Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 31.10.2017

MedicalResearch.com Interview with: Philipp Gerner MD Candidate - Class of 2018 University of Massachusetts Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids. As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients. Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain.
Author Interviews, Mental Health Research, Nature / 30.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37766" align="alignleft" width="127"]Hyun Ji Noh PhD Postdoc in the Genome Sequencing and Analysis Program Broad Institute of MIT and Harvard Dr. Hyun Ji Noh[/caption] Hyun Ji Noh PhD Computational Scientist, Medical and Population Genetics Broad Institute of MIT and Harvard MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder, characterized by intrusive thoughts and repetitive behaviors. OCD is estimated to affect roughly 80 million people worldwide, but its neurobiology remains poorly understood. To understand the disorder’s underpinnings, we searched for genetic mutations that are associated with OCD. For this, we first identified 608 genes that were most likely to be important  in OCD - some that have previously been identified in OCD-like behaviors in dogs and mice, and others in human autism, which also involves repetitive behaviors. We compared these genes in 592 people with OCD and 560 people without OCD, and found that 4 of these genes were significantly different between people with and without OCD: NRXN1, HTR2A, CTTNBP2 and REEP3. All of these four genes have important functions in the brain. Specifically, we found that the variants in NRXN1 are likely to change its ability to bind other synaptic proteins. Synaptic proteins link neurons together, and are critical for transmitting signals through the brain. We also found that the variants in CTTNBP2 and REEP3 don’t actually change the proteins made by these genes, but instead probably affect gene regulation (for example, how much of the protein is made). These ‘regulatory’ variants disrupt the binding of transcription factors (proteins that regulate expression of genes in the body) near the gene.
Author Interviews, Brain Injury, Exercise - Fitness / 30.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37762" align="alignleft" width="150"]Michael D. Cusimano MD, FRCSC, DABNS, FACS, PhD, MHPE Adjunct Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital Division of Neurosurgery, St. Michael\'s Hospital Professor of Neurosurgery, Education and Public Health University of Toronto Dr. Cusimano[/caption] Michael D. Cusimano MD, FRCSC, DABNS, FACS, PhD, MHPE Adjunct Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital Division of Neurosurgery, St. Michael\'s Hospital Professor of Neurosurgery, Education and Public Health University of Toronto MedicalResearch.com: What is the background for this study? Response: Baseball is played by millions annually and is traditionally seen as a low risk sport for head injury when compared to sports like American Football, Ice Hockey and Rugby. Over 6 million children and youth are enrolled in formal baseball or softball leagues annually.
Author Interviews, Cancer Research, Lancet / 30.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37758" align="alignleft" width="110"]Dr Miranda M Fidler, PhD Section of Cancer Surveillance International Agency for Research on Cancer Lyon, France  Dr. Fidler[/caption] Dr Miranda M Fidler, PhD Section of Cancer Surveillance International Agency for Research on Cancer Lyon, France  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The burden of cancer among young adults has been rarely studied in depth. To our knowledge, we describe for the first time the scale and profile of cancer incidence and mortality worldwide among 20-39 year-olds, highlighting major patterns by age, sex, development level, and geographic region. Although cancer is less frequent than that observed at older ages, its impact remains considerable because these individuals have a large proportion of their expected lifespans remaining, contribute substantially to the economy, and play a major role in caring for their families. Worldwide, almost 1 million new cases of cancer and 400 000 cancer-related deaths occurred among young adults aged 20–39 years in 2012. Overall, the most common cancer types in terms of new cases were female breast cancer, cervical cancer, thyroid cancer, leukemia, and colorectal cancer, and the most common types of cancer-related deaths were those due to female breast cancer, liver cancer, leukemia, and cervical cancer. The burden was disproportionately greater among women, with an estimated 633 000 new cancer cases (65% of all new cancer cases in that age group) and 194 000 cancer-related deaths (54% of all cancer-related deaths in that age group) in 2012.
Author Interviews, Breast Cancer, OBGYNE / 30.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37778" align="alignleft" width="150"]Hatem A. Azim Jr, MD, PhD Adjunct Assistant Professor, American University of Beirut (AUB) Beirut, Lebanon  Dr. Azim[/caption] Hatem A. Azim Jr, MD, PhD Adjunct Assistant Professor, American University of Beirut (AUB) Beirut, Lebanon  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study aimed at evaluating the safety of pregnancy after breast cancer particularly in patient with history of ER+ breast cancer; a subset in which safety of future pregnancy is always put into question by oncologists and obstetricians. This study included more than 300 pregnant women and 800 non-pregnant breast cancer patients who acted as a comparator group The results show that after more than 7 years after pregnancy, women who became pregnant did not have an increased risk of recurrence compared to those who did not become pregnant irrespective of ER status. There was no impact of breastfeeding, abortion or time of pregnancy on patient outcome.
