Author Interviews, Heart Disease / 30.11.2018

MedicalResearch.com Interview with: Jonathan S. Steinberg, MD Director, SMG Arrhythmia Center Summit Medical Group Professor of Medicine (adj) University of Rochester School of Medicine Core Professor of Cardiology and Internal Medicine Hackensack Meridian School of Medicine at Seton Hall U Short Hills, NJ 0707 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The autonomic nervous system activity plays an important role in the onset and perpetuation of atrial fibrillation, particularly for AF that follows cardiac surgery. Botulinum toxin (BTX) is a potent inhibitor of neural transmission. In a randomized placebo-controlled study of 60 patients undergoing coronary artery bypass graft surgery, patients who received intraoperative Botulinum toxin injections to the neural ganglia on the cardiac surface exhibited a sustained reduction in the incidence and overall burden of atrial fibrillation (AF) over 3 years of follow-up, accompanied by a reduction in need for hospitalization. (more…)
Alzheimer's - Dementia, Author Interviews, MRI / 29.11.2018

MedicalResearch.com Interview with: Cyrus A. Raji, MD PhD Asst Prof of Radiology, Mallinckrodt Institute of Radiology Neuroradiology Faculty and the Neuoimaging Laboratories Washington University School of Medicine St. Louis MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Alzheimer's disease is the most common cause of dementia and every patient suspected of having this disorder receives an MRI scan of the brain. MRI scans of the brain in dementia are currently limited to evaluating for structural lesions that could be leading to memory loss such as stroke or tumor. What this study sought to accomplish was to determine if a newer type of MRI scan called diffusion tensor imaging (DTI) can predict who will experience cognitive decline and dementia. We found that DTI can predict persons who will demented 2.6 years before the earliest onset of symptoms. This study was done in 61 individuals, 30 converters and 31 non-converters, from the Alzheimer's Disease Neuroimaging Initiative and we found that DTI metrics could predict dementia 2.6 years later with 89-95% accuracy. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 29.11.2018

MedicalResearch.com Interview with: Pratyaksh K. Srivastava, MD Division of General Internal Medicine, UCLA Gregg C. Fonarow, MD Ahmanson-UCLA Cardiomyopathy Center UCLA  Medical Center, Los Angeles Associate Editor, JAMA Cardiology MedicalResearch.com: What is the background for this study?  Response: Angiotensin Receptor-Neprilysin Inhibitors represent a novel class of heart failure therapeutics that have been shown to significantly improve mortality among patients with heart failure with reduced ejection fraction (HFrEF). In the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with Angiotensin Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, sacubitril-valsartan was associated with a 20% relative risk reduction in the primary outcome of death from cardiovascular causes or first hospitalization for worsening heart failure over a median follow up of 27 months. In our current study, we present long term (5-year) absolute risk reductions associated with the addition of angiotensin receptor-neprilysin inhibition to standard HFrEF background therapy using data from PARADIGM-HF. We utilize the number needed to treat (NNT) to quantify absolute risk reduction, and ultimately compare 5-year NNT values for sacubitril-valsartan to those of well-established HFrEF therapeutics for the outcome of all-cause mortality. (more…)
Author Interviews, Gender Differences / 29.11.2018

MedicalResearch.com Interview with: Emily J. Cross, MS School of Psychology, Science Centre The University of Auckland Auckland  MedicalResearch.com: What is the background for this study? Response: Aggression and violence in intimate relationships is very harmful, and unfortunately Aggression and violence in intimate relationships is very harmful, and unfortunately very common. So identifying what predicts relationship aggression and why is important. Men’s hostile sexism toward women is an established risk factor for relationship aggression, but we actually know little about why these attitudes promote relationship aggression. Understanding why helps to identify how these damaging processes may be reduced. (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics, USPSTF / 28.11.2018

MedicalResearch.com Interview with: Alex Kemper, M.D., M.P.H., M.S.  Dr. Kemper is a board-certified pediatrician and chief of the Division of Ambulatory Pediatrics at Nationwide Children’s Hospital. He is also the deputy editor of Pediatrics. MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations?  Response: Child maltreatment, which includes abuse and neglect, is a serious health problem that affects too many children in the United States.  Abuse and neglect can have devastating health consequences, including long-term disabilities, depression, physical injury, and even death. In 2016, approximately 676,000 children were subjected to maltreatment, and more than 1,700 children died as a result. Because this is such an important public health issue, the U.S. Preventive Services Task Force looked at the most recent evidence on whether primary care clinicians can help prevent child maltreatment and its negative consequences. We found that, unfortunately, there is not enough evidence to recommend for or against these interventions. The Task Force is calling for more research on this important subject so that we can help prevent children from being abused and neglected.    (more…)
Author Interviews, Circadian Rhythm / 28.11.2018

