Cardiovascular and Renal Drugs Advisory Committee; Notice of Meeting, 38717-38718 [2013-15332]
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Federal Register / Vol. 78, No. 124 / Thursday, June 27, 2013 / Notices
Key Question 2
What is the comparative effectiveness
of imaging techniques for restaging
patients with primary and recurrent
colorectal cancer after initial treatment?
a. What is the test performance of the
imaging techniques used (singly, in
combination, or in a specific sequence)
to restage colorectal cancer when
compared with a reference standard?
b. What is the impact of alternative
imaging techniques on intermediate
outcomes, including stage
reclassification and changes in
therapeutic management?
c. What is the impact of alternative
imaging techniques on clinical
outcomes?
d. What are the adverse effects or
harms associated with using imaging
techniques, including harms of testdirected management?
e. How is the comparative
effectiveness of imaging techniques
modified by the following factors:
i. Patient-level characteristics (e.g.,
age, sex, body mass index)
ii. Disease characteristics (e.g., tumor
grade)
iii. Imaging technique or protocol
characteristics (e.g., use of different
tracers or contrast agents, radiation dose
of the imaging modality, slice thickness,
timing of contrast)
PICOTS Criteria (Population,
Intervention, Comparator, Outcomes,
Timing, Setting)
Populations
• Adult patients with an established
diagnosis of primary colorectal cancer
• Adult patients with an established
diagnosis of recurrent colorectal cancer
Interventions
Noninvasive imaging using the
following tests (alone or in combination)
to assess the stage of colorectal cancer:
• CT
• PET/CT
• MRI
• Endoscopic ultrasound
Combinations of particular interest
include endoscopic ultrasound to
evaluate the T stage combined with
PET/CT or CT to evaluate the N and M
stages.
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Reference Standards To Assess Test
Performance
• Histopathological examination of
tissue
• Intraoperative findings
• Clinical followup
Histopathology of surgically resected
specimens is the reference standard for
pretherapy staging. In patients
undergoing surgery, the nodal (N) stage
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and spread of the tumor to nearby
regional structures and other organs is
assessed intraoperatively, either by
palpation or ultrasound. However, in
patients with metastatic disease who
undergo palliative care, a combination
of initial biopsy results and clinical
followup serves as the reference
standard.
Clinicians use the results from the
imaging modality or modalities to arrive
at a stage determination that is
compared against the stage established
by the reference standard. These
comparisons tell us how many people
were correctly classified in the various
stages of the disease and allow us to
calculate the test performance metrics of
sensitivity, specificity, and accuracy.
The selection of the reference standard
is important in evaluating the true
performance of an imaging modality for
staging.
Comparators
• Any direct comparisons of the
imaging tests of interest
• Any direct comparisons of
variations of any of the imaging tests of
interest (e.g., diffusion-weighted MRI vs.
T2-weighted MRI)
Comparators thought to be of
particular clinical interest are listed
below:
• For colon cancer: a contrastenhanced CT of the chest, abdomen, and
pelvis versus whole-body PET/CT
versus a contrast-enhanced MRI of the
chest, abdomen, and pelvis
• For rectal cancer: a contrastenhanced CT of the abdomen and pelvis
versus an MRI of the abdomen and
pelvis
• For rectal cancer: endoscopic
ultrasound versus MRI
• For suspected liver metastasis: CT
scan versus MRI or PET/CT of the
abdomen
• For suspected widespread
metastasis, CT of the chest, abdomen,
and pelvis versus whole-body PET/CT
or contrast-enhanced MRI of the chest,
abdomen, and pelvis
We note that this list is based on a
preliminary literature search and
discussions with a limited number of
clinicians and the Technical Expert
Panel (TEP). Thus, we do not anticipate
that the listed items cover all of the
comparisons of interest. We expect that
additional comparisons will be
identified during the literature review.
