The benefits of statins highly offset the associated risks in appropriate patients, according to a scientific statement issued by the American Heart Association.

“The review covers the general patient population, as well as demographic subgroups, including the elderly, children, pregnant women, East Asians, and patients with specific conditions.” wrote Connie B. Newman, MD, of New York University, together with her colleagues. The report is in Arteriosclerosis, Thrombosis, and Vascular Biology.

After an extensive review of the literature pertaining to statin safety and tolerability, Dr. Newman and her colleagues reported the compiled findings from several randomized controlled trials, in addition to observational data, where required. They found that the risk of serious muscle complications, such as rhabdomyolysis, attributable to statin use was less than 0.1%. Furthermore, they noted that the risk of serious hepatotoxicity was even less likely, occurring in about 1 in 10,000 patients treated with therapy.

“There is no convincing evidence for a causal relationship between statins and cancer, cataracts, cognitive dysfunction, peripheral neuropathy, erectile dysfunction, or tendinitis,” the experts wrote. “In U.S. clinical practices, roughly 10% of patients stop taking a statin because of subjective complaints, most commonly muscle symptoms without raised creatine kinase,” they further reported.

Contrastingly, data from randomized trials have shown that the change in the incidence of muscle-related symptoms in patients treated with statins versus placebo is less than 1%. Moreover, the incidence is even lower, with an estimated rate of 0.1%, in those who stopped statin therapy because of these symptoms. Given these results, Dr. Newman and her colleagues said that muscle-related symptoms among statin-treated patients are not due to the pharmacological activity of the statin.

“Restarting statin therapy in these patients can be challenging, but it is important, especially in patients at high risk of cardiovascular events, for whom prevention of these events is a priority,” they added.

A large proportion of the population takes statin therapy to lower the risk of major cardiovascular events, including ischemic stroke, myocardial infarction, and other adverse effects of cardiovascular disease. At maximal doses, statins may decrease LDL-cholesterol levels by roughly 55%-60%. In addition, given the multitude of available generics, statins are an economical treatment option for most patients.

However, Dr. Newman and her colleagues suggested that, when considering statin therapy in special populations, particularly in patients with end-stage renal failure or severe hepatic disease, commencing treatment is not recommended.

“The lack of proof of cardiovascular benefit in patients with end-stage renal disease suggests that initiating statin treatment in these patients is generally not warranted,” the experts wrote. “Data on safety in people with more serious liver disease are insufficient, and statin treatment is generally discouraged,” they added.

With respect to statin-induced adverse effects, they are usually reversible upon discontinuation of therapy, with the exception of hemorrhagic stroke. However, damage from an ischemic stroke or myocardial infarction may result in death. As a result, in patients who would benefit from statin therapy, based on most recent guidelines, cardiovascular benefits greatly exceed potential safety concerns.

Dr. Newman and her coauthors disclosed financial affiliations with Amgen, Kowa, Regeneron, Sanofi, and others.

SOURCE: Newman CB et al. Arterioscler Thromb Vasc Biol. 2018 Dec 10. doi: 10.1161/ATV.0000000000000073

The benefits of statins highly offset the associated risks in appropriate patients, according to a scientific statement issued by the American Heart Association.

“The review covers the general patient population, as well as demographic subgroups, including the elderly, children, pregnant women, East Asians, and patients with specific conditions.” wrote Connie B. Newman, MD, of New York University, together with her colleagues. The report is in Arteriosclerosis, Thrombosis, and Vascular Biology.

After an extensive review of the literature pertaining to statin safety and tolerability, Dr. Newman and her colleagues reported the compiled findings from several randomized controlled trials, in addition to observational data, where required. They found that the risk of serious muscle complications, such as rhabdomyolysis, attributable to statin use was less than 0.1%. Furthermore, they noted that the risk of serious hepatotoxicity was even less likely, occurring in about 1 in 10,000 patients treated with therapy.

“There is no convincing evidence for a causal relationship between statins and cancer, cataracts, cognitive dysfunction, peripheral neuropathy, erectile dysfunction, or tendinitis,” the experts wrote. “In U.S. clinical practices, roughly 10% of patients stop taking a statin because of subjective complaints, most commonly muscle symptoms without raised creatine kinase,” they further reported.

Contrastingly, data from randomized trials have shown that the change in the incidence of muscle-related symptoms in patients treated with statins versus placebo is less than 1%. Moreover, the incidence is even lower, with an estimated rate of 0.1%, in those who stopped statin therapy because of these symptoms. Given these results, Dr. Newman and her colleagues said that muscle-related symptoms among statin-treated patients are not due to the pharmacological activity of the statin.

“Restarting statin therapy in these patients can be challenging, but it is important, especially in patients at high risk of cardiovascular events, for whom prevention of these events is a priority,” they added.

A large proportion of the population takes statin therapy to lower the risk of major cardiovascular events, including ischemic stroke, myocardial infarction, and other adverse effects of cardiovascular disease. At maximal doses, statins may decrease LDL-cholesterol levels by roughly 55%-60%. In addition, given the multitude of available generics, statins are an economical treatment option for most patients.

However, Dr. Newman and her colleagues suggested that, when considering statin therapy in special populations, particularly in patients with end-stage renal failure or severe hepatic disease, commencing treatment is not recommended.

“The lack of proof of cardiovascular benefit in patients with end-stage renal disease suggests that initiating statin treatment in these patients is generally not warranted,” the experts wrote. “Data on safety in people with more serious liver disease are insufficient, and statin treatment is generally discouraged,” they added.

With respect to statin-induced adverse effects, they are usually reversible upon discontinuation of therapy, with the exception of hemorrhagic stroke. However, damage from an ischemic stroke or myocardial infarction may result in death. As a result, in patients who would benefit from statin therapy, based on most recent guidelines, cardiovascular benefits greatly exceed potential safety concerns.

Dr. Newman and her coauthors disclosed financial affiliations with Amgen, Kowa, Regeneron, Sanofi, and others.

SOURCE: Newman CB et al. Arterioscler Thromb Vasc Biol. 2018 Dec 10. doi: 10.1161/ATV.0000000000000073

The benefits of statins highly offset the associated risks in appropriate patients, according to a scientific statement issued by the American Heart Association.

“The review covers the general patient population, as well as demographic subgroups, including the elderly, children, pregnant women, East Asians, and patients with specific conditions.” wrote Connie B. Newman, MD, of New York University, together with her colleagues. The report is in Arteriosclerosis, Thrombosis, and Vascular Biology.

After an extensive review of the literature pertaining to statin safety and tolerability, Dr. Newman and her colleagues reported the compiled findings from several randomized controlled trials, in addition to observational data, where required. They found that the risk of serious muscle complications, such as rhabdomyolysis, attributable to statin use was less than 0.1%. Furthermore, they noted that the risk of serious hepatotoxicity was even less likely, occurring in about 1 in 10,000 patients treated with therapy.

“There is no convincing evidence for a causal relationship between statins and cancer, cataracts, cognitive dysfunction, peripheral neuropathy, erectile dysfunction, or tendinitis,” the experts wrote. “In U.S. clinical practices, roughly 10% of patients stop taking a statin because of subjective complaints, most commonly muscle symptoms without raised creatine kinase,” they further reported.

Contrastingly, data from randomized trials have shown that the change in the incidence of muscle-related symptoms in patients treated with statins versus placebo is less than 1%. Moreover, the incidence is even lower, with an estimated rate of 0.1%, in those who stopped statin therapy because of these symptoms. Given these results, Dr. Newman and her colleagues said that muscle-related symptoms among statin-treated patients are not due to the pharmacological activity of the statin.

“Restarting statin therapy in these patients can be challenging, but it is important, especially in patients at high risk of cardiovascular events, for whom prevention of these events is a priority,” they added.

A large proportion of the population takes statin therapy to lower the risk of major cardiovascular events, including ischemic stroke, myocardial infarction, and other adverse effects of cardiovascular disease. At maximal doses, statins may decrease LDL-cholesterol levels by roughly 55%-60%. In addition, given the multitude of available generics, statins are an economical treatment option for most patients.

However, Dr. Newman and her colleagues suggested that, when considering statin therapy in special populations, particularly in patients with end-stage renal failure or severe hepatic disease, commencing treatment is not recommended.

“The lack of proof of cardiovascular benefit in patients with end-stage renal disease suggests that initiating statin treatment in these patients is generally not warranted,” the experts wrote. “Data on safety in people with more serious liver disease are insufficient, and statin treatment is generally discouraged,” they added.

With respect to statin-induced adverse effects, they are usually reversible upon discontinuation of therapy, with the exception of hemorrhagic stroke. However, damage from an ischemic stroke or myocardial infarction may result in death. As a result, in patients who would benefit from statin therapy, based on most recent guidelines, cardiovascular benefits greatly exceed potential safety concerns.

Dr. Newman and her coauthors disclosed financial affiliations with Amgen, Kowa, Regeneron, Sanofi, and others.

SOURCE: Newman CB et al. Arterioscler Thromb Vasc Biol. 2018 Dec 10. doi: 10.1161/ATV.0000000000000073

SAN ANTONIO – A tailored 12-month exercise program during adjuvant breast cancer treatment appears to protect cardiovascular function, particularly in patients receiving chemotherapy, according to findings from the randomized EBBA-II trial.
 

The overall change in VO_2max at 12 months was +0.3% in 271 patients randomized to the intervention group, compared with –8.9% in 274 patients in the “usual care” control group, Inger Thune, MD, PhD, said at the San Antonio Breast Cancer Symposium.

