Author Interviews, Education, Heart Disease / 31.08.2015

Jaclyn Portanova, Ph.D School of Gerontology University of Southern California DavisMedicalResearch.com Interview with: Jaclyn Portanova, Ph.D student School of Gerontology University of Southern California Davis Medical Research: What is the background for this study? Response: Over the past two decades, we have made a lot of progress in educating the public about the need to engage in advance care planning and make health care decisions, such as whether or not to receive CPR in a medical crisis. The media plays a major role in shaping the way people think about life-saving measures such as cardiopulmonary resuscitation (CPR). In fact, a study published in 1996 showed that popular medical shows portrayed CPR as having a much higher rate of success than actual rates. We sought to determine if popular media has improved in the accuracy of their depiction of CPR survival rates. Medical Research: What are the main findings? Response: Nearly 70% of TV show patients who received CPR survived the initial incident. This success rate is twice as high as actual rates. Even more striking, survival rate to hospital discharge following receipt of CPR was four times higher in popular medical television shows than actual rates. Advance care planning discussions between physicians and patients were rarely portrayed, but when they did occur patient preferences were honored.
Author Interviews, Mental Health Research, Psychological Science / 30.08.2015

Brian W. Haas, Ph.D. Assistant Professor Department of Psychology University of Georgia MedicalResearch.com Interview with: Brian W. Haas, Ph.D. Assistant Professor Department of Psychology University of Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Haas: We used a new way to study Borderline Personality Disorder.  We studied the traits associated with this condition in healthy people not diagnosed with Borderline Personality Disorder.  We found that people that possess more Borderline Personality traits exhibit reduced brain activity in parts of the brain important for empathy.
ADHD, Author Interviews, Memory / 28.08.2015

Dr. Graham Murray PhD University Lecturer Department of Psychiatry Addenbrooke's Hospital Cambridge UKMedicalResearch.com Interview with: Dr. Graham Murray PhD University Lecturer Department of Psychiatry Addenbrooke's Hospital Cambridge UK Medical Research: What is the background for this study? What are the main findings? Dr. Murray: There is debate about the extent to which ADHD persists into adulthood, with estimates suggesting that between 10-50% of children still have ADHD in adulthood. Diagnosis (whether in childhood or adulthood) is currently reliant on meeting symptom checklists (such as the American Psychiatric Association’s Diagnostic and Statistical Manual), and a current diagnosis is often the prerequisite to access health care from psychiatric services. We decided to follow up a sample of 49 teens who all had a confirmed diagnosis of ADHD at age 16. We also followed a control group made up of comparison healthy volunteers from the same social, ethnic and geographical background. When we used the symptom checklist criteria of persistence, only 10% of patients still met ADHD diagnostic criteria in adulthood. However, there is more to ADHD than this. When it comes to adult brain structure and function, it didn’t make any difference whether symptom checklists were still met or not. On reaching adulthood, the adolescent ADHD group show reduced brain volume in the caudate nucleus - a key brain region that supports a host of cognitive functions, including working memory function. When we assessed working memory ability, we noted persistent problems in the adolescent ADHD group, with a third of the adolescent ADHD sample failing the memory test. The poor memory scores seemed to relate to a lack of responsiveness in the activity of the caudate nucleus that we could detect using functional MRI scans. In the control group, when the memory questions became more difficult, the caudate nucleus became more active, and this appeared to help the control group perform well; in the adolescent ADHD group, the caudate nucleus kept the same level of activity throughout the test. It was as if, for the controls, when the test got harder, the caudate nucleus went up a gear in its activity, and this is likely to have helped solve the memory problems. But for the adolescence ADHD group, the caudate couldn’t go up a gear when the test became harder, and this likely resulted in poorer performance. 
Author Interviews, BMJ, Nutrition, Weight Research / 28.08.2015

Dr Aseem Malhotra MBChB, MRCP Honorary Consultant Cardiologist - Frimley Park Hospital Consultant Clinical Associate to the Academy of Medical Royal Colleges Science Director- Action on Sugar Saving Londoners Lives - External Advisory Board MemberMedicalResearch.com Interview with: Dr Aseem Malhotra MBChB, MRCP Honorary Consultant Cardiologist - Frimley Park Hospital Consultant Clinical Associate to the Academy of Medical Royal Colleges Science Director- Action on Sugar Saving Londoners Lives - External Advisory Board Member   Medical Research: What is the background for this study? What are the main findings? Dr. Malhotra: It is a review of all the research up to date on what is the impact of diet on health. What type of diet has the most robust evidence for weight and health and how this can be translated into policy to rapidly reduce the burden of chronic disease. Medical Research: What should clinicians and patients take away from your report? Dr. Malhotra:
  • That "low fat" diets to do not improve health outcomes and the public should stop counting calories.
  • That a high fat Mediterranean diet is more powerful in reducing the risk of heart attack and stroke than any medical treatment.
  • That it's effect is independent of cholesterol lowering.
  • That rapid weight loss through calorie counting combined with exercise doesn't only not improve health outcomes in the long term for diabetics but can also be potentially harmful by increasing CVD risk.
Author Interviews, PLoS, Vaccine Studies / 28.08.2015

