Author Interviews, Cost of Health Care, Fertility, OBGYNE / 09.05.2016
IVF: More Embryos Transferred Means More Costs and Worse Outcomes
MedicalResearch.com Interview with:
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Dr. E. Scott Sills[/caption]
Dr. Scott Sills MD, PhD
Medical Director at the Center for Advanced Genetics
an IVF program based in Carlsbad, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sills: Often regarded as a miracle procedure by many infertile couples, in vitro fertilization (IVF) can be financially difficult for those without insurance coverage for the treatment. This prohibitive cost leads many would-be parents who pursue IVF to transfer multiple embryos at once, to increase their chances of getting a baby and minimize the need for additional attempts.
This new study now reports that the economic impact of IVF deserves a closer look. As corresponding author E. Scott Sills, MD PhD noted, rates of cesarean-section deliveries, premature births, and low birth weight of babies are all greater with two or more embryos transferred to the mother at once, compared to a lower risk, single-embryo pregnancy.
The data derived from a comprehensive analysis of all IVF cases in Vermont (UVM) and was recently published in the journal Applied Health Economics & Health Policy. It is believed to be the first effort to calculate the difference in infant hospital costs based on the number of embryos transferred. Sills and his team had access to UVM Medical Center records of patients who conceived through IVF and delivered at least 20 weeks into their pregnancies between 2007 and 2011.
Dr. E. Scott Sills[/caption]
Dr. Scott Sills MD, PhD
Medical Director at the Center for Advanced Genetics
an IVF program based in Carlsbad, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Sills: Often regarded as a miracle procedure by many infertile couples, in vitro fertilization (IVF) can be financially difficult for those without insurance coverage for the treatment. This prohibitive cost leads many would-be parents who pursue IVF to transfer multiple embryos at once, to increase their chances of getting a baby and minimize the need for additional attempts.
This new study now reports that the economic impact of IVF deserves a closer look. As corresponding author E. Scott Sills, MD PhD noted, rates of cesarean-section deliveries, premature births, and low birth weight of babies are all greater with two or more embryos transferred to the mother at once, compared to a lower risk, single-embryo pregnancy.
The data derived from a comprehensive analysis of all IVF cases in Vermont (UVM) and was recently published in the journal Applied Health Economics & Health Policy. It is believed to be the first effort to calculate the difference in infant hospital costs based on the number of embryos transferred. Sills and his team had access to UVM Medical Center records of patients who conceived through IVF and delivered at least 20 weeks into their pregnancies between 2007 and 2011.
Dr. Julie Shakib[/caption]
Julie H. Shakib, DO, MS, MPH
Assistant Professor of Pediatrics | University of Utah
Medical Director | Well Baby and Intermediate Nursery
Salt Lake City
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Shakib: Immunization against influenza in the first six months of life is ineffective due to an immature immune response. Passive protection via maternal immunization offers an alternative but only a few studies have evaluated the efficacy of this immunization strategy. We found that in infants born to women immunized against influenza during pregnancy, the risk of laboratory-confirmed influenza and influenza-related hospitalization were reduced by 70% and 81% in their first 6 months of life, respectively.This large study provides more evidence that when women are immunized against influenza during pregnancy, their infants are much less likely to be diagnosed with influenza in their first 6 months.
Wenpeng You[/caption]
Wenpeng You, PhD student
Biological Anthropology and Comparative Anatomy Research Unit
University of Adelaide | School of Medicine
Adelaide, Australia
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Dr. Maciej Henneberg[/caption]
Maciej Henneberg, PhD, DSc, FAIBiol
Wood Jones Professor of Anthropological and Comparative Anatomy
University of Adelaide School of Medicine;
Institute for Evolutionary Medicine, University of Zurich
Editor in Chief, Journal of Comparative Human Biology HOMO
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Type 1 diabetes disease has very strong genetic background. Prevalence of type 1 diabetes has been increasing globally. Previous studies focusing on regional genetics and environmental factors cannot fully explain this phenomenon. Due to insufficient medical knowledge up until early 20th century, people with type 1 diabetes disease would most commonly die during their teens or early 20s. Therefore, they did not have the opportunity to pass on their genes providing background for the development of type 1 diabetes to their next generations. Since discovery and introduction of insulin to modern medicine in early 1920s, more and more type 1 diabetes patients have been able to survive their reproduction cycle (up until and past 50 years of age). This has made more and more genes related to type 1 diabetes to accumulate in human populations.
