Top AAN picks from Clinical Neurology News’ medical editor

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Standout presentations at this year’s American Academy of Neurology annual meeting range from targeting tau in Alzheimer’s disease, to new treatments for spinal muscular atrophy, to the controversial topic of allowing your child to play contact sports, but all are sure to have an impact, according to Clinical Neurology News Medical Editor Richard J. Caselli, MD.

“There are a lot of good talks and papers being presented, and it is impossible without having seen and heard them all to accurately predict what will be the real standouts, but from a purely personal perspective, and with all due apologies to any others not mentioned below, these are some of the ones I think could have large and, in some cases, almost immediate impact or potential impact,” said Dr. Caselli, professor of neurology at the Mayo Clinic Arizona in Scottsdale and also associate director and clinical core director of the Arizona Alzheimer’s Disease Center.
 

Targeting tau in Alzheimer’s

Dr. Richard J. Caselli
Among the Aging and Dementia oral abstract sessions, presentations on “the monoclonal antibody trials aimed at amyloid continue to be of interest,” said Dr. Caselli. But “I was more intrigued by the abstract by Mignon and colleagues about a tau-lowering antisense oligonucleotide in patients with Alzheimer’s disease.” This study was designed to assess the safety, tolerability, and pharmacokinetic parameters of repeated intrathecal injections of the tau-lowering antisense oligonucleotide IONIS-MAPTRx in patients with mild Alzheimer’s. It’s set to be presented during the Sunday, April 22, session S2, “Clinical Trials and Therapeutic Approaches in Neurodegenerative Diseases.”

The measuring of plasma tau to detect preclinical Alzheimer’s, as is described in the abstract from Pase and colleagues, is an “intriguing” approach, Dr. Caselli said. In that study, higher plasma tau levels were observed across correlates of preclinical Alzheimer’s: poorer cognitive function and smaller hippocampal volumes on MRI. Plasma tau level was also a strong predictor of future dementia. It will be presented Friday, April 27, 1:00-3:00 in S48, “Novel Biomarkers in Aging and Dementia.”
 

Focus continues on SMA

More advancements continue to be made in the treatment of various forms of spinal muscular trophy. In Monday morning’s Presidential Plenary Session, Richard Finkel’s presentation in receipt of the Sidney Carter Award in Child Neurology, should chart the development, current state, and future of antisense oligonucleotide therapy for SMA.

In the Emerging Science poster program on Wednesday, April 25, attendees will get an update on trial results for a different approach to the treatment of SMA using AVXS-101 gene replacement therapy for SMA type 1. John W. Day, MD, PhD, will provide longer-term outcomes after last year’s presentation of results in 15 patients.

 

 

Big news in stroke

Gregory Albers, MD, will describe in the Clinical Trials Plenary Session how new evidence from stroke thrombectomy trials such as DEFUSE 3 have led to new recommendations for extending the time window for thrombectomy. The results of DEFUSE 3 were first reported in January at the International Stroke Conference.

Other plenary presentations

In Wednesday’s Frontiers in Neuroscience Session, Dr. Caselli recommended Alan Evans’ discussion of the development and current and upcoming work to use and update the giant, freely accessible “BigBrain” High Resolution 3D Digital Human Brain Atlas.

In the always “fun and interesting” Controversies in Neurology on the morning of Thursday, April 26, the debate on “Should We Use Biomarkers Alone For Diagnosis of Alzheimer’s?” takes on greater interest now that the National Institute on Aging and the Alzheimer’s Association have defined Alzheimer’s disease as a diagnosis based on biomarkers. The separate debate of “Would You Let Your Child Play Contact Sports?” should also bring lots of interesting questions to the forefront of attendees’ minds.

Dr. Steven R. Messé’s talk, “Finally, Some Closure on PFO Closure,” at the Neurology Year in Review on Friday morning, April 27, is “of immediate relevance” as recent clinical trials have begun to determine patient groups for whom PFO closure appears worthwhile, Dr. Caselli said.

He has no relevant disclosures.

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Standout presentations at this year’s American Academy of Neurology annual meeting range from targeting tau in Alzheimer’s disease, to new treatments for spinal muscular atrophy, to the controversial topic of allowing your child to play contact sports, but all are sure to have an impact, according to Clinical Neurology News Medical Editor Richard J. Caselli, MD.

“There are a lot of good talks and papers being presented, and it is impossible without having seen and heard them all to accurately predict what will be the real standouts, but from a purely personal perspective, and with all due apologies to any others not mentioned below, these are some of the ones I think could have large and, in some cases, almost immediate impact or potential impact,” said Dr. Caselli, professor of neurology at the Mayo Clinic Arizona in Scottsdale and also associate director and clinical core director of the Arizona Alzheimer’s Disease Center.
 

Targeting tau in Alzheimer’s

Dr. Richard J. Caselli
Among the Aging and Dementia oral abstract sessions, presentations on “the monoclonal antibody trials aimed at amyloid continue to be of interest,” said Dr. Caselli. But “I was more intrigued by the abstract by Mignon and colleagues about a tau-lowering antisense oligonucleotide in patients with Alzheimer’s disease.” This study was designed to assess the safety, tolerability, and pharmacokinetic parameters of repeated intrathecal injections of the tau-lowering antisense oligonucleotide IONIS-MAPTRx in patients with mild Alzheimer’s. It’s set to be presented during the Sunday, April 22, session S2, “Clinical Trials and Therapeutic Approaches in Neurodegenerative Diseases.”

The measuring of plasma tau to detect preclinical Alzheimer’s, as is described in the abstract from Pase and colleagues, is an “intriguing” approach, Dr. Caselli said. In that study, higher plasma tau levels were observed across correlates of preclinical Alzheimer’s: poorer cognitive function and smaller hippocampal volumes on MRI. Plasma tau level was also a strong predictor of future dementia. It will be presented Friday, April 27, 1:00-3:00 in S48, “Novel Biomarkers in Aging and Dementia.”
 

Focus continues on SMA

More advancements continue to be made in the treatment of various forms of spinal muscular trophy. In Monday morning’s Presidential Plenary Session, Richard Finkel’s presentation in receipt of the Sidney Carter Award in Child Neurology, should chart the development, current state, and future of antisense oligonucleotide therapy for SMA.

In the Emerging Science poster program on Wednesday, April 25, attendees will get an update on trial results for a different approach to the treatment of SMA using AVXS-101 gene replacement therapy for SMA type 1. John W. Day, MD, PhD, will provide longer-term outcomes after last year’s presentation of results in 15 patients.

 

 

Big news in stroke

Gregory Albers, MD, will describe in the Clinical Trials Plenary Session how new evidence from stroke thrombectomy trials such as DEFUSE 3 have led to new recommendations for extending the time window for thrombectomy. The results of DEFUSE 3 were first reported in January at the International Stroke Conference.

Other plenary presentations

In Wednesday’s Frontiers in Neuroscience Session, Dr. Caselli recommended Alan Evans’ discussion of the development and current and upcoming work to use and update the giant, freely accessible “BigBrain” High Resolution 3D Digital Human Brain Atlas.

In the always “fun and interesting” Controversies in Neurology on the morning of Thursday, April 26, the debate on “Should We Use Biomarkers Alone For Diagnosis of Alzheimer’s?” takes on greater interest now that the National Institute on Aging and the Alzheimer’s Association have defined Alzheimer’s disease as a diagnosis based on biomarkers. The separate debate of “Would You Let Your Child Play Contact Sports?” should also bring lots of interesting questions to the forefront of attendees’ minds.