Among patients receiving chemotherapy, the VO_2max change at 12 months was +1.6% in 120 patients in the intervention group, compared with –2.76% in 122 patients in the control group, said Dr. Thune of the Cancer Center at Oslo University Hospital.

Study participants were women aged 18-75 years (mean of 55 years at diagnosis) with stage I-II breast cancer, mean body mass index of 25 kg/m², and a mean VO_2max before surgery of 31.5 mL/kg per minute. The intervention group entered a 12-month individualized exercise program 2-3 weeks after surgery based on their own VO_2max at baseline.


They met for training sessions in groups of 10-12 women for 60 minutes twice weekly over the 12-month study period, and were also told to perform at least 120 minutes of exercise at home for a total of 240 minutes of exercise weekly.

Of note, the adherence rate among participants was encouragingly high at about 90%, she said, adding that the findings strongly support tailored exercise during adjuvant breast cancer treatment, as such an intervention appears to counteract declines in cardiovascular function – particularly in those receiving chemotherapy.

In this video interview, Dr. Thune further discussed the study design, implications of the findings, and future directions.

“Cardiovascular morbidity is so important for our breast cancer patients that I think that it’s time to have physical activity [and] physical function as a main interest for all clinicians dealing with breast cancer patients,” she said.

Dr. Thune reported having no disclosures.

SAN ANTONIO – A tailored 12-month exercise program during adjuvant breast cancer treatment appears to protect cardiovascular function, particularly in patients receiving chemotherapy, according to findings from the randomized EBBA-II trial.
 

The overall change in VO_2max at 12 months was +0.3% in 271 patients randomized to the intervention group, compared with –8.9% in 274 patients in the “usual care” control group, Inger Thune, MD, PhD, said at the San Antonio Breast Cancer Symposium.

Among patients receiving chemotherapy, the VO_2max change at 12 months was +1.6% in 120 patients in the intervention group, compared with –2.76% in 122 patients in the control group, said Dr. Thune of the Cancer Center at Oslo University Hospital.

Study participants were women aged 18-75 years (mean of 55 years at diagnosis) with stage I-II breast cancer, mean body mass index of 25 kg/m², and a mean VO_2max before surgery of 31.5 mL/kg per minute. The intervention group entered a 12-month individualized exercise program 2-3 weeks after surgery based on their own VO_2max at baseline.


They met for training sessions in groups of 10-12 women for 60 minutes twice weekly over the 12-month study period, and were also told to perform at least 120 minutes of exercise at home for a total of 240 minutes of exercise weekly.

Of note, the adherence rate among participants was encouragingly high at about 90%, she said, adding that the findings strongly support tailored exercise during adjuvant breast cancer treatment, as such an intervention appears to counteract declines in cardiovascular function – particularly in those receiving chemotherapy.

In this video interview, Dr. Thune further discussed the study design, implications of the findings, and future directions.

“Cardiovascular morbidity is so important for our breast cancer patients that I think that it’s time to have physical activity [and] physical function as a main interest for all clinicians dealing with breast cancer patients,” she said.

Dr. Thune reported having no disclosures.

SAN ANTONIO – A tailored 12-month exercise program during adjuvant breast cancer treatment appears to protect cardiovascular function, particularly in patients receiving chemotherapy, according to findings from the randomized EBBA-II trial.
 

The overall change in VO_2max at 12 months was +0.3% in 271 patients randomized to the intervention group, compared with –8.9% in 274 patients in the “usual care” control group, Inger Thune, MD, PhD, said at the San Antonio Breast Cancer Symposium.

Among patients receiving chemotherapy, the VO_2max change at 12 months was +1.6% in 120 patients in the intervention group, compared with –2.76% in 122 patients in the control group, said Dr. Thune of the Cancer Center at Oslo University Hospital.

Study participants were women aged 18-75 years (mean of 55 years at diagnosis) with stage I-II breast cancer, mean body mass index of 25 kg/m², and a mean VO_2max before surgery of 31.5 mL/kg per minute. The intervention group entered a 12-month individualized exercise program 2-3 weeks after surgery based on their own VO_2max at baseline.


They met for training sessions in groups of 10-12 women for 60 minutes twice weekly over the 12-month study period, and were also told to perform at least 120 minutes of exercise at home for a total of 240 minutes of exercise weekly.

Of note, the adherence rate among participants was encouragingly high at about 90%, she said, adding that the findings strongly support tailored exercise during adjuvant breast cancer treatment, as such an intervention appears to counteract declines in cardiovascular function – particularly in those receiving chemotherapy.

In this video interview, Dr. Thune further discussed the study design, implications of the findings, and future directions.

“Cardiovascular morbidity is so important for our breast cancer patients that I think that it’s time to have physical activity [and] physical function as a main interest for all clinicians dealing with breast cancer patients,” she said.

Dr. Thune reported having no disclosures.

Investigating the link between statin use and type 2 diabetes risk. Also today, should metabolic syndrome be renamed circadian syndrome? A smart phone application diagnoses STEMI nearly as well as ECG, and fewer people having insurance may have helped slow health spending growth in 2017.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
 

Investigating the link between statin use and type 2 diabetes risk. Also today, should metabolic syndrome be renamed circadian syndrome? A smart phone application diagnoses STEMI nearly as well as ECG, and fewer people having insurance may have helped slow health spending growth in 2017.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
 

Investigating the link between statin use and type 2 diabetes risk. Also today, should metabolic syndrome be renamed circadian syndrome? A smart phone application diagnoses STEMI nearly as well as ECG, and fewer people having insurance may have helped slow health spending growth in 2017.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
 

A review of registry data from a major cancer center revealed a strong, bidirectional association between renal cell carcinoma (RCC) and melanoma.

A greater than twofold risk of melanoma in patients with RCC, and a nearly threefold risk of RCC in melanoma patients, were found in the review of the International Tumor Registry Database at The University of Texas MD Anderson Cancer Center.

The incidence of subsequent melanomas or RCCs in this study was in line with other recent reports from cancer registry analyses, reported Kevin B. Kim, MD, and his coinvestigators.

“Clinicians should be more watchful for these secondary cancers in patients with a history of melanoma or RCC,” they wrote. The report is in Cancer Epidemiology.

They found a total of 13,879 patients with melanoma and 7,597 patients with RCC in their review. Of those patients, 89 had both a melanoma and an RCC diagnosis. About 30% were first diagnosed with RCC, 61% were first diagnosed with melanoma, and 9% had both diagnoses around the same time.

Among the RCC-first patients, the standardized incidence ratio for developing a second primary melanoma was 2.31 (95% confidence interval, 1.52-3.37; P less than .001), while for melanoma-first patients, for developing a second primary RCC, it was 2.87 (95% CI, 2.16-3.74; P less than .001).

Those statistics were consistent with other registry reports, according to Dr. Kim and his colleagues, who wrote that the standardized incidence ratios in those studies ranged from 1.28 to 2.5.

In the MD Anderson registry study, nearly one-third of patients with secondary primary melanoma or RCC had a history of additional secondary cancers, according to the researchers. Those diagnoses included nonmelanoma skin cancers, leukemias, prostate cancer, breast cancer, and colon cancer, among others.

That suggested the presence of possible common risk factors that may have included abnormal genetics, though the database lacked the genetic sequencing and family history data to explore that hypothesis further.

“It would be highly desirable to assess germline genetic information on patients and their families, and also somatic gene aberrations in the tumor lesions, in a more systematic way in order to better elucidate the contribution of the genetics in the association between melanoma and RCC,” Dr. Kim and his colleagues said.

They reported that they had no conflicts of interest.

SOURCE: Kim KB et al. Cancer Epidemiol. 2018 Oct 19;57:80-4.

A review of registry data from a major cancer center revealed a strong, bidirectional association between renal cell carcinoma (RCC) and melanoma.

A greater than twofold risk of melanoma in patients with RCC, and a nearly threefold risk of RCC in melanoma patients, were found in the review of the International Tumor Registry Database at The University of Texas MD Anderson Cancer Center.

The incidence of subsequent melanomas or RCCs in this study was in line with other recent reports from cancer registry analyses, reported Kevin B. Kim, MD, and his coinvestigators.

“Clinicians should be more watchful for these secondary cancers in patients with a history of melanoma or RCC,” they wrote. The report is in Cancer Epidemiology.

They found a total of 13,879 patients with melanoma and 7,597 patients with RCC in their review. Of those patients, 89 had both a melanoma and an RCC diagnosis. About 30% were first diagnosed with RCC, 61% were first diagnosed with melanoma, and 9% had both diagnoses around the same time.

Among the RCC-first patients, the standardized incidence ratio for developing a second primary melanoma was 2.31 (95% confidence interval, 1.52-3.37; P less than .001), while for melanoma-first patients, for developing a second primary RCC, it was 2.87 (95% CI, 2.16-3.74; P less than .001).

Those statistics were consistent with other registry reports, according to Dr. Kim and his colleagues, who wrote that the standardized incidence ratios in those studies ranged from 1.28 to 2.5.

In the MD Anderson registry study, nearly one-third of patients with secondary primary melanoma or RCC had a history of additional secondary cancers, according to the researchers. Those diagnoses included nonmelanoma skin cancers, leukemias, prostate cancer, breast cancer, and colon cancer, among others.

That suggested the presence of possible common risk factors that may have included abnormal genetics, though the database lacked the genetic sequencing and family history data to explore that hypothesis further.