Outcomes
• Test performance outcomes
• Test performance (e.g., sensitivity,
specificity, understaging, and
overstaging) against a reference
standard test (pathological
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38717
examination, intraoperative
findings, clinical followup)
• Intermediate outcomes
• Stage reclassification
• Changes in therapeutic management
• Clinical outcomes
• Overall mortality
• Colorectal cancer-specific mortality
• Quality of life and anxiety
• Need for additional staging tests,
including invasive procedures
• Need for additional treatment,
including surgery, radiotherapy, or
chemotherapy
• Resource utilization related to
testing and treatment (when
reported in the included studies)
• Adverse effects and harms
• Harms of testing per se (e.g.,
radiation exposure)
• Harms from test-directed treatments
(e.g., overtreatment,
undertreatment)
Timing
• Primary staging
• Interim restaging
• Duration of followup will vary by
outcome (e.g., from no followup for test
performance measurements to many
years for mortality)
Setting
• Any setting will be considered
Dated: June 13, 2013.
Carolyn M. Clancy,
AHRQ, Director.
[FR Doc. 2013–15288 Filed 6–26–13; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2013–N–0001]
Cardiovascular and Renal Drugs
Advisory Committee; Notice of Meeting
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
This notice announces a forthcoming
meeting of a public advisory committee
of the Food and Drug Administration
(FDA). The meeting will be open to the
public.
Name of Committee: Cardiovascular
and Renal Drugs Advisory Committee.
General Function of the Committee:
To provide advice and
recommendations to the Agency on
FDA’s regulatory issues.
Date and Time: The meeting will be
held on August 6, 2013, from 8 a.m. to
4 p.m.
Location: FDA White Oak Campus,
10903 New Hampshire Ave., Building
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38718
Federal Register / Vol. 78, No. 124 / Thursday, June 27, 2013 / Notices
31 Conference Center, the Great Room
(Rm. 1503), Silver Spring, MD 20993–
0002. Information regarding special
accommodations due to a disability,
visitor parking, and transportation may
be accessed at: https://www.fda.gov/
AdvisoryCommittees/default.htm; under
the heading ‘‘Resources for You,’’ click
on ‘‘Public Meetings at the FDA White
Oak Campus.’’ Please note that visitors
to the White Oak Campus must enter
through Building 1.
Contact Person: Kristina Toliver,
Center for Drug Evaluation and
Research, Food and Drug
Administration, 10903 New Hampshire
Ave., Bldg. 31, Rm. 2417, Silver Spring,
MD 20993–0002, 301–796–9001, FAX:
301–847–8533, email:
CRDAC@fda.hhs.gov, or FDA Advisory
Committee Information Line, 1–800–
741–8138 (301–443–0572 in the
Washington, DC area).
A notice in the Federal Register about
last minute modifications that impact a
previously announced advisory
committee meeting cannot always be
published quickly enough to provide
timely notice. Therefore, you should
always check the Agency’s Web site at
https://www.fda.gov/
AdvisoryCommittees/default.htm and
scroll down to the appropriate advisory
committee meeting link, or call the
advisory committee information line to
learn about possible modifications
before coming to the meeting.
Agenda: On August 6, 2013, the
committee will discuss new drug
application (NDA) 204819, proposed
trade name ADEMPAS (riociguat coated
tablet), submitted by Bayer HealthCare
Pharmaceuticals Inc., for the treatment
of: (1) Chronic thromboembolic
pulmonary hypertension World Health
Organization (WHO) Group 4 to
improve exercise capacity and WHO
functional class and (2) pulmonary
arterial hypertension (WHO Group 1) to
improve exercise capacity, improve
WHO functional class, and to delay
clinical worsening.
FDA intends to make background
material available to the public no later
than 2 business days before the meeting.
If FDA is unable to post the background
material on its Web site prior to the
meeting, the background material will
be made publicly available at the
location of the advisory committee
meeting, and the background material
will be posted on FDA’s Web site after
the meeting. Background material is
available at https://www.fda.gov/
AdvisoryCommittees/Calendar/
default.htm. Scroll down to the
appropriate advisory committee meeting
link.