Dr. Steven R. Messé’s talk, “Finally, Some Closure on PFO Closure,” at the Neurology Year in Review on Friday morning, April 27, is “of immediate relevance” as recent clinical trials have begun to determine patient groups for whom PFO closure appears worthwhile, Dr. Caselli said.

He has no relevant disclosures.

 

Standout presentations at this year’s American Academy of Neurology annual meeting range from targeting tau in Alzheimer’s disease, to new treatments for spinal muscular atrophy, to the controversial topic of allowing your child to play contact sports, but all are sure to have an impact, according to Clinical Neurology News Medical Editor Richard J. Caselli, MD.

“There are a lot of good talks and papers being presented, and it is impossible without having seen and heard them all to accurately predict what will be the real standouts, but from a purely personal perspective, and with all due apologies to any others not mentioned below, these are some of the ones I think could have large and, in some cases, almost immediate impact or potential impact,” said Dr. Caselli, professor of neurology at the Mayo Clinic Arizona in Scottsdale and also associate director and clinical core director of the Arizona Alzheimer’s Disease Center.
 

Targeting tau in Alzheimer’s

Dr. Richard J. Caselli
Among the Aging and Dementia oral abstract sessions, presentations on “the monoclonal antibody trials aimed at amyloid continue to be of interest,” said Dr. Caselli. But “I was more intrigued by the abstract by Mignon and colleagues about a tau-lowering antisense oligonucleotide in patients with Alzheimer’s disease.” This study was designed to assess the safety, tolerability, and pharmacokinetic parameters of repeated intrathecal injections of the tau-lowering antisense oligonucleotide IONIS-MAPTRx in patients with mild Alzheimer’s. It’s set to be presented during the Sunday, April 22, session S2, “Clinical Trials and Therapeutic Approaches in Neurodegenerative Diseases.”

The measuring of plasma tau to detect preclinical Alzheimer’s, as is described in the abstract from Pase and colleagues, is an “intriguing” approach, Dr. Caselli said. In that study, higher plasma tau levels were observed across correlates of preclinical Alzheimer’s: poorer cognitive function and smaller hippocampal volumes on MRI. Plasma tau level was also a strong predictor of future dementia. It will be presented Friday, April 27, 1:00-3:00 in S48, “Novel Biomarkers in Aging and Dementia.”
 

Focus continues on SMA

More advancements continue to be made in the treatment of various forms of spinal muscular trophy. In Monday morning’s Presidential Plenary Session, Richard Finkel’s presentation in receipt of the Sidney Carter Award in Child Neurology, should chart the development, current state, and future of antisense oligonucleotide therapy for SMA.

In the Emerging Science poster program on Wednesday, April 25, attendees will get an update on trial results for a different approach to the treatment of SMA using AVXS-101 gene replacement therapy for SMA type 1. John W. Day, MD, PhD, will provide longer-term outcomes after last year’s presentation of results in 15 patients.

 

 

Big news in stroke

Gregory Albers, MD, will describe in the Clinical Trials Plenary Session how new evidence from stroke thrombectomy trials such as DEFUSE 3 have led to new recommendations for extending the time window for thrombectomy. The results of DEFUSE 3 were first reported in January at the International Stroke Conference.

Other plenary presentations

In Wednesday’s Frontiers in Neuroscience Session, Dr. Caselli recommended Alan Evans’ discussion of the development and current and upcoming work to use and update the giant, freely accessible “BigBrain” High Resolution 3D Digital Human Brain Atlas.

In the always “fun and interesting” Controversies in Neurology on the morning of Thursday, April 26, the debate on “Should We Use Biomarkers Alone For Diagnosis of Alzheimer’s?” takes on greater interest now that the National Institute on Aging and the Alzheimer’s Association have defined Alzheimer’s disease as a diagnosis based on biomarkers. The separate debate of “Would You Let Your Child Play Contact Sports?” should also bring lots of interesting questions to the forefront of attendees’ minds.

Dr. Steven R. Messé’s talk, “Finally, Some Closure on PFO Closure,” at the Neurology Year in Review on Friday morning, April 27, is “of immediate relevance” as recent clinical trials have begun to determine patient groups for whom PFO closure appears worthwhile, Dr. Caselli said.

He has no relevant disclosures.

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Upadacitinib for RA shows encouraging results in phase 3 trial

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Thu, 12/06/2018 - 11:51

 

In a recent phase 3 trial, the investigational oral JAK1 inhibitor upadacitinib met all primary and secondary endpoints in patients with moderate to severe rheumatoid arthritis – including clinical remission – compared with adalimumab and placebo, according to its manufacturer.

The ongoing SELECT-COMPARE trial randomized patients with a stable background on methotrexate but with a limited response to the drug to upadacitinib (n = 651), adalimumab (n = 327), or placebo (n = 651). In terms of primary endpoints, 28% of patients taking upadacitinib achieved remission based on 28-joint Disease Activity Score using C-reactive protein at week 12, compared with 18% of those taking adalimumab and 6% taking placebo. A total of 71% achieved an American College of Rheumatology 20% (ACR20) level of response, compared with 63% of those taking adalimumab and 36% of those taking placebo.

In addition, upadacitinib met the ranked secondary endpoints, showing superiority over adalimumab. It did so in terms of ACR50 and ACR70 at week 12, as well as reduction in patient pain scores and improvement in physical function at week 12. Furthermore, it significantly inhibited radiographic progression.

The safety profile was consistent with previous findings: By week 26, 3.7% of patients taking upadacitinib experienced serious adverse events, compared with 4.3% of patients taking adalimumab and 2.9% of those taking placebo.

Find out more in AbbVie’s press release.

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In a recent phase 3 trial, the investigational oral JAK1 inhibitor upadacitinib met all primary and secondary endpoints in patients with moderate to severe rheumatoid arthritis – including clinical remission – compared with adalimumab and placebo, according to its manufacturer.

The ongoing SELECT-COMPARE trial randomized patients with a stable background on methotrexate but with a limited response to the drug to upadacitinib (n = 651), adalimumab (n = 327), or placebo (n = 651). In terms of primary endpoints, 28% of patients taking upadacitinib achieved remission based on 28-joint Disease Activity Score using C-reactive protein at week 12, compared with 18% of those taking adalimumab and 6% taking placebo. A total of 71% achieved an American College of Rheumatology 20% (ACR20) level of response, compared with 63% of those taking adalimumab and 36% of those taking placebo.

In addition, upadacitinib met the ranked secondary endpoints, showing superiority over adalimumab. It did so in terms of ACR50 and ACR70 at week 12, as well as reduction in patient pain scores and improvement in physical function at week 12. Furthermore, it significantly inhibited radiographic progression.

The safety profile was consistent with previous findings: By week 26, 3.7% of patients taking upadacitinib experienced serious adverse events, compared with 4.3% of patients taking adalimumab and 2.9% of those taking placebo.

Find out more in AbbVie’s press release.

 

In a recent phase 3 trial, the investigational oral JAK1 inhibitor upadacitinib met all primary and secondary endpoints in patients with moderate to severe rheumatoid arthritis – including clinical remission – compared with adalimumab and placebo, according to its manufacturer.