MedicalResearch.com Interview with: Yujiro Yamanaka, Ph.D. Associate Professor Hokkaido University Graduate School of Education Sapporo, Japan  MedicalResearch.com: What is the background for this study? Response: My laboratory has focused on the human circadian rhythms in particularly investigating the time of day effect of non-photic cues especially physical exercise and psychological stressor on circadian rhythms. In mammals including humans, the central circadian pacemaker is located in the suprachiasmatic nucleus (SCN) in the brain hypothalamus. The SCN entrains to an external light-dark cycle and generates endogenous 24 h rhythmicity in body function. The hypothalamic-pituitary-adrenal (HPA) axis is our major stress response system. We can assess the response of HPA axis to psychological stress event by measuring the level of glucocorticoid hormone, cortisol in saliva. The cortisol shows clear circadian rhythm with higher levels in the morning and lower levels in the evening. This rhythm is generated by the SCN circadian pacemaker. Previous study (Kudielka et al. Psychoneuroendocrinology 2004) could demonstrate that the cortisol stress level is significantly elevated by acute psychological stress event in the morning (9 a.m. to 10 a.m.) and afternoon (3 p.m. to 4 p.m.). However, there are no study examining the effect of evening psychological stress event on the HPA axis activity. Thus, our new study focused on examining whether the HPA axis differentially responses to morning and evening stress event in healthy subjects. (more…)
Author Interviews, Biomarkers, Cancer Research / 28.11.2018

MedicalResearch.com Interview with: Ricardo Alvarez MD MSc Medical Director of the Breast Cancer Center Director of Cancer Research Cancer Treatment Centers of America, CTCA Atlanta MedicalResearch.com: What is the background for this study? What are the main findings? Response: “The background of this study comes from five years of experience in one of our precision medicine programs that was launched in 2013 and this is the experience of a group of personnel from a hospital that helps physicians in five different hospitals that are a part of the CTCA network and for physicians who order a next generation sequencing test. In this particular report, we have only one vendor, and that is Foundation Medicine and we analyze three different genomic platforms, Foundation One test, Foundation Act and Foundation One Hem. In total, approximately 8,800 tests have been analyzed and that was the presentation at ESMO 2018. It’s important that the Precision Medicine Program (PMed) helps physicians to identify actionable and potentially actionable targets for the result of this test so patients can be treated with targeted therapy, and this can be done by selecting clinical trials or recommending patients to be treated off-label agents. When we say off label, meaning that they are not specifically FDA-approved drugs for this indication that we are treating.” (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 28.11.2018

MedicalResearch.com Interview with: Michael Rozier, S.J., Ph.D. Assistant Professor, Health Management and Policy College for Public Health and Social Justice St. Louis University MedicalResearch.com: What is the background for this study? Response: Patients considering surgery for weight loss have several options, which differ in significant ways, such as expected weight loss, risk of complication, modification of diet, effect on other medical conditions, and more. Previous studies have asked patients why they chose one procedure over another. Instead, we quantified the relative importance of the key characteristics of surgical options. Using a discrete choice experiment, potential patients were given profiles of two weight loss options. They were asked to select one profile based on key characteristics such as out-of-pocket costs, total weight loss, risk of complication, and five other factors. (more…)
Author Interviews, CT Scanning, Pain Research / 28.11.2018

