Author Interviews, BMJ, Mental Health Research, Sleep Disorders / 26.08.2016

MedicalResearch.com Interview with: Donna Littlewood PhD School of Health Sciences Faculty of Biology, Medicine and Health The University of Manchester MedicalResearch.com: What is the background for this study? What are the main findings? Response: This was the first qualitative study to examine the role of sleep problems in relation to suicidal thoughts and behaviours. In-depth semi-structured interviews were conducted with 18 participants, who all had experienced major depressive episode(s) and suicidal thoughts and behaviours. Data were analysed with thematic analysis which identified three interrelated pathways whereby sleep contributed to suicidal thoughts and behaviours. The first was that being awake at night heightened the risks of suicidal thoughts and attempts, which in part was seen as a consequence of the lack of help or resources available at night. Secondly, the research found that a prolonged failure to achieve a good night's sleep made life harder for respondents, adding to depression, as well as increasing negative thinking, attention difficulties and inactivity. Finally, participants said sleep acted as an alternative to suicide, providing an escape from their problems. However, the desire to use sleep as an avoidance tactic led to increased day time sleeping which in turn caused disturbed sleeping patterns - reinforcing the first two pathways. (more…)
Author Interviews, Environmental Risks, Infections / 26.08.2016

MedicalResearch.com Interview with: Lin Op De Beeck, PhD student Laboratory of Aquatic Ecology, Evolution and Conservation University of Leuven Leuven, Belgium MedicalResearch.com: What is the background for this study? Response: Mosquitoes transmit quite a few deadly diseases, including West Nile Virus. Around the world, therefore, the fight against these insects is high on the agenda. Existing strategies for mosquito control often involve the use of chemical pesticides that harm the environment. These pesticides are increasingly less effective as well, as insects can become resistant to existing products relatively quickly. Biopesticides are a possible alternative. The most commonly used biological pesticide is the Bacillus thuringiensis israelensis (Bti) bacteria. Unfortunately, mosquitoes are already developing resistance to this pesticide as well. This means we have to keep increasing the dose of Bti to kill mosquitoes, so that this biological substance, too, is beginning to harm the environment. Therefore we set out to find a new strategy in the fight against mosquitoes. We already knew that chemical substances emitted by the backswimmer – a natural enemy of mosquito larvae in the water – trigger a stress response in mosquitoes. This stress response, in turn, suppresses the mosquito’s immune system. What makes the use of these predator cues even more interesting for mosquito control is that scientists recently found a way to produce a synthetic version of these chemical substances. We discovered that this synthetic version triggers a stress response in the mosquitoes and impairs their immune system, just like the natural predator cues. This gave us the idea to combine these synthetic predator cues with the biological pesticide Bti. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Genetic Research, JAMA, NEJM / 26.08.2016

MedicalResearch.com Interview with: Prof. Laura van ’t Veer, PhD Leader, Breast Oncology Program, and Director, Applied Genomics, UCSF Helen Diller Family Comprehensive Cancer Center Angela and Shu Kai Chan Endowed Chair in Cancer Research UCSF Helen Diller Family Comprehensive Cancer Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: MINDACT was designed to involve only patients with node negative and 1 to 3 positive lymph node breast cancer. Node negative breast cancer is a cancer that has not spread to the surrounding lymph nodes and therefore has a lower risk of recurrence. Scientists have also demonstrated that breast cancer which has spread to 1 to 3 lymph nodes may behave like node negative breast cancer. Patients with either node negative cancer or with a cancer that involves 1-3 lymph nodes are often prescribed chemotherapy, although physicians believe that approximately 15% of them do not require such treatment. MINDACT provides the highest level of evidence to show that using MammaPrint® can substantially reduce the use of chemotherapy in patients with node-negative and 1-to-3 node positive breast cancer – in other words, it can identify patients with these types of breast cancer who can safely be spared a treatment that may cause significant side effects, and will offer no to very little benefit. (more…)
Author Interviews, Cancer Research, Immunotherapy / 26.08.2016

