosures.
SOURCE: Korenaga TRK et al. SGO 2019. Abstract 10.
, according to a retrospective study.
Researchers found that patients who received brachytherapy in addition to chemotherapy and external beam radiation therapy had better overall survival than patients who received chemoradiation alone.
Although the best overall survival was observed in patients who received brachytherapy within the recommended 8 weeks, patients who received brachytherapy outside that timeframe also had better overall survival than patients treated with chemoradiation alone.
Travis-Riley K. Korenaga, MD, of University of California, San Francisco, presented these findings at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
To examine the use of brachytherapy, Dr. Korenaga and his colleagues analyzed patients from the U.S. National Cancer Database who had stage II-IVA cervical cancer and were diagnosed between 2004 and 2015.
The researchers identified 18,592 patients who received at least 4,500 cGy of external beam radiation therapy and concurrent chemotherapy as their primary treatment. In this group, there were 17,150 patients who had data on brachytherapy use and time to treatment completion.
A majority of patients (n = 13,642) received brachytherapy, and roughly half of those (n = 6,871) received it within the recommended 8 weeks.
“This is a pretty low rate of adherence to standard of care; 36.9% of women receive brachytherapy and complete it within that 8-week timeframe,” Dr. Korenaga said. “And that 36.9% of women do have a superior overall survival that blows everything else out of the water.”
The median overall survival was:
- 113.7 months (95% confidence interval [CI], 103.3-121.3) in patients who received brachytherapy within 8 weeks
- 75.7 months (95% CI, 69.7-82.4) in those who received brachytherapy for more than 8 weeks
- 58.5 months (95% CI, 48.3-74.2) in patients who received only chemoradiation within 8 weeks
- 46.2 months (95% CI, 39.8-56.4) in those who received only chemoradiation for more than 8 weeks.
“Getting some type of brachytherapy, no matter whether it’s within 8 weeks or beyond 8 weeks, is still associated with an improved overall survival,” Dr. Korenaga noted.
He and his colleagues also identified factors that were significantly associated with a reduced likelihood of receiving brachytherapy within 8 weeks, including:
- Having stage III/IVA disease vs. stage II disease (P less than .0001)
- Being non-Hispanic black vs. non-Hispanic white (P less than .001)
- Having an annual income below $38,000 vs. $63,000 or higher (P less than .0001)
- Having public vs. private insurance (P less than .0001)
- Living 10 to 60 miles (P = .01) or more than 100 miles (P less than .001) from the treatment facility vs. less than 10 miles
- Being treated at a facility with a community cancer program (P = .02) or a comprehensive community cancer program (P less than .0001) vs. an academic research program.
Dr. Korenaga said these results highlight the fact that more work needs to be done to increase the use of brachytherapy in patients with locally advanced cervical cancer.
He and his colleagues have suggested a few measures that might help, including early referrals for brachytherapy, connecting patients with care navigators, and developing centers of excellence for brachytherapy.
Dr. Korenaga had no relevant financial disclosures.
SOURCE: Korenaga TRK et al. SGO 2019. Abstract 10.
REPORTING FROM SGO 2019
CAC score over 1,000 carries higher risks
, based on data from a large retrospective study presented by Allison W. Peng at the annual meeting of the American College of Cardiology.
“Our data argues for consideration of CAC 1000 (or more) as a distinct group with CVD mortality greater than that of contemporary secondary prevention trials ... We showed that those with CAC 1000 (or more) have both a higher area and density of calcification, a more dispersed pattern of calcification in their coronary artery tree (the majority with 4-vessel disease), with a markedly more diffuse distribution of extra-coronary calcification compared to the other CAC groups,” Ms. Peng and her colleagues wrote in the study, which was published online in the Journal of the American College of Cardiology.
Future guidelines should address these patients as a distinct risk group that might gain the most benefit from targeted, aggressive preventive therapy, the researchers said.
Current guidelines identify individuals with CAC scores over 400 as the highest risk group. With a mean follow-up time of 12.3 years, the results from 66,636 asymptomatic individuals in the CAC consortium study, which included over 2,800 patients with CAC (Agatston) scores of 1,000 or more, indicate patients with CAC scores of 1000 or more have nearly a 2-fold higher risk of CVD mortality compared to those with CAC scores of 400-999. While the mortality risk levels off slightly in those with scores exceeding 1000, all-cause and cause-specific mortality risk still increases with no apparent upper CAC threshold.