MedicalResearch.com Interview with: Alessandro Napoli MD PhD Department of Radiological, Oncological and Pathological Sciences Sapienza University of Rome  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Disc Herniation in the lumbar region can create intense pain in the lower back and along the leg as a result of nerve compression. People suffering disc herniation may either experience a spontaneous relief from the pain or requiring further medical actions in order to improve quality of life and going back to work and daily activities. When the pain is not responding to usual conservative care (both physical and pharmacological therapy) surgery is often considered a valid option.However, most of the people (despite the intense pain) would possibly avoid surgery. For this reason, Interventional percutaneous therapies such as intraforaminal injection of steroid have become more popular. Pulsed radiofrequency is a percutaneous therapy that may have the potential to rapidly relief the pain in a long lasting way by means of single 10 minutes procedure. We decided to undertook a randomized clinical trial to test the clinical benefit of pulsed radiofrequency therapy using intraforaminal injection as a control group. in both groups percutaneous approach was guided under precise guidance of CT images. Pulsed radiofrequency group patients experience a faster and more durable pain control during the 1 year period follow up. Incidence of retreatment or cross-over was significantly higher in the injection only group. (more…)
Author Interviews, Immunotherapy, Multiple Sclerosis / 27.11.2018

MedicalResearch.com Interview with: Dietmar P. Berger, MD, PhD Head of Global R&D Atara Biotherapeutic MedicalResearch.com: What is the background for this study? Response: Epstein-Barr virus (EBV) is present in B lymphocytes, plasma cells and epithelial cells of over 95% of individuals over the age of 40.  Multiple studies have shown that nearly all patients with Multiple Sclerosis (MS) are EBV positive, including a recent presentation at the 2018 ECTRIMS Congress in Berlin that showed 100% of MS patients are positive for EBV (Ruprecht et. al). Current B cell directed therapies such as anti-CD20 therapies have demonstrated an effect on  Multiple Sclerosis activity. These therapies work by depleting B cells including those infected by EBV. Our belief is that loss of EBV-specific T cell function (e.g., T cell exhaustion) occurs in patients who develop Multiple Sclerosis, which results in the accumulation of EBV infected B and plasma cells in the CNS leading to the autoreactive immune cycle seen in MS patients. The increasing evidence of a link between EBV infection and the development of MS led to the initiation of a Phase 1 study to investigate the use of an autologous T-cell immunotherapy (ATA190) to selectively target and deplete EBV infected cells in patients with progressive MS. As T cell immunotherapies (like ATA190) are designed to penetrate the central nervous system, this approach was felt to be particularly useful in  Multiple Sclerosis where the inflammatory response and infected B lymphocytes and plasma cells are inaccessible inside the CNS to the vast majority of classic targeted agents. (more…)
Annals Internal Medicine, Author Interviews, Columbia, Genetic Research, Kidney Disease / 27.11.2018

MedicalResearch.com Interview with: Hila Milo Rasouly, PhD Postdoctoral research scientist Ali Gharavi Lab Columbia University MedicalResearch.com: What is the background for this study? Response: Genome sequencing is increasingly used in clinical medicine to help make a clinical diagnosis and make predictions about potential future complications. The diagnostic yield and limitations for different indications are still being worked out.  We are interested in studying the applications of genome sequencing for chronic kidney diseases. It is estimated that 10% of adults have chronic kidney disease (CKD), and amongst them, 10% are caused by single-gene (Mendelian) forms of disease. The American College of Medical Genetics and Genomics developed guidelines on how to interpret genetic variants in order to make a genetic diagnosis. Our lab has been engaged in studying the yield and impact of genetic testing for  CKD, and in the course of our research, we realized that a very large number of individuals have genetic variants that may be classified as pathogenic based on automated application of the guidelines. However, in majority of these cases, the genetic variant was much too frequent in the population to be plausibly disease-causing or did not match up well with the clinical diagnosis. This led us to wonder about the risk of false-positive genetic diagnosis. To analyze this risk for false-positive genetic diagnosis, we analyzed the genome sequence of 7,974 self-reported healthy adults. (more…)
Author Interviews, Autism, Nature, Pediatrics / 27.11.2018

