Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, Pediatrics, University of Pittsburgh / 25.07.2018

MedicalResearch.com Interview with: Idris V.R. Evans, M.D.,MA Assistant Professor Department of Critical Care Medicine University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: New York State issued a state-wide mandate in 2013 for all hospitals to develop protocols for sepsis recognition and treatment. This mandate was called “Rory’s Regulations” in honor of Rory Staunton, a boy who died from sepsis in 2012. Pediatric protocols involved a bundle of care that included blood cultures, antibiotics, and an intravenous fluid bolus within 1–hour. We analyzed data collected by the NYS Department of Health on 1,179 patients from 54 hospitals and found that the completion of the pediatric bundle within 1 hour was associated with a 40% decrease in the odds of mortality.  (more…)
Author Interviews, Cancer Research, ENT, HPV / 25.07.2018

MedicalResearch.com Interview with: Eric Adjei PhD, MA Saint Louis University Center for Health Outcomes Research (SLUCOR) St. Louis, Missouri  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Survivors of head and neck cancer (HNC) develop second primary cancers (SPCs) at a higher rate than most common cancers. This is concerning because the number of HNC survivors are increasing due to advancements in treatment and technology. Patients whose head and neck cancer was caused by smoking and alcohol are different than those whose HNC were caused by human papillomavirus (HPV). We therefore used data from 2000-2014 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) 18 database to examine if the incidence and the type of SPC that patients with smoking-related HNC develop were different from those from HPV-related head and neck cancer. First, independent of group of HNC (HPV-related or not), we found that SPCs among survivors of head and neck cancer were high, with about 1-in-8 patients developing an SPC. Additionally, irrespective of whether the index . head and neck cancer was from smoking-related or HPV-related, the majority of SPCs were second malignancies in head and neck region (e.g. tongue, gum, mouth floor etc), lung and esophagus. However, we observed different incidence rates between the two groups. Patients with smoking-related head and neck cancer developed SPCs at a higher rate (14%) than those with HPV-related HNC (10%). (more…)
Author Interviews, Brigham & Women's - Harvard, Genetic Research, Microbiome / 24.07.2018

MedicalResearch.com Interview with: A. Sloan Devlin, PhD Assistant Professor Department of Biological Chemistry and Molecular Pharmacology Harvard Medical School MedicalResearch.com: What is the background for this study? Response: It is known that the microbiome, the collection of bacteria that live in and on our bodies, influences the development of metabolic diseases including diabetes and obesity. The ways in which the microbiome affects host metabolism, however, are poorly understood. One reason for this lack of understanding is because the gastrointestinal tract contains hundreds of species of bacteria producing many different kinds of metabolites. Untangling the effects of these bacteria and the molecules they make is a significant challenge. In this study, we decided to concentrate on a group of metabolites found in the human gut called bile acids. When we eat a meal, these compounds are released into the gastrointestinal tract where they act as detergents that aid in digestion. Once these molecules reach the lower gastrointestinal tract, the gut bacteria residing there chemically modify these compounds, producing a pool of over 50 different bile acids total. Imbalances in this bile acid pool are thought to influence the progression of diet-induced obesity. However, it is unclear which specific bile acids are responsible for either beneficial or detrimental effects on host metabolism. We set out to address this question by first identifying a selective type of bacterial enzyme called a bile salt hydrolase, then by genetically deleting this enzyme from a common gut bacterium and investigating how this change affected host metabolism. (more…)
Author Interviews, HIV, OBGYNE, Pediatrics, Pediatrics, STD / 24.07.2018

MedicalResearch.com Interview with: Monika K. Goyal, M.D., M.S.C.E., senior study author Assistant professor of Pediatrics and Emergency Medicine Children’s National Health System Washington, DC  MedicalResearch.com: What is the background for this study? Response: Patients with pelvic inflammatory disease (PID) are at an increased risk for syphilis and HIV. We know that adolescents account for 20 percent of the 1 million cases of PID that are diagnosed each year. We also know that an estimated one in four sexually active adolescent females has a sexually transmitted infection (STI). While screening for syphilis and HIV is recommended when diagnosing PID, actual screening rates among adolescents have been understudied. This multi-center study aimed to quantify rates of HIV and syphilis screening in young women diagnosed with . pelvic inflammatory disease in pediatric emergency departments and to explore patient- and hospital-specific characteristics associated with screening for these two sexually transmitted infections. (more…)
Author Interviews, JAMA, Stroke, UCLA / 24.07.2018

