Eggs Should Be Eaten In Moderation – Higher Intake Linked to Increased Mortality

MedicalResearch.com Interview with:

Prof. Katherine Tucker PhD Director of the Center for Population Health Zuckerberg College of Health Sciences Lowell’s Biomedical and Nutritional Sciences UMass

Dr. Tucker

Prof. Katherine Tucker PhD
Director of the Center for Population Health
Zuckerberg College of Health Sciences
Lowell’s Biomedical and Nutritional Sciences
UMass

MedicalResearch.com: What is the background for this study? 

Response: Cholesterol was excluded from the recent dietary guidelines, but research remains unclear about eggs and cholesterol on health.

MedicalResearch.com: What are the main findings? Why is the advice about the benefits/harms regarding egg intake often so conflicting?

Response: Higher egg intake and cholesterol intake were related to increased risk of mortality. Individual observational studies can be confusing as the overall results depend on the baseline intake of the population and adjustment for confounders.  

MedicalResearch.com: What should readers take away from your report?

Response: Balance and moderation is the key. Complete avoidance of eggs and egg yolks is not recommended because they have healthy nutrients as well. Extremely high intake of any single food may lead to imbalances. 3-4 eggs a week appears healthy but intakes of multiple eggs/day are probably not a good idea.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to clarify what exactly it is about too many eggs that is causing the risk. Healthy metabolism depends on a complex interaction of nutrients.

No disclosures 

Citation:

Zhong VW, Van Horn L, Cornelis MC, et al. Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality. JAMA. 2019;321(11):1081–1095. doi:10.1001/jama.2019.1572

https://jamanetwork.com/journals/jama/article-abstract/2728487 

Jun 6, 2019 @ 3:32 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Fewer Psychiatrists Willing To Accept Medicaid Patients

MedicalResearch.com Interview with:

Hefei Wen, PhDAssistant Professor, Department of Health Management & PolicyUniversity of Kentucky College of Public Health

Dr. Wen

Hefei Wen, PhD
Assistant Professor,
Department of Health Management & Policy
University of Kentucky College of Public Health 

MedicalResearch.com: What is the background for this study?

Response: Medicaid is the principal payer of behavioral health services in the U.S. and expected to play an increasing role in financing behavioral health services following Medicaid expansions under the ACA.

Continue reading

Even if Opioids Relieve Pain, They Don’t Necessarily Improve Sleep

MedicalResearch.com Interview with:

Dr-Nicole Tang

Dr. Tang

Nicole Tang, D.Phil, C.Psychol (Reader)
Department of Psychology
Warwick Sleep and Pain Lab
University of Warwick

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current guidelines recommend non-opioid therapy as the preferred treatment of chronic non-malignant (CNP) pain, with opioids reserved to situations “when benefits for pain and function are expected to outweigh risks” [1,10]. Whilst the effectiveness of opioid therapy is usually measured in terms of pain outcomes, less is known about its effect on day-to-day functions.

A particular function of concern to patients with chronic non-malignant pain
is the ability to get a good night’s sleep.

The current systematic review has identified a set of papers with relevant outcomes regarding the effect of opioid therapy on sleep quality and sleep architecture in CNP patients. It
extends our understanding from the drug’s respiratory depression effect in healthy
individuals to the potential risks and utility of opioid therapy for chronic non-malignant pain
patients with sleep disturbances.

Whilst the narrative synthesis and the exploratory meta-analysis of a subset of data both suggest that the use of opioid therapy is associated with an overall report of sleep quality improvement, such an improvement is not consistently replicated across studies
or substantiated by improvements in sleep parameters linked to deeper and better-sleep quality. Moreover, the improvement may be accompanied by undesirable side effects and increased daytime sleepiness that contradict with the very idea of improved
sleep quality. We are also painfully aware of the methodological limitations of the studies reviewed; their exposure to different sources of biases has heightened the risk of result inflation.

To many patients with chronic non-malignant pain, improved sleep is a top priority
when evaluating the performance of a new drug and non-drug intervention.

If we were to advance our current understanding of the
opioid-sleep relationship, future trials need to be designed with
this interdisciplinary question in mind such that validated measures
of sleep can be incorporated as an outcome measure alongside pain.