Patients with a CAC score of at least 1000 were 66.3 years old, on average; 86.3% were male, 52.4% had 4-vessel CAC, and they had a larger total CAC area.
Compared to patients with CAC scores of 400-999, those with a CAC score of 1000 or more had a greater risk of cardiovascular disease (HR, 1.71; 95% CI, 1.41-2.08), coronary heart disease (HR, 1.84; 95% CI, 1.43-2.36), cancer (HR, 1.36; 95% CI, 1.07-1.73), and all-cause mortality (HR, 1.51; 95% CI, 1.33-1.70).
Those with CAC scores of 400-999 had a 2.1, 3.6, 2.7, and 9.8 mortality rate per 1000 person-years for CHD, CVD, cancer, and all-cause mortality, respectively. But those with CAC scores of 1000 of more had a 5.1, 8.0, 4.6, and 18.8 mortality rate per 1000 person-years for CHD, CVD, cancer, and all-cause mortality, respectively.
The leading cause of death was CVD; 36.5% in the CAC 400-999 group and 42.6% in the CAC 1000 or more group. CHD mortality, as a subset of CVD mortality, constituted 21.1% of deaths in the CAC 400-999 group and 27.1% of deaths in the CAC 1000 or more group.
“Future randomized controlled trials of aggressive preventative therapies, for example PCSK9-inhibitors and anti-inflammatory drugs, in patients with CAC ≥ 1000, may prove helpful to evaluate the benefits of such treatment in this unique group,” the authors wrote. They also urged updating current guidelines to reflect best practices for these patients.
The study was funded by The National Institutes of Health. The authors have no relevant financial disclosures.
SOURCE: Peng A et al. Journal of the American College of Cardiology.
, based on data from a large retrospective study presented by Allison W. Peng at the annual meeting of the American College of Cardiology.
“Our data argues for consideration of CAC 1000 (or more) as a distinct group with CVD mortality greater than that of contemporary secondary prevention trials ... We showed that those with CAC 1000 (or more) have both a higher area and density of calcification, a more dispersed pattern of calcification in their coronary artery tree (the majority with 4-vessel disease), with a markedly more diffuse distribution of extra-coronary calcification compared to the other CAC groups,” Ms. Peng and her colleagues wrote in the study, which was published online in the Journal of the American College of Cardiology.
Future guidelines should address these patients as a distinct risk group that might gain the most benefit from targeted, aggressive preventive therapy, the researchers said.
Current guidelines identify individuals with CAC scores over 400 as the highest risk group. With a mean follow-up time of 12.3 years, the results from 66,636 asymptomatic individuals in the CAC consortium study, which included over 2,800 patients with CAC (Agatston) scores of 1,000 or more, indicate patients with CAC scores of 1000 or more have nearly a 2-fold higher risk of CVD mortality compared to those with CAC scores of 400-999. While the mortality risk levels off slightly in those with scores exceeding 1000, all-cause and cause-specific mortality risk still increases with no apparent upper CAC threshold.
Patients with a CAC score of at least 1000 were 66.3 years old, on average; 86.3% were male, 52.4% had 4-vessel CAC, and they had a larger total CAC area.
Compared to patients with CAC scores of 400-999, those with a CAC score of 1000 or more had a greater risk of cardiovascular disease (HR, 1.71; 95% CI, 1.41-2.08), coronary heart disease (HR, 1.84; 95% CI, 1.43-2.36), cancer (HR, 1.36; 95% CI, 1.07-1.73), and all-cause mortality (HR, 1.51; 95% CI, 1.33-1.70).
Those with CAC scores of 400-999 had a 2.1, 3.6, 2.7, and 9.8 mortality rate per 1000 person-years for CHD, CVD, cancer, and all-cause mortality, respectively. But those with CAC scores of 1000 of more had a 5.1, 8.0, 4.6, and 18.8 mortality rate per 1000 person-years for CHD, CVD, cancer, and all-cause mortality, respectively.
The leading cause of death was CVD; 36.5% in the CAC 400-999 group and 42.6% in the CAC 1000 or more group. CHD mortality, as a subset of CVD mortality, constituted 21.1% of deaths in the CAC 400-999 group and 27.1% of deaths in the CAC 1000 or more group.
“Future randomized controlled trials of aggressive preventative therapies, for example PCSK9-inhibitors and anti-inflammatory drugs, in patients with CAC ≥ 1000, may prove helpful to evaluate the benefits of such treatment in this unique group,” the authors wrote. They also urged updating current guidelines to reflect best practices for these patients.