MedicalResearch.com Interview with: Kristina Shkirkova Doctoral Student in Neuroscience Zilkha Neurogenetic Institute University of Southern California Los Angeles, CA MedicalResearch.com: What is the background for this study? Response: Stroke is the second leading cause of death and a leading cause of adult disability worldwide. Stroke onset is sudden with symptoms progressing rapidly in the first hours after onset. The course of symptom progression after stroke is not well studied in the ultra-early window before hospital arrival and during early postarrival period. There is an urgent need to characterize the frequency, predictors, and outcomes of neurologic deterioration among stroke patients in the earliest time window. (more…)
Author Interviews, Environmental Risks, Pediatrics, Toxin Research / 24.07.2018

MedicalResearch.com Interview with: “Pipe” by Sharon Mollerus is licensed under CC BY 2.0Adrienne Katner, DEnv Assistant Research Professor of Environmental & Occupational Health Sciences LSU Health New Orleans School of Public Health MedicalResearch.com: What is the background for this study? Response: Ever since Flint, there's been a lot of interest by the public in how to reduce exposures to lead in water. Several news articles suggested that many consumers and school officials have been considering flushing as a routine exposure prevention measure. But before Flint, we had a much worse lead in water crisis which didn't get as much public attention- an event which happened in Washington DC between 2001 and 2004. That event demonstrated that flushing for only 15–30 seconds would expose people to lead in cities which had lead service lines- these are water pipes which bring water from the main in the street to the home. A decade of follow up research confirmed that flushing protocols are highly dependent on variables that are difficult or impossible to control, including the length, material, condition and disturbance of water service lines, and water use patterns. However, this knowledge has not translated into widespread changes in public health messaging. In fact, the EPA still requires water utilities to promote flushing as an exposure prevention measure. The original required messaging was to run the water for 15–30 seconds. EPA eventually recognized the need for longer flush times in homes with lead service lines, and they revised the regulations to allow utilities to modify flush times, but many water utilities continued to rely on the same messaging year after year. We thought it was about time to test the recommendations in one of these cities- New Orleans, LA.  Best estimates from the mid-1990s suggested that lead service lines may comprise 65–80% of the city’s service line system. The city’s water utility encouraged residents to flush their taps for 30 sec to 2 min daily under normal use conditions. New Orleans is unique in that extensive hurricane damage to water infrastructure has necessitated a historically unprecedented scale of infrastructure replacement.  While over ten years have passed since Hurricane Katrina, the rebuilding process is ongoing—city and utility officials are in the process of conducting 16,000 partial lead service lines replacements- activities which are well known to destabilize scale that has been intentionally built up in the pipes over time to reduce lead from leaching into the water. We had previously observed high water lead levels in homes after line replacements- along the order of 200 ppb. To put that into perspective, the EPA's water standard for lead is 15 ppb. But even in undisturbed normal use homes we observed lead levels as high as 58 ppb. To evaluate whether flushing could effectively reduce water lead levels, we collected over 1400 water samples from 376 residential sites. Samples were collected at first draw, and after incremental flushes of 30–45 s; 2.5–3 min; and 5.5–6 min. We also collected survey data to better understand water use habits, homes treatment systems, and flushing practices. (more…)
Author Interviews, Diabetes, JAMA, Weight Research / 24.07.2018

MedicalResearch.com Interview with: “Diabetes Test” by Victor is licensed under CC BY 2.0Sharayah Carter PhD candidate|BNutDiet|BMedPharmSc (Hons)|APD School of Pharmacy and Medical Sciences University of South Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Intermittent energy restriction is a new popular diet method with promising effects on metabolic function but limited research exists on its effects on improving glycemic control in people with type 2 diabetes. The findings of our research demonstrate that a diet with 2-days of severe energy restriction per week is comparable to a diet with daily moderate energy restriction for glycaemic control.  (more…)
Author Interviews, Cancer Research, JAMA / 24.07.2018

MedicalResearch.com Interview with: James Yu, MD, MHS Director of Yale Medicine's Prostate & Genitourinary Cancer Radiotherapy Program MedicalResearch.com: What is the background for this study? Response: We previously investigated alternative medicine (therapy used instead of conventional medicine) and showed its use (vs. non-use) was associated with an increased risk of death, but we did not investigate complementary medicine (non-medical therapy used in addition to conventional medicine).  Approximately two-thirds of cancer patients believe CM will prolong life and one-third expect it to cure their disease despite lack of evidence to support this. (more…)
Author Interviews, Coffee, Weight Research / 23.07.2018

MedicalResearch.com Interview with: Coffee being poured Coffee pot pouring cup of coffee. copyright American Heart Association Leah Panek-Shirley, PhD Assistant Professor Buffalo State College Health, Nutrition, and Dietetics Houston Texas MedicalResearch.com: What is the background for this study? What are the main findings? Response: The findings of existing previous research evaluating the effects of caffeine on appetite and eating are equivocal. This study evaluated the effects of no (0 mg/kg body weight, e.g. placebo), low (1 mg/kg body weight), and moderate (3 mg/kg body weight) doses of caffeine in juice on appetite and eating in the laboratory and under free-living conditions. While this study identified a small decrease (about 70 calories) in caloric intake after consuming the low (1 mg/kg) dose of caffeine in the laboratory at breakfast, this difference did not persist throughout the entire day.  In addition, there were no differences in hunger, fullness, thirst, or desire to eat as a result of caffeine. (more…)
Author Interviews, Frailty, Heart Disease / 23.07.2018

