FEATURE

• shorter , more frequent assessments

• alternative MOC assessment formats to choose from

• remote proctoring , allowing the use of an individual ’ s home or office computer

Also , physicians who perform well on shorter assessments would test-out of the longer-form , 10-year assessment . This means that as long as physicians who consistently opt to take shorter assessments and achieve a defined level of performance , they will not need to take the 10-year exam again to remain certified . ( For more about what these changes will mean for you , see the SIDEBAR .)

We ’ ve been trying to reach that point for a couple of years now , but we will need a bit more patience from our diplomates . Our goal with the revised program is to have a meaningful certifying and MOC system . We did not just want diplomates to report Continuing Medical Education ( CME ) credits without an assessment component ; it ’ s essential that the board certification have real meaning to the public and the profession .

I was at the question-review meeting . When it came to the specialized malignant hematology topics , I realized that I was not as nearly as well-versed in those areas as I am in coagulation and nonmalignant hematology . However , in my practice , I do not treat those diseases .

Personally , I think we all should have some fundamental knowledge of all aspects of hematology , but I don ’ t think we should be expected to know or to be tested on the detailed aspects of the areas of sub-specialization where we no longer practice . When patients see me , they want to know that I am up-to-date on non-malignant hematology , not necessarily conditions that I no longer treat .

I think everyone would agree that physicians do need to maintain knowledge and professionalism .

Dr . Williams : What ABIM is in the process of doing now , across all of internal medicine and all the sub-specialties , is

What Do the MOC Changes Mean for Me ?

For diplomates whose certification is expiring before 2018 who would like to be reported as certified and participating , the following must be completed :

• Enroll in MOC

• Every 2 years : at least one MOC activity

• Every 5 years : 100 MOC points

• Every 10 years : Pass the MOC exam

Enhancing hemostasis when fibrinolysis contributes to bleeding .

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Dr . Zumberg : Diplomates – not just from ASH – are angst-ridden about what the exam has represented and what they were getting out of it . The changes that ABIM is exploring , if implemented correctly , could be welcome steps to making MOC more user-friendly and meaningful .

The future of Part 4 of the MOC program , focused on medical practice improvement , is still unclear . It has been suspended , but will it be gone for good ? As ABIM embarks on changes to the MOC program , people may be nervous about where it is headed . We are welcoming of change , but both ASH and hematologists want to be involved in the process .

Dr . Williams : Another element we are keeping in mind is the scope of the knowledge base that will be included in the MOC assessments .

A number of hematologists are focused in one specific area of our field – whether that ’ s malignant hematology or stem cell transplantation or hemostasis and thrombosis . Clinicians who specialize in primarily one area may ask , “ Why should I have to study the entire field when that ’ s not part of my professional activities ?” We at ABIM hear that , and we at the ABIM Hematology Board will be eager to have ASH insight on this aspect as the MOC process evolves .

Dr . Zumberg : The significance of this topic became even clearer to me when

See Important Safety Information below and full prescribing information on reverse side .

INDICATIONS AND USAGE

AMICAR is useful in enhancing hemostasis when fibrinolysis contributes to bleeding . In life-threatening situations , transfusion of appropriate blood products and other emergency measures may be required . Fibrinolytic bleeding may frequently be associated with surgical complications following heart surgery ( with or without cardiac bypass procedures ) and portacaval shunt ; hematological disorders such as amegakaryocytic thrombocytopenia ( accompanying aplastic anemia ); acute and life-threatening abruptio placentae ; hepatic cirrhosis ; and neoplastic disease such as carcinoma of the prostate , lung , stomach , and cervix . Urinary fibrinolysis , usualIy a normal physiological phenomenon , may contribute to excessive urinary tract fibrinolytic bleeding associated with surgical hematuria ( following prostatectomy and nephrectomy ) or nonsurgical hematuria ( accompanying polycystic or neoplastic diseases of the genitourinary system ).

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

AMICAR should not be used when there is evidence of an active intravascular clotting process . When there is uncertainty as to whether the cause of bleeding is primary fibrinolysis or disseminated intravascular coagulation ( DIC ), this distinction must be made before administering AMICAR . AMICAR must not be used in the presence of DIC without concomitant heparin .

WARNINGS

• In patients with upper urinary tract bleeding , AMICAR administration has been known to cause intrarenal obstruction in the form of glomerular capillary thrombosis or clots in the renal pelvis and ureters . For this reason , AMICAR should not be used in hematuria of upper urinary tract origin , unless the possible benefits outweigh the risk .

• Subendocardial hemorrhages have been observed in dogs given intravenous infusions of 0.2 times the maximum human therapeutic dose of AMICAR and in monkeys given 8 times the maximum human therapeutic dose of AMICAR .

• Fatty degeneration of the myocardium has been reported in dogs given intravenous doses of AMICAR at 0.8 to 3.3 times the maximum human therapeutic dose and in monkeys given intravenous doses of AMICAR at 6 times the maximum human therapeutic dose .

• Rarely , skeletal muscle weakness with necrosis of muscle fibers has been reported following prolonged administration . Clinical presentation may range from mild myalgias with weakness and fatigue to a severe proximal myopathy with rhabdomyolysis , myoglobinuria , and acute renal failure . Muscle enzymes , especially creatine phosphokinase ( CPK ) are elevated . CPK levels should be monitored in patients on long-term therapy . AMICAR administration should be stopped if a rise in CPK is noted .

• The possibility of cardiac muscle damage should also be considered when skeletal myopathy occurs . One case of cardiac and hepatic lesions observed in man has been reported . The patient received 2 g of aminocaproic acid every 6 hours for a total dose of 26 g . Death was due to continued cerebrovascular hemorrhage . Necrotic changes in the heart and liver were noted at autopsy .

ADVERSE REACTIONS

AMICAR is generally well tolerated . The following adverse experiences have been reported :

• General : Edema , headache , malaise .

• Hypersensitivity Reactions : Allergic and anaphylactoid reactions , anaphylaxis .

• Cardiovascular : Bradycardia , hypotension , peripheral ischemia , thrombosis .

• Gastrointestinal : Abdominal pain , diarrhea , nausea , vomiting .

• Hematologic : Agranulocytosis , coagulation disorder , leukopenia , thrombocytopenia .

• Musculoskeletal : CPK increased , muscle weakness , myalgia , myopathy ( see WARNINGS ), myositis , rhabdomyolysis .

• Neurologic : Confusion , convulsions , delirium , dizziness , hallucinations , intracranial hypertension , stroke , syncope .

• Respiratory : Dyspnea , nasal congestion , pulmonary embolism .

• Skin : Pruritis , rash .

• Special Senses : Tinnitus , vision decreased , watery eyes .

• Urogenital : BUN increased , renal failure . There have been some reports of dry ejaculation during the period of AMICAR treatment . These have been reported to date only in hemophilia patients who received the drug after undergoing dental surgical procedures . However , this symptom resolved in all patients within 24 to 48 hours of completion of therapy .

ASHClinicalNews . org

ASH Clinical News September 2016 | Page 61

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