Addiction, Author Interviews, Opiods, Pain Research / 23.05.2018

MedicalResearch.com Interview with: Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic. MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study? Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention. The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna. (more…)
Author Interviews, Cost of Health Care, End of Life Care, Geriatrics, JAMA, Medicare / 23.05.2018

MedicalResearch.com Interview with: William B Weeks, MD, PhD, MBA The Dartmouth Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for the study is that a common narrative is that end-of-life healthcare costs are driving overall healthcare cost growth.  Growth in end-of-life care has been shown, in research studies through the mid 2000’s, to be attributable to increasing intensity of care at the end-of-life (i.e., more hospitalizations and more use of ICUs). The main findings of our study are that indeed there have been substantial increases in per-capita end-of-life care costs within the Medicare fee-for-service population between 2004-2009, but those per-capita costs dropped pretty substantially between 2009-2014.  Further, the drop in per-capita costs attributable to Medicare patients who died (and were, therefore, at the end-of-life) accounts for much of the mitigation in cost growth that has been found since 2009 in the overall Medicare fee-for-service population. (more…)
Author Interviews, JAMA, NIH / 23.05.2018

MedicalResearch.com Interview with: Jennifer Villani, PhD, MPH Office of Disease Prevention National Institutes of Health MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The US Preventive Services Task Force (USPSTF) develops recommendations for the delivery of clinical preventive services based on the highest quality scientific evidence available. We performed a comprehensive assessment of the sources of funding for the research studies in this evidence base. The results showed that government agencies supported the most articles (56%), with the remaining support coming from nonprofits or universities (32%), and industry (17%). The National Institutes of Health was the single largest funder of research articles underlying the USPSTF recommendations.  (more…)
Asthma, Author Interviews, NEJM / 22.05.2018

MedicalResearch.com Interview with: Mario Castro, M.D., M.P.H. Alan A. and Edith L. Wolff Professor of Pulmonary and Critical Care Medicine, Professor of Medicine, Pediatrics, and Radiology Washington University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This is a confirmatory phase 3 pivotal study that assessed the efficacy and safety of dupilumab in a population of uncontrolled moderate to severe asthmatics. This was the largest phase 3 placebo controlled trial conducted in this population evaluating a biologic. It enrolled patients without any minimum requirement for any type of biomarker such as blood eosinophils. It clearly confirmed the efficacy of dupilumab in reducing severe asthma exacerbations, improving lung function, asthma control and quality of life in the overall population. It also showed that patients with evidence of type 2 inflammation (increased blood eosinophils or exhaled NO) had a greater magnitude of effect. (more…)
Addiction, Author Interviews, Opiods / 22.05.2018

MedicalResearch.com Interview with: Christopher J. Ruhm, PhD Frank Batten School of Leadership and Public Policy University of Virginia Charlottesville, VA MedicalResearch.com: What is the background for this study? What are the main findings? Response: I have been interested for some time in understanding the extent to which the rise in drug fatalities can explaining the rising mortality rates of midlife whites that have been experienced since the turn of the century. The primary findings are as follows:
  1. The rise in drug mortality is sufficiently large to explain the entire growth in mortality rates and years of potential life lost experienced by 22-56 year old non-Hispanic whites (NHW) from 1999-2015. This does not imply that there are not other sources of concern related to this decline in life expectancy but indicate a key role of drug deaths.
  2. The growth in drug deaths is particularly pronounced for males in their 20s and 30s, in contrast to some earlier research focusing on NHW in their 40s and 50s.
  3. Deaths involving illicit opioids are the primary driver for young NHW males, with more equal contributions of illicit and prescription opioids for some what older NHWs. These results also indicate that prior studies focusing on persons in their 40s and 50s may provide a misleading picture of the pattern of deaths for the group experiencing the greatest increases.
(more…)
Author Interviews, Brain Injury, Environmental Risks, Science, UCSF / 22.05.2018