Dr Javier Martin PhD Principal Scientist Division of Virology National Institute for Biological Standards and Control (NIBSC) Medicines and Healthcare products Regulatory Agency (MHRA) Blanche Lane, South Mimms, Potters Bar United KingdomMedicalResearch.com Interview with: Dr Javier Martin PhD Principal Scientist Division of Virology National Institute for Biological Standards and Control (NIBSC) Medicines and Healthcare products Regulatory Agency (MHRA) United Kingdom Medical Research: What is the background for this study? Dr. Martin: The global eradication of polio appears to be within reach.  There has been no case of poliomyelitis caused by circulating wild type 2 poliovirus since 1999, no case of type 3 since November 2012 and the last case of type 1 in Africa was in August 2014, leaving some areas of Pakistan and Afghanistan as the main remaining reservoirs of circulating wild type 1 poliovirus. Poliovirus strains in the live-attenuated oral polio vaccine (OPV) are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation. These vaccine-derived poliovirus (VDPV) strains can transmit from person to person in populations with low immunity potentially leading to poliomyelitis outbreaks.
Author Interviews, Biomarkers, Pancreatic / 28.08.2015

Jenny Permuth Wey, PhD, MS Assistant Member Departments of Cancer Epidemiology and Gastrointestinal Oncology Moffitt Cancer Cente MedicalResearch.com Interview with: Jenny Permuth Wey, PhD, MS Assistant Member Departments of Cancer Epidemiology and Gastrointestinal Oncology Moffitt Cancer Center   Medical Research: What is the background for this study? What are the main findings? Dr. Wey: Pancreatic cancer is one of the deadliest cancers world-wide. It is currently the fourth leading cause of cancer-related deaths in the United States, and is predicted to become the second leading cause by 2030. Currently there are no accurate methods to diagnose pancreatic cancer early when a patient may be eligible for surgery to remove the tumor and hopefully survive longer. To beat this disease, early detection is key, and our team has dedicated efforts to studying pancreatic cancer in its ‘precancerous’ state because we and other researchers believe that the identification and treatment of precancerous pancreatic lesions offers a promising strategy to reduce the number of people losing their lives to this disease. Similar to how colon polyps can progress into colon cancer, we now know that certain types of pancreatic cystic lesions can progress into pancreatic cancer. Pancreatic cancer precursors/pre-cancers known as intraductal papillary mucinous neoplasms (IPMNs) account for nearly one-half of the estimated 150,000 asymptomatic pancreatic cysts detected as ‘incidental findings’ on computed tomography (CT) scans or magnetic resonance imaging (MRI) scans each year during the clinical work-up for an unrelated condition.  Imaging alone cannot reliably distinguish between benign, pre-cancerous, and cancerous cysts, and cannot differentiate ‘low-risk’intraductal papillary mucinous neoplasms' (defined as low- or moderate-grade disease) that can be monitored from ‘high-risk’ IPMNs (defined as high-grade or invasive disease) that should be surgically removed.  The decision to undergo pancreatic surgery is not trivial for the patient and medical team since pancreatic surgery can be associated with an estimated 40% chance of complications and a 4% chance of death. Noninvasive tests are needed to accurately detect precancerous lesions of the pancreas so that personalized risk assessment and care can be provided. microRNAs (miRNAs) are small molecules that act as ‘master-regulators’ of cancer-related processes in the body. One of the main purposes of our ‘proof of principle’ study was to measure miRNAs in the blood and determine whether a set of miRNAs could distinguish patients with IPMNs from healthy individuals. We then sought to determine whether a set of miRNAs could distinguish patients known to have ‘low-risk’ IPMNs from those with ‘high-risk’ IPMNs.  We show that new, relatively inexpensive digital technology could reliably measure miRNAs in blood plasma (the pale yellow liquid component of blood) from individuals newly-diagnosed with pancreatic cancer precursors (IPMNs) and healthy individuals.  Thirty miRNAs out of 800 tested showed higher levels in IPMN patients compared to healthy individuals, providing a preliminary ‘miRNA signature’ that may be found only in people with early pancreatic disease, suggesting it could serve as an early diagnostic tool.  Furthermore, we also provide preliminary data to suggest that a 5-miRNA signature can partially distinguish high-risk IPMNs that warrant resection from low-risk IPMNs that can be watched.  This is important clinically because it would be opportune to personalize care such that high-risk IPMNs that warrant resection are properly identified while individuals with low-risk IPMNs are spared the substantial  risks of mortality and morbidity associated with overtreatment from unnecessary surgery.
Author Interviews, Depression, Fertility / 28.08.2015

MedicalResearch.com Interview with: Camilla Sandal Sejbaek PhD Department of Public Health University of Copenhagen Medical Research: What is the background for this study? What are the main findings? Response: Previous literature have shown ambiguous results when investigating the association between becoming a mother and depression among women in fertility treatment. Small questionnaire-based studies with self-reported depression have shown that women in unsuccessful fertility treatment had a higher risk of depressive symptoms compared to women in successful fertility treatment. Two larger register-based studies using clinical depression (depression diagnosed at the psychiatric hospitals) have shown that women becoming a mother are at increased risk of clinical depression. Our findings, from a large register-based study with about 41,000 women in assisted reproductive technology (ART) treatment, showed that women WHO became mothers had a higher risk of clinical depression compared to women in ART treatment WHO did not become mothers. The risk of clinical depression were more than five-fold higher within the first 6 weeks after becoming a mother to a live-born child.
Allergies, Asthma, Author Interviews, Microbiome, Pulmonary Disease / 28.08.2015

Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London MedicalResearch.com Interview with: Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London     Medical Research: What is the background for this study? Response: Asthma is a common, long-term, respiratory condition which affects over 300 million people worldwide. It is a burden not only for the individual with asthma but also for the health services that care for them and the wider economy, due to days lost from work and school. Asthma therapies aim to prevent attacks and improve symptoms by reducing airway constriction and inflammation, but they come with their own risks of side effects. For example, long-term high-dose inhaled corticosteroids have been associated with growth restriction in children and long-acting beta2-agonists as mono-therapy have been associated with increased risk of death in people with asthma. There is growing interest in developing novel treatments for asthma and one such treatment is specific allergen immunotherapy. Immunotherapy has the potential to be a useful approach for asthma as it is thought that for approximately half of people with asthma, allergies are an important trigger for their symptoms and attacks. Immunotherapy can be delivered by injection (subcutaneously) or under the tongue (sublingually) and aims to bring about immune tolerance. Immunotherapy has already been demonstrated to be effective in certain conditions, such as allergic rhinitis and wasp and bee sting allergy, but its effectiveness and safety in asthma is less clear. In fact, immunotherapy is not recommended at all for use in people with severe or uncontrolled asthma due to the risk of triggering a serious respiratory reaction. Medical Research: What are the main findings? Response: Our review looked for trials in which people with asthma who were given sublingual immunotherapy (SLIT) were compared with those given placebo, or who continued usual asthma care. We found 52 randomised controlled trials which met our inclusion criteria, allocating over 5,000 people to either SLIT or placebo/usual care. Most of the participants had mild asthma and were allergic to either house dust mite or pollen. Despite the large number of eligible trials we were only able to perform a limited meta-analysis. This is because most of the trials did not report the efficacy outcomes we were most interested in: exacerbations and quality of life. Asthma symptoms and medication use were both more frequently reported, but often using different, un-validated scales so we did not perform a meta-analysis for these outcomes. However, we were able to combine serious adverse event data from 22 trials involving 2560 participants and data for all adverse events from 19 trials including 1755 participants. SLIT did not appear to be associated with an increased risk of serious adverse events, although very few events were observed overall. SLIT was associated with a small increase in the risk of all adverse events, which in absolute terms equated to an increase from 222 per 1000 people in the control group to 327 per 1000 (95% confidence intervals 257 to 404). Importantly, many of these events were mild and transient local reactions and did not generally result in participants withdrawing from the trial.
Author Interviews, Case Western, Dermatology, Genetic Research / 27.08.2015

Nely Aldrich, MD Department of Dermatology University Hospitals Case Medical CenterMedicalResearch.com Interview with: Nely Aldrich, MD Department of Dermatology University Hospitals Case Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Aldrich:   To our knowledge, no formal studies have been performed on the genetic vs. environmental factors that lead to the development of rosacea. Our department has the unique opportunity to attend the Twins Days festival in Twinsburg, Ohio. This is a yearly festival where thousands of twin pairs come from all over the world. This was the perfect setting to ask our research question. Our main finding was that there is an approximately 50% contribution of genetics to rosacea and the other 50% can be attributed to environmental factors. Sun exposure, smoking, alcohol use, skin cancer history, and heart disease were also found to be correlated with a higher rosacea severity.
Author Interviews, Infections / 27.08.2015

Kyong Sup Yoon, Ph.D. Assistant Professor Department of Biological Sciences and Environmental Sciences Program Southern Illinois University-Edwardsville Edwardsville, IL 62026MedicalResearch.com Interview with: Kyong Sup Yoon, Ph.D. Assistant Professor Department of Biological Sciences and Environmental Sciences Program Southern Illinois University-Edwardsville Edwardsville, IL 62026  Medical Research: What is the background for this study? What are the main findings? Response: Dr. John Clark (Professor, University of Massachusetts-Amherst) and I have been studying this matter for 15 years. The goal of our current study is to determine resistance (knockdown resistance or kdr conferred by 3 point mutations in voltage gated sodium channel alpha subunit gene) frequencies in US head louse populations collected from 48 contiguous states. We were able to analyze 109 populations from 30 states and found 100% kdr frequencies in 104 populations.  Hopefully, we can achieve our original goal in near future and publish it. head lice, cdc imageMedical Research: What should clinicians and patients take away from your report? Response: We need to implement practical resistance management. Now, for the first time since introduction of pyrethroids, we have different compounds already available or will be (hopefully) available in near future. We suggest to use mixture strategies to minimize development of resistance to any new products.
Author Interviews, Dermatology, Endocrinology / 27.08.2015

Abdulmaged Traish; Photo by Vernon Doucette for Boston University Photography MedicalResearch.com Interview with: Abdulmaged M. Traish, MBA, Ph.D. Professor of Biochemistry Professor of Urology Boston University School of Medicine Boston, MA 02118   Medical Research: What is the background for this study?  Dr. Traish: This study was undertaken to evaluate the data in the contemporary literature on the use of finasteride and dutasteride for treatment of ( benign prostatic hypertrophy) BPH and androgenetic alopecia (AGA). These drugs were proven effective in management of patients withy BPH andandrogenetic alopecia; however, these drugs inhibit a family of enzymes widely distributed in many tissues and organs and therefore may have undesirable effects. Most importantly, few studies have been undertaken to evaluate the effects of these drugs on the central nervous system. The adverse impact of these drugs on sexual function and well-being in a subset of patients raised the questions that we do not know much about the safety of such drugs. Medical Research: What are the main findings?  Dr. Traish: The main findings of this study is that these agents, while useful in treatment of BPH and androgenetic alopecia, exert undesirable side effects on sexual function and well-being. More importantly, limited data is available on the impact of these agents on the central nervous system.
Author Interviews, Pediatrics, Sleep Disorders, Technology / 27.08.2015