We applied the Biological State Index which measures a probability to pass genes on to the next generation at population level. We found that the rapid increase in type 1 diabetes over the last few decades was correlated with increases of the Biological State Index and its proxy, human life expectancy, especially in more developed world in which natural selection has been relaxed most. This correlation was found after statistically excluding differences in countries income, levels of urbanization, sugar consumption and obesity prevalence.
Dr. Charu Kaushic[/caption]
Charu Kaushic. PhD.
Professor
OHTN Applied HIV Research Chair
Department of Pathology and Mol. Medicine
McMaster Immunology Research Center,
McMaster University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Kaushic: Female sex hormones, estradiol and progesterone have been shown to regulate immune responses in many experimental and clinical studies. We and others have shown previously that these hormones also regulate susceptibility to and outcome of sexually transmitted infections (STIs), including Chlamydia, HSV-2, SIV and HIV-1. Most studies show that progesterone generally increases susceptibility while estradiol generally confers protection against STIs. This has recently gained much more widespread attention because of the controversy surrounding use of injectable hormonal contraceptives in geographical areas where there is high prevalence of HIV-1. The most frequently used injectable contraceptive uses a progestin-based formulation which has been correlated with 2-fold increase in HIV acquisition and transmission in epidemiological studies. Oral contraceptives that contain a combination of estradiol and progesterone do not show similar correlation with increased infection. This is currently a very important women’s health issue, which is being carefully monitored by many public health agencies, including WHO. Many researchers are focusing efforts in understanding how sex hormones can increase or decrease susceptibility of women to STIs.
We have published in this area for more than a decade, including a series of papers showing that in a mouse model, the outcome of genital herpes (HSV-2) infection can depend on which hormone we treat the mice with. A few years ago, we showed for the first time that mice that received an HSV-2 vaccine under the influence of estradiol were much better protected and showed less disease pathology (Bhavanam et al, Vaccine 2008). These results were reproduced a year later by another group, using an actual HSV-2 vaccine formulation. Since then, we have been working to understand at a cellular level, the underlying mechanism of estradiol-mediated enhanced protection. In this PLOS Pathogens paper, we report for the first time a cellular mechanism by which estradiol was seen to enhance immune protection against HSV-2 infection in mice.
The main findings are that estradiol primes dendritic cells in the vaginal tract to induce enhanced anti-viral T cell responses. Dendritic cells are key immune cells that decide what type of immune responses will be mounted against an infection. Under the influence of estradiol, the dendritic cells in the vaginal tract of mice induced Th17 cells which in turn helped enhance anti-viral T cell responses (Th1), resulting in better protection against genital HSV-2. This regulation of anti-viral immunity was seen only in the reproductive tract.
Dr. Riyaz Bashir[/caption]
Riyaz Bashir MD, FACC, RVT
Professor of Medicine
Director, Vascular and Endovascular Medicine
Department of Medicine
Division of Cardiovascular Diseases
Temple University Hospital
Philadelphia, PA 19140
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Bashir: The use of compression stockings in the prevention of post thrombotic syndrome following an episode of deep vein thrombosis is common in clinical practice. However, the evidence to suggest its efficacy has been put into question by the recent publication of the SOX trial. Since this was the largest randomized controlled trial to date addressing this issue, it has led to clinicians questioning whether compression stockings should be used at all in these patients.
The main finding of this meta-analysis was that in patients with deep venous thrombosis, use of elastic compression stockings does not significantly reduce the development of post thrombotic syndrome. However the current body of evidence is limited and we believe at present it is too early to give up on the use of this therapy, which may benefit many subgroups of patients.
Dr. Martha Rumore[/caption]
Martha M. Rumore, PharmD, JD, MS, LLM, FAPhA
Associate Professor, Social, Behavioral & Administrative Pharmacy
Touro College of Pharmacy
New York, NY 10027
& Of Counsel Sorell, Lenna, & Schmidt, LLP
MedicalResearch.com: What is the background for this study?
