Author Interviews, Biomarkers, Breast Cancer, Genetic Research, Journal Clinical Oncology / 21.03.2017

MedicalResearch.com Interview with: Anne Kuijer, MD Departments of Surgery and Radiology University Medical Center Utrecht and Thijs van Dalen, PhD Department of Surgery Netherlands Cancer Institute, Amsterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years it has become evident that clinicopathological factors fail to accurately determine prognosis in hormone receptor positive early stage breast cancer patients at intermediate risk of developing metastases. Gene-expression profiles, such as the 70-gene signature (MammaPrint) are therefore increasingly used for chemotherapy decision-making. In the current multicentre study we assessed the impact of 70-gene signature use on chemotherapy decisions in these patients. We demonstrated that, without the use of the 70-gene signature, half of patients was advised chemotherapy, which reflects the current controversy regarding chemotherapy benefit. Use of the 70-gene signature changed the chemotherapy advice in half of all patients and adherence to the 70-gene signature result was high. (more…)
Author Interviews, Education, Gender Differences / 20.03.2017

MedicalResearch.com Interview with: Tasseli McKay, MPH Violence and Victimization Research Program Center for Justice, Safety and Resilience RTI International MedicalResearch.com: What is the background for this study? Response: Prompted by a mass murder of LGBTQ+ individuals in Orlando in 2016 and a range of pending legislation affecting LGBTQ+ communities, RTI researchers analyzed 20 years’ worth of published studies on violence and LGBTQ+ communities. The systematic review identified patterns of evidence across 102 peer-reviewed studies as well as a few unpublished analyses and non-peer-reviewed papers. With The Henne Group, RTI also carried out a series of focus-group discussions to elicit the perspectives of members of LGBTQ+ communities on the violence and victimization issues identified in the review. These were conducted with LGBTQ+ communities in San Francisco; New York City; Durham, North Carolina; and rural Wyoming. (more…)
Author Interviews, Sugar / 20.03.2017

MedicalResearch.com Interview with: Shu Wen Ng, Ph.D., FTOS Research Associate Professor, Department of Nutrition Gillings School of Global Public Health Fellow, Carolina Population Center Duke-UNC Center for Behavioral Economics and Healthy Food Choice Research University of North Carolina at Chapel Hill MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Mexican government enacted a 1 peso per liter tax on sugar sweetened beverages (SSB) after studies showed that more than 70 percent of the country’s population was overweight or obese, and that in excess of 70 percent of the added sugar calories in the Mexican diet were coming from SSBs. We were interested in learning how purchases of SSBs and other beverages changed in the 2 years after the tax was implemented in Mexico. The Health Affairs study titled “In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax” found that in the two-year period spanning 2014 to 2015, the tax resulted in a 5.5 percent reduction in the first year and continued to decline, averaging 9.7 percent the second year, with lower socioeconomic households, for whom health care costs are most burdensome, lowered their purchases of sweetened beverages the most. Meanwhile, purchases of untaxed beverages such as bottled water increased 2.1 percent. (more…)
Author Interviews, Orthopedics / 20.03.2017

MedicalResearch.com Interview with: Alexis Colvin, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity. We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early. (more…)
Author Interviews, Heart Disease, Pharmacology / 20.03.2017

MedicalResearch.com Interview with: Kathrine Bach Søndergaard MD, Research Fellow Gentofte University Hospital Department of Cardiology Hellerup  MedicalResearch.com: What is the background for this study? Response: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have in previous studies been associated with an increased risk of cardiovascular adverse events, such as myocardial infarction and heart failure. Cardiac arrest is the ultimate adverse event; however, no research exists of the association between cardiac arrest and use of NSAIDs, which we aimed to assess in this study. (more…)
Author Interviews, Heart Disease, Medical Imaging / 20.03.2017