The study was funded by The National Institutes of Health. The authors have no relevant financial disclosures.
SOURCE: Peng A et al. Journal of the American College of Cardiology.
, based on data from a large retrospective study presented by Allison W. Peng at the annual meeting of the American College of Cardiology.
“Our data argues for consideration of CAC 1000 (or more) as a distinct group with CVD mortality greater than that of contemporary secondary prevention trials ... We showed that those with CAC 1000 (or more) have both a higher area and density of calcification, a more dispersed pattern of calcification in their coronary artery tree (the majority with 4-vessel disease), with a markedly more diffuse distribution of extra-coronary calcification compared to the other CAC groups,” Ms. Peng and her colleagues wrote in the study, which was published online in the Journal of the American College of Cardiology.
Future guidelines should address these patients as a distinct risk group that might gain the most benefit from targeted, aggressive preventive therapy, the researchers said.
Current guidelines identify individuals with CAC scores over 400 as the highest risk group. With a mean follow-up time of 12.3 years, the results from 66,636 asymptomatic individuals in the CAC consortium study, which included over 2,800 patients with CAC (Agatston) scores of 1,000 or more, indicate patients with CAC scores of 1000 or more have nearly a 2-fold higher risk of CVD mortality compared to those with CAC scores of 400-999. While the mortality risk levels off slightly in those with scores exceeding 1000, all-cause and cause-specific mortality risk still increases with no apparent upper CAC threshold.
Patients with a CAC score of at least 1000 were 66.3 years old, on average; 86.3% were male, 52.4% had 4-vessel CAC, and they had a larger total CAC area.
Compared to patients with CAC scores of 400-999, those with a CAC score of 1000 or more had a greater risk of cardiovascular disease (HR, 1.71; 95% CI, 1.41-2.08), coronary heart disease (HR, 1.84; 95% CI, 1.43-2.36), cancer (HR, 1.36; 95% CI, 1.07-1.73), and all-cause mortality (HR, 1.51; 95% CI, 1.33-1.70).
Those with CAC scores of 400-999 had a 2.1, 3.6, 2.7, and 9.8 mortality rate per 1000 person-years for CHD, CVD, cancer, and all-cause mortality, respectively. But those with CAC scores of 1000 of more had a 5.1, 8.0, 4.6, and 18.8 mortality rate per 1000 person-years for CHD, CVD, cancer, and all-cause mortality, respectively.
The leading cause of death was CVD; 36.5% in the CAC 400-999 group and 42.6% in the CAC 1000 or more group. CHD mortality, as a subset of CVD mortality, constituted 21.1% of deaths in the CAC 400-999 group and 27.1% of deaths in the CAC 1000 or more group.
“Future randomized controlled trials of aggressive preventative therapies, for example PCSK9-inhibitors and anti-inflammatory drugs, in patients with CAC ≥ 1000, may prove helpful to evaluate the benefits of such treatment in this unique group,” the authors wrote. They also urged updating current guidelines to reflect best practices for these patients.
The study was funded by The National Institutes of Health. The authors have no relevant financial disclosures.
SOURCE: Peng A et al. Journal of the American College of Cardiology.
FROM ACC 2019
Match Day 2019: Residency spots increase, but improvements needed
For the seventh straight year, the Main Residency Match experienced record growth, with more spots for residency programs and a higher number of slots filled than ever before.
A total of 38,376 applicants in 2019 submitted program choices for 35,185 positions, a 6% slot increase from 2018, while the number of available first-year (PGY-1) positions rose to 32,194, an increase of 6.5% (1,962) from 2018, according to data from the National Resident Matching Program (NRMP). Of the total PGY-1 positions offered, 95% were filled.
“Many of the programs previously accredited by the American Osteopathic Association came into our match this year because they’re now accredited by the [The Accreditation Council for Graduate Medical Education],” Ms. Signer said in an interview. “That contributed to a significant increase in physicians and a significant increase in the number of applicants.”
Family medicine residency programs offered 4,107 positions this year, up by 478 from 2018. Of the family medicine offerings, 93% positions were filled, and 39% were filled with U.S. allopathic seniors. The number of U.S. allopathic seniors matching to family medicine decreased in 2019; however, a record 986 osteopathic students matched to family medicine, accounting for 26% of all applicants who matched to the specialty.
