Author Interviews, Autism, BMJ, Nutrition / 14.10.2017

MedicalResearch.com Interview with: Elizabeth DeVilbiss, PhD MPH Dornsife School of Public Health Drexel University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unfortunately, not much is known about how diet during pregnancy affects autism risk.  There have been studies in recent years about varied aspects of diet during pregnancy and autism risk involving multivitamins, iron, folic acid, vitamin D, and more, but the evidence is still inconclusive. After adjusting for several potentially influencing factors in both mothers and children, we found that multivitamin use, with or without additional iron and/or folic acid, was associated with a lower likelihood of child autism spectrum disorder with intellectual disability relative to mothers who did not use folic acid, iron, and multivitamins. (more…)
Author Interviews, ENT, JAMA, Stanford, Surgical Research / 12.10.2017

MedicalResearch.com Interview with: David Schoppy, MD PhD Resident, Division of Head and Neck Surgery Department of Otolaryngology Stanford University School of Medicine Stanford, Palo Alto, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a growing focus in healthcare on quality, and one component of this focus is the development of robust measures of quality. Currently, there are relatively few validated metrics of performance in oncologic surgery, and several of these indicators are relatively static metrics (such as hospital case volume and institution type). This study examined the relationship between overall survival (one surrogate of quality cancer surgery) and two modifiable variables in Head and Neck surgery - achieving negative surgical margins around a primary tumor and 18 or more lymph nodes from a concurrent neck dissection. After controlling for multiple other patient variables, data collected from the National Cancer Database (NCDB) showed that treatment at hospitals where a high percentage of patients had a surgery with negative margins and 18 or more lymph nodes removed from their neck was associated with improved survival. Importantly, this survival benefit was independent of the individual, patient-level survival benefit conferred by having either of these surgical process measures reached. This study therefore highlights two modifiable measures of institutional performance in Head and Neck surgery that may serve as targets for quality improvement programs. (more…)
Author Interviews, Cost of Health Care, Infections, Merck, Stem Cells, Transplantation / 12.10.2017

MedicalResearch.com Interview with: Dr. Jonathan Schelfhout, PhD Director, Outcomes Research Merck & Co. Inc. North Wales, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The cost of hematopoietic stem cell transplantation has received increased attention after it was identified as a top 10 contributor to increasing healthcare costs in an AHRQ 2016 report. Many recent studies have explored the cost of HSCT but additional research is needed on the costly complications that can follow the transplant procedure. This research is particularly relevant for inpatient decision makers, as most transplant centers receive one bundled payment for the transplant and the treatment of any complications over the first 100 days. (more…)
Author Interviews, Education, Pediatrics, Sleep Disorders / 12.10.2017

MedicalResearch.com Interview with: Jack Peltz, Ph.D. Clinical assistant professor in Psychiatry Rochester Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 90% of high-school aged adolescents get either insufficient sleep during school nights or barely meet the required amount of sleep (ie, 8–10 hours) expected for healthy functioning.(1) In fact, sleep problems and insufficient sleep are so pervasive for adolescents that they could be considered an epidemic due to their adverse impact on adolescent mental and physical health.(2–5) As a result,addressing insufficient adolescent sleep represents a critical point of study and intervention. The growing body of evidence suggests that later school start times (SST), 8:30 AM or later as recommended by the American Academy of Pediatricians,6 convey multiple benefits on adolescents, including improved sleep, better mental and physical health, and improved academic outcomes.(7–10) This research, however, has focused on the direct effects of delaying school start times, or specifically how moving SST back directly predicts changes in an outcome (eg, mental health, academic achievement). This type of analysis precludes examining the important role that SST might play as a condition or context under which other sleeprelated processes take place. For instance, earlier school start times might exacerbate the impact of sleep-related processes on adolescent behavioral health outcomes. Thus, incorporating school start times as a larger contextual variable that might moderate models of sleep and adolescent functioning represents a gap in the literature and a unique opportunity to advance conceptual models. Accordingly, the current study examines the moderating role of school start times on the associations between sleep hygiene, sleep quality, and mental health. (more…)
Accidents & Violence, Author Interviews, Gender Differences, Psychological Science, Social Issues / 11.10.2017