MedicalResearch.com Interview with: Dr Charles Akle, Chairman and Linda Summerton, CEO Immodulon Therapeutics Short Hills, NJ 07078 and London, UKDr Charles Akle, Chairman and Dr. Linda Summerton, CEO Immodulon Therapeutics Short Hills, NJ 07078 and London, UK MedicalResearch.com: What is the background for Immodulon? Would you tell us a little about Dr. Charles Akle? Response: Immodulon was established in November 2007. The founder and Chairman, Dr Charles Akle, was a Harley Street surgeon and pioneer of keyhole surgery who established Immodulon with the financial support of a former patient. His interest in immunology led him to the potential of cancer immunotherapy long before the term “immuno-oncology” was coined and when skepticism, rather than optimism was the norm. His ambition from the start was to develop an affordable immunotherapy treatment that would transform the way that cancer is treated in the world today. Since then, Immodulon has become a leading, independent biopharmaceutical company with one of the longest running research projects into how to harness the power of the immune system in treating cancer. It also has its own R&D and manufacturing capability in Lyon, France. The wider Immodulon senior team has extensive experience of bringing drugs to market and includes Dr James Shannon and Dr Jean Pierre Bizzari. (more…)
Author Interviews, Orthopedics / 26.08.2016

MedicalResearch.com Interview with: Brandon J. Erickson, MD Midwest Orthopaedics Rush, Rush University Medical Center Chicago, IL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Ulnar collateral ligament reconstruction (UCLR), also known as Tommy John surgery has become a common procedure amongst major league baseball (MLB) pitchers. It is unclear if a limit on innings pitched following Tommy John surgery should be instituted to prevent revision Tommy John surgery. The purpose of this study was to determine if innings pitched following Tommy John surgery is associated with an increased risk of revision Tommy John surgery amongst MLB pitchers. To answer this question we located all MLB pitchers between 1974-2015 who pitched at least one full season following their Tommy John surgery and included them in our analysis. Pitch counts and innings pitched for the first full season following Tommy John surgery as well as total pitch count and total innings pitched over the course of the player’s career were recorded. Pitch counts and innings pitched were compared amongst players who required revision Tommy John surgery and those who did not. We were able to include 154 pitchers. Of these, 135 pitchers did not require revision Tommy John surgery while 19 underwent revision Tommy John surgery.  No significant difference existed between pitchers who underwent revision Tommy John surgery and those who did not when comparing number of innings pitched in the season following Tommy John surgery,  number of pitches thrown in the season following Tommy John surgery,  number of innings pitched in the pitcher’s career following Tommy John surgery and number of pitches thrown in the pitcher’s career following Tommy John surgery.  Furthermore, no difference existed in revision rate between pitchers who pitched more or less than 180 innings in the first full season following Tommy John surgery. (more…)
Author Interviews, Primary Care / 25.08.2016

MedicalResearch.com interview with: Diane Hayes, Ph.D., President and co-founder, InCrowd Areal time market intelligence service to the life sciences MedicalResearch.com: What is the background for this survey? Response: Physician burnout is a significant concern across the healthcare continuum, as Affordable Care Act (ACA) measures change the nature of doctoring, and as at least 30 major teaching hospitals at least 30 major teaching hospitals undertake initiatives aimed at reducing burnout ahead of its potential impact on patient safety and quality outcomes. Numerous studies have documented the issue. We thought it would be instructive to use InCrowd’s mobile microsurvey platform for a mid-year snapshot of burnout sentiment. The microsurvey used the Maslach Burnout Inventory of symptoms to determine respondents who could be considered to be experiencing burnout—the same index as used by the widely cited Mayo Clinic and MedScape studies. We also asked if facilities are addressing the issue, a topic not always covered. (more…)
Author Interviews, Cancer Research, Chemotherapy, JAMA / 25.08.2016

