Allergies, Author Interviews, Cost of Health Care, Pediatrics / 17.03.2017

MedicalResearch.com Interview with: Lavanya Diwakar, FRCPath Honorary consultant in immunology Queen Elizabeth Hospital, Birmingham, and Research fellow in health economic University of Birmingham Birmingham UK MedicalResearch.com: What is the background for this study? Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK. We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens. (more…)
Author Interviews, Orthopedics / 16.03.2017

MedicalResearch.com Interview with: Alexander S. McLawhorn, MD, MBA Orthopedic Surgery, Hip and Knee Replacement Hospital for Special Surgery New York, NY 10021 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hospital for Special Surgery (HSS) researchers saw the need for a shorter, more patient friendly outcome survey for revision knee replacement surgery. This is an area where patient-reported outcomes data are essential to improving quality of care. In fact, knee replacement revisions, which are more complex and heterogeneous than primary knee surgery, are under-studied in this regard. A commonly used knee replacement survey, the KOOS (Knee Injury and Osteoarthritis Outcome Score), is 42 questions and often leaves physicians with partial and unusable information secondary to patient burden and fatigue. Previously, researchers at HSS created the KOOS, JR, which is a shorter, 7-question survey that accurately measures “knee health”, meaning it reflects aspects of pain, symptom severity, and activities of daily living relevant and difficult for patients with knee arthritis. The current research presented at AAOS showed that the KOOS, JR can be extended to knee replacement revision patients and that it is a valid and efficient tool for assessing knee health in this challenging patient population. (more…)
Author Interviews, Exercise - Fitness, Pediatrics / 16.03.2017

MedicalResearch.com Interview with: Michael G. Ciccotti, MD Professor of Orthopaedic Surgery Rothman Institute Chief of Sports Medicine, and Director of the Sports Medicine Fellowship Thomas Jefferson University MedicalResearch.com: What is the background for this study?  Response: No doubt sports plays a huge role in the United States and all over world with millions of young people between the ages 6 and 18 participating in an organized sport on a regular basis. Over the past decade, there has been a tremendous focus on youth single sport specialization (SSS), with pressure from coaches, parents and the athletes themselves to participate in one sport year round. Many participants, coaches and parents believe that early specialization may allow the young athlete to become better and progress more quickly in their sport, perhaps allowing them a greater chance of becoming a professional athlete. This drive toward early specialization has been fueled by popular icons i.e. Tiger Woods (golf) and Lionel “Leo” Messi (soccer) as well as by media hits such as Friday Night Tykes (young football players) and The Short Game (7-year old golfers). The pop-psych writer, Malcolm Gladwell, whose The 10,000 Hour Rule (in his book Outliers) holds that 10,000 hours of "deliberate practice" are needed to become world-class in any field may have also encouraged the specialization trend. There is little doubt that youth sports may encourage a lifelong interest in a healthy lifestyle as well as improved self-esteem and social relationships. The flip side is that extreme training and singular focus on a sport can lead to stress on the developing musculo-skeletal system, a pressure to succeed at all costs, reduced fun, burnout and sometimes social isolation. The dilemma we are beginning to scratch the surface of is does single sport specialization enhance the likelihood of getting to an elite level and does it increase the risk of injury? There is a growing sense in the medical community that SSS raises injury risk without enhancing progression to a higher level. (more…)
Author Interviews, ENT, JAMA, Johns Hopkins, Surgical Research / 16.03.2017

MedicalResearch.com Interview with: Lisa E. Ishii, MD, MHS Associate Professor of Otolaryngology - Head and Neck Surgery John Hopkins Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: There was a gap in our knowledge about what the average lay person thought about the impact of a facelift. We had information about what experts in the field like Dr. Swail thought, and some about what patients themselves thought, but nothing about lay people. Patients who choose to have a facelift are typically concerned about the opinions of: 1) Themselves when they look in the mirror, and 2) Laypeople they encounter socially in society. Our study showed for the first time that laypeople find people who have had a facelift to appear more attractive, more youthful, healthier and more successful than they were before their facelift. (more…)
Author Interviews, NYU, Orthopedics / 16.03.2017