Continue reading

Traumatic Injuries Cost Medicare More Than Heart Failure, Pneumonia, Stroke or Heart Attacks

MedicalResearch.com Interview with:

Dr. Mark R. Hemmila MD Associate Professor of Surgery Division of Acute Care Surgery University of Michigan

Dr. Hemmila

Dr. Mark R. Hemmila MD
Associate Professor of Surgery
Division of Acute Care Surgery
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traumatic injury has a tendency to be thought of as a disease that preferentially impacts younger people.  We wanted to explore the prevalence and impact of traumatic injury within the population of patients for whom Medicare is the third party payer.  Continue reading

Accumulation of Metabolite M-2 Predicts Overall Survival of Chemorefractory Metastatic Colorectal Cancer Patients Treated with Regorafenib (Stivarga®)

MedicalResearch.com Interview with:
Joseph Germino, M.D., PhD
Vice President US Medical Affairs Oncology
Bayer Healthcare Pharmaceuticals
Whippany, N.J. 07981

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Regorafenib is an oral multi-kinase inhibitor that potently blocks multiple protein kinases involved in tumor angiogenesis (VEGFR1, -2, -3, TIE2), oncogenesis (KIT, RET, RAF-1, BRAF), metastasis (VEGFR3, PDGFR, FGFR) and tumor immunity (CSF1R).

This prospective pharmacokinetic (PK) ancillary study is part of a prospective phase II study evaluating treatment response with regorafenib in patients with chemorefractory metastatic colorectal cancer (mCRC) called TEXAN, which aimed to investigate correlations between overall survival (OS) and regorafenib, or its enterohepatic cycle-dependent active metabolites M-2 and M-5 concentrations.

As measured by LC-MS/MS, the main findings showed that regorafenib, M-2 and M-5 were respectively 1.99 (1.03-2.73), 1.44 (0.89-2.49) and 1.61 (0.79-2.37) mg/L during the first cycle at day 15 (C1D15) and 1.90 (1.10-2.76), 1.29 (0.77-2.24) and 1.17 (0.45-2.42) mg/L at during the second cycle at day 15 (C2D15).  Continue reading

Children with High Risk AML: Intensification of Induction II Chemotherapy and Liberalization of Stem Cell Donor Source does not Improve Outcomes

MedicalResearch.com Interview with:
Joseph Germino, M.D., PhD
Vice President US Medical Affairs Oncology
Bayer Healthcare Pharmaceuticals
Whippany, N.J. 07981

MedicalResearch.com: What is the background for this study?

Response: Sorafenib (Nexavar®) is an oral anticancer therapy approved in more than 100 countries worldwide. It is approved for the treatment of patients with advanced hepatocellular carcinoma (HCC); advanced renal cell carcinoma (RCC) who have failed prior interferon-alpha or interleukin-2 based therapy or are considered unsuitable for such therapy; progressive, locally advanced or metastatic differentiated thyroid carcinoma (papillary/follicular/Hürthle cell), that is refractory to radioactive iodine (RAI).

The AAML 1031 is a recently completed Phase III clinical trial evaluating the use of bortezomib and sorafenib in patients 30 years or younger with newly diagnosed acute myeloid leukemia (AML).

At the 2019 ASCO Annual meeting, results of a report from the AAML1031 trial, which assessed whether intensification of Induction II chemotherapy (ADE or AraC/ Mitoxantrone) and liberalized stem cell transplant (SCT) donor source criteria improved clinical outcomes in patients with residual AML.  Continue reading

Home Based Physical Therapy Can Help Prevent Falls in the Elderly

MedicalResearch.com Interview with:

Teresa Liu-Ambrose, PT, PhDCanada Research Chair (Tier II), Physical Activity, Mobility, and Cognitive NeuroscienceDirector, Aging, Mobility, and Cognitive Neuroscience LaboratoryUniversity of British Columbia

Dr. Liu-Ambrose

Teresa Liu-Ambrose, PT, PhD
Canada Research Chair (Tier II), Physical Activity, Mobility, and Cognitive Neuroscience
Director, Aging, Mobility, and Cognitive Neuroscience Laboratory
University of British Columbia

MedicalResearch.com: What is the background for this study?

Response:  Falls in older adults are the third-leading cause of chronic disability and the leading cause of hospitalization for adults over age 65. Older adults who experience multiple falls are at increased risk for disability, loss of independence, and even death. How to best prevent falls in this high risk group is not well established. 

Continue reading

Many Teens Do Not Fill Their Prescriptions for STDs

MedicalResearch.com Interview with:

Monika K. Goyal, M.D., MSCE Assistant chief of Children’s Division Emergency Medicine and Trauma Services

Dr. Goyal

Monika K. Goyal, M.D., MSCE
Assistant chief of Children’s Division
Emergency Medicine and Trauma Services 

MedicalResearch.com: What is the background for this study?

Response: Adolescents are disproportionately affected by sexually transmitted infections (STIs) and often present to the emergency department for care. I have devoted almost 15 years of my career trying to improve the sexual health of teens through advocacy and the development of novel interventions in the emergency department to increase access to sexual health services for youths.