“It would be highly desirable to assess germline genetic information on patients and their families, and also somatic gene aberrations in the tumor lesions, in a more systematic way in order to better elucidate the contribution of the genetics in the association between melanoma and RCC,” Dr. Kim and his colleagues said.

They reported that they had no conflicts of interest.

SOURCE: Kim KB et al. Cancer Epidemiol. 2018 Oct 19;57:80-4.

A review of registry data from a major cancer center revealed a strong, bidirectional association between renal cell carcinoma (RCC) and melanoma.

A greater than twofold risk of melanoma in patients with RCC, and a nearly threefold risk of RCC in melanoma patients, were found in the review of the International Tumor Registry Database at The University of Texas MD Anderson Cancer Center.

The incidence of subsequent melanomas or RCCs in this study was in line with other recent reports from cancer registry analyses, reported Kevin B. Kim, MD, and his coinvestigators.

“Clinicians should be more watchful for these secondary cancers in patients with a history of melanoma or RCC,” they wrote. The report is in Cancer Epidemiology.

They found a total of 13,879 patients with melanoma and 7,597 patients with RCC in their review. Of those patients, 89 had both a melanoma and an RCC diagnosis. About 30% were first diagnosed with RCC, 61% were first diagnosed with melanoma, and 9% had both diagnoses around the same time.

Among the RCC-first patients, the standardized incidence ratio for developing a second primary melanoma was 2.31 (95% confidence interval, 1.52-3.37; P less than .001), while for melanoma-first patients, for developing a second primary RCC, it was 2.87 (95% CI, 2.16-3.74; P less than .001).

Those statistics were consistent with other registry reports, according to Dr. Kim and his colleagues, who wrote that the standardized incidence ratios in those studies ranged from 1.28 to 2.5.

In the MD Anderson registry study, nearly one-third of patients with secondary primary melanoma or RCC had a history of additional secondary cancers, according to the researchers. Those diagnoses included nonmelanoma skin cancers, leukemias, prostate cancer, breast cancer, and colon cancer, among others.

That suggested the presence of possible common risk factors that may have included abnormal genetics, though the database lacked the genetic sequencing and family history data to explore that hypothesis further.

“It would be highly desirable to assess germline genetic information on patients and their families, and also somatic gene aberrations in the tumor lesions, in a more systematic way in order to better elucidate the contribution of the genetics in the association between melanoma and RCC,” Dr. Kim and his colleagues said.

They reported that they had no conflicts of interest.

SOURCE: Kim KB et al. Cancer Epidemiol. 2018 Oct 19;57:80-4.

Younger players are not immune to the brain damage that can come with playing football, National Public Radio says, quoting a grim report from the annual meeting of the Radiological Society of North America.

©james boulette/Thinkstock

The technique of magnetic resonance imaging, which essentially records a video of brain structure and function in real time, was used to scan the brains of 26 boys aged an average of 12 years before and after a season of football. The findings were compared with the brain scans of 26 other boys of similar age who were not football players, according to NPR.

Damage to the region that connects the two halves of the brain was evident in a majority of the football players but not in their control counterparts. The unproven suggestion, but one that seems reasonable given the findings from pro football players, is that repeated blows to the head could lead to changes in the shape of the corpus callosum. When these changes come at a time in life when the brain is developing, the results can be lifetime consequences on thought, behavior, and emotion.

“You have to understand that the NFL players were also most likely once collegiate players; they were also high school players and they were also probably youth players,” says radiologist Christopher T. Whitlow, MD, PhD, of Wake Forest Baptist Health in Winston-Salem, N.C., and a coauthor of the new findings, in the interview. “To us, it’s more than a question about concussions, it’s a question about long-term cumulative exposure.

“We don’t know what [the results] mean … do these changes persist over time? Do they accumulate with multiple seasons? And then No. 3, probably the most important: Do they have any relevance to long-term health?”

Average can be just fine

The need to excel is drilled into many people from childhood. Hard work is a virtue, but the pressure to shine can have disastrous consequences. In South Korea, for example, academic pressure is a major cause of suicide in youth.

A recent TED Women conference held in Palm Springs, Calif., provided some reassurance for those in the “forgotten middle” – those who were adequate but not stellar students, and who do their work diligently but not outstandingly.

“Those at the top get noticed and those at the bottom get extra help but no one really thinks about the kids in the middle who make up the majority,” says Danielle R. Moss Lee, EdD, a social activist and chief of the New York Civil Liberties Union, who spoke at the conference. These folks can be valuable contributors but are often overlooked. As a result, when it comes to excelling, they “check out.”

“We have to create different ways to harness their potential. I didn’t appreciate how average I was until I was a college student and I bumped into a science teacher and he couldn’t believe what college I was attending,” Dr. Lee says.

Sometimes it takes a push from a loved one to spur action. In Dr. Lee’s case, she says she was happy being an average student. Her mother’s search for extracurricular activities led her to discover writing and set her on a path to personal and professional accomplishment.

Dr. Lee’s message was that “the middle isn’t a permanent location.”

Others experts see the situation differently. “Most psychological traits are evenly distributed, meaning that a significant proportion of the population will have average intelligence and leadership potential,” says Tomas Chamorro-Premuzic, PhD, of University College London, in an interview with BBC News.

“The world’s progress depends on those who stand out via their exceptional and innovative contributions, but these individuals are part of the top 1% in their field, combining truly unconventional levels of talent, work ethic, and focus,” Dr. Chamorro-Premuzic says. “For the remaining 99% of us, the acceptance that our talents and motivation are much more conventional, and unlikely to result in world-changing accomplishments, would reflect a healthier, more rational self-concept than illusions of grandiosity or fantasized talent.”

Shared sorrow mark club members

A recent article in Time described the experiences of some who have lost their children and whose worlds have been forever altered. From all walks of life and diverse backgrounds, these folks become tethered together. “It’s a club you spend your whole life hoping you won’t ever become a part of,” says Nicole Hockley, whose son Dylan, 6, was killed in the December 2012 shooting at Sandy Hook Elementary School in Connecticut. “But once you’re in, you’re in.”

Mitchell Dworet and Melissa Wiley are connected by death of their children. Mr. Dworet’s 17-year-old son Nicholas was killed during the shooting at Marjory Stoneman Douglas High School in Parkland, Fla., in February 2018. A month later, Ms. Willey’s daughter Jaelynn, 16, was shot to death by a fellow student at Great Mills High School in Maryland. They connected through Facebook. “I felt like I should reach out. I wanted to pay it forward,” explains Mr. Dworet.

“When you’ve gone through this kind of tragedy with other people, you see their humanity, where they’re coming from,” says Darrell Scott, whose 17-year-old daughter Rachel was killed at Columbine. Politics can differ – as can views on the painful issue of gun control measures – and friendships might not develop. Still, however, they share one enduring bond.

The connection with others can help in the immediate aftermath, and can continue to be important over time. “When you lose a child violently and publicly, there’s an outpouring of support at first,” said Sandy Phillips, whose 24-year-old daughter Jessi was shot with 11 others at a cinema in Aurora, Colo., in 2012. “Once the vigils are over and the media is gone, that’s when things get really bad. The world moves on, and you don’t. You can’t. It’s a pain you can’t outrun.”

“A huge emotional jolt”

In the aftermath of the magnitude 7.0 earthquake that shook Anchorage, Alaska, on Nov. 30, and the many aftershocks, residents are scrambling to cope with their changed lives. For those who lost possessions, the pain is real. But there comes the realization for many that they survived and that material possessions can, for the most part, be replaced.

Psychological changes, meanwhile, can prove profound and lasting. Researchers have found that large earthquakes can produce PTSD and anxiety. Some survivors can come away from earthquakes with difficulty concentrating and hypervigilance.

As one resident explains to Anchorage Daily News, “I felt yesterday like I had one final nerve and every aftershock was playing on that nerve.”

K.J. Worbey, a mental health counselor for Southcentral Foundation – an Alaska Native health care organization – describes the experience as a “huge emotional jolt.” She adds there is “lots of uncertainly about our own safety. Safety of our families and our homes. ... When we are faced with that kind of an emotional crisis, it takes a whole lot of energy to navigate it.”

Ms. Worbey recommends limiting alcohol, eating a healthy diet, and exercising appropriately. “Try to get some energy out. Try and get that excess emotional stuff out,” she said. Other prudent measures include sticking to a normal routine as much as is possible, including mealtimes and sleep, and talking with neighbors and friends.

Drug diversions can cost lives

A recent article in the Dallas Morning News has highlighted the humanity of health caregivers. Within the past several years, two nurses at University of Texas Southwestern Medical Center’s Williams P. Clements Jr. Hospital in Dallas have died of self-inflicted drug overdoses during a work shift.

It’s unusual for one hospital to have two caregivers die of overdoses in such a short time, experts say.

“This is an extreme example,” says Kimberly New, a nurse and lawyer in Tennessee who consults with hospitals nationwide on how to prevent diversions. “That type of alarming situation would be the reason to bring someone in and look at their controls.”

For addicted health care staff, access to their drug of need can be as near as the hospital’s drug supply room. In the past 4 years, hospitals in Texas have reported more than 200 thefts by employees. The tally is likely much higher, as thefts go undetected. The consequences of the thefts in terms of overdoses and deaths are unknown, as those details are not tracked.

Other consequences also hit home for those tasked with providing care: While focusing on their addictions, a nurse or other caregiver can dangerously comprise their duties. This can, in turn, compromise patient care – and can threaten survival if an oversight or mistake is egregiously wrong.