MedicalResearch.com Interview with: Dr Aaron J. Buckland Spinal and scoliosis surgeon and Assistant professor Orthopedic surgery NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: For decades, surgeons performing hip replacements have placed the acetabular component adjacent to the pelvis in a “safe zone” which has been shown to reduce dislocation risk. However, beginning in residency, I would notice that several of my patients with spinal deformities or lumbar fusions, would experience dislocations despite the safe zone placement of these implants. Our initial research demonstrated that there was an increased dislocation risk in patients with lumbar fusions, particularly if they underwent spinal realignment. We investigated this phenomenon further by retrospectively reviewing 107 patients who met the criteria for sagittal spinal deformity, including 139 hip replacements collectively. (more…)
Author Interviews, Journal Clinical Oncology, Prostate Cancer, Radiation Therapy / 16.03.2017

MedicalResearch.com Interview with: Charles N Catton, MD, FRCPC Cancer Clinical Research Unit (CCRU) Princess Margaret Cancer Centre UHN  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prostate cancer is a very common malignancy which is frequently treated with external beam radiotherapy. A typical standard treatment course can extend over 7.5-8.5 weeks. The introduction of high-precision radiotherapy treatment techniques provided the opportunity to compress treatment courses by delivering fewer, but more intensive daily treatments. The concerns with giving fewer and larger daily treatments (hypofractionation) is that toxicity may increase and that cancer control may become worse. This international randomized trial enrolled 1206 men with intermediate risk prostate cancer and compared a standard 8 week course of external beam radiation treatment with a novel hypofractionated treatment course that was given over 4 weeks. Cancer control as measured by PSA control and clinical evidence of failure, bowel and bladder toxicity and quality of life were compared. At a median follow-up of 6 years the hypofractionated regimen was found to be non-inferior to the standard regimen for cancer control. There was no difference early or late bladder toxicity between the two treatments. There was slightly worse early bowel toxicity during and immediately after treatment with the hypofractionated regimen, but there was actually slightly less long-term bowel toxicity with this same regimen. (more…)
Author Interviews, Johns Hopkins, OBGYNE, Pediatrics / 16.03.2017

MedicalResearch.com Interview with: Krishna K. Upadhya, M.D., M.P.H. Division of General Pediatrics & Adolescent Medicine Department of Pediatrics Johns Hopkins University School of Medicine Baltimore, MD 21287 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study reviewed medical literature to examine the question of whether minor teens should be treated differently from older women with regard to a future over the counter oral contraceptive product.  Our analysis found that oral contraceptive pills are safe and effective for teens and there is no scientific rationale to restrict access to a future oral contraceptive pill based on age. (more…)
Author Interviews, Breast Cancer, Cancer Research, Genetic Research, Race/Ethnic Diversity, Yale / 16.03.2017

MedicalResearch.com Interview with: Cary P. Gross, MD Section of General Internal Medicine Yale University School of Medicine New Haven, CT MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior work has demonstrated racial and socioeconomic disparities in breast cancer diagnosis, treatment, and outcomes.  As the oncology field has progressed over the past decade, the use of genetic testing to guide treatment decisions is one of the most exciting new developments. Our team was concerned that these new gene tests, which can offer important benefits, may have the potential to exacerbate disparities further.  That is, if there is unequal access to gene testing among patients for whom it is recommended, then our progress against cancer will not be equitably shared among people of all races and ethnicities. (more…)
ASCO, Author Interviews, Boehringer Ingelheim, Journal Clinical Oncology, NYU, Prostate Cancer, Testosterone / 16.03.2017

MedicalResearch.com Interview with: Dr. Stacy Loeb MD Msc Assistant Professor of Urology and Population Health New York University Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The association between exposure to testosterone replacement therapy and prostate cancer risk is controversial.  The purpose of our study was to examine this issue using national registries from Sweden, with complete records on prescription medications and prostate cancer diagnoses.  Overall, we found no association between testosterone use and overall prostate cancer risk. There was an early increase in favorable cancers which is likely due to a detection bias, but long-term users actually had a significantly reduced risk of aggressive disease. (more…)
Author Interviews, Diabetes, Gender Differences, Lipids / 16.03.2017

MedicalResearch.com Interview with: Dr Mark Jones, Senior Lecturer Faculty of Medicine and Biomedical Sciences, School of Public Health The University of Queensland MedicalResearch.com: What is the background for this study? Response: Multiple clinical trials have shown statins reduce LDL cholesterol, cardiovascular events, and all-cause mortality. However statins are also associated with adverse events, including type 2 diabetes. There have been very few older women included in statin trials hence effects of the drug in this population are somewhat uncertain. Also, more generally, results from clinical trials may not translate well into clinical practice. (more…)
Author Interviews, Columbia, Global Health, Schizophrenia / 16.03.2017

