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Aplastic anemia (AA) is a bone marrow failure syndrome of pancytopenia due to impaired hematopoiesis. It is strongly associated with paroxysmal nocturnal hemoglobinuria (PNH). Each condition can cause the other, or occur simultaneously. There are no guidelines for treating concomitant AA and PNH; immunosuppressive therapy (IST) or hematopoietic stem cell therapy (HSCT) is first-line for the former, and eculizumab is first-line for the latter. New studies suggest that treating AA/PNH together versus sequentially should depend on AA severity. We report the case of a previously healthy male (31-year-old, Nigerian immigrant) who developed jaundice, scleral icterus, easy fatigability, and epistaxis. He was diagnosed with AA on bone marrow biopsy and with PNH on flow cytometry. He initially underwent chemotherapy due to increased infection risk with eculizumab in a neutropenic patient; however, he showed minimal response and thus began eculizumab pending allogeneic stem cell transplant. There are no guidelines for treating patients with both AA and PNH, and clinical decision making is generally individualized based on disease severity. Only one prior publication reported simultaneous treatment with eculizumab and chemotherapy, due to stated concern for pancytopenia, especially neutropenia, being the most immediate cause of morbidity/mortality. This demonstrates the individualized decisions that must be made when treating simultaneous PNH and AA, and the importance of PNH/severe AA patients as a separate subpopulation.

Purpose Prostate cancer is a heterogeneous disease with variable clinical outcomes. Despite numerous recent approvals of novel therapies, castration-resistant prostate cancer remains lethal. A “real-world” clinical-genomic database is urgently needed to enhance our characterization of advanced prostate cancer and further enable precision oncology. Methods The Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) is a consortium whose aims are to establish a repository of de-identified clinical and genomic patient data that are linked to patient outcomes. The consortium structure includes a (1) bio-informatics committee to standardize genomic data and provide quality control, (2) biostatistics committee to independently perform statistical analyses, (3) executive committee to review and select proposals of relevant questions for the consortium to address, (4) diversity/inclusion committee to address important clinical questions pertaining to racial disparities, and (5) patient advocacy committee to understand patient perspectives to improve patients’ quality of care. Results The PROMISE consortium was formed by 16 academic institutions in early 2020 and a secure RedCap database was created. The first patient record was entered into the database in April 2020 and over 1000 records have been entered as of early 2021. Data entry is proceeding as planned with the goal to have over 2500 patient records by the end of 2021. Conclusions The PROMISE consortium provides a powerful clinical-genomic platform to interrogate and address data gaps that have arisen with increased genomic testing in the clinical management of prostate cancer. The dataset incorporates data from patient populations that are often underrepresented in clinical trials, generates new hypotheses to direct further research, and addresses important clinical questions that are otherwise difficult to investigate in prospective studies.

Introduction: The expansion of medical schools, faculty attrition, and trainees' disinterest in academia, all highlight the need to encourage the next generation of academic physicians. The published literature indicates that early academic career awareness and involvement in scholarship activities can positively influence trainees' interest in academia. Teaching experience has been shown to positively influence interest in an academic career, trainees who can engage in educational activities, and who transform their work into educational scholarship are more likely than their counterparts to pursue the medical educator academic track. We hypothesized that heightening diverse trainees' awareness of opportunities to engage in various educational roles through the fellow as clinical teacher (FACT) may help them consider future academic positions as well as improve their medical knowledge. Method: We implemented a hematology FACT program that utilized an hour didactics session that is held every month focused on benign hematology curriculum. We aimed to help fellows to 1) develop as teachers, 2) improve knowledge in benign hematology, and 3) increase their career interest in educators' academic track. After implementing the program, post-intervention surveys focusing on evaluating their reaction to the program, whether participation in the program increased their interest in academic medicine, and whether attending the program benefitted their knowledge and advanced their learning. Focusing on level 1 and 2 on the Kirkpatrick four-level educational model. Results: The FACT program included nine participants, all participants served as trainees and educators in the program. Participants were asked to indicate the most challenging topics in the benign hematology field to guide building the content of the curriculum. The cellular basis of hematopoiesis was noted as the most challenging for six participants. Majority of participants reported having struggles evaluating hemoglobinopathy disorders, hematologic women's health issues, bleeding disorders, and transfusion medicine challenges. Those subjects concluded majority of the curriculum content. Post-intervention surveys were sent out to all participants after eighteen months of implementing the program, asking their feedback about the program, their reaction about the program and knowledge benefit, nine surveys were collected. The implemented program helped improving participants' level of knowledge for hemophilia and other bleeding disorders such as Von Willebrand Disease, in most participants (7 of 9). Also, five participants reported a benefit in regards to cellular basis of hematopoiesis and hemoglobinopathy disorders. The majority of participants (7 of 9) found that the course material was very useful and they rated the lectures to be very good to excellent. And all participants agreed on the discussed topics to be appropriate for their level of training, moreover, it improved the overall understanding and level of interest in benign hematology. All participants noted the impact of the program on augmenting their teaching skills and interest in exploring the academic medicine track. The drawback of the program reported by participants (3 of 9) was experiencing a communication barrier and feeling restricted communicating their questions, opinions, and concerns to their co-fellow educators. Discussion: Implementing the fellow as clinical teacher program has been a strategy that is used to increase trainees' interest in academic careers and educators' tracks, although its barriers and impact on fellow's education is not clear. In this review, we aimed at evaluating the program from trainees' perspectives. The program was beneficial to all trainees, all served as educators at a certain time, it was appropriate for their level of training, it improved the overall knowledge for benign hematology topics, and it positively impacted their teaching skills and interest in academic medicine. With a longer follow-up time, it would be beneficial to evaluate the program's impact on the fellows' commitment towards academic medicine. Conclusion: Fellow as clinical teacher program could be a tool to increase hematology fellows' interest in academic educators' track, increase level of knowledge and confidence managing different challenging topics, without affecting the quality of medical education. Disclosures Ellis: Rafael Pharmaceuticals: Consultancy.

