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Training the physician-scientist: views from program directors and aspiring young investigators.
Williams CS, Iness AN, Baron RM, Ajijola OA, Hu PJ, Vyas JM, Baiocchi R, Adami AJ, Lever JM, Klein PS, Demer L, Madaio M, Geraci M, Brass LF, Blanchard M, Salata R, Zaidi M
(2018) JCI Insight 3:
MeSH Terms: Awards and Prizes, Biomedical Research, Career Choice, Charities, Education, Education, Medical, Education, Medical, Graduate, Foundations, Humans, National Institutes of Health (U.S.), Physicians, Research Personnel, Societies, Medical, Students, Medical, Surveys and Questionnaires, Training Support, United States, Workforce
Show Abstract · Added April 15, 2019
There is growing concern that the physician-scientist is endangered due to a leaky training pipeline and prolonged time to scientific independence (1). The NIH Physician-Scientist Workforce Working Group has concluded that as many as 1,000 individuals will need to enter the pipeline each year to sustain the workforce (2). Moreover, surveys of postgraduate training programs document considerable variability in disposition and infrastructure (3). Programs can be broadly grouped into two classes: physician-scientist training programs (PSTPs) that span residency and fellowship training, and research-in-residency programs (RiRs), which are limited to residency but trainees are able to match into PSTPs upon transitioning to fellowship (Figure 1). Funding sources for RiRs and PSTPs are varied and include NIH KL2 and T32 awards, charitable foundations, philanthropy, and institutional support. Furthermore, standards for research training and tools for evaluating programmatic success are lacking. Here, we share consensus generated from iterative workshops hosted by the Alliance of Academic Internal Medicine (AAIM) and the student-led American Physician Scientists Association (APSA).
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18 MeSH Terms
Survivorship, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology.
Denlinger CS, Sanft T, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, King A, Koura D, Lally RM, Langbaum TS, McDonough AL, Melisko M, Montoya JG, Mooney K, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peppercorn J, Pirl W, Rodriguez MA, Ruddy KJ, Silverman P, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Wakabayashi MT, Zee P, McMillian NR, Freedman-Cass DA
(2018) J Natl Compr Canc Netw 16: 1216-1247
MeSH Terms: Anthracyclines, Antibiotics, Antineoplastic, Antineoplastic Agents, Immunological, Bacterial Infections, Cancer Survivors, Cardiotoxicity, Humans, Immunocompromised Host, Lymphedema, Mass Screening, Medical Oncology, Neoplasms, Risk Assessment, Societies, Medical, Survivorship, United States, Vaccination, Virus Diseases
Show Abstract · Added December 13, 2018
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.
Copyright © 2018 by the National Comprehensive Cancer Network.
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18 MeSH Terms
Anaphylactoid Reactions After Instillation of Contrast Material Into the Urinary Tract: A Survey of Contemporary Practice Patterns and Review of the Literature.
Dai JC, Brisbane WG, Chang HC, Hsi RS, Harper JD
(2018) Urology 122: 58-63
MeSH Terms: Anaphylaxis, Contrast Media, Drug Hypersensitivity, Endoscopy, Humans, Incidence, Instillation, Drug, Practice Guidelines as Topic, Practice Patterns, Physicians', Societies, Medical, Surveys and Questionnaires, Urinary Tract, Urologists, Urology
Show Abstract · Added February 26, 2019
OBJECTIVE - To assess drug reactions (ADRs) encountered by practicing urologists for contrast instilled into the urinary collecting system, and to describe current practice patterns regarding contrast administration into the urinary tract for patients with known contrast allergies.
METHODS - Endourological Society members were e-mailed a web-based survey about their prior experience with contrast-related ADRs and practices for contrast administration into the urinary tract among patients with known intravenous contrast allergies. Chi-squared analysis was used to compare management patterns between patients with established allergies and those without.