MedicalResearch.com Interview with: L. H. Lumey, MD, PhD Professor of Epidemiology Mailman School of Public Health Columbia University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Chinese Great Leap Forward Famine in 1959-1961 is the largest famine in human history. Earlier studies have reported that overweight, type 2 diabetes, hyperglycemia, the metabolic syndrome and schizophrenia were more common among adults who were exposed to the famine. Our re-analysis of all previous studies shows no increases in diabetes, high blood pressure and other chronic conditions among famine births except for schizophrenia. (more…)
Author Interviews, Diabetes, Kidney Disease, Pediatrics / 16.03.2017

MedicalResearch.com Interview with: Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada MedicalResearch.com: What is the background for this study? Response: I decided to conduct this study after observing a few cases of severe acute kidney injury (AKI) in children hospitalized with diabetic ketoacidosis (DKA) (with two patients requiring dialysis) while on call in the 18 months prior to initiating the study. While caring for these patients, I scanned the literature and realized that aside from 2 published case reports, there had been no large-scale systematic studies assessing AKI in children with DKA. It immediately became apparent to me that managing patients with AKI and DKA was more challenging. On presentation to hospital, many of these children with DKA present quite volume depleted but fluid management is conservative because of the risk for cerebral edema. One of the most important management strategies for acute kidney injury in patients with DKA is early detection and correcting volume depletion in a timely manner to prevent further injury. I discussed my observations and these clinical cases with pediatric nephrologist and co-investigator Dr. Cherry Mammen, a pediatric AKI expert, and he confirmed my initial literature review findings. Thus, we decided to conduct this study to better understand the scope of the problem and any associated risk factors. (more…)
Author Interviews, Brain Injury, Exercise - Fitness, Gender Differences, Mental Health Research / 16.03.2017

MedicalResearch.com Interview with: Wellington K. Hsu, MD Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery Associate Professor of Orthopaedic Surgery Northwestern University Chicago, IL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Concussions remains a significant problem in youth sports. The recent enactment of Traumatic brain injury laws have certainly heightened awareness regarding this problem. Our study looked at publicly available data regarding diagnosis of concussion in high school athletes. We found that females are more likely to be diagnosed with a concussion than males. We also concluded that girl soccer players and boys football players are at highest risk for a diagnosis of concussion. Since the neck meant of the Traumatic brain injury state laws, the diagnosis of concussion in this patient group increased significantly past decade. (more…)
Author Interviews, CDC, Dermatology, Education, Environmental Risks, JAMA / 16.03.2017

MedicalResearch.com Interview with: Sherry Everett Jones PhD, MPH, JD, FASHA Health Scientist, Division of Adolescent School Health Centers for Disease Control & Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: Skin cancer is the most common form of cancer in the United States. Results from the School Health Policies and Practices Study found that in 2014, most schools lacked practices that could protect children and adolescents from sun exposure while at school. Positive attitudes and beliefs about sun safety behavior, which would make such behavior more likely, can be promoted and supported by school system policies and practices. (more…)
Author Interviews, Vitamin D / 15.03.2017

MedicalResearch.com Interview with: Dr. Sheila Sprague, PhD Assistant Professor, Research Methodologist McMaster University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous research has found that daily administration of vitamin D is important for maintaining bone homeostasis. There has been an increased interest among the orthopaedic community regarding vitamin D supplementation and patient outcomes following fractures. Using data from the FAITH trial (NCT01908751), a multicenter randomized controlled trial that compared cancellous screws versus sliding hip screws in patients over the age of 50 with femoral neck fractures, we: 1) determined the proportion of patients consistently taking vitamin D following hip fracture surgery and 2) determined if supplementation was associated with improved health related quality of life and reduced re-operation. Patients enrolled in the FAITH trial were recruited from 81 clinical sites in 8 countries over a 6-year span. We asked a subset of them about vitamin D supplementation and categorized them as consistent users, inconsistent users, or non-users. The final analysis included 573 patients and we found that a surprisingly low proportion of elderly hip fracture patients are consistently taking vitamin D (18.7% of patients reported never taking vitamin D, 35.6% reported inconsistent use, and 45.7% reported consistent use). We also found that vitamin D was associated with a statistically (p=0.033), but not clinically, significant improvement in health-related quality of life following a hip fracture. Lastly, supplementation was discovered to not be associated with reduced re-operation (p=0.386). (more…)
Author Interviews, General Medicine, Orthopedics / 15.03.2017

