Author Interviews, Depression, JAMA / 06.07.2017

MedicalResearch.com Interview with: Robb B. Rutledge, PhD Max Planck University College London Centre for Computational Psychiatry and Ageing Research University College London London, England MedicalResearch.com: What is the background for this study? What are the main findings? Response: Depression is associated with deficits in how the brain responds to rewards, something the neurotransmitter dopamine is strongly implicated in. Dopamine represents what is called a reward prediction error, the difference between experienced and predicted reward. This error signal is used for learning. For example, if the outcome of a decision is better than expected, you can update your expectations using this error signal and you should expect more next time. Previous research has shown that depression reduces these signals in the brain when people are learning about the world around them. We designed a task where participants did not have to learn anything during the experiment and we found that in this situation reward prediction error signals were not affected by depression. The signals we measured in the ventral striatum, a brain area with a lot of input from the dopamine neurons, looked the same in depressed and non-depressed individuals. We also found that the emotional impacts of reward prediction errors were similar in depressed and non-depressed individuals when we eliminated the need for learning during the task in both the lab and using a smartphone experiment with 1833 participants. (more…)
Author Interviews, JAMA, Pediatrics / 06.07.2017

MedicalResearch.com Interview with: Seetha Shankaran, M.D. Professor, Neonatology Wayne State University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The study was performed because infants with moderate or severe hypoxic-ischemic encephalopathy (abnormal neurological exam within 6 hours of birth due to lack of blood and oxygen supply to the brain at birth) have rates of death or survival with disability that were still high in spite of current intensive care including hypothermia. Whole-body hypothermia, cooling the infant for 72 hours at a depth of 33.5°C that was performed by the Neonatal Research Network funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development was the first trial of this therapy in the USA. We found that hypothermia therapy did decrease the rate of death or survival with disability from 62 to 44%. Since 44% is still high we wanted to see if longer cooling or deeper cooling or both would reduce this rate. This was a randomized controlled clinical trial to examine whether longer cooling or deeper cooling or both reduced the rate of death or survival with disability among full term neonates with hypoxic-ischemic encephalopathy. The study lasted from October of 2010 to January 2016. 364 infants were enrolled. Neonates were randomly assigned to 4 groups of cooling therapy and the major findings were that neither longer cooling nor deeper cooling nor both were more superior to cooling for 72 hours at 33.5°C. Our results were surprising because at the time we planned this study there were reports from animal model studies that longer/deeper cooling were more protective to the brain. (more…)
Author Interviews, Electronic Records, JAMA, UCSF / 05.07.2017

MedicalResearch.com Interview with: Neda Ratanawongsa, MD, MPH Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network Associate Professor, Division of General Internal Medicine UCSF Center for Vulnerable Populations Physician, Richard H. Fine People's Clinic (RHPC) Zuckerberg San Francisco General Hospital San Francisco, CA 94110 MedicalResearch.com: What is the background for this study? What are the main findings? Response: U.S. federal incentives allowed many safety net healthcare systems to afford fully functional electronic health record systems (EHRs). Although EHRs can help clinicians provide care to vulnerable populations, clinicians may struggle with managing the EHR workload, particularly in resource-limited settings. In addition, clinicians’ use of EHRs during clinic visits may affect how they communicate with patients. There are two forms of EHR use during clinic visits.  Clinicians can multitask, for example, by ordering laboratory tests while chatting with a patient about baseball.  However, like distracted driving, using EHRs while talking with increases risks – in this case, the risk of errors in patient-provider communication or in the EHR task. Alternatively, clinicians can use EHRs in complete silence, which may be appropriate for high-risk tasks like prescribing insulin. However, silence during visits has been associated with lower patient satisfaction and less patient-centered communication. So we studied how primary and specialty care clinicians used EHRs during visits with English- and Spanish-speaking patients in a safety net system with an EHR certified for Centers for Medicare & Medicaid Services meaningful use incentive programs. We found that multitasking EHR use was more common than silent EHR use (median of 30.5% vs. 4.6% of visit time). Focused patient-clinician talk comprised one-third of visit time. We also examined the transitions into and out of silent EHR use. Sometimes clinicians explicitly stated a need to focus on the EHR, but at times, clinicians drifted into silence without warning. Patients played a role in breaking silent EHR use, either by introducing small talk or by bringing up their health concerns. (more…)
Author Interviews, Diabetes, JAMA, Pharmacology / 05.07.2017