MedicalResearch.com Interview with: Rakesh Arora MD PhD Department of Surgery, Max Rady College of Medicine University of Manitoba, Winnipeg, Canada Cardiac Sciences Program St Boniface Hospital Winnipeg, Manitoba, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is increasingly understood that patients with heart disease are getting older and sicker. In Canada, over 5.7 million people are estimated to be aged over 65 years and as a result a greater number of older adults often complex other health issues are now require cardiac procedures.  This places some patients, particular those who are more frail at a higher vulnerability to poorer postoperative outcomes and a complicated recovery process after cardiac surgery.  In addition, such patients experience a reduced quality of life as a result of loss of the ability to independently perform activities of daily living (i.e. as cooking, cleaning, bathing activities, toileting etc). During the preoperative waiting period, the cardiac symptoms and anxiety induces inactivity that in turn compounds the physical and mental deconditioning. In order to improve the functional capacity and enhance postoperative recovery, prehabilitation (“prehab”), a component of the Enhanced Recovery Protocols (ERPs), may be of particular importance. Prehabilitation (a.k.a. “prehab”) has been described as a preoperative cardiac rehabilitation intervention, a combination of exercise training, education, and social support, affecting patients’ physical and psychological readiness for surgery with the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital to the community.   (more…)
Author Interviews, Biomarkers, Cancer Research, Genetic Research, Prostate Cancer / 23.07.2018

MedicalResearch.com Interview with: Gong-Hong Wei, PhD Professor, Academy Research Fellow Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu University of Oulu, Finland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prostate cancer is the second most common cancer and the fifth leading cause of cancer-related death in men, with more than 1,100,000 new cases diagnosed and 300,000 deaths yearly around the globe. Among the risk factors for prostate cancer development, the genetic heritability of prostate cancer has been reported near 60%. Over the past decade, genome-wide association studies have identified more than 150 independent single nucleotide polymorphisms (SNPs) associated with prostate cancer risk. However, we know very little mechanisms accounting for these associations. SNP rs11672691 at the chromosome 19q13 locus has been found not only associated with prostate cancer risk but also aggressiveness, a form of prostate cancer often with worse prognosis and eventually progression to incurable stage. However, how this genomic variant accounts for prostate cancer severity remains totally unknown. Here we found the association of rs11672691 with additional clinical features of aggressive prostate cancer in an independent cohort of patients with prostate cancer, and discovered a rs11672691-mediated gene regulatory network including several novel genes, HOXA2, CEACAM21 and PCAT19, likely causing prostate cancer progression to incurable stage. In particular, the risk G (guanine) allele of rs11672691 was associated with higher RNA levels of PCAT19 and CEACAM21, and poor prognosis in prostate cancer patients. Rs11672691 G allele enhances chromatin binding of HOXA2 to regulate the expression of CEACAM21 and PCAT19. Using the CRISPR-Cas9 genome editing method, we revealed that rs11672691 genotype directly influence HOXA2 in regulating PCAT19 and CEACAM21 expression, and prostate cancer cellular phenotype. (more…)
Author Interviews, Cost of Health Care / 23.07.2018

MedicalResearch.com Interview with: Jonathan Gruber PhD Department of Economics, E52-434 MIT Cambridge, MA 02139 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is a large literature trying to estimate the extent of 'defensive  medicine' by looking at what happens when it gets harder to sue and/or  you can win less money. But there have been no studies of what happens if you just get rid of the right to sue.  That's what we have with active duty patients treated on a military base. The main finding is that when patients can't sue they are treated about  5% less intensively.  Much of the effect appears to arise from fewer diagnostic tests. (more…)
Author Interviews, Breast Cancer, Cancer Research, Genetic Research, Nature / 23.07.2018