The response by hospitals like the Clements facility is typically a hard-line approach to institute procedures to safeguard the drugs from diversion. This tact is necessary but completely overlooks the reasons for the drug addiction. As with such measures, the effect can be to drive the abuser underground. Hiding the addiction and raiding the hospital’s drug supply can be preferred over admitting the problem and risking the health care workers’ careers – and ultimately, their lives.

Younger players are not immune to the brain damage that can come with playing football, National Public Radio says, quoting a grim report from the annual meeting of the Radiological Society of North America.

©james boulette/Thinkstock

The technique of magnetic resonance imaging, which essentially records a video of brain structure and function in real time, was used to scan the brains of 26 boys aged an average of 12 years before and after a season of football. The findings were compared with the brain scans of 26 other boys of similar age who were not football players, according to NPR.

Damage to the region that connects the two halves of the brain was evident in a majority of the football players but not in their control counterparts. The unproven suggestion, but one that seems reasonable given the findings from pro football players, is that repeated blows to the head could lead to changes in the shape of the corpus callosum. When these changes come at a time in life when the brain is developing, the results can be lifetime consequences on thought, behavior, and emotion.

“You have to understand that the NFL players were also most likely once collegiate players; they were also high school players and they were also probably youth players,” says radiologist Christopher T. Whitlow, MD, PhD, of Wake Forest Baptist Health in Winston-Salem, N.C., and a coauthor of the new findings, in the interview. “To us, it’s more than a question about concussions, it’s a question about long-term cumulative exposure.

“We don’t know what [the results] mean … do these changes persist over time? Do they accumulate with multiple seasons? And then No. 3, probably the most important: Do they have any relevance to long-term health?”

Average can be just fine

The need to excel is drilled into many people from childhood. Hard work is a virtue, but the pressure to shine can have disastrous consequences. In South Korea, for example, academic pressure is a major cause of suicide in youth.

A recent TED Women conference held in Palm Springs, Calif., provided some reassurance for those in the “forgotten middle” – those who were adequate but not stellar students, and who do their work diligently but not outstandingly.

“Those at the top get noticed and those at the bottom get extra help but no one really thinks about the kids in the middle who make up the majority,” says Danielle R. Moss Lee, EdD, a social activist and chief of the New York Civil Liberties Union, who spoke at the conference. These folks can be valuable contributors but are often overlooked. As a result, when it comes to excelling, they “check out.”

“We have to create different ways to harness their potential. I didn’t appreciate how average I was until I was a college student and I bumped into a science teacher and he couldn’t believe what college I was attending,” Dr. Lee says.

Sometimes it takes a push from a loved one to spur action. In Dr. Lee’s case, she says she was happy being an average student. Her mother’s search for extracurricular activities led her to discover writing and set her on a path to personal and professional accomplishment.

Dr. Lee’s message was that “the middle isn’t a permanent location.”

Others experts see the situation differently. “Most psychological traits are evenly distributed, meaning that a significant proportion of the population will have average intelligence and leadership potential,” says Tomas Chamorro-Premuzic, PhD, of University College London, in an interview with BBC News.

“The world’s progress depends on those who stand out via their exceptional and innovative contributions, but these individuals are part of the top 1% in their field, combining truly unconventional levels of talent, work ethic, and focus,” Dr. Chamorro-Premuzic says. “For the remaining 99% of us, the acceptance that our talents and motivation are much more conventional, and unlikely to result in world-changing accomplishments, would reflect a healthier, more rational self-concept than illusions of grandiosity or fantasized talent.”

Shared sorrow mark club members

A recent article in Time described the experiences of some who have lost their children and whose worlds have been forever altered. From all walks of life and diverse backgrounds, these folks become tethered together. “It’s a club you spend your whole life hoping you won’t ever become a part of,” says Nicole Hockley, whose son Dylan, 6, was killed in the December 2012 shooting at Sandy Hook Elementary School in Connecticut. “But once you’re in, you’re in.”

Mitchell Dworet and Melissa Wiley are connected by death of their children. Mr. Dworet’s 17-year-old son Nicholas was killed during the shooting at Marjory Stoneman Douglas High School in Parkland, Fla., in February 2018. A month later, Ms. Willey’s daughter Jaelynn, 16, was shot to death by a fellow student at Great Mills High School in Maryland. They connected through Facebook. “I felt like I should reach out. I wanted to pay it forward,” explains Mr. Dworet.

“When you’ve gone through this kind of tragedy with other people, you see their humanity, where they’re coming from,” says Darrell Scott, whose 17-year-old daughter Rachel was killed at Columbine. Politics can differ – as can views on the painful issue of gun control measures – and friendships might not develop. Still, however, they share one enduring bond.

The connection with others can help in the immediate aftermath, and can continue to be important over time. “When you lose a child violently and publicly, there’s an outpouring of support at first,” said Sandy Phillips, whose 24-year-old daughter Jessi was shot with 11 others at a cinema in Aurora, Colo., in 2012. “Once the vigils are over and the media is gone, that’s when things get really bad. The world moves on, and you don’t. You can’t. It’s a pain you can’t outrun.”

“A huge emotional jolt”

In the aftermath of the magnitude 7.0 earthquake that shook Anchorage, Alaska, on Nov. 30, and the many aftershocks, residents are scrambling to cope with their changed lives. For those who lost possessions, the pain is real. But there comes the realization for many that they survived and that material possessions can, for the most part, be replaced.

Psychological changes, meanwhile, can prove profound and lasting. Researchers have found that large earthquakes can produce PTSD and anxiety. Some survivors can come away from earthquakes with difficulty concentrating and hypervigilance.

As one resident explains to Anchorage Daily News, “I felt yesterday like I had one final nerve and every aftershock was playing on that nerve.”

K.J. Worbey, a mental health counselor for Southcentral Foundation – an Alaska Native health care organization – describes the experience as a “huge emotional jolt.” She adds there is “lots of uncertainly about our own safety. Safety of our families and our homes. ... When we are faced with that kind of an emotional crisis, it takes a whole lot of energy to navigate it.”

Ms. Worbey recommends limiting alcohol, eating a healthy diet, and exercising appropriately. “Try to get some energy out. Try and get that excess emotional stuff out,” she said. Other prudent measures include sticking to a normal routine as much as is possible, including mealtimes and sleep, and talking with neighbors and friends.

Drug diversions can cost lives

A recent article in the Dallas Morning News has highlighted the humanity of health caregivers. Within the past several years, two nurses at University of Texas Southwestern Medical Center’s Williams P. Clements Jr. Hospital in Dallas have died of self-inflicted drug overdoses during a work shift.

It’s unusual for one hospital to have two caregivers die of overdoses in such a short time, experts say.

“This is an extreme example,” says Kimberly New, a nurse and lawyer in Tennessee who consults with hospitals nationwide on how to prevent diversions. “That type of alarming situation would be the reason to bring someone in and look at their controls.”

For addicted health care staff, access to their drug of need can be as near as the hospital’s drug supply room. In the past 4 years, hospitals in Texas have reported more than 200 thefts by employees. The tally is likely much higher, as thefts go undetected. The consequences of the thefts in terms of overdoses and deaths are unknown, as those details are not tracked.

Other consequences also hit home for those tasked with providing care: While focusing on their addictions, a nurse or other caregiver can dangerously comprise their duties. This can, in turn, compromise patient care – and can threaten survival if an oversight or mistake is egregiously wrong.

The response by hospitals like the Clements facility is typically a hard-line approach to institute procedures to safeguard the drugs from diversion. This tact is necessary but completely overlooks the reasons for the drug addiction. As with such measures, the effect can be to drive the abuser underground. Hiding the addiction and raiding the hospital’s drug supply can be preferred over admitting the problem and risking the health care workers’ careers – and ultimately, their lives.

Younger players are not immune to the brain damage that can come with playing football, National Public Radio says, quoting a grim report from the annual meeting of the Radiological Society of North America.

©james boulette/Thinkstock

The technique of magnetic resonance imaging, which essentially records a video of brain structure and function in real time, was used to scan the brains of 26 boys aged an average of 12 years before and after a season of football. The findings were compared with the brain scans of 26 other boys of similar age who were not football players, according to NPR.

Damage to the region that connects the two halves of the brain was evident in a majority of the football players but not in their control counterparts. The unproven suggestion, but one that seems reasonable given the findings from pro football players, is that repeated blows to the head could lead to changes in the shape of the corpus callosum. When these changes come at a time in life when the brain is developing, the results can be lifetime consequences on thought, behavior, and emotion.

“You have to understand that the NFL players were also most likely once collegiate players; they were also high school players and they were also probably youth players,” says radiologist Christopher T. Whitlow, MD, PhD, of Wake Forest Baptist Health in Winston-Salem, N.C., and a coauthor of the new findings, in the interview. “To us, it’s more than a question about concussions, it’s a question about long-term cumulative exposure.

“We don’t know what [the results] mean … do these changes persist over time? Do they accumulate with multiple seasons? And then No. 3, probably the most important: Do they have any relevance to long-term health?”

Average can be just fine

The need to excel is drilled into many people from childhood. Hard work is a virtue, but the pressure to shine can have disastrous consequences. In South Korea, for example, academic pressure is a major cause of suicide in youth.

A recent TED Women conference held in Palm Springs, Calif., provided some reassurance for those in the “forgotten middle” – those who were adequate but not stellar students, and who do their work diligently but not outstandingly.