MedicalResearch.com Interview with: Michael Lombardo, PhD Assistant professor of Psychology the University of Cyprus  MedicalResearch.com: What is the background for this study? Response: Autism is a diagnostic label we give to children with difficulties in the areas of social-communication and restricted, repetitive stereotyped behaviors and interests. The diagnosis is made based on observations about behavior and is a consensus label, meaning that clinicians can show high degrees of agreement that a given set of behaviors is ‘autism’. But aside from the diagnostic label, there is a fair degree of heterogeneity within patients that have the diagnosis. One way in which patients are heterogeneous is with regard to early language development. Some toddlers with autism are minimally verbal, while at the other end, many toddlers with autism develop language typically. An important question to answer is whether that kind of difference in language development indicates a subtype with different underlying biology. To examine this question, we first split toddlers with autism into two subtypes defined by their language outcome at 4 years of age. Some toddlers were classified as poor language outcome, because their language performance was 1 standard deviation below typical norms. Other toddlers with autism had relatively good language outcome, as their language performance by 4 years of age was within 1 standard deviation of typical norms. We also measured the biology behind these two autism subtypes. First we used functional magnetic resonance imaging (fMRI), which is a non-invasive method to look at blood oxygenation response that changes according to a task. Blood oxygenation changes are an indirect measure of neural activity. We used fMRI during natural sleep at around 29 months of age while the toddlers were played language stimuli through headphones to elicit neural responses to speech. Second, we measured molecular aspects of biology, by taking blood samples, isolating leukocyte cells, and then quantifying gene expression for all protein coding genes in the genome, at around the same time as the fMRI scan. (more…)
Author Interviews, JAMA, Neurology, Stroke / 27.11.2018

MedicalResearch.com Interview with: Giacomo Koch, MD, PhD Laboratorio di Neurologia Clinica e Comportamentale Fondazione S. Lucia I.R.C.C.S. Italy MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We show in this paper that non invasive stimulation of the cerebellum in patients with stroke is able to improve motor functions. In particular we found that after three weeks of repetitive TMS of the intact cerebellum patients with hemiparesis due to stroke in the cerebral hemisphere remarkably improved their ability to walk and keep their balance, thus highly reducing the risk of fall.  (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pharmacology / 26.11.2018

MedicalResearch.com Interview with: Abiy Agiro, PHD HealthCore Inc Wilmington, Delaware  MedicalResearch.com: What is the background for this study? Response: Biosimilar approval pathway, authorized in 2010 by the Biologics Price Competition and Innovation Act as part of the Affordable Care Act, aims to increase adoption of biosimilar products and generate significant cost savings to payers and patients alike. Biosimilar filgrastim, used to prevent febrile neutropenia, is one of the first biosimilars to be approved in the United States. A large scale, post-approval real-world analysis was needed that compares biosimilar filgrastim to the original drug for safety and efficacy. (more…)
Author Interviews, Cancer Research, JAMA / 26.11.2018

MedicalResearch.com Interview with: Ola Landgren, MD, PhD Professor of Medicine Chief, Myeloma Service Department of Medicine Memorial Sloan Kettering Cancer Center New York, NY 10065 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Meta-analysis show that minimal residual disease (MRD) negativity is a strong predictor of longer progression-free survival (PFS). Emerging data show that an increasing proportion of newly diagnosed multiple myeloma patients obtain MRD negativity after modern combination therapy, even in the absence of bone marrow transplant. The first generation of 3-drug combination therapy (RVd) was associated with quite high rates of peripheral neuropathy which may be life-long. The current study was designed to define the rates of peripheral neuropathy in newly diagnosed multiple myeloma treated with the second generation of 3-drug combination therapy (KRd), and per default delayed transplant (i.e. collection of stem cells which were stored for potential future use). This single arm, phase 2 study found no cases of grade 3 peripheral neuropathy. The rates of MRD negativity wereunprecedented; 28 of 45 patients achieved MRD-negative CR (62%). The durability of MRD-negative CR has been observed up to 70 months (median duration 52.4 months). Patients who achieved MRD negativity by the end of cycle 8 had a 78% reduced risk of progression. The results were regardless of age or cytogenetic risk category. The results from this second generation of 3-drug combination therapy (KRd) without transplant,  compare favorably to first generation of 3-drug combination therapy (RVd) followed by stem cell transplant. (more…)
Author Interviews, Heart Disease, JAMA, Lifestyle & Health, Nutrition / 26.11.2018

MedicalResearch.com Interview with: Ravi B. Patel, MD Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois MedicalResearch.com: What is the background for this study? What are the main findings? Response: The digital attention of scientific articles can be readily quantified using the Altmetric score. The Altmetric score is a weighted measure, incorporating a variety of media platforms. We aimed to characterize the Top 10% of articles by Altmetric score among 4 major cardiovascular journals (Circulation, European Heart Journal, Journal of the American College of Cardiology, and JAMA Cardiology) in 2017. Our primary findings were: 1) nearly half of the most disseminated articles were not original research investigations, 2) the most common article topic was nutrition/lifestyle, and 3) there was a weak but significant correlation between Altmetric scores and citation number.  (more…)
Alzheimer's - Dementia, Author Interviews, CMAJ, Pharmacology / 26.11.2018