The ongoing SELECT-COMPARE trial randomized patients with a stable background on methotrexate but with a limited response to the drug to upadacitinib (n = 651), adalimumab (n = 327), or placebo (n = 651). In terms of primary endpoints, 28% of patients taking upadacitinib achieved remission based on 28-joint Disease Activity Score using C-reactive protein at week 12, compared with 18% of those taking adalimumab and 6% taking placebo. A total of 71% achieved an American College of Rheumatology 20% (ACR20) level of response, compared with 63% of those taking adalimumab and 36% of those taking placebo.

In addition, upadacitinib met the ranked secondary endpoints, showing superiority over adalimumab. It did so in terms of ACR50 and ACR70 at week 12, as well as reduction in patient pain scores and improvement in physical function at week 12. Furthermore, it significantly inhibited radiographic progression.

The safety profile was consistent with previous findings: By week 26, 3.7% of patients taking upadacitinib experienced serious adverse events, compared with 4.3% of patients taking adalimumab and 2.9% of those taking placebo.

Find out more in AbbVie’s press release.

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Grind it out

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Thu, 03/28/2019 - 14:38

 

“And five more, four more, three more, two more, one more, and done!” Just when you thought you could not stand the searing pain any longer, it ends. Your spin instructor is not only helping you be fit, she is also teaching you an important lesson for life: Sometimes you just need to grind it out.

“Grind it out” is a phrase I’ve heard a lot lately. You might associate this with push-ups and burpees, but grinding it out applies to much more. College basketball teams need to simply grind it out to advance in the NCAA championship tournament. How might Tiger Woods recover from a disastrous few holes at the Masters? “He’ll just have to grind it out on the back nine.” How will you finally finish your PhD thesis? You’ll have to grind it out this month. It’s how I’m writing this column, how I got my taxes in on time, and, sometimes, how I get through clinic.

UberImages/iStock/Getty Images

The phrase is used to describe something which needs to be done that is tedious, laborious, or joyless. Although the outcome of grinding it out is always pleasant, the task is often considered arduous.

In my dermatology practice, patient demand came in like a lion this March, and to meet our awesome access goals, we needed to add clinics on Saturdays, early mornings, and even a few nights. We met our goal, with supply to spare, and felt proud of our accomplishments. Physician wellness gurus (this author not included) say that, to avoid burnout from such excess work, you must find meaning in your work. Be grateful to help that 24-year-old with acne at 8:15 p.m. Think about how lucky you are to serve that lawyer with hand dermatitis at 8:45 p.m. Celebrate the mom’s cancer-free skin screening at 9:00 p.m. By finding meaning in our work, we’re told, we can achieve clinic nirvana. Except it doesn’t always work, and sometimes it serves us badly.

Dr. Jeffrey Benabio
No matter how concerning the alopecia areata is to this 20-year-old man, it’s just another hair loss case for me. Third one today. Draw up Kenalog injection. Push play on alopecia areata spiel. Type note. Repeat. Being grateful to see him is a lovely idea, but I’m just not feeling it. Not only is this feeling acceptable, it’s normal. Always trying to find meaning in our work can be exhausting and often disappointing. This is true of any work. Rory McIlroy might love playing golf, but sometimes he just has to grind out the back nine. You may love being a doctor, but sometimes you just have to grind out the prior authorizations, paperwork, and patient messages. You’d no more seek meaning from these tasks than you would from abdominal crunches. And it’s not just about the money. As you, and rapper 50 Cent know, you could be making “a mil on the deal” and be “still on the grind.”

 

 


For the long days that ended in night clinic last month, I found myself counting down those last few patients – “four more, three more, two more, and last one.” I love my work and care about my patients, but sometimes I just have to grind it out. I’m proud of what I’ve accomplished.

Now it’s on to spin class.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

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“And five more, four more, three more, two more, one more, and done!” Just when you thought you could not stand the searing pain any longer, it ends. Your spin instructor is not only helping you be fit, she is also teaching you an important lesson for life: Sometimes you just need to grind it out.

“Grind it out” is a phrase I’ve heard a lot lately. You might associate this with push-ups and burpees, but grinding it out applies to much more. College basketball teams need to simply grind it out to advance in the NCAA championship tournament. How might Tiger Woods recover from a disastrous few holes at the Masters? “He’ll just have to grind it out on the back nine.” How will you finally finish your PhD thesis? You’ll have to grind it out this month. It’s how I’m writing this column, how I got my taxes in on time, and, sometimes, how I get through clinic.

UberImages/iStock/Getty Images

The phrase is used to describe something which needs to be done that is tedious, laborious, or joyless. Although the outcome of grinding it out is always pleasant, the task is often considered arduous.

In my dermatology practice, patient demand came in like a lion this March, and to meet our awesome access goals, we needed to add clinics on Saturdays, early mornings, and even a few nights. We met our goal, with supply to spare, and felt proud of our accomplishments. Physician wellness gurus (this author not included) say that, to avoid burnout from such excess work, you must find meaning in your work. Be grateful to help that 24-year-old with acne at 8:15 p.m. Think about how lucky you are to serve that lawyer with hand dermatitis at 8:45 p.m. Celebrate the mom’s cancer-free skin screening at 9:00 p.m. By finding meaning in our work, we’re told, we can achieve clinic nirvana. Except it doesn’t always work, and sometimes it serves us badly.

Dr. Jeffrey Benabio
No matter how concerning the alopecia areata is to this 20-year-old man, it’s just another hair loss case for me. Third one today. Draw up Kenalog injection. Push play on alopecia areata spiel. Type note. Repeat. Being grateful to see him is a lovely idea, but I’m just not feeling it. Not only is this feeling acceptable, it’s normal. Always trying to find meaning in our work can be exhausting and often disappointing. This is true of any work. Rory McIlroy might love playing golf, but sometimes he just has to grind out the back nine. You may love being a doctor, but sometimes you just have to grind out the prior authorizations, paperwork, and patient messages. You’d no more seek meaning from these tasks than you would from abdominal crunches. And it’s not just about the money. As you, and rapper 50 Cent know, you could be making “a mil on the deal” and be “still on the grind.”

 

 


For the long days that ended in night clinic last month, I found myself counting down those last few patients – “four more, three more, two more, and last one.” I love my work and care about my patients, but sometimes I just have to grind it out. I’m proud of what I’ve accomplished.

Now it’s on to spin class.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

 

“And five more, four more, three more, two more, one more, and done!” Just when you thought you could not stand the searing pain any longer, it ends. Your spin instructor is not only helping you be fit, she is also teaching you an important lesson for life: Sometimes you just need to grind it out.

“Grind it out” is a phrase I’ve heard a lot lately. You might associate this with push-ups and burpees, but grinding it out applies to much more. College basketball teams need to simply grind it out to advance in the NCAA championship tournament. How might Tiger Woods recover from a disastrous few holes at the Masters? “He’ll just have to grind it out on the back nine.” How will you finally finish your PhD thesis? You’ll have to grind it out this month. It’s how I’m writing this column, how I got my taxes in on time, and, sometimes, how I get through clinic.

UberImages/iStock/Getty Images

The phrase is used to describe something which needs to be done that is tedious, laborious, or joyless. Although the outcome of grinding it out is always pleasant, the task is often considered arduous.

