Author Interviews, COVID -19 Coronavirus, Dermatology, Respiratory / 06.10.2021

MedicalResearch.com Interview with: Lara van der Schoot  MD, PhD candidate Department of Dermatology Radboud University Medical Center Nijmegen, The Netherlands MedicalResearch.com: What is the background for this study? Response: Psoriasis is a chronic, immune mediated skin disease for which effective targeted biological agents have become available the past years. Inherent to their immunomodulatory mechanism of action, biologics might increase infections risk. We know from clinical trial data that respiratory tract infections are among the most common adverse events during biologic treatment, but real-world data is sparse. Regarding the risk of serious infections among biologic users, mostly defined as infections requiring hospitalization, previous studies provided different results and there is limited comparative data for the newer biologics available. The COVID-19 pandemic turned attention to the risk of infections among biologic users, especially for respiratory tract infections, as they might relate to susceptibility for viral respiratory tract infections such as COVID-19. In our study, the primary aim was to determine the risk of respiratory tract infections among real-world psoriasis patients treated with biologics, including the newer IL-17 and IL-23 inhibitors. The secondary aim was to assess risk of serious infections in this cohort. Additionally, rates of SARS-CoV-2 infections were assessed. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA, Technology / 05.10.2021

MedicalResearch.com Interview with: Pinar Zorlutuna, PhD Sheehan Family Collegiate Professor of Engineering Aerospace and Mechanical Engineering Chemical and Biomolecular Engineering (Concurrent) Bioengineering Graduate Program University of Notre Dame  MedicalResearch.com: What is the background for this study? Response: Acute myocardial infarction (AMI) is the primary cause of death among cardiovascular diseases. The current clinical standard of diagnosis combines echocardiogram (ECG) and several circulating protein biomarkers from plasma. In their current state, both are incapable of distinguishing between patients with and without complete coronary occlusion, unless additional invasive testing is implemented, and both have significant false positive rates. MicroRNAs (miRNAs) have shown great potential as rapid and discriminating biomarkers for acute myocardial infarction (AMI) diagnosis. (more…)
Author Interviews, Diabetes, Statins / 04.10.2021

MedicalResearch.com Interview with: Ishak Mansi, MD Staff Internist, VA North Texas Health System. Professor in Department of Medicine & Department of Data & Population Science, University of Texas Southwestern, Dallas, TX MedicalResearch.com: What is the background for this study? Response: Several scientific societies guidelines recommend Statins prescription to patients with diabetes aged 40 to 75 with LDL-cholesterol ≥70 mg/dL to prevent cardiovascular diseases from occurring. Statins have been shown to lower the risk of cardiovascular diseases. However, prior research has shown statins to be associated with increased insulin resistance. But doctors do not routinely measure “insulin resistance” for their patients, rather, it is done on research and academic circles only but not in everyday life. Increased insulin resistance may result in less controlled diabetes and/or escalation of anti-diabetes medications. (more…)
Author Interviews, HIV, Infections, Vanderbilt / 02.10.2021

MedicalResearch.com Interview with: Rachael Pellegrino, MD Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: We know that HIV care and outcomes have dramatically improved over the last 20 years, but disparities still exist at each step of the HIV care continuum, which can ultimately lead to differences in mortality rates. In addition to assessing trends and disparities in mortality, we wanted to look at differences in premature mortality, which has not been widely studied in the HIV population in the US. This concept serves to emphasize and quantify the time lost by death at an early age as an important measurement of the impact of diseases and can expose disparities that are not apparent in the mortality rates alone. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections / 02.10.2021