MedicalResearch.com Interview with: Matthias Götberg, MD, PhD Director Cardiac Cath Lab Department of Coronary Heart Disease Skane University Hospital- Lund Lund, Sweden MedicalResearch.com: What is the background for this study? Response: Cardiologists encounter patients with narrowing of the coronary arteries on a daily basis. They typically use visual estimation of the severity of narrowing when performing coronary angiography, but it is difficult to accurately assess, based on a visual estimation alone, whether a stent is needed to widen the artery and allow the blood to more freely. FFR (Fractional Flow Reserve) is more precise tool and results in better outcomes than using angiography alone to assess narrowing of the coronary arteries. With FFR, the doctor threads a thin wire through the coronary artery and measures the loss of blood pressure across the narrowed area. To acquire an accurate measurement, the patient must be given adenosine, which is a drug that dilates the blood vessels during the procedure. This drug causes discomfort; patients describe having difficulty breathing or feeling as if someone is sitting on their chest. The drug also adds to the cost of the procedure and can have other rare but serious side effects. iFR (Instantaneous Wave-Free Ratio) is also based on coronary blood pressure measurements using a thin wire, but unlike FFR, it uses a mathematical algorithm to measure the pressure in the coronary artery only when the heart is relaxed and the coronary blood flow is high. As a result, a vasodilator drug is not needed. iFR has been validated in smaller trials and have been found to be equally good as FFR to detect ischemia, but larger randomized outcome trials are lacking. iFR-Swedeheart is a Scandinavian Registry-based Randomized Clinical Trial (RRCT) in which 2000 patients were randomized between iFR and FFR as strategies for performing assessment of narrowed coronary vessels. The primary composite endpoint at 12 months was all-cause death, non-fatal myocardial infarction, and unplanned revascularization. RRCT is a new trial design originating from Scandinavia using existing web-based national quality registries for online data entry, randomization and tracking of events. This allows for a very high inclusion rate and low costs to run clinical trials while ensuring robust data quality. (more…)
Author Interviews, Heart Disease, JACC / 19.03.2017

MedicalResearch.com Interview with: Raffaele De Caterina MD, PhD Professor of Cardiology and Director of the University Cardiology Division 'G d'Annunzio' University in Chieti MedicalResearch.com: What is the background for this study? What are the main findings? Response: The widely used term “valvular atrial fibrillation” encompasses a variety of conditions in which atrial fibrillation and valvular heart disease coexist. Since most trials of the non-vitamin K antagonist oral anticoagulants (NOACs) have variably excluded “valvular atrial fibrillation”, in more or less restrictive terms, there has been uncertainty whether NOACs can be used in such varied conditions. While atrial fibrillation in the presence of a mechanical valve or rheumatic mitral stenosis has to be a true contraindication (unfavorable data with one NOAC in the former setting; no data in the latter setting), patients with valvular diseases such as mitral insufficiency, aortic stenosis, aortic insufficiency, or with the presence of a bioprosthesis, have been variably included in the phase III trials of NOACs, but had not been extensively and conclusively studied before. (more…)
Author Interviews, Heart Disease, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Sung-Han Yoon MD Clinical Trials, Cardiology, Developmental Biology Cedars-Sinai Medical Center, Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) has become the standard treatment in inoperable patients in high surgical risk patients with symptomatic severe aortic stenosis (AS). However, major randomized trials excluded congenital bicuspid AS due to its unique morphological features. The indication of TAVR is expanding into a younger population, in which the frequency of bicuspid AS is higher. Therefore, we will encounter TAVR for bicuspid AS more frequently. However, the experience of TAVR in bicuspid AS is limited to small series. Therefore, we aim to evaluate the clinical outcomes of TAVR in bicuspid AS and compare them to tricuspid AS. (more…)
Author Interviews, Heart Disease, Imperial College, Medical Imaging, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Dr. Justin Davies PhD Senior Reserch Fellow and Hononary Consultant Cardiologist National Heart and Lung Institute, Imperial College London MedicalResearch.com: What is the background for this study? Response: We know from the FAME study that compared to angiography alone, FFR guided revascularization improves long-term clinical outcomes for our patients. Despite this, adoption of FFR into everyday clinical practice remains stubbornly low. One major factor for this is the need for adenosine (or other potent vasodilator medications) in order to perform an FFR measurement. Adenosine is expensive, unpleasant for the patient, time consuming and even potentially harmful. iFR is a newer coronary physiology index that does not require adenosine for its measurement. In the prospective, multi center, blinded DEFINE FLAIR study, 2492 patients were randomly assigned to either FFR guided revascularisation or iFR guided revascularization and followed up for a period of 1 year. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care / 19.03.2017