In my dermatology practice, patient demand came in like a lion this March, and to meet our awesome access goals, we needed to add clinics on Saturdays, early mornings, and even a few nights. We met our goal, with supply to spare, and felt proud of our accomplishments. Physician wellness gurus (this author not included) say that, to avoid burnout from such excess work, you must find meaning in your work. Be grateful to help that 24-year-old with acne at 8:15 p.m. Think about how lucky you are to serve that lawyer with hand dermatitis at 8:45 p.m. Celebrate the mom’s cancer-free skin screening at 9:00 p.m. By finding meaning in our work, we’re told, we can achieve clinic nirvana. Except it doesn’t always work, and sometimes it serves us badly.

Dr. Jeffrey Benabio
No matter how concerning the alopecia areata is to this 20-year-old man, it’s just another hair loss case for me. Third one today. Draw up Kenalog injection. Push play on alopecia areata spiel. Type note. Repeat. Being grateful to see him is a lovely idea, but I’m just not feeling it. Not only is this feeling acceptable, it’s normal. Always trying to find meaning in our work can be exhausting and often disappointing. This is true of any work. Rory McIlroy might love playing golf, but sometimes he just has to grind out the back nine. You may love being a doctor, but sometimes you just have to grind out the prior authorizations, paperwork, and patient messages. You’d no more seek meaning from these tasks than you would from abdominal crunches. And it’s not just about the money. As you, and rapper 50 Cent know, you could be making “a mil on the deal” and be “still on the grind.”

 

 


For the long days that ended in night clinic last month, I found myself counting down those last few patients – “four more, three more, two more, and last one.” I love my work and care about my patients, but sometimes I just have to grind it out. I’m proud of what I’ve accomplished.

Now it’s on to spin class.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

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FDA approves immunotherapy combo for advanced RCC

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Fri, 01/04/2019 - 14:16

 

The Food and Drug Administration has granted approvals to checkpoint inhibitors nivolumab and ipilimumab in combination for the treatment of intermediate- or poor-risk, previously untreated advanced renal cell carcinoma.

The approvals were based on statistically significant improvements in overall survival (OS) and objective response rate (ORR) for patients receiving the combination of nivolumab and ipilimumab (n = 425), compared with those receiving sunitinib (n = 422) in CheckMate 214, the FDA said in a press statement.

In the randomized, open-label trial, patients with previously untreated advanced renal cell carcinoma received nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) every 3 weeks for four doses followed by nivolumab monotherapy (3 mg/kg) every 2 weeks or sunitinib (50 mg daily) for 4 weeks, followed by 2 weeks off every cycle.

Median OS was not yet reached in the combination arm at follow-up of 32 months, compared with 25.9 months in the sunitinib arm (hazard ratio, 0.63; 95% confidence interval, 0.44-0.89; P less than .0001). The ORR was 41.6% (95% CI, 36.9-46.5) for the combination versus 26.5% (95% CI, 22.4-31) in the sunitinib arm (P less than .0001).

Efficacy of the combination was not established for patients with favorable-risk disease.

The most common adverse reactions were fatigue, rash, diarrhea, musculoskeletal pain, pruritus, nausea, cough, pyrexia, arthralgia, and decreased appetite.

 

 


The recommended schedule and dose is 3 mg/kg nivolumab, followed by 1 mg/kg ipilimumab, on the same day every 3 weeks for four doses, then 240 mg nivolumab every 2 weeks or 480 mg every 4 weeks, the FDA said.

Nivolumab is marketed as Opdivo and ipilimumab as Yervoy by Bristol-Myers Squibb.
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The Food and Drug Administration has granted approvals to checkpoint inhibitors nivolumab and ipilimumab in combination for the treatment of intermediate- or poor-risk, previously untreated advanced renal cell carcinoma.

The approvals were based on statistically significant improvements in overall survival (OS) and objective response rate (ORR) for patients receiving the combination of nivolumab and ipilimumab (n = 425), compared with those receiving sunitinib (n = 422) in CheckMate 214, the FDA said in a press statement.

In the randomized, open-label trial, patients with previously untreated advanced renal cell carcinoma received nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) every 3 weeks for four doses followed by nivolumab monotherapy (3 mg/kg) every 2 weeks or sunitinib (50 mg daily) for 4 weeks, followed by 2 weeks off every cycle.

Median OS was not yet reached in the combination arm at follow-up of 32 months, compared with 25.9 months in the sunitinib arm (hazard ratio, 0.63; 95% confidence interval, 0.44-0.89; P less than .0001). The ORR was 41.6% (95% CI, 36.9-46.5) for the combination versus 26.5% (95% CI, 22.4-31) in the sunitinib arm (P less than .0001).

Efficacy of the combination was not established for patients with favorable-risk disease.

The most common adverse reactions were fatigue, rash, diarrhea, musculoskeletal pain, pruritus, nausea, cough, pyrexia, arthralgia, and decreased appetite.

 

 


The recommended schedule and dose is 3 mg/kg nivolumab, followed by 1 mg/kg ipilimumab, on the same day every 3 weeks for four doses, then 240 mg nivolumab every 2 weeks or 480 mg every 4 weeks, the FDA said.

Nivolumab is marketed as Opdivo and ipilimumab as Yervoy by Bristol-Myers Squibb.

 

The Food and Drug Administration has granted approvals to checkpoint inhibitors nivolumab and ipilimumab in combination for the treatment of intermediate- or poor-risk, previously untreated advanced renal cell carcinoma.

The approvals were based on statistically significant improvements in overall survival (OS) and objective response rate (ORR) for patients receiving the combination of nivolumab and ipilimumab (n = 425), compared with those receiving sunitinib (n = 422) in CheckMate 214, the FDA said in a press statement.

In the randomized, open-label trial, patients with previously untreated advanced renal cell carcinoma received nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) every 3 weeks for four doses followed by nivolumab monotherapy (3 mg/kg) every 2 weeks or sunitinib (50 mg daily) for 4 weeks, followed by 2 weeks off every cycle.

Median OS was not yet reached in the combination arm at follow-up of 32 months, compared with 25.9 months in the sunitinib arm (hazard ratio, 0.63; 95% confidence interval, 0.44-0.89; P less than .0001). The ORR was 41.6% (95% CI, 36.9-46.5) for the combination versus 26.5% (95% CI, 22.4-31) in the sunitinib arm (P less than .0001).

Efficacy of the combination was not established for patients with favorable-risk disease.

The most common adverse reactions were fatigue, rash, diarrhea, musculoskeletal pain, pruritus, nausea, cough, pyrexia, arthralgia, and decreased appetite.

 

 


The recommended schedule and dose is 3 mg/kg nivolumab, followed by 1 mg/kg ipilimumab, on the same day every 3 weeks for four doses, then 240 mg nivolumab every 2 weeks or 480 mg every 4 weeks, the FDA said.

Nivolumab is marketed as Opdivo and ipilimumab as Yervoy by Bristol-Myers Squibb.
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MDedge Daily News: Can a nasal spray reverse suicidality?

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Can a nasal spray reverse suicidality? Smoking boosts heart failure risk in black patients. Respiratory infections increase risk of heart attack and stroke. And pain relievers and inflammatory bowel disease? It’s complicated.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

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Can a nasal spray reverse suicidality? Smoking boosts heart failure risk in black patients. Respiratory infections increase risk of heart attack and stroke. And pain relievers and inflammatory bowel disease? It’s complicated.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

 

Can a nasal spray reverse suicidality? Smoking boosts heart failure risk in black patients. Respiratory infections increase risk of heart attack and stroke. And pain relievers and inflammatory bowel disease? It’s complicated.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

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Is “Runner’s Kidney” a Thing?