RESULTS - An estimated 2300-2500 e-mails were reached, resulting in an estimated response rate of 6.3%-8%. Over 75% of respondents were fellowship trained. Average time in practice was 16 years, and respondents performed a mean of 6.7 urologic contrast studies per week. Among respondents, 32.6%, 14.7%, and 4.0% had treated at least 1 patient with a mild, moderate, or severe reaction, respectively. Contrast-related ADRs were most commonly associated with retrograde pyelogram (50%). For patients with known contrast allergies, 5.4% pursue additional work-up before administering contrast in the urinary tract. Pretreatment with antihistamine or steroids is used by 24.8% and 23.4%, respectively. When performing retrograde pyelograms for such patients, urologists are more likely to use dilute contrast (P = .003), but otherwise do not significantly alter technique.
CONCLUSION - Contrast ADRs are encountered not infrequently among practicing urologists. There is notable practice variation in the management of patients with known contrast allergies, though the overall perceived risk of contrast use in these patients is low, provided good technique is used.
Copyright © 2018 Elsevier Inc. All rights reserved.
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14 MeSH Terms
Use of the thyroid imaging, reporting, and data system (TI-RADS) scoring system for the evaluation of subcentimeter thyroid nodules.
Weiss VL, Andreotti RF, Ely KA
(2018) Cancer Cytopathol 126: 518-524
MeSH Terms: Adult, Aged, Aged, 80 and over, Biopsy, Fine-Needle, Data Systems, Female, Follow-Up Studies, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Practice Guidelines as Topic, Prognosis, Retrospective Studies, Societies, Medical, Thyroid Gland, Thyroid Neoplasms, Thyroid Nodule, Ultrasonography, Young Adult
Show Abstract · Added April 15, 2019
BACKGROUND - The American Thyroid Association (ATA) recommends fine-needle aspiration (FNA) biopsy of nodules measuring >1.5 cm with low-suspicion sonographic patterns or >1.0 cm with high/intermediate-suspicion features. Routine biopsy of nodules <1 cm is not recommended. However, despite these recommendations, subcentimeter nodules are often referred for FNA biopsy.
METHODS - This was a retrospective chart review of consecutive thyroid FNAs during an 18-month period (1157 patients, 1491 nodules, 2016-2017) to evaluate age, sex, medical history, diagnoses, and follow-up. Radiographic information was used to identify 61 subcentimeter nodules (4%) from 57 patients. Ultrasound studies were re-evaluated using criteria according to the American College of Radiology Thyroid Imaging, Reporting, and Data System (TI-RADS).
RESULTS - Reported reasons for biopsy included a larger companion nodule (44%), a personal or family history of cancer (26%), or a suspicious sonogram, including calcification and/or irregular contours (16%). FNA diagnoses included: 69% benign (42 of 61 nodules), 10% papillary thyroid carcinoma (PTC) (6 of 61 nodules), and 15% atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (9 of 61 nodules). Seven percent of nodules were unsatisfactory/nondiagnostic (4 of 61 nodules) compared with a 3% nondiagnostic rate for all sized nodules. Fifty-one nodules had an ultrasound available for re-review using the TI-RADS scoring system. A high TI-RADS score (4-5) was indicative of PTC in 29.4% of nodules. A low TI-RADS score (1-2) was indicative of PTC in 0% of nodules (P < .01). High and intermediate TI-RADS scores (3 and 4-5, respectively) were indicative of PTC/AUS/FLUS in 32% of nodules compared with 0% in those with low TI-RADS scores (P < .01).
CONCLUSIONS - The current results demonstrate successful use of the TI-RADS scoring system in evaluation of the risk of malignancy in subcentimeter nodules. Larger studies will be necessary to determine whether biopsy is warranted for TI-RADS high-subcentimeter nodules. Cancer Cytopathol 2018. © 2018 American Cancer Society.
© 2018 American Cancer Society.
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20 MeSH Terms
Evaluating Molecular Biomarkers for the Early Detection of Lung Cancer: When Is a Biomarker Ready for Clinical Use? An Official American Thoracic Society Policy Statement.
Mazzone PJ, Sears CR, Arenberg DA, Gaga M, Gould MK, Massion PP, Nair VS, Powell CA, Silvestri GA, Vachani A, Wiener RS, ATS Assembly on Thoracic Oncology
(2017) Am J Respir Crit Care Med 196: e15-e29
MeSH Terms: Biomarkers, Tumor, Early Detection of Cancer, Humans, Lung Neoplasms, Societies, Medical, United States
Show Abstract · Added January 29, 2018
BACKGROUND - Molecular biomarkers have the potential to improve the current state of early lung cancer detection. The goal of this project was to develop a policy statement that provides guidance about the level of evidence required to determine that a molecular biomarker, used to support early lung cancer detection, is appropriate for clinical use.