MedicalResearch.com Interview with: Dr. Thekla Morgenroth Preferred pronouns: They/them/their Research Fellow in Social and Organisational Psychology Psychology University of Exeter Washington Singer Laboratories, Exeter UK  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Risk-taking is often seen as an important trait that leads to economic success - for example when it comes to investing money - and career success. For example, we often hear that leaders need to be willing to take risks. Risk-taking is also strongly associated with masculinity, which leads to the idea that maybe gender differences in economic and career success can be explained by the fact that women are just too risk averse. When you look at the risk-taking literature, it appears that there is support for this idea with many studies showing that men do indeed take more risks than men. Our research questions these ideas. We show that current measures of risk-taking are biased. They focus only on stereotypical "masculine" risk taking behaviors such as betting your money on the outcome of a sporting event or going whitewater rafting, and ignore the many risks that women take, such as going horseback riding or donating a kidney to a family member. When this bias is addressed, gender differences in risk-taking disappear or even reverse. (more…)
Author Interviews, Mental Health Research, Pharmacology, Psychological Science / 10.10.2017

MedicalResearch.com Interview with: Vanda Faria PhD Department of Psychology Uppsala, Sweden  MedicalResearch.com: What is the background for this study? What are the main findings? Response: It has been debated whether selective serotonin reuptake inhibitors (SSRIs), which are commonly prescribed for depression and anxiety, are more effective than placebo. Concerns have been raised that the beneficial effects of SSRIs, as measured in double-blind clinical trials, may be explained by expectancies (a crucial placebo mechanism) rather than the biochemical compound. But no study has tested experimentally the extent to which the SSRI treatment effect can be influenced by expectancies induced by verbal suggestions. We compared the efficacy of overt vs. covert administration of an SSRI (escitalopram) in patients with social anxiety disorder. Rather than comparing the SSRI with placebo, we compared it with itself while manipulating the patients’ expectations of improvement. This was achieved by informing one group correctly about the SSRI and its effectiveness (overt group) whereas the comparison (covert) group received incorrect information. By use of a cover story, the covert group was led to believe they were treated with a so called “active placebo”, an ineffective neurokinin-1 antagonist yielding similar side effects as the SSRI but lacking anxiety-reducing properties. But the treatment, dosage and duration was in fact identical in both groups. Results showed that overt outperformed covert SSRI treatment, as the number of treatment responders was more than three times higher on the main clinical outcome measure when correct information was given. Using neuroimaging (fMRI) we also noted differences between the overt and covert SSRI groups on objective brain activity measures. There were differences between the groups e.g. with regard to activation of the posterior cingulate cortex with treatment, and the functional coupling between this region and the amygdala which is a brain region crucially involved in fear and anxiety. The fMRI  results may reflect the interaction between cognition and emotion as the brain changes differently with treatment pending on the expectations of improvement. (more…)
Author Interviews, Gender Differences, Social Issues / 09.10.2017

MedicalResearch.com Interview with: Rebecca Horne, MSc, PHEc MSc graduate in Family Sciences from the University of Alberta Professional human ecologist PhD student in Psychology at the University of Toronto Research area in intimate relationships MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although several studies have argued that time, money, and gender are important factors that shape the division of household labour, we know little about how these factors impact housework at different stages of the life course. Specifically, are time, money, and gender-related variables equally important for explaining housework involvement at different life stages? In our study, we compared men’s and women’s housework contributions at different life stages and explored how work hours, income (relative to one’s partner), marital status, raising children, and gender impacted housework at these distinct stages. We drew on data from the Edmonton Transitions Study, which has tracked the school-to-work and adolescence-to-adulthood transitions of nearly 1,000 Canadians for over three decades. We analyzed survey data from participants who had romantic partners during three developmental periods: the transition to adulthood (age 25; assessed in 1992), young adulthood (age 32; assessed in 1999), and midlife (age 43; assessed in 2010). We found that regardless of age or life stage, women performed more housework than men. In addition, lower housework involvement was most reliably predicted by earning a greater share of income and being male at age 25; working longer hours and raising children (for men only) at age 32; and earning a greater share of income, working longer hours, and being male at age 43. Importantly, gender was the strongest predictor of housework responsibility earlier and later in life. (more…)
Author Interviews, C. difficile, CDC, Dental Research, Infections / 09.10.2017