MedicalResearch.com Interview with: Darwin Chen, MD Assistant Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Total hip and knee replacement surgery are among the most commonly performed orthopaedic procedures today. Although success rates are high, complications can occur and some may be preventable. The goal of our research was to assess the impact of gender on complications within the first 30 days after hip and knee replacement. (more…)
Author Interviews, Brigham & Women's - Harvard / 15.03.2017

MedicalResearch.com Interview with: Kimberly Gold Blumenthal, M.D Assistant Professor of Medicine Massachusetts General Hospital MedicalResearch.com: What is the background for this study? Response: Over-reported penicillin allergies negatively impact patient care, as alternative drugs that are often used can be less effective, more toxic, more broad-spectrum (killing all of the good bacteria and leaving patients increasingly vulnerable to C.diff colitis), and more expensive. Most hospitalized patients who have a recorded penicillin allergy are not actually allergic. This has drawn attention by national organizations such as the CDC, National Quality Forum, and both allergy and infectious diseases professional societies. The message is clear: Address reported penicillin allergies in some way to improve care. (more…)
Author Interviews, Depression, Mayo Clinic / 15.03.2017

MedicalResearch.com Interview with: Hilal Maradit Kremers, M.D. M.Sc.  Associate Professor of Epidemiology Mayo Clinic College of Medicine  MedicalResearch.com: What is the background for this study? Response: Depression and mood disorders are common comorbidities in patients undergoing total hip and total knee arthroplasty.  Based on previous research, there is evidence to suggest presence of depression in arthroplasty patients is associated with worse functional and clinical outcomes, such as complications, readmissions and mortality.  Although the mechanisms are poorly understood, it is important to identify strategies to effectively manage perioperative depression in an effort to improve arthroplasty outcomes.  One potential strategy is effective medical treatment of underlying depression which can potentially improve depression symptoms, thereby surgical outcomes. (more…)
Author Interviews, Endocrinology, Fertility / 15.03.2017

MedicalResearch.com Interview with: Matthias Straub Senior Director, Clinical Development Abbott MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Lotus I study provides clinical evidence that oral dydrogesterone is a treatment option for women who undergo in vitro fertilization (IVF) treatment. The current standard of care for IVF globally is micronized vaginal progesterone (MPV), which is administered vaginally. The Lotus I study concludes that oral dydrogesterone is similarly well-tolerated and efficacious compared to MVP, while being easier to administer than MVP. (more…)
Anesthesiology, Author Interviews, BMJ, Opiods, Stanford / 15.03.2017

MedicalResearch.com Interview with: Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%. (more…)
Author Interviews, Dermatology, Pediatrics, Smoking, Tobacco Research / 15.03.2017

MedicalResearch.com Interview with: Dr. Saskia Trump PhD Helmholtz-Centre for Environmental Research – UFZ Department of Environmental Immunology Leipzig, Germany MedicalResearch.com: What is the background for this study? Response: Environmental chemicals have long been discussed to contribute to the exacerbation or even the development of allergic diseases. In our study we were particularly interested in the effect of tobacco smoke exposure, which is the main source for indoor benzene exposure, on regulatory T cell (Treg) function and its relation to the development of childhood atopic dermatitis (AD). Tregs play a critical in controlling T effector cell activity by avoiding overexpression. A deficiency in this T cell subset increases the risk for allergic inflammation. We have previously described that exposure to tobacco smoke during pregnancy can decrease the number of regulatory T cells (Treg) in the cord blood and predispose the child to the development of AD (1). In this subsequent study we were interested in the underlying mechanism involved. Benzene itself is not considered to be toxic, however its metabolization leads to the formation of highly reactive molecules. In humans for example the metabolite 1,4-benzochinone (1,4-BQ) can be found in the blood as a consequence of benzene exposure. To further assess the effect of benzene on Treg and the development of AD we combined in vitro studies, evaluating the impact of 1,4-BQ on human expanded Treg, with data from our prospective mother-child cohort LINA. The LINA study, recruited in Leipzig, Germany, is a longitudinal evaluation of mother-child pairs with respect to lifestyle and environmental factors that might contribute to disease development in the child. Based on this deeply phenotyped cohort we were able to translate our in vitro findings to the in vivo scenario. (more…)
Author Interviews, Heart Disease / 15.03.2017