Internal medicine programs offered 8,116 positions in 2019, 574 more than in 2018. Of internal medicine programs, 97% of the positions were filled and 42% were filled with U.S. allopathic seniors. The NRMP notes the percentage of internal medicine positions filled by U.S. allopathic seniors has declined every year since 2015.
Pediatrics programs offered 2,847 residency positions in 2019, an increase of 79 from 2018. Nearly 98% of the slots were filled, and 60% were filled with U.S. allopathic seniors.
Clifton Knight, MD, vice president for education at the American Academy of Family Physicians, said he was pleased to see that the overall number of family medicine residency matches increased this year. However, he expressed concern that the number of U.S. allopathic seniors who applied to family medicine residencies continued to go down.
“That should be a big red flag for everyone at a time [when] it’s important to grow the family medicine workforce because of the increasing needs for family physicians,” Dr. Knight said in an interview. “We need more folks to choose family medicine. We applaud those schools that are producing higher levels of family physicians, but we are concerned there are a lot of schools that the academic environment is not supportive of family medicine. We would like to see a greater emphasis on improving that academic environment to support family medicine at all medical schools.”
Davoren Chick, MD, senior vice president for medical education at the American College of Physicians, said she found the 7.5% increase in internal medicine residency program slots reassuring, and she noted that internal medicine remains the largest field in the match.
“Internal medicine clearly continues to grow because institutions and applicants believe in the value of internal medicine in terms of how it contributes to the overall health care workforce,” Dr. Chick said in an interview.
However, the ACP would like to see a greater number of internists who remain within general internal medicine at the end of their residency, Dr. Chick said. ACP data shows only 11% of third-year residents in internal medicine training programs plan a career in general internal medicine, she added, a percentage that has continued to fall over the last 20 years.
“While we are very happy to see growth and interest in very essential areas of subspecialty internal medicine [and] growing interest in hospital-based careers in internal medicine, we do feel we need to continue advocating for the practice environment needs of generalists across the primary care spectrum,” Dr. Chick said.
Twitter was abuzz with celebratory tweets and photos under the hashtag #MatchDay in the days leading up to March 15 and after official assignments were revealed.
Kyle Yasuda, MD, president for the American Academy of Pediatrics tweeted his congratulations to students matching to pediatric residency programs.
“Being a pediatrician is rewarding beyond words because we #PutKids1st,” he tweeted. “Welcome.”
Supportive tweets also were sent to those who did not match, including an uplifting tweet by Jenny Wang, a fourth-year medical student in New York who matched this year to a dermatology residency at the University of California, Davis. In her tweet, Ms. Wang wrote that in 2018, she applied but did not match, which she described as the “worst feeling in the world.”
“Take some time to heal and ignore the world,” Ms. Wang tweeted, sharing a blog she wrote about not matching. “Just know that when you’re ready, there is a path ahead, and you don’t have to walk it alone.”
For the seventh straight year, the Main Residency Match experienced record growth, with more spots for residency programs and a higher number of slots filled than ever before.
A total of 38,376 applicants in 2019 submitted program choices for 35,185 positions, a 6% slot increase from 2018, while the number of available first-year (PGY-1) positions rose to 32,194, an increase of 6.5% (1,962) from 2018, according to data from the National Resident Matching Program (NRMP). Of the total PGY-1 positions offered, 95% were filled.
“Many of the programs previously accredited by the American Osteopathic Association came into our match this year because they’re now accredited by the [The Accreditation Council for Graduate Medical Education],” Ms. Signer said in an interview. “That contributed to a significant increase in physicians and a significant increase in the number of applicants.”
Family medicine residency programs offered 4,107 positions this year, up by 478 from 2018. Of the family medicine offerings, 93% positions were filled, and 39% were filled with U.S. allopathic seniors. The number of U.S. allopathic seniors matching to family medicine decreased in 2019; however, a record 986 osteopathic students matched to family medicine, accounting for 26% of all applicants who matched to the specialty.
Internal medicine programs offered 8,116 positions in 2019, 574 more than in 2018. Of internal medicine programs, 97% of the positions were filled and 42% were filled with U.S. allopathic seniors. The NRMP notes the percentage of internal medicine positions filled by U.S. allopathic seniors has declined every year since 2015.
Pediatrics programs offered 2,847 residency positions in 2019, an increase of 79 from 2018. Nearly 98% of the slots were filled, and 60% were filled with U.S. allopathic seniors.
