Author Interviews, Education, Race/Ethnic Diversity / 25.09.2015

MedicalResearch.com Interview with: Meng-Yun Lin, MPH PhD candidate Department of Health Policy & Management Boston University School of Public Health Boston MA  02118 Medical Research: What is the background for this study? What are the main findings? Response: Racial and ethnic disparities in health care are widely documented, however the process by which they occur is not fully understood. One potential mechanism is through the process of treatment decision making, and racial/ethnic variations in that communication process. Thus, the goal of this study was to examine racial/ethnic differences in the types of information communicated by physicians regarding their rationale for recommendations for care, using national data collected from a diverse group of respondents. We found that Americans’ experiences with information communicated by physicians regarding rationale behind treatment recommendations vary on some dimensions by race and ethnicity. In general, Blacks and Hispanics receive less information from their doctors than non-minorities do regarding the rationale for treatment decision-making. Specially, Blacks’ and Hispanics’ doctors less often cited their own experiences, or scientific research as a reason for treatment recommendations. Our findings suggest differences in key elements of shared decision making are evident in the care of racial/ethnic minorities. (more…)
Author Interviews, Geriatrics, Hearing Loss, JAMA / 25.09.2015

Kevin J. Contrera, MPH MD Candidate Johns Hopkins School of MedicineMedicalResearch.com Interview with: Kevin J. Contrera, MPH MD Candidate Johns Hopkins School of Medicine Medical Research: What is the background for this study? What are the main findings? Response: Hearing impairment is common in older adults. The prevalence of clinically significant hearing loss doubles with every decade of life, affecting two-thirds of adults 70 years of age or older. Hearing loss has been shown to be associated with various negative cognitive, mental, and physical health outcomes. In a nationally representative sample of 1,666 adults aged 70 years or older, moderate or greater hearing impairment was associated with a 54% increased risk of mortality. This was after we statistically took into account factors that could influence this association. Essentially, the worse the patient's hearing loss, the greater the risk of death. (more…)
Author Interviews, CDC, Flu - Influenza, Vaccine Studies / 25.09.2015

MedicalResearch.com Interview with: Carla L. Black PhD Immunization Services Division National Center for Immunization and Respiratory Diseases CDC Carla L. Black PhD Immunization Services Division National Center for Immunization and Respiratory Diseases CDC  Medical Research: What is the background for this study? What are the main findings? Dr. Black: The Advisory Committee on Immunization Practices (ACIP) recommends that all health-care personnel (HCP) be vaccinated annually against influenza. Vaccination of health-care personnel can reduce influenza-related morbidity and mortality among HCP and their patients. Overall, 77.3% of HCP reported receiving an influenza vaccination in the 2014-15 season, similar to the 75.2% coverage among HCP reported in the 2013-14 season. Coverage was highest among  health-care personnel working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%). Flu vaccination coverage was highest in settings with employer flu vaccination requirements and promotion of flu vaccination. Vaccination coverage was 96% among HCP with an employer requirement for vaccination. Among HCP without an employer requirement for vaccination, vaccination coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for one day (73.6%) or multiple days (83.9%) compared with  health-care personnel  working in settings where vaccination was promoted but not offered on-site (59.5%) or not promoted in any manner (44.0%). (more…)
Author Interviews, HIV, PLoS / 25.09.2015

MedicalResearch.com Interview with: Christine Bourgeois Unité UMR 1184 / Centre IMVA CR1 INSERM, Coordinatrice site Bicêtre Le Kremlin-Bicêtre Cedex Medical Research: What is the background for this study? What are the main findings? Response: Antiretroviral therapy (ART)  treatment in HIV infected patients had successfully reduced the development of AIDS (acquired immune deficiency syndrome). However, chronic HIV infection in ART treated patients exhibit rapid uprising of viral load following ART interruption indicating that the virus is not eradicated and persist in some cellular or anatomical sites that are called “reservoir”. Secondly, ART controlled HIV-infected patients exhibit low grade inflammation developing despite efficient viral control. This low grade inflammation has been associated with non AIDS related pathologies. The aim of our work was to identify site that may combine viral persistence and inflammatory potential. We believed that adipose tissue was a very promising candidate because it included the major targets of HIV infection (CD4 T cells, and macrophages) and exhibited a highly pro-inflammatory potential. Although adipose tissue has been extensively studied as a target of antiretroviral toxicity, we readdress the role of adipose tissue as a reservoir and a site of inflammation. We demonstrated that indeed, adipose tissue from  Antiretroviral therapy controlled HIV-infected patients contained infected CD4 T cells that upon in vitro reactivation were able to produce HIV RNA. These results are extremely important because adipose tissue represents 15%-20% of body weight and is diffusely located. We thus identify a large new reservoir. (more…)
Author Interviews, Endocrinology, OBGYNE / 25.09.2015