MedicalResearch.com Interview with: Leni van Doorn, MSc Department of Medical Oncology Erasmus MC Cancer Institute Rotterdam, the Netherlands MedicalResearch.com: What is the background for this study? Response: The common cancer treatment capecitabine, a regular treatment for patients mostly diagnosed with breast-, colon- or gastic cancer, induces hand foot syndrome (HFS). HFS is a cutaneous condition that may lead to red palms and blisters in approximately 50% to 60% of the patients and is believed to result in the loss of fingerprints. This fingerprint loss has been described sporadically in the literature. The main aim of our prospective study was to have a closer look of the association between  hand foot syndrome and the loss of fingerprints. (more…)
AHA Journals, Author Interviews, Emory, Heart Disease / 25.08.2016

MedicalResearch.com Interview with: Alvaro Alonso, MD, PhD Associate Professor Department of Epidemiology Rollins School of Public Health Emory University Atlanta, GA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sudden cardiac death (SCD) is a major public health problem. Each year, 300,000-400,000 Americans experience SCD and, in more than half of these cases, sudden cardiac death is the first manifestation of heart disease. To date, however, we lack effective strategies to identify those at higher risk of developing sudden cardiac death so targeted preventive strategies can be applied. In this study, we develop and validate the first model for the prediction of SCD in ~18,000 adults without a prior history of cardiovascular disease. We show that information on demographic variables (age, sex, race), some traditional cardiovascular risk factors (smoking, elevated blood pressure, diabetes, HDL cholesterol) as well as some factors more specifically related to SCD causes (electrocardiogram QT interval) and novel biomarkers (albumin, potassium in blood, kidney function) can be leveraged to predict risk of SCD and identify individuals more likely to suffer this event. (more…)
Author Interviews, Radiology, Zika / 25.08.2016

MedicalResearch.com Interview with: Fernanda Tovar Moll, MD, PhD Vice president of the D'Or Institute for Research and Education Professor,Federal University of Rio de Janeiro Rio de Janeiro, Brazil MedicalResearch.com: What is the background for this study? Response: The consequences of congenital zika virus infection are still under investigation. Recent studies suggest microcephaly as one of the consequences, but we wanted to go deeper in investigating what other kinds of neurological changes could happen in the developing central nervous system. Based on that, we performed a cohort study with multimodal images exams and longitudinal follow up (pre and post natal analyses) of some cases. (more…)
Author Interviews, Cancer Research, Weight Research / 25.08.2016

MedicalResearch.com Interview with: Beatrice Lauby-Secretan, PhD IARC – Section IMO (International Agency for Research on Cancer) Lyon, France MedicalResearch.com: What is the background for this study? Response: The IARC Handbook of Cancer Prevention Series perform systematic reviews and evaluations of the cancer-preventive effects of interventions and strategies. The summary article published today presents the conclusions of a Working Group of experts who examined and assessed the currently available literature on the link between overweight/obesity and cancer. Thus this is not a single study, but the report on more than 1000 individual studies. (more…)
Allergies, Asthma, Author Interviews, Pediatrics / 25.08.2016

MedicalResearch.com Interview with: David A. Hill, M.D., Ph.D. Fellow Physician Division of Allergy and Immunology The Children's Hospital of Philadelphia Philadelphia, PA 19104-3375 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Eczema, asthma, allergic rhinitis, and food allergies are among the most common childhood medical conditions in the United States. Importantly, disease rates for these conditions are thought to be changing, prompting the need for continued surveillance. In our study, we examined electronic medical record data of over 1 million children to measure incidence and prevalence rates of these conditions in our community. We found that 1 in 5 children seen in our network are diagnosed with asthma, a rate that is among the highest in the nation. Additionally, the large size of our study allowed us to measure the extent to which food allergies are associated with asthma or allergic rhinitis. In this analysis, we found that children with food allergies are 2 to 3 times more likely to develop asthma or allergic rhinitis, as compared with children without food allergy. (more…)
Author Interviews, Depression, Heart Disease, HIV, Vanderbilt / 25.08.2016