Stephanie J. Crowley, Ph.D. Assistant Professor Biological Rhythms Research Laboratory Department of Behavioral Sciences Rush University Medical Center Chicago, IL 60612MedicalResearch.com Interview with: Stephanie J. Crowley, Ph.D. Assistant Professor Biological Rhythms Research Laboratory Department of Behavioral Sciences Rush University Medical Center Chicago, IL 60612 Medical Research: What is the background for this study? Dr. Crowley: Your readers may have seen recent reports by the American Academy of Pediatrics and the CDC about problems with early morning school bells for teens and the need to push school start times later.  These recent calls for later school start times come from data showing that biological processes make it challenging for a teen to get enough sleep and be rested for school when they have to wake up very early for school.  One of these biological processes is the circadian timing system, which is the approximate 24-hour brain clock that regulates the timing of sleep and wake.  During the teen years, the brain clock is shifted later making it more difficult for many teens to fall asleep early enough to get sufficient sleep on school nights. Medical Research: What are the main findings? Dr. Crowley: Melatonin suppression, as tested in this new study, is a good indication of how light affects the circadian system.  Our findings show that even a very small amount of light (similar to “romantic mood lighting”) in the evening suppressed melatonin levels in the middle-school-aged adolescents.  Because evening light “seen” by the brain clock shifts the clock later in time, the message is that biologically-driven later sleep times starts at this early age and needs to be considered when managing school and sleep schedules.
Author Interviews, Breast Cancer, Duke, Genetic Research, JAMA / 27.08.2015

Michaela Ann Dinan Ph.D. Assistant Professor in Medicine Member of Duke Cancer Institute Duke University School of MedicinMedicalResearch.com Interview with: Michaela Ann Dinan Ph.D. Assistant Professor in Medicine Member of Duke Cancer Institute Duke University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Dinan: For many years we have known that overall, women with early stage, hormone receptor positive breast cancer show an overall survival benefit from the receipt of adjuvant chemotherapy.  However, depending on the age of the patient, we have also known that between 3 to 10% of patients appear to be truly experiencing this survival benefit and that we are treating a lot of women unnecessarily.  The use of the Oncotype DX assay has provided additional information for patients to assess who at low risk of disease progression and can forgo chemotherapy. In this study we looked to see whether the adoption of this assay was associated with reduce rates of chemotherapy in women over the age of 65.  We found that somewhat surprisingly, there was no overall association with receipt of the assay and use of chemotherapy.  However, in women who had high risk disease, receipt of the assay was associated with reduced rates of chemotherapy use.  In patients with low risk disease, receipt of the assay was associated with increased chemotherapy use.
Author Interviews, Social Issues / 27.08.2015

Juliana Schroeder PhD, Assistant Professor Berkeley Haas Management of Organizations Group University of California at BerkeleyMedicalResearch.com Interview with: Juliana Schroeder PhD, Assistant Professor Berkeley Haas Management of Organizations Group University of California at Berkeley Medical Research: What is the background for this study? What are the main findings? Dr. Schroeder: Whereas much research examines how physicians perceive their patients,in this paper we instead study how patients perceive physicians. We propose that patients consider their physicians like personally emotionless “empty vessels:” The higher is individuals’ need for care, the less they value physicians’ traits related to physicians' personal lives (e.g., self-focused emotions) but the more they value physicians’ traits relevant to patient care (e.g., patient-focused emotions). ​In a series of experiments,we show that participants in higher need for care believe their physicians have less personal emotions. That is, they perceive physicians as emotionally "empty" the more they need them. This was true both when we manipulated need for care - for example, by having participants focus on potential medical problems or reminding them they needed to get a medical check-up - and also when we measured it, for example by comparing patients at a medical clinic (high need) to people not at a clinic (low need).
Author Interviews, Cancer Research, Pain Research / 27.08.2015

Dr. Sebastiano Mercadante MD Director, Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center, Palermo, ItalyMedicalResearch.com Interview with: Dr. Sebastiano Mercadante MD Director, Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center, Palermo, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Mercadante:  Breakthrough cancer pain (BTcP) has been defined as a transitory increase in pain intensity that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background (1). Breakthrough cancer pain is a common problem in patients with cancer and is associated with significant morbidity. In a recent report in which a pragmatic definition of breakthrough cancer pain was used (2), the prevalence of BTcP was 75% (3). Oral morphine (OM) has been traditionally offered as a breakthrough cancer pain medication in doses of about 1/6 of the daily opioid regimen for years, although this approach has never been supported by any evidence. Different technologies have been developed to provide a rapid onset of effect with potent opioid drugs such as fentanyl (rapid onset opioids, ROOs) delivered by non-invasive routes. Fentanyl products have been shown to be significantly superior to oral opioids, but it has been suggested that the dose of fentanyl should be individually titrated in order to enable effective analgesia to be delivered while minimizing the risk of clinically significant adverse effects. The need of dose titration with rapid onset opioids has never been appropriately assessed and this statement is derived by a series of weaknesses of papers published for regulatory issues. Indeed, the only existing study comparing dose titration and proportional doses, reported that proportional doses of (Fentanyl buccal tablet) FBT are more effective and safe over dose titration method. NICE guidelines did not provide evidence for that, at least at certain time intervals after administration. To scientifically compare rapid onset opioids and oral morphine, we used a similar approach and made a strict selection of patients, according to a more specific algorithm for a diagnosis o fbreakthrough cancer pain. Thus, patients were randomized to receive in a crossover design Fentanyl buccal tablet and oral morphine, both given in doses proportional to opioid daily doses, for the management of breakthrough cancer pain. This comparative study has shown that, when giving the drugs for breakthrough cancer pain in doses proportional to the opioid regimen for background pain, Fentanyl was clearly superior for efficacy and rapidity in comparison with oral morphine. The analgesic effect was more intense either at 15 and 30 minutes after study medications were given. A larger number of episodes treated with Fentanyl buccal tablet  presented a decrease in pain intensity of ≥33% and ≥50% in comparison with episodes treated with oral morphine, and a relevant difference in SPID30 was reported. Of interest, adverse effects commonly observed in patients receiving opioids were not severe and did not differ between the treatments, suggesting that the use of proportional doses of both drugs are safe, reflecting what is derived by the long-lasting experience with oral morphine.  
Author Interviews, Social Issues / 27.08.2015