“Those at the top get noticed and those at the bottom get extra help but no one really thinks about the kids in the middle who make up the majority,” says Danielle R. Moss Lee, EdD, a social activist and chief of the New York Civil Liberties Union, who spoke at the conference. These folks can be valuable contributors but are often overlooked. As a result, when it comes to excelling, they “check out.”

“We have to create different ways to harness their potential. I didn’t appreciate how average I was until I was a college student and I bumped into a science teacher and he couldn’t believe what college I was attending,” Dr. Lee says.

Sometimes it takes a push from a loved one to spur action. In Dr. Lee’s case, she says she was happy being an average student. Her mother’s search for extracurricular activities led her to discover writing and set her on a path to personal and professional accomplishment.

Dr. Lee’s message was that “the middle isn’t a permanent location.”

Others experts see the situation differently. “Most psychological traits are evenly distributed, meaning that a significant proportion of the population will have average intelligence and leadership potential,” says Tomas Chamorro-Premuzic, PhD, of University College London, in an interview with BBC News.

“The world’s progress depends on those who stand out via their exceptional and innovative contributions, but these individuals are part of the top 1% in their field, combining truly unconventional levels of talent, work ethic, and focus,” Dr. Chamorro-Premuzic says. “For the remaining 99% of us, the acceptance that our talents and motivation are much more conventional, and unlikely to result in world-changing accomplishments, would reflect a healthier, more rational self-concept than illusions of grandiosity or fantasized talent.”

Shared sorrow mark club members

A recent article in Time described the experiences of some who have lost their children and whose worlds have been forever altered. From all walks of life and diverse backgrounds, these folks become tethered together. “It’s a club you spend your whole life hoping you won’t ever become a part of,” says Nicole Hockley, whose son Dylan, 6, was killed in the December 2012 shooting at Sandy Hook Elementary School in Connecticut. “But once you’re in, you’re in.”

Mitchell Dworet and Melissa Wiley are connected by death of their children. Mr. Dworet’s 17-year-old son Nicholas was killed during the shooting at Marjory Stoneman Douglas High School in Parkland, Fla., in February 2018. A month later, Ms. Willey’s daughter Jaelynn, 16, was shot to death by a fellow student at Great Mills High School in Maryland. They connected through Facebook. “I felt like I should reach out. I wanted to pay it forward,” explains Mr. Dworet.

“When you’ve gone through this kind of tragedy with other people, you see their humanity, where they’re coming from,” says Darrell Scott, whose 17-year-old daughter Rachel was killed at Columbine. Politics can differ – as can views on the painful issue of gun control measures – and friendships might not develop. Still, however, they share one enduring bond.

The connection with others can help in the immediate aftermath, and can continue to be important over time. “When you lose a child violently and publicly, there’s an outpouring of support at first,” said Sandy Phillips, whose 24-year-old daughter Jessi was shot with 11 others at a cinema in Aurora, Colo., in 2012. “Once the vigils are over and the media is gone, that’s when things get really bad. The world moves on, and you don’t. You can’t. It’s a pain you can’t outrun.”

“A huge emotional jolt”

In the aftermath of the magnitude 7.0 earthquake that shook Anchorage, Alaska, on Nov. 30, and the many aftershocks, residents are scrambling to cope with their changed lives. For those who lost possessions, the pain is real. But there comes the realization for many that they survived and that material possessions can, for the most part, be replaced.

Psychological changes, meanwhile, can prove profound and lasting. Researchers have found that large earthquakes can produce PTSD and anxiety. Some survivors can come away from earthquakes with difficulty concentrating and hypervigilance.

As one resident explains to Anchorage Daily News, “I felt yesterday like I had one final nerve and every aftershock was playing on that nerve.”

K.J. Worbey, a mental health counselor for Southcentral Foundation – an Alaska Native health care organization – describes the experience as a “huge emotional jolt.” She adds there is “lots of uncertainly about our own safety. Safety of our families and our homes. ... When we are faced with that kind of an emotional crisis, it takes a whole lot of energy to navigate it.”

Ms. Worbey recommends limiting alcohol, eating a healthy diet, and exercising appropriately. “Try to get some energy out. Try and get that excess emotional stuff out,” she said. Other prudent measures include sticking to a normal routine as much as is possible, including mealtimes and sleep, and talking with neighbors and friends.

Drug diversions can cost lives

A recent article in the Dallas Morning News has highlighted the humanity of health caregivers. Within the past several years, two nurses at University of Texas Southwestern Medical Center’s Williams P. Clements Jr. Hospital in Dallas have died of self-inflicted drug overdoses during a work shift.

It’s unusual for one hospital to have two caregivers die of overdoses in such a short time, experts say.

“This is an extreme example,” says Kimberly New, a nurse and lawyer in Tennessee who consults with hospitals nationwide on how to prevent diversions. “That type of alarming situation would be the reason to bring someone in and look at their controls.”

For addicted health care staff, access to their drug of need can be as near as the hospital’s drug supply room. In the past 4 years, hospitals in Texas have reported more than 200 thefts by employees. The tally is likely much higher, as thefts go undetected. The consequences of the thefts in terms of overdoses and deaths are unknown, as those details are not tracked.

Other consequences also hit home for those tasked with providing care: While focusing on their addictions, a nurse or other caregiver can dangerously comprise their duties. This can, in turn, compromise patient care – and can threaten survival if an oversight or mistake is egregiously wrong.

The response by hospitals like the Clements facility is typically a hard-line approach to institute procedures to safeguard the drugs from diversion. This tact is necessary but completely overlooks the reasons for the drug addiction. As with such measures, the effect can be to drive the abuser underground. Hiding the addiction and raiding the hospital’s drug supply can be preferred over admitting the problem and risking the health care workers’ careers – and ultimately, their lives.

The abstract submission site for the 2019 Vascular Annual Meeting is now open. Submissions may be considered for the following programs: Scientific Session, Vascular and Endovascular Surgical Society (VESS), International Forum, International Fast Talk, Poster Competition and Interactive Poster. In addition to the International Forum and International Fast Talk, the international community has added two further opportunities to showcase research: The International Young Surgeon Competition and the International Poster Competition. This year the submission site is mobile friendly! Get more information on submission and policy guidelines here.

The abstract submission site for the 2019 Vascular Annual Meeting is now open. Submissions may be considered for the following programs: Scientific Session, Vascular and Endovascular Surgical Society (VESS), International Forum, International Fast Talk, Poster Competition and Interactive Poster. In addition to the International Forum and International Fast Talk, the international community has added two further opportunities to showcase research: The International Young Surgeon Competition and the International Poster Competition. This year the submission site is mobile friendly! Get more information on submission and policy guidelines here.

The abstract submission site for the 2019 Vascular Annual Meeting is now open. Submissions may be considered for the following programs: Scientific Session, Vascular and Endovascular Surgical Society (VESS), International Forum, International Fast Talk, Poster Competition and Interactive Poster. In addition to the International Forum and International Fast Talk, the international community has added two further opportunities to showcase research: The International Young Surgeon Competition and the International Poster Competition. This year the submission site is mobile friendly! Get more information on submission and policy guidelines here.

Anticipation is growing for SVSConnect, a new online community for SVS members. This site will give users an online home for connecting with colleagues on various topics including case complications, techniques, practice management and even work-life balance. A group of “early adopters” has already begun testing the waters, but the site will become open to all members before year’s end. Keep an eye on our Pulse newsletters, emails and the SVS website for an official launch date.
 

Anticipation is growing for SVSConnect, a new online community for SVS members. This site will give users an online home for connecting with colleagues on various topics including case complications, techniques, practice management and even work-life balance. A group of “early adopters” has already begun testing the waters, but the site will become open to all members before year’s end. Keep an eye on our Pulse newsletters, emails and the SVS website for an official launch date.
 

Anticipation is growing for SVSConnect, a new online community for SVS members. This site will give users an online home for connecting with colleagues on various topics including case complications, techniques, practice management and even work-life balance. A group of “early adopters” has already begun testing the waters, but the site will become open to all members before year’s end. Keep an eye on our Pulse newsletters, emails and the SVS website for an official launch date.
 

The SVS Foundation is supporting travel scholarships for trainees to attend the annual Vascular Research Initiatives Conference (VRIC), which will be held on May 13, 2019, in Boston. Recipients of the scholarship will receive complimentary registration to both VRIC and the Vascular Discovery Scientific Sessions, as well as a $1,000 award for conference travel. VRIC is considered a key event for connecting with vascular researchers and the theme this year is Hard Science: Calcification and Vascular Solution. Learn more and apply today. VRIC registration is now open; register today.

The SVS Foundation is supporting travel scholarships for trainees to attend the annual Vascular Research Initiatives Conference (VRIC), which will be held on May 13, 2019, in Boston. Recipients of the scholarship will receive complimentary registration to both VRIC and the Vascular Discovery Scientific Sessions, as well as a $1,000 award for conference travel. VRIC is considered a key event for connecting with vascular researchers and the theme this year is Hard Science: Calcification and Vascular Solution. Learn more and apply today. VRIC registration is now open; register today.

The SVS Foundation is supporting travel scholarships for trainees to attend the annual Vascular Research Initiatives Conference (VRIC), which will be held on May 13, 2019, in Boston. Recipients of the scholarship will receive complimentary registration to both VRIC and the Vascular Discovery Scientific Sessions, as well as a $1,000 award for conference travel. VRIC is considered a key event for connecting with vascular researchers and the theme this year is Hard Science: Calcification and Vascular Solution. Learn more and apply today. VRIC registration is now open; register today.

