MedicalResearch.com Interview with: Arnon D. Cohen, MD, MPH, PhD Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv Siaal Research...
MedicalResearch.com Interview with: Dr. Jake Liang MD Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of...
MedicalResearch.com Interview with:
Brian Montague, DO MS MPH
Assistant Professor of Medicine and of Health Services, Policy and Practice
Division of Infectious Diseases
Brown University / The Miriam Hospital
Medical Research: What is the background for this study?
Dr. Montague: Hepatitis C is in an important public health problem affecting 4-5 million persons in the US alone. Given the risk of infection associated with drug use, the prevalence of hepatitis C in corrections has been significantly higher than in the general population.
Prior to 2013, the available treatment options were both expensive and of significant toxicity and limited efficacy. Uptake to these therapies were low. Starting in 2013, new therapeutics options offering shorter course treatments and efficacies greater than 90% became available. These therapies offer new possibilities to increase uptake to treatment, however the cost of the therapies has made rapid scale up of treatment impossible. Given the risk of serious harms to patients with advanced liver disease if not treated, insurance has begun to approve these new therapies for patients with more advanced disease.
Departments of corrections are obliged to provide the same standard of care to persons in corrections as they would receive in the community. Unlike Medicaid and community insurance providers, correctional systems worker under a fixed budget. Large increases in expenditures for treatment of hepatitis C without establishing mechanisms to offset these costs risks compromising other essential programs and functions in the correctional health system.
Medical Research: What are the main findings?
Dr. Montague: In a cross-sectional analysis we estimated the burden of hepatitis C within the department of corrections. At the time of the study, an estimated 836 persons have chronic hepatitis C. Among these an estimated 119 have advanced liver disease, stage 3 or 4 fibrosis, and would meet criteria for treatment under most insurance programs. Even a conservative approach of restricting treatment in corrections to those with stage 3 or 4 fibrosis would incur costs of over $15 million, which is greater than 6 times the current correctional health budget for pharmaceuticals and 76% of the overall correctional health budget.
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MedicalResearch.com Interview with:
Gabriel Brooks, MD
Gastrointestinal Cancer Center
Dana-Farber Cancer Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Brooks: The background for our study is that hospitalizations in patients with cancer are common, costly, and distressing to patients. Acute hospital care is the single largest expenditure category in cancer care, accounting for substantially greater costs than even chemotherapy. However, patients generally wish to avoid hospitalization, and they certainly want to avoid complications of treatment that can lead to hospitalization. For these reasons, we sought to identify the extent to which hospitalizations are perceived as potentially avoidable by clinicians who are directly involved in patient care.
We interviewed three physicians for each of 103 patients with cancer who experienced a hospitalization. For 24 patients (23%) two or more of the three physicians agreed that hospitalization had been potentially avoidable.
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MedicalResearch.com Interview with:
Dr. Agnieszka Witkiewicz MD
Associate Professor of Pathology
Harold C. Simmons Comprehensive Cancer Center
UT Southwestern
MedicalResearch: What is the background for this study?
Dr. Witkiewicz: Pancreatic ductal adenocarcinoma (PDA) has a dismal prognosis, with a five year survival rate of approximately 6%. This poor outcome is related to multiple factors, including the relatively late stage of diagnosis, many patients presenting with unresectable disease, and therapy recalcitrance resulting in disease recurrence in spite of operable disease and systemic therapy. Thus far, insights into how to target the treatment of Pancreatic ductal adenocarcinoma have remained unclear in spite of prior sequencing efforts.
MedicalResearch: What are the main findings?
Dr. Witkiewicz: The underlying critical finding of the study was that Pancreatic ductal adenocarcinoma is genetically diverse and that, in principle, this diversity could be exploited for the treatment of disease. Specifically, many cases harbored deregulation in pathways that are the target for drug development. For example, we identified cases that were driven by BRAF V600E and that were sensitive to the FDA approved drug Vemurafenib. Similarly, multiple cases harbored defects in DNA repair processes that impart sensitivity to select chemotherapeutic agents and PARP inhibitors. Common pathway deregulation was observed in reference to beta-catenin, notch, hedgehog, chromatin remodeling, and cell cycle regulatory pathways that are all targets for therapeutic intervention.
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MedicalResearch.com Interview with:
Nancy E. Thomas, MD, PhD
Department of Dermatology
University of North Carolina
MedicalResearch: What is the background for this study?
Dr. Thomas: BRAF and NRAS mutations found in melanomas are important for tumor initiation and maintenance. There are drugs that target BRAF mutations or the pathway that are approved for BRAF-mutant metastatic melanoma and help improve survival. However, it remains unknown whether these mutations in primary melanoma are markers for melanomas with a worse prognosis.