MedicalResearch.com Interview with: Jennifer Watt, PhD Clinical Epidemiology and Health Care Research Institute of Health Policy, Management, and Evaluation University of Toronto MedicalResearch.com: What is the background for this study?   Response: Behavioral and psychological symptoms of dementia (e.g. aggression, agitation) are common among persons living with dementia. Pharmacological (e.g. antipsychotics) and non-pharmacological (e.g. reminiscence therapy) interventions are often used to alleviate these symptoms. However, antipsychotics are associated with significant harm among older adults with dementia (e.g. death, stroke). Regulatory agencies such as the Food and Drug Administration (FDA) and Health Canada issued black box warnings to advise patients and clinicians of this potential for harm. And initiatives were championed to decrease the use of antipsychotics in persons living with dementia. In response, we have seen a rise in the use of other pharmacological interventions, such as trazodone (an antidepressant). Its potential to cause harm in older adults with dementia is largely unknown. (more…)
Accidents & Violence, Author Interviews, Mental Health Research, Race/Ethnic Diversity, Social Issues / 26.11.2018

MedicalResearch.com Interview with: "USA - NY - City of New York Police VARIATION" by conner395 is licensed under CC BY 2.0Dr. Jordan E. DeVylder, PhD Graduate School of Social Service Fordham University, New York, New York MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study is intended to address the lack of empirical research on police violence from a public health perspective. The main findings are that police violence is relatively widespread in Baltimore and New York City, is disproportionately directed toward people of color and sexual or gender minorities, and is associated with psychological distress, suicidal behavior, and psychosis-like symptoms. (more…)
Author Interviews, Dermatology, JAMA / 26.11.2018

MedicalResearch.com Interview with: Dr Tarun Narang MD MNAMS Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh, India MedicalResearch.com: What is the background for this study? Response: Acne is one of the most common dermatological problem for which the patients seek medical care. Post acne scarring is a complication of acne, resulting in long lasting physical disfigurement and low self esteem in the affected individuals. Even though there are various methods like microneedling, chemical peeling, cryorolling and ablative lasers to address the post acne atrophic scarring, these procedures are office based hence physician dependent. A home based treatment modality that can treat post acne atrophic scarring with a comparable efficacy to the procedural modalities of treatment will be beneficial to the patient. Our study was done to assess the efficacy of a topical modality of treatment, tazarotene gel, 0.1% in the management of post acne atrophic scarring in comparison to an established method, the microneedling. (more…)
Author Interviews, Environmental Risks, JAMA, Melanoma / 24.11.2018

MedicalResearch.com Interview with: Reza Ghiasvand, PhD Oslo Centre for Biostatistics and Epidemiology Faculty of Medicne University of Oslo Oslo, Norway  MedicalResearch.com: What is the background for this study? Response: Melanoma is the most dangerous type of skin cancer. It is estimated that about 288,000 individuals will be diagnosed and about 61,000 will die from it in 2018, with the majority of patients in Australia, New Zealand, Europe and North America. Ultraviolet (UV) exposure (from both the sun and tanning beds) is the most important preventable risk factor for melanoma. However, the association between UV exposure and melanoma is complex and does not accord with a simple model in which risk increases directly with exposure. An individual risk of melanoma also depends on personal characteristics such as skin color and skin sensitivity to the UV exposure, hair color, number of moles, and age. It has been hypothesized that the pattern of UV exposure may play a role in melanoma development in different body sites. For example, melanoma on the trunk (chest and back) has been linked to the recreational UV exposure such as sunbathing and frequent sunburns in people with high number of moles on their body. In contrast, melanomas on the head and neck have been linked to constant sun exposure such as occupational UV exposure, mainly in older people. Epidemiologic and molecular evidence in support of this hypothesis has been published based on analyses of small datasets. Also, melanoma on legs and arms is less studied under this hypothesis. In our study, we examined UV exposure (sunbathing, sunburn and sunbed use) and pigmentary factors (skin, eye, and hair color, freckling, and number of moles), and risk of melanoma on different body sites. We used information from the Norwegian Women and Cancer Study, a population-based cohort study that started in 1991, and includes more than 161,000 Norwegian women followed for an average of 18 years. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Diabetes, Occupational Health / 24.11.2018