MedicalResearch.com Interview with: “Space Shuttle Model” by terren in Virginia is licensed under CC BY 2.0Susanna Rosi, PhD Director of Neurocognitive Research Brain and Spinal Injury Center Professor in the departments of Physical Therapy and Rehabilitation Science and of Neurological Surgery UCSF MedicalResearch.com: What is the background for this study? What are the main findings? Response: NASA and private space companies like SpaceX plan to send humans to the red planet within the next 15 years — but among the major challenges facing future crewed space missions is how to protect astronauts from the dangerous cosmic radiation of deep space. In this study we identified the first potential treatment for the brain damage caused by exposure to cosmic rays — a treatment can be given after exposure and that prevents memory impairment in mice exposed to simulated space radiation. (more…)
Author Interviews, Dermatology, Environmental Risks, Melanoma / 22.05.2018

MedicalResearch.com Interview with: “Sunscreen” by Tom Newby is licensed under CC BY 2.0Carla Burns, M.S. Environmental Working Group She is one of the coauthors of the 2018 Guide to Sunscreens.  MedicalResearch.com: What is the background for the EWG report?  Response: Environmental Working Group (EWG) published its first Sunscreen Guide in 2007. When we first started the guide, many sun protection products sold in the U.S. were not as safe and used misleading marketing claims. Throughout the years, EWG has continued to find that a common sunscreen ingredient, oxybenzone, poses a hazard to human health and the environment. Despite EWG’s efforts to draw attention to the health hazards associated with this ingredient over the last 12, oxybenzone remains widely used in chemical-based sunscreens. So, this year, we are ramping up our efforts to rid the market of this ingredient by launching a campaign to urge companies and consumers to go oxybenzone-free by 2020. (more…)
Author Interviews, Dermatology, Genetic Research / 22.05.2018

MedicalResearch.com Interview with: http://www.proqr.com/team-and-boards/Daniel de Boer Founding Chief Executive Officer ProQR MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by dystrophic epidermolysis bullosa? Response: Dystrophic epidermolysis bullosa (DEB) is caused by a mutation in the COL7A1 gene which is responsible for the formation of a protein called type VII collagen (C7). This protein helps bind the inner and outer layers of the skin together. Mutations in one part of COL7A1 gene, exon 73, are the most common cause of DEB resulting in a non-functional C7 protein. ProQR's QR-313 is designed to skip exon 73 of the COL7A1 gene, leading to a shortened C7 protein called C7Δ73. The current studies are intended to determine whether C7Δ73 functions the same as normal C7 protein. This mechanism can hopefully restore normal skin function for DEB patients. DEB is a rare genetic skin disease characterized by easy blistering of the skin, poorly healing wounds and skin infections. DEB is present at birth and in severe cases leads to skin cancer, which can significantly reduce a patient’s lifespan. There are currently no treatments for DEB that target the underlying cause of the disease. The current standard of care consists of expensive time-consuming wound care, antibiotics to prevent infection and pain medications. As a result, this disease presents a huge burden to the patients themselves, as well as people who help with daily care. (more…)
Author Interviews, Genetic Research, Pediatrics, Weight Research / 22.05.2018

MedicalResearch.com Interview with: “Great Grandmother” by David Amsler is licensed under CC BY 2.0Rebecca Somerville MB BCh BAO, BMedSci, MRCPI, MPH, PhD School of Public Health, Physiotherapy and Sports Science University College Dublin Dublin, Ireland  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Rates of obesity in the Western world have increased dramatically over recent decades. The negative health consequences of obesity are well known and significant amounts of research have been conducted into the causes and possible solutions. While it is clear that there have been massive changes in diet and physical activity at a societal level that are primarily responsible for this 'obesity epidemic', it is less clear the extent to which obesity, once established, or risk factors for same, can be perpetuated down generations. Family studies lend opportunity to explore these questions, however there are few world wide which incorporate 3 generations. We therefore sought to examine patterns of central adiposity, as measured by waist circumference, between grandparents and their grandchildren, separately in maternal and paternal lines. We were able to utilize prospectively collected data from the Lifeways Cross-Generation Cohort Study. This is a longitudinal birth cohort, established in Ireland in 2001, involving up to 7 members of the same family (mother, father, child and 4 grandparents). In the 589 families where a child had a waist circumference measurement we found that, at the age of both 5 and 9, there was a direct relationship between the waist circumference of the maternal grandmother and her grandchild (both male and female). This remained after adjustment for a wide range of confounding variables including mother's waist circumference. There was no relationship seen with any of the other grandparents. (more…)
Author Interviews, Depression, Emory, Heart Disease, JAMA / 22.05.2018