MedicalResearch.com Interview with: Wendy Lane MD Director of Clinical Research Mountain Diabetes and Endocrine Center Asheville, NC MedicalResearch.com: What is the background for this study? What are the main findings? Response: The SWITCH1 trial was the first double blinded insulin trial to compare the rate of severe, nocturnal severe and symptomatic blood glucose-confirmed hypoglycemia between two basal insulins, insulin glargine U100 and insulin degludec U100, in patients with type 1 diabetes. The trial design (double blinded crossover treat-to-target) eliminated any bias in the results, which showed clear-cut reductions in all categories of hypoglycemia with insulin degludec compared to insulin glargine. Severe hypoglycemia has dangerous and greatly feared consequences including cognitive impairment, seizures, coma and death, and it is the main barrier to effective use of insulin in the treatment of type 1 diabetes. Insulin degludec, which was shown to reduce the risk of hypoglycemia compared to insulin glargine in the SWITCH1 trial, should be viewed by clinicians as an advancement in insulin therapy which will increase its safety and improve the quality of life of our patients with type 1 diabetes. (more…)
Author Interviews, Education, NYU, Sexual Health / 05.07.2017

MedicalResearch.com Interview with: Richard E. Greene, MD, FACP Medical Director, Bellevue Adult Primary Care Center Assistant Professor, NYU School of Medicine Associate Program Director, Primary Care Residency Program Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality  MedicalResearch.com: What is the background for this study? Response: Transgender individuals face complex health disparities and have historically been mistreated and even denied care in medical settings. As a provider in New York City, I saw how this affected my trans patients, resulting in mistrust of the health care system, resulting in negative health outcomes. This sparked my interest in improving medical education to serve the needs of trans patients. It’s important to teach medical students and residents that they are not just treating a set of symptoms, they are working with a individuals with complex lived experiences who deserve compassionate care. I found with traditional didactic methods, like lectures, learners smiled and nodded in agreement, but when faced with a patient who was transgender, they would stammer and feel uncomfortable with aspects of the cases that were specific to transgender patients, from pronouns to hormones. Residents should be prepared to treat transgender patients not only with dignity, but also in medically appropriate ways. Without exposure to the transgender community, it’s difficult for providers to decipher their trans patients’ health care needs and contextualize them within a care plan. In order to provide a low stakes environment for residents to practice these skills, we developed an OSCE focused on a transgender woman with health care needs specific to her transition. The goal of the case was to discuss the patient’s medical concerns while also taking into consideration her goals around her hormone therapy and surgical interests. (more…)
Author Interviews, CDC, Exercise - Fitness, JAMA / 04.07.2017

MedicalResearch.com Interview with: Emily Neusel Ussery, MPH PhD Epidemiologist, Physical Activity and Health Branch CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Walking is an easy way for most people to start and maintain a physically active lifestyle. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities identifies walking as an important public health strategy to increase physical activity levels in the U.S. A previous report found that the percentage of adults who reported walking for transportation or leisure increased by 6 percentage points between 2005 and 2010, but it is unknown if this increase has continued. This report examined trends in the proportion of U.S. adults who reported walking for transportation or leisure for at least one 10-minute period in the past week, using nationally representative data from the 2005, 2010, and 2015 National Health Interview Surveys. We also examined differences in walking trends by sociodemographic characteristics. If you take walking seriously, make sure you invest in some custom boots to make sure you don't damage your feet. For those who need to transport larger items while walking isn't an option, utilizing a Large Item Courier service can help ensure safe and efficient delivery. (more…)
Author Interviews / 04.07.2017

MedicalResearch.com Interview with: Chintan V. Dave, PharmD Department of Pharmacotherapy and Translational Research College of Pharmacy, University of Florida Gainesville, FL MedicalResearch.com: What is the background for this study? Response: Use of generic drugs as a percentage of total dispensed prescriptions has increased in recent years, from 57% in 2004 to 86% in 2013. The U.S. health care system has recently witnessed a relatively new phenomenon where prices for some older generic drugs have increased hundreds — even thousands — of percentage points in a short time span. Many factors have been linked to these price increases, including shortages in the manufacturing supply chain (leading to reduced production) and a reduction in the number of manufacturers of a drug (resulting in insufficient competition). Understanding how prices relate to market changes may help identify drugs at risk for price changes so that interventions may occur before patient care is affected. (more…)
Author Interviews, JAMA, Pain Research / 04.07.2017