MedicalResearch.com Interview with: "Night Shift" by Yuchung Chao is licensed under CC BY-ND 3.0Dr. Zhilei Shah PhD Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety Ministry of Education Key Lab of Environment and Health, School of Public Health Tongji Medical College, Huazhon University of Science and Technology Wuhan,  China MedicalResearch.com: What is the background for this study? Response: Shift work has progressed in response to changes in economic pressure and greater consumer demand for 24-hour services. There are many economic advantages to increased shift work, including higher employment, increased services to customers, and improved trade opportunities. Currently, one in five employees in the U.S. works nonstandard hours in the evening, night, or rotating shifts. However, shift work, especially night shift work, has been associated with a higher risk of chronic diseases, including type 2 diabetes, cardiovascular disease, and several types of cancer. Compelling evidence has shown that body weight and lifestyle behaviors, such as smoking, diet, and physical activity can influence type 2 diabetes risk. Among shift workers, excess adiposity and increased smoking are frequently and consistently reported, whereas the evidence on physical activity and diet is mixed. Additionally, no previous study has examined the joint associations of rotating night shift work duration and unhealthy lifestyle factors with risk of type 2 diabetes, or evaluated their potential interactions. Therefore, we prospectively assessed the joint association of rotating night shift work and established type 2 diabetes lifestyle risk factors with risk of type 2 diabetes and quantitatively decomposed the proportions of the joint association to rotating night shift work alone, to lifestyle alone and to their interaction in two large US cohorts. (more…)
Author Interviews, CDC, Exercise - Fitness, JAMA, Lifestyle & Health / 24.11.2018

MedicalResearch.com Interview with: Emily N Ussery, PhD Epidemiologist LT, US Public Health Service Physical Activity and Health Branch National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention  MedicalResearch.com: What is the background for this study? Response: Sitting for too long and being physically inactive can have negative health consequences, and it is important to understand how common these behaviors are among US adults. This study describes sitting time and leisure-time physical activity reported by US adults in a national survey. (more…)
Author Interviews, Hospital Readmissions, JAMA, Schizophrenia, University of Pittsburgh / 22.11.2018

MedicalResearch.com Interview with: Hayley D. Germack PHD, MHS, RN Assistant Professor, School of Nursing University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: As nurse scientists, we repeatedly witness the impact of having a serious mental illness (i.e. schizophrenia, bipolar disorder, and major depression disorder) on patients’ inpatient and discharge experience. As health services researchers, we know how to make use of large secondary data to illuminate our firsthand observations. In 2016, Dr. Hanrahan and colleagues (https://www.sciencedirect.com/science/article/pii/S0163834316301347) published findings of a secondary data analysis from a large urban hospital system that found 1.5 to 2.4 greater odds of readmission for patients with an  serious mental illness diagnosis compared to those without. We decided to make use of the AHRQ’s HCUP National Readmissions Database to illuminate the magnitude of this relationship using nationally representative data. We found that even after controlling for clinical, demographic, and hospital factors, that patients with SMI have nearly 2 times greater odds of 30-day readmission.  (more…)
Asthma, AstraZeneca, Author Interviews, Pulmonary Disease / 22.11.2018

MedicalResearch.com Interview with: “Asthma Inhaler” by NIAID is licensed under CC BY 2.0Sean O'Quinn MPH Director, Patient Reported Outcomes AstraZeneca  MedicalResearch.com: What is the background for this study? How does benralizumab differ from traditional medications for asthma? Response:  FASENRA™ (benralizumab 30mg for subcutaneous injection as add-on maintenance therapy in severe eosinophilic asthma for patients 12 years and older) has a strong clinical profile, including powerful efficacy against exacerbations and the ability to improve lung function. Benralizumab is a respiratory biologic that binds directly to the IL-5α receptor on eosinophils and attracts natural killer cells to induce rapid and near-complete depletion of eosinophils via apoptosis. (NOTE: The mechanism of action of FASENRA in asthma has not been definitively established.) Benralizumab is not indicated for treatment of other eosinophilic conditions or for relief of acute bronchospasm or status asthmaticus. The most common adverse reactions include headache and pharyngitis. Dependence on rescue medications is indicative of poor asthma control. In the Phase III SIROCCO/CALIMA trials, patients with severe eosinophilic asthma had significantly reduced exacerbation frequency and improved lung function when treated with benralizumab 30mg Q8W (first three doses Q4W) vs. placebo. Less was known about the effects of benralizumab on rescue medication usage—specifically daily total rescue medication use, daytime and nighttime rescue medication use, and nighttime awakenings requiring rescue medication use. The aim of this analysis was to understand the potential treatment effects of benralizumab on these parameters.  (more…)
Author Interviews, JAMA, Weight Research / 22.11.2018