Richard S. Legro, MD Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences Penn State College of MedicineMedicalResearch.com Interview with: Richard S. Legro, MD Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences Penn State College of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Legro: Weight loss is recommended for obese women with PCOS, but there are no randomized studies to show that it improves fertility outcomes. Both Lifestyle modification and oral contraceptives are also recommended for chronic treatment of women with PCOS so that this study has relevance to all obese women with PCOS. We designed this study to prospectively examine the effects of these common treatments on reproductive, metabolic and quality of life parameters, as well as on fertility in women seeking pregnancy. The main findings are summarized in the abstract and conclusion to the study.  I would repeat those here.  I would highlight that quality of life improved in all treatment groups, but the group that had both oral contraceptives and lifestyle modification had a significant improvement in their physical well-being compared to the oral contraceptive group. (more…)
Author Interviews, Cancer Research, CT Scanning, JAMA, Melanoma, Radiology, University of Michigan / 25.09.2015

MedicalResearch.com Interview with: Benjamin Y. Scheier, MD Division of Hematology/Oncology Department of Internal Medicine University of Michigan, Ann Arbor Medical Research: What is the background for this study? What are the main findings? Dr. Scheier: Existing data suggests that PET/CT has use in the detection of metastases from multiple primary tumor types. However, PET/CT lacks data supporting its use in staging asymptomatic patients with early-stage melanoma, may inconsistently impact treatment decisions, and carries a false-positive finding risk that may detract from its use. To evaluate an evolving practice, this study aims to assess the use of PET/CT in detecting occult metastases in SLN-positive melanoma prior to resection. In this retrospective evaluation of patients with melanoma and clinically silent regional lymph nodes treated at the University of Michigan, only 7% had PET/CT findings that ultimately identified metastatic melanoma and precluded LND. Of the 46 patients who underwent a preoperative PET/CT, 15 (33%) had intense uptake distant from the primary tumor and local lymph node basin. Nine of those 15 patients (60%) had abnormalities biopsied prior to LND. Three of the 9 biopsies yielded metastatic melanoma, a false-positive rate of 67% for PET/CT in identifying distant metastases in asymptomatic patients. (more…)
Author Interviews, Cancer Research, CDC, Occupational Health / 24.09.2015

Robert D. Daniels Ph.D Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health Cincinnati, OhioMedicalResearch.com Interview with: Robert D. Daniels Ph.D Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health Cincinnati, Ohio Medical Research: What is the background for this study? Dr. Daniels: In 2010, National Institute for Occupational Safety and Health (NIOSH) researchers, with funding assistance from the U.S. Fire Administration, launched a multi-year study to examine whether fire fighters have a higher risk of cancer and other causes of death due to job exposures. Our study was designed to address limitations of previous fire fighter cancer research. ? We included a significantly larger population. With more than 30,000 career fire fighters who served in Chicago, Philadelphia, and San Francisco Fire Departments between 1950 and 2010, it is the largest study of United States fire fighters ever undertaken. In addition, both non-white and female fire fighters are represented. ? We looked not only at deaths from cancer, but also at the diagnosis of certain kinds of cancer, such as testicular and prostate cancer, which have higher survival rates. We also examined other causes of death to better understand the risk for various cancers and illnesses among fire fighters compared to the general public. ? We also examined the relation between cancer and several proxies of exposure, such as the number of fire runs, time spent at fires, and duration of employment of each firefighter (Dahm et al. 2015). The study was conducted in two parts. The first part was aimed to answer the question: “Is cancer associated with firefighting?” by comparing firefighter cancer risk to that of the general population. The second part focused on the question: “Are higher-exposed firefighters more at risk?” Findings from both parts have been published in the journal, Occupational and Environmental Medicine (Daniels et al. 2014, 2015). (more…)
Author Interviews, Neurological Disorders, Technology / 24.09.2015

An Do, MD Assistant Professor Department of Neurology University of California, IrvineMedicalResearch.com Interview with: An Do, MD Assistant Professor Department of Neurology University of California, Irvine Medical Research: What is the background for this study? What are the main findings? Dr. An Do: In this study, we demonstrated that it is possible for a person with paraplegia due to spinal cord injury to regain brain-controlled walking through the use of a brain-computer interface. This system records EEG signals as a person is thinking about walking. While the person is thinking about walking, EEG signals change in a manner which can be detected by a computer algorithm. Upon detecting that a person is thinking about walking from the EEG signals, the computer sends a command signal to an electrical stimulation system to stimulate the nerves in the legs to continuously generate alternating right and left stepping movements. This stepping stimulation stops when he stops thinking about walking. (more…)
Author Interviews, Mental Health Research / 24.09.2015

MedicalResearch.com Interview with: Dr. Sanda Dolcos PhD Post-doc Fellow University of Illinois Medical Research: What is the background for this study? Dr. Dolcos : With its high prevalence rate, anxiety is a pressing concern in our society. Identifying psychological and neural markers indexing resilience against anxiety will help the development of prevention and intervention programs. It has been recognized that trait optimism fosters resilience against anxiety, and the orbitofrontal cortex (OFC) is sensitive to anxiety symptoms, but the relationship among the factors at these different levels --personality, brain, and symptoms-- has not been clear. Medical Research:  What are the main findings? 1) trait optimism was associated with lower level of anxiety 2) trait optimism is positively associated with the left OFC volume 3) the left OFC volume was negatively linked to anxiety, a relation partially accounted for by their mutual association with trait optimism. (more…)
Author Interviews, Cleveland Clinic, Cost of Health Care, Herpes Viruses, Vaccine Studies / 24.09.2015