Author Interviews, Health Care Systems, Hospital Readmissions / 30.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37751" align="alignleft" width="148"]Hsueh-Fen Chen, Ph.D. Associate Professor Department of Health Policy and Management College of Public Health University of Arkansas for Medical Sciences Little Rock, AR 72205 Dr. Chen[/caption] Hsueh-Fen Chen, Ph.D. Associate Professor Department of Health Policy and Management College of Public Health University of Arkansas for Medical Sciences Little Rock, AR 72205 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Centers for Medicare and Medicaid Services announced the Hospital Readmissions Reduction Program (HRRP) and Hospital Value-based Purchasing (HVBP) Program in 2011 and implemented the two programs in 2013. These two programs financially motivate hospitals to reduce readmission rates and improve quality of care, efficiency, and patient experience. The Mississippi Delta Region is one of the most impoverished areas in the country, with a high proportion of minorities occupying in the region.  Additionally, these hospitals are  safety-net resources for the poor. It was largely unknown what the financial performance for the hospitals in the Mississippi Delta Region was under the HRRP and HVBP programs.

Dr. Chen and colleagues in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences compared the financial performance between Delta hospitals and non-Delta hospitals (namely, other hospitals in the nation) from 2008 through 2014 that were covered before and after the implementation of the HRRP and HVBP programs. The financial performance was measured by using the operating margin (profitability from patient care) and total margin (profitability from patient care and non-patient care)

Before the implementation of the HRRP and HVBP programs, Delta hospitals had weaker financial performance than non-Delta hospitals but their differences were not statistically significant. After the implementation of the HRRP and HVBP programs, the gap in financial performance between Delta and non-Delta hospitals became wider and significant. The unadjusted operating margin for Delta hospitals was about -4.0% in 2011 and continuously fell to -10.4% in 2014, while the unadjusted operating margin for non-Delta hospitals was about 0.1% in 2011 and dropped to -1.5% in 2014. The unadjusted total margin for Delta hospitals significantly fell from 3.6% in 2012 to 1.1% in 2013 and reached 0.2% in 2014, while the unadjusted total margin for non-Delta hospitals remained about 5.3% from 2012 through 2014. After adjusting hospital and community characteristics, the difference in financial performance between Delta and non-Delta remained significant.

Author Interviews, Breast Cancer / 30.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37747" align="alignleft" width="100"]Judith A. Malmgren, PhD President, HealthStat Consulting, Inc Epidemiology Department University of Washingto Dr. Malmgren[/caption] Judith A. Malmgren, PhD President, HealthStat Consulting, Inc Epidemiology Department University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Metastatic breast cancer (MBC) has two types, de novo stage IV MBC discovered to be metastatic at initial diagnosis as advanced disease and recurrent MBC found on follow up after diagnosis and treatment for initial invasive breast cancer. Our institutional breast cancer registry tracks both de novo metastatic breast cancer and invasive breast cancer for distant metastases. With this information we were able to compare the presentation, treatment and outcomes of both types, something that is not possible in national SEER data as recurrent MBC is not tracked. We found a remarkable improvement in 5-year survival from 28% to 55% over time among the de novo metastatic breast cancer patients.  Recurrent MBC 5-year survival did not improve in the same time period (23% to 13%) although incidence of recurrent MBC fell from 18% to 7% from 1990 to 2010. Incidence of recurrent metastatic breast cancer hormone receptor and HER2 positive breast cancer declined the most, leaving a large number of triple-negative recurrent metastatic breast cancer cases in the most recent time period. Worse metastatic breast cancer survival was associated with recurrent vs. de novo MBC, hormone receptor negative disease, older age (70+) and visceral dominant disease. HER2 positive disease was associated with better outcomes.
ASCO, Author Interviews, Cancer Research, Electronic Records, University Texas / 29.10.2017

MedicalResearch.com Interview with: Dr. Ali Haider, MBBS MD Assistant Professor, Department of Palliative Care and Rehabilitation Medicine Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston, TX  MedicalResearch.com: What is the background for this study? Response: Patients with chronic and serious illnesses such as cancer often experience high physical and psychosocial symptoms. Recent studies have reported association of physicians' examination room computer use with less face to face interactions and eye contact. It's important for the clinicians to look for certain physical cues to better understand the well being of their patients. Therefore we conducted this randomized clinical trial to understand patients perception of physicians compassion, communication skills and professionalism with and without the use of examination room computer.