MedicalResearch.com Interview with: Matthew S Freiberg, MD, MSc Cardiovascular Medicine Division, Vanderbilt University School of Medicine Tennessee Valley Geriatric Research Education and Clinical Center, Nashville  TN Tasneem Khambaty, PhD Department of Psychology, University of Miami, Coral Gables, Florida Jesse C. Stewart, PhD Department of Psychology, Indiana University–Purdue University , Indianapolis, Indianapolis MedicalResearch.com: What is the background for this study? Response: Due to highly effective antiretroviral therapy, people with HIV are living longer. Unfortunately, these HIV-infected individuals remain at a higher risk for other chronic diseases, with cardiovascular disease (CVD) being one of the leading cause of death in this population. In the general population, depressive disorders, such as major depressive disorder (MDD) and dysthymic disorder, are associated with increased risk of new-onset CVD. Given that roughly 24-40% of HIV-infected individuals have a depressive disorder, we examined whether MDD and dysthymic disorder are also associated with an increased risk of new-onset CVD in people with HIV. (more…)
Author Interviews, Mental Health Research / 25.08.2016

MedicalResearch.com Interview with: Ian Rockett, PhD, MPH, FACE Professor, Department of Epidemiology School of Public Health West Virginia University Morgantown, WV MedicalResearch.com: What is the background for this study? Response: Self-injury deaths in the United States are seriously underestimated because they are officially limited to registered suicides, and exclude non-suicide deaths from drug self-intoxication. Suicides themselves are undercounted due primarily to under-resourcing of medical examiner and coroner offices and associated challenges in detecting drug suicides. Although most drug-intoxication deaths involve deliberate behaviors that markedly elevate risk of premature death, they are formally classified, but mischaracterized, as “accidents” on death certificates. Representing self-injury mortality (SIM) as a combination of registered suicides and estimated deaths from drug self-intoxication (DDSI), this study compared its national trends and patterns with those of 3 proximally ranked top 10 causes of death. (more…)
Author Interviews, Autism, Diabetes, Mental Health Research / 25.08.2016

MedicalResearch.com Interview with: Evdokia Anagnostou MD Canada Research Chair (Tier II) in Translational Therapeutics in Autism Senior Clinician Scientist and co-lead of the Autism Research Centre Holland Bloorview Kids Rehabilitation Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Researchers from Holland Bloorview Kids Rehabilitation Hospital / University of Toronto (Canada), Ohio State University, University of Pittsburgh, Columbia University, and Vanderbilt University, led a double-blind, placebo-controlled randomized clinical trial to examine whether metformin, a common type-2 diabetes drug, may be effective in counteracting weight gain commonly seen with the use of atypical antipsychotic medications, indicated by the FDA for the treatment of irritability in children and youth with autism spectrum disorder (ASD). Results showed that metformin was effective in helping overweight children and adolescents with autism spectrum disorder (ASD) who take antipsychotic medications lower their body mass index (BMI). Both FDA-approved antipsychotic medications for treating irritability and agitation symptoms in children and adolescents with ASD can cause a significant increase in weight gain, which in addition to increasing BMI, enhances long-term risk of diabetes. This complicates an already challenging issue as adolescents with autism spectrum disorder are ~ two times more likely to be obese than adolescents without developmental disabilities. Findings of this research are important, especially for families of children with ASD, as managing long-term physical health while also treating irritability/agitation symptoms, can help ensure that their child can participate fully in life (school, etc.). (more…)
Author Interviews, Columbia, Heart Disease, JAMA, Medical Imaging / 25.08.2016

MedicalResearch.com Interview with: Adam Castano, M.D., M.S. Division of Cardiology Columbia University Medical Center New York Presbyterian Hospital MedicalResearch.com: What is the background for this study? Response: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF). Traditionally, the gold standard for diagnosis has required an endomyocardial biopsy coupled with either immunohistochemistry or mass spectroscopy. These specialized tests are only performed at centers with experienced satff, do not yield prognostically useful information, may be inadvisable for frail older adults, and often present logistical challenges that lead to delayed care. Fortunately, single center studies have demonstrated excellent diagnostic accuracy using technetium 99m pyrophosphate (Tc99mPYP) cardiac imaging for noninvasively detecting ATTR-CA and differentiating it from another major type of cardiac amyloidosis called light chain (AL). But the diagnostic accuracy of this technique in a multicenter study and the association of Tc99mPYP myocardial uptake with survival were not known prior to this study. Therefore, we assessed in a multicenter study Tc99mPYP cardiac imaging as a diagnostic tool and its association with survival. We conducted a retrospective cohort study of 229 patients evaluated at 3 academic specialty centers for cardiac amyloidosis and also underwent Tc99mPYP cardiac imaging. We measured retention of Tc99mPYP in the heart using a semiquantitative visual score (range 0-3) and a more quantitative heart-to-contralateral (H/CL) ratio calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc99mPYP imaging. (more…)
Author Interviews, Cancer Research, JAMA / 25.08.2016