MedicalResearch.com Interview with: Marleen Boerma MD Department of Emergency Medicine Elisabeth-Tweesteden Hospital Tilburg, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED. This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor. (more…)
Author Interviews, Orthopedics / 19.03.2017

MedicalResearch.com Interview with: Michael Hausman, MD Chief, Hand and Upper Extremity Surgery Mount Sinai Health System Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lateral epicondylitis has traditionally been thought of as a tendon problem, but tendon pathology has not been well documented. Our study supports our hypothesis that the problem lies within the elbow joint, rather than in the tendon outside the joint. (more…)
Author Interviews, Opiods, Pain Research / 19.03.2017

MedicalResearch.com Interview with: Dr. Sommer Hammoud MD ABOS Board Certified Assistant Professor of Orthopedic Surgery Thomas Jefferson University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this exhibit stemmed from the growing problem of prescription opioid abuse in the United States.  As we saw this issue developing, we aimed to investigate the history behind this epidemic, what information we have now to fight it, and what information we need in the future to improve care our patients. Our main findings for each of those aims are the following: 1) It would appear that a large push at the end of the last century led to a lower threshold to prescribe opiates in the effort to control pain, leading to the current opioid epidemic 2) Mulitmodal methods of pain control and the expanding skill of regional anesthesia can be used to help decrease narcotic use and thus limit exposure to narcotics, and 3) Future research needs to focus on the psychologic aspect of patients' ability to manage pain and we should strive to be able to categorize patients in order to create an individualized pain management protocol which will most effectively manage pain. (more…)
Author Interviews, Cannabis, Heart Disease, Stroke / 19.03.2017

MedicalResearch.com Interview with: Aditi Kalla, MD Cardiology Research Fellow Einstein Medical Center Philadelphia MedicalResearch.com: What is the background for this study? Response: As of the recent 2016 election, decriminalization of cannabis passed in several states bringing the total count up to 28 states and D.C. where cannabis is now legal for medicinal and/or recreational purposes. From a physician’s perspective, it is rare that a drug has “hit the market” so to speak without undergoing clinical trials to determine safety and efficacy. Hence, we sought out to study if cannabis had any effects (positive or negative) on the cardiovascular system. (more…)
Author Interviews, Environmental Risks, Heart Disease, Medical Imaging / 19.03.2017

MedicalResearch.com Interview with: Dr. Marco Valgimigli, MD, PhD Interventional Cardiology Sandro Pertini Hospital, ASL RM2, Rome, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: Every year millions of people with coronary artery disease are treated worldwide with percutaneous coronary intervention (PCI). Radial access as compared to femoral access reduces bleeding and mortality in patients with acute coronary syndrome (ACS) undergoing invasive management. However, prior studies have raised concerns over the increased risk of radiation exposure for both patients and operators with radial instead of femoral access and it remains still unclear whether radial access increases the risk of operator or patient radiation exposure in contemporary practice when performed by expert operators. The MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial is the largest randomized trial comparing radial versus femoral access in ACS patients undergoing invasive management. In this radiation sub-study (RAD-MATRIX), we collected fluoroscopy time and dose area product (DAP) and equipped radial operators consenting to participate with dedicated dosimeters, each wearing a thorax (primary endpoint), wrist and head (secondary endpoints) lithium fluoride thermo luminescent dosimeter, during study conduct to establish non-inferiority of radial versus femoral access. Among eighteen operators, performing 777 procedures in 767 patients, the non-inferiority primary endpoint was not achieved. Operator equivalent dose at the thorax was significantly higher with radial than femoral access. After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ in the right radial compared to the left radial access. In the overall MATRIX population, fluoroscopy time and DAP were higher with radial as compared to femoral access. (more…)
Author Interviews, Orthopedics / 19.03.2017