Phuc Le, Ph.D., M.P.H. Center for Value-Based Care Research, Medicine Institute Cleveland, OHMedicalResearch.com Interview with: Phuc Le, Ph.D., M.P.H. Center for Value-Based Care Research, Medicine Institute Cleveland, OH  Medical Research: What is the background for this study? What are the main findings? Dr. Phuc Le: The live attenuated herpes zoster vaccine is approved by the FDA for persons aged 50 years and above. However, the Advisory Committee on Immunization Practices recommends it for only persons aged 60 years and older. Therefore, we aimed to analyze the vaccine’s cost-effectiveness among persons aged 50-59 years to see if ACIP’s recommendation is reasonable. We found that the vaccine is not cost-effective among people at aged 50 years, having an incremental costs of $323,000 per QALY gained, which is 3 times more than a commonly accepted threshold ($100,000/QALY). (more…)
Author Interviews, Clots - Coagulation, CT Scanning, Emergency Care, Geriatrics / 24.09.2015

MedicalResearch.com Interview with: Dr Lim Beng Leong MBBS, MRCS (A&E), FAMS Jurong Health Services Emergency Department, Singapore  Medical Research: What is the background for this study? What are the main findings? Dr. Leong: It is common in the emergency department to see patients with warfarin who suffer a minor head injury (HI) with GCS >13. It is standard practice according to international guidelines to perform a plain CT scan of the head. What is contentious in the literature is the subsequent management of those patients with a normal initial CT scan. Practice is heterogeneous and includes a mandatory second CT scan at 24 hours mark or observation and repeat CT scan at the discretion of the attending doctor. We have found in our study that the "observe and repeat CT scan for symptomatic cases" approach only was safe as abnormal second CT scans were rare (1 in 295 cases). We traced the patients' course 2 weeks post discharge and none of the patients were re-admitted for reasons of delayed intra-cranial hemorrhage (ICH). However, the cohort of patients consist largely of geriatric patients with falls. More than 50% of these patients were hospitalized for more than 3 days; the longest of 2-3 weeks. They were likely to have various reasons that required longer hospitalizations apart from observation for delayed ICH, such as assessing for risk, etc. (more…)
Author Interviews, Electronic Records / 24.09.2015

MedicalResearch.com Interview with: Lara Varpio, PhD Associate Professor, Department of Medicine Acting Associate Director, Graduate Programs in Health Professions Education Uniformed Services University of the Health Sciences Bethesda MD and Dr. Judy Rashotte PhD Director Nursing Research and Knowledge Translation Consultant   Ottawa Canada Medical Research: What is the background for this study? Drs. Varpio and Rashotte: Electronic health records (EHRs) are being adopted in healthcare centers around the world. The patient record is intricately implicated in care processes, clinical reasoning activities, and in collaborative work. As part of a larger study aimed at understanding how EHRs impact health professionals’ interprofessional collaborative practice (ICP), we explored how changing from a paper chart to an EHR can impact clinical reasoning. Medical Research: What are the main findings? Drs. Varpio and Rashotte: Our research demonstrated how different parts of the patient record (i.e. communication genres / artefacts) are part of the contextual factors that influence clinical reasoning and ICP. A key finding of our study is that building the patient’s story is an essential part of clinical reasoning activities. Making and understanding data interconnections is facilitated when clinicians are actively engaged in assembling isolated data bits into contextually-derived, comprehensive, and comprehensible ensembles. Building the patient’s story is facilitated through the use of a chronologically-organized textual narrative (i.e. free-text notations) structure and structures that promote visual bundles of clinical data. The use of an EHR can problematize clinicians’ ability to build the patient’s story and to disseminate it with other members of the care team when data interconnections are fragmented. Fragmentation happens when narrative spaces are dispersed and/or character-limited, and when data displays are not chronologically organized in visual assemblies. The constraint of chronologically and contextually isolated data inhibits clinicians’ ability to read the why and how interpretations of clinical activities from other team members. When an EHR splinters narrative reports, there is a loss of shared interprofessional understanding of the patient’s story, and time efficient care delivery can be compromised. (more…)
Author Interviews, HIV, Pediatrics / 24.09.2015

MedicalResearch.com Interview with: Gayatri Mirani MD and Tulane University School of Medicine New Orleans, Louisiana Paige L. Williams, PhD Department of Biostatistics Harvard T. H. Chan School of Public Health Boston, MA 02115 Medical Research: What is the background for this study Response: Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in HIV-related opportunistic infections and deaths in US youth, but both continue to occur. IMPAACT P1074, a long-term US-based prospective multicenter cohort study funded through NIH was conducted from April 2008 to June 2014. We reviewed complications and mortality rates in HIV-infected US youth enrolled in this study. Comparisons were made with a previous observational cohort study, P219C. While P219C was conducted from 2000 to 2007, we restricted our analysis to 2004-2007 in order to evaluate changes over the past decade. A total of 1201 HIV-infected youth were enrolled in the IMPAACT P1074 study, with most (1040, or 90%) infected with HIV at birth. The overall study population was 52% female, 58% black non-Hispanic and 28% Hispanic. Their mean age at the first chart abstraction was 17.4 (±5.4 Std. Dev.) years. The majority were on cART, had a stable CD4 count (baseline mean > 500 cells/mm3) and a suppressed viral load over a median follow-up of 3.7 years. The P219C group was younger, with a mean age of 11.9 (±5.0 Std. Dev.) years at the start of the 2004-2007 follow-up period. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 24.09.2015