MedicalResearch.com Interview with: Luca Magnani, Ph.D CRUK Fellow/Senior Research Fellow Department of Surgery and Cancer Imperial Centre for Translational and Experimental Medicine Room 140 1st floor ICTEM building Imperial College Hammersmith London, UK MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by the Yin Yang1 molecule? Response: This study was designed to investigate the evidence of non-genetic mechanisms that could contribute to breast cancer biology. Specifically, we developed a map of regulatory regions from luminal breast cancer patients. Regulatory regions are pieces of DNA that are not transcribed into protein-coding genes but they provide information about where and how much each gene should be activated. It is worth highlighting that cancer is not only the consequence of gene mutations but also the result of the wrong genes expressed at the wrong time.  To catalogue regulatory regions we looked for specific modifications that are strongly associated with their activity (epigenetic modifications). Doing so we developed the first extensive catalogue  of non-coding DNA regions that might play an essential role in regulating how breast cancer cell behaves. Regulatory regions do their job by interacting with specific molecules called transcription factors. These molecules can read the information stored in these regulatory regions and contribute to regulate gene expression. Yin Yang 1 is one of such molecules and was previously thought as a ambiguous player capable of activating or repressing gene activity.   (more…)
Author Interviews, CMAJ, Heart Disease, Lifestyle & Health, Stroke / 23.07.2018

MedicalResearch.com Interview with: Dr. Doug Manuel MD, MSc, FRCPC Professor and Senior Scientist Ottawa Hospital Research Institute | L’Institut de Recherche de l’Hôpital d’Ottawa Department of Family Medicine, University of Ottawa Départment de Médicine Familiale Université d’Ottawa  MedicalResearch.com: What is the background for this study? What are the main findings? Response: A lot of people are interested in healthy living, but often we don't have that discussion in the doctor's office," says Dr. Manuel, who is also a professor at the University of Ottawa. "Doctors will check your blood pressure and cholesterol levels, but they don't necessarily ask about lifestyle factors that could put you at risk of a heart attack and stroke. We hope this tool can help people — and their care team — with better information about healthy living and options for reducing their risk of heart attack and stroke." "What sets this cardiovascular risk calculator apart is that it looks at healthy living, and it is better calibrated to the Canadian population," says Dr. Doug Manuel, lead author, senior scientist at The Ottawa Hospital and a senior core scientist at the Institute for Clinical Evaluative Sciences (ICES).”  (more…)
Addiction, Anesthesiology, Author Interviews, Emergency Care, Pain Research / 23.07.2018

MedicalResearch.com Interview with: Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department. Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED. In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups. (more…)
Author Interviews, Education, Gender Differences, JAMA, Pediatrics / 22.07.2018

MedicalResearch.com Interview with: Julie Silver, MD Associate Professor and Associate Chair Department of Physical Medicine and Rehabilitation at Harvard Medical School and Staff physician at Massachusetts General Brigham and Women’s and Spaulding Rehabilitation Hospitals  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are many documented disparities for women in medicine that include promotion and compensation. For physicians in academic medicine, both promotion and compensation may be directly or indirectly linked to publishing. Similarly, opportunities that stem from publishing such as speaking engagements, may be affected by a physician’s ability to publish. For more than twenty years, there have been reports of women being underrepresented on journal editorial boards and gaps in their publishing rates. For example, a report titled “Is There a Sex Bias in Choosing Editors?” by Dickersin et al was published in JAMA in 1998 and made a compelling case for bias. Moreover, the authors noted that “a selection process favoring men would have profound ramifications for the professional advancements and influence of women”. Despite a steady stream of reports over the years, gaps have not been sufficiently addressed, and in 2014 Roberts published an editorial in Academic Psychiatry titled “Where Are the Women Editors?”. The 2017 review by Hengel titled “Publishing While Female” highlights many of the gaps, disparities and barriers for women in medicine. Conventional reasons for disparities, such as there are not enough women in the pipeline or women do not want to conduct research or pursue leadership positions, are simply not valid. Therefore, it is important to look at other barriers, such as unconscious (implicit) bias that may affect the editorial process. In this study, we analyzed perspective type articles from four high impact pediatric journals. We selected pediatrics, because most pediatricians are women, and therefore there are plenty of highly accomplished women physicians. We found that women were underrepresented among physician first authors in all of the journals (140 of 336 [41.7%]). We also found that underrepresentation was more pronounced in article categories that were described as more scholarly (range, 15.4%-44.1%) versus narrative (52.9%-65.6%).  (more…)
Aging, Author Interviews, Dermatology / 21.07.2018

MedicalResearch.com Interview with: Keshav K. Singh, Ph.D. Joy and Bill Harbert Endowed Chair in Cancer Genetics Professor of Genetics, Pathology and Environmental Health Founding Editor-in-Chief, Mitochondrion Journal Director, Cancer Genetics Program The University of Alabama at Birmingham Birmingham, AL 35294 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Decline in mitochondrial DNA content and mitochondrial function has been observed in aging humans. We created mouse to mimic those condition to show that decline in mitochondrial function leads to development of wrinkles and loss of hair. The main finding is that by restoring mitochondrial function we can reverse skin wrinkles to normal healthy skin and also regain hair growth.  (more…)
Author Interviews, Genetic Research, Weight Research / 21.07.2018