Asmir Gračanin, PhD Tilburg University Department of Medical and Clinical Psychology & Department of Communication and Information Sciences Tilburg The NetherlandsMedicalResearch.com Interview with: Asmir Gračanin, PhD Tilburg University Department of Medical and Clinical Psychology & Department of Communication and Information Sciences Tilburg The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Gračanin: Background for this study are primarily the results from previous paper and pencil studies in which people (retrospectively) claimed that crying made them feel better, which also corresponds to popular cultural beliefs. The remaining background were the results from lab studies that showed mood decreases immediately following crying episodes that were typically induced by emotional films. So, as you can see in both cases background is quite devoid of any theory, but it represented enough motivation to try to see what is really happening here. In addition, human tears are surprisingly understudied and we do not know exactly what is their function, so any research that looks for their intra-individual as well as inter-individual functions is badly needed. In this laboratory study we found that those individuals that cried felt much worse immediately after crying (which corresponds to previous lab studies), but their mood recovered surprisingly quickly (new finding), and finally it went even above the initial levels, that is, they felt even a bit better than before the emotional film that made them cry (corresponds to previous retrospective but not lab studies). No mood changes were observed in those that did not cry. Therefore, it seems that there is something to the popular belief that crying makes one feel better. However, we suspect that people could misinterpret that large mood improvement, which appears just necessarily after the initial mood deterioration, as a general mood improvement. So it is a strong return to initial mood levels that people could experience as a relief. In addition, we did observe a general mood improvement as well, although this effect was quite small. Thus, if there is general positive effect of crying on one's mood, it seems to take more time. This is the first such laboratory finding.
Author Interviews, Heart Disease, JAMA / 27.08.2015

Jay R. Desai, PhD, MPH HealthPartners Institute for Education and Research Minneapolis, MN 55425MedicalResearch.com Interview with: Jay R. Desai, PhD, MPH HealthPartners Institute for Education and Research Minneapolis, MN 55425 Medical Research: What is the background for this study? What are the main findings? Dr. Desai: SUPREME-DM is a consortium of 11 integrated health systems throughout the United States that serve a culturally and economically diverse population of 16 million members. This study monitors changes in cardiovascular outcomes from 2005 through 2011 among the 1.2 million members identified with diabetes and a matched sample of 1.2 million members without diabetes. We found very encouraging and sustained declines in the rates of myocardial infarction/acute coronary syndrome (MI), stroke, heart failure (HF), and all-cause mortality among adults with and without diabetes.   Declines were greatest among the 15% adults who were already at high risk for cardiovascular events (such as people with diabetes or a prior history of heart disease). There was less improvement in cardiovascular event rates and mortality among the other 85% of members with low to moderate cardiovascular risk.
Author Interviews, Mental Health Research, Microbiome / 26.08.2015

Keith A. Crandall, PhD Director - Computational Biology Institute George Washington University Innovation Hall Suite 305 Ashburn, VA 20147-2766MedicalResearch.com Interview with: Keith A. Crandall, PhD Director - Computational Biology Institute George Washington University Innovation Hall Suite 305 Ashburn, VA 20147-2766 Medical Research: What is the background for this study? What are the main findings? Dr. Crandall: We wanted to investigate whether or not there were significant differences in the microbiome (microbial composition) of patients with schizophrenia versus controls.  The other researchers have demonstrated a connection between microbiome diversity and brain development and behavior modulation associated with a variety of disorders.  Our initial study focuses on the oropharyngeal as a target for the microbiome characterization, but we have additional work relating to other microbiomes (e.g., gut) for which we are still in the process of analyzing the data.     Collected microbiome data from 16 individuals with schizophrenia and 16 controls (matched as best we could and corrected statistically for differences between the populations), we showed differences in the microbiome taxonomic diversity and functional diversity.  Specifically, we identified a significant increase in the number of metabolic pathways related to metabolite transport systems; whereas, carbohydrate and lipid pathways and energy metabolism were abundant in controls.
Author Interviews, Toxin Research / 26.08.2015