MedicalResearch: What are the main findings?
Dr. Thomas:
MedicalResearch.com Interview with:
Catherine M. Stein, PhD
Associate professor of epidemiology and biostatistics
Case Western Reserve
Dr. Stein is a leader of international research on resistance to Mycobacterium tuberculosis (MTB) infection
MedicalResearch: What is the background for this study? What do you hope to learn?
Dr. Stein: In a 2002 study, we began to clinically characterize people who lived in households where there were infectious tuberculosis cases. We followed them for a two-year period and noticed that approximately 9 percent of household members were resistant to Mycobacterium tuberculosis (MTB) infection, even though they were highly exposed to the organism. This finding surprised us because the prevailing notion had been that everyone living in TB-endemic settings or living with someone who has TB would become infected eventually. After several years of study, we found a substantial number of these people who do not have any evidence for MTB infection, so we wanted to do studies to learn if we could figure out why.
MedicalResearch: Is MTB resistance a new phenomenon? Do MTB resisters react to a tuberculin purified protein derivative (PPD) or a gold immunoassay but don’t develop clinical disease?
Dr. Stein: We don’t have any reason to believe that MTB-infection resistance is a new phenomenon. It’s just that no one has thought to look for it before. In terms of the PPD or gold immunoassays, MTB-resisters produce a negative response to both tests. The way gold immunoassays are done, three tubes are collected. One is a control. Another is a test for reacting to MTB. Still another is a positive control to make sure immune cells are alive. The MTB-resisters show a response to that positive control but not to MTB. It’s not that these patients don’t have an immune response. It’s just that they have no response to MTB, which means they have no previous exposure to cause their T-cells to make that response.
MedicalResearch: Are MTB-resisters immune to the newer multi-drug resistant strains of TB?
Dr. Stein: Resistance to MTB infection is independent of the drug resistance pattern of the bacteria. Thus we would expect them to resist multidrug resistant (MDR)-TB as well. There is no strong evidence that MDR-TB is more aggressive or virulent.
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MedicalResearch.com Interview with:
Mohamed Kabbaj, PHD
Professor of Biomedical Sciences & Neurosciences
College of Medicine
Florida State University
Medical Research: What is the background for this study? What are the main findings?
Dr. Kabbaj: While anxiety and depressive disorders a major public health concern worldwide, so too are the pervasive sex differences that exist within these pathologies. Fluctuations in the predominant female reproductive hormones, estradiol and progesterone, are thought to be a major contributor to the higher prevalence of anxiety and depression in women compared to men. However, many studies in humans and rodents alike have demonstrated that testosterone, the primary male sex hormone, also influences affective status and may yield protective benefits against the development of mood-related disturbances. Indeed, hypogonadal males with low testosterone levels experience increased rates of anxiety and depressive symptoms. In many of these cases, testosterone replacement alone or in addition to antidepressant medication have been shown to effectively improve mood. How this hormone acts in the brain to exert its beneficial effects, however, is much less clear. Interestingly, it is well-known that many of testosterone’s effects in the brain occur via its conversion to estrogen by the enzyme aromatase. What remained unclear was whether or not this conversion to estrogen was critical for testosterone’s protective anxiolytic and antidepressant effects—so Nicole Carrier and Samantha Saland from Dr. Kabbaj’s lab aimed to figure out just that.
To do this, Carrier and Saland targeted an area of the hippocampus in the brain involved in mood regulation where testosterone is known to act to carry out some of its anxiolytic and antidepressant effects in male rats. Here, they inhibited the enzyme responsible for the conversion of testosterone into estrogen and investigated performance in mood-related behaviors. In doing so, they discovered that testosterone’s anxiolytic- and antidepressant-like effects were lost unless this hormone was first converted into estrogen. Importantly, they also found that continuous testosterone and estrogen treatments had very similar effects on the expression of genes within this brain region that are highly implicated in the regulation of mood as well as antidepressant treatments.
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MedicalResearch.com Interview with:
Haichang Xin, PhD
Department of Health Care Organization and policy
School of Public Health
University of Alabama at Birmingham
MedicalResearch: What is the background for this study?
Dr. Xin: Research suggests that nearly half of all emergency department (ED) visits in the United States are for nonurgent conditions, leading to billions of dollars in potentially avoidable spending annually. A well-functioning primary care system has the capacity to provide timely, adequate, and effective care for patients in order to avoid nonurgent emergency department use and care costs.