MedicalResearch.com Interview with: Ching-Ti Liu, PhD Department of Biostatistics Boston University School of Public Health Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Being overweight and obese are increasing worldwide and this obesity epidemic threatens to reverse the gains in life expectancy achieved over the past century. However, many investigators have observed, paradoxically, that overweight individuals are associated with a lower mortality risk. These results may suffer from a potential confounding due to illness or reverse causality in which preexisting conditions may alter both body weight and the risk of death.  Recently published studies have tried to mitigate this reverse causal bias by implementing sample exclusion and they came to a different conclusion: between BMI and all-cause mortality there is an increased risk of death for the entire range of weights that are in the overweight and obesity ranges. However, the elimination strategies may lead to the loss of generalizability or precision due to over-adjustment. In addition, the traditional investigations have only utilized a subject’s weight at a single point in time, which makes it difficult to adequately address bias associated with reverse causality. Currently, the idea incorporating a subject’s weight history has been proposed to deal with the concern of reverse causality, but the existing works had been based on a subject’s recall or self-reported data, which may lead to misclassification and, therefore, result in overestimating the risk of mortality. To help assess the relevance of being overweight or obese to the risk of death in the general population, we conducted a prospective study, using an individuals’ maximum BMI before the beginning of survival follow-up instead of their weight status at a single point in time, using data from the Framingham Heart Study (FHS). We observed increasing risk of mortality across various BMI categories (overweight < obese I < obese II) relative to normal weight using maximum BMI over 24 years of weight history. (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC, Surgical Research / 22.11.2018

MedicalResearch.com Interview with: Peter Hu MD Cleveland ClinicPeter T. Hu MD Department of Cardiology Cleveland Clinic MedicalResearch.com: What is the background for this study? What are the main findings? Response: Among patients with blockages in multiple coronary vessels, we studied predictors and outcomes of having a staged versus one-time multivessel percutaneous coronary intervention. By "staged" we mean performing coronary intervention only on one vessel, letting the patient recover, and fixing the other blockages at a later date. We know that multivessel coronary artery disease is very common - present in up to 2/3 of patients who require coronary interventions. Previous studies in patients with STEMI (ST-elevation myocardial infarction) suggested that staged multivessel PCI was associated with lower risk of death compared with one-time multivessel revascularization. Outside of STEMI patients, very little data exist in a broader group of patients who undergo coronary interventions to multiple vessels. In our study, we found an association between doing a staged PCI and lower long-term mortality benefit compared with fixing multiple blockages at once. What was surprising was there seemed to be a correlation with the degree of benefit from staged PCI based on the symptoms and signs the patient presented with. The association with improved outcomes was strongest in patients with STEMI, followed by those with NSTEMI, unstable angina, and stable angina, respectively. We also found that the decision to perform staged PCI was driven by patient and procedural characteristics, as well as other unmeasured site variation.  (more…)
Author Interviews, Gastrointestinal Disease, Microbiome, NEJM, Pediatrics, Probiotics / 22.11.2018

MedicalResearch.com Interview with: Stephen Freedman MDCM, MSc Alberta Children's Hospital Foundation Professor in Child Health and Wellness Sections of Pediatric Emergency Medicine and Gastroenterology Alberta Children's Hospital & Research Institute University of Calgary Calgary, AB  MedicalResearch.com: What is the background for this study? Response: Vomiting and diarrhea remain extremely common diseases in children and are the most common reason children are brought for emergency department care in North America.  While we have options to reduce vomiting there historically has been little physicians can offer to reduce the severity of the diarrhea. Probiotics have recently emerged as an option with some early evidence of benefit in clinical trials but the studies performed to date have been small and few little research has been conducted in North America in outpatient or emergency department children. The one study to date that was performed in a US emergency department did not find probiotic use to be beneficial.  Given the increasing importance of clarifying this issue we undertook this study. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension / 20.11.2018

