Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pediatrics / 07.10.2016

MedicalResearch.com Interview with: Dr. Lars W. Andersen MD MPH Department of Emergency Medicine, Beth Israel Deaconess Medical Center Boston, Massachusetts Department of Anesthesiology and Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pediatric in-hospital cardiac arrest continues to carry a very high mortality. Thanks to companies such as AEDLeader, professional healthcare staff are able to obtain relevant equipment to help people in need. The health of patients is the priority of any paramedic or doctor. Given the relative rarity of these events at most centers and the acuity and complexity of cardiac arrest, few randomized trials exist. Moreover, few observational studies have addressed the effectiveness of intra-cardiac arrest interventions, including the use of medications and advanced airway management. This is further highlighted in the current American and international guidelines, which provide limited guidance to providers in regards to advanced airway management during pediatric in-hospital cardiac arrest. The primary objective of our study was to establish whether there is an association between tracheal intubation during in-hospital pediatric cardiac arrest and outcomes. As respiratory failure and hypoxia are common prior to cardiac arrest in children, there is a good rational for early advanced airway management in this population. (more…)
Author Interviews, Electronic Records, JAMA, NYU, Technology / 07.10.2016

MedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health New York University Langone School of Medicine, New York, NY 10016 Saul.Blecker@nyumc.org MedicalResearch.com: What is the background for this study? What are the main findings? Response: The identification of conditions or diseases in the electronic health record (EHR) is critical in clinical practice, for quality improvement, and for clinical interventions. Today, a disease such as heart failure is typically identified in real-time using a “problem list”, i.e., a list of conditions for each patient that is maintained by his or her providers, or using simple rules drawn from structured data. In this study, we examined the comparative benefit of using more sophisticated approaches for identifying hospitalized patients with heart failure. (more…)
AACR, Author Interviews, Cancer Research, Genetic Research / 07.10.2016

MedicalResearch.com Interview with: Riccardo Taulli, PhD Assistant Professor of Biochemistry Dept. of Oncology, University of Turin Via Santena 5, 10126 Torino, Italy MedicalResearch.com: What is the background for this study? Response: Rhabdomyosarcoma is a muscle-derived pediatric cancer for which therapeutic options have not improved significantly over the past decades, especially for its metastatic form. MicroRNAs are small regulatory molecules that control gene expression at the post-transcriptional level, fine tuning a wide number of cellular mechanisms, processes and behaviors. In our work, we underwent a large microRNA isolation and sequencing effort using human samples of the three major rhabdomyosarcoma subtypes, along with cell lines and normal muscle, to identify novel molecular circuits with therapeutic potential. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Surgical Research / 06.10.2016

MedicalResearch.com Interview with: Diego Lopez Harvard medical student and Dr. Andrew Loehrer MD former surgical resident at MGH senior author: David C. Chang, PhD, MPH, MBA Associate Professor of Surgery Director of Healthcare Research and Policy Development Department of Surgery Massachusetts General Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Income inequality in the United States has been increasing in recent decades, and has become an important in this election cycle. Although income inequality is often framed in terms of its effects on politics and the economy, little attention has been paid to its effect on the healthcare system. In our study, we set out to evaluate the way in which counties with differing levels of income inequality made use of the healthcare system while controlling for the overall income (as well as other demographic variables). We found that areas with higher income inequality were associated with higher Medicare expenditures.  And these effects are independent of – meaning they are in addition to – the known effect of poverty on healthcare utilization. (more…)
AHA Journals, Author Interviews, Heart Disease, Pharmacology / 06.10.2016

MedicalResearch.com Interview with: Xiaoxi Yao, PhD, MPH, MS Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, MN MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial fibrillation (AF) is the most common arrhythmia requiring treatment, affecting 3-6 million Americans. AF is associated with a 5 fold risk of stroke, which can be substantially reduced by oral anticoagulants. For over a half century, warfarin was the only option for long-term oral anticoagulation in the U.S., but the use of warfarin can be cumbersome. Warfarin has numerous interactions with food and other drugs, and requires regular lab testing and dose adjustment. Since 2010, four non–vitamin K antagonist oral anticoagulants (NOACs) have been approved by the FDA. In comparison to warfarin, the fixed-dosage NOACs provide more convenient therapeutic options and demonstrated at least equivalent efficacy and safety in large phase III clinical trials. However, the outcomes achieved in idealized clinical trial settings may not necessarily translate to routine clinical practice. In this large cohort of patients with nonvalvular AF, we assessed the real-world effectiveness and safety of three NOACs (dabigatran, rivaroxaban, and apixaban), comparing each agent with warfarin. We found apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin. (more…)
Author Interviews, Gastrointestinal Disease, Pancreatic / 06.10.2016