This study examined how deficiencies in ambulatory care were associated with nonurgent emergency department care costs nationwide, and to what extent these costs can be reduced if deficiencies in primary care systems could be improved.
MedicalResearch: What are the main findings?
Dr. Xin: Patient perceived poor and intermediate levels of primary care quality had higher odds of nonurgent emergency department care costs (OR=2.22, p=0.035, and OR=2.05, p=0.011, respectively) compared to high quality care, with a marginal effect (at means) of 13.0% and 11.5% higher predicted probability of nonurgent ED care costs.
These ambulatory care quality deficiency related costs amounted up to $229 million for private plans (95% CI: $100 million, $358 million), $58.5 million for public plans (95% CI: $33.9 million, $83.1 million), and an overall of $379 million (95% CI: $229 million, $529 million) at the national level.
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MedicalResearch.com Interview with:
Carolina P B Gracitelli, M.D.
Ophthalmology - PhD Candidate/ Research Fellow
University of California San Diego - Hamilton Glaucoma Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Gracitelli: Of all the diseases that can lead to blindness, glaucoma is one of the most important diseases; it affects more than 70 million people worldwide, of whom approximately 10 % are bilaterally blind. Different studies have reported that the damage caused by glaucomatous disease lead to retinal ganglion cell (RGC) loss and consequently loss of intrinsically photosensitive retinal ganglion cells (ipRGCs), which is a subtype of retinal ganglion cell. This subpopulation of RGC is clearly related with non-image-forming visual function such as photic synchronization of circadian rhythms and the pupillary light reflex. However, the true impact of glaucoma on sleep quality, sleep disturbance or circadian rhythm was until nowadays controversial.
The main clinical finding of our study was that glaucoma leads to retinal ganglion cell death, including ipRGC death. These cells are connected to several non-image-forming functions, including circadian photoentrainment and pupillary reflexes. Therefore, the image-forming and non-image-forming visual systems are associated with glaucoma. Circadian function has not been well investigated in clinical daily practice, but it can interfere with the quality of life of these patients. Concerns about sleep disturbances in glaucoma patients should be incorporated into clinical evaluations.
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MedicalResearch.com Interview with:
Kira S. Birditt, Ph.D.
Research Associate Professor
Life Course Development Program
The Institute for Social Research
University of Michigan Ann Arbor, MI
Medical Research: What is the background for this study? What are the main findings?
Dr. Birditt: We know that negative marital quality (e.g., conflict, irritation) has important implications for physical health but the mechanisms that account for these links are still unclear. This study explored links between negative marital quality (e.g., criticism, demands), stress (long term chronic stresses) and blood pressure among older married couples in a large longitudinal nationally representative sample of couples in the U.S.. We found that husbands had higher blood pressure when wives reported greater stress and that this link was even greater when husbands felt more negative about the relationship. In addition, negative marital quality experienced by only one member of the couple was not associated with blood pressure but when both members of the couple reported higher negative marital quality they had higher blood pressure. (more…)
MedicalResearch.com Interview with:
Jeanne M. Meck, PhD FACMG
Director, Prenatal Diagnosis & Cytogenomic
GeneDx
Gaithersburg, MD 20877
Medical Research: What is the background for this study?
Dr. Meck: Non-invasive prenatal screening (NIPS) for fetal aneuploidy is a new test which requires only a blood sample from the pregnant mother to provide a risk estimate of whether or not her fetus has a chromosomal aneuploidy such as trisomy 21 (Down syndrome), trisomies 13 or 18, or a sex chromosome abnormality. This testing relies on the fact that circulating maternal blood contains cell free fetal DNA. Published studies have reported very high specificities and sensitivities. However, the more important question is what is the positive predictive value (PPV= #true positive results/#true positive + false positive results) since it answers the question of interest to physicians and patients: “Given an Non-invasive prenatal screening result that shows a high risk for a given fetal aneuploidy, what is the chance that the fetus is affected?” We attempted to answer this question by looking at the results of fetal chromosome analyses on chorionic villus samples (CVS) or amniotic fluid that were referred to our cytogenetics laboratories after Non-invasive prenatal screening in order to see if NIPS correctly predicted the fetal karyotype.
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MedicalResearch.com Interview with:
Stacie B. Dusetzina PhD
Assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health
University of North Carolina at Chapel Hill
Member of the Lineberger Comprehensive Cancer Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Dusetzina: Charges for health services — the amounts providers request before payments are negotiated — have not been widely known for services delivered in physicians’ offices. Charges can be considered the maximum amount that would be paid by a person without insurance who does not or is unable to negotiate for a lower price. In this study we used recently released data from the Medicare Provider Utilization and Payment Public Use File and other sources to measure what physicians charged for chemotherapy drugs delivered intravenously in 2012 and the amounts reimbursed by Medicare and private health plans for the same services.