Author Interviews, Heart Disease, JAMA, Pulmonary Disease, Vanderbilt / 27.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37714" align="alignleft" width="112"]Dr. Evan L. Brittain, MD Assistant Professor of Medicine Vanderbilt University School of Medicine Dr. Brittain[/caption] Dr. Evan L. Brittain, MD Assistant Professor of Medicine Vanderbilt University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The purpose of this study was to determine whether pulmonary pressure values below the diagnostic threshold for pulmonary hypertension (25mmHg) are associated with an increased risk of mortality. We studied over 4,000 consecutive individuals referred for right heart catheterization, the “gold-standard” procedure for measuring pulmonary pressure. We found that borderline levels of mean pulmonary pressure (19-24mmHg) were common, representing 18% of all patients referred for this procedure. Borderline mean pulmonary pressure values were also associated with 31% increase in mortality after accounting for many other clinical factors. Finally, we found that most of the patients with borderline pulmonary hypertension who underwent repeat catheterization often progressed to overt pulmonary hypertension. This study suggests that patients with borderline pulmonary hypertension should be considered an at-risk group.
Author Interviews, Heart Disease, JAMA / 27.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37742" align="alignleft" width="200"]Elad Asher, M.D, M.H.A Interventional Cardiologist, Director Intensive Cardiac Care Unit Deputy Director Heart Institute Assuta Ashdod Medical Cent Dr. Asher[/caption] Elad Asher, M.D, M.H.A Interventional Cardiologist, Director Intensive Cardiac Care Unit Deputy Director Heart Institute Assuta Ashdod Medical Center MedicalResearch.com: What is the background for this study? Response: Dual antiplatelet therapy represents the standard care for treating ST elevation myocardial infarction (STEMI) patients. Given the higher risk of peri-procedural thrombotic events in patients undergoing primary percutaneous coronary intervention (PPCI), there is a need to achieve inhibition of platelet aggregation (IPA) more promptly. Although chewing ticagrelor has been shown to be more efficient for IPA in stable coronary disease and in patients with acute coronary syndrome (ACS)/non-ST elevation myocardial infarction (NSETMI), there are no studies that have specifically assessed the efficacy and safety of chewing ticagrelor in STEMI patients. Therefore, the aim of our study was to investigate whether chewing ticagrelor (180mg) loading dose is associated with more favorable platelet inhibitory effects compared with the conventional way of swallowing whole tablets loading dose in STEMI patients undergoing PPCI.
Aging, Author Interviews, BMJ, Cost of Health Care, Exercise - Fitness, Social Issues / 27.10.2017

MedicalResearch.com Interview with: Dr. Scarlett McNally Consultant Orthopaedic Surgeo Eastbourne D.G.H. MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are vast differences between older people in their abilities and their number of medical conditions. Many people confuse ageing with loss of fitness. Ageing has specific effects (reduction in hearing and skin elasticity for example) but the loss of fitness is not inevitable. Genetics contributes only 20% to diseases. There is abundant evidence that adults who take up physical activity improve their fitness up to the level of someone a decade younger, with improvements in ‘up and go’ times. Physical activity can reduce the severity of most conditions, such as heart disease or the risk of onset or recurrence of many cancers. Inactivity is one of the top four risk factors for most long-term conditions. There is a dose-effect curve. Dementia, disability and frailty can be prevented, reduced or delayed. The need for social care is based on an individual’s abilities; for example, being unable to get to the toilet in time may increase the need for care from twice daily care givers to needing residential care or live-in care, which increases costs five-fold. Hospitals contribute to people reducing their mobility, with the ‘deconditioning syndrome’ of bed rest, with 60% of in-patients reducing their mobility. The total cost of social care in the UK is up to £100 billion, so even modest changes would reduce the cost of social care by several billion pounds a year.
Author Interviews, Cognitive Issues, Heart Disease / 26.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37734" align="alignleft" width="200"]Dr. Leif Friberg MD, PhD Associate professor in cardiology Karolinska Institute Friberg Resarch Stockholm, Sweden  Dr. Leif Friberg[/caption] Dr. Leif Friberg MD, PhD Associate professor in cardiology Karolinska Institute Friberg Resarch Stockholm, Sweden  MedicalResearch.com: What is the background for this study? What are the main findings? Response: I have been doing research on atrial fibrillation and stroke risk for many years and knew that the very common heart arrhythmia is associated with a 40% increased risk of dementia. Considering that that 12-15% of 75 years olds have this arrhythmia, and even more at higher ages, the problem is significant to say the least. The mechanism behind stroke in atrial fibrillation is that blood clots are formed in the heart. When these are dislodged they travel with the blood stream and may get stuck in the narrow vessels of the brain where they stop blood flow causing brain infarction or stroke. Oral anticoagulant drugs like warfarin or the newer so called NOAC (new oral anticoagulant) drugs are highly efficient in preventing formation of these large blood clots and offer at least 70% risk reduction. Now, blood clots come in different sizes. There are also microscopic clots that do not cause symptoms of stroke but all the same eat away at the brain at a slow but steady pace. Imaging studies shows this after only a few months or even weeks of atrial fibrillation. Our hypothesis was therefore: If anticoagulants are so effective in protecting against large clots, will they not help against the small ones too?