Clifton Knight, MD, vice president for education at the American Academy of Family Physicians, said he was pleased to see that the overall number of family medicine residency matches increased this year. However, he expressed concern that the number of U.S. allopathic seniors who applied to family medicine residencies continued to go down.
“That should be a big red flag for everyone at a time [when] it’s important to grow the family medicine workforce because of the increasing needs for family physicians,” Dr. Knight said in an interview. “We need more folks to choose family medicine. We applaud those schools that are producing higher levels of family physicians, but we are concerned there are a lot of schools that the academic environment is not supportive of family medicine. We would like to see a greater emphasis on improving that academic environment to support family medicine at all medical schools.”
Davoren Chick, MD, senior vice president for medical education at the American College of Physicians, said she found the 7.5% increase in internal medicine residency program slots reassuring, and she noted that internal medicine remains the largest field in the match.
“Internal medicine clearly continues to grow because institutions and applicants believe in the value of internal medicine in terms of how it contributes to the overall health care workforce,” Dr. Chick said in an interview.
However, the ACP would like to see a greater number of internists who remain within general internal medicine at the end of their residency, Dr. Chick said. ACP data shows only 11% of third-year residents in internal medicine training programs plan a career in general internal medicine, she added, a percentage that has continued to fall over the last 20 years.
“While we are very happy to see growth and interest in very essential areas of subspecialty internal medicine [and] growing interest in hospital-based careers in internal medicine, we do feel we need to continue advocating for the practice environment needs of generalists across the primary care spectrum,” Dr. Chick said.
Twitter was abuzz with celebratory tweets and photos under the hashtag #MatchDay in the days leading up to March 15 and after official assignments were revealed.
Kyle Yasuda, MD, president for the American Academy of Pediatrics tweeted his congratulations to students matching to pediatric residency programs.
“Being a pediatrician is rewarding beyond words because we #PutKids1st,” he tweeted. “Welcome.”
Supportive tweets also were sent to those who did not match, including an uplifting tweet by Jenny Wang, a fourth-year medical student in New York who matched this year to a dermatology residency at the University of California, Davis. In her tweet, Ms. Wang wrote that in 2018, she applied but did not match, which she described as the “worst feeling in the world.”
“Take some time to heal and ignore the world,” Ms. Wang tweeted, sharing a blog she wrote about not matching. “Just know that when you’re ready, there is a path ahead, and you don’t have to walk it alone.”
For the seventh straight year, the Main Residency Match experienced record growth, with more spots for residency programs and a higher number of slots filled than ever before.
A total of 38,376 applicants in 2019 submitted program choices for 35,185 positions, a 6% slot increase from 2018, while the number of available first-year (PGY-1) positions rose to 32,194, an increase of 6.5% (1,962) from 2018, according to data from the National Resident Matching Program (NRMP). Of the total PGY-1 positions offered, 95% were filled.
“Many of the programs previously accredited by the American Osteopathic Association came into our match this year because they’re now accredited by the [The Accreditation Council for Graduate Medical Education],” Ms. Signer said in an interview. “That contributed to a significant increase in physicians and a significant increase in the number of applicants.”
Family medicine residency programs offered 4,107 positions this year, up by 478 from 2018. Of the family medicine offerings, 93% positions were filled, and 39% were filled with U.S. allopathic seniors. The number of U.S. allopathic seniors matching to family medicine decreased in 2019; however, a record 986 osteopathic students matched to family medicine, accounting for 26% of all applicants who matched to the specialty.
Internal medicine programs offered 8,116 positions in 2019, 574 more than in 2018. Of internal medicine programs, 97% of the positions were filled and 42% were filled with U.S. allopathic seniors. The NRMP notes the percentage of internal medicine positions filled by U.S. allopathic seniors has declined every year since 2015.
Pediatrics programs offered 2,847 residency positions in 2019, an increase of 79 from 2018. Nearly 98% of the slots were filled, and 60% were filled with U.S. allopathic seniors.
Clifton Knight, MD, vice president for education at the American Academy of Family Physicians, said he was pleased to see that the overall number of family medicine residency matches increased this year. However, he expressed concern that the number of U.S. allopathic seniors who applied to family medicine residencies continued to go down.
“That should be a big red flag for everyone at a time [when] it’s important to grow the family medicine workforce because of the increasing needs for family physicians,” Dr. Knight said in an interview. “We need more folks to choose family medicine. We applaud those schools that are producing higher levels of family physicians, but we are concerned there are a lot of schools that the academic environment is not supportive of family medicine. We would like to see a greater emphasis on improving that academic environment to support family medicine at all medical schools.”