MedicalResearch.com Interview with: Esther Maas, PhD Postdoctoral Research Fellow Partnership for Work, Health and Safety School of Population and Public Health University of British Columbia Vancouver, BC  MedicalResearch.com: What is the background for this study? Esther Maas, PhD Chronic low back pain causes more disability than any other condition, and has major social and economic consequences. Radiofrequency denervation is a commonly used treatment in pain clinics for a subgroup of patients with chronic low back pain resulting from anatomical structures such as facet joints, sacroiliac joint and intervertebral disc. Radiofrequency denervation uses an electric current that damages the innervating nerve of the painful structure. Despite its frequent application, until now, there was only very low quality and conflicting evidence for its effectiveness. The aim of this study was to establish whether radiofrequency denervation in addition to a standardized exercise program is more effective than the standardized exercise program alone in the selected subgroup of patients with chronic low back pain. (more…)
Abuse and Neglect, Hearing Loss, JAMA, Johns Hopkins / 04.07.2017

MedicalResearch.com Interview with: Nicholas S. Reed, AuD Instructor | Department of Otolaryngology-Head/Neck Surgery PhD Candidate  | Graduate Training Program in Clinical Investigation Center on Aging and Health Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hearing Aids are medical devices regulated by the FDA which must be purchased through a licensed individual while personal sound amplification products (PSAPs) are essentially unregulated devices some of which can manipulate and increase sound similar to a hearing aid but cannot market themselves are devices for hearing loss. PSAPs can be purchased online or in the back of a store and are generally less expensive than hearing aids. We aimed to explore a select group of PSAPs to see if they helped someone with mild to moderate hearing loss improve speech understanding (i.e. ability to repeat back sentences) in the presence of mild background noise (think a lunch crowd at a restaurant) as well as a hearing aid. We selected four PSAP devices that were technologically strong (i.e. meet many standards a hearing aid might be asked to meet) and one PSAP that was technologically fairly poor (i.e. lots of sound distortion) after an in-house electroacoustic analysis of devices. Our hearing aid was selected because it was a popular choice at a university audiology clinic. Forty-two people completed the speech testing unaided (i.e. with no device) and then with each of the five PSAPs and one hearing aid (order of devices was randomized). We looked at improvement with the devices from unaided. We found that some PSAPs help people understand speech about as well as a hearing aid in this controlled environment while one PSAP actually hindered participants’ ability to understand speech due to sound distortion – imagine how difficult it can be when listening on a poor cell phone signal. (more…)
Author Interviews, Diabetes / 04.07.2017

MedicalResearch.com Interview with: Stefan Amisten, PhD The Oxford Centre for Diabetes, Endocrinology & Metabolism University of Oxford, Oxford Diabetes Research Group, Division of Diabetes & Nutritional Sciences King’s College London, Faculty of Life Sciences & Medicine, London UK MedicalResearch.com: What is the background for this study? Response: Type 2 diabetes is a global epidemic that is causing an increasing medical and financial burden on both individuals and society in general. Type 2 diabetes is characterized by insulin resistance, poor insulin response to blood glucose which leads to chronically elevated blood glucose and damage to the cardiovascular system and other organs, which may ultimately lead to blindness, kidney failure, blindness, toe amputations, cardiovascular disease and premature death. Although a number of drugs are available for the treatment of Type 2 diabetes, no drug is currently able to cure diabetes, as they are only able to slow down the disease progression. There is therefore a need to develop novel therapies to treat Type 2 diabetes. G-protein coupled receptors (GPCRs) constitute a family of almost 400 cell surface receptors that is the target of a large number of modern medicines. Interestingly, only a small subset of all GPCRs are currently targeted by modern medicines, which means that a large number of GPCRs still have untapped therapeutic potential, largely because they have not been studied in-depth, or because their ligands (i.e. binding partners) have not been identified. This study is a result of a thorough cataloguing of all G-protein coupled receptors (GPCRs) in human pancreatic islets (Amisten et al. Pharmacol Ther. 2013 Sep;139(3):359-91.), where the receptor GPRC5C was identified as one of the most abundant orphan GPCRs in human islets. (more…)
Author Interviews, BMJ, Dermatology / 03.07.2017