In this era of “burnout”—when a PubMed search of the term yields more than 13,000 results—it’s heartening to discover that 72% of all clinicians are always and almost always satisfied at work. In contrast to physicians, who report a 42% burnout rate, only 6% of NPs and PAs report the same.¹ This bodes well for your patients’ satisfaction.²

On the following pages, we focus on the details, with breakouts by specialty, region, and practice setting. Be sure to check out your top seven most desirable benefits by availability; CE/CME reimbursements; and salary information by gender and workweek.

1. Medscape National Physician Burnout & Depression Report 2018. www.medscape.com/slideshow/2018-lifestyle-burnoutdepression-6009235#2. Accessed November 17, 2018.
2. The Connection Between Employee Satisfaction and Patient Satisfaction. www.amnhealthcare.com/latest-healthcare-news/459/1033. AMN Healthcare. Accessed November 17, 2018.

Continue to: Nurse Practitioners

NURSE PRACTITIONERS

Continue to: Physician Assistants

PHYSICIAN ASSISTANTS

Continue to: NPs & PAs

NPs & PAs

METHODOLOGY

Fielded electronically under the Clinician Reviews logo, an introductory email letter signed by the Editors-in-Chief invited participation in the online 3rd annual NP/PA Job Satisfaction Survey of 35 questions.

The survey was fielded October 4, 2018, to a random representative sample of 16,000 NPs and 9,000 PAs within the United States, excluding students. The first 150 respondents to complete the survey received a $25 Amazon.com gift certificate.

A total of 1,207 usable responses—a projectable sample size—were received by October 19, 2018, the final cut-off date.

Of the total respondents, 65% are NPs (789) and 35% are PAs (418), which is proportional to the universe of NPs and PAs.^1,2 This summary of results is based on only those respondents who designated their profession as NP or PA.

1. American Association of Nurse Practitioners. NP Fact Sheet. www.aanp.org/all-about-nps/np-fact-sheet. Accessed November 20, 2018.
2. NCCPA. 2017 Statistical Profile of Certified Physician Assistants: an Annual Report of the National Commission on Certification of Physician Assistants. http://prodcmsstoragesa.blob.core.windows.net/uploads/files/2017StatisticalProfileofCertifiedPhysicianAssistants6.27.pdf. Accessed November 20, 2018.

In this era of “burnout”—when a PubMed search of the term yields more than 13,000 results—it’s heartening to discover that 72% of all clinicians are always and almost always satisfied at work. In contrast to physicians, who report a 42% burnout rate, only 6% of NPs and PAs report the same.¹ This bodes well for your patients’ satisfaction.²

On the following pages, we focus on the details, with breakouts by specialty, region, and practice setting. Be sure to check out your top seven most desirable benefits by availability; CE/CME reimbursements; and salary information by gender and workweek.

1. Medscape National Physician Burnout & Depression Report 2018. www.medscape.com/slideshow/2018-lifestyle-burnoutdepression-6009235#2. Accessed November 17, 2018.
2. The Connection Between Employee Satisfaction and Patient Satisfaction. www.amnhealthcare.com/latest-healthcare-news/459/1033. AMN Healthcare. Accessed November 17, 2018.

Continue to: Nurse Practitioners

NURSE PRACTITIONERS

Continue to: Physician Assistants

PHYSICIAN ASSISTANTS

Continue to: NPs & PAs

NPs & PAs

METHODOLOGY

Fielded electronically under the Clinician Reviews logo, an introductory email letter signed by the Editors-in-Chief invited participation in the online 3rd annual NP/PA Job Satisfaction Survey of 35 questions.

The survey was fielded October 4, 2018, to a random representative sample of 16,000 NPs and 9,000 PAs within the United States, excluding students. The first 150 respondents to complete the survey received a $25 Amazon.com gift certificate.

A total of 1,207 usable responses—a projectable sample size—were received by October 19, 2018, the final cut-off date.

Of the total respondents, 65% are NPs (789) and 35% are PAs (418), which is proportional to the universe of NPs and PAs.^1,2 This summary of results is based on only those respondents who designated their profession as NP or PA.

1. American Association of Nurse Practitioners. NP Fact Sheet. www.aanp.org/all-about-nps/np-fact-sheet. Accessed November 20, 2018.
2. NCCPA. 2017 Statistical Profile of Certified Physician Assistants: an Annual Report of the National Commission on Certification of Physician Assistants. http://prodcmsstoragesa.blob.core.windows.net/uploads/files/2017StatisticalProfileofCertifiedPhysicianAssistants6.27.pdf. Accessed November 20, 2018.

In this era of “burnout”—when a PubMed search of the term yields more than 13,000 results—it’s heartening to discover that 72% of all clinicians are always and almost always satisfied at work. In contrast to physicians, who report a 42% burnout rate, only 6% of NPs and PAs report the same.¹ This bodes well for your patients’ satisfaction.²

On the following pages, we focus on the details, with breakouts by specialty, region, and practice setting. Be sure to check out your top seven most desirable benefits by availability; CE/CME reimbursements; and salary information by gender and workweek.

1. Medscape National Physician Burnout & Depression Report 2018. www.medscape.com/slideshow/2018-lifestyle-burnoutdepression-6009235#2. Accessed November 17, 2018.
2. The Connection Between Employee Satisfaction and Patient Satisfaction. www.amnhealthcare.com/latest-healthcare-news/459/1033. AMN Healthcare. Accessed November 17, 2018.

Continue to: Nurse Practitioners

NURSE PRACTITIONERS

Continue to: Physician Assistants

PHYSICIAN ASSISTANTS

Continue to: NPs & PAs

NPs & PAs

METHODOLOGY

Fielded electronically under the Clinician Reviews logo, an introductory email letter signed by the Editors-in-Chief invited participation in the online 3rd annual NP/PA Job Satisfaction Survey of 35 questions.

The survey was fielded October 4, 2018, to a random representative sample of 16,000 NPs and 9,000 PAs within the United States, excluding students. The first 150 respondents to complete the survey received a $25 Amazon.com gift certificate.

A total of 1,207 usable responses—a projectable sample size—were received by October 19, 2018, the final cut-off date.

Of the total respondents, 65% are NPs (789) and 35% are PAs (418), which is proportional to the universe of NPs and PAs.^1,2 This summary of results is based on only those respondents who designated their profession as NP or PA.

1. American Association of Nurse Practitioners. NP Fact Sheet. www.aanp.org/all-about-nps/np-fact-sheet. Accessed November 20, 2018.
2. NCCPA. 2017 Statistical Profile of Certified Physician Assistants: an Annual Report of the National Commission on Certification of Physician Assistants. http://prodcmsstoragesa.blob.core.windows.net/uploads/files/2017StatisticalProfileofCertifiedPhysicianAssistants6.27.pdf. Accessed November 20, 2018.

Photo by Jen Smith

SAN DIEGO—Early results of the DASCERN trial indicate that patients with chronic myeloid leukemia (CML) in chronic phase who have a suboptimal response to imatinib as a first-line treatment benefit from switching to dasatinib at 3 months.

Twenty-nine percent of dasatinib-treated patients achieved a major molecular response (MMR) at 12 months, compared to 13% of patients who remained on imatinib (P=0.005).

Dasatinib-treated patients also attained MMR much faster than those on imatinib, at a median of 14 months, compared to 20 months for those treated with imatinib.

DASCERN is the first study, according to investigators, to explore the significance of an early switch for patients who have not achieved an early molecular response (EMR) with imatinib.

“[EMRs] are important because they correlate with the outcome of patients, certainly with progression-free survival and overall survival,” explained Jorge E. Cortes, MD, of The University of Texas MD Anderson Cancer Center in Houston.

“[T]he possibility of changing to dasatinib appears, with these early results, to suggest that there may be a benefit to switching these patients to achieve better long-term outcomes. But also, those patients that have these early molecular responses have a better probability of achieving deep molecular responses that we desire for treatment-free remission.”

Dr. Cortes elaborated on the DASCERN data at the 2018 ASH Annual Meeting (abstract 788*).

Study design

DASCERN (NCT01593254) is a randomized, open-label, international, phase 2b trial in adult patients with chronic-phase CML who had achieved a complete hematologic response but still had more than 10% BCR-ABL1 transcripts at 3 months.

Patients were initially treated with imatinib at 400 mg daily, and 1,126 patients had a molecular assessment at 3 months.

Those who did not achieve an MMR (n=260) were randomized in a 2:1 fashion to 100 mg daily of dasatinib (n=174) or 400 mg daily or twice daily of imatinib (n=86).

If patients subsequently failed imatinib treatment by European LeukemiaNet standards, they could cross over to dasatinib.

“Importantly, there was a window of enrollment up to 8 weeks after the 3-month assessment, allowing for time to get response results and screen and enroll patients onto the study,” Dr. Cortes clarified.

Patients were also stratified according to Sokal risk score and time from molecular assessment to randomization.

Dr. Cortes noted that about 40% of patients were started on treatment within 4 weeks of the 3-month assessment. And another 58% were enrolled between 4 and 8 weeks from the 3-month assessment.

The primary endpoint is the achievement of MMR at 12 months from the first day of imatinib treatment; that is, at about 9 months from the start of the protocol treatment, in both trial arms.

Patient characteristics

Seventy-eight percent of patients were male, and 95% were younger than 65.

“This is a relatively younger patient population,” Dr. Cortes noted. “This has to do with the fact that this was an international study with a significant representation of patients that were from Asia (73%).”