MedicalResearch.com Interview with: Dr. Aaron Mitchell MD Hematology/Oncology Fellow University North Carolina MedicalResearch.com: What is the background for this study? Response: It is well known that many physicians work with the pharmaceutical industry. In some cases, this can create conflicts of interest with physicians' other responsibilities. The Open Payments law, passed as part of the Affordable Care Act, recently made these relationships public, which now allows us to study them more systematically. (more…)
Author Interviews, Dermatology, JAMA / 25.08.2016

MedicalResearch.com Interview with: Lisa Earnest Ishii, M.D. Associate Professor, Department of Otolaryngology-Head and Neck Surgery Division of Facial Plastic and Reconstructive SurgeryJohns Hopkins School of Medicine Baltimore Maryland 21287 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hair transplantation for men suffering from male pattern hair loss is a common procedure to improve their appearance. However, to the best of our knowledge the impact of the procedure for men with hair loss had never been clearly demonstrated. We showed, for the first time, that men who undergo the procedure can have real improvements in attractiveness, age, and the appearance of successfulness as perceived by the casual observer in society. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Chemotherapy, Nature / 25.08.2016

MedicalResearch.com Interview with: Shyamala Maheswaran, PhD Associate Professor of Surgery Harvard Medical School Assistant Molecular Biologist Center for Cancer Research MedicalResearch.com: What is the background for this study? What are the main findings? Response: About 85% hormone receptor positive HER2 negative metastatic breast cancer patients show that cancer cells acquire HER2 expression during disease progression. These HER2 positive cells coexist with HER2 negative cancer cells, and these two populations are able to spontaneously oscillate between these two states; in culture and in cancers established in mice. Both HER2 positive and HER2 negative cells form tumors when injected into mice, but HER2 positive cancer cells form tumors more rapidly than HER2 negative tumors. At a molecular level, several growth factor pathways are activated in HER2 positive cancer cells, while activation of the Notch pathway, an embryonic signaling event, is observed in HER2 negative cells. Thus the HER2 positive and HER2 negative cancer cells exhibit differential sensitive to drugs: the HER2 positive cells, which are more proliferative and non-responsive to HER2-targeting agents, are responsive to chemotherapy drugs whereas the HER2 negative tumor cells are sensitive to Notch inhibitors. A combination of chemotherapeutic drugs and notch inhibitors effectively eliminate tumors formed by a mixture of these two population of cancer cells compared to either drug alone. These findings highlight the importance of tumor heterogeneity in cancer progression and drug responses and suggest that targeting all the different populations within cancers is necessary to effectively manage cancer progression. (more…)
Author Interviews, Diabetes, Diabetologia, Nutrition, Weight Research / 25.08.2016

MedicalResearch.com Interview with: Jaime Uribarri, MD Professor, Nephrology Icahn School of Medicine Mt. Sinai Medical Center MedicalResearch.com: What is the background for this study? Response: We have been doing research in the area of dietary advanced glycation end-products (AGEs) for many years. AGEs are chemical compounds that form normally in the body in small amounts and also in food when cooking under high heat and dry conditions; a percent of AGEs in food is absorbed and part of it is retained in the body leading to increased smoldering inflammation and oxidative stress that eventually produce most of modern chronic diseases such as diabetes, cardiovascular disease, dementia, etc. We have previously demonstrated that a diet low in AGEs, which essentially means changing the cooking methods to include less application of heat, plenty of water,etc, decreases inflammation of oxidative stress in people with diabetes, chronic kidney disease and in healthy subjects. In the current study we applied the same low dietary AGE intervention to a group of obese patients with the so-called Metabolic syndrome, a risk factor for Diabetes Mellitus. (more…)
Author Interviews, Dermatology, Diabetes, Heart Disease, JAMA, Medical Imaging, NIH / 24.08.2016