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Q) Many of my patients are athletes. I recall reading something about kidney disease in marathon runners. Am I remembering correctly?

Although data on acute kidney injury (AKI) in marathon runners are limited, two recent studies have added to our knowledge. In 2017, Mansour et al studied 22 marathon runners, collecting urine and blood samples 24 hours before, immediately after, and 24 hours after a race. The results showed that in 82% of the subjects, serum creatinine increased to a level correlated with stage 1 or 2 AKI (as defined by the Acute Kidney Injury Network criteria).1

Based on urine microscopy results, as well as serum creatinine and novel biomarker levels, the researchers concluded that the runners’ AKI was caused by acute tubular injury—likely induced by ischemia. However, the subjects did not show any evidence of chronic kidney disease (CKD), despite years of running and intensive training. One theory: Habitual running might condition the kidneys to transient ischemic conditions—in other words, they build tolerance to repetitive injury over time.1

Continue to: The other recent study

 

 

The other recent study examined use of NSAIDs by ultramarathon runners (ie, those who run more than 26.219 miles). In an intention-to-treat analysis, 52% of runners taking ibuprofen developed AKI, compared with 34% of those receiving placebo; the number needed to treat was 5.5. AKI was also more severe in NSAID users than in placebo users. The results were not statistically significant due to an underpowered study (N = 89). However, the authors also observed that slower runners were less likely to develop AKI, and those who lost the most weight during the race were more likely to develop AKI—suggesting that lower intensity running and adequate hydration may help prevent kidney injury.2

In summary: While marathon runners are prone to AKI, the injury seems to be transient and does not progress to CKD. Furthermore, use of NSAIDs during endurance running may contribute to AKI development, so patients should be advised to use caution with these analgesics. Finally, remind your endurance runners to stay hydrated, since it may help to limit kidney damage. As for the casual runner? The impact on the kidney remains unclear and needs further investigation. —DSW

Danielle S. Wentworth, MSN, FNP-BC
Division of Nephrology, University of Viriginia Health System, Charlottesville

References

1. Mansour SG, Verma G, Pata RW, et al. Kidney injury and repair biomarkers in marathon runners. Am J Kidney Dis. 2017;70(2):252-261.
2. Lipman GS, Shea K, Christensen M, et al. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J. 2017;34(10):637-642.

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Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation's Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month's responses were authored by Danielle S. Wentworth, MSN, FNP-BC, who practices in the Division of Nephrology at the University of Virginia Health System in Charlottesville, and Barbara Weis Malone, DNP, FNP-C, FNKF, who is an Assistant Professor in the Adult/Gerontology NP Program in the College of Nursing, and a Nurse Practitioner in the School of Medicine, at the University of Colorado Anschutz Medical Campus.

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Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation's Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month's responses were authored by Danielle S. Wentworth, MSN, FNP-BC, who practices in the Division of Nephrology at the University of Virginia Health System in Charlottesville, and Barbara Weis Malone, DNP, FNP-C, FNKF, who is an Assistant Professor in the Adult/Gerontology NP Program in the College of Nursing, and a Nurse Practitioner in the School of Medicine, at the University of Colorado Anschutz Medical Campus.

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Q) Many of my patients are athletes. I recall reading something about kidney disease in marathon runners. Am I remembering correctly?

Although data on acute kidney injury (AKI) in marathon runners are limited, two recent studies have added to our knowledge. In 2017, Mansour et al studied 22 marathon runners, collecting urine and blood samples 24 hours before, immediately after, and 24 hours after a race. The results showed that in 82% of the subjects, serum creatinine increased to a level correlated with stage 1 or 2 AKI (as defined by the Acute Kidney Injury Network criteria).1

Based on urine microscopy results, as well as serum creatinine and novel biomarker levels, the researchers concluded that the runners’ AKI was caused by acute tubular injury—likely induced by ischemia. However, the subjects did not show any evidence of chronic kidney disease (CKD), despite years of running and intensive training. One theory: Habitual running might condition the kidneys to transient ischemic conditions—in other words, they build tolerance to repetitive injury over time.1

Continue to: The other recent study

 

 

The other recent study examined use of NSAIDs by ultramarathon runners (ie, those who run more than 26.219 miles). In an intention-to-treat analysis, 52% of runners taking ibuprofen developed AKI, compared with 34% of those receiving placebo; the number needed to treat was 5.5. AKI was also more severe in NSAID users than in placebo users. The results were not statistically significant due to an underpowered study (N = 89). However, the authors also observed that slower runners were less likely to develop AKI, and those who lost the most weight during the race were more likely to develop AKI—suggesting that lower intensity running and adequate hydration may help prevent kidney injury.2

In summary: While marathon runners are prone to AKI, the injury seems to be transient and does not progress to CKD. Furthermore, use of NSAIDs during endurance running may contribute to AKI development, so patients should be advised to use caution with these analgesics. Finally, remind your endurance runners to stay hydrated, since it may help to limit kidney damage. As for the casual runner? The impact on the kidney remains unclear and needs further investigation. —DSW

Danielle S. Wentworth, MSN, FNP-BC
Division of Nephrology, University of Viriginia Health System, Charlottesville

Q) Many of my patients are athletes. I recall reading something about kidney disease in marathon runners. Am I remembering correctly?

Although data on acute kidney injury (AKI) in marathon runners are limited, two recent studies have added to our knowledge. In 2017, Mansour et al studied 22 marathon runners, collecting urine and blood samples 24 hours before, immediately after, and 24 hours after a race. The results showed that in 82% of the subjects, serum creatinine increased to a level correlated with stage 1 or 2 AKI (as defined by the Acute Kidney Injury Network criteria).1

Based on urine microscopy results, as well as serum creatinine and novel biomarker levels, the researchers concluded that the runners’ AKI was caused by acute tubular injury—likely induced by ischemia. However, the subjects did not show any evidence of chronic kidney disease (CKD), despite years of running and intensive training. One theory: Habitual running might condition the kidneys to transient ischemic conditions—in other words, they build tolerance to repetitive injury over time.1

Continue to: The other recent study

 

 

The other recent study examined use of NSAIDs by ultramarathon runners (ie, those who run more than 26.219 miles). In an intention-to-treat analysis, 52% of runners taking ibuprofen developed AKI, compared with 34% of those receiving placebo; the number needed to treat was 5.5. AKI was also more severe in NSAID users than in placebo users. The results were not statistically significant due to an underpowered study (N = 89). However, the authors also observed that slower runners were less likely to develop AKI, and those who lost the most weight during the race were more likely to develop AKI—suggesting that lower intensity running and adequate hydration may help prevent kidney injury.2

In summary: While marathon runners are prone to AKI, the injury seems to be transient and does not progress to CKD. Furthermore, use of NSAIDs during endurance running may contribute to AKI development, so patients should be advised to use caution with these analgesics. Finally, remind your endurance runners to stay hydrated, since it may help to limit kidney damage. As for the casual runner? The impact on the kidney remains unclear and needs further investigation. —DSW

Danielle S. Wentworth, MSN, FNP-BC
Division of Nephrology, University of Viriginia Health System, Charlottesville

References

1. Mansour SG, Verma G, Pata RW, et al. Kidney injury and repair biomarkers in marathon runners. Am J Kidney Dis. 2017;70(2):252-261.
2. Lipman GS, Shea K, Christensen M, et al. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J. 2017;34(10):637-642.