MedicalResearch.com Interview with: Stacy Holzbauer, DVM, MPH, DACVPM CDC Career Epidemiology Field Officer (CEFO) Commander, USPHS Minnesota Department of Health St. Paul, MN MedicalResearch.com: What is the background for this study?
  • Antibiotics are not harmless drugs—Clostridium difficile infection, which can sometimes cause a deadly diarrhea, is a complication of antibiotic use and can occur after even one dose of an antibiotic.
  • The Minnesota Department of Health (MDH) is part of the larger Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP). The healthcare-associated infection component of CDC’s EIP engages a network of state health departments and their academic medical center partners to help answer critical questions about emerging HAI threats including Clostridium difficile also known as “C. diff.”
  • In Minnesota, the majority of C. diff infections occur outside the hospital and are driven by antibiotic use in community or outpatient settings. In addition to routine surveillance data, we interview patients with C. diff who were not hospitalized prior to their infection to identify potential risks for developing C. diff infection, including identifying antibiotics received outside of routine healthcare settings.
  • Dentists prescribe approximately 10% of the antibiotics in outpatient settings, which was over 24 million prescriptions in 2013. When asked about their prescribing practices in a 2015 survey with the Minnesota Dental Association, 36% of dentists surveyed prescribed antibiotics for dental conditions that are generally not recommended to receive antibiotics according to American Dental Association (ADA) guidelines.
(more…)
Author Interviews, Cost of Health Care / 09.10.2017

MedicalResearch.com Interview with: John N. Mafi MD MPH Assistant Professor of Medicine David Geffen School of Medicine University of California, Los Angeles Natural scientist in Health Policy RAND Corporation Santa Monica, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Of the 3 trillion dollars the U.S. spends annually on health care, an estimated 10-30% consists of “low-value care”, or patient care that provides no net benefit in specific clinical scenarios (think antibiotics given for the common cold virus). Determining where and why this waste occurs is critical to efforts to safely reducing healthcare spending. Little is known, however, about the distribution of costs among such “low-value” services. In this context, we used the Virginia All Payer Claims Database in order to assess the quantity and total costs of 44 low-value services in 2014 among 5.5 million beneficiaries. (more…)
Author Interviews, Geriatrics, Race/Ethnic Diversity / 09.10.2017

MedicalResearch.com Interview with: Karen Joynt Maddox, MD, MPH Washington University School of Medicine Saint Louis MO MedicalResearch.com: What is the background for this study? What are the main findings? Response: Home health is one of the fastest-growing sectors in Medicare, and the setting of a new federal value-based payment program, yet little is known about disparities in clinical outcomes among Medicare beneficiaries receiving home health care. We found that beneficiaries who were poor or Black had worse clinical outcomes in home health care than their peers. These individuals were generally more likely to have unplanned hospitalizations, readmissions, and emergency department visits. Under Home Health Value-Based Purchasing, these patterns should be tracked carefully to ensure the program helps close the gaps rather than widening them. (more…)
Author Interviews, Cancer Research, Weight Research / 09.10.2017

MedicalResearch.com Interview with: Dr. C. Brooke Steele D.O. Division of Cancer Prevention and Control Centers fo Disease Control and Prevention  MedicalResearch.com: What is the background for this study? Response: This report contains new information about cancer risk and people being overweight and obese. Research shows that being overweight or having obesity is associated with at least 13 types of cancer (adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovaries, pancreas, and thyroid; meningioma; and multiple myeloma). We also know that the number of people who weigh more than recommended has increased over the past few decades. Therefore, we looked at the numbers of new cases of cancers associated with overweight and having obesity in the United States, as well as how the rates have changed over a 10-year period. Because screening for colorectal cancer can reduce colorectal cancer incidence through detection and removal of precancerous polyps before they become cancerous, we analyzed trends with and without colorectal cancer. (more…)
Author Interviews, Occupational Health, Weight Research / 09.10.2017