MedicalResearch.com Interview with: Nehal N. Mehta, .MD., M.S.C.E. F.A.H.A. Lasker Clinical Research Scholar Section of Inflammation and Cardiometabolic Diseases NIH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Psoriasis is associated with accelerated cardiovascular (CV) disease; however, screening for CV risk factors in psoriasis remains low. Coronary artery calcium (CAC) score estimates the total burden of atherosclerosis. Psoriasis has been associated with increase CAC score, but how this compares to patients with diabetes, who are aggressively screened for CV risk factors, is unknown. (more…)
Author Interviews, Lancet, Stroke / 24.08.2016

MedicalResearch.com Interview with: Dr Alexander Kunz MD Department of Neurology Charité-University Medicine Berlin Berlin, Germany MedicalResearch.com: What is the background for this study? Response: Systemic thrombolysis with tissue plasminogen activator (tPA) in acute ischemic stroke has been an approved therapy for over 20 years now. To date, tPA can be administered to eligible patients within a 4.5 hours time window after the onset of symptoms. Results from large thrombolysis trials and meta-analyses have shown, that the beneficial effects of tPA are inversely correlated with the delay from symptoms onset to start of tPA treatment. This relationship is frequently summarized in the slogan “Time is brain!” Currently, several research groups are evaluating the concept of pre-hospital thrombolysis using a mobile stroke treatment unit (MSTU) in order to achieve significant reductions in onset-to-treatment delays. MSTU are specialized ambulances equipped with a CT scanner and a mini-laboratory. In Berlin, Germany, we have been operating an MSTU (stroke emergency mobile vehicle, STEMO) since 2011. Previous studies had shown that start of tPA treatment was 25min earlier when patients were cared by STEMO than within conventional care, i.e. admission to hospital by regular ambulance and in-hospital tPA treatment. However, these studies did not prove, that earlier treatment in STEMO is associated with better outcome. Therefore, the aim of the current study was to compare 3-month functional outcome after tPA in patients with acute ischemic stroke who received STEMO care vs conventional care. (more…)
Author Interviews, Fertility, OBGYNE, PNAS / 23.08.2016

MedicalResearch.com Interview with: Peter Sutovsky PhD Professor of Animal Science in the College of Agriculture, Food and Natural Resources University of Missouri Professor of Obstetrics, Gynecology and Women’s Health at the School of Medicine University of Missouri Health System MedicalResearch.com: What is the background for this study? What are the main findings? Response: Strictly maternal inheritance of mitochondria, the cellular power stations, and mitochondrial genes that mitochondria harbor, is a major biological paradigm in mammals. Propagation of paternal, sperm-contributed mitochondrial genes, resulting in a condition called heteroplasmy, is seldom observed in mammals, due to post-fertilization elimination sperm mitochondria, referred to as “sperm mitophagy.” Our and others’ recent results suggest that this process is mediated by the synergy of ubiquitin–proteasome system (UPS) pathway that recycles outlived cellular proteins one molecule at a time, and autophagic pathway capable of engulfing and digesting an entire mitochondrion. Here we demonstrate that the co-inhibition of the ubiquitin-binding autophagy receptor proteins SQSTM1, GABARAP, and UPS, and the UPS protein VCP dependent pathways delayed the digestion of sperm mitochondria inside the fertilized pig egg. By manipulating said proteins, we created heteroplasmic pig embryos with both the paternal and maternal mitochondrial genes. Such animal embryos that could be used as a biomedical model to research and alleviate certain forms of mitochondrial disease. (more…)
Allergies, Author Interviews, Infections / 23.08.2016