MedicalResearch.com Interview with: Viola Vaccarino, MD, PhD Department of Epidemiology and Division of Cardiology Professor, Department of Medicine Emory University School of Medicine Atlanta, Georgia  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies have shown that people with depression tend to have lower heart rate variability (HRV), an index of autonomic nervous system dysregulation derived by monitoring the electrocardiogram over time, usually for 24 hours. Other literature, however, has pointed out that autonomic dysregulation (as indexed by reduced HRV) may also cause depression. Thus, the direction of the association between reduced HRV and depression still remains unclear. In addition, these two characteristics could share common pathophysiology, making shared familial background and genetic factors potential determinants of this association. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, Kidney Disease / 22.05.2018

MedicalResearch.com Interview with: Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis. This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality.  (more…)
Annals Internal Medicine, Author Interviews, Biomarkers, Heart Disease / 22.05.2018

MedicalResearch.com Interview with: Prof. Dr. med. Konstantinos Stellos,MD, FAHA, FESC Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle upon Tyne United Kingdom MedicalResearch.com: What is the background for this study?   Response: Risk stratification of patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains a major challenge in clinical cardiology. Risk stratification is important to identify patients at high risk, to whom an early coronary intervention with optimal adjunctive medical therapy shall be applied to reduce that risk. Conversely, it is equally important to identify patients at low risk, to whom a potentially hazardous invasive therapy or a multi-drug administration shall be avoided. Current ACC/AHA and ESC guidelines agree in a standardized approach that uses Global Registry of Acute Coronary Events (GRACE) score, a well validated scoring system, to calculate a patient’s risk and guide triage and management decisions. Amyloid-β (Aβ) 1-40 and 1-42 peptides (Aβ40 and Aβ42), are proteolytic fragments of a larger protein, the amyloid precursor protein (APP) cleaved by β- and γ-secretases, found in typical brain amyloid deposits in Alzheimer’s disease. Many lines of evidence support a role of Aβ40 in cardiovascular disease as a peptide with pro-inflammatory and pro-thrombotic properties. Most cardiovascular risk factors seem to affect APP metabolism and thus, Aβ production and its soluble circulating APP770 isoform are elevated in patients with ACS_ENREF_15, suggesting a role for Aβ40 in the triggering and outcome of ACS in stable CAD patients. Although vascular inflammation is considered as a hallmark in the pathophysiologic pathways of coronary artery disease (CAD) and novel mechanisms are continuously recognized in its pathogenesis, no inflammatory marker is currently recommended for risk stratification of patients with NSTE-ACS individually or as a component of the GRACE score. This may partly explain the moderate discriminative ability of GRACE score in some studies, especially in older patients and those after early percutaneous coronary intervention (PCI). In this retrospective study, we used data from two independent prospective cohorts, the Heidelberg study (n=1,145) and the validation multicenter international APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation, n=734) study and determined the clinical prognostic and reclassification value of baseline circulating Aβ40 levels in the prediction of mortality over the GRACE risk score in patients with NSTE-ACS across a median follow-up of 21.9 ( Heidelberg cohort) and 24.9 months (APACE cohort), respectively. (more…)
Author Interviews, Global Health, JAMA, Leukemia / 21.05.2018

MedicalResearch.com Interview with: Andrew J. Cowan, MD Seattle Cancer Care Alliance Division of Medical Oncology University of Washington, Seattle MedicalResearch.com: What is the background for this study? What are the main findings?   Response: Multiple myeloma (MM) is a plasma cell neoplasm with substantial morbidity and mortality. A comprehensive description of the global burden of multiple myeloma is needed to help direct health policy, resource allocation, research, and patient care. Myeloma cases and deaths increased from 1990 to 2016, with middle-income countries contributing the most to this increase. Treatment availability is very limited in countries with low socioeconomic development. (more…)
Author Interviews, Cannabis, Pediatrics / 21.05.2018