MedicalResearch.com Interview with: Sun Miaomiao Prof. Shelly Tse JC School of Public Health and Primary Care The Chinese University of Hong Kong Sha Tin, Hong Kong MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 20% of the overall workforce is involving in a shift work schedule, which is equivalent to nearly 0.7 billion workers. It has been several studies and systematic reviews reported that shift work could contribute a risk to abdominal obesity, that was identified to be associated with increased mortality. However, the previous related studies derived from different industries and companies that held with various occupational settings of night shift work, and the results have been inconsistent or lack of statistical power. We believed that a better understanding of the knowledge gaps on the associations between specific obesity types and different shift work settings has important implications for occupational health practice. Our meta-analysis provided a clearer picture for the association between night shift work and overweight/ obesity with a potential gradient association, especially for the abdominal obesity. (more…)
Author Interviews, Gender Differences / 07.10.2017

MedicalResearch.com Interview with: Adam C. Davis, MSc PhD Education student University of Ottawa Ottawa, Ontario Canada  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Charles Darwin argued that animals compete with members of the same sex for desired mates (i.e., intrasexual competition). Using this framework, evolutionary researchers have explored the variety of ways in which this kind of competition may play out across human cultures. Several researchers have argued that gossip may be an effective way for humans to compete for mates, but most of the research has been indirect up until this point. In our study, we provide evidence that the reported tendency to compete with same-sex others for mates is associated with gossiping and positive attitudes toward learning about and spreading gossip. Gossip has also been argued to be women’s weapon of choice to compete for mates; however, few studies have tested this hypothesis. We provide evidence that women gossip to a greater extent than men, particularly about social information (e.g., friendships, romantic relationships) and the physical appearance of others (e.g., clothing), whereas men gossip more about achievement (e.g., salaries, promotions). Women also expressed more favourable attitudes toward gossiping than men. (more…)
Author Interviews, Kidney Stones / 07.10.2017

MedicalResearch.com Interview with: Benjamin Freedman, Ph.D. Assistant Professor | University of Washington Department of Medicine | Division of Nephrology Member, Kidney Research Institute Member, Institute for Stem Cell and Regenerative Medicine Seattle WA 98109  MedicalResearch.com: What is the background for this new technology and study? What are the main findings? Response: Polycystic kidney disease (PKD) is the leading genetic cause of end stage renal disease, affecting approximately twelve million people. The hallmark of the disease is the massive expansion of kidney tubules into large, fluid-filled cysts. Although we know the genes that are mutated in this disease, we do not have a firm grasp on what they do to protect the body from disease. We used a new system, human kidney organoids with gene-edited PKD mutations, to discover how factors outside the cell affect cyst formation. We found that liberating the organoids from plastic dishes into floating cultures greatly increased the number and size of cysts that formed. We also found that PKD organoids had problems in their ability to change the shape of collagen scaffolds surrounding them, compared to control organoids of the same genetic background. (more…)
Author Interviews, Genetic Research, PLoS / 07.10.2017

MedicalResearch.com Interview with: Colin Sharpe School of Biology Institute of Biomolecular and Biomedical Science School of Biological Sciences University of Portsmouth Portsmouth, United Kingdom  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have long been fascinated by the question of what underpins the increasing complexity of multicellular animals. In a recent publication we looked at changes to the diversity of the NCoR family corepressors (NCoRs) across the Deuterostomes and found an increase in diversity from sea urchins to humans (1). This is due to gene duplication, an increase in alternative splicing and the encorporation of more protein motifs and domains. In this study we devised a measure of functional diversity based on these three factors and calculated this value for over 12000 genes involved in transcription in nine species from the nematode worm to humans. Orthologues whose increase in diversity correlated with the increase in complexity of these animals were then selected and we looked for common features and interactions between the selected genes. We found that proteins that regulate the dynamic organisation of chromatin were significantly enriched within the selection. (more…)
Author Interviews, BMJ / 07.10.2017

MedicalResearch.com Interview with: Dr Mark A Green BA (Hons), MSc, PhD, AFHEA Lecturer in Health Geography University of Liverpool MedicalResearch.com: What is the background for this study? What are the main findings? Response: Between Dec 2013 and Dec 2015 there was an increase of 41% in the number of acute patients delayed being discharged from hospital. If we compare the previous year of data –Dec 2012- Dec 2014 – there was only a 10% increase. 2015 saw one of the largest annual spikes in mortality rates for almost 50 years – we wanted to explore if there was any correlation between these two trends. (more…)
Alzheimer's - Dementia, Author Interviews, Medical Imaging, MRI / 06.10.2017