MedicalResearch.com Interview with: “In-N-Out meal #1” by Chris Makarsky is licensed under CC BY 2.0Dr. Christina Holzapfel PhD Junior Research Group Leader at Institute for Nutritional Medicine Technical University of Munich MedicalResearch.com: What is the background for this study? What are the main findings? Response: A lot of articles about genetic factors and nutritional intake have been published in the last years. Findings are inconsistent and it is not clear, whether genetic variants, especially associated with body mass index, are associated with nutritional intake. Therefore we performed a systematic literature search in order to get an overview about the association between single nucleotide polymorphisms and total energy, carbohydrate and fat intakes. We identified about specific search terms and their combinations more than 10,000 articles. Of these, 39 articles were identified for a relationship between genetic factors and total energy, carbohydrate, or fat consumption. In all studies, we most frequently encountered the fat mass and obesity (FTO) associated gene as well as the melanocortin 4 receptor gene (MC4R). There are indications of a relationship between these two genes and total energy intake. However, the evaluation of the studies did not provide a uniform picture. There is only limited evidence for the relationship between the FTO gene and low energy intake as well as between the MC4R gene and increased energy intake. (more…)
Author Interviews, Biomarkers, Infections / 21.07.2018

MedicalResearch.com Interview with: David K. Hong, M.D. VP Medical Affairs and Clinical Development at Karius MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Invasive fungal infections (IFI) are a cause of significant mortality and morbidity in immunocompromised patients. The diagnosis of IFIs is challenging, and often requires an invasive biopsy in order to identify the causal pathogen. There is a need for non-invasive methods of fungal identification to help guide targeted anti-fungal therapy. (more…)
Author Interviews, Biomarkers, Brain Cancer - Brain Tumors, Cancer Research, Genetic Research / 21.07.2018

MedicalResearch.com Interview with: Arnab Chakravarti MD Professor and Chair of Radiation Oncology Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The Ohio State University Comprehensive Cancer Center MedicalResearch.com: What is the background for this study?   Response: Historically, the treatment for grade two gliomas has been a black box without really a standard-of-care therapy. In the past, it was really dealer’s choice, where it was based upon physician and patient preference. Either radiation alone, radiation plus chemotherapy, or chemotherapy alone, there wasn't really any data to guide therapeutic decision-making. Then about three years ago the landmark study RTOG 9802 was published, which demonstrated a survival benefit with the addition of chemotherapy to radiation versus radiation alone. That became the standard of care for the treatment of grade two gliomas. One of the tricky issues with regards to these tumors is that there's a wide range of outcomes. There are patients that succumb to disease within months, others that live decades. It's very important to personalize care for the individual patient and that's why biomarkers, prognostic and predictive biomarkers are so important. The 9802 study showed us for the general population of patients that the addition of chemotherapy to radiation improved outcomes versus radiation alone. The patient population that was selected for our study were the high-risk low-grade glioma patients. Patients who are generally over the age of 40, tumor sizes that exceeded 6 cm in terms of maximum dimension, tumors that invaded the corpus callosum, astrocytic histology of patients with neurological symptoms. These are typically the patients that were included in the study. Really the main objective of this study was to determine the efficacy of treatment compared to historical controls. (more…)
Author Interviews, CDC, Infections / 20.07.2018

MedicalResearch.com Interview with: wash-hands-well . CDC wellAaron E. Glatt, MD, FACP, FIDSA, FSHEA Chairman, Department of Medicine & Hospital Epidemiologist South Nassau Communities Hospital Clinical Professor of Medicine Icahn School of Medicine at Mount Sinai Oceanside, NY 11572  MedicalResearch.com: What is the background for the CDC alert regarding a multistate outbreak of multidrug-resistant Salmonella Reading infections linked to raw turkey products?   Is this Salmonella strain different or more dangerous than other Salmonella food poisoning outbreaks?  Response: The CDC has reported that as of yesterday, there have been 90 people infected with Salmonella Reading from 26 states. No deaths have been reported, but 40 patients to date required hospitalization. There was a previous outbreak of S. Reading in 2016 related to contaminated alfalfa sprouts, but this organism is not that much different nor is it more virulent than many other salmonella strains.  (more…)
Author Interviews, CDC, Infections, JAMA / 20.07.2018

MedicalResearch.com Interview with: Dr. Katherine Fleming-Dutra MD Deputy Director Office of Antibiotic Stewardship CDC MedicalResearch.com: What is the background for this study? Response: Antibiotics are life-saving medications that treat bacterial infections. Any time antibiotics are used, they can lead to antibiotic resistance and could cause side effects such as rashes and adverse events, such as Clostridium difficile infection, which is a very serious and sometimes even fatal diarrheal disease. This is why it is so important to only use antibiotics when they are needed. When antibiotics aren’t needed, they won’t help you and the side effects could still hurt you. A previous study* reported at least 30% of antibiotic prescriptions written in doctor’s offices and emergency departments were unnecessary. However, the data from that study did not include urgent care centers or retail health clinics. We conducted the current analysis to examine antibiotic prescribing patterns in urgent care centers, retail health clinics, emergency departments, and medical offices. *Fleming-Dutra, K., et al. (2016). "Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011." JAMA: the Journal of the American Medical Association 315(17): 1864-1873. https://jamanetwork.com/journals/jama/fullarticle/2518263 (more…)
Alzheimer's - Dementia, Author Interviews, Herpes Viruses / 20.07.2018