AHA Journals, Author Interviews, Heart Disease, Thyroid, UCSF / 26.10.2017

MedicalResearch.com Interview with: Christine Baumgartner MD Inselspital Universitätsspital Bern Bern, Switzerland Research Fellow, Division of Hospital Medicine UCSF MedicalResearch.com: What is the background for this study? What are the main findings? Response: Overt and subclinical hyperthyroidism increase the risk of atrial fibrillation, but it is unclear whether subclinical hypothyroidism, which is known to increase cardiovascular events, or thyroid function in the normal range are also associated with incident atrial fibrillation. Given the high prevalence of atrial fibrillation and its associated morbidity and mortality, identifying potentially modifiable risk factors is important. Therefore, we aimed to assess the risk of atrial fibrillation in individuals with subclinical hypothyroidism or variations of thyroid function within the normal range. Our main findings are that higher free thyroxine levels are associated with an increased risk of atrial fibrillation in euthyroid individuals, but thyroid-stimulating hormone levels within the euthyroid or subclinical hypothyroid range was not related to atrial fibrillation risk.
Author Interviews, Dermatology, Environmental Risks, Pediatrics / 26.10.2017

MedicalResearch.com Interview with: Erik Stratman, MD Chairman, Department of Dermatology Marshfield Clinic, WI MedicalResearch.com: What is the background for this study? What are the main findings? Response: The United States Food and Drug Administration has classified tanning beds as cancer-causing. Tanning bed exposure has been linked with increased risk of melanoma, a deadly form of skin cancer that preferentially affects young people.  While no current federal ban exists on indoor tanning of minors, there have been over 40 states (43) and the District of Columbia that passed laws limiting the use of tanning beds for minors.  Despite these laws, nearly 1.9 million high school students in the United States are tanning in tanning salons. In this study, researchers posed as minors called 427 tanning salons in 42 states and the District of Columbia.  Following a script that included questions like ‘would my mom have to come with me? I was hoping to come after school.’ Salons were randomly selected by zip code, with 10 salons selected for each state.  Overall, 37.2% of tanning salons were out of compliance with state legislation. Illinois, New Hampshire, and Oregon were the only states scoring 100% compliant with the state law for those tanning salons contacted.  Alabama scored the lowest with 0% compliant for those tanning salons contacted.  Statistically significant decreases in compliance were found for rural, independently owned, and Southern US tanning salons.
Author Interviews, Epilepsy, NEJM, Neurological Disorders, Pediatrics, Surgical Research / 25.10.2017

MedicalResearch.com Interview with: Dr. Manjari Tripathi Professor, Epileptology, Neurology Dr. P Sarat Chandra, Chief epilepsy Neurosurgeon AIIMS, New Delhi MedicalResearch.com: What is the background for this study?:
  1. Surgery for drug resistant epilepsy (DRE) is an accepted procedure for children and there have been multiple surgical series and surgical techniques published in literature. However, till date there are no randomized controlled trials (RCT) available to objectively demonstrate the safety and efficacy of surgical therapy in children with DRE. There are till date only 2 randomized trials for adult patients with drug resistant epilepsy (both for mesial temporal sclerosis only, Wiebe S et al, New Eng J Med, 2001 & Engel J et al, JAMA, 2012).
  2. Children constitute a significant proportion of patients undergoing surgical therapy for DRE (close to 50% in tertiary centers). They have unique problems associated due to uncontrolled epilepsy and some of these include epileptic encephalopathy and status epilepticus. In addition, surgery is also associated with problems like hypothermia, issues related to blood loss etc. Thus the senior author (Manjari Tripathi) and her team felt that a RCT would be very important to objectively assess the role of surgery and hence designed this study.