Aaron L. Schwartz, PhD Department of Health Care Policy Harvard Medical School Boston, Massachusetts MedicalResearch.com Interview with: Aaron L. Schwartz, PhD Department of Health Care Policy Harvard Medical School Boston, Massachusetts   Medical Research: What is the background for this study? What are the main findings? Dr. Schwartz: It is widely believed that much health care spending is devoted to services that provide little or no health benefit to patients. In previous work, we demonstrated that low-value services were commonly delivered to the Medicare population. In this study, we examined whether a new form of paying physicians and hospitals was effective in discouraging the use of low-value services. The payment reform we studied was the Medicare Pioneer Accountable Care Organization (ACO)  Program, a feature of the Affordable Care Act. This program financially rewards health care provider groups who keep spending under a specified budget and achieve high performance on measures of quality of care. This voluntary program employs a similar ACO payment model that some private insurers have adopted.  The hope is that such models can encourage providers to be more efficient by allowing them to share in the savings generated by lower health care spending. In previous work, we demonstrated that the Pioneer ACO Program was associated with lower overall health care spending and steady or improved performance on health care quality measures. However, it was unclear whether providers were focusing on low-value services in their attempts to reduce spending. We examined  2009-2012 Medicare claims data and measured the use of, and spending on, 31 services often provided to patients that are known to provide minimal clinical benefit. We found that patients cared for in the ACO model experienced a greater reduction in the use of low-value services when compared to patients who were not served by ACOs. We attributed a 4.5 percent reduction in low-value service spending to the ACO program. Interestingly, this was a greater reduction than the 1.2 percent reduction in overall spending attributed to the program, which suggests that providers were targeting low-value services in their efforts to reduce spending. In addition, we found that providers with the greatest rate of low-value services prior to the ACO program showed the greatest reduction in these services. We also found similar reductions in service use between services that are more likely to be requested by patients (i.e. early imaging for lower-back pain) and other services. (more…)
Asthma, Author Interviews, Pediatrics, Tobacco Research / 24.09.2015

Avni Y Joshi, MD, MSc Assistant Professor of Pediatrics and Medicine Pediatric and Adult Allergy / Immunology Cellular and Molecular Immunology Laboratory Mayo ClinicMedicalResearch.com Interview with: Avni Y Joshi, MD, MSc Assistant Professor of Pediatrics and Medicine Pediatric and Adult Allergy / Immunology Cellular and Molecular Immunology Laboratory Mayo Clinic   Medical Research: What is the background for this study? What are the main findings? Dr. Joshi: We sought to quantify the risk of asthma outcomes in children with asthma who are exposed to second hand tobacco smoke (SHS). This was a pooled analysis of 25 studies that were included for looking at asthma outcomes in children. Children with asthma who were exposed to second hand tobacco smoke (SHS) were nearly twice as likely to be hospitalized as compared to children with asthma who were not exposed to  second hand tobacco smoke  exposure. (more…)
Author Interviews, Lancet, Mental Health Research / 24.09.2015

Professor Jane Pirkis PhD Centre for Mental Health Melbourne School of Population and Global Health University of Melbourne, AustraliaMedicalResearch.com Interview with: Professor Jane Pirkis PhD Centre for Mental Health Melbourne School of Population and Global Health University of Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Professor Pirkis:  Public sites that gain a reputation as places where people might go to seek to end their lives are a particular problem in suicide prevention.  Any suicide is tragic, but suicides at these sites have an extra level of complexity because they can lead to copycat acts and can have a major impact on people who work at or live near these sites, or visit them for other reasons.  Our meta-analysis, which pooled data from 18 individual studies from around the world,  found that three interventions work really well in reducing suicides at these sites.
  • Restricting access to means (e.g., installing barriers) can reduce suicides at these sites by 90% or more, and
  • encouraging help-seeking (e.g., installing phones that link directly to crisis services) and
  • increasing the likelihood of someone intervening (e.g., installing CCTV cameras, training staff who work at these sites) can each reduce them by around 50%, or more in some cases.  The interventions seem to work well together and complement each other too.  
(more…)
Author Interviews, Imperial College, Parkinson's / 23.09.2015