MedicalResearch.com Interview with: Joann G. Elmore M.D., M.P.H. Professor of Medicine, Adjunct Professor of Epidemiology, University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104-2499 MedicalResearch.com: What is the background for this study? JE: Previous studies on diagnostic accuracy in interpreting melanocytic lesions exist but have small sample size, inclusion of experts only, or small numbers of specimens. We sought to examine accuracy and reproducibility in melanocytic skin lesions by improving upon the methodological limitations of previous studies. Specifically, we recruited a large national sample of practicing community and academic pathologists with a wide range of experience, and we utilized a large sample of biopsy cases that were carefully selected. Given that diagnostic errors can lead to patient deaths and invasive melanoma kills more than 9,000 Americans each year, we wanted to study the issue of diagnostic accuracy in interpreting melanocytic skin lesions in a very robust fashion. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 29.06.2017

MedicalResearch.com Interview with: Suzanne J. Baron, MD, MSc Saint Luke’s Mid America Heart Institute School of Medicine University of Missouri, Kansas City MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter Aortic Valve Replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis in patients at high and intermediate surgical risk.  Prior studies have demonstrated that both TAVR and surgical AVR (SAVR) results in substantial quality of life benefit in patients at high surgical risk. Whether these results applied to an intermediate risk population was unknown and so we performed a prospective study alongside the PARTNER 2A trial to compare both short- and long-term health status outcomes in intermediate-risk patients with AS treated with either TAVR or SAVR.   The analysis included 1833 patients (950 TAVR, 833 SAVR), who were evaluated at 1 month, 1 year and 2 years post procedure.  By 1 month, quality of life had improved in both the TAVR and SAVR groups, although the gain was significantly greater in patients treated with TAVR via the transfemoral approach as opposed to patients treated with SAVR or with TAVR via the transthoracic approach (i.e. direct aortic access or transapical access).   At 1 and 2 years, both TAVR (via either approach) and SAVR were associated with similarly large, clinically meaningful improvements from baseline in both disease-specific and generic health status scales at 2 years. (more…)
Author Interviews, Neurological Disorders, Technology / 29.06.2017

MedicalResearch.com Interview with: Howard Jay Chizeck ScD Professor, Electrical Engineering Adjunct Professor, Bioengineering Co-Director UW Biorobotics Laboratory Graduate Program in Neuroscience UW CoMotion Presidential Innovation Fellow Research Thrust Testbed Co-Leader MedicalResearch.com: What is the background for this study? What are the main findings? Response: Essential Tremor is treated using Deep Brain Stimulation (DBS) in some patients. Current clinical practice involves Deep Brain Stimulation with an "always on" stimulation. This causes extra battery drain, because stimulation is applied when not needed. Also excessive stimulation is not necessarily a good thing, Our work is aimed at adjusting the stimulation, so that it comes on and turns off only when needed to suppress tremor symptoms. (more…)
Author Interviews, Brigham & Women's - Harvard, Environmental Risks, NEJM, Race/Ethnic Diversity / 29.06.2017

MedicalResearch.com Interview with: Qian Di, M.S, Doctoral Student Department of Environmental Health and Francesca Dominici, Ph.D. Principal Investigator of this study Professor of Biostatistics co-Director of the Harvard Data Science Initiative Harvard T.H. Chan School of Public Health Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Clean Air Act requires Environmental Protection Agency to set National Ambient Air Quality Standard (NAAQS). Currently the annual NAAQS for PM2.5 is 12 microgram per cubic meter; and there is no annual or seasonal ozone standard. However, is current air quality standard stringent enough to protect human health? This is our main motivation. We conducted the largest attainable cohort study, including over 60 million Medicare participants, to investigate the association between long-term exposure to ozone/PM2.5 and all-cause mortality. We found significant harmful effect of PM2.5 even below current NAAQS. Each 10 microgram per cubic meter increase in PM2.5 is associated with 13.6% (95% CI: 13.1%~14.1%) increase in all-cause mortality. For ozone, 10 ppb increase in ozone exposure is associated with 1.1% (95% CI: 1.0%~1.2%) increase in mortality. Also, there is no appreciable level below which mortality risk tapered off. In other words, there is no “safe” level for PM2.5 and ozone. In other words, if we would reduce the annual average of PM2.5 by just 1 microgram per cubic meter nationwide, we should save 12,000 lives among elder Americans every year; 5 microgram --- 63,817 lives every year. Similarly, if we would reduce the annual summer average of ozone by just 1 ppb nationwide, we would save 1,900 lives every year; 5 ppb --- 9537 lives. Besides, we found black people, males and people of low SES are more vulnerable to air pollution. (more…)
Author Interviews, Gender Differences / 29.06.2017