MedicalResearch.com Interview with: Chanu Rhee, MD, MPH Harvard Medical School and Harvard Pilgrim Health Institute Boston, MA MedicalResearch.com: What is the background for this study? Response: Sepsis is a leading cause of death, disability, and healthcare costs.  This has triggered regulators and hospitals to invest heavily in improving sepsis recognition and care.  Most notably, the Centers for Medicare & Medicaid Services (CMS) implemented the Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) by the in October 2015.  SEP-1 requires hospitals to report compliance with a 3 and 6 hour sepsis care bundle, which includes initial and repeat lactate measurements, blood culture orders, broad-spectrum antibiotic, specific quantities of fluid boluses for hypotension, vasopressors for persistent hypotension, and documentation of a repeat volume and perfusion assessment for patients with septic shock. While SEP-1 has helped raise awareness of sepsis and catalyzed sepsis quality improvement initiatives around the country, concerns have been raised about its potential unintended consequences -- particularly around increasing unnecessary broad spectrum antibiotic use -- and the strength of evidence supporting the measure.  In this study, we used detailed clinical data from a diverse cohort of hospitals to assess whether SEP-1 implementation was associated with changes in key processes of care and mortality in patients with suspected sepsis.  (more…)
Author Interviews, HPV, Vaccine Studies / 01.10.2021

MedicalResearch.com Interview with: Holly Frost, MD Assistant Professor Pediatrics University of Colorado Anschutz School of Medicine Thersia Sebastian, MD Pediatrics, Denver Health  MedicalResearch.com: What is the background for this study? Response: Among children with acute otitis media (AOM) S.pneumoniae, H.influenzae, and M.catarrhalis are the predominant bacterial otopathogens. Historically, the gold standard for diagnosing otopathogens has been through middle ear fluid (MEF) culture. The challenge with MEF culture is that it is time-consuming and requires expert training often only done by specialists, thereby limiting its diagnostic utility to guide routine clinical care. Recent studies have shown that there is a high correlation between nasopharyngeal (NP) and MEF organisms during AOM. It is easier to collect NP swabs and less training is required. Thus, NP samples could serve as a surrogate for detection of otopathogens, potentially making identification of otopathogens practical and feasible in a typical practice environment compared to a MEF collection. Identification of otopathogens could be critical in treatment management of AOM, especially in the era of antimicrobial stewardship efforts to overall reduce unnecessary antibiotic use. Our goal was to compare the sensitivity and specificity of NP PCR to NP culture for common bacteria that cause ear infections.  (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Stroke / 30.09.2021

MedicalResearch.com Interview with: Daniel E. Singer, MD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School of Public Health Division of General Internal Medicine Massachusetts General Hospital Boston, MA, 02114 MedicalResearch.com: What is the background for this study? Response: Atrial fibrillation (AF) raises the risk of ischemic stroke 4-5-fold and this risk is largely reversible by oral anticoagulants (OAC). These facts are part of the core knowledge of internal medicine and the basis of multiple guidelines. They are based on studies of patients with persistent or predominantly “heavy burden” paroxysmal AF completed in the 1990s. More recent studies using cardiac implantable devices (CIEDs: implantable defibrillators, pacemakers, etc) which have the capacity to monitor heart rhythm continuously have found that many older patients have brief, often undiagnosed, episodes of AF. Several of these studies have found that strokes occur during periods of sinus rhythm temporally distant from a preceding episode of AF. This has led to a widespread suspicion that AF is not a direct causal risk factor but a risk “marker” indicating the presence of other truly causal features like a diseased left atrium (atrial myopathy). If the risk marker hypothesis is correct, then long-term anticoagulation is needed even for brief and rare episodes of AF (assuming the patient’ s CHA2DS2-VASc score is high enough). The key problem with prior prospective studies using CIEDs was that only a small number of strokes were observed leading to inadequate statistical power. Our study addressed this power problem by linking the very large Optum electronic health record database which could identify ischemic strokes with the Medtronic CareLink database of long-term, continuous heart rhythm records of patients with CIEDs. We ended up studying 891 individuals who had an ischemic stroke and had 120 days of continuous heart monitoring prior to the stroke. (more…)
Author Interviews, CDC, COVID -19 Coronavirus, Vaccine Studies / 30.09.2021