Continue reading

Despite Large Numbers of Female Gynecologic Surgeons, Gender Disparities and Harassment Persist

MedicalResearch.com – Responses

Marina Stasenko, MD Memorial Sloan Kettering Cancer Center

Dr. Stasenko
Photo: MSKCC

Marina Stasenko, MD
Memorial Sloan Kettering Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sexual harassment is a form of discrimination that includes gender harassment, unwanted sexual attention, and sexual coercion. A recent report in Fortune magazine noted that over half of US women have experienced sexual harassment at some point in their lives. Until recently, much of the conversation about sexual harassment in the workplace has been relegated to private discussions behind closed doors. However, the MeToo movement has shined a spotlight on the pervasive nature of sexual harassment in various fields, like media and business world. Although there are more female physicians in practice today than ever before, with women accounting for over 50% of young physicians, sexual harassment and gender disparities continue to plague the field of medicine.

Despite the large female representation, gynecologic oncology is not immune from gender disparities. The Society of Gynecologic Oncology is a professional organization of over 2000 physicians, scientists, allied health professionals, nurses, and patient advocates dedicated to the care of patients with gynecologic cancer. As of 2015, 46% of members of the SGO were women, and that number is steadily growing. SGO leadership is also increasingly female – with 2 of the last 3 presidents being women.

Despite the large female representation, gynecologic oncology is not immune from gender disparities. The 2015 SGO practice survey noted that while 22% of male Gynecologic Oncologists held the rank of professor, only 11% of their female counterparts held the title. They also noted that the mean annual salary for male physicians was nearly 150,000$ greater than salary for female physicians.

Given the fact that there is little objective data on sexual harassment in gynecologic oncology, the objective of our study was to evaluate perceptions of sexual harassment and gender disparities among physician members of the Society of Gynecologic Oncology.

Continue reading

Canadian ERs Use Less Pediatric Diagnostic Imaging Than US

MedicalResearch.com Interview with:

Eyal Cohen, MD, M.Sc, FRCP(C)Professor, PediatricsUniversity of TorontoCo-Founder, Complex Care ProgramThe Hospital for Sick Children

Dr. Cohen

Eyal Cohen, MD, M.Sc, FRCP(C)
Professor, Pediatrics
University of Toronto
Co-Founder, Complex Care Program
The Hospital for Sick Children
 

MedicalResearch.com: What is the background for this study?

Response: Minimizing care that provides little benefit to patients has become an important focus to decrease health care costs and improve the quality of care delivery.  Diagnostic imaging in children is a common focus for campaigns designed to reduce overuse both in Canada and the US. There are some suggestions that there may be more overuse of care in the United States than Canada, but there has been little study in children.

We compared the use of low-value diagnostic imaging rates from four pediatric emergency departments in Ontario to 26 in the United States from 2006 to 2016.  We defined low-value imaging as situations where children are discharged from an emergency department with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation.  Continue reading

Atrial Fibrillation Common After TAVR and Aortic Valve Replacement

MedicalResearch.com Interview with:
Rajat Kalra, MBCh
Cardiovascular Division
University of Minnesota, Minneapolis

MedicalResearch.com: What is the background for this study?

Response: New-onset atrial fibrillation after aortic valve procedures is thought to occur frequently after aortic valve procedures, such as transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR). However, the incidence estimates and implications of this new-onset atrial fibrillation in the contemporary era are unclear.

We sought to examine the incidence of atrial fibrillation after aortic valve procedures, compare the incidence between TAVI and AVR, and evaluate the associated morbidity and mortality implications using a ‘big data’ approach. This big data approach employed the National Inpatient Sample and was validated in the New York State Inpatient Database. Both are publicly available datasets that are developed as part of the Healthcare Cost and Utilization Project, a federal-state-industry partnership that is sponsored by the Agency for Healthcare Research and Quality.  Continue reading

Food Food Spending by Lower Economic Groups Has Greater Environmental Impact

MedicalResearch.com Interview with:

Joe F. Bozeman III, MS, CEM, Ph.D. Candidate Chair, Gordon Research Seminar (Industrial Ecology) University of Illinois at Chicago (UIC) Institute for Environmental Science and Policy

Joe F. Bozeman III

Joe F. Bozeman III, MS, CEM, Ph.D. Candidate
Chair, Gordon Research Seminar (Industrial Ecology)
University of Illinois at Chicago (UIC)
Institute for Environmental Science and Policy

MedicalResearch.com: What is the background for this study?  

Response: This study is actually a part of my dissertation which explores how climate change, human health, and other socioecological factors can be used to manage food-energy-water impacts. After establishing environmental impact and climate change adaptation implications of food consumption across major U.S. demographic groups in a previous study, my colleagues and I decided it would be interesting to investigate how food spending and household income correlate with food-consumption environmental impacts. Our efforts led to the development of a novel quantitative metric (i.e., food-consumption impact per dollar spent [FCI$]) which encompasses land, water, and greenhouse gas emission impacts of basic foods; the amount spent on food; and socioeconomic status. All major food groups are included in this study.