Carla Kantara, Ph.D. Postdoctoral fellow Dept. of Biochemistry and Molecular Biology University of Texas Medical Branch at Galveston MedicalResearch.com Interview with: Carla Kantara, Ph.D. Postdoctoral fellow Dept. of Biochemistry and Molecular Biology University of Texas Medical Branch at Galveston   Medical Research: What is the background for this study? What are the main findings? Dr. Kantara: The increasing threats of radiation exposure and nuclear disasters have become a significant concern for the United States and countries worldwide. Such concern has increased national and international recognition for the need to develop novel medicinal countermeasures that can prevent radiation-induced tissue damage and keep thousands of people alive, even if administered a day or more after nuclear exposure. To date, there are only a few mitigating or radioprotective agents that are approved by the FDA, however they are unsuccessful in treating the gastrointestinal toxicity induced by high-dose radiation exposures, and are ineffective as a post-exposure treatment for the thousands of potential exposed individuals. In our study, we showed that a single injection of TP508, administered 24 hours post-radiation, significantly increased mice survival and effectively protected the gastrointestinal mucosa by delaying crypt dissociation and directly stimulating stem cell regeneration. This suggests that TP508 may be an effective post-exposure medicinal countermeasure for mitigating radiation-induced gastrointestinal damage and mortality following a nuclear incident and may provide exposed victims additional time to be evacuated so that they can receive additional life-saving medical treatment.
Author Interviews, Breast Cancer, Genetic Research, Race/Ethnic Diversity / 26.08.2015

Tuya Pal MD Division of Population Sciences Department of Health Outcomes and Behavior Moffitt Cancer Center Tampa, Florida MedicalResearch.com Interview with: Tuya Pal MD Division of Population Sciences Department of Health Outcomes and Behavior Moffitt Cancer Center Tampa, Florida   Medical Research: What is the background for this study? Dr. Pal:  Young Black women bear a disproportionate burden associated with breast cancer incidence and mortality compared to their White counterparts. Given that inherited mutations in the BRCA1 and BRCA2 genes are more common among young breast cancer survivors, we questioned to what extent mutations in these genes might contribute to the racial disparity in breast cancer incidence among young women. Medical Research: What are the main findings? Dr. Pal:  Through conducting the largest U.S. based study of BRCA mutation frequency in young black women diagnosed with breast cancer at or below age 50, we discovered they have a much higher BRCA mutation frequency than that previously reported among young white women with breast cancer.  Specifically, of the 396 Black women with breast cancer diagnosed at or below age 50, 12.4% had mutations in either BRCA1 or BRCA2.  Furthermore, over 40 percent of those with a mutation had no close relatives with breast or ovarian cancer, which suggests that family history alone may not identify those at risk for carrying a BRCA mutation. 
Author Interviews, JAMA, Social Issues / 26.08.2015

Adi V. Gundlapalli, MD, PhD Associate Professor of Internal Medicine University of Utah School of Medicine and University of Utah Hospitals and ClinicsInformatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System, Salt Lake City, Utah MedicalResearch.com Interview with: Adi V. Gundlapalli, MD, PhD Associate Professor of Internal Medicine University of Utah School of Medicine and University of Utah Hospitals and ClinicsInformatics, Decision Enhancement, and Analytic Sciences Center VA Salt Lake City Health Care System, Salt Lake City, Utah   Medical Research: What is the background for this study? What are the main findings? Dr. Gundlapalli: We wanted to explore the hypothesis that those separated for misconduct-related reasons would have more difficulty reintegrating into their communities post-deployment, with homelessness as an extreme example of such difficulties. Misconduct-related separations from the military are associated with subsequent adverse civilian outcomes that are of substantial public health concern. This study analyzed the association between misconduct-related separations and homelessness among recently returned active-duty military service members. Using US Department of Veterans Affairs (VA) data, investigators identified 448,290 Veterans who were separated from the military (end date of last deployment) between October 1, 2001 and December 31, 2011; had been deployed to Iraq and/or Afghanistan; and had subsequently used VA healthcare. Homelessness was determined by an assignment of “lack of housing” during a VA healthcare visit, by participation in a VA homelessness program, or both. Veterans’ housing status was followed through April 30, 2012. We assessed risk for homelessness as a function of separation category (e.g., normal, misconduct, early release), controlling for patient demographics and military service covariates, including service-related disability, branch, rank, and combat exposure. In our opinion, the most significant finding was that 26% of Veterans who were separated for misconduct related reasons were homeless at their first VA encounter; and this number climbed to 28% within one year after their first VA encounter. Additionally, the likelihood of being homeless at the first VA encounter was nearly 5 times greater for those separated for misconduct-related reasons as compared to normal separations; this climbed to nearly 7 times greater at one year after the first VA encounter. Collectively, these results represent the strongest risk factor for homelessness among US Veterans observed to date, and helps to explain the higher risk of homelessness observed among Veterans, despite access to VA benefits and services.
Author Interviews, BMJ, Outcomes & Safety / 26.08.2015