MedicalResearch.com Interview with: Dr. Baron Lonner MD Professor of Orthopaedic Surgery Mount Sinai Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Adolescent idiopathic scoliosis is the most common form of scoliosis, lateral curvature of the spine, in the pediatric population. 2-3% of adolescents are affected and approximately 10% of patients require surgery. Operative treatment has traditionally involved a spinal fusion with the use of metallic implants. I personally have been practicing spine surgery with an emphasis on the treatment of the pediatric patient with scoliosis for over twenty years. During the course of my own practice, I have seen significant changes in the way my colleagues and I operatively manage adolescent idiopathic scoliosis (AIS). Being part of a group of surgeons from around the world who contribute clinical data on patients with AIS, with a database of nearly 3000 patients, a group called the Harms Study Group after Professor Jurgen Harms of Germany, an innovator in this area, and housed within the larger Setting Scoliosis Straight Foundation, I felt, now, as we reached the twenty year mark of data collection in January 2015, was the moment to look at trends in our collective experience. Our goal was to evaluate changes in the surgical approach to AIS over this time span and to assess whether or not these changes have been associated with improvements in outcomes for the patient including decreases in complication rates. Perhaps we could learn lessons from this data, contributed by leaders in the treatment of AIS, that might inform future innovations and to be confirmatory of the trajectory of our approach to these patients. (more…)
Author Interviews, Heart Disease, NYU, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Adam Skolnick, MD Cardiologist Associate professor of medicine NYU Langone Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings? Response: I am privileged to serve on the ACC Program Planning Committee and helped to design this important session that seeks to determine the line between when a cardiovascular procedure is high risk and when it is futile.    I am co-chairing the session with the incoming chair of the section on Geriatric Cardiology for the ACC, Dr. Karen Alexander from Duke. We are practicing medicine at one of the most extraordinary times when there are so many devices and procedures to prolong and improve quality of life.    It is critical to assess a patient's goals of care for a given intervention.   In some patients, particularly those who are multiple degenerative chronic conditions, are frail and/or have cognitive impairment it is difficult to know when a given procedure multiple medical conditions will achieve a patient's goals.   When is a procedure high risk, and when is it simply futile?    This is the fine line upon which many cardiologists often find themselves. The speakers present case examples of high risk patients considering TAVI, high risk PCI or CABG and mechanical support devices and with interaction from the audience work through when each procedure is high risk and when it is unlikely to achieve a patient's goals of care.   We also have a dedicated talk on high risk procedures in patients with cognitive impairment, such as advanced dementia. (more…)
Author Interviews, Heart Disease / 19.03.2017

MedicalResearch.com Interview with: Harmony Reynolds, MD Cardiologist Saul J. Farber Associate Professor of Medicine NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: Some patients with heart attack have open, rather than severely narrowed, coronary arteries when they have a heart attack. This type of heart attack, known as myocardial infarction with non-obstructive coronary arteries or MINOCA, can be caused by a number of different problems. Cardiac MRI is useful because it can help physicians to find the underlying cause of MINOCA. MINOCA patients with ST elevation on the ECG are at higher risk of death than those without ST elevation but it is not known whether ST elevation correlates with any specific underlying cause of MINOCA. (more…)
Author Interviews, CDC, Opiods, Pain Research / 19.03.2017

MedicalResearch.com Interview with: Anuj Shah (B.Pharm) Doctoral Student Division of Pharmaceutical Evaluation and Policy University of Arkansas for Medical Sciences MedicalResearch.com: What is the background for this study? Response: The CDC guideline on opioid prescribing, published in March 2016, included recommendations for initiation of opioid therapy. The guideline noted that there is a lack of data describing how acute opioid use transitions to long-term opioid use. This report seeks to address this gap by determining characteristics of initial opioid prescribing prognostic of long-term use, among opioid naïve cancer-free adults. (more…)
Author Interviews, Gastrointestinal Disease, Inflammation, Microbiome, Nature / 19.03.2017