We found that uninsured cancer patients may be asked to pay from 2 to 43 times what Medicare pays for chemotherapy drugs. Medicare and insurers don’t pay the sticker price of health care. They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price. On average, Medicare paid approximately 40 percent of the charged amounts for chemotherapy drugs. Private insurers paid nearly 57 percent of the charged amounts on average. We also looked at what cancer patients were asked to pay for an office visit. Uninsured patients may be asked to pay from $129 to $391, depending on the complexity of the visit. Medicare paid between $65 and $188 and private insurance paid between $78 and $246 for the same visits.
(more…)MedicalResearch.com Interview with: Cary P. Gross MD Professor of General Medicine, of Epidemiology (Chronic Diseases) and of Faculty of Arts and Sciences Yale...
MedicalResearch.com Interview with:
Emily Finlayson, MD, MS
Department of Surgery, Division of General Surgery
Department of Medicine, Division of Geriatrics
Philip R Lee Institute for Health Policy
University of California, San Francisco
Director, UCSF Center for Surgery in Older Adults
Medical Research: What is the background for this study? What are the main findings?
Dr. Finlayson: In general, the goal of lower extremity revascularization is to preserve the leg so that patients can maintain the ability to ambulate and maintain functional independence. We evaluated the results of this operation in older nursing home residents in the United States. We found that over the 3 year study period, over 10,000 nursing home residents underwent this procedure. Most of them were functionally dependent before surgery, 3/4 were unable to walk, and over half had dementia.
After 1 year, half of the residents had died. Among residents who could not walk before surgery, 89% were dead or non ambulatory 1 year after surgery.
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MedicalResearch.com Interview with:
Thomas Karakolis
Department of Kinesiology
University of Waterloo
Waterloo, Ontario, Canada
Medical Research: What is the background for this study? What are the main findings?
Response: Major League Baseball (MLB) pitchers have an injury rate approaching 1 in 4, depending on the study you look at. As an occupational injury rate, this number is extremely high. In fact, I think you would be hard pressed to find another industry where the injury rate is that high.
One way that coaches and managers in MLB are trying to lower the
injury rate is to restrict the total 'workload' on pitchers per
season. Particularly in young pitchers, many MLB organizations
restrict the number of innings a pitcher can pitch based upon the
number of innings they pitched the previous year. Essentially, they
are using innings pitched as a surrogate for workload.
If this is an effective strategy, you would expect a correlation
between the increase in number of innings pitched between successive
seasons and future injury. Our study found that no such correlation
exists. Innings pitched does not appear to be a sensitive enough
measure to asses the true workload a pitcher experiences throughout
the season.
(more…)MedicalResearch.com Interview with: Dr. Joseph Bosco MD III Orthopedic Surgery The New York University Langone Medical Center Medical Research: What is the background for...
MedicalResearch.com Interview with:
Kimberly Gudzune, MD, MPH
Assistant Professor; The Johns Hopkins University School of Medicine
Core Faculty; Welch Center for Prevention, Epidemiology, and Clinical Research
The Johns Hopkins Digestive Weight Loss Center
Medical Research: What is the background for this study? What are the main findings?
Dr.Gudzune: Changes in healthcare policy may encourage healthcare providers to screen their patients for obesity, so it is critical to then have a weight management plan if obesity is identified. Recent guidelines recommend that clinicians consider referring patients to high intensity weight loss programs. Commercial weight loss programs may be one of the options available, so providers need to know which programs help people lose weight and keep it off.
We found that only 11 out of 32 programs that we looked at had rigorous studies reporting on weight loss, which means that we do not know whether most programs work. Several well-known commercial programs have been scientifically tested and two programs, Weight Watchers and Jenny Craig, achieved significant weight loss that was sustained 12 months later.
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MedicalResearch.com Interview with:
Dr. Reshma Jagsi MD, DPhil
Associate Professor and Deputy Chair for Faculty and Financial Operations in the Department of Radiation Oncology at the University of Michigan Health System
Research Investigator at the Center for Bioethics and Social Sciences in Medicine
University of Michigan
Medical Research: What is the background for this study? What are the main findings?
Dr. Jagsi: We surveyed women diagnosed with breast cancer and found that many women were concerned about the genetic risk of developing other cancers themselves or of a loved one developing cancer. Overall, 35 percent of the women we studied expressed a strong desire for genetic testing, but 43 percent of those did not have a relevant discussion with a health care professional. In addition, minority patients with a strong desire for testing were less likely to discuss it with a professional, even though studies show that minority patients are not at lower risk for these mutations.