MedicalResearch.com Interview with: Prof Ruth Itzhaki Emeritus Professor Division of Neuroscience & Experimental Psychology The University of Manchester MedicalResearch.com: What is the background for this study? Response: The background arises from the unexpected discovery, made by my lab almost 30 years ago, that the DNA of the common virus, herpes simplex virus type 1 (HSV1), known as the "cold sore" virus, was present in a high proportion of autopsy brains from elderly humans. Subsequently, we found that HSV1, when in brain of people who have a specific genetic factor, APOE-e4, confers a strong risk of developing Alzheimer's disease. We found also a parallelism with cold sores in that APOE-e4 is a risk for the sores, which occur in about 25-40% of people infected with HSV1. We then looked for links between the effects of HSV1 infection of cells in culture and AD, and found some major associations between virus and disease. Firstly, HSV1 causes an increase in the formation of a small protein called beta amyloid, which is the main component of the abnormal "plaques" seen in Alzheimer's Disease brains. Secondly, we discovered that in AD brains, the viral DNA is located precisely within amyloid plaques, which suggests that the virus is responsible for the formation of these abnormal structures. Thirdly, we confirmed the finding of another lab that HSV1 causes the increased formation of an abnormal form of the protein known as tau, which is the main component of the other characteristic abnormality of Alzheimer's Disease brains - "neurofibrillary tangles". All these discoveries suggested that the damage caused by HSV1 leads eventually to the development of AD. Lastly, we showed that treating HSV1-infected cells in culture greatly reduces the formation of beta amyloid and abnormal tau. This suggests that antiviral agents might be used for treating Alzheimer's Disease patients. (more…)
Author Interviews, Education, JAMA, Ophthalmology, Pediatrics / 20.07.2018

MedicalResearch.com Interview with: Aparna Raghuram, OD, PhD Optometrist, Department of Ophthalmology Instructor, Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Developmental dyslexia is a specific learning disability of neurobiological origin whose core cognitive deficit is widely believed to involve language (phonological) processing. Although reading is also a visual task, the potential role of vision has been controversial, and experts have historically dismissed claims that visual processing might contribute meaningfully to the deficits seen in developmental dyslexia. Nevertheless, behavioral optometrists have for decades offered vision therapy on the premise that correcting peripheral visual deficits will facilitate reading. Yet there is a surprising dearth of controlled studies documenting that such deficits are more common in children with developmental dyslexia, much less whether treating them could improve reading. In the present study, we simply assessed the prevalence and nature of visual deficits in 29 school aged children with developmental dyslexia compared to 33 typically developing readers. We found that deficits in accommodation 6 times more frequent in the children with developmental dyslexia and deficits in ocular motor tracking were 4 times more frequent. In all, more than three-quarters of the children with developmental dyslexia had a deficit in one or more domain of visual function domain compared to only one third of the typically reading group. (more…)
AHA Journals, Author Interviews, Heart Disease, Lipids, Menopause, University of Pennsylvania, Women's Heart Health / 19.07.2018

MedicalResearch.com Interview with: Samar R. El Khoudary, Ph.D., M.P.H. BPharm, FAHA Associate Professor Department of Epidemiology University of Pittsburgh Graduate School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study is based on the current measurements used to determine cardiovascular disease risk in postmenopausal women. Higher levels of HDL “good cholesterol” as measured by the widely available clinical test, HDL-Cholesterol, may not always be indicative of a lower risk of cardiovascular disease in postmenopausal women. HDL is a family of particles found in the blood that vary in sizes, cholesterol contents and function. HDL particles can become dysfunctional under certain conditions such as chronic inflammation. HDL has traditionally been measured as the total cholesterol carried by the HDL particles, known as HDL cholesterol. HDL cholesterol, however, does not necessarily reflect the overall concentration, the uneven distribution, or the content and function of HDL particles. We looked at 1,138 women aged 45 through 84 enrolled across the U.S. in the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study sponsored by the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH). MESA began in 1999 and is still following participants today. We assessed two specific measurements of HDL: the number and size of the HDL particles and total cholesterol carried by HDL particles. Our study also looked at how age when women transitioned into post menopause, and the amount of time since transitioning, may impact the expected cardio-protective associations of HDL measures. Our study points out that the traditional measure of the good cholesterol, HDL cholesterol, fails to portray an accurate depiction of heart disease risk for postmenopausal women. We reported a harmful association between higher HDL cholesterol and atherosclerosis risk that was most evident in women with older age at menopause and who were greater than, or equal to, 10 years into post menopause. In contrast to HDL cholesterol, a higher concentration of total HDL particles was associated with lower risk of atherosclerosis. Additionally, having a high number of small HDL particles was found beneficial for postmenopausal women. These findings persist irrespective of age and how long it has been since women became postmenopausal. On the other hand, large HDL particles are linked to an increased risk of cardiovascular disease close to menopause. Women are subject to a variety of physiological changes in their sex hormones, lipids, body fat deposition and vascular health as they transition through menopause. We are hypothesizing that the decrease of estrogen, a cardio-protective sex hormone, along with other metabolic changes, can trigger chronic inflammation over time, which may alter the quality of HDL particles. Future studies should test this hypothesis. The study findings indicate that measuring size and number of HDL particles can better reflect the well-known cardio-protective features of the good cholesterol in postmenopausal women. (more…)
Author Interviews, End of Life Care / 19.07.2018

