Patients’ preferences for selection of endpoints in cardiovascular clinical trials

Background: To reduce the duration and overall costs of cardiovascular trials, use of the combined endpoints in trial design has become commonplace. Though this methodology may serve the needs of investigators and trial sponsors, the preferences of patients or potential trial subjects in the trial design process has not been studied. Objective: To determine the preferences of patients in the design of cardiovascular trials. Design: Participants were surveyed in a pilot study regarding preferences among various single endpoints commonly used in cardiovascular trials, preference for single vs. composite endpoints, and the likelihood of compliance with a heart medication if patients similar to them participated in the trial design process. Participants: One hundred adult English-speaking patients, 38% male, from a primary care ambulatory practice located in an urban setting. Key results: Among single endpoints, participants rated heart attack as significantly more important than death from other causes (4.53 vs. 3.69, p=0.004) on a scale of 1–6. Death from heart disease was rated as significantly more important than chest pain (4.73 vs. 2.47, p<0.001), angioplasty/PCI/CABG (4.73 vs. 2.43, p<0.001), and stroke (4.73 vs. 2.43, p<0.001). Participants also expressed a slight preference for combined endpoints over single endpoint (43% vs. 57%), incorporation of the opinions of the study patient population into the design of trials (48% vs. 41% for researchers), and a greater likelihood of medication compliance if patient preferences were considered during trial design (67% indicated a significant to major effect). Conclusions: Patients are able to make judgments and express preferences regarding trial design. They prefer that the opinions of the study population rather than the general population be incorporated into the design of the study. This novel approach to study design would not only incorporate patient preferences into medical decision making, but it also has the potential to improve compliance with cardiovascular medications

Stop Atherosclerosis in Native Diabetics Study (SANDS): Baseline Characteristics of the Randomized Cohort

Objectives: To present baseline characteristics of American Indians in the Stop Atherosclerosis in Native Diabetics Study (SANDS) and compare them with population-based data from American Indians and other ethnic groups. Design: 499 people with type 2 diabetes ≥ age 40, without known CVD, were recruited for a randomized 3-year trial to evaluate treatment targets for LDL-C (70 vs. 100 mg/dL) and systolic blood pressure (BP) (115 vs. 130 mmHg). Baseline evaluations included physical exam, collection of blood and urine samples, and carotid ultrasound and echocardiographic measures. Results: Mean age was 56 years; 66% were female. Average BMI was 33 kg/m2. Average duration of both hypertension and diabetes was 10 years, average A1c was 8.0 %, and mean LDL-C was 104 mg/dL. Participants in the conventional treatment group had slightly higher systolic BPs than participants in the aggressive treatment group (133 mm Hg vs. 128 mm Hg, p \u3c 0.002). Compared with the population-based cohorts of the Strong Heart Study (SHS), NHANES, and the TRIAD registry, SANDS participants had similar values for lipids, BP, and CRP, as well as degree of obesity, smoking rates, and renal function as indicated by estimated glomerular filtration rate. Conclusions: The baseline characteristics of the SANDS cohort are similar to those of a population-based sample of American Indian diabetic men and women and closely resemble diabetic men and women of other ethnic groups. Results from this study can be used to identify appropriate targets for LDL-C and BP lowering in diabetic American Indians and diabetic patients in other ethnic groups

Estimated GFR and Incident Cardiovascular Disease Events in American Indians: The Strong Heart Study

In populations with high prevalence of diabetes and obesity, estimating glomerular filtration rate (GFR) by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation may predict cardiovascular disease risk better than by using the Modification of Diet in Renal Disease (MDRD) Study equation

Beyond burnout: Understanding the well-being gender gap in general surgery by examining professional fulfillment and control over schedule

BACKGROUND: Prior research has revealed a gender gap in physician burnout. Our study attempts to elucidate the cause for the differences in burnout among male and female general surgeons (GS). METHODS: The study is based on a sample of 431 GS from 11 healthcare organizations participating in the Physician Wellness Academic Consortium. RESULTS: Female (N = 154) and male (N = 277) GS significantly differed in burnout (46% vs 33%, p = 0.008) and professional fulfillment (PF), (37% vs 56% p \u3c 0.001). Male surgeons reported a higher sense of control over their schedule (COS) (5.0 vs 4.2, p = 0.001). Mediation analyses showed that the gender effect on burnout was fully mediated through PF and COS. CONCLUSIONS: This study demonstrates that the observed differences in burnout between female and male GS are due to their differences in PF and COS. Longitudinal research is needed to determine whether interventions targeting PF and COS may mitigate burnout among female GS

Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

Abstract Background The American Board of Internal Medicine Certification Examination (ABIM-CE) is one of several methods used to assess medical knowledge, an Accreditation Council for Graduate Medical Education (ACGME) core competency for graduating internal medicine residents. With recent changes in graduate medical education program directors and internal medicine residents are seeking evidence to guide decisions regarding residency elective choices. Prior studies have shown that formalized elective curricula improve subspecialty ABIM-CE scores. The primary aim of this study was to evaluate whether the number of subspecialty elective exposures or the specific subspecialties which residents complete electives in impact ABIM-CE scores. Methods ABIM-CE scores, elective exposures and demographic characteristics were collected for MedStar Georgetown University Hospital internal medicine residents who were first-time takers of the ABIM-CE in 2006–2010 (n=152). Elective exposures were defined as a two-week period assigned to the respective subspecialty. ABIM-CE score was analyzed using the difference between the ABIM-CE score and the standardized passing score (delta-SPS). Subspecialty scores were analyzed using percentage of correct responses. Data was analyzed using GraphPad Prism version 5.00 for Windows. Results Paired elective exposure and ABIM-CE scores were available in 131 residents. There was no linear correlation between ABIM-CE mean delta-SPS and the total number of electives or the number of unique elective exposures. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures (143.4 compared to 129.7, p=0.051). Repeated electives in individual subspecialties were not associated with significant difference in mean ABIM-CE delta-SPS. Conclusions This study did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean delta-SPS score. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures suggesting there may be an “ideal” number of elective exposures that supports improved ABIM-CE performance. Repeated elective exposures in an individual specialty did not correlate with overall or subspecialty ABIM-CE performance.</p

Radioiodine Treatment of Metastatic Thyroid Cancer: Relative Efficacy and Side Effect Profile of Preparation by Thyroid Hormone Withdrawal Versus Recombinant Human Thyrotropin

Church of the Virgin of Smolensk, detail showing parried pilasters and windows; The monastery remains an important centre of the Russian Orthodox Church and contains the Sergiyev Posad Historical and Art Museum. The monastery was founded in 1345 by St Sergius Radonezhsky (1322-1392) and played an important role in the history of medieval Russia. The miraculous survival of Sergius’s body after the Tatar devastation of the monastery in 1408 made it into a place of pilgrimage. In the 15th century a calligraphic centre was established there, enabling scribes and artists to develop their own style of writing, illuminating and illustrating. In 1744 the monastery was elevated to the rank of a lavra. Fortress walls (1540-1550; rebuilt 17th century) surround the conventual buildings and have a total length of 1.5 km with 11 towers . The oldest church in the monastery is the Trinity Cathedral (Troitskiy Sobor), built of stone in 1422-1423 near the site of an earlier wooden church. It is a four-piered, single-dome structure with an 18th-century porch on the south side. Most of the icons on the iconostasis were the work of Andrey Rublyov and Daniil Chorny (ca. 1360-1430); frescoes (1635) decorate the walls. Source: Grove Art Online; http://www.oxfordartonline.com/ (accessed 6/22/2009