MedicalResearch.com Interview with: Emily L. Heil, PharmD, BCPS-AQ ID Assistant Professor Department of Pharmacy Practice and Science University of Maryland School of Pharmacy 20 N Pine St Baltimore, Maryland 21201 MedicalResearch.com: What is the background for this study? Response: As many as nine out of ten people who think they are allergic to penicillin are, in fact, not allergic when penicillin allergy skin testing is performed. This mistaken belief, confirmed in multiple other studies and a matter of concern of the U.S. Centers for Disease Control and Prevention (CDC), has widespread implications given that patients who report penicillin allergies tend to get suboptimal antibiotic therapy compared with patients who do not. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious disease (ID) fellow managed PST program and to assess the need for PST via national survey. Our study found that inpatient Penicillin skin testing can be successfully managed by ID fellows, thereby promoting optimal antibiotic use. Our study showed that by testing patients for penicillin allergy via skin test, we could improve their care: 80 percent of patients were able to switch to more effective antibiotic therapy once they were tested. (more…)
Author Interviews, Lipids, Pharmacology / 23.08.2016

MedicalResearch.com Interview with: Prof. Dr. Ioana Gouni-Berthold MD Center for Endocrinology, Diabetes and Preventive Medicine (ZEDP) University of Cologne Cologne, Germany MedicalResearch.com: What is the background for this study? Response: In Europe, up to half of the population aged between 35 and 64 has hypercholesterolemia (high levels of low-density lipoprotein cholesterol [LDL-C]), putting them at risk of heart disease. Despite increased treatment rates in recent years, many patients still do not receive adequate therapy, and heart disease remains the biggest cause of death in the USA and most European countries. Two drugs, alirocumab and evolocumab, have recently been approved for lowering LDL-C in patients with hypercholesterolaemia as an ‘add-on’ therapy to other lipid-lowering medication, or for use alone in patients unable to tolerate statins. These drugs have a unique mode of action– they inhibit proprotein convertase subtilisin/kexin type 9 (PCSK9), a protein that binds to LDL receptors and targets them for degradation. In the absence of PCSK9, the LDL receptor recycling is restored and the receptors are able to remove LDL from the blood. Both alirocumab and evolocumab have been tested in numerous patient populations in phase 3 trials; albeit evolocumab has an additional indication of homozygous familial hypercholesterolemia. We therefore felt that there was a need to collate the available data to assess the efficacy and safety of each agent. We chose reduction in LDL-C as our outcome of interest, because this was the primary endpoint of the pivotal clinical trials. (more…)
Author Interviews, JAMA, Kidney Disease / 23.08.2016

MedicalResearch.com Interview with: Fan Fan Hou Chief, Division of Nephrology, Nanfang Hospital Professor of Medicine, Southern Medical UniversityFan Fan Hou MD Chief, Division of Nephrology, Nanfang Hospital Professor of Medicine, Southern Medical University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous trials (HOST and DIVINe) of folic acid therapy in CKD patients were conducted in patients with advanced CKD and treated with super-high dose of vitamin B or with cyanocobalamin that has been shown to be renal toxic. The current study sought to evaluated the efficacy of folic acid therapy without cyanocobalamin on renal outcomes in patients without folic acid fortification and across a spectrum of renal function at baseline from normal to moderate CKD. We found that treatment with enalapril-folic acid, as compared with enalapril alone, reduced the risk of progression of CKD by 21% and the rate of eGFR decline by 10% in hypertensive patients. More importantly, the presence of CKD at baseline was a significant modifier of the treatment effect (p for interaction = 0.01). Patients with CKD benefited most from the folic acid therapy, with a 56% and 44% reduction in the risk for progression of CKD and the rate of eGFR decline, respectively. In contrast, the renal protective effect in those without CKD was nominal. (more…)
Addiction, Author Interviews, Compliance, Opiods, Pharmacology / 23.08.2016