Continue reading

Larotrectinib (VITRAKVI® ): Efficacy and Safety in Pediatric TRK Fusion Cancer Patients

MedicalResearch.com Interview with:

Douglas S. Hawkins, M.D. Hematology/Oncology Division Chief and Professor Pediatrics at Seattle Children's Hospital University of Washington School of Medicine

Dr. Hawkins

Douglas S. Hawkins, M.D.
Hematology/Oncology Division Chief and Professor
Pediatrics at Seattle Children’s Hospital
University of Washington School of Medicine

MedicalResearch.com: What is the background for this study?

Response: TRK fusion cancer is caused by a rare genomic alteration called a neurotrophic receptor tyrosine kinase (NTRK) gene fusion.

Larotrectinib is a central nervous system (CNS) active, oral and highly selective TRK inhibitor used for the treatment of adult and pediatric patients with solid tumors that have a rare genomic alteration called an NTRK gene fusion. Larotrectinib was approved at the end of 2018 in the U.S. under the brand name VITRAKVI®, with European and worldwide regulatory submissions underway.

At ASCO 2019, we will be presenting results from a new analysis specifically looking at the efficacy and safety of larotrectinib in pediatric patients (n=34) included in the expanded dataset from both adults and children across 24 tumor types, which was presented first at the European Society for Medical Oncology (ESMO) 2019 Annual Meeting.  Continue reading

SPARTAN Study: Older Castration-Resistant Prostate Cancer Patients Can Tolerate and Benefit from Apalutamide (ERLEADA®)

Dr. Julie Graff

MedicalResearch.com Interview with:
Julie N. Graff, MD
Associate Professor of Medicine
Knight Cancer Institute
Chief of Hematology/Oncology
VA Portland Health Care System

MedicalResearch.com: What is the background for this study?

Response: Androgen deprivation therapy is often deployed in patients with a rising PSA after local therapy (such as radical prostatectomy or radiation therapy). With time, the prostate cancer can develop resistance to ADT, at which point it is called castration resistant prostate cancer (CRPC). There were 6 treatments for metastatic CRPC that have shown improved survival. However, in non-metastatic disease, there was nothing that showed improved survival.

The SPARTAN study was designed to determine if a next generation androgen receptor antagonist could delay the time to metastatic disease. Overall survival was a secondary endpoint.  Continue reading

CLL: Ibrutinib (IMBRUVICA®) Demonstrated Durable Responses for High Risk Patients

MedicalResearch.com Interview with:

Paul M. Barr, M.D. Associate Professor of Medicine and Director of the Clinical Trials Office Director of the Clinical Trials Office Wilmot Cancer Institute

Dr. Barr

Paul M. Barr, M.D.
Associate Professor of Medicine and Director of the Clinical Trials Office
Director of the Clinical Trials Office
Wilmot Cancer Institute 

MedicalResearch.com: What is the background for this study?  

Response: When the study was designed, chronic lymphocytic leukemia (CLL)  treatment options were largely limited to chemotherapy and monoclonal antibodies.

Ibrutinib had shown promise in early studies. The intent was to compare ibrutinib to a standard of care treatment option at that time, of atumumab, in patients with relapsed or refractory disease. The goal of the current analysis is to evaluate the durability of ibrutinib and report the long-term safety results.

Continue reading

Laundry Detergent Packets Still Poison Kids, Despite Tougher Standards

MedicalResearch.com Interview with:

Dr-Gary A. Smith

Dr. Gary Smith

Dr. Gary Smith, MD MPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our 2016 study (https://pediatrics.aappublications.org/content/137/5/e20154529) investigated calls to US poison control centers related to laundry and dishwasher detergent exposures among children younger than 6 years old from 2013 through 2014 and found that poison control centers received more than 30 calls a day about children who had been exposed to a laundry detergent packet, which is about one call every 45 minutes.

The current study investigated trends in calls to poison control centers across the country for exposure to liquid laundry detergent packets in order to evaluate the impact of the voluntary safety standard for this product with a focus on young children. The study found only a modest decrease (18%) in calls for children younger than 6 years of age following adoption of a 2015 product safety standard as well as an increase in calls for older children and adults. Exposures to the eyes also continued to climb.

The observed decrease in exposures among young children is considerably less than the 40% to 55% decrease in toxic ingestions seen after passage of the Poison Prevention Packaging Act. This demonstrates that the current liquid laundry detergent safety standard is inadequate and needs to be strengthened. Continue reading

What Kind of Personality Goes to the Emergency Room Often?

MedicalResearch.com Interview with:

Stephen L. Ristvedt, Ph.D. Associate Professor of Anesthesiology Washington University St. Louis, MO  63110-1093

Dr. Ristvedt

Stephen L. Ristvedt, Ph.D.
Associate Professor of Anesthesiology
Washington University
St. Louis, MO  63110-1093 

MedicalResearch.com: What is the background for this study?