Key Points Question How common are payments from pharmaceutical companies and device manufacturers to gastroenterologists? Finding This cohort study of 15 497 gastroenterologists found that 86.9% received industry payments, with direct financial awards accounting for 62.7% of the total expenditures and 10 drugs accounting for 63.8% of the total payments. Twenty-nine of 36 recent guidelines included authors who had received industry payments. Meaning While mandated reporting of industry payments to physicians provides transparency, the practice remains common and may continue to affect the advice these physicians give to patients and peers., This cohort study investigates industry payments to gastroenterologists and evaluates participation by compensated physicians in the formulation of clinical practice guidelines., Importance Payments from pharmaceutical and device manufacturers to physicians may influence the advice physicians give patients and peers. Objectives To investigate the nature and amounts of monetary and other benefits that gastroenterologists received and to determine the participation of those receiving benefits in the formulation of clinical practice guidelines. Design, Setting, and Participants This cohort study analyzed information from the Centers for Medicare & Medicaid Services Open Payments database, including all reports about payments that pharmaceutical and device manufacturers gave to adult or pediatric gastroenterologists in 2016. PubMed was used to examine the professional affiliations and publication records of top payment recipients. Panelists of clinical guidelines who also received personal financial rewards listed in the Open Payments database were identified. Main Outcomes and Measures Payments made to gastroenterologists by pharmaceutical company and device manufacturers. Results Of 15 497 gastroenterologists, 13 467 (86.9%) received a total of 432 463 payments accounting for a total expenditure of $67 144 862. Direct financial payments for consultations, talks, or other services were made to 2055 physicians and were responsible for 4.2% of payments (18 179 of 432 463), but for 62.7% of total expenditures ($42 086 207 of $67 144 862). Although a significant number of submissions were for food and beverages, they constituted only a small amount of total expenditure. For gastroenterologists treating adult patients, 10 products were linked to 63.8% of payments (11 221 of 17 588) related to direct financial rewards and 37.1% of the total expenditures ($24 892 643 of $67 144 862). Twenty-nine of 36 clinical practice guidelines included panelists who had received honoraria or consultation fees from industry sources, with amounts exceeding $10 000 in 8 of them (22%). Conclusions and Relevance Most gastroenterologists accept meals or gifts from industry, with 2055 of 15 497 gastroenterologists receiving direct payments and 8 of 36 clinical practice guidelines panelists having received more than $10 000. Considering the known impact of such benefits on prescribing patterns and other professional behaviors, policy makers should consider revising regulations governing interactions with industry and disclosure formats alerting others to their potential biasing impact.

Management of multiple sclerosis (MS) has shifted from supportive to disease modifying therapy. Considering the increasingly widespread adoption of this approach in managing MS patients, we hypothesized that hospitalizations and surrogates of disease-related complications should have declined during the last decade.Methods. Using the Nationwide Inpatient Sample, hospitalizations for MS and associated secondary diagnoses and procedures as well as discharge status were examined. Time trends were examined for different age cohorts focusing on the period from 2001 to 2010.Results. During the preceding decade, annual hospitalizations for MS increased by 40%, with stable rates in all age groups except geriatric patients, who accounted for a significantly higher fraction of admissions. Nursing home transfers as a surrogate marker of disability remained unchanged for all age groups. Similarly, urinary tract infections, the need for skin debridement, or gastrostomy tube placement did not vary during the decade.Conclusion. During a time of increased adoption of disease modifying therapy, MS-related hospitalizations continued to increase and surrogate measures of disability in admitted patients remained stable, demonstrating the still significant impact of the disease on affected individuals.