Dr. Rumore: The management of lipid therapy is only one component that affects overall cardiovascular outcomes.This study is one of the first to look at the benefits of dose titration versus intensity-based statin therapy. To evaluate whether patients titrated on statin therapy using ATPIII algorithm with an LDL goal of <100mg/dL also met the 2013 ACC/AHA Guideline for Management of Blood Cholesterol goal of ≥40% LDL reduction from baseline compared to inpatients initiated on high-moderate intensity statin (HIS). Other objectives included comparison of algorithms to lower LDL ≥40%, final dose, adverse drug events (ADEs), clinic visits to goal, and cardiovascular event occurrence.
MedicalResearch.com: What are the main findings?
Dr. Rumore: 981 patients were included- 43% were titrated and 57% achieved LDL<100; 38% achieved both LDL <100mg/dL and LDL ≥40% reduction; 58% received HIS and 53% achieved LDL <100; 43% achieved both LDL <100mg/dL and LDL ≥40% reduction.
Initiating patients on High Intensity statins was not more effective than dose titration in achieving <100mg/dL and ≥40% LDL reduction;X2=0.006,N=159,p=0.938. A 50% LDL reduction in patients that also achieved an LDL <100 was 54% and 48%, in titration and HIS groups, respectively; X2=0.611,N=159,p=0.434. The titration group required an average of 4.3 clinic visits to achieve goal, compared to 3.1 visits for HIS; p=0.309; 95% CI(-1.36,1.06).
Dr. T. Jared Bunch[/caption]
T. Jared Bunch, MD
Director of Heart Rhythm Research
Medical Director for Heart Rhythm Services
Intermountain Healthcare System
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Bunch: Approximately 6 years ago we found that patients with atrial fibrillation experienced higher rates of all forms of dementia, including Alzheimers disease. At the time we started to ask the questions of why this association existed. We know that atrial fibrillation patients experience higher rates of stroke. These patients are placed on blood thinners, most commonly warfarin, to lower risk of stroke which at the same time expose that patient to a higher risk of intracranial bleeding. One possibility to explain the association was that perhaps dementia in the manifestation of many small clots or bleeds in the brain that in total lead to cognitive decline. If this is the case, then the efficacy and use of anticoagulation is very important in atrial fibrillation patients.
We conducted additional studies that showed this to be the case. In patients with no history of dementia, managed long-term with warfarin anticoagulation, those that had levels that were frequently too higher or too low that resulted in poor times in therapeutic range, experienced significantly higher rates of dementia. The risk was highest in younger atrial fibrillation patients that were less than 80 years of age. We then found that in atrial fibrillation patients that were frequently over anticoagulated and also use an antiplatelet agent, aspirin or plavix, the dementia rates nearly doubled. At this point we raised the question if atrial fibrillation increased the risk beyond anticoagulation, or does anticoagulation efficacy drive most of the risk. This question formed the background of the current study.
Robert Bonacci[/caption]
Robert Bonacci MPH, MD Candidate’16
University of Pennsylvania School of Medicine
MedicalResearch.com: What is the background for this study?
Response: During the mid-2000’s, the HIV incidence rate stubbornly persisted around 50,000 infections per year. Responding to this trend, President Obama released the first comprehensive US National HIV/AIDS Strategy (NHAS) in 2010. The NHAS hoped to spur a more coordinated national response and set ambitious targets for reducing HIV incidence (25 percent) and the transmission rate (30 percent), among other goals, by 2015.
To evaluate whether the U.S. achieved the NHAS goals by 2015, we used mathematical models drawing on data from the U.S. Centers for Disease Control and Prevention (CDC) on HIV prevalence and mortality for 2007 to 2012, and our own previously published incidence estimates from 2008-2012. Changes seen from 2010 through 2012 were extrapolated for the time period 2013 through 2015.
Dr. Melissa Stockwell[/caption]
Melissa Stockwell, MD, MPH, FAAP
Florence Irving Associate Professor of Pediatrics and
Population and Family Health
Columbia University - College of Physicians & Surgeons and
Mailman School of Public Health
Medical Director, New York-Presbyterian Hospital Immunization Registry (EzVac)
Co-Director, Primary Care Clinician Research Fellowship in Community Health
New York, NY 10032
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Stockwell: Fragmentation of immunization records place children at risk for underimmunization and overimmunization. Nearly all 50 states, 5 cities, and the District of Columbia operate an immunization information system, which is a system that collects and centralizes immunization data for children and adolescents from immunization providers at a regional or state level. More than 75% of US office-based physicians have adopted an electronic health record (EHR), but until recently, clinicians wanting to access patient immunization information in an IIS generally had to manually look up the patient data on a state or local IIS website, that data was not available to them within their own EHR. In this study, we demonstrated that exchange of immunization information between an immunization information system (IIS) and an EHR at point of care had a significant impact on up-to-date rates, overimmunization, and immunization record completeness for low-income, urban children and adolescents.