Response: Having a usual source of healthcare – either with a regular doctor or a medical clinic – is the best way to manage one’s health in a proactive way.  Doctors and clinics can provide ongoing guidance with regard to the use of preventive medical screenings as well as the management of chronic illness.  Unfortunately, a significant proportion of US adults do not have a usual source of healthcare.  Also, many people often rely for their healthcare needs on a hospital emergency department, where there is neither sufficient continuity of care nor counseling for prevention.

We wanted to investigate what factors might contribute to suboptimal utilization of healthcare resources.  We were particularly interested in looking at individual psychological factors that might play a role in the choices that people make when seeking healthcare.  One specific psychological characteristic proved to be important in our study.  That characteristic is called “threat sensitivity,” and it is measured with a simple questionnaire.  People who are relatively high in threat sensitivity are prone to experience high levels of anxiety in potentially threatening situations  Continue reading

Older Adults Using More Cannabis But Still Fear Stigma

MedicalResearch.com Interview with:

Julie Bobitt, PhD Director Interdisciplinary Health Sciences College of Applied Health Sciences University of Illinois at Urbana Champaign Champaign, IL  61820

Dr. Bobitt

Julie Bobitt, PhD
Director
Interdisciplinary Health Sciences
College of Applied Health Sciences
University of Illinois at Urbana Champaign
Champaign, IL  61820

MedicalResearch.com: What is the background for this study?

Response:  Older adults are using cannabis at an increasing rate but little is known about their attitudes about, and experiences – including outcomes- with, recreational and medical cannabis use. We believed a qualitative study, where we conducted focus group interviews, would provide a novel perspective to our understanding and help to identify the most salient themes concerning the use of medical and recreational cannabis by adults aged 60 and older living in Colorado.

Continue reading

Novartis Piqray® Approved for Patients with a PIK3CA Mutation in HR+/HER2- Advanced Breast Cancer

MedicalResearch.com Interview with:

Fabrice André, MD, PhD Research director and head of INSERM Unit U981 Professor in the Department of Medical Oncology Institut Gustave Roussy in Villejuif, France Global SOLAR-1 Principal Investigator.

Dr. Fabrice André

Fabrice André, MD, PhD
Research director and head of INSERM Unit U981
Professor in the Department of Medical Oncology
Institut Gustave Roussy in Villejuif, France
Global SOLAR-1 Principal Investigator.

MedicalResearch.com: What is the background for this study? How does Piqray®  differ from other treatments for this type of advanced breast cancer? 

  • The US Food and Drug Administration (FDA) approved Piqray® (alpelisib, formerly BYL719) in combination with fulvestrant for the treatment of postmenopausal women, and men, with hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2-), PIK3CA-mutated, advanced or metastatic breast cancer, as detected by an FDA-approved test after disease progression following an endocrine-based regimen.
  • Piqray is the first and only combination treatment with fulvestrant specifically for postmenopausal women, and men, with HR+/HER2- advanced or metastatic breast cancer with a PIK3CA mutation following progression on or after an endocrine-based regimen, bringing a biomarker-driven therapy option to this population for the first time.
  • Advanced breast cancer is incurable, and patients with all types need more treatment options. With this approval, physicians can now use an FDA-approved test to determine if their patients’ HR+/HER2- advanced breast cancer has a PIK3CA mutation and may be eligible for treatment with Piqray plus fulvestrant combination therapy. 

Continue reading

Congestion Might Mean Something Different To You and Your Doctor

MedicalResearch.com Interview with:

Edward McCoul, MD, MPH, FACS Associate Professor Director, Rhinology and Sinus Surgery Department of Otorhinolaryngology Ochsner Clinic New Orleans, Louisiana

Dr. McCoul

Edward McCoul, MD, MPH, FACS
Associate Professor
Director, Rhinology and Sinus Surgery
Department of Otorhinolaryngology
Ochsner Clinic
New Orleans, Louisiana 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although the potential for doctors and patients to misunderstand each other has been noted in other areas of medicine, the meaning of the word “congestion” had not previously been the subject of study.  This paper calls attention to the relevance of potential communication gap in otolaryngology.  This is particularly important since congestion is a major diagnostic criteria of sinusitis, which ranks nationwide in the top 5 reasons for clinical encounters year after year.  If a communication gap is evident around this particular term, which is integral to establishing a diagnosis of sinusitis, then the likelihood increases that patients who present with “sinusitis” will be incorrectly diagnosed.