Dr. Ilse S. Pienaar Honorary Lecturer in Neuroscience at Imperial College London (& Snr. Lecturer in Cellular Pathology, Northumbria University) Centre for Neuroinflammation & Neurodegeneration Division of Brain Sciences Faculty of Medicine Imperial College London Hammersmith Hospital Campus London United KingdomMedicalResearch.com Interview with: Dr. Ilse S. Pienaar Honorary Lecturer in Neuroscience at Imperial College London (& Snr. Lecturer in Cellular Pathology, Northumbria University) Centre for Neuroinflammation & Neurodegeneration Division of Brain Sciences Faculty of Medicine Imperial College London Hammersmith Hospital Campus London United Kingdom   Medical Research: What is the background for this study? What are the main findings? Dr. Pienaar: A highly heterogeneous brainstem structure, the pedunculopontine nucleus (PPN) has been deemed a promising target for the delivery of deep-brain stimulation (DBS), to alleviate aspects of Parkinson's disease (PD), especially gait and postural instability. However, optimal therapeutic targeting of the PPN has been hampered due to DBS being unable to discriminate between cell types being targeted. We optomised a novel technique, Designer Receptors Exclusively Activated by Designer Drugs (DREADD) in a rat model of PD, by which to target only the PPN cholinergic neurons. A series of behavioral tests revealed that selective stimulation of the PPN cholinergics completely reverses gait problems and postural instability in the PD rats. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pulmonary Disease, University of Michigan / 23.09.2015

Thomas Valley, MD Fellow, Division of Pulmonary and Critical Care University of Michigan Ann Arbor, MIMedicalResearch.com Interview with: Thomas Valley, MD Fellow, Division of Pulmonary and Critical Care University of Michigan Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Dr. Valley: There has been dramatic growth in intensive care unit (ICU) use over the past 30 years. As the reasons for this growth are not entirely clear, some have suggested that the ICU is a meaningful source of low-value care. The value of the ICU, however, depends on the net benefit that ICUs provide patients. Prior observational studies assessing the effectiveness of the ICU were limited because patients admitted to the ICU are inherently sicker and more likely to die than patients admitted to the general ward. Given the substantial number of patients with pneumonia who are admitted to an ICU, it is vital to understand whether admission to the ICU is beneficial. In our study of 1.1 million Medicare beneficiaries with pneumonia between 2010 and 2012, we used an instrumental variable, a statistical technique to pseudo-randomize patients based on their proximity to a hospital that uses the ICU frequently for pneumonia, in order to determine whether ICU admission saved lives and at what financial cost. An estimated 13 percent of patients were admitted to the ICU solely because they lived closest to a hospital that used the ICU frequently for pneumonia. Among these patients, ICU admission was associated with a nearly six percent reduction in 30-day mortality compared to general ward admission. In addition, there were no significant differences in hospital costs or Medicare reimbursement between patients admitted to the ICU and to the general ward. (more…)
Alzheimer's - Dementia, Author Interviews, Cleveland Clinic, JAMA / 22.09.2015

Jeffrey L. Cummings, M.D., Sc.D. Director, Lou Ruvo Center for Brain Health Camille and Larry Ruvo Chair for Brain Health Cleveland Clinic Las Vegas, NV 89106MedicalResearch.com Interview with: Jeffrey L. Cummings, M.D., Sc.D. Director, Lou Ruvo Center for Brain Health Camille and Larry Ruvo Chair for Brain Health Cleveland Clinic  Las Vegas, NV 89106  Medical Research: What is the background for this study? What are the main findings? Dr. Cummings: Agitation is a common problem in Alzheimer’s disease (AD); approximately 70% of patients with AD will experience periods of agitation.  This difficult behavior challenges patients and caregivers, adversely affects quality of life, and may precipitate institutionalization.  There are not drugs approved for treatment of agitation in Alzheimer’s disease. The study reported in JAMA showed that a drug based on a combination of dextromethorphan and quinidine (DM/Q) produced statistically significant and clinically meaningful reduction in agitation in Alzheimer’s disease patients.  The study met its primary outcome (decline in the Neuropsychiatric Inventory agitation scale in drug compared to placebo) and many of its secondary outcomes (e.g, decreases in caregiver stress).  The agent was safe and well tolerated. (more…)
Author Interviews, End of Life Care, Heart Disease, JAMA / 22.09.2015

MedicalResearch.com Interview with: Dr. Timothy J. FendlerMedicalResearch.com Interview with: Dr. Timothy J. Fendler MD MS Department of Cardiology, Saint Luke’s Mid America Heart Institute Kansas City, Missouri Medical Research: What is the background for this study? What are the main findings? Dr. Fendler: In-hospital cardiac arrest occurs commonly in the United States and is associated with low rates of meaningful survival. This poor prognosis should prompt patient-clinician discussions about goals of care and preferences for future resuscitative efforts. Little is known about how prognosis is aligned with code status decisions among survivors of in-hospital cardiac arrest (in other words, as prognosis worsens, are patients more likely to adopt Do-Not-Resuscitate orders, a sign of less aggressive treatment preferences, should recurrent cardiac arrest occur). We found that, among patients who survive an in-hospital cardiac arrest, there is generally good alignment between prognosis and code status decisions. That is, as prognosis worsens among survivors of in-hospital cardiac arrest, the rate of DNR status adoption increases, on average. However, among patients with very low levels of neurologic functioning and very poor prognosis, nearly two-thirds did not adopt DNR status, despite the fact that only about 4% of these patients with poor prognosis experienced actual favorable neurological survival. These results imply that there could be better alignment between prognosis and goals of care decisions that places the patient's wishes, safety, and quality of life at the forefront of decision-making and decreases the likelihood of undue suffering when the outcome may not be improved by it. Second, survival rates were much lower in patients with DNR orders, compared to those who did not adopt DNR status, after survival from in-hospital cardiac arrest. This was observed regardless of prognosis, implying that patients who adopt DNR status, and thus only request they be treated differently in the setting of recurrent cardiac arrest, may be receiving less aggressive treatment than they prefer, in areas of their care outside of resuscitation from cardiac arrest. (more…)
Accidents & Violence, Author Interviews, Brigham & Women's - Harvard, Pediatrics, Social Issues / 22.09.2015