Dagfinn Anne[/caption]
Dagfinn Aune
Department of Epidemiology and Biostatistics
School of Public Health
Imperial College London
St. Mary's Campus
Norfolk Place, Paddington, London
MedicalResearch.com: What is the background for this study?
Response: The prevalence of overweight and obesity has increased rapidly over the past decades in all areas of the world. This has raised serious public health concerns because of the relationship between excess weight and increased risk of many chronic diseases including cardiovascular disease, several types of cancer, type 2 diabetes, gallstones, gout, osteoarthritis, and several other conditions as well as all-cause mortality.
Body mass index (BMI) is an established way of measuring adiposity and is calculated by dividing the weight in kilograms with the height in metres squared. Although overweight (BMI 25-29.9) and obesity (BMI ≥30) has been associated with increased risk of mortality in several previous studies, the largest previous study showed that when compared to normal weight, overweight was associated with reduced mortality, and only grade 2 obesity (BMI ≥35) was associated with increased risk of mortality.
However, there were several limitations in that study, for example, smoking and prevalent or prediagnostic illness were not taken into account, both of which can cause lower body weight and increased mortality and may therefore bias the optimal BMI range upwards. In addition, many large studies which did not use the standard WHO categories of normal weight, overweight and obesity, but had used smaller increments to categorize BMI to provide more detailed assessment of the dose-response relationship between BMI and mortality, had been excluded.
Dr. Serene Chen[/caption]
Serene I. Chen MD
Dr. Chen is an emergency medicine resident at Highland Hospital, in Oakland, California. She was a student at the Yale School of Medicine when this research was conducted.
MedicalResearch.com: What is the background for this study?
Dr. Chen: To address the rise in U.S. drug shortages, the Food and Drug Administration Safety and Innovation Act (FDASIA) was passed in 2012—and early evidence does suggest that the overall number of new shortages have decreased. However, we found that drugs that are frequently used emergency departments and other acute settings are still affected by more frequent and increasingly prolonged shortages.
Dr. Kevin Curl[/caption]
Dr. Kevin Curl, MD
Sidney Kimmel Medical College
Jefferson University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Curl: If left untreated, half of coronary bypass vein grafts will become occluded within 10 years of surgery. We reviewed the health records of over 350 patients who had a previous coronary artery bypass graft (CABG) a minimum of three years prior. Our goal was to identify the long-term trends with medication adherence in this high risk population, namely aspirin and statin medications. The American College of Cardiology and the American Heart Association recommend both statins and aspirin medications unless they are unsafe for the individual patient. The mean age of the study population was 69 years, most patients had previously undergone "triple bypass" with 3 grafts, and the mean time from surgery was 11 years. We found that only 52 percent of patients were taking both aspirin and a statin medication. In addition, patients not taking a statin had higher (22 percent) low-density lipid or “bad” cholesterol.
Dr. Emily Severance[/caption]
Emily G. Severance, Ph.D
Stanley Division of Developmental Neurovirology
Department of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Severance: This research stems in part from anecdotal dialogues that we had with people with psychiatric disorders and their families, and repeatedly the issue of yeast infections came up. We found that Candida overgrowth was more prevalent in people with mental illness compared to those without psychiatric disorders and the patterns that we observed occurred in a surprisingly sex-specific manner. The levels of IgG antibodies directed against the Candida albicans were elevated in males with schizophrenia and bipolar disorder compared to controls. In females, there were no differences in antibody levels between these groups, but in women with mental illness who had high amounts of these antibodies, we found significant memory deficits compared to those without evidence of past infection.
Dr. Albert Roh[/caption]
Albert Roh MD
Radiology Resident
Maricopa Integrated Health System
MedicalResearch.com: What is the background for this study?