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MedicalResearch.com Interview with:
Anthony Delitto, PT, Ph.D, FAPTA
Professor and Chair
Department of Physical Therapy
Associate Dean for Research, SHRS
School of Health and Rehabilitation Sciences
University of Pittsburgh
Medical Research: What is the background for this study? What are the main findings?
Dr. Delitto: I work with a team, many of whom were authors on the paper, and we see a lot of patients with lumbar spinal stenosis. Some of them did very well with Physical Therapy and avoided surgery. Some people didn’t do well and we ended up having surgery. We really wanted to do a study that compared, in a randomized format, doing surgery vs. a non-surgical approach to lumbar spinal stenosis. The idea we had was to really put the two approaches head to head – a randomized trial of surgery vs. physical therapy for people with lumbar spinal stenosis. We decided only to recruit patients after they had consented to surgery in order to avoid the pitfalls of previous studies where people crossed over after being assigned to a group, for example, being assigned to surgery and then deciding against having surgery.
Medical Research: What should clinicians and patients take away from your report?
Dr. Delitto: Probably the biggest point to put across to physicians, patients and practitioners, one of the things we realized was: patients don’t exhaust all of their non-surgical options before they consent to surgery. And physical therapy is one of the non-surgical options. The obvious finding is, when you compare the two groups, they seem to do the same. The results were equivalent at two years. Now, embedded in that, there are patients who did well in surgery, and patients who failed in surgery. There are patients who did well in Physical Therapy, and there are patients who failed with PT. But when we looked across the board at all of those groups, their success and failure rates were about the same. So it tells us that for the most part there were equivalent outcomes at two years.
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MedicalResearch.com Interview with:
Holly Gooding, MD, MS
Harvard T.H. Chan School of Public Health
Instructor in Pediatrics at Harvard Medical School
Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital Division of General Internal Medicine
Brigham and Women’s Hospital Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Gooding: As an adolescent medicine physician, I primarily care for patients between the ages of 12 and 30, although I first trained in internal medicine. One of the things I noticed when I started working with this age group is that pediatric and adult guidelines differ for many conditions. Cholesterol treatment is one condition that comes up frequently, because the NHLBI and the AAP recommend screening youth ages 17 to 21 for cholesterol problems.
The study team and I set out to discover the proportion of American youth ages 17 to 21 who would meet criteria for pharmacologic treatment of abnormal cholesterol levels if clinicians applied the pediatric versus the adult guidelines. We found that 2.6% of young people ages 17 to 21 would qualify for pharmacologic treatment of abnormal LDL cholesterol levels under the pediatric guidelines, but less than 1% would qualify under the adult guidelines. This translates to almost 500,000 youth qualifying for treatment under the pediatric guidelines, but only about 78,000 under the adult guidelines. Those who met pediatric criteria had lower LDL levels but higher proportions of high blood pressure, smoking, and obesity.
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MedicalResearch.com Interview with:
Prof. Chetna Malhotra M.B.B.S., M.D. M.P.H.
Lien Centre for Palliative Care
Duke-NUS Graduate Medical School Singapore, Singapore
Medical Research: What is the background for this study? What are the main findings?
Dr. Malhotra: Patients with advanced cancer often have to make difficult decisions, such as how much to spend on moderately life- extending treatments. This and other end-of-life decisions are also influenced by their informal caregivers. In this study, we aim to understand the relative value that advanced cancer patients and their caregivers place on various aspects of end-of-life care. We conducted a cross-sectional survey of 211 patients with stage IV cancer and their primary informal caregivers. Participants were asked to choose their most-preferred end-of-life scenarios out of a series of options that varied along key dimensions, including years of life remaining, degree of pain experienced, place of death, level of burden on caregivers, quality of healthcare experience, cost, and source of payment (cash, Medisave, or family members’ cash or Medisave). Using the results, we quantified patients and caregivers willingness to pay to improve their end of life experience. We found that the patients’ willingness to pay to extend their life by one year was valued at S$18,570, which is lower than their willingness to pay to avoid severe pain (S$22,199), or to die at home (S$31,256). Caregivers had a three-fold greater willingness to pay than patients to extend life by one year and for most of the other features considered. These results suggest that health insurers and physicians may be putting too much emphasis on life extending treatments for these patients. Further, there is a need to elicit patient preferences during treatment decision making as opposed to just relying on caregiver input.
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