The Asian patients were primarily from China, Dr. Cortes said, “and we know that, in some parts of the world, including Asia, patients seem to be younger.”

“This is also associated with a higher percentage of patients with high-risk Sokal scores, more than 20%,” he added. “That is different than what’s seen, for example, in the U.S. or in Europe.”

The prevalence of male patients, he said, broadly represents the distribution of patients in other parts of the world.

Patient disposition

Patients were followed for a median of 30 months.

Of the randomized patients—the intent-to-treat (ITT) population—143 (84%) in the dasatinib arm and 72 (84%) in the imatinib arm continued on treatment.

Study drug toxicity was the most common reason for discontinuing treatment and occurred in 9 patients (5%) in the dasatinib arm and 3 (4%) in the imatinib arm.

Nearly half the imatinib patients (n=42, 49%) crossed over to dasatinib at a median of 9 months.

The median duration of treatment was 22 months (range, 1 – 44) for patients on imatinib who did not cross over and 15 months (range, <1 – 38) for patients on dasatinib after crossing over from imatinib.

Response

In the ITT population, the rate of MMR at 12 months was 29% in the dasatinib arm and 13% in the imatinib arm (P=0.005).

The median time to MMR was significantly shorter for patients who received dasatinib compared with imatinib—14 months and 20 months, respectively (P=0.053).

“Over 60% of patients on the dasatinib arm achieved a major molecular response,” Dr. Cortes said. “This compares to about 55% of patients on the imatinib arm, even when you consider the crossover of a significant number of these patients.”

A few patients achieved a molecular response of a 4.5-log reduction in BCR-ABL1 transcripts (MR4.5).

“Of course, the follow-up is short, but we had twice as many patients [on dasatinib] at 12 months with MR4.5— 5% with dasatinib versus 2% with imatinib,” Dr. Cortes said.

Survival outcomes

Both overall and progression-free survival “look very good with both treatment approaches,” Dr. Cortes pointed out.

At a median follow-up of 30 months, the overall survival in the ITT population was 98.8% in each treatment arm.

Progression-free survival was 96.9% in the dasatinib arm and 97.6% in the imatinib arm.

“It is important to note that no patient in either treatment arm has transformed to accelerated or blast phase,” Dr. Cortes said.

Safety

Treatment was well tolerated with both agents, Dr. Cortes observed, with very few grade 3 adverse events (AEs) noted to date.

“The one that stands out here, and it’s only 2% of patients, is headache with dasatinib,” he said.

The headache did not lead to treatment discontinuation, and the patients were managed with dose adjustments.

The investigators observed no new safety signals with either drug.

Treatment-emergent AEs of any grade occurring in 15% or fewer dasatinib- or imatinib-treated patients, respectively, in the ITT population included headache (15%, 9%), diarrhea (9%, 8%), nausea (9%, 8%), eyelid edema (1%, 9%), hypocalcemia (1%, 7%), and muscle spasms (1%, 8%).

Patients who crossed over to dasatinib had similar rates of AEs to those documented for imatinib.

“They are typical for what we know of both of these tyrosine kinase inhibitors,” Dr. Cortes stated.

Investigators observed pleural effusion in 9 (5%) patients on dasatinib, and only one grade 3. That patient discontinued therapy due to the AE.

Of the patients who were on imatinib and crossed over to dasatinib, 3 (7%) experienced pleural effusion, most of them grade 1 or 2. One patient with grade 4 discontinued therapy with dasatinib due to the AE.

“Hematologic toxicity has been mild,” Dr. Cortes said, and in keeping with the known toxicities of dasatinib and imatinib.

Grade 3/4 treatment-emergent AEs in the dasatinib and imatinib arms, respectively, in the ITT population included anemia (5%, 4%), neutropenia (11%, 16%), thrombocytopenia (11%, 11%), and leukopenia (1%, 1%).

Patients who crossed over to dasatinib experienced more of these AEs than patients who did not cross over, Dr. Cortes clarified, but they are still within the expected range with these agents.

“We acknowledge the results are early and we need to continue following for both safety and efficacy, as it will be important to see if those rates of MR4.5 continue to increase with the same difference in favor of dasatinib that we are starting to see very early on,” Dr. Cortes said.

He disclosed serving as a consultant for Pfizer, Daiichi Sankyo, Astellas Pharma, Novartis, and Bristol-Myers Squibb, and he received research funding from Pfizer, Daiichi Sankyo, Arog Pharmaceuticals, Astellas Pharma, Novartis, and Bristol-Myers Squibb.

The study was supported by Bristol-Myers Squibb. 

*Data in the abstract differ from the presentation.

Photo by Jen Smith

SAN DIEGO—Early results of the DASCERN trial indicate that patients with chronic myeloid leukemia (CML) in chronic phase who have a suboptimal response to imatinib as a first-line treatment benefit from switching to dasatinib at 3 months.

Twenty-nine percent of dasatinib-treated patients achieved a major molecular response (MMR) at 12 months, compared to 13% of patients who remained on imatinib (P=0.005).

Dasatinib-treated patients also attained MMR much faster than those on imatinib, at a median of 14 months, compared to 20 months for those treated with imatinib.

DASCERN is the first study, according to investigators, to explore the significance of an early switch for patients who have not achieved an early molecular response (EMR) with imatinib.

“[EMRs] are important because they correlate with the outcome of patients, certainly with progression-free survival and overall survival,” explained Jorge E. Cortes, MD, of The University of Texas MD Anderson Cancer Center in Houston.

“[T]he possibility of changing to dasatinib appears, with these early results, to suggest that there may be a benefit to switching these patients to achieve better long-term outcomes. But also, those patients that have these early molecular responses have a better probability of achieving deep molecular responses that we desire for treatment-free remission.”

Dr. Cortes elaborated on the DASCERN data at the 2018 ASH Annual Meeting (abstract 788*).

Study design

DASCERN (NCT01593254) is a randomized, open-label, international, phase 2b trial in adult patients with chronic-phase CML who had achieved a complete hematologic response but still had more than 10% BCR-ABL1 transcripts at 3 months.

Patients were initially treated with imatinib at 400 mg daily, and 1,126 patients had a molecular assessment at 3 months.

Those who did not achieve an MMR (n=260) were randomized in a 2:1 fashion to 100 mg daily of dasatinib (n=174) or 400 mg daily or twice daily of imatinib (n=86).

If patients subsequently failed imatinib treatment by European LeukemiaNet standards, they could cross over to dasatinib.

“Importantly, there was a window of enrollment up to 8 weeks after the 3-month assessment, allowing for time to get response results and screen and enroll patients onto the study,” Dr. Cortes clarified.

Patients were also stratified according to Sokal risk score and time from molecular assessment to randomization.

Dr. Cortes noted that about 40% of patients were started on treatment within 4 weeks of the 3-month assessment. And another 58% were enrolled between 4 and 8 weeks from the 3-month assessment.

The primary endpoint is the achievement of MMR at 12 months from the first day of imatinib treatment; that is, at about 9 months from the start of the protocol treatment, in both trial arms.

Patient characteristics

Seventy-eight percent of patients were male, and 95% were younger than 65.

“This is a relatively younger patient population,” Dr. Cortes noted. “This has to do with the fact that this was an international study with a significant representation of patients that were from Asia (73%).”

The Asian patients were primarily from China, Dr. Cortes said, “and we know that, in some parts of the world, including Asia, patients seem to be younger.”

“This is also associated with a higher percentage of patients with high-risk Sokal scores, more than 20%,” he added. “That is different than what’s seen, for example, in the U.S. or in Europe.”

The prevalence of male patients, he said, broadly represents the distribution of patients in other parts of the world.

Patient disposition

Patients were followed for a median of 30 months.

Of the randomized patients—the intent-to-treat (ITT) population—143 (84%) in the dasatinib arm and 72 (84%) in the imatinib arm continued on treatment.

Study drug toxicity was the most common reason for discontinuing treatment and occurred in 9 patients (5%) in the dasatinib arm and 3 (4%) in the imatinib arm.

Nearly half the imatinib patients (n=42, 49%) crossed over to dasatinib at a median of 9 months.

The median duration of treatment was 22 months (range, 1 – 44) for patients on imatinib who did not cross over and 15 months (range, <1 – 38) for patients on dasatinib after crossing over from imatinib.

Response

In the ITT population, the rate of MMR at 12 months was 29% in the dasatinib arm and 13% in the imatinib arm (P=0.005).

The median time to MMR was significantly shorter for patients who received dasatinib compared with imatinib—14 months and 20 months, respectively (P=0.053).

“Over 60% of patients on the dasatinib arm achieved a major molecular response,” Dr. Cortes said. “This compares to about 55% of patients on the imatinib arm, even when you consider the crossover of a significant number of these patients.”

A few patients achieved a molecular response of a 4.5-log reduction in BCR-ABL1 transcripts (MR4.5).

“Of course, the follow-up is short, but we had twice as many patients [on dasatinib] at 12 months with MR4.5— 5% with dasatinib versus 2% with imatinib,” Dr. Cortes said.

Survival outcomes

Both overall and progression-free survival “look very good with both treatment approaches,” Dr. Cortes pointed out.

At a median follow-up of 30 months, the overall survival in the ITT population was 98.8% in each treatment arm.

Progression-free survival was 96.9% in the dasatinib arm and 97.6% in the imatinib arm.

“It is important to note that no patient in either treatment arm has transformed to accelerated or blast phase,” Dr. Cortes said.

Safety

Treatment was well tolerated with both agents, Dr. Cortes observed, with very few grade 3 adverse events (AEs) noted to date.