Davoren Chick, MD, senior vice president for medical education at the American College of Physicians, said she found the 7.5% increase in internal medicine residency program slots reassuring, and she noted that internal medicine remains the largest field in the match.
“Internal medicine clearly continues to grow because institutions and applicants believe in the value of internal medicine in terms of how it contributes to the overall health care workforce,” Dr. Chick said in an interview.
However, the ACP would like to see a greater number of internists who remain within general internal medicine at the end of their residency, Dr. Chick said. ACP data shows only 11% of third-year residents in internal medicine training programs plan a career in general internal medicine, she added, a percentage that has continued to fall over the last 20 years.
“While we are very happy to see growth and interest in very essential areas of subspecialty internal medicine [and] growing interest in hospital-based careers in internal medicine, we do feel we need to continue advocating for the practice environment needs of generalists across the primary care spectrum,” Dr. Chick said.
Twitter was abuzz with celebratory tweets and photos under the hashtag #MatchDay in the days leading up to March 15 and after official assignments were revealed.
Kyle Yasuda, MD, president for the American Academy of Pediatrics tweeted his congratulations to students matching to pediatric residency programs.
“Being a pediatrician is rewarding beyond words because we #PutKids1st,” he tweeted. “Welcome.”
Supportive tweets also were sent to those who did not match, including an uplifting tweet by Jenny Wang, a fourth-year medical student in New York who matched this year to a dermatology residency at the University of California, Davis. In her tweet, Ms. Wang wrote that in 2018, she applied but did not match, which she described as the “worst feeling in the world.”
“Take some time to heal and ignore the world,” Ms. Wang tweeted, sharing a blog she wrote about not matching. “Just know that when you’re ready, there is a path ahead, and you don’t have to walk it alone.”
Dr. Julie Thompson Discusses Primary Biliary Cholangitis
At Digestive Diseases: New Advances (DDNA 2019), Dr. Julie A. Thompson of the University of Minnesota reviews key issues surrounding primary biliary cholangitis, including difficult symptoms to treat, an update on clinical trials, and patients that take medication and see no improvements.
At Digestive Diseases: New Advances (DDNA 2019), Dr. Julie A. Thompson of the University of Minnesota reviews key issues surrounding primary biliary cholangitis, including difficult symptoms to treat, an update on clinical trials, and patients that take medication and see no improvements.
At Digestive Diseases: New Advances (DDNA 2019), Dr. Julie A. Thompson of the University of Minnesota reviews key issues surrounding primary biliary cholangitis, including difficult symptoms to treat, an update on clinical trials, and patients that take medication and see no improvements.
AT DIGESTIVE DISEASES: NEW ADVANCES
Match Day 2019: Pediatrics up from last year
The pediatrics specialty filled 97.6% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 60.2% were filled by U.S. seniors, which was down from last year’s 63.1%.
Pediatrics brought 2,847 first-year positions to the 2019 Main Resident Match day, up from 2,768 in 2018. However, a slightly higher proportion (97.9%) of Match Day offerings were filled in 2018 than in 2019. Internal medicine/pediatrics offered 390 positions, more than 2018’s 382 positions. Although a slightly smaller proportion were filled in 2019 (98.2% vs. 98.7% ), a slightly larger proportion of positions in 2019 were filled by U.S. graduates (80.8% in 2019 vs. 80.1% in 2018). For all specialties, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP in its 2019 Main Resident Match report.
Overall, the 2019 Match set a new high for total positions offered at 35,135, for which there were a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.
“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
The pediatrics specialty filled 97.6% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 60.2% were filled by U.S. seniors, which was down from last year’s 63.1%.
Pediatrics brought 2,847 first-year positions to the 2019 Main Resident Match day, up from 2,768 in 2018. However, a slightly higher proportion (97.9%) of Match Day offerings were filled in 2018 than in 2019. Internal medicine/pediatrics offered 390 positions, more than 2018’s 382 positions. Although a slightly smaller proportion were filled in 2019 (98.2% vs. 98.7% ), a slightly larger proportion of positions in 2019 were filled by U.S. graduates (80.8% in 2019 vs. 80.1% in 2018). For all specialties, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP in its 2019 Main Resident Match report.
Overall, the 2019 Match set a new high for total positions offered at 35,135, for which there were a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.
“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
The pediatrics specialty filled 97.6% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 60.2% were filled by U.S. seniors, which was down from last year’s 63.1%.