References

1. Mansour SG, Verma G, Pata RW, et al. Kidney injury and repair biomarkers in marathon runners. Am J Kidney Dis. 2017;70(2):252-261.
2. Lipman GS, Shea K, Christensen M, et al. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J. 2017;34(10):637-642.

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Dr. Pellegrini receives Seattle Business Leaders in Health Care Lifetime Achievement Award

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Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), a Past-President of the American College of Surgeons, has received Seattle Business magazine’s 2018 Leaders in Health Care Lifetime Achievement Award for his committed service to improving the quality of patient care in the Seattle, WA, area.

Dr. Pellegrini has worked in the University of Washington (UW), Seattle, department of surgery since 1993, first as chair of the department and then in 1996 as the Henry N. Harkins Professor and Chair, until 2015, when he was appointed to serve as UW Medicine’s first chief medical officer (CMO).

According to the Seattle Business article on Dr. Pellegrini’s achievement, as CMO, Dr. Pellegrini oversees thousands of health care providers and has led a program that has visibly improved patient care quality, reduced costs, and “ensured that all of the health care system’s 270,000 patients have an assigned primary care provider across its primary care clinics.” He also integrated clinical services for key programs and created a training program to prepare young clinicians for leadership roles.

Dr. Carlos Pellegrini


Dr. Pellegrini said that his motivation has always been to help people, as a surgeon, a mentor, or, as he notes about his role as CMO, by “advancing social issues and the care that we provide our patients.”

 

 


Read more about Dr. Pellegrini’s life and career in the Seattle Business article at http://seattlebusinessmag.com:8080/health-care/2018-leaders-health-care-lifetime-achievement-award-carlos-pellegrini-uw-medicine.
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Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), a Past-President of the American College of Surgeons, has received Seattle Business magazine’s 2018 Leaders in Health Care Lifetime Achievement Award for his committed service to improving the quality of patient care in the Seattle, WA, area.

Dr. Pellegrini has worked in the University of Washington (UW), Seattle, department of surgery since 1993, first as chair of the department and then in 1996 as the Henry N. Harkins Professor and Chair, until 2015, when he was appointed to serve as UW Medicine’s first chief medical officer (CMO).

According to the Seattle Business article on Dr. Pellegrini’s achievement, as CMO, Dr. Pellegrini oversees thousands of health care providers and has led a program that has visibly improved patient care quality, reduced costs, and “ensured that all of the health care system’s 270,000 patients have an assigned primary care provider across its primary care clinics.” He also integrated clinical services for key programs and created a training program to prepare young clinicians for leadership roles.

Dr. Carlos Pellegrini


Dr. Pellegrini said that his motivation has always been to help people, as a surgeon, a mentor, or, as he notes about his role as CMO, by “advancing social issues and the care that we provide our patients.”

 

 


Read more about Dr. Pellegrini’s life and career in the Seattle Business article at http://seattlebusinessmag.com:8080/health-care/2018-leaders-health-care-lifetime-achievement-award-carlos-pellegrini-uw-medicine.

 

Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), a Past-President of the American College of Surgeons, has received Seattle Business magazine’s 2018 Leaders in Health Care Lifetime Achievement Award for his committed service to improving the quality of patient care in the Seattle, WA, area.

Dr. Pellegrini has worked in the University of Washington (UW), Seattle, department of surgery since 1993, first as chair of the department and then in 1996 as the Henry N. Harkins Professor and Chair, until 2015, when he was appointed to serve as UW Medicine’s first chief medical officer (CMO).

According to the Seattle Business article on Dr. Pellegrini’s achievement, as CMO, Dr. Pellegrini oversees thousands of health care providers and has led a program that has visibly improved patient care quality, reduced costs, and “ensured that all of the health care system’s 270,000 patients have an assigned primary care provider across its primary care clinics.” He also integrated clinical services for key programs and created a training program to prepare young clinicians for leadership roles.

Dr. Carlos Pellegrini


Dr. Pellegrini said that his motivation has always been to help people, as a surgeon, a mentor, or, as he notes about his role as CMO, by “advancing social issues and the care that we provide our patients.”

 

 


Read more about Dr. Pellegrini’s life and career in the Seattle Business article at http://seattlebusinessmag.com:8080/health-care/2018-leaders-health-care-lifetime-achievement-award-carlos-pellegrini-uw-medicine.
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Royal Australasian College of Surgeons partners with ACS for Annual Scientific Congress

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The Royal Australasian College of Surgeons (RACS), along with the American College of Surgeons (ACS), will host the 87th Annual Scientific Congress, May 7–11 at the International Convention Centre in Sydney, Australia.

The theme of the 2018 Scientific Congress, Reflecting on What Really Matters, explores the challenges of providing quality patient care within complex health care systems—a universal situation familiar to U.S. surgeons.

RAS Annual Scientific Congress 2018


The ACS has partnered in the planning of this program, and many U.S. surgeons will be featured as speakers throughout the week. Additionally, an ACS panel will take place the morning of Thursday, May 10. The ACS also will be involved in other Annual Scientific Congress activities, including the following:

 

 

• ACS Lecture, The Surgical Patient in the ICU—Insights into Survivorship, by Mayur B. Patel, MD, MPH, FACS, a neurosurgeon and surgical intensivist, from Nashville, TN

• Region 16 meeting for ACS Fellows from Australia and New Zealand, the U.S., and other Pacific countries

Among the ACS leaders attending the Congress are Barbara L. Bass, MD, FACS, FRCS(Hon),

ACS President; Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, Director, ACS Division of

Research and Optimal Patient Care; Ronald V. Maier, MD, FACS, ACS President-Elect; M.

Margaret (Peggy) Knudson, MD, FACS, Medical Director, Military Health System Strategi

Partnership American College of Surgeons; and Tyler G. Hughes, MD, FACS, Co-Editor, ACS

Surgery News, and Editor-in-Chief, ACS Communities.

For more information on the conference and to register, visit the RACS 87th Annual Scientific Congress website at https://asc.surgeons.org/.
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The Royal Australasian College of Surgeons (RACS), along with the American College of Surgeons (ACS), will host the 87th Annual Scientific Congress, May 7–11 at the International Convention Centre in Sydney, Australia.

The theme of the 2018 Scientific Congress, Reflecting on What Really Matters, explores the challenges of providing quality patient care within complex health care systems—a universal situation familiar to U.S. surgeons.

RAS Annual Scientific Congress 2018


The ACS has partnered in the planning of this program, and many U.S. surgeons will be featured as speakers throughout the week. Additionally, an ACS panel will take place the morning of Thursday, May 10. The ACS also will be involved in other Annual Scientific Congress activities, including the following:

 

 

• ACS Lecture, The Surgical Patient in the ICU—Insights into Survivorship, by Mayur B. Patel, MD, MPH, FACS, a neurosurgeon and surgical intensivist, from Nashville, TN

• Region 16 meeting for ACS Fellows from Australia and New Zealand, the U.S., and other Pacific countries

Among the ACS leaders attending the Congress are Barbara L. Bass, MD, FACS, FRCS(Hon),

ACS President; Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, Director, ACS Division of

Research and Optimal Patient Care; Ronald V. Maier, MD, FACS, ACS President-Elect; M.