The process of congestion refers to the microscopic accumulation of blood and/or fluid within cells or the spaces between cells in a particular tissue or body part.  When this occurs in the nose, the result is swelling inside the nose, which narrows the space for air to flow.  A patient would perceive this as blockage or obstruction of airflow.  This can be treated with anti-inflammatory medication that reduces swelling.  Medications that clear up mucus generally are not great at reducing swelling.  Many over-the-counter products are available that combine both types of medications, but using those products runs the risk of overmedication, which can have adverse consequences.

Continue reading

Fewer Oncologists Have Financial Ties to Pharmaceutical Companies

MedicalResearch.com Interview with:
Deborah C. Marshall, MD
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Open Payments has brought sweeping change to medicine by introducing transparency to physician relationships with industry. We have seen its impact on oncology through the recent media attention to high-profile physicians in oncology scrutinized for their failure to disclose industry relationships and through the resulting changes to conflict of interest policies of clinical, professional and research organizations in recent months.

We wanted to better understand the impact of Open Payments on individual physician behavior due to the important ethical and policy implications.  We have a cohort of oncology physicians that we followed from the inception of Open Payments to see whether the implementation and increasing awareness of Open Payments have resulted in fewer physicians engaging with industry and has shifted payments towards those considered more appropriate.

The study is important because we evaluate trends at the physician-level to explore the impact of Open Payments on how physicians interact with industry, which is difficult to measure. 

MedicalResearch.com: What should readers take away from your report?

Response: The most important finding is that oncology physician interactions with industry are decreasing, which we interpret as being due to the effect of Open Payments.  Notably, we do not see large shifts in the types of payments yet, which suggests that transparency alone may not be enough to significantly alter behavior.  Moreover, while there has been a decrease in oncology physicians interacting with industry, the number and value of these interactions has not shifted greatly, which should reassure those who were concerned that this type of transparency program would have a negative impact on beneficial industry interactions.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We are likely going to see the continued impact of Open Payments over time as the downstream effects of transparency become apparent, which warrants ongoing attention to help guide future policy-making.  Engaging stakeholders in these discussions, as well as investigating the impact of industry relationships on how physicians are providing care, conducting and reporting research, and educating future doctors are relevant areas of further research.  Also, there is increasing financial interest in oncology so addressing the risk associated with financial interactions with industry and conflicts of interest are more important than ever. 

Citation: 2019 ASCO Annual Meeting  June 1 2019

Trends in financial relationships between industry and individual medical oncologists in the United States from 2014 to 2017: A cohort study.

Author(s): Deborah Catherine Marshall, Elizabeth Stieglitz Tarras, Kenneth Rosenzweig, Deborah Korenstein, Susan Chimonas; Icahn School of Medicine at Mount Sinai, New York, NY; New York University School of Medicine, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY

https://abstracts.asco.org/239/AbstView_239_258191.html 

Jun 3, 2019 @ 12:45 am

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Older Women With Early Breast Cancer May Have A Choice of Radiation Therapy Alone

MedicalResearch.com Interview with:

Manjeet Chadha, MD, MHA, FACR, FASTRO Prof. Radiation Oncology Director of the Department of Radiation Oncology Mount Sinai Downtown 

Prof. Chadha

Manjeet Chadha, MD, MHA, FACR, FASTRO
Prof. Radiation Oncology
Director of the Department of Radiation Oncology
Mount Sinai Downtown 

MedicalResearch.com: What is the background for this study?

Response: Largely, the goal of cancer care among the elderly is to de-escalate therapy searching for a modality that is both an effective treatment and also associated with minimal toxicity.

Approximately, 30% of new breast cancers diagnosed annually are among women older than 70 years of age. Age-adjusted trends note a relatively higher incidence of stage I breast cancer in women between the ages of 70-74 years. For this group of patients, it is imperative that we take a closer look at the evidence-base for our current practice standards, and evaluate opportunities to improve cancer care delivery in the elderly.

Randomized trials have helped arrive at an acceptance of adjuvant endocrine monotherapy in older patients with ER positive, node negative breast cancer. However, in the older patients high rates of non-compliance to tamoxifen secondary to poor tolerance is widely recognized. Emerging data also detail the side effect profile of aromatase inhibitors. Most commonly observed symptoms of arthralgia, reduced bone mineral density, and increased risk of fractures throughout the duration of treatment are important considerations for an older population. At least a quarter of patients on aromatase inhibitors discontinue therapy specifically due to skeletal events and musculoskeletal symptoms. Overall, the side effects of ET contribute to a high rate of non-compliance and negative impact on patients’ quality of life.

Continue reading

Majority of Antibiotics Prescribed Before Dental Procedures Are Unnecessary

MedicalResearch.com Interview with:

Dr. Katie Suda, PharmD, M.S. Associate ProfessorCollege of PharmacyUniversity of Illinois at Chicago

Dr. Suda

Dr. Katie Suda, PharmD, M.S. 
Associate Professor
College of Pharmacy
University of Illinois at Chicago 

MedicalResearch.com: What is the background for this study?