MedicalResearch.com Interview with: Dr. Sanja Josef Golubic, dr. sc Department of Physics, Faculty of Science University of Zagreb, Croatia MedicalResearch.com: What is the background for this study? Response: Our study was aimed to search the topological biomarker of Alzheimer’s disease. A recent evidences suggest that the decades long progression of brain degeneration that is irreversible by the stage of symptomatic Alzheimer’s disease, may account for failures to develop successful disease-modifying therapies. Currently, there is a pressing worldwide search for a marker of very early, possibly reversible, pathological changes related to Alzheimer’s disease in still cognitively intact individuals, that could provide a critical opportunity for evolving of efficient therapeutic interventions. Three years ago we reported the discovery of the novel, fast brain pathway specialized for rapid processing of the simple tones. We named it gating loop. Gating loop directly links auditory brain areas to prefrontal brain area. We have also noticed the high sensitivity of the gating loop processing on AD pathology. It was inspiration to focus our Alzheimer’s disease biomarker search in the direction of prefrontal brain activation during listening of simple tones. (more…)
Annals Thoracic Surgery, Author Interviews, Gender Differences, Heart Disease, Surgical Research, Women's Heart Health / 06.10.2017

MedicalResearch.com Interview with: Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa MedicalResearch.com: What is the background for this study? What are the main findings Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes. The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG). (more…)
Author Interviews, HIV, Infections / 06.10.2017

MedicalResearch.com Interview with: Paul M. Salcuni, MPH Department of Health and Mental Hygiene New York City MedicalResearch.com: What is the background for this study? What are the main findings? Response: NYC Health Department is committed to ensuring equitable access to HIV pre-exposure prophylaxis (PrEP) for all New Yorkers who are HIV-negative and may be exposed to HIV. We examined trends in PrEP prescribing by 602 ambulatory care practices in New York City from 2014 to 2016, as well as associated patient and practice factors, to inform our comprehensive scale-up efforts. For every 100,000 medical visits in the first three months of 2014, roughly 39 involved a patient being prescribed PrEP. In the second quarter of 2016, 419 of every 100,000 medical visits at those same practices involved a PrEP prescription. Despite this nine-fold increase overall, some groups of patients among these practices were less likely to be prescribed PrEP. Those groups include men of color, women, and people getting health care at smaller private practices or practices outside of the city center. (more…)
Author Interviews, Lancet, OBGYNE / 06.10.2017

MedicalResearch.com Interview with: Jonathan Marc Bearak, PhD Senior Research Scientist Guttmacher Institute New York MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although U.S. women who live farther from abortion clinics are less likely to obtain one, no national study has examined inequality in women’s access to abortion and whether inequality in abortion access has increased as the number of abortion clinics have declined. We found that half of women live within 11 miles of an abortion provider. However, 1 in 5 women would need to travel at least 43 miles. We found substantially greater variation within than across states, because even in relatively rural states, women and clinics were concentrated in urban areas. These disparities have persisted since at least 2000. (more…)
Author Interviews, Cost of Health Care, JAMA, PTSD / 06.10.2017

MedicalResearch.com Interview with: Gregory H. Cohen, MPhil, MSW Statistical Analyst Department of Epidemiology School of Public Health Boston University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy. Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care. Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. (more…)
Author Interviews, CDC, Cost of Health Care, Pediatrics / 06.10.2017

MedicalResearch.com Interview with: Scott D. Grosse, PhD National Center on Birth Defects and Developmental Disabilities CDC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The U.S. Institute of Medicine (IOM) in 2007 published estimates of the economic costs associated with preterm birth. That report is publicly available: https://www.ncbi.nlm.nih.gov/pubmed/20669423. The total societal cost over a lifetime of a single year’s cohort of infants born preterm was estimated as $26 billion in 2005 US dollars. The study in Pediatrics sought to provide more current estimates of one component of those costs: medical care between birth and 12 months and to answer two additional questions:
  1. What costs are specifically incurred by employer-sponsored private health plans?
  2. How much of the overall cost burden of prematurity is attributable to infants born preterm with major birth defects (congenital malformations and chromosome abnormalities)?
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Allergies, Asthma, Author Interviews, Pediatrics, Respiratory / 06.10.2017