MedicalResearch.com Interview with: Sanger Insitute - Wellcome Trust. Photo by Phil MynottDr Natasha Karp PhD Senior Staff Scientist – Biostatistician Wellcome Trust Sanger Institute MedicalResearch.com: What is the background for this study? Response: There is evidence that the prevalence of disease, the symptoms experienced,  the progression,  and the side effects can be  dependent on sex.  However, women are underrepresented within biomedical research and this can be seen in the reporting, design of the experiments and subsequent statistical analysis. Examples
  • A review of international animal research between 2011 and 2012 found that 22 per cent of studies did not state the sex of the animals, and of those that did, 80 per cent of studies used solely males and only 3 per cent included both males and females (https://www.ncbi.nlm.nih.gov/pubmed/25175501)
  • In a study across 10 fields of biology,  80% of the rodents were male  (Beery and Zucker 2011 Neurosci Biobehav Rev).  This rate has not changed in 20 years  (Mazure and Jones 2015 BMC Women’s health)
  • Women encounter adverse drug reactions more often than men (odds ratio 1.596 confidence interval: 1.3-1.94)( Zopf et al 2008  Eur J Clinic Pharmacol)
  • Example – cardiovascular disease is the number one killer of US women,  and women differ to men in symptoms, outcomes and risk factors, yet only one third of cardiovascular trials subjects are female and only 31% of trials report results by sex (http://www.brighamandwomens.org/Departments_and_Services/womenshealth/ConnorsCenter/Policy/ConnorsReportFINAL.pdf)
  • Example – It took 21 years to lower the  dosing guidelines for women for the insomnia drug Zolpidem due to differences in the clearance rate of the drug exposing women to greater health risks (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918870/)
As a result of these observations, multiple bodies have called for sex to be considered as a biological variable in preclinical research.  The largest funders of biomedical research (National Institute of Health) made inclusion of sex a requirement of funding with a few well defined exceptions.  There was some push back on this,  particularly that scientists should be trusted and would know when sex was a variable and it was a waste of resources. I felt there was a knowledge gap on the role of sex.  We have had published studies of individual examples where sex had a role but no large scale study. (more…)
Aging, Author Interviews, McGill, Nature / 29.06.2017

MedicalResearch.com Interview with: Pr. Siegfried Hekimi PhD McGill University MedicalResearch.com: What is the background for this study? What are the main findings? Response: We analyzed data about the longest living individuals over the period of time during which the record can be trusted. We found that there was no detectable plateauing of the maximum possible lifespan. This is consistent with not clearly observed plateau in the currently increasing average lifespan as well. (more…)
Author Interviews, Cancer Research, Melatonin, Occupational Health / 28.06.2017

MedicalResearch.com Interview with: Parveen Bhatti, PhD Associate Member Fred Hutchinson Cancer Research Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Evidence in humans for an association between shift work and cancer has been mixed. This may be due to difficulties in accurately assessing long-term exposures to shift work in studies of cancer risk. We took a different approach that circumvented these difficulties. Rather than look at cancer risk directly, we measured, among actively employed shift workers, a marker of DNA damage that has been linked to cancer. When repaired by cellular machinery, this particular marker is excreted in urine where it can be measured. We found that, compared to sleeping at night during their night off, shift workers had lower urinary levels of the DNA damage marker during their night work. This effect appears to be driven by reductions in circulating melatonin levels among shift workers during night work relative to night sleep. Given that melatonin has been shown to enhance repair of DNA damage, our results suggest that, during night work, shift workers have reduced ability to repair DNA damage resulting in lower levels being excreted in their urine. Because of this, shift workers likely have higher levels of DNA damage remaining in their cells, which can lead to mutations and cause cancer. (more…)
Aging, Author Interviews, Geriatrics, Sexual Health / 28.06.2017