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Procedure: Interested persons may
present data, information, or views,
orally or in writing, on issues pending
before the committee. Written
submissions may be made to the contact
person on or before July 22, 2013. Oral
presentations from the public will be
scheduled between approximately 12:30
p.m. to 1:30 p.m. Those individuals
interested in making formal oral
presentations should notify the contact
person and submit a brief statement of
the general nature of the evidence or
arguments they wish to present, the
names and addresses of proposed
participants, and an indication of the
approximate time requested to make
their presentation on or before July 12,
2013. Time allotted for each
presentation may be limited. If the
number of registrants requesting to
speak is greater than can be reasonably
accommodated during the scheduled
open public hearing session, FDA may
conduct a lottery to determine the
speakers for the scheduled open public
hearing session. The contact person will
notify interested persons regarding their
request to speak by July 15, 2013.
Persons attending FDA’s advisory
committee meetings are advised that the
Agency is not responsible for providing
access to electrical outlets.
FDA welcomes the attendance of the
public at its advisory committee
meetings and will make every effort to
accommodate persons with physical
disabilities or special needs. If you
require special accommodations due to
a disability, please contact Kristina
Toliver at least 7 days in advance of the
meeting.
FDA is committed to the orderly
conduct of its advisory committee
meetings. Please visit our Web site at
https://www.fda.gov/
AdvisoryCommittees/
AboutAdvisoryCommittees/
ucm111462.htm for procedures on
public conduct during advisory
committee meetings.
Notice of this meeting is given under
the Federal Advisory Committee Act
(5 U.S.C. app. 2).
Dated: June 21, 2013.
Jill Hartzler Warner,
Acting Associate Commissioner for Special
Medical Programs.
[FR Doc. 2013–15332 Filed 6–26–13; 8:45 am]
BILLING CODE 4160–01–P
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Lists of Designated Primary Medical
Care, Mental Health, and Dental Health
Professional Shortage Areas
Health Resources and Services
Administration, HHS.
ACTION: Notice.
AGENCY:
This notice advises the public
of the published lists of all geographic
areas, population groups, and facilities
designated as primary medical care,
mental health, and dental health
professional shortage areas (HPSAs) as
of May 11, 2013, available on the Health
Resources and Services Administration
(HRSA) Web site at https://
www.hrsa.gov/shortage/. HPSAs are
designated or withdrawn by the
Secretary of Health and Human Services
(HHS) under the authority of section
332 of the Public Health Service (PHS)
Act and 42 CFR part 5.
FOR FURTHER INFORMATION CONTACT:
Requests for further information on the
HPSA designations listed on the HRSA
Web site below and requests for
additional designations, withdrawals, or
reapplication for designation should be
submitted to Victoria Hux, Chief,
Shortage Designation Branch, Bureau of
Clinician Recruitment and Service,
Health Resources and Services
Administration, Room 9A–55, Parklawn
Building, 5600 Fishers Lane, Rockville,
Maryland 20857, (301) 594–0816,
https://www.hrsa.gov/shortage/.
SUPPLEMENTARY INFORMATION:
SUMMARY:
Background
Section 332 of the PHS Act, 42 U.S.C.
254e, provides that the Secretary of HHS
shall designate HPSAs based on criteria
established by regulation. HPSAs are
defined in section 332 to include (1)
Urban and rural geographic areas with
shortages of health professionals, (2)
population groups with such shortages,
and (3) facilities with such shortages.
Section 332 further requires that the
Secretary annually publish a list of the
designated geographic areas, population
groups, and facilities. The lists of
HPSAs are to be reviewed at least
annually and revised as necessary.
HRSA’s Bureau of Clinician
Recruitment and Service (BCRS) has the
responsibility for designating and
updating HPSAs.
Public or private nonprofit entities are
eligible to apply for assignment of
National Health Service Corps (NHSC)
personnel to provide primary care,
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Agencies
[Federal Register Volume 78, Number 124 (Thursday, June 27, 2013)]
[Notices]
[Pages 38717-38718]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-15332]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA-2013-N-0001]
Cardiovascular and Renal Drugs Advisory Committee; Notice of
Meeting
AGENCY: Food and Drug Administration, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
This notice announces a forthcoming meeting of a public advisory
committee of the Food and Drug Administration (FDA). The meeting will
be open to the public.
Name of Committee: Cardiovascular and Renal Drugs Advisory
Committee.