“The one that stands out here, and it’s only 2% of patients, is headache with dasatinib,” he said.

The headache did not lead to treatment discontinuation, and the patients were managed with dose adjustments.

The investigators observed no new safety signals with either drug.

Treatment-emergent AEs of any grade occurring in 15% or fewer dasatinib- or imatinib-treated patients, respectively, in the ITT population included headache (15%, 9%), diarrhea (9%, 8%), nausea (9%, 8%), eyelid edema (1%, 9%), hypocalcemia (1%, 7%), and muscle spasms (1%, 8%).

Patients who crossed over to dasatinib had similar rates of AEs to those documented for imatinib.

“They are typical for what we know of both of these tyrosine kinase inhibitors,” Dr. Cortes stated.

Investigators observed pleural effusion in 9 (5%) patients on dasatinib, and only one grade 3. That patient discontinued therapy due to the AE.

Of the patients who were on imatinib and crossed over to dasatinib, 3 (7%) experienced pleural effusion, most of them grade 1 or 2. One patient with grade 4 discontinued therapy with dasatinib due to the AE.

“Hematologic toxicity has been mild,” Dr. Cortes said, and in keeping with the known toxicities of dasatinib and imatinib.

Grade 3/4 treatment-emergent AEs in the dasatinib and imatinib arms, respectively, in the ITT population included anemia (5%, 4%), neutropenia (11%, 16%), thrombocytopenia (11%, 11%), and leukopenia (1%, 1%).

Patients who crossed over to dasatinib experienced more of these AEs than patients who did not cross over, Dr. Cortes clarified, but they are still within the expected range with these agents.

“We acknowledge the results are early and we need to continue following for both safety and efficacy, as it will be important to see if those rates of MR4.5 continue to increase with the same difference in favor of dasatinib that we are starting to see very early on,” Dr. Cortes said.

He disclosed serving as a consultant for Pfizer, Daiichi Sankyo, Astellas Pharma, Novartis, and Bristol-Myers Squibb, and he received research funding from Pfizer, Daiichi Sankyo, Arog Pharmaceuticals, Astellas Pharma, Novartis, and Bristol-Myers Squibb.

The study was supported by Bristol-Myers Squibb. 

*Data in the abstract differ from the presentation.

Photo by Jen Smith

SAN DIEGO—Early results of the DASCERN trial indicate that patients with chronic myeloid leukemia (CML) in chronic phase who have a suboptimal response to imatinib as a first-line treatment benefit from switching to dasatinib at 3 months.

Twenty-nine percent of dasatinib-treated patients achieved a major molecular response (MMR) at 12 months, compared to 13% of patients who remained on imatinib (P=0.005).

Dasatinib-treated patients also attained MMR much faster than those on imatinib, at a median of 14 months, compared to 20 months for those treated with imatinib.

DASCERN is the first study, according to investigators, to explore the significance of an early switch for patients who have not achieved an early molecular response (EMR) with imatinib.

“[EMRs] are important because they correlate with the outcome of patients, certainly with progression-free survival and overall survival,” explained Jorge E. Cortes, MD, of The University of Texas MD Anderson Cancer Center in Houston.

“[T]he possibility of changing to dasatinib appears, with these early results, to suggest that there may be a benefit to switching these patients to achieve better long-term outcomes. But also, those patients that have these early molecular responses have a better probability of achieving deep molecular responses that we desire for treatment-free remission.”

Dr. Cortes elaborated on the DASCERN data at the 2018 ASH Annual Meeting (abstract 788*).

Study design

DASCERN (NCT01593254) is a randomized, open-label, international, phase 2b trial in adult patients with chronic-phase CML who had achieved a complete hematologic response but still had more than 10% BCR-ABL1 transcripts at 3 months.

Patients were initially treated with imatinib at 400 mg daily, and 1,126 patients had a molecular assessment at 3 months.

Those who did not achieve an MMR (n=260) were randomized in a 2:1 fashion to 100 mg daily of dasatinib (n=174) or 400 mg daily or twice daily of imatinib (n=86).

If patients subsequently failed imatinib treatment by European LeukemiaNet standards, they could cross over to dasatinib.

“Importantly, there was a window of enrollment up to 8 weeks after the 3-month assessment, allowing for time to get response results and screen and enroll patients onto the study,” Dr. Cortes clarified.

Patients were also stratified according to Sokal risk score and time from molecular assessment to randomization.

Dr. Cortes noted that about 40% of patients were started on treatment within 4 weeks of the 3-month assessment. And another 58% were enrolled between 4 and 8 weeks from the 3-month assessment.

The primary endpoint is the achievement of MMR at 12 months from the first day of imatinib treatment; that is, at about 9 months from the start of the protocol treatment, in both trial arms.

Patient characteristics

Seventy-eight percent of patients were male, and 95% were younger than 65.

“This is a relatively younger patient population,” Dr. Cortes noted. “This has to do with the fact that this was an international study with a significant representation of patients that were from Asia (73%).”

The Asian patients were primarily from China, Dr. Cortes said, “and we know that, in some parts of the world, including Asia, patients seem to be younger.”

“This is also associated with a higher percentage of patients with high-risk Sokal scores, more than 20%,” he added. “That is different than what’s seen, for example, in the U.S. or in Europe.”

The prevalence of male patients, he said, broadly represents the distribution of patients in other parts of the world.

Patient disposition

Patients were followed for a median of 30 months.

Of the randomized patients—the intent-to-treat (ITT) population—143 (84%) in the dasatinib arm and 72 (84%) in the imatinib arm continued on treatment.

Study drug toxicity was the most common reason for discontinuing treatment and occurred in 9 patients (5%) in the dasatinib arm and 3 (4%) in the imatinib arm.

Nearly half the imatinib patients (n=42, 49%) crossed over to dasatinib at a median of 9 months.

The median duration of treatment was 22 months (range, 1 – 44) for patients on imatinib who did not cross over and 15 months (range, <1 – 38) for patients on dasatinib after crossing over from imatinib.

Response

In the ITT population, the rate of MMR at 12 months was 29% in the dasatinib arm and 13% in the imatinib arm (P=0.005).

The median time to MMR was significantly shorter for patients who received dasatinib compared with imatinib—14 months and 20 months, respectively (P=0.053).

“Over 60% of patients on the dasatinib arm achieved a major molecular response,” Dr. Cortes said. “This compares to about 55% of patients on the imatinib arm, even when you consider the crossover of a significant number of these patients.”

A few patients achieved a molecular response of a 4.5-log reduction in BCR-ABL1 transcripts (MR4.5).

“Of course, the follow-up is short, but we had twice as many patients [on dasatinib] at 12 months with MR4.5— 5% with dasatinib versus 2% with imatinib,” Dr. Cortes said.

Survival outcomes

Both overall and progression-free survival “look very good with both treatment approaches,” Dr. Cortes pointed out.

At a median follow-up of 30 months, the overall survival in the ITT population was 98.8% in each treatment arm.

Progression-free survival was 96.9% in the dasatinib arm and 97.6% in the imatinib arm.

“It is important to note that no patient in either treatment arm has transformed to accelerated or blast phase,” Dr. Cortes said.

Safety

Treatment was well tolerated with both agents, Dr. Cortes observed, with very few grade 3 adverse events (AEs) noted to date.

“The one that stands out here, and it’s only 2% of patients, is headache with dasatinib,” he said.

The headache did not lead to treatment discontinuation, and the patients were managed with dose adjustments.

The investigators observed no new safety signals with either drug.

Treatment-emergent AEs of any grade occurring in 15% or fewer dasatinib- or imatinib-treated patients, respectively, in the ITT population included headache (15%, 9%), diarrhea (9%, 8%), nausea (9%, 8%), eyelid edema (1%, 9%), hypocalcemia (1%, 7%), and muscle spasms (1%, 8%).

Patients who crossed over to dasatinib had similar rates of AEs to those documented for imatinib.

“They are typical for what we know of both of these tyrosine kinase inhibitors,” Dr. Cortes stated.

Investigators observed pleural effusion in 9 (5%) patients on dasatinib, and only one grade 3. That patient discontinued therapy due to the AE.

Of the patients who were on imatinib and crossed over to dasatinib, 3 (7%) experienced pleural effusion, most of them grade 1 or 2. One patient with grade 4 discontinued therapy with dasatinib due to the AE.

“Hematologic toxicity has been mild,” Dr. Cortes said, and in keeping with the known toxicities of dasatinib and imatinib.

Grade 3/4 treatment-emergent AEs in the dasatinib and imatinib arms, respectively, in the ITT population included anemia (5%, 4%), neutropenia (11%, 16%), thrombocytopenia (11%, 11%), and leukopenia (1%, 1%).

Patients who crossed over to dasatinib experienced more of these AEs than patients who did not cross over, Dr. Cortes clarified, but they are still within the expected range with these agents.

“We acknowledge the results are early and we need to continue following for both safety and efficacy, as it will be important to see if those rates of MR4.5 continue to increase with the same difference in favor of dasatinib that we are starting to see very early on,” Dr. Cortes said.

He disclosed serving as a consultant for Pfizer, Daiichi Sankyo, Astellas Pharma, Novartis, and Bristol-Myers Squibb, and he received research funding from Pfizer, Daiichi Sankyo, Arog Pharmaceuticals, Astellas Pharma, Novartis, and Bristol-Myers Squibb.

The study was supported by Bristol-Myers Squibb. 

*Data in the abstract differ from the presentation.