MedicalResearch.com Interview with: Dr. Pouria Jandaghi Functional Genome Analysis, Deutsches Krebsforschungszentrum Heidelberg, Germany Department of Human Genetics, McGill University University and Genome Quebec Innovation Centre Montreal, Canada MedicalResearch.com: What is the background for this study? Response: Although the overall five-year survival of all patients with cancer stands at 63%, for pancreatic cancer patients, it is a disheartening 8% - a number that remains largely unchanged for three decades. Of the patients diagnosed with pancreatic cancer, about 85% exhibit pancreatic ductal adenocarcinoma (PDAC). Most of these patients die within 4 to 6 months after diagnosis. The poor prognosis is caused by the its detection at only late stages, and lack of effective options for chemotherapy. The widely used chemotherapeutic agent gemcitabine, confers a median survival advantage of only 6 months, and resistance to therapy develops in the vast majority of patients. Given this poor prognosis of patients with PDAC, there is an urgent need to find more effective therapies. In this study, we set out to investigate potential therapeutic targets by dissecting gene expression profiles of tumors and control samples. Candidate targets were validated with respect to their suitability and analyzed functionally. (more…)
Author Interviews, Duke, Exercise - Fitness, Lancet / 06.10.2016

MedicalResearch.com Interview with: Aarti Sahasranaman, PhD Duke-NUS Gradaute Medical School Singapore MedicalResearch.com: What is the background for this study? Response: More than half of adults in developed countries do not achieve recommended levels of physical activity. Despite the popularity of activity trackers as a tool for motivating and monitoring activity levels, little research exists on whether they can help people lead healthier lives, or if financial incentives could encourage people to wear them for longer and achieve higher fitness levels. One in ten US adults owns an activity tracker but research suggests that about a third of people abandon them within 6 months of purchase. (more…)
Author Interviews, Cost of Health Care, Ophthalmology, Pharmacology / 06.10.2016

MedicalResearch.com Interview with: Aleksandra Rachitskaya, MD Assistant Professor of Ophthalmology Retina Service, Department of Ophthalmology Cole Eye Institute Cleveland, OH 44195 MedicalResearch.com: What is the background for this study? Response: The Centers for Medicare and Medicaid Services (CMS) Open Payments database lists payment records from drug and device manufacturers to physicians. Anti-vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab (Lucentis®, Genentech, Inc., San Francisco, CA), aflibercept (Eylea™, Regeneron, Tarrytown, NY) and off-label bevacizumab (Avastin®, Genentech, Inc., San Francisco, CA) are used for a variety of indications in ophthalmology. The current study examined the payments made to ophthalmologists related to ranibizumab and aflibercept and correlated those payments to provider usage of these medications. The former was achieved by utilizing Centers for Medicare and Medicaid Services (CMS) Provider Utilization and Payment database. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease, JACC, Salt-Sodium / 06.10.2016

MedicalResearch.com Interview with: Nancy Cook ScD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School Public Health Brigham & Women’s Hospital Division of Preventive Medicine Boston, MA 02215 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The association of sodium intake with later mortality has been controversial. While there is a well-accepted effect on blood pressure, the effects of sodium on later cardiovascular disease, and particularly mortality, have been subject to dispute. While the adverse effects of high sodium are now widely accepted, effects at lower levels of sodium intake are less clear. Some recent studies have found a J-shaped relationship, with increased disease rates among those consuming lower levels of sodium, contrary to the effects on blood pressure. In contrast, we found a direct linear relationship of usual intake of sodium with later mortality over 20 years of follow-up. Those with the lowest sodium intake experienced the lowest mortality. Our measure of intake was based on the average over 1-3 years of several measures of 24hr urine sodium excretion, the gold standard of sodium measurement. This is much more precise than measurements based on a single 24hr sodium excretion or especially on a spot urine sample, which is used in many publications that found the J-shaped curve. Our data were assessed in a healthy cohort of men and women without hypertension or cardiovascular disease, so had less potential bias due to these factors. We thus believe that our results showing the lowest mortality among those consuming the lowest levels of sodium are more accurate. (more…)
Author Interviews, Education, JAMA, Mental Health Research, Pediatrics / 06.10.2016