Pediatrics brought 2,847 first-year positions to the 2019 Main Resident Match day, up from 2,768 in 2018. However, a slightly higher proportion (97.9%) of Match Day offerings were filled in 2018 than in 2019. Internal medicine/pediatrics offered 390 positions, more than 2018’s 382 positions. Although a slightly smaller proportion were filled in 2019 (98.2% vs. 98.7% ), a slightly larger proportion of positions in 2019 were filled by U.S. graduates (80.8% in 2019 vs. 80.1% in 2018). For all specialties, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP in its 2019 Main Resident Match report.
Overall, the 2019 Match set a new high for total positions offered at 35,135, for which there were a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.
“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.
FDA advises alternatives to paclitaxel-coated devices for PAD, pending review
“Alternative treatment options should generally be used for most patients,” rather than paclitaxel-coated balloons and stents for peripheral arterial disease (PAD), pending an ongoing safety review, according to the Food and Drug Administration.
The FDA conducted a preliminary analysis of long-term follow-up data (up to 5 years in some studies) of the pivotal premarket randomized trials for paclitaxel-coated products indicated for peripheral arterial disease (PAD). In a Letter to Healthcare providers issued March 15, the FDA reported that their preliminary review of these data found “a potentially concerning signal of increased long-term mortality in study subjects treated with paclitaxel-coated products, compared to patients treated with uncoated devices.”
The three trials (totaling 975 patients) that had 5-year follow-up data demonstrated an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices vs. those treated with control devices (20.1% vs. 13.4% crude risk of death at 5 years), according to the agency.
The FDA indicated that these data “should be interpreted with caution for several reasons.” They cited a large variability in the risk estimate of mortality because of the limited amount of long-term data and pointed out that the studies were not designed to be pooled. In addition, the specific cause and mechanism of the increased mortality was unknown.
The FDA also announced that they are planning on convening an Advisory Committee meeting of the Circulatory System Devices Panel to address this issue, including plausible mechanisms for this mortality effect, a re-examination of the benefit-risk profile, modifications of current and future clinical trials regarding these devices, and guidance to any regulatory action, as needed. The timing of this meeting is to be announced within the upcoming weeks.
The FDA letter further stated that the agency intends to conduct additional analyses “to determine whether the benefits continue to outweigh the risks for approved paclitaxel-coated balloons and paclitaxel-eluting stents when used in accordance with their indications for use.”
[email protected]
SOURCE: Food and Drug Administration Letter to Healthcare Providers. 2019 Mar 15.
“Alternative treatment options should generally be used for most patients,” rather than paclitaxel-coated balloons and stents for peripheral arterial disease (PAD), pending an ongoing safety review, according to the Food and Drug Administration.
The FDA conducted a preliminary analysis of long-term follow-up data (up to 5 years in some studies) of the pivotal premarket randomized trials for paclitaxel-coated products indicated for peripheral arterial disease (PAD). In a Letter to Healthcare providers issued March 15, the FDA reported that their preliminary review of these data found “a potentially concerning signal of increased long-term mortality in study subjects treated with paclitaxel-coated products, compared to patients treated with uncoated devices.”
The three trials (totaling 975 patients) that had 5-year follow-up data demonstrated an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices vs. those treated with control devices (20.1% vs. 13.4% crude risk of death at 5 years), according to the agency.
The FDA indicated that these data “should be interpreted with caution for several reasons.” They cited a large variability in the risk estimate of mortality because of the limited amount of long-term data and pointed out that the studies were not designed to be pooled. In addition, the specific cause and mechanism of the increased mortality was unknown.
The FDA also announced that they are planning on convening an Advisory Committee meeting of the Circulatory System Devices Panel to address this issue, including plausible mechanisms for this mortality effect, a re-examination of the benefit-risk profile, modifications of current and future clinical trials regarding these devices, and guidance to any regulatory action, as needed. The timing of this meeting is to be announced within the upcoming weeks.
The FDA letter further stated that the agency intends to conduct additional analyses “to determine whether the benefits continue to outweigh the risks for approved paclitaxel-coated balloons and paclitaxel-eluting stents when used in accordance with their indications for use.”
[email protected]
SOURCE: Food and Drug Administration Letter to Healthcare Providers. 2019 Mar 15.
“Alternative treatment options should generally be used for most patients,” rather than paclitaxel-coated balloons and stents for peripheral arterial disease (PAD), pending an ongoing safety review, according to the Food and Drug Administration.