MedicalResearch.com Interview with: Ann H Cottingham MA MAR Indiana University School of Medicine Indianapolis,IN. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Advance care planning provides patients with cancer an opportunity to reflect on future care and treatment options with their physician and family and identify and document their preferences in preparation for a time when they may be unable to speak for themselves. Advance care planning increases both quality of life and satisfaction with care, however the majority of patients with cancer have not participated in these important conversations. Common emotional responses to cancer, such as feelings of anxiety, fear, and sadness, pose one barrier to planning as they can keep patients from thinking about or discussing sensitive topics related to their illness. We conducted a pilot study to explore whether training in mindfulness, the psychological process of bringing one's attention to experiences occurring in the present, could enhance the ability of patients and families to consider and discuss emotionally challenging topics -- such as end-of-life preparations -- and support timely advance care planning. Twelve patient-family caregiver pairs participated in a pilot study of Mindfully Optimizing Delivery of End-of-Life (MODEL) Care, which combined mindfulness meditation, mindful communication practices, and information about advance care planning. MODEL Care focused on developing emotional and communication capacities to enable patients and their family caregivers to respond to the experience of living with advanced cancer and to talk about the disease and future care preferences with greater ease. The study found that MODEL Care successfully supported patients and their family caregivers in thinking about and then talking about the care they would want to receive if they become unable to speak for themselves, enhancing their ability to respond to emotional challenges, and decreasing barriers to end-of-life planning. MODEL Care improved patient and caregiver ability to cope, lowered emotional reactivity, and enhanced ability to respond to issues that incited emotion. It also strengthened the patient-caregiver relationship and enhanced communication with each other. MODEL Care also improved both patient and family caregiver communication with the physicians caring for the patient.   Patients noted that the practices enabled them to cope more effectively with the symptoms of their disease, including pain. Caregivers reported changes in their loved one's ability to cope with their disease following the mindfulness sessions. (more…)
Author Interviews, Cost of Health Care, JAMA, Pediatrics / 19.07.2018

MedicalResearch.com Interview with: Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Since 2013, public coverage has increased not only among low-income adults newly eligible for Medicaid but also among children and adults who were previously eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Recent research has shown that growth in public coverage varied by state-level policy choices. In this paper we study the growth in public coverage (Medicaid/CHIP) for three population samples living in Medicaid Expansion states between 2013 and 2015: previously eligible children, previously eligible parents, and newly eligible parents by state-level marketplace policies (Note: eligibility refers to eligible for Medicaid/CHIP, eligibility for marketplace subsidized coverage). All marketplaces are required to assess each applicants’ eligibility for both the marketplace and for Medicaid/CHIP. States running state-based marketplaces are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage (Medicaid or CHIP), but states using federally-facilitated marketplaces can opt to require their marketplace to forward these cases to state Medicaid/CHIP authorities for final eligibility determination and enrollment. We study the impact of marketplace policies on public coverage by observing changes in the probability Medicaid-/CHIP-eligible children and parents are enrolled in public coverage across three marketplace structures: state-based marketplaces that are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage, federally-facilitated marketplaces in states that enroll Medicaid-/CHIP-eligible applicants directly into public coverage, and federally-facilitated marketplaces with no authority to enroll Medicaid-/CHIP-eligible applicants into public coverage. Supporting the existing literature, we find that public coverage grew between 2013-2015 for all three of our samples of Medicaid-/CHIP-eligible children and parents living in Medicaid expansion states. However, we show that growth in public coverage was smallest in expansion states that adopted a federally-facilitated marketplace and gave no authority to the marketplace to enroll Medicaid-/CHIP-eligible applicants directly into public coverage. Additionally, once we account for enrollment authority, we found no differences in growth of public coverage for eligible children and parents living in expansion states that adopted a state-based marketplace versus those in states that adopted a federally-facilitated marketplaces with the authority to directly enroll Medicaid-/CHIP-eligible applicants (more…)
Author Interviews, Cancer Research, Testosterone / 19.07.2018