Margaret (Peggy) Knudson, MD, FACS, Medical Director, Military Health System Strategi

Partnership American College of Surgeons; and Tyler G. Hughes, MD, FACS, Co-Editor, ACS

Surgery News, and Editor-in-Chief, ACS Communities.

For more information on the conference and to register, visit the RACS 87th Annual Scientific Congress website at https://asc.surgeons.org/.

 

The Royal Australasian College of Surgeons (RACS), along with the American College of Surgeons (ACS), will host the 87th Annual Scientific Congress, May 7–11 at the International Convention Centre in Sydney, Australia.

The theme of the 2018 Scientific Congress, Reflecting on What Really Matters, explores the challenges of providing quality patient care within complex health care systems—a universal situation familiar to U.S. surgeons.

RAS Annual Scientific Congress 2018


The ACS has partnered in the planning of this program, and many U.S. surgeons will be featured as speakers throughout the week. Additionally, an ACS panel will take place the morning of Thursday, May 10. The ACS also will be involved in other Annual Scientific Congress activities, including the following:

 

 

• ACS Lecture, The Surgical Patient in the ICU—Insights into Survivorship, by Mayur B. Patel, MD, MPH, FACS, a neurosurgeon and surgical intensivist, from Nashville, TN

• Region 16 meeting for ACS Fellows from Australia and New Zealand, the U.S., and other Pacific countries

Among the ACS leaders attending the Congress are Barbara L. Bass, MD, FACS, FRCS(Hon),

ACS President; Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, Director, ACS Division of

Research and Optimal Patient Care; Ronald V. Maier, MD, FACS, ACS President-Elect; M.

Margaret (Peggy) Knudson, MD, FACS, Medical Director, Military Health System Strategi

Partnership American College of Surgeons; and Tyler G. Hughes, MD, FACS, Co-Editor, ACS

Surgery News, and Editor-in-Chief, ACS Communities.

For more information on the conference and to register, visit the RACS 87th Annual Scientific Congress website at https://asc.surgeons.org/.
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ACS releases 2018 update to the Physicians as Assistants at Surgery report

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The American College of Surgeons (ACS), in collaboration with 15 other national specialty surgical organizations, has recently published the eighth edition of the Physicians as Assistants at Surgery report, a study first undertaken in 1994. The 2018 report reflects the most recent clinical practices and provides guidance on how often an operation might require a physician to assist at surgery. The report is available on the ACS website at www.facs.org/~/media/files/advocacy/pubs/2018_pas.ashx.

Using the American Medical Association’s Current Procedural Terminology (CPT) codes from the 2018 manual, each participating organization reviewed new or revised codes since 2016 and any other codes of interest that are applicable to their specialty and indicated whether the operation requires a physician as an assistant with the following frequency: almost always, almost never, or some of the time. The 2018 report adds 93 codes that the CPT Editorial Panel has approved since the last report was issued in 2016. In addition, the 2018 report updates 384 revised codes and deletes 48 codes that are no longer in CPT.

The ACS maintains that a physician who assists with an operation should be trained to participate in and actively assist the surgeon in safely completing the operation. When a surgeon is unavailable to serve as an assistant, a qualified surgical resident or other qualified health care professional, such as a nurse practitioner or physician assistant with experience in assisting, may participate in operations, according to the ACS Statements on Principles (available at www.facs.org/about-acs/statements/stonprin).

Organizations that collaborated with the ACS to conduct the study include the American Academy of Ophthalmology, the American Academy of Orthopaedic Surgeons, the American Academy of Otolaryngology–Head and Neck Surgery, the American Association of Neurological Surgeons, the American Pediatric Surgical Association, the American Society of Colon and Rectal Surgeons, the American Society of Plastic Surgeons, the American Society of Transplant Surgeons, the American Urological Association, the Congress of Neurological Surgeons, the Society for Surgical Oncology, the Society for Vascular Surgery, the Society of American Gastrointestinal Endoscopic Surgeons, the American College of Obstetricians and Gynecologists, and the Society of Thoracic Surgeons.

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The American College of Surgeons (ACS), in collaboration with 15 other national specialty surgical organizations, has recently published the eighth edition of the Physicians as Assistants at Surgery report, a study first undertaken in 1994. The 2018 report reflects the most recent clinical practices and provides guidance on how often an operation might require a physician to assist at surgery. The report is available on the ACS website at www.facs.org/~/media/files/advocacy/pubs/2018_pas.ashx.

Using the American Medical Association’s Current Procedural Terminology (CPT) codes from the 2018 manual, each participating organization reviewed new or revised codes since 2016 and any other codes of interest that are applicable to their specialty and indicated whether the operation requires a physician as an assistant with the following frequency: almost always, almost never, or some of the time. The 2018 report adds 93 codes that the CPT Editorial Panel has approved since the last report was issued in 2016. In addition, the 2018 report updates 384 revised codes and deletes 48 codes that are no longer in CPT.

The ACS maintains that a physician who assists with an operation should be trained to participate in and actively assist the surgeon in safely completing the operation. When a surgeon is unavailable to serve as an assistant, a qualified surgical resident or other qualified health care professional, such as a nurse practitioner or physician assistant with experience in assisting, may participate in operations, according to the ACS Statements on Principles (available at www.facs.org/about-acs/statements/stonprin).

Organizations that collaborated with the ACS to conduct the study include the American Academy of Ophthalmology, the American Academy of Orthopaedic Surgeons, the American Academy of Otolaryngology–Head and Neck Surgery, the American Association of Neurological Surgeons, the American Pediatric Surgical Association, the American Society of Colon and Rectal Surgeons, the American Society of Plastic Surgeons, the American Society of Transplant Surgeons, the American Urological Association, the Congress of Neurological Surgeons, the Society for Surgical Oncology, the Society for Vascular Surgery, the Society of American Gastrointestinal Endoscopic Surgeons, the American College of Obstetricians and Gynecologists, and the Society of Thoracic Surgeons.

The American College of Surgeons (ACS), in collaboration with 15 other national specialty surgical organizations, has recently published the eighth edition of the Physicians as Assistants at Surgery report, a study first undertaken in 1994. The 2018 report reflects the most recent clinical practices and provides guidance on how often an operation might require a physician to assist at surgery. The report is available on the ACS website at www.facs.org/~/media/files/advocacy/pubs/2018_pas.ashx.

Using the American Medical Association’s Current Procedural Terminology (CPT) codes from the 2018 manual, each participating organization reviewed new or revised codes since 2016 and any other codes of interest that are applicable to their specialty and indicated whether the operation requires a physician as an assistant with the following frequency: almost always, almost never, or some of the time. The 2018 report adds 93 codes that the CPT Editorial Panel has approved since the last report was issued in 2016. In addition, the 2018 report updates 384 revised codes and deletes 48 codes that are no longer in CPT.

The ACS maintains that a physician who assists with an operation should be trained to participate in and actively assist the surgeon in safely completing the operation. When a surgeon is unavailable to serve as an assistant, a qualified surgical resident or other qualified health care professional, such as a nurse practitioner or physician assistant with experience in assisting, may participate in operations, according to the ACS Statements on Principles (available at www.facs.org/about-acs/statements/stonprin).