Author Interviews, Heart Disease, JAMA / 25.10.2017

[caption id="attachment_37719" align="alignleft" width="150"]Hawkins C. Gay, MD, MPH Resident Physician, Internal Medicine Feinberg School of Medicine Northwestern University  Dr. Gay[/caption] MedicalResearch.com Interview with: Hawkins C. Gay, MD, MPH Resident Physician, Internal Medicine Feinberg School of Medicine Northwestern University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The National Academy of Medicine and other leading institutions have highlighted clinical trial data sharing as an important initiative for enhancing trust in the clinical research enterprise. More recently, the International Committee of Medical Journal Editors stipulated that manuscripts published in their journals must clearly state plans for data sharing in the trial’s registration, and the National Institutes of Health now requires a data sharing plan as part of new grant applications. Many clinical trialists rightly debate the costs and time required to curate their data into a format that is usable by third part data analysts. Similarly, there has been debate about the most efficient platforms from which to distribute this data, and different models exist, including governmental (NIH BioLINCC), commercial (ClinicalStudyDataRequest.com), and academic (Yale Open Access Data Project [YODA]) platforms. Our study sought to explore these questions by conducting a reproduction analysis of the Thermocool Smarttouch Catheter for Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial (NCT01385202), which is the only cardiovascular clinical trial available through the YODA platform. Reproduction analyses represent a fundamental approach for and outcome from data sharing but are uncommonly performed even though results change more than one-quarter of the time in reproduction analyses. SMART-AF was a multicenter, single-arm trial evaluating the effectiveness and safety of an irrigated, contact force-sensing catheter for ablation of drug refractory, symptomatic paroxysmal atrial fibrillation in 172 participants recruited from 21 sites between June 2011 and December 2011. The time from our initial proposal submission to YODA and the final analysis completion was 11 months. Freedom from atrial arrhythmias at 12 months post-procedure was similar compared with the primary study report (74.0%; 95% CI, 66.0-82.0 vs 76.4%; 95% CI, 68.7-84.1). The reproduction analysis success rate was higher than the primary study report (65.8%; 95% CI 56.5-74.2 vs 75.6%; 95% CI, 67.2-82.5). Adverse events were minimal and similar between the two analyses. We could not reproduce all analyses that were conducted in the primary study report; specifically, the analyses relating to contact force range and regression models. The primary reason for non-reproducibility was missing or un-locatable data in the analyzable dataset.
Author Interviews, Biomarkers, Heart Disease, JACC, Karolinski Institute / 25.10.2017

MedicalResearch.com Interview with: Martin Holzmann PhD Department of Medicine Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge Stockholm, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been a few studies in the general population that indicate that subjects with detectable and elevated high-sensitivity troponin T (hs-cTnT) levels have an increased risk of death and cardiovascular disease. However, in clinical practice troponins are not used for anything else than to rule in or rule out myocardial infarction in the emergency department. In addition, in a previous publication we have shown that patients with persistently elevated troponin levels are rarely investigated or followed-up to exclude heart disease. Therefore, we wanted to investigate how the association between different levels of hs-cTnT are associated with outcomes in patients with chest pain but no MI or other acute reasons for having an acutely elevated troponin level.
Author Interviews, JAMA, Kidney Disease, Surgical Research / 25.10.2017

MedicalResearch.com Interview with: In Gab Jeong, MD Associate Professor Department of Urology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea MedicalResearch.com: What is the background for this study? What are the main findings? Response: Use of robotic surgery has increased in urological practice over the last decade especially for the surgery that was difficult to perform with laparoscopic techniques such as radical prostatectomy for prostate cancer or partial resection of kidney cancer. However, the use, outcomes, and costs of robotic nephrectomy are unknown. We examined the trend in use of robotic-assisted operations for radical nephrectomy in the United States and compared the perioperative outcomes and costs with laparoscopic radical nephrectomy. The proportion of radical nephrectomies using robotic-assisted operations increased from 1.5% in 2003 to 27.0% in 2015. Although there was no significant difference between robotic-assisted vs laparoscopic radical nephrectomy in major postoperative complications, robotic-assisted procedures were associated with longer operating time and higher direct hospital costs. The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519).
AHRQ, Author Interviews, Health Care Systems, Opiods / 24.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37708" align="alignleft" width="150"]Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 Dr. Elixhauser[/caption] Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hospital inpatient data began using ICD-10-CM (I-10) codes on October 1, 2015.  We have been doing analysis using the new codeset to determine to what extent we can follow trends crossing the ICD transition—do the trends look consistent when we switch from I-9 to I-10?  Tracking the opioid epidemic is a high priority so we made this one of our first detailed analyses.  We were surprised to find that hospital stays jumped 14% across the transition, compared to a 5% quarterly increase before the transition (under I-9) and a 3.5% quarterly increase after the transition (under I-10).  The largest increase (63.2%) was for adverse effects in therapeutic use (side effects of legal drugs), whereas stays involving opioid abuse decreased 21% and opioid poisoning (overdose) decreased 12.4%.
