Research Spotlight

Haas, E. M., S. L. Ramamoorthy and W. R. Peters (2019). “What Every Colorectal Surgeon Should Know About the American Society of Colon and Rectal Surgeons’ Physician Compensation Survey.” Dis Colon Rectum 62(2): 139-140.

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One of the most significant changes for surgeons in the United States over the past 30 years has been the shift from a self-employed, small practice model to one of employment by large healthcare organizations. Given the increasing economic, regulatory, and operational pressures facing these employers, the need to appropriately and fairly compensate physicians has never been greater. Increasingly, healthcare organizations are using physician compensation data obtained through third-party surveys to help inform compensation (e.g., salary, incentives, and benefits) decisions. As part of a strategic plan designed to provide value to our members, the American Society of Colon and Rectal Surgeons (ASCRS) charged its Healthcare Economics Committee (HEC) to broadly examine the current state of colorectal surgery practice and compensation. In furtherance of this request, the ASCRS has contracted with a third-party healthcare consultant, ECG Management Consultants (ECG), to conduct a detailed survey of our members. The survey will be conducted in February and March 2019. The purpose of the ASCRS survey is to develop a more reliable and representative compensation and production benchmark for ASCRS members that will provide information on surgeon demographics, practice characteristics, incentives, benefits, and other relevant factors. By engaging all of our members from the United States, it is anticipated that the ASCRS survey will have a much larger number of respondents than any other survey, allowing more granular comparisons. The knowledge gained will benefit our members in many ways. For those surgeons in a self-employed model, the data will allow evaluation of the economic health of their practice. Surgeons considering employment or negotiating an employment contract will benefit from a more robust benchmark by which to set realistic productivity goals and fair compensation. Physician leaders may be guided in structuring compensation models and making employment decisions. Finally, the ASCRS leadership will be better informed regarding our members and the issues they are facing. (Excerpt from text, p. 139; abstract not available.)

Grunwald, V., T. Powles, T. K. Choueiri, T. E. Hutson, C. Porta, M. Eto, C. N. Sternberg, S. Y. Rha, C. S. He, C. E. Dutcus, A. Smith, L. Dutta, K. Mody and R. J. Motzer (2019). “Lenvatinib plus everolimus or pembrolizumab versus sunitinib in advanced renal cell carcinoma: study design and rationale.” Future Oncol Jan 28. [Epub ahead of print].

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AIM: Lenvatinib plus everolimus is approved for the treatment of advanced renal cell carcinoma (RCC) after one prior vascular endothelial growth factor-targeted therapy. Lenvatinib plus pembrolizumab demonstrated promising antitumor activity in a Phase I/II trial of RCC. METHODS: We describe the rationale and design of the CLEAR study, a three-arm Phase III trial comparing lenvatinib plus everolimus and lenvatinib plus pembrolizumab versus sunitinib monotherapy for first-line treatment of RCC. Eligible patients must have advanced clear cell RCC and must not have received any prior systemic anticancer therapy. The primary end point is progression-free survival; secondary end points include objective response rate, overall survival, safety, health-related quality of life and pharmacokinetics. Biomarker evaluations are included as exploratory end points.

Graney, C., N. Shibuya, H. Patel and D. C. Jupiter (2019). “Popliteal Versus Local Field Block for Pain-Related Postoperative Unplanned Emergency Room Visits After Foot and Ankle Surgery.” Foot Ankle Spec Jan 10. [Epub ahead of print].

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Ultrasound-guided popliteal blocks for postoperative pain management have grown in popularity within foot and ankle surgery. The purpose of this study was to evaluate the efficacy of popliteal block in preventing postoperative emergency department visits after foot and ankle surgery. We compared rates of presentation to the emergency department for pain following foot and ankle surgery between surgeries with a popliteal block and those with local field block alone. We identified 101 charts, of which 26 presented to the emergency department for postoperative pain following popliteal block. Our results demonstrated that popliteal blocks did not perform better than local blocks, and that there is no statistically significant difference between the 2 methods of postoperative pain control in terms of rates of presentation to the emergency department for pain. Levels of Evidence: Level III, All statistical analyses were carried out using the R statistical package by the primary author (NS) (R Developmental, Core Team. R: A Language and Environment for Statistical Computing, 2012. http://www.R-project.org ).E

Goraya, N. and D. E. Wesson (2019). “Clinical evidence that treatment of metabolic acidosis slows the progression of chronic kidney disease.” Curr Opin Nephrol Hypertens Jan 23. [Epub ahead of print].

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PURPOSE OF REVIEW: We review the growing clinical evidence that metabolic acidosis mediates chronic kidney disease (CKD) progression and that treatment to increase the associated low serum bicarbonate (HCO3) in CKD is disease-modifying. RECENT FINDINGS: Seven prospective studies of patients with wide ranges of estimated glomerular filtration rates (eGFRs) and serum HCO3 examined the effect on CKD of increasing serum HCO3 using dietary acid reduction with either oral alkali (sodium bicarbonate or sodium citrate), a vegetarian diet very low in acid-producing protein (0.3 g/kg/day) supplemented with ketoanalogues or added base-producing fruits and vegetables. Clinical outcomes included slower kidney function decline (using eGFR measurements) and fewer patients progressing to end-stage kidney disease. Post hoc analyses demonstrated that: treatment of metabolic acidosis for 2 years decreased the number of patients with a at least 40% eGFR decline, a validated surrogate for progression to end-stage kidney disease and across four studies, treatment to increase serum HCO3 4-6.8 mEq/l in acidotic patients with CKD was associated with a approximately 4 ml/min/1.73 m reduction in the rate of eGFR decline over 6-24 months compared with controls. SUMMARY: Metabolic acidosis appears to enhance CKD progression and its treatment should be studied further as a potential disease-modifying intervention.

Egan, G., S. Goldman and S. Alexander (2019). “Mature B-NHL in children, adolescents and young adults: current therapeutic approach and emerging treatment strategies.” Br J Haematol Jan 6. [Epub ahead of print].

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Mature B cell lymphomas account for approximately 60% of all cases of non-Hodgkin lymphoma (NHL) in children and adolescents and includes Burkitt lymphoma (BL), diffuse large B cell lymphoma (DLBCL) and other less common histologies. The outcome for patients treated with modern regimens in resource-intensive settings is excellent. Improvements in care have been accomplished through enhanced supportive therapy, including tumour lysis management and incremental refinement of chemotherapy backbones via cooperative group clinical trials in which patients receive risk group-specific intensive chemotherapy. More recent trials have established the safety and efficacy of immunotherapy. Ongoing work is required to address the substantial burden of acute therapy-related toxicity, as well as the identification of effective therapies for those patients with relapsed and refractory disease, for whom outcomes remain very poor. In this review we will summarize the results from recent therapeutic clinical trials, describe the evidence to support the inclusion of rituximab and review the rationale for the investigation of several new categories of novel agents for mature B cell lymphomas in children and adolescents.