MedicalResearch.com Interview with: Simon Graff MD Department of Public Health Research Unit for General Practice Aarhus University Aarhus C, Denmark  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The presented study is a continuation of our interest in the role of stress and the possible causes of atrial fibrillation.  We published a study that showed that spousal bereavement were followed by a transiently increased risk of new onset of atrial fibrillation. With spousal bereavement being one of the most stressful life-event, we wanted to know whether minor and differentiated stress exposures had an effect as well. Therefore we used register based data on perceived stress as a new measure of exposure. (more…)
Author Interviews, Genetic Research, Social Issues / 15.03.2017

MedicalResearch.com Interview with: Emily Rauscher PhD Assistant Professor Department of Sociology University of Kansas   MedicalResearch.com: What is the background for this study? Response: A lot of previous research has identified genotypes that increase sensitivity to context.  Much of this research, however, looks at particular aspects of health and is not able to address the methodological challenges of investigating gene-environment interactions.  To gain a better sense of the potential outcomes that may be susceptible to gene-environment interactions, I examine financial standing in young adulthood.  Testing this type of interaction is challenging because genotype and social environment are not randomly distributed throughout the population. Given this non-random distribution, unobserved confounders (such as parental behaviors, education, ethnicity, or social capital) could influence both parent and child financial standing. (more…)
AHRQ, Author Interviews, Cost of Health Care / 15.03.2017

MedicalResearch.com Interview with: Anita Soni, PhD, MBA Survey Analyst/Statistician Agency for Healthcare Research and Quality Rockville, MD MedicalResearch.com: What is the background for this study? Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data on the demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment of Americans. This brief focuses on adults 18 and older who received some medical care in 2014. Persons who have multiple chronic conditions—those who were treated for two or more conditions considered to be chronic during 2014 -- are compared to those who, while they had medical care, reported use associated with only one or no chronic conditions.  (more…)
Author Interviews, Gender Differences, JAMA / 15.03.2017

MedicalResearch.com Interview with: David A. Klein, MD, MPH Uniformed Services University of the Health Sciences (USUHS) Bethesda, Maryland Fort Belvoir Community Hospital (FBCH), Fort Belvoir, Virginia MedicalResearch.com: What is the background for this study? What are the main findings? Response: In June 2016, the ban was lifted on transgender personnel serving openly in the military. Research suggests approximately 200 active-duty service members may request a gender transition annually. The purpose of this study is to determine military family physician readiness to care for such patients. The majority (74 percent) of physicians have not received any formal education on the treatment of patients with gender dysphoria. Almost half of surveyed physicians are willing to prescribe cross-hormone therapy; of these, 99 percent report the need for additional training and/or assistance to do so. 53 report an unwillingness to prescribe even with additional education and assistance. (more…)
Aging, Author Interviews, Geriatrics, Karolinski Institute, Social Issues / 14.03.2017

MedicalResearch.com Interview with: Dr. Karin Modig, PhD Institute of Environmental Medicine,Epidemiology Karolinska Institute MedicalResearch.com: What is the background for this study? Response: The background to the study was that even though it is established that parents live longer than non-parents the underlying mechanisms are not clear. And it was not known how the association changed with the age of the parents. We hypothesize that if social support is one mechanism – the association between having children and the death risk of parents-non-parents would increase with age of the parents, when health starts to deteriorate and the need of support increases. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Microbiome, Transplantation / 14.03.2017

MedicalResearch.com Interview with: Dr. H. L. DuPont MD Director, Center for Infectious Diseases, UTHealth School of Public Health Mary W. Kelsey Chair in the Medical Sciences, McGovern Medical School at UTHealth Professor, Department of Epidemiology, Human Genetics and Environmental Sciences UTHealth School of Public Health Houston, TX 77030 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many diseases and disorders are associated with “dysbiosis,” where the intestinal microbiota diversity is reduced. This contributes to disease and to the acquisition of antibiotic resistance. Fecal microbiota transplantation (FMT) is successful in conditions with pure dysbiosis (e.g. C diff infection) and a single dose of FMT is curative in most cases. (more…)