Author Interviews, Biomarkers, Prostate Cancer / 24.10.2017

MedicalResearch.com Interview with: Zahava Berkowitz, MSPH, MSc Statistician Division of Cancer Prevention and Control Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? Response: The US Preventive Services Task Force 2017 draft prostate cancer screening recommendations  suggest that clinicians inform men aged 55–69 years about the potential benefits and harms of PSA-based screening for prostate cancer. The CDC conducted an analysis using the National Health Interview Surveys in 2005, 2008, 2010, 2013, and 2015 to describe trends in the receipt of routine PSA testing in the past year by age group (40–54, 55–69, ≥70 years) and by risk group. We compared routine PSA screening among higher risk men (defined as African American men or men with a family history of prostate cancer) with other men. The analysis was conducted because CDC wanted to examine how the guidelines affect men at higher risk. The 2017 guideline did not include specific guidelines for African American men who have a higher incidence of prostate cancer than white men, more likely to develop prostate cancer at a young age, more likely to have a high-risk diagnosis and die from prostate cancer.
AACR, Alzheimer's - Dementia, Author Interviews, Cancer Research, Cognitive Issues, Colon Cancer, UCSF / 24.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37702" align="alignleft" width="112"]Yingjia Chen, M.Sc, MPH, Ph.D. Postdoctoral Fellow University of California, San Francisco Dr. Chen[/caption] Yingjia Chen, M.Sc, MPH, Ph.D. Postdoctoral Fellow University of California, San Francisco  MedicalResearch.com: What is the background for this study? Response: Both colon cancer and dementia are prevalent among the elderly and have a high risk of co-occurrence. Previous studies found that patients with dementia were treated less aggressively. In this study, we hypothesized that presence of pre-existing dementia was associated with worse survival for stage III colon cancer patients, and that post-operative chemotherapy was on the causal pathway.
Abuse and Neglect / 24.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37698" align="alignleft" width="262"]Ben-Gurion University of the Negev student researcher Shir Kashi interacts with robotic arm as part of her research in personalizing human-robot interactions to develop an interactive movement protocol for rehabilitation. Ben-Gurion University of the Negev student researcher Shir Kashi interacts with robotic arm as part of her research in personalizing human-robot interactions to develop an interactive movement protocol for rehabilitation.[/caption] Shelly Levy-Tzedek, PhD Head of the Cognition, Aging and Rehabilitation Lab Faculty of Health Sciences, Dept. of Physical Therapy & The Zlotowski Center for Neuroscience The Ben Gurion University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Following brain injury, patients who need to practice their physical therapy exercises at home. Many don’t practice enough or at all at home, and so we are designing robot companions to encourage them to practice and to track their progress. This study is a first step towards this goal. Here, we studied how people played a leader-follower mirror game with a robotic arm, where a person and robot took turns following each other's joint movements patterns. When the robotic arm was leading, it performed movements that were either sharp, like dribbling a ball, or smooth, like tracing a circle.
Author Interviews, Salt-Sodium, University of Michigan / 23.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37686" align="alignleft" width="101"]Julia Wolfson, PhD MPP Assistant Professor Department of Health Management and Policy Department of Nutritional Sciences University of Michigan School of Public Health Ann Arbor, MI 48109 Dr. Wolfson[/caption] Julia Wolfson, PhD MPP Assistant Professor Department of Health Management and Policy Department of Nutritional Sciences University of Michigan School of Public Health Ann Arbor, MI 48109 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the past several years, Large chain restaurants in the United States have made some progress in introducing new lower calorie items on their menus. Since 2012, calories of items consistently on restaurant menus in all years have not significantly change. In this study, we examined the sodium content of restaurant menu items among 66 of the 100 largest restaurants in the US. We examined sodium content among items on the menu in all years (2012-2016) and among newly introduced items in 2013, 2014, 2015 and 2016 compared to items on the menu in 2012 only. We found that sodium content of menu items on the menu in all years did not change, but that restaurants were introducing new, lower sodium menu items. However, sodium content of restaurant menu items remains high. This is important because diets high in sodium are associated with serious adverse health outcomes including hypertension, stroke and cardiovascular disease.
Author Interviews, Hepatitis - Liver Disease / 23.10.2017

MedicalResearch.com Interview with:
[caption id="attachment_37692" align="alignleft" width="112"]Donna R. Cryer, JD CEO, Global Liver Institute Donna Cryer JD[/caption] Donna R. Cryer, JD
CEO, Global Liver Institute
MedicalResearch.com: What is the background for this Council? Response: The Global Liver Institute operates my constantly assessing the liver health landscape for what we call advocacy gaps to determine where we allocate our time and resources. We identified NASH 2 years ago as an imminent global public health crisis due to the tens of millions of diagnosed and estimated undiagnosed patients rising with rates of obesity and diabetes with no concomitant recognition and activity by public, patients, or physicians. We decided to launch the NASH Council with collaborative patient and physician leadership and involving Hepatology but deliberately reaching out to primary care, endocrine, cardiology, and obesity organizations.