MedicalResearch.com Interview with: Natalie Castellanos Ryan, PhD École de Psychoéducation Université de Montréal Outremont Canada  MedicalResearch.com: What is the background for this study? Response: Our study followed a group of boys living in low socioeconomic neighbourhoods in Montreal (N=1030) from early childhood to 28 years of age to investigate: 1) whether the age at which one starts to use cannabis across adolescence is associated with the risk of developing drug abuse by early adulthood, when one controls for  arrange of known risk factors for cannabis use and problems assessed across development (risk factors in childhood, adolescence and early adulthood); and 2) the developmental pathways from early risk factors to drug abuse problems. To examine these associations, the study collected  self-reported cannabis use information from these boys annually from ages 13 to 17 years and drug abuse symptoms at 28 years, as well as teacher, parent and child reported information on a number of environmental (family and friend) and child characteristics (e.g., impulsivity, delinquency, school performance) across childhood and adolescence. Alcohol and other drug use was also assessed across adolescence and early adulthood. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Opiods, University of Pittsburgh / 21.05.2018

MedicalResearch.com Interview with: Jason Kennedy, MS Research project manager Department of Critical Care Medicine University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Most previous studies of opioid use in health care have focused on the outpatient setting. But opioids are often introduced during hospitalization. That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital. We analyzed the medical records of 357,413 non-obstetrical adults hospitalized between 2010 and 2014 at 12 University of Pittsburgh Medical Center (UPMC) hospitals in southwestern Pennsylvania. The region is one of the areas of the country where opioid addiction is a major public health problem. We focused on the 192,240 patients who had not received an opioid in the year prior to their hospitalization – otherwise known as “opioid naïve” patients. Nearly half (48 percent) of these patients received an opioid while hospitalized.  After discharge, those patients receiving hospital opioids were more than twice as likely to report outpatient opioid use within 90-days (8.4 percent vs. 4.1 percent). Patients who receive an opioid for most of their hospital stay and patients who are still taking an opioid within 12 hours of being discharged from the hospital appear more likely to fill a prescription for opioids within 90 days of leaving the hospital.  (more…)
ADHD, Author Interviews, Columbia, JAMA, Toxin Research / 21.05.2018

MedicalResearch.com Interview with: Marianthi-Anna Kioumourtzoglou ScD Assistant Professor Environmental Health Sciences Mailman School of Public Health Columbia University  Marianthi-Anna Kioumourtzoglou ScD Assistant Professor Environmental Health Sciences Mailman School of Public Health Columbia University  MedicalResearch.com: What is the background for this study? Response: The prevalence of neurodevelopmental disorders, like attention deficit/hyperactivity disorder (ADHD) has been increasing. One of the hypothesized risk factors for increased risk for neurodevelopmental disorders is a class of chemicals known as endocrine disrupting chemicals (EDCs). These chemicals are known to interfere with the endocrine system, i.e. the system that uses hormones to control and coordinate metabolism, reproduction and development. Several high production volume chemicals, ubiquitously present in commercial products, are known or suspected endocrine disruptors. Because of their widespread use in consumer products, the population-wide exposure to known and suspected EDCs is very high. Recently, there has been increased attention in the potential effects of EDCs on neurodevelopment that span multiple generations. Animal studies have provided evidence that exposure to EDCs, such as phthalates and bisphenol A (BPA), alter the behavior and social interactions in mice in three to five generations after exposure. However, evidence of such multi-generational impacts of EDC exposure on neurodevelopment in humans is unavailable, likely because of the lack of detailed information on exposures and outcomes across generations. For this study we leveraged information from a nationwide cohort, the Nurses’ Health Study II (NHSII), to investigate the potential link between exposure to diethylstilbestrol (DES) and third generation ADHD, i.e. ADHD among the grandchildren of the women who used DES while pregnant. DES is a very potent endocrine disruptor that was prescribed between 1938 and 1971 to pregnant women thought to prevent pregnancy complications. In the United States, between 5 and 10 million women are estimated to have used DES, although the exact number is not known. DES was banned in 1971, when was linked to vaginal adenocarcinomas (a rare cancer of the reproductive system) in the daughters of the women who had used it during pregnancy. Since then, DES has been also linked to multiple other reproductive outcomes in DES daughters, as well as with some reproductive outcomes in the grandchildren of the women who used it, such as hypospadias and delated menstrual regularization. However, to our knowledge, no study to date has evaluated the association between DES, or any other EDC, and multigenerational neurodevelopment. (more…)
Author Interviews, Infections / 21.05.2018