MedicalResearch.com Interview with: Giovanni Piedimonte, MD Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education Professor & Chair of Pediatrics Cleveland Clinic Lerner College of Medicine Case Western Reserve University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study proves that asthmatic children already have a hyperactive calcium channel that’s extremely sensitive to environmental triggers. If these children contract a virus, such as RSV, the hyperactive channel causes more severe symptoms that may require care in a hospital setting. When a child developed asthma or bronchitis in the past, doctors thought these conditions could only be triggered by environmental allergens. There was no explanation why two out of three children ages five and under who wheeze and cough – and still test negative for allergies. We needed to explore the mechanisms of the calcium molecule and the epithelial cells, which seem to trigger these symptoms without an allergic reaction. If the molecule’s behavior is producing the cough, we just need to figure out how to control the molecule to properly deactivate the cough mechanism in the asthmatic child (more…)
Author Interviews, Dermatology, JAMA, Melanoma, Surgical Research / 05.10.2017

MedicalResearch.com Interview with: Adewole Adamson, MD, MPP Department of Dermatology UNC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Surgery is the primary intervention for the treatment of melanoma. Little is known about how delays for surgery, defined as the time between diagnosis and surgical treatment, among melanoma patient differ by insurance type. After adjustment of patient-level, provider-level, and tumor-level factors we found that Medicaid patients experience a 36% increased risk of delays in surgery for melanoma. These delays were 19% less likely in patients diagnosed and 18% less likely in patients surgically treated by dermatologists. Non-white patients also had a 38% increased risk of delays. (more…)
Author Interviews, Boehringer Ingelheim, Clots - Coagulation, Stroke / 05.10.2017

MedicalResearch.com Interview with: Craig Anderson | MD PhD FRACP Executive Director Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney Neurologist, Neurology Department, Royal Prince Alfred Hospital The George Institute for Global Health at Peking University Health Science Center Haidian District | Beijing, 100088 P.R. China MedicalResearch.com: What is the background for this study? What are the main findings? Response:  There is much controversy over the benefits of a lower dose of intravenous alteplase, particularly in Asia, after the Japanese regulatory authorities approved a dose of 0.6 mg/kg 10 years ago compared to the US FDA and other regulatory authorities approving 0.9 mg/kg 20 years ago.  The investigator inititiated and conducted ENCHANTED trial aimed to determine the effectiveness and safety of these two doses in an international multicentre pragmatic open design. The main results did not confirm the low-dose to be statistically ‘non-inferior’ partly due to the primary outcome measure chosen and partly due to the statistical approach, but it did confirm that the lower dose was safer with less risk of the major complication of this treatment, that of major bleeding in the brain.  However, it would appear that this safety effect was offset by some reduce efficacy in terms of functional recovery. The aim of this secondary analysis of the trial data was to examine in more detail the differences between low and standard dose alteplase according to the participants’ age, ethnicity (Asian vs non-Asian) and severity of neurological deficit at the time of treatment.  We did this because the popular belief is that a lower dose might be preferred in older people, and Asians, because of the potential for more likelihood of bleeding, and preferentially to use the standard dose in those with more severe strokes potentially due to greater ‘clot burden’ from a blocked artery to the brain. The results showed that the main findings on the outcome of surviving free of disability were the same according to age, ethnicity and stroke severity – that is, there was no preferential dose in any of these groups.  Similarly, the safety benefit of low dose alteplase on brain haemorrhage, did not clearly translate into clinical disability outcomes in any of the patient groups studied. (more…)
Author Interviews, Clots - Coagulation, Genetic Research, JAMA, Surgical Research / 04.10.2017

MedicalResearch.com Interview with: Anne R. Bass, MD Associate Professor of Clinical Medicine Weill Cornell Medical College Rheumatology Fellowship Program Director Hospital for Special Surgery New York, NY 10021 MedicalResearch.com: What is the background for this study? Response: Blood thinners are used after orthopedic surgery to prevent blood clots from forming in the legs and traveling to the lungs. They are also used in patients with certain heart diseases to prevent strokes. Blood thinners, like warfarin, are effective but can be associated with serious bleeding complications, especially if the wrong dose is given. Genetic testing can help doctors predict the right warfarin dose to use in an individual patient. In this trial, ≈1600 elderly patients undergoing hip or knee replacement were randomly assigned to receive warfarin dosing based on genetics plus clinical factors (like height, weight and gender), or based on clinical factors alone. The specific genes tested wereVKORC1, CYP2C9, and CYP4F2 which influence warfarin metabolism and the body’s ability to produce clotting factors. (more…)
Author Interviews, Gastrointestinal Disease, JAMA, Surgical Research / 04.10.2017