Organizations that collaborated with the ACS to conduct the study include the American Academy of Ophthalmology, the American Academy of Orthopaedic Surgeons, the American Academy of Otolaryngology–Head and Neck Surgery, the American Association of Neurological Surgeons, the American Pediatric Surgical Association, the American Society of Colon and Rectal Surgeons, the American Society of Plastic Surgeons, the American Society of Transplant Surgeons, the American Urological Association, the Congress of Neurological Surgeons, the Society for Surgical Oncology, the Society for Vascular Surgery, the Society of American Gastrointestinal Endoscopic Surgeons, the American College of Obstetricians and Gynecologists, and the Society of Thoracic Surgeons.

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Applications for ACS Academy of Master Surgeon Educators are now being accepted –

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The American College of Surgeons (ACS) Academy of Master Surgeon Educators, a new College enterprise that will advance the science and implementation of education across all surgical specialties, is now accepting applications for Membership and Associate Membership. Applications are due May 14, 2018.


You could be considered for membership in the Academy through two avenues:

• You may apply directly.

• You may be nominated by a colleague and then complete the application.
 

Background

In October 2014, the American College of Surgeons (ACS) Board of Regents approved a proposal from the ACS Division of Education to establish the ACS Academy of Master Surgeon Educators. A Steering Committee was appointed to create a model for the Academy, which articulated the desired outcomes, defined standards and criteria for membership, and developed the process for application. The ACS Steering Committee for the Academy of Master Surgeon Educators is co-chaired by ACS Past-President L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), and Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education. Other members include Sir Murray Brennan, MD, FACS, ACS Distinguished Service Award recipient; Haile Debas, MD, FACS, founding executive director, Global Health Sciences, University of California, San Francisco; David B. Hoyt, MD, FACS, ACS Executive Director; L. Scott Levin, MD, FACS, ACS Regent; Leigh Neumayer, MD, FACS, Chair, ACS Board of Regents; and Carlos Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), ACS Past-President.

The Academy formally launched at the ACS Clinical Congress 2017 in San Diego, CA, and was received enthusiastically.

 

 

Purposes of the Academy

The goals of this unique Academy are to define megatrends in surgical education, steer advances in this field, and underscore the critical importance of surgical education in the changing milieu of health care. The Academy will meet these goals by recognizing and assembling a cadre of master surgeon educators of national and international renown who will support cutting-edge surgical education and provide mentorship to the next generation of surgeon educators.

Members of the Academy will be selected through a rigorous peer-review process, and induction will be a high honor in the field of surgical education. Members of the Academy will be expected to engage in activities to address the aforementioned goals. Membership in the Academy will be open to Master Surgeon Educators from across the surgical specialties.

Three categories of membership will be available: Member, Associate Member, and Affiliate Member. Applications for Membership and Associate Membership in the Academy are now being accepted. You are invited to apply or nominate a colleague for membership via the ACS website at facs.org/acsacademy.

The ACS is truly excited about this seminal endeavor, which will impact the profession of surgery for generations to come.

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The American College of Surgeons (ACS) Academy of Master Surgeon Educators, a new College enterprise that will advance the science and implementation of education across all surgical specialties, is now accepting applications for Membership and Associate Membership. Applications are due May 14, 2018.


You could be considered for membership in the Academy through two avenues:

• You may apply directly.

• You may be nominated by a colleague and then complete the application.
 

Background

In October 2014, the American College of Surgeons (ACS) Board of Regents approved a proposal from the ACS Division of Education to establish the ACS Academy of Master Surgeon Educators. A Steering Committee was appointed to create a model for the Academy, which articulated the desired outcomes, defined standards and criteria for membership, and developed the process for application. The ACS Steering Committee for the Academy of Master Surgeon Educators is co-chaired by ACS Past-President L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), and Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education. Other members include Sir Murray Brennan, MD, FACS, ACS Distinguished Service Award recipient; Haile Debas, MD, FACS, founding executive director, Global Health Sciences, University of California, San Francisco; David B. Hoyt, MD, FACS, ACS Executive Director; L. Scott Levin, MD, FACS, ACS Regent; Leigh Neumayer, MD, FACS, Chair, ACS Board of Regents; and Carlos Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), ACS Past-President.

The Academy formally launched at the ACS Clinical Congress 2017 in San Diego, CA, and was received enthusiastically.

 

 

Purposes of the Academy

The goals of this unique Academy are to define megatrends in surgical education, steer advances in this field, and underscore the critical importance of surgical education in the changing milieu of health care. The Academy will meet these goals by recognizing and assembling a cadre of master surgeon educators of national and international renown who will support cutting-edge surgical education and provide mentorship to the next generation of surgeon educators.

Members of the Academy will be selected through a rigorous peer-review process, and induction will be a high honor in the field of surgical education. Members of the Academy will be expected to engage in activities to address the aforementioned goals. Membership in the Academy will be open to Master Surgeon Educators from across the surgical specialties.

Three categories of membership will be available: Member, Associate Member, and Affiliate Member. Applications for Membership and Associate Membership in the Academy are now being accepted. You are invited to apply or nominate a colleague for membership via the ACS website at facs.org/acsacademy.

The ACS is truly excited about this seminal endeavor, which will impact the profession of surgery for generations to come.

The American College of Surgeons (ACS) Academy of Master Surgeon Educators, a new College enterprise that will advance the science and implementation of education across all surgical specialties, is now accepting applications for Membership and Associate Membership. Applications are due May 14, 2018.


You could be considered for membership in the Academy through two avenues:

• You may apply directly.

• You may be nominated by a colleague and then complete the application.
 

Background

In October 2014, the American College of Surgeons (ACS) Board of Regents approved a proposal from the ACS Division of Education to establish the ACS Academy of Master Surgeon Educators. A Steering Committee was appointed to create a model for the Academy, which articulated the desired outcomes, defined standards and criteria for membership, and developed the process for application. The ACS Steering Committee for the Academy of Master Surgeon Educators is co-chaired by ACS Past-President L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), and Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education. Other members include Sir Murray Brennan, MD, FACS, ACS Distinguished Service Award recipient; Haile Debas, MD, FACS, founding executive director, Global Health Sciences, University of California, San Francisco; David B. Hoyt, MD, FACS, ACS Executive Director; L. Scott Levin, MD, FACS, ACS Regent; Leigh Neumayer, MD, FACS, Chair, ACS Board of Regents; and Carlos Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), ACS Past-President.

The Academy formally launched at the ACS Clinical Congress 2017 in San Diego, CA, and was received enthusiastically.

 

 

Purposes of the Academy

The goals of this unique Academy are to define megatrends in surgical education, steer advances in this field, and underscore the critical importance of surgical education in the changing milieu of health care. The Academy will meet these goals by recognizing and assembling a cadre of master surgeon educators of national and international renown who will support cutting-edge surgical education and provide mentorship to the next generation of surgeon educators.

Members of the Academy will be selected through a rigorous peer-review process, and induction will be a high honor in the field of surgical education. Members of the Academy will be expected to engage in activities to address the aforementioned goals. Membership in the Academy will be open to Master Surgeon Educators from across the surgical specialties.

Three categories of membership will be available: Member, Associate Member, and Affiliate Member. Applications for Membership and Associate Membership in the Academy are now being accepted. You are invited to apply or nominate a colleague for membership via the ACS website at facs.org/acsacademy.

The ACS is truly excited about this seminal endeavor, which will impact the profession of surgery for generations to come.

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