MedicalResearch.com Interview with: Traver Wright, Ph.D. Research Assistant Professor Department of Health and Kinesiology Texas A&M University College Station, TX MedicalResearch.com: What is the background for this study?   Response: Many cancer patients suffer from a loss of body mass known as cachexia which results in not only a loss of fat, but a debilitating loss of muscle mass and function. This cachexia negatively impacts patient mobility and quality of life, and can also reduce their eligibility to undergo treatments such as radiation and chemotherapy.  Despite the profound negative consequences of cachexia, there are no established therapies to directly address this debilitating loss of body mass during treatment. In this National Cancer Institute funded double-blind, placebo-controlled study we examined the effectiveness of 7 weeks of treatment with the muscle-building hormone testosterone to preserve the body condition of men and women with cervical or head and neck cancer.  Twenty-one patients received weekly injections of either placebo or testosterone.  Over the 7 weeks of treatment, patients were monitored for changes in body composition, activity level, physical ability, and questionnaires regarding quality of life and well-being. (more…)
Author Interviews, Biomarkers, Infections, NEJM, University of Pittsburgh / 19.07.2018

MedicalResearch.com Interview with: David T. Huang, MD, MPH Associate Professor, Critical Care Medicine, Emergency Medicine, Clinical and Translational Science Director, MACRO (Multidisciplinary Acute Care Research Organization) Director, CRISMA Administrative Core (Clinical Research, Investigation, and Systems Modeling of Acute illness) University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: The overuse of antibiotics has become a serious threat to global public health, causing antibiotic resistance and increasing health care costs. Physicians have long known that antibiotics are usually unnecessary for acute bronchitis and for some other cases of lower respiratory tract infections, and that antibiotics treat only bacterial infections, not viral. But in daily practice, many physicians often prescribe them. Previous research had reported that using a biomarker blood test and following an antibiotic guideline tied to the test results could reduce antibiotic use in lower respiratory tract infections. In February 2017, the U.S. Food and Drug Administration approved the biomarker test that measures procalcitonin – a peptide that typically increases in bacterial infections, but not viral. We conducted the Procalcitonin Antibiotic Consensus Trial (ProACT) trial to evaluate whether a procalcitonin antibiotic prescribing guideline, implemented for the treatment of suspected lower respiratory tract infection with reproducible strategies, would result in less exposure to antibiotics than usual care, without a significantly higher rate of adverse events. The ProACT trial involved 14 predominately urban academic hospitals. We enrolled 1,656 adult patients who presented to the hospital emergency department and were initially diagnosed with a lower respiratory tract infection. All the patients were tested for their procalcitonin levels, but the results were shared only with the physicians of the patients randomly assigned to procalcitonin-guided antibiotic prescription. (more…)
Author Interviews, Heart Disease, JAMA, PAD, Stroke / 19.07.2018

MedicalResearch.com Interview with: Dr. Michael Barry MD Director of the Informed Medical Decisions Program Health Decision Sciences Center at Massachusetts General Hospital Physician at Massachusetts General Hospit Professor of Medicine,Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Peripheral artery disease—which is known as PAD—is a disease that reduces blood flow to a person’s limbs, especially the legs. PAD can cause leg and foot pain when resting or walking, wounds to not heal properly, and loss of limbs. Additionally, people with PAD are more likely to experience a cardiovascular disease event, such as heart attack and stroke. The U.S. Preventive Services Task Force looked at the latest research to see if screening people without signs or symptoms of PAD using the ankle brachial index (ABI) can prevent heart attack, stroke, or other adverse health effects. We found that more research is needed to determine if screening with ABI can help to identify PAD and/or prevent heart attack or stroke in people without signs or symptoms. Additionally, in a separate recommendation statement, we looked into the effectiveness of what we call nontraditional risk factors for assessing a person’s risk of cardiovascular disease. Clinicians typically check someone’s risk for cardiovascular disease using traditional risk factors, such as age, race, and smoking status. The Task Force looked at the current evidence to see if three additional, nontraditional risk factors can help prevent heart disease or stroke. The nontraditional factors considered were ABI measurements, an elevated amount of high-sensitivity C-reactive protein (hsCRP) in the blood, and an elevated amount of calcium in the coronary arteries (CAC score). In this recommendation, we also found that there is insufficient evidence to recommend for or against using nontraditional risk factors in addition to those normally used to assess cardiovascular disease risk in people without signs or symptoms.  (more…)