MedicalResearch.com Interview with: Christopher M. Waters PhD Departments of Microbiology and Molecular Genetics BEACON Center for The Study of Evolution in Actio Michigan State University East Lansing, MI  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research really centers on understanding and targeting bacterial biofilms. These are multicellular communities of bacteria encased in a slimy matrix that protects them from the immune system and antibiotic treatment during infections. One of the most common types of biofilm infections is in the lungs of cystic fibrosis by the bacterium Pseudomonas aeruginosa. CF patients can become chronically colonized by P. aeruginosa, and antibiotics are not able to clear these infections. Our idea was can we find other molecules that make antibiotics more effective at killing biofilms? To this end, we screened about 6,000 compounds for those that would make tobramycin more effective at killing P. aeruginosa biofilms, and one of the best hits we found was the antimicrobial triclosan that has been widely used for decades in hand sanitizers, soaps, and tooth paste. Although neither triclosan nor tobramycin can kill biofilms alone, the combination is 100X more effective against virtually every P. aeruginosa strain tested. It also worked against other bacteria that commonly infect cystic fibrosis lungs such as Staphylococcus aureus and Burkholderia cenocepacia. (more…)
Author Interviews, Duke, Mental Health Research / 21.05.2018

MedicalResearch.com Interview with: Maxwell Elliott Clinical psychology PhD student Working with Ahmad Hariri and the Moffitt & Caspi lab Duke University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The traditional clinical science model identifies individuals who meet specific criteria for mental illness diagnoses (e.g. Depression, Anxiety) and compares them to “healthy” controls to find brain correlates of mental illness.  However, this approach often overlooks the high rates of comorbidity and shared symptamatology across mental illnesses. Emerging research has identified a general factor of psychopathology that accounts for shared risk among internalizing, externalizing, and thought disorders across diverse samples. This general factor of psychopathology has been called the p-factor. In our study we investigate the brain correlates of the p-factor using a data-driven analysis of resting state functional connectivity. We find that higher p-factor scores and associated risk for common mental illness maps onto hyper-connectivity between visual association cortex and both frontoparietal and default mode networks. (more…)
Author Interviews, JAMA, Pulmonary Disease, Stem Cells, Transplantation / 21.05.2018

MedicalResearch.com Interview with: Emmanuel Martinod MD PhD Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, Université Paris Descartes, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris, France  MedicalResearch.com: What is the background for this exciting new technology and study? What are the main findings?  Response: What is the background for this exciting new technology and study? What are the main findings? Response:  The background is 10 years of research at laboratory followed by 10 years of academic clinical research. We demonstrated the feasability of airway bioengeenring using stented aortic matrices for complex tracheal or bronchial reconstruction.  (more…)
Author Interviews, JAMA, Orthopedics, Pain Research / 21.05.2018

MedicalResearch.com Interview with: “Back Pain” by betterhealthosteopathy is licensed under PDM 3.0Christine Goertz DC, PhD Vice Chancellor for Research and Health Policy Palmer College of Chiropractic MedicalResearch.com: What is the background for this study? Response: Low back pain in the leading cause of physical disability worldwide, with up to 80% of US adults seeking care for this debilitating condition at some point in their lives. Low-back pain is also one of the most common causes of disability in U.S. military personnel. Although a number of studies have previously evaluated chiropractic care for low back pain, the vast majority had small sample sizes and did not study chiropractic as part of a multi-disciplinary approach to care in real world settings, including the military. (more…)
Author Interviews, Social Issues / 21.05.2018