MedicalResearch.com Interview with: Laurie Miller Brotman, PhD Bezos Family Foundation Professor of Early Childhood Development Director, Center for Early Childhood Health and Development Department of Population Health NYU Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Children attending high-poverty schools are often exposed to an accumulation of stressors and adverse childhood experiences that can interfere with optimal mental health and learning. This study examines mental health and academic outcomes through second grade in nearly 800 Black and Latino children who participated in a randomized controlled trial of ParentCorps--a family-centered, school-based intervention in pre-kindergarten. In the original trial, elementary schools with pre-k programs serving primarily Black and Latino children from low-income families were randomized to receive ParentCorps or standard pre-k programming. ParentCorps includes professional development for pre-k and kindergarten teachers on family engagement, social-emotional learning, and behavioral regulation, and a program for families and pre-k students provided over four months at the school by specially trained pre-k teachers and mental health professionals. ParentCorps creates a space for families to come together, reflect on their cultural values and beliefs, and set goals for their children. Parents learn a set of evidence-based strategies and choose which ones fit for their families—such as helping children solve problems and manage strong feelings, reinforcing positive behavior, setting clear rules and expectations, and providing effective consequences for misbehavior. Teachers and parents help children learn social, emotional and behavioral regulation skills such as identifying feeling sad, mad, or scared, calming bodies during stressful situations, paying attention, and solving problems together. This three year follow-up study finds that ParentCorps as an enhancement to pre-k programming in high-poverty schools results in fewer mental health problems (behavioral and emotional problems) and better academic performance through second grade. (more…)
Author Interviews, Bone Density, JAMA, Mental Health Research, Mineral Metabolism, Pediatrics / 06.10.2016

MedicalResearch.com Interview with: Alexis Jamie Feuer MD Assistant Professor of Clinical Pediatrics Weill Cornell Medical College MedicalResearch.com: What is the background for this study? Response: Osteoporosis is a debilitating disorder characterized by low bone density and increased risk of fractures. Adolescence and young adulthood are critically important times for accruing peak bone density and failure to obtain adequate bone mass by early adulthood may result in future osteoporosis. In children, the use of certain medications can lead to a decrement in the acquisition of bone mass. Past studies have shown that stimulant medications, such as those used to treat Attention Deficit Hyperactivity Disorder (ADHD), may slow the rate of linear growth in children. To date, little research has been done to see what effects stimulant use may have on bone density and bone accrual in children. Stimulants exert their effects via activation of the sympathetic nervous system, and as there is mounting evidence that indicates the sympathetic nervous system plays a critical role in the acquisition of bone density, we sought to determine if there is any association between stimulant medication use and bone mass in the pediatric population. (more…)
Author Interviews, Imperial College, Stroke, Technology / 06.10.2016

MedicalResearch.com Interview with: Dr Paul Bentley MA MRCP PhD Clinical Senior Lecturer in Clinical Neuroscience Honorary Consultant Neurologist Neurology Dept Imperial College NHS Healthcare Trust Charing Cross Hospital London MedicalResearch.com: What is the background for this study? What are the main findings? Response: gripAble was designed to help people with arm disability practise physiotherapy when a physiotherapist is not available, or in between physiotherapy sessions. We know that the amount of physiotherapy provision in the UK, after stroke or arm injury, is typically below that which is recommended by professional bodies. Furthermore, increasing research suggests that higher-intensity training can boost functional outcomes. The innovation was designed to help people with a range of disabilities including severe paralysis engage with computer games with their weak arm. At the same time its designed to be portable for use at home or in bed, and low-cost. gripAble also enables remote measurement and monitoring of arm function, by setting users a series of calibrated tasks played out on the tablet screen. This way doctors and physiotherapists can assess the needs of a patient, and gain an idea of how well a patient is responding to home physiotherapy. (more…)
Author Interviews, CDC, Gender Differences, STD / 06.10.2016