MedicalResearch.com Interview with: Adam Bress, Pharm.D Department of Population Health Sciences School of Medicine University of Utah MedicalResearch.com: What is the background for this study? What are the main findings? o   The background here is that the new 2017 ACC/AHA BP guidelines lowered the threshold for antihypertensive medication initiation and intensification from <140 mmHg in most patients to <130 mm Hg. o   We used contemporary, population-based studies of US adults to estimate the potential population health impact of achieving and maintaining the lower treatment targets recommended in the 2017 ACC/AHA BP guidelines compared to previous guidelines. o   We found that achieving and maintain the lower thresholds recommended in the 2017 ACC/AHA BP guidelines over 10 years would:
  • Prevent 3.0 million CVD events compared to currently blood pressure and treatment levels
  • Prevent 0.5 million more events compared to achieving and maintain JNC7 goals
  • Prevent 1.4 million more events compared to achieving and maintain JNC7 goals
o   We estimated the size of the population health impact of achieving and maintaining the lower blood pressure treatment targets in the 2017 ACC/AHA BP guidelines compared to previous guidelines.
  • Achieving and maintaining the lower blood pressure thresholds for antihypertensive medication initiation and titration by the 2017 guidelines, are projected to prevent ~20% and ~90% more CVD events over ten years compared to achieving and maintaining JNC7 or JNC8 goals respectively.
o   Although we estimated more adverse events with the lower treatment goal, what our analysis found is that the benefits of achieving and maintaining the 2017 high blood pressure treatment recommendations far outweighs the risks. Many adverse events from high blood pressure treatment can be managed medically – and the lower threshold for treatment could potentially help millions of Americans lower their chances of developing heart disease or dying from heart attacks, strokes and other cardiovascular events, (more…)
Author Interviews, Heart Disease, JACC, Surgical Research, Technology / 20.11.2018

MedicalResearch.com Interview with: Evolut TAVR PlatformDr. Shazia Afzal MD University Hospital Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany MedicalResearch.com: What is the background for this study? Response: Since its introduction in 2002, transcatheter aortic valve replacement (TAVR) emerged to an increasingly important interventional procedure in the field of structural heart disease. Widespread use in Europe, the USA and Canada lead to continuous technological development and improved patient’s safety, procedural success and clinical outcome. In 08/2017 one of the market leaders introduced its latest generation valve model -the CoreValve Evolut PROTM- which was especially designed to mitigate paravalvular leakage after valve deployment. We conducted the first prospective study which directly compares the Evolut PROTM with its direct predecessor the Evolut RTM as a head-to-head analysis especially focusing on hemodynamic performance and clinical outcome in a real-world setting. To ensure comparability between groups, we performed propensity score matching with special interest in CT-derived data to guarantee equitable anatomical conditions. Since both valves are on the market but sold at different prices the pivotal question is whether the Evolut PROTM reaches its target. In a highly budget restricted health care system with limited refunding cost-effectiveness evolves to a substantial discussion point in daily clinical practice. Our results may not be marketing friendly but we think of relevance for the interventional community.  (more…)
Author Interviews, CMAJ, HIV, Sexual Health / 20.11.2018

MedicalResearch.com Interview with: Rachel Rodin Centre for Communicable Diseases and Infection Control Public Health Agency of Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: On December 1, 2016 (World AIDS Day), the Honourable Jody Wilson-Raybould, federal Minister of Justice, committed to working with provinces and territories, affected communities, and medical professionals to examine the criminal justice system’s response to non-disclosure of HIV status in the context of sexual relations. To this end, Justice Canada worked with the Public Health Agency of Canada (PHAC), provincial and territorial public health and justice counterparts, and a variety of other stakeholders to develop a comprehensive report on the issue of HIV non-disclosure. As part of this work, Justice Canada asked PHAC to provide an assessment of the most recent medical science on sexual HIV transmission risk. In collaboration with external peer reviewers, PHAC undertook a systematic review of the full body of scientific evidence on sexual HIV transmission risk. The review found that the risk of sexual transmission of HIV is negligible when an individual is taking antiretroviral therapy as prescribed and maintains a suppressed viral load. The review also concluded that the risk remains low when the individual is on antiretroviral therapy with varying viral load, or is not on antiretroviral therapy but uses condoms.    (more…)