MedicalResearch.com Interview with: Dr Hayley Wright BSc(Hons) MSc PhD C.Psychol Research Associate Faculty of Health and Life Sciences, Coventry University Centre for Research in Psychology, Behaviour and Achievement, Coventry University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Last year, we published a study that showed a significant association between sexual activity and cognitive function (Wright & Jenks, 2016). This study showed that sex is linked to cognition, even after we account for other factors such as age, education, and physical and mental wellbeing. One important question that emerged from this study was centred around the role of frequency with which we engage in sexual activity. In the current study (Wright, Jenks & Demeyere, 2017), we found that engaging in sexual activity on a weekly basis is associated with better scores on specific cognitive tasks. (more…)
Author Interviews, CDC, Occupational Health / 28.06.2017

MedicalResearch.com Interview with: Taylor M. Shockey MPH CDC/National Institute for Occupational Safety and Health CDC MedicalResearch.com: What is the background for this study? Response: Our study examined health-related quality of life (HRQOL) among 22 major occupation groups using the Behavioral Risk Factor Surveillance System (BRFSS) data. The BRFSS is an annual telephone survey that collects data from U.S. residents on their health-related risk behaviors, chronic health conditions, and use of preventive services. HRQOL is an individual’s self-perception of their physical and mental health over time and it provides a valuable measure of well-being. HRQOL is used by a variety of different fields, outside of public health, including psychology, social work, economics, and urban planning. HRQOL is a measure capable of linking these different fields and is used to determine disease burden, to monitor progress in achieving the Healthy People goals, to guide policy and legislation, to develop interventions, and to allocate resources where they are most needed. The Healthy People goals are 10-year targets for improving the health of Americans through health promotion activities and disease prevention efforts. In relation to occupation, prior research that has evaluated HRQOL has typically focused on employment status, but not on specific job type. It’s been established, however, that job characteristics such as high demand, low control, role stress, bullying, work hours, etc., are associated with greater risk for common mental health problems as well as physical outcomes like headaches, fatigue, and gastrointestinal problems. Our study wanted to determine if differences in HRQOL would exist among occupation groups. (more…)
Author Interviews, JAMA, Urology / 28.06.2017

MedicalResearch.com Interview with: Baoyan Liu, MD Guang’an Men Hospital China Academy of Chinese Medical Sciences Beijing, China MedicalResearch.com: What is the background for this study? What are the main findings? Response: The prevalence of stress urinary incontinence(SUI) is as high as 49% and varies according to the population studied and the definition of stress urinary incontinence. SUI causes psychological burden, affects relationships, lowers physical productivity, and decreases quality of life in women. Yet, few effective therapies are available for treating stress urinary incontinence. In this randomized clinical trial that included 504 women, the mean decrease in urine leakage, measured by the 1-hour pad test from baseline to week 6, was 9.9 g with electroacupuncture vs 2.6 g with sham electroacupuncture, a significant difference. (more…)
Author Interviews, Emory, Flu - Influenza, Lancet, Technology, Vaccine Studies / 28.06.2017

MedicalResearch.com Interview with: Dr Nadine G Rouphael MD Associate Professor of Medicine, Emory University Director of the VTEU and HIPC networks at the Hope Clinic of the Emory Vaccine Center Decatur GA 30030, USA MedicalResearch.com: What is the background for this new technology and study? What are the main findings? Response: Different groups including a group of researchers at Georgia Tech have been working on the microneedle technology for more than 20 years. The dissolvable microneedle patches are already used in several cosmetic products and drugs. However, vaccination with microneedle patches has been studied mostly in animals. Our phase 1 trial published this week in The Lancet showed that vaccination with the microneedle patches was safe, with no related serious adverse events reported. Local skin reactions to the patches were mostly mild itching and faint redness that lasted two to three days. No new chronic medical illnesses or influenza-like illnesses were reported with either the patch or the injection groups. Antibody responses generated by the vaccine, as measured through analysis of blood samples, were similar in the groups vaccinated using patches and those receiving intramuscular injection, and these immune responses were still present after six months. When asked after immunization, more than 70 percent of patch recipients reported they would prefer patch vaccination over injection or intranasal vaccination for future vaccinations. (more…)
Author Interviews, Heart Disease, JACC, Women's Heart Health / 27.06.2017