MedicalResearch.com Interview with: Anne Hause PhD Epidemiologist Centers for Disease Control and Prevention  MedicalResearch.com: What is the background for this study? Response: On August 12, 2021, the Food and Drug Administration (FDA) amended Emergency Use Authorizations (EUA) for the Pfizer-BioNTech and Moderna COVID-19 vaccines to authorize administration of an additional dose following completion of a primary vaccination series to eligible persons with moderate to severe immunocompromise.  (more…)
Author Interviews, COVID -19 Coronavirus, Pediatrics, Vaccine Studies / 28.09.2021

MedicalResearch.com Interview with: Jonathan Baktari, MD CEO of e7health.com Dr. Baktari, CEO discusses Pfizer’s recent announcement that their vaccine trial for children ages 5-11 has been safe and effective, marking a major milestone in the fight against COVID-19.   MedicalResearch.com: What risks should parents weigh? Response: Pfizer has already said that based on their studies the lower dose two shot COVID vaccine for children is safe, meaning that their data shows minimal side effects. If that data is correct, then we should expect the same minor symptoms we see with teenagers to the COVID vaccine  (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease, Transplantation / 27.09.2021

MedicalResearch.com Interview with: Joel T. Adler, MD, MPH Department of Surgery, Brigham and Women’s Hospital Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts  MedicalResearch.com: What is the background for this study? Response: For patients who require renal replacement therapy for failed kidneys, kidney transplantation increased length of life and improves quality of life.  For many of these patients, their dialysis centers are the source of referral for evaluation for transplantation.  These dialysis centers have a number of publicly-reported quality measures, but they largely focus on the provision of dialysis care and not how often the centers’ patients undergo a kidney transplant.  Because these higher-rated facilities provide better dialysis care, we wanted to know if that benefit also spilled over into higher transplant listing rates. (more…)
Author Interviews, CMAJ, COVID -19 Coronavirus, Pediatrics / 27.09.2021

MedicalResearch.com Interview with: Shaun K. Morris MD, MPH, FRCPC, FAAP, DTM&H Divisions of General Pediatrics Clinician-Scientist, Division of Infectious Diseases Division of Infectious Diseases at the Hospital for Sick Children (SickKids) for the Canadian Paediatric Surveillance Program COVID-19 Study Team MedicalResearch.com: What is the background for this study? Response: The SARS-CoV-2 virus can cause the disease we now call COVID-19. In early 2020, when the SARS-CoV-2 virus first spread outside of China, it quickly became apparent that cases may be seen in Canada. It was not known at the time how infection with the virus would affect children and youth. Because more severe disease from other respiratory viruses often disproportionally affect the very young, we expected that a similar pattern may be seen with SARS-CoV-2. We also did not know if children and youth with certain underlying medical conditions may be at higher risk for more severe disease. Ultimately, this study was designed to get a better understanding of how often children and youth in Canada are hospitalized with SARS-CoV-2 infection, how often severe disease happens, and which children or youth may be at higher risk for severe disease.      (more…)
Author Interviews, JAMA, Methamphetamine, NIH, Race/Ethnic Diversity / 24.09.2021

MedicalResearch.com Interview with: Beth Han, M.D., Ph.D., M.P.H. Epidemiologist, Science Policy Branch of the National Institute on Drug Abuse (NIDA), National Institutes of Health MedicalResearch.com: What is the background for this study? Response: In the U.S., overdose deaths involving psychostimulants with abuse potential other than cocaine (i.e. largely methamphetamine), increased dramatically during the past decade. Psychostimulant-involved overdose deaths also often involved opioids (50% in 2017). However, it was still undetermined how trends in methamphetamine use among vulnerable populations and specific patterns of use [e.g. methamphetamine use with or without other substances, frequent methamphetamine use, methamphetamine use disorder (MUD), and injection] may contribute to greater risk for overdose mortality. Moreover, understanding characteristics that are associated with methamphetamine use, frequent use, MUD, and injection is of value in guiding strategies to address the root causes for the recent surge in methamphetamine overdose deaths. (more…)
Author Interviews, CDC, JAMA, Sexual Health, STD, USPSTF / 21.09.2021