MedicalResearch.com Interview with: Alex de Voux, PhD, Epidemiologist Centers for Disease Control Division of STD Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reported cases of primary and secondary syphilis have been increasing steadily in the United States since 2001, with men-who-have-sex-with-men (MSM) accounting for 83% of male primary and secondary syphilis cases with information on sex of sex partner in 2014. However calculating the true disparity of primary and secondary syphilis cases relative to the MSM population size has been difficult because census data does not routinely collect information on sexual orientation or same-sex behavior. Through a recent collaboration with Emory University and CDC, Grey and colleagues developed refined estimates of the population size of MSM by state allowing us to calculate state-specific rates of primary and secondary syphilis for the first time. Looking at data from 44 states that had information on sex of sex partner for at least 70% of their male primary and secondary syphilis cases, the overall rate of syphilis was 309 per 100,000. The state level data found syphilis rates among gay and bisexual men ranged widely among the 44 states, from 73.1 per 100,000 in Alaska to 748.3 per 100,000 in North Carolina. Some of the highest rates among MSM were in states in the Southeast and the West. Comparing rates of syphilis among MSM to men reporting sex with women only (MSW), the overall rate for MSM was 107 times the rate for MSW. By state, the rate among MSM was at least 40 times the rate among MSW – and at most, 340 times the rate among MSW. (more…)
Author Interviews, Dermatology, Technology, UCLA / 05.10.2016

MedicalResearch.com Interview with: Dr. Andrea M Armani PhD Fluor Early Career Chair and Associate Professor Mork Family Department of Chemical Engineering and Materials Science University of Southern California, Los Angeles, California MedicalResearch.com: What is the background for this study? Response: The “Internet of Things” (IoT) has seen an explosion in online sensor technologies, including UV sensors and monitors; for example, those from Apple and Samsung. However, they require connectivity and power, and they are integrated into delicate electronic systems that are not compatible with outdoor, athletic activities such as swimming, which is precisely when you should monitor UV exposure. Therefore, somewhat ironically, the technologies developed to meet the demands of the IoT are not ideal for cumulative UV exposure detection. Our goal was to develop a single use patch – like a smart “band-aid” – for the beach to alert users when they had been in the sun for an hour and needed to re-apply sunscreen or get out of the sun altogether. This application required a rugged system that was waterproof, bendable, and compatible with sunscreen. Additionally, the sensor readout needed to be easy to interpret. These requirements influenced our design and material selection. (more…)
Author Interviews, JAMA, Karolinski Institute, Mental Health Research / 05.10.2016

MedicalResearch.com Interview with: Gustaf Brander Department of Clinical Neuroscience Karolinska Institutet MedicalResearch.com: What is the background for this study? Response: Obsessive-compulsive disorder (OCD) is believed to be caused by a complex interaction between genetic and environmental factors. Whereas genetic studies are well underway, the research on environmental factors has been lagging behind. As they explain a significant portion of the variance, are potentially malleable, and are essential for understanding how the genetic component works, this area of research is of great importance. (more…)
Aging, Author Interviews, Dermatology / 05.10.2016

MedicalResearch.com Interview with: Simone Ribero, M.D., Ph.D. University of Turin Department of Medical Sciences Turin. Italy & King’s College London Department of Twin Research and Genetic Epidemiology St Thomas’ campus London MedicalResearch.com: What is the background for this study? What are the main findings? Response: For many years dermatologists have identified that the skin of acne sufferers appears to age more slowly than in those who have not experienced any acne in their lifetime. We have demonstrated in our paper that there is an association between acne and longer telomere length that means that acne patients , with the same anagraphic age , have a younger chronological age. (more…)
Author Interviews, Karolinski Institute, Stem Cells, Tobacco / 05.10.2016

MedicalResearch.com Interview with: Lukasz Antoniewicz MD, PhD candidate Karolinska Institutet Department of Clinical Sciences Danderyd University Hospital Stockholm, Sweden MedicalResearch.com: What is the background for this study? Response: Electronic cigarette sales increase exponentially on a global scale without knowledge about possible negative effects on human health. We performed an exposure study in young healthy volunteers and analyzed blood samples for endothelial progenitor cells and microvesicles. Increase in those markers may reflect vascular injury, inflammation and platelet activation. (more…)
Author Interviews, Depression, Journal Clinical Oncology, Lung Cancer / 05.10.2016