The FDA conducted a preliminary analysis of long-term follow-up data (up to 5 years in some studies) of the pivotal premarket randomized trials for paclitaxel-coated products indicated for peripheral arterial disease (PAD). In a Letter to Healthcare providers issued March 15, the FDA reported that their preliminary review of these data found “a potentially concerning signal of increased long-term mortality in study subjects treated with paclitaxel-coated products, compared to patients treated with uncoated devices.”
The three trials (totaling 975 patients) that had 5-year follow-up data demonstrated an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices vs. those treated with control devices (20.1% vs. 13.4% crude risk of death at 5 years), according to the agency.
The FDA indicated that these data “should be interpreted with caution for several reasons.” They cited a large variability in the risk estimate of mortality because of the limited amount of long-term data and pointed out that the studies were not designed to be pooled. In addition, the specific cause and mechanism of the increased mortality was unknown.
The FDA also announced that they are planning on convening an Advisory Committee meeting of the Circulatory System Devices Panel to address this issue, including plausible mechanisms for this mortality effect, a re-examination of the benefit-risk profile, modifications of current and future clinical trials regarding these devices, and guidance to any regulatory action, as needed. The timing of this meeting is to be announced within the upcoming weeks.
The FDA letter further stated that the agency intends to conduct additional analyses “to determine whether the benefits continue to outweigh the risks for approved paclitaxel-coated balloons and paclitaxel-eluting stents when used in accordance with their indications for use.”
[email protected]
SOURCE: Food and Drug Administration Letter to Healthcare Providers. 2019 Mar 15.
Key clinical point: FDA advises that alternatives to paclitaxel-coated devices for PAD should be used for most patients.
Major finding: Five-year data demonstrated an approximately 50% increased risk of mortality in patients with paclitaxel-coated devices, compared with uncoated ones.
Study details: Preliminary FDA review of three trials with 975 patients.
Disclosures: Study is funded and performed by the FDA.
Source: Food and Drug Administration. Letter to Healthcare Providers. 2019 Mar 15.
Match Day 2019: Family medicine slots up by 13%
for the first time since 2009, according to the National Resident Matching Program (NRMP).
First-year FP slots rose from 3,629 to 4,107 as family medicine doubled the 6.5% increase in all first-year positions over 2018. The numbers of applicants (38,376) and total positions offered (35,185) were both record highs for the Match,although they were affected, in part, by “increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs,” the NRMP noted.
Family medicine programs filled 39.0% of first-year positions with U.S. allopathic seniors, which was down from 44.9% in 2018 and 45.1% in 2017. In terms of the numbers of U.S. seniors involved, the drop was fairly small: from 1,628 in 2018 to 1,601 in 2019; however, the 986 osteopathic students and graduates who matched set a new record and accounted for almost 26% of all successful FP applicants, the NRMP reported.“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said in a written statement.
for the first time since 2009, according to the National Resident Matching Program (NRMP).
First-year FP slots rose from 3,629 to 4,107 as family medicine doubled the 6.5% increase in all first-year positions over 2018. The numbers of applicants (38,376) and total positions offered (35,185) were both record highs for the Match,although they were affected, in part, by “increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs,” the NRMP noted.
Family medicine programs filled 39.0% of first-year positions with U.S. allopathic seniors, which was down from 44.9% in 2018 and 45.1% in 2017. In terms of the numbers of U.S. seniors involved, the drop was fairly small: from 1,628 in 2018 to 1,601 in 2019; however, the 986 osteopathic students and graduates who matched set a new record and accounted for almost 26% of all successful FP applicants, the NRMP reported.“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said in a written statement.
for the first time since 2009, according to the National Resident Matching Program (NRMP).
First-year FP slots rose from 3,629 to 4,107 as family medicine doubled the 6.5% increase in all first-year positions over 2018. The numbers of applicants (38,376) and total positions offered (35,185) were both record highs for the Match,although they were affected, in part, by “increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs,” the NRMP noted.
Family medicine programs filled 39.0% of first-year positions with U.S. allopathic seniors, which was down from 44.9% in 2018 and 45.1% in 2017. In terms of the numbers of U.S. seniors involved, the drop was fairly small: from 1,628 in 2018 to 1,601 in 2019; however, the 986 osteopathic students and graduates who matched set a new record and accounted for almost 26% of all successful FP applicants, the NRMP reported.“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said in a written statement.