General Function of the Committee: To provide advice and
recommendations to the Agency on FDA's regulatory issues.
Date and Time: The meeting will be held on August 6, 2013, from 8
a.m. to 4 p.m.
Location: FDA White Oak Campus, 10903 New Hampshire Ave., Building
[[Page 38718]]
31 Conference Center, the Great Room (Rm. 1503), Silver Spring, MD
20993-0002. Information regarding special accommodations due to a
disability, visitor parking, and transportation may be accessed at:
https://www.fda.gov/AdvisoryCommittees/default.htm; under the heading
``Resources for You,'' click on ``Public Meetings at the FDA White Oak
Campus.'' Please note that visitors to the White Oak Campus must enter
through Building 1.
Contact Person: Kristina Toliver, Center for Drug Evaluation and
Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg.
31, Rm. 2417, Silver Spring, MD 20993-0002, 301-796-9001, FAX: 301-847-
8533, email: CRDAC@fda.hhs.gov, or FDA Advisory Committee Information
Line, 1-800-741-8138 (301-443-0572 in the Washington, DC area).
A notice in the Federal Register about last minute modifications
that impact a previously announced advisory committee meeting cannot
always be published quickly enough to provide timely notice. Therefore,
you should always check the Agency's Web site at https://www.fda.gov/AdvisoryCommittees/default.htm and scroll down to the appropriate
advisory committee meeting link, or call the advisory committee
information line to learn about possible modifications before coming to
the meeting.
Agenda: On August 6, 2013, the committee will discuss new drug
application (NDA) 204819, proposed trade name ADEMPAS (riociguat coated
tablet), submitted by Bayer HealthCare Pharmaceuticals Inc., for the
treatment of: (1) Chronic thromboembolic pulmonary hypertension World
Health Organization (WHO) Group 4 to improve exercise capacity and WHO
functional class and (2) pulmonary arterial hypertension (WHO Group 1)
to improve exercise capacity, improve WHO functional class, and to
delay clinical worsening.
FDA intends to make background material available to the public no
later than 2 business days before the meeting. If FDA is unable to post
the background material on its Web site prior to the meeting, the
background material will be made publicly available at the location of
the advisory committee meeting, and the background material will be
posted on FDA's Web site after the meeting. Background material is
available at https://www.fda.gov/AdvisoryCommittees/Calendar/default.htm. Scroll down to the appropriate advisory committee meeting
link.
Procedure: Interested persons may present data, information, or
views, orally or in writing, on issues pending before the committee.
Written submissions may be made to the contact person on or before July
22, 2013. Oral presentations from the public will be scheduled between
approximately 12:30 p.m. to 1:30 p.m. Those individuals interested in
making formal oral presentations should notify the contact person and
submit a brief statement of the general nature of the evidence or
arguments they wish to present, the names and addresses of proposed
participants, and an indication of the approximate time requested to
make their presentation on or before July 12, 2013. Time allotted for
each presentation may be limited. If the number of registrants
requesting to speak is greater than can be reasonably accommodated
during the scheduled open public hearing session, FDA may conduct a
lottery to determine the speakers for the scheduled open public hearing
session. The contact person will notify interested persons regarding
their request to speak by July 15, 2013.
Persons attending FDA's advisory committee meetings are advised
that the Agency is not responsible for providing access to electrical
outlets.
FDA welcomes the attendance of the public at its advisory committee
meetings and will make every effort to accommodate persons with
physical disabilities or special needs. If you require special
accommodations due to a disability, please contact Kristina Toliver at
least 7 days in advance of the meeting.
FDA is committed to the orderly conduct of its advisory committee
meetings. Please visit our Web site at https://www.fda.gov/AdvisoryCommittees/AboutAdvisoryCommittees/ucm111462.htm for procedures
on public conduct during advisory committee meetings.
Notice of this meeting is given under the Federal Advisory
Committee Act (5 U.S.C. app. 2).
Dated: June 21, 2013.
Jill Hartzler Warner,
Acting Associate Commissioner for Special Medical Programs.
[FR Doc. 2013-15332 Filed 6-26-13; 8:45 am]
BILLING CODE 4160-01-P