MedicalResearch.com Interview with: C. Noel Bairey Merz, MD, FACC  Director, Barbra Streisand Women's Heart Center Director, Linda Joy Pollin Women's Heart Health Program Director, Erika Glazer Family Foundation Women's Heart Disease Initiative Director, Preventive Cardiac Center Professor of Medicine Cedars-Sinai Medical Center MedicalResearch.com: What is the background for this study? Response: Cardiovascular disease (CVD) is the number 1 killer of women in the U.S.A., yet few younger women personalize awareness. CVD campaigns focus little attention on physicians and their role assessing risk. MedicalResearch.com: What are the main findings? Response: Overall, 45% of women were unaware that CVD is the #1 killer of women, only 11% knew a woman who has died from it.  Overall, 45% of women reported it is common to cancel or postpone a physician appointment until losing weight. Cardiovascular disease was a top concern for only 39% of PCPs, after weight and breast health. A minority of physicians (22% of PCPs and 42% of cardiologists) felt well prepared to assess women’s CVD risk, and infrequently use guidelines. (more…)
Author Interviews, Emergency Care, Heart Disease, JAMA, Stanford / 27.06.2017

MedicalResearch.com Interview with: Alexander Sandhu, MD MS Cardiology Fellow Stanford University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Millions of patients present to the emergency department with chest pain but most do not have lab or EKG findings that indicate the patient is having a heart attack. In patients without signs of a heart attack, stress testing is frequently used to determine the need for further workup and treatment. However, there is limited evidence regarding the benefit of stress testing in these patients. We evaluated how cardiac testing - stress testing and coronary angiography - in these low-risk patients was associated with clinical outcomes. We used a statistical approach that took advantage of the fact that testing is more available on weekdays than weekends. We found that testing was associated with more angiography and revascularization (coronary stenting or coronary artery bypass surgery) but was not associated with a reduction in future heart attacks. (more…)
Author Interviews, Dermatology, UCSF / 26.06.2017

MedicalResearch.com Interview with: Dr. Katrina Abuabara MD, MA, MSCE University of California San Francisco MedicalResearch.com: What is the background for this study? Response: Atopic dermatitis (synonymous with atopic eczema or just “eczema”) is a common and burdensome condition that often presents in childhood but can occur in individuals of any age. It is episodic, meaning that it waxes and wanes over time, and many patients will have periods without signs or symptoms of the disease. Conventional wisdom suggests that “most children” improve by adolescence, but prior studies have not had sufficiently frequent follow-up to detect episodic disease beyond childhood. (more…)
Author Interviews, Cancer Research / 24.06.2017

MedicalResearch.com Interview with: Dr. Ajai Chari, MD Associate Professor of Medicine Multiple Myeloma Program and Associate Director of Clinical Research Mount Sinai Hospital, New York MedicalResearch.com: What is the background for this study? Would you briefly explain multiple myeloma (How common is it, whom does it chiefly affect, etc.)? Response: Multiple myeloma is a rare form of blood cancer that occurs when plasma cells grow uncontrollably in the bone marrow. It is estimated that approximately 30,280 people will be diagnosed and 12,590 will die from the disease in the United States in 2017. While some patients with multiple myeloma have no symptoms at all, symptoms can include bone fracture or pain, low red blood counts, fatigue, calcium elevation, kidney problems or infections. Despite tremendous progress, most patients with multiple myeloma continually relapse or become resistant to available therapies, such as proteasome inhibitors (PIs) and immunomodulatory agents. Therefore, these patients continue to need new options. The MMY1001 (EQUULEUS) study is a Phase 1b, open-label study assessing daratumumab in combination with multiple backbone regimens for multiple myeloma. In one arm of the study, supporting the recent approval of DARZALEX (daratumumab), the treatment was assessed in combination with pomalidomide and dexamethasone in patients with multiple myeloma who had received a prior PI and an immunomodulatory agent. Data from the study showed that the addition of daratumumab resulted in an overall response rate (ORR) of 59.2 percent (95 percent CI: 49.1 percent, 68.8 percent), with very good partial response (VGPR) achieved in 28.2 percent of patients. Complete response (CR) was achieved in 5.8 percent of patients and stringent CR (sCR) was achieved in 7.8 percent of patients. (more…)
Addiction, Author Interviews, Technology / 24.06.2017