MedicalResearch.com Interview with: Donald R. Sullivan, M.D., M.A. Assistant Professor, Division of Pulmonary & Critical Care Medicine Oregon Health & Science University Investigator, VA Portland Health Care System MedicalResearch.com: What is the background for this study? Response: There is an inextricably link between physical and mental health, and all too often clinicians focus solely on the physical components of disease. A life-threatening diagnosis such as cancer often evokes significant psychological distress and lung cancer patients are at significantly risk. Up to 44% of lung cancer patients experience depression symptoms and 5-13% major depressive disorder, higher than most other cancers. Previous studies have demonstrated the development of depression or depression symptoms at lung cancer diagnosis can increase patient mortality, but there is a paucity of research exploring how longitudinal changes in depression symptoms impact patient outcomes. (more…)
Author Interviews, Cost of Health Care, Pharmacology / 04.10.2016

MedicalResearch.com Interview with: Kevin Bowen MD MBA Senior Health Outcomes Researcher Prime Therapeutics LLC 1305 Corporate Center Drive Eagan, MN 55121 MedicalResearch.com: What is the background for this study? What are the main findings? • Autoimmune specialty drugs now account for about one of every 10 dollars of combined drug expense through the medical and pharmacy benefits in a commercially insured population. • The autoimmune drug class is one of the fastest growing, with this study finding a doubling in autoimmune drug expenditures and a 38 percent increase in utilization, in the most recent four years. • Integrated analysis of medical and pharmacy claims is essential for this category of drugs because more than 25 percent of autoimmune specialty drug use is paid through the medical benefit and medical claims diagnosis coding provides a means of determining what conditions were treated with drugs covered by pharmacy claims. (more…)
Author Interviews, Dermatology / 04.10.2016

MedicalResearch.com Interview with: Craig Leonardi, MD Adjunct Professor of Dermatology Saint Louis University School of Medicine Saint Louis, Missouri MedicalResearch.com: What is the background for this study? Response: A2304E1 is a multicenter, double-blind and open-label extension study to evaluate the long-term safety and efficacy of Cosentyx in patients with moderate to severe plaque psoriasis. Patients who completed 52 weeks of the core SCULPTURE and STATURE studies and re-consented to treatment were eligible for the extension, and continued the same Cosentyx dose and regimen that they were receiving in their core study. Patients did not have to achieve a PASI 75 response at the end of their core study to enroll. A total of 642 patients entered the extension study: 168 continued on Cosentyx 300 mg every 4 weeks, 152 continued on Cosentyx 150 mg every 4 weeks, 172 continued on Cosentyx 300 mg retreatment-as-needed, and 150 continued on Cosentyx 150 mg retreatment-as-needed. At the end of Week 156, the study was open-label and patients could continue their assigned dose and regimen or switch to 300 mg every 4 weeks based on the investigator’s judgment. Results presented at EADV focus on those patients from the SCULPTURE core study who enrolled in the extension study. The primary endpoint of this extension study was overall safety and tolerability. Secondary efficacy measures included the proportion of patients achieving PASI 75, PASI 90 and PASI 100. (more…)
Author Interviews, Cancer Research, ENT, HPV / 04.10.2016

MedicalResearch.com Interview with: Eric M Genden, MD, FACS Isidore Friesner Professor and Chairman Department of Otolaryngology-Head and Neck Surgery The Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this report? How has the clinical picture of HPV infections of oral and throat cancers changed over the past two decades? Response: There has been no change however there has been a epidemic of viral induced throat cancer in men. The HPV virus has been established a the causative agent in cervical cancer in women. It has now been identified as a major causative agent in tonsillar and base of tongue cancer. (more…)
Author Interviews, Breast Cancer, Race/Ethnic Diversity / 04.10.2016

MedicalResearch.com Interview with: Bijou R. Hunt,  MA Sinai Urban Health Institute, Sinai Health System Chicago, IL  MedicalResearch.com: What is the background for this study? Response: Breast cancer is the most commonly diagnosed cancer in Hispanic women, as well as the leading cause of cancer death for this group. Research has shown that there are differences by Hispanic subgroup in various causes of death, including cancer, but we haven’t seen data on breast cancer specifically among Hispanic subgroups. The most important question we wanted to address with this study was: do breast cancer prevalence and mortality vary by Hispanic subgroup? (more…)
Author Interviews, Cancer Research, Cognitive Issues, Education, Lancet, Leukemia, Mental Health Research, Pediatrics / 04.10.2016