MedicalResearch.com Interview with: Justin E. Wilson, Ph.D On behalf of the authors Research Assistant Professor - Laboratory of Jenny Ting Department of Genetics Lineberger Comprehensive Cancer Center The University of North Carolina at Chapel Hill Chapel Hill, NC 27599 MedicalResearch.com: Could you provide me with some background on this project? Why did you decide to do this research project? What prior work led up to this latest paper? Response: Previous work from our lab and others discovered two major points about NLRP12: a) NLRP12 suppresses inflammation in response to bacterial components b) NLRP12 provides protection against the inflammatory bowel disease colitis and colitis-associated colon cancer (i.e., Nlrp12-defcient mice have greater colon inflammation and inflammation-driven colon cancer). Therefore, we wanted to know if Nlrp12 was regulating inflammation in the colon by responding to the trillions of intestinal microbes collective referred to as the microbiome. Mounting evidence also indicates that the immune system both responds to and influences the composition of the intestinal microbiome during intestinal health and disease, and we hypothesized that NLRP12 could be one of the important immune components during this process. Moreover, we were also interested in this topic because targeting the microbiome to treat inflammatory disorders and other diseases is an attractive method that has many advantages over immune suppression. (more…)
Author Interviews, JAMA, Mental Health Research / 19.03.2017

MedicalResearch.com Interview with: Florian Walter MSc Centre for Mental Health and Safety University of Manchester, Manchester, England Dr Roger Webb PhD and Reader in Mental Health Epidemiology Senior Postgraduate Research Tutor Division of Psychology and Mental Health Faculty of Biology, Medicine and Health The University of Manchester MedicalResearch.com: What is the background for this study? Response: Mental disorders are associated with an elevated risk of premature mortality, and risk is especially heightened soon after discharge from inpatient psychiatric services. Previous studies have focused on single causes of death, whereas our study considered a comprehensive array of cause-specific mortality outcomes. We analysed over 1.7 million Danish residents in our national interlinked registry study, which was conducted collaboratively by the Centre of Mental Health and Safety, University of Manchester, UK and the National Centre for Register-based Research, Aarhus University, Denmark. We compared the risk of dying from specific natural and unnatural causes of death among patients following their first discharge from inpatient psychiatric care versus people not admitted. (more…)
Author Interviews, Nutrition / 19.03.2017

MedicalResearch.com Interview with: Lillian MacNell PhD Assistant Professor Department of Public Health Campbell University MedicalResearch.com: What is the background for this study? Response: There’s been a lot of research done on how to define and measure food deserts (areas with limited access to supermarkets), and some other studies on the dietary and related health effects of living in a food desert. But there’s been a lot less attention paid to how the people who live in those food deserts deal with this—how do they feel it affects them? How and where do they shop for food? In this study, we wanted to get a better understanding of the daily reality of living in a food desert and the strategies that people use to respond to low access to food. We interviewed 42 low-income mothers and grandmothers of young children in one urban food desert about this, and we also profiled the available food stores in the neighborhood to get a sense of what’s available for these families. One thing we found is that most of the food stores in the neighborhood were small corner and convenience stores; these rarely offered fresh fruits and vegetables, and only a few carried canned produce or other nutritious options like low-fat milk and wheat bread. When we did see those items in the neighborhood, they cost about 25% more than they did at the nearest supermarkets. So in terms of the environment, these women were working with fewer options at a higher price, unless they traveled outside of their neighborhoods to reach large supermarkets. (more…)
Author Interviews, Exercise - Fitness, Genetic Research, Heart Disease, JAMA, University of Michigan / 19.03.2017