MedicalResearch.com Interview with: Dr. Phil Reed,  D.Phil. Professor Psychology Swansea University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Problematic internet use has been a growing concern for many people and bodies over the last decade, and more study has been requested into various aspects of this possible disorder.  One of the key questions is whether people overuse the internet, due to an addiction.  If it is an addiction, then there should be signs of withdrawal when people, who report having this problem, stop using the internet.  In this study, 144 participants, aged 18 to 33, had their heart rate and blood pressure measured before and after a brief internet session.  Their anxiety and self-reported internet addiction were also assessed. The results showed increases in heart rate and systolic blood pressure on terminating the internet session for those with problematically-high internet usage.  These increases in physiological arousal were mirrored by increased feelings of anxiety.  However, there were no such changes for those participants who reported no internet-usage problems. (more…)
Author Interviews, Pediatrics, Weight Research / 24.06.2017

MedicalResearch.com Interview with: Michelle S. Wong PhD Department of Health Policy and Management Johns Hopkins School of Public Health Baltimore, Maryland MedicalResearch.com: What is the background for this study? Response: As background, there haven't been many studies on how fathers might influence overweight or obesity in their children. Unsurprisingly most of the research has focused on the mothers' influence. Existing studies on fathers have focused on the relationship between their parenting practices (e.g., discipline), as well as feeding and physical activity behaviors, with child overweight or obesity. A few studies found that some father feeding practices were related to higher child BMI, but we don’t know whether fathers’ general caregiving matters. (more…)
Author Interviews, Cost of Health Care / 24.06.2017

MedicalResearch.com Interview with: Nitin Mehta PhD Associate Professor in Marketing Rotman School MedicalResearch.com: What is the background for this study? Response: The focus of this paper is an investigation of the increase in health care costs associated with chronic disease in the context of consumers enrolled in employer sponsored insurance plans. Chronic illnesses – including conditions such as heart disease, cancer, hypertension, rheumatoid arthritis, respiratory diseases, diabetes, and kidney disease – account for nearly 75 percent of health care expenditures in the U.S. Treatments vary widely in terms of cost and impact: expensive “frontier” treatments provide the best outcome for only the seriously ill, while cheaper, established treatments prove effective for most other patients. As an example, the annual cost to an insurer for “biologics” – novel genetically modified protein drugs – is upwards of $20,000, while the more established drug – methotrexate – costs only $1,000 a year. We investigate whether a part of the increase in healthcare costs stems from consumers opting for the more expensive treatments even when the lesser expensive treatments may have worked well. To do so, we examined data from a health insurer in the United States on the insurance plan and treatment options for 3,000 chronically ill patients over a three year period. (more…)
Author Interviews, Columbia, Memory / 24.06.2017

MedicalResearch.com Interview with: Samuel Schacher, PhD and Jiangyuan Hu, PhD, Department of Neuroscience Columbia University Medical Cente New York State Psychiatric Institute New York, NY 10032, USA MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well established that learning and memory requires changes in the properties of specific neural circuits in the brain activated by the experience. The long-term storage of the memory is encoded through changes in the function of the synapses within the circuit. Synapses are sites of communication between neurons, and the changes in their function come in two varieties: increases in strength and decreases in strength. The encoding of memories typically requires some combination of these synaptic changes, synaptic plasticity, which can last a long time to contribute to long-term memory. Thus the maintenance of a memory will require the persistent change (long-term synaptic memory) in the function of specific synapses. But memories come in different flavors. In the original experiment by Pavlov, a neutral tone, which dogs ignore, came to predict the immediate appearance of a meal. After several of these pairings, the dogs would become happily excited just with the tone. The same type of conditioning could have a negative valence - the tone could proceed a shock to one of the dog's paw. Now the neutral tone would predict a negative stimulus and the dog would express fearful behavior just with the tone (associative learning). A non-associative form of memory would be the same types of stimuli but without the preceding neutral stimulus. At random times the animal will be given a meal or a shock. The behavior of the animal for some time will take on the positive or negative features of its environment - a contented versus depressed condition. Each of these forms of long-term memory would be maintained by increases in the strength of specific synapses. The questions addressed in our study published in Current Biology, based on previous work in my lab and the lab of my colleague Wayne Sossin at McGill, were: 1) Do the same molecules maintain increases in synaptic strength in the neurons of the circuit after stimuli that produce long-term classical conditioning (associative learning) and long-term sensitization (non-associative learning)? 2) If different molecules maintain the different synaptic memories, is it possible to reverse or erase the different synaptic memories by interfering with the function of the different molecules? 3) If true, can we reverse the different synaptic memories expressed in the same neuron by interfering with the function of the different molecules. (more…)