Dr. Roh: Obesity is well documented to be associated with many medical conditions. Currently, obesity is defined as body mass index (BMI) over 30 kg/m^2. Although simple to calculate and relatively accurate, BMI has its limitations. BMI does not factor in the subject’s body type or fat distribution pattern. For example, a muscular subject and a fatty subject may both have BMI of 30 and be considered obese, although the muscular subject would not be predisposed to the comorbidities associated with obesity. Similarly, two subjects may have the same BMI but have different fat distribution patterns: “apple” with fat distributed primarily on the chest/abdomen and “pear” with fat distributed on the hips. The “apple” fat distribution correlates better with the comorbidities associated with obesity.
Dr. Hui-Lin Pan[/caption]
Hui-Lin Pan, MD, PhD
Helen T. Hawkins Distinguished Professor
and Deputy Division Head for Research
Division of Anesthesiology and Critical Care, Unit 110
The University of Texas MD Anderson Cancer Center
Houston, TX
MedicalResearch.com: What is the background for this study?
Dr. Hui-Lin Pan: Chronic nerve pain caused by damage to the peripheral nerve is a debilitating health problem and remains very difficult to treat. Sensory neurons in the spinal cord are normally inhibited by inhibitory neurotransmitters (GABA and glycine) to regulate transmission of painful information. A major feature of nerve injury-induced chronic pain is reduced spinal cord inhibition, resulting from diminished activity of a chloride transporter called KCC2. In this study, we investigated whether increasing KCC2 expression at the spinal level using a lentiviral vector can restore KCC2 activity, thereby reducing chronic nerve pain.
Dr. Josefin Segelman[/caption]
Josefin Segelman MD, PhD
Senior consultant colorectal surgeon
Department of Molecular Medicine and Surgery
Karolinska Institutet
Ersta Hospital
Stockholm Sweden
MedicalResearch.com: What is the background for this study?
Dr. Segelman: Hormonal factors influence the development of colorectal cancer. Observational studies and clinical trials have reported a protective effect of hormone replacement therapy and oral contraceptives. Oophorectomy alters endogenous levels of sex hormones, but the effect on colorectal cancer risk is unclear. Removal of the ovaries alters levels of sex hormones in both pre- and postmenopausal women. In premenopausal women, bilateral oophorectomy is followed by surgical menopause as the endogenous estrogen levels drop. Both before and after natural menopause, bilateral oophorectomy promptly decreases endogenous androgen levels by half as the ovaries and adrenals are equally important for androgen production.
MedicalResearch.com: What are the main findings?
Dr. Segelman: The present nationwide cohort study explored the association between removal of the ovaries for benign indications and subsequent risk of colorectal cancer. Among 195 973 women who underwent the procedure from 1965 – 2011, there was a 30% increased risk of colorectal cancer compared with the general population. After adjustment for various factors, women who underwent bilateral oophorectomy had a higher risk of rectal cancer than those who had unilateral oophorectomy (HR 2.28, 95% CI 1.33-3.91).
Michael Daniel[/caption]
Michael Daniel
The Johns Hopkins University School of Medicine
M.D. Candidate 2016
Michael G. Daniel is a graduating medical student at the Johns Hopkins School of Medicine. He will be attending the Osler Internal Medicine Residency Training Program next year at the Johns Hopkins Hospital. His research focus is on Patient Safety, Quality, and Outcomes improvement.
Summary:
Medical error ranks as the third leading cause of death in the United States, but is not recognized in national vital statistics because of a flawed reporting process. Using recent studies on preventable medical error and extrapolating the results to the 2013 U.S. hospital admissions we calculated a mortality rate or 251,454 deaths per year.
MedicalResearch.com: What made you want to research this topic?
Response: I decided to study medicine because I wanted to improve patient health. However, I realized that improving patient health is not only about curing a disease but is sometimes about fixing the way we deliver healthcare.
MedicalResearch.com: Is this news surprising to you?
Response: Yes, because all previous estimates of medical error were much lower and when I started the research I couldn’t use the CDC statistics to get current data.
Dr. Jed Friedman[/caption]
Jacob (Jed) E. Friedman, Professor, Ph.D.
Department of Pediatrics, Biochemistry & Molecular Genetics
Director, NIH Center for Human Nutrition Research Metabolism Core Laboratory
University of Colorado Anschutz
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Scientists have long established that children who are breastfed are less likely to be obese as adults, though they have yet to identify precisely how breastfeeding protects children against obesity. One likely reason is that children who are breastfed have different bacteria in their intestines than those who are formula fed.