Author Interviews, Gastrointestinal Disease, Pharmaceutical Companies, University of Michigan / 23.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37675" align="alignleft" width="106"]William D. Chey Dr. Chey[/caption] William D. Chey, M.D., F.A.C.G. Timothy T. Nostrant Professor of Gastroenterology & Nutrition Director, Digestive Disorders Nutrition & Lifestyle Program Michigan Medicine Ann Arbor, Michigan  MedicalResearch.com: What is the background for this study? Response: Functional Dyspepsia (FD) has been characterized as recurring indigestion with no known organic cause and is an area of high unmet medical need. This medical condition, which is non-life threatening, can have a significant impact on an individual’s quality of life. It remains poorly recognized and presents a significant management challenge for providers and patients. Gastrointestinal symptoms can include epigastric pain or discomfort, inability to finish a normal-sized meal, heaviness, pressure, nausea, bloating and belching. Currently, there are no FDA-approved drugs for FD. Off-label medications are used to treat the condition and patient dissatisfaction remains high.[1] In a real-world, observational study, called FDACT™ (Functional Dyspepsia Adherence and Compliance Trial), we analyzed information on the frequency of FD symptoms, daily consumption of capsules, onset of action, improvement in FD symptoms, quality of life and patient satisfaction among 600 patients who took FDgard®, a nonprescription medical food specially formulated for the dietary management of FD.
Author Interviews, PLoS, Stem Cells / 23.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37669" align="alignleft" width="150"]Serge Horbach MSc Institute for Science in Society Radboud University Nijmegen Serge Horbach[/caption] Serge Horbach MSc Institute for Science in Society Radboud University Nijmegen   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Since the late 60s, researchers have pointed to issues in biomedical research stemming from the misidentification of cells. Starting with controversy around HeLa cells, researchers became aware of cells invading other cell cultures. Currently, 488 cell lines have become mixed up with the wrong cells, still often HeLa cells. This leads to errors in reporting research. For example, some research papers have reported results for "lung cancer cells" that turned out to be liver cancer cells, or even mouse cells. We wanted to know what happened to past research and set out to estimate the number of scientific publications affected by misidentified cells. By tracing misidentified cells of the ICLAC database in Web of Science, we found 32.755 contaminated publications, or 0,8% of all literature in cell biology. These articles are cited by at least 500.000 other publications. More worryingly, it turned out that this problem is highly stubborn. Currently, still a few dozen new articles are published every month reporting on other cells than were actually used, leading to a total of 1200 each year. And this number is not decreasing, in spite of a database of misidentified cells, of genetic testing availability, requirements by some prominent journals, or attention for the problem in the literature. We were also able to establish that this is not just a problem for newly emergent countries in the international research community, but also for countries with well-establishments research traditions. In spite of great efforts, the problem of cell misidentification is not at all solved.
Author Interviews, Heart Disease / 22.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37661" align="alignleft" width="138"]Parveen K. Garg, MD, MPH Assistant Professor of Clinical Medicine Keck Hospital of USC  Dr. Garg[/caption] Parveen K. Garg, MD, MPH Assistant Professor of Clinical Medicine Keck Hospital of USC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial fibrillation is the most commonly presenting cardiac arrhythmia in clinical practice, affecting over 2 million people in the United States. This arrhythmia accounts for up to 15% of all strokes and annual costs for AF treatment are estimated at over 6.5 billion dollars. Despite the growing public health challenge that AF poses, effective prevention strategies are lacking. In 2010, the American Heart Association identified metrics of ideal cardiovascular health known as Life’s Simple 7 to target for the primary prevention of cardiovascular disease. We wanted to determine whether adherence to these health metrics helps prevent atrial fibrillation as well. Therefore, we examined the association between the Life’s Simple 7 (LS7) and incident atrial fibrillation in the REasons for Geographic And Ethnic Differences in Stroke (REGARDS) study. We found that individuals in this study with optimal cardiovascular health (high adherence to LS7 metrics) had an over 30% lower risk of developing atrial fibrillation compared to those with inadequate cardiovascular health (low adherence to LS7 metrics). We also observed that even minor improvements in adherence to the LS7 (increase in total score by 1-point) were associated with a 5% lower risk of atrial fibrillation.