MedicalResearch.com Interview with: Sara Saberi, MD Assistant Professor Inherited Cardiomyopathy Program Frankel Cardiovascular Center University of Michigan Hospital and Health Systems  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients with hypertrophic cardiomyopathy are often told not to exercise or to significantly curb their exercise due to concern over the potential risk of increased ventricular arrhythmias and sudden cardiac death. There is no data regarding risks/benefits of exercise in HCM though. There is, however, data that shows that patients with HCM are less active and more obese than the general population AND a majority feel that exercise restrictions negatively impact their emotional well-being. So, we devised a randomized clinical trial of a 16-week moderate-intensity aerobic exercise program versus usual activity with the primary outcome being change in peak VO2 (oxygen consumption). This exercise intervention resulted in a 1.27 mL/kg/min improvement in peak VO2 over the usual activity group, a statistically significant finding. There were no major adverse events (no death, aborted sudden cardiac death, appropriate ICD therapies, or sustained ventricular tachycardia). There was also a 10% improvement in quality of life as measured by the Physical Functioning scale of the SF-36v2. (more…)
Author Interviews, Dermatology, UCLA / 19.03.2017

MedicalResearch.com Interview with: Madalene Heng MD, FRACP, FACD, FAAD Professor of Medicine/Dermatology UCLA School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Curcumin, the active ingredient in the spice, turmeric, is an excellent anti-inflammatory agent with unique healing properties. However, this is only observed with our preparation of topical curcumin but not with oral curcumin. This is because curcumin is not absorbed and does not cross cell membranes - low bioavailability. The biochemical basis for the efficacy of topical curcumin is based on the fact that it is a phosphorylase kinase inhibitor. Phosphorylase kinase is an enzyme released by injured tissue 5 mins following injury, and is responsible for activating the transcription activator (NF-kB), resulting in turning on over 200 genes responsible for inflammation, and scarring among others, resulting in redness, swelling, pain, and eventually scarring. By blocking phosphorylase kinase activity early in the injury pathway, topical curcumin (curcumin gel) results in rapid healing with minimal or no scarring following many types of healing, including burns and scalds. The unique healing properties are also due to the fact that curcumin induces cell death (apoptosis) to damaged cells, resulting in the "space" for replacement by new healthy cells, resulting in normal appearing skin following burns and scalds. The salutary result depends on when the curcumin gel is applied - the earlier the better. We observed that when curcumin gel was applied within 4 days to second degree burns- hourly applications, tapering after the patient is improved - we observed rapid healing within 5 days, with the skin returning to normal within 6 weeks to 2 months without redness or visible scarring. Minor burns and scalds heal even more rapidly. Pain was improved within hours. MedicalResearch.com: What should readers take away from your report? Response: If the readers happen to have curcumin gel (Psoria-Gold) in their first aid kit, they should apply curcumin gel multiple times as soon as possible. Within the first hour, they should apply it every 5-10 mins, tapering off when the pain and swelling is improved. If they do this, it is possible that blistering may be aborted. The scarring is also minimal. The curcumin gel should be applied twice daily until the skin returns to normal (no redness, swelling, pigmentation etc) and no visible scarring is seen. (more…)
Author Interviews, Heart Disease, Medical Imaging, NEJM / 19.03.2017

MedicalResearch.com Interview with: Dr. Matthias Götberg MD PhD Department of Cardiology, Clinical Sciences Lund University, Skåne University Hospital Lund, Sweden MedicalResearch.com: What is the background for this study? Response: Cardiologists encounter patients with narrowing of the coronary arteries on a daily basis. They typically use visual estimation of the severity of narrowing when performing coronary angiography, but it is difficult to accurately assess, based on a visual estimation alone, whether a stent is needed to widen the artery and allow the blood to more freely. FFR (Fractional Flow Reserve) is more precise tool and results in better outcomes than using angiography alone to assess narrowing of the coronary arteries. With FFR, the doctor threads a thin wire through the coronary artery and measures the loss of blood pressure across the narrowed area. To acquire an accurate measurement, the patient must be given adenosine, which is a drug that dilates the blood vessels during the procedure. This drug causes discomfort; patients describe having difficulty breathing or feeling as if someone is sitting on their chest. The drug also adds to the cost of the procedure and can have other rare but serious side effects. iFR (Instantaneous Wave-Free Ratio) is also based on coronary blood pressure measurements using a thin wire, but unlike FFR, it uses a mathematical algorithm to measure the pressure in the coronary artery only when the heart is relaxed and the coronary blood flow is high. As a result, a vasodilator drug is not needed. iFR has been validated in smaller trials and have been found to be equally good as FFR to detect ischemia, but larger randomized outcome trials are lacking. iFR-Swedeheart is a Scandinavian Registry-based Randomized Clinical Trial (RRCT) in which 2000 patients were randomized between iFR and FFR as strategies for performing assessment of narrowed coronary vessels. The primary composite endpoint at 12 months was all-cause death, non-fatal myocardial infarction, and unplanned revascularization. RRCT is a new trial design originating from Scandinavia using existing web-based national quality registries for online data entry, randomization and tracking of events. This allows for a very high inclusion rate and low costs to run clinical trials while ensuring robust data quality.  (more…)
Author Interviews, NYU, Smoking, Surgical Research, Tobacco Research / 17.03.2017