METHODS - An ad hoc project steering committee was formed, to include individuals with expertise in the early detection of lung cancer and molecular biomarker development, from inside and outside of the Assembly on Thoracic Oncology. Key questions, generated from the results of a survey of the project steering committee, were discussed at an in-person meeting. Results of the discussion were summarized in a policy statement that was circulated to the steering committee and revised multiple times to achieve consensus.
RESULTS - With a focus on the clinical applications of lung cancer screening and lung nodule evaluation, the policy statement outlines categories of results that should be reported in the early phases of molecular biomarker development, discusses the level of evidence that would support study of the clinical utility, describes the outcomes that should be proven to consider a molecular biomarker clinically useful, and suggests study designs capable of assessing these outcomes.
CONCLUSIONS - The application of molecular biomarkers to assist with the early detection of lung cancer has the potential to substantially improve our ability to select patients for lung cancer screening, and to assist with the characterization of indeterminate lung nodules. We have described relevant considerations and have suggested standards to apply when determining whether a molecular biomarker for the early detection of lung cancer is ready for clinical use.
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6 MeSH Terms
Meeting report: Metastasis Research Society-Chinese Tumor Metastasis Society joint conference on metastasis.
Bankaitis K, Borriello L, Cox T, Lynch C, Zijlstra A, Fingleton B, Gužvić M, Anderson R, Neman J
(2017) Clin Exp Metastasis 34: 203-213
MeSH Terms: China, Humans, Medical Oncology, Neoplasm Metastasis, Neoplasms, Research Report, Societies, Medical
Show Abstract · Added April 6, 2017
During September 16th-20th 2016, metastasis experts from around the world convened for the 16th Biennial Congress of the Metastasis Research Society and 12th National Congress of the Chinese Tumor Metastasis Society in Chengdu, China to share most current data covering basic, translational, and clinical metastasis research. Presentations of the more than 40 invited speakers of the main congress and presentations from the associated Young Investigator Satellite Meeting are summarized in this report by session topic. The congress program also included three concurrent short talk sessions, an advocacy forum with Chinese and American metastatic patient advocates, a 'Meet the Professors Roundtable' session for young investigators, and a 'Meet the Editors' session with editors from Cancer Cell and Nature Cell Biology. The goal of integrating expertise and exchanging the latest findings, ideas, and practices in cancer metastasis research was achieved magnificently, thanks to the excellent contributions of many leaders in the field.
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7 MeSH Terms
Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee.
Mullon JJ, Burkart KM, Silvestri G, Hogarth DK, Almeida F, Berkowitz D, Eapen GA, Feller-Kopman D, Fessler HE, Folch E, Gillespie C, Haas A, Islam SU, Lamb C, Levine SM, Majid A, Maldonado F, Musani AI, Piquette C, Ray C, Reddy CB, Rickman O, Simoff M, Wahidi MM, Lee H
(2017) Chest 151: 1114-1121
MeSH Terms: Accreditation, Bronchoscopy, Clinical Competence, Curriculum, Education, Medical, Graduate, Faculty, Medical, Fellowships and Scholarships, Humans, Pulmonary Medicine, Societies, Medical, Thoracoscopy, Time Factors
Show Abstract · Added April 3, 2017
Interventional pulmonology (IP) is a rapidly evolving subspecialty of pulmonary medicine. In the last 10 years, formal IP fellowships have increased substantially in number from five to now > 30. The vast majority of IP fellowship trainees are selected through the National Resident Matching Program, and validated in-service and certification examinations for IP exist. Practice standards and training guidelines for IP fellowship programs have been published; however, considerable variability in the environment, curriculum, and experience offered by the various fellowship programs remains, and there is currently no formal accreditation process in place to standardize IP fellowship training. Recognizing the need for more uniform training across the various fellowship programs, a multisociety accreditation committee was formed with the intent to establish common accreditation standards for all IP fellowship programs in the United States. This article provides a summary of those standards and can serve as an accreditation template for training programs and their offices of graduate medical education as they move through the accreditation process.
Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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12 MeSH Terms
HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology.
Bartley AN, Washington MK, Ventura CB, Ismaila N, Colasacco C, Benson AB, Carrato A, Gulley ML, Jain D, Kakar S, Mackay HJ, Streutker C, Tang L, Troxell M, Ajani JA
(2016) Arch Pathol Lab Med 140: 1345-1363
MeSH Terms: Adenocarcinoma, Biomarkers, Tumor, Clinical Decision-Making, Combined Modality Therapy, Decision Trees, Diagnosis, Differential, Esophageal Neoplasms, Evidence-Based Medicine, Humans, Medical Oncology, Molecular Diagnostic Techniques, Molecular Targeted Therapy, Mutation, Neoplasm Grading, Neoplasm Staging, Pathology, Clinical, Receptor, ErbB-2, Societies, Medical, Stomach Neoplasms, United States
Show Abstract · Added March 14, 2018
CONTEXT - - ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2) is currently the only biomarker established for selection of a specific therapy for patients with advanced gastroesophageal adenocarcinoma (GEA). However, there are no comprehensive guidelines for the assessment of HER2 in patients with GEA.
OBJECTIVES - - To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor specimens are appropriate, and to provide guidance on clinical decision making.
DESIGN - - The College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature to develop an evidence-based guideline with recommendations for optimal HER2 testing in patients with GEA.
RESULTS - - The panel is proposing 11 recommendations with strong agreement from the open-comment participants.
RECOMMENDATIONS - - The panel recommends that tumor specimen(s) from all patients with advanced GEA, who are candidates for HER2-targeted therapy, should be assessed for HER2 status before the initiation of HER2-targeted therapy. Clinicians should offer combination chemotherapy and a HER2-targeted agent as initial therapy for all patients with HER2-positive advanced GEA. For pathologists, guidance is provided for morphologic selection of neoplastic tissue, testing algorithms, scoring methods, interpretation and reporting of results, and laboratory quality assurance.
CONCLUSIONS - - This guideline provides specific recommendations for assessment of HER2 in patients with advanced GEA while addressing pertinent technical issues and clinical implications of the results.
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20 MeSH Terms
Celebrating the ASN at 50.
Harris RC, Ibrahim T, Nath KA
(2016) J Am Soc Nephrol 27: 1575-6
MeSH Terms: Nephrology, Societies, Medical, United States
Added April 26, 2017
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3 MeSH Terms
Cardio-Oncology Training: A Proposal From the International Cardioncology Society and Canadian Cardiac Oncology Network for a New Multidisciplinary Specialty.
Lenihan DJ, Hartlage G, DeCara J, Blaes A, Finet JE, Lyon AR, Cornell RF, Moslehi J, Oliveira GH, Murtagh G, Fisch M, Zeevi G, Iakobishvili Z, Witteles R, Patel A, Harrison E, Fradley M, Curigliano G, Lenneman CG, Magalhaes A, Krone R, Porter C, Parasher S, Dent S, Douglas P, Carver J
(2016) J Card Fail 22: 465-71
MeSH Terms: Canada, Cardiology, Cardiovascular Diseases, Consensus, Education, Medical, Graduate, Humans, Interprofessional Relations, Medical Oncology, Societies, Medical
Show Abstract · Added March 26, 2017
There is an increasing awareness and clinical interest in cardiac safety during cancer therapy as well as in optimally addressing cardiac issues in cancer survivors. Although there is an emerging expertise in this area, known as cardio-oncology, there is a lack of organization in the essential components of contemporary training. This proposal, an international consensus statement organized by the International Cardioncology Society and the Canadian Cardiac Oncology Network, attempts to marshal the important ongoing efforts for training the next generation of cardio-oncologists. The necessary elements are outlined, including the expectations for exposure necessary to develop adequate training. There should also be a commitment to local, regional, and international education and research in cardio-oncology as a requirement for advancement in the field.
Copyright © 2016 Elsevier Inc. All rights reserved.
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9 MeSH Terms