MedicalResearch.com Interview with: Yin Ting Cheung, PhD Department of Epidemiology and Cancer Control and Noah D Sabin, MD Department of Diagnostic Imaging St Jude Children's Research Hospital Memphis, TN MedicalResearch.com: What is the background for this study? What are the main findings? Response: Long-term survivors of childhood acute lymphoblastic leukemia (ALL) who are treated with high-dose intravenous methotrexate or intrathecal chemotherapy are at risk for neurocognitive impairment, particularly in cognitive processes such as processing speed, attention and executive function. However, many children who receive these therapies do not experience significant impairments, suggesting the need for biomarkers to identify patients at greatest risk. Prior research from our team demonstrated that, during chemotherapy, patients were at risk for white matter changes in the brain, also known as leukoencephalopathy. No studies documented the persistence or impact of brain leukoencephalopathy in long-term survivors of childhood ALL treated on contemporary chemotherapy-only protocols. In this study, we included prospective neuroimaging from active therapy to long-term follow-up, and comprehensive assessment of brain structural and functional outcomes in long-term survivors of ALL treated with contemporary risk-adapted chemotherapy. We demonstrated that survivors who developed leukoencephalopathy during therapy displayed more neurobehavioral problems at more than 5 years post-diagnosis. Moreover, these survivors also had reduced white matter integrity at long-term follow-up, and these structural abnormalities were concurrently associated with the neurobehavioral problems. (more…)
Accidents & Violence, Author Interviews, Clots - Coagulation, JAMA, Surgical Research, Thromboembolism / 03.10.2016

MedicalResearch.com Interview with: Charles A. Karcutskie IV, MD, MA Postdoctoral Research Fellow University of Miami Miller School of Medicine Department of Surgery Divisions of Trauma, Surgical Critical Care, and Burns MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research group at the Ryder Trauma Center have recently done several studies showing various differences in outcomes and risk based on mechanism of injury. Additionally, venous thromboembolism (VTE) is another topic that our group has focused on in the past several years. Because trauma patients are inherently at a higher risk for VTE due to the nature of their injury, we questioned whether the most important risk factors for VTE were different after blunt or penetrating trauma. At our institution, we assess VTE risk with the Greenfield Risk Assessment Profile, which is a list of several risk factors that each have weight toward an overall risk score. We took these risk factors and analyzed them individually based on mechanism of injury. We found that the factors that contribute to the VTE risk are different based on injury mechanism: After blunt trauma, transfusion status, neurologic status, and pelvic fracture contributed most. After penetrating trauma, vascular injury, severe abdominal injury, and age 40-59 years contributed most. This tells us that mechanism of injury may need to be incorporated into the risk assessment in order to discover the highest risk patients. (more…)
Author Interviews, Diabetes, JAMA / 03.10.2016

MedicalResearch.com Interview with: Dr. Saeid Shahraz Assistant Professor of Medicine Tufts Medical Center MedicalResearch.com: What is the background for this study? Response: American Diabetes Association (ADA) has set up a lower cut point for diagnosing prediabetes ( those with Impaired Fasting  Glucose   100 mg/dL) compared to the World Health Organization's cut point, which is 110 mg/dL. This arbitrariness in cut point definition triples the number of cases labeled as prediabetes. Along with lowering the diagnostic threshold by the ADA, the Centers for Disease Control and Prevention (CDC), the American Medical Association (AMA), and the ADA endorsed and advertised a web-based risk model to define high-risk population for prediabetes. The risk engine asks a few questions ( age, sex, family history of diabetes, history of gestational diabetes and high blood pressure, physical activity and weight) and outputs a score that defines if the person is at risk for prediabetes. We suspected that the risk engine might overestimate the risk. (more…)
Author Interviews, End of Life Care, JAMA / 03.10.2016

MedicalResearch.com Interview with: Joshua R. Lakin, MD Assistant Professor of Medicine Harvard Medical School Dana Farber Cancer Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: Research has increasingly shown the benefits of early palliative care interventions, especially in those around communication about patient goals and preferences in serious illness. These benefits include improved quality of life and psychological outcomes for patients as well as eased bereavement and decision making for loved ones. We have a large gap to fill in initiating early goals and values conversations with our patients and there are a myriad of systems failures and clinician barriers that do not allow us to do this work in a timely and effective way. Doing so with limited resources, both in specialty palliative care and in the many frontline clinicians doing this work, requires targeting our resources carefully. Doing these conversations earlier means identifying patients upstream, before they are in the last days of life. The Surprise Question – “Would you be surprised if this patient died in the next year?” – has emerged as an attractive option for screening for early palliative care interventions. It has been studied primarily in dialysis and cancer patients and has been demonstrated to have a strong association with risk of death. We set out to test it in a more diverse primary care population. (more…)
Author Interviews, Endocrinology, JCEM, Kidney Disease, Mineral Metabolism / 03.10.2016