MedicalResearch.com Interview with: Martha Kubik, Ph.D., R.N. Professor, School of Nursing College of Health and Human Services George Mason University Member, U.S. Preventive Services Task Force MedicalResearch.com: What is the background for this study? Are these infections increasing in incidence in the US? Response: Chlamydia and gonorrhea are two of the most common sexually transmitted infections in the U.S. More people are being diagnosed with both of these STIs than ever, with nearly 2 million cases of chlamydia and more than 600,000 cases of gonorrhea reported in 2019, according to the CDC. Because most do not have symptoms, screening is vitally important to help ensure that these infections are discovered and treated, and serious health complications prevented. (more…)
Anesthesiology, Author Interviews, Brigham & Women's - Harvard, Opiods, Surgical Research / 21.09.2021

MedicalResearch.com Interview with: Andres Zorrilla Vaca, MD Resident Physician Brigham and Women’s Hospital Boston, Massachusetts  MedicalResearch.com: What is the background for this study? Response: The background for this study was Enhanced Recovery After Surgery, also known as ERAS protocols. They basically consisted of a bundle of interventions that are performed preoperatively, intraoperatively and postoperatively with the aim of enhancing patient recovery and reducing complications. This protocol in our institution started with a thorough preoperative counseling which includes, smoking cessation, pain and analgesia education, ERAS program expectations, pulmonary rehabilitation based on pulmonary function tests and incentive spirometry. On the day of surgery, prolonged fasting is avoided and a carbohydrate loading is given orally 2 hours before surgery. Our protocol also included a standardized multimodal analgesic regimen consisting of tramadol ER 300mg p.o. and gabapentin 300mg p.o., intraoperative acetaminophen 1gm i.v., posterior intercostal nerve blockade with liposomal bupivacaine 266mg prior to incision, intraoperative 30mg ketorolac upon wound closure and scheduled postoperative acetaminophen 1g p.o. q 6hrs and ketorolac 15mg i.v. q 6 hrs, as well as additonal interventions recommended by ERAS Society Guidelines. As a general rule, preoperative sedatives (midazolam) are avoided as premedication and prophylaxis against nausea and vomiting (ondansetron, dexamethasone and scopolamine) is administered. Patients are kept euvolemic by using validated goal-directed fluid therapy algorithms (stroke volume variation and cardiac output) and normothermia is maintained throughout the procedure. (more…)
Author Interviews, Columbia, Emergency Care, JAMA, Pediatrics, Race/Ethnic Diversity, Yale / 17.09.2021

MedicalResearch.com Interview with: Destiny Tolliver, MD National Clinician Scholars Program Yale University School of Medicine New Haven, CT 06510-8088 Katherine Nash MD, MHS Assistant Professor of Pediatrics Columbia University Irving Medical Center MedicalResearch.com: What is the background for this study? Response: This study was motivated by work from our colleagues in the adult Emergency Medicine world. Earlier this year Dr. Ambrose Wong and colleagues published work describing racial disparities in the physical restraint of adults in the ED. This prompted our group to consider whether these disparities were also present for children. (more…)
Author Interviews, Cannabis / 17.09.2021