Alicia A. Bergman, Ph.D. Research Health Scientist VA Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation & Policy North Hills, CA 91343MedicalResearch.com Interview with: Alicia A. Bergman, Ph.D. Research Health Scientist VA Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation & Policy North Hills, CA 91343  Medical Research: What is the background for this study? What are the main findings? Dr. Bergman: The impetus for this study comes from several sources but most notably the IOM report of 2002 entitled, Crossing the Quality Chasm in which the IOM estimated that between 44,000 and 98,000 lives are lost each year due to preventable medical errors in the hospital.  The IOM further reported that 80% of all adverse outcomes in the hospital can be traced back to breakdowns in communication during handoffs and transfers of care.  A 2005 study by our VA research team found that only 7% of medical schools in the US teach the handoff as part of the formal curriculum. As such, handoffs represent a vulnerable gap in the quality and safety of patient care. We were interested to know how end of shift handoffs in medicine, nursing, and surgery were enacted and audio and videotaped them in a single VA hospital. We found that there was a great deal of variation in how the handoffs were conducted and similar variations in the ways in which language was used to characterize technical and interpersonal aspects of care. We were especially interested in what we term “anticipatory management communication” and its functions during handoffs. While much technical information can easily be conveyed in the electronic medical record, some types of psychological or social information that are more informal in nature, such as “Mr. Smith’s been our problem child today,” do not lend themselves to being transmitted in the electronic medical record. However, such ‘heads up’ information and communication is often critical to understanding a patient’s context, course, and outcome of care. We also found that indirect anticipatory management communication was used among all dyads but more commonly among nurse dyads, with instructions and tasks implied and often inferential. We conclude that contextually sensitive information about anticipated events is best communicated directly (and ideally face-to-face), and that talk-backs and more explicit use of language can improve handoff quality, making them safer for patients.
Alzheimer's - Dementia, Author Interviews, JAMA / 26.08.2015

Dr. Eric Reiman MD Executive Director, Banner Alzheimer’s Institute (BAI) Chief Executive Officer, Banner Research, Clinical Director of the Neurogenomics Division at the Translational Genomics Research Institute (TGen) Professor of Psychiatry, University of Arizona Director, Arizona Alzheimer’s ConsortiumMedicalResearch.com Interview with: Dr. Eric Reiman MD Executive Director, Banner Alzheimer’s Institute (BAI) Chief Executive Officer, Banner Research Clinical Director of the Neurogenomics Division at the Translational Genomics Research Institute (TGen) Professor of Psychiatry, University of Arizona Director, Arizona Alzheimer’s Consortium Phoenix Arizona   Medical Research: What is the background for this study? What are the main findings? Dr. Reiman: Beta-amyloid plaque deposition is a cardinal feature of Alzheimer’s disease. Recent positron emission tomography (PET) have suggested that about one-fourth of patients with the clinical diagnosis of mild-to-moderate Alzheimer’s dementia—and more than a third of those who had no copies of the APOE4 gene, the major genetic risk factor for Alzheimer’s—do not have appreciable amyloid plaque deposition. We wondered whether this finding reflected an absence of appreciable brain amyloid, particularly in APOE4 non-carriers, or instead an underestimation of amyloid plaques using PET. In those patients with minimal plaque deposition, we also wondered what percentages had neuropathological evidence of another dementia-causing disease, neurofibrillary tangle pathology (the other cardinal feature of Alzheimer’s, or no known pathological contribution. We surveyed data from the 100 APOE4 non-carriers and 100 APOE4 carriers who had the clinical diagnosis of mild-to-moderate Alzheimer’s dementia during their last visit at any of the nation’s Alzheimer’s Disease Centers and had an autopsy performed within the next 2 years. As we reported in JAMA Neurology, 37 percent of APOE4 non-carriers and 13 percent of APOE4 carriers with a clinical diagnosis of mild-to-moderate Alzheimer’s had minimal evidence of neuritic or diffuse amyloid plaques—and those for whom we had brain samples had no evidence of increased soluble amyloid. A proportion of individuals had a different neuropathological diagnosis. While nearly half of those patients with minimal amyloid or any other pathology had extensive tangle formation, a similar percentage was found in cognitively unimpaired persons in the same age range. Our findings suggest the PET findings are correct – that a quarter of all patients (and more than a third of APOE4 non-carriers) with the clinical diagnosis of Alzheimer’s dementia do not have appreciable amyloid pathology, and that about 10 to 15 percent of patients do not have a clear explanation for their dementia.
Author Interviews, Electronic Records / 26.08.2015

Professor Susan A. Sherer, Ph.D. Lehigh University College of Business and Economics Department of Management Bethlehem, PA 18015 MedicalResearch.com Interview with: Professor Susan A. Sherer, Ph.D. Lehigh University College of Business and Economics Department of Management Bethlehem, PA 18015  MedicalResearch: What is the background for this study? What are the main findings? Dr. Sherer: With the growth in electronic health record implementation, there has been increasing demand for integration of these records within and across practice settings that have different work cultures, e.g. ambulatory and hospital locations. We find that computer integration alone does not result in coordination; users must value the integrated information and incorporate this information within their workflows. Users must move beyond technology acceptance and adaptation to focus on and value coordination. The system itself cannot drive these process changes; specific work process changes must be instituted and the users must adapt these changes.
Author Interviews, Sexual Health / 26.08.2015

Elizabeth Aura McClintock PhD Assistant Professor Department of Sociology University of Notre Dame Notre Dame, IN 46556MedicalResearch.com Interview with: Elizabeth Aura McClintock PhD Assistant Professor Department of Sociology University of Notre Dame Notre Dame, IN 46556 Medical Research: What is the background for this study? What are the main findings? Dr. McClintock: Sexual identity is a social construct that emerged in the late nineteenth century. People have always engaged in homosexual and heterosexual behavior, but we have not always had the concept of homosexual and heterosexual as types of personal identities. That is not to say that sexual desire or sexual preference does not have biological origins, but the concept of sexual identity and the specific labels that we use (gay, straight, bi-curious, etc.) are fundamentally social in origins. Given that sexual identity is a social construct, social context should influence it. By social context I mean socioeconomic position, social networks, romantic status and experience, and family, among other factors. As a parallel example, researchers have recently shown that racial identification depends on context--a person may be perceived differently and self-identify differently depending as their social context changes. Extant research on sexual identity, however, largely ignores social context. My goal was to begin to fill this gap. I found that several aspects of social context, including class background, educational attainment, race, and timing of childbirth, are associated with sexual identity. Indeed, context is associated with sexual identity net of sexual attraction. Perhaps because women have more flexible sexual attractions (they are more likely than men to report attraction to both sexes), social context has a larger effect on women's sexual identity.
Author Interviews, Depression, Dermatology, NYU/NYMC / 26.08.2015