Response: Dentists prescribe approximately 1 in every 10 antibiotics in the United States and are the top specialty prescriber. Dentists are the primary prescriber of clindamycin in the U.S., which is associated with a high risk of C. difficile infection (an overgrowth of bacteria in the GI tract that can cause a life-threatening infection). Clinical guidelines recommend that patients with specific cardiac conditions receive a dose of antibiotics prior to undergoing invasive dental procedures to prevent infective endocarditis (an infection of the heart values). Taking a dose of antibiotics prior to a dental visit is referred to as antibiotic prophylaxis. Starting in 2007, these guidelines were narrowed secondary to poor evidence on the effectiveness of antibiotic prophylaxis and the risk of antibiotic-related adverse events. Antibiotic adverse events include antibiotic resistance, C. difficile infection, and other general adverse events (nausea, vomiting, diarrhea).

While significant research has been conducted on unnecessary prescribing of antibiotics by medical providers, little work has described appropriateness of prescribing by dentists. We assessed if antibiotics prescribed for prophylaxis prior to dental procedures were consistent with clinical guidelines.

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Circulating DNA Can Indicate Melanoma Treatment Failure

MedicalResearch.com Interview with:

David Polsky, MD, PhDDermatologist and Director of the Digmented Lesion Service

Dr. Polsky

David Polsky, MD, PhD
Dermatologist and Director of the Digmented Lesion Service

Mahrukh M. Syeda, MS
Research Associate

Ronald O. Perelman Department of Dermatology
NYU Langone Health

MedicalResearch.com: What is the background for this study?

Response: Several studies of metastatic melanoma patients have demonstrated that measuring circulating tumor DNA (ctDNA) associates with their disease burden and survival.  Generally, patients with detectable pre-treatment ctDNA levels and/or detectable ctDNA at various time intervals after starting treatment have shorter survivals than patients with lower pre-treatment or on-treatment ctDNA levels.  Studies have varied in their methods to detect ctDNA, the thresholds chosen to call a sample positive or negative, and the follow up time point for measurement, if any.

In this study, we examined pre-treatment and week 4 on-treatment plasma samples from patients enrolled in Combi-D, the Phase III, randomized, double-blind trial of the BRAF and MEK inhibitors Dabrafenib and Trametinib, which led to FDA approval of the combination therapy for patients with unresectable stage III/IV melanoma.

Only patients with BRAF V600E or V600K mutations identified from tumor genotyping were enrolled in the clinical trial.

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Mortality: Number of Steps Matter, Up To a Point

MedicalResearch.com Interview with:

I-Min Lee, MD, ScDProfessor of Medicine, Harvard Medical SchoolProfessor of EpidemiologyHarvard T.H. Chan School of Public Health

Prof. I-Min Lee

I-Min Lee, MD, ScD
Professor of Medicine, Harvard Medical School
Professor of Epidemiology
Harvard T.H. Chan School of Public Health 

MedicalResearch.com: What is the background for this study?

Response: While we have many studies showing that physical activity is beneficial for health, there are few data on steps and health, particularly long-term health outcomes.  An expert committee – the 2018 Physical Activity Guidelines Advisory Committee, which reviewed the scientific evidence to support the recently released Physical Activity Guidelines for Americans, 2nd edition – noted this (i.e., the relation between steps and health outcomes) to be a critical gap in knowledge, since many individuals are using wearables and monitoring their step counts.

We often hear the number 10,000 steps cited as a daily goal, but the basis for this number is unclear. It likely originated as a marketing tool: in 1965, the Yamasa Clock and Instrument Company, Japan sold a pedometer called “Manpo-kei” – “ten thousand steps meter” in Japanese.

For many older people, 10,000 steps/day can be a very daunting goal; thus, we wanted to investigate whether this was necessary for lower mortality rates in older women.  Additionally, steps taken can be fast or slow, and there are no published studies on step intensity and long-term health outcomes.  Note that walking pace and step intensity are not the same concept: walking pace gauges intensity when walking purposefully (e.g., for exercise or transportation), while step intensity assesses an overall best natural effort in our daily life. Continue reading

TItan Study: Apalutamide (ERLEADA®) plus Androgen Deprivation Therapy Improved Survival in Some Metastatic Prostate Cancer Patients

MedicalResearch.com Interview with:

Dr. Kim Chi. MDProfessor of MedicineMedical Oncologist and Medical Director at BC Cancer – VancouverUniversity of British Columbia,Principal Investigator of the TITAN Study.

Dr. Kim Chi

Dr. Kim Chi. MD
Professor of Medicine
Medical Oncologist and Medical Director at BC Cancer – Vancouver
University of British Columbia,
Principal Investigator of the TITAN Study.