The study, published Monday in the American Journal of Clinical Nutrition examines the role of human milk hormones in the development of infants’ microbiome, a bacterial ecosystem in the digestive system that contributes to multiple facets of health.
“This is the first study of its kind to suggest that hormones in human milk may play an important role in shaping a healthy infant microbiome,” said Bridget Young, co-first author and assistant professor of pediatric nutrition at CU Anschutz. “We’ve known for a long time that breast milk contributes to infant intestinal maturation and healthy growth. This study suggests that hormones in milk may be partly responsible for this positive impact through interactions with the infant’s developing microbiome.”
Researchers found that levels of insulin and leptin in the breastmilk were positively associated with greater microbial diversity and families of bacteria in the infants’ stool. Insulin and leptin were associated with bacterial functions that help the intestine develop as a barrier against harmful toxins, which help prevent intestinal inflammation. By promoting a stronger intestinal barrier early in life, these hormones also may protect children from chronic low-grade inflammation, which can lead to a host of additional digestive problems and diseases.
In addition, researchers found significant differences in the intestinal microbiome of breastfed infants who are born to mothers with obesity compared to those born to mothers of normal weight. Infants born to mothers with obesity showed a significant reduction in gammaproteobacteria, a pioneer species that aids in normal intestinal development and microbiome maturation.
Gammaproteobacteria have been shown in mice and newborn infants to cause a healthy amount inflammation in their intestines, protecting them from inflammatory and autoimmune disorders later in life. The 2-week-old infants born to obese mothers in this study had a reduced number of gammaproteobacteria in the infant gut microbiome.
Dr. William Eggleston[/caption]
William Eggleston, PharmD
Fellow in Clinical Toxicology/Emergency Medicine
Upstate Medical University
Upstate New York Poison Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Eggleston: The case series describes two deaths associated with loperamide abuse with supportive post-mortem findings. It adds to the growing body of literature reporting cardiac toxicity after loperamide abuse and demonstrates the deadly consequences. It also highlights the growing trend of loperamide abuse amongst opioid addicted patients looking to get high or stave off withdrawal symptoms.
MedicalResearch.com: What should readers take away from your report?
Dr. Eggleston: Readers should recognize that loperamide is an OTC opioid medication that acts similarly to morphine or heroin in the body after high doses. The drug is easily abused due to its low cost, ease of accessibility, legal status, and lack of social stigma associated with its possession. Most importantly, loperamide is a cardiac toxin that causes conduction disturbances in high doses and can produce deadly dysrhythmias.
Dr. Uscher-Pines[/caption]
Lori Uscher-Pines, PhD
RAND Corporation
Arlington, Virginia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although many communities in the U.S. are underserved by dermatologists, access is particularly limited among Medicaid patients. Teledermatology may be one solution to improve access. Our goal with this study was to assess the effect of a novel teledermatology initiative on access to dermatologists among enrollees in a Medicaid Managed Care Plan in California’s Central Valley.
Among all patients who visited a dermatologist after the introduction of teledermatology from 2012-2014 (n=8614), 49% received care via teledermatology. Among patients newly enrolled in Medicaid following Medicaid expansion in 2014, 76% of those who visited a dermatologist received care via teledermatology. Patients of primary care practices that engaged in teledermatology had a 64% increase in the fraction of patients visiting a dermatologist (vs. 21% in other practices) (p<.01). Compared with in-person dermatology, teledermatology served more patients under age 17, male patients, nonwhite patients, and patients without comorbid conditions. Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms.
Dr. Reina Haque[/caption]
Reina Haque, PhD MPH
Research scientist
Kaiser Permanente Southern California Department of Research & Evaluation
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Haque: The study fills an important knowledge gap about the long-term association of aromatase inhibitors on cardiovascular disease risk in breast cancer survivors.
This was a retrospective cohort study that included a cohort of 13,273 postmenopausal breast cancer survivors who were diagnosed with breast cancer, either estrogen or progesterone receptor positive, from 1991 to 2010. The patients were followed through 2011, or a maximum of 21 years. The study participants were divided into four groups based on the drugs they received: 31.7 percent were treated only with tamoxifen; 28.6 percent only with aromatase inhibitors; 20.2 percent used both; and 19.4 percent did not use any of these drugs. These oral drugs are used to combat breast cancer recurrence, but may have long-term side effects on other organs.