MedicalResearch.com Interview with: “Droid Apps Cell Phone” by Carissa Rogers is licensed under CC BY 2.0Leif Edward Ottesen Kennair  PhD Professor, Department of Psychology Norwegian University of Science and Technology  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The background is all earlier research on sexual behavior, showing both robust individual differences predictors as well as sex differences. We wished to investigate to what degree picture (PBMDA) based mobile dating apps differ from other arenas of sexual behavior.
  • How many have used or are current users:
  • Nearly half of the participants reported former or current Picture-Based Mobile Dating Apps (PBMDA) use. One in five was a current user.”
Our main prediction was confirmed:
  • We found that PBMDA-users tend to report being less restricted in their sociosexuality (as measured with the SOI-R) than participants who have never used PBMDAs
Including  specifation:
  • This effect was equally strong for men and women. Sociosexuality essentially accounted for the effects of other variables such as seeking a casual sex partner, being comfortable picking up strangers, and self-reported short-term mate value.
Sex differences were also found:
  • As predicted, women and men's reasons for using PBMDAs differed. Relative to women, men emphasized desire for sex as a reason for using PBMDAs.
The most surprising finding was as often due to a discussion with reviewer who was worried whether unrestricted sociosexuality was not more likely a result of use rather than a predictor of use. This improved the detail of our analysis and the conclusion that “When controlling for sex, age and SOI Desire there was no evidence that length of use increased lifetime casual sex partners.” (more…)
Author Interviews, Infections, Leukemia, MD Anderson, Transplantation / 20.05.2018

MedicalResearch.com Interview with: Roy F. Chemaly, MD, MPH F.A.C.P., F.I.D.S.A. Department of Infectious Diseases Infection Control and Employee Health Division of Internal Medicine MD Anderson Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: CytomegalovirusCMV infection is a common cause of morbidity and mortality in allo-HCT recipients. Evidence suggests that CMV infection has not only an enormous clinical burden, but a substantial economic burden as well. We conducted this study at MD Anderson to determine the economic and clinical burden of preemptive therapy (PET) for CMV infection. Between 2012 and 2015, 100 consecutive patients hospitalized at our institution for allo-HCT who experienced reactivation of CMV and were treated pre-emptively, were enrolled. The majority of patients were men (55%), who had underlying leukemia (73%), and underwent matched unrelated donor transplant (59%). At the time of hospitalization, most patients had acute GvHD (62%), and were on steroids (58%) within 30 days of CMV reactivation which occurred at a median of 32 days post-HCT (2 -174). A total of 192 episodes of PET occurred in the 100 allo-HCT recipients within 1 year post-HCT. PET consisted of ganciclovir (41%), foscarnet (40%), and valganciclovir (38%). IVIG was also used as adjunct therapy in 20% of episodes. Progression to Cytomegalovirus disease occurred in 4 patients (4%) and mainly affected the GI tract. Mean length of stay for patients treated with ganciclovir or foscarnet was 32 days (2-141) and 41 days (1-177), respectively. The average direct cost per patient admitted for PET was $126,038 ($7,866-$641,841) and the mean cost of CMV antiviral drug per hospitalization was $6,096 for IVIG, $2,410 for foscarnet, $836 for ganciclovir, and $780 for valganciclovir. Serious side effects from PET were observed in 35% of patients on ganciclovir and 12% of patients on foscarnet. Total direct cost per encounter was significantly higher in patients who had serious side effects from foscarnet. All-cause mortality was 59% at 1 year post-transplant. (more…)
Author Interviews, Emergency Care, Technology / 19.05.2018