MedicalResearch.com Interview with: Sam Craft Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King’s College London, London UK MedicalResearch.com: What is the background for this study? Response: Synthetic cannabinoid receptor agonists (SCRAs, also known as Spice or K2) are a group of synthetic drugs originally produced to mimic the effects of cannabis. As they are often more accessible or cheaper and cannot be detected on drugs tests, SCRAs may be used as an alternative to cannabis. However, although they act on the same receptors – cannabinoid receptor type 1 and 2 (CBR1; CBR2) – SCRAs are far more potent than cannabis which may make them more addictive and increase the severity of withdrawal (unpleasant symptoms experienced after cessation of a drug which has been used in large amounts for a long period of time) As part of the Global Drug Survey, in this study we asked participants who use both SCRAs and cannabis to compare their effects across different measures which indicate how likely a drug is to result in long-term harm. For example, how severe withdrawal symptoms are and how long the effects last. We also asked participants which withdrawal symptoms they experienced when attempting to stop.  (more…)
Author Interviews, CDC, COVID -19 Coronavirus, Vaccine Studies / 17.09.2021

MedicalResearch.com Interview with: Scott Pauley Press Officer, News Media Branch Division of Public Affairs Office of the Associate Director for Communication MedicalResearch.com: What is the background for this study?
  • In this real-world study of vaccine effectiveness:
    • Researchers compared hospitalized patients who tested positive for the virus that causes COVID-19 (case patients) to hospitalized patients who tested negative for the virus (control patients)
    • Vaccine effectiveness was calculated for each type of vaccine by comparing the proportion of cases patients and control patients vaccinated
    • 3,689 patients were included (1,682 case-patients and 2,007 control-patients)
Vaccination status breakdown: 2,362 unvaccinated; 476 fully vaccinated with Moderna; 738 fully vaccinated with Pfizer-BioNTech; and 113 fully vaccinated with Janssen vaccine. (more…)
Author Interviews, CDC, HPV, JAMA, Vaccine Studies / 17.09.2021

MedicalResearch.com Interview with: Kalyani Sonawane, PhD Assistant Professor of Management, Policy and Community Health UTHealth School of Public Health in Houston MedicalResearch.com: What is the background for this study? Response: Safety concern regarding the HPV vaccine is one of the most significant barriers to vaccination. Our objective was to determine how many US adolescents did not initiate the HPV vaccine during 2015-2018 because their parents had concerns regarding the vaccine’s safety. We also analyzed vaccine adverse event reporting data, in parallel, to understand if the public sentiment of HPV vaccine safety is in alignment with evidence from the vaccine safety surveillance system.  (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 17.09.2021

MedicalResearch.com Interview with: Hirotaka Kato, PhD Graduate School of Health Management Keio University  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Physicians are increasingly engaging in clinical practice on a part-time basis, but little is known about the quality of care provided by these physicians. In this analysis of nationally representative data of the elderly patients admitted to hospitals, we found that patients treated by hospitalists who worked more clinical days per year had significantly lower 30-day mortality compared with patients treated by hospitalists working fewer clinical days, even after accounting for the differences in severity of illness.  (more…)
Author Interviews, HPV, JAMA, OBGYNE / 16.09.2021

MedicalResearch.com Interview with: Helen Trottier Ph.D Assistant Professor, Department of Social and Preventive Medicine, Researcher, CHU Sainte-Justine Research Center Université de Montréal Montréal, Québec, Canada MedicalResearch.com: What is the background for this study? Response: We know that HPV infection can have serious consequences such as the development of cancerous lesions in the cervix. HPV infection is also very prevalent in young women of childbearing age but the possible consequences of HPV in pregnancy have been poorly studied. Some population registers around the world have shown a reduction in the risk of preterm birth with HPV mass vaccination, but we must be careful with this kind of ecological correlation. We have set up a large cohort study in pregnant women to study the association between HPV in pregnancy and preterm birth by targeting certain HPV genotypes and the duration of the infection. (more…)
Author Interviews, Dermatology / 15.09.2021