MedicalResearch.com: What is the background for this study?

Response: For more than 70 years, androgen deprivation therapy (ADT) has been the standard of care therapy for patients with metastatic prostate cancer. The Phase 3 TITAN study looked at adding apalutamide (®®®®) to ADT compared with placebo plus ADT in a broad group of patients with metastatic castration-sensitive prostate cancer (mCSPC), regardless of disease volume or prior docetaxel treatment history.

Metastatic castration-sensitive prostate cancer is prostate cancer that still responds to androgen deprivation therapy and has spread to other parts of the body. Patients with mCSPC tend to have a poor prognosis, with a median overall survival (OS) of less than five years, underscoring the need for new treatment options. The dual primary endpoints of this study were overall survival and radiographic progression-free survival (rPFS).  Continue reading

Less Air Pollution in Southern California Linked to Less Asthma in Children

MedicalResearch.com Interview with:

Erika Garcia, PhD, MPHPostdoctoral ScholarDivision of Environmental HealthDepartment of Preventive MedicineKeck School of MedicineUniversity of Southern CaliforniaLos Angeles, CA 90089-9237

Dr. Garcia

Erika Garcia, PhD, MPH
Postdoctoral Scholar
Division of Environmental Health
Department of Preventive Medicine
Keck School of Medicine
University of Southern California
Los Angeles, CA 90089-9237

MedicalResearch.com: What is the background for this study?

Response: It is known that air pollution can exacerbate pre-existing asthma, but what is not yet established is whether air pollution exposure contributes to the development of new cases of asthma. There is increasing scientific evidence supporting a role of air pollution in asthma development.

In this study we examined whether reductions in air pollution levels in Southern California were associated with subsequent reductions in rates of new-onset asthma in children. We separately evaluated four pollutants: nitrogen dioxide, ozone, coarse particulate matter (PM10), and fine particulate matter (PM2.5).

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Vitiligo: Off Label Topical Calcineurin Inhibitors Help Some Patients

MedicalResearch.com Interview with:

Dr-Jung Min Bae

Dr. Jung Min Bae

Jung Min Bae, MD, PhD
Associate Professor, Department of Dermatology
St. Vincent’s Hospital
College of Medicine, The Catholic University of Korea 

MedicalResearch.com: What is the background for this study?

Response: Vitiligo is a common chronic skin disease affecting 1% of the population, and it causes low self-esteem and social stigma. To date, there are no approved drugs for the treatment of vitiligo, even though growing evidence indicates favorable therapeutic responses of topical calcineurin inhibitors (TCIs) including tacrolimus and pimecrolimus.

In this study, we conducted a systematic review and meta-analysis of all relevant prospective studies (n = 46) and identified remarkable therapeutic responses of TCI monotherapy and TCI plus phototherapy for vitiligo. Continue reading

Myrbetriq® (mirabegron) Improved BPH Urinary Symptoms in Men Already on Tamsulosin (Flomax)

MedicalResearch.com Interview with:

Steven A. Kaplan, M.D., FACS Professor of Urology Director, The Men's Health Program Icahn School of Medicine at Mount Sinai

Dr. Kaplan

Steven A. Kaplan, M.D., FACS
Professor of Urology
Director, The Men’s Health Program
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study?

Response: PLUS is the first large-scale trial conducted in North America and Europe specifically designed to study the effects of mirabegron in controlling residual symptoms of urinary urgency and frequency in men with benign prostatic hyperplasia (BPH) using common agents such as tamsulosin (Flomax).

We explored whether mirabegron (Myrbetriq), an agent approved for the treatment of overactive bladder (OAB), improved patient outcomes when added to tamsulosin. This was a randomized, double-blind, placebo-controlled, multi-center study enrolling 715 male patients 40 years of age and older.

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Proton-pump inhibitors (PPIs) Linked to Increased Risk of Death

MedicalResearch.com Interview with:

Ziyad Al-Aly, MD, FASNAssistant Professor of MedicineDirector of the Clinical Epidemiology CenterChief of Research and EducationDepartment of Veterans Affairs Health Care SystemSaint Louis

Dr. Ziyad Al-Aly

Ziyad Al-Aly, MD, FASN
Assistant Professor of Medicine
Director of the Clinical Epidemiology Center
Chief of Research and Education
Department of Veterans Affairs Health Care System
Saint Louis 

MedicalResearch.com: What is the background for this study?  

Response: In 2017, we published a paper showing increased risk of death associated with Proton-pump inhibitors (PPI) use. Following the publication of that 2017 paper, several key stakeholders including patients, doctors, research scientists, medical media folks, mainstream media folks, and others asked us: what do these people die from? Did you study causes of death attributable to PPI use? In the study published today, we developed a causal inference framework to answer this question.

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