MedicalResearch.com Interview with: Dr. Raymond E. Bertino, MD airRx lead developer and Clinical Professor of Radiology and Surgery at UICOMP MedicalResearch.com: What is the background for the airRX app and study? Response: With increasing air travel, in-flight medical emergencies have increased and physicians on commercial airline flights are routinely asked to volunteer assistance. A study presented this week at the annual meeting of The Society for Academic Emergency Medicine (SAEM) examined physician performance during practice simulations of in-flight medical emergencies with use of a smartphone app, airRx. In the unique study, cases based on commonly occurring in-flight medical emergencies were portrayed in a mockup of the airline cabin setting. Actors portrayed patients, family members, seat neighbors and flight attendants. Resident physicians in non-emergency specialties were asked to assist as if they were volunteering in actual medical emergencies. The study utilized airRx, the mobile app developed to help physicians and other medical personnel volunteering during in-flight medical events. The airRx app enables healthcare professionals to access 23 scenarios of the most common medical emergencies, with concise treatment algorithms and reference information to help evaluate and treat the patient.  (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 19.05.2018

MedicalResearch.com Interview with: Anna Gundlund, MD, PhD Herlev-Gentofte Hospital, Department of Cardiology Denmark  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial fibrillation increases a person’s risk of ischemic strokes up to 5-fold. Oral anticoagulation therapy lowers this risk effectively (>60%) and is therefore recommended for patients with atrial fibrillation and at least 1-2 other risk factors for stroke. Our study show, that oral anticoagulation therapy is still underused in patients with atrial fibrillation – even after a stroke event. In stroke survivors with atrial fibrillation, oral anticoagulation therapy were associated with better outcomes than no oral anticoagulation therapy.  (more…)
Author Interviews, Exercise - Fitness, Genetic Research, Heart Disease / 19.05.2018

MedicalResearch.com Interview with: Prof. Patricia Munroe PhD Professor of Molecular Medicine William Harvey Research Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London MedicalResearch.com: What is the background for this study? Response: Over the years, it has become increasingly evident that impaired capacity to increase heart rate during exercise and reduce heart rate following exercise are important predictors of all-cause and cardiovascular mortality. A person's capability to regulate their heart rate is the result of complex interactions of biological systems, including the autonomic nervous and hormonal systems. Prior work has demonstrated that genetic factors significantly contribute to variations in resting heart rate among different individuals, but less was known about the genetic factors modulating the response of heart rate to exercise and recovery. (more…)
Author Interviews, Nutrition, Pediatrics / 18.05.2018

MedicalResearch.com Interview with: Katherine Ottolini MD, lead study author Children’s National Health System and Catherine Limperopoulos, Ph.D., senior study author and Director of Developing Brain Research Laboratory Children’s National Health System MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nutrition is an important modifiable factor for brain development in premature infants, however few studies have evaluated the impact of nutritional interventions in the neonatal intensive care unit (NICU) on structural brain development in very premature infants using advanced, quantitative MRI techniques. The goal of this study was to utilize quantitative MRI to evaluate the impact of macronutrient (carbohydrate, protein, fat) and energy intake throughout the duration of the NICU stay on brain volumes and white matter development in very premature infants at term-equivalent age (TEA). We prospectively enrolled 68 very low birthweight infants (< 1500g) admitted to Children’s NICU within the first 7 days of life. We found significant negative associations between cumulative macronutrient and energy intake on both the brain’s white matter microstructural development (in the superior cerebellar peduncle, corpus callosum) and regional brain volumetric growth (cortical gray matter and cerebellum). In contrast, when evaluating average nutritional intake, we found significant associations between lipid and energy intake and regional brain volumes in the cortical gray matter, brainstem and cerebellum.  (more…)
AHA Journals, Author Interviews, Genetic Research, Heart Disease, Lipids, Vanderbilt / 18.05.2018