Avik Chatterjee, MD, MPH Physician, Boston Health Care for the Homeless Program Instructor, Harvard Medical School Associate Epidemiologist, Division of Global Health Equity, Brigham and Women's Hospital Boston, MAMedicalResearch.com Interview with: Avik Chatterjee, MD, MPH Physician, Boston Health Care for the Homeless Program Instructor, Harvard Medical School Associate Epidemiologist, Division of Global Health Equity, Brigham and Women's Hospital Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Chatterjee: Substance use, sexual activity and violent behaviors are common during adolescence. Understanding risk factors for these behaviors will improve our ability to prevent them and their sequelae. The Chaos, Hubbub and Order Scale (CHAOS) is a measure of household physical and social disorder, and higher CHAOS score, as reported by parents, has been shown to be correlated with less self-regulatory behavior in children. Thus, CHAOS could be a risk factor for the above behaviors in adolescents. We used data from the RISE study, in which 929 adolescents completed face-to-face and computer-assisted (for sensitive questions) interviews about their health behaviors to analyze the relationship between CHAOS score and risky health behaviors. We found that students with highest CHAOS score, compared to those with zero CHAOS score, had elevated odds for tobacco use (3x), alcohol use (2.5x), any substance use at school (6x) and fighting in the past 12 months (2x). (more…)
AHA Journals, Author Interviews, Heart Disease, OBGYNE, Women's Heart Health / 22.09.2015

Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, CaliforniaMedicalResearch.com Interview with: Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, California Medical Research: What is the background for this study? Dr. Cohn: I guessed that pregnancy complications would be an early warning sign of cardiovascular problems because of the extraordinary demands that pregnancy places on a woman’s cardiovascular system. Medical Research: What data were used for this study? Dr. Cohn: The Child Health and Development Studies is a large pregnancy cohort that enrolled more than 20,000 pregnancies in the 1960’s. Women and their families have been followed now for more than 50 years. Information on pregnancy complications was captured from medical records as they occurred, long before cardiovascular disease developed. These data are the basis for the current study. Medical Research: Why hasn’t this study already been done? Dr. Cohn: Long-term, large studies of pregnancy are rare. I first tried to do this study forty years ago when I was in graduate school.   At that time, Dr. Bea van den Berg, the late, second director of the Child Health and Development Studies advised that the study mothers were still too young to observe their cardiovascular disease experience. Now 40 years later, my colleague Piera Cirillo and I have been able to test the idea that combinations of pregnancy complications are linked to cardiovascular disease death for women. (more…)
Author Interviews, Cancer Research, PLoS / 22.09.2015

Dr. Cristiano Ferlini, MD Director of Biomedical Research Rudy and Sally Ruggles Chief of cancer research Western Connecticut Health Network Research InstituteMedicalResearch.com Interview with: Dr. Cristiano Ferlini, MD Director of Biomedical Research Rudy and Sally Ruggles Chief of cancer research Western Connecticut Health Network Research Institute Medical Research: What is the background for this study? Dr. Ferlini: Our aim is to understand why some cancer patients respond well to conventional treatment while others suffer progressive disease.  Nextgen sequencing technologies provide data that shed light on the mechanisms underlying differences in clinical outcome. However, analyses utilizing these data have been focused on human genes. This is to be expected given that the subjects under investigation are indeed humans. We adopted a novel approach in this and a prior study which involved in-depth, comprehensive mapping of microRNA sequences in human cancers to viral genes to assess their presence and significance. Medical Research: What are the main findings? Dr. Ferlini: We discovered a surprising number of viral microRNA sequences in a wide variety of cancer tissues. We also documented an interplay between these viral microRNAs and genes related to anticancer immunity. Both viruses and cancers share a common goal of suppressing the immune system to promote their own survival. Synergistic immunosuppression seems particularly relevant for the Epstein Barr virus, an unfortunate fact given its ubiquity in human populations. After the acute phase of EBV infection, the virus persists indefinitely in a dormant state inside B lymphocytes. When cancers grow, they create a protected microenvironment in which  anticancer immunity is suppressed.  We have obtained evidence suggesting that when EBV infected B cells circulate within these domains, the virus becomes reactivated and produces microRNAs which further amplify immunosuppressive genes. (more…)
Author Interviews, Blood Pressure - Hypertension, JACC, NYU, Race/Ethnic Diversity / 22.09.2015

Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and Medicine Director, Division of Health and Behavior Director, Center for Healthful Behavior Change Vice Dean, NYU College of Global Public Health NYU Langone School of Medicine Department of Population Health New York, NY 10016MedicalResearch.com Interview with: Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and Medicine Director, Division of Health and Behavior Director, Center for Healthful Behavior Change Vice Dean,  NYU College of Global Public Health NYU Langone School of Medicine Department of Population Health New York, NY 10016 Medical Research: What is the background for this study? Dr. Ogedebge: Evidence from clinical trials have previously indicated that a common blood pressure medication, angiotensin-converting-enzyme (ACE) inhibitors, (when prescribed as first line treatment) may not provide the same benefits in blacks compared to whites. However blacks are grossly underrepresented in these studies, despite the fact they have disproportionately higher rates of hypertension-related morbidity and mortality than whites. Thus, we chose to study this particular question because it allows us to evaluate this evidence in a large population of hypertensive black patients who receive care in a real-world practice setting. This study evaluates racial differences in cardiovascular outcomes and mortality between hypertensive black and white patients whose treatment was initiated with angiotensin-converting-enzyme (ACE) inhibitors, outside of a clinical trial.  ACE inhibitors are one of several classes of drugs commonly prescribed to individuals with hypertension to prevent deaths, heart attack, kidney failure, heart failure and stroke. (more…)
Author Interviews, Breast Cancer, JNCI / 21.09.2015

Philip S. Rosenberg, PhD Biostatistics Branch, Senior Investigator Division of Cancer Epidemiology and Genetics National Cancer Institute, 9609 Medical Center Drive Bethesda, MD 20892MedicalResearch.com Interview with: Philip S. Rosenberg, PhD Biostatistics Branch, Senior Investigator Division of Cancer Epidemiology and Genetics National Cancer Institute, 9609 Medical Center Drive Bethesda, MD 20892  Medical Research: What is the background for this study? What are the main findings? Dr. Rosenberg: It has been previously reported that breast cancer burden (number of new cases diagnosed in a year) is expected to rise in the future, mostly due to the aging of the female population in the US. Also, it has been established that the age-adjusted breast cancer incidence rates (cases per 100,000 women per year) are increasing for invasive ER-positive cancers overall and decreasing for ER-negative cancers overall. When taken together, these two trends tend balance each other out, resulting in a somewhat flat breast cancer incidence rate overall.  Though the overall trends for invasive breast cancer have been previously reported, this study uses a more refined forecasting method by including recent birth cohort patterns to forecast breast cancer to 2030 by age group, estrogen receptor-status, and invasive vs. in situ tumors. New in this report are the findings for in situ tumors and the more granular break down by age, ER status, and invasive vs. in situ tumors both for rate and burden (number of cases). (more…)
Author Interviews, Psychological Science, University of Pittsburgh, Weight Research / 21.09.2015

MedicalResearch.com Interview with: Linda J Ewing PhD RN Department of Psychiatry and Lora E Burke PhD, MPH, RN, FAAN Department of Health and Community Systems University of Pittsburgh School of Nursing Pittsburgh, Pennsylvania Medical Research: What is the background for this study? What are the main findings? Response: This study was the product both of work done in Dr. Burke’s lab as well as cumulative findings of other investigators demonstrating that improved self-efficacy is related to positive changes in health behaviors (e.g., physical activity, increased Intake of healthier foods, such as fruits and vegetables).  Given that, we designed a behavioral weight loss study that included an intentional focus on enhancing participant self-efficacy for healthy behaviors related to weight loss maintenance.  No previous study had self-efficacy enhancement as a focus of intervention with the long-term goal of increasing weight loss maintenance.  Thus our study focused on mastery performance of weight loss related behaviors.  Findings supported our hypothesis; participants in both arms of the study (standard behavioral weight loss (SBT) and SBT with self-efficacy enhancement (SBT+SE) achieved clinically significant weight loss.  Participants in the SBT+SE group had greater weight loss maintenance while those in the SBT group had clinically significant weight regain. (more…)
Author Interviews, FDA, JAMA, University of Pittsburgh / 21.09.2015

Dr. Tamar Krishnamurti PhD Department of Engineering & Public Policy Carnegie Mellon University Pittsburgh, PA 15213MedicalResearch.com Interview with: Dr. Tamar Krishnamurti PhD Department of Engineering & Public Policy Carnegie Mellon University Pittsburgh, PA 15213  Medical Research: What is the background for this study? What are the main findings? Dr. Krishnamurti: In 2012, the Food and Drug Administration Safety and Innovation Act became law. As part of this law, FDA can assign drugs the “breakthrough” designation. Breakthrough drugs are drugs that are intended to treat a serious or life threatening condition and have shown preliminary evidence of a substantial improvement over existing therapies on at least one one clinically significant endpoint. These clinical endpoints can be surrogate outcomes and don't have to be a direct outcome of the disease. All FDA press releases announcing approval of breakthrough-designated drugs use the term “breakthrough” and about half use the term “promising” when describing the drugs. Our study randomly assigned participants to read 1 of 5 short descriptions of a recently approved drug. These vignettes differed by the term assigned to the drug (e.g. "breakthrough" or "promising") or by whether the basis for the designation was clearly and succinctly explained in the description. We found that using the terms "breakthrough" and "promising" to describe these drugs resulted in people having unwarranted confidence about the effectiveness of breakthrough drugs, which could prevent them from making a fully informed decision about whether to take the drug or not. The influence of these terms on peoples' judgments was mitigated by explaining the regulatory meaning of the drug's approval (which is required in the drug's professional label, but not in public discourse about the drug). (more…)
Accidents & Violence, Author Interviews, JAMA, Pediatrics / 21.09.2015