MedicalResearch.com Interview with: Jonas Esche Dipl.-Mol. Biomed University of Bonn Institute of Nutritional and Food Sciences DONALD Study MedicalResearch.com: What is the background for this study? Response: Modern western diets increase diet-dependent acid load and net acid excretion which are suggested to have adverse long-term effects on bone. Urinary potential renal acid load (uPRAL) is an established parameter to assess nutritional acid load. Urinary citrate, on the other hand, integrates nutritional and also systemic influences on acid-base homeostasis with high citrate indicating prevailing alkalization. Against this background urinary citrate excretion was used as a new index of acid-base status and its relationship with bone strength and long-term fracture risk was examined. (more…)
Author Interviews, Biomarkers, Cancer Research, ENT, HPV / 03.10.2016

MedicalResearch.com Interview with: Elizabeth Franzmann, M.D. Scientific Founder and Chief Scientific Officer Vigilant Biosciences MedicalResearch.com: What is the background for this study? Response: Head and neck cancer involves cancers of the oral cavity, oropharynx and larynx. It is difficult to treat. Part of the challenge is that it is distinguishing the patients with tumors that are going to behave aggressively from those with less aggressive disease. As a result, many patients undergo treatment that may be more intensive and morbid than they need while others need more aggressive treatment. Tissue markers associated with prognosis may be able to help clinicians differentiate patients who need more aggressive treatment from those whose treatment can be less intensive. CD44 is a cell surface glycoprotein and tumor-initiating marker. CD44 and another surface protein, EGFR, are involved in tumor extension and are associated with poor prognosis. Certain forms of Human Papillomavirus (HPV) are known to cause oropharyngeal cancer and are associated with a good prognosis. P16 is a surrogate marker for the kind of HPV that causes cancer. Understanding the relationships between how these markers are expressed in cancer tissue may direct patient treatment in the future. (more…)
Author Interviews, Exercise - Fitness, Heart Disease, JACC, Pediatrics / 03.10.2016

MedicalResearch.com Interview with: Dr. James McKinney MD MSc FRCP(C) Division of Cardiology University of British Columbia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sudden cardiac death (SCD) is the leading medical cause of death in young athletes. Sporting activity may predispose athletes with underlying cardiovascular conditions to develop life threatening ventricular arrhythmias during physical exercise. Despite being a relatively rare event, the death of a young healthy person is a tragic event that is difficult to comprehend. The prevalence of an underlying cardiovascular disorder in young athletes that predisposes to SCD is approximately 0.3%. Sudden cardiac death is often the first clinical manifestation of an underlying cardiovascular condition; up to 80% of athletes are previously asymptomatic. Pre-participation screening is the systematic practice of medically evaluating athletes for the purpose of identifying (or raising suspicion of) abnormalities that could provoke sudden death. There is agreement amongst sporting and medical bodies that athletes should undergo some form of pre-participation screening. An Achilles’ heel of screening is the significant number of false-positive screens that require subsequent costly secondary testing to rule out disease. Prevention of sudden cardiac death among athletes is a common goal, however the optimal strategy for its achievement is uncertain. (more…)
Author Interviews, Health Care Systems, Lancet, Mayo Clinic / 03.10.2016

MedicalResearch.com Interview with: Colin P. West, MD, PhD, FACP Divisions of General Internal Medicine and Biomedical Statistics and Informatics Departments of Internal Medicine and Health Sciences Research Mayo Clinic MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practicing physicians demonstrating burnout rates in excess of 50%. Consequences include negative effects on patient care, professionalism, physicians’ own care and safety, and the viability of health-care systems. We conducted a systematic review and meta-analysis to better understand the quality and outcomes of the literature on approaches to prevent and reduce burnout. We identified 2617 articles, of which 15 randomized trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Across interventions, overall burnout rates decreased from 54% to 44%, emotional exhaustion score decreased from 23.82 points to 21.17 points, and depersonalization score decreased from 9.05 to 8.41. High emotional exhaustion rates decreased from 38% to 24% and high depersonalization rates decreased from 38% to 34%. (more…)