MedicalResearch.com Interview with: Wei-Qi Wei, MD, PhD Assistant Professor Department of Biomedical Informatics Vanderbilt University Nashville, TN 37203 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The study was motived by the clinical observation that some patients develop coronary heart disease events despite taking statins, one of our most effective drugs to reduce cardiovascular risk. We collected data within the eMERGE network of people taking statins and monitored them for development of coronary heart disease events over time.  We  conducted a genome-wide association study of those with events compared to those without events. Our results showed that single nucleotide polymorphisms (SNPs) on the LPA gene were associated with a significantly increased risk of coronary heart disease events. Individuals with the variant were 50% more likely to have an event. More importantly, even among patients who achieved ideal on-treatment LDL cholesterol levels (<70 mg/dL), the association remained statistically significant. We then did a phenome-wide association study to see if other diseases or conditions were associated with these LPAvariants. The major associated conditions were all cardiovascular. This sort of study can highlight potential other indications for a drug targeting this pathway and suggest potential adverse events that might be experienced from targeting this pathway. Clearly, more and larger studies will be needed to truly understand the potential risks and benefits of a future drug targeting this pathway.  (more…)
Author Interviews, Cognitive Issues, JAMA, Social Issues / 18.05.2018

MedicalResearch.com Interview with: Dr Dorina Cadar Research Associate in Dementia Psychobiology Group Department of Behavioural Science and Health University College London London MedicalResearch.com: What is the background for this study? Response: Dementia is one of the most feared medical conditions, which represents a significant global challenge to health and social care. Education may serve different roles in the development of dementia: it is a proxy for early life experiences and (parental) socioeconomic status, it is related to future employment prospects, income and wealth, determines occupational exposures and characteristics of adult life (e.g., job complexity, work stress, environmental exposures) and it provides lifelong skills for optimal mental abilities and mastery. However, given that education is typically completed many decades before dementia onset, other individual and area-based components of socioeconomic status, such as wealth, income and area deprivation may provide a more accurate indication of current socioeconomic resources.  Also, at older ages, accumulated wealth represents a more robust measure of socioeconomic resources than income or occupation alone. (more…)
Author Interviews, JAMA, Medical Imaging, Prostate Cancer, Technology / 17.05.2018

MedicalResearch.com Interview with: Andrew J. Armstrong, MD ScM FACP Associate Professor of Medicine, Surgery, Pharmacology and Cancer Biology Associate Director for Clinical Research in Genitourinary Oncology Duke Cancer Institute Divisions of Medical Oncology and Urology Duke University MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Men with prostate cancer commonly develop bone metastases and undergo nuclear medicine bone scans. However, these scans are non-quantitative, and disease burden has been challenging to assess over time and to relate to clinical outcomes. We developed a software program and measurement called the automated bone scan index that essentially reads a standard of care nuclear bone scan, provides a quantitative metric, and demonstrate in a phase 3 trial that this aBSI is highly associated with clinical outcomes including survival, time to symptomatic progression, and prostate cancer specific survival. We accomplished this within a prospective phase 3 international trial of men with metastatic hormone resistant prostate cancer who were followed over a long period of time.  All bone scans were read and measured using the aBSI at baseline, and we found that the aBSI was highly prognostic.  This work validates prior smaller phase 2 BSI studies, and demonstrates both the feasibility and clinical utility for incorporating the aBSI into clinical practice to provide this important prognostic information to patients and providers. (more…)
Author Interviews, Cancer Research, J&J-Janssen, Leukemia / 17.05.2018

MedicalResearch.com Interview with: Andrzej Jakubowiak, MD, PhD Professor of Medicine Director, Myeloma Program University of Chicago MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by multiple myeloma?   Response: DARZALEX (daratumumab) in combination with VELCADE (bortezomib), melphalan and prednisone - VMP - received U.S. FDA approval for the treatment of patients with newly diagnosed multiple myeloma who are ineligible for autologous stem cell transplant (ASCT). With this most recent approval, DARZALEX is now the first monoclonal antibody approved for newly diagnosed patients with this disease. Multiple myeloma is an incurable blood cancer that occurs when malignant plasma cells grow uncontrollably in the bone marrow. Despite the introduction of new medicines over the last decade, which has led to significant improvements in outcomes for patients with multiple myeloma, multiple myeloma remains an incurable disease. In 2018, it is estimated that 30,700 people will be diagnosed and 12,770 will die from the disease in the United States. (more…)