MedicalResearch.com Interview with: F. Leland McClure III, MSci, PhD, F-ABFT Medical science liaison director Quest Diagnostics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many physicians associate Quest Diagnostics with their lab service needs because of our leadership in laboratory testing. But Quest is more than a lab, which is why we refer to ourselves as a diagnostic information services provider. This means that we help providers, health plans and even patients use the insights we derive from our lab testing data to deliver better care, quality and outcomes, both for the patient and the managed population. Our 2016 Quest Diagnostics Health Trends(TM) Prescription Drug Monitoring Report is an example of how we provide important health insights from Quest's laboratory data. Prescription drug misuse is a major epidemic in the United States. Laboratory testing can help identify if a patient is using or misusing prescribed medications. For instance, lab tests can show evidence of additional medications and other drugs in a patient’s urine specimen, suggesting potentially dangerous drug combinations. Earlier this year, the CDC issued guidelines that call for laboratory testing for patients prescribed certain medications, such as opioids, that carry a risk of abuse. Quest's prescription drug monitoring services help the physician identify if a patient is taking or not taking up to about four dozen drugs, such as oxycodone, Adderall XR® and Percocet®. For the Quest analysis, we analyzed more than 3 million de-identified lab test results. In this report, we found that 54 percent of patients’ results tested in 2015 showed evidence of drug misuse, slightly above the 53 percent misuse rate in 2014. That is certainly unacceptably high, but it’s a significant decline from the high of 63 percent we observed in 2011. We also found that an increasing proportion of patients who misuse medications combine their prescription medication with non-prescribed drugs. Among patients with inconsistent test results, forty-five percent of these patients showed evidence of one or more other drug(s) in addition to their prescribed drug regimen. That’s much higher than our findings of 35 percent in 2014 and 2013, 33 percent in 2012, and 32 percent in 2011. Finally, we were alarmed by the data showing the connection between heroin and benzodiazepines misuse. Our data showed one in three heroin users combine their drug use with benzodiazepines, the vast majority of which were unprescribed. This is an extremely dangerous practice given that benzodiazepines can have strong respiratory depressant effects when combined with other substances. Drug combinations, but particularly of heroin with benzodiazepines, can be potentially very dangerous, leading to coma and even death in some cases. (more…)
Author Interviews, CDC, Ophthalmology / 23.08.2016

MedicalResearch.com Interview with: Dr. Jennifer Cope MD, MPH Medical Epidemiologist CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 41 million people in the United States wear contact lenses, a safe and effective form of vision correction if worn and cared for as directed. Contact lenses are medical devices that are regulated by the Food and Drug Administration (FDA). Adverse events related to contact lenses are reported to FDA’s Medical Device Report (MDR) database. During 2005–2015, a total of 1,075 Medical Device Reports describing contact lens–related corneal infections were reported to the FDA Medical Device Report database. Approximately 20% of these reports described a patient who suffered serious eye damage. More than 25% of the 1,075 reports described modifiable behaviors that might have put the patient at risk for a contact lens–related corneal infection, such as sleeping in lenses or wearing lenses longer than for the prescribed period. (more…)
Author Interviews, Frailty, Hip Fractures, JAMA, Pharmacology / 22.08.2016

MedicalResearch.com Interview with: Jeffrey Munson, MD, MSCE Assistant Professor The Dartmouth Institute for Health Policy & Clinical Practice Assistant Professor, Department of Medicine Geisel School of Medicine at Dartmouth MedicalResearch.com: What is the background for this study?  Response: Fragility fractures due to osteoporosis are a common and costly event among older Americans. Patients who experience one fragility fracture are at increased risk to have a second fracture. Our group is interested in exploring ways in which the risk of a second fracture could be reduced. In this paper, we studied prescription drug use both before and after fracture. We know many prescription drugs have been shown to increase the risk of fracture, but we don’t know whether doctors try to reduce the use of these drugs after a fracture has occurred. Our study was designed to answer this question. (more…)
Author Interviews, Cost of Health Care, Emergency Care, JAMA, Kidney Disease / 22.08.2016

MedicalResearch.com Interview with: Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation MedicalResearch.com: What is the background for this study? Response: Patients with End Stage Renal Disease (ESRD) make up less than 1% of all Medicare patients, but account for more than 7% of all Medicare expenses. Patients with ESRD have the highest risk of hospitalization of any patient with a chronic disease, and while hospital admissions have decreased over the last several years, emergency department utilization for this patient population has increased by 3% in the last 3 years. The purpose of the study we conducted was to describe the clinical and demographic characteristics associated with emergency department utilization. (more…)