MedicalResearch.com Interview with: Amy Wasterlain, MD Fourth-year orthopaedic surgery resident NYU Langone Medical Center who led the study with Dr. Richard Iorio  MedicalResearch.com: What is the background for this study? Response:  We looked at smoking habits and outcomes for 539 smokers undergoing primary total hip or knee arthroplasty, 73 of whom participated in a pre-operative smoking cessation program. Patients who participated in program were 4.3 times more likely to quit than smokers who tried to quit on their own. Program participants also reduced their tobacco intake dramatically (10.6 fewer cigarettes/day) compared to smokers who didn’t participate (2.3 fewer cigarettes/day), even if they weren’t able to quit completely. Patients who completed the program before undergoing total knee arthroplasty had about 24% fewer adverse events (readmission, venous thromboembolism, stroke, urinary tract infection, pneumonia, and surgical site infection) than smokers who didn’t participate in the program. (more…)
Author Interviews, Dermatology, JAMA / 17.03.2017

MedicalResearch.com Interview with: Dr. Alex M. Glazer MD National Society for Cutaneous Medicine New York, New York  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We had previously studied the geographic distribution of dermatologists throughout the United States which revealed that dermatologists are unevenly geographically distributed throughout the country, with many regions having fewer than the 4 providers per 100,000 people needed to adequately care for a population. Because of the influx of PAs and NPs into the healthcare workforce throughout the past decade, we wanted to see how these providers were supplementing dermatologic care. The main finding of our study is that dermatology PAs are helping to supplement dermatologists and together are providing broader, more uniform coverage across the United States (more…)
Author Interviews, Electronic Records / 17.03.2017

MedicalResearch.com Interview with: Neil Smiley CEO of Loopback Analytics MedicalResearch.com: What is the background for Loopback Analytics? What are the problems Loopback Analytics is attempting to mitigate? Response: Loopback Analytics (Loopback) is a Software-as-a-Service company that provides event-driven population health management. Founded in 2009, Loopback integrates and manages diverse data sources to support predictive analytics and intervention solutions to address health reform reimbursement challenges with the goal of achieving the Triple Aim – better care, better health and lower costs. Loopback enabled intervention solutions address key challenges associated with value-based care, such as reducing avoidable hospitalizations, high emergency department utilization, medication adherence and optimization of post-acute care networks. (more…)
Author Interviews, Orthopedics, Outcomes & Safety / 17.03.2017

MedicalResearch.com Interview with: Brad Parsons, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: As bundled payment initiatives increase in order to contain health care costs, total shoulder arthroplasty (TSA) is a likely future target. Understanding modifiable drivers of complications and unplanned readmission as well as identifying when such events occur will be critical for orthopedic surgeons and hospitals to improve outcomes and to make fixed-price payment models feasible for TSA. Utilizing the American College of Surgeons National Surgical Quality Improvement Program we identified 5801 patients that underwent TSA with a 2.7% readmission rate and 2.5% severe adverse event rate. Patients with 3 or more risk factors were found to have a significantly increased risk of readmission and severe adverse events within the first two weeks postoperatively. (more…)
Addiction, Author Interviews, Cost of Health Care / 17.03.2017

MedicalResearch.com Interview with: Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder. We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending. (more…)
Allergies, Author Interviews, Cost of Health Care, Pediatrics / 17.03.2017

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