Author Interviews, Brain Injury, Exercise - Fitness, Pediatrics / 21.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37562" align="alignleft" width="100"]Jingzhen (Ginger) Yang, PhD, MPH Principal Investigator Associate Professor, Center for Injury Research and Policy The Research Institute at Nationwide Children’s Hospital Dept. of Pediatrics, College of Medicine, The Ohio State University Columbus, Ohio 43205 Dr. Yang[/caption] Jingzhen (Ginger) Yang, PhD, MPH Principal Investigator Associate Professor, Center for Injury Research and Policy The Research Institute at Nationwide Children’s Hospital Dept. of Pediatrics, College of Medicine, The Ohio State University Columbus, Ohio 43205  MedicalResearch.com: What is the background for this study? Response: From 2009-2014, all 50 states and the District of Columbia passed their state TBI laws, more commonly known as concussion laws, to mitigate severe consequences of concussions. These laws often include 3 core components: (1) mandatory removal from play following actual or suspected concussions, (2) requirements to receive clearance to return to play from a licensed health professional, and (3) education of coaches, parents, and athletes regarding concussion symptoms and signs. Our study aimed to evaluate whether the laws achieve the intended impact. MedicalResearch.com: What are the main findings? Response: The main findings showed that:
  • The rates of new and recurrent concussions initially increase significantly after a law goes into effect. This is likely due to more people – athletes, athletic trainers, coaches, and parents – becoming aware of the signs and symptoms of concussion and actually reporting a potential or actual concussion. Lack of knowledge about concussion signs and symptoms may have resulted in underreporting of concussions during the prelaw period. This trend is consistent across sports in our study and other studies looking at youth sports-related concussions.
  • The rate of recurrent concussions shows a significant decline approximately 2 ½ years after the law is in place. This demonstrates that the laws are having an impact. One of the core function of these laws is to reduce the immediate risk of health consequences caused by continued play with concussion or returning to play too soon without full recovery. The decline in recurrent concussion rates in our study is likely the results of the laws requirements of mandatory removal from play or permission requirements to return to play.
  • Football had the highest average annual concussion rate, followed by girls’ soccer and boys’ wrestling. Males had a higher average annual concussion rate than females. However, when comparing the rates in gender comparable sports (basketball, soccer, baseball/softball), females had almost double the annual rate of concussions as males. These results are consistent with findings from other studies. It is possible that girls have higher risk of concussions than boys or are more likely to report injuries. Future studies are needed to look specifically at these disparities.
Author Interviews, OBGYNE / 21.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37616" align="alignleft" width="160"]Jenna Jerman Senior Research Associate Guttmacher Institute New York, NY   10038 Jenna Jerman[/caption] Jenna Jerman Senior Research Associate Guttmacher Institute New York, NY   10038 MedicalResearch.com: What is the background for this study? What are the main findings? Response:   Abortion is a critical component of public health. The objectives of this study were to assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014, as well as to provide an updated estimate of the lifetime incidence of abortion. To estimate abortion rates, we used data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth; the estimate of the lifetime incidence of abortion used data from the Abortion Patient Survey. Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1,000 women aged 15 to 44.  Abortion rates declined among all groups of women, though declines steeper for some populations than others. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-white women than for non-Hispanic white women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women in that year will have an abortion by age 45.
Author Interviews, Heart Disease / 20.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37652" align="alignleft" width="157"]Deepika Laddu PhD Assistant Professor Department of Physical Therapy College of Applied Health Sciences The University of Illinois at Chicago Chicago, IL 60612 Dr. Laddu[/caption] Deepika Laddu PhD Assistant Professor Department of Physical Therapy College of Applied Health Sciences The University of Illinois at Chicago Chicago, IL 60612  MedicalResearch.com: What is the background for this study? Response: Recent findings in population-based cohort studies on cumulative exercise dose have caused some controversy and debate showing U-shaped trends of association between physical activity and disease risk. Our objective was to better understand this association between physical activity and cardiovascular disease risk from young adulthood to middle age. Given that engagement in physical activity is a continuously evolving behavior throughout life, this study looked at the physical activity trajectories of 3,175 black and white participants in the multicenter, community-based, longitudinal cohort CARDIA study who reported physical activity patterns over 25 years (from 1985 through 2011), and assessed the presence of coronary artery calcification, or CAC, among participants. Unique to this study is the evaluation of long-term exercise patterns from young adulthood into middle age in CARDIA participants. Based on the trajectories (or patterns of change) of physical activity over 25 years, participants were categorized into three distinct trajectory groups: trajectory group one was defined as exercising below the national guidelines (less than 150 minutes a week), group two as meeting the national guidelines for exercise (150 minutes a week), and group three as exercising three-times the national guidelines (more than 450 minutes a week).