MedicalResearch.com Interview with: Marc D. Basson, MD, PhD, MBA Professor of Surgery, Pathology, and Biomedical Science Senior Associate Dean for Medicine and Research University of North Dakota School of Medicine & Health Sciences Grand Forks, ND 58202  MedicalResearch.com: What is the background for this study? What are the main findings? Response: I and other surgeons have previously had the experience of caring for patients with appendicitis who had recently undergone colonoscopy, and wondered if there might be a connection.  However, colonoscopy and appendicitis are both common events, and so it would be difficult to tell whether they are linked or just coincidences from scattered occurrences. After obtaining appropriate regulatory approvals, we identified almost 400,000 veterans from the US Department of Veterans Affairs database who had undergone screening colonoscopy and compared their rates of appendectomy and acute appendicitis in the week following colonoscopy to rates of appendectomy and appendicitis over each of the following 51 weeks.  We asked the question in several different ways and verified our results by examining surgical and pathology reports.  Depending on how the question was asked and appendicitis or appendectomy defined, rates of appendectomy and appendicitis were clearly 4-9 times higher in the first week after diagnostic colonoscopy.  This wasn’t true when we asked whether appendectomy was more common after several other procedures that also required sedation and contact with the medical system. (more…)
Accidents & Violence, Author Interviews, Cost of Health Care, Johns Hopkins / 04.10.2017

MedicalResearch.com Interview with: Faiz Gani MD Postdoctoral research fellow Department of Surgery Johns Hopkins University School of Medicine Baltimore, Maryland MedicalResearch.com: What is the background for this study? What are the main findings? Response: The current study sought to evaluate epidemiological trend in emergency department (ED) visits for firearm-related injuries in the US. In our study, we observed that 25.3 patients per 100,000 presented to the ED for a firearm-related injury. This translated to over 78,000 ED visits per year. Over time, while firearm injuries decreased from 2006-2013, an increase in the incidence of firearm-related injuries was observed in 2014. Additionally, over time injuries among older patients and those injured in an unintentional firearm injury increased. Injuries due to an assault decreased over time. The average ED and inpatient charges were $5,254 and $95,887, respectively, resulting in an overall financial burden of approximately $25 billion over the study or an annual $2.8 billion in ED and inpatients charges. (more…)
Author Interviews, Diabetes, Nature / 04.10.2017

MedicalResearch.com Interview with: Andrew F. Stewart MD Irene and Dr. Arthur M. Fishberg Professor of Medicine Director, Diabetes, Obesity and Metabolism Institute Institute at the Icahn School of Medicine at Mount Sinai New York, NY 10029 MedicalResearch.com: What is the background for this study? Response: Diabetes results ultimately from an inadequate number of insulin-producing “beta” cell in the pancreas.  Ideally, these would regenerate when they are lost or damaged, but unfortunately inducing them to regenerate or proliferate has proven impossible until recently. In 2015 and others we identified the first class of drugs – the harmine analogues - that are able to induce human beta cells to proliferate.  In this study, we wanted to identify additional pathways that can lead to human beta cell proliferation at higher rates than we had been able to induce with harmine.   For this we turned to a rare type of benign (i.e., not malignant, not cancer) tumor of the beta cells in the pancreas called “insulinomas”. These tiny tumors overproduce insulin and cause hypoglycemia (low blood glucose) which in turn causes seizures, loss of consciousness and confusion.  Once they are discovered, then can easily be removed via laparoscopic surgery, and the person is cured.  Since they are so rare, and since they are benign and easily cured, insulinomas have not been included in large genome sequencing studies of patients wit cancer.  However, we reasoned that they must hold the genomic recipe or wiring diagram for inducing human beta cells to replicate, so we perfumed next-generation DNA and RNA sequencing on a large series (38) of insulinomas. (more…)