Roger S. Ho, MD, MS, MPH, FAAD Assistant Professor The Ronald O. Perelman Department of Dermatology NYU Langone Medical CenterMedicalResearch.com Interview with: Roger S. Ho, MD, MS, MPH, FAAD Assistant Professor The Ronald O. Perelman Department of Dermatology NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Ho: In recent years, the impact of psoriasis on quality of life has come to light. We have seen several studies show that patients with psoriasis experience worse quality of life because of their disease. Few studies however have examined the association between psoriasis and mental illness, specifically depression. Many chronic diseases are known to be associated with depression. As more and more evidence supports the relationship between psoriasis and cardiovascular disease, it is important to examine the relationship between psoriasis and depression, while controlling for cardiovascular comorbidity. In our study of a nationally-representative population of US patients, we found that patients with psoriasis had twice the odds of having depression than patients without psoriasis, even after adjusting for major confounders including a history of myocardial infarction, stroke, and diabetes that may independently be associated with depression. The risk of depression did not depend on extent or severity of psoriatic disease.
Author Interviews, Emergency Care, Infections / 25.08.2015

John P. Haran MD Assistant Professor of Emergency Medicine University of Massachusetts Medical School, Worcester, MA MedicalResearch.com Interview with: John P. Haran MD Assistant Professor of Emergency Medicine University of Massachusetts Medical School, Worcester, MA Medical Research: What is the background for this study? What are the main findings? Dr. Haran: The Infectious Disease Society of America (IDSA) publishes evidence based guidelines for the treatment of skin and soft tissue infections, however, how closely clinicians follow these guidelines is unknown. Observation units have been increasingly used over the past decade in emergency medicine for short-term care of patients for many medical conditions including skin infections. These units offer a great alternative to hospitalization especially for older adults. We set out to describe the treatment patterns used in the observation unit of an academic institute and compare them to the IDSA guidelines. We found that physicians had poor adherence to these guidelines. Additionally, we discovered that older adults were at increased risk of being over-treated while women were at increased risk for being under-treated. These age and gender biases are not new to medicine and emergency departments should standardize antibiotic treatments to reduce treatment bias.
Author Interviews, Nutrition, Weight Research / 25.08.2015

Candida Rebello, PhD candidate Louisiana State University Pennington Biomedical Research Center School of Nutrition and Food Sciences Baton Rouge , Louisiana MedicalResearch.com Interview with: Candida Rebello, PhD candidate Louisiana State University Pennington Biomedical Research Center School of Nutrition and Food Sciences Baton Rouge , Louisiana   MedicalResearch: What is the background for this study? What are the main findings? Response: Oats contain a soluble fiber called beta-glucan. When mixed with liquids, this fiber induces viscosity or what is commonly called thickening. The degree of thickening depends on a number of factors such as the structure and concentration of the fiber, its molecular weight, and the ease with which the fiber will absorb water. These qualities of the fiber can be affected by various processing techniques used in the preparation of food products. Viscosity affects appetite by influencing the way foods interact with the mouth, as well as the stomach and intestines. Viscosity in the stomach can cause distension and promote a feeling of fullness. Viscosity in the intestinal tract delays digestion and absorption allowing nutrients to interact with cells and release hormones that reduce hunger and keep a person full for a prolonged period after eating a meal which is termed satiety. Viscosity in the mouth also affects appetite and all these effects often work in concert. In animal studies, oat beta-glucan has been shown to influence appetite regulating hormones, as well as reduce food intake and body weight.1,2 In human trials, several studies have shown that oat beta-glucan reduces appetite.3-10 In this study, we found that instant oatmeal eaten at breakfast reduced hunger, increased fullness, and reduced food intake at lunch, compared to an oat-based ready-to-eat cereal containing equal calories. Instant oatmeal had greater viscosity than the ready-to-eat cereal.
Author Interviews, Dermatology / 25.08.2015

William W. Huang, MD, MPH Assistant Professor and Program Director Wake Forest School of Medicine Department of Dermatology Winston-Salem, NC 27104MedicalResearch.com Interview with: William W. Huang, MD, MPH Assistant Professor and Program Director Wake Forest School of Medicine Department of Dermatology Winston-Salem, NC 27104 Medical Research: What is the background for this study? What are the main findings? Dr. Huang: This particular study was an update of a previous study our group had published in 2008 (JAAD, 6/08). As the use of biologics in dermatology has increased dramatically in recent years, we wanted to evaluate the evidence for the screening and monitoring tests that are routinely performed for patients with psoriasis and psoriatic arthritis on biologic agents. We found that current guidelines for screening and monitoring tests varied among various national organizations (Table 1) including the American Academy of Dermatology, Japanese Dermatology Association, European Academy of Dermatology and Venerology, and the British Association of Dermatologists. Using evidence grading based on methods developed by the US Preventative Services Task Force (USPSTF), we found that the evidence was strongest (Grade B) for tuberculosis screening. High level evidence was in general lacking for other routine screening and monitoring tests except in select populations (Table 2, Table 3).