The study determined that the risk of cardiac ischemia (which can lead to a heart attack) and stroke were not elevated in patients who only took aromatase inhibitors compared to those who only took tamoxifen. These results provide reassurance that aromatase inhibitors may not increase risk of the potentially fatal cardiovascular outcomes compared to tamoxifen.
Dr. Redlich[/caption]
Dipl.-Psych. R. Redlich
Neuroimaging Group
Klinik und Poliklinik für Psychiatrie und Psychotherapie
Westfaelische Wilhelms-Universitaet Muenster
MedicalResearch.com: What is the background for this study?
Response: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. The ability to advise psychiatrists and patients accurately regarding the chances of successful ECT is of considerable value, particularly since ECT is a demanding procedure and, despite having relatively few side effects, has a profound impact on patients. Therefore, the present study sought to predict ECT response in a psychiatric sample by using a combination of structural Magnetic Resonance Imaging data and machine-learning techniques.
Dr. Ben Freedman[/caption]
Dr. Ben Freedman OAM
Deputy Director Research Strategy, Heart Research Institute/Charles Perkins Centre
Professor of Cardiology, Sydney Medical School
Head Vascular Biology Anzac Research Institute
Honorary VMO, Concord Repatriation General Hospital
University of Sydney
MedicalResearch.com: What is the background for this study?
Dr. Freedman: Guidelines recommend that patients with atrial fibrillation (AF) at high enough risk for stroke should be treated with anticoagulant. Anticoagulant drugs are remarkably effective in reducing stroke risk by about two thirds, and death by between a quarter and a third. Unfortunately, strokes can still occur when patients are prescribed anticoagulant for Atrial Fibrillation, and it is often presumed this residual risk of stroke represents treatment failure, though there are few data about this important issue.
MedicalResearch.com: What are the main findings?
Dr. Freedman: We were able to compare the risk of stroke in a cohort of patients with AF commenced on anticoagulant, with a very large closely-matched cohort seen in general practice at the same time but without AF. This is a unique comparison. We found that the residual risk of stroke in such anticoagulant-treated patients was virtually identical to that in the matched control cohort. The implication is that the residual risk of stroke may not be treatment failure, but the risk of non-cardioembolic stroke in people of a similar age and stroke risk profile but without Atrial Fibrillation. The residual risk of death in those on anticoagulant was higher than the matched controls, and intermediate between the control rate and the mortality rate for untreated AF.
Dr. Alison Fecher[/caption]
Alison M. Fecher, MD
Assistant Professor of Surgery
Indiana University Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Fecher: It has long been known that female faculty are underrepresented in departments of surgery at U.S. medical schools. Our study wanted to identify obstacles women face in entering certain surgical subspecialties and in career advancement. We found that women are poorly represented in some of the most competitive subspecialties, including cardiothoracic and transplant surgery. We also found that women tend to advance more slowly up the career ladder, with many of them spending more years at the assistant professor level than their male counterparts. One reason for this may be that they tend to publish less peer-reviewed articles than male faculty; however, our results show that the publications of female faculty often has a greater impact on the field, as measured by citations and recentness of articles.
Dr. Fleming Dutra[/caption]
MedicalResearch.com: What is the background for this study?
Dr. Fleming-Dutra: One of the most urgent public health threats of our time is the emergence of antibiotic-resistant bacteria. The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. Simply using antibiotics creates resistance. To combat antibiotic resistance we have to use antibiotics appropriately — only when needed and, if needed, use them correctly. In 2015, the White House released the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which set a goal for reducing inappropriate outpatient antibiotic use by 50% by 2020. However, the amount of antibiotic use in the outpatient setting that is inappropriate was unknown.
MedicalResearch.com: What are the main findings?
Dr. Fleming-Dutra: In this study, we estimate that at least 30% of antibiotics prescribed in doctors’ offices, emergency departments and hospital-based clinics are unnecessary—meaning that no antibiotic was needed at all, which equates to 47 million unnecessary antibiotic prescriptions written annually in these outpatient settings. Most of those unnecessary antibiotic prescriptions were written for acute respiratory conditions, a key driver of antibiotic overuse. Thus, in order to reach the White House goal of reducing inappropriate outpatient antibiotic use by 50%, a 15% reduction in overall antibiotic use in outpatient settings is needed by 2020.