Dr. Ziming Xuan ScD, SM, MA Assistant Professor, Community Health Sciences School of Public Health Boston University MedicalResearch.com Interview with: Dr. Ziming Xuan ScD, SM, MA Assistant Professor, Community Health Sciences School of Public Health Boston University  Medical Research: What is the background for this study? Dr. Xuan: With respect to background, among the 15000 some teenagers died annually in the US, the 3 leading causes of death were unintentional injuries, homicide, and suicide. Among these fatal youth injuries, 83% homicides were gun-related, and about half of suicides involved a gun (45%). So, The purpose of the study was to investigate the association between state gun law environment and youth gun carrying in the United States, and whether this association is mediated by adult gun ownership. Medical Research: What are the main findings? Dr. Xuan:
  • Among 38 states in our study, 5.7%of high school students living in the 19 states with stricter gun laws carried a gun in past 30 days while 7.3% of students living in states with the weaker gun laws carried a gun.
  • A 10-point increase in the strictness of the state gun law score was associated with a 9% decrease in the odds of youth gun carrying.
  • Across states, restrictive gun laws may reduce youth gun carrying by limiting adult gun ownership.
(more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC / 21.09.2015

MedicalResearch.com Interview with: Renato Valenti, MD David Antoniucci, MD Cardiology Department; Careggi Hospital Florence; Italy Medical Research: What is the background for this study? Response: Previous data have shown that high residual platelet reactivity in patients receiving clopidogrel is associated with high risk of ischemic events and cardiac death after PCI at short-  and long-term follow-up. Clopidogrel nonresponders patients of  the  REsponsiveness to CLOpidogrel and StEnt thrombosis (RECLOSE-2) ACS study received an increased dose of clopidogrel or switched to ticlopidine under light transmittance aggregometry (LTA) adenosine diphosphate  (ADP) test guidance. Despite some decrease of ADP test after treatment adjustment, there was no improvement on clinical outcome. Currently no evidence exists that the achievement of an optimal platelet aggregation inhibition in clopidogrel nonresponders  modifies  the risk profile of  these patients. The RECLOSE-3  study invesigated if a new antiplatet therapy with prasugrel in clopidogrel nonresponders can modify the risk profile of these patients and improve the outcome in term of cardiac mortality. From the RECLOSE-3 registry we identified  302 consecutive  patients who were clopidogrel nonresponders.  Nonresponders  switched to prasugrel therapy.  Due to the nonrandomized study design the clinical outcome of clopidogrel nonresponders switched to prasugrel (from RECLOSE-3 study) was compared with the historical cohort of clopidogrel nonresponders of the RECLOSE-2 ACS (248 patients)  study. The primary endpoint of the study was cardiac mortality. The 2-year cardiac mortality rate was  4.0% in the RECLOSE-3 group and 9.7% in the RECLOSE-2 group (p=0.007). The difference in 2-year cardiac mortality remained also considering exclusively patients  with ACS on admission: 3.2% and 9.7%, respectively, p=0.023.At the final model of multivariable analysis, prasugrel treatment was inversely related to the risk of  2-year cardiac death (HR 0.32; p=0.036)  after adjusting for ACS and other well known covariates related to the outcome. Medical Research: What are the main findings? Response: The main finding of the RECLOSE-3 study is that nonresponsiveness to clopidogrel may be a “modifiable risk factor” for cardiac death after PCI. Prasugrel treatment overcomes nonresponsiveness to clopidogrel and results in thrombotic risk similar to the one of clopidogrel responders. (more…)
Author Interviews, Cancer Research, Cost of Health Care / 21.09.2015

Steven L. D'Amato, BSPharm, BCOP President and Executive Director New England Cancer Specialists Scarborough, Maine Association of Community Cancer CenteMedicalResearch.com Interview with: Steven L. D'Amato, BSPharm, BCOP President and Executive Director New England Cancer Specialists Scarborough, Maine Association of Community Cancer Centers Medical Research: What is the background for this study? What are the main findings? Response: The Trends in Cancer Programs annual survey, which began in 2009, provides key insight into nationwide developments in the business of cancer care. It’s a joint project between the Association of Community Cancer Centers and Lilly Oncology.  The goals of the survey are to:
  • Provide ACCC with information to help guide its education and advocacy mission
  • Assist member organizations to understand nationwide developments in the business of cancer care
  • Assist members in evaluating their own cancer program’s performance relative to similar organizations through a consistent and meaningful benchmark.
This year’s key findings show that patient-centered services – like nurse navigation, psychological counseling, survivorship care and palliative care – are continuing to grow in U.S. cancer programs. However, the biggest challenge facing cancer centers is reimbursement for these types of services. Additionally, mirroring what we are seeing in the industry in general, measurement is becoming more and more important. More cancer programs are now using quality metrics to show payers the value of care provided. More information about our findings can be viewed here: http://www.accc-cancer.org/surveys/pdf/Trends-in-Cancer-Programs-2015.pdf. (more…)