MedicalResearch.com Interview with: Elena Ezhkova, PhD Professor, Department of Cell, Developmental, and Regenerative Biology Professsor, Dermatology Lab Head,The Black Family Stem Cell Institute Icahn School of Medicine at Mount Sinai New York Meng-Yen Li, PhD Postdoctoral Fellow The Black Family Stem Cell Institute MedicalResearch.com: What is the background for this study? Response: The epidermis is the primary barrier and the first line of defense to combat environmental stressors. The sun's ultraviolet (UV) is one of the main environmental stressors that our body is exposed to daily. UV produces DNA damage in epidermal cells and is a leading cause of skin cancers. To protect from the damaging effects of UV, epidermal cells become pigmented by melanocytes, pigment-producing cells. Taken up by epidermal cells, the melanin pigment absorbs UV light and reduces DNA damage. How the epidermis senses UV and how it leads to epidermal pigmentation is poorly understood. (more…)
Author Interviews, JAMA, Primary Care, Social Issues / 13.09.2021

MedicalResearch.com Interview with: Karina W. Davidson, Ph.D., M.A.Sc. Professor of Behavioral Medicine Zucker School of Medicine at Hofstra University/Northwell Health Chairperson, USPSTF MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The social and economic conditions in someone’s life, such as whether or not they have secure food, housing, or transportation, can affect their health in multiple ways. As part of our commitment to improving health equity, the U.S. Preventive Services Task Force took two key steps. We both thoroughly reviewed the existing research around screening and interventions for social risk factors, and audited our own portfolio of recommendation statements to determine how and how often social risks have been considered in the past. This information serves as a benchmark and foundation for our ongoing work to further advance health equity through our methods and recommendations. (more…)
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA, Race/Ethnic Diversity / 13.09.2021

MedicalResearch.com Interview with: Megan B. Cole, PhD, MPH Assistant Professor | Dept. of Health Law, Policy, & Management Co-Director | BU Medicaid Policy Lab Boston University School of Public Health Boston, MA 02118 MedicalResearch.com: What is the background for this study? Response: Under the Affordable Care Act, states were given the option to expand Medicaid eligibility to nonelderly adults with incomes up to 138% of the federal poverty level, where in January 2014, 25 states plus Washington, DC expanded eligibility, with 13 additional states expanding thereafter. State Medicaid expansion decisions were particularly consequential for federally qualified health centers (FQHCs), which serve nearly 30 million low-income, disproportionately uninsured patients across the US. We know from earlier work that in the shorter-term, Medicaid expansion was associated with improvements in quality of care process measures and FQHC service capacity. However, we conducted the first known nationally representative study to examine how Medicaid expansion impacted key chronic disease outcome measures at FQHCs over the longer-term by looking at changes five years after implementation, including changes by race/ethnicity.  (more…)
Author Interviews, Exercise - Fitness, Gender Differences, Mental Health Research / 13.09.2021

MedicalResearch.com Interview with: Martina Svensson Experimental Neuroinflammation Laboratory Department of Experimental Medical Science Lund University, Lund, Sweden MedicalResearch.com: What is the background for this study? Response: We followed almost 200,000 long-distance skiers for up to two decades and investigated how many of these skiers were diagnosed with anxiety disorders compared to people of the same sex and age in the general population. In total, the study included almost 400,000 people. (Previous studies have shown that Vasaloppet skiers are significantly more physically active than the general population.) (more…)
Asthma, Author Interviews, Brigham & Women's - Harvard, Circadian Rhythm, Occupational Health, PNAS, Pulmonary Disease, Sleep Disorders / 11.09.2021

MedicalResearch.com Interview with: Frank Scheer, PhD, MSc Professor and Director of the Medical Chronobiology Program Division of Sleep and Circadian Disorders Brigham and Women’s Hospital Steve Shea, PhD Professor and Director Oregon Institute of Occupational Health Sciences MedicalResearch.com: What is the background for this study? Response: For hundreds of years, people have observed that asthma severity often worsens in the nighttime. As many as 75 percent of people with asthma—20 million people in the U.S.—report experiencing worsening asthma severity at night. One longstanding question has been to what degree the body’s internal circadian clock—as opposed to behaviors, such as sleep and physical activities—contributes to worsening of asthma severity. Our research used long term intensive monitoring throughout two circadian protocols in dim light and without time cues to carefully isolate the influence of the circadian system from the other factors that are behavioral and environmental, including sleep. (more…)
Addiction, Author Interviews, Opiods, Race/Ethnic Diversity / 10.09.2021

John A. Furst BS Geisinger Commonwealth School of Medicine MedicalResearch.com: What is the background for this study? Response: Methadone is an evidence-based pharmacotherapy for opioid detoxification, maintenance therapy, and pain management. However, accessibility of this treatment remains variable across much of the country. Methadone for the treatment of opioid use disorder (OUD) is exclusively provided by federally regulated opioid treatment programs (OTPs) and has provoked significant community-based and legal controversy regarding its role in the management of this condition. This has created disparities related to the distribution and access of methadone throughout the United States (U.S.). The goal of this study1 was to highlight the most recent pharmacoepidemiologic trends associated with methadone in the face of unique restrictions at the local, state, and federal levels. (more…)
Author Interviews, NEJM, Stroke, University Texas / 08.09.2021

MedicalResearch.com Interview with: James Grotta, MD Director of Stroke Research Clinical Institute for Research and Innovation Memorial Hermann - Texas Medical Center Director, Mobile Stroke Unit Consortium University of Texas Health  MedicalResearch.com: What is the background for this study? Response: We have good stroke treatments (thrombolysis and thrombectomy).  Since the initial studies showing benefit of thrombolysis, it has been difficult to improve on the amount of benefit except by speeding its delivery; the earlier the treatment, the better the outcome. Biologically, treatment in the first hour is likely to have greatest benefit since the brain is less irreversibly damaged and the clot is more soluble. But treatment in the first hour is rare if it is carried out in the emergency department.  So MSUs take the emergency department to the patient. We know that Mobile Stroke Units (MSUs) can speed treatment; our study addressed if this be accomplished in the US, and how much difference does it make in outcome.  In particular, outcomes important to patients given the probable costs of implementing MSUs.  (more…)
Aging, Author Interviews, Cancer Research, Dermatology, Frailty, JAMA / 08.09.2021

MedicalResearch.com Interview with: Marieke van Winden MD MSc PhD candidate Dermatology Radboud Institute for Health Sciences Department of Dermatology Radboud University Medical Center Nijmegen, the Netherlands MedicalResearch.com: What is the background for this study? What underlying conditions would factor in a decision for Watchful Waiting?  Response: Basal cell carcinomas are frequently treated because of the risk for progression, which can cause a significant morbidity due to local tissue invasion and destruction. However, most BCCs are characterized by a relatively indolent nature, growing slowly and frequently asymptomatically. Because patients with a limited life expectancy might not live long enough to develop symptoms from basal cell carcinoma progression, they might not live long enough to benefit from treatment. Underlying conditions that determine life expectancy should therefore be considered when weighing BCC management options. When life expectancy is expected to be relatively short, and the consequences of  watchful waiting (WW) are relatively low risk (low tumor burden expected within the remaining lifespan), WW should be considered. (more…)
Author Interviews, Cost of Health Care, JAMA, Surgical Research / 07.09.2021

MedicalResearch.com Interview with: Andrew P. Loehrer, MD, MPH Assistant Professor Department of Surgery, Division of Surgical Oncology Dartmouth-Hitchcock MedicalResearch.com: What is the background for this study? Response: Patient cost sharing represents the portion of costs covered by insurance that individuals pay out of pocket, including deductibles, co-payment, and co-insurance. Cost sharing is increasingly common and also increasingly expensive for patients with commercial health insurance across the United States. While designed to increase patient responsibility for health care spending, prior work has shown that higher cost sharing is also associated with decreased use of health care overall, both needed and discretionary. However, little work has been done as to how high cost sharing may affect common and costly conditions